Pocket Tutor Clinical Examination Peter Cartledge, Catherine Cartledge, Andrew Lockey, Caleb Van Essen
INDEX
ABCDEFGHIJKLMNOPQRSTUVWX
Note: Page numbers in bold or italic refer to tables or figures respectively.
A
Abbreviated Mental Test 207, 207, 278, 326
ABC approach 300, 304
ABCDE approach 331–6
Abdomen
anatomy 109, 110, 111
auscultation 122
cardiovascular disease 66
common scars 121
critically ill patients 337
elderly patients 325
gastrointestinal disease 117, 118–19, 120–9
genitourinary organs see Genitourinary system
imaging investigations 132
inspection 120–21, 164
neonates 313
pain 112–13, 115, 123, 124
palpation 122–7, 164–5
percussion 127
pregnant women 165–6
respiratory disease 93
Abdominal aorta 75, 127
Abdominal aortic aneurysm 115, 127
Abducens nerve (CN VI) 172, 179–81
Accessory nerve (CN XI) 173, 189
Active listening 2
Activities of daily living 11, 11
Addison's disease 286
Adolescents 299, 304
see also Paediatrics
Advanced life support algorithm 340, 341
AEIOU TIPS mnemonic 340
Affect 276
Air hunger 32
Alcohol use 13
Allergies 10
Alopecia 55
Ambulatory blood pressure monitoring 35
Amenorrhoea 156
Amniotic fluid volume 167
AMT see Abbreviated Mental Test
Anal canal 111, 130
Ankle
musculoskeletal examination 246, 258–9
thyroid examination 290
Ankle–brachial pressure index 81–2
Anxiety 268
Aorta, palpation 75, 127
Aortic valves 59, 60, 68, 77, 79
Apex, palpation 99
Apex beat 72, 74
APGAR score 310, 311
Apnoea 33
Appendicitis 115, 124
Appendix 110
Arm see Upper limb
Arterial bruits 82, 122
Ascites 118, 128
Asterixis 47, 47, 210
Asthma 103
Atrioventricular valves
anatomy 59
apex beat 72
cardiac cycle 60
cardiac pattern and diagnoses 68
heart sounds/murmurs 78, 79
surface markings 77
Auditory function 184, 187
Auditory hallucinations 277
Auroscopy 51, 52, 305
Auscultation 38–9
see also specific systems
Autonomy 24, 26
AVPU scale 305, 337
B
Babinski's sign 221
Balanitis 141
Barium studies 132
Basic activities of daily living 11
Beneficence 25
Biliary colic 115
Bimanual pelvic examination 162
Bladder see Urinary bladder
Blood
abnormal bleeding in women 156
coughed up 92
in stools 116
in urine 137
vomiting 114
Blood oxygen saturation see Oxygen saturation
Blood pressure 61, 65
ankle–brachial pressure index 81–2
elderly patients 322
measurement 34–5, 36, 81
National Early Warning Score 338
paediatric patients 322
Blood tests
cardiovascular disease 83
dementia 326
endocrine disease 292
musculoskeletal disease 262
psychiatric assessment 279
respiratory disease 104
sexually transmitted infections 145
Blumberg's sign 124
Body mass index 41
Body surface area 41, 296
Bones 241
Borborygmi 111, 122
Bouchard's nodes 245, 247
Boutonnière's deformity 245, 247
Bowel sounds 111, 122
Bradycardia 66
Bragard's test 255, 261
Brain
anatomy 195–8
visual fields 174
see also Neurological system
Breast 147, 148, 149–55, 168, 287, 328
examination 152–4, 168
Breast tissue 118, 286
Breath smells 120
Breath sounds, reduced 94
Breathing
ABC approach 300, 304
ABCDE approach 331–6
advanced life support 341
bronchial sounds 94
cardiac pathology 62
paediatric patients 296, 300, 301, 304, 31
patterns 32–3, 39
physiology 88
Breathlessness 32, 62, 92
Bronchial tree 87
Bronchoscopy 104
Brudzinski's test 230
Bruising 120
Bruits, arterial 82, 122
BSA see Body surface area
C
CAGE 13
Candida albicans 156
Capacity 25
Capillary refill time 36, 305
Carbon dioxide 89
Cardiogenic shock 43
Cardiopulmonary resuscitation 26, 340, 341
Cardiovascular system 59–86
ABC approach 300, 304
ABCDE approach 332, 334
anatomy 59
auscultation 75–6, 306
cardiac patterns 68
causes of fever 33
critically ill patients 331, 333–4, 336, 341
elderly patients 323, 324
examination 67–71, 86
general inspection 67
history taking 17, 63
investigations 83
jugular venous pressure 51, 68, 97
paediatric patients 300, 301, 304, 306
palpation 72, 81–2, 83
percussion 75, 306
physiology 60–62
pulse assessment 72, 81
signs of dehydration/shock 42
signs of disease 44, 46, 66
symptoms of disease 62–5
Carotid arterial pressure 71
Carotid ultrasonography 84
Carpal tunnel assessment 255–6
Central nervous system 195–98
Cerebellum 198, 225
Cerebrospinal fluid analysis 232
Cervix 148
colposcopy 169
smear and swabs 160
Chest
cardiovascular examination 66, 68, 75–6
critically ill patients 337
elderly patients 327
gastrointestinal disease 117
inspection 97
musculoskeletal disease 241
neonates 312
pain 62–3, 64
percussion 38, 94–5, 99, 101
radiographs 84, 102
respiratory disease 94
respiratory examination 98
surface anatomy 88
Chest radiograph interpretation 105–7
Cheyne–Stokes respiration 32
Child abuse 314
Chlamydia infection 158
Cholangiopancreatography 132
Cholecystitis 124
Circulation
ABC approach 300
ABCDE approach 332, 334
see also Cardiovascular system
Claudication 65
Clock drawing 205–6
Clonus 211
Clubbing 45, 46, 46, 288
CNs see Cranial nerves
Cochlear function 173, 184, 185
Cognitive function 205–6, 321, 320–1, 326
Collateral ligament stability 259, 263
Colonoscopy 132
Colour
APGAR score 311see also Cyanosis; Jaundice
Colposcopy 169
Compulsions 268
Computed tomography 231
Confidentiality 25
Congestive heart failure 61
Consciousness
ABCDE approach 334
AVPU scale 306
delirium 269
Glasgow Coma Scale 335National Early Warning Score 338
paediatric patients 305, 335
sudden loss of 199
Consent 26, 30
Consolidation, lung 103
Constipation 116, 324
Consultations 1
active listening 2
adolescents 300
clinical examination see Clinical examination
documenting 20
elderly patients 318–19
environment for 4
history taking 1, 3, 3–18
psychiatric 269
question techniques 1–2, 8, 17
Coronary angiography 84
Corrigan's sign 68
Cough 90
Crackles 67, 79, 323–4
Cranial nerves
anatomy 171–3
examination 176–89
eye movements 171, 177–8
Cremasteric reflex 143
Crepitations see Crackles
Critically ill patients 331–41
advanced life support 340, 341
early warning score 336, 338
examination 331–41
primary survey 331–36
secondary survey 336
Cruciate ligaments 259–60, 264
Cyanosis 40, 97
D
Deafness 184, 187
Deep tendon reflexes see Reflexes
Deep vein thrombosis 81
Dehydration 42, 42, 302
Delirium 207, 207, 207, 269, 320
DELIRIUM mnemonic 269
Dementia 207, 207, 207, 320
Depression 267
Dermatomes 196, 197, 222
Development assessment 307–10
Diabetes 284, 290–92, 292
Diarrhoea 116
Differential diagnosis 18–19
Digital rectal examination 129–31, 325
Disability, ABCDE approach 332, 334–5
Distributive shock 43
DNA SORAN mnemonic 1, 3
Doctor–patient relationship 1, 2
Documentation 20
Draw test 259
Dropped finger 245, 247
Drug history 3, 4, 8–9
breast disease 151
cardiovascular disease 63
elderly patients 318
endocrine disease 285
gastrointestinal disease 113
gynaecological disease 155
musculoskeletal disease 238
neurological disease 199
paediatric patients 296, 297
pregnant women 163
respiratory disease 90
Drug use, illicit 14
Dual-energy X-ray absorptiometry 266
Dupuytren's contracture 44
Durkan's compression 256
Durosier's sign 68
DVT see Deep vein thrombosis
Dysarthria 202
Dysdiadochokinesia 226
Dysfluency 206
Dyspareunia 156
Dysphagia 113–16
Dysphasia 206
Dysphonia 206
Dyspnoea see Breathlessness
Dysuria 137
E
Ear
CN VIII function 184–7, 188
elderly patients 319
general inspection 51–2
paediatric patients 305
Early warning score 336, 338
EBM see Evidence-based medicine
Echocardiography 85
ECG interpretation 85
Ectopic pregnancy 115
Elbow examination 245, 252
Elderly patients 315–28
examination 321–28
functional age 315
history taking 317–18
multidisciplinary teams 328–9
physiological changes 315–16
symptoms 317–20
Electrocardiography 83
Electroencephalography 231–2
Electromyography 231
Emotional state 39, 276
Endocrine system 281–93
anatomy 281, 282
diabetes 284, 290–1, 292
history taking 284, 285
investigations 292
physiology 281–2, 283
signs of disease 44, 286–7
symptoms of disease 284–6
thyroid examination 287–90
Endoscopy, gastrointestinal 132
Epididymis 141, 142, 143
Epispadias 142
Erectile dysfunction 138
Erythema, palmar 44–5
Ethicolegal considerations 24–6
Evidence-based medicine 21–4
Exposure
ABCDE approach 332, 335–6
for examination 31, 119
Eye
anatomy 175
cardiovascular disease 66, 81
colour vision 177
dehydration 42
elderly patients 323, 327
endocrine disease 287, 288
examination 189–91
gastrointestinal disease 117, 119–20
general inspection 39
innervation 172–3, 171, 174
investigations 191–92
movements 172, 173, 175, 179–80
musculoskeletal disease 241
neonates 313
neurological disease 202
ophthalmoscopy 177, 179–80
pupil 96, 172, 175, 180–1
respiratory disease 96
visual acuity 176, 189, 317
visual fields 174, 176–8, 189, 192, 286
visual symptoms 173–6
F
Face
cardiovascular disease 66
cutaneous innervation 172, 185
elderly patients 323, 327
endocrine disease 287, 288
facial nerve examination 172, 183, 184
gastrointestinal disease 117
general inspection 40, 50
musculoskeletal disease 241
neurological disease 202
respiratory disease 93
veins of 70
Facial nerve (CN VII) 172, 185
Fainting 64
Faith history 12
Fallopian tubes, palpation 162
Falls, elderly patients 319
Family history 3, 4, 10
breast disease 151
cardiovascular disease 63
endocrine disease 285
gastrointestinal disease 113
gynaecological disease 155
musculoskeletal disease 238
neurological disease 199
paediatric patients 297
pregnant women 163
psychiatric assessment 274
respiratory disease 90
Family trees 11
Female reproductive system 147–69
anatomy 135, 147–9
breast 147, 148, 149–54, 168
examination summary 168
gynaecology 149, 150, 154–56, 168
history taking 149–51, 150
investigations 167
obstetric examination 164–7, 168
physiology 149
Femoral hernias 141, 144, 145
Femoral nerve stretch test 255
Fetor hepaticus 53, 120
Fetuses, obstetrics 165
Fever 33–4
elderly patients 321
paediatric patients 301–3
FH see Family history
Fibrosis, lung 99
Finger nails see Nails
Finger rub test, hearing 184
Fits 199–200, 286
Flap 47
see also Tremor
Fluid thrills 128
Fluorescein, topical 192
Fluorescein angiography 192
Foot 40, 53, 218–21, 246
Fundus fluorescein angiography 192
G
Gait 230–2
elderly patients 325
GALS assessment 242–3, 306
Gallbladder 109, 110, 124
Gas exchange, lungs 8
Gastrointestinal system 109–33
anatomy 109, 111, 110–11
auscultation 122, 306
causes of chest pain 64
causes of fever 33
digital rectal examination 129–31, 324
elderly patients 316, 324
examination 119–32, 133
history taking 15, 113
inspection 119–22, 306
investigations 132
paediatric patients 301, 306
palpation 122–27, 306
percussion 127–9, 306
physiology 111
proctoscopy 131
prostate examination 130, 135
signs of disease 44, 46, 116–18, 117
symptoms of disease 112–16
Genetic disorders 310
family trees 11
see also Family history
Genitourinary system
anatomy 135, 136, 147–9
cardiovascular disease 66, 75
causes of fever 33
endocrine disease 285
examination summary 144, 168
female 147–9, 154–67, 155
gastrointestinal disease 117
history taking 15, 137, 139–40, 153, 155
investigations 144, 167
male 135–44
Get-up-and-go test 325
Glasgow Coma Scale 333
Glossopharyngeal nerve (CN IX) 173, 188–9
Glucose test, ABCDE approach 335
Glycaemic control 282, 284
Goitre 287, 286
Goniometers 253
Gonioscopy 192
Graphaesthesia 225
Graves’ disease 288
Groin lumps 141
Growth, paediatric patients 307
Gunstock deformity 247
Gynaecology 149, 150, 153, 154–57, 168
examination 157–62, 168
Gynaecomastia 118, 287
H
Haematemesis 116
Haematuria 137
Haemoptysis 93
Hair 55, 285, 288
Hallpike's manoeuvre 187
Hallucinations 277
Hand
cardiovascular disease 43, 44, 66
deformities 247
endocrine disease 43, 266, 287, 268
gastrointestinal disease 44, 46, 117, 120
general inspection 40, 43–7, 57
hand hygiene 30
movement coordination tests 226
musculoskeletal disease 44, 241, 242
musculoskeletal examination 239, 241, 247, 248, 253–4
neonates 313
osteoarthritis 230
respiratory disease 44, 46, 93
rheumatoid arthritis 240
Head
critically ill patients 337
elderly patients 323, 327
neonates 313
Headache 198–9
Hearing 173, 184, 187
development 308, 309–10
elderly patients 319, 323
Heart
advanced life support algorithm 341
anatomy 59
auscultation 75–80, 80
cardiac cycle 60, 61
cardiac output 61
cardiac patterns and diagnoses 68
chest wall percussion 75
elderly patients 322, 323
failure 61, 65, 68
fetal 167
investigations 83
jugular venous pressure 69, 69–70
murmurs 68, 77, 78–9, 79, 281–99
National Early Warning Score 338
paediatric patients 300, 301
palpation 61–2
signs of disease 64–5
sounds 59, 68, 69, 75, 78
symptoms of disease 62–5
Heaves 73, 74
Heberden's nodes 247
Height, children 307, 308
Hepatojugular reflex 71
Hepatomegaly 124, 126
Hernias 141, 142, 143, 144
Hip examination 246, 247, 257–8
History 3, 4, 6–7
psychiatric assessment 270, 271
History taking 1, 3, 3–17
allergies 8–9
drug history 3, 87–9
family history 3, 10
history of presenting complaint 3, 6–7
immunisation history 10
past medical history 3, 8, 8
past surgical history 3, 8
pitfalls 17
presenting complaint 6
social history 2, 10–14
see also specific systems
HIV/AIDS 43
Horner's syndrome 96, 182
Hydration 42, 42, 302
Hydrocele 142
Hyperbilirubinaemia 117
Hyperglycaemia 286, 335
Hyperkyphosis 247
Hyperpyrexia 34
Hypertension 35, 65
Hyperthyroidism 288, 290
Hypertonia 203
Hypoglossal nerve (CN XII) 173, 189, 193
Hypoglycaemia 286,
Hypomania 267
Hypospadias 142
Hypotension 35, 65, 305, 322
Hypothalamopituitary axis 281, 283
Hypothermia 33, 34
Hypothyroidism 288, 290
Hypovolaemic shock 43
I
Iatrogenic problems 320
Ileus 122
Illusions 277
Immobility 319
Immunisation history 10
Incontinence 156, 324
Inguinal region
anatomy 135, 136
hernias 141, 145
inspection 141
Inherited disease 308–10
family trees 10
see also Family history
Insight 277
Instability 319–20
Instrumental activities of daily living 11, 11
Interferon gamma release assay 104
Intermenstrual bleeding 156
Investigations 19
see also specific systems
Ischaemic heart disease 62
J
Janeway's lesions 44
Jaundice 117
Jaw jerk 181
Joints
active movement 245, 246, 250, 251–62
effusions 239, 258–9
GALS assessment 242, 243
inspection 244, 245–6
investigations 265
loss of function 237
osteoarthritis 236, 240
pain 235, 239, 237–8, 250
palpation 248–9
passive movement 245, 246, 250, 255
position sense 222, 223
range of movement 250–4, 251–62
rheumatoid arthritis 236, 240
special tests 245, 246, 254–60, 261–4
stability 250
stiffness 235
swelling 237–8
types 233
Jugular venous pressure 60, 68, 69–71, 97
K
Kayser–Fleischer rings 119–20
Kernig's sign 230
Ketosis 120
Kidney, palpation 126, 127
Knee examination 246, 258–9, 265
Koilonychia 46, 57
Korotkoff's sounds 35
Kussmaul's respiration 32–3
Kwashiorkor 307, 308
Kyphosis 244, 245, 247, 342
L
Labour 167, 299–300
Lachman's test 259, 264
Language abnormalities 202, 205, 206
Language development 309–10
Large intestine 109, 167
Laseque's test 261
Leg see Lower limb
Legal concepts 24–7
Leuconychia 46, 57
Libido 138
Listening 2
Lithotomy position 157, 158
Liver
anatomy 109, 111
investigations 132
palpation 75, 123, 126
percussion 38
Lobectomy, lung 103
Lordosis 243, 245, 247
Lower limb
GALS assessment 242, 306
general inspection 39, 53
meningism tests 228
muscle tone 212
musculoskeletal examination 246, 250
neonates 313
peripheral vascular system 59–60
power 213, 214
reflexes 218–21
respiratory disease 93
Lumps
breast 153–7
groin 141
lymph node 49, 141
scrotal 141, 142
Lung
anatomy 87, 88
bronchoscopy 104
CT pulmonary angiography 104
elderly patients 327
function tests 104
gas exchange 89
main pathologies 103
signs of disease 93–6
symptoms of disease 96
vocal resonance 101
Lymph nodes 49–50, 50, 99
M
Magnetic resonance imaging 191, 231, 266
Mallet finger 245, 247
Malnutrition 41, 307, 308
Mania 267
Marasmus 307, 307
Mastalgia 151
McBurney's point 124
McMurray's test 264
Median nerve compression 255–6
Medical history see Past medical history
Medical notes 20
Medication history see Drug history
Melaena 116
Memory 207, 320, 326
Meningism 230
Meniscal tears 260
Menstruation
abnormal bleeding 156
menstrual cycle 149, 150
menstrual history 153
Mental state assessment 40–1, 207–8, 208, 275–8, 326
Mental State Examination 275–8
Micturition 137–8
Mini-mental state examination 207–8, 208, 326
Mistreated children 314
Mitral valve see Atrioventricular valves
Mood 276
Motor development 307–10
Motor functions, CNs 172, 181, 183, 188
Motor pathways 195–6
Motor power 203, 213, 218, 219
Mouth
cardiovascular disease 66
elderly patients 323–4, 327
gastrointestinal disease 117, 120
general inspection 40, 51
neonates 313
see also Throat
Movement abnormalities 210, 213
CN XII 189
eye 179–80
joint examination 249–62
see also Tremor
Multidisciplinary teams 328–9
Murphy's sign 124
Muscle power 203, 213–18, 219
Muscle tone 203, 203, 211, 311
Musculoskeletal system 233–66
anatomy 233
causes of chest pain 64
elderly patients 316, 325, 327
examination 240–62, 265
GALS assessment 242–3, 306
history taking 15, 233, 238, 242
investigations 262–6
joint examination 244–62, 265
paediatric patients 301, 306
red flags 236
signs of disease 44, 237–8, 240
symptoms of disease 235–7
N
Nails
general inspection 45–7, 57, 57
thyroid disease 288
National EWS system 336, 338
Nausea 114
Neck
cardiovascular disease 66
critically ill patients 337
deformities 247
elderly patients 327
gastrointestinal disease 117
general inspection 40, 48–51, 50
goitre 286, 287, 289
meningism 228–30
musculoskeletal disease 241
musculoskeletal examination 245, 247, 250, 259
neonates 313
respiratory disease 93
veins of 70
Neonates 295, 310–13
Nerve conduction studies 231, 266
Neurological system 195–232
abbreviated assessment 205, 207
ABCDE approach 335–6
anatomy 195–8
causes of fever 33
cerebellar function 210
critically ill patients 337
dehydration/shock 42
elderly patients 316, 325, 327
examination equipment 204
examination 203–9, 232
gait 230, 325
general inspection 208, 306
higher mental function 205–10, 326
history taking 15, 198–201
investigations 207–8
meningism tests 228–30
paediatric patients 301, 306, 311, 335
physiology 198
positioning the patient 205
power 203, 213–18, 219
reflexes 198, 202, 203, 218–21
sensation 202, 221–5
signs of disease 44, 202–3
symptoms of disease 198–201
tone 203, 203,s 211, 311
see also Cranial nerves; Ophthalmology; Psychiatric assessment
NEWS system 336, 338
Nipples 151–2, 153
Nocturia 138
Nocturnal dyspnoea 32, 63
Non-maleficence 25
Nose 53, 54, 313
Note making 20
Nutrition
clinical assessment 41–2
elderly patients 322
history taking 14–15, 297
paediatric patients 297, 307, 308
Nystagmus 179
O
Observations see Vital signs
Obsessions 268
Obstetric examination 164–7, 168
Obstructive sleep apnoea 31
Oculomotor nerve (CN III) 172, 179
Odynophagia 113
Oedema 67, 75
Olfactory nerve (CN I) 172
OPERATES+ mnemonic 3, 270
Ophthalmology
cardiovascular examination 81
cranial nerve examinations 176–9
eye anatomy 176
eye innervation 172, 173
investigations 191–2
visual symptoms 173–4
visual system examination 176–7, 189–91
Ophthalmoscopy 204, 179–80
Optic disc 177
Optic nerve (CN II) 172, 176
Optic tract 171
Optical coherence tomography 191
Orchitis 141
Orthopnoea 62
Orthostatic hypotension 35, 321
Osler's nodes 44
Osteoarthritis 236
Otoscopes 52, 53
Ovaries 164
Oxygen
advanced life support 341
central cyanosis 97
delivery devices 97
partial pressure 36
respiration 89
supplemental 96, 333
Oxygen saturation 36
elderly patients 321
National Early Warning Score 338
paediatric patients 304
P
Paediatrics 295–314
age definitions 295
anatomy 295–96
child mistreatment 314
clinical environment 295
development assessment 307–10
examining children 314
examining neonates 310–13
history taking 299–300
key symptoms 301
physiology 296
red flags 300
Paediatric consultation 296
Paget's disease 153
Pain history 3, 6, 7
Pain sensation 223–4
Palms 44–45
Palpation 37
lymph nodes 49–50, 99
see also specific systems
Palpitations 64
Pancreas
abdominal pain 115
anatomy 109, 110
glycaemic control 282
investigations 132
Parotid glands 51
Paroxysmal nocturnal dyspnoea 32
Past medical history 2, 4, 8–9
breast disease 151
cardiovascular disease 63
elderly patients 318
endocrine disease 285
gastrointestinal disease 113
genitourinary disease 137, 153, 155
musculoskeletal disease 238
neurological disease 199
paediatric patients 297
pregnant women 163
psychiatric assessment 271
respiratory disease 90
Past surgical history 3, 8
cardiovascular disease 63
elderly patients 318
gastrointestinal disease 113
musculoskeletal disease 238
neurological disease 199
pregnant women 163
psychiatric assessment 271
respiratory disease 90
Patent ductus arteriosus 302
Pelvic examination 157–8, 160–62
Pelvic pain 156
Pelvis, fetal engagement 166–67
Penis 141, 142
Peptic ulcers 115
Perceptions, abnormal 277
Percussion 38
see also specific systems
Peripheral oedema 61, 67, 75
Peripheral vascular system 59–60
auscultation 82
elderly patients 324
inspection 81
mid-calf diameter 83
palpation 81–3
signs of disease 66, 67
symptoms of disease 65
Peristalsis 111
Peritoneum 109, 115, 124
Personal history 272, 273
Phalen's test 255
Phimosis 141, 142
Phobias 268
Pituitary tumours 286
Plantar reflex 221
Pleural effusion 103
Pneumonectomy 103
Pneumothorax 103
Polydipsia 284, 286
Polyuria 284, 286
Position sense 208, 222
Positioning of patients 30, 119, 152, 157, 205
paediatric 305
Postcoital bleeding 156
Postural hypotension 35, 322
Power 204, 213–18, 219
Prayer signs 242, 255
Pregnancy
Ectopic 115
obstetrics 164–7, 168
paediatric history taking 299
Presenting complaint 3, 4
breast disease 151
cardiovascular 63
elderly patients 318
endocrine 285
gastrointestinal 113
genitourinary 137, 153, 155
history of 3, 4, 6
musculoskeletal 238
neurological 199
obstetric 163
paediatric patients 297
psychiatric assessment 271
respiratory disease 90
Privacy 30
Probity 26
Pronator drift 213
Proprioception 196
Prostate
abdominal pain 115
anatomy 135
examination 131
investigations 144
micturition problems 138
Proximal myopathy 288–9
Pruritus 120
Pseudohallucinations 277
Psychiatric assessment 267–79
elderly patients 326
higher mental function 278
history taking 269–70
investigations 279–80
Mental State Examination 275–8
physical examination 278–9
summary 280
symptoms 267–9
Psychotic symptoms 268
Pulmonary oedema 61, 67
Pulmonary valve 76, 79
Pulse oximetry see Oxygen saturation
Pulse(s)
assessment 72
cardiovascular disease 66
elderly patients 321
endocrine disease 288
paediatric patients 304
Pupil, 172, 179
Pyrexia 33
Pyrogens 34
Q
Quincke's sign 68
R
Radiography 84, 102, 132, 265
Record keeping 20–21
Rectum
anatomy 109, 110, 111
bleeding 116
digital examination 129–30
proctoscopy 131
Reduced conscious 340
Reflex irritability, neonates 311–12
Reflexes 177, 198
Relative afferent pupillary defect 181
Religion, faith history 10–11
Renal colic 115
Resistance testing 213, 214
Respiration
ABC approach 300, 304
ABCDE approach 332, 333
advanced life support 341
breathlessness 32, 62, 92
cardiac pathology 62
National Early Warning Score 338
paediatric patients 296
patterns of 32
physiology 88
Respiratory failure 89
Respiratory rate 32
elderly patients 298
National Early Warning Score 338
paediatric patients 304
Respiratory system 87–107
anatomy 87
auscultation 100–4
cardiovascular disease 59, 66
causes of fever 32
chest percussion 38, 94
critically ill patients 331, 333–4, 341
elderly patients 321–5, 327
examination 96–106
history taking 17, 89–90
inspection 96, 306
investigations 104
main lung pathologies 103
paediatric patients 299, 304
palpation 98–9
physiology 88
signs of disease 43, 93–6
symptoms of disease 90–3
upper respiratory tract see Mouth; Nose
Resuscitation 26, 336
Retching 114
Reticular activating system 198
Rheumatoid arthritis 236, 240
Rigidity 203
Rigor 34
Rinne's test 184–5, 187
Risk assessment, psychiatric 277
Romberg's test 208
Rovsing's sign 124
Rubs 95
S
SAD PERSONS mnemonic 278
Scapula 247
Schizophrenia 268
Schober's test 254
Sciatic nerve stretch test 255, 261
Scoliosis 244, 245, 247
Scratch marks 120
Scrotum 136, 141, 142, 144
Seizures 199–200, 286
Sensory examination 202, 221–5
Sensory functions, CNs 188–9, 202, 209
Sensory pathways 196, 197, 222
Sepsis evaluation, 336–8
Sexual function 138
Sexual history 139–40
Sexual intercourse 156
Sexually transmitted infections 140, 140, 160, 299
Shock 43
Shortness of breath see Breathlessness
Shoulder examination 245, 247, 251
Skeletal system 233
see also Musculoskeletal system
Skin
breast tumours 153
critically ill patients 337
elderly patients 322, 327
endocrine disease 285, 287, 287, 288
gastrointestinal disease 117
general assessment, 39, 40, 53–4
graphaesthesia 225
lesion types 56
musculoskeletal disease 241
pregnancy changes 164
Sleep apnoea 33
Small intestine 109, 110, 132–3
Smell
of breath 120
sense of 172–3
Smoking 12
Social development 308, 309–10
Social history 3, 4, 10–15
breast disease 151
cardiovascular disease 63
elderly patients 318
endocrine disease 285
gastrointestinal disease 113
genitourinary disease 137, 138, 155
musculoskeletal disease 238
neurological disease 199
paediatric patients 297
pregnant women 163
psychiatric assessment 274
respiratory disease 90
SOCRATES mnemonic 3, 7, 7
Spasticity 203
Speculum examinations 159–61, 164, 167
Speech 202, 205, 206, 276
Spider naevi 120
Spinal cord 196, 222
Spinal tap 232
Spine
deformities 247
elderly patients 324
GALS assessment 242–3, 306
musculoskeletal disease 224
musculoskeletal examination, 240–62, 241, 247
Spiritual history 12
Spleen 110, 124–5, 125, 126, 127
Splenomegaly 125–6
Splinter haemorrhages 46, 57
Sputum 92, 104
Squint 190
SSS CCC FFF TTT mnemonic 49, 49
Starling's law 62
Stenosing tenosynovitis see Trigger finger
Stereognosis 224
Stethoscopes 39, 100, 101
STIs see Sexually transmitted infections
Stomach 109, 110
Stools 116, 132
Strabismus 190–1
Straight leg raise 255, 261
Stretch reflexes see Reflexes
Stridor 95
Suicidal assessment 278
Surgical history see Past surgical history
Swallowing, problems with 113
Swan-neck deformity 240, 245
Symphyseal–fundal height 164–5, 165
Syncope 65, 199
Systemic vascular resistance 61
T
Tachycardia 65
Tactile vocal fremitus 99
Taste sense 173
Teeth 51
Temperature 33–4, 37
elderly patients 321
National Early Warning Score 338
paediatric patients 300, 304, 313
Temperature sensation 223–4
Tendon reflexes see Reflexes
Testicles
anatomy 136
carcinoma 141, 150
cremasteric reflex 143
pain 139, 141
palpation 142, 143
signs of disease 141
torsion 139, 141
ultrasound 145
Thirst, polydipsia 284, 286
Thomas's test 257
Thoughts 276
Thrills 73, 74, 128, 302
Throat 51–2, 53 55, 303, 305
Thudicum speculum 54
Thyroid
anatomy 281, 282
auscultation 20
examination 40, 287–90, 293
goitre 286, 287, 288
investigations 292
palpation 289–90
regulation 281, 283
Thyroid acropachy 288
Tinel's sign 2
Toe movements 258
Toe nails see Nails
Tone (muscle) 203, 209, 211, 227, 311
Tongue
general inspection 51, 97
innervation 172, 173, 185, 185,
Tonometry 192
Tophi 47
Torticollis 245, 247
Touch sensation 222, 224, 225
Trachea 87, 88, 98
Tremor 47, 47, 202, 210, 288
Trendelenburg's test (hip) 257
Trendelenburg's test (veins) 83
Trichomonas vaginalis 156
Tricuspid valve see Atrioventricular valves
Trigeminal nerve (CN V) 172, 181
Trigger finger 245, 247
Trochlear nerve (CN IV) 172, 179
Tympanic membrane 52, 52, 305
U
Ulcers
genital 141
peptic 115
Ultrasound 42, 132, 141, 191, 292
Undernutrition 42, 307, 308
Upper limb
active movements 250
deformities 247
endocrine disease 287
GALS assessment 241–2, 305
joint examination 245, 247, 251, 258
muscle tone 211
neonates 313
power 214, 213
reflexes 218, 220
see also Hand
Uraemic fetor 120
Urethra (female) 135, 148
Urethra (male) 135, 138, 142
Urinary bladder
palpation 126
Urinary tract, anatomy 135
Urine
blood in 137
incontinence of 156, 320
investigations 132, 144
micturition problems 137
polyuria 284, 286
Urine tests
endocrine disease 292
genitourinary assessment 167–9
musculoskeletal disease 263
psychiatric assessment 279
Uterus 147–9, 162, 164–5, 167
V
Vagina 147–9, 156, 159–62, 167
Vaginosis, bacterial 156
Vagus nerve (CN X) 173, 188–89
Valgus deformities 248
Values, patient 22
Varicocele 141, 143
Varicose veins 82
Varus deformities 247, 248
Vestibular function 172, 187, 188
Vestibulocochlear nerve (CN VIII) 173, 184–7, 188
Vibration sensation 223, 224
Virus serology 104
Vision development 308, 309–10
Visual acuity 176, 189, 317
Visual fields 174, 177, 189, 192, 286
Visual symptoms 173–76
Visual system examination 189–91
Visual tract 171, 174
Vital signs 31–36
cardiovascular disease 66, 66, 82
dehydration/shock 42
elderly patients 321–2
musculoskeletal disease 241
National Early Warning Score 338
paediatric patients 301, 304, 308, 313
respiratory disease 93
VITAMIN CDE mnemonic 18
Vocal fremitus 101, 102
Vocal resonance 101–2
Vomiting 114
W
Weakness 201, 213–18, 219
Weber's test 184, 187
Weight, children 295–6, 307, 308
Weight change 116, 285, 288
Wernicke's area 206
Wheeze 95
Whisper test, hearing 184
Whispering pectoriloquy 101
Wrist deformities 247
Wrist examination 245, 247, 248, 255–8
X
Xanthomas 47
xanthelasma 120
×
Chapter Notes

Save Clear