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Red Reflex

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61. Cataracts

or acquired), medications, or congenital problems. This topic mainly addresses acquired cataract. History and exam presence of risk factors subjective decrease in vision blurred or cloudy vision glare washed-out colour vision reduced visual acuity defects in the red reflex inadequate glasses prescription disruption in activities of daily living age >65 years smoking long-term UV exposure diabetes mellitus other metabolic or hereditary conditions eye trauma long-term ocular corticosteroid use FHx

2018 BMJ Best Practice

62. Assessment of gait disorders in children

., infection, tumours, child abuse). Appropriate evaluation requires an understanding and knowledge of normal and abnormal gait patterns, potential causes, and 'red flags'. Beresford MW, Cleary AG. Evaluation of a limping child. Curr Pediatr. 2005;15:15-22. The assessment of limp will depend on whether the presentation is acute or not. Kimura Y. Common presenting problems. In: Arthritis in children and adolescents: juvenile idiopathic arthritis. Szer I, Kimura Y, Malleson PN, et al (eds). Oxford: Oxford (...) , neurological, and developmental assessments. Foster HE, Cabral DA. Is musculoskeletal history and examination so different in paediatrics? Best Pract Res Clin Rheumatol. 2006;20:241-262. Further information about paediatric musculoskeletal medicine, including red flags, video demonstrations of joint examinations (pGALS, pREMS), investigations, and referral guidance, is available at Paediatric Musculoskeletal Medicine (PMM). Normal motor milestones [Figure caption and citation for the preceding image starts

2018 BMJ Best Practice

63. Vitamin B3 deficiency

, and dementia. Death results if the condition is untreated. History and exam presence of risk factors dermatitis insomnia, depression, or memory loss intermittent stupor hallucinations or delirium weakness peripheral neuropathy oppositional hypertonus or myoclonus cogwheel rigidity primitive reflexes ataxia nausea, vomiting, or diarrhoea glossitis, cheilitis, or stomatitis fatigue anxiety or paranoia anorexia, weight loss, or cachexia headache vertigo incontinence constipation heartburn angular palpebritis (...) biopsy photosensitivity testing FBC serum albumin serum protein LFTs gamma-GT serum total iron iron-binding capacity ferritin transketolase activity thiamine pyrophosphate (TPP) riboflavin coefficient serum pyridoxal-5-phosphate serum cyanocobalamin serum folic acid red cell folic acid stool examination neutral aminoaciduria serum serotonin platelet serotonin urinary 5-hydroxyindoleacetic acid HIV antibodies mental-state examination ECG Treatment algorithm ACUTE Contributors Authors Senior Research

2018 BMJ Best Practice

64. Optimisation of RIZIV – INAMI lump sums for incontinence

of neurological conditions such as different forms of paralysis, spina bifida, stroke, multiple sclerosis, motor neurone disease, but also diabetes. Patients can have UUI or dysfunction of sphincter(s) with or without FI. Neurological disorders affecting the brain, spinal cord, or the peripheral nervous system have FI due to impaired anal sphincter control, reduced or absent anorectal sensibility, or abnormal anorectal reflexes. Diabetic patients can have neuropathy of the anal canal or chronic diarrhoea (...) Faecal incontinence Faecal continence is a complex interaction of the internal anal sphincter muscle (IAS), the external anal sphincter muscle (EAS), the rectal smooth muscle, the puborectalis muscle, sensory nerve cells of the anal canal, and the anal sampling reflex. Any disturbance of the factors above can make a subject incontinent. FI is considered secondary when an underlying pathology can be demonstrated whereas primary FI is functional or idiopathic and without a pathology. Conditions

2019 Belgian Health Care Knowledge Centre

65. Proposals for a more effective antibiotic policy in Belgium

195 Figure 28 – Antibiotic policy 197 Figure 29 – Sensitisation campaigns 198 Figure 30 – Antibiotic prescription guidelines (human) 200 Figure 31 – Antibiotic prescription guidelines (veterinary) 201 Figure 32 – Practitioner expertise and reflexivity 204 Figure 33 – Ambulatory practitioner-patient relationship 206 Figure 34 – Market of antibiotics 208 Figure 35 – Veterinary sector autoregulation 210 Figure 36 – Farmers 213 Figure 37 – Livestock business model 1 215 Figure 38 – Livestock business

2019 Belgian Health Care Knowledge Centre

66. Major trauma: assessment and initial management

. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 5 of 23consider using a supraglottic device if the patient's airway reflexes are absent use basic airway manoeuvres and adjuncts if the patient's airway reflexes are present or supraglottic device placement is not possible transport the patient to a major trauma centre for RSI provided the journey time is 60 minutes or less only divert to a trauma unit for RSI before onward transfer if a patent airway (...) ) use a ratio of 1 unit of plasma to 1 unit of red blood cells to replace fluid volume. 1.5.25 For children (under 16s) use a ratio of 1 part plasma to 1 part red blood cells, and base the volume on the child's weight. Haemorrhage protocols in hospital settings Haemorrhage protocols in hospital settings 1.5.26 Hospital trusts should have specific major haemorrhage protocols for adults (16 or over) and children (under 16s). 1.5.27 For patients with active bleeding, start with a fixed-ratio protocol

2016 National Institute for Health and Clinical Excellence - Clinical Guidelines

67. CRACKCast E197 – Shock

to the process. [5] What is neurogenic shock, and how does it differ from spinal shock? Neurogenic shock = interrupted sympathetic and parasympathetic input from spinal cord to heart and vasculature. Classically – vasodilation and bradycardia (but can have a wide variation in heart rate depending on other factors). Spinal shock = loss of sensation and motor function following spinal cord injury. reflexes are depressed or absent distal to site of injury. This may last for hours to weeks post-injury. The end (...) of spinal shock is marked by the return of the bulbocavernosus reflex (internal/external anal sphincter contraction in response to squeezing the glans penis or clitoris, or tugging on an indwelling foley). Never checked one of them before. [6] What are the empirical criteria for the diagnosis of circulatory shock? (Box 6.2) Why do we care: ED patients presenting with shock often have no obvious cause. We need to key on key elements of the history/exam to make a diagnosis and start appropriate management

2019 CandiEM

68. New and emerging technologies in neurophysiology and operating theatres

Magnetic resonance imaging MRN Magnetic resonance neurography MS Multiple sclerosis MUNIX Motor Unit Number Index NCS Nerve-conduction studies NHMRC National Health and Medical Research Council NIBS Non-invasive brain stimulation NICE National Institute for Health and Care Excellence (UK) NIRS Near infra-red spectroscopy OSA Obstructive sleep apnoea OSET International) Organisation of Societies for Electrophysiological Technology 6 TECHNOLOGY IN NEUROPHYSIOLOGY AND OPERATING THEATRES | SAX INSTITUTE PA (...) enhanced visual displays of important clinical information — is also likely to become more widespread over the coming years. Non-invasive haemodynamic monitoring technology, to guide fluid management during surgery, appears to be a viable alternative to more invasive techniques. At least one device is commercially available. Based on the results of further trials, such devices may be more widely adopted over the next decade. There is increasing evidence that near infra-red spectroscopy (NIRS

2018 Sax Institute Evidence Check

69. Malignant Spinal Cord Compression

of sphincter control is a late sign with a poor prognosis. Cauda equina syndrome Compression of lumbosacral nerve roots below the level of the cord itself results in a different clinical picture. New, severe root pain affecting low back, buttocks, perineum, thighs, legs. Loss of sensation often with tingling or numbness in the saddle area. Leg weakness, often asymmetrical. Bladder, bowel and sexual dysfunction; occur earlier than in cord compression. Loss of anal reflex. Management Emergency referral (...) are also essential for further information). References Copyright © 2014 NHSScotland Last Updated: 10 Jul 2018 Created: 24 Apr 2014 Indicates this use is off licence Indicates this medication is associated with QT prolongation Colour codes: Red – For medicines normally initiated and used under specialist guidance Amber – For medicines normally initiated by a specialist but may be used by generalists Green – For medicines routinely initiated and used by generalists

2018 Scottish Palliative Care Guidelines

70. Spine imaging

. AIM Specialty Health. All Rights Reserved. 9 General prerequisites for spine imaging: ? Evidence of nerve root or cord compression – objective muscle weakness or sensory abnormality corresponding to a specific dermatome/myotome, reflex changes or spasticity ? Conservative management – a combination of strategies to reduce inflammation, alleviate pain, and improve function, including but not limited to the following: o Prescription strength anti-inflammatory medications and analgesics o Adjunctive (...) imaging is considered medically necessary in ANY of the following scenarios: ? Persistent pain not explained by radiograph and not responsive to a course of conservative therapy of at least 4 weeks duration ? Pain in children younger than age 5 ? Pain accompanied by any red flag features (see Table 1) Table1: Red flag features of low back pain IMAGING STUDY - CT or MRI lumbar spine - CT myelogram Rationale Low back pain (LBP) is currently the second most common cause of disability in the United States

2019 AIM Specialty Health

71. Head and neck imaging

Tumor/Soft Tissue Mass 12 Cholesteatoma 12 Neck mass 12 Parathyroid adenoma 13 Thyroid nodule or thyromegaly (goiter) 13 Tumor – not otherwise specified 14 Nasal Indications 14 Anosmia 14 Cerebrospinal fluid leak 14 Foreign body 14 Mucocele of the paranasal sinus 14 Nasal airway obstruction refractory to medical therapy 14 Nasal or sinus polyposis 14 Recurrent epistaxis 14 Orbital Indications 14 Absence of red reflex (pediatric only) 15 Dysconjugate gaze 15 Exophthalmos or proptosis 15 Extraocular (...) Mucocele of the paranasal sinus Nasal airway obstruction refractory to medical therapy Nasal or sinus polyposis Recurrent epistaxis IMAGING STUDY - CT paranasal sinuses and maxillofacial area Orbital Indications Advanced imaging is considered medically necessary for evaluation of ANY of the following conditions: Head and Neck Imaging Copyright © 2019. AIM Specialty Health. All Rights Reserved. 15 Absence of red reflex (pediatric only) Dysconjugate gaze Exophthalmos or proptosis Extraocular muscle

2019 AIM Specialty Health

72. Appropriate Use Criteria: Imaging of the Brain

for detection of posterior fossa strokes. 119, 121 Headache ADULT Advanced imaging is considered medically necessary in EITHER of the following scenarios: ? New headache o When associated with one or more red flag features (see Table 1) o Headache has not improved or has worsened during a course of physician-directed treatment, and the patient has been reevaluated by a clinician following completion of therapy ? Recurrent headache Imaging of the Brain Copyright © 2019. AIM Specialty Health. All Rights (...) Reserved. 22 o When associated with at least one red flag feature (see Table 1) and advanced imaging (CT or MRI) has not been performed to evaluate the headache o When CT or MRI has been performed to evaluate the headache, and a red flag feature has developed since the prior imaging study o Headaches are increasing in frequency and/or severity despite at least 4 weeks of physician- directed treatment and reevaluation by a clinician following completion of therapy IMAGING STUDY - CT or MRI - CTA or MRA

2019 AIM Specialty Health

73. Diphenhydramine

The purpose of this study is to evaluate the antitussive (cough-suppressing) effects of two liquid medications: a combination of diphenhydramine and phenylephrine in a naturally cocoa flavoring 2014 7. Inhibition of cough reflex sensitivity by diphenhydramine during acute viral respiratory tract infection 25673148 2015 04 27 2016 05 09 2017 02 20 2210-7711 37 3 2015 Jun International journal of clinical pharmacy Int J Clin Pharm Inhibition of cough reflex sensitivity by diphenhydramine during acute viral (...) respiratory tract infection. 471-4 10.1007/s11096-015-0081-8 Currently available over-the-counter cough remedies historically have been criticized for lack of scientific evidence supporting (...) their efficacy. Although the first-generation antihistamine diphenhydramine is classified as an antitussive by the United States Food and Drug Administration, to the authors' knowledge it has never been shown to inhibit cough reflex sensitivity in subjects with pathological cough. To evaluate the effect

2018 Trip Latest and Greatest

75. 34m with fever, headache and myalgias

hospitalized, they diagnosed him with a UTI. This was surprising, because we find out he doesn’t have any dysuria, any flank pain, any overt hematuria. And so I wondered is what the ER physicians actually saw a UA that had white cells and red blood cells on it. So I think thinking broadly about this positive UA and considering well, what reasons could there be for there to be cells in his urine besides a standard UTI was an important clue early on in the case. Sterile pyuria, meaning white cells (...) or lesions. There were no oropharyngeal lesions or cervical LAD. Heart and lung exam were unremarkable. His abdomen was soft and non-tender without any appreciable hepatosplenomegaly. Lower extremity strength, sensation, and reflexes were all within normal limits. CBC was notable for a WBC of 19,200 with 58% neutrophils and 5% bands, a Hgb of 12.4, and a Plt count of 62,000. BMP revealed a K of 3.3 and BUN/Cr of 73/1.6, respectively. LFTs were notable for total bilirubin of 21.2, direct bilirubin of 16.8

2019 Clinical Correlations

77. Global Vascular Guidelines for patients with chronic limb-threatening ischemia

, cardiovascular disease; HDL, high-density lipoprotein. ---- | ---- Fig 2.3 Association of risk factors with the level of atherosclerotic target lesions. The red overlay on the anatomic cartoon illustrates the association of risk factor with patterns of atherosclerotic disease. x 217 Reinecke, H., Unrath, M., Freisinger, E., Bunzemeier, H., Meyborg, M., Lüders, F. et al. Peripheral arterial disease and critical limb ischaemia: still poor outcomes and lack of guideline adherence. Eur Heart J . 2015 ; 36 : 932

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2019 Society for Vascular Surgery

78. Paediatric Urology

: 44. 45. Kaefer, M., et al. The incidence of intersexuality in children with cryptorchidism and hypospadias: stratification based on gonadal palpability and meatal position. J Urol, 1999. 162: 1003. 46. Kollin, C., et al. Cryptorchidism: a clinical perspective. Pediatr Endocrinol Rev, 2014. 11 Suppl 2: 240. 47. Caesar, R.E., et al. The incidence of the cremasteric reflex in normal boys. J Urol, 1994. 152: 779. 48. Barthold, J.S., et al. The epidemiology of congenital cryptorchidism, testicular (...) epididymitis in boys: evidence of a post-infectious etiology. J Urol, 2004. 171: 391. 151. Yerkes, E.B., et al. Management of perinatal torsion: today, tomorrow or never? J Urol, 2005. 174: 1579. 152. Boettcher, M., et al. Clinical and sonographic features predict testicular torsion in children: a prospective study. BJU Int, 2013. 112: 1201. 153. Nelson, C.P., et al. The cremasteric reflex: a useful but imperfect sign in testicular torsion. J Pediatr Surg, 2003. 38: 1248. 154. Mushtaq, I., et al

2019 European Association of Urology

80. Cardiorenal Syndrome: Classification, Pathophysiology, Diagnosis, and Treatment Strategies

. The cardiorenal neural reflexes initiating from the PA circulation or the RV have not been well delineated, and the elevated levels of natriuretic peptides seen with PA hypertension/RV dysfunction do not account for the sodium avid state seen in RV failure, albeit their negative prognostic significance. , Other mechanisms of the direct effect of RV dysfunction on renal hemodynamics include interventricular asynchrony and pericardium-mediated RV-LV interactions. This is a consequence of prolonged contraction

2019 American Heart Association

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