Making sense of clinical examination of the adult patient : hands-on guide

313 Pages·2006·6.69 MB·English

by  D G Model

MAKING SENSE OF CLINICAL EXAMINATION
OF THE ADULT PATIENT
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MAKING SENSE OF
CLINICAL
EXAMINATION OF
THE ADULT
PATIENT
A HANDS-ON GUIDE
Douglas Model
MBBS BSc (Physiology) FRCP
American University of the Caribbean,
St Maarten, West Indies
Formerly Consultant Physician,
Eastbourne District General Hospital,
Eastbourne, UK
Hodder Arnold
AMEMBER OF THE HODDER HEADLINE GROUP
First published in Great Britain in 2006 by
Hodder Arnold, an imprint of Hodder Education and a member of the
Hodder Headline Group, 338 Euston Road, London NW1 3BH
http://www.hoddereducation.com
Distributed in the United States of America by
Oxford University Press Inc.,
198 Madison Avenue, New York, NY10016
Oxford is a registered trademark of Oxford University Press
© 2006 Douglas Model
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
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the Copyright licensing Agency: 90 Tottenham Court Road, London W1T 4LP.
Whilst the advice and information in this book are believed to be true and accurate
at the date of going to press, neither the author[s] nor the publisher can accept any
legal responsibility or liability for any errors or omissions that may be made. In
particular, (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-10[normal]: 0 340 928 247
ISBN-13 [normal]: 978 0 340 928 240
ISBN-10[ISE]: 0 340 928 425
ISBN-13 [ISE]: 978 0 340 928 424
(International Students’ Edition, restricted territorial availability)
1 2 3 4 5 6 7 8 9 10
Commissioning Editor: Joanna Koster
Project Editor: Jane Tod
Production Controller: Lindsay Smith
Cover Design: Nichola Smith
Indexer: Shirley May, Indexing specialists (UK) Ltd
Artist: Kate Nardoni
Cover artwork: Barking Dog Art
Typeset in 101⁄2on 13 pt Rotis Serif by Phoenix Photosetting, Chatham, Kent
Printed and bound in Italy
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To my wife, Jillie, and to the students who inspired this book.
Teaching the students has been both a privilege and a joy.
The more knowledge and the more facts and concepts you
have at your immediate disposal, the more use you will be to
your patients.
Douglas Model
CONTENTS
Preface ix
Acknowledgements xi
List of abbreviations xiii
1 Practical considerations 1
2 Clinical thinking and the diagnostic process 3
3 History-taking 13
4 General appearance of the patient 31
5 Vital signs 54
6 Head, nose, ears, mouth and neck 69
7 Cardiovascular system 80
8 Peripheral vascular system 112
9 Respiratory system 120
10 Abdominal system 140
11 Mental status examination 156
12 Cranial nerves 161
13 Motor system 193
14 Sensory system 214
15 Unconscious patient 225
16 Musculoskeletal system 232
17 Breasts and axillae 260
18 Female genitalia and rectum 265
19 Male genitalia and rectum 276
Conclusion and further reading 285
Index 287
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PREFACE
This book is intended for students at any stage of their training
and for doctors who wish to revise. In writing it, I have had
two main aims. The first is to explain in a clear, step-by-step
manner how to take a history and examine an adult patient.
The second is to explain the principles underlying the various
parts of the history and as many aspects of clinical signs as
possible, as learning is much easier if one understands
underlying principles rather than resorting to rote learning –
both, however, are necessary to an extent, as medicine is so
complex and full of facts as well as ideas and concepts.
Examples of the underlying principles that are explained are
the physiology of the radial pulse on pages 60–68, cardiac
signs on pages 93–111 and respiratory signs on pages 128–39.
Each chapter covers the examination of a complete body
system, for example the cardiovascular system or the
musculoskeletal system. To make the text clear and enable the
book to be used when actually examining a patient or
practicing examination techniques, as well as for private study,
most chapters are presented in two parts. First is a clearly
labelled Examination section consisting of short bulleted
paragraphs containing step-by-step details of examination
techniques. Following this are Background sections consisting
of conventional paragraphs containing details of the principles
underlying the various signs.
In the hope that students will find them helpful, I have also
included clinical vignettes and text boxes containing