Wednesday, 19 October 2011

Clinical Examination: Feeling & Hearing "abnormal" for the first time

For my year 1 and 2 OSCE exams i more or less learnt a "script" of what needs to be done, without really knowing what i was suppose to be feeling for, hearing out for or eliciting when i do a certain clinical examination.

(Well, i knew the exam, in that i know i can hear murmurs for different valves at certain points, feel an enlarged kidney if i balloted and can percuss the chest to look for areas of dullness etc..But i didn't really "KNOW" the sounds, or the feeling... since we only ever practised on healthy individuals)

BUT, slowly slowly now, i've had the opportunity to feel and listen out for different signs, and have started to collect a small collection of ideas as to what "abnormal" feels or sounds like... and hopefully i will pick up more of these "sounds" and "feelings" throughout the year. It sounds so odd, but i when i do a routine examination as i would in an OSCE exam and feel something for the first time, it really surprises me, and in a way in which i think i will never be able to forget "the first time"

Examples:
"the man in the side room with aortic stenosis"

- i approached the chest with my stethoscope, and first placed it at the 2nd intercostal space on the right of the patient's sternum and listened to the aortic valve (i've been taught to go A-P-T-M) and heard a wooshing sound... i wasn't sure if it was abnormal, and continued to place my stethoscope at the P position and so on, and then all of a sudden i realised.. A was definately abnormal! I timed this with the pulse, and the abnormal sound occured with systole, this was aortic stenosis!


"the lady with malaria, and hepatomegaly"

- i was on a ward round with the team, and when we got to this lady, my FY1 told me they had found something on an abdominal examination, but i had to go find out what it was myself. I started feeling all 9 quadrants, and they all felt pretty much the same to me, soft and non-tender. Then i continued to find the borders of the liver, and this was when i first suspected the liver may have been enlarged, and to confirm i continued to feel for hepatomegaly and there it was, an approximate 3cm enlargement. The first time i've ever come across hepatomegaly.

I've had many of these "firsts" so far, and hope to continue adding more experiences to my collection.

3 comments:

Grumpy Biomed said...

Wooh, sounds like you're making progress! You must be chuffed!

Dr Sunshine said...

9 quadrants.... The one phrase that I tease people about :-p It sounds like you're doing really well. I still get that excited when I see, hear or feel something for the first time.

Tofu said...

Oopsies... haha 9 quadrants sounds a bit funny doesn't it >.< i think i will try to resist putting 9 and quadrants together.. and stick with 9 sections or the 4 quadrants from now ^^

and im not sure if im making progress as such, but i love finding "something different" for the first time!