Physical Diagnosis: Bedside Evaluation of Diagnosis and Function.

Willms JL, Schneiderman H, Algranati PS. Baltimore, MD 21202, Williams & Wilkins, 1994, hardback, 804 pp, illus, $48.

The goal of this text is to provide material to students in a sequential fashion as they acquire information during their medical education. The text is well written and consists of 16 chapters, of which, the last 14 are divided into two sections: the screening examination and the extended examination. The goal of dividing the chapters into sections is to help distinguish between what is considered to be basic clinical knowledge and what is considered to be specialized knowledge. Screening examination sections are designed to teach basic assessment skills in the absence of clinical medicine or medical problem solving. Extended examination sections are aimed at advanced students and focus on the skills students should gain with experience.

All of the chapters provide excellent photographs and illustrations. When applicable, the chapters begin with quick, but adequate reviews of anatomical structures to be examined.

The first two chapters thoroughly examine patient interviews and patient appearances, and obtaining past medical histories and vital signs. These are the only two chapters that are not divided into screening and extended examination sections. These chapters are very basic and well written. All students in health care professions would benefit from reading these two fine chapters.

The next 14 chapters cover the physical examination of patients and address interpretations of physical findings. Regions covered include the head, eyes, ears, nose, oral cavity, throat, neck, breasts and axillae, thorax and lungs, heart and great vessels, abdomen, limbs, low back, and male and female genitalia and rectum. Two additional chapters provide an in-depth discussion of the neurologic and pediatric examination. A final chapter addresses typical and uncomfortable situations faced by clinicians during, or as a result of, the patient interview. Four appendixes follow, with the most useful one being a list of abbreviations found in medical records.

Some chapters are especially helpful for physical therapists. Chapters 7 and 8 are excellent for those individuals who are involved in cardiopulomonary physical therapy and cardiac rehabilitation. Chapter 7 is a discussion of the thorax and lungs and contains excellent diagrams and photographs of bony and soft tissue relationships in this region. It demonstrates various respiratory therapy techniques, such as palpation, percussion, and auscultation, and addresses normal and pathological respiratory examination findings. Chapter 8 provides a detailed examination of the heart and great vessels. It probably gives more information than most physical therapists require unless they care for patients with cardiac disorders.

Chapter 10 examines the limbs. The screening section of this chapter is very basic, covering such topics as anatomy, inspection, palpation, active and passive range of motion, and pulses. The extended examination section discusses and demonstrates different techniques to assess the status of the peripheral vasculature, including the lymphatic system. There is much analysis of neuromuscular problems as well. This section, however, provides little in terms of examination of peripheral joints (eg, there is only one small paragraph on drawer tests for knee cruciate ligament integrity).

The information on neurologic examination that is found in chapter 11 would be valuable reading for all physical therapists. The screening examination section discusses and illustrates all major components of a quick neurologic examination, whereas the extended examination section reviews most of what is taught in a clinical neuroscience course.

The screening and extended examination sections in chapter 12 provide basic evaluative skills necessary for examination 4of the low back. Physical therapists specifically involved with evaluation and treatment of low back disorders may not gain significant information from this chapter.

This text would be most useful to medical students during their formal 4 years of education. The first two chapters would be extremely valuable to first- and second-year medical students. Resident physicians may also benefit from the chapters on physical examination as a reference guide. Other than those chapters mentioned above, however, it is unlikely that this text would benefit the physical therapist. It is also likely that information gained from this text could easily be located in references either owned by or accessible to physical therapists.

James L Karnes, Phd, PT D'Youville College Buffalo, NY

Dr Karnes is assistant professor and assistant director in the physical therapy program. His research interests include the transmission of topical medications through skin and morphological studies of the spine.