The Cardiac Examination

Author(s):  
Joseph Loscalzo

In this era of high technology and expensive testing, there is nothing more important than a good history and physical examination in the process of medical care. A focused cardiac history allows the clinician to establish a differential diagnosis. The physical examination is utilized not only as an overall assessment of the cardiovascular system but more specifically to pursue those diagnoses in the historical differential that can be confirmed or refuted by the physical findings. Critical physical examination findings are rarely uncovered unless the clinician is specifically probing for given physical examination characteristics and knows what would be expected in the face of disease. Only by applying skilled history and physical examination techniques can the clinician determine the rank order of the differential diagnosis and order those tests most likely to answer the question with the least inconvenience, pain, and cost to the patient.

Author(s):  
Klepikov O.V. ◽  
Kolyagina N.M. ◽  
Berezhnova T.A. ◽  
Kulintsova Ya.V.

Relevance. Today, in preventive medicine, climatic conditions that have a pathological effect on the functional state of a person are increasingly being updated. the occurrence of exacerbations of many diseases can be causally associated with various weather conditions. Aim: to develop the main tasks for improving the organization of medical care for weather-dependent patients with diseases of the cardiovascular system. Material and methods. The assessment of personnel, material and technical support and the main performance indicators of an outpatient clinic was carried out on the example of the Voronezh city polyclinic No. 18 to develop the main tasks for improving the organization of medical care for weather-dependent patients with diseases of the cardiovascular system. Results. The main personnel problem is the low staffing of district therapists and specialists of a narrow service. One of the priorities for reducing the burden on medical hospitals is the organization of inpatient replacement medical care on the basis of outpatient clinics. The indicators for the implementation of state guarantees for the outpatient network for 2018, which were fully implemented, are given. The analysis of the planned load performance by polyclinic specialists is presented. Cardiological and neurological services carry out measures to reduce the risk of exacerbations of diseases with cerebral atherosclerosis, hypertension, and major neurological nosologies. Conclusion. Improving the organization of medical care for weather-dependent patients with cardiovascular diseases are: informing patients about the sources of specialized medical weather forecasts in the region, organizing the work of the medical prevention office, implementing an interdepartmental approach to providing health care to the most vulnerable groups of the population.


2021 ◽  
Vol 10 (14) ◽  
pp. 3144
Author(s):  
Danilo L. Andrade ◽  
Marina C. Viana ◽  
Sandro C. Esteves

The differential diagnosis between obstructive and nonobstructive azoospermia is the first step in the clinical management of azoospermic patients with infertility. It includes a detailed medical history and physical examination, semen analysis, hormonal assessment, genetic tests, and imaging studies. A testicular biopsy is reserved for the cases of doubt, mainly in patients whose history, physical examination, and endocrine analysis are inconclusive. The latter should be combined with sperm extraction for possible sperm cryopreservation. We present a detailed analysis on how to make the azoospermia differential diagnosis and discuss three clinical cases where the differential diagnosis was challenging. A coordinated effort involving reproductive urologists/andrologists, geneticists, pathologists, and embryologists will offer the best diagnostic path for men with azoospermia.


2015 ◽  
Vol 34 (9) ◽  
pp. 1683-1690 ◽  
Author(s):  
Bruce J. Kimura ◽  
David J. Shaw ◽  
Stan A. Amundson ◽  
James N. Phan ◽  
Daniel G. Blanchard ◽  
...  

2016 ◽  
Vol 34 (1) ◽  
pp. 1-44
Author(s):  
Jeffrey S. Adler

On May 11, 1938, two New Orleans policemen entered the Astoria Restaurant, marched to the kitchen, and approached Loyd D. T. Washington, a 41-year-old African American cook. They informed Washington that they would be taking him to the First Precinct station for questioning, although they assured the cook that he need not change his clothes and “should be right back” to the “Negro restaurant,” where he had worked for 3 years. Immediately after arriving at the station house, police officers “surrounded” Washington, showed him a photograph of a man, and announced that he had killed a white man in Yazoo City, Mississippi, 20 years earlier. When Washington insisted that he did not know the man in the photograph, that he had never been to (or even heard of) Yazoo City, and that he had been in the army at the time of the murder, the law enforcers confined him in a cell, although they had no warrant for his arrest and did not charge him with any crime. The following day, a detective brought him to the “show-up room” in the precinct house, where he continued the interrogation and, according to Washington, “tried to make me sign papers stating that I had killed a white man” in Mississippi. As every African American New Orleanian knew, the show-up (or line-up) room was the setting where detectives tortured suspects and extracted confessions. “You know you killed him, Nigger,” the detective roared. Washington, however, refused to confess, and the detective began punching him in the face, knocking out five of his teeth. After Washington crumbled to the floor, the detective repeatedly kicked him and broke one of his ribs. The beating continued for an hour, until other policemen restrained the detective, saying “give him a chance to confess and if he doesn't you may start again.” But Washington did not confess, and the violent interrogation began anew. A short time later, another police officer interrupted the detective, telling him “do not kill this man in here, after all he is wanted in Yazoo City.” Bloodied and writhing in pain, Washington asked to contact his family, but the request was ignored. Because he had not been formally charged with a crime, New Orleans law enforcers believed that Washington had no constitutional protection again self-incrimination or coercive interrogation and no right to an arraignment or bail, and they had no obligation to contact his relatives or to provide medical care for him.


1965 ◽  
Vol 32 (4) ◽  
pp. 221-228
Author(s):  
Betty Jane McWilliams

This article presents the problems involved in definitive differential diagnosis of children with delayed language. It suggests the need to describe language, auditory, mental, and emotional functioning as opposed to depending upon specific diagnostic labels which may rely upon clinical bias. The classroom teacher is viewed as an individual competent to devise teaching methods applicable to the peculiar requirements of widely differing children and is encouraged to trust herself in the face of “experts.”


Author(s):  
Evgeny K. Beltyukov ◽  
Valery A. Shelyakin ◽  
Veronika V. Naumova ◽  
Alexander V. Vinogradov ◽  
Olga G. Smolenskaya

Background: Biologicals use in severe asthma (SA) is associated with problem of targeted therapy (TT) availability. Ensuring availability of biologicals can be resolved within the territorial compulsory medical insurance program (TCMIP) in day-stay or round-the-clock hospital. Aims: development and implementation of program for introduction of immunobiological therapy (IBT) for SA in Sverdlovsk Region (SR). Materials and methods: Program for introduction of IBT for SA was developed in SR in 2018 to provide patients with expensive biologicals within the TCMIP. Program includes: SA prevalence study in SR; practitioners training in differential diagnosis of SA; organization of affordable therapy for patients with SA; register of SA patients сreation and maintenance; patients selection and management of patients with SA in accordance with federal clinical guidelines. Results: Atopic phenotype in SA was detected in 5%, eosinophilic - in 2.3% of all analyzed cases of asthma (n=216). Practitioners of SR were trained in differential diagnosis of SA. The orders of the Ministry of Health of SR were issued, regulating the procedure for referring patients with SA to IBT, a list of municipal medical organizations providing IBT in a day-stay or round-the-clock hospital; approved regional register form of SA patients requiring biologicals use; ungrouping of clinical and statistical groups of day-stay hospital was carried out depending on INN and dose of biologicals; patients with SA are selected for TT and included in the regional register. Initiating of TT in round-the-clock hospital and continuation therapy in day-stay hospital provides a significant savings in compulsory medical insurance funds. Conclusions: introduction of IBT for SA in SR is carried out within framework of developed program. Principle of decentralization brings highly specialized types of medical care closer to patients and makes it possible to provide routine medical care in allergology-immunology profile in context of restrictions caused by COVID-19 pandemic.


2011 ◽  
Vol 18 (03) ◽  
pp. 535-537
Author(s):  
MAQSOOD AHMAD ◽  
MUMTAZ AHMAD ◽  
MUHAMMAD SAQIB

The children presenting with acute scrotum have many diseases in differential diagnosis and testicular torsion in undescended testis and normal testis is an important consideration. Torsion of the testis, or more correctly, torsion of the spermatic cord, is a surgical emergency because it causes strangulation of gonadal blood supply with subsequent testicular necrosis and atrophy. In most of cases history and physical examination are sufficient to make an accurate diagnosis. While other causes may require simple treatment but torsion require immediate exploration to save the testis. Early diagnosis and prompt treatment is essential to help such children.


Author(s):  
Ashiya Goel ◽  
Aman . ◽  
Vinny Raheja ◽  
Manisha Kumari

<p class="abstract"><span lang="EN-US">Chondroid syringomas are uncommon cutaneous neoplasms of sweat gland origin which are slow-growing, nontender, subcutaneous or intracutaneous in location and often occurring in the head and neck region. Chondroid syringoma should be considered in the differential diagnosis of any subcutaneous nodule over the face. The clinician may miss the diagnosis of this lesion and if it is suspected, tumour should be excised with a margin of normal tissue and regular follow up should be done.</span></p>


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