That shy doctor

So, if the physical exam was developed because the good ol' doctors didn't have the same advanced tools and technologies that we have now, then what's the point of teaching the physical exam today?

More commonly, the physical exam can provide not a diagnosis but an essential clue to direct further testing—a shortcut to the right answer. Ordering a slew of studies to evaluate a patient might get you the answer eventually, but time is often short in the care of a very sick patient. In many cases a careful exam can focus the search and help the physician find the problem faster. Where such an advantage would be most helpful, naturally, is among those patients who are critically ill. But even here—maybe especially here—the physical exam is becoming as obsolete as the doctor’s black bag.
The sicker the patient, the greater the temptation to skip the fundamentals—like the physical examination—and to rely on the available technology to provide us with answers. It’s a temptation that can sometimes prove fatal

- Every patient tells a story

And that's where Dr. Braverman comes in to the scene:

Dr. Irwin Braverman, a professor of dermatology for over fifty years, had long been frustrated by the difficulty students had in describing findings of the skin. It might have been a knowledge deficit—easily remedied with books, pictures, and tests. But Braverman suspected that what his students principally lacked was the skill of close observation. Too often they wanted to cut straight to the answer without paying attention to the details that took them there.

- Every patient tells a story

You look, but you don't observe

Physical exam, but for paintings

The Death of Chatterton,
by Henry Wallis

More is missed by not looking, than by not knowing.

- Thomas McCrae

طلعت شارحها ومفصخها قبل سنة كاملة

وهسة ناسيها تمامًا ولله الحمد

Hyperreflexia & Myoclonus

تصحيح بالنسبة للـ pronator drift:

The patient is asked to hold both arms at 90 degree flexion and elbows fully extended at shoulder level in front of them, with the palms upwards (supinated), and hold the position. If they are unable to maintain the position and the arms pronate, the result is positive. Closing the eyes accentuates the effect, because the brain is deprived of visual information about the position of the body and must rely on proprioception.

باختصار: تبدي بـ supination وإذا صار أكو drift للـ pronation معناها الاختبار positive
And the patient has UMN lesion

When you see absent P-waves, you must check whether the rhythm is regular or irregular based on the QRS complex:-

- Irregular and normal QRS: most likely to be atrial fibrillation.

- Regular: if the QRS < 120 ms (narrow), then it's likely to be paroxysmal SVT.
If the QRS > 120 ms (wide) then it's probably VT.

JUST TO BE CLEAR: This is an oversimplification with a lot of buts and ifs.
For example, some paroxysmal SVTs can present with wide QRS if they're associated with pre-existing LBBB.

In AF, the P-wave is either absent or it's replaced by rapid, variable, irregular and low-amplitude oscillating fibrillatory waves.