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SRB’s Clinical Methods in Surgery Sriram Bhat M

1:Introduction on Clinical Examination
- Introduction
- History Taking
- Physical Examination
  - Local Examination
2:Examination of an Ulcer
- Definition
- Parts of an Ulcer (Fig. 2.1)
- Classifications
- Causes of Ulcer Becoming Chronic in the Skin
- History
- General Examination
- Local Examination of an Ulcer
- Investigations for an Ulcer
  - Assessment of an Ulcer
3:Examination of a Swelling/Lump
- History
- General Examination
- Local Examination
- Relevant Systemic Examination
  - Relevant Investigations
- Differential Diagnosis
4:Examination of Sinus and Fistula
- Clinical Features of Sinus
- History
- General Examination
- Local Examination
  - Inspection
  - Palpation
    - Examination Using a Probe
- Investigations
- Classification of Sinus
- Classification of Fistula
- Sequestrum
- Median Mental Sinus
- Actinomycosis
- Madura Foot (Mycetoma Pedis)
5:Examination in Arterial Diseases
- Chief Complaints
- History
- General Examination
- Local Examination
- Systemic Examination
- Intermittent Claudication
- Rest Pain
- Critical Limb Ischaemia
- Investigations for Arterial Diseases
- Diseases of the Arteries
6:Examination in Venous Diseases
- Writing a Case Sheet for Varicose Veins (Long Case)
  - Chief Complaints
- History
- General Examination
- Local Examination
  - Inspection
  - Palpation
- Investigations for Varicose Veins
  - Laboratory Studies
  - Specific Tests
- Surgical Anatomy of Lower Limb Veins
- Different Types of Perforators
- Physiology of Venous Blood Flow in Lower Limb
- Venous Pathology
7:Examination of Lymphatic System
- Surgical Anatomy
  - Lymphatic Watersheds of Skin
  - Microanatomy of Lymph Node
    - Function
- Chief Complaints
- History
- General Examination
- Local Examination
- Systemic Examination
- Investigations
- Pathology of Lymph Systems
8:Examination of Peripheral Nervous System
- History
  - History of Present Illness
    - History of Trauma
- Local Examination
- Relevant Investigations
- Peripheral Nerve Injuries
- Brachial Plexus Injury
- Causalgia
- Median Nerve Injury
  - Carpal Tunnel Syndrome
- Ulnar Nerve Injury
  - Clinical Features
  - Claw Hand
- Radial Nerve Lesions
- Common Peroneal Nerve
  - Foot Drop
- Medial Popliteal Nerve
- Axillary Nerve Injury
- Long Thoracic Nerve Injury (Nerve of Bell)
- Accessory Nerve Injury
- Hypoglossal Nerve Injury
9:Examination of Muscles, Tendons and Fasciae
- History
- General Examination
- Local Examination (Look/Feel/Measure/Move)
10:Examination of Oral Cavity
- History
- General Examination
- Local Examination
  - Inspection
  - Palpation
- Examination of Cervical Lymph Nodes
- Systemic Examination
- Investigations
11:Examination of Jaw
- History
- General Examination
- Local Examination of Jaw
- Investigations for Jaw Disease
- Maxillary Tumours
  - Epulis
- Jaw Tumours
- Micrognathism and Prognathism
- Diseases of the Palate
- Maxillofacial Injuries
12:Examination of Salivary Gland
- History
- Local Examination
- Investigations
13:Examination of Neck
- History
- General Examination
- Local Examination
- Investigations
14:Examination of Thyroid
- Chief Complaints
- History
- General Examination
- Local Examination
- Investigations for Thyroid Diseases
15:Examinations of Face and Head
- Introduction
- Cleft Lip and Cleft Palate
- Hydrocephalous
  - Classification I
  - Classification II
- Meningocele
- Preauricular Sinus
- Traumatic Problems of Face and Head
- Problems with Infective Lesions of Face and Head
- Benign Swellings of the Face and Head
- Malignant Conditions of Face and Head
  - Cylindroma
- Examination of Cranial Nerves
16:Examination of Breast
- History
- General Examination
- Local Examination of Breasts
  - Inspection
  - Palpation
    - Palpation of Axillary Lymph Nodes
- Investigations in Carcinoma Breast/Breast Lump
- Differential Diagnosis
17:Examination of Hernia
- Chief Complaints
- History
- General Examination
- Local Examination
- Investigations
  - Testing Inguinal Hernia in Children
  - Inguinal Hernia in Females
- Boundaries and Anatomy of the Inguinal Canal
- Types of Indirect Inguinal Hernia
- Direct Hernia
- Differential Diagnoses for Groin Swelling (Figs 17.31 and 17.32)
- Parts of Hernia
- Groin Hernia
  - Fruchaud's Myopectineal Orifice
- Newer Anatomical Considerations
  - Newer Classifications of Groin Hernias
    - Nyhus Classification
    - Bendavid Classification
- Clinical Classification of Hernia
- Incisional Hernia
18:Examination of Inguinoscrotal and Scrotal Swelling
- History
- General Examination
- Local Examination
  - Inspection
  - Palpation
- Systemic Examinations
  - Abdomen Examination
- Investigations
19:Examination of Male External Genitalia
- History
- General Examination
- Local Examination
- Disorders of Penis
20:Examinations in Chronic Abdominal Conditions
- History
- Local Examination
- Examination of Left Supraclavicular Lymph Nodes
- Digital Examination of Rectum
- Systemic Examinations
- Investigations
21:Examination of Mass Abdomen
- Chief Complaints
- History
- General Examination
- Local Abdominal Examination
- Differential Diagnosis
22:Examination in Rectal and Vaginal Problems
- History
- Examination of the Anorectum
- Examinations
23:Examination in Urinary Diseases
- Haematuria
  - Types
  - Investigation
    - Urine culture and sensitivity:
- Retention of Urine
  - Causes
  - Clinical Features
  - Investigations
- Increased Urinary Frequency
- Definitions of Various Terms
- History
  - Age
  - Sex
  - Residence
  - Occupation
  - History of Present Illness
  - Past History
  - Family History
- General Examination
- Local Examination
  - Kidney
  - Ureter
  - Bladder
  - Prostate
  - Seminal Vesicles
  - Urethra
- Systemic Examination
- Examination of Urine
  - Blood Evaluation
  - Renal Function Tests
- Plain X-ray-KUB (Kidney, Ureter Bladder)
- Intravenous Urogram (IVU)
  - Procedure
- Retrograde Pyelography (RGP)
- Antegrade Pyelogram/Urogram
- Renal Angiogram
- Flush Venogram
- Micturating Cystourethrography (MCU)
- Ascending Urethrogram
- Isotope Renography
- Cystoscopy
- Urethroscopy
- CT Scan
- Horse-Shoe Kidney
  - Clinical Features
  - Diagnosis
- Polycystic Kidney Disease (PCKD)
  - Clinical Features
  - Differential Diagnosis
  - Investigations
- Solitary Renal Cyst
- Duplication of Renal Pelvis
- Retrocaval Ureter
- Ureterocele
- Perinephric Abscess
  - Causes
  - Clinical Features
  - Investigations
- Renal Tuberculosis
  - Pathological Types
  - Clinical Features
- Hydronephrosis (HN)
  - Aetiology
  - Classification
  - Clinical Features
  - Complications
  - Investigations
    - Whitaker Test
    - Isotope Renography
- Pyonephrosis
  - Clinical Features
  - Investigations
- Carbuncle of Kidney (Renal Carbuncle)
- Renal Calculus
  - Aetiology
  - Types
  - Clinical Features
- Ureteric Calculi
  - Clinical Features
- Staghorn Calculus
- Wilms’ Tumour (Nephroblastoma)
  - Clinical Features
  - Investigations
- Renal Cell Carcinoma (RCC)
  - Aetiology
  - Pathology
  - Spread
  - Clinical Features
  - Investigation
  - Differential Diagnosis
- Ectopia Vesicae (Exstrophy of the Bladder)
- Vesical Calculus
  - Types
  - Clinical Features
  - Investigations
    - Urine Microscopy
- Cystitis
  - Causes
  - Predisposing Factors
  - Features
- Interstitial Cystitis (Hunner's Ulcer, Elusive Ulcer)
  - Clinical Features
- Schistosoma Haematobium (Endemic Haematuria, Urinary Bilharziasis)
  - Life Cycle
  - Pathology in the Bladder
  - Clinical Features
  - Differential Diagnosis
- Thimble or Systolic Bladder
  - Causes
  - Clinical Features
  - Investigations
- Bladder Tumours
  - Transitional Cell Carcinoma (TCC)
    - Clinical Features
    - Investigations
- Residual Urine
- Malakoplakia
- Acid Phosphatase
- Prostate Specific Antigen (PSA)
- Benign Prostatic Hyperplasia (BPH)
  - Theories
  - Pathology
  - Clinical Features
  - Differential Diagnosis
  - Investigations
- Carcinoma Prostate
  - Types of Carcinoma Prostate
  - Histology
  - Staging of Carcinoma Prostate
  - Clinical Features
  - Differential Diagnoses
  - Investigations
- Prostatitis
- Stricture Urethra
  - Clinical Features
  - Investigations
  - Complications of Stricture Urethra
- Posterior Urethral Valve
  - Differential Diagnosis
- Urethral Calculi
  - Sites of Impaction
  - Clinical Features
  - Complications
- Urethritis
  - Causes
  - Clinical Features
- Urinary Fistulas
  - Causes
24:Examination of Acute Abdomen
- History
  - Age
  - Sex
  - Residence
  - Socioeconomic Group
  - History of Present Illness
  - Past History
  - Personal History
- General Examination
- Local Examination of Abdomen
  - Inspection
  - Palpation
  - Percussion
  - Auscultation
  - Digital Examination of the Rectum
  - Pervaginal Examination
  - Examination of External Genitalia
- Systemic Examination
- Investigations
- Acute Appendicitis
  - Etiology
    - Organisms
    - Types
  - Clinical Features
- Acute Cholecystitis
  - Classification
  - Clinical Features
- Acute Pancreatitis
  - Pathogenesis
  - Clinical Features
  - Investigations
- Acute Peritonitis
  - Types
  - Bacteria Causing Peritonitis
  - Mode of Infection
  - Factors Affecting the Spread of the Infection in Peritonitis
  - Clinical Features
  - Investigation
  - Differential Diagnosis
- Subphrenic Spaces and Subphrenic Abscess
  - Intraperitoneal Spaces
  - Extraperitoneal Spaces
- Amoebic Liver Abscess
  - Pathology
    - Course and Sequelae of Amoebic Liver Abscess
  - Clinical Features
  - Differential Diagnosis
- Perforated Duodenal Ulcer
  - Clinical Features
  - Terminal Stage
  - Investigations
- Perforation of Typhoid Ulcer
- Meckel's Diverticulum
  - Presentations
  - Diagnosis
- Intestinal Obstruction
  - Pathology
    - Closed Loop Obstruction
  - Clinical Features
  - Investigations
- Adhesions and Bands
  - Causes
  - Types
  - Clinical Features
- Acute Intussusception
- Volvulus
- Bolus Obstruction
- Acute Salpingitis
- Acute Nonspecific Mesenteric Lymphadenitis
- Ruptured Ectopic Gestation
- Ruptured Aortic Aneurysm
- Munchausen's Syndrome
25:Examination in Dysphagia
- HISTORY
- General Examination
- Dysphagia
  - Causes of Dysphagia
  - Evaluation of a Patient with Dysphagia
- Foreign Body in the Oesophagus
- Gastro-oesophageal Reflux Disease (GORD/GERD)
- Barrett's Oesophagus
- Barrett's Ulcer
- Hiatus Hernia
  - Rolling Hernia (Paraoesophageal Hernia)
- Boerhaave's Syndrome
- Mallory-Weiss Syndrome
- Tracheo-oesophageal Fistula (TOF)
  - Types
  - Clinical Features
- Achalasia Cardia
- Corrosive Stricture of Oesophagus
- Plummer-Vinson Syndrome (Paterson-Kelly Syndrome)
- Reflux Oesophagitis
- Schatzki Rings
- Carcinoma Oesophagus
26:Examination of Chest Diseases
- History
- General Examination
- Local Examination
  - Inspection
    - Shape of the Chest Wall
  - Palpation
- Investigations
- Empyema Thoracis
- Mediastinal Tumours
  - Presentations
- Shock Lung (Stiff Lung)
  - Causes
  - Pathogenesis
- Pulmonary Embolism (PE)
- Carcinoma Lung
- Pancoast Tumour
  - Features
- Pulmonary Complications during Postoperative Period
  - Precipitating Factors
  - Complications
- Pericarditis
  - Causes
  - Clinical Features
- Cardiac Tamponade
  - Causes
  - Clinical Features
- Diaphragmatic Hernia
  - Types
- Chest Wall Tumours
27:Examination of Hand and Foot
- History
- Examination
  - Inspection
  - Palpation
- Hand Infections
- Hand Injuries
  - Classifications
  - Assessment of Injury
- Syndactyly
- History
- Examination
  - Inspection
  - Palpation
- Investigations
28:Examination in Head, Chest and Abdomen Injuries
- History
- Examination
  - General Examination
- Local Examination
  - Scalp
  - Position
  - Level and Depth of Consciousness
  - Bleeding from Nose, Ear and Mouth
  - Neurological Deficits
  - Cranial Nerve Examination
  - Examination of Eye
  - Examinations of Other Systems
- Investigations
- Mechanism of Head Injury
- Effects of Brain Injuries
- Adelaid Coma Scale
- Indications for Admission
- Complications of Head Injuries
- Extradural Haematoma
  - Pathology
  - Clinical Features
- Subdural Haematoma
  - Types
    - Acute Subdural Haematoma
    - Chronic Subdural Haematoma
  - Clinical Features
  - Differential Diagnosis
- Depressed Skull Fracture
  - Problems in Depressed Fracture
- History
- Examination
  - General Examination
  - Inspection
  - Palpation
  - Percussion
  - Auscultation
- Investigations
- Chest Injuries
  - Types
  - Causes
  - Factors and Pathophysiology of Chest Injuries
  - Clinical Features of Thoracic Injuries
  - Indications for Thoracotomy
  - Complications
- Flail Chest and Stove in Chest
  - Pathophysiology
- Pneumothorax
  - Classification
  - Causes
  - Clinical Features
  - Chest X-ray Reveals
- Tension Pneumothorax
  - Clinical Features
- Haemothorax
  - Causes
  - Clinical Features
  - Complications
- Triage
  - Assessing Four Components
- General Examination
  - Inspection of Abdomen
  - Palpation
  - Percussion and Auscultation
- Investigations
- Liver Injury
  - Causes
  - Types
  - Clinical Features
  - Complications and Sequelae of Liver Injury
- Splenic Injury (Rupture Spleen)
  - Types of Injury
  - Presentation
  - Plain X-ray
  - Complications of Splenic Injury
- Injuries to Kidney
  - Types
  - Clinical Features
  - Investigations
  - Complications
- Pancreatic Trauma
  - Types
  - Features
  - Investigations
  - Complications
- Rupture Bladder
  - Causes
  - Types
    - Intraperitoneal Rupture
    - Extraperitoneal Rupture of the Bladder
- Urethral Injury
  - Classification
    - Rupture of Membranous Urethra (Prostatic Urethra/Posterior Urethra]
    - Rupture of Bulbous Urethra (Anterior Urethra)
- Abdominal Compartment Syndrome
29:Examination in Intracranial Diseases
- History
- General Examination
- Nervous System Examination
- Examination of Cranial Nerves
  - Nystagmus
    - Cerebellar Lesion
  - Reflexes
    - Relevant Other Examinations
- Investigations
- Intracranial Abscess
- Subarachnoid Haemorrhage
- Intracranial Aneurysms
  - Types
  - Presentations
- Intracranial Tumours
- Pituitary Tumours
- Craniopharyngiomas
  - Clinical Features
30:Examination of Bone and Joint Injuries and Pathology
- History
- Examination
  - Inspection
  - Palpation
- Investigations
- Fracture
  - Complications of Fracture
- Dislocation
- Examination of Shoulder Joint in Injuries
  - Inspection
  - Palpation
  - Fracture Clavicle
  - Shoulder Dislocation
- Examination of Elbow Joint in Injuries
  - Posterior Dislocation of Elbow
  - Monteggia Fracture Dislocation
- Examination of Wrist in Injuries
  - Colles’ Fracture (Sir Abraham Colles’ 1814)
  - Smith's Fracture
  - Chauffeur's Fracture
  - Madelung Deformity (Otto Madelung, France 1926)
  - Scaphoid Fracture
  - Lunate Dislocation
  - Bennett's Fracture Dislocation
  - Galeazzi Fracture
- Injuries to Pelvis
  - Isolated Pelvic Injury
  - Fracture with Disruption of the Pelvic Ring
  - Avulsion Fractures
  - Injury to Sacrum and Coccyx
  - Malgaigne Fracture
  - Complications of Pelvic Injury
- Examination of Hip in Injuries
  - Fracture Neck of Femur
  - Dislocation of Hip
  - Avulsion Fracture of Lesser Trochanter
  - Intertrochanteric Fracture
  - Subtrochanteric Fracture
- Examination of Knee in Injuries
- Examination of Ankle in Injuries
- History
- Examination
  - Inspection
  - Palpation
- Investigations
- Infections of the Bone
  - Acute Osteomyelitis
  - Chronic Osteomyelitis
- Pathological States of Bones
  - Paget's Disease of Bone
  - Rickets
  - Bone Disease of Hyperparathyroidism (von Recklinghausen's Disease of Bone)
  - Osteoporosis
  - Scurvy
  - Osteogenesis Imperfecta (Brittle Bones)
  - Achondroplasia
  - Diaphyseal Aclasia (Multiple Exostosis)
  - Enchondromatosis (Ollier's Disease)
  - Marfan's Syndrome
- Bone Tumours
  - Benign Bone Tumours
  - Malignant Bone Tumours
    - Primary Malignant Bone Tumours
- Cysts of the Bone
  - Unicameral Bone Cyst (Solitary/Simple Bone Cyst)
  - Aneurysmal Bone Cyst
- Examination
  - Inspection
  - Palpation
- Investigations
  - Acute Pyogenic Arthritis
  - Chronic Pyogenic Arthritis
  - Rheumatoid Arthritis
  - Osteoarthrosis
  - Tuberculous Arthritis
  - Gouty Arthritis
  - Clutton's Joint
  - Osteochondritis
  - Ankylosis
- Examination of Pathological Shoulder Joint
  - Inspection
  - Palpation
  - Tuberculosis of Shoulder Joint
  - Rotator Cuff
  - Frozen Shoulder
- Examination of Pathological Elbow Joint
  - Tennis Elbow
  - Golfer's Elbow
  - Cubitus Valgus
  - Cubitus Varus
- Examination of Pathological Wrist and Joints of Hand
  - de Quervain's Stenosing Tenosynovitis
- Examination of Pathological Hip Joint
  - Inspection
  - Attitude
  - Palpation
  - Movements in Hip Joints
  - Tests for Stability of Hip Joint
  - Measurements
  - Other Examinations
- Examination in Pathological Knee Joint
  - Palpation
- Calcaneal Spur
- Spinal Injuries
  - Examination
    - Attitude
  - Fracture Spine
  - Spinal Cord Injuries
- Spinal Diseases
  - Examination
- Investigations
  - Ankylosing Spondylitis (Poker's Back, Marie Strumpell Arthritis)
  - Kyphosis
  - Scoliosis
  - Spondylolisthesis
  - Intervertebral Disc Prolapse (IVDP)
  - Tuberculosis of Spine (Pott's Disease of Spine)
  - Spina Bifida
  - Spinal Cord Tumours

INDEX

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Chapter Notes