Polithicsssssssssss

GOVERNMENT EXPLAINED:

FEUDALISM

You have two cows.Your lord takes some of the milk.

FACISM

You have two cows.The government takes both, hires you to take care of them, and sells you the milk.

RUSSIAN COMMUNISM

You have two cows.You count the cows and find that you have four cows. You count again and, you now have 40 cows. You count again and finally find out that you have two cows. You don't care and simply pour another shot of Vodka.

DICTATORSHIP

You have two cows.The government takes both the cows and drafts you.

PURE DEMOCRACY

You have two cows.Your neighors decide who gets the milk.

BUREAUCRACY

You have two cows.At fist the government regulates what you can feed them and when you can milk them.Then it pays you not to milk them. Then it takes both, shoots one, milks the other and pours the milk down the drain.Then it requires you to fill out forms accounting for the missing cows.

SURREALISM

You have two girrafes.The government requires you to take the harmonica lessons.

COMMUNISM

You have two cows.The government takes both and gives you the milk.

NAZISM

You have two cows.The government takes both and shoots you.

CAPITALIS

MYou have two cows.You sell one and buy a bull.

NEPALESE DEMOCRACY

You have two cows.You sell one, buy a bull;take out huge loan on the cow, and ignore both the cow and loan from that point on; then you try to milk the bull, and blame the Japanese for its lack of production.

Technique of palpation of liver

Techniques:
Liver
Approach the examination of the liver from the right side of the patient. Have the patient lying supine. Preserve the patient’s privacy by draping the top of their body with the gown and below the waist with a sheet. For the best exam, make sure the patient is warm and comfortable. Additionally make sure your hands are warm so as to not startle the patient.

InspectionLook for gross asymmetries across the abdomen. Look at the skin for signs of liver disease, such as caput medusa, or spider angiomata.

AuscultationFollow the inspection of the liver, as with the rest of the abdominal exam, with auscultation. Listen over the area of the liver for bruits or venous hums.

Percussion for the upper and lower margins of the liver. Place your non-dominant hand palm down flat on the abdomen with the fingers parallel to the lower costal margin pointed toward the midline. Percuss with the middle finger of your dominant hand on the middle finger of your non-dominant one.
Begin percussion over the lungs and move from the area of resonant lung sounds to the areas of dullness. Mark the area of change. Repeat the same process from below, moving again from resonance over the bowel to dullness and again mark the area of change. Start in the lower right quadrant so as to not miss a greatly enlarged liver. Measure the vertical distance from the top to the bottom. You can also use palpation to determine the lower border.

PalpationBegin palpation over the right lower quadrant, near the anterior iliac spine. Palpate for the liver with one or two hands palm down moving upward 2-3 cm at a time towards the lower costal margin. Have the patient take a deep breath. The liver will move downward due to the downward movement of the diaphragm. Feel for the liver to hit the caudal aspect of your palpating hand. Palpate the bottom margin of the liver for the texture of the liver, i.e. soft/ firm/hard/nodular.

Scratch TestSeveral different techniques have been described for this exam. One is to place the diaphragm over the area of the liver and then scratch parallel to the costal margin until the sound intensity drops off marking the edge of the liver. Other techniques involve different patterns of the scratching, for example as in spokes of a wheel and other places for placing the stethoscope such as over the abdomen.
back to top

Memories Remain... Reality Fades away

Chief Complaint: A 49-year-old female presented with exercise intolerance and palpitations that have worsened over the past two years.

Past Medical History: Significant for tetralogy of Fallot (TOF) status/post repair at age 10; prior left Blalock-Taussig shunt at age 2
Physical FindingsAge: 49 Gender: Female Blood Pressure: 150/70 mm Hg Pulse: 75 bpm Head and Neck: Jugular venous pressure estimated at 10 mm Hg with a prominent V wave Chest and Lungs: Clear to auscultation bilaterally Cardiac Exam: Left parasternal heave; second heart sound was single; 3/6 holosystolic murmur at the left lower sternal border and a diastolic murmur 3/4 over the left upper sternal border Abdomen: Soft; no hepatosplenomegaly Extremities: Absent left radial pulse; no cyanosis or clubbing of the digits Additional Info: ECG revealed normal sinus rhythm with right bundle branch block. QRS duration: 140 ms

Options
A. Aortic insufficiency (AI) with a dilated aortic root.
B. Residual ventricular septal defect (VSD) with enlarged right ventricle (RV).
C. RV dysfunction due to severe pulmonary insufficiency and chronic volume overload of the RV.
D. Residual VSD with enlarged RV, and overriding aorta, and AI.

Eyes as u see ( med literature)

Each and every one has it in a pair. But nobody is sure if every of them percieve an object to be the same.Take it this way- if I see an object to be red you can not be sure a third person also percieves it as red. I mean he maybe perceiving it as blue but still saying it to be red as per his learnt habit since childhood. So the Biggest problem of the globe today is about belief. A belief which is created in ones mind as the influence of his/her environment.

As you Say:If little knowledge is dangerous then, show me a single man who has as much as to be out of danger.

Rabindra Nayak

Eyes-Nayak

EYES AS U SEE

Each and every one has it in a pair. But nobody is sure if every of them percieve an object to be the same.Take it this way- if I see an object to be red you can not be sure a third person also percieves it as red. I mean he maybe perceiving it as blue but still saying it to be red as per his learnt habit since childhood. So the Biggest problem of the globe today is about belief. A belief which is created in ones mind as the influence of his/her environment.

Rabindra Nayak

As you Say:If little knowledge is dangerous then, show me a single man who has as much as to be out of danger.

CASE IV

History
A 35-year-old man presented with with elevated blood pressure (188/112, seated) at a yearly physical exam. Previous exams noted blood pressures of 160/94 and 158/92. On questioning, he admitted episodes about twice a month of apprehension, severe headache, perspiration, rapid heartbeat, and facial pallor. These episodes had an abrupt onset and lasted 10-15 minutes.

Physical Exam
30 min after the initial blood pressure measurement, the seated blood pressure was 178/110 with a heart rate of 90. The blood pressure after 3 min of standing was 152/94 with a heart rate of 112. The optic fundi showed moderately narrowed arterioles with no hemorrhages or exudates.

Initial lab studiesRoutine hematology and chemistry studies were within the reference ranges and a chest film and EKG were essentially normal.

Questions
How would you assess this patient's presentation?

CASE III

History

A 50-year-old man presents with enlargement of left anterior neck. He has noted increased appetite over past month with no weight gain, and more frequent bowel movements over the same period.

Physical Exam

He is 5'8" tall and weighs 150 lb. The heart rate is 82 and the blood pressure is 110/76. There is an ocular stare with a slight lid lag. The thyroid gland is asymmetric to palpation, weighing an estimated 40g (normal = 15-20g). There is a 3 x 2.5 cm firm nodule in left lobe of the thyroid.

Questions

What do you think the patient's primary problem is?

Answer here or wait for next week

http://www.mcl.tulane.edu/classware/pathology/medical_pathology/endocrine_cases/c1q1.html

Case II

A 6-year-old boy born to consanguineous parents presented with short stature and deformity of chest and limbs. Clinical examination revealed a very short child with the height of 86 cm (height age 2½ years). He had mild coarse facies, clear corneas, short neck and normal intelligence. Other salient features were short trunk, kyphosis, pectus carinatum, protruded abdomen and knock knees (Fig. 1). Liver was palpable 6 cm below the right costal margin and spleen was 2 cm palpable. The blood picture was normal and urine was positive for mucopolysaccharides. X-ray spine showed marked platyspondyly typical of Morquio Syndrome. Echocardio-gram revealed grade II mitral valve prolapse.
Hint( a genetic cause of short stature)

Case Study I

CASE STUDY I

A 69 year-old male farmer, non-smoker, was admited to our department due to dyspnea on exertion, night sweats during the last two months and severe thrombocytopenia revealed during a routine screening by his general practitioner. The patient had a medical history of congestive heart failure, and osteoarthritis.

Physical examination revealed body temperature 36.8°C, pulse rate 80 beats/min, blood pressure 150/90 mmHg, respiratory rate 20 breaths/min and oxygen saturation 94% on room air. Auscultation disclosed decreased breath sounds at the right lower base, with dullness on percussion. In addition the patient had ecchymoses in his lower limps and trunk without petechiae. Laboratory work-up showed: hemoglobin 15.6 g/dL, white blood cell count 10,900 cells/µL (71% neutrophils and 18% lymphocytes), and platelet count 20,000 cells/µL. Prothrombin time and partial thromboplastine time where within normal limits, as well as the rest of the laboratory tests

Reply post