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Student Education

Clinical exam skills: Hand signs

BMJ 2004; 329 doi: (Published 01 November 2004) Cite this as: BMJ 2004;329:0411402
  1. Ian Bickle, Senior house officer1
  1. 1Department of Medicine, Royal Victoria Hospital, Belfast

In the third part of our series about clinical exam skills, Ian Bickle takes you through typical questions about hand signs

The first aspect of clinical assessment is observation. This often begins before formal examination during the history taking process. Signs identified in the hands may trigger the diagnostic process. Hands offer excellent spot diagnoses in clinical exams of all levels and as talking points for follow up questioning of systemic diseases.

Below are a number of common examples.

Person 1

  • (1a) Describe the findings on this man's hands.

  • (1b) Which condition involving the oesophagus is associated with this finding?

Person 2

  • (2a) Describe the findings on this man's hands.

  • (2b) How is this finding classified and what are the common causes?

Person 3

  • (3a) Describe the findings on this woman's hands and arms.

  • (3b) What are the potential causes?


(1a) There is a spoon shape to the nails--most evident on …

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