Appendix - Textbook of Physical Diagnosis: History and Examination, 6th Ed.

Textbook of Physical Diagnosis: History and Examination, 6th Ed. by Mark H. Swartz

Appendix A

Commonly Abused Drugs

Drug	Street Name	How Used	Symptoms and Signs
Marijuana, hashish	Pot, grass, reefer, weed, hash, sinsemilla, joint	Smoked Ingested	Loss of initiative Recent memory loss Dry mouth and throat Mood changes Increased appetite
Alcohol	Booze, brew, hooch	Ingested	Impaired coordination Impaired judgment
Nicotine	Smoke, butt, coffin nail	Smoked Chewed	Tobacco smell Stained teeth
Amphetamines	Speed, uppers, pep pills, bennies, dexies, black beauties, meth, crystal	Ingested Injected Sniffed	Dilated pupils Increased energy Irritability Nervousness Needle marks
Cocaine	Coke, crack, snow, white lady, toot	Snorted Injected Ingested Smoked	Dilated pupils Increased energy Restlessness Intense anxiety Paranoid behavior Needle marks
Barbiturates	Downers, barbs, yellow jackets, red devils, blue devils, double trouble	Injected Ingested	Constricted pupils Confusion Impaired judgment Drowsiness Slurring of speech Needle marks
Methaqualone	Ludes, sopors, quaaludes	Ingested	Slurring of speech Drowsiness Impaired judgment Euphoria Seizures

Drug	Street Name	How Used	Symptoms and Signs
Heroin, morphine	Junk, scag, dope, horse, smack, dreamer	Injected Smoked Sniffed ''Skin popped'' (injected subcutaneously)	Constricted pupils Needle marks Drowsiness Mental clouding
Codeine	School boy	Ingested Sniffed	Constricted pupils Drowsiness
Demerol		Ingested Injected	Constricted pupils
Methadone		Ingested	Drowsiness
Percodan		Ingested	Mental clouding
Pentazocine		Injected	Needle marks
PCP (phencyclidine)	Angel dust, hog, killer weed, supergrass	Smoked Snorted Injected Ingested	Dilated pupils Slurring of speech Hallucinations Blurring of vision Lack of coordination Agitation Confusion Aggressive behavior
LSD (lysergic acid diethylamide)	Acid, cubes, purple haze	Ingested Injected	Dilated pupils Hallucinations Mood swings Increased alertness Acute panic reactions
Mescaline	Mesc, cactus	Ingested	Dilated pupils Hallucinations Mood swings
Psilocybin	Magic mushrooms	Ingested	Dilated pupils Hallucinations Mood swings
Airplane glue, paint thinner*		Inhaled Sniffed	Poor motor coordination Impaired vision Violent behavior
Nitrous oxide	Laughing gas, whippets	Inhaled Sniffed	Hilarity Euphoria Lightheadedness
Amyl nitrite	Poppers, rush, locker room, snappers, amies	Inhaled Sniffed	Hilarity Dizziness Headache Impaired thought

*The active agent in airplane glue and paint thinner is toluene. Naphtha, methyl ethyl ketone, and gasoline may produce similar symptoms.

Appendix B

Signs and Symptoms in Deficiency States

Deficiency	Signs		Symptoms
Vitamin A (see Fig. 5-6)	Hyperkeratinization of the skin		Night blindness
	Keratinizing metaplasia in the		Retarded growth (children)
	linings of the respiratory,		Xerophthalmia
	gastrointestinal, and genitourinary tracts Metaplasia of the endocrine, salivary, sebaceous, and lacrimal glands		Xeroderma
Vitamin D (rickets,	Craniotabes		Irritability
osteomalacia)	Rachitic rosary^*		Restlessness
	Bowing of the legs		Dental problems
	Knock-knee		Coughing
	Pigeon chest deformity		Pulmonary infections
	Harrison's grooves* Scoliosis Compression of affected vertebrae Carpopedal spasms Generalized spasticity Convulsive seizures		Seizures
Thiamine (beriberi)	Bilateral, symmetric peripheral		Lack of initiative
	neuropathy (distal parts of lower		Anorexia
	extremities first)		Mental depression
	Decreased perception of light		Irritability
	touch		Poor memory
	Calf muscle tenderness		Easy fatigability
	Loss of vibration sense		Inability to concentrate
	Loss of normal reflexes		Vague abdominal problems
	Motor weakness		Paresthesias of the toes
	Secondary muscle atrophy		Burning sensation in the lower
	Cardiac enlargement		extremities
	Congestive heart failure		Dyspnea
	Wide pulse pressure		Palpitations
	Arrhythmias Polyneuropathy		Peripheral edema
Deficiency		Signs	Symptoms
Niacin (pellagra) (see Fig. 5-10)		Extensive dermatitis (common on	Skin rashes
		parts of body exposed to	Swollen tongue
		sunlight or mechanical trauma;	Increased salivation
		often bilateral and symmetric)	Burning sensation in mouth
		Glossitis	Poor digestion
		Stomatitis	Diarrhea (often foul smelling;
		Chronic hypertrophy with	sometimes bloody)
		induration of skin	Gaseous distention
		Pigmentation on pressure points	Eructation
		Skin fissuring	Vomiting
		Atrophic skin changes	Disorientation
		Scaling of skin	Confusion Hallucinations Delirium Paranoia Depression
Riboflavin		Cheilosis	Photophobia
		Angular stomatitis	Burning sensation in eyes
		Glossitis	Itching of eyes
		Seborrheic dermatitis, especially in the	Skin rashes
		nasolabial region, around the eyes, behind the ears, and on the scrotum Ocular manifestations	Fissuring of mouth
Vitamin C (scurvy)		Defective collagen formation	Impaired wound healing
(see Figs. 5-7 and 5-8)		Ecchymoses	Failure to thrive, irritability, and
		Subperiosteal hematomas	frequent crying (children)
		Follicular hyperkeratoses	Bleeding tendencies
		Petechial hemorrhages (lower	Painful joints
		extremities)	Weight loss
		Gingival hemorrhages	Nonspecific aches and pains
		Hemarthroses	Brown pigmentation
		Hemorrhages	Curling of hair
		Anemia	Keratoconjunctivitis sicca^§
		Scorbutic rosary^{	Emotional changes
Protein-calorie (kwashiorkor)		Retarded growth	Apathy
(see Fig. 5-5)		Edema	Anorexia
		Hyperpigmentation of skin	Edema
		Depigmentation of skin	Changes in hair color and
		Hepatomegaly	consistency
		Severe tissue wasting	Changes in skin color
		Loss of subcutaneous fat	Abdominal enlargement
		Functional dehydration	Diarrhea Steatorrhea
Folate (see Fig. 5-9)		Anemia	Pallor
		Stomatitis	Weakness
		Glossitis	Diarrhea
Calcium		Osteoporosis Osteomalacia	Bone fractures
Iron		Anemia	Pallor
		Koilonychia*	Weakness
		Glossitis	Fatigability Dyspnea on exertion Headache Palpitations Fissuring at corners of mouth Painful tongue
*Beading of the ribs at the costochondral junction.
*Lateral thoracic depressions at the sites of attachment of the diaphragm.
^*Beading of the ribs at the costochondral junction.
§A condition of marked hyperemia of the conjunctiva, lacrimal deficiency, thickening of the corneal epithelium,			itching and burning of the eye,
and reduced visual acuity. ^*Spoon nail.

Continued

Deficiency	Signs	Symptoms
Iodine	Goiter	Swelling of neck Hypothyroid symptoms (see Chapter 9, The Head and Neck)
Zinc (see Fig. 5-11)	Growth retardation Hypogonadism Delayed sexual maturation Seborrheic dermatitis	Loss of taste Anorexia Behavioral problems Skin rashes Hair loss Decreased libido Decreased fertility Diarrhea
Magnesium	Vertical nystagmus	Muscle tremor Choreiform movements Convulsions Weakness Paralysis Dysphagia
Potassium	Arrhythmias	Diarrhea Weakness Nervous irritability Disorientation Palpitations
Sodium	Dehydration signs	Confusion Coma Vomiting Lethargy Anorexia Nausea Headache Obtundation Seizures
Beading of the ribs at the costochondral junction.Lateral thoracic depressions at the sites of attachment of the diaphragm. Beading of the ribs at the costochondral junction. *A condition of marked hyperemia of the conjunctiva, lacrimal deficiency, thickening of the corneal epithelium, itching and burning of the eye, and reduced visual acuity. ^§Spoon nail.

Appendix C

Conversion Tables

Temperature*
Centigrade	Fahrenheit	Centigrade	Fahrenheit
33.0	91.4	37.8	100.0
33.2	91.8	38.0	100.4
33.4	92.1	38.2	100.7
33.6	92.5	38.4	101.1
33.8	92.8	38.6	101.4
34.0	93.2	38.8	101.8
34.2	93.6	39.0	102.2
34.4	93.9	39.2	102.5
34.6	94.3	39.4	102.9
34.8	94.6	39.6	103.2
35.0	95.0	39.8	103.6
35.2	95.4	40.0	104.0
35.4	95.7	40.2	104.3
35.6	96.1	40.4	104.7
35.8	96.4	40.6	105.1
36.0	96.8	40.8	105.4
36.2	97.1	41.0	105.8
36.4	97.5	41.2	106.1
36.6	97.8	41.4	106.5
36.8	98.2	41.6	106.8
37.0	98.6	41.8	107.2
37.2	98.9	42.0	107.6
37.4	99.3	42.2	108.0
37.6	99.6	42.4	108.3

*To convert centigrade to Fahrenheit: (9/5 x centigrade temperature) + 32. To convert Fahrenheit to centigrade: 5/9 x (Fahrenheit temperature — 32).

Weight*
Pound	Kilogram	Kilogram	Pound
1	0.5	1	2.2
2	0.9	2	4.4
4	1.8	3	6.6
6	2.7	4	8.8
8	3.6	5	11.0
10	4.5	6	13.2
20	9.1	8	17.6
30	13.6	10	22
40	18.2	20	44
50	22.7	30	66
60	27.3	40	88
70	31.8	50	110
80	36.4	60	132
90	40.9	70	154
100	45.4	80	176
150	68.1	90	198
200	90.8	100	220
*To convert pounds to kilograms: pounds x 0.454 kilogram. To convert kilograms to pounds: kilograms Measurements in table are rounded to the nearest first decimal place.			x 2.204 pounds.
Length*
Inch	Centimeter	Centimeter	Inch
1	2.54	1	0.4
2	5.08	2	0.8
4	10.16	3	1.2
6	15.24	4	1.6
8	20.32	5	2.0
10	25.40	6	2.4
20	50.80	8	3.1
30	76.20	10	3.9
40	101.60	20	7.9
50	127.00	30	11.8
60	152.40	40	15.7
70	177.80	50	19.7
80	203.20	60	23.6
90	228.60	70	27.6
100	254.00	80	31.5
150	381.00	90	35.4
200	508.00	100	39.4
*To convert inches to centimeters: inches x 2.54 centimeters. To convert centimeters to inches: centimeters x 0.3937 inch. Measurements in centimeters calculated from inches are rounded to the nearest second decimal place; those in inches calculated from centimeters, to the nearest first decimal place.

Appendix D

The Rational Clinical Examination: Additional References

Akshay B, Thavendiranathan P, Detsky AS: Does this patient have hearing impairment? JAMA 295:416-428, 2006.

Anand SS, Wells PS, Hunt D, et al: Does this patient have deep vein thrombosis? JAMA 279:1094-1099, 1998.

Anderson MR, Klink K, Cohrssen A: Evaluation of vaginal complaints. JAMA 291:1368-1379, 2004.

Attia J, Hatala R, Cook DJ, et al: Does this adult patient have acute meningitis? JAMA 282:175-181, 1999.

Barton MB, Harris R, Fletcher SW: Does this patient have breast cancer? The screening clinical breast examination: should it be done? How? JAMA 282:1270-1280, 1999.

Bastian LA, Smith CM, Nanda K: Is this woman perimenopausal? JAMA 289:895-902, 2003.

Bent S, Nallamothu BK, Simel DL, et al: Does this woman have an acute uncomplicated urinary tract infection? JAMA 287:2701-2710, 2002.

Booth CM, Boone RH, Tomlinson G, et al: Is this patient dead, vegetative, or severely neurologically impaired? Assessing outcome for comatose survivors of cardiac arrest. JAMA 291:870-879, 2004.

Bundy DG, Byerley JS, Liles EA, et al: Does this child have appendicitis? JAMA 298:438-451, 2007.

Butalia S, Palda VA, Sargeant RJ, et al: Does this patient with diabetes have osteomyelitis of the lower extremity? JAMA 299:806-813, 2008.

Call SA, Vollenweider MA, Hornung CA: Does this patient have influenza? JAMA 293:987-997, 2005.

Choudhry NK, Etchells EE: Does this patient have aortic regurgitation? JAMA 281:2231-2238, 1999.

Chunilal SD, Eikelboom JW, Attia J, et al: Does this patient have pulmonary embolism? JAMA 290: 2849-2858, 2003.

D'Arcy CA, McGee S: Does this patient have carpal tunnel syndrome? JAMA 283:3110-3117, 2000.

Ebell MH, Smith MA, Barry HC, et al: Does this patient have strep throat? JAMA 284:2912-2918, 2000.

Ganz DA, Bao Y, Shekelle PG, et al: Will my patient fall? JAMA 297:77-86, 2007.

Goldstein LB, Simel DL: Is this patient having a stroke? JAMA 293:2391-2402, 2005.

Green AD, Colon-Emeric CS, Bastian L, et al: Does this woman have osteoporosis? JAMA 292:2890-2900, 2004.

Holroyd-Leduc JM, Tannenbaum C, Thorpe KE, et al: What type of urinary incontinence does this woman have? JAMA 299:1446-1456, 2008.

Holsinger T, Deveau J, Boustani M, et al: Does this patient have dementia? JAMA 297:2391-2404, 2007.

Khan NA, Rahim SA, Anand S, et al: Does the clinical examination predict lower extremity peripheral arterial disease? JAMA 295:536-546, 2006.

Klompas M: Does this patient have acute thoracic aortic dissection? JAMA 287:2262-2272, 2002.

Klompas M: Does this patient have ventilator-associated pneumonia? JAMA 297:1583-1593, 2007.

Lederle FA, Simel DL: Does this patient have abdominal aortic aneurysm? JAMA 281:77-82, 1999.

Luime JJ, Verhagen AP, Miedema HS, et al: Does this patient have an instability of the shoulder or a labrum lesion? JAMA 292:1989-1999, 2004.

Margaretten ME, Kohlwes J, Moore D, et al: Does this adult patient have septic arthritis? JAMA 297: 1478-1488, 2007.

Margolis P, Gadomski A: Does this infant have pneumonia? JAMA 279:308-313, 1998.

McGee S, Abernethy WB, Simel DL: Is this patient hypovolemic? JAMA 281:1022-1029, 1999.

Moayyedi P, Talley NJ, Fennerty MB, et al: Can the clinical history distinguish between organic and functional dyspepsia? JAMA 295:1566-1576, 2006.

Murff HJ, Spigel DR, Syngal S: Does this patient have a family history of cancer?: An evidence-based analysis of the accuracy of family cancer history. JAMA 292:1480-1489, 2004.

Myers KA, Farquhar DRE: Does this patient have clubbing? JAMA 286:341-347, 2001.

Panju AA, Hemmelgarn BR, Guyatt GH, et al: Is this patient having a myocardial infarction? JAMA 280:1256-1263, 1998.

Rao G, Fisch L, Srinivasan S, et al: Does this patient have Parkinson disease? JAMA 289:347-353, 2003.

Rothman R, Owens T, Simel DL: Does this child have acute otitis media? JAMA 290:1633-1640, 2003.

Roy CL, Minor MA, Brookhart MA, et al: Does this patient with a pericardial effusion have cardiac tamponade? JAMA 297:1810-1818, 2007.

Salkind AR, Cuddy PG, Foxworth JW: Is this patient allergic to penicillin? An evidence-based analysis of the likelihood of penicillin allergy. JAMA 285:2498-2505, 2001.

Scherer K, Bedlack RS, Simel DL: Does this patient have myasthenia gravis? JAMA 293:1906-1914, 2005.

Shaikh N, Morone NE, Lopez J, et al: Does this child have a urinary tract infection? JAMA 298:2895-2904, 2007.

Smetana GW, Shmerling RH: Does this patient have temporal arteritis? JAMA 287:92-101, 2002.

Solomon DH, Simel DL, Bates DW, et al: Does this patient have a torn meniscus or ligament of the knee? Value of the physical examination. JAMA 286:1610-1620, 2001.

Steiner MJ, DeWalt DA, Vyerley JS: Is this child dehydrated? JAMA 291:1368-1379, 2004.

Straus SE, Thorpe KE, Holroyd-Leduc J: How do I perform a lumbar puncture and analyze the results to diagnose bacterial meningitis? JAMA 296:2012-2022, 2006.

Sumant RR, Goldman LE, Simel DL, et al: Do opiates affect the clinical evaluation of patients with acute abdominal pain? JAMA 296:1764-1774, 2006.

Tibbles CD, EdlowJA: Does this patient have erythema migrans? JAMA 297:2617-2627, 2007.

Trowbridge RL, Rutkowski NK, Shojania KG: Does this patient have acute cholecystitis? JAMA 289:80-86, 2003.

Whited JD, Grichnik JM: Does this patient have a mole or a melanoma? JAMA 279:696-701, 1998.

Williams JW, Noel PH, Cordes JA, et al: Is this patient clinically depressed? JAMA 287:1160-1170, 2002.

Wong CL, Holroyd-Leduc JM, Thorpe KE, et al: Does this patient have bacterial peritonitis or portal hypertension? How do I perform a paracentesis and analyze the results? JAMA 299:1166-1178, 2008.

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