Mosby's Guide to Physical Examination

by Seidel, Henry M.

• ISBN13: 9780323001786
• ISBN10: 0323001785
• Format: Hardcover
• Copyright: 1998-08-01
• Publisher: Elsevier Science Health Science div

Summary

This text presents a comprehensive approach to physical examination that is appropriate for all health care disciplines (nursing, medical, chiropractic, and allied health). Chapter organization of physical examination content is based on a body systems approach. The fourth edition includes new chapters on nutrition, mental status, and critical thinking; a new feature that highlights differential diagnosis content; 150 new illustrations (1,200 total), most in full-color; and new appendixes featuring a sports pre-participation evaluation guide and nutrition screening forms. A CD for students with a "toolbox" of interactive learning activities is included FREE! * Thoroughly revised and updated content throughout text. * Uses consistent chapter organization to provide easy access to information and facilitate student learning: Anatomy and physiology, review of related history, examination techniques and findings, and common abnormalities. * Features 1200 illustrations that visually emphasize normal anatomy and physiology, the key steps in physical examination, and identification of common abnormalities. * Supports a lifespan approach to physical examination by clustering age-related variations by age group at the end of each section in the body systems chapters. * Includes mnemonics boxes in the margins to help students remember examination techniques or health history questions. * Lists tables and boxes in table of contents for easy access to information. NEW FEATURES: * NEW CD ROM (free with textbook): An interactive "tool box" of learning activities and forms included to facilitate development of critical thinking. Includes: * Body system interactive challenge questions for each of the 14 body systems chapters. * 20 Patient Teaching Guides for print out and use. * Clinical Laboratory Guidelines that may be printed for use in the clinical setting. * Hundreds of illustrations have been updated, most in full color, and 150 new illustrations have been added to enhance visual learning. * New separate chapters for Mental Status and Neurologic System highlight the importance of each in the assessment of health. * New comprehensive chapter on Nutrition emphasizes the importance of nutrition and its impact on overall health. * New chapter on Critical Thinking added to help students assess the value and significance of the information gathered from the history and exam and learn how to set priorities and institute management plans. * Differential Diagnosis content highlighted throughout with special heading for easy access and details to assist the student with critical thinking. (PREVIOUS EDITION AVAILABLE IN SPANISH.8481741655)(Includes FREE CD-ROM and Mosby website at:www.harcourthealth.com/Mosby/Seidel/)

Table of Contents

1 THE HISTORY AND INTERVIEWING PROCESS	1	(35)
ETHICAL CONSIDERATIONS IN PATIENT RELATIONSHIPS	2	(2)
An ethical context to the partnership with the patient	2	(2)
COMMUNICATING WITH THE PATIENT	4	(11)
Factors that enhance communication	4	(4)
Moments of tension	8	(4)
Knowing yourself	12	(3)
THE HISTORY	15	(21)
Setting for the interview	16	(1)
Structure of the history	16	(1)
Taking the history	17	(1)
An approach to sensitive issues	18	(3)
Outline of clinical history	21	(15)
2 CULTURAL AWARENESS	36	(11)
A definition of culture	36	(1)
Distinguishing physical characteristics	36	(1)
Impact of culture	37	(1)
The blurring of cultural distinctions	37	(1)
The primacy of the individual in health care	38	(2)
Relationships within the health professions	40	(1)
Cultural impact on disease	41	(1)
The components of a cultural response	42	(1)
Communications	43	(1)
Health beliefs and practices	44	(1)
Diet practices	45	(1)
Family relationships	45	(1)
Summing up	46	(1)
3 EXAMINATION TECHNIQUES AND EQUIPMENT	47	(31)
PRECAUTIONS TO PREVENT INFECTION	47	(2)
LATEX ALLERGY	49	(2)
EXAMINATION TECHNIQUES	51	(4)
Inspection	51	(1)
Palpation	52	(1)
Percussion	53	(2)
Ausculatation	55	(1)
MEASUREMENT OF VITAL SIGNS	55	(3)
Pulse	55	(1)
Respiration	55	(1)
Blood pressure	56	(1)
Temperature	57	(1)
MEASUREMENT OF HEIGHT AND WEIGHT	58	(2)
INSTRUMENTATION	60	(18)
Stethoscope	60	(3)
Doppler	63	(1)
Fetal monitoring equipment (fetoscope, Left scope, stethoscope, and electronic verification of the fetal heartbeat)	63	(1)
Ophthaknisciope	64	(1)
Strabismoscope	65	(1)
Snellen Visual Acuity Chart	66	(1)
Near vision charts	66	(1)
Amsler grid	66	(2)
Otoscope	68	(1)
Tympanometer	69	(1)
Nasal speculum	70	(1)
Tuning fork	70	(1)
Percussion (reflex) hammer	71	(1)
Neurologic hammer	72	(1)
Tape measure	73	(1)
Transilluminator	73	(1)
Vaginal speculum	73	(2)
Goniometer	75	(1)
Wood's lamp	75	(1)
Episcope	75	(1)
Calipers for skinfold thickness	76	(1)
Monofilament	76	(2)
4 MENTAL STATUS	78	(19)
ANATOMY AND PHYSIOLOGY	78	(2)
REVIEW OF RELATED HISTORY	80	(1)
Present problem	80	(1)
Past medical history	80	(1)
Family history	80	(1)
Personal and social history	80	(1)
EXAMINATION AND FINDINGS	81	(13)
Physical appearance and behavior	82	(1)
Congnitive abilities	83	(4)
Emotional stability	87	(1)
Speech and language skills	87	(1)
Additional procedures	88	(6)
COMMON ABNORMALITIES	94	(3)
Disorders of altered mental status	94	(3)
5 GROWTH AND MEASUREMENT	97	(36)
ANATOMY AND PHYSIOLOGY	97	(5)
Endocrine Influences	97	(1)
Differences in growth by organ system	98	(4)
REVIEW OF RELATED HISTORY	102	(2)
Present problem	102	(1)
Past medical history	103	(1)
Family history	103	(1)
Personal and social history	103	(1)
EXAMINATION AND FINDINGS	104	(23)
Equipment	104	(1)
Weight and Standing height	104	(1)
Triceps skinfold thickness	105	(4)
Recumbent length	109	(1)
Weight	109	(1)
Head circumference	110	(1)
Chest circumference	110	(1)
Gestational age	111	(2)
Size for gestational age	113	(2)
Stature and weight	115	(3)
Skinfold thickness	118	(1)
Sitting height	118	(1)
Arm Span	119	(8)
COMMON ABNORMALITIES	127	(6)
Metabolic disorders	127	(1)
Other disorders	128	(5)
6 NUTRITION	133	(28)
ANATOMY AND PHYSIOLOGY	133	(6)
Macronutrients	133	(3)
Micronutrients	136	(1)
Water	136	(1)
Energy requirements	136	(5)
REVIEW OF RELATED HISTORY	141	(8)
24-hour diet recall	142	(1)
Food diary	142	(1)
Measures of nutrient analysis	142	(4)
Measures of nutrient adequacy	146	(1)
Present problem	146	(1)
Past Medical history	147	(1)
Family history	147	(1)
Personal and social history	147	(2)
EXAMINATION AND FINDINGS	149	(8)
Equipment	149	(1)
Anthropometrics	150	(3)
Biochemical measurement	153	(4)
COMMON ABNORMALITIES	157	(4)
7 SKIN, HAIR, AND NAILS,	161	(57)
ANATOMY AND PHYSIOLOGY	161	(4)
Epidermis	161	(1)
Dermis	162	(1)
Hypodermis	162	(1)
Appendages	162	(3)
REVIEW OF RELATED HISTORY	165	(3)
Present problem	165	(1)
Past medical history	166	(1)
Family history	166	(1)
Personal and social history	166	(2)
EXAMINATION AND FINDINGS	168	(30)
Equipment	168	(1)
Skin	168	(11)
Skin lesions	172	(11)
Hair	183	(1)
Nails	183	(15)
COMMON ABNORMALITIES	198	(20)
Skin: nonmalignant abnormalities	198	(6)
Skin: malignant abnormalities	204	(2)
Hair	206	(1)
Nails: infection	207	(1)
Nails: injury	207	(2)
Nails: changes associated with systemic disease	209	(1)
Nails: Periungual growths	210	(8)
8 LYMPHATIC SYSTEM	218	(26)
ANATOMY AND PHYSIOLOGY	218	(11)
Lymph nodes,	224	(1)
Lymphocytes	224	(2)
Thymus	226	(1)
Spleen	226	(1)
Tonsils and adenoids	226	(1)
Peyer patches	226	(3)
REVIEW OF RELATED HISTORY	229	(1)
Present problem	229	(1)
Past medical history	229	(1)
Family history	229	(1)
EXAMINATION AND FINDINGS	230	(8)
Equipment	230	(1)
Inspection and palpation	230	(3)
Head and neck	233	(1)
Axillae	234	(1)
Other lympth nodes	235	(3)
COMMON ABNORMALITIES	238	(6)
9 HEAD AND NECK	244	(28)
ANATOMY AND PHYSIOLOGY	244	(6)
REVIEW OF RELATED HISTORY	250	(2)
Present problem	250	(1)
Past medical history	251	(1)
Personal and social history	251	(1)
Family history	251	(1)
EXAMINATION AND FINDINGS	252	(10)
Equipment	252	(1)
Head and face	252	(1)
Neck	253	(9)
COMMON ABNORMALITIES	262	(10)
Head	262	(5)
Neck	267	(2)
Thyroid	269	(3)
10 EYES	272	(36)
ANATOMY AND PHYSIOLOGY	272	(5)
External eye	272	(1)
Internal eye	273	(4)
REVIEW OF RELATED HISTORY	277	(1)
Past medical history	277	(1)
Family history	277	(1)
Personal and social history	278	(1)
EXAMINATION AND FINDINGS	278	(19)
Equipment	278	(1)
Visual testing	278	(2)
External examination	280	(5)
Extraocular eye muscles	285	(2)
Ophthalmoscopic examination	287	(10)
COMMON ABNORMALITIES	297	(11)
External eye	297	(2)
Extraocular muscles	299	(1)
Internal eye	300	(6)
Visual fields	306	(2)
11 EARS, NOSE, AND THROAT	308	(44)
ANATOMY AND PHYSIOLOGY	308	(10)
Ears,	308	(3)
Nose and nasopharynx	311	(2)
Mouth and oropharynx	313	(5)
REVIEW OF RELATED HISTORY	318	(3)
Present problem	318	(2)
Past medical history	320	(1)
Family history	320	(1)
Personal and social history	320	(1)
EXAMINATION AND FINDINGS	321	(25)
Equipment,	321	(1)
Ears	321	(6)
Nose and nasopharynx	327	(2)
Mouth and oropharynx	329	(7)
Additional procedures	336	(1)
Ears	337	(1)
Nose and sinuses	338	(1)
Mouth	338	(2)
Ears	340	(1)
Nose and sinuses	340	(1)
Mouth	341	(2)
Ears and hearing	343	(1)
Nose	343	(1)
Mouth	343	(3)
COMMON ABNORMALITIES	346	(6)
Ear	346	(2)
Nose and sinuses	348	(1)
Mouth and oropharynx	349	(3)
12 CHEST AND LUNGS	352	(57)
ANATOMY AND PHYSIOLOGY	352	(8)
Chemical and neurologic control of respiration	358	(1)
Anatomic landmarks	358	(2)
REVIEW OF RELATED HISTORY	360	(3)
Present problem	360	(1)
Past medical history	361	(1)
Family history	361	(1)
Personal and social history	361	(2)
EXAMINATION AND FINDINGS	363	(29)
Equipment	363	(1)
Inspection	363	(3)
Respiration	366	(1)
Descriptors of respiration	366	(5)
Palpation	371	(2)
Percussion	373	(4)
Auscultation	377	(15)
COMMON ABNORMALITIES	392	(17)
13 HEART AND BLOOD VESSELS	409	(77)
ANATOMY AND PHYSIOLOGY	409	(16)
Heart	409	(8)
Blood circulation	417	(8)
REVIEW OF RELATED HISTORY	425	(5)
Present problem	425	(2)
Past medical history	427	(1)
Family history	427	(1)
Personal and social history	427	(3)
EXAMINATION AND FINDINGS	430	(37)
Equipment	430	(1)
Heart	430	(14)
Peripheral arteries	444	(11)
Peripheral veins	455	(12)
COMMON ABNORMALITIES	467	(19)
Cardiac disorders	467	(7)
Abnormalities in heart rates and rhythms	474	(2)
Congenital defects	476	(4)
Vessel disorders	480	(2)
Jugular venous pressure disorders	482	(4)
14 BREASTS AND AXILLAE	486	(27)
ANATOMY AND PHYSIOLOGY	486	(4)
REVIEW OF RELATED HISTORY	490	(3)
Present problem	490	(1)
Past medical history	490	(1)
Family history	490	(1)
Personal and social history	491	(2)
EXAMINATION AND FINDINGS	493	(15)
Equipment	493	(1)
Inspection	494	(4)
Reinspection in varied positions	498	(1)
Palpation	498	(10)
COMMON ABNORMALITIES	508	(5)
15 ABDOMEN	513	(60)
ANATOMY AND PHYSIOLOGY	513	(7)
Alimentary tract	513	(3)
Liver	516	(1)
Gallbladder	516	(1)
Pancreas	517	(1)
Spleen	517	(1)
Kidneys, ureters, and bladder	517	(1)
Musculature and connective tissues	518	(1)
Vasculature	518	(2)
REVIEW OF RELATED HISTORY	520	(4)
Present problem	520	(2)
Past medical history	522	(1)
Family history	523	(1)
Personal and social history	523	(1)
EXAMINATION AND FINDINGS	524	(38)
Equipment	524	(1)
Preparation	524	(1)
Inspection	524	(5)
Auscultation	529	(1)
Percussion	530	(4)
Palpation	534	(9)
Additional procedures	543	(9)
Inspection	552	(1)
Auscultation and percussion	553	(1)
Palpation	553	(2)
Gestational age	555	(1)
Fetal well-being	556	(1)
Fetal position	557	(3)
Contractions	560	(2)
COMMON ABNORMALITIES	562	(11)
Alimentary tract	562	(3)
Hepatobiliary system	565	(2)
Pancreas	567	(1)
Spleen	567	(1)
Kidneys	567	(6)
16 FEMALE GENITALIA	573	(71)
ANATOMY AND PHYSIOLOGY	573	(10)
External genitalia	573	(1)
Internal genitalia	574	(3)
The bony pelvis	577	(6)
REVIEW OF RELATED HISTORY	583	(5)
Present problem	583	(2)
Past medical history	585	(1)
Family history	586	(1)
Personal and social history	586	(2)
EXAMINATION AND FINDINGS	588	(39)
Equipment	588	(1)
Preparation	588	(1)
Positioning	588	(1)
Draping and gloving	589	(1)
External examination	589	(4)
Internal examination	593	(6)
Bimanual examination	599	(4)
Rectovaginal examination	603	(5)
Rectal examination	608	(19)
COMMON ABNORMALITIES	627	(17)
Lesions from sexually transmitted diseases	627	(3)
Vulva and vagina	630	(4)
Cervix	634	(2)
Uterus	636	(3)
Adnexa	639	(5)
17 MALE GENITALIA	644	(26)
ANATOMY AND PHYSIOLOGY	644	(4)
Sexual physiology	647	(1)
REVIEW OF RELATED HISTORY	648	(2)
Present problem	648	(1)
Past medical history	649	(1)
Family history	649	(1)
Personal and social history	649	(1)
EXAMINATION AND FINDINGS	650	(9)
Equipment	650	(1)
Inspection and palpation	650	(6)
Inspection and palpation in infants	656	(2)
Inspection and palpation in children	658	(1)
COMMON ABNORMALITIES	659	(11)
Penis	661	(4)
Scrotum	665	(5)
18 ANUS, RECTUM, AND PROSTATE	670	(19)
ANATOMY AND PHYSIOLOGY	670	(3)
REVIEW OF RELATED HISTORY	673	(2)
Present problem	673	(1)
Past medical history	673	(1)
Family history	673	(1)
Personal and social history	674	(1)
EXAMINATION AND FINDINGS	675	(7)
Equipment	675	(1)
Preparation	675	(1)
Positioning	675	(1)
Sacrococcygeal and perianal areas	675	(1)
Anus	675	(1)
Sphincter	675	(1)
Anal ring	676	(1)
Lateral and posterior rectal walls	676	(1)
Bidigital palpation	676	(1)
Anterior rectal wall and prostate	676	(2)
Uterus and cervix	678	(1)
Stool	678	(4)
COMMON ABNORMALITIES	682	(7)
Anus, rectum, and surrounding skin,	682	(4)
Prostate	686	(3)
19 MUSCULOSKELETAL SYSTEM	689	(66)
ANATOMY AND PHYSIOLOGY	689	(13)
Head and spine	695	(1)
Upper extremities	695	(3)
Lower extremities	698	(4)
REVIEW OF RELATED HISTORY	702	(2)
Present problem	702	(1)
Past medical history	702	(1)
Family history	703	(1)
Personal and social history	703	(1)
EXAMINATION AND FINDINGS	704	(42)
Equipment	704	(1)
Inspection	705	(1)
Palpation	706	(1)
Range of motion	706	(1)
Muscle strength	707	(1)
Specific joints and muscles	707	(20)
Additional procedures	727	(19)
COMMON ABNORMALITIES	746	(9)
Sports injuries	749	(6)
20 NEUROLOGIC SYSTEM	755	(50)
ANATOMY AND PHYSIOLOGY	755	(13)
Brain	758	(4)
Spinal cord and spinal tracts	762	(6)
REVIEW OF RELATED HISTORY	768	(3)
Present problem	768	(1)
Past medical history	769	(1)
Family history	770	(1)
Personal and social history	770	(1)
EXAMINATION AND FINDINGS	771	(27)
Equipment	771	(1)
Cranial nerves	772	(6)
Proprioception and cerebellar function	778	(5)
Sensory function	783	(3)
Reflexes	786	(3)
Additional procedures	789	(9)
COMMON ABNORMALITIES	798	(7)
Disorders of the central nervous system	798	(3)
Disorders of the peripheral nervous system	801	(4)
21 PUTTING IT ALL TOGETHER	805	(30)
GENERAL GUIDELINES	806	(6)
Reliability	809	(3)
EXAMINATION SEQUENCE	812	(20)
General inspection	813	(1)
Patient instructions	813	(1)
Measurements	813	(1)
Patient seated, wearing gown	814	(1)
Patient seated, back exposed	815	(1)
Patient seated, chest exposed	816	(1)
Patient reclining 45 degrees	816	(1)
Patient supine, chest exposed	817	(1)
Patient supine, abdomen exposed	817	(1)
Patient supine, legs exposed	818	(1)
Patient sitting, lap draped	818	(1)
Patient standing	819	(1)
Female patient, lithotomy position	820	(1)
Male patient, bending forward	820	(2)
Newborns	822	(1)
Older infants	823	(1)
Physical examination sequence	823	(5)
Child playing	828	(1)
Child on parent's lap	828	(1)
Child relatively supine, still on lap, diaper loosened	829	(1)
Child standing	829	(1)
Child returns to parent's lap	829	(1)
Functional assessment	830	(2)
ALLIANCE AND COMPLIANCE	832	(3)
22 TAKING THE NEXT STEPS: CRITICAL THINKING	835	(7)
THE CLINICAL EXAMINATION	835	(1)
CRITICAL THINKING	835	(6)
Assessment/judgment	835	(1)
Problem identification	836	(1)
Valid hypotheses	837	(1)
Possible barriers to critical thinking	838	(2)
Validity of the clinical examination	840	(1)
Bayes' formula	840	(1)
THE MANAGEMENT PLAN/SETTING PRIORITIES	841	(1)
23 EMERGENCY OR LIFE-THREATENING SITUATIONS	842	(19)
THE ABCs OF PRIMARY ASSESSMENT	842	(10)
Primary assessment	845	(4)
Secondary assessment	849	(3)
INJURY ASSESSMENT	852	(6)
Blunt trauma	852	(1)
Penetrating trauma	853	(1)
Burns	854	(1)
Assessment in children	855	(3)
RECORDS AND LEGAL CONSIDERATIONS	858	(2)
Records	858	(1)
Consent for treatment	859	(1)
Advance directives, living wills, and durable power of attorney for health care	859	(1)
SUMMARY	860	(1)
24 RECORDING INFORMATION	861	(30)
GENERAL GUIDELINES	862	(3)
Description of findings	862	(3)
PROBLEM-ORIENTED MEDICAL RECORD	865	(1)
Comprehensive health history and physical examination	865	(1)
Problem list	865	(1)
Assessment	866	(1)
Plan	866	(1)
Progress notes	866	(1)
PROBLEM-ORIENTED MEDICAL RECORD FORMAT	866	(12)
The history	866	(3)
Review of systems	869	(1)
Physical examination findings	870	(4)
Assessment (for each problem on problem list)	874	(1)
Plan (for each problem on problem list)	874	(4)
SAMPLE RECORDS	878	(11)
Ambulatory adult	878	(7)
Infant	885	(1)
Episodic illness visit	885	(4)
Episodic illness notes	889	(1)
Episodic note sample write up	889	(1)
SUMMARY	889	(2)
PHOTO AND ILLUSTRATION CREDITS	891	(2)
REFERENCES	893	(5)
GLOSSARY	898	(9)
APPENDIXES	907
A ASSESSMENT OF PAIN	907	(5)
ANATOMY AND PHYSIOLOGY	907	(1)
REVIEW OF RELATED HISTORY	908	(1)
PHYSICAL EXAMINATION	908	(4)
B SPORTS PREPARTICIPATION EVALUATION	912	(13)
C CONVERSION TABLES	925	(1)
D TEMPERATURE EQUIVALENTS	926	(1)
E GROWTH CURVE CHARTS FOR CHILDREN AND ADOLESCENTS	927	(11)
F DENVER II DEVELOPMENTAL SCREENING TOOL	938	(3)
G NUTRITION SCREENING FORMS	941	(12)
H ABBREVIATIONS	953	(3)
I WORD PARTS	956	(4)
J ENGLISH-TO-SPANISH TRANSLATION GUIDE: KEY MEDICAL QUESTIONS	960