This 83-year-old woman presented with chest pain and was found to be having a heart attack. She has a history of hypertension but was previously well-controlled. Her current presentation included toothache-like chest pain, EKG changes, and elevated cardiac enzymes consistent with a heart attack. Her past medical history also includes prior admissions for chest pain and heart failure. She received thrombolytic therapy and was admitted to the intensive care unit.
This is a small booklet in an outline format to assist undergraduate medical students to aid in writing case write ups. This mainly contains how to elicit symptoms and signs.
This presentation gives general overview of all aspects of bowel sounds including its pathophysiology, auscultation techniques and features of normal versus abnormal bowel sounds.
Gluteal abscess with diabetes mellitus and diabetic ketoacidosis (2)Goutham Kondeti
About the patient with Diabetes mellitus and ketoacidosis with abscess, his treatment plan, goals of treatment, monitoring parameters, drug interactions, patient counseling, precautions
This is a small booklet in an outline format to assist undergraduate medical students to aid in writing case write ups. This mainly contains how to elicit symptoms and signs.
This presentation gives general overview of all aspects of bowel sounds including its pathophysiology, auscultation techniques and features of normal versus abnormal bowel sounds.
Gluteal abscess with diabetes mellitus and diabetic ketoacidosis (2)Goutham Kondeti
About the patient with Diabetes mellitus and ketoacidosis with abscess, his treatment plan, goals of treatment, monitoring parameters, drug interactions, patient counseling, precautions
PSYCHOSOCIAL FACTORS DETERMINING QUALITY
OF LIFE AMONG CANCER PATIENTS IN NEPAL
A DISSERTATION SUBMITTED TO THE FACULTY OF HUMANITIES
AND SOCIAL SCIENCES OF TRIBHUVAN UNIVERSITY IN
FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF
DOCTOR OF PHILOSOPHY
BY TARA SHAH
This Slides Covers common headers found in PCAP file ,Slides describe Ether header structure , Global header structure , Internet protocol version 4 Header structure (IPv4) ,Address Resolution Protocol header structure , Internet Control Message Protocol header structure , User Datagram Protocol header structure , Transmission Control Protocol header structure.
PCAP Graphs for Cybersecurity and System TuningDr. Mirko Kämpf
Cybersecurity is a broad topic and many commercial products are related to it. We demonstrate a fundamental concept in network analysis: re-construction and visualization of temporal networks. Furthermore, we apply the method to describe operational conditions of a Hadoop cluster. Our experiments provide first results and allow a classification of the cluster state related to current workloads. The temporal networks show significant differences for different operation modes. In reallity we would expect mixed workloads. If such workload parameters are known, we are able to handle a-typical events accordingly - which means, we are able to create alerts based on context information, rather than only the package content. We show an end-to-end example: (1) Data collection is done via python, using the sniffer script; (2) using Apache Hive and Apache Spark we analyze the network traffic data and create the temporary network. Finally, we are able to visualize the results using Gephi in step (3). In a next step, we plan to contribute to the Apache Spot project.
Psychosocial Development Case Study AssessmentKylee Grafton
For this psychosocial development case study I have chosen three characters from the film. “My big fat Greek weeding” to analyze based on the life stages they are in during the film. I have chosen the three characters based on the crises they are experiencing in their particular life stages as well and how they have reached their ending goal of having a more healthy relationship with one another. Using what I have learned about counseling and family counseling as my chosen specialization I chose three family members to use as an example of my analyses. The first and main character Toula Portokalos and she father Gus Portokalos, Maria Portokalos the wife and mother of Toula. These three characters relationship with one another is unstable due to the different crises leading up to the current life stages they are in.
Workshop: Big Data Visualization for SecurityRaffael Marty
Big Data is the latest hype in the security industry. We will have a closer look at what big data is comprised of: Hadoop, Spark, ElasticSearch, Hive, MongoDB, etc. We will learn how to best manage security data in a small Hadoop cluster for different types of use-cases. Doing so, we will encounter a number of big-data open source tools, such as LogStash and Moloch that help with managing log files and packet captures.
As a second topic we will look at visualization and how we can leverage visualization to learn more about our data. In the hands-on part, we will use some of the big data tools, as well as a number of visualization tools to actively investigate a sample data set.
This student "cheat sheet" is designed to provide medical students with basic information regarding how to write a basic Subjective, Objective, Assessment & Plan (SOAP) Clinic Note. It also includes information on how to organize a presentation to an attending physician and how to write a basic prescription.
These guides are particularly designed for first and second-year medical students as an introduction to ambulatory care medicine and attempts to tie in the basic pathophysiology that is high-yield for USMLE Step 1.
Any and all feedback is very welcomed.
Comprehensive SOAP ExemplarPurpose To demonstrate what each s.docxdonnajames55
Comprehensive SOAP Exemplar
Purpose: To demonstrate what each section of the SOAP Note should include. Remember that nurse practitioners treat patients in a holistic manner, and your SOAP Note should reflect that premise.
Patient Initials: _______ Age: _______ Gender: _______
SUBJECTIVE DATA:
Chief Complaint (CC): Coughing up phlegm and fever
History of Present Illness (HPI): Sara Jones is a 65-year-old Caucasian female who presents today with a productive cough x 3 weeks and fever for the last 3 days. She reported that the “cold feels like it is descending into her chest.” The cough is nagging and productive. She brought in a few paper towels with expectorated phlegm – yellow/brown in color. She has associated symptoms of dyspnea of exertion and fever. Her Tmax was reported to be 102.4 last night. She has been taking Ibuprofen 400mg about every 6 hours and the fever breaks, but it returns after the medication wears off. She rated the severity of her symptom discomfort at 4/10.
Medications:
1.) Lisinopril 10mg daily
2.) Combivent 2 puffs every 6 hours as needed
3.) Serovent daily
4.) Salmeterol daily
5.) Over-the-counter Ibuprofen 200mg -2 PO as needed
6.) Over-the-counter Benefiber
7.) Flonase 1 spray each night as needed for allergic rhinitis symptoms
Allergies:
Sulfa drugs - rash
Past Medical History (PMH):
1.) Emphysema with recent exacerbation 1 month ago – deferred admission – RX’d with outpatient antibiotics and hand held nebulizer treatments.
2.) Hypertension – well controlled
3.) Gastroesophageal reflux (GERD) – quiet, on no medication
4.) Osteopenia
5.) Allergic rhinitis
Past Surgical History (PSH):
1.) Cholecystectomy 1994
2.) Total abdominal hysterectomy (TAH) 1998
Sexual/Reproductive History:
Heterosexual
G1P1A0
Non-menstruating – TAH 1998
Personal/Social History:
She has smoked 2 packs of cigarettes daily x 30 years; denied ETOH or illicit drug use.
Immunization History:
Her immunizations are up to date. She received the influenza vaccine last November and the Pneumococcal vaccine at the same time.
Significant Family History:
Two brothers – one with diabetes, dx at age 65, and the other with prostate CA, dx at age 62. She has one daughter in her 30s, healthy, living in nearby neighborhood.
Lifestyle:
She is retired, has been widowed x 8 years, and lives in the city in a moderate crime area with good public transportation. She is a college graduate, owns her home, and receives a pension of $50,000 annually – financially stable.
She has a primary care nurse practitioner provider and goes for annual and routine care twice annually and as needed for episodic care. She has medical insurance but often asks for drug samples for cost savings. She has a healthy diet and eating pattern. There are resources and community groups in her area at the senior center that she attends regularly. She enjoys bingo. She has a good support system composed of family and friends.
Review of Systems:
General: + fatigue sinc.
Comprehensive SOAP ExemplarPurpose To demonstrate what each s.docxmaxinesmith73660
Comprehensive SOAP Exemplar
Purpose: To demonstrate what each section of the SOAP Note should include. Remember that nurse practitioners treat patients in a holistic manner, and your SOAP Note should reflect that premise.
Patient Initials: _______ Age: _______ Gender: _______
SUBJECTIVE DATA:
Chief Complaint (CC): Coughing up phlegm and fever
History of Present Illness (HPI): Sara Jones is a 65-year-old Caucasian female who presents today with a productive cough x 3 weeks and fever for the last 3 days. She reported that the “cold feels like it is descending into her chest.” The cough is nagging and productive. She brought in a few paper towels with expectorated phlegm – yellow/brown in color. She has associated symptoms of dyspnea of exertion and fever. Her Tmax was reported to be 102.4 last night. She has been taking Ibuprofen 400mg about every 6 hours and the fever breaks, but it returns after the medication wears off. She rated the severity of her symptom discomfort at 4/10.
Medications:
1.) Lisinopril 10mg daily
2.) Combivent 2 puffs every 6 hours as needed
3.) Serovent daily
4.) Salmeterol daily
5.) Over-the-counter Ibuprofen 200mg -2 PO as needed
6.) Over-the-counter Benefiber
7.) Flonase 1 spray each night as needed for allergic rhinitis symptoms
Allergies:
Sulfa drugs - rash
Past Medical History (PMH):
1.) Emphysema with recent exacerbation 1 month ago – deferred admission – RX’d with outpatient antibiotics and hand held nebulizer treatments.
2.) Hypertension – well controlled
3.) Gastroesophageal reflux (GERD) – quiet, on no medication
4.) Osteopenia
5.) Allergic rhinitis
Past Surgical History (PSH):
1.) Cholecystectomy 1994
2.) Total abdominal hysterectomy (TAH) 1998
Sexual/Reproductive History:
Heterosexual
G1P1A0
Non-menstruating – TAH 1998
Personal/Social History:
She has smoked 2 packs of cigarettes daily x 30 years; denied ETOH or illicit drug use.
Immunization History:
Her immunizations are up to date. She received the influenza vaccine last November and the Pneumococcal vaccine at the same time.
Significant Family History:
Two brothers – one with diabetes, dx at age 65, and the other with prostate CA, dx at age 62. She has one daughter in her 30s, healthy, living in nearby neighborhood.
Lifestyle:
She is retired, has been widowed x 8 years, and lives in the city in a moderate crime area with good public transportation. She is a college graduate, owns her home, and receives a pension of $50,000 annually – financially stable.
She has a primary care nurse practitioner provider and goes for annual and routine care twice annually and as needed for episodic care. She has medical insurance but often asks for drug samples for cost savings. She has a healthy diet and eating pattern. There are resources and community groups in her area at the senior center that she attends regularly. She enjoys bingo. She has a good support system composed of family and friends.
Review of Systems:
General: + fatigue sinc.
Clinical ScenarioREASON FOR CONSULTATION Desaturation to 64.docxbartholomeocoombs
Clinical Scenario:
REASON FOR CONSULTATION:
Desaturation to 64% on room air 1 hours ago with associated shortness of breath.
HISTORY OF PRESENT ILLNESS:
Mrs. X is 73-year-old Caucasian female who was admitted to the general surgery service 3 days ago for a leaking j-tube which was surgically replaced 2 days ago and is now working properly. This morning at 07:30, the RN reported that the patient was sleeping and doing fine, then the CNA made rounds at 0900 and Mrs. X was found be mildly dyspneic. Vital signs were checked at that time and were; temperature 38.6, pulse 120, respirations 22, blood pressure 138/38. O2 sat was 64% on room air. The general surgeon was notified by the nursing staff of the hypoxia, an order for a chest x-ray and oxygen therapy were given to the RN. The O2 sat is maintaining at 91% on 4L NC. The patient was seen and examined at 10:10 a.m. She reports that she has been having mild dyspnea for 2 days that has progressively gotten worse. She does not use oxygen at home. Her respiratory rate at the time of visit was 22 and she feels short of breath. She has felt this way in the past when she had pneumonia. She is currently undergoing radiation treatment for laryngeal cancer and her last treatment was 1 to 2 weeks ago. She reports that she has 2 to 3 treatments left. She denies any chest pain at this time and denies any previous history of CHF. Review of her vital signs show that she has been having intermittent fevers since yesterday morning. Of note, she was admitted to the hospital 3 weeks ago for an atrial fibrillation with RVR for which she was cardioverted and has not had any further problems. The cardiologist at that time said that she did not need any anticoagulation unless she reverted back into A-fib.
REVIEW OF SYSTEMS:
Constitutional:
Negative for diaphoresis and chills.
Positive for fever and fatigue.
HEENT:
Negative for hearing loss, ear pain, nose bleeds, tinnitus.
Positive for throat pain secondary to her laryngeal cancer.
Eyes:
Negative for blurred vision, double vision, photophobia, discharge or redness.
Respiratory:
Positive for cough and shortness of breath
. Negative for hemoptysis and wheezing.
Cardiovascular:
Negative for chest pain, palpitations, orthopnea, leg swelling or PND.
Gastrointestinal:
Negative for heartburn, nausea, vomiting, abdominal pain, diarrhea, constipation, blood in stool or melena.
Genitourinary:
Negative for dysuria, urgency, frequency, hematuria and flank pain.
Musculoskeletal:
Negative for myalgias, back pain and falls.
Skin:
Negative for itching and rash.
Neurological:
Negative for dizziness, tingling, tremors, sensory changes, speech changes.
Endocrine/hematologic/allergies:
Negative for environmental allergies or polydipsia. Does not bruise or bleed easily.
Psychiatric:
Negative for depression, hallucinations and memory loss.
PAST MEDICAL HISTORY:
Diabetes mellitus that was diagnosed 12 years ago with neuropathy. This resolved after gastric.
Instructions· This week’s case study will introduce concepts r.docxmariuse18nolet
Instructions
· This week’s case study will introduce concepts related to the pulmonary system and shock states. Read the scenario and thoroughly complete the questions. Some of the answers will be short answers and may not require a lot of details. For example: what is the most common organism to cause a hospital acquired infection? The answer is pseudomonas aeruginosa. Answers to questions that relate to the pathogenesis of a disease must include specific details on the process. For example: How does hypoxia lead to cellular injury? Simply writing that a lack of blood flow, causes a lack of oxygen available to the cell and the cell cannot function without oxygen is not sufficient. This type of response is NOT reflective of an advanced understanding of the concept or graduate level work. This answer should discuss the cascade of events leading to the lack of oxygen and how it specifically impairs cellular function. All answers to these type of questions should address the effects at the cellular level, then the effects on the organ and then the body as a whole. Additionally describing the normal anatomical and/or physiologic processes underlying the pathogenesis will be necessary to thoroughly answer the question.
It is very likely that you will need to reference multiple sources to answer the questions thoroughly. Your text book will not necessarily have all the answers. Only professional sources may be used to complete the assignment. These include text books, primary and secondary journal articles from peer reviewed journals, government and university websites, and publications from professional societies who establish disease management guidelines and recommendations. Sources such as Wikipedia or other generic websites are not considered professional references and should not be used to complete the case studies.
· Reason for Consultation:
Desaturation to 64% on room air 1 hour ago with associated shortness of breath.
History of Present Illness:
Mrs. X is 73-year-old Caucasian female who was admitted to the general surgery service 3 days ago for a leaking j-tube which was surgically replaced 2 days ago. This morning at 07:30, the RN reported that the patient was sleeping and doing fine, then the CNA made rounds at 0900 and Mrs. X was found to be mildly dyspneic. Vital signs were checked at that time and were; temperature 38.6, pulse 120, respirations 20, blood pressure 138/38. O2 sat was 64% on room air. The general surgeon was notified by the nursing staff of the hypoxia, an order for a chest x-ray and oxygen therapy were given to the RN. The O2 sat is maintaining at 91-92% on 4L NC. The patient was seen and examined at 10:10 a.m. She reported that she has had mild dyspnea for 2 days that has progressively gotten worse. She does not use oxygen at home. Her respiratory rate at the time of this visit was 20 and she feels short of breath. She has felt this way in the past when she had pneumonia. She is currently undergoing radiatio.
Comprehensive SOAP ExemplarPurpose To demonstrate what each sec.docxmaxinesmith73660
Comprehensive SOAP Exemplar
Purpose: To demonstrate what each section of the SOAP Note should include. Remember that nurse practitioners treat patients in a holistic manner, and your SOAP Note should reflect that premise.
Patient Initials: _______
Age: _______
Gender: _______
SUBJECTIVE DATA:
Chief Complaint (CC): Coughing up phlegm and fever
History of Present Illness (HPI): Sara Jones is a 65-year-old Caucasian female who presents today with a productive cough x 3 weeks and fever for the last 3 days. She reported that the “cold feels like it is descending into her chest.” The cough is nagging and productive. She brought in a few paper towels with expectorated phlegm – yellow/brown in color. She has associated symptoms of dyspnea of exertion and fever. Her Tmax was reported to be 102.4 last night. She has been taking Ibuprofen 400mg about every 6 hours and the fever breaks, but it returns after the medication wears off. She rated the severity of her symptom discomfort at 4/10.
Medications:
1.) Lisinopril 10mg daily
2.) Combivent 2 puffs every 6 hours as needed
3.) Serovent daily
4.) Salmeterol daily
5.) Over-the-counter Ibuprofen 200mg -2 PO as needed
6.) Over-the-counter Benefiber
7.) Flonase 1 spray each night as needed for allergic rhinitis symptoms
Allergies:
Sulfa drugs - rash
Past Medical History (PMH):
1.) Emphysema with recent exacerbation 1 month ago – deferred admission – RX’d with outpatient antibiotics and hand held nebulizer treatments.
2.) Hypertension – well controlled
3.) Gastroesophageal reflux (GERD) – quiet, on no medication
4.) Osteopenia
5.) Allergic rhinitis
Past Surgical History (PSH):
1.) Cholecystectomy 1994
2.) Total abdominal hysterectomy (TAH) 1998
Sexual/Reproductive History:
Heterosexual
G1P1A0
Non-menstruating – TAH 1998
Personal/Social History:
She has smoked 2 packs of cigarettes daily x 30 years; denied ETOH or illicit drug use.
Immunization History:
Her immunizations are up to date. She received the influenza vaccine last November and the Pneumococcal vaccine at the same time.
Significant Family History:
Two brothers – one with diabetes, dx at age 65, and the other with prostate CA, dx at age 62. She has one daughter in her 30s, healthy, living in nearby neighborhood.
Lifestyle:
She is retired, has been widowed x 8 years, and lives in the city in a moderate crime area with good public transportation. She is a college graduate, owns her home, and receives a pension of $50,000 annually – financially stable.
She has a primary care nurse practitioner provider and goes for annual and routine care twice annually and as needed for episodic care. She has medical insurance but often asks for drug samples for cost savings. She has a healthy diet and eating pattern. There are resources and community groups in her area at the senior center that she attends regularly. She enjoys bingo. She has a good support system composed of family and friends.
Review of Systems:
General: + fatigue .
Bilateral Pulmonary Hydatid Cysts with Ruptured & Infected Hydatid Cyst of Le...Dharmendra Joshi
Bilateral Pulmonary Hydatid Cysts with Ruptured & Infected Hydatid Cyst of Left Lung - A Case Presentation
Operations:
First Operation:
VATS Enucleation of Hydatid Cyst of Lung (Right side)
Second Operation:
VATS followed by minimally invasive open Enucleation and Capitonnage of Hydatid Cyst of Lung (Left side)
Give an example from your own experience or research an article or.docxhanneloremccaffery
Give an example from your own experience or research an article or the media in which a business executive did something of significance that is morally right. Use APA format to cite your material from your sources.
Is there a relationship between obesity and socio-economic status? Should obese people be considered a protected class under Title VII of the Civil Rights Act?
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Comprehensive SOAP Exemplar
Purpose: To demonstrate what each section of the SOAP Note should include. Remember that nurse practitioners treat patients in a holistic manner, and your SOAP Note should reflect that premise.
Patient Initials: _______
Age: _______
Gender: _______
SUBJECTIVE DATA:
Chief Complaint (CC): Coughing up phlegm and fever
History of Present Illness (HPI): Sara Jones is a 65-year-old Caucasian female who presents today with a productive cough x 3 weeks and fever for the last 3 days. She reported that the “cold feels like it is descending into her chest.” The cough is nagging and productive. She brought in a few paper towels with expectorated phlegm – yellow/brown in color. She has associated symptoms of dyspnea of exertion and fever. Her Tmax was reported to be 102.4 last night. She has been taking Ibuprofen 400mg about every 6 hours and the fever breaks, but it returns after the medication wears off. She rated the severity of her symptom discomfort at 4/10.
Medications:
1.) Lisinopril 10mg daily
2.) Combivent 2 puffs every 6 hours as needed
3.) Serovent daily
4.) Salmeterol daily
5.) Over-the-counter Ibuprofen 200mg -2 PO as needed
6.) Over-the-counter Benefiber
7.) Flonase 1 spray each night as needed for allergic rhinitis symptoms
Allergies:
Sulfa drugs - rash
Past Medical History (PMH):
1.) Emphysema with recent exacerbation 1 month ago – deferred admission – RX’d with outpatient antibiotics and hand held nebulizer treatments.
2.) Hypertension – well controlled
3.) Gastroesophageal reflux (GERD) – quiet, on no medication
4.) Osteopenia
5.) Allergic rhinitis
Past Surgical History (PSH):
1.) Cholecystectomy 1994
2.) Total abdominal hysterectomy (TAH) 1998
Sexual/Reproductive History:
Heterosexual
G1P1A0
Non-menstruating – TAH 1998
Personal/Social History:
She has smoked 2 packs of cigarettes daily x 30 years; denied ETOH or illicit drug use.
Immunization History:
Her immunizations are up to date. She received the influenza vaccine last November and the Pneumococcal vaccine at the same time.
Significant Family History:
Two brothers – one with diabetes, dx at age 65, and the other with prostate CA, dx at age 62. She has one daughter in her 30s, healthy, living in nearby neighborhood.
Lifestyle:
She is retired, has been widowed x 8 years, and lives in the city in a moderate crime area with good public transportation. She is a college graduate, owns her home, and receives a pension of $50,000 annually – financially stable.
She has a primary care nurse practitioner provider and goes for annual and r ...
Similar to Example of a complete history and physical write (20)
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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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
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. 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
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
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Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Novas diretrizes da OMS para os cuidados perinatais de mais qualidade
Example of a complete history and physical write
1. Example of a Complete History and Physical Write-up
Patient Name:
Unit No:
Location:
Informant: patient, who is reliable, and old CPMC chart.
Chief Complaint: This is the 3rdCPMC admission for this 83 year old woman with a
long history of hypertension who presented with the chief complaint of substernal
“toothache like” chest pain of 12 hours duration.
History of Present Illness: Ms J. K. is an 83 year old retired nurse with a long history
of hypertension that was previously well controlled on diuretic therapy. She was
first admitted to CPMC in 1995 when she presented with a complaint of intermittent
midsternal chest pain. Her electrocardiogram at that time showed first
degreeatrioventricular block, and a chest X-ray showed mild pulmonary congestion,
with
cardiomegaly. Myocardial infarction was ruled out by the lack of
electrocardiographic and cardiac enzyme abnormalities. Patient was discharged
after a brief stay on a regimen of enalapril, and lasix, and digoxin, for presumed
congestive heart failure. Since then she has been followed closely by her
cardiologist. Aside from hypertension and her postmenopausal state, the patient
denies other coronary artery disease risk factors, such as diabetes, cigarette
smoking, hypercholesterolemia or family history for heart disease. Since her
previous admission, she describes a stable two pillow orthopnea, dyspnea on
exertion after walking two blocks, and a mild chronic ankle edema which is worse
on prolonged standing. She denies syncope, paroxysmal nocturnal dyspnea, or
recent chest pains.
She was well until 11pm on the night prior to admission when she noted the onset
of “aching pain under her breast bone” while sitting, watching television. The pain
was described as “heavy” and “toothache” like. It was not noted to radiate, nor
increase with exertion. She denied nausea, vomiting, diaphoresis, palpitations,
dizziness, or loss of consciousness. She took 2 tablespoon of antacid without relief,
but did manage to fall sleep. In the morning she awoke free of pain, however upon
walking to the bathroom, the pain returned with increased severity. At this time she
called her daughter, who gave her an aspirin and brought her immediately to the
emergency room.
Her electrocardiogram on presentation showed sinus tachycardia at 110, with
marked ST elevation in leads I, AVL, V4-V6 and occasional ventricular paroxysmal
contractions. Patient immediately received thrombolytic therapy and cardiac
medications, and was transferred to the intensive care unit.
2. Current Regimen
Digoxin 0.125mg once daily
Enalapril 20mg twice daily
Lasix 40mg once every other day
KCl 20mg once daily
Tylenol 2 tabs twice daily as needed for arthritis
Past Health
General: Relatively good
Infectious Diseases: Usual childhood illnesses. No history of rheumatic fever.
Immunizations: Flu vaccine yearly. Pneumovax 1996
Allergic to Penicillin-developed a diffuse rash after an injection 20 years ago.
Transfusions: 4 units received in 1980 for GI hemorrhage, transfusion complicated
by Hepatitis B infection.
Hospitalizations, Operations, Injuries:
1) Normal childbirth 48 years ago
2) 1980 Gastrointestinal hemorrhage, see below
3) 9/1995 chest pain- see history of present illlness 4) Last mammogram 1994,
Flexible Sigmoidoscopy 1997
Systems Review
1.Constitutional: energy level generally good, weight is stable at 160 lbs, height 5’8”
2.HEENT: No headaches
Eyes: wears reading glasses but thinks vision getting is worse, no diplopia or eye
pain
Ears: hearing loss for many years, wears hearing aid now
Nose: no epistaxis or obstruction
No history of tonsillitis or tonsillectomy
Wears full set of dentures for more than 20 years, works well.
3.Respiratory: No history of pleurisy, cough, wheezing, asthma, hemoptysis,
pulmonary emboli, pneumonia, TB or TB exposure
4.Cardiac: See HPI
5.Vascular: No history of claudication, gangrene, deep vein thrombosis, aneurysm.
Has chronic venous stasis skin changes for many years
6.G.I.: Admitted to CPMC in 1980 after two days of melena and hematemesis.
Upper G.I. series was negative but endoscopy showed evidence of gastritis,
presumed to be caused by ibuprofen intake. Her hematocrit was 24% on admission
and she received four units of packed cells. Colonoscopy revealed
multiplediverticuli. Since then her stool has been brown and consistently hematest
3. negative when checked in clinic. Several months after this admission she was noted
to be mildly jaundiced and had elevated liver enzymes, at this time it was realized
that she contracted hepatitis B from the transfusions. Since then she has not had
any evidence of chronic hepatitis.
7.GU: History of several episodes of cystitis, most recently E Coli 3/1/90, treated
with Bactrim. Reports dysuria in the 3 days prior to hospitalization. No fever, no
hematuria. No history of sexually transmitted disease. Menarche was at 15,
menstrual cycles were regular interval and duration, menopause occurred at 54.
Seven pregnancies with 5 normal births and 2 miscarriages.
8. Neuromuscular: Osteoarthritis of the both knees, shoulder, and hips for more
than 20 years. Took ibruprofen until 1980, has taken acetaminophen since her GI
bleed, with good relief of intermittent arthritis pain. There is no history of seizures,
stroke, syncope, memory changes.
9. Emotional: Denies history of depression, anxiety.
10. Hematological: no known blood or clotting disorders.
11. Rheumatic: no history of gout, rheumatic arthritis, or lupus.
12. Endocrine: no know diabetes or thyroid disease.
13. Dermatological: no new rashes or pruitis.
Personal History
1. Mrs. Johnson is widowed and lives with one of her daughters.
2. Occupation: she worked as a nurse to age 67, is now retired.
3. Habits: No cigarettes or alcohol. Does not follow any special diet.
4. Born in South Carolina, came to New York in 1931. she has never been outside of
the United States.
5. Present environment: lives in a one bedroom apartment on the third floor of a
building with and elevator. She has a home helper who comes 3 hours a day.
6. Financial: Receives social security and Medicare, and is supported by her
children.
7. Psychosocial: The patient is generally an alert and active woman despite her
arthritic symptoms. She understands that she is having a “heart attack” at the
present time and she appears to be extremely anxious.
Family History
The patient was brought up by an aunt; her mother died at the age of 36 from
kidney failure; her father died at the age of 41 in a car accident. Her husband died 9
years ago of seizures and pneumonia. She had one sister who died in childbirth. She
has 4 daughters (ages 60, 65, 56, 48) who are all healthy, and had a son who died at
the age of 2 from pneumonia. She has 12 grandchildren, 6 great grandchildren and
4 great, great grandchildren. There is no known family history of hypertension,
diabetes, or cancer.
4. Physical Exam
1. Vital Signs: temperature 100.2 Pulse 96 regular with occasional extra beat,
respiration 24, blood pressure 180/100 lying down
2. Generally a well developed, slightly obese, elderly black woman sitting up in bed,
breathing with slight difficulty. She complains of resolving chest pain.
3. HEENT: Eyes: extraocular motions full, gross visual fields full to confrontation,
conjunctiva clear. sclerae non-icteric, pulpils equal round and reactive to light and
accomodation, fundi not well visualized due to possible presence of cataracts.
Ears: Hearing very poor bilaterally. Tympanic membrane landmarks well
visualized.
Nose: No discharge, no obstruction, septum not deviated.
Mouth: Complete set of upper and lower dentures. Pharynx not injected, no
exudates. Uvula moves up in midline. Normal gag reflex.
4. Neck: jugular venous pressure 8cm, thyroid not palpable. No masses.
5. Nodes: No adenopathy
6. Chest: Breasts: atrophic and symmetric, nontender, no masses or discharges.
Lungs: bibasilar rales. No dullness to percussion. Diaphragm moves well with
respiration. No rhonchi, wheezes or rubs.
7. Heart: PMI at the 6th ICS, 1 cm lateral to MCL. No heaves or thrills. Regular
rhythm with occasional extra beat. Normal S1, S2 narrowly split; positive S4 gallop.
A grade II/VI systolic ejection murmur is heard at the left upper sternal border
without radiation. Pulses are notable for sharp carotid upstrokes.
Pulses: Carotid brachial radial femoral DP PT
R 2+ 2+ 2+ 2+ 1+ 0
L 2+ 2+ 2+ 2+ 1+ 0
8. Spine: mild kyphosis, mobile, nontender, nocostovertebral tenderness
9. Abdomen: soft, flat, bowel sounds present, no bruits. Nontender to palpation.
Liver edge, spleen, kidney not felt. No masses. Liver span 10cm by percussion.
10. Extremities: skin warm and smooth except for chronic venous stasis changes in
both legs. 1+ edema to the knees, non-pitting and very tender to palpation.
No clubbing nor cyanosis.
11.Neurological: Awake, alert and fully oriented. Cranial nerves III-XII intact except
for decreased hearing. Motor: Strength not tested, patient moves all extremities.
Sensory: Grossly normal to touch and pin prick. Cerebellar: no tremor nor
dysmetria. Reflexes symmetrical 1+ through out, no Babinski sign.
12. Pelvic: deferred until patient more stable.
13. Rectal: Prominent external hemorrhoids. No masses felt. Stool brown, negative
for blood
5. Labs
WBC 12,400Hgb 12.0 Hct 38.0 MCV 80.0 Plts 218,000 Retic 1.3 Diff Na 143
K4.1 C1 103 CO229 Glu 102 BUN 9 Creat 0.8; T bili 0.5 Dbili 0.1
AlkPhos155 AST 55 ALT 26 LDH 274 CPK 480, MB fraction positive,
Troponin 25
U/A Sp Gr 1.008 pH 6.5 2+ Alb many WBC many RBC 3+ bact
ABG pH 7.46 pCO234 PO284 O2Sat 98% (room air)
EKG NSR 96, ST elevations I, AVL, V4-V6; rare unifocal VPC’s
CXR portable AP, probable cardiomegaly, mild PVC (*Note: In the Physical
Diagnosis Course the labs will not generally be a part of the
write-ups, as the chart is not usually available to the students)
Formulation
This 83 year old woman with a history of congestive heart failure, and coronary
artery disease risk factors of hypertension and post-menopausal state presents with
substernal chest pain. On exam she was found to be in sinus tachycardia, with
no JVD, but there are bibasilar rales and pedal edema, suggestive of some degree
of congestive heart failure. There were EKG changes indicate an acute
anterolateral myocardial infarction, and the labs shows elevation of CPK and
troponin.
Impression
1. Acute antelorateralmyocardioal infarction, complicated by mild left ventricular
dysfunction. Patient has received thrombolysis therapy.
2. Hypertension
3. Dysuria - 3+ bacteria in urine with pyuria
Plan
1.Continue aspirin, heparin, nitrates, beta blockers, nasal oxygen. Follow
serial physical exams, EKGs, and labs.
2. Obtain echocardiogram to assess post MI heart function and murmurs heard
6. on cardiac exam. If LV ejection fraction is preserved, to start early beta blocker
therapy.
3. Continue ACE inhibitor therapy, and monitor blood pressure.
4. Dysuria and pyuria- probable recurrent cystitis, as she is afebrile and without
costovertebral tenderness. Start Bactrim treatment for presumed uncomplicated
urinary tract infection and follow up on urine culture result.