SURGICAL FINALS Passing the Clinical - PasTest

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S E C T I O N 1Look for JACCOL (jaundice, anaemia, cyanosis, clubbing, oedema,lymphadenopathy) and examine the hands. In your systems approach payparticular attention to the system relevant to the presenting complaint.However, aim to be thorough; always take the pulse and blood pressure.Remember to test the urine. A dipstick should be provided.Observation, palpation, percussion and auscultation will have beenrepeatedly drummed into you by your teachers, and look, feel, move andmeasure for joints – this is not the time to forget them! When palpating,always watch your patient’s face for distress, and apologise for causingany discomfort. When auscultating, warm the bell or diaphragm and tapthe end to make sure that you are plugged into the right bit before youstart.An examiner may ask what you are doing at each stage; take this intoaccount when you are preparing with a colleague and do likewise. Whenyou have finished your examination make sure that the patient is coveredand comfortable.Thinking timeIf you are not being observed you will usually have a few minutes betweenexamining the patient and presenting your findings. During this time,reorganise any misplaced information and summarise the case in writing.You might also predict your examiners’ questions so that you are one stepahead. The sections on ‘typical cases’ in this book will help you to do this.Presenting your f indingsThe examiners will usually tell you what they want. Normally they will askyou to tell them about the patient who you have just seen. They may adda rider such as ‘stick to the important features’. Don’t get flustered if theystart with ‘What’s the diagnosis?’If your patient was a poor historian, start by commenting on this fact: thisis an important sign in itself and allowances will be made. However, it isno excuse for a poor presentation.Your presentation should be as concise, snappy and comprehensive aspossible. Place your notes in front of you for reference but talk, don’t read,10
G E N E R A L P O I N T Sto the examiners. Don’t panic if your notes are taken away from you: thehistory and examination will be fresh in your mind and you will remembermore than you think.If the patient has more than one complaint this should be brought outby listing the presenting complaints. Then explain, ‘I will describe each ofthese in turn.’You should not give long lists of negative findings: if the main problemis abdominal and you have found no other abnormality, it is quitepermissible to state that ‘other systems are normal’.The examiners may interrupt you in the middle of your presentation. Theymay be happy with the way that you have started and want to go on to thenext point, they may wish to discuss a problem in more depth, or they maysimply be bored after listening to several well-delivered histories in a row.You may be taken back to the patient to demonstrate an abnormalfinding. This does not necessarily mean that there is any doubt about yourfindings: you may have elicited a sign previously missed! At the end ofyour presentation give the diagnosis (if you are sure of it), and/or list thecommon differentials or causes of the patient’s problem.11
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SURGICAL FINALS Passing the Clinical - PasTest

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