Bates' Pocket Guide to Physical Examination and History Taking

451 Pages·2016·13.13 MB·English

by  Lynn S. Bickley

Pocket Guide to
B '
AT E S
Physical
Examination
History Taking
AND
B ' Pocket Guide to
A T E S
Physical
Examination
History Takin g
AND
E I G H T H E D I T I O N
Lynn S. Bickley,
MD, FACP
Clinical Professor of Internal Medicine
School of Medicine
University of New Mexico
Albuquerque, New Mexico
Peter G. Szilagyi,
MD, MPH
Professor of Pediatrics and Executive Vice-Chair
Department of Pediatrics
University of California at Los Angeles (UCLA)
Los Angeles, California
Guest Editor
Richard M. Hoffman, MD, MPH, FACP
Professor of Internal Medicine and Epidemiology
Director, Division of General Internal Medicine
University of Iowa Carver College of Medicine
Iowa City, Iowa
Acquisitions Editor: Crystal Taylor
Product Development Editor: Greg Nicholl
Marketing Manager: Michael McMahon
Production Project Manager: Cynthia Rudy
Design Coordinator: Holly McLaughlin
Art Director: Jennifer Clements
Illustrator: Body Scientific International
Manufacturing Coordinator: Margie Orzech
Prepress Vendor: Aptara, Inc.
Eighth Edition
Copyright © 2017 Wolters Kluwer.
Copyright © 2013, 2009 by Wolters Kluwer Health | Lippincott Williams & Wilkins. Copyright
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Printed in China
Library of Congress Cataloging-in-Publication Data
Names: Bickley, Lynn S., author. | Szilagyi, Peter G., author. | Hoffman,
Richard M., editor. | Abridgement of (expression): Bickley, Lynn S. Bates’
guide to physical examination and history-taking. 12th ed.
Title: Bates’ pocket guide to physical examination and history taking / Lynn
S. Bickley, Peter G. Szilagyi ; guest editor, Richard M. Hoffman.
Other titles: Pocket guide to physical examination and history taking
Description: Eighth edition. | Philadelphia : Wolters Kluwer, [2017] |
Abridgement of: Bates’ guide to physical examination and history-taking. /
Lynn S. Bickley, Peter G. Szilagyi. Twelfth edition. [2017]. | Includes
bibliographical references and index.
Identifiers: LCCN 2016030575 | ISBN 9781496338488 (alk. paper)
Subjects: | MESH: Physical Examination–methods | Medical History
Taking–methods | Handbooks
Classification: LCC RC76 | NLM WB 39 | DDC 616.07/54–dc23
LC record available at https://lccn.loc.gov/2016030575
This work is provided “as is,” and the publisher disclaims any and all warranties, express or
implied, including any warranties as to accuracy, comprehensiveness, or currency of the content
of this work.
This work is no substitute for individual patient assessment based upon healthcare professionals’
examination of each patient and consideration of, among other things, age, weight, gender, current
or prior medical conditions, medication history, laboratory data and other factors unique to the
patient. The publisher does not provide medical advice or guidance and this work is merely a
reference tool. Healthcare professionals, and not the publisher, are solely responsible for the use of
this work including all medical judgments and for any resulting diagnosis and treatments.
Given continuous, rapid advances in medical science and health information, independent
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matter of products liability, negligence law or otherwise, or from any reference to or use by any
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We would like to dedicate this book to all our
students, trainees, and mentees who have
taught us the true value of both
the science and the
art of medicine.
Faculty Reviewers
J. D. Bartleson Jr., MD Amit Garg, MD
Associate Professor of Neurology Dermatologist
Mayo Clinic Northwell Health Physician Partners
Rochester, Minnesota Manhasset, New York
John D. Bartlett, MD Catherine F. Gracey, MD
Assistant Clinical Professor of Associate Professor
Ophthalmology Department of Medicine
Jules Stein Eye Institute School of Medicine and Dentistry
David Geffen School of Medicine University of Rochester Medical
Los Angeles, California Center
Rochester, New York
Amy E. Blatt, MD
Assistant Professor Carla Herman, MD, MPH
Department of Medicine Chief
School of Medicine and Dentistry Division of Geriatrics and Palliative
University of Rochester Medical Center Medicine
Rochester, New York Professor
Department of Internal Medicine
Adam Brodsky, MD School of Medicine
Associate Professor University of New Mexico
Medical Director Albuquerque, New Mexico
Geriatric Psychiatry Services
Department of Psychiatry and William C. Hulbert, MD
Behavioral Sciences Professor
School of Medicine Department of Urology
University of New Mexico Psychiatric School of Medicine and Dentistry
Center & Sandoval Regional University of Rochester Medical Center
Medical Center Rochester, New York
Albuquerque, New Mexico
Mark Landig, OD
Thomas M. Carroll, MD, PhD Department of Ophthalmology
Assistant Professor Jules Stein Eye Institute
Department of Medicine David Geffen School of Medicine
School of Medicine and Dentistry Los Angeles, California
University of Rochester Medical Center
Rochester, New York Helen R. Levey, DO, MPH
PGY5 Resident
Adam J. Doyle, MD School of Medicine and Dentistry
Assistant Professor University of Rochester Medical
Department of Surgery Center
School of Medicine and Dentistry Rochester, New York
University of Rochester Medical Center
Rochester, New York
vi
Faculty Reviewers vii
Patrick McCleskey, MD Scott A. Vogelgesang, MD
Dermatologist Director
Oakland Medical Center Division of Immunology
Oakland, California Clinical Professor
Department of Internal Medicine–
Jeanne H. S. O’Brien, MD Immunology
Associate Professor University of Iowa Carver College
Department of Urology of Medicine
School of Medicine and Dentistry Iowa City, Iowa
University of Rochester Medical Center
Rochester, New York Brian P. Watkins, MD
Surgeon
Alec B. O’Connor, MD, MPH Genesee Surgical Associates
Director, Internal Medicine Rochester, New York
Associate Professor
Department of Medicine Paula Zozzaro-Smith, DO
School of Medicine and Dentistry Fellow of Maternal-Fetal Medicine
University of Rochester Medical Center Department of Obstetrics and
Rochester, New York Gynecology
The University of Rochester
A. Andrew Rudmann, MD Rochester, New York
Associate Professor
Department of Medicine STUDENT REVIEWERS
University of Rochester Medical Center
Ayala Danzig
School of Medicine and Dentistry
University of Rochester School of
Rochester, New York
Medicine and Dentistry
Moira A. Szilagyi, MD, PhD
Benjamin Edmonds
Professor of Pediatrics
University of Central Florida College
University of California at Los Angeles
of Medicine
(UCLA)
Los Angeles, California
Nicholas P. N. Goldstein
University of Rochester School of
Loralei Lacina Thornburg, MD
Medicine and Dentistry
Associate Professor
Department of Obstetrics and
Gynecology
School of Medicine and Dentistry
University of Rochester Medical Center
Rochester, New York
Preface
Bates’ Pocket Guide to Physical Examination and History Taking, eighth edi-
tion, is a concise, portable text, with new chapters on assessing clinical
evidence and examination of the skin, hair, and nails, that:
■ Recommends how to sequence the physical examination and document
an accurate written record.
■ Clari es assessment of clinical evidence.
■ Describes how to interview the patient and take the health history.
■ Details and illustrates the steps of each of the regional physical examina-
tions.
■ Reminds students of common, normal, and abnormal physical ndings.
■ Provides visual aids and comparative tables to guide recognition of
common and selected ndings.
There are several ways to use the Pocket Guide:
■ To review and remember the content of a health history.
■ To review and rehearse the techniques of examination. This can be
done while learning a single section and again while combining the
approaches to several body systems or regions into an integrated
examination (see Chapter 1).
■ To review common variations of normal and selected abnormalities.
Observations are keener and more precise when the examiner knows
what to look, listen, and feel for.
■ To look up special techniques as the need arises. Maneuvers such as
The Timed Get Up and Go test are included in the Special Techniques
section in each chapter.
■ To look up additional information about possible ndings, including
abnormalities and standards of normal.
The Pocket Guide is not intended to serve as a primary text for learning the
skills of history taking or physical examination. Its detail is too brief. It is
intended instead as an aid for student recall of the regional examinations
and examinations for special populations and as a convenient, brief, and
portable reference.
viii
Contents
Faculty Reviewers vi
Preface viii
1
C H A P T E R Foundations for Clinical Proficiency 1
2
C H A P T E R Evaluating Clinical Evidence 27
3
C H A P T E R Interviewing and the Health History 41
4
C H A P T E R Beginning the Physical Examination: General Survey,
Vital Signs, and Pain 59
5
C H A P T E R Behavior and Mental Status 77
6
C H A P T E R The Skin, Hair, and Nails 89
7
C H A P T E R The Head and Neck 115
8
C H A P T E R The Thorax and Lungs 145
9
C H A P T E R The Cardiovascular System 167
10
C H A P T E R The Breasts and Axillae 187
11
C H A P T E R The Abdomen 199
12
C H A P T E R The Peripheral Vascular System 219
13
C H A P T E R Male Genitalia and Hernias 233
14
C H A P T E R Female Genitalia 247
15
C H A P T E R The Anus, Rectum, and Prostate 265
16
C H A P T E R The Musculoskeletal System 275
17
C H A P T E R The Nervous System 311
18
C H A P T E R Assessing Children: Infancy through Adolescence 349
19
C H A P T E R The Pregnant Woman 383
2 0
C H A P T E R The Older Adult 399
Index 423
ix
C 1H A P T E R
Foundations for Clinical
Proficiency
This chapter provides a road map to clinical pro ciency in two critical
areas: the health history and the physical examination.
For adults, the comprehensive history includes Identifying Data and
Source of the History, Chief Complaint(s), Present Illness, Past History,
Family History, Personal and Social History, and Review of Systems. New
patients in the of ce or hospital merit a comprehensive health history;
however, in many situations, a more exible focused, or problem-oriented,
interview is appropriate. The components of the comprehensive health
history structure the patient’s story and the format of your written record,
but the order shown below should not dictate the sequence of the interview.
The interview is more uid and should follow the patient’s leads and cues,
as described in Chapter 3.
O v e rv ie w : C o m p o n e n t s o f t h e A d u lt He a lt h His t o ry
Identifying Data ● Identifying d t —such s ge, gender, occu tion,
rit l st tus
Source of the history—usu lly the tient, but c n
●
be f ily e ber or friend, letter of referr l, or
the clinic l record
If ro ri te, est blish source of referr l bec use
●
written re ort y be needed
Reliability ● V ries ccording to the tient’s e ory, trust, nd
ood
Chief Complaint(s) ● The one or ore sy to s or concerns c using the
tient to seek c re
Present Illness ● A lifies the Chief Co l int; describes how e ch
sy to develo ed
Includes tient’s thoughts nd feelings bout the
●
illness
Pulls in relev nt ortions of the Review of Syste s,
●
c lled “ ertinent ositives nd neg tives” (see . 3)
M y include edic tions, llergies, h bits of s ok-
●
ing nd lcohol, which frequently re ertinent to
the resent illness
(continued )
1