Lecture Notes Clinical Skills by Robert Turner

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By Robert Turner

An organization favorite of scientific scholars and junior medical professionals, Lecture Notes on scientific abilities covers the basic ideas and strategies of background taking and exam, and gives assistance at the key expert talents interested in constructing and preserving reliable verbal exchange among health professional and sufferer. This new fourth variation has been revised to supply up to date info on methods and a better emphasis at the patient-centred strategy.

First category medical talents are important for all scientific scholars and medical professionals. This pocket-sized speedy reference consultant exhibits you the way to take an entire background; how one can study a sufferer completely; the way to request the main applicable investigations; and the way to place all of this jointly and are available to a analysis

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Bimanually: stand behind the patient and palpate with fin° Palpate gers of both hands. Is the thyroid of normal size, shape and texture? ° If a lump is felt: 42 Chapter 2: General Examination – is thyroid multinodular? – does lump feel cystic? ° ° ° ° ° ° The thyroid is normally soft. g. g. autoimmune thyroiditis, thyrotoxicosis Goitre – multinodular A swelling does not mean the gland is under- or overactive. In many cases the patient may be euthyroid. The thyroid becomes slightly enlarged in pregnancy.

Start examination at 1 m from the patient, identify red reflex and approach the patient at an angle of 15° to the patient. Approach on the same horizontal plane as patient’s equator of their eye. This will bring the observer straight to the optic disc. After observing the disc examine the peripheral retina fully by following the blood vessels to and back from the four main quadrants. – Use your right eye for patient’s right eye, left eye for patient’s left eye. g. g. tumour accelerated hypertension optic neuritis, acute stage – glaucoma — enlarged cup, diminished rim – new vessels — new fronds of vessels coming forward from disc; ischaemic diabetic retinopathy Look at arteries – arteries narrowed in hypertension, with increased light reflex along top of vessel Hypertension grading: 1 narrow arteries 2 ‘nipping’ (narrowing of veins by arteries) 3 flame-shaped haemorrhages and cotton-wool spots 4 papilloedema.

Inspect Look at: ° – skin – redness — inflammation scars — old injury bruising — recent injury soft tissues muscle wasting — old injury 46 Chapter 2: General Examination swelling — injury/inflammation Varus – bones ° ° ° deformity — compare with other side Varus: bent in to midline Valgus Valgus: bent out from midline Assess whether an isolated joint is affected, or if there is polyarthritis. If there is polyarthritis, note if it is symmetrical or asymmetrical. Compare any abnormal findings with the other side.

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