Right Eardrum 1
Inspect the eardrum, noting its color and contour. The cone of light usually easy to see helps to orient you. Identify the handle of the malleus, noting its position, and inspect the short process of the malleus. Gently move the speculum so that you can see as much of the drum as possible, including the pars flaccida superiorly and the margins of the pars tensa. Look for any perforations. The anterior and inferior margins of the drum may be obscured by the curving wall of the ear canal....
Info Djm
A smooth and often sore tongue that has lost its papillae suggests a deficiency in riboflavin, niacin, folic acid, vitamin B12, pyridoxine, or iron. Specific diagnosis is often difficult. Anticancer drugs may also be responsible. Whitish raised areas that have a feathery or corrugated pattern suggest hairy leukoplakia. Unlike candidiasis, these areas cannot be scraped off. The sides of the tongue are most often affected. This lesion is seen in HIV infection and AIDS. The thick white coat on...
Or 1
Thorax symmetric with moderate kyphosis and increased anteroposterior Suggests chronic obstructive lung AP diameter, decreased expansion. Lungs are hyperresonant. Breath disease sounds distant with delayed expiratory phase and scattered expiratory wheezes. Fremitus decreased no bronchophony, egophony, or whispered pectoriloquy. Diaphragms descend 2 cm bilaterally. Substance Abuse and Mental Health Services Administration, 1999 National Household Survey. www.samhsa.gov hhsurvey content 1999....
TABLE 522 Findings in the Gums and Teeth
Marginal gingivitis is common among teenagers and young adults. The gingival margins are reddened and swollen, and the interdental papillae are blunted, swollen, and red. Brushing the teeth often makes the gums bleed. Plaque the soft white film of salivary salts, protein, and bacteria that covers the teeth and leads to gingivitis is not readily visible. Acute Necrotizing Ulcerative Gingivitis This uncommon form of gingivitis occurs suddenly in adolescents and young adults and is accompanied by...
Cross Section Of The Right Eye From Above Showing A Portion Of The Fundus
The posterior part of the eye that is seen through an ophthalmoscope is often called the fundus of the eye. Structures here include the retina, choroid, fovea, macula, optic disc, and retinal vessels. The optic nerve with its retinal vessels enters the eyeball posteriorly. You can find it with an oph thalmoscope at the optic disc. Lateral and slightly inferior to the disc, there is a small depression in the retinal surface that marks the point of central vision. Around it is a darkened circular...
Info Rpk
Superficial retinal hemorrhages are small, linear, flame-shaped, red streaks in the fundi. They are shaped by the superficial bundles of nerve fibers that radiate from the optic disc in the pattern illustrated O optic disc F fovea . Sometimes the hemorrhages occur in clusters and then simulate a larger hemorrhage, but the linear streaking at the edges shows their true nature. Superficial hemorrhages are seen in severe hypertension, papilledema, and occlusion of the retinal vein, among other...
A Note on Cardiovascular Assessment
A good cardiovascular examination requires more than observation. You need to think about the possible meanings of your individual observations, fit them together in a logical pattern, and correlate your cardiac findings with the patient's blood pressure, arterial pulses, venous pulsations, jugular venous pressure, the remainder of your physical examination, and the patient's history. Evaluating the common systolic murmur illustrates this point. In examining an asymptomatic teenager, for...
The Health History 1
Blood-streaked sputum hemoptysis Complaints of chest pain or chest discomfort raise the specter of heart disease, but often arise from structures in the thorax and lung as well. To assess this symptom, you must pursue a dual investigation of both thoracic and cardiac causes. Sources of chest pain are listed below. For this important symptom, you must keep all of these in mind. The trachea and large bronchi The chest wall, including the musculoskeletal system and skin Extrathoracic structures...
Relation of Auscultatory Findings to the Chest Wall
The locations on the chest wall where you hear heart sounds and murmurs help to identify the valve or chamber where they originate. Sounds and murmurs arising from the mitral valve are usually heard best at and around the cardiac apex. Those originating in the tricuspid valve are heard best at or near the lower left sternal border. Murmurs arising from the pulmonic valve are usually heard best in the 2nd and 3rd left interspaces close to the sternum, but at times may also be heard at higher or...
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To the naked eye, the two descents are the most obvious events in the normal jugular pulse. Of the two, the sudden collapse of the x descent late in systole is the more prominent, occurring just before the second heart sound. The y descent follows the second heart sound early in diastole. Cardiovascular findings vary significantly with age. Aging may affect the location of the apical impulse, the pitch of heart sounds and murmurs, the stiffness of the arteries, and blood pressure. The Apical...
Steps For Palpating The Thyroid Gland
Ask the patient to flex the neck slightly forward to relax the sternomastoid muscles. Place the fingers of both hands on the patient's neck so that your index fingers are just below the cricoid cartilage. Ask the patient to sip and swallow water as before. Feel for the thyroid isthmus rising up under your finger pads. It is often but not always palpable. Displace the trachea to the right with the fingers of the left hand with the right-hand fingers, palpate laterally for the right lobe of the...
Clinician Goals For Cultural Competence
Self-awareness. Learn about your own biases . we all have them. Enhanced communication. Work to eliminate assumptions about what is normal. Learn directly from your patients they are the experts on their culture and illness. Collaborative partnerships. Build your relationships with patients on respect and mutually acceptable plans. Self-awareness. Start by exploring your own cultural identity. How do you describe yourself in terms of ethnicity, class, region or country of origin, religion, and...
The Carotid Pulse
After you measure the JVP, move on to assessment of the carotid pulse. The carotid pulse provides valuable information about cardiac function and is especially useful for detecting stenosis or insufficiency of the aortic valve. Take the time to assess the quality of the carotid upstroke, its amplitude and contour, and presence or absence of any overlying thrills or bruits. For irregular rhythms, see Table 3-10, Selected Heart Rates To assess amplitude and contour, the patient should be lying...
Jugular Venous Pressure and Pulsations
Jugular Venous Pressure JVP . Estimating the JVP is one of the most iportant and frequently used skills of physical examination. At first it will seem ficult, but with practice and supervision you will find that the JVP provides aluable information about the patient's volume status and cardiac function. you have learned, the JVP reflects pressure in the right atrium, or central venous pressure, and is best assessed from pulsations in the right internal jugular vein. Note, however, that the...
Jugular Venous Pressure and Pulses
Jugular Venous Pressure JVP . Systemic venous pressure is much lower than arterial pressure. Although venous pressure ultimately depends on left ventricular contraction, much of this force is dissipated as blood passes through the arterial tree and the capillary bed. Walls of veins contain less smooth muscle than walls of arteries, which reduces venous vascular tone and makes veins more distensible. Other important determinants of venous pressure include blood volume and the capacity of the...
Interviewing Patients of Different Ages
As patients move through different stages of life, you will need to make certain adaptations in your interviewing style. This section provides suggestions for talking with children, adolescents, and the elderly. Talking With Children. Unlike adults, children usually are accompanied by a parent or caregiver. Even when adolescents are alone, they are often seeking health care at the request of their parents indeed, the parent is usually sitting in the waiting room. When interviewing a child, you...
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Now rare, a bluish-black line on the gums may signal chronic lead poisoning. The line is about 1 mm from the gum margin, follows its contours, and is absent where there are no teeth. In this example, as is common, periodontitis coexists. Dental caries is first visible as a chalky white area in the enamel surface of a tooth. This area may then turn brown or black, become soft, and cavitate. Special dental techniques, including x-rays, are necessary for early detection. Sources of photos...
The Tavistock Principles
Rights People have a right to health and health care. Balance Care of individual patients is central, but the health of populations is also our concern. Comprehensiveness In addition to treating illness, we have an obligation to ease suffering, minimize disability, prevent disease, and promote health. Cooperation Health care succeeds only if we cooperate with those we serve, each other, and those in other sectors. Improvement Improving health care is a serious and continuing responsibility....
Steps For Using The Ophthalmoscope
Darken the room. Switch on the ophthalmoscope light and turn the lens disc until you see the large round beam of white light. Shine the light on the back of your hand to check the type of light, its desired brightness, and the electrical charge of the ophthalmoscope. Turn the lens disc to the 0 diopter a diopter is a unit that measures the power of a lens to converge or diverge light . At this diopter the lens neither converges nor diverges light. Keep your finger on the edge of the lens disc...
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Small purplish or blue-black round swellings may appear under the tongue with age. They are dilatations of the lingual veins and have no clinical significance. Reassure a worried patient. These varicosities are also called caviar lesions. A painful, small, round or oval ulcer that is white or yellowish gray and surrounded by a halo of reddened mucosa typifies the common aphthous ulcer. These ulcers may be single or multiple. They heal in 7 to 10 days, but may recur. A persisting painless white...
Cd 1
This cyst behind the ear used to be called a sebaceous cyst. It is a benign, closed, firm sac that lies in the dermis, forming a dome-shaped lump. It can be moved over underlying tissues but is attached to the epidermis. A dark dot blackhead may be visible on its surface. Histologically, one of two diagnoses is likely 1 epidermoid cyst, which is common on the face and neck, and 2 pilar trichilemmal cyst, which is common in the scalp. Each may become inflamed. The raised nodule behind this ear...
Cd 00 1
Perforations are holes in the eardrum that usually result from purulent infections of the middle ear. They are classified as central perforations, which do not extend to the margin of the drum, and marginal perforations, which do involve the margin. The more common central perforation is illustrated here. In this case a reddened ring of granulation tissue surrounds the perforation, indicating a chronic infectious process. The eardrum itself is scarred and no landmarks are discernible. Discharge...
Interviewing and the Health History
The health history interview is a conversation with a purpose. As a clinician, you will draw on many of the interpersonal skills that you use every day, but with unique and important differences. Unlike social conversation, in which you express your own needs and interests with responsibility only for yourself, the primary goal of the clinician-patient interview is to improve the well-being of the patient. At its most basic level, the purpose of conversation with a patient is threefold to...