Chamberlain's Symptoms and Signs in Clinical Medicine: An Introduction to Medical Diagnosis

504 Pages·2010·19.088 MB·English

by  Andrew R. Houghton

13th Edition
CHAMBERLAIN’S
SYMPTOMS AND SIGNS
IN CLINICAL MEDICINE
An Introduction to Medical Diagnosis
This page intentionally left blank
13th Edition
CHAMBERLAIN’S
SYMPTOMS AND SIGNS
IN CLINICAL MEDICINE
An Introduction to Medical Diagnosis
Edited by
Andrew R Houghton MA(Oxon) DM FRCP(Lond) FRCP(Glasg)
Consultant Physician and Cardiologist, Grantham and District
Hospital, Grantham, and Visiting Fellow, University of Lincoln,
Lincoln, UK
David Gray DM MPH BMedSci BM BS FRCP(Lond) FRSPH
Reader in Medicine and Honorary Consultant Physician,
Department of Cardiovascular Medicine, Nottingham University
Hospitals NHS Trust, Queen’s Medical Centre, Nottingham, UK
First published in Great Britain in 1936
Second edition 1938
Third edition 1943
Fourth edition 1947
Fifth edition 1952
Sixth edition 1957
Seventh edition 1961
Eighth edition 1967
Ninth edition 1974
Tenth edition 1980
Eleventh edition 1987
Twelfth edition 1997
This thirteenth edition published in 2010 by
Hodder Arnold, an imprint of Hodder Education, an Hachette Livre UK Company,
338 Euston Road, London NW1 3BH
http://www.hodderarnold.com
© 2010 Edward Arnold (Publishers) Ltd
All rights reserved. Apart from any use permitted under UK copyright law, this publication may only be reproduced, stored or
transmitted, in any form, or by any means with prior permission in writing of the publishers or in the case of reprographic
production in accordance with the terms of licences issued by the Copyright Licensing Agency. In the United Kingdom such
licences are issued by the Copyright Licensing Agency: Saffron House, 6-10 Kirby Street, London EC1N 8TS.
Whilst the advice and information in this book are believed to be true and accurate at the date of going to press, neither the
editors nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made. In particu-
lar (but without limiting the generality of the preceding disclaimer) every effort has been made to check drug dosages; however
it is still possible that errors have been missed. Furthermore, dosage schedules are constantly being revised and new side-
effects recognized. For these reasons the reader is strongly urged to consult the drug companies’ printed instructions before
administering any of the drugs recommended in this book.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging-in-Publication Data
A catalog record for this book is available from the Library of Congress
ISBN-13 978 0 340 974 254
1 2 3 4 5 6 7 8 9 10
Commissioning Editor: Joanna Koster
Production Editor: Jane Tod
Production Controller: Kate Harris
Cover Designer: Amina Dudhia
Indexer: Linda Antoniw
Typeset in 10 pt Minion by Phoenix Photosetting, Chatham, Kent
Printed and bound in India
What do you think about this book? Or any other Hodder Arnold title?
Please visit our website: www.hodderarnold.com
Contents
Instructions for companion website vi
Preface vii
List of contributors viii
Chamberlain and his textbook of symptoms and signs x
Acknowledgements xii

Section A - The Basics
1 Taking a history 2
2 An approach to the physical examination 11
3 Devising a differential diagnosis 20
4 Ordering basic investigations 23
5 Medical records 29
6 Presenting cases 35
Section B - Individual Systems
7 The cardiovascular system 40
8 The respiratory system 82
9 The gastrointestinal system 108
10 The renal system 137
11 The genitourinary system 160
12 The nervous system 185
13 Psychiatric assessment 209
14 The musculoskeletal system 233
15 The endocrine system 254
16 The breast 269
17 The haematological system 286
18 Skin, nails and hair 306
19 The eye 329
20 Ear, nose and throat 351
21 Infectious and tropical diseases 370
Section C - Special Situations
22 Assessment of the newborn, infants and children 390
23 The acutely ill patient 425
24 The patient with impaired consciousness 434
25 The older patient 438
26 Death and the dying patient 458
Further reading 466
Index 467
INSTRUCTIONS FOR COMPANION WEBSITE
This book has a companion website available at:
http://www.hodderplus.com/chamberlainssymptomsandsigns
To access the image library and multiple choice questions included on the website, please register on the
website using the following access details:
Serial number: kwlt294ndpxm
Once you have registered, you will not need the serial number but can log in using the username and
password you will create during registration.
Preface
The student of medicine has to learn both the ‘bot- We have split this textbook into three sections. The
tom up’ approach of constructing a differential diag- fi rst section introduces the basic skills underpinning
nosis from individual clinical fi ndings, and the ‘top much of what follows – how to take a history and
down’ approach of learning the key features pertain- perform an examination, how to devise a differential
ing to a particular diagnosis. In this textbook we have diagnosis and select appropriate investigations, and
integrated both approaches into a coherent working how to record your fi ndings in the case notes and
framework that will assist the reader in preparing present cases on ward rounds.
for academic and professional examinations, and The second section takes a systems-based
in every day practice. In so doing, we have remained approach to history taking and examining patients,
true to the original intention of E Noble Chamber- and also includes information on relevant diagnostic
lain who, in 1936, wrote the following in the preface tests and common diagnoses for each system. Each
to the fi rst edition of his textbook: chapter begins with the individual ‘building blocks’
of the history and examination, and ends by draw-
As the title implies, an account has been given ing these elements together into relevant diagnoses.
of the common symptoms and physical signs A selection of self-assessment questions pertaining
of disease, but since his student days the author to each chapter is also available on the companion
has felt that these are often wrongly described website so you can test what you have learnt.
divorced from diagnosis. An attempt has been The third and fi nal section of the book covers
made, therefore, to take the student a stage further ‘special situations’, including the assessment of the
to the visualisation of symptoms and signs as newborn, infants and children, the acutely ill patient,
forming a clinical picture of some pathological the patient with impaired consciousness, the older
process. In each chapter some of the commoner patient and death and the dying patient.
or more important diseases have been included We are grateful to all of our contributors for shar-
to illustrate how symptoms and signs are pieced ing their expertise in the chapters they have written.
together in the jig-saw puzzle of diagnosis. We hope that today’s reader fi nds the 13th edition of
E Noble Chamberlain Chamberlain’s Symptoms and Signs in Clinical Medi-
Symptoms and Signs in Clinical Medicine, cine to be as useful and informative as previous gen-
1st edition (1936) erations have done since 1936.
Andrew R Houghton
David Gray
2010
List of contributors
Guruprasad P Aithal MD PhD FRCP John S C English FRCP
Consultant Hepatobiliary Physician, Nottingham Consultant Dermatologist, Department of Dermatology,
Digestive Disease Centre; NIHR Biomedical Research Nottingham University Hospitals NHS Trust, Queen’s
Unit, Nottingham University Hospitals NHS Trust, Medical Centre Campus, Nottingham, UK
Queen’s Medical Centre Campus, Nottingham, UK
Jennifer Eremin MBBS DMRT FRCR
David Baldwin MD FRCP Senior Medical Researcher and Former Consultant
Consultant Respiratory Physician, Respiratory Clinical Oncologist, United Lincolnshire Hospitals NHS
Medicine Unit, David Evans Centre, Nottingham Trust, Lincoln, UK
University Hospitals NHS Trust, City Campus,
Nottingham, UK Oleg Eremin MB ChB MD FRACS FRCSEd FRCST(Hon)
FMedSci DSc (Hon)
Christine A Bowman MA FRCP Consultant Breast Surgeon and Lead Clinician for
Consultant Physician in Genitourinary Medicine, Breast Services, United Lincolnshire Hospitals NHS
Sheffi eld Teaching Hospitals NHS Foundation Trust, Trust, Lincoln, UK
Sheffi eld, UK
David Gray DM MPH BMedSci BM BS FRCP(Lond) FRSPH
Stuart N Cohen BMedSci (Hons) MMedSci (Clin Ed) MRCP Reader in Medicine and Honorary Consultant
Consultant Dermatologist, Department of Dermatology, Physician, Department of Cardiovascular Medicine,
Nottingham University Hospitals NHS Trust, Queen’s Nottingham University Hospitals NHS Trust, Queen’s
Medical Centre Campus, Nottingham, UK Medical Centre Campus, Nottingham, UK
Declan Costello MA MBBS FRCS(ORL-HNS) Alan J Hakim MA FRCP
Specialist Registrar in Otolaryngology, Ear, Nose and Consultant Physician and Rheumatologist, Associate
Throat Department, John Radcliffe Hospital, Oxford, Director for Emergency Medicine and Director of
UK Strategy and Business Improvement, Whipps Cross
University Hospital NHS Trust, London, UK
Robert N Davidson MD FRCP DTM&H
Consultant Physician in Infection and Tropical Rowan H Harwood MA MSc MD FRCP
Medicine, Department of Infection and Tropical Consultant Physician in General, Geriatric and Stroke
Medicine, Lister Unit, Northwick Park Hospital, Medicine, Nottingham University Hospitals NHS Trust,
Harrow, Middlesex, UK Queen’s Medical Centre Campus, Nottingham, UK
Alastair K Denniston PhD MA MRCP MRCOphth Andrew R Houghton MA(Oxon) DM FRCP(Lond) FRCP(Glasg)
Clinical Lecturer and Honorary Specialist Registrar Consultant Physician and Cardiologist, Grantham
in Ophthalmology, Academic Unit of Ophthalmology, and District Hospital, Grantham, and Visiting Fellow,
University of Birmingham, Birmingham and Midland University of Lincoln, Lincoln, UK
Eye Centre, City Hospital, Birmingham, UK
Martin R Howard MD FRCP FRCPath
Chris Dewhurst MbChB MRCPCH PgCTLCP Consultant Haematologist York Hospital, and
Specialist Registrar in Neonatology, Liverpool Women’s Clinical Senior Lecturer, Hull, York Medical School,
Hospital, Liverpool, UK Department of Haematology, York Hospital, York, UK
List of contributors ix
Prathap Kumar Kanagala MBBS MRCP Basant K Puri MA PhD MB BChir BSc(Hons)MathSci
Specialist Registrar in Cardiology, Department of MRCPsych DipStat PGCertMaths MMath
Medicine, Grantham and District Hospital, Professor and Honorary Consultant in Imaging and
Grantham, UK Psychiatry, Hammersmith Hospital and Imperial
College London, London, UK
Peter Mansell DM FRCP
Venkataraman Subramanian DM MD MRCP
Associate Professor and Honorary Consultant
Walport Lecturer, Nottingham Digestive Disease
Physician, Department of Diabetes and
Centre: NIHR Biomedical Research Unit, Nottingham
Endocrinology, Nottingham University Hospitals
University Hospitals NHS Trust, Queen’s Medical
NHS Trust, Queen’s Medical Centre Campus,
Centre Campus, Nottingham, UK
Nottingham, UK
Peter Topham MD FRCP
Philip I Murray PhD FRCP FRCS FRCOphth Senior Lecturer in Nephrology, John Walls Renal Unit,
Professor of Ophthalmology, Academic Unit University Hospitals of Leicester, Leicester, UK
of Ophthalmology, University of Birmingham,
Birmingham and Midland Eye Centre, City Hospital, Ian H Treasaden MB BS LRCP MRCS FRCPsych LLM
Birmingham, UK Honorary Clinical Senior Lecturer in Psychiatry,
Imperial College London, London, and Consultant
Forensic Psychiatrist Three Bridges Medium Secure
Leena Patel MD FRCPCH MHPE MD
Unit, West London Mental Health NHS Trust,
Senior Lecturer in Child Health and Honorary
Middlesex, UK
Consultant Paediatrician, University of Manchester,
Royal Manchester Children’s Hospital, Central
Adrian Wills BSc(Hons) MMedSci MD FRCP
Manchester University Hospitals Foundation Trust,
Consultant Neurologist, Department of Neurosciences,
Manchester, UK
Nottingham University Hospitals NHS Trust, Queen’s
Medical Centre Campus, Nottingham
Hina Pattani BSc MBBS MRCP
Specialist Registrar in Intensive Care and Bob Winter DM FRCP FRCA
Respiratory Medicine, Nottingham University Consultant in Intensive Care Medicine, Nottingham
Hospitals NHS Trust, Queen’s Medical Centre University Hospitals NHS Trust, Queen’s Medical
Campus, Nottingham Centre Campus, Nottingham, UK