How to make the most of this book xi
SECTION 1 PRINCIPLES OF CLINICAL HISTORY AND EXAMINATION 1
1 Managing clinical encounters with patients 3
Karen Fairhurst, Anna R Dover, J Alastair Innes
2 General aspects of history taking 9
J Alastair Innes, Karen Fairhurst, Anna R Dover
3 General aspects of examination 19
Anna R Dover, J Alastair Innes, Karen Fairhurst
SECTION 2 SYSTEM-BASED EXAMINATION 37
4 The cardiovascular system 39
Nicholas L Mills, Alan G Japp, Jennifer Robson
J Alastair Innes, James Tiernan
6 The gastrointestinal system 93
Shyamanga Borooah, Naing Latt Tint
9 The ear, nose and throat 171
11 The reproductive system 211
Oliver Young, Colin Duncan, Kirsty Dundas, Alexander Laird
13 The musculoskeletal system 251
14 The skin, hair and nails 283
SECTION 3 APPLYING HISTORY AND EXAMINATION SKILLS IN SPECIFIC SITUATIONS 295
16 The patient with mental disorder 319
17 The frail elderly patient 329
Andrew Elder, Elizabeth MacDonald
18 The deteriorating patient 339
SECTION 4 PUTTING HISTORY AND EXAMINATION SKILLS TO USE 353
20 Preparing for assessment 355
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,
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