The 10-Minute Clinical Assessment (eBook)

Knut Schroeder (Autor)

eBook Download: PDF

2016 | 2. Auflage
John Wiley & Sons (Verlag)
978-1-119-10636-4 (ISBN)

Infos

THE 10-MINUTE CLINICAL ASSESSMENT

Clinical assessment is at the heart of medicine. Health professionals working in busy clinical settings, such as general practitioners, nurse practitioners and hospital doctors on-call, often have to assess patients under considerable time constraints. This book teaches the reader how to gather clinical information effectively, accurately and safely even when time is at a premium. Using a focused and evidence-based approach, it provides step-by-step assessment strategies for common and important clinical scenarios, particularly those that require 'lateral'and holistic thinking, such as falls in the elderly, weight loss, 'tired all the time'and assessment of diabetic or homeless people.

This second edition of The 10-Minute Clinical Assessment is fully updated in line with the latest guidelines and includes brand new general chapters on focused clinical assessment, red flags, and useful consultation tools. It covers a wide range of common and important topics, including cardiovascular, respiratory, haematology, musculoskeletal, neurology, mental health, gynaecology, obstetrics, urology, ophthalmology and ear, nose and throat. This new edition also includes sectionson undifferentiated and miscellaneous presentations, on paediatrics and adolescent health; and on problems in older people. Each of the individual disease sections is uniformly structured to provide rapid reference, including:

• Key features of the history, including questions relevant to patientsand important for making a diagnosis
• Common patient ideas, concerns and expectations
• The 'value' of present or absent symptoms for diagnosis and prognosis
• What should be examined, and why
• A summary of 'red flags' - issues that must be assessed
• Important differential diagnoses and their clinical features
• Useful tips, tricks and hints for effective patient assessment

Written by an experienced medical educator and practicing GP, in consultation with a multidisciplinary team of medical students, GPs, PG trainees, hospital doctors and nurses, this title specifically covers the clinical skills assessment (CSA) part of the Membership of the Royal College of General Practitioners (RCGP) examination.

New to this edition is a refreshed approach to the methodology employed inclinical assessment, to reflect recent trends in the teaching of clinical assessment. This edition also includes the latest evidence-based recommendations (including the latest NICE guidelines) and recent developments in order to provide the reader with a concise yet comprehensive resource for clinical reference.

Knut Schroeder MD, MSc, DRCOG, DCH, MRCGP, MRCP, PhD
General Practitioner, Bristol, UK; and Honorary Senior Clinical Lecturer in General Practice, Centre for Academic Primary Care, University of Bristol, Bristol, UK
Knut Schroeder holds a Certificate in Medical Education and developed undergraduate and postgraduate courses on clinical diagnosis and evidence based medicine. While a full-time Consultant Senior Lecturer, he was responsible for developing and running the general practice part of the final examination for medical students at the University of Bristol.
In addition to the first edition of The 10-Minute Clinical Assessment, Dr Schroeder has previously written for GP registrars (Top Tips for GPs, Radcliffe Medical Press, 2000) and co-written numerous book chapters, including two chapters for the Oxford Textbook of Primary Medical Care and a chapter on symptoms and signs for the Oxford Handbook of General Practice (3rd ed). He has had papers published in international peer-reviewed journals including the BMJ, Family Practice, and Archives of Internal Medicine, as well as articles in the GP press. His main clinical and teaching interest is clinical assessment and diagnosis.

Inhalt

The 10-Minute Clinical Assessment 3
Table of contents 8
Foreword 13
Preface to the 1st edition 14
Preface to 2nd edition 16
About the author 17
Acknowledgements 18
Selected useful resources 19
1 The focused consultation 21
Focused clinical assessment 23
Key issues 23
Practical points 23
Structuring the consultation 23
Preparation 23
History 23
Examination 24
The diagnostic process 24
Consider ‘early triggers’ in the consultation 24
Strategies for narrowing down the possibilities 25
Consider other strategies 25
Writing useful case notes 25
Summary of main principles 26
Key references and further reading 27
Useful consultation tools 28
Key thoughts 28
Practical points 28
History-taking 28
Introducing yourself 28
Opening the consultation 28
History of the presenting complaint 29
Ideas, concerns and expectations 30
Asking direct or sensitive questions 30
Key references and further reading 31
Red flags in general practice 32
Key thoughts 32
Practical points 32
Red flags in context 32
Spotting and interpreting red flags 32
The role of red flags 32
Reasons for missing red flags 33
Useful techniques for identifying red flags 33
Key references and further reading 33
2 Undifferentiated and miscellaneous presentations 35
Suspected cancer 37
Key thoughts 37
Practical points 37
History 37
Ideas, concerns and expectations 37
History of presenting complaint 37
Nonspecific symptoms 38
Risk factors for cancer 38
Lung cancer 38
Upper gastrointestinal cancer 38
Lower gastrointestinal cancer 39
Breast cancer 39
Gynaecological cancer 39
Urological cancer 39
Haematological cancer 40
Skin cancer 40
Head and neck cancer 40
Brain tumour 40
Features suggestive of metastasis 41
Social history 41
Review of previous investigations 41
Examination 41
General 41
Vital signs 42
Skin 42
Head and neck 42
Chest 42
Abdomen 42
Vaginal examination in women with symptoms suggestive of cancer 42
Lower limbs 43
Key references and further reading 43
Weight loss 44
Key thoughts 44
Practical points 44
Possible causes 44
History 45
Ideas, concerns and expectations 45
History of presenting complaint 45
Past and current medical problems 46
Medication 46
Social history 46
Alcohol, smoking and ‘recreational drugs’ 46
Review of previous investigations 46
Examination 47
General 47
Vital signs 47
Skin 47
Head and neck 47
Upper and lower limbs 47
Chest 47
Abdomen 47
Bedside tests 47
Key references and further reading 48
Tiredness 49
Key thoughts 49
Practical points 49
Possible causes 49
History 50
Ideas, concerns and expectations 50
History of presenting complaint 50
Past and current medical problems 51
Medication 51
Family history 51
Social history 51
Alcohol, smoking and recreational drugs 51
Review of previous investigations 51
Examination 52
General 52
Vital signs 52
Skin 52
Head and neck 53
Chest 53
Abdomen 53
Lower limbs 53
Bedside tests 53
Key references and further reading 53
Dizziness 55
Key thoughts 55
Practical points 55
Possible causes 55
History 56
Ideas, concerns and expectations 56
Common presenting symptoms 56
History of presenting complaint 56
Past and current medical problems 57
Medication 57
Other treatments 58
Social history 58
Alcohol, smoking and recreational drugs 58
Review of previous investigations 58
Examination 58
General 58
Vital signs 59
Cerebellar function and balance 59
Head and neck 59
Chest 60
Limbs 60
Bedside tests 60
Key references and further reading 60
Chronic pain 61
Key thoughts 61
Practical points 61
Possible causes 61
History 61
Ideas, concerns and expectations 61
History of presenting complaint 62
Impact on the quality of life 62
Past and current medical problems 62
Medication 62
Other treatments 63
Allergies 63
Social history 63
Review of previous investigations 63
Examination 63
General 63
Vital signs 63
Skin 63
Head and neck 63
Other systems, as guided by the history 64
Key references and further reading 64
Sudden collapse and syncope 65
Key thoughts 65
Practical points 65
Possible causes 65
History 65
Ideas, concerns and expectations 65
History of presenting complaint 66
Past and current medical problems 67
Medication 67
Other treatments 67
Allergies 67
Social history 67
Alcohol and recreational drugs 67
Examination 67
General assessment 67
Vital signs 68
Skin 68
Head and neck 68
Upper limbs 68
Chest 68
Abdominal examination 69
Lower limbs 69
Bedside tests 69
Key references and further reading 69
Frequent attenders 70
Key thoughts 70
Practical points 70
Possible causes 70
History 70
Ideas, concerns and expectations 70
History of presenting complaint 71
Review of previous investigations 71
Past and current medical problems 72
Medication 72
Other treatments 72
Family history 72
Social history 72
Alcohol, smoking and recreational drugs 72
Examination 72
General 72
Vital signs 73
Skin 73
Chest 73
Abdomen 73
Bedside tests 73
Key references and further reading 73
Medication review and polypharmacy 74
Key thoughts 74
Practical points 74
History 74
Ideas, concerns and expectations 74
Medication review 75
Past and current medical problems 76
Examination 76
General 76
Key references and further reading 76
Medically unexplained symptoms 78
Key thoughts 78
Practical points 78
Possible causes 78
History 78
Ideas, concerns and expectations 78
History of presenting complaint 79
Systems review 79
Past and current medical problems 80
Medication 80
Family history 80
Social history 80
Alcohol, smoking and recreational drugs 80
Review of previous investigations 80
Examination 81
General 81
Vital signs 81
Skin 81
Head and neck 81
Chest 81
Abdomen 81
Spine and limbs 81
Bedside tests 82
Key references and further reading 82
Insomnia 83
Key thoughts 83
Practical points 83
Possible causes 83
History 83
Ideas, concerns and expectations 83
History of presenting complaint 84
Past and current medical problems 84
Medication 85
Other treatments 85
Social history 85
Alcohol, smoking and recreational drugs 85
Review of previous investigations 85
Examination 85
General 85
Vital signs 86
Skin 86
Chest 86
Abdomen 86
Limbs 86
Key references and further reading 86
Irritability and ‘stress’ 87
Key thoughts 87
Practical points 87
Possible causes 87
History 87
Ideas, concerns and expectations 87
History of presenting complaint 88
Past and current medical problems 88
Medication 89
Social history 89
Review of previous investigations 89
Examination 89
General 89
Vital signs 89
Chest 90
Key references and further reading 90
Domestic violence 91
Key thoughts 91
Practical points 91
Differential diagnosis 91
Associated conditions 91
Important risk factors 91
History 92
Ideas, concerns and expectations 92
History of presenting complaint 92
Past and current medical problems 93
Social history 93
Alcohol and drugs 93
Examination 93
General 93
Skin 94
Key references and further reading 94
Homelessness 95
Key thoughts 95
Practical points 95
Associated conditions 95
History 95
Ideas, concerns and expectations 95
History of presenting complaint 96
Systems review 97
Past and current medical problems 97
Medication 97
Family history 97
Social history 97
Smoking 98
Review of previous investigations 98
Examination 98
General 98
Vital signs 98
Skin 98
Head and neck 98
Chest 98
Abdomen 99
Lower limbs 99
Key references and further reading 99
3 Paediatrics and adolescent health 101
The sick and/or feverish child 103
Key thoughts 103
Practical points 103
Possible causes 103
History 104
Ideas, concerns and expectations 104
History of presenting complaint 104
Past and current medical problems 105
Medication 106
Allergies 106
Family history 106
Social history 106
Review of previous investigations 106
Examination 106
General 106
Vital signs 107
Skin 108
Head and neck 108
Chest 108
Abdomen 109
Upper and lower limbs 109
Bedside tests 109
Key references and further reading 109
Suspected meningococcal meningitis and septicaemia 110
Key thoughts 110
Practical points 110
Differential diagnosis 110
Important risk factors 110
History 111
Ideas, concerns and expectations 111
History of presenting complaint 111
Common presenting patterns 111
Allergies 112
Examination 112
General 112
Vital signs 112
Skin 113
Head and neck 113
Upper and lower limbs 113
Chest 113
Bedside tests 113
Key references and further reading 113
Neonatal jaundice 115
Key thoughts 115
Practical points 115
Possible causes 115
History 115
Ideas, concerns and expectations 115
History of presenting complaint 116
Family history 116
Social history 116
Review of previous investigations 117
Examination 117
General 117
Vital signs 117
Skin 117
Head and neck 117
Chest 117
Abdomen 117
Bedside tests 118
Key references and further reading 118
Faltering growth 119
Key thoughts 119
Practical points 119
Possible causes 119
History 120
Ideas, concerns and expectations 120
History of presenting complaint 120
Past and current medical problems 121
Medication 121
Other treatments 121
Social history 121
Review of previous investigations 121
Examination 122
General 122
Weight and height 122
Abdomen 122
Key references and further reading 122
Headache and migraine in children 124
Key thoughts 124
Practical points 124
Possible causes 124
History 124
Ideas, concerns and expectations 124
History of presenting complaint 125
Past and current medical problems 125
Medication 126
Allergies 126
Family history 126
Social history 126
Review of previous investigations 126
Examination 126
General 126
Vital signs 126
Skin 127
Head and neck 127
Chest 127
Limbs 127
Key references and further reading 127
Head injury in children 128
Key thoughts 128
Practical points 128
History 128
Ideas, concerns and expectations 128
History of presenting complaint 128
Past and current medical problems 129
Medication 129
Allergies 129
Social history 130
Alcohol, smoking and recreational drugs 130
Examination 130
General 130
Vital signs 130
Head and neck 130
Skin 131
Upper and lower limbs 131
Chest 131
Abdomen 131
Bedside tests 131
Regular observation 131
Key references and further reading 132
Suspected cancer in children and adolescents 133
Key thoughts 133
Practical points 133
Important cancers in children and adolescents 133
History 133
Ideas, concerns and expectations 133
History of presenting complaint 134
Past and current medical problems 135
Medication 135
Allergies 135
Family history 135
Social history 135
Review of previous investigations 136
Examination 136
General 136
Skin 136
Head and neck 136
Abdomen 136
Limbs 137
Key references and further reading 137
Abdominal pain in children 138
Key thoughts 138
Practical points 138
Possible causes in infants 138
Possible causes in older children 138
Additional possible causes in adolescents 138
History 139
Ideas, concerns and expectations 139
History of presenting complaint 139
Past and current medical problems 141
Medication 141
Allergies 141
Family history 141
Social history 141
Alcohol and recreational drugs 142
Review of previous investigations 142
Examination 142
General 142
Vital signs 142
Abdomen 142
Lower limbs 143
Bedside tests 143
Key references and further reading 143
Hearing loss in children 144
Key thoughts 144
Practical points 144
Possible causes 144
History 144
Ideas, concerns and expectations 144
History of presenting complaint 145
Past and current medical problems 145
Medication 145
Family history 145
Social history 146
Previous investigations 146
Examination 146
General 146
Vital signs 146
Head and neck 146
Hearing 147
Key references and further reading 147
Childhood cough 148
Key thoughts 148
Practical points 148
Possible causes 148
History 148
Ideas, concerns and expectations 148
History of presenting complaint 149
Past and current medical problems 150
Medication and other treatment 150
Family history 150
Allergies 150
Social history 150
Review of previous investigations 150
Examination 151
General 151
Vital signs 151
Head and neck 151
Chest 151
Bedside tests 151
Key references and further reading 151
Childhood wheeze 153
Key thoughts 153
Practical points 153
Possible causes 153
History 153
Ideas, concerns and expectations 153
History of presenting complaint 154
Important underlying conditions 154
Past and current medical problems 155
Medication 155
Family history 155
Social history 155
Review of previous investigations 156
Examination 156
General 156
Vital signs 156
Skin 156
Head and neck 156
Chest 157
Bedside tests 157
Key references and further reading 157
Constipation in children 158
Key thoughts 158
Practical points 158
Possible causes 158
History 158
Ideas, concerns and expectations 158
History of presenting complaint 159
Past and current medical problems 160
Medication 160
Family history 160
Social history 160
Review of previous investigations 160
Examination 160
General 160
Abdomen 161
Lower limbs and spine 161
Key references and further reading 161
Childhood obesity 162
Key thoughts 162
Practical points 162
Possible causes 162
History 162
Ideas, concerns and expectations 162
History of presenting complaint 163
Past and current medical problems 164
Medication 164
Family history 164
Social history 165
Alcohol, smoking and recreational drugs 165
Review of previous investigations 165
Examination 165
General 165
Vital signs 166
Skin 166
Head and neck 166
Abdomen 166
Lower limbs 166
Bedside tests 166
Key references and further reading 167
Suspected child abuse and neglect 168
Key thoughts 168
Practical points 168
Forms of child abuse 168
Risk factors 168
Differential diagnosis 168
History 169
Ideas, concerns and expectations 169
History of presenting complaint 169
Common forms of abuse 169
Past and current medical problems 170
Examination 171
General 171
Skin 171
Head and neck 171
Abdomen 172
Key references and further reading 172
Nocturnal enuresis 173
Key thoughts 173
Practical points 173
Possible causes 173
History 173
Ideas, concerns and expectations 173
History of presenting complaint 174
Common symptom patterns 174
Medication 175
Other treatments 175
Family history 175
Social history 175
Review of previous investigations 175
Examination 175
General 175
Vital signs 176
Abdomen 176
Spine 176
Lower limbs 176
Bedside tests 176
Key references and further reading 176
Knee problems in children 178
Key thoughts 178
Practical points 178
Possible causes 178
History 178
Ideas, concerns and expectations 178
History of presenting complaint 179
Common symptom patterns 180
Past and current medical problems 180
Medication 180
Allergies 180
Other treatments 181
Social history 181
Review of investigations 181
Examination 181
General 181
Vital signs 181
Knee examination 181
Key references and further reading 182
Hip problems in children 183
Key thoughts 183
Practical points 183
Possible causes 183
History 183
Ideas, concerns and expectations 183
History of presenting complaint 184
Common symptom patterns 184
Past and current medical problems 184
Medication 185
Allergies 185
Other treatments 185
Social history 185
Review of investigations 185
Examination 185
General 185
Vital signs 185
Hip examination 186
Abdomen 186
Key references and further reading 186
Adolescent health problems 187
Key thoughts 187
Practical points 187
Potential health risks and problems 187
History 187
Ideas, concerns and expectations 187
History of presenting complaint 188
Past and current medical problems 189
Medication 189
Social history 189
Examination 189
General 189
Skin 190
Key references and further reading 190
Self-harm in teenagers 191
Key thoughts 191
Practical points 191
Forms of self-harm 191
History 191
Ideas, concerns and expectations 191
History of presenting complaint 192
Suicide risk and red flags 192
Past and current medical problems 193
Medication 193
Social history 193
Alcohol and drugs 193
Examination 193
General 193
Vital signs 194
Ensure physical safety 194
Neurology 194
Key references and further reading 194
Eating disorders 195
Key thoughts 195
Practical points 195
Types of eating disorders 195
Important risk factors 195
Potential complications of anorexia nervosa 195
History 196
Ideas, concerns and expectations 196
History of presenting complaint 196
Past and current medical problems 197
Medication 197
Social history 198
Alcohol and drugs 198
Review of previous investigations 198
Examination 198
General 198
Vital signs 198
Nutrition 199
Skin 199
Head and neck 199
Key references and further reading 199
Autism-spectrum disorder 200
Key thoughts 200
Practical points 200
Differential diagnosis 200
History 200
Ideas, concerns and expectations 200
History of presenting complaint 201
Past and current medical problems 201
Family history 202
Social history 202
Examination 202
General 202
Response in toddlers 202
Key references and further reading 202
4 Cardiovascular 203
Chest pain 205
Key thoughts 205
Practical points 205
Possible causes 205
Risk factors 205
History 206
Ideas, concerns and expectations 206
History of presenting complaint 206
Past and current medical problems 207
Medication 207
Allergies 208
Family history 208
Social history 208
Alcohol, smoking and recreational drugs 208
Review of previous investigations 208
Examination 209
General 209
Vital signs 209
Head and neck 209
Upper limbs 209
Chest 209
Abdomen 210
Lower limbs 210
Key references and further reading 210
Palpitations 211
Key thoughts 211
Practical points 211
Differential diagnosis 211
Important risk factors 211
History 212
Ideas, concerns and expectations 212
History of presenting complaint 212
Past and current medical problems 212
Medication 213
Family history 213
Social history 213
Alcohol, smoking and recreational drugs 213
Review of previous investigations 213
Examination 213
General 213
Vital signs 214
Chest 214
Legs 214
Key references and further reading 214
Cardiovascular risk assessment 215
Key thoughts 215
Challenges in assessment 215
Risk factors used in the calculation of CHD and CVD risk 215
Groups of people in whom the use of charts is inappropriate (i.e. already high risk) 215
Situations in which risk-assessment tools are likely to underestimate risk 215
Selected risk assessment tools 216
History 216
Ideas, concerns and expectations 216
History of presenting complaint 216
Past and current medical problems 217
Medication 217
Family history 217
Alcohol, smoking and recreational drugs 217
Review of previous investigations 218
Examination 218
General 218
Vital signs 218
Chest 218
Bedside tests 218
Key references and further reading 218
Hypertension 220
Key thoughts 220
Practical points 220
Differential diagnosis 220
Risk factors 220
History 221
Ideas, concerns and expectations 221
History of presenting complaint 221
Past and current medical problems 222
Medication 222
Family history 222
Alcohol, smoking and recreational drugs 222
Review of previous investigations 223
Examination 223
General 223
Vital signs 223
Skin 223
Head and neck 223
Chest 223
Abdomen 224
Lower limbs 224
Bedside tests 224
Key references and further reading 224
Atrial fibrillation 225
Key thoughts 225
Practical points 225
Possible causes 225
History 225
Ideas, concerns and expectations 225
History of presenting complaint 226
Past and current medical problems 227
Medication 227
Social history 227
Alcohol, smoking and recreational drugs 227
Review of previous investigations 227
Examination 228
General 228
Vital signs 228
Head and neck 228
Chest 228
Lower limbs 228
Key references and further reading 228
Heart failure 229
Key thoughts 229
Practical points 229
Possible causes 229
History 230
Ideas, concerns and expectations 230
History of presenting complaint 230
Past and current medical problems 231
Medication 231
Social history 232
Alcohol, smoking and recreational drugs 232
Review of previous investigations 232
Examination 232
General 232
Vital signs 233
Head and neck 233
Chest 233
Abdomen and back 233
Lower limbs 233
Bedside tests 233
Key references and further reading 233
Peripheral vascular disease 235
Key thoughts 235
Practical points 235
Differential diagnosis 235
Risk factors 235
History 236
Ideas, concerns and expectations 236
History of presenting complaint 236
Past and current medical problems 237
Medication 237
Allergies 237
Social history 237
Alcohol, smoking and recreational drugs 237
Review of previous investigations 238
Examination 238
General 238
Vital signs 238
Abdomen 238
Lower limbs 238
Bedside tests 239
Key references and further reading 239
5 Respiratory 241
Shortness of breath 243
Key thoughts 243
Practical points 243
Possible causes 243
Important risk factors 243
History 244
Ideas, concerns and expectations 244
History of presenting complaint 244
Past and current medical problems 245
Medication 245
Allergies 245
Social history 245
Alcohol, smoking and recreational drugs 245
Review of previous investigations 245
Examination 246
General 246
Vital signs 246
Skin 246
Head and neck 246
Upper limbs 246
Chest 247
Abdomen 247
Lower limbs 247
Bedside tests 247
Key references and further reading 247
Haemoptysis 248
Key thoughts 248
Practical points 248
Possible causes 248
Important risk factors 248
History 249
Ideas, concerns and expectations 249
History of presenting complaint 249
Past and current medical problems 249
Medication 250
Allergies 250
Family history 250
Social history 250
Alcohol, smoking and recreational drugs 250
Review of previous investigations 250
Examination 250
General 250
Vital signs 251
Skin 251
Head and neck 251
Upper limbs 251
Chest 251
Lower limbs 251
Bedside tests 252
Key references and further reading 252
Suspected lung cancer 253
Key thoughts 253
Practical points 253
Differential diagnosis 253
Important risk factors 253
History 254
Ideas, concerns and expectations 254
History of presenting complaint 254
Past and current medical problems 254
Medication 254
Allergies 254
Family history 255
Social history 255
Alcohol, smoking and recreational drugs 255
Review of previous investigations 255
Examination 255
General 255
Vital signs 255
Head and neck 256
Chest 256
Abdomen 256
Upper and lower limbs 256
Key references and further reading 256
Asthma 257
Key thoughts 257
Practical points 257
Differential diagnosis 257
Important risk factors 257
History 258
Ideas, concerns and expectations 258
History of presenting complaint 258
Past and current medical problems 259
Medication 259
Allergies 259
Family history 259
Social history 260
Alcohol, smoking and recreational drugs 260
Review of previous investigations 260
Examination 260
General 260
Vital signs 260
Chest 261
Bedside tests 261
Key references and further reading 261
Chronic obstructive pulmonary disease 262
Key thoughts 262
Practical points 262
Differential diagnosis 262
Important risk factors 262
History 263
Ideas, concerns and expectations 263
History of presenting complaint 263
Past and current medical problems 264
Medication 264
Allergies 264
Family history 264
Social history 264
Alcohol, smoking and recreational drugs 265
Review of previous investigations 265
Examination 266
General 266
Vital signs 266
Skin 266
Head and neck 266
Upper limbs 266
Chest 266
Abdomen 267
Lower limbs 267
Bedside tests 267
Key references and further reading 267
Suspected pneumonia 268
Key thoughts 268
Practical points 268
Differential diagnosis 268
Important risk factors 268
History 269
Ideas, concerns and expectations 269
History of presenting complaint 269
Past and current medical problems 269
Medication 269
Allergies 269
Social history 270
Alcohol, smoking and recreational drugs 270
Review of previous investigations 270
Examination 270
General 270
Vital signs 270
Chest 271
Bedside tests 271
CRB score 271
Key references and further reading 271
Pleural effusion 272
Key thoughts 272
Practical points 272
Possible causes 272
Risk factors 272
History 272
Ideas, concerns and expectations 272
History of presenting complaint 273
Past and current medical problems 273
Medication 273
Allergies 274
Social history 274
Alcohol, smoking and recreational drugs 274
Review of previous investigations 274
Examination 275
General 275
Vital signs 275
Head and neck 275
Upper limbs 275
Chest 275
Abdomen 275
Lower limbs 275
Key references and further reading 275
Pulmonary embolism 276
Key thoughts 276
Practical points 276
Differential diagnosis 276
Important risk factors 276
History 277
Ideas, concerns and expectations 277
History of presenting complaint 277
Past and current medical problems 277
Medication 278
Family history 278
Social history 278
Alcohol, smoking and recreational drugs 278
Review of previous investigations 278
Examination 278
General 278
Vital signs 278
Head and neck 279
Chest 279
Abdomen 279
Lower limbs 279
Bedside tests 279
Key references and further reading 280
6 Endocrine and metabolic 281
Diabetes review 283
Key thoughts 283
Practical points 283
Exacerbating factors 283
Important risk factors 283
History 284
Ideas, concerns and expectations 284
History of presenting complaint 284
Complications of diabetes 284
Past and current medical problems 285
Medication 285
Alcohol, smoking and recreational drugs 285
Review of previous investigations 285
Examination 286
General 286
Vital signs 286
Skin 286
Head and neck 286
Chest 286
Abdomen 286
Lower limbs 286
Bedside tests 286
Key references and further reading 287
Obesity 288
Key thoughts 288
Practical points 288
Possible causes 288
Complications 288
History 288
Ideas, concerns and expectations 288
History of presenting complaint 289
Past and current medical problems 290
Medication 290
Other treatments 290
Family history 290
Social history 290
Alcohol, smoking and recreational drugs 290
Review of previous investigations 291
Examination 291
General 291
Vital signs 291
Skin 291
Head and neck 291
Chest 291
Abdomen 292
Lower limbs 292
Bedside tests 292
Key references and further reading 292
Hirsutism in women 293
Key thoughts 293
Practical points 293
Differential diagnosis 293
History 293
Ideas, concerns and expectations 293
History of presenting complaint 294
Past and current medical problems 294
Medication and other treatments 294
Family history 295
Social history 295
Review of previous investigations 295
Examination 295
General 295
Hair distribution 295
Skin changes 296
Vital signs 296
Abdomen 296
Bedside tests 296
Key references and further reading 296
Hypothyroidism 297
Key thoughts 297
Practical points 297
Possible causes 297
History 297
Ideas, concerns and expectations 297
History of presenting complaint 298
Past and current medical problems 298
Medication 299
Family history 299
Social history 299
Review of previous investigations 299
Examination 299
General 299
Vital signs 299
Skin 299
Head and neck 300
Upper and lower limbs 300
Bedside tests 300
Key references and further reading 300
Hyperthyroidism 301
Key thoughts 301
Practical points 301
Possible causes 301
History 301
Ideas, concerns and expectations 301
History of presenting complaint 302
Past and current medical problems 302
Medication and other treatments 302
Family history 303
Social history 303
Review of previous investigations 303
Examination 303
General 303
Vital signs 303
Skin 303
Head and neck 303
Upper limbs 303
Chest 304
Bedside tests 304
Key references and further reading 304
Hyponatraemia 305
Key thoughts 305
Practical points 305
Differential diagnosis 305
History 305
History of presenting complaint 305
Past and current medical problems 306
Medication 306
Family history 307
Alcohol, smoking and recreational drugs 307
Review of previous investigations 307
Examination 307
General 307
Vital signs 307
Skin 307
Head and neck 308
Chest 308
Abdomen 308
Lower limbs 308
Key references and further reading 308
Hypernatraemia 309
Key thoughts 309
Practical points 309
Possible causes 309
History 309
History of presenting complaint 309
Past and current medical problems 310
Medication 310
Review of previous investigations 310
Examination 310
General 310
Vital signs 311
Chest 311
Upper and lower limbs 311
Key references and further reading 311
Hypokalaemia 312
Key thoughts 312
Practical points 312
Possible causes 312
History 312
History of presenting complaint 312
Past and current medical problems 313
Medication 313
Family history 313
Alcohol, smoking and recreational drugs 314
Review of previous investigations 314
Examination 314
General 314
Vital signs 314
Abdomen 315
Limbs 315
Key references and further reading 315
Hyperkalaemia 316
Key thoughts 316
Practical points 316
Possible causes 316
History 316
History of presenting complaint 316
Past and current medical problems 317
Medication 317
Review of previous investigations 317
Examination 317
General 317
Vital signs 317
Abdomen 318
Bedside tests 318
Key references and further reading 318
Hypocalcaemia 319
Key thoughts 319
Practical points 319
Possible causes 319
History 319
History of presenting complaint 319
Past and current medical problems 320
Medication 320
Review of previous investigations 320
Examination 321
General 321
Vital signs 321
Head and neck 321
Upper limbs 321
Chest 321
Abdomen 321
Key references and further reading 321
Hypercalcaemia 322
Key thoughts 322
Practical points 322
Possible causes 322
History 323
History of presenting complaint 323
Past and current medical problems 323
Medication 323
Family history 324
Review of previous investigations 324
Examination 324
General 324
Vital signs 324
Neck 324
Chest 325
Abdomen 325
Limbs 325
Bedside tests 325
Key references and further reading 325
7 Gastrointestinal 327
Nausea and vomiting 329
Key thoughts 329
Practical points 329
Possible causes 329
History 330
Ideas, concerns and expectations 330
History of presenting complaint 330
Review of previous investigations 330
Past and current medical problems 331
Medication and other treatments 331
Social history 331
Alcohol, smoking and recreational drugs 331
Examination 331
General 331
Vital signs 331
Head and neck 332
Abdomen 332
Bedside tests 332
Key references and further reading 332
Dysphagia 333
Key thoughts 333
Practical points 333
Possible causes 333
History 333
Ideas, concerns and expectations 333
History of presenting complaint 334
Past and current medical problems 334
Medication 334
Other treatments 335
Family history 335
Social history 335
Review of previous investigations 335
Examination 335
General 335
Vital signs 335
Limbs 335
Head and neck 336
Abdomen 336
Chest 336
Neurological 336
Key references and further reading 336
Dyspepsia and reflux 337
Key thoughts 337
Practical points 337
Possible causes 337
History 337
Ideas, concerns and expectations 337
History of presenting complaint 338
Past and current medical problems 338
Medication and other treatments 338
Family history 339
Alcohol, smoking and recreational drugs 339
Review of previous investigations 339
Examination 339
General 339
Vital signs 339
Skin 339
Head and neck 340
Abdomen 340
Chest 340
Key references and further reading 340
Upper gastrointestinal bleeding and melaena 341
Key thoughts 341
Practical points 341
Possible causes 341
Risk factors 341
History 342
Ideas, concerns and expectations 342
History of presenting complaint 342
Past and current medical problems 343
Medication 343
Social history 343
Alcohol, smoking and recreational drugs 343
Review of previous investigations 343
Examination 344
General 344
Vital signs 344
Head and neck 344
Abdomen 344
Key references and further reading 344
Abdominal pain 346
Key thoughts 346
Practical points 346
Possible causes 346
History 347
Ideas, concerns and expectations 347
History of presenting complaint 347
Past and current medical problems 348
Medication 348
Allergies 349
Family history 349
Social history 349
Alcohol, smoking and recreational drugs 349
Review of previous investigations 349
Examination 349
General 349
Vital signs 349
Skin 350
Head and neck 350
Upper limbs 350
Chest 350
Abdomen 350
Lower limbs 351
Bedside tests 351
Key references and further reading 351
Constipation 352
Key thoughts 352
Practical points 352
Possible causes 352
History 353
Ideas, concerns and expectations 353
History of presenting complaint 353
Past and current medical problems 354
Medication 354
Social history 354
Alcohol, smoking and recreational drugs 354
Review of previous investigations 354
Examination 354
General 354
Abdomen 355
Key references and further reading 355
Diarrhoea 356
Key thoughts 356
Practical points 356
Possible causes 356
History 356
Ideas, concerns and expectations 356
History of presenting complaint 357
Past and current medical problems 358
Medication 358
Family history 358
Social history 358
Alcohol, smoking and recreational drugs 358
Review of previous investigations 358
Examination 359
General 359
Vital signs 359
Skin 359
Head and neck 359
Abdomen 359
Bedside tests 359
Key references and further reading 359
Rectal bleeding and suspected bowel cancer 361
Key thoughts 361
Practical points 361
Possible causes 361
Risk factors for bowel cancer 361
History 362
Ideas, concerns and expectations 362
History of presenting complaint 362
Past and current medical problems 363
Medication 363
Other treatments 363
Family history 363
Social history 363
Review of previous investigations 363
Examination 364
General 364
Vital signs 364
Head and neck 364
Upper limbs 364
Chest 364
Abdomen 364
Bedside tests 365
Key references and further reading 365
Abnormal liver function tests 366
Key thoughts 366
Practical points 366
Possible causes 366
Risk factors 366
History 367
Biochemical markers 367
Ideas, concerns and expectations 367
History of presenting complaint 367
Past and current medical problems 368
Medication 368
Review of previous investigations 368
Examination 369
General 369
Skin 369
Abdomen 369
Bedside tests 369
Key references and further reading 369
Irritable bowel syndrome 371
Key thoughts 371
Practical points 371
Differential diagnosis 371
History 372
Ideas, concerns and expectations 372
History of presenting complaint 372
Past and current medical problems 373
Medication and other therapies 373
Intolerances 373
Family history 373
Social history 373
Alcohol, smoking and recreational drugs 373
Review of previous investigations 373
Examination 374
General 374
Vital signs 374
Abdomen 374
Key references and further reading 374
Inflammatory bowel disease 376
Key thoughts 376
Practical points 376
Differential diagnosis 376
History 376
Ideas, concerns and expectations 376
History of presenting complaint 377
Past and current medical problems 377
Medication 377
Family history 378
Social history 378
Alcohol, smoking and recreational drugs 378
Review of previous investigations 378
Examination 378
General 378
Vital signs 378
Skin 379
Head and neck 379
Abdomen 379
Musculoskeletal 379
Key references and further reading 379
Coeliac disease 381
Key thoughts 381
Practical points 381
Associated conditions and complications 381
Differential diagnosis 381
History 381
Ideas, concerns and expectations 381
History of presenting complaint 382
Past and current medical problems 383
Medication 383
Family history 383
Review of previous investigations 383
Examination 383
General 383
Skin 383
Head and neck 384
Abdomen 384
Lower limbs and spine 384
Key references and further reading 384
8 Infectious diseases 385
Fever of unknown origin 387
Key thoughts 387
Practical points 387
Differential diagnosis 387
Important risk factors 387
History 388
Ideas, concerns and expectations 388
History of presenting complaint 388
Past and current medical problems 388
Medication 389
Allergies 389
Social history 389
Review of previous investigations 389
Examination 390
General 390
Vital signs 390
Skin 390
Head and neck 390
Upper limbs 390
Chest 390
Abdomen 390
Lower limbs 391
Neurology 391
Bedside tests 391
Key references and further reading 391
Fever and illness in the returning traveller 392
Key thoughts 392
Practical points 392
Possible causes 392
Important risk factors 392
History 393
Ideas, concerns and expectations 393
History of presenting complaint 393
Common presenting patterns 394
Past and current medical problems 394
Medication 394
Allergies 395
Review of previous investigations 395
Examination 395
General 395
Vital signs 395
Skin 396
Chest 396
Abdomen 396
Lower limbs 396
Key references and further reading 396
HIV infection and AIDS 397
Key thoughts 397
Practical points 397
Important risk factors 397
Complications of HIV infection 397
History 398
Ideas, concerns and expectations 398
History of presenting complaint 398
Common presenting patterns 399
Past and current medical problems 400
Medication 400
Allergies 400
Social history 400
Alcohol, smoking and recreational drugs 400
Review of previous investigations 400
Examination 401
General 401
Vital signs 401
Skin 401
Head and neck 402
Upper and lower limbs 402
Chest 402
Abdomen 402
Bedside tests 402
Key references and further reading 402
Tuberculosis 403
Key thoughts 403
Practical points 403
Differential diagnosis 403
Important risk factors 403
History 404
Ideas, concerns and expectations 404
History of presenting complaint 404
Systems review 404
Past and current medical problems 405
Medication 405
Allergies 405
Social history 405
Alcohol, smoking and recreational drugs 405
Review of previous investigations 405
Examination 406
General 406
Vital signs 406
Skin 406
Limbs and back 406
Chest 406
Abdomen 407
Bedside tests 407
Key references and further reading 407
Rheumatic fever 408
Key thoughts 408
Practical points 408
Differential diagnosis 408
Important risk factors 408
History 409
Ideas, concerns and expectations 409
History of presenting complaint 409
Past and current medical problems 410
Medication 410
Allergies 410
Social history 410
Review of previous investigations 410
Examination 410
General 410
Vital signs 410
Skin 411
Head and neck 411
Upper and lower limbs 411
Chest 411
Key references and further reading 411
9 Haematology 413
Iron-deficiency anaemia 415
Key thoughts 415
Practical points 415
Differential diagnosis of microcytic anaemia 415
Possible causes 415
History 416
Ideas, concerns and expectations 416
History of presenting complaint 416
Past and current medical problems 416
Medication 417
Family history 417
Alcohol 417
Review of previous investigations 417
Examination 417
General 417
Vital signs 418
Head and neck 418
Upper limbs 418
Abdomen 418
Chest 418
Key references and further reading 418
Macrocytic anaemia (B12 and folate deficiency) 420
Key thoughts 420
Practical points 420
Possible causes of macrocytic anaemia 420
Other causes of macrocytosis 420
Associated conditions 420
History 421
Ideas, concerns and expectations 421
History of presenting complaint 421
Past and current medical problems 422
Medication 422
Family history 422
Smoking and alcohol 422
Review of previous investigations 422
Examination 423
General 423
Mental state 423
Vital signs 423
Head and neck 423
Abdomen 423
Chest 423
Limbs 424
Key references and further reading 424
Bleeding disorders 425
Key thoughts 425
Practical points 425
Haematological causes 425
General causes 425
History 426
Ideas, concerns and expectations 426
History of presenting complaint 426
Past and current medical problems 426
Medication 426
Family history 427
Alcohol, smoking and recreational drugs 427
Review of previous investigations 427
Examination 427
General 427
Vital signs 428
Skin 428
Head and neck 428
Upper limbs 428
Abdomen 428
Key references and further reading 428
Myeloma 429
Key thoughts 429
Practical points 429
Differential diagnosis 429
Risk factors 429
History 430
Ideas, concerns and expectations 430
History of presenting complaint 430
Past and current medical problems 430
Medication 431
Social history 431
Review of previous investigations 431
Examination 432
General 432
Vital signs 432
Head and neck 432
Musculoskeletal 432
Chest 432
Abdomen 432
Bedside tests 432
Key references and further reading 432
10 Musculoskeletal 433
Soft-tissue injury 435
Key thoughts 435
Practical points 435
Differential diagnosis 435
Important risk factors 435
History 435
Ideas, concerns and expectations 435
History of presenting complaint 436
Past and current medical problems 436
Medication 436
Allergies 437
Social history 437
Alcohol and other drugs 437
Review of previous investigations 437
Examination 437
General 437
Vital signs 437
Inspection of the injury 438
Palpation 438
Neurological examination 438
Circulation 438
Abdomen 438
Key references and further reading 439
Acute hot and swollen joint 440
Key thoughts 440
Practical points 440
Possible causes 440
Risk factors 440
History 441
Ideas, concerns and expectations 441
History of presenting complaint 441
Important symptom patterns 441
Medication 442
Allergies 442
Review of previous investigations 442
Examination 442
General 442
Vital signs 442
Joint examination 443
Key references and further reading 443
Chronic musculoskeletal pain 444
Key thoughts 444
Practical points 444
Possible causes 444
History 444
Ideas, concerns and expectations 444
History of presenting complaint 445
Common symptom patterns 445
Medication and other treatments 446
Social history 446
Alcohol and drugs 446
Review of previous investigations 446
Examination 447
General 447
Musculoskeletal 447
Skin 447
Head and neck 448
Key references and further reading 448
Polyarthralgia 449
Key thoughts 449
Practical points 449
Possible causes 449
Risk factors 449
History 449
Ideas, concerns and expectations 449
History of presenting complaint 450
Common symptom patterns 450
Medication 451
Other treatments 451
Family history 451
Social history 451
Review of previous investigations 451
Examination 452
General 452
Vital signs 452
Joints 452
Head and neck 453
Chest 453
Abdomen 453
Legs 453
Key references and further reading 453
Neck pain 455
Key thoughts 455
Practical points 455
Possible causes 455
Risk factors 455
History 456
Ideas, concerns and expectations 456
History of presenting complaint 456
Common symptom patterns 456
Medication 457
Review of previous investigations 457
Past and current medical problems 457
Social history 457
Examination 457
General 457
Inspection and palpation of the neck 458
Neck movement 458
Upper and lower limbs 458
Abdomen 459
Key references and further reading 459
Back pain 460
Key thoughts 460
Practical points 460
Possible causes 460
Risk factors 460
History 461
Ideas, concerns and expectations 461
History of presenting complaint 461
Past and current medical problems 462
Medication 462
Other treatments 463
Allergies 463
Social history 463
Review of previous investigations 463
Examination 463
General 463
Examination of the spine 463
Lower limbs 464
Abdomen 464
Key references and further reading 464
Shoulder and arm problems 466
Key thoughts 466
Practical points 466
Possible causes 466
Risk factors 466
History 467
Ideas, concerns and expectations 467
History of presenting complaint 467
Past and current medical problems 468
Medication 468
Other past treatments 468
Social history 469
Alcohol and smoking 469
Review of previous investigations 469
Examination 469
General 469
Cervical spine 469
Shoulder 470
Chest 470
Abdomen 470
Bedside tests 471
Key references and further reading 471
Elbow problems 472
Key thoughts 472
Practical points 472
Possible causes 472
History 472
Ideas, concerns and expectations 472
History of presenting complaint 473
Past and current medical problems 473
Family history 473
Medication 473
Allergies 473
Social history 473
Examination 474
Inspection 474
Palpation 474
Movement 474
Function 474
Key references and further reading 475
Hand problems 476
Key thoughts 476
Practical points 476
Important hand and wrist problems 476
History 476
Ideas, concerns and expectations 476
History of presenting complaint in case of injury 477
Injuries 477
Common symptom patterns 477
Past and current medical problems 478
Medication 478
Allergies 478
Social history 478
Examination 478
Inspection 478
Palpation 479
Movement 479
Function 480
Neurology 480
Key references and further reading 480
Hip pain 481
Key thoughts 481
Practical points 481
Possible causes 481
History 481
Ideas, concerns and expectations 481
Clinical features 482
Past and current medical problems 483
Medication 483
Other treatments 483
Involvement of other health professionals 483
Investigation findings 483
Social history 483
Examination 484
General 484
Vital signs 484
Inspection 484
Hip joint assessment 484
Lower spine 485
Key references and further reading 485
Groin problems 486
Key thoughts 486
Practical points 486
Possible causes 486
History 486
Ideas, concerns and expectations 486
History of presenting complaint 486
Past and current medical problems 487
Medication 488
Allergies 488
Social history 488
Examination 488
General 488
Groin 488
Abdominal examination 489
Locomotor 489
Key references and further reading 489
Leg pain and/or swelling 490
Key thoughts 490
Practical points 490
Possible causes of leg pain and swelling 490
Possible causes of leg swelling only 490
Possible causes of leg pain only 490
Risk factors for deep venous thrombosis 490
Risk factors for arterial disease 491
History 491
Ideas, concerns and expectations 491
History of presenting complaint 491
Past and current medical problems 492
Medication 493
Social history 493
Review of previous investigations 493
Examination 494
General 494
Vital signs 494
Legs 494
Chest 494
Abdomen 494
Bedside tests 495
Key references and further reading 495
Knee pain 496
Key thoughts 496
Practical points 496
Possible causes 496
Risk factors 496
History 497
Ideas, concerns and expectations 497
History of presenting complaint 497
Review of previous investigations 499
Past and current medical problems 499
Medication 499
Allergies 499
Social history 499
Examination 499
General inspection 499
Vital signs 499
Inspection 500
Palpation 500
Movement 500
Posterior cruciate ligament 500
Anterior cruciate ligament 501
Collateral ligaments 501
Menisci 501
Patella 501
Function 501
Examination of other structures 501
Key references and further reading 501
Foot and ankle problems 503
Key thoughts 503
Practical points 503
Possible causes 503
Risk factors 503
History 504
Ideas, concerns and expectations 504
History of presenting complaint 504
Common symptom patterns 504
Past and current medical problems 505
Medication 505
Other treatments 505
Social history 505
Review of previous investigations 506
Examination 506
General 506
Vital signs 506
Gait 506
Foot inspection 506
Palpation 507
Movement 507
Knees, hips and spine 508
Key references and further reading 508
Gout 509
Key thoughts 509
Practical points 509
Differential diagnosis 509
Important risk factors 509
History 510
Ideas, concerns and expectations 510
History of presenting complaint 510
Past and current medical problems 510
Family history 511
Medication and other treatments 511
Alcohol 511
Review of previous investigations 511
Examination 512
General inspection 512
Vital signs 512
Joint examination 512
Skin 512
Bedside test 512
Key references and further reading 512
Osteoporosis 513
Key thoughts 513
Practical points 513
Important risk factors 513
History 514
Ideas, concerns and expectations 514
History of presenting complaint 514
Common presenting patterns 514
Past and current medical problems 515
Family history 515
Medication 515
Social history 515
Review of previous investigations 515
Examination 516
General 516
Head and neck 516
Locomotor 516
Key references and further reading 516
11 Neurology 519
Headache 521
Key thoughts 521
Practical points 521
Possible causes 521
History 522
Ideas, concerns and expectations 522
History of presenting complaint 522
Common symptom patterns 523
Medication 524
Family history 524
Social history 524
Alcohol, smoking and recreational drugs 525
Review of previous investigations 525
Examination 525
General 525
Vital signs 525
Skin 525
Head and neck 525
Limbs 526
Key references and further reading 526
Transient ischaemic attack and stroke 528
Key thoughts 528
Practical points 528
Differential diagnosis 528
Important risk factors for ischaemic stroke 528
History 529
Ideas, concerns and expectations 529
History of presenting complaint 529
Past and current medical problems 530
Medication 530
Allergies 530
Family history 530
Social history 531
Alcohol, smoking and recreational drugs 531
Review of previous investigations 531
Examination 532
General 532
Vital signs 532
Skin 532
Head and neck 532
Upper and lower limbs 532
Chest 533
Abdomen 533
Bedside tests 533
Key references and further reading 533
Head injury in adults 534
Key thoughts 534
Practical points 534
Complications 534
History 534
Ideas, concerns and expectations 534
History of presenting complaint 535
Past and current medical problems 535
Medication 536
Allergies 536
Social history 536
Alcohol, smoking and recreational drugs 536
Examination 536
General 536
Vital signs 536
Head and neck 537
Skin 537
Upper and lower limbs 537
Chest 537
Abdomen 537
Bedside tests 537
Key references and further reading 537
Suspected or confirmed brain tumour 539
Key thoughts 539
Practical points 539
Differential diagnosis 539
History 540
Ideas, concerns and expectations 540
History of presenting complaint 540
Past and current medical problems 541
Medication 541
Other treatments 541
Allergies 541
Family history 541
Social history 541
Alcohol, smoking and recreational drugs 542
Review of previous investigations 542
Examination 542
General 542
Vital signs 542
Head and neck 542
Chest 543
Abdomen 543
Upper and lower limbs 543
Key references and further reading 543
Tremor 544
Key thoughts 544
Practical points 544
Differential diagnosis 544
History 544
Ideas, concerns and expectations 544
History of presenting complaint 545
Common presenting patterns 545
Medication 545
Family history 546
Alcohol and drugs 546
Social history 546
Review of previous investigations 546
Examination 546
General 546
Vital signs 546
Head and neck 547
Upper and lower limbs 547
Check for cerebellar dysfunction 547
Key references and further reading 547
Motor neurone disease 548
Key thoughts 548
Practical points 548
Differential diagnosis 548
Risk factors 548
History 549
Ideas, concerns and expectations 549
History of presenting complaint 549
Past and current medical problems 550
Medication 550
Family history 550
Social history 550
Review of previous investigations 551
Examination 551
General 551
Skin 551
Head and neck 551
Limbs 551
Chest 552
Abdomen 552
Key references and further reading 552
Peripheral neuropathy 553
Key thoughts 553
Practical points 553
Possible causes 553
History 553
Ideas, concerns and expectations 553
History of presenting complaint 554
Past and current medical problems 555
Family history 555
Medication 555
Social history 555
Alcohol, smoking and recreational drugs 555
Review of previous investigations 555
Examination 556
General 556
Limbs 556
Bedside tests 557
Key references and further reading 557
Multiple sclerosis 558
Key thoughts 558
Practical points 558
Differential diagnosis 558
History 558
Ideas, concerns and expectations 558
History of presenting complaint 558
Impact on the quality of life 559
Common symptom patterns 560
Past and current medical problems 560
Medication 560
Allergies 560
Social history 560
Review of previous investigations 561
Examination 561
General 561
Skin 561
Head and neck 561
Limbs 561
Chest 561
Abdomen 561
Bedside tests 562
Key references and further reading 562
12 Gynaecology 563
Combined oral contraception 565
Key thoughts 565
Practical points 565
Cautions 565
History 566
Ideas, concerns and expectations 566
History of presenting complaint 566
Past and current medical problems 567
Medication 567
Family history 567
Alcohol, smoking and recreational drugs 567
Review of previous investigations 567
Examination 568
General 568
Vital signs 568
Key references and further reading 568
Menorrhagia 569
Key thoughts 569
Practical points 569
Possible causes 569
Risk factors for endometrial cancer 569
History 570
Ideas, concerns and expectations 570
History of presenting complaint 570
Past and current medical problems 570
Medication 571
Social history 571
Review of previous investigations 571
Examination 571
General 571
Vital signs 571
Abdomen 571
Key references and further reading 572
Amenorrhoea 573
Key thoughts 573
Practical points 573
Possible causes 573
History 573
Ideas, concerns and expectations 573
History of presenting complaint 574
Past and ongoing medical problems 574
Medication 574
Family history 575
Social history 575
Alcohol, smoking and recreational drugs 575
Review of previous investigations 575
Examination 575
General 575
Skin 575
Head and neck 576
Chest 576
Abdomen 576
Bedside tests 576
Key references and further reading 576
Breast lumps 577
Key thoughts 577
Practical points 577
Possible causes 577
History 578
Ideas, concerns and expectations 578
History of presenting complaint 578
Past and current medical problems 578
Medication 579
Family history 579
Alcohol, smoking and recreational drugs 579
Review of previous investigations 579
Examination 579
General 579
Vital signs 579
Breasts 579
Axillae 580
Bedside tests 580
Key references and further reading 580
Loss of libido 581
Key thoughts 581
Practical points 581
Possible causes 581
History 581
Ideas, concerns and expectations 581
History of presenting complaint 581
Past and ongoing medical problems 583
Medication 583
Social history 583
Alcohol, smoking and recreational drugs 583
Review of previous investigations 583
Examination 583
General 583
Abdomen 584
Key references and further reading 584
Polycystic ovary syndrome 585
Key thoughts 585
Practical points 585
Diagnostic features 585
Differential diagnosis 585
History 586
Ideas, concerns and expectations 586
History of presenting complaint 586
Past and current medical problems 586
Medication 587
Family history 587
Social history 587
Review of previous investigations 587
Examination 588
General 588
Vital signs 588
Skin 588
Abdomen 588
Bedside tests 588
Key references and further reading 588
Suspected ovarian cancer 590
Key thoughts 590
Practical points 590
Differential diagnosis 590
History 590
Ideas, concerns and expectations 590
History of presenting complaint 591
Past and current medical problems 591
Medication 591
Family history 591
Social history 591
Review of previous investigations 592
Examination 592
General 592
Vital signs 592
Head and neck 592
Chest 592
Abdomen 592
Key references and further reading 593
13 Obstetrics 595
Routine antenatal care 597
Key thoughts 597
Practical points 597
Important risk factors from past pregnancies 597
History 598
Ideas, concerns and expectations 598
Suggested issues to cover at the booking visit 598
16-week appointment 599
Medication 600
Social history 600
Alcohol, smoking and recreational drugs 600
Review of previous investigations 600
Examination 601
General 601
Vital signs 601
Abdominal examination 601
Bedside tests 601
Key references and further reading 601
Bleeding in early pregnancy 602
Key thoughts 602
Practical points 602
Possible causes 602
Risk factors for miscarriage 602
History 603
Ideas, concerns and expectations 603
History of presenting complaint 603
Past and ongoing medical problems 603
Medication 603
Social history 603
Review of previous investigations 603
Examination 604
General 604
Vital signs 604
Abdomen 604
Bedside tests 604
Key references and further reading 604
Abdominal pain in pregnancy 606
Key thoughts 606
Practical points 606
Possible causes 606
Risk factors for ectopic pregnancy 606
History 607
Ideas, concerns and expectations 607
History of presenting complaint 607
Common symptom presentations 608
Past and ongoing medical problems 608
Medication 608
Social history 608
Smoking 608
Review of previous investigations 609
Examination 609
General 609
Vital signs 609
Abdomen 609
Limbs 609
Bedside tests 610
Key references and further reading 610
Pre-eclampsia 611
Key thoughts 611
Practical points 611
Risk factors and indications for specialist referral 611
History 612
Ideas, concerns and expectations 612
History of presenting complaint 612
Past and ongoing medical problems 612
Medication 612
Review of previous investigations 613
Examination 613
General 613
Vital signs 613
Head and neck 613
Chest 613
Abdomen 613
Upper and lower limbs 613
Bedside tests 613
Key references and further reading 613
14 Urology and renal medicine 615
Suspected urinary tract infection inwomen 617
Key thoughts 617
Practical points 617
Differential diagnosis 617
Important risk factors 617
History 617
Ideas, concerns and expectations 617
History of presenting complaint 618
Past and current medical problems 618
Medication 618
Allergies 619
Family history 619
Social history 619
Alcohol and smoking 619
Review of previous investigations 619
Examination 619
General 619
Vital signs 619
Abdomen 620
Bedside tests 620
Key references and further reading 620
Lower urinary tract symptoms inmen 621
Key thoughts 621
Practical points 621
Possible causes 621
Important risk factors 621
History 622
Ideas, concerns and expectations 622
History of presenting complaint 622
Past and current medical problems 623
Medication 623
Other treatments 623
Allergies 623
Family history 623
Social history 623
Alcohol, smoking and recreational drugs 623
Review of previous investigations 623
Examination 624
General 624
Abdomen 624
Lower back 624
Bedside tests 624
Key references and further reading 624
Urinary incontinence 626
Key thoughts 626
Practical points 626
Differential diagnosis 626
Important risk factors 626
History 627
Ideas, concerns and expectations 627
History of presenting complaint 627
Common symptom patterns 627
Past and current medical problems 628
Medication 628
Allergies 629
Family history 629
Social history 629
Alcohol, smoking and recreational drugs 629
Review of previous investigations 629
Examination 629
General 629
Vital signs 630
Abdomen 630
Lower limbs 630
Bedside tests 630
Key references and further reading 630
Urethral discharge in men 632
Key thoughts 632
Practical points 632
Possible causes 632
Important risk factors 632
History 632
Ideas, concerns and expectations 632
History of presenting complaint 633
Past and current medical problems 633
Medication 634
Allergies 634
Review of previous investigations 634
Examination 634
General 634
Vital signs 634
Abdomen 634
Genitalia 634
Skin 635
Head and neck 635
Upper and lower limbs 635
Bedside tests 635
Key references and further reading 635
Scrotal and testicular problems 636
Key thoughts 636
Practical points 636
Differential diagnosis 636
History 636
Ideas, concerns and expectations 636
History of presenting complaint 637
Common symptom patterns 637
Past and current medical problems 638
Allergies 638
Review of previous investigations 638
Examination 638
General 638
Vital signs 638
Groin 639
Scrotal examination 639
Chest 639
Abdomen 640
Bedside tests 640
Key references and further reading 640
Erectile dysfunction 641
Key thoughts 641
Practical points 641
Possible causes 641
History 641
Ideas, concerns and expectations 641
History of presenting complaint 642
Past and current medical problems 643
Medication 643
Alcohol, smoking and recreational drugs 643
Review of previous investigations 644
Examination 644
General 644
Vital signs 644
Chest 644
Abdomen 644
Lower limbs 645
Bedside tests 645
Key references and further reading 645
Renal or ureteric colic (kidney stones) 646
Key thoughts 646
Practical points 646
Differential diagnosis 646
Important risk factors 646
History 647
Ideas, concerns and expectations 647
History of presenting complaint 647
Past and current medical problems 648
Medication 648
Other treatments 648
Allergies 648
Family history 648
Alcohol, smoking and recreational drugs 648
Review of previous investigations 648
Examination 649
General 649
Vital signs 649
Abdomen 649
Lower limbs 649
Bedside tests 649
Key references and further reading 649
Haematuria 651
Key thoughts 651
Practical points 651
Possible causes 651
Differential diagnosis of dark or red urine 651
Important risk factors 651
History 652
Ideas, concerns and expectations 652
History of presenting complaint 652
Common symptom patterns 653
Past and current medical problems 653
Medication 653
Review of previous investigations 653
Examination 654
General 654
Vital signs 654
Abdomen 654
Bedside tests 654
Key references and further reading 654
Chronic kidney disease 655
Key thoughts 655
Practical points 655
Possible causes 655
Important risk factors 655
History 655
Ideas, concerns and expectations 655
History of presenting complaint 656
Degree of renal failure 656
Risk factors and complications 656
Important presentations 657
Past and current medical problems 657
Medication 657
Family history 657
Review of previous investigations 658
Examination 658
General 658
Vital signs 658
Skin 658
Head and neck 659
Chest 659
Abdomen 659
Lower limbs 659
Bedside tests 659
Key references and further reading 659
15 Mental health 661
Depression 663
Key thoughts 663
Practical points 663
Differential diagnosis 663
Important risk factors 663
History 663
Ideas, concerns and expectations 663
History of presenting complaint 664
Past and current medical problems 665
Medication and other treatments 665
Social history 665
Alcohol and drugs 666
Review of previous investigations 666
Examination 666
General 666
Signs of depression 666
Key references and further reading 667
Self-harm and harm to others 668
Key thoughts 668
Practical points 668
Differential diagnosis 668
History 668
Ideas, concerns and expectations 668
History of presenting complaint 669
Medication 670
Social history 670
Alcohol and drugs 670
Examination 671
General 671
Vital signs 671
Preliminary psychosocial assessment 671
Skin 671
Head and neck 671
Key references and further reading 671
Anxiety, phobias and panic disorder 673
Key thoughts 673
Practical points 673
Differential diagnosis 673
History 673
Ideas, concerns and expectations 673
History of presenting complaint 674
Common symptom patterns 675
Past and current medical problems 675
Medication and other treatments 675
Alcohol and drugs 675
Social history 676
Examination 676
General 676
Vital signs 676
Endocrine assessment 676
Key references and further reading 676
Alcohol screening 677
Key thoughts 677
Practical points 677
Important risk factors 677
History 677
Ideas, concerns and expectations 677
History of alcohol intake 678
Levels of drinking 678
Effects of alcohol problems on daily life 679
Questions to ask if answers are vague 679
Mental health 679
Social history 680
Examination 680
General 680
Signs of liver disease 680
Abdominal examination 680
Key references and further reading 681
Alcohol dependence 682
Key thoughts 682
Practical points 682
Important risk factors 682
History 682
Ideas, concerns and expectations 682
History of alcohol-related problems 683
Signs and complications of alcohol dependence 683
Past and current medical problems 683
Social history 684
Assessment of readiness for detoxification 684
Indications for asking specialist services for advice or support 684
Review of recent investigations 685
Examination 685
General 685
Vital signs 685
Skin 685
Head and neck 685
Abdomen 685
Key references and further reading 685
Illicit drug misuse 687
Key thoughts 687
Practical points 687
Important risk factors 687
History 687
Ideas, concerns and expectations 687
History of presenting complaint 688
Drug-taking behaviour 688
Past and current medical problems 689
Medication 689
Alcohol 689
Social history 690
Review of previous investigations 690
Examination 690
General 690
Vital signs 690
Skin 690
Head and neck 691
Chest 691
Abdomen 691
Mental state 691
Key references and further reading 691
Obsessive–compulsive disorder 692
Key thoughts 692
Practical points 692
Differential diagnosis 692
Associated conditions 692
History 692
Ideas, concerns and expectations 692
History of presenting complaint 693
Past and current medical problems 693
Social history 693
Examination 694
General condition 694
Skin 694
References 694
Mania 695
Key thoughts 695
Practical points 695
Differential diagnosis 695
Risk factors 695
History 695
Ideas, concerns and expectations 695
History of presenting complaint 696
Past and current medical problems 697
Medication 697
Family history 697
Social history 697
Alcohol, smoking and recreational drugs 697
Review of previous investigations 698
Examination 698
General 698
Mental state 698
Key references and further reading 698
Schizophrenia 699
Key thoughts 699
Practical points 699
Differential diagnosis (organic and psychiatric) 699
Risk factors 699
Associated conditions 699
History 700
Ideas, concerns and expectations 700
History of presenting complaint 700
Past and current medical problems 701
Medication 701
Social history 702
Alcohol and drugs 702
Examination 702
General 702
Mental state 702
Key references and further reading 703
16 Skin 705
Moles and malignant melanoma 707
Key thoughts 707
Practical points 707
Risk factors for melanoma 707
Differential diagnosis 707
History 708
Ideas, concerns and expectations 708
History and features of melanoma 708
Family history 708
Social history 709
Examination 709
General 709
Skin 709
Chest 709
Abdomen 709
Key references and further reading 709
Pressure ulcers 710
Key thoughts 710
Practical points 710
Potential causes 710
Important risk factors 710
History 711
Ideas, concerns and expectations 711
History of presenting complaint 711
Effects of problem on daily life 712
Past and current medical problems 712
Medication 712
Allergies 712
Social history 712
Alcohol 713
Review of recent investigations 713
Examination 713
General 713
Vital signs 713
Skin inspection 713
Lower limbs 714
Beside tests 714
Key references and further reading 714
17 Ophthalmology 715
Eye injuries 717
Key thoughts 717
Practical points 717
Differential diagnosis 717
Important risk factors 717
History 718
Ideas, concerns and expectations 718
History of presenting complaint 718
Review of previous investigations 718
Past and current medical problems 719
Medication 719
Allergies 719
Examination 719
General 719
Eye inspection 719
Eye tests 719
Head and neck 720
Key references and further reading 720
The acute red eye 721
Key thoughts 721
Practical points 721
Serious and sight-threatening causes 721
Differential diagnosis and associated conditions 721
Important risk factors 721
History 722
Ideas, concerns and expectations 722
History of presenting complaint 722
Review of previous investigations 723
Past and current medical problems 723
Medication 723
Allergies 724
Examination 724
General 724
Head and neck 724
Eye inspection 724
Eye tests 725
Vital signs 725
Skin 725
Key references and further reading 725
Gradual painless visual disturbance 726
Key thoughts 726
Practical points 726
Possible causes 726
Important risk factors 726
History 726
Ideas, concerns and expectations 726
History of presenting complaint 727
Past and current medical problems 727
Medication 728
Family history 728
Social history 728
Alcohol, smoking and recreational drugs 728
Review of previous investigations 728
Examination 728
General 728
Eye inspection 728
Eye tests 729
Head and neck 729
Bedside tests 729
Key references and further reading 729
Sudden painless visual disturbance 730
Key thoughts 730
Practical points 730
Possible causes 730
Important risk factors 730
History 731
Ideas, concerns and expectations 731
History of presenting complaint 731
Common symptom patterns 732
Past and current medical problems 732
Medication 732
Social history 732
Review of previous investigations 732
Examination 733
General 733
Vital signs 733
Eye inspection 733
Eye tests 733
Head and neck 734
Key references and further reading 734
Eye problems in older people 735
Key thoughts 735
Practical points 735
Possible causes 735
History 735
Ideas, concerns and expectations 735
History of presenting complaint 736
Common symptom patterns 736
Past and current medical problems 736
Medication 737
Social history 737
Examination 737
General 737
Vital signs 737
Eyes 737
Neurological 738
Key references and further reading 738
18 Ear, nose and throat 739
Neck swelling 741
Key thoughts 741
Practical points 741
Possible causes 741
History 741
Ideas, concerns and expectations 741
History of presenting complaint 741
Past and current medical problems 742
Family history 742
Social history 742
Review of previous investigations 743
Examination 743
General 743
Head and neck 743
Abdomen 743
Key references and further reading 744
Sore throat 745
Key thoughts 745
Practical points 745
Possible causes 745
History 745
Ideas, concerns and expectations 745
History of presenting complaint 746
Past and current medical problems 746
Medication 747
Allergies 747
Social history 747
Review of previous investigations 747
Examination 748
General 748
Vital signs 748
Skin 748
Head and neck 748
Abdomen 748
Key references and further reading 748
Ear pain 750
Key thoughts 750
Practical points 750
Possible causes 750
History 750
Ideas, concerns and expectations 750
History of presenting complaint 751
Past and current medical problems 751
Medication 751
Allergies 752
Social history 752
Examination 752
General 752
Vital signs 752
Head and neck 752
Key references and further reading 753
Hearing loss in adults 754
Key thoughts 754
Practical points 754
Possible causes 754
History 754
Ideas, concerns and expectations 754
History of presenting complaint 755
Past and current medical problems 756
Family history 756
Medication 756
Allergies 756
Social history 756
Review of previous investigations 756
Examination 756
General 756
Vital signs 756
Ears 757
Head and neck 757
Key references and further reading 757
Tinnitus 758
Key thoughts 758
Practical points 758
Possible causes 758
History 758
Ideas, concerns and expectations 758
History of presenting complaint 759
Past and current medical problems 759
Medication 759
Other treatments 760
Family history 760
Social history 760
Review of previous investigations 760
Examination 760
General 760
Vital signs 760
Head and neck 760
Chest 761
Key references and further reading 761
Sinusitis and facial pain 762
Key thoughts 762
Practical points 762
Differential diagnosis 762
History 762
Ideas, concerns and expectations 762
History of presenting complaint 763
Past and current medical problems 763
Medication 763
Allergies 764
Social history 764
Review of previous investigations 764
Illicit drugs 764
Examination 764
General 764
Vital signs 764
Head and neck 764
Key references and further reading 765
19 Problems in older people 767
General health assessment in older people 769
Key thoughts 769
Practical points 769
Common reasons for initial presentation 769
History 770
Ideas, concerns and expectations 770
History of presenting complaint 770
Functional assessment 770
Past and current medical problems 771
Medication 771
Alcohol and smoking 771
Review of previous investigations 772
Examination 772
General assessment 772
Signs of abuse 772
Vital signs 773
Head and neck 773
Chest 773
Abdomen 773
Musculoskeletal 773
Bedside tests 773
Key references and further reading 774
Cognitive problems and dementia 775
Key thoughts 775
Practical points 775
Possible causes 775
Important risk factors 775
History 775
Ideas, concerns and expectations 775
History of presenting complaint 776
Effects of memory loss on daily life 776
Features of underlying disease 776
Past and current medical problems 777
Medication 777
Social history 777
Review of previous investigations 777
Examination 778
General 778
Vital signs 778
Cognitive function 778
Head and neck 778
Chest 778
Abdomen 779
Bedside tests 779
Key references and further reading 779
Falls in older people 780
Key thoughts 780
Practical points 780
Potential causes 780
History 781
Ideas, concerns and expectations 781
History of presenting complaint 781
Past and current medical problems 782
Medication 782
Social history 782
Alcohol 782
Review of previous investigations 782
Examination 783
General 783
Vital signs 783
Skin 783
Head and neck 783
Upper limbs 784
Chest 784
Lower limbs 784
Cognitive function 785
Bedside tests 785
Key references and further reading 785
Delirium and acute confusional state 786
Key thoughts 786
Practical points 786
Possible causes 786
History 786
Ideas, concerns and expectations 786
History of presenting complaint 787
Common symptom patterns 787
Past and current medical problems 788
Medication 788
Social history 788
Alcohol and drugs 788
Review of previous investigations 789
Examination 789
General 789
Mental state 789
Vital signs 789
Head and neck 790
Cognitive function 790
Chest 790
Abdomen 790
Lower limbs 790
Bedside tests 790
Key references and further reading 791
Depression in older people 792
Key thoughts 792
Practical points 792
Potential causes 792
History 792
Ideas, concerns and expectations 792
History of presenting complaint 793
Past and current medical problems 793
Personal history 794
Medication 794
Social history 794
Alcohol 794
Review of previous investigations 795
Examination 795
General 795
Cognitive function 795
Skin 795
Head and neck 795
Abdomen 795
Bedside tests 796
Key references and further reading 796
Palliative and end-of-life care 797
Key thoughts 797
Practical points 797
History 797
Ideas, concerns and expectations 797
Current problems 798
Past and current medical problems 798
Medication 798
Prognosis 799
Social history 799
Review of previous investigations 799
Examination 799
General inspection 799
Skin 800
Head and neck 800
Chest 800
Abdomen and back 800
Limbs 800
Key references and further reading 800
Parkinsons disease 801
Key thoughts 801
Practical points 801
Differential diagnosis and important comorbidities 801
History 801
Ideas, concerns and expectations 801
Quality of life 802
Motor symptoms 802
Non-motor symptoms 802
Past and current medical problems 802
Medication 803
Involvement of other health professionals 803
Review of previous investigations 803
Examination 803
General 803
Signs of Parkinsons disease 803
Vital signs 804
Cognitive function 804
Key references and further reading 804
Index 805
EULA 835

Rezensionen

"This book does cover all the basics one must keep in mind when diagnosing and treating patients in the outpatient office...While the focus is on younger clinicians, this book clearly has great insights for primary care clinicians at every level of experience...5 Stars!" (Doody Enterprises 24/03/2017)

"Although the clinical content is
great, this book was a real winner for me in
terms of the practical points and guidance
provided at the start of each section...I can certainly see myself using
this book as a quick reference tool during
consultations and have already found a
special spot for it on my desk."(British Journal of General Practice 28/04/2017)

Produkt-Details

• Erscheint lt. Verlag: 12.9.2016
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Allgemeines / Lexika
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Innere Medizin
• Themenwelt: Studium ► 2. Studienabschnitt (Klinik) ► Anamnese / Körperliche Untersuchung
• Schlagworte: Allgemeine u. Innere Medizin • Allgemeinpraxis, hausärztliche Praxis • Allgemeinpraxis, hausärztliche Praxis • Clinical Assessment • Clinical Skills • Clinical skills assessment • csa • differential diagnoses • evidence-based • General & Internal Medicine • General Practice/Family Practice • general practitioners • Klinische Fertigkeiten • Klinische Medizin • Knut Schroeder • medical educators • Medical Science • Medizin • Membership of the Royal College of General Practitioners • nurse practitioners • RCGP • Red Flags • The 10-Minute Clinical Assessment
• ISBN-10: 1-119-10636-2 / 1119106362
• ISBN-13: 978-1-119-10636-4 / 9781119106364