Future Doctors Presentation Physical Examination Seminar
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Transcript of Future Doctors Presentation Physical Examination Seminar
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TRAINING IN RUSSIA: WHAT ARE WE MISSING OUT?Alan Na, KSMU 2011
FUTURE DOCTORS PROGRAM
MSA, KURSK
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PROGRAM ITINENARY
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Time Itinerary5.00-5.40 PM:
[PRESENTATION] Training in Russia – What are we missing out? By Alan Na.
5.40-6.00 PM
Break
6.00 – 6.15 PM
[GROUP ACTIVITY] Physical Examination Mastery.
6.15 – 6.30 PM
[GROUP ACTIVITY] Solving Tasks.
6.30 – 7.00 PM
Group Presentations
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3 ASPECTS
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Procedural skills
Case presentation
History taking & Physical
examination
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THE OSCE
Objective Structured Clinical Examination
ComponentsHistory TakingPhysical ExaminationCommunication SkillsoExplaining ProceduresoExplaining to a newly diagnosed patient.oBreaking bad news, etc.
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RELEVANCE
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OSCE
USMLE
PLAB
AMC
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POST-GRADUATE STUDIES
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OSCEMRCP
MRCS MRCOG
LOCAL MASTER
S PROGRA
M
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Long CaseA component of the examination where the
students are given ONE hour to examine a patient and he/she is required to present the case to the examiners.
After that, 30 minutes with 2 lecturers. They may bring you to see the patient, ask you to perform examination.
Cases are from Major postings: Internal Medicine, O&G, Paediatrics, Surgery.
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Short CaseA component where students are evaluated on
the skills in physical examination, history taking, procedural skills, etc.
Virtually anything under the sun can be tested, from Urinary catheter insertion to performing ERPOC to calling the consultant to report a case.
4 stations : 1 Internal Medicine, 1 Surgery or 0rthopaedics, 1 O&G and 1 Miscellaneous ( includes Psychiatry, Paediatrics, ENT, Opthalmology).
10 minutes each station.8
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THE PHYSICAL EXAMINATION
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CLINICAL EXAMINATIONA Systematic Guide to Physical DiagnosisNicholas J. Talley, Simon O’Connor
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The Physical Examination of the Cardiovascular System
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GI
HANDS
BP
FACE BACK
AUSCULTATION
PRECORDIUM
NECK ABDOMEN
LEGS
OTHERS
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GENERAL INSPECTION (GI)
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Marfan's, Turner's, Down syndromeRheumatological disorders, e.g. ankylosing
spondylitis (aortic regurgitation)Acromegaly etcDyspnoea
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HANDS
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Radial pulses-right and leftRadiofemoral delayClubbingSigns of infective endocarditis-splinter
haemorrhages etcPeripheral cyanosisXanthomata
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BLOOD PRESSURE (BP)
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HypertensionWide pulse pressure – Valvular pathology.
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FACE
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EyesoSclerae-pallor, jaundiceoPupils-Argyll Robertson (aortic regurgitation)oXanthelasma
Malar flush (mitral stenosis, pulmonary stenosis)
MouthoCyanosisoPalate (high arched-Marfan's)oDentition
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NECK
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Jugular venous pressureCentral venous pressure heightWave formCarotids-pulse character
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PRECORDIUM (ANTERIOR CHEST)
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InspectoScars-whole chest, backoDeformityoApex beat-position, characteroAbnormal pulsations
PalpateoApex beat-position, characteroThrillsoAbnormal impulses
NB: Beware of dextrocardia
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AUSCULTATION
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Heart sounds (4 point auscultation)MurmursPosition patientoLeft lateral positionoSitting forward (forced expiratory apnoea)
NB: Palpate for thrills again after positioningDynamic auscultationoRespiratory phasesoValsalvaoExercise (isometric, e.g. hand grip)oCarotids
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BACK (SITTING FORWARD)
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Scars, deformitySacral oedemaPleural effusion (percuss)Left ventricular failure (auscultate)
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ABDOMEN (LYING FLAT – 1 PILLOW)
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Palpate liver (pulsatile etc.), spleen, aortaPercuss for ascites (right heart failure)Femoral arteries-palpate, auscultate
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LEGS
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Peripheral pulsesCyanosis, cold limbs, trophic changes,
ulceration (peripheral vascular disease)OedemaXanthomataCalf tenderness
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OTHERS
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Urine analysis (infective endocarditis)Fundi (endocarditis)Temperature chart (endocarditis)
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X’Press Revision in Short CasesDr. Chew Nee KongUniversity of Malaya Press
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Physical and Examination at a GlanceJonathan Gleadle
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The Big Picture
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HISTORY TAKING
PHYSICAL EXAMINATION
PRIMARY DIAGNOSIS
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HISTORY TAKING
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1. Presenting (principal) symptom (PS)
2. History of presenting illness (HPI)
3. Past history (PH)
4. Social history (SH)
5. Family history (FH)
6. Systems review (SR) – Often done after HPI.
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The systems review
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Enquire about common symptoms and three or four of the common disorders in each major system listed in the next slide.
Not all these questions should be asked of every patient.
Adjust the detail of questions based on the presenting problem, the patient's age and the answers to the preliminary questions.
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1. Gen: appetite, weight change, fevers night sweats
2. Head: headache, loss of consciousness, seizures, trauma
3. EENT: blindness, hearing loss, tinnitus, vertigo, otitis, sinusitis, frequent sore throats, oral sores, epistaxis
4. Resp: hemoptysis, cough, dyspnea, wheezing, pleurisy
5. CV: chest pain, dyspnea, palpitations, known murmur, edema, claudication
6. GI: hematemesis, melena, hematochezia, abdominal pain, dysphagia, change in bowel habits, jaundice
7. Menses: menarche, amount, irregularity, menopause, post menstrual bleeding
8. Rheum: pain, swelling, stiffness, locking of joint
9. Endo: polyuria, polydipsia, heat or cold intolerance
10. Hemat: prolonged bleeding, easy bruising, known anemia
11. Derm: rashes, pruritus, prior removal of mole or tumor
12. Neuro: paralysis, weakness, numbness, involuntary movements
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An example
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•Chest Pain, Dyspnea
COMPLAINTS/PS
•SOCRATES
HPI
•HTN, Hyperlipidemia
PAST HISTORY
SOCIAL HISTORY
FAMILY HISTORY
SYSTEM REVIEW
• Smoking, Drinking
• Father passed away due to MI (1986)
• CVS: Orthopnea, Edema, IC• Resp: Nil• GIT: Nil
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GENERAL PHYSICAL EXAMINATION (Head to Toe)
CARDIOVASCULAR PHYSICAL EXAMINATION
PRIMARY DIAGNOSIS
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[VIDEO] PHYSICAL EXAMINATION OF THE CARDIOVASCULAR SYSTEM.
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“the key to success is
CONFIDENCE,
the key to confidence is
PREPARATION”
thank you