Oxford American Handbook of Clinical Examination and Practical Skills (Oxford American Handbooks of Medicine)

The Oxford American Handbook of Clinical Examination and Practical Skills is a comprehensive pocket guide for medical, physician assistant, and nurse practitioner students. It is designed to help students transition from classroom to clinical internships, preceptorships, and clerkships. Providing clear and user-friendly guidance on all aspects of history taking, physical examination, common practical procedures, data interpretation and communication skills, it gives realistic advice on coping with and mastering common situations. Each systems chapter follows a structured format covering applied anatomy, history, examination, and the presentation of common and important disorders. The procedures section includes approximately forty practical procedures that the final year medical student and senior nurse are expected to perform. The section on data interpretation covers the basics of chest x-rays, abdominal x-rays, ECGs, lung function tests and several other areas that the student is expected to carry out in their early years of training. -- [Résumé de l'éditeur, 4e de couverture] Cover......Page 1 Contents......Page 14 1 Communication skills......Page 30 Introduction......Page 31 Essential considerations......Page 33 Essential rules......Page 35 Getting started......Page 36 General principles......Page 38 Communicating with deaf patients......Page 41 Cross-cultural communication......Page 42 Interpreters......Page 43 Angry patients......Page 44 Talking about sex......Page 45 Breaking bad news......Page 46 Body language: an introduction......Page 50 Written communication......Page 52 Law, ethics, and communication......Page 55 2 The history......Page 58 History-taking......Page 59 Patient profile (PP)......Page 60 Chief complaint (CC)......Page 61 History of present illness (HPI)......Page 62 Past medical history (PMH)......Page 64 Drug history......Page 65 Alcohol......Page 66 Smoking......Page 67 Family history (FH)......Page 68 Social history (SH)......Page 70 Review of systems (ROS)......Page 71 The elderly patient......Page 72 The pediatric patient......Page 74 3 General examination......Page 76 Approaching the physical examination......Page 77 Preparing for the examination......Page 79 Color......Page 80 Temperature......Page 82 Hydration......Page 83 Edema......Page 84 Nutritional status......Page 85 Lymph nodes......Page 87 Hands......Page 91 Recognizable syndromes......Page 97 Vitamin and trace element deficiencies......Page 99 The elderly patient......Page 101 4 Skin, hair, and nails......Page 104 Applied anatomy and physiology......Page 105 Dermatological history......Page 107 Hair and nail symptoms......Page 109 Examining the skin......Page 111 Describing a lesion......Page 113 Examining a lump......Page 117 Examining an ulcer......Page 119 The elderly patient......Page 121 5 Endocrine system......Page 124 Applied anatomy and physiology......Page 125 Presenting symptoms in endocrinology......Page 127 The rest of the history......Page 129 General examination......Page 131 Examining the thyroid......Page 133 Eye signs in thyroid disease......Page 135 Examining the patient with diabetes......Page 137 The fundus in endocrine disease......Page 139 Important presenting patterns......Page 143 6 Ear, nose, and throat......Page 148 Applied anatomy and physiology......Page 149 Symptoms of ear disorders......Page 151 Tinnitus......Page 153 Symptoms of nasal disorders......Page 156 Symptoms of throat disorders......Page 158 Examining the ear......Page 161 Examining the nose......Page 164 Examining the nasal sinuses......Page 166 Examining the mouth and throat......Page 167 Important presentations......Page 170 7 Cardiovascular system......Page 174 Applied anatomy and physiology......Page 175 Chest pain......Page 177 Breathlessness and edema......Page 179 Syncope......Page 181 Other cardiovascular symptoms......Page 182 The rest of the history......Page 183 General inspection and hands......Page 184 Peripheral pulses......Page 186 The face and neck......Page 190 Examining the precordium......Page 194 Auscultating the precordium......Page 196 The rest of the body......Page 202 Important presenting patterns......Page 204 The elderly patient......Page 208 8 Respiratory system......Page 210 Applied anatomy and physiology......Page 211 Dyspnea......Page 213 Cough and expectoration......Page 214 Other respiratory symptoms......Page 216 The rest of the history......Page 217 General appearance......Page 219 Hands, face, and neck......Page 220 Inspection of the chest......Page 222 Palpation......Page 223 Percussion......Page 225 Auscultation......Page 227 Important presenting patterns......Page 229 The elderly patient......Page 230 9 Abdomen......Page 232 Applied anatomy......Page 233 Esophageal symptoms......Page 235 Nausea, vomiting, and vomitus......Page 237 Abdominal pain......Page 239 Bowel habit......Page 241 Jaundice and pruritus......Page 245 Abdominal swelling......Page 246 Urinary and prostate symptoms......Page 247 Appetite and weight......Page 249 The rest of the history......Page 250 Outline examination......Page 252 Hand and upper limb......Page 253 Face and chest......Page 255 Inspection of the abdomen......Page 258 Auscultation......Page 260 Palpation......Page 261 Palpating the abdominal organs......Page 262 Percussion......Page 268 Rectal examination......Page 270 Hernial orifices......Page 272 Important presenting patterns......Page 275 The elderly patient......Page 281 10 Nervous system......Page 284 Presenting symptoms in neurology......Page 285 The rest of the history......Page 287 General inspection and mental state......Page 288 Speech and language......Page 289 Cognitive function......Page 291 Cranial nerve I: olfactory......Page 292 Cranial nerve II: optic......Page 293 Cranial nerve II: ophthalmoscopy......Page 297 Pupils......Page 302 Cranial nerves III, IV, and VI......Page 305 Palsies of cranial nerves III, IV, and VI......Page 309 Cranial nerve V: trigeminal......Page 312 Cranial nerve VII: facial......Page 314 Cranial nerve VIII: vestibulocochlear......Page 316 Cranial nerves IX and X......Page 318 Cranial nerve XI: accessory......Page 320 Cranial nerve XII: hypoglossal......Page 322 Motor: applied anatomy......Page 323 Motor: inspection and tone......Page 325 Motor: upper limb power......Page 327 Motor: lower limb power......Page 329 Tendon reflexes......Page 331 Other reflexes......Page 334 Primitive reflexes......Page 336 Sensory: applied anatomy......Page 337 Sensory examination......Page 341 Coordination......Page 344 Some peripheral nerves......Page 346 Gait......Page 350 Important presenting patterns......Page 352 The unconscious patient......Page 360 The elderly patient......Page 363 11 Musculoskeletal system......Page 366 Applied anatomy and physiology......Page 367 Important locomotor musculoskeletal symptoms......Page 369 The rest of the history......Page 373 Outline examination......Page 375 GALS screen......Page 376 Elbow......Page 378 Shoulder......Page 380 Spine......Page 383 Hip......Page 385 Knee......Page 387 Ankle and foot......Page 392 Important presenting patterns......Page 394 The elderly patient......Page 402 12 Male reproductive system......Page 404 Applied anatomy and physiology......Page 405 Sexual history......Page 407 Symptoms......Page 408 Examining the male genitalia......Page 410 Important presenting patterns......Page 415 The elderly patient......Page 417 13 Female breast......Page 420 Applied anatomy and physiology......Page 421 Important symptoms......Page 423 Inspection of the breast......Page 426 Palpation of the breast......Page 428 Examining beyond the breast......Page 431 Important presentations......Page 433 14 Female reproductive system......Page 436 Applied anatomy......Page 437 Applied physiology......Page 440 History-taking in gynecology......Page 442 Abnormal bleeding in gynecology......Page 444 Other symptoms in gynecology......Page 448 Outline gynecological examination......Page 452 Pelvic examination......Page 453 Taking a cervical smear......Page 459 History-taking in obstetrics......Page 462 Presenting symptoms in obstetrics......Page 466 Outline obstetric examination......Page 470 Abdominal examination......Page 471 The elderly patient......Page 476 15 Psychiatric assessment......Page 478 Approach to psychiatric assessment......Page 479 History......Page 481 Mental status examination......Page 487 Physical examination......Page 495 Important presenting patterns......Page 496 Medical conditions with psychiatric symptoms and signs......Page 505 16 Pediatric assessment......Page 508 History-taking......Page 509 Examination: an approach......Page 511 Respiratory system......Page 513 Ear, nose, and throat......Page 517 Cardiovascular system......Page 519 Abdomen and gastrointestinal system......Page 522 Palpation......Page 524 Nervous system......Page 526 Developmental assessment......Page 529 The newborn......Page 531 17 Examination under special circumstances......Page 536 Overview......Page 537 Disasters, terrorism, and public health emergencies......Page 538 Other thoughts......Page 539 18 Practical procedures......Page 540 Infiltrating anesthetic agents......Page 541 Sterility and preparation......Page 542 Hand-washing......Page 543 Injections......Page 545 Venipuncture......Page 547 Peripheral IV catheterization......Page 551 Setting up an infusion......Page 553 External jugular vein catheterization......Page 555 Central venous catheterization......Page 556 Blood pressure measurement......Page 560 Recording a 12-lead ECG......Page 562 Arterial blood gas sampling......Page 564 Peak flow measurement......Page 566 Inhaler technique......Page 567 Oxygen administration......Page 573 Basic airway management......Page 576 Tracheostomy management......Page 584 Endotracheal (ET) intubation......Page 586 Noninvasive ventilation (NIV)......Page 588 Pleural fluid sampling (thoracentesis)......Page 590 Chest tube insertion......Page 592 Nasogastric (NG) tube insertion......Page 596 Ascitic tap......Page 598 Abdominal paracentesis (drainage)......Page 600 Male urethral catheterization......Page 602 Female urethral catheterization......Page 604 Suprapubic catheterization......Page 606 Basic suturing......Page 608 Lumbar puncture......Page 610 Pericardial aspiration......Page 612 Defibrillation......Page 613 Knee joint aspiration......Page 617 19 Data interpretation......Page 620 ECG: introduction......Page 621 Chest X-rays: introduction......Page 645 Abdominal X-rays: introduction......Page 670 Radiology: pelvis......Page 675 Radiology: hips and femurs......Page 677 Radiology: knees......Page 679 Radiology: shoulder......Page 681 Radiology: cervical spine......Page 683 Radiology: thoracic and lumbar spine......Page 685 Lung function tests......Page 687 Arterial blood gas analysis......Page 692 Cerebrospinal fluid (CSF)......Page 696 Urinalysis......Page 698 Pleural and ascitic fluid......Page 700 A......Page 702 B......Page 703 C......Page 704 D......Page 706 E......Page 707 F......Page 708 H......Page 709 I......Page 710 L......Page 711 M......Page 712 N......Page 713 O......Page 714 P......Page 715 R......Page 717 S......Page 718 T......Page 719 V......Page 720 Z......Page 721 Cover 1 Contents 14 1 Communication skills 30 Introduction 31 Essential considerations 33 Essential rules 35 Getting started 36 General principles 38 Communicating with deaf patients 41 Cross-cultural communication 42 Interpreters 43 Imparting information 44 The importance of silence 44 Angry patients 44 Telephone and e-mail communication 45 Talking about sex 45 Breaking bad news 46 Body language: an introduction 50 Written communication 52 Law, ethics, and communication 55 2 The history 58 History-taking 59 Using this book 60 Patient profile (PP) 60 Chief complaint (CC) 61 History of present illness (HPI) 62 Past medical history (PMH) 64 Allergies 65 Drug history 65 Alcohol 66 Smoking 67 Family history (FH) 68 Social history (SH) 70 Review of systems (ROS) 71 The elderly patient 72 The pediatric patient 74 3 General examination 76 Approaching the physical examination 77 First impressions 79 Preparing for the examination 79 Color 80 Temperature 82 Hydration 83 Edema 84 Nutritional status 85 Lymph nodes 87 Hands 91 Recognizable syndromes 97 Vitamin and trace element deficiencies 99 The elderly patient 101 4 Skin, hair, and nails 104 Applied anatomy and physiology 105 Dermatological history 107 Hair and nail symptoms 109 Examining the skin 111 Describing a lesion 113 Examining a lump 117 Examining an ulcer 119 The elderly patient 121 5 Endocrine system 124 Applied anatomy and physiology 125 Presenting symptoms in endocrinology 127 The rest of the history 129 General examination 131 Examining the thyroid 133 Eye signs in thyroid disease 135 Examining the patient with diabetes 137 The fundus in endocrine disease 139 Important presenting patterns 143 6 Ear, nose, and throat 148 Applied anatomy and physiology 149 Symptoms of ear disorders 151 Tinnitus 153 Symptoms of nasal disorders 156 Symptoms of throat disorders 158 Examining the ear 161 Examining the nose 164 Examining the nasal sinuses 166 Examining the mouth and throat 167 Important presentations 170 7 Cardiovascular system 174 Applied anatomy and physiology 175 Chest pain 177 Breathlessness and edema 179 Palpitations 181 Syncope 181 Other cardiovascular symptoms 182 The rest of the history 183 General inspection and hands 184 Peripheral pulses 186 The face and neck 190 Examining the precordium 194 Auscultating the precordium 196 The rest of the body 202 Important presenting patterns 204 The elderly patient 208 8 Respiratory system 210 Applied anatomy and physiology 211 Dyspnea 213 Cough and expectoration 214 Other respiratory symptoms 216 The rest of the history 217 General appearance 219 Hands, face, and neck 220 Inspection of the chest 222 Palpation 223 Percussion 225 Auscultation 227 Important presenting patterns 229 The elderly patient 230 9 Abdomen 232 Applied anatomy 233 Esophageal symptoms 235 Nausea, vomiting, and vomitus 237 Abdominal pain 239 Bowel habit 241 Jaundice and pruritus 245 Abdominal swelling 246 Urinary and prostate symptoms 247 Appetite and weight 249 The rest of the history 250 Outline examination 252 Hand and upper limb 253 Face and chest 255 Inspection of the abdomen 258 Auscultation 260 Palpation 261 Palpating the abdominal organs 262 Percussion 268 Rectal examination 270 Hernial orifices 272 Important presenting patterns 275 The elderly patient 281 10 Nervous system 284 Presenting symptoms in neurology 285 The rest of the history 287 The outline examination 288 General inspection and mental state 288 Speech and language 289 Cognitive function 291 Cranial nerve I: olfactory 292 Cranial nerve II: optic 293 Cranial nerve II: ophthalmoscopy 297 Pupils 302 Cranial nerves III, IV, and VI 305 Palsies of cranial nerves III, IV, and VI 309 Cranial nerve V: trigeminal 312 Cranial nerve VII: facial 314 Cranial nerve VIII: vestibulocochlear 316 Cranial nerves IX and X 318 Cranial nerve XI: accessory 320 Cranial nerve XII: hypoglossal 322 Motor: applied anatomy 323 Motor: inspection and tone 325 Motor: upper limb power 327 Motor: lower limb power 329 Tendon reflexes 331 Other reflexes 334 Primitive reflexes 336 Sensory: applied anatomy 337 Sensory examination 341 Coordination 344 Some peripheral nerves 346 Gait 350 Important presenting patterns 352 The unconscious patient 360 The elderly patient 363 11 Musculoskeletal system 366 Applied anatomy and physiology 367 Important locomotor musculoskeletal symptoms 369 The rest of the history 373 Outline examination 375 GALS screen 376 Elbow 378 Shoulder 380 Spine 383 Hip 385 Knee 387 Ankle and foot 392 Important presenting patterns 394 The elderly patient 402 12 Male reproductive system 404 Applied anatomy and physiology 405 Sexual history 407 Symptoms 408 Examining the male genitalia 410 Important presenting patterns 415 The elderly patient 417 13 Female breast 420 Applied anatomy and physiology 421 Important symptoms 423 Inspection of the breast 426 Palpation of the breast 428 Examining beyond the breast 431 Important presentations 433 14 Female reproductive system 436 Applied anatomy 437 Applied physiology 440 History-taking in gynecology 442 Abnormal bleeding in gynecology 444 Other symptoms in gynecology 448 Outline gynecological examination 452 Pelvic examination 453 Taking a cervical smear 459 History-taking in obstetrics 462 Presenting symptoms in obstetrics 466 Outline obstetric examination 470 Abdominal examination 471 The elderly patient 476 15 Psychiatric assessment 478 Approach to psychiatric assessment 479 History 481 Mental status examination 487 Physical examination 495 Important presenting patterns 496 Medical conditions with psychiatric symptoms and signs 505 16 Pediatric assessment 508 History-taking 509 Examination: an approach 511 Respiratory system 513 Ear, nose, and throat 517 Cardiovascular system 519 Abdomen and gastrointestinal system 522 Palpation 524 Nervous system 526 Developmental assessment 529 The newborn 531 17 Examination under special circumstances 536 Overview 537 Disasters, terrorism, and public health emergencies 538 Sexual assault 539 Other thoughts 539 18 Practical procedures 540 Using this chapter 541 Infiltrating anesthetic agents 541 Sterility and preparation 542 Hand-washing 543 Injections 545 Venipuncture 547 Peripheral IV catheterization 551 Setting up an infusion 553 External jugular vein catheterization 555 Central venous catheterization 556 Blood pressure measurement 560 Recording a 12-lead ECG 562 Arterial blood gas sampling 564 Peak flow measurement 566 Inhaler technique 567 Oxygen administration 573 Basic airway management 576 Tracheostomy management 584 Endotracheal (ET) intubation 586 Noninvasive ventilation (NIV) 588 Pleural fluid sampling (thoracentesis) 590 Chest tube insertion 592 Nasogastric (NG) tube insertion 596 Ascitic tap 598 Abdominal paracentesis (drainage) 600 Male urethral catheterization 602 Female urethral catheterization 604 Suprapubic catheterization 606 Basic suturing 608 Lumbar puncture 610 Pericardial aspiration 612 Defibrillation 613 Knee joint aspiration 617 19 Data interpretation 620 ECG: introduction 621 Chest X-rays: introduction 645 Abdominal X-rays: introduction 670 Radiology: pelvis 675 Radiology: hips and femurs 677 Radiology: knees 679 Radiology: shoulder 681 Radiology: cervical spine 683 Radiology: thoracic and lumbar spine 685 Lung function tests 687 Arterial blood gas analysis 692 Cerebrospinal fluid (CSF) 696 Urinalysis 698 Pleural and ascitic fluid 700 Index 702 A 702 B 703 C 704 D 706 E 707 F 708 G 709 H 709 I 710 J 711 K 711 L 711 M 712 N 713 O 714 P 715 Q 717 R 717 S 718 T 719 U 720 V 720 W 721 Z 721 9780195389722 Oxford University Press The Oxford American Handbook of Clinical Examination and Practical Skills is a comprehensive pocket guide for medical, physician assistant, and nurse practitioner students. It is designed to help students transition from classroom to clinical internships, preceptorships, and clerkships. Providing clear and user-friendly guidance on all aspects of history taking, physical examination, common practical procedures, data interpretation and communication skills, it gives realistic advice on coping with and mastering common situations. Each systems chapter follows a structured format covering applied anatomy, history, examination, and the presentation of common and important disorders. The procedures section includes approximately forty practical procedures that the final year medical student and senior nurse are expected to perform. The section on data interpretation covers the basics of chest x-rays, abdominal x-rays, ECGs, lung function tests and several other areas that the student is expected to carry out in their early years of training. -- [Résumé de l'éditeur, 4e de couverture] Communication Skills -- The History -- General Examination -- Skin, Hair, And Nails -- Endocrine System -- Ear, Nose, And Throat -- Cardiovascular System -- Respiratory System -- Abdomen -- Nervous System -- Musculoskeletal System -- Male Reproductive System -- Female Breast -- Female Reporductive System -- Psychiatric Assessment -- Examination Under Special Circumstances -- Practical Procedures -- Data Interpretation. Elizabeth A. Burns, Kenneth Korn, James Whyte Iv ; With James Thomas, Tanya Monaghan. Includes Index.