BOOK
Seidel's Guide to Physical Examination - E-Book
Jane W. Ball | Joyce E. Dains | John A. Flynn | Barry S. Solomon | Rosalyn W. Stewart
(2014)
Additional Information
Book Details
Abstract
With a strong patient-centered approach to care and an author team comprised of nurses and physicians, Seidel’s Guide to Physical Examination, 8th Edition, addresses teaching and learning health assessment in nursing, medical, and a wide variety of other health-care programs, at both undergraduate and graduate levels. This new edition offers an increased focus on evidence-based practice and improved readability, along with integrated lifespan content and numerous special features such as Clinical Pearls and Physical Variations, Functional Assessment, and Staying Well boxes.
- Evidence-Based Practice in Physical Examination boxes supply you with current data on the most effective techniques for delivering quality patient care.
- Clinical Pearls lend insights and clinical expertise to help you develop clinical judgment skills.
- Functional Assessment boxes present a more holistic approach to patient care that extends beyond the physical exam to patients’ functional ability.
- Staying Well boxes focus you on patient wellness and health promotion.
- Risk Factor boxes provide opportunities for patient teaching or genetic testing for a variety of conditions.
- Differential diagnosis content offers you an understanding of how disease presentations vary and specific information for how to make diagnoses from similar abnormal findings.
- Abnormal Findings tables equip you with a quick, illustrated reference that allows for comparisons of various abnormalities along with key symptoms and underlying pathophysiology.
- Sample Documentation boxes clarify appropriate professional language for the process of recording patient assessment data.
- NEW! Advance Practice Skills highlighted throughout text makes identification and reference easier for students.
- NEW! Updated content throughout provides you with cutting-edge research and a strong evidence-based approach to care.
- NEW! Vital Signs and Pain Assessment Chapter groups important, foundational tasks together for easy reference in one location.
- NEW! Improve readability ensures content remains clear, straightforward, and easy to understand.
- NEW! Updated illustrations and photographs enhances visual appeal and clarifies anatomic concepts and exam techniques.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Inside Front Cover | ifc1 | ||
| Half title page | i | ||
| Brief TOC | ii | ||
| Seidel's Guide to Physical Examination, 8/e | iii | ||
| Copyright Page | iv | ||
| Dedication | v | ||
| About The Authors | vii | ||
| Jane W. Ball, DrPH, RN, CPNP | vii | ||
| Joyce E. Dains, DrPH, JD, RN, FNP-BC, FAANP | vii | ||
| John A. Flynn, MD, MBA, MEd | viii | ||
| Barry S. Solomon, MD, MPH | viii | ||
| Rosalyn W. Stewart, MD, MS, MBA | viii | ||
| Reviewers | ix | ||
| Preface | x | ||
| Organization | x | ||
| Special Features | xi | ||
| New to This Edition | xi | ||
| Our Ancillary Package | xi | ||
| Our Core Values | xii | ||
| Acknowledgments | xii | ||
| Table Of Contents | xiii | ||
| 1 The History and Interviewing Process | 1 | ||
| Developing a Relationship with the Patient | 1 | ||
| Effective Communication | 2 | ||
| Seeking Connection. | 2 | ||
| Enhancing Patient Responses. | 4 | ||
| Moments of Tension: Potential Barriers to Communication | 4 | ||
| Curiosity About You. | 4 | ||
| Anxiety. | 4 | ||
| Silence. | 4 | ||
| Depression. | 5 | ||
| Crying and Compassionate Moments. | 5 | ||
| Physical and Emotional Intimacy. | 5 | ||
| Seduction. | 5 | ||
| Anger. | 5 | ||
| Avoiding the Full Story. | 5 | ||
| Financial Considerations. | 5 | ||
| The Patient History | 6 | ||
| Setting for the Interview | 6 | ||
| Structure of the History | 6 | ||
| Building the History | 6 | ||
| Sensitive Issues | 7 | ||
| Alcohol. | 8 | ||
| Intimate Partner Violence. | 8 | ||
| Spirituality. | 10 | ||
| Sexuality. | 10 | ||
| Outline of the History | 10 | ||
| Chief Concern or the Reason for Seeking Care. | 10 | ||
| History of Present Illness or Problem. | 11 | ||
| Past Medical History. | 11 | ||
| Family History | 12 | ||
| Personal and Social History | 12 | ||
| Review of Systems (ROS). | 13 | ||
| Females | 14 | ||
| Males | 14 | ||
| Concluding Questions. | 14 | ||
| Adaptations for Age, Gender, and Possible Disabilities | 14 | ||
| Infants and Children | 14 | ||
| Chief Concern. | 14 | ||
| History of Present Illness. | 14 | ||
| Past Medical History | 14 | ||
| Family History | 15 | ||
| Personal and Social History | 15 | ||
| Review of Systems. | 16 | ||
| Adolescents | 16 | ||
| Pregnant Women | 17 | ||
| Basic Information | 17 | ||
| History of Present Illness or Problem. | 17 | ||
| Obstetric History. | 18 | ||
| Menstrual History. | 18 | ||
| Gynecologic History. | 18 | ||
| Past Medical History. | 18 | ||
| Family History. | 18 | ||
| Personal and Social History. | 18 | ||
| Review of Systems. | 18 | ||
| Risk Assessment. | 18 | ||
| Postpartum. | 18 | ||
| Older Adults | 18 | ||
| The Frail. | 19 | ||
| Patients with Disabilities | 20 | ||
| The Next Step | 20 | ||
| 2 Cultural Competency | 21 | ||
| A Definition of Culture | 21 | ||
| Distinguishing Physical Characteristics | 21 | ||
| Cultural Competence | 22 | ||
| Cultural Humility | 23 | ||
| The Impact of Culture | 23 | ||
| The Blurring of Cultural Distinctions | 23 | ||
| The Primacy of the Individual in Health Care | 24 | ||
| Professional Cultures within the Health Professions | 24 | ||
| The Impact of Culture on Illness | 24 | ||
| The Components of a Cultural Response | 25 | ||
| Modes of Communication | 26 | ||
| Health Beliefs and Practices | 27 | ||
| Family Relationships | 27 | ||
| Diet and Nutritional Practices | 28 | ||
| Summing Up | 28 | ||
| 3 Examination Techniques and Equipment | 30 | ||
| Precautions to Prevent Infection | 30 | ||
| Latex Allergy | 30 | ||
| Examination Technique | 32 | ||
| Patient Positions and Draping | 32 | ||
| Seated. | 32 | ||
| Supine. | 32 | ||
| Prone. | 32 | ||
| Dorsal Recumbent. | 32 | ||
| Lateral Recumbent. | 32 | ||
| Lithotomy. | 32 | ||
| Sims. | 32 | ||
| Inspection | 32 | ||
| Palpation | 33 | ||
| Percussion | 34 | ||
| Auscultation | 35 | ||
| Modifications for Patients with Disabilities | 35 | ||
| Patients with Mobility Impairments | 35 | ||
| Pivot Transfer. | 35 | ||
| Cradle Transfer. | 35 | ||
| Two-Person Transfer. | 36 | ||
| Equipment. | 36 | ||
| Patients with Sensory Impairment | 36 | ||
| Impaired Vision. | 36 | ||
| Impaired Hearing or Speech. | 36 | ||
| Special Concerns for Patients with Spinal Cord Injury or Lesion | 37 | ||
| Bowel and Bladder Concerns. | 37 | ||
| Autonomic Hyperreflexia. | 37 | ||
| Hypersensitivity. | 37 | ||
| Spasticity. | 37 | ||
| Equipment | 37 | ||
| Weight Scales and Height Measurement Devices | 37 | ||
| Thermometer | 39 | ||
| Stethoscope | 39 | ||
| Sphygmomanometer | 40 | ||
| Pulse Oximeter | 40 | ||
| Doppler | 41 | ||
| Portable Ultrasound | 41 | ||
| Fetal Monitoring Equipment | 41 | ||
| Ophthalmoscope | 42 | ||
| PanOptic Ophthalmoscope | 43 | ||
| StrabismoScope | 43 | ||
| Photoscreening | 43 | ||
| Visual Acuity Charts | 43 | ||
| Snellen Alphabet. | 43 | ||
| Tumbling E. | 44 | ||
| HOTV. | 44 | ||
| LH Symbols (LEA Symbols). | 44 | ||
| Broken Wheel Cards. | 44 | ||
| Near Vision Charts | 44 | ||
| Amsler Grid | 44 | ||
| Otoscope | 45 | ||
| Tympanometer | 45 | ||
| Nasal Speculum | 45 | ||
| Tuning Fork | 45 | ||
| Percussion (Reflex) Hammer | 46 | ||
| Neurologic Hammer | 46 | ||
| Tape Measure | 46 | ||
| Transilluminator | 47 | ||
| Vaginal Speculum | 47 | ||
| Goniometer | 48 | ||
| Wood’s Lamp | 48 | ||
| Dermatoscope | 48 | ||
| Calipers for Skinfold Thickness | 49 | ||
| Monofilament | 49 | ||
| Scoliometer | 49 | ||
| 4 Vital Signs and Pain Assessment | 50 | ||
| Anatomy and Physiology | 50 | ||
| Temperature | 50 | ||
| Pulse Rate | 50 | ||
| Respiratory Rate | 50 | ||
| Blood Pressure | 50 | ||
| Pain | 50 | ||
| Infants | 51 | ||
| Pregnant Women | 51 | ||
| 5 Mental Status | 64 | ||
| Anatomy and Physiology | 64 | ||
| Infants and Children | 64 | ||
| Adolescents | 64 | ||
| Older Adults | 65 | ||
| Review of Related History | 65 | ||
| History of Present Illness | 65 | ||
| Past Medical History | 66 | ||
| Family History | 66 | ||
| Personal and Social History | 66 | ||
| Children | 66 | ||
| Adolescents | 66 | ||
| Older Adults | 66 | ||
| Examination and Findings | 66 | ||
| Physical Appearance and Behavior | 66 | ||
| Grooming | 66 | ||
| Emotional Status | 67 | ||
| Nonverbal Communication (Body Language) | 67 | ||
| State of Consciousness | 67 | ||
| Cognitive Abilities | 67 | ||
| Analogies | 67 | ||
| Abstract Reasoning | 69 | ||
| Arithmetic Calculation | 69 | ||
| Writing Ability | 69 | ||
| Execution of Motor Skills | 69 | ||
| Memory | 70 | ||
| Attention Span | 70 | ||
| Judgment | 70 | ||
| Speech and Language Skills | 70 | ||
| Voice Quality | 70 | ||
| Articulation | 70 | ||
| Comprehension | 70 | ||
| Coherence | 70 | ||
| Emotional Stability | 71 | ||
| Mood and Feelings | 71 | ||
| Thought Process and Content | 71 | ||
| Perceptual Distortions and Hallucinations | 71 | ||
| Infants and Children | 72 | ||
| Pregnant Women | 73 | ||
| Older Adults | 73 | ||
| Abnormalities | 75 | ||
| Mental Status | 75 | ||
| Disorders of Altered Mental Status | 75 | ||
| Concussion | 75 | ||
| Delirium | 75 | ||
| Disorders of Mood | 76 | ||
| Depression | 76 | ||
| Mania | 76 | ||
| Anxiety Disorder | 77 | ||
| Schizophrenia | 77 | ||
| Infants and Children | 77 | ||
| Intellectual Disability | 77 | ||
| Attention-Deficit/Hyperactivity Disorder (ADHD) | 77 | ||
| Autism | 78 | ||
| Older Adults | 78 | ||
| Dementia | 78 | ||
| 6 Growth and Measurement | 79 | ||
| Anatomy and Physiology | 79 | ||
| Differences in Growth by Organ System | 80 | ||
| Infants and Children | 81 | ||
| Pregnant Women | 81 | ||
| Older Adults | 82 | ||
| Review of Related History | 82 | ||
| History of Present Illness | 82 | ||
| Past Medical History | 82 | ||
| Family History | 82 | ||
| Personal and Social History | 82 | ||
| Infants | 82 | ||
| Children and Adolescents | 82 | ||
| Pregnant Women | 82 | ||
| Older Adults | 83 | ||
| Examination and Findings | 83 | ||
| Equipment | 83 | ||
| Weight and Standing Height | 83 | ||
| Body Mass Index | 83 | ||
| Infants | 83 | ||
| Recumbent Length | 83 | ||
| Weight | 84 | ||
| Head Circumference | 84 | ||
| Chest Circumference | 85 | ||
| Gestational Age | 85 | ||
| Size for Gestational Age. | 85 | ||
| Stature and Weight | 86 | ||
| Upper-to-Lower Segment Ratio | 87 | ||
| Arm Span | 87 | ||
| Sexual Maturation | 87 | ||
| Pregnant Women | 88 | ||
| Older Adults | 89 | ||
| Abnormalities | 91 | ||
| Growth and Measurement | 91 | ||
| Acromegaly | 91 | ||
| Cushing Syndrome | 92 | ||
| Turner Syndrome | 92 | ||
| Hydrocephalus | 93 | ||
| Failure To Thrive | 93 | ||
| Growth Hormone Deficiency | 94 | ||
| Precocious Puberty | 94 | ||
| 7 Nutrition | 95 | ||
| Anatomy and Physiology | 95 | ||
| Macronutrients | 95 | ||
| Carbohydrate | 95 | ||
| Protein | 96 | ||
| Fat | 96 | ||
| Micronutrients | 96 | ||
| Water | 96 | ||
| Energy Requirements | 97 | ||
| Resting Energy Expenditure | 97 | ||
| Physical Activity | 97 | ||
| Thermogenesis | 97 | ||
| Review of Related History | 97 | ||
| History of Present Illness | 97 | ||
| Past Medical History | 97 | ||
| Family History | 98 | ||
| Personal and Social History | 98 | ||
| Infants and Children | 98 | ||
| Adolescents | 99 | ||
| Pregnant Women | 99 | ||
| Older Adults | 99 | ||
| Examination and Findings | 99 | ||
| Equipment | 99 | ||
| Anthropometrics | 100 | ||
| Waist Circumference and Waist-Height Ratio | 100 | ||
| Waist-to-Hip Circumference Ratio | 100 | ||
| Determination of Diet Adequacy | 101 | ||
| Twenty–Four-Hour Recall Diet | 101 | ||
| Food Diary | 101 | ||
| Measures of Nutrient Analysis | 101 | ||
| ChooseMyPlate.gov | 101 | ||
| Vegetarian Diets | 102 | ||
| Ethnic Food Guide Pyramids | 102 | ||
| Measures of Nutrient Adequacy | 102 | ||
| Special Procedures | 107 | ||
| Triceps Skinfold Thickness | 107 | ||
| Mid-Upper Arm Circumference | 108 | ||
| Midarm Muscle Circumference/ Midarm Muscle Area | 108 | ||
| Biochemical Measurement | 108 | ||
| Abnormalities | 110 | ||
| Nutrition | 110 | ||
| Obesity | 110 | ||
| Anorexia Nervosa | 111 | ||
| Bulimia Nervosa | 112 | ||
| Anemia | 112 | ||
| 8 Skin, Hair, and Nails | 114 | ||
| Anatomy and Physiology | 114 | ||
| Epidermis | 115 | ||
| Dermis | 115 | ||
| Hypodermis | 115 | ||
| Appendages | 115 | ||
| Infants and Children | 116 | ||
| Adolescents | 116 | ||
| Pregnant Women | 116 | ||
| Older Adults | 116 | ||
| Review of Related History | 117 | ||
| History of Present Illness | 117 | ||
| Past Medical History | 118 | ||
| Family History | 118 | ||
| Personal and Social History | 118 | ||
| Infants | 119 | ||
| Children and Adolescents | 119 | ||
| Pregnant Women | 119 | ||
| Older Adults | 119 | ||
| Examination and Findings | 119 | ||
| Equipment | 119 | ||
| Skin | 119 | ||
| Inspection | 119 | ||
| Palpation | 124 | ||
| Skin Lesions | 125 | ||
| Characteristics | 125 | ||
| Hair | 133 | ||
| Nails | 134 | ||
| Inspection | 134 | ||
| Color. | 134 | ||
| Nail Plate. | 135 | ||
| Nail Base Angle. | 135 | ||
| Palpation | 135 | ||
| Infants and Children | 137 | ||
| Adolescents | 140 | ||
| Pregnant Women | 140 | ||
| Older Adults | 141 | ||
| Abnormalities | 144 | ||
| Skin, Hair, Nails | 144 | ||
| Skin: Inflammatory and Infectious Conditions | 144 | ||
| Eczematous Dermatitis | 144 | ||
| Folliculitis | 144 | ||
| Furuncle (Boil) | 145 | ||
| Cellulitis | 145 | ||
| Tinea (Dermatophytosis) | 146 | ||
| Pityriasis Rosea | 147 | ||
| Psoriasis | 147 | ||
| Rosacea | 148 | ||
| Herpes Zoster (Shingles) | 148 | ||
| Herpes Simplex | 149 | ||
| Lyme Disease | 149 | ||
| Skin: Cutaneous Reactions | 150 | ||
| Drug Eruptions | 150 | ||
| Acanthosis Nigricans (AN) | 150 | ||
| Skin: Disease Caused by Biologic Warfare | 151 | ||
| Skin: Malignant/Neoplastic Abnormalities | 152 | ||
| Basal Cell Carcinoma | 152 | ||
| Squamous Cell Carcinoma | 152 | ||
| Malignant Melanoma | 153 | ||
| Kaposi Sarcoma (KS) | 154 | ||
| Hair Disorders | 154 | ||
| Alopecia Areata | 154 | ||
| Scarring Alopecia | 155 | ||
| Traction Alopecia | 155 | ||
| Hirsutism | 155 | ||
| Nails: Infection | 155 | ||
| Paronychia | 155 | ||
| Onychomycosis | 156 | ||
| Nails: Injury | 156 | ||
| Ingrown Nails | 156 | ||
| Subungual Hematoma | 157 | ||
| Onycholysis | 157 | ||
| Nails: Changes Associated with Systemic Disease | 158 | ||
| Koilonychia (Spoon Nails) | 158 | ||
| Beau Lines | 158 | ||
| White Banding (Terry Nails) | 158 | ||
| Psoriasis | 159 | ||
| Nails: Periungual Growths | 159 | ||
| Warts | 159 | ||
| Digital Mucous Cysts | 159 | ||
| Pregnant Women | 160 | ||
| Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP) | 160 | ||
| Herpes Gestationis (Pemphigoid Gestationis) | 160 | ||
| Infants and Children | 160 | ||
| Seborrheic Dermatitis | 160 | ||
| Miliaria Rubra (“Prickly Heat”) | 161 | ||
| Impetigo | 161 | ||
| Acne Vulgaris | 161 | ||
| Chickenpox (Varicella) | 162 | ||
| Measles (Rubeola) | 162 | ||
| German Measles (Rubella) | 163 | ||
| Hair-Pulling (Trichotillomania) | 163 | ||
| Patterns of Injury in Physical Abuse | 164 | ||
| Older Adults | 165 | ||
| Stasis Dermatitis | 165 | ||
| Solar Keratosis (Actinic Keratosis) | 165 | ||
| Physical Abuse in Older Adults | 165 | ||
| 9 Lymphatic System | 166 | ||
| Anatomy and Physiology | 166 | ||
| Lymph Nodes | 167 | ||
| Lymphocytes | 169 | ||
| Thymus | 170 | ||
| Spleen | 170 | ||
| Tonsils and Adenoids | 170 | ||
| Peyer Patches | 170 | ||
| Infants and Children | 170 | ||
| Pregnant Women | 171 | ||
| Older Adults | 171 | ||
| Review of Related History | 171 | ||
| History of Present Illness | 171 | ||
| Past Medical History | 171 | ||
| Family History | 172 | ||
| Personal and Social History | 172 | ||
| Infants and Children | 172 | ||
| Pregnant Women | 172 | ||
| Older Adults | 172 | ||
| Examination and Findings | 172 | ||
| Equipment | 172 | ||
| Inspection and Palpation | 172 | ||
| Head and Neck | 174 | ||
| Axillae | 175 | ||
| Epitrochlear Lymph Nodes | 175 | ||
| Inguinal and Popliteal Lymph Nodes | 176 | ||
| Spleen | 176 | ||
| Infants and Children | 176 | ||
| Abnormalities | 178 | ||
| Lymphatic System | 178 | ||
| Acute Lymphangitis | 178 | ||
| Acute Suppurative Lymphadenitis | 178 | ||
| Lymphedema | 178 | ||
| Lymphangioma/Cystic Hygroma | 179 | ||
| Lymphatic Filariasis (Elephantiasis) | 179 | ||
| Non-Hodgkin Lymphoma | 180 | ||
| Hodgkin Lymphoma | 180 | ||
| Epstein-Barr Virus Mononucleosis | 181 | ||
| Toxoplasmosis | 181 | ||
| Roseola Infantum (HHV-6) | 181 | ||
| Herpes Simplex (HSV) | 181 | ||
| Cat Scratch Disease | 182 | ||
| Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) | 182 | ||
| Serum Sickness (Type III Hypersensitivity Reaction) | 182 | ||
| Latex Allergy Type IV Dermatitis (Delayed Hypersensitivity) | 183 | ||
| Latex Allergy Type I Reaction | 183 | ||
| 10 Head and Neck | 184 | ||
| Anatomy and Physiology | 184 | ||
| Infants | 186 | ||
| Children and Adolescents | 186 | ||
| Pregnant Women | 186 | ||
| Older Adults | 186 | ||
| Review of Related History | 186 | ||
| History of Present Illness | 187 | ||
| Past Medical History | 188 | ||
| Family History | 188 | ||
| Personal and Social History | 188 | ||
| Infants | 188 | ||
| Pregnant Women | 188 | ||
| Older Adults | 188 | ||
| Examination and Findings | 188 | ||
| Equipment | 188 | ||
| Head and Face | 189 | ||
| Inspection | 189 | ||
| Palpation | 192 | ||
| Percussion | 192 | ||
| Auscultation | 192 | ||
| Neck | 192 | ||
| Inspection | 192 | ||
| Palpation | 193 | ||
| Lymph Nodes | 193 | ||
| Thyroid Gland | 193 | ||
| Inspection | 195 | ||
| Palpation | 196 | ||
| Transillumination | 196 | ||
| Children | 197 | ||
| Pregnant Women | 197 | ||
| Older Adults | 197 | ||
| Abnormalities | 198 | ||
| Head | 198 | ||
| Headaches | 198 | ||
| Salivary Gland Tumor | 198 | ||
| Neck | 199 | ||
| Thyroglossal Duct Cyst | 199 | ||
| Branchial Cleft Cyst | 199 | ||
| Torticollis (Wry Neck) | 200 | ||
| Thyroid | 200 | ||
| Hypothyroidism | 200 | ||
| Hyperthyroidism | 201 | ||
| Myxedema | 201 | ||
| Graves Disease | 201 | ||
| Hashimoto Disease | 201 | ||
| Infants | 202 | ||
| Encephalocele | 202 | ||
| Hydrocephalus | 202 | ||
| Microcephaly | 202 | ||
| Craniosynostosis | 203 | ||
| 11 Eyes | 204 | ||
| Anatomy and Physiology | 204 | ||
| External Eye | 205 | ||
| Eyelid | 205 | ||
| Conjunctiva | 205 | ||
| Lacrimal Gland | 205 | ||
| Eye Muscles | 205 | ||
| Internal Eye | 205 | ||
| Sclera | 206 | ||
| Cornea | 206 | ||
| Uvea | 206 | ||
| Lens | 206 | ||
| Retina | 206 | ||
| Infants and Children | 206 | ||
| Pregnant Women | 206 | ||
| Older Adults | 206 | ||
| Review of Related History | 207 | ||
| History of Present Illness | 207 | ||
| Past Medical History | 208 | ||
| Family History | 208 | ||
| Personal and Social History | 208 | ||
| Infants and Children | 208 | ||
| Pregnant Women | 208 | ||
| Older Adults | 208 | ||
| Examination and Findings | 208 | ||
| Equipment | 208 | ||
| Visual Acuity Testing | 208 | ||
| External Examination | 209 | ||
| Surrounding Structures | 210 | ||
| Eyelids | 210 | ||
| Palpation | 211 | ||
| Conjunctiva | 211 | ||
| Cornea | 212 | ||
| Iris and Pupil | 212 | ||
| Lens | 214 | ||
| Sclera | 214 | ||
| Lacrimal Apparatus | 214 | ||
| Extraocular Muscles | 214 | ||
| Ophthalmoscopic Examination | 216 | ||
| Unexpected Findings | 218 | ||
| Infants | 218 | ||
| Children | 221 | ||
| Pregnant Women | 222 | ||
| Older Adults | 222 | ||
| Abnormalities | 223 | ||
| External Eye | 223 | ||
| Exophthalmos | 223 | ||
| Episcleritis | 223 | ||
| Band Keratopathy | 223 | ||
| Corneal Ulcer | 224 | ||
| Extraocular Muscles | 224 | ||
| Strabismus | 224 | ||
| Internal Eye | 225 | ||
| Horner Syndrome | 225 | ||
| Cataracts | 225 | ||
| Diabetic Retinopathy (Background or Non-Proliferative) | 225 | ||
| Diabetic Retinopathy (Proliferative) | 226 | ||
| Lipemia Retinalis | 226 | ||
| Retinitis Pigmentosa | 227 | ||
| Glaucoma | 227 | ||
| Chorioretinitis (Chorioretinal Inflammation) | 227 | ||
| Visual Fields | 228 | ||
| Visual Field Defects | 228 | ||
| Children and Infants | 229 | ||
| Retinoblastoma | 229 | ||
| Retinopathy of Prematurity (ROP) | 229 | ||
| Retinal Hemorrhages in Infancy | 230 | ||
| Older Adult | 230 | ||
| Macular Degeneration | 230 | ||
| 12 Ears, Nose, and Throat | 231 | ||
| Anatomy and Physiology | 232 | ||
| Ears and Hearing | 232 | ||
| Nose, Nasopharynx, and Sinuses | 233 | ||
| Mouth and Oropharynx | 234 | ||
| Infants and Children | 235 | ||
| Pregnant Women | 235 | ||
| Older Adults | 236 | ||
| Review of Related History | 236 | ||
| History of Present Illness | 236 | ||
| Past Medical History | 237 | ||
| Family History | 237 | ||
| Personal and Social History | 238 | ||
| Infants and Children | 238 | ||
| Pregnant Women | 238 | ||
| Older Adults | 238 | ||
| Examination and Findings | 238 | ||
| Equipment | 238 | ||
| Ears and Hearing | 238 | ||
| External Ear | 238 | ||
| Otoscopic Examination | 239 | ||
| Hearing Evaluation | 241 | ||
| Whispered Voice. | 241 | ||
| Weber and Rinne Tests. | 241 | ||
| Nose, Nasopharynx, and Sinuses | 242 | ||
| External Nose | 242 | ||
| Nasal Cavity | 242 | ||
| Sinuses | 243 | ||
| Mouth and Oropharynx | 244 | ||
| Lips | 244 | ||
| Buccal Mucosa, Teeth, and Gums | 244 | ||
| Oral Cavity | 246 | ||
| Oropharynx | 248 | ||
| Infants | 249 | ||
| Ears. | 249 | ||
| Nose and Sinuses. | 249 | ||
| Mouth. | 250 | ||
| Children | 251 | ||
| Ears. | 251 | ||
| Nose and Sinuses. | 252 | ||
| Mouth. | 252 | ||
| Pregnant Women | 252 | ||
| Older Adults | 252 | ||
| Ears and Hearing. | 252 | ||
| Nose. | 252 | ||
| Mouth. | 253 | ||
| Abnormalities | 254 | ||
| Ear | 254 | ||
| Otitis Media with Effusion and Acute Otitis Media | 254 | ||
| Otitis Externa | 255 | ||
| Cholesteatoma | 255 | ||
| Hearing Loss | 256 | ||
| Conductive Hearing Loss | 256 | ||
| Sensorineural Hearing Loss | 256 | ||
| Ménière Disease (Endolymphatic Hydrops) | 256 | ||
| Vertigo | 257 | ||
| Sinuses | 257 | ||
| Sinusitis | 257 | ||
| Mouth and Oropharynx | 257 | ||
| Acute Pharyngitis | 257 | ||
| Peritonsillar Abscess | 258 | ||
| Retropharyngeal Abscess | 258 | ||
| Oral Cancer | 259 | ||
| Periodontal Disease | 259 | ||
| Cleft Lip and Palate | 259 | ||
| 13 Chest and Lungs | 260 | ||
| Anatomy and Physiology | 260 | ||
| Anatomic Landmarks | 262 | ||
| Infants and Children | 262 | ||
| Pregnant Women | 263 | ||
| Older Adults | 263 | ||
| Review of Related History | 264 | ||
| History of Present Illness | 264 | ||
| Coughs | 264 | ||
| Dry or Moist. | 265 | ||
| Onset. | 265 | ||
| Frequency of Occurrence. | 265 | ||
| Regularity. | 265 | ||
| Pitch and Loudness. | 265 | ||
| Postural Influences. | 265 | ||
| Quality. | 265 | ||
| Sputum | 265 | ||
| Past Medical History | 265 | ||
| Family History | 266 | ||
| Personal and Social History | 266 | ||
| Infants and Children | 266 | ||
| Pregnant Women | 266 | ||
| Older Adults | 266 | ||
| Equipment | 267 | ||
| Examination and Findings | 267 | ||
| Inspection | 267 | ||
| Observing Respiration | 267 | ||
| Looking for Clues at the Periphery | 271 | ||
| Palpation | 271 | ||
| Tactile Fremitus | 272 | ||
| Examining the Trachea | 273 | ||
| Percussion | 273 | ||
| Diaphragmatic Excursion | 274 | ||
| Auscultation | 276 | ||
| Breath Sounds | 276 | ||
| Crackles. | 278 | ||
| Rhonchi. | 278 | ||
| Wheezes. | 278 | ||
| Other Sounds. | 278 | ||
| Vocal Resonance | 279 | ||
| Infants | 279 | ||
| Children | 280 | ||
| Pregnant Women | 281 | ||
| Older Adults | 281 | ||
| Abnormalities | 283 | ||
| Asthma (Reactive Airway Disease) | 284 | ||
| Atelectasis | 284 | ||
| Bronchitis | 284 | ||
| Pleurisy | 285 | ||
| Pleural Effusion | 285 | ||
| Empyema | 286 | ||
| Lung Abscess | 286 | ||
| Pneumonia | 287 | ||
| Influenza | 287 | ||
| Tuberculosis | 288 | ||
| Pneumothorax | 288 | ||
| Hemothorax | 289 | ||
| Lung Cancer | 289 | ||
| Pulmonary Embolism | 290 | ||
| Infants, Children, and Adolescents | 290 | ||
| Diaphragmatic Hernia | 290 | ||
| Cystic Fibrosis | 290 | ||
| Epiglottitis | 291 | ||
| Croup (Laryngotracheal Bronchitis) | 291 | ||
| Tracheomalacia | 292 | ||
| Bronchiolitis | 292 | ||
| Chronic Obstructive Pulmonary Disease | 292 | ||
| Emphysema | 292 | ||
| Bronchiectasis | 293 | ||
| Chronic Bronchitis | 293 | ||
| 14 Heart | 294 | ||
| Anatomy and Physiology | 294 | ||
| Structure | 295 | ||
| Cardiac Cycle | 297 | ||
| Electrical Activity | 298 | ||
| Infants and Children | 299 | ||
| Pregnant Women | 299 | ||
| Older Adults | 301 | ||
| Review of Related History | 301 | ||
| History of Present Illness | 301 | ||
| Past Medical History | 302 | ||
| Family History | 303 | ||
| Personal and Social History | 303 | ||
| Infants | 303 | ||
| Children | 304 | ||
| Pregnant Women | 304 | ||
| Older Adults | 304 | ||
| Examination and Findings | 304 | ||
| Equipment | 304 | ||
| Inspection | 304 | ||
| Palpation | 305 | ||
| Percussion | 306 | ||
| Auscultation | 306 | ||
| Basic Heart Sounds | 307 | ||
| S1 and S2. | 307 | ||
| Splitting. | 308 | ||
| S3 and S4. | 310 | ||
| Extra Heart Sounds | 310 | ||
| Heart Murmurs | 311 | ||
| Rhythm Disturbance | 318 | ||
| Infants | 318 | ||
| Children | 319 | ||
| Pregnant Women | 319 | ||
| Older Adults | 319 | ||
| Abnormalities | 320 | ||
| Heart | 320 | ||
| Angina | 320 | ||
| Bacterial Endocarditis | 320 | ||
| Congestive Heart Failure (CHF)—Left-Sided | 321 | ||
| Congestive Heart Failure (CHF)—Right-Sided | 321 | ||
| Pericarditis | 322 | ||
| Cardiac Tamponade | 322 | ||
| Cor Pulmonale | 323 | ||
| Myocardial Infarction | 323 | ||
| Myocarditis | 324 | ||
| Abnormalities in Heart Rate and Rhythm | 324 | ||
| Conduction Disturbances | 324 | ||
| Sick Sinus Syndrome | 324 | ||
| Infants and Children | 328 | ||
| Tetralogy of Fallot | 328 | ||
| Ventricular Septal Defect (VSD) | 328 | ||
| Patent Ductus Arteriosus | 329 | ||
| Atrial Septal Defect (ASD) | 330 | ||
| Acute Rheumatic Fever | 330 | ||
| Older Adults | 331 | ||
| Atherosclerotic Heart Disease (Atherosclerosis, Coronary Heart Disease) | 331 | ||
| Mitral Insufficiency, Regurgitation | 331 | ||
| Senile Cardiac Amyloidosis | 331 | ||
| 15 Blood Vessels | 332 | ||
| Anatomy and Physiology | 332 | ||
| Blood Circulation | 332 | ||
| Arterial Pulse and Pressure | 336 | ||
| Jugular Venous Pulse and Pressure | 336 | ||
| Infants and Children | 336 | ||
| Pregnant Women | 337 | ||
| Older Adults | 337 | ||
| Review of Related History | 337 | ||
| History of Present Illness | 337 | ||
| Past Medical History | 337 | ||
| Family History | 338 | ||
| Personal and Social History | 338 | ||
| Infants and Children | 338 | ||
| Pregnant Women | 338 | ||
| Older Adults | 338 | ||
| Examination and Findings | 338 | ||
| Equipment | 338 | ||
| Peripheral Arteries | 338 | ||
| Palpation | 338 | ||
| Auscultation | 340 | ||
| Assessment for Peripheral Arterial Disease | 340 | ||
| Peripheral Veins | 342 | ||
| Jugular Venous Pressure | 342 | ||
| Hepatojugular Reflux | 343 | ||
| Evaluation of Hand Veins | 343 | ||
| Assessment for Venous Obstruction and Insufficiency | 343 | ||
| Thrombosis. | 343 | ||
| Homan Sign. | 344 | ||
| Edema. | 344 | ||
| Varicose Veins. | 345 | ||
| Infants | 345 | ||
| Children | 345 | ||
| Pregnant Women | 345 | ||
| Older Adults | 345 | ||
| Abnormalities | 346 | ||
| Blood Vessels | 346 | ||
| Vessel Disorders | 346 | ||
| Temporal Arteritis (Giant Cell Arteritis) | 346 | ||
| Arterial Aneurysm | 346 | ||
| Arteriovenous Fistula | 346 | ||
| Peripheral Arterial Disease | 347 | ||
| Raynaud Phenomenon | 347 | ||
| Arterial Embolic Disease | 347 | ||
| Venous Thrombosis | 348 | ||
| Jugular Venous Pressure Disorder | 348 | ||
| Tricuspid Regurgitation | 348 | ||
| Children | 348 | ||
| Coarctation of the Aorta | 348 | ||
| Kawasaki Disease | 349 | ||
| Pregnant Women | 349 | ||
| Preeclampsia-Eclampsia | 349 | ||
| Older Adults | 349 | ||
| Venous Ulcers | 349 | ||
| 16 Breasts and Axillae | 350 | ||
| Anatomy and Physiology | 350 | ||
| Children and Adolescents | 352 | ||
| Pregnant Women | 353 | ||
| Lactating Women | 353 | ||
| Older Adults | 353 | ||
| Review of Related History | 353 | ||
| History of Present Illness | 353 | ||
| Past Medical History | 353 | ||
| Family History | 355 | ||
| Personal and Social History | 355 | ||
| Pregnant Women | 355 | ||
| Lactating Women | 355 | ||
| Older Adults | 355 | ||
| Examination and Findings | 355 | ||
| Equipment | 355 | ||
| Inspection | 355 | ||
| Breasts | 355 | ||
| Nipples and Areolae | 356 | ||
| Reinspection in Varied Positions | 357 | ||
| Palpation | 358 | ||
| Patient in Seated Position | 360 | ||
| Chest Wall Sweep. | 360 | ||
| Bimanual Digital Palpation. | 360 | ||
| Lymph Node Palpation. | 360 | ||
| Patient in Supine Position | 360 | ||
| Females. | 363 | ||
| Males. | 363 | ||
| Infants | 363 | ||
| Children and Adolescents | 363 | ||
| Pregnant Women | 364 | ||
| Lactating Women | 365 | ||
| Older Adults | 365 | ||
| Abnormalities | 365 | ||
| Breasts | 365 | ||
| Breast Lumps | 365 | ||
| Fibrocystic Changes | 366 | ||
| Fibroadenoma | 366 | ||
| Malignant Breast Tumors | 366 | ||
| Fat Necrosis | 366 | ||
| Nipples and Areolae | 367 | ||
| Intraductal Papillomas and Papillomatosis | 367 | ||
| Duct Ectasia | 367 | ||
| Galactorrhea | 367 | ||
| Paget Disease | 368 | ||
| Mastitis | 368 | ||
| Gynecomastia | 369 | ||
| Children | 369 | ||
| Premature Thelarche | 369 | ||
| 17 Abdomen | 370 | ||
| Anatomy and Physiology | 370 | ||
| Alimentary Tract | 370 | ||
| Liver | 372 | ||
| Gallbladder | 373 | ||
| Pancreas | 373 | ||
| Spleen | 373 | ||
| Kidneys, Ureters, and Bladder | 373 | ||
| Musculature and Connective Tissues | 373 | ||
| Vasculature | 373 | ||
| Infants | 374 | ||
| Pregnant Women | 374 | ||
| Older Adults | 375 | ||
| Review of Related History | 375 | ||
| History of Present Illness | 375 | ||
| Past Medical History | 377 | ||
| Family History | 377 | ||
| Personal and Social History | 377 | ||
| Infants | 377 | ||
| Children | 377 | ||
| Pregnant Women | 377 | ||
| Older Adults | 377 | ||
| Examination and Findings | 377 | ||
| Equipment | 377 | ||
| Preparation | 377 | ||
| Inspection | 378 | ||
| Surface Characteristics | 378 | ||
| Contour | 379 | ||
| Movement | 381 | ||
| Auscultation | 381 | ||
| Bowel Sounds | 381 | ||
| Additional Sounds and Bruits | 381 | ||
| Percussion | 381 | ||
| Liver Span | 381 | ||
| Spleen | 383 | ||
| Gastric Bubble | 383 | ||
| Kidneys | 383 | ||
| Palpation | 383 | ||
| Light Palpation | 383 | ||
| Moderate Palpation | 383 | ||
| Deep Palpation | 384 | ||
| Masses | 384 | ||
| Umbilical Ring | 385 | ||
| Palpation of Specific Organs and Structures | 385 | ||
| Liver. | 385 | ||
| Liver: Alternative Techniques. | 386 | ||
| Gallbladder. | 386 | ||
| Spleen. | 386 | ||
| Left Kidney. | 387 | ||
| Right Kidney. | 388 | ||
| Aorta. | 388 | ||
| Urinary Bladder. | 388 | ||
| Advanced Skills | 388 | ||
| Ascites Assessment | 388 | ||
| Shifting Dullness. | 388 | ||
| Fluid Wave. | 388 | ||
| Pain Assessment | 388 | ||
| Abdominal Signs | 391 | ||
| Rebound Tenderness | 391 | ||
| Iliopsoas Muscle Test | 393 | ||
| Obturator Muscle Test | 393 | ||
| Ballottement | 393 | ||
| Infants and Children | 394 | ||
| Inspection | 394 | ||
| Auscultation and Percussion | 395 | ||
| Palpation | 395 | ||
| Liver Palpation | 396 | ||
| Deep Palpation | 396 | ||
| Adolescents | 397 | ||
| Pregnant Women | 398 | ||
| Older Adults | 398 | ||
| Abnormalities | 399 | ||
| Abdomen | 399 | ||
| Alimentary Tract | 399 | ||
| Acute Diarrhea | 399 | ||
| Gastroesophageal Reflux Disease | 400 | ||
| Irritable Bowel Syndrome | 400 | ||
| Hiatal Hernia with Esophagitis | 401 | ||
| Duodenal Ulcer (Duodenal Peptic Ulcer Disease) | 401 | ||
| Crohn Disease | 401 | ||
| Ulcerative Colitis | 402 | ||
| Stomach Cancer | 403 | ||
| Diverticular Disease | 403 | ||
| Colon Cancer (Colorectal Cancer) | 403 | ||
| Hepatobiliary System | 404 | ||
| Hepatitis | 404 | ||
| Cirrhosis | 404 | ||
| Primary Hepatocellular Carcinoma | 405 | ||
| Cholelithiasis | 405 | ||
| Cholecystitis | 406 | ||
| Nonalcoholic Fatty Liver Disease (NAFLD) | 406 | ||
| Pancreas | 406 | ||
| Acute Pancreatitis | 406 | ||
| Chronic Pancreatitis | 407 | ||
| Spleen | 407 | ||
| Spleen Laceration/Rupture | 407 | ||
| Kidney | 407 | ||
| Acute Glomerulonephritis | 407 | ||
| Hydronephrosis | 408 | ||
| Pyelonephritis | 408 | ||
| Renal Abscess | 408 | ||
| Renal Calculi | 409 | ||
| Acute Renal Failure | 409 | ||
| Infants | 410 | ||
| Intussusception | 410 | ||
| Pyloric Stenosis | 410 | ||
| Meconium Ileus | 411 | ||
| Biliary Atresia | 412 | ||
| Meckel Diverticulum | 412 | ||
| Necrotizing Enterocolitis | 413 | ||
| Children | 413 | ||
| Neuroblastoma | 413 | ||
| Wilms Tumor (Nephroblastoma) | 414 | ||
| Hirschsprung Disease (Congenital Aganglionic Megacolon) | 414 | ||
| Hemolytic Uremic Syndrome (HUS) | 414 | ||
| Older Adults | 415 | ||
| Fecal Incontinence | 415 | ||
| 18 Female Genitalia | 416 | ||
| Anatomy and Physiology | 416 | ||
| External Genitalia | 416 | ||
| Internal Genitalia | 418 | ||
| Bony Pelvis | 419 | ||
| Infants and Children | 422 | ||
| Adolescents | 422 | ||
| Pregnant Women | 422 | ||
| Older Adults | 423 | ||
| Review of Related History | 423 | ||
| History of Present Illness | 423 | ||
| Past Medical History | 424 | ||
| Family History | 425 | ||
| Personal and Social History | 425 | ||
| Infants and Children | 426 | ||
| Adolescents | 427 | ||
| Pregnant Women | 427 | ||
| Older Adults | 427 | ||
| Examination and Findings | 427 | ||
| Equipment | 427 | ||
| Preparation | 427 | ||
| Positioning | 428 | ||
| Draping and Gloving | 428 | ||
| External Examination | 428 | ||
| Inspection and Palpation | 428 | ||
| Labia Majora | 428 | ||
| Labia Minora | 429 | ||
| Clitoris | 429 | ||
| Urethral Orifice | 429 | ||
| Vaginal Introitus | 429 | ||
| Skene and Bartholin Glands | 429 | ||
| Muscle Tone | 430 | ||
| Perineum | 430 | ||
| Anus | 430 | ||
| Internal Examination | 430 | ||
| Preparation | 430 | ||
| Insertion of Speculum | 430 | ||
| Cervix | 431 | ||
| Color. | 431 | ||
| Position. | 431 | ||
| Surface Characteristics. | 431 | ||
| Discharge. | 431 | ||
| Size and Shape. | 431 | ||
| Withdrawal of Speculum | 435 | ||
| Bimanual Examination | 435 | ||
| Cervix | 436 | ||
| Uterus | 437 | ||
| Position. | 437 | ||
| Size, Shape, and Contour. | 437 | ||
| Mobility. | 437 | ||
| Adnexa and Ovaries | 437 | ||
| Rectovaginal Examination | 438 | ||
| Preparation | 438 | ||
| Anal Sphincter | 438 | ||
| Rectal Walls and Rectovaginal Septum | 439 | ||
| Uterus | 439 | ||
| Adnexa | 439 | ||
| Stool | 439 | ||
| Completion | 439 | ||
| Infants | 439 | ||
| Indications for Examination | 440 | ||
| Inspection and Palpation | 440 | ||
| Discharge | 441 | ||
| Injuries | 441 | ||
| Bleeding | 441 | ||
| Rectal Examination | 441 | ||
| Adolescents | 442 | ||
| Pregnant Women | 442 | ||
| Gestational Age | 442 | ||
| Uterus Size and Contour | 442 | ||
| Pelvic Examination | 443 | ||
| Cervical Effacement and Dilation | 443 | ||
| Fetal Well-Being | 443 | ||
| Fetal Position | 444 | ||
| Station | 445 | ||
| Contractions | 446 | ||
| Fetal Head Position | 447 | ||
| Other Pregnancy-Associated Changes | 447 | ||
| Older Adults | 447 | ||
| Preparation | 447 | ||
| Alternative Positions for the Pelvic Examination | 448 | ||
| Knee-Chest Position. | 448 | ||
| Diamond-Shaped Position. | 448 | ||
| Obstetric Stirrups Position. | 448 | ||
| M-Shaped Position. | 448 | ||
| V-Shaped Position. | 449 | ||
| Women with Sensory Impairment | 449 | ||
| Abnormalities | 450 | ||
| Female Genitalia | 450 | ||
| Premenstrual Syndrome (PMS) | 450 | ||
| Infertility | 450 | ||
| Endometriosis | 451 | ||
| Lesions From Sexually Transmitted Infections | 451 | ||
| Condyloma Acuminatum (Genital Warts) | 451 | ||
| Molluscum Contagiosum | 452 | ||
| Syphilitic Chancre | 453 | ||
| Condyloma Latum | 453 | ||
| Genital Herpes | 454 | ||
| Vulva and Vagina | 454 | ||
| Inflammation of Bartholin Gland | 454 | ||
| Vaginal Carcinoma | 455 | ||
| Vulvar Carcinoma | 456 | ||
| Vaginal Infections | 456 | ||
| Cervix | 457 | ||
| Cervical Cancer | 457 | ||
| Uterus | 458 | ||
| Uterine Prolapse | 458 | ||
| Uterine Bleeding | 459 | ||
| Myomas (Leiomyomas, Fibroids) | 459 | ||
| Endometrial Cancer | 460 | ||
| Adnexa | 460 | ||
| Ovarian Cysts | 460 | ||
| Ovarian Cancer | 461 | ||
| Tubal (Ectopic) Pregnancy | 461 | ||
| Pelvic Inflammatory Disease (PID) | 462 | ||
| Salpingitis | 462 | ||
| Infants and Children | 463 | ||
| Ambiguous Genitalia | 463 | ||
| Hydrocolpos | 464 | ||
| Vulvovaginitis | 464 | ||
| Pregnant Women | 465 | ||
| Premature Rupture of Membranes | 465 | ||
| Vaginal Bleeding during Pregnancy | 465 | ||
| Older Adults | 465 | ||
| Atrophic Vaginitis | 465 | ||
| Urinary Incontinence | 465 | ||
| 19 Male Genitalia | 466 | ||
| Anatomy and Physiology | 466 | ||
| Infants and Children | 468 | ||
| Adolescents | 468 | ||
| Older Adults | 468 | ||
| Review of Related History | 468 | ||
| History of Present Illness | 468 | ||
| Past Medical History | 469 | ||
| Family History | 469 | ||
| Personal and Social History | 469 | ||
| Infants and Children | 469 | ||
| Adolescents | 469 | ||
| Older Adults | 469 | ||
| Examination and Findings | 471 | ||
| Equipment | 471 | ||
| Inspection and Palpation | 471 | ||
| Genital Hair Distribution | 471 | ||
| Penis | 471 | ||
| Urethral Meatus | 472 | ||
| Penile Shaft | 472 | ||
| Scrotum | 472 | ||
| Hernia | 472 | ||
| Testes | 473 | ||
| Cremasteric Reflex | 474 | ||
| Prostate | 474 | ||
| Infants | 474 | ||
| Inspection and Palpation | 474 | ||
| Transillumination | 475 | ||
| Children | 475 | ||
| Inspection and Palpation | 475 | ||
| Adolescents | 475 | ||
| Older Adults | 475 | ||
| Abnormalities | 476 | ||
| Infertility | 476 | ||
| Hernia | 476 | ||
| Penis | 477 | ||
| Paraphimosis | 477 | ||
| Syphilitic Chancre | 477 | ||
| Genital Herpes | 478 | ||
| Condyloma Acuminata | 478 | ||
| Lymphogranuloma Venereum | 478 | ||
| Molluscum Contagiosum | 479 | ||
| Peyronie Disease | 479 | ||
| Penile Cancer | 479 | ||
| Scrotum | 480 | ||
| Hydrocele | 480 | ||
| Spermatocele | 480 | ||
| Varicocele | 481 | ||
| Orchitis | 481 | ||
| Epididymitis | 482 | ||
| Testicular Torsion | 482 | ||
| Testicular Cancer | 483 | ||
| Klinefelter Syndrome | 483 | ||
| Ambiguous Genitalia | 484 | ||
| Hypospadias | 484 | ||
| 20 Anus, Rectum, and Prostate | 485 | ||
| Anatomy and Physiology | 485 | ||
| Infants and Children | 486 | ||
| Pregnant Women | 487 | ||
| Older Adults | 487 | ||
| Review of Related History | 487 | ||
| History of Present Illness | 487 | ||
| Past Medical History | 488 | ||
| Family History | 488 | ||
| Personal and Social History | 488 | ||
| Infants and Children | 488 | ||
| Pregnant Women | 489 | ||
| Older Adults | 489 | ||
| Examination and Findings | 489 | ||
| Equipment | 489 | ||
| Preparation | 489 | ||
| Positioning | 489 | ||
| Sacrococcygeal and Perianal Areas | 489 | ||
| Anus | 489 | ||
| Sphincter | 489 | ||
| Anal Ring | 489 | ||
| Lateral and Posterior Rectal Walls | 490 | ||
| Bidigital Palpation | 490 | ||
| Anterior Rectal Wall | 490 | ||
| Prostate | 491 | ||
| Uterus and Cervix | 491 | ||
| Stool | 491 | ||
| Infants and Children | 491 | ||
| Pregnant Women | 493 | ||
| Older Adults | 493 | ||
| Abnormalities | 494 | ||
| Anus, Rectum, and Surrounding Skin | 494 | ||
| Pilonidal Cyst | 494 | ||
| Anal Warts (Condyloma Acuminata) | 494 | ||
| Perianal and Perirectal Abscesses | 495 | ||
| Anorectal Fissure | 495 | ||
| Anal Fistula | 496 | ||
| Pruritus Ani | 496 | ||
| Hemorrhoids | 496 | ||
| Polyps | 497 | ||
| Anal Cancer | 497 | ||
| Colorectal Cancer | 498 | ||
| Prostate | 498 | ||
| Prostatitis | 498 | ||
| Benign Prostatic Hypertrophy (BPH) | 498 | ||
| Prostate Cancer | 499 | ||
| Infants and Children | 499 | ||
| Imperforate Anus | 499 | ||
| Enterobiasis (Roundworm, Pinworm) | 500 | ||
| 21 Musculoskeletal System | 501 | ||
| Anatomy and Physiology | 501 | ||
| Upper Extremities | 505 | ||
| Head and Spine | 505 | ||
| Lower Extremities | 507 | ||
| Infants and Children | 508 | ||
| Adolescents | 508 | ||
| Pregnant Women | 508 | ||
| Older Adults | 508 | ||
| Review of Related History | 508 | ||
| History of Present Illness | 508 | ||
| Past Medical History | 509 | ||
| Family History | 509 | ||
| Personal and Social History | 509 | ||
| Infants and Children | 509 | ||
| Pregnant Women | 510 | ||
| Older Adults | 510 | ||
| Examination and Findings | 510 | ||
| Equipment | 510 | ||
| Inspection | 510 | ||
| Palpation | 510 | ||
| Range of Motion and Muscle Tone | 511 | ||
| Muscle Strength | 511 | ||
| Specific Joints and Muscles | 512 | ||
| Hands and Wrists | 512 | ||
| Elbows | 513 | ||
| Shoulders | 514 | ||
| Temporomandibular Joint | 516 | ||
| Cervical Spine | 516 | ||
| Thoracic and Lumbar Spine | 518 | ||
| Hips | 519 | ||
| Legs and Knees | 520 | ||
| Feet and Ankles | 522 | ||
| Advanced Skills | 524 | ||
| Hand and Wrist Assessment | 524 | ||
| Shoulder Assessment | 524 | ||
| Lower Spine Assessment | 526 | ||
| Hip Assessment | 526 | ||
| Knee Assessment | 527 | ||
| Limb Measurement | 529 | ||
| Infants | 529 | ||
| Children | 530 | ||
| Adolescents | 532 | ||
| Pregnant Women | 533 | ||
| Older Adults | 534 | ||
| Abnormalities | 535 | ||
| Musculoskeletal | 535 | ||
| Ankylosing Spondylitis | 535 | ||
| Lumbosacral Radiculopathy (Herniated Lumbar Disk) | 535 | ||
| Lumbar Stenosis | 536 | ||
| Carpal Tunnel Syndrome | 536 | ||
| Gout | 536 | ||
| Temporomandibular Joint Syndrome | 537 | ||
| Osteomyelitis | 537 | ||
| Bursitis | 537 | ||
| Paget Disease of the Bone (Osteitis Deformans) | 537 | ||
| Osteoarthritis | 538 | ||
| Rheumatoid Arthritis | 538 | ||
| Sports Injuries | 538 | ||
| Muscle Strain | 539 | ||
| Dislocation | 539 | ||
| Fracture | 539 | ||
| Tenosynovitis (Tendonitis) | 539 | ||
| Rotator Cuff Tear | 540 | ||
| Infants and Children | 540 | ||
| Clubfoot (Talipes Equinovarus) | 540 | ||
| Metatarsus Adductus (Metatarsus Varus) | 540 | ||
| Legg-Calvé-Perthes Disease | 541 | ||
| Osgood-Schlatter Disease | 541 | ||
| Slipped Capital Femoral Epiphysis | 541 | ||
| Muscular Dystrophy | 541 | ||
| Scoliosis | 541 | ||
| Radial Head Subluxation (Nursemaid’s Elbow) | 542 | ||
| Older Adults | 542 | ||
| Osteoporosis | 542 | ||
| Dupuytren Contracture | 543 | ||
| 22 Neurologic System | 544 | ||
| Anatomy and Physiology | 544 | ||
| Brain | 545 | ||
| Cerebrum | 545 | ||
| Cerebellum | 546 | ||
| Brainstem | 546 | ||
| Cranial Nerves | 547 | ||
| Spinal Cord and Spinal Tracts | 547 | ||
| Spinal Nerves | 547 | ||
| Infants and Children | 549 | ||
| Pregnant Women | 549 | ||
| Older Adults | 549 | ||
| Review of Related History | 550 | ||
| History of Present Illness | 550 | ||
| Past Medical History | 551 | ||
| Family History | 551 | ||
| Personal and Social History | 551 | ||
| Infants | 551 | ||
| Children | 551 | ||
| Pregnant Women | 552 | ||
| Older Adults | 552 | ||
| Examination and Findings | 552 | ||
| Equipment | 552 | ||
| Cranial Nerves | 553 | ||
| Olfactory (I) | 553 | ||
| Optic (II) | 554 | ||
| Oculomotor, Trochlear, and Abducens (III, IV, and VI) | 554 | ||
| Trigeminal (V) | 554 | ||
| Facial (VII) | 555 | ||
| Acoustic (VIII) | 556 | ||
| Glossopharyngeal (IX) | 556 | ||
| Vagus (X) | 556 | ||
| Spinal Accessory (XI) | 556 | ||
| Hypoglossal (XII) | 556 | ||
| Proprioception and Cerebellar Function | 556 | ||
| Coordination and Fine Motor Skills | 556 | ||
| Rapid Rhythmic Alternating Movements. | 556 | ||
| Accuracy of Movements. | 557 | ||
| Balance | 559 | ||
| Equilibrium. | 559 | ||
| Gait. | 559 | ||
| Sensory Function | 559 | ||
| Primary Sensory Functions | 561 | ||
| Superficial Touch. | 561 | ||
| Superficial Pain. | 561 | ||
| Temperature and Deep Pressure. | 561 | ||
| Vibration. | 561 | ||
| Position of Joints. | 561 | ||
| Cortical Sensory Functions | 561 | ||
| Stereognosis. | 562 | ||
| Two-Point Discrimination. | 562 | ||
| Extinction Phenomenon. | 562 | ||
| Graphesthesia. | 562 | ||
| Point Location. | 562 | ||
| Reflexes | 562 | ||
| Superficial Reflexes | 562 | ||
| Plantar Reflex. | 563 | ||
| Abdominal Reflex. | 563 | ||
| Cremasteric Reflex. | 564 | ||
| Deep Tendon Reflexes | 564 | ||
| Biceps Reflex. | 564 | ||
| Brachioradial Reflex. | 564 | ||
| Triceps Reflex. | 564 | ||
| Patellar Reflex. | 564 | ||
| Achilles Reflex. | 564 | ||
| Clonus. | 565 | ||
| Advanced Skills | 565 | ||
| Protective Sensation | 565 | ||
| Meningeal Signs | 565 | ||
| Jolt Accentuation of Headache | 566 | ||
| Posturing | 566 | ||
| Infants | 566 | ||
| Children | 569 | ||
| Pregnant Women | 570 | ||
| Older Adults | 570 | ||
| Abnormalities | 573 | ||
| Neurologic System | 573 | ||
| Disorders of the Central Nervous System | 573 | ||
| Multiple Sclerosis (MS) | 573 | ||
| Seizure Disorder (Epilepsy) | 573 | ||
| Encephalitis | 573 | ||
| Meningitis | 574 | ||
| Intracranial Tumor | 574 | ||
| Pseudotumor Cerebri | 574 | ||
| Stroke (Brain Attack or Cerebrovascular Accident) | 574 | ||
| Disorders of the Peripheral Nervous System | 576 | ||
| Myasthenia Gravis | 576 | ||
| Guillain-Barré Syndrome | 577 | ||
| Trigeminal Neuralgia (Tic Douloureux) | 577 | ||
| Bell Palsy | 577 | ||
| Peripheral Neuropathy | 578 | ||
| Children | 578 | ||
| Cerebral Palsy (CP) | 578 | ||
| Myelomeningocele (Spina Bifida) | 578 | ||
| Shaken Baby Syndrome | 579 | ||
| Pregnant Women | 579 | ||
| Intrapartum Maternal Lumbosacral Plexopathy | 579 | ||
| Older Adults | 579 | ||
| Parkinson Disease | 579 | ||
| Normal Pressure Hydrocephalus | 580 | ||
| Postpolio Syndrome (Progressive Postpoliomyelitis Muscular Atrophy) | 580 | ||
| 23 Sports Participation Evaluation | 581 | ||
| 24 Putting It All Together | 594 | ||
| At the Start | 594 | ||
| Accuracy | 595 | ||
| The Potential for Error | 596 | ||
| Uncertainty | 596 | ||
| Examination Sequence | 596 | ||
| Adults and Adolescents | 596 | ||
| General Inspection | 597 | ||
| Preparation | 597 | ||
| Measurements | 597 | ||
| Patient Seated, Wearing Gown | 597 | ||
| Head and Face | 598 | ||
| Eyes | 598 | ||
| Ears | 598 | ||
| Nose | 598 | ||
| Mouth and Pharynx | 598 | ||
| Neck | 598 | ||
| Upper Extremities | 598 | ||
| Patient Seated, Back Exposed | 599 | ||
| Back and Posterior Chest | 599 | ||
| Lungs | 599 | ||
| Patient Seated, Chest Exposed | 599 | ||
| Anterior, Chest, Lungs, and Heart | 599 | ||
| Female Breasts | 599 | ||
| Male Breasts | 599 | ||
| Patient Reclining 45 Degrees | 599 | ||
| Patient Supine, Chest Exposed | 600 | ||
| Female Breasts | 600 | ||
| Heart | 600 | ||
| Patient Supine, Abdomen Exposed | 600 | ||
| Abdomen | 600 | ||
| Inguinal Area | 600 | ||
| External Genitalia, Males | 600 | ||
| Patient Supine, Legs Exposed | 600 | ||
| Feet and Legs | 600 | ||
| Hips | 600 | ||
| Patient Sitting, Lap Draped | 600 | ||
| Musculoskeletal. | 600 | ||
| Neurologic. | 600 | ||
| Patient Standing | 601 | ||
| Spine | 601 | ||
| Neurologic | 601 | ||
| Abdominal/Genital | 601 | ||
| Female Patient, Lithotomy Position | 601 | ||
| External Genitalia | 601 | ||
| Internal Genitalia | 601 | ||
| Male Patient, Bending Forward (Lateral Decubitus or Knee-Chest Positions Are Also Possible) | 601 | ||
| Newborns | 602 | ||
| Older Infants | 602 | ||
| Examination Sequence with Infants | 603 | ||
| General Inspection | 603 | ||
| Chest, Lungs, and Heart | 603 | ||
| Abdomen | 603 | ||
| Head and Neck. | 604 | ||
| Upper Extremities | 604 | ||
| Lower Extremities | 604 | ||
| Genitals and Rectum | 605 | ||
| Neurologic. | 605 | ||
| Back. | 605 | ||
| Behavior. | 605 | ||
| Children | 605 | ||
| General Inspection | 606 | ||
| Child Playing | 606 | ||
| Child on Parent’s Lap | 606 | ||
| Upper Extremities. | 606 | ||
| Lower Extremities. | 606 | ||
| Head and Neck. | 607 | ||
| Chest, Heart, and Lungs. | 607 | ||
| Child Relatively Supine, Still on Lap, Diaper Loosened | 607 | ||
| Child Standing | 607 | ||
| Child Returns to Parent’s Lap | 607 | ||
| Pregnant Women | 607 | ||
| Older Adults | 608 | ||
| The Closing Discussion | 608 | ||
| 25 Taking the Next Steps: | 610 | ||
| The Clinical Examination | 610 | ||
| Critical Thinking | 610 | ||
| Assessment, Judgment, and Evidence | 610 | ||
| Problem Identification | 610 | ||
| Valid Hypotheses | 611 | ||
| Possible Barriers to Critical Thinking | 611 | ||
| Feelings, Attitudes, and Values. | 612 | ||
| The Ethical Context. | 612 | ||
| Mechanism and Probabilism. | 612 | ||
| Validity of the Clinical Examination | 613 | ||
| Bayes Theorem | 613 | ||
| Evidence-Based Practice | 614 | ||
| Evaluation and Management Plan and Setting Priorities | 614 | ||
| 26 Recording Information | 616 | ||
| General Guidelines | 616 | ||
| EMR Replicating Functions | 617 | ||
| Organization of the Note | 617 | ||
| Organizing the Patient’s Health Record with SOAP Notes | 618 | ||
| Subjective Data | 618 | ||
| Objective Data | 618 | ||
| Location of Findings. | 618 | ||
| Incremental Grading. | 618 | ||
| Organs, Masses, and Lesions. | 618 | ||
| Discharge. | 619 | ||
| Illustrations | 619 | ||
| Problem-Oriented Medical Record | 619 | ||
| Comprehensive Health History and Physical Examination | 619 | ||
| Problem List | 619 | ||
| Assessment | 620 | ||
| Plan | 620 | ||
| SOAP Notes | 620 | ||
| APSO Notes | 621 | ||
| Notes from Subsequent Evaluations | 621 | ||
| Problem-Oriented Medical Record Format | 621 | ||
| The History | 621 | ||
| Identifying Information. | 621 | ||
| Problems, Allergies, Medications, and Immunizations (PAMI) List. | 621 | ||
| General Patient Information. | 621 | ||
| Source and Reliability of Information. | 621 | ||
| Chief Concern/Presenting Problem/Reason for Seeking Care. | 621 | ||
| History of Present Illness. | 621 | ||
| Recording the History of the Present Illness: OLDCARTS. | 622 | ||
| Past Medical History. | 622 | ||
| Family History. | 622 | ||
| Personal and Social History. | 622 | ||
| Review of Systems | 622 | ||
| Physical Examination Findings | 624 | ||
| General Statement | 624 | ||
| Mental Status | 624 | ||
| Skin | 624 | ||
| Head | 624 | ||
| Eyes | 624 | ||
| Ears | 624 | ||
| Nose | 624 | ||
| Throat and Mouth | 624 | ||
| Neck | 624 | ||
| Chest | 624 | ||
| Lungs | 624 | ||
| Breasts | 625 | ||
| Heart | 625 | ||
| Blood Vessels | 625 | ||
| Abdomen | 625 | ||
| Male Genitalia | 625 | ||
| Female Genitalia | 625 | ||
| Anus and Rectum | 625 | ||
| Lymphatic System | 625 | ||
| Musculoskeletal System | 625 | ||
| Neurologic System | 625 | ||
| Assessment (for Each Problem on Problem List) | 625 | ||
| Plan (for Each Problem on Problem List) | 625 | ||
| Infants | 626 | ||
| History | 626 | ||
| Present Problem. | 626 | ||
| Details of Pregnancy. | 626 | ||
| Infant’s Status at Birth. | 626 | ||
| First Month of Life. | 626 | ||
| Past Medical History. | 626 | ||
| Family History. | 626 | ||
| Personal and Social History. | 626 | ||
| Growth and Development. | 626 | ||
| Developmental Milestones. | 626 | ||
| Injury Prevention. | 626 | ||
| Diet. | 626 | ||
| Breast-Fed Infants. | 626 | ||
| Formula-Fed Infants. | 626 | ||
| Solid Foods. | 626 | ||
| Physical Examination Findings | 626 | ||
| General | 626 | ||
| Mental Status | 626 | ||
| Skin | 626 | ||
| Lymphatics | 626 | ||
| Head | 626 | ||
| Eyes | 626 | ||
| Ears | 626 | ||
| Nose | 626 | ||
| Mouth | 626 | ||
| Neck | 626 | ||
| Chest and Lungs | 627 | ||
| Heart and Blood Vessels | 627 | ||
| Abdomen | 627 | ||
| Male Genitalia | 627 | ||
| Female Genitalia | 627 | ||
| Anus, Rectum | 627 | ||
| Musculoskeletal System | 627 | ||
| Neurologic System | 627 | ||
| Children and Adolescents | 627 | ||
| 27 Emergency or Life-Threatening Situations | 632 | ||
| Emergency Assessment of the Injured Patient | 632 | ||
| The Primary Survey | 632 | ||
| Airway and Cervical Spine. | 632 | ||
| Breathing. | 632 | ||
| Circulation. | 633 | ||
| Disability. | 634 | ||
| Exposure and Environmental Control. | 635 | ||
| Secondary Assessment of the Injured Patient | 635 | ||
| History. | 635 | ||
| Head and Neck. | 635 | ||
| Chest. | 635 | ||
| Abdomen. | 635 | ||
| Extremities and Back. | 636 | ||
| Rectum and Perineum. | 636 | ||
| Neurologic Examination. | 636 | ||
| Reevaluate the Patient. | 636 | ||
| Injury Mechanisms | 636 | ||
| Blunt Trauma | 637 | ||
| Penetrating Trauma | 637 | ||
| Burns | 637 | ||
| Assessment of an Acute Medical Emergency | 637 | ||
| Advanced Cardiac Life Support Survey | 637 | ||
| Assessment of Infants and Children | 638 | ||
| Assessment of Older Adults | 638 | ||
| Legal Considerations | 641 | ||
| Records | 641 | ||
| Consent for Treatment | 641 | ||
| Trauma Due to Violence | 641 | ||
| Medical Orders for Life-Sustaining Treatment | 642 | ||
| Summary | 642 | ||
| Abnormalities | 642 | ||
| Upper Airway Obstruction | 642 | ||
| Hypoxemia | 642 | ||
| Shock State | 643 | ||
| Ventilatory Failure | 643 | ||
| Increased Intracranial Pressure | 643 | ||
| Pulmonary Embolism | 644 | ||
| Severe Asthma Episode (Status Asthmaticus) | 644 | ||
| Status Epilepticus | 644 | ||
| Photo and Illustration Credits | 645 | ||
| References and Readings | 647 | ||
| Glossary | 666 | ||
| Appendix A Height/Weight Growth Charts | 675 | ||
| Appendix B Pediatric Blood Pressure Tables | 679 | ||
| Appendix C Conversion Tables and Anthropometric Measurements | 684 | ||
| Conversion Tables | 684 | ||
| Anthropometric Measurements | 685 | ||
| Index | 686 | ||
| A | 686 | ||
| B | 689 | ||
| C | 690 | ||
| D | 693 | ||
| E | 694 | ||
| F | 696 | ||
| G | 697 | ||
| H | 697 | ||
| I | 699 | ||
| J | 700 | ||
| K | 700 | ||
| L | 701 | ||
| M | 702 | ||
| N | 703 | ||
| O | 704 | ||
| P | 705 | ||
| Q | 708 | ||
| R | 708 | ||
| S | 709 | ||
| T | 711 | ||
| U | 712 | ||
| V | 713 | ||
| W | 714 | ||
| X | 714 | ||
| Y | 714 | ||
| Z | 714 | ||
| Inside Back Cover | ibc1 |