China
Africa
Explore chapters and articles related to this topic
Medical Decision Making
Published in Pat Croskerry, Karen S. Cosby, Mark L. Graber, Hardeep Singh, Diagnosis, 2017
Aging but experienced mentors sometimes have to convince the cynical student that old-fashioned methods of physical examination still have merit and are worth the investment of time and effort. Exhortations about the importance of the physical examination may be heard resounding from the hallways and corridors of academic medical centers, such as: You can’t see what you don’t look for. You will never diagnose papilledema without a funduscopic exam.You aren’t inclined to look for what you don’t expect to see. If your clinical experience is limited you may never learn to recognize some of the occult manifestations of disease. Necrotizing fasciitis may be detected by palpating distant from the initial skin findings; the surprise soft crunch of soft tissue air may be felt before the erythema spreads. The presence of dilated vessels in the upper torso may provide the first clue of a superior vena cava syndrome, the finding of an underlying lung cancer. One of the thrilling parts of learning medicine is the unexpected clue, the recognition of its relevance to the matter at hand, and the delight in using and sharing the finding to “crack the case.” I still recall the delight of an intern who detected the low rumbling diastolic murmur of mitral stenosis that helped establish the diagnosis of endocarditis, a finding and diagnosis missed by all the other members of the more senior examining team. The finding likely saved the patient’s life.Success depends on the expertise and interest you bring to the exam. As described by Stanley and Campos, “sometimes even a minor detail—an inadvertent gesture; a change in voice or speech; the mood of a patient; a factor such as foreign travel … can lead the observer in a different direction for diagnosing” [19]. Those who minimize the value of the exam will likely never benefit from its value. Physical exam skills come from personal experience with patients and cannot be gained from sitting in the library reading a textbook. They are the gift patients give us to unlock their mystery.The absence of a finding is not necessarily proof of lack of disease. Many have witnessed firsthand the typical symptoms of zoster only to have the rash appear after the onset of pain, remote from the first exam. That fact can be acknowledged without undermining the argument to look for a rash and the willingness to revisit the exam on another day.The presence of a pathognomonic finding may be very specific for disease, and the presence of one cardinal finding may save unnecessary tests. A constellation of findings often provides very strong, if not conclusive, evidence of disease.
An experimental training support framework for eye fundus examination skill development
Published in Computer Methods in Biomechanics and Biomedical Engineering: Imaging & Visualization, 2019
Minh Nguyen, Alvaro Quevedo-Uribe, Bill Kapralos, Michael Jenkin, Kamen Kanev, Norman Jaimes
Papilledema (or papilloedema) refers to the swelling of the optic disc and is caused by increased intracranial pressure (see Figure 2(c)). The swelling is usually bilateral and is primarily seen as a symptom resulting from another pathophysiological process. If the condition is not treated properly, it can result in a loss of sight. During the eye fundus examination, the ocular findings may include: (i) disc swelling, (ii) venous engorgement, (iii) absent venous pulsation, (iv) hemorrhages around the optic disc, (v) elevation of the optic disc, and (vi) radial retinal lines.