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David L. Simel - The Rational Clinical Examination

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The ultimate guide to the evidence-based clinical encounter

This book is an excellent source of supported evidence that provides useful and clinically relevant information for the busy practitioner, student, resident, or educator who wants to hone skills of physical diagnosis. It provides a tool to improve patient care by using the history and physical examination items that have the most reliability and efficiency.Annals of Internal Medicine

The evidence-based examination techniques put forth by Rational Clinical Examination is the sort that can be brought to bear on a daily basis to save time, increase confidence in medical decisions, and help decrease unnecessary testing for conditions that do not require absolute diagnostic certainty. In the end, the whole of this book is greater than its parts and can serve as a worthy companion to a traditional manual of physical examination.Baylor University Medical Center...

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The Rational Clinical Examination

NOTICE

Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information contained in this work. Readers are encouraged to confirm the information contained herein with other sources. For example and in particular, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs.

The Rational Clinical Examination

Evidence-Based Clinical Diagnosis

Editors

David L. Simel, MD, MHS

Chief, Medicine Service
Durham Veterans Affairs Medical Center
Professor of Medicine
Duke University School of Medicine
Durham, North Carolina

Drummond Rennie, MD

JAMA
Chicago, Illinois
Philip R. Lee Institute for Health Policy Studies
University of California,
San Francisco San Francisco, California

Editor, Education Guides

Sheri A. Keitz, MD, PhD

Chief, Medicine Service
Miami Veterans Affairs Medical Center
Associate Dean for Faculty Diversity and Development
University of Miami Miller School of Medicine Miami, Florida

Copyright 2009 by the American Medical Association Published by The - photo 1

Copyright 2009 by the American Medical Association Published by The - photo 2

Copyright 2009 by the American Medical Association. Published by The McGraw-Hill Companies, Inc. All rights reserved. Manufactured in the United States of America. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher.

0071590315

The material in this eBook also appears in the print version of this title: 0-07-159030-7.

All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every occurrence of a trademarked name, we use names in an editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the trademark. Where such designations appear in this book, they have been printed with initial caps.

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This is a copyrighted work and The McGraw-Hill Companies, Inc. ("McGraw-Hill") and its licensors reserve all rights in and to the work. Use of this work is subject to these terms. Except as permitted under the Copyright Act of 1976 and the right to store and retrieve one copy of the work, you may not decompile, disassemble, reverse engineer, reproduce, modify, create derivative works based upon, transmit, distribute, disseminate, sell, publish or sublicense the work or any part of it without McGraw-Hill's prior consent. You may use the work for your own noncommercial and personal use; any other use of the work is strictly prohibited. Your right to use the work may be terminated if you fail to comply with these terms.

THE WORK IS PROVIDED "AS IS." McGRAW-HILL AND ITS LICENSORS MAKE NO GUARANTEES OR WARRANTIES AS TO THE ACCURACY, ADEQUACY OR COMPLETENESS OF OR RESULTS TO BE OBTAINED FROM USING THE WORK, INCLUDING ANY INFORMATION THAT CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR OTHERWISE, AND EXPRESSLY DISCLAIM ANY WARRANTY, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. McGraw-Hill and its licensors do not warrant or guarantee that the functions contained in the work will meet your requirements or that its operation will be uninterrupted or error free. Neither McGraw-Hill nor its licensors shall be liable to you or anyone else for any inaccuracy, error or omission, regardless of cause, in the work or for any damages resulting therefrom. McGraw-Hill has no responsibility for the content of any information accessed through the work. Under no circumstances shall McGraw-Hill and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages. This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise.

DOI: 10.1036/0071590307

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CONTENTS

JAMAevidence: Using Evidence to Improve Care

Founded around the Users' Guides to the Medical Literature and The Rational Clinical Examination: Evidence-Based Clinical Diagnosis, JAMAevidence offers an invaluable online resource for learning, teaching, and practicing evidence-based medicine (EBM). Updated regularly, the site includes fully searchable content of the Users' Guides to the Medical Literature and The Rational Clinical Examination and features podcasts from the leading minds in EBM, interactive worksheets, question wizards, functional calculators, and a comprehensive collection of PowerPoint slides for educators and students.

www.JAMAevidence.com

Please visit www.JAMAevidence.com for subscription information.

CONTRIBUTORS John Attia MD MSc PhD Academic Director of General - photo 4

CONTRIBUTORS

.

John Attia, MD, MSc, PhD

Academic Director of General Medicine
University of Newcastle
John Hunter Hospital
New Lambton, New South Wales, Australia
Meningitis, adult

Robert G. Badgett, MD

Clinical Professor of Medicine
University of Texas, San Antonio
San Antonio, Texas, USA
Congestive heart failure

Allan N. Barkun, MD, MSc

Professor of Medicine and Epidemiology, Biostatistics and Occupational Health
McGill University
Montreal General Hospital
Montreal, Quebec, Canada
Splenomegaly

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