This section deals with pain in the upper limb unrelated to joint pains, and focuses on causes related to either neurological or vascular lesions. Musculoskeletal causes of arm pain are covered in the chapter on Joint Disorders (p. 247). Causes Cervical lesions ● Disc lesion ( Fig. 4 ) ● Cervical spondylosis ● Syringomyelia ● Infection, e.g. osteitis, TB ● Tumours ● Spinal cord ● Meninges…
Anorectal pain is a common presenting complaint. The majority of patients have an obvious cause, e.g. fissure-in-ano, perianal abscess or thrombosed haemorrhoids. Causes Acute ● Fissure-in-ano ● Perianal haematoma ● Thrombosed haemorrhoids ( Fig. 3 ) ● Anorectal abscess (i.e. perinal, interspincteric, ischiorectal) ● Trauma ● Anorectal gonorrhoea ● Herpes You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles…
Abdominal swellings are a common surgical problem. Abdominal swellings may be divided into generalised and localised swellings. Generalised swellings are classically described as the ‘five Fs’, namely fat, faeces, flatus, fluid or fetus. For the purpose of description of localised swellings, the abdomen can be divided into nine areas, i.e. right upper quadrant, left upper quadrant, epigastrium, umbilical, right lumbar, left lumbar, right iliac fossa, left…
Abdominal pain is an extremely common presenting symptom. The pain may be acute (sudden onset) or chronic (lasting for more than a few days or presenting intermittently). It is important to be able to distinguish causes of abdominal pain which need urgent surgery (e.g. ruptured aortic aneurysm, perforated bowel, or acute mesenteric ischaemia) from those that do not (e.g. biliary colic, ureteric colic, acute pancreatitis). The…
You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here
You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here
You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here
You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here
You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here
Introduction Bioethics is the study of the ethical issues emerging from advances in science and medicine. This includes moral deliberation on the intersection of societal views of health care, law, and moral philosophy. The field of bioethics is quite expansive, as it applies to all aspects of human development and our interaction with our environment and the use of technology. The term medical ethics or clinical…
Videos 29.1 A focused history and physical exam General Considerations The focused history and physical examination constitute a modality that is important to master to explore a patient's needs and to educate the patient within a short period. It is a great skill and takes time to master. Only after becoming comfortable and confident with the complete history and physical examination can the clinician master the…
Putting the History and Physical Examination Together Until this point, this book has dealt separately with the history and the physical examination. Chapter 1, Chapter 2, Chapter 3, Chapter 4, Chapter 5 give an in-depth analysis of history-taking techniques. Chapter 6, Chapter 7, Chapter 8, Chapter 9, Chapter 10, Chapter 11, Chapter 12, Chapter 13, Chapter 14, Chapter 15, Chapter 16, Chapter 17, Chapter 18, Chapter…
Art, Science, and Observation This is one of the most important chapters of the book because it considers the methods and concepts of evaluating the signs and symptoms involved in diagnostic reasoning. The previous chapters discuss the “science” of medicine by explaining the techniques for interviewing and performing the physical examination. The ability to make the “best” decision in the presence of uncertainty is the “art”…
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…
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…
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…
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…
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.…
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…
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,…