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Clinical Examination Skills
Farrukh Iqbal
CHAPTER 1:
Introduction
CHAPTER 2:
Skills in Medical Education
COMMUNICATION SKILLS
CLINICAL SKILLS
ORGANIZATIONAL SKILLS
CLERICAL SKILLS
ETHICAL SKILLS
PROCEDURAL SKILLS
CHAPTER 3:
History Taking
HISTORY OF PRESENT ILLNESS
PAST MEDICAL HISTORY
FAMILY HISTORY
PERSONAL AND SOCIAL HISTORY
MENSTRUAL HISTORY
DRUGS AND ALLERGIES
NEGATIVE DATA
Respiratory System
Ask about
Cardiovascular System
Ask about
Gastrointestinal System
Ask about and Look for
Urogenital System
Ask about
Haematological System
Ask about and Look for
Central Nervous System (CNS)
Ask about and look for
Nonspecific
Ask about and Look for
Locomotor System
Ask about and Look for
Endocrine System
Ask about and Look for
Dermatological System
Ask about and look for
CHAPTER 4:
Instruments Required
CHAPTER 5:
General Physical Examination
PEARLS
GENERAL INSTRUCTIONS FOR CONDUCTING EXAMINATION
GENERAL PHYSICAL EXAMINATION
CASE WRITING TIPS
STEP BY STEP EXAMINATION OF THE PATIENT AS A WHOLE
The Candidate
GENERAL PHYSICAL EXAMINATION
Common Commands Asked during Examination
GENERAL PHYSICAL EXAMINATION COMMANDS
Assess the Nutritional Status of the Patient
The Candidate
PEARLS
Look for Pallor
The Candidate
PEARLS
Look for Cyanosis
The Candidate
PEARLS
Look for Clubbing
The Candidate
PEARLS
Look for Jaundice
The Candidate
PEARLS
Check for Lymphadenopathy
The Candidate
Check Lymph Nodes in Axilla
The Candidate
Check Lymph Nodes in the Inguinal Region
The Candidate
PEARLS
Look for Peripheral Oedema
The Candidate
PEARLS
CHECK PERIPHERAL PULSES
Check for Radial Pulse
The Candidate
PEARLS
Check the Carotid Pulse
The Candidate
PEARLS
Check Collapsing (water hammer) Pulse
The Candidate
PEARLS
Check Pulsus Paradoxus
PEARLS
Check the Blood Pressure
The Candidate
PEARLS
Check Blood Pressure in Lower Limbs
The Candidate
If Large Cuff is Unavailable
The Candidate
PEARLS
Check Temperature
The Candidate
PEARLS
Examine the Thyroid
The Candidate
PEARLS
Examine the Breasts
The Candidate
PEARLS
Examine the Patient's Throat
The Candidate
PEARLS
Examine the Patient's Tongue
The Candidate
PEARLS
CHAPTER 6:
Examination of Respiratory System
PRINCIPLES OF EXAMINATION OF RESPIRATORY SYSTEM
Principles of Inspection
Principles of Palpation
Principles of Percussion
Principles of Auscultation
General Instructions for the Use of Stethoscope
PEARLS
Auscultation is done under the following headings:
General Principles of Auscultation
STEP BY STEP EXAMINATION OF RESPIRATORY SYSTEM (FOR LONG CASES)
The Candidate
CASE WRITING TIPS (RESPIRATORY SYSTEM)
COMMON COMMANDS
RESPIRATORY SYSTEM
Commands for Short Cases
COMMON COMMANDS (EXAMINATION OF THE RESPIRATORY SYSTEM)
Inspect the Chest (See also Principles of Inspection on Page 66)
The Candidate
PEARLS
Palpate the Chest (See also Principles of Palpation on Page 67)
The Candidate
PEARLS
Percuss the Chest (See also Principles of Percussion on Page 68)
The Candidate
PEARLS
Check for Liver Dullness (Upper border)
The Candidate
PEARLS
Auscultate the Chest (See also Principles of Auscultation on Page 69)
The Candidate
PEARLS
Check for the Tracheal Tug
The Candidate
PEARLS
Check for Tracheal Position
The Candidate
PEARLS
Percuss for Ellis's Curve (See also Principles of Percussion on Page 68)
The Candidate
PEARLS
Elicit Succussion Splash
The Candidate
PEARLS
Examine for Diaphragmatic Palsy
The Candidate
PEARLS
Check for Spinal Tenderness (See also Principles of Percussion of Page 68)
The Candidate
PEARLS
Do the Coin Test
The Candidate
PEARLS
CHAPTER 7:
Examination of Cardiovascular System
PRINCIPLES OF EXAMINATION OF CARDIOVASCULAR SYSTEM
Principles of Inspection
Principles of Palpation
Principles of Percussion
Principles of Auscultation
PEARLS
PEARLS
Dynamic Auscultation
STEP BY STEP EXAMINATION OF CARDIOVASCULAR SYSTEM (FOR LONG CASE)
The Candidate
CASE WRITING TIPS
Peripheral CVS
Central CVS
COMMON COMMANDS
Look at the Jugular Venous Pressure (JVP) or Examine the JVP
The Candidate
PEARLS
Inspect the Precordium (See also Principles of Inspection on Pages 66 and Pages 95)
The Candidate
PEARLS
Palpate the Precordium (See also Principles of Palpation on Pages 67 and Pages 95)
The Candidate
PEARLS
Percuss the Heart (See also Principles of Percussion on Pages 68 and Pages 96)
The Candidate
PEARLS
Auscultate the Precordium (See also Principles of Auscultation on Pages 69 and Pages 97)
The Candidate
PEARLS
Auscultate the Heart for Gallop (See Principles of Auscultation on Page 97)
The Candidate
PEARLS
Look for Aortic Regurgitation
The Candidate
Palpate for the Apex Beat (See also the Principles of Palpation on Pages 67 and Pages 95)
The Candidate
PEARLS
Look for the Signs of Cardiac Failure
The Candidate
Auscultate the Base of the Heart (See also Principles of Auscultation on Page 97)
The Candidate
PEARLS
CHAPTER 8:
Examination of Gastrointestinal System (Abdomen)
PRINCIPLES OF EXAMINATION OF GASTROINTESTINAL SYSTEM
PRINCIPLES OF INSPECTION IN ABDOMINAL EXAMINATION
PRINCIPLES OF PALPATION OF ABDOMEN
PRINCIPLES OF PERCUSSION OF ABDOMEN
PRINCIPLES OF AUSCULTATION OF ABDOMEN
STEP BY STEP FOR EXAMINATION OF ALIMENTARY SYSTEM (FOR LONG CASE)
CASE WRITING TIPS
Inspection
COMMANDS
COMMON COMMANDS
Inspect the Teeth
The Candidate
PEARLS
PALPATE THE LIVER
The Candidate (See also Principles of Palpation on Page 126)
PEARLS
OTHER METHODS TO PALPATE LIVER
Method 1
The Candidate
Method 2
The Candidate
Method 3
The Candidate
PEARLS
Method 4
The Candidate
PEARLS
PALPATE THE SPLEEN (SEE ALSO PRINCIPLES OF PALPATION ON Page 126)
Method 1
The Candidate
Method 2
The Candidate
Method 3
The Candidate
Method 4
The Candidate
Method 5
The Candidate
PEARLS
Palpate the Kidneys (Bimanual palpation) (See also Principles of Palpation on Pages 126 and Pages 128)
The Candidate
Examine this Patient for Ascites
The Candidate
PEARLS
Perform Ballottement (See also Bimanual Palpation of Kidneys on Pages 126 and Pages 128)
The Candidate
PEARLS
Examine the Engorged Abdominal Veins and Determine the Flow of Blood
The Candidate
PEARLS
Perform a Digital Rectal Examination
The Candidate
PEARLS
CHAPTER 9:
Examination of Genitourinary System
CHECK LIST FOR NEPHROLOGICAL EXAMINATION (FOR LONG CASES)
CASE WRITING TIPS
CHAPTER 10:
Examination of Nervous System
BASIC PRINCIPLES
NEUROLOGICAL EXAMINATION AS A WHOLE (FOR LONG CASE)
CASE WRITING TIPS
COMMON COMMANDS (SHORT CASES)
How would you check the level of consciousness?
The Candidate
How would you check memory of the patient?
The Candidate
How would you check the speech?
The Candidate
PEARLS
Check the Patient for Apraxia
The Candidate
PEARLS
Check the Patient for Agnosia
The Candidate
PEARLS
CRANIAL NERVES
Olfactory Nerve
The Candidate
PEARLS
Optic Nerve
The Candidate
PEARLS
Field of Vision
The Candidate
PEARLS
CHECK LIGHT AND ACCOMMODATION REFLEXES
Light Reflex
The Candidate
PEARLS
Accommodation Reflex
The Candidate
PEARLS
Examine this Patient for Squint
The Candidate
PEARLS
Perform Fundoscopic Examination
The Candidate
PEARLS
Examine Ocular Movements
The Candidate
PEARLS
Examination this Patient for Nystagmus
The Candidate
PEARLS
Examine the Trigeminal Nerve
The Candidate
PEARLS
Check for Corneal Reflex
The Candidate
PEARLS
Examine the Facial Nerve
The Candidate
PEARLS
Check for Taste Sensation
The Candidate
PEARLS
Check the Auditory Part of Eight Nerve
The Cochlear Part of 8th Nerve
The Candidate
PEARLS
Vestibular Part of 8th Nerve (Caloric test)
The Candidate
PEARLS
Examine Glossopharyngeal and Vagus Nerves
The Candidate
PEARLS
Examine Accessory Nerve
The Candidate
PEARLS
Examine Hypoglossal Nerve
The Candidate
PEARLS
Examine for Horner's Syndrome
The Candidate
PEARLS
MOTOR SYSTEM
Examination of Bulk of Muscles
The Candidate
PEARLS
Check for Tone of Muscles
The Candidate
PEARLS
Test the Power of Muscles
The Candidate
PEARLS
Check Power of the Individual Muscles
MUSCLES OF THE UPPER LIMB
Deltoid (C5, C6)
The Candidate
Supraspinatus (C4, C5, C6)
The Candidate
Infraspinatus (C5, C6)
The Candidate
Subscapularis [C5,C6,(C7)]
The Candidate
Rhomboids (C4 C5)
The Candidate
Latissimus Dorsi (C6, C7, C8)
The Candidate
PEARLS
Serratus Anterior (C5, C6, C7)
The Candidate
PEARLS
Pectoralis Major
The Candidate
Sternocostal Part (C7, C8 and T1)
The Candidate
Biceps Brachii (C5, C6)
The Candidate
Triceps (C6, C7, C8)
The Candidate
Supinator (C5, C6)
The Candidate
PEARLS
Brachioradialis (C5, C6 and C7)
The Candidate
Extensor Carpi Ulnaris (C7, C8)
The Candidate
Extensor Carpi Radialis Longus (C6, C7)
The Candidate
Extensor Digitorum (C7, C8)
The Candidate
Flexor Carpi Radialis (C6, C7)
The Candidate
Flexor Carpi Ulnaris (C7, C8)
The Candidate
Abductor Digiti Minimi (C8,T1)
The Candidate
Flexor Digitorum Superficialis (C7,C8 and T1)
The Candidate
Flexor Digitorum Profundus (C8 and T1)
The Candidate
First Palmar and Dorsal Interossei (C8 and T1)
The Candidate
Lumbricals (C8 and T1)
The Candidate
Abductor Pollicis Longus (C7,C8)
The Candidate
Abductor Pollicis Brevis (C8,T1)
The Candidate
PEARLS
Opponens Pollicis (C8 and T1)
The Candidate
Adductor Pollicis (C8 and T1)
The Candidate
Extensor Pollicis Longus (C7,C8)
The Candidate
Extensor Pollicis Brevis (C7,C8)
The Candidate
Flexor Pollicis Longus (C8 and T1)
The Candidate
Interossei (C8, T1) (Dorsal)
The Candidate
Interossei (C8 T1) (Palmar)
The Candidate
PEARLS
Trunk Muscles (Abdominal muscles) (T7 to T12 and L1)
The Candidate
PEARLS
Trunk Muscles (Erector spinae)
The Candidate
Iliopsoas (Iliacus-L2, L3), (Psoas-L1, L2, L3)
The Candidate
PEARLS
Diaphragm (C3, C4, C5)
The Candidate
PEARLS
MUSCLES OF LOWER LIMBS
Sartorius(L2, L3)
The Candidate
Adductors of the Hips (L5 and S1)
The Candidate
Abductors of the Hips (L2, L3, L4)
The Candidate
Extensors of the Thigh (L5, S1, S2)
The Candidate
PEARLS
Flexors of the Thigh (L1, L2, L3)
The Candidate
Rotators of the Thigh (Medial and Lateral L5, S1, S2)
The Candidate
Extensors of the Knee (L2, L3, L4)
The Candidate
Flexors of the Knee (L5, S1, S2)
The Candidate
Dorsiflexors of the Ankle [(L4, L5 and S1) (Dorsiflexion)]
The Candidate
Plantar Flexors of the Ankle [(L4, L5 and S1, S2, S3) (Plantar flexion)]
Eversion (L5 and S1, S2) Inversion (L4, L5 and S1)
The Candidate
PEARLS
Small Intrinsic Muscles (S1, S2)
The Candidate
PEARLS
Extensor Hallucis Longus (L5 and S1)
The Candidate
Extensor Digitorum Longus (L5 and S1)
The Candidate
COORDINATION OF MOVEMENTS
Check for Coordination in the Upper Limbs Method No. 1
The Candidate
Method No. 2
Method No. 3
Check for Dysdiadochokinesia Method No. 1
The Candidate
Method No. 2
Heel Shin Test or Heel Knee Tibia Test
The Candidate
PEARLS
SUPERFICIAL REFLEXES
Abdominal Reflex (T7-T12 and L1)
The Candidate
PEARLS
Cremasteric Reflex (L1 and L2)
The Candidate
PEARLS
Bulbocavernosus Reflex (S2, S3, and S4)
The Candidate
Superficial Anal Reflexes (S2, S3 and S4)
The Candidate
Plantar Response (L5-S1)
The Candidate
PEARLS
DEEP REFLEXES
General Principles
INDIVIDUAL TENDON REFLEXES
Jaw Jerk
The Candidate
Biceps Jerk (C5, C6)
The Candidate
PEARLS
Triceps Jerk (C6, C7, C8)
The Candidate
PEARLS
Supinator Jerk (C5, C6)
The Candidate
PEARLS
Knee Jerk (L2, L3, L4)
The Candidate
Method No. 2
The Candidate
Method No. 3
The Candidate
Method No. 4
The Candidate
Ankle Jerk (S1, S2)
The Candidate
Method No. 2
The Candidate
PEARLS
Method No.3
The Candidate
Method No. 4
The Candidate
MISCELLANEOUS REFLEXES
Check for Finger Flexion Jerk
The Candidate
PEARLS
Check for Hoffman's Sign
The Candidate
PEARLS
Elicit Wartenberg's Sign
The Candidate
PEARLS
GAIT
PEARLS
INVOLUNTARY MOVEMENTS
CLONUS
Patellar Clonus
The Candidate
Ankle Clonus
The Candidate
Wrist Clonus
The Candidate
PEARLS
SUPERFICIAL SENSATIONS
Touch
The Candidate
PEARLS
Pain
The Candidate
Elicit Deep Pain
The Candidate
PEARLS
Temperature
The Candidate
PEARLS
DEEP SENSATIONS
Sense of Vibration
The Candidate
PEARLS
Sense of Joint Position
Method No. 1
The Candidate
PEARLS
Method No.2
The Candidate
Methods No.3
The Candidate
PEARLS
Method No. 4
The Candidate
PEARLS
Romberg's Sign
PEARLS
CORTICAL SENSATIONS
Tactile Localization
The Candidate
PEARLS
Tactile Discrimination
The Candidate
The Candidate
PEARLS
Stereognosis
The Candidate
PEARLS
Graphaesthesia
The Candidate
PEARLS
Sensory Inattention
The Candidate
PEARLS
GENERAL PRINCIPLES FOR EXAMINING SENSORY SYSTEM
SIGNS OF MENINGEAL IRRITATION
The Candidate
PEARLS
PRIMITIVE REFLEXES
Palmomental Reflex
The Candidate
PEARLS
Grasp Reflex
The Candidate
Avoidance Reflex
The Candidate
PEARLS
Snout Reflex
The Candidate
Suckling Reflex
The Candidate
Glabellar Tap
The Candidate
PEARLS
CHECK FOR BRAINSTEM DEATH OR BRAIN DEATH
The Candidate
PEARLS
CHECK ELICIT PAIN IN THE PATIENT
The Candidate
PEARLS
ELICIT FOCAL NEUROLOGICAL SIGNS IN AN UNCONSCIOUS PATIENT
HOW TO CONFIRM THAT PATIENT IS PRETENDING PARALYSIS?
For Upper Limbs
The Candidate
PEARLS
Other Method
The Candidate
For Lower Limbs
The Candidate
PEARLS
CHAPTER 11:
Dermatological Examination
PRINCIPLES OF DERMATOLOGICAL EXAMINATION
Principles of Inspection
Principles of Palpation
STEP BY STEP FOR EXAMINATION OF THE SKIN (FOR LONG CASES)
The Candidate
CASE WRITING TIPS
COMMANDS
CHAPTER 12:
Examination of Musculoskeletal System
PRINCIPLES OF EXAMINATION OF MUSCULOSKELETAL SYSTEM
BASIC PRINCIPLES
Inspection (Look)
Palpation (Feel)
Movements (Move)
Measurements (Measure)
EXAMINATION OF MUSCULOSKELETAL SYSTEM AS A WHOLE (FOR LONG CASE)
The Candidate
OVERVIEW OF EXAMINATION OF MUSCULOSKELETAL SYSTEM
Inspection (Look)
Palpation (Feel)
Movements (Move)
Measurements (Measure)
X-ray
COMMANDS
Examine this Patient's Vertebral Column
The Candidate
Cervical Spine
The Candidate
Thoracolumbar Spine
The Candidate
Elicit Schober's Test
The Candidate
PEARLS
Demonstrate SLR Test
The Candidate
To Elicit Tenderness at Sacroiliac Joints
The Candidate
PEARLS
Temporomandibular Joint
The Candidate
PEARLS
EXAMINATION OF THE UPPER LIMB
EXAMINE THE SHOULDER JOINT
The Candidate
PEARLS
EXAMINE THE ELBOW JOINT
The Candidate
PEARLS
EXAMINE THE WRIST JOINT
The Candidate
PEARLS
EXAMINE THE METACARPOPHALANGEAL JOINTS
The Candidate
PEARLS
EXAMINE THE INTERPHALANGEAL JOINTS
The Candidate
EXAMINE THE MOVEMENTS OF THE THUMB
The Candidate
EXAMINE THE HANDS
The Candidate
PEARLS
EXAMINE THE HIP JOINT
The Candidate
PEARLS
EXAMINE THE KNEE JOINT
The Candidate
PEARLS
PEARLS
EXAMINE THE ANKLE JOINT
The Candidate
PEARLS
EXAMINE METATARSOPHALANGEAL JOINTS
The Candidate
EXAMINE INTERPHALANGEAL JOINTS OF THE FOOT
The Candidate
CHAPTER 13:
Patient's Record
CHAPTER 14:
Investigations
PEARLS
ROUTINE INVESTIGATIONS
PEARLS
SYSTEMIC INVESTIGATIONS
BIBLIOGRAPHY
INDEX
TOC
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