Abdominal Examination: How to describe.

Learn How to describe other systems and pathological conditions.

| Abdominal | Respiratory | Cardiovascular | Nose and PNS | Oral Cavity | Ear | Digital Rectal Examination | Ulcer | 

Describing an abdominal examination.

>>Before you perform examination may be you should know what a history of pain abdomen looks like.

Inspection

Abdomen is flat (scaphoid/distended), moving corresponding with respiration (silent).

The umbilicus is centrally (more towards xiphisternum or symphysis pubis) placed and inverted (slit like/everted).

Flanks are not full.

A horizontal scar of around 15cm around 5 cm away from the umbilicus anteriorly and 5 cm away from vertebrae posteriorly us present. Multiple erythematous papules present over the abdomen.

No visible or dilated veins, no visible peristalsis and no visible pulsations present.

Hernial orifices are intact

No supraclavicular and renal angle fullness.

>>Take a look what the various scars in abdomen mean.

Palpation

Palpation of Liver 

On palpation, there is no local rise in temperature and no tenderness.

No masses palpable on superficial palpation and deep palpation. (If any mass palpable describe the mass accordingly in terms of size, shape, tenderness, consistency, border, margin, intraperitoneal vs retroperitoneal vs abdominal wall)

Liver and spleen were not palpable. (If organomegaly describe according to its size from anatomic landmarks, tenderness, surface, margins, borders, consistency. If liver is palpable, the percussion of the chest for its upper margin and the liver span should also be mentioned.)

Kidneys were not ballotable.

Renal angle tenderness present over the right side.

No gross deformity seen on genital examination

Supraclavicular lymph nodes were not palpable.

Percussion

Tympanic note was present all over the abdomen. (If dullness present, mention about shifting dullness and fluid thrill.)

Auscultation

Normal bowel sounds heard, 3/min.

Per rectal examination was not performed.

>>No abdominal examination is complete without digital rectal examination. 

Learn How to describe other systems and pathological conditions.

| Abdominal | Respiratory | Cardiovascular | Nose and PNS | Oral Cavity | Ear | Digital Rectal Examination | Ulcer | 

Examination of Ulcer: How to describe.

Learn How to describe other systems and pathological conditions.

Abdominal | Respiratory | Cardiovascular | Nose and PNS | Oral Cavity | Ear | Digital Rectal Examination | Ulcer | 

Examination of an Ulcer

(The description below does not match with the images given beside the text. The images are only for illustrative purposes.)

Inspection

Ulcer over the sole.

On inspection of the right leg, the leg is slightly elevated on the pillow and slightly flexed over the knee joint. (Attitude of the limb).

A single (number), irregularly shaped (shape) ulcer of size around 10 cm x 5cm (size) is present over the dorsum of the foot (site), extending from the lateral malleolus up to the base of the toes (extension).

The floor of the ulcer is pinkish to red (color) with minimal (amount) serous (type of discharge) discharge. No slough, foreign bodies or any other debris (Content on the floor). Multiple tendons are visible towards the distal end (base).

The edge of the ulcer is sloping type (character), with healthy pink granulation tissue (content) and the margin is sharp and regular.

The surrounding skin is exfoliated upto the level of ankle joint. The skin around the ulcer is non-erythematous, and non-edematous. No scars, abnormal pigmentation, or excoriation marks present.

The joint mobility of the proximal and distal joint along with that of the entire limb is not impaired. (Gross motor status and Range of motion of the affected joints)

Palpation

Ulcer over the dorsum of foot

On palpation, there is local rise in temperature and mid tenderness over the ulcer.

The edges are not indurated and the base of the wound are also not indurated. The ulcer is 3-4mm deep, does not bleed on touch, and mobile over the underlying base.

The skin around the ulcer has mild rise in temperature locally with tenderness present. The skin is freely mobile on the underlying structure.

Dorsalis pedis artery, anterior tibial and posterior tibial artery are palpable and bilaterally symmetrical. Capillary refill time over the distal phalanges is more than 2 s.(Gross vascular status)

Active and passive range of motion over the limb is not restricted. Sensation is grossly intact over the area distal to the ulcer. (Gross Neurological status and range of motion)

The draining lymph nodes over the left inguinal region are not palpable significantly.

Ulcer examination is incomplete without draining lymph nodes palpation. 

Learn How to describe other systems and pathological conditions.

Abdominal | Respiratory | Cardiovascular | Nose and PNS | Oral Cavity | Ear | Digital Rectal Examination | Ulcer | 

Digital Rectal Examination: How to describe

Describing a rectal examination and prostate

(Per Rectal examination is a part of abdominal examination and no per rectal examination is complete without perineal examination, per rectal examination and examination of supraclavicular node (Nodes of Virchow) along with renal angle tenderness. The following describes a normal finding of per rectal examination. If any abnormality or significant findings it must be described 

accordingly.)

Inspection

On inspection of the perineal area, no redness, no any perianal mass or tag, no fissure, no ulceration or any sinus opening seen.

Palpation

No palpation of the perineal area, there is no local rise in temperature, no tenderness felt. No any palpable mass present.

Digital Rectal Examination

The tone of the sphincter is normal with no tenderness is present.

The anal canal is empty and no hard masses, impacted fecal material and polyps are palpable.

The mucosa overlying the anal canal is soft and mobile. There is no any palpable ulceration and fungating mass on examination of the walls of anal canal.

The prostate is enlarged and the upper border can not be palpated. The consistency is firm, the surface is smooth and borders are regular. The median sulcus can be palpated well and the mucosa overlying the prostate is freely mobile.

No blood stain was present on the tip of the finger at the end of digital Rectal Examination.

7 Tips to excel in Medicine: Presentation

7 tips to excel medical theory exams | Answer to the Point | Common Format |Divide and Rule|Clinical Corelation | Highlight |Whats the question | Neat |

Answer writing techniques in medical and allied subjects.

Tip 1: Answer to the Point.

Tip 2: Answer any disease condition in common subheadings.

Tip 3:  Systematic listing of causes, complications, medication and  investigations.

Tip 4: Include point of clinical significance

Tip 5: Focus on the important points.

Tip 6: Understand what the question wants you to write.

Tip 7: Be neat and presentable

Just don’t fold the pages to make the margins. Use scale and pencil at least in the first set of answering book you are provided with before the beginning of exam hours when you have adequate time. Examiners can consider the fact that you didn’t have adequate time towards the end.

Don’t start a new question from the bottom of the page if there are just 4-5 lines left after answering the question. Almost always try to answer a new question in a new page. In case you remember something very important that could not be missed you could at least write it at the end.

You just can not change the way you write overnite. So the few things that can be done to improve your handwriting overnite are first try to make sure that all your letter are comprehensive. Next is you keep adequate spaces between two words such that they do not look like single word. If you have small handwriting making sure that it covers more than half of the space in any given line. Don’t extend the tails of j, l , t so long that they disturb the character written in the line above or disturb you while you write below.

If any mistakes don’t make a patch of black or blue color to hide the mistake. Just give one or two stroke to cancel the words.

Incase you miss any major sentences just don’t cramp in the space that is not at all available. Rather make a star and use those sentences in the last of the paragraph/page. Remember you have some space at the end of each question because you are trying to start each question in a new page.

7 tips to excel medical theory exams | Answer to the Point | Common Format |Divide and Rule|Clinical Corelation | Highlight |Whats the question | Neat |

7 Tips to excel in Medicine: Highlight

7 tips to excel medical theory exams | Answer to the Point | Common Format |Divide and Rule|Clinical Corelation | Highlight |Whats the question | Neat |

Answer writing techniques in medical and allied subjects.

Tip 1: Answer to the Point.

Tip 2: Answer any disease condition in common subheadings.

Tip 3:  Systematic listing of causes, complications, medication and  investigations.

Tip 4: Include point of clinical significance

Tip 5: Focus on the important points.

Whenever you have no other option but to write the text, you better highlight the points that you want to stress. This can be achieved by writing the important line as a sentence in a separate paragraph which is separated from previous or later paragraph by 2 lines.

Important and high yield words can be stressed by CAPITALIZING in the sentence.

Next what can be done is use a different color pen (other than red) or highlighter to focus on your point. This may not be applicable if your institution policy does not allow you to use different color pens.

Tip 6: Understand what the question wants you to write.

Tip 7: Be neat and presentable

7 tips to excel medical theory exams | Answer to the Point | Common Format |Divide and Rule|Clinical Corelation | Highlight |Whats the question | Neat |

7 Tips to excel in Medicine: Relate Clinically

7 tips to excel medical theory exams | Answer to the Point | Common Format |Divide and Rule|Clinical Corelation | Highlight |Whats the question | Neat |

Answer writing techniques in medical and allied subjects.

Tip 1: Answer to the Point.

Tip 2: Answer any disease condition in common subheadings.

Tip 3:  Systematic listing of causes, complications, medication and  investigations.

Tip 4: Include point of clinical significance

Make sure you incorporate at least one or two things of clinical significance because we are going to be doctors and not scientists. So, how the same knowledge of basic science affects the clinician would be an extra added gem in your answer. Include an extra heading of CLINICAL CORRELATION at the end of the question from basic science, this will for no doubt add an extra marks to your question.

Tip 5: Focus on the important points.

Tip 6: Understand what the question wants you to write.

Tip 7: Be neat and presentable

7 tips to excel medical theory exams | Answer to the Point | Common Format |Divide and Rule|Clinical Corelation | Highlight |Whats the question | Neat |

7 Tips to excel in Medicine: Divide and Rule

7 tips to excel medical theory exams | Answer to the Point | Common Format |Divide and Rule|Clinical Corelation | Highlight |Whats the question | Neat |

Answer writing techniques in medical and allied subjects.

Tip 1: Answer to the Point.

Tip 2: Answer any disease condition in common subheadings.

Tip 3:  Systematic listing of causes, complications, medication and  investigations.

Whenever you are asked to list any thing be it causes, complications, medication or investigation make sure that you divide the heading under which you are going to make a list. If you make a list rampantly, you may merely remember 10 causes by far. But you list under headings may be you can make a list 3-4 items under each heading, you may list more than 15 -20 causes and it will look more systematic.

Eg. Causes of hematuria can be listed in anyway. But if you list it in anatomical fashion starting from the systemic causes, renal artery causes, renal parenchymal causes, renal pelvic causes, ureteric, bladder, and urethral causes. You can have more than necessary causes to elaborate.

Similarly the causes of anaemia if classified based upon etiology can be subdivided into so much of branches that the total sum of all the causes list based upon this can reach more than 50. 
Maybe you could try naming 10 of the causes of anemia. Check how many can be remembered if you present dividing those.

The complications can as well be classified as immediate, early, intermediate and late. This is especially applicable in chronic disease, or disease with major systemic effect or the complication of any surgical procedures.

The investigation can also be classified as investigation to  identify risk factor, diagnose the disease, evaluate the progression or regression of disease and complication as well.

Example

Causes of Hydronephrosis

In the illustration above, the student was asked the causes of Hydrouretronephrosis. He smartly divided the causes of hydroureteronephrosis in a matrix of 3x3. The anatomical locations were placed along the columns as ureter, bladder outlet and urethra. Similarly, the rows had pathological etiologies either congenital or acquired with intrinsic defect or acquired with extrinsic defect.

So, this impressive method of listing of causes is far effect than just making a list. Because on dividing you can remember so many pathologies which you would not have remember by making a long list of causes.

Tip 4: Include point of clinical significance

Tip 5: Focus on the important points.

Tip 6: Understand what the question wants you to write.

Tip 7: Be neat and presentable

7 tips to excel medical theory exams | Answer to the Point | Common Format |Divide and Rule|Clinical Corelation | Highlight |Whats the question | Neat |

How to get more marks in medical subjects: Common heading in all answers

7 tips to excel medical theory exams | Answer to the Point | Common Format |Divide and Rule|Clinical Corelation | Highlight |Whats the question | Neat |

Answer writing techniques in medical and allied subjects.

Tip 1: Answer to the Point.

Tip 2: Answer any disease condition in common subheadings.

Whenever you are asked to write the management of any disease divide the topic into smaller subheadings and the one applicable to all.

Pathology	Clinical subjects
1.      Definition 2.      Epidemiology 3.      Etiology 4.      Pathophysiology 5.      Sign and symptoms  6.      Gross Pathology 7.      Histopathology 8.      Complication 9.      Prognosis	1.      Definition 2.      Epidemiology 3.      Etiology 4.      Pathophysiology 5.      History 6.      Clinical examination 7.      Investigations 8.      Treatment 9.      Follow up 10.  Complication 11.  Prognosis

Pharmacology	Microbiology
1.      Drug classification 2.      Mechanism of action 3.      Pharmacokinetics 4.      Pharmacodynamics 5.      Dose and formualtions 6.      Adverse effects 7.Spectrum of organism susceptible (In antibiotics, antivirals, antifungal) 8.      Indications and contraindications	1. Classification and type of organism 2.   Basic Morphology 3.   Transport and culture method 4.   Other Newer lab diagnosis 5.  Spectrum of antibiotic they are susceptible to

Diving in major  heading like this makes your presentation of knowledge more organised and remembering what yo know about the condition more easy. It is also easy for examiner to search for what he wants to see in your answer. And certain pathological condition about which you are totally blank and may have dropped the question can also be answered.

Tip 3:  Systematic listing of causes, complications, medication and  investigations.

Tip 4: Include point of clinical significance

Tip 5: Focus on the important points.

Tip 6: Understand what the question wants you to write.

Tip 7: Be neat and presentable

7 tips to excel medical theory exams | Answer to the Point | Common Format |Divide and Rule|Clinical Corelation | Highlight |Whats the question | Neat |