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TEXTBOOK OF H IS I ORY AND EXAMINATION W.B. SAUNDERS COMPANY An Imprint of Elsevier Science Philodelphio London New York St. Louis Sydney Toronto €17,04
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TEXTBOOK OF H IS I ORY AND EXAMINATION W.B. SAUNDERS COMPANY An Imprint of Elsevier Science Philodelphio London New York St. Louis Sydney Toronto
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TEXTBOOK OF H IS I ORY AND EXAMINATION W.B. SAUNDERS COMPANY An Imprint of Elsevier Science Philodelphio London New York St. Louis Sydney Toronto

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" Physical •, Diagnosis HISTORY AND EXAMINATION



TEXTBOOK OF H IS I ORY AND EXAMINATION W.B. SAUNDERS
COMPANY An Imprint of Elsevier Science Philodelphio London New
York St. Louis Sydney Toronto

Contents

SECTION ! The Art of Interviewing

CHAPTER

CHAPTER2

CHAPTER 3

CHAPTER 4

CHAPTER .

The Interviewer's Questions ............ 3 Basic Principles 3 Symptoms
and Signs 7 Conducting an Interview 8 Basic Interviewing
Techniques 10 Format of the History 16 Concluding Thoughts 31

The Patient's Responses ............... 35 Responses to Illness 35
Responses to the Interviewer 38 Influence of Background and Age
on Patient Response 41 Influence of Disease on Patient Response
46

Caring for Patients in a Culturally Diverse Society ..............................
51 General Considerations 52 Specific Cross-Cultural Perspectives
62 Traditional Chinese Medicine 70 Conclusion 77

Assessment of Nutritional Status... 79

,Medical History 80 Physical Examination 87 Special Populations 89
Clinicopathologic Correlations Concluding Thoughts 99

96

Putting the History Together ........ 101 Interview of Mr. John Doe 101
Written History of Mr. John Doe 110

SECTION !! The Science of the Physical Examination CHAPTER
The Physical Examination ............ 115 The Basic Procedures 115
Preparation for the Examination 117

CHAPTER

CHAPTER 8

CHAPTER

CHAPTER

CHAPTER

Precautions to Take During the Examination 118 The Goal of the
Physical Examination

119

The Skin ...................................... 123 General Considerations 123
Structure and Physiology 124 Review of Specific Symptoms 127
Impact of Skin Disease on the Patient 129 Physical Examination 129
Description of Lesions 135 Clinicopathologic Correlations 141

The Head and Neck ..................... 179 General Considerations 179
Structure and Physiology 180 Review of Specific Symptoms 183
Impact of Head and Neck Disease on the Patient 183 Physical
Examination 184 Clinicopathologic Correlations 188

The Eye ........................................ 195 Historical Considerations 195
Structure and Physiology 195 Review of Specific Symptoms 201

,Impact of Blindness on the Patient 205 Physical Examination 206
Ophthalmoscopic Examination 226 Clinicopathologic Correlations
233

The Ear and Nose ....................... 257

General Considerations 257 Structure and Physiology 257 Review of
Specific Symptoms 263 Impact of Deafness on the Patient Physical
Examination 269 Clinicopathologic Correlations 279

268

The Oral Cavity and Pharynx ...... 285 General Considerations 285
Structure and Physiology 286 Review of Specific Symptoms 290
Impact of a Voice Disorder on the Patient 293 Phygical Examination
294 Clinicopathologic Correlations 306



xviii CONTENTS

CHAPTER 12

CHAPTER 13

CHAPTER 14

CHAPTER 15

CHAPTER 16

CHAPTER I 7

The Chest ..................................... 315 General Considerations 315
Structure and Physiology 315 Review of Specific Symptoms 320
Impact of Lung DIsease on the Patient 326 Physical Examination
327 Clinicopathologic Correlations 338

, The Heart ..................................... 345 General Considerations 345
Structure and Physiology 346 Review of Specific Symptoms 354
Impact of Cardiac Disease on the Patient 362 Physical Examination
362 Clinicopathologic Correlations 382

The Peripheral Vascular System .................................... 391 General
Considerations 391 Structure and Physiology 392 Review of Specific
Symptoms 392 Impact of Vascular Disease on the Patient 394
Physical Examination 394 Clinicopathologic Correlations 402

The Breast .................................... 407 General Considerations 407
Structure and Physiology 408 Review of Specific Symptoms 411
Impact of Breast Disease on the Patient 414 Physical Examination
415 Clinicopathologic Correlations 424

The Abdomen ............................... 427

Structure and Physiology 427 Review of Specific Symptoms 430
Impact of Inflammatory Bowel Disease on the Patient 436 Physical
Examination 437 Clinicopathologic Correlations 458

Male Genitalia and Hernias ......... 461 General Considerations 461
Structure and Physiology 462 Review of Specific Symptoms 467
Impact of Erectile Dysfunction on the Patient 474 Physical
Examination 475 Clinicopathologic Correlations 486

CHAPTER 18

CHAPTER 19

CHAPTER 20

CHAPTER 21

Female Genitalia .......................... 495 General Considerations 495
Structure and Physiology 496 Review of Specific Symptoms 501
Impact of Infertility on the Patient 507 Physical Examination 508
Clinicopathologic Correlations 522

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