Think before you speak

In the previous section, we discuss the importance of observation in clinical examination. However, it is equally important not to jump into conclusion without considering other possible diagnosis. One useful way of avoiding this pitfall is to have lists of differential diagnosis for common physical signs and avoid giving the diagnosis (unless the examiner wants you to give a spot diagnosis) at the beginning of the clinical examination. 

Common mistakes include:

  • Mistaking pseudoptosis for example in a patient with hypotropia
  • Mistaking a prosthetic eye for unreactive pupil
  • Mistaking a big eye for proptosis.
The two patients below have features of thyroid eye disease. What further test(s) or observation(s) would you like to perform? (click on the picture for explanation)



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