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 |