CHAPTER 1: Foundations for Clinical Proficiency

Introduction The techniques of physical examination and history taking that you are about to learn embody the time-honored skills of healing and patient care. Gathering a sensitive and nuanced history and performing a thorough and accurate examination deepen your relationships with patients, focus your assessment, and set the guideposts that direct your clinical decision making […]

CHAPTER 2: Evaluating Clinical Evidence

Introduction Excellence in clinical care requires integrating clinical expertise, patient preferences, and the best available clinical evidence.[1] Carefully study the clear descriptions of how the history and physical examination can be viewed as diagnostic tests; how to assess the accuracy of laboratory tests, radiographic imaging, and diagnostic procedures; and how to evaluate clinical research studies […]

CHAPTER 3: Interviewing and the Health History

Introduction The health history interview is a conversation with a purpose. As you learn to elicit the patient’s story, you will draw on many of the interpersonal skills that you use every day, but with unique and important differences. In social conversation, you freely express your own views and are responsible only for yourself. In […]

CHAPTER 4: Beginning the Physical Examination: General Survey, Vital Signs, and Pain

Introduction Now that you have elicited the patient’s concerns and formed a trusting relationship, you are ready to begin the physical examination. At first you may feel unsure of your skills, but through study and repetition, the physical examination will soon flow more smoothly, and you will shift your attention from technique and how to […]

CHAPTER 5: Behavior and Mental Status

Introduction As clinicians, we are uniquely poised to detect clues to mental illness and harmful behavior through empathic listening and close observation. Nonetheless, these clues are often missed. Recognizing mental illness is especially important given its significant prevalence and morbidity, the high likelihood that it is treatable, the shortage of psychiatrists, and the increasing importance […]

CHAPTER 6: The Skin, Hair, and Nails

Introduction In this edition, you will find a helpful new approach to examining the skin, hair, and nails and many new tables and photographs. This approach features careful history taking; thorough inspection and palpation of benign and suspicious lesions to better detect the three major skin cancers—basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and […]

CHAPTER 7: The Head and Neck

Introduction Many critical structures like the sensory organs, cranial nerves (CNs), and major blood vessels originate in the head and neck. To help students integrate this complex anatomy and physiology with the skills of physical examination, this chapter follows a special format. The Health History and the Health Promotion and Counseling sections cover the “HEENT” […]

CHAPTER 8: The Thorax and Lungs

Anatomy and Physiology Study the anatomy of the chest wall, identifying the structures illustrated (Fig. 8-1). Note that the number of the intercostal space between two ribs is the same number as the rib above it. FIGURE 8-1 Chest wall anatomy. Locating Findings on the Chest Describe chest findings in two dimensions: along the vertical […]

CHAPTER 9: The Cardiovascular System

Introduction Listening to the heart has come to epitomize the art of bedside diagnosis. Mastering the skills of cardiac examination requires patience, practice, and repetition—a process especially vulnerable to evolving technology and the time constraints of clinical practice.[1]–[4] Many reports attest to the current decline in physical examination skills, well documented for the cardiovascular system […]

CHAPTER 10: The Breasts and Axillae

Anatomy and Physiology The Female Breast The female breast lies against the anterior thoracic wall, extending from the clavicle and 2nd rib down to the 6th rib, and from the sternum across to the midaxillary line. Its surface area is generally rectangular rather than round (Fig. 10-1). FIGURE 10-1 The female breast. The breast overlies […]