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5
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PCU Think Tank 1 | 06 - Multimodality Therapy for High-Risk Disease

Multimodality Therapy for High-Risk Disease  
Dr Neil Love
over 9 years ago
6
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4

PCU Think Tank 1 | 06 - Treatment of Patients with Metastatic Disease

Treatment of Patients with Metastatic Disease  
Dr Neil Love
over 9 years ago
4
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POCB1 | Management of Breast Cancer

Patterns of Care in Medical Oncology – Management of Breast Cancer in the Adjuvant and Metastatic Settings: Adjuvant Endocrine Therapy, Adjuvant Chemotherapy, Systemic Therapy for Metastatic Disease  
Dr Neil Love
over 9 years ago
11
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12

VPB2 2009 | Case 5

ResearchToPractice.com/VPB209 - Case 5: A woman diagnosed nine years ago at the age of 42 with a 9-cm, ER-positive, PR-positive, HER2-positive IDC who has received multiple lines of therapy for metastatic disease. Interviews conducted by Neil Love, MD. Produced by Research To Practice.  
Dr Neil Love
over 9 years ago
4
1
9

VPL1 2009 | Case 2

ResearchToPractice.com/VPL109 – Case 2: A 53-year-old man with adenocarcinoma and metastatic disease to the skull who received radiation therapy followed by carboplatin/docetaxel/bevacizumab and maintenance bevacizumab. Interviews conducted by Neil Love, MD. Produced by Research To Practice.  
Dr Neil Love
over 9 years ago
9
1
10

VPB1 2009 | Case 09

ResearchToPractice.com/VP/Breast – 53yo w/7.5-cm, multi node+/ER+/PR-/HER2+ BC w/lymphatic invasion and residual disease after mastectomy. Moderated by Neil Love, MD. Produced by Research To Practice.  
Dr Neil Love
over 9 years ago
29749
7
375

Cranial Nerve Examination - Abnormal

Cranial Nerve 1- Olfaction This patient has difficulty identifying the smells presented. Loss of smell is anosmia. The most common cause is a cold (as in this patient) or nasal allergies. Other causes include trauma or a meningioma affecting the olfactory tracts. Anosmia is also seen in Kallman syndrome because of agenesis of the olfactory bulbs. Cranial Nerve 2- Visual acuity This patientâs visual acuity is being tested with a Rosenbaum chart. First the left eye is tested, then the right eye. He is tested with his glasses on so this represents corrected visual acuity. He has 20/70 vision in the left eye and 20/40 in the right. His decreased visual acuity is from optic nerve damage. Cranial Nerve II- Visual field The patient's visual fields are being tested with gross confrontation. A right sided visual field deficit for both eyes is shown. This is a right hemianopia from a lesion behind the optic chiasm involving the left optic tract, radiation or striate cortex. Cranial Nerve II- Fundoscopy The first photograph is of a fundus showing papilledema. The findings of papilledema include 1. Loss of venous pulsation 2. Swelling of the optic nerve head so there is loss of the disc margin 3. Venous engorgement 4. Disc hyperemi 5. Loss of the physiologic cup an 6. Flame shaped hemorrhages. This photograph shows all the signs except the hemorrhages and loss of venous pulsations. The second photograph shows optic atrophy, which is pallor of the optic disc resulting form damage to the optic nerve from pressure, ischemia, or demyelination. Images Courtesy Dr. Kathleen Digre, University of Uta Cranial Nerves 2 & 3- Pupillary Light Refle The swinging flashlight test is used to show a relative afferent pupillary defect or a Marcus Gunn pupil of the left eye. The left eye has perceived less light stimulus (a defect in the sensory or afferent pathway) then the opposite eye so the pupil dilates with the same light stimulus that caused constriction when the normal eye was stimulated. Video Courtesy of Dr.Daniel Jacobson, Marshfield Clini and Dr. Kathleen Digre, University of Uta Cranial Nerves 3, 4 & 6- Inspection & Ocular Alignmen This patient with ocular myasthenia gravis has bilateral ptosis, left greater than right. There is also ocular misalignment because of weakness of the eye muscles especially of the left eye. Note the reflection of the light source doesn't fall on the same location of each eyeball. Video Courtesy of Dr.Daniel Jacobson, Marshfield Clini and Dr. Kathleen Digre, University of Uta Cranial Nerves 3, 4 & 6- Versions • The first patient shown has incomplete abduction of her left eye from a 6th nerve palsy. • The second patient has a left 3rd nerve palsy resulting in ptosis, dilated pupil, limited adduction, elevation, and depression of the left eye. Second Video Courtesy of Dr.Daniel Jacobson, Marshfield Clini and Dr. Kathleen Digre, University of Uta Cranial Nerves 3, 4 & 6- Duction Each eye is examined with the other covered (this is called ductions). The patient is unable to adduct either the left or the right eye. If you watch closely you can see nystagmus upon abduction of each eye. When both eyes are tested together (testing versions) you can see the bilateral adduction defect with nystagmus of the abducting eye. This is bilateral internuclear ophthalmoplegia often caused by a demyelinating lesion effecting the MLF bilaterally. The adduction defect occurs because there is disruption of the MLF (internuclear) connections between the abducens nucleus and the lower motor neurons in the oculomotor nucleus that innervate the medial rectus muscle. Saccades Smooth Pursui The patient shown has progressive supranuclear palsy. As part of this disease there is disruption of fixation by square wave jerks and impairment of smooth pursuit movements. Saccadic eye movements are also impaired. Although not shown in this video, vertical saccadic eye movements are usually the initial deficit in this disorder. Video Courtesy of Dr.Daniel Jacobson, Marshfield Clini and Dr. Kathleen Digre, University of Utah Optokinetic Nystagmu This patient has poor optokinetic nystagmus when the tape is moved to the right or left. The patient lacks the input from the parietal-occipital gaze centers to initiate smooth pursuit movements therefore her visual tracking of the objects on the tape is inconsistent and erratic. Patients who have a lesion of the parietal-occipital gaze center will have absent optokinetic nystagmus when the tape is moved toward the side of the lesion. Vestibulo-ocular refle The vestibulo-ocular reflex should be present in a comatose patient with intact brainstem function. This is called intact "Doll’s eyes" because in the old fashion dolls the eyes were weighted with lead so when the head was turned one way the eyes turned in the opposite direction. Absent "Doll’s eyes" or vestibulo-ocular reflex indicates brainstem dysfunction at the midbrain-pontine level. Vergenc Light-near dissociation occurs when the pupils don't react to light but constrict with convergence as part of the near reflex. This is what happens in the Argyll-Robertson pupil (usually seen with neurosyphilis) where there is a pretectal lesion affecting the retinomesencephalic afferents controlling the light reflex but sparing the occipitomesencephalic pathways for the near reflex. Video Courtesy of Dr.Daniel Jacobson, Marshfield Clini and Dr. Kathleen Digre, University of Uta Cranial Nerve 5- Sensor There is a sensory deficit for both light touch and pain on the left side of the face for all divisions of the 5th nerve. Note that the deficit is first recognized just to the left of the midline and not exactly at the midline. Patients with psychogenic sensory loss often identify the sensory change as beginning right at the midline. Cranial Nerves 5 & 7 - Corneal refle A patient with an absent corneal reflex either has a CN 5 sensory deficit or a CN 7 motor deficit. The corneal reflex is particularly helpful in assessing brainstem function in the unconscious patient. An absent corneal reflex in this setting would indicate brainstem dysfunction. Cranial Nerve 5- Motor • The first patient shown has weakness of the pterygoids and the jaw deviates towards the side of the weakness. • The second patient shown has a positive jaw jerk which indicates an upper motor lesion affecting the 5th cranial nerve. First Video Courtesy of Alejandro Stern, Stern Foundation Cranial Nerve 7- Motor • The first patient has weakness of all the muscles of facial expression on the right side of the face indicating a lesion of the facial nucleus or the peripheral 7th nerve. • The second patient has weakness of the lower half of his left face including the orbicularis oculi muscle but sparing the forehead. This is consistent with a central 7th or upper motor neuron lesion. Video Courtesy of Alejandro Stern, Stern Foundatio Cranial Nerve 7- Sensory, Tast The patient has difficulty correctly identifying taste on the right side of the tongue indicating a lesion of the sensory limb of the 7th nerve. Cranial Nerve 8- Auditory Acuity, Weber & Rinne Test This patient has decreased hearing acuity of the right ear. The Weber test lateralizes to the right ear and bone conduction is greater than air conduction on the right. He has a conductive hearing loss. Cranial Nerve 8- Vestibula Patients with vestibular disease typically complain of vertigo – the illusion of a spinning movement. Nystagmus is the principle finding in vestibular disease. It is horizontal and torsional with the slow phase of the nystagmus toward the abnormal side in peripheral vestibular nerve disease. Visual fixation can suppress the nystagmus. In central causes of vertigo (located in the brainstem) the nystagmus can be horizontal, upbeat, downbeat, or torsional and is not suppressed by visual fixation. Cranial Nerve 9 & 10- Moto When the patient says "ah" there is excessive nasal air escape. The palate elevates more on the left side and the uvula deviates toward the left side because the right side is weak. This patient has a deficit of the right 9th & 10th cranial nerves. Video Courtesy of Alejandro Stern, Stern Foundatio Cranial Nerve 9 & 10- Sensory and Motor: Gag Refle Using a tongue blade, the left side of the patient's palate is touched which results in a gag reflex with the left side of the palate elevating more then the right and the uvula deviating to the left consistent with a right CN 9 & 10 deficit. Video Courtesy of Alejandro Stern, Stern Foundation Cranial Nerve 11- Moto When the patient contracts the muscles of the neck the left sternocleidomastoid muscle is easily seen but the right is absent. Looking at the back of the patient, the left trapezius muscle is outlined and present but the right is atrophic and hard to identify. These findings indicate a lesion of the right 11th cranial nerve. Video Courtesy of Alejandro Stern, Stern Foundation Cranial Nerve 12- Moto Notice the atrophy and fasciculation of the right side of this patient's tongue. The tongue deviates to the right as well because of weakness of the right intrinsic tongue muscles. These findings are present because of a lesion of the right 12th cranial nerve.  
Neurologic Exam
almost 9 years ago
Preview
8
155

Genetic epidemiology

1. Introductory lecture in genetic epidemiology for second year (pre-clinical) medical students. 2. Computer-aided learning exercises on genetics of common disease and their place in clinical practice  
Daniel Swerdlow
over 8 years ago
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8
182

Stroke & Balint's syndrome

The presentation given to my tutorial group for my second year dissertation on types of stroke and the interesting resulting effects on visual perception.  
Daniel Sapier
over 8 years ago
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41

Maternal preconception and gender selection

Maternal preconception and gender selection has long been a controversial topic. Are you more likely to conceive a boy if you eat red meat, and a girl if you make love under a full moon? Oldwives tales and fantasies exploring sexual position, diet, and dominance circulate the Internet however how can we logically distinguish between fact and fiction? The topic has widespread cultural implications. Sex-related abortions are on the increase in China and India where local customs and religious virtues appear to strongly correlate with the systematic elimination of girls. In an effort to challenge the dogma of chance fertilization two main research streams have explored variations in maternal condition and gender conception. The ‘Maternal Dominance’ hypothesis has suggested trait dominance, underpinned by serum testosterone, correlates with increased male conception rates. The second, ‘Maternal condition’ hypothesis relates to pre-conceptual maternal diet, investigating variations in both quantity and quality of diet and effects on sex ratios. However such assumptions have been difficult to replicate and more recent evidence has suggested changes in maternal condition may have a stronger influence Maternal adaptations in behavior appear to closely correlate with biased gender ratios and can have wider connotations on sex-linked disease inheritance. However unless we can identify molecular mechanisms influencing the intrauterine environment and follicular development, hypothesis will remain mere assumptions.  
Langhit Kurar
over 8 years ago
30083o
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18

Pathology of the Small Intestine

An audio podcast discussing the pathology of the small intestine. This includes a discussion on obstruction, infections diseases and inflammatory disorders such as Crohn's and coeliac disease.  
Podmedics
about 8 years ago
30085
4
153

Upper GI Pathology

Video tutorial outlining upper gastrointestinal disease affecting the oesophagus and stomach. Oesophageal disease processes discussed include gastroesophageal reflux, hiatus hernia, peptic stricture, Barrett's oesophagus, oesophageal carcinoma and achalasia. Disease processes affecting the stomach include gastritis, peptic ulcer disease and gastric lymphoma.  
Podmedics
about 8 years ago
30092o
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21

Hyperuricaemia

Audio podcast on hyperuricaemia. This podcasts covers urate metabolism, aetiology and diseases associated with hyperuricaemia.  
Podmedics
about 8 years ago
30107
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286

Mneumonics/Acronyms for Population Health and Evidence-Based Practice

Some easy methods to remember: - the definition of 'Epidemiology' and 'Public Health'. - what are Primary, Secondary, and Tertiary disease prevention. - the Bradford-Hill criteria for disease causation.  
David Jones
about 8 years ago
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2
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Breast Examination

 INSPECTION - of breast and nipples  EXAMINATION (palpation) - of breast, nipples & local lymph nodes  GENERAL EXAMINATION - for disseminated disease › Abdo…  
Anisha Sukha
about 8 years ago
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18
868

Respiratory disease symptoms

This document lists the symptoms of all the respiratory disease I came across in the rspiratory module in my first year of medical school.  
Lucy Faulkner
over 7 years ago
Preview 300x421
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2220

Blood groups and Haemolytic Disease of the Newborn

A poster detailing Rhesus and ABO blood systems, and a brief outline of Haemolytic Disease of the Newborn.  
Thomas Lemon
over 7 years ago
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No Title

revIse: Medicine Through Imagination Topic: Parkinson’s disease Format: Short story Short story used to illustrate the signs and symptoms of Parkinson’s diseas…  
Hibba Kurdi
over 7 years ago
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1001

Short guide to respiratory medicine

Short guide detailing diseases of the respiratory system.  
John Ferns
about 7 years ago
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4
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Clinical Manifestation of Disease

common manifestation of medical disease; tremor, cerebellar sign, dupuytren contracture, palmar erythema, clubbing and horner's syndrome  
malek ahmad
about 7 years ago