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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…

Sexually transmitted infections

Introduction The following chapter covers the history, examination and investigation of the patient who presents with genital symptoms and outlines the common sexually transmitted infections (STI) and non-infective conditions encountered in the sexual health clinic. A fundamental principle in the treatment of the patient with genital symptoms is recognition of the stigma associated with the condition and the shame he may feel in presenting himself to…

Renal and urology system

Introduction Many patients with renal disease have few or non-specific symptoms, whereas disease within the urinary tract usually does have symptoms, many of which are reasonably specific for the disease processes involved. As the kidney and urinary tract are clearly and closely linked, this chapter combines kidney and urinary tract problems in a coherent whole. The diagnostic process in nephrology and urology The clinical syndromes associated…

Nervous system

Introduction In recent years impressive advances have been made throughout the field of neurology—in delineating disease entities and understanding their aetiology and pathogenesis; in diagnostic methods, particularly imaging and genetic testing; and in treatment and management. However, despite advances in investigations, careful clinical assessment remains of central importance. The fundamental importance of the clinical history and examination cannot be overemphasized. In the diagnosis of neurological disease,…

Locomotor system

Introduction Musculoskeletal symptoms are a major cause of pain and disability, accounting for a quarter of all general practitioner consultations in the United Kingdom (UK), with significant economic consequences. Common musculoskeletal conditions, such as back pain and osteoarthritis, are the dominant causes of chronic pain, disability and work loss in the UK and many other countries, consuming considerable health and social service resources. In addition, inflammatory…

Gastrointestinal system

General principles A key requirement of being a good doctor is the ability to make a robust diagnosis. Making a diagnosis requires identifying departure from normal and involves answering two key questions: 1. Where is the problem (i.e. the anatomical site)? 2. What is the problem (i.e. nature of disease)? A good history and a focused examination are the keys to making a diagnosis/differential diagnoses, and…

Cardiovascular system

Introduction Recent decades have seen major changes in patterns of cardiovascular disease. In the developed world, syphilitic and tuberculous involvement of the cardiovascular system has become rare, and the incidence of rheumatic disease has declined considerably. Myocardial and conducting tissue diseases are diagnosed with increasing frequency and the importance of arterial hypertension has become recognized. Coronary artery disease has emerged as the major cardiovascular disorder of…