Preface to the First Edition ix

Preface to the Third Edition x

Preface to the Fourth Edition xi

Preface to the Fifth Edition xii

Contributors xiii

Acknowledgements xv

1 HISTORY-TAKING AND CLINICAL 1

EXAMINATION

Kevin G Burnand, Norman L Browse

How to take the history 2

An example of how to take a detailed 9

history of pain

The clinical examination 12

General assessment 12

General appearance 13

The patient’s size, shape and physical 15

characteristics

The examination 22

History and examination of a lump 36

History and examination of an ulcer 41

2 THE HEART, LUNGS AND PLEURA 45

Timothy JP Batchelor

Introduction 45

Breathlessness 45

Pneumothorax 47

Pleural effusion 48

Mesothelioma 50

Empyema 50

Pulmonary embolism 51

Lung cancer 51

Heart failure 54

Valvular disease 55

Infective endocarditis 57

Congenital heart disease 58

Left atrial myxoma 61

Cough 61

Inhaled foreign body 63

Pneumonia 63

Lung abscess 64

Bronchiectasis 64

Chest pain 65

Chronic stable angina 67

Acute coronary syndromes 68

Aortic dissection 69

Mediastinal masses and tumours 71

Other symptoms/signs 72

Stridor 72

Haemoptysis 72

Distended neck veins 72

Chest and cardiac trauma 75

Chest wall abnormalities 75

Finger clubbing 76

Ankle swelling 77

Cyanosis 77

Horner’s syndrome 78

3 THE BRAIN, CENTRAL NERVOUS 79

SYSTEM AND PERIPHERAL NERVES

Peter Bullock

History 79

Neurological symptoms arising from 79

cranial conditions

Neurological symptoms arising from

spinal conditions 84

Neurological examination 84

Head and spine 84

Practical neurological examination 85

Specific intracranial conditions 96

Head injury 96

Brain tumours 101

Brain haemorrhage 103

Infections of the brain 104

Hydrocephalus 105

Peripheral nerve injury 106

4 THE SKIN AND SUBCUTANEOUS 111

TISSUES

Pari-Naz Mohanna, Samer Saour

Anatomy and function 111

Diagnosis of skin conditions 111

Congenital skin disorders 114

Genetic skin disorders 114

Non-genetic congenital skin 115

disorders

Haemangiomas/lymphangiomas 117

Acquired dermatological conditions 121

Conditions of the skin caused by 121

trauma

Infections of the skin 127

Pruritus 137

Benign skin lumps 137

Benign subcutaneous swellings 145

Tumours of the skin appendages 150

Premalignant skin lesions 151

Malignant diseases of the skin 152

Other common skin conditions 161

sometimes seen in surgical patients

The fingernails 163

The toenails 165

5 THE SYMPTOMS, SIGNS AND 167

EMERGENCY MANAGEMENT OF

MAJOR INJURIES

Tom Carrell

First aid 167

The primary survey and management 168

at the site of the event

The primary survey in the accident 170

and emergency department

The secondary survey 173

General examination of a conscious 174

patient

The secondary survey in the 179

unconscious patient

Assessment of multiple casualties 180

Scoring systems 180

6 BONES, JOINTS, MUSCLES 181

AND TENDONS

Steven A Corbett, Kevin G Burnand

Common symptoms 181

A general plan for examining the 182

muscles, bones and joints of a limb

Examination of the muscles 185

Examination of the bones 186

Examination of the joints 189

General examination of the limb 190

Common conditions affecting muscles 190

Fibrous tissue 192

Tendons and tendon sheaths 194

Conditions of bones 194

Fractures 194

Bone diseases and deformities 198

Abnormalities of bone metabolism 199

Infections of bone 202

Miscellaneous conditions of bone 204

Conditions of joints 210

Congenital/genetic disorders of 217

bones and joints

7 UPPER LIMB SYMPTOMS AND SIGNS 219

Steven A Corbett

Shoulder 219

Plan for examination of the shoulder 219

Causes of shoulder pain 225

Elbow joint 231

Plan for examination of the elbow 231

Causes of elbow pain 232

The hand 236

Plan for examination of the hand 237

Abnormalities and conditions of 238

the hand

Fractures and dislocations of the 246

upper limb

Fractures of the clavicle 246

Fractures of the scapula 247

Injuries of the acromioclavicular joint 247

Injuries of the sternoclavicular joint 248

Dislocation of the glenohumeral joint 248

Fractures of the humerus 249

Dislocation of the elbow 250

Fractures of head and neck of radius 251

Fractures of the olecranon 251

Fractures of the shafts of the radius 251

and ulna

Fractures of the distal radius and ulna 252

Fractures of the scaphoid bone 253

Perilunate and lunate and dislocation 254

of the wrist

Metacarpal fractures and 254

dislocations

Fractures and dislocations of the 255

phalanges

8 LOWER LIMB SYMPTOMS AND SIGNS 257

Steven A Corbett, Diane L Back, Sam Singh, Jay

D Smith

The hip 257

Symptoms 257

Plan for examination of the hip joint 258

Causes of pain in the hip 262

The knee joint 267

Symptoms 267

Plan for examination of the knee joint 268

Causes of knee pain 273

The foot and ankle 280

The ankle joint 280

The foot arches 280

Symptoms 280

Plan for examination of foot and ankle 281

Congenital and acquired conditions 283

of the foot and ankle

Fractures of the lower limb 290

Proximal femoral fractures 290

Dislocations of the hip 290

Fractures of the femoral shaft 291

Supracondylar fractures of the femur 292

Fractures of the patella 292

Dislocation of the patella 292

Dislocation of the knee 293

Proximal fractures of the tibia and 293

fibula

Fractures of the shafts of the 293

tibia and fibula

Fractures of and around the ankle 293

Ankle dislocation 294

Fractures of the talus and calcaneum 294

Mid-tarsal fractures 295

Metatarsal fractures 295

Fractured toes 295

Fractured sesamoid bones 295

9 THE SPINE AND PELVIS 297

Jonathan Lucas

The cervical spine 297

Examination of the cervical spine 297

Common conditions of the cervical 298

spine

The thoraco-lumbar-sacral spine 301

Examination of the thoraco- 301

lumbar-sacral spine

Common conditions of the thoraco- 305

lumbar-sacral spine

Fractures of the spine and pelvis 312

Fractures of the cervical spine 313

Fractures of the thoraco-lumbar 315

spine

Fractures of the sacrum and coccyx 316

Pelvic fractures 316

10 THE ARTERIES, VEINS 319

AND LYMPHATICS

Kevin G Burnand, Bijan Modarai

The arteries 319

Clinical assessment of the arterial 319

circulation of the lower limb

Symptoms produced by acute arterial 324

insufficiency of the limbs

Symptoms of chronic arterial 325

insufficiency of the lower limb

Haemorrhage 335

Transient and permanent neurological 335

weakness, paralysis and blindness

Cold, blue digits, hands and feet 338

Erythromelalgia 340

Large limbs 341

Surgically correctable causes of 341

hypertension

Intestinal ischaemia 342

The veins 342

Clinical assessment of the venous 342

circulation of the lower limb

Lower limb venous disease 350

The lymphatics 359

Conditions affecting the lymph

glands 359

11 THE MOUTH, TONGUE AND LIPS 363

Mark McGurk, Leandros-Vassilios Vassiliou

Congenital orofacial abnormalities 363

The lips, buccal mucosa and tongue 366

Other conditions of the tongue 376

The palate 377

The tonsils 379

The floor of the mouth 380

The gums 382

The jaw 383

12 THE NECK 387

William EG Thomas

History and examination of swellings 387

in the neck

Cervical lymphadenopathy and 388

other neck swellings

The salivary glands 404

Symptoms of thyroid disease 415

Examination of the thyroid gland 418

Different forms of goitre 423

Thyrotoxicosis and myxoedema 426

(hyperthyroidism and hypothyroidism)

Carcinoma of the thyroid gland 431

Thyroiditis 434

Parathyroid disease 437

13 THE BREAST 439

John Black

History and examination of 439

breast disease

Presentation of breast disease 444

Carcinoma of the female breast 444

Benign breast tumours 448

Benign breast disease 449

The nipple 451

Breast abscess 453

Pregnancy 453

The male breast 454

14 THE ABDOMINAL WALL, HERNIAS 457

AND THE UMBILICUS

John Black

Abdominal hernia 458

Inguinal hernia 459

Femoral hernia 469

Umbilical hernia 471

Epigastric hernia 474

Incisional hernia 474

Divarication of the recti 475

Rare abdominal hernias 475

The umbilicus 476

15 THE ABDOMEN 481

James A Gossage, Kevin G Burnand

Examination of the abdomen 481

Abdominal pain 485

The pathology of the acute abdomen 488

Inflammation of a viscus 488

Perforation of a viscus 488

Obstruction of a viscus/intestinal

obstruction 488

Infarction of a viscus 491

Abdominal pain caused by 492

intra-abdominal or retroperitoneal

haemorrhage

Extra-abdominal and medical conditions

causing acute abdominal pain 494

Causes of acute upper abdominal pain 496

Acute central abdominal pain 501

Acute lower abdominal pain 504

Chronic abdominal pain 508

Chronic upper abdominal pain 508

Chronic central abdominal pain 512

Chronic lower abdominal pain 514

Conditions presenting with dysphagia 516

Conditions presenting with vomiting 517

Conditions presenting with 518

haematemesis or melaena

Conditions presenting with jaundice 518

Conditions presenting with diarrhoea 519

Abdominal masses: causes and signs 520

Causes of a mass in the right iliac fossa 528

Causes of a mass in the left iliac fossa 530

Causes of a lump in the groin 531

Abdominal distension 531

16 THE RECTUM AND ANAL CANAL 535

Ruth McKee

Applied anatomy 535

Symptoms of ano-rectal disease 535

Technique for digital ano-rectal 537

examination

Sigmoidoscopy and proctoscopy 540

Conditions presenting with 543

rectal bleeding

Conditions presenting with anal pain 547

Conditions presenting as an anal lump 552

with or without pain

Prolapse of the rectum 554

Conditions presenting with pruritus ani 555

Conditions presenting with 556

faecal incontinence

17 THE KIDNEY, URINARY TRACT 559

AND PROSTATE

Matthew Bult itude, Ben Challacombe

Symptoms of renal and urinary 559

tract disease

Diseases of the urinary tract 561

Retention of urine 567

The prostate gland 569

The urethra 571

Trauma to the urinary tract 572

18 THE EXTERNAL GENITALIA 573

Matthew Bult itude, Ben Challacombe

Examination of the male genitalia 573

The penis 576

The scrotal skin 583

The testes 585

The female external genitalia 598

Intersex conditions 598

INDEX 601