Index
Note: page numbers in italics refer to
figures and tables, those in bold
refer to short cases and those with
suffix ‘n’ refer to footnotes
abdominal aortic aneurysm
132
abdominal examination
21–6
auscultation 25
checklist 309–10
diagnoses 22–3
external genitalia 26
normal abdomen 136–7
palpation 24–5
percussion 25
rectal examination 26
shifting dullness 25
abdominal mass 131–2
Crohn’s disease 133
abdominal short cases, examination
frequency 313–14
acanthosis nigricans 104
accessory nerve testing 29
accommodation–convergence
reflex 29, 48
acoustic neuroma, cerebellopontine
lesion 256
acromegaly 272
acute inflammatory demyelinating
polyradiculopathy (AIDP)
247–8
acute interstitial pneumonia
(AIP) 74n
acute rejection, lung transplant
99–100
acute respiratory distress syndrome
(ARDS) 74n
adipocytes 104
agnosia 220
airways obstruction, forced
expiratory time 21
alcohol consumption/alcoholism
acute toxicity 270n
cerebellar syndrome 218
chronic liver disease 121
hepatomegaly 126
alcoholic liver disease,
haemochromatosis 144
alcoholic tuberculosis 129n
Alström syndrome 105
Alzheimer’s disease 210, 216
amyloidosis
dysarthria 279
hepatosplenomegaly 124n
neuropathy 205n
amyotrophic lateral sclerosis
226
anaemia 24
collapsing pulse 12
hereditary spherocytosis 142
see also pernicious anaemia
anal fistula, Crohn’s disease 133, 134
android fatness 104
ankle clonus
motor neurone disease 226
multiple sclerosis 224
spastic paraparesis 217
ankle jerk reflex 61
absent 255
Charcot–Marie–Tooth disease 212
Friedreich’s ataxia 229
spinal cord compression 240
subacute combined degeneration
of the cord 280
ankle oedema 15, 21
chronic liver disease 121
cor pulmonale 109
pulmonary incompetence 199
ankylosing spondylitis 178
aortic incompetence 161
α1-antitrypsin deficiency 80
aorta, coarctation 191–2
radiofemoral delay 12, 15
aortic aneurysm
abdominal 132
Horner’s syndrome 286
palpation 25
aortic incompetence 161–2
carotid pulse 191n
collapsing pulse 12
mixed aortic valve disease 165,
166
water-hammer pulse 12
aortic sclerosis 164
aortic stenosis 163–4
calcific 164
mixed aortic valve disease 165,
166
aortic valve, bicuspid 163
aortic valve disease 13
mixed 165, 166
bisferiens pulse 12
mixed mitral valve disease 171
aortic valve prosthesis 156
apex beat 20
aortic incompetence 161
aortic stenosis 163
displaced 86
hypertrophic cardiomyopathy
185
Kartagener’s syndrome 98
mitral incompetence 157
mitral valve prolapse 172
mixed aortic valve disease 165
mixed mitral valve disease 159,
160
palpation 15–16
patent ductus arteriosus 198
tetralogy of Fallot 188
ventricular septal defect 175
apical fibrobullous disease 85
apraxia 221
areflexia, Miller–Fisher syndrome
248
Argyll Robertson pupils 281,
286n
aortic incompetence 161
syphilitic 267
tabes 301
arms
choreoathetosis 249
dermatome 33
muscle wasting 226, 228, 233n
neurological conditions 31
Parkinson’s disease 209
subclavian-steal syndrome 299
arms examination 30–3, 38
checklist 310
coordination testing 33
diagnoses 31, 38
muscle bulk 32
power tests 32–3
sensory screen 33
tone 32
visual survey 31–2
Arnold–Chiari malformation
270n
arthropathy, Felty’s syndrome
154
ascites 129, 130
chronic liver disease 121
chylous 129
pancreatic 129
tricuspid incompetence 174n
astereognosis 221n
asthma, pneumothorax 107
ataxia 221n
cerebellar 218, 219
Friedreich’s ataxia 229
Miller–Fisher syndrome 248
multiple sclerosis 224
sensory 214–15
ataxia–telangiectasia 218
atelectasis 110–11
atherosclerosis, collapsing pulse
12
athetosis 249, 250n
Index
|
321
atrial fibrillation
with hemiplegia 12
irregular pulse 169
with mitral valvotomy scar 12
slow pulse 201
with thyrotoxicosis 12
treatment 170
atrial septal defect 179–80
Austin Flint murmur 161
autoimmune chronic active hepatitis
121
autosomal recessive polycystic
kidney disease (ARPKD) 120
axillae, skin examination 56
Babinski’s sign 36n, 258
basilar–subclavian artery link 300
Bassen–Kornzweig syndrome 229
Becker muscular dystrophy 222
Bell’s palsy 275, 277
Bell’s phenomenon 275
benign X-linked muscular dystrophy
222
birth injury, spastic paraparesis
217
bisferiens pulse, mixed aortic valve
disease 12, 165
bitemporal hemianopia 10
Blalock shunt 177, 188
blepharoclonus, Parkinson’s disease
209
blood pressure
coarctation of the aorta 191
measurement 15
Blount’s disease 105
‘blue bloater’ 79
body hair decrease, idiopathic
haemochromatosis 143
body mass index (BMI), obesity
103
bone tuberculosis 114
brachial artery tension 299
brachial pulse 12
heart examination 15
brachial/ankle index, coarctation of
the aorta 191
bradycardia 201
bradykinesia 209
brainstem demyelination 286
brainstem infarction syndromes
292–3
brainstem lesions 290
brainstem vascular disease 286
breath sounds, auscultation 20
breathing
accessory muscle use 18
listening to 19
breathlessness
bronchiectasis 81
cystic fibrosis 101
kyphoscoliosis 90
Broca’s dysphasia 284
bronchial carcinoma 94–5, 96
superior vena cava obstruction
112
322
|
Index
bronchiectasis 77, 81–2
cystic fibrosis 101
Kartagener’s syndrome 98
bronchiolitis obliterans 74n, 85
lung transplant 99
rheumatoid lung 85
bronchiolitis obliterans organizing
pneumonia 74n
bronchitis, chronic 79, 80
Brown–Séquard syndrome 240, 242
Budd–Chiari syndrome 129
bulbar palsy 251, 279
cachexia, bronchial carcinoma 94,
96
calcification, degenerative with aortic
stenosis 163
calcium metabolism, renal failure
118n
cannon waves 190, 201
Caplan’s syndrome 85
carcinoid syndrome 147, 148
pulmonary incompetence 200n
carcinoma of the bronchus see
bronchial carcinoma
carcinomatous proximal myopathy
254
cardiac conditions, clubbing 9n
cardiac pacing 201
cardiomyopathy
hypertrophic 185
irregular pulse 169n
cardiovascular disease, obesity 104
cardiovascular short cases,
examination frequency
314–15
carotid aneurysm 286
carotid dissection 286n
carotid pulse 12
aortic incompetence 191n
coarctation of the aorta 191
heart examination 14, 15
carpal tunnel syndrome 272, 273
Carpenter’s syndrome 105
Carvallo’s sign, tricuspid
incompetence 174n
cataract, myotonic dystrophy 207
cavernous sinus 237
central nervous system (CNS)
normal 263
short case examination frequency
315–16
central scotoma 27, 28, 231
central sleep apnoea 103n
cerebellar artery lesion 292
cerebellar ataxia 218, 219
hereditary 255
cerebellar disease, gait 214
cerebellar lesions, nystagmus 268
cerebellar signs
lateral medullary syndrome
292
multiple sclerosis 224
nystagmus 268
cerebellar syndrome 218–19
cerebellopontine angle lesion 256
cerebrovascular accident,
pseudobulbar palsy 295
cervical cord compression 226
cervical lymph nodes
lymphadenitis 141
palpation 24
cervical myelopathy 257, 258
cervical pyramidal lesions 32n
cervical rib, hand muscle wasting
304, 305, 306
cervical spondylosis 257
hand muscle wasting 304
Chaddock’s manoeuvre 36n
channelopathies 208
Charcot–Marie–Tooth disease 212,
213, 215
hand muscle wasting 212, 213,
304, 305
Charcot’s joints 264, 265, 266
tabes dorsalis 301, 302
checklists 10, 309–12
examination routines 4, 9
chest examination 16–21
asymmetry 20
back of chest 20–1
checklist 309
diagnoses 17–18
expansion 20
normal chest 116
percussion 20
visual survey 18–19, 21n
chest expansion, collapsed lung/
atelectasis 110
chest infection 87–8
chest wall movement 19
cholinergic crisis 259
chorda tympani 276
choreoathetosis 249–50
drug-induced extrapyramidal
syndrome 274
chronic bronchitis 79, 80
chronic liver disease 121–2, 123
hepatosplenomegaly 124
tricuspid incompetence 174n
chronic lymphocytic leukaemia
(CLL) 140
chronic myeloid leukaemia (CML)
127n, 128n
chronic obstructive pulmonary
disease (COPD) 79n
pneumothorax 107
chronic progressive external
ophthalmoplegia (CPEO)
243
chylous ascites 129
cirrhosis 121
ascites 129
hepatomegaly 126
hepatosplenomegaly 124
primary biliary 121, 145, 146
claw hand 304
clinical examination, competence
4
clinical skills 3
clubbing 15, 19
bronchial carcinoma 94
bronchiectasis 81
cardiac conditions 9n
chronic liver disease 121, 123
cor pulmonale 109
cystic fibrosis 101, 102
Eisenmenger’s syndrome 193
hands examination 52
interstitial lung disease 74
Kartagener’s syndrome 98
Pancoast’s tumour 306
primary biliary cirrhosis 145
rheumatoid lung 85
tetralogy of Fallot 188
Clutton’s joints 282
coal dust, emphysema 80
coarctation of the aorta 191–2
radiofemoral delay 12, 15
Cobb angle 91n
Cohen’s syndrome 105
colic 317
collapsing pulse 11, 12, 14, 15
aortic incompetence 161
mixed aortic valve disease 165
patent ductus arteriosus 198
Collet–Sicard syndrome 290
colon, palpation 25
common peroneal nerve palsy 215,
252, 253
complete heart block 201
conditions 3
congestive cardiac failure
ascites 129
hepatomegaly 126
raised jugular venous pressure
183
constrictive pericarditis 129
cor pulmonale 109
cord compression see spinal cord
compression
corneal reflex testing 30
Corrigan’s sign 14, 15
aortic incompetence 161
cough
bronchiectasis 81
cystic fibrosis 101
Kartagener’s syndrome 98
Courvoisier’s sign 132
crackles 20
cranial nerves examination 27–30
checklist 310
diagnoses 27–8
eye movements 28–9
impairment in cerebellopontine
lesion 256
jugular foramen syndrome 290
smell sense 28
taste sense 28
visual survey 28
crepitations 20
Creutzfeldt–Jakob disease 210
Crohn’s disease 133, 134
cryptogenic organizing pneumonia
(COP) 74n
CURB-65 score 88
Cushing’s syndrome 254
lung transplant 99
cyanosis
bronchiectasis 81
bronchitis 79
central 18
cor pulmonale 109
Eisenmenger’s syndrome 193
interstitial lung disease 74
lips 24
pulmonary incompetence 199
superior vena cava obstruction
112, 113
tetralogy of Fallot 188
cystic fibrosis 101, 102
lung transplant 99
cystinosis, renal transplantation 118
cytomegalovirus (CMV) infection
205n
de Musset’s sign 161n
dementia
Alzheimer’s disease 210, 216
PEG tube contraindication 138
demyelinating disease 224
dermatomes
hand 53
head and neck 30
lower limb 36, 37
upper limb 33, 53
dermatomyositis 254, 294
dextrocardia 186
Kartagener’s syndrome 98
diabetes mellitus
Argyll Robertson pupils 281
fundi examination 45, 46
idiopathic haemochromatosis
143n
iris neovascularization 50n
obesity 104
renal transplantation 118
diabetic foot 266
diabetic mononeuritis 238
diabetic proximal myopathy 254
diabetic retinopathy 46n
diagnosis 3, 65–8
additional/associated features 68
checklist 312
routines 9
visual survey 67–8
diastolic murmur 15
coarctation of the aorta 191n
Eisenmenger’s syndrome 193
mitral stenosis 167
mixed aortic valve disease 165
mixed mitral and aortic valve
disease 171
patent ductus arteriosus 198
pulmonary incompetence 199,
200
tetralogy of Fallot 188
dilated cardiomyopathy 169n
distal muscular dystrophy 222
disuse atrophy 304
dopa-responsive dystonia 250n
Down’s syndrome 184
downward spiral syndrome 5–6
drug-induced chorea 249
drug-induced dyskinesias 250n
drug-induced extrapyramidal
syndrome 274
drug-induced proximal myopathy
254
Duchenne muscular dystrophy 216,
222
ductus arteriosus, patent 12, 198
Dupuytren’s contracture, chronic
liver disease 121, 123
dysarthria 40, 41–2, 279
Friedreich’s ataxia 229
pseudobulbar palsy 295
dyscalculia 221
dysgraphia 221
dyskinesias 249–50
dyslexia 221
dysphagia 256
dysphasia 40, 41, 42, 284–5
hemiplegia 220
nominal 42
dysphonia 256
dyspraxia, orofacial 42
dystonia 249n, 250
dystrophia myotonica see myotonic
dystrophy
Eaton–Lambert syndrome 260
Ebstein’s anomaly 181–2
edrophonium test 259
Eisenmenger’s syndrome 180,
193–4
tetralogy of Fallot differential
diagnosis 194
elbows
Charcot’s joint 264, 265
examination 54
fracture/dislocation 233
osteoarthritis 233
skin examination 56
visual survey 32
elderly people, gait apraxia 216
emphysema 79, 80
empyema 83n
end-stage renal failure 254
enophthalmos, Horner’s syndrome
286
epigastric pain, normal abdomen
136
epilepsy, infantile hemiplegia
288, 289
erythropoietin, polycythaemia rubra
vera 135
essential thrombocythaemia 127n,
128n
everyday work, clinical experience 3
examination
complete sequence 9
psychological scenario 5–6
examination ordeal 4–6
examination practice, simulated 3
Index
|
323
examination routines 4, 9–68
abdomen examination 21–6
arms examination 30–3
chest examination 16–21, 17–18
cranial nerves examination 27–30
diagnoses 65–8
eye examination 47–9
fundi examination 43–6
gait examination 38, 39–40
hands examination 23, 51–4
heart examination 12–16
hip examination 64–5
knee examination 62–3
legs examination 34–8
limbs examination 30–40
neck examination 58–60
pulse examination 11–12
skin examination 55–6
speech examination 40–3
visual fields examination 26–7,
28
examiners 4, 5
expressive and receptive dysphasia
284
external genitalia examination 26
extrapyramidal syndrome, druginduced 274
eye movements
examination 28–9, 238–9
normal CNS 263
ocular palsy 236
eyes
congenital syphilis 282, 283
examination 47–9
checklist 311
movements 48
thyroid assessment 61
visual survey 47–8
hereditary spherocytosis 142
Holmes–Adie–Moore syndrome
267, 268
lower motor neurone VIIth nerve
palsy 275, 277, 278
multiple sclerosis 224
myotonic dystrophy 207, 208
Parkinson’s disease 209
periorbital oedema in nephrotic
syndrome 150
polycythaemia rubra vera 135
superior vena cava obstruction
112, 113
see also fundi examination;
nystagmus; pupils;
strabismus
Fabry’s disease, renal transplantation
118
face
aortic incompetence 161
carcinoid syndrome 147, 148
congenital syphilis 282, 283
diagnoses 49–50
examination 49–50
checklist 311
hemiplegia 220
324
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Index
lower motor neurone VIIth nerve
palsy 275–6, 277–8
malar flushing 159
mitral stenosis 167, 168
mixed mitral and aortic valve
disease 171
movements 29
muscular dystrophy 222, 223
myasthenia gravis 259, 261, 262
myotonic dystrophy 207, 208
paralysis 29n
Parkinson’s disease 209
polycythaemia rubra vera 135
pulse examination 11
skin examination 55
superior vena cava obstruction 112,
113
tabes 301
visual survey 31, 48
weakness in Guillain–Barré
syndrome 247
facial sensation testing 30
factitious illness 296–7
Fallot’s tetralogy see tetralogy of Fallot
fascioscapulohumeral muscular
dystrophy 222, 223
fat, body 104
Felty’s syndrome 154
femoral pulse 12
fever, collapsing pulse 12
fibrillary glomerulonephritis 150
fibrosing alveolitis see interstitial lung
disease
flaccid dysarthria 279
flushing
carcinoid syndrome 147, 148
mitral stenosis 167
mixed mitral and aortic valve
disease 171
mixed mitral valve disease 159
focal and segmental glomerulosclerosis
150
focal glomerulosclerosis 118
foot
diabetic 266
skin 56
subacute combined degeneration of
the cord 280
forced expiratory time (FET) 21
Foster–Kennedy syndrome 232n
fourth nerve palsy 237
Frank’s sign 14n
Friedreich’s ataxia 229, 230
Froment’s thumb sign 233n
fundi examination 43–6
arterioles/venules 45
checklist 311
diabetes mellitus 45, 46
diagnoses 44
disc 45
macular area 45–6
ophthalmoscopy 45
quadrants 45–6
visual survey 45
fundoscopy 29, 44
gag reflex 29
absence in jugular foramen
syndrome 290
gait
abnormal 214–16
apraxia 216
cerebellar disease 214
Charcot–Marie–Tooth disease 212
festinant 215
hemiplegic 216
lateral popliteal nerve palsy 252
Parkinson’s disease 209, 215
sensory ataxia 214–15
spastic paraplegia 214
steppage 215
tabes 301
waddling 216
see also walking
gait examination 38, 39–40, 65
abnormal 214–16
checklist 311
diagnoses 39
gallstone pain 317
gastrointestinal disease, obesity 104
Gaucher’s disease, splenomegaly
127n
gaze, conjugate 269, 271
general paresis of the insane
279, 301
genital tuberculosis 115
genitalia, skin examination 56
global dysphasia 284
glomerulonephritis
nephrotic syndrome 150
renal transplantation 118
glutamate toxicity 226n
Gordon’s reflex 36n
Graham Steell murmur
mitral stenosis 167
pulmonary incompetence 199
Graves’ disease 169n
Guillain–Barré syndrome
247–8
bulbar palsy 251
lower motor neurone VIIth nerve
palsy 275, 278
gynaecoid fatness 104
gynaecomastia 24
bronchial carcinoma 96
chronic liver disease 121, 123
idiopathic haemochromatosis
143
haemochromatosis 122
idiopathic 143–4
haemolytic anaemia 142
haemolytic uraemic syndrome
(HUS) 118
hand(s)
carpal tunnel syndrome
272, 273
choreoathetosis 249
claw hand 304
disuse atrophy 304
flapping tremor 19, 23, 121
muscle wasting
cervical rib 304, 305–6
Charcot–Marie–Tooth disease
212, 213, 304, 305
motor neurone disease 226,
228
small muscle 94, 264, 304,
305–6
ulnar nerve palsy 233–4
muscle weakness 264
myelopathy hand sign 257, 258
myotonic dystrophy 207, 208
syringomyelia 264
see also nails
hand examination 23, 51–4
checklist 311–12
dermatomes 53
diagnoses 51–2
elbows 54
joints 52
motor system 54
muscle tone 53
muscles 52–3
palpation 53
radial pulses 54
sensation testing 53
skin 52, 56
visual survey 32, 52–3
head and neck, dermatomes 30
hearing examination 30
heart block, complete 201
heart examination 12–16
auscultation 15
cannon waves 190, 201
checklist 309
diagnoses 13–14
murmurs 15
normal 189
pulse examination 14, 15
visual survey 13–14
heart sounds
aortic stenosis 163
atrial septal defect 179
cor pulmonale 109
Ebstein’s anomaly 181
Eisenmenger’s syndrome 193
hypertrophic cardiomyopathy
185
infective endocarditis 195
Kartagener’s syndrome 98
mitral incompetence 157
mitral stenosis 167
mixed mitral valve disease 159,
160
prosthetic valves 156
pulmonary incompetence 199
heart valves
prosthetic 156
see also aortic valve entries; mitral
valve entries; tricuspid
incompetence
hemianopia, bitemporal/
homonymous 10
hemichorea/hemiballism 249
hemiparesis 221n
hemiplegia 220–1
with atrial fibrillation 12
infantile 288, 289
thalamic syndrome 303
visual fields assessment 9–10
hepatitis see viral hepatitis
hepatomegaly 126
chronic liver disease 121
idiopathic haemochromatosis
143
primary biliary cirrhosis 145
hepatosplenomegaly 124–5, 127n,
128n
hereditary motor and sensory
neuropathy see
Charcot–Marie–Tooth
disease
hereditary spherocytosis 142
hip examination 64–5
checklist 312
HIV infection, neuropathy 205n
Hodgkin’s disease 140, 317
Holmes–Adie–Moore syndrome
267, 268
homonymous hemianopia 10, 231,
232
Horner’s syndrome 94, 96, 286, 287
lateral medullary syndrome 292
Pancoast’s tumour 306
ptosis 243, 245
syringomyelia 264
Hughlings Jackson syndrome 290
human T cell lymphotropic virus 1
(HTLV-1) 217
Huntington’s chorea 249
dysarthria 279
Hutchinson’s teeth 282
hydrocephalus, normal pressure
210
hydronephrosis 139
hypertension, obesity 104
hypertensive renal disease, renal
transplantation 118
hypertrophic cardiomyopathy
185
hyporeflexia 247
hypothyroidism, structural
dysarthria 279
icterus 24
idiopathic interstitial pneumonias
(IIPs) 74n
idiopathic pulmonary fibrosis (IPF)
74n
iliac fossa mass 131
immunosuppression, lung transplant
100
infantile hemiplegia 288, 289
infective endocarditis 195–6, 197
acute 196
antimicrobial prophylaxis 196
aortic incompetence 161
subacute 196
inguinal lymph nodes, palpation 25
inspiratory clicks, bronchiectasis 81
inspiratory crackles/crepitations 15
bronchiectasis 81
bronchitis 79
chest infection 87
cor pulmonale 109
cystic fibrosis 101
interstitial lung disease 74
Kartagener’s syndrome 98
old tuberculosis 86
rheumatoid lung 85
insulin resistance, obesity 104
intercostal muscles, indrawing 18
internuclear ophthalmoplegia
237, 269
interstitial lung disease 20n,
74–6
acute 74
chronic 74–5
investigations 75–6
rheumatoid lung 85
intervertebral disc, prolapse/
herniation 240
intrapulmonary nodules,
rheumatoid lung 85
introduction to patient 10
Jakob–Creutzfeldt disease 210
Janeway lesions, infective
endocarditis 195, 197
jargon dysphasia 284
jaundice, hereditary spherocytosis
142
joints
congenital syphilis 282
tuberculosis 114
see also ankle entries; Charcot’s
joints; elbows; knee; shoulder
journal sign 233n
jugular foramen syndrome 290, 291
jugular venous pressure
Ebstein’s anomaly 181
pulmonary incompetence 199,
200
raised 183
tricuspid incompetence 174
Kartagener’s syndrome 98
dextrocardia 186
kidney(s)
enlargement 120
hypertrophy of single functioning
139
palpation 25
polycystic 118, 120, 139
single palpable 139
transplantation 118, 119
kidney disease 118
proximal myopathy 254
Klippel–Feil syndrome 97
knee
Charcot’s joints 301, 302
examination 62–3
checklist 312
Friedreich’s ataxia 229
Kugelberg–Welander disease 227
Index
|
325
kyphoscoliosis 90–1
Friedreich’s ataxia 229
syringomyelia 264
kyphosis 90
Lambert–Eaton syndrome 254
lateral medullary syndrome 292–3
lateral popliteal nerve palsy 215,
252, 253
Laurence–Moon–Bardet–Biedl
syndrome 105
left iliac fossa mass 131
left ventricular dilatation 157
legs
lateral popliteal nerve palsy 252,
253
multiple sclerosis 224
muscle wasting 235, 240, 252,
253
oedema in nephrotic syndrome
150
old polio 235
spastic paraparesis 217
spinal cord compression 240
subacute combined degeneration
of the cord 280
tibia in congenital syphilis 282
see also ankle entries; knee
legs examination 34–8
checklist 310
coordination testing 36
dermatomes 36, 37
diagnoses 34–5, 39
fasciculation 36
gait 38, 39–40
length inequality 35, 65
muscle bulk 35–6
muscle tone 36
plantar response 36
power testing 36
skin 56
straight leg raise 64
vibration testing 37–8
visual survey 35–6, 39, 62
see also hip examination
lens examination 45
leuconychia, chronic liver disease
121, 123
Lhermitte’s phenomenon 280
light reflex 29
limb-girdle muscle weakness
254
limb-girdle muscular dystrophy
222, 223
limbs
examination 30–40
lower limb
dermatomes 36, 37
oedema in nephrotic syndrome
150
subacute combined
degeneration of the cord
280
syringomyelia 264
wasting 212, 213
326
|
Index
upper limb
choreoathetosis 249
dermatomes 33, 53
multiple sclerosis 224
muscle wasting 212, 213
normal CNS 263
syringomyelia 264
see also arms; foot; hand(s); knee;
legs
lipid abnormalities, obesity 104
lipoprotein lipase (LPL) 104
lips, Crohn’s disease 133, 134
liver
carcinoma 126
palpation 15, 25
transplantation for primary biliary
cirrhosis 145
see also chronic liver disease
lobectomy 77, 78
lower motor neurone VIIth nerve
palsy 275–6, 277–8
lung(s)
collapsed 110–11
consolidation 87–8
apical 114–15
inspiratory crepitations 15
lobectomy 77, 78, 95
radiotherapy damage 94
rheumatoid lung 85
surgical resection 77, 78
transplantation 99–100
lung base dullness 83–4
Lyme disease 275
lymph node examination
cervical lymph node palpation 24
inguinal lymph node palpation 25
neck 24, 59–60
lymphadenitis, tuberculous 115
lymphadenopathy 19
generalized 140, 141
lymphoma
abdominal mass 132
CNS 227
splenomegaly 127n
lymphoproliferative disorders 128
lymphoreticular disorder 140
machinery murmur, patent ductus
arteriosus 198
Macleod’s syndrome, emphysema 80
main-en-griffe 304, 306
partial 233n
malabsorption, cystic fibrosis 101,
102
malaria, nephrotic syndrome 150
malignancy
intraabdominal, ascites 129
obesity 104
polymyositis 294
proximal myopathy 254
spinal cord compression 240, 241
malingering 296n
Marfan’s syndrome 10, 93, 176
McArdle’s syndrome 254
McMurray’s sign 63
medial medullary syndrome 292
median nerve palsy 272
Meig’s syndrome 129
membranous glomerulonephritis
150
meningioma, cerebellopontine lesion
256
meningitis
bulbar palsy 251
tuberculous 114
meningovascular syphilis 301
mesangiocapillary
glomerulonephritis 150
metabolic syndrome 104n
metastases, bronchial carcinoma 94
mid-cervical reflex pattern 257n
miliary tuberculosis 114
Miller–Fisher syndrome 248
minimal change disease, nephrotic
syndrome 150
miosis, Horner’s syndrome 286
mistakes, making 5–6
mitochondrial cytopathies 243n, 244
mitochondrial myopathy 254
mitral incompetence 157–8
collapsing pulse 12
infective endocarditis 195
mitral stenosis 167, 168, 199
severe 171n
mitral valve disease 13
mixed 159, 160
with aortic valve disease 171
mitral valve prolapse 172–3
mitral valve prosthesis 156
mitral valvotomy scar, with atrial
fibrillation 12
mixed aortic valve disease 165, 166
bisferiens pulse 12
with mitral valve disease 171
mixed mitral valve disease 159, 160
with aortic valve disease 171
‘mock’ examiners 3
mononeuritis multiplex 236
Moon’s molars 282
motor neurone disease 149, 226–7,
228
ankle jerk absence 255
bulbar palsy 251
extensor plantars 255
hand muscle wasting 304, 305
lower motor neurone VIIth nerve
palsy 275
spastic paraparesis 217
motor neuropathy, predominantly
205, 247
mouth
congenital syphilis 282
examination 24
cranial nerve examination 29
skin 55
lower motor neurone VIIth nerve
palsy 275
pseudobulbar palsy 295
ulceration and dysarthria 279
see also palatal movements; tongue
movements
choreoathetosis 249–50
drug-induced extrapyramidal
syndrome 274
see also gait; palatal movements
Müller manoeuvre, tricuspid
incompetence 174n
multiple sclerosis 224–5
Friedreich’s ataxia differential
diagnosis 230
spastic paraparesis 217
Munchausen’s syndrome 297
muscle fasciculation 226
muscle wasting, polymyositis 294
muscle weakness
limb girdle 254
myasthenia gravis 259
polymyositis 294
spinal cord compression 240
muscular dystrophy 216, 222, 223,
243n
lower motor neurone VIIth nerve
palsy 275
oculopharyngeal 222, 243n,
244
myasthenia gravis 237, 259–60,
261–2
dysarthria 279
lower motor neurone VIIth nerve
palsy 275
ptosis 243, 245
myasthenic crisis 259–60
myasthenic–myopathic syndrome
260
mycotic abdominal aortic aneurysm
132n
myelofibrosis 127n
myelopathy hand sign 257, 258
myeloproliferative disorders 127n,
128n
myoclonus 250
myopathic dysarthria 279
myotonia congenita 207–8
myotonic dystrophy 207–8
dysarthria 279
ptosis 243, 245
myxoedema 129, 272
nails
examination 52
infective endocarditis 195, 197
leuconychia in chronic liver
disease 121, 123
skin 56
yellow nail syndrome 89
neck examination 58–60
checklist 312
dermatomes 30
diagnoses 58–9
lymph nodes 24, 59–60
palpation 24
pulse examination 11
skin examination 56
visual survey 32, 59
see also thyroid
neck weakness, painless 29n
nephrotic syndrome 129, 150–1
nerve root compression 241
neuroleptic drugs 274
neurological conditions, arms 31
neurosyphilis 281, 286n, 301
bulbar palsy 251
neutropenia, Felty’s syndrome
154
nominal dysphasia 285
non-alcoholic fatty liver disease
(NAFLD) 122
non-alcoholic steatohepatitis
(NASH) 122n
non-Hodgkin’s lymphoma 140
non-invasive ventilation (NIV),
kyphoscoliosis 91
non-specific interstitial pneumonia
(NSIP) 74n
nose, congenital syphilis 282, 283
notch–cricoid distance 19
nutritional deficiency
cerebellar syndrome 218
see also malabsorption
nystagmus 29, 268–9, 270
ataxic 224
cerebellopontine lesion 256
Friedreich’s ataxia 229
obesity 103–5, 106
endocrine causes 105
genetic diseases 105
normal abdomen 137
obliterative bronchiolitis see
bronchiolitis obliterans
obstructive sleep apnoea 103n
ocular myopathy 237, 243n, 246
ocular palsy 236–7, 238–9
oculopharyngeal muscular dystrophy
222, 243n, 244
ophthalmoplegia 236n
chronic progressive external
243
exophthalmic 237
external 248
internuclear 237, 269
ophthalmoscopy, fundi examination
45
Oppenheim’s sign 36n, 258
optic atrophy 45
tabes dorsalis 301
optic chiasma lesion 231
optic tract lesion 231
orofacial dyspraxia 42
Osler’s nodes, infective endocarditis
195
osteoarthritis
elbow 233
obesity 104
osteomalacia 254
ostium primum/secundum defects
179, 180
otitis media 218n
oxalosis, renal transplantation
118
pacemakers, demand 201
PACES
marking system 10
patients 3
pain
epigastric 136
nameless 318
palatal movements 29
bulbar palsy 251
jugular foramen syndrome 290
paralysis
lateral medullary syndrome
292
motor neurone disease 226
pseudobulbar palsy 295
palate, Friedreich’s ataxia 229
Pancoast’s syndrome 94, 96
Horner’s syndrome 286
Pancoast’s tumour 304, 306
pancreatic ascites 129
pancreatic carcinoma 132
pancreatic insufficiency, cystic
fibrosis 101
pansystolic murmur
Ebstein’s anomaly 181
Eisenmenger’s syndrome 193
infective endocarditis 195
mitral incompetence 157
mixed mitral valve disease 159
pulmonary incompetence 200
ventricular septal defect 175
papilloedema 232n
cerebellopontine lesion 256
paramyotonia 208
paraphasia 284n
parasternal heave
atrial septal defect 179
Eisenmenger’s syndrome 193
left 15
mitral stenosis 167
mixed mitral and aortic valve
disease 171
mixed mitral valve disease 159
patent ductus arteriosus 198
pulmonary stenosis 177
tetralogy of Fallot 188
ventricular septal defect 175
parkinsonian syndrome 209
Parkinson’s disease 32, 209–10,
211
arteriosclerotic 209–10
dysarthria 279
parotitis, dysarthria 279
patent ductus arteriosus 12, 198
patients
management 10
PACES 3
Pel Ebstein fever 317
percutaneous endoscopic
gastrostomy (PEG) tube 138
perianal skin, Crohn’s disease 133,
134
peripheral neuropathy 205–6
peritonitis, tuberculous 115, 129n
permission to examine patient 10
Index
|
327
pernicious anaemia 152
fever 317–18
pes cavus 35
Friedreich’s ataxia 229
petechial haemorrhages, infective
endocarditis 195
Phalen’s sign 272n
phonocardiography, mitral valve
prolapse 172
physical signs, abnormal 4
Pickwickian syndrome 103–5, 106
‘pink puffer’ 79
plantar reflex
cervical myelopathy 257
Charcot–Marie–Tooth disease
212
extensor 255, 257, 264, 280
Friedreich’s ataxia 229
spastic paraparesis 217
subacute combined degeneration
of the cord 280
syringomyelia 264
tabes 301
plantar strike technique 36n
pleural biopsy 84
pleural effusion 83–4, 85n
bronchial carcinoma 94
pleural friction rub 87
pneumonectomy 77, 78
pneumonia 87–8
acute interstitial 74n
community-acquired 87
pleural effusion 83n
treatment 87
pneumothorax 107–8
polio
bulbar palsy 251
old 227, 235
polycystic kidneys 118, 120, 139
polycythaemia rubra vera 127n,
128n, 135
polymyalgia rheumatica 254, 294
polymyositis 254, 294
Poncet’s disease 114
portal hypertension 121
ascites 129
hepatosplenomegaly 124, 125
post polio syndrome 235n
poststreptococcal
glomerulonephritis,
nephrotic syndrome 150n
Prader–Willi syndrome, obesity 105
pregnancy, collapsing pulse 12
presystolic impulse, hypertrophic
cardiomyopathy 185
primary biliary cirrhosis 121, 145,
146
progressive bulbar palsy 226
progressive muscular atrophy 226
progressive supranuclear palsy 210
proprioceptive loss 221
prosthetic heart valves 156
proximal myopathy 254
pruritus, primary biliary cirrhosis
145
328
|
Index
pseudoathetosis 258
pseudobulbar palsy 279, 295
psoriasis, hands examination 52
psychogenic illness 296–7
ptosis 29, 237n, 243–4, 245–6
Horner’s syndrome 286
myasthenia gravis 259, 261
ocular palsy 236
tabes 301
pulmonary arteritis 85
pulmonary fibrosis, rheumatoid 85
pulmonary hypertension 159n
cor pulmonale 109
Eisenmenger’s syndrome 193
mitral stenosis 167
obesity 103
pulmonary incompetence 199
pulmonary incompetence 177n,
199–200
pulmonary nodule, solitary 77
pulmonary plethora 179n
pulmonary stenosis 177
congenital 199
pulmonary valve disease, mixed
199
pulse examination 11–12
character 11–12
checklist 309
chest examination 19
diagnoses 11
hand examination 54
heart examination 14, 15
irregular 169–70
mitral stenosis 167
mixed mitral and aortic valve
disease 171
mixed mitral valve disease 159,
160
pulmonary incompetence 199
rate 11
rhythm 11
slow 201
slow rising 11, 12
aortic stenosis 163
mixed aortic valve disease 165
thyroid status assessment 61
water-hammer 11–12
see also collapsing pulse
pupillary light reflex 48
pupils
examination 48
Holmes–Adie–Moore syndrome
267, 268
reflexes 29
see also Argyll Robertson pupils
pyoderma gangrenosum 153
Quincke’s sign 161n
radial nerve palsy 10, 298
radial pulse 11–12
hands examination 54
radiation burns 94
radiofemoral delay, coarctation of
the aorta 12, 15
Ramsay Hunt syndrome 275, 276,
278
rash examination 57–8
checklist 312
diagnoses 57
terminology 58
rectal examination 26
reflexes
cervical myelopathy 257
Charcot–Marie–Tooth disease 212
Friedreich’s ataxia 229
mid-cervical reflex pattern 257n
motor neurone disease 226
myotonic dystrophy 207, 208
old polio 235
syringomyelia 264
tabes 301
thyroid assessment 61
Refsum’s disease 229
renal cell carcinoma 139
renal transplantation 118, 119
respiratory short cases, examination
frequency 313
rheumatic fever, aortic incompetence
161
rheumatic heart disease, aortic
stenosis 163
rheumatoid arthritis 187, 272
hand examination 52
hand muscle wasting 304n, 306
rheumatoid lung 85
rhonchi
bronchiectasis 81
bronchitis 79
cor pulmonale 109
rib notching, coarctation of the
aorta 192
right iliac fossa mass 131
Crohn’s disease 133
right ventricular lift 15
rigidity, Parkinson’s disease 209
Rinné test 30n
Romberg’s test 38, 39–40, 215
subacute combined degeneration
of the cord 280
tabes 301
Roth’s spots, infective endocarditis
195n
Roussy–Lévy syndrome 229
rubeosis iridis 50n
sabre tibiae 282
sacral oedema 15
cor pulmonale 109
sarcoidosis, lower motor neurone
VIIth nerve palsy 275
scalp examination 55
scapulae, winging 222, 223
Schmidt’s syndrome 290
scoliosis 90
classification 91n
Friedreich’s ataxia 229
syringomyelia 264
scotoma, central 27, 28, 231
scratch marks 24
senile chorea 249
sensation impairment
Charcot–Marie–Tooth disease
212
peripheral neuropathy 205
sensory ataxia, gait 214–15
sensory loss, dissociated in
syringomyelia 264
short cases 4, 71–2
clinical features 4
common conditions 6
confidence 6
examination frequency 313–16
presentation to examiner 71–2
rarities with good physical signs
6
records 4
straightforward 5–6
see also named topics
shoulder
Charcot’s joint 264
jugular foramen syndrome
290
shoulder girdle, muscle wasting
226, 228
sickle cell disease, renal
transplantation 118
signs 3
abnormal 4
simulation, examination practice
3
skin
Crohn’s disease 133, 134
infective endocarditis 195
obesity 104
pigmentation
idiopathic haemochromatosis
143
primary biliary cirrhosis 145,
146
tuberculosis 115
skin examination 55–6
checklist 312
diagnoses 55
lesion distribution 56, 57
rash 57–8
sleep apnoea, obesity 103
smell sense 28
smoking, emphysema 80
Snellen chart 48
sodium sweat test, cystic fibrosis 101
solitary pulmonary nodule 77
spastic dysarthria 279
spastic paraparesis 217
spastic paraplegia 224
gait 214
specialist wards 3
speech automatism 284n
speech examination 40–3
articulation 41
bulbar palsy 251
comprehension 42
diagnoses 40
dysarthria 40, 41–2, 279
dysphasia 284
higher mental functions 43
motor neurone disease 226
multiple sclerosis 224
myasthenia gravis 259
Parkinson’s disease 209
repetition 41
visual survey 41
speech therapy 42n
spider naevi 24
chronic liver disease 121, 123
primary biliary cirrhosis
145, 146
spinal cord
subacute combined degeneration
of the cord 217, 255, 280
tumour 257
spinal cord compression 240–1, 242
spastic paraparesis 217
spinal muscular atrophy of juvenile
onset 227
spinocerebellar ataxia 218n
spleen
hepatosplenomegaly 124–5
palpation 25
splenectomy, hereditary
spherocytosis 142n
splenomegaly 127–8
chronic liver disease 121
congestive heart failure 122n
Felty’s syndrome 154
hereditary spherocytosis 142
polycythaemia rubra vera 135
types 127n
see also hepatosplenomegaly
splinter haemorrhages 15
infective endocarditis 195, 197
spondylolisthesis 90
Steele–Richardson–Olszewski
syndrome 210
sternotomy scar
prosthetic valves 156
pulmonary incompetence
199
stiff person syndrome (SPS) 210
stomach carcinoma 131
strabismus 236, 238
nystagmus 268
straight leg raise 64
striatonigral degeneration 210
stridor 92
structural dysarthria 279
subacute combined degeneration
of the cord (SACD) 217,
255, 280
subclavian-steal syndrome 299, 300
superior orbital fissure syndromes
237
superior vena cava obstruction
112, 113
bronchial carcinoma 94
Swyer–James syndrome 80
Sydenham’s chorea 249
syphilis
Argyll Robertson pupils 267
congenital 282, 283
meningovascular 301
tabes dorsalis 301n, 302
syphilitic amyotrophy 226–7
syphilitic taboparesis 255
syringobulbia 264
bulbar palsy 251
syringomyelia 264, 265
hand muscle wasting 304
Horner’s syndrome 286
systemic sclerosis
hand examination 52
renal transplantation 118
systolic murmur
coarctation of the aorta 191
ejection
aortic stenosis 163, 164
atrial septal defect 179
hypertrophic cardiomyopathy
185
mixed aortic valve disease
165
mixed mitral and aortic valve
disease 171
tetralogy of Fallot 188
mitral valve prolapse 172
patent ductus arteriosus 198
pulmonary stenosis 177
short 173
systolic thrill
aortic stenosis 163
coarctation of the aorta 191
hypertrophic cardiomyopathy
185
mixed aortic valve disease 165
pulmonary stenosis 177
tetralogy of Fallot 188
tabes 301, 302
tabes dorsalis 301, 302
Argyll Robertson pupils 281
Friedreich’s ataxia differential
diagnosis 230
ptosis 243
taboparesis 301
tactile vocal fremitus 20
tardive dyskinesia 274
taste sense 28
teeth, Hutchinson’s teeth/Moon’s
molars 282
telangiectasia, carcinoid syndrome
147
temporomandibular arthritis 279
tendon reflexes, polymyositis 294
tendon strike technique 36n
Tensilon test 259
tetralogy of Fallot
Blalock shunt 188
Eisenmenger’s syndrome
differential diagnosis
194
surgical correction 177
Texidor’s twinge 317–18
thalamic syndrome 303
thenar eminence 233, 234
wasting 272, 273, 304
Index
|
329
third nerve palsy 236–7, 238–9
ptosis 243, 245
Thomsen’s disease 207–8
thoracic curvature 90
see also kyphoscoliosis; scoliosis
thoracoscopy 84
thoracotomy scar 77, 78
bronchial carcinoma 95
coarctation of the aorta 191
lung transplant 99
mitral stenosis 167, 168
mixed mitral valve disease 159
old tuberculosis 86
pulmonary stenosis 177
tetralogy of Fallot 188
thyroid
auscultation 60, 61
bruit 61n
palpation 59, 61
reflex assessment 61
status assessment 60–1
checklist 312
visual survey 60–1
thyrotoxicosis 12, 254
tibia, bowing 35
tics, drug-induced extrapyramidal
syndrome 274
Tinel’s sign 272
tongue
bulbar palsy 251
choreoathetosis 249
examination 29
lower motor neurone VIIth nerve
palsy 275, 277
motor neurone disease 226
myotonic dystrophy 207, 208, 245
pseudobulbar palsy 295
superior vena cava obstruction
112
touch sensation, thalamic syndrome
303
trachea
chest examination 19
deviation 83n, 86, 94, 95
collapsed lung 110
tracheal stenosis, stridor 92
tracheal tug, cor pulmonale 109
transoesophageal echo (TOE)
atrial septal defect 180
mitral stenosis 167n
trauma
hand muscle wasting 304
Horner’s syndrome 286
330
|
Index
pneumothorax 107
spastic paraparesis 217
tremor 250
benign essential 210
fine 19
flapping tremor of hands 19,
23, 121
Friedreich’s ataxia 229
Parkinson’s disease 32, 209,
215
pill-rolling 215
thyroid assessment 61
tricuspid incompetence 174
Ebstein’s anomaly 181
pulmonary incompetence 200
raised jugular venous pressure
183
Troisier’s sign 24n, 129, 131
trunk, skin examination 56
tuberculosis 114–15
alcoholics 129n
old 86
primary/postprimary pulmonary
114
surgical treatment 77
treatment 86, 115
types 114–15
tunnel vision 231
ulnar claw hand 233, 234
ulnar nerve palsy 233–4
hand examination 52
urinary tract, tuberculosis 114–15
venous pressure
assessment 15
raised 19
ventilation, non-invasive in
kyphoscoliosis 91
ventricular septal defect 175
Eisenmenger’s syndrome 193
vermis lesion 219
Vernet’s syndrome 290
vestibular nystagmus 270
vigabatrin 231n
viral hepatitis
chronic liver disease 121
hepatosplenomegaly 124
Virchow’s node see Troisier’s sign
visual acuity assessment 48
visual field defect 231–2
visual field loss, homonymous upper
quadrantic 232
visual fields examination 26–7, 28,
48, 232
central scotoma 27
checklist 310
diagnoses 26
hemiplegia 9–10
hemisensory loss 220
peripheral visual fields 27
visual inattention 26
visual survey 26–7
visual survey 9, 10
abdomen examination 23–4
arm examination 31–2
chest examination 18–19, 21n
cranial nerves examination 28
diagnosis 67–8
eyes examination 47–8
face examination 31, 48
fundi examination 45
hand examination 52–3
heart examination 13–14
hip examination 64
knee examination 62
leg examination 35–6, 39, 62
neck examination 59
pulse examination 11
speech examination 41
thyroid 60–1
visual fields examination 26–7
vitamin B12 deficiency 280
vitamin D 118n
vocal resonance 20
auscultation 110n
collapsed lung 110
walking 39, 40, 65
Parkinson’s disease 209
spinal cord compression 240
Wallenberg’s syndrome 292–3
water-hammer pulse 11–12
Weber test 30n
Wernicke’s dysphasia 284
Wernicke’s encephalopathy,
nystagmus 270n
whispering pectoriloquy 20, 87
Wilson’s disease 210
wrist-drop 298
xanthelasma 24
primary biliary cirrhosis
145, 146
yellow nail syndrome 89