Handbook of Signs & Symptoms Fifth Edition

Book Preface

“The CT scan is normal,” the emergency department physician explains to the resident. “I’m thinking of sending the patient home, but I’ve only done a cursory examination.” Ten minutes later, the resident returns. “The patient had a stroke. She has a positive Homans sign and a positive Babinski’s reflex. Arrange a room.”

As this type of drama plays out every day in hospitals and clinics, eliciting a thorough history and performing a careful examination continue to be the cornerstones of clinical practice. Despite marked improvements in technology, the patient assessment is based on both subtle history clues and an observant exam. This still yields the highest diagnostic results, not to mention the cost-benefit ratio and the rapport it establishes with the patient. Those clues should always direct the technology, not the other way around.

Handbook of Signs & Symptoms, Fifth Edition, is a treasure trove of prompts and reminders for the clinician. It provides a comprehensive description of common to unusual patient complaints, coupled with diagnostic testing that is both routine and specific. It describes physical examination findings in detail and clarifies the mechanics of performing even rarely used tests.

Signs and symptoms are formatted alphabetically for quick retrieval, and elicited history is linked to the essentials of the exam. Readers are alerted to urgent situations in the Emergency Interventions section. Differential diagnoses are listed under Medical Causes, following the elaboration of the symptom history and exam findings. Under the heading Other Causes, the clinician is alerted to medications or herbal remedies that are associated with the patient’s complaint. Special Considerations address pediatric, gender-specific, and geriatric concerns.

This new edition of the handbook has been updated to include important signs and symptoms related to diseases that have recently taken center stage in clinical medicine, including avian influenza, respiratory syncytial virus, Kawasaki disease, and metabolic syndrome — an epidemic , disease that has become essential to diagnose and manage.

Illustrations are scattered throughout the book to augment the reader’s understanding of particular tests, and tables point out the often subtle differences in signs and symptoms to help distinguish among the most common complaints. These visual graphics make great teaching tools, too. The index is invaluable to the reader looking for a particular, familiar exam finding as well as for the differential utilizing that finding. The addition of a new appendix that focuses on obtaining a health history answers the need for comprehensive, reliable, and consistent documentation information that is important to formatting electronic medical records.

Handbook of Signs & Symptoms, Fifth Edition, sharpens the novice clinician’s ability to listen to the patient with an ear tuned to critical history and offers the seasoned clinician an opportunity to hone examination skills. It is an invaluable tool for maximizing the evaluation of a puzzling patient.

Following the handbook’s format provides the clinician with an added measure of security that the most careful history and educated examination have been performed.

Richard R. Roach, MD, FACP