Robert E.J. Ryder is Consultant Physician and Clinical IT Lead at City Hospital NHS Trust, Birmingham, and Honorary Senior Lecturer in Medicine at the University of Birmingham.Dr M. Afzal Mir is Senior Lecturer and Consultant Physician at University Hospital of Wales, CardiffDr Anne Freeman is Consultant Physician at Royal Gwent Hospital, Newport, and Clinical Adviser and Chairwoman of the Welsh Stroke Alliance

• Preface viiPreface to the Third Edition xiPreface to the Second Edition xiiiPreface to the first edition xvIntroduction xviiSection A: Preparation 1Section B: Examination Routines 71 Pulse 112 Heart 123 Chest 174 Abdomen 215 Visual fields 266 Cranial nerves 277 Arms 308 Legs 349 Legs and arms 3810 Gait 3911 Ask some questions 4012 Fundi 4313 Eyes 4714 Face 4915 Hands 5116 Skin 5517 Rash 5718 Neck 5819 Thyroid status 6020 Knee 6221 Hip 6422 What is the diagnosis? 65Section C: Short Case Records 69Station 1 Respiratory 731 Interstitial lung disease (fibrosing alveolitis) 742 Pneumonectomy/lobectomy 773 Chronic bronchitis and emphysema 794 Bronchiectasis 815 Dullness at the lung base 836 Rheumatoid lung 857 Old tuberculosis 868 Chest infection/consolidation/pneumonia 879 Yellow nail syndrome 8910 Kyphoscoliosis 9011 Stridor 9212 Marfan’s syndrome 9313 Carcinoma of the bronchus 9414 Klippel–Feil syndrome 9715 Kartagener’s syndrome 9816 Lung transplant 9917 Cystic fibrosis 10118 Obesity/Pickwickian syndrome 10319 Pneumothorax 10720 Cor pulmonale 10921 Collapsed lung/atelectasis 11022 Superior vena cava obstruction 11223 Tuberculosis/apical consolidation 11324 Normal chest 115Station 1 Abdominal 1171 Transplanted kidney 1182 Polycystic kidneys 1203 Chronic liver disease 1214 Hepatosplenomegaly 1245 Hepatomegaly (without splenomegaly) 1266 Splenomegaly (without hepatomegaly) 1277 Ascites 1298 Abdominal mass 1319 Crohn’s disease 13310 Polycythaemia rubra vera 13511 Normal abdomen 13612 PEG tube 13813 Single palpable kidney 13914 Generalized lymphadenopathy 14015 Hereditary spherocytosis 14216 Idiopathic haemochromatosis 14317 Primary biliary cirrhosis 14518 Carcinoid syndrome 14719 Motor neurone disease 14920 Nephrotic syndrome 15021 Pernicious anaemia 15222 Pyoderma gangrenosum 15323 Felty’s syndrome 154Station 3 Cardiovascular 1551 Prosthetic valves (mechanical) 1562 Mitral incompetence (lone) 1573 Mixed mitral valve disease 1594 Aortic incompetence (lone) 1615 Aortic stenosis (lone) 1636 Mixed aortic valve disease 1657 Mitral stenosis (lone) 1678 Irregular pulse 1699 Other combinations of mitral and aortic valve disease 17110 Mitral valve prolapse 17211 Tricuspid incompetence 17412 Ventricular septal defect 17513 Marfan’s syndrome 17614 Pulmonary stenosis 17715 Ankylosing spondylitis 17816 Atrial septal defect 17917 Ebstein’s anomaly 18118 Raised jugular venous pressure 18319 Down’s syndrome 18420 Hypertrophic cardiomyopathy 18521 Dextrocardia 18622 Rheumatoid arthritis 18723 Fallot’s tetralogy with a Blalock shunt 18824 Normal heart 18925 Cannon waves 19026 Coarctation of the aorta 19127 Eisenmenger’s syndrome 19328 Infective endocarditis 19529 Patent ductus arteriosus 19830 Pulmonary incompetence 19931 Slow pulse 201Station 3 Central Nervous System 2031 Peripheral neuropathy 2052 Myotonic dystrophy (dystrophia myotonica) 2073 Parkinson’s disease 2094 Charcot–Marie–Tooth disease (hereditary motor and sensory neuropathy) 2125 Abnormal gait 2146 Spastic paraparesis 2177 Cerebellar syndrome 2188 Hemiplegia 2209 Muscular dystrophy 22210 Multiple sclerosis 22411 Motor neurone disease 22612 Friedreich’s ataxia 22913 Visual field defect 23114 Ulnar nerve palsy 23315 Old polio 23516 Ocular palsy 23617 Spinal cord compression 24018 Ptosis 24319 Guillain–Barré syndrome (acute inflammatory demyelinating polyradiculopathy) 24720 Choreoathetosis 24921 Bulbar palsy 25122 Lateral popliteal (common peroneal) nerve palsy 25223 Proximal myopathy 25424 Absent ankle jerks and extensor plantars 25525 Cerebellopontine angle lesion 25626 Cervical myelopathy 25727 Myasthenia gravis 25928 Normal central nervous system 26329 Syringomyelia 26430 Diabetic foot/Charcot’s joint 26631 Holmes–Adie–Moore syndrome 26732 Nystagmus 26933 Carpal tunnel syndrome 27234 Drug-induced extrapyramidal syndrome 27435 Lower motor neurone VIIth nerve palsy 27536 Dysarthria 27937 Subacute combined degeneration of the cord 28038 Argyll Robertson pupils 28139 Congenital syphilis 28240 Dysphasia 28441 Horner’s syndrome 28642 Infantile hemiplegia 28843 Jugular foramen syndrome 29044 Lateral medullary syndrome (Wallenberg’s syndrome) 29245 Polymyositis 29446 Pseudobulbar palsy 29547 Psychogenic/factitious 29648 Radial nerve palsy 29849 Subclavian-steal syndrome 29950 Tabes 30151 Thalamic syndrome 30352 Wasting of the small muscles of the hand 304Appendices 3071 Checklists 3092 Examination frequency of MRCP PACES short cases 3133 Texidor’s twinge and related matters 3174 Abbreviations 319Index 321