"Strategies of presentation"

• There are 2 different ways of presentation. The first one is "hit hard" strategy and the second one would be "long story" strategy. There is no hard and fast rule in choosing this 2 strategies. It really depends on your self confidence and comfort in presenting the clinical signs after you gathered the signs.

• However, I would prefer "hit hard" for station 5 and "long story" for station 1 and 3.

• "Hit hard" means we present the diagnosis straight at the start followed by the evidences to support it. For example, this is rheumatoid arthritis as evidenced by symmetrical deforming arthropathy involving PIP and MCP with the sparing of DIP. There is swan neck deformity and wasting of small muscle of hands. The joints are not warm/tender and functionaly are limited by the deformities.

• "Long story" is more applicable for major stations that involve a lots of signs. This style of presentation allows us to present systematically and avoid unnecessary omissions. I would suggest we start from peripheral signs. For example, this man is comfortable at rest. The pulse is...../min and ...collapsing. There is... peripheral signs to suggest IE. He is ...pink...jaundice....cyanosis. The JVP is.....This is a midline sternotomy scar......The apex beat is at......There ...parasternal heave......and palpable 2nd HS . The 1st HS is .........metallic in nature......2nd HS is.......loud. There is ..........signs of HF i.e. basal creps ....ankle edema. In conclusion,the man has prosthetic valve ....which valve and evidence of...........IE/HF/PHT.

Which one do you prefer?