1: Partnership With Patients: Building A History -- Developing a relationship with the patient -- Ethical context -- Effective communication -- Patient history -- Setting for the interview -- Structure of the history -- Building the history -- Sensitive issues -- Outline of the history -- Adaptations for age, gender, and possible disabilities -- Next step -- 2: Cultural Awareness -- Cultural competence -- Definition of culture -- Distinguishing physical characteristics -- Impact of culture -- Blurring of cultural distinctions -- Primacy of the individual in health care -- Professional cultures within the health professions -- Impact of culture on illness -- Components of a cultural response -- Modes of communication -- Health beliefs and practices -- Family relationships -- Diet and nutritional practices -- Summing up -- 3: Examination Techniques And Equipment -- Precautions to prevent infection -- Latex allergy -- Examination technique -- Patient positions and draping -- Inspection -- Palpation -- Percussion -- Auscultation -- Measurement of vital signs -- Pulse -- Respirations -- Blood pressure -- Temperature -- Oxygen saturation -- Pain -- Measurement of height and weight -- Modifications for patients with disabilities -- Patients with mobility impairments -- Patients with sensory impairment -- Special concerns for patients with disabilities -- Instruments -- Stethoscope -- Pulse oximeter -- Doppler -- Fetal monitoring equipment -- Ophtalmoscope -- Strabismoscope -- Visual acuity charts -- Near vision charts -- Amsler grid -- Otoscope -- Tympanometer -- Nasal speculum -- Tuning fork -- Percussion (reflex) hammer -- Neurologic hammer -- Tape measure -- Transilluminator -- Vaginal speculum -- Goniometer -- Wood's lamp -- Dermatoscope -- Calipers for skinfold thickness -- Monofilament -- 4: Mental Status -- Anatomy and physiology -- Review of related history -- History of present illness -- Past medical history -- Family history -- Personal and social history -- Examination and findings -- Physical appearance and behavior -- Grooming -- Emotional status -- Body language -- State of consciousness -- Cognitive abilities -- Analogies -- Abstract reasoning -- Arithmetic calculation -- Writing ability -- Execution of motor skills -- Memory -- Attention span -- Judgment -- Speech and language skills -- Voice quality -- Articulation -- Comprehension -- Coherence -- Emotional stability -- Mood and feelings -- Thought process and content -- Perceptual distortions and hallucinations -- Additional procedures -- Glasgow coma scale -- Abnormalities --
5: Growth And Measurement -- Anatomy and physiology -- Differences in growth by organ system -- Review of related history -- History of present illness -- Past medical history -- Family history -- Personal and social history -- Examination and findings -- Equipment -- Weight and standing height -- Body mass index -- Sexual maturation -- Abnormalities -- 6: Nutrition -- Anatomy and physiology -- Macronutrients -- Carbohydrate -- Protein -- Fat -- Micronutrients -- Water -- Energy requirements -- Resting energy expenditure -- Physical activity -- Thermogenesis -- Review of related history -- History of present illness -- Past medical history -- Family history -- Personal and social history -- Examination and findings -- Equipment -- Anthropometrics -- Waist circumference -- Waist-to-hip circumference ratio -- Determination of diet adequacy -- Twenty-four-hour recall diet -- Food diary -- Measures of nutrient analysis -- MyPyramid food guide -- Vegetarian diets -- Ethnic food guide pyramids -- Measures of nutrient adequacy -- Special procedures -- Triceps skinfold thickness -- Mid-upper arm circumference -- Midarm muscle circumference/midarm muscle area -- Biochemical measurement -- Abnormalities -- 7: Assessment Of Pain -- Anatomy and physiology -- Review of related history -- Present problem -- Personal and social history -- Examination and findings -- Self-report pain rating scales -- Assessing pain behaviors -- Abnormalities -- 8: Skin, Hair, And Nails -- Anatomy and physiology -- Epidermis -- Dermis -- Hypodermis -- Appendages -- Review of related history -- History of present illness -- Past medical history -- Family history -- Personal and social history -- Examination and findings -- Equipment -- Skin -- Inspection -- Palpation -- Skin lesions -- Hair -- Nails -- Inspection -- Palpation -- Abnormalities -- 9: Lymphatic System -- Anatomy and physiology -- Lymph nodes -- Lymphocytes -- Thymus -- Spleen -- Tonsils and adenoids -- Peyer patches -- Review of related history -- History of present illness -- Past medical history -- Family history -- Personal and social history -- Examination and findings -- Equipment -- Inspection and palpation -- Head and neck -- Axillae -- Epitrochlear lymph nodes -- Inguinal and popliteal lymph nodes -- Spleen -- Abnormalities -- 10: Head And Neck -- Anatomy and physiology -- Review of related history -- History of present illness -- Past medical history -- Family history -- Personal and social history -- Examination and findings -- Equipment -- Head and face -- Inspection -- Palpation -- Percussion -- Auscultation -- Neck -- Inspection -- Palpation -- Lymph nodes -- Thyroid gland -- Abnormalities -- 11: Eyes -- Anatomy and physiology -- External eye -- Eyelid -- Conjunctiva -- Lacrimal gland -- Eye muscles -- Internal eye -- Sclera -- Cornea -- Uvea -- Lens -- Retina -- Review of related history -- History of present illness -- Family history -- Personal and social history -- Examination and findings -- Equipment -- Visual acuity testing -- External examination -- Surrounding structures -- Eyelids -- Palpation -- Conjunctiva -- Cornea -- Iris and pupil -- Lens -- Sclera -- Lacrimal apparatus -- Extraocular muscles -- Ophtalmoscopic examination -- Unexpected findings -- Abnormalities --
12: Ears, Nose, And Throat -- Anatomy and physiology -- Ears and hearing -- Nose, nasopharynx, and sinuses, mouth and oropharynx -- Review of related history -- History of present illness -- Past medical history -- Family history -- Personal and social history -- Examination and findings -- Equipment -- Ears and hearing -- External ear -- Otoscopic examination -- Hearing evaluation -- Nose, nasopharynx, and sinuses -- External nose -- Nasal cavity -- Sinuses -- Mouth and oropharynx -- Lips -- Buccal mucosa, teeth, and gums -- Oral cavity -- Oropharynx -- Abnormalities -- 13: Chest And Lungs -- Anatomy and physiology -- Anatomic landmarks -- Review of related history -- History of present illness -- Past medical history -- Family history -- Personal and social history -- Equipment -- Examination and findings -- Inspection -- Respiratory patterns -- Observing respiration -- Looking for clues at the periphery -- Palpation -- Examining the trachea -- Percussion -- Diaphragmatic excursion -- Auscultation -- Breath sounds -- Vocal resonance -- Coughs -- Sputum -- Abnormalities -- 14: Heart -- Anatomy and physiology -- Structure -- Cardiac cycle -- Electrical activity -- Review of related history -- History of present illness -- Past medical history -- Family history -- Personal and social history -- Examination and findings -- Equipment -- Inspection -- Palpation -- Percussion -- Auscultation -- Basic heart sounds -- Extra heart sounds -- Heart murmurs -- Rhythm disturbance -- Abnormalities -- 15: Blood Vessels -- Anatomy and physiology -- Blood circulation -- Arterial pulse and pressure -- Jugular venous pulse and pressure -- Review of related history -- History of present illness -- Past medical history -- Family history -- Personal and social history -- Examination an findings -- Equipment -- Peripheral arteries -- Palpation -- Auscultation -- Assessment for peripheral arterial disease -- Blood pressure -- Peripheral veins -- Jugular venous pressure -- Hepatojugular reflux -- Evaluation of hand veins -- Assessment for venous obstruction and insufficiency -- Abnormalities -- 16: Breasts And Axillae -- Anatomy and physiology -- Review of related history -- History of present illness -- Past medical history -- Family history -- Personal and social history -- Examination and findings -- Equipment -- Inspection -- Breasts -- Nipples and areolae -- Reinspection in varied positions -- Palpation -- Patient in seated position -- Patient in supine position -- Abnormalities -- 17: Abdomen -- Anatomy and physiology -- Alimentary tract -- Liver -- Gallbladder -- Pancreas -- Spleen -- Kidneys, ureters, and bladder -- Musculature and connective tissues -- Vasculature -- Review of related history -- History of present illness -- Past medical history -- Family history -- Personal and social history -- Examination and findings -- Equipment -- Preparation -- Inspection -- Surface characteristics -- Contour -- Movement -- Auscultation -- Bowel sounds -- Additional sounds and bruits -- Percussion -- Liver span -- Spleen -- Gastric bubble -- Kidneys -- Palpation -- Light palpation -- Moderate palpation -- Deep palpation -- Masses -- Umbilical ring -- Palpation of specific organs and structures -- Additional procedures -- Ascites assessment -- Pain assessment -- Abdominal signs -- Rebound tenderness -- Illiopsoas muscle test -- Obturator muscle test -- Ballottement -- Abnormalities -- 18: Female Genitalia -- Anatomy and physiology -- External genitalia -- Internal genitalia -- Bony pelvis -- Review of related history -- History of present illness -- Past medical history -- Family history -- Personal and social history -- Examination and findings -- Equipment -- Preparation -- Positioning -- Draping and gloving -- External examination -- Inspection and palpation -- Labia majora -- Labia minora -- Clitoris -- Uretharal orifice -- Vaginal introitus -- Skene and Bartholin glands -- Muscle tone -- Perineum -- Anus -- Internal examination -- Preparation -- Insertion of speculum -- Cervix -- Withdrawal of speculum -- Bimanual examination -- Cervix -- Uterus -- Adnexa and ovaries -- Rectovaginal examination -- Preparation -- Anal sphincter -- Rectal walls and rectovaginal septum -- Uterus -- Adnexa -- Stool -- Completion -- Abnormalities --
Review of related history
History of present illness
Personal and social history
Genital hair distribution
20: Anus, Rectum, And Prostate
Review of related history
History of present illness
Personal and social history
Sacrococcygeal and perianal areas
Lateral and posterior rectal walls
21: Musculoskeletal System
Review of related history
History of present illness
Personal and social history
Specific joints and muscles
Thoracic and lumbar spine
Hand and wrist assessment
Spinal cord and spinal tracts
Review of related history
History or present illness
Personal and social history
Oculomotor, trochlear, and abducens (III, IV, and VI)
Proprioception and cerebellar function
Coordination and fine motor skills
Primary sensory functions
Cortical sensory functions
23: Sports Participation Evaluation
24: Putting It All Together
Patient seated, wearing gown
Patient seated, back exposed
Patient seated, chest exposed
Patient reclining 45 degrees
Patient supine, chest exposed
Patient supine, abdomen exposed
Patient supine, legs exposed
Patient sitting, lap draped
Female patient, lithotomy position
Male patient, bending forward (lateral decubitus or knee-chest positions are also possible)
Examination sequence with children
25: Taking The Next Steps: Clinical Judgment
Assessment, judgment, and evidence
Possible barriers to critical thinking
Validity of the clinical examination
Evaluation and management plan and setting priorities
26: Recording Information
Problem-oriented medical record
Comprehensive health history and physical examination
Notes from subsequent evaluations
Problem-oriented medical record format
Physical examination findings
Assessment (for each problem on problem list)
Plan (for each problem on problem list)
27: Emergency Or Life-Threatening Situations
Primary assessment of the injured patient
Secondary assessment of the injured patient
Acute medical emergencies
Advance directives, living wills, and durable power of attorney for health care
Illustration and photo credits
Appendix A: Height/weight growth charts
Appendix B: Conversion tables and body mass index.
