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Babies and Children

Babies A baby is a neonate for its first 4 weeks and an infant for its first year. Neonates are classified by gestational age or birthweight ( Box 15.1 ). 15.1 Classification of newborn infants Birthweight Extremely low birthweight (ELBW): <1000 g Very low birthweight (VLBW): <1500 g Low birthweight (LBW): <2500 g Normal: ≥2500 g Gestational age Extremely preterm: <28 weeks Preterm: <37 weeks (<259th day) Term: 37–42 weeks Post-term: >42 weeks (>294th day) The history Ask…

The skin, hair and nails

Dermatological conditions are very common (10–15% of general practice consultations) and present to healthcare professionals in all specialties. In the UK, 50% are lesions (‘lumps and bumps’), including skin cancers, and most of the remainder are acute and chronic inflammatory disorders (‘rashes’), including infections, with genetic conditions accounting for a small minority; this ratio will vary across the world, although the principles of skin assessment are…

The musculoskeletal system

The history Common presenting symptoms Pain In musculoskeletal pain, the acronym SOCRATES (see Box 2.2 , p. 12) suggests questions that help reveal useful diagnostic clues. Site Fig. 13.1 illustrates the anatomy of a typical joint. Determine which component is painful: the joint (arthralgia), muscle (myalgia) or other soft tissue. Pain may be localised and may suggest the diagnosis, for example, a red, hot, tender first metatarsophalangeal joint…

The renal system

Anatomy and physiology The kidneys lie posteriorly in the abdomen, retroperitoneally on either side of the spine at the T12–L3 level, and are 11–14 cm long ( Fig. 12.1 ). The right kidney lies 1.5 cm lower than the left because of the liver. The liver and spleen lie anterior to the kidneys. The kidneys move downwards during inspiration as the lungs expand. Together, the kidneys receive approximately 25%…

The reproductive system

Breast Anatomy and physiology The adult breast lies over the pectoralis major and serratus anterior muscles; it extends from the lateral border of the sternum into the lower axilla as the tail of Spence. The centre of the breast is the nipple, which is composed mostly of smooth muscle fibres. The areola is the pigmented skin around the nipple that contains numerous Montgomery glands. The breast…

The endocrine system

Endocrine glands synthesise hormones that are released into the circulation and act at distant sites. Diseases may result from excessive or inadequate hormone production, target organ hypersensitivity or resistance to the hormone. The main endocrine glands are the pituitary, thyroid, adrenals, gonads (testes and ovaries), parathyroids and the endocrine pancreas. With the notable exception of the pancreatic islet cells (which release insulin) and the parathyroids, most…

The ear, nose and throat

Ear Anatomy and physiology The ear is the specialised sensory organ of hearing and balance; it is divided anatomically into the external, middle and inner ear. External ear The external ear consists of the cartilaginous pinna, the external auditory canal (cartilage in the lateral one-third, bone in the medial two-thirds), and the lateral surface of the tympanic membrane ( Fig. 9.1 ). Sound is collected and channelled by…

The visual system

Anatomy and physiology The eye lies in the bony orbit of the skull and is covered by the eyelid, which protects it from foreign bodies and keeps the anterior surface moist by maintaining the tear film. The upper lid is elevated by two muscles: the levator palpebrae superioris, innervated by cranial nerve III; and Müller’s muscle, innervated by sympathetic nerves. The orbicularis oculi muscle closes both…

The nervous system

Anatomy and physiology The nervous system consists of the brain and spinal cord (central nervous system, CNS) and the peripheral nerves (peripheral nervous system, PNS). The PNS includes the autonomic nervous system, which is responsible for controlling involuntary functions. The neuron is the functional unit of the nervous system. Each neuron has a cell body and axon terminating at a synapse, supported by astrocytes and microglial…

The gastrointestinal system

Anatomy and physiology The gastrointestinal system comprises the alimentary tract, liver, biliary system, pancreas and spleen. The alimentary tract extends from the mouth to the anus and includes the oesophagus, stomach, small intestine or small bowel (comprising the duodenum, jejunum and ileum), colon (large intestine or large bowel) and rectum ( Figs 6.1–6.2 and Box 6.1 ). 6.1 Surface markings of the main non-alimentary tract abdominal organs…

The respiratory system

Anatomy and physiology Understanding the surface anatomy of the lungs ( Fig. 5.1 ) and their relation to adjacent structures is essential for the practice of respiratory medicine. At the end of tidal expiration, the dome of the diaphragm extends high into the thorax, level with the anterior end of the fifth rib, slightly lower on the left. The lower lateral ribs therefore overlie the liver on…

The cardiovascular system

Heart Anatomy and physiology The heart comprises two muscular pumps working in a series, covered in a serous sac (pericardium) that allows free movement with each heart beat and respiration ( Fig. 4.1 ). The right heart (right atrium and ventricle) pumps deoxygenated blood returning from the systemic veins into the pulmonary circulation at relatively low pressures. The left heart (left atrium and ventricle) receives blood from…

General aspects of examination

General principles of physical examination The process of taking a history and conducting a physical examination is artificially separated in classical medical teaching, to encourage learners to develop a structured approach to information gathering. However, your physical assessment of patients undoubtedly begins as soon as you see them, and the astute clinician may notice signs of disease, such as subtle abnormalities of demeanour, gait or appearance,…

General aspects of history taking

The importance of a clear history Understanding the patient’s experience of illness by taking a history is central to the practice of all branches of medicine. The process requires patience, empathy and understanding to yield the key information leading to correct diagnosis and treatment. In a perfect situation a calm, articulate patient would describe clearly their experience of their symptoms in the order of their occurrence,…

Managing clinical encounters with patients

The clinical encounter The clinical encounter between a patient and doctor lies at the heart of most clinical practice. At its simplest, it is the means by which people who are ill, or believe themselves to be ill, seek the advice of a clinician whom they trust. Traditionally, the clinical encounter is conducted face to face, although non–face-to-face or remote consultation using the telephone, video technology…

SARS-CoV-2 and the COVID-19 pandemic

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a novel coronavirus that belongs to the same family of viruses as the Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) and the Middle East respiratory syndrome coronavirus (MERS-CoV). It was first identified in Wuhan, China and subsequently spread worldwide, leading the World Health Organization to declare a pandemic on the 30th January 2020. SARS-CoV-2 and other human coronaviruses Human coronaviruses…

Ear, nose and throat

Acknowledgements Ashok Adams, Consultant Neuroradiologist, for helping with the radiological images, and Rachael Mcfarlane, Senior Audiologist, for helping with the vestibular testing and audiological testing images. Introduction This chapter describes the assessment of potential diseases of the ear, nose and throat. The formal title of the specialty is otorhinolaryngology, also known as ear, nose and throat (ENT). The specialty has many interactions with oral and maxillofacial…

Eyes

Introduction Although proportionally a greater contribution towards the diagnosis of ophthalmic disorders is made by the examination compared with the history, it is important to obtain a detailed account of the presenting complaint and associated visual symptoms from the patient with an ocular problem. History Disturbance of vision, the most important ocular symptom, may be sudden or gradual, unilateral or bilateral, and lead to loss of…

Skin, nails and hair

Introduction The skin is the largest organ in the human body. Forming a major interface between man and his environment, it covers an area of approximately 2 m and weighs about 4 kg. The structure of human skin is complex ( Figs 20.1 and 20.2 ), consisting of four distinct layers and tissue components with many important functions ( Box 20.1 ). Reactions may occur in…

Endocrine and metabolic disorders

Introduction The endocrine system is composed of the classic endocrine organs: ▪ Hypothalamus/pituitary ▪ Thyroid ▪ Parathyroid ▪ Adrenal ▪ Pancreatic islet cells ▪ Gonads The mode of presentation of endocrine disorders does not fit neatly into a system-based model, the symptoms rarely being specific to a particular system. Frequently, endocrine disease is suggested by a constellation of non-specific symptoms. The endocrine history As in other…