This document provides instructions for performing an abdominal examination, including techniques for palpation, percussion, and auscultation. It describes how to palpate the abdominal quadrants and specific organs like the liver and spleen. Instructions are given for percussion of the liver and checking for shifting dullness. The fluid thrill test and listening for bowel sounds and bruits are also outlined. The goal is to examine the abdominal contour, feel for masses or swelling, and check the size and position of internal organs.
Gastrointestinal. Assessment will include inspection, auscultation, and light palpation of the abdomen to identify visible abnormalities; bowel sounds and softness/tenderness. Ensure stomach is not full at time of assessment as this may induce vomiting.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
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5th edition of the Diagnostic and Statistical Manual of Mental Disorders
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disorder called alcohol use disorder (AUD), with mild, moderate,
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In the DSM-5, all types of substance abuse and dependence have been
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AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
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the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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9. Technique
Kneel beside the patient right side
Ask the patient if he has pain at any site of his abdomen
Start palpation while looking to the patient face
Superficial palpation for tenderness, rigidity & guarding
Deep palpation for masses , hepatomegaly and
splenomegaly
Bimanual palpation and ballottement for kidneys
Palpate hernial orifices (cough impulse)
Palpate for inguinal LAP
Palpate from the back for renal angles
10. Palpation for hepatomegaly
Start from the right iliac fossa
Use finger tips or index finger side
Apply slow, steady pressure, pushing up
and in while the patient takes a deep
breath
Try to feel the lower edge of the liver
touching your fingers during inspiration
12. Palpation for splenomegaly
Start from right iliac fossa
Use the tips of your fingers progress diagonally
up ward and to the left
Try to feel the lower border of the spleen
touching your fingers during inspiration
Try to localize the spleenic notch
Try to hook fingers below the left lower costal
margin
Repeat the exam with the patient turned onto
their right side
13. Palpation of the kidneys
Put left hand at the renal angle (costo-
vertebral angle) and the right hand parallel
to it on the flank and try to push and rock
to feel for an enlarged kidney (bimanual
palpation)
Then push the kidney up by the hand at
the renal angle and try to feel the kidney
hitting the other hand and goes back
(ballottement)
14. Percussion for liver dullness
Percussion for spleenic dullness
Percussion for shifting dullness
Check for fluid thrill
15. Percussion notes
Tympanitic (drum-like) sounds produced
by percussing over air filled structures
( stomach & bowels).
Dull sounds that occur over a solid
structure (e.g. liver) or fluid (e.g. ascites)
16. Percussion for liver dullness
Start just below the right breast at the
midclavicular line. Percussion in this area should
produce a relatively resonant note.
Move your hand down a few centimeters and
repeat. After doing this several times, you will be
over the liver, which will produce a duller
sounding tone.
Continue your march downward until the sound
changes once again. This may occur just as you
pass over the costal margin. At this point, you
will have reached the inferior margin of the liver.
17. Shifting dullness
With the patient supine, begin percussion at the level of
the umbilicus and proceed down laterally. In the
presence of ascites, you will reach a point where the
sound changes from tympanitic to dull.
Mark this point on both the right and left sides of the
abdomen and then have the patient roll into a lateral
decubitus position (i.e. onto either their right or left
sides).
Repeat percussion, beginning at the top of the patient's
now up-turned side and moving down towards the
umbilicus. If there is ascites, fluid will flow to the most
dependent portion of the abdomen. The place at which
sound changes from tympanitic to dull will therefore have
shifted upwards
19. Fluid thrill
Ask the patient or an observer to place their hand so that
it is oriented longitudinally over the center of the
abdomen.
They should press firmly so that the subcutaneous tissue
and fat do not jiggle.
Place your right hand on the left side of the abdomen
and your left hand opposite
firmly tap on the abdomen with your right hand while
your left remains against the abdominal wall.
If there is large ascites, you may be able to feel a fluid
wave strike against the abdominal wall under your left
hand (fluid thrill)
20. listening for 15 or 20 seconds.
Listen for bowel sounds and bruits
Bowel sounds occur every 2 to 5 seconds.
check for bruits over renal arteries, aortic
artery and common iliac arteries
Listen for sucction splash