About the Book

• Updated and more comprehensive 2nd edition with lot of additions and corrections.
• Covers general and clinical examination in various surgical areas and conditions with accurate reasoning and analysis.
• Discusses different clinical methods and signs.
• Chapter second on Investigations is the latest addition to the current edition for a quick review.
• Chapters on Orthopedics are rewritten with more text, photographs and diagrams.
• Each chapter contains clinical examination methods, investigations, and a brief outline of surgical conditions.
• Case Discussion and Clinical Pearls are added at the end of most of the chapters to enhance surgical wisdom.
• Incorporates latest innovations of expert clinicians, such as Srinivasan costal sign in abdominal distension, A cricketing approach to the abdomen, Triple ABC technique for clinical breast examination, and Examination of the back.
• General examination of common surgical cases, such as examination of an ulcer, swelling, arterial disease, oral cavity, thyroid swelling, breast lump, hernia/hydrocele, abdomen, etc. are shown in the added VIDEOS with a voice background.
• Important notes, laboratory investigations, clinical features are highlighted on a yellow colored background at relevant places.
• Enriched with excellent new clinical photographs and illustrations.
• Self-sufficient clinical book to both undergraduates and postgraduates in their learning period.
• It is also useful for practicing clinicians and surgeons worldwide to understand the surgical conditions and to achieve proper clinical diagnosis.

About the Author

Sriram Bhat M MS, Professor , Department of Surgery, Kasturba Medical College,Mangaluru, Karnataka, India

Table of Contents:
SECTION 1: EXAMINATION IN GENERAL SURGERY 1. Introduction on Clinical Examination ................ 1 Clinical methods 1 Symptoms and signs 2 History taking 3 Chief complaints 5 History of present illness 5 Past history 5 Personal history 6 Family history and genetic history 8 Other relevant history 8 Assessment of specific symptoms and signs 8 Physical examination 15 Examination of skin and mucous membrane 22 Examination of nails 26 Skin changes and eruptions 29 Texture of the skin 33 Pigmented lesions in the skin 33 Hair 33 Edema 35 Visible veins 36 Examination of pulse 39 Blood pressure (BP) 40 Respiration 42 Eyes 42 Nose 44 Ears 45 Fever/rise in temperature 45 Tongue 47 Crepitus 48 Local examination 49 Systemic examination 50 Final diagnosis 50 Levels of evidences 51 Contentsxx SRB’S CLINICAL METHODS IN SURGERY Ecog performance status (eastern cooperative oncology group) 52 Karnofsky performance status (KPS) 52 2. Investigations .............................................................................................................................53 Introduction 53 Types of investigation 54 Cellular study 54 Biopsy 55 Endoscopic examination 57 X-ray and imaging 57 Examination by exploration 64 Preanesthetic assessment (check up for fitness for surgery) 64 Examination of feces 67 Examination of urine 68 3. Examination of an Ulcer..................................70 Definition 70 Parts of an ulcer 70 Life history of an ulcer 71 Causes of ulcer becoming chronic in the skin 73 History 74 General examination 76 Local examination of an ulcer 76 4. Examination of a Swelling/Lump ..98 History 98 General examination 102 Local examination 102 Relevant systemic examination 119 Proper clinical diagnosis 120 Relevant investigations 120 Differential diagnosis 121 5. Examination of Sinus and Fistula..........................................................................................153 History 154 General examination 155 Local examination 155 Investigations 157 Classification of sinus 158 Classification of fistula 158 Sequestrum 159 Median mental sinus 159 Actinomycosis 160 Madura foot (mycetoma pedis) 160 6. Examination in Arterial Diseases...........................................................................................162 History 162 Chief complaints 162 General examination 166 Local examination 166 Systemic examination 177CONTENTS xxi Intermittent claudication 177 Rest pain 179 Limb ischemia 179 Investigations for arterial diseases 181 Diseases of the arteries 184 7. Examination in Venous Diseases...........................................................................................198 History 198 General examination 200 Local examination 200 Investigations for varicose veins 211 Surgical anatomy of lower limb veins 214 Venous pathology 216 8. Examination of Lymphatic System .......................................................................................222 Surgical anatomy 222 Chief complaints 226 General examination 227 Local examination 228 Investigations 235 Pathology of lymphatic systems 237 9. Examination of Peripheral Nervous System........................................................................247 History 247 Examination 248 Local examination 248 Relevant investigations 256 Peripheral nerve injuries 257 Brachial plexus injury 258 Median nerve injury 259 Ulnar nerve injury 261 Radial nerve lesions 262 Common peroneal nerve 263 Medial popliteal nerve 264 Axillary nerve injury 264 Long thoracic nerve injury (nerve of bell) 265 Accessory nerve injury 265 Hypoglossal nerve injury 266 10. Examination in Diseases of Muscles, Tendons and Fasciae..............................................268 History 268 General examination 268 Local examination (look/feel/measure/move) 268 11. Examination of Oral Cavity.....................................................................................................274 History 274 General examination 276 Local examination 276 Examination of cervical lymph nodes 290 Systemic examination 290 Investigations 291xxii SRB’S CLINICAL METHODS IN SURGERY 12. Examination of Jaw..................................................................................................................302 History 304 General examination 304 Local examination of jaw 304 Investigations for jaw disease 307 Maxillary tumors 308 Jaw tumors 309 Diseases of the palate 314 Maxillofacial injuries 314 13. Examination of Salivary Gland ..............................................................................................318 History 318 General examination 320 Local examination 320 Investigations for salivary diseases 329 Salivary neoplasms 331 14. Examination of Neck................................................................................................................340 History 340 General examination 341 Local examination 341 Systemic examination 351 Investigations 352 Classification of neck swellings 352 15. Examinations of Pharynx, Larynx, Nasal Cavities and Paranasal Sinuses .....................364 Examination of pharynx 364 Examination of larynx 366 Examination of nasal cavities and paranasal air sinuses 369 16. Examination of Thyroid...........................................................................................................372 General examination 375 Local examination 380 Systemic examination 389 17. Examination of Breast.............................................................................................................406 History 406 General examination 408 Local examination of breasts 408 Investigations in carcinoma breast/breast lump 424 Differential diagnosis 430 18. Examination of Hernia.............................................................................................................442 History 443 General examination 445 Local examination 445 Investigations 452 Hernia 452 Groin hernia 453 Parts of inguinal hernia 453CONTENTS xxiii Boundaries and anatomy of the inguinal canal 453 Newer anatomical considerations 454 Clinical classification of hernia 455 Newer classifications of groin hernias 456 Types of indirect inguinal hernia 456 Direct hernia 457 Differences between indirect inguinal and direct inguinal hernias 458 Differential diagnoses for groin swelling 459 Recurrent hernia 460 Incisional hernia 460 Epigastric hernia 462 Paraumbilical hernia 462 Umbilical hernia 462 Ventral hernia 462 Richter’s hernia 463 Sliding hernia 463 Pantaloon hernia 463 Strangulated hernia 463 Femoral hernia 464 19. Examination of Inguinoscrotal and Scrotal Swelling ........................................................469 History 469 General examination 471 Local examination 471 Investigations 479 20. Examination of Male External Genitalia ..............................................................................491 History 491 General examination 492 Local examination 492 Disorders of penis 495 SECTION 2: EXAMINATION IN ABDOMINAL AND RELATED CONDITIONS 21. Examinations in Chronic Abdominal Conditions ...............................................................501 History 501 General examination 506 Local examination 506 Systemic examinations 517 Investigations 517 22. Examination of Mass Abdomen ............................................................................................529 History 530 General examination 531 Local abdominal examination 531 Differential diagnosis 543 Diseases of the umbilicus and abdominal wall 560xxiv SRB’S CLINICAL METHODS IN SURGERY 23. Examination in Rectal and Vaginal Problems .....................................................................564 History 564 Examination of the anorectum 566 Vaginal examination 573 24. Examination of Acute Abdomen...........................................................................................585 History 585 General examination 588 Local examination of abdomen 589 Systemic examination 593 Investigations 594 Acute appendicitis 595 Acute cholecystitis 596 Acute pancreatitis 597 Acute peritonitis 598 Subphrenic spaces and subphrenic abscess 599 Amebic liver abscess 600 Perforated duodenal ulcer 601 Perforation of typhoid ulcer 602 Meckel’s diverticulum 602 Intestinal obstruction 603 Adhesions and bands 604 Acute intussusception 605 Volvulus 605 Bolus obstruction 606 Acute salpingitis 606 Acute nonspecific mesenteric lymphadenitis 606 Ruptured ectopic gestation 607 Ruptured aortic aneurysm 607 Munchausen’s syndrome 607 History 608 25. Examination in Dysphagia......................................................................................................608 General examination 609 Dysphagia 610 Foreign body in the esophagus 613 Gastroesophageal reflux disease (gord gerd) 613 Barrett’s esophagus 613 Barrett’s ulcer 614 Hiatus hernia 614 Boerhaave’s syndrome 614 Mallory–weiss syndrome 614 Tracheoesophageal fistula (TEF) 614 Achalasia cardia 615 Corrosive stricture of Esophagus 615 Plummer–vinson syndrome (paterson–kelly syndrome) 616 Reflux esophagitis 616 Schatzki rings 616 Carcinoma of esophagus 616CONTENTS xxv SECTION 3: EXAMINATION IN SPECIALIZED AREAS 26. Examination in Urinary Diseases...........................................................................................619 Hematuria 619 Retention of urine 620 Increased urinary frequency 621 Definitions of various terms 621 History 622 General examination 625 Local examination 625 Systemic examination 628 Examination of urine 628 Plain x-ray kub (kidney, ureter bladder) 629 Ultrasound abdomen 630 Intravenous urogram (IVU) 630 Retrograde pyelography (RGP) 630 Antegrade pyelogram/urogram 631 Renal angiogram 631 Micturating cystourethrography (MCU) 632 Ascending urethrogram 632 Isotope renography 632 Cystoscopy 632 Urethroscopy 633 Ct scan 633 Horseshoe kidney 633 Polycystic kidney disease 634 Solitary renal cyst 634 Duplication of renal pelvis 634 Retrocaval ureter 634 Ureterocele 634 Perinephric abscess 635 Renal tuberculosis 635 Hydronephrosis (HN) 636 Pyonephrosis 637 Carbuncle of kidney (renal carbuncle) 637 Renal calculus 638 Ureteric calculi 639 Staghorn calculus 639 Wilms’ tumor (nephroblastoma) 639 Renal cell carcinoma (RCC) 640 Ectopia vesicae (exstrophy of the bladder) 641 Vesical calculus 642 Cystitis 642 Interstitial cystitis (hunner’s ulcer, elusive ulcer) 643 Schistosoma hematobium (endemic hematuria, urinary bilharziasis) 643 Thimble or systolic bladder 644 Bladder tumors 644 Residual urine 645xxvi SRB’S CLINICAL METHODS IN SURGERY Malakoplakia 645 Acid phosphatase 646 Prostate specific antigen (PSA) 646 Benign prostatic hyperplasia (BPH) 646 Carcinoma prostate 647 Prostatitis 648 Stricture urethra 648 Posterior urethral valve 649 Urethral calculi 649 Urethritis 650 Urinary fistulas 650 27. Examination in Hand Diseases ..............................................................................................651 History 651 Examination 651 Investigations 654 Hand infections 655 Hand injuries 659 Syndactyly 659 28. Examination in Foot Diseases ................................................................................................660 History 660 Examination 660 Investigations 661 29. Examination of Face and Head..............................................................................................664 Introduction 664 Cleft lip and cleft palate 665 Hydrocephalous 668 Meningocele 668 Preauricular sinus 668 Problems of face and head trauma 668 Problems with infective lesions of face and head 669 Benign swellings of the face and head 670 Malignant conditions of face and head 670 Examination of cranial nerves 671 30. Examination of Chest Diseases..............................................................................................673 History 673 General examination 673 Local examination 673 Investigations 674 Empyema thoracis 675 Mediastinal tumors 676 Shock lung (stiff lung) 677 Pulmonary embolism (pe) 677 Carcinoma of lung 677 Pancoast tumor 678 Pulmonary complications during postoperative period 678 Pericarditis 678 Cardiac tamponade 679CONTENTS xxvii Diaphragmatic hernia 679 Chest wall tumors 680 31. Examination in Intracranial Diseases ...................................................................................681 History 681 General examination 681 Nervous system examination 681 Examination of cranial nerves 682 Investigations 684 Intracranial abscess 684 Subarachnoid hemorrhage 685 Intracranial aneurysms 685 Intracranial tumors 686 Pituitary tumors 687 Craniopharyngiomas 688 SECTION 4: EXAMINATION IN TRAUMA 32. Examination in Head Injuries.................................................................................................689 History 689 Examination 689 Local examination 690 Investigations 691 Mechanism of head injury 691 Adelaid coma scale 693 Indications for admission 693 Complications of head injuries 693 Extradural hematoma 693 Subdural hematoma 694 Depressed skull fracture 695 33. Examination in Chest Injuries ................................................................................................696 History 696 Examination 696 Investigations 697 Chest injuries 697 Flail chest and stove in chest 698 Pneumothorax 699 Tension pneumothorax 699 Hemothorax 699 Triage 700 34. Examination in Abdominal Injuries ......................................................................................701 General examination 701 Investigations 702 Liver injury 703 Splenic injury (rupture spleen) 703 Injuries to kidney 704 Pancreatic trauma 705xxviii SRB’S CLINICAL METHODS IN SURGERY Rupture bladder 705 Urethral injury 706 Abdominal compartment syndrome 707 SECTION 5: CLINICAL METHODS IN ORTHOPEDICS 35. Examinations of Bone and Joint Injuries .............................................................................709 History 709 Examination 710 Investigations 712 Fracture 713 Dislocation 715 36. Examinations in Injuries of Various Joints...........................................................................716 Examination in injuries around shoulder joint and arm 716 Examination in injuries of elbow joint and forearm 720 Examination in injuries of wrist and hand 723 Examination in injuries to pelvis 726 Examination in injuries of hip and thigh 729 Examination in injuries of knee joint and leg bones 733 Examination in injuries of ankle joint and foot 738 37. Examinations in Bone Diseases .............................................................................................742 History 742 Examination 743 Investigations 745 38. Examination of Pathological Joint........................................................................................753 History 753 Examination 754 Investigation 756 39. Examinations in Pathologies of Individual Joints..............................................................759 Examination of pathological shoulder joint 759 Examination of pathological elbow joint 763 Examination of pathological wrist and joints of hand 765 Examination of pathological hip joint 767 Examination in pathological knee joint 774 Examination of pathological ankle joint and foot 778 40. Examinations in Spine Injuries and Diseases......................................................................781 Spinal injuries 781 Fracture spine 783 Spinal cord injuries 784 Spinal diseases 785 Investigations 791 Examination of the back 795 Index....................................................................................................................................................801