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Lynn S. Bickley, MD, FACP
Clinical Professor of Internal Medicine
School of Medicine
University of New Mexico
Albuquerque, New Mexico
Peter G. Szilagyi, MD, MPH
Professor of Pediatrics
Chief, Division of General Pediatrics
University of Rochester School of Medicine and Dentistry
Rochester, New York
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11th Edition
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Copyright © 2009 by Wolters Kluwer Health | Lippincott Williams & Wilkins. Copyright © 2007, 2003, 1999 by Lippincott
Williams & Wilkins. Copyright © 1995, 1991, 1987, 1983, 1979, 1974, by J. B. Lippincott Company. All rights reserved. This
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9 8 7 6 5 4 3 2 1
Printed in China
Library of Congress Cataloging-in-Publication Data
Bickley, Lynn S.
Bates’ guide to physical examination and history-taking.—11th ed./Lynn S. Bickley, Peter G. Szilagyi.
p.; cm.
Guide to physical examination and history-taking
Includes bibliographical references and index.
ISBN 978-1-60913-762-5 (hardback : alk. paper)
I. Szilagyi, Peter G. II. Bates, Barbara, 1928–2002. Guide to physical examination and history-taking.
III. Title. IV. Title: Guide to physical examination and history-taking.
[DNLM: 1. Physical Examination—methods. 2. Medical History Taking—methods. WB 205]
616.07′54—dc23
2012029587
Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices.
However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from appli-
cation of the information in this book and make no warranty, expressed or implied, with respect to the currency, complete-
ness, or accuracy of the contents of the publication. Application of this information in a particular situation remains the
professional responsibility of the practitioner; the clinical treatments described and recommended may not be considered
absolute and universal recommendations.
The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text
are in accordance with the current recommendations and practice at the time of publication. However, in view of ongoing
research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions,
the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings
and precautions. This is particularly important when the recommended agent is a new or infrequently employed drug.
Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clearance for
limited use in restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each
drug or device planned for use in his or her clinical practice.
LWW.COM
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To
Randolph B. Schiffer,
for his lifelong care and support,
and to our students world-wide committed to clinical excellence.
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A c k n o w l e d g m e n t s
For his ever-thoughtful insights into improving the examination of children
and adolescents, we highlight the important contribution of Peter Szilagyi,
MD, MPH, our pediatrics author, to Chapter 18, Assessing Children: Infancy
Through Adolescence in our 11th edition of Bates’ Guide to Physical Exami-
nation and History Taking. He has been a responsive and valued coauthor
over the past three editions.
As with each edition, many experts across the nation enriched the 11th edi-
tion. We are grateful to two colleagues at the University of New Mexico
School of Medicine: George Comerci, MD, Division of Integrative Medi-
cine, an excellent internist and teacher, provided an intensive look at Chap-
ter 9, The Cardiovascular System; and Carla Herman, MD, MPH, Chief of
Geriatrics, suggested many useful updates for Chapter 20, The Older Adult.
Andrew Dentino, MD, from Texas Tech University Health Sciences Center
School of Medicine also lent enthusiastic comments to the text of Chapter
20. We appreciate the helpful revisions proposed by Susan Langer, MD,
psychiatrist, which guided changes in Chapter 3, Interviewing and the Health
History, and Chapter 5, Mental Status and Behavior. Ron Rapini, MD, from
the University of Texas Health Sciences Center in Houston offered valuable
suggestions for Chapter 6, The Skin, Hair, and Nails, as did Elaine Dan-
nefer, PhD and Nancy Obuchowski, PhD, at the Cleveland Clinic in their
reviews of Chapter 2, Clinical Reasoning, Assessment, and Recording Your
Findings. Several contributors deserve special mention for enhancing the
focus on women’s health: Justina Trott, MD, from Women’s Health Services
in Santa Fe and the Robert Wood Johnson Center for Health Policy at the
University of New Mexico, who facilitated a general women’s health content
review; Julie Craig, MD, MPH, also from Women’s Health Services, who
thoroughly updated Chapter 19, The Pregnant Woman; and Kim Templeton,
MD, University of Kansas, who provided detailed scrutiny of Chapter 16, The
Musculoskeletal System. Valuable contributors to Chapter 9, The Cardiovascu-
lar System; Chapter 10, The Breasts and Axillae; and Chapter 14, Female Gen-
italia include Annabelle Volgman, MD, Rush Heart Center for Women;
Patricia Dawson, MD, PhD, Swedish Cancer Institute and the University of
Washington School of Medicine; Janice Werbinski, MD, Borgess Women’s
Health and Michigan State University; and Dutima Batra, MD, Permanente
Medical Group. Jennifer Pierce, MD, PhD, Women’s Health Services in
Santa Fe, assessed Chapter 8, The Thorax and Lungs, and also reviewed Chap-
ter 16. Randolph Schiffer, MD displayed his customary excellence clarifying
the challenging content in Chapter 17, The Nervous System.
Acknowledgments vii
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We would also like to thank Michael Barone, MD, The Johns Hopkins
University School of Medicine; Anne Gadomski, MD, Mary Imogene
Bassett Center; Nancy Mogielnicki, Child Health Associate; Mark Craig;
and multiple fellows and medical students for their excellent reviews of
Chapter 18, Assessing Children: Infancy Through Adolescence.
As always, this book reflects the special talents and expertise of the publish-
ing team at Wolters Kluwer/Lippincott Williams & Wilkins. Annette Fer-
ran, Supervising Product Manager, tackled the innumerable details of
editing each chapter and aligning content, layout, and illustration with per-
severance and unflagging attention to excellence for both the 11th edition
and Bates Pocket Guide to Physical Examination and History Taking, 7th
edition. Chris Miller, Project Manager with Aptara, has brought meticulous
care to every aspect of the book’s production, ensuring its polished appear-
ance and easy-to-follow format for students and teachers. Brett MacNaugh-
ton, Art Director, has overseen the valued integration of both photographs
and illustrations with layout and text. Marcelo Oliver and Body Scientific
International are responsible for the new, beautifully rendered illustrations
in the 11th edition. We remain grateful to these people, as well as to the
many staff members of Wolters Kluwer/Lippincott Williams & Wilkins
who have contributed so much to the editions of this textbook over the
decades.
Finally, for his invaluable and cheerful help answering requests for the
hundreds of references reviewed for this new edition, we applaud Arthur
Robinson, medical librarian at the Christus St. Vincent Regional Medical
Center in Santa Fe.
viii Acknowledgments
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