Clinical assessment of older people

Author(s):  
Lesley K. Bowker ◽  
James D. Price ◽  
Ku Shah ◽  
Sarah C. Smith

This chapter provides information on consultation skills, multiple pathology and frailty, taking a history, other sources of information, problem lists, general physical examination, investigations, common blood test abnormalities, and comprehensive geriatric assessment.

Author(s):  
Lesley K Bowker ◽  
James D Price ◽  
Sarah C Smith

Consultation skills 52 Multiple pathology and aetiology 54 Taking a history 56 Other sources of information 58 Problem lists 60 General physical examination 62 HOW TO . . . Assess gait in an older person 63 Investigations 66 Common blood test abnormalities 68 Comprehensive geriatric assessment 70 There are certain skills that are key to any consultation, but some are more important with an older patient....


Author(s):  
Randolph B. Schiffer ◽  
Robert F. Klein ◽  
Roger C. Sider

2020 ◽  
Vol 36 (3) ◽  
Author(s):  
Javeria Nasir ◽  
Anum Javed ◽  
Owais Arshad ◽  
Mohammad Hanif` Chatni

Ophthalmologists, including general practitioners definitely encounter ocular foreign bodies in their clinics. Theconjunctival fornices are potential sites of impaction. We report a case of a 9-month infant boy who was referred to us for a persistent lower lid swelling for one month. He had already been to an eye specialist before presenting to us. Upon examination, a round, pink coloured, toy cart-wheel came out of his lower eye lid of the right eye. Surprisingly, there was no associated conjunctival or adnexal damage. The authors wish to emphasize the importance of taking a thorough history and adequate general physical examination. A missing part of a toy, elucidated on history, should always raise the suspicion among parents and/or care givers for a probable foreign body in infants and children.


2018 ◽  
Vol 21 (1) ◽  
Author(s):  
Wioletta Mędrzycka-Dąbrowska ◽  
Renata Piotrkowska ◽  
Katarzyna Kwiecień-Jaguś ◽  
Piotr Jarzynkowski ◽  
Sandra Popiołek

Introduction. The history of the use of physical examination by nurses in the United States of America dates back to the 1960s. Transformation of nurses’ education and midwives in Poland also enabled the introduction of classes preparing students and nurses for physical examination. Aim. The aim of the study was to assess the scope of physical examination used by nurses in selected surgical and non-surgical departments. Material and methods. The study involved 89 nurses employed in one of the hospitals in the Pomeranian Voivodeship. The study was conducted in 2017. The work involved the method of a diagnostic survey and the research tool was a questionnaire of own authorship. The results of the study were subjected to statistical analysis using the Microsoft Excel 2013 spreadsheet and the IBM SPSS Statistics 23 statistical package. Results. There are statistically significant differences in the physical examination of the general subjects (assessment of the structure and body proportions, nutritional status), as well as the measurement of breathing, heart rate, blood pressure, body temperature during hospitalization and within the head and neck and chest. Conclusions. Nurses working in surgical wards are more likely to perform general physical examination and measurement of breathing, pulse, blood pressure and body temperature during hospitalization compared to nurses from non-surgical wards. However, when admitted to the hospital, they more often assess the arterial system. Level of education and work experience in the profession are factors affecting the frequency of physical examination.


Author(s):  
Seeba Zachariah ◽  
Kiran Kumar ◽  
Shaun Wen Huey Lee ◽  
Wai Yee Choon ◽  
Saba Naeem ◽  
...  

2019 ◽  
Vol 22 (6) ◽  
pp. 521-530 ◽  
Author(s):  
Stephanie L Mella ◽  
Thomas JA Cardy ◽  
Holger A Volk ◽  
Steven De Decker

Objectives The aim of this study was to evaluate if a combination of discrete clinical characteristics can be used to identify the most likely differential diagnoses in cats with spinal disease. Methods Two hundred and twenty-one cats referred for further evaluation of spinal disease were included and categorised as follows: non-lymphoid neoplasia (n = 44); intervertebral disc disease (n = 42); fracture/luxation (n = 34); ischaemic myelopathy (n = 22); feline infectious peritonitis virus myelitis (n = 18); lymphoma (n = 16); thoracic vertebral canal stenosis (n = 11); acute non-compressive nucleus pulposus extrusion (n = 11); traumatic spinal cord contusion (n = 8); spinal arachnoid diverticula (n = 7); lumbosacral stenosis (n = 5); and spinal empyema (n = 3). Information retrieved from the medical records included signalment, clinical history and clinical presentation. Univariate analyses of variables (clinical history, breed, age, sex, general physical examination findings, onset, progression, spinal hyperaesthesia, asymmetry, ambulatory status and neuroanatomical location) were performed, and variables were retained in a multivariate logistic regression model if P <0.05. Results Multivariate logistic regression revealed that intervertebral disc disease most often occurred in middle-aged, purebred cats with a normal general physical examination and an acute onset of painful and progressive clinical signs. Ischaemic myelopathy occurred most often in older cats with a stable or improving, non-painful, lateralising, C6–T2 myelopathy. Spinal fracture/luxation occurred most often in younger cats and resulted most often in a peracute onset, painful, non-ambulatory neurological status. Concurrent systemic abnormalities or abnormal findings detected on general physical examination were significantly associated with feline infectious peritonitis virus myelitis, spinal lymphoma or spinal empyema. Conclusions and relevance This study suggests that using easily identifiable characteristics from the history and clinical examination can assist in obtaining a preliminary differential diagnosis when evaluating cats with spinal disease. This information could aid veterinary practitioners in clinical decision-making.


2021 ◽  
Author(s):  
Lucas Vilas Bôas Magalhães

Educative, organized, modern and realistic. This book is different because it took 10 years to write and has a completely original system to teach how to care for patients with neurological, psychiatric and/or neuropsychiatric disorders. It is educative and organized since, after a review of the modern medical interview and the presentation of a proposal for a general physical examination – the physical approach examination (PAE) –, with its main trunk and branches (extra maneuvers, linked according to context), we structured the approach to the neurological patient in ten steps (chapters 3 to 12). Each step is developed using several clinical vignettes of real routine patients, the majority of whom were attended by the author. The idea is that the reader can be proficient in the elaboration of syndromic diagnoses and become able to correctly solve or direct the real cases. After each chapter, an overview of the key points is made. It is modern and realistic since, whenever possible and available, we inform the statistical performance of the interview and of the neurological physical examination maneuvers according to the precepts of evidence-based medicine. Only what should be used in daily practice is emphasized, excluding useless tests and maneuvers. The book can serve mainly as a guide to neurological (and psychiatric) semiology in undergraduate courses, but also as an introductory reading for medical residents in family medicine, psychiatry, neurology, neurosurgery or neuropediatrics. It can also be useful for the continuing education of practicing physicians, especially those in Family Health Strategy.


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