| In the clinical
examination, it is tempting to dive in and perform the examination requested
by the examiner(s). In so doing, one may miss vital sign(s) which can guide
one to the right diagnosis. It is recommended that you stand back and observe
the whole patient for a few seconds before carrying out the examination.
Sometimes, observation alone is sufficient to give you the diagnosis and
the examination only serves to confirm it.
Observation is especially rewarding
in pupillary examination. Look at the following pictures and test your
observation skills (click on the picture for questions and answers):
Although all you observe may not
be relevant to the diagnosis; the examiner is likely to be impressed with
your examination skill. Do not jump into conclusion before
you finish the examination as this may irritate the examiner and the diagnosis
may be wrong.
The following are some guides to
observation in the relevant techniques:
| pupil |
look for anisocoria,
heterochromia iridis, ptosis, scar over the temple from temporal artery
biopsy. |
| ptosis |
anisocoria, heterochromia |
| slit-lamp exam. |
heterochromia,
aphakic glasses, hearing aids |
| ophthalmoscopy |
hearing aids, aphakic
glasses or high myopic glasses (risk of retinal detachment) |
| orbital exam. |
neck scar for thyroidectomy |
| ocular motility |
hypermetropic glasses,
prisms, head tilt |
| visual field exam |
features of acromegaly |
| neurological exam |
nystagmus |
| thyroid status |
neck scar from
thyroidectomy |
Here is another picture to test your
observation and association skills (click on the picture for questions and
answers).
|
