Neck Examination - Cervical Spine Assessment - Clinical Skills - Dr Gill

Compose a new pain within athletes is cervical spine discomfort, thankfully in the vast majority of cases when the neck is examined the cause of the neck pain is found to be muscular.

However, pain can also refer from the neck to the arm, in which case it is important to be able to assess for cervical radiculopathy prior to gaining more information which may indicate an MRI is needed

We assess for radiculopathy by doing Spurling's test, an often overlooked part of the neck examination, but it should be included for completeness and reassurance of the patient - not forgetting the athlete or not, neck pain can be a considerable source of distress, so it's vital to be able to get information from the neck examination which allows you to safely reassure a patient when appropriate, or comment that neck exam found evidence that needs further investigation

#DRGill #neck #asmr

An ectopic pregnancy (EP) is a condition in which a fertilized egg settles and grows in any location other than the inner lining of the uterus. The vast majority of ectopic pregnancies are so-called tubal pregnancies and occur in the Fallopian tube.

Sean Langenfeld, M.D., UNMC College of Medicine

The most reliable clinical sign to detect ascites is checking for bilateral flank dullness. If a patient with ascites is lying supine, fluid accumulates in the flank regions, leading to dullness on percussion. At the same time, the air-filled bowel loops are forced upwards by the free fluid due to buoyancy, resulting in tympanitic percussion. To locate specifically where dullness shifts to tympany, or the air-fluid level, percussion should be performed from the sides towards the middle. To confirm that the dullness is caused by ascites, ask the patient to switch to a lateral decubitus position. If ascites is present, the air-filled bowel loops will shift accordingly and remain at the surface of the fluid. As a result, the air-fluid level will shift as well. This is known as shifting dullness.

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Watch that video to know How to Insert Enema

this video is showing the barrier devices

Obstructive lung diseases include conditions that make it hard to exhale all the air in the lungs. People with restrictive lung disease have difficulty fully expanding their lungs with air. Obstructive and restrictive lung disease share the same main symptom: shortness of breath with exertion.

At one time, women who had delivered by cesarean section in the past would usually have another cesarean section for any future pregnancies. The rationale was that if allowed to labor, many of these women with a scar in their uterus would rupture the uterus along the weakness of the old scar. Over time, a number of observations have become apparent: Most women with a previous cesarean section can labor and deliver vaginally without rupturing their uterus. Some women who try this will, in fact, rupture their uterus. When the uterus ruptures, the rupture may have consequences ranging from near trivial to disastrous. It can be very difficult to diagnose a uterine rupture prior to observing fetal effects (eg, bradycardia). Once fetal effects are demonstrated, even a very fast reaction and nearly immediate delivery may not lead to a good outcome. The more cesarean sections the patient has, the greater the risk of subsequent rupture during labor. The greatest risk occurs following a “classical” cesarean section (in which the uterine incision extends up into the fundus.) The least risk of rupture is among women who had a low cervical transverse incision. Low vertical incisions probably increase the risk of rupture some, but usually not as much as a classical incision. Many studies have found the use of oxytocin to be associated with an increased risk of rupture, either because of the oxytocin itself, or perhaps because of the clinical circumstances under which it would be contemplated. Pain medication, including epidural anesthetic, has not resulted greater adverse outcome because of the theoretical risk of decreasing the attendant’s ability to detect rupture early. The greatest risk of rupture occurs during labor, but some of the ruptures occur prior to the onset of labor. This is particularly true of the classical incisions. Overall successful vaginal delivery rates following previous cesarean section are in the neighborhood of 70 This means that about 30of women undergoing a vaginal trial of labor will end up requiring a cesarean section. Those who undergo cesarean section (failed VBAC) after a lengthy labor will frequently have a longer recovery and greater risk of infection than had they undergone a scheduled cesarean section without labor. Women whose first cesarean was for failure to progress in labor are only somewhat less likely to be succesful in their quest for a VBAC than those with presumably non-recurring reasons for cesarean section. For these reasons, women with a prior cesarean section are counseled about their options for delivery with a subsequent pregnancy: Repeat Cesarean Section, or Vaginal Trial of Labor. They are usually advised of the approximate 70successful VBAC rate (modified for individual risk factors). They are counseled about the risk of uterine rupture (approximately 1in most series), and that while the majority of those ruptures do not lead to bad outcome, some of them do, including fetal brain damage and death, and maternal loss of future childbearing. They are advised of the usual surgical risks of infection, bleeding, anesthesia complications and surgical injury to adjacent structures. After counseling, many obstetricians leave the decision for a repeat cesarean or VBAC to the patient. Both approaches have risks and benefits, but they are different risks and different benefits. Fortunately, most repeat cesarean sections and most vaginal trials of labor go well, without any serious complications. For those choosing a trial of labor, close monitoring of mother and baby, with early detection of labor abnormalities and preparation for

Urinary incontinence isn't a disease, it's a symptom. It can be caused by everyday habits, underlying medical conditions or physical problems. A thorough evaluation by your doctor can help determine what's behind your incontinence. Temporary urinary incontinence Certain drinks, foods and medications can act as diuretics — stimulating your bladder and increasing your volume of urine. They include: Alcohol Caffeine Decaffeinated tea and coffee Carbonated drinks Artificial sweeteners Corn syrup Foods that are high in spice, sugar or acid, especially citrus fruits Heart and blood pressure medications, sedatives, and muscle relaxants Large doses of vitamins B or C Urinary incontinence also may be caused by an easily treatable medical condition, such as: Urinary tract infection. Infections can irritate your bladder, causing you to have strong urges to urinate, and sometimes incontinence. Other signs and symptoms of urinary tract infection include a burning sensation when you urinate and foul-smelling urine. Constipation. The rectum is located near the bladder and shares many of the same nerves. Hard, compacted stool in your rectum causes these nerves to be overactive and increase urinary frequency. Persistent urinary incontinence Urinary incontinence can also be a persistent condition caused by underlying physical problems or changes, including: Pregnancy. Hormonal changes and the increased weight of the uterus can lead to stress incontinence. Childbirth. Vaginal delivery can weaken muscles needed for bladder control and also damage bladder nerves and supportive tissue, leading to a dropped (prolapsed) pelvic floor. With prolapse, the bladder, uterus, rectum or small intestine can get pushed down from the usual position and protrude into the vagina. Such protrusions can be associated with incontinence. Changes with age. Aging of the bladder muscle can decrease the bladder's capacity to store urine. Menopause. After menopause women produce less estrogen, a hormone that helps keep the lining of the bladder and urethra healthy. Deterioration of these tissues can aggravate incontinence. Hysterectomy. In women, the bladder and uterus are supported by many of the same muscles and ligaments. Any surgery that involves a woman's reproductive system, including removal of the uterus, may damage the supporting pelvic floor muscles, which can lead to incontinence. Enlarged prostate. Especially in older men, incontinence often stems from enlargement of the prostate gland, a condition known as benign prostatic hyperplasia. Prostate cancer. In men, stress incontinence or urge incontinence can be associated with untreated prostate cancer. But more often, incontinence is a side effect of treatments for prostate cancer. Obstruction. A tumor anywhere along your urinary tract can block the normal flow of urine, leading to overflow incontinence. Urinary stones — hard, stone-like masses that form in the bladder — sometimes cause urine leakage. Neurological disorders. Multiple sclerosis, Parkinson's disease, stroke, a brain tumor or a spinal injury can interfere with nerve signals involved in bladder control, causing urinary incontinence.

Detailed examination of the joints is usually not included in the routine medical examination. However, joint related complaints are rather common, and understanding anatomy and physiology of both normal function and pathologic conditions is critically important when evaluating the symptomatic patient. By gaining an appreciation for the basic structures and functioning of the joint, you'll be able to "logic" your way thru the exam, even if you can't remember the eponym attached to each specific test!

http://www.amerra.com In this patient education video from Colorectal Surgical Associates in Houston, Texas, learn more about the single incision laparoscopic colectomy procedure. This minimally invasive procedure uses a mini incision that
results in less pain, fewer complications, earlier recovery, and a smaller scar. Colorectal cancer is the second leading cause of cancer death in the United States. For more information please visit our website: www.csamd.com or call (713)-790-0600.

A VCUG (Voiding Cystourethrogram) is a test that looks at how well your child's kidneys, ureters and bladder are working. Your child's kidneys make urine. The urine flows from the kidneys through thin tubes (called ureters) into your child's bladder.

Prostatitis is an infection or inflammation of the prostate gland that presents as several syndromes with varying clinical features. The term prostatitis is defined as microscopic inflammation of the tissue of the prostate gland and is a diagnosis that spans a broad range of clinical conditions. The National Institutes of Health (NIH) has recognized and defined a classification system for prostatitis in 1999.[1] The 4 syndromes of prostatitis are as follows: I - Acute bacterial prostatitis II - Chronic bacterial prostatitis III - Chronic prostatitis and chronic pelvic pain syndrome (CPPS; further classified as inflammatory or noninflammatory) IV - Asymptomatic inflammatory prostatitis

Septic arthritis is also known as infectious arthritis, and is usually caused by bacteria, or fungus. The condition is an inflammation of a joint that's caused by infection. Typically, septic arthritis affects one large joint in the body, such as the knee or hip. Less frequently, septic arthritis can affect multiple joints

Brain port surgery is a minimally invasive surgical technique performed through a specially designed tube about the size of a dime. Using neuronavigation GPS-like guidance, the brain port is inserted into the brain with millimeter accuracy and is used as a channel to guide the surgeon and his/her instruments to various regions of the brain. Colloid cysts, metastatic tumors, and a variety of tumors within the ventricles are often candidates for this approach.

Vaginoplasty is any surgical procedure that results in the construction or reconstruction of the vagina. It is a type of genitoplasty. Pelvic organ prolapse is often treated with one or more surgeries to repair the vagina.

Carefully select the site for injection so major blood vessels and nerves are avoided. Buttock (Gluteus Medius)- Hip (Ventrogluteal) - Leg (Vastus Lateralis) - Arm (Deltoid)

This case study video from www.5thavesurgery.com shows a 19 year old patient getting breast reduction surgery in NYC. This surgery made a tremendous difference in the life of this young woman, see how it can do the same for you.

http://mylapbandsuccess.plus101.com
---Lap Band Success Stories And Pictures. "My Journey With The Lap Band Has Been Rough... In Fact, I Almost Took Matters Into My Own Hands, And Ended That Journey A few Years Ago...
But the fact that I'm still here today -- slim and happy, is proof that it is possible to overcome, and end your emotional reliance on food, and get the body and life you've always wanted!
Let Me Tell You My Story...
It was the worst week I had since my surgery -- Thanksgiving week. I was at a point where all I was thinking about all day, was food. I had to actually fight to resist my strong cravings...
I just wanted to take one bite of that turkey... just eat one piece of pumpkin pie! I just wanted to be able to taste some of the same things everyone else was eating!
Not Only Was I Still Obese, But I Couldn't Even Enjoy My Own Life!
My cravings were driving me insane, but I did my best to resist the temptation. When I got onto the scales that week, I was dumb-founded - My weight loss had stalled! All the agony and deprivation I'd suffered... was for nothing!
I was so angry at myself for even putting me in such a low, pitiful state in the first place! I was to blame for the way I looked! I was frustrated and... I felt helpless!
My Weight Loss Had Stalled...
Ok, so maybe I needed another refill but nothing could improve my emotional state-of-mind...
I became so disillusioned that I could not remember my reasonsfor wanting to lose weight, and how critical it was for me to resist my favorite foods. All I thought, was that the lap band was not working for me... and I gave in!
I Was Once Too Embarrassed To Share My Story With Anyone, But I'm Telling It To You Today, So You'll Know That You're Not Alone!...

I had lost all hope of losing weight, that I began to out-eat my band, and find ways to cheat it...

One of my favorite foods before the surgery was french fries dipped in a mix of mayonnaise and ketchup. Since I couldn't have it after the lap band, I improvised... and blended it!
I Would Actually Put Fries, Mayo And Ketchup Into A Blender... And Then Drink It!
If you've ever fallen off the wagon then I don't have to tell you about theguilt that sets in after-wards...
I'd drink it, then I'd feel guilty and start to cry...
It would make me sick... but I did it anyway!
I hated myself for doing it... but I did it anyway!
When the scales began to creep back up again, I knew why... but I didn't know what to do about it!
I felt like my life was in a tail-spin. The worst part was that I was just too embarrassed & humiliated to talk to anyone about it!
Have you ever felt that way?
To find out what happened next, scroll down!
In an amazing twist of fate, find out how I found it easier to lose the last 132 lbs than it ever was to lose the first 60 lbs!"
By April Cannon


Lap, Band, Success, Stories, And, Pictures, Laparoscopic, gastric, Banding, costs, stomach, surgery, diet, successfull, Raisa Khan, April Cannon

Misgav Ladach - Joel Cohen approach for breech presentation