CFB MED01 History Taking And General Examination
History taking and general examination is the foundational clinical process of systematically gathering a patient's medical history through structured interviewing and performing an overall physical assessment to guide diagnosis and management.
History Taking & General Physical Examination
This lecture (CFB MED01 by Prof Richard YH Yu) is the foundational scaffolding upon which every clinical encounter in medicine is built. It covers:
- The philosophical and ethical basis of medicine (Declaration of Geneva, Medical Professionalism)
- Aetiology of diseases — a classification framework that helps you think through differential diagnoses from first principles
- How diseases affect the host — the distinction between disturbance of internal environment (→ symptoms) and derangement of anatomical structures (→ signs)
- The structured clinical approach: History taking → Physical examination → Investigations → Diagnosis
- The four bedside diagnostic principles that Prof Yu considers core to clinical reasoning
- General physical examination — the survey of the whole patient before diving into system-specific examination
This is supported by CFB MED02 (Clinical Demonstration on General Examination), CFB History Taking and Physical Examination in General (Prof M. Co), and relevant Ryan Ho Fundamentals notes. [1][2][3][4]
Why this matters for exams: This content is tested in OSCEs (history-taking stations, general examination stations), written SAQs ("List the components of history taking," "What are the causes of oedema"), and minicases. The four bedside diagnostic principles are a favourite viva/OSCE question.
Core Concepts & Mechanisms from First Principles
The Declaration of Geneva was first adopted by the World Medical Association (WMA) in 1948 and is the contemporary successor to the 2,500-year-old Hippocratic Oath. The current revised version was adopted by the WMA General Assembly on 14 October 2017. [1]
Key pledges from the Physician's Pledge that are exam-relevant:
| Pledge | Why It Matters |
|---|---|
| "I solemnly pledge to dedicate my life to the service of humanity" | The overarching commitment of the medical profession [1] |
| "The health and well-being of my patient will be my first consideration" | Patient-centred care is the foundation of all clinical decisions |
| "I will respect the autonomy and dignity of my patient" | Underpins informed consent, confidentiality, shared decision-making |
| "I will give to my teachers, colleagues, and students the respect and gratitude that is their due" | Collegiality and the duty to educate [1] |
| "I will not use my medical knowledge to violate human rights and civil liberties, even under threat" | Ethical boundary — relevant to fitness-to-practise questions |
| "I will share my medical knowledge for the benefit of the patient and the advancement of healthcare" | Teaching, research, evidence-based medicine |
Medical professionalism (Royal College of Physicians, 2005): Medicine is a vocation where knowledge, clinical skills, and judgement serve to protect and restore human well-being through a partnership between patient and doctor based on mutual respect, individual responsibility, and appropriate accountability. [1]
In their day-to-day practice, doctors are committed to: [1]
- Integrity
- Compassion
- Altruism
- Continuous improvement
- Excellence
- Working in partnership with the wider healthcare team
Exam Framing
These values are commonly tested in professionalism-themed SAQs and OSCE communication stations. If asked "What are the core values of medical professionalism?", list these six from the RCP framework.
"Clinical medicine is the science of OBSERVATION, CRITICAL ANALYSIS AND LOGICAL DEDUCTION. One which can only be acquired by long and patient study, nor is life long enough to allow any mortal to attain the highest possible perfection in it." [1]
This quote captures the essence of the clinical method. You are not just pattern-matching — you are hypothesising and testing.
Prof Yu's aetiological classification is a structured way to generate differential diagnoses. When you see any patient, you should mentally run through these categories:
| Category | Examples from Lecture | Why It Matters |
|---|---|---|
| Congenital | ASD, VSD, Patent Ductus Arteriosus | Developmental defects present from birth; consider in paediatrics and young adults |
| Hereditary | Thalassaemia, Polycystic kidneys | Transmitted across generations — always ask family history |
| Metabolic | Calcium disorders (osteoporosis, hyperparathyroidism), amino acid metabolism (cystinuria), purine metabolism (gout), lipid metabolism disorders | Derangement of biochemical pathways; detected by blood/urine tests |
| Endocrine | DM (pancreas), Cushing's/Acromegaly (anterior pituitary), DI (posterior pituitary), Hyperaldosteronism (adrenal cortex), Phaeochromocytoma (adrenal medulla) | Hormone excess or deficiency; ask about weight change, sweating, polyuria |
| Immunological | SLE, Rheumatoid Arthritis, Connective tissue disorders | Autoimmune — immune system attacking self |
| Degenerative | Atherosclerosis, Musculoskeletal degeneration, Neurological degeneration | Part of ageing process; key in > 65 age group |
| Neoplastic | Colorectal, Hepatic, Lung, Breast, Prostate cancers | Always consider malignancy in unexplained weight loss, anaemia, mass |
| Infective | Viral (HBsAg, HCV, HIV), Bacterial (Gram +ve, Gram -ve, Mycobacterium), Parasitic (Malaria) | Commonest worldwide cause of disease; ask travel, contacts, immunosuppression |
| Iatrogenic | Drug side effects, procedural complications | Doctor-caused harm — always take a thorough drug history |
High Yield for Exams
The mnemonic "CHIME-DINI" can help you recall: Congenital, Hereditary, Immunological, Metabolic, Endocrine — Degenerative, Infective, Neoplastic, Iatrogenic. Prof Yu's classification is commonly tested as "List the aetiological categories of disease."
Effects of Disease on the Host
This is the conceptual bridge between pathology and clinical presentation.
Symptoms are what the patient tells you. They arise from:
1. Disturbance of internal environment (homeostasis of body fluid)
| Symptom | Underlying Disturbance | Example Condition |
|---|---|---|
| Weakness of extremities | Hypokalaemia | Hyperaldosteronism |
| Hyperkalaemia | Chronic renal failure | |
| Hypercalcaemia | Parathyroid adenoma | |
| Polyuria & Polydipsia | Hyperglycaemia → increased osmotic load to renal tubules | Diabetes mellitus |
| Lost of ADH | Diabetes insipidus | |
| Sweating and Palpitation | Hypoglycaemia → stimulates adrenaline production | Insulinoma, insulin overdose |
| Increased thyroid hormone | Hyperthyroidism | |
| Catecholamine excess | Phaeochromocytoma | |
| Shortness of breath (Dyspnoea) | Hypoxia → stimulates respiratory centre | Pneumonia, PE, heart failure |
| Acidosis (metabolic) | DKA, renal failure | |
| Oedema of lower extremities | Hypoalbuminaemia → reduced plasma oncotic pressure | Multiple causes (see below) |
Why this matters: When a patient presents with a symptom, you should trace it back to the underlying physiological disturbance. This is how Prof Yu wants you to think — not just memorise symptom lists, but understand why the symptom occurs.
2. Disturbance of physiological function of the body
This refers to impaired organ function (e.g., heart failure causing dyspnoea, liver failure causing coagulopathy).
Signs are what the doctor detects on examination. They represent structural changes (e.g., hepatomegaly, clubbing, joint deformity, skin rash).
Key Definition — Know This Cold
"Symptoms are clinical manifestations of disturbances of normal homeostasis of body fluid and physiological function of the body. Signs are derangement of normal anatomical structure of the body." [1]
Students commonly confuse symptoms and signs. A symptom is subjective (patient reports it). A sign is objective (you detect it). However, some things can be both (e.g., oedema: the patient notices swollen ankles = symptom; you press and detect pitting = sign).
The Oedema Pathways — A Case Study in Clinical Reasoning
Prof Yu devotes several slides to building the oedema pathway step by step. This is a masterclass in how to think about a single clinical finding from multiple angles. [1]
Hypoproteinaemia reduces oncotic pressure in capillaries, allowing fluid to shift from intravascular to interstitial space → oedema. [1]
| Mechanism of Hypoproteinaemia | Example |
|---|---|
| Reduced intake | Dietary malnutrition, addiction (poor diet), old age |
| Massive proteinuria | Nephrotic syndrome (> 3.5 g/day protein loss in urine) |
| Impaired production | Chronic liver disease (liver makes albumin) |
| Excessive loss | Protein-losing enteropathy |
| Impaired absorption | Malabsorption syndrome, Inflammatory bowel disease |
When venous pressure rises, it pushes more fluid out of capillaries into the interstitium:
| Cause of ↑ Hydrostatic Pressure | Mechanism |
|---|---|
| Congestive heart failure | Failing heart cannot pump blood forward → backs up into venous system |
| Constrictive pericarditis | Rigid pericardium restricts filling → back-pressure |
| Pericardial effusion | Fluid around heart restricts filling (similar mechanism) |
| Increased intrathoracic pressure | Chronic lung disease (COPD), fibrosing alveolitis → impedes venous return |
Exam Trap
If asked "Causes of oedema," students often list only heart failure. Remember to think in two categories: (1) Reduced oncotic pressure (hypoproteinaemia) and (2) Increased hydrostatic pressure (cardiac, pulmonary, venous). Also consider (3) Increased capillary permeability (inflammation, allergy), (4) Lymphatic obstruction, and (5) Sodium/water retention.
History Taking — The Complete Structure
The 3 Basic Principles in Clinical Practice: [1]
- Observation — from what you see and what you hear
- Critical analysis
- Logical deduction
Slide 25 presents these three principles as a connected clinical-information sequence applied at the bedside: [1]
NAME → AGE → CHIEF COMPLAINT / SYMPTOMS → HISTORY OF PRESENT ILLNESS| Step | Key Action |
|---|---|
| Name | Establish doctor–patient relationship |
| Age | > 60–65 yrs vs < 60 yrs → process of exclusion/inclusion |
| Chief Complaint / Symptoms | Acute (days) vs Chronic (weeks/months) — disturbance of internal environment |
| History of Present Illness | Elicit the natural history of the disease |
| Component | What to Ask | Why |
|---|---|---|
| Name | Full name, preferred address | Establish doctor-patient relationship [1] |
| Age | Exact age; arbitrary division at 65 years [1] | > 65: think degenerative disease and malignancy. < 65: wider differential. This is a process of exclusion/inclusion |
| Sex | Male/Female | Some diseases have sex preferences, e.g., SLE in females [1] |
| Chief Complaint | The major symptom(s) prompting the visit | Onset: Short (days/weeks) = acute disease. Long (months/years) = chronic disease [1] |
| History of Present Illness (HPI) | A chronological narrative of the disease process | "A natural history of disease process which may be modified by intervention" [1]. Document timeline, progression, treatments tried, response to treatment |
| Past Health | Previous diseases, procedures, diabetes, hypertension, stroke | "DM and HTN — two common diseases that patients often forget" [1]. Always ask specifically! Also ask about any invasive procedure and stroke with/without residual disability |
| Personal History | Smoking, alcohol, sexual history (venereal exposure) | Risk factors for many diseases [1] |
| Family History | Hereditary disorders | Important for genetic diseases [1] |
| Obstetric History (Female) | Pregnancy, complications (pre-eclamptic toxaemia, eclampsia) | Relevant to hypertensive disorders, clotting, etc. [1] |
From CFB History Taking by Prof M. Co and Ryan Ho Fundamentals: [2][4]
The SOCRATES Mnemonic for Pain Characterisation:
| Letter | Component | Details |
|---|---|---|
| S | Site | Where is the pain? Point to it. |
| O | Onset | When did it start? Sudden/gradual? What were you doing? |
| C | Character | Sharp, dull, burning, cramping, tearing, stabbing? |
| R | Radiation | Does the pain go anywhere else? |
| A | Associations | Other symptoms at the same time (nausea, sweating, SOB)? |
| T | Time course | Constant/intermittent? Getting better/worse? Duration? |
| E | Exacerbating/alleviating factors | What makes it worse/better? |
| S | Severity | On a scale of 1-10? Worst pain ever? |
Drug History (DHx): Current medications, dosages, compliance, over-the-counter drugs, traditional/herbal remedies, allergies (specify reaction type — true allergy vs intolerance)
Social History (SHx): Occupation, living situation, functional status (ADLs, iADLs), travel history, dietary habits, recreational drugs
Review of Systems (ROS): A systematic screen of all body systems to catch symptoms the patient may not have volunteered. This includes:
- General: fever, weight change, appetite, fatigue, night sweats
- CVS: chest pain, palpitations, dyspnoea, orthopnoea, PND, ankle swelling
- Respiratory: cough, sputum, haemoptysis, wheeze, stridor
- GI: nausea/vomiting, dysphagia, heartburn, abdominal pain, change in bowel habit, PR bleeding, melaena
- GU: dysuria, frequency, urgency, haematuria, nocturia
- Neuro: headache, dizziness, weakness, numbness, visual changes, fits, falls
- MSK: joint pain, stiffness, swelling, functional limitation
- Skin: rash, itch, changes in moles
- Psychiatric: mood, sleep, anxiety, suicidal ideation
- Read referral letter before consultation
- Greet child by first name
- Determine relationship of adults to child
- Use age-appropriate vocabulary ("tummy" not "abdomen")
- Ask about 食屙玩瞓 (eating, bowel/bladder, playing, sleeping) — the paediatric equivalent of ROS
- Always compare baseline vs current
- Always draw a 3-generation family tree
- For children in nappies (< 2-3y): ask about nappy weight/frequency, not "how many times do they pee"
Physical Examination — The General Examination
"Signs are derangement of normal anatomical structure of the body." [1]
| Modality | What It Detects | Exception |
|---|---|---|
| Inspection | Visual abnormalities — skin changes, masses, deformities, breathing pattern | — |
| Palpation | Masses, tenderness, organ enlargement, temperature, pulse, crepitus | — |
| Percussion | Fluid (dull), air (resonant), organ borders | — |
| Auscultation | Heart sounds, breath sounds, bowel sounds, bruits | — |
"EXCEPT C.N.S." — The CNS examination uses a different approach (inspection, tone, power, reflexes, sensation, coordination) rather than the classical Inspection-Palpation-Percussion-Auscultation sequence. [1]
Physical examination covers: [1]
- Cardiovascular
- Respiratory
- Abdominal
- Central Nervous System
- Musculoskeletal
- Urinalysis
Prof Yu shows clinical photographs of key findings. These are high-yield for visual recognition in OSCEs and photo-based MCQs:
| Finding | What to Look For | Associated Conditions |
|---|---|---|
| Finger Clubbing [1] | Loss of nail bed angle (Schamroth's sign), increased nail bed fluctuation, drumstick appearance | Respiratory: bronchiectasis, lung CA, empyema, mesothelioma, ILD. Cardiac: cyanotic CHD, IE. GI: Crohn's, cirrhosis, coeliac. Others: thyroid acropachy |
| Acute Gout [1] | Red, hot, swollen, exquisitely tender joint (often 1st MTP) | Hyperuricaemia — purine metabolism disorder |
| Tophaceous Gout [1] | White/yellow chalky deposits in soft tissues/around joints | Chronic gout with urate crystal deposition |
| Primary Osteoarthritis (OA) Hands [1] | Heberden's nodes (DIP), Bouchard's nodes (PIP), squaring of 1st CMC | Degenerative joint disease |
| Rheumatoid Arthritis (RA) Hands [1] | Ulnar deviation at MCPs, swan-neck/boutonnière deformities, Z-thumb, MCP subluxation, symmetrical | Autoimmune inflammatory arthritis |
| Ankylosing Spondylitis [1] | Question mark posture, loss of lumbar lordosis, fixed kyphosis | HLA-B27 associated seronegative spondyloarthritis |
| Oedema [1] | Pitting on pressure over bony prominences (ankle, sacrum) | Heart failure, nephrotic syndrome, liver disease, venous insufficiency |
| Malar rash (SLE) [1] | Butterfly distribution across cheeks and nose bridge, sparing nasolabial folds | Systemic Lupus Erythematosus |
| Exophthalmos [1] | Protrusion of eyeballs beyond orbital rim | Graves' disease (thyroid eye disease) |
| Spider naevi [1] | Central arteriole with radiating legs; blanch from centre; > 5 in SVC distribution is pathological | Chronic liver disease, pregnancy, OCP |
| Neurofibromatosis (Von Recklinghausen) [1] | Multiple café-au-lait spots, neurofibromas, axillary freckling | Autosomal dominant; NF1 gene |
| Erythema Induratum [1] | Tender nodules on calves (posterior legs), may ulcerate | TB-related (Bazin's disease) or idiopathic |
| Pemphigus [1] | Flaccid blisters on skin/mucous membranes, Nikolsky sign positive | Autoimmune (anti-desmoglein antibodies) |
| Henoch-Schönlein Purpura [1] | Palpable purpura on lower limbs and buttocks, arthralgia, abdominal pain, renal involvement | IgA vasculitis — most common vasculitis in children |
| Eschar [1] | Black necrotic scab at site of arthropod bite | Scrub typhus (Orientia tsutsugamushi); also anthrax, rickettsial infections |
Hands:
- Clubbing, tar stains, peripheral cyanosis, palmar erythema, Dupuytren's contracture, leukonychia, koilonychia
- Signs of infective endocarditis: Osler's nodes (painful, fingertip), Janeway lesions (painless, palmar), splinter haemorrhages
- Joint changes: RA, OA, gout, psoriatic arthropathy
- Pulse: rate, rhythm, character
Face and Eyes:
- Pallor (conjunctival) → anaemia
- Jaundice (scleral) → liver disease, haemolysis
- Xanthelasma → hyperlipidaemia
- Malar flush → mitral stenosis
- Central cyanosis (tongue/lips) → severe hypoxaemia (SaO2 ≤ 90%)
- Exophthalmos → Graves' disease
Neck:
- JVP: height and waveform
- Carotid pulse
- Lymphadenopathy
- Thyroid
Skin:
- Spider naevi (> 5 in SVC distribution = pathological)
- Bruising, petechiae
- Scratch marks (cholestasis, uraemia)
- Pigmentation changes
Legs:
- Oedema (pitting vs non-pitting)
- Ulcers (venous, arterial, neuropathic)
- DVT signs
Investigations — The Three Categories
Prof Yu classifies investigations into three domains: [1]
- Purpose: Detect changes in body fluid composition caused by disease
- Applications: Confirmation of diagnosis, assess severity
- Examples: FBC, U&E, LFT, CRP, cultures, blood gases
- Purpose: Assess the degree of functional impairment by disease
- Organ-specific:
| Organ | Function Test Examples |
|---|---|
| Renal | Creatinine, eGFR, creatinine clearance, urine analysis |
| Hepatic | ALT, AST, ALP, GGT, bilirubin, albumin, PT/INR |
| Respiratory | Spirometry (FEV1/FVC), DLCO, ABG |
| Gastrointestinal | Endoscopy, breath tests |
| Endocrine | Hormone levels (TSH, cortisol, glucose) |
| Metabolic | HbA1c, lipid profile |
| Modality | What It Shows |
|---|---|
| Conventional radiology | Chest X-ray, abdominal X-ray — structure |
| Interventional radiology | Angiography, guided drainage |
| Ultrasonography | Structure of internal organs, echocardiography, Doppler study of blood flow |
| CT | Static and dynamic cross-sectional imaging |
| MRI | Static and functional imaging; no radiation |
| Nuclear scan (Isotope) | Cardiac (perfusion), Renal (DMSA, MAG3) |
| PET | Malignancy and infection (metabolic activity) |
These are Prof Yu's "Four Principles" — extremely high yield for viva and OSCE: [1]
| # | Principle | Explanation |
|---|---|---|
| 1 | "Commence with a process of EXCLUSION/INCLUSION" | Use age, sex, risk factors to narrow the differential. Always start broad, then systematically include or exclude possibilities |
| 2 | "Symptoms are clinical manifestations of disturbances of internal environment (homeostasis) of the body and normal physiological functions" | Symptoms = functional derangement. Trace each symptom to its pathophysiology |
| 3 | "Signs are derangement of normal anatomical structure of the body" | Signs = structural change. Examine systematically to detect them |
| 4 | "Common diseases always come commonly" | Think of common things first! A galloping hoofbeat is usually a horse, not a zebra. But don't forget serious/life-threatening conditions |
High Yield — Four Principles of Bedside Diagnosis
These four principles are directly from the lecture and are the kind of thing examiners love to ask in viva or short-answer format. Memorise them verbatim. [1]
Integration with Specialty-Specific History & Examination
- General exam → hands (clubbing, signs of IE), face (malar flush, central cyanosis), JVP, carotid pulse
- Inspection → scars, pacemakers, apex beat
- Palpation → apex beat character, thrills, parasternal heave
- Auscultation → heart sounds, murmurs
- Complete with: lung bases, liver, peripheral pulses, BP, ankle oedema
- General → O2, inhalers, sputum, cachexia, respiratory distress
- Hands → clubbing, tar stains, wrist tenderness (HPO), small muscle wasting (Pancoast)
- Face → Horner's syndrome, central cyanosis
- Neck → lymphadenopathy, JVP (SVCO, cor pulmonale), tracheal deviation
- Chest → inspection (shape, symmetry, scars), palpation (expansion), percussion, auscultation (breath sounds, vocal resonance)
- General → jaundice, pallor, spider naevi, gynaecomastia, palmar erythema, clubbing, leukonychia, Dupuytren's, asterixis
- Inspection of abdomen → shape, umbilicus, scars, stomas, dilated veins, visible peristalsis
- Palpation → superficial, deep, liver, spleen, kidneys, any mass
- Percussion → shifting dullness for ascites
- Auscultation → bowel sounds
- Does NOT follow Inspection-Palpation-Percussion-Auscultation
- Instead: General → Cranial nerves (I-XII) → Upper limbs (motor, sensory, coordination) → Trunk → Lower limbs → Gait
- General CNS exam: conscious level, higher functions, handedness, posture, abnormal movements
- General → gait, deformity, pattern of joint involvement
- Joint examination → Look, Feel, Move, Function
- Pattern recognition:
- Monoarthritis → gout, septic arthritis
- Oligoarthritis (≤ 4 joints) → ankylosing spondylitis
- Polyarthritis (≥ 5 joints) → RA, SLE
- Psychiatric history + Mental State Examination (MSE) + Risk assessment
- MSE components: Appearance/Behaviour, Speech, Mood/Affect, Thought (form, content), Perception, Cognition, Insight
- Safety first: alarm, arm's length, sit nearest to door
- History from parents/carers (informant ≠ patient)
- 食屙玩瞓 framework
- Birth history, developmental milestones, immunisation history, feeding history
- 3-generation family tree mandatory
| Step | What to Do | Key Points from Lecture |
|---|---|---|
| 1. History | Structured, systematic | Name → Age → Sex → CC → HPI → Past Hx → Personal Hx → Family Hx → Obstetric Hx → Drug Hx → ROS |
| 2. Physical Exam | General → System-specific | Inspection → Palpation → Percussion → Auscultation (except CNS) |
| 3. Investigation | Blood/fluid → Function tests → Imaging | Confirm diagnosis + assess severity |
| 4. Diagnosis | Use 4 bedside principles | Exclusion/inclusion, common things commonly, symptoms = function, signs = structure |
| 5. Treatment | Based on diagnosis | Medical, surgical, supportive, preventive |
Exam Intelligence
- SAQ: "List the components of a complete medical history" → List all 9 components
- SAQ: "What are the aetiological categories of disease?" → List all 9 categories (CHIME-DINI)
- SAQ/Minicase: "A 70-year-old presents with bilateral lower limb oedema. List the possible causes." → Think oncotic pressure (hypoproteinaemia causes) AND hydrostatic pressure (cardiac, pulmonary) AND other mechanisms
- MCQ: "Which of the following is NOT a cause of clubbing?" → Know the full list
- OSCE: "Take a history from this patient with chest pain" → Use structured approach with SOCRATES
- Viva: "What are the four principles of bedside diagnosis?" → Quote Prof Yu verbatim
| Trap | How to Avoid It |
|---|---|
| Forgetting to ask about DM and HTN in past history | Prof Yu specifically warns these are "two common diseases that patients often forget" — always ask directly [1] |
| Confusing symptoms and signs | Symptoms = patient tells you (function). Signs = you find (structure). |
| Listing only cardiac causes of oedema | Remember hypoproteinaemia causes (nephrotic, liver, malnutrition, malabsorption, protein-losing enteropathy) |
| Forgetting iatrogenic causes | Always consider drug side effects in your differential |
| Assuming CNS exam uses IPPA | "Except CNS" — Prof Yu explicitly states this [1] |
| Not asking obstetric history in females | Can reveal pre-eclampsia, eclampsia, gestational DM |
| Concept A | Concept B | Key Discriminator |
|---|---|---|
| Symptom | Sign | Symptom = subjective (patient reports); Sign = objective (doctor finds) |
| Acute onset | Chronic onset | Days/weeks vs months/years |
| Congenital | Hereditary | Congenital = present at birth (may not be genetic); Hereditary = transmitted across generations |
| Primary OA hands | RA hands | OA: DIP (Heberden's) + PIP (Bouchard's) + 1st CMC. RA: MCP + PIP, spares DIP, symmetrical, ulnar deviation |
| Spider naevi | Cherry angioma | Spider naevi: central arteriole + blanch from centre, > 5 pathological. Cherry angioma: uniform red, benign |
High Yield Summary
- History taking
- follows a systematic structure: Name → Age → Sex → Chief Complaint → HPI → Past Health (always ask DM, HTN, procedures, stroke) → Personal History (smoking, alcohol, sexual) → Family History → Obstetric History.
- Symptoms arise from disturbance of internal environment (homeostasis) and physiological function.
- Signs arise from derangement of normal anatomical structure.
- Physical examination uses Inspection → Palpation → Percussion → Auscultation (except CNS).
- The four bedside diagnostic principles are: (1) Process of exclusion/inclusion, (2) Symptoms = functional disturbance, (3) Signs = structural derangement, (4) Common diseases come commonly.
- Oedema arises from reduced oncotic pressure (hypoproteinaemia from multiple causes) OR increased hydrostatic pressure (cardiac, pulmonary, venous causes).
- The aetiological classification of diseases (Congenital, Hereditary, Metabolic, Endocrine, Immunological, Degenerative, Neoplastic, Infective, Iatrogenic) provides a systematic framework for generating differentials.
- Medical professionalism is built on integrity, compassion, altruism, continuous improvement, excellence, and teamwork.
Active Recall - History Taking & General Examination
[1] Lecture slides: CFB (MED01) History taking and general examination.pdf [2] Lecture slides: CFB History Taking and Physical Examination in general_Prof. M Co.pdf [3] Lecture slides: CFB (MED02) Clinical Demonstration on general examination.pdf [4] Senior notes: Ryan Ho Fundamentals.pdf [5] Lecture slides: CFB (PAE01) Paediatric history taking.pdf [6] Senior notes: Ryan Ho Cardiology.pdf (Ch 1 - Examination of CVS) [7] Senior notes: Ryan Ho Respiratory.pdf (Ch 1 - Examination of Respiratory System) [8] Senior notes: Ryan Ho GI.pdf (Ch 1 - Examination of Abdomen) [9] Senior notes: Ryan Ho Neurology.pdf (Ch 1 - Physical Examination) [10] Lecture slides: CFB (MED04) Central Nervous System.pdf [11] Senior notes: Ryan Ho Rheumatology.pdf (Ch 1 - Examination of Rheumatological System) [12] Senior notes: Ryan Ho Psychiatry.pdf (Ch 2.2 - Psychiatric Assessment)
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