Additional Information
Book Details
Abstract
Derive the maximum diagnostic information from interviewing and examining patients with Textbook of Physical Diagnosis. Employing a compassionate, humanistic approach, Dr. Swartz explores how cultural differences can influence communication, diet, family relationships, and health practices and beliefs, and demonstrates that your interpersonal awareness is just as essential in physical diagnosis as your level of technical skill. This medical reference book features numerous high-quality color images, an easy-to-use design, and detailed descriptions of exam techniques, making it an essential guide for physicians, nurse practitioners, and physician assistants.
- Consult this title on your favorite e-reader, conduct rapid searches, and adjust font sizes for optimal readability.
- Learn about special considerations related to patient’s unique situations, such as cultural differences, nutritional status, and overall health, which may affect your approach to their treatment.
- Understand the causes of the symptoms you encounter with Pathophysiology explanations.
- Easily review illustrated components with abundant color photographs capturing the true appearance of various diseases.
- Access coverage of complementary and alternative medicine so you can be alerted to the clinical implications of these increasingly popular modalities.
- Communicate effectively in Spanish. An appendix on the examination of Spanish-speaking patients provides translations for commonly used medical phrases and questions.
- Provide the best medical care through the art of interviewing and physical examination with the most recent coverage of relevant physical diagnosis standards and tests, as well as detailed discussions of key exam techniques.
- View examination techniques and clinical presentations more clearly than ever before with help from high-quality color images, over 900 photographs, and line art supplementing the detailed text.
- Stream more than 3 hours of in-depth video at Student Consult.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Inside Front Cover | ifc1 | ||
| Textbook of Physical Diagnosis, 7/e | i | ||
| Copyright Page | iv | ||
| Dedication to Francis Weld Peabody | v | ||
| Dedication | vii | ||
| Preface | ix | ||
| Acknowledgments | xi | ||
| Photograph Credits | xiii | ||
| Table Of Contents | xvii | ||
| 1 The Art of Interviewing | 1 | ||
| 1 The Interviewer’s Questions | 3 | ||
| Basic Principles | 3 | ||
| Using an Interpreter | 4 | ||
| Important Interviewing Concepts | 5 | ||
| Speech Patterns | 7 | ||
| Body Language | 7 | ||
| Touch | 8 | ||
| Depersonalization of the Doctor-Patient Relationship | 8 | ||
| Medical Malpractice and Communication Skills | 9 | ||
| Doctor-Patient Engagement | 9 | ||
| Privacy Standards | 9 | ||
| Symptoms and Signs | 10 | ||
| Conducting an Interview | 10 | ||
| Getting Started and Introduction | 10 | ||
| To Stand or to Sit? | 11 | ||
| The Opening Statement | 12 | ||
| The Narrative | 12 | ||
| The Closing | 12 | ||
| Basic Interviewing Techniques | 13 | ||
| Questioning | 13 | ||
| Open-Ended Questions | 13 | ||
| Direct Questions | 14 | ||
| Bodily Location | 14 | ||
| Onset (and Chronology) | 14 | ||
| Precipitating Factors | 14 | ||
| Palliating Factors | 14 | ||
| Quality | 14 | ||
| Radiation | 14 | ||
| Severity (or Quantity) | 15 | ||
| Temporal | 15 | ||
| Associated Manifestations | 15 | ||
| Question Types to Avoid | 15 | ||
| Silence | 17 | ||
| Facilitation | 17 | ||
| Confrontation | 17 | ||
| Interpretation | 18 | ||
| Reflection | 18 | ||
| Support | 18 | ||
| Reassurance | 19 | ||
| Empathy | 19 | ||
| Transitions | 19 | ||
| Format of the History | 20 | ||
| Source and Reliability | 20 | ||
| Chief Complaint | 21 | ||
| History of Present Illness and Debilitating Symptoms | 21 | ||
| Pain | 21 | ||
| Past Medical History | 23 | ||
| General State of Health | 23 | ||
| Past Illnesses | 24 | ||
| Prior Injuries and Accidents | 24 | ||
| Hospitalizations | 24 | ||
| Surgery | 24 | ||
| Allergies | 24 | ||
| Immunizations | 24 | ||
| Substance Abuse | 25 | ||
| Diet | 27 | ||
| Sleep Patterns | 28 | ||
| Medications | 28 | ||
| Alternative Therapies | 28 | ||
| Health Maintenance | 29 | ||
| Occupational and Environmental History | 30 | ||
| Biographic Information | 31 | ||
| Family History | 31 | ||
| Psychosocial and Spiritual History | 31 | ||
| Sexual, Reproductive, and Gynecologic History | 32 | ||
| Violence and Abuse | 33 | ||
| Reproductive and Gynecologic History | 35 | ||
| Review of Systems | 35 | ||
| Taking Notes | 37 | ||
| Concluding Thoughts | 38 | ||
| Putting the Patient at Ease | 38 | ||
| Bibliography | 39.e1 | ||
| 2 The Patient’s Responses | 40 | ||
| Responses to Illness | 40 | ||
| Conflict | 40 | ||
| Anxiety | 41 | ||
| Depression | 42 | ||
| Denial | 43 | ||
| Projection | 44 | ||
| Regression | 44 | ||
| Responses to the Interviewer | 45 | ||
| The Silent Patient | 45 | ||
| The Overtalkative Patient | 46 | ||
| The Seductive Patient | 46 | ||
| The Angry Patient | 46 | ||
| The Paranoid Patient | 47 | ||
| The Insatiable Patient | 47 | ||
| The Ingratiating Patient | 47 | ||
| The Aggressive Patient | 47 | ||
| The Help-Rejecting Patient | 48 | ||
| The Demanding Patient | 48 | ||
| The Compulsive Patient | 48 | ||
| The Dependent Patient | 48 | ||
| The Masochistic Patient | 48 | ||
| The Borderline Patient | 48 | ||
| Influence of Background and Age on Patient Response | 49 | ||
| The Child Who Is Ill | 49 | ||
| The Aged Patient | 49 | ||
| The Widowed Patient | 50 | ||
| The Patient with Post-traumatic Stress Disorder | 50 | ||
| The Sick Physician | 53 | ||
| Influence of Disease on Patient Response | 53 | ||
| The Disabled Patient | 53 | ||
| The Patient with Cancer | 54 | ||
| The Patient with AIDS | 54 | ||
| The Dysphasic Patient | 55 | ||
| The Psychotic Patient | 55 | ||
| The Demented or Delirious Patient | 55 | ||
| The Acutely Ill Patient | 56 | ||
| The Surgical Patient | 56 | ||
| The Alcoholic Patient | 56 | ||
| The Psychosomatic Patient | 57 | ||
| The Dying Patient | 57 | ||
| Bibliography | 58.e1 | ||
| 3 Putting the History Together | 59 | ||
| Interview of Mr. John Doe | 59 | ||
| Written History of Mr. John Doe | 68 | ||
| Summary | 69 | ||
| 2 The Science of the Physical Examination | 71 | ||
| 4 The Physical Examination | 73 | ||
| The Basic Procedures | 73 | ||
| Inspection | 73 | ||
| Palpation | 74 | ||
| Percussion | 75 | ||
| Auscultation | 75 | ||
| Preparation for the Examination | 75 | ||
| Health Care Infection Control Practices | 76 | ||
| Goal of the Physical Examination | 77 | ||
| Bibliography | 80.e1 | ||
| 5 The Skin | 81 | ||
| General Considerations | 81 | ||
| Structure and Physiologic Characteristics | 82 | ||
| Review of Specific Symptoms | 84 | ||
| Rash or Skin Lesion | 85 | ||
| Changes in Skin Color | 85 | ||
| Pruritus | 85 | ||
| Changes in Hair | 86 | ||
| Changes in Nails | 86 | ||
| General Suggestions | 86 | ||
| Effect of Skin Disease on the Patient | 86 | ||
| Physical Examination | 87 | ||
| General Principles | 87 | ||
| Examination with Patient Seated | 88 | ||
| Inspect the Hair | 88 | ||
| Inspect the Nail Beds | 88 | ||
| Inspect the Nails for Clubbing | 90 | ||
| Inspect the Nails for Pitting | 92 | ||
| Inspect the Skin of the Face and Neck | 92 | ||
| Inspect the Skin of the Back | 93 | ||
| Examination with Patient Lying Down | 93 | ||
| Inspect the Skin of the Chest, Abdomen, and Lower Extremities | 93 | ||
| Description of Lesions | 93 | ||
| Primary and Secondary Lesions | 94 | ||
| Configuration of Skin Lesions | 94 | ||
| Clinicopathologic Correlations | 94 | ||
| Skin Self-Examination | 140 | ||
| Bibliography | 144.e1 | ||
| 6 The Head and Neck | 145 | ||
| General Considerations | 145 | ||
| Structure and Physiology | 146 | ||
| The Head | 146 | ||
| The Neck | 147 | ||
| Review of Specific Symptoms | 148 | ||
| Neck Mass | 148 | ||
| Neck Stiffness | 149 | ||
| Effect of Head and Neck Disease on the Patient | 150 | ||
| Physical Examination | 150 | ||
| Inspection | 151 | ||
| Palpation | 151 | ||
| Palpate the Head and Neck | 151 | ||
| Palpate the Thyroid Gland | 153 | ||
| Palpate for Supraclavicular Nodes | 154 | ||
| Clinicopathologic Correlations | 155 | ||
| Bibliography | 160.e1 | ||
| 7 The Eye | 161 | ||
| Historical Considerations | 161 | ||
| Structure and Physiology | 161 | ||
| Review of Specific Symptoms | 168 | ||
| Loss of Vision | 168 | ||
| Eye Pain | 168 | ||
| Diplopia | 168 | ||
| Tearing and Dryness | 169 | ||
| Discharge | 170 | ||
| Redness | 170 | ||
| General Suggestions | 170 | ||
| Effect of Blindness on the Patient | 171 | ||
| Physical Examination | 173 | ||
| Visual Acuity | 174 | ||
| Using the Standard Snellen Chart | 174 | ||
| Using a Pocket Visual Acuity Card | 174 | ||
| Evaluation of Patients with Poor Vision | 174 | ||
| Evaluation of Patients Who Cannot Read | 174 | ||
| Visual Fields | 174 | ||
| Assess Fields by Confrontation Testing | 174 | ||
| Assess Visual Field Abnormalities | 176 | ||
| Assess Optokinetic Nystagmus | 176 | ||
| Ocular Movements | 177 | ||
| Assess Eye Alignment | 177 | ||
| Perform the Cover Test | 177 | ||
| Evaluate the Six Diagnostic Cardinal Positions of Gaze | 177 | ||
| Evaluate the Pupillary Light Reflex | 179 | ||
| Evaluate the Near Reflex | 179 | ||
| External and Internal Eye Structures | 180 | ||
| Inspect the Orbits and Eyelids | 180 | ||
| Inspect the Lacrimal Apparatus | 188 | ||
| Inspect the Conjunctiva | 189 | ||
| Inspect the Sclera | 193 | ||
| Inspect the Cornea | 196 | ||
| Inspect the Pupils | 199 | ||
| Inspect the Iris | 200 | ||
| Inspect the Anterior Chamber | 201 | ||
| Inspect the Lens | 202 | ||
| Ophthalmoscopic Examination | 203 | ||
| The Ophthalmoscope | 203 | ||
| Using the Ophthalmoscope | 206 | ||
| Inspect the Optic Disc | 208 | ||
| Inspect the Retinal Vessels | 209 | ||
| Inspect the Macula | 211 | ||
| Describe Any Retinal Lesions | 211 | ||
| Difficulties in Using the Ophthalmoscope | 213 | ||
| Clinicopathologic Correlations | 214 | ||
| Bibliography | 248.e1 | ||
| 8 The Ear and Nose | 249 | ||
| General Considerations | 249 | ||
| Structure and Physiology | 249 | ||
| The Ear | 249 | ||
| The Nose | 253 | ||
| Review of Specific Symptoms | 255 | ||
| The Ear | 255 | ||
| Hearing Loss | 255 | ||
| Vertigo | 256 | ||
| Tinnitus | 257 | ||
| Otorrhea | 257 | ||
| Otalgia | 258 | ||
| Itching | 258 | ||
| The Nose | 258 | ||
| Obstruction | 258 | ||
| Discharge | 259 | ||
| Bleeding | 259 | ||
| Sinus Disease Symptoms | 259 | ||
| Effect of Deafness on the Patient | 259 | ||
| Physical Examination | 261 | ||
| The Ear | 261 | ||
| External Examination | 261 | ||
| Inspect the External Ear Structures | 261 | ||
| Palpate the External Ear Structures | 261 | ||
| Auditory Acuity Testing | 262 | ||
| The Rinne Test | 262 | ||
| The Weber Test | 263 | ||
| Example 1 | 265 | ||
| Example 2 | 265 | ||
| Otoscopic Examination | 265 | ||
| The Techniques | 265 | ||
| Inspect the External Canal | 266 | ||
| Inspect the Tympanic Membrane | 267 | ||
| Determine the Mobility of the Tympanic Membrane | 268 | ||
| The Nose | 268 | ||
| External Examination | 269 | ||
| Inspect the Nose | 269 | ||
| Palpate the Sinuses | 269 | ||
| Internal Examination | 269 | ||
| Use a Nasal Illuminator | 270 | ||
| Use a Nasal Speculum | 270 | ||
| Transilluminate the Sinuses | 270 | ||
| Clinicopathologic Correlations | 271 | ||
| Bibliography | 277.e1 | ||
| 9 The Oral Cavity and Pharynx | 278 | ||
| General Considerations | 278 | ||
| Structure and Physiologic Characteristics | 280 | ||
| The Oral Cavity | 280 | ||
| The Pharynx | 283 | ||
| The Larynx | 284 | ||
| Review of Specific Symptoms | 285 | ||
| The Oral Cavity | 285 | ||
| Pain | 285 | ||
| Ulceration | 285 | ||
| Bleeding | 286 | ||
| Mass | 286 | ||
| Halitosis | 286 | ||
| Xerostomia | 286 | ||
| The Pharynx | 287 | ||
| Nasal Obstruction | 287 | ||
| Pain | 287 | ||
| Dysphagia | 287 | ||
| Deafness | 287 | ||
| Snoring | 287 | ||
| The Larynx | 288 | ||
| Dysphonia | 288 | ||
| Effect of a Voice Disorder on the Patient | 289 | ||
| Physical Examination | 289 | ||
| The Oral Cavity | 289 | ||
| Inspect the Lips | 290 | ||
| Inspect the Buccal Mucosa | 290 | ||
| Inspect the Gingivae | 293 | ||
| Inspect the Teeth | 293 | ||
| Inspect the Tongue | 294 | ||
| Palpate the Tongue | 296 | ||
| Inspect the Floor of the Mouth | 296 | ||
| Palpate the Floor of the Mouth | 297 | ||
| Inspect the Hard and Soft Palates | 297 | ||
| Inspect the Salivary Glands | 300 | ||
| Inspect the Twelfth Cranial Nerve | 301 | ||
| The Pharynx | 301 | ||
| Inspect the Pharynx | 301 | ||
| Inspect the Tonsils | 301 | ||
| Inspect the Posterior Pharyngeal Wall | 302 | ||
| Inspect the Gag Reflex | 302 | ||
| The Larynx | 302 | ||
| Using the Laryngeal Mirror | 302 | ||
| Clinicopathologic Correlations | 303 | ||
| Bibliography | 314.e1 | ||
| 10 The Chest | 315 | ||
| General Considerations | 315 | ||
| Structure and Physiology | 316 | ||
| Review of Specific Symptoms | 319 | ||
| Cough | 320 | ||
| Sputum Production | 322 | ||
| Hemoptysis | 322 | ||
| Dyspnea | 323 | ||
| Wheezing | 324 | ||
| Cyanosis | 325 | ||
| Chest Pain | 326 | ||
| Snoring | 326 | ||
| Other Symptoms | 326 | ||
| Effect of Lung Disease on the Patient | 326 | ||
| Physical Examination | 327 | ||
| General Assessment | 327 | ||
| Inspect the Patient’s Facial Expression | 327 | ||
| Inspect the Patient’s Posture | 327 | ||
| Inspect the Neck | 328 | ||
| Inspect the Configuration of the Chest | 328 | ||
| Assess the Respiratory Rate and Pattern | 328 | ||
| Inspect the Hands | 330 | ||
| The Posterior Chest | 330 | ||
| Palpation | 330 | ||
| Palpate for Tenderness | 330 | ||
| Evaluate Posterior Chest Excursion | 330 | ||
| Evaluate Tactile Fremitus | 330 | ||
| Percussion | 332 | ||
| Percuss the Posterior Chest | 333 | ||
| Evaluate Diaphragmatic Movement | 334 | ||
| Auscultation | 335 | ||
| Types of Breath Sounds | 335 | ||
| Auscultate the Posterior Chest | 336 | ||
| The Anterior Chest | 336 | ||
| Evaluate the Position of the Trachea | 337 | ||
| Evaluate Tactile Fremitus | 337 | ||
| Percuss the Anterior Chest | 337 | ||
| Auscultate the Anterior Chest | 338 | ||
| Clinicopathologic Correlations | 338 | ||
| Bibliography | 342.e1 | ||
| 11 The Heart | 343 | ||
| General Considerations | 343 | ||
| Structure and Physiology | 345 | ||
| The Cardiac Cycle | 348 | ||
| The Arterial Pulse | 351 | ||
| Blood Pressure | 352 | ||
| Jugular Venous Pulse | 352 | ||
| Review of Specific Symptoms | 353 | ||
| Chest Pain | 353 | ||
| Palpitations | 355 | ||
| Dyspnea | 356 | ||
| Syncope | 357 | ||
| Fatigue | 358 | ||
| Dependent Edema | 359 | ||
| Hemoptysis | 359 | ||
| Cyanosis | 360 | ||
| Effect of Cardiac Disease on the Patient | 360 | ||
| Physical Examination | 361 | ||
| Inspection | 361 | ||
| Evaluate General Appearance | 361 | ||
| Inspect the Skin | 361 | ||
| Inspect the Nails | 362 | ||
| Inspect the Facies | 363 | ||
| Inspect the Eyes | 363 | ||
| Inspect the Mouth | 363 | ||
| Inspect the Neck | 364 | ||
| Inspect the Chest Configuration | 364 | ||
| Inspect the Extremities | 365 | ||
| Blood Pressure Assessment | 365 | ||
| The Principles | 365 | ||
| Determine Blood Pressure by Palpation | 366 | ||
| Determine Blood Pressure by Auscultation | 367 | ||
| Rule Out Orthostatic Hypotension | 367 | ||
| Rule Out Supravalvular Aortic Stenosis | 367 | ||
| Rule Out Coarctation of the Aorta | 367 | ||
| Rule Out Cardiac Tamponade | 367 | ||
| The Arterial Pulse | 368 | ||
| Determine the Cardiac Rate | 368 | ||
| Determine the Cardiac Rhythm | 368 | ||
| Palpate the Carotid Artery | 369 | ||
| Evaluate the Characteristics of the Pulse | 370 | ||
| The Jugular Venous Pulse | 370 | ||
| Determine the Jugular Wave Forms | 370 | ||
| Estimate the Jugular Venous Pressure | 370 | ||
| Evaluate the Hepatojugular Reflux | 370 | ||
| Percussion | 373 | ||
| Percuss the Heart’s Borders | 373 | ||
| Palpation | 373 | ||
| Palpate the Point of Maximum Impulse | 373 | ||
| Palpate for Localized Motion | 374 | ||
| Palpate for Generalized Motion | 374 | ||
| Palpate for Thrills | 375 | ||
| Auscultation | 376 | ||
| The Technique | 376 | ||
| Auscultate the Cardiac Areas | 376 | ||
| The Standard Auscultation Positions | 376 | ||
| The Influence of Breathing | 377 | ||
| Time the Cardiac Events | 377 | ||
| Approach to Careful Auscultation | 378 | ||
| Describe Any Murmurs Present | 378 | ||
| Describe Any Pericardial Rubs | 379 | ||
| The Goals of Auscultation | 379 | ||
| Examination for Edema | 379 | ||
| Test for Edema | 380 | ||
| Clinicopathologic Correlations | 380 | ||
| Abnormalities of the First Heart Sound | 381 | ||
| Abnormalities of the Second Heart Sound | 382 | ||
| Abnormalities of the Intensity of the Second Heart Sound | 382 | ||
| Abnormalities of Splitting of the Second Heart Sound | 382 | ||
| Systolic Clicks | 383 | ||
| Diastolic Opening Snaps | 383 | ||
| Murmurs | 384 | ||
| Bibliography | 389.e1 | ||
| 12 The Peripheral Vascular System | 390 | ||
| General Considerations | 390 | ||
| Structure and Physiology | 392 | ||
| Review of Specific Symptoms | 392 | ||
| Pain | 392 | ||
| Skin Changes | 393 | ||
| Edema | 394 | ||
| Ulceration | 394 | ||
| Emboli | 395 | ||
| Neurologic Symptoms | 395 | ||
| Effect of Vascular Disease on the Patient | 395 | ||
| Physical Examination | 395 | ||
| Inspection | 395 | ||
| Inspect for Symmetry of the Extremities | 395 | ||
| Inspect the Lower Extremities | 396 | ||
| Assess the Skin Temperature | 396 | ||
| Inspect for Varicosities | 396 | ||
| Examination of the Arterial Pulses | 396 | ||
| Palpate the Radial Pulse | 396 | ||
| Palpate the Brachial Pulse | 397 | ||
| Auscultate the Carotid Artery | 398 | ||
| Palpate the Abdominal Aorta | 398 | ||
| Rule Out Abdominal Bruits | 398 | ||
| Palpate the Femoral Pulse and Rule Out Coarctation of the Aorta | 399 | ||
| Palpate the Popliteal Pulse | 400 | ||
| Palpate the Dorsalis Pedis Pulse | 400 | ||
| Palpate the Posterior Tibial Pulse | 401 | ||
| Grading of Pulses | 401 | ||
| Examination of the Lymphatic System | 402 | ||
| Palpate for Epitrochlear Nodes | 402 | ||
| Other Special Techniques | 403 | ||
| Evaluate Arterial Supply in the Lower Extremity | 403 | ||
| Evaluate Capillary Refill Time in the Lower Extremity | 404 | ||
| Evaluate Arterial Supply in the Upper Extremity | 404 | ||
| Test for Incompetent Saphenous Veins | 404 | ||
| Test for Retrograde Filling | 404 | ||
| Clinicopathologic Correlations | 405 | ||
| Bibliography | 408.e1 | ||
| 13 The Breast | 409 | ||
| General Considerations | 409 | ||
| Structure and Physiology | 410 | ||
| Review of Specific Symptoms | 413 | ||
| Mass or Swelling | 413 | ||
| Pain | 414 | ||
| Nipple Discharge | 414 | ||
| Change in Skin over Breast | 415 | ||
| General Suggestions | 415 | ||
| Impact of Breast Disease on the Woman | 416 | ||
| Physical Examination | 416 | ||
| Inspection | 417 | ||
| Inspect the Breasts | 417 | ||
| Inspect the Breasts in Various Postures | 419 | ||
| Axillary Examination | 419 | ||
| Palpation | 420 | ||
| Palpate the Breast | 420 | ||
| Describe the Findings | 421 | ||
| Evaluate for Retraction Phenomenon | 421 | ||
| Palpate the Subareolar Area | 422 | ||
| Examine the Nipple | 422 | ||
| Examination of the Male Breast | 422 | ||
| Breast Self-Examination | 424 | ||
| The Male Breast | 425 | ||
| Clinicopathologic Correlations | 426 | ||
| Cancer of the Breast | 426 | ||
| Screening Guidelines for Early Detection of Cancer of the Breast | 427 | ||
| Bibliography | 428.e1 | ||
| 14 The Abdomen | 429 | ||
| General Considerations | 429 | ||
| Structure and Physiology | 430 | ||
| Review of Specific Symptoms | 432 | ||
| Pain | 432 | ||
| Nausea and Vomiting | 434 | ||
| Change in Bowel Movements | 435 | ||
| Rectal Bleeding | 436 | ||
| Jaundice | 437 | ||
| Abdominal Distention | 438 | ||
| Mass | 438 | ||
| Pruritus | 439 | ||
| Loss of Appetite | 439 | ||
| Impact of Inflammatory Bowel Disease on the Patient | 439 | ||
| Physical Examination | 440 | ||
| Inspection | 440 | ||
| Evaluate General Appearance | 440 | ||
| Determine Respiratory Rate | 441 | ||
| Inspect the Skin | 441 | ||
| Inspect the Hands | 442 | ||
| Inspect the Facies | 442 | ||
| Inspect the Contour of the Abdomen and Inspect for Hernias | 442 | ||
| Inspect the Superficial Veins | 444 | ||
| Auscultation | 444 | ||
| Evaluate Bowel Sounds | 444 | ||
| Rule Out Obstructed Viscus | 446 | ||
| Rule Out Abdominal Bruits | 446 | ||
| Rule Out Peritoneal Rubs | 446 | ||
| Percussion | 446 | ||
| Percuss the Abdomen | 447 | ||
| Percuss the Liver | 447 | ||
| Percuss the Spleen | 447 | ||
| Rule Out Ascites | 448 | ||
| Palpation | 450 | ||
| Light Palpation | 450 | ||
| Deep Palpation | 451 | ||
| Rule Out Rebound Tenderness | 451 | ||
| Liver Palpation | 452 | ||
| Rule Out Hepatic Tenderness | 454 | ||
| Spleen Palpation | 454 | ||
| Kidney Palpation | 456 | ||
| Rule Out Renal Tenderness | 456 | ||
| Rectal Examination | 457 | ||
| Patient Positioning | 457 | ||
| The Technique | 459 | ||
| Palpate the Rectal Walls | 460 | ||
| Palpate the Prostate Gland | 461 | ||
| Fecal Occult Blood Test | 462 | ||
| Special Techniques | 462 | ||
| Clinicopathologic Correlations | 463 | ||
| Tests That Find Polyps and Cancer: | 463 | ||
| Tests That Primarily Find Cancer: | 463 | ||
| Bibliography | 467.e1 | ||
| 15 Male Genitalia and Hernias | 468 | ||
| General Considerations | 468 | ||
| Structure and Physiologic Characteristics | 470 | ||
| Review of Specific Symptoms | 474 | ||
| Pain | 475 | ||
| Dysuria | 475 | ||
| Changes in Urine Flow | 476 | ||
| Red Urine | 477 | ||
| Penile Discharge | 478 | ||
| Penile Lesions | 478 | ||
| Genital Rashes | 479 | ||
| Scrotal Enlargement | 480 | ||
| Groin Mass or Swelling | 480 | ||
| Erectile Dysfunction | 480 | ||
| Infertility | 482 | ||
| Impact of Erectile Dysfunction on the Man | 482 | ||
| Physical Examination | 483 | ||
| Inspection and Palpation with the Patient Lying Down | 483 | ||
| Inspect the Skin and Hair | 483 | ||
| Inspect the Penis and Scrotum | 483 | ||
| Inspect the Perineum | 485 | ||
| Inspect for Groin Masses | 486 | ||
| Inspection and Palpation with the Patient Standing | 486 | ||
| Inspect the Penis | 486 | ||
| Inspect the External Meatus | 487 | ||
| Palpate the Penis and Urethra | 487 | ||
| Inspect the Scrotum | 488 | ||
| Palpate the Testes | 488 | ||
| Palpate the Epididymis and Vas Deferens | 489 | ||
| Transilluminate Scrotal Masses | 489 | ||
| Hernia Examination | 490 | ||
| Inspect Inguinal and Femoral Areas | 490 | ||
| Palpate for Inguinal Hernias | 491 | ||
| Clinicopathologic Correlations | 492 | ||
| Bibliography | 499.e1 | ||
| 16 Female Genitalia | 500 | ||
| General Considerations | 500 | ||
| Structure and Physiologic Characteristics | 502 | ||
| Review of Specific Symptoms | 506 | ||
| Abnormal Vaginal Bleeding | 507 | ||
| Dysmenorrhea | 507 | ||
| Masses or Lesions | 508 | ||
| Vaginal Discharge | 508 | ||
| Vaginal Itching | 508 | ||
| Abdominal Pain | 509 | ||
| Dyspareunia | 509 | ||
| Changes in Hair Distribution | 510 | ||
| Changes in Urinary Pattern | 511 | ||
| Infertility | 512 | ||
| General Suggestions | 512 | ||
| Effect of Infertility on the Woman | 513 | ||
| Physical Examination | 514 | ||
| General Considerations | 514 | ||
| Preparation for the Examination | 515 | ||
| Inspection and Palpation of External Genitalia | 515 | ||
| Inspect the External Genitalia and Hair | 515 | ||
| Inspect the Labia | 515 | ||
| Inspect the Clitoris | 517 | ||
| Inspect the Urethral Meatus | 517 | ||
| Inspect the Area of Bartholin’s Glands | 518 | ||
| Inspect the Perineum | 518 | ||
| Test for Pelvic Relaxation | 518 | ||
| Examination with Speculum | 518 | ||
| Preparation | 518 | ||
| Technique | 519 | ||
| Inspect the Cervix | 519 | ||
| Pap Smear | 522 | ||
| Inspect the Vaginal Walls | 523 | ||
| Bimanual Palpation | 523 | ||
| Technique | 523 | ||
| Palpate the Cervix and Uterine Body | 524 | ||
| Palpate the Adnexa | 524 | ||
| Rectovaginal Palpation | 526 | ||
| Palpate the Rectovaginal Septum | 526 | ||
| Completion of the Examination | 527 | ||
| Clinicopathologic Correlations | 527 | ||
| Bibliography | 532.e1 | ||
| 17 The Musculoskeletal System | 533 | ||
| General Considerations | 533 | ||
| Structure and Physiology | 535 | ||
| Review of Specific Symptoms | 550 | ||
| Pain | 550 | ||
| Weakness | 551 | ||
| Deformity | 551 | ||
| Limitation of Motion | 551 | ||
| Stiffness | 551 | ||
| Joint Clicking | 552 | ||
| Effect of Musculoskeletal Disease on the Patient | 552 | ||
| Physical Examination | 552 | ||
| Screening Examination | 552 | ||
| General Principles | 552 | ||
| Evaluate Gait | 553 | ||
| Evaluate the Spine | 553 | ||
| Evaluate Strength of the Lower Extremities | 553 | ||
| Evaluate Neck Flexion | 556 | ||
| Evaluate Neck Extension | 557 | ||
| Evaluate Neck Rotation | 557 | ||
| Evaluate Intrinsic Muscles of the Hand | 558 | ||
| Evaluate External Rotation of the Arm | 558 | ||
| Evaluate Internal Rotation of the Arm | 558 | ||
| Evaluate Strength of the Upper Extremities | 558 | ||
| Examination of Specific Joints | 558 | ||
| Temporomandibular Joint | 559 | ||
| 3 Evaluation of Specific Patients | 649 | ||
| 20 The Pregnant Patient | 651 | ||
| General Considerations | 651 | ||
| Structure and Physiologic Characteristics | 652 | ||
| Basic Physiologic Characteristics of Reproduction | 652 | ||
| Functional Anatomy of Birth | 654 | ||
| Review of Specific Symptoms | 655 | ||
| Amenorrhea | 656 | ||
| Nausea | 656 | ||
| Breast Changes | 657 | ||
| Heartburn | 658 | ||
| Backache | 658 | ||
| Abdominal Enlargement | 658 | ||
| Quickening | 658 | ||
| Skin Changes | 658 | ||
| Changes in Urination | 659 | ||
| Vaginal Discharge | 660 | ||
| Fatigue | 660 | ||
| Other Symptoms | 660 | ||
| Obstetric Risk Assessment | 660 | ||
| Age | 660 | ||
| Parity | 660 | ||
| Height | 660 | ||
| Pregnancy Weight | 661 | ||
| Diabetes, Hypertension, or Renal Disease | 661 | ||
| Hemoglobinopathy and Isoimmunization | 661 | ||
| History of Previous Pregnancies | 661 | ||
| Sexually Transmitted Infections | 661 | ||
| Other Infections | 661 | ||
| Tobacco, Alcohol, and Drug Use | 661 | ||
| Calculation of Due Date | 662 | ||
| Effect of Pregnancy on the Patient | 662 | ||
| Physical Examination | 662 | ||
| Initial Comprehensive Evaluation | 663 | ||
| Head, Eyes, Ears, Nose, Throat, and Neck | 663 | ||
| Chest | 663 | ||
| Heart | 663 | ||
| Breasts | 664 | ||
| Abdomen | 664 | ||
| Genitalia | 665 | ||
| Extremities | 666 | ||
| Subsequent Antenatal Examinations | 666 | ||
| Clinicopathologic Correlations | 666 | ||
| Bibliography | 670.e1 | ||
| 21 The Pediatric Patient | 671 | ||
| General Considerations | 671 | ||
| The Pediatric History | 672 | ||
| Birth History | 674 | ||
| Past Medical History | 676 | ||
| Nutrition | 677 | ||
| Growth and Development | 677 | ||
| Immunization History | 679 | ||
| Social and Environmental History | 681 | ||
| Cultural History | 682 | ||
| Family History | 683 | ||
| Review of Systems | 684 | ||
| The Adolescent Interview | 684 | ||
| Examination of the Newborn | 687 | ||
| General Assessment | 687 | ||
| Skin | 692 | ||
| Head | 698 | ||
| Eyes | 700 | ||
| Ears | 701 | ||
| Nose | 702 | ||
| Mouth and Pharynx | 702 | ||
| Neck | 703 | ||
| Chest | 703 | ||
| Breast | 704 | ||
| Heart | 704 | ||
| Pulses | 704 | ||
| Abdomen | 704 | ||
| Genitalia | 705 | ||
| Musculoskeletal Examination | 706 | ||
| Neurologic Examination | 707 | ||
| Examination of the Infant | 709 | ||
| General Assessment | 710 | ||
| Skin | 711 | ||
| Head | 714 | ||
| Eyes | 714 | ||
| Nose | 715 | ||
| Neck | 715 | ||
| Chest | 716 | ||
| Heart | 716 | ||
| Abdomen | 716 | ||
| Genitalia | 717 | ||
| Musculoskeletal Examination | 717 | ||
| Neurologic Examination | 717 | ||
| Ears | 717 | ||
| Mouth and Pharynx | 719 | ||
| Review of Systems and Examination of the Young Child | 719 | ||
| General Assessment | 720 | ||
| Skin | 721 | ||
| Head | 721 | ||
| Chest | 723 | ||
| Heart | 723 | ||
| Abdomen | 723 | ||
| Genitalia | 724 | ||
| Musculoskeletal Examination | 724 | ||
| Neurologic Examination | 725 | ||
| Eyes | 725 | ||
| Nose | 725 | ||
| Ears | 725 | ||
| Mouth and Pharynx | 726 | ||
| Review of Systems and Examination of the Older Child | 728 | ||
| General Assessment | 728 | ||
| Skin | 728 | ||
| Eyes | 728 | ||
| Ears | 728 | ||
| Nose | 728 | ||
| Mouth and Pharynx | 728 | ||
| Neck | 728 | ||
| Chest | 729 | ||
| Heart | 729 | ||
| Abdomen | 729 | ||
| Genitalia | 729 | ||
| Musculoskeletal Examination | 729 | ||
| Neurologic Examination | 733 | ||
| Review of Systems and Examination of the Adolescent | 733 | ||
| General Assessment | 734 | ||
| Skin | 734 | ||
| Breasts | 735 | ||
| Abdomen | 735 | ||
| Genitalia | 736 | ||
| Musculoskeletal Examination | 736 | ||
| Clinicopathologic Correlations | 736 | ||
| Bibliography | 742.e1 | ||
| 22 The Geriatric Patient | 743 | ||
| General Considerations | 743 | ||
| Structure and Physiologic Characteristics | 744 | ||
| Skin | 744 | ||
| Eyes | 746 | ||
| Ears | 746 | ||
| Nose and Throat | 746 | ||
| Mouth | 746 | ||
| Lungs | 746 | ||
| Cardiovascular System | 746 | ||
| Breasts | 747 | ||
| Gastrointestinal System | 747 | ||
| Genitourinary System | 747 | ||
| Endocrine System | 747 | ||
| Musculoskeletal System | 747 | ||
| Nervous System | 748 | ||
| Hematopoietic System | 748 | ||
| Immune System | 748 | ||
| Basic Principles of Geriatric Medicine | 748 | ||
| The Geriatric History | 749 | ||
| Effect of Growing Old on the Patient | 752 | ||
| Physical Examination | 752 | ||
| Assessment of Vital Signs | 752 | ||
| Skin | 753 | ||
| Head, Eyes, Ears, Nose, Throat, and Neck | 753 | ||
| Breasts | 753 | ||
| Chest | 753 | ||
| Cardiovascular System | 753 | ||
| Abdomen | 753 | ||
| Musculoskeletal Examination | 753 | ||
| Neurologic Examination | 754 | ||
| Clinicopathologic Correlations | 754 | ||
| Bibliography | 757.e1 | ||
| 23 The Acutely Ill or Injured Patient | 758 | ||
| Personal Safety | 758 | ||
| Current Cardiopulmonary Resuscitation Guidelines | 759 | ||
| C-A-B | 760 | ||
| Cardiopulmonary Resuscitation Survey | 760 | ||
| Summary of CPR Guidelines for Adults, Children, and Infants | 761 | ||
| Check | 761 | ||
| CPR | 761 | ||
| Continue Sets of 30 Pushes and 2 Breaths | 761 | ||
| Assessment of the Acutely Ill or Injured Patient | 762 | ||
| Primary Survey | 763 | ||
| Key Vital Functions Assessment Survey | 763 | ||
| A–Airway | 763 | ||
| B–Breathing | 764 | ||
| C–Circulation | 764 | ||
| D–Disability | 765 | ||
| E–Expose | 765 | ||
| Vital Signs | 765 | ||
| Assess and Reassess Vital Signs | 765 | ||
| Secondary Survey | 766 | ||
| History | 766 | ||
| Secondary Survey Physical Examination | 766 | ||
| Head and Neck | 766 | ||
| Chest | 767 | ||
| Abdomen | 767 | ||
| Pelvis | 767 | ||
| Extremities | 768 | ||
| Back | 768 | ||
| The Pediatric Emergency | 769 | ||
| Bibliography | 770.e1 | ||
| 4 Putting the Data to Work | 771 | ||
| 24 Diagnostic Reasoning in Physical Diagnosis | 773 | ||
| Art, Science, and Observation | 773 | ||
| Diagnostic Reasoning from Signs and Symptoms | 775 | ||
| Sensitivity and Specificity | 775 | ||
| Likelihood Ratio | 776 | ||
| Ruling In and Ruling Out Disease | 777 | ||
| Positive and Negative Predictive Values | 777 | ||
| Prevalence | 778 | ||
| Bayes’ Theorem | 779 | ||
| Nomogram | 780 | ||
| Multiple Signs and Symptoms | 781 | ||
| Decision Analysis | 782 | ||
| Construct Decision Tree | 783 | ||
| Assign Probabilities | 783 | ||
| Attach Utilities | 784 | ||
| Compute Expected Values | 784 | ||
| Make a Decision | 784 | ||
| The Rational Clinical Examination | 785 | ||
| Bibliography | 785.e1 | ||
| 25 The Clinical Record | 786 | ||
| Putting the History and Physical Examination Together | 786 | ||
| Patient: John Doe | 787 | ||
| History | 787 | ||
| Source | 787 | ||
| Chief Complaint | 787 | ||
| History of Present Illness | 787 | ||
| Past Medical History | 787 | ||
| Family History (Figure 25-1) | 788 | ||
| Psychosocial History | 788 | ||
| Sexual, Reproductive, and Gynecologic History | 788 | ||
| Review of Systems | 788 | ||
| Physical Examination | 789 | ||
| Summary | 791 | ||
| The Human Dimension | 792 | ||
| Bibliography | 792.e1 | ||
| 26 The Focused History and Physical Examination | e1 | ||
| General Considerations | e1 | ||
| Illustrative Case | e2 | ||
| The History of Mr. Roger Stern | e2 | ||
| Diagnostic Evaluation | e5 | ||
| The Physical Examination of Mr. Roger Stern | e6 | ||
| Bibliography | e6 | ||
| 5 Special Additional Important Topics (Internet-Based) | e9 | ||
| 27 Caring for Patients in a Culturally Diverse Society | e9 | ||
| General Considerations | e10 | ||
| Race, Culture, and Ethnicity | e11 | ||
| Disease, Illness, and Health | e11 | ||
| Culture and Health | e12 | ||
| Genetic Diseases | e13 | ||
| Traditional Medical Beliefs | e15 | ||
| Culture and Response to Pain | e17 | ||
| Ethnicity and Pharmacotherapy | e18 | ||
| Cross-Cultural Differences in Morbidity and Mortality Rates | e18 | ||
| Traditional Healing Systems | e19 | ||
| Specific Cross-Cultural Perspectives | e21 | ||
| African Americans | e22 | ||
| Hispanic/Latino People | e22 | ||
| Asian Americans | e26 | ||
| Asian Indians | e27 | ||
| Native Americans | e28 | ||
| The Jewish People | e29 | ||
| International Society for Krishna Consciousness | e29 | ||
| Romanies | e30 | ||
| Concluding Thoughts | e30 | ||
| Bibliography | e30 | ||
| 28 Understanding Complementary and Alternative Medicine | e32 | ||
| General Considerations | e32 | ||
| Classifications of Complementary and Alternative Medicine | e33 | ||
| Traditional Chinese Medicine | e42 | ||
| Concluding Thoughts | e47 | ||
| Bibliography | e47 | ||
| 29 Assessment of Nutritional Status | e49 | ||
| Medical History | e50 | ||
| Chief Complaint | e50 | ||
| History of Present Illness | e50 | ||
| Body Weight History | e50 | ||
| Past Medical History | e51 | ||
| Past Surgical History | e51 | ||
| Medications | e51 | ||
| Allergies and Food Intolerances | e54 | ||
| Social History | e54 | ||
| Lifestyle Habits | e54 | ||
| Dietary History | e54 | ||
| Physical Activity | e56 | ||
| Review of Systems | e56 | ||
| Physical Examination | e56 | ||
| Vital Signs | e56 | ||
| Appearance | e58 | ||
| Special Populations | e59 | ||
| Obese Patients | e59 | ||
| Obesity-Focused History | e59 | ||
| Obesity-Focused Physical Examination | e61 | ||
| Malnourished Patients | e62 | ||
| Older Adult Patients | e65 | ||
| Clinicopathologic Correlations | e66 | ||
| Concluding Thoughts | e69 | ||
| Bibliography | e70 | ||
| Epilogue | e72 | ||
| Ethical Challenges | e72 | ||
| Unethical Labeling of Patients | e74 | ||
| Health Care Proxy | e74 | ||
| Concluding Thoughts | e76 | ||
| Bibliography | e76 | ||
| Appendix A Commonly Abused Drugs | e77 | ||
| Appendix B Signs and Symptoms of Deficiency States | e79 | ||
| Appendix C Conversion Tables | e82 | ||
| Appendix D The Rational Clinical Examination: Additional References | e84 | ||
| Appendix E Advisory Committee on Immunization Practices (ACIP) Recommended Immunization Schedule for Adults Aged 19 Years and Older—United States, 2013 | e86 | ||
| Footnotes: Recommended Immunization Schedule for Adults Aged 19 Years and Older—United States, 2013 | e88 | ||
| APPENDIX F Advisory Committee on Immunization Practices (ACIP) Recommended Immunization Schedule for Persons Aged 0 Through 18 Years—United States, 2013 | e96 | ||
| Footnotes: Recommended Immunization Schedule for Persons Aged 0 Through 18 Years—United States, 2013 | e99 | ||
| Index | 793 | ||
| A | 793 | ||
| B | 796 | ||
| C | 797 | ||
| D | 800 | ||
| E | 801 | ||
| F | 803 | ||
| G | 804 | ||
| H | 805 | ||
| I | 807 | ||
| J | 808 | ||
| K | 808 | ||
| L | 808 | ||
| M | 810 | ||
| N | 812 | ||
| O | 813 | ||
| P | 814 | ||
| Q | 818 | ||
| R | 818 | ||
| S | 819 | ||
| T | 822 | ||
| U | 823 | ||
| V | 824 | ||
| W | 824 | ||
| X | 825 | ||
| Y | 825 | ||
| Z | 825 | ||
| Inside Back Cover | ibc1 |