The document provides practice OSCE scenarios for medical students, including patient histories, exam checklists, and role directions. It includes 7 scenarios covering topics like chest pain, shoulder pain, asthma management, and sore throat. The goal is for students to practice history taking, physical exams, and presenting assessments and plans to standardized patients.
A 45 years old lady presented with generalized weakness and palpitations. She is a diagnosed case of chronic renal failure with Diabetes mellitus and Hypertension. Her serum K+ level is 6.8 meq/L. She had the following ECG.
Case; A 54 years old gentleman complained of chest discomfort on exertion for the last 5 months. He is smoker for 10 years, diabetic for 5 years and hypertensive for 3 years. He had the following ECG.
Case: A 25 years old gentleman presented with chest pain and fever .He was normotensive, non-smoker and non-diabetic. His pulse 128b/min and BP-130/80 mm Hg. Troponin I was normal.
Case: A 58 years old gentleman complained of severe central chest pain with excessive sweating 5 days back. He is smoker for 7 years, diabetic for 5 years and hypertensive for 4 years. His BP-90/70 mm Hg. He had the following ECG.
This week we are covering HEENT. At this time you are assigned an TakishaPeck109
This week we are covering HEENT. At this time you are assigned an episodic/focused note. You will need this assigned case study to complete the Case Study Assignment for this week. Focused assessment means you still fill out all review of systems and as needed type “Patient denies” in the sections that you are not covering or are needed. Again, you are allowed to make up the information that is needed to fill out the episodic note.
If your LAST NAME starts with letters A – J: please proceed with Option 1.
If your LAST NAME starts with letters K – Z: please proceed with Option 2.
Option 1:
CASE STUDY: 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 during the past 2 weeks, Lily figured she shouldn't take her 3-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.
To Prepare
· By Day 1 of this week, you will be assigned to a specific case study for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
· Also, your Case Study Assignment should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP Notes have specific data included in every patient case.
With regard to the case study you were assigned:
· Review this week's Learning Resources and consider the insights they provide.
· Consider what history would be necessary to collect from the patient.
· Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient's condition. How would the results be used to make a diagnosis?
· Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.
The Assignment
Use the Episodic/Focused SOAP Template and create an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient's differential diagnosis and justify why you selected each.
This
week
we
are
covering
HEENT.
At
this
time
you
are
assigned
an
episodic
/
focuse
d
note.
You
will
need
this
assigned
case
study
to
complete
the
Case
Study
Assignment
for
this
week.
Focused
assessment
means
you
still
fill
out
all
review
of
systems
and
...
Approach to internship (mbbs in bangladesh perspective)Pritom Das
Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.
A 45 years old lady presented with generalized weakness and palpitations. She is a diagnosed case of chronic renal failure with Diabetes mellitus and Hypertension. Her serum K+ level is 6.8 meq/L. She had the following ECG.
Case; A 54 years old gentleman complained of chest discomfort on exertion for the last 5 months. He is smoker for 10 years, diabetic for 5 years and hypertensive for 3 years. He had the following ECG.
Case: A 25 years old gentleman presented with chest pain and fever .He was normotensive, non-smoker and non-diabetic. His pulse 128b/min and BP-130/80 mm Hg. Troponin I was normal.
Case: A 58 years old gentleman complained of severe central chest pain with excessive sweating 5 days back. He is smoker for 7 years, diabetic for 5 years and hypertensive for 4 years. His BP-90/70 mm Hg. He had the following ECG.
This week we are covering HEENT. At this time you are assigned an TakishaPeck109
This week we are covering HEENT. At this time you are assigned an episodic/focused note. You will need this assigned case study to complete the Case Study Assignment for this week. Focused assessment means you still fill out all review of systems and as needed type “Patient denies” in the sections that you are not covering or are needed. Again, you are allowed to make up the information that is needed to fill out the episodic note.
If your LAST NAME starts with letters A – J: please proceed with Option 1.
If your LAST NAME starts with letters K – Z: please proceed with Option 2.
Option 1:
CASE STUDY: 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 during the past 2 weeks, Lily figured she shouldn't take her 3-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.
To Prepare
· By Day 1 of this week, you will be assigned to a specific case study for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
· Also, your Case Study Assignment should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP Notes have specific data included in every patient case.
With regard to the case study you were assigned:
· Review this week's Learning Resources and consider the insights they provide.
· Consider what history would be necessary to collect from the patient.
· Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient's condition. How would the results be used to make a diagnosis?
· Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.
The Assignment
Use the Episodic/Focused SOAP Template and create an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient's differential diagnosis and justify why you selected each.
This
week
we
are
covering
HEENT.
At
this
time
you
are
assigned
an
episodic
/
focuse
d
note.
You
will
need
this
assigned
case
study
to
complete
the
Case
Study
Assignment
for
this
week.
Focused
assessment
means
you
still
fill
out
all
review
of
systems
and
...
Approach to internship (mbbs in bangladesh perspective)Pritom Das
Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.
Assignment DetailsCase Study #2Date November 12, 2016, .docxfaithxdunce63732
Assignment Details
Case Study #2
Date: November 12, 2016, 2:00 pm
Location: XYZ Family Practice
You are an NP student in this practice. Your next patient is the following:
“I had to come in today because I have been coughing for a long time”
Amanda Smith (69 year old, black female) is a retired postal worker. During the visit, she is coughing continually. She states the cough started 5 days ago intermittently but 2 days ago it became constant. Her chart indicates that she has been a patient of the practice for 5 years, gets care regularly and her HTN has been controlled for 4 years.
Social History
Married – 2 adult children A & W
Non-Smoker now. Smoke 1 pack a day for 15 years. Quit x5 years ago
No alcohol or drug use
Baptist, attends church regularly and is a member of the choir
Family History
Mother – Deceased at age 27 from traumatic accident
Father – Deceased age 78 related to renal failure secondary to diabetes type II
Siblings – one brother age 61 A & W
Medical/Surgical/Health Maintenance Hx
Measles, mumps and chicken pox as a child.
Tetanus/Diptheria/Pertussis – Last dose 2 years ago
Influenza – Last dose 9 months ago
Pneumococcal vaccine at age 65
Zostivax at age 60
Chronic diagnoses – HTN x 5 years
Takes HCTZ 25 mg daily
ROS
General
Usual weight has been maintained
Fever for 5 days up to 101
Skin
Dry skin, uses emollient frequently
HEENT
Wears reading glasses
Dentition fair. Partial upper denture
Neck
No swelling or stiffness
Chest
Substernal pain on cough
Respiratory
Began coughing 4 days ago. Started mild, intermittent and non-productive. Two days ago became constant and productive of frothy sputum. Keeps her awake at night. No relief with OTC cough syrup. She states she is short of breath today.
CV
No CP at rest or when not coughing
PV
Some swelling of feet and ankles at end of day, relieved by elevating feet
GI
Decreased appetite for one week
No change in bowel habits
GU
No frequency, hesitancy, nocturia or change in bladder habits
Genitalia
No changes
MS
Stiffness in hands and legs on awakening. Relieved with activity
Psych
No depression, anxiety, or memory change
Neurologic
No numbness, weakness, headache, change in mentation, or paralysis
Hematologic
No past anemia
Endocrine
No change in weight, thirst, heat/cold intolerance.
Your physical exam reveals:
Temp 101.4, Resp 30 labored, no retractions, BP 135/92, HR 110, Pulse Ox 90 Wt 130 lbs
General appearance – Alert in all spheres, in mild respiratory distress, able to answer questions with short sentences, tripod breathing
HEENT –
Eyes ,ear, nose, head wnl
Mouth -mucosa dry
Pharynx – tonsils present not enlarged, normal pink color
Lymph – no enlargement
Skin – Dry and scaly legs and arms. Tenting of skin noted
Heart- regular rhythm at 110 bpm, no murmurs or extra sounds
Lungs – normal breath sound without crackles, bronchophony or egophony
Abdomen – no mass, tenderness, rigidity
Extremities – Hands – no sw.
Soap Note 1 Acute Conditions (15 Points) asthmaPick any .docxpbilly1
Soap Note 1 Acute Conditions (15 Points)
asthma
Pick any Acute Disease from Weeks 1-5 (see syllabus)
Soap notes will be uploaded to Moodle and put through TURN-It-In (anti-Plagiarism program)
Turn it in Score must be less than 50% or will not be accepted for credit, must be your own work and in your own words. You can resubmit, Final submission will be accepted if less than 50%. Copy paste from websites or textbooks will not be accepted or tolerated. Please see College Handbook with reference to Academic Misconduct Statement.
Late Assignment Policy
Assignments turned in late will have 1 point taken off for every day assignment is late, after 7 days assignment will get grade of 0. No exceptions
Follow the MRU Soap Note Rubric as a guide:
Grading Rubric
Student______________________________________
This sheet is to help you understand what we are looking for, and what our margin remarks might be about on your write ups of patients. Since at all of the white-ups that you hand in are uniform, this represents what MUST be included in every write-up.
1) Identifying Data (___5pts): The opening list of the note. It contains age, sex, race, marital status, etc. The patient complaint should be given in quotes. If the patient has more than one complaint, each complaint should be listed separately (1, 2, etc.) and each addressed in the subjective and under the appropriate number.
2) Subjective Data (___30pts.): This is the historical part of the note. It contains the following:
a) Symptom analysis/HPI(Location, quality , quantity or severity, timing, setting, factors that make it better or worse, and associate manifestations.(10pts).
b) Review of systems of associated systems, reporting all pertinent positives and negatives (10pts).
c) Any PMH, family hx, social hx, allergies, medications related to the complaint/problem (10pts). If more than one chief complaint, each should be written u in this manner.
3) Objective Data(__25pt.): Vital signs need to be present. Height and Weight should be included where appropriate.
a) Appropriate systems are examined, listed in the note and consistent with those identified in 2b.(10pts).
b) Pertinent positives and negatives must be documented for each relevant system.
c) Any abnormalities must be fully described. Measure and record sizes of things (likes moles, scars). Avoid using “ok”, “clear”, “within normal limits”, positive/ negative, and normal/abnormal to describe things. (5pts).
4) Assessment (___10pts.): Diagnoses should be clearly listed and worded appropriately.
5) Plan (___15pts.): Be sure to include any teaching, health maintenance and counseling along with the pharmacological and non-pharmacological measures. If you have more than one diagnosis, it is helpful to have this section divided into separate numbered sections.
6) Subjective/ Objective, Assessment and Management and Consistent (___10pts.): Does the note support the appropriate differential diagnosis process? Is there eviden.
CASE STUDY 2 Focused Throat Exam Lily is a 20-year-old student .docxmoggdede
CASE STUDY 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 during the past 2 weeks, Lily figured she shouldn't take her 3-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.
To Prepare
· By Day 1 of this week, you will be assigned to a specific case study for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
· Also, your Case Study Assignment should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP Notes have specific data included in every patient case.
With regard to the case study you were assigned:
· Review this week's Learning Resources and consider the insights they provide.
· Consider what history would be necessary to collect from the patient.
· Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient's condition. How would the results be used to make a diagnosis?
· Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.
The Assignment
Use the Episodic/Focused SOAP Template and create an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient's differential diagnosis and justify why you selected each.
Episodic/Focused SOAP Note Template
– (delete information on this template and input one related to the patient in the case study above).
Patient Information:
Initials, Age, Sex, Race
S.
CC
(chief complaint) a BRIEF statement identifying why the patient is here - in the patient’s own words - for instance "headache", NOT "bad headache for 3 days”.
HPI
: This is the symptom analysis section of your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis. Paint a picture of what is wrong with the patient. Use LOCATES Mnemonic to complete your HPI. You need to start EVERY HPI with age, race, and gender (e.g., 34-year-old AA male). You must include the seven attributes of each principal symptom in paragraph form not a list. If the CC was “headache”, the LOCATES for the HPI might look like the following example:
Location: h.
Focused Ear ExamMartha brings her 11-year old grandson, James, t.docxkeugene1
Focused Ear Exam
Martha brings her 11-year old grandson, James, to your clinic to have his right ear checked. He has complained to her about a mild earache for the past 2 days. His grandmother believes that he feels warm but did not verify this with a thermometer. James states that the pain was worse while he was falling asleep and that it was harder for him to hear. When you begin basic assessments, you notice that James has a prominent tan. When you ask him how he's been spending his summer, James responds that he's been spending a lot of time in the pool.
Use the Episodic/Focused SOAP Template and create an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient's differential diagnosis and justify why you selected each.
Episodic/Focused SOAP Note Template
Patient Information:
Initials, Age, Sex, Race
S.
CC
(chief complaint) a BRIEF statement identifying why the patient is here - in the patient’s own words - for instance, "headache", NOT "bad headache for 3 days”.
HPI
: This is the symptom analysis section of your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis. Paint a picture of what is wrong with the patient. Use LOCATES Mnemonic to complete your HPI. You need to start EVERY HPI with age, race, and gender (e.g., 34-year-old AA male). You must include the seven attributes of each principal symptom in paragraph form, not a list. If the CC was “headache”, the LOCATES for the HPI might look like the following example:
Location: head
Onset: 3 days ago
Character: pounding, pressure around the eyes and temples
Associated signs and symptoms: nausea, vomiting, photophobia, phonophobia
Timing: after being on the computer all day at work
Exacerbating/ relieving factors: light bothers eyes, Aleve makes it tolerable but not completely better
Severity: 7/10 pain scale
Current Medications
: include dosage, frequency, length of time used and reason for use; also include OTC or homeopathic products.
Allergies:
include medication, food, and environmental allergies separately (a description of what the allergy is ie angioedema, anaphylaxis, etc. This will help determine a true reaction vs intolerance).
PMHx
: include immunization status (note date of
last tetanus
for all adults), past major illnesses and surgeries. Depending on the CC, more info is sometimes needed
Soc Hx
: include occupation and major hobbies, family status, tobacco & alcohol use (previous and current use), any other pertinent data. Always add some health promo question here - such as whether they use seat belts all the time or whether they have working smoke detectors in the house, living environment, text/cell phone use while driving, and support system.
Fam Hx
: i.
Chief compliant(CC) Joshuas hyperactive and attentional difficultJinElias52
Chief compliant(CC) Joshua's hyperactive and attentional difficulties have been exhibited both at school and at home.
HISTORY: Joshua is a Hispanic or Latino 10-year-old boy. This evaluation was requested because
mother is worried about patient's aggressive behavior toward his younger brother and ADHD
symptoms. Mother report that patient was diagnosed at age 6 by pediatrician with ADHD,
medication was started at that time (mother unable to remember name) until age 9. Mother stopped
administering medication because it caused decrease appetite, insomnia and weight loss. Patient
is not currently taking any medication at this time.
Behavior Described In:
Symptoms/ behavior Joshua exhibits symptoms of inattention. He reports difficulty sustaining attention. His mind
wanders or he forgets. He does not seem to listen when spoken to directly. He often needs
directions repeated. Joshua is easily distracted by noises. by the radio. by other people. Joshua
needs supervision or frequent redirection. He has a short attention span.
Joshua exhibits signs of hyperactivity. He exhibits restlessness or fidgety behavior. This
behavior is evident during school hours. He tends to frequently leave his seat. He is
easily bored and changes activities frequently. Joshua 's excessive movement has been noted. He
is fidgety or squirms when required to sit still for a period of time. He frequently jumps or climbs.
Joshua exhibits signs of impulsive behavior. He frequently interrupts others. He often acts
in a reckless manner. He has difficulty accepting limits.
Joshua has other exhibited symptoms.
He exhibits stubborn or willful behavior.
EXAM: Joshua appears flat, inattentive, distracted, normal weight, He exhibits speech that is
normal in rate, volume, and articulation and is coherent and spontaneous. Language skills are
intact. Affect is appropriate, full range, and congruent with mood. Associations are intact and
logical. There are no apparent signs of hallucinations, delusions, bizarre behaviors, or other
indicators of psychotic process. Associations are intact, thinking is logical, and thought content
appears appropriate. Suicidal ideas or intentions are denied. Homicidal ideas or intentions are
denied. There are signs of anxiety. A short attention span is evident. Judgment appears to be
poor. Insight into problems appears to be poor. He is easily distracted. Joshua is restless. Joshua is
fidgety. There is physical hyperactivity. Joshua displayed defiant behavior during the examination.
Joshua made poor eye contact during the examination. Vocabulary and fund of knowledge indicate
cognitive functioning in the normal range. Cognitive functioning and fund of knowledge are intact
and age appropriate. Short- and long-term memory are intact, as is ability to abstract and do
Assignment 2: Comprehensive Psychiatric Evaluation and Patient Case Presentation
Comprehensive psychiatric evaluations are a way to reflect on your practicum experiences and connect the experiences ...
Below isthe template you are to follow when developing your .docxtangyechloe
Below is
the template you are to follow when developing your management
plan. Also, always be sure to complete the EMR on the case. Use
this template with each case. It is not a SOAP format as
that is not required. Points will be deducted for not utilizing
the template.
THIS
SECTION IS 30 POINTS!!! Follow the bullet points below. Copy and answer each
bullet point on a word document and cut and paste your responses to the
management section!
Primary
Diagnosis and ICD-10 code
: Also include any
procedural codes.
3-5 Differential Diagnoses-
Why? What made you select each one as a DDX? How
did you rule out? This would be a good area to include references.
Additional laboratory and diagnostic tests:
It may be necessary to establish or evaluate a
condition. Some tests, such as MRI, may require prior authorization from
the patient’s insurance carrier.
Consults:
referrals
to specialists, therapists (physical, occupational), counselors, or other
professionals. If you are sending it to the hospital, what orders would
you write for a direct admit?
Therapeutic modalities:
pharmacological
and nonpharmacological management.
Health Promotion:
Address risk factors as appropriate. Consider
age-appropriate preventive health screening.
Patient education:
Explanations and advice given to patient and
family members.
Disposition/follow-up instructions:
when the patient is to return sooner, and
when to go to another facility such as the emergency department, urgent
care center, specialist, or therapist.
References
(minimum
of 3, timely, that prove this plan follows the current standard of care
Pediatric SOAP Note
Name:
P. L
Date:
03/09/2018
Sex:
Male
Age/DOB/Place of Birth:
16 y.o/03/01/2001/Cuba
SUBJECTIVE
Historian:
Mother and patient
Present Concerns/CC:
“I’ve been having horrible headaches
on and off for the last 2 weeks”
Child Profile:
Patient is a high school student with no
significant past medical history. He is enrolled in a dual program where he
is taking college classes in advance. Described by his mother as an A+
student. He does participate in sports at school being part of the baseball
league. Patient goes to school during the day and spends most of his free
time studying. He eats a balanced diet including meat, vegetables, and salads.
Patient drinks water throughout the day and does not like soda beverages.
Denies drinking energetic drinks. He uses seatbelt at all times while in a
car.
HPI:
Otherwise healthy 16 y/o male seen in the
office for complaints of daily headache for 2 weeks. Pain is described as
dull and pounding and intermittent. Pain is mainly located in the back of the
head but at times radiates to the top and to the sides. Patient can’t say if
there are specific triggers for the pain because he experiences it at any
time. Pain is alleviated by rest and i.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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
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.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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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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practice-osce-scenarios.pdf
1. PRIMARY CARE CLERKSHIP PRACTICE EXAMS
1. Practice Exam: https://learnuw.wisc.edu/ (requires log in)
2. Practice OSCE Scenarios (below)
OSCE Scenarios
Introduction
Students: The following practice OSCE scenarios are provided to help prepare you for the end of
the rotation exam.
Although these are not the exact stations that you will encounter, the scenarios are representative
of the types of problems that will be tested. Scenario A contains an-depth assessor checklist to
give you a more detailed guide to the depth of knowledge and skills expected; the remaining
scenarios have a more general list of assessor criteria.
To maximize your learning, we suggest that you:
Practice these scenarios in groups of 3, alternating among Patient, Student, and Assessor
roles.
Complete and review each scenario individually--it will maximize your learning if the
‘Student’ does not view the other roles before the performance.
You may wish to print out the patient information, assessor form and any linked/attached
materials for each scenario.
Limit your time to 10 minutes per scenario. ‘Assessor’ should keep time and give a 2-
minute warning.
Assessor should note questions asked/not asked during the interviews; consider video or
audiotaping to improve recollection and feedback.
For Scenarios B-G, review and discuss the likely components of the assessor checklist.
Give each other honest feedback about performance.
2. Practice OSCE Scenario A
Student Directions:
A 27-year old woman comes into the office complaining of chest pain.
Obtain a complete history of this complaint.
After obtaining the history to your satisfaction, excuse yourself to go talk with your preceptor.
3. Practice OSCE Scenario A
Assessor Checklist
Reminder: Keep time and give a 2-minute warning before the 10 minutes is up
Introduces self appropriately
Clarifies reason for visit
Obtains history of chest pain
Onset
Location
Precipitating factors
Alleviating factors
Associated symptoms
Quality
Radiation
Severity
Timing/duration
Identifies risk factors for heart disease
Past medical history
Family history of heart disease or risk factors
Smoking history
Illicit Drug use (especially cocaine)
Hypertension
Lipids/cholesterol
Recent stressors
Exercise tolerance
Focused review of systems
Heartburn/GERD symptoms
Pain with movement/palpation
Medications
Allergies
Summarizes history
Checks for any other concerns or missed information
Overall performance
Communication skills performance
Ask Standardized Patient: How likely would you be to go back to him/her ?
4. Practice OSCE Scenario A
Patient information
You are a previously healthy 27 year-old woman. You have been having chest discomfort about
twice a week for the last 2 weeks. It is sharp, associated with difficulty getting a deep breath. It
seems to come on mostly at work or when you are driving. It lasts about a half-hour at a time.
You’ve tried Tylenol, Advil, drinking cold water, and antacids without much benefit. It doesn’t
radiate. It is severe enough to interrupt your work but not excruciating. You haven’t had any
heartburn or stomach symptoms. You are concerned that it could be a heart problem.
You smoke 15 cigarettes a day. You’re trying to quit; had cut down from 1 pack/day to ½ pack
but recently went back up to ¾ PPD, ‘probably from stress.’ No drug use. You’ve never been in
the hospital or been told you had any chronic illnesses, never had anything like this before, never
had a cholesterol test.
You are separated from your husband of two years, which is very stressful. You had argued a lot
and just grown apart, no history of domestic violence. You work as a bank supervisor, no
children, not currently sexually active or using birth control. You do aerobics 3-4 times a week
and haven’t had any problems with chest pain or breathing while exercising; ‘Actually that’s
when I feel best.’
Your father had a heart attack last year when he was 64, which is one of the reasons you are
worried about these pains. He also smokes and has high blood pressure. Your mother and older
brother are healthy.
You take a multivitamin daily, no other meds, no allergies.
5. Practice OSCE Scenario C
Student Information:
A 51-year old man comes into the office for right shoulder pain, progressive over the last 3
weeks, aggravated by his work sanding car hoods.
Perform a focused physical exam of the shoulders, explaining what you are doing, what you
are looking for, and what you are finding as you go.
When you are finished examining the patient, summarize your findings to him and explain that
you will go talk with your preceptor.
6. Practice OSCE Scenario C
Assessor Criteria
Reminder: Keep time and give a 2-minute warning before the 10 minutes is up
Introduction/agenda
Shoulder exam
Inspection
Palpation
Range of Motion
Strength
Special tests:
Summarizes findings/Checks for any other concerns or missed information
Overall performance, Communication skills, attention to patient comfort
7. Practice OSCE Scenario C:
Patient Information
You are a 50 year-old man coming in for right shoulder pain for the last 3 weeks. It seems to be
getting worse and worse. About a month ago you began a job in an autobody shop; your primary
job is sanding the paint off of car hoods. It hurts the most when you have to lean over the car and
reach across the hood holding the heavy sander. Ibuprofen helps a bit.
On the exam you will have a slight pain on palpation over the lateral aspect of the shoulder joint.
Abduction is limited actively to about 110 degrees, passively to about 130 degrees. Strength is
good, some pain with supraspinatus testing. Neers and Hawkins maneuvers elicit pain. Otherwise
normal exam.
8. Practice OSCE Scenario D
Student information
Mr. Jones, a 27 year-old previously healthy man, is seen with a 1-day history of low back pain.
You obtained his history and learned that the pain is non-radiating, worse with bending/twisting,
and not associated with any bladder/bowel incontinence. He has no symptoms or signs of
systemic illness. It started after he helped a friend move some furniture. Aspirin and a hot shower
have helped transiently.
His exam showed moderate right paralumbar muscle tenderness, normal lower extremity strength
and reflexes.
You discussed this with your preceptor, who agrees with you that this seems like an
uncomplicated back muscle strain, and asks you to now present your assessment and plan to
the patient.
9. Practice OSCE Scenario D
Assessor Criteria
Reminder: Keep time and give a 2-minute warning before the 10 minutes is up
Re-introduces
Gives diagnosis, rationale
Treatment recommendations
Acknowledges concerns, probes, negotiates
Overall performance
Communication skills
Standardized Patient: Would you go back to him/her?
10. Practice OSCE Scenario D
Patient Information
You are a 27-year old man, self-employed as a carpenter, and have always been ‘healthy as a
horse.’ This weekend you were helping a friend move, including carrying a very heavy sleeper-
sofa up 2 flights of stairs.
Yesterday you woke up with bad pain in your right lower back; you could hardly get out of bed.
You took some aspirin and a hot shower, which loosened it up enough to go to work. It got more
and more painful; you barely made it through the day. Another hot shower and aspirin helped
when you got home.
This morning it was really stiff again; there’s no way you can go through another day like
yesterday.
You have an associates degree from the local state university. You smoke about a pack of
cigarettes per day, with no real interest in quitting, and marijuana about once a week, again with
no real interest in quitting. You have had about 14 lifetime sexual partners and just started dating
someone seriously. You play softball and volleyball in a tavern league. You drink beer on the
weekends, maybe 6-10 a night.
Your older brother is disabled from a back injury (he was a fireman in a burning building that
collapsed); you have no disability insurance and are really scared that you will end up disabled.
Your father has high blood pressure.
You expect the doctor to do some tests and order an MRI to know exactly what is going on and
make sure it gets better. You will ask “Are you sure it’s not a slipped disk?” if symptomatic
treatment is suggested initially, and request an MRI. You will agree to symptomatic treatment
and monitoring if the rationale is presented adequately.
11. Practice OSCE Scenario E:
Student Information
A 17-year old young man comes in for follow-up of his asthma, which was diagnosed by
spirometry on your first visit with him 2 months ago.
He was prescribed a fluticasone (steroid) inhaler, to use 1 puff twice a day, and albuterol inhaler
with a spacer as needed.
He was recommended to check peak flow twice a day; his maximum peak flow was 600.
Assess his control and use of peak flow meter (borrow one if possible) and counsel the
patient on use of an Asthma Action Plan.
12. Practice OSCE Scenario E
Assessor Criteria
Reminder: Keep time and give a 2-minute warning before the 10 minutes is up
Introduction/agenda
Asthma history
Peak flow teaching and asthma action plan
Verifies/summarizes/follow-up
You can print an asthma action plan at:
http://www.health.state.mn.us/asthma/documents/aapenglish0107.pdf
13. Practice OSCE Scenario E
Patient Information
You are a 17-year old guy. You’ve had trouble with coughing and not being able to run very far
for a couple of years. Your gym teacher is always like, get moving, and it’s like, dude, I can’t
breathe, you know?
You saw this new doctor here 2 months ago. You told her that you had had asthma when you
were a kid but had not had any problems for several years. She did a test where you breathed into
a tube, and said it looked like your asthma had come back.
You were really bummed about that and really didn’t hear everything else she said. You were
thinking that sucks ‘cause you had been thinking of maybe trying to join the Marines and you
heard you can’t have asthma. The doctor gave you a sample of an albuterol inhaler, which you
could really feel open up your lungs and help right away. That was awesome! You’ve been using
that once or twice a day but forgot it in the car ‘cause your stupid metal shop teacher wouldn’t let
you leave school on time.
The doctor gave you a prescription for another inhaler but you kind of thought it was only if the
albuterol wasn’t working, so you haven’t filled that prescription. She gave you a peak flow meter
too but you thought that was only for when you couldn’t breathe, so you haven’t used that at all.
You noticed that it seems like going out in the cold makes your chest feel tight. That sucks
‘cause your girlfriend wanted to build a snowman and do snow angels and you had to go in the
house and she was like, you’re such a bummer and I was like, Dude I can’t breathe, you know?
Last week you were over by a friend’s house where they have, like, a hundred cats, and you
totally started wheezing, and it was like, Dude, I totally thought I was gonna die!
Other than that, you’re feeling great and really happy about how things are going.
You’re still wondering about if you can join the Marines though.
14. Practice OSCE Scenario F
Student Directions
A 51-year old post-menopausal woman is coming in for a well-woman exam.
Before you go in to see her, the nurse tells you that the patient has not changed into a gown
because she was hoping that she would not need a Pap smear. She has no health problems or
specific concerns. She just wants to get a general exam, have mammograms ordered, and get any
shots that she’s due for.
Discuss Pap smear screening with this patient, counsel her and negotiate a plan for the
visit. Then excuse yourself to talk with your preceptor
15. Practice OSCE Scenario F
Assessor Criteria
Reminder: Keep time and give a 2-minute warning before the 10 minutes is up
Introduction/agenda
Asks about Pap smears, urogynecologic history & risk factors
Negotiates plan for visit
Overall performance
Communication skills performance
(see Dr/Pt Communication student handouts)
Standardized Patient: Would you go back to him/her?
16. Practice OSCE Scenario F
Patient Information
You are a 51-year old professional woman, coming into the office for a physical. You are in
good health, with no chronic problems. No allergies. Only medications are a multi-vitamin and
baby aspirin. You’ve never smoked and you exercise regularly.
You went through menopause in your mid-40’s and didn’t really have a lot of symptoms with
that. You currently have no symptoms or concerns. You have had an exam with normal Pap
smears annually for several years.
Your family history is positive for lung cancer, which killed your father at age 55. Your mother
has high blood pressure and may be showing some signs of Alzheimer ’s disease. Two sisters are
alive and well.
You obtained your MBA from Harvard and work as a senior vice-president of human resources
for a large health care system, directing benefits for over 25,000 employees. You have been
married for 26 years and have had 3 term normal vaginal deliveries with 3 living children (18,
22, 24 years old). The oldest is in grad school working on a PhD in mathematics, his dissertation
work is on applications of Mertens Conjecture for the Rieman zeta function; the other two are
doing very well are in college.
You have never had any sexual infections, never had an abnormal pap smear, and have no
concerns that your husband has been with anyone else. Your frequency of intercourse has
‘naturally’ declined; now about 1 time per month and going just fine, thank you.
You came in for a general physical but really dislike the pelvic examination and would like to
skip that if it’s not absolutely necessary. When discussing purpose of Pap smears, you will ask
“How good are they, really? I mean if you did pap smears on a hundred women with cancer how
many would show up?”
If offered a bimanual exam, you will ask “What good would that do?”and decline.
17. Practice OSCE Scenario G
Student Information
Joe is a 5-year old boy being brought in by his parent for evaluation of a sore throat.
Obtain a history of his illness from his parent and tell the faculty what you would look for
on his exam.
Your faculty will advise you of the physical exam findings.
Present an assessment and plan to the patient’s parent. You do not need to give specific
medication dosages.
18. Practice OSCE Scenario G
Assessor Criteria and information
Reminder: Keep time and give a 2-minute warning before the 10 minutes is up
Introduction/agenda
History of present illness
Past/family/social history, focused review of systems
[After student has obtained history, ask her/him what exam components she/he would perform
and provide information that: Temperature 100.7 Looks a bit tired but non-toxic otherwise
normal exam, show mouth photo next page]
Summarizes, presents diagnostic and treatment plan
[Parent may ask about how long it will take to get a rapid strep test done: The lab is really busy
today, so it will take about 30 minutes to get a rapid strep test done.]
19.
20. Practice OSCE Scenario G
Parent Information
Your 4-year old son Joe has been sick for 2 days with a sore throat. He couldn’t go to school
today because of the pain. It hurts to swallow but he’s been taking cold liquids OK and urinating
his usual amount as far as you know. He’s had a fever up to 101.8 by mouth this morning. You
gave him Tylenol last night and this morning (about an hour ago), which seemed to bring his
temperature down. His voice seems a little ‘husky.’ No rashes, no cough or runny nose, no other
symptoms.
He has generally been healthy, up to date with all of his shots. He’s in kindergarten; there’s not
anything unusual going through the school that you know of. He has a 2-year old sister,
Emmillee, who’s in day care, so she’s had some usual colds. He has a golden retriever named Liz
and a gecko named Fido. No allergies. No one smokes at home. No unusual family history, no
recent travel or other exposures.
When/if rapid strep testing discussed, you will ask how long that will take (answer--about 30
minutes as the lab is really busy today). You need to pick up your younger daughter from day
care, so you will at first ask if the student-doctor can’t just go ahead and treat him for strep.
Ultimately you will agree to make arrangements for your spouse to pick her up, or for the
student-doctor to communicate the results to you by phone.