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Knee Exam

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921. Where will you find happiness now?

of the mall. Within minutes, Pópo is flying past us! She grins as she strolls on the moving walkway, a conveyor belt that pushes patrons toward their shopping destination. Eventually, she reaches the end and gingerly hobbles off. We pass her. She grows smaller and smaller. We round a corner and she’s disappeared. After an hour, I meet Pópo at a wooden bench. I sit with her for a while. Patting her arthritic knees, she says that it will probably rain more today. She looks off into the distance. Then she (...) of withdrawal. As Pópo tells me, “The only good thing the Communists did was to get rid of drugs and prostitution.” Betrayed by her parents and by her country, my grandmother discovered that happiness was not an easy thing to find. Nor was unhappiness an easy thing to evade. Pópo escaped her unhappiness in brief spurts through dreams of education, through novels and through music. At 17, she finished the national university entrance exam and qualified for a government-sponsored education in electrical

2015 KevinMD blog

922. Telemedicine: Why professional concern shouldn’t be dismissed

Telemedicine: Why professional concern shouldn’t be dismissed Telemedicine: Why professional concern shouldn't be dismissed Telemedicine: Why professional concern shouldn’t be dismissed | | July 5, 2015 160 Shares The current state of telemedicine — that is, teleconferencing with a physician over one’s smartphone — worries many critics because it assumes patients can be evaluated without a physical exam. The critics are right that those with a financial interest in “disrupting” health care (...) and the mind. It’s not easy parenting an adolescent. Sophomoric self-righteousness, know-it-all smugness, and knee-jerk rebellion can be irritating as hell. Suddenly, adults are idiots and “just don’t understand.” The young person veers toward obvious trouble, but they have to learn for themselves. It’s nerve-wracking to balance freedom and reasonable risk; to refrain, except in extreme circumstances, from wagging a parental finger and chiding, “you have a LOT to learn!” And all these challenges grow

2015 KevinMD blog

923. The electronic chart turns us into data druggies

. Someone somewhere adds another question we are supposed to ask our patients. We get back on our hands and knees. We start sifting once again. Have you been to the continent of Africa in the last twenty-one days? Click. Do you or a loved one feel threatened at home? Click. How was your experience today? Click. In the background the blood pressure cuff inflates, the quiet hiss filling the room. The monitor beeps along with the patient’s pulse, each ding another penny tossed into the ever-growing bank (...) lock on to mine. I smile. “Hey, little buddy,” I say quietly. He smiles back with a toothless grin, and clear drool runs down his chin over my hand and onto his belly. I finish my exam. He is fine. I hold him on my hip while I wait for the parents to finish what they are doing. I can see Dad is playing a game on his phone. He is trying to slice pieces of fruit tossed across the screen. Strawberries spin in red bunches, bananas burst in yellow bombs, pineapples pop in showers of stars. I cannot

2015 KevinMD blog

924. Should radiologists disclose results to patients? The answer isn’t what you think.

, that we must make it clear we are “part of the team.” Then the patients will finally understand the important role we play, which will somehow translate into a stronger position for us at King ACO’s round table. Having become even more cantankerous in my old age and semi-retirement, I view this as little more than a desperate Hail Mary and a naive, knee-jerk response to the coming economic pressures of the (Un)Affordable Care Act. We are being asked to jump up on tables and shout, “We’re doctors, too (...) that patients the results of imaging exams from the physician who ordered them. I would urge everyone to read the entire report, but, in essence, the majority of patients surveyed “appear to prefer the current model of results delivery, in which ordering physicians provide results.” And this makes perfect sense. The usual course of events established decades ago is that results are communicated to the physician who ordered the study, and he or she then discusses them with the patient. There are only two

2015 KevinMD blog

925. Doctor saves patient from harm after her insurer tries save money

, they didn’t even inform me about the appointment. My patient later told me that the exam was exhaustive. The PA, who incidentally graduated school the day before and had never seen an actual patient as a licensed practitioner, poked and prodded the ninety-year-old woman for over an hour. He asked her about drugs and sexually transmitted diseases. He examined every joint and performed a Babinski test. A few days later I received a call from him. He tried to leave a message with my secretary, but I (...) intercepted the call. He had two recommendations. He thought I should do a better job of addressing the patient’s knee pain. When I asked if he thought it was a result of her polymyalgia, rheumatoid, or osteoarthritis, he had no idea. When I mentioned that the pain had been treated in the past with various medications (and physical therapy), and the patient had stopped them all due to fatigue (even Tylenol), he was surprised. When we discussed that she was in the hospital multiple times for pain control

2015 KevinMD blog

926. Bedside Ultrasound Case: Look Left and Right! #FOAMed, #FOAMus

Examination) is what I start with, after an ultrabasic history. So my first couple of views show a more-or-less normal IVC, and here is the parasternal long axis: Anything exciting here? Not really, nothing to hang your hat on at a glance. Ok, so thanks to FOAM, I recently decided to add the right parasternal view to my regular exam, both to look for lung sliding (I admit I sometimes skip this when not specifically looking for pneumothorax) but also to possibly see some right sided pericardial (...) abnormalities, etc… Here is what I see: Hmm… A large, vascular structure that seems to have two lumens… a flap? Back to the patient exam, and the left toe is upgoing and seems more flaccid in the left upper extremity… Lets creep up the vascular path to the neck vessels: Here, we can clearly see that most of the carotid lumen (lower right) doesn’t have any flow. That’s suboptimal. In fact, only a small crescent of flow between 3 and 6 o’clock is seen. Here is the CT: So here we can clearly see the dissected

2015 Thinking critical care blog

927. Enteral Fluid Resuscitation (EFR): Third-world medicine in the modern ED/ICU? (ORT part 2) – #FOAMed, #FOAMcc, #FOAMer

huge amount of fluids, but this has been done mostly in healthy but dehydrated athletes – not the case for most of our patients. I’ve been going with 250ml every 1-2h, as – for now – an adjunct to IV fluid therapy. This is conservative and completely arbitrary, but essentially a glass every hour or two certainly doesn’t seem excessively taxing. Who can I give this to? You do need a functional gut, so for now, my criteria are (1) essentially normal abdominal exam, (2) obviously no recent bowel (...) account. ( / ) Connecting to %s Notify me of new comments via email. Notify me of new posts via email. This site uses Akismet to reduce spam. . on Colin on on on on the best is yet to come. This WordPress.com site is the bee's knees where everything is up for debate . . . Brazilian Jiu Jitsu for Wrestlers Spheres of basic emergency medicine knowledge Critical discussions on critical care a blog for thinking docs: blending good evidence, physiology, common sense, and applying it at the bedside! Post

2015 Thinking critical care blog

928. How Can I Help You?

” not the x-ray or the family system sometimes? (ie did you ask him the question in front of them so they could hear also?) EOL – A referral to hospice? What indicated he only had 6 months of life left? AGE – What was “telling” about the exam? Did it clearly indicate he didn’t need surgery? Many patients in their 80’s have hip and knee surgery so what were the indicators that lead you to say “you might survive the surgery”. EMOTIONAL HEALTH Isn’t it possible he was simply afraid of the surgery? Did you (...) How Can I Help You? How Can I Help You? - Howard J. Luks, MD | Search for: How Can I Help You? Last Updated January 27, 2015 by Howard J. Luks, MD Related Posts Post navigation About the author: Howard J. Luks, MD A Board Certified Orthopedic Surgeon in Hawthorne, NY. Dr. Howard Luks specializes in the treatment of the shoulder, knee, elbow, and ankle. He has a very "social" patient centric approach and believes that the more you understand about your issue, the more informed your decisions

2015 Howard J. Luks, MD blog

929. Please forgive us for prescribing controlled drugs to just about everybody

by methamphetamine and prescription drug abuse. The little clinic in town is unwittingly a partner in this crime. Like the U.S. itself, this small community clinic has been generous with prescribing controlled substances for those who appear to need them. Sedatives in the benzodiazepine (Valium, Ativan and Xanax are brand name examples) family are prescribed for those with anxiety. Opiates, from the family that includes morphine, are prescribed for patients with back pain and knee pain and a host of other long (...) to study better. They have become extremely common on college campuses at exam time, since they also allow a person to go without sleep and sometimes without much food. One person with a regular prescription for this kind of medication can supply his or her friends with drugs as needed. Side effects can include heart rhythm disturbances and erratic behavior, especially in higher doses, as are sometimes used recreationally. Some of the patients in this little clinic get ADD drugs so they can work

2015 KevinMD blog

930. You MUST have surgery

. Dawn :-) Thank you! says: I agree with you Dawn, his patients are very fortunate. I had to make a decision re knee surgery and after reading Dr Luks honest clinical point of view about surgery, I weighed up the options, and decided against the surgery. Should my condition deteriorate….I may think about the surgery then. I thank you Howard, for helping me to make an informed decision. Wish all surgeons were as people focussed as you. Carol. I had shoulder pain and my PCP’s physical exam immediately (...) You MUST have surgery You MUST have surgery - Howard J. Luks, MD | Search for: You MUST have surgery Last Updated December 19, 2014 by Howard J. Luks, MD Related Posts Post navigation About the author: Howard J. Luks, MD A Board Certified Orthopedic Surgeon in Hawthorne, NY. Dr. Howard Luks specializes in the treatment of the shoulder, knee, elbow, and ankle. He has a very "social" patient centric approach and believes that the more you understand about your issue, the more informed your

2014 Howard J. Luks, MD blog

931. Evaluation of the Elderly Patient

extremities is also beneficial for overall function. Increased muscle tone, measured by flexing and extending the elbow or knee, is a normal finding in elderly people; however, jerky movements during examination and cogwheel rigidity are abnormal. Sarcopenia (a decrease in muscle mass) is a common age-related finding. It is insignificant unless accompanied by a decline or change in function (eg, patients can no longer rise from a chair without using chair arms). Sarcopenia affects the hand muscles (eg (...) , interosseous and thenar muscles) in particular. Weak extensor muscles of the wrist, fingers, and thumb are common among patients who use wheelchairs because compression of the upper arm against the armrest injures the radial nerve. Arm function can be tested by having patients pick up an eating utensil or touch the back of their head with both hands. Coordination Motor coordination is tested. Coordination decreases because of changes in central mechanisms and can be measured in the neuro exam

2013 Merck Manual (19th Edition)

932. Treatment of Pain

How to do a 4-Minute Neurologic Exam SOCIAL MEDIA Add to Any Platform Loading , MD, Mayo Clinic Click here for Patient Education NOTE: This is the Professional Version. CONSUMERS: Topic Resources Nonopioid and opioid analgesics are the main drugs used to treat pain. Antidepressants, anticonvulsants, and other CNS-active drugs may also be used for chronic or neuropathic pain and are first-line therapy for some conditions. Neuraxial infusion, nerve stimulation, injection therapies, and neural (...) because response varies from drug to drug. It is prudent during long-term NSAID therapy to monitor for occult blood in stool and changes in CBC, electrolytes, and hepatic and renal function. Topical NSAIDs may be applied directly to the painful region for disorders such as osteoarthritis and minor sprains, strains, and contusions. A 1.5% solution of diclofenac has been shown to effectively treat pain and limited joint function caused by osteoarthritis of the knees; dose is 40 drops (1.2 mL) applied

2013 Merck Manual (19th Edition)

933. Malnutrition

in the buttocks and thighs Skeletal Deformities usually a result of calcium, vitamin D, or vitamin C deficiencies Abdomen Distended – hepatomegaly with fatty liver, ascites may be present Cardiovascular Bradycardia, hypotension, reduced cardiac output, small vessel vasculopathy Neurologic Global development delay, loss of knee and ankle reflexes, poor memory Hematological Pallor, petechiae, bleeding diathesis Behavior Lethargic, apathetic Source: "Protein Energy Malnutrition" Cognitive development [ ] can (...) , rectal is recommended. Blood sugar levels should be re-checked on two hour intervals. Hypothermia [ ] can occur. To prevent or treat this, the child can be kept warm with covering including of the head or by direct skin-to-skin contact with the mother or father and then covering both parent and child. Prolonged bathing or prolonged medical exams should be avoided. Warming methods are usually most important at night. Epidemiology [ ] Main article: Percentage of population affected by undernutrition

2012 Wikipedia

934. Magnetic resonance imaging (Full text)

/€2,600 and a professional charge might be $350/€260, although the actual fees received by the equipment owner and interpreting physician are often significantly less and depend on the rates negotiated with insurance companies or determined by the Medicare fee schedule. For example, an orthopedic surgery group in Illinois billed a charge of $1,116/€825 for a knee MRI in 2007, but the Medicare reimbursement in 2007 was only $470.91/€350. Many insurance companies require advance approval of an MRI (...) procedure as a condition for coverage. In the US, the significantly reduced reimbursement rates paid by federal insurance programs for the equipment component of many scans, shifting the economic landscape. Many private insurers have followed suit. [ ] In the United States, an MRI of the brain with and without contrast billed to Medicare Part B entails, on average, a technical payment of US$403 /€300 and a separate payment to the radiologist of US$93 /€70. In France, the cost of an MRI exam

2012 Wikipedia

935. Piriformis syndrome (Full text)

is believed to result from compression of the around the . Symptoms may include pain and numbness in the and down the leg. Often symptoms are worsened with sitting or running. Causes may include trauma to the , spasms of the piriformis muscle, , or an . Few cases in athletics, however, have been described. Diagnosis is difficult as there is no definitive test. A number of physical exam maneuvers can be supportive. is typically normal. Other conditions that may present similarly include a . Treatment may (...) sciatica (radiating pain in the buttock, posterior thigh, and lower leg) and the physical exam finding of tenderness in the area of the sciatic notch. If the piriformis muscle can be located beneath the other gluteal muscles, it will feel noticeably cord-like and will be painful to compress or massage. The pain is exacerbated with any activity that causes flexion of the hip including lifting, prolonged sitting, or walking. The diagnosis is largely clinical and is one of . During a physical examination

2012 Wikipedia

936. Radiology

, the radiographer may specialize in one of the above-mentioned imaging modalities or have expanded roles in image reporting. Contents Diagnostic imaging modalities [ ] Main article: Projection (plain) radiography [ ] Main article: Radiography of the knee using a DR machine. of the knee. (originally called roentgenographs, named after the discoverer of , ) are produced by transmitting X-rays through a patient. The X-rays are projected through the body onto a detector; an image is formed based on which rays pass (...) used with CT for enhanced delineation of anatomy. Although radiographs provide higher spatial resolution, CT can detect more subtle variations in attenuation of X-rays (higher contrast resolution). CT exposes the patient to significantly more ionizing radiation than a radiograph. Spiral multidetector CT uses 16, 64, 254 or more detectors during continuous motion of the patient through the radiation beam to obtain fine detail images in a short exam time. With rapid administration of intravenous

2012 Wikipedia

937. Health care in Canada

a guaranteed right for First Nations due to the many treaties the government of Canada signed for access to First Nations lands and resources, the amount of coverage provided by the Federal government's program has diminished drastically for optometry, dentistry, and medicines. Status First Nations individuals qualify for a set number of visits to the optometrist and dentist, with a limited amount of coverage for glasses, eye exams, fillings, root canals, etc. For the most part, First Nations people use (...) . Canadians will be guaranteed timely access to healthcare in at least one of the following priority areas, prioritized by each province: cancer care, hip and knee replacement, cardiac care, diagnostic imaging, cataract surgeries or primary care. The current cultural shift towards evidence-based medicine is burgeoning in Canada with the advent of organizations like Choosing Wisely Canada. Organizations like this hope to encourage and facilitate doctor-patient communication, decreasing unnecessary care

2012 Wikipedia

938. Hip fracture

in the year following a fracture is about 20% in older people. Contents Signs and symptoms [ ] the affected extremity is often shortened and unnaturally, externally rotated compared to the unaffected leg The classic clinical presentation of a hip fracture is an elderly patient who sustained a low-energy fall and now has groin pain and is unable to bear weight. Pain may be referred to the supracondylar knee. On examination, the affected extremity is often shortened and unnaturally, externally rotated (...) fracture. Smoking (associated with osteoporosis). Mechanism [ ] X-ray of a normal hip joint. Functional anatomy [ ] The , an enarthrodial joint, can be described as a ball and socket joint. The femur connects at the of the pelvis and projects laterally before angling medially and inferiorly to form the knee. Although this joint has three , it is still stable due to the interaction of and . The lines the circumference of the to provide stability and shock absorption. Articular cartilage covers

2012 Wikipedia

939. Hip dysplasia (human) (Full text)

often been linked to traditions of infants, use of overly restrictive baby seats, carriers and other methods of transporting babies, or use of a which locks the hip joint in an "adducted" position (pulling the knees together tends to pull the heads of the femur bone out of the sockets or acetabulae) for extended periods. Modern swaddling techniques, such as the 'hip healthy swaddle' have been developed to relieve stress on hip joints caused by traditional swaddling methods. Further risk factors (...) include , gender, genetics (family history), and firstborns. In breech position the femoral head tends to get pushed out of the socket. A narrow uterus also facilitates hip joint dislocation during fetal development and birth. Diagnosis [ ] α and β angles used in hip ultrasound Hip ultrasound X-Ray Image showing hip dysplasia in a baby Most countries have standard newborn exams that include a hip joint exam for early detection of hip dysplasia. Sometimes during an exam a "click" or more precisely

2012 Wikipedia

940. Inferior vena cava filter (Full text)

(DVT). All patients were on anticoagulation drugs during the study. Results from the PREPIC study and other studies which have shown many long-term complications of IVC filters led to the introduction of retrievable IVC filters. The first retrievable IVC filters were approved by FDA in 2003 and 2004. In 2012, the recommended IVC filters for those with to who either have acute PE or acute proximal (above the knee) (DVT). Contents History [ ] The first IVC filter was created by who published his (...) designs, and developments in techniques mean that some filters can now be left in for prolonged periods and retrievals after a year are now being reported. This would include the ALN, Bard G2 and G2x, Option, Tulip and Celect filters. It is important to note that the clinical exam prior to the removal of the filter is vital in understanding both the risk and pathophysiological effects removing the filter will have on the patient. Doctors and medical professionals must consider several key factors (see

2012 Wikipedia

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