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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_2853_Библиотеки_им_академика_М_И_Перельмана
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13. Allergies and Medication Intolerances 24
14. Preventive Care Services 24
15. Advance Directives 24
16. Physical Examination 25
17 Laboratory 25
18. Assessment 25
19. The Plan 26
C.
The Oral Presentation 26
D. Other Clinical Notes 26
1. Inpatient Progress Notes 26
2. Discharge Summary 26
3. Clinic Notes 27
3. PHYSICAL EXAMINATION 28
A. Methods for Physical Examination 28
1. Inspection 28
2. Palpation 29
3. Percussion 30
4. Auscultation 32
B. The Screening Physical Examination 33
1. Preparing the Screening Examination 33
2. Performing the Screening Examination 34
C. Ultrasound in Bedside Diagnosis 38
1. Technical Considerations 38
2. Scope of Ultrasound in Diagnostic Examination 40
PART 2
THE DIAGNOSTIC EXAMINATION
The Diagnostic Examination: Chapters 4 to 15 44
4. VITAL SIGNS, ANTHROPOMETRIC DATA, AND PAIN 45
A. Vital Signs 45
1. Body Temperature 45
2. The Pulse: Rate, Volume, and Rhythm 53
3. Respiratory Rate and Pattern 61
4. Blood Pressure (BP) and Pulse Pressure 63
B. Anthropometric Data 69
1. Height 69
2. Weight 70
C. Pain 74
1. Diagnostic Attributes of Pain, PQRST 74
2. Pain Syndromes 75
D. Clinical Vignettes and Questions 76
5. NONREGIONAL SYSTEMS AND DISEASES 78
A. Constitutional Symptoms 78
1. Fatigue 78
2. Appetite Disturbance 79
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3. Thirst Disturbance 80
4. Constitutional Syndromes and Diseases 80
B.
The Immune System 81
1. Common Immunodeciency Syndromes 81
C.
The Lymphatic System 82
1. Lymph Node Examination 82
2. Diseases and Syndromes of Lymphocytes,
Lymph Nodes, and Plasma Cells
3. B-cell and plasma cell disorders 86
4. Diseases and Syndromes of Specic Regional
Lymph Nodes 87
D. The Hematopoietic System and Hemostasis 90
1. Red Blood Cell (RBC, Erythrocyte) Disorders 91
2. Neutrophil Disorders 92
3. Myeloproliferative Disorders and Acute Leukemia 93
4. Platelet Disorders 93
5. Coagulation Disorders 94
E. The Endocrine System 95
1. Diabetes and Hypoglycemia 95
2. Disorders of Thyroid Function 96
3. Adrenal Disorders 98
4. Disorders of Parathyroid Function 99
5. Disorders of Pituitary Function 100
F. Clinical Vignettes and Questions 101
6. THE SKIN AND NAILS 103
A. Physiology of the Skin and Nails 103
B. Functional Anatomy of the Skin and Nails 103
1. Skin Layers 103
2. Skin Associated Structures 104
C. Examining the Skin and Nails 107
1. Evaluating Skin Turgor and Elasticity 107
2. Examining Nailfold Capillaries 107
D. Supplemental Aids to Dermatologic Diagnosis 108
1. Magnication 108
2. Diascopy 108
3. KOH Preparation 108
4. Tzanck Smear 109
5. Wood Light 109
6. Skin Biopsy 109
E. Skin and Nail Symptoms 109
1. Itching (Pruritus) 109
F. Skin and Nail Signs 109
1. Distribution of Lesions 109
2. Pattern of Lesions 111
3. Morphology of Individual Lesions 112
4. Generalized Skin Signs 116
5. Changes in Skin Color 118
6. Hair Changes 121
7. Fingernail Signs 121
8. Foot and Toenail Signs 126
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9. Vascular Signs 127
10. Signs of Systemic Lipid Disorders 134
G.
Skin and Nail Syndromes 134
1. Common Skin Disorders 134
2. Skin Infections and Infestations 139
3. Bullous Skin Diseases 146
4. Skin Manifestations of Systemic Diseases 147
5. Vascular Disorders 151
6. Skin Neoplasms 154
H. Clinical Vignettes and Questions 157
7. THE HEAD AND NECK 159
A. Major Systems of the Head and Neck 159
B. Functional Anatomy of the Head and Neck 159
1. The Scalp and Skull 159
2. The Face and Neck 160
3. The Ear 160
4. The Eyes 162
5. The Nose 165
6. Mouth and Oral Cavity 166
7. Larynx 168
8. The Salivary Glands 170
9. The Thyroid Gland 170
C. Physical Examination of the Head and Neck 171
1. Examining the Scalp, Face, and Skull 171
2. Examining the Ears, Hearing, and Labyrinth Function 172
3. Examining the Eyes, Visual Fields, and Visual Acuity 175
4. Examining the Nose and Sinuses 180
5. Examining the Lips, Mouth, Teeth, Tongue, and Pharynx 182
6. Examining the Temporomandibular Joint 184
7. Examining the Larynx 184
8. Examining the Salivary Glands 185
9. Examining the Neck 185
10. Examining the Lymph Nodes 187
11. Examining the Vascular System 187
D. Head and Neck Symptoms 187
1. General Symptom 187
2. Skull, Scalp, and Face Symptoms 187
3. Ear Symptoms 188
4. Eye Symptoms 189
5. Nose Symptoms 189
6. Lip, Mouth, Tongue, Teeth, and Pharynx Symptoms 190
7. Larynx Symptoms 191
8. Salivary Gland Symptoms 191
9. Neck Symptoms 191
E. Head and Neck Signs 192
1. Scalp, Face, Skull, and Jaw Signs 192
2. External Ear Signs 193
3. External Acoustic Meatus Signs 194
4. TM Signs 195
5. Hearing Signs 195
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6. Eye Lid Signs 195
7. Eye Movement Signs 199
8. Conjunctiva Signs 199
9. Cornea Signs 202
10. Sclera Signs 202
11. Pupil Signs 203
12. Lens Signs 203
13. Retina Signs 205
14. Nose and Sinus Signs 217
15. Breath Signs 221
16. Lip Signs 221
17. Oral Mucosa and Palate Signs 223
18. Teeth and Gum Signs 226
19. Tongue Signs 227
20. Pharynx Signs 231
21. Larynx and Trachea Signs 231
22. Salivary Gland Signs 234
23. Neck Signs 235
24. Midline Cervical Mass 236
25. Lateral Cervical Masses 237
26. Thyroid Signs 238
F. Head and Neck Syndromes 239
1. Squamous Cell Cancers of the Head and Neck 239
2. Scalp, Face, Skull, and Jaw Syndromes 240
3. Eye Syndromes 241
4. Ear Syndromes 243
5. Nose and Sinus Syndromes 247
6. Oral Syndromes (Lips, Mouth, Tongue, Teeth,
and Pharynx) 250
7. Larynx Syndromes 252
8. Salivary Gland Syndromes 255
9. Thyroid Syndromes 256
10. Thyroid Goiters and Nodules 256
G. Clinical Vignettes and Questions 260
8. THE CHEST: CHEST WALL, PULMONARY, AND
CARDIOVASCULAR SYSTEMS; THE BREASTS
SECTION 1
Chest Wall, Pulmonary, and Cardiovascular Systems 263
A. Major Systems and Physiology 263
1. The Thoracic Wall 263
2. The Respiratory System 264
3. The Lungs and Pleura 266
4. The Cardiovascular System 268
B.
Supercial Thoracic Anatomy 270
1. The Chest Wall 270
2. The Lungs and Pleura 271
3. The Heart and Precordium 273
C. Physical Exam of The Chest and Major Vessels 273
263
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1. Inspection of the Rib Cage and Thoracic
Musculature
2. Palpating the Rib Cage and Thoracic Musculature 273
3. Examining the Lungs and Pleura 274
4. Examining the Heart and Precordium 280
5. Examining the Blood Vessels 285
6. Examining the Arterial Circulation in the
Extremities
7. Examining Large Limb Veins 292
D. Chest, Cardiovascular, and Respiratory Symptoms 292
1. General Symptoms 292
2. Chest Wall Symptoms 296
3. Lung and Pleura Symptoms 296
4. Cardiovascular Symptoms 297
E. Chest, Trachea, and Respiratory Signs 297
1. Chest Wall Signs 297
2. Trachea Signs 303
3. Lung, Pleura, and Respiratory Signs 303
4. Vibratory Palpation 304
5. Sonorous Percussion 304
6. Auscultating Breath Sounds 305
7. Auscultating Voice Sounds 307
8. Auscultating Abnormal Sounds 307
9. Interpretating Pulmonary and Pleural Signs 307
10. Sputum Signs 313
F. Cardiovascular Signs 313
1. Inspection 314
2. Palpation 314
3. Percussion 317
4. Auscultating Heart Sounds 317
5. Auscultating Extracardiac Sounds 322
6. Auscultating Heart Murmurs 323
7. Systolic Murmurs 323
8. Diastolic Murmurs 331
9. Continuous Murmurs 333
10. Vascular Signs of Cardiac Activity 334
11. Arterial Circulation Signs 338
G. Chest, Cardiovascular, and Respiratory Syndromes 339
1. Chest Wall Syndromes 339
2. Respiratory Syndromes 340
3. Cardiovascular Syndromes 349
4. Other Cardiovascular Syndromes 355
5. Valvular Heart Disease 358
6. Congenital Heart Disease 358
7. Mediastinal Tumors 359
8. Pericardial Syndromes 359
9. Disorders of the Arterial and Venous Circulations. 360
10. Circulatory Disorders in the Head, Neck, and Trunk 365
11. Disorders of Large Limb Arteries 373
12. Disorders of the Major Extremity Veins 377
273
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SECTION 2
The Breasts
H. Breast Physiology 380
I.
Supercial Breasts Anatomy 381
Physical Exam of the Breasts 381
J.
K. Breast Symptoms 383
L. Breast Signs 383
M. Breast Syndromes 386
N. Clinical Vignettes and Questions 390
9. THE ABDOMEN, PERINEUM, ANUS, AND RECTOSIGMOID 393
A. Major Systems and Their Physiology 393
B. Supercial Anatomy of the Abdomen and Perineum 395
C. Physical Exam of the Abdomen 396
D. Abdominal, Perineal, and Anorectal Symptoms 407
380
1. The Female Breast 380
2. The Male Breast 381
1. Breast Examination 382
1. Breast Pain 383
1. Breast Mass 383
2. Breast Tenderness (Mastodynia) 384
3. Breast Cysts 384
4. Supernumerary Nipples (Polythelia)
and Breasts (Polymastia) 385
5. Inverted Nipples 385
6. Nipple Fissures 385
7. Duct Fistula 385
8. Skin or Nipple Retraction 385
9. Nipple Discharge 385
10. Nipple Scaling and Excoriation—Paget Disease 385
11. Areolar Gland Abscess 385
1. The Female Breast 386
2. The Male Breast 389
1. Alimentary System 393
2. Hepatobiliary and Pancreatic System 394
3. Spleen and Lymphatics 394
4. Kidneys, Ureters, and Bladder 395
1. The Abdomen 395
2. The Anus 396
3. The Rectum 396
4. The Sigmoid and Descending Colon 396
1. Inspection 397
2. Auscultation 397
3. Percussion 398
4. Palpation 398
5. Examining the Perineum, Anus, Rectum, and
Distal Colon 405
6. Examining the Rectum 406
7. Examining the Sigmoid Colon 407
1. Nonspecic Symptoms 407
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2. Site-Attributable Symptoms 410
3. Esophagus, Stomach, and Duodenum Symptoms 411
4. Small Intestine and Colon Symptoms 412
5. Pelvic Symptoms 413
E.
Abdominal Signs 414
1. Inspection 414
2. Auscultation 421
3. Percussion 422
4. Palpation 423
F. Perineal, Anal, and Rectal Signs 426
1. Inspection 426
2. Palpation 428
Abdominal, Perineal, and Anorectal
G.
Syndromes 430
1. Hepatobiliary and Pancreatic Syndromes 430
2. Acute Abdominal Pain Syndromes 431
3. Acute Abdominal Pain 433
4. Acute Epigastric Pain 434
5. Acute RUQ Pain 437
6. Acute LUQ Pain 439
7. Acute RLQ Pain 440
8. Acute LLQ Pain 441
9. Acute Suprapubic Pain 441
10. Subacute Abdominal Pain Syndromes 441
11. Chronic and Recurrent Abdominal Pain 442
12. Bloating and Distention Syndromes 444
13. Diarrhea Syndromes 445
14. Constipation Syndromes 451
15. Bowel Obstruction Syndromes 453
16. Abdominal Masses 455
17. Abdominal, Inguinal, and Other Hernias 460
18. Perineal, Anal, and Rectal Syndromes 464
19. Occult GI Blood Loss 464
H. Clinical Vignettes and Questions 466
10. THE URINARY SYSTEM 469
A. Overview and Physiology of the Urinary System 469
B. Urinary System Anatomy 469
Examining the Urinary System 469
C.
D. Urinary System Symptoms 470
E. Urinary System Signs 471
F. Urethral Signs 474
G. Urinary System Syndromes 474
1. Hematuria 474
H. Clinical Vignettes and Questions 480
11. THE FEMALE GENITALIA AND REPRODUCTIVE SYSTEM 483
A. Overview of Female Reproductive Physiology 483
B. Anatomy of the Female Genitalia and
Reproductive System 483
1. The Vulva 483
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2. The Vagina, Uterus, and Adnexa 485
Examing the Female Genitalia and Reproductive System 486
C.
1. The Female Pelvic Examination 486
Female Genital and Reproductive Symptoms 489
D.
1. General Symptoms 489
2. Vulvar and Vaginal Symptoms 490
Female Genital and Reproductive Signs 490
E.
1. Vulvar Signs 490
2. Urethral Meatus Abnormalities 492
3. Vagina Signs 492
4. Cervix Signs 495
5. Uterine Signs 496
6. Adnexal Signs 497
7. Rectal Signs 499
F. Female Genital and Reproductive Syndromes 499
1. Menstrual Disorders 499
2. Ovary Disorders 502
3. Uterine Disorders 503
G. Clinical Vignettes and Questions 504
12. THE MALE GENITALIA AND REPRODUCTIVE SYSTEM 506
A. Overview of Male Reproductive Physiology 506
B. Male Reproductive System Anatomy 506
1. The Penis 506
2. The Scrotum 507
3. Testis, Epididymis, Vas Deferens, and Spermatic Cord 508
4. The Prostate and Seminal Vesicles 508
C. Examining the Male Genitalia and Reproductive System 510
1. Examining the Penis 510
2. Examining the Scrotum 510
3. Examining Scrotal Contents 510
4. Examining for Scrotal Hernia 510
5. Examining the Testes 510
6. Examining the Epididymis 510
7. Examining the Spermatic Cord 511
8. Examining the Male Inguinal Region for Hernia 511
9. Male Rectal Exam 511
Male Genital and Reproductive Symptoms 512
D.
E. Male Genital and Reproductive Signs 513
1. Penis Signs 513
2. Urethral Signs 517
3. Scrotum Signs 518
4. Testis, Epididymis, and Other Intrascrotal Signs 519
5. Prostate and Seminal Vesicle Signs 522
Male Genital and Reproductive Syndromes 522
F.
G. Clinical Vignettes and Questions 525
13. THE SPINE, PELVIS, AND EXTREMITIES 527
A. Major Systems and Their Physiology 527
1. Bones 527
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2. Joints 528
3. Muscles, Tendons, and Bursae 528
B.
Supercial Anatomy of the Spine and Extremities 528
1. The Axial Skeleton—Spine and Pelvis 528
2. Appendicular Skeleton 530
Examining the Spine and Extremities 539
C.
1. Examining the Spine 539
2. Examining the Appendicular Skeleton 542
3. Brief Examination for Skeletal Injuries 555
D. Musculoskeletal and Soft Tissue Symptoms 556
1. Pain 556
E. Musculoskeletal and Soft Tissue Signs 559
1. General Signs 559
2. Thoracolumbar Spine and Pelvis Signs 561
3. Appendicular Skeleton, Joint, Ligament, Tendon,
F. Musculoskeletal and Soft Tissue Syndromes 580
G. Musculoskeletal Trauma Syndromes 609
H. Clinical Vignettes and Questions 620
and Soft-Tissue Signs 564
1. General Syndromes 580
2. Syndromes Primarily Affecting Joints 581
3. Conditions Primarily Affecting Bone 589
4. Neck, Spine, and Pelvis Syndromes 593
5. Upper Extremity Syndromes 597
6. Conditions of the Entire Upper Limb 604
7. Lower Extremity Syndromes 604
8. Muscle Syndromes 607
1. Traumatic Neck Pain 609
2. Traumatic Back Pain 610
3. Traumatic Wrist, Arm, and Shoulder Pain 611
4. Traumatic Hip Pain 614
5. Traumatic Knee Pain 615
6. Traumatic Calf Pain 618
7. Traumatic Anterior Leg Pain 618
8. Traumatic Ankle Pain 618
9. Traumatic Heel Pain 619
14. THE NERVOUS SYSTEM 623
A. Overview of the Nervous System 623
1. Anatomic Organization of the Nervous System 624
2. The Peripheral Nervous System 624
3. Functional Organization of the Nervous System 624
B. The Neurologic Examination 624
1. Mental Status Screening Examination 624
2. Cranial Nerve (CN) Exam 625
3. Motor Examination 632
4. Examining Reexes 633
5. Posture, Balance, and Coordination—
The Cerebellar Exam 639
6. Sensory Examination 642
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7. Testing Higher Integrative Functions 645
8. Testing Specic Peripheral Nerves 646
9. Specic Muscle and Nerve Movements 647
Neurologic Symptoms 651
C.
1. General Symptoms 651
2. Cranial Nerve Symptoms 653
3. Motor Symptoms 654
4. Posture, Balance, and Coordination Symptoms 655
5. Sensory Symptoms 655
D. Neurologic Signs 656
1. Cranial Nerve Signs 656
2. Motor Signs 667
3. Reex Signs 668
E. Posture, Balance, and Coordination Signs 671
1. Cerebellar Signs 671
2. Gait Disorders 672
3. Movement Disorders 673
4. Sensory Signs 675
5. Autonomic Nervous System Signs 676
6. Some Peripheral Nerve Signs 676
F. Neurologic Syndromes 680
1. Recurrent Headache Syndromes 680
2. Intracranial Traction, Displacement, and Inammation
Causing Headache 683
3. Intracranial Bleeding Headaches 684
4. Other Headaches 685
5. Seizures 686
6. Transiently Impaired Consciousness 688
7. Persistently Impaired Consciousness 690
8. Ischemic Cerebrovascular Disease 694
9. Degenerative and Autoimmune CNS Diseases 697
10. CNS Infections 697
11. Spinal Cord Disorders 699
12. Peripheral Neuropathies 700
13. Other Motor and Sensory Syndromes 703
14. Disorders of Language and Speech 704
15. Delirium 705
16. Impaired Cognition Syndromes 706
17. Other Syndromes 707
G. Clinical Vignettes and Questions 710
15. THE MENTAL STATUS, PSYCHIATRIC, AND SOCIAL EVALUATIONS 712
SECTION 1
The Mental Status and Psychiatric Evaluation
A.
The Mental Status Evaluation 713
1. Level of Consciousness (LOC) 713
2. Orientation 713
3. Attention 713
4. Memory 714
5. Thought 715
713
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