,BATES’ Guide to
Physical
Examination
AND History Taking
THIRTEENTH EDITION
Lynn S. Bickley, MD, FACP
Clinical Professor of Internal Medicine
School of Medicine
University of New Mexico
Albuquerque, New Mexico
Peter G. Szilagyi, MD, MPH
Professor of Pediatrics and Executive Vice-Chair
Department of Pediatrics
University of California at Los Angeles (UCLA)
Los Angeles, California
Richard M. Hoffman, MD, MPH, FACP
Professor of Internal Medicine and Epidemiology
Director, Division of General Internal Medicine
University of Iowa Carver College of Medicine
Iowa City, Iowa
Guest Editor
Rainier P. Soriano, MD
Associate Professor of Medical Education, Geriatrics and Palliative
Medicine
Brookdale Department of Geriatrics and Palliative Medicine
,Acquisitions Editor: Crystal Taylor
Development Editor: Andrea Vosburgh
Freelance Development Editor: Kelly Horvath
Editorial Coordinator: Emily Buccieri
Editorial Assistant: Parisa Saranj
Marketing Manager: Phyllis Hitner
Senior Production Project Manager: Alicia Jackson
Team Lead, Design: Stephen Druding
Art Director, Illustration: Jennifer Clements
Illustrator: Body Scientific International
Photography: Thibodeau Media Group
Manufacturing Coordinator: Margie Orzech
Prepress Vendor: Aptara, Inc.
Thirteenth Edition
Copyright © 2021 Wolters Kluwer.
Copyright © 2017 Wolters Kluwer. Copyright © 2013, 2009 by Wolters Kluwer Health/Lippincott
Williams & Wilkins. Copyright © 2007, 2003, 1999 by Lippincott Williams & Wilkins. Copyright © 1995,
1991, 1987, 1983, 1979, 1974 by J. B. Lippincott Company. All rights reserved. This book is protected by
copyright. No part of this book may be reproduced or transmitted in any form or by any means,
including as photocopies or scanned-in or other electronic copies, or utilized by any information storage
and retrieval system without written permission from the copyright owner, except for brief quotations
embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part
of their official duties as U.S. government employees are not covered by the above-mentioned
copyright. To request permission, please contact Wolters Kluwer at Two Commerce Square, 2001
Market Street, Philadelphia, PA 19103, via email at , or via our website at
shop.lww.com (products and services).
987654321
Printed in China
Library of Congress Cataloging-in-Publication Data
Names: Bickley, Lynn S., author. | Szilagyi, Peter G., author. | Hoffman, Richard M., author. | Soriano,
Rainier P., editor.
Title: Bates’ guide to physical examination and history taking / Lynn S. Bickley, Peter G. Szilagyi,
Richard M. Hoffman ; guest editor, Rainier P. Soriano.
Other titles: Guide to physical examination and history taking
Description: Thirteenth edition. | Philadelphia: Wolters Kluwer, [2021] | Includes bibliographical
references and index. | Summary: “The thirteenth edition of Bates’ Guide to Physical Examination
and History Taking is your comprehensive guide to learning to effectively conduct the health
interview and physical examination. This section introduces you to the features and learning tools that
will lead to successful health assessments, regional examinations, and working with special patient
populations. At the start of every chapter, you will see a list of additional learning resources that
, complement the book in order to build your knowledge and confidence in history taking and
examination. The Bates’ Visual Guide to Physical Examination offers over more than 8 hours of
video content and delivers head-to-toe and systems-based physical examination techniques. When
used alongside the book, you have a complete learning solution for preparedness for the boards and
patient encounters”– Provided by publisher.
Identifiers: LCCN 2020019448 | ISBN 9781496398178 (paperback)
Subjects: MESH: Physical Examination–methods | Medical History Taking–methods
Classification: LCC RC76 | NLM WB 205 | DDC 616.07/54–dc23
LC record available at https://lccn.loc.gov/2020019448
This work is provided “as is,” and the publisher disclaims any and all warranties, express or implied,
including any warranties as to accuracy, comprehensiveness, or currency of the content of this work.
This work is no substitute for individual patient assessment based upon healthcare professionals’
examination of each patient and consideration of, among other things, age, weight, gender, current or
prior medical conditions, medication history, laboratory data and other factors unique to the patient. The
publisher does not provide medical advice or guidance and this work is merely a reference tool.
Healthcare professionals, and not the publisher, are solely responsible for the use of this work including
all medical judgments and for any resulting diagnosis and treatments.
Given continuous, rapid advances in medical science and health information, independent professional
verification of medical diagnoses, indications, appropriate pharmaceutical selections and dosages, and
treatment options should be made and healthcare professionals should consult a variety of sources.
When prescribing medication, healthcare professionals are advised to consult the product information
sheet (the manufacturer’s package insert) accompanying each drug to verify, among other things,
conditions of use, warnings and side effects and identify any changes in dosage schedule or
contraindications, particularly if the medication to be administered is new, infrequently used or has a
narrow therapeutic range. To the maximum extent permitted under applicable law, no responsibility is
assumed by the publisher for any injury and/or damage to persons or property, as a matter of products
liability, negligence law or otherwise, or from any reference to or use by any person of this work.
shop.lww.com
,This book is dedicated to you, the ever-constant student, teacher,
and practitioner of this continuously evolving art and science of
medicine.
, Faculty Reviewers and
Additional Contributors
GEORGE A. ALBA, MD
Instructor, Pulmonary and Critical Care Medicine
Department of Medicine
Massachusetts General Hospital
Harvard Medical School
Boston, Massachusetts
CATHERINE A. BIGELOW, MD
Maternal-Fetal Medicine Subspecialist
Minnesota Perinatal Physicians
Allina Health
Minneapolis, Minnesota
Y. JULIA CHEN, MD
Clinical Fellow
Department of Pediatric Surgery
Johns Hopkins University School of Medicine
Baltimore, Maryland
SUZANNE B. COOPEY, MD
Assistant Professor, Harvard University Faculty of Medicine
Division of Surgical Oncology
Massachusetts General Hospital
Boston, Massachusetts
,CHRISTOPHER T. DOUGHTY, MD
Instructor, Neurology
Department of Neurology, Division of Neuromuscular Disorders
Harvard Medical School/Brigham and Women’s Hospital
Boston, Massachusetts
RALPH P. FADER, MD
Child and Adolescent Psychiatry Fellow
Department of Psychiatry
New York-Presbyterian
New York, New York
RAISA GAO, MD, FACOG
Assistant Professor
Department of Obstetrics, Gynecology, and Reproductive Science
Icahn School of Medicine at Mount Sinai
New York, New York
SARAH GUSTAFSON, MD
Assistant Clinical Professor, Pediatrics
Division of Pediatric Hospital Medicine, Harbor-UCLA
David Geffen School of Medicine at UCLA
Los Angeles, California
ALEXANDER R. LLOYD, MD
Resident Physician
Department of Physical Medicine and Rehabilitation
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania
CHRISTOPHER C. LO, MD
Instructor
Stein and Doheny Eye Institutes, Department of Orbital and Oculofacial
Plastic Surgery
University of California at Los Angeles
Los Angeles, California
,S. ANDREW MCCULLOUGH, MD
Assistant Professor, Clinical Medicine
Assistant Director, Graphics Laboratory
Department of Medicine, Division of Cardiology
Weill Cornell Medicine
New York, New York
MATTHEW E. POLLARD, MD
Fellow, Male Reproductive Medicine and Surgery
Scott Department of Urology
Baylor College of Medicine
Houston, Texas
KATELYN O. STEPAN, MD
Fellow, Head and Neck Surgical Oncology and Microvascular
Reconstruction
Otolaryngology—Head and Neck Surgery
Washington University School of Medicine in St. Louis
St. Louis, Missouri
JOSEPH M. T RUGLIO, MD, MPH
Assistant Professor of Internal Medicine, Pediatrics and Medical Education
Program Director, Internal Medicine and Pediatrics Residency
Departments of Internal Medicine and Pediatrics
Icahn School of Medicine at Mount Sinai
New York, New York
ADDITIONAL CONTRIBUTORS
PAUL J. CUMMINS, PhD
Assistant Professor, Medical Education
Department of Medical Education, The Bioethics Program
Icahn School of Medicine at Mount Sinai
New York, New York
ROCCO M. FERRANDINO, MD, MSCR
Resident Physician
Department of Otolaryngology—Head and Neck Surgery
,Icahn School of Medicine at Mount Sinai
New York, New York
DAVID W. FLEENOR, STM
Director of Education, Center for Spirituality and Health
Icahn School of Medicine at Mount Sinai
New York, New York
BEVERLY A. FORSYTH, MD
Associate Professor of Medicine, Infectious Diseases and Medical
Education
Medical Director of the Morchand Center for Clinical Competence
Division of Infectious Diseases and Department of Medical Education
Icahn School of Medicine at Mount Sinai
New York, New York
NADA GLIGOROV, PHD
Associate Professor, Medical Education
Department of Medical Education, The Bioethics Program
Icahn School of Medicine at Mount Sinai
New York, New York
JOANNE R. HOJSAK, MD
Professor, Pediatrics and Medical Education
Director, Pediatric LifeLong Care Team
Pediatric Critical Care/Mount Sinai Kravis Children’s Hospital
Icahn School of Medicine at Mount Sinai
New York, New York
SCOTT JELINEK, MD, MED, MPH
Resident Physician
Department of Pediatrics
Icahn School of Medicine at Mount Sinai
New York, New York
GISELLE N. LYNCH, MD
Resident Physician
, Department of Ophthalmology
New York Eye and Ear Infirmary of Mount Sinai
New York, New York
ANTHONY J. MELL, MD, MBA
Resident Physician
Boston Combined Residency Program
Boston Children’s Hospital and Boston Medical Center
Boston, Massachusetts
ANN-GEL S. PALERMO, DRPH, MPH
Associate Professor
Associate Dean for Diversity and Inclusion in Biomedical Education
Department of Medical Education
Office for Diversity and Inclusion
Icahn School of Medicine at Mount Sinai
New York, New York
KATHERINE A. ROZA, MD
Staff Physician
Northwell Health House Calls Program
Zucker School of Medicine at Hofstra/Northwell
New Hyde Park, New York
ANNETTY P. SOTO, DMD
Clinical Assistant Professor and Team Leader
Division of General Dentistry
Department of Restorative Dental Sciences
University of Florida College of Dentistry
Gainesville, Florida
MITCHELL B. WICE, MD
Integrated Geriatric and Palliative Care Fellow
Brookdale Department of Geriatrics and Palliative Medicine
Icahn School of Medicine at Mount Sinai
New York, New York
Physical
Examination
AND History Taking
THIRTEENTH EDITION
Lynn S. Bickley, MD, FACP
Clinical Professor of Internal Medicine
School of Medicine
University of New Mexico
Albuquerque, New Mexico
Peter G. Szilagyi, MD, MPH
Professor of Pediatrics and Executive Vice-Chair
Department of Pediatrics
University of California at Los Angeles (UCLA)
Los Angeles, California
Richard M. Hoffman, MD, MPH, FACP
Professor of Internal Medicine and Epidemiology
Director, Division of General Internal Medicine
University of Iowa Carver College of Medicine
Iowa City, Iowa
Guest Editor
Rainier P. Soriano, MD
Associate Professor of Medical Education, Geriatrics and Palliative
Medicine
Brookdale Department of Geriatrics and Palliative Medicine
,Acquisitions Editor: Crystal Taylor
Development Editor: Andrea Vosburgh
Freelance Development Editor: Kelly Horvath
Editorial Coordinator: Emily Buccieri
Editorial Assistant: Parisa Saranj
Marketing Manager: Phyllis Hitner
Senior Production Project Manager: Alicia Jackson
Team Lead, Design: Stephen Druding
Art Director, Illustration: Jennifer Clements
Illustrator: Body Scientific International
Photography: Thibodeau Media Group
Manufacturing Coordinator: Margie Orzech
Prepress Vendor: Aptara, Inc.
Thirteenth Edition
Copyright © 2021 Wolters Kluwer.
Copyright © 2017 Wolters Kluwer. Copyright © 2013, 2009 by Wolters Kluwer Health/Lippincott
Williams & Wilkins. Copyright © 2007, 2003, 1999 by Lippincott Williams & Wilkins. Copyright © 1995,
1991, 1987, 1983, 1979, 1974 by J. B. Lippincott Company. All rights reserved. This book is protected by
copyright. No part of this book may be reproduced or transmitted in any form or by any means,
including as photocopies or scanned-in or other electronic copies, or utilized by any information storage
and retrieval system without written permission from the copyright owner, except for brief quotations
embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part
of their official duties as U.S. government employees are not covered by the above-mentioned
copyright. To request permission, please contact Wolters Kluwer at Two Commerce Square, 2001
Market Street, Philadelphia, PA 19103, via email at , or via our website at
shop.lww.com (products and services).
987654321
Printed in China
Library of Congress Cataloging-in-Publication Data
Names: Bickley, Lynn S., author. | Szilagyi, Peter G., author. | Hoffman, Richard M., author. | Soriano,
Rainier P., editor.
Title: Bates’ guide to physical examination and history taking / Lynn S. Bickley, Peter G. Szilagyi,
Richard M. Hoffman ; guest editor, Rainier P. Soriano.
Other titles: Guide to physical examination and history taking
Description: Thirteenth edition. | Philadelphia: Wolters Kluwer, [2021] | Includes bibliographical
references and index. | Summary: “The thirteenth edition of Bates’ Guide to Physical Examination
and History Taking is your comprehensive guide to learning to effectively conduct the health
interview and physical examination. This section introduces you to the features and learning tools that
will lead to successful health assessments, regional examinations, and working with special patient
populations. At the start of every chapter, you will see a list of additional learning resources that
, complement the book in order to build your knowledge and confidence in history taking and
examination. The Bates’ Visual Guide to Physical Examination offers over more than 8 hours of
video content and delivers head-to-toe and systems-based physical examination techniques. When
used alongside the book, you have a complete learning solution for preparedness for the boards and
patient encounters”– Provided by publisher.
Identifiers: LCCN 2020019448 | ISBN 9781496398178 (paperback)
Subjects: MESH: Physical Examination–methods | Medical History Taking–methods
Classification: LCC RC76 | NLM WB 205 | DDC 616.07/54–dc23
LC record available at https://lccn.loc.gov/2020019448
This work is provided “as is,” and the publisher disclaims any and all warranties, express or implied,
including any warranties as to accuracy, comprehensiveness, or currency of the content of this work.
This work is no substitute for individual patient assessment based upon healthcare professionals’
examination of each patient and consideration of, among other things, age, weight, gender, current or
prior medical conditions, medication history, laboratory data and other factors unique to the patient. The
publisher does not provide medical advice or guidance and this work is merely a reference tool.
Healthcare professionals, and not the publisher, are solely responsible for the use of this work including
all medical judgments and for any resulting diagnosis and treatments.
Given continuous, rapid advances in medical science and health information, independent professional
verification of medical diagnoses, indications, appropriate pharmaceutical selections and dosages, and
treatment options should be made and healthcare professionals should consult a variety of sources.
When prescribing medication, healthcare professionals are advised to consult the product information
sheet (the manufacturer’s package insert) accompanying each drug to verify, among other things,
conditions of use, warnings and side effects and identify any changes in dosage schedule or
contraindications, particularly if the medication to be administered is new, infrequently used or has a
narrow therapeutic range. To the maximum extent permitted under applicable law, no responsibility is
assumed by the publisher for any injury and/or damage to persons or property, as a matter of products
liability, negligence law or otherwise, or from any reference to or use by any person of this work.
shop.lww.com
,This book is dedicated to you, the ever-constant student, teacher,
and practitioner of this continuously evolving art and science of
medicine.
, Faculty Reviewers and
Additional Contributors
GEORGE A. ALBA, MD
Instructor, Pulmonary and Critical Care Medicine
Department of Medicine
Massachusetts General Hospital
Harvard Medical School
Boston, Massachusetts
CATHERINE A. BIGELOW, MD
Maternal-Fetal Medicine Subspecialist
Minnesota Perinatal Physicians
Allina Health
Minneapolis, Minnesota
Y. JULIA CHEN, MD
Clinical Fellow
Department of Pediatric Surgery
Johns Hopkins University School of Medicine
Baltimore, Maryland
SUZANNE B. COOPEY, MD
Assistant Professor, Harvard University Faculty of Medicine
Division of Surgical Oncology
Massachusetts General Hospital
Boston, Massachusetts
,CHRISTOPHER T. DOUGHTY, MD
Instructor, Neurology
Department of Neurology, Division of Neuromuscular Disorders
Harvard Medical School/Brigham and Women’s Hospital
Boston, Massachusetts
RALPH P. FADER, MD
Child and Adolescent Psychiatry Fellow
Department of Psychiatry
New York-Presbyterian
New York, New York
RAISA GAO, MD, FACOG
Assistant Professor
Department of Obstetrics, Gynecology, and Reproductive Science
Icahn School of Medicine at Mount Sinai
New York, New York
SARAH GUSTAFSON, MD
Assistant Clinical Professor, Pediatrics
Division of Pediatric Hospital Medicine, Harbor-UCLA
David Geffen School of Medicine at UCLA
Los Angeles, California
ALEXANDER R. LLOYD, MD
Resident Physician
Department of Physical Medicine and Rehabilitation
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania
CHRISTOPHER C. LO, MD
Instructor
Stein and Doheny Eye Institutes, Department of Orbital and Oculofacial
Plastic Surgery
University of California at Los Angeles
Los Angeles, California
,S. ANDREW MCCULLOUGH, MD
Assistant Professor, Clinical Medicine
Assistant Director, Graphics Laboratory
Department of Medicine, Division of Cardiology
Weill Cornell Medicine
New York, New York
MATTHEW E. POLLARD, MD
Fellow, Male Reproductive Medicine and Surgery
Scott Department of Urology
Baylor College of Medicine
Houston, Texas
KATELYN O. STEPAN, MD
Fellow, Head and Neck Surgical Oncology and Microvascular
Reconstruction
Otolaryngology—Head and Neck Surgery
Washington University School of Medicine in St. Louis
St. Louis, Missouri
JOSEPH M. T RUGLIO, MD, MPH
Assistant Professor of Internal Medicine, Pediatrics and Medical Education
Program Director, Internal Medicine and Pediatrics Residency
Departments of Internal Medicine and Pediatrics
Icahn School of Medicine at Mount Sinai
New York, New York
ADDITIONAL CONTRIBUTORS
PAUL J. CUMMINS, PhD
Assistant Professor, Medical Education
Department of Medical Education, The Bioethics Program
Icahn School of Medicine at Mount Sinai
New York, New York
ROCCO M. FERRANDINO, MD, MSCR
Resident Physician
Department of Otolaryngology—Head and Neck Surgery
,Icahn School of Medicine at Mount Sinai
New York, New York
DAVID W. FLEENOR, STM
Director of Education, Center for Spirituality and Health
Icahn School of Medicine at Mount Sinai
New York, New York
BEVERLY A. FORSYTH, MD
Associate Professor of Medicine, Infectious Diseases and Medical
Education
Medical Director of the Morchand Center for Clinical Competence
Division of Infectious Diseases and Department of Medical Education
Icahn School of Medicine at Mount Sinai
New York, New York
NADA GLIGOROV, PHD
Associate Professor, Medical Education
Department of Medical Education, The Bioethics Program
Icahn School of Medicine at Mount Sinai
New York, New York
JOANNE R. HOJSAK, MD
Professor, Pediatrics and Medical Education
Director, Pediatric LifeLong Care Team
Pediatric Critical Care/Mount Sinai Kravis Children’s Hospital
Icahn School of Medicine at Mount Sinai
New York, New York
SCOTT JELINEK, MD, MED, MPH
Resident Physician
Department of Pediatrics
Icahn School of Medicine at Mount Sinai
New York, New York
GISELLE N. LYNCH, MD
Resident Physician
, Department of Ophthalmology
New York Eye and Ear Infirmary of Mount Sinai
New York, New York
ANTHONY J. MELL, MD, MBA
Resident Physician
Boston Combined Residency Program
Boston Children’s Hospital and Boston Medical Center
Boston, Massachusetts
ANN-GEL S. PALERMO, DRPH, MPH
Associate Professor
Associate Dean for Diversity and Inclusion in Biomedical Education
Department of Medical Education
Office for Diversity and Inclusion
Icahn School of Medicine at Mount Sinai
New York, New York
KATHERINE A. ROZA, MD
Staff Physician
Northwell Health House Calls Program
Zucker School of Medicine at Hofstra/Northwell
New Hyde Park, New York
ANNETTY P. SOTO, DMD
Clinical Assistant Professor and Team Leader
Division of General Dentistry
Department of Restorative Dental Sciences
University of Florida College of Dentistry
Gainesville, Florida
MITCHELL B. WICE, MD
Integrated Geriatric and Palliative Care Fellow
Brookdale Department of Geriatrics and Palliative Medicine
Icahn School of Medicine at Mount Sinai
New York, New York
