Countless physicians, medical students, and therapists can describe a similar experience at one time or another during their training: a patient is behind the door in an examination room and the daily schedule has the words “shoulder pain” listed as the chief complaint. Depending on one’s experience or comfort level, many questions may immediately flood one’s mind regarding how to approach the patient: What are the various causes of shoulder pain? Is the pain really coming from the shoulder? What structures are important in the shoulder? What aspects of the physical examination will help distinguish one shoulder problem from another? The physical examination of musculoskeletal and peripheral nervous system problems is essential knowledge for broad areas of healthcare, as these problems are among the leading reasons for medical encounters. This pocket reference offers instant access to a wide array of clinical pearls to guide the physical examination and diagnosis. Whether one can choose to keep the print copy handy or use the digital version on our phone or tablet, our answer is quickly within reach. In this updated and refreshed second edition, one can search by body part or suspected diagnosis and find detailed descriptions of physical examination maneuvers, along with associated evidence of sensitivity and specificity, to help us with our diagnosis. Additionally, the reader will find all new colorized illustrations, high-resolution photos demonstrating the maneuvers, and corresponding videos that bring the examination to life. Video icons throughout chapters indicate which tests include an accompanying video. There is no substitute for excellent physical diagnosis skills. The authors hope that one will find this book useful as one develop and fine-tune their skills in order to give patients the very best care.
Your search for all content returned 3,654 results
- Go to chapter: An 18-Year-Old Woman Who Attacked a Policeman With a Knife: Our Memorable Lesson on Treatable Causes of Dystonia
An 18-Year-Old Woman Who Attacked a Policeman With a Knife: Our Memorable Lesson on Treatable Causes of Dystonia
This chapter discusses the case of an 18-year-old woman, who had dystonia. She was sent to a psychiatric facility. She received low doses of haloperidol and a tricyclic antidepressant and after 2 weeks developed drooling, twisting of the neck to the right, and trouble walking. At that point, the psychiatrist consulted the movement disorders neurologist. She had drooling and cervical dystonia with laterocollis to the right with a mild rotational component. She presented an interesting diagnostic and treatment challenge. At the outset, the differential diagnosis consisted of primary psychiatric disorder and a possibility of drug-induced movement disorder versus a spontaneous movement disorder with psychiatric manifestations as seen in Wilson’s disease (WD). Her tests confirmed the diagnosis of WD, and she was treated with Penicillamine with the knowledge that it can cause further drop in platelets. Over the next several months, her eye movement became normal and the cervical dystonia disappeared.
- Go to chapter: A 38-Year-Old Brazilian Woman Presenting With Reversible Parkinsonism Associated With Neurocysticercosis
A 38-Year-Old Brazilian Woman Presenting With Reversible Parkinsonism Associated With Neurocysticercosis
This chapter discusses the case of a 38-year-old woman with diffuse, occasionally throbbing, headaches associated with nausea, which was worse while waking, together with intense pain accompanied by episodes of vomiting, diplopia, drowsiness, and torpor. Since symptoms’ onset, she reported being slower and having bilateral hand tremor. Analysis of cerebrospinal fluid (CSF) demonstrated a mild inflammatory reaction and neurocysticercosis (NCC) as detected by positive reactions to cysticercus antigens. She was assessed in the neurology service and diagnosed with intracranial hypertension after a brain MRI that showed the presence of supratentorial hydrocephalus with evidence of intraventricular cysts, as well as edema in the midbrain periaqueductal region. Methylprednisolone pulse therapy was then started, together with half a tablet of levodopa/carbidopa, with progressive improvement in the symptoms of parkinsonism. Eight months later, she was progressively taken off entacapone and then levodopa. She remained asymptomatic and returned to normal activities of daily life.
In 1920, in America, psychology was dominated by two main currents. The first was a tendency to reduce life to habit, and the second was to establish differences between humans by test. The second tendency, toward testing, had burst suddenly on the scene with the coming of the Binet tests to America in 1905. The idea of contextualized relationships determined by perceptual interpretation challenged the notions that had sprung up around behaviorism that the brain was empty, functioning only as a router between environmental stimulus and motor response. The idea, still vivid in American psychology during the 1920s, that psychology was “the science of mental life” was reinforced and extended by the diffusion of Gestalt psychology through American psychology over the coming decades, as the rest of these reviews of theory and practice will show.
Gordon Allport, addressing the American Psychological Association (APA) as its president in September 1939, observed that psychology, over the preceding 50 years, had divided into its pure and applied aspects. Troland was a socialist, and proposed that a “technology of behavior” be devised to maximize human happiness. In his comprehensive psychological system, Troland proposed a hedonic theory of motivation: Behavior depends on the quantity of pleasure to which it is related. Taken together, Troland and Miles represent the flowering, during this decade, of two persisting areas of psychological applications: consultation on the design of technologies in which human sensory and perceptual characteristics interact with equipment and devices, and the study of the effects of drugs of various kinds on human performance. Within psychiatry, psychology had long had allies, and during the 1930s some powerful ones became associated with psychology and supported its aims to develop a parallel nonmedical psychotherapy system.
The year 1945 saw the culmination of many developments in psychology since the 1920s, which led to two major coalitions being formed. The first of these was represented in the reorganization of the American Psychological Association (APA). The most important aspect of this reorganization was the consensus that theory, applications, and clinical activities, formerly represented by separate organizations and carrying on their affairs at a distance from each other, were indeed all parts of a unitary entity, psychology. Psychologists advanced their own comprehensive views of behavioral science as a complex system. The perception that psychology was a united front continued to be a successful strategy, which further confirmed its presence within the spectrum of physical and social sciences. Social psychology, which in previous decades was a melange of crowd psychology and anthropological ideas, acquired a perceptual and cognitive focus.
The 1950s, in American society as well as psychology, were characterized by two pairs of opposites: liberty versus repression and conformity versus creativity. Repression of suspected Communists and other left-leaning individuals was in full swing at the beginning of the decade, driven by long-standing partisan enmity as well as fresh anger over the loss of atomic superiority to Soviet Russia. Many of those who had been instrumental in the creation of the bonds between them had died or retired to other interests, and a new generation of psychiatrists emerged to question the qualifications of what they saw as psychiatrists practicing without medical licenses. Cognition and internal states also emerged in the 1950s versions of theories of motivation. Applied cognitive psychology, in its 1950s incarnation, interested Eddie, Helen’s husband, and he occasionally read articles by aviation psychologists working on contract for the Office of Naval Research.
The 1960s were brought to the United States on television. In ensuing decades, psychologists would engage in inconclusive debates about whether violence on TV had social effects. Ultimately, psychologists’ isolation in the academy, their cultural backgrounds, and their focus on integrating individuals by adjustment and assimilation rather than on managing immediate mass social change pushed psychology, as a field, to the periphery of civil rights, at least as they pertained to color. The pages of psychology’s journal of record, the American Psychologist, recorded few traces of the Vietnam conflict, a central feature of American life in the second half of the 1960s. Counseling psychologists concentrated on civilian problems. Hospital clinicians worked to develop ways to implement the new community mental health system. The combined effect of the Community Mental Health Act and the Great Society’s medical programs was a further infusion of energy and resources into rapidly developing clinical psychology.