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Macleod's Clinical Examination E-Book

Macleod's Clinical Examination E-Book

J. Alastair Innes | Anna R Dover | Karen Fairhurst

(2018)

Additional Information

Book Details

Abstract

This classic textbook aims to assist clinicians develop the consultation skills required to elicit a clear history, and the practical skills needed to detect clinical signs of disease. Where possible, the physical basis of clinical signs is explained to aid understanding. Formulation of a differential diagnosis from the information gained is introduced, and the logical initial investigations are included for each system.

  • The first part of the book addresses the general principles of good interaction with patients, from the basics of taking a history and examining, to the use of pattern recognition to identify spot diagnoses.
  • The second part documents the relevant history, examination and investigations for all the major body systems.
  • The third part illustrates the application of these skills to specific clinical situations.
  • The final part covers preparation for assessments of clinical skills and the use of these skills in everyday practice.
  • The book has accompanying videos demonstrating many of the key clinical examination routines as set out in the book.
  • A new editorial team has undertaken a substantial review of the book’s contents and with the help of many new authors has radically revised the order and approach of the text.
  • Several new chapters have been created including a chapter on patients with mental disorders; a chapter covering the approach to a deteriorating patient; a chapter on assessment of patients towards the end of life and two new chapters on applying the key clinical skills during assessments and in practice.
  • The structure of the text has been rationalised with careful use of boxes, tables and figures to set out the concepts for maximum clarity.

Table of Contents

Section Title Page Action Price
Front Cover cover
Inside Front Cover ifc1
Half title page i
John Macleod (1915–2006) ii
Macleod's Clinical Examination iii
Copyright Page iv
Table Of Contents v
Preface vii
Acknowledgements ix
How to make the most of this book xi
Examination sequences xi
Clinical skills videos xiii
Key points in examinations: photo galleries xiii
Video contents xiii
Video production team xiii
Director and editor xiii
Producer xiii
Sound and narrators xiii
Clinical examiners xiii
Patients xiii
Contributors xv
1 Principles of Clinical History and Examination 1
1 Managing clinical encounters with patients 3
The clinical encounter 4
Reasons for the encounter 4
The clinical environment 4
Opening the encounter 5
Gathering information 5
Handling sensitive information and third parties 5
Managing patient concerns 5
Showing empathy 5
Showing cultural sensitivity 6
Addressing the problem 6
Concluding the encounter 6
Alternatives to face-to-face encounters 6
Professional responsibilities 6
Confidentiality and consent 7
Social media 7
Personal responsibilities 7
2 General aspects of history taking 9
The importance of a clear history 10
Gathering information 10
Beginning the history 10
Preparation 10
Allowing sufficient time 10
Starting your consultation 10
Using different styles of question 10
Showing empathy when taking a history 10
The history of the presenting symptoms 11
Past medical history 13
Drug history 13
Concordance and adherence 13
Drug allergies/reactions 13
Non-prescribed drug use 13
Family history 14
Social history and lifestyle 14
Smoking 14
Alcohol 15
Alcohol problems 15
Occupational history and home environment 15
Travel history 16
Sexual history 16
Systematic enquiry 16
Closing the interview 16
Difficult situations 16
Patients with communication difficulties 16
Patients with cognitive difficulties 16
Sensitive situations 16
Emotional or angry patients 16
3 General aspects of examination 19
General principles of physical examination 20
Preparing for physical examination 20
Sequence for performing a physical examination 21
Initial observations 22
Gait and posture 22
Facial expression and speech 23
Hands 23
Deformity 23
Colour 23
Temperature 23
Skin 24
Nails 24
Skin 26
Haemochromatosis 26
Haemosiderin 26
Easy bruising 26
Hypercarotenaemia 26
Discoloration 26
Jaundice 27
Pallor 27
Cyanosis 28
Central cyanosis 28
Peripheral cyanosis 28
Characteristic skin changes 28
Tongue 29
Odours 29
Body habitus and nutrition 29
Weight 29
Obesity 29
Weight loss 29
Stature 29
Short stature 29
Tall stature 30
Hydration 30
Localised oedema 30
Venous causes 30
Lymphatic causes 31
Inflammatory causes 31
Allergic causes 31
Lumps and lymph nodes 31
Lumps 31
Size 32
Position 32
Attachment 32
Consistency 32
Edge 32
Surface and shape 32
Pulsations, thrills and bruits 32
Inflammation 32
Transillumination 32
Lymph nodes 32
Spot diagnoses 34
Major chromosomal abnormalities 34
Down’s syndrome (trisomy 21 – 47XX/XY + 21) 36
Turner’s syndrome (45XO) 36
Klinefelter’s syndrome (47XXY) 36
Achondroplasia 36
2 System-Based Examination 37
4 The cardiovascular system 39
Heart 40
Anatomy and physiology 40
The history 40
Common presenting symptoms 40
Chest pain 40
Intermittent chest pain 40
Acute chest pain 41
Dyspnoea (breathlessness) 42
Palpitation 43
Syncope and presyncope 43
Oedema 44
Other symptoms of cardiac disease 44
Past medical history 44
Drug history 44
Family history 45
Social history 45
The physical examination 45
General examination 46
Hands 46
Face 47
Arterial pulses 47
Rate and rhythm 47
Volume and character 48
Blood pressure 49
Hypertension 50
Korotkoff sounds 51
Common problems in BP measurement 51
Jugular venous pressure and waveform 52
Precordium 53
Inspection 53
Palpation 54
Auscultation 55
Heart sounds 55
First heart sound 55
Second heart sound 56
Third heart sound 56
Fourth heart sound 57
Added sounds 57
Murmurs 58
Systolic murmurs 59
Diastolic murmurs 60
Continuous murmurs 61
Interpretation of the findings 61
Investigations 61
Haematology and clinical chemistry 61
Electrocardiography 61
Ambulatory ECG monitoring 61
Exercise ECG 61
Ambulatory blood pressure monitoring 61
Chest X-ray 63
Echocardiography 63
Radionuclide studies 63
Cardiac catheterisation 63
Computed tomography and magnetic resonance imaging 64
Peripheral arterial system 64
Anatomy and physiology 64
The history 64
Common presenting symptoms 64
Leg pain 64
Asymptomatic ischaemia 64
Intermittent claudication 64
Night pain 65
Rest pain 65
Tissue loss (ulceration and/or gangrene) 65
Acute limb ischaemia 65
Compartment syndrome 66
Abdominal pain 66
Mesenteric ischaemia 66
Abdominal aortic aneurysm 66
Digital ischaemia 66
Blue toes 66
Vasospastic symptoms 66
Stroke 67
Past medical history 67
Drug history 67
Family history 67
Social history 67
The physical examination 67
Buerger’s test 69
Ankle : brachial pressure index 69
Investigations 69
Peripheral venous system 70
Anatomy and physiology 70
The history 70
Common presenting symptoms 70
Pain 71
Limb swelling 72
Skin changes 72
Chronic venous ulceration 72
Superficial venous thrombophlebitis 72
Past history 72
The physical examination 72
Investigations 73
5 The respiratory system 75
Anatomy and physiology 76
The history 76
Common presenting symptoms 77
Breathlessness 77
Wheeze 77
Cough 77
Sputum 79
Colour 79
Volume 79
Consistency 79
Haemoptysis 79
Stridor 79
Chest pain 80
Fevers/rigors/night sweats 81
Weight loss 81
Sleepiness 81
Past medical history 81
Drug and allergy history 81
Family history 81
Social history 81
Home circumstances 82
Smoking 82
Occupational history 82
Systematic enquiry 82
The physical examination 82
Inspection 82
Hands and arms 85
Face 86
Neck 86
Thorax 86
Palpation 87
Percussion 87
Auscultation 88
Use of the stethoscope 88
Breath sounds 88
Added sounds 89
Vocal resonance 89
Interpretation of the findings 89
Investigations 89
6 The gastrointestinal system 93
Anatomy and physiology 94
The history 94
Common presenting symptoms 94
Mouth symptoms 94
Anorexia and weight loss 94
Pain 95
Painful mouth 95
Heartburn and reflux 95
Dyspepsia 95
Odynophagia 96
Abdominal pain 96
Site 96
Onset 96
Character 96
Radiation 96
Associated symptoms 97
Timing 97
Exacerbating and relieving factors 98
Severity 98
The acute abdomen 98
Dysphagia 98
Nausea and vomiting 99
Wind and flatulence 99
Abdominal distension 99
Altered bowel habit 99
Diarrhoea 99
Constipation 100
Bleeding 100
Haematemesis 100
Melaena 101
Rectal bleeding 101
Jaundice 101
Prehepatic jaundice 102
Hepatic jaundice 102
Posthepatic/cholestatic jaundice 102
Groin swellings and lumps 102
Past medical history 102
Drug history 102
Family history 102
Social history 102
The physical examination 103
General examination 103
Liver disease 104
Abdominal examination 104
Inspection 104
Skin 104
Visible veins 104
Abdominal swelling 104
Abdominal scars and stomas 104
Palpation 105
Tenderness 105
Palpable mass 105
Enlarged organs 105
Hepatomegaly 106
Percussion 107
Splenomegaly 108
Ascites 109
Auscultation 109
Hernias 110
Rectal examination 111
Proctoscopy 113
Investigations 113
7 The nervous system 119
Anatomy and physiology 120
The history 120
Time relationships 120
Precipitating, exacerbating or relieving factors 122
Associated symptoms 122
Common presenting symptoms 122
Headache 122
Transient loss of consciousness 122
Seizure 122
Stroke and transient ischaemic attack 123
Dizziness and vertigo 123
Functional neurological symptoms 123
Past medical history 123
Drug history 124
Family history 124
Social history 124
Occupational history 124
The physical examination 124
Assessment of conscious level 124
Meningeal irritation 124
Speech 125
Dysphasias 125
Anatomy 125
Cortical function 126
Frontal lobe 127
Temporal lobe 127
Parietal lobe 127
Occipital lobe 127
Cranial nerves 127
Olfactory (I) nerve 127
Anatomy 127
Optic (II), oculomotor (III), trochlear (IV) and abducens (VI) nerves 128
Trigeminal (V) nerve 128
Anatomy 128
Facial (VII) nerve 130
Anatomy 130
Vestibulocochlear (VIII) nerve 131
Glossopharyngeal (IX) and vagus (X) nerves 131
Anatomy 132
Accessory (XI) nerve 133
3 Applying History and Examination Skills in Specific Situations 295
15 Babies and children 297
Babies 298
The history 298
Maternal history 298
Pregnancy history 298
Birth history 298
Infant’s progress 298
Presenting problems and definitions 298
Pallor 298
Respiratory distress 298
Cyanosis 298
Acrocyanosis 298
Jaundice 298
Jitteriness 299
Dysmorphism 299
Hypotonia 299
Apgar score 299
The physical examination of newborns 299
Timing and efficacy of the routine neonatal examination 299
General examination 299
Skin 299
Normal findings 299
Abnormal findings 299
Head 300
4 Putting History and Examination Skills to Use 353
20 Preparing for assessment 355
General principles 356
Methods of assessment 356
Clinical simulation 357
OSCEs 357
Marking structures 357
Approach to preparation 358
Approach to assessment 359
Professionalism 359
Managing time 359
Communication during assessment 359
Managing unexpected difficulties 360
Putting it all together 360
21 Preparing for practice 361
Adapting history and examination skills appropriately 362
Integrated examination 362
Diagnostic strategies 362
Pre-test probability 362
Rare diseases 362
Approach to the patient with medically unexplained symptoms 363
Assessment of a patient with minor injury or illness 364
Assessment of a critically ill patient 364
Documenting your findings 364
Subjective 364
Objective 364
Assessment 364
Plan 365
Communicating with colleagues 365
Verbal communication 365
Using SBAR 365
Written communication 374
Index 375
A 375
B 375
C 376
D 376
E 377
F 377
G 378
H 378
I 378
J 379
K 379
L 379
M 379
N 380
O 380
P 380
Q 381
R 381
S 382
T 382
U 383
V 383
W 383
X 383
Y 383