auscultation

* practical clinical skills
- vesicular .... crackles  ..... bronchophony .....

* easyauscultation.com

* lung auscultation (swf - Flash - Open in Mozilla!!!, (Meded, Cugell, )

* blaufuss.org (heart sounds, quiz) (use Mozilla, or Puffin browser in iOS, may need to allow flash

* heart auscultation (Ohio)

* lung auscultation () 

fundoscopy, eye,

fundoscopy - finding (Flash required, Ohio uni)

fundoscopic examination 

RHEUMATOLOGY

online zdroje pre reumatológiu
work in progress

CZ - Vyšetrenie končatín

EN - merck manual - professional - musculoskeletal diseases

EN - rheumatic disease patient - intro - exam (South Africa),
- concise text, includes, schemas, images

EN - physical examination - musculoskeletal system - series of videos - vyšetrenie v reumatológii
- GALS - gait, arms, legs, spine - SCREEN 
- VIDEOS:
- examination of musculoskeletal system  EULAR - online alebo videá na stiahnutie vpravo - mp4, wmv formats

Primer: history and examination in the assessment of musculoskeletal problems (Nature Clinical Practice Rheumatology (2008))

http://www.nature.com/nrrheum/journal/v4/n1/full/ncprheum0673.html

springer verlag - Rheumatology primer - DOWNLOAD chapter on EXAMINATION (pdf)
- history, exam,
- imaging,
- lab exams

image library in rheumatology - clinical images, imaging techniques (X-ray, CT ...)
- comprehensive resource on images in rheumatic diseases
- includes clinical images, imaging studies (X-ray, CT, MRI, USG)
- histology
http://images.rheumatology.org/

rheuma tutor - selected topics, classifications, dg criteria


Medscape - prezentácie, klinické a rtg
* can´t miss radiographic changes in rheumatologic diseases
* Cutaneous Clues to Accurately Diagnosing Rheumatologic Disease* SLE - 18 complications you need to know
* Rheumatoid arthritis - in and out of joint

text + obrázok - examination, inflammatory vs non-inflammatory pain

http://www.doctorshangout.com/page/rheumatology-musculoskeletal-system-physical-examination
http://www.doctorshangout.com/page/socrates-physical-examination
http://www.doctorshangout.com/page/differential-diagnosis-checklist-physical-examination

http://www.rheumatology.org/Learning-Center/Treatment-Guidelines
http://www.rheumatology.org/Learning-Center/Educational-Activities
http://www.rheumatology.org/Learning-Center/Educational-Activities/Rheumatology-Image-Library
http://www.hopkinsarthritis.org/wp-content/uploads/2011/04/Patient-History-Form.pdf

https://www.hss.edu/podcasts.asp#kneeexam
https://hss.classroom24-7.com/
https://www.google.sk/webhp?sourceid=chrome-instant&ion=1&espv=2&ie=UTF-8#q=rheumatology%20physical%20exam%20template
https://www.google.sk/webhp?sourceid=chrome-instant&ion=1&espv=2&ie=UTF-8#q=rheumatology+physical+examination+video&start=10
http://images.rheumatology.org/albums.php?albumId=75696&page=1

http://www.wikiskripta.eu/index.php/Vy%C5%A1et%C5%99en%C3%AD_pohyblivosti_p%C3%A1te%C5%99e

https://www.ucl.ac.uk/pcph/undergrad/cbt/year4/history-and-examination

musculoskeletal examination - orthopaedic surgeon
- low back pain
https://www.youtube.com/user/nabilebraheim/videos?shelf_id=3&view=0&sort=p
https://www.youtube.com/watch?v=zfWKcTixM6E
https://www.youtube.com/watch?v=HE0lk5MVFEg
http://www.physio-pedia.com/Trendelenburg_Gait

komorová tachykardia;CZ;SK;EN;case;širokokomplexové tachykardie;

širokokomplexové tachykardie - dif dg. - komorové tachykardie
dr Haman.
- algoritmus Brugada
- algoritmus aVR (Vereckel)

- NEJM case study
- young patient with syncope
- learning opportunities with interactive graphics.


diferenciálna diagnostika širokokomplexových tachykardií + možnosti liečby
- dr Kautzner -  IKEM
- úžasná, pokročilá, náročná arytmológia

CZ odporúčania-guidelines - komorové tachykardie (2005)
- tu všetky odporúčania CZ kardio

renal ultrasound;basics;images;radiology;CT

renal ultrasound; images
- sonoguide
---video right;  video left
- ultrasoundopaedia
- usg kidney/urinary bladder images
- emergency ultrasound lectures incl RENAL (28 min)
----
radiopaedia.org
-
- pyelonephritis
- urolithiasis

renal failure; obličkové zlyhanie; acute; chronic; SK;EN;

slide share:

ARI/ARF -
*Palevsky* - very instructive 67 slides
*Saxena* -  nice 90+slides

Maj Neal Das 47 slides

KDIGO - guidelines 2012 - advanced.

*CKD* - education program; important facts!, some charts, becoming obsolete (eg eGF MDRD now obsolete, preferred is eGF-CKD-EPI)

SK *** SK *** SK ***
SK *** SK *** SK ***

ARI/CHRI ***Uni Komenského*** akútne a chronické zlyhanie obličiek - handout (pdf) - SK
-9x6slidov

SK (niektoré prezentácie sú pre dialyzačné sestry, užitočné aj tak)

stránka by dr Polaščin - NEPHROSITE  - SK
- CHRONICKé OBLIčKOVé OCHORENIE - (KDIGO2012)
- dialyzačné intervencie u akútneho obličkového zlyhania/poškodenia (dr Polaščin 2013)
- lipidy u pacientov s CKD (KDIGO odporúčania)
- transplantácia obličky - 60slidov (dr Polaščin)
- peritoneálna dialýza (PD vs HD) 2010
- peritoneálna dialýza (2007 nižšia kvalita obrázkov)
- nephrosite - hlavne text 100 slidov, časť zle čitateľná


-----------
renal ultrasound basics
- sonoguide

head up tilt test; test na naklonenej rovine; HUT; vasovagal syncope

Head up tilt test; HUT

- video (BradfordHospitals)

- detailed explanation of HUT at Cleveland Clin

- Newcastle HUT protocols (paper)


vasovagal (neurocardiogenic) SYNCOPE (overview)

- family practice notebook - concise

- detailed article on SYNCOPE (emedicine)

2012 JACC: new concepts in assessment of syncope

2011 AAFP: syncope evaluation

2006 AHA guidelines on syncope evaluation

- syncope guidelines (Europe)
-- summary - take home message (2pages)  ( FULL detailed 40pp)

diagnosis:


from European guidelines 2009:

1. Syncope is a transient loss of consciousness (T-LOC) due to transient global 
 cerebral hypoperfusion characterized by
- rapid onset, 
- short duration, and 
- spontaneous complete recovery.

2. Syncope can be classified as 
- neurally-mediated (reflex syncope), 
- secondary to orthostatic hypotension or
- secondary to cardiac causes.

3. Reflex syncope traditionally refers to a heterogeneous group of conditions in which 
cardiovascular reflexes that are normally useful in controlling the circulation become 
intermittently inappropriate, in response to a trigger.

4. Orthostatic intolerance syndromes are a common cause of syncope in elderly 
population, and are usually secondary to autonomic failure, to the use of vasodilator 
drugs or to volume depletion. 

5. Arrhythmias are the most common cause of cardiac syncope, but structural 
cardiovascular disease can also cause syncope in some circumstances. 

6. There is a bimodal distribution of patient age on presentation: in adolescents 
and young adults a reflex mechanism is the most common and above the age of 65 a 
cardiac cause or orthostatic hypotension should be suspected. 

7. The initial evaluation after T-LOC consists of:
- a careful history, 
- physical examination, including orthostatic blood pressure measurements
- and electrocardiogram (ECG). 
- Based on these findings, simple additional examinations such as, carotid sinus
 massage, echocardiogram, ECG monitoring or orthostatic challenge can be indicated.

8. The initial evaluation can define the cause of syncope in 23-50% of patients and should 
 answer three key questions: 
- Is it a true syncopal episode or not?
- Has the aetiological diagnosis been determined?
- Are there findings suggestive of a high risk of cardiovascular events or death? 

9. Increased cardiac risk may be indicated by:
- severe structural or coronary heart disease,
- syncope on exertion or supine, 
- palpitations at the time of syncope, 
- family history of sudden cardiac death or non sustained ventricular tachycardia,
- abnormal ECG (see full text).
- Patients with high risk criteria require prompt hospitalization or intensive evaluation. 

10. In low risk patients the degree of investigation depends on the frequency of 
syncope and its impact on quality of life. In those low risk patients with T-LOC of 
unknown origin and frequent recurrences, either a strategy consisting on early implant 
of a loop recorder and wait for new T-LOC or to perform cardiac or neurally mediated 
tests, can be followed.

11. The principal goals of treatment for patients with syncope are to prolong survival, 
mainly by decreasing the risk of sudden cardiac death, limit physical injuries, and 
prevent recurrences. The importance and priority of these different goals depend on 
the cause of syncope. 

12. Evaluation of T-LOC should ideally be performed by Syncope Management Units:
The main objectives of such units are to provide state-of-the-art guideline-based 
assessment of symptomatic patients, in order to risk-stratify them, obtain an accurate 
aetiological diagnosis and assess prognosis.

atrial fibrillation video; guidelines

video overview of atrial fibrillation;

NEW 2014 discussion of guidelines updates on atrial fibrillation management (free registration)

2014 guidelines AFib treatment - US  (detailed)

2012 AFib management guidelines update - Europe (detailed)

EKG turorial of supraventricular tachycardias blaufuss.org (requires free installation of flash)

surgical procedures, operácie, ONLINE

http://www.orlive.com/videos

meducation.net

http://www.orlive.com/bethisrael/videos/the-ross-procedure-for-aortic-valve-replacement-

WPW syndrome and atrial fibrillation

Very instructive lecture on diagnosis and managment of presenting with atrial fibrillation and WPW.

Pacienti s WPW syndrómom, u ktorých sa vyvinie fibrilácia predsiení sú ohrození fibriláciou komôr, v dôsledku prítomnosti akcesórnej dráhy, ktorej tkanivo nie je schopné spomaliť, regulovať počet vzruchov prenesených na komory, ako je to v prípade AV uzla.

Je dôležité týchto pacientov správne rozpoznať, pretože liečba

excelentná prednáška vrátane mnohých záznamov ekg.
enjoy.

clinical education, video, clinical pearls

clinical pearls
klinické perly

video training
videá medicínskych zákrokov 

CARDIO, investigation, treatment, echocardiography, coronary angiography

transthoracic echocardiography (Ontario)
- visualization - anatomy, image
- ********

-------------------------------------------------


atlas of echocardiordiography (cardiac ultrasound), - Yale Uni
- includes US images of heart, categorized by view, pathology
- includes figures of anatomical structures,
- and echo videoclips as well as instructional animations !!!
- SK - echokardiografia, obrázky, videá, animácie, rozdelené podľa projekcií (aj transezofageálne!), a podľa patológie

coronary angiography - animations showing procedure of percutaneous coronary cathetrisation which is used to perform "gold statndard diagnostics" of coronary artery disease as well as for its treatment - percutaneous coronary interventions (balloon angioplasty, with\out placing of stent).
- animations are simplified
animation 1
animation 2

coronary angiography (romanian)
procedure + angiography
femoral access
youtube

radial access coronary angiography procedure (EN subtitles)

AV disociácia, ekg

http://ecg-interpretation.blogspot.sk/2011/05/ecg-interpretation-review-21-complete_10.html

AV dissociation - emedicine

pulmonary embolism

ECHO
http://lifeinthefastlane.com/2010/09/cardiovascular-curveball-011/


CTA in PE

PE treatment guidelines 2008
http://www.escardio.org/guidelines-surveys/esc-guidelines/Pages/acute-pulmonary-embolism.aspx

outpatient PE treatment
http://blog.ercast.org/2012/05/pulmonary-embolus-outpatient-treatment/

add images
ekg, xray, CTA, VP scan,

ocular findings, herbal intoxications

mydriasis
---------------------

atropa belladona - ľuľkovec zlomocný- spôsobuje mydriázu, tachykardiu, halucinácie .... , v dôsledku anticholeingergického/parasympatikolytického účinku...

http://sk.wikipedia.org/wiki/%C4%BDu%C4%BEkovec_zlomocn%C3%BD

angel s trumpet

http://www.nejm.org/doi/full/10.1056/NEJMicm1208053

--

Kayser-fleischer ring

http://www.nejm.org/doi/full/10.1056/NEJMicm1101534

--

endocrinological cases, images - NEJM

ectopic thyroid

http://www.nejm.org/doi/full/10.1056/NEJMicm1106077

---

insulin lipohypertrophy

http://www.nejm.org/doi/full/10.1056/NEJMicm1101527

---

neuropathic ulcer

http://www.nejm.org/doi/full/10.1056/NEJMicm0810905

---------------------

ectopic cushing

http://www.nejm.org/doi/full/10.1056/NEJMicm1010540

----

neurofibromatosis

http://www.nejm.org/doi/full/10.1056/NEJMicm1103859

------

amenorrhea, abdominal pain, 

http://www.nejm.org/doi/full/10.1056/NEJMicm1103447

-----------------

gynecomastia - antiandrogen in prostate ca

http://www.nejm.org/doi/full/10.1056/NEJMicm1209166

-------------------------------

hypocalcemia - physical signs

http://www.nejm.org/doi/full/10.1056/NEJMicm1110569

----

graves disease

http://www.nejm.org/doi/full/10.1056/NEJMicm1012081

-------

delayed graves ophtalmopathy

http://www.nejm.org/doi/full/10.1056/NEJMicm0809071

-------------------

gestational pituitary hemorrhage

http://www.nejm.org/doi/full/10.1056/NEJMicm0900500

-------

large prolactinoma

http://www.nejm.org/doi/full/10.1056/NEJMicm0906033

pituitary tumor program at UCLA - operation, lecture, case

UCLA resources:

- pituitary adenomas

- endoscopic operation of pituitary tumor

- YOUTUBE lecture on pituitary tumor treatment 


- 100 subjects inneurosurgery - itunes videos

- what to expect before/after pituitary surgery

checked - 20161005

- following links are down
transnasal endoscopic operation of pituitary tumor
LECTURES on pituitary tumors
endocrinology - pituitary CASE STUDIES

added 201710 

nice visualization, nice hospital

Endoscopic Transsphenoidal Pituitary Surgery - YouTube

▶ 8:46

https://www.youtube.com/watch?v=0upPEE63ZCg

Apr 12, 2016 - Uploaded by Ramandeep Virk

thrombocytopenia, low platelets, trombocytopénia

thrombocytopenia at ICU (intensive care unit)
http://asheducationbook.hematologylibrary.org/content/2010/1/135.full

cf NEJM case

cf nice review


medscape
merckmanual

clinical examination - medical history - useful forms

CLINICAL MEDICINE - intro  
--------------------------------------------------------------------

medical record
medical history
physical examination
step-by-step
patient-centered medicine I, II
-- read outline to get into context, than delve into depth, and review with outline

Intro


pdf:
http://www.meddean.luc.edu/lumen/MedEd/IPM/Ipm2/Forms/BasScrnHxOutline.pdf
http://www.meddean.luc.edu/lumen/MedEd/IPM/Ipm2/Forms/HxSmplWrt-Up.pdf
http://www.meddean.luc.edu/lumen/MedEd/IPM/Ipm2/Forms/BasScrnHxDETAILS.pdf

http://www.meddean.luc.edu/lumen/MedEd/IPM/Ipm2/Forms/BSE_laminated%20card.pdf
http://www.meddean.luc.edu/lumen/MedEd/IPM/Ipm2/Forms/BSEDetails.pdf


*** A MUST SEE ******** PHYSICAL EXAMINATION *****
loyola Uni - LUMEN- medical education - physical examination or here
physical examination by anatomic system 
-IMPORTANT-- within each section NOTE link at the bottom (method of exam, abnormal findings, knowledge, and self-eval)

http://www.meddean.luc.edu/lumen/meded/medicine/pulmonar/pdself/menu_f.htm

-----------------------------------------------------------------------------------------
from Charles Uni:
CLINICAL MEDICINE - intro
history taking, physical examination, incl. images, audio,
http://int-prop.lf2.cuni.cz/aindex.htm

 physical examination -
http://www.meddean.luc.edu/lumen/MedEd/MEDICINE/PULMONAR/PD/Contents.htm




----------------------------------------------------------------------------------------------------

****  CLINICAL MEDICINE - intro   *****

comprehensive source for studying clinical medicine -
history taking, physical examination, write-up

http://meded.ucsd.edu/clinicalmed/write.htm
see also introduction and individual chapters on exam. videos also included
----------------------------------------------------------------------------------------------------
---------------------------------------------------------------------------------------------------- 



Loyola Uni - Stritch School of Medicine - Patient Centered Medicine I, II 
BASICS OF clinical medicine.
-----------------------------------------------------------

clinical History data - basic outline (pdf)
clinical history - details  (pdf)

• Physical Exam Outline
• Physical Exam Details

auscultation, blood pressure measurement BASICS - VIDEOCAST (also otoscopy, ophtalmoscopy)  - from Loyla uni (for INTRODUCTION) (place to start)


History & Physical Exam:
< Basic Screening History Outline
< Basic Screening History Details

< Basic Screening PE Outline (Pocket Guide)
< Basic Screening PE Details

< Data Base:  History (Blank Form)
< Physical Exam Write-Up (Blank Form)


physical exam checklist (performance)



------------------------------
downloadable pdf/ppt of physical exam lectures (A.J. Chandrasekhar, M.D.)


videos of physical examination (on one site)




*************************************
TEST YOURSELF - QUIZZES:  *********
*************************************


self-evaluation ppts, quizzes  - select "self evaluation exercises" from menu
 Self Evaluation Exercises

http://www.meddean.luc.edu/lumen/meded/medicine/pulmonar/pdself/menu_f.htm 

cranial nerves examination

cranial nerve introduction - yoube EN
review of anatomy
CN I, II
CN V, VII

pupil examination

ophtalmology - tropias and phorias