The document provides guidance on taking history for cases of cerebrovascular accidents (stroke), chronic obstructive pulmonary disease (COPD), and alcoholic liver disease. It outlines the key presenting complaints and areas of focus for each condition. For stroke, it describes assessing weakness, facial deviation, loss of consciousness and risk factors. For COPD, it includes evaluating shortness of breath, cough, exposure history and smoking. And for alcoholic liver disease, it mentions examining yellow skin, abdominal distension, alcohol intake and withdrawal symptoms.
Breast cancer is known as the cancer that grow up in the cells of breasts. Breast cancer is the most typical cancer detected in the women. We are celebrating October month as the breast cancer awareness month. It helps the women to get more information about the breast cancer. DDRC SRL diagnostics center in Kerala provides free mammography campaigns for the women in Kerala in this breast cancer awareness month.
This document discusses twin pregnancies and provides information on:
1. The types of twins based on chorionicity and zygosity.
2. The maternal and fetal complications that can occur in twin pregnancies including preeclampsia and preterm birth.
3. The diagnosis and management of twin pregnancies including ultrasound examination and increased surveillance of monochorionic twins.
Primary teeth begin to emerge around 6 months of age and are gradually replaced by permanent teeth. The first primary teeth to erupt are usually the mandibular central incisors, while the last are the maxillary second molars around 24 months. Permanent first molars emerge around age 6 between the primary second molars and are occasionally called "6-year molars". The sequence of permanent tooth emergence continues with the mandibular central incisors at age 6, followed by other incisors and canines into the early teens.
This document discusses benign tumors of the ovaries and fallopian tubes. It describes various types of functional cysts such as follicular cysts, lutein cysts, and theca-lutein cysts. It also discusses inflammatory conditions, metaplastic conditions like endometriosis, and various neoplastic tumors including epithelial, sex cord-stromal, and germ cell tumors. Diagnosis and management are discussed for different types of ovarian tumors based on factors like size, symptoms, and patient's desire for future fertility. Surgical exploration and microscopic examination are usually needed for definitive diagnosis and treatment.
The permanent mandibular second molar is the 7th tooth from the midline. It has 4 cusps of nearly equal size and a simpler occlusal design than the first molar, lacking a distal cusp and distobuccal groove. It resembles the first molar but is smaller in all dimensions. It develops later than the first molar, with initiation of calcification around 2.5-3 years and eruption typically occurring between 11-13 years of age. It has 2 roots that are shorter and less divergent than the first molar roots.
This document discusses oligohydramnios and intrauterine growth restriction (IUGR). It begins by explaining the functions of amniotic fluid, including allowing fetal movement, swallowing, breathing, and preventing umbilical cord compression. It then defines oligohydramnios as a decreased amniotic fluid index or single deepest pocket, and notes its association with uterine size smaller than gestational age and IUGR. Complications of oligohydramnios include limb deformities and pulmonary hypoplasia. The document also discusses evaluating and managing cases of oligohydramnios and IUGR, including admission, testing, monitoring fetal distress, and indications for delivery.
Interventions For Clients With Breast CancerJolene Bethune
The document provides an overview of interventions for clients with breast disorders, including early detection strategies, benign and malignant breast conditions, risk factors, surgical and nonsurgical management options, and nursing care. It describes a 3-pronged approach to early detection using mammography, breast self-examination, and clinical breast examination. Nursing assessments and interventions are outlined to address anxiety, potential for metastasis, and promote recovery.
Breast cancer is known as the cancer that grow up in the cells of breasts. Breast cancer is the most typical cancer detected in the women. We are celebrating October month as the breast cancer awareness month. It helps the women to get more information about the breast cancer. DDRC SRL diagnostics center in Kerala provides free mammography campaigns for the women in Kerala in this breast cancer awareness month.
This document discusses twin pregnancies and provides information on:
1. The types of twins based on chorionicity and zygosity.
2. The maternal and fetal complications that can occur in twin pregnancies including preeclampsia and preterm birth.
3. The diagnosis and management of twin pregnancies including ultrasound examination and increased surveillance of monochorionic twins.
Primary teeth begin to emerge around 6 months of age and are gradually replaced by permanent teeth. The first primary teeth to erupt are usually the mandibular central incisors, while the last are the maxillary second molars around 24 months. Permanent first molars emerge around age 6 between the primary second molars and are occasionally called "6-year molars". The sequence of permanent tooth emergence continues with the mandibular central incisors at age 6, followed by other incisors and canines into the early teens.
This document discusses benign tumors of the ovaries and fallopian tubes. It describes various types of functional cysts such as follicular cysts, lutein cysts, and theca-lutein cysts. It also discusses inflammatory conditions, metaplastic conditions like endometriosis, and various neoplastic tumors including epithelial, sex cord-stromal, and germ cell tumors. Diagnosis and management are discussed for different types of ovarian tumors based on factors like size, symptoms, and patient's desire for future fertility. Surgical exploration and microscopic examination are usually needed for definitive diagnosis and treatment.
The permanent mandibular second molar is the 7th tooth from the midline. It has 4 cusps of nearly equal size and a simpler occlusal design than the first molar, lacking a distal cusp and distobuccal groove. It resembles the first molar but is smaller in all dimensions. It develops later than the first molar, with initiation of calcification around 2.5-3 years and eruption typically occurring between 11-13 years of age. It has 2 roots that are shorter and less divergent than the first molar roots.
This document discusses oligohydramnios and intrauterine growth restriction (IUGR). It begins by explaining the functions of amniotic fluid, including allowing fetal movement, swallowing, breathing, and preventing umbilical cord compression. It then defines oligohydramnios as a decreased amniotic fluid index or single deepest pocket, and notes its association with uterine size smaller than gestational age and IUGR. Complications of oligohydramnios include limb deformities and pulmonary hypoplasia. The document also discusses evaluating and managing cases of oligohydramnios and IUGR, including admission, testing, monitoring fetal distress, and indications for delivery.
Interventions For Clients With Breast CancerJolene Bethune
The document provides an overview of interventions for clients with breast disorders, including early detection strategies, benign and malignant breast conditions, risk factors, surgical and nonsurgical management options, and nursing care. It describes a 3-pronged approach to early detection using mammography, breast self-examination, and clinical breast examination. Nursing assessments and interventions are outlined to address anxiety, potential for metastasis, and promote recovery.
Breast cancer develops from abnormal cell growth in the breast tissue. It occurs due to mutations in genes that control cell growth. The document discusses risk factors like family history, obesity, alcohol use, and describes signs and symptoms. Diagnosis involves imaging tests, biopsies, and determining the cancer stage and characteristics. Treatment options include surgery, radiation, chemotherapy, hormone therapy, and medication depending on the cancer type and stage. Maintaining a healthy lifestyle and regular screening can help reduce breast cancer risk.
Overview of Breast Health Problems with Focus on Benign Breast Conditions Reynaldo Joson
Breast - Benign and Malignant Conditions - Overview of Breast Health Problem - Benign Conditions of the Breast - ROJoson's Lecture to UP College of Medicine Level 4 Students - 13sept 16
The permanent maxillary first molar is the largest and strongest tooth in the upper jaw. It has a trapezoidal shape and four main cusps along with a smaller supplemental cusp. The tooth contains three roots - two buccal roots that are shorter than the single, tapered lingual root. The maxillary first molar functions to grind food during chewing and is an important component in anchoring the upper dental arch.
Awareness session on breast cancer awareness on 21st oct 2021 at Mehran university, Jamshoro organized by American institute of Chemical engineering society AIChE MUET chapter
A hysterectomy is a surgical procedure to remove a woman's uterus. It is the most common non-obstetrical surgery for women in the United States, with approximately 300 out of every 100,000 women undergoing the procedure. There are several types of hysterectomies, including total abdominal hysterectomy, vaginal hysterectomy, supracervical hysterectomy, laparoscopy-assisted vaginal hysterectomy, and laparoscopic supracervical hysterectomy. A total abdominal hysterectomy involves removing the uterus through an abdominal incision, while a vaginal hysterectomy removes the uterus through the vagina. A laparoscopy-assisted vaginal hysterectomy adds the use of a laparoscope to the vaginal
Breast Cancer Awareness Conversation Starters Series by iStudentNurseiStudentNurse.com
The 'Conversation Starters' is a series by iStudentNurse designed to promote discussions about life-saving awareness topics. Composed by a team of RNs, it draws upon the latest evidence-based research to provide a summary of the most crucial breast cancer awareness concepts. While designed as a lecture outline for nursing students, the Breast Cancer Awareness presentation is also of value to patients, survivors, and healthcare professionals. Topics addressed include: pathophysiology, etiology, epidemiology, risk factors, genetic testing/counseling, the 3 Tiers of Early Detection, screening and diagnostic methods, and treatment modalities (surgery, chemo, radiation, and endocrine therapy). The self-breast exam (SBE) is described step-by-step. Additionally, an example nursing care plan for a post-operative mastectomy is provided, which describes nursing diagnoses, interventions, and outcomes. Happy Student Nursing!
The document describes the anatomical features and characteristics of the permanent maxillary premolars. Some key points:
- The maxillary first premolar typically has two roots and two canals, while the second premolar usually has a single root with one or two canals.
- The maxillary first premolar has two approximately equal-sized cusps, with the lingual cusp about 1mm shorter than the facial cusp. It emerges after the lateral incisor but before the canine.
- Both maxillary premolars are wider from facial to lingual than from mesial to distal. The first premolar crown profile is hexagonal while the second is more ovoid.
This document provides an overview of several obstetric emergencies including the collapsed/unresponsive patient, sepsis, obstetric hemorrhage, eclampsia, amniotic fluid embolism, umbilical cord prolapse, shoulder dystocia, thrombosis and thromboembolism, uterine inversion, and uterine rupture. For each emergency, it describes signs, symptoms, risk factors, diagnosis, and management strategies with the goal of limiting maternal and fetal morbidity and mortality through a structured and methodical approach.
This document discusses the morphology and chronology of the mandibular central incisor. It notes that the mandibular central incisor is the smallest tooth in the mouth, erupts between ages 6-7, and has a straight single root. Key anatomical features include its bilaterally symmetrical shape, narrow mesiodistal width, sharp mesioincisal and distoincisal angles, and nearly straight labial outline with a convex cervical third.
Cervical and broad ligament fibroids are rare; with incidence of only 2% and 1% respectively.
Cervical fibroid often present with pressure symptoms and often pose surgical difficulties due to its proximity to bladder and rectum.
Broad ligament fibroid though rare , but have the propensity of growing into large adnexal masses and may mimic ovarian malignancy.
This document provides details on the anatomy of various anterior teeth, including the permanent maxillary and mandibular incisors. It describes the crown and root morphology, measurements, and developmental characteristics of the maxillary central incisor, maxillary lateral incisor, mandibular central incisor, and mandibular lateral incisor. Key anatomical features discussed include crown outlines, surfaces, contact areas, developmental grooves, root shape, pulp cavity morphology, and comparative measurements between tooth types.
The incidence of multiple gestation continues to increase, and now accounting for more than 3% of all live births.
Twin pregnancies and higher-order multiple births comprise an increasing proportion of the total pregnancies in the developed world due to the expanded use of fertility treatments and older maternal age at childbirth.
Multiple gestation is associated with:
Increase in neonatal morbidity and mortality rates.
Increase in maternal complications at least two folds.
The number of triplet, quadruplet, and higher-order multiple births peaked in 1998 and has dropped slightly recently, most likely because of limits in the number of embryos transferred and because of the availability and acceptance of multifetal pregnancy reduction (MFPR) procedures.
Prematurity, monochorionicity, and growth restriction pose the main risks to fetuses and neonates in multiple gestations.
The mean duration of pregnancy is 35.3 weeks for twin gestations, 31.9 weeks for triplets, and 29.5 weeks for quadruplets.
Stillbirth rates increase from 6.8 /1000 for singletons to 16.1 for twins and to 21.5 for triplets, and infant mortality rates increase from 5 to 23.4 and to 51.2 /1000 births, respectively.
Infants of multiple gestations comprise almost one quarter of very-low-birth-weight infants.
The incidence of severe handicap among neonatal survivors of multiple gestation is also increased: 34.0 and 57.5 /1000 twin and triplet survivors, respectively, compared with 19.7 /1000 singleton survivors.
Maternal morbidity is significantly increased in mothers with multiple gestations and is apparently related to the number of fetuses.
Multiple gestations are associated with significantly higher risks for:
Hypertension
Placental abruption
Preterm labor (78%)
Preeclampsia (26%);
HELLP syndrome (9%) (hemolysis, elevated liver enzymes, low platelets)
Anemia (24%)
Preterm premature rupture of membranes (pPROM) (24%)
Gestational diabetes (14%)
Acute fatty liver (4%)
Chorioendometritis (16%)
Postpartum hemorrhage (9%)
Twins can be dizygotic (DZ), resulting from the fertilization of two separate ova during a single ovulatory cycle.
DZ twins have dichorionic-diamniotic (DCDA) placentas, although these may fuse during pregnancy.
Monozygotic (MZ), resulting from a single fertilized ovum that subsequently divides into two separate individuals.
In MZ twins, the timing of egg division determines placentation (تكون المشيمة):
Diamniotic, dichorionic (DCDA) placentation occurs with division prior to the morula stage (within 3 days post fertilization).
Diamniotic, monochorionic (MCDA) placentation occurs with division between 4-8 days postfertilization.
Monoamniotic, monochorionic (MCMA) placentation occurs with division between 8-12 days postfertilization.
Division at or after day 13 results in conjoined twins.
The document discusses breast cancer awareness and prevention. It notes that 13.2% of women will be diagnosed with breast cancer in their lifetime, making it the second most common cancer in women after skin cancer. The text provides information on breast self-exams, risk factors, myths and facts about the disease. It also profiles several famous women who fought breast cancer and encourages annual clinical exams and healthy lifestyle practices to reduce risks.
Gestational trophoblastic disease is a spectrum of interrelated disease processes originating from the placenta.
GTD is a spectrum of tumours with a wide range of biologic behaviour and potential for metastases
They are characterised by an abnormally high amount of HcG levels in the blood
1. Breast cancer develops from mutations in genes controlling cell growth and health. Abnormal cells divide uncontrollably, forming tumors that can be benign or malignant.
2. Malignant tumors are cancerous and can spread via the lymphatic system to other parts of the body. Breast cancer refers specifically to malignant tumors in the breast.
3. Treatment plans consider cancer type, stage, hormone sensitivity, and patient history. Early detection through education and screening as well as primary and adjuvant therapies can help improve outcomes for breast cancer.
Breast cancer forms in the breast tissues and spreads mainly through the lymphatic system. Risk factors include gender, age, family history, and certain lifestyle habits. Signs include lumps, skin changes, and nipple discharge. Diagnosis involves exams, mammograms, biopsies and imaging tests. The cancer is staged based on tumor size, lymph node involvement and metastasis. Treatment options include surgery, radiation therapy, drug therapy, and chemotherapy. Radiation therapy is delivered in multiple sessions over several weeks and aims to kill cancer cells while minimizing side effects like skin changes, fatigue and nerve damage.
This document discusses cervical pregnancy, beginning with an introduction covering the history, definition, incidence, causes, risk factors, and morbidity/mortality. It then covers diagnosis through physical exam, ultrasound criteria, and differential diagnosis compared to other conditions. The treatment section discusses both minimally invasive options like methotrexate injection or uterine artery embolization, as well as more invasive options like dilation and curettage or hysterectomy if bleeding cannot be controlled. Conservative treatment aims to preserve the uterus and can resolve most cases under 12 weeks, though bleeding may still require additional procedures like embolization.
This powerpoint presentation covers abnormal uterine bleeding, including its causes, classifications, investigations, and management. It discusses evaluating the endometrium and endometrial cavity, as well as medical treatments like the Mirena IUS, surgical treatments such as endometrial ablation and hysterectomy, and interventional treatments like uterine artery embolization. The goal of management is to exclude malignant causes, diagnose benign causes, and treat the condition based on factors like the patient's health, tolerance of medications, and future fertility plans.
Raising Awareness And Understanding of Breast CancerBanupriyaMBBSMD
The document discusses breast cancer awareness month which is observed in October. It provides facts about breast cancer including that it is the most common cancer in Indian women, with one woman being diagnosed every 4 minutes. It describes symptoms, types, stages, risk factors, diagnostic tests, treatments including surgery, radiation and chemotherapy, as well as prevention and treatment options in Chennai.
The patient is a 57-year-old female who presented with a rapidly enlarging swelling in her neck accompanied by pain. She has had a history of a multinodular goiter for over 30 years. On examination, her thyroid gland was enlarged bilaterally with the right lobe being larger than the left. She has no other associated symptoms. Her past medical history and family history are unremarkable. She is scheduled for surgery to address the enlarging goiter.
Breast cancer develops from abnormal cell growth in the breast tissue. It occurs due to mutations in genes that control cell growth. The document discusses risk factors like family history, obesity, alcohol use, and describes signs and symptoms. Diagnosis involves imaging tests, biopsies, and determining the cancer stage and characteristics. Treatment options include surgery, radiation, chemotherapy, hormone therapy, and medication depending on the cancer type and stage. Maintaining a healthy lifestyle and regular screening can help reduce breast cancer risk.
Overview of Breast Health Problems with Focus on Benign Breast Conditions Reynaldo Joson
Breast - Benign and Malignant Conditions - Overview of Breast Health Problem - Benign Conditions of the Breast - ROJoson's Lecture to UP College of Medicine Level 4 Students - 13sept 16
The permanent maxillary first molar is the largest and strongest tooth in the upper jaw. It has a trapezoidal shape and four main cusps along with a smaller supplemental cusp. The tooth contains three roots - two buccal roots that are shorter than the single, tapered lingual root. The maxillary first molar functions to grind food during chewing and is an important component in anchoring the upper dental arch.
Awareness session on breast cancer awareness on 21st oct 2021 at Mehran university, Jamshoro organized by American institute of Chemical engineering society AIChE MUET chapter
A hysterectomy is a surgical procedure to remove a woman's uterus. It is the most common non-obstetrical surgery for women in the United States, with approximately 300 out of every 100,000 women undergoing the procedure. There are several types of hysterectomies, including total abdominal hysterectomy, vaginal hysterectomy, supracervical hysterectomy, laparoscopy-assisted vaginal hysterectomy, and laparoscopic supracervical hysterectomy. A total abdominal hysterectomy involves removing the uterus through an abdominal incision, while a vaginal hysterectomy removes the uterus through the vagina. A laparoscopy-assisted vaginal hysterectomy adds the use of a laparoscope to the vaginal
Breast Cancer Awareness Conversation Starters Series by iStudentNurseiStudentNurse.com
The 'Conversation Starters' is a series by iStudentNurse designed to promote discussions about life-saving awareness topics. Composed by a team of RNs, it draws upon the latest evidence-based research to provide a summary of the most crucial breast cancer awareness concepts. While designed as a lecture outline for nursing students, the Breast Cancer Awareness presentation is also of value to patients, survivors, and healthcare professionals. Topics addressed include: pathophysiology, etiology, epidemiology, risk factors, genetic testing/counseling, the 3 Tiers of Early Detection, screening and diagnostic methods, and treatment modalities (surgery, chemo, radiation, and endocrine therapy). The self-breast exam (SBE) is described step-by-step. Additionally, an example nursing care plan for a post-operative mastectomy is provided, which describes nursing diagnoses, interventions, and outcomes. Happy Student Nursing!
The document describes the anatomical features and characteristics of the permanent maxillary premolars. Some key points:
- The maxillary first premolar typically has two roots and two canals, while the second premolar usually has a single root with one or two canals.
- The maxillary first premolar has two approximately equal-sized cusps, with the lingual cusp about 1mm shorter than the facial cusp. It emerges after the lateral incisor but before the canine.
- Both maxillary premolars are wider from facial to lingual than from mesial to distal. The first premolar crown profile is hexagonal while the second is more ovoid.
This document provides an overview of several obstetric emergencies including the collapsed/unresponsive patient, sepsis, obstetric hemorrhage, eclampsia, amniotic fluid embolism, umbilical cord prolapse, shoulder dystocia, thrombosis and thromboembolism, uterine inversion, and uterine rupture. For each emergency, it describes signs, symptoms, risk factors, diagnosis, and management strategies with the goal of limiting maternal and fetal morbidity and mortality through a structured and methodical approach.
This document discusses the morphology and chronology of the mandibular central incisor. It notes that the mandibular central incisor is the smallest tooth in the mouth, erupts between ages 6-7, and has a straight single root. Key anatomical features include its bilaterally symmetrical shape, narrow mesiodistal width, sharp mesioincisal and distoincisal angles, and nearly straight labial outline with a convex cervical third.
Cervical and broad ligament fibroids are rare; with incidence of only 2% and 1% respectively.
Cervical fibroid often present with pressure symptoms and often pose surgical difficulties due to its proximity to bladder and rectum.
Broad ligament fibroid though rare , but have the propensity of growing into large adnexal masses and may mimic ovarian malignancy.
This document provides details on the anatomy of various anterior teeth, including the permanent maxillary and mandibular incisors. It describes the crown and root morphology, measurements, and developmental characteristics of the maxillary central incisor, maxillary lateral incisor, mandibular central incisor, and mandibular lateral incisor. Key anatomical features discussed include crown outlines, surfaces, contact areas, developmental grooves, root shape, pulp cavity morphology, and comparative measurements between tooth types.
The incidence of multiple gestation continues to increase, and now accounting for more than 3% of all live births.
Twin pregnancies and higher-order multiple births comprise an increasing proportion of the total pregnancies in the developed world due to the expanded use of fertility treatments and older maternal age at childbirth.
Multiple gestation is associated with:
Increase in neonatal morbidity and mortality rates.
Increase in maternal complications at least two folds.
The number of triplet, quadruplet, and higher-order multiple births peaked in 1998 and has dropped slightly recently, most likely because of limits in the number of embryos transferred and because of the availability and acceptance of multifetal pregnancy reduction (MFPR) procedures.
Prematurity, monochorionicity, and growth restriction pose the main risks to fetuses and neonates in multiple gestations.
The mean duration of pregnancy is 35.3 weeks for twin gestations, 31.9 weeks for triplets, and 29.5 weeks for quadruplets.
Stillbirth rates increase from 6.8 /1000 for singletons to 16.1 for twins and to 21.5 for triplets, and infant mortality rates increase from 5 to 23.4 and to 51.2 /1000 births, respectively.
Infants of multiple gestations comprise almost one quarter of very-low-birth-weight infants.
The incidence of severe handicap among neonatal survivors of multiple gestation is also increased: 34.0 and 57.5 /1000 twin and triplet survivors, respectively, compared with 19.7 /1000 singleton survivors.
Maternal morbidity is significantly increased in mothers with multiple gestations and is apparently related to the number of fetuses.
Multiple gestations are associated with significantly higher risks for:
Hypertension
Placental abruption
Preterm labor (78%)
Preeclampsia (26%);
HELLP syndrome (9%) (hemolysis, elevated liver enzymes, low platelets)
Anemia (24%)
Preterm premature rupture of membranes (pPROM) (24%)
Gestational diabetes (14%)
Acute fatty liver (4%)
Chorioendometritis (16%)
Postpartum hemorrhage (9%)
Twins can be dizygotic (DZ), resulting from the fertilization of two separate ova during a single ovulatory cycle.
DZ twins have dichorionic-diamniotic (DCDA) placentas, although these may fuse during pregnancy.
Monozygotic (MZ), resulting from a single fertilized ovum that subsequently divides into two separate individuals.
In MZ twins, the timing of egg division determines placentation (تكون المشيمة):
Diamniotic, dichorionic (DCDA) placentation occurs with division prior to the morula stage (within 3 days post fertilization).
Diamniotic, monochorionic (MCDA) placentation occurs with division between 4-8 days postfertilization.
Monoamniotic, monochorionic (MCMA) placentation occurs with division between 8-12 days postfertilization.
Division at or after day 13 results in conjoined twins.
The document discusses breast cancer awareness and prevention. It notes that 13.2% of women will be diagnosed with breast cancer in their lifetime, making it the second most common cancer in women after skin cancer. The text provides information on breast self-exams, risk factors, myths and facts about the disease. It also profiles several famous women who fought breast cancer and encourages annual clinical exams and healthy lifestyle practices to reduce risks.
Gestational trophoblastic disease is a spectrum of interrelated disease processes originating from the placenta.
GTD is a spectrum of tumours with a wide range of biologic behaviour and potential for metastases
They are characterised by an abnormally high amount of HcG levels in the blood
1. Breast cancer develops from mutations in genes controlling cell growth and health. Abnormal cells divide uncontrollably, forming tumors that can be benign or malignant.
2. Malignant tumors are cancerous and can spread via the lymphatic system to other parts of the body. Breast cancer refers specifically to malignant tumors in the breast.
3. Treatment plans consider cancer type, stage, hormone sensitivity, and patient history. Early detection through education and screening as well as primary and adjuvant therapies can help improve outcomes for breast cancer.
Breast cancer forms in the breast tissues and spreads mainly through the lymphatic system. Risk factors include gender, age, family history, and certain lifestyle habits. Signs include lumps, skin changes, and nipple discharge. Diagnosis involves exams, mammograms, biopsies and imaging tests. The cancer is staged based on tumor size, lymph node involvement and metastasis. Treatment options include surgery, radiation therapy, drug therapy, and chemotherapy. Radiation therapy is delivered in multiple sessions over several weeks and aims to kill cancer cells while minimizing side effects like skin changes, fatigue and nerve damage.
This document discusses cervical pregnancy, beginning with an introduction covering the history, definition, incidence, causes, risk factors, and morbidity/mortality. It then covers diagnosis through physical exam, ultrasound criteria, and differential diagnosis compared to other conditions. The treatment section discusses both minimally invasive options like methotrexate injection or uterine artery embolization, as well as more invasive options like dilation and curettage or hysterectomy if bleeding cannot be controlled. Conservative treatment aims to preserve the uterus and can resolve most cases under 12 weeks, though bleeding may still require additional procedures like embolization.
This powerpoint presentation covers abnormal uterine bleeding, including its causes, classifications, investigations, and management. It discusses evaluating the endometrium and endometrial cavity, as well as medical treatments like the Mirena IUS, surgical treatments such as endometrial ablation and hysterectomy, and interventional treatments like uterine artery embolization. The goal of management is to exclude malignant causes, diagnose benign causes, and treat the condition based on factors like the patient's health, tolerance of medications, and future fertility plans.
Raising Awareness And Understanding of Breast CancerBanupriyaMBBSMD
The document discusses breast cancer awareness month which is observed in October. It provides facts about breast cancer including that it is the most common cancer in Indian women, with one woman being diagnosed every 4 minutes. It describes symptoms, types, stages, risk factors, diagnostic tests, treatments including surgery, radiation and chemotherapy, as well as prevention and treatment options in Chennai.
The patient is a 57-year-old female who presented with a rapidly enlarging swelling in her neck accompanied by pain. She has had a history of a multinodular goiter for over 30 years. On examination, her thyroid gland was enlarged bilaterally with the right lobe being larger than the left. She has no other associated symptoms. Her past medical history and family history are unremarkable. She is scheduled for surgery to address the enlarging goiter.
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 .
KA, a 7-month-old Malay boy, was admitted to the hospital due to shortness of breath, coughing, and vomiting. On examination, he showed signs of respiratory distress including rapid breathing and recession of the ribs. Auscultation revealed widespread crackles and wheezes throughout both lungs. A provisional diagnosis of pneumonia was made, with bronchiolitis and asthma considered as differentials. Blood tests and renal function were normal.
Bilateral Pulmonary Hydatid Cysts with Ruptured & Infected Hydatid Cyst of Le...Dharmendra Joshi
A 42-year-old woman presented with a 22-day history of cough, fever, and chest pain. She had undergone surgery two years prior for bilateral pulmonary hydatid cysts. On examination, she had decreased breath sounds and crepitations in her left lung. Imaging showed opacities in her right lung from her prior surgery. She was diagnosed with a ruptured hydatid cyst in her left lung. She underwent VATS surgery to remove the cyst that was converted to open surgery due to adhesions. Histopathology confirmed the diagnosis of hydatid cyst. She recovered well after the operation.
This medical case report summarizes the diagnosis and treatment of a 42-year-old male patient admitted with erysipelas. Key findings include fever, abdominal pain, hyperaemia and xanthoma on the abdomen. Laboratory tests found leukocytosis, neutrophilia, lymphocytopenia, proteinuria and bacteria in the urine. The patient was diagnosed with erysipelas based on symptoms and signs. Treatment included antibiotics, symptom relief and rest. Proper wound care and management of risk factors like edema are important for preventing recurrence.
This document provides an outline for writing up a surgical long case presentation. It includes sections for history, physical examination, summary, provisional diagnosis, investigations suggested, differential diagnosis, and treatment plan.
The history section details what information should be collected, including chief complaints, history of present illness, past medical history, personal history, family history, and treatment history.
The physical examination section describes the components of general, local, and systemic examinations. It provides examples of what should be assessed for different body systems.
The outline provides guidance on documenting all essential details to form a complete case workup and presentation.
Nursing information helps you to collect history of patient which is helpfulYashaswiniV20
1) Ms. Rogers, a 56-year-old woman, presented to the emergency department with chest pain. She described a week history of dull, aching chest pain that radiated to her neck and was exacerbated by exertion.
2) Her medical history included hypertension diagnosed 3 years ago, a total abdominal hysterectomy and bilateral oophorectomy 6 years ago, and a family history of premature coronary artery disease.
3) On examination, she had an elevated blood pressure, a systolic murmur, and crackles in her lung bases. The assessment was that her symptoms were suggestive of unstable angina due to coronary artery disease given her risk factors.
The document provides guidance on how to conduct a thorough patient history, including how to structure the history taking session and how to approach each component of the history. It discusses taking the chief complaint, history of present illness, past medical history, drug history, family history, and social history. For each component, it provides tips on what information to obtain and how to record it in the patient's own words. It also describes doing a review of all body systems to check for any associated symptoms.
The patient, an 11-year-old boy, presented with weakness of all four limbs and difficulty swallowing over the past 10 days. Examination found symmetrical weakness, hypotonia, diminished reflexes, and facial nerve palsy. Investigations including CSF analysis and nerve conduction study supported a diagnosis of Guillain-Barré syndrome. He was treated with IVIG and made gradual improvement over his hospital stay, with resolution of accompanying hypertension. He was discharged with advice for outpatient physiotherapy follow up.
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 ...
The document describes a case of a 14 month old boy presenting with cyanosis of the nails, lips and fast labored breathing on exertion. A history of difficulty feeding since birth and recurrent respiratory infections is noted. On examination, cyanosis is present and a systolic murmur is heard. Previous echocardiograms showed ventricular septal defect initially and later tetralogy of Fallot. The patient has now been referred for corrective cardiac surgery. Tetralogy of Fallot is characterized by four anatomical abnormalities and causes decreased pulmonary blood flow and cyanosis. Management involves medical therapy, palliative shunt surgery or corrective open heart surgery.
This document summarizes the case report of a 45-year-old male patient presenting with a 1-month history of cough. On examination, the patient appeared weak and malnourished with tachycardia, tachypnea, dullness on left lung percussion, and decreased breath sounds on the left side. The differential diagnosis included pulmonary tuberculosis, pneumonia, bronchiectasis, and lung cancer. The final diagnosis was pulmonary tuberculosis with acute community-acquired pneumonia based on symptoms, physical exam findings, and need for further diagnostic workup.
CPC held at Frontier Medical College on Acute Pancreatitis
Prepared by Quratulain Nasir,Zeeshan Ghias Khan,Ummair Munawar,Parsa Bashir,Kanwal Shehzadi,Urfa Mir and Zeeshan Ahmed
1 History Taking of Cardiovascular System-The Essentials.pptxMahmoudAbdelaty21
1. The document outlines the essential components of taking a history for cardiovascular issues, including the presenting complaint, past medical history, drug history, family history, and social history.
2. Key symptoms to inquire about include chest pain, shortness of breath, fatigue, palpitations, syncope, and edema. Additional symptoms like cough and limb pain may also indicate cardiovascular problems.
3. When evaluating the presenting complaint, details like onset, duration, severity, and exacerbating/relieving factors provide important clues to the diagnosis. A systems review helps identify any related symptoms.
A 9-year-old boy presented with a history of cough, breathlessness, palpitations and fever for the past 15 days along with joint pain. On examination, he was found to have tachycardia, pallor, elevated apex beat and a pansystolic murmur. His history was suggestive of previous rheumatic fever. The clinical findings indicated acute rheumatic carditis with mitral regurgitation and pulmonary hypertension. Investigations were ordered to confirm the diagnosis and evaluate organ function.
Minu Akter, a 1-year-old female, presented with fever, cough, and breathlessness. Examination found tachycardia, tachypnea, and a continuous murmur. Investigations confirmed moderate patent ductus arteriosus (PDA) with heart failure and pneumonia. She was treated with antibiotics, diuretics, and angiotensin-converting enzyme inhibitors, and her symptoms improved. An echocardiogram showed the PDA, and it was successfully closed with a device during catheterization. She was discharged with advice to follow up in one month.
The document provides guidance on taking medical histories from patients. It outlines the general structure and components of a history, including:
1) Presenting complaint, history of presenting complaint, past medical history, drug history, family history, and social history.
2) It then provides targeted questions for common symptoms involving the cardiovascular, respiratory, gastrointestinal, and other body systems.
3) The purpose is to help medical students and practitioners obtain an accurate medical history to make a preliminary diagnosis and determine appropriate next steps in evaluation and treatment.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
The Children are very vulnerable to get affected with respiratory disease.
In our country, the respiratory Disease conditions are consider as major cause for mortality and Morbidity in Child.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
Know the difference between Endodontics and Orthodontics.Gokuldas Hospital
Your smile is beautiful.
Let’s be honest. Maintaining that beautiful smile is not an easy task. It is more than brushing and flossing. Sometimes, you might encounter dental issues that need special dental care. These issues can range anywhere from misalignment of the jaw to pain in the root of teeth.
Debunking Nutrition Myths: Separating Fact from Fiction"AlexandraDiaz101
In a world overflowing with diet trends and conflicting nutrition advice, it’s easy to get lost in misinformation. This article cuts through the noise to debunk common nutrition myths that may be sabotaging your health goals. From the truth about carbohydrates and fats to the real effects of sugar and artificial sweeteners, we break down what science actually says. Equip yourself with knowledge to make informed decisions about your diet, and learn how to navigate the complexities of modern nutrition with confidence. Say goodbye to food confusion and hello to a healthier you!
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- 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
Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
Spontaneous Bacterial Peritonitis - Pathogenesis , Clinical Features & Manage...Jim Jacob Roy
In this presentation , SBP ( spontaneous bacterial peritonitis ) , which is a common complication in patients with cirrhosis and ascites is described in detail.
The reference for this presentation is Sleisenger and Fordtran's Gastrointestinal and Liver Disease Textbook ( 11th edition ).
Tele Optometry (kunj'sppt) / Basics of tele optometry.
Historytaking
1. History Taking
The Medical Post (www.themedicalpost.net)
History taking in
Medicine and Surgery
for final MBBS
practical exams
FIRST EDITION
2. History Taking
The Medical Post (www.themedicalpost.net)
Cerebrovascular Accidents (Stroke)
Common presenting complaints –
Weakness on one side of the body.
Facial deviation or asymmetry.
Loss of consciousness.
History of presenting illness –
In such cases the history should ideally start as my patient was apparently
asymptomatic _ days back when he developed weakness on one side of the
body. The weakness was acute/insidious in onset and gradually
progressive/static in nature.
Mention what activity the patient was involved in at the time when this
weakness developed.
Whether the patient fell down and hurt themselves as the attack occurred.
Important points during the pre ictal phase: Any history of headache, vomiting,
dizziness.
Facial deviation: Ask to which side the angle of mouth/face is deviated, any
history of slurred speech, drooling of saliva, difficulty in drinking liquids and
regurgitation of food after the stroke attack.
Seizures: History of abnormal body movements, tongue biting, up rolling of eyes
and frothy secretions from the mouth.
Embolic evidence – History of chest pain, dyspnea and palpitations.
3. History Taking
The Medical Post (www.themedicalpost.net)
Incontinence of stools and urine.
Blurring/loss of vision.
Any history of recent head injury/trauma.
Past history –
Rule of any previous episode of TIAs.
Any similar episodes in the past.
Any history of significant medical condition in the past.
Predisposing factors like Hypertension, Diabetes, Smoking, and Alcohol.
History of intake of drugs like OCPs, Aspirin, Warfarin, Hormones, etc.
Family history of stroke.
Ideal CNS Diagnosis:
4. History Taking
The Medical Post (www.themedicalpost.net)
Chronic Obstructive Pulmonary Disorder
Common presenting complaints –
Sudden increase in the shortness of breath
Cough (More with patients of Chronic Bronchitis)
History of presenting illness –
There are two ways to present a case of COPD. Either start the history dating
back to so and so years when the first episode of SOB occurred, or you could
present the acute episode first by saying how many days back the patient was
apparently asymptomatic plus with elaboration of the previous episodes in the
past history.
Shortness of breath: Onset (usually insidious) - initial MRC grading –
progression (usually there is sudden progression to the current condition) –
current MRC grading.
Ask for Orthopnea and PND to rule out any cardiac cause.
Cough: Onset, progression, about sputum (Cases of chronic bronchitis may -
complain of cough as their chief complaint), hemoptysis. Associated chest pain?
Ask for any seasonal variation/ exposure to air borne irritants on the job.
Fever: Onset, pattern, maximum temperature recorded or not, associated with
chills and rigors? A patient of COPD usually presents in acute exacerbation
either because of infection or rupture of emphysematous bullae.
History of weight loss and loss of appetite. (Note that emphysematous patients
are usually thin built).
5. History Taking
The Medical Post (www.themedicalpost.net)
Any history of bluish discoloration of the generalized skin. (For features of
hypoxia).
Complication:
History of tremors (salbutamol use).
Ask for bowel habits (constipation because of hyperkalemia).
Headache, mental confusion (features of CO2 narcosis).
Personal history:
Whether the patient smokes? Duration of smoking. Calculate the number of
pack years. Number of pack years = (number of cigarettes smoked per day ×
number of years smoked)/20 (1 pack has 20 cigarettes).
If quit smoking – Why and When did he quit?
Family history of similar illness.
Past history:
Number of episodes in the past.
Drug intake – mention all the drugs the patient is currently taking.
How the patient’s condition is affecting his/her quality of life: missed work,
disrupted routines and depression.
Ideal Respiratory System Diagnosis:
6. History Taking
The Medical Post (www.themedicalpost.net)
Alcoholic Liver Disease
Common presenting complaints –
Yellowish discoloration of the skin.
Abdominal distension.
History of presenting illness –
Yellowish discoloration: Onset, progression (usually it is first noticed in the
sclera and then it becomes evident on whole of the body).
Abdominal distension: Onset, progression. Associated abdominal pain and
difficulty in breathing (as massive ascites pushes the diaphragm up and makes
difficult for the patient to take deep breaths).
Upper GI Bleed – History of Hematemesis.
Hepatic Encephalopathy: Ask the patient party for any history of
disorientation/restlessness, tremors, excessive sleep.
History of foul smelling odor; fetor hepaticus.
Alcohol withdrawal: mental confusion, irrelevant speech, agitation
/aggressiveness.
Ask any history of loss of hair.
Also rule out features of congestive cardiac failure from history.
Personal history:
History of intake of alcohol – duration of drinking – current situation.
History of intravenous drug abuse.
7. History Taking
The Medical Post (www.themedicalpost.net)
Bowel habits – pale stools (obstructive jaundice), black tarry stools (portal
hypertension).
Urine – Dark in color? (Suggesting obstructive jaundice).
Past history:
Similar episodes in the past.
History of hepatitis in the past.
Ideal Diagnosis –
8. History Taking
The Medical Post (www.themedicalpost.net)
Rheumatic Heart Disease
Common presenting complaints –
Shortness of breath
Hemoptysis
History of presenting illness –
Shortness of breath: Onset (usually insidious) - initial NYHA grading –
progression (usually there is sudden progression to the current condition) –
current NYHA grading.
Ask for Orthopnea and PND (orthopnea indicates more severe disease).
Cough: Onset, progression, about sputum. (Cases of chronic bronchitis may -
complain of cough as their chief complaint). Associated chest pain?
History of palpitations.
Swelling of both the limbs: (due to congestive cardiac failure/RHF). Explain
about the onset, progression.
Abdominal distension / abdominal pain.
History of dizziness/syncope/loss of consciousness/fatigue – due to decreased
cardiac output.
Personal history:
Smoking- Diabetes – Hypertension – Exercise habits – Eating habits.
Family history of similar illness.
9. History Taking
The Medical Post (www.themedicalpost.net)
Past history:
History of similar episodes in the past – number of hospital admissions.
History intake of intramuscular penicillin injections every 21 days or intake of
Phenoxybenzyl penicillin 250 mg PO BD in the past.
Ideal diagnosis –
10. History Taking
The Medical Post (www.themedicalpost.net)
Thyroid Swelling / Thyrotoxicosis / Multi nodular Goitre
XYZ 57 years old female come from Palpa to the Manipal Teaching Hospital on
09/05/2010 and was examined by me on 13/05/2010
The chief complaints were: Rapid increase in the size of the swelling with pain in
the mid line of the neck for the past 2-3 months.
History of presenting illness:
The history dates back to 30-40 yrs back when the pt noticed a small marble
sized swelling on the left side near the mid line of the neck at the age of 16 yrs
in the mirror and also when told the neighbor.
Initially the swelling was not associated with pain and was stationary and after
16 yrs interval the pt noticed similar welling on the right side of the neck which
was also stationary and also not associated with pain. But since the last 2-3
months there has been rapid increase in the size of the swelling on the both
side and its associated with pain which is insidious in onset intermittent, dull
aching type and radiating towards the back of the neck and the upper back of
the shoulder. The pain was relieved on rest and no aggravating factors were
found.
No history of other swellings in the body, no difficulty in swallowing solid of
liquid food, no difficulty in breathing, no hoarseness of voice, no loss of
appetite, no loss of weight, no diarrhea or constipation.
No history of chest pain, palpitations, nervousness, irritability, difficulty in
sleeping, no tremors and no weakness of the limbs, no heat or cold intolerance,
no sweating, no decreased or double vision, no ocular pain or redness.
11. History Taking
The Medical Post (www.themedicalpost.net)
Past history:
No history of TB, DM, HTN, Asthma. No history of surgery or any prolonged
hospitalization.
Personal history:
Non smoker, non alcoholic, normal bowel bladder and sleep habits.
Family history:
No similar swelling among the family members seen but however there has
been significant number of women suffering from similar neck swellings in the
locality.
Menstrual history:
The pt. attended menopause at the age of 40, no history of post menopausal
bleeding or any per vaginal discharge.
Treatment history:
The pt. has not received any treatment for this condition.
The pt. has been planned for surgery.
EXAMINATION
The pt. is moderately built, well alert, cooperative and well oriented to time
place and person.
The Vitals were in the normal range.
There is no pallor, icterus, cyanosis, clubbing, edema and lymphadenopathy.
12. History Taking
The Medical Post (www.themedicalpost.net)
Local examination of the Neck-
1. Inspection-
The swelling moves up and down with deglutition.Does not moves with the
protrusion of the tongue.
The swelling is situated infront and side of the neck extending laterally uptill the
sternocleidomastoid muscles and below upto the suprasternal notch and
involves whole of the front of the neck.
Both the lobes of the thyroid glands are enlarged and the right lobe appears to
be more prominent. The right lobe is about 10*8cm and the left lobe about
7*6cm.
Trachea is not visible.
Dilated veins are seen at the lower border of the swelling.
2. Palpation-
I confirmed my inspection findings.
No raised temperature, No tenderness.
Swelling moves with deglutition.
The swelling is heart shaped.Size- Rt lobe – 13cm vert. and 9cm horz. Lt lobe is
9cm and 7cm respectively., Isthmus is 10cm vertically.
It is variable in consistency.
Margins are well defined.-Trachea not palpable.Skin over the swelling can be
pinched out.
No pulsations and thrill were felt.
Mobility is present from side to side and not vertically.
Swelling is attached to the sternocleidomastoid muscle and on making the neck
taught the mobility of swelling is restricted.
Carotid pulsations are felt at the ant. border of the sternocledomastoid muscle.
13. History Taking
The Medical Post (www.themedicalpost.net)
Percussion-
Superior mediastinum is resonant.
Auscultation-
No bruit over the swelling heard.
There were no signs of the toxicity present.
Special Test-
Kocher test is positive.
Pembertant sign is negative.
14. History Taking
The Medical Post (www.themedicalpost.net)
Hernia/Hydrocele
Common presenting complaints –
[HERNIA] Swelling on the left/right groin since the past _
days/months/years.
[HYDROCELE] Swelling on the left/right scrotum since the past _
days/months/years.
History of presenting illness –
Swelling: Onset (usually spontaneous) – site (left / right groin) - initially of a size
similar to some object (e.g. marble), progression (usually gradual to the current
size) – extent (groin to the scrotum/scrotum to the groin).
Change in the size of the swelling on lying down/standing position.
Increase in the size of the swelling on coughing, defecation, etc.
Note that in Hydrocele there is no change in the size of the swelling during
standing, walking, with strenuous activities or on lying down. Also there is no
pain and other symptoms.
Features of strangulation/toxicity :
Any sudden increase in the size of the swelling.
Any color change ?
Pain over the swelling.
History of vomiting, fever.
Pain: site of pain, character, radiation, relation of pain with straining (usually the
pain increases on straining), relieving factors.
15. History Taking
The Medical Post (www.themedicalpost.net)
History for straining factor (to find the cause of hernia) -
Cough, Constipation
Predisposing factors like – Bronchial asthma, Diabetes, Tuberculosis,
Hypertension.
Bladder habits: Urgency, frequency, narrowing or irregular urinary stream
(features suggestive of BPH).
16. History Taking
The Medical Post (www.themedicalpost.net)
Breast Lump
Common presenting complaints –
Swelling in the right/left breast.
Pain in the breast/ over the swelling.
History of presenting illness –
Swelling: Onset, site, size, progression. How did the patient notice the swelling
(usually on breast self examination).
Any swelling in the axilla or the opposite breast.
Pain: site, duration, character (usually dull aching), relationship with the
swelling and the menstrual cycle.
Fever (Swelling, pain and fever are characteristics of breast abscess).
Ulcer (usually associated with carcinoma of breast) – explain with site, duration,
discharge.
Nipple discharge.
Any history of loss of appetite and weight. (Suggestive of carcinoma).
History suggestive of metastasis -
Any history of cough, breathlessness, hemoptysis, chest pain.
Any history of low back pain, and radiation of pain to the lower limbs.
Any history of headache, vomiting, weakness of any limbs, any history of
seizures.
17. History Taking
The Medical Post (www.themedicalpost.net)
Personal history:
Menstrual history – age at menarche.
Obstetric history – age at first pregnancy, total number of pregnancy, number of
abortion, last child birth.
History of lactation.
History of use of OCPs or any hormonal therapy.
18. History Taking
The Medical Post (www.themedicalpost.net)
Road Traffic Accident
Common presenting complaints –
Loss of consciousness/headache following a road traffic accident or fall
from height. [HEAD INJURY]
Difficulty in breathing. [CHEST INJURY]
Drowsy. [SHOCK / BLUNT ABDOMINAL TRAUMA]
History of presenting illness –
Usually start the history as the following,
My patient was apparently asymptomatic 4 hours back when he met with a
road traffic accident following which is banged his/her head on the road (in a
case of head injury).
Details about the accident :
Whether the patient was a driver/passenger/pedestrian.
The impact occurred from which side.
Wearing a seat belt or not.
Did he strike on anything after the accident. If yes then what body parts
were involved?
Road conditions – dry, wet, snow/ice, banged on the divider?
Who brought the patient to the hospital and how?
Important history taking in a case of head injury,
Any period of loss of consciousness following the accident. Duration of
the period. Any lucid interval present (it means any history of the
19. History Taking
The Medical Post (www.themedicalpost.net)
patient being restless, talkative, irritable, confused, etc. before
becoming completely unconscious).
Vomiting – usually in a case of underlying head injury there are multiple
episodes of vomiting; projectile in nature. (It is because of the raised
intracranial pressure).
Headache.
Blurring or loss of vision following the accident.
Prolonged confusion.
Abnormal body movements (seizures).
In case the patient presents after a few days of the accident, we must ask for if
the patient is having difficulty in concentration – increased mood swings –
lethargy – aggression – altered sleep habits.
Other important points to be asked,
Difficulty in breathing (to rule out chest injury).