You are allowed only to have a white coat, a stethoscope and what you will eat during the breaks into the exam area. The day starts at 8am for morning session and 3pm for the afternoon session so it is better to be at the exam center at and respectively. The day start by an introduction about the exam and demonstration of the tools that is used in the exam rooms during the encounter, please feel free to use all the equipments during the demonstration so you can feel comfortable while using them during the encounters.
At 9am and 3pm the sessions begins with every doctor standing in front of an examination room with the patients notes written on the door, you are not allowed to see the patient notes until you hear the announcement that you can start the encounter then you knock and enter the room. Discussed later in details in the how to take a history.
Discussed later in details in how to make the physical exam. Discussed later in details in how to write patient notes. Child abuse at home? Other injuries? Weapons at home? Regular abuse? Drinking problems for the abuser? Pediatric: number of wet diapers and vigorous cry to assess dehydration , recent URI, day care center. How much?
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Concerned about your health? Like it? Side effects? Other drugs in the past? How often?
Last measurement? Blood transfusion? Previous birth problems? Recent immunization? Last measured? Multiple sexual partners or homosexual or sore throat cases. Past history of medical problems. A Allergies. M Medications prescription and over the counter. H Hospitalizations and past surgical history. S Sleep problems. S Sexual history sexually active? Who is your partner? If not his wife ask do you use any method of contraception? If condoms, ask used regularly or not? Thyroid cold or heat intolerance, voice change, tremors, hair fall, Palpitations. D Duration of symptoms.
S Support do you have someone to talk to when depressed? Suicide considered ending your life? Guns or pills at home? Sense of guilt. M Mood what has been your mood lately?
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Memory do you have problems remembering things? A Anxiety have you been feeling anxious lately? WR Realize do you realize you have a problem? Willing are you willing to get help? Cotton tips, tooth picks. Tongue depressors 3. BP cuff and monitor.
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Tuning fork, hummer. The physical exam is divided into: 1. General exam. Systems examination. Miscellaneous examinations. General examination These examinations are not necessarily done routinely in every case, but you should think about them and do what is relevant to the case. Head Tender sinuses. Eye Conjunctive for pallor. Fundoscopic exam.
Nose For nasal discharge. Throat Pharyngeal injection and tonsillitis. Ear Ear discharge. Neck LNS. Carotid bruit auscultation. Systems examination Chest examination: patient sitting or lying down 1. Inspection: Distress Depth,rhythm,rate Deformity. Lying down: 1- Inspection, palpation: Pulsation of jugular vein at 30 degree. Sitting: Auscultate the 4 areas. Inspection: Swelling Scar Pulsations Peristalsis. Auscultation: Bowl Bruit 3. Percussion: 4 quadrants. Palpation: Superficial watch the SP face Deep palpation. Liver Spleen 5. Special exam: Tenderness Rebound pain on releasing hand , done if tenderness on palpation.
Orientation tell me your full name? What day it is? Memory SHORT I will say 3 words and I want you to repeat them pen, pencil, car immediately and after 5 minutes so please remember them. LONG who was the previous president of the states? Judgment please take my pen with you right hand put it in your left hand and give it back to me.
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Eye movements 3,4,6 Trigeminal palpate the masseter while the SP clinching his teeth. Vestibulocochlear rub your fingers near the patient ears to see if he hears it. Vibration, position: Done if abnormalities in light touch and pain. Lt thumb on the chin to fix the head and the Rt index moves in the 3 cardinal positions on the Rt and vice versa. Otoscope exam: rest your hand on the mastoid process. B: ENT are always examined together.
Inspection: Swelling Scars Symmetry 2. Palpation: Tenderness Thyroid anterior approach: press on one lobe with your fingers while you examine the other from inside out toward the sternomastoid with the thumb. Posterior approach: examine both lobes together in a rolling movement while the SP swallows. Lymph nodes: Posterior occipital post auricular anterior auricular submandibular submental superficial and deep cervical supraclavicular N. B: forbidden examination not done but tell the SP you will need to do them if indicated female breast, pelvic, rectal, genital, corneal reflex and inguinal hernia examination.
Maximum of 5 DD and 5 diagnostic work up. History Physical examination Differential diagnosis Diagnostic workup: 1. Affect mood congruent. D Delusions and hallucinations Duration. S Suicide. Speech scant or excessive, goal oriented or not. T Thyroid. C Concentration. I Insight does the patient realize he has a problem.
Difficile toxin. Multiple Myeloma. Heart: MI, angina, pericarditis, arrhythmias. Lung: PE, pleuritis, pneumonia. Chest: costochondritis. Esophagus: GERD, perforation, obstruction. Aorta: dissection 6. Psychiatric: panic attack. Common cold 2. Acute sinusitis 3. Acute bronchitis 4. Bronchial Asthma 5. GERD 7. Pneumonia 8. Drugs: ACEI.
CHF 3. COPD exacerbation 4. Anxiety, Panic attack. Pneumonia 2. Pleuritic pain 3. Lung cancer 5. Posterior nasal drip 2. Chronic bronchitis 3. Bronchiectasis 4. Lung cancer 6. Regulation: The main stimulus for ADH release is an increase in osmolality of circulating blood. It also releases in response to hypovolemia. Physiological Functions: ADH binds to V2 receptors on the distal tubule and collecting ducts of the kidney to up-regulate aquaporin channel expression on the basolateral membrane and increase water reabsorption.
It, as its name suggests, also acts as a vasoconstrictor upon binding to V1 receptors on the arteriolar smooth muscle. Other causes include medications, pregnancy, lactation, stress and cranial radiation therapy. Excess of GH after epiphyseal closure causes acromegaly whereas gigantism results from GH hypersecretion before epiphyseal closure.
Acromegaly occurs more frequently than gigantism. Pathophysiology: excess GH causes an increase in growth of soft tissues and increases in IGF-1production from the liver, which promotes growth in the bones of the hands and feet. Individuals with acromegaly may also develop carbohydrate intolerance and diabetes due to excess GH.
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Create quizzes and track your progress. Sign Up. Stat Pearls Knowledge Base. Article Sections Chapter Questions. Physiology, Pituitary Gland. Article Author: Suzan El Sayed. Azhar Hussain. Janice Schwartz. Divyesh Nemakayala. William Gossman. Orawan Chaigasame. Carrie Smith. Answers and Explations 1. Pain following a TKR is normal, and breakdown over the heels is a gradual process.
Moreover, a subacute ankle sprain is almost never a medical emergency. Print or eBook. Guaranteed to raise your score. Get started today! A doctor is working in an outpatient orthopedic clinic. A doctor at outpatient clinic is determining the appropriate sequence to arrange patients in the afternoon.