SURGICAL FINALS Passing the Clinical - PasTest

G E N E R A L P O I N T S5. Family historyAgain, include questions about anaesthetic reactions.6. Social historyA good social history will make you stand out from other candidates.Don’t just ask about alcohol and smoking; check environmental hazards(eg asbestos exposure). It is important that you know how well thepatient will manage at home during the postoperative period. Thereforeask about family, neighbours, carers, GP home visits, district nurses, homehelp, meals on wheels and financial problems.Your social history should be relevant to the patient’s problem, so ifyou have a patient with a stoma, enquire into the details of stoma care,and whether they can change the bag themself. If you have a patientwith an orthopaedic problem or amputation, ask about physiotherapy,occupational therapy, aids and appliances.7. Systemic enquiryAs in subsequent sections.The examinationYour hands should be washed clean and warm before commencing anyexamination. (For more than one station there will usually be an alcoholwash at the bedside; if not, ask an attendant where you can wash yourhands.) Your examination may be observed by an examiner. This doesnot mean that you should change your clinical approach: the order forgeneral and regional examination is just the same, as outlined in thetext, and the one you have practised with supervisors and your chosencolleague (page 5).Start your examination by forming a general impression of the patient:observing him or her from the end of the bed. If you are being monitoredby an examiner, state what you are doing and comment on the presenceor absence of the signs that you are looking for. Next move to thepatient’s right-hand side (this is not only a time-honoured tradition, butalso efficient [even if you are left handed] – manoeuvres in this text aredescribed from this position).9