SWELLING LONG CASE: HISTORY TAKING AND CLINICAL EXAMINATION POINTS: BY DR. MUZAFAR HUSSAIN BURIRO DISCLAIMER: FOR ACADEMIC PURPOSE ONLY

1. SWELLING:
HIST0RY AND EXAMINATION
DR. MUZAFAR HUSSAIN
BURIRO
FELLOW ORTHOPAEDIC SURGERY

2. PREREQUISITES:
• BE GENTLE
• BE PROFESSIONAL
• BE A KEEN LISTENER
• SHOW EMPATHY
• BE SYSTEMIC
• RESPECT PRIVACY
• HELP EXAMINERS LISTEN YOU
• MANAGE TIME
SWELLING:
HISTROY AND EXAMINATION

3. 1. INTRODUCTION AND CONSENT
2. BIODATA OF PATIENT
3. PRESENTING COMPLAIN
4. HISTORY OF PRESENTING COMPLAIN
5. SYSTEMIC REVIEW
6. PAST MEDICAL HISTORY
7. PAST SURGICAL HISTORY
8. DRUG HISTORY
9. PERSONAL HISTORY
10. FAMILY HISTORY
11. SOCIOECONOMIC HISTORY
12. EXPECTAION
SWELLING: HISTORY TAKING

4. SWELLING: HISTORY TAKING
1. INTRODUCTON & INFORMED CONSENT

5. 2. BIODATA OF PATIENT (NASOMA-D)
Name
Age
Sex
Occupation
Marrital Status
Address
Dominant Hand
SWELLING: HISTORY TAKING

6. 3. PRESENTING COMPLAIN:
A. Swelling at....for.....
B. Pain in Swelling for.......
SWELLING: HISTORY TAKING

7. 4. HISTORY OF PRESENTING COMPLAIN
SWELLING: ( SDO-PSO-DATE )
Site:
Duration:
Onset: How was swelling first seen ?
Progression:
Symptoms:
a. General: Pain, Fever, Anorexia, Weight Loss, Discharge
b. Mechanical: N/V Pressure symptoms, Restricted ROM
Other Swellings(bone, LN, Primary sites) and Questions(TB,RA
etc)
Disability
Treatment taken
Expectation:
SWELLING: HISTORY TAKING

8. 4. HISTORY OF PRESENTING COMPLAIN
PAIN: (SOCRATES-A)
• Site:
• Onset:
• Character:
• Radiation:
• Alleviating Factors:
• Timing:
• Exacerbating Factors:
• Severity
• Associations:
SWELLING: HISTORY TAKING

9. 5. SYSTEMIC SYMPTOMS REVIEW
• GENERAL
• HEAD(CNS, OPTHO, ENT)
• CHEST( PULMO, CVS)
• GASTRO-UROGENITAL
• MUSCULOSKELETAL
• SKIN
SWELLING: HISTORY TAKING

10. 6. PAST MEDICAL HISTORY
Previous Hospitalization
DM, BP, CAD, Asthma,
Any disease of Liver, Stomach, Small & Large
Intestines, Kidneys, Blood, Skin, MSK, Bleeding
Disorder, Developmental Disease
SWELLING: HISTORY TAKING

11. 7. PAST SURGICAL HISTORY:
Any Surgical Procedure
Perioperative Complication
Blood Transfusion
SWELLING: HISTORY TAKING

12. 8. DRUG HISTORY:
• Routine Medicines
• Homeopathic medicines
• Blood thinners
• Any Chemotherapy
• Drug allergies
• Radiation exposure
• Vaccination
SWELLING: HISTORY TAKING

13. 9. PERSONAL HISTORY
Sleep, smoking, alcohol, extramarrital activities
10. FAMILY HISTORY
Family number and support system
Familial disorders
11. SOCIOECONOMIC HISTORY
Nature of job/occupation
Hobbies
SWELLING: HISTORY TAKING

14. 12. EXPECTATIONS:
SWELLING: HISTORY TAKING

15. CLINICAL EXAMINATION

16. GENERAL PHYSICAL EXAMINAITON
GENERAL LOOK/BUILT:
Normal/Cachexic
VITALS:
• Pulse:
• Temperature
• R/R
• Blood Pressure
Sub-vitals: Pallor, Clubbing, Anaemia, Jaundice
Lymph Nodes, Thyroid
SWELLING: EXAMINATION

17. LOCAL EXAMINATION OF SWELLING:
LOOK:
1. Site
2. Shape
3. Surface
4. Scar
5. Sinus
6. Colour
7. Number
SWELLING: EXAMINATION

18. SWELLING: EXAMINATION
LOCAL EXAMINATION OF SWELLING:
FEEL AND MOVE 11. Fixity
12. Relationship with limb movement
13. ROM of Joint
14. Lymph Nodes
15. Pulses Distal
16. Sensation Distal
17. Other Swelling examination if any
18. Graft Sites where applicable
1. Temperature
2. Tenderness
3. Pulsality
4. Sensation local
5. Size
6. Skin Pinch
7. Consistency
8. Margins
9. Transillumination
10. Fluidity/Fluctuation Soft /Cystic Swelling

19. SYSTEMIC EXAMINATION: PRIMARY SITES
• ABDOMEN: Liver Palpation (Hepatic Mats)
• Renal Mass (Renal Ca)
DRE (Ca Prostate)
• Chest : Auscultation (Pumonary Mats/Ca Lung)
Breast Examination (CA Breast )
SWELLING: EXAMINATION

20. • Say THANK YOU to the patient
• Help cover the patient
• Consolidate your history and examination
findings.
• Present your case just like you are a consultant
SWELLING: EXAMINATION

21. I wish you best of luck
Regards:
DR. MUZAFAR HUSSAIN BURIRO
FELLOW ORTHOPAEDIC SURGERY