BOOK
Seidel's Guide to Physical Examination - E-Book
Jane W. Ball | Joyce E. Dains | John A. Flynn | Barry S. Solomon | Rosalyn W. Stewart
(2017)
Additional Information
Book Details
Abstract
Seidel's Guide to Physical Examination 9th Edition offers a uniquely interprofessional, patient-centered, lifespan approach to physical examination and health assessment. This new edition features an increased focus on patient safety, clinical reasoning, and evidence-based practice, along with an emphasis on the development of good communication skills and effective hands-on examination techniques. Each core chapter is organized into four sections – Anatomy and Physiology, Review of Related History, Examination and Findings, and Abnormalities – with lifespan content integrated into each area. Written by an author team comprised of advance practice nurses and physicians with specialties in the care of adults, older adults, and children, this one-of-a-kind textbook addresses health assessment and physical examination for a wide variety of disciplines.
- UNIQUE! Interprofessional, interdisciplinary approach, written by two advanced practice nurses and three physicians, with expertise in both pediatric and adult-geriatric health.
- UPDATED! Infectious outbreak content addresses the growing problem of global infectious disease outbreaks such as Zika and Ebola and the need for infection precautions.
- UNIQUE! Cross-references to Dains et al:Advanced Health Assessment & Clinical Diagnosis in Primary Care help you take "the next step" in your clinical reasoning abilities and provides a more seamless user experience.
- UNIQUE! Compassionate, patient-centered approach emphasizes developing good communication skills, use of effective hands-on examination techniques, and reliance on clinical reasoning and clinical decision-making.
- Integrated lifespan content includes separate sections in each chapter on Infants and Children, Adolescents, Pregnant Women, and Older Adults.
- NEW! Emphasis on clinical reasoning provides insights and clinical expertise to help you develop clinical judgment skills.
- NEW! Enhanced emphasis on patient safety and healthcare quality, particularly as it relates to sports participation.
- NEW! Content on documentation has been updated with a stronger focus on electronic charting (EHR/EMR).
- NEW! Enhanced social inclusiveness and patient-centeredness incorporates LGBTQ patients and providers, with special a emphasis on cultural competency, history-taking, and special considerations for examination of the breasts, female and male genitalia, reproductive health, thyroid, and anus/rectum/prostate.
- NEW! Telemedicine, virtual consults, and video interpreters content added to the Growth, Measurement, and Nutrition chapter.
- NEW! Improved readability with a clear, straightforward, and easy-to-understand writing style.
- NEW! Updated drawing, and photographs enhance visual appeal and clarify anatomical content and exam techniques.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Inside Front Cover | ifc1 | ||
| Endsheet_3 | IFC3 | ||
| Seidel's Guide to Physical Examination | i | ||
| Copyright Page | ii | ||
| About the Authors | iii | ||
| Jane W. Ball, DrPH, RN, CPNP | iii | ||
| Joyce E. Dains, DrPH, JD, RN, FNP-BC, FNAP, FAANP | iii | ||
| John A. Flynn, MD, MBA, MEd | iii | ||
| Barry S. Solomon, MD, MPH | iv | ||
| Rosalyn W. Stewart, MD, MS, MBA | iv | ||
| Reviewers | v | ||
| Preface | vii | ||
| Organization | vii | ||
| Special Features | viii | ||
| New to This Edition | viii | ||
| Our Ancillary Package | viii | ||
| Our Core Values | ix | ||
| Dedication | ix | ||
| Acknowledgments | ix | ||
| Table Of Contents | x | ||
| 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. | 5 | ||
| Silence. | 5 | ||
| Depression. | 5 | ||
| Crying and Compassionate Moments. | 5 | ||
| Physical and Emotional Intimacy. | 5 | ||
| Seduction. | 5 | ||
| Anger. | 5 | ||
| Avoiding the Full Story. | 6 | ||
| Financial Considerations. | 6 | ||
| The Patient History | 6 | ||
| Setting for the Interview | 6 | ||
| Structure of the History | 6 | ||
| Building the History | 7 | ||
| Sensitive Issues | 8 | ||
| Alcohol. | 8 | ||
| Intimate Partner Violence. | 9 | ||
| Spirituality. | 10 | ||
| Sexuality and Gender Identity | 10 | ||
| Identity. | 11 | ||
| Outline of the History | 11 | ||
| Chief Concern or the Reason for Seeking Care. | 11 | ||
| History of Present Illness or Problem. | 11 | ||
| Past Medical History. | 12 | ||
| Family History. | 13 | ||
| Personal and Social History | 13 | ||
| Review of Systems (ROS). | 14 | ||
| Females and Transmales | 14 | ||
| Males and Transfemales | 15 | ||
| Concluding Questions. | 15 | ||
| Adaptations for Age, Pregnancy, and Possible Disabilities | 15 | ||
| Infants and Children | 15 | ||
| Chief Concern. | 15 | ||
| History of Present Illness. | 15 | ||
| Past Medical History | 15 | ||
| Family History | 16 | ||
| Personal and Social History | 16 | ||
| Review of Systems. | 16 | ||
| Adolescents | 17 | ||
| Pregnant Patients | 18 | ||
| Basic Information | 18 | ||
| History of Present Illness or Problem. | 19 | ||
| Obstetric History. | 19 | ||
| Menstrual History. | 19 | ||
| Gynecologic History. | 19 | ||
| Past Medical History. | 19 | ||
| Family History. | 19 | ||
| Personal and Social History. | 19 | ||
| Review of Systems. | 19 | ||
| Risk Assessment. | 19 | ||
| Postpartum. | 19 | ||
| Older Adults | 19 | ||
| The Frail. | 20 | ||
| Patients With Disabilities | 20 | ||
| The Next Step | 21 | ||
| 2 Cultural Competency | 22 | ||
| A Definition of Culture | 22 | ||
| Distinguishing Physical Characteristics | 22 | ||
| Genomics and Personalized Medicine | 22 | ||
| Cultural Competence | 23 | ||
| Cultural Humility | 23 | ||
| The Impact of Culture | 24 | ||
| The Blurring of Cultural Distinctions | 24 | ||
| The Primacy of the Individual in Health Care | 25 | ||
| Interprofessional Care—A Culture Shift in the Health Professions | 25 | ||
| The Impact of Culture on Illness | 26 | ||
| The Components of a Cultural Response | 27 | ||
| Modes of Communication | 27 | ||
| Health Beliefs and Practices | 28 | ||
| Family Relationships | 28 | ||
| Diet and Nutritional Practices | 29 | ||
| Summing Up | 29 | ||
| 3 Examination Techniques and Equipment | 32 | ||
| Precautions to Prevent Infection | 32 | ||
| Latex Allergy | 32 | ||
| Examination Technique | 33 | ||
| Patient Positions and Draping | 33 | ||
| Seated. | 33 | ||
| Supine. | 33 | ||
| Prone. | 34 | ||
| Dorsal Recumbent. | 34 | ||
| Lateral Recumbent. | 34 | ||
| Lithotomy. | 34 | ||
| Sims. | 34 | ||
| Inspection | 34 | ||
| Palpation | 35 | ||
| Percussion | 35 | ||
| Auscultation | 37 | ||
| Modifications for Patients With Disabilities | 37 | ||
| Patients With Mobility Impairments | 37 | ||
| Pivot Transfer. | 37 | ||
| Cradle Transfer. | 37 | ||
| Two-Person Transfer. | 37 | ||
| Equipment. | 38 | ||
| Patients With Sensory Impairment | 38 | ||
| Impaired Vision. | 38 | ||
| Impaired Hearing or Speech. | 38 | ||
| Special Concerns for Patients With Spinal Cord Injury or Lesion | 39 | ||
| Bowel and Bladder Concerns. | 39 | ||
| Autonomic Hyperreflexia. | 39 | ||
| Hypersensitivity. | 39 | ||
| Spasticity. | 39 | ||
| Equipment | 39 | ||
| Weight Scales and Height Measurement Devices | 39 | ||
| Thermometer | 40 | ||
| Stethoscope | 41 | ||
| Sphygmomanometer | 42 | ||
| Pulse Oximeter | 42 | ||
| Doppler | 43 | ||
| Portable Ultrasound | 43 | ||
| Fetal Monitoring Equipment | 43 | ||
| Ophthalmoscope | 44 | ||
| PanOptic Ophthalmoscope | 45 | ||
| StrabismoScope | 45 | ||
| Photoscreening | 45 | ||
| Visual Acuity Charts | 45 | ||
| Snellen Alphabet and Sloan Letters Charts. | 45 | ||
| HOTV. | 46 | ||
| LH Symbols (LEA Symbols). | 46 | ||
| Near Vision Charts | 46 | ||
| Amsler Grid | 47 | ||
| Otoscope | 47 | ||
| Nasal Speculum | 47 | ||
| Tympanometer | 47 | ||
| Tuning Fork | 48 | ||
| Percussion (Reflex) Hammer | 48 | ||
| Neurologic Hammer | 48 | ||
| Tape Measure | 49 | ||
| Transilluminator | 49 | ||
| Vaginal Speculum | 49 | ||
| Goniometer | 50 | ||
| Wood’s Lamp | 50 | ||
| Monofilament | 50 | ||
| Scoliometer | 51 | ||
| 4 Taking the Next Steps | 52 | ||
| The Clinical Examination | 52 | ||
| Clinical Reasoning | 52 | ||
| Assessment, Judgment, and Evidence | 52 | ||
| Problem Identification | 52 | ||
| Valid Hypotheses | 53 | ||
| Possible Barriers to Clinical Reasoning | 54 | ||
| Feelings, Attitudes, and Values. | 54 | ||
| The Ethical Context. | 54 | ||
| Mechanism and Probabilism. | 55 | ||
| Validity of the Clinical Examination | 55 | ||
| Bayes Theorem | 55 | ||
| Evidence-Based Practice | 56 | ||
| Evaluation and Management Plan and Setting Priorities | 56 | ||
| 5 Recording Information | 58 | ||
| General Guidelines | 58 | ||
| EMR Replicating Functions | 59 | ||
| Organization of the Note | 59 | ||
| Organizing the Patient’s Health Record With SOAP Notes | 60 | ||
| Subjective Data | 60 | ||
| Objective Data | 60 | ||
| Location of Findings. | 60 | ||
| Incremental Grading. | 60 | ||
| Organs, Masses, and Lesions. | 61 | ||
| Discharge. | 61 | ||
| Illustrations | 61 | ||
| Problem-Oriented Medical Record | 61 | ||
| Comprehensive Health History and Physical Examination | 61 | ||
| Problem List | 61 | ||
| Assessment | 62 | ||
| Plan | 62 | ||
| SOAP Notes | 62 | ||
| APSO Notes | 62 | ||
| Notes From Subsequent Evaluations | 63 | ||
| Problem-Oriented Medical Record Format | 63 | ||
| The History | 63 | ||
| Identifying Information. | 63 | ||
| Problems, Allergies, Medications, and Immunizations List. | 63 | ||
| General Patient Information. | 63 | ||
| Source and Reliability of Information. | 63 | ||
| Chief Concern/Presenting Problem/Reason for Seeking Care. | 63 | ||
| History of Present Illness. | 63 | ||
| Recording the History of the Present Illness: OLDCARTS. | 64 | ||
| Past Medical History. | 64 | ||
| Family History. | 64 | ||
| Personal and Social History. | 64 | ||
| Review of Systems | 65 | ||
| Physical Examination Findings | 66 | ||
| General Statement | 66 | ||
| Mental Status | 66 | ||
| Skin | 66 | ||
| Head | 66 | ||
| Eyes | 66 | ||
| Ears | 66 | ||
| Nose | 67 | ||
| Throat and Mouth | 67 | ||
| Neck | 67 | ||
| Chest | 67 | ||
| Lungs | 67 | ||
| Breasts | 67 | ||
| Heart | 67 | ||
| Blood Vessels | 67 | ||
| Abdomen | 67 | ||
| Male Genitalia | 67 | ||
| Female Genitalia | 67 | ||
| Anus and Rectum | 68 | ||
| Lymphatic System | 68 | ||
| Musculoskeletal System | 68 | ||
| Neurologic System | 68 | ||
| Assessment (for Each Problem on Problem List) | 68 | ||
| Plan (for Each Problem on Problem List) | 68 | ||
| Infants | 68 | ||
| History | 68 | ||
| Present Problem. | 68 | ||
| Details of Pregnancy | 68 | ||
| Infant’s Status at Birth | 68 | ||
| First Month of Life | 68 | ||
| Past Medical History. | 68 | ||
| Family History. | 68 | ||
| Personal and Social History. | 68 | ||
| Growth and Development. | 69 | ||
| Developmental Milestones. | 69 | ||
| Injury Prevention. | 69 | ||
| Diet. | 69 | ||
| Breast-Fed Infants. | 69 | ||
| Formula-Fed Infants. | 69 | ||
| Solid Foods. | 69 | ||
| Physical Examination Findings | 69 | ||
| General | 69 | ||
| Mental Status | 69 | ||
| Skin | 69 | ||
| Lymphatics | 69 | ||
| Head | 69 | ||
| Eyes | 69 | ||
| Ears | 69 | ||
| Nose | 69 | ||
| Mouth | 69 | ||
| Neck | 69 | ||
| Chest and Lungs | 69 | ||
| Heart and Blood Vessels | 69 | ||
| Abdomen | 69 | ||
| Male Genitalia | 69 | ||
| Female Genitalia | 69 | ||
| Anus, Rectum | 69 | ||
| Musculoskeletal System | 69 | ||
| Neurologic System | 70 | ||
| Children and Adolescents | 70 | ||
| 6 Vital Signs and Pain Assessment | 74 | ||
| Anatomy and Physiology | 74 | ||
| Vital Signs | 74 | ||
| Temperature | 74 | ||
| Pulse Rate | 74 | ||
| Respiratory Rate | 74 | ||
| Blood Pressure | 74 | ||
| Pain | 74 | ||
| Infants | 75 | ||
| Pregnant Patients | 75 | ||
| 7 Mental Status | 88 | ||
| Anatomy and Physiology | 88 | ||
| Infants and Children | 88 | ||
| Adolescents | 88 | ||
| Older Adults | 88 | ||
| Review of Related History | 89 | ||
| History of Present Illness | 89 | ||
| Disorientation and Confusion | 89 | ||
| Depression | 89 | ||
| Anxiety | 89 | ||
| Past Medical History | 89 | ||
| Family History | 90 | ||
| Personal and Social History | 90 | ||
| Children | 90 | ||
| Adolescents | 90 | ||
| Older Adults | 90 | ||
| Examination and Findings | 90 | ||
| Physical Appearance and Behavior | 91 | ||
| Grooming | 91 | ||
| Emotional Status | 91 | ||
| Nonverbal Communication (Body Language) | 91 | ||
| State of Consciousness | 91 | ||
| Cognitive Abilities | 91 | ||
| Analogies | 91 | ||
| Abstract Reasoning | 91 | ||
| Arithmetic Calculation | 92 | ||
| Writing Ability | 92 | ||
| Execution of Motor Skills | 92 | ||
| Memory | 92 | ||
| Attention Span | 92 | ||
| Judgment | 92 | ||
| Speech and Language Skills | 92 | ||
| Voice Quality | 92 | ||
| Articulation | 93 | ||
| Comprehension | 93 | ||
| Coherence | 93 | ||
| Emotional Stability | 93 | ||
| Mood and Feelings | 93 | ||
| Thought Process and Content | 94 | ||
| Perceptual Distortions and Hallucinations | 94 | ||
| Infants and Children | 94 | ||
| Pregnant Patients | 96 | ||
| Older Adults | 96 | ||
| Abnormalities | 99 | ||
| Mental Status | 99 | ||
| Disorders of Altered Mental Status | 99 | ||
| Traumatic Brain Injury. | 99 | ||
| Disorders of Mood | 100 | ||
| Depression. | 100 | ||
| Mania. | 100 | ||
| Anxiety Disorder. | 101 | ||
| Schizophrenia. | 101 | ||
| Intellectual Disability | 102 | ||
| Attention-Deficit/Hyperactivity Disorder (ADHD) | 102 | ||
| Autism | 102 | ||
| Delirium | 103 | ||
| Dementia | 103 | ||
| 8 Growth and Nutrition | 105 | ||
| Anatomy and Physiology | 105 | ||
| Differences in Growth by Organ System | 106 | ||
| Infants and Children | 107 | ||
| Pregnant Patients | 108 | ||
| Older Adults | 108 | ||
| Review of Related History | 108 | ||
| History of Present Illness | 108 | ||
| Weight Loss | 108 | ||
| Weight Gain | 109 | ||
| Changes in Body Proportions | 109 | ||
| Increased Metabolic Requirements | 109 | ||
| Past Medical History | 109 | ||
| Family History | 109 | ||
| Personal and Social History | 110 | ||
| Infants | 110 | ||
| Adolescents | 110 | ||
| Pregnant Patients | 111 | ||
| Older Adults | 111 | ||
| Determination of Diet Adequacy | 111 | ||
| Twenty–Four-Hour Recall Diet | 111 | ||
| Food Diary | 112 | ||
| Measures of Nutrient Analysis | 112 | ||
| Vegetarian Diets | 112 | ||
| Ethnic Food Guide Pyramids | 112 | ||
| Examination and Findings | 112 | ||
| Equipment | 112 | ||
| Weight and Standing Height | 113 | ||
| Body Mass Index | 113 | ||
| Waist Circumference and Waist-Height Ratio | 113 | ||
| Waist-to-Hip Circumference Ratio | 113 | ||
| Infants | 113 | ||
| Recumbent Length | 114 | ||
| Weight | 114 | ||
| Head Circumference | 117 | ||
| Chest Circumference | 117 | ||
| Gestational Age | 117 | ||
| Size for Gestational Age. | 119 | ||
| Stature and Weight | 119 | ||
| Upper-to-Lower Segment Ratio | 120 | ||
| Arm Span | 120 | ||
| Sexual Maturation | 120 | ||
| Pregnant Patients | 122 | ||
| Older Adults | 123 | ||
| Abnormalities | 125 | ||
| Growth | 125 | ||
| Acromegaly | 125 | ||
| Cushing Syndrome | 126 | ||
| Turner Syndrome | 126 | ||
| Hydrocephalus | 127 | ||
| Failure to Thrive | 127 | ||
| Growth Hormone Deficiency | 128 | ||
| Precocious Puberty | 128 | ||
| Nutrition | 129 | ||
| Obesity | 129 | ||
| Anorexia Nervosa | 129 | ||
| Bulimia Nervosa | 130 | ||
| 9 Skin, Hair, and Nails | 131 | ||
| Anatomy and Physiology | 131 | ||
| Epidermis | 132 | ||
| Dermis | 132 | ||
| Hypodermis | 132 | ||
| Appendages | 132 | ||
| Infants and Children | 133 | ||
| Adolescents | 133 | ||
| Pregnant Patients | 133 | ||
| Older Adults | 133 | ||
| Review of Related History | 134 | ||
| History of Present Illness | 134 | ||
| Skin | 134 | ||
| Hair | 135 | ||
| 10 Lymphatic System | 184 | ||
| Anatomy and Physiology | 184 | ||
| Lymph Nodes | 185 | ||
| Lymphocytes | 187 | ||
| Thymus | 188 | ||
| Spleen | 188 | ||
| Tonsils and Adenoids | 188 | ||
| Peyer Patches | 188 | ||
| Infants and Children | 188 | ||
| Pregnant Patients | 189 | ||
| Older Adults | 189 | ||
| Review of Related History | 189 | ||
| History of Present Illness | 189 | ||
| Past Medical History | 189 | ||
| Family History | 190 | ||
| Personal and Social History | 190 | ||
| Infants and Children | 190 | ||
| Pregnant Patients | 190 | ||
| Older Adults | 190 | ||
| Examination and Findings | 190 | ||
| Equipment | 190 | ||
| Inspection and Palpation | 190 | ||
| Head and Neck | 192 | ||
| Axillae | 193 | ||
| Epitrochlear Lymph Nodes | 193 | ||
| Inguinal and Popliteal Lymph Nodes | 194 | ||
| Spleen | 194 | ||
| Infants and Children | 195 | ||
| Abnormalities | 196 | ||
| Lymphatic System | 196 | ||
| Acute Lymphangitis | 196 | ||
| Acute Suppurative Lymphadenitis | 196 | ||
| Lymphedema | 196 | ||
| Lymphangioma/Cystic Hygroma | 197 | ||
| Lymphatic Filariasis (Elephantiasis) | 198 | ||
| Non-Hodgkin Lymphoma | 198 | ||
| Hodgkin Lymphoma | 199 | ||
| Epstein-Barr Virus Mononucleosis | 199 | ||
| Toxoplasmosis | 200 | ||
| Roseola Infantum (HHV-6) | 200 | ||
| Herpes Simplex (HSV) | 200 | ||
| Cat Scratch Disease | 201 | ||
| Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) | 201 | ||
| Serum Sickness (Type III Hypersensitivity Reaction) | 201 | ||
| Latex Allergy Type IV Dermatitis | 202 | ||
| Latex Allergy Type I Reaction | 202 | ||
| 11 Head and Neck | 203 | ||
| Anatomy and Physiology | 203 | ||
| Infants | 205 | ||
| Children and Adolescents | 205 | ||
| Pregnant Patients | 205 | ||
| Older Adults | 205 | ||
| Review of Related History | 206 | ||
| History of Present Illness | 206 | ||
| Traumatic Brain Injury | 206 | ||
| Headache | 207 | ||
| Stiff Neck | 207 | ||
| Past Medical History | 207 | ||
| Family History | 207 | ||
| Personal and Social History | 207 | ||
| Infants | 207 | ||
| Pregnant Patients | 208 | ||
| Older Adults | 208 | ||
| Examination and Findings | 208 | ||
| Equipment | 208 | ||
| Head and Face | 208 | ||
| Inspection | 208 | ||
| Palpation | 211 | ||
| Percussion | 212 | ||
| Auscultation | 212 | ||
| Neck | 212 | ||
| Inspection | 212 | ||
| Palpation | 212 | ||
| Lymph Nodes | 213 | ||
| Thyroid Gland | 213 | ||
| Inspection | 214 | ||
| Palpation | 215 | ||
| Transillumination | 216 | ||
| Children | 216 | ||
| Pregnant Patients | 216 | ||
| Older Adults | 217 | ||
| Abnormalities | 218 | ||
| Head | 218 | ||
| Headaches | 218 | ||
| Salivary Gland Tumor | 219 | ||
| Thyroid | 219 | ||
| Hypothyroidism | 219 | ||
| Hyperthyroidism | 220 | ||
| Myxedema | 220 | ||
| Graves Disease | 220 | ||
| Hashimoto Disease | 221 | ||
| Thyroglossal Duct Cyst | 221 | ||
| Branchial Cleft Cyst | 221 | ||
| Torticollis (Wry Neck) | 222 | ||
| Encephalocele | 222 | ||
| Hydrocephalus | 223 | ||
| Microcephaly | 223 | ||
| Craniosynostosis | 224 | ||
| 12 Eyes | 225 | ||
| Anatomy and Physiology | 225 | ||
| External Eye | 225 | ||
| Eyelid | 225 | ||
| Conjunctiva | 226 | ||
| Lacrimal Gland | 226 | ||
| Eye Muscles | 226 | ||
| Internal Eye | 226 | ||
| Sclera | 226 | ||
| Cornea | 226 | ||
| Uvea | 227 | ||
| Lens | 227 | ||
| Retina | 227 | ||
| Infants and Children | 227 | ||
| Pregnant Patients | 227 | ||
| Older Adults | 227 | ||
| Review of Related History | 228 | ||
| History of Present Illness | 228 | ||
| Red Eye (Presence of Conjunctival Injection or Redness) | 228 | ||
| Vision Problem(s) | 228 | ||
| Past Medical History | 229 | ||
| Family History | 229 | ||
| Personal and Social History | 229 | ||
| Infants and Children | 229 | ||
| Pregnant Patients | 229 | ||
| Older Adults | 229 | ||
| Examination and Findings | 229 | ||
| Equipment | 229 | ||
| Visual Acuity Testing | 229 | ||
| External Examination | 231 | ||
| Surrounding Structures | 231 | ||
| Eyelids | 231 | ||
| Palpation | 232 | ||
| Conjunctiva | 232 | ||
| Cornea | 233 | ||
| Iris and Pupil | 233 | ||
| Lens | 235 | ||
| Sclera | 235 | ||
| Lacrimal Apparatus | 235 | ||
| Extraocular Muscles | 235 | ||
| Ophthalmoscopic Examination | 237 | ||
| Unexpected Findings | 238 | ||
| Infants | 240 | ||
| Children | 241 | ||
| Pregnant Patients | 242 | ||
| Older Adults | 243 | ||
| Abnormalities | 244 | ||
| External Eye | 244 | ||
| Exophthalmos | 244 | ||
| Episcleritis | 244 | ||
| Band Keratopathy | 245 | ||
| Corneal Ulcer | 245 | ||
| Extraocular Muscles | 245 | ||
| Strabismus | 245 | ||
| Internal Eye | 246 | ||
| Horner Syndrome | 246 | ||
| Cataracts | 246 | ||
| Diabetic Retinopathy (Background or Nonproliferative) | 247 | ||
| Diabetic Retinopathy (Proliferative) | 247 | ||
| Lipemia Retinalis | 248 | ||
| Retinitis Pigmentosa | 248 | ||
| Glaucoma | 249 | ||
| Chorioretinitis (Chorioretinal Inflammation) | 249 | ||
| Visual Fields | 250 | ||
| Visual Field Defects | 250 | ||
| Retinoblastoma | 251 | ||
| Retinopathy of Prematurity (ROP) | 251 | ||
| Retinal Hemorrhages in Infancy | 252 | ||
| Macular Degeneration | 252 | ||
| 13 Ears, Nose, and Throat | 253 | ||
| Anatomy and Physiology | 253 | ||
| Ears and Hearing | 253 | ||
| Nose, Nasopharynx, and Sinuses | 255 | ||
| Mouth and Oropharynx | 255 | ||
| Infants and Children | 256 | ||
| Pregnant Patients | 257 | ||
| Older Adults | 257 | ||
| Review of Related History | 258 | ||
| History of Present Illness | 258 | ||
| Ear Pain | 258 | ||
| Hearing Loss: One or Both Ears | 258 | ||
| Vertigo (A False Sense of Motion) | 258 | ||
| Nasal Discharge | 258 | ||
| Snoring | 259 | ||
| Sinus Pain | 259 | ||
| Dental Problems | 259 | ||
| Mouth Lesions | 259 | ||
| Sore Throat | 259 | ||
| Hoarseness | 259 | ||
| Difficulty Swallowing | 259 | ||
| Past Medical History | 259 | ||
| Family History | 260 | ||
| Personal and Social History | 260 | ||
| Infants and Children | 260 | ||
| Pregnant Patients | 260 | ||
| Older Adults | 260 | ||
| Examination and Findings | 260 | ||
| Equipment | 260 | ||
| Ears and Hearing | 260 | ||
| External Ear | 260 | ||
| Otoscopic Examination | 261 | ||
| Hearing Evaluation | 262 | ||
| Whispered Voice. | 262 | ||
| Weber and Rinne Tests. | 263 | ||
| Nose, Nasopharynx, and Sinuses | 265 | ||
| External Nose | 265 | ||
| Nasal Cavity | 266 | ||
| Sinuses | 266 | ||
| Mouth and Oropharynx | 267 | ||
| Lips | 267 | ||
| Buccal Mucosa, Teeth, and Gums | 268 | ||
| Oral Cavity | 270 | ||
| Oropharynx | 272 | ||
| Infants | 273 | ||
| Ears. | 273 | ||
| Nose and Sinuses. | 273 | ||
| Mouth. | 274 | ||
| Children. | 275 | ||
| Ears. | 275 | ||
| Nose and Sinuses. | 276 | ||
| Mouth. | 276 | ||
| Pregnant Patients | 276 | ||
| Older Adults | 276 | ||
| Ears and Hearing. | 276 | ||
| Nose. | 277 | ||
| Mouth. | 277 | ||
| Abnormalities | 278 | ||
| Ear | 278 | ||
| Cholesteatoma | 278 | ||
| Hearing Loss | 278 | ||
| Conductive Hearing Loss | 278 | ||
| Sensorineural Hearing Loss | 278 | ||
| Ménière Disease | 279 | ||
| Vertigo | 279 | ||
| Sinuses | 279 | ||
| Sinusitis | 279 | ||
| Mouth and Oropharynx | 280 | ||
| Acute Bacterial Pharyngitis | 280 | ||
| Peritonsillar Abscess | 280 | ||
| Retropharyngeal Abscess | 281 | ||
| Oral Cancer | 281 | ||
| Periodontal Disease (Periodontitis) | 282 | ||
| Oropharyngeal Clefts (Cleft Lip, Cleft Palate, Cleft Lip and Palate) | 282 | ||
| 14 Chest and Lungs | 283 | ||
| Anatomy and Physiology | 283 | ||
| Anatomic Landmarks | 285 | ||
| Infants and Children | 285 | ||
| Pregnant Patients | 287 | ||
| Older Adults | 287 | ||
| Review of Related History | 287 | ||
| History of Present Illness | 287 | ||
| Cough | 287 | ||
| Coughs | 287 | ||
| Dry or Moist. | 287 | ||
| Onset. | 287 | ||
| Frequency of Occurrence. | 287 | ||
| Regularity. | 288 | ||
| Pitch and Loudness. | 288 | ||
| Postural Influences. | 288 | ||
| Quality. | 288 | ||
| Sputum | 288 | ||
| Shortness of Breath (Box 14.2) | 288 | ||
| Chest Pain (see Clinical Pearl, “Chest Pain”) | 288 | ||
| Past Medical History | 289 | ||
| Family History | 289 | ||
| Personal and Social History | 289 | ||
| Infants and Children | 289 | ||
| Pregnant Patients | 289 | ||
| Older Adults | 289 | ||
| Equipment | 290 | ||
| Examination and Findings | 290 | ||
| Inspection | 290 | ||
| Observing Respiration | 292 | ||
| Looking for Clues at the Periphery | 295 | ||
| Palpation | 295 | ||
| Tactile Fremitus | 295 | ||
| Examining the Trachea | 296 | ||
| Percussion | 297 | ||
| Diaphragmatic Excursion | 297 | ||
| Auscultation | 299 | ||
| Breath Sounds | 299 | ||
| Crackles. | 301 | ||
| Rhonchi. | 301 | ||
| Wheezes. | 302 | ||
| Other Sounds. | 302 | ||
| Vocal Resonance | 302 | ||
| Infants | 302 | ||
| Children | 304 | ||
| Pregnant Patients | 304 | ||
| Older Adults | 304 | ||
| Abnormalities | 306 | ||
| Asthma | 307 | ||
| Atelectasis | 307 | ||
| Bronchitis | 307 | ||
| Pleurisy | 308 | ||
| Pleural Effusion | 308 | ||
| Empyema | 309 | ||
| Lung Abscess | 309 | ||
| Pneumonia | 309 | ||
| Influenza | 310 | ||
| Tuberculosis | 310 | ||
| Pneumothorax | 311 | ||
| Hemothorax | 311 | ||
| Lung Cancer | 312 | ||
| Pulmonary Embolism | 312 | ||
| Epiglottitis | 313 | ||
| Diaphragmatic Hernia | 313 | ||
| Cystic Fibrosis | 314 | ||
| Croup (Laryngotracheal Bronchitis) | 314 | ||
| Tracheomalacia | 314 | ||
| Bronchiolitis | 315 | ||
| Chronic Obstructive Pulmonary Disease | 315 | ||
| Emphysema | 315 | ||
| Bronchiectasis | 316 | ||
| Chronic Bronchitis | 316 | ||
| 15 Heart | 317 | ||
| Anatomy and Physiology | 317 | ||
| Structure | 317 | ||
| Cardiac Cycle | 320 | ||
| Electrical Activity | 321 | ||
| Infants and Children | 322 | ||
| Pregnant Patients | 322 | ||
| Older Adults | 323 | ||
| Review of Related History | 324 | ||
| History of Present Illness | 324 | ||
| Chest Pain (Boxes 15.1 and 15.2) | 324 | ||
| Past Medical History | 324 | ||
| Family History | 326 | ||
| Personal and Social History | 326 | ||
| Infants | 326 | ||
| Children and Adolescents | 326 | ||
| Pregnant Patients | 326 | ||
| Older Adults | 326 | ||
| Examination and Findings | 327 | ||
| Equipment | 327 | ||
| Inspection | 327 | ||
| Palpation | 327 | ||
| Percussion | 328 | ||
| Auscultation | 329 | ||
| Basic Heart Sounds | 331 | ||
| S1 and S2. | 331 | ||
| Splitting. | 332 | ||
| S3 and S4. | 332 | ||
| Extra Heart Sounds | 333 | ||
| Heart Murmurs | 335 | ||
| Rhythm Disturbance | 340 | ||
| Infants | 340 | ||
| Children | 342 | ||
| Pregnant Patients | 342 | ||
| Older Adults | 342 | ||
| Abnormalities | 343 | ||
| Heart | 343 | ||
| Angina | 343 | ||
| Bacterial Endocarditis | 344 | ||
| Congestive Heart Failure (CHF)—Left-Sided | 344 | ||
| Congestive Heart Failure (CHF)—Right-Sided | 344 | ||
| Pericarditis | 345 | ||
| Cardiac Tamponade | 345 | ||
| Cor Pulmonale | 346 | ||
| Myocardial Infarction | 346 | ||
| Myocarditis | 347 | ||
| Heart Rate and Rhythm | 347 | ||
| Conduction Disturbances | 347 | ||
| Sick Sinus Syndrome | 347 | ||
| Ventricular Septal Defect (VSD) | 351 | ||
| Tetralogy of Fallot | 351 | ||
| Patent Ductus Arteriosus | 352 | ||
| Atrial Septal Defect (ASD) | 353 | ||
| Acute Rheumatic Fever | 353 | ||
| Atherosclerotic Heart Disease (Atherosclerosis, Coronary Heart Disease) | 354 | ||
| Senile Cardiac Amyloidosis | 354 | ||
| 16 Blood Vessels | 355 | ||
| Anatomy and Physiology | 355 | ||
| Blood Circulation | 355 | ||
| Arterial Pulse and Pressure | 359 | ||
| Jugular Venous Pulse and Pressure | 359 | ||
| Infants and Children | 359 | ||
| Pregnant Patients | 360 | ||
| Older Adults | 360 | ||
| Review of Related History | 360 | ||
| History of Present Illness | 360 | ||
| Past Medical History | 361 | ||
| Family History | 361 | ||
| Personal and Social History | 361 | ||
| Infants and Children | 361 | ||
| Pregnant Patients | 361 | ||
| Older Adults | 361 | ||
| Examination and Findings | 361 | ||
| Equipment | 361 | ||
| Palpation | 361 | ||
| Auscultation | 363 | ||
| Assessment for Peripheral Arterial Disease | 363 | ||
| Peripheral Veins | 365 | ||
| Jugular Venous Pressure | 365 | ||
| Hepatojugular Reflux | 366 | ||
| Evaluation of Hand Veins | 366 | ||
| Assessment for Venous Obstruction and Insufficiency | 367 | ||
| Thrombosis. | 367 | ||
| Edema. | 367 | ||
| Varicose Veins. | 367 | ||
| Infants | 368 | ||
| Children | 368 | ||
| Pregnant Patients | 368 | ||
| Older Adults | 368 | ||
| Abnormalities | 369 | ||
| Vessel Disorders | 369 | ||
| Temporal Arteritis (Giant Cell Arteritis) | 369 | ||
| Arterial Aneurysm | 369 | ||
| Arteriovenous Fistula | 369 | ||
| Peripheral Arterial Disease | 369 | ||
| Raynaud Phenomenon | 370 | ||
| Arterial Embolic Disease | 370 | ||
| Venous Thrombosis | 370 | ||
| Jugular Venous Pressure Disorder | 371 | ||
| Tricuspid Regurgitation | 371 | ||
| Coarctation of the Aorta | 371 | ||
| Kawasaki Disease | 372 | ||
| Preeclampsia-Eclampsia | 372 | ||
| Venous Ulcers | 372 | ||
| 17 Breasts and Axillae | 373 | ||
| Anatomy and Physiology | 373 | ||
| Children and Adolescents | 375 | ||
| Pregnant Patients | 375 | ||
| Lactating Patients | 375 | ||
| Older Adults | 376 | ||
| Review of Related History | 376 | ||
| History of Present Illness | 376 | ||
| Past Medical History | 376 | ||
| Family History | 377 | ||
| Personal and Social History | 377 | ||
| Pregnant Patients | 377 | ||
| Lactating Patients | 377 | ||
| Older Adults | 377 | ||
| Examination and Findings | 378 | ||
| Equipment | 378 | ||
| Inspection | 378 | ||
| Breasts | 378 | ||
| Nipples and Areolae | 379 | ||
| Reinspection in Varied Positions | 381 | ||
| Palpation | 382 | ||
| Patient in Seated Position | 382 | ||
| Chest Wall Sweep. | 382 | ||
| Bimanual Digital Palpation. | 382 | ||
| Lymph Node Palpation. | 382 | ||
| Patient in Supine Position | 383 | ||
| Patients With Female Breasts. | 384 | ||
| Patients With Male Breasts. | 385 | ||
| Infants | 385 | ||
| Children and Adolescents | 386 | ||
| Pregnant Patients | 386 | ||
| Lactating Patients | 386 | ||
| Older Adults | 387 | ||
| Abnormalities | 387 | ||
| Breasts | 387 | ||
| Breast Lumps | 387 | ||
| Fibrocystic Changes | 388 | ||
| Fibroadenoma | 388 | ||
| Malignant Breast Tumors | 388 | ||
| Fat Necrosis | 389 | ||
| Nipples and Areolae | 389 | ||
| Intraductal Papillomas and Papillomatosis | 389 | ||
| Duct Ectasia | 389 | ||
| Galactorrhea | 390 | ||
| Paget Disease | 390 | ||
| Mastitis | 391 | ||
| Gynecomastia | 391 | ||
| Premature Thelarche | 392 | ||
| 18 Abdomen | 393 | ||
| Anatomy and Physiology | 393 | ||
| Musculature and Connective Tissues | 393 | ||
| Alimentary Tract | 393 | ||
| Liver | 395 | ||
| Gallbladder | 396 | ||
| Pancreas | 396 | ||
| Spleen | 396 | ||
| Kidneys, Ureters, and Bladder | 396 | ||
| Vasculature | 396 | ||
| Infants | 396 | ||
| Pregnant Patients | 397 | ||
| Older Adults | 397 | ||
| Review of Related History | 398 | ||
| History of Present Illness | 398 | ||
| Past Medical History | 400 | ||
| Family History | 400 | ||
| Personal and Social History | 400 | ||
| Infants | 400 | ||
| Children | 400 | ||
| Pregnant Patients | 400 | ||
| Older Adults | 401 | ||
| Examination and Findings | 401 | ||
| Equipment | 401 | ||
| Preparation | 401 | ||
| Inspection | 401 | ||
| Surface Characteristics | 401 | ||
| Contour | 403 | ||
| Movement | 404 | ||
| Auscultation | 404 | ||
| Bowel Sounds | 404 | ||
| Additional Sounds and Bruits | 404 | ||
| Percussion | 405 | ||
| Liver Span | 405 | ||
| Spleen | 406 | ||
| Gastric Bubble | 406 | ||
| Kidneys | 406 | ||
| Palpation | 406 | ||
| Light Palpation | 406 | ||
| Moderate Palpation | 407 | ||
| Deep Palpation | 407 | ||
| Masses | 408 | ||
| Umbilical Ring | 408 | ||
| Palpation of Specific Organs and Structures | 408 | ||
| Liver. | 408 | ||
| Liver: Alternative Techniques. | 409 | ||
| Gallbladder. | 409 | ||
| Spleen. | 409 | ||
| Left Kidney. | 410 | ||
| Right Kidney. | 410 | ||
| Aorta. | 411 | ||
| Urinary Bladder. | 411 | ||
| Advanced Skills | 411 | ||
| Ascites Assessment | 411 | ||
| Shifting Dullness. | 411 | ||
| Fluid Wave. | 411 | ||
| Pain Assessment | 412 | ||
| Abdominal Signs | 414 | ||
| Rebound Tenderness | 414 | ||
| Iliopsoas Muscle Test | 415 | ||
| Obturator Muscle Test | 415 | ||
| Ballottement | 416 | ||
| Infants and Children | 416 | ||
| Inspection | 416 | ||
| Auscultation and Percussion | 418 | ||
| Palpation | 418 | ||
| Liver Palpation | 419 | ||
| Deep Palpation | 419 | ||
| Adolescents | 420 | ||
| Pregnant Patients | 420 | ||
| Older Adults | 421 | ||
| Abnormalities | 422 | ||
| Abdomen | 422 | ||
| Alimentary Tract | 422 | ||
| Acute Diarrhea | 422 | ||
| Gastroesophageal Reflux Disease | 422 | ||
| Irritable Bowel Syndrome | 423 | ||
| Hiatal Hernia With Esophagitis | 423 | ||
| Duodenal Ulcer (Duodenal Peptic Ulcer Disease) | 424 | ||
| Crohn Disease | 424 | ||
| Ulcerative Colitis | 425 | ||
| Stomach Cancer | 425 | ||
| Diverticular Disease | 425 | ||
| Colon Cancer (Colorectal Cancer) | 426 | ||
| Hepatobiliary System | 426 | ||
| Hepatitis | 426 | ||
| Cirrhosis | 427 | ||
| Primary Hepatocellular Carcinoma | 427 | ||
| Cholelithiasis | 427 | ||
| Cholecystitis | 428 | ||
| Nonalcoholic Fatty Liver Disease (NAFLD) | 428 | ||
| Pancreas | 429 | ||
| Acute Pancreatitis | 429 | ||
| Chronic Pancreatitis | 429 | ||
| Spleen | 429 | ||
| Spleen Laceration/Rupture | 429 | ||
| Kidney | 430 | ||
| Acute Glomerulonephritis | 430 | ||
| Hydronephrosis | 430 | ||
| Pyelonephritis | 430 | ||
| Renal Abscess | 431 | ||
| Renal Calculi | 431 | ||
| Intussusception | 431 | ||
| Pyloric Stenosis | 432 | ||
| Meconium Ileus | 432 | ||
| Biliary Atresia | 433 | ||
| Meckel Diverticulum | 433 | ||
| Necrotizing Enterocolitis | 434 | ||
| Neuroblastoma | 434 | ||
| Wilms Tumor (Nephroblastoma) | 434 | ||
| Hirschsprung Disease (Congenital Aganglionic Megacolon) | 435 | ||
| Hemolytic Uremic Syndrome (HUS) | 435 | ||
| Fecal Incontinence | 435 | ||
| 19 Female Genitalia | 437 | ||
| Anatomy and Physiology | 437 | ||
| External Genitalia | 437 | ||
| Internal Genitalia | 438 | ||
| Bony Pelvis | 440 | ||
| Infants and Children | 443 | ||
| Adolescents | 443 | ||
| Pregnant Patients | 443 | ||
| Older Adults | 444 | ||
| Review of Related History | 444 | ||
| History of Present Illness | 444 | ||
| Past Medical History | 445 | ||
| Family History | 447 | ||
| Personal and Social History | 447 | ||
| Infants and Children | 447 | ||
| Adolescents | 447 | ||
| Pregnant Patients | 448 | ||
| Older Adults | 448 | ||
| Examination and Findings | 448 | ||
| Equipment | 448 | ||
| Preparation | 449 | ||
| Positioning | 449 | ||
| Draping and Gloving | 449 | ||
| External Examination | 449 | ||
| Inspection and Palpation | 449 | ||
| Labia Majora | 450 | ||
| Labia Minora | 450 | ||
| Clitoris | 450 | ||
| Urethral Orifice | 450 | ||
| Vaginal Introitus | 450 | ||
| Skene and Bartholin Glands | 450 | ||
| Muscle Tone | 451 | ||
| Perineum | 451 | ||
| Anus | 451 | ||
| Internal Examination | 451 | ||
| Preparation | 451 | ||
| Insertion of Speculum | 452 | ||
| Cervix | 452 | ||
| Color. | 452 | ||
| Position. | 452 | ||
| Surface Characteristics. | 452 | ||
| Discharge. | 454 | ||
| Size and Shape. | 454 | ||
| Withdrawal of Speculum | 454 | ||
| Bimanual Examination | 454 | ||
| Cervix | 458 | ||
| Uterus | 458 | ||
| Position. | 458 | ||
| Size, Shape, and Contour. | 459 | ||
| Mobility. | 460 | ||
| Adnexa and Ovaries | 460 | ||
| Rectovaginal Examination | 460 | ||
| Preparation | 460 | ||
| Anal Sphincter | 460 | ||
| Rectal Walls and Rectovaginal Septum | 460 | ||
| Uterus | 461 | ||
| Adnexa | 461 | ||
| Stool | 461 | ||
| Completion | 461 | ||
| Infants | 461 | ||
| Indications for Examination | 461 | ||
| Inspection and Palpation | 462 | ||
| Discharge | 462 | ||
| Injuries | 462 | ||
| Bleeding | 463 | ||
| Rectal Examination | 463 | ||
| Adolescents | 464 | ||
| Pregnant Patients | 464 | ||
| Gestational Age | 464 | ||
| Uterus Size and Contour | 464 | ||
| Pelvic Examination | 465 | ||
| Cervical Effacement and Dilation | 465 | ||
| Fetal Well-Being | 465 | ||
| Fetal Position | 466 | ||
| Station | 467 | ||
| Contractions | 467 | ||
| Fetal Head Position | 467 | ||
| Other Pregnancy-Associated Changes | 469 | ||
| Older Adults | 469 | ||
| Preparation | 470 | ||
| Alternative Positions for the Pelvic Examination | 470 | ||
| Knee-Chest Position. | 470 | ||
| Diamond-Shaped Position. | 470 | ||
| Obstetric Stirrups Position. | 470 | ||
| M-Shaped Position. | 471 | ||
| V-Shaped Position. | 471 | ||
| Patients With Sensory Impairment | 471 | ||
| Abnormalities | 472 | ||
| Female Genitalia | 472 | ||
| Premenstrual Syndrome (PMS) | 472 | ||
| Infertility | 472 | ||
| Endometriosis | 473 | ||
| Lesions From Sexually Transmitted Infections | 473 | ||
| Condyloma Acuminatum (Genital Warts) | 473 | ||
| Molluscum Contagiosum | 474 | ||
| Syphilitic Chancre | 474 | ||
| Condyloma Latum | 475 | ||
| Genital Herpes | 475 | ||
| Vulva and Vagina | 476 | ||
| Inflammation of Bartholin Gland | 476 | ||
| Vaginal Carcinoma | 476 | ||
| Vulvar Carcinoma | 477 | ||
| Vaginal Infections | 477 | ||
| Cervix | 478 | ||
| Cervical Cancer | 478 | ||
| Uterus | 479 | ||
| Uterine Prolapse | 479 | ||
| Uterine Bleeding | 480 | ||
| Myomas (Leiomyomas, Fibroids) | 481 | ||
| Endometrial Cancer | 481 | ||
| Adnexa | 482 | ||
| Ovarian Cysts | 482 | ||
| Ovarian Cancer | 482 | ||
| Tubal (Ectopic) Pregnancy | 483 | ||
| Pelvic Inflammatory Disease (PID) | 483 | ||
| Salpingitis | 484 | ||
| Ambiguous Genitalia | 484 | ||
| Hydrocolpos | 485 | ||
| Vulvovaginitis | 486 | ||
| Premature Rupture of Membranes | 486 | ||
| Vaginal Bleeding During Pregnancy | 487 | ||
| Atrophic Vaginitis | 487 | ||
| Urinary Incontinence | 487 | ||
| 20 Male Genitalia | 488 | ||
| Anatomy and Physiology | 488 | ||
| Infants and Children | 490 | ||
| Adolescents | 490 | ||
| Older Adults | 490 | ||
| Review of Related History | 490 | ||
| History of Present Illness | 490 | ||
| Past Medical History | 491 | ||
| Family History | 491 | ||
| Personal and Social History | 491 | ||
| Infants and Children | 491 | ||
| Adolescents | 491 | ||
| Older Adults | 491 | ||
| Examination and Findings | 492 | ||
| Equipment | 492 | ||
| Inspection and Palpation | 493 | ||
| Genital Hair Distribution | 493 | ||
| Penis | 493 | ||
| Urethral Meatus | 494 | ||
| Penile Shaft | 494 | ||
| Scrotum | 494 | ||
| Hernia | 495 | ||
| Testes | 495 | ||
| Cremasteric Reflex | 496 | ||
| Prostate | 496 | ||
| Infants | 496 | ||
| Inspection and Palpation | 496 | ||
| Transillumination | 497 | ||
| Children | 497 | ||
| Inspection and Palpation | 497 | ||
| Adolescents | 497 | ||
| Older Adults | 498 | ||
| Abnormalities | 498 | ||
| Hernias | 498 | ||
| Hernia | 498 | ||
| Penis | 499 | ||
| Paraphimosis | 499 | ||
| Chancre | 500 | ||
| Genital Herpes | 500 | ||
| Condyloma Acuminata | 501 | ||
| Lymphogranuloma Venereum | 501 | ||
| Molluscum Contagiosum | 502 | ||
| Peyronie Disease | 502 | ||
| Penile Cancer | 502 | ||
| Scrotum | 503 | ||
| Spermatocele | 503 | ||
| Varicocele | 503 | ||
| Orchitis | 503 | ||
| Epididymitis | 504 | ||
| Testicular Cancer | 505 | ||
| Infertility | 505 | ||
| Congenital Anomalies | 505 | ||
| Ambiguous Genitalia | 505 | ||
| Hypospadias | 505 | ||
| Scrotum | 506 | ||
| Hydrocele | 506 | ||
| Testicular Torsion | 506 | ||
| Klinefelter Syndrome | 506 | ||
| 21 Anus, Rectum, and Prostate | 507 | ||
| Anatomy and Physiology | 507 | ||
| Infants and Children | 508 | ||
| Pregnant Patients | 508 | ||
| Older Adults | 508 | ||
| Review of Related History | 509 | ||
| History of Present Illness | 509 | ||
| Past Medical History | 510 | ||
| Family History | 510 | ||
| Personal and Social History | 510 | ||
| Infants and Children | 510 | ||
| Pregnant Patients | 510 | ||
| Older Adults | 511 | ||
| Examination and Findings | 511 | ||
| Equipment | 511 | ||
| Preparation | 511 | ||
| Positioning | 511 | ||
| Sacrococcygeal and Perianal Areas | 511 | ||
| Anus | 511 | ||
| Sphincter | 511 | ||
| Anal Ring | 512 | ||
| Lateral and Posterior Rectal Walls | 512 | ||
| Bidigital Palpation | 512 | ||
| Anterior Rectal Wall | 513 | ||
| Prostate | 513 | ||
| Uterus and Cervix | 513 | ||
| Stool | 513 | ||
| Infants and Children | 514 | ||
| Pregnant Patients | 515 | ||
| Older Adults | 515 | ||
| Abnormalities | 516 | ||
| Anus, Rectum, and Surrounding Skin | 516 | ||
| Pilonidal Cyst | 516 | ||
| Anal Warts (Condyloma Acuminata) | 516 | ||
| Perianal and Perirectal Abscesses | 517 | ||
| Anorectal Fissure | 517 | ||
| Anal Fistula | 517 | ||
| Pruritus Ani | 518 | ||
| Hemorrhoids | 518 | ||
| Polyps | 518 | ||
| Anal Cancer | 519 | ||
| Colorectal Cancer | 519 | ||
| Prostate | 520 | ||
| Prostatitis | 520 | ||
| Benign Prostatic Hypertrophy (BPH) | 520 | ||
| Prostate Cancer | 521 | ||
| Imperforate Anus | 521 | ||
| Enterobiasis (Roundworm, Pinworm) | 522 | ||
| 22 Musculoskeletal System | 523 | ||
| Anatomy and Physiology | 524 | ||
| Upper Extremities | 524 | ||
| Head and Spine | 527 | ||
| Lower Extremities | 527 | ||
| Infants and Children | 529 | ||
| Adolescents | 530 | ||
| Pregnant Patients | 530 | ||
| Older Adults | 530 | ||
| Review of Related History | 530 | ||
| History of Present Illness | 530 | ||
| Past Medical History | 531 | ||
| Family History | 531 | ||
| Personal and Social History | 531 | ||
| Infants and Children | 531 | ||
| Pregnant Patients | 531 | ||
| Older Adults | 531 | ||
| Examination and Findings | 532 | ||
| Equipment | 532 | ||
| Inspection | 532 | ||
| Palpation | 533 | ||
| Range of Motion and Muscle Tone | 533 | ||
| Muscle Strength | 533 | ||
| Specific Joints and Muscles | 534 | ||
| Hands and Wrists | 534 | ||
| Elbows | 535 | ||
| Shoulders | 537 | ||
| Temporomandibular Joint | 538 | ||
| Cervical Spine | 538 | ||
| Thoracic and Lumbar Spine | 540 | ||
| Hips | 542 | ||
| Legs and Knees | 544 | ||
| Feet and Ankles | 544 | ||
| Advanced Skills | 546 | ||
| Hand and Wrist Assessment | 546 | ||
| Shoulder Assessment | 548 | ||
| Lower Spine Assessment | 549 | ||
| Hip Assessment | 549 | ||
| Knee Assessment | 549 | ||
| Limb Measurement | 551 | ||
| Infants | 552 | ||
| Children | 554 | ||
| Adolescents | 555 | ||
| Pregnant Patients | 555 | ||
| Older Adults | 556 | ||
| Abnormalities | 558 | ||
| Musculoskeletal | 558 | ||
| Ankylosing Spondylitis | 558 | ||
| Lumbosacral Radiculopathy (Herniated Lumbar Disk) | 558 | ||
| Lumbar Stenosis | 559 | ||
| Carpal Tunnel Syndrome | 559 | ||
| Gout | 559 | ||
| Temporomandibular Joint Syndrome | 559 | ||
| Osteomyelitis | 560 | ||
| Bursitis | 560 | ||
| Paget Disease of the Bone (Osteitis Deformans) | 560 | ||
| Osteoarthritis | 561 | ||
| Rheumatoid Arthritis | 561 | ||
| Sports Injuries | 562 | ||
| Muscle Strain | 562 | ||
| Dislocation | 562 | ||
| Fracture | 563 | ||
| Tenosynovitis (Tendonitis) | 563 | ||
| Rotator Cuff Tear | 563 | ||
| Clubfoot (Talipes Equinovarus) | 563 | ||
| Metatarsus Adductus (Metatarsus Varus) | 564 | ||
| Legg-Calvé-Perthes Disease | 564 | ||
| Osgood-Schlatter Disease | 564 | ||
| Slipped Capital Femoral Epiphysis | 565 | ||
| Muscular Dystrophy | 565 | ||
| Scoliosis | 565 | ||
| Radial Head Subluxation (Nursemaid’s Elbow) | 566 | ||
| Osteoporosis | 566 | ||
| Dupuytren Contracture | 566 | ||
| 23 Neurologic System | 567 | ||
| Anatomy and Physiology | 567 | ||
| Brain | 567 | ||
| Cerebrum | 568 | ||
| Cerebellum | 569 | ||
| Brainstem | 569 | ||
| Cranial Nerves | 569 | ||
| Spinal Cord and Spinal Tracts | 569 | ||
| Spinal Nerves | 571 | ||
| Infants and Children | 572 | ||
| Pregnant Patients | 573 | ||
| Older Adults | 573 | ||
| Review of Related History | 573 | ||
| History of Present Illness | 573 | ||
| Seizures or Convulsions | 573 | ||
| Pain | 573 | ||
| Gait Coordination | 573 | ||
| Weakness or Paresthesia | 574 | ||
| Tremor | 574 | ||
| Past Medical History | 574 | ||
| Family History | 574 | ||
| Personal and Social History | 574 | ||
| Infants | 574 | ||
| Children | 575 | ||
| Pregnant Patients | 575 | ||
| Older Adults | 575 | ||
| Examination and Findings | 575 | ||
| Equipment | 575 | ||
| Cranial Nerves | 575 | ||
| Olfactory (I) | 576 | ||
| Optic (II) | 577 | ||
| Oculomotor, Trochlear, and Abducens (III, IV, and VI) | 577 | ||
| Trigeminal (V) | 577 | ||
| Facial (VII) | 577 | ||
| Acoustic (VIII) | 579 | ||
| Glossopharyngeal (IX) | 579 | ||
| Vagus (X) | 579 | ||
| Spinal Accessory (XI) | 579 | ||
| Hypoglossal (XII) | 579 | ||
| Proprioception and Cerebellar Function | 580 | ||
| Coordination and Fine Motor Skills | 580 | ||
| Rapid Rhythmic Alternating Movements | 580 | ||
| Accuracy of Movements | 580 | ||
| Balance | 581 | ||
| Equilibrium. | 581 | ||
| Gait. | 581 | ||
| Sensory Function | 582 | ||
| Primary Sensory Functions | 583 | ||
| Superficial Touch. | 583 | ||
| Superficial Pain. | 583 | ||
| Temperature and Deep Pressure. | 583 | ||
| Vibration. | 583 | ||
| Position of Joints. | 585 | ||
| Cortical Sensory Functions | 585 | ||
| Stereognosis. | 585 | ||
| Two-Point Discrimination. | 585 | ||
| Extinction Phenomenon. | 585 | ||
| Graphesthesia. | 585 | ||
| Point Location. | 586 | ||
| Reflexes | 586 | ||
| Superficial Reflexes | 586 | ||
| Plantar Reflex. | 586 | ||
| Abdominal Reflex. | 587 | ||
| Cremasteric Reflex. | 587 | ||
| Deep Tendon Reflexes | 587 | ||
| Biceps Reflex. | 587 | ||
| Brachioradial Reflex. | 588 | ||
| Triceps Reflex. | 588 | ||
| Patellar Reflex. | 588 | ||
| Achilles Reflex. | 588 | ||
| Clonus. | 588 | ||
| Advanced Skills | 588 | ||
| Protective Sensation | 588 | ||
| Meningeal Signs | 588 | ||
| Jolt Accentuation of Headache | 589 | ||
| Posturing | 589 | ||
| Infants | 590 | ||
| Children | 592 | ||
| Pregnant Patients | 593 | ||
| Older Adults | 593 | ||
| Abnormalities | 596 | ||
| Neurologic System | 596 | ||
| Disorders of the Central Nervous System | 596 | ||
| Multiple Sclerosis (MS) | 596 | ||
| Seizure Disorder (Epilepsy) | 597 | ||
| Encephalitis | 597 | ||
| Meningitis | 597 | ||
| Intracranial Tumor | 598 | ||
| Pseudotumor Cerebri | 598 | ||
| Stroke (Brain Attack or Cerebrovascular Accident) | 599 | ||
| Disorders of the Peripheral Nervous System | 601 | ||
| Myasthenia Gravis | 601 | ||
| Guillain-Barré Syndrome | 601 | ||
| Trigeminal Neuralgia (Tic Douloureux) | 602 | ||
| Bell Palsy | 602 | ||
| Peripheral Neuropathy | 603 | ||
| Cerebral Palsy (CP) | 603 | ||
| Myelomeningocele (Spina Bifida) | 604 | ||
| Shaken Baby Syndrome | 604 | ||
| Older Adults | 605 | ||
| Parkinson Disease | 605 | ||
| Normal Pressure Hydrocephalus | 606 | ||
| Postpolio Syndrome (Progressive Postpoliomyelitis Muscular Atrophy) | 606 | ||
| 24 Sports Participation Evaluation | 607 | ||
| 25 Putting It All Together | 619 | ||
| At the Start | 619 | ||
| Accuracy | 620 | ||
| The Potential for Error | 621 | ||
| Uncertainty | 621 | ||
| Examination Sequence | 621 | ||
| Adults and Adolescents | 621 | ||
| General Inspection | 621 | ||
| Preparation | 622 | ||
| Measurements | 622 | ||
| Patient Seated, Wearing Gown | 623 | ||
| Head and Face | 623 | ||
| Eyes | 623 | ||
| Ears | 623 | ||
| Nose | 623 | ||
| Mouth and Pharynx | 623 | ||
| Neck | 624 | ||
| Upper Extremities | 624 | ||
| Patient Seated, Back Exposed | 624 | ||
| Back and Posterior Chest | 624 | ||
| Lungs | 624 | ||
| Patient Seated, Chest Exposed | 624 | ||
| Anterior, Chest, Lungs, and Heart | 624 | ||
| 26 Emergency or Life-Threatening Situations | 636 | ||
| Emergency Assessment of the Injured Patient | 636 | ||
| The Primary Survey | 636 | ||
| Hemorrhage. | 636 | ||
| Airway and Cervical Spine. | 636 | ||
| Breathing. | 636 | ||
| Circulation. | 637 | ||
| Disability. | 638 | ||
| Exposure and Environmental Control. | 638 | ||
| Secondary Assessment of the Injured Patient | 639 | ||
| History. | 639 | ||
| Head and Neck. | 639 | ||
| Chest. | 639 | ||
| Abdomen. | 640 | ||
| Extremities and Back. | 640 | ||
| Rectum and Perineum. | 640 | ||
| Neurologic Examination. | 640 | ||
| Reevaluate the Patient. | 640 | ||
| Injury Mechanisms | 641 | ||
| Blunt Trauma | 641 | ||
| Penetrating Trauma | 641 | ||
| Burns | 641 | ||
| Assessment of an Acute Medical Emergency | 641 | ||
| Advanced Cardiac Life Support Survey | 641 | ||
| Infants and Children | 642 | ||
| Older Adults | 642 | ||
| Legal Considerations | 645 | ||
| Records | 645 | ||
| Consent for Treatment | 645 | ||
| Trauma Due to Violence | 646 | ||
| Medical Orders for Life-Sustaining Treatment | 646 | ||
| Summary | 646 | ||
| Abnormalities | 646 | ||
| Upper Airway Obstruction | 646 | ||
| Hypoxemia | 646 | ||
| Shock State | 647 | ||
| Ventilatory Failure | 647 | ||
| Increased Intracranial Pressure | 648 | ||
| Pulmonary Embolism | 648 | ||
| Status Asthmaticus | 649 | ||
| Status Epilepticus | 649 | ||
| Photo and Illustration Credits | 650 | ||
| References | 655 | ||
| Chapter 1 | 655 | ||
| Chapter 2 | 656 | ||
| Chapter 3 | 657 | ||
| Chapter 4 | 657 | ||
| Chapter 5 | 658 | ||
| Chapter 6 | 658 | ||
| Chapter 7 | 658 | ||
| Chapter 8 | 659 | ||
| Chapter 9 | 660 | ||
| Chapter 10 | 661 | ||
| Chapter 11 | 661 | ||
| Chapter 12 | 661 | ||
| Chapter 13 | 662 | ||
| Chapter 14 | 662 | ||
| Chapter 15 | 662 | ||
| Chapter 16 | 663 | ||
| Chapter 17 | 663 | ||
| Chapter 18 | 663 | ||
| Chapter 19 | 664 | ||
| Chapter 20 | 665 | ||
| Chapter 21 | 665 | ||
| Chapter 22 | 665 | ||
| Chapter 23 | 665 | ||
| Chapter 24 | 666 | ||
| Chapter 25 | 666 | ||
| Chapter 26 | 667 | ||
| Appendix A Height/Weight Growth Charts | 668 | ||
| Appendix B Pediatric Blood Pressure Tables | 672 | ||
| Index | 677 | ||
| A | 677 | ||
| B | 679 | ||
| C | 681 | ||
| D | 683 | ||
| E | 684 | ||
| F | 686 | ||
| G | 687 | ||
| H | 688 | ||
| I | 689 | ||
| J | 691 | ||
| K | 691 | ||
| L | 691 | ||
| M | 692 | ||
| N | 693 | ||
| O | 694 | ||
| P | 695 | ||
| Q | 698 | ||
| R | 699 | ||
| S | 699 | ||
| T | 702 | ||
| U | 703 | ||
| V | 703 | ||
| W | 704 | ||
| X | 704 | ||
| Z | 704 | ||
| Special Features | IBC1 |