If possibledo some of the examinationesp. inspectionwhile you are asking alow-yield part of the Hxlike a systems review.
If it is an important examinationlet pt knowas they may have had other times where astudent came to visit just as a ward assignment or to prepare for a tutorial: "Thisis my final medical examinationmy entire future career depends on it. I have 30 minutesto ask you some questions in order and do a quick examination. I'm quite nervous and I'mdependent on your help".
Ask pt to point out all their relevant scars to you.
Fetal heart auscultation: ask pt where the nurses are measuring it.
If potential to be asked to examine something later with examinershave things ready:
Place whatever relevant equipment on table: tape measurereflex hammerfundoscope.This drops a hint to examiners that it would be a good questionand also preventsfumbling pockets looking for the particular tool.
Have pt in relevant position (45degreesetc)and sheets folded neatly at the level atwhich to show the presenting part (ie abdominal: folded across at the level of the pubicsymphysis).
Know how bed and siderail moves up and down.
Have corner of sheets loose enough that can smoothly remove them if asked to test legreflexes.
If will be presenting in pt's room: remove glossy magazines from table at end of pt'sbed so examiners can't read the covers and lose interest while you are presenting.
Tidy the room if things are scattered all overit looks better.
Place your relevant clinical examination tools laid out on the end-of-bed-table beforeexaminers return. This is so you aren't fumbling in pockets to look for them. Thisis also is a good cue for the examiners to ask you to use the tools you have laid outsoyou can lead them somewhat by what tools you laid out.
If you finish the history and examination earlyconsider jotting down your managementplanscomplicationsrisk factorsetiologyetc about the pt's disease. These are themost likely questions that your examiners will ask when they returnand you can respondquicker and in more detail if you have already organized them.
If you feel that you may be nervousyou may wish to write out your introductory andconcluding sentences in fullso that you can read them off if neededas these are themost important two sentences to deliver well.
A good line to start with when presenting findings after examining alone: "My nameis <Robert O'Connor>my student number is <34523>. I wouldlike to introduce <Mrs. Johnston>. These are my examiners: <Dr.O'Donnell> and <Dr. Bryne>". [They will usually shake hands atthis pointor say "Nice to meet you"]. "Would you like me to begin mypresentation?" [The examiners will then say "Yes"and you are off andrunning].
When presenting the findingsyou need a strong introduction of the caseand a strongconclusion of the case. Some examiners may lose attention to the middleespecially as theday wears on.
Don't mention anything you don't know much aboutor aren't prepared to be quizzed uponat the end of your presentation.
If the history is difficult and many admissionsyou may wish to cut out all theindividual admissionsand instead say: "She has a longcomplicated history of <endometriosis><being admitted to hospital 6 times between 1992 and 2002>".
If the pt has multiple problemsit is better to give a warning first and then itemizeso the examiner doesn't get confused. Something like: "He has <3>problems currently. Number 1:...". If factyou should prewarn anytime that youwill unexpectedly be presenting multiple itemsinstead of just one.
Only use even numbers for pulse and respiratory rateas you should only measure for 15or 30 seconds then multiply to get a figure per minute: and odd number per minute soundsfishy.
Depending on the devicemost blood pressure readings are in gradations of 2 mmHg--onlyreport in the gradations possible on the device. Alsoonly a statistical probability of1of getting an actual BP reading where they both end in a zero--an even 130:80 readingseems fishy as though you didn't actually take it properly.
Pull things together towards a diagnosis. Conclusion should sum up risk factors thatwere gained during a history.
If you are asked about something that you didn't get to examinea good response is:"Given the time constraints of this examI did not have the chance <hereyes>. It would be important because she is <diabetic>. What Iwould be looking for is ..."
If an emergency dzthen begin with "An emergency situation begins with assessmentof airwaybreathingand circulation. Other dz: begin with "I would take a fullhistory and perform a complete examination".
