About the Book

A complete textbook both for the curious students who have started learning the basics of clinical evaluation as well as a complete guide for the senior surgeons teaching clinical methods to the students.
The entire text is spread over 9 major sections and includes 38 chapters in specific areas pertaining to surgery as well as allied specialties.
Each section is divided into different parts for the ease of the student to learn history taking, conduct of physical examinations, planning and ordering investigations as well as formulating the differential diagnoses to reach the correct diagnosis.
The book of amply illustrated with color photographs, X-rays, diagrams and charts for easy understanding and long term retention.
The various academic materials are all compiled by both senior authors as well as new surgeons, all of whom have been associated with the premier AIIMS, New Delhi, India.

About the Author

Sunil Chumber MBBS MS (AIIMS)

Table of Contents:
Contents Section 1: History, Signs and Symptoms 1. History of the Patient 3 Anurag Srivastava, Maneesh Singhal, Sunil Chumber • First Contact with a Patient 3 • Taking a History 3 • Physical Examination 7 • General Examination 7 • Systemic Examination 11 • Local Examination 12 • Provisional Diagnosis 13 • Investigations 13 • Complete Diagnosis 13 • Management 13 • Treatment 13 • Discharge of the Patient 13 • Follow-up Visit 14 • Last Point 14 2. Symptoms and Signs 15 Anurag Srivastava, Maneesh Singhal, Sunil Chumber • Symptoms 15 • Signs 20 3. Lump, Ulcer, Sinus and Fistula 25 Anurag Srivastava, Sushma Sagar, Sunil Chumber • Lump 25 • History 25 • Physical Examination 28 • Local Examination 28 • Systemic Examination 33 • Investigations 34 • Diagnosis of a Swelling 36 • Differential Diagnosis 38 • Ulcer 41 • History 41 • Physical Examination 45 • Systemic Examination 45 • Investigations 46 • Differential Diagnosis 47 • Sinus and Fistula 52 • History 53 • Local Examination 53 • Systemic Examination 54 • Investigations 54 • Differential Diagnosis 55 Section 2: Vessels, Lymphatics, Lymph Nodes and Nerves 4. Arteries 59 Varinder Bansal, Rakesh Mahajan, Krishna Asuri, Sunil Chumber • History 59 • Physical Examination 60 • Local Examination 60 • Systemic Examination 66 • Investigations 66 • Differential Diagnosis 68 5. Veins 76 Rakesh Mahajan, Varinder Bansal, Aloy Mukherjee, Krishna Asuri, Sunil Chumber • Varicose Veins 76 • History 76 • General Examination 77 • Physical Examination 77 • Systemic Examination 80 • Investigations 80 • Deep Vein Thrombosis 81 • History 81 • Physical Examination 81 • Investigations 82 • Differential Diagnosis 82 xvi Clinical Surgery A Text and Atlas 6. Lymphatics 85 Varinder Bansal, Rakesh Mahajan, Krishna Asuri, Sunil Chumber • History 85 • Local Examination 86 • Systemic Examination 87 • Investigations 88 • Differential Diagnosis 88 7. Lymph Nodes 91 Mahesh Chander Misra, Krishna Asuri, Sunil Chumber • History 91 • Physical Examination 93 • Local Examination 93 • Systemic Examination 100 • Investigations 100 • Differential Diagnosis 101 8. Nerves 108 Maneesh Singhal, Sunil Chumber • History 108 • Physical Examination 109 • Local Examination 110 • General Examination 116 • Investigations 116 • Differential Diagnosis 116 Section 3: Bones, Joints and Skin 9. Bone 123 Hira Lal Nag, Kamran Farooque, Sunil Chumber • History 123 • Local Examination 123 • Systemic Examination 126 • Investigations 127 • Differential Diagnosis 128 10. Joints, Muscle, Tendon and Fascia 138 Hira Lal Nag, Ravi Mittal, CS Yadav, Sunil Chumber • Joints 138 • History 138 • Physical Examination 139 • Local Examination 139 • Systemic Examination 139 • Investigations 140 • Shoulder Joint 140 • History 140 • Local Examination 140 • Investigations 142 • Differential Diagnosis 142 • Elbow Joint 143 • History 143 • Local Examination 143 • Investigations 144 • Differential Diagnosis 144 • Wrist and Hand 145 • History 145 • Local Examination 145 • Investigations 145 • Differential Diagnosis 145 • Hip Joint 146 • History 146 • Physical Examination 147 • Local Examination 147 • Systemic Examination 151 • Investigations 151 • Differential Diagnosis 152 • Knee Joint 153 • History 153 • Local Examination 153 • Systemic Examination 156 • Investigations 156 • Differential Diagnosis 156 • Ankle and Foot 157 • History 157 • Local Examination 157 • Differential Diagnosis 158 • Muscle, Tendon and Fascia 159 • History 159 • Physical Examination 159 • Differential Diagnosis 159 11. Hand and Foot 162 Vijay Sharma, Sunil Chumber • Hand 162 • History 162 • Physical Examination 162 • Differential Diagnosis 164 Contents xvii • Foot 169 • History 169 • Physical Examination 169 • Systemic Examination 170 • Differential Diagnosis 170 12. Spine 176 Arvind Jaiswal, Budhdev Choudhary, Sunil Chumber • History 176 • Physical Examination 177 • Local Examination 177 • Systemic Examination 180 • General Examination 180 • Sacroiliac Joint 181 • History 181 • Physical Examination 181 • Investigations 181 • Differential Diagnosis 181 13. Skin, Hair and Nails 186 Garima Beri, Kaushal Kishore Verma, Rakesh Kumar, Sunil Chumber • Skin 186 • History 186 • Examination of the Skin 186 • Mucous Membranes 193 • Hair 194 • Nails 194 • Peripheral Nerves 196 • Investigations 196 • Differential Diagnosis 197 Section 4: Head and Neck 14. Eyes 205 Puneet Agarwal, Jeevan Singh Titiyal • History 206 • Examination of Eyes 209 • General Examination 209 • Eye Examination 209 15. Face and Head 217 Pradeep Subramaniam, Padma MV Srivastava, Ashish Suri, Sumit Sinha, Sandeep Agarwala, Sunil Chumber • Face 217 • Physical Examination 217 • Head 222 • History 222 • General Examination 223 • Physical Examination 223 • Systemic Examination 234 • Investigations 234 • Differential Diagnosis 235 16. Teeth, Jaws and Temporomandibular Joint 243 Ritu Duggal, Ajoy Roychoudhary • Teeth 243 • History 243 • Physical Examination 243 • General Examination 243 • Local Examination 243 • Jaws 244 • Differential Diagnosis 247 • Temporomandibular Joint 250 • Local Examination 251 • Differential Diagnosis 251 • Ankylosis 251 17. Mouth 253 SVS Deo, Anurag Srivastava, Sudipto Saha, Sunil Chumber • History 253 • Physical Examination 254 • Lips 255 • Tongue 255 • Lingual Tonsil 257 • Gums 257 • Cheek 258 • Floor of Mouth (FOM) 259 • Palate 259 • Retromolar Trigone (RMT) 260 xviii Clinical Surgery A Text and Atlas • Tonsils 260 • Systemic Examination 261 • Investigations 261 • Differential Diagnosis 261 18. Salivary Glands 267 Arun Kumar, Sudipto Saha, Anurag Srivastava, Sunil Chumber • Parotid Gland 267 • History 267 • Local Examination 268 • Submandibular Gland 269 • History 269 • Local Examination 269 • Minor Salivary Glands 271 • Investigations 271 • Differential Diagnosis 272 19. Ear, Nose and Throat 276 Kumud Kumar Handa, Ameet Kishore • Ear 276 • History 276 • Physical Examination 277 • Investigations 279 • Nose 280 • History 280 • Physical Examination 281 • Investigation 282 • Head, Neck and Larynx 282 • History 282 • Physical Examination 282 • Investigations 284 20. Thyroid 285 Rajesh Khadgawat, Nikhil Tandon, Vishwanath S, Sudipto Saha, Sunil Chumber • History 285 • General Examination 288 • Local Examination 288 • Investigations 295 • Differential Diagnosis 297 • Parathyroids 302 • History 303 • Physical Examination 303 • Investigations 303 • Differential Diagnosis 304 21. Neck 305 Subodh Garg, Sudipto Saha, Sunil Chumber • History 305 • General Examination 306 • Local Examination 306 • Systemic Examination 309 • Investigations 309 • Differential Diagnosis 310 Section 5: Breast, Chest and Heart 22. Breast 317 Anurag Srivastava, SVS Deo, V Seenu, Sunil Chumber • History 317 • Physical and Local Examination 318 • Systemic Examination 324 • Male Breast 325 • History 325 • Physical Examination 325 • Investigations 326 • Differential Diagnosis 327 23. Chest 337 Sanjeev Sinha, Subodh Garg, Ravinder K Dewan, R Ramchandani, Sunil Chumber • History 337 • Physical Examination 338 • Local Examination 338 • Systemic Examination 342 • Investigations 343 • Differential Diagnosis 345 Contents xix 24. Heart 354 Rajiv Narang, AK Bisoi, Aditya Prakash Sharma • Clinical Evaluation of Patients with Heart Disease 354 • General Physical Examination 356 • Investigations 360 • Brief Description of Common Cardiac Diseases 371 Section 6: Abdomen and Hernia 25. Esophagus 379 TK Chattopadhyay, Rajinder Prashad, Sandeep Agarwala, Sunil Chumber • History 379 • Physical Examination 381 • Systemic Examination 382 • Investigations 382 • Differential Diagnosis 384 26. Abdomen 389 Shaji Thomas, Manoj Kumar, Nitin Agarwal, Nihar Ranjan Dash, MS Ansari, Anoop Saraya, Sandeep Agarwala, Amlesh Seth, Sunesh Kumar, Sunil Chumber • Acute Abdomen 389 • History 389 • Physical Examination 393 • Child with Acute Abdomen 397 • History 397 • Physical Examination 397 • Abdominal Examination 398 • Investigations 398 • Differential Diagnosis 401 • Chronic Abdomen 406 • History 406 • Physical Examination 411 • Differential Diagnosis 419 • Abdominal Lump 428 • History 428 • Physical Examination 429 • Systemic Examination 440 • Investigations 440 • Differential Diagnosis 445 • Urologic Problems 472 • History 472 • General Examination 478 • Local Examination 478 • Systemic Examination 480 • Investigations 480 • Differential Diagnosis 483 27. Rectum and Anus 493 Sudipto Saha, Nitin Agarwal, Sujoy Pal, Sunil Chumber • History 493 • Per-rectal Examination 494 • Investigations 497 • Differential Diagnosis 498 28. Hernia 503 Mahesh Chander Misra, Krishna Asuri, Sudipto Saha, Sunil Chumber • Groin Hernias 503 • History 503 • Physical Examination 505 • General Examination 510 • Systemic Examination 510 • Differential Diagnosis 510 • Incisional Hernia 510 • History 510 • Physical Examination 511 • Systemic Examination 512 • Umbilical and Paraumbilical 512 • History 513 • Physical Examination 514 • Epigastric Hernia 514 • History and Physical Examination 515 • Rare Hernias 514 • Differential Diagnosis 515 xx Clinical Surgery A Text and Atlas 29. Male Genitalia 520 Nitin Agarwal, Lalit Aggarwal, Sunil Chumber • Scrotum 520 • History 520 • Local Examination 521 • Testis 524 • Systemic Examination 525 • Penis 525 • History 525 • Local Examination 526 • Investigations 528 • Differential Diagnosis 529 Section 7: Special Groups 30. Preanesthetic Evaluation 539 V Darlong, Mandeep Singh • History 539 • Physical Examination 540 • Investigations 542 • Risk Assessment 543 31. Psychiatric Evaluation 546 Hemraj Pal, Amardeep Kumar, Pratap Sharan • History 546 • Physical Examination 547 32. Female Patient 552 Ashok Kumar, Minu Basra, Sunesh Kumar, Sunil Chumber • Gynecological Assessment 552 • History 552 • Physical Examination 555 • Pelvic Examination 556 • Investigations 560 • Differential Diagnosis 563 • Obstetric Assessment 566 • History 566 • Physical Examination 568 • General Examination 568 • Systemic Examination 568 • Obstetric Examination 569 33. Child and Newborn 573 M Raghavan, Minu Bajpai, Sunil Chumber • History 574 • Physical Examination 575 • Newborn 577 • General Examination 577 • Physical Examination 577 • Care and Transport of the Newborn 579 34. Elderly Patient 581 AB Dey • Assessment of the Elderly Patient 581 • Physical Examination 582 • System-wise Approach 584 • Common Problemsin the Elderly Patient 588 Section 8: Trauma and Medicolegal Negligence 35. Patient with Trauma 599 Amit Gupta, Mahesh Chander Misra, CS Yadav, Budhdev Choudhary, Pradeep Subramanian, Sunil Chumber • Primary Survey 600 • Secondary Survey 604 • Brief History 604 • Physical Examination 604 • Definitive Care 606 Contents xxi • Head Injury 606 • History 606 • Physical Examination 608 • Local Examination 609 • Investigations 612 • Specific Injuriesin Head Trauma 612 • Maxillofacial Injuries 614 • History 614 • Physical Examination 614 • Chest Injuries 616 • History 616 • Physical Examination 616 • Investigations 617 • Injuriesto the Chest 617 • Abdominal Injuries 619 • History 620 • Abdominal Examination 620 • Systemic Examination 622 • Investigations 622 • Abdominal Injuries 623 • Spinal Injuries 625 • History 625 • Physical Examination 625 • Systemic Examination 628 • Investigations 628 • Differential Diagnosis 628 • Musculoskeletal Trauma 630 • History 630 • Local Examination 631 • Investigation 636 • Differential Diagnosis 637 • Pelvis and Perineum 644 • Triage 645 36. Death 647 Amit Gupta, Sajal Haldar, Sunil Chumber • Causes of Death 647 • Brain Death 648 • At Death 649 37. Doctor–Patient Relationship and Medicolegal Negligence 650 Amit Gupta, Sajal Haldar, Sunil Chumber • Doctor–patient Relationship 650 • Ethical Practices 650 • Medical Negligence 651 38. Laboratory Investigations 653 Sukhbir Singh Badhal, M Irshad, Sunil Chumber • Liver Function Tests 653 • Renal Function Test 655 • Cardiac Marker Tests 656 • Pulmonary Function Tests 658 • Arterial Blood Gases 660 • Electrolyte Disorders 662 • Serum Protein Electrophoresis 664 • Urinalysis 664 • Cerebrospinal Fluid 666 • Coagulogram 667 • Complete Hemogram 668 • Viral Markers 670 • Thyroid Disease 673 • Laboratory Values of Clinical Importance 673 Appendix 677 Index 683