Topic Progress:

 

WHEN I READ – identify THE CASE – outline
RAPPORT  building is the most important in this exam – if the patient tells me all, I can manage all and score the marks – 
 
in a typical short case plan as 
4 mins history 
1 min – ex ( ask the examination findings – do not ask nonrelevant things eg, VE in gout ) 
3 min – management
 
THERE WOULD BE ONLY ONE PHYSICAL EXAMINATION CASE – 
give running comment 
 
There would be a medicolegal case
there can be a critical appraisal case. 
    • Counseling station – the patient should direct us – ( answer their concerns ) 
    • Management station – we talk more – 
Hence the amount of us we talking would be balance based on case – so would be the marks at a station – 
 
WHEN AT EXAM _ 
      • Understand the case – what to do ( if a single session  – no ix results ) 
      • structure the consult at the door in 3 min – 
      • once you sit – use visual skills 
      • If its a new patient to practice – well come the patient – ask about the move and settling in if needed – be casual 
      • during consult take a hint from the examiner  – do not go in thinking what the diagnosis is 
      • If they say ATSI – the case is ATSI 
History taking  – 
be methodical and focused – 
 
every thing in history is important – 
eg – if he states he is going in a trip overseas – might have relevance – ( eg COPD and fitness to travel )
 
IS the patient young – remember confidentiality, and HEADASS
remember ICE 
IS it a STD – remember the history 
If from overseas – ask if they are comfortable with english and can offer translator 
DO NOT BE IN PRE OCCUPATION – ( eg – 71 year old can be very active ) 
even in some mx only questions, you mat need some history questions 
 
ASK OPEN-ENDED QUESTIONS A FEW times – take a hint from the examiner/ patient ( the patient is highly scripted ) 
 eg what symptoms have you experienced
     tell me more about it 
Empathyic coment – it sounds horrific/traumatic, 
 
( see the structure section ) 
Presenting complaint – 
history of presenting complaint – pain history / lump history 
relevant systemic inquiry to exclude D/Ds
 
LOW/LOA Night sweats. 
 
Insomnia – 
 
How has this affected your life / ADL/ your activity/socializing/ friends / 
 
PMHx 
PShx  
 
Medications and allergies – all ways ask compliance ————— especially in chronic diseases ( don’t assume the patient takes the medications, just because the list is present ) 
 
Family history 
 
Alcohol, Smoking, Exercise and nutrition ( SNAP ) 
Tell me more about your home situation
Tell me more about your work env. 
Is there anything that I have not asked, but you think you should tell me 
ask not “do you drink” – ask “how is your alcohol intake”
                                               ” how is your smoking” 
 
generally we can relay on given printed history – 
but some times need to confirm alcohol and smoking ( eg; if the patient is going through depression ) 
 
Ideas – what doyou think the cause is 
Concerns – why are you concerned of it ( eg brother had bowel ca ) 
Expectations – what is the expectation of the patient via the consult 
communication and rapport 
maintains a pleasant consult
make communication clear
flow is logical 
– use proper language  – ( child / adult/ truck dirver ) 
 
be empathetic – this is about getting in to his shoes / try to feel what he feels , eg – if patient says he is anxious – acknowledge it 
and use ACTIVE LISTENING 
talk non verbal ques ( nod and smile ) 
this needs to be done once or twice in every case so the examiners can mark it 
 
no medical jargon – ( but can explain after saying the medical word ) 
 
when a diagnosis is given – watch for response and make sure the patient understands 
 
PATIENT CENTERD APPROACH 
we don’t talk at the patient – we talk with the patient 
  eg – based on what you tell me, i think you have depression – so I think seeing a psychologist would help you – how do you think about you 
                   Involve patient in decision making – 
                   let him talk  
   do not say you must see a psychologist 
 
EXAMINATION – 
Ask Grouped 
General appearance 
BMI
BP ( postural drop ) , PR, RR, Saturation and hydration 
LN and thyroid
K10 
 
General examination – clubbing, palmar erythema, 
 
CVS – Pulse ( rate/rhythm/character/volume ) , BP, JVP, Peripheral edema, APEX , Parasternal heaves, thrills, heart sounds with murmurs 
Respi – shape of chest, expansion, percussion note, trachea position, auscultation 
Abdomen – superficial or deep tenderness, organomegaly/hepatosplenomegaly/ kidney and bladder , PR and PV after taking patient consent 
Nervous system – cranial nerves, LL/UL – power/ sensation/reflexus – tremor sp in elderly, 
Mental health – 
 
Vision and hearing ( vision correctable with pin hole ) 
 
Joints 
Rash 
Ulcer 
 
INVESTIGATION – 
first ask surgery tests – 
      • ECG
      • Urine dip stick
      • Urine pregnancy 
      • RBS
      • Spirometry 
do not do unnecessary tests
 
Diagnosis – 
Ability to make an accurate diagnosis on interpretation of history, examination and investigations – 
One should be able to deduce a problem list ( during the history, examination and investigations are done ) 
 
However- remember, getting the correct diagnosis does not pass you at the exam. Its the process of getting a diagnosis and managing the patient which is looked at 
 
Mx 
Patient-centered please – should be shared decision making 
 
safety netting – review 
Family involved
 
allied health, 
Public health – must be covered 
 eg – childhood diarrhea – hand wash and childcare
 
be within my strengths in consult – 
 
PREVENTION _ NOT TO BE DONE IN SHORT CASE UNLESS YOU HAVE TIME 
 
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