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Development Editor:  Harsha Madan

Editorial Assistant:     Keshav Kumar

Cover Design:        Seema Dogra

Medicine is both an art and a science. Scientific knowledge creates the foundation and the art of deduction and application enables the discerning clinician to arrive at the correct diagnosis and therefore appropriate management.

I am glad that the 1st edition of this book was very well-received and was a resounding success. The book has gained wide popularity among international candidates (particularly those preparing for their MRCP, PACES, MRCPI, and Arab Board clinical examinations) over less than four years from its publication. Feedback from internal medicine residents and medical students indicated that the book was extremely helpful during their preparation for clinical examinations. I was pleasantly surprised and extremely delighted to receive positive feedback not only from candidates but also from experienced clinician colleagues and seasoned examiners. I am ever grateful for their comments and suggestions for improvement in future editions of this book. The main driver of the book was a desire to provide a resource to busy clinicians during their clinical examination preparation, which is both concise and easy to assimilate but, at the same time, comprehensive and does not omit any vital component of the examination. A consistent theme from the positive feedback is the book's unique conversational style and the precise and concise information it delivers to the readers. Although this was the intention of starting this project in the first place, this positive feedback exceeded my expectations and encouraged me to improve even further the utility of the book by bringing this 2nd edition. As teaching has always been a passion for me, I always looked at how medical education can be made easy and more straightforward for a busy clinician. While acting as an examiner for many years, I realised the particular areas in which candidates struggle during examinations. This book is an effort to help candidates overcome these difficulties.

Clinical examinations are considered in many countries as an integral part of the assessment of a doctor's clinical competence. To candidates, they represent a major hurdle during their training. There are significant anxiety and stress associated with the preparation of these examinations that peak on the day of the examination. Internationally, there is a significant variation in the way these examinations are conducted. Two types of postgraduate clinical short case examinations are currently conducted at national and international levels. In the traditional unstandardised examination, a candidate is typically assessed by two examiners on all short cases. The more standardised and structured form of examination requires two examiners (who mark independently) at each station. The former examinations have a considerable number of disadvantages including inconsistency in marking and judgement between examiners (hawk versus dove), gender, personality, and ethnic biases. Furthermore, many national and some international boards appoint clinical examiners without prior training, which results in further variability and inconsistency in marking. Despite being considered as more objective and fair, the recent standardised types of clinical examinations have the disadvantages of cost and preparation. Nevertheless, the key factor for passing clinical examinations remains the candidate's preparation. Going for a clinical examination is like going to a battle. Irrespective of clinical experience, preparation and practice are the keys to passing clinical examinations. You can hear about cardiology fellows who fail cardiac cases, gastroenterology fellows who fail abdominal cases, or neurology fellows who fail neurology cases in clinical examinations because they have not prepared well. Preparation for such examinations requires, in addition to the attainment of broad medical knowledge, acquisition of the required clinical skills of physical examination and mastering the art and discipline of presenting findings and case discussion in a clear systematic manner. Several crucial steps can help candidates to prepare for their short/OSCE cases. While many candidates feel confident in their clinical skills and techniques, the stress in the ‘real examination’ will expose significant skill and knowledge gaps. It is essential, therefore, that a day-by-day short case practice should become second nature to all candidates preparing for their clinical examinations. The best way of attaining this is by frequent bedside assessment and teaching of a motivated group of candidates by a registrar or a consultant (preferably who has been through the examination hurdle). Examination-oriented consultant supervision and comments during the ward round and mock examinations are also helpful. Revision courses may help to familiarise candidates with the common examination cases and examination methods, but alone are never sufficient to pass clinical examinations. Parallel to mastering proper examination skills is a good grasp of medical knowledge related to the common examination cases. Reading medical textbooks without considering commonly encountered cases in clinical examinations is virtually guaranteed with failure. The examiners are assessing knowledge and clinical acumen and the latter cannot be derived from the textbooks. Candidates should also focus on reading books that are dedicated to helping candidates to pass their clinical examinations. These books familiarise candidates with the most common cases encountered in examinations. Nevertheless, many candidates believe that currently there are not enough books that meet this purpose. Hence, many of these books are becoming large medical textbooks that are detailed and extremely wordy, but lack focus and include detailed theoretical information that is useful in written rather than clinical examinations. The examiners are looking for common sense clinical answers, not the latest theories on the molecular basis of disease. As an international clinical examiner, _fm10a primary organiser, and host examiner for different clinical board examinations, I endorse the view that candidates need concise information to help them systematically examine cases, quickly identify the abnormality, and derive the correct diagnosis. In this book, I have put a tremendous effort into including all possible questions that my examiner colleagues have asked or may ask in the clinical examinations. To provide the candidate with a model answer, I have provided a typical conversation between an examiner and a candidate where the examiner asks and the candidate provides the expected answer. This may also put the reader of this book in a more interactive atmosphere rather than reading a large text with the bottom line information lost in the details. Furthermore, being a previous candidate for undergraduate and postgraduate clinical examinations, I realise how a candidate's working memory is negatively affected by examination-provoked stress. Candidates, for example, can easily forget a simple list of causes of a disease as a result of such stress. Considering this, I have included some mnemonics in various pages to help recall some long lists. Each case or system in this book is preceded by ‘how to examine’ to help candidates focus on important physical signs related to that case. Common mistakes or pitfalls committed by candidates and various examiner instructions that have been observed in real examinations are also clearly addressed at the beginning of each case. Particular attention has been paid to the up-to-date management of each case, which is a mandatory question in clinical examinations. Finally, I have gathered all my experience as a clinical examiner, organiser, and educator in this book to help postgraduate doctors feel confident when proceeding to their clinical examinations.

This book is intended to provide postgraduate medical doctors and medical students with the necessary information to pass their clinical examinations. The author of this book has made every effort and care to ensure the information provided in this book is accurate. However, since medical knowledge is constantly changing, neither the author nor the publisher can assume any responsibility for any consequences arising from the use of the information contained in this book.

I am indebted to the following colleagues from Hamad Medical Corporation for their great assistance and providing some photographic materials included in this book—Dr Amjad Mahboob, Dr Gowri Karuppasamy, and Dr Elrazi Awadelkarim from Internal Medicine Section; Dr Liaquat Ali, Dr Dirik Deleu, Dr Mohammed Alhatou, Dr Ahmad Shihab, Dr Suha Makki, Dr Naveed Akhtar, Dr Faisal Ibrahim, and Dr Yasser Osman from Neurology Section; Dr Abdul-Wahab Al-Allaf, Dr Fiaz Alam, Dr Samar Al-Emadi, Dr Izzat Khanjar, Dr Abdul-Razzakh Poil, Dr Salah Mahdi, and Dr Mohammed Hamoudeh from Rheumatology Section; Dr Hamda Ali and Dr Mohsen Elidrisi from the Endocrinology Section; Dr Farouq Hamed, Dr Hawraa Omran, Dr Hisham Elsabah, Dr Kakil Rasul, and Dr Mufid Elmistiri from Oncology Section; Dr Maha Elshafei, Dr Mohammed Mousa, and Dr Fatima Almansouri from Ophthalmology Section; Dr Farook Ahmed from Nephrology Section; and Ms Mary Anne Tourette from the Department of Medicine. Special thanks go to Professor Rayaz Malik, Dr Mushtaq Ahmed, Dr Tasleem Raza, Dr Salah Elbadri, Dr Ahmed Al-Mohammed, and Dr Dhabia Al-Mohanadi and my brother Dr Gamal Ibrahim for their invaluable suggestions and continuous support during the preparation of this book.