1997 Documentation Guidelines for Evaluation and Management Services
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Prevention of Traumatic Corneal Ulcer in South East Asia
FROM OUR SOUTH ASIA EDITION Prevention of traumatic corneal ulcer in South East Asia S C AE Srinivasan/ (c)M Country Principal Investigator and Lead Principal Investigator with village health workers in Bhutan Dr. M. Srinivasan ciasis, and leprosy, are declining, and (VVHW) of the Government were utilized Director Emeritus, Aravind Eye Care, soon the majority of corneal blindness will to identify ocular injury and treat corneal Madurai, Tamil Nadu India. be due to microbial keratitis. Most abrasion corneal ulcers occur among agricultural Myanmar: Village Health Workers (VHW) workers in developing countries following of the health department Introduction corneal abrasion. India: paid village volunteers were utilized Corneal ulceration is a leading cause of Several non-randomized prevention visual impairment globally, with a dispro- studies conducted before 2000 Inclusion criteria 2 portionate burden in developing (Bhaktapur Eye Study) and during 2002 • Resident of study area countries. It was estimated that 6 million to 2004 in India, Myanmar, and Bhutan • Corneal abrasion after ocular injury, corneal ulcers occur annually in the ten by World Health Organization(WHO), have confirmed by clinical examination with countries of South East Asia Region suggested that antibiotic ointment fluorescein stain and a blue torch encompassing a total population of 1.6 applied promptly after a corneal abrasion • Reported within 48 hours of the injury billion.1 While antimicrobial treatment is could lower the incidence of ulcers, • Subject aged >5 years of age generally effective in treating infection, relative to neighbouring or historic “successful” treatment is often controls.3-4 Prevention of traumatic Exclusion criteria associated with a poor visual outcome. -
HEENT EXAMINIATION ______HEENT Exam Exam Overview
HEENT EXAMINIATION ____________________________________________________________ HEENT Exam Exam Overview I. Head A. Visual inspection B. Palpation of scalp II. Eyes A. Visual Acuity B. Visual Fields C. Extraocular Movements/Near Response D. Inspection of sclera & conjunctiva E. Pupils F. Ophthalmoscopy III. Ears A. External Inspection B. Otoscopy C. Hearing Acuity D. Weber/Rinne IV. Nose A. External Inspection B. Speculum/otoscope C. Sinus areas V. Throat/Mouth A. Mouth Examination B. Pharynx Examination C. Bimanual Palpation VI. Neck A. Lymph nodes B. Thyroid gland 29 HEENT EXAMINIATION ____________________________________________________________ HEENT Terms Acuity – (ehk-yu-eh-tee) sharpness, clearness, and distinctness of perception or vision. Accommodation - adjustment, especially of the eye for seeing objects at various distances. Miosis – (mi-o-siss) constriction of the pupil of the eye, resulting from a normal response to an increase in light or caused by certain drugs or pathological conditions. Conjunctiva – (kon-junk-ti-veh) the mucous membrane lining the inner surfaces of the eyelids and anterior part of the sclera. Sclera – (sklehr-eh) the tough fibrous tunic forming the outer envelope of the eye and covering all of the eyeball except the cornea. Cornea – (kor-nee-eh) clear, bowl-shaped structure at the front of the eye. It is located in front of the colored part of the eye (iris). The cornea lets light into the eye and partially focuses it. Glaucoma – (glaw-ko-ma) any of a group of eye diseases characterized by abnormally high intraocular fluid pressure, damaged optic disk, hardening of the eyeball, and partial to complete loss of vision. Conductive hearing loss - a hearing impairment of the outer or middle ear, which is due to abnormalities or damage within the conductive pathways leading to the inner ear. -
New Observations Letters Familial Spinocerebellar Ataxia Type 2 Parkinsonism Presenting As Intractable Oromandibular Dystonia
Freely available online New Observations Letters Familial Spinocerebellar Ataxia Type 2 Parkinsonism Presenting as Intractable Oromandibular Dystonia 1,2 2,3 1,3* Kyung Ah Woo , Jee-Young Lee & Beomseok Jeon 1 Department of Neurology, Seoul National University Hospital, Seoul, KR, 2 Department of Neurology, Seoul National University Boramae Hospital, Seoul, KR, 3 Seoul National University College of Medicine, Seoul, KR Keywords: Dystonia, spinocerebellar ataxia type 2, Parkinson’s disease Citation: Woo KA, Lee JY, Jeon B. Familial spinocerebellar ataxia type 2 parkinsonism presenting as intractable oromandibular dystonia. Tremor Other Hyperkinet Mov. 2019; 9. doi: 10.7916/D8087PB6 * To whom correspondence should be addressed. E-mail: [email protected] Editor: Elan D. Louis, Yale University, USA Received: October 20, 2018 Accepted: December 10, 2018 Published: February 21, 2019 Copyright: ’ 2019 Woo et al. This is an open-access article distributed under the terms of the Creative Commons Attribution–Noncommercial–No Derivatives License, which permits the user to copy, distribute, and transmit the work provided that the original authors and source are credited; that no commercial use is made of the work; and that the work is not altered or transformed. Funding: None. Financial Disclosures: None. Conflicts of Interest: The authors report no conflict of interest. Ethics Statement: This study was reviewed by the authors’ institutional ethics committee and was considered exempted from further review. We have previously described a Korean family afflicted with reflex, mildly stooped posture, and parkinsonian gait. There was spinocerebellar ataxia type 2 (SCA2) parkinsonism in which genetic no sign of lower motor lesion, including weakness, muscle atrophy, analysis revealed CAG expansion of 40 repeats in the ATXN2 gene.1 or fasciculation. -
Cramp Fasciculation Syndrome: a Peripheral Nerve Hyperexcitability Disorder Bhojo A
View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by eCommons@AKU Pakistan Journal of Neurological Sciences (PJNS) Volume 9 | Issue 3 Article 7 7-2014 Cramp fasciculation syndrome: a peripheral nerve hyperexcitability disorder Bhojo A. Khealani Aga Khan University Hospital, Follow this and additional works at: http://ecommons.aku.edu/pjns Part of the Neurology Commons Recommended Citation Khealani, Bhojo A. (2014) "Cramp fasciculation syndrome: a peripheral nerve hyperexcitability disorder," Pakistan Journal of Neurological Sciences (PJNS): Vol. 9: Iss. 3, Article 7. Available at: http://ecommons.aku.edu/pjns/vol9/iss3/7 CASE REPORT CRAMP FASCICULATION SYNDROME: A PERIPHERAL NERVE HYPEREXCITABILITY DISORDER Bhojo A. Khealani Assistant professor, Neurology section, Aga khan University, Karachi Correspondence to: Bhojo A Khealani, Department of Medicine (Neurology), Aga Khan University, Karachi. Email: [email protected] Date of submission: June 28, 2014, Date of revision: August 5, 2014, Date of acceptance:September 1, 2014 ABSTRACT Cramp fasciculation syndrome is mildest among all the peripheral nerve hyperexcitability disorders, which typically presents with cramps, body ache and fasciculations. The diagnosis is based on clinical grounds supported by electrodi- agnostic study. We report a case of young male with two months’ history of body ache, rippling, movements over calves and other body parts, and occasional cramps. His metabolic workup was suggestive of impaired fasting glucose, radio- logic work up (chest X-ray and ultrasound abdomen) was normal, and electrodiagnostic study was significant for fascicu- lation and myokymic discharges. He was started on pregablin and analgesics. To the best of our knowledge this is report first of cramp fasciculation syndrome from Pakistan. -
In Diagnosis Must Be Based on Clinical Signs and Symptoms. in This Paper
242 POST-GRADUATE MEDICAL JOURNAL August, 1938 Postgrad Med J: first published as 10.1136/pgmj.14.154.242 on 1 August 1938. Downloaded from SOME REMARKS ON DIFFERENTIAL DIAGNOSIS OF BLOOD DISEASES. By A. PINEY, M.D., M.R.C.P. (Assistant Physician, St. Mary's Hospital for Women and Children.) Differential diagnosis of blood diseases has been discussed time and again, but, as a rule, blood-pictures, rather than clinical features, have been taken into account, so that the impression has become widespread that the whole problem is one for the laboratory, rather than for the bed-side. It is obvious, however, that the first steps in diagnosis must be based on clinical signs and symptoms. In this paper, there- fore, certain outstanding clinical features of blood diseases, and various rather puzzling syndromes will be described. The outstanding external sign that leads the practitioner to consider the possi- bility of a blood disease is pallor, which is not quite so simple a state as is often supposed. It is, of course, well known that cutaneous pallor is not an infallible sign of anaemia, but it is often presumed that well-coloured mucous membranes are fairly good evidence that anaemia is not present. This is not necessarily true. The conjunctive may be bright pink in spite of anaemia, because mild inflammationProtected by copyright. may be present, masking the pallor. This is quite frequently due to irritation by eyelash dyes. Similarly, the finger-nails, which used to serve as a reliable index of pallor, are now found disguised with coloured varnish. -
A Neurological Examination
THE 3 MINUTE NEUROLOGICAL EXAMINATION DEMYSTIFIED Faculty: W.J. Oczkowski MD, FRCPC Professor and Academic Head, Division of Neurology, Department of Medicine, McMaster University Stroke Neurologist, Hamilton Health Sciences Relationships with commercial interests: ► Not Applicable Potential for conflict(s) of interest: ► Not Applicable Mitigating Potential Bias ► All the recommendations involving clinical medicine are based on evidence that is accepted within the profession. ► All scientific research referred to, reported, or used is in the support or justification of patient care. ► Recommendations conform to the generally accepted standards. ► Independent content validation. ► The presentation will mitigate potential bias by ensuring that data and recommendations are presented in a fair and balanced way. ► Potential bias will be mitigated by presenting a full range of products that can be used in this therapeutic area. ► Information of the history, development, funding, and the sponsoring organizations of the disclosure presented will be discussed. Objectives ► Overview of neurological assessment . It’s all about stroke! . It’s all about the chief complaint and history. ► Overview: . 3 types of clinical exams . Neurological signs . Neurological localization o Pathognomonic signs o Upper versus lower motor neuron signs ► Cases and practice Bill ► 72 year old male . Hypertension . Smoker ► Stroke call: dizzy, facial droop, slurred speech ► Neurological Exam: . Ptosis and miosis on left . Numb left face . Left palatal weakness . Dysarthria . Ataxic left arm and left leg . Numb right arm and leg NIH Stroke Scale Score ► LOC: a,b,c_________________ 0 ► Best gaze__________________ 0 0 ► Visual fields________________ 0 ► Facial palsy________________ 0 ► Motor arm and leg__________ -Left Ptosis 2 -Left miosis ► Limb ataxia________________ -Weakness of 1 ► Sensory_______________________ left palate ► Best Language______________ 0 1 ► Dysarthria_________________ 0 ► Extinction and inattention____ - . -
Respiratory Examination Cardiac Examination Is an Essential Part of the Respiratory Assessment and Vice Versa
Respiratory examination Cardiac examination is an essential part of the respiratory assessment and vice versa. # Subject steps Pictures Notes Preparation: Pre-exam Checklist: A Very important. WIPE Be the one. 1 Wash your hands. Wash your hands in Introduce yourself to the patient, confirm front of the examiner or bring a sanitizer with 2 patient’s ID, explain the examination & you. take consent. Positioning of the patient and his/her (Position the patient in a 3 1 2 Privacy. 90 degree sitting position) and uncover Exposure. full exposure of the trunk. his/her upper body. 4 (if you could not, tell the examiner from the beginning). 3 4 Examination: General appearance: B (ABC2DEVs) Appearance: young, middle aged, or old, Begin by observing the and looks generally ill or well. patient's general health from the end of the bed. Observe the patient's general appearance (age, Around the bed I can't state of health, nutritional status and any other see any medications, obvious signs e.g. jaundice, cyanosis, O2 mask, or chest dyspnea). 1 tube(look at the lateral sides of chest wall), metered dose inhalers, and the presence of a sputum mug. 2 Body built: normal, thin, or obese The patient looks comfortable and he doesn't appear short of breath and he doesn't obviously use accessory muscles or any heard Connections: such as nasal cannula wheezes. To determine this, check for: (mention the medications), nasogastric Dyspnea: Assess the rate, depth, and regularity of the patient's 3 tube, oxygen mask, canals or nebulizer, breathing by counting the respiratory rate, range (16–25 breaths Holter monitor, I.V. -
Approach to Cyanosis in a Neonate.Pdf
PedsCases Podcast Scripts This podcast can be accessed at www.pedscases.com, Apple Podcasting, Spotify, or your favourite podcasting app. Approach to Cyanosis in a Neonate Developed by Michelle Fric and Dr. Georgeta Apostol for PedsCases.com. June 29, 2020 Introduction Hello, and welcome to this pedscases podcast on an approach to cyanosis in a neonate. My name is Michelle Fric and I am a fourth-year medical student at the University of Alberta. This podcast was made in collaboration with Dr. Georgeta Apostol, a general pediatrician at the Royal Alexandra Hospital Pediatrics Clinic in Edmonton, Alberta. Cyanosis refers to a bluish discoloration of the skin or mucous membranes and is a common finding in newborns. It is a clinical manifestation of the desaturation of arterial or capillary blood and may indicate serious hemodynamic instability. It is important to have an approach to cyanosis, as it can be your only sign of a life-threatening illness. The goal of this podcast is to develop this approach to a cyanotic newborn with a focus on these can’t miss diagnoses. After listening to this podcast, the learner should be able to: 1. Define cyanosis 2. Assess and recognize a cyanotic infant 3. Develop a differential diagnosis 4. Identify immediate investigations and management for a cyanotic infant Background Cyanosis can be further broken down into peripheral and central cyanosis. It is important to distinguish these as it can help you to formulate a differential diagnosis and identify cases that are life-threatening. Peripheral cyanosis affects the distal extremities resulting in blue color of the hands and feet, while the rest of the body remains pinkish and well perfused. -
Visual Examination
Visual Examination • Consider the impact of chest shape on the respiratory condition of the patient – Barrel chest – Kyphosis – Scoliosis – Pectus excavatum (funnel chest) – Pectus carinatum Visual Assessment of Thorax • Thoracic scars from previous surgery • Chest symmetry • Use of accessory muscles • Bruising • In drawing of ribs • Flail segment www.nejm.org/doi/full/10.1056/NEJMicm0904437 • Paradoxical breathing /seesaw breathing • Pursed lip breathing • Nasal flaring Palpation • For vibration of secretion • Surgical emphysema • Symmetry of chest movement • Tactile vocal fremitus • Check for a tracheal tug • Palpate Nodes http://www.ncbi.nlm.nih.gov/books/NBK368/ https://m.youtube.com/watch?v=uzgdaJCf0Mk Auscultation • Is there any air entry? • Differentiate – Normal vesicular sounds – Bronchial breathing – Wheeze – Distinguish crackles • Fine • Coarse • During inspiration or expiration • Profuse or scanty – Absent sounds – Vocal resonance http://www.easyauscultation.com/lung-sounds.aspx Percussion • Tapping of the middle phalanx of the left middle finger with the right middle finger • Sounds should be resonant but may be – Hyper resonant – Dull – Stony Dull http://stanfordmedicine25.stanford.edu/the25/pulmonary.html Pathological Expansion Mediastinal Percussion Breath Further Process Displacement Note Sounds Examination Consolidation Reduced on None Dull Bronchial affected side breathing Vocal resonance Whispering pectoriloquy Collapse Reduced on Towards Dull Reduced None affected side affected side Pleural Reduced on Towards Stony dull Reduced/ Occasional rub effusion affected side opposite side Absent Empyema Asthma Reduced None Resonant Normal/ Wheeze throughout Reduced COPD Reduced None Resonant/ Normal/ Wheeze throughout Hyper-resonant Reduced Pulmonary Normal or None Normal Normal Bibasal crepitations Fibrosis reduced throughout Pneumothorax Reduced on Towards Hyper-resonant Reduced/ None affected side opposite side Absent http://www.cram.com/flashcards/test/lung-sounds-886428 sign up and test yourself.. -
Advanced Interpretation of Adult Vital Signs in Trauma William D
Advanced Interpretation of Adult Vital Signs in Trauma William D. Hampton, DO Emergency Physician 26 March 2015 Learning Objectives 1. Better understand vital signs for what they can tell you (and what they can’t) in the assessment of a trauma patient. 2. Appreciate best practices in obtaining accurate vital signs in trauma patients. 3. Learn what teaching about vital signs is evidence-based and what is not. 4. Explain the importance of vital signs to more accurately triage, diagnose, and confidently disposition our trauma patients. 5. Apply the monitoring (and manipulation of) vital signs to better resuscitate trauma patients. Disclosure Statement • Faculty/Presenters/Authors/Content Reviewers/Planners disclose no conflict of interest relative to this educational activity. Successful Completion • To successfully complete this course, participants must attend the entire event and complete/submit the evaluation at the end of the session. • Society of Trauma Nurses is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. Vital Signs Vital Signs Philosophy: “View vital signs as compensatory to the illness/complaint as opposed to primary.” Crowe, Donald MD. “Vital Sign Rant.” EMRAP: Emergency Medicine Reviews and Perspectives. February, 2010. Vital Signs Truth over Accuracy: • Document the true status of the patient: sick or not? • Complete vital signs on every patient, every time, regardless of the chief complaint. • If vital signs seem misleading or inaccurate, repeat them! • Beware sending a patient home with abnormal vitals (especially tachycardia)! •Treat vital signs the same as any other diagnostics— review them carefully prior to disposition. The Mother’s Vital Sign: Temperature Case #1 - 76-y/o homeless ♂ CC: 76-y/o homeless ♂ brought to the ED by police for eval. -
Physical Eye Examination
Physical Eye Examination Kaevalin Lekhanont, MD Department of Ophthalmology Ramathibodi Hospp,ital, Mahidol Universit y Outline • Visual acuity (VA) testing – Distant VA test – Pinhole test – Near VA test • Visual field testing • Record and interpretations Outline • Penlight examination •Swingggping penli ght test • Direct ophthalmoscopy – Red reflex examination • Schiotz tonometry • RdditttiRecord and interpretations Conjunctiva, Sclera Retina Cornea Iris Retinal blood vessels Fovea Pupil AtAnteri or c ham ber Vitreous Aqueous humor Lens Optic nerve Trabecular meshwork Ciliary body Choriod and RPE Function evaluation • Visual function – Visual acuity test – Visual field test – Refraction • Motility function Anatomical evaluation Visual acuity test • Distant VA test • Near VA test Distance VA test Snellen’s chart • 20 ฟุตหรือ 6 เมตร • วัดที่ละขาง ตาขวากอนตาซาย • ออานทละตาานทีละตา แถวบนลงลแถวบนลงลางาง • บันทึกแถวลางสุดที่อานได Pinhole test VA with pinhole (PH) Refractive error emmetitropia myypopia hyperopia VA record 20/200 ผูปวยสามารถอานต ัวเลขทมี่ ี ขนาดใหญขนาดใหญพอทคนปกตพอที่คนปกติ สามารถอานไดจากท ี่ระยะ 200 ฟตฟุต แตแตผผปูปวยอานไดจากวยอานไดจาก ที่ระยะ 20 ฟุต 20/20 Distance VA test • ถาอานแถวบนสุดไไไมได ใหเดินเขาใกล chthart ทีละกาวจนอานได (10/200, 5/200) • Counting finger 2ft - 1ft - 1/2ft • Hand motion • Light projection • Light perception • No light perception (NLP) ETDRS Chart Most accurate Illiterate E chart For children age ≥ 3.5 year Near VA test Near chart •14 นวิ้ หรอื 33 เซนตเมตริ • วัดที่ละขาง ตาขวากอนตาซาย • อานทีละตา แถวบนลงลาง -
Practical Cardiac Auscultation
LWW/CCNQ LWWJ306-08 March 7, 2007 23:32 Char Count= Crit Care Nurs Q Vol. 30, No. 2, pp. 166–180 Copyright c 2007 Wolters Kluwer Health | Lippincott Williams & Wilkins Practical Cardiac Auscultation Daniel M. Shindler, MD, FACC This article focuses on the practical use of the stethoscope. The art of the cardiac physical exam- ination includes skillful auscultation. The article provides the author’s personal approach to the patient for the purpose of best hearing, recognizing, and interpreting heart sounds and murmurs. It should be used as a brief introduction to the art of auscultation. This article also attempts to illustrate heart sounds and murmurs by using words and letters to phonate the sounds, and by presenting practical clinical examples where auscultation clearly influences cardiac diagnosis and treatment. The clinical sections attempt to go beyond what is available in standard textbooks by providing information and stethoscope techniques that are valuable and useful at the bedside. Key words: auscultation, murmur, stethoscope HIS article focuses on the practical use mastered at the bedside. This article also at- T of the stethoscope. The art of the cardiac tempts to illustrate heart sounds and mur- physical examination includes skillful auscul- murs by using words and letters to phonate tation. Even in an era of advanced easily avail- the sounds, and by presenting practical clin- able technological bedside diagnostic tech- ical examples where auscultation clearly in- niques such as echocardiography, there is still fluences cardiac diagnosis and treatment. We an important role for the hands-on approach begin by discussing proper stethoscope selec- to the patient for the purpose of evaluat- tion and use.