Introduce yourself Wash hands Check patient details Explain procedure Gain consent Gather equipment Non sterile gloves Apron Cannula Dressing Gauze Cannula - the standard size is 20g (pink) Tourniquet Saline - 10ml Syringe – 10ml Alcohol swab Prepare equipment Put on gloves & apron Open cannula: Open wings Check top cap is working Slightly withdraw & replace needle – this will make it glide easier Unscrew the cap at the back of the cannula & place upright Palpate a vein Apply tourniquet - avoid nipping the patients skin Feel for a vein: Go for a vein you can feel – it’s best if they feel “springy” It should be straight Tapping the vein & asking the patient to pump their fist can make it easier to see & feel veins It’s often easier to feel veins without gloves on Avoid placing the cannula where there will be lots of movement - e.g. antecubital fossa Avoid areas where two veins are joining (valves present) Inserting the Cannula 1. Once you have found an ideal vein it’s time to cannulate! 2. Put gloves back on if you took them off to palpate the vein 3. Clean the area with an alcohol swab for 30 seconds - outward circular motion 4. Check with the patient that its ok to proceed 5. Remove the cannula sheath 6. Ensure needle’s bevel is pointing upwards 7. Secure the vein with your non-dominant hand from below 8. Warn them of a sharp scratch 9. Insert cannula at 20-40º – do it in a smooth firm motion & don’t hesitate 10. When you enter the vein you’ll see flashback – blood filling cannula 11. Advance the needle a further 1mm after flashback to ensure it’s in the veins lumen 12. Hold the needle still & advance the cannula forwards slightly 13. Withdraw the needle slightly so that it’s sharp point is inside of the plastic tubing 14. Advance cannula fully into vein – the needle inside the tube will stop the plastic from kinking 15. Release the tourniquet – this will reduce bleeding 16. Place some gauze directly underneath the cannula - this will prevent blood dripping 17. Apply pressure over the vein from above - this should occlude the vein & reduce bleeding 18. Remove the needle 19. Get the cap you unscrewed at the beginning & quickly screw back onto the cannula 20. Ensure you dispose of the needle into a sharps bin as soon as possible 21. Put some sticky strips on the cannula wings to steady before you flush it There are many different methods of cannulation, this is just one example What’s important is that you find a method you are comfortable with, and practice lots Securing the Cannula Place the sticky dressing over the cannulated area Remove the sticky covering to reveal the clear plastic dressing - this can be fidgety! Flushing the Cannula Set up flush: Open 5-10ml syringe Get 10ml bottle of saline Confirm type of fluid & date of expiry Withdraw fluid from saline bottle into syringe Remove any air bubbles within syringe Ask them to tell you if they feel any pain or discomfort Remove the top cap from the cannula port & insert syringe Inject the fluid into the cannula: It should go in smoothly with little resistance Watch for signs of swelling around the site – stop immediately if you see this! If the patient complains of pain you should also stop immediately! Close the cannula port To complete the procedure… Thank the patient Document the following; Patient details Date & time of cannulation Reason for cannulation Type of cannula used - e.g 20 gauge Date the cannula should be removed or replaced Your name What if I fail my first attempt? Don’t panic! – this is common and not the big deal you’ll feel it is Try again: Get some new equipment Try another part of the vein, or another vein entirely If you fail again ask someone else to try - don’t let it get you down, it’s not a big deal . DO NOT Relentlessly continue trying to cannulate a patient - ask for help Re-use the same equipment
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د.كمال سيد Admin
عدد المساهمات : 2397نقاط : 4183السٌّمعَة : 9الجنس : علم بلدك : تاريخ الميلاد : 03/04/1950تاريخ التسجيل : 30/07/2012العمر : 74 الموقع : السودان - سنارالعمل/الترفيه : طبيب عمومى وموجات صوتيةالساعة الان : دعائي :
A physical examination, medical examination, or clinical examination (more popularly known as a check-up or medical) is the process by which a doctor investigates the body of a patient for signs of disease. It generally follows the taking of the medical history — an account of the symptoms as experienced by the patient. Together with the medical history, the physical examination aids in determining the correct diagnosis and devising the treatment plan. This data then becomes part of the medical record. [/color][وحدهم المديرون لديهم صلاحيات معاينة هذا الرابط] --------------
Vital signs Vital signs are measures of various physiological statistics, often taken by health professionals, in order to assess the most basic body functions. Vital signs are an essential part of a case presentation. The act of taking vital signs normally entails recording body temperature, pulse rate (or heart rate), blood pressure, and respiratory rate, but may also include other measurements. Vital signs often vary by age. Primary four
There are four vital signs which are standard in most medical settings: Body temperature Pulse rate (or heart rate) Blood pressure Respiratory rate The equipment needed is a thermometer, a sphygmomanometer, and a watch. Though a pulse can often be taken by hand, a stethoscope may be required for a patient with a very weak pulse.
Normal human body temperature, also known as normothermia or euthermia, depends upon the place in the body at which the measurement is made, and the time of day and level of activity of the person. Despite what many schoolchildren are taught, there is no single number that represents a normal or healthy temperature for all people under all circumstances using any place of measurement. Different parts of the body have different temperatures. Rectal and vaginal measurements, or measurements taken directly inside the body cavity, are typically slightly higher than oral measurements, and oral measurements are somewhat higher than skin temperature. The commonly accepted average core body temperature (taken internally) is 37.0 °C (98.6 °F). The typical oral (under the tongue) measurement is slightly cooler, at 36.8° ± 0.4°C (98.2° ± 0.7°F), and temperatures taken in other places (such as under the arm or in the ear) produce different typical numbers.[1] Although some people think of these numbers as representing the normal temperature, a wide range of temperatures has been found in healthy people.[2]
Human body temperature
In healthy adults, body temperature fluctuates about 0.5 °C (0.9 °F) throughout the day, with lower temperatures in the morning and higher temperatures in the late afternoon and evening, as the body's needs and activities change.[1] The time of day and other circumstances also affect the body's temperature. The core body temperature of an individual tends to have the lowest value in the second half of the sleep cycle; the lowest point, called the nadir, is one of the primary markers for circadian rhythms. The body temperature also changes when a person is hungry, sleepy, or cold.
Circadian rhythm
A circadian rhythm ( /sɜrˈkeɪdiən/) is any biological process that displays an endogenous, entrainable oscillation (occurs when rhythmic physiological or behavioral events match their period and phase to that of an environmental oscillation) of about 24 hours. These rhythms are driven by a circadian clock, and rhythms have been widely observed in plants, animals, fungi and cyanobacteria. The term circadian comes from the Latin circa, meaning "around" (or "approximately"), and diem or dies, meaning "day". The formal study of biological temporal rhythms, such as daily, tidal (diurnal falls & rises), weekly, seasonal, and annual rhythms, is called chronobiology. Although circadian rhythms are endogenous ("built-in", self-sustained), they are adjusted (entrained) to the local environment by external cues called zeitgebers, commonly the most important of which is daylight. Zeitgeber (from German for "time giver," or "synchronizer") is any exogenous (external) cue that synchronizes an organism's endogenous time-keeping system (internal clock) to the earth's 24-hour light/dark cycle and 12 month cycle . The strongest zeitgeber, for both plants and animals, is light.
يتبع
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د.كمال سيد Admin
عدد المساهمات : 2397نقاط : 4183السٌّمعَة : 9الجنس : علم بلدك : تاريخ الميلاد : 03/04/1950تاريخ التسجيل : 30/07/2012العمر : 74 الموقع : السودان - سنارالعمل/الترفيه : طبيب عمومى وموجات صوتيةالساعة الان : دعائي :
Diurnal variation in body temperature, ranging from about 37.5 °C from 10 a.m. to 6 p.m., and falling to about 36.4 °C from 2 a.m. to 6 a.m. Temperature control (thermoregulation) is part of a homeostatic mechanism that keeps the organism at optimum operating temperature, as it affects the rate of chemical reactions. In humans the average internal temperature is 37.0 °C (98.6 °F), though it varies among individuals. However, no person always has exactly the same temperature at every moment of the day. Temperatures cycle regularly up and down through the day, as controlled by the person's circadian rhythm. The lowest temperature occurs about two hours before the person normally wakes up. Additionally, temperatures change according to activities and external factors.[3] Normal body temperature may differ as much as 0.5 °C (0.9 °F) from day to day. [ ]Natural rhythms Body temperature normally fluctuates over the day, with the lowest levels around 4 a.m. and the highest in the late afternoon, between 4:00 and 6:00 p.m. (assuming the person sleeps at night and stays awake during the day).[4][1] Therefore, an oral temperature of 37.3 °C (99.1 °F) would, strictly speaking, be a normal, healthy temperature in the afternoon but not in the early morning. Body temperature is sensitive to many hormones, so women have a temperature rhythm that varies with the menstrual cycle, called a circamensal rhythm.[3] A woman's basal body temperature rises sharply after ovulation, as estrogen production decreases and progesterone increases. Fertility awareness programs use this predictable change to identify when a woman is able to become pregnant. During the luteal phase of the menstrual cycle, both the lowest and the average temperatures are slightly higher than during other parts of the cycle. However, the amount that the temperature rises during each day is slightly lower than typical, so the highest temperature of the day is not very much higher than usual.[5] Hormonal contraceptives both suppress the circamensal rhythm and raise the typical body temperature by about 0.6 °C (1.1 °F).[3] Temperature also varies with the change of seasons during each year. This pattern is called a circannual rhythm.[5] . People living in different climates may have different seasonal patterns. Increased physical fitness increases the amount of daily variation in temperature.lor=red] increased age, both average body temperature and the amount of daily variability in the body temperature tend to decrease.[5] Elderly patients may have a decreased ability to generate body heat during a fever, so even a somewhat elevated temperature can indicate a serious underlying cause in geriatrics. [edit]Variations due to measurement methods Different methods used for measuring temperature produce different results. Generally, oral, rectal, gut, and core body temperatures, although slightly different, are well-correlated, with oral temperature being the lowest of the four. Oral temperatures are generally about 0.4 °C (0.9 °F) lower than rectal temperatures.[1] Oral temperatures are influenced by drinking, chewing, smoking, and breathing with the mouth open. Cold drinks or food reduce oral temperatures; hot drinks, hot food, chewing, and smoking raise oral temperatures.[3] Axillary (armpit), tympanic (ear), and other skin-based temperatures correlate relatively poorly with core body temperature.[5] Tympanic measurements run higher than rectal and core body measurements, and axillary temperatures run lower.[5] The body uses the skin as a tool to increase or decrease core body temperature, which affects the temperature of the skin. Skin-based temperatures are more variable than other measurement sites.[5] The peak daily temperature for axillary measurements lags about three hours behind the rest of the body.[5] Skin temperatures are also more influenced by outside factors, such as clothing and air temperature. [ Variations due to outside factors Many outside factors affect the measured temperature as well. "Normal" values are generally given for an otherwise healthy, non-fasting adult, dressed comfortably, indoors, in a room that is kept at a normal room temperature (22.7 to 24.4 °C or 73 to 76 °F), during the morning, but not shortly after arising from sleep. Furthermore, for oral temperatures, the subject must not have eaten, drunk, or smoked anything in at least the previous fifteen to twenty minutes, as the temperature of the food, drink, or smoke can dramatically affect the reading. Temperature is increased after eating or drinking anything with calories. Caloric restriction, as for a weight-loss diet, reduces overall body temperature.[3] Drinking alcohol reduces the amount of daily change, slightly lowering daytime temperatures and noticeably raising nighttime temperatures.[3] Exercise raises body temperatures. In adults, a noticeable increase usually requires strenuous exercise or exercise sustained over a significant time. Children develop higher temperatures with milder activities, like playing. Psychological factors also influence body temperature: a very excited person often has an elevated temperature. Wearing more clothing slows daily temperature changes and raises body temperature.[3] Similarly, sleeping with an electric blanket raises the body temperature at night.[3] Sleep disturbances also affect temperatures. Normally, body temperature drops significantly at a person's normal bedtime and throughout the night. Short-term sleep deprivation produces a higher temperature at night than normal, but long-term sleep deprivation appears to reduce temperatures.[3] Insomnia and poor sleep quality are associated with smaller and later drops in body temperature.[3] Similarly, waking up unusually early, sleeping in, jet lag and changes to shift work schedules may affect body temperature.[3]
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د.كمال سيد Admin
عدد المساهمات : 2397نقاط : 4183السٌّمعَة : 9الجنس : علم بلدك : تاريخ الميلاد : 03/04/1950تاريخ التسجيل : 30/07/2012العمر : 74 الموقع : السودان - سنارالعمل/الترفيه : طبيب عمومى وموجات صوتيةالساعة الان : دعائي :
Taking a patient's temperature is an initial part of a full clinical examination. Sites used for measurement include: In the anus (rectal temperature) In the mouth (oral temperature) Under the arm (axillary temperature) In the ear (tympanic temperature) In the vagina (vaginal temperature) On the skin of the forehead Over the temporal artery In the gut (by swallowing a small thermometer)
The temperature reading depends on which part of the body is being measured. The typical daytime temperatures among healthy adults are as follows: Temperature in the anus (rectum/rectal), vagina, or in the ear (otic) is about 37.5 °C (99.5 °F)[8] Temperature in the mouth (oral) is about 37.0 °C (98.6 °F)[4] Temperature under the arm (axillary) is about 36.5 °C (97.7 °F) [8]
Normal human body temperature varies slightly from person to person and by the time of day. Consequently, each type of measurement has a range of normal temperatures. The range for normal human body temperatures, taken orally, is 37.0±0.5 °C (98.6±0.9 °F).[4] This means that any oral temperature between 36.5 and 37.5 °C (97.7 and 99.5 °F) is likely to be normal. The temporal artery is close to the surface of the skin and therefore accessible for reading. The temporal artery is linked to the heart by the carotid artery which is directly linked to the aorta. It forms part of the main trunk of the arterial system. So long as the patient’s blood flow is permanent and regular, the method allows precise measurement of the temperature. [ Measurement devices
There is a risk of injury from cracking glass thermometers if too much force is applied by the teeth to hold them in place and the alcohol or mercury contents are poisonous. This is avoided by the use of electronic thermometers which are made from solid plastic and use a metal (thermocouple) sensor. A plastic thermometer strip placed on the forehead gives an approximate local reading, which depends to a great extent on ambient (surrounding) air temperature and local circulation effects. Using a thermometer to record the temperature under the armpit is less affected by surrounding air temperature, but is still prone to diverge from true core temperature if there are alterations in blood circulation. Since the year 2000, small ear thermometers have become available. It is thought that the eardrum closely mirrors core temperature values, and these devices work by detecting the infrared heat emission from the tympanic membrane. A measurement is quickly taken within one second, making them popular for use with children. While the electronic display of the temperature value is easier to read than interpreting the graduation marks on a thermometer, there are some concerns for the accuracy of ear thermometers in home use.
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د.كمال سيد Admin
عدد المساهمات : 2397نقاط : 4183السٌّمعَة : 9الجنس : علم بلدك : تاريخ الميلاد : 03/04/1950تاريخ التسجيل : 30/07/2012العمر : 74 الموقع : السودان - سنارالعمل/الترفيه : طبيب عمومى وموجات صوتيةالساعة الان : دعائي :
Principles of Musculoskeletal Examination and Examination of the Upper Extremity
LEARNING OBJECTIVES
By the end of this module, you will be able to:
Describe techniques and principles of examination for any joint Identify surface anatomy of the shoulder, elbow, wrist and hand. Be aware of the normal range of motion of the joints of the upper extremity. Describe how to perform an examination of the upper extremity. Be aware of common musculoskeletal abnormalities Be aware of special maneuvers for the evaluation of carpal tunnel syndrome Be aware of special maneuvers for the evaluation of shoulder impingement syndrome
INSTRUCTIONS
The best way to prepare yourself for your small group exercises is to first watch the upper extremity exam video from beginning to end, then proceed through all the explanations of the upper extremity exam that follow. To go through the material in the recommended sequence, just click the "Next" button in the upper right corner of the screen. But you may also jump to any section using the menu to the right.
There are practice questions spread throughout the learning module. At the end of the module you will be able to take the graded exam. You are required to take the graded exam prior to your small group session.
PRINCIPLES AND TECHNIQUES OF EXTEMITY EXAMINATION
All musculoskeletal exams usually follow the same order : على الرابط
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inspection, palpation, active and passive range of motion, strength testing, and when needed, special maneuvers.
QUIZ
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SHOULDER JOINT
Recall that the shoulder joint is a spheroidal, or ball and socket joint. It has an incredibly wide range of motion, due to the complex structures of the shoulder girdle. على الرابط
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ELBOW JOINT
The elbow is a complex joint with three different articulations. The humeroulnar joint is a hinge joint, and allows the forearm to flex and extend, and provides stability. The radiohumeral and radioulnar joints allow for flexion, extension and rotation of the radius on the ulna, which in turn allows the forearm to pronate and supinate.
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HAND AND WRIST
Multiple joints make up the hand and wrist. The radiocarpal joint (wrist) consists of multiple condyloid joints, between the radius and the carpal bones. This allows the wrist to move in two planes - to flex, extend, and abduct and adduct. The carpal bones articulate with each other, and the distal row of carpal bones articulate with the metacarpal bones. The metacarpal joints (MCP) are condyloid joints, as are the proximal and distal interphalangeal (PIP and DIP) joints. The carpal-metacarpal joint (thumb) is a saddle type joint, allowing for movement in two planes. There is an articular disc between the ulna and the carpal bones, and the ulna articulates with the radius distally, allowing for supination and pronation of the forearm.
[وحدهم المديرون لديهم صلاحيات معاينة هذا الرابط] hand & wrist
[وحدهم المديرون لديهم صلاحيات معاينة هذا الرابط] X-ray of wrist, with bones labeled
[وحدهم المديرون لديهم صلاحيات معاينة هذا الرابط] hand & wrist
[وحدهم المديرون لديهم صلاحيات معاينة هذا الرابط] X-ray of hand and wrist
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د.كمال سيد Admin
عدد المساهمات : 2397نقاط : 4183السٌّمعَة : 9الجنس : علم بلدك : تاريخ الميلاد : 03/04/1950تاريخ التسجيل : 30/07/2012العمر : 74 الموقع : السودان - سنارالعمل/الترفيه : طبيب عمومى وموجات صوتيةالساعة الان : دعائي :
Vital Signs and Chest Examination [وحدهم المديرون لديهم صلاحيات معاينة هذا الرابط]
INTRODUCTION
The best way to prepare yourself for your small group exercises is to first watch the Vital Signs and Chest Exam video from beginning to end, then proceed through all the explanations that follow. To go through the material in the recommended sequence, just click the "Next" button in the upper right corner of the screen. But you may also jump to any section using the menu to the left.
There are practice questions spread throughout the learning module. At the end of the module you will be able to take the graded exam. You are required to take the graded exam prior to your small group session.
LEARNING OBJECTIVES
• To understand "normal"
• To introduce examination of vital signs and the chest
• To relate anatomy to physical examination of the chest
• To introduce the "why" of examining blood pressure and chest - some common findings and what they mean
EXAM SECTIONS
Part 1: Vital Signs
Temperature Blood Presure Pulse Respiration
Part 2: Examination of the chest
Surface Anatomy Lungs Methods of Chest Examination
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د.كمال سيد Admin
عدد المساهمات : 2397نقاط : 4183السٌّمعَة : 9الجنس : علم بلدك : تاريخ الميلاد : 03/04/1950تاريخ التسجيل : 30/07/2012العمر : 74 الموقع : السودان - سنارالعمل/الترفيه : طبيب عمومى وموجات صوتيةالساعة الان : دعائي :
The HEENT, or Head, Eye, Ear, Nose and Throat Exam is usually the initial part of a general physical exam, after the vital signs. Like other parts of the physical exam, it begins with inspection, and then proceeds to palpation. It requires the use of several special instruments in order to inspect the eyes and ears, and special techniques to assess their special sensory function. This module reviews some of the relevant surface anatomy and describes the basic HEENT exam. The module includes an introduction to use of the ophthalmoscope.
LEARNING OBJECTIVES:
Identify anatomic landmarks of the head, neck, ear, nose mouth and throat. Describe the physical examination techniques for routine evaluation of the head, neck, eye, ear, nose and throat. Describe the physical examination techniques to distinguish types of hearing loss. Describe normal findings of the head, neck, ear, nose and throat exam.
Procedure
1. OTOSCOPY: Ex gently pulls the auricle up and back. While holding the otoscope the Ex slowly inserts the speculum with a downward and forward movement into the ear canal. Repeats with opposite ear.
2. HEARING ACUITY: Ex asks Pt to block one ear with finger while Ex checks the auditory acuity in the opposite ear. Ex then rubs fingers together 3 ft. from the unobstructed ear and then moves fingers in until Pt can hear the rubbing.
AND / OR
The Ex whispers a word or number while standing approximately 3 feet from Pt's side and asks him/her to repeat word.
3. WEBER TEST: The Ex sets the tuning fork in vibration and places the base of the fork on the midline of the Pt's head. Ex asks Pt whether the sound is heard equally in both ears or better in one ear.
4. RINNE TEST: The Ex sets the tuning fork in vibration and places the base against Pt's mastoid bone. Ex asks Pt to specify when the sound is no longer heard. The Ex then places tuning fork in front of Pt's ear while Ex asks Pt if he can now hear the sound from tuning fork. Repeats with opposite ear.
5. PATENCY: Ex asks Pt to inhale through each nostril separately while the opposite nostril is held shut.
6. SPECULUM: Ex is positioned in front of Pt while gently inserting the short wide-tipped speculum into Pt's nostril. Ex examines the lower portions of the nose and then asks Pt to tilt head slightly backwards.
7-9. INSPECTION:
7. Ex uses a light to inspect the buccal mucosa and the BACK of the mouth and throat. Using a tongue depressor Ex depresses more than halfway back on the tongue. Ex may have Pt phonate while inspecting the throat.
8. Ex asks Pt to bite down. Ex inspects the TEETH and GUMS at the same time using a tongue depressor or gloved finger to move the lips out of the way.
9. Ex asks Pt to extend TONGUE and move it from side to side. Ex uses a cotton gauze or gloved finger when touching tongue. (May inspect tongue at the same time Ex is inspecting the floor of mouth). Ex is not required to palpate the tongue.
ANATOMY
ANATOMY OF THE HEEN :Anatomy of the Nose and Sinuses Anatomy of the Mouth and Oropharynx Anatomy of the Neck
Quiz 1
PHYSICAL EXAM
Exam of the Head Exam of the Neck Exam of the Thyroid Exam of the Ear Hearing Evaluation Exam of the Eye Ophthalmoscopic Exam Examination of the Nose Exam of the Sinuses Exam of the Mouth and Oropharynx
The best way to prepare yourself for your small group exercises is to first watch the cardiac exam video from beginning to end, then proceed through all the explanations of cardiac anatomy and physiology that follow. To go through the material in the recommended sequence, just click the "Next" button in the upper right corner of the screen. But you may also jump to any section using the menu to the left.
There are practice questions spread throughout the learning module. At the end of the module you will be able to take the graded exam. You are required to take the graded exam prior to your small group session.
LEARNING OBJECTIVES
By the end of this session, you will be able to:
Recognize the elements and significance of the jugular venous pulse
Know the physiology and sound of S1 and S2
Know the physiology and sound of S3 and S4
Identify systole and diastole by palpation and listening
Describe heart murmurs
Hear and understand the mechanism of three common systolic murmurs
SECTIONS OF CARDIAC EXAM
Examination of the heart includes:
• Inspection: of jugular venous pulse and point of maximal impulse
• Palpation: of point of maximum impulse, and precordium for lifts, heaves and thrills
• Auscultation: for valve closing sounds (S1 and S2), extra sounds (S3 and S4), murmurs, clicks and rubs
Inspection: Jugular VenousPulse Phases of Jugular Venous Pulse Measuring the Jugular Venous Pulse Estimating Central Venous Pressure Diagnosing Complete Heart Block
Locations Location of Heart in the Chest Location of Point of Maximum Impulse The Four Cardiac Listening Areas
Methods and Tools
Palpation of Parasternal Area and Base
Qustion 1 Question 2
Auscultation of the Heart
Auscultation: What Makes Noises in the Heart S1 and S2
S1
Question 3
S2
S2 Splitting
Rhythm
Gallops: S3 and S4
S3
S4
Question 4
Heart Murmurs
How to Describe Heart Murmur Heart Murmur Intencity Heart Murmur Timing Heart Murmur Quality Finding the Areas to Auscultate
To know the four quadrants and nine regions of the abdomen; To be aware of some common findings on inspection, auscultation and palpation of the abdomen, and what they may mean; To know the reason for the sequence of abdominal examination; To learn how some common abdominal conditions are diagnosed using physical examination.
EXAM SECTIONS
Inspection Auscultation Percussion Palpation
Inspection
Four Quadrants Nine Regions Location of Abdominal Organs Some Common Findings on Inspection Scars Striae Colors Jaundice Prominent Veins Other Findings on Inspection Causes of Abdominal Distension Hernias
Auscultation
Stop, Look and Listen Gut Sounds Bruits Case 1
Percussion
Percussing the Liver and Spleen Case 2 Using Purcussion to Diagnose Ascites Percussion for CVA Tenderness
Palpation
Palpation Technique Palpation of Liver Palpation of Kidneys Case 3 Case 4 How Sensitive is Palpation for Detecting Abdominal Aortic Aneurism?
Case5
Physical Findings
More Physical Findings
Case6
Useful Clinical Signs of Cholecystitis
An Uncommon Clinical Signs of Pancreatitis
Summary
Final Test
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د.كمال سيد Admin
عدد المساهمات : 2397نقاط : 4183السٌّمعَة : 9الجنس : علم بلدك : تاريخ الميلاد : 03/04/1950تاريخ التسجيل : 30/07/2012العمر : 74 الموقع : السودان - سنارالعمل/الترفيه : طبيب عمومى وموجات صوتيةالساعة الان : دعائي :
This module provides an overview of the surface anatomy of the spine and lower extremity, and an introduction to the examination of the spine and lower extremity. Please review this module in preparation for your small group. Note that the back exam is not taught during POM-1 (it is taught in year 3 during the Family Medicine Clerkship), but it is included here as an introduction.
OBJECTIVES
Upon completion of this module, you should be able to:
Identify important landmarks necessary for the exam of the spine and lower extremities. Describe the physical examination technique for examination of the spine and lower extremities. Be familiar with normal findings, including range of motion. Recognize some common abnormal findings. Describe some special maneuvers for examination of the spine, knee and ankle.
Physical Examination:
(Objective Structured Clinical Examination (OSCE
LOWER EXTREMITY EXAMINATION CHECKLIST
Procedure
1. INSPECTION:
a. Examiner assesses strength of hip muscles by asking patient to rise from chair.
b. Examiner assesses hips, knees, ankles and feet for symmetry, deformity and discoloration while patient is standing.
2. HIP Palpate: Ex palpates iliac crest and greater trochanter.
3. HIP Range of motion: (Passive)
a. Flexion - with the patient supine, Ex flexes the patient's hip with knee bent.
b. Extension (prone or standing) - Ex extends patient's hip.
c. Adduction and abduction - with patient supine, Ex adducts and abducts patient's hip.
d. Internal and external rotation - with patient supine and knee flexed to ~90 ° , Ex internally and externally rotates patient's hip.
4. KNEE Inspect: Ex inspects knee with patient supine for swelling and discoloration.
5. KNEE Palpate: Ex palpates popliteal space, tibiofemoral joint space laterally and medially, and patella.
6. KNEE Range of motion: Ex asks patient to flex and extend knee.
7. KNEE Strength: Ex resists patient while patient flexes and extends knee.
8. KNEE Special maneuvers:
a. Mediolateral instability - Ex flexes knee to 30 ° and applies varus and valgus stress to knee, assessing for medial and lateral laxity.
b. Cruciate ligament : Lachman test - Ex flexes knee to 20 ° to 30 ° , grasps the distal thigh above the patella with one hand (thumb should wrap over thigh just above patella), grasps proximal tibia with other hand and pulls tibia anteriorly.
-or-
Cruciate ligament : Drawer test - Ex flexes knee to 90 ° , stabilizes foot by lightly sitting on it, and pulls tibia anteriorly for anterior drawer test, and also pushes posteriorly for posterior test. (Ex may choose which cruciate test to perform)
c. McMurray test (included only for small group use, not for testing) - Ex flexes knee completely, encircles joint space with thumb and index finger, rotates foot laterally, and extends knee. Maneuver should be repeated with medial rotation of foot.
9. ANKLE and FOOT Inspection: Ex inspects feet and ankles without shoes or socks for deformity or discoloration.
10. ANKLE and FOOT Palpation: Ex palpates Achilles tendon, lateral and medial malleoli and forefoot.
11. ANKLE and FOOT Range of motion: Ex asks patient to dorsiflex, plantar flex, evert and invert the ankle.
12. ANKLE and FOOT Strength: Ex resists patient while patient dorsiflexes and plantar flexes ankle. Ex also resists inversion and eversion.
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د.كمال سيد Admin
عدد المساهمات : 2397نقاط : 4183السٌّمعَة : 9الجنس : علم بلدك : تاريخ الميلاد : 03/04/1950تاريخ التسجيل : 30/07/2012العمر : 74 الموقع : السودان - سنارالعمل/الترفيه : طبيب عمومى وموجات صوتيةالساعة الان : دعائي :
How to test the cranial nerves, and common reasons for abnormalities How some cranial nerve abnormalities look How to test touch, sharp, position and vibration sensation How to grade a patient's strength How to grade reflexes, and how some abnormal reflexes look Which nerve roots you are testing when you check reflexes Several abnormal gaits How to test coordination, how abnormal tests look and what they mean.
EXAM SECTIONS
The Neurologic Examination has six sections:
Mental Status Examination Testing Cranial Nerves Sensation Examination Testing Strength Deep Tendon Reflexes Examination Coordination Examination
Mental Status Exam Mini Mental Status Testing Cranial Nerves I. The Olfactory Nerve Cranial Nerve II Cranial Nerve III, IV and VI Abnormalities Cranial Nerve V Cranial NerveV II Cranial Nerve VIII Cranial Nerve IX and X Cranial Nerve XI Cranial Nerve XII Sensory Exam Special Tests Testing and Grading Strength Deep Tendon Reflexes Exam Grading Reflexes Babinski's Sign Abnormal Gaits Spastic Hemiplegia Parkinsonian Gait Antalgic Gait Ataxic Gait Coordination Finger to Nose Heel to Shin Rapid Alternating Movements Fine Motor Romberg's Sign Summary FinalTest
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د.كمال سيد Admin
عدد المساهمات : 2397نقاط : 4183السٌّمعَة : 9الجنس : علم بلدك : تاريخ الميلاد : 03/04/1950تاريخ التسجيل : 30/07/2012العمر : 74 الموقع : السودان - سنارالعمل/الترفيه : طبيب عمومى وموجات صوتيةالساعة الان : دعائي :
Describe the sequence of the complete history and physical exam Be familiar with one clinician's approach to the complete history and physical exam Be familiar with the POM-2 Complete History and Physical checklist.
HOW TO USE THIS MODULE
This module provides you with a link to the complete history and physical, the POM-2 History and Physical checklist, and links to shorter segments of the complete history and physical. We recommend that you begin by printing and reviewing the History and Physical checklist (if you don't already have a hard copy), paying attention to the general content and order. As the entire video is an hour and 8 minutes in length, we recommend you watch the shorter videos, with the written comments in each section and the checklist as a guide. After each video, reflect on how you would organize your approach to this particular section, how Dr. Corbett's approach differed from yours, and what pieces of the exam were not included.
Complete History and Physical Video History History of Present Illness Video Past Medical History Video Review of Systems Video Physical Examination Video Procedural Checlist Interview Physical Examination Clinical Courtesy Vital Signs Head, Neck & Eyes Ears, Nose & Throat Upper Extremity Lower Extremity Chest & Lungs Heart & Blood Vessels Abdominal Neurological Global Assessment Global Rating Summary
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د.كمال سيد Admin
عدد المساهمات : 2397نقاط : 4183السٌّمعَة : 9الجنس : علم بلدك : تاريخ الميلاد : 03/04/1950تاريخ التسجيل : 30/07/2012العمر : 74 الموقع : السودان - سنارالعمل/الترفيه : طبيب عمومى وموجات صوتيةالساعة الان : دعائي :