Mosbys Guide to
PHYSICAL EXAMINATION,
6th edition
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 1
Chapter 1
The History and Interviewing Process
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 2
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 3
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 4
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 8
Flexibility
Specificity
Clarity
Subtlety
Empathy
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 9
Communication Tensions
Intimacy
Compassion
Seduction
Anger
Dissembling
Money
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 10
Children
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 11
Adolescents
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 12
Pregnant Women
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 13
Older Adults
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 14
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 15
The History
Taking the history usually begins your
relationship with the patient.
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 16
The History
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 17
The History
Chief complaint
Present problem
Past medical history
Family history
Personal/social history
Systems review
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 18
The History
Introduce yourself.
Address patient properly.
Be courteous.
Make eye contact.
Dont overtire patient.
Dont be judgmental.
Be flexible.
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 19
The History
Slide 20
The History
Ensure privacy.
Be direct and firm.
Dont apologize for broaching the issue.
Dont preach.
Use language that is understandable.
Dont push too hard.
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 21
The History
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 22
The History
History-Taking Outline
Chief complaint
Present problem
Past medical history
Family history
Personal/social history
Systems review
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 23
The History
Chief Complaint
Slide 24
The History
Chronology of events
Health state before
present problem
First symptoms
Exposure to infection
or toxic agents
Typical attack
Illness impact on
lifestyle
Stability of problem
Immediate reason
for visit
Review of involved
systems
Medications list
Chronology review
Problem list
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 25
The History
Past medications
Allergies (drugs,
environment, food)
Past transfusions
Emotional status
Use of
complementary and
alternative health
and medical
systems
General health
Childhood illnesses
Major adult illnesses
Immunizations
Surgery
Serious injuries and
resulting disability
Functional ability
limitations
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 26
The History
Family History:
Explore the following
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 27
The History
Personal status
Habits
Sexual history
Home conditions
Occupation
Environment
Military record
Religious preference
Cost of care
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 28
The History
Review of Systems:
Explore the following
General constitutional
symptoms
Diet
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 29
The History
Fever
Chills
Malaise
Fatigability
Night sweats
Weight change
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 30
The History
Diet
Appetite
Likes and dislikes
Diet restrictions, cultural constraints
Vitamins and other supplements
Caffeine
Dietary recall
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 31
The History
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 32
The History
Musculoskeletal
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 33
The History
Headaches
Dizziness
Syncope
Head injuries
Loss of consciousness
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 34
The History
Acuity
Blurring
Diplopia
Photophobia
Pain
Vision changes
Glaucoma
Eye medications
Trauma
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 35
The History
Hearing loss
Pain
Discharge
Tinnitus
Vertigo
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 36
The History
Sense of smell
Colds
Obstruction
Epistaxis
Postnasal discharge
Sinus pain
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 37
The History
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 38
The History
Endocrine: General
Thyroid enlargement
or tenderness
Heat/cold
intolerance
Weight change
Diabetes
Polydipsia
Polyuria
Changes in facial or
body hair
Increased hat or
glove size
Skin striae
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 39
The History
Male:
Puberty onset
Erections
Emissions
Testicular pain
Libido
Infertility
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 40
The History
Pain
Sputum
Dyspnea
Hemoptysis
Cyanosis
Night sweats
Wheezing
Cough
Exposure to
tuberculosis
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 41
The History
Chest pain
Hypertension
Palpitations
Dyspnea
Previous myocardial
infarction
Orthopnea
Exercise tolerance
Edema
Claudication
Date of last
electrocardiogram
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 42
The History
Hematologic
Anemia
Tendency to bruise/bleed easily
Thromboses
Thrombophlebitis
Blood cell abnormalities
Past transfusions
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 43
The History
Lymph Nodes
Enlargement
Tenderness
Suppuration
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 44
The History
Gastrointestinal
Changes in stool
Flatulence
Hemorrhoids
Jaundice
Dark urine
Previous radiographs
Food intolerances
Dysphagia
Heartburn
Nausea/vomiting
Hematemesis
Regularity of bowels
Appetite
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 45
The History
Genitourinary
Sexually transmitted
infections
Polyuria
Hesitancy
Dysuria
Dribbling
Pain
Passage of stone
Edema of face
Urgency
Frequency
Stress incontinence
Nocturia
Hernias
Hematuria
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 46
The History
Neurologic
Syncope
Seizures
Weakness or paralysis
Abnormalities of sensation or coordination
Tremors
Loss of memory
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 47
The History
Psychiatric
Depression
Mood changes
Difficulty concentrating
Nervousness
Tension
Suicidal thoughts
Irritability
Sleep disturbances
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 48
The History
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 49
The History
Children
Adolescents
Pregnant women
Older adults
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 50
The History
Children:
Explore following issues
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 51
The History
Adolescents
Slide 52
The History
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 53
The History
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 54
The History
Older Adults
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 55
The History
Kinds of Histories
Complete
Inventory
Problem or focused
Interim
Mosby items and derived items 2006, 2003, 1999, 1995, 1991, 1987
by Mosby, Inc. an affiliate of Elsevier Inc.
Slide 56