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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!