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Clinical Surgery: A Text and Atlas
Sunil Chumber
SECTION 1: HISTORY, SIGNS AND SYMPTOMS
1:
History of the Patient
2:
Symptoms and Signs
Symptoms
SIGNS
3:
Lump, Ulcer, Sinus and Fistula
Lump
HISTORY
Duration
Onset
Location
Other Symptoms
Pain
Onset
Site
Nature
Fever
Loss of Weight
Progression of Lump
Other Lumps
Impairment of Function
Secondary Changes in the Lump
Recurrence of the Lump
Past History
Personal History
Family History
PHYSICAL EXAMINATION
LOCAL EXAMINATION
Inspection
Site
Size
Shape
Color
Surface
Edge
Pedicle
Number
Pulsation
Peristalsis
Expansile Cough Impulse
Movements
Deglutition
Protrusion of Tongue
Respiration
Pulse
Skin Changes
Pressure-effects
Palpation
Temperature
Tenderness
Surface
Size, Shape and Extent
Edge
Consistency
Uniform Consistency
Variable Consistency
Fluctuation
Method of Testing for Fluctuation
Fluid-thrill
Translucency
Expansile Cough Impulse
Reducibility
Compressibility
Response to Pressure
Pulsatility
Fixity
Skin
Moving the Skin over the Swelling
Pinching the Skin off the Swelling
Underlying Structures
Adjacent Structure
Adjacent Joints
Pressure Effects
Percussion
Auscultation
Measurements
Regional Lymph Nodes
SYSTEMIC EXAMINATION
Chest
Abdomen
Long-bones and Spine
Other Lymph Nodes
INVESTIGATIONS
Hemogram
Chemistry
Urinalysis
Serology
Culture and Sensitivity
Plain X-ray
Ultrasonography
Computed Tomography Scan
Magnetic Resonance Imaging
Angiography
Digital Subtraction Angiography
Fine Needle Aspiration Cytology
Exfoliative Cytology
Biopsy
Tuberculin Test
DIAGNOSIS OF A SWELLING
Anatomical Diagnosis
Etiological Diagnosis
Pathological Diagnosis
Malignant Transformation in a Benign Swelling
DIFFERENTIAL DIAGNOSIS
Congenital
Traumatic
Inflammatory
Pyogenic Abscess
Antibioma
Pyemic Abscess
Cold Abscess
Neoplastic
Other Swellings
Ulcer
HISTORY
Onset
Duration
Pain
Discharge
Number
Location
Edge
Types of Ulcer Edge
Undermined Edge
Punched-out Edge
Sloping Edge
Raised and Beaded Edge
Rolled-out or Everted Edge
Floor
Odor
Skin
Adjacent Structures
Associated Disease
Palpation
Tenderness
Edge
Base
Bleeding
Fixity
Skin and Adjacent Structures
Nerves
Adjacent Arteries and Veins
Regional Lymph Nodes
PHYSICAL EXAMINATION
SYSTEMIC EXAMINATION
Chest
Abdomen
Peripheral Vessels
Neurologic Examination
INVESTIGATIONS
Hemogram
Chemistry
Urine
Culture and Sensitivity
Plain X-ray
Color Doppler
Sexually Transmitted Diseases
Gonorrhea
Nongonococcal Urethritis and Genital Infection
Trichomoniasis
Syphilis
Chancroid
Donovanosis (Granuloma Inguinale)
Lymphogranuloma Venereum
Genital Herpes
Genital Warts (Condyloma Acuminata)
HIV
DIFFERENTIAL DIAGNOSIS
Ulcers Classification
Noduloulcerative Type
Superficial Spreading Type
SINUS AND FISTULA
HISTORY
Age
Temperature
Discharge
Swelling
Operations
Pain
Past History
LOCAL EXAMINATION
Inspection
Number
Position
Ear
Neck
Natal Cleft
Perineum
Other Sites
External Openings
Discharge
Skin
Palpation
Tenderness
Wall of the Sinus
Mobility
Regional Lymph Nodes
SYSTEMIC EXAMINATION
Abdomen and Perineum
Chest
Long Bones
Per-rectal Examination
INVESTIGATIONS
Microscopy, Culture and Sensitivity
Plain X-rays
Sinogram or Fistulogram
Computed Tomography Sonogram
Dye Study
DIFFERENTIAL DIAGNOSIS
SECTION 2: VESSELS, LYMPHATICS, LYMPH NODES AND NERVES
4:
Arteries
5:
Veins
Varicose Veins
HISTORY
Age
Sex
Occupation
Pain
Swelling
Bleeding
Skin
Past History
Treatment History
Family History
GENERAL EXAMINATION
PHYSICAL EXAMINATION
Inspection
Swelling
Skin
Venous Ulcer
Expansile Cough Impulse
Limb Length
Palpation
Brodie-Trendelenburg Test
Short Saphenous System
Perforators
Perthe's Test
Multiple Tourniquets Test
Saphena Varix
Transmitted Cough Impulse
Limb Length
Peripheral Pulses
Contralateral Limb
Percussion
Tap Sign
Auscultation
SYSTEMIC EXAMINATION
Chest
Abdomen
Per-rectal Examination
Regional Lymph Nodes
INVESTIGATIONS
Handheld Doppler
Color Doppler and Ultrasound
Venography
Handheld Doppler Examination
Deep Vein Thrombosis
HISTORY
Pain
Fever
Asymptomatic
Dyspnea
Family History
PHYSICAL EXAMINATION
Inspection
Edema
Pallor
Cyanosis
Palpation
Edema
Tenderness
Homan's Test
Moses’ Test
Other Areas
Measurements
INVESTIGATIONS
Blood: D-dimers
Nuclear Scan
Venography
DIFFERENTIAL DIAGNOSIS
Classification
Serverity Scoring
6:
Lymphatics
7:
Lymph Nodes
8:
Nerves
SECTION 3: BONES, JOINTS AND SKIN
9:
Bone
10:
Joints, Muscle, Tendon and Fascia
Joints
HISTORY
General Information
Age
Sex
Onset and Progress
Pain
Site
Character
Relation to Movements
Locking
Deformity
Past History
Family History
PHYSICAL EXAMINATION
LOCAL EXAMINATION
Inspection
Muscular Spasm
Range of Movement
Adjacent Joints
Palpation
Crepitus
Ausculation
Measurements
Length
Circumference
Regional Lymph Nodes
Adjacent Joints
Neurological Examination
SYSTEMIC EXAMINATION
Neck and Chest
Heart
INVESTIGATIONS
Hemogram
Microbiology
Plain Films
Ultrasonography
Computed Tomographic Scan
Magnetic Resonance Imaging
Shoulder Joint
HISTORY
Pain
LOCAL EXAMINATION
Inspection
Position
Contour
Palpation
Bony Points
Tenderness
Crepitus
Adjacent Joints
Swelling
Movements
Abduction
Flexion
Complex Movements
Range of Movements
Active Movements
Abduction
External Rotation
Shrugging
Painful Arc Syndrome
Passive Movements
Other Joints
Acromioclavicular and Sternoclavicular Joints
INVESTIGATIONS
X-rays
Blood
DIFFERENTIAL DIAGNOSIS
Elbow Joint
HISTORY
LOCAL EXAMINATION
Inspection
Swelling
Position and Deformity
Muscle Wasting
Palpation
Temperature and Tenderness
Swelling
Fluctuation
Bony Points of the Joint
Regional Lymph Node
Movements
Humeroulnar Joint
Radioulnar Joint
INVESTIGATIONS
X-rays
DIFFERENTIAL DIAGNOSIS
Wrist and Hand
HISTORY
Pain
Deformity
Swelling
LOCAL EXAMINATION
Inspection
Position
Swelling
Deformity
Palpation
Swelling
Fluctuation
Tenderness
Deformity
Movements
INVESTIGATIONS
X-rays
DIFFERENTIAL DIAGNOSIS
Hip Joint
HISTORY
Pain
Gait
Functional Assessment
Associated Symptoms
Fever
Loss of Weight and Appetite
Other Joints
Past History
Family History
Personal History
PHYSICAL EXAMINATION
Vital Parameters
LOCAL EXAMINATION
Inspection
Standing Position
Weight Bearing
Curvature of Spine
Levels of Shoulders
Levels of Posterior Superior Iliac Spines
Supine Position
Lumbar Lordosis
Levels of Anterior Superior Iliac Spine
Attitude of the Limb
Limb-length Discrepancy
Scars and Veins
Swelling
Muscle Wasting
Palpation
Lumbar Lordosis
Levels of Anterior Superior Iliac Spine
Temperature
Tenderness
Mass
Femoral Pulse
Trochanter
Deformity
Flexion Deformity
Abduction and Adduction Deformities
Kothari's Angle
Rotational Deformities
Movements
Flexion
Extension
Adduction
Abduction
Rotation
Measurements
Linear Measurements
Apparent Measurement
True Measurement
Bryant's Triangle
Circumferential Measurement
Other Tests
Telescopy
Trendelenburg's Sign
Nelaton's Line
Shoemaker's Line
Allis Test
Ortolani's Test
Barlow's Provocative Test
Gait
Regional Lymph Nodes
Adjacent Joints
SYSTEMIC EXAMINATION
Neurological and Vascular Examination
Per-rectal Examination
INVESTIGATIONS
Plain X-rays
MRI
DIFFERENTIAL DIAGNOSIS
Knee Joint
HISTORY
LOCAL EXAMINATION
Inspection
Gait
Attitude
Position of Patella
Swelling
Anterior Swellings
Posterior Swellings
Muscle Wasting
Palpation
Temperature and Tenderness
Swelling
Fluctuation
Patellar Tap
Synovial Membrane
Bursa
Cartilage
Popliteal Fossa
Transillumination Test
Compression Test
Bony Components
Crepitus
Click
Muscle Wasting
Patella
Patellofemoral Component
Tibiofemoral Component
Movements
Flexion and Extension
Abduction and Adduction
Rotation
Abnormal Movements
Measurements
Circumference of the Thigh
Circumference of the Calf
Limb Length
Deformity of Limb
Regional Lymph Nodes
SYSTEMIC EXAMINATION
Neurological Examination
INVESTIGATIONS
DIFFERENTIAL DIAGNOSIS
Anterior
Prepatellar Bursitis or Housemaid's Knee
Infrapatellar Dursitis or Clergyman's Knee
Medial
Bursa Anserina
Cyst of the Medial Meniscus
Lateral
Cyst of the Lateral Meniscus
Posterior
Semimembranosus Bursitis
Morrant Baker's Cyst
Ankle and Foot
HISTORY
LOCAL EXAMINATION
Inspection
Attitude
Swelling
Muscle Wasting
Palpation
Temperature and Tenderness
Swelling
Fluctuation
Bony Irregularity
Movements
Dorsiflexion and Plantar Flexion
Inversion and Eversion and Abduction and Adduction
Passive Movements at Ankle Joint
At Subtalar Joint
At the Midtarsal Joint
Regional Lymph Nodes
DIFFERENTIAL DIAGNOSIS
Muscle, Tendon and Fascia
HISTORY
Pain
Deformity
PHYSICAL EXAMINATION
Inspection
Swelling
Deformity
Palpation
Tenderness
Other Abnormalities
DIFFERENTIAL DIAGNOSIS
11:
Hand and Foot
Hand
HISTORY
Onset
PHYSICAL EXAMINATION
Inspection
Attitude
Deformity
Swelling
Muscular Wasting
Palpation
Temperature and Tenderness
Swelling
Pulses
Nerves Supply of the Hands
Sensory
Motor
Median Nerve
Ulnar Nerve
Radial Nerve
Movements
Wrist Joint
Carpometacarpal Joints
Metacarpophalangeal Joints
Interphalangeal Joints
DIFFERENTIAL DIAGNOSIS
Foot
HISTORY
Pain
Deformity
PHYSICAL EXAMINATION
Inspection
Deformity
Swelling, Ulcer or Sinus
Palpation
Tenderness and Temperature
Movements
Ankle Joint
Subtalar Joint
SYSTEMIC EXAMINATION
Neurological Examination
Knee, Hip and Spine
DIFFERENTIAL DIAGNOSIS
Deep Fascial Space
Pain in the Heel
Pain in the Mid Foot
Pain in the Fore Foot
Accessory Navicular Bone
Plantar Fasciitis
12:
Spine
Sacroiliac Joint
HISTORY
Tenderness
PHYSICAL EXAMINATION
Movements
Pelvic Examination
INVESTIGATIONS
Plain X-rays
Magnetic Resonance Imaging
DIFFERENTIAL DIAGNOSIS
Cervical
Thoracic
Lumbar
Lumbar Disc Prolapse
13:
Skin, Hair and Nails
Skin
HISTORY
Onset
Progression
Distribution
Mode of Spread
Symptoms
EXAMINATION OF THE SKIN
Inspection
Morphology
Primary Lesions
Macule
Papule
Vesicle
Pustule
Wheal
Scale
Purpura
Telangiectasia
Secondary Lesions
Lichenification
Umbilication
Excoriation
Scarring
Crusting
Vegetations
Atrophy
Erosion
Calcinosis
Size
Shape
Color
Margins
Surface
Pattern
Distribution
Site
Appearances
Palpation
Temperature
Tenderness
Surface
Consistency
Induration
Fluctuation
Translucency
Reducibility
Compressibility
Pulsatility
Fixity
Skin
Deep Structures
Percussion
Fluid Thrill
Three-finger Test
Auscultation
Murmur
Bruit
Regional Lymphadenopathy
Mucous Membranes
Hair
Nails
Peripheral Nerves
INVESTIGATIONS
Gram's Stain
Giemsa Stain
Slit Skin Smear
KOH Mount
Woods Lamp (365)
Biopsy
Culture
Immunofluorescence
Patch Test
Tzanck Smear
DIFFERENTIAL DIAGNOSIS
Staging
SECTION 4: HEAD AND NECK
14:
Eyes
15:
Face and Head
Face
PHYSICAL EXAMINATION
Clefts of the Primary Palate
Clefts of the Secondary Palate
Midline Cleft of the Lip
Adenoid Facies
Hippocratic Facies
Moon Facies
Cretin Facies
Facies of Cirrhosis
Carcinoid Facies
Hemolytic Facies
Cancrum Oris or Infective Gangreous Stomatitis
Head
HISTORY
Age
Infections and Trauma
Raised Intracranial Tension
Headache
Vomiting
Vision
Seizures
Cerebral Hemisphere
Parasagittal Tumors
Cerebellar Hemisphere
Other Symptoms
Herniation of Brain
GENERAL EXAMINATION
PHYSICAL EXAMINATION
Inspection and Palpation
Level of Consciousness
Best Eye Response (E)
Best Motor Response (M)
Best Verbal Response (V)
Cognitive Abilities
Mini Mental Status Examination
Speech
Cranial Nerves
Cranial Nerve I: Olfactory Nerve
Cranial Nerve II: Optic Nerve
Visual Acuity
Visual Fields
Fundus Examination
Cranial Nerves II and III: Optic and Oculomotor Nerves
Pupil
Cranial Nerves III, IV and VI: Oculomotor, Trochlear and Abducens Nerve
Cranial Nerve V (V1, V2, V3): Trigeminal Nerve
Motor
Sensory
Corneal Reflex
Cranial Nerve VII: Facial Nerve
Cranial Nerve VIII: Vestibulo-cochlear Nerve
Cranial Nerves IX and X: Glossopharyngeal and Vagus Nerve
Cranial Nerve XI: Accessory Nerve
Cranial Nerve XII: Hypoglossal Nerve
Motor System
Muscle Tone
Muscle Power
Upper Motor Neuron Lesions
Lower Motor Neuron Lesions
Fasciculations
Deltoid Muscle
Biceps Muscle
Triceps Muscle
Wrist Extensors
Movements of the Fingers
Thumb
Hamstrings
Ankle Flexors
Ankle Extensors
Sensory System
Pain and Light Touch
Stereognosia
Graphesthesia
Extinction or Simultagnosia
Deep Tendon Reflexes
Biceps and Brachioradialis Reflexes
Triceps Reflex
Knee Jerk
Ankle Jerk
Jaw Jerk
Finger Flexion
Hoffman's Response
Wartenburg
Superficial Reflexes
Abdominal Reflexes (T7-11)
Cremasteric Reflex (T12)
Plantar Reflex
Others
Ankle Clonus (S1, 2)
Patellar Clonus (L2, 3, 4)
Coordination and Cerebellar Signs
Nystagmus
Pendular Nystagmus
Vertical Nystagmus
Rotatory Nystagmus
Speech
Dysdiadochokinesis
Dysmetria
Coordination
Gait and Romberg's Sign
Romberg's Test
Meningeal Irritation
Neck Rigidity
Brudzinski's Test
Kernig's Test
SYSTEMIC EXAMINATION
Head and Neck
Ears and Nose
Chest
Heart
Abdomen
Per Rectal or Pelvic Examination
INVESTIGATIONS
CSF Protein
CSF Glucose
X-ray skull
CT Scan
MRI
PET
DIFFERENTIAL DIAGNOSIS
Frontal Lobe Tumors
Parietal Lobe Tumors
Temporal Lobe Tumors
Cerebellar Tumors
Subgaleal Abscess
Osteomyelitis
Pott's Puffy Tumor
Subdural Subdural Empyema
Scaphocephaly
16:
Teeth, Jaws and Temporomandibular Joint
Teeth
HISTORY
Presenting Complaints
Medical History
Dental History
Allergies
Social History
Family History
PHYSICAL EXAMINATION
GENERAL EXAMINATION
LOCAL EXAMINATION
Jaws
DIFFERENTIAL DIAGNOSIS
Granulomatous Epulis
Fibrous Epulis
Giant-celled Epulis (Osteoclastoma)
Carcinomatous Epulis
Fibro-osseous Group
Paget's Disease
Giant-cell Tumor or Osteoclastoma
Other Tumors
Temporomandibular Joint
LOCAL EXAMINATION
Inspection and Palpation
Normal Opening
Crepitus or Click
Disc Displacement with Reduction
Disc Displacement without Reduction or “Closed-lock”
Joint Dislocation, or “Open-lock”
Trismus
Movements
DIFFERENTIAL DIAGNOSIS
ANKYLOSIS
17:
Mouth
Lips
Tongue
Lingual Tonsil
Gums
Cheek
Floor of Mouth (FOM)
Palate
Retromolar Trigone (RMT)
Tonsils
SYSTEMIC EXAMINATION
Chest
INVESTIGATIONS
Plain X-ray or Orthopantogram (Panorex)
Contrast-enhanced Computed Tomography
Fine Needle Aspiration Cytology
Biopsy
DIFFERENTIAL DIAGNOSIS
Primary Syphilis
Chancre on Lip and Tongue
Secondary Syphilis
Mucous Patch
Snail Track Ulcers
Hutchinson's Wart
Tertiary Syphilis
Gumma
Chronic Superficial Glossitis
Leukoplakia
Submucous Fibrosis
Plummer-Vinson Syndrome
Spread
TNM Staging
Lip
Buccal Mucosa
Hard Palate
Floor of Mouth
Alveolus
Tongue
18:
Salivary Glands
Parotid Gland
HISTORY
Swelling
Site
Onset
Progression
Relationship to Meals
Pain
Fever
Redness
Others
LOCAL EXAMINATION
Inspection
Swelling
Fistula
Palpation
Fixity
Duct
Bidigital Examination
Facial Nerve
Other Glands
Movements of the Jaw
Regional Lymph Nodes
Submandibular G land
HISTORY
LOCAL EXAMINATION
Inspection
Lemon Test
Submandibular Duct
Palpation
Regional Lymph Nodes
Minor Salivary Glands
INVESTIGATIONS
Fine Needle Aspiration Cytology
Excisional Biopsy
Sialography
CT Scan and MRI
DIFFERENTIAL DIAGNOSIS
Facial Nerve Damage
Salivary Fistula
Frey's Syndrome
19:
Ear, Nose and Throat
Ear
HISTORY
Deafness
Discharge
Earache
Dizziness
PHYSICAL EXAMINATION
External Examination
Otoscopy
External Ear Canal
Middle Ear and Tympanic Membrane
Mastoid
Mobility of Eardrum
Neurological Examination
INVESTIGATIONS
Voice Testing
Tuning Fork Tests
Audiometry
X-rays
CT Scan
Magnetic Resonance Imaging
Nose
HISTORY
Nasal Obstruction
Nasal Discharge
Nasal Bleed
PHYSICAL EXAMINATION
Anterior Rhinoscopy
Posterior Rhinoscopy
Nasal Endoscopy
INVESTIGATION
X-rays
CT Scan
Head, Neck and Larynx
HISTORY
Change in Voice
Difficulty in Swallowing
Difficulty in Breathing
Other Symptoms
PHYSICAL EXAMINATION
Indirect Laryngoscopy
Videostroboscopy
INVESTIGATIONS
X-rays
CT Scan
20:
Thyroid
Parathyroids
HISTORY
Skeletal
Renal
Gastrointestinal
Nervous System
Other
PHYSICAL EXAMINATION
INVESTIGATIONS
Serum Calcium
Serum Phosphate
Urinary Calcium
Serum Alkaline Phosphatase
Vitamin D
Serum PTH
Skeletal Survey
Ultrasound
CT Scan
Angiography
Parathyroid Scan
Intraoperative Localization
DIFFERENTIAL DIAGNOSIS
Chvostek's Sign
Trousseau's Sign
21:
Neck
SECTION 5: BREAST, CHEST AND HEART
22:
Breast
Male Breast
HISTORY
PHYSICAL EXAMINATION
INVESTIGATIONS
Mammography
Ultrasonography
Fine Needle Aspiration Cytology
Core Biopsy
Open Surgical Biopsy
Frozen Section
DIFFERENTIAL DIAGNOSIS
In Situ
Invasive
In Situ
Invasive
Spread of Breast Cancer
Staging of Breast Cancer
Aspiration
Mammography
Evaluation for Distant Disease
Hormone Receptors
23:
Chest
24:
Heart
Clinical Evaluation of Patients with Heart Disease
GENERAL PHYSICAL EXAMINATION
Pulse
Blood Pressure
Hands
Pedal Edema
Jugular Venous Pulse
Wave Form
Central Venous Pressure
Precordial Examination
Inspection
Palpation
Percussion
Auscultation
Investigations
Brief Description of Common Cardiac Diseases
SECTION 6: ABDOMEN AND HERNIA
25:
Esophagus
26:
Abdomen
Acute Abdomen
HISTORY
Pain
Onset
Time
Location of Pain
Shifting of Pain
Character of Pain
Severity of Pain
Referral of Pain
Relation to a Natural Acts Like Defecation, Micturition or Respiration
Relief from Pain
Vomiting
Relation to Pain
Frequency and Quantity
Character of Vomiting
Contents of Vomitus
Bowel Function
Diarrhea
Constipation
Distension of Abdomen
Problems of Micturition
History of Systemic Illness
PHYSICAL EXAMINATION
Emptying of the Bladder
Position of the Patient
Quadrants of the Abdomen
Regions of the Abdomen
Inspection
Contour of Abdomen
Respiratory Movements
Visible Peristalsis
Skin
Hernial Sites
Palpation
Hyperesthesia
Tenderness
Muscular Guarding (Rigidity)
Lump and Organomegaly
Percussion
Shifting Dullness
Loss of Liver Dullness
Auscultation
Rectal and Pelvic Examination
Groin and Genitalia
Child with Acute Abdomen
HISTORY
Age
PHYSICAL EXAMINATION
General Condition/Activity Level
Head and Neck
Ears
Chest
ABDOMINAL EXAMINATION
Inspection
Palpation
Palpation and Auscultation
Rectal Examination
Genitalia
INVESTIGATIONS
Hemogram
Hemoglobin
White Blood Count (TLC)
Electrolytes and Urea
Plasma Amylase
Plain Radiographs
Ultrasound Examination
Barium Gastrointestinal Studies
Abdominal CT Scan
Laparoscopy
DIFFERENTIAL DIAGNOSIS
Chronic Abdomen
HISTORY
Age
Sex
Abdominal Pain
Location of Pain
Character of Pain
Parietal or Visceral Pain
Referred Pain
Onset and Duration
Periodicity
Associated Factors
Nausea and Vomiting
Character and Amount
Frequency and Relation to Food
Hematemesis and Malena
Jaundice
Examination in Daylight
Color of Urine
Color of Stools
Pruritus
Appetite
Altered Bowel Function
Loss of Weight
Fever
Past History
Family History
PHYSICAL EXAMINATION
Inspection
Skin
Contour of the Abdomen
Umbilicus
Symmetry
Respiration
Peristalsis
Pulsation
Palpation
Superficial Palpation
Deep Palpation
Rebound Tenderness
Palpation of Intra-abdominal Organs
Liver
Spleen
Kidney
Renal Angle Tenderness
Gallbladder
Pancreas
Free Fluid
Shifting Dullness
Fluid-Thrill
Bulging Flanks
Percussion
Liver-dullness
Auscultation
Succussion Splash
Rectal Examination
DIFFERENTIAL DIAGNOSIS
Abdominal Lump
HISTORY
PHYSICAL EXAMINATION
Inspection
Position, Size and Shape of Lump
Skin
Movement with Respiration
Visible Peristalsis
Hernial Orifices
Genitalia
Palpation
Superficial Palpation
Deep Palpation
Tenderness
Local Temperature
Size, Shape and Surface
Position of the Lump
Parietal or Intra-abdominal
Head Raising Test
Leg Raising Test
Knee-elbow Test
Consistency
Fluctuation and Fluid Thrill
Pitting
Movement with Respiration
Mobility
Bimanual Palpation
Ballotment
Pulsatile Swelling
Finger Separation Test
Knee-elbow Position
Hernial Sites
Palpation of Normal Solid Viscera
Percussion
Kidney or Spleen?
Shifting Dullness
Fluid Thrill
Hydatid Thrill
Liver Dullness
Auscultation
Left Supraclavicular Lymph Nodes
Pelvic Examination
SYSTEMIC EXAMINATION
Neck
INVESTIGATIONS
Hemogram
Plasma Amylase
Bilirubin
Proteins
Sugar and Lipids
Liver Enzymes
Coagulation Factors
Urine Examination
Stool Examination
Plain Radiographs
Barium Meal Follow Through (BaMFT)
Small Bowel Enema (Enteroclysis)
Barium Enema
Angiography
Ultrasound Examination
Computed Tomography Scan
Magnetic Resonance Imaging
Percutaneous Transhepatic Cholangiography
Intravenous Urogram (IVU or IVP)
Technetium Scan
Liver Scan
Biliary Scan
Needle Biopsy of the Liver
Gastric Acid Output Study
Gastric Emptying
Carcinoembronic Antigen
Beta-subunit of Human Chorionic Gonadotropin (β-hCG)
Markers of Viral Hepatitis
Endoscopy
Esophagoscopy
Endoscopic Retrograde Cholangiopancreatography
Sigmoidoscopy and Colonoscopy
Laparoscopy
DIFFERENTIAL DIAGNOSIS
Parietal Wall Swellings
Intra-abdominal Swellings
Right Hypochondrium
Colon
Epigastrium
Insulinoma
Gastrinoma
Other Tumors
Left Hypochondrium
Primary Hypersplenism
Secondary Hypersplenism
Hodgkin's Disease
Non-Hodgkin's Lymphoma
Colon
Lumbar Regions (Left and Right)
Umbilical Region
Small Intestine
Mesentery
Omentum
Right Iliac Fossa
Left Iliac Fossa
Hypogastrium
Urologic Problems
HISTORY
Age
Sex
Geographic Distribution
Occupation
Pain
Renal Pain
Pseudorenal Pain (Radiculitis)
Ureteral Pain
Bladder Pain
Prostate Pain
Penile or Urethral Pain
Scrotal Pain
Changes in Urine Volume
Anuria
Oliguria
Polyuria
Irritative Symptoms
Dysuria
Strangury
Frequency
Nocturia
Nycturia
Urgency
Obstructive Symptoms
Hesitancy
Straining on Micturition
Decreased Force and Caliber of the Urinary Stream
Terminal Dribbling of Urine
Sense of Residual Urine
Lower Urinary Tract Symptoms
Urinary Retention
Interruption of the Urinary Stream
Bifurcation of the Urinary Stream
Incontinence
True or Total Incontinence
False or Overflow Incontinence
Urgency Incontinence
Stress Incontinence
Enuresis
Changes in the Gross Appearance of the Urine
Cloudy Urine
Pyuria
Chyluria
Pneumaturia
Hematuria
Colored Urine
Urethral Discharge
Sexual Dysfunction
Infertility
Penile Problems
Scrotum
Abdomen
Swelling
Chronic Renal Failure
Gastrointestinal Manifestations or Syndromes
Nausea, Vomiting and Abdominal Distension
Generalized Abdominal Pain and Distension
Compression or Displacement Manifestations
Chronic Gastrointestinal Disease
Past History
Drug History
GENERAL EXAMINATION
Edema
Tongue
Level of Consciousness
Pulse and Respiration
Blood Pressure
LOCAL EXAMINATION
Inspection
Supine Position
Sitting Position from Behind
Palpation
Supine Position
Bimanual Palpation
Lateral Position
Sitting Position
Renal Lump
Consistency
Fluctuation
Percussion
Anterior Percussion
Posterior Percussion
Auscultation
Palpation and Percussion
Bimanual Examination
Abdomen
Urethra
External Genitalia
Perineum
Rectal Examination
Sphincter Tone
Lobes of Prostate
Size
Consistency
Surface
Rectal Mucosa
Prostatic Massage
SYSTEMIC EXAMINATION
Chest
INVESTIGATIONS
Urine Examination
Blood Urea and Serum Creatinine
Plain X-ray
Intravenous Urogram or Pyelogram (IVU or IVP)
Renal Arteriography
Cystography and Micturating Cystourethrography
Retrograde Urethrography (RGU)
Ultrasonography
Transrectal Ultrasound (TRUS) and Prostate Biopsy
Computerized Tomography (CT Scan)
Magnetic Resonance Imaging (MRI)
Tc-99m DMSA Renal Scan
DTPA Renal Scan
Diuretic Renal Scan
Bone Scan
Urethrocystoscopy
Ureterorenoscopy
Nephroscopy
Prostate Specific Antigen
Alpha-fetoprotein
hCG
LDH
Uroflowmetry
Urodynamic Study
DIFFERENTIAL DIAGNOSIS
Infantile Polycystic Kidney Disease
Adult Polycystic Kidney Disease (DPK)
Multicystic Kidney
27:
Rectum and Anus
28:
Hernia
Groin Hernias
HISTORY
Age
Sex
Pain
Lump or Swelling
Onset
Location
Size and Extent
Duration of Symptoms
Unilateral or Bilateral
Expansile Cough Impulse
Reducibility
Aggravating Factors
Complications
Intestinal Obstruction
Strangulation
Past History
PHYSICAL EXAMINATION
Position of Patient
Inspection
Overlying Skin
Size and Shape of Swelling
Location of the Swelling
Expansile Cough Impulse
Visible Peristalsis
Position of the External Genitalia
Palpation
To Get Above the Swelling
Location of Swelling
Extent of Swelling
Consistency
Relation to the Testis and Spermatic Cord
Expansile Cough Impulse
Tenderness and Temperature
Fluctuation and Transillumination
Reducibility
Deep Ring Occlusion Test
Finger Invagination Test
Tone of the Abdominal Muscles
Testis, Epididymis, Spermatic Cord and Urethra
Percussion
Auscultation
Per-rectal Examination
GENERAL EXAMINATION
SYSTEMIC EXAMINATION
Chest
Abdomen
DIFFERENTIAL DIAGNOSIS
Incisional Hernia
HISTORY
Previous Operation
Patient Related Factors
Postoperative Conditions
PHYSICAL EXAMINATION
Inspection
Operative Scar
Overlying Skin
Swelling
Palpation
Swelling
Reducibility
Expansile Cough Impulse
Head-raising
Defect
Percussion
Auscultation
Per-rectal Examination
SYSTEMIC EXAMINATION
Chest
Umbilical and Paraumbilical Hernia
HISTORY
Age
PHYSICAL EXAMINATION
Inspection
Expansile Cough Impulse Swelling
Location of Umbilicus
Skin
Palpation
Defect
Reducibility
Expansile Cough Impulse
Scar
Complications
Percussion
Auscultation
Epigastric Hernia
HISTORY AND PHYSICAL EXAMINATION
Rare Hernias
DIFFERENTIAL DIAGNOSIS
Indirect Inguinal Hernia
Direct Inguinal Hernia
Spigelian Hernia
Obturator Hernia
Reducible Hernia
Irreducible Hernia
Obstructed Hernia
Incarcerated Hernia
Strangulated Hernia
Pantaloon Hernia
Prevesical Hernia
Maydl's Hernia (Hernia-en-W)
Interparietal Hernias (Interstitial Hernias)
Sliding Hernia (Hernia-en-glissade)
Paraostomy Hernias
Littre's Hernia
Amyand's Hernia
Irreducibility
Obstruction
Strangulation
Incarceration
Inflammation
29:
Male Genitalia
Scrotum
HISTORY
Age
Occupation
Pain
Fever
Trauma
Lump
LOCAL EXAMINATION
Inspection
Skin
Swelling
Ulcers
Edema
Lymphedema
Palpation
Transillumination
Reducibility
Expansile Cough Impulse
Testis
SYSTEMIC EXAMINATION
Chest and Abdomen
Per-rectal Examination
Penis
HISTORY
Age
Race
Stream of Urine
Phimosis
Paraphimosis
Penile Ulcers
Discharge
Burning During Micturition
LOCAL EXAMINATION
Inspection
Retraction of the Prepuce
Infection
Meatus
Premalignant Lesions
Palpation
Growth
Body of Penis
Milking the Penis
Size
Chordee
Regional Lymph Nodes
INVESTIGATIONS
Ultrasonography
Computerized Tomography Scan
AFP
hCG
LDH
Semen Analysis
Testicular Biopsy
FSH/LH Levels
Prolactin
Testosterone
Chromosomal Studies
Uroflowmetry
Urodynamic Study
Prostate Specific Antigen
Transrectal Ultrasound (TRUS) and Prostate Biopsy
Bone Scan
DIFFERENTIAL DIAGNOSIS
Congenital Hydrocele
Infantile Hydrocele
Encysted Hydrocele of the Cord
Acquired Hydrocele
Idiopathic (Primary) Hydrocele
Staging
SECTION 7: SPECIAL GROUPS
30:
Preanesthetic Evaluation
31:
Psychiatric Evaluation
32:
Female Patient
Gynecological Assessment
HISTORY
Age
Marital Status
Parity
Chief Complaints
History of Presenting Complaint
Abnormal Menstrual Bleeding
Frequency, Duration and Regularity
Periods of Amenorrhea
Quantity of Flow
Pain and Passage of Clots
Abnormal Vaginal Discharge
Others
Pelvic Pain
Vaginal Discharge
Abdominoplevic Mass
Lump at the Vulva
Backache
Dyspareunia
Urinary Symptoms
Lower Gastrointestinal Symptoms
Infertility
Unrelated Illness
Phobias
Menstrual History
Obstetric History
Total Number of Pregnancies
Deliveries
Type of Delivery and Weight of Baby
Condition of the Babies at Birth
Postpartum Complications
Breastfeeding
Abortions
Date of the Last Pregnancy and Delivery or Abortion
Complications of Pregnancy/Abortion
Postpartum Contraception
Menstruation after Delivery
Current Status of Children
Marital History
Contraceptive History
Past History
Personal History
Family History
Drug History
Social History
PHYSICAL EXAMINATION
Neck
Chest
Breasts
Abdomen
Inspection
Palpation
Percussion
Auscultation
PELVIC EXAMINATION
Supine Position
Lateral Position
Sims’ Position
Lithotomy Position
Inspection
External Genitalia
Vagina
Speculum Examination
Cervix
Palpation
Vagina and Cervix
Perineal Body
Bimanual Palpation
Adnexa
Pouch of Douglas
Rectal Examination
Rectovaginal Examination
Hernial Orifices
INVESTIGATIONS
Cytology and Pap Smear
Vaginal Cytology for Hormonal Assay
Visual inspection with Acetic or Lugol's Iodine
Schiller's Test
Colposcopy
Cervical Biopsy
Endometrial Biopsy
Cervical Mucus Arborization Test
Semen Analysis
Basal Body Temperature
Others Tests
Ultrasonography
Hysterosalpingography
Culdocentesis
Hysteroscopy
Pituitary Hormones
Follicular Stimulating Hormone
Luteinizing Hormone
Prolactin
Human Chorionic Gonadotropin
Steroidal Hormones
Estrogens
Progesterone
Androgens and Adrenal Steroids
Thyroid Function Tests
DIFFERENTIAL DIAGNOSIS
Puberty Menorrhagia
Painful Menses (Dysmenorrhea)
Oligomenorrhea (Prolonged Cycles)
Obstetric Assessment
HISTORY
Age
Occupation
Gravidity and Parity
Duration of Marriage
Socioeconomic Status
Period of Gestation
Complaints during Pregnancy
History of Present Illness
Nausea and Vomiting
Heartburn
Constipation
Urinary Frequency
Backache
Leg Cramps
Syncope
Vaginal Discharge
Ankle Edema
Pain
Obstetric Outcomes
Past Medical and Surgical History
Personal History
Family History
PHYSICAL EXAMINATION
GENERAL EXAMINATION
Height
Weight
Build
Pallor
Oral Cavity
Neck
Edema of Legs
Varicose Veins
Vital Parameters
SYSTEMIC EXAMINATION
Cardiovascular System
Respiratory System
Reflexes
Breasts
OBSTETRIC EXAMINATION
Inspection
Uterine Contour
Size of Uterus
Cutaneous Changes
Striae Gravidarum
Scars
Umblicus
Hernial Sites
Fetal Movements
Palpation
Fundal Height
Palpation of the Upper Margin of the Fundus
Palpation of the Upper Margin of the Symphysis Pubis
Abdominal Girth
Obstetric Grips
Fundal Grip (First Leopold)
Lateral Grip (Second Leopold)
Pelvic Grips
1st Pelvic Grip (Powlik's Grip)
2nd Pelvic Grip
Liquor Volume Assessment
Auscultation
Fetal Heart Rate
Speculum Examination
Vaginal Examination
Clinical Pelvimetry
33:
Child and Newborn
Newborn
GENERAL EXAMINATION
PHYSICAL EXAMINATION
Skin
Head, Neck and Face
Eyes
Chest
Heart
Abdomen and Perineum
Genitourinary System
Pelvis and Extremities
Hip
Feet
Upper Limb
Spine
Neurologic Examination
Other Congenital Abnormalities
CARE AND TRANSPORT OF THE NEWBORN
34:
Elderly Patient
SECTION 8: TRAUMA AND MEDICOLEGAL NEGLIGENCE
35:
Patient with Trauma
Head Injury
HISTORY
Mode of Injury
Level of Consciousness
Glasgow Coma Scale
Lucid Interval
Duration of Unconsciousness
Amnesia
Retrograde Amnesia
Convulsions
Headache
Vomiting
Swelling
Bleeding and Cerebrospinal Fluid Discharge
Cerebrospinal Fluid Rhinorrhea
Others
Alcohol and Drugs
Past History
Personal History
Family History
PHYSICAL EXAMINATION
Pulse and Blood Pressure
Respiration
Temperature
LOCAL EXAMINATION
Fractures
Hematoma
Wounds
Lacerations and Bruising
Boggy Swelling
Position of the Patient
Eyes
Eye Movements
Pupils
Limb Weakness
Rigidity of the Neck
Cranial Nerves
Other Manifestations
Seizures
Cerebellar Signs
Decerebrate Rigidity
Reflexes
Serial Neurological Examination
Delayed Effects of Head Injury
Post-traumatic Epilepsy
Early Epilepsy (Within the First Week from Injury)
Late Epilepsy (After the First Week from Injury)
Cerebrospinal Fluid Leak
Altered Taste and Smell
Postconcussional Symptoms
Cumulative Brain Damage
INVESTIGATIONS
X-ray
Computed Tomography Scan
Magnetic Resonance Imaging
SPECIFIC INJURIES IN HEAD TRAUMA
Maxillofacial Injuries
HISTORY
PHYSICAL EXAMINATION
Facial Skeleton
Nasal Bones
Zygoma
Middle Third of Face (Maxilla)
Le Fort I
Le Fort II
Le Fort III (Craniofacial Dysjunction)
Mandible
Neck and Condyle of Mandible
Body of the Mandible
Dislocation of the Mandible
Neck
Chest Injuries
HISTORY
PHYSICAL EXAMINATION
Inspection
Skin
Respiration
Swelling
Sputum
Palpation
Subcutaneous Emphysema
Ribs
Chest Compression Test
Sternum
Swelling
Spine
Percussion
Mediastinal Shift
Auscultation
Crepitus
Lungs
Heart
INVESTIGATIONS
Chest Radiography
Computed Tomography (CT) Scan
Bronchoscopy
Thoracoscopy
INJURIES TO THE CHEST
Aorta
Heart
Esophagus
Diaphragm
Abdominal Injuries
HISTORY
Initial Assessment
Mechanism of Injury
Type of Weapon
Site of Injury
Pain
Passing of Urine
Other
ABDOMINAL EXAMINATION
Vital Parameters
Inspection
Skin
Contour
Movement
Swelling
Palpation
Tenderness
Muscle Guarding
Rigidity
Rebound Tenderness
Swelling
Percussion
Liver Dullness
Fluid Thrill
Shifting Dullness
Suprapubic Area
Auscultation
Repeated Examinations
SYSTEMIC EXAMINATION
Head, Neck and Face
Spine and Pelvis
Chest
Rectal and Vaginal Examinations
INVESTIGATIONS
Diagnostic Peritoneal Lavage
CT Scan
Focussed Abdominal Sonography for Trauma
ABDOMINAL INJURIES
Bladder Injury during Childbirth
Anterior Urethral Injuries
Posterior Urethral Injuries
Spinal Injuries
HISTORY
Mechanism of Trauma
Spinal Ligaments
Fractures and Fracture-dislocations
Seat-belt Injury
Paralysis
Paraplegia
Sensory Loss
PHYSICAL EXAMINATION
Inspection
Limbs
Upper Limbs
Attitude
Sensations
Muscle Power
Lower Limbs
Segmental Levels of Injury
Sensation
Muscle Power
Reflexes
Urinary Bladder
Respiration
Skin
Bed Sore
Swelling
Other Findings
Palpation
Spinal Column
Prominent Spinous Process
Swelling
Tenderness
Abnormal Mobility
Percussion
Movements
Rectal Examination
SYSTEMIC EXAMINATION
Associated Injuries
Head
Chest
Abdomen
Pelvis
Limbs
INVESTIGATIONS
Plain X-rays and CT Scan
CT and MRI
DIFFERENTIAL DIAGNOSIS
Musculoskeletal Trauma
HISTORY
Mode of Injury
Age
Medical Illnesses
Systemic Survey
Musculoskeletal Examination
LOCAL EXAMINATION
Inspection
Look
Attitude
Swelling and Deformity
Shortening
Skin
Palpation (Table 35.18)
Feel
Tenderness
Bony Irregularity
Abnormal Mobility and Crepitus
Transmitted Movements
Wound and Soft Tissue
Splinting
Movement
Painful Restriction of Movements
Swollen and Tender Joint
Widening of Bone Ends
Stress Testing of Joint (Static Stability)
Deformity
Measurements
Longitudinal Length
Circumferential Girth
Neighboring Structures and Associated Injuries
Vascular Structures
Neural Damage
Associated Organ Damage
Cervical Spine
Pelvis
Chest
Other illness
Pathological Fractures
Complications of Fractures
General
Local
Commonly Overlooked Fractures
Fracture of Scaphoid
Basilar Skull Fractures
Fracture of Odontoid Process in Cervical Spine Injuries
Zygomatic Arch and Orbital Fractures in Maxillofacial Injuries
Injury to C7 Vertebra
Posterior Dislocation of Shoulder
Fracture Scaphoid, Lunate, Perilunate Dislocations
Seat-belt Fracture
Fractures of Tarsal Bones
INVESTIGATION
Plain X-rays
CT Scan
DIFFERENTIAL DIAGNOSIS
Epiphyseal Injury
Injuries of Upper Limb
Three-point Relationship
Injuries of Lower Limb
Type I Fractures
Type II Fractures
Type III Fractures
Type IV Fractures
Posterior
Anterior
Central
Abduction Injuries
Pronation Injuries or Diastasis
Supination Injuries
Vertical Compression Injuries
Pelvis and Perineum
TRIAGE
In-Hospital Triage Protocol in Mass Casualties
Priority Color Codes
Priority I
Priority II
Priority III
36:
Death
37:
Doctor-Patient Relationship and Medicolegal Negligence
38:
Laboratory Investigations
Appendix
INDEX
TOC
Index
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