Answering Questions

In a clinical exam the four most common questions you are likely to be asked are:

1. diagnosis
2. investigations
3. management
4. complications

Candidates often have enough knowledge to answer these questions but sometimes they fall down because of the pressures of time and because they do not structure their answers. These situations can be made much easier if some simple frameworks are memorized.

For example, given the question "how would you investigate this patient with pneumonia," using the below framework it is possible you can immediately answer "I would take a sputum sample and send it off for culture. I would take some bloods, these would include FBC, ESR, WBC, LFT, U+Es, inflammatory markers and cultures. I would perform lung function tests. I would take a chest XR. I might consider broncheolar lavage [a special test in this framework] to obtain a more reliable culture result."

Diagnosis

Surgical Sieve

(Congenital +) TIN CAN MED DIP = Trauma, Inflammatory (physical, chem, infective), Neoplastic (benign, malig, primary/secondary), Circulatory, Autoimmune, Nutritional, Metabolic, Endocrine, Drugs, Degenerative, Iatrogenic, Psychosomatic.

Anatomical Sieve

eg. organs in that region: extramural/intramural/luminal.

Investigations

1. Body excretions: urine (eg. dipstix, m+c, pregnancy), stool, swabs, sputum
2. Blood
   • Hematological (FBC, WBC, clotting time)
   • Biochemical (LFT, TFT, U&E, amylase - for any abdo pain, glucose)
   • Inflammatory
   • Special: eg. PSA
3. Function: ECG, EEG, Lung tests (FEV)
4. Imaging/staging: X-rays (plain film or contrast eg. barium) do CXR & AXR for suspected perforation, Angiography, USS, dopplers, CT/MRI/PET, Endoscopy
5. Special/Diagnostic: V/Q, Biopsy

Treatment

1. Emergency: This is covered in its own section .
2. Conservative (↓RFs)
3. Medical (drugs, radio, chemo): analgesia, oxygen, abx
4. POSSET : Physiotherapy, Occupational therapy, Specialist care eg. nurse/speech/stoma, Social workers, Education, Terminal care

Complications

Generalized

E.g. Anaesthesia

Specific

E.g. Anatomical, or tissue types. Subdivide in to:

Immediate

Early

Late