ectal exam is an internal examination of the rectum such as by a physician or other healthcare professional.
The digital rectal examination (DRE, Latin palpatio per anum or PPA) is a relatively simple procedure. The patient is placed in a position where the anus is accessible and relaxed (lying on the side, squatting on the examination table, bent over the examination table, etc). The physician inserts a gloved and lubricated finger into the rectum through the anus and palpates the insides.
The DRE is inadequate as a screening tool for colorectal cancer because it examines less than 10% of the colorectal mucosa; colonoscopy is preferred. However, it's an important part of a general examination, as many tumors or other diseases are made manifest in the distal part of the rectum.

This examination may be used: * for the diagnosis of rectal tumors and other forms of cancer; * in males, for the diagnosis of prostatic disorders, notably tumors and benign prostatic hyperplasia; * for the diagnosis of appendicitis or other examples of an acute abdomen (i.e. acute abdominal symptoms indicating a serious underlying disease); * for the estimation of the tonicity of the anal sphincter, which may be useful in case of fecal incontinence or neurologic diseases, including traumatic spinal cord injuries; * in females, for gynecological palpations of internal organs * for examination of the hardness and color of the feces (ie. in cases of constipation, and fecal impaction); * prior to a colonoscopy or proctoscopy. * to evaluate haemorrhoids

The DRE is frequently combined with an FOBT (fecal occult blood test), which may be useful for diagnosing the etiology of an anemia and/or confirming a gastrointestinal bleed.

Sometimes proctoscopy may also be part of a rectal examination.

Routine pelvic exams are important for good reproductive health. A woman should have her first GYN exam when she first thinks about becoming sexually active, when she becomes sexually active or when she turns 18.

At the gynecologist, you will have a short general physical exam, including a breast exam. You will wear a hospital gown and nothing else. For the actual pelvic examination, you will lie down on an examination table with your feet resting in elevated “stirrups” (props that support your legs in the air). Stirrups might look a little scary, but they are there to keep you comfortable. Your legs will be spread apart, with your knees falling to each side so that your vagina is exposed. You may feel uncomfortable, but relax and realize that everyone goes through this.

External Exam
The practitioner will visually examine your vulva for discoloration, irritation, swelling and other abnormalities, and will gently feel for glands.

Internal Exam
There are two parts to the internal exam. The first involves a speculum, a metal or plastic instrument that the practitioner inserts into the vagina. The speculum is shaped like a duck’s bill, and once it is inserted into the vaginal canal, it is gently widened to spread the interior vaginal walls (this is not painful). As the vaginal walls are spread, the practitioner is able to see the walls of the vagina itself, and up the vaginal canal to the cervix. When viewing the vaginal canal and the cervix, the practitioner can look for discoloration, abnormal discharge, lesions, growths and signs of infection. It is possible for you to look at your own cervix during this process by propping yourself up on your elbows and using a mirror. Some practitioners ask if you would like to do this, but feel free to ask to if she doesn’t mention it first.

Pap Smear
Next the practitioner will take a pap smear. She/he uses a long-stemmed cotton swab to collect a sample of cells in the cervix. Some women feel a slight cramping sensation when their cervix is touched. The collected cells are smeared onto a slide and sent to a lab for testing and examination. The pap smear is extremely important for spotting abnormalities in the cervix which may indicate infection or disease.

STD Testing
If you are sexually active, the practitioner will test for STDs. The gynecologist will swab the inside of the cervix with a long cotton swab. The speculum is then taken out of the vagina. The samples are sent to a laboratory for various STD testing. The tests will probably take a couple days. Ask when your results will be available so you can call. If you want to be tested for HIV, syphilis, genital herpes or hepatitis you need to have blood taken. They can do that as well, but you will need to ask since it is not usually routine.

Manual Exam
The second part of the pelvic exam is called the manual or bi-manual exam. The practitioner will insert one or two fingers into your vagina and press with her/his other hand on the outside of your lower abdomen. They will use a lubricant on their fingers so it is more comfortable. The person can then feel the uterus, fallopian tubes and ovaries, and check for any swelling or tenderness. Once the doctor is finished checking your uterus and ovaries, the exam is complete. The entire pelvic exam (the parts involving your vagina, cervix, uterus, and ovaries) takes 3 to 5 minutes to complete.

Continuous Connell Pattern Suture

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An endoscopy showing celiac disease

A video showing breast examination after breast implants

ACTUAL CATHETERIZATION A clinical view of insertion into the male urethra. A 14 french coude cath was used.

A video showing the process of Oral Medications Absorption

Purse String Suture

How to properly apply a tourniquet

this vide shows how to setup an use the SphygmoCor System

Intraoral Camera

ost of us come across this particular sign quite often. Of course, you can just jump to the numerous investigations and one after another, rule out the possible causes, finally getting to the diagnosis. For me, that’s no fun at all. Although I still don’t know whether I am going to become a surgeon or not (embarassing for me, since I’m going to be done with med-school this year), its pretty fascinating. If I were to work in a country whether investigations aren’t that expensive, I would definitely just perform a small examination and take a short history, sending off my patient to get a myriad of investigations, reporting to me after a while, with the diagnosis in his reports.

Dr Chris Steele demonstrates a breast examination on a live model. This shows how to check yourself for early signs of tumours, cysts and other symptoms of breast cancer.

The complex circuitry interconnecting different areas in the brain, known collectively as white matter, is composed of millions of axons organized into fascicles and bundles. Upon macroscopic examination of sections of the brain, it is difficult to discern the orientation of the fibers. The same is true for conventional imaging modalities. However, recent advancements in magnetic resonance imaging (MRI) make such task possible in a live subject. By sensitizing an otherwise typical MRI sequence to the diffusion of water molecules it is possible to measure their diffusion coefficient in a given direction1. Normally, the axonal membrane and myelin sheaths pose barriers to the movement of water molecules and, thus, they diffuse preferentially along the axon2. Therefore, the direction of white matter bundles can be elucidated by determining the principal diffusivity of water. The three-dimensional representation of the diffusion coefficient can be given by a tensor and its mathematical decomposition provides the direction of the tracts3; this MRI technique is known as diffusion tensor imaging (DTI). By connecting the information acquired with DTI, three-dimensional depictions of white matter fascicles are obtained4. The virtual dissection of white matter bundles is rapidly becoming a valuable tool in clinical research.

Our journey begins with a transverse section of tightly packed axons as seen through light microscopy. Although represented as a two-dimensional "slice", we see that these axons in fact resemble tubes. A simulation of water molecules diffusing randomly inside the axons demonstrates how the membranes and myelin hinder their movement across them and shows the preferred diffusion direction --along the axons. The tracts depicted through DTI slowly blend in and we ride along with them. As we zoom out even more, we realize that it is a portion of the corpus callosum connecting the two sides of the brain we were traveling on and the great difference in relative scale of the individual axons becomes evident. The surface of the brain is then shown, as well as the rest of the white matter bundles--a big, apparently chaotic tangle of wires. Finally, the skin covers the brain.

With the exception of the simulated water molecules, all the data presented in the animation is obtained through microscopy and MRI. Computer algorithms for the extraction of the cerebral structures and a custom-built graphics engine make our journey through the brain's anatomy possible in a living person.

Micrograph courtesy of Dr. Christian Beaulieu, University of Alberta.
Music by Mario Mattioli.

References:
1. Stejskal, E.O., et al., J. Chem. Phys., 1965. 42:
2. Beaulieu, C., NMR Biomed., 2002. 15:435-55.
3. Basser, P.J., et al., J. Magn. Reson. B, 1994. 103:247-54.
4. Mori, S., et al., NMR Biomed., 2002. 15:468-80.

Posterior Chest Examination from the USMLE collection

Proctoscopy in Jackknife Position for examination of the rectum

Physical exam by a urologist including kidney, testicular and prostate exam.

Proctoscope rectal examination

A video showing how to do Spinal Anaesthesia