THE HISTORY OF EXAMINATION

We came across an issue this week regarding the issue of history and examination findings. There has always been a bit of a blurred line in the exam between the two, but in general history was stuff that you asked the patient, and examination was stuff you looked for and found on the patient.

So, in the context of an obstructed airway, are voice changes, difficulty swallowing secretions and stridor or wheeze history, or examination findings?

"..more precisely, it depends on how you ask the question and how you answer it...."

The answer in our opinion is interesting, because it's both. Or, more precisely, it depends on how you ask the question and how you answer it....

So, if you were asked what features you would inquire about on history it would be important to phrase your answer correctly.

1. Ask the patient if their voice has changed today
2. Ask the patient if they can swallow their own spit
3. Ask the patient if they have noticed any unusual noises when they take a deep breath in

Alternatively, to examine the patient for the same three things, a candidate would need to write a little differently.

1. Listen for a "hot potato" voice
2. Look for excessive drooling or tongue protrusion
3. Listen/auscultate for stridor/upper airway noise.

Although both answers contain substantively the same information, they answer two entirely different questions. More to the point, they answer two questions that the examiners are likely to regard as different.

It brings us back to a common theme here at fellowshipexam.com. How you answer (in this case the use of appropriate verbs and context) is just as important as what you answer.