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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…

The Physical Examination

The Basic Procedures In the previous chapters, the general rules for mastering the art of taking the history are discussed. The specific skills necessary to perform a proper physical examination are discussed in this chapter. The four principles of physical examination are as follows: Inspection Palpation Percussion Auscultation To achieve competence in these procedures, the student must, in the words of Sir William Osler, “teach the…

Deconstructing Racism and Bias in Clinical Medicine

Introduction Biases exist at every level of the clinical encounter, and numerous studies have documented their impact on cognitive errors and clinical outcomes. Although bias can be most obvious in the direct clinician patient relationship, it occurs structurally and at the institution and medical system level as well. The 2003 Institute of Medicine Report “Unequal Treatment” proposed that conscious (explicit) and unconscious (implicit) biases of physicians…

Understanding Complementary and Alternative Medicine

General Considerations Complementary and alternative medicine (CAM) includes a group of diverse medical and health care systems, practices, and products, taken from around the world, that fall outside the realm of conventional medicine. Many aspects of CAM are rooted in ancient systems of healing from China, Tibet, India, Japan, Korea, Mongolia, Africa, and the Americas. Today, CAM alongside conventional medicine is widely used to treat and…

The Patient’s Responses

Responses to Illness Health is characterized by a state of well-being, enthusiasm, and energetic pursuit of life's goals. Illness is characterized by feelings of discomfort, helplessness, and a diminished interest in the future. Once patients recognize that they are ill and possibly face their own mortality, a series of emotional reactions occurs, including anxiety, fear, depression, denial, projection, regression, anger, frustration, withdrawal, and an exaggeration of…

The Interviewer’s Questions

Basic Principles Good communication skills are the foundation of excellent medical care. Even with the exciting new technology that has appeared since 2000, communicative behavior is still paramount in the care of patients. Studies have shown that good communication improves health outcomes by resolving symptoms and reducing patients’ psychological distress and anxiety. In the United States, 85% of all malpractice lawsuits are based on poor communication…