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[Music] so this is a 67 year old man with classical hepatosplenomegaly there are no signs of chronic liver disease although indeed this could still be important in the etiology of his hepatosplenomegaly there are no lymph nodes either and no other evidence to suggest a hematological malignancy but this is also important in the differential for the student to pass this case wed expect a good general approach including washing of the hands and ensuring that there are gentle with the patient wed expect the student to inspect palpate percuss and auscultate we would expect the student to pick there is an abnormality and we would expect the student to at least have some idea of the major diagnosis differential diagnosis wed also expect the student to consider looking outside of the abdomen for other important physical signs of potential relevance which may include examining for all the lymph nodes properly and a rectal exam although we would not expect the student of course to do a recta