Health Questions and Answers

Question: I want to impress the attending physicians. Do you have any tips on physical examination that will let me assume my rightful position as star student?

Answer:

  • If a confused patient is suspected of being postictal, look in the mouth. A tongue laceration supports the diagnosis of a seizure.
  • Put on gloves and inspect the scalp. Occult trauma is often overlooked, and you may find a laceration or dried blood. An old scar on the scalp may tip you off to a posttraumatic seizure disorder.
  • Do not be fooled by a positive blink test in a patient with suspected psychogenic coma. When you rapidly flick your hand at a comatose patient who has open eyes, air movement may stimulate a corneal reflex in a patient who is truly comatose.
  • Do not be misled by the odor of alcohol. Alcohol has almost no detectable odor, which is why alcoholics drink vodka at work. Other spirited liquors such as brandy have a strong odor. The comatose executive who “smells drunk” may have had a sudden subarachnoid hemorrhage and spilled brandy on his shirt.

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