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Macleod's Clinical Diagnosis E-Book

Macleod's Clinical Diagnosis E-Book

Alan G Japp | Colin Robertson

(2012)

Additional Information

Book Details

Abstract

Macleod’s Clinical Diagnosis is an innovative new book complementing its companion sister textbook, the internationally-respected Macleod’s Clinical Examination. It is a practical manual of clinical assessment that describes how common presenting problems are evaluated and diagnosed in modern clinical practice. This book will be an invaluable resource for senior medical students and junior doctors as they attempt to make the difficult transition from mastering basic clinical skills to assessing patients in the real world of clinical medicine.

The format of the book is as follows:

  • Part 1: The principles of clinical assessment: in addition to defining the scope and remit of the book this initial group of chapters invites readers to reconsider the overall aims of clinical assessment, the contribution that each element of the assessment can make to these aims and how the approach must be adapted to fit the clinical context. It also touches on diagnostic theory and explains some different approaches to diagnosis.

  • Part 2: How to assess common presenting problems: this section forms the core of the book and consists of a series of ‘diagnostic guides’ covering the major presenting problems in medicine and surgery; these provide the reader with a system for how to use the tools of history-taking, physical examination and routine tests to arrive at a logical differential diagnosis. The guides also cover some limited ‘post-diagnosis information’ in the form of severity/prognostic indicators.
  • A unique book allowing a reader to apply the skills of clinical examination in the formulation of a differential diagnosis and placing a patient’s symptoms in context.
  • Takes a problem-based approach to diagnostic reasoning, reflecting both modern medical and current educational practices.
  • Builds on the clinical skills outlined in the companion Macleod’s Clinical Examination textbook.

Table of Contents

Section Title Page Action Price
Front Cover cover
Macleod's Clinical Diagnosis i
Copyright Page iv
Preface v
Acknowledgements vi
Figure sources vi
Contributors vii
Table Of Contents ix
Abbreviations xi
1 Principles of clinical assessment 1
1 What’s in a diagnosis? 3
From differential diagnosis to final diagnosis 3
Probability and risk 3
Special situations 4
Medically unexplained symptoms 4
Treatment before diagnosis 5
The patient who comes with a diagnosis 6
2 Assessing patients: 7
Introduction 7
Rapid assessment of the sick patient 7
Routine assessment of the stable patient: The full clinical assessment 11
The history 11
The clinical examination 12
Additional steps 14
Basic investigations 15
Approach to the frail, elderly patient 15
Specific tips for assessment of the elderly/frail patient 16
Inspection 16
3 The diagnostic process 19
Diagnostic methods 19
Pattern recognition 19
Probability analysis 20
A different approach: Tailored diagnostic guides 20
How to use the diagnostic guides 21
2 Assessment of common presenting problems 24
4 Abdominal pain 26
Acute abdominal pain 26
Key questions 26
What are the characteristics of the pain? 26
Is there a systemic inflammatory response? 26
Chronic/episodic abdominal pain 27
Gastroduodenal disorders 28
Gallstones 28
Pancreatic pain 28
Mesenteric ischaemia 29
Inflammatory bowel disease 29
Colon cancer 29
Functional disorders 29
Renal tract disorders 29
Gynaecological conditions 29
Other diagnostic possibilities 29
5 Breast lump 44
Breast cancer 44
Breast abscess 44
Fibroadenoma 44
Fibrocystic change 45
Fat necrosis 45
Other causes 45
Male breast disease 45
6 Chest pain 48
Acute chest pain 48
Acute coronary syndromes (ACS) 48
Aortic dissection 48
Pulmonary embolism 48
Acute pericarditis 49
Gastro-oesophageal disorders 49
Pneumothorax 49
Pneumonia 49
Musculoskeletal problems 49
Anxiety 50
Other causes 50
Intermittent chest pain 50
Angina pectoris 50
Gastro-oesophageal disorders 50
Musculoskeletal disorders 51
Asthma 51
Anxiety 51
Further assessment of NSTEMI/unstable angina 63
Step 1 Identify critically unwell patients 63
Step 2 Consider all potential factors contributing to myocardial ischaemia 63
Step 3 Identify high-risk patients 63
Step 4 Use cardiac biomarkers to differentiate unstable angina from NSTEMI 63
Further assessment of suspected angina 69
Step 1 Consider unstable angina and structural heart disease 69
Step 2 Confirm or refute the diagnosis 69
Step 3 Assess symptom severity and risk 69
7 Coma and altered consciousness 70
Metabolic causes 70
Drugs/toxins 70
CNS causes 70
Organ failure 71
8 Confusion: 76
Delirium 76
Drugs 76
Metabolic/physiological disturbance 76
Infection 76
Intracranial causes 76
Appendix 264
Index 267
A 267
B 268
C 268
D 269
E 270
F 270
G 271
H 271
I 272
J 272
K 272
L 272
M 273
N 273
O 274
P 274
R 275
S 275
T 276
U 276
V 277
W 277
X 277
Z 277