BATCH 23 MEDICAL UST #دفعة الدكتور حسن العريفي

Breast Examination 💠Great, introduce, permission, privacy, wash 💠Position: Inspection➡️sitting Palpation➡️supine axilla➡️sitting or all the procedure at 45°! 💠Exposure: ideally untill the waist 💠Well, comfortable, lie 🟫Inspection: from in (nipple) to out (axilla) ◾️Symmetry ◾️Nipple-areola complex (6 Ds +R) 1. Direction 2. Displacement (from nipple line) 3 .Deviation 4. Discharge 5. Distruction 6. Dublication 7. Retraction ◾️Skin: 1. Scar 2. Sinus 3. Discoloration 4. Dilated viens or pulsation 5. Dimpling 6. Peau d'orange 7. Ulcer 8. Vesible lump (4s) 9. Inframammary fold for scar ◾️Axilla 1. Skin tethering 2. Axillary swellings (LN) 3. Arm swelling (LN & lymphedema) 🟫Palpation 👉Ask about the pain 👉Use both hands if large breast 👉Start with normal site, 👉Anticlock, 👉6 areas, 👉Palpate nipple area with the palm! ◾️Tenderness ◾️Temperature ◾️Palpate mass 1. size 2. site, 3. shape, 4. surface 5. consistency, 6. edge, 7. attached to skin 8. attached to underlying structure (ask her to push againt the waist then move the lump) ◾️Press the areola for discharge ◾️Axillary LN + Supra and Infra clavicular joint 👉Your right hand with right hand of the patient & vice vera 👉If palpable comment on: 1. site 2. size 3. shape 4. consistency 5. fixity 6. single or multible 7. molten together 🔸anterior 🔸posterior 🔸lateral 🔸pectoral 🔸apical 🟫Other area to examine ◾️chest for pleural effusion ◾️abdomen for organomegally and ascitis ◾️back for tenderness ◾️general examination

Thyroid Examination 💠Great, introduce, permission, privacy, wash 💠General: well, sitting, comfortable, not agitated, thin/fat his/her cloth suitable for room temperature 💠Exposure: from nipple line & above 🟫 Inspection: 6Ss 1⃣Swallowing/tongue protrusion 2⃣Site 3⃣Size 4⃣Shape 5⃣Skin over it ▪️scar ▪sinus/discharge ▪️discoloration ▪️dilated veins/ vesible pulsation ▪️ulcer 6⃣Suprasternal notch 🟫Palpation From anterior: 4Ts ask about the pain Temperature Tenderness Trachea Thrill From posterior 🔸Tell the pt you want to examine him from posterior! 🔸Relax muscle 🔸Support with one ✋and palpate with the other for: ▪️site ▪️size ▪️shape __ ▪️surface ▪️consistency ▪️edge __ ▪️attachment to skin ▪️attachment to muscle __ ▪️palpate isthmus ▪️Movement with swallowing + Retrosternal extension (palpate the lower edge by your little fingers and ask the pt to swallow) 🔸Lymphnodes ▪️submental ▪️submandibular ▪️pre/post auricular ▪️anterior/posterior cervical ▪️occipital ▪️supra/infra clavicular 🔸Skull for swelling 🟫Percussion clavicle sternum (from resonant area) 🟫Ascultation over the swelling above the swelling 🟫General examination 🔹Upper limp moist/dry cold/hot palmar erythema acropathy Vitiligo fine tremors pulse PB temp Proximal myopathy (resist abduction of the arm) 🔹Eye Passive 1⃣lid retraction: sclera above the iris 2⃣exophthalmos: from behind and above the pt 3⃣chemosis 4⃣loss of lateral eye brows 5⃣periorbital edema or redness Active 6⃣ophthalmoplegia 7⃣convergnce 8⃣lid lag 🔹Reflexes 🔹pretibial myxedema 🔹cardiovascular ex

〰〰〰〰〰〰〰〰〰 2. Thyroid 〰〰〰〰〰〰〰〰〰 Thyroid History 💠 Introduce, permission, privacy 💠 Personal data 💠 Complain/duration 💠HPI 🟫History of the lump How Discovered Onset Progression Multiplicity Causes/trauma Associated symptoms ▪️Pain ▪️Fever ▪️Discharge 🟫Pressure Symptoms Shortness of breath Discomfort swallowing Hoarsness 🟫History of metabolic status &systemic review for mets 🔻Non specific: Increase sweating/dryness Heat/cold intolerance Generalize fatigue Loss of hair 🔻CNS: Metabolic; nervousness, irritability, Insomnia, proximal myopathy. Systemic review; Weakness, headage 🔻GIT: Metabolic; Diarrhea/constipation, weight loss/gain, Increase/decrease appetite. SR; jaundice, abdominal pain/distension 🔻Cardiorespiratory: Metabolic; palpitation SR, chest pain, hemoptysis, cough 🔻Genitourinary: Menses; stop? regular? amount? Urine; color, amount, frequency 🟫Eye symptoms Double vision Blurred vision Eye pain Difficult eye closue 💠Past medical history Similar condition Admission Surgery Blood transfusion Radiation FNA Asthma, DM, HTN 💠Family history similar condition Malignancy 💠Drug history current chronic allergy 💠Social Smoking Alcohol Insurance

〰〰〰〰〰〰〰〰〰〰〰 1. Lump 〰〰〰〰〰〰〰〰〰〰〰 Lump Hx: 💠 Introduce, permission, Privacy 💠 Personal Data 💠 Complain/duration 💠 HPI ▪️How Discovered ▪️Onset ▪️Progression ▪️Persistence ▪️Multiplicity ▪️Causes/trauma ▪️associated symptoms 🔸Pain 🔸Fever 🔸Discharge 💠 systemic review 💠 Past medical hx 💠 Family hx 💠 social hx 💠 drug hx Lump Examination 💠Great, Introduce, Permission, Privacy, Wash 💠Exposure bilateral ______ 🟫 Inspection: 6s 🔸Site: measure from bony prominance 🔸Size: 3 dimensions 🔸Shape eg hemispherical, oval 🔸Skin over it 1. scar 2. sinus/️discharge 3. dilated vien/️pulsation 4. discoloration 5. ulceration 🔸Symmetry if multible 🔸Special character ______ 🟫 Palpation: 🔸Have pain? 🔸Tenderness 🔸Temperature ______ 🔸Surface: ▪️smooth ▪️nodular ▪️lobular ▪️irregular 🔸Consistency: ▪️soft ▪️firm ▪️hard ▪️cystic 👉paget test if very small ! 👉signs of molding if soft or cystic 🔸Edge ▪️well define ▪️ill define ▪️slippery (lipoma) ______ If soft or cystic do: 🔸Fluctuation test 🔸Translumination 🔸Pulsatile/expansile 🔸Compressiblity: re expand again to its original size without any external effects 🔸Reducablility: re expand again to its original size with cough, straigning or gravity ______ 🔸Attached to skin 🔸Attached to underling structure: ▪️first free move ▪️then with muscle acting ▪️In the abdomen elevate the leg if disappear➡️ from viscera if still appear➡️ subcutanous ▪️in the ganglion it will fix to the tendon so it will move with the movement of the tendon, and it will be fix when extend the wrist ______ 🟫Special Tests: According to the site: Bruit, resonance, etc 🟫 Complete by: 1. Regional LN 2. Near joint 3. General ex

Safe triangle of chest tube Insertion

Surgical specimens د. محمد البعداني

اللجنة المنظمة للفعاليات تحدد مكاناً للخروج الجماهيري في #صنعاء إسناداً للمقاومة الفلسطينية بشارع الستين الشمالي عصر اليوم الجمعة. #طوفان_الاقصى