SURGICAL FINALS Passing the Clinical - PasTest

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