Li Jie, Ali Al Joboory, Asia Joseph, Christopher Teow Kang

Jun, Janpreet Kainth, Ayush Karmacharya, JS Karthik, Aneesh

Karwande, Adhishesh Kaul, Alper Kaymak, Ali Kenawi, Abdullah

Al Arefin Khadem, Haania Khan, Muhammad Hassan Khan,

Sehrish Khan, Shrayash Khare, Laith Khweir, Ankit Kumar, Vinay

Kumar, Ibrahim Lafi, Armeen Lakhani, Christopher Lee, David Lee,

Benjamin Leeves, Soo Ting Joyce Lim, Chun Hin Lo, Lai Hing Loi,

Chathura Mihiran Maddumabandara, Joana Sousa Magalhães,

Aditya Mahajan, Mahabubul Islam Majumder, Aaditya Mallik,

Mithilesh Chandra Malviya, Santosh Banadahally Manjegowda,

Jill Marshall, Balanuj Mazumdar, Alan David McCrorie, Paras

Mehmood, Kartik Mittal, Mahmood Kazi Mohammed, Amber

Moorcroft, Jayne Murphy, Sana Mustafa, Arvi Nahar, Akshay

Prakash Narad, Shehzina Nawal, Namia Nazir, Viswanathan

Neelakantan, Albero Nieto, Angelina Choong Kin Ning, Faizul

Nordin, Mairead O’Donoghue, Joey O’Halloran, Amit Kumar Ojha,

Ifeolu James Oyedele, Anik Pal, Vidit Panchal, Asha Pandu, Bishal

Panthi, Jacob Parker, Ujjawal Paudel, Tanmoy Kumar Paul, Kate

Perry, Daniel Pisaru, David Potter, Dipesh Poudel, Arijalu Syaram

Putra, Janine Qasim, Muhammad Qaunayn Qays, Mohammad

Qudah, Jacqueline Quinn, Varun MS Venkat Raghavan, Md.

Rahmatullah, Ankit Raj, Jerin Joseph Raju, Prasanna A Ramana,

Ashwini Dhanraj Rangari, Anurag Ramesh Rathi, Anam Raza,

Rakesh Reddy, Sudip Regmi, Amgad Riad, Patel Riya, Emily

Robins, Grace Robinson, Muhammad’Azam Paku Rozi, Cosmin

Rusneac, Ahmed Sabra, Anupama Sahu, Mohammad Saleh,

Manjiri Saoji, Saumyadip Sarkar, Rakesh Kumar Shah, Basil Al

Shammaa, Sazzad Sharhiar, Anmol Sharma, Homdutt Sharma,

Shivani Sharma, Shobhit Sharma, Johannes Iikuyu Shilongo,

Dhan Bahadur Shrestha, Pratima Shrestha, Anurag Singh,

Kareshma Kaur Ranjit Singh, Nishansh Singh, Aparna Sinha,

Liam Skoda, Ethan-Dean Smith, Prithviraj Solanki, Meenakshi

Sonnilal, Soundarya Soundararajan, Morshedul Islam Sowrav,

Kayleigh Spellar, Siddharth Srinivasan, Pradeep Srivastava,

Anthony Starr, Michael Suryadisastra, Louisa Sutton, Komal

Ashok Tapadiya, Areeba Tariq, Imran Tariq, Jia Chyi Tay, Javaria

Tehzeeb, Daniel Theron, Michele Tosi, Pagavathbharathi Sri Balaji

Vidyapeeth, Amarjit Singh Vij, Cathrine Vincent, Ghassan Wadi,

Amirah Abdul Wahab, James Warrington, Luke Watson, Federico

Ivan Weckesser, Ben Williamson, Kevin Winston, Kyi Phyu Wint,

Harsh Yadav, Saroj Kumar Yadav, Amelia Yong, Awais Zaka

and Nuzhat Zehra.

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How to make

the most of this book

The purpose of this book is to document and explain how to:

• interact with a patient as their doctor

• take a history from a patient

• examine a patient

• formulate your findings into differential diagnoses

• rank these in order of probability

• use investigations to support or refute your differential

diagnosis.

Initially, when you approach a section, we suggest that you

glance through it quickly, looking at the headings and how it

is laid out. This will help you to see in your mind’s eye the

framework to use.

Learn to speed-read. It is invaluable in medicine and in life

generally. Most probably, the last lesson you had on reading

was at primary school. Most people can dramatically improve

their speed of reading and increase their comprehension by

using and practising simple techniques.

Try making mind maps of the details to help you recall and

retain the information as you progress through the chapter. Each

of the systems chapters is laid out in the same order:

• Introduction: anatomy and physiology.

• The history: common presenting symptoms, what

questions to ask and how to follow them up.

• The physical examination: what and how to examine.

• Investigations: how to select the most relevant and

informative initial tests, and how these clarify the diagnosis.

• Objective Structured Clinical Examination (OSCE)

examples: a couple of short clinical scenarios included to

illustrate the type of problems students may meet in an

OSCE assessment of this system.

• Integrated examination sequence: a structured list of steps

to be followed when examining the system, intended as a

prompt and revision aid.

Return to this book to refresh your technique if you have

been away from a particular field for some time. It is surprising

how quickly your technique deteriorates if you do not use it

regularly. Practise at every available opportunity so that you

become proficient at examination techniques and gain a full

understanding of the range of normality.

Ask a senior colleague to review your examination technique

regularly; there is no substitute for this and for regular practice.

Listen also to what patients say – not only about themselves

but also about other health professionals – and learn from these

comments. You will pick up good and bad points that you will

want to emulate or avoid.

Finally, enjoy your skills. After all, you are learning to be able

to understand, diagnose and help people. For most of us, this

is the reason we became doctors.

Examination sequences

Throughout the book there are outlines of techniques that you

should follow when examining a patient. These are identified

with a red ‘Examination sequence’ heading. The bullet-point list

provides the exact order in which to undertake the examination.

To help your understanding of how to perform these techniques

many of the examination sequences have been filmed and these

are marked with an arrowhead.

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Clinical skills videos

Included with your purchase are clinical examination videos,

custom-made for this textbook. Filmed using qualified doctors,

with hands-on guidance from the author team, and narrated

by former Editor Professor Colin Robertson, these videos offer

you the chance to watch trained professionals performing many

of the examination routines described in the book. By helping

you to memorise the essential examination steps required for

each major system and by demonstrating the proper clinical

technique, these videos should act as an important bridge

between textbook learning and bedside teaching. The videos

will be available for you to view again and again as your clinical

skills develop and will prove invaluable as you prepare for your

clinical OSCE examinations.

Each examination routine has a detailed explanatory narrative

but for maximum benefit view the videos in conjunction with the

book. See the inside front cover for your access instructions.

Key points in examinations: photo galleries

Many of the examination sequences are included as photo

galleries, illustrating with captions the key stages of the

examination routine. These will act as a useful reminder of the

main points of each sequence. See the inside front cover for

your access instructions.

Video contents

• Examination of the cardiovascular system.

• Examination of the respiratory system.

• Examination of the gastrointestinal system.

• Examination of the neurological system.

• Examination of the ear.

• Examination of the thyroid gland.

• Examination of the musculoskeletal system.

Video production team

Director and editor

Dr Iain Hennessey

Producer

Dr Alan G Japp

Sound and narrators

Professor Colin Robertson

Dr Nick Morley

Clinical examiners

Dr Amy Robb

Dr Ben Waterson

Patients

Abby Cooke

Omar Ali

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Contributors

Anthony Bateman MD MRCP FRCA FFICM

Consultant in Critical Care and Long Term Ventilation, Critical

Care NHS Lothian, Edinburgh, UK

Shyamanga Borooah MRCP(UK) MRCS(Ed)

FRCOphth PhD

Fulbright Fight for Sight Scholar, Shiley Eye Institute,

University of California, San Diego, USA

Kirsty Boyd PhD FRCP MMedSci

Consultant in Palliative Medicine, Royal Infirmary of Edinburgh;

Honorary Clinical Senior Lecturer, Primary Palliative Care

Research Group, University of Edinburgh, UK

Ivan Brenkel FRCS(Ed)

Consultant Orthopaedic Surgeon, Orthopaedics, NHS Fife,

Kirkcaldy, UK

Gareth Clegg PhD MRCP FRCEM