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Assess peripheral pulses Carry out an ECG Dipstick urine Bedside Blood Glucose Fundoscopy source :
CVS Examination
Introduction
Introduce yourself Explain what you would like to examine Gain consent Place patient at 45° with chest exposed Ask if patient has any pain anywhere before you begin!General Inspection
Bedside for treatments or adjuncts – GTN spray, O2, Tablets, Wheelchair, Warfarin Comfortable at rest? SOB Malar Flush Chest for scars & visible pulsations Legs for harvest site scars and peripheral oedema ..Hands
Temperature - poor peripheral vasculature Capillary refill – should be <2 seconds Colour – cyanosis Clubbing Splinter haemorrhages, Jane-way lesions, Oslers Nodes – infective endocarditis Palmar Erythema – hyperthyroidism, pregnancy, polycythaemia Nicotine Staining – smokerPulses
Radial Pulse – rate & rhythm Radial-Radial Delay – aortic coarctation Collapsing Pulse – aortic regurgitation BP – narrow pulse pressure = Aortic Stenosis | wide pulse pressure = Aortic Regurgitation Carotid – character & volume JVP – measure and also possibly carry out hepatojugular reflexFace
Eyes – conjunctival pallor, jaundice, corneal arcus, xanthelasma Mouth – central cyanosis, angular stomatitis Dental hygiene – infective endocarditisClose Inspection Of Chest
Scars - lateral thoracotomy (mitral valve), midline sternotomy (CABG), clavicular (pacemaker) Apex beat – visible in aortic regurgitation and thyrotoxicosis Chest wall deformities – pectus excavatum, pectus carniatumPalpation
Apex beat – 5th intercostal space, mid clavicular Heaves- left sternal edge – seen in left & right ventricular hypertrophy Thrills – Palpatable murmurs over aortic valve & apexAuscultation
Listen over 4 valves - ensure palpation of carotid pulse to determine first heart sound Roll onto left side & listen in mitral area – mitral stenosis Lean forward & listen over aortic area- aortic regurgitation Carotids - radiation of aortic stenosis murmurs & bruits Lung bases – pulmonary oedema Sacral Oedema & Pedal OedemaTo complete the examination
Thank Patient Wash hands Summarise Findings Say you wouldAssess peripheral pulses Carry out an ECG Dipstick urine Bedside Blood Glucose Fundoscopy source :
- Macleod
- http://geekymedics.com/osce/cardiovascular-examination-2/
Labels:
internalMed,
pictures
Spider Nevi
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| ecchymosis |
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| purpura |
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| petechiae |
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| Spider Nevi |
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| Paraumbilical Hernia |
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misc,
tips
It is no secret that medical training is a long and time-consuming process frequently referred to as an exercise in delayed gratification. Indeed, completing college, 4 years of medical school, and at least 3 years of specialty training (in addition to any time off before starting medical school) takes a decade or longer.
Thinking about the time commitment can be overwhelming. The feelings can become especially acute when you see your nonmedical friends finding "real jobs," getting married, buying homes, or otherwise enjoying their lives.
The anxiety you might feel about figuring out your life can be particularly challenging if you're in your 20s and 30s -- the prime years of medical training for most of us.
I speak from experience: I am a medical resident in my late 20s and have yet to get married or buy a home. I have many friends outside of medicine who seem considerably farther ahead in their lives than I am. I admit that I have questioned my career decisions at times.
It's normal to have these feelings. Remember that you chose to become a physician, and the training process will be challenging and time-consuming. Regardless of what you do, medical school and residency is predefined and cannot be shortened.
Viewing these years as lost time before a "real job" is a mistake, however. You are taking important -- albeit occasionally grueling and certainly not financially rewarding -- steps in developing your career and learning the skills you need to excel as an independent clinician. Although training requires many sacrifices, it allows you to figure out your preferred path within the medical profession.
That said, there is no shame in taking the time to enjoy your life, and sometimes doing so is necessary. Make the sacrifices when they are required, but try to take some time for your friends, family, and yourself. Close your textbooks early or skip the latest journal articles if you need a break.
Medicine is just one part of your life, and it should not come at the expense of your personal well-being. You'll confront the same and additional new pressures when you become a physician: Finding ways to make time for yourself and others will help you succeed as a well-rounded and balanced professional.
Finally, I think it can be easy to develop a "grass is always greener" mentality when you see others having fun. Although your friends may never experience the distinct pleasure of being paged awake at 3 AM to clarify a sawdust allergy, they have their own career and life hurdles that can be equally daunting even if they do not appear to be on the surface.
Most important, remember that your medical training in the grand scheme of things is just a small part in the journey to an amazingly satisfying and rewarding career that you will ultimately have the ability to shape.
http://www.medscape.com/viewarticle/745834?src=mp&spon=25
Is Your 'Social Clock' Ticking Like Mine?
Question
Sometimes I feel like I'm missing out on my 20s: Everyone else seems to be living their lives and I'm still in school. Does this frustrate anyone else?It is no secret that medical training is a long and time-consuming process frequently referred to as an exercise in delayed gratification. Indeed, completing college, 4 years of medical school, and at least 3 years of specialty training (in addition to any time off before starting medical school) takes a decade or longer.
Thinking about the time commitment can be overwhelming. The feelings can become especially acute when you see your nonmedical friends finding "real jobs," getting married, buying homes, or otherwise enjoying their lives.
The anxiety you might feel about figuring out your life can be particularly challenging if you're in your 20s and 30s -- the prime years of medical training for most of us.
I speak from experience: I am a medical resident in my late 20s and have yet to get married or buy a home. I have many friends outside of medicine who seem considerably farther ahead in their lives than I am. I admit that I have questioned my career decisions at times.
It's normal to have these feelings. Remember that you chose to become a physician, and the training process will be challenging and time-consuming. Regardless of what you do, medical school and residency is predefined and cannot be shortened.
Viewing these years as lost time before a "real job" is a mistake, however. You are taking important -- albeit occasionally grueling and certainly not financially rewarding -- steps in developing your career and learning the skills you need to excel as an independent clinician. Although training requires many sacrifices, it allows you to figure out your preferred path within the medical profession.
That said, there is no shame in taking the time to enjoy your life, and sometimes doing so is necessary. Make the sacrifices when they are required, but try to take some time for your friends, family, and yourself. Close your textbooks early or skip the latest journal articles if you need a break.
Medicine is just one part of your life, and it should not come at the expense of your personal well-being. You'll confront the same and additional new pressures when you become a physician: Finding ways to make time for yourself and others will help you succeed as a well-rounded and balanced professional.
Finally, I think it can be easy to develop a "grass is always greener" mentality when you see others having fun. Although your friends may never experience the distinct pleasure of being paged awake at 3 AM to clarify a sawdust allergy, they have their own career and life hurdles that can be equally daunting even if they do not appear to be on the surface.
Most important, remember that your medical training in the grand scheme of things is just a small part in the journey to an amazingly satisfying and rewarding career that you will ultimately have the ability to shape.
http://www.medscape.com/viewarticle/745834?src=mp&spon=25
Why Pediatrics Is Priceless
===============
An extra blue scrub top is tucked away in the lower right cabinet of the nurse's station. Every so often, after being sprayed with bodily fluid, I have to make a midday swap of my work clothes. However, it's a small price to pay to be a part of children's lives; one day the baby who spits up on your shoulder will be the same kid who runs down the hall screaming your name and clings to your leg with the dexterity of a koala. What makes pediatrics so rewarding is the long-term relationships that you build with children and their families who every day make you feel like a small hero.
Practicing general pediatrics often feels like searching for a needle in a haystack. Hidden in a sea of upper respiratory infections, reflux, eczema, and diaper rashes is a cystic fibrosis diagnosis, for example, that the astute clinician must not overlook. There are enough challenging cases to keep you on your toes to make everyday clinic interesting, but they don't overwhelm you. As a result, you'll have plenty of time each day to build new relationships and foster old ones. These relationships create the backbone of a successful pediatrician's practice.
By knowing the histories of an individual family -- for instance, remembering the grandfather who has Crohn disease or the younger sibling who has a milk protein allergy -- a pediatrician has unique insight into each medical conundrum that presents itself, no matter how big or small. The trust and relationships that you develop allow you to take a personal and tailored approach to an ill-appearing child. That can save countless hours in an emergency department or avoid an unnecessary x-ray or blood test. Knowing that a mom is meticulous and reliable gives you an extra day of watchful waiting for a fever that an emergency department doctor might otherwise work up. This saves time, money, and anxiety.
A successful pediatrician should also be an excellent educator. The better job you do teaching your families -- that fever is a symptom and not a disease, that every cough does not need medication, and that in most cases diarrhea will go away with time -- the better doctor you will be. Using an evidence-based approach to simple problems will help prevent more complex ones; by avoiding the overuse of antibiotics for routine viral infections, you can curb the rise of antibiotic-resistant bacteria and the subsequent complications that they create.
Most pediatricians do not hold master of public health degrees, but we each play a vital role in preventive medicine to protect the individual and society as a whole. Immunizations are probably the single greatest advance of modern medicine. Diseases such as small pox, polio, measles, mumps, and rubella have been extinguished to the point that most modern pediatricians have seen few if any cases of these maladies. The world has benefited from the immense power of immunizations, and pediatricians stand at the front line in protecting children and the public at large.
Pediatrics is not everyone's cup of tea. You should have a high tolerance for shrieking, crying, and the errant stream of bodily fluid that will disrupt the occasional workday. Perhaps the most difficult aspect of caring for a child is working with the array of parental personalities. Both the pediatrician and the parent may have the best interest of the child at heart, but misinformation from old wives' tales, the Internet, and Aunt Bertha can confound clear communication and good intentions. This is where the art of medicine shines its brightest: Strategic word choice and good listening can go a long way to assuaging anxiety and making sure that children receive the best care possible.
Sometimes in the routine day-to-day of things, it is easy to forget that every visit counts; that each teaching moment may save an unnecessary test; and that each shot prevents a possible death. However. when you feel the familiar clutch of a child on your leg, you remember why you chose this job, and you gladly take your blue scrub home to be washed so that you're ready once again for whatever comes your way.
http://www.medscape.com/viewarticle/743742?src=mp&spon=25
Labels:
General
Question
I often panic before an exam because I am so worried about my performance. This makes it even harder to do well. What should I do?
Response from Sohil H. Patel, MD
Sohil H. Patel, MD, Intern, St. Vincent's Hospital, New York, NY
There is an obvious answer to this question: prepare well for the examination. But of course, it is hard to find anyone who would actually claim to be well prepared in the days before an exam. This is particularly true for exams that encompass a vast amount of information. No student knows every detail about the topic being tested. That is why it may always seem like you need more time to study, and why you never feel fully prepared.
The examinations themselves can generate anxiety as well, whether because of the time limits for finishing or perhaps because of an oral performance component. Of course, no two people handle stress in the same way, but here are some things that helped me.
The first step in destressing involves gaining some perspective. Having been in the clinical setting for a few years now, I have been exposed to life and death situations that legitimately stress people out. Given those experiences, I now find it hard to believe that I ever stressed out over my medical school examinations to the extent that I did.
In fact, I remember developing a different (and more healthy) attitude toward studying and exams after I started my clinical rotations, which made me realize just how insulating the pre-clinical years can be. So, if you are a first- or second-year medical student, shadowing a physician in the hospital might help put your exams in proper perspective.
Another way to gain perspective is to remember why you chose to attend medical school (hopefully, doing well on medical school examinations was not the reason). Studying really should be viewed as a means to a much larger goal than just passing a test. Exams should never be treated as ends in themselves. They are really just little check marks of approval on your way to becoming a physician -- nothing more.
Certain study techniques may also be effective in reducing your stress level. Cramming facts into your brain at random is not effective; if your mind goes blank during an exam, you won't have any broader framework on which to anchor your thoughts. Before memorizing details, I always tried to build a framework.
Take pulmonology, for example. Instead of learning pulmonary diseases at random, learn the basic categories of disease (eg, obstructive, restrictive), then learn the common features within each category, and finally, fill in the categories with particular diseases. This way, if the answer to an examination question is not immediately obvious, you have a systematic way of proceeding and narrowing your choices.
Another helpful method, particularly for oral exams involving standardized patients, is to develop routine practices. Before the exam, run through common scenarios or complaints you might encounter and think of the basic steps you should always take in those scenarios. Do this a few times so that, if a similar situation is encountered in the exam, your brain can run on auto-pilot as you follow through with your prepared steps.
Of course, there are many ways to address the stress itself, and what works for one person may not work for another.
For me, it seemed to help if I stuck with my workout schedule regardless of how close I was to an examination; this helped me set aside some time when I was not thinking about the exam. I also had the peculiar habit of taking a shower if I thought I was getting overly stressed out and I needed a break. But these methods vary for everyone. In general, it is probably a good policy to keep your life as close to normal as possible before an exam. This avoids giving the examination undue significance.
Finally, it is important to be confident. Medicine is not the single most complicated field of study, and most minds are similarly suited to learning it (unlike, perhaps, philosophy or some other fields that some people seem more inherently suited for than others). It means that there is a good correlation between how much effort a person puts into learning medicine and how well that person masters the subject.
It is less a matter of "getting it" and more a matter of "knowing it," and almost anyone can learn the material with a certain amount of effort. So, work hard and take confidence that your honest effort will pay off!
Link
How Do You Handle Pre-examination Stress?
Question
I often panic before an exam because I am so worried about my performance. This makes it even harder to do well. What should I do?
Response from Sohil H. Patel, MD
Sohil H. Patel, MD, Intern, St. Vincent's Hospital, New York, NY
There is an obvious answer to this question: prepare well for the examination. But of course, it is hard to find anyone who would actually claim to be well prepared in the days before an exam. This is particularly true for exams that encompass a vast amount of information. No student knows every detail about the topic being tested. That is why it may always seem like you need more time to study, and why you never feel fully prepared.
The examinations themselves can generate anxiety as well, whether because of the time limits for finishing or perhaps because of an oral performance component. Of course, no two people handle stress in the same way, but here are some things that helped me.
The first step in destressing involves gaining some perspective. Having been in the clinical setting for a few years now, I have been exposed to life and death situations that legitimately stress people out. Given those experiences, I now find it hard to believe that I ever stressed out over my medical school examinations to the extent that I did.
In fact, I remember developing a different (and more healthy) attitude toward studying and exams after I started my clinical rotations, which made me realize just how insulating the pre-clinical years can be. So, if you are a first- or second-year medical student, shadowing a physician in the hospital might help put your exams in proper perspective.
Another way to gain perspective is to remember why you chose to attend medical school (hopefully, doing well on medical school examinations was not the reason). Studying really should be viewed as a means to a much larger goal than just passing a test. Exams should never be treated as ends in themselves. They are really just little check marks of approval on your way to becoming a physician -- nothing more.
Certain study techniques may also be effective in reducing your stress level. Cramming facts into your brain at random is not effective; if your mind goes blank during an exam, you won't have any broader framework on which to anchor your thoughts. Before memorizing details, I always tried to build a framework.
Take pulmonology, for example. Instead of learning pulmonary diseases at random, learn the basic categories of disease (eg, obstructive, restrictive), then learn the common features within each category, and finally, fill in the categories with particular diseases. This way, if the answer to an examination question is not immediately obvious, you have a systematic way of proceeding and narrowing your choices.
Another helpful method, particularly for oral exams involving standardized patients, is to develop routine practices. Before the exam, run through common scenarios or complaints you might encounter and think of the basic steps you should always take in those scenarios. Do this a few times so that, if a similar situation is encountered in the exam, your brain can run on auto-pilot as you follow through with your prepared steps.
Of course, there are many ways to address the stress itself, and what works for one person may not work for another.
For me, it seemed to help if I stuck with my workout schedule regardless of how close I was to an examination; this helped me set aside some time when I was not thinking about the exam. I also had the peculiar habit of taking a shower if I thought I was getting overly stressed out and I needed a break. But these methods vary for everyone. In general, it is probably a good policy to keep your life as close to normal as possible before an exam. This avoids giving the examination undue significance.
Finally, it is important to be confident. Medicine is not the single most complicated field of study, and most minds are similarly suited to learning it (unlike, perhaps, philosophy or some other fields that some people seem more inherently suited for than others). It means that there is a good correlation between how much effort a person puts into learning medicine and how well that person masters the subject.
It is less a matter of "getting it" and more a matter of "knowing it," and almost anyone can learn the material with a certain amount of effort. So, work hard and take confidence that your honest effort will pay off!
Link
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