Contents
1 History taking and clinical
examination 1
How to take the history 2
History of pain 7
The clinical examination 11
History and examination of a lump 29
History and examination of an ulcer 32
2 The symptoms, signs and emergency
management of major injuries 36
The primary survey and management
at the site of the event: first-aid 36
The primary survey in the accident and
emergency department 38
The secondary survey 41
3 The skin and subcutaneous tissues 47
The diagnosis of skin conditions 47
Congenital skin disorders 50
Genetic skin disorders 50
Non-genetic skin disorders 51
Haemangiomata/lymphangiomata 53
Acquired dermatological conditions 57
Conditions of the skin caused by trauma 57
Infections of the skin 66
Benign tumours and benign skin lumps 71
Pigmented naevi 75
Benign subcutaneous swellings 78
Tumours of the skin appendages 86
Pre-malignant skin lesions 87
Malignant diseases of the skin 89
Other common skin conditions
often seen in surgical patients 99
Subcutaneous infections 100
4 Muscles, tendons, bones and joints 104
A general plan for examining the
muscles, bones and joints of a limb 104
Soft tissues 106
Muscles and muscle disease 106
Fibrous tissue 110
Tendons and tendon sheaths 112
Bones and bone irregularities 114
Examination of bones 114
Fractures 117
Bone diseases and deformities 118
Benign tumours of bone 122
Malignant tumours of bone 123
Joints 127
Examination of a joint 127
Examination of the spine 134
Diseases of joints 136
5 Conditions peculiar to the hands 143
A plan for the examination of the hand 143
Recording data about the hand 148
Abnormalities and lesions of the hand 149
The nails 160
Infections in the hand 162
6 Conditions peculiar to the feet 165
Congenital and acquired deformities
of the foot and ankle 165
The toe nails 170
7 The arteries, veins and lymphatics 175
The arteries 175
Clinical assessment of the arterial
circulation of the lower limb 175
Symptoms produced by arterial
insufficiency 179
Haemorrhage 190
Transient and permanent weakness,
paralysis and blindness 190
Cold, blue digits, hands and feet 192
Hypertension 196
Intestinal ischaemia 196
The veins 196
Clinical assessment of the venous
circulation of the lower limb 196
The lymphatics 209
8 General and facial appearance 214
Colour 214
General appearance 217
Diseases affecting facial appearance 224
The eyes 226
The nose 230
Shape of the skull 230
The ears 232
Meningocele 234
The chest wall 234
9 The salivary glands 239
The submandibular salivary gland 239
The parotid gland 242
Autoimmune disease 248
10 The mouth 250
Congenital abnormalities of the lips
and palate 250
The lips, buccal mucosa and tongue 251
Other conditions of the tongue 261
The palate 261
The tonsils 263
The floor of the mouth 263
The gums 266
Swellings of the jaw 267
The jaw 268
11 The neck 270
The history and examination of
swellings in the neck 270
Cervical lymphadenopathy and other
neck swellings 271
The thyroid gland 288
Symptoms of thyroid disease 288
Examination of the thyroid gland 290
Different forms of goitre 295
Thyrotoxicosis and myxoedema 299
Carcinoma of the thyroid gland 303
Thyroiditis 307
12 The breast 312
History and examination of
breast disease 312
Presentation of breast disease 318
Carcinoma of the female breast 318
Benign breast tumours 322
Benign breast disease 323
The nipple 326
Breast abscess 328
Pregnancy 329
The male breast 329
Carcinoma of the male breast 330
13 The external genitalia 331
Examination of the male genitalia 331
The penis 334
The scrotal skin 342
The testes 343
The female external genitalia 357
14 The abdominal wall, herniae and the
umbilicus 359
Abdominal herniae 360
Inguinal hernia 361
Femoral hernia 373
Umbilical hernia 375
Epigastric hernia 378
Incisional hernia 378
Divarication of the recti 379
Rare abdominal herniae 381
The umbilicus 381
15 The abdomen 386
The examination of the abdomen 386
Abdominal pain 391
Upper abdominal pain – acute and/or
chronic – caused by inflammatory and
malignant conditions 393
Central abdominal pain – acute
and/or chronic 401
General abdominal pain – acute
and/or chronic 403
Lower abdominal pain – acute and/or
chronic – caused by inflammatory
and/or malignant conditions 405
Symptoms and signs resulting from
the perforation of a viscus 411
Symptoms and signs caused by an
obstructed viscus 412
Infarction of a viscus causing
abdominal pain 414
Abdominal pain caused by intraabdominal
or retroperitoneal
haemorrhage 415
Extra-abdominal and medical conditions
causing acute abdominal pain 418
Alimentary conditions presenting
with dysphagia or vomiting 419
Conditions presenting with diarrhoea 420
The abdominal mass: causes and signs 421
Causes of a mass in the right iliac fossa 427
Causes of a mass in the left iliac fossa 430
Causes of a lump in the groin 430
Abdominal distension 431
16 The kidneys, urinary tract and
prostate 435
Symptoms of renal and urinary tract
disease 435
Diseases of the urinary tract 437
Retention of urine 441
The prostate gland 443
The urethra 445
17 The rectum and anal canal 447
Symptoms of ano-rectal disease 447
Technique for ano-rectal examination 448
Sigmoidoscopy and proctoscopy 451
Conditions presenting with rectal
bleeding 454
Conditions presenting with anal pain 459
Conditions presenting as an anal lump
with or without pain 465
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