The 10-minute Clinical Assessment

Clinical assessment is at the heart of medicine. Health professionals working in busy clinical settings, such as general practitioners, nurse practitioners and hospital doctors on-call, often have to assess patients under considerable time constraints. This book teaches the reader how to gather clinical information effectively, accurately and safely even when time is at a premium. Using a focused and evidence-based approach, it provides step-by-step assessment strategies for common and important clinical scenarios, particularly those that require ‘lateral’and holistic thinking, such as falls in the elderly, weight loss, ‘tired all the time’and assessment of diabetic or homeless people.

This second edition of The 10-Minute Clinical Assessment is fully updated in line with the latest guidelines and includes brand new general chapters on focused clinical assessment, red flags, and useful consultation tools. It covers a wide range of common and important topics, including cardiovascular, respiratory, haematology, musculoskeletal, neurology, mental health, gynaecology, obstetrics, urology, ophthalmology and ear, nose and throat. This new edition also includes sectionson undifferentiated and miscellaneous presentations, on paediatrics and adolescent health; and on problems in older people. Each of the individual disease sections is uniformly structured to provide rapid reference, including:

• Key features of the history, including questions relevant to patientsand important for making a diagnosis
• Common patient ideas, concerns and expectations
• The ‘value’ of present or absent symptoms for diagnosis and prognosis
• What should be examined, and why
• A summary of ‘red flags’ – issues that must be assessed
• Important differential diagnoses and their clinical features
• Useful tips, tricks and hints for effective patient assessment

Written by an experienced medical educator and practicing GP, in consultation with a multidisciplinary team of medical students, GPs, PG trainees, hospital doctors and nurses, this title specifically covers the clinical skills assessment (CSA) part of the Membership of the Royal College of General Practitioners (RCGP) examination.

New to this edition is a refreshed approach to the methodology employed inclinical assessment, to reflect recent trends in the teaching of clinical assessment. This edition also includes the latest evidence-based recommendations (including the latest NICE guidelines) and recent developments in order to provide the reader with a concise yet comprehensive resource for clinical reference.

Knut Schroeder MD, MSc, DRCOG, DCH, MRCGP, MRCP, PhD
General Practitioner, Bristol, UK; and Honorary Senior Clinical Lecturer in General Practice, Centre for Academic Primary Care, University of Bristol, Bristol, UK
Knut Schroeder holds a Certificate in Medical Education and developed undergraduate and postgraduate courses on clinical diagnosis and evidence based medicine. While a full-time Consultant Senior Lecturer, he was responsible for developing and running the general practice part of the final examination for medical students at the University of Bristol.
In addition to the first edition of The 10-Minute Clinical Assessment, Dr Schroeder has previously written for GP registrars (Top Tips for GPs, Radcliffe Medical Press, 2000) and co-written numerous book chapters, including two chapters for the Oxford Textbook of Primary Medical Care and a chapter on symptoms and signs for the Oxford Handbook of General Practice (3rd ed). He has had papers published in international peer-reviewed journals including the BMJ, Family Practice, and Archives of Internal Medicine, as well as articles in the GP press. His main clinical and teaching interest is clinical assessment and diagnosis.

Foreword, xi

Preface to 1st edition, xii

Preface to 2nd edition, xiv

About the author, xv

Acknowledgements, xvi

Selected useful resources, xvii

The focused consultation, 1

Focused clinical assessment, 3

Useful consultation tools, 8

Red flags in general practice, 12

Undifferentiated and miscellaneous presentations, 15

Suspected cancer, 17

Weight loss, 24

Tiredness, 29

Dizziness, 35

Chronic pain, 41

Sudden collapse and syncope, 45

Frequent attenders, 50

Medication review and polypharmacy, 54

Medically unexplained symptoms, 58

Insomnia, 63

Irritability and ‘stress’, 67

Domestic violence, 71

Homelessness, 75

Paediatrics and adolescent health, 81

The sick and/or feverish child, 83

Suspected meningococcal meningitis and septicaemia, 90

Neonatal jaundice, 95

Faltering growth, 99

Headache and migraine in children, 104

Head injury in children, 108

Suspected cancer in children and adolescents, 113

Abdominal pain in children, 118

Hearing loss in children, 124

Childhood cough, 128

Childhood wheeze, 133

Constipation in children, 138

Childhood obesity, 142

Suspected child abuse and neglect, 148

Nocturnal enuresis, 153

Knee problems in children, 158

Hip problems in children, 163

Adolescent health problems, 167

Self-harm in teenagers, 171

Eating disorders, 175

Autism-spectrum disorder, 180

Cardiovascular, 183

Chest pain, 185

Palpitations, 191

Cardiovascular risk assessment, 195

Hypertension, 200

Atrial fibrillation, 205

Heart failure, 209

Peripheral vascular disease, 215

Respiratory, 221

Shortness of breath, 223

Haemoptysis, 228

Suspected lung cancer, 233

Asthma, 237

Chronic obstructive pulmonary disease, 242

Suspected pneumonia, 248

Pleural effusion, 252

Pulmonary embolism, 256

Endocrine and metabolic, 261

Diabetes review, 263

Obesity, 268

Hirsutism in women, 273

Hypothyroidism, 277

Hyperthyroidism, 281

Hyponatraemia, 285

Hypernatraemia, 289

Hypokalaemia, 292

Hyperkalaemia, 296

Hypocalcaemia, 299

Hypercalcaemia, 302

Gastrointestinal, 307

Nausea and vomiting, 309

Dysphagia, 313

Dyspepsia and reflux, 317

Upper gastrointestinal bleeding and melaena, 321

Abdominal pain, 326

Constipation, 332

Diarrhoea, 336

Rectal bleeding and suspected bowel cancer, 341

Abnormal liver function tests, 346

Irritable bowel syndrome, 351

Inflammatory bowel disease, 356

Coeliac disease, 361

Infectious diseases, 365

Fever of unknown origin, 367

Fever and illness in the returning traveller, 372

HIV infection and AIDS, 377

Tuberculosis, 383

Rheumatic fever, 388

Haematology, 393

Iron-deficiency anaemia, 395

Macrocytic anaemia (B12 and folate deficiency), 400

Bleeding disorders, 405

Myeloma, 409

Musculoskeletal, 413

Soft-tissue injury, 415

Acute hot and swollen joint, 420

Chronic musculoskeletal pain, 424

Polyarthralgia, 429

Neck pain, 435

Back pain, 440

Shoulder and arm problems, 446

Elbow problems, 452

Hand problems, 456

Hip pain, 461

Groin problems, 466

Leg pain and/or swelling, 470

Knee pain, 476

Foot and ankle problems, 483

Gout, 489

Osteoporosis, 493

Neurology, 499

Headache, 501

Transient ischaemic attack and stroke, 508

Head injury in adults, 514

Suspected or confirmed brain tumour, 519

Tremor, 524

Motor neurone disease, 528

Peripheral neuropathy, 533

Multiple sclerosis, 538

Gynaecology, 543

Combined oral contraception, 545

Menorrhagia, 549

Amenorrhoea, 553

Breast lumps, 557

Loss of libido, 561

Polycystic ovary syndrome, 565

Suspected ovarian cancer, 570

Obstetrics, 575

Routine antenatal care, 577

Bleeding in early pregnancy, 582

Abdominal pain in pregnancy, 586

Pre-eclampsia, 591

Urology and renal medicine, 595

Suspected urinary tract infection in women, 597

Lower urinary tract symptoms in men, 601

Urinary incontinence, 606

Urethral discharge in men, 612

Scrotal and testicular problems, 616

Erectile dysfunction, 621

Renal or ureteric colic (kidney stones), 626

Haematuria, 631

Chronic kidney disease, 635

Mental health, 641

Depression, 643

Self-harm and harm to others, 648

Anxiety, phobias and panic disorder, 653

Alcohol screening, 657

Alcohol dependence, 662

Illicit drug misuse, 667

Obsessive–compulsive disorder, 672

Mania, 675

Schizophrenia, 679

Skin, 685

Moles and malignant melanoma, 687

Pressure ulcers, 690

Ophthalmology, 695

Eye injuries, 697

The acute red eye, 701

Gradual painless visual disturbance, 706

Sudden painless visual disturbance, 710

Eye problems in older people, 715

Ear, nose and throat, 719

Neck swelling, 721

Sore throat, 725

Ear pain, 730

Hearing loss in adults, 734

Tinnitus, 738

Sinusitis and facial pain, 742

Problems in older people, 747

General health assessment in older people, 749

Cognitive problems and dementia, 755

Falls in older people, 760

Delirium and acute confusional state, 766

Depression in older people, 772

Palliative and end-of-life care, 777

Parkinson’s disease, 781

Index, 785

The New copy of this book will include any supplemental materials advertised. Please check the title of the book to determine if it should include any access cards, study guides, lab manuals, CDs, etc.

The Used, Rental and eBook copies of this book are not guaranteed to include any supplemental materials. Typically, only the book itself is included. This is true even if the title states it includes any access cards, study guides, lab manuals, CDs, etc.