To date, Prognosis has been downloaded by half a million users. While over half of them hail from the United States, virtually every country in the world is represented. Over a million cases are played each month.

Half a million medical professionals is no insignificant number - even the United States has only a million doctors.

When I founded Prognosis almost an year ago, this degree of success was hard to imagine. Most people I spoke to then could not imagine why I would leave my comfortable job as a doctor to (in their own words) "chase an unrealistic dream".

My reply was that I had a vision - that smartphones would find themselves into the hands of everyone, everywhere - and that I could use them to disseminate medical education around the world and help people globally. My experiences as a struggling medical student had taught me that every bit of help matters.

For each and every week since then, we have released at least one new clinical case scenario - from all the major specialities of medicine. I think that the results speak for themselves.

Yet, all of these cases have been created by a very small team of doctors : just 25 specialists at the last count.

One of my dreams has been to make Prognosis a truly Global endeavor by allowing users from all over the world to create and contribute their own cases. In fact, almost since inception, users have been emailing in interesting case histories.

Unfortunately, building up a Prognosis case is no simple matter. Not only do the history and examination findings need to be "spot on", the discussion has to be concise and most importantly, credible and referenced.

A few case histories we received met these criteria - and we went on to feature them. Many others were "almost" complete - but needed a little additional work. Unfortunately, we did not have the infrastructure in place to support these users and help them develop these cases fully.

I am very happy to announce that this time is at an end - after many months of work, the Prognosis Case Builder is finally ready.

The case builder allows users to create their own cases, to simulate them and check how they will appear in the iPhone, and to submit them to our team of editors (who will then go on to review the cases / help complete them where necessary).

Check the case builder out a http://cases.prognosisapp.com - let me know what you think of it !

Breast lumps (both benign and malignant) are commonly encountered during the clinical component of the final year exams.

These patients may be encountered either as a short case (where the focus is on demonstrating your mastery of the examination technique), or as a long case (where the focus mainly lies in showing your understanding of the principles of management and overall knowledge of the disease).

Regardless of whether the format is short or long, what should be kept in mind is that this is one of the easiest cases, as the examination is stereotypic and the discussion is predictable.

Given below are my notes on how to approach such a patient if encountered as a short case. I also have some notes on the approach for a long case, but I'll leave those for another day.

(Click on the image to enlarge)

Note: All cases are copyrighted by Nayana Somaratna and Harshani Perera (2006 onwards). 

I make no guarantees about the accuracy of the material (and given that I built these while I was in medical college, I heartily recommend that you use this as a guide on how and what to study, rather than relying on this completely).

I just realized that the previous case (Sebaceous cyst / Pilar cyst) only included the discussion - evidently I thought that the examination is so straightforward and simple that it did not need commenting on.

Note: All cases are copyrighted by Nayana Somaratna and Harshani Perera (2006 onwards). 

I make no guarantees about the accuracy of the material (and given that I built these while I was in medical college, I heartily recommend that you use this as a guide on how and what to study, rather than relying on this completely).

While searching through my old emails, I came across some of the old notes made while I was a student (quite a long time ago !).

In retrospect, I am surprised how advanced I was - while my colleagues were using pens and paper, I ended up using Mindjet MindManager to create mindmaps. Luckily, my study partner was forward minded enough to install mind-manager on her computer as well :)

Of course, I never made notes about theory stuff - these notes are all about how to examine a patient in an exam-oriented setting and on how to answer the questions examiners usually ask afterwards (i.e. the stuff you really need in order to pass exams).

I've thought of posting the notes online, since these are definitely of value for anyone studying for their finals / clinical exams.

I'll start with something small - examination of a sebaceous cyst (pilar cyst).

(Click on the image to enlarge it)

After quite some time and a fair amount of deliberation, we've decided to add a legal disclaimer to Prognosis.

I am in two minds about this - as a Doctor, I would never sue another Doctor just for trying to help / educate me - even if something he said turned out to be wrong. And my gut feeling is that 99.99% of medical professionals would feel the same. We all know just how easy it is to make a mistake - and how incredibly complex medicine is.

On the other hand, there are enough crackpots around - what if a legal scamster tried to sue us and make a quick buck ? We hardly have the financial resources to mount a legal defense at the moment.

If this sounds silly, read the horror story from the noted Doctor-Blogger Dr Wes Fisher's blog:

http://drwes.blogspot.com/2010/08/some-blogging-insights-for-doctors.html

After only 10 days, Prognosis is already a top 10 free medical app in the US app store. Not bad, especially considering that our marketing and promotion budget was $0.  We owe a lot to ScienceRoll and Medgadget for featuring Prognosis at the start - their publicity made a big difference.