Contents

Faculty Reviewers and Additional Contributors

Preface

Acknowledgments

How To Use Bates? Guide to Physical Examination and History Taking

UNIT 1

Foundations of Health Assessment

CHAPTER 1

Approach to the Clinical Encounter

FOUNDATIONAL SKILLS ESSENTIAL TO THE CLINICAL ENCOUNTER

APPROACH TO THE CLINICAL ENCOUNTER

STRUCTURE AND SEQUENCE OF THE CLINICAL ENCOUNTER

Stage 1: Initiating the Encounter

Stage 2: Gathering Information

Stage 3: Performing the Physical Examination

Stage 4: Explaining and Planning

Stage 5: Closing the Encounter

DISPARITIES IN HEALTH CARE

Social Determinants of Health

Racism and Bias

Cultural Humility

OTHER MAJOR CONSIDERATIONS

Spirituality

Medical Ethics

Documenting the Clinical Encounter

REFERENCES

CHAPTER 2

Interviewing, Communication, and Interpersonal Skills

FUNDAMENTALS OF SKILLED INTERVIEWING

Active or Attentive Listening

Guided Questioning

Empathic Responses

Summarization

Transitions

Partnering

Validation

Empowering the Patient

Reassurance

APPROPRIATE VERBAL COMMUNICATION

Use Understandable Language

Use Nonstigmatizing Language

APPROPRIATE NONVERBAL COMMUNICATION

OTHER CONSIDERATIONS IN COMMUNICATION AND INTERPERSONAL�SKILLS

Broaching Sensitive Topics

Informed Consent

Working with a Medical Interpreter

Advance Directives

Disclosing Serious News

Motivational Interviewing

Interprofessional Communication

CHALLENGING PATIENT SITUATIONS AND�BEHAVIORS

Patient Who Is Silent

Patient Who Is Talkative

Patient with Confusing Narrative

Patient with Altered State or Cognition

Patient with Emotional Lability

Patient Who Is Angry or Aggressive

Patient Who Is Flirtatious

Patient Who Is Discriminatory

Patient with Hearing Loss

Patient with Low or Impaired Vision

Patient with Limited Intelligence

Patient Burdened by Personal Problems

Patient Who Is Nonadherent

Patient with Low Literacy

Patient with Low Health Literacy

Patient with Limited Language Proficiency

Patient with Terminal Illness or Who Is Dying

BEING PATIENT-CENTERED IN COMPUTERIZED CLINICAL SETTINGS

LEARNING COMMUNICATION SKILLS FROM STANDARDIZED PATIENTS

REFERENCES

CHAPTER 3

Health History

HEALTH HISTORY

Different Kinds of Health Histories

Determining the Scope of Your Patient Assessment: Comprehensive or Focused?

Subjective versus Objective Data

COMPREHENSIVE ADULT HEALTH HISTORY

Initial Information

Chief Complaint

History of Present Illness

Past Medical History

Family History

Personal and Social History

Review of Systems

RECORDING YOUR FINDINGS

MODIFICATION OF THE CLINICAL INTERVIEW FOR VARIOUS CLINICAL SETTINGS

Ambulatory Care Clinic

Emergency Care

Intensive Care Unit

Nursing Home

Home

REFERENCES

CHAPTER 3

Physical Examination

ROLE OF THE PHYSICAL EXAMINATION IN THE ERA OF TECHNOLOGY

DETERMINING SCOPE OF THE PHYSICAL EXAMINATION: COMPREHENSIVE OR�FOCUSED?

Comprehensive Adult Physical Examination

HEAD-TO-TOE PHYSICAL EXAMINATION

General Survey

Vital Signs

Skin

Head, Eyes, Ears, Nose, Throat

Neck

Back

Posterior Thorax and Lungs

Breasts and Axillae

Anterior Thorax and Lungs

Cardiovascular System

Abdomen

Lower Extremities

Nervous System

Additional Examinations

ADAPTING THE PHYSICAL EXAMINATION: SPECIFIC PATIENT CONDITIONS

Patient on Bedrest

Patient Using a Wheelchair

Patient Who Is Postprocedure

Patient Who Is Obese

Patient in Pain

Patient on Special Precautions

RECORDING YOUR FINDINGS

REFERENCES

CHAPTER 5

Clinical Reasoning, Assessment, and Plan

CLINICAL REASONING: PROCESS

Basic Structure of the Clinical Reasoning Process

Clinical Diagnostic Errors

CLINICAL REASONING: DOCUMENTATION

Document the Problem Representation (Summary Statement)

Assessment and Plan

RECORDING YOUR FINDINGS

PROGRESS NOTE AND PATIENT PROBLEM LIST IN THE ELECTRONIC HEALTH RECORD

Patient Problem List

ORAL PRESENTATION

REFERENCES

CHAPTER 6

Health Maintenance and�Screening

CONCEPT OF PREVENTIVE CARE

GUIDELINE RECOMMENDATIONS

U.S. Preventive Services Task Force Approach

Grading of Recommendations, Assessment, Development, and Evaluation

SCREENING

Basic Approach to Screening

BEHAVIORAL COUNSELING

Motivational Interviewing

IMMUNIZATIONS

SCREENING GUIDELINES FOR ADULTS

Screening for Unhealthy Weight and Diabetes�Mellitus

Screening for Substance Use Disorders, Including Misuse of Prescription and Illicit Drugs

Screening for IPV, Domestic Violence, Elder Abuse, and Abuse of Vulnerable Adults

COUNSELING GUIDELINES FOR ADULTS

Weight Loss

Healthful Diet and Physical Activity

SCREENING AND COUNSELING GUIDELINES�FOR ADULTS

Unhealthy Alcohol Use

Tobacco Use

Screening and Counseling for STIs

IMMUNIZATION GUIDELINES FOR ADULTS

Influenza Vaccine

Pneumococcal Vaccine

Varicella Vaccine

Herpes Zoster Vaccine

Tetanus, Diphtheria, Pertussis Vaccine

Human Papillomavirus Vaccine

Hepatitis A Vaccine

Hepatitis B Vaccine

PREVENTIVE CARE IN SPECIAL POPULATIONS

DISEASE-SPECIFIC RECOMMENDATIONS

REFERENCES

CHAPTER 7

Evaluating Clinical Evidence

USING ELEMENTS OF THE HISTORY AND�PHYSICAL EXAMINATION AS DIAGNOSTIC TESTS

EVALUATING DIAGNOSTIC TESTS

Validity

APPLYING CONCEPTS TO SCREENING TESTS

Fagan Nomogram

Natural Frequencies

Reproducibility

CRITICALLY APPRAISING THE CLINICAL EVIDENCE

COMMUNICATING CLINICAL EVIDENCE TO PATIENTS

REFERENCES

UNIT 2

Regional Examinations

CHAPTER 8

General Survey, Vital Signs, and Pain

HEALTH HISTORY: GENERAL APPROACH

Fatigue and Weakness

Fever, Chills, and Night Sweats

Weight Change

Pain

PHYSICAL EXAMINATION: GENERAL APPROACH

TECHNIQUES OF EXAMINATION

General Survey

Vital Signs

Acute and Chronic Pain

Types of Pain

Assessing Acute and Chronic Pain

RECORDING YOUR FINDINGS

HEALTH PROMOTION AND COUNSELING: EVIDENCE AND RECOMMENDATIONS

Screening for Hypertension

Blood Pressure and Dietary Sodium

REFERENCES

CHAPTER 9

Cognition, Behavior, and�Mental Status

ANATOMY AND PHYSIOLOGY

HEALTH HISTORY: GENERAL APPROACH

Anxiety, Excessive Worrying

Depressed Mood

Memory Problems

Patients with Medically Unexplained Symptoms

PHYSICAL EXAMINATION: GENERAL APPROACH

TECHNIQUES OF EXAMINATION

Appearance and Behavior

Speech and Language

Mood

Thought

Perceptions

Cognitive Functions

Higher Cognitive Functions

RECORDING YOUR FINDINGS

HEALTH PROMOTION AND COUNSELING: EVIDENCE AND RECOMMENDATIONS

Screening for Depression

Assessing for Suicide Risk

Screening for Neurocognitive Disorders

Screening for Substance Use Disorders, Including Misuse of Alcohol and Prescription and Illicit Drugs

REFERENCES

CHAPTER 10

Skin, Hair, and Nails

ANATOMY AND PHYSIOLOGY

Skin

Hair

Nails

Pilosebaceous Glands and Sweat Glands

HEALTH HISTORY: GENERAL APPROACH

Lesions

Rashes and Itching (Pruritus)

Hair Loss and Nail Changes

DESCRIBING SKIN LESIONS

Primary Lesion

Size

Number

Distribution

Configuration

Texture

Color

PHYSICAL EXAMINATION: GENERAL APPROACH

Lighting, Equipment, and Dermoscopy

Patient Gown

Handwashing

TECHNIQUES OF EXAMINATION

Standard Technique: Patient Position?Seated Then Standing

Alternative Technique: Patient Position?Supine Then Prone

Integrated Skin Examinations

SPECIAL TECHNIQUES

Patient Instructions for the Skin Self-Examination

Examining the Patient with Hair Loss

Evaluating the Bedbound Patient

RECORDING YOUR FINDINGS

HEALTH PROMOTION AND COUNSELING: EVIDENCE AND RECOMMENDATIONS

Epidemiology

Skin Cancer Prevention

Skin Cancer Screening

Screening for Melanoma: The ABCDEs

REFERENCES

CHAPTER 11

Head and Neck

ANATOMY AND PHYSIOLOGY

Head

Neck

HEALTH HISTORY: GENERAL APPROACH

Neck Mass or Lump

Thyroid Mass, Nodule, or Goiter

PHYSICAL EXAMINATION: GENERAL APPROACH

TECHNIQUES OF EXAMINATION

Hair

Scalp

Skull

Face

Skin

Cervical Lymph Nodes

Trachea

Thyroid Gland

Carotid Arteries and Jugular Veins

RECORDING YOUR FINDINGS

HEALTH PROMOTION AND COUNSELING: EVIDENCE AND RECOMMENDATIONS

Screening for Thyroid Dysfunction

Screening for Thyroid Cancer

REFERENCES

CHAPTER 12

Eyes

ANATOMY AND PHYSIOLOGY

Visual Fields

Visual Pathways

Autonomic Nerve Supply to the Eyes

Extraocular Movements

HEALTH HISTORY: GENERAL APPROACH

Vision Changes

Eye Pain, Redness, or Tearing

Double Vision

PHYSICAL EXAMINATION: GENERAL APPROACH

TECHNIQUES OF EXAMINATION

Visual Acuity

Visual Fields

Color Vision

Contrast Sensitivity

Eye Position and Alignment

Eyebrows

Eyelids

Lacrimal Apparatus

Conjunctiva and Sclera

Cornea and Lens

Iris

Pupils

Extraocular Muscles

Ophthalmoscopic (Funduscopic) Examination

SPECIAL TECHNIQUES

Eye Protrusion (Proptosis or Exophthalmos)

Nasolacrimal Duct Obstruction

Everting Upper Eyelid to Search for Foreign Body

Swinging Flashlight Test

RECORDING YOUR FINDINGS

HEALTH PROMOTION AND COUNSELING: EVIDENCE AND RECOMMENDATIONS

Visual Impairment

Screening for Glaucoma

UV-Related Eye Injuries

REFERENCES

CHAPTER 13

Ears and Nose

ANATOMY AND PHYSIOLOGY

Ear

Nose and Paranasal Sinuses

HEALTH HISTORY: GENERAL APPROACH

Hearing Loss

Earache and Ear Discharge

Tinnitus

Dizziness and Vertigo

Rhinorrhea and Nasal Congestion

Epistaxis

PHYSICAL EXAMINATION: GENERAL APPROACH

TECHNIQUES OF EXAMINATION

Auricle

Ear Canal and Tympanic Membrane

Testing Auditory Acuity or Gross Hearing

Testing for Conductive versus Sensorineural Hearing Loss: Tuning Fork Tests

Surface of the Nose

Nasal Cavity and Mucosa

Nasal Septum

Paranasal Sinuses

RECORDING YOUR FINDINGS

HEALTH PROMOTION AND COUNSELING: EVIDENCE AND RECOMMENDATIONS

SCREENING FOR HEARING LOSS

REFERENCES

CHAPTER 14

Throat and Oral Cavity

ANATOMY AND PHYSIOLOGY

Mouth, Gingiva, and Teeth

Tongue

Pharynx

HEALTH HISTORY: GENERAL APPROACH

Sore Throat

Bleeding or Swollen Gums

Hoarseness

Malodorous Breath

PHYSICAL EXAMINATION: GENERAL APPROACH

TECHNIQUES OF EXAMINATION

Lips and Oral Mucosa

Gums and Teeth

Roof and Floor of the Mouth and the Tongue

Pharynx

RECORDING YOUR FINDINGS

HEALTH PROMOTION AND COUNSELING: EVIDENCE AND RECOMMENDATIONS

Oral Health

Oral and Pharyngeal Cancer

REFERENCES

CHAPTER 15

Thorax and Lungs

ANATOMY AND PHYSIOLOGY

Locating Findings on the Chest

Breathing

HEALTH HISTORY: GENERAL APPROACH

Shortness of Breath (Dyspnea) and Wheezing

Cough

Hemoptysis

Chest Pain

Daytime Sleepiness, Snoring and Disordered Sleep

PHYSICAL EXAMINATION: GENERAL APPROACH

TECHNIQUES OF EXAMINATION

Initial Survey of Respiration and the Thorax

Posterior Chest

Anterior Chest

SPECIAL TECHNIQUES

Clinical Assessment of Pulmonary Function

Forced Expiratory Time

Identification of a Fractured Rib

RECORDING YOUR FINDINGS

HEALTH PROMOTION AND COUNSELING: EVIDENCE AND RECOMMENDATIONS

Lung Cancer

Latent Tuberculosis

Obstructive Sleep Apnea

REFERENCES

CHAPTER 16

Cardiovascular System

ANATOMY AND PHYSIOLOGY

Surface Projections of the Heart and Great Vessels

Cardiac Chambers, Valves, and Circulation

Events in the Cardiac Cycle

Splitting of Heart Sounds

Heart Murmurs

Relation of Auscultatory Findings to the Chest Wall

Conduction System

The Heart as a Pump

Arterial Pulses and Blood Pressure

Jugular Venous Pressure and Pulsations

Changes Over the Life Span

HEALTH HISTORY: GENERAL APPROACH

Chest Pain

Palpitations

Shortness of Breath

Swelling (Edema)

Fainting (Syncope)

PHYSICAL EXAMINATION: GENERAL APPROACH

TECHNIQUES OF EXAMINATION

Blood Pressure and Heart Rate

Jugular Venous Pressure

Carotid Arteries

Heart

SPECIAL TECHNIQUES: BEDSIDE MANEUVERS TO IDENTIFY MURMURS AND HEART FAILURE

Standing and Squatting

Valsalva Maneuver

Isometric Handgrip

Transient Arterial Occlusion

RECORDING YOUR FINDINGS

HEALTH PROMOTION AND COUNSELING: EVIDENCE AND RECOMMENDATIONS

Challenges of Cardiovascular Disease Prevention

Health Disparities in Cardiovascular Disease

Screening for Cardiovascular Risk Factors

Promoting Lifestyle Change and Risk Factor Modification

REFERENCES

CHAPTER 17

Peripheral Vascular System

ANATOMY AND PHYSIOLOGY

Arterial System

Venous System

Lymphatic System

Transcapillary Fluid Exchange

HEALTH HISTORY: GENERAL APPROACH

Peripheral Arterial Disease

Peripheral Venous Disease (or Venous Thromboembolism)

PHYSICAL EXAMINATION: GENERAL APPROACH

TECHNIQUES OF EXAMINATION

Arms

Abdomen

Legs

SPECIAL TECHNIQUES

Assessing for Peripheral Arterial Disease

Evaluating Arterial Perfusion of the Hand

RECORDING YOUR FINDINGS

HEALTH PROMOTION AND COUNSELING: EVIDENCE AND RECOMMENDATIONS

Screening for Lower Extremity Peripheral Artery Disease

Screening for Abdominal Aortic Aneurysm

REFERENCES

CHAPTER 18

Breasts and Axillae

ANATOMY AND PHYSIOLOGY

Female Breast

Axilla

Male Breast

HEALTH HISTORY: GENERAL APPROACH

Breast Lump or Mass

Breast Discomfort or Pain

Nipple Discharge

PHYSICAL EXAMINATION: GENERAL APPROACH

TECHNIQUES OF EXAMINATION

Female Breast

Axillae

Male Breast

SPECIAL TECHNIQUES

Examination after Mastectomy or Breast Reconstruction

RECORDING YOUR FINDINGS

HEALTH PROMOTION AND COUNSELING: EVIDENCE AND RECOMMENDATIONS

Breast Cancer in Women

MALE BREAST CANCER

REFERENCES

CHAPTER 19

Abdomen

ANATOMY AND PHYSIOLOGY

Abdominal Cavity and Contents

Pelvic Cavity and Contents

HEALTH HISTORY: GENERAL APPROACH

Abdominal Pain

Abdominal Pain and Associated Gastrointestinal Symptoms

Difficulty Swallowing (Dysphagia) and/or Painful Swallowing (Odynophagia)

Change in Bowel Function

Diarrhea

Constipation

Jaundice

Urinary Symptoms

Flank Pain and Ureteral Colic

PHYSICAL EXAMINATION: GENERAL APPROACH

TECHNIQUES OF EXAMINATION

Abdomen

Liver

Spleen

Kidneys

Urinary Bladder

Aorta

SPECIAL TECHNIQUES

Assessing Possible Ascites

Assessing Possible Appendicitis

Assessing Possible Acute Cholecystitis

Assessing Ventral Hernias

Abdominal Wall Mass

RECORDING YOUR FINDINGS

HEALTH PROMOTION AND COUNSELING: EVIDENCE AND RECOMMENDATIONS

Viral Hepatitis

Colorectal Cancer

REFERENCES

CHAPTER 20

Male Genitalia

ANATOMY AND PHYSIOLOGY

Genitalia

Groin

Lymphatics

Male Sexual Development and Function

HEALTH HISTORY: GENERAL APPROACH

Penile Discharge or Lesions and Scrotal or Testicular Pain, Swelling, or Lesions

Sexually Transmitted Infections

PHYSICAL EXAMINATION: GENERAL APPROACH

TECHNIQUES OF EXAMINATION

Penis

Scrotum and Scrotal Contents

SPECIAL TECHNIQUES

Evaluating Groin Hernias

Testicular Self-Examination

RECORDING YOUR FINDINGS

HEALTH PROMOTION AND COUNSELING: EVIDENCE AND RECOMMENDATIONS

Testicular Cancer

REFERENCES

CHAPTER 21

Female Genitalia

ANATOMY AND PHYSIOLOGY

Vulva

Vagina

Uterus

Adnexa

Pelvic Floor

Lymphatics

HEALTH HISTORY: GENERAL APPROACH

Menarche and Menses

Abnormal Bleeding

Menopause

Pelvic Pain?Acute and Chronic

Vulvovaginal Symptoms

PHYSICAL EXAMINATION: GENERAL APPROACH

Positioning

Examining Equipment

TECHNIQUES OF EXAMINATION

External Examination

Internal Examination

Hernias

SPECIAL TECHNIQUES

Assessing Urethritis

RECORDING YOUR FINDINGS

HEALTH PROMOTION AND COUNSELING: EVIDENCE AND RECOMMENDATIONS

Cervical Cancer

Menopause and Hormone Replacement Therapy

Ovarian Cancer

REFERENCES

CHAPTER 22

Anus, Rectum, and Prostate

ANATOMY AND PHYSIOLOGY

HEALTH HISTORY: GENERAL APPROACH

Change in Bowel Habits

Pain on Defecation

Anal Warts and Fissures

Weak Urinary Stream

PHYSICAL EXAMINATION: GENERAL APPROACH

TECHNIQUES OF EXAMINATION

Patient with a Prostate

Patient without a Prostate (Woman or Man with Prostatectomy)

RECORDING YOUR FINDINGS

HEALTH PROMOTION AND COUNSELING: EVIDENCE AND RECOMMENDATIONS

Prostate Cancer

REFERENCES

CHAPTER 23

Musculoskeletal System

ANATOMY AND PHYSIOLOGY

Joints

Bursae

Articular and Extraarticular Joint Structures

HEALTH HISTORY: GENERAL APPROACH

Joint Pain

Neck Pain

Low Back Pain

PHYSICAL EXAMINATION: GENERAL APPROACH

Inspection

Palpation

Range of Motion

Special Maneuvers

Other Examination Techniques

REGIONAL JOINT EXAMINATIONS

Temporomandibular Joint

Shoulder Joint

Elbow Joint

Wrist and Hand Joints

Vertebral Spine

Hip Joint

Knee Joint

Special Techniques: Tests for Knee Joint Effusions

Ankle Joint and Foot

SPECIAL TECHNIQUES

Measuring Leg Length

Describing Limited Joint Motion

RECORDING YOUR FINDINGS

HEALTH PROMOTION AND COUNSELING: EVIDENCE AND RECOMMENDATIONS

Low Back Pain

Osteoporosis

Preventing Falls

REFERENCES

CHAPTER 24

Nervous System

ANATOMY AND PHYSIOLOGY

Central Nervous System

Peripheral Nervous System

Motor Pathways

Sensory Pathways

Spinal Reflexes: Muscle Stretch Response

HEALTH HISTORY: GENERAL APPROACH

Headache

Dizziness or Lightheadedness

Weakness

Numbness or Abnormal or Absent Sensation

Fainting and Blacking Out (Near-Syncope and�Syncope)

Seizures

Tremors or Involuntary Movements

PHYSICAL EXAMINATION: GENERAL APPROACH

TECHNIQUES OF EXAMINATION

Cranial Nerves

Motor System

Sensory System

Muscle Stretch Reflexes

Cutaneous or Superficial Stimulation Reflexes

SPECIAL TECHNIQUES

Meningeal Signs

Lumbosacral Radiculopathy: Straight-Leg Raise

Asterixis (Flapping Tremor)

Assessing the Comatose Patient

RECORDING YOUR FINDINGS

HEALTH PROMOTION AND COUNSELING: EVIDENCE AND RECOMMENDATIONS

Preventing Cerebrovascular Disease

Screening for Asymptomatic Carotid Artery�Stenosis

Screening for Diabetic Peripheral Neuropathy

REFERENCES

UNIT 3

Special Populations

CHAPTER 25

Children: Infancy through Adolescence

GENERAL PRINCIPLES OF CHILD�DEVELOPMENT

SURVEILLANCE OF DEVELOPMENT

Physical Development

Cognitive Development

Language Development

Social and Emotional Development

Developmental Quotient

KEY COMPONENTS OF HEALTH PROMOTION

NEWBORNS AND INFANTS

HEALTH HISTORY: GENERAL APPROACH

SURVEILLANCE OF DEVELOPMENT

Physical Development

Cognitive and Language Development

Social and Emotional Development

PHYSICAL EXAMINATION: GENERAL APPROACH

Newborns

Infants

TECHNIQUES OF EXAMINATION: INFANTS

Assessment at Birth

RECORDING YOUR FINDINGS

HEALTH PROMOTION AND COUNSELING: EVIDENCE AND RECOMMENDATIONS

PRESCHOOL AND SCHOOL-AGED CHILDREN?HEALTH HISTORY: GENERAL APPROACH

Establishing Rapport

Working with Families

Multiple Agendas

Family as a Resource

Hidden Agendas

SURVEILLANCE OF DEVELOPMENT: EARLY CHILDHOOD: 1 TO 4 YEARS

Physical Development

Cognitive and Language Development

SURVEILLANCE OF DEVELOPMENT: MIDDLE CHILDHOOD, 5 TO 10 YEARS

Physical Development

Cognitive and Language Development

Social and Emotional Development

PHYSICAL EXAMINATION: GENERAL APPROACH

Assessing Younger Children

Assessing Older Children

TECHNIQUES OF EXAMINATION

Somatic Growth

Vital Signs

Skin

Head

Eyes

Ears

Nose and Sinuses

Mouth and Pharynx

Thorax and Lungs

Heart

Abdomen

Female Genitalia

Rectum and Anus

Musculoskeletal System

Nervous System

RECORDING YOUR FINDINGS

HEALTH PROMOTION AND COUNSELING: EVIDENCE AND RECOMMENDATIONS

Children 1 to 4 Years

Children 5 to 10 Years

ADOLESCENTS: HEALTH HISTORY

HEEADSSS Assessment

SURVEILLANCE OF DEVELOPMENT: 11 TO 20 YEARS

Physical Development

Cognitive Development

Social and Emotional Development

Gender and Sexual Identity Formation among�Adolescents

PHYSICAL EXAMINATION: GENERAL APPROACH

TECHNIQUES OF EXAMINATION

Somatic Growth: Height and Weight

Vital Signs

Skin

Head, Eyes, Ears, Nose, Mouth, and Neck

Thorax and Lungs

Breasts

Heart

Abdomen

Male Genitalia

Female Genitalia

Rectum and Anus

Musculoskeletal System

Nervous System

RECORDING YOUR FINDINGS

HEALTH PROMOTION AND COUNSELING: EVIDENCE AND RECOMMENDATIONS

REFERENCES

CHAPTER 26

Pregnant Woman

ANATOMY AND PHYSIOLOGY

Physiologic Hormonal Changes

Anatomic Changes

HEALTH HISTORY: GENERAL APPROACH

Initial Prenatal History

Subsequent Prenatal Visits

PHYSICAL EXAMINATION: GENERAL APPROACH

TECHNIQUES OF EXAMINATION

Positioning

Examining Equipment

General Inspection

Height, Weight, and Vital Signs

Head and Neck

Thorax and Lungs

Heart

Breasts

Abdomen

Genitalia

Anus, Rectum, and Rectovaginal Septum

Extremities

SPECIAL TECHNIQUES

Leopold Maneuvers

RECORDING YOUR FINDINGS

HEALTH PROMOTION AND COUNSELING: EVIDENCE AND RECOMMENDATIONS

Nutrition

Weight Gain

Exercise and Physical Activity

Substance Use including Tobacco, Alcohol, and Illicit Drugs

Intimate Partner Violence Screening

Screening for Perinatal Depression

Immunizations

Prenatal Laboratory Screenings

Genetic Testing and Aneuploidy Screening

Prenatal Supplementation

Unintended Pregnancy

REFERENCES

CHAPTER 27

Older Adult

ANATOMY AND PHYSIOLOGY

Vital Signs

Skin, Nails, and Hair

Eyes

Ears

Nose, Mouth, Teeth, and Lymph Nodes

Thorax and Lungs

Cardiovascular System

Peripheral Vascular System

Breasts and Axillae

Abdomen

Male and Female Genitourinary System; Prostate

Musculoskeletal System

Nervous System

HEALTH HISTORY: GENERAL APPROACH

Communicating Effectively with Older Adults

Shaping the Content and Pace of the Visit

Eliciting Symptoms from the Older Adult

Addressing Cultural Dimensions of Aging

Functional Impairments in Activities of Daily Living and Instrumental Activities of Daily Living

Medication Management

Smoking

Alcohol

Nutrition

SPECIAL TOPICS IN OLDER ADULT CARE

Frailty

Advance Directives and Palliative Care

PHYSICAL EXAMINATION: GENERAL APPROACH

TECHNIQUES OF EXAMINATION

Assessing Functional Status

General Survey

Vital Signs

Skin, Hair, and Nails

Eyes

Ears

Mouth and Teeth

Neck

Thorax and Lungs

Cardiovascular System

Breasts and Axillae

Peripheral Vascular System

Abdomen

Female Genitalia and Pelvic Examination

Male Genitalia and Prostate

Musculoskeletal System

Nervous System

RECORDING YOUR FINDINGS

HEALTH PROMOTION AND COUNSELING: EVIDENCE AND RECOMMENDATIONS

When to Screen

Screening for Visual and Hearing Impairments

Exercise and Physical Activity

Household Safety and Fall Prevention

Immunizations

Cancer Screening

Detecting the ?3 Ds?: Delirium, Dementia, and Depression

Elder Mistreatment and Abuse

REFERENCES

Index