A nephron (from Greek νεφρός (nephros) meaning "kidney") is the basic structural and functional unit of the kidney. Its chief function is to regulate the concentration of water and soluble substances like sodium salts by filtering the blood, reabsorbing what is needed and excreting the rest as urine.

Coarctation of the aorta (CoA[1][2] or CoAo), also called aortic narrowing, is a congenital condition whereby the aorta is narrow, usually in the area where the ductus arteriosus (ligamentum arteriosum after regression) inserts. The word “coarctation” means narrowing. Coarctations are most common in the aortic arch. The arch may be small in babies with coarctations. Other heart defects may also occur when coarctation is present, typically occurring on the left side of the heart. When a patient has a coarctation, the left ventricle has to work harder. Since the aorta is narrowed, the left ventricle must generate a much higher pressure than normal in order to force enough blood through the aorta to deliver blood to the lower part of the body. If the narrowing is severe enough, the left ventricle may not be strong enough to push blood through the coarctation, thus resulting in lack of blood to the lower half of the body. Physiologically its complete form is manifested as interrupted aortic arch

Hypertensive emergencies encompass a spectrum of clinical presentations in which uncontrolled blood pressures (BPs) lead to progressive or impending end-organ dysfunction. In these conditions, the BP should be lowered aggressively over minutes to hours. Neurologic end-organ damage due to uncontrolled BP may include hypertensive encephalopathy, cerebral vascular accident/cerebral infarction, subarachnoid hemorrhage, and/or intracranial hemorrhage.[1] Cardiovascular end-organ damage may include myocardial ischemia/infarction, acute left ventricular dysfunction, acute pulmonary edema, and/or aortic dissection. Other organ systems may also be affected by uncontrolled hypertension, which may lead to acute renal failure/insufficiency, retinopathy, eclampsia, or microangiopathic hemolytic anemia.[1] With the advent of antihypertensives, the incidence of hypertensive emergencies has declined from 7% to approximately 1% of patients with hypertension.[2] In addition, the 1-year survival rate associated with this condition has increased from only 20% (prior to 1950) to a survival rate of more than 90% with appropriate medical treatment

As a doctor many people ask me about masturbation and if it is harmful or not. As a doctor you have already been asked this and this video will give you some hints

Compartment syndrome can develop in the foot following crush injury or closed fracture. Following some critical threshold of bleeding and/or swelling into the fixed space compartments, arterial pulse pressure is insufficient to overcome the osmotic tissue pressure gradient, leading to cell death. The complicating factor is related to the magnitude of the force of the crush injury. The amount of swelling or bleeding has to be sufficient to impair arterial inflow, while not being of sufficient magnitude to produce an open injury, which decompresses the pressure within the affected compartments. When the injury is open, we then attribute the late disability primarily to the crushing injury to the involved muscles.

This animation describes the goals of inflammatory bowel disease (IBD) management and how patients can take an active role in managing their disease.

Peripheral Vascular Examination OSCE - Clinical Skills - Dr Gill

In the cardiovascular examination, particularly in the case of an OSCE station, we conclude the examination often by stating that the examiner would want to perform:
- An ECG
- Check full blood count
- and "do a peripheral vascular examination

In this video, we demonstrate that oft-talked about, but comparatively less common examination.

Starting off, with the examination of the hands, the radial, brachial and carotid pulses. before moving down to assess for a AAA, checking the femoral and popliteal pulses, before wrapping up around the ankle with the posterior tibial and dorsalis pedis pulses

For completeness, the cardiovascular examination is demonstrated here
https://www.youtube.com/watch?v=ECs9O5zl6XQ&t=2s

#PeripheralVascular #ClinicalSkills #DrGill

Professional breast exam

During 34 week of pregnancy, the baby is getting ready for delivery, you may feel less wriggling and kicking. Watch out this video to learn more about being 34 weeks pregnant.

Epilepsy is a chronic disorder, the hallmark of which is recurrent, unprovoked seizures. Many people with epilepsy have more than one type of seizure and may have other symptoms of neurological problems as well. Sometimes EEG testing, clinical history, family history and outlook are similar among a group of people with epilepsy. In these situations, their condition can be defined as a specific epilepsy syndrome. The human brain is the source of human epilepsy. Although the symptoms of a seizure may affect any part of the body, the electrical events that produce the symptoms occur in the brain. The location of that event, how it spreads and how much of the brain is affected, and how long it lasts all have profound effects. These factors determine the character of a seizure and its impact on the individual. Esssentially, anything the brain can do, it can do in the form of a seizure. Having seizures and epilepsy can affect one's safety, relationships, work, driving and so much more. Public perception and treatment of people with epilepsy are often bigger problems than actual seizures.

Multiple sclerosis (MS) is a disease of the central nervous system estimated to affect 2.3 million people worldwide. It is a chronic disease in which the immune system abnormally attacks the insulation and support around the nerve cells (myelin sheath) in the brain, spinal cord and optic nerves, causing inflammation and consequent damage. MS is a leading cause of non-traumatic disability in young people, usually striking between 20 and 40 years of age. There is no cure for MS, but research continues to better understand and treat the disease.

Pulmonary fibrosis is a condition in which the tissue deep in your lungs becomes scarred over time. This tissue gets thick and stiff. That makes it hard for you to catch your breath, and your blood may not get enough oxygen. Causes of pulmonary fibrosis include environmental pollutants, some medicines, some connective tissue diseases, and interstitial lung disease. Interstitial lung disease is the name for a large group of diseases that inflame or scar the lungs. In most cases, the cause cannot be found. This is called idiopathic pulmonary fibrosis

Tracheotomy is a surgical procedure which consists of making an incision on the anterior aspect of the neck and opening a direct airway through an incision in the trachea (windpipe). The resulting stoma (hole), or tracheostomy, can serve independently as an airway or as a site for a tracheostomy tube to be inserted; this tube allows a person to breathe without the use of his or her nose or mouth. Both surgical and percutaneous techniques are widely used in current surgical practice. It is among the oldest described procedures.

If you're pregnant or might become pregnant, it's critically important to get enough folic acid, the synthetic form of vitamin B9, also known as folate. Folic acid helps prevent neural tube defects (NTDs) – serious birth defects of the spinal cord (such as spina bifida) and the brain (such as anencephaly).

A Fistulotomy is the surgical opening or removal of a fistulous tract. They can be performed by excision of the tract and surrounding tissue, simple division of the tract, or gradual division and assisted drainage of the tract by means of a seton; a cord passed through the tract in a loop which is slowly tightened over a period of days or weeks.

Fistulas can occur in various areas of the human body, and the location of the fistula influences the necessity of the procedure. Some, such as ano-vaginal and perianal fistulas are chronic conditions, and will never heal without surgical intervention.

Arthritis occurs when the cartilage breaks down explains Dr. Derek Papp, Sports Medicine Physician with Miami Orthopedics & Sports Medicine Institute. This it’s a very common knee injury such as the damage of the cartilage and meniscus tear.
ACL tears is another common injury especially in sports like soccer or Australian football, the specialist explains.

UPDATE 1/30/15: Watch the updated version of this animation: https://www.youtube.com/watch?v=LVP6JngpgEE

This 3D medical animation shows how adhesions in the abdomen may cause complications. These problems may include obstruction, twisting, and dislocating areas of the small intestine. Adhesions can be separated with laparoscopic instruments.

ANH00037

Dr. James Wall performs a bilateral inguinial hernia repair surgical procedure.

Featured:
James Wall, MD
Assistant Professor of Surgery, Pediatric Surgery
Assistant Professor of Bioengineering (By Courtesy)
Lucile Salter Packard Children's Hospital

Micaela Esquivel, MD
Chief Resident of General Surgery

A torn meniscus is one of the most common knee injuries. Any activity that causes you to forcefully twist or rotate your knee, especially when putting your full weight on it, can lead to a torn meniscus. Each of your knees has two menisci — C-shaped pieces of cartilage that act like a cushion between your shinbone and your thighbone. A torn meniscus causes pain, swelling and stiffness. You also might feel a block to knee motion and have trouble extending your knee fully. Conservative treatment — such as rest, ice and medication — is sometimes enough to relieve the pain of a torn meniscus and give the injury time to heal on its own. In other cases, however, a torn meniscus requires surgical repair.

Shoulder Clinical Examination - Medical School Clinical Skills - Dr Gill

Personally, I find the shoulder examination the most complex examination possibly as there are so many variations and special tests. Some of which overlap and some will relate specifically to a patients presentation.

Often in a medical school syllabus, only select special tests will be used. In this shoulder exam demonstration, we include the Hawkins-Kennedy Test looking for impingement. This is dovetailed with examination for bicipital tendonitis as this is another possible cause of impingement type symptoms.

This shoulder upper limb exam follows the standard "Look, Feel, Move" orthopaedic exam approach, and overall order as set out in MacLeods Clinical Examination

Watch further orthopaedic examinations for your OSCE revision:

The Spine Examination:
https://youtu.be/pJxMHa6SCgU

Knee Examination
https://youtu.be/oyKH4EYfJDM

Hip Joint Clinical Examination
https://youtu.be/JC9GKq5nSdQ
________

Please note that there is no ABSOLUTE way to perform a clinical examination. Different institutions and even clinicians will have differing degrees of variations - the aim is the effectively identify medically relevant signs.

However during OSCE assessments. Different medical schools, nursing colleges, and other health professional courses will have their own preferred approach to a clinical assessment - you should concentrate on THEIR marks schemes for your assessments.

The examination demonstrated here is derived from Macleods Clinical Examination - a recognized standard textbook for clinical skills.


#ShoulderExamination #ClinicalSkills #DrGill