General Approach
Principle:
- Examine intelligently
- Ask questions appropriately
- Focus on how to present yourself and pick up the important physical signs
- Think about the common things
- Demonstrate foresight
General Approach to clinical cases:
- Introduce yourself and establish rapport
- Take care to appropriately expose the patient
- Examine the relevant parts, start with the hands
- Accuarately identify problems
- Derive possible further investigations that could be done
- Generate a list of differential diagnoses, definite diagnosis and investigation
Reasons for not doing well
- Not showing due concern for patient
- Not introducing yourself
- Not exposing adequately
- Not asking permission
- Ignoring the hints
- Not listening carefully to the instructions
- Gross lack of knowledge
Golden Rules
No
- Repetition
- Hesitation
- Derivation
Cases
Scalp
- Sebaceous cyst
- Osteoma
Face
- Parotids
- Thyroid
- Lymph node
- Branchial cyst
- Submandibular gland
Thorax
- Breast lumps - must know all physical signs and cancer and post treatment signs
- Benign breast disease
Upper Limb
- Axillary node
- Dupuytren's contracture
- Osteoarthritis
- Rheumatoid arthritis
- Nerve injury - median, ulnar, radial
- Carpal tunnel
Abdomen
- Abdominal aortic aneurysm
- Visceromegaly
- Hernias
- Stoma
- Fistula
- Sister joseph nodule
Groin
- Hernias
- Saphena varix
Scrotum
- Hydrocoele
- Varicocoele
- Inguinal-scrotal hernia
- Solid testicular mass
- Epipdymal cyst
Lower Limb
- Osteoarthritis of the hip
- Osteoarthritis of the knee
- Cruciate injury
- Peripheral vascular disease
- Varicose veins
- Popliteal aneurysm
- Baker's cyst
