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.
To help your understanding of how to perform these techniques
many of the examination sequences have been filmed and these
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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
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
• Examination of the cardiovascular system.
• Examination of the respiratory system.
• Examination of the gastrointestinal system.
• Examination of the neurological system.
• Examination of the thyroid gland.
• Examination of the musculoskeletal system.
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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)
Fulbright Fight for Sight Scholar, Shiley Eye Institute,
University of California, San Diego, USA
Consultant in Palliative Medicine, Royal Infirmary of Edinburgh;
Honorary Clinical Senior Lecturer, Primary Palliative Care
Research Group, University of Edinburgh, UK
Consultant Orthopaedic Surgeon, Orthopaedics, NHS Fife,
Senior Clinical Lecturer, University of Edinburgh; Honorary
Consultant in Emergency Medicine, Royal Infirmary of
Consultant and Honorary Professor in Paediatric Respiratory
Medicine, Royal Hospital for Sick Children, Edinburgh, UK
Consultant Neurologist, Western General Hospital and Royal
Infirmary of Edinburgh; Honorary Senior Lecturer, University of
Senior Lecturer and Honorary Consultant Nephrologist,
Consultant in Diabetes, Endocrinology and General Medicine,
Edinburgh Centre for Endocrinology and Diabetes, Royal
Infirmary of Edinburgh; Honorary Clinical Senior Lecturer,
Professor of Reproductive Medicine and Science, University
of Edinburgh; Honorary Consultant Gynaecologist, Royal
Consultant Obstetrician, Royal Infirmary of Edinburgh;
Honorary Senior Lecturer and Associate Senior Tutor,
Andrew Elder FRCP(Ed) FRCPSG FRCP FACP FICP(Hon)
Consultant in Acute Medicine for the Elderly, Western General
Hospital, Edinburgh; Honorary Professor, University of
General Practitioner, Mackenzie Medical Centre, Edinburgh;
Clinical Senior Lecturer, Centre for Population Health
Sciences, University of Edinburgh, UK
Jane Gibson MD FRCP(Ed) FSCP(Hon)
Consultant Rheumatologist, Fife Rheumatic Diseases Unit,
NHS Fife, Kirkcaldy, Fife; Honorary Senior Lecturer, University
Iain Hathorn DOHNS PGCME FRCS(Ed) (ORL-HNS)
Consultant ENT Surgeon, NHS Lothian, Edinburgh, UK;
Honorary Clinical Senior Lecturer, University of Edinburgh, UK
Clinical Director of Innovation, Consultant Paediatric and
Neonatal Surgeon, Alder Hey Children’s Hospital,
J Alastair Innes BSc PhD FRCP(Ed)
Consultant Physician, Respiratory Unit, Western General
Hospital, Edinburgh; Honorary Reader in Respiratory
Medicine, University of Edinburgh, UK
Consultant Cardiologist, Royal Infirmary of Edinburgh;
Honorary Senior Lecturer, University of Edinburgh, UK
Reader in Nephrology, University of Edinburgh, UK
Alexander Laird PhD FRCS(Ed) (Urol)
Consultant Urological Surgeon, Western General Hospital,
Elizabeth MacDonald FRCP(Ed) DMCC
Consultant Physician in Medicine of the Elderly, Western
General Hospital, Edinburgh, UK
Consultant Neurologist and Honorary Senior Lecturer,
National Hospital for Neurology and Neurosurgery,
Nicholas L Mills PhD FRCP(Ed) FESC
Chair of Cardiology and British Heart Foundation Senior
Clinical Research Fellow, University of Edinburgh; Consultant
Cardiologist, Royal Infirmary of Edinburgh, UK
Nick Morley MRCS(Ed) FRCR FEBNM
Consultant Radiologist, University Hospital of Wales,
Professor of Surgical Sciences, Clinical Surgery, University of
Edinburgh; Honorary Consultant Hepatobiliary and Pancreatic
Surgeon, Royal Infirmary of Edinburgh, UK
Consultant in Critical Care, Western General Hospital,
John Plevris DM PhD FRCP(Ed) FEBGH
Professor and Consultant in Gastroenterology, Royal Infirmary
of Edinburgh, University of Edinburgh, UK
Stephen Potts FRCPsych FRCP(Ed)
Consultant in Transplant Psychiatry, Royal Infirmary of
Edinburgh; Honorary Senior Clinical Lecturer, University of
Colin Robertson FRCP(Ed) FRCS(Ed) FSAScot
Honorary Professor of Accident and Emergency Medicine,
Clinical Lecturer in Surgery, University of Edinburgh, UK
Janet Skinner FRCS MMedEd FCEM
Director of Clinical Skills, University of Edinburgh; Emergency
Medicine Consultant, Royal Infirmary of Edinburgh, UK
Consultant Neonatologist, Royal Infirmary of Edinburgh;
Honorary Professor of Neonatology, University of
Michael J Tidman MD FRCP(Ed) FRCP (Lond)
Consultant Dermatologist, Royal Infirmary of Edinburgh, UK
James Tiernan MSc(Clin Ed) MRCP(UK)
Consultant Respiratory Physician, Royal Infirmary of
Edinburgh; Honorary Senior Clinical Lecturer, University of
Consultant Ophthalmic Surgeon, Ophthalmology, Princess
Alexandra Eye Pavilion, Edinburgh, UK
Clinical Director, Edinburgh Breast Unit, Western General
Consultant in Diabetes, Endocrinology and General Medicine,
Edinburgh Centre for Endocrinology and Diabetes, Royal
Infirmary of Edinburgh; Honorary Clinical Senior Lecturer,
Principles of clinical history
1 Managing clinical encounters with patients 3
2 General aspects of history taking 9
3 General aspects of examination 19
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