Mosby's Physical Examination Handbook

514 Pages·2010·6.35 MB·English

by  Jane W. Ball, Joyce E. Dains, Barry S. Solomon, M.D., Henry M. Seidel

Mosby’s Physical Examination

Handbook

Seven Edition

Henry M. Seidel, MD

Professor Emeritus of Pediatrics, The Johns Hopkins
University, School of Medicine, Baltimore, Maryland

Jane W. Ball, RN, DrPH, CPNP, DPNAP

Trauma Systems Consultant, American College of

Surgeons, Gaithersburg, Maryland

Joyce E. Dains, DrPH, JD, RN, FNP-BC, DPNAP

Advanced Practice Nursing Program Director, The
University of Texas, M. D. Anderson Cancer Center,

Houston, Texas

John A. Flynn, MD, MBA, FACP, FACR

Clinical Director and Professor of Medicine, Division of

General Internal Medicine, The Johns Hopkins

University, School of Medicine, Baltimore, Maryland

Barry S. Solomon, MD, MPH

Assistant Professor of Pediatrics, Medical Director,

Harriet Lane Clinic, Division of General Pediatrics and
Adolescent Medicine, The Johns Hopkins University,

School of Medicine, Baltimore, Maryland

Rosalyn W. Stewart, MD, MS, MBA Assistant

Professor of Pediatrics and Medicine,

Department of Internal Medicine and Pediatrics,

The Johns Hopkins University, School of

Medicine, Baltimore, Maryland

Mosby

Front Matter

Mosby’s PHYSICAL EXAMINATION HANDBOOK

Seventh Edition

Henry M. Seidel, MD Professor Emeritus of Pediatrics, The

Johns Hopkins University, School of Medicine, Baltimore,
Maryland

Jane W. Ball, RN, DrPH, CPNP Trauma Systems

Consultant, American College of Surgeons, Gaithersburg,
Maryland

Joyce E. Dains, DrPH, JD, RN, FNP-BC, NAP Advanced

Practice Nursing Program Director, The University of Texas,
MD Anderson Cancer Center, Houston, Texas

John A. Flynn, MD, MBA, FACP, FACR Clinical Director

and Professor of Medicine, Division of General Internal
Medicine, The Johns Hopkins University, School of Medicine,
Baltimore, Maryland

Barry S. Solomon, MD, MPH Assistant Professor of

Pediatrics, Medical Director, Harriet Lane Clinic, Division of
General Pediatrics and Adolescent Medicine, The Johns
Hopkins
University,
School
of
Medicine,
Baltimore,

Maryland

Rosalyn Stewart, MD, MS, MBA Assistant Professor,

Department of Internal Medicine and Pediatrics, The Johns
Hopkins University, Baltimore, Maryland

Copyright

3251 Riverport Lane
St. Louis, Missouri 63043
Mosby’s Physical Examination Handbook ISBN: 978-0-

32306540-5

© 2011, 2006, 2003, 1999, 1995 by Mosby, Inc., an

affiliate of Elsevier Inc. All rights reserved.

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Notices

Knowledge and best practice in this field are constantly

changing. As new research and experience broaden our
understanding, changes in research methods, professional
practices, or medical treatment may become necessary.

Practitioners and researchers must always rely on their

own experience and knowledge in evaluating and using any
information,
methods,
compounds,
or
experiments

described herein. In using such information or methods,
they should be mindful of their own safety and the safety of
others, including parties for whom they have a professional
responsibility.

With respect to any drug or pharmaceutical products

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information provided (i) on procedures featured or (ii) by
the manufacturer of each product to be administered to
verify the recommended dose or formula, the method and
duration of administration, and contraindications. It is the
responsibility of practitioners, relying on their own
experience and knowledge of their patients, to make
diagnoses, to determine dosages and the best treatment for
each individual patient, and to take all appropriate safety
precautions.

To the fullest extent of the law, neither the Publisher nor

the authors, contributors, or editors, assume any liability 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.

International Standard Book Number 978-0-32306540-

5

Executive Publisher: Robin Carter Developmental Editor:

Deanna Dedeke Publishing Services Manager: Anne Altepeter
Senior Project Manager: Cheryl A. Abbott Designer: Charlie
Seibel Printed in China

Last digit is the print number: 9 8 7 6 5 4 3 2 1

Preface

Mosby’s Physical Examination Handbook, seventh edition, is a

portable clinical reference on physical examination that is
suitable for students of nursing, medicine, chiropractic,
osteopathic, and other allied health disciplines, as well as for
practicing health care providers. It offers brief descriptions of
examination
techniques
and
guidelines
on
how
the

examination should proceed, step by step. This handbook is
intended to be an aid to review and recall the procedures of
physical examination. It cannot, because of its brevity,
describe the specific techniques of history taking by organ
system.

The handbook begins with an outline of what information

should be obtained for the patient’s medical history and
review of systems. Subsequent chapters for each of the body
systems list equipment needed to perform the examination
and present the techniques to be used. Expected and
Unexpected Findings follow the description of each technique,
presented in distinctive color type for easy recognition.
Numerous illustrations interspersed throughout the text
reinforce techniques and possible findings.

Each chapter offers Aids to Differential Diagnosis and also

provides Sample Documentation, which is focused on a
specific complaint to illustrate good documentation practice.
Subjective Data and Objective Data are now clearly
differentiated for each abnormality in the Aids to Differental
Diagnosis section of each chapter in the seventh edition.

As in previous editions, separate chapters give an overview

of the entire examination for all adults; for healthy females;

and for infants, children, and adolescents. Pediatric Variations
are highlighted in each body systems chapter. The final
chapter gives guidelines for Reporting and Recording findings.

New to this edition is an appendix on Pain Assessment Tools,

including the Numeric Pain Intensity Scale, the Visual
Analogue Scale, and the Wong/Baker FACES Rating Scale.

Henry M. Seidel, Jane W. Ball, Joyce E. Dains,
John A. Flynn, Barry S. Solomon, Rosalyn W.

Stewart

Table of Contents

Front Matter
Copyright

Preface
Chapter 1: The History

Chapter 2: Mental Status
Chapter 3: Nutrition and Growth and Measurement

Chapter 4: Skin, Hair, and Nails
Chapter 5: Lymphatic System

Chapter 6: Head and Neck
Chapter 7: Eyes

Chapter 8: Ears, Nose, and Throat
Chapter 9: Chest and Lungs

Chapter 10: Heart
Chapter 11: Blood Vessels

Chapter 12: Breasts and Axillae
Chapter 13: Abdomen

Chapter 14: Female Genitalia
Chapter 15: Male Genitalia

Chapter 16: Anus, Rectum, and Prostate
Chapter 17: Musculoskeletal System

Chapter 18: Neurologic System

Chapter 19: Head-to-Toe Examination

Chapter 20: The Healthy Female Evaluation
Chapter 21: Age-Specific Examination

Chapter 22: Reporting and Recording
Appendix

References
Index

CHAPTER 1

The History

BUILDING THE HISTORY

The following outline of a patient history is a guideline and
should not be considered a rigid structure. You are beginning
your relationship with the patient at this point. Take care with
this relationship. The information you gain in the history loses
meaning if your bond with the patient is less than strong.
Choose a comfortable setting and help the patient get settled.
Maintain eye contact and use a conversational tone. Begin by
introducing yourself and explaining your role. Help the patient
understand why you are building the history and how it will be
used. Explore positive responses with additional questions:
Where, when, what, how, and why. Be sensitive to the patient’s
emotions at all times. Avoid confrontation and asking leading
questions.

CHIEF COMPLAINT

Problem or symptom: Reason for visit Duration of problem

Patient information: Age, sex, marital status, previous hospital
admissions; occupation Other complaints: Secondary issues,
fears, concerns, what made patient seek care Always consider
why this particular problem may be affecting this particular