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 |