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Additional info for Making sense of clinical examination of the adult patient: hands-on guide
3 Splinter haemorrages Koilonychia This is a spoon or concave shape of the nail in its transverse diameter that is occasionally seen with severe iron deficiency. Pitting Pitting is pin-sized holes in the nails that are seen in association with psoriasis. White nails Statistically, white nails are associated with chronic liver disease, but they also occasionally occur in healthy people. Yellow nails Yellow nails are occasionally seen with bronchiectasis. Anaemia In the hands, anaemia causes a variable degree of paleness of the nails and palmar surfaces of the fingers, as described on page 33.
Patients should be asked to bring their medications with them, so that a list may be made that includes the name of each drug, its dose, its frequency and how long the patient has been taking it. For example, the past medical history of a 50-year-old man might be: ● German measles aged 4 ● chicken pox aged 8 ● appendicectomy aged 17 ● gonorrhoea aged 21 ● diabetes controlled by diet for 7 years ● hypertension for 5 years ● immunizations: all childhood immunizations; tetanus 5 years ago ● allergies: nuts and bee-stings ● medications: ᭺ atenolol 50 mg daily for 5 years ᭺ hydrochlorothiazide 25 mg daily for 5 years ᭺ syringe of adrenaline in case of bee-sting.
Past medical history The purpose of the past medical history is to document the general health of the patient and to identify any condition or conditions, such as diabetes or hypertension, that may be contributing to the present complaint by way of complications. Start the past medical history by asking about childhood illnesses, such as measles or mumps, and, in addition, the year in which any serious illness, hospitalization, operation or other significant health event occurred. Alternatively, you can ask the patient’s age when each incident happened or, if the condition is still present, how long he has had it.