Case study on Varicose Veins & Venous UlcersAbhineet Dey
A clinically based study of a case of Varicose Veins & Venous Ulcers.
Moderator:
Dr M. K. Mazumdar
Asst. Professor,
Dept. of Obstetrics and Gynaecology,
Gauhati Medical College & Hospital
Presented by:
29: Abhineet Dey
30: Devasree Kalita
31: Parishmita Sharma
32: Samadrita Borkakoty
33: Ankur Jain
34: Dhurjyoti Nath
35: Mousumi Mehtaz
Students of 8th Semester,
Gauhati Medical College & Hospital, Guwahati, Assam
Case study on Varicose Veins & Venous UlcersAbhineet Dey
A clinically based study of a case of Varicose Veins & Venous Ulcers.
Moderator:
Dr M. K. Mazumdar
Asst. Professor,
Dept. of Obstetrics and Gynaecology,
Gauhati Medical College & Hospital
Presented by:
29: Abhineet Dey
30: Devasree Kalita
31: Parishmita Sharma
32: Samadrita Borkakoty
33: Ankur Jain
34: Dhurjyoti Nath
35: Mousumi Mehtaz
Students of 8th Semester,
Gauhati Medical College & Hospital, Guwahati, Assam
GERD ( Gasrtro-esophageal reflux disease )
Gastroesophageal reflux disease (GERD) is a condition in which the stomach contents (food or liquid) leak backwards from the stomach into the esophagus (the tube from the mouth to the stomach). This action can irritate the esophagus, causing heartburn and other symptoms.
And Case study at the end
Medical college of wasit
Department of medicine
Case sheet history
Thing to remember :-
1) Stand on the right side of the patient with good confidence .
2) Introduce yourself as a medical student not as a doctor . ( you may face difficult question ).
3) Talk the patient gently with clear comprehensible words .
4) Remember don’t hurt the patient in your speak & touch .
GERD ( Gasrtro-esophageal reflux disease )
Gastroesophageal reflux disease (GERD) is a condition in which the stomach contents (food or liquid) leak backwards from the stomach into the esophagus (the tube from the mouth to the stomach). This action can irritate the esophagus, causing heartburn and other symptoms.
And Case study at the end
Medical college of wasit
Department of medicine
Case sheet history
Thing to remember :-
1) Stand on the right side of the patient with good confidence .
2) Introduce yourself as a medical student not as a doctor . ( you may face difficult question ).
3) Talk the patient gently with clear comprehensible words .
4) Remember don’t hurt the patient in your speak & touch .
This presentation was done on 2022 December 13 to the department of dermatology in National Medical College Nepal. presentation Discussed on various subtopics .
Introduction
Skin innervations
Sensory innervation
Autonomic nervous system
Neurophysiological testing for skin innervation
Neurological conditions
Neuropathic ulcer
Syringomyelia
Spinal dysraphism
Dermatoses associated with spinal cord injury
Hereditary sensory and autonomic neuropathies
Sympathetic nerve injury
Complex regional pain syndrome
Horner syndrome,
Gustatory hyperhidrosis
Restless legs syndrome/burning feet syndrome
Key references
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
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.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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
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.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
2. GENERAL PRINCIPLES OF PHYSICAL
EXAMINATION
1. Quite, warm and well lit room.
2. Privacy
3. Reassure and relax the patient
4. Gentleness
5. Avoid exhausting the patient
6. Always plan the examination relevant to
the patient
7. Further questioning if abnormal finding
2nd year MBBS 2Family medicine
3. VITAL SIGNS
PULSE
BLOOD PRESSURE
TEMPERATURE
RESPIRATORY RATE
2nd year MBBS 3Family medicine
4. PULSE
The arterial palpation of a heartbeat
can be palpated in any place that allows for
an artery to be compressed against a bone
Main peripheral arterial pulses:
Radial
Brachial
Carotid
Femoral
Popliteal
Posterior tibial
Dorsalis pedis
2nd year MBBS 4Family medicine
5. Examination of pulses
• radial pulse used generallyRate
• radial pulse used generallyRhythm
• The carotid arteryCharacter
• The carotid arteryVolume
• Compare arteries both sideSymmetry
• Compare radial and femoral pulseRadio femoral delay
Condition of vessels2nd year MBBS 5Family medicine
6. Pulse: Rate
Beats per minute
Physiological variation:
childhood
Emotion
Sleep
Athlete
Adult 60-100 bpm
Neonate 120-160 bpm
Upto 3 yrs 100-120 bpm
At 6 yrs 80-100 bpm
2nd year MBS 6Family medicine
7. Pulse: Rhythm
• Count for at least
half a minuteRegular
• Regularly irregular
• Irregularly irregularIrregular
2nd year MBBS 7Family medicine
8. Carotid pulse
•Be careful
•Always one at a time
Stimulating its
baroreceptors
with low
palpitation
Severe
bradycardia
even
stop
the
heart
2nd year MBBS 8Family medicine
9. Blood pressure
The pressure exerted by circulating blood on the walls
of blood vessels
Affected by exertion, anxiety, excitement and changes
in body posture, cuff size
The first number is the systolic blood pressure
reading, and it represents the maximum pressure
exerted when the heart contracts
The second number is the diastolic blood pressure
reading, and it represents the pressure in the arteries
when the heart is at rest.
2nd year MBBS 9Family medicine
10. Cuff size guidelinesa device used for
measuring
arterial pressure.
Mercury,
aneroid, electric
Cuff Arm Circumference
Range at Midpoint
(cm)
Adult 27-34 cm
Large
Adult
35-44 cm
Adult
thigh
Cuff
45-52 cm
Sphygmomanometer
2nd year MBBS 10Family medicine
11. Measurement
• Palpatory
method
• Can measure
only systolic
pressure
• Auscultatory
method
• 1st sound-
systolic
• Dissapearance-
diastolic
2nd year MBBS 11Family medicine
12. Classification of Blood Pressure for
adults aged 18 and older
Category Systolic pressure
(mm Hg)
Diastolic pressure
(mm Hg)
Normal <120 <80
Prehypertension 120-139 80-89
Hypertention
Stage 1 140-159 90-99
Stage 2 >160 >100
Family medicine2nd year MBBS 12
14. Body temperature
Normal value
Oral 36.30C~37.20C
Rectal 36.50C~37.70C
Axillary 360C~370C
The normal body temperature varies from person to
person, by age, and throughout day
Being lowest in the early hours of the morning and
highest in the afternoon
The variation may range within 10C
Rectal T >Oral T> Axillary T (each in 0.50C)
2nd year MBBS 14Family medicine
15. Respiratory rate
It is expansion and relaxation of of chest wall
Normal value is : 16 – 22 bpm (Adult)
Rate
Depth
Type
2nd year MBBS 15Family medicine
16. CARDINAL SIGNS :
1. Pallor
2. Icterus
3. Cyanosis
4. Clubbing
5. Lymphadenopathy
6. Oedema
7. Dehydration
2nd year MBBS Family medicine 16
17. Pallor
Paleness may be the result of decreased blood supply to the
skin (cold, fainting, shock, hypoglycemia) or decreased
number of red blood cells (anemia)
Depends upon
Thickness of skin
Quality of skin
Amount and quality of blood in capillaries.
2nd year MBBS Family medicine 17
18. Sites where pallor is seen
1. Lower palpebral conjuntiva
2. Dorsum of tongue
3. Mucous membrane of mouth
4. Nail bed
5. Palm of the hand
6. Sole of the feet
(must be compared with both side and must
be observed in daylight)
2nd year MBBS Family medicine 18
19. E.g :
Hookworm infestation
Chronic bleeding Hemorrhoids
Chronic reanal failure
Massive Haemorrhage
Aplastic Anemia
Acute Leukemia
2nd year MBBS Family medicine 19
20. Icterus (jaundice)
It is a clinical condition characterised by yellowish
discoloration of skin , sclera , mucous membranes
due to excessive bilirubin concentration in the body
fluids.
Normal level- o.3-1 mg/dl
Latent jaundice- below 3 mg/dl
Clinical jaundice- more than 3 mg/dl
20
21. Carotenaemia :
Clinical condition with yellow pigmentation of skin
associated with increased blood carotene levels,
associated with large carotene consumption of
carotene in diet, confused with jaundice.
21
22. Sites
Upper sclera
Ventral surface of tongue (between lingual vein and
frenulum)
Nail bed
Palm of the hand
Sole of feet
22
23. Types
1. Pre –hepatic or haemolytic : E.g
Hemolytic anemia, Malaria
2. Hepatocellular : E.g Cirrhosis of liver,
Hepatitis
3. Post hepatic or obstructive : E.g
Carcinoma of head of Pancreas, Gallstone, Ca
Gallbladder
23
24. Cyanosis
It is a bluish discoloration of the skin and mucous
membranes due to the presence of reduced
haemoglobin level > 5 gmdl in the blood.
24
25. Types of cyanosis
Central Peripheral
Imperfect
oxygenation of the
blood e.g Heart
failure , COAD
Admixture of venous
with arterial blood
e.g Congenital heart
diseases
Excessive reduction
of oxyhaemoglobin in
the capillaries when
the blood flow is
slowed
Vasoconstriction-
exposure to cold
Arterial
obstruction
Low cardiac output
25
26. Sites :
Tip of tongue (central cyanosis)
Lips
Tips fingers and toes
Tip and alae of nose
Earlobules
26
Central
+Peripheral
cyanosis
29. Oedema
Abnormal and excessive accumulation of
free fluid within the interstitial space or
body cavities.
Types
Pitting or non pitting
Localised and generalised (anasarca)
29
30. Sites
Relatively mobile patient – over distal end
of tibia or shin of tibia
In bedridden patient- over sacrum
Periorbital, Malar prominence of face
30
31. How edema can be recognized?
Inspection:
Pallid and glossy
appearance of the
skin at the
swollen part
Palpation:
Doughy feeling
Pitting on
finger.(the
pressure of the
finger should be
maintained for 30
seconds.
31
32. Causes of Oedema
Pitting
• Heart failure
• Nephrotic syndrome
• Cirrhosis of liver
• Severe Malnutrition
• Severe Anaemia
• Hypo proteinemia
Non-pitting
• Lymphatic obstruction
• Deep vein thrombosis
• Myxoedema
• Scleroderma
32
33. Dehydration
Loss of excessive water from the body.
How to elicit?
a. Skin pinch test Skin turgor
b. Tongue dryness
c. Lips crackled
d. Dry Mucous membrane (tongue)
e. Tears
33
34. Symptoms Signs
a. Increased thirst
b. Dry mouth
c. Decreased urine
output
d. Headache
e. Dry skin
f. Dizziness
g. Few or no tears
h. Lethargy, confusion
34
a. Low blood pressure
b. Rapid heart rate
c. Fever
d. Seizure
e. Poor skin elasticity
f. Shock
g. Coma
40. Inguinal group of Lymphnode
E.g
Infection : Tuberculosis
Carcinoma :
i. Hodgkin’s lymphoma
ii. Non Hodgkin’s lymphoma
iii. Carcinoma of stomach
iv. Carcinoma of breast
40
44. Points to be noted
Site
Number of nodes
Size
Consistency- hard, firm, rubbery, soft
Tenderness
Discrete or confluent
Mobile or fixed
Condition of overlying skin (local temp, discharging
sinuses)
44
47. 2. Localized :
• Local or acute infection
• Metastasis from carcinoma or other
solid tumour
• Lymphoma especially Hodgkin’s disease
48. CLUBBING
It is bulous swelling of subungal
connective tissue at onychodermal
angle
It is loss of onychodermal angle
(Lovi’s Bond), Normally < 160
Increase in the soft tissue of the base
of the nail
Drumstick appearance of the tip of
the finger
HOW TO ELICIT?
i. Fluctuation test
ii. Schamroth’s sign (Diamond shape)