Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
  1. Home
  2. Search

Refine search

Refine search

Access:
Content type:
Publication date:
Apply   From and To filters
Subject: Show more
Journals Show more
Publishers: Show more
Societies Show more
Series: Show more
Collections: Show more

Actions for selected content:

Select all | Deselect all
  • View selected items
  • Export citations
  • Download PDF (zip)
  • Save to Kindle
  • Save to Dropbox
  • Save to Google Drive

Save Search

You can save your searches here and later view and run them again in "My saved searches".

Please provide a title, maximum of 40 characters.
Cancel
×

55 results

Page 1 of 3

  • 31 - Examination of the heart and great vessels

  • from Section 7 - Heart and thorax
  • Edited by Petrut Gogalniceanu, James Pegrum, William Lynn
  • Book:
    Physical Examination for Surgeons
    Published online:
    05 July 2015
    Print publication:
    25 June 2015, pp 264-270

  • Summary

    Checklist

    WIPER

    • Patient sitting on edge of examination couch with all clothing above the waist removed

    Physiological parameters

    General

    • Bedside: GTN spray, cigarettes, oxygen

    • Cachexia: severe mitral valve disease

    • Morbidly obese: cor pulmonale

    Inspection

    • Hands: nicotine stains, radial artery harvest

    • Neck: JVP

    • Chest wall : scars of previous chest surgery (midline, lateral and posterior)

    • Legs: groin incisions, varicose veins, scars from vein harvest

    Palpation

    • Hands: radial artery pulse: rate and rhythm

    • Neck: carotid pulse, pulsatile trachea (aortic arch aneurysm), carotid–carotid or carotid–subclavian bypass, visible JVP

    • Chest wall: apex beat, heaves, thrills, pacemaker, implantable defibrillator

    • Sacrum: sacral oedema

    • Legs : peripheral oedema, radio-femoral delay

    Auscultation

    • Carotid artery: bruit

    • Precordium: heart sounds, murmurs, pericardial rub

    • Lung bases: effusion, pulmonary oedema

    To complete the examination…

    • Chest x-ray

    • ECG

    Examination notes

    What are the basic cardiac symptoms?

    The main symptoms of cardiac disease are chest pain, shortness of breath, ankle swelling, orthopnoea, paroxysmal nocturnal dyspnoea, palpitations and syncope.

    How do you prepare for the examination of the cardiac surgery patient?

    The patient needs to be lying at 45° in underwear on the examination couch. The groins are covered but the legs are exposed.

    What do you inspect in the examination of the heart?

    1. • Jugular venous pressure (JVP). The patient is positioned at 45° with the head slightly turned to the contralateral side. Look for the JVP wave form and the height above the sternal notch. It should normally be seen 3 cm vertically above the sternal angle. A raised JVP is associated with congestive cardiac failure, pericardial tamponade or constrictive pericarditis. A collapsed JVP is caused by dehydration or shock.

    2. • Identify scars from previous carotid endarterectomy.

    3. • Inspect the chest for scars from previous cardiac or thoracic surgery.

    4. • Inspect the legs for scars from previous saphenous vein harvest or varicose vein avulsions.

    5. • The groins must be checked for evidence of previous vascular or endovascular surgery or percutaneous intervention.

    6. • At the beginning or end of the examination the patient should be asked to stand, to look for varicose veins.

  • 7 - Examination of a stoma

  • from Section 2 - General surgery
  • Edited by Petrut Gogalniceanu, James Pegrum, William Lynn
  • Book:
    Physical Examination for Surgeons
    Published online:
    05 July 2015
    Print publication:
    25 June 2015, pp 80-83

  • Summary

    Checklist

    WIPER

    Physiological parameters

    Inspection

    Scars:

    • Midline laparotomy

    • Laparoscopic scars

    • No scars and stoma: trephine colostomy

    • Linear or purse-string scar in RIF or LIF: reversed stoma

    Stoma character:

    • Site: RIF vs. LIF

    • Spouted vs. flush

    • Size of lumen

    • Number of lumens

    • Stoma bridge

    • Bag contents:

    •urine (urostomy)

    •small bowel contents: liquid (ileostomy)

    •formed faeces (colostomy)

    Stoma complications:

    • Parastomal mass (hernia)

    • Dusky or ischaemic mucosa

    • Surrounding skin excoriated

    • Stoma edge dehiscence

    • Stoma retraction

    Palpation

    • Palpate around stoma and ask patient to cough to exclude parastomal hernia.

    • Digitate stoma with a well-lubricated finger (only if required).

    Percussion

    • Hyper-resonance: bowel obstruction

    Auscultation

    • Hyperactive bowel sounds in bowel obstruction

    • Quiet bowel sounds in ileus

    To complete the examination…

    • Ask to examine the perineum to determine if the anal orifice is present.

    • Perform a full examination of the abdomen.

    Examination notes

    What is the definition of a stoma?

    A stoma is a surgically created communication between a hollow viscus and the skin.

    What are the different types of stomas?

    1. • Ileostomy – ileum

    2. • Colostomy – colon

    3. • Urostomy – ileum anastomosed to ureters

    How are stomas constructed?

    1. • End-stoma: single lumen. Suggests that the distal end of the viscus has either been resected or closed and left in the abdomen; e.g. Hartmann's procedure.

    2. • Loop-ileostomy: two lumens may be seen. The distal end of the viscus is present but defunctioned, e.g. to allow an anastomosis to heal.

    3. • A urostomy is formed when the urinary bladder has been excised. A loop of ileum (ileal conduit) is separated proximally and distally. The ureters are anastomosed to one end, and the other end is used to form the stoma (urostomy).

  • 30 - Examination of the thorax and lungs

  • from Section 7 - Heart and thorax
  • Edited by Petrut Gogalniceanu, James Pegrum, William Lynn
  • Book:
    Physical Examination for Surgeons
    Published online:
    05 July 2015
    Print publication:
    25 June 2015, pp 255-263

  • Summary

    Checklist

    WIPER

    • Patient sitting on edge of examination couch with all clothing above the waist removed

    Physiological parameters

    General

    • End of bed: shortness of breath, wheeze

    • Bedside: sputum pot, bedside oxygen, cigarettes, inhalers

    • Hands: nicotine staining and finger clubbing

    • Face: Horner's syndrome (ptosis and meiosis) and venous engorgement of head and neck veins

    Inspection

    • Neck: lymphadenopathy, low transverse cervical scar for mediastinoscopy, tracheostomy scar, tuberculous abscesses

    • Chest wall deformities: pectus excavatum (pushed in) or pectus carinatum (pushed out)

    • Chest movement: asymmetry of expansion, contraction of one side of the chest wall, paradoxical movement (flail chest)

    • Scars: midline sternotomy, lateral/posterior/posterolateral thoracotomy, small scars (video-assisted thorascopic surgery or chest drains)

    • Radiotherapy tattoos

    • Chest drains

    Palpation

    • Neck: lymphadenopathy, goitre, position of trachea

    • Chest: sternal tenderness or instability, rib tenderness, asymmetry of expansion

    Percussion

    • Chest wall: resonant, dull or hyper-resonant

    Auscultation

    • Chest wall: breath sounds (vesicular, crackles, wheeze, reduced air entry)

    To complete the examination…

    • Bedside spirometry

    • Chest x-ray

    Examination notes

    What are the basic thoracic and pulmonary symptoms?

    The main symptoms of thoracic disease are shortness of breath, fatigue, wheeze, stridor, cough, sputum production, haemoptysis, chest pain and voice hoarseness.

    How do you prepare for the examination of the thorax?

    The patient needs to be sitting on the edge of the examination couch, exposed from the waist up.

    What do you look for during inspection?

    1. • Start the examination by inspecting the hands. Look for nicotine stains from cigarette smoking (risk factor for lung malignancy) and finger clubbing (a possible sign of malignancy or chronic lung disease).

    2. • Move up to the face, looking at the eyes for evidence of ptosis (drooping of the eyelid) and meiosis (a constricted pupil), which are signs of Horner's syndrome. This may be caused by a Pancoast's tumour originating from the superior sulcus of the lung.

  • 44 - Principles of plain film

  • from Section 11 - Surgical radiology
  • Edited by Petrut Gogalniceanu, James Pegrum, William Lynn
  • Book:
    Physical Examination for Surgeons
    Published online:
    05 July 2015
    Print publication:
    25 June 2015, pp 383-385

  • Summary

    Plain film consists of a single shot image using x rays.

    What are the different densities in x rays?

    1. • Black – gas

    2. • White – calcified structures

    3. • Grey – soft tissues

    4. • Darker grey – fat

    5. • Intense white – metallic objects

    What are the basics that must not be missed?

    Always check:

    1. • Name of patient, date of birth and date – this may give information about patient's age and gender, which could elucidate the underlying pathology.

    2. • Adequacy of imaging: does the x ray cover the entire area of interest?

    3. • Orientation of film: right vs. left – ‘R’ label on corner of film.

    4. • Position of patient. For example, a pneumothorax will look different on supine chest x ray vs. erect film; air under the diaphragm will not be seen in a chest x ray of a patient lying flat.

    5. • Cervical spine: multiple standardised views (see Chapter 49, Cervical spine x ray).

    6. • Distal limbs: minimum of two views. If only one view is shown, ask for a second view.

    What are the rules of 2?

    1. • 2 sides: in paired structures (e.g. limbs) always compare the affected structure with the contralateral one, which may be normal.

    2. • 2 views: obtain two views of the same structure, e.g. anteroposterior and lateral.

    3. • 2 times: view images of the same structure at two different points in time: compare current images with previous ones.

    4. • 2 joints (in orthopaedics): view the joint above and the joint below the one of interest.

    5. • 2 readers: get a second opinion.

    What is fluoroscopy?

    1. • An imaging modality that uses continuous x ray exposure to get dynamic imaging

    2. • Has the capacity to save representative images

    3. • Contrast material used to help differentiate pathology.

  • 22 - Examination of the knee

  • from Section 5 - Orthopaedic surgery
  • Edited by Petrut Gogalniceanu, James Pegrum, William Lynn
  • Book:
    Physical Examination for Surgeons
    Published online:
    05 July 2015
    Print publication:
    25 June 2015, pp 175-189

  • Summary

    Checklist

    WIPER

    • Patient standing in shorts or underwear; hip and ankle joints exposed.

    Physiological parameters

    Gait

    • Asymmetry of spine and pelvis

    • Antalgic gait and walking aids

    • Soles of footwear

    Tape

    • Quadriceps diameter: muscle bulk

    Look

    • Skin: scars, erythema, ecchymoses, sinuses, skin creases

    • Soft tissues: wasting of quadriceps, swelling in popliteal fossa, knee effusion

    • Bone:

    • deformity or asymmetry

    • pelvic tilt

    • posterior subluxation of the tibia on the femur

    • varus/valgus deformities of the knee

    • flexion deformity or recurvatum

    Feel

    • Skin: temperature, tenderness

    • Soft tissues:

    • knee effusion and ‘ bulge ’ test

    • patellar tap test

    • popliteal fossa: Baker's cyst, popliteal artery aneurysm

    • tendons: quadriceps tendon, patella tendon, pes anserinus, collateral ligaments and menisci, iliotibial band

    • pulses, capillary refill, neurology

    • Bone:

    • tibial tuberosity and patella

    • femur, tibia and joint line

    • origin and insertion of collateral ligaments

    Move

    • Active:

    • straight leg raise

    • flexion and assess for crepitus

    • extension against gravity

    • Passive

    • flexion

    • hyperextension

    • Resisted

    • flexion

    Special tests (* = essential tests)

    • Patella: patella apprehension test,* patella tracking test, Clarke's test

    • Collateral ligaments: valgus/varus pressure* (knee flexed at 30° flexion and extension)

    • Menisci: McMurray's test*

    • Cruciate ligaments: posterior sag test,* anterior & posterior drawer test,* Lachman's test,* pivot shift test, dial test

    To complete the examination…

    • Examine the joint above (hip joint) and the joint below (ankle joint).

    • Check full neurovascular status of the lower limb.

    • Order appropriate radiographs and further imaging.

    Examination notes

    How do you measure quadriceps diameter in order to assess wasting?

    • Locate the tibial tuberosity. This is found on the proximal anterior tibia and demarcates the insertion of the patella tendon.

    • Mark a point 20 cm proximal to this landmark, which is mid-thigh. (A longer measurement may be required in very tall individuals.)

  • 13 - Examination of the scrotum

  • from Section 4 - Pelvis and perineum
  • Edited by Petrut Gogalniceanu, James Pegrum, William Lynn
  • Book:
    Physical Examination for Surgeons
    Published online:
    05 July 2015
    Print publication:
    25 June 2015, pp 112-120

  • Summary

    Checklist

    WIPER

    • Patient standing. Trousers removed. Exposure from nipple to knee. Chaperone as required.

    Physiological parameters

    Inspection

    • Scrotal asymmetry: pathology within hemiscrotum:

    • absent testicle: failure of scrotal development or testicular descent, or orchidectomy

    • scrotal mass

    • Skin:

    • oedema, cellulitis, Fournier's gangrene

    • scars from previous scrotal surgery or orchidopexy

    • Groin: scars (hernia repair) and masses (undescended testis)

    Palpation

    Patient standing:

    Ask: ‘Do you have any pain?’

    • Anatomy: define (a) superficial inguinal ring, (b) spermatic cord and vas deferens, (c) testicle, (d) epididymis. Compare left and right sides.

    • Scrotal skin lumps: sebaceous cysts, abscesses and furuncles.

    • Testicle: presence, contour, masses, size. If absent testicle, palpate groin and see if able to manipulate testicle into scrotum.

    • Epididymis (posterior aspect of testis): tender or swollen.

    • If scrotal mass felt:

    • Can you get above it?

    • Can you define testis and epididymis separately?

    • Does the mass transilluminate (hydrocoele)?

    • Is there a cough impulse (hernia/varicocoele)?

    Patient supine:

    • Re-examine the scrotum. Assess if any palpable abnormality becomes less prominent, as in the case of a varicocoele or hernia. Always ensure the scrotum is lifted up to inspect the posterior aspect of the scrotum and perineum.

    To complete the examination…

    • Examine the abdomen, especially if the testicle feels abnormal.

    • Examine groin, penis and perineum: identify hernias, undescended or ectopic testes.

    Examination notes

    What are the essential history points for a scrotal mass?

    History as for any mass (see Chapter 39, Examination of skin lesions and lumps). Specific points to elucidate:

    1. • Previous scrotal operations

    2. • Risk factors for testicular malignancy (undescended testis, family history, infertility, small testis)

    What do you look for on inspection of the scrotum?

    1. • Assess scrotal symmetry and development. Scrotal asymmetry together with the history may indicate the underlying pathology: e.g. a patient with a recent history of an inguinal hernia repair who has a smaller testicle on the same side would suggest testicular atrophy following hernia repair (ischaemic orchitis).

  • 39 - Examination of skin lesions and lumps

  • from Section 10 - Plastic surgery
  • Edited by Petrut Gogalniceanu, James Pegrum, William Lynn
  • Book:
    Physical Examination for Surgeons
    Published online:
    05 July 2015
    Print publication:
    25 June 2015, pp 353-358

  • Summary

    Checklist

    WIPER

    • Good light source. Lesion and loco-regional lymph nodes exposed.

    Physiological parameters

    • Ask: ‘Where is the lesion?’

    • Ask: ‘Is the lesion painful?’

    System

    • S-E-I-S (Site, External, Internal, Surroundings)

    Skin type

    • Fitzpatrick classification of skin type

    Site

    • Location of lesion

    • Number of lesions

    External features

    • Size (in cm)

    • Shape:

    • smooth or irregular edge

    • flat or raised profile

    • Surface:

    • skin: intact or ulcerated skin, skin adnexae

    • colour/pigmentation and telangiectasia

    • colour distribution: regular vs. irregular

    • discharge: blood, pus, lymph

    • Scars from previous surgery (skin lesions or lymphadenectomy)

    Internal

    • Consistency: soft, hard

    • Content: gas (crepitus), fluid (fluctuant and transilluminable), solid (nontransilluminable)

    • Dynamic interaction: pulsatile, reducible, indentable, compressible

    • Mobility and attachment to surrounding structures (above, below and laterally)

    • Percussion: dull or resonant (gas, fluid, solid)

    • Auscultation: bruits, bowel sounds

    Surroundings

    • Assess surrounding skin: normal or satellite lesions.

    • Palpate for local, regional, general lymphadenopathy.

    • Assess nerves: local and distal sensory and motor functions.

    • Assess vascular supply of lesion: capillary refill time and pulses.

    • Palpate liver for an irregular edge or enlargement and vertebral spine for tenderness if concerned about metastatic deposits.

    Examination notes

    Tip

    The examination of a lump is very poorly done in general, due to a lack of a systematic or anatomical way of approaching the lesion. Palpation in particular needs to be structured as described above in order to avoid redundant gestures.

    What is the system for examining a skin lump?

    S-E-I-S:

    Skin (type) and Site (inspection)

    External features (inspection)

    Internal features (inspection and palpation)

    Surroundings: skin, local, regional or distal lymph nodes (inspection, palpation and movement)

    Tip

    Beware the melanoma patient with a prosthetic eye or ear.

    What are the principal questions in assessing a skin lesion?

    1. • Where is the lesion located on the body?

    2. • What does the lesion look like externally?

    3. • What is inside the lesion?

    4. • What is the anatomical plane of the lesion?

  • 12 - Examination of the penis

  • from Section 4 - Pelvis and perineum
  • Edited by Petrut Gogalniceanu, James Pegrum, William Lynn
  • Book:
    Physical Examination for Surgeons
    Published online:
    05 July 2015
    Print publication:
    25 June 2015, pp 109-111

  • Summary

    Checklist

    WIPER

    • Patient supine. Trousers removed. Groins and genitals exposed. Chaperone as required.

    Physiological parameters

    Inspection

    • Penile shape: chordae, priapism

    • Presence or absence of foreskin (circumcision)

    • Retract foreskin (if uncircumcised): phimosis, paraphimosis, tight frenulum

    • Position of external meatus: normal, hypospadias, epispadias

    • Lesions on glans: carcinoma, papillomata acuminata, balanitis, ulcers (chancre)

    • Lesions on inner or outer foreskin: as above

    Palpation

    • Open external meatus to assess size of urethral opening:

    • discharge (urinary incontinence, pus, blood)

    • erythema/ulceration

    • pinhole meatus

    • Palpate glans and shaft of penis: evidence of Peyronie's disease.

    • Palpate urethra: urethral stricture, carcinoma, diverticulum or abscess.

    To complete the examination…

    • Palpate inguinal lymph nodes: particularly in the presence of a penile lesion.

    • Perform a scrotal, perineal and rectal examination.

    • Urine dipstick.

    Examination notes

    What are the essential history points prior to a penile examination?

    1. • Nature of lesion

    2. • Circumcised or not

    3. • Effect of erection on lesion

    4. • Sexual history including erectile function and risk of sexually transmitted infections

    What do you look for on inspection?

    Assess whether the patient is circumcised. If the patient is not circumcised it is important to retract the foreskin to expose the glans. This allows inspection of the glans as well as the inner surface of the prepuce for any suspicious lesions. One needs to assess the position of the external urethral meatus.

    What do you palpate in a penile examination?

    Assess the actual diameter of the urethral opening deep to the external meatus, as a pinhole meatus may be present despite an apparently large external orifice. This is best performed by gently squeezing the tip of the glans in the anteroposterior axis, which encourages the slit-like urethra to open into a circular orifice.

    The glans and shaft of the penis need to be palpated. There may be palpable fibrotic plaques on the penile shaft suggestive of Peyronie's disease. Gross urethral lesions in the penile shaft may also be palpable.

  • 18 - Examination of the shoulder

  • from Section 5 - Orthopaedic surgery
  • Edited by Petrut Gogalniceanu, James Pegrum, William Lynn
  • Book:
    Physical Examination for Surgeons
    Published online:
    05 July 2015
    Print publication:
    25 June 2015, pp 140-151

  • Summary

    Checklist

    WIPER

    • Patient standing in shorts or underwear with shoulder girdle exposed (bra to remain on in women).

    • Expose upper limb and cervical spine.

    Physiological parameters

    • Observe for spinal lordosis, kyphosis or scoliosis.

    Look

    • Skin: erythema, scars, sinuses, symmetry of skin creases or skin elevation from underlying fracture

    • Soft tissues:

    • joint and soft tissue swelling

    • wasting of deltoid, biceps, supraspinatus and infraspinatus muscles

    • Bone: prominence of acromion, clavicular asymmetry or deformity

    Feel

    • Skin: temperature, tenderness, sensation

    • Soft tissues:

    • muscle mass: trapezius, deltoid, triceps, biceps and biceps tendon

    • ligaments: coracoclavicular ligaments

    • radial and ulnar pulses, capillary refill time

    • sensation in ‘regimental badge' area (axillary nerve) and in hand

    • Bone:

    • sternoclavicular joint

    • clavicle: deformity or malunion

    • acromioclavicular joint

    • coracoid process

    • spine and borders of the scapula

    • greater tuberosity of humerus

    • margins of glenoid cavity

    • cervical spine

    Move

    • Active and passive:

    • flexion/extension

    • internal/external rotation

    • abduction/adduction

    • Resisted:

    • deltoid

    • serratus anterior (winging of the scapula)

    • pectoralis major

    • trapezius

    Special tests (* = essential tests)

    • Acromioclavicular test*

    • Impingement test*

    • Instability and apprehension test*

    • Rotator cuff test*

    • Biceps tendon test

    • SLAP test

    • Thoracic outlet syndrome tests

    To complete the examination…

    • Examine the joint above (cervical spine: up to 30% of shoulder pain is referred from the cervical region) and the joint below (elbow).

    • Check full neurovascular status of the upper limb.

    • Order appropriate radiographs and further imaging.

    Examination notes

    What do you look for during initial observations?

    1. • Assess the skin quality and contours of the shoulder girdle, clavicle and scapula.

    2. • The soft tissues mass and muscle bulk are evaluated for evidence of muscle loss from disuse atrophy, found around the scapular from rotator cuff atrophy or pectoral muscles anteriorly. Deltoid muscle atrophy can also be found in axillary nerve injury.

  • 21 - Examination of the hip

  • from Section 5 - Orthopaedic surgery
  • Edited by Petrut Gogalniceanu, James Pegrum, William Lynn
  • Book:
    Physical Examination for Surgeons
    Published online:
    05 July 2015
    Print publication:
    25 June 2015, pp 162-174

  • Summary

    Checklist

    WIPER

    • Patient standing in shorts or underwear, back and knees exposed.

    • Access is required to the groin, thighs and gluteal region.

    Physiological parameters

    Gait

    • Asymmetry of spine

    • Gait: antalgic, short leg, Trendelenburg gait

    • Walking aids

    Test

    • Trendelenburg's test

    Tape: leg length

    • Apparent leg length (xiphisternum to medial malleolus)

    • True leg length (ASIS to medial malleolus)

    Look

    • Skin:

    • scars, erythema, ecchymosis

    • sinuses and alignment of skin creases

    • psoas abscess draining in sub gluteal fold

    • Soft tissues: swelling or wasting of glutei and quadriceps.

    • Bone:

    • deformity or asymmetry: shortening of leg; external or internal rotation of hip

    • pelvic tilt

    • valgus or varus knee, lordosis, kyphosis, scoliosis

    Feel

    • Skin: temperature, tenderness, sensation.

    • Soft tissues:

    • adductor tenderness, bursitis

    • pulses, capillary refill time

    • sensation and movement

    • Bone:

    • greater trochanter

    • midpoint of inguinal ligament (hip joint)

    • pubic bone and symphysis

    • femoral shaft

    • tenderness or mobility

    Move

    • Active and passive:

    • flexion/fixed flexion

    • internal rotation (foot moves outwards)

    • external rotation (foot moves inwards)

    • extension (press thigh onto bed)

    • abduction/adduction whilst stabilising pelvis (palpating contralateral ASIS)

    • Resisted:

    • flexion

    • adduction

    Special tests (* = essential tests)

    • Thomas's test*

    • Impingement sign*

    • Straight leg raise*

    • FABER test

    • Sciatic nerve stretch test

    • Ober's test

    To complete the examination…

    • Examine the joint above (back and sacroiliac joint) and the joint below (knee).

    • Check full neurovascular status of the lower limb.

    • Order appropriate radiographs and further imaging.

    Examination notes

    What do you look for during gait and initial observations?

    1. • Look for an antalgic gait or the use of any walking aids.

    2. • Inspect the soles of the shoes for the pattern of wear.

    3. • In the setting of possible neck of femur fracture, gait and weight-bearing activities should not be examined.

  • Introduction

  • Edited by Petrut Gogalniceanu, James Pegrum, William Lynn
  • Book:
    Physical Examination for Surgeons
    Published online:
    05 July 2015
    Print publication:
    25 June 2015, pp xv-xv

  • Summary

    The Intercollegiate Membership of the Royal College of Surgeons (MRCS) examination aims to assess a junior doctor's competence to enter surgical training. This is based on the candidate's understanding of core clinical and professional principles needed to diagnose and treat surgical disease. The exam is the first step in a process that transforms a doctor into a surgeon and provides a common foundation of practice for all surgeons in the UK, irrespective of their subspecialty.

    Focused, systematic and diagnostic physical examination skills are a key aspect of surgical practice. Their purpose is to assess anatomical form and test physiological function

    in order to allow a professional opinion to be formulated.

    The book provides one method of performing physical examination from a surgeon's perspective, addressing key topics in the objective structured clinical examination (OSCE) part of the assessment. It also addresses related diagnostic skills, such as history taking, communication, critical care assessment and interpretation of surgical radiology images.

    It aims to be a practical manual, being neither exhaustive nor specific to a single syllabus. It includes chapters on topics such as gynaecology and neurosurgery, which, although not tested in the MRCS exam, may be relevant to the practice of general surgery.

    We recommend the consultation of reference manuals for the acquisition of finer details and clinical knowledge. Updated details of the MRCS examination format, syllabus and

    requirements must be obtained from the relevant examining bodies.

    Each chapter contains the following key elements:

    1. At-a-glance checklists on how to perform any physical examination routine.

    2. Examination notes, including focused questions and answers.

    3. Mind maps of differential diagnoses, to facilitate the easy formulation and recall of diagnoses.

    4. Tips, mnemonics and examples.

    We hope this book will be of use in caring for your patients.

Page 1 of 3