Clinical examination notes based on TU/KU curriculum of MBBS in nepal. Hope this will be very much helpful in step wise approach to you people especially during exam time.
Clinical examination notes based on TU/KU curriculum of MBBS in nepal. Hope this will be very much helpful in step wise approach to you people especially during exam time.
Clinical examination of the spine/back covering the following sections:
INSPECTION
PALPATION
MOVEMENTS
MEASUREMENTS
SPECIAL TESTS
(Neurological examination covered separately in another slideshow : SPINE EXAMINATION - PART 2)
Knee clinical examination for orthopaedic residents.dr mohamed ashraf TD medi...drashraf369
a comprehensive and examination oriented presentation of clinical examination of knee joint.contains lot of demonstrations and tips.author is dr mohamed ashraf,professor and head of orthopaedics,govt TD medical college hospital,alleppey,kerala,india. drashraf369@gmail.com
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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
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.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
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.
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
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
4. Traditional steps
History of symptoms.
General examination
Examination of Hip proper.
Inspection
Palpation
Movements
Measurements
Special tests
6. PAIN
Site :
Anterior hip pain : arthritis, hip flexor strain,
ilio-psoas bursitis, lebral tear.
Lateral hip pain : GT bursitis, GM tear,
iliotibial band syndrome(athletes),meralgia
paresthetica.
Posterior hip pain : hip extensor and external
rotators pathology, degenerative disc disease,
spinal stenosis.
7. Pain cont..
Onset :
Gradual : RA,OA, etc
Sudden onset : fractures ,muscle tear
,haematoma,
Any fall ? Fracture, haematoma, muscle tear
Playing sports? Muscle sprain, labral tear, etc
Character
Sharp: muscle strain/tear, fracture
Dull: OA, RA
Achy: OA, RA, AVN
8. Contd..
Radiation of pain : knee ,back of
thigh, leg
Aggravating or relieving factors :
OA gets worse as they day goes on and
is relieved by rest
Muscle tears/sprains may be
exacerbated by movement
RA is worse after prolonged periods of
rest
10. LIMP
any abnormality of normal
rhythmic biphasic walking.
Usually noted by kin
Onset
Duration
Association with pain
Progression
Ambulatory status
Stiffness
Deformity
Limb length disparity
Paralytic disability
15. Local examination of hip
Inspection
Palpation
Movements
Measurements
Special tests
16. Inspection
Should be done from
the front, side and
back
Gait of the patient.
Attitude of the upper
and lower limb.
17. Gait :
Simplest of all definitions “mode of walking”
Normal gait is rhythmical bipedal biphasic
walking in which the lumbar spine, hip and
legs move in unison.
18. Types of gait :
Antalgic gait : In painful hip
conditions pt walks with reduced
stance phase on the affected side.
19. Waddling gait:
Body sways from side to side on a wide base seen in
b/l DDH,pregnancy.
20. Circumduction gait
In fixed abduction deformity or in
hemiparesis the pt moves his limbs
while dragging his body along with limb
in a semi circle.
23. Short limb gait-
When the affected
limb becomes short
Up and down
movement of half
of the body.
Pt lurches on the
affected side with a
pelvis drop on the
same side.
24. Quadriceps gait
In quadriceps
weakness body
collapses-hence
the trunk goes for
anterior bending
to shift the
vertical vector
anterior to the
knee to balance.
25. Toe in and toe out gait:
Toe in : Pt walks
with both feet
turned inwards,
seen in femoral
antiversion.
Toe out : Pt walks
with both feet
turned outwards-
seen in femoral
retroversion.
26.
27. Attitude and Diagnosis
CDH – Broadening at trochantric level,
widening of the perineum, assymetry of
gluteal folds
Synovitis – mild flexion, abduction, Ext
Rotation ,with apparent lengthening
True arthritis – Flex Adduc Int Rota(FADIR)
with or without true shortening
Posterior dislocation – FADIR with apparent
and true shortening.
30. Inspection (side)
Iliac crest
/Trochanteric
region
Lumbar
lordosis/Gluteal
bulge /supra or
infratrochanteric
depression & thigh
ms mass
Level of tip of
trochanters.
33. Palpation:
Marking of bony
points.
Superficial:Temperatu
re ,Tenderness, area of
anesthesia etc.
Deep palpation:
Tenderness over bony
pt(ASIS,PSIS,GT,IT,Pub
is,iliac crest)
ASIS
PUBIS
GT
34. Deep palpation contd…
Anterior hip joint(direct)
Bitrochanteric
compression test.
Iliac crest
Femoral pulse(vascular
sign of Narah)
Iliac fossa
Lymb nodes
35. MOVEMENTS:
Should be performed in
squaring pelvis.
Flexion : 0 to 110-130 deg.
Extension : o to 20 deg.
Abduction:o to 45-55 deg
Adduction:0 to 35-45 deg
Internal rotation : 30-40
deg.
External rotation: 40-50
deg.
36. Flexion :
Other muscle
contribution
Active SLRT against
resistance
For ilio-psoas
contribution.(sitting)
41. THOMAS TEST(IN FFD)
Deformity and
compensation:
Fixed flexion deformity –
Lordosis
Fixed abd. deformity –
lowering of pelvis and
scoliosis with convexity
towards the affected side
Fixed add. deformity –
raised pelvis and scoliosis
with convexity towards
unaffected side
Fixed rotational deformity
–no compensation
42. CRITICISM OF THOMAS TEST
Painful hip
Obese or heavily
built individuals
B/L fixed flexion
deformity of the
hip
In presence of
ankylosed knee.
45. Apparent measurement
Helps in assessing the extent
compensation developed for
concealing the actual deformity .
Prerequisites
Lying supine comfortably
Lower limbs parallel
Measurement taken from
central fixed point on the trunk
to tip of medial malleolus
No squaring of pelvis
46. True length
Prerequisites
Pt exposed adequately
Bony points marked with
pencil (metal end of the
tape)
Squaring of the pelvis
48. Total length
(quick assessment )
Allis or Galeazzi
sign
Hips flexed up to 600 ,
knees at 90 with feet
planted over the bed .
Both the knees should
be at the same level .
Any disparity in level
indicates limb length
disparity
49. Localization of limb length
disparity
Segmental
measurement
Leg length
Thigh length
Supra trochanteric infra tro-
(BRYANT’S TRIANGLE) -chanteric
51. Measurement of muscle bulk
Circumferential
measurements
Any muscle
wasting indicates
chronic disease.
Should be in
same position.
52. Tests for stability of hip
SLR Test
Telescopy Test
Trendelenburg’s Test
Ortolani’s test
Barlow’s Test
53. Telescopy Test
Flex the hip to 90 deg
•one hand with the
thumb on ASIS and
the remaining
fingers over the soft
tissue proximal to
femur
•other hand at the
distal femur
•push and pull the
femur
54. Trendelenberg Test
assess the ability of the hip
abductors.
A positive test
demonstrates that the hip
abductors are not
functioning.
Causes:
• Power : Weakness of the
hip abductors e.g.
myopathy, neuropathy
• Lever : # NOF, Troch# etc
• Fulcrum:
Arthritis,RA,dislocation
55. ORTOLANI TEST
First flexion the hips and
knees of a supine infant to
90 degrees, then with the
examiner's index fingers
placing anterior pressure
on the greater trochanters
gently and smoothly
abducting the infant's legs
using the examiner's
thumbs.
A positive sign is a
distinctive 'clunk' which can
be heard and felt as the
femoral head relocates
anteriorly into the
acetabulum
56. BARLOW’S MANOUVRE
The maneuver is easily
performed by
adducting the hip
while applying light
pressure on the knee,
directing the force
Posteriorly.[2] If the hip
is dislocatable - that is,
if the hip can be
popped out of socket
with this maneuver -
the test is considered
positive.
57. Tests for hip pathology
PATRIC TESTS
Distinguish between SI
joint and hip joint
pathology.
Also known as
FABER TEST
JANSEN’S TEST
FIGURE OF FOUR
TEST
BUCKET HANDLE
TEST
58. Anterior labral tear test
TEST FOR starting
anterior superior
impingement
syndrome
Anterior labial tear
Iliopsoas end
tendinitis
60. Craig’s test
To measure femoral
anteversion
Also called Ryder
method for measuring
femoral anteversion
61. TESTS FOR JOINT CONTRACTURES
OBER’S TEST:
Test for ileo-tibial tract
contracture.
In lateral decubitus position
knee is flexed to 90 degree
hip is abducted to 40 degree
and pelvis is stabilised.
limb is gently adducted
towards the examining
table normally the hip
adducts and the limb
crosses the midline
62. ELY’S TEST
for the contracture of
the rectus femoris
prone position with the
knees extended
passively flex one knee
to be tested
normally knee can be
flexed fully
in contracted rectus full
flexion of the knee
forces the hip into
flexion causing the rise
of buttocks
63. PHELP’S TEST:
To detect the contracture
of gracilis muscle
Prone position with the
knee extended
Passive abduction to the
maximum with the
extended knee
Knees are then flexed to
relax gracilis
Attempt to further abduct
the hip with knee in
flexion
Further abduction is
possible in gracilis
contracture
64. PIRIFORMIS TEST(FADIR)
Lateral decubitus position
•hip is flexed to 45 degree
•knee is flexed to 90
degree
•one hand stabilises the
pelvis
•other hand pushes the
knee to the floor causing
the internal rotation
•pain locally-piriformis
tendinitis
•pain radiates down-
piriformis syndrome