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Additional resources for Making sense of clinical examination of the adult patient: hands-on guide
Arteritis, that is, inflammation of small arteries 3. infective endocarditis. 3 Splinter haemorrages Koilonychia This is a spoon or concave shape of the nail in its transverse diameter that is occasionally seen with severe iron deficiency. Pitting Pitting is pin-sized holes in the nails that are seen in association with psoriasis. White nails Statistically, white nails are associated with chronic liver disease, but they also occasionally occur in healthy people. Yellow nails Yellow nails are occasionally seen with bronchiectasis.
The first doctor he saw ordered an electrocardiograph and a computed tomography scan of his head. A second doctor took a more detailed history and uncovered the facts that the patient worked a 60-hour week and was under a lot of stress. Explanation and a slight adjustment of the patient’s working week completely resolved his symptoms and enabled him to jog again. One way of finding out about hidden emotions is to take any opportunity that presents during the course of the history. During the psychosocial history, for instance, when asking about the patient’s occupation, it is a good idea to also ask how he feels about it, and if he has a boss and it seems appropriate, how he gets on with him or her.
Pets: Keeps a dog and a cat. ) ● Hobbies: Goes to the theatre and art galleries. Jogs twice a week, cycles to work, hikes at weekends. ● Smoking: 10 cigarettes per day for 20 years; stopped 10 years ago. ) ● Alcohol: 3 units per day (where one unit is half a pint of beer, a wine glass of wine or a measure of spirits). HISTORY-TAKING 27 ● Recreational drugs: Smoked one or two cigarettes of marijuana a month until 10 years ago. ● Spiritual life: The patient is a practising Catholic. Says he thinks a lot about the meaning of life and whether there is a life hereafter.