Shortness of Breath
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This 60-year-old man presented with sudden onset of dyspnea at rest for 1 day along with orthopnea and chest tightness. On examination, he had rhonchi and crepitations in both lungs with low oxygen saturation. Relevant tests showed hyperinflated lungs on CXR, LBBB on ECG, and hypoxemia and hypercapnia on ABG. The final diagnosis was acute left ventricular failure exacerbating chronic obstructive pulmonary disease.
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Clinical methods
1. Making a diagnosis involves two steps - observation through clinical methods like history taking, physical examination, and ancillary investigations, and interpretation of the information obtained.
2. A thorough history taking involves assessing the patient's presenting complaint, history of present complaint, reviewing systems, past medical history, drug history, social history, and family history.
3. A physical examination follows a set order and assesses the cardiovascular, respiratory, gastrointestinal, and other body systems through inspection, palpation, percussion, and auscultation. Specific physical findings provide clues to different conditions.
Cardiorespiratory Assessment
This document provides information on assessing patients with respiratory disorders. It defines assessment as an ongoing process to continuously monitor and reassess the patient. Key areas of assessment include gathering information, subjective assessment through patient interviews, and objective assessment through physical examination. Specific questions are outlined to gather information on symptoms like cough, sputum, chest pain, wheezing and breathlessness. Physical examination focuses on vital signs, respiratory rate, breath sounds, jugular venous pressure, and chest examination. Assessment aims to determine the severity and nature of the respiratory disorder.
Ortners Syndrome: A Rare Cause of Hoarseness of Voice
Ortners Syndrome: A Rare Cause of Hoarseness of VoiceSSR Institute of International Journal of Life Sciences
Dr. Amit kumar Suresh Rathi*, Dr. Vinod Gite, Dr. Kanchan Rahul Tadke
ABSTRACT- INTRODUCTION: Hoarseness of voice is a very common symptom seen in the ENT outpatient department. Vocal cord palsy due to cardiac diseases and conditions are very less reported .Ortners syndrome or cardiovocal syndrome is one of it, which constitutes hoarseness of voice due to left recurrent laryngeal nerve involvement in cardiovascular disease.
CASE REPORT : A 40 year old lady was referred to ENT outpatient department by the physicians for hoarseness of voice. Patient had hoarseness since 10months; there was no history of smoking, alcohol abuse, voice abuse or upper respiratory tract infection. On complete ENT examination including the indirect laryngoscopy left vocal cord was found to be immobile. Other ENT examination was normal.
DISCUSSION: Hoarseness of voice due to paralysis of the left recurrent laryngeal nerve caused by a dilated left atrium in mitral stenosis was first discussed by Nobert Ortner, a Viennese physician, in1897. He explained that hoarseness was caused by compression of the left recurrent laryngeal nerve by the enlarged left atrium. Later it was described with other identifiable cardiovascular diseases associated either with left atrial enlargement including mitral regurgitation and atrial myxoma or severe pulmonary hypertension including congenital heart diseases. For this reason it is also known as cardiovocal syndrome.
CONCLUSION: For an ENT surgeon, in a case of clinical fix, when all possible causes of the vocal cord palsy are ruled out, a complete cardiovascular examination should be sought.
Key-words: Ortners syndrome, Left recurrent laryngeal nerve palsy, Mitral stenosis, Cardiovocal syndrome
Writing a SOAP Clinic Note Cheat Sheet
This student "cheat sheet" is designed to provide medical students with basic information regarding how to write a basic Subjective, Objective, Assessment & Plan (SOAP) Clinic Note. It also includes information on how to organize a presentation to an attending physician and how to write a basic prescription.
These guides are particularly designed for first and second-year medical students as an introduction to ambulatory care medicine and attempts to tie in the basic pathophysiology that is high-yield for USMLE Step 1.
Any and all feedback is very welcomed.
Cardiopulmonary assessment
This document provides information on cardiopulmonary assessment, including measurements, documentation, subjective and objective assessments, and common investigations. It details the components of history taking including symptoms, medications, family history, and social history. Objective assessment includes vital signs, respiratory effort, accessory muscle use, and investigations like chest X-rays, pulmonary function tests, and bloodwork. Key symptoms of respiratory disease like dyspnea, cough, sputum, and chest pain are described in detail regarding causes, types, and scales to evaluate severity.
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This document describes a case of chronic suppurative otitis media in a 27-year-old male patient who presented with a 1-year history of right ear discharge and decreased hearing. On examination, the patient was found to have a central perforation in the right eardrum. Investigations including audiogram and x-ray mastoid confirmed the diagnosis. The patient was treated with ear drops, oral antibiotics, nasal decongestants, and antihistamines. He was counseled on keeping the ear dry and the possibility of undergoing myringoplasty surgery.
History taking (cardio respiratory)
THIS PPT CONTAINS DESCRIPTION ABOUT HISTORY TAKING IN PATIENTS WITH CARDIORESPIRATORY DISEASES, EXPLAINED IN DETAILS ABOUT ALL SYMPTOMS & ITS DETAILED HISTORY.
History taking in respiratory system
The document provides guidance on taking a thorough respiratory system history. It emphasizes allowing the patient to describe their own complaints before asking focused questions. Key areas to inquire about include the onset, duration, characteristics and exacerbating/relieving factors of cough, sputum, haemoptysis and breathlessness. Details on these symptoms such as color, consistency and diurnal variation provide clinical insights into potential conditions. A complete respiratory history is important for determining the nature and severity of a patient's problems.
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Clinical methods
1. Making a diagnosis involves two steps - observation through clinical methods like history taking, physical examination, and ancillary investigations, and interpretation of the information obtained.
2. A thorough history taking involves assessing the patient's presenting complaint, history of present complaint, reviewing systems, past medical history, drug history, social history, and family history.
3. A physical examination follows a set order and assesses the cardiovascular, respiratory, gastrointestinal, and other body systems through inspection, palpation, percussion, and auscultation. Specific physical findings provide clues to different conditions.
Cardiorespiratory Assessment
This document provides information on assessing patients with respiratory disorders. It defines assessment as an ongoing process to continuously monitor and reassess the patient. Key areas of assessment include gathering information, subjective assessment through patient interviews, and objective assessment through physical examination. Specific questions are outlined to gather information on symptoms like cough, sputum, chest pain, wheezing and breathlessness. Physical examination focuses on vital signs, respiratory rate, breath sounds, jugular venous pressure, and chest examination. Assessment aims to determine the severity and nature of the respiratory disorder.
Ortners Syndrome: A Rare Cause of Hoarseness of Voice
Ortners Syndrome: A Rare Cause of Hoarseness of VoiceSSR Institute of International Journal of Life Sciences
Dr. Amit kumar Suresh Rathi*, Dr. Vinod Gite, Dr. Kanchan Rahul Tadke
ABSTRACT- INTRODUCTION: Hoarseness of voice is a very common symptom seen in the ENT outpatient department. Vocal cord palsy due to cardiac diseases and conditions are very less reported .Ortners syndrome or cardiovocal syndrome is one of it, which constitutes hoarseness of voice due to left recurrent laryngeal nerve involvement in cardiovascular disease.
CASE REPORT : A 40 year old lady was referred to ENT outpatient department by the physicians for hoarseness of voice. Patient had hoarseness since 10months; there was no history of smoking, alcohol abuse, voice abuse or upper respiratory tract infection. On complete ENT examination including the indirect laryngoscopy left vocal cord was found to be immobile. Other ENT examination was normal.
DISCUSSION: Hoarseness of voice due to paralysis of the left recurrent laryngeal nerve caused by a dilated left atrium in mitral stenosis was first discussed by Nobert Ortner, a Viennese physician, in1897. He explained that hoarseness was caused by compression of the left recurrent laryngeal nerve by the enlarged left atrium. Later it was described with other identifiable cardiovascular diseases associated either with left atrial enlargement including mitral regurgitation and atrial myxoma or severe pulmonary hypertension including congenital heart diseases. For this reason it is also known as cardiovocal syndrome.
CONCLUSION: For an ENT surgeon, in a case of clinical fix, when all possible causes of the vocal cord palsy are ruled out, a complete cardiovascular examination should be sought.
Key-words: Ortners syndrome, Left recurrent laryngeal nerve palsy, Mitral stenosis, Cardiovocal syndrome
Writing a SOAP Clinic Note Cheat Sheet
This student "cheat sheet" is designed to provide medical students with basic information regarding how to write a basic Subjective, Objective, Assessment & Plan (SOAP) Clinic Note. It also includes information on how to organize a presentation to an attending physician and how to write a basic prescription.
These guides are particularly designed for first and second-year medical students as an introduction to ambulatory care medicine and attempts to tie in the basic pathophysiology that is high-yield for USMLE Step 1.
Any and all feedback is very welcomed.
Cardiopulmonary assessment
This document provides information on cardiopulmonary assessment, including measurements, documentation, subjective and objective assessments, and common investigations. It details the components of history taking including symptoms, medications, family history, and social history. Objective assessment includes vital signs, respiratory effort, accessory muscle use, and investigations like chest X-rays, pulmonary function tests, and bloodwork. Key symptoms of respiratory disease like dyspnea, cough, sputum, and chest pain are described in detail regarding causes, types, and scales to evaluate severity.
CSOM by Nomi
This document describes a case of chronic suppurative otitis media in a 27-year-old male patient who presented with a 1-year history of right ear discharge and decreased hearing. On examination, the patient was found to have a central perforation in the right eardrum. Investigations including audiogram and x-ray mastoid confirmed the diagnosis. The patient was treated with ear drops, oral antibiotics, nasal decongestants, and antihistamines. He was counseled on keeping the ear dry and the possibility of undergoing myringoplasty surgery.
History taking (cardio respiratory)
THIS PPT CONTAINS DESCRIPTION ABOUT HISTORY TAKING IN PATIENTS WITH CARDIORESPIRATORY DISEASES, EXPLAINED IN DETAILS ABOUT ALL SYMPTOMS & ITS DETAILED HISTORY.
History taking in respiratory system
The document provides guidance on taking a thorough respiratory system history. It emphasizes allowing the patient to describe their own complaints before asking focused questions. Key areas to inquire about include the onset, duration, characteristics and exacerbating/relieving factors of cough, sputum, haemoptysis and breathlessness. Details on these symptoms such as color, consistency and diurnal variation provide clinical insights into potential conditions. A complete respiratory history is important for determining the nature and severity of a patient's problems.
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This document outlines questions to ask patients regarding their cardiovascular history and presenting complaints. It includes inquiries about chest pain characteristics, shortness of breath, ankle swelling, fainting or dizziness, and palpitations. It also prompts gathering information on past medical history, drug history, family history, social history, and allergies. The goal is to perform a thorough review of symptoms to evaluate patients for potential heart issues.
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This document provides a template for conducting a cardio-respiratory assessment of a patient. It includes sections for collecting information on the patient's chief complaints, medical history, subjective examination involving the history of present illness and associated symptoms, as well as an objective examination involving vital signs, physical inspection, palpation, percussion, and auscultation of the chest, neck, and extremities. The assessment aims to gather comprehensive details on the patient's respiratory and cardiovascular health through a structured interview and physical exam.
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4. Rheumatic heart disease.
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- Mark Baxter, Head of Product (FitBrains) at Rosetta Stone
- Itamar Lesuisse, CEO of Peak
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Access to Health Care Affects Teenage Childbearing
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The document summarizes key points about low back pain (LBP):
- LBP is extremely common, with lifetime prevalence rates from 50-80% and point prevalence rates of 15-30%
- LBP can be classified as acute (<4 weeks), subacute (4 weeks to 3 months) or chronic (>3 months)
- Causes of LBP include mechanical (80-90%), neurogenic (5-15%), and other non-mechanical causes
- Features in history and examination can help distinguish neuropathic from mechanical LBP and identify red flags requiring further evaluation
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The first case involves an elderly male patient at a nursing home with chest pain and difficulty breathing. After assessment, the patient is diagnosed with a spontaneous pneumothorax.
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UPPER LIMB ISCHAEMIA.pptx
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Neuro Urology...Fantastic presentation by Prof Drake of Southmead
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An Interesting Case of Giddiness.pptx
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Oral Psychosomatic Disorder part 1
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SENSATION AND PERCEPTION By group 1.pptx
The document discusses sensation and perception. It defines sensation as the reaction of sense organs to stimuli, while perception is the interpretation of sensory information by the brain. It describes the different types of sensation - organic, special, and motor. Factors like thresholds and adaptation affect sensation and perception. Numbness occurs when there is a loss of sensation and can be diagnosed through tests and imaging. Its causes include medical conditions and injuries, and treatment involves medication, therapy, or surgery.
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History taking (History of Physical Examination)
A History of Physical Examination Texts and the Conception of Bedside Diagnosis. ... Throughout this paper we construct a difference between a “bedside diagnosis,” made when the physician and patient are in each other's presence, and a “remote diagnosis,” made when the patient and physician are separated.
historytaking-180726181841.pdf
This document provides guidance on taking a patient's medical history. It discusses obtaining information from sources other than the patient if they are unable to provide their own history. It also outlines the components of a thorough history, including chief complaint, history of present illness, past medical history, allergies, medications, social history, and review of systems. The goal is to understand the nature and progression of the patient's condition.
Psycho dynamics & patho physiology of diseases
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Neuro Urology...Fantastic presentation by Prof Drake of Southmead
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Shortness of Breath
- 1. ASSESS A PAT IEN T W ITH D YSPN O EA HOW TO Rohitha Jayamaha
- 2. • 60 yr old man presenting with sudden onsetdyspnoea at rest for 1 day duration. He is orthopneic and complains of intermittent chest tightnesstoo. • He is a smoker (20 pack-years) • O/E he has diffuse rhonchi and fine basalcrepitations in both lung fields. BP100/70mmHg, PR102/min, RR 20/min, saturation 92%
- 3. H O W D O YO U M X T HIS PAT IEN T? • Diagnosis? • Investigations? • Treatment?
- 4. D YSPN O EA “ D y s p n e a is a t e r m u s e d to characterize a subjective experience of breathing discomfort that is c o m p r i s e d of qualitatively distinct sensations that vary in intensity. T h e experience derives from interactions a m o n g multiple physiological, psychological, social a n d environmental factors, a n d m a y i nduce s e c o n d a r y physiological a n d behavioral responses.” - American Thoracic Society C o n s e n s u s Statement
- 5. • 15 - 20% of Hospital admissions • • • • • • • • • • • • • • • • • • • • • • • • Asthma Primary lung cancer Metastatic cancer Chronic bronchitis Bronchiolitis Laryngeal disease Tracheal stenosis Tracheaomalacia Alveolitis Drug toxicity Anaphylaxis Emphysema Chronic Bronchitis Pneumonitis Pulmonary edema Pulmonary fibrosis Abdominal distention Chest wall trauma Pulmonary effusion Pericardial effusion Pulmonary hypertension Pulmonary embolism Vasculitis Myocardial Infarction • • • • • • • • • • • • • • • • • • • • • • • • Arrhythmia Myocardial ischemia Congestive heart failure Intracardiac shunt Left ventricular hypertrophy Atrial myxoma Pericarditis Myocarditis Valvular disease Myopathy Neuropathy Phrenic nerve dysfunction Spinal cord injury Anemia Deconditioning Gastroesophageal reflux disease Hyperthyroidism Metabolic Acidosis ARDS Sepsis Psychogenic dyspnea Acute bronchitis High altitude pulmonary edema PLUS HUNDREDS MORE>>>>>>>>>>
- 6. PAT H O PH YSIO LO G Y
- 7. A N A LYSIS O F D YSPN O EA • Affected Organ/ System • Cardic • Pulmonray • Non - Cardiopulmonary • Onset • Acute • Gradual • Progression • minutes • days • weeks • Months/years
- 8. O RG A N / SYSTEM organ/system specific clinical features (Symptoms/signs) • Cardiac - • H/O Cardiac D • Chest Pain, Palpitations, SOB (Exertion, Orthopnea, PND, Trepopnea,Platypnea) • Pulmonary - • H/O Pulmonary Disease • Cough, Sputum, Wheezing, Pleuritic chest pain • Renal / Endocrine (eg.Kussmaul breathing)/ CNS (Biot's respiration,Cheyne–Stokes respiration)
- 9. O N SET A N D PRO G RESSIO N Aetiological Diagnosis
- 10. PRO BA BLE D IA G N O SIS • Affected organ system • Onset / Progression -Aetiology Probable Dx Relavent Ix Definite Diagnosis
- 11. IN VESTIG AT IO N S- 1ST LINE • Pulmonary • Saturation (Pulse oxymetry) • Spirometry • Chest X-ray • Cardiac • ECG
- 12. O TH ER IN VESTIG AT IO NS • 2nd Line • • • • ABG Echocardiography Treadmill test Lung Function tests • 3rd Line • Non - Cardiopulmonary Ix • • CBS/RBS, BU/S.Cr, Neuo-Imaging, FBC Other relevant Ix depending on the casescenario
- 13. • 60 yr oldman presenting with sudden onset dyspnoea at rest for 1 day duration. —> Acute LVF/ Exacerbation ofCOPB 3rd • He is orthopneic and complains of intermittent chest tightness too. —> Cardiac Cause?1st • He is a smoker (20 pack-years) 2nd • O/E he has diffuse rhonchi and fine basal crepitations in both lung fields. BP100/70mmHg, PR102/min, RR20/min, saturation 88% —> LVF+/- COPD 4th
- 14. RELAV EN T IN VESTIG AT IO NS • CXR- Hyperinflated lung fields with basal haziness • ECG - LBBB • ABG - PaO2 60mmHg , PCO2 50mmHg Final Diagnosis - Acute LVFin a patient with COPD