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Clinical Surgical Skills Made Easy
AhmedFarag EhabA.Mansour DesmondC.Winter
Editors
123
Ahmed Farag • Ehab A. Mansour Desmond C. Winter
Editors
Clinical Surgical Skills Made Easy
Editors
Ahmed Farag Kasr Al Ainy-Faculty of Medicine Cairo University hospitals Cairo, Egypt
Desmond C. Winter St Vincent's University Hospital Dublin, Ireland
Ehab A. Mansour General and Colorectal Surgery St. Vincent's University Hospital Dublin, Ireland
ISBN 978-3-031-69157-7 ISBN 978-3-031-69158-4 (eBook)
https://doi.org/10.1007/978-3-031-69158-4
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2024 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microlms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specic statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional afliations.
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If disposing of this product, please recycle the paper.

Preface

A lot of the excellent books in clinical surgery have been written all over the world, but to the best of my knowledge none of them have helped the student or even the practicing physician to understand the philosophy of why they are taking a patient’s history or performing the clinical examination in an orthodox way, and why we examine them and even may fail them in the exam if they ignore basic steps? Why despite being swellings, we have a separate sheet for thyroid and hernia and don’t include them in the general sheet for swellings? Is there a different way for clinical examination than what we have to do in our practice later on? Is there a common goal for clinical examination, labs, and X-rays? Why do we have a separate sheet for neck swellings, chest, and abdomen but we don’t have a comprehensive sheet to examine a limb? This book includes a sheet for the examination of a limb in order to avoid the common mistakes during examination of a limb swelling or ulcer, both by students and by young practicing clinicians.
From my experience, the answer is simple, and it is that every single step in his­tory taking and clinical, laboratory, radiologic, instrumental (e.g., endoscopic and others), and pathologic examination has to reach a clinical diagnosis that rests on two pillars:
1. Anatomical diagnosis
2. Pathologic diagnosis
in the milieu of the general condition of the patient, which may affect the decision­making or help in tailoring the treatment according to their general condition.
We are treating the patient in general not only the disease.
Cairo, Egypt AhmedFarag Dublin, Ireland EhabA.Mansour Dublin, Ireland DesmondC.Winter
v

Contents

1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Ahmed Farag, Ehab A. Mansour, and Desmond C. Winter
2 A Qualifying Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Ahmed Farag, Ehab A. Mansour, and Desmond C. Winter
3 General Examination Sheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Ahmed Farag and Ehab A. Mansour
4 Examination of Swellings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Mohamed Yehia Elbarmelgi and Mahmoud Mostafa
5 DD. of Swelling in the Femoral Triangle . . . . . . . . . . . . . . . . . . . . . . . . 31
Ahmed Farag
6 Swelling in the Popliteal Fossa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Ahmed Farag
7 Examination of an Ulcer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Mohamed Yehia Elbarmelgi and Mahmoud Mostafa
8 Lymphadenopathy Sheet and D.D. of Multiple Swellings . . . . . . . . . . 55
Ahmed Farag
9 General Limb Sheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Ahmed Farag
10 DD. of Limb Edema . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Ahmed Farag
11 Limb Pain Sheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Ahmed Farag
12 Examination of the Thyroid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Alexandra M. Zaborowski and Ruth S. Prichard
vii
viii
Contents
13 Abdominal Examination Sheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Ahmed Farag and Reem Awad Alharbi
14 Digital Rectal Examination “DRE” . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Shimaa Alkhaldi
15 Pelvic and Rectal Clinical Examination . . . . . . . . . . . . . . . . . . . . . . . . 127
Ilario Froehner Junior and Peter Petros
16 Acute Abdomen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Kimberley Logbochi Olivia Mvetimbo Tamb and Audrius Dulskas
17 Urology Sheet. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
Steven Anderson, Elsayed M. Salih, and Mohammed Aboelmaged
18 Hernia Sheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
Ahmed Farag, Asif Mehraj, and Patrick Jordan
19 D.D. of Inguinoscrotal Swelling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
Ahmed Farag, Asif Mehraj, and Patrick Jordan
20 Vascular Examination Sheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
Mohammed Elkassaby
21 Breast Examination Sheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
Tim Harding
22 Examination of the Axilla . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215
Alexandra M. Zaborowski and Arnold D. K. Hill
23 Examination of the Head and Neck . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
Husam Hosny and Ahmed Farag
24 Examination of a Mass in the Head and Face . . . . . . . . . . . . . . . . . . . 235
Ahmed Farag, Amr Kamel Elfeky, and Nicholas Johnson
25 Clinical Examination of Thoracic Surgery . . . . . . . . . . . . . . . . . . . . . . 259
Sandhya Chalasani
26 Peripheral Nerve and Hand Examination . . . . . . . . . . . . . . . . . . . . . . 271
Husam Hosny
27 Neurological Examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281
Ahmed Adel Mohamed Ezzat and Hazem Abdel Badie Ahmed Gouda
28 Examination of the Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289
Khaled Saoud
Contents
29 Orthopedic Examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299
Mahmoud Massoud and Ashraf Mohey
30 Sheet for of a Swelling from the Bone . . . . . . . . . . . . . . . . . . . . . . . . . . 321
Ashraf Mohey and Ahmed Hassan Amin
31 Peri-Operative Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329
Lauren O’Connell
32 Management of the Patient in the Post- Operative Setting . . . . . . . . . 337
Lauren O’Connell
33 Stoma Examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 349
Enda Hannan, Nicholas Johnson, Tim Harding, and Ehab A. Mansour
34 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361
Ahmed Farag
ix
Chapter 1
Introduction
AhmedFarag, EhabA.Mansour, andDesmondC.Winter
Abstract Clinical diagnosis, as well as, interpretation of X-Rays and Surgical Jars
represent the nal common pathway of medical education. Clinical diagnosis is a part of applied Medical Science which is based on the basic sciences namely Anatomy, Histology, physiology, Biochemistry, pathology, Parasitology and Bacteriology…. etc. In fact diagnosis is based on two Pillars namely: Anatomical Diagnosis and Pathologic diagnosis. Clinical examination is never complete with­out thorough though swift General examination.
Keywords Diagnosis · Clinical · Anatomical · Pathologic · General · Examination
· Pillars · Thorough
Clinical diagnosis, as well as, interpretation of X-Rays and Surgical Jars represent the nal common pathway of medical education. Clinical diagnosis is a part of applied Medical Science which is based on the basic sciences namely Anatomy, Histology, physiology, Biochemistry, pathology, Parasitology and Bacteriology…. etc.
In fact diagnosis is based on two Pillars namely: Anatomical Diagnosis and
Pathologic diagnosis. Clinical examination is never complete without through though swift General examination.
Diagnoses such as liver Cirrhosis, Cancer stomach or Ulcerative Colitis includes the name of the organ affected and the Pathology responsible for the Patients’ Symptoms.
In Fact from my more than 40years of Clinical Practice and 35years of teaching Clinical skills to Medical students. I can claim that the knowledge of the anatomic
A. Farag (*) Kasr Alainy Hospital, Cairo University, Cairo, Egypt
E. A. Mansour General and Colorectal Surgery, St. Vincent’s University Hospital, Dublin, Ireland
D. C. Winter St Vincent’s University Hospital, Dublin, Ireland
Switzerland AG 2024 A. Farag et al. (eds.), Clinical Surgical Skills Made Easy,
https://doi.org/10.1007/978-3-031-69158-4_1
1© The Author(s), under exclusive license to Springer Nature
2
A. Farag et al.
diagnosis (the organ affected) represents a more difcult question than the diagnosis of the pathology in that organ.
This explains why the Medical student is subconsciously happy if he knows that he will take the sheet of Thyroid or the sheet of a hernia because he had one of the questions already answered namely the anatomic diagnosis. Similarly if he knows that the case is Hepato-splenomegaly or Varicose Veins. Accordingly the most dif­cult sheet to take is the case of Abdominal examination where a lot of organs are closely packed in this single space which makes the anatomic diagnosis and accord­ingly the nal diagnosis, the most difcult to achieve which make this examination from my point of view “The Mark of A Good Clinician”.
This book which I had decided to write in order to serve both functions of pass­ing the clinical examination and optimizing our diagnostic skills. In fact both tasks are intimately related as we will see through the rest of the book. Authors
“Clinical skills save Lives. Clinical skills save resources” Authors.
“The Key for correct treatment is correct diagnosis”. I keep telling my patients that
“Even the medical student knows the treatment of any disease when he is asked about it in
the examination. Diagnosis may be the major challenge to reach the diagnosis even for the
most Challenging task even for the most talented doctor”. “Authors”.
“A good Clinician who detects more (Symptoms) and signs
Than others do”. Norman Browse modied by authors.
“Eyes Don’t See what Mind doesn’t Know (only gifted people Do)” Unknown wise man
modied by Authors.
“Clinical Diagnosis is like the detective work in CSI”. A good Clinician can reach the
diagnosis because he asked a question or found a clue that others failed to do” Authors.
“Clinical Diagnosis is like us walk on two limbs or rests on Two Pillars namely
Anatomical and Pathologic Diagnosis in a milieu of associated disease and General
Condition of the patient”. “Authors.”
“The Brain of the Clinician is like a CPU of a computer which literally allocates all the
data taken in the Clinical Sheet in one of 3 Categories namely anatomical diagnosis,
Pathologic diagnosis and/or the General Condition of the patient”. Failing to do such
allocation with each single item can risk losing the diagnosis or doing a medical Error.
“Authors.”
“Clinical signs should be done exactly in the same way it had been described otherwise
we can miss the diagnosis” Authors.
“The Key for proper treatment is proper Clinical diagnosis which has to guide our
Further Investigations”. “Authors”.
Complete and swift Clinical Examination not only saves Health care resources by
avoiding unnecessary Investigations or interventions but also it can save lives and
decreases the Preventable health care Errors “i.e. Morbidity and Mortality”.
“Authors”.