Table Of Contents:

List of Table xv
Introduction xix

An Overview of Physical Examination and History Taking 1(20)

The Health History: Structure and Purposes 2(2)

The Comprehensive Adult Health History 4(5)

Chief Complaint(s) 4(1)

Present Illness 4(1)

Past History 5(1)

Family History 5(1)

Personal and Social History 6(1)

Review of Systems 6(3)

The Physical Examination: Approach and Overview 9(4)

The Comprehensive Physical Examination 10(1)

General Survey 10(1)

Vital Signs 10(1)

Skin 10(1)

Heent 10(1)

Neck 10(1)

Back 10(1)

Posterior Thorax and Lungs 11(1)

Breasts, Axillae, and Epitrochlear Nodes 11(1)

Anterior Thorax and Lungs 11(1)

Cardiovascular System 11(1)

Abdomen 11(1)

Lower Extremities 11(1)

Nervous System 12(1)

Additional Examinations 13(1)

Recording Your Findings 13(6)

The Case of Mrs. N 14(5)

Learning History Taking and Physical Examination 19(2)

Interviewing and the Health History 21(38)

Getting Ready: The Approach to the Interview 23(1)

Taking Time for Self-Reflection 23(1)

Reviewing the Chart 23(1)

Setting Goals for the Interview 23(1)

Reviewing Clinician Behavior and Appearance 24(1)

Improving the Environment 24(1)

Taking Notes 24(1)

Learning About the Patient: The Process of Interviewing 24(1)

Greeting the Patient and Establishing Rapport 25(1)

Inviting the Patient's Story 26(1)

Establishing the Agenda for the Interview 27(1)

Expanding and Clarifying the Health History (The Patient's Perspective) 27(1)

Generating and Testing Diagnostic Hypotheses (The Clinician's Perspective) 28(1)

Creating a Shared Understanding of the Problem 28(1)

Negotiating a Plan 29(1)

Planning for Follow-Up and Closing 30(1)

Facilitating the Patient's Story: The Techniques of Skilled Interviewing 30(1)

Active Listening 31(1)

Adaptive Questioning 31(1)

Nonverbal Communication 32(1)

Facilitation 32(1)

Echoing 32(1)

Empathic Responses 32(1)

Validation 33(1)

Reassurance 33(1)

Summarization 33(1)

Highlighting Transitions 33(1)

Adapting Interviewing Techniques to Specific Situations 34(1)

The Silent Patient 34(1)

The Talkative Patient 34(1)

The Anxious Patient 35(1)

The Crying Patient 35(1)

The Confusing Patient 35(1)

The Angry or Disruptive Patient 36(1)

The Patient With a Language Barrier 37(1)

The Patient With Reading Problems 38(1)

The Patient With Impaired Hearing 38(1)

The Patient With Impaired Vision 38(1)

The Patient With Limited Intelligence 39(1)

The Poor Historian 39(1)

The Patient With Personal problems 40(1)

Special Aspects of Interviewing 40(1)

Cultural Competence 41(2)

The Alcohol and Drug History 43(2)

The Sexual History 45(1)

Domestic and Physical Violence 46(1)

The Mental Health History 47(1)

Death and the Dying Patient 47(2)

Sexuality in the Clinician-Patient Relationship 49(1)

Ethical Considerations 49(3)

Interviewing Patients of Different Ages 52(1)

Talking With Children 52(3)

Talking With Adolescents 55(1)

Talking With Aging Patients 56(3)

Beginning the Physical Examination: General Survey and Vital Signs 59(36)

Anatomy and Physiology 59(3)

Calculating the BMI 60(1)

Interpreting and Acting on the BMI 61(1)

The Health History 62(3)

Changes in Weight 62(1)

Fatigue and Weakness 63(1)

Fever and Chills 64(1)

Health Promotion and Counseling 65(2)

Optimal Weight and Nutrition 65(1)

Exercise 65(1)

Blood Pressure and Diet 65(2)

Techniques of Examination 67(5)

Beginning the Examination: Setting the Stage 67(1)

Approaching the Patient 67(1)

Scope of the Examination: How Complete Should It Be? 68(1)

Choosing the Examination Sequence, Examining Position and Handedness 68(2)

Adjusting Lighting and the Environment 70(1)

Promoting the Patient's Comfort 71(1)

The General Survey 72(3)

Apparent State of Health 73(1)

Level of Consciousness 73(1)

Signs of Distress 73(1)

Height and Build 73(1)

Weight 73(1)

Skin Color and Obvious Lesions 73(1)

Dress, Grooming, and Personal Hygiene 73(1)

Facial Expression 74(1)

Odors of the Body and Breath 74(1)

Posture, Gait and Motor Activity 74(1)

The Vital Signs 75(20)

Blood Pressure 75(4)

Special Problems 79(1)

Heart Rate and Rhythm 80(1)

Respiratory Rate and Rhythm 81(1)

Temperature 81(14)

The Skin 95(20)

Anatomy and Physiology 95(3)

Changes with Aging 97(1)

The Health History 98(1)

Health Promotion and Counseling 98(2)

Techniques of Examination 100(15)

Skin 100(2)

Nails 102(1)

Hair 102(1)

Skin Lesions in Context 102(13)

The Head and Neck 115(94)

Anatomy and Physiology 115(21)

The Head 115(1)

The Eye 115(8)

The Ear 123(2)

The Nose and Paranasal Sinuses 125(3)

The Mouth and Pharynx 128(3)

The Neck 131(3)

Changes With Aging 134(2)

The Health History 136(5)

The Head 136(1)

The Eyes 137(1)

The Ears 138(1)

The Nose and Sinuses 139(1)

The Mouth, Throat, and Neck 140(1)

Health Promotion and Counseling 141(3)

Techniques of Examination 144(65)

The Head 144(1)

The Hair 144(1)

The Scalp 144(1)

The Skull 144(1)

The Face 144(1)

The Skin 144(1)

The Eyes 144(1)

Visual Acuity 144(1)

Visual Fields by Confrontation 145(2)

Position and Alignment of the Eyes 147(1)

Eybrows 147(1)

Eyelids 147(1)

Lacrimal Apparatus 147(1)

Conjunctive and Sclera 147(1)

Cornea and Lens 148(1)

Iris 148(1)

Pupils 148(1)

Extraocular Muscles 149(2)

Ophthalmoscopic Examination 151(5)

The Ears 156(1)

The Auricle 156(1)

Ear Canal and Drum 156(1)

Auditory Acuity 157(1)

Air and Bone Conduction 157(2)

The Nose and Paranasal Sinuses 159(1)

The Mouth and Pharynx 160(1)

The Lips 160(1)

The Oral Mucosa 160(1)

The Gums and Teeth 161(1)

The Roof of the Mouth 161(1)

The Tongue and the Floor of the Mouth 161(1)

The Pharynx 162(1)

The Neck 163(1)

Lymph Nodes 163(2)

The Trachea and the Thyroid Gland 165(3)

The Carotid Arteries and Jugular Veins 168

Special Techniques 167(1)

For Assessing Prominent Eyes 167(1)

For Nasolacrimal Duct Obstruction 167(1)

For Inspection of the Upper Palpebral Conjunctiva 168(1)

Swinging Flashlight Test 169(1)

Transillumination of the Sinuses 169(40)

The Thorax and Lungs 209(36)

Anatomy and Physiology 209(7)

Locating Findings on the Chest 210(2)

Lungs, Fissures, and Lobes 212(2)

Locations on the Chest 214(1)

The Trachea and Major Bronchi 214(1)

The Pleurae 214(1)

Breathing 215(1)

Changes With Aging 216(1)

The Health History 216(2)

Health Promotion and Counseling 218(2)

Techniques of Examination 220(25)

Initial Survey of Respiration and the Thorax 220(1)

Examination of the Posterior Chest 221(8)

Examination of the Anterior Chest 229(4)

Special Techniques 233(1)

Clinical Assessment of Pulmonary Function 233(1)

Forced Expiratory Time 233(1)

Identification of a Fractured Rib 233(12)

The Cardiovascular System 245(52)

Anatomy and Physiology 245(15)

Surface Projections of the Heart and Great Vessels 245(2)

Cardiac Chambers, Valves, and Circulation 247(1)

Events in the Cardiac Cycle 248(2)

The Splitting of Heart Sounds 250(1)

Heart Murmurs 251(1)

Relation of Auscultatory Findings to the Chest Wall 252(1)

The Conduction System 253(1)

The Heart as a Pump 254(1)

Arterial Pulses and Blood Pressure 255(1)

Jugular Venous Pressure and Pulses 256(2)

Changes With Aging 258(1)

The Apical Impulse and Heart Sounds 258(1)

Cardiac Murmurs 259(1)

Arteries and Blood Pressure 260(1)

The Health History 260(2)

Health Promotion and Counseling 262(4)

Techniques of Examination 266(31)

Jugular Venous Pressure and Pulsations 266(3)

The Carotid Pulse 269(1)

Thrills and Bruits 270(1)

The Brachial Artery 270(1)

The Heart 271(12)

A Note on Cardiovascular Assessment 283(1)

Special Techniques 283(1)

Aids to Identify Systolic Murmurs 283(1)

Pulsus Alternans 284(1)

Paradoxical Pulse 285(12)

The Breasts and Axillae 297(20)

Anatomy and Physiology 297(4)

Changes With Aging 299(1)

Adulthood 299(1)

Aging 300(1)

Lymphatics 300(1)

The Health History 301(1)

Health Promotion and Counseling 301(4)

Risk Factors for Breast Cancer 302(2)

Breast Cancer Screening 304(1)

Techniques of Examination 305(12)

The Female Breast 305(5)

The Male Breast 310(1)

The Axillae 310(1)

Special Techniques 311(1)

Assessment of Spontaneous Nipple Discharge 311(1)

Examination of the Mastectomy Patient 312(1)

Instructions for the Breast Self-Examination 312(5)

The Abdomen 317(50)

Anatomy and Physiology 317(3)

Changes With Aging 320(1)

The Health History 320(9)

The Gastrointestinal Tract 321(6)

The Urinary Tract 327(2)

Health Promotion and Counseling 329(3)

Techniques of Examination 332(35)

The Abdomen 332(5)

The Liver 337(3)

The Spleen 340(3)

The Kidneys 343(1)

The Bladder 344(1)

The Aorta 344(1)

Special Techniques 345(1)

Assessing Possible Ascites 345(2)

Assessing Possible Appendicitis 347(1)

Assessing Possible Acute Cholecystitis 348(1)

Assessing Ventral Hernias 348(1)

Mass in the Abdominal Wall 349(18)

Male Genitalia and Hernias 367(16)

Anatomy and Physiology 367(3)

Lymphatics 368(1)

Anatomy of the Groin 369(1)

Changes With Aging 369(1)

The Health History 370(1)

Health Promotion and Counseling 371(2)

Techniques of Examination 373(10)

The Penis 373(1)

The Scrotum and Its Contents 374(1)

Hernias 375(1)

Special Techniques 376(1)

The Testicular Self-Examination 376(7)

Female Genitalia 383(26)

Anatomy and Physiology 383(3)

Lymphatics 385(1)

Changes With Aging 385(1)

The Health History 386(3)

Menarche, Menstruation, Menopause 386(1)

Pregnancy 387(1)

Vulvovaginal Symptoms 388(1)

Sexual Activity 388(1)

Health Promotion and Counseling 389(2)

The Pap Smear 389(1)

Options for Family Planning 389(1)

STDs and HIV 390(1)

Changes in Menopause 390(1)

Techniques of Examination 391(18)

Choosing Equipment 392(1)

Positioning the Patient 393(1)

External Examination 393(1)

Internal Examination 394(6)

Hernias 400(1)

Special Techniques 400(9)

The Pregnant Woman 409(18)

Anatomy and Physiology 409(4)

The Health History 413(1)

Health Promotion and Counseling 414(3)

Techniques of Examination 417(10)

Positioning 417(1)

Equipment 418(1)

General Inspection 418(1)

Vital Signs and Weight 418(1)

Head and Neck 419(1)

Thorax and Lungs 419(1)

Heart 419(1)

Breasts 419(1)

Abdomen 420(2)

Genitalia, Anus, and Rectum 422(1)

Extremities 423(1)

Special Techniques 424(1)

Modified Leopold's Maneuvers 424(2)

Concluding the Visit 426(1)

The Anus, Rectum, and Prostate 427(14)

Anatomy and Physiology 427(2)

Changes With Aging 428(1)

The Health History 429(1)

Health Promotion and Counseling 430(3)

Techniques of Examination 433(8)

Male 433(3)

Female 436(5)

The Peripheral Vascular System 441(24)

Anatomy and Physiology 441(5)

Arteries 441(1)

Veins 442(2)

The Lymphatic System and Lymph Nodes 444(1)

Fluid Exchange and the Capillary Bed 445(1)

Changes With Aging 446(1)

The Health History 446(2)

Health Promotion and Counseling 448(2)

Techniques of Examination 450(15)

Arms 450(1)

Legs 451(6)

Special Techniques 457(1)

Evaluating the Arterial Supply to the Hand 457(1)

Postural Color Changes of Chronic Arterial Insufficiency 458(1)

Mapping Varicose Veins 459(1)

Evaluating the Competency of Venous Valves 459(6)

The Musculoskeletal System 465(70)

Anatomy and Physiology 465(19)

Structure and Function of Joints 465(2)

Temporomandibular Joint 467(2)

The Shoulder 469(2)

The Elbow 471(2)

The Wrist and Hands 473(2)

The Spine 475(3)

The Hip 478(1)

The Knee 479(4)

The Ankle and Foot 483(1)

Changes With Aging 484(1)

The Health History 484(3)

Health Promotion and Counseling 487(3)

Techniques of Examination 490(45)

The Temporomandibular Joint (TMJ) 491(1)

The Shoulder 492(4)

The Elbow 496(1)

The Wrist and Hand 497(4)

The Spine 501(5)

The Hip 506(5)

The Knee and Lower Leg 511(6)

The Ankle and Foot 517(2)

Special Techniques 519(1)

For the Carpal Tunnel Syndrome 519(1)

For Low Back Pain With Radiation Into the Leg 520(1)

Measuring the Length of Legs 520(1)

Describing Limited Motion of a Joint 521(14)

The Nervous System 535(88)

Anatomy and Physiology 535(13)

Central Nervous System 536(1)

The Brain 536(1)

The Spinal Cord 537(1)

Peripheral Nervous System 538(1)

The Cranial Nerves 538(1)

The Peripheral Nerves 538(2)

Spinal Reflexes: The Deep Tendon Response 540(1)

Motor Pathways 541(1)

Sensory Pathways 542(5)

Changes With Aging 547(1)

The Health History 548(3)

Health Promotion and Counseling 551(4)

Techniques of Examination 555(68)

Mental Status 556(2)

Appearance and Behavior 558(1)

Speech and Language 559(1)

Mood 560(1)

Thought and Perceptions 561(2)

Cognitive Functions 563(2)

Higher Cognitive Functions 565(2)

The Cranial Nerves 567(4)

The Motor System 571(12)

The Sensory System 583(3)

Deep Tendon Reflexes 586(6)

Special Techniques 592(1)

Mini-Mental State Examination (MMSE) 592(1)

Asterixis 592(1)

Winging of the Scapula 593(1)

Meningeal Signs 593(1)

Anal Reflex 594(1)

The Stuporous or Comatose Patient 594(29)

Assessing Children: Infancy Through Adolescence 623(160)

Child Development 625(9)

Key Principles 625(1)

Infancy: The First Year of Life 626(2)

Early Childhood: 1 Through 4 Years 628(2)

Middle Childhood: 5 Through 10 Years 630(1)

Adolescence: 11 Through 20 Years 631(3)

Health Promotion and Counseling 634(2)

Approach to the Examination of Children at Different Ages 636(19)

Sequence of the Examination 638(1)

Assessing the Newborn 639(6)

Assessing the Infant 645(4)

Assessing Early Childhood 649(3)

Assessing Middle Childhood 652(1)

Assessing the Adolescent 653(2)

Techniques of Examination 655(128)

General Survey 655(3)

Vital Signs 658(5)

The Skin 663(3)

The Head 666(4)

The Neck 670(2)

The Eye 672(4)

The Ear 676(4)

The Nose and Paranasal Sinuses 680(1)

The Mouth and Pharynx 681(5)

The Thorax and Lungs 686(4)

The Heart 690(9)

The Breasts 699(1)

The Abdomen 700(4)

Male Genitalia 704(4)

Female Genitalia 708(7)

The Rectal Examination 715(1)

The Musculoskeletal System 715(11)

The Nervous System 726(57)

Clinical Reasoning, Assessment, and Plan 783(18)

Assessment and Plan: The Process of Clinical Reasoning 783(4)

The Case of Mrs. N: Assessment and Plan 787(2)

Approaching the Challenges of Clinical Data 789(1)

Clustering Data into Single Versus Multiple Problems 789(1)

Sifting Through an Extensive Array of Data 790(1)

Assessing the Quality of the Data 790(2)

Displaying Clinical Data 792(2)

Building Your Case: The Interplay of Clinical Reasoning and Assessment of Clinical Data 794(1)

Organizing the Patient Record 795(3)

Generating the Problem List 798(1)

Writing the Progress Note 799(1)

Clinical Assessment: The Journey to Excellence 800(1)
Appendix: Prevalence and Predictive Value 801(2)
Bibliography 803(22)
Index 825