Abdominal Examination for OSCEs
In examination of any system there are
2 important points to remember. They are:
1. Correct
method
2. Practice
Method
The method used by the most senior
clinicians and the most junior medical students is one and the same. The
difference is that the senior clinician has practiced it innumerable times and
hence is far better at it.
Learn the method of abdominal
examination. Read ACES for PACES chapter 12 read
examination of the kidneys in
chapter 13 of ACES for PACES then
practice on patients, read again and refine your method. Repeat ad
infinitum
Ask a colleague to observe you and see
if you are going through every step
Use the summary in the
appendix of ACES for PACES as a checklist
to make sure you are going through every step
Diagnosis
After you are confident that your
method is satisfactory, think of making a diagnosis
Read the preface of
ACES for PACES and learn the hypothetico
deductive method of making a diagnosis.
Study the common lesions of
the gastrointestinal system, the kidneys and urinary system and the
haematological system (ACES for PACES pages
280-284, 315-324, 362-382)
Study the symptoms and signs that may
occur in relation to gastrointestinal disease, diseases of the kidneys and
urinary system and diseases of the haematological system and the causes of
these clinical features (ACES for PACES pages
285-309, 325-336,382-392)
Points to Remember
Marks are awarded for each step of
the examination.
Hence it is essential to have a good
method and go through every step of it
Abdominal lesions are not diagnosed on the basis of the physical signs in the
abdomen
The signs that one elicits in other
parts of the examination are often much more useful in determining the lesion
present
Examples of this are:
The clinical features of hepatocellular
failure and portal hypertension are very useful in determining the cause of
hepatosplenomegaly
Lymphadenopathy in the cervical,
axillary or inguinal region will give a clue to the cause of
hepatosplenomegaly
For examples of analysis of cases using the advanced clinical
evaluation system (ACES) see the examples on this website and the cases
analysed in the blog clinical-skills.blogspot.com
