Includes bibliographical references and index. Summary: “This concise pocket- sized guide presents the classic Bates approach to physical exami- nation and. Bates' Pocket Guide to Physical Examination and History Taking. Pages· · The Navy SEAL Physical Fitness Guide - Human Performance. Download File Bates' Pocket Guide to Physical Examination and History Taking 8th You have requested

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Bates' Pocket Guide to Physical Examination and History Taking: downloadd this pocket guide and found the PDF older version of this book and it was perfect. Bates' Pocket Guide to Physical Examination and History Taking, 8e (Nov 1, )_()_(LWW).pdf - Ebook download as PDF File. Read Bates' Pocket Guide to Physical Examination and History Taking PDF - by Lynn S. Bickley MD FACP LWW | This concise pocket-sized.

The Pocket Guide is an abbreviated v We would be glad to answer any of your queries. Hardcover edition. Slightly dog-earred on the corners; in otherwise good condition. It may have a minor bump or bruise. The pages are slightly stained or discolored, but not excessive. There may be creases or Contents are identical to US Edition and written in English.

Some of the pages have writing and underline words. Great condition over all. Condition is Like New. This is 11 edition. This book was bought new in Has been in a box since then basically. Like new. Some bends in the corner of pages. No software included. PB VeryGood. Book has appearance of light use with no easily noticeable wear.

Millions of satisfied customers Condition is Brand New. No highlights or writing on it. It explains physical examinations v Bate's Guide to Physical Examination 9th edition. Used for one semester. Pages are in great condition. Cover shows a little wear, but it's a soft cover and black so the creases show white. Does not af She h s issed work on sever l occ sions bec use of ssoci ted n use nd vo iting. They re relieved by slee nd utting d towel over her forehe d. Chapter 1 Foundations for Clinical Proficiency 17 ndings and a differential diagnosis.

Study the case of Mrs. Note the standard format of the clinical record. She h d he d ches with n use nd vo iting beginning t ge 15 ye rs. There is little relief fro s irin. There re no ssoci ted visu l ch nges. He d ches now ver ge once week. None Source and Reliability. These recurred throughout her id-2 s.

Compose the clinical record as soon after seeing the patient as possible. These re usu lly bifront l.

Adult Illnesses: Pyelone hritis. L st enses 6 onths go. She e ts three e ls d y nd drinks three cu s of coffee d y nd te t night.

No sc rlet fever or rheu t ic fever. Health Maintenance: Or l olio v ccine. Tra in a ccide nt S troke. Past History Childhood Illnesses: Me sles. No concerns bout HIV infection. No illicit drugs. She thinks her he d ches y be like those in the st. Three living children. Tonsillec- to y. Screening tests: Acet ino hen. Family History The f ily history is de icted below. A icillin c uses r sh. About 1 ck of cig rettes er d y since ge 18 36 ck-ye rs. Little interest in sex.

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Wine on r re occ sions. Continued The tient re orts incre sed ressure t work fro de nding su ervisor. Sutures for l cer tion. Men rche ge Re orts x-r ys were nor l. She is concerned bec use her he d ches interfere with her work nd ke her irrit ble with her f ily.

Uses sunblock. No cough. She h s friends but r rely discusses f ily roble s: Continued OR. Diet high in c rbohydr tes. L st chest x-r y. No lu s. F ther died t ge 43 ye rs in tr in ccident. Returned to work 15 ye rs go to i rove f ily fin nces. Four ye rs go Mr. One brother. Cle ning solut ions in unlocked c binet below sink.

No r shes or other ch nges. No f ily history of di betes. No h y fever. Throat or mouth and phar- ynx: So e bleeding of gu s recently.

Safety measures. Occ sion l c nker sore. Medic t ions ke t in n unlocked edicine c binet. He ring good. Mother died t ge 67 ye rs fro stroke. Does bre st self-ex in tion s or dic lly. L st dent l visit 2 ye rs go.

No swollen gl nds. Re ding gl sses for 5 ye rs. No known he rt dise se or high blood ressure. Review of Systems General: Is bel. No dys ne. Husb nd died t ge 54 of he rt tt ck D ughter.

Chil- dren ll rried. H s never h d n electroc rdiogr ECG. Uses se t belt regul rly.

Download File Bates’ Pocket Guide to Physical Examination and History Taking 8th Edition.pdf

See Present Illness. Gets little exercise. Exercise and diet. Worked s s les clerk for 2 ye rs. Occ sion l ild cold. No history of he d injury. No tinnitus. No sy to s. No v gin l or elvic infections. No in. Vital signs: Ph rynx without exud tes. BMI N ils without clubbing.

No f inting. No rteriol r n rrowing or A-V nicking. P l s cold nd oist. Extr ocul r ove ents int ct. Tonsils bsent.

Her h ir is well groo ed. W x rti lly obscures right ty nic e br ne TM. TM with good cone of light. Weber idline.

Visu l fields full by confront tion. Or l ucos ink. Me ory good. Sc l without lesions. He rt r te HR 88 nd regul r. Sever l interdent l ill e red. No dys reuni. Continued Gastrointestinal: A etite good. She is so ewh t t ense. Pu ils 4 constricting to 2. Conjunctiv ink. H ir of ver ge texture. No frequency. Her color is good. Wt dressed 65 kg lb. Mucos ink.

Bowel ove- ent bout once d ily. Peripheral vascular: V ricose veins e red in both legs during first regn ncy. For 1 ye rs. Disc rgins sh r. Occ sion lly loses urine when coughing. Exce t for bleeding gu s. No sy to s or history of di betes. Dentition good. Sc ttered cherry ngio s over u er trunk. No history of de ression or tre t ent for sychi tric disorders. Te - er ture or l No ot her joint in. No sinus tenderness.

No ne i. Musculoskelet al: Mild low b ck ches. Tongue idline. Res ir tory r te RR No known thyroid disorders or he t or cold intoler nce. Acuity good to whis ered voice. S leen nd kidneys not felt. Jugul r venous ressure 1 c bove the stern l ngle. No di stolic ur urs. Rectov gin l w ll int ct. Good S1. No joint defor ities. Lymph nodes: Oriented to erson. Well-he led sc r. Adnex not l ted due to obesity nd oor rel x tion.

Moder te v ricosities of s he- nous veins both in lower extre ities. Lungs reson nt. Tr che idline. Thorax and lungs: Thor x sy etric with good excursion. Rect l v ult without sses. Protuber nt. V gin l ucos ink. No sses. C lves su le. Stool brown. Uterus nterior. Di hr g s descend 4 c bil ter lly. C rotid u strokes brisk. Good r nge of otion in h nds.

R id ltern ting ove ents RAMs. A ic l i ulse discrete nd t ing. Thyroid isth us b rely l ble. Bowel sounds ctive. No costovertebr l ngle tenderness CVAT. No cervic l or dnex l tenderness.

Thought coherent. G it st ble. Liver s n 7 c in right idcl vicul r line. No tenderness or sses. Sever l s ll inguin l nodes bil ter lly. Good uscle bulk nd tone. No xill ry or e itrochle r nodes. Cranial nerves: II to XII int ct. Bre th sounds vesicul r with no dded sounds.

Ro berg neg tive. Cervix ink. No st sis ig ent tion or ulcers. Pin rick. Mild cystocele t introitus on str ining. Tr ce ede t both nkles. W r nd without ede.

Bates' Guide to Physical Examination and History Taking

Mental Status: Extern l genit li without lesions. Continued Neck: Neck su le. Not t king ny contributing edic - tions. A ye r-old wo n with igr ine he d ches since childhood.

The differenti l di gnosis includes tension he d che. Continued Reflexes: M y be rel ted to nxiety fro first visit. No evidence of end-org n d ge to retin or he rt.

Systolic hy ertension is resent. There re no fever. He d ches re ssoci ted with stress nd relieved by slee nd cold co resses. Usu lly involves s ll ounts of urine. Migraine headaches. Elevat ed blood pressure. P tient is eri eno us l. Incontinence re orted with coughing. No dysuri. Cystocele with occasional stress incontinence. Cystocele on elvic ex i- n tion. There is no illede. BMI is Varicose veins. History of right pyelonephritis. Stress currently situ tion l.

P tient lso h s fin nci l constr ints. Continued Pl n: Tobacco abuse. Son-in-l w de loyed. P in does not r di te. Occasional musculoskelet al low back pain. No co l ints currently. Health maintenance.

Usu lly with rolonged st nd- ing. Ampicillin allergy. Develo ed r sh but no other llergic re ction. Urge tient to ove gun nd c rtridges to locked gun c binet. Doubt disc or nerve root co ression. Family stress. No current evidence of jor de ression. No history of tr u or otor vehicle ccident.

Think especially about the order and readability of the record and the amount of detail needed. Use the following checklist to make sure your record is informative and easy to follow.

Order is i er tive. Kee the subjective ite s of the history. A sample Problem List for Mrs. Some clinicians make separate lists for active or inactive problems. List the most active and serious problems rst. Did you: M ke sure th t re ders c n e sily find s ecific oints of infor tion.

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Short Words. M ke sure there is sufficient det il to su ort your differenti l di gnosis nd l n. For ex le. Are Pertinent Negatives Speci cally Described? Often ortions of the history or ex in tion suggest th t n bnor lity ight exist or develo in th t re. S ell out the su orting evidence. Is Data Unnecessarily Repeated? M ke your descri tions concise.

Are Phrases. You c n o it uni ort nt struct ures even though you ex ined t he. For the tient who is de ressed but not suicid l. Remember that data not recorded are data lost. In the tient with tr nsient ood swing. Is there excess infor tion or redund ncy?

Is i ort nt infor t ion buried in ss of det il. No tter how vividly you c n rec ll clinic l det ils tod y. They lso ight rove difficult to defend in leg l setting. Di gr s dd gre tly to the cl rity of the record. Never use infl tory or de e ning words or unc- tu tion. It is i ort nt to be objective. To ensure ccur te ev lu tions nd future co risons. Me ade M. As you approach clinical problems. Figure 14—2. Re nnie D.

Adapte d w ith pe rm is s ion from Guyatt G. New York. These recommendations are also based on evidence from the clinical literature that can be evaluated according to criteria presented in this chapter. Throughout the regional examination chapters. Carefully study the clear descriptions of how the history and physical examination can be viewed as diagnostic tests.

McGraw-Hill Com pany. Chapte r As you learn about your patient. The area between the test and treatment thresholds represents clinical uncertainty. The two rows correspond to positive and negative test results. V a lid it y Does the test provide valid results and accurately identify whether the patient has a disease? This involves comparing the test against a gold standard—the best measure of whether a patient has disease.

The rst test statistics to estimate are sensitivity and speci city. This could be a biopsy. There are two columns—patients with disease present and patients with disease absent. These categorizations are based on the gold standard test. Evaluating Diagnostic Tests Two concepts in evaluating diagnostic tests are the validity of the ndings and the reproducibility of the test results.

The four cells a. An ex le of this st tistic is found in rost te c ncer screening see Ch ter The positive predictive value calculated. Predictive value statistics vary substantially according to the prevalence of disease i. An ex le of these st tistics would be the rob bility th t s leno- eg ly see Ch ter Con- versely. To determine the prob- ability that a patient actually has disease based on a test result that is either positive or negative.

An ex le is: A ong en with PSA level of 4. S ec- ificity is lso known s the true neg tive r te. Sensitivity is lso known s the true ositive r te. A negative result from a test with a high sensitivity i. This means that half of the people with a positive test have disease.

The likelihood ratio for a positive test is the ratio of getting a positive test result in a diseased person divided by the probability of getting a positive test result in.

The likelihood ratio tells us how much a test result changes the pre-test disease probability prevalence to the post-test disease probability. To evaluate the performance of a diagnostic test that can account for the varying disease prevalence observed in different patient populations. A test with likelihood ratio of 1 rovides no ddition l infor tion bout the rob bility of dise se. With this nomogram. The likelihood ratio for a negative test is the ratio of the probability of getting a negative test result in a diseased person divided by the probability of getting a negative test result in a nondiseased person.

Chapter 2 Evaluating Clinical Evidence 31 a nondiseased person. If you are more comfortable thinking in terms of probability of having disease. This theorem requires converting the estimated prevalence pre-test probability to odds using the equation: One way to use likelihood ratios to revise probabilities for disease is with the Bayes theorem.

Adapte d w ith pe rm is s ion from Fagan TJ. Le tte r: Figure 2. A negative test result red line leads to a post-test probability of 0. Two clinicians examining a patient may not always agree upon the presence of a given nding.

Bates' Pocket Guide to Physical Examination and History Taking 8th Edition Pdf

Understanding whether there is agreement well beyond chance is important in knowing whether the nd- ing is useful enough to support clinical decision making. The kappa score measures the amount of agreement that occurs beyond chance. The box shows how to interpret Kappa values. In the context of reproducibility, precision refers to being able to apply the same test to the same unchanged person and obtain the same results. Precision is often used when referring to laboratory tests.

A statisti- cal test used to characterize precision is the coef cient of variation, de ned as the standard deviation divided by the mean value. Lower values indicate greater precision. Health Promotion Throughout the book you will nd health promotion sections that make recommendations for primary prevention interventions designed to prevent disease as well as secondary prevention screening tests designed to nd disease or disease processes at an early, asymptomatic stage.

The rationale for secondary prevention is that treatment for early-stage disease is often more effective than treatment for later-stage disease. We highlight guide- lines from professional organizations that are evidence-based, such as those of the U.

The strongest health promotion rec- ommendations are based on results from randomized controlled trials or. Figure Evidence pyramid. Evidence-Based Medicine: Churchill Livingstone; When search- ing for evidence-based information, you should select the highest level of available evidence Fig.

Critical Appraisal Learn the process of critically appraising the clinical literature in order to interpret new studies and guidelines as they appear throughout your professional career. The Evidence-Based Working Group, which consists of experts in epidemiology, has created a rigorous and standardized approach for evaluating studies that has been applied to a wide range of clinical topics, including therapeutic and prevention trials, diagnostic tests, meta- analysis, cost-effectiveness analyses, and practice guidelines.

This approach asks three basic questions: Are the results valid can you believe them? What are the results magnitude and precision? How can you apply the results to patient care?

Bates' Pocket Guide to Physical Examination and History Taking

U n d e r s t a n d in g B ia s When evaluating study results, it is important to have a thorough under- standing of bias. The key sources of bias in clinical research are selection bias, performance bias, detection bias, and attrition bias. The statistics used to characterize the performance of a treatment or prevention intervention include relative risks, relative risk differences can be a reduction or increase, re ecting bene t or harm , absolute risk differ- ences can be a reduction or increase, re ecting bene t or harm , numbers needed to treat, and numbers needed to harm.

If the intervention actually increases the risk for a bad outcome, then this statistic becomes the number needed to harm. In many studies these calculations are used to measure treatment effective- ness between control and treatment interventions comparing medications, procedures, or diagnostic tests. G e n e r a liz a b ilit y To make this determination, you need to rst look at the demographics of the study subjects e.

Then, you need to determine: Are the study demographics applicable to your patient? Is the intervention feasible in your clinical setting? And, most importantly, is the range of potential ben- e ts and harm of the intervention acceptable for your patient? G u id e lin e R e c o m m e n d a t io n s There are many approaches for rating the strength of recommendations and we will discuss several grading systems. Review the rating systems in Tables to pp. Table U. Offer or provide this There is high certainty that the net service.

C The USPSTF recommends selectively Offer or provide this offering or providing this service to service for selected individual patients based on patients depending professional judgment and patient on individual preferences. There is at least moderate circumstances. There is moderate or high this service. I The USPSTF concludes that the current If the service is evidence is insufficient to assess the offered, patients balance of benefits and harms of the should understand the service.

Evidence is lacking, of poor uncertainty about the quality, or conflicting, and the balance balance of benefits of benefits and harms cannot be and harms. Grade De nitions. Preventive Services Task Force. October Le ve l o f C e r t a in t y D e s c r ip t io n High The available evidence usually includes consistent results from well-designed, well-conducted studies in representative primary care populations.

These studies assess the effects of the preventive service on health outcomes. This conclusion is therefore unlikely to be strongly affected by the results of future studies. Moderate The available evidence is sufficient to determine the effects of the preventive service on health outcomes, but confidence in the estimate is constrained by such factors as: As more information becomes available, the magnitude or direction of the observed effect could change, and this change may be large enough to alter the conclusion.

Low The available evidence is insufficient to assess effects on health outcomes. Evidence is insufficient because of: More information may allow estimation of effects on health outcomes. Update on Methods: Estimating Certainty and Magnitude of Net Bene t. Preven- tive Services Task Force. February Grading strength of recommendations and quality of evidence in clinical guidelines: For new patients in the of ce. In social conver- sation.

The primary goal of the clinician—patient interview is to listen and improve the well-being of the patient through a trust- ing and supportive relationship.

For patients who seek care for a speci c complaint. Both are fundamental to your work with patients but serve different purposes. The interviewing process differs sig- ni cantly from the format for the health history presented in Chapter 1.

This format focuses your attention on the speci c kinds of information you need to obtain. Patients may express—with or without words—feelings they have not consciously acknowledged. Elicit these feelings rather than assume how the patient feels. This requires listening closely to what the patient is communicating. Practice these techniques and nd ways to be observed or recorded so that you can receive feedback on your progress.

To express empathy. Respond with understanding and acceptance. Avoid premature or false reassurance. Be sensitive to cultural variations in uses and meanings of nonverbal behaviors. Even in your role as a student. Express your desire to work with patients in an ongoing way. Nod your head or remain silent.

Lean forward. Chapter 3 Interviewing and the Health History 43 Ask questions that require a graded response rather than a single answer. Pay close attention to eye contact.

For patients using words that are ambiguous. Offer multiple- choice answers. Sometimes patients seem unable to describe symptoms. Such reassur- ance may block further disclosures.

Reassure patients that regardless of what happens with their disease. Patients have many reasons to feel vulnerable: It often provides valuable information about past diagnoses and treatments. Summarization allows you to organize your clinical reasoning and to convey your thinking to the patient. Review the principles below.

The Sequence and Context of the Interview P r e p a r a t io n. Before seeing the patient. This gives patients a greater sense of control. Differences of gender. The clinician—patient relationship is inherently unequal.

Giving a capsule summary lets the patient know that you have been listening carefully. Tell patients when you are changing directions during the interview.

Ask how he or she is feeling and if you are coming at a convenient time. Clarify your goals for the interview. Move any physical barriers between you and the patient. Arranging the bed may make the patient more comfortable. Choose a distance that facili- tates conversation and good eye contact. Whenever visitors are present. Patients nd cleanliness.

Avoid rst names unless you have speci c permission from the patient. Reactions that betray disap- proval. Consider the best way to arrange the room. Look for signs of discomfort. Throughout this sequence. Consciously or not. If possible. Let the patient decide if visitors or family members should remain in the room. The skilled interviewer is calm and unhurried. Suggest moving to an empty room rather than having a conversation that can be overheard..

A clinician must balance provider-centered goals with patient-centered goals. Greet the patient by name and introduce yourself. Wu is always best. Pull shut any bedside curtains. Using a title to address the patient e. Try to sit at eye level with the patient. If this is the rst contact.

The health history interview needs to include both of these views of reality. Learning how patients perceive illness means asking patient-centered questions in the four domains listed below. Use con- tinuers. Whenever the patient is talking about sensitive or disturbing material.

Which one are you most concerned about? Encourage patients to tell their own stories. Use verbal and nonverbal cues that prompt patients to recount their stories spontaneously. Begin with open-ended questions that allow full freedom of response: In this model. Maintain good eye contact. Spend enough time on small talk to put the patient at ease. This is crucial to patient satisfaction. If necessary.

Illness is a construct that explains how the patient experiences the disease. Quantity or severity. Onset setting in which symptom occurs.

Does nything ke it better or worse? To pursue the seven attributes. Where is it? Does it r di te? Always elicit the seven features of every symptom. Wh t is it like? Floyd MR.

Remitting or exacerbating factors. For in. When did does it st rt? How long did does it l st? How often did does it occur? Patients offer various clues to their concerns that may be direct or indirect. Arch Fam Med. Beine KL. Each symptom has attributes that must be clari ed.

Acknowledging and responding to these clues help build rapport. Include environ ent l f ctors. Associated manifestations. H ve you noticed nything else th t cco nies it? Technical language confuses patients and blocks communication. Often you will need to use directed questions see pp. This avoids the common trap of premature closure. Whenever pos- sible. Firs t. Identifying all the features of each symp- tom is fundamental to recognizing patterns of disease and to generating the differential diagnosis.

You can say. Motiv tion l Interview- ing. Make sure the patient fully understands the plans you have developed together. Because we bring our own values. As clinicians. Self-re ection brings a deepening personal awareness to our work with patients and is one of the most rewarding aspects of providing patient care. Quoted directly fro Rollnick S. Shared decision-making involves a three-step process: Kinnersly P. Culture is a system of shared ideas. Give the patient a chance to ask any nal questions.

As you provide care for an ever-expanding and diverse group of patients. Motivational interviewing may help the patient achieve desired behavior changes. Learning about the disease and conceptual- izing the illness give you and the patient the basis for planning further evaluation physical examination.

Butler CC. Respectful communication. Collaborative partnerships. It re ects the ability to acquire and use knowledge of the health-related bene ts. Watch closely for nonver- bal cues such as dif culty controlling emotions. Build your tient rel tionshi s on res ect nd utu lly cce t ble l ns.

Are you asking too many direct questions? Have you offended the patient? Le rn bout your own bi ses. You may need to shift your inquiry to symptoms of depression or begin an exploratory mental status examination. Silence has many meanings. This de nition of culture is broader than the term ethnicity. Cultural competence commonly is viewed as: The following three-point framework will help you.

The in uence of culture is not limited to minority groups—it is relevant to everyone. J ckson JL. If the patient had not identi ed a surrogate decision maker. Others cannot relate certain parts of the history. Sessu s LL. In such cases. Focus on the context of the symptoms and guide the interview into a psychosocial assessment. Some patients have multiple symptoms or a soma- tization disorder. When you suspect a psychiatric or neurologic disorder.Inspect the sclera and conjunctiva of each eye.

You can also ask a series of key questions that may steer your thinking in one direction and allow you to temporarily ignore the others. To ensure ccur te ev lu tions nd future co risons. Bates' Pocket Guide. Cancel Save. The Thorax and Lungs Chapter 9. Chapter 1. Move any physical barriers between you and the patient. Visibility Others can see my Clipboard.

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