Short Cases in Clinical Medicine

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“To study the phenomena of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all” –Sir William Osler.
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1

look at the patient or look at the face or look
at the legs etc. What are your findings? What is the likely diagnosis?

General examination

2

• Examine the precordium. Or look at the precordium, what are your findings?
• Palpate and auscultate the precordium.
• Examine the pulse.
• Examine the CVS.

Cardiovascular system (CVS):

3

• Examine the chest (front or back or both).
• Auscultate the chest (front or back or both).
• Percuss and auscultate the back of chest.

Respiratory system:

4

• Examine the abdomen.
• Look at the abdomen. What are the findings?
• Palpate the abdomen and relevants.
• Examine the gastrointestinal system.

Abdomen:

5

• Examine the lower limbs or upper limbs.
• Examine the cranial nerves or a particular cranial nerve (e.g., facial nerve).
• Examine for cerebellar signs. Or show the reflex, rigidity, sensory test.
• Look at the gait of the patient.
• Look at the patient (If any gross finding e.g., tremor, chorea, dystonia).
• Talk with the patient (e.g., dysphasia, aphasia, hoarseness).

Neurology:

6

• Examine the neck (usually for goitre).
• Examine the thyroid gland and relevants (Goitre, features of hyper or hypothyroidism).
• Look at the face (e.g., in thyrotoxicosis, myxoedema, acromegaly or Cushingoid, hirsutism).
• Perform the general examination (e.g., obesity, features of myxoedema, pigmentation in
Addison’s disease).
• Look at the patient (e.g., may be short or long stature), also see the relevants.

Endocrinology:

7

• Examine the hands (e.g., rheumatoid hand, systemic sclerosis).
• Examine the knee joints (or any particular joint e.g., monoarthritis, polyarthritis, effusion in
knee joints).
• Examine the face and relevants (e.g., systemic sclerosis, systemic lupus erythematosus,
dermatomyositis).
• Look at the skin (dermatomyositis, psoriatic arthritis).
• Look at the patient and examine the relevants (e.g., ankylosing spondylitis)

Rheumatology:

8

• Perform the general examination (e.g., psoriasis, exfoliative dermatitis).
• Look at the skin. What are the findings? (e.g., skin rash, erythema multiforme, purpura,
Stevens Johnson syndrome, blisters).
• Look at the face. What are the findings? (e.g., butterfly rash, PKDL, leprosy, pigmentation).

Dermatology:

9

• Examine the eyes or look at the eyes (e.g., xanthelasma, ptosis, squint, pigmentation of sclera,
Kayser–Fleischer ring, corneal arcus, subconjunctival haemorrhage, exophthalmos, pupil,
movement of eyeball).
• Perform fundoscopy (e.g., optic atrophy, papilloedema, retinopathy, retinal haemorrhage)

Eyes:

10

Depends on a particular type of case, e.g., Turner’s syndrome, Down’s syndrome, xanthelasma etc.
• Look at the tongue. What is the diagnosis? What are the diseases that can be diagnosed by
looking at the tongue?
• Look at the face. What is your diagnosis? Name some diseases that can be diagnosed by
looking at the face.
• Examine the hands. What is your diagnosis? What are the diseases that can be diagnosed by
examining the hands? Or by hand shake?
• Look at the nails. What is your diagnosis? What diseases are diagnosed by looking at
the nail?

Miscellaneous:

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(ill-looking, depressed, anxious, Cushingoid or expressionless face).

Appearance

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(obese, emaciated or cachexic, tall, short or normal).

• Built

13

(well nourished, poor or normal).

• Nutrition

14

(on choice, propped up or Mohammedan prayer position).

Decubitus

15

(see in palpebral part of conjunctiva, tongue, palm, nails and whole body).

• Anaemia

16

(see in sclera, under surface of tongue, palm or whole body).

• Jaundice

17

(see in tip of nose, lips, ear lobule, tongue, tip of fingers and toes).

• Cyanosis

18

(see

1) fluctuation of nail base,

2) angle between the nail and its base,

3) curvature of nails,

4) Drum stick

5) look for hypertrophic osteoarthropathy by pressing the lower end of tibia, fibula or radius, ulna).

• Clubbing

19

(see dryness, brittleness, flattening, thinning and spooning of nails).

• Koilonychia

20

(white spots or white nail).

• Leukonychia

21

(see in leg above medial malleolus, sacrum if the patient is recumbent).

• Oedema

22

(see skin turgor or dry tongue).
• Pigmentation (see in exposed parts, face, neck, palmar creases, knuckles, inner side of mouth or
recent scar).
• Lips, tongue, oral mucosa, nose.
• Lymph nodes (examine systematically in different areas).
• Thyroid gland (if enlarged, examine in detail and see the features of toxicosis or
hypothyroidism).
• Breasts (to see gynaecomastia or lipomastia).
• Body hair distribution (including head to see alopecia).

• Dehydration

23

(see in exposed parts, face, neck, palmar creases, knuckles, inner side of mouth or recent scar).

• Pigmentation

24

(examine systematically in different areas).

Lymph nodes

25

(if enlarged, examine in detail and see the features of toxicosis or
hypothyroidism).
• Breasts (to see gynaecomastia or lipomastia).
• Body hair distribution (including head to see alopecia).

• Thyroid gland

26

(to see gynaecomastia or lipomastia).
• Body hair distribution (including head to see alopecia).

• Breasts• Breasts

27

(including head to see alopecia).

• Body hair distribution