Examination of Peripheral Vascular System - Clinical Skills OSCE Revision - Dr Gill

In this video, we demonstrate the peripheral vascular examination - a less common examination, but still vitally important, particularly amongst the older population

Starting with the examination of the hands looking for clinical signs of vascular compromise, we then check the pulses of the major arteries of the upper body - the radial, brachial and carotid arteries, before moving down to assess for an abdominal aortic aneurysm.

At this point, I feel it's a practical step to check the femoral pulses before doing the overview of the legs.

After visually assessing we must examine the major vascular areas of leg.- namely the 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

The "Get up and go" test is most commonly used to assess postural stability. In this test, the physician instructs the patient to stand up from a chair without assistance, walk a short distance, turn around, return, and sit down again. If the patient is unsteady or has difficulties during the test, further evaluation is necessary.

The cause of schizophrenia is still unclear. Some theories about the cause of this disease include: genetics (heredity), biology (abnormalities in the brain’s chemistry or structure); and/or possible viral infections and immune disorders.

Watch that video to know What is Vaginal Discharge and how to Get Rid of it ?

(cryptorchidism) is a testicle that hasn't moved into its proper position in the bag of skin hanging below the penis (scrotum) before birth. Usually just one testicle is affected, but about 10 percent of the time both testicles are undescended. An undescended testicle is uncommon in general, but common among baby boys born prematurely. The vast majority of the time, the undescended testicle moves into the proper position on its own, within the first few months of life. If your son has an undescended testicle that doesn't correct itself, surgery can relocate the testicle into the scrotum.

A brain (cerebral) aneurysm is a bulging, weak area in the wall of an artery that supplies blood to the brain. In most cases, a brain aneurysm causes no symptoms and goes unnoticed. In rare cases, the brain aneurysm ruptures, releasing blood into the skull and causing a stroke. When a brain aneurysm ruptures, the result is called a subarachnoid hemorrhage. Depending on the severity of the hemorrhage, brain damage or death may result. The most common location for brain aneurysms is in the network of blood vessels at the base of the brain called the circle of Willis. What causes a brain aneurysm? A person may inherit the tendency to form aneurysms, or aneurysms may develop because of hardening of the arteries (atherosclerosis) and aging. Some risk factors that can lead to brain aneurysms can be controlled, and others can't. The following risk factors may increase your risk for an aneurysm or, if you already have an aneurysm, may increase your risk of it rupturing: Family history. People who have a family history of brain aneurysms are more likely to have an aneurysm than those who don't. Previous aneurysm. People who have had a brain aneurysm are more likely to have another. Gender. Women are more likely to develop a brain aneurysm or to suffer a subarachnoid hemorrhage. Race. African Americans are more likely than whites to have a subarachnoid hemorrhage. High blood pressure. The risk of subarachnoid hemorrhage is greater in people who have a history of high blood pressure. Smoking. In addition to being a cause of high blood pressure, the use of cigarettes may greatly increase the chances of a brain aneurysm rupturing.

Heavy period blood can be especially alarming if it contains clots. In most cases, though, red, brown, or even black menstrual blood clots are normal—just bits of the endometrium (the lining of the uterus) that are shed during menstruation.

Thought a snake in your boot was bad? That old 19th-century idiom is nothing compared to one in your ear.

Shocking footage captured the alleged moment that a “surgeon” tried to remove a live snake that infiltrated a woman’s ear. Video of the herpetological surgery has racked up more than 125,000 views as viewers speculate whether or not the squirm-inducing footage is authentic.

“The snake has gone in the ear,” reads the caption to the bizarre Facebook clip, which was posted Sept. 1 by an India-based social media star named Chandan Singh to his 20,126 followers. However, it’s unclear where, when or how this unfortunate event transpired, local outlet the Economic Times reported.

In the nearly four-minute clip, an alleged medical practitioner can be seen using tweezers in a desperate attempt to extract a black and yellow serpent that’s peeking its head out from a female patient’s ear.

The exam should be performed in an orderly fashion as follows: 1. Have the patient stick out their tongue so that you can examine the posterior pharynx (i.e. the back of the throat). Ask the patient to say "Ah", which elevates the soft palate, giving you a better view. If you are still unable to see, place the tongue blade � way back on the tongue and press down while the patient again says "Ah," hopefully improving your view. This causes some people to gag, particularly when the blade is pushed onto the more proximal aspects of the tongue. It may occasionally be important to determine whether the gag reflex is functional (e.g. after a stroke that impairs CNs 9 or 10; or to determine if a patient with depressed level of consciousness is able to protect their airway from aspiration). This is done by touching a q-tip against the posterior pharynx, uvula or tongue. It is not necessary to do this during your routine exam as it can be quite noxious!
2. Note that the uvula hangs down from the roof of the mouth, directly in the mid-line. With an "Ah," the uvula rises up. Deviation to one side may be caused by CN 9 palsy (the uvula deviates away from the affected side), a tumor or an infection. CN9 Pasly Cranial Nerve 9 Dysfunction: Patient has suffered stroke, causing loss of function of left CN 9. As a result, uvula is pulled towards the normally functioning (ie right) side. 3. The normal pharynx has a dull red color. In the setting of infection, it can become quite red, frequently covered with a yellow or white exudate (e.g. with Strep. Throat or other types of pharyngitis).
4. The tonsils lie in an alcove created by arches on either side of the mouth. The apex of these arches are located lateral to and on a line with the uvula. Normal tonsils range from barely apparent to quite prominent. When infected, they become red, are frequently covered by whitish/yellow discharge. In the setting of a peritonsilar abscess, the tonsils appear asymmetric and the uvula may be pushed away from the affected side. When this occurs, the tonsil may actually compromise the size of the oral cavity, making breathing quite difficult.
5. Look carefully along the upper and lower gum lines and at the mucosa in general, which can appear quite dry if the patient is dehydrated.
6. Examine the teeth to get a sense of general dentition, particularly if the patient has a dental complaint. Pain produced by tapping on a tooth is commonly caused by a root abscess. Tooth Abscess: Tooth abscess involving left molar region. Associated inflammation of left face can clearly be seen. 7. Have the patient stick their tongue outside their mouth, which allows evaluation of CN 12. If there is nerve impairment, the tongue will deviate towards the affected side. Any obvious growths or abnormalities? Ask them to flip their tongue up so that you can look at the underside. If you see something abnormal, grasp the tongue with gauze so that you can get a better look. Left CN 12 Dysfunction: Stroke has resulted in L CN 12 Palsy. Tongue therefore deviates to the left.
8. Make note of any growths along the cheeks, hard palate (the roof of the mouth between the teeth), soft palate, or anywhere else. In particular, patients who smoke or chew tobacco are at risk for oral squamous cell cancer. Any areas which are painful or appear abnormal should also be palpated. Put on a pair of gloves to better explore these regions. What do they feel like? Are they hard? To what extent does a growth involve deeper structures? If the patient feels something that you cannot see, try to get someone else to hold the light source, freeing both your hands to explore the oral cavity with two tongue depressors.

Christopher J. Rapuano, MD, Director of the Cornea Service at Wills Eye Institute describes his surgical approach of a Combined Penetrating Keratoplasty (PK) and Cataract Surgery

A hernia occurs when an organ or fatty tissue squeezes through a weak spot in a surrounding muscle or connective tissue called fascia. The most common types of hernia are inguinal (inner groin), incisional (resulting from an incision), femoral (outer groin), umbilical (belly button), and hiatal (upper stomach).

Mitosis, a process of cell duplication, or reproduction, during which one cell gives rise to two genetically identical daughter cells. Strictly applied, the term mitosis is used to describe the duplication and distribution of chromosomes, the structures that carry the genetic information.

How Male to Female Sex Gender Reassignment Surgery Really Works

Orthopedic spine surgeons and vascular surgeons at UW Health in Madison, WI work together to perform minimally invasive anterior lumbar interbody fusion (Mini-ALIF). With this type of spinal fusion surgery, patients have smaller incisions, usually spend less time in the hospital and typically return to daily activities more quickly. Learn more https://www.uwhealth.org/ALIF

Sleep apnea is a potentially serious sleep disorder in which breathing repeatedly stops and starts. You may have sleep apnea if you snore loudly, and you feel tired even after a full night's sleep. The main types of sleep apnea are: Obstructive sleep apnea, the more common form that occurs when throat muscles relax. Central sleep apnea, which occurs when your brain doesn't send proper signals to the muscles that control breathing. Complex sleep apnea syndrome, also known as treatment-emergent central sleep apnea, occurs when someone has both obstructive sleep apnea and central sleep apnea. If you think you might have any form of sleep apnea, see your doctor. Treatment can ease your symptoms and may help prevent heart problems and other complications.

Orchitis (or-KIE-tis) is an inflammation of one or both testicles. It is usually caused by a bacterial infection or by the mumps virus. Bacterial orchitis can be caused by sexually transmitted infections (STIs), particularly gonorrhea or chlamydia. Bacterial orchitis often results from epididymitis, an inflammation of the coiled tube (epididymis) at the back of the testicle that stores and carries sperm. In that case, it's called epididymo-orchitis. Orchitis causes pain and can affect fertility. Medication can treat the causes of bacterial orchitis and can ease some signs and symptoms of viral orchitis. But it may take several weeks for scrotal tenderness to disappear.

Comas are caused by an injury to the brain. Brain injury can be due to increased pressure, bleeding, loss of oxygen, or buildup of toxins. The injury can be temporary and reversible. It also can be permanent.

UChicago Medicine organ transplant surgeon Dr. Rolf Barth explains a how the laparoscopic donor nephrectomy – also known as the single-port nephrectomy – procedure works to remove an organ donor’s kidney from their body to be transplanted into a recipient. This minimally invasive kidney donor transplant surgery allows living organ donors the get back to their lives more quickly than the traditional approach and leaves them with a nearly invisible scar in the belly button.

Learn more about living kidney donation: https://www.uchicagomedicine.o....rg/conditions-servic

Experience with endoscopic retrograde cholangiopancreatography (ERCP) in children has been limited due to multiple factors, including the relatively low incidence of diseases requiring ERCP in this age group, the impression that the procedure is technically difficult in children, and because the indications and safety of ERCP in children have not been well defined. As a result, patients are generally referred to a tertiary care facility or to adult endoscopists who perform a high volume of procedures.

Lupus is an autoimmune disease that can affect almost any part of your body, most often your joints, skin, kidneys, heart, lungs, blood, or brain. Your two kidneys are part of your renal system, which also includes two ureters, the bladder, and the urethra. As the primary organs of the renal system, your kidneys are responsible for: Maintaining the correct amount and type of body fluids Removing waste products and toxic substances Regulating the hormones (chemical messengers) that help control blood pressure and blood volume