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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3067_Библиотеки_им_академика_М_И_Перельмана
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CLINICAL SKILLS
POCKET GUIDE
NET TER’S
This page intentionally left blank
ILENE ROSENBERG, MD, FCCP
Remediation Specialist
Associate Professor
Department of Medical Sciences
Frank H. Netter MD School
of Medicine
Quinnipiac University
Hamden, Connecticut
Internal Medicine of Milford, P.C.
Milford, Connecticut
TODD CASSESE, MD, FACP
Director, Clinical Arts and
Sciences Course
Associate Professor
Department of Medical Sciences
Frank H. Netter MD School
of Medicine
Quinnipiac University
Hamden, Connecticut
Illustrated by
DENNIS BARBON, RN
MD Candidate Class of 2019
Frank H. Netter MD School
of Medicine
Quinnipiac University
Hamden, Connecticut
Additional Illustrations by
Frank H. Netter, MD
Carlos A.G. Machado, MD
Kristen Wienandt Marzejon,
MS, MFA
CLINICAL SKILLS
POCKET GUIDE
NET TER’S
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
NETTER’S CLINICAL SKILLS POCKET GUIDE ISBN: 978-0-323-55164-9
Copyright © 2019 by Elsevier, Inc. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by any means,
electronic or mechanical, including photocopying, recording, or any information storage and
retrieval system, without permission in writing from the publisher. Details on how to seek
permission, further information about the Publisher’s permissions policies and our arrangements
with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency,
can be found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the
Publisher (other than as may be noted herein).
Notices
Knowledge and best practice in this field are constantly changing. As new research and
experience broaden our understanding, changes in research methods, professional practices,
or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in
evaluating and using any information, methods, compounds, or experiments described
herein. In using such information or methods they should be mindful of their own safety and
the safety of others, including parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to
check the most current information provided (i) on procedures featured or (ii) by the
manufacturer of each product to be administered, to verify the recommended dose or
formula, the method and duration of administration, and contraindications. It is the
responsibility of practitioners, relying on their own experience and knowledge of their
patients, to make diagnoses, to determine dosages and the best treatment for each
individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or
editors, assume any liability for any injury and/or damage to persons or property as a matter
of products liability, negligence or otherwise, or from any use or operation of any methods,
products, instructions, or ideas contained in the material herein.
International Standard Book Number: 978-0-323-55164-9
Executive Content Strategist: Elyse O’Grady
Senior Content Development Specialist: Marybeth Thiel
Publishing Services Manager: Patricia Tannian
Senior Project Manager: Amanda Mincher
Design Direction: Patrick Ferguson
Printed in China
Last digit is the print number: 9 8 7 6 5 4 3 2 1
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vv
ABOUT THE AUTHORS
Ilene Rosenberg, MD, FCCP, is Associate Professor of medical
sciences at the Frank H. Netter MD School of Medicine at Quinnipiac
University, where she serves as Clinical Skills Remediation Specialist.
Dr. Rosenberg is also in private practice as a pulmonologist and internist
at Internal Medicine of Milford, P.C.
Todd Cassese, MD, FACP, is Associate Professor of medical sciences
at the Frank H. Netter MD School of Medicine at Quinnipiac University,
where he serves as the Director of the Clinical Arts and Sciences course.
Dr. Cassese works clinically as a hospitalist at Yale New Haven Hospital.
He is the President Elect of the Directors of Clinical Skills Courses (DOCS)
national organization that focuses on promoting the careers of clinical skills
course directors and teachers.
Dennis Barbon, RN, is a second-year medical student at the Frank H.
Netter MD School of Medicine at Quinnipiac University. Mr. Barbon has
studied fine arts for many years and uses his art skills to educate peers
and patients.
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vivi
PREFACE
The aim of this booklet is to provide a guide for the collective clinical skills
learned early in medical school and practiced over a lifetime. These are
skills that you should know and be able to draw on from your “toolbox”
when called for in practice. There are scattered “hints” along the way to
help jog your memory. We have shown both basic (core) and systems-
focused (full) exams throughout the booklet. The skills for the full exams
are used when a problem in that organ is suspected. This booklet helps
refresh these exams easily for the reader.
As in most aspects of medicine, there are a number of ways to perform
certain skills. This guide uses methods taught in the Foundations of Clinical
Care curriculum at the Frank H. Netter MD School of Medicine at Quinnipiac
University.
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viivii
ACKNOWLEDGMENTS
Special thanks:
• Benjamin D. Brink, a third-year medical student at the Frank H. Netter
MD School of Medicine at Quinnipiac University, for his help with
developing the idea and formatting the guide.
• Dr. Ramon Gonzalez for his radiographs and expertise.
• Dr. Joel Morgenstern for his meticulous editing and exceptional input.
• Dr. Tom Murray for his excellent insight and editing.
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viiiviii
ABOUT FRANK H. NETTER, MD
Frank H. Netter was born in New York City in 1906. He studied art at the
Art Students League and the National Academy of Design before entering
medical school at New York University, where he received his Doctor of
Medicine degree in 1931. During his student years, Dr. Netter’s notebook
sketches attracted the attention of the medical faculty and other physicians,
allowing him to augment his income by illustrating articles and textbooks.
He continued illustrating as a sideline after establishing a surgical practice
in 1933, but he ultimately opted to give up his practice in favor of a
full-time commitment to art. After service in the United States Army during
World War II, Dr. Netter began his long collaboration with the CIBA
Pharmaceutical Company (now Novartis Pharmaceuticals). This 45-year
partnership resulted in the production of the extraordinary collection of
medical art so familiar to physicians and other medical professionals
worldwide.
Icon Learning Systems acquired the Netter Collection in July 2000 and
continued to update Dr. Netter’s original paintings and to add newly
commissioned paintings by artists trained in the style of Dr. Netter. In 2005,
Elsevier Inc. purchased the Netter Collection and all publications from Icon
Learning Systems. There are now over 50 publications featuring the art of
Dr. Netter available through Elsevier Inc.
Dr. Netter’s works are among the finest examples of the use of
illustration in the teaching of medical concepts. The 13-book Netter
Collection of Medical Illustrations, which includes the greater part of the
more than 20,000 paintings created by Dr. Netter, became and remains one
of the most famous medical works ever published. The Netter Atlas of
Human Anatomy, first published in 1989, presents the anatomic paintings
from the Netter Collection. Now translated into 16 languages, it is the
anatomy atlas of choice among medical and health professions students the
world over.
The Netter illustrations are appreciated not only for their aesthetic
qualities, but, more importantly, for their intellectual content. As Dr. Netter
wrote in 1949, “clarification of a subject is the aim and goal of illustration.
No matter how beautifully painted, how delicately and subtly rendered a
subject may be, it is of little value as a medical illustration if it does not
serve to make clear some medical point.” Dr. Netter’s planning, conception,
point of view, and approach are what inform his paintings and what make
them so intellectually valuable.
Frank H. Netter, MD, physician and artist, died in 1991.
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ixix
CONTENTS
Introduction
1 History and Communication 1
2 Review of Systems 2
3 Core Physical Exam 5
Special Senses
4 HEENT 6
5 Neck 7
6 Eyes 8
Integumentary
7 Skin 9
Neurological
8 Neurological 13
9 Dermatomes 15
Cardiovascular
10 Vascular 17
11 Cardiac 18
Pulmonary
12 Pulmonary 19
Digestive
13 Abdomen 21
14 Advanced Abdomen 23
Musculoskeletal
15 Spine 25
16 Upper Musculoskeletal 27
17 Lower Musculoskeletal 29
18 Advanced Shoulder 31
19 Advanced Elbow 35
20 Advanced Wrist 36
21 Advanced Lower Back 37
22 Advanced Hip 38
23 Advanced Knee 39
Reproductive/Urinary
24 Male Genitourinary 41
25 Female Genitourinary 42
26 Breast 43
27 Rectal 44
Procedures and Testing
28 Procedures 45
29 Electrocardiogram
Interpretation 47
30 Chest Radiograph 53
Putting it All Together
31 Screening Physical 57
32 Write Up 59
References 61
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