This document provides guidance on performing a general physical examination in 4 steps: inspection, palpation, percussion, and auscultation. Key areas of examination include general appearance, hands, pulse, blood pressure, face, neck, and jugular veins. Abnormal findings may indicate various underlying conditions. A thorough physical exam following these steps can provide important clinical clues.
Brief Presentation on clinical examination of Cardio Vascular System with Report of Normal case
references:
macleod's clinical examination 13th edition
hutchinson clinical methods
The jugular venous pressure (JVP, sometimes referred to as jugular venous pulse) is the indirectly observed pressure over the venous system via visualization of the internal jugular vein. It can be useful in the differentiation of different forms of heart and lung disease.
Pulse Examination PPT -- By Prof.Dr.R.R.deshpande -- This is PPT abput Pulse Examination .Prof.Deshpande has explained how pulse should be examined for Rate,Rhythm,Volume ,Tension ,equality on both side ,Condition of vessel wall .He also explained about Sphygmograph .
Mobile – 922 68 10630
Also visit – www.ayurvedicfriend.com
Brief Presentation on clinical examination of Respiratory System with Report of Normal case
references:
macleod's clinical examination 13th edition
hutchinson clinical methods
R Alagappan - Manual of Practical Medicine, 4th Edition
Edema is defined and its mechanism explained with reference to the Starling's forces. The causes of localized edema and anasarca discussed.
In history taking, the site and distribution of edema, its duration, association with pain, variability, systemic illness, drug intake, trauma, radiation discussed.
The local and systemic examination described. The approach to investigation including lab tests and imaging explained.
Finally, management is discussed in short.
Brief Presentation on clinical examination of Cardio Vascular System with Report of Normal case
references:
macleod's clinical examination 13th edition
hutchinson clinical methods
The jugular venous pressure (JVP, sometimes referred to as jugular venous pulse) is the indirectly observed pressure over the venous system via visualization of the internal jugular vein. It can be useful in the differentiation of different forms of heart and lung disease.
Pulse Examination PPT -- By Prof.Dr.R.R.deshpande -- This is PPT abput Pulse Examination .Prof.Deshpande has explained how pulse should be examined for Rate,Rhythm,Volume ,Tension ,equality on both side ,Condition of vessel wall .He also explained about Sphygmograph .
Mobile – 922 68 10630
Also visit – www.ayurvedicfriend.com
Brief Presentation on clinical examination of Respiratory System with Report of Normal case
references:
macleod's clinical examination 13th edition
hutchinson clinical methods
R Alagappan - Manual of Practical Medicine, 4th Edition
Edema is defined and its mechanism explained with reference to the Starling's forces. The causes of localized edema and anasarca discussed.
In history taking, the site and distribution of edema, its duration, association with pain, variability, systemic illness, drug intake, trauma, radiation discussed.
The local and systemic examination described. The approach to investigation including lab tests and imaging explained.
Finally, management is discussed in short.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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
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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).
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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
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
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The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
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Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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General examination by md151
1. PREPARED BY: MD 151
General physical examination
The four principles of examination
1- Inspection/looking
2 –palpation/feeling
3 - Percussion/tapping
4 –Auscultation/listening
Important points:
1- Wash your hands in front of the patient before the examination
2- Come to the right side of the patient
3- Great the patient and introduce your self
4- Take consent from the patient
5- Ask the patient if there is tenderness anywhere
6- Properly expose the patient
7- After the examination is done, cover the patient and thank him/her
1- General Appearance:
Come to the foot end of the bed and have a general look of the patient.
1- Assess the degree of the patient’s consciousness and illness whether he looks well,
mildly ill, severely ill or deeply comatose.
2- Posture and attitude
❖ Cardiac bed indicating respiratory or cardiac problem
❖ Pt bending forward indicating pancreatitis and pericarditis
❖ Squatting position indicating tetralogy of fallot
3- Gait
❖ Assess the patient as he walks towards you the gait may suggest an important
neurological or masculoskeletal disorders
4- Physique
❖ Height and weight
✓ Marfan syndrome and hypogonadism the arm span is more than double the
sitting height.
✓ Achondroplasia arms and legs are short while trunk is normal, so sitting
height is more than length of legs as measured from pupis to feet.
2. PREPARED BY: MD 151
✓ Pituitary dwarf the total height is less than the normal but limbs and trunk
are proportionate
2-Hand:
A. Palm
➢ Palmar erythema: pregnancy, liver cirrhosis, hemochromatosis and polycythemia.
➢ Pallor: pale in anemia
➢ Muscle wasting: RA and median nerve compression
➢ Debuytrens’s contracture: liver cirrhosis, Dm, epilepsy and alcoholism.
Grades:
1-loss of extension
2- partial flexion
3-complete flexion
B. Dorsum
➢ Skin pigmentation
➢ Janeway nodules: IE
➢ Heberden’s nodule in the joints: osteoarthritis
➢ Deformity: ulnar deviation indicating RA
C. Nails
➢ Kolinychia: Iron deficiency anemia
➢ Splinter hemorrhage: IE, antiphospholipid syndrome, trauma to the nail, nail
psoriasis, rheumatic heart disease and SLE.
➢ Capillary pulsations: Aortic regurge
➢ Leukonychia: hypo-proteinemia
➢ Clubbing:
▪ Grades
1- Loss of schamroth angle
2- Increase curvature
3- Fluctuations
4- Drum stick
▪ According to colour:
1- Pink: toxemic clubbing indicating IE
2- Bule: hypoxemicclubbing associated with peripheral cyanosis
▪ CAUSES
1)Cardiovascular: cyanotic congenital heart disease and IE
2) Respiratory: lung carcinoma, bronchiectasis, lung abscess and empyema
3. PREPARED BY: MD 151
3)Gastrointestinal: cirrhosis ,IBS and Coeliac disease
4)Thyrotoxicosis
D. tip of the fingers
➢ Peripheral cyanosis
Causes of Peripheral cyanosis
1)Decreased arterial oyygen saturation.
-high altitude
-lung disease
-right to left cardiac shunt
2)Polycythaemia
3)Haemoglobin abnormalities;methaemoglobinemia,sulphaemoglobinemia
4)Exposure to cold
5)Reduced cardiac output as in
-left ventricular failure
-shock
6)Arterial or venous obstruction
➢ Osler nodules: seen in IE, Gonococcal infection and SLE.
3. Pulse
1-Rate
• 60-100 normal
• >100 tachycardia
• <60 bradycadia
2-Rhythm: [regular- regular, regular-irregular,and irregular- irregular]
3- volume (pulse pressure)
• High volume as in increased SBP: Aortic incompetence, thyrotoxicosis and
bradycardia
• High volume as in decreased DBP: anemia, hypoxia, pregnancy and sepsis.
• Low volume: HF, hypovolemia, MI, pulmonary hypertension and pericardial
diseases as in effusion and pericarditis
4-character
• Collapsing pulse or water hammer pulse: High volume
• Pulse alternative: dilated cardiomyopathy and left ventricular hypertrophy
• Pulses plateau: Aortic stenosis
4. PREPARED BY: MD 151
5-synchronicity
▪ Causes of radio-radial delay
Outside the wall: cervical rib and pancoast tumor.
In the wall: Aneurysm ( Aortic or subclavian ), Dissection of the Aorta
including the subclavian and aortic arch coacrtation.
In the lumen: Thrombosis and Embolism.
▪ Exanples of radioradial delay or not synchronous: Takayasu arteritis,
Obsrtuction, Aortic dissection and subclavian steal syndrome
7-radio-femoral delay: Coacrtation of the aorta
8-Peripheral pulse: carotid, brachial, femoral, popliteal, posterior tibial and dorsalis
pedis.
▪ Comment: the pulse is 72p/m regular, normal in volume synchronous with no
radiofemoral delay, peripheral pulse is intact and present and there is obvious
character seen in pulse.
4. Blood Pressure
❖ Normal blood pressure ranges
✓ Systolic from 90 to 140mmhg
✓ Diastolic from 60 to 90mmhg
❖ How to measure the blood presuure
1- The Bp cuff bladder should be at least 20% wider than the arm
2- The patient should be relaxed and the arm at the level of the heart
3- Wrap the cuff at least 2cm above the cubital fossa
4- Palpate the brachial pulse medial to the biceps tendon and use this area for
auscultation
5- First assess the systolic Bp by palpation of the radial artery to avoid
auscultatory gap
6- Auscultate for the SBP by rising the pressure of the sphygmomanometer until
the brachial pulse is obliterated then deflate the cuff slowly at a rate of
3mmhg/sec
7- The point at which the sound appears is the SBP
8- Then continue to deflate till the point of diastolic muffling and the point of
diastolic disappearance which is recorded as DBP
NB: the difference of both upper limb ranges between 5 to 10mmhg.
▪ Causes of larger difference ( more than 15mmhg )
Same causes of unequal pulse volume importantly to exclude life threatening
aortic dissection
5. PREPARED BY: MD 151
NB: the normal difference between the upper limb and the lower limp is less than
20mmhg.
▪ Indications to measure the BP from the lower limb
1- To diagnose lower limb ischemia
2- To diagnose coarctation of the aorta
3- To diagnose increased volume as in aortic regurge ( Hill sign )
5. Face
⚫ Specific diagnosis can be made by just looking at a patient’s face.
⚫ Some facial characteristics are so typical of certain diseases that they immediately
suggest the diagnosis….so called diagnostic facies
Acromegaly
6. PREPARED BY: MD 151
Down syndrome Thyrotoxicosis
Cushing’s syndrome
7. PREPARED BY: MD 151
❖ Hair
- Random alopecia: chemotherapy
- Colour change: malnutrition
- Distribution
❖ Eye
-look up: pallor indicating Anemia
-look down: yellowish discoloration of the sclera indicating jaundice
-subconjunctival hemorrhage:
- Bitot spots: vitamin A deficiency
-Kayser-fleischer ring: Wilson’s diseases
-corneal ulcers
-cataract: Dm and hypertension.
❖ Nose
-anomaly
-discharge
-working ala nasi: respiratory distress syndrome
❖ Ear
-anomaly
-discharge
❖ Mouth
-blue dot discoloration in lips: central cyanosis
-angular stomatitis
-cavity: congenital anomaly and hygiene
-tongue: macroglossia, red pink in clour,
leukoplakia, ulcer, fissure and bald(smooth) tongue
6. Neck
1) Neck mass
-Thyroid enlargement: midline moving with Swallowing
-Thyroglossal cyst: midline below adam’s apple,small in size, moves with swallowing
With tongue protrusion
-lipoma
Sepacious cyst
2) Lymph node
-During palpation of lymph nodes the following features should be considered;
⚫ SITE
-Localised or generalized
⚫ Number
⚫ SIZE
-normal lyph nodes are <5cm in diameter
8. PREPARED BY: MD 151
⚫ CONSISTENCY
-hard are suggestive of carcinoma
-soft may be normal
-rubbery may be due to lymphoma
⚫ TENDERNESS
-Acute infection of inflammation
FIXATION
-If fixed to the underlying structures its most likely malignant
OVERLYING SKIN
-if inflammed then its suggestive of infection,teethered suggests carcinoma.
-left supraclavicular lymphnode “ Virshow lymphnode” if palpable “ Tousers sign”
indicating pancreatic or gastric malignancy.
-Epitrochlear if palpable indicating generalized lymphadenopathy
CAUSES OF LYMPHADENOPATHY
⚫ GENERALISED
-lymphoma
-leukemia
-infections
9. PREPARED BY: MD 151
-viral;infectious mononucleosis,CMV,HIV
-bacterial;tuberculosis,syphilis
-protozoal;toxoplasmosis
-connective tissue disease
-infitration;sarcoidosis
-drugs;phenytoin
• Localized
Local or acute infection
Metastasis from carcinoma or other solid tumour
Lymphoma especially hodgkin’s disease
3) JVP
-Examine the patient from the right side while head of the bed is elevated about 45
degree.
-Look for venous pulsations in the internal jugular vein along the anterior border of the
sternocleidomastoid and measure vertical distance from the highest of venous pulsations
to the sternal angle.
-If it’s more than 3cm it is abnormal and indicates right side heart failure.
Characters of JVP
1- wavy form
2 -disappears on pressure
3-positive hepatojugular reflex
Causes increased JVP
-svc obstruction
-restrictive cardiomyopathy
-constrictive pericarditis
-right ventricular failure
Kussmaul sign: increases with inspiration
-restrictive cardiomyopathy
-constrictive pericarditis
Jugular vein distended but not wavy: SVC obstruction associated with chest vein
dilations.