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Sir Norman Browse History taking and clinical examination You must be constantly alert from the moment you first see the patient, and employ your eyes, . The text teaches the clinical symptoms and signs of surgical disease, stressing the in detail the techniques of clinical examination, this text enables students to elicit key symptoms and make sound clinical decisions. صيغة الكتاب: pdf. Part 4: General Surgery. 24 Disorders of the Abdominal Wall, 25 Disorders of the Oesophagus, 26 Disorders of the Stomach and Duodenum,

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Together with Sir Norman Browse, the three additional authors bri. Department of Surgery, Division of Vascular Surgery. University Pages from _i. Consultant Surgeon Emeritus and former Clinical Director of Sheffield Teaching Hospitals NHS Norman L Browse Kt MD FRCS FRCP. Browse's Introduction to the Symptoms & Signs of Surgical Disease. FRCS Consultant Surgeon and Clinical Director, Sheffield Teaching Hospitals Trust Member of .. Sir Norman Browse Preface to the Fourth Edition.

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It's a must to read this book during surgery rounds , I love it! Sep 16, Nur Izzati rated it liked it Shelves: Not that helpful for my surgical posting.

Jun 23, Bethelhem added it. Aug 07, Al-anoud Al-jarbou rated it really liked it. Oct 15, Zahra rated it liked it.

This review has been hidden because it contains spoilers. To view it, click here. It's helpful. I've studied parts of this book during the clinical exam of surgery.

Mar 18, Abdulrahman added it. I totally love the editing of this book with the hard cover, the colors and every thing. Nov 11, Sopnil Rahman rated it did not like it. Cheat you not giving book. Saniulhassan rated it it was amazing Mar 06, Moony Awamy rated it really liked it Sep 23, Emmanuel rated it really liked it Jan 17, Hanadi AboSaif rated it really liked it Dec 18, Zashim rated it really liked it Dec 20, Kubeh Pascal rated it really liked it Apr 09, Jun 09, Dhanushka added it.

Free think. Viqar Aslam rated it it was ok Jul 11, Hayyatudeen Sani rated it it was amazing Mar 25, Mohammed rated it it was amazing Sep 12, Shaaban rated it really liked it Aug 12, Readers Also Enjoyed. Blankensteijn, M. Appendix definition, supplementary material at the end of a book, article, document, or other text, usually of an explanatory, statistical, or bibliographic nature.

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Browse s Introduction to the Symptoms and Signs of Surgical. Norman And Browse Clinical Surgery - pdfsdocuments2. New knowledge, experience. Background Hospital mortality that is associated with inpatient surgery varies widely. Reducing rates of postoperative complications, the current focus of payers. Browse s Introduction to the Symptoms and Signs. Two-Year Outcomes after Conventional or Endovascular. You can directly download and save in in to your device Norman Browse Clinical Surgery 4shared - ebookdig.

We have millions index of Ebook Files urls from around the world. The eMedicine point-of-care clinical reference features up-to-date, searchable, peer-reviewed medical articles organized in specialty-focused textbooks Variation in Hospital Mortality Associated with Inpatient. Are they vegetarian? When do they eat their meals? By how much? Over how long a time? Many patients never weigh themselves, but they usually notice if their clothes have got tighter or looser and friends may have told them of a change in physical appearance.

Teeth and taste Can they chew their food? Do they have their own teeth? Do they get odd tastes and sen- sations in their mouth?

Are there any symptoms of water brash or acid brash? This is sudden filling of 2 Chap How to take the history 3 Revision panel 1.

History of present complaint HPC Include the answers to the direct questions concerning the system of the presenting complaint.

Systematic direct questions a Alimentary system and abdomen AS Appetite.

Indigestion pain. Abdominal pain. Abdominal distension. Bowel habit. Nature of stool. Rectal bleeding. Chest pain. Exercise tolerance. Paroxysmal nocturnal dyspnoea. Ankle swelling. Limb pain. Walking distance. Colour changes in hands and feet. Frequency of micturition including nocturnal frequency. Poor stream. Painful micturition.

In men Problems with sexual intercourse and impotence. In women Date of menarche or menopause. Quantity and duration of menstruation. Vaginal discharge. Previous pregnancies and their complications. Urinary incontinence. Breast pain. Nipple discharge. Skin changes. Memory loss. Syncopal attacks. Loss of consciousness.

Muscle weakness. Sensory disturbances. Changes of smell, vision or hearing. Swelling joints. Limitation of joint movements. Disturbances of gait. Previous history PH Previous illnesses. Operations or accidents.

Rheumatic fever. Bleeding tendencies. Hay fever. Tropical diseases. Drug history Insulin. Anti-depressants and the contraceptive pill. Drug abuse.

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Immunizations BCG. Whooping cough. Family history FH Causes of death of close relatives. Familial illnesses in siblings and offspring. Social history SH Marital status. Sexual habits. Living accommodation. Exposure to industrial hazards. Travel abroad. Leisure activities. Habits Smoking. Number of cigarettes smoked per day. Units of alcohol drunk per week. History taking and clinical examination the mouth with watery or acid-tasting fluid — saliva and gastric acid respectively. Swallowing If they complain of difficulty in swal- lowing dysphagia , ask about the type of food that causes difficulty,the level at which the food sticks,and the duration and progression of these symptoms.

Is swallowing painful? Regurgitation This is the effortless return of food into the mouth. It is quite different from vomiting, which is associated with a powerful involuntary con- traction of the abdominal wall.

Do they regurgitate? What comes up? If food, is it digested or recognizable and undigested? How often does it occur and does anything,such as stooping or straining,precipitate it? Flatulence Does the patient belch frequently? Does this relate to any other symptoms? Heartburn Patients may not realize that this symptom comes from the alimentary tract and they may have to be asked about it directly. It is a burning sensation behind the sternum caused by the reflux of acid into the oesophagus.

How often does it occur and what makes it happen, e. Vomiting How often do they vomit? Is the vomiting preceded by nausea? What is the nature and volume of the vomitus? Is it recognizable food from previ- ous meals, digested food, clear acidic fluid or bile- stained fluid?

Is the vomiting preceded by another symptom such as indigestion pain, headache or gid- diness? Does it follow eating? Haematemesis Always ask if they have ever vomited blood because it is such an important symptom. Some patients have difficulty in differentiating between vomited or regurgitated blood and coughed-up blood haemoptysis. The latter is usually pale pink and frothy. When patients have had a haematemesis, always ask if they have had a recent nose bleed.

They may be vomiting up swallowed blood. Indigestion or abdominal pain Some people call all abdominal pains indigestion; the difference between a discomfort after eating and a pain after eating may be very small.

Concentrate on the features of the pain, its site, time of onset, severity, nature, progres- sion, duration, radiation, course, precipitating, exac- erbating and relieving factors see pages 7— Abdominal distension Have they noticed any abdom- inal distension? What brought this to their atten- tion?

When did it begin and how has it progressed? Is it constant or variable? What factors are associ- ated with any variations? Is it painful? Does it affect their breathing? Is it relieved by belching, vomiting or defaecation? Defaecation How often does the patient defaecate?

What are the physical characteristics of the stool? They are lay words and mean different things to dif- ferent people.

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These words should not be written in the notes without also recording the frequency of bowel action and the consistence of the faeces. Rectal bleeding Has the patient ever passed any blood in the stool? Was it bright or dark? How much? Was it mixed in with or on the surface of the stool, or did it only appear after the stool had been passed?

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Flatus, mucus, slime Is the patient passing more gas than usual? Has the patient ever passed mucus or pus? Is defaecation painful? When does the pain begin — before, during, after, or at times unrelated to defaecation? Prolapse and incontinence Does anything come out of the anus on straining? Does it return spontane- ously or have to be pushed back? Is the patient con- tinent of faeces and flatus? Have they had any injuries or anal operations in the past?

Tenesmus Do they experience any urgent, painful but unproductive desire to pass stool? This is called tenesmus. How long did it last? Were there any other accompanying symp- toms such as abdominal pain or loss of appetite? Did the skin itch? The respiratory system Cough How often does the patient cough? Does the coughing come in bouts? Does anything, such as a 4 Chap How to take the history change of posture, precipitate or relieve the cough- ing?

Is it a dry or a productive cough? Sputum What is the quantity teaspoon, dessert- spoon,etc. Some patients only produce sputum in the morning or when they are in a particular position. Haemoptysis Has the patient ever coughed up blood?

Was it frothy and pink? Were there red streaks in the mucus, or clots of blood? What quantity was pro- duced? How often does the haemoptysis occur? Dyspnoea Does the patient wheeze? Does he get breathless? How many stairs can he climb? How far can he walk on a level surface before the dyspnoea interferes with the exercise? Can he walk and talk at the same time? Is the dyspnoea present at rest? Is it present when sitting or made worse by lying down? Dyspnoea on lying flat is called orthop- noea.

How many pillows does the patient need at night? Does the breathlessness wake them up at night — paroxysmal nocturnal dyspnoea — or get worse if they slip off their pillows? There are classi- fications that grade dyspnoea numerically, but it is better to describe the causative conditions rather than write down a number.

Is the dyspnoea induced or exacerbated by exter- nal factors such as allergy to animals, pollen or dust? Does the difficulty with breathing occur with both phases of respiration or on expiration?

Pain in the chest Ascertain the site, severity and nature of the pain. Chest pains can be continuous, pleuritic made worse by inspiration , constricting or stabbing. Orthopnoea and paroxysmal nocturnal dyspnoea Orthopnoea and paroxysmal nocturnal dyspnoea are the forms of dyspnoea especially associated with heart disease. Pain Cardiac pain begins in the mid-line and is usually retrosternal but may be epigastric. It is often described as constricting or band-like. It is usually brought on by exercise or excitement.

The patient should be asked if the pain radiates to the neck or to the left arm and whether it is relieved by rest. Palpitations These are episodes of tachycardia which the patient notices as a sudden fluttering or thump- ing of the heart in the chest.

Ankle swelling Do the ankles or legs swell? When do they swell? Dizziness, headache and blurred vision These are some of the symptoms associated with hyperten- sion and postural hypotension. Peripheral vascular symptoms Does the patient get pain in the leg muscles on exer- cise intermittent claudication?

Which muscles are involved? How far can the patient walk before the pain begins? Is the pain so bad that he has to stop walking? How long does the pain take to wear off? Can the same distance be walked again? Is there any pain in the limb at rest? Which part of the limb is painful? Does the pain interfere with sleep? What positions relieve the pain? What analgesic drugs give relief? Are the extremities of the limbs cold?

Are there colour changes in the skin, particularly in response to a cold environment? Does the patient experience any paraesthesiae in the limb, such as tingling or numbness? The urogenital system Urinary tract symptoms Pain Has there been any pain in the loin, groin or suprapubic region? What is its nature and severity? Does it radiate to the groin or scrotum?

Oedema Do any parts of the body other than the ankles swell? Thirst Is the patient thirsty? Do they drink excessive volumes of water? Micturition How often does the patient pass urine? How much urine is passed? Is the volume and frequency excessive polyuria? Is micturition painful? What is the nature and site of the pain? Is there any difficulty with micturition, such as a need to strain or to wait? Is the stream good? Can it be stopped at will? Is there any dribbling at the end of micturition?

Does 5 Chap History taking and clinical examination the bladder feel empty at the end of micturition or do they have to pass urine a second time? Urine Has the patient ever passed blood in the urine? When and how often? Have they ever passed gas bubbles with the urine pneumaturia?

Symptoms of uraemia These include headache, drowsiness, visual disturbance, fits and vomiting. Genital tract symptoms MALE Scrotum, penis and urethra Has the patient any pain in the penis or urethra during micturition or intercourse?

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Is there any difficulty with retraction of the prepuce or any urethral discharge? Has the patient noticed any swelling of the scrotum? Can he achieve an erection and ejaculation? When did it end menopause? What is the duration and quantity of the menses? Is menstrua- tion associated with pain dysmenorrhoea? What is the nature and severity of the pain? Is there any abdominal pain mid-way between the periods mit- telschmerz? Has the patient had any vaginal dis- charge? What is its character and amount?

Has she noticed any prolapse of the vaginal wall or cervix or any urinary incontinence, especially when straining or coughing stress incontinence? Dyspareunia Is intercourse painful? Breasts Do the breasts change during the men- strual cycle?

Are they ever painful or tender? Has the patient noticed any swellings or lumps in the breasts? Did she breast-feed her children? Has there been any nipple discharge or bleeding? Has she noticed any skin changes over the breasts? Secondary sex characteristics When did these appear?

The nervous system Mental state Is the patient placid or nervous? Has the patient noticed any changes in their behaviour or reactions to others?

Patients will often not appre- ciate such changes themselves and these questions may have to be asked of close relatives. Does the patient get depressed and withdrawn, or are they excitable and extroverted? Brain and cranial nerves Does the patient ever become unconscious or have fits? What happens during a fit? It is often necessary to ask a relative or a bystander to describe the fit. Did the patient lie still or jerk about, bite their tongue, pass urine?

Was the patient sleepy after the fit? Was there any warning an aura that the fit was about to develop? Has there been any subsequent change in the senses of smell, vision and hearing?

Is there a history of headache? Where is it experi- enced?

Browse's Introduction to the Investigation and Management of Surgical Disease

When does it occur? Are the headaches asso- ciated with any visual symptoms?

Clinical surgery pdf norman browse

Has the face ever become weak or paralysed? Have any of the limbs been paralysed or had pins and needles? Has there ever been any buzzing in the ears, dizziness or loss of speech? Can the patient speak clearly and use words properly?

Peripheral nerves Are any limbs or part of a limb weak or paralysed? Is there ever any loss of cutaneous sensation anaesthesia? Musculoskeletal system Ask if the patient suffers from pain, swelling or lim- itation of the movement of any joint. What precipi- tates or relieves these symptoms? What time of day do they occur? Are any limbs or groups of muscles weak or painful? Can he walk normally? Has he any congenital musculoskeletal deformities? Previous history of other illnesses, accidents or operations Record the history of those conditions which are not directly related to the present complaint.

Ask specif- ically about tuberculosis, diabetes, rheumatic fever, allergies, asthma, tropical diseases, bleeding tenden- cies, diphtheria, gonorrhoea, syphilis, and the likeli- hood of intimate contact with carriers of the human immunodeficiency virus HIV. Drug history Ask if the patient is taking any drugs.

Specifically, enquire about steroids, anti-depressants, insulin, 6 Chap History of pain diuretics, anti-hypertensives, hormone replacement therapy and the contraceptive pill. Patients usually remember about drugs prescribed by a doctor but often forget about self-prescribed drugs they have bought at a pharmacy.

Is the patient sensitive to any drugs or any topical applications such as adhesive plaster? If they are, write it in large letters on the front of the notes. Immunizations Most children are immunized against diphtheria, tetanus, whooping cough, measles, mumps, rubella and poliomyelitis.