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Index
Cover Page
DeGowin's Diagnostic Examination
Copyright page
Contents
Preface
Common Abreviations
Introduction and User's Guide
PART 1 THE DIAGNOSTIC FRAMEWORK
1. Diagnosis
1. Why is Diagnosis Important?
2. Diseases and Syndromes: Communication and Entry to the Medical Literature
A. The Diagnostic Examination
1. Stories: Listen, Examine, Interpret, Explain
2. Finding Clues to the Diagnosis
3. Select Hypotheses: Generate a Differential Diagnosis
4. Cognitive Tests of the Diagnostic Hypotheses
5. Selection of Diagnostic Tests
6. Rare Diseases
7. Certainty and Diagnosis
8. Prognostic Uncertainty
9. Deferred Diagnoses
10. A Summary of the Diagnostic Process
11. Caveat
12. An Example of the Diagnostic Process
B. Other Examinations
1. The Autopsy
2. Other Varieties of Medical Examinations
2. History Taking and the Medical Record
A. Outline of the Medical Record
B. Procedure for Taking a History
1. Definition of the Medical History
2. Scope of the History
3. Methods in History Taking
4. Conducting the Interview
C. Completion of the Medical Record
1. Identification
2. The Informant
3. Chief Complaints (CC)
4. History of Present Illness (HPI)
5. Past Medical and Surgical History
6. Family History (FH)
7. Social History (SH)
8. Review of Systems (ROS)
9. Medications
10. Allergies and Medication Intolerances
11. Preventive Care Services
12. Advance Directives
13. Physical Examination (PE)
14. Laboratory
15. Assessment
16. The Plan
D. The Oral Presentation
E. Other Clinical Notes
1. Inpatient Progress Notes
2. Off-Service Note
3. Discharge Summary
4. Clinic Notes
F. The Patient's Medical Record
1. Purposes
2. Physician's Signature
3. Custody of the Record
G. Electronic Medical Records
3. The Screening Physical Examination
A. Methods for Physical Examination
1. Inspection
2. Palpation
3. Percussion
4. Auscultation
B. Procedure for the Screening Physical Examination
1. Preparing for the Screening Examination
2. Performance of the Screening Examination
PART 2 THE DIAGNOSTIC EXAMINATION
The Diagnostic Examination: Chapters 4 to 16
4. Vital Signs, Anthropometric Data, and Pain
A. Vital Signs
1. Body Temperature
2. The Pulse: Rate, Volume, and Rhythm
3. Respirations: Respiratory Rate and Pattern
4. Blood Pressure and Pulse Pressure
B. Anthropometric Data
1. Height
2. Weight
C. Pain
1. Diagnostic Attributes of Pain
2. Pain Syndromes
5. Non-Regional Systems and Diseases
A. Constitutional Symptoms
B. The Immune System
1. Two Common Syndromes
C. The Lymphatic System
1. Examination of the Lymph Nodes
2. Lymph Node Signs
3. Lymph Node Syndromes
D. The Hematopoietic System and Hemostasis
1. Red Blood Cell (Erythrocyte) Disorders
2. Neutrophil Disorders
3. Myeloproliferative Disorders and Acute Leukemia
4. Platelet Disorders
5. Coagulation Disorders
E. The Endocrine System
1. Diabetes and Hypoglycemia
2. Disorders of Thyroid Function
3. Disorders of Adrenal Function
4. Disorders of Parathyroid Function
5. Disorders of Pituitary Function
6. The Skin and Nails
A. Physiology of the Skin and Nails
B. Functional Anatomy of the Skin and Nails
1. Epidermis
2. Dermis and Subcutaneous Tissue
3. The Fingernails
4. The Toenails
5. Skin Coloration
6. Hair
7. Sebaceous Glands
8. Eccrine (Sweat) Glands
9. Apocrine Glands
10. Nerves
11. Circulation of the Skin and Mucosa
12. Cutaneous Wound Healing and Repair
C. Examination of the Skin and Nails
D. Skin and Nail Symptoms
E. Skin and Nail Signs
1. Anatomic Distribution of Lesions
2. Pattern of Lesions
3. Morphology of Individual Lesions
4. Generalized Skin Signs
5. Changes in the Hair
6. Fingernail Signs
7. Arterial Circulation Signs
8. Purpura
9. Non-Purpuric Vascular Lesions
F. Common Skin and Nail Syndromes
1. Common Skin Disorders
2. Skin Infections and Infestations
3. Bullous Skin Diseases
4. Skin Manifestations of Systemic Diseases
5. Vascular Disorders
6. Skin Neoplasms
7. The Head and Neck
A. Major Systems of the Head and Neck
B. Functional Anatomy of the Head and Neck
1. The Scalp and Skull
2. The Face and Neck
3. The Ears
4. The Eyes
5. The Nose
6. The Mouth and Oral Cavity
7. The Larynx
8. The Salivary Glands
9. The Thyroid Gland
C. Physical Examination of the Head and Neck
1. Examination of the Scalp, Face, and Skull
2. Examination of the Ears, Hearing, and Labyrinthine Function
3. Examination of the Eyes, Visual Fields and Visual Acuity
4. Examination of the Nose and Sinuses
5. Examination of the Lips, Mouth, Teeth, Tongue, and Pharynx
6. Examination of the Larynx
7. Examination of the Salivary Glands
8. Examination of the Temporomandibular Joint
9. Examination of the Neck
10. Examination of the Lymph Nodes
11. Examination of the Vascular System
D. Head and Neck Symptoms
1. General Symptoms
2. Skull, Scalp, and Face Symptoms
3. Ear Symptoms
4. Eye Symptoms
5. Nose Symptoms
6. Lip, Mouth, Tongue, Teeth, and Pharynx Symptoms
7. Larynx Symptoms
8. Salivary Gland Symptoms
9. Neck Symptoms
E. Head and Neck Signs
1. Scalp, Face, Skull, and Jaw Signs
2. Ear Signs
3. Eye Signs
4. Nose and Sinus Signs
5. Lip Mouth, Teeth, Tongue and Pharynx Signs
6. Larynx and Trachea Signs
7. Salivary Gland Signs
8. Neck Signs
9. Thyroid Signs
F. Head and Neck Syndromes
1. Scalp, Face, Skull, and Jaw Syndromes
2. Eye Syndromes
3. Ear Syndromes
4. Nose and Sinus Syndromes
5. Oral Syndromes (Lips, Mouth, Tongue, Teeth, and Pharynx)
6. Larynx Syndromes
7. Salivary Gland Syndromes
8. Thyroid Goiters and Nodules
8. The Chest: Chest Wall, Pulmonary, and Cardiovascular Systems; The Breasts
SECTION 1 Chest Wall, Pulmonary, and Cardiovascular Systems
A. Major Systems and Physiology
1. The Thoracic Wall
2. The Lungs and Pleura
3. The Cardiovascular System
B. Superficial Thoracic Anatomy
1. The Chest Wall
2. The Lungs and Pleura
3. The Heart and Precordium
C. Physical Examination of the Chest and Major Vessels
1. Examination of the Rib Cage and Thoracic Musculature
2. Examination of the Lungs and Pleura
3. Examination of the Cardiovascular System
D. Chest, Cardiovascular and Respiratory Symptoms
1. General Symptoms
2. Chest Wall Symptoms
3. Lung and Pleural Symptoms
4. Cardiovascular Symptoms
E. Chest, Cardiovascular and Respiratory Signs
1. Chest Wall Signs
2. Lung, Pleura, and Respiratory Signs
3. Cardiovascular Signs
4. Mid-Precordial Systolic Murmurs
5. Apical Systolic Murmurs
6. Basal Diastolic Murmurs
7. Mid-Precordial Diastolic Murmur
8. Apical Diastolic Murmurs
9. Pulse Contour
10. Pulse Volume
11. Arterial Sounds
12. Venous Signs of Cardiac Action
F. Chest, Cardiovascular and Respiratory Syndromes
1. Chest Wall Syndromes
2. Respiratory Syndromes
3. Cardiovascular Syndromes
4. Myocardial Ischemia Six-Dermatome Pain Syndromes
5. Inflammatory Six-Dermatome Pain Syndromes
6. Mediastinal and Vascular Six-Dermatome Pain Syndromes
7. Gastrointestinal Six-Dermatome Pain Syndromes
8. Pulmonary Six-Dermatome Pain Syndromes
SECTION 2 The Breasts
A. Breast Physiology
1. The Female Breast
2. The Male Breast
B. Superficial Anatomy of the Breasts
C. Physical Examination of the Breasts
1. Breast Examination
2. Nipple Examination
D. Breast Symptoms
E. Breast Signs
F. Breast Syndromes
1. The Female Breast
2. The Male Breast
9. The Abdomen, Perineum, Anus, and Rectosigmoid
A. Major Systems and Their Physiology
1. Alimentary System
2. Hepatobiliary and Pancreatic System
3. Spleen and Lymphatics
4. Kidneys, Ureters, and Bladder
B. Superficial Anatomy of the Abdomen and Perineum
1. The Abdomen
2. The Anus
3. The Rectum
4. The Sigmoid and Descending Colon
C. Physical Examination of the Abdomen
1. The Abdomen
2. Examination of the Perineum, Anus, Rectum, and Distal Colon
3. Examination of the Anus
4. Examination of the Rectum
5. Examination of the Sigmoid Colon
D. Abdominal, Perineal and Anorectal Symptoms
1. General Symptoms
2. Site-Attributable Symptoms
E. Abdominal, Perineal and Anorectal Signs
1. Abdominal Signs
2. Perineal, Anal, and Rectal Signs
F. Abdominal, Perineal and Anorectal Syndromes
1. GI, Hepatobiliary and Pancreatic Syndromes
2. Perineal, Anal, and Rectal Syndromes
3. Occult GI Blood Loss
10. The Urinary System
A. Overview and Physiology of The Urinary System
B. Anatomy of the Urinary System
C. Physical Examination of the Urinary System
D. Urinary System Symptoms
E. Urinary System Signs
F. Urinary System Syndromes
11. The Female Genitalia and Reproductive System
A. Overview of Female Reproductive Physiology
B. Anatomy of the Female Genitalia and Reproductive System
C. Physical Examination of the Female Genitalia and Reproductive System
1. The Female Pelvic Examination
D. Female Genital and Reproductive Symptoms
1. General Symptoms
2. Vulvar and Vaginal Symptoms
E. Female Genital and Reproductive Signs
1. Vulvar Signs
2. Vaginal Signs
3. Cervical Signs
4. Uterine Signs
5. Adnexal Signs
6. Rectal Signs
F. Female Genital and Reproductive Syndromes
12. The Male Genitalia and Reproductive System
A. Overview of Male Reproductive Physiology
B. Anatomy of the Male Reproductive System
1. The Penis
2. The Scrotum
3. Testis, Epididymis, Vas Deferens, and Spermatic Cord
4. The Prostate and Seminal Vesicles
C. Physical Examination of the Male Genitalia and Reproductive System
1. Examination of the Penis
2. Examination of the Scrotum
3. Examination of Scrotal Contents
4. Examination for Scrotal Hernia
5. Examination of the Testes
6. Examination of the Epididymis
7. Examination of the Spermatic Cord
8. Examination of the Inguinal Regions for Hernia
D. Male Genital and Reproductive Symptoms
E. Male Genital and Reproductive Signs
1. Penis Signs
2. Urethral Signs
3. Scrotum Signs
4. Testis, Epididymis, and Other Intrascrotal Signs
5. Prostate and Seminal Vesicle Signs
F. Male Genital and Reproductive Syndromes
13. The Spine, Pelvis and Extremities
A. Major Systems and Their Physiology
1. Bones and Ligaments
2. Joints
3. Muscles, Tendons, and Bursae
B. Superficial Anatomy of the Spine and Extremities
1. The Axial Skeleton: Spine and Pelvis
2. Appendicular Skeleton Including Joints, Ligaments, Tendons, and Soft Tissues
C. Physical Examination of the Spine and Extremities
1. Examination of the Axial Skeleton: Spine and Pelvis
2. Examination of the Appendicular Skeleton Including Joints, Ligaments, Tendons, and Soft Tissues
D. Musculoskeletal and Soft Tissue Symptoms
E. Musculoskeletal and Soft Tissue Signs
1. General Signs
2. Axial Musculoskeletal Signs
3. Appendicular Skeleton, Joint, Ligament, Tendon, and Soft-Tissue Signs
4. Muscle Signs
F. Musculoskeletal and Soft Tissue Syndromes
1. General Syndromes
2. Conditions Primarily Affecting Joints
3. Conditions Primarily Affecting Bone
4. Axial Skeleton: Spine and Pelvis Syndromes
5. Appendicular Skeletal Syndromes (Including Joints, Tendons, Ligaments, and Soft Tissues)
6. Muscle Syndromes
14. The Neurologic Examination
A. Overview of the Nervous System
1. Anatomic Organization
2. Functional Organization of the Nervous System
B. Superficial Anatomy of the Nervous System
C. The Neurologic Examination
1. Cranial Nerve Examination
2. Motor Examination
3. Examination of Reflexes
4. Posture, Balance, and Coordination: The Cerebellar Examination
5. Testing Specific Peripheral Nerves
6. Movements of Specific Muscles and Nerves
D. Neurologic Symptoms
1. General Symptoms
2. Cranial Nerve Symptoms
3. Motor Symptoms
4. Posture, Balance, and Coordination Symptoms
5. Sensory Symptoms
E. Neurologic Signs
1. Cranial Nerve Signs
2. Motor Signs
3. Reflex Signs
4. Posture, Balance, and Coordination Signs: Cerebellar Signs
5. Sensory Signs
6. Autonomic Nervous System Signs
7. Some Peripheral Nerve Signs
F. Neurologic Syndromes
1. Falling
2. Headache
3. Seizures
4. Impaired Consciousness
5. Chronic Vegetative and Minimally Conscious States
6. Cerebrovascular Syndromes
7. Other CNS Syndromes
8. Other Motor and Sensory Syndromes
9. Disorders of Language and Speech
10. Syndromes of Impaired Mentation
11. Other Syndromes
15. The Mental Status, Psychiatric, and Social Evaluations
SECTION 1 The Mental Status and Phychiatric Evaluation
A. The Mental Status Evaluation
B. Psychiatric Symptoms and Signs
1. Abnormal Perception
2. Abnormal Affect and Mood
3. Abnormal Thinking
4. Abnormal Memory
5. Abnormal Behaviors
C. Psychiatric Syndromes
1. Multiaxial Assessment
2. Acute and Subacute Confusion
3. Anxiety Disorders
4. Disorders of Mood
5. Personality Disorders
6. Other Personality Disorders
7. Thought Disorders
8. Other Disorders
SECTION 2 The Social Evaluation
A. Evaluation of Social Function and Risk
B. Common Social Syndromes and Problems
PART 3 PREOPERATIVE EVALUATION
16. The Preoperative Evaluation
A. Introduction to Preoperative Screening
B. The History
1. Assessment of Cardiovascular and Pulmonary Risk from History
2. Assessment of Bleeding Risk from History
3. Assessment of Metabolic Risk: Diabetes, Renal, and Hepatic Insufficiency
4. Family History
5. Medications
6. Personal Habits
7. Mechanical and Positioning Risks
C. The Physical Examination
D. Mental Status
E. Laboratory Tests
F. Summative Risk Assessment
PART 4 USE OF THE LABORATORY AND DIAGNOSTIC IMAGING
17. Principles of Diagnostic Testing
A. Principles of Laboratory Testing
1. Principles of Testing for Disease
2. Aids in the Selection and Interpretation of Tests
3. Examples
4. 2 × 2 Tables Revisited: Caveat Emptor
5. Rule In; Rule Out
6. Summary
B. Principles of Diagnostic Imaging
18. Common Laboratory Tests
A. Blood Chemistries
B. Hematologic Data
1. Blood Cells
2. Coagulation
C. Urinalysis
D. Cerebrospinal Fluid
E. Serous Body Fluids
Index
page 706
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