List of Tables | p. xv |
Introduction | p. xix |
An Overview of Physical Examination and History Taking | p. 1 |
The Health History: Structure and Purposes | p. 2 |
The Comprehensive Adult Health History | p. 4 |
Chief Complaint(s) | p. 4 |
Present Illness | p. 4 |
Past History | p. 5 |
Family History | p. 5 |
Personal and Social History | p. 6 |
Review of Systems | p. 6 |
The Physical Examination: Approach and Overview | p. 9 |
The Comprehensive Physical Examination | p. 10 |
Recording your Findings | p. 13 |
The Case of Mrs. N | p. 14 |
Learning History Taking and Physical Examination | p. 19 |
Interviewing and the Health History | p. 21 |
Getting Ready: The Approach to the Interview | p. 23 |
Learning About the Patient: The Process of Interviewing | p. 24 |
Facilitating the Patient's Story: The Techniques of Skilled Interviewing | p. 30 |
Adapting Interviewing Techniques to Specific Situations | p. 34 |
Special Aspects of Interviewing | p. 40 |
Ethical Considerations | p. 49 |
Interviewing Patients of Different Ages | p. 52 |
Beginning the Physical Examination: General Survey and Vital Signs | p. 59 |
Anatomy and Physiology | p. 59 |
The Health History | p. 62 |
Health Promotion and Counseling | p. 65 |
Preview: Recording the Physical Examination--The General Survey and Vital Signs | p. 66 |
Techniques of Examination | p. 67 |
Beginning the Examination: Setting the Stage | p. 67 |
The General Survey | p. 72 |
The Vital Signs | p. 75 |
Blood Pressure | p. 75 |
Special Problems | p. 79 |
Heart Rate and Rhythm | p. 80 |
Respiratory Rate and Rhythm | p. 81 |
Temperature | p. 81 |
The Skin | p. 95 |
Anatomy and Physiology | p. 95 |
Changes with Aging | p. 97 |
The Health History | p. 98 |
Health Promotion and Counseling | |
Preview: Recording the Physical Examination--The Skin | p. 99 |
Techniques of Examination | p. 100 |
Skin | p. 100 |
Nails | p. 102 |
Hair | p. 102 |
Skin Lesions in Context | p. 102 |
The Head and Neck | p. 115 |
Anatomy and Physiology | p. 115 |
The Head | p. 115 |
The Eye | p. 115 |
The Ear | p. 123 |
The Nose and Paranasal Sinuses | p. 125 |
The Mouth and Pharynx | p. 128 |
The Neck | p. 131 |
Changes With Aging | p. 134 |
The Health History | p. 136 |
The Head | p. 136 |
The Eyes | p. 137 |
The Ears | p. 138 |
The Nose and Sinuses | p. 139 |
The Mouth, Throat, and Neck | p. 140 |
Health Promotion and Counseling | |
Preview: Recording the Physical Examination--The Head, Eyes, Ears, Nose, and Throat (Heent) | p. 143 |
Techniques of Examination | p. 144 |
The Head | p. 144 |
The Eyes | p. 144 |
The Ears | p. 156 |
The Nose and Paranasal Sinuses | p. 159 |
The Mouth and Pharynx | p. 160 |
The Neck | p. 163 |
Special Techniques | p. 167 |
The Thorax and Lungs | p. 209 |
Anatomy and Physiology | p. 209 |
Changes With Aging | p. 216 |
The Health History | p. 216 |
Health Promotion and Counseling | p. 218 |
Preview: Recording the Physical Examination--The Thorax and Lungs | p. 219 |
Techniques of Examination | p. 220 |
Initial Survey of Respiration and the Thorax | p. 220 |
Examination of the Posterior Chest | p. 221 |
Examination of the Anterior Chest | p. 229 |
Special Techniques | p. 233 |
The Cardiovascular System | p. 245 |
Anatomy and Physiology | p. 245 |
Surface Projections of the Heart and Great Vessels | p. 245 |
Cardiac Chambers, Valves, and Circulation | p. 247 |
Events in the Cardiac Cycle | p. 248 |
The Splitting of Heart Sounds | p. 250 |
Heart Murmurs | p. 251 |
Relation of Auscultatory Findings to the Chest Wall | p. 252 |
The Conduction System | p. 253 |
The Heart as a Pump | p. 254 |
Arterial Pulses and Blood Pressure | p. 255 |
Jugular Venous Pressure and Pulses | p. 256 |
Changes With Aging | p. 258 |
The Health History | p. 260 |
Health Promotion and Counseling | p. 262 |
Preview: Recording the Physical Examination--The Cardiovascular Examination | p. 265 |
Techniques of Examination | p. 266 |
Jugular Venous Pressure and Pulsations | p. 266 |
The Carotid Pulse | p. 269 |
The Heart | p. 271 |
A Note on Cardiovascular Assessment | p. 283 |
Special Techniques | p. 283 |
The Breasts and Axillae | p. 297 |
Anatomy and Physiology | p. 297 |
Changes With Aging | p. 299 |
Lymphatics | p. 300 |
The Health History | p. 301 |
Health Promotion and Counseling | p. 301 |
Preview: Recording the Physical Examination--Breasts and Axillae | p. 304 |
Techniques of Examination | p. 305 |
The Female Breast | p. 305 |
The Male Breast | p. 310 |
The Axillae | p. 310 |
Special Techniques | p. 311 |
The Abdomen | p. 317 |
Anatomy and Physiology | p. 317 |
Changes With Aging | p. 320 |
The Health History | p. 320 |
The Gastrointestinal Tract | p. 321 |
The Urinary Tract | p. 327 |
Health Promotion and Counseling | p. 329 |
Preview: Recording the Physical Examination--The Abdomen | p. 331 |
Techniques of Examination | p. 332 |
The Abdomen | p. 332 |
The Liver | p. 337 |
The Spleen | p. 340 |
The Kidneys | p. 343 |
The Bladder | p. 344 |
The Aorta | p. 344 |
Special Techniques | p. 345 |
Male Genitalia and Hernias | p. 367 |
Anatomy and Physiology | p. 367 |
Changes With Aging | p. 369 |
The Health History | p. 370 |
Health Promotion and Counseling | p. 371 |
Preview: Recording the Pelvic Examination--Male Genitalia and Hernias | p. 372 |
Techniques of Examination | p. 373 |
The Penis | p. 373 |
The Scrotum and Its Contents | p. 374 |
Hernias | p. 375 |
Special Techniques | p. 376 |
Female Genitalia | p. 383 |
Anatomy and Physiology | p. 383 |
Changes With Aging | p. 385 |
The Health History | p. 386 |
Health Promotion and Counseling | p. 389 |
Preview: Recording the Pelvic Examination--Female Genitalia | p. 390 |
Techniques of Examination | p. 391 |
External Examination | p. 393 |
Internal Examination | p. 394 |
Hernias | p. 400 |
Special Techniques | p. 400 |
The Pregnant Woman | p. 409 |
Anatomy and Physiology | p. 409 |
The Health History | p. 413 |
Health Promotion and Counseling | p. 414 |
Preview: Recording the Physical Examination--the Pregnant Woman | p. 416 |
Techniques of Examination | p. 417 |
General Inspection | p. 418 |
Vital Signs and Weight | p. 418 |
Head and Neck | p. 419 |
Thorax and Lungs | p. 419 |
Heart | p. 419 |
Breasts | p. 419 |
Abdomen | p. 420 |
Genitalia, Anus, and Rectum | p. 422 |
Extremities | p. 423 |
Special Techniques | p. 424 |
Concluding the Visit | p. 426 |
The Anus, Rectum, and Prostate | p. 427 |
Anatomy and Physiology | p. 427 |
Changes With Aging | p. 428 |
The Health History | p. 429 |
Health Promotion and Counseling | p. 430 |
Preview: Recording the Physical Examination--the Anus, Rectum, and Prostate | p. 432 |
Techniques of Examination | p. 433 |
Male | p. 433 |
Female | p. 436 |
The Peripheral Vascular System | p. 441 |
Anatomy and Physiology | p. 441 |
Arteries | p. 441 |
Veins | p. 442 |
The Lymphatic System and Lymph Nodes | p. 444 |
Fluid Exchange and the Capillary Bed | p. 445 |
Changes With Aging | p. 446 |
The Health History | p. 446 |
Health Promotion and Counseling | p. 448 |
Preview: Recording the Physical Examination--the Peripheral Vascular System | p. 449 |
Techniques of Examination | p. 450 |
Arms | p. 450 |
Legs | p. 451 |
Special Techniques | p. 457 |
The Musculoskeletal System | p. 465 |
Anatomy and Physiology | p. 465 |
Structure and Function of Joints | p. 465 |
Temporomandibular Joint | p. 467 |
The Shoulder | p. 469 |
The Elbow | p. 471 |
The Wrist and Hands | p. 473 |
The Spine | p. 475 |
The Hip | p. 478 |
The Knee | p. 479 |
The Ankle and Foot | p. 483 |
Changes With Aging | p. 484 |
The Health History | p. 484 |
Health Promotion and Counseling | p. 487 |
Preview: Recording the Examination--the Musculoskeletal System | p. 489 |
Techniques of Examination | p. 490 |
The Temporomandibular Joint (TMJ) | p. 491 |
The Shoulder | p. 492 |
The Elbow | p. 496 |
The Wrist and Hand | p. 497 |
The Spine | p. 501 |
The Hip | p. 506 |
The Knee and Lower Leg | p. 511 |
The Ankle and Foot | p. 517 |
Special Techniques | p. 519 |
The Nervous System | p. 535 |
Anatomy and Physiology | p. 535 |
Central Nervous System | p. 536 |
Peripheral Nervous System | p. 538 |
Spinal Reflexes: The Deep Tendon Response | p. 540 |
Motor Pathways | p. 541 |
Sensory Pathways | p. 542 |
Changes With Aging | p. 547 |
The Health History | p. 548 |
Health Promotion and Counseling | p. 551 |
Preview: Recording the Examination--the Nervous System | p. 554 |
Techniques of Examination | p. 555 |
Mental Status | p. 556 |
The Cranial Nerves | p. 567 |
The Motor System | p. 571 |
The Sensory System | p. 583 |
Deep Tendon Reflexes | p. 586 |
Special Techniques | p. 592 |
Assessing Children: Infancy Through Adolescence | p. 623 |
Child Development | p. 625 |
Key Principles | p. 625 |
Infancy: The First Year of Life | p. 626 |
Early Childhood: 1 Through 4 Years | p. 628 |
Middle Childhood: 5 Through 10 Years | p. 630 |
Adolescence: 11 Through 20 Years | p. 631 |
Health Promotion and Counseling | p. 634 |
Approach to the Examination of Children at Different Ages | p. 636 |
Assessing the Newborn | p. 639 |
Assessing the Infant | p. 645 |
Assessing Early Childhood | p. 649 |
Assessing Middle Childhood | p. 652 |
Assessing the Adolescent | p. 653 |
Techniques of Examination | p. 655 |
General Survey | p. 655 |
Vital Signs | p. 658 |
The Skin | p. 663 |
The Head | p. 666 |
The Neck | p. 670 |
The Eye | p. 672 |
The Ear | p. 676 |
The Nose and Paranasal Sinuses | p. 680 |
The Mouth and Pharynx | p. 681 |
The Thorax and Lungs | p. 686 |
The Heart | p. 690 |
The Breasts | p. 699 |
The Abdomen | p. 700 |
Male Genitalia | p. 704 |
Female Genitalia | p. 708 |
The Rectal Examination | p. 715 |
The Musculoskeletal System | p. 715 |
The Nervous System | p. 726 |
Clinical Reasoning, Assessment, and Plan | p. 783 |
Assessment and Plan: The Process of Clinical Reasoning | p. 783 |
The Case of Mrs. N: Assessment and Plan | p. 787 |
Approaching the Challenges of Clinical Data | p. 789 |
Building Your Case: The Interplay of Clinical Reasoning and Assessment of Clinical Data | p. 794 |
Organizing the Patient Record | p. 795 |
Clinical Assessment: The Journey to Excellence | p. 800 |
Prevalence and Predictive Value | p. 801 |
Bibliography | p. 803 |
Index | p. 825 |
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