HOW TO PRESENT A CASE

Dr. G. V. S. MoorthyProfessor & HOD of Orthopaedics

Osmania Medical College

ACCENT AND ATTITUDE

ACCENT AND ATTITUDE

ACCENT AND ATTITUDE

ACCENT AND ATTITUDE

SPOKEN ENGLISH

SPOKEN ENGLISH - ABC

SPOKEN ENGLISH - CHINESE

SPOKEN ENGLISH - BUTTLER

INDIAN ENGLISH

North Indian

East Indian

South Indian

West Indian

COMMUNICABLE ENGLISH

• CLARITY• SPACING• FLUENCY AND FLOW• AUDIBLE• SIMPLE WORDS• SINGLE SENTENCES• GRAMMATIC

GADGETS

GADGETS

BROAD HEADINGS

• HISTORY• GENERAL EXAMINATION• REGIONAL EXAMINATION• PROVISIONAL DIAGNOSIS• INVESTIGATIONS• DEFINITIVE DIAGNOSIS• MANAGEMENT• PROGNOSIS

HISTORY

• HISTORY OF PRESENT ILLNESS• PAST HISTORY• PERSONAL HISTORY• FAMILY HISTORY• TREATMENT HISTORY• MENSTRUAL HISTORY• BIRTH HISTORY• RETROSPECTIVE HISTORY

COMPLAINTS & PRESENT ILLNESS

• PAIN• SWELLING• DEFORMITY• DISABILITY• SHORTENING• LOSS OF FUNCTION• FEVER• TRAUMA

PAIN

• SITE – PRESENT AND IN PAST• RADIATION• CHARACTER• SEVERITY• TIME COURSE• AGGREVATING, RELEIVING FACTORS• ASSOCIATED SYMPTOMS

PROGRESS OF SYMPTOMS

• PROGRESSIVE DETERIORATION• PROGRESSIVE BETTERMENT• AGGREVATION AND RELEIF• REMISSIONS AND RELAPSES• MODIFICATION WITH MEDICATION ETC.• DIURNAL AND SEASONAL VARIATION• REST PAIN

GENERAL EXAMINATION

• PERIPHERAL PULSES• PERIPHERAL NERVES• SKIN PATCHES AND PIGMENTATION• LYMPHADENOPATHY• SOFT TISSUE LAXITY, SKIN TURGOR• ORGANOMEGALY• BUILT, ANAEMIA, JAUNDICE. CLUBBING ETC.

REGIONAL EXAMINATION

• GAIT• ATTITUDE AND DEFORMITY• INSPECTION• PALPATION• (PERCUSSION AND AUSCULTATION)• MOVEMENTS• MEASUREMENTS• SPECIAL TESTS• LYMPH NODES, DISTAL N.V. STATUS• SPINE AND OTHER JOINTS

GAIT

OBSERVED AS THE PATIENT WALKS IN TO AVOID PATIENT BIASS / RECHECKED AT THE END OF EXAMINATION

• STABLE, PAINLESS, ASYMMETRIC

• STABLE, PAINFUL

• UNSTABLE, PAINLESS

• UNSTABLE AND PAINFUL

GAIT – SPECIFIC TYPES

• TRENDLENBERG GAIT (PAINLESS, UNSTABLE)• SHORT LIMB GAIT (PAINLESS, STABLE)• ANTALGIC GAIT (PAINFUL, STABLE)• NON WEIGHT BEARING ( PAINFUL, UNSTABLE)• HIGH STEPPING GAIT ( FOOT DROP )• WADDLING GAIT (BILATERAL PAINLESS,UNSTABLE)• STIFF HIP GAIT (PAINLESS, STABLE)• CIRCUMDUCTION GAIT (SPASTIC LOWER LIMB)• SCISCORING GAIT (SPASTICITY BOTH LEGS)• MINCING IN CHOREA, FESTINANT IN PARKINSONISM

INSPECTION

SEE ALL SIDES:

• HOLLOWS• SWELLINGS• BONY LAND MARKS• MUSCLE SPASM AND WASTING• SKIN CREASES, SCARS, SINUSES• VESSELS

PALPATION

• TEMPERATURE• TENDERNESS – DIRECT / INDIRECT - BONE,

JOINT, TENDON, LIGAMENT, CARTILAGE• NORMAL BONY LAND MARKS• ABNORMAL MASSES• SWELLING – ARTICULAR / EXTRA ARTICULAR –

FLUID / SOLID• VESSELS, SKIN, SOFT TISSUE, MUSCLE TONE

MOVEMENTS

• FIXED DEFORMITIES• MOVEMENTS – ACTIVE / PASSIVE• MOVEMENTS – POSITION OF LIMB• CREPITUS, PAIN• DEVIATIONS – AXIS DEVIATION• ABNORMAL MOVEMENTS / INSTABILITY• TRANSMITTED MOVEMENTS

MEASUREMENTS

• LENGTH• BREADTH• CIRCUMFERENCE• APPARENT AND REAL• LINES• ANGLES

THANK YOU

• KNOWLEDGE MAKES A MAN WISE,

• PRACTICE MAKES HIM PERFECT,

• RESULTS MAKE ALL REJOICE!