Additional Information
Book Details
Abstract
Hutchison’s Clinical Methods, first published over a century ago, is the classic textbook on clinical skills. It provides an outstanding source of learning and reference for undergraduate medical students and postgraduate doctors. It seeks to teach an integrated approach to clinical practice, so that new methods and investigations are grafted onto established patterns of clinical practice, rather than added on as something extra. The text is organised so that both system-related and problem-oriented chapters are included. Particular emphasis is placed on the importance of the doctor-patient relationship, the essential skills needed for clinical examination, and for planning the appropriate choice of investigations in diagnosis and management.
- Provides a comprehensive account of the traditional methods of patient history-taking and examination but updated with a full account of the role of modern investigative techniques.
- A book for students of all ages and all degrees of experience.
- The most comprehensive account of clinical methods on the market.
- New editorial team on the 23rd Edition continue to set the highest standards of content and presentation
- A planned condensation of some sections will allow a slimmer volume but still retain extensive coverage of all major areas of clinical examination and investigation
- Further details of new edition to follow
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Hutchison's Clinical Methods | i | ||
| Copyright Page | iv | ||
| Preface to the twenty-third edition | v | ||
| Dedication | vii | ||
| Contributors | ix | ||
| Table Of Contents | xi | ||
| 1 General patient assessment | 1 | ||
| 1 Doctor and patient: | 3 | ||
| Introduction | 3 | ||
| Setting the scene | 3 | ||
| History taking | 4 | ||
| Beginning the history | 4 | ||
| Developing themes | 5 | ||
| Non-verbal communication | 5 | ||
| Vocabulary | 5 | ||
| Indirect and direct questions | 6 | ||
| Disease-centred versus patient-centred | 6 | ||
| Judging the severity of symptoms | 7 | ||
| Which issues are important? | 7 | ||
| A schematic history | 7 | ||
| Direct questions about bodily systems | 8 | ||
| Clarifying detail | 8 | ||
| Pain | 8 | ||
| Drug history | 9 | ||
| Family history | 9 | ||
| Occupational history | 9 | ||
| Alcohol history | 9 | ||
| Retrospective history | 10 | ||
| Particular situations | 10 | ||
| Garrulous patients | 10 | ||
| Angry patients | 11 | ||
| The well-informed patient | 11 | ||
| Accompanying persons | 11 | ||
| Using interpreters/advocates | 12 | ||
| Analysing symptoms | 12 | ||
| ‘Hard and soft’ symptoms | 12 | ||
| Time course | 13 | ||
| Pattern recognition versus logical analysis | 13 | ||
| Negative data | 13 | ||
| What does the patient actually want? | 13 | ||
| Retaking the history | 14 | ||
| Note taking | 14 | ||
| Conclusion | 14 | ||
| 2 General patient examination and differential diagnosis | 15 | ||
| Introduction | 15 | ||
| General examination of a patient | 15 | ||
| Posture and gait | 16 | ||
| Speech and interaction | 16 | ||
| Physique and nutrition | 16 | ||
| Temperature | 16 | ||
| Hands | 17 | ||
| Odours | 18 | ||
| Lymph glands and lymphadenopathy | 19 | ||
| Axillae | 20 | ||
| Skin | 20 | ||
| Pulses | 21 | ||
| Legs and feet | 22 | ||
| Breasts | 23 | ||
| Putting it all together | 24 | ||
| General | 24 | ||
| Mouth and pharynx | 24 | ||
| Hands | 24 | ||
| Cardiovascular and respiratory (anterior, patient semi-recumbent) | 24 | ||
| Cardiovascular and respiratory (posterior, sitting forward) | 25 | ||
| Neck (while sitting forward) | 25 | ||
| Abdomen | 25 | ||
| Upper limbs | 25 | ||
| Lower limbs | 25 | ||
| Cranial nerves | 25 | ||
| Documentation and communication | 25 | ||
| Constructing a differential diagnosis | 27 | ||
| Multiple causation | 28 | ||
| The beginnings of a management plan | 28 | ||
| Selecting appropriate investigations | 29 | ||
| Summary | 30 | ||
| 3 Ethical considerations | 31 | ||
| Introduction | 31 | ||
| Autonomy | 31 | ||
| Consent | 31 | ||
| Obtaining consent | 32 | ||
| Setting the scene | 32 | ||
| Implications of consent or refusal | 32 | ||
| Legal requirements for consent | 32 | ||
| Competence and capacity for consent | 32 | ||
| Appropriately informed | 33 | ||
| Confidentiality | 33 | ||
| With permission | 33 | ||
| In the patient’s interests | 33 | ||
| An overriding duty to society | 33 | ||
| Statutory disclosure | 33 | ||
| Inspection of medical records | 33 | ||
| After death | 34 | ||
| Organ donation | 34 | ||
| Resuscitation | 34 | ||
| Not for resuscitation | 34 | ||
| Consent for autopsy | 34 | ||
| Other ethical problems | 34 | ||
| Medical negligence | 34 | ||
| HIV | 35 | ||
| Genetics | 35 | ||
| Genetic counselling | 35 | ||
| Principles of medical ethics | 36 | ||
| 2 Assessment in particular patient groups | 37 | ||
| 4 Women | 39 | ||
| Introduction | 39 | ||
| Gynaecological history | 39 | ||
| Presenting complaint | 39 | ||
| History of presenting complaint | 39 | ||
| Menstrual history | 40 | ||
| Vaginal discharge | 40 | ||
| Urinary tract and uterovaginal prolapse symptoms | 40 | ||
| Sexual symptoms | 41 | ||
| Cervical cytology history | 41 | ||
| Past gynaecological history | 41 | ||
| Obstetric history | 41 | ||
| Past medical/surgical/anaesthetic history | 41 | ||
| Medication or treatment history | 42 | ||
| Social history | 42 | ||
| Family history | 42 | ||
| Gynaecological examination | 42 | ||
| Abdominal examination | 42 | ||
| Pelvic examination | 42 | ||
| Pelvic examination in special circumstances | 44 | ||
| Vaginal bleeding | 44 | ||
| Cervical smear | 44 | ||
| Examination under general anaesthesia | 44 | ||
| Vaginismus | 44 | ||
| Intact hymen | 45 | ||
| Pregnancy | 45 | ||
| Speculum examination | 45 | ||
| Taking a cervical (Papanicolaou) smear | 47 | ||
| Assessment for prolapse | 47 | ||
| Obstetric history | 47 | ||
| Present obstetric history | 47 | ||
| Past obstetric history | 48 | ||
| Drug/smoking/alcohol history | 48 | ||
| Family history | 48 | ||
| Social history | 48 | ||
| Presentation of obstetric cases | 48 | ||
| Obstetric examination | 48 | ||
| General examination | 48 | ||
| Abdominal examination in pregnancy | 48 | ||
| Vaginal examination in pregnancy | 50 | ||
| Vaginal examination in labour | 51 | ||
| Investigations in obstetrics and gynaecology | 51 | ||
| Pregnancy testing | 51 | ||
| Bacteriological and virus tests | 52 | ||
| Imaging | 52 | ||
| Hysterosalpingography | 52 | ||
| Pelvimetry | 52 | ||
| Ultrasound | 52 | ||
| Computed tomography and magnetic resonance imaging | 53 | ||
| Endometrial sampling (biopsy) | 53 | ||
| Colposcopy | 53 | ||
| Hysteroscopy | 53 | ||
| Cystoscopy and cystometry | 53 | ||
| Laparoscopy | 54 | ||
| Tests of fetal wellbeing | 54 | ||
| Biochemical tests | 54 | ||
| Early pregnancy markers | 54 | ||
| α-Fetoprotein (AFP), unconjugated oestriol, βhCG, inhibin A, PAPP A | 54 | ||
| Late pregnancy | 54 | ||
| Biological tests | 55 | ||
| Chorion biopsy (chorionic villus sampling; CVS) | 55 | ||
| Amniocentesis | 55 | ||
| Biophysical tests | 56 | ||
| Fetal movements | 56 | ||
| Cardiotocography (CTG) | 56 | ||
| Ultrasound visualization | 56 | ||
| Doppler blood flow | 56 | ||
| Placental volume | 56 | ||
| 5 Children and adolescents | 57 | ||
| Introduction | 57 | ||
| History | 57 | ||
| Family history | 58 | ||
| Social history | 58 | ||
| Examination | 60 | ||
| General examination | 60 | ||
| The limbs | 60 | ||
| The head, face and neck | 61 | ||
| The abdomen | 62 | ||
| The chest | 63 | ||
| Neurological examination | 64 | ||
| The eyes | 65 | ||
| The genitalia, groins and anus | 66 | ||
| The nose, ears, mouth and throat | 66 | ||
| Routine measurements | 67 | ||
| Height and weight | 67 | ||
| Head circumference | 72 | ||
| Blood pressure | 72 | ||
| Temperature | 72 | ||
| Stools | 72 | ||
| Urine | 72 | ||
| Developmental screening examination | 72 | ||
| Techniques used | 73 | ||
| Head control | 73 | ||
| Testing vision | 73 | ||
| Testing hearing | 74 | ||
| Examination of the newborn | 74 | ||
| The skin | 75 | ||
| The face | 75 | ||
| The head | 75 | ||
| The eyes | 76 | ||
| The mouth and tongue | 76 | ||
| The neck | 76 | ||
| The limbs | 76 | ||
| The chest | 76 | ||
| The abdomen | 76 | ||
| The perineum and genitalia | 76 | ||
| Neurological assessment | 77 | ||
| Primitive reflexes | 77 | ||
| Examination of the hips | 77 | ||
| Assessment of gestation | 78 | ||
| Screening for genetic disorders | 78 | ||
| Summary | 78 | ||
| 6 Older people | 79 | ||
| Introduction | 79 | ||
| Presentation of disease in older people | 79 | ||
| History | 81 | ||
| The social history and social networks | 82 | ||
| Activities of daily living (ADL) | 82 | ||
| Drug history | 83 | ||
| Review of systems | 83 | ||
| Examination | 83 | ||
| General | 83 | ||
| Special considerations | 84 | ||
| Skin | 84 | ||
| Cardiovascular system | 84 | ||
| Respiratory system | 85 | ||
| Gastrointestinal system | 85 | ||
| Nervous system | 85 | ||
| Vision and the eyes | 86 | ||
| Hearing | 87 | ||
| The ‘geriatric giants’ | 87 | ||
| Immobility | 88 | ||
| Instability/falls | 88 | ||
| Incontinence | 88 | ||
| Pressure ulcers | 89 | ||
| Confusion | 90 | ||
| The confused older patient | 90 | ||
| Assessment of capacity | 90 | ||
| Other issues | 91 | ||
| Ethnic elders | 91 | ||
| Inadequate care and elder abuse | 91 | ||
| 7 Psychiatric assessment | 93 | ||
| Introduction | 93 | ||
| History taking | 93 | ||
| Context of the interview | 94 | ||
| Patient factors | 94 | ||
| Factors in the physical environment | 94 | ||
| Safety | 94 | ||
| Privacy | 94 | ||
| Background information gathering | 94 | ||
| The psychiatric history | 94 | ||
| Introduction | 94 | ||
| Confidentiality and note keeping | 94 | ||
| Interviewing a patient who does not speak English | 95 | ||
| Interviewing technique | 95 | ||
| Structure of the psychiatric history | 95 | ||
| Order of sections | 95 | ||
| Presenting complaint | 95 | ||
| History of presenting complaint | 96 | ||
| History of psychiatric disorder | 97 | ||
| Past medical history | 97 | ||
| Current medication | 97 | ||
| Family history | 97 | ||
| Personal history | 97 | ||
| Birth and early developmental milestones | 97 | ||
| Family milieu, childhood health and early relationships with caregivers | 98 | ||
| Schooling | 98 | ||
| Occupational history | 98 | ||
| Psychosexual history, including marital/relationship history and children | 99 | ||
| Current social situation – see Box 7.6 | 99 | ||
| Forensic history | 99 | ||
| Use of alcohol and non-prescribed recreational drugs | 99 | ||
| Alcohol | 99 | ||
| Taking a full drinking history | 100 | ||
| Recreational drugs | 100 | ||
| Personality assessment | 101 | ||
| The mental state examination | 101 | ||
| Appearance and behaviour | 101 | ||
| Appearance | 101 | ||
| Behaviour | 101 | ||
| General demeanour | 102 | ||
| Rapport | 102 | ||
| Eye contact | 102 | ||
| Gait | 102 | ||
| Reduced motor activity | 102 | ||
| Increased motor activity | 103 | ||
| Speech | 103 | ||
| Rate | 103 | ||
| Structure | 103 | ||
| Mood | 103 | ||
| Thought | 104 | ||
| Exploring thoughts in elevated mood | 105 | ||
| Obsessional thoughts | 105 | ||
| Abnormal beliefs | 105 | ||
| Perception | 106 | ||
| Abnormal perception | 107 | ||
| Cognition | 108 | ||
| Basic assessment of cognitive function | 109 | ||
| Level of consciousness | 109 | ||
| Orientation | 109 | ||
| Time | 109 | ||
| Place | 109 | ||
| Person | 110 | ||
| Attention and concentration | 110 | ||
| Memory | 110 | ||
| Testing registration and immediate recall | 110 | ||
| Testing short-term memory | 110 | ||
| Testing longer term memory – recent | 111 | ||
| Testing longer term memory – remote | 111 | ||
| Intelligence | 111 | ||
| Abstraction | 111 | ||
| Insight | 111 | ||
| Ending the interview | 111 | ||
| Final reflection | 112 | ||
| Further investigations | 112 | ||
| Mental state evaluation | 112 | ||
| Neuropsychological testing | 112 | ||
| Brain imaging | 112 | ||
| 8 Patients presenting as emergencies | 113 | ||
| Introduction | 113 | ||
| The importance of clinical assessment | 113 | ||
| Scenarios outside the emergency department | 113 | ||
| Diagnosis versus resuscitation | 114 | ||
| Logic rather than lists | 114 | ||
| The pyrexial and septic patient | 114 | ||
| The patient with hypotension or shock | 115 | ||
| The patient with diminished consciousness | 116 | ||
| The patient with chest pain | 119 | ||
| Logical thinking | 119 | ||
| The breathless patient | 120 | ||
| The patient with palpitations | 123 | ||
| The syncopal patient | 123 | ||
| The patient with seizures | 124 | ||
| The patient with dizziness | 126 | ||
| The patient with acute confusion | 127 | ||
| The patient with acute headache | 129 | ||
| The acutely weak patient | 131 | ||
| The patient with abdominal pain | 132 | ||
| The patient with haematemesis or melaena | 133 | ||
| The patient with diarrhoea and vomiting | 135 | ||
| The jaundiced patient | 136 | ||
| Some special scenarios | 136 | ||
| 9 Patients in pain | 139 | ||
| Introduction | 139 | ||
| Definition | 139 | ||
| Classification of pain | 139 | ||
| Aetiology and pathogenesis | 139 | ||
| Duration | 139 | ||
| Mechanisms of pain | 139 | ||
| The patient in pain | 140 | ||
| History | 140 | ||
| The pain | 140 | ||
| Past medical history | 141 | ||
| Impact of pain | 141 | ||
| Psychosocial history | 141 | ||
| Examination | 141 | ||
| Investigation | 141 | ||
| Difficult cases | 142 | ||
| Measuring pain | 143 | ||
| Single-dimensional scales | 143 | ||
| Multidimensional (complex) scales | 143 | ||
| Treatment strategies | 143 | ||
| Acute pain | 143 | ||
| Chronic pain | 143 | ||
| Treatment options | 143 | ||
| Pharmacology | 143 | ||
| Non-pharmacological options | 143 | ||
| Summary | 144 | ||
| 3 Basic systems | 145 | ||
| 10 Respiratory system | 147 | ||
| Introduction | 147 | ||
| The history | 147 | ||
| Breathlessness | 147 | ||
| Cough | 147 | ||
| Sputum | 147 | ||
| Haemoptysis | 148 | ||
| Wheezing | 148 | ||
| Pain in the chest | 148 | ||
| Other symptoms | 148 | ||
| Upper airway | 148 | ||
| The smoking history | 148 | ||
| The family history | 149 | ||
| The occupational history | 149 | ||
| The examination | 149 | ||
| General assessment | 149 | ||
| Hands | 149 | ||
| Respiratory rate and rhythm | 150 | ||
| Venous pulses | 150 | ||
| Head | 150 | ||
| Examination of the chest | 150 | ||
| Relevant anatomy | 150 | ||
| Looking: inspection of the chest | 151 | ||
| Appearance of the chest | 151 | ||
| Movement of the chest | 151 | ||
| Feeling: palpation of the chest | 152 | ||
| Lymph nodes | 152 | ||
| Swellings and tenderness | 152 | ||
| Trachea and heart | 152 | ||
| Chest expansion | 153 | ||
| Feeling: percussion of the chest | 153 | ||
| Listening: auscultation of the chest | 154 | ||
| The breath sounds | 154 | ||
| Added sounds | 154 | ||
| Vocal resonance | 155 | ||
| Vocal fremitus | 155 | ||
| Putting it together: an examination of the chest | 155 | ||
| Putting it together: interpreting the signs | 156 | ||
| Other investigations | 156 | ||
| Sputum examination | 156 | ||
| At the bedside | 156 | ||
| In the laboratory | 156 | ||
| Lung function tests | 157 | ||
| Arterial blood sampling | 158 | ||
| Imaging the lung and chest | 158 | ||
| The chest X-ray | 158 | ||
| The position of the patient | 159 | ||
| The outline of the heart and the mediastinum | 159 | ||
| The position of the trachea | 159 | ||
| The diaphragm | 159 | ||
| The lung fields | 159 | ||
| The bony skeleton | 159 | ||
| The computed tomography scan | 160 | ||
| Radioisotope imaging | 160 | ||
| Magnetic resonance imaging | 160 | ||
| Ultrasound | 160 | ||
| Positron emission tomography (PET) scanning | 160 | ||
| Flexible bronchoscopy | 161 | ||
| Pleural aspiration and biopsy | 161 | ||
| Thoracoscopy | 162 | ||
| Lung biopsy | 162 | ||
| Immunological tests | 162 | ||
| Clinical images | 164 | ||
| 11 Cardiovascular system | 165 | ||
| Introduction | 165 | ||
| The cardiac history | 165 | ||
| Chest pain | 166 | ||
| Myocardial ischaemia | 166 | ||
| Acute coronary syndromes | 167 | ||
| Pericarditis | 168 | ||
| Aortic dissection | 168 | ||
| Pulmonary embolism | 168 | ||
| Dyspnoea | 168 | ||
| Exertional dyspnoea | 168 | ||
| Orthopnoea | 169 | ||
| Paroxysmal nocturnal dyspnoea | 169 | ||
| Fatigue | 169 | ||
| Palpitation | 170 | ||
| Dizziness and syncope | 170 | ||
| Postural hypotension | 170 | ||
| Vasovagal syncope | 170 | ||
| Carotid sinus hypersensitivity | 170 | ||
| Valvular obstruction | 170 | ||
| Stokes-Adams attacks | 170 | ||
| The cardiac examination | 171 | ||
| Inspection of the patient | 171 | ||
| Anaemia | 172 | ||
| Cyanosis | 172 | ||
| Clubbing of the fingers and toes | 172 | ||
| Other cutaneous and ocular signs of infective endocarditis | 172 | ||
| Coldness of the extremities | 172 | ||
| Pyrexia | 172 | ||
| Oedema | 172 | ||
| Arterial pulse | 172 | ||
| Rate and rhythm | 172 | ||
| Character | 173 | ||
| Symmetry | 173 | ||
| Measurement of blood pressure | 174 | ||
| Jugular venous pulse | 174 | ||
| Jugular venous pressure | 174 | ||
| Waveform of jugular venous pulses | 174 | ||
| Palpation of the chest wall | 175 | ||
| Auscultation of the heart | 175 | ||
| First sound (S1) | 175 | ||
| Second sound (S2) | 176 | ||
| Third and fourth sounds (S3, S4) | 176 | ||
| Systolic clicks and opening snaps | 177 | ||
| Heart murmurs | 177 | ||
| Friction rubs and venous hums | 179 | ||
| The electrocardiogram | 179 | ||
| Electrophysiology | 180 | ||
| Generation of electrical activity | 180 | ||
| Inscription of the QRS complex | 180 | ||
| Electrical axis | 180 | ||
| Normal 12-lead ECG | 180 | ||
| Analysis of the ECG | 181 | ||
| Heart rate | 181 | ||
| Rhythm | 181 | ||
| Electrical axis | 182 | ||
| P-wave morphology | 182 | ||
| PR interval | 182 | ||
| QRS morphology | 182 | ||
| QT interval | 183 | ||
| ST segment morphology | 183 | ||
| T-wave morphology | 184 | ||
| Clinical applications of ECG | 184 | ||
| Diagnosis of coronary heart disease | 184 | ||
| Stable angina | 184 | ||
| Exercise stress testing | 184 | ||
| Acute coronary syndromes | 185 | ||
| Detection of cardiac arrhythmias | 186 | ||
| In-hospital ECG monitoring | 186 | ||
| Ambulatory (Holter) ECG monitoring | 186 | ||
| Patient-activated ECG recording | 187 | ||
| Implantable loop recording | 187 | ||
| Exercise testing | 189 | ||
| Tilt testing | 189 | ||
| Electrophysiological study | 189 | ||
| Diagnosis of atrial arrhythmias | 189 | ||
| Atrial ectopic beats | 189 | ||
| Atrial fibrillation | 189 | ||
| Atrial flutter | 189 | ||
| Diagnosis of nodal arrhythmias | 189 | ||
| Atrioventricular nodal re-entry tachycardia (AVNRT) | 189 | ||
| Wolff-Parkinson-White syndrome | 190 | ||
| Diagnosis of ventricular arrhythmias | 191 | ||
| Ventricular premature beats | 191 | ||
| Ventricular tachycardia | 192 | ||
| Ventricular fibrillation | 193 | ||
| Diagnosis of sinoatrial disease | 193 | ||
| Sinus bradycardia (<50 bpm) | 193 | ||
| Sinoatrial block | 193 | ||
| Sinus arrest | 194 | ||
| Bradycardia-tachycardia syndrome | 194 | ||
| Diagnosis of atrioventricular block | 194 | ||
| First-degree atrioventricular block | 196 | ||
| Second-degree atrioventricular block: Mobitz type I (Wenckebach) | 196 | ||
| Second-degree atrioventricular block: Mobitz type II | 196 | ||
| Third-degree (complete) atrioventricular block | 196 | ||
| Right bundle branch block | 196 | ||
| Left bundle branch block | 196 | ||
| The chest X-ray | 196 | ||
| Cardiac silhouette | 196 | ||
| Ventricular dilatation | 197 | ||
| Atrial dilatation | 197 | ||
| Vascular dilatation | 197 | ||
| Intracardiac calcification | 197 | ||
| Lung fields | 198 | ||
| Altered pulmonary flow | 198 | ||
| Increased left atrial pressure | 198 | ||
| Other lung field abnormalities | 198 | ||
| Pulmonary infarction | 198 | ||
| Pneumonic consolidation and abscess | 198 | ||
| Interstitial lung disease | 199 | ||
| Bony abnormalities | 199 | ||
| Echocardiography | 199 | ||
| Principles | 199 | ||
| Physics | 199 | ||
| M-mode echocardiogram | 199 | ||
| Two-dimensional echocardiogram | 199 | ||
| Clinical applications | 199 | ||
| Congenital heart disease | 199 | ||
| Myocardial disease | 199 | ||
| Valvular disease | 201 | ||
| Pericardial disease | 201 | ||
| Other clinical applications | 201 | ||
| Stress echocardiography | 203 | ||
| Doppler echocardiography | 204 | ||
| 4 Clinical specialties | 331 | ||
| 15 Skin, nails and hair | 333 | ||
| Introduction | 333 | ||
| History | 333 | ||
| Examination | 333 | ||
| Colour and pigmentation | 333 | ||
| Skin lesions and eruptions | 336 | ||
| Morphology of skin lesions | 336 | ||
| Inspection and palpation | 336 | ||
| Subcutaneous oedema | 336 | ||
| Subcutaneous emphysema | 336 | ||
| Distribution of skin lesions | 337 | ||
| Configuration of skin lesions | 337 | ||
| The hair | 338 | ||
| Growth of hair | 338 | ||
| Alopecia | 338 | ||
| The nails | 339 | ||
| Nail matrix abnormalities | 339 | ||
| Nail and nail-bed abnormalities | 340 | ||
| The nails in systemic disease | 340 | ||
| Clubbing | 340 | ||
| Cutaneous manifestations of internal disease | 341 | ||
| Genodermatoses (lesions of inherited origin) | 341 | ||
| Non-organ-specific autoimmune disorders | 341 | ||
| Skin pigmentation | 342 | ||
| Haemorrhage in the skin | 343 | ||
| The skin in sexually transmitted diseases | 343 | ||
| Viral infection of the skin | 344 | ||
| Drug eruptions | 344 | ||
| Tumours in the skin | 345 | ||
| Special techniques in examination of the skin | 345 | ||
| Tzanck preparation | 345 | ||
| Microscopic examination | 346 | ||
| Scabies | 346 | ||
| Pediculosis | 346 | ||
| Fungal infections | 346 | ||
| Microscopic examination for fungus infection | 346 | ||
| Wood’s light | 347 | ||
| Contact allergy patch testing | 347 | ||
| Skin biopsy | 347 | ||
| 16 Endocrine disorders | 349 | ||
| Introduction | 349 | ||
| The history | 349 | ||
| Presenting symptoms | 349 | ||
| Thirst and polyuria | 349 | ||
| Weight loss | 349 | ||
| Weight gain or redistribution | 349 | ||
| Muscle weakness | 350 | ||
| Cold intolerance | 350 | ||
| Heat intolerance | 351 | ||
| Increased sweating | 351 | ||
| Tremor | 351 | ||
| Palpitations | 351 | ||
| Postural unsteadiness | 351 | ||
| Visual disturbance | 351 | ||
| Fasting symptoms | 351 | ||
| Cramps and ‘pins and needles’ | 352 | ||
| Nausea | 352 | ||
| Dysphagia | 352 | ||
| Neck pain and swelling | 352 | ||
| Impotence | 352 | ||
| Gynaecomastia | 352 | ||
| Amenorrhoea | 353 | ||
| Galactorrhoea | 353 | ||
| Excess hair growth | 353 | ||
| Bowel disturbance | 353 | ||
| Skin changes | 354 | ||
| Family history | 354 | ||
| Thyroid disease | 354 | ||
| Renal calculi | 354 | ||
| The examination | 354 | ||
| General assessment | 354 | ||
| The skin | 355 | ||
| The thyroid | 356 | ||
| The cardiovascular system | 359 | ||
| The breasts and genitalia | 359 | ||
| The eyes | 360 | ||
| The nervous system | 361 | ||
| Investigation | 361 | ||
| Endocrine stimulation tests | 361 | ||
| Endocrine suppression tests | 361 | ||
| Endocrine imaging | 362 | ||
| 17 Diabetes and other metabolic disorders | 363 | ||
| Introduction | 363 | ||
| Diabetes mellitus and the metabolic syndrome | 363 | ||
| Presenting symptoms of diabetes | 364 | ||
| Polyuria, polydipsia and nocturia | 365 | ||
| Weight loss and lethargy | 366 | ||
| Skin problems | 366 | ||
| Visual disturbance | 366 | ||
| Other important aspects of a diabetic history | 366 | ||
| Family history | 366 | ||
| Diet and lifestyle history | 366 | ||
| Assessment of other cardiovascular risk factors | 366 | ||
| Home glucose testing | 367 | ||
| Insulin injections | 367 | ||
| Symptoms of complications of diabetes | 367 | ||
| Symptoms of macrovascular disease | 367 | ||
| Symptoms of microvascular disease | 368 | ||
| Hypoglycaemia | 368 | ||
| Examination of the diabetic patient | 369 | ||
| General assessment | 369 | ||
| Skin, nails and hands | 369 | ||
| Eyes | 370 | ||
| Cardiovascular system | 371 | ||
| Feet | 372 | ||
| Investigation | 373 | ||
| Lipid disorders | 373 | ||
| History | 374 | ||
| Examination | 374 | ||
| Investigation | 376 | ||
| 18 Kidneys and urinary tract | 377 | ||
| The diagnostic process in nephrology and urology | 377 | ||
| Symptoms of renal and urological disease | 377 | ||
| Pain | 377 | ||
| Haematuria | 377 | ||
| Oliguria/anuria | 378 | ||
| Polyuria | 378 | ||
| Frequency of micturition | 378 | ||
| Nocturia | 378 | ||
| Dysuria | 379 | ||
| Urgency of micturition, incontinence and enuresis | 379 | ||
| Slow stream, hesitancy and terminal dribbling | 379 | ||
| Urethral discharge | 379 | ||
| Physical signs in renal and urological disease | 379 | ||
| General features | 379 | ||
| The circulation in the renal patient | 380 | ||
| Abdominal palpation | 380 | ||
| Auscultation | 381 | ||
| The eye in uraemia | 381 | ||
| The renal and urological syndromes | 381 | ||
| Acute renal failure | 381 | ||
| Chronic renal failure | 381 | ||
| The acute nephritic syndrome | 382 | ||
| The nephrotic syndrome | 382 | ||
| Asymptomatic urinary abnormality | 382 | ||
| Recurrent gross haematuria | 383 | ||
| Urinary tract infection | 383 | ||
| Urinary tract obstruction | 383 | ||
| Renal and urinary tract stones | 383 | ||
| Renal hypertension | 383 | ||
| Renal tubular syndromes | 384 | ||
| Laboratory assessment and imaging of the kidneys and urinary tract: assessment of structure and function | 384 | ||
| The urine | 384 | ||
| Quantity | 384 | ||
| Colour | 384 | ||
| Specific gravity and osmolality | 384 | ||
| pH | 385 | ||
| Glucose | 385 | ||
| Protein | 385 | ||
| Microscopy | 386 | ||
| Microbiological examination of the urine | 387 | ||
| Measurement of the glomerular filtration rate | 387 | ||
| Measurement of renal tubular function | 388 | ||
| Assessment of the urine in the stone-forming patient | 388 | ||
| Kidney biopsy | 389 | ||
| Imaging of the urinary tract | 389 | ||
| Plain radiographs | 389 | ||
| Ultrasound | 389 | ||
| Intravenous urography | 389 | ||
| Antegrade and retrograde urography | 389 | ||
| Cystography | 390 | ||
| Radionuclide studies | 390 | ||
| Computed tomography and magnetic resonance imaging | 390 | ||
| Arteriography and venography | 390 | ||
| 19 Eyes | 393 | ||
| Introduction | 393 | ||
| History | 393 | ||
| Examination | 393 | ||
| Visual acuity | 393 | ||
| Snellen distance vision | 394 | ||
| Technique | 394 | ||
| Recording visual acuity | 395 | ||
| Colour vision | 395 | ||
| Visual field testing | 396 | ||
| Pupils | 396 | ||
| Pupil size: anisocoria | 396 | ||
| Pupil reactions: afferent and central defects | 396 | ||
| Pupil shape | 397 | ||
| Direct ophthalmoscopy | 397 | ||
| Preparation | 398 | ||
| Examining the fundi | 399 | ||
| Optic disc | 399 | ||
| Blood vessels | 402 | ||
| Retina and macula | 403 | ||
| Slit lamp and intraocular pressure | 403 | ||
| Measuring intraocular pressure: applanation tonometry | 405 | ||
| Eyelid, lacrimal and orbital assessment | 405 | ||
| Eyelids | 405 | ||
| Lacrimal | 406 | ||
| Orbit | 407 | ||
| Examination of the eye in children | 408 | ||
| Imaging | 408 | ||
| Plain X-rays | 408 | ||
| Computed tomography and magnetic resonance imaging | 409 | ||
| A- and B-mode ultrasound | 409 | ||
| Retinal photography and fundus fluorescein angiography | 409 | ||
| Retinal and optic disc tomography | 410 | ||
| Special examination techniques | 410 | ||
| Refraction and refractive assessment | 410 | ||
| Amsler grid | 410 | ||
| Indirect ophthalmoscopy | 410 | ||
| Electrophysiological tests | 411 | ||
| 20 Ear, nose and throat | 413 | ||
| Introduction | 413 | ||
| The ear | 413 | ||
| Anatomy | 413 | ||
| Symptoms of ear disease | 414 | ||
| Otalgia | 414 | ||
| Otorrhoea | 415 | ||
| Hearing loss | 416 | ||
| Tinnitus | 417 | ||
| Vertigo | 417 | ||
| Clinical examination of the ear and hearing | 417 | ||
| Pinna and postauricular area | 417 | ||
| External ear canal | 417 | ||
| The tympanic membrane | 418 | ||
| The facial nerve | 418 | ||
| Clinical assessment of hearing | 420 | ||
| Clinical assessment of balance | 422 | ||
| Special investigations of hearing | 423 | ||
| Pure tone audiometry | 423 | ||
| Speech audiometry | 423 | ||
| Tympanometry | 423 | ||
| Otoacoustic emissions | 423 | ||
| Evoked-response audiometry | 423 | ||
| Special tests of balance | 424 | ||
| Radiological examination | 424 | ||
| The nose and paranasal sinuses | 426 | ||
| Anatomy | 426 | ||
| Symptoms of nasal disease | 428 | ||
| General features | 428 | ||
| Nasal blockage | 428 | ||
| Rhinorrhoea | 428 | ||
| Itching and sneezing | 428 | ||
| Disturbances of smell | 428 | ||
| Facial pain | 428 | ||
| Other symptoms | 428 | ||
| Examination of the nose and face | 428 | ||
| Special tests | 429 | ||
| Allergy testing | 429 | ||
| Nasal patency | 430 | ||
| Mucociliary clearance | 430 | ||
| Radiological examination | 430 | ||
| The throat | 431 | ||
| Anatomy | 431 | ||
| Symptoms of throat disease | 432 | ||
| Oral ulceration and pain | 433 | ||
| Sore throat | 433 | ||
| Stridor and stertor | 434 | ||
| Dysphonia | 434 | ||
| Dysphagia | 434 | ||
| Lump in the neck | 435 | ||
| Examination of the mouth and throat | 436 | ||
| Examination of the neck | 437 | ||
| Tissue sampling | 438 | ||
| Radiological examination | 438 | ||
| 21 Sexually transmitted infections | 439 | ||
| Introduction | 439 | ||
| History | 439 | ||
| Presenting symptoms | 439 | ||
| Urethral discharge | 439 | ||
| Dysuria | 439 | ||
| Urinary frequency | 439 | ||
| Vaginal discharge | 439 | ||
| Dyspareunia | 439 | ||
| Anogenital ulcer | 440 | ||
| Painful scrotal swelling | 440 | ||
| Pubic and genital itch | 440 | ||
| Genital rash | 440 | ||
| Anorectal symptoms | 441 | ||
| Systemic review | 441 | ||
| Other aspects of the history | 441 | ||
| Sexual history | 441 | ||
| Genital examination | 442 | ||
| Male genitalia | 442 | ||
| The penis | 442 | ||
| The testes | 443 | ||
| The epididymis | 443 | ||
| The spermatic cord | 443 | ||
| Anorectal examination | 443 | ||
| Female genitalia | 444 | ||
| Bimanual examination | 444 | ||
| Colposcopy | 444 | ||
| Pubic regions and groins | 444 | ||
| HIV infections | 445 | ||
| Systemic examination | 447 | ||
| The skin | 447 | ||
| The mouth | 447 | ||
| The eyes | 447 | ||
| The joints | 447 | ||
| The abdomen | 448 | ||
| Special investigations | 448 | ||
| Gram staining | 448 | ||
| ‘Two-glass’ test | 449 | ||
| Vaginal discharge | 449 | ||
| Genital ulcer | 449 | ||
| Serological tests for syphilis | 450 | ||
| Investigations for HIV infections | 450 | ||
| Investigations in homosexual and bisexual men | 451 | ||
| Ophthalmia neonatorum | 451 | ||
| Index | 453 | ||
| A | 453 | ||
| B | 454 | ||
| C | 455 | ||
| D | 457 | ||
| E | 458 | ||
| F | 458 | ||
| G | 459 | ||
| H | 460 | ||
| I | 461 | ||
| J | 462 | ||
| K | 462 | ||
| L | 462 | ||
| M | 463 | ||
| N | 464 | ||
| O | 465 | ||
| P | 465 | ||
| Q | 467 | ||
| R | 467 | ||
| S | 468 | ||
| T | 470 | ||
| U | 470 | ||
| V | 471 | ||
| W | 471 | ||
| X | 472 | ||
| Y | 472 | ||
| Z | 472 |