Work Related Musculoskeletal Disorders

Work Related Musculoskeletal Disorders

Upper Extremity Disorders

* Carpel tunnel syndrome
* Cubital tunnel syndrome
* Thoracic outlet syndrome
* Raynaud’s syndrome (white finger)
* Rotator cuff syndrome
* DeQuervain’s disease
* Tendinitis
* Tenosynovitis
* Trigger finger
* Ganglion cyst

Neurovascular Disorders

* Carpal Tunnel Syndrome
o Impingement of the median nerve caused by irritation and swelling of the tendons in the carpal tunnel
* Cubital Tunnel Syndrome
o Pressure on the ulnar nerve when the elbows are exposed to hard surfaces
* Thoracic Outlet Syndrome
o Compression of the blood vessels between the neck and shoulder caused by reaching above shoulder level or carrying heavy objects
* Raynaud’s Syndrome
o Also known as Vibration White Finger ; Blood vessels of the hand are damaged (narrowed) from repeated exposure to vibration for long periods of time

Tendon Disorders

* Rotator Cuff Syndrome
* DeQuervain’s Disease
o Combination of tendinitis and tenosynovitis
* Tendinitis
o Irritation of the tendon
* Tenosynovitis
o Irritation of the synovial sheath
* Ganglion Cyst
o Accumulation of fluid within the tendon sheaths

Tendinitis
Hand and Wrist
Common Occupational CTDs of the Upper Extremities
Carpal Tunnel Syndrome
Common Occupational CTDs
of the Upper Extremities
Raynaud’s Syndrome
Symptoms

o Numbness and tingling in the fingers during vibration exposure; may continue after exposure has been discontinued
o Blanching (whitening) of one fingertip because of a temporary constriction of blood flow
o Other fingers also blanch
o Intensity of pain & frequency of attacks increase in time

Common Occupational CTDs of the Upper Extremities
Symptoms include:

+ pain in the ring and little fingers
+ tingling in these areas
+ numbness in these areas

Cubital Tunnel Syndrome
Common Occupational CTDs of the Upper Extremities
Symptoms include:

+ the arms “falling asleep”
+ weakened pulse
+ numbness in the fingers

Thoracic Outlet Syndrome
Common Occupational CTDs of the Upper Extremities

Symptoms include:
o Pain when you bend the arm and rotate it outwards against resistance
o Pain on the outside of the shoulder possibly radiating down into the arm
o Pain in the shoulder, which is worse at night
o Stiffness in the shoulder joint.

Rotator Cuff Syndrome
Anterior View
Posterior View
Common Occupational CTDs of the Upper Extremities
Symptoms include:

# point tenderness
# swelling
# tennis elbow, pain radiates down to back of hand
# golfer’s elbow, pain radiates down to back of hand
Tendinitis
Common Occupational CTDs of the Upper Extremities
Tenosynovitis
Trigger Finger
Ganglion Cyst

Common Occupational CTDs of the Upper Extremities
De Quervain’s Disease
Prospective Study of Computer Users
Primary Results
Common Occupational Injuries of the Back
Common Occupational CTDs of the Back
Disc Erosion
Herniated/Bulging Disc

Work Related Musculoskeletal Disorders.ppt

Read more...

Recreational Drug Use and Sexual Functioning

Recreational Drug Use and Sexual Functioning

Presentation by: Dr. Penny Frohlich
University of Texas at Austin

Recreational Drug Use and Sexual Functioning

Nicotine(Complex impact on hormones & neurotransmitters.)
Short term = interferes with erection
Decreases blood flow to penis
Increases venous outflow from penis
Long term use destroys penile tissues = erectile dysfunction
Passive smoking can have similar impact



Alcohol(Diffuse affects on neurotransmitter processes)
(Affects hippocampus)
Males
Self-report
Increased latency to orgasm (reduced likelihood of premature ejaculation)
Increased likelihood of erectile failure
Alcoholic males: erectile dysfunction (59%); anorgasmic dysfunction (48%); at least one sexual dysfunction (84%) (Mandell et al., 1983)
Laboratory Studies
Inhibits erection (dose dependent)
Increased latency to ejaculation (dose dependent)

Alcohol: FemalesSelf-report:
No change in sexual functioning when intoxicated
Moderate alcohol use (2 per week – 2 per day) associated with lowest rates of sexual dysfunction
Alcoholic females report decrease in sex drive and difficulty achieving orgasm/anorgasmia
Laboratory Studies:
Decreased arousal (Wilson & Lawson, 1976)

Alcohol: FemalesSelf-report:
No change in sexual functioning when intoxicated
Moderate alcohol use (2 per week – 2 per day) associated with lowest rates of sexual dysfunction
Alcoholic females report decrease in sex drive and difficulty achieving orgasm/anorgasmia
Laboratory Studies:
Decreased arousal (Wilson & Lawson, 1976)
Longer latency to orgasm (Malatesta et al, 1982)
Decreased intensity of orgasm (Malatesta et al, 1982)
Increased subjective arousal and orgasm pleasure (Malatesta et al, 1982)

Marijuana(THC (active ingredient) – THC receptors rich in the hippocampus)
lowers testosterone (mixed evidence)
Enhances sexual enjoyment in both men and women (83% and 81% respectively)
Does not affect erection, lubrication, or orgasm.
Increases relaxation, sociability, touch, and comfort.
high doses = sedation and impaired sexual performance.
In animals, decreases sexual activity – general decrease in physical activity.

Amphetamines “speed”(Enhanced release and block reuptake of norepinephrine, and at higher doses, dopamine.)
Can cause vasoconstriction of genital tissue
Sexual Performance:
Increased libido (increased energy)
Erectile failure; prolonged erection (up to 18 hours!)
Anorgasmia; multiple orgasms
Long term use: loss of interest in sex

MDMA “Ecstasy”(Similar to amphetamines, stimulates SNS)
Purported effects:
increased energy
increased endurance
feelings of euphoria
increased sociability
feelings of intimacy
altered visual perception
enhanced libido

MDMA “Ecstasy”Sexual functioning
Subjective ratings: 20 men, 15 women (Zemishlany et al., 2001)
Desire: moderately to profoundly increased
Erection: impaired in 40%
Orgasm: delayed but more intense
Satisfaction: moderately to profoundly increased
Laboratory studies?

MDMA “Ecstasy”Acute side effects/adverse effects (Smith, Larive & Romanelli, 2002):
agitation, anxiety, tachycardia, hypertension
arrhythmias, hyperthermia
Chronic adverse effects:
Toxicity to serotonin system
cardiovascular system
CNS serotonin
Overlap between recreational and fatal dose (Kalant, 2001)

Crystal Methamphetamine
“Crank,” “Crystal,” “Speed”(Increased release of dopamine, adrenaline)
Purported effects:
sense of exhilaration
sharpening of focus
sense of sexual liberation
Sexual Functioning
constricts blood vessels
erectile dysfunction
Risks: similar to amphetamines, risk greater

Physiology of penile erection
Viagra (Sildenafil): Inhibitor of cGMP PDE5
Nitric Oxide & Penile/Clitoral Tumescence
20 SextasyCombining Viagra with ecstasy, “hammerheading”
headache, prolonged erection (priapism)
high risk sexual behavior
long-term heart damage
Viagra with:
crystal methamphetamine
amyl nitrate
any drug that produces erectile dysfunction
Viagra and illegal recreational drugs (40%)

Amyl Nitrate “Poppers”Organic nitrate
Short-acting vasodilator
Increased blood flow to heart and brain
Purported to make sexual organs feel “Herculean”

CocaineInhibits reuptake of dopamine
Potent vasoconstrictor
Increased sexual desire
Arousal:
Men:
low doses – prolonged erection
high doses – erectile failure
Women: reports of both increased and decreased subjective arousal
Delayed or absent orgasm

Opioids: HeroinStimulate opiate receptors (enkephalins (body) and endorphins (brain)) – results in reduction in circulating testosterone
Produce relaxation/sense of well being
Analgesic affect – opiate receptors in female genital tract
Few reports of acute use: lowers drive, delays orgasm
Male Heroin addicts:
loss of drive, erectile dysfunction, orgasmic dysfunction
Withdrawal: increased morning erections, spontaneous ejaculation, slow return of sex drive, erectile and orgasmic dysfunction
Female Heroin addicts:
Decreased drive, increased drive, anorgasmia
Withdrawal: loss of libido

Hallucinogens (LSD, PCP)Purported to be “ultimate sex drug.”
Affects dopamine, serotonin, and with PCP, glutamate.
Sexual pleasure enhanced (all pleasure enhanced – e.g., watching paint dry is equally pleasurable)
Sexual Performance (animal studies):
low doses:
Males: premature ejaculation
Females: normal receptivity
Moderate to high doses – lack of physical coordination precludes any sexual activity.

Psychotropic Drug Use and Sexual Functioning

AntidepressantsMAO inhibitors, SSRIs
Impair all aspects of the sexual response cycle in men and women
Serotonin 5-HT2 receptor implicated
Nephazadone (serzone) SSRI and 5-HT2 antagonist – fewer sexual side effects
Stimulation of the 5-HT2 receptor (peripherally) causes vasoconstriction

AntipsychoticsDecreases dopamine activity
Males
Enhances erection
Several reported cases of priapism
Females
Enhances vaginal lubrication?
Delayed and inhibited orgasm

Anti-Parkinsonian drugsIncreases dopamine activity
Sexual drive:
Increases sex drive
Several cases of hypersexuality in men (<1%)
One reported case of hypersexuality in a woman (levodopa/carbidopa)
Sexual arousal: L-dopa increases erection in men with erectile failure

Recreational Drug Use and Sexual Functioning.ppt

Read more...

Paraphilias - sexual interest other than in copulatory

Paraphilias
Presentation by: Dr. Penny Frohlich
University of Texas at Austin

Definition: According to wikipedia, Paraphilias refers to powerful and persistent sexual interest other than in copulatory or precopulatory behavior with phenotypically normal, consenting adult human partners.


DSM-IV

* 6-months, recurrent, intense, sexually arousing fantasies/sexual urges
* fantasies/urges involve a specific act
* involving:
o non-human objects
o suffering or humiliation of oneself or another
o children or non-consenting persons
* cause significant distress or impairment


Paraphilias

* Fetishes
* Transvestic fetishism
* Voyeurism
* Exhibitionism
* Frotteurism
* Sadism/masochism
* Pedophilia

Fetishes

* Sexual arousal by:
o using or thinking about an inanimate object
o viewing a particular part of the body
o Common items:
+ womens’ clothing (shoe, stockings, underpants, bras)
+ feet
* Characteristics:
o male
o 25% homosexual
* Causes:
o temporal lobe abnormalities
o learned behavior - classical conditioning
+ 5/7 men conditioned to become sexually aroused to a knee length leather boot
+ 3/7 generalized to other shoes (Rachman & Hodgson, 1968)

Transvestites & Transvestic Fetishism

* Sexual arousal by dressing in clothes of the opposite sex
* crossdressing
* Characteristics:
o broad age range
o broad religious affiliation
o well educated
o in committed relationships
o parents
o heterosexual
o began before age 10
* Causes
o Family:
+ positive paternal role model
+ negative maternal relationship
o associated with learning disabilities
o temporal lobe abnormalities

Sex Offenders

* Voyeurism
* Exhibitionism
* Frotteurism
* Preferential Rape Pattern
* Pedophilia
* Psychopathic Sexual Sadism

Courtship Disorders

* Voyeurism:
o “peeping tom”
o sexual arousal by observing nude individuals without their knowledge or consent
o intense urges and recurrent behavior
* Exhibitionism: sexual arousal by exposing genitals to unsuspecting strangers - typically in inappropriate settings
* Frotteurism: sexual arousal by rubbing one’s genitals against others in public
* Preferential rape pattern: prefer rape over consensual sex

Voyeurism

* Characteristics:
o youngest child
o few sisters
o good relationship with parents
o parents with poor relationship
o underdeveloped socially
+ later 1st sexual experience
+ less likely to marry
* Females:
o rare
o peeping fantasies not uncommon (Friday, 1975)

Exhibitionism

* Characteristics:
o almost exclusively male
o timid/unassertive
o undeveloped social skills
o uncomfortable with anger/hostility
o more likely to be raised in puritanical background
* Females:
o do not derive pleasure
o motivation: money (e.g., strippers) or attention (e.g., Marti Gras)

Frotteurism

* Characteristics:
o comorbidity: 79%
o Average number of acts:
+ 849 (Abel et al., 1987)
o in females: molestation secondary to erectile failure, low desire (Sarrel & Masters, 1982)

Sadism & Masochism
* Sadism: sexual arousal by inflicting pain on another
* Masochism: sexual arousal by having pain inflicted upon oneself
* History
o “masochist” (1886) Krafft-Ebing, after Leopold von Sacher-Masoch
o “sadist” (1700s) after Marquis de Sade

Sadomasochism (S & M)

* Major vs minor sexual sadism
* Sadomasochism (S & M)
o pre-determined acts
o activities & themes (Arndt, 1991; Weinberg et al., 1984):
+ flagellation
+ bondage
+ water sports (urophilia, coprophilia, mysophilia)
+ penis and nipple torture
+ master & slave
+ severe boss and naughty secretary
+ queeen and many slavves
+ arrest
+ military training
* Characteristics
o predominantly male
o female: 25% prostitutes
o meet through S & M magazines
o come from all walks of life, SES, educ. etc
o 1/3 heterosexual, 1/3 bisexual, 1/3 homosexual

Major Sexual Sadism

* Seto & Kuban (1996)
o sadistic rapist, non-sadistic rapist, controls
o penile volume changes
o Five films:
+ nonviolent, non-sexual w/ female
+ consensual sex w/ female
+ non-sexual violence against female
+ rape
+ violent rape
* Seto & Kuban (1996) continued
o both types of rapist equally aroused by different types of sex
o controls differentiated between consensual and non-consensual sex
* Temporal lobe abnormalities (Langevin et al., 1988)

Psychopathic Sexual Sadism

* DSM-IV
o sexual sadism
o antisocial personality disorder (ASPD)
* Serial murderer
o arousal from inflicting pain
o arousal from killing
* Characteristics
o Lack of guilt or compassion for victim
o Euphoria during murder
o mentally disturbed, rarely psychotic
* Geberth & Turco (1997)
o 387 serial murders
o 248 sexually assaulted victims
o 68 met criteria for sexual sadism & ASPD
+ childhood aggressiveness
+ childhood antisocial behavior
+ killing involving sexual violence, humiliation, domination and control
+ derived pleasure from killing
o examples: Ted Bundy, Gary Ridgeway

Pedophilia

* Sexual fantasies, urges, or behavior involving children under 14 years old
* prevalence
* Characteristics/Causes:
o 40% homosexual
+ high maternal age
+ low IQ
+ developmental disorder?
o history of childhood sexual abuse (49%) by a male abuser

Development of Paraphilias

* Physiological characteristics:
o higher baseline cortisol, prolactin, body temperature
o stronger cortisol response
o disturbance in serotonin regulation --> OCD
o showed slides of nude male and female children
o pedophiles and controls
o measured penile volume changes
o Results: pedophiles less differentiation between slide types

Treatment of Paraphilias

* 1900 castration, psychosurgery
* Cognitive-Behavioral Therapy - Aversion Therapy
o effective in lowering arousal
o relapse high
* Pharmaceutical
o agents that lower testosterone/produce pharmaceutical castration
o SSRIs

Additional Paraphilias

* Bestiality & zoophilia
* coprolalia
* coprophilia
* klismaphilia
* mysophilia
* necrophilia
* pedophilia
* scoptophilia
* stigmatophilia
* telephone scatologia
* troilism
* urophilia
* kleptomamia
* pyromania
* salirophilia
* somnophilia
* sotophilia

Paraphilia-Related Disorders

* compulsive masturbation
* protracted promiscuity
* dependence on pornography (more common in men)
* dependence on cybersex

Check regarding diagnosing if no distress - with regard to pedophilia etc.


Generalized to:
Family:
Results
pharmaceutical:
Bestiality & zoophilia: sexual arousal through contact with animals
coprolalia: need to hear filthy language to become sexually aroused
coprophilia: need to smell or riew feces to become aroused
klismaphilia: sexual arousal by being given an enema
mysophilia: arousal by filth or filthy surroundings
necrophilia:
scoptophilia: by observing others engaged in sexual intercourse
stigmatophilia: marking body, inserting objects into the body
telephone scatologia: arousal by making obscene phone calls
troilism: arousal by sharing partner and looking on
urophilia: “golden showers” on or watching
kleptomamia; aroused by act of steeling
pyromania: aroused by setting fires, watching fires
salirophilia: injestion of anothers sweet or saliva
somnophilia: having sex with someone who is sleeping
sotophilia: aroused by sight of certain foods.

Paraphilias.ppt

Read more...

Anorectal Disorders

Anorectal Disorders
Presenteation by: Carrie Lotenero, DO

Anatomy
Hemorrhoids: MCC rectal bleeding
Hemorrhoids
Anorectal abscesses
Anal fistula
Anal Fissure
Anal Fissure
Venereal Proctitis
Rectal prolapse = procidentia
Anorectal tumors
Anal crypts, columns of morgagni, dentate line
Surgery-partial sphincterotomy and excision of fissure

Anorectal Disorders.ppt

Read more...

Acute Appendicitis

Acute Appendicitis
Presentation by:Stephen Cluff D.O.

Acute Appendicitis

Begins as a Lumen obstruction
…mucosal secretion increases pressure
…overcomes perfusion pressure
…obstructs venous/lymphatic drainage
…epithelial breakdown
…invasion by bowel flora
…eventual arterial stasis and necrosis
…spillage of infected contents into peritoneum

Pain Presentation
History
Physical Exam
Labs
Imaging
Special Cases
Treatment

* Appendectomy
* NPO, IV fluids, pre-op antibiotics

Disposition

QUIZ
Acute Appendicitis.ppt

Read more...

Pain Perception, Management And Assessment

Pain Perception, Management And Assessment
Amy C. Chavarria, RN, MSN, MBA, HCM, CCE


THE PAIN PROCESS

Mechanical
Chemical
Thermal

Pain receptors are stimulated
NOCICEPTORS
Spinal Cord
Brain


STRUCTURES RELATED TO PAIN PROCESS
Physiologic Pain
Neuropathic Pain
Four Processes Involved in Nociception

* Transduction
* Transmission
* Perception
* Modulation

Pain Theories
III. Pattern (Summation) Theory
IV. Endorphin/Enkephalin Theory
Gate Control Theory
CHARACTERISTICS OF PAIN
PAIN SCALES
Adult and Older Adult
FACTORS AFFECTING PAIN PERCEPTION/RESPONSE
MANIFESTATIONS OF PAIN
ASSESS THE PATIENT’S PAIN

Develop Nursing
Diagnosis
Develop a Nursing
Care Plan
Implement
Plan of Care
BEHAVIORAL RESPONSES
Pain Assessment
OTHER FACTORS

Causative Factors
Relieving Factors
Pain-related
Problems
Activities for daily living
Treatment Plan
COGNITIVE THERAPY
Mind Interventions
GUIDED IMAGERY
HEAT AND COLD APPLICATION
Spiritual
TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS)
TENS ELECTRODE APPLICATION
SAFETY ISSUES
Implementation of Therapy
Maintenance of Therapy
Nonpharmacologic Invasive Techniques
Pharmacologic Interventions for Pain
Opioids (Narcotics)
Nonopioids/NSAIDS
Coanalgesic Drugs
WHO Ladder Step
Approach for Cancer Pain Control
Rational Polypharmacy
Oral Administration
Transmucosa/Transnasal and Transdermal Administration
Medication Administration
Subcutaneous Infusion Placement
Medication Administration
PATIENT CONTROLLED ANALGESIC (PCA)
Barriers to Effective Pain Management
DOCUMENTATION OF PAIN MANAGEMENT THERAPY
Pain is known as the 5th vital sign.
Specificity Theory
Clinical application of gate control theory:
Pain intensity and much more topcis are covered in this 143 slides presentation.

PAIN PERCEPTION, MANAGEMENT AND ASSESSMENT.ppt

Read more...

Molecular techniques used in medical diagnosis

Molecular techniques used in medical diagnosis

Separation of DNA Fragments by Gel Electrophoresis
Restriction Endonucleases

Methods of Sequence Analysis
The human genome project
Big Dye Sequencing
Polymerase Chain Reaction
PCR Analysis - Multiple rounds of amplification
Polymorphisms
Types of polymorphisms
X-linked Inheritance
RFLP Analysis
Southern Blotting
An example of VNTR linkage analysis
The use of PCR in Forensics Medicine
Fragile X syndrome is caused by the expansion of a VNTR region
DNA microarray analysis
Preparation of cDNA from mRNA

Molecular techniques used in medical diagnosis.ppt

Read more...

Clinical Decision making and Decision Analysis

Clinical Decision making and Decision Analysis
Presentation by: Dr. Dinesh P Mital

Hospital Based Decision Support
Medication prescribed

-Allergies -Physical examination

-Blood gases -Admit/discharge info.

-Electrocardiogram -X-ray findings

-Demographic information -Dietary information

-Cardiac data -Surgical procedures

-Biopsy results -Procedures reports

-Hematology -Respiratory notes

-Pulmonary functions -Microbiological data

-Nursing data -Pathology department data


Categories of Decision Support Technologies

1. Processes which respond to clinical data by issuing an alert.

2. Programs that respond to recorded decision to alter care by critiquing the decisions and proposing alternate care - as appropriate.

3. Applications that respond to a request by decision maker by suggesting a set of diagnosis of therapeutic maneuvers fitted to patient’s needs.

4. Retrospective quality assurance applications where clinical data are abstracted from patient’s records and decisions about the quality of care are made and fed back to care providers.


Alerting Systems

Manual approach.
Antibiotic Assistant and much more topics are discussed in this presentation


Clinical Decision making and Decision Analysis.ppt

Read more...

Medical profession

Medical profession
Detailed Presentation by: Janos Lonovics MD

Diagnostic examinations

Medical history

Physical examination

Laboratory examination

Special examinations (US, CT, MR, Endoscopy, etc)

Consultations with other professionals

Treatment procedures

Medical treatment

Surgical treatment



Structure of a medical record

Medical history

Findings of the physical examination

Reports of the laboratory tests

Conclusions from special examinations
(US, CT, MR, Endoscopy etc)
Report and suggestions of the consultants
Diagnosis by (competent) attending physician
Notes on treatment (medications, interventions)
Progress notes
Discharge summary\
Medical diagnosis
Tentative diagnosis (at the end of the case history)
Provisional diagnosis (to begin the diagnostic work)
Working diagnosis (to put things on the right track)
Final diagnosis (if achieved)

PURPOSES OF THE PATIENT’S MEDICAL RECORD

LEGAL PURPOSES

Medical history - anamnesis

* Identifications and vital statistics
* Present illness and chief complaints
* Past history
* Social history
* Family history

Identifications and vital statistics
Name, Date of birth, Place of birth
Sex, Nationality, Race, Residence,
Marriage status, Occupation
Source of information: patient, others
Interpreter

Present illness and chief complaints
Heart of medical history
Searching for diagnostic clues (complaints, symptoms)

Accumulation of facts
Evaluation of facts
Preparation of hypotheses
Insist upon symptoms, do not accept patient’s diagnosis

Nature of symptoms
Quantification of symptoms
Chronology of symptoms
Current medication
Past history
Previous illnesses
Previous operations, injuries
Previous hospitalization
Infectious diseases
General health issues

Appetite, Body weight, Weight loss

Stool habits

Urine complaints

Family history

Parents, Siblings

Age and health

Death and causes

History of diseases

Hypertension, Hearth disease, Diabetes

Obesity, Endocrine disorders

Tuberculosis, Syphilis, AIDS

Malignancies

Alcoholism, Mental disturbances, etc.

METHODS IN THE PHYSICAL EXAMINATION
* Inspection
* Palpation
* Percussion
* Auscultation
* Smelling

o Heigh and weight
o Body temperature
o Blood pressure
o Rectal digital examination
o Eye (fundoscopic) examination
o Bimanual (gynecological) examination
o Basic neurological examination


INSPECTION

Inspection of the body as a whole

Motor activity

Body build

Anatomic malformation

Nutrition

Appearance of illness

Behaviour

Speech


LOCAL INSPECTION

Focuses observation on a single anatomic region

o Observation with unaided eyes
o Observation through special equipments

ophtalmoscope

otoscope, nasoscope

laryngoscope

bronchoscope

gastroscope, anoscope, colonoscope

thoracoscope, peritoneoscope

gonioscope

cystoscope

microscope

PALPATION

Palpation in the act of feeling by sense of touch

Physican’s hands perceives physical signs by his (her)

Tactile sense

Temperature sense

Kinesthetic sense of position and vibration
Sensitive parts of the hands

Tactile sense - the tips of the fingers

Temperature sense – the dorsa of hands

Vibratory sense – palmar base of the fingers

Sense of position and consistency – grasping fingers
Structures examined by palpation

All external structures

Solid abdominal viscera

Solid contents of hollow viscera

Lymph nodes

Thrombosed veins

Structures accesible through body orifices

Qualities elicited by palpation

Texture – the skin and hair

Moisture – The skin and mucosa

Masses – The size, shape, consistency, etc.

Precordial cardiac thrust

Crepitus – in bones, pleura, etc.

Tenderness – in all accesible tissues

Thrills – over the heart, and blood vessels

Vocal fremitus – over the lung

Special methods of palpation

Light palpation

Deep palpation

Ballottement

Fluctuation

Fluid wave

LIGHT ABDOMINAL PALPATION

* Ticklishness
* Direct Tenderness
* Rebound Tenderness
* Voluntary Rigidity of Muscle
* Involuntary Rigidity of Muscle
* Subcutaneous Crepitus
* Abdominal Masses

DEEP ABDOMINAL PALPATION – RUQ AND RLQ

* Liver
* Enlarged (Tender and Nontender) Gallbladder
* Enlarged Right Kidney
* Masses in Cecal Region

DEEP ABDOMINAL PALPATION – LUQ AND LLQ

* Spleen
* Enlarged Left Kidney (Ballottement)
* Masses in Sigmoid Region


Vibratory palpation of the lungs and pleura
Detection of vocal fremitus

PERCUSSION

A method of examination in which the surface of the body is struck to emit sounds that vary in quality according to the density of the underlying tissue

Methods:

* Bimanual, Mediate or Indirect
* Immediate or Direct


SONOROUS PERCUSSION

Its purpose to ascertain the density of the tissue

* Percussion Notes

Tympani – air-filled stomach

Resonance –air-filled lungs

Hyperresonance – emphysematous lungs

Dullness – blood-filled heart

Flatness - thigh

DEFINITIVE PERCUSSION

Its purpose to determine the size and borders of a structure

Lung borders: bases, apices

Size of the heart

Size of the liver and spleen

Size of the distended gallbladder

Level of ascites fluid

Sizes of different masses


Percussion map of the thorax

* Procedure of thoracic percussion

SUPRAPUBIC MASSES

* Distended Urinary Bladder
* Ovarian Cyst


AUSCULTATION

Act of hearing through the stethoscope

Skull – bruit

Neck – carotid artery, jugular vein

Lungs – breath sounds, rales, friction rub

Heart – valve sounds, rhythm, murmurs

Abdomen – bowel sounds, murmurs

Crepitus – bones, pleural layer

Auscultation of the lungs and pleura

Breath sounds

* Vesicular breathing

Vesicular breath sounds have a long inspiratory and a short expiratory phase

* Broncial breathing

Bronchial breath sounds have a short inspiratory and a long expiratory phase

* Bronchovesicular breathing

The two respiratory phases are about equal in duration

* Ashmatic breathing

Voice sounds

* Whispered pectoriloquy (Whispered voice sounds)
* Bronchophony (Spoken voice sounds)

ASK the patients to repeat the test word ”ninety-nine” or ”one-two-three”

COMPARE symmetric parts of the lung sequentially by stethoscope

* Are increased in:

Pulmonary consolidation

Pulmonary infarction

Pulmonary atelectasis

* Are diminished or absent in:

Pleural effusion

Pneumothorax

Thickened pleura

Alveoli filled with

Fluid, red and white cells

Pleural fluid or thickening

Adventitious sounds - Rales

* Moist Rales

Inspiratory crackels or crepitation

Bronchial rales (heard in both phases)

Moist fine or subcrepitant rales

Moist medium or crepitant rales

Moist coarse or gurgling rales

* Dry rales

Musical (sibilant) rales

Sonorous rales

Ronchus
* Pleural friction rub
* Special sounds in hydropneumothorax Succusion splash Falling drop sounds, etc.
* Bruit in the lungs
* Subcutaneous crepitus
* Bone crepitus


Interpretation of pulmonary and pleural findings Pulmonary consolidation

Dullness and increased vibration

* Percussion: dull or flat
* Breath sounds: bronchial
* Voice sounds: increased
* Rales: crepitation or subcrepitation
* Vocal fremitus: increased


Alveoli filled with

Fluid, red and white cells

Interpretation of pulmonary and pleural findings
Pleural fluid (Hydrothorax, Pyothorax, Hemothorax)

Dullness and diminished vibration

* Percussion: dull or flat
* Breath sounds: absent

or bronchial

* Voice sounds: absent
* Rales: absent
* Vocal fremitus: absent
* Tracheal deviation to the unaffected side



Pleural fluid

or thickening

Interpretation of pulmonary and pleural findings
Thickened pleura

Dullness and diminished vibration

* Percussion: dull or flat
* Breath sounds: absent

or bronchial

* Voice sounds: absent
* Rales: absent
* Vocal fremitus: absent
* Tracheal deviation to the affected side



Pleural fluid or thickening

Interpretation of pulmonary and pleural findings
Pneumothorax

Resonance or hyperresonance


Percussion: resonant hyperresonant or tympanitic

Breath sounds: diminished absent

Voice sounds: diminished absent

Rales: absent absent

Vocal fremitus: absent absent

Tracheal deviation: no yes


Interpretation of pulmonary and pleural findings
Hydropneumothorax

Resonance or hyperresonance

* Percussion: a. hyperresonant b. flat
* Breath sounds: absent
* Voice sounds: absent
* Rales: absent
* Vocal fremitus: absent
* Sucussion splash, shifting dullnes may be present
* Tracheal deviation to the unaffected side

Interpretation of pulmonary and pleural findings
Pulmonary edema

Resonance and Dyspnea

* Causes: left sided heart failure, pulmonary diseases, noxious gases
* Characteristics:

Cyanosis, dyspnea, frothy (bloody) sputum

Prolonged exspiratory phase, accompanied

with musical rales (may resemble to asthma)

Moist bronchial (gurgling) rales

Interpretation of pulmonary and pleural findings
Bronchial asthma

Resonance and Dyspnea

* Characteristics: Dyspnea (pts rising to sitting position) Unproductive cough

Anxiety expressed by facial muscles Prolonged exspiratory phase, accompanied

with musical and sonorous rales Wheezing may be heard at a distance

* Between attacks pts may be perfectly well



Auscultation of the heart

* Cardiac valve areas

Normal heart sounds

* First heart sound (S1): produced by vibration of the left ventricular muscle, during early v. systole

accentuated in mitral stenosis, fever, etc

diminished in pericardial effusion, etc

* Second heart sound (S2: A2, P2): produced by vibration of great vessels and closed valves

accentuated A2 in arterial hypertension

accentuated P2 in pulmonary hypertension

splitting of P2: may be normal or pathologic


Abdominal auscultation
Abdominal murmurs

Clinical occurence:

Aortic aneurism

Renal artery stenosis

Arteriovenous fistula in renal vessels

Abdominal auscultation
Peristaltic sounds

Increased peristalsis Abscence of sounds

early pyloric obstruction peritonitis

early intestinal obstruction mesenteric thrombosis

brisk diarrhea electrolite abnormality

spinal cord injury

advanced intest. obstr.

Abdominal auscultation
Succussion splash

The sound is produced by the combination of air and fluid in the stomach and intestine

* Clinical significance: obstruction in the stomach or anywhere in the gut gastric dilatation

It can be elicitated by moving the patient or by palpation of the viscera


Abdominal auscultation
Peritoneal friction rub

Its presence indicates peritoneal inflammation

carcinoma of the liver or liver abscess

splenic infartion or abscess

syphilitic or gonococcal hepatitis

after liver biopsy


Medical profession.ppt

Read more...

Diagnosis of Musculoskeletal Disorders

Diagnosis of Musculoskeletal Disorders
This 172 slides presentation covered the following topics

Musculoskeletal System
Investigations of MS Disease
Bone Mineral Density
Acute Phase Response (blood tests for inflammation & systemic disease)
Immunological Tests
Rheumatoid Factor
Antinuclear Antibody
Pansma autoantibodies & Disease Association
Manifestations of MS Disease
Arthralgia (Joint Pain)
Arthritis (Joint Inflammation)
Chronic Inflammatory Monoarthritis
Oligoarthritis
Polyarthritis
Back Pain
Neck Pain
Bone Pain
Fracture
Muscle Pain & Weakness
Orthodox Treatment in MS Disease
Osteoarthritis
Classical Clinical Features Osteoarthritis
Investigations & Diagnosis
Inflammatory Joint Disease
Rheumatoid Arthritis
Criteria for Diagnosis of RA
Extra-Articular Features of Rheumatoid Disease
Seronegative Spondarthritis
Ankylosing Spondylitis
Infectious Arthritis
Reiter’s Syndrome
Psoriatic Arthritis
Arthritis associated with IBD
Crystal Associated Arthritis & Deposition in CT
Gout
Pseudogout
Non-Articular Rheumatism
Spasmodic Torticollis
Bursitis
Tendonitis & Tenosynovitis
Fibromyalgia
Aetiological Hypotheses or Contributing Factors
Disease of Bone
Osteoporosis
Causes of Secondary Osteoporosis
Osteomalacia
Osteomyelitis
Paget’s Disease
Cancer Associated Bone Disease
Connective Tissue Disease
Systemic Lupus Erythematous
Sjogrens Syndrome
Scleroderma / Systemic Sclerosis
Idiopathic Inflammatory Myopathy
Polymyalgia Rheumatica
Vasculitis

Musculoskeletal Disorders.ppt

Read more...

Diagnosis of External Features of disease

Diagnosis of External Features of disease

This 64 slides presentation covers the following topics.

Jaundice
Anaemia
Clubbing
Cyanosis
Oedema
Lymphadenopathy
Dehydration

Haemolytic jaundice
Hepatocellular jaundice
Obstructive jaundice

The Skin
Erythema nodosum
Erythema multiform
Erythema Marginatum
Palmer erythema
Pyoderma Gangrenosum
Generalised Purpura
Dermatitis herpitiformis
Telangiectasia
The Hands
The Nails
Koilonychia
Leukonychia
Beau’s Lines
Mees’ Lines
Splinter haemorrhages
Pitting
Onycholysis
Hair
Alopecia - Hair loss
Hirsutism - Excessive growth of coarse hair in the female
Hypertrichosis - (Warewolf syndrome) - Excessive growth of coasrse hair which does not follow androgen-induced pattern
Secondary Sexual Hair

External Features of disease.ppt

Read more...

Diagnosis of Kidney & Genito-Urinary System

Diagnosis of Kidney & Genito-Urinary System

This 107 slides presentation is covered the following topics

Kidney Functions
Urine Analysis
Renal Function
Manifestations of Kidney & Urinary Tract Disease
Polyuria
Oliguria
Anuria
Dysuria, fequency & urgency
Urinary Incontinence - an uncontrollable loss of urine
Haematuria
Proteinuria
Uraemia
Oedema
Hypertension
Renal Failure
Acute Renal Failure and Causes
Chronic Renal Failureand Causes
Investigations & Diagnosis
Glomerular Disease
Glomerulonephritis
Nephritic Syndrome
IgA nephropathy (Berger’s Disease)
Nephrotic Syndrome
Urinary Tract Infection
Bacterial Infection
Urinary Tract Pathogens
Abacterial Cystitis/Urethral Syndrome
Pyelonephritis - bacterial infection of kidney parenchyma
Acute & Chronic Pyelonephritis
Nephrocalcinosis & Nephrolithiasis
Abnormal Renal Transport Syndromes
Renal Tubular Acidosis
Nephrogenic Diabetes Insipidus
Inherited & Congenital Renal Disorders
Polycystic Kidney Disease
Prostatic Disease
Benign Prostatic Hyperplasia (BPH)
Prostate Carcinoma
Disorders of Penis & Scrotum

Kidney & Genito-Urinary System.ppt

Read more...

Diagnosis of Liver & Biliary Tree Diseases

Diagnosis of Liver & Biliary Tree Diseases

165 slides presentation covered the following the topics.
Hepatic Acinus
Liver Function Tests
Laboratory Evaluation of Liver Disease
Imaging Studies & Biopsy
Manifestations of Liver Disease
Life-Threatening Complications
Pathway of bilirubin excretion
Haemolytic Jaundice
Hepatocellular Jaundice
Cholestasis (Obstructive Jaundice)
Clinical Features of Cholestasis
Diagnostic Approach to Jaundice
Ascites- accumulation of free fluid within the peritoneal cavity
Clinical Features & Diagnosis
Abdominal Paracentesis
Management of Acites
Portal Hypertension - increased pressure in the portal venous system
Hepatomegally - enlargement of the liver
Drugs, Toxins & the Liver
Drug Metabolism
Fatty Liver Disease
Classification Clinical Features & Diagnosis of Steatosis
Alcoholic Liver Disease
Metabolism of Alcohol
Pathogenesis
Acute Viral Hepatits Investigations & Diagnosis
Hepatitis A
Hepatitis B
HBV – Life Cycle
Hepatitis C
Autoimmune Hepatitis
Chronic Liver Disease
Fibrosis
Cirrhosis Clinical Features & Diagnosis
Chronic Liver Failure
Antitrypsin Deficiency
Obstructive Biliary Disease
Primary Biliary Cirrhosis
Secondary Biliary Cirrhosis
Other Causes of Liver Disease
Iron Metabolism
Classification of Haemosiderosis & Haemochromatosis
and much more are discussed eloborately

Diagnosis of Liver & Biliary Tree Diseases.ppt

Read more...

Diagnosis of alimentary canal / gastrointestinal tract

Examination of The alimentary canal / gastrointestinal tract

Diagnosis of GIT disorders
History & Physical Exam
Investigations of GIT disease
X-Rays & barium studies
Ultrasound, CT & MRI
Endoscopy
Colonoscopy
Manometry
Gastric analysis
Laparoscopy
Bacterial cultures (stool) & serology

Manifestations of GIT disease
Dyspepsia & Differential Diagnoses
History Taking
Investigatations
Diarrhoea
Aetiology & Pathophysiology
Constipation
Gastro-Intestinal Bleeding
Causes of Weight Loss
Abdominal Pain
Areas of Pain & Differentials
Malabsorption Syndromes
Pruitis Ani - anal and perianal itching
Causes of Oral Ulcerations
Recurrent Aphthous Stomatitis
Herpes Simplex Virus
Oral Candidiasis
Salivary Gland Disorders
Suppurative Parotitis - bacterial infection of parotid glands
Mumps
Ulcerative Gingivitis
Oesophagitis
Hiatus Hernia
Mallory-Weiss Syndrome

This is 222 slides presentation. Extensively covered many topics.

The alimentary canal / gastrointestinal tract.ppt

Read more...

Introduction to Diagnostics

Introduction to Diagnostics

Following topics are discussed in this presentation

Cornerstones of Medical Ethics
Ethical Principles to Guide Behavior
Process of Diagnosis
History taking

– Physical examination
– Laboratory tests
– Diagnostic Approaches
• Recognition
• Reasoning
• Waiting on events
• Hypothesis
• Selective doubting Reliability of data? Symptoms vs Signs
Attributes of a Symptom
The Health History
Identification data
– Date & time of history
– Age, gender, occupation, marital status
– Source of history & reliability

• Main complaint
– One or more symptoms that is causing the patient to seek help
– Quote patients own words

• History of main complaint
– Amplifies the main complaint
– Pulls in relative portions of systems review
– Includes patients thoughts & feelings
• Past medical history
– Childhood diseases & vaccinations
– Lists adult diseases & surgery
– Health maintenance practice

• Medications & supplements
– Prescription drugs name; dose; route; frequncy
– Home remedies otc; vitamins & minerals; herbal supplements; OCP

• Health status
– Allergies
– Smoking; Alcohol; Recreations drugs
– Caffeine
– Sexual history
• Family history
– Outlines or diagram's
– Age & health of patients
– Age and cause of death
– Particularly parents, grandparents & siblings

• Psycho-Social history
– Educational level
– Economic standards
– Personnel interests
– Lifestyle Etc

• Systems review
– Documents presence or absence of sommon symptoms related to each body system


Techniques of Interviewing
• Active listening
• Adaptive questioning general to direct
• Non-verbal communication
• Facilitation
• Echoing
• Empathetic responses
• Validation
• Reassurance
• Summarization

The Physical Examination
• General overview
• Vital signs
• Skin
• Head, eyes, ears, nose & throat
• Neck & back
• Cardiovascular system
• Respiratory system
• Gastrointestinal system
• Upper & lower extremities & peripheral vascular system
• Nervous system
• Breast exam
• Genital & rectal examination

Introduction to Diagnostics.ppt

Read more...

General Medicine - Nutritional & Metabolic Disorders

Nutritional & Metabolic Disorders

water & sodium metabolism
potassium metabolism
calcium metabolism
phosphate metabolism
magnesium metabolism
acid-base metabolism

Understand Nutritional Basics
Vitamins
Vitamin A (Retinol) Deficiency
Clinical Features
Vitamin A (Retinol) Toxicity
* Acute toxicity
* Chronic toxicity
* Hypercarotenosis

Vitamin D Disorders
* Deficiency
Rickets (children)
Osteomalacia

Prohormone
Causes of Rickets & Osteomalacia
Diagnosis of Rickets & Osteomalacia
Vitamin D Toxicity
Vitamin E (tocopherol) Deficiency
Vitamin K Deficiency
Vitamin B1 (thiamine) Deficiency
Beri-Beri
Aetiology
Clinical Features
Types of Beri-Beri & Treatment
Vitamin B2 (riboflavin) Deficiency
Vitamin B3 (niacin; nicotinic acid) Deficiency
Pellegra
Aetiology
Clinical Features
Vitamin B5 (pentothenic acid) Deficiency
Vitamin B6 (pyridoxine, pyridoxal & pyridoxamine) Deficiency
Vitamin B7 (biotin) Deficiency
Vitamin B9 (folate; folic acid) Deficiency
Causes of Folate deficiency
Vitamin B12 (cyanocobalamin) Deficiency
Causes of Vit B12 deficiency
Vitamin C (ascorbic acid) Deficiency
Scurvy
Minerals
* Iron deficiency
* Iodine deficiency
* Iodine toxicity
Goitre (swelling of neck due to enlargement of the thyroid gland)


* Flourine deficiency
* Flourine toxicity (fluorosis)
* Zinc toxicity
* Chromium deficiency
* Chromium toxicity
* Copper deficiency
* Copper toxicosis
Wilson’s Disease
Fluid & Electrolyte Imbalences
Hyponatraemia
Clinical Features
Syndrome of Inappropriate ADH Secretion
Aetiology
Pathology
Biochemical Values
Malignancy
Pulmonary disorders
CNS disorders
Hypernatraemia
Hypocalcaemia (abnormally low Ca2+ concentration in the blood)
Hypercalcaemia (abnormally high Ca2+ concentration in the blood)
Hyperparathyroidism
Acid-Base Balance
Respiratory Changes
Renal Changes
pH buffers
Metabolic Acidosis
Lipoprotein Disorders
Lipids
Essential Fatty Acid
Triglycerides
Hypertriglycerolaemia
Cholesterol
Hypercholesterolaemia
Familial Hypercholesterolaemia
Management of Hyperlipidaemia
Dietary Guidelines
DL-cholesterol
Fibrates
Nicotinic acid
Malnutrition
Early Detection & Awareness in Undernutrition
Risk Factors for Undernutrition
Risk Factors for Overnutrition
Diagnosis of Malnutrition
Classification of Nutritional Status via BMI
Marasmus
Kwashiorkor
Aetiology & Risk Factors
Medical Complications of Weight Gain
Benefits of Moderate Weight Loss

and much more topics are covered in this presentation.

General Medicine.ppt

Read more...