CHAPTER 20: The Older Adult

Introduction Older Americans now number more than 43 million people and are expected to reach 80 million by 2040, over 20% of the population.[1],[2] Americans are living longer than previous generations: life span at birth is currently 81 years for women and 76 years for men. The population over age 85 years is projected to […]

CHAPTER 19: The Pregnant Woman

Introduction This chapter presents the history and physical examination of the healthy pregnant woman. Many of the techniques of examination are similar to those of the nonpregnant woman; however, the clinician must distinguish the changes of pregnancy from abnormal findings. This chapter reviews common anatomic and physiologic changes as they evolve throughout pregnancy, elements of […]

CHAPTER 18: Assessing Children: Infancy through Adolescence

Introduction This chapter highlights clinical assessment for each pediatric age group, beginning with general principles of development and key components of health promotion. Newborns, infants, young and school-aged children, and adolescents are covered in separate sections, with relevant discussions of development, history taking, health promotion and counseling, and techniques of examination for each (Figs. 18-1 […]

CHAPTER 17: The Nervous System

Introduction The focus of this chapter is the evaluation of the cranial nerves (CNs), the motor system with all its components, the sensory system, and the reflexes. The complex anatomy and physiology of the nervous system make examination and assessment especially challenging, but attainable with practice and dedication. For many of the body systems, the […]

CHAPTER 16: The Musculoskeletal System

Introduction Musculoskeletal disorders are the leading primary diagnosis during office visits in the United States.[1] In 2012, these disorders totaled 93 million visits, or 10% of all ambulatory care visits, highlighting the need for competent office examinations. Arthritis affects one in five Americans, or 22% of the adult population, and is the leading cause of […]

CHAPTER 15: The Anus, Rectum, and Prostate

Anatomy and Physiology The sigmoid colon terminates at the rectum, which lies against the sacrum and coccyx, then merges with the short segment of the anal canal (Fig. 15-1). The rectum extends from the rectosigmoid junction, anterior to the S3 vertebra, to the anorectal junction at the tip of the coccyx. The external margin of […]

CHAPTER 14: Female Genitalia

Anatomy and Physiology Knowing the basics of pelvic anatomy will enhance your examination skills and improve your detection of abnormal findings. Begin by reviewing the anatomy of the external female genitalia, or vulva (Fig. 14-1). Note the mons pubis, a hair-covered fat pad overlying the symphysis pubis; the labia majora, rounded folds of adipose tissue […]

CHAPTER 13: Male Genitalia and Hernias

Anatomy and Physiology Review the anatomy of the male genitalia (Fig. 13-1). The shaft of the penis is formed by three columns of vascular erectile tissue: the corpus spongiosum, containing the urethra, and two corpora cavernosa. The corpus spongiosum extends from the bulb of the penis to the cone-shaped glans with its expanded base, or […]

CHAPTER 12: The Peripheral Vascular System

Introduction Careful assessment is essential for detection of diseases of the peripheral arteries (Fig. 12-1) and veins. Peripheral artery disease (PAD) is generally defined as atherosclerotic disease distal to the aortic bifurcation, although some guidelines also include the abdominal aorta.[1],[2] PAD affects roughly 8 million Americans, with estimates ranging from 5.8% to 12% of the […]

CHAPTER 11: The Abdomen

Anatomy and Physiology Visualize or palpate the bony landmarks of the abdominal wall and pelvis, as shown in Figure 11-1: the xiphoid process, iliac crest, anterior superior iliac spine, pubic tubercle, and symphysis pubis. The rectus abdominis muscles become more prominent when the patient raises the head and shoulders or lifts the legs from the […]