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  • Computerized Medicine Practical
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Electronic Book- A truly Interactive Electronic Book (TIEB) with companion :  Computerized Medicine Practical  370 pp.


I


 

 

 

 

 

 

Computerized Medicine Practical

An electronic doctor program and manual for the medical student

 

 

 

 

 

 Book 1: Clinical examination

 

 

 

 

Oluwole Ogunranti

Formerly Dean, Faculty of Medical Sciences

University of Jos Nigeria

 

 

 

 

 

 

 

 

Electronic School of Medicine [ESM] Publications

____________________________________________________

www.oluwoleogunranti.com


 

 

 

 

 

 

Computerized Medicine Practical

An electronic doctor program and manual for the medical student

 

 Book 1: Clinical examination

 

© Electronic School of Medicine Publication 2012

 

 

ISBN 978-2756-38-5

 

All Rights Reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise for sale, without the prior permission of ESM Publications.

 

Other related titles by ESM Publications by the same author

Computerized Practical Manuals

Computerized Neuroanatomy Practical

Computerized Surgery Practical

Computerized Medicine Practical

Computerized Obstetrics Practical

Computerized Gynecology Practical

Computerized Public Health Practical

Computerized Medicine Practical II: Electronic procedures etc


Other advanced books published by ESM by the same author

Degree Anatomy
Reproductive biology, Technology and Medicine
Recombinant DNA and Genetic Medicine

 

 

 

Printed by

Davworldprints -234-803-970-7008

 

 

  

PREFACE

                                                                                                                 

I became Dean of Medicine at the University of Jos at a very critical time in the history of the institution. Admissions were sky rocketing and accreditation bodies were demanding reduction in admissions. I had to find a way to ameliorate the situation quickly and I turned to information technology. I succeeded and the result of this success is this book.

 

Clinical medicine is a professional discipline which entails learning the art of clinical examination. This is one of the most difficult areas for the medical student and yet the most important in clinical practice of medicine. In the years when anatomy and physiology courses were robust, it was not very difficult. But in view of the contractions in these areas more and more anatomy and physiology have to be taught to the clinical student for him to appreciate the scientific basis of clinical practice and physical examinations at the bedside. This book is borne out of our interest to use modern tools to teach procedures in medicine so that individual student can learn the art with the aid of the modern microcomputer. For example, such methods like listening to fetal heart sounds, heart murmurs and crepitations were difficult art to learn in the past and requires the student to wait for good clinical cases before he/she can learn and to stay with the patient for a long period learning, thereby causing discomfort and more misery to the patient. It is no more the case for all a student needs to do is to use the electronic book at home to study clinical sounds. But more importantly, just listening to the sounds on the computer should not be enough. The sounds/clinical signs should be localised to particular areas of the patient’s anatomy in order for the learning process to be relevant to the needs of the clinical student. The Electronic Doctor program being used in this Electronic Book has such functionality with also computer aids to diagnosis which is a feature to be added in the near future. It is also able to localise sounds and vision at the most relevant sites of the electronic patient anatomy (it is the first known book to do so) and it contains considerable basic sciences for the student to understand the art of clinical examination. It has all known sounds in medicine ranging from normal to abnormal, joint crepitus, murmurs etc. It also mimics most known clinical signs. Clinical evaluations can be performed using the in-built eOSCE programme which allows short and long clinical cases to mimic as closely as possible patient-examination real situations. Also Electronic Patients are designed to mimic Electronic Diseases and disease processes. As in previous electronic texts, stupendous illustrations are provided and many modalities of image display are used in this electronic book. They include animations, scan, simulations, morphing, rollover alternate displays etc, to include audios and videos, to enable the learner to study in a modified environment which is learning friendly with well written learning objectives. It is supported by the resource base at the world wide web- Electronic School of Medicine, www.oluwoleogunranti.com with fully integrated facilities and links for all subjects of medicine.

 

This book is another of the TIEB (totally interactive electronic books) series under the Electronic School of Medicine Publications on the World Wide Web in which the hard book is the literature and the actual book is electronic (CD). It is mainly designed for self instructional learning but can also be used in a class room setting, e.g. a digital classroom, or clinical examination laboratory. Although the present book is written in the same style as other computerized manuals in Medicine, the student may not need to submit the workbook as assignment unless the instructor sees this fit. In many medical schools today clinical examination units are being built where students can use all sorts of models to learn clinical examination instead of patients, and some include computerised models which mimic clinical features of diseases (e.g. Yale robot). The present book is different although it has similar objective, in the sense that it contains a completely interactive program called Electronic Doctor which can be used by several students at the same time or as individual self instructional package (SIP) with electronic objective structured clinical evaluation (eOSCE) built into it, on a modern computer. It also contains long and short clinical cases which can mimic as closely as possible real patient and real clinic situations in real time. The actual book is the electronic version which contains lots of interactive materials which cannot be displayed on a hard book (such as heart sounds, videos etc) with access to materials that fill a whole Library of Medicine, with the hard book as literature and companion/revision and secondary to it. The electronic book contains mainly internet TIEB links. It also has a teacher’s page to guide the instructor.

 

Please read the ebook Computerized Living Anatomy Practical before using this book, if possible.

 

 

John Oluwole Ogunranti

Imperial College London

15 July 2011

 


 

 

 

 

CONTENTS

 

 

SECTION A

SECTION A- INTRODUCTION

 

     
     

Chapter 1

Introduction to Integrated Medicine

1

Chapter 2

History taking

3

Chapter 3

Introduction to Clinical Examination

4

Chapter 4

Vital signs

11

Chapter 5

General Examination

14

SECTION B

SECTION B- CLINICAL EXAMINATIONS

 

Chapter 6

Clinical Examination of Regions

18

Chapter 7

Clinical Examination of Organs

45

Chapter 8

Neurological Examination

90

Chapter 9

Specialized Clinical Examination

108

Chapter 10

Stethoscopy

116

SECTION C

CLINICAL FEATURES OF DISEASES

 

Chapter 11

Clinical Symptoms

134

Chapter 12

Clinical Signs

165

Chapter 13

Specialized Clinical Signs of Diseases

214

SECTION D

SECTION D- DISEASES AND SIGNS OF DISEASES

 

Chapter 14

Diseases of Organs

219

Chapter 15

Electronic Diagnosis

256

Chapter 16

Electronic Clinical cases

258

Chapter 17

Electronic Diseases

291

Chapter 18

Atlas of Electronic Spot Diagnoses

294

Chapter 19

Clinical Anatomy

301 

 

Teacher’s page

302

 

Useful Links

309

 

Index of Subjects

311 

 

Medical Dictionary

316

 

 

 

 


 

 

 

HOW TO USE THIS BOOK FOR ALL IT’S WORTH

 

GEP_IAS-Meet_28

 

You have just acquired a unique book which is also the first of its kind. It is a dream of a moving library in which information can be check out on a larger resource base as quickly as it is possible, which in this case is the World Wide Web. Do not USE THIS BOOK LIKE ANY OTHER OR READ IT THE WAY OTHER BOOKS ARE READ. It is an Electronic Book which means it is a book to be read or used on the computer. Open your CD/DVD and copy all the items into your computer in case the CD is lost. Then use the links on the computer and store your CD/DVD in a safe place.

 

Prelab

Your teacher may use the link on the Teacher’s page to introduce the Practical (Clinical) for the day by digital projection in the clinic/classroom.

 

Lab

The actual literature or hard book is meant for revision or, using the language of the Electronic School of Medicine, for postlab. For laboratory activity the actual Electronic Book should be used. In the classroom or clinic the electronic book must be hooked unto internet via a modem on a laptop or any other internet link. Then use the computer to perform instructions and answer all questions on the workbook. Each chapter is a single clinical schedule. Take time to check the links with other colleagues in a practical group of 2 or more other students. Electronic schedules on the internet are performed on simulated or electronic patients. It is preferable to have the real patient on the bed/trolley during the use of the book. The instructor then demonstrates the clinical schedule and ask each student to do likewise. After then students will open the electronic schedule. After the digital instructions the student is then free to use the book at home without the patient. Simply follow the instructions on the book and check all examinations on the links provided. Then tick the worklist for submission to the teacher/instructor.

 

During the period of your clinical class class try to open links that would make you as a group understand the clinical schedule you are performing, which will include links to images, videos, or audios, which are played to the hearing of everyone in your group.

 

Postlab

In the comfort of your own home you can perform postlab or revision. Again it is wise to begin with the Electronic Book itself. Check it out on internet and make sure it assists you in understanding the subject matter of the clinical. After then you can safely use only the literature for revision which will include studying your own labelled diagrams and/or comments together with the comments found in the book. You can perform quizzes after every chapter and these are themselves interactive or do revision here.

 

Images

Click all images to open their links

 

More

Check the link TIEBS on internet to obtain more information on what your Truly (or totally) Interactive Electronic Book you have just purchased can do for you.
 

 

 

 

 

 

 

 

SECTION A:

 

INTRODUCTION

TO CLINICAL EXAMINATION


 

 

 

 

1

Clinical examination   Clinical symptoms    Clinical signs  Spot diagnosis Museum      Chapter Quiz  Medical Dictionary    Clinical examination videos    Clinical demonstrations    Medical theory   Integrated specialties    High tech medicine    Electronic Doctor   Electronic diseases  Electronic Patient   Electronic Midwife   Electronic Surgeon   Clinical anatomy  Living anatomy   Surface anatomy       eOSCE (long cases, short cases)

Diseases: All diseases  700 common diseases  100 common diseases  Genetic diseases  Tropical diseases   All microbes pathogenetic to man    All parasites    Congenital anomalies

 

Introduction to Integrated Medicine
Psychomotor learning

 

Learning objective

Outline the steps involved in studying fully integrated medicine.

 

 

 

 

 

 

Integrated medicine

 

Integrated medicine involves the study of all subjects of medicine at every level, begining from cells, to tissues, to organs, systems and regions. In studying clinical examination it is very essential in evaluating a region of the human body which is being examined. Since every clinical examiner must place at the back of his/her mind background information when examining any part of the body, it is useful to keep all the relevant information of all subjects of medicine in reaching diagnosis of disease.

 

For example the picture of the right iliac fossa shows the appendix and cecum in this region. Examination of the area must take into consideration integration of the area which will include all structures in that region, their physiology and pathology etc. in addition to medicine, surgery, pharmacology and biochemistry. There are two types of integration; integration of organs and regions. Integration of organs is more comprehensive, involving all subjects of medicine which may number up to 20 or more. Regions have moderate integration involving clinical integration of trauma to the area, clinical anatomy and examination of the area which will include its medicine and surgery.

GLW_LX
Dissector                       Physiology
  
Lymphatic drainage    Biochemistry
  
Clinical anatomy       Pharmacology
  
Clinical examination            Imaging
  
Medicine
  
Surgery
  
Quiz
  
See body map medicaldico


 

 

 

Integrated medicine continued

 

In order to appreciate the study of clinical examination in this book, the knowledge, and ipso facto, links to the various subjects of medicine to examine regions and organs are provided. The integrated subjects are provided for each area under study for ease of reference to all subjects of the human body. This is the integrated approach to clinical examination. In the past it has been very difficult to teach integrated medicine because of the rigid departments. But with the use of hypertext pages as can be done in electronic approach which is the method used  in this electronic book, it is now very easy for the student of electronic medicine to learn in an integrated environment. Learning under clinical examination involves mainly psychomotor learning more than cognate-identification.

 

 

IPEM

 

IPEM1,2 simply means integrated procedural electronic medicine. In this kind of electronic medicine, emphasis is placed on learning medicine through procedures and through integration of subject matter so that every organ or system has integration of subjects from embryology in anatomy right down to physiology, pathology, medicine, surgery etc. The method of integration is through hypertexted pages via links and hyperlinks. Learning procedure is another emphasis on the IPEM method so that learning obviates rÔte through electronic learning which involves the use of animations, videos, and stupendous images to illustrate and simulate. To illustrate with anatomy, structures are digitally located stereoscopically by their depth and the body is electronically dissected; in histology the actual physiological process in a microenvironment of a tissue is animated and simulated and in embryology the process of development of an organ, cell or tissue is programmed and animated. Medical procedures are learnt in a virtual environment; clinical examination is performed using the mouse so that it becomes the stethoscope, palpating hand, percussion fingers etc. If you wish to know more about the principles of IPEM method please click this link for demonstration of IPEM in the clinical study of hepatology. It is found on the Electronic School of Medicine on the world Wide Web.

 

 

 


 

Clinical specialities

 

Specialties in medicine are best examined using integrated approach involving all subjects. Hence we have the following clinical specialties.

Andrology

Cardiology

 

Gastroenerology

Nephrology

Neuropsychiatry

Pancreatology

Pulmonology

Urology

Venerology

 

 

 

 

1. Ogunranti J.O (2008). Electronic Medicine and Medical Education. Journal of Medicine in the Tropics 10 (2): 3-7.
2. Ogunranti J.O (2009). Web based Integrated procedural electronic medicine (IPEM) and  medical education
.
Medical Teacher  31 (6) 562.

 


 

2

Clinical examination   Clinical symptoms    Clinical signs  Spot diagnosis Museum      Chapter Quiz  Medical Dictionary    Clinical examination videos    Clinical demonstrations    Medical theory   Integrated specialties    High tech medicine    Electronic Doctor   Electronic diseases  Electronic Patient   Electronic Midwife   Electronic Surgeon   Clinical anatomy  Living anatomy   Surface anatomy       eOSCE (long cases, short cases)

Diseases: All diseases  700 common diseases  100 common diseases  Genetic diseases  Tropical diseases   All microbes pathogenetic to man    All parasites    Congenital anomalies

 

 

History taking
Psychomotor learning

 

Learning objective

Outline the steps involved in obtaining history from a patient and list the categories of history.

 

 

History

 

Before physical or clinical examination, history must be obtained to establish symptoms of disease from the patient, or the lack of it. Obtaining information from the patient is called history. The history is very important in diagnosis of diseases for it details the process of disease formation and unravels what are called ‘symptoms’ as opposed to what the doctor elicits from clinical examination which are called ‘signs’. The different categories of history are as follows

·         Biodata

·         Presenting complaint

·         History of presenting complaint

·         Past History

·         Treatment history

·         Family History

·         Social history

·         Psychiatric history

 

 

Click all images to open     images and videos

 

Instructions: Is hypotension a symptom, sign or disease? Write down.

 

   
History of presenting complaint video Complete history  video

 

 

3

Clinical examination   Clinical symptoms    Clinical signs  Spot diagnosis Museum      Chapter Quiz  Medical Dictionary    Clinical examination videos    Clinical demonstrations    Medical theory   Integrated specialties    High tech medicine    Electronic Doctor   Electronic diseases  Electronic Patient   Electronic Midwife   Electronic Surgeon   Clinical anatomy  Living anatomy   Surface anatomy       eOSCE (long cases, short cases)

Diseases: All diseases  700 common diseases  100 common diseases  Genetic diseases  Tropical diseases   All microbes pathogenetic to man    All parasites    Congenital anomalies

 

 

Introduction to clinical examination
Psychomotor learning

 

Learning objective

Outline the steps involved in a simple clinical examination of a patient with the use of the quartet of inspection, palpation, percussion and auscultation.

 

 

 

babyanim

 

Examine all sides: the examiner always stands at the right bedside of the patient when examining

imageanim2

Electronic Patients

Anterior

89a

Right lateral

89clight

Posterior

89d

Left lateral

89e

 

 

GLW_LX
 
History taking  
 
Learn clinical examination  
 
Long cases  
 
Short cases   
 
Clinicopathological cases  
 
Female examination 
 
Electronic clinical demonstrations  
 
Electronic clinical conferences  
 
Electronic clinicopathological conferences  
 
Integrated Organ   
 
Heart    
 
Lung 
 
 
medicaldico

 

 

 

 

 

 

 

 

 

 

Instruction: Identify the marked structure on the picture

 

 

respiratoryrate20

Video 

 

Instructions: List all the quartet of examination modalities

 

4aa
Electronic Patients

 

 

Introduction

 

There are four main modalities of clinical examination which we may be called the quartet. They are inspection, palpation, percussion

and auscultation. The information obtained from these four modalities of examination will be collated for diagnosis at the end of the exercise. They provide the basis for the clinical signs elicited by the doctor.

3

 

 

 

 

 Inspection

Inspection is a special way by which doctors pick very obvious clinical signs. It is possible to see the left chest rising more than the right during quiet respiration and this may be all that would clinch a diagnosis of atelectasis. Also precordial movement, thrill, parasternal heave, etc suggestive of cardiomegaly can be picked by good inspection. Also skin lesions missed at general skin examination can be seen on special inspection.


Always examine on the right side of patient

 


 
Global Inspection Perineum female video          Layers of perineum links       Electronic dissector    Structure locator

eyemov                                           Video

Inspection is the most vital tool of physical examination. Nothing can be achieved without proper inspection of the patient. It involves looking and comparing with its opposite side to determine leanness, fullness, lesions, abnormal movement etc.

In hepatology there is a need to examine the right hypochondrium which houses the liver during inspection and relate it to the rising and falling of the chest during respiration.

 

Learn more about Inspection

 

Inspection  

 

Click the page to display integrated medicine of organs

 

eyemov

Eye inspector
 
Light inspector
 
Magnifier
 
Examiner's inspector

 

Dissection of chest

Clinical Inspection of chest video Thorax dissection video     Thorax-abdomen dissection video     Thorax dissector

 

 


Clinical Inspection of trunk

 Dissection of trunk
Trunk video        Full pelvis dissector         Pelvis locator

 
 
Clinical Inspection of abdomen

Dissection of trunk
Full female pelvis video    Pelvis layers  Female pelvis dissector   Female pelvis locator

 

 

 

Palpation

 

Palpation is a vital tool of examination. It elicits tenderness, consistency which determines nature of masses and organs; and heat. First palpate head and neck region and compare two sides to determine if any is cooler or hotter than the other. Then palpate the extremities.

Video

Instruction: What are the senses which palpation elicites?

 


 
Global Palpation Perineum female video          Layers of perineum links       Electronic dissector    Structure locator

 

Then palpate the chest- first precordium to determine if there is heave, thrill, whispering pectoriloquy and vocal or tactile fremiti. Then palpate the remaining part of chest. Go now to the abdomen and palpate the costal margin and then the abdomen proper (using the recognized regions) to feel for enlargement of organs such as hepatomegaly, splenomegaly or renal enlargement which requires bimanual examination.

To palpate is to feel. After inspection this is the second most important tool of physical examination. Feel each part of the body and determine its consistency (whether soft or hard) or tenderness  (if it elicits pain) and compare with the opposite side.

 

A mass can be evaluated as follows

What is its position in the abdomen? Is it from pelvis, or extend to costal margin or the pelvis?

What is its size, what is its character? Is it soft, cystic or hard? Is it movable or does it move with respiration?

Is it attached to the abdominal wall or any organ or does it remain on its own?

In hepatology there is a need to palpate the right hypochondrium to determine hepatic tenderness.

Learn more about palpation      

 

 

Palpation

 

Click to display anatomy of organs pages

Mouse palpator
Hand palpatoralpator

Organ-display palpator
 
Examiners' palpator

palpation

 

 
Clinical palpation of chest

Chest dissection
Thorax dissection video     Thorax-abdomen dissection video     Thorax dissector

 Thorax abdomen

 

 

 
Clinical palpation of precordium
 
Precordium palpation video
 

 
Palpation of abdomen

Dissection of female pelvis
Full female pelvis video    Pelvis layers  Female pelvis dissector   Female pelvis locator

 

 

Percussion

 

Percussion is like beating a drum. If the drum is empty the sound will be different from if it is filled. Percussion of the chest is always resonant because of air within the lungs except in areas which contain the liver (hepatic dullness) and the heart (cardiac dullness).

 

Video

Global Percussion Perineum female video          Layers of perineum links       Electronic dissector    Structure locator


 

Mouse percussor
Hand percussor
 
 Examiners' percussor

Percussion of the abdomen is always tympanitic. Other areas of the body are dull. Dullness is present in the chest in consolidation of lungs, but hyerresonant in pneumothorax. In the abdomen it is dull in ascites, but highly tympanitic in gaseous distension.

 

Percussion is the next most important tool for physical examination. When you percuss you are attempting to determine what is the underlying consistency or character of the area of percussion. Whereas palpation gives opinion about the surface, percussion provides information about the deep.

In hepatology there is a need to percuss the area of hepatic dullness to determine the extent of the liver which may begin from the nipple to the costal margin in normal situation. In this demonstration percussion note is dull over the liver up to the right flank from the right hypochondrium and the lower right chest. If the fullness passes below the costal margin then palpate the margin to feel for an enlarged liver called hepatomegaly in the patient.

 

Learn more about percussion  

 

 

 

Percussion Pathology  Display Page

 

Click to display pathology of organs pages

percssion

 

 

Dull

 

On percussion the entire body is dull except the chest which is resonant and the abdomen which is tympanitic. On the chest there are areas of cardiac dullness which represent the precordium and area of hepatic dullness which represent the extent of the liver. The chest is stony dull when there is consolidation of the lungs as in pneumonia and in pleural effusion.

Dullness is also found in lung collapse, consolidation, fibrosis and
thickening.  Resonance is the percussion note in the normal
chest
.

Demonstrate dullness with this link


 

Dull percussion video Full female pelvis video    Pelvis layers  Female pelvis dissector   Female pelvis locator

 

 

percssionbig

 

 

Resonance

 

 

Dullness is normally found in the liver area (called hepatic dullness) and the precordium called cardiac dullness.
In pleural effusion it causes stony dullness. Dullness is also found in
lung collapse, consolidation, fibrosis and
thickening.  Resonance is the percussion note in the normal
chest
.

 

Demonstrate resonance with this link

 

 

percssionbig

 

   
Resonant percussion video  

 

Hyperresonance

 

Hyper-resonance occurs in pneumothorax and hyperinflated lungs as in chronic obstructive pulmonary disease
 

 
Hyperesonance percussion video  

Demonstrate hyperresonance with this

link

percssion

Tympanitic

Roll

Tympanitic percussion note Full female pelvis video    Pelvis layers  Female pelvis dissector   Female pelvis locator

 

Dull percussion videoll Full female pelvis video    Pelvis layers  Female pelvis dissector   Female pelvis locator

 

 

 
Back video                    Back dissector                          Backlayers                  Back locators
Percussion/ of chest/back Back dissection video

 

 

   
Percussion of abdomen Dissection -locator of liver

 

Auscultation

 

Auscultation   is the art of listening to the body sounds with the aid of a stethoscope or a machine device. There are normal heart sounds and abnormal ones and there are also normal breath sounds which are said to be vesicular and abnormal ones.

 

To listen to breath sounds follow the same points of percussion in auscultation. To listen to heart sounds try to follow the areas where the valves of the heart can be best heard. Also note the surface anatomy of heart valves.

 

Mouse auscultator
Stethoscope auscultator
Examiner's auscultator
Stethoscopy

Video

examine2

Normal heart sound   consists of two sounds. -First heart sound and second heart sound. Both are best heard in the apex. The apex of the heart is usually at the left 5th intercostal space just medial to the midclavicular line.

 

Physiology of heart sounds


First heart sound is caused by the closure of the
tricuspid and mitral valves and normally lasts for 0.15 seconds with a frequency of about 25-45Hz. The second sound is shorter and lasts for 0.12 seconds with a frequency of about 50Hz. It is caused by closure of aortic and pulmonary valves at the end of ventricular systole. It may be split physiologically between the aortic and pulmonary valves. The events in the cardiac cycle show the first sound occurs at systole while the second comes at diastole.

 

 

Auscultation

 

Click to display physiology of organs pages

 

 

stethoscopeanim

 

 
Back video                    Back dissector                          Backlayers                  Back locators
Auscultation of back  

 

 

   
Auscultation of abdomen Full female pelvis

 

Instructions

 

Discuss the principles of inspection and the various methods for demonstrating electronic inspection

 

 

 

 

 

 

 

 

 

 

Discuss the principles of palpation  and the various methods for demonstrating electronic palpation

 

 

 

 

 

 

 

 

 

Discuss the principles of percussion and the various methods for demonstrating electronic percussion

 

 

 

 

 

 

 

 

 

Discuss the principles of auscultation and the various methods for demonstrating electronic auscultation

 

 

 

 

 

 

 


 

 


 

 

 

These books are provided on CDs/DVDs and also on internet for interactive learning. When their CDs are installed, they function either as internet TIEB or CD-ROM TIEB

 

 

Vital signs (learning)
   Temperature
   Pulse
   Respiration
   Blood pressure

General examination

Stethoscopy

Lung sounds

Ausculatory sound
  
Fine crepitations
  
Coarse crepitations
  
Tracheal sound
  
Bronchial sound
  
Whispering pectoriloquy
  
Egophony
  
Rhonchi
  
Inspiratory stridor
  
Vesicular breath sound
  
Vocal/tactile fremitus
  
Wheezes
  
Pleural friction rub

Breathing sounds
   Status asthmaticus
  
Kussmaul's breathing
  
Cheyne-Stokes respiration
  
Pulmonary edema

Cough

   Normal cough
  
Whooping cough
  
Croup

Heart sounds


   Normal heart sound
   Third heart sound
   Fourth heart sound
  
Aortic stenosis murmur
  
Midsystolic click
  
Ventricular septal defect
  
Aortic regurgitation
  
Carey Coombs murmur
  
Continuous murmur of patent ductus arteriosus
  
Early diastolic murmur
  
Late diastolic murmur
  
Mid diastolic murmur
  
Mitral regurgitation
  
Tricuspid regurgitation
   Austin Flint murmur
  
Mitral stenosis murmur
  
Midsystolic murmur (click)
  
Pansystolic murmur
  
Presystolic murmur
   Pulmonary regurgitation
   Atrial septal defect
   Graham Steell murmur

Fetal heart sound

Joint sound

Placenta/pregnancy sound

 

Revision for Electronic Medicine

History

 

Alcholism history video

Auscultation video

Blood pressure video

Commercial sex worker history video

Cor pulmonale history video

Cephalopelvic disproportion history video

Diabetes mellitus history video

General examination video

History video

Hypertension history video

Joint pain history video

Leopard skin history video

Sickle cell disease history video

Supracondylar fracture history video

 

Clinical examination of heart
   Inspection

   Palpation

   Percussion

   Auscultation

Regions of the abdomen

The regions are as follows right  and left hypochondriac, right and left lumbar, right and, left iliac fossae, paraumbilical, epigastric and hypogastric regions.

Full Clinical examination video

Inspection video

Palpation video

Percussion

Auscultation video

Ataxic gait video

Clinical examination 1 video

Clinical examination 2 video

Clinical examination of abdomen video

Clinical examination of adrenal gland video
Clinical examination of anus-rectum video
Clinical examination of appendix video

Clinical examination of brain (mental examination)
Clinical examination of breast video
Clinical examination of cervix video
Clinical examination of colon video
Clinical examination of ductus deferens video
Clinical examination of ear video
Clinical examination of epididymis video
Clinical examination of esophagus video
Clinical examination of eye video
Clinical examination of fallopian tube video
Clinical examination of gall bladder video

Clinical examination of heart inspection video

Clinical examination of heart palpation video

Clinical examination of heart percussion video

Clinical examination of heart auscultation video
Clinical examination of joint video
Clinical examination of kidney video
Clinical examination of liver video
Clinical examination of larynx video
Clinical examination of lung video
Clinical examination of lymph node video
Clinical examination of mouth video
Clinical examination of nose video
Clinical examination of pancreas video
Clinical examination of parathyroid gland video
Clinical examination of pelvis video
Clinical examination of penis-scrotum video
Clinical examination of pharynx video
Clinical examination of prostate gland video
Clinical examination of skin
Clinical examination of skeletal muscle
Clinical examination of spleen
Clinical examination of stomach
Clinical examination of thymus
Clinical examination of thyroid gland
Clinical examination of trachea
Clinical examination of ureter
Clinical examination of vagina
Clinical examination of uterus
Clinical examination of vulva

Intention tremor video

Rest tremor video
 

 

Reflexes

Cranial nerves

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Electronic Doctor

Electronic Surgeon

Electronic Midwife

 

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Degree Anatomy

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


History taking  
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Long cases  
Short cases   
Clinicopathological cases  
Female examination 
Electronic clinical demonstrations  
Electronic clinical conferences  
Electronic clinicopathological conferences  
Integrated Organ examination 
Heart sounds  
Lung sounds

 


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