Every chapter has the same three parts. Part 1 is the examination itself, in the order it is done at the bedside, ending with the patterns the signs are assembled into. Part 2 is the literature: how well examiners agree on each sign, the likelihood ratios from the JAMA Rational Clinical Examination series and later meta-analyses, the studies of examiner skill, and what has changed since 2020 — point-of-care ultrasound, AI-enabled auscultation, wearables. Part 3 is what that evidence means for how the examination should be taught.
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Each chapter as a Word document or a PDF. The files carry the same text as the pages.
Cardiovascular Examination · Word Cardiovascular Examination · PDF Neurological Examination · Word Neurological Examination · PDF Haematological Examination · Word Haematological Examination · PDF Endocrine Examination · Word Endocrine Examination · PDF Musculoskeletal Examination · Word Musculoskeletal Examination · PDF Renal Examination · Word Renal Examination · PDF Dermatological Examination · Word Dermatological Examination · PDF Psychiatric Examination · Word Psychiatric Examination · PDF Ophthalmological Examination · Word Ophthalmological Examination · PDF
Chapters
Chapter 1 · 5,070 words
The Cardiovascular Examination
Venous pressure, pulses, the precordium and the murmurs — then the kappa values, the likelihood ratios, and the 2020–2026 ultrasound and AI-stethoscope literature.
Chapter 2 · 2,529 words
The Chest Examination
The chest examination step by step, then the kappa values behind each of its signs — from 0.85 for asymmetric expansion to chance for tactile fremitus — and what lung ultrasound and digital stethoscopes have added since 2020.
Chapter 3 · 3,223 words
The Abdominal Examination
The abdominal examination step by step, then which of its signs change the probability of disease, which two examiners agree on, and which do neither — from the fluid wave and Castell's sign to Murphy's sign and bowel sounds.
Chapter 4 · 4,867 words
The Neurological Examination
Higher functions, cranial nerves, the motor and sensory systems and gait — then why watched signs are reproducible and elicited ones are not, the JAMA series on stroke, meningitis, parkinsonism, neuropathy and delirium, and what HINTS, video-oculography, tele-neurology and digital biomarkers have changed.
Chapter 5 · 4,669 words
The Haematological Examination
Pallor, jaundice, skin and mouth, the lymph nodes, the spleen and liver, bone, veins and the systems blood disease damages — then pallor between examiners, the JAMA chapters on the spleen, the liver and deep vein thrombosis, lymphadenopathy and malignancy, bleeding scores, and what the probe on the spleen and the vein and the camera on the conjunctiva have changed.
Chapter 6 · 5,420 words
The Endocrine Examination
The thyroid and thyroid status, the face and habitus of cortisol and growth hormone, the diabetic foot and eye, calcium, the adrenal and the bone — then goitre between examiners, the likelihood ratios for the thyroid, Cushing's and osteoporosis, the diabetic-foot chapters of the JAMA series, and what the algorithm reading the face and the retina has changed.
Chapter 7 · 5,625 words
The Musculoskeletal Examination
The GALS screen and the regional examination of hands, shoulder, spine, hip, knee and foot — then why measurements agree and judgements do not, the knee, shoulder, hip and fracture evidence, the JAMA chapters on septic arthritis and temporal arteritis, and what ultrasound of the joint, the artery and the fracture has changed.
Chapter 8 · 4,585 words
The Renal Examination
Volume status, the signs of uraemia, the kidneys, bladder and prostate, the dialysis access, and the eye and heart kidney disease damages — then the clinician's guess at filling pressure, the dry axilla and the abdominal bruit, the bladder that palpation cannot measure, the fistula examination that works, and what the probe on the lungs, the cava and the veins has changed.
Chapter 9 · 4,831 words
The Dermatological Examination
The whole skin in good light, the language of the lesion, the special signs, the pigmented lesion and the dermatoscope, the red leg and the blister — then agreement on descriptors and scores, the naked eye against the dermatoscope, the cellulitis that is not cellulitis, Nikolsky's sign, and what the algorithm, the app and the skin-tone gap have changed.
Chapter 10 · 4,397 words
The Psychiatric Examination
The mental state examination under its fixed headings, the instruments laid over it, and the physical examination that belongs to psychiatry — then the kappa of 0.3 for depression, the questionnaires that beat the diagnosis, the capacity that clinicians miss, the suicide-risk tools that cannot predict, and what telepsychiatry, speech algorithms and large language models have changed.
Chapter 11 · 4,242 words
The Ophthalmological Examination
Acuity and the pinhole, the fields by confrontation, the pupils, alignment, the lids and the red eye, the red reflex and the fundus — then the disc that experts cannot agree on, the fields confrontation misses, the three findings of a serious red eye, the ophthalmoscope most physicians cannot use, and what the algorithm reading papilloedema and glaucoma from a photograph has changed.