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The Acutely Ill or Injured Patient

The objective of this chapter is to provide a practical approach to acutely ill and injured patients. The emphasis is on a prioritized assessment and diagnostic considerations, not on therapy. The chapter is for those who provide care in traditional health care environments such as clinics, doctors’ offices, and hospitals as well as those potentially caring for patients outside of traditional medical settings, or perhaps acting…

The Geriatric Patient

Videos 25.1 Discussing the activities of daily living 25.2 Screening for depression in the geriatric patient 25.3 Demonstrating polypharmacy 25.4 Full video: Discussing advance directives 25.5 Evaluating the geriatric patient 25.6 Full video: Interviewing a patient with a cognitive impairment 21.1 Assessing mental status General Considerations Ten thousand people in the United States turn 65 every day. If you break this down by time, seven people…

The Pediatric Patient

Videos 24.1 Full video: Examining the newborn 24.2 Full video: Examining the toddler 24.3 Full video: Performing the neurologic examination 24.4 Conducting a telephone interview with a parent of a sick toddler General Considerations Since the late 1920s, awareness of the importance of child health care has increased. Along with better control of infectious diseases and great strides in nutrition and technology has come the recognition…

The Pregnant Patient

General Considerations Diagnosis and confirmation of pregnancy is one of the common reasons that women come to visit health care providers. At some point in their reproductive years, the vast majority of women will be pregnant and give birth. The percentage of women in the United States who have ever given birth has been increasing. In 2016, 86% of women have given birth over their lifetime…

Putting the Examination Together

The Techniques The previous chapters dealt with the individual organ systems and the history and physical examinations related to each of them. The purpose of this chapter is to help the student assimilate each of the individual examinations into one complete and smoothly performed examination. Ideally, a complete examination is performed in an orderly, thorough manner with as few movements as possible required of the patient.…

The Nervous System

Videos 21.1 Assessing mental status 21.2 Testing cranial nerve V (trigeminal) 21.3 Testing cranial neve VII (facial) 21.4 Testing cranial nerve VIII (vestibulocochlear) 21.5 Testing cranial nerve IX (glossopharyngeal) and X (vagus) 21.6 Testing cranial nerve XI (spinal accessory) 21.7 Testing cranial nerve XII (hypoglossal) and motor function 21.8 Testing the biceps tendon reflex 21.9 Testing the brachioradialis tendon reflex 21.10 Testing the triceps tendon reflex…

The Musculoskeletal System

Videos 20.1 Performing the screening musculoskeletal examination. 20.2 Evaluating gait 20.3 Examining a patient with a trigger finger 20.4 Full video: Performing the nervous and musculoskeletal systems examinations General Considerations Pathology of the musculoskeletal system 1 1 . Reviewed April 20, 2017. Accessed January 26, 2019. ranks first among disease conditions that alter the quality of life. This is related to limitation of activity, disability,…

Female Genitalia

Videos 19.1 Preparing for the pelvic examination 19.2 Inspecting and palpating the external genitalia of the woman 19.3 Testing for pelvic organ prolapse 19.4 Using the vaginal speculum 19.5 Performing the traditional Pap smear 19.6 Inspecting the vaginal walls 19.7 Performing the bimanual palpation 19.8 Palpating the rectovaginal septum 19.9 Full video: Performing the speculum examination 19.10 Full video: Performing the bimanual examination 19.11 Full video:…

Male Genitalia and Hernias

Videos 18.1 Inspecting the external genitalia 18.2 Inspecting the penis 18.3 Inspecting the external meatus of the penis 18.4 Palpating the penis and urethra 18.5 Inspecting the scrotum 18.6 Palpating the testes 18.7 Palpating the epididymis and vas deferens 18.8 Palpating for inguinal hernias 18.9 Full video: Examining the male genitalia General Considerations Since the beginning of recorded history, the external genitalia and the urologic system…

The Abdomen

Videos 17.1 Inspecting the contour of the abdomen and evaluating for abdominal hernias 17.2 Evaluating bowel sounds 17.3 Evaluating for abdominal bruits 17.4 Evaluating for shifting dullness 17.5 Evaluating the abdomen by light palpation 17.6 Evaluating the abdomen by deep palpation 17.7 Palpating the liver 17.8 Palpating the spleen 17.9 Performing the rectal examination 17.10 Demonstrating the Sims’ position for the rectal examination 17.11 Full video:…

The Breast

Videos 16.1 Inspecting the breasts 16.2 Performing an axillary examination 16.3 Palpating the breast 16.4 Examining the nipple 16.5 Full video: Examination of the female breast General Considerations In the United States in 2018, approximately 3,418,124 women were living with breast cancer. The National Cancer Institute estimates that one of every eight women (approximately 12.4%) will develop breast cancer during her lifetime. Among the malignant diseases…

The Peripheral Vascular System

Videos 15.1 Palpating the radial artery pulse 15.2 Palpating the brachial artery pulse 15.3 Auscultating the carotid artery pulse 15.4 Palpating the femoral artery pulse and evaluating for coarctation of the aorta 15.5 Palpating the popliteal artery pulse 15.6 Palpating the dorsalis pedis artery pulse 15.7 Palpating the posterior tibial artery pulse 15.8 Full video: Examining the peripheral vascular system 13.13 Full video: Vital signs 14.16…

The Heart

Videos 14.1 Assessing blood pressure 14.2 Determining blood pressure by palpation 14.3 Determining blood pressure by auscultation 14.4 Evaluating for orthostatic hypotension 14.5 Evaluating for supravalvular aortic stenosis 14.6 Determining cardiac rate 14.7 Evaluating the carotid artery pulse 14.8 Evaluating the jugular venous pulse 14.9 Assessing the jugular venous wave form of tricuspid insufficiency. Courtesy of Xiangya Hospital of Central South University, Changsha, China. 14.10 Palpating…

The Chest

Videos 13.1 Assessing respiratory rate and pattern 13.2 Palpating the posterior chest for tenderness 13.3 Evaluating excursion of the posterior chest 13.4 Evaluating tactile fremitus of the posterior chest 13.5 Percussing the posterior chest 13.6 Auscultating the posterior chest 13.7 Evaluating the position of the trachea 13.8 Evaluating tactile fremitus of the anterior chest 13.9 Percussing the anterior chest 13.10 Auscultating the anterior chest 13.11 Full…

The Oral Cavity and Pharynx

Videos 12.1 Examining the oral cavity 12.2 Palpating the tongue 12.3 Palpating the floor of the mouth 12.4 Testing cranial nerve XII (hypoglossal) 12.5 Inspecting the pharynx 12.6 Examination of the oral cavity General Considerations Individuals use the mouth and oral cavity to express an entire range of emotions. As early as infancy, the mouth provides gratification and sensory pleasure. Approximately 20% of all visits to…

The Ear and Nose

Yet it was not possible for me to say to people, “Speak louder, shout, for I am deaf.” … Alas! how could I declare the weakness of a sense which in me ought to be more acute than in others—a sense which formerly I possessed in highest perfection, a perfection such as few in my profession enjoy, or ever have enjoyed. Ludwig van Beethoven (1770–1827) Videos…

The Eye

Videos 10.1 Assessing visual activity (CN II–optic) 10.2 Assessing visual fields 10.3 Assessing ocular movements 10.4 Evaluating the cardinal positions of gaze (CN III–oculomotor; CN IV–trochlear; CN VI–abducens) 10.5 Evaluating the pupillary light reflex 10.6 Examining the external eye structures 10.7 Using the ophthalmoscope 10.8 Inspecting the optic disc 10.9 Evaluating the retinal vessels 10.10 Full video: Examination of the eye Historical and General Considerations The…

The Head and Neck

Videos 9.1 Palpating the head and neck 9.2 Palpating the thyroid gland 9.3 Palpating for supraclavicular nodes General Considerations The appearance of the head and face, their contours and texture, often provides the first insight into the nature of illness. Sunken cheeks, wasting of the temporal muscles, and flushing of the face are important visible clues of systemic illness. Some facial appearances are pathognomonic of disease.…

The Skin

General Considerations The skin, which is the largest organ of the body, is one of the best indicators of general health. Even a person without medical training is capable of detecting changes in skin color and texture. The trained examiner can detect these changes and at the same time evaluate more subtle cutaneous signs of systemic disease. Diseases of the skin are common. Approximately one-third of…

Assessment of Nutritional Status

Video 7.1 Counseling a Patient about Health Issues Nutrition is one of the most important factors regarding development and treatment of disease in individuals because it affects almost every system. It has been shown that dietary habits contribute in important ways to the pathogenesis of many of the major noncommunicable causes of death in the United States. One of the most challenging nutritional problems in the…