2ND

Year

DOCTOR
COMMUNITY HEALTH
INTEGRATED CURRICULUM

Islamic International Medical College

RIPHAH INTERNATIONAL UNIVERSITY
 DOCTOR COMMUNITY HEALTH INTEGRATED CURRICULUM

DOCTORS COMMUNITY HEALTH MODULE

PLACEMENT IN CURRICULUM Vertical Module in 2nd Year
MODULE DURATION 3 Weeks in 2nd Year
PRE-REQUISITE All Modules of 1st Year

SUPERVISED BY
Dean FHMS / Principal, IIMC Lt. Gen. (Retd) Prof. Azhar Rashid HI (M)

Vice Principal, IIMC Brig. (Retd) Prof. Maqsood-ul-Hassan

Chairperson Curriculum Committee Prof. Saadia Sultana

MODULE TEAM
MODULE DIRECTOR Prof. Abdul Ghani abdul.ghani@riphah.edu.pk
Waseem
MODULE COORDINATOR Dr. Shahzad Akhtar shahzad.aziz@riphah.edu.pk
Aziz
MODULE CO-COORDINATOR Dr. Sadiq Jan

CURRICULUM COMMITTEE
Chairperson Curriculum Prof. Saadia Sultana, saadia.sultana@riphah.edu.pk
Committee
Prof. Obstetrics & Gynecology
Member Curriculum Committee Prof. Madiha Sajid madiha.sajjad@riphah.edu.pk
Prof. of Pathology Minhas
Member Curriculum Committee Dr. Tahira Sadiq madiha.sajjad@riphah.edu.pk
Assoc. Prof. Comm Med
Member Curriculum Committee Dr. Nighat Qamar nighat.qamar@riphah.edu.pk
Assoc. Prof. ENT
Member Curriculum Committee Dr. Uzma Naeem uzma.naeem@riphah.edu.pk
Assoc. Prof. Pharmacology
Member Curriculum Committee Dr. Wajiha Shadab uzma.naeem@riphah.edu.pk
Assoc. Prof. OBGYN
Member Curriculum Committee Dr. Saddaf Ayub saddaf.ayub@riphah.edu.pk
Assist. Prof. Biochemistry

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ACADEMIC TEAM
COMMUNITY MEDICINE Dr. Shahzad Akhtar Aziz
MEDICINE Dr. Saqib Habib
SURGERY Dr. Zahid, Dr. M. Asad
OBSTETRICS & GYNAECOLOGY Dr. Sadaq Jan
PEDIATRICS Dr. Saba Afzal
COMMUNICATION SKILLS Dr. Uzma Naeem

INTRODUCTION The rationale of this module is to expose a beginner to the hospital and community in
/RATIONALE
multiple disciplines at the start of their medical career.
Early hospital exposure will help the student to overcome his / her own feeling of hesitance
from patients. It will also inculcate interest in the medical students to see patients with
different ailments. They will learn basic bed side manners and other skills and attitude
necessary for a healthy doctor- patient interaction.
On the other hand by going to the community, our medical students will appreciate the
relationship of factors in the community leading to disease development. This will help
students understand how disease prevention can be done by improving health education,
community behavior and modification of the environment. They will understand the
community health problems and national / international efforts to solve them
The student will be exposed to concepts of research, basic requirement for research and will
develop the competency for research.
COMPETENCIES  KNOWLEDGE
 Student will be able to know the structure of basic and tertiary health care system
 Student will be able to know the common complaints with which the patients come
in various disciplines of hospital.
 Students will be able to understand the basic components of history and
examination that form the basis of diagnosing a clinical problem.
 Students will be able to understand the basic components of demographic profile of
the community and various vertical / horizontal health care programs working in
rural areas
 SKILL
 Students will be able to take history in a proper sequence for different clinical
problems in various specialties.
 Students will be able to demonstrate steps of clinical examination.
o Students will be able to collect the data regarding various health problems
o The student will develop basic competency for research. They will be able to

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develop research tools for collection of data and research material. They will
also be able for research writing specially literature review, compiling results,
discussion and references. At the end will be able to publish the research in
reputable journals.
 ATTITUDE
 Students will be able to demonstrate communication skills while taking history from
the patients.
 Students will be able to demonstrate bed side manners while examining patients

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COMMUNITY VISITS

TOPIC LEARNING OBJECTIVES LEARNING ASSESSMEN

STRATEGY T TOOL
Health Education  Define health education LECTURE MCQS
And Communication  Enlist the barriers of communication
 Describe health communication
 Enlist aims and objectives of health education.
 Health education activities i.e. promotion of SGA OSPE
breast feeding
Approaches and  Describe approaches to health education. LECTURE MCQS
Principles of Health  Differentiate between health education
Education models
 Describe the principles of health education
 Describe practice of health education
 Health education activities i.e. nutrition SGA
Health Programs  Discuss national health programs lecture MCQS

 Immunization status/family planning SGA MCQs

services/nutritional survey
Data  Breast Feeding SURVEY MCQs
Collection/Interpretatio  Family Planning
n  Immunization
 Nutrition
Data Collection/  Personal Hygiene SURVEY MCQs
Interpretation  ARI
 Diarrhoeal Disease
 Sanitation Survey
Data Collection/  Health care waste management SURVEY MCQs
Interpretation  Population demography
 T.B./Malaria/Dengue
 Diabetes and Hypertension
COMMUNICATION SKILLS

CONTENT LEARNING OBJECTIVES LEARNING ASSESSMENT

STRATEGY TOOL
Opening A  Describe importance of doctor patient 1 Hour Interactive OSPE
Consultation (Doctor relationship Lecture
Patient Relationship)  Discuss purposes of consultation 1 Hour activity
 Enlist different phases of consultation
 Discuss required behavior of a doctor for
consultation
 Enlist different tasks of opening phase
 Perform opening phase of consultation
according to checklist
Mid Phase  Explain the steps of mid phase of consultation 1 Hour OSPE
Consultation (Building  Demonstrate the mid phase of a medical Interactive
Rapport) consultation with a simulated patient according Lecture
to a check list. 1 Hour activity
Closing A Consultation  Enlist and explain the steps of closing a 1 Hour Interactive OSPE
consultation Lecture
 Demonstrate steps of closing consultation 1 Hour activity

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DISCPLINE / TOPIC LEARNING OBJECTIVES TEACHING ASSESSMENT

VISITS STRATEGY TOOLS
MEDICINE
VISIT - 1 HISTORY TAKING  Demonstrate history taking from a BED SIDE OSCE
– BASIC sick person under the following TEACHING
PRINCIPLES headings. Patient’s profile
Presenting complaint
History of present illness
Past medical and surgical
history
 Treatment history
 Family history
 Socioeconomic history
 Systemic history
VISIT – 2 HISTORY TAKING  Demonstrate history taking for BED SIDE OSCE
TEACHING
FOR A GI AND the following common presenting
RESPIRATORY symptoms
PROBLEM  Vomiting
 Diarrhea
 Hematemesis
 Jaundice
 Dysphagia
 Cough
 Dyspnoea
 Haemoptysis
 Sputum

VISIT – 3 HISTORY TAKING  Demonstrate history taking for BED SIDE OSCE
FOR A
the following common presenting TEACHING
NEUROLOGICAL
AND symptoms
CARDIOVASCULA
 Headache
R
 Vertigo
PROBLEM
 Weakness
 Loss of consciousness
 Chest pain
 Dyspnoea
 Palpitations
 Ankle swelling
 FORMATIVE ASSESSMENT

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SURGERY
VISIT- 1 History Taking in  Take history in a patient with Bed Side OSCE
Abdominal Pain abdominal pain Teaching

VISIT- 2 Intramuscular  Describe the techniques of Bedside OSCE

Injection intramuscular injections Teaching
 Observe administration of
intramuscular injections
VISIT-3 Wound Dressing  Describe the concept of Bedside OSCE
sterilization and disinfection Teaching
 Describe the items used in
dressings
 Observe application of bandages
OBSTETRICS & GYNAECOLOGY
VISIT - 1 Obstetric  Perform obstetric examination SGA OSCE
Examination demonstrating
 Inspection
 Symphysiofundal height
measurement
 Fundal grip
 Lateral grip
 Powlik’s grip
 Bimanual pelvic grip
 Fetal heart auscultation
 Demonstrate the steps of
assessment of descent of
presenting part on patient/dummy
including
 Abdominal assessment by
rule of 5th
 Pelvic assessment by
determining the station
VISIT - 2 Bishop Scoring  Demonstrate the steps of bishop SGA OSCE
scoring by doing vaginal
examination
 Describe the components of
bishop scoring
VISIT - 3 Pelvic  Demonstrate the steps of pelvic SGA OSCE
Examination examination on dummy/patient
including
 Inspection
 Speculum examination
 Bimanual pelvic examination
PEDIATRICS
VISIT -1 History Taking Demonstrate taking a comprehensive Bedside OSCE
history from a patient. Teaching
VISIT- 2 History Taking Demonstrate taking a comprehensive Bedside OSCE
history from a patient. Teaching
VISIT -3 Vital Signs Record vital signs and anthropometric Bedside OSCE
measurements in a child Teaching

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CHECKLIST MEDICINE

EXAMINE THE ABDOMEN OF THIS PATIENT

CLINICAL SKILLS DONE NOT MARKS

DONE
Approaches from right side. Introduces Him / Herself. Explains Exam & takes Permission.
Makes proper exposure and position
Inspection :
From the foot-end & right side Shape & symmetry. Position & shape of umbilicus.
Hair distribution, dilated veins, scar, visible bulge.
Asks patient to cough to check for hernia.
Palpation ( Superficial and Deep Palpation)
Enquires for any pain before starting palpation. Palpates with Hand flat against abdomen,
commencing at a point remote from the site of any pain, In sequence, covering all
quadrants and looks at patient’s face throughout palpation
Visceral Palpation.
LIVER :
Starts palpation from RIF, Asks the patient to take deep breath. With each expiration
advances the hand by 1or 2 cm closer to right costal margin with each expiration & during
Inspiration keeps the hand still.
If liver palpable, assess the consistency, margin & surface.
Percuss the lower and upper border of the liver and measures the total span.
SPLEEN
Starts deep palpation from RIF .Asks the patient to take deep breath & palpates .Palpates
for spleen in supine position, while left hand supports ribcage posteriorly
Palpates for spleen in right lateral position, while left hand supports ribcage posteriorly.
Right Kidney
Places left hand beneath 12th rib posteriorly in cost vertebral angle & right hand parallel to
rectus muscle anteriorly. Pushes the kidney back and forwards between the two hands.

Same for left Kidney. Left hand supporting ribcage and right hand palpating
PERCUSSION
Shifting Dullness :
Start percussion from epigastrium towards umbilicus and then moves laterally, until dull
note appears.
Keep the fingers in place & then the patient to opposite side.
After 10 seconds starts percussion from same location & trace back till dullness is felt
again.
Fluid Thrill :
Ask the patient to place his/her hand in midline over rectus muscle.
Place one hand flat on left flank, and strike right flank with right hand.
See if there is any palpable thrill.
Auscultation: Auscultates for bowel sounds, liver spleen and renal bruit.
Re-covers and thanks the patient.

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CHECK LIST FOR EXAMINATION OF CHEST

YES NO
Before Examination
1. Greets the patient
2. Introduces himself / herself
3. Explains the process to the patient
4. Seeks permission for examination from the patient
Examination of back of chest
1. Helps the patient in proper exposure and positioning
Inspection:
a. Inspects carefully for any deformity / Scar / Bulge / discoloration / Flattening asymmetry of
chest
Palpation
a. Palpates carefully for any tenderness
b. Does apical palpation
c. Palpates for chest excursion movements at four different points backs at the back of chest
Percussion
a. Does apical percussion on both sides
b. Does percussion on at least four symmetrical points at the back of chest
Auscultation
a. Places stethoscope correctly on the least four different symmetrical points a the back of
chest
b. Asks the patients to take deep breath
c. Keeps stethoscope at one point for at least one complete respiratory cycle (inspiration +
expiration)
d. Checks for vocal resonance on at least four different symmetrical points
Examination of front of chest
1. Helps the patient in proper exposure and positioning
Inspection
a. Inspects carefully for any deformity / Scar / Bulge / discoloration / Flattening / Asymmetry
for chest movements
Palpation
a. Palpate carefully for any tenderness
b. Palpates for position of traches
c. Localizes Apex beat
d. Palpate for chest excursion movements at three different points at the front of chest
Percussion
a. Does supraclavicular / Clavicular / infra Clavicular / percussion correctly on both sides
b. Does percussion correctly on at least three different points symmetrically on front of chest
c. Percussses lateral part of chest at symmetrical points
Auscultation
a. Places stethoscope correctly on at least three different symmetrical points at the front chest
b. Asks the patients to take deep breath
c. Keeps stethoscope at one point for at least one complete respiratory cycle (inspiration +
expiration)
d. Checks of vocal resonance on at last three different symmetrical points

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e. Auscultation lateral part of chest at symmetrical points

After examination
1. Thanks the patient
f. Helps him in redressing

PALPATE THE FRONT OF CHEST

CLINICAL SKILLS DONE NOT MARKS

DONE
Introduction and greeting (1)
 Approaches from right side. Introduces Him / Herself. Explains Exam & takes
Permission. Makes proper position and exposure.
Palpation of the FRONT OF CHEST (8)
Palpates carefully for any tenderness
Palpates for position of trachea
Localizes Apex beat
Palpates for chest excrusion movements at three different points at the front of
chest
Thanks the patient, helps him in redressing (1)

EXAMINATION OF MOTOR SYSTEM

CLINICAL SKILLS DONE NOT MARKS
DONE
Introduces Him/Herself.
Takes Permission & Explains Exam.
Proper posture and exposure. Patient should be supine.
Inspects and compares bulk on both sides.
Looks for any fasciculation /abnormal movements.
Measures mid-thigh and mid-Calf diameter and compares with other side.
Checks Tone of Lower limb.
Check &Compares power on both sides
Asks patient to dorsi-flex and plantar-flex ankle joint against resistance.
Asks patient to flex and extend Knee joint against resistance.
Asks patient to flex, extend, abduct & adduct Hip joint against resistance.
Check. Reflexes( Knee, Ankle & Plantar)
&Clonus ( if applicable )
Co-ordination (Heel-Shin test )
Examines the Gait
thanks the patient

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CHECKLIST PEDIATRICS

TOPICS CHECKLISTS
History 1. Introduce yourself.
2. Ask about demographic data (name, age, gender, place of residence).
3. Ask the presenting complaints.
4. Take a detailed history of presenting complaints.
5. Ask about past history.
6. Take a detailed birth history.
7. Ask about feeding history.
8. Take a detailed developmental history.
9. Take family (consanguinity, diseases) and social history.
10. Ask about immunizations.
Vital signs 1. Introduce yourself.
2. Pulse.
a. Take brachial pulse in infants. And count for 1 minute.
b. Take radial pulse in older children and count for 1 minute.
3. Respiratory rate
a. Remove clothes from the chest.
b. Count respiratory rate in a sleeping or calm child for 1 minute.
4. Temperature
a. Check the thermometer for the reading.
b. Place the thermometer in the armpit and hold it in place for 1- 2 min.
c. Remove the thermometer and recheck the reading.
5. Blood pressure
a. Choose an appropriate sized cuff for the child (covering 2/3rds of arm).
b. Take B.P. by palpatory method.
c. Repeat by using a sphygmomanometer.
6. Correlate findings with age appropriate norms.
Anthropometry 1. Weight
a. Choose the right age appropriate equipment
b. Check the pointer and adjust at zero.
c. Lie down an infant on the infant weight machine and take the reading.
d. Make the child stand on the weight machine with loose hands and take the reading.
2. Length/ height
a. Place the infant on the infantometer with head on the fixed side and feet on the
sliding side.
b. Hold the legs in straight position with vertical feet and take the reading.
3. Fronto-occipital circumference.
a. Place the inch tape around the head at the nucchal posteriorly and one finger
above the glabella and take the reading.
GPE 1. Take consent.
2. Look at the general appearance.
3. Take vital signs.
4. Take anthropometric measurements.
5. Examine skin for bruises, petechiea.
6. Check hands for clubbing and pallor.
7. Check eyes for anemia and jaundice.
8. Check oral cavity for thrush , dental carries and pharygitis.
9. Palpate anterior fontanelle in infants.
10. Examine the cervical, axillary and inguinal lymph nodes.
11. Examine thyroid gland.
Respiratory 1. Take consent
system 2. Listen for abnormal sounds (stridor, wheeze)

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3. Examine for cyanosis, chest deformities, chest indrawings

4. Percuss chest anteriorly, posteriorly and laterally
5. Auscultate chest anteriorly, posteriorly and laterally
6. Perform vocal resonance
Abdominal 1. Take consent
examination 2. Inspect abdomen
3. Palpate for tenderness and masses
4. Palpate and percuss the liver
5. Palpate and percuss the spleen
6. Palpate kidneys
7. Perform shifting dullness and fluid thrill
8. Examine hernia orifices
9. Examine back
10. Examine genitalia.
Cardiovascular 1. Take consent
system 2. Examine for central and peripheral cyanosis, clubbing, oral hygiene, JVP, oedema.
3. Examine pulses
4. Check blood pressure with appropriate sized cuff
5. Examine shape of precordium and pulsation
6. Palpate for pulsations and thrills
7. Auscultate precordium for heart sounds.

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CHECKLIST OBSTETRICS & GYNAECOLOGY

ROLL NO. -
Obstetric Examination-Check List Total marks-10
Makes Rapport with the patient Marks
1. Greets the patient 0.25
2. Introduces herself to the patient 0.25
3. Explains the procedure to the patient 0.25
4. Takes informed verbal consent from the patient 0.25
5. Enquires about voiding 0.25
Performs inspection of abdomen correctly on a subject/model
1. Helps patient in proper exposure 0.25
2. Makes proper position for examination 0.25
3. Spends at least 30 seconds in observing the abdomen from foot end &/or side of the bed.
4. Comment regarding
i. Shape of abdomen.
ii. Symmetry of abdomen. 0.25
iii. Localized / General, (distention, swelling) 0.25
iv. Position and shape of umbilicus 0.25
v. Movement of abdominal wall
vi. Visible fetal movements
vii. Visible Pulsation
viii. Presence of Scar / Striae 0.25
ix. Presence of prominent superficial viens
x. Pigmentation / De-pigmentation of abdominal wall 0.25
xi. Presence of Hernias 0.25
Performs palpation of abdomen correctly on a subject/model
Steps
1. Tells the patient to relax 0.25
2. Enquires about the site of pain 0.25
3. Makes her hands warm before palpation (in cold weather) 0.25
4. Positions her wrist and forearm in the horizontal plane while palpating abdomen 0.25
5. Makes superficial palpation in all nine quadrants of abdomen correctly looking at face of patient
0.25

Obstetric examination
1. Measures SFH in centimeters 1.5
2. Places both hands correctly on the side for fundal grip 0.5
3. Places both hands correctly on the side with fingers pointing towards the rib for lateral palpation.
0.5
4. Demonstrates Pollick’s grip 0.5
5. Demonstrates bimanual pelvic grip 0.5
Auscultation of fetal heart sounds
1. The fetoscope should be placed on anterior fetal shoulder along with the palpation of maternal radial pulse for
1 minute 1.0
Closing the session
1. Thanks the patient 0.25
2. Covers the patient back 0.25
3. Tells her to lie in left lateral position 0.25
4. Keeps count of fetal movements 0.25

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Roll no
Assessment of descent abdominally - CHECK LIST Total Marks 10
Introduces herself/himself. 0.5
Takes consent. 0.5
Properly exposes / covers before examination. 0.5
Demonstrates Powlik’s grip 1
Demonstrates bimanual pelvic grip 1
Demonstrates 5/5 palpable 1
Demonstrates 4/5 palpable 1
Demonstrates 3/5 palpable 1
Demonstrates 2/5 palpable 1
Demonstrates 1/5 palpable 1
Demonstrates not palpable per abdomen 1
Dress/ cover the patient 0.5

Roll no
BISHOP SCORE - CHECK LIST Total Marks 10
Introduces herself/himself. 0.5
Takes consent. 0.5
Properly exposes/ covers before examination. 1
Wears gloves. 1
Measures cervical dilatation. 1
Measures Length of the cervix 1
Assesses Consistency of the cervix 1
Assesses Station of the presenting part. 1
Assesses Position of the cervix 1
Calculates the score 1
Dresses/ covers the patient 1

GYNAECOLOGICAL PELVIC EXAMINATION

Makes rapport with the patient
1. Greets the patient
2. Introduces her/himself to the patient
3. Explains the procedure to the patient
4. Takes verbal consent from the patient
5. Enquires about voiding / or any area of tenderness
Vaginal Examination
1. Places patient in dorsal position, hips flexed and abducted and knee flexed
2. Inspects the vulva under good light
3. Inserts the bivalve (cusco’s) speculum with blades in horizontal plane
4. Takes papsmear correctly
5. Performs bimanual digital vaginal examination using right hand and left hand is
placed on abdomen. Both hands are used to palpate size, shape position,
mobility and tenderness of uterus. Places fingers in both fornixes to examine
the adenxas
6. Make the patient comfortable and counsel for rectal examination

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Closing the session

1. Thanks the patient
2. Covers the patient up
3. Encourages her to lie in a comfortable position

HISTORY TAKING GYNAECOLOGY

Makes rapport with the patient
1. Greets the patient
2. Introduces her/himself to the patient
Profile
Name, w/o, age, married for how long, consanguinity, parity, LMP, education of both
partners, occupation of both, residential address & contact number
Presenting Complaints
Leading complaints in chronological order
History of present Illness
1. Details of resenting complaints in sequence
2. Explains symptoms
3. Systemic review
Gynaecological History
1. Menarche
2. LMP
3. Menstrual cycle
4. Dysmenorrheal
5. Dyspareunnia
6. Pap Smear
7. Minor & Major Gynaecological Procedures
8. Contraception
Obstetrics History
1. Married for how long
2. Consanguinity
3. Gravidity, parity, miscarriages
4. Mode & gestational age at the time of deliveries / details of miscarriages
5. Number of living children
6. Immunization & breast feeding
7. LCB
Past History
1. Past medical history, hospital admission, surgical history, drugs, allergies,
transfusions.
Family History
1. Family history of HTN, diabetes melitis, cardiac disease and other diseases
running in families. Gynaecological cancers or infectious diseases
Socioeconomic History
1. Living details, family framework

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HISTORY TAKING OBSTETRICS

Makes Rapport with Patient
1. Greets the patient
2. Introduces her/himself to the patient
Profile
1. Name, w/o, Married for, consanguinity, parity, LMP, education of both
partners, occupation of both, residential address & contact number, date &
mode of admission.
Presenting Complaints
1. Gestational age, leading complaints in chronological order.
History of Present Illness
1. Confirmation of pregnancy, history of booking visits, trimester wise history.
1st Trimester – Folic acid intake, dating scan & investigations.
2nd Trimester – Intake of tonics, quickening, tetanus prophylaxis & anomaly
scan.
3rd Trimester – Tonic, growth scans, frequency of visits & plan of delivery.
Current problems with their aggravating and relieving factor and treatment.
Obstetric History
1. Married for how long
2. Consanguinity
3. Gravidity, Parity & Miscarriage
4. Mode of gestational age at the time of delivery / details of miscarriage.
5. Number of living children
6. Immunization & breast feeding
7. Last child born
Gynecological History
1. Menarche
2. LMP
3. Menstrual cycle
4. Dysmenorrhea
5. Dyspareunia
6. Pap Smear
7. Major & Minor Gynecological procedure
8. Contraception
Past History
1. Past medical history, hospital admission, surgical history, drugs, allergies &
transfusions
Family History
1. Family history of HTN, Diabetes mellitus, cardiac disease and other diseases
running in families. Gynecological cancers or infectious diseases.
Socioeconomic History
1. Living details, family framework
Time keeping, eye contact, sympathy & empathy

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Roll No.
PAP SMEAR
Makes rapport with the patient
1. Greets the patient
2. Introduces herself to the patient
3. Explains the procedure to the patient
4. Takes informed verbal consent from the patient
5. Labels the slides with name of patient, date & time
6. Wears gloves
7. Swab clean the area
8. Select cuscos speculum
9. Take smear from squamocolumnar junction stick aseptically
10. Spread on two slides
11. Single layer cytology (by using single stroke on side)
12. Fix with the alcohol
13. Air drying of slides
14. Fills request form with name, age, LMP, test required and use of
hormones, history of PCB/IMB (if any)
Closing the session
1. Thanks the patient
2. Covers the patient back

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Surgery Checklists DCH Module

Abdominal Examination
 Introduction
 Consent
 Exposure (from xiphisternum to symphysis pubis( ideally up to midthigh)
 Inspection from foot end and from right side:
 Shape of abdomen
 Movement with respiration
 Scar marks
 Swelling
 Striae
 Pigmentation

Palpation:

 Superficial Palpation
 Deep Palpation
 Individual organ Palpation: Liver
 Spleen
 Bladder
 Kidney
 Palpate the left Supraclavicular fossa

Percussion:

 Individual organ percussion(Liver, Spleen, bladder, any other mass)

 Percussion for ascites (shifting dullness)
 Percussion for ascites ( fluid thrill)

Auscultation

 Bowel Sounds
 Succussion Splash

Ask the patient to sit-up:

 Inspection: any swelling

 Cough Impulse
 Renal Punch

Ask the patient to lie down again:

 Inspect the groin

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 Cough Impulse
 Femoral Pulse
 Inguinal Lymphadenopathy

Genitalia Examination and digital rectal Examination are ideally part of abdominal
examination

Examination of Ulcer

Inspection

 Site
 Side
 Size
 Edges
 Floor
 Discharge
 Surrounding area

Palpation:

 Tenderness
 Temperature
 Depth
 Base
 Distal neurovascular status
 Draining Lymph nodes

History in a patient with Bleeding per Rectum

1. Introduction
2. Since when there is bleeding Per rectum?
3. What is the color of blood
4. Is bleeding is in drops or there are clots as well.
5. Is bleeding mixed with stools or comes after defecation
6. Does any mass come out upon defecation
7. (If yes to the above question) does the mass spontaneously reduces /needs manual
reduction.
8. `Is there is any pain on defecation
9. History of easy bruisibility
10. History of bleeding from other orifices

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Digital Rectal Examination

 Introduction
 Consent
 Exposure
 Position :
Left lateral with right Lower limb fully flexed and left lower limb partially flexed.

Alternative positions: knee Elbow position

Lithotomy position

The following examination checklist proceeds with patient assuming the left lateral
position.

Inspection:

Any scars/swellings/sinuses/redness in the perianal area

Palpation:

With Lubricated, gloved, Index finger of right hand

Ask the patient if he /she feels any pain during the examination, then inform the
examiner
Palpates within the lumen (Hard or soft stool, mass)
 Asks the patient to strain(any higher mass may become palpable)
 Palpates the wall )any thickening or growth)and
 Palpates outside the wall (any pararectal tenderness, prostate gland)
Takes the finger out and watches the finger for any staining

Wipes the area with gauze piece

Thanks and covers the patient.

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TEACHING HOURS

KNOWLEDGE SKILL
TOTAL
SUBJECTS INTERACTIVE SGA SKILL LAB
SGD HOURS
LECTURE Total No. Hours(2) Total No. Hours(2)
Surgery 0 0 0 0 3 6 6
Medicine 0 0 0 0 3 6 6
Gynaecology 0 0 3 6 0 0 6
Community
3 0 3 6 3 6 15
Medicine
Communication
3 0 3 6 0 0 9
Skills
Paediatrics 0 0 0 0 3 6 6
TOTAL HOURS 6 0 9 18 12 24 48
Last Updated: 15 February 2021

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