Despite the wealth of diagnostic tools available to the modern
physician, the acquisition of information by direct interaction
with the patient through history taking and clinical examination
remains the bedrock of the physician’s art. These time-honoured
skills can often allow clinicians to reach a clear diagnosis without
recourse to expensive and potentially harmful tests.
This book aims to assist clinicians in developing the consultation
skills required to elicit a clear history, and the practical skills
needed to detect clinical signs of disease. Where possible, the
physical basis of clinical signs is explained to aid understanding.
Formulation of a differential diagnosis from the information gained
is introduced, and the logical initial investigations are included for
each system. Macleod’s Clinical Examination is designed to be
used in conjunction with more detailed texts on pathophysiology,
differential diagnosis and clinical medicine, illustrating specifically
how the history and examination can inform the diagnostic
In this edition the contents have been restructured and the
text comprehensively updated by a team of existing and new
authors, with the aim of creating an accessible and user-friendly
text relevant to the practice of medicine in the 21st century.
Section 1 addresses the general principles of good interaction
with patients, from the basics of taking a history and examining,
to the use of pattern recognition to identify spot diagnoses.
Section 2 deals with symptoms and signs in specific systems
and Section 3 illustrates the application of these skills to specific
clinical situations. Section 4 covers preparation for assessments
of clinical skills and for the use of these skills in everyday practice.
An expertly performed history and examination of a patient
allows the doctor to detect disease and predict prognosis, and is
crucial to the principle of making the patient and their concerns
central to the care process, and also to the avoidance of harm
from unnecessary or unjustified tests.
We hope that if young clinicians are encouraged to adopt
and adapt these skills, they not only will serve their patients
as diagnosticians but also will themselves continue to develop
clinical examination techniques and a better understanding of
their mechanisms and diagnostic use.
The 14th edition of Macleod’s Clinical Examination has an
accompanying set of videos available in the online Student
Consult electronic library. This book is closely integrated with
Davidson’s Principles and Practice of Medicine and is best read
in conjunction with that text.
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The editors would like acknowledge the immense contribution
made by Graham Douglas, Fiona Nicol and Colin Robertson
who edited the three previous editions of Macleod’s Clinical
Examination. Together they re-shaped the format of this textbook
and their efforts were rewarded by a substantial growth in both
its sales and international reputation.
The editors would like to acknowledge and offer grateful thanks
for the input of all previous editions’ contributors, without whom
this new edition would not have been possible. In particular, we
are indebted to those former authors who step down with the
arrival of this new edition. They include: Elaine Anderson, John
Bevan, Andrew Bradbury, Nicki Colledge, Allan Cumming, Graham
Devereux, Jamie Douglas, Rebecca Ford, David Gawkrodger,
Neil Grubb, James Huntley, John Iredale, Robert Laing, Andrew
Longmate, Alastair MacGilchrist, Dilip Nathwani, Jane Norman,
John Olson, Paul O’Neill, Stephen Payne, Laura Robertson,
David Snadden, James C Spratt, Kum-Ying Tham, Steve Turner
We are particularly grateful to the following medical students,
who undertook detailed reviews of the book and gave us a wealth
of ideas to implement in this latest edition. We trust we have listed
all those who contributed, and apologise if any names have been
accidentally omitted: Layla Raad Abd Al-Majeed, Ali Adel Ne’ma
Abdullah, Aanchal Agarwal, Hend Almazroa, Alhan Alqinai, Amjed
Alyasseen, Chidatma Arampady, Christian Børde Arkteg, Maha
Arnaout, Rashmi Arora, Daniel Ashrafi, Herry Asnawi, Hemant Atri,
Ahmed Ayyad, Kainath N Azad, Sadaf Azam, Arghya Bandhu,
Jamie Barclay, Prithiv Siddarth Saravana Bavan, Rajarshi Bera,
Craig Betton, Apoorva Bhagat, Prachi Bhageria, Geethanjali
Bhas, Navin Bhatt, Shahzadi Nisar Bhutto, Abhishek Ghosh
Biswas, Tamoghna Biswas, Debbie Bolton, Claude Borg, Daniel
Buxton, Anup Chalise, Amitesh Kumar Chatterjee, Subhankar
Chatterjee, Farhan Ashraf Chaudhary, Aalia Chaudhry, Jessalynn
Chia, Bhaswati Chowdhury, Robin Chowdhury, Marshall Colin,
Michael Collins, Margaret Cooper, Barbara Corke, Andrea Culmer,
Gowtham Varma Dantuluri, Abhishek Das, Sonali Das, Aziz Dauti,
Mark Davies, Adam Denton, Muinul Islam Dewan, Greg Dickman,
Hengameh Ahmad Dokhtjavaherian, Amy Edwards, Muhammad
Eimaduddin, Laith Al Ejeilat, Divya G Eluru, Emmanuel Ernest, El
Bushra El Fadil, Fathima Ashfa Mohamed Faleel, Malcolm Falzon,
Emma Farrington, Noor Fazal, Sultana Ferdous, Matthew Formosa,
Brian Forsyth, David Fotheringham, Bhargav Gajula, Dariimaa
Ganbat, Lauren Gault, Michaela Goodson, Mounika Gopalam,
Ciaran Grafton-Clarke, Anthony Gunawan, Aditya Gupta, Digvijay
Gupta, Kshitij Gupta, Sonakshi Gupta, Md. Habibullah, Kareem
Hendry, Malik Hina, Bianca Honnekeri, Justina Igwe, Chisom
Ikeji, Sushrut Ingawale, Mohammad Yousuf ul Islam, Sneha Jain,
Maria Javed, Ravin Jegathnathan, Helge Leander B Jensen,
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
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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
• formulate your findings into differential diagnoses
• rank these in order of probability
• use investigations to support or refute your differential
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
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
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
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.
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.
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