The examination consists of three portions: Inspection, Palpation, and Synthesis of data from these techniques In addition to palpating for size, also note the gland texture, mobility, tenderness and the presence of nodules. Inspection Inspection: Anterior Approach The patient should be seated or standing in a comfortable position with the neck in a neutral or slightly extended position. Cross-lighting increases shadows, improving the detection of masses. To enhance visualization of the thyroid, you can: Extending the neck, which stretches overlying tissues Have the patient swallow a sip of water, watching for the upward movement of the thyroid gland. quicktime video 251KB video demo from Return to the Bedside Inspection: Lateral Approach After completing anterior inspection of the thyroid, observe the neck from the side. Estimate the smooth, straight contour from the cricoid cartilage to the suprasternal notch. Measure any prominence beyond this imagined contour, using a ruler placed in the area of prominence. Palpation Note: There is no data comparing palpation using the anterior approach to the posterior approach so examiners should use the approach that they find most comfortable. Palpation: Anterior Approach placement of hands for palpatation of thyroid in anterior approach The patient is examined in the seated or standing position. Attempt to locate the thyroid isthmus by palpating between the cricoid cartilage and the suprasternal notch. Use one hand to slightly retract the sternocleidomastoid muscle while using the other to palpate the thyroid. Have the patient swallow a sip of water as you palpate, feeling for the upward movement of the thyroid gland. quicktime video 454KB video demo from Return to the Bedside. Palpation: Posterior Approach placement of hands for palpatation of thyroid in posterior approach The patient is examined in the seated or standing position. Standing behind the patient, attempt to locate the thyroid isthmus by palpating between the cricoid cartilage and the suprasternal notch. Move your hands laterally to try to feel under the sternocleidomstoids for the fullness of the thyroid. Have the patient swallow a sip of water as you palpate, feeling for the upward movement of the thyroid gland.

The examination of the groin, hernial orifices and male external genitalia are clinical examinations which undergraduate medical students are commonly less confident about performing competently, due to the lack of clinical exposure.

The video will shed some light on fungal infections. Please see disclaimer on my website.

A new and safer method of inserting a Foley catheter suprapubically. The technique allows the insertion to be carried out in an Outpatient setting, thus saving time, cost and effort. By using the Seldinger technique, the product reduces the chances of bowel or bladder perforation and resultant morbidity.
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Bone is not a static part of the body — it's constantly being resorbed (broken down) and formed throughout your life. Your entire skeleton is replaced about every decade, according to the NIH. During your childhood and teenage years, bone formation occurs more quickly than bone resorption, resulting in growth. You reach your maximum bone density and strength around age 30, after which bone resorption slowly overtakes bone formation. Osteoporosis develops when there's an abnormal imbalance between bone resorption and formation — that is, resorption occurs too quickly, or formation too slowly.

Uncontrolled hyperthyroidism during pregnancy can lead to serious health problems in the mother and the unborn baby. During pregnancy, mild hyperthyroidism does not require treatment. More severe hyperthyroidism is treated with antithyroid medications, which act by interfering with thyroid hormone production.

A ureteral stent is a thin, hollow tube that is placed in the ureter to help urine pass from the kidney into the bladder. Ureters are the tubes that connect the kidneys to the bladder. You may have a small amount of blood in your urine for 1 to 3 days after the procedure.

Uncomplicated acute otitis media (AOM) should be treated empirically with amoxicillin. Recurrent AOM should raise concern for beta-lactamase resistance and warrants treatment with amoxicillin-clavulanic acid. Ototopical medications are unnecessary, even if there is tympanic membrane perforation.

Papillary fibroelastoma is the third most common primary tumor of the heart and is most likely to involve the cardiac valves. Like myxomas, they arise from the endocardium in most patients and since these tumors are often incidental findings at echocardiography or autopsy, the true incidence is difficult to estimate. Most patients are older than 60 years, which also contrasts with myxomas. Papillary fibroelastomas can embolize, leading to severe neurological complications and therefore, surgical removal is advised, although there is controversy regarding small incidental lesions and the need for surgery.

Pulmonary circulation is the portion of the cardiovascular system which carries deoxygenated blood away from the heart, to the lungs, and returns oxygenated (oxygen-rich) blood back to the heart. The function of pulmonary circulation is to exchange carbon dioxide for oxygen in the blood. It is the passage of blood from the heart to the capillaries of the lungs, where the gases are exchanged, and back to the heart to be pumped around the body.

The dural venous sinuses are spaces between the endosteal and meningeal layers of the dura. They contain venous blood that originates for the most part from the brain or cranial cavity. The sinuses contain an endothelial lining that is continuous into the veins that are connected to them.

The pelvic floor or pelvic diaphragm is composed of muscle fibers of the levator ani, the coccygeus, and associated connective tissue which span the area underneath the pelvis. The pelvic diaphragm is a muscular partition formed by the levatores ani and coccygei, with which may be included the parietal pelvic fascia on their upper and lower aspects. The pelvic floor separates the pelvic cavity above from the perineal region (including perineum) below.

The right and left levator ani lie almost horizontally in the floor of the pelvis, separated by a narrow gap that transmits the urethra, vagina, and anal canal. The levator ani is usually considered in three parts: pubococcygeus, puborectalis, and iliococcygeus. The pubococcygeus, the main part of the levator, runs backward from the body of the pubis toward the coccyx and may be damaged during parturition. Some fibers are inserted into the prostate, urethra, and vagina. The right and left puborectalis unite behind the anorectal junction to form a muscular sling . Some regard them as a part of the sphincter ani externus. The iliococcygeus, the most posterior part of the levator ani, is often poorly developed.

The coccygeus, situated behind the levator ani and frequently tendinous as much as muscular, extends from the ischial spine to the lateral margin of the sacrum and coccyx.

The pelvic cavity of the true pelvis has the pelvic floor as its inferior border (and the pelvic brim as its superior border.) The perineum has the pelvic floor as its superior border.

Some sources do not consider “pelvic floor” and “pelvic diaphragm” to be identical, with the “diaphragm” consisting of only the levator ani and coccygeus, while the “floor” also includes the perineal membrane and deep perineal pouch. However, other sources include the fascia as part of the diaphragm. In practice, the two terms are often used interchangeably.

Inferiorly, the pelvic floor extends into the anal triangle.

Head to Toe Assesment

Transjugular intrahepatic portosystemic shunt or transjugular intrahepatic portosystemic stent shunting (commonly abbreviated as TIPS or TIPSS) is an artificial channel within the liver that establishes communication between the inflow portal vein and the outflow hepatic vein.

Renal artery stenosis is a narrowing of arteries that carry blood to one or both of the kidneys. Most often seen in older people with atherosclerosis (hardening of the arteries), renal artery stenosis can worsen over time and often leads to hypertension (high blood pressure) and kidney damage.

The video will describe air crescent sign on Chest x-rays and CT scans. Please see disclaimer on my website. www.academyofprofessionals.com

The gold standard treatment for bladder outlet obstruction.This is an endoscopic procedure in which a resectoscope is placed transurethrally and the obstructing lobes of the prostate are removed as chips of tissue. TURP results in improvement of flow rate, and symptom scores are superior to that of other minimally invasive therapies

Meningococcal meningitis - causes, features, symptoms and treatment

Cranial Nerves Mnemonic

Wedge Resection of a gastric GIST