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.

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.

Inhalt

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