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Views & Reviews

Stumbling on the shoulders of giants

BMJ 2010; 341 doi: (Published 22 September 2010) Cite this as: BMJ 2010;341:c5205
  1. Will Muirhead, foundation year 1, medicine, Queen’s Medical Centre, Nottingham
  1. wmuirhead{at}

    “Could you talk me through what you’re doing as you go?”

    “So, I’m inspecting for any loss of the nail bed angle and looking for splinter haemorrhages. Now I’m pressing on the nail bed to measure the capillary refill time and checking for Quincke’s sign. (Could you turn your hands over, please?) I’m looking for any Janeway lesions that might be present, palpating for Osler’s nodes, feeling for any tendon xanthoma.

    “Now I’m checking the rate, rhythm, and character of the pulse. (Do you have any pain in your shoulder?) And checking for Watson’s water-hammer pulse. I’m comparing both wrists for any radio-radial delay and (Is it ok if I check a pulse in your groin?) any radio-femoral delay. Normally at this point I would measure the blood pressure. Now I’m inspecting the eyes more closely, looking for xanthelasma, corneal arcus, and (Could you pull your eyelid down for me? Like this?) any conjunctival pallor. (Could you say “aargh,” please?) I’m looking inside …

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