CHAPTER Ⅰ ROUTINE DATA 1
METHODS OF PHYSICAL DIAGNOSIS 1
Temperature 1
Oral Temperature 1
Rectal Temperature 2
Pathogenesis of Fever 2
Effect of Ovulation on Temperature 2
Types of Fever 3
Subnormal Temperature 4
The Pulse 4
Pulse Rate 4
Pulse Tension 5
Respiration 6
Types of Breathing 6
Blood Pressure 9
Blood Pressure Technic and Equipment 9
Height and Weight 10
Race 10
Childhood Nutrition 11
Climatic Factors 11
General Evolution 11
Effects of Disease on Height 11
Achondroplasia 11
Heart Disease 12
Renal Disease 12
Progeria 12
Ateliotic Dwarfs 12
Gigantism 13
Hypogonadism 13
Hypergonadism 13
Ovarian Insufficiency 13
Weight 14
Habitus 14
Male and Female Body Types 16
REFERENCES 16
CHAPTER Ⅱ EXAMINATION OF THE HEAD 17
THE CRANIUM 17
Size and Shape 17
Microcephalus 17
Hydrocephalus 17
The Acromegalic Head 18
Paget＇s Disease(Osteitis Deformans) 19
Craniostoses 19
The Rachitic Head 21
THE HAIR AND SCALP 21
Alopecia 21
Hirsutism(Hypertrichosis) 22
THE FACE 24
Dehydration of the Face 24
Edema of the Face 24
Color of the Face 27
Anemia 27
Polycythemia 28
Cyanosis of the Face 29
Malar Flush 29
Pigmentation of the Face 30
Jaundice 30
Argyria 30
Mask of Pregnancy(Chloasma Gravidarum) 30
Hemochromatosis 30
Addison＇s Disease 31
Albinism(Congenital Achromodermia) 32
Vitiligo 32
Chrysiasis 32
Local and Systemic Diseases Manifested in the Face 32
Nevi(Birthmarks) 32
Acne Vulgaris(Common Acne) 33
Collagen Diseases 34
Periarteritis Nodosa 34
Disseminated Lupus Erythematosus 35
Scleroderma 35
The Facies of Diseases of the Endocrine Glands 37
Cretinism 37
Mongolian Idiocy 38
Myxedema(Mucus Edema) 38
Hyperthyroidism 39
THE EYES 39
The Eyelids 43
The Conjunctiva 44
Subconjunctival Hemorrhage 45
The Cornea 46
Corneal Sensitivity 46
Keratitis 46
Herpetic Lesions 47
Arcus Senilis 47
The Sclera 48
Osteogenesis Imperfecta(Fragilitas Ossium) 48
Intraocular Tension 48
The Pupils 48
Horner＇s Syndrome 49
The Palpebral Fissures 50
Exophthalmos 50
Strabismus(Squint) 52
Nystagmus 54
The Visual Field 54
THE EARS 54
Color 54
Contour 54
Auricles 54
The Auditory Canal 55
Tympanic Membrane 55
Mastoid Region 56
Tests for Hearing 56
THE NOSE 56
Play of the Alae Nasi 58
Intranasal Examination 58
THE LIPS 59
THE BUCCAL CAVITY 62
Eruptions 62
Pigmentation 62
THE TONGUE 62
Monilial Infections 64
Leukoplakia(White Plaque) 66
Syphilitic Lesions 66
Tuberculosis of the Tongue 67
Carcinoma of the Tongue 67
THE TEETH AND GUMS 68
Hutchinson＇s Teeth 69
Hypertrophy of the Gums 70
Gingivitis 70
Lead Line 72
THE BREATH 72
THE TONSILS 73
THE PHARYNX 74
THE PALATE AND UVULA 74
THE LARYNX 75
Tuberculosis of the Larynx 76
Tumors of the Larynx 76
Paralysis of the Vocal Cords 76
REFERENCES 76
CHAPTER Ⅲ EXAMINATION OF THE NECK 78
CERVICAL LYMPHADENOPATHY 80
INFECTIONS 81
Acute Regional Infections 81
Acute Systemic Infections 81
Chronic Systemic Infections 82
Tuberculosis 82
Sarcoidosis 83
ALLERGIC REACTIONS 83
Serum Sickness 83
PRIMARY LYMPH NODE DISEASES 83
Leukemia 86
Metastatic Lymphadenopathy 86
THE SALIVARY GLANDS 86
Tumors of the Salivary Glands 87
THE THYROID GLAND 87
Anomalies of the Thyroid 87
Intrathoracic(Substernal)Goiter 88
Simple Goiter(Colloid Goiter) 88
Toxic Goiter 90
Nodular Goiters 91
Thyroid Malignancy 91
Acute Thyroiditis 91
VASCULAR PULSATIONS IN THE NECK 92
DISTENTION OF THE VEINS OF THE NECK 93
REFERENCES 93
CHAPTER Ⅳ EXAMINATION OF THE MUSCULOSKELETAL SYSTEM 95
EXAMINATION OF THE MUSCLES 95
EXAMINATION OF THE JOINTS 107
The Shoulder Joint 108
Motions 108
Lesions 109
The Elbow Joint 111
The Wrist Joint 113
Lesions 113
The Hip Joint 115
Motions 116
Lesions 117
The Knee Joint 120
Lesions 121
The Ankle Joint 123
Lesions 123
The Foot 124
Deformities 125
The Back 128
Spinal Curvature 128
Scoliosis 129
Low Back Pain 131
REFERENCES 133
CHAPTER Ⅴ EXAMINATION OF THE BREASTS 134
SELF-EXAMINATION 134
PHYSICAL EXAMINATION 135
Carcinoma 138
Gynecomastia 142
Tuberculosis of the Breast 142
REFERENCES 143
CHAPTER Ⅵ SOUNDS FROM THE THORAX：ACOUSTIC PRINCIPLES＆by S．Reid Warren，Jr Sc．D．in E．E 144
SOUNDS PRODUCED IN THE THORAX 145
Percussion 145
Auscultation 145
Electrical Pickups 146
Preliminary Conclusions 148
PRODUCTION AND PROPAGATION OF SOUND 148
What Sound Is 148
Kinds of Sounds 149
Sounds in Media Other than Air 151
Attenuation，Absorption and Reflection 151
Reflection and Viscosity 151
Attenuation and the Stethoscope 152
Thoracic Sounds：Frequency Range 152
Sensations of Sounds 153
Loudness 153
Intensity 153
Physical Aspects of Hearing 155
Audibility of Sounds 156
Ambient Sounds 157
Pitch of Sounds 157
Loudness of Sounds 157
Timbre 157
Location of Sounds 157
SOURCES OF SOUND IN THE THORAX 158
Circulatory System：Loudness and Frequency Range 158
Respiratory System：Loudness and Frequency Range 158
Vocal Sounds 158
Percussion 158
Interpretation 159
CONCLUSIONS 159
REFERENCES 160
CHAPTER Ⅶ EXAMINATION OF THE CHEST 161
ROENTGENOLOGIC VERSUS PHYSICAL EXAMINATION 163
INSPECTION OF THE CHEST 165
Beside Inspection 166
Conformation of the Normal Chest 166
Size and Development of the Chest 169
Asymmetry of the Chest 170
Shape and Movement of the Subcostal Angle 173
Local Bulging and Pulsations of the Thorax 173
Abnormal Thoracic Conformation 176
The Rachitic Chest 176
The Long Flat Chest(Pterygoid Chest，Alar Chest) 178
The Emphysematous(Barrel-Shaped)Chest 179
REFERENCES 181
CHAPTER Ⅷ PALPATION OF THE CHEST 182
TECHNIC OF PALPATION 182
VOCAL FREMITUS 183
Voice Production 184
Production of Fremitus 184
Tactile Vibrations 186
REFERENCE 186
CHAPTER Ⅸ PERCUSSION OF THE CHEST 187
TECHNIC OF PERCUSSION 188
Diaphragmatic Excursion 189
PERCUSSION SOUNDS 189
Tympany 189
Modified Tympany 190
Metallic Ring 190
Bell Tympany 191
Cracked-Pot Sound 191
Resonance 192
Hyperresonance 192
Dullness 192
Flatness 192
PERCUSSION RESISTANCE 192
OTHER PERCUSSION METHODS 192
Orthopercussion 193
Auscultatory Percussion 193
MOVABLE OR SHIFTING DULLNESS 195
REFERENCES 195
CHAPTER Ⅹ AUSCULTATION OF THE CHEST 196
Effect of Posture 197
The Stethoscope 197
NORMAL BREATH SOUNDS 197
Laryngeal or Bronchial Element of the Breath Sounds 197
Vesicular Element of the Breath Sounds 198
Vesicular Breath Sounds 199
ABNORMAL BREATH SOUNDS 200
Absent Breath Sounds 200
Decreased Breath Sounds 200
Exaggerated Breathing 200
Bronchial Breathing 200
Bronchovesicular Breathing 201
Cavernous Breathing 201
Amphoric Breathing 201
ADVENTITIOUS SOUNDS 202
Rales 202
Musical Rales 202
Crepitant(Consonating)Rales 202
Subcrepitant(Crackling)Rales 202
Bubbling(Gurgling)Rales 203
Marginal(Atelectatic)Rales 203
Production of Rales 203
Friction Sounds 204
Succussion Splash 204
Metallic Tinkle 204
VOICE SOUNDS 205
Vocal Resonance 205
Bronchophony 205
Pectoriloquy 205
Egophony 206
REFERENCES 206
CHAPTER Ⅺ PHYSICAL SIGNS IN CERTAIN DISEASES OF THE LUNGS AND PLEURA：CORRELATIVE DATA 207
DISEASES OF THE LUNGS 207
Pulmonary Tuberculosis 207
Lobar Pneumonia 207
Auscultation 209
Physical Signs 209
Bronchiectasis 209
Bronchial Asthma 210
Interstitial Emphysema 211
Massive Collapse of the Lung 212
Physical Signs 212
Inspection 212
Palpation 212
Percussion 212
Auscultation 213
Pulmonary Embolism 213
Physical Signs 213
Pulmonary(Venous)Air Embolism 213
Arterial Air Embolism 217
DISEASES OF THE PLEURA 218
Dry Pleurisy 218
Inspection 218
Palpation 218
Percussion 219
Auscultation 219
Diaphragmatic Pleurisy 219
Epidemic Pleurodynia(Bornholm Disease，Devil＇s Grip) 219
Pleural Effusion 220
Inspection 220
Palpation 220
Percussion 220
Auscultation 223
Loculated Pleural Fluid 224
REFERENCES 227
CHAPTER Ⅻ EXAMINATION OF THE CIRCULATORY SYSTEM 228
BLOOD PRESSURE 228
Normal Arterial Blood Pressure 228
High Blood Pressure(Arterial Hypertension) 229
Low Blood Pressure(Vascular Hypotension) 229
Pulse Pressure 230
Venous Blood Pressure 230
THE HEART 230
The Valves 231
Inspection 234
Palpation 236
Normal Position of the Cardiac Impulse 239
Displacement of the Cardiac Impulse 239
Thrills 240
Percussion 240
Heart Size 240
Method 242
Cardiac Dullness 245
Significance of Cardiac Dullness 246
Percussion versus Roentgenology 247
Auscultation 251
Valve Areas 251
Heart Sounds 252
Origin and Characteristics of Heart Sounds 252
The First Sound 252
The Second Sound 253
The Third Sound 253
Increased Intensity of the First Sound 253
Decreased Intensity of the First Sound 253
Increased Intensity of the Second Sound 254
Splitting or Reduplication of Heart Sounds 254
Gallop Rhythm 254
Heart Murmurs 255
Intensity 256
Cardiac Arrhythmias 257
Sinus Arrhythmia 258
Sinus Pauses 258
Auricular and Ventricular Premature Beats 258
Paroxysmal Auricular Tachycardia 259
Auricular Flutter 259
Auricular Fibrillation 259
Paroxysmal Ventricular Tachycardia 260
Ventricular Fibrillation 260
Heart Block 261
First Degree Heart Block 261
Second Degree Block(Partial Block) 261
Third Degree Block(Complete Block) 261
Pulsus Alternans 262
REFERENCES 262
CHAPTER ⅩⅢ PHYSICAL SIGNS IN CERTAIN DISEASES OF THE HEART AND GREAT VESSELS：CORRELATIVE DATA 264
VALVULAR DISEASES 264
Mitral Regurgitation(Insufficiency) 264
Mitral Stenosis 264
Aortic Insufficiency 267
Physical Signs 268
Inspection 268
Palpation 269
Percussion 271
Auscultation 271
Interpretation 272
Aortic Stenosis 272
Physical Signs 273
Inspection and Percussion 273
Palpation 274
Auscultation 274
Tricuspid Insufficiency 275
Physical Signs 275
Inspection 275
Palpation 275
Percussion 276
Auscultation 276
Tricuspid Stenosis 277
Pulmonary Insufficiency 277
Pulmonary Stenosis 277
Transmission of Murmurs 277
The Continuous Murmur 278
CONGENITAL CARDIAC AND VASCULAR DEFECTS 279
Patent Ductus Arteriosus 279
Coarctation of the Aorta 279
Aberrant Right Subclavian Artery 280
Interventricular Septal Defect(Roger＇s Disease) 283
Eisenmenger＇s Complex 283
Tetralogy of Fallot 284
Patent Foramen Ovale 285
MISCELLANEOUS CONDITIONS 286
Pericardial Effusion 286
Physical Signs 286
Inspection 286
Palpation 288
Percussion 290
Auscultation 291
Cor Pulmonale 291
Ayerza＇s Disease 292
Xiphosternal Crunch 293
REFERENCES 294
CHAPTER ⅩⅣ EXAMINATION OF THE ABDOMEN 295
Position of the Patient 295
Regions of Abdomen 295
Surface Markings 296
INSPECTION OF THE ABDOMEN 296
Visible Peristalsis 296
Bodily Movements 296
The Skin 297
Rashes 297
Contour 297
Enlarged and Tortuous Veins 298
Hirsutism and Hair Distribution 298
Abdominal Pulsations 298
Respiratory Movements of the Abdomen 299
Abdominal Asymmetry 299
Examination of the Umbilicus 300
Abdominal Hernias 300
Ventral Hernia 300
Umbilical Hernia 301
Inguinal Hernia 301
Femoral Hernia 302
Diaphragmatic Hernia 302
PALPATION OF THE ABDOMEN 302
Muscular Rigidity 303
Tenderness 303
Parietal Pain 303
Intercostal Neuralgia 304
Fluctuation 304
Ascites 304
Tumors 305
Palpation of the Liver 306
Technic 307
Palpation of the Spleen 307
Technic 308
Palpation of the Kidneys 309
PERCUSSION OF THE ABDOMEN 310
AUSCULTATION OF THE ABDOMEN 310
REFERENCES 310
CHAPTER ⅩⅤ THE GYNECOLOGIC EXAMINATION 311
EXAMINATION OF THE PATIENT 311
Position of the Patient 311
Position of the Examiner 314
Technic 314
EXTERNAL GENITALIA 314
Mons Veneris 315
Clitoris 315
Labia Majora 315
Labia Minora 315
Vulva 315
Bartholin＇s Glands 315
Perineal Body 316
Vestibule 316
Urethral Meatus 317
Skene＇s Ducts 317
Hymen 317
VAGINA AND ITS CONTENTS 318
Speculum Examination 318
Technic 318
Cervix 320
Vagina 323
Vaginitis 323
Vaginal Walls 323
Descensus Uteri 325
Palpation 325
Bimanual Examination 327
Uterus 328
Position 328
Size，Shape and Consistency 328
Motion 329
Adnexa 330
Hydrosalpinx 330
Ectopic Pregnancy 330
Tumors 330
Endometriosis 331
Parovarian Cyst 332
Parametrium 332
Special Tests 332
Papanicolaou Smears 332
Rubin Test 332
Hysterosalping-ography 332
Cervical Biopsy 333
Sperm Analysis 333
Huhner Test 333
Hanging Drop Preparations 333
Tests for Gonococci 333
REFERENCES 333
CHAPTER ⅩⅥ EXAMINATION OF THE MALE GENITALIA，AND OF THE ANUS，RECTUM AND RECTOSIGMOID COLON 334
MALE GENITALIA 334
Size and Development 334
Hypogonadism 334
Hypergonadism 334
Congenital Anomalies 335
Hypospadias 335
Epispadias 335
Incomplete Descent of One or Both Testes 335
Congenital Hydrocele 335
Lesions of the Penis 335
Phimosis 335
Chancre 335
Chancroid 335
Lymphopathia Venereum(Lymphogranuloma Inguinale) 337
The Testes and Scrotum 338
Hydrocele 339
Varicocele 339
Prostate and Seminal Vesicles 339
ANUS，RECTUM AND RECTOSIGMOID COLON 339
Digital Examination 339
Preparation 339
Position 339
Equipment 339
Anus and Rectum 340
Inspection and Palpation 340
Prostate and Seminal Vesicles 342
Prostate 342
Carcinoma of the Prostate 343
Seminal Vesicles 343
Proctosigmoidoscopy 344
Preparation 344
Position 344
Equipment 345
Conduct of the Examination 345
Anoscopy 347
REFERENCES 347
CHAPTER ⅩⅦ EXAMINATION OF THE EXTREMITIES 348
NUTRITIONAL，METABOLIC AND ENDOCRINE DISORDERS MANIFESTED IN THE EXTREMITIES 348
Rickets 348
Pellagra 349
Scurvy 349
Acromegaly 349
Paget＇s Disease(Osteitis Deformans) 349
Gout 350
THE EXTREMITIES IN CERTAIN SYSTEMIC INFECTIONS AND DEGENERATIVE STATES 351
Rheumatic Fever 351
Subacute Bacterial Endocarditis 352
Gonococcal Arthritis 352
Rheumatoid Arthritis 353
(Arthritis Deformans) 353
Hypertrophic Arthritis(Osteoarthritis，Senile Arthritis) 353
Tuberculous Arthritis 354
Tuberculous Osteomyelitis 354
Syphilis 354
Charcot＇s Joint 355
CLUBBING OF THE FINGERS AND TOES AND HYPERTROPHIC PULMONARY OSTEOARTHROPATHY 355
Symmetrical Clubbing 356
Pulmonary Diseases 356
Cardiac Diseases 358
Hepatic and Gastrointestinal Diseases 359
Unilateral Clubbing 359
Unidigital Clubbing 359
MISCELLANEOUS CONDITIONS 359
Tetany 359
Dupuytren＇s Contracture 360
Volkmann＇s Ischemic Contracture 360
Ganglia of the Wrist 360
Carphologia 360
Edema of the Extremities 360
Acute Lymphangitis 362
THE PERIPHERAL ARTERIES 362
Palpation 362
Peripheral Arteriosclerosis 363
Thromboangiitis Obliterans(Buerger＇s Disease) 363
Arterial Embolism 363
Exposure to Cold 364
Raynaud＇s Disease 364
Raynaud＇s Phenomenon 365
PERIPHERAL VEINS 365
Varicose Veins 365
Thrombophlebitis 365
Phlebothrombosis 366
REFERENCES 366
CHAPTER ⅩⅧ NEUROLOGIC EXAMINATION 367
ANATOMIC AND PHYSIOLOGIC CONSIDERATIONS 367
Voluntary Motor System 367
Voluntary Motor Control 367
Tone 368
Sensory System 368
Coordination 369
Special Senses 369
Gnostic Functions 369
Psychologic Component 370
PRACTICAL METHODS OF EXAMINATION AND INTERPRETATIONS OF INDIVIDUAL FINDINGS 370
Involuntary Movements 370
Fibrillations(Fasciculations) 370
Tremors 370
Choreiform Movements 371
Athetoid Movements 371
Dystonic Movements 371
Spasms 371
Tics(Habit Spasms) 372
Convulsive Seizures 372
Posture，Gait and Station 372
Posture 372
Gait 372
Station 373
Meningeal Irritation 374
The Head 374
The Cranial Nerves 374
First Nerve 374
Second，Third，Fourth and Sixth Nerves 375
Fifth Nerve 375
Seventh Nerve 376
Eighth Nerve 378
Ninth Nerve 380
Tenth Nerve 380
Eleventh Nerve 380
Twelfth Nerve 381
The Neck 381
The Back and Trunk 382
The Extremities 383
Upper Extremities 383
Coordination 383
Palpation of Muscles 384
Atrophy of Muscles 384
Muscle Strength 384
Nerve Lesions 384
Muscle Tone 385
Reflexes 385
Sensory Determination 386
Lower Extremities 387
Reflexes 390
Coordination 391
Sensory Determination 392
NEUROLOGIC EVALUATION 392
REFERENCES 393
CHAPTER ⅩⅨ PSYCHIATRIC SURVEY 394
MENTAL STATUS 394
General Attitude of the Patient 395
Memory 395
Orientation 396
Stream of Thought 396
Disturbances of Perception 397
Association of Ideas 397
Judgment 398
Mood 398
Anxiety 399
Apathy 399
Depression 399
Elation 400
Other Moods 400
Special Preoccupations 400
Phobias，Obsessions and Compulsions 400
Insight 401
REFERENCES 402
CHAPTER ⅩⅩ THE HISTORY 403
Physician-Patient Rapport 403
Use of Understandable Words 404
Patient Personalities 404
TECHNIC OF HISTORY TAKING 404
History of Present Illness 405
Systemic Review 405
Past Medical History 406
Occupational History 406
Social History 407
Family History 407
REFERENCES 407
INDEX 409