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).

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