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    Physical Diagnosis for Surgical Students
    Physical Diagnosis for Surgical Students
    Physical Diagnosis for Surgical Students
    Ebook102 pages2 hours

    Physical Diagnosis for Surgical Students

    By Syed Asif Razvi

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    About this ebook

    A handbook that will serve as a great teaching tool for medical students starting to learn physical diagnosis as well as during their third year surgical rotation. A ready reference that can fit in their lab coat pocket.
    LanguageEnglish
    PublisherTrafford Publishing
    Release dateDec 12, 2012
    ISBN9781466971363
    Physical Diagnosis for Surgical Students
    Author

    Syed Asif Razvi

    Dr. Razvi migrated from Bombay to Boston in 1966 to complete his post-graduate education in surgery. Razvi, 2nd of two sons of a surgeon, has had an exemplary carrier starting with graduating from high school 2nd in his class at the age of 14 and entering medical school at the age of 16 after two years of college. Completing medical school at the age of 20 and a rotating internship at the age of 21 is when he migrated to the US and finished 6 years of post-graduate training in surgery. He received certification by the American Board of Surgery in 1974 and has had several decades of an illustrious surgical carrier in the Boston area. He was on the teaching faculty of Tufts University School of Medicine since 1972 and rising through the ranks of the clinical ladder, finished as clinical professor of surgery. Dr. Razvi went back to school part-time in 1998 and received his MBA in 1999 from Northeastern University. He was recognized as one of the best teachers by the Tufts medical students every year and received the William Halstead Award for teaching surgical residents at St. Elizabeth’s Medical Center of Boston in 1995 and 2007. Dr. Razvi closed his surgical practice in October, 2011 and is currently dedicating his full time energy towards wound care. He is the Medical Director of the Elliot Center for Wound Care and hyperbaric Medicine in Manchester, NH.

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      Book preview

      Physical Diagnosis for Surgical Students - Syed Asif Razvi

      PHYSICAL

      DIAGNOSIS

      FOR SURGICAL

      STUDENTS

      Syed Asif Razvi, MD

      Order this book online at www.trafford.com

      or email [email protected]

      Most Trafford titles are also available at major online book retailers.

      © Copyright 2012 Syed Asif Razvi, MD.

      All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the written prior permission of the author.

      isbn: 978-1-4669-7135-6 (sc)

      isbn: 978-1-4669-7137-0 (hc)

      isbn: 978-1-4669-7136-3 (e)

      Library of Congress Control Number: 2012922773

      Trafford rev. 12/03/2012

      7-Copyright-Trafford_Logo.ai

      www.trafford.com

      North America & international

      toll-free: 1 888 232 4444 (USA & Canada)

      phone: 250 383 6864 • fax: 812 355 4082

      Contents

      History Taking

      Physical Examination General Principles

      Examination of Skin and Soft Tissues

      Head and Neck

      Chest and Breast

      Abdominal Examination

      Acute Abdomen

      Hernia

      External Genitalia, Rectal, and Pelvic Examination

      Vascular Examination

      This book is dedicated to my brother, the late Syed Ahsan Razvi, MD.

      A great clinician and a cardiologist loved and respected by thousands of his patients

      Introduction

      P hysical diagnosis is rapidly becoming a forgotten art in the practice of modern-day medicine. Dependence on ancillary tools (lab work and imaging) for making a diagnosis has reached near-addiction levels. It is lack of knowledge of physical diagnosis that results in physicians ordering a lot of unnecessary tests. Uncertainty about the physician’s ability to make a diagnosis by physical examination not only adds to poor quality of care, but also significantly increases the cost of care. Lack of confidence in making the diagnosis increases fear of litigation and makes the physician order a lot more tests than what are required, thus contributing to the escalating cost of medical care today.

      Experienced physicians with expertise in physical diagnosis and willingness to teach this art are few and far between. There are no practical handbooks of surgical physical diagnosis for medical students or young surgeons in training that can be conveniently carried with them for ready reference. The purpose of this work is to provide such a guide for the medical students during their surgical clerkship and also make it useful for PGY (Post Graduate Year) 1 surgical residents.

      This handbook will use the classic tools of physical diagnosis, which include inspection, palpation, percussion, and auscultation. Appropriate examples will depict the correct methods of examination. The differential diagnosis will be looked upon in the light of conditions being congenital or acquired, and the acquired conditions could be traumatic, inflammatory, or neoplastic.

      Accuracy in arriving at a diagnosis is dependent on the correlation between a thorough history taking and the physical findings. It takes an effort to learn to develop proper listening skills to take a good history. It is not uncommon for a patient who is a good historian to give away the diagnosis if the medical student or a house officer on the other end has been listening and paying attention to what is being said.

      Some suggestions for proper history taking relative to the chief complaint will be included in this text.

      History Taking

      H istory taking is an integral part of physical diagnosis, and unfortunately, there is not enough stress on its importance and methodology. As America has increasingly become a melting pot of diverse cultures and ethnicities, the art of extracting pertinent and useful information from patients has become challenging. Some patients love to talk and blurt out a lot of unnecessary information that may not have anything to do with their chief complaint, whereas others will not open up to every physician and hold back important information. It is important to know what kinds of leading questions need to be asked to get the necessary information. For example, a patient with a complaint of recurrent gastrointestinal bleeding might not be able to shed any light on the magnitude of the previous bleed; however, if asked about the number of blood transfusions received, this patient might know the answer.

      It is a good idea to adopt a system or a method of history taking and stick to it so one does not forget any important steps. The usual and customary method is to start with the chief complaint, followed in sequence with the history of present illness, past medical history, past surgical history, social history, current medications, and known drug allergies. Following the sequence or method is not as much of a problem as obtaining accurate information. The first student or resident recording information on a newly admitted patient has a lot of responsibility on his/her shoulders. Unfortunately, it is common practice for students or residents to copy information from the old records during subsequent hospital admissions. So any incorrect information is likely to get recorded year after year without being corrected until a compulsive or a thorough student actually talks with the patient or the family to verify the facts.

      One of the most important steps in history taking is to gain the patient’s confidence first. Many psychologists have studied the doctor-patient interactions and concluded that many patients are astute observers and they are studying the doctor while the doctor is talking to them. They prefer that the person talking with them make eye contact. It is preferable to sit down by the bedside to make the patient believe that you have all the time in the world and you have their undivided attention. Never stand in the doorway while speaking, and avoid putting your hands in your pockets.

      It is beyond the scope of this book to elaborate on every symptom of surgical disease, but an attempt is made to offer some practical hints on the most common surgical symptoms.

      PAIN

      1. Onset of pain: Whether sudden or gradual helps one decide if the problem was acute or chronic.

      2. Character of pain: Sharp pain may be indicative, for example, of a perforated viscus, whereas dull pain will suggest an inflammatory process. A stabbing pain is seen in a dissecting aneurysm, and a colicky pain in bowel obstruction or kidney stone. As each one of these characters of pain are suggestive of a diagnosis, it is important to document this finding. Pain is now expressed on a scale of one to ten, with ten being the most severe.

      3. Radiation of pain: A right upper-quadrant pain radiating around to the back is typical of biliary colic. An epigastric pain radiating straight through to the back is often seen in pancreatitis. It is important to know some unusual patterns of radiation in some situations; for example, pancreatitis may present with pain in the right lower quadrant, or gall bladder disease may present with chest pain.

      4. Exacerbation or relief of pain: For example, pain from a muscle tear will be exacerbated with walking or exercise, whereas pain from a duodenal ulcer will be relieved by eating.

      5. Associated symptoms: Association of nausea and vomiting and diarrhea and constipation, and determination of whether these symptoms preceded or followed the onset of pain are important to know.

      6. Relationship to food: Pain following a fatty meal is suggestive of gall bladder disease; pain immediately following eating may suggest gastritis or gastric ulcer. Sometimes the type of food eaten and the onset of pain give one a clue to the possible etiology. An

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