This document provides guidance on performing a physical examination of the central nervous system. It outlines examination of various body systems and signs, including attitude, level of consciousness, head, facies, eyes, ears, mouth, neck, skin, extremities, and spine. It describes abnormalities to examine for, such as craniosynostosis deformities of the head, facial palsies, ptosis, neurocutaneous lesions, clubbing, and peripheral nerve disorders. The examination aims to detect neurological deficits or systemic diseases that may involve the CNS.
"Mastering the Basics: General Physical Examination in Neurology with Dr. Ganeshgouda"
🌟 Greetings, aspiring healthcare professionals! Dr. Ganeshgouda here, and today, we're delving into the fundamentals of neurological assessment through General Physical Examination (GPE). Whether you're a medical student, a resident, or anyone eager to understand the essentials of examining the nervous system, this discussion is tailored just for you.
"Mastering the Basics: General Physical Examination in Neurology with Dr. Ganeshgouda"
🌟 Greetings, aspiring healthcare professionals! Dr. Ganeshgouda here, and today, we're delving into the fundamentals of neurological assessment through General Physical Examination (GPE). Whether you're a medical student, a resident, or anyone eager to understand the essentials of examining the nervous system, this discussion is tailored just for you.
A PPT on neurocutaneous markers containing
short history, and short description of following N C markers
Cafe au lait spots
Ash leaf patch
Litsch nodules
Axillary and inguinal freckling.
Facial angiofibromas .
Cutaneous neurofibromatosis.
Multiple unqualified fibromas .
Cutaneous neurofibromatosis
Adenoma sebacum.
Hypo / hyper pigmented Macules
hairy tuft at sacrum.
Facial angioma /Port wine stain
PREMATURE AGING SYNDROMES AND THEIR CLINICAL MANIFESTATIONSDR. MOHNISH SEKAR
Aging is an inevitable consequence of human life resulting in a gradual deterioration of cell, tissue and organismal function and an increased risk to develop chronic ailments. Premature aging syndromes, also known as progeroid syndromes, recapitulate many clinical features of normal aging and offer a unique opportunity to elucidate fundamental mechanisms that contribute to human aging. Progeroid syndromes can be broadly classified into those caused by perturbations of the nuclear lamina, a meshwork of proteins located underneath the inner nuclear membrane (laminopathies); and a second group that is caused by mutations that directly impair DNA replication and repair.
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
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
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.
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
Associate Division Director for Ambulatory Operations
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.
Target Audience
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
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.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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.
12. contd...
Plagiocephaly
produces a flattening of the forehead and the
brow on the affected side, with the forehead
tending to be excessively prominent on the
opposite side
13. contd...
Trigonocephaly
Early closure of this suture may result in a
prominent ridge running down the forehead.
The forehead looks quite pointed, like a
triangle, with closely placed eyes
(hypotelorism).
14. contd...
Scaphocephaly
This is the most common type of synostosis.
This suture runs front to back, down the middle
of the top of the head. This fusion causes a
long, narrow skull.
15. contd...
Premature closure of cranial sutures can
produce a wide variety of abnormally shaped
skulls.
CLINICAL FEATURES
Increased ICP Strabismus amblyopia
Orbital
hypertelorism
Proptosis
Restricted eye ball
movement
Poor visual acquity
Orbital
hypotelorism
corneal exposure Dacrocystitis
19. contd...
Palpation of the skull may disclose deformities
due to old trauma, burr hole, or craniotomy
defects, tenderness, or scars.
The size and patency of the fontanelles is
important in infants as bulging of the
fontanelles & suture separation can occur with
increased ICP in children.
21. contd...
In those with head trauma, ecchymosis over
the mastoid (Battle sign) or around the eyes
but not extending beyond the orbital rim
(“raccoon eyes”) suggests basilar skull
fracture.
22. contd...
Neurofibromas of the scalp occur in von
Recklinghausen’s disease.
Exostoses may indicate an underlying
meningioma
23. Bruits may be heard best over the temporal
regions of the skull, the eyeballs, and the
mastoids.
Cephalic bruits may occur with angiomas,
aneurysms, arteriovenous malformations,
neoplasms that compress large arteries.
52. contd...
Scarlet red tongue- niacin deficiency
Dark red bald tongue- riboflavin deficiency
In thiamine defi ciency, the tongue is smooth,
shiny, atrophic, and reddened
Triple furrowed tongue is seen in myasthenia
gravis
Lingua plicata in Melkersson-Rosenthal
syndrome
53. contd...
Fasciculation- motor neuron
disease,syringomyelia
Myotonia- myotonic dystrophy
Deviation of tongue to same side on protrusion
– hypoglossal nerve palsy
54. EAR
Examination of the ears is particularly
important in patients with hearing loss or
vertigo.
Examination of the ear canal may reveal a
glomus tumor in a patient with jugular foramen
syndrome
vesicles due to herpes zoster infection
evidence of a posterior fossa cholesteatoma.
55. contd...
Cerebrospinal fluid(CSF) otorrhea may cause
a clear or bloody ear discharge.
Hemorrhage into the middle ear may cause a
bulging, blue-red tympanic membrane in
patients with basilar skull fracture.
56. contd...
Hitzelberger’s sign
Seen in acoustic neuroma.
It occurs due to involvement of the 7th cranial
nerve.
There is early involvement of the sensory
fibers which causes hypoesthesia of the
posterior meatal wall.
57. NOSE
Perforation of the nasal septum may be a clue
to cocaine abuse,leprosy.
A saddle nose may be a sign of congenital
syphilis
Evidence of bacterial infection in dangerous
area of face may be a sign of cavernous sinus
thrombosis
Watery drainage may be due to CSF
rhinorrhea.
58. NECK
Meningeal irritation may cause nuchal rigidity,
head retraction, and opisthotonos.
Neck movement may also be restricted with
cervical spondylosis, cervical radiculopathy,
and dystonias.
In meningeal irritation the primary limitation is
in neck flexion; in spondylosis the limitation is
either global or primarily in rotation and lateral
bending
59. contd...
In the Klippel-Feil syndrome, syringomyelia,
and platybasia, the neck may be short and
broad, movement limited, and the hairline low.
60. contd...
The carotid arteries should be cautiously and
lightly palpated bilaterally, one at a time, and,
followed by auscultation for carotid bruits.
TITUBATION
Cerebellar disease
Multiple sclerosis
Friedreichs ataxia
63. SKIN
Cafe-au-lait macules--Dark brown
hypermelanotic macules with smooth or
irregular borders, commonly seen in back,
buttocks and trunk.
Seen in neurofibromatosis.
Also seen in Albright's synd, Fanconi anemia,
Bloom syndrome.
66. contd...
Ash leaf hypopigmented macule
Hypomelanotic polygonal macules grow upto 5
cm over trunk and buttocks.
>3 lesions are seen in 90% of TS patients.
Also seen in MEN1, vitiligo, nevus anemicus,
koyanagi syndrome
68. contd...
Adenoma sebaceum
Numerous discrete smooth glistening round
rubbery papules pinhead to pea size, over
butterfly area in the face and nasolabial folds,
cheeks, nose, chin.
slow growing angiofibroma.
69. contd...
Shagreen patch
These are Connective tissue naevi.
Skin colored irregular lumpy cobblestone- like
plaques in lumbosacral areas which grow to
the size of a palm.
70. contd...
Satellite papules grow around a central plaque
with orange peel like indentation.
Seen in 70% of pts in TS.
Also seen in MEN1, Cowden syndrome and
Hunter's syndrome.
80. contd...
Heliotrope rash:
A reddish-purple eruption on the upper Eyelid
accompanied by swelling of the eyelid
Most specific rash in DM
Only present in a minority of patients.
82. contd...
Spider angiomas in alcohol abuse
Erythema chronicum migrans in lyme disease
Purpura and petechiae in thrombotic
thrombocytopenic purpura, meningococcemia,
and rocky mountain spotted fever
83. contd...
Livedo reticularis in antiphospholipid syndrome
and cryoglobulinemia
Hyperpigmentation in nelson’s syndrome,
Carotenemia or addison’s disease
Herpes zoster causes a vesicular eruption in
the distribution of the involved root.
84. contd...
Hemangiomas of the spinal cord may be
accompanied by skin nevi in the same
metamere.
Symmetrically placed, painless, recurring,
poorly healing lesions of the extremities may
occur in syringomyelia and hereditary sensory
neuropathy.
Peripheral nerve disease, tabes dorsalis, and
myelopathy may produce trophic changes in
the skin.
85. NAILS
Ungual/periungual fibroma
Firm pink to skin colored papules, nodules
from under the nail bed in toe & finger nails.
Seen in 90% of patients in TS.
89. SPINE
Tuberculosis and neoplasms of the spine may
cause a marked kyphosis (gibbus)
Muscular dystrophy often results in an
increased lumbar lordosis
Scoliosis is common in syringomyelia and
friedreich’s ataxia.
90. contd...
Localized rigidity with a slight scoliosis and
absence of the normal lordosis are symptoms
of lumbosacral radiculopathy.
Tenderness to percussion over the spinous
processes, can occur with localized processes
such as spinal epidural hematoma or abscess.
91. EXTREMETIES
Claw hand
Wrist drop
Pes cavus(claw foot)
• Peroneal muscular dystrophy
• Friederichs ataxia
• Syringomyelia
• Spina bifida occulta
• Anterior poliomyelitis
93. contd...
Painless arthropathy (Charcot joint) occurs when a
joint is deafferented
Painless enlargement of the shoulder has been
reported as the presenting manifestation of
syringomyelia.
Decreased peripheral pulses occur in Takayasu’s
disease as well as atherosclerosis.
Acrocyanosis occurs in ergotism.
Diseases of the nervous system are found in
association with such skeletal and developmental
anomalies as syndactyly, polydactyly, and
arachnodactyly.