This document provides guidance on taking a thorough musculoskeletal history. It emphasizes that history taking is the most important part of making a diagnosis, as a clinician is 60% closer to a diagnosis with a thorough history compared to 40% from physical examination and investigations alone. It outlines the key components of a musculoskeletal history, including chief complaint, history of present illness, functional assessment, review of systems, past medical and surgical history, medications, social history, and specific questions for common conditions like pain, swelling, instability, and loss of function. Examination techniques like inspection, palpation, and active and passive range of motion testing are also summarized. The goal is to educate clinicians on how to take a comprehensive history for the major musculoskeletal
references:
Campbell’s operative orthopaedics 11th edition
Text book of orthopaedics & fractures 5th edition Dr B. Aalami Harandi
Gray’s anatomy 2nd edition
Clinical anatomy Richard S. Snell
This presentation is a comprehensive summary about all aspects of back pain. Back pain is one of the most common orthopaedic morbidity or orthopedic disability. Sciatica and lumbar disc diseases are common cause of spinal disability. Back pain are divided into Red flags, green flags and yellow flags for quick clinical screening. both treatment, prevention aspects are covered. Spinal anatomy and Biomechanics are covered. Epidemiology and role of various types of spine surgery, microdiscectomy, endoscopic spine surgery are also described.
references:
Campbell’s operative orthopaedics 11th edition
Text book of orthopaedics & fractures 5th edition Dr B. Aalami Harandi
Gray’s anatomy 2nd edition
Clinical anatomy Richard S. Snell
This presentation is a comprehensive summary about all aspects of back pain. Back pain is one of the most common orthopaedic morbidity or orthopedic disability. Sciatica and lumbar disc diseases are common cause of spinal disability. Back pain are divided into Red flags, green flags and yellow flags for quick clinical screening. both treatment, prevention aspects are covered. Spinal anatomy and Biomechanics are covered. Epidemiology and role of various types of spine surgery, microdiscectomy, endoscopic spine surgery are also described.
Spinal cord injuries complete topic about it and how to make good rehabilitation for the patient with spinal cord injuries .
wish it help people
my pleasure :)
Mostafa shakshak
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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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
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
2. Importance
Structure
Orthopedic C/O…
History of treatment
Special H/O:
Pediatric
Spine
Shoulder
Knee
3. History taking is the most important step in making
a diagnosis.
A clinician is:
60% closer to a diagnosis with a thorough history.
40% by (examination & investigations).
History taking can either:
Traumatic,
Non-traumatic injury.
4. By end of this session, you should be
able & know how to take a MSK
relevant history of the
major musculoskeletal conditions
5. • Demographic features
• Chief complaint
• History of presenting
illness
• Functional level
• MSK systemic review
• Systemic enquiry
• PMH
• PSH
• Drug Hx
• Smoking
• Occupational Hx
• Allergy
• Family Hx
• Social Hx
6. 1. Pain
2. Stiffness.
3. Swelling
4. Instability
5. Deformity
6. Limp
7. Loss of function
8. Altered Sensation.
9. Weakness.
7. • Location
Point with a finger to where it is
• Radiation
Does the pain go anywhere else
• Type
• How long have you had the pain
• How did it start
Injury:
oMechanism of injury
oHow was it treated ?
Insidious
8. • Progression
Is it better, worse or the same
• When
Mechanical / Walking
Rest
Night
Constant
• Aggravating & Relieving Factors
Stairs
Start up, mechanical
Pain with twisting & turning
Up & down hills
Kneeling
Squatting
9. Onset
Duration
Painful or not
Local vs. generalized
Constant vs. comes and goes
Size progression: same or ↑
Rapidly or slowly
Aggravated & relived factors
Associated with injury or reactive
From: soft tissue, joint, or bone
10. • Onset
• How dose it start?
• Any Hx of trauma?
• Frequency
• Trigger/aggravated factors
• Giving way
• Locking
• I can not trust my leg!
• Associated symptoms
Swelling
Pain
12. When did you notice it?
Progressive or not?
Associated with symptoms pain, stiffness, …
Impaired function or not?
Past Hx of trauma or surgery
PMHx (neuromuscular, polio)
13. Onset (acute or chronic)
Traumatic or non-traumatic ?
Painful vs. painless
Progressive or not ?
Use walking aid ?
Functional disability ?
Associated swelling, deformity, or fever.
14. How has this affected the patient’s life
Home (daily living activities DLA)
Prayer
Squat or kneel for gardening
Using toilet
Getting out of chairs / bed
Socks
Stairs
Walking distance
Go in & out of car
Work
Sport
Type & intensity
Run, jump
15. Weight loss
Fever
Loss of sensation
Loss of motor function
Sudden difficulties with urination or defecation
16. Age (the extremes)
Gender
Obesity
Lack of physical
activity
Inadequate dietary
calcium and vitamin D
Smoking
Occupation and Sport
Family History (as: SCA)
Infections
Medication (as: steroid)
Alcohol
PHx MSK
injury/condition
PHx Cancer
17. • Non-operative:
Medications:
o Analgesia
o Antibiotic
o Patient's own
Physiotherapy
Orthotics:
o Walking aid
o Splints
• Operative:
What, where, and when ?
Peri-operative complications
18. Product of F.T or premature
Pregnancy normal or not
Delivery SVD (cephalic vs. breach), C/S (elective vs.
E.R)
Family parents relatives, patient sequence, F/H of same
D.
Any NICU, jaundice, blood transfusion
Vaccination
Milestones neck, flip, sit, stand, walk
Who noticed the C/O
19. • Pain radiation as L4, exact dermatome or myotome
• Coughing, straining
• Sphincter control (urine & stool)
• Shopping trolleys (forward flexion)
• Neuropathic:
Increase back extension & walking downhill
Improves walking uphill & sitting
• Vascular:
Increase walking uphill (generates more work)
Improves stop walking (stand) is better than sitting due to
pressure gradient
20. • Cervical myelopathy:
Hand assessment
Coughing, straining
• Red Flags
Constitutional symptoms fevers, sweat, weight loss
Pain night or rest
Immunosuppression
21. • Age of the patient
Younger patients more:
o shoulder instability,
o acromioclavicular joint injuries
Older patients more:
o rotator cuff injuries,
o degenerative joint problems
• Mechanism of injury
Abduction & external rotation dislocation of the shoulder
Chronic pain upon overhead activity or at night time rotator
cuff problem.
22. Pain where:
Rotator Cuff anterolateral & superior
Bicipital tendonitis referred to elbow
Stiffness, Instability, Clicking, Catching, Grinding:
Initial trauma
What position
How often
Weakness if large tear in the R.C, not as neuro
23. Loss of function:
Home:
oDressing coat, bra
oGrooming toilet, brushing hair
oLift objects
oArm above shoulder top shelves, hanging
Work
Sport
Referred pain mediastinal disorders, cardiac
ischaemia
24. Injury as: ACL
Mechanism position of leg at time of injury
Direct / indirect
Audible POP
Did it swell up:
Immediately (haemathrosis)
Delayed (traumatic synovitis)
What first aid was done / treated
Could continue football match or had to leave
25. Insidious as O.A
Walking distance
Walking aid
How pray regular or chair
Cross legs on ground
Squat (traditional toilet)
Swelling on & off
Old injury intra-articular
26. Importance
Structure
Orthopedic C/O…
History of treatment
Special H/O:
Pediatric
Spine
Shoulder
Knee
27. Clinical examination of orthopedic pt:-Clinical examination of orthopedic pt:-
The examination actually begins from
the moment we set eyes on patient. We
observe his or her general appearance,
posture and gait. When we proceed to
the structured examination, the patient
must be suitably undressed, if one limb is
affected both limbs must be exposed so that
they can be compared.
28. 1- look (inspection):-1- look (inspection):-
1.Skin:- Rash, discoloration, abrasions.
2.Soft tissues:- vessels, nerves, other
e.g. muscles, tendons, ligaments, fat,
fascia, lymph nodes.
3.Bone and joint including synovial
and ligaments.
30. 3- move:-3- move:-
1-active movement:-ask pt to move the joint
and test for power.
2-passive movement:-examiner who moves
the joint in each anatomical plane.
31. *Joint movement:-
1-Flexion/extension
(These are movements in the sagittal plane for e.g. knee
elbow and ankle joints of toes).
2-Abduction/adduction
(These are movements in the coronal plane, towards or
away from the midline)
3-Internal/external rotation
(These are rotational movement around the
longitudinal axis).
4-Pronation/ supination
(There are also rotatory movement they are applied
only to movement of forearm and foot)
5-Circumduction
(This is a composite movement. It is possible only
for ball and socket joints e.g. hip and shoulder)