By R. Turner, Chris Hatton, Roger Blackwood
An organization favorite of scientific scholars and junior medical professionals, Lecture Notes on medical abilities covers the fundamental ideas and methods of historical past taking and exam, and offers counsel at the key expert abilities excited about constructing and retaining strong verbal exchange among medical professional and sufferer. This new fourth variation has been revised to supply updated info on strategies and a better emphasis at the patient-centred strategy. first-class scientific abilities are important for all clinical scholars and medical professionals. This pocket-sized speedy reference consultant indicates you ways to take an entire historical past; the way to study a sufferer completely; tips on how to request the main applicable investigations; and the way to place all of this jointly and are available to a prognosis.
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Additional resources for Clinical Skills (Lecture Notes)
You may choose a different order from those suggested if it helps you. Learn the major features by rote. At the end of each examination chapter is such a list. ‘Examine the face’ skin: rodent ulcer ° observe upper face: Paget’s disease, balding, myopathy, Bell’s palsy ° eyes: anaemia, jaundice, thyrotoxicosis, myxoedema, xanthelasma, ptosis, ° eye palsies, Horner’s syndrome face: steroid therapy, acromegaly, Parkinson’s disease, hemiparesis, ° lower parotid tumour, thyroid enlargement System-oriented Examination ‘Examine the eyes’ jaundice, anaemia, arcus, ptosis, Horner’s syndrome ° observe: examine: ° – check if patient is blind — beware of glass eye – movements of the eyes – amblyopia or palsy – diplopia, nystagmus/false image – visual acuity – visual fields – pupils: light and accommodation reflexes – fundi: disc, arteries and veins, retina, particularly fovea ‘Examine the neck’ from front and side ° –inspect thyroid (ask patient to swallow) – – – – ° lymph nodes raised jugular venous pressure lymph glands other swellings inspect from front – examine neck veins – feel carotid arteries – auscultate bruits over thyroid and carotid arteries – check trachea is central 49 CHAPTER 3 Examination of the Cardiovascular System General examination ° –Examine: clubbing of fingernails – – – – – 50 Clubbing in relation to the heart suggests infective endocarditis or cyanotic heart disease (Plate 2b).
If there are any possible lumps, proceed to a more complete examination. Full breast examination When patient has a symptom or a lump has been found: Inspect – sitting up and ask the patient to raise hands – inspect for asymmetry or obvious lumps – differing size or shape of breasts – nipples — symmetry – rashes, redness (abscess) Breast cancer is suggested by: – asymmetry – skin tethering – peau d’orange (oedema of skin) – nipple deviated or inverted Palpate – patient lying flat, one pillow – examine each breast with flat of hand, each quadrant in turn – examine bimanually if large – examine any lump as described on p.
Gently inflate the cuff until the radial artery is no longer palpable. – Using the stethoscope, listen over the brachial artery for the pulse ° ° to appear as you drop the pressure slowly (3– 4 mm/s). Systolic blood pressure: appearance of sounds – Korotkoff phase 1 Diastolic blood pressure: disappearance of sounds – Korotkoff phase 5 Use large cuff for fat arms (circumference >30 cm) so that inflatable cuff >1/2 arm circumference. Beware auscultatory gap with sounds disappearing mid-systole.