PSPal Surgery

Model clerkings · General surgery

Learn History Writing

Twelve complete histories and physical examinations, written the way a good surgical clerking reads on the ward, with the reason for every line beside it.

  • Key boxes on the right of each page explain why it is written that way
  • A differential diagnosis table and a model answer for the OSCE
  • The clinical signs that belong to each case, and how to elicit them
Start with Case 1 Choose a case Test yourself

How every case is laid out

Each clerking follows the same six parts, in the order you would write them at the bedside.

  1. 1Presenting complaintOne symptom and one duration, in the patient’s own words.
  2. 2History of the complaintOne continuous story in time order, ending with the negatives that rule things out.
  3. 3BackgroundPast illness, operations, drugs, allergies, family, social history and the last meal.
  4. 4ExaminationGeneral state and vital signs first, then the system, in a fixed order.
  5. 5Summary and planThree sentences for the examiner, a provisional diagnosis and the first steps.
  6. 6Differential and signsA table to answer from in the OSCE, and the signs that belong to the case.

Choose a case

The cards show the presentation only. The diagnosis is inside, where it belongs: at the end of the clerking.

Case 1 · Acute abdomen Right upper quadrant pain 42-year-old woman The pain history in proseMurphy's signRelevant negatives Case 2 · Acute abdomen Left iliac fossa pain 62-year-old man Bowel habitRectal examinationGuarding or rigidity Case 3 · Acute abdomen Right iliac fossa pain in a woman of reproductive age 26-year-old woman Menstrual historyMcBurney and RovsingPregnancy test first Case 4 · Acute abdomen Colicky abdominal pain, vomiting and distension 58-year-old man Four cardinal featuresHernial orificesSigns of strangulation Case 5 · Jaundice and bleeding Painless progressive jaundice 67-year-old man Urine, stool and itchingCourvoisier's lawSigns of liver disease Case 6 · Lumps Breast lump 48-year-old woman Risk factorsDescribing a lumpTriple assessment Case 7 · Acute abdomen Painful irreducible groin lump 64-year-old man The pubic tubercleCough impulseEmergency clerking Case 8 · Jaundice and bleeding Fresh rectal bleeding with a change in bowel habit 59-year-old man Describing the bloodRed flagsA rectal mass Case 9 · Lumps Neck swelling 34-year-old woman Thyroid statusMoves on swallowingPressure symptoms Case 10 · Limb and trauma Sudden painful cold leg 68-year-old man The six PsTime of onsetEmbolus or thrombosis Case 11 · Limb and trauma Blunt abdominal trauma 24-year-old man Ambulance handoverPrimary surveySources of shock Case 12 · Limb and trauma Non-healing foot ulcer in a diabetic patient 58-year-old man Describing an ulcerMonofilament testGrading infection

How to use these

  • Read the presenting complaint, then stop and write down the questions you would ask.
  • Read the clerking in the left column once without the boxes, as a record.
  • Read it again with the boxes, and note which lines you would have left out.
  • Cover the differential table and say your own answer aloud before reading the model one.

Now test yourself

Once you have read the cases, revise the signs they contain, then compete on them.

Flashcards · 173 signsClinical signsEvery sign from the twelve cases. Say how you would elicit it, then flip the card.Open the pack Challenge · Champions boardChampionTen questions, thirty seconds each. Enter a name, a country and an avatar, and put your best round on the board.Play a round

Practise next

Interactive · 9 casesClerk a patient yourselfChoose your own questions in the history-taking simulator and compare your clerking with a model.OSCETaking a jaundice historySix questions, the exact words to say, and a model summary for the examiner.TopicThe acute abdomenThe five questions that separate the causes of abdominal pain.