Handbook of Clinical Diagnostics

Description

The book covers basic theories, basic knowledge and basic skills on clinical diagnosis, basic requirements for doctors’ ethical conduct, clinical reasoning and documentation of medical records during the process of making a diagnosis. It consists of six parts, including ‘Symptoms’, ‘History Taking’, ‘Physical Examination’, ‘Supplementary Examination’, ‘Common Clinical Diagnosis Techniques’, and ‘Diagnostic Process and Clinical Reasoning’. A vocabulary index is included for easy reference at the end of the book. This book is compiled by authors of 14 Chinese medical schools and universities, whose years of experience in clinical diagnostics, rich overseas learning and working experiences. This book is included in the first round of English textbooks series for clinical medicine major of China's higher medical colleges; and is among "13th Five-Year" planning textbooks of National Health Commission of the People’s Republic of China. It is also an ideal textbook for MBBS (Bachelor of Medicine and Bachelor of Surgery) student It is a co-publication book with People's Medical Publishing House (PMPH). The ISBN of PMPH version in China is 978-7-117-23852-6. Preface......Page 5 Contents......Page 7 Part I: Symptoms......Page 12 1.1.2 Noninfectious Causes......Page 13 1.3 Fever Patterns......Page 14 1.4 Accompanying Symptoms and Signs......Page 16 2.2 Pathogenesis......Page 18 2.4 Accompanying Symptoms......Page 19 3.2 Clinical Manifestations......Page 20 3.3 Accompanying Symptoms......Page 21 4.1 Measurements of Obesity......Page 22 4.3 Clinical Manifestations and Accompanying Symptoms......Page 23 5.2 Clinical Manifestations and Accompanying Symptoms......Page 25 6.2 Clinical Manifestation......Page 27 6.3 Accompanying Symptom......Page 28 7.1 Etiology and Pathogenesis......Page 30 7.3 Accompanying Symptom......Page 31 8.1 Etiology and Mechanism......Page 33 8.3 Accompanying Symptoms......Page 34 9.1 Etiology and Mechanism......Page 36 9.3 Accompanying Symptoms......Page 37 10.2 Clinical Manifestations......Page 38 10.3 Accompanying Symptoms......Page 39 11.1.2 Cardiac Dyspnea......Page 40 11.2.1 Respiratory Dyspnea......Page 41 11.3 Accompanying Symptoms......Page 42 12.1 Etiology and Mechanism......Page 44 12.3 Accompanying Symptom......Page 45 13.2 Accompanying Symptoms......Page 46 14.2 Etiology......Page 48 14.3 Clinical Manifestation......Page 49 15.2.2 Motility Dysphagia......Page 51 15.3.3 Points of Clinical Symptoms of Common Diseases......Page 52 16.2 Clinical Manifestations......Page 54 17.2 Mechanism......Page 56 17.3 Clinical Manifestations......Page 57 18.2 Clinical Manifestations......Page 59 19.2 Clinical Manifestations......Page 61 20.2 Mechanism......Page 63 20.3 Clinical Manifestations......Page 64 21.2 Mechanism......Page 66 21.4 Accompanying Symptoms......Page 67 22.3 Etiology and Mechanism......Page 68 22.5 Specific Examinations......Page 70 23.1 Etiology......Page 72 23.3 Clinical Manifestations and Accompanying Symptoms......Page 73 24.2 Clinical Manifestations and Accompanying Symptoms......Page 75 25.1.2 Polyuria......Page 77 25.2.2 Polyuria......Page 78 26.2 Clinical Manifestations and Accompanying Symptoms......Page 79 26.3 Accompanying Symptoms......Page 80 27.2 Clinical Manifestations and Accompanying Symptoms......Page 81 28.2 Mechanism......Page 83 28.5 Differentiation of Inflammatory and Mechanical Back Pain (Table 28.1)......Page 84 29.3 Clinical Manifestations......Page 85 29.4 Accompanying Symptoms......Page 86 30.3 Clinical Manifestations......Page 87 30.4 Accompanying Symptoms......Page 88 31.3 Clinical Manifestations......Page 89 31.4 Accompanying Symptoms......Page 90 32.3 Clinical Manifestations......Page 91 32.4 Accompanying Symptoms......Page 92 33.3 Clinical Manifestations......Page 93 33.4 Accompanying Symptoms......Page 94 34.1 Clinical Manifestations......Page 95 Part II: History Taking......Page 98 35: Necessity and Ethics of History Taking......Page 99 36.5 Review of Systems......Page 100 36.8 Marital History......Page 101 36.10 Family History......Page 102 37.3 Transitional Statements......Page 103 37.5 Questioning Skills-Type of Question......Page 104 37.9 Questioning Skills-Documentation......Page 105 37.13 Patient’s Perspective......Page 106 37.19 Rapport-Encouragement of Questions......Page 107 37.20 Closure of History Taking......Page 108 38: Guide for Focused History Taking......Page 109 39: History Taking in Special Situations......Page 111 40.1 Written Record......Page 113 Suggested Readings......Page 114 Part III: Physical Examination......Page 115 41.1 Inspection......Page 116 41.2.2 Deep Palpation......Page 117 41.3.1.2 Indirect Percussion......Page 118 41.3.2 Percussion Sounds......Page 119 41.4.2 Indirect Auscultation......Page 120 Suggested Readings and Websites......Page 121 42.1.3.1 Temperature......Page 122 42.1.3.4 Blood Pressure......Page 123 42.1.4.1 Development......Page 124 42.1.5.1 Commonly Used Assessment Indicators......Page 125 42.1.6 Consciousness......Page 126 42.1.7.6 Disorientation......Page 127 42.1.9 Facial Features and Expression......Page 128 42.1.10.3 Compulsive Position......Page 129 42.1.12 Gait......Page 130 42.2.1 Color......Page 131 42.2.4 Skin Eruption......Page 132 42.2.8 Edema......Page 133 42.2.10 Ulcer and Erosion......Page 134 42.3.1 Normal Lymph Nodes......Page 135 42.3.1.1 Drainage Area of Superficial Lymph Nodes......Page 136 42.4.1.1 Short Stature......Page 137 Etiology......Page 138 42.4.2.2 Clinical Characteristics and Differential Diagnosis......Page 139 42.4.3.1 Etiology......Page 141 Differential Diagnosis......Page 142 42.4.4.2 Clinical Characteristics and Differential Diagnosis......Page 143 Suggested Websites......Page 144 43.3 Section 3: Face......Page 145 43.3.1.1 Vision Testing......Page 146 43.3.1.2 External Eye Examination (Fig. 43.3)......Page 147 43.3.1.3 Anterior Segment......Page 149 43.3.2 Ear......Page 151 43.3.3 Nose......Page 152 43.3.4 Mouth......Page 153 43.3.5 Parotid Gland......Page 156 Suggested Readings and Websites......Page 157 44.4 Vessels......Page 158 44.5 Thyroid......Page 159 Suggested Reading and Website......Page 161 45.1.1 Bony Landmarks......Page 162 45.1.2 Imaginary Lines......Page 163 45.1.3 Natural Fossa and Anatomic Region......Page 164 45.1.4 Topography of Lungs and Pleura......Page 165 45.2.2 Thorax......Page 167 45.2.3.1 Inspection......Page 168 45.2.3.2 Palpation......Page 169 45.3.1.3 Respiratory Depth......Page 170 45.3.2.1 Thoracic Expansion......Page 171 45.3.2.2 Vocal Fremitus......Page 172 45.3.3.3 Percussion of the Lung Boundary......Page 173 45.3.3.4 Abnormal Percussion Notes of the Thorax......Page 174 Abnormal Vesicular Breath Sound......Page 175 Moist Rales......Page 176 45.3.4.4 Vocal Resonance......Page 177 45.4.1 Inspection......Page 178 45.4.1.2 Apical Impulse......Page 179 45.4.2.1 Apical Impulse and Abnormal Precordial Pulsations......Page 180 45.4.3.1 Percussion Method......Page 181 45.4.3.4 Variation and Clinical Significance......Page 182 Cardiac Rhythm......Page 184 Heart Sound......Page 185 Changes of Heart Sound......Page 186 Extra Cardiac Sound......Page 188 Cardiac Murmurs......Page 189 Pericardial Friction Sound......Page 192 45.5.1.5 Pulse Wave......Page 193 45.5.2.3 Abnormal Blood Pressure......Page 194 45.5.2.4 Ambulatory Blood Pressure Monitoring (ABPM)......Page 195 Suggested Readings......Page 196 46.1.1 Abdominal Landmarks......Page 197 46.1.2.2 The Nine Abdominal Areas......Page 198 Peritoneal Air......Page 199 46.2.1.2 Abdominal Concavity......Page 200 46.2.3 Veins of Abdominal Wall......Page 201 46.2.5 Gastral or Intestinal Pattern and Peristalsis......Page 202 46.3.2 Blood Murmur......Page 203 46.4.1 Abdominal Percussion Sound......Page 204 46.4.3 Traube Semilunar Space......Page 205 46.4.6 Percussion of Bladder......Page 206 46.5.1.1 The Increase of Abdominal Tenseness......Page 208 46.5.2 Tenderness and Rebound Tenderness......Page 209 Size......Page 210 Hepatojugular Reflux......Page 211 46.5.3.2 Palpation of Spleen......Page 212 46.5.3.3 Palpation of Gallbladder......Page 213 46.5.3.5 Palpation of Bladder......Page 214 Transverse Colon......Page 215 46.5.6 Succusion Splash......Page 216 47.1.1.2 Left-Lateral Recumbent Position (Fig. 47.2)......Page 218 47.1.2.4 Hemorrhoids......Page 219 47.1.3 Palpation......Page 220 47.2.2.1 Prepuce......Page 221 Penis size and Shape......Page 222 Scrotum......Page 223 Testis......Page 224 47.2.4 Prostate......Page 225 47.3.1 External Genital Organs......Page 226 Bimanual Pelvic Exam......Page 227 Rectovaginal Exam......Page 228 47.3.2.3 Uterine Accessories......Page 229 48.1.2.1 Posterior Inspection......Page 231 48.1.2.2 Lateral Inspection......Page 232 48.1.2.4 Special Tests of the Vertebrae......Page 233 48.2.1.1 Acromegaly......Page 235 Koilonychia......Page 236 Wrists and Hands......Page 237 Hip Joints......Page 239 Knees......Page 240 Ankles and Feet......Page 241 Suggested Websites......Page 243 49.2.3 Ocular Nerve, Trachlear Nerve and Abducens Nerve......Page 244 49.2.6 Acoustic Nerve......Page 245 49.3.2 Sensory Terminology......Page 246 49.4.1 Muscle Strength......Page 247 49.5 Reflexes......Page 248 49.5.2 Deep Tendon Reflex......Page 249 49.5.4 Menigeal Signs......Page 250 49.6 Autonomic System Examination......Page 252 Suggested Readings......Page 253 50.1 Basic Requirements of Complete Physical Examination......Page 254 50.2.2 Head and Neck......Page 255 50.2.4 Back......Page 256 50.2.7 Lower Limbs......Page 257 50.4 Physical Examination for the Elderly......Page 258 50.5.3 Physical Examination for Patients with Physiological Defects......Page 259 Suggested Readings......Page 260 Part IV: Auxiliary Examination......Page 261 51.1.2.1 The Depolarization and Repolarization of Heart......Page 262 51.1.2.2 Resting Potential of Myocardial Cell......Page 263 51.1.2.3 Action Potential of Cardiac Muscle Cell......Page 264 51.1.2.5 Relationships of Depolarization, Repolarization and Waveforms on ECG......Page 265 51.1.3.1 The Conventional 12-Leads......Page 266 51.1.3.3 The Axis......Page 267 51.2.3 QRS Complex......Page 268 51.2.6 QT Interval......Page 269 51.2.7 U Wave......Page 272 52.1.1 Regular Rhythm......Page 273 ECG Recognition (Fig. 52.6)......Page 274 52.2.1.3 Abnormality in Voltage or Duration of Sinus P Wave......Page 275 52.2.2 Non-Sinus P Wave......Page 276 Atrial Escape Contraction......Page 277 52.2.3.1 Atrial Flutter......Page 278 ECG Recognition (Fig. 52.17)......Page 279 ECG Recognition (Fig. 52.19)......Page 280 ECG Recognition (Fig. 52.21)......Page 281 Third-Degree AV Block......Page 282 52.3.2.2 Shortened PR Interval (Preexcitation Syndromes)......Page 283 Features of Normal QRS Complex Voltage......Page 284 52.4.1.5 Another Weird Retrograde P′ Wave (Dextrocardia)......Page 285 52.4.2.1 Abnormalities in QRS Complex Axis......Page 286 ECG Recognition......Page 288 ECG Recognition (Fig. 52.40)......Page 289 ECG Recognition (Fig. 52.44)......Page 291 ECG Recognition (Fig. 52.47)......Page 293 ECG Recognition (Fig. 52.51)......Page 294 ECG Recognition (Fig. 52.55)......Page 295 52.5 Section 5: Analyze ST Segment......Page 297 ECG Recognition (Fig. 52.58)......Page 298 ECG Recognition (Fig. 52.67)......Page 299 52.6.2 Useful Methods for Analyzing T Wave......Page 301 52.6.3.2 Peaked T wave......Page 303 52.7.1 QT Interval Prolongation......Page 306 52.7.3.1 ECG Recognition (Fig. 52.80)......Page 307 ECG Recognition (Fig. 53.2)......Page 309 ECG Recognition (Fig. 53.5)......Page 311 ECG Recognition (Fig. 53.7)......Page 312 53.2 Section 2: Tachycardia with Wide QRS Complex......Page 313 53.2.2.3 Duration of the QRS Complex......Page 314 53.2.2.6 Others......Page 315 54.1.3 Arterial Oxygen Saturation......Page 317 54.1.6 Buffer Base......Page 318 54.2.2 To Judge the Types and Classification of Acid-Base Disorders......Page 319 54.2.2.1 Siggaard-Andersen Card......Page 320 54.2.2.3 The Common Types of Acid-Base Disorders......Page 321 Expiratory Reserve Volume (ERV)......Page 323 55.1.2.6 Maximal Expiratory Flow-Volume Curve (MEFV)......Page 324 55.1.2.7 Maximum Mid-Expiratory Flow (MMEF)......Page 325 55.2.1.3 Mixed Ventilation Dysfunction......Page 326 55.2.2.3 Bronchial Provocation Test......Page 327 55.2.3 Evaluation of the Tolerance and Security in Operation......Page 328 56.1.1.2 Contraindications......Page 329 Preparation Before Examination......Page 330 56.1.1.5 Endoscopic Diagnosis of Upper Gastrointestinal Disease......Page 331 Preparation......Page 332 56.1.2.4 Complications and Management......Page 333 56.2.1.2 For Treatment......Page 334 56.2.3.5 Postoperation Management......Page 335 56.2.5.5 Postoperative Fever......Page 336 56.2.6.5 Clinical application......Page 337 Part V: Common Diagnostic Techniques......Page 339 57.3 Attention......Page 340 58.4 Attention......Page 342 59.3 Procedure......Page 344 59.4 Attention......Page 345 60.3 Procedure......Page 346 60.4 Attention......Page 347 61.3 Attention......Page 348 62.3 Procedure......Page 350 62.4 Attention......Page 351 63.2 Section 2: Procaine Allergy Skin Test......Page 352 63.4.2 Attention......Page 353 64.3 Clinical Significance......Page 354 64.4 Attention......Page 355 Part VI: Medical Record......Page 356 65: Significance......Page 357 66.1.2 Accurate Expressions and Proper Words......Page 358 66.1.5 Obeying Legislation and Respecting Rights......Page 359 Complete Medical Record......Page 360 Physical Examination......Page 361 67.1.2.2 Medical History......Page 363 67.1.2.3 Physical Examination......Page 364 67.1.3 Other Medical Records......Page 365 67.2.1 Requirements......Page 366 67.2.2.3 Subsequent-Visit Medical Record......Page 367 Development Trend......Page 368 68.2 Written Medical Case Report......Page 369 Part VII: Clinical Reasoning......Page 371 69: The Importance of Clinical Reasoning......Page 372 70: Procedures of Diagnosis-Making......Page 373 71: Clinical Reasoning......Page 375 72: Common Reasons for Misdiagnoses and Omitted Diagnoses......Page 377 References......Page 378 Index......Page 379