Macleod’s Clinical Examination

Description

This classic textbook aims to assist clinicians develop the consultation skills required to elicit a clear history, and the practical skills needed to detect clinical signs of disease. Where possible, the physical basis of clinical signs is explained to aid understanding. Formulation of a differential diagnosis from the information gained is introduced, and the logical initial investigations are included for each system. Key Features The first part of the book addresses the general principles of good interaction with patients, from the basics of taking a history and examining, to the use of pattern recognition to identify spot diagnoses. The second part documents the relevant history, examination and investigations for all the major body systems. The third part illustrates the application of these skills to specific clinical situations. The final part covers preparation for assessments of clinical skills and the use of these skills in everyday practice. The book has accompanying videos demonstrating many of the key clinical examination routines as set out in the book. Front Cover......Page 1 Inside Front Cover......Page 2 Half title page......Page 3 John Macleod (1915–2006)......Page 4 Macleod's Clinical Examination......Page 5 Copyright Page......Page 6 Table Of Contents......Page 7 Preface......Page 9 Acknowledgements......Page 11 Examination sequences......Page 13 Patients......Page 15 Contributors......Page 17 1 Principles of Clinical History and Examination......Page 19 1 Managing clinical encounters with patients......Page 21 The clinical environment......Page 22 Showing empathy......Page 23 Professional responsibilities......Page 24 Personal responsibilities......Page 25 2 General aspects of history taking......Page 27 Showing empathy when taking a history......Page 28 The history of the presenting symptoms......Page 29 Non-prescribed drug use......Page 31 Smoking......Page 32 Occupational history and home environment......Page 33 Emotional or angry patients......Page 34 3 General aspects of examination......Page 37 Preparing for physical examination......Page 38 Sequence for performing a physical examination......Page 39 Gait and posture......Page 40 Temperature......Page 41 Nails......Page 42 Discoloration......Page 44 Pallor......Page 45 Characteristic skin changes......Page 46 Short stature......Page 47 Venous causes......Page 48 Lumps......Page 49 Lymph nodes......Page 50 Major chromosomal abnormalities......Page 52 Achondroplasia......Page 54 2 System-Based Examination......Page 55 4 The cardiovascular system......Page 57 Intermittent chest pain......Page 58 Acute chest pain......Page 59 Dyspnoea (breathlessness)......Page 60 Syncope and presyncope......Page 61 Drug history......Page 62 The physical examination......Page 63 Hands......Page 64 Rate and rhythm......Page 65 Volume and character......Page 66 Blood pressure......Page 67 Hypertension......Page 68 Common problems in BP measurement......Page 69 Jugular venous pressure and waveform......Page 70 Inspection......Page 71 Palpation......Page 72 First heart sound......Page 73 Third heart sound......Page 74 Added sounds......Page 75 Murmurs......Page 76 Systolic murmurs......Page 77 Diastolic murmurs......Page 78 Ambulatory blood pressure monitoring......Page 79 Cardiac catheterisation......Page 81 Intermittent claudication......Page 82 Acute limb ischaemia......Page 83 Vasospastic symptoms......Page 84 The physical examination......Page 85 Investigations......Page 87 Common presenting symptoms......Page 88 Pain......Page 89 The physical examination......Page 90 Investigations......Page 91 5 The respiratory system......Page 93 The history......Page 94 Cough......Page 95 Stridor......Page 97 Chest pain......Page 98 Social history......Page 99 Inspection......Page 100 Hands and arms......Page 103 Thorax......Page 104 Percussion......Page 105 Breath sounds......Page 106 Investigations......Page 107 6 The gastrointestinal system......Page 111 Anorexia and weight loss......Page 112 Dyspepsia......Page 113 Radiation......Page 114 Timing......Page 115 Dysphagia......Page 116 Diarrhoea......Page 117 Haematemesis......Page 118 Jaundice......Page 119 Social history......Page 120 General examination......Page 121 Abdominal scars and stomas......Page 122 Enlarged organs......Page 123 Hepatomegaly......Page 124 Percussion......Page 125 Splenomegaly......Page 126 Auscultation......Page 127 Hernias......Page 128 Rectal examination......Page 129 Investigations......Page 131 7 The nervous system......Page 137 Time relationships......Page 138 Seizure......Page 140 Past medical history......Page 141 Meningeal irritation......Page 142 Anatomy......Page 143 Cortical function......Page 144 Anatomy......Page 145 Anatomy......Page 146 Anatomy......Page 148 Glossopharyngeal (IX) and vagus (X) nerves......Page 149 Anatomy......Page 150 Anatomy......Page 151 Stance and gait......Page 152 Myoclonic jerks......Page 154 Hypertonia......Page 155 Power......Page 156 Anatomy......Page 157 Anatomy......Page 159 Anatomy......Page 160 Common presenting symptoms......Page 161 Peripheral nerve and dorsal root......Page 162 Intracranial lesions......Page 163 Ulnar nerve......Page 164 Initial investigations......Page 165 Neurophysiological tests......Page 167 8 The visual system......Page 169 Extraocular muscles......Page 170 Pupillary pathways......Page 171 Swollen eyes......Page 173 Social history......Page 177 Visual acuity......Page 178 Direct and consensual light reflex......Page 179 Visual fields......Page 180 Detection of squint......Page 181 Ophthalmoscopy......Page 182 Investigations......Page 183 9 The ear, nose and throat......Page 189 Middle ear......Page 190 Tinnitus......Page 191 Nystagmus......Page 192 The physical examination......Page 193 Rinne’s test......Page 195 Head impulse test (or head thrust test)......Page 196 Anatomy and physiology......Page 197 Epistaxis (bleeding from inside the nose)......Page 198 Nasal and facial pain......Page 199 The physical examination......Page 200 Investigations......Page 201 Sore mouth......Page 202 Sore throat......Page 203 Neck lump......Page 204 Mouth and throat......Page 205 Neck......Page 207 Investigations......Page 208 10 The endocrine system......Page 211 Neck swelling......Page 212 Neck pain......Page 213 Past medical, drug, family and social history......Page 214 Thyroid gland......Page 215 Common presenting symptoms......Page 216 The physical examination......Page 217 Acromegaly......Page 218 Common presenting symptoms......Page 219 Cushing’s syndrome......Page 220 Common presenting symptoms......Page 222 Past medical, drug, family and social history......Page 223 Assessment of a patient with newly diagnosed diabetes......Page 224 The diabetic foot......Page 225 11 The reproductive system......Page 229 Breast lump......Page 230 Nipple changes......Page 231 The physical examination......Page 232 Anatomy and physiology......Page 234 Abnormal vaginal bleeding......Page 235 Abdominal distension and bloating......Page 236 Drug history......Page 237 Passing a speculum......Page 238 Bimanual examination......Page 240 Investigations......Page 241 Social history......Page 243 Vaginal bleeding in pregnancy......Page 244 Pruritus......Page 245 The physical examination......Page 246 The history......Page 248 Scrotal swelling or pain......Page 249 Erectile dysfunction......Page 250 Penis......Page 251 Hydrocoele......Page 252 Investigations......Page 253 12 The renal system......Page 255 Anatomy and physiology......Page 256 Voiding symptoms......Page 257 Prerenal AKI......Page 258 Chronic kidney disease......Page 259 Other presenting symptoms......Page 260 Face......Page 261 Jugular venous pressure......Page 262 Abdominal examination......Page 263 Urinalysis......Page 264 Investigation of renal function......Page 265 13 The musculoskeletal system......Page 269 Onset......Page 270 Patterns of joint involvement......Page 271 Swelling......Page 272 Extra-articular symptoms......Page 273 Look – feel – move......Page 274 General features......Page 275 Initial questions......Page 276 Definitions......Page 277 The physical examination......Page 278 Anatomy and physiology......Page 279 The history......Page 280 Root compression tests......Page 281 Upper limb......Page 282 The physical examination......Page 283 The history......Page 286 The physical examination......Page 287 The physical examination......Page 289 Anatomy......Page 291 The physical examination......Page 292 Collateral ligament......Page 293 Anatomy......Page 294 Non-traumatic conditions......Page 295 Mulder’s sign for Morton’s neuroma......Page 296 The physical examination......Page 297 Investigations......Page 298 14 The skin, hair and nails......Page 301 Skin......Page 302 Past medical and drug history......Page 303 Morphology of a rash......Page 304 Hair and nail signs......Page 308 Dermatoscopy......Page 309 Patch testing......Page 310 3 Applying History and Examination Skills in Specific Situations......Page 313 15 Babies and children......Page 315 Jaundice......Page 316 Abnormal findings......Page 317 Ophthalmoscopy......Page 318 Cardiovascular examination......Page 319 Respiratory examination......Page 320 Perineum......Page 321 General neurological assessment......Page 322 Limbs......Page 323 Weighing and measuring......Page 324 Obtaining a history from children compared with adults......Page 325 Common presenting symptoms......Page 326 Neurological development......Page 328 The school-age child (5+ years)......Page 329 3–5 years......Page 330 Height......Page 331 Normal findings......Page 332 Child protection......Page 333 16 The patient with mental disorder......Page 337 Behaviour......Page 338 Thought form......Page 339 Delusional beliefs......Page 340 Memory......Page 341 Capacity......Page 342 Putting it all together: clinical vignettes......Page 343 17 The frail elderly patient......Page 347 Communication difficulties, cognition and mood......Page 348 Drug history......Page 349 Systematic enquiry......Page 350 Hydration and nutrition......Page 351 Cardiovascular examination......Page 352 Functional assessment......Page 353 Interpretation of the findings......Page 355 18 The deteriorating patient......Page 357 Early warning scores......Page 358 A: Airway......Page 359 B: Breathing......Page 360 C: Circulation......Page 361 D: Disability......Page 362 Sepsis......Page 363 Ongoing management......Page 364 19 The dying patient......Page 365 The physical examination......Page 366 Brainstem death......Page 367 Looking after yourself and others......Page 368 4 Putting History and Examination Skills to Use......Page 371 20 Preparing for assessment......Page 373 Methods of assessment......Page 374 Marking structures......Page 375 Approach to preparation......Page 376 Communication during assessment......Page 377 Putting it all together......Page 378 21 Preparing for practice......Page 379 Rare diseases......Page 380 Approach to the patient with medically unexplained symptoms......Page 381 Assessment......Page 382 Using SBAR......Page 383 Written communication......Page 392 B......Page 393 D......Page 394 F......Page 395 I......Page 396 M......Page 397 P......Page 398 R......Page 399 T......Page 400 Y......Page 401