Macleod's Clinical Examination E-Book

402 Pages·2018·55.04 MB·English

by  Dover, Anna R.;Fairhurst, Karen;Innes, J. Alastair

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2015v1.0
Macleod’s
Clinical Examination
John Macleod (1915–2006)
John Macleod was appointed consultant physician at the Western General Hospital,
Edinburgh, in 1950. He had major interests in rheumatology and medical education.
Medical students who attended his clinical teaching sessions remember him as
an inspirational teacher with the ability to present complex problems with great
clarity. He was invariably courteous to his patients and students alike. He had an
uncanny knack of involving all students equally in clinical discussions and used
praise rather than criticism. He paid great attention to the value of history taking
and, from this, expected students to identify what particular aspects of the physical
examination should help to narrow the diagnostic options.
His consultant colleagues at the Western welcomed the opportunity of contributing
when he suggested writing a textbook on clinical examination. The book was first
published in 1964 and John Macleod edited seven editions. With characteristic
modesty he was very embarrassed when the eighth edition was renamed Macleod’s
Clinical Examination. This, however, was a small way of recognising his enormous
contribution to medical education.
He possessed the essential quality of a successful editor – the skill of changing
disparate contributions from individual contributors into a uniform style and format
without causing offence; everybody accepted his authority. He avoided being
dogmatic or condescending. He was generous in teaching others his editorial
skills and these attributes were recognised when he was invited to edit Davidson’s
Principles and Practice of Medicine.
Content Strategist: Laurence Hunter
Content Development Specialist: Helen Leng
Project Manager: Anne Collett
Designer: Miles Hitchen
Illustration Manager: Karen Giacomucci
Macleod’s

14th Edition EC
Edited by x
l
J Alastair Innes
i
BSc PhD FRCP(Ed)
a
Consultant Physician, Respiratory Unit, Western General n
Hospital, Edinburgh; Honorary Reader in Respiratory Medicine,
University of Edinburgh, UK
m
Anna R Dover i
PhD FRCP(Ed)
c
Consultant in Diabetes, Endocrinology and General Medicine,
Edinburgh Centre for Endocrinology and Diabetes, Royal
Infirmary of Edinburgh; Honorary Clinical Senior Lecturer, i
a
University of Edinburgh, UK
n
Karen Fairhurst
PhD FRCGP
l
General Practitioner, Mackenzie Medical Centre, Edinburgh; a

Clinical Senior Lecturer, Centre for Population Health Sciences,
University of Edinburgh, UK
t
Illustrations by Robert Britton and Ethan Danielson
i
o
n
Edinburgh London New York Oxford Philadelphia St Louis Sydney 2018
© 2018 Elsevier Ltd. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical,
including photocopying, recording, or any information storage and retrieval system, without permission in writing from
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can be found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the publisher (other than
as may be noted herein).
First edition 1964 Sixth edition 1983 Eleventh edition 2005
Second edition 1967 Seventh edition 1986 Twelfth edition 2009
Third edition 1973 Eighth edition 1990 Thirteenth edition 2013
Fourth edition 1976 Ninth edition 1995 Fourteenth edition 2018
Fifth edition 1979 Tenth edition 2000
ISBN 978-0-7020-6993-2
International ISBN 978-0-7020-6992-5
Notices
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any
information, methods, compounds or experiments described herein. Because of rapid advances in the medical
sciences, in particular, independent verification of diagnoses and drug dosages should be made. To the fullest extent
of the law, no responsibility is assumed by Elsevier, authors, editors or contributors for any injury and/or damage to
persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any
methods, products, instructions, or ideas contained in the material herein.
The
publisher’s
policy is to use
paper manufactured
from sustainable forests
Printed in Europe
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Contents
Preface vii
Acknowledgements ix
How to make the most of this book xi
Clinical skills videos xiii
Contributors xv
SECTION 1 PRINCIPLES OF CLINICAL HISTORY AND EXAMINATION 1
1 Managing clinical encounters with patients 3
Karen Fairhurst, Anna R Dover, J Alastair Innes
2 General aspects of history taking 9
J Alastair Innes, Karen Fairhurst, Anna R Dover
3 General aspects of examination 19
Anna R Dover, J Alastair Innes, Karen Fairhurst
SECTION 2 SYSTEM-BASED EXAMINATION 37
4 The cardiovascular system 39
Nicholas L Mills, Alan G Japp, Jennifer Robson
5 The respiratory system 75
J Alastair Innes, James Tiernan
6 The gastrointestinal system 93
John Plevris, Rowan Parks
7 The nervous system 119
Richard Davenport, Hadi Manji
8 The visual system 151
Shyamanga Borooah, Naing Latt Tint
9 The ear, nose and throat 171
Iain Hathorn
10 The endocrine system 193
Anna R Dover, Nicola Zammitt
11 The reproductive system 211
Oliver Young, Colin Duncan, Kirsty Dundas, Alexander Laird
vi • Contents
12 The renal system 237
Neeraj Dhaun, David Kluth
13 The musculoskeletal system 251
Jane Gibson, Ivan Brenkel
14 The skin, hair and nails 283
Michael J Tidman
SECTION 3 APPLYING HISTORY AND EXAMINATION SKILLS IN SPECIFIC SITUATIONS 295
15 Babies and children 297
Ben Stenson, Steve Cunningham
16 The patient with mental disorder 319
Stephen Potts
17 The frail elderly patient 329
Andrew Elder, Elizabeth MacDonald
18 The deteriorating patient 339
Ross Paterson, Anna R Dover
19 The dying patient 347
Anthony Bateman, Kirsty Boyd
SECTION 4 PUTTING HISTORY AND EXAMINATION SKILLS TO USE 353
20 Preparing for assessment 355
Anna R Dover, Janet Skinner
21 Preparing for practice 361
Karen Fairhurst, Gareth Clegg
Index 375
Preface
Despite the wealth of diagnostic tools available to the modern to the use of pattern recognition to identify spot diagnoses.
physician, the acquisition of information by direct interaction Section 2 deals with symptoms and signs in specific systems
with the patient through history taking and clinical examination and Section 3 illustrates the application of these skills to specific
remains the bedrock of the physician’s art. These time-honoured clinical situations. Section 4 covers preparation for assessments
skills can often allow clinicians to reach a clear diagnosis without of clinical skills and for the use of these skills in everyday practice.
recourse to expensive and potentially harmful tests. An expertly performed history and examination of a patient
This book aims to assist clinicians in developing the consultation allows the doctor to detect disease and predict prognosis, and is
skills required to elicit a clear history, and the practical skills crucial to the principle of making the patient and their concerns
needed to detect clinical signs of disease. Where possible, the central to the care process, and also to the avoidance of harm
physical basis of clinical signs is explained to aid understanding. from unnecessary or unjustified tests.
Formulation of a differential diagnosis from the information gained We hope that if young clinicians are encouraged to adopt
is introduced, and the logical initial investigations are included for and adapt these skills, they not only will serve their patients
each system. Macleod’s Clinical Examination is designed to be as diagnosticians but also will themselves continue to develop
used in conjunction with more detailed texts on pathophysiology, clinical examination techniques and a better understanding of
differential diagnosis and clinical medicine, illustrating specifically their mechanisms and diagnostic use.
how the history and examination can inform the diagnostic The 14th edition of Macleod’s Clinical Examination has an
process. accompanying set of videos available in the online Student
In this edition the contents have been restructured and the Consult electronic library. This book is closely integrated with
text comprehensively updated by a team of existing and new Davidson’s Principles and Practice of Medicine and is best read
authors, with the aim of creating an accessible and user-friendly in conjunction with that text.
text relevant to the practice of medicine in the 21st century.
Section 1 addresses the general principles of good interaction JAI, ARD, KF
with patients, from the basics of taking a history and examining, Edinburgh, 2018
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