Manipal Manual of Clinical Methods in Surgery differential Diagnosis and Clinical Discussion is a unique book specially written for both undergraduate and postgraduate medical students to help them achieve distinctively in their clinical examinations. The limited time-frame available to the undergraduate students makes it necessary for them to be able to read a good, comprehensive clinical book reliably: This manual fully meets just that requirement. The book presents the entire information necessary for undergraduate students in an easy-to-read format which will help the reader in understanding the facts with long-term retention. The frequently given clinical photographs, colour graphics, flowcharts, tables, clinical boxes and algorithms lucidly explain the facts discussed in the text. These will help even the postgraduate students of surgery and practising surgeons.
1. Covers all clinical cases the students see in the general surgery clinical examination
2. Includes short and long cases
3. Colourful illustrations of clinical methods
4. Clinical discussion about common cases such as how? why? what?
5. Discusses all aspects of differential diagnosis
6. Clinical analysis on how to arrive at a diagnosis
7. Rich inserts like Clinical Case Capsules Clinical Wisdom
8. Provides key to secrets through clinical boxes
9. Problem oriented discussions
Table of Contents:-
1. Introduction to Examination of a Surgical Patient 1–17
Introduction 1
Student–patient relationship 1
Patient data 2
Summary 3
Complaints 3
History of present illness 4
General physical examination 7
Local examination (regional examination) 13
Per rectal (PR) and per vaginal (PV) examination 15
Systemic examination 15
Clinical diagnosis/working diagnosis 15
2. Surgical Patient—Symptoms and Signs of Surgical
Importance 18–29
Introduction 18
Loss of appetite (anorexia) 18
Flushing 18
Hiccup 19
Pain 19
Itching: Pruritus 20
Pedal oedema 20
A few signs of surgical importance 21
Prominent veins 21
Fluctuation 23
Transillumination 24
Mobility 24
Bimanual palpation 25
Ballottement 25
Crepitus 25
Tracheal tug 26
Pigmentation 26
Skin lesions 26
Virchow node 27
Scalene node 27
Tongue 28
3. Examination of an Ulcer 30–46
Definition 30
Introduction 30
History of present illness 31
Past history 31
General physical examination 31
Clinical examination of an ulcer 31
Relevant clinical examination 35
Investigations 37
Treatment 37
Ulcer head and neck including face 42
Ulcer in the back 43
Analysis of a case of ulcer in the back and clinical discussion 44
Ulcers in the abdominal wall 45
Viva favourite questions and answers 46
4. Examination of Swelling 47–91
Introduction 47
Patient data 47
Local regional examination 52
Contraction of the muscles against resistance 60
Clinical diagnosis 62
Clinical analysis of four common cases 78
Site-specific differential diagnosis 79
Common swellings in the legs/foot 80
Common swellings in the axilla 82
Common swellings in the back 84
Common swellings in the face 85
Common swellings in the chest wall 87
Swellings in the scalp 89
5. Examination of a Sinus and Fistula 92–102
Introduction 92
Sinus 92
Fistula 93
History 94
Past history 94
Local examination 95
Relevant clinical examination 98
Investigations 99
Clinical analysis of a case of sinus in the chest wall 101
Case of multiple sinuses in the leg 102
6. Examination of Keloid, Hypertrophic Scar and Contractures 103–105
Introduction 103
History taking 103
Inspection 103
Palpation 104
Sternum, vaccination sites (arm), lower jaw, nape of the neck, scars are various sites of keloid 104
A case of post-burn contracture 105
7. Examination of Lower Limb Ischaemia,
Peripheral Arterial Occlusive Disease and Aneurysm 106–125
Introduction 106
Patient data 106
History of present illness 106
Local/regional examination 110
Systemic examination 116
Investigations 120
Treatment 121
Aneurysm 122
Clinical examination 122
Local examination 122
Examination of a case of arteriovenous fistula 124
Local examination 124
8. Examination of Upper Limb Ischaemia 126–135
Introduction 126
Patient data 126
History 126
Clinical examination of a case of
upper limb Ischaemia 128
Gangrene 133
9. Examination of Varicose Veins 136–146
Introduction 136
Clinical examination of a case of varicosity of the leg 137
General physical examination and its relevance in varicose veins 137
Local examination/regional examination 138
Tests for short saphenous varicosity 143
Deep vein thrombosis (DVT) 145
10. Examination of the Lymphatic System 147–163
Introduction 147
Terminology 147
Patient data and history of present illness 147
General physical examination 148
Local/regional examination 149
Special lymph nodes 154
Supraclavicular lymph node—Virchow’s node 154
Epitrochlear node enlargement 155
Scalene node 155
Look for evidence of the primary 155
Examination of abdomen 156
Lymphadenopathy in the groin 160
Lymphadenopathy in the axilla 161
Lymphoedema of leg 161
Examination of lymphatic vessels 162
A case of lymphoedema of the leg 163
11. Examination of Peripheral Nerves 164–171
Introduction 164
History of present illness 164
Inspection 164
Palpation 165
Examination of nerves of upper limb 166
Sensations of the upper limb 170
Nerves of the lower limb 170
Sciatic nerve 170
Sensations 171
12. Examination of the Hand and Foot 172–184
Introduction 172
Classification 172
History of present illness 172
Clinical examination 173
Examination of foot 181
Malignant tumours in the foot 183
13. Examination of Skin and Skin Tumours 185–198
Introduction 185
History of present illness 185
Personal history/occupation 188
General physical examination 188
Local examination 188
Benign lesions of the skin 196
Miscellaneous—few pictures 198
14. Examination of Face, Pinna and Scalp 199–205
Introduction 199
Differential diagnosis 199
Some characteristic facies 202
Cleft lip and palate 203
Cleft palate 204
Trigeminal nerve and surgeon 205
15. Examination of the Salivary Glands 206–221
Introduction 206
Patient data 206
History of present illness 206
Clinical checklist in salivary gland swellings 212
Tests for facial nerve paralysis 213
Parotid swelling 213
Submandibular swelling 218
16. Examination of the Oral Cavity 222–235
Introduction 222
Patient data 222
History of presenting illness 224
Clinical checklist 231
Diagnosis 231
Carcinoma maxillary antrum 234
Benign swellings in the tongue—macroglossia 234
Miscellaneous 235
17. Examination of Jaw Swelling 236–241
Introduction 236
History and physical examination 236
Jaw swelling 238
Sinuses of the jaw 240
Miscellaneous 241
18. Examination of the Neck Swelling 242–265
Introduction 242
Triangles of neck 242
History of present illness 243
Local/regional examination 245
Differential diagnosis of midline swellings 250
Differential diagnosis of lateral swellings 254
Differential diagnosis of swellings in the anterior triangle 254
Cysticercosis and the surgeon 262
19. Examination of Thyroid Swelling 266–289
Introduction 266
Patient data 266
Presenting complaints 267
Past history/treatment history 269
General physical examination 270
Local examination/regional examination 271
Systemic examination 277
Diagnosis 281
Investigations 281
20. Examination of the Breast 290–309
Introduction 290
Patient data 290
History of present illness 290
General physical examination 293
21. Examination of a Case of Dysphagia 310–316
Introduction 310
History of present illness 310
General physical examination/Regional examination 311
Causes 312
Mediastinal masses 315
22. Examination of an Acute Abdomen 317–337
Introduction 317
Patient’s data 317
Complaints—history of present illness 318
General physical examination (GPE) 322
General physical examination and acute abdomen 322
Abdominal examination—per abdomen 323
Look for hernial sites 325
An interesting case of acute abdomen 337
23. Examination of Chronic Abdomen 338–359
Introduction 338
History of present illness 338
General physical examination 340
Abdominal examination 340
Per rectal examination and per vaginal examination 348
24. Examination of Abdominal Mass 360–412
Introduction 360
Clinical examination of abdominal mass 360
History of present illness 360
General physical examination 364
Abdominal examination—regional examination 364
Mass in the right hypochondrium 377
Mass in the epigastrium 384
Mass in the left hypochondrium 389
Mass in the right lumbar region 393
Mass in the umbilical region 396
Mass in the left lumbar region 398
Mass in the right iliac fossa 398
Intra-abdominal swelling 399
Specific masses in females 404
Mass in the hypogastrium 405
Mass in the left iliac fossa 407
The cystic mass in the abdomen 409
Large masses in the abdomen 410
Three interesting clinical case capsules 411
25. Examination of Anorectal Case 413–425
Introduction 413
Complaints: History of present illness 413
Inspection of the anal region 415
Rectal examination 417
26. Examination of Urinary Tract and Renal Mass 426–439
Introduction 426
Patient data 426
History of present illness (complaints) 426
Regional examination or local examination 429
Examination of the urinary bladder 430
Rectal examination 431
Other diseases of kidney 434
Diseases of ureter and bladder 436
27. Examination of Hernia 440–458
Introduction 440
Indirect hernia 440
Direct hernia 441
Clinical examination of inguinal hernia 441
More details about inguinal hernia 448
Anatomical classification 449
Clinical classification 449
Femoral hernia 452
Differential diagnosis of femoral hernia 453
Case of umbilical hernia of adults 453
Incisional hernia 454
Epigastric hernia 455
Spigelian hernia 456
Lumbar hernia 457
Obturator hernia 458
28. Examination of Scrotum and Testis 459–469
Introduction 459
History of present illness 459
Regional examination 460
29. Examination of Penis 470–475
Introduction 470
Complaints/history of present illness 470
Phimosis 473
Paraphimosis 473
Hypospadias 473
Condyloma acuminatum 473
Buschke-Löwenstein tumour 473
Carcinoma penis 474
Peyronie’s disease (penile fibromatosis) 475
Fracture of penis 475
30. Viva Voce Examination 476–531
Introduction 476
Instruments 487
Suture materials 500
Absorbable 500
Nonabsorbable 501
Specimens 502
Operative surgery 511
Introduction 511
Appendicectomy 511
Modified Bassini’s herniorrhaphy and Lichtenstein repair 513
Lichtenstein repair 515
Surgery for hydrocoele 515
Incision and drainage (I and D) 517
incision and drainage of breast abscess 518
Circumcision 519
Venesection or cut down 519
Vasectomy 520
Tracheostomy 521
Suprapubic cystostomy (SPC) 522
Thyroidectomy 523
Amputations 525
Amputations in leg 527
Upper limb amputations 529
Excision of swellings 530