Most people will pass these unless you do or say something stupid. As one of my mentors told me “Play with a straight bat”. So always appear in control and as if you have done the exam a hundred times before. Don’t be nervous – if you are having trouble everyone else did as well and the examiners understand that.
You will of course be carrying your bag. Don’t know what to carry, read this (The BAG)
Always introduce yourself to the patient and try to remember their name when told.
Always shake hands with the patient (miss myotonic dystrophy and you’ll feel like an idiot).
Always stand back, have a general look at the patient and ask yourself is there anything generally here I need to comment on before taking a deep breath and starting the exam.
When presenting, if you are sure what you listened too then say it – “This man presents with severe aortic stenosis” otherwise if you are unsure then start safe “ I examined Mr Bloggs, who presented with chest pain. Examination of his cardiovascular system revealed…”. Try and summarise the positives and negatives especially in a laborious hand exam. Then give your differential with reasons for each diagnosis then ask for the investigations you would like to see and the finally the management although you are unlikely to get that far.
Unfortunately this is all a game, a friend of mine tried the following.
Examiner; “This lady presents with shortness of breath, would you please examine her cardiovascular system”
Candidate – looks for peripheral signs, pulse, neck, etc. Listens at apex, listens over pulmonary area, listens over aortic area.
Turns to examiners and says “This lady has mitral stenosis of mild to moderate severity. There are no complications. Are there any questions?”
Examiners – “Would you like to carry out some dynamic manoeuvres?”
Candidate – “No, no further examination is necessary, she has mitral stenosis”.
He failed.
Another big question is what books do I need? If you don’t know the basics get Talley and O’Connors “Clinical Examination”, otherwise the obvious is Talley and O’Conner’s “Examination Medicine” but I also found Ragavendra Baliga’s book “250 Short Cases in Clinical Medicine” useful to read through. John Morris’s “The Neurology Short Case” is very good and rather expensive – there’s a CD on the way too.