SURGICAL FINALS Passing the Clinical - PasTest

G E N E R A L P O I N T SNote the following points:gospel. Modify them according to your own teaching and individualpreference.the examiner tells you to ‘palpate the abdomen’, do not start with thehands.actually show your examiners that you are following the correctroutine, eg by standing at the end of the bed to observe the patient.case, you are allowed certain questions, eg before examining a lumpyou cannot see, ask the patient to point out its exact position.Three further questions that should be asked regarding a lump are:Is it tender/painful (before you start)? How long have you had it? Is itchanging in size?There are certain things that you are not expected to include in theexamination situation, such as a rectal examination. However, you mustindicate to the examiners that you would normally examine these areas.Furthermore, you should express a desire to examine other systems toseek underlying causes of local conditions, eg tell the examiners that youwould like to examine the abdomen for secondary causes of hernias orvaricose veins.It is usually up to you whether you talk as you examine or you presentyour findings at the end. Practise both ways: you may be requestedspecifically to ‘explain what you are doing’ or you may be interrupted atany stage of the examination to ‘present your findings so far’.3. An abilit y to elicit and draw conclusions fromphysical signsYou will not fail the examination if you do not pick up all the physicalsigns. However, you will be asked questions such as ‘What are the causesof X?’ and ‘What is the differential diagnosis?’ Aim to be one step ahead ofyour examiners by pre-empting such questions.13