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In the United States, end-stage liver disease (ESLD) is the 12th leading cause of death and the 7th leading cause of death in people between the ages of 25 and 64 years. Complications of ESLD such as ascites, variceal hemorrhage, hepatic encephalopathy, and renal impairment primarily account for these deaths. Patients with ESLD require increasingly complex medical support and manifest a spectrum of complications and symptoms that have significant impact on both survival and quality of life.
How do you assess cerebellar function? Ask them to do this as fast as possible while you slowly move your finger. Repeat the test with the other hand. Perform the heel-to-shin test. Have the patient lying down for this and get them to run the heel of one foot down the shin of the other leg, and then to bring the heel back up to the knee and start again.
The epididymis is a long coiled tube that lies above and behind each testicle. The epididymis collects and transports sperm from the testis to the vas deferens (tubes that transport sperm to the urethra). An epididymal cyst is a cyst-like mass in the epididymis that contains clear fluid. Typically, epididymal cysts and spermatoceles do not cause symptoms. When discovered, the epididymal cyst is usually about the size of a pea and feels separate from the top of the testis. Spermatoceles typically arise from the head of the epididymis, and are felt on the top portion of the testicle. Epididymal cysts and spermatoceles are often incidental findings on testicular self-examination or routine physical examination. It is important that any mass noted in the scrotum be examined by a urologist in order to obtain an accurate diagnosis, especially a mass on the testicle itself. Our team in the Division of Urology will typically be able to confirm the diagnosis on physical exam. However, a scrotal ultrasound may also be used in order to rule out other conditions.
A successful cardiovascular exam includes visual examination, palpation of the apical impulse, auscultation of Erb's point, auscultation of the carotids, and auscultation over the four different heart valve locations (aortic, pulmonic, tricuspid, and mitral). Additionally, the radial pulse is palpated while auscultating to distinguish whether a murmur is diastolic or systolic.
Video Index:
0:13 - Inspection of the thorax
0:29 - Palpation of the apex heart beat
0:59 - Auscultation of the heart
1:16 - Auscultation of the Erb’s point
1:33 - Using Erb’s point to check the heart rate
1:45 - Systolic and diastolic heart sound identification
2:01 - Ascultating individual valves: aortic, pulmonary, tricuspid, mitral
2:41 - Ascultation of the carotids
2:54 - Ascultating the pulmonary and aortic valves
3:04 - Ascultation of the mitral valve
3:16 - Mitral valve murmurs
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Frostbite is an injury caused by freezing of the skin and underlying tissues. First your skin becomes very cold and red, then numb, hard and pale. Frostbite is most common on the fingers, toes, nose, ears, cheeks and chin. Exposed skin in cold, windy weather is most vulnerable to frostbite. But frostbite can occur on skin covered by gloves or other clothing.