Clinical Skills Manual 2013

transcript

8/10/2019 Clinical Skills Manual 2013

http://slidepdf.com/reader/full/clinical-skills-manual-2013 1/44

ACKNOWLEDGEMENT:

The college is grateful to all the e!ers fro facult" of College of Me#ici$e i$ Al

Ahsa% for their acti&e co$tri!utio$ i$ the tiel" co'letio$ of this a$ual a$# its

i'lee$tatio$ strateg"(

Me!ers De'arte$t of Surger"

Dr. Hamad Al Wadhani

Me!ers De'arte$t of I$ter$al Me#ici$e

Dr. Amr Darwaish

Me!ers De'arte$t of )ail" a$# Cou$it" Me#ici$e

Dr. Waseem Suleman

Me!ers of Cli$ical Neuroscie$ces

Dr. Shahid Masud Bai

BASIC CLINICAL SKILLS COURSE (BCS)

COLLEGE OF MEDICINE IN AL-AHSA

Venue : Skills La! Cen"#al Buil$in%! C&lle%e &' Me$iine

C#e$i" H&u#s :

*i+e : ,:. a+-:/. a+ Female S!uden!s

0:1 2+ 3 :1 2+ Male S!uden!sDu#a"i&n &' &u#se : 4 5eeks

AIMS OF *HE COURSE

Teaching and ea!ning a!e c"n#in$"$%& changing '!"ce%%( The #eaching and ea!ning %)i% a!e *eing%hi+#ed #",a!d% #he '!"ce%% "+ %e+ ea!ning ,he!e*& %#$den#% a!e enc"$!aged #" dee"' %)i% and)n",edge #h!"$gh die!%i+ied ea!ning !e%"$!ce% %$ch a% !eading .a#e!ia #h!"$gh E-ea!ning/C".'$#e! a%%i%#ed ea!ning0( The cinica %)i% c"$!%e ,i *e a *!idge #",a!d% '!e'a!a#i"n "+ %#$den#%+"! a''ica#i"n "+ #hei! *a%ic %cience% )n",edge in#" cinica .edicine(

H",ee! in #he dee"'.en# "+ cinica c".'e#encie% ce!#ain *a%eine '!inci'e% a!e nece%%a!& #" *e

+"",ed( The%e *a%ic cinica c".'e#enc& and %)i% can *e *e##e! ea!ned "n %i.$a#ed ."d$e% %" #ha# *& #he #i.e %#$den#% a''!"ach #" #he !ea 'a#ien# #he& %h"$d *e c".'e#en# and c"n+iden# en"$gh #"a''& #hei! %)i% ,i#h .ini.$. .en#a and 'h&%ica ag"n& #" a!ead& %ic) 'a#ien#( On %i.$a#ed."d$e% #he %#$den#% ,i hae adan#age "+ !e'ea#ing ea.ina#i"n% and '!"ced$!e% #i #he& *ec".e

c"n+iden# en"$gh #" #!an%a#e #hei! %)i% "n 'a#ien#% ,i#h"$# an& '!"*e.(

OB6EC*IVES:

A" "7e en$ &' "7e &u#se! "7e s"u$en"s a#e e82e"e$ "& e ale "&:

1( De."n%#!a#e *a%ic c"..$nica#i"n %)i%(

2( O*#ain .edica hi%#"!& in a %#!$c#$!ed +"!.a#(3( 4e!+"!. 'h&%ica ea.ina#i"n in a %&%#e.a#ic .anne!(5( U%e a''!"'!ia#e& c".."n diagn"%#ic aid% %$ch a% %#e#h"%c"'e !e+e ha..e! #$ning

+"!) *""d '!e%%$!e a''a!a#$% .ea%$!ing #a'e "'h#ha."%c"'e "#"%c"'e e#c(6( 4!ac#ice a%e'#ic #echni7$e% in #he h"%'i#a %e#$' %$ch a% handing "+ *i""gica %a.'e% i%i# #" "'e!a#i"n #hea#!e a*"!a#"!ie% e#c(

8( Iden#i+& and $%e a''!"'!ia#e& c".."n e7$i'.en#% %$ch a% $!ina!& ca#he#e!% na%"ga%#!ic#$*e% in+$%i"n and in9ec#i"n %e# e#c(

:( A''& '!inci'e% "+ *a%ic i+e %$''"!#(

The%e cinica %)i% ,i *e ea!n# "n d$..ie% and .ani)in% in #he %#anda!d and '!"+e%%i"na .anne!(

CLINICAL SKILLS LAB

IM9LEMEN*A*ION S*RA*EG

( ;#h &ea! ca%% ,i *e diided in#" #," g!"$'% /G!"$' 1 < 20( G!"$' 1 ,i a##end #he c"$!%e "nT$e%da& ,hie G!"$' 2 ,i a##end "n M"nda&(

( The!e ,i *e gene!a "!ien#a#i"n "+ #he %#$den#% "n +i!%# ,ee) "+ c"$!%e( S#$den#% ,i *e

in+"!.ed a*"$# c"nce'# "+ '!e-!eading "+ !eean# #e# and '!e-ie,ing "+ !eean# ide" +"!ne# ,ee) #"'ic(

( On #he da& "+ %e%%i"n %#$den#% ,i *e +$!#he! diided in#" 3-; %$*-g!"$'%( Each %$*g!"$'a"ng ,i#h i#% +acii#a#"! ,i *e a"##ed a cinica a!ea +"! ea.ina#i"n(

( The +acii#a#"!% ,i de."n%#!a#e cinica %)i% "n %i.$a#"!( D$!ing #hi% ee!ci%e %#$den#% ,i

*e enc"$!aged #" a%) an& 7$e%#i"n% !ea#ed #" #he ea.ina#i"n(

( Each %#$den# ,i *e a%)ed #" 'e!+"!. cinica %)i% in #he '!e%ence "+ +acii#a#"!( The+acii#a#"!% ,i he' and g$ide %#$den# "+ an& %h"!#+a in #he 'e!+"!.ance "+ %)i%(

( A+#e! #hi% ee!ci%e #he %#$den#% ,i *e gien "''"!#$ni#& #" '"i%h #hei! cinica %)i%

#h!"$gh %e+ ea!ning(

( In #he end each %#$den# ,i *e !eea$a#ed !ega!ding c".'e#enc& "+ #hei! cinica %)i%(

( I# i% .anda#"!& +"! each %#$den# #" +i and %$*.i# #he Hand% "n %e%%i"n ea$a#i"n +"!.( A"$n#ee! a."ng #he %#$den#% ,i *e %eec#ed "n +i!%# ,ee) #" c"ec# #hi% +"!.(

( L"g +"!.% %h"$d *e %igned a+#e! "*%e!ing #he 'e!+"!.ance "n #he %a.e da&(

S9ECIFIC INS*RUC*IONS FOR S*UDEN*S

( D$!ing ea$a#i"n "+ cinica %)i% %#$den#% a!e e'ec#ed #" *e %ien# < '!".'#ing

%h"$d *e a"ided(

( Each %#$den# %ha *e ,ea!ing ,hi#e c"a#(

( Sign &"$! a##endance "n #he de%igna#ed %hee# in a",ed #i.e in each %e%%i"n(

( =!ing &"$! ",n *a%ic #""% "+ ea.ina#i"n /%ee a''endi0

( Read #he !ec"..ended *"") +"! cinica .e#h"d% /%ee a''endi0

( 4!ac#ice and 'e!+"!. ea.ina#i"n +!". !igh# %ide "+ #he *ed(

( Se+-in#!"d$c#i"n and 'e!.i%%i"n #" ea.ina#i"n i% "*iga#"!&(

( Ge# &"$! "g +"!.% %igned "n #he da& "+ %e%%i"n < %$*.i# i# a# #he end "+ c"$!%e *e+"!e +inaea.ina#i"n(

( Fi and %$*.i# #he Hand% "n %e%%i"n ea$a#i"n +"!. +"! each %e%%i"n(

S9ECIFIC INS*RUC*IONS FOR FACILI*A*OR (F)

M"%# "+ #he %)i% ,i *e de."n%#!a#ed and ea$a#ed "n %i.$a#"!% and .ani)in%(

( A F a!e !e7$i!ed #" a##end #he '!e %e%%i"n .ee#ing "n Sa#$!da& in #he %a.e ,ee) '!i"! #" #he%e%%i"n(

( The F ,i adi%e #he %#$den# #" 'e!+"!. ea.ina#i"n +!". !igh# %ide "+ #he *ed(

( The F ,i adi%e and g$ide #he %#$den#% a*"$# #he i.'"!#ance "+ %e+-in#!"d$c#i"n and ge##ing 'e!.i%%i"n #" ea.ine #he 'a#ien#(

( A+#e! c".'e#i"n "+ #he 'a!#ic$a! %)i *& #he %#$den# #he F ,i highigh# #he .i%#a)e% and,i de."n%#!a#e #he c"!!ec# ,a& "+ ea.ina#i"n %eg.en#(

( The F ,i adi%e %#$den#% !ega!ding '!"'e! e'"%$!e and '"%i#i"ning "+ #he 'a#ien# *e+"!eea.ina#i"n(

( The F ,i )ee' #he *a%ic di%ci'ine "+ cinica ea.ina#i"n in +"!. "+ In%'ec#i"n 4a'a#i"n4e!c$%%i"n and A$%c$#a#i"n(

E;ui2+en"s '&# Basi Clinial Skills &u#se

The +"",ing ,"$d *e !e7$i!ed +"! =a%ic Cinica S)i% /=CS0 c"$!%e and a%" in &"$! 9$ni"! and%eni"! ce!)%hi'%>-

1( ?hi#e c"a#%2( S#e#h"%c"'e /#hic) ,a #$*ing a% %h"!# a% '"%%i*e and '!e+e!a*& ,i#h *e and dia'h!ag.03( 4enigh#;( ?a#ch5( T"ng$e de'!e%%"!%6( Fei*e !$e! and .ea%$!ing #a'e

8( Cinica The!.".e#e! :( S'h&g.".an".e#e! @( Re+e ha..e! 1( T$ning +"!)% "+ 12: HB and 512 HB11( Di%'"%a*e %a+e#& 'in%12( C"##"n %,a*

An"#he! #"" "+ i..en%e i.'"!#ance ,i *e #he "'h#ha."%c"'e and "#"%c"'e and .a& *e "'#i.a #"

*$& a g""d 7$ai#& %e# n",(

RECOMMENDED BOOK FOR 9RE-READING

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FINAL E@AMINA*ION >1:1213 1

BASIC CLINICAL SKILLS COURSECOLLEGE OF MEDICINE-AL-HASA

Venue: Cinica S)i% La* C"ege "+ Medicine in A-Ah%a

*i+in%: Fe.ae S#$den#%> :>15 a. #" 11>;5 a.

Mae S#$den#%> 12>3 '. #" 3>3 '.

CLINICAL SKILLS ASSESSMEN*

ASSESSMEN*:

Assess+en" 5ill e ase$ &n C&n"inu&us assess+en" an$ 0 E8a+ina"i&ns (&ne Mi$-"e#+ an$ &ne Final e8a+)

a C"n#in$"$% a%%e%%.en# a##endance < "g *"") F"!.a#ie

Mid#e!. ea.ina#i"n ;J

Fina ea.ina#i"n /ea$a#i"n "+ cinica %)i%0 6J

• C&n"inu&us assess+en"! a""en$ane l&% &&k:

A##endance %hee# ,i *e ci!c$a#ed in #he ."!ning( I# i% .anda#"!& #" ge# #he "g +"!.% %igned "n #he %a.e da&( I# i% #he

!e%'"n%i*ii#& "+ each %#$den# #" %$*.i# #he "g +"!. 1 ,ee) *e+"!e #he +ina ea.ina#i"n(

• Mi$ "e#+ E8a+ina"i&n>

1( O?e"i=e S"#u"u#e$ Clinial E8a+ina"i&n (OSCE)>

2 %#a#i"n% *a%ed "n Cinica S)i% c"e!ed #i Mid Te!. Ea.ina#i"n

C$.$a#ie %c"!e ,i *e di%'a&ed in #he %)i% a* a+#e! a ,ee) "+ ea.ina#i"n(

L", 'e!+"!.e!% /8 J0 a!e !e7$e%#ed #" i%i# D! ?a%ee.% "++ice /D""! 213:0 a# de%igna#ed #i.e /,i *e .en#i"ned "n

c$.$a#ie %c"!e0 +"! +eed*ac)(

• Final E8a+ina"i&n:

1( OSCE: 3 %#a#i"n% *a%ed "n !and".& %eec#ed ea$a#i"n "+ 1 %$!gica %&%#e.ea.ina#i"n 1 *a%ic i+e %$''"!# and 1 ne$!""g& ea.ina#i"n(

• Mai.$. Ti.e +"! each OSCE %#a#i"n ,i *e 5 .in$#e%(

• Each OSCE %#a#i"n ,i hae 2 .a!)%(

• S#$den#% ,i *e .a!)ed a*%en# in #he %e%%i"n i+ a#e +"! ."!e #han 1 .in$#e%(

• Leae a''ica#i"n ,i *e acce'#a*e a% 'e! #he Unie!%i#& !$e% and !eg$a#i"n%(

• Fina %c"!e ,i *e di%'a&ed ia *anne! %&%#e. "n "++icia Unie!%i#& ,e* %i#e(

S9ECIFIC OB6EC*IVES

C&++unia"i&n Skills an$ E"7is in Me$ial 9#a"ie

The %#$den#% %h"$d )n", and +"", #he '!inci'e% "+ g""d .edica '!ac#ice and #he %#anda!d% "+ c"nd$c# and ca!e in a a%'ec#% "+#hei! !ea#i"n%hi' ,i#h #he 'a#ien#% c"eag$e% and "#he!%(

*7e 2#ini2les &' %&&$ +e$ial 2#a"ie inlu$e "7e '&ll&5in%

1( G""d i%#ening2( Re%'ec#ing ie,% "+ "#he!%3( 4"i#e and c"n%ide!a#e *ehai"! ;( Re%'ec#ing #he '!iac& and digni#&

5( T!ea#ing 'a#ien#% in+"!.a#i"n a% c"n+iden#ia6( T!ea#ing "#he!% +ai!&8( N"# a*$%ing #he 'a#ien#% #!$%#:( 4a#ien#% "+ "''"%i#e gende! %h"$d *e in#e!ie,ed and ea.ined in '!e%ence "+ cha'e!"ne(@( F"",ing !e+e!!a %#anda!d%1( 4!"#ec#ing 'a#ien#% and c"eag$e% ,hen #he c"nd$c# "! 'e!+"!.ance i% a #h!ea#

11( O*#aining c"n%en# "+ #he indiid$a% #" 'a!#ici'a#e in cinica #!ia% "! "#he! !e%ea!ch

12( Re%ea!ch %h"$d n"# *e c"n#!a!& #" #he indiid$a% in#e!e%#

E=alua"i&n:

C"n#in$"$% "*%e!a#i"n "+ #he a##i#$de d$!ing each ea.ina#i"n

SKILLS IN HIS*OR *AKING

Skills

His"&# "akin%

a( The %#$den# %h"$d *e a*e #" $nde!%#and #he *a%ic +"!.a# "+ hi%#"!& #a)ing %)i in "!de! #" eici#>

10 Iden#i+&ing da#a /na.e age %e !ace !eigi"n020 Chie+ c".'ain#30 Hi%#"!& "+ '!e%en# ine%%

;0 4a%# hea#h

50 S"cia and 'e!%"na hi%#"!&60 D!$g hi%#"!&80 Fa.i& hi%#"!&:0 O*%#e#!ic% < G&nae in ca%e "+ +e.ae 'a#ien#%

*( The %#$den# %h"$d *e a*e #">

10 O!ganie #he da#a +!". 'a#ien# in a "gica "!a "! ,!i##en '!e%en#a#i"n(

GENERAL 9RINCI9LES OF E@AMINA*ION

A# #he end "+ in#e!ie, #he %#$den# %h"$d>

• A''!"ach #he 'a#ien# '"i#e& and c"n+iden#& and ,i#h 'e!.i%%i"n

4"%i#i"n %e+ and 'a#ien# c"!!ec#& +"! a gien ea.ina#i"n( Idea& #he ea.ine! %h"$d *e "n !igh# %ide "+ #he 'a#ien#

• A!!ange igh# e++ec#ie& +"! a gien ea.ina#i"n

• E'"%e 'a!# #" *e ea.ined ade7$a#e&

• F"", #he !"$#ine "+ In%'ec#i"n 'a'a#i"n 'e!c$%%i"n and a$%c$#a#i"n in a ea.ina#i"n%

E@AMINA*ION

Skills

S#$den#% %h"$d *e a*e #" 'e!+"!. an ade7$a#e gene!a ea.ina#i"n ,hich %h"$d inc$de>

a Gene#al i+2#essi&n> Age %e '"%#$!e ee "+ c"n%ci"$%ne%% and c".+"!# n$#!i#i"na %#a#$% g!"".ing 'e!%"na

h&giene and an& "d"! "+ *"d& "! *!ea#h(

Vi"al Si%ns: 4$%e /!a#e < !h&#h.0 *""d '!e%%$!e !e%'i!a#"!& !a#e and *"d& #e.'e!a#$!e

Hei%7" an$ 5ei%7" +easu#e+en"

$ Skin an$ +uus +e+#ane e8a+ina"i&n: c$**ing c""! 'ig.en#a#i"n c&an"%i% 'a"! ic#e!$% #e#$!e and

"#he! e%i"n%

e E8a+ina"i&n &' nails: c$**ing )"i"n&chia% e$)"n&chia 'a!"n&chia %'in#e! he."!!hage%

' E8a+ina"i&n &' 7ai#: di%#!i*$#i"n and #e#$!e

% E8a+ina"i&n &' L+27 n&$es: ce!ica aia!& e'i#!"chea! ing$ina

7 E$e+a: gene!aied 'eda %ac!a

0 Kn&5le$%e

A# #he end "+ #he c"$!%e #he %#$den# %h"$d>• Kn", #he di++e!ence *e#,een cen#!a and 'e!i'he!a c&an"%i%

• Kn", #he na.e and d!ainage "+ &.'h n"de% in ce!ica aia!& and ing$ina g!"$'%

E@AMINA*ION OF CERVICAL LM9H NODES

SkillThe %#$den# %h"$d *e a*e #" 'e!+"!. %&%#e.a#ic ea.ina#i"n #" inc$de>

Ins2e"i&n>

a S$*.en#a %$*.andi*$a! '!ea$!ic$a! '"%#a$!ic$a! and "cci'i#a g!"$' "+ &.'h n"de% S$'e!+icia ce!ica < '"%#e!i"! ce!ica g!"$'% Dee' ce!ica$ S$'!acaic$a!

9al2a"i&n:F"! #he a*"e g!"$' "+ &.'h n"de%(

0 Kn&5le$%e:

The %#$den# %h"$d )n", #he ana#".ica "caia#i"n "+ #he ce!ica &.'h n"de%(

E@AMINA*ION OF ABDOMEN

S#$den#% %h"$d *e a*e #" 'e!+"!. %&%#e.a#ic ea.ina#i"n #" inc$de>

a Ins2e"i&n:• F"! c"n#"$!% "+ a*d".en and c"n+ig$!a#i"n "+ #he $.*iic$%

• F"! %ca!% %#!e#ch .a!)% and 'ig.en#a#i"n

• F"! ."e.en# "+ an#e!i"! a*d".ina ,a ,i#h !e%'i!a#i"n

9al2a"i&n:• S$'e!+icia and dee' 'a'a#i"n

• O+ ie! %'een )idne&% c""n

9e#ussi&n:• F"! ie! < %'een

• F"! %hi+#ing d$ne%%

$ Ausul"a"i&n:• O+ g$# %"$nd%

0 Kn&5le$%e

A# #he end "+ #he c"$!%e %#$den#% %h"$d )n",>

The %$!+ace ana#".& "+ #he nine !egi"n% "+ #he a*d".en and #hei! *"$nda!ie%

E@AMINA*ION OF ANO-REC*AL REGION

S#$den# %h"$d *e a*e #" 'e!+"!. %&%#e.a#ic ea.ina#i"n #" inc$de>

a In%'ec#i"n

• O+ #he ana !egi"n

Digi#a Ea.ina#i"n

• F"! #he #"ne "+ ana %'hinc#e!% #he an"-!ec#a ange #he ."!'h""g& "+ #he '!"%#a#e gand and !ec#"-e%ica '"$ch

• F"! #he cha!ac#e!i%#ic "+ %#"" "n +inge! %#a

0 Kn&5le$%e

A# #he end "+ #he c"$!%e %#$den# %h"$d )n",>

• The %$!+ace ana#".& "+ an$% ,i#h !e%'ec# #" %ac!"-c"cc&gea !egi"n 'e!ine$. and i%chia #$*e!"%i#ie%(

E@AMINA*ION OF RES9IRA*OR SS*EM

a Ins2e"i&n>

F"! !e%'i!a#"!& !a#e

F"! %ha'e "+ #he che%# and %&..e#!&

F"! 'a##e!n "+ !e%'i!a#i"n

O+ acce%%"!& .$%ce% "+ !e%'i!a#i"n

M"e.en#% "+ che%#

9al2i"a"i&n: O+ #!achea

O+ a'e *ea#

F"! che%# e'an%i"n

F"! #ac#ie "ca +!e.i#$%

9e#ussi&n>

Oe! caice

Oe! $ng%

F"! $''e! *"!de! "+ he'a#ic d$ne%%

F"! dia'h!ag.a#ic ec$!%i"n

$ Ausul"a"i&n> =!ea#h %"$nd% /ai! en#!& < cha!ac#e!0

F"! #&'e% "+ *!ea#hing /e%ic$a! % *!"nchia0

E@AMINA*ION OF CARDIOVASCULAR SS*EM

S#$den# %h"$d *e a*e #" 'e!+"!. %&%#e.a#ic ea.ina#i"n #" inc$de:

a A#"e#ial 9ulses:

Redia> +"! !a#e !h&#h.

Ca!"#id> +"! "$.e cha!ac#e!

4e!i'he!a> +"! '!e%ence and %&..e#!&

Bl&&$ 9#essu#e:

4!"'e! #echni7$e "+ .ea%$!ing *""d '!e%%$!e

=& 'a'a#i"n and a$%c$#a#i"n

Chec) +"! '"%#$!a d!"' and c".'a!e =4 in *"#h a!.%

6V9 (6u%ul&=en&us 9#essu#e)

Iden#i+& #he "ca#i"n "+ in#e!na 9$g$a! ein

Mea%$!e #he heigh# "+ V4

$ 9#e&#$iu+:

Ins2e"i&n:F"! de+"!.i#ie% a'e *ea# '$%a#i"n and %ca!%

9al2a"i&n:F"! a'e *ea# and hea!# %"$nd%

Ausul"a"i&n:F"! hea!# %"$nd% in a #he +"$! a!ea% /S1 < S2 A2 < 420

0 Kn&5le$%e

( A# #he end "+ #he c"$!%e %#$den# %h"$d>

( =e a*e #" de+ine #he cha!ac#e!i%#ic% "+ n"!.a '$%e( =e a*e #" .ea%$!e *""d '!e%%$!e( =e a*e #" de+ine h&'e!#en%i"n

E@AMINA*ION OF 9ERI9HERAL VASCULAR SS*EM

SkillS#$den# %h"$d *e a*e #" 'e!+"!. 'e!i'he!a a%c$a! %&%#e. ea.ina#i"n #" inc$de>

a Ins2e"i&n:

%&..e#!& "+ *"#h ",e! i.*%

'a"! c&an"%i% gang!ene %,eing #"e c$**ing hai! %)in $ce!a#i"n .$%ce ,a%#ing

=$!ge!% 4"%#$!a #e%#> #" de#ec# adanced "cc$%ie a!#e!ia di%ea%e

9al2a"i&n:

+"! c"dne%% 'a'a#i"n "+ +e."!a '"'i#ea an#e!i"! #i*ia < '"%#e!i"! #i*ia and d"!%ai% 'edi% a!#e!&

Ausul"a"i&n:

F"! +e."!a *!$i#

Kn&5le$%e

The %#$den# %h"$d )n", #he ana#".& "+ #he a!#e!ie%(

E@AMINA*ION OF NERVOUS SS*EM

Skills

The %#$den#% %h"$d *e a*e #" 'e!+"!. %&%#e.ic ea.ina#i"n #" inc$de>a Hi%7e# +en"al 'un"i&ns

O!ien#a#i"n in #i.e 'ace and 'e!%"n

Me."!& /%h"!# #e!. and "ng #e!.0

C#anial ne#=es C!ania ne!e% 1 #" II and iden#i+& de+ici#%

M&"&# ss"e+

In%'ec# #he .$%ce g!"$'% +"! *$) and in"$n#a!& ."e.en#%

Ea.ine #he .a9"! .$%ce g!"$' +"! #"ne

Te%# and g!ade #he '",e! in .$%ce% Eici# and g!ade #he dee' #end"n !e+ee% and =a*in%)i %ign

S$'e!+icia a*d".ina !e+ee%

$ Sens&# ss"e+

S&%#e.a#ic ea.ina#i"n +"! 'ain #"$ch and #e.'e!a#$!e

C"!#ica %en%a#i"n%

4"%#e!i"! c"$.n %ign% inc$ding R".*e!g% %ign

e C&&#$ina"i&n

' Gai" A%%e%% and iden#i+& .a9"! gai# di%"!de!%

% Si%ns &' +enin%eal i##i"a"i&n

0 Kn&5le$%e

A# #he end "+ #he c"$!%e #he %#$den# %h"$d )n",>

4a#h,a&% "+ c!ania ne!e% /"ca#i"n "+ n$cei 0

Di++e!en#ia#ing +ea#$!e% "+ $''e! ."#"! and ",e! ."#"! ne$!"n e%i"n

R""# a$e "+ dee' #end"n !e+ee%

Na.e "+ #he %'ina #!ac#% and #hei! .a9"! +$nc#i"n%

E@AMINA*ION OF A S<ELLING

a Ins2e"i&n:F"! %i#e %ie %ha'e %$!+ace "e!&ing < %$!!"$nding %)in an& '$%a#i"n

9al2a"i&n:

F"! ,a!.#h < #ende!ne%% c"n%i%#enc&F"! edge 'e!#aining #" &.'h n"de

9e#ussi&n:

$ Ausul"a"i&n:

F"! *!$i#

Kn&5le$%e

Di++e!en#ia#e *e#,een %"id < c&%#ic %,eing

E@AMINA*ION OF *HROID GLAND

The %#$den# %h"$d *e a*e #" 'e!+"!. %&%#e.a#ic ea.ina#i"n #" inc$de>

a Ins2e"i&n

( O+ #he *a%e "+ #"ng$e( O+ #he ."e.en# "+ #he #h&!"id

9al2a"i&n

( O+ #he #h&!"id gand

( O+ #!achea( O+ ce!ica &.'h n"de% and %#e!n"ceid".a%#"id

9e#ussi&n

( Oe! #he .an$*!i$. %#e!ni

$ Ausul"a"i&n

Oe! #he ca!"#id a!#e!ie% and #he #h&!"id

0 Kn&5le$%e

The %$!+ace ana#".& "+ #he #!iange% "+ #he nec) h&"id *"ne c!ic"id and #h&!"id ca!#iage% and #!achea ca!"#id a!#e!&

in#e!na and e#e!na 9$g$a! ein% ce!ica &.'h n"de% %aia!& gand% #h&!"id gand(

E@AMINA*ION OF INGUINO-SCRO*AL REGION

S#$den#% %h"$d *e a*e #" 'e!+"!. %&%#e.a#ic ea.ina#i"n #" inc$de:

a Ins2e"i&n:

F"! %,eing and c"$gh i.'$%e

9al2a"i&n: F"! %,eing and c"$gh i.'$%e

o T" "cc$de #he dee' ing$ina !ing

o O+ %$'e!+icia ing$ina !ing

o O+ #e%#e%

o O+ #he e'idid&.i%

o O+ #he c"!d and a% de+e!en%

*#ans-illu+ina"i&n "es"

0 Kn&5le$%e

A# #he end "+ #he c"$!%e %#$den# %h"$d *e a*e #" )n",>

• Di++e!en#ia#ing +ea#$!e% "+ %c!"#a and ing$in"-%c!"#a %,eing

• The %$!+ace ana#".& "+ +e."!a e%%e% and +e."!a cana ing$ina iga.en# dee' and %$'e!+icia ing$ina !ing% and

ing$ina &.'h n"de%

E@AMINA*ION OF AN ULCER

a Ins2e"i&n• +"! %i#e %ie %ha'e edge .a!gin +""! di%cha!ge d!aining &.'h n"de%

9al2a"i&n:• edge +"! ind$!a#i"n < #ende!ne%%

• .a!gin +"! ind$!a#i"n e#ending *e&"nd a .a!gin

• *a%e +"! a##ach.en# #" $nde!&ing %#!$c#$!e%• d!aining &.'h n"de%

0 Kn&5le$%e

T&'e% and .ain ca$%e% "+ $ce!%

E@AMINA*ION OF BREAS* AND A@ILLA

a Ins2e"i&n

• +"! c"n#"$!% "+ #he *!ea%#% and di!ec#i"n "+ #he ni''e% +"! #he ."e.en# "+ #he *!ea%#% ,i#h change% in '"%#$!e(

*( 9al2i"a"i&n:• "+ #he *!ea%#% +"! gand$a! #i%%$e and $.'%

• "+ aia!& &.'h n"de%

Kn&5le$%e

• The *"$nda!ie% "+ aia and #he %$!+ace ana#".& "+ #he *!ea%# and aia!& #ai and #he $nde!&ing %#!$c#$!e%(

9RINCI9LES OF FIRS* AID IN *RAUMA

The %#$den#% %h"$d *e a*e #">

a Re&%nie an$ #elie=e ai#5a &s"#u"i&n

4!"."#i"n "+ ade7$a#e ga% echange

Ci!c$a#"!& %$''"!# i)e c"n#!" "+ ac#ie he."!!hage and

In#!aen"$% in+$%i"n%

9#i+a# Su#=e

Ai!,a& 'a#enc& and ce!ica %'ine %$''"!#

=!ea#hing

Ci!c$a#i"n

Sec"nda!& S$!e&

Head #" #"e ea.ina#i"n%

2( Kn&5le$%e

Ana#".& "+ ai!,a&% /'edia#!ic e!%$% ad$#%0

E@AMINA*ION OF BLOOD 9RESSURE (B9) MEASUREMEN*/in %i##ing '"%i#i"n0

S#$den#% Na.e>

Acade.ic N"(>

Ins"#u"i&ns "& s"u$en"

De."n%#!a#e &"$! #echni7$e in #a)ing #hi% 'a#ien#% *""d '!e%%$!e(

Ma8i+u+

E8a+ine# C&++en"s

Mee"! %#ee"! in"#&$ue "ake &nsen" 2

9al2a"es &"7 #a$ial 2ulses 2

9#&2e# a22lia"i&n &' u''

4a'a#e *!achia '$%e 1

Midine "+ c$++ i% "n *!achia '$%a#i"n 1

L",e! c$++ *"!de! i% 1P a*"e c$*i#a +"%%a 1

C$++ i% a''ied ,i#h a''!"'!ia#e #igh#ne%% 1

De"e#+ine Ss"&li 2#essu#e 2al2a"i&n 2

B9 $e"e#+ine$ ausul"a"i&n

Reea%e *adde! '!e%%$!e c".'e#e& 1

S$''"!# a!. a# hea!# ee 1

Fee# "n #he g!"$nd *ac) !e%#ed 2

In+a#e 2-3 .. ."!e #han 'a'a#"!& !eading 1

D!"' '!e%%$!e %",& 2-5 ..% 1

4ace %#e#h"%c"'e "n *!achia '$%a#i"n 1

Assis" 2a"ien" in #e+&=in% "7e e;ui2+en" an$

&=e#in% "7e e82&se$ 2a#"2

*7anks "7e 2a"ien" a" "7e en$ 1

T"#a 01

C"..en#% < Signa#$!e>

E@AMINA*ION OF CERVICAL LM9H NODES

S#$den#% Na.e>

Acade.ic N"(>

Ins"#u"i&ns "& s"u$en"s:

Ea.ine #he ce!ica &.'h n"de% "+ #hi% 'a#ien#(

Ma8i+u+

S&#e$C&++en"s

C"..$nica#i"n < e#hica %)i% 1

4!"'e! '"%i#i"ning "+ 'a#ien# 1

Ins2e"i&n /and des"ri#e0

S$*ing$a %$*.andi*$a! '!e-'"%#a$!ic$a! < "cci'i#a 2

S$'e!+icia ce!ica < '"%#e!i"! ce!ica 2

Dee' ce!ica 2

S$'!caic$a! 2

9al2a"i&n

S$*ing$a %$*.andi*$a! '!e-'"%#a$!ic$a! < "cci'i#a 2

S$'e!+icia ce!ica < '"%#e!i"! ce!ica 2

Dee' ce!ica 2

S$'!acaic$a! 2

O!ganied a''!"ach and c"!!ec# c"nc$%i"n 2

T"#a 01

E@AMINA*ION FOR LIVER AND ASCI*ES

S#$den#% Na.e>

Acade.ic N"(>

Ins"#u"i&n "& S"u$en"

Ea.ine #hi% 'a#ien#% a*d".en #" a%%e%% #he ie! and +!ee +$id in #he a*d".en( A% &"$ '!"ceed e'ain ,ha#

&"$ a!e d"ing(

Ma8i+u+

E8a+ine#

C&++en"s

4!"'e! '"%i#i"ning "+ 'a#ien# 2

In%'ec#i"n "+ a*d".en 2 Li=e#

4a'a#i"n

S#a!#% ", 1

C"!!ec# hand '"%i#i"n 2

4a'a#i"n ,i#h in%'ec#i"n 1

4e!c$%%i"nU''e! and ",e! *"!de! 2

Mea%$!e ie! %'an 2

0 E8a+ina"i&n '&# F#ee Flui$

Shi+#ing d$ne%% 2

F$id #h!i 2

O!ganied a''!"ach 2

T"#a 01

S#$den#% Sc"!e>

E@AMINA*ION OF S9LEEN AND KIDNES

S#$den#% Na.e>

Acade.ic N"(>

Ins"#u"i&n "& S"u$en"s

Ea.ine #hi% 'a#ien#% a*d".en #" de#e!.ine #he %ie "+ #he %'een and )idne&%( A% &"$ '!"ceed e'ain ,ha#

&"$ a!e d"ing(

Ma8i+u+

E8a+ine#

C&++en"s

C"!!ec# '"%i#i"n "+ 'a#ien# 2

In%'ec#i"n "+ a*d".en 2

1( S4LEEN

9al2a"i&n

S#a!#% ", in R( ",e! 7$ad!an# 1

C"!!ec# '"%i#i"n "+ hand% 2

4a'a#i"n ,i#h in%'i!a#i"n 1

T$!n% 'a#ien# #" R( a#e!a '"%i#i"n 2

9e#ussi&n 2

2( KIDNEYS

=i.an$a 4a'a#i"n 3

4e!+"!.% a"#.en# 1

O!ganied a''!"ach 2

T"#a 01

S#$den#% Sc"!e>

DIGI*AL REC*AL E@AMINA*ION

S#$den#% Na.e>

Acade.ic N"(>

Ins"#u"i&n "& s"u$en"

4e!+"!. digi#a !ec#a ea.ina#i"n

Ma8i+u+

E8a+ine#s

C&++en"s

E'ain% #he '!"ced$!e #" #he 'a#ien#

'!"'e!& and #a)e% c"n%en#;

4$#% #he 'a#ien# in#" #he c"!!ec# '"%i#i"n 2

In%'ec#% #he 'e!iana !egi"n +"! 'a#h""g& ;

?ea!% g"e% and $*!ica#e% inde +inge! 2

4a%%e% #he +inge! in #he !igh# di!ec#i"n 2

A%%e%%e% #he %'hinc#e! #"ne 2

L"")% +"! #ende!ne%% "! %,eing 2

4a'a#e% #he '!"%#a#e gand 2

T"#a 01

S#$den#% Sc"!e>

AN*ERIOR *HORA@ E@AMINA*ION/In .ae 'a#ien#% "n&0

S#$den#% Na.e>

Acade.ic N"(>

Ea.ine #he an#e!i"! #h"!a "+ #hi% 'a#ien#( A% &"$ '!"ceed e'ain ,ha# &"$ a!e d"ing

Ma8i+u+

E8a+ine# C&++en"s

Ins2e"i&n

Sha'e and %&..e#!& "+ che%# 2

Re%'i!a#"!& !a#e 2

9al2a"i&n

4"%i#i"n "+ #!achea 2

4"%i#i"n "+ a'e *ea# 2

Che%# e'an%i"n 2

Tac#ie "ca +!e.i#$% 2

9e#ussi&n

Techni7$e and a!ea c"e!ed 2

Ausul"a"i&n

Techni7$e and a!ea c"e!ed 2

T"#a 01

S#$den#% Sc"!e>

9OS*ERIOR *HORA@ E@AMINA*ION

S#$den#% Na.e>

Acade.ic N"(>

Ea.ine #he '"%#e!i"! #h"!a "+ #hi% 'a#ien#( A% &"$ '!"ceed e'ain ,ha# &"$ a!e d"ing

Ma8i+u+

E8a+ine#

C&++en"s

Ins2e"i&n

S'ine 2

Che%# ,i#h !e%'i!a#i"n 2

9al2a"i&n

S'ine and che%# ,a 1

Che%# e'an%i"n 2

Tac#ie "ca +!e.i#$% 2

9e#ussi&n

Techni7$e < a!ea c"e!ed 3

Ausul"a"i&n

Techni7$e < a!ea c"e!ed ;

T"#a 01

S#$den#% Sc"!e>

E@AMINA*ION OF 6UGULAR VENOUS 9RESSURE

S#$den#% Na.e>

Acade.ic N"(>

Ea.ine #hi% 'a#ien#% 9$g$a! ein% and .ea%$!e #he 9$g$a! en"$% '!e%%$!e( E'ain ,ha# &"$ a!e d"ing a% &"$

'!"ceed(

Ma8i+u+

E8a+ine#

C&++en"s

C"..$nica#i"n < e#hica )i% 2

A''!"'!ia#e eea#i"n "+ 'a#ien# ;

A''!"'!ia#e '"%i#i"n "+ head and nec) ,i#h

ade7$a#e igh#;

Iden#i+ie% in#e!na 9$g$a! ;

Mea%$!e and de%c!i*e% en"$% '!e%%$!e

c"!!ec#&(;

O!ganied a''!"ach 2

T"#a 01

S#$den#% Sc"!e>

E@AMINA*ION OF 9RECORDIUM

S#$den#% Na.e>

Acade.ic N"(>

Ins"#u"i&ns "& S"u$en"s

De."n%#!a#e h", &"$ ,"$d ea.ine #hi% 'a#ien#% hea!#(

Ma8i+u+

E8a+ine#

C&++en"s

4"%i#i"n "+ 'a#ien# 2

In%'ec#i"n "+ '!ec"!di$. ;

4a'a#i"n +"!

4"in# "+ .ai.a i.'$%e < "#he! a!ea% ;

A$%c$#a#i"n

A$%c$#a#e% in a ca!diac a!ea

U%e "+ *e and dia'h!ag. a''!"'!ia#e&

A$%c$#a#e% in di++e!en# '"%i#i"n% Le+# a#e!a dec$*i#$%

U'!igh# eaning +"!,a!d

O!ganied a''!"ach 2

T"#a 01

S#$den#% Sc"!e>

E@AMINA*ION OF 9ERI9HERAL VESCULAR SS*EM

S#$den#% Na.e>

Acade.ic N"(>

4e!+"!. a 'h&%ica ea.ina#i"n "+ #hi% 'a#ien#% eg% #" "") +"! eidence "+ a!#e!ia in%$++icienc&( De%c!i*e ,ha#

&"$ a!e d"ing and &"$! +inding%(

Ma8i+u+

E8a+ine#

C&++en"s

In%'ec# eg% +"! $ce! gang!ene hai! di%#!i*$#i"n( 1

In%'ec# eg% +"! c""! #e.'( 1

Eea#e eg% #" 3 deg!ee% +"! 2 %ec #" eici#

'a"! 1

Leg% de'endan# #" eici# !$*"! and en"$% +iing 1

4a'a#e% and c".'a!e %ide%

F"! #e.'e!a#$!eFe."!a a!#e!ie%

4"'i#ea a!#e!ie%

D"!%ai% 4edi%

4"%#e!i"! #i*ia

Li%#en% +"! +e."!a *!$i#% 2

O!ganied a''!"ach 2

T"#a 01

S#$den#% Sc"!e>

#$ ! /"7 ! 4"7 CRANIAL NERVES

S#$den#% Na.e>

Acade.ic N"(>

Ea.ine #hi% 'a#ien#% #hi!d +"$!#h and %i#h c!ania ne!e%

Ma8i+u+

E8a+ine#

C&++en"s

Ea.ina#i"n "+ '$'i% +"! %&..e#!& ;

Reac#i"n #" igh# di!ec# < c"n%en%$a 3

E&e% ."ed #h!"$gh 6 ca!dina di!ec#i"n% "+

O!ganied a''!"ach 2

?ha# i% #he ac#i"n "+ %$'e!i"! "*i7$e .$%ce 3

T"#a 01

S#$den# Sc"!e>

C"..en#%>

."7 CRANIAL NERVE

S#$den#% Na.e>

Acade.ic N"(>

Ea.ine #hi% 'a#ien#% +i+#h c!ania ne!e( E'ain #" #he ea.ine! a% &"$ '!"ceed(

Ma8i+u+

E8a+ine#

C&++en"s

O'h#ha.ic dii%i"n 2

Maia!& dii%i"n 2

Mandi*$a! dii%i"n 2

C"!nea !e+e 2

C".'a!e %ide% 2

Ma%%e#e! < #e.'"!ai% 2

4#e!&g"id 2

a, 9e!) 2

O!ganied a''!"ach 2

T"#a 01

S#$den#% Sc"!e>

"7 CRANIAL NERVE

S#$den#% Na.e>

Acade.ic N"(>

Ea.ine #he 'a#ien#% %een#h c!ania ne!e( E'ain #" #he ea.ine! a% &"$ '!"ceed(

MO*OR Ma8i+u+

E8a+ine#

C&++en"s

In%'ec#i"n

- L"")ing +"! d!""'ing "+ ."$#h +a##ening"+ na%"a*ia +"d and ina*ii#& #" c"%e e&e

?!in)e +"!ehead 2

C"%e e&e% #igh#& 2

C"%e e&e% again%# !e%i%#ance 2

S.ie "! %h", #ee#h 2

?hi%#e "! *", "$# chee)% 2

C".'a!e% %ide% 2

O!ganied a''!"ach 2

T"#a 01

S#$den#% Sc"!e>

MO*OR 9O<ER IN U99ER LIMBS AND SHOULDER

S#$den#% Na.e>

Acade.ic N"(>

Ea.ine #he ."#"! '",e! in #hi% 'a#ien#% %h"$de!% and $''e! i.*%(

E8a+ines a%ains" #esis"aneMa8i+u+

E8a+ine#

C&++en"s

Sh"$de! a*d$c#i"n < Add$c#i"n 3

E*", Fei"n < E#en%i"n 3

?!i%# Fei"n < E#en%i"n 3

Finge! a*d$c#i"n < add$c#i"n 3

Hand g!i' 2

O!ganied a''!"ach 2

E8a+ine# "& Ask

Ma8i+u+

E8a+ine#

C&++en"s

De%c!i*e h", d" &"$ g!ade '",e! /G!ade -50 2

T"#a 01

S#$den#% Sc"!e>

DEE9 *ENDON REFLE@ES

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Acade.ic N"(>

Ea.ine #hi% 'a#ien#% dee' #end"n !e+ee% 'an#a! !e+e and %#a#e #he inne!a#i"n% "+ each "+ #he !e+ee%(

Ma8i+u+

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C&++en"s

=ice'% /C5-60 2

=!achi"!adiai% /C5-60 2

T!ice'% /C6-:0 2

Knee e!) /L2-;0 2

An)e e!) /S1-20 2

4an#a! !e+e 2

Techni7$e

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S)i% ,i#h ha..e!

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Ma8i+u+

E8a+ine#

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De%c!i*e h", d" &"$ g!ade !e+ee% /G!ade -30 2

T"#a 01

S#$den#% Sc"!e>

E@AMINA*ION OF SENSOR SS*EM

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Acade.ic N"(>

De."n%#!a#e "n #hi% 'a#ien#% eg h", &"$ ,"$d #e%# d"!%a c"$.n ."dai#ie%(

Ma8i+u+

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A( 4"%i#i"n Sen%e

- 4!"'e! h"ding "+ g!ea# #"e /*& i#%

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."e% digi# !and".&

- S$i#a*e inc!e.en#% "+ #"e ."e.en#

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/a# ea%# 5 #i.e%0(

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C( Vi*!a#i"n Sen%e

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ca%e "+ +aing(

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T"#a 01

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E@AMINA*ION OF CEREBELLAR FUNC*ION

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Acade.ic N"(>

Ea.ine #hi% 'a#ien#% ce!e*ea! +$nc#i"n( A% &"$ '!"ceed gie #he ea.ine! a !$nning c"..en#a!& "n ,ha# &"$

a!e d"ing and ,h&(

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U''e! Li.*

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L",e! Li.*

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Tande. ,a)ingQ 1

O!ganied a''!"ach 2

T"#a 01

Q S#$den# .a& de."n%#!a#e "n %e+

E@AMINA*ION OF A S<ELLING

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Acade.ic N"(>

Ins"#u"i&n "& s"u$en":

Ea.ine #he 'a#ien# +"! a %,eing in #he !igh# $''e! a!.>

Ma8i+u+

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'$%a#i"n

9al2a"i&n:

?a!.#h #ende!ne%% c"n+i!.

Sie %ha'e %$!+ace

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Regi"na &.'h n"de%

O!ganied a''!"ach 2

T"#a 01

S#$den#% Sc"!e>

E@AMINA*ION OF *HROID

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Acade.ic N"(>

Ea.ine #he #h&!"id gand "+ #hi% 'a#ien#(

Ma8i+u+

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O!ganied a''!"ach 2

T"#a 01

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E@AMINA*ION OF INGUINOSCRO*AL S<ELLING

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Acade.ic N"(>

Ea.ine #hi% 'a#ien#% ing$in"%c!"#a !egi"n +"! #he '!e%ence "+ a he!nia( E'ain ,ha# &"$ a!e d"ing a% &"$

'!"ceed(

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C"..$nica#i"n < E#hica S)i% < "!ganied

a''!"ach;

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and ing$in"%c!"#a %,eing%;

De."n%#!a#e% E#e!na !ing inagina#i"n #e%# ;

De."n%#!a#e% in#e!na !ing "cc$%i"n #e%# ;

T"#a 01

S#$den#% %c"!e>

E@AMINA*ION OF AN ULCER

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Acade.ic N"(>

Ins"#u"i&n "& s"u$en":

Ea.ine #he 'a#ien# +"! an $ce! /e(g( e+# +"!ea!.0>

Ma8i+u+

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Ins2e"i&n:

Si#e %ie %ha'e %$!+ace 3

Edge .a!gin 2

Di%cha!ge 2

D!aining &.'h n"de% 2

9al2a"i&n:

Edge +"! #ende!ne%% < ind$!a#i"n 3

Ma!gin +"! ind$!a#i"n e#en%i"n 2

D!aining &.'h n"de% 2

O!ganied a''!"ach 2

T"#a 01

S#$den#% Sc"!e>

E@AMINA*ION OF BREAS*

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Acade.ic N"(>

Ins"#u"i&ns "& s"u$en"s:

Ea.ine #he =!ea%#( A% &"$ '!"ceed e'ain ,ha# &"$ a!e d"ing(

Ma8i+u+

E8a+ine#

C&++en"s

Ins2e"i&n 1( Ea.ine hea#h& %ide 1

2( S&..e#!& "+ *!ea%# 1

3( Ni''e < a!e"a 1

;( S)in change% 1

5( S,eing /%0> %i#e %ie %ha'e e#c 2

6( Aiae %$'!acaic$a! !egi"n% < a!.% 2

9al2a"i&n

1( Ea.ine hea#h& %ide +i!%# 2

2( S,eing /%0> %i#e %ie %ha'e c"n%i%#enc&edge #ende!ne%% ,a!.#h 2

3( Aiae 2

;( S$'!acaic$a! !egi"n% < a!.%( 2

O#%anie$ a22#&a7 an$ &##e" &nlusi&n 2

T"#a 01

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ASSESSMEN* OF 9ERFORMANCE-ADUL* BASIC LIFE SU99OR* (BLS)/N" =!ea#hing < N" 4$%e0

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(DR CAB)Ma8i+u+

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E#e!na

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2 *!ea#h% in #"#a 1

De%c!i*e Rec"e!& '"%i#i"n 0

T"#a 01

S#$den#% Sc"!e>

S#$den#% Na.e>

Acade.ic N$.*e!>

SrNo Clinical Skill Faculty Signature

1. Principles of General physical examination

2. Principles of Abdominal Examination

3. Principles of Respiratory System Examination

4. Principles of Cardioasc!lar System Examination

". Principles of #e!rolo$ical Examination

%. Principles of Examination of &!mp' s(ellin$ and )lcer

*. Principles of Pediatrics Examination

+. Principles of ,reast Examination

Principles of emale Genital tract Examination

1/. Principles of ,asic &ife S!pport

LOG FORM

BASIC CLINICAL SKILLS COURSECOLLEGE OF MEDICINE-AL-HASA

Clinical Skills Manual 2013

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