Genetic disorder - Philadelphia chromosomeYour assignment is tJeanmarieColbert3
Genetic disorder - Philadelphia chromosome
Your assignment is to investigate a genetic disorder that is Philadelphia chromosome
1. The symptoms and/or effects of having the disorder. How is this disorder diagnosed?
2. Any treatments currently in use or proposed for the future - include medications, therapies, surgeries, etc.
3. The prognosis of having the disorder. In other words, can you survive the disorder? If so, what is the life expectancy of the individual? What is lifelike for that individual living with this disorder. Can he/she be independent? Can there be quality of life with this disorder?
4. Any other pertinent facts about this disorder
5. Include images for a visual component relating to the disease, individuals affected by the disease, the actual chromosome involved, treatments, timeline, etc. These must include the following aspects of a visual component:
a. Description – the ability to engage in written discourse intended to convey a mental image of a visual media object. Students should include a legend or caption for the visual image that includes appropriate terminology.
b. Explanation – the ability to explain plausible meanings and/or purposes of the image. Students should explain what the image is/represents and/or depicts. A source for this image must be included in the Work's Cited slide
c. Consequences & Implications – the ability to discuss the potential consequences and/or implications of the visual image’s meaning. Students must discuss the implication/consequence (effect/significance) of the inclusion of this image into the project and how it adds to the overall content of the project (how does it help to better represent the genetic disorder)
8. MLA citations for sources consulted (minimum of 3). This includes all visual components.
9. The information that you are providing should be written in 3rd person.
Final Project Part I Patient Analysis Template
This patient analysis template includes an overview of the interview and the systems that you reviewed for your volunteer patient for Final Project Part I, as well as an interpretation of the findings from the physical health assessment, possible collaborative diagnoses, and health promotion recommendations.
Complete this template by replacing the bracketed text with the relevant information.
1. Patient Identification
a. Initials used for name (make sure there are no other identifiers)
[C.K]
b. Age, sex, race, marital status
[28, Male, African-American, Single]
c. Any Information that needs to be known immediately—e.g., deafness, blindness.
[None at this time.]
2. Results and Treatment
a. Provide an overview of the information collected in the patient health history in Module Three. How did this inform the comprehensive health assessment that you conducted?
[Insert text.]
b. Interpret your findings for each system from the comprehensive, client-centered, head-to-toe health assessment that you conducted. Make sure that you discuss the appli ...
Research paperTopic Respiratory SystemFormat (APA) ST.docxeleanorg1
Research paper
Topic :Respiratory System
Format : (APA) STYLE size : 12
Table of content, introduction, body etc must be detailed
1. The student will be able to trace, name, and describe the anatomy of the respiratory tree from the mouth to the alveoli.
2. The student will be able to describe the gross structure of the lungs and surrounding pleural membranes.
3. The student will be able to describe the mechanical and pressure physiology of ventilation.
4. The student will be able to describe external and internal respiration.
5. The student will be able to describe the physical and chemical factors that influence the transport of oxygen and carbon dioxide between the lungs and the tissues.
6. The student will be able to describe the nervous system regulation of respiration.
7. The student will be able to describe the pulmonary air volumes and capacities and be able to calculate vital capacity using other lung volumes.
8. The student will be able to describe the relationship between depth of inhalation, dead space and alveolar ventilation.
.
Research paperTopic Respiratory SystemFormat (APA) STYLE .docxaudeleypearl
Research paper
Topic :Respiratory System
Format : (APA) STYLE size : 12
Table of content, introduction, body etc must be detailed
1. The student will be able to trace, name, and describe the anatomy of the respiratory tree from the mouth to the alveoli.
2. The student will be able to describe the gross structure of the lungs and surrounding pleural membranes.
3. The student will be able to describe the mechanical and pressure physiology of ventilation.
4. The student will be able to describe external and internal respiration.
5. The student will be able to describe the physical and chemical factors that influence the transport of oxygen and carbon dioxide between the lungs and the tissues.
6. The student will be able to describe the nervous system regulation of respiration.
7. The student will be able to describe the pulmonary air volumes and capacities and be able to calculate vital capacity using other lung volumes.
8. The student will be able to describe the relationship between depth of inhalation, dead space and alveolar ventilation.
...
Genetic disorder - Philadelphia chromosomeYour assignment is tJeanmarieColbert3
Genetic disorder - Philadelphia chromosome
Your assignment is to investigate a genetic disorder that is Philadelphia chromosome
1. The symptoms and/or effects of having the disorder. How is this disorder diagnosed?
2. Any treatments currently in use or proposed for the future - include medications, therapies, surgeries, etc.
3. The prognosis of having the disorder. In other words, can you survive the disorder? If so, what is the life expectancy of the individual? What is lifelike for that individual living with this disorder. Can he/she be independent? Can there be quality of life with this disorder?
4. Any other pertinent facts about this disorder
5. Include images for a visual component relating to the disease, individuals affected by the disease, the actual chromosome involved, treatments, timeline, etc. These must include the following aspects of a visual component:
a. Description – the ability to engage in written discourse intended to convey a mental image of a visual media object. Students should include a legend or caption for the visual image that includes appropriate terminology.
b. Explanation – the ability to explain plausible meanings and/or purposes of the image. Students should explain what the image is/represents and/or depicts. A source for this image must be included in the Work's Cited slide
c. Consequences & Implications – the ability to discuss the potential consequences and/or implications of the visual image’s meaning. Students must discuss the implication/consequence (effect/significance) of the inclusion of this image into the project and how it adds to the overall content of the project (how does it help to better represent the genetic disorder)
8. MLA citations for sources consulted (minimum of 3). This includes all visual components.
9. The information that you are providing should be written in 3rd person.
Final Project Part I Patient Analysis Template
This patient analysis template includes an overview of the interview and the systems that you reviewed for your volunteer patient for Final Project Part I, as well as an interpretation of the findings from the physical health assessment, possible collaborative diagnoses, and health promotion recommendations.
Complete this template by replacing the bracketed text with the relevant information.
1. Patient Identification
a. Initials used for name (make sure there are no other identifiers)
[C.K]
b. Age, sex, race, marital status
[28, Male, African-American, Single]
c. Any Information that needs to be known immediately—e.g., deafness, blindness.
[None at this time.]
2. Results and Treatment
a. Provide an overview of the information collected in the patient health history in Module Three. How did this inform the comprehensive health assessment that you conducted?
[Insert text.]
b. Interpret your findings for each system from the comprehensive, client-centered, head-to-toe health assessment that you conducted. Make sure that you discuss the appli ...
Research paperTopic Respiratory SystemFormat (APA) ST.docxeleanorg1
Research paper
Topic :Respiratory System
Format : (APA) STYLE size : 12
Table of content, introduction, body etc must be detailed
1. The student will be able to trace, name, and describe the anatomy of the respiratory tree from the mouth to the alveoli.
2. The student will be able to describe the gross structure of the lungs and surrounding pleural membranes.
3. The student will be able to describe the mechanical and pressure physiology of ventilation.
4. The student will be able to describe external and internal respiration.
5. The student will be able to describe the physical and chemical factors that influence the transport of oxygen and carbon dioxide between the lungs and the tissues.
6. The student will be able to describe the nervous system regulation of respiration.
7. The student will be able to describe the pulmonary air volumes and capacities and be able to calculate vital capacity using other lung volumes.
8. The student will be able to describe the relationship between depth of inhalation, dead space and alveolar ventilation.
.
Research paperTopic Respiratory SystemFormat (APA) STYLE .docxaudeleypearl
Research paper
Topic :Respiratory System
Format : (APA) STYLE size : 12
Table of content, introduction, body etc must be detailed
1. The student will be able to trace, name, and describe the anatomy of the respiratory tree from the mouth to the alveoli.
2. The student will be able to describe the gross structure of the lungs and surrounding pleural membranes.
3. The student will be able to describe the mechanical and pressure physiology of ventilation.
4. The student will be able to describe external and internal respiration.
5. The student will be able to describe the physical and chemical factors that influence the transport of oxygen and carbon dioxide between the lungs and the tissues.
6. The student will be able to describe the nervous system regulation of respiration.
7. The student will be able to describe the pulmonary air volumes and capacities and be able to calculate vital capacity using other lung volumes.
8. The student will be able to describe the relationship between depth of inhalation, dead space and alveolar ventilation.
...
WHAT IS EXPEXTED IN THIS DISCUSSIONStudent applies relevant pro.docxphilipnelson29183
WHAT IS EXPEXTED IN THIS DISCUSSION:
Student applies relevant professional, personal, or other real-world experiences to the discussion. Thought and analysis are present, but may lack depth or detail.
Student addresses all elements of the discussion prompt, and demonstrates Distinguished knowledge of the discussion topic. Student relates content in initial post to course content, or to real-life situations, though the connection may lack depth.
Student communicates a central idea or point that is weaved through most of the post in a coherent manner. Post is, for the most part, easy to understand.
Initial post contains several minor errors related to grammar, spelling, and sentence structure, but they do not distract the reader from the content of the post. Student properly cites resources (if applicable), per instructor expectations.
SPE103 Oral Communication – Presentation Outline Samples
Weak Outline Sample
The following outline is unacceptable and would receive a failing grade. It has no details, no
strategy or speaking plan, and no supporting evidence.
Introduction: Learning how to perform CPR is as easy as knowing your ABCs
Body:
Main point #1: Airway
Main point #2: Breathing
Main point #3: Circulation
Conclusion: If you follow your ABCs, you can be a real life-saver.
Minimal Outline Sample
The following outline is minimally acceptable and would get a grade of no more than C. While
an outline like this is not the best one to turn in for an outline in this class, it may be useful to
actually deliver a speech from such a “speaking outline,” once you are very familiar with the
much more detailed formal outline.
Introduction:
Attention-getting introduction: Imagine finding someone lying on the ground who was not
breathing. Would you know what to do to save them? I can teach you easy steps for performing
CPR.
Body:
Main Point #1: Airway
A. Tilt head back
B. Look
C. Listen
D. Feel
Main Point #2: Breathing
A. Close nose
B. Open mouth
C. Blow air
Main Point #3: Circulation
A. Check pulse
B. External chest compressions
Conclusion: If you follow your ABCs, you will be a real life-saver.
Exemplary Outline Sample
Following the format for a “best practices” formal outline like the one below would not only
likely earn an A for the assignment, but it would be of the most use to you in helping you
practice your presentation for optimal delivery. Note that some parts in the introduction and
conclusion are written verbatim and that each main point contains supporting material that is also
written in complete sentences. References to cited material from credible outside sources are
included and formatted using the APA guidelines. Transitions are provided as well.
Title: The ABCs of CPR
Specific Purpose: To inform my audience of the simple steps needed to properly perform CPR
Audience: General audience
Organizational Pattern: Sequentia.
Orthodontic diagnosis deals with recognition of the various characteristics of the malocclusion. It involves collection of pertinent data in a systemic manner to help in the identifying the nature and cause of the problem.
Make a SOAP Note Assessing Ear, Nose, and ThroatMost ear, nose, a.docxeubanksnefen
Make a SOAP Note: Assessing Ear, Nose, and Throat
Most ear, nose, and throat conditions that arise in non-critical care settings are minor in nature. However, subtle symptoms can sometimes escalate into life-threatening conditions that require prompt assessment and treatment. Nurses conducting assessments of the ears, nose, and throat must be able to identify the small differences between life-threatening conditions and benign ones. For instance, if a patient with a sore throat and a runny nose also has inflamed lymph nodes, the inflammation is probably due to the pathogen causing the sore throat rather than a case of throat cancer. With this knowledge and a sufficient patient health history, a nurse would not need to escalate the assessment to a biopsy or an MRI of the lymph nodes, but would probably perform a simple strep test.
In this Discussion, you consider case studies of abnormal findings from patients in a clinical setting. You determine what history should be collected from the patients, what physical exams and diagnostic tests should be conducted, and formulate a differential diagnosis with several possible conditions.
Note:
By Day 1 of this week, your instructor will have assigned you to one of the following case studies to review for this Discussion. Also, your Discussion post should be in the SOAP Note format, rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in the Week 4 Learning Resources for guidance.
Remember that not all comprehensive SOAP data are included in every patient case.
Case 1:
Nose Focused Exam
Richard is a 50-year-old male with nasal congestion, sneezing, rhinorrhea, and postnasal drainage. Richard has struggled with an itchy nose, eyes, palate, and ears for 5 days. As you check his ears and throat for redness and inflammation, you notice him touch his fingers to the bridge of his nose to press and rub there. He says he's taken Mucinex OTC the past two nights to help him breathe while he sleeps. When you ask if the Mucinex has helped at all, he sneers slightly and gestures that the improvement is only minimal. Richard is alert and oriented. He has pale, boggy nasal mucosa with clear thin secretions and enlarged nasal turbinates, which obstruct airway flow but his lungs are clear. His tonsils are not enlarged but his throat is mildly erythematous.
Case 2:
Focused Throat Exam
Lily is a 20-year-old student at the local community college. When some of her friends and classmates told her about an outbreak of flu-like symptoms sweeping her campus over the past two weeks, Lily figured she shouldn't take her three-day sore throat lightly. Your clinic has treated a few cases similar to Lily's. All the patients reported decreased appetite, headaches, and pain with swallowing. As Lily recounts these symptoms to you, you notice that she has a runny nose and a slight hoarseness in her voice but doesn't sound congested.
Case.
WHAT IS EXPEXTED IN THIS DISCUSSIONStudent applies relevant pro.docxphilipnelson29183
WHAT IS EXPEXTED IN THIS DISCUSSION:
Student applies relevant professional, personal, or other real-world experiences to the discussion. Thought and analysis are present, but may lack depth or detail.
Student addresses all elements of the discussion prompt, and demonstrates Distinguished knowledge of the discussion topic. Student relates content in initial post to course content, or to real-life situations, though the connection may lack depth.
Student communicates a central idea or point that is weaved through most of the post in a coherent manner. Post is, for the most part, easy to understand.
Initial post contains several minor errors related to grammar, spelling, and sentence structure, but they do not distract the reader from the content of the post. Student properly cites resources (if applicable), per instructor expectations.
SPE103 Oral Communication – Presentation Outline Samples
Weak Outline Sample
The following outline is unacceptable and would receive a failing grade. It has no details, no
strategy or speaking plan, and no supporting evidence.
Introduction: Learning how to perform CPR is as easy as knowing your ABCs
Body:
Main point #1: Airway
Main point #2: Breathing
Main point #3: Circulation
Conclusion: If you follow your ABCs, you can be a real life-saver.
Minimal Outline Sample
The following outline is minimally acceptable and would get a grade of no more than C. While
an outline like this is not the best one to turn in for an outline in this class, it may be useful to
actually deliver a speech from such a “speaking outline,” once you are very familiar with the
much more detailed formal outline.
Introduction:
Attention-getting introduction: Imagine finding someone lying on the ground who was not
breathing. Would you know what to do to save them? I can teach you easy steps for performing
CPR.
Body:
Main Point #1: Airway
A. Tilt head back
B. Look
C. Listen
D. Feel
Main Point #2: Breathing
A. Close nose
B. Open mouth
C. Blow air
Main Point #3: Circulation
A. Check pulse
B. External chest compressions
Conclusion: If you follow your ABCs, you will be a real life-saver.
Exemplary Outline Sample
Following the format for a “best practices” formal outline like the one below would not only
likely earn an A for the assignment, but it would be of the most use to you in helping you
practice your presentation for optimal delivery. Note that some parts in the introduction and
conclusion are written verbatim and that each main point contains supporting material that is also
written in complete sentences. References to cited material from credible outside sources are
included and formatted using the APA guidelines. Transitions are provided as well.
Title: The ABCs of CPR
Specific Purpose: To inform my audience of the simple steps needed to properly perform CPR
Audience: General audience
Organizational Pattern: Sequentia.
Orthodontic diagnosis deals with recognition of the various characteristics of the malocclusion. It involves collection of pertinent data in a systemic manner to help in the identifying the nature and cause of the problem.
Make a SOAP Note Assessing Ear, Nose, and ThroatMost ear, nose, a.docxeubanksnefen
Make a SOAP Note: Assessing Ear, Nose, and Throat
Most ear, nose, and throat conditions that arise in non-critical care settings are minor in nature. However, subtle symptoms can sometimes escalate into life-threatening conditions that require prompt assessment and treatment. Nurses conducting assessments of the ears, nose, and throat must be able to identify the small differences between life-threatening conditions and benign ones. For instance, if a patient with a sore throat and a runny nose also has inflamed lymph nodes, the inflammation is probably due to the pathogen causing the sore throat rather than a case of throat cancer. With this knowledge and a sufficient patient health history, a nurse would not need to escalate the assessment to a biopsy or an MRI of the lymph nodes, but would probably perform a simple strep test.
In this Discussion, you consider case studies of abnormal findings from patients in a clinical setting. You determine what history should be collected from the patients, what physical exams and diagnostic tests should be conducted, and formulate a differential diagnosis with several possible conditions.
Note:
By Day 1 of this week, your instructor will have assigned you to one of the following case studies to review for this Discussion. Also, your Discussion post should be in the SOAP Note format, rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in the Week 4 Learning Resources for guidance.
Remember that not all comprehensive SOAP data are included in every patient case.
Case 1:
Nose Focused Exam
Richard is a 50-year-old male with nasal congestion, sneezing, rhinorrhea, and postnasal drainage. Richard has struggled with an itchy nose, eyes, palate, and ears for 5 days. As you check his ears and throat for redness and inflammation, you notice him touch his fingers to the bridge of his nose to press and rub there. He says he's taken Mucinex OTC the past two nights to help him breathe while he sleeps. When you ask if the Mucinex has helped at all, he sneers slightly and gestures that the improvement is only minimal. Richard is alert and oriented. He has pale, boggy nasal mucosa with clear thin secretions and enlarged nasal turbinates, which obstruct airway flow but his lungs are clear. His tonsils are not enlarged but his throat is mildly erythematous.
Case 2:
Focused Throat Exam
Lily is a 20-year-old student at the local community college. When some of her friends and classmates told her about an outbreak of flu-like symptoms sweeping her campus over the past two weeks, Lily figured she shouldn't take her three-day sore throat lightly. Your clinic has treated a few cases similar to Lily's. All the patients reported decreased appetite, headaches, and pain with swallowing. As Lily recounts these symptoms to you, you notice that she has a runny nose and a slight hoarseness in her voice but doesn't sound congested.
Case.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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.
Basavarajeeyam - Ayurvedic heritage book of Andhra pradesh
Obj, cog and clinic, organ system
1. FAP Health Assessment for Advanced Practice
Cognitive and Clinical Objectives by Organ System
Think of cognitive as the “why” objective(s) behind the
clinical objective(s), “the actual skill(s)”
General Survey and Vital Signs
Cognitive Objectives
Upon completion of the lesson, the student will be able to:
1. Describe the important aspects of a general survey of the patient.
2. Identify the components of measurement and vital signs and discuss the
considerations for each.
3. Describe steps taken if the clinician is suspecting orthostatic hypotension.
4. Describe abnormalities a clinician may find when taking pulse rates and
respiratory rates.
5. Discuss and give examples of the term "differential diagnosis".
6. Discuss the significance of the Body Mass Index (BMI) waist-to hip-ratio and
waist measurement and how it is utilized in clinical practice.
7. Discuss general recommendations for conducting the physical exam.
8. Verbalize the importance of hand washing as a primary means of infection
control.
Clinical Objectives
The student will demonstrate a complete and systematic performance of the general
survey and vital signs by:
1. Demonstrating appropriate hand washing prior to examination of a patient.
2. Correctly demonstrating the techniques for obtaining measurements and vital
signs (temperature, pulse, respirations, and blood pressure, including orthostatic
VS).
3. Identifying normal expected findings for height, weight, and BMI measurements
and vital signs.
4. Performing a general survey as part of the physical exam.
Skin, Hair, Nails
Cognitive Objectives
Upon completion of this lesson the student should be able to:
2. 1. List and describe the 3 layers of the skin.
2. Describe the 5 functions of the skin.
3. Describe the differences between the sebaceous, eccrine and apocrine glands.
4. Discuss the cause of central cyanosis and peripheral cyanosis.
5. Identify the changes in the skin that occur with aging.
6. Identify risk factors and preventive measures related to skin.
7. List 6 elements noted in the examination of the skin.
8. List 4 features to note regarding skin lesions.
9. Describe and give an example of the following primary skin lesions: macule,
papule, pustule, vesicle, wheal, nodule, plaque and tumor, cherry angioma,
telangectasias.
10. Describe and give an example of the following secondary skin lesions: scar, scale,
fissure, crust, erosion, ulcer excoriation, keloid, atrophic scar, lichenification.
11. Describe and give examples of vascular skin lesions.
12. Describe appearance and possible causes of the following abnormalities fo the
nails: clubbing, Terry's nails, tranverse white lines (Mee's lines), and transverse
depressions (Beau's lines).
13. Compare and contrast primary and secondary skin lesions.
14. State features that the examiner should note about hair and nails.
Clinical Objectives
1. Obtain a relevant history for complaints relating to the skin, hair, and nailst o
include the history of present illness (HPI), relevant past medical history (PMH),
social history (SH) and family history (FH) and review of system(s) (ROS) as
outlined in Bickley and H&P Plus Booklet.
2. The student will demonstrate and document a thorough examination of the skin,
hair and nails.
Head and Neck
Cognitive Objectives
Upon completion of this lesson, the student should be able to:
1. Identify the bones of the head.
2. Identify the anatomical structures of the eye.
3. Describe the function of each part of the eye.
4. Explain the causes of visual field defects.
5. Explain the causes of an abnormal extra ocular movement exam (EOM's)
3. 6. Discuss the difference between papillary reaction to light by direct and consensual
reaction.
7. Discuss the importance of the cover / uncover test.
8. Define ptosis.
9. Describe and identify corneal arcus.
10. Describe normal findings on insufflation of the tympanic membrane with a
pneumatic otoscope.
11. Identify the anatomical parts of the outer, middle, and inner ear.
12. Identify the anatomical structures of the nose and sinuses.
13. Identify anatomical structures of the mouth and pharynx.
14. Identify lymph nodes in the head and neck.
15. Discuss function of lymph nodes and sites of drainage.
16. Identify anatomical landmarks of the neck.
Clinical Objectives
1. Obtain a relevant history for complaints relating to the head, eyes, ears, nose,
mouth. throat, and neck, to include the history of present illness (HPI), relevant
past medical history (PMH) , social history (SH) and family history (FH) and
review of system(s) (ROS) as outlined in Bickley and H&P Plus Booklet.
2. The student will demonstrate a complete and systematic examination of the head
and neck by completion of the following objectives:
a. Describe and document appropriate examination of the head, including
scalp and hair.
b. Obtain relevant history for complaints related to the eye, ear, nose, mouth,
and neck.
c. Demonstrate and document appropriate examination of the eye, including
the cover/uncover test and screening of visual fields by confrontation.
d. Describe the steps to use an ophthalmoscope.
e. Demonstrate skill in the use of the ophthalmoscope.
f. Discuss and demonstrate the functional assessment of hearing.
g. Describe and demonstrate the Weber and Rinne tests.
h. Describe a normal tympanic membrane and common abnormalities of the
tympanic membrane (TM).
i. Demonstrate a complete ear examination using the otoscope.
j. Demonstrate ability to document a complete ear examination (objective).
4. k. Demonstrate an appropriate examination of the nose, frontal, and
maxillary sinuses.
l. Demonstrate a complete oral examination and document findings.
m. Identify cranial nerves that innervate the eye, ear, face, tongue, soft palate,
and neck (also covered in Neurology).
n. Demonstrate proper lymph node examination techniques.
o. Demonstrate and document an appropriate examination of the neck to
include lymph nodes and thyroid gland.
p. Accurately record history and physical exam findings related to the
HEENT systems using appropriate terminology
Thorax and Lungs
Cognitive Objectives
Upon completion of this lesson, the student should be able to:
1. Identify bony anatomical landmarks found on the thorax.
2. Identify the following anatomical lines found on the thorax:
a. Midsternal
b. Midclavicular
c. Anterior midaxillary
d. Posterior midaxillary
e. Vertebral
f. Scapular
3. If given a drawing be able to identify the location of the three lobes of the right
lung and two lobes of the left lung.
4. Define tactile fremitus, provide a rationale for both increased and decreased
tactile fremitus, and provide an example of a patient who would have increased
and decreased fremitus.
5. Describe the following abnormalities of the chest wall:
a. Barrel chest
b. Pectus excavatum
c. Pectus carinatum
6. Define percussion and compare and contrast the characteristics of the following
five percussion notes:
5. a. Dullness
b. Tympany
c. Resonance
d. Hyperresonance
e. Flat
7. Compare and contrast the characteristics, normal location on exam, and the
physiological rationale for the following breath sounds:
a. Vesicular
b. Bronchovesicular
c. Bronchial
8. Describe the characteristics of the following adventitious breath sounds, provide a
physiological rationale for each, and identify a type of patient in which they may
be commonly found.
a. Crackles
b. Wheezes
c. Rhonchi
9. Define the following transmitted voice sounds and describe their significance
when found on exam.
a. Bronchophony
b. Egophony
c. Whispered pectoriloquy
10. Compare and contrast the following physical findings noted on the exam of a
patient with pneumonia (consolidation) versus pneumothorax:
a. percussive note
b. breath sounds
c. adventitious sounds
d. transmitted voice sounds ( tactile and vocal fremitus)
11. Describe the importance of the following symptoms of respiratory disease
a. Dyspnea
b. Chest pain
c. Wheezing
d. Cough
e. Hemoptysis
6. Clinical Objectives
1. Obtain a relevant history for complaints relating to the respiratory system, to
include the history of present illness (HPI), relevant past medical history (PMH).
social history (SH) and family history (FH) and review of system(s) (ROS) as
outlined in Bickley and H&P Plus Booklet.
2. The student will demonstrate a complete and systematic examination of the lungs
and thorax by completion of the following objectives:
a. Demonstrate inspection of the chest noting respiratory rate and rhythm,
deformities of chest wall, and presence of retractions.
b. Demonstrate palpation of the chest wall noting tenderness or the presence
of masses.
c. Demonstrate chest expansion looking for symmetry of expansion.
d. Demonstrate tactile fremitus noting symmetry.
e. Demonstrate percussion of the anterior, posterior, lateral chest wall noting
symmetry and percussive note.
f. Demonstrate percussion of the diaphragmatic level.
g. Demonstrate auscultation of the anterior, posterior, and lateral chest wall
in 5 cm segments describing type of breath sounds and presence of
adventitious sounds.
h. Demonstrate vocal fremitus by bronchophony, egophony, and whispered
pectroriloquy.
i. Record a complete respiratory exam using correct terminology.
Cardiovascular and Peripheral Vascular
Cognitive Objectives
Upon completion of this lesson, the student should be able to:
1. Define systole and diastole.
2. If given a drawing of the anterior chest identify the position of important cardiac
structures that lie underneath the chest wall.
3. Describe the structure and the function of the atrioventricular and semilunar
valves.
4. Describe the characteristics of the normal pulse.
5. Describe the effect of inspiration on heart rate.
6. Identify the role of the atrioventricular valves in the formation of S1.
7. Identify the role of the semilunar valves in the formation of S2.
7. 8. Describe the flow of blood through the heart making sure to differentiate diastolic
and systolic flow.
9. Define “apical pulse” (PMI) and identify its normal location on the chest wall.
10. Describe the location of the Aortic, Pulmonic, Tricuspid, and Mitral areas on the
chest wall.
11. Define “jugular venous pressure (JVP)” and identify why “JVP” is measured
during the cardiovascular exam.
12. Define “bruit” and explain its causes.
13. Define “thrill” and identify its causes.
14. Define “lift” and “heave” and identify their causes.
15. Describe the mechanisms responsible for the development of a physiologic
splitting of S2.
16. Describe the physiologic mechanisms responsible for the development of an S3
and S4.
17. Identify in what type of patients you would commonly hear an S3 or S4.
18. Describe the following characteristics of a "functional" (physiologic or innocent)
murmur: timing, shape, location of maximal impulse, radiation, intensity, pitch,
and quality.
19. Define “clubbing” and describe why it can occur in cardiovascular disease.
20. Describe signs and symptoms of arterial insufficiency.
21. Describe signs and symptoms of venous insufficiency.
22. Define the following symptoms of cardiac disease and identify why they are
important in cardiac evaluation.
a. Chest pain
b. Shortness of breath
c. Palpitations
d. Orthopnea
e. Dyspnea on exertion (DOE)
f. Paroxysmal Nocturnal Dyspnea (PND)
g. Peripheral edema
Clinical Objectives
1. Obtain a relevant history for complaints relating to the cardiovascular system, to
include the history of present illness (HPI), relevant past medical history (PMH) ,
social history (SH) and family history (FH) and review of system(s) (ROS) as
outlined in Bickley and H&P Plus Booklet.
8. 2. The student will demonstrate a complete and systematic examination of the
cardiovascular system by completion of the following objectives:
a. Identify the function of the bell and diaphragm of the stethoscope and give
an example of a situation in which the use of each is appropriate.
b. Identify signs of cardiac disease that can be noted on inspection of the
patient.
c. Inspect the anterior chest and identify the position of the apical pulse.
d. Palpate the anterior chest and note the position and characteristics of the
apical pulse.
e. Identify on the chest wall the position of the Aortic, Pulmonic, Tricuspid,
and Mitral area.
f. Palpate each of the above areas and note the presence and characteristics
of pulsations or the presence of thrills.
g. Listen to the following areas with the diaphragm and bell of your
stethoscope and identify the heart sounds heard and the characteristics of
each:
1. Aortic
2. Pulmonic
3. Tricuspid
4. Mitral
h. Listen with the bell to the tricuspid and mitral areas for the presence of a
S3 or S4
i. Palpate the carotid pulse and note symmetry.
j. Auscultate the carotid pulse and note the presence of a bruit.
k. Inspect for jugular venous distension with the patient in a semi-fowler’s
position.
l. Demonstrate the proper location and technique for palpating the following
pulses:
1. Radial
2. Brachial
3. Femoral
4. Popliteal
5. Dorsalis pedis
6. Posterior tibial
7. Carotid
9. m. Record rate, rhythm, character, and grading of pulses.
n. Inspect for evidence of arterial or venous insufficiency.
o. Demonstrate the proper method for checking for a Homan’s sign.
p. Demonstrate the proper method for testing for ulnar artery patency
(Allen's test).
q. Record a complete cardiovascular exam using appropriate terminology.
Breast
Cognitive Objectives
Upon completion of this lesson, the student should be able to:
1. Identify components of the normal breast.
2. Describe normal changes in the female breast throughout the life cycle.
3. Describe the characteristics of each of the five Tanner stages of breast
development.
4. Identify the effect of cyclical secretion of estrogen and progesterone on the breast
and the best time in the menstrual cycle to perform an examination of the breast.
5. State the rationale for the inclusion in the breast examination of assessment of the
axillary, infraclavicular, and supraclavicular lymph nodes.
6. Describe the location of the pectoral, subscapular, lateral, infraclavicular and
supraclavicular lymph nodes.
7. Identify variations of normal related to the breast and axilla and provide
appropriate patient education.
8. Differentiate between breast masses based on characteristics and common age of
occurrence.
9. Discuss signs visible on inspection suggesting underlying breast cancer and the
mechanism which causes them.
10. List the characteristics that are used to describe a dominant breast mass.
11. Discuss recommendations for breast cancer screening in patients at average or
normal risk.
12. Identify risk factors for breast cancer.
13. Describe the techniques and procedure of clinical breast examination for both
men and women.
Clinical Objectives
10. 1. Obtain a relevant history for complaints relating to the breast, to include the
history of present illness (HPI), relevant past medical history (PMH) , social
history (SH) and family history (FH) and review of system(s) (ROS) as outlined
in Bickley and H&P Plus Booklet.
2. The student will demonstrate a complete and systematic examination of the breast
by completion of the following objectives:
a. Incorporate history questions related to risk factors for breast cancer into
the patient visit.
b. Incorporate knowledge of the anatomy and physiology of the breast into
the physical examination.
c. Properly position the patient for inspection and palpation of the breasts.
d. List characteristics to be observed in the inspection of the breast.
e. Demonstrate a complete and systematic examination of the breast and
related lymph nodes using proper technique and draping.
f. Incorporate instruction in breast self-examination into the process of the
clinical breast examination.
g. Differentiate between the examination procedures and findings for the
female with normal breasts, the female post-mastectomy, and the male
breast.
h. Describe breast masses according to size, shape, consistency, mobility,
tenderness, location, and delimitation and accurately record findings.
i. Appropriately determine sexual maturity rating of females using Tanner
staging of the breast.
j. Accurately document history and physical examination findings related to
the breast.
Abdomen
Cognitive Objectives
Upon completion of this lesson, the student should be able to:
1. Identify organs found within the following regions of the abdominal cavity:
a. Right upper quadrant
b. Right lower quadrant
c. Left upper quadrant
d. Left lower quadrant
e. epigastrum
f. umbilical
11. g. suprapubic
2. Define and locate on a drawing of the abdomen the epigastric, umbilical, and
hypogastric or suprapubic areas of the abdomen.
3. Define the following symptoms of gastrointestinal disease and identify why they
are important in the evaluation of the gastrointestinal system:
a. Heartburn
b. Anorexia
c. Nausea and vomiting
d. Hematemesis
e. Abdominal pain
f. Dysphagia
g. Jaundice
h. Constipation or diarrhea
4. Describe the concept of referred pain and identify on a drawing locations of pain
referred from the spleen, appendix, or gallbladder.
5. Describe the characteristics of normal bowel sounds, hyperactive bowel sounds,
hypoactive bowel sounds, and borborygmi.
6. Describe the function and location of the parietal and visceral pleura.
7. Describe the function and location of the gallbladder and liver.
8. Describe the function and location of the spleen.
9. Describe the function and location of the kidneys.
10. Locate the costovertebral angle on a drawing of the posterior thorax and identify.
11. Describe the general principles that should be considered prior to doing an
abdominal exam.
12. Identify the appropriate order of the abdominal exam and provide the rationale.
13. Define rebound tenderness and provide the rationale for the presence in
peritonitis.
14. Define the following abnormal findings on an abdominal exam and describe the
rationale for the presence of each:
a. Psoas sign
b. Obturator
c. Rovsing’s
d. Murphy’s
e. Cutaneous hyperesthesia
12. f. Voluntary vs. involutary guarding
15. Define ascites and provide a rationale for the presence on a abdominal exam.
16. Describe the concept of “shifting dullness”.
17. Define “tympany” and identify why it is the predominant percussive note found
on the abdominal exam.
18. Describe where “dullness” as a percussive note may be found on the abdominal
exam.
19. Identify the normal size of the liver at the MCL
20. Compare light and deep palpation as to purpose and technique.
Clinical Objectives
Obtain a relevant history for complaints relating to the abdomen and gastrointestinal
system, to include the history of present illness (HPI), relevant past medical history
(PMH) , social history (SH) and family history (FH) and review of system(s) (ROS) as
outlined in Bickley and H&P Plus Booklet.
1. The student will demonstrate a complete and systematic examination of the
abdomen by completion of the following objectives:
a. Properly position and drape the patient for an abdominal examination.
b. Inspect the abdomen noting contour, pulsations, skin color, lesions,
peristaltic waves, pulsatile mass.
c. Auscultate the fours quadrants of the abdomen using the diaphragm of the
stethoscope.
d. Auscultate the abdomen using the bell for renal, aortic, iliac, and femoral
bruits.
e. Systematically percuss the entire abdomen.
f. Percuss the size of the liver in the right upper quadrant.
g. Percuss the left upper quadrant for evidence of splenic enlargement.
h. Percuss the suprapubic area to detect the presence of bladder distension.
i. Lightly palpate all four quadrants of the abdomen noting tenderness,
superficial masses, or the presence of guarding.
j. Deeply palpate all four quadrants of the abdomen noting the presence of
pain or masses.
k. Correctly palpates the right upper quadrant for characteristics of the liver.
l. Correctly palpates the left upper quadrant for characteristics of the spleen.
m. Correctly palpates for the kidneys bilaterally.
n. Correctly demonstrates the procedure for testing for rebound tenderness.
13. o. Correctly demonstrates the procedure for testing for CVA tenderness.
p. Correctly demonstrates the following tests:
1. Psoas
2. Obturator
3. Murphy’s
4. Navel tug
5. Rovsing’s
6. Cutaneous hyperesthesia
q. Correctly demonstrates testing for the presence of ascites, fluid wave, and
shifting dullness.
r. Palpates the femoral pulse.
s. Palpates for inguinal nodes.
t. Accurately record history and physical exam findings related to the
gastrointestinal system using appropriate terminology.
Female Genitalia
Cognitive Objectives
Upon completion of this lesson, the student should be able to:
1. Incorporate knowledge of anatomy and physiology of the female genito-
reproductive system into the physical examination.
2. Describe the location of the structures of the internal and external female
genitalia.
3. Define common term and abbreviations related to the female genital tract.
4. Describe the effects of estrogen on the female genitoreproductive tract throughout
the life cycle.
5. Define the Tanner Stages of sexual development of the female genitalia.
6. Identify common presenting complaints related to the female genitoreproductive
tract and appropriate history to be obtained related to each.
7. Describe the technique and procedures employed in the examination of the female
genitalia.
8. Identify indications for rectal or rectovaginal examination.
9. Describe the significance of the finding of cervical motion tenderness on
bimanual examination.
14. Clinical Objectives
1. Obtain a relevant history for complaints relating to the female genitalia, anus &
rectum to include the history of present illness (HPI), relevant past medical
history (PMH) , social history (SH) and family history (FH) and review of
system(s) (ROS) as outlined in Bickley and H&P Plus Booklet.
2. The student will demonstrate a complete and systematic examination of the
female genitalia, anus & rectum by completion of the following objectives:
a. Incorporate history questions related to risk factors for breast cancer into
the patient visit.
b. Incorporate techniques for physical and psychological preparation of the
patient for a pelvic examination.
c. Incorporate history questions related to the female genitalia into the
patient visit.
d. Incorporate knowledge of the anatomy and physiology of the female
genitalia into the physical examination.
e. Properly position the patient for examination of the genitalia.
f. Employ infection control precautions during examination of the female
genitalia.
g. Demonstrate correct techniques for both the speculum and bimanual
examination of the female genitalia.
h. Inspect and describe findings related to the external genitalia.
i. Employ appropriate examination techniques for the assessment of pelvic
relaxation.
j. Correctly obtain and prepare specimens for the pap smear, cervical
culture, and wet mount.
k. Correctly perform a rectal and rectovaginal examination.
l. Employ proper techniques in the palpation of the Skene’s and Bartholin’s
glands.
m. Accurately document history and physical examination findings related to
the female reproductive system using appropriate terminology.
Male Genitalia
Cognitive Objectives
Upon completion of this lesson, the student should be able to:
1. Incorporate knowledge of the anatomy and physiology of the male genitalia, anus,
rectum, and prostate into the physical examination.
15. 2. Describe the effects of testosterone on the male genitoreproductive tract
throughout the life cycle.
3. Define the Tanner Stages of sexual development of the male genitalia.
4. List indications for transillumination of the scrotum.
5. Describe the function of the cremaster muscle.
6. Define terms and abbreviations commonly associated with the male reproductive
system.
7. Describe the characteristics of the normal prostate gland that are assessed by
palpation.
8. Compare and contrast the underlying pathophysiology and characteristics of
direct and indirect hernias.
9. Describe the risk factors for prostate cancer and prostate cancer screening
guidelines for patients with normal or average risk.
10. Describe the risk factors for colorectal cancer and the screening guidelines for
patients with normal or average risk.
11. Describe the procedure for fecal occult blood testing.
12. Describe the technique for rectal examination in the male.
Clinical Objectives:
1. Obtain a relevant history for complaints relating to the female genitalia, anus &
rectum to include the history of present illness (HPI), relevant past medical
history (PMH) , social history (SH) and family history (FH) and review of
system(s) (ROS) as outlined in Bickley and H&P Plus Booklet.
2. The student will demonstrate a complete and systematic examination of the
female genitalia, anus & rectum by completion of the following objectives:
a. Incorporate history questions related to risk factors for breast cancer into
the patient visit.
b. Demonstrate a complete and systematic examination of the external male
genitalia and internal structures of the scrotum.
c. Demonstrate examination for femoral and inguinal hernias.
d. Demonstrate appropriate specimen collection from the male urethra.
e. Demonstrate examination of the anums, prostate and rectum.
f. Provide complete and correct patient education related to testicular self
examination (TSE).
g. Accurately record history and physical exam findings related to the male
reproductive system using appropriate terminology.
16. Musculskeletal
Cognitive Objectives
Upon completion of this lesson, the student should be able to:
1. Incorporate knowledge of the anatomy and physiology of the musculoskeletal
system into the history and physical exam.
2. Identify the joint the following joint types and compare their characteristics:
fibrous, cartilaginous & synovial joints.
3. Compare and contrast the 3 main categories & 2 subtypes of each category of
synovial joints: hinge, pivot, saddle, condyle, ball & socket, and gliding.
4. Describe the structure and function of the bursae, tendons, and ligaments.
5. Define active and passive range of motion and describe the indications for
performing each type of exam.
6. Describe the structure and function of the TM joint.
7. Describe the structure and function of the SITS muscles of the shoulder joint.
8. If given a drawing identify the bony components of the following joints:
a. Shoulder joint
b. Elbow joint
c. Wrist and Hand (carpal, metacarpal, and phalangeal)
d. Hip
e. Knee
f. Ankle and Foot (tarsal, metatarsal and phalangeal)
9. Describe the function of the anterior and posterior cruciate ligaments.
10. Describe the function of the medial and lateral collateral ligaments of the knee.
11. Describe the function of the following ligaments of the ankle:
a. Deltoid
b. Anterior and posterior talo-fibular
c. Calcanofibular ligament
12. Describe the important components of the history for a patient with a
musculoskeletal complaint.
13. Describe the following special test used in the musculoskeletal examination,
identify normal and abnormal findings, and indications for use:
a. Phalen’s
b. Tinel’s
c. McMurray
17. d. Drawer sign
e. Bulge sign
f. Ballottement
g. Straight leg raising
h. Hyperextension test
14. Describe clinical manifestations noted in a patient with joint inflammation.
15. Describe the clinical signs of kyphosis, scoliosis, and lordosis.
16. Describe the importance of crepitus noted on examination of a joint.
17. Define carpal tunnel syndrome and identify what are common clinical
manifestations of the disease.
Clinical Objectives
1. Obtain a relevant history for complaints relating to the musculoskeletal system, to
include the history of present illness (HPI), relevant past medical history (PMH) ,
social history (SH) and family history (FH) and review of system(s) (ROS) as
outlined in Bickley and H&P Plus Booklet.
2. The student will demonstrate a complete and systematic examination of the
musculoskeletal system by completion of the following objectives:
a. Identify normal and abnormal findings noted on inspection and palpation
of the following joints:
1. Spine
2. TM
3. Shoulder
4. Elbow
5. Wrist
6. Hand
7. Hip
8. Knee
9. Ankle
10. Foot
b. Correctly locate and perform range of motion on the above joints.
c. Correctly perform the following special tests:
1. Phalen’s
2. Tinel’s
3. Bulge
18. 4. Ballottement
5. McMurray
6. Anterior and Posterior Drawer
7. Straight leg raising
8. Hyperextension
d. Correctly demonstrate how to measure leg length.
e. Correctly demonstrate range of motion of the spine.
f. Correctly examine the spine for evidence of kyphosis, scoliosis, and
lordosis.
g. Accurately record history and physical exam findings related to the
musculoskeletal system using appropriate terminology.
Neurological and Mental Status
Cognitive Objectives
Upon completion of this lesson, the student should be able to:
1. Describe the function of the following structures within the central nervous
system:
a. Frontal lobe
b. Parietal lobe
c. Occipital lobe
d. Temporal lobe
e. Cerebellum
f. Thalamus
g. Basal Ganglia
h. Corticospinal tract
i. Extrapyramidal tracts
j. Posterior column
k. Spinothalamic tracts
2. Describe the function of Wernicke and Broca’s area.
3. List the two main divisions of the central nervous system.
4. Describe the components of a deep tendon reflex and identify the function of each
component.
5. Identify the twelve cranial nerves, their function, and how they are tested.
19. 6. Describe the following components of the mental status exam and identify
possible abnormalities in each.
a. Level of consciousness
b. Appearance and Behavior
c. Speech and Language
d. Mood and affect
e. Thought Processes, insight, and judgment
f. Cognitive function: orientation, attention, memory, higher cognitive
function.
7. Define efferent and afferent transmission within the central nervous system.
8. Define the following discriminative sensations: stereognosis and graphesthesia
and describe their function during the neurological exam.
9. Describe the scale used to test muscle strength.
10. Describe three tests used to test coordination during the neurological exam.
11. Compare and contrast the methods used to test (pain, temperature, light touch)
and (vibration and position sense). Make sure and document differences in the
actual testing procedures.
12. Describe the scale used to grade deep tendon reflexes and define each level.
13. Compare and contrast upper and lower motor neurons with respect to location,
function, and clinical manifestations of disease.
14. Describe the use of standardized monofilament testing in the evaluation of
peripheral neuropathy.
15. Describe the following tests used to identify the presence of meningeal
inflammation and identify an abnormal response:
a. Brudzinski’s sign
b. Kernig’s sign
16. Differentiate between decorticate and decerebrate posturing.
17. Describe the characteristics of the following gaits:
a. Parkinsonian gait
b. Scissors gait
c. Steppage gait
d. Ataxic gait
18. Compare and contrast the clinical findings of flaccidity, spasticity, and rigidity.
20. 19. Identify the following dermatomes: Cervical 4, 5, 6, 7, 8; Thoracic 4, 10; Lumbar
4, 5; Sacral 1, 5.
20. Identify the following peripheral nerve regions: radial, median, ulnar, sciatic,
common peroneal.
Clinical Objectives
1. Obtain a relevant history for complaints relating to the neurological system, to
include the history of present illness (HPI), relevant past medical history (PMH) ,
social history (SH) and family history (FH) and review of system(s) (ROS) as
outlined in Bickley and H&P Plus Booklet.
2. The student will demonstrate a complete and systematic examination of the
neurological system by completion of the following objectives:
a. Demonstrate a complete mental status exam
b. Demonstrate the examination of cranial nerves I-XII.
c. Demonstrate testing for pain, temperature, and light touch evaluating all
major dermatomes of the upper and lower extremities and describe
abnormalities of function.
d. Demonstrate testing for position and vibratory sense and describe
abnormalities of function.
e. Demonstrate stereognosis, graphesthesia, point localization and two point
discrimination and describe abnormalities of function.
f. Demonstrate assessment of muscle mass and describe abnormalities noted.
g. Demonstrate range of motion of all major joints of the neck, extremities,
and back.
h. Demonstrate muscle strength testing in all major muscle groups of the
neck and extremities.
i. Demonstrate assessment of gait including as assessment of tandem gait.
j. Demonstrate the Romberg exam (with eyes open and eyes closed) and
describe abnormalities of function.
k. Demonstrate the following deep tendon reflexes (DTRs):
1. Biceps
2. Triceps
3. Brachioradialis
4. Patellar
5. Achilles
21. 6. Plantar
l. Demonstrate correct use of a 10 g monofilament for peripheral sensory
testing.
m. Accurately record history and physical exam findings related to the
neurologic system using appropriate terminology.