Expected date of delivery Estimated gestational age ing or routine) ‘Arrange main symptoms and duration OBSTETRICS & GYNAECOLOGY CLERKSHIPSECRETS SRR Drugs taken; Haematinics, Antimalarial prophylaxis, Anti retroviral others ‘Any new complaints (fever, flashes of light, bleeding per vaginam) Any illness since onset of pregnancy ‘Year of pregnancy ‘Term orpretern & outcome Labour (spontaneous or induced) & duration Modeof delivery Post partum events (PPH, shoulder Aaystocia, fever, stillbirth) Gynaccologic Ageatmenarche ‘Length ofeycleandperiod Hx of Menorthagia, Dyspareunia, Dysmenorthoea Contraceptives (Aware & Usage of) Abortions & procedures (Gestational ages, Mode of, Comp! Last Cervical smear:Previous surgery (Myomectomy, VVF Brea Re ‘With her arms by the sides, then in akimbo, thenraisedabovethe head Inspect for; symmetry, size, shape, skin over breast & its surroundings; areola, (Ss) she lies at 45a, tert first on 8 (Type), Oceupation of husband, Alcohol, smoking Plans for breastfeeding rans, nipple-areola complex & ‘mobility, attachment nodes (t-sse-man) No breast exam is complete until you've palpated forlymph nodes Review of System frequency, urgency, dysuria, Bone pain, joint sweling,, thes, weakness symphysio-fun pated <20 weeks, measure | >20 weeks CLERKsuP secrets (OO cuerksiup secreTs A CASE OF WRONG! OF DATE INSURE, HISTORY TAKING Hxof feeling fetal movements Biodata Hx of UTI, recurrent candidiasis, Name, age, occupation, level of vaginal discharge address, religion tribe Hx of any illness suffered Gravidity & parity Last menstrual period ‘ALEXAMINATION ination Determine symphysio-fundal height (SFA) Determine number of fetal poles; ? resentation (part of the the pelvic brim)CLERKSHIP SECRETS CUERKSHI SECRETS ay A CASE OF RHESUS NEGATIVE Hx of feeling fetal movements MOTHER: Hx of UTI, recurrent candic ACASE OF POST DATE (INTHE HX of UTI, recurrent candidiasis, 42x» WEEK) vaginal discharge lIness suffered HISTORY TAKING vaginal discharge of Treatment ‘ ‘any lle: Treatment so far reveived, booking Be NG eer Ultasound scan done, Naw HEGrivestniegs ‘Treatment 0 far received, booking ted datcof delivery. parameters, UI Estimated gestational age P&C (ifany) HPC ‘Symptom Analysis (ifany) PHYSICAL EXAMINATION General Examination Fever, Pallor, Jaundice, Dehydration, Pedal edem: Height & weight logy Previous pregnancies & Abdominal Exam rth, chronic hypertension , es (induced abortions, inspect; sized shape, s © contraindications to vaginal ectopies, molar delivery) J t N.B: Accuracy indating is Greater; ') If she kept @ menstrual cycle lendar before pregnancy had normal & reg If she was not breast Palpate Uterus & itgcont Delermine symphysiostusdel height If she was not on hs prior to pregnancy had an early Ultrasound sean, ideal 8-13 weeks, acceptable before 22 weeks number of fetal poles; ? lefetal poles fetal lie (relationship of the pathologic long axis of the fetus to that of the uterus) lotype or Kh Determine presentation (part of the Ix of fetus overlying thepelvie brim) 0 Dotetmine descent lerine fetal 8 Broast ExamCLERKSHIP SECRETS CLERKS! Hxof Treatment ‘Treatment so far received, booking Parameters, Ultrasound sean done, Urinalysis, Tetanus Toxo ‘malarial prophylaxis, Haemat compliance. ACASE OF BREEC A CASE OF HIV POSITIVE — HxofComplic MOTHER ions Hxofbleeding per vaginam Hxofliquor drainage HISTORY TAKING xf feeling fetal movements Biodata Hx of UTI, recurrent candidiasis, Name, age, occupation, level of vaginal discharge ‘cducation, address, religion, tribe Last menstrual period vay eas Expected date of delivery Estimated gestational age PC (Bpigastric discomfort’ pain) HPC ‘Symptom Analysis (DOCTOR) Di ous signs of inea nigra, Mat/everted Hx of Aetiology Hx of multiparity Hx ofn prea assisted reproduet (relationship of Jong axis of the fetus to Determine presentation (part of Polar {eusoveryngthepeviebrin) Determine symphysio-fundal height Auscultatefetalheartrate Determine number of fetal poles; ‘multiple fetal poles Thyre Exam Us toxoid, Determine fetal le (rel long axis of the ft Breast Exam iCLERKSIIP SECRETS CLERKSHI oS TT ACASE OF DIABETICMOTHER Hx of any illness suffered Hy ofbeeding per vaginam Hx of liquor drainage Hx of feeling fetal movements ACASE OF HYPERTENSION IN Hx of ‘Treatment PREGNANCY ‘Treatment so far received, booking parameters, Ultrasound scan done, Urinalysis, Tetanus Toxoid, Anti HISTORY TAKING ta Haematinies + compliance, oe Treatment so far received, booking, PHYSICAL £3 Last menstrual period General Examiny Expected date of delivery Fever, Pallor, Jaundice, Dehydration, Estimated gestational age Pedal edema Pc Asymptomatic most times, may be an incidental finding of hypertension + Inspect; size & shape, symmetry, inuria during routine ANC visit fetal movements, Cutaneous signs of Determine symphysio-fundal height (SFE) Determine number of fetal po ketoacidosis, multiple fetal poles eet Determine fetal lie (relationship of the long axis of the fetus to that of 1 height {SFI}; palpated <20 weeks, measure in em 220 wooks Se termine mumber of fetal poles; ? Determine descent Det be pol Auscultate fetal heart rate ing per vaginam Others; Hix of liquor drainage ‘Thyroid & Breast Exam Ix of feeling fetal movements BLUT, roeA CASE OF PREMATURE RUPTURE OF MEMBRANES (PROM) Feeling wed inab (duration) Pc Smplomanalysisusing:M2ctor Onset Course; no of times in the day {irequeney), ‘Variation in day nocturia Pier Symptoms; Dysuri, urgency, mena; Vaginal ‘CLERKSHIP SECRETS Hix of fishy, malodorous discharge (r/o Bacteri is) Acute chest infection/ Invasive procedures during pregnancy Hxoftobacco use premature rupure of membranes isa previous of preterm birth, Reeure Hx of Compticat HotiGuorientions Hixof feeling fetal movements Hx of UTI, recurrent’ candidiasis, vaginal discharge Hxofany illness suffered Hx of Treatment Treatment so far received, booking ul ‘malarial prophylaxis, and Hacmatinies:: compliance. PHYSICALEXAMIN General Examination Fever, Pallor, Jaundice, Dehydratioi Pedal ede: Height & weight Abdominal Exam Inspec Determine fetal lie (rela Jong axis of the fetus to uterus) Determine presentation (part 0 fetus overlying the pelvic brim) Determine descent leakage from Os on lum exam for dilatation wound scan for fluid (Discharge home + CLERKSHIP SECRETS EE | A CASE OF ANTEPARTUM. HAEMORRHAGE HISTORY TAKING Biodata Name, age, occu ‘education, address, Gravidity & parity PC Bleedingper vaginam> (duration) HPC ‘Symptom analysis using:doctor Duration Onset Course; Amount (estimate in mis & no of pads used) Colour (bright red or dark) Ce lots or vesicles) ‘Other symptoms; weakness, dizziness + fainting, dyspnoea, ankleedema Related Phenomena; abdominal pain, ‘rauma prio to onset, coitus Hxofanticongulanttherapy Determine gestational age; LMP, Pregnancy symptoms; nausea, breast tendemess, positive pregnancy test, ultrsound scan, quickening, Hxofliquor drainage Hx of reduced fetal movements (r/o Placenta abrupticCLERKSHP SECRETS EE CLERKStUP SECRETS CASE OF REDUCED FETAL — HxofComplications MOVEMENT) INTRAUTERINE — Hxofliquordrainage FETAL DEATH OR PREVIOUS — Hxoffecling fetal movements DELIVERY OF; STILL BIRTH) Hx of UTI, recurrent candidiasis, MALFORMED FETUS vaginal discharge Hex of any illness suffered Hix of Aetiology Placentapraevia « Previous uterine surgeries, D&C, ‘Myomectomy, sections High pavty or randmultipacity Advane age >35 (3 times & shape, symmetry, fetal Cutaneous signs of cy; linea nigra, Maveverted umbilicus & st STORY TAKING iodata Name, age, occupation, level of Previous Placenta praevia Placenta Abruptio ‘Trauma 7 ted date of delivery Increased _matemal age, increased pa sd gestational age it ine fetus overl ‘Height & weight ; Abdominal Exam feral age >35, Ob Thyroid Exam ont ize & shape, symmetry, fetal oats Cutancou Breast Exam of congenital ncy; gra, ‘vaginal discharge = umbilicus & striae gravidarum, Hx of any febrile illness suffered superficial veins, surgical scar, Hy or treatment ‘Treatment so far received, booking parameters, Ultrasound scan done, Urinalysis, Tetanus Toxoid, Anti prophylaxis, PILY THU TRANSFUSION SYNDROME; ey oer'a nchule: Intrauterine growah restriction. fetal anaes ial shea on af herpesast menstrual period | HPC ‘Symptom At Analyse pain usin, Sito A CASE OF ABDOMINAL PAIN IN PREGNANCY xpected date of delivery timated gestational age Abdominat pain * (duration) Onset Character Radiation CLERKSHIP SECRETS Allleviating factors Timing Exacerbating factors Severity Hx of Aetiology SITE cuaracter | RADIATION [DIAGNOSIS Lower abdomen ‘None topie rupture Lower abdomen Flank & thigh | Pelvie in, Disease [Right Lower quadrant BadWitanke ‘Appendicitis i Grain Renal stones ‘Scapular, Shoulder Gallstones Uterus & itscontent) jetermine symphysio-fundal height (SFR) Determine number of fetal poles; ? Multiple fetal poles Determine fetal lie (relationship of the Jong axis of the fetus to that of the uterus) Determine presentation (part of the fetus overlying the pelvie brim) ‘CLERKSHIP SECRETS IE A CASE OF HYPEREMESIS GRAVIDARUM HISTORY TAKING Biodata ‘Name, age, occupation, level of education, address, religion, tribe PC Excessive vomitin, PC ‘Symptom analysis using; doctor Ptyalism(excessive salivation) Hyperolfaction(enhanced sense of smell) Dysgeusia+ reduced gustatory discernment Relsted Phenomenaemployment, source of py, ial support Determi Ix of diets & habits (smoking & alcohol) of Complications EissE Guamplcaton fetal movements iront candidiasis, regnane} ates(Uterus & it ine “symphys ins, surgical scar, ie number of fetal pol fetal ie (relationship of the fetus to that of the Presentation (part of the lying the pelvic brim) fered cent fetal heartrate Hxof Treatment Fisatment so far received, booking Chery param rasound sean done, ‘Thyroid Exam Breast Exam GYNAECOLOGY CLERKSHIP. Ex shape, symmetry, eta movements, Cutaneous signs of ea nigra, flat/everted striae gravidarum, ‘CLERKSHP SECRETS ‘Trauma, Hereditary, Infections, Nut letabolic, Auto’ /Allergic, Intoxicants/Idiopathic, Drugs/Degenerative, Endocrine, Neoplastic, Smoking ‘Hx of Complications Using ; Neuro response since admission Gynaecologic History ‘Age at menarche 2 Duration of menses (3-7 days) Cycle Menstrual abnormalities; dysmenorrhoca, menorriagia, intermenstrual bleeds Dyspareunia (superficial or deep) Contraception; aware + usage of Miscarriages/ terminations with surgeries Previous Pap smear resultPast Obstetries History. Details ofeach ‘ost partum events (PPH, Fever) Sexofbaby & Birth weight Days spentb/4 discharge Children} Puerperium Drug Hx & Allergies Family History Diabetes, Hypertension, Sickle cell . disease (Type), Occupation of Icohol, smoking ‘CLERKSHIP SECRETS [EI CLERKSHIP SECRETS Sy Pelvic Exam Informed consent Il equipments (speculum, Jelly, swabs, ayre’s spatula) ready ‘before the patient isexposed Position; dorsal (most times), (prolapse) Renals; frequency, urgency, dysuria, loin pai le she lies at 450, start first Bono pain, joint swelting, leaches, weakness 3 Rash, sear, pruritus, swelling may uncover problems sims i patient overlooked; a direct exploration usually enhances clinical picture & aid diagnosis, “Some Examiners therefore prefer review of systems immediately after theHPC, ‘complete uni palpated forlymph nodes, Describe samd for vagina & cervix when the speculum is Passed Complaints & duration, ings, Investigations done Speculum exam | Bimanual exam it the exam & obtain ient should undress 10 PHYSICALEXAMINATION General Examination Fever jaundice, dehydration, ‘abnormal hair height, weight & BMI distribution, Thyroid Exam Inspect, Palpate, Percuss, Auscullal (Enlarged, Tender, Nodular?) With her arms by imbo, then raised above(CLERKSHIP SECRETS [IEE ACASE OF INFEI HISTORY TAKING Biodata lity to achieve pregnancy x (Guration) B Frequency of coitus (normal 2-3 times/wk) Pre! post coital pr lubricants & douches) Timing of coitus; if around ovulation (use of Hx of contraceptive usage & for long? Hypothalamo- Hix of cold intolerance, weight gain, decreased appetite (r/o Hypothyroidism) Hx of abnormal milk discharge from breast (galactorthoea) Hx of abnormal hair distribution (beards, chest) Hx of premenstrual symptoms; fatigue, mid-cycle pain (makes ovulation likely) Menses; pattem, length, duration, volume’ Tubal & Hx of previous vaginal discharge & ‘bdominal pain ( pe Hx of perforate Hx ofpertenitis Male Partner Oceupat ary) ‘Hx of previous purulent dj urethra + Dysuria & frec ‘smoking, alcohol use, therapy CLERKSHDP SECRETS Ey Palpate while she lies at 450, start first on the The 4 quadrants, axillary tail & express nipple-areola complex Ifa mass is felt, check for temperature, tenderness size, surface, consistency, edge, mobility, attachment, nodes (tts ‘you've palpated f Abdominal Exam,HISTORY TAK Bi Name, age, occupation, level of ‘education, religion, tribe, marital ‘confinement Last menstrual period Course; Amount (estimate in mls & no of pads used) Colour (bright red ‘or dark) Content (clots) Character rofuse or spotting) symptoms; weakness, Ss fainting, Dyspnoea (ed Phenomer KALLMAW'S SINDROMB: Congoiellypogonnisroph CLERKSHIP secrets IEE CLERKSIP SECRETS Timing EXAMINATION ACASE OF UTERINE, Other symptoms; dysmenorthoes, a PROLAPSE dyspareunia, + discharge ce, dehydration, Related Phenomena; frequency HISTORY TAKING (pressure on bladder), constipation + ic abnormal hair distribution, — lodaie vomiting (pressure on rectum), ‘weight & BMI edematous leg swelling (pressure on lymphatics) ‘Name, age, occupati education, religion, lum exam; usually palpable Hx of Aetiology (risk factors) Hx of heavier but regular periods Hx of intermenstn usually due to necrosis Hx of mild ramping pai ties to expel polyp Hx of posteoital bleeding (1/0 Lastconfinement Last menstrual perio! ‘vam 'alpate, Percuss, Auscultate imp coming down the vagina (Guration) Hix of acute abdominal pain(rio Torsion of eyst) Hx of abdominal pain in pregnancy(r/o Red degeneration) Hx of rapid increase in size, anorexia, weight loss (metastasis) Hx of urinary frequency or retent Hx of cons Hx of subfertlity (rare, excey there is synchronous bilateral blockade or tumour disto endometrium) Hx of Treatment Investigations; Ultra ‘Treatment; medical therg done, + response to complianceCLERKSHIP SECRETS CLERKSHIP SECRETS [ETRE A CASE OF VESICO VAGINAL Hx of amenorthoea (i/o chemical STULA, cendometritis) Hx of Aetiology Increased parity & vi ‘cough, constipation oF Pelvic exam Bimanual exam ‘Vaginal exam; Sims speculum observe prolapse on staining (ORY TAKING ata Inspeet, Palpatc, Percuss, Auscultate 8B, occupation, level of apetite, weight | PP: + marital insomnia, suicidal ideati f previous unsupervisedidifficult discord (ro depression) dellverios ibdomen for symmetry, Hex of previous hysterectomy vault air distribution, scars, prolapse was, done? Route of repair + compliance, Spouse support Hx of incor Hx of Dysparenia PHYSICALEXAMINATION Hix of recurrent back mg midline for masses ion dullness, do fluid Hx of manual re tions done, ultrasound scan, urodynamic studies, full blood count, efuler Treatment ; kegel exercises, lise of pessaries, surgery # response PHYSICAL EXAMINATION » General Examination Fever, pallor, jaundice, dehydration, pedal edema abdomen for symmetry, distribution, sars, Ask for any region of pain then proceed to light palpation for tenderness Deep palpation for liver, spleen & ballot the kidneys long:nidline formassesACASE OF LATE/ REDUCED/ABSENT MENSES HISTORY TAKING Last confinement Last menstrual period Pc Absenv/reduced menses x (duration) 0; periodic or const Timing Other symptoms; vagi Related Phenomena; Female acie/physique is menstrual flow \ ‘menarche, pattem of flow, gt CLERKSHIP SECRETS IY CLERKSHIP SECRETS (Eames Hx of penetrative sex (if teenager) + 6 Syncope ‘Months; socrates Site; located in. pelvis ‘Onset ‘Chai r Hx of smoking & multiple sexual Partners (r/o STDs) Hx of assisted conception (r/o IVE, GIFT) ig factors; Unrelieved by IIfor _Exacorbating factors 8 < lousness Severity sudden falls fing factors a Hx of Aetiology Severity Hx of Treatment Hx of multiple sexual partners, ‘multiple marriages Determine gestational age; or LMP, Prognai = eS Hx of previous Sexually transmitted diseases.exusu secners EES eekstur secRsTS I A CASE OF VAGINAL Colour (cleas, white, green, bloody, Ux of predominant left sided pain(t/o Pelvic Exam DISCHARGE brown) Character (watery, frothy, Diverticulitis) Digital exam; fornices are tender mucoid, curc-tike) Bimanual exam; cervical excitation HISTORY TAKING ‘Timing; sexual stimulation, nt pain over several tendemess Biodata periovulatory months (1/0 Torsionofcyst) Abdominal Exam Name, age, occupation, level of Other symptoms; pruritus, pyrexia, HX of amenorrhoea, loss of Inspect, Palpate, Percuss, Auscultate ccducation, religion, tribe, marital pain consciousness (1/0 Eetopic/molar (IPPA) Related Phenomena; gestation) Inspection Use of tampons: urin TOF Abdominal pain, vaginal Inspect the abdomen for symmetry, Use of Drugs; OCPs, bleeding (r/o Abort ‘movement, hair distribution, scars, Hx of recent tise o Hx of dyspareunia (r/o Pelvic Palpation deodor adhesions) Ask for any region of pain then Hxofdysmenorthoea & infertility (fo proceed to palpation for Endometriosis) ‘endemess (general paper), allergies Lx of cyclical pain post hysterectomy Deep palpation for liver, spleen & Hx of overuse of ti ings, (v/oResidual Ovarian syndrome) ballotthe' nylon panties (groin heat & Hx of vaginal fullness (r/o ‘moisture) Uterovaginal prolapse) Hx of wiping from back to front Hx of sexual abuse Hxof Complications Hx of post ¢% on Bowel sounds, renal bruits Hx of mood changes, ivtabilty, Girenisn insomnia (r/o depression) Moderate | whitish Malodorows ++ Yeasty Hxof Treatment Fishy = = Pabpatin ‘al Torany region of pin then proceed io ligt palpation foe weight & BMICASE OF CERVICAL! ENDOMETRIAL CANCER HISTORY TAKING Biodata Last confinement Last menstrual period PC Bleeding per vaginam (duration) MPC ‘Symptom analy’ Duration Onset Course; Amount (estimate in mls & no of pads used) Colour (bright red or dark) Content (clots) Character (malodorous & profuse) Timing Other symptoms; weakness, dizziness + fainting, dyspnoca Related Phenomena; 1/o Pregnancy is using; doctor Hx of Aetiology He suggestive of Cervical cancer Hx of early coitache Hx of LERKSHIP SCR Hx of previous Sexually transmitted diseases Hx of multiparty Hx of postcoital bleeds: Hix of post menopausal blecds(v/o Endometrial Cancer) Ask about frequency of such bleeds Previous Hx of pruritus & retroviral status Previous Pap smear results (if any) Palpate, Percuss, Auscultate Previous Hx of COCP use & oe, tbdomen for symmetry, in (r/o Vag abd mmetry, Pees tin ee Vagal Ini dsbation, ca, “© vaginal dryness (r/o Atrophic region of pain then ight palpation for laceration) Hix of intermenstrual bleeds coagulant therapy Hx of contraceptive(s) use Hx of Complications Hx of fistula Hx of reduced urine output ‘Hx of cough, haemoptysis, dyspnoe Hx of Treatment done, blood; fe, ‘efwlr, liver function tests, uti & mols, chest x-ray, ultraso & urogram, psy & sampling, ‘Treatment so far received; ‘chemotherapy + response to treatmentCLERKSHI? SUCRETS me duration, onset, charactet/course, iming, other symptoms in the affected tem, related pheniomena RY CLERKS Y TAKING tibg ““UPAtlon, address, Causes (Fix of eetclogy) should be sought for & autoimmune/a ischaemia/ ia casualty or clinic and nona on admission efore the presen Intravenous , blood transfus d & dosing intervals + and response sincepatient about the physic chest & abdomen, provide aserven & adequate lighting position & stand on the Inspect & palpate apical impulse ‘Note the location, amplitude & Check for hepatomegaly & ast tate the lung bases for CLERKSHIP SECRETS [TIN ‘CLERKSHIP SECRUTS (ETC ‘Ask for any region of pain then eed to light palpation for 1e physical exam & obtain consent Expose; patient should undress to expose the chest & abdomen, provide a soreen & adequat Position; supine po the righ h Inspect the chest symmetry, chest ‘movement, count respiratory iroduce yourself, inform physical exam & should expose the sereen & adequate Stiainconent tipne poston & stand on muscle & jointsweats, Of amenotrhoea, reduced flow, (to Endocrine effec insomnia irita ns (ro Neuromuscul blurring of visi fects) Hx of residing in hilly/mountainous reas Water source from streams or borehole, do others have goitere community? (r’o Endemicity) Hx of use of tolbutamide, CLERKSHIP SECRETS Tama INALHERNIA ‘rss: forretrostemal extension uscultare:forbruits Proptosis while behind address, igations done, (Natlrigger’ sign le, ic acid, val (Ultrasound, x. Go in front & check: one, oral contraceptives . Lidretraction Dalrymple’ si eral; whether referred Treatment; Intravenous infusions, ‘Staring gaze (s \PoSure to irradiation dhugs received & dosing intervale-+ Conjunctival red ) Fesponse, ty or clinic and n(mr. mad) remove scarf & expose neck, Position; she should sit in chair lump using; doctor how many weeks, months or Mun slessness (hyperthyroidism), 8: ect, uftiness polyphagia (rate & rhythm), Blood chronic cough, r # domaing tremors & upper limb ity iptoms; abdominal pain Phenomena; worsened by or standing? Does emer or diffuse? shin jal_myxoedema, Ask Patient to swe ion, protruding, ing but l cyst moves as she tongue) alpate HxofTrauma Jn front; temperature, tend Hxoflifting heavy objects trachea, Hx ofaCLERKSHIP SECRETS Hx of abdom ‘appendicectomy damage of i inal surgery; (i/o Traumatic erve) © cough, chr straining to stool(vo traabdominal pressure) x (Dysutia, fequency, incontinence (Cio Prostatism) (CLERKSHP SECRETS [I] LADDER OUTLET. TION ‘A PROSTATE, RAL STRICTURE) HISTORY TAKING Biodata Name, age, occupation, address, Ux Of varicose veins (Wo Saphena isarms aro religion, tribe vacix) Stoop to 1 ’ Hx of serotum feeling like bag of — Penis(circumcision, ‘meatal openin, ther referred ‘worms (to Varicocoole) & Inguino scrotal axes shape, solitary or doub Hxof Complications swelling, scar of previous its surround: cougivimpulse Palpate fi Hx of colicky abdominal anorexia & vomiting (0/9 Obstrh in casualty or clinic and duration on admission (mr, md) Pc Difficulty in passing urine x (Guration) Hx of Care treatment) Since onset of symptor aids & hospitals visited, On admission; Invest Asies? then proceed to check for fluctuaney, tran: for palpable cough impulse, mss ask; home Ask patenttoligon the coach igations done; urinalysis. (Hx of investigations & ints analysis & Course Duration; Other symptoms; lower urinary tract symptoms (imitative & obstructive) Related Phenomena; Dysuia (CALEXAMINATION Examination Place your index finger at {tubercle & ask the patient to cou I hemia bulges superio to the tubercle, a ulges inferiorly & lat lor, jaundice, clubbing, Iymph Pedal oedema CosTocHONDRAL.S*NOROMRy, ‘Patches wth endren on oor merceCLERKSIIP SECRETS CLERKSHP SECRETS p Hx of fever & pain (r/o UTI, Acute prostatitis) Investigations done; lysis prostate specific :ymptoms; chest x-rays Hx of haematuria (pai Intravenous vido); Hx of weak (poor) stream Hx of intermittency (stop-start Hx of paint worker, cigarette phenomenon) hol(r/o Ca. bladder) ‘Hx of straining (in urethral stricture, of resi Straining improves stream, but forks oF sprays out) Expose; sereen patient he should remove n; Left lateral Dart the buttocks & assess anal hygiene, inspect for anal tags, hhacmorthoids, fissures or fistulas, Ask patient to bear down while checking for protusion orprolapsed anal sphineteric tone, rectal content, rectal wall mass’ &/or tenderness ion) Hix of retention of urine Hx of incomplete voiding (feel some remnant urin Hx of terminal blood dyserasi Hx of loin pain radiating to the Broin+ passage of parti te abdomen for symmetry, (r/o urethral stones) emia orifices for vis Hx of painful b region of pain then ight palpation for ‘Check stai (normal stool + blood) on gloved finger Hx of anorexia & weigh for liver, spleen & fatigability « Hx of Back pain & paraplegia Cardiovascularexam (metastasis to bone) do fluid thrill for Respiratory exam Hx of Cough & haemoptysis ‘Neurological exam (metastasis to lungs) ‘Musculoskeletal exam of trauma (r/o Urethral stricture) urologic surgery or renal bruits+CLERKSHIP SECRETS CLERKSHIP SECRETS I(r ACASE OF APPENDICITIS Hx of Cause (Hx of aetioto, : Ix of i 7 Aulafoerbometsymponatice Eu Cite xo nvexiains & Hx of dyspepsia, sudden eee ee fossa (r/o Perforated PUD) ‘Hx of abd pain relieved by leaning forward + Steatorrhoea (r/o Cholecystitis) wundice, TV drug abuse (cloAcute hepatitis) Hx of abdominal cramps, profuse PC bloody/mucoid diarthoca + weight Abdominal pain x (duration) HISTORY TAKIN ls, renal bruits | Plus digital rectal exam casualty or clinic and uration on admission (mr. md) Cough test, Bed ized guarding (voluntary) & involuntary) Blumberg's in painful distress, pallor, hydration ints analysis & Course ‘lexamination {1PPA} erates ero ies) colicky or dull Hx ofdysuria& frequency (”UTI) Hx of scrotal pain & swelling (r/o Testicular torsion) is). Hx of menses; LMP (r/o Ectopic, Mid "8, cyclepain| may have progressed to sharp, constant or intense May be associated Obturator sign; flex rot reetal Cardiovascularexam Respiratory exam Neurological exam Museuloskeletal examn tundice, bone pain, recu 1g factors; movements fusions (r/o Sickle cell Severe enough to obstruct daily activities Also ask of; fever, jaundice, ‘uprapubie pain, dys ation(r/o obstructio {LUMATER VINSON SYNDROME: Esophageal teCLERKSHIP SECRETS [py CLERKSHIP SECRETS (Tm my 7 any point of pain (palpate it hunger Light palpation for tendemess over ugh to affect daily ‘he nine regions systematically Deep palpation for iver, ball Name, age, religion, tl ic and on admission (mr, md) sounds, renal bruits Digital rectal exam Others; Cardiovascular exam AIPPA} Respiratory exann Hh Rapport; - Neurological exam PUD or Ca stomach Masculoskeletal exam Hx of blood group (PUD). group A (Ca stomach) short in Cancer wudden or recurrent (PUD) iy have progressed ice (ca '0 eat (Gastric ulcer) stomach), a fever (iCLERKSHIP SECRETS TTY (2a of preceeding abdominal surgery, (r/oAdhesion & Bands) address, Ask alsoabout; ions & Bands) ale of reteral; whether referrea {5°84 groin/abdomn from any hospital becomes ai means; via casualty or clinic and Hernia) ‘duration on admission (mr. md) Hx of an bleeding, Tumour) Hx of chr lorexia, weight loss rectal abdominal mass (r/o or duration on admission (mr, p Difficult ty with swallowing x (duration) Analyse vomitingusing: doctor Duration Onset; gradual orsudden GUE! Fecent meals, Billous fds or 11 fuecutent Ix of fever, weaknes: 1 Shxortecurence Hyofdecrensedaes Symptoms; profuse, persistent inesis tor Is ‘© progressed to toswallow saliva na; Non projecti Acreascd frequency, anorexia, nausea Analyse Abdominal: painidstente Using; soer Other symptoms; abdominal mass, regurgitation, vomiting, wei Related Phenomen: hos; d On admission plain abdominal, BUC Radiation, Exacerbating tuctors; arityHx of foreign body; bor ingestion PHYSICAL EX; (tlo Foreign body) General examinati CASE OF ANORECTAL { Hx of swallowing corrosives (r/o Note painful distress, pal E Corrosive strictures) j Jaundice, + malnourished Hx of epigastric pain related to meals, recurrent heart b {Gastroesophageal reflux disease) establish Ray PEE EAKIN Hex of anorexia, w s, obtain consent, Expose; he shor 2 Htundiee, alcoho, cigarette abuse (xo i IS, FISSURES, move sin ftom Nipliser oe age, occupation, address, fe oesophagus) Position; Paties ibe ‘of progressive swallowi dificult, fst : I; whether refered Achalasia) Hx of chronic fever & diarrhoea, ae, pain on swallowing (ro Oesophageal ire abdomen for ‘candidiasis in symmetry & movement Of steroids (Wo Ask pat nganal mass» (lu bleeding (dura Hex of easy. dizziness Co 4 is using; doctor Hx of cough & recurrent chest infections fatigability, weakness, itstart taneous or manual renal bruits itals visited, rectal exam Respiratory exam Added sounds (cre CLERKSHIP SECRETS (ETT Hx ofperianal boils, (vo Fistul ugh, drenching night loss Hx of yellowness of hnematemesis or varicose Portal hypertension) Hx of child bith & surgery during birth treatment) Since onset of symptoms, ask; home Ads (sitz baths) & hospitals visited. On admission; Investigat blood, electrolytes & urea, urinaly endoscopy radioloCLERKSINP stCRETS PHYSICALEXAMINATION General examination Notepatior, jaundice, malnourished A CASE OF SURGICAL JAUNDICE, (CHOLELITHIASIS & CA HEAD OF PANCREAS) Systemic examination lominalexam HISTORY TAKING Gist REP patient; establish Rapport; nnn Cbiain ‘consent, Expose; he should Names Wve shirt from Xi thigh, supine, age, occupation, address, temum to religion, tibe Position; Patient lies ofrecent travels, ofeating contaminated foods of alcohol abuse A of IV drug abuse, tattooing, nected sexu Inspection; ‘Squat at eye level from the foot of the bed & from the right side to Inspect, ire abdomen for symmetry PC Yellowness of theeyes x (duration) Abdominal pain x Complaints analy Analyse jaundice using; doctor ion for tendemess over the regions systematically Duration & Onset ipation for hhow/vhen was itnoticed? kidneys rmittent or deeper symptoms (GIT) appetite, abd Vomiting, hacmatemesis, bowel habit, weight loss Related phenomena; pruritus, ¢ Urine, easy bleeding ‘hifting dullness, do fluid formassive ascites lyse abdominal pain Others; Socrates Cardiovascularexam Reg Me (beachwear mel epigastric pain radi iliac fossa (ro Pe Hx of abd pai lieved by leaning forward + steatorrhoea (r/o Cholecystitis) Hx of abdominal pain + conjunc arthritis & urethritis (s/o R syndrome) fever, vomiting, right pain (r/o Acute 1x of Complications HR ofGealis asters, tured speech, loss of consciousness(i/0 Hepaticencephatopathy) Tot lorexia & weight loss, casy fatigability naemat Hx of polyuria, p polydipsia (vio Diabetes Mellitus) Hy of Care (Hx of investigations & reatment Since ansel of symptoms, ask; home aids & he |, occult blood, ova & par ragound Soa CLERKSHP SECRETS ppm‘Treatment; Intravenous glucose infusions, blood transfusions, { Intramuscular vitamin K, antibiotic drugs received & dosing intervals, urinary catheter + surgery & response here & when itoccured 1s of Cause (Htx of aetiology) Mechanism of injury (asabove) ‘mode of referral; whether referred fiom any ‘means; Via casualty or clinic and duration on admission RC ‘Abdominal injury » (duration) Ascites, Hepato-splenomegaly; size, shape, surface, consistency, pulsatile ipport; he should veins or venous collaterals, ites, Previous scar. Rectal Analyse Stab’ Gunshot wound us doctor CLERKSILP SECRETS EI talexam bs, muscle & joints Cardiovascular exam, Respiratory exam ‘Neurological exam,CLERKSHIP SECRETS ACASE OF BURNS INJURY s& 4 CASE OF HYDROCEPHALUS) tres NEURAL TUBE DEFECTS HISTORY TAKING Fol me aids; cold Biodata funning water on burnt area, & Name, age, occu re fmetgency room care; 100% oxygen urs, endotracheal diabetes mellitus, hypertension Hix of as preterm delivery rimates, Hx of labour; spontaneous, induced, mode of referral; whether referred religion & tribe; or prolonged from any he informant Hix ‘means; via casualty or clinic and uration on admi ission (mr, md) RC Bums injury « (duration) oF injury, agent 'e burns, arca of body Hx of Cause (Hy of a ‘Mechanism of injury (as aboce te base of ulcers for i Consistency of healed scar & tation of joint movements in fractures NDR cam eabiaagansmnon teton psn we ta gasraeinatonydomeanour & rishment, note apparatus around thee febrile, check for pallor, jaundice, cyanosis, dehydration, Deripheral lymph nodes enlargement finger clubbing, pedal edema Anthropometric measurements; CLERKSiP SECRETS HE ‘bour; spontaneous, induced, or vin forceps, or caesarean ory distress +/- birth mode of referral; whether referred from any hospital ‘means; via cher or clinie and duration onadmission rar. md) m= iodominal ischsprungdisease) Other symptom: poor suck, excessive ery Related Phenomena; ss during pregnancy Heotpolsiydramais Hx of prescription medicines, drugs Hrxofradiation exposure diabetes melitus, hypertension Hrxofas preterm delivery