Essentials of Clinical Examination Handbook

719 Pages·2018·204.059 MB·English

by  Yuhao Shi, Zahra Sohani, Brandon Tang

ESSENTIALS OF
Clinical Examination
HANDBOOK
Eighth Edition
Editors-in-Chief:
Yuhao Shi, BSc Brandon Tang, BSc
Zahra Sohani, MSc, PhD Florentina Teoderascu, MD, HBHSc
TMSP I
Thieme
TORONTO MEDICAL STUDENT
PUBLICATIONS
Toronto Medical Student Publications Thieme
Toronto, Ontario, Canada New York · StuUgart • Delhi· Rio de Janeiro
Essentials of Clinical Examination Handbook, Eighth Edition, Copyright© 2017 Toronto Medical
Student Publications
Editors:
Yuhao Shi
Zahra Sohani
Brandon Tang
Florentina Teoderascu
Cover Design: Wendy Gu
Thieme Publishers (www.thieme.com) is the exclusive worldwide distributor of Essentials of Clinical
Examination Handbook, Eighth Edition.
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Essentials of Clinical Examination Handbook, Eighth Edition, is provided for the sole use of the
purchaser. This book, including all parts thereof, is legally protected by copyright. Any use, exploitation, or
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Notice: The editors of this edition have taken every effort to ensure that the information contained herein is
accurate and conforms to the standards accepted at the time of publication. However, due to the constantly
changing nature of the medical sciences and tha possibility of human error, the reader is encouraged to
exercise individual clinical judgment and consult with other sources of information that may become available
with continuing research. The authors, editors, and publisher are not responsible for errors or omissions
or for any consequences from application of the information in this book and make no warranty, expressed
or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. In
particular, the reader is advised to check Iha manufacturer's insert of all pharmacologic products before
administration.
Seventh Edition copyright @2 013 Editors: Justin Hall, Katrina Piggott, Miliana Vojvodic, and Kirill Zaslavsky
Sixth Edition copyright@ 201 O Editors: Matthew Lincoln, Christopher Tran, Gordon McSheffrey, Denise
Wong
Flffh Ed/Uon copyright@ 2005 Editors: Woganee Filate, Dawn Ng, Rico Leung, Mark Sinyor
Fourth Edition copyright@ 2002 Editors: Sonial Butalia, Catherine Lam, Hin Hin Ko, Jensen Tan
Third Edition copyright@ 2000 Editors: Tyler Rouse, Cory Torgerson, Gilbert Tang, Hariette Van Spall
Second Edition copyright@ 1999 Editors: Ashis Chawla, Rizwan somani
First Edition copyright@ 1997 Editors: Shana Burch, Derek Plausinis
Library and Archives Canada Cataloguing in Publication Information is available from the publisher.
ISBN 978-1-62623~
elSBN 978-1-62623-945-8
Printed in the United States
54321
Table of Contents
Preface and Acknowledgements ......................................................................................... V
Contributors ........................................................................................................................ VI
Common Abbreviations ...................................................................................................... IX
Foundations in Clinical Examination:
1. General History and Physical Exam ...............................................................................1
History & Examination of Systems:
2. The Circulatory System ................................................................................................ 18
a. The Precordial Exam .............................................................................................. 18
b. The Peripheral Vascular Exam ............................................................................... 49
3. The Endocrine System .................................................................................................7 0
4. The Gastrointestinal System ........................................................................................9 1
5. The Head, Neck, and Throat ...................................................................................... 114
6. The Lymphatic System ...............................................................................................1 46
7. The Musculoskeletal System ......................................................................................1 60
8. The Nervous System ..................................................................................................2 14
9. The Reproductive System ..........................................................................................2 49
a. The Breast Exam ..................................................................................................2 49
b. The Gynecological Exam ......................................................................................2 62
c. The Obstetrical Exam ...........................................................................................2 82
d. The Urological Exam ............................................................................................3 09
10. The Respiratory System .............................................................................................3 28
History, Examination, & Clinical Information for Specific Settings
11. Anesthesiology and Pain Management ......................................................................3 44
12. Dermatology ...............................................................................................................3 56
13. Emergency Medicine ..................................................................................................3 84
14. Fluids, Electrolytes, and Acid/Base Disturbances ......................................................4 05
15. General Surgery ........................................................................................................ .426
16. Geriatrics ....................................................................................................................4 40
17. Infectious Disease ......................................................................................................4 52
18. Medical Imaging .........................................................................................................4 75
19. Oncology ....................................................................................................................5 13
20. Ophthalmology ...........................................................................................................5 23
21. Pediatrics ....................................................................................................................5 38
22. Pharmacology and Toxicology ....................................................................................5 80
23. Psychiatry ...................................................................................................................5 95
24. Primer on Evidence Based Clinical Practice ..............................................................6 13
Appendices
1. Commonly-Used Medications .....................................................................................6 29
2. Common Laboratory Values .......................................................................................6 46
3. Basics of Suturing and Needles .................................................................................6 56
lndex .................................................................................................................................6 61

Preface and
Acknowledgements
The Essentials of Clinical Examination Handbook is a publication made by students, for
students. The Handbook was first published in 1997 to fill a need for a concise, portable, and
affordable guide to clinical examination. This edition marks our 20th anniversary in aiding
medical students and trainees of allied health professions around the world.
The Eighth Edition was written, illustrated, and edited by over 70 students and 60 faculty
members at the University of Toronto. It has been revised to reflect evidence-based advances
in clinical examination through incorporation of the JAMA Rational Clinical Exam, inclusion of
succinct summary tables for differential diagnoses and clinical presentations, as well as new
graphics to improve usability for students. Furthermore, we are proud to feature a companion
mobile application (app) featuring clinical examination checklists which users can use to
practice and test themselves on the go.
With the Essentials of Clinical examination Handbook, students, residents, fellows, and staff
physicians have come together to create a resource aimed at improving education for future
doctors, nurses, and allied health professionals. The Handbook reflects a long tradition of
excellence in medical education and research innovation at the University of Toronto, dating
back to its inception as a medical school in 1843. Part of this tradition is to give back to our
community and encourage social justice among healthcare students; as such, all revenue
generated from the sales of this book are donated to support student charities and community
health initiatives in Toronto and Mississauga, Ontario, Canada.
We would like to express our utmost appreciation to our team who made this edition into reality
- including chapter editors, illustrators, layout editors, copy editors, resident reviewers, and
faculty advisors. Their dedication, passion, and hard work have been invaluable. We would
also like to acknowledge the University of Toronto Medical Society for their guidance in the
production of this text. We extend our gratitude to our predecessors for their strong foundation
on which we have built our new edition. Finally, we thank our international distributor Thieme for
bringing this book to the desks of students worldwide.
To our readers, we hope that you enjoy learning from this book as much as we have enjoyed
creating it.
Sincerely,
Editors in Chief, Essentials of Clinical examination Handbook Eighth Edition
Yuhao Shi, Zahra Sohani, Brandon Tang, and Florentina Teoderascu
Contributors
Editors In Chief
Yuhao Shi Brandon Tang
Zahra Sohani Florentina Teoderascu
Chief Layout Editors
Wendy Gu Susan Le
Angela Han
Art Editors
Erina He Marina Spyridis
Chapter Editors
Arnav Agarwal Danny Mansour
Waleed S. Ahmed Graham Mazereeuw
Devon Alton Yasmin Nasirzadeh
Gillian Bedard Erica Pascoal
Joshua Bernick Priyanka Patel
Andrea Copeland Armin Rahmani
AdrianCozma Mark Shafarenko
Matthew Da Silva Omid Shearkhani
Maya Deeb Yuhao Shi
Ayan K. Dey Qazi Zain Sohail
Ahmed Faress Zahra Sohani
Mohammed Firdouse Rebecca Stepita
Claudia Frankfurter Kata Tana
Elise Fryml Brandon Tang
Rushi Gandhi Florentina Teoderascu
Aaron Gazendam Taraneh Tofighi
Mena Gewarges Gary Tran
Lauren Glick Brian Tsang
Joel Gupta Tiffanie Tse
Sheliza Halani Jane Wang
Angela Han Marie Yan
Saurabh Kalra Thomas Ying
Eli Kisilevsky Daniel Tae Oh Yoo
Reha Kumar Ahmed Zaki
Sangwoo Leem Stephanie Zhou
Marina Abdel Malak Jeremy Zung
Resident Reviewers
Manreet Alangh, MD, FRCSC Emily Moon, MD, CCFP
Zenita Alidina, MD Andrew Prine, MD
Benny Dua. MD, PhD Shohinee Sarma, MD, MPH
Anjali Kulkarni, MD, MSc Shixin Shen, MD, MSc
Jenny Li, MD, BMSc Amy Rebecca Zipursky, BA, MD
Fahim Merali, MD, MSc, CCFP Tristan Juvet, MD, esc
Faculty Reviewers
Hosanna Au, MD, DlpMEd, FRCPC Maria Cino, MD, FRCPC
David N. Adam, MD, FRCPC Natalie Clavel, MD, FRCPC
Anne Agur, PhD, MSc, BSc(OT) Scott Fung, MD, FRCPC
Meyer Balter MD, FRCPC Jeannette Goguen, MD, FRCPC
Adrian Brown, MD, FRCSC David Hall, MD, PhD, FRCPC
Esther Bui, MD, FRCPC Nathan Herrmann, MD, FRCPC
Kathy Cao, MD, FRCSC Kevin M. Higgins, MD, FRCSC
Grant Chen, MD, FRCPC Douglas Ing, MD, FRCPC, FACC
Tulin Cil, MD, MEd, FRCSC Shinya Ito, MD, FRCPC
Faculty Reviewers (continued)
Nasir Jaffer, MD, FRCPC Fahad Razak, MD, MSc, FRCPC
Jacqueline James, MD, FRCPC Evelyn Rubin, MD, CCFP
Raymond Jang, MD, FRCPC Ayal Schaffer, MD, FRCPC
Michael Jewett, MD, FRCSC Martin Schreiber, MD, MEd, FRCSC
David Juurlink, BPhm, MD, PhD, FRCPC Samir Sinha, MD, DPhll, FRCPC
Yoo-Joung Ko, MD, MMSc, SM, FRCPC Peter StoUand, MD, MSc, FRCSC
Edward Kucharski, MD, CCFP Gemini Tanna, MD, FRCPC
Shoba Sujana Kumar, MD, MSc, FRCPC Richard Tsang, MD, FRCPC
Paul Kuzyk,MD,MASc,FRCSC Catherine Varner, MD, MSc, CCFP(EM)
Prateek Lala, MD, MSc Allan D. Vescan, MD, FRCSC
Jacques s. Lee, MD, MSc, FRCPC Kyle Wanzel, MD, MEd, FRCSC
Elyse Levinsky, MD, MHSc, FRCSC Daniel Weisbrod, MD, FRCSC
Catherine Maurice, MD, FRCPC Rory Windrim, MD, FRCSC
Lawrence Mbuagbaw, MD, MPH, PhD, FRSPH Camilla Wong, MD, FRCPC
Andrew Morris, MD, SM, FRCPC Albert H.C. Wong, MD, PhD, FRCPC
George Oreopoulos, MD, MSc, FRCSC Frances Wright, MD, MEd, FRCPSC
Richard Pittini, MD, MEd, FACOG, FRCSC Doreen Yee, MD, FRCPC
Susan M. Poutanen, MD, MPH, FRCPC Jensen Yeung, MD, FRCPC
Angela Punnett, MD, FRCPC Eugene Yu, MD, FRCPC, ABR
Sudhashree Rajagopal, MD, FRCPC Eric Yu, MD, MEd, FRCPC, FACC
Editorial Support
Pediatrics The Head, Neck, and Throat
Patrina Cheung Terence Fu
Rageen Rajendram Alvin Yang
Taraneh Tofighi
Sex and Gender Content
Brian H. Kim
Edward Kucharski, MD, CCFP
Artists
Ruth Chang Melissa Lee
Ursula Florjanczyk Alison McFadden
Wendy Gu Sonia Seto
Angela Han Marina Spyridis
Susan Le
Cover Artist
Wendy Gu
Copy Editors
Alexandre Coutin Talha Maqbool
Sarah Park Irene Harmsen
Arunima Sivanand Cecilia Alvarez
Alon Caret Tyler Hauer
Jae Eun Ryu Ananth Lionel
Eric Yung Sukhmani Sodhi
Special Acknowledgements
We extend our gratitude to the following faculty members who provided us with direction for our
unique vision of the Essentials of Clinical Examination Handbook, Eighth Edition:
Martin Schreiber, MD, MMedEd, FRCPC David Wong, MD, CCFP, FCFP, MScCH
Katina Tzanetos, MD, MSc, FRCPC
We are also grateful for the work, creativity, and commitment of the app development team:
Ahmad Alhashemi Adrian Cozma
Zubair Baig Sonia Seto
Arjun Balachandar Kota Talia
Matan Berson
Tue ESSBNTIALS OF CLINICAL EXAMINATION HANDBOOJC, 8TH BD. VII

Common
Abbreviations
ACE Angiotensin converting enzyme
ACTH Adrenocorticotropic hormone
ALP Alkaline phosphatase
ALT Alanine transaminase
AP Anterior-Posterior
aPTI Activated partial thromboplastin time
ASA Acetylsalicylic acid
AST Aspartate aminotransferase
13-hCG 13-human chorionic gonadotropin
BMI Body mass index
BP Blood pressure
BPM Beats per minute
BUN Blood urea nitrogen
C&S Culture and sensitivity
CAD Coronary artery disease
CBC Complete blood count
cc Chief complaint
CHF Congestive heart failure
CN Cranial nerve
CNS Central nervous system
COPD Chronic obstructive pulmonary disease
Cr Creatinine
CRP C-reactive protein
CSF Cerebrospinal fluid
CT Computerized tomography
CVS cardiovascular system
CXR Chest X-ray
DDx Differential diagnosis
DHEAS Dehydroepiandrosterone
DIP Distal interphalangeal
OM Diabetes mellitus
DOB Date of birth
DRE Digital rectal exam
DVT Deep vein thrombosis
ECG Electrocardiogram