Additional Information
Book Details
Abstract
This classic textbook sets out clearly and concisely how to evaluate symptoms and elicit relevant physical signs. It describes the practical skills which every clinician must acquire and develop in order to evolve diagnostic procedures and management strategies and plans. ‘Highly Commended’ in the 2006 and 2010 BMA Medical Book Competitions, this Thirteenth Edition contains over 500 clinical photographs and diagrams to illustrate the text, with new topics added to make the book even more comprehensive.
This Thirteenth Edition has four sections:
- History taking and general examination.
- System examination covering symptoms and signs.
- Examination in special situations including babies & children and the critically ill.
- How to pass an OSCE.
Included on the Student Consult site are the specially-recorded videos demonstrating many of the clinical examination routines described in the main text.
- The book starts with a general overview section on history taking and the general examination that provide the framework on which to hang the detail.
- The systematic examination section documents clearly the relevant history, examination and special investigations as well as giving advice on their significance.
- The third section covers examination in specific situations and emphasises an integrated and structured approach to these patients.
- A final section spells out how to demonstrate the techniques learned in the book in an OSCE.
- Macleod’s is closely linked to its sister publication, Davidson’s Principles & Practice of Medicine, which complements the information in this text.
- Available with full online access on Student Consult and ancillary videos demonstrating key clinical examination routines following the format laid out in the book.
- There are two new chapters on examination in specific situations:
- The frail elderly
- The adult with fever
- A new section explicitly spells out how to demonstrate the techniques learned in the book in an OSCE and other formative and summative examinations.
- Over 50 new text boxes highlight the evidence-base for the examination techniques discussed.
- An Advisory Board of students, junior doctors, and representatives from the nursing, ambulance, Primary Care and academic communities from six countries has made detailed comments and critically appraised the entire book.
- The text has been substantially rewritten with more on medically unexplained symptoms in the History Taking chapter and extended coverage of diabetes mellitus in the Endocrine System chapter.
- Integrated with the online text are clinical examination videos of trained professionals performing many of the examination routines described in the book with an accompanying commentary by the Editor, Professor Colin Robertson
- Two new videos show how the Glasgow Coma Scale should be performed in clinical situations, demonstrating the correct techniques and also common pitfalls in using the GCS.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Half-title page | i | ||
| John Macleod (1915–2006) | ii | ||
| Macleod's Clinical Examination, 13/e | ii | ||
| Copyright Page | iv | ||
| Preface | v | ||
| Acknowledgements | vi | ||
| Picture and box credits | vii | ||
| Chapter 1 | vii | ||
| Chapter 2 | vii | ||
| Chapter 3 | vii | ||
| Chapter 5 | vii | ||
| Chapter 6 | vii | ||
| Chapter 7 | vii | ||
| Chapter 8 | vii | ||
| Chapter 9 | vii | ||
| Chapter 11 | vii | ||
| Chapter 12 | viii | ||
| Chapter 13 | viii | ||
| Chapter 14 | viii | ||
| Chapter 15 | viii | ||
| Chapter 16 | viii | ||
| Chapter 19 | viii | ||
| How to get the most out of this book | ix | ||
| Boxes and tables | ix | ||
| Evidence-based examination | ix | ||
| Examination sequences | ix | ||
| Glasgow Coma Scale videos | x | ||
| Video production team | x | ||
| Writer, narrator, director and producer | x | ||
| Nurses | x | ||
| Patient | x | ||
| Production | x | ||
| Clinical skills videos | xi | ||
| Video contents | xi | ||
| Video production team | xi | ||
| Director and editor | xi | ||
| Producer | xi | ||
| Sound and narrator | xi | ||
| Clinical examiners | xi | ||
| Patients | xi | ||
| Contributors | xii | ||
| Advisory board | xv | ||
| UK advisory board | xv | ||
| International advisory board | xv | ||
| Table Of Contents | xvi | ||
| 1 History Taking and General Examination | 1 | ||
| 1 Approach to the patient | 1 | ||
| Being a ‘good’ doctor | 2 | ||
| Confidentiality and consent | 2 | ||
| Personal responsibilities | 3 | ||
| Dress and demeanour | 3 | ||
| Communication skills | 3 | ||
| Expectations and respect | 3 | ||
| Hand washing and cleanliness | 3 | ||
| 2 History taking | 5 | ||
| Talking with patients | 6 | ||
| Patient-centred medicine | 6 | ||
| Beginning | 6 | ||
| Setting up | 6 | ||
| Preparation | 6 | ||
| Where will you see your patient? | 6 | ||
| How long will you have? | 7 | ||
| How will you sit? | 7 | ||
| Non-verbal communication | 7 | ||
| Starting your consultation | 7 | ||
| Active listening | 7 | ||
| Empathy | 8 | ||
| Understanding your patient’s context | 8 | ||
| Sharing information and agreeing goals | 9 | ||
| Engaging your patient | 9 | ||
| Difficult situations | 9 | ||
| Your patient has communication difficulties | 9 | ||
| Your patient has cognitive difficulties | 9 | ||
| Sensitive situations | 9 | ||
| Your patient is emotional | 10 | ||
| Cultural sensitivity | 10 | ||
| Third-party information | 10 | ||
| Telephone consultation | 10 | ||
| Breaking bad news | 10 | ||
| Gathering information | 11 | ||
| The presenting complaint | 11 | ||
| Diagnosis | 11 | ||
| What sort of pathology does the patient have? | 11 | ||
| What about physical signs? | 12 | ||
| Pain | 12 | ||
| Associated symptoms | 12 | ||
| Effects on lifestyle | 12 | ||
| Attitudes to illness | 13 | ||
| Past history | 13 | ||
| Drug history | 13 | ||
| Compliance, concordance and adherence | 14 | ||
| Drug allergies/reactions | 14 | ||
| Family history | 14 | ||
| Social history | 14 | ||
| Lifestyle | 14 | ||
| Exercise | 14 | ||
| Diet | 14 | ||
| Occupational history | 16 | ||
| Travel history | 16 | ||
| Sexual history | 16 | ||
| Smoking | 16 | ||
| Alcohol | 17 | ||
| Alcohol problems | 17 | ||
| Non-prescribed drug use | 18 | ||
| Systematic enquiry | 18 | ||
| Putting it all together | 18 | ||
| The psychiatric history | 21 | ||
| The history | 21 | ||
| Sensitive topics | 21 | ||
| The uncooperative patient | 21 | ||
| Mental state examination | 21 | ||
| Appearance | 22 | ||
| Behaviour | 22 | ||
| Speech | 22 | ||
| Mood | 22 | ||
| Thought form | 22 | ||
| Thought content | 23 | ||
| Perceptions | 24 | ||
| Cognition | 24 | ||
| Risk assessment | 25 | ||
| Screening questions for mental illnesses | 25 | ||
| The physical examination | 26 | ||
| Collateral history | 26 | ||
| Psychiatric rating scales | 26 | ||
| Medically unexplained symptoms (MUS) | 27 | ||
| Symptoms and definitions | 27 | ||
| Causes | 28 | ||
| History | 28 | ||
| Presenting complaint | 28 | ||
| Past history | 28 | ||
| Social history | 28 | ||
| Psychiatric history | 29 | ||
| Physical examination | 29 | ||
| Investigation | 29 | ||
| Putting it all together | 29 | ||
| Documenting the findings: the case notes | 30 | ||
| Computer records | 30 | ||
| Confidentiality | 30 | ||
| Writing letters | 30 | ||
| 3 The general examination | 41 | ||
| The setting for a physical examination | 42 | ||
| Sequence for performing a physical examination | 42 | ||
| First impressions | 42 | ||
| Gait and posture | 42 | ||
| The handshake | 43 | ||
| Facial expression and general demeanour | 43 | ||
| Clothing | 43 | ||
| Complexion | 44 | ||
| Haemoglobin | 44 | ||
| Cyanosis | 44 | ||
| Central cyanosis | 45 | ||
| Peripheral cyanosis | 45 | ||
| Melanin | 46 | ||
| Vitiligo | 46 | ||
| Albinism | 46 | ||
| Overproduction of melanin | 46 | ||
| Pregnancy and oral contraceptives | 46 | ||
| Carotene | 46 | ||
| Bilirubin | 46 | ||
| Iron | 47 | ||
| Easy bruising | 47 | ||
| Odours | 47 | ||
| Spot diagnoses | 47 | ||
| Major chromosomal abnormalities | 47 | ||
| Down’s syndrome (trisomy 21 – 47XX/XY + 21) | 47 | ||
| Turner’s syndrome (45XO) | 48 | ||
| Achondroplasia | 48 | ||
| The hands | 49 | ||
| Abnormal findings | 49 | ||
| Deformity | 49 | ||
| Colour | 49 | ||
| Temperature | 49 | ||
| Skin | 49 | ||
| Finger clubbing | 49 | ||
| Abnormal findings | 50 | ||
| Joints | 50 | ||
| Muscles | 51 | ||
| The tongue | 51 | ||
| Normal findings | 51 | ||
| Abnormal findings | 51 | ||
| Lumps or swellings | 51 | ||
| Size | 52 | ||
| Position | 52 | ||
| Attachments | 52 | ||
| Consistency | 52 | ||
| Edge | 52 | ||
| Surface and shape | 52 | ||
| Pulsations, thrills and bruits | 52 | ||
| Inflammation | 52 | ||
| Transillumination | 53 | ||
| The lymph nodes | 53 | ||
| Size | 54 | ||
| Attachments | 54 | ||
| Consistency | 54 | ||
| Tenderness | 54 | ||
| Abnormal findings | 55 | ||
| Weight and height | 55 | ||
| Nutritional status | 56 | ||
| Vitamin deficiencies | 56 | ||
| Abnormal findings | 56 | ||
| Obesity | 56 | ||
| Weight loss | 56 | ||
| Short stature | 57 | ||
| Tall stature | 57 | ||
| Hydration | 58 | ||
| Dehydration | 58 | ||
| Oedema | 58 | ||
| Generalised oedema | 59 | ||
| Fluid overload | 59 | ||
| Hypoproteinaemia | 59 | ||
| Localised oedema | 60 | ||
| Venous causes | 60 | ||
| Lymphatic causes | 60 | ||
| Inflammatory causes | 60 | ||
| Allergic causes | 61 | ||
| Postural oedema | 61 | ||
| Temperature | 61 | ||
| Fever | 62 | ||
| Hypothermia | 62 | ||
| 2 System Examination | 63 | ||
| 4 The skin, hair and nails | 63 | ||
| Examination of the skin, hair and nails | 64 | ||
| Anatomy | 65 | ||
| Hair cycle | 66 | ||
| Puberty | 66 | ||
| Nails | 66 | ||
| Symptoms and definitions | 66 | ||
| Rashes | 66 | ||
| Distribution patterns | 67 | ||
| Duration | 71 | ||
| Associated features | 71 | ||
| Common patterns of hair disease | 71 | ||
| Nail abnormalities | 72 | ||
| Mucous membranes and other sites | 73 | ||
| The history | 73 | ||
| Presenting complaint | 73 | ||
| Past and drug histories | 74 | ||
| Social, family and genetic histories | 75 | ||
| Occupational and environmental histories | 75 | ||
| The physical examination | 75 | ||
| General examination | 75 | ||
| The skin, hair and nails | 75 | ||
| Putting it all together | 75 | ||
| Investigations | 75 | ||
| 5 The endocrine system | 77 | ||
| Endocrine examination | 78 | ||
| Anatomy | 79 | ||
| Symptoms and definitions | 79 | ||
| The history | 80 | ||
| General points | 80 | ||
| Past history | 80 | ||
| Drug history | 80 | ||
| Family history | 80 | ||
| The thyroid | 80 | ||
| Anatomy | 80 | ||
| Symptoms and definitions | 80 | ||
| History | 81 | ||
| Presenting complaint | 81 | ||
| Past drug, family and social history | 82 | ||
| The thyroid gland | 82 | ||
| Normal findings | 83 | ||
| Abnormal findings | 83 | ||
| Shape, surface and consistency | 83 | ||
| Mobility | 83 | ||
| Thyroid bruit | 83 | ||
| The parathyroids | 84 | ||
| Anatomy | 84 | ||
| Symptoms and definitions | 84 | ||
| History | 84 | ||
| Abnormal findings | 84 | ||
| The pancreas | 85 | ||
| Anatomy | 85 | ||
| Symptoms and definitions | 85 | ||
| Diabetes mellitus | 85 | ||
| Abnormal findings | 86 | ||
| The diabetic foot | 87 | ||
| Abnormal findings | 87 | ||
| Risk assessment | 87 | ||
| The pituitary | 87 | ||
| Anatomy | 87 | ||
| Acromegaly | 87 | ||
| History | 88 | ||
| Hypopituitarism | 89 | ||
| The adrenals | 90 | ||
| Anatomy | 90 | ||
| Symptoms and definitions | 90 | ||
| Cushing’s syndrome | 90 | ||
| Addison’s disease | 90 | ||
| The gonads | 92 | ||
| Symptoms and definitions | 92 | ||
| Other endocrine disorders | 94 | ||
| Carcinoid syndrome | 94 | ||
| Putting it all together | 94 | ||
| A structured approach to the general endocrine examination | 94 | ||
| Investigations | 95 | ||
| 6 The cardiovascular system | 97 | ||
| Cardiovascular examination | 98 | ||
| The heart | 99 | ||
| Anatomy | 99 | ||
| Heart valves | 99 | ||
| Symptoms and definitions | 99 | ||
| Chest pain and discomfort | 99 | ||
| Angina pectoris | 99 | ||
| Dyspnoea (breathlessness) | 101 | ||
| Palpitation | 102 | ||
| Syncope | 103 | ||
| Oedema | 104 | ||
| Other symptoms | 105 | ||
| The history | 105 | ||
| Presenting complaint | 105 | ||
| Functional impairment | 105 | ||
| Past history | 105 | ||
| Drug history | 105 | ||
| Family history | 105 | ||
| Social history | 106 | ||
| Occupational history | 106 | ||
| The physical examination | 106 | ||
| General examination | 106 | ||
| Hands and skin | 106 | ||
| Normal findings | 106 | ||
| Abnormal findings | 106 | ||
| The face and eyes | 107 | ||
| Abnormal findings | 107 | ||
| Arterial pulses | 107 | ||
| Anatomy | 107 | ||
| Radial pulse | 108 | ||
| Brachial pulse | 109 | ||
| Carotid pulse | 109 | ||
| Femoral pulse | 109 | ||
| Normal findings | 109 | ||
| Rate | 109 | ||
| Rhythm | 109 | ||
| 3 Examination in Specific Situations | 355 | ||
| 15 Babies and children | 355 | ||
| EXAMINATION OF BABIES | 356 | ||
| Symptoms and definitions | 356 | ||
| Pallor | 356 | ||
| Respiratory distress | 356 | ||
| Cyanosis | 356 | ||
| Acrocyanosis | 356 | ||
| Jaundice | 356 | ||
| Jitteriness | 356 | ||
| Dysmorphism | 356 | ||
| Hypotonia | 356 | ||
| Apgar score | 357 | ||
| The history | 357 | ||
| The physical examination | 357 | ||
| Timing and efficacy of the routine neonatal examination | 357 | ||
| General examination | 358 | ||
| Skin | 358 | ||
| Normal findings | 358 | ||
| Abnormal findings | 358 | ||
| Head | 359 | ||
| 4 Assessing Clinical Examination Technique | 427 | ||
| 21 OSCEs and other examination formats | 427 | ||
| Introduction | 428 | ||
| History taking and general communication | 428 | ||
| Approach to the patient | 428 | ||
| History taking | 428 | ||
| Demonstrate competence in communication | 428 | ||
| Have an appropriate communication framework | 428 | ||
| General examination | 428 | ||
| Comment on your first impressions | 428 | ||
| Spot diagnosis or focus for further assessment | 428 | ||
| The communication station | 429 | ||
| Other examples of communication stations | 429 | ||
| The endocrine station | 430 | ||
| Thyroid | 430 | ||
| Acromegaly | 430 | ||
| Diabetes mellitus | 430 | ||
| Other metabolic disturbances | 430 | ||
| A person with general tiredness and thirst | 430 | ||
| The cardiovascular station | 431 | ||
| Peripheral vascular disease | 431 | ||
| Other examples of OSCEs | 431 | ||
| Examine this patient with a leg ulcer | 431 | ||
| Examine this patient with varicose veins | 431 | ||
| Examine this patient with high blood pressure | 431 | ||
| The heart | 431 | ||
| Take a history from this person with chest pain | 431 | ||
| Examine this person’s heart | 431 | ||
| The respiratory station | 432 | ||
| Other examples of OSCEs | 432 | ||
| Take a history from this patient with breathlessness | 432 | ||
| Take a history from this patient with haemoptysis | 432 | ||
| Take a history from this patient with chest pain | 432 | ||
| Examine this patient who complains of wheeze | 432 | ||
| The gastrointestinal station | 433 | ||
| Other examples of OSCEs | 433 | ||
| Take a history from this patient with difficulty swallowing | 433 | ||
| Take a history from this patient with upper abdominal pain | 433 | ||
| Take a history from this patient with altered bowel habit | 433 | ||
| Examine this patient with abdominal swelling | 433 | ||
| The renal station | 434 | ||
| Other examples of OSCEs | 434 | ||
| Examine this patient with loin pain | 434 | ||
| Examine this patient with newly diagnosed kidney failure | 434 | ||
| Examine this patient with oedema | 434 | ||
| Examine this patient with prostatism | 434 | ||
| Examine this patient with urinary incontinence | 434 | ||
| The visual station | 435 | ||
| Other examples of OSCEs | 435 | ||
| Examine the eyes in this patient with acute redness and pain in one eye | 435 | ||
| Examine the eyes in this patient with diabetes mellitus | 435 | ||
| Examine the eyes in this patient with cataract | 435 | ||
| Examine the eyes in this patient with glaucoma | 435 | ||
| The ear, nose and throat station | 436 | ||
| Other examples of OSCEs | 436 | ||
| Examine this patient who complains of being dizzy and lightheaded | 436 | ||
| The musculoskeletal station | 437 | ||
| Other examples of OSCEs | 437 | ||
| Examine this patient with pain in the hands | 437 | ||
| Examine this patient with pain in the hip | 437 | ||
| Examine this patient with pain in the knee (worse on walking) | 437 | ||
| Take a history from this patient with joint pain | 437 | ||
| The nervous station | 438 | ||
| Other examples of OSCEs | 438 | ||
| Take a history in a patient with sudden loss of consciousness | 438 | ||
| Take a history in a patient with headaches | 438 | ||
| Take a history in a patient with transient ischaemic attack (TIA) or stroke | 438 | ||
| Take a history in a patient with brain tumour | 438 | ||
| Examine this patient with diplopia | 438 | ||
| Examine this patient with facial palsy | 438 | ||
| Examine this patient with peripheral nerve lesion on the hand | 439 | ||
| Index | 441 | ||
| A | 441 | ||
| B | 442 | ||
| C | 442 | ||
| D | 443 | ||
| E | 444 | ||
| F | 444 | ||
| G | 445 | ||
| H | 445 | ||
| I | 446 | ||
| J | 446 | ||
| K | 446 | ||
| L | 446 | ||
| M | 447 | ||
| N | 447 | ||
| O | 448 | ||
| P | 448 | ||
| Q | 449 | ||
| R | 449 | ||
| S | 450 | ||
| T | 450 | ||
| U | 451 | ||
| V | 451 | ||
| W | 451 | ||
| X | 451 | ||
| Y | 451 |