Anatomy

This Song Helps to Distinguish between Upper and Lower Motor Neuron Signs.  

Video produced by St Georges University outlining the Abdominal examination  

Examination of the Thyroid Gland produced by St Georges University  

Rectal And Perianal Bleeding Ben Savage  

This is a podcast covering that oh-so-difficult topic of hernias. Specifically we shall look at: * Basic anatomy and terminology/definitions * Inguinal hernias * Femoral hernias * Incisional hernias * Umbilical/paraumbilical hernias * Rare types  

 

In this video podcast Mr Alaistair Pace demonstrates an effective technique for examination of the hands. Further video podcasts can be found at www.surgeryandmedicine.com  

This image displays a large left sided haemothorax with mediastinal displacement to the opposite side. Clinically the patient would be in respiratory distress - percussion of the left side of the chest would be dull and breath sounds and vocal resonance would be reduced. A Haemothorax such as this falls into the category of life threatening chest injuries (ATOMFC) and requires emergent treatment using a chest drain in the 5th intercostal space, mid-axillary line and treatment according to ALS or ATLS protocols. ATOMFC = A = airway obstruction, T = tension pneumothorax, O = open pneumothorax, M = massive haemothorax, F = flail chest, C = cardiac tamponade.  

Brain exploration and automatic testing  

This image is a contrast enhanced CT Scan of the abdomen. The contrast is sitting in the arterial system and displays the aorta. As we can see the aorta is grossly dilated and almost as large as the vertebral bodies showing that it is anueysmal. An aneurysm over 7cm wide has a 20% chance of rupture each year and if this happens the outcome is catastrophic  

This PA Chest X-Ray demonstrates a left sided pleural effusion. In this condition fluid collects between the parietal and visceral pleura and appears as a shadowy fluid level on the X-Ray with obliteration of the costophrenic angles. If you were to examine this patient they might be in respiratory distress from reduced oxygen uptake (so have low sats, high resp rate, possible cyanosis and accessory muscle useage) - they may have reduced chest expansion on the affected side and it would be stony dull to percussion. Fluid transmits sound poorly so breath sounds would be decreased as would vocal resonance/fremitus. Someone with consolidation may have very similar clinical findings but the underlying area of lung is almost solid due to pus from the infective process - as sounds travel well through solids they would have increased vocal fremitus which is how you can clinically differentiate between the two conditions. Clinical examination and understanding of conditions is paramount to practice effective medicine. Before you recieved this X-Ray you should be able to diagnose the condition and use the X-Ray to confirm your suspicions.  

Small bowel obstruction can be identified by the dilated loops of centrally placed bowel with the venae commitantes (circular bands of muscle) that span the entire width of the bowel as opposed to tenae coli in the large bowel which only span part of it.  

This image shows dilated loops of large bowel. It can be identified as large bowel because of the tenae coli which form bands that never cross the whole width of the bowel unlike the venae commitantes of small bowel  

In this Chest X-Ray we can identify a left sided pneumothorax - there is absence of lung markings in the periphery and we can also see a shadow which outlines the edge of the lung. A pneumothorax is caused when air enters the potential space between the viceral and parietal pleura and causes the lung to collapse down under the pressure of it's elsatic recoil. In this case it is likely that the pneumothorax has been caused by trauma as we can see air in the soft tissues on the left side (surgical emphysema - clinically feels like bubble wrap). A pneumothorax can be a life threatening condition. The patient presents in respiratory distress with decreased expansion on the affected side. There will be hyperresonance to percussion on that side but absent breath sounds. The emergency treatment is decompression with a large bore cannula in the 2nd intercostal space mid-clavicular line followed by insertion a chest drain in the 5th intercostal space mid-axilllary line  

This image shows a dislocated shoulder with a fracture through the surgical neck of humerus. The patient is at high risk of axillary nerve injury. The axillary nerve supplies deltoids but this is difficult to test in these conditions - luckily it also supplies an area of skin over the shoulder known as the regimental badge - this must be tested before and after any procedure involving the shoulder.  

In this video Mr Alaistair Pace demonstrates an effective technique for the examination of the elbow joint. Morecontent can be found on www.surgeryandmedicine.com  

In this video Miss Scammell demonstrates an effective technique for examination of the foot. More content can be found at www.surgeryandmedicine.com  

In this video Miss Scammell demonstrates an effective technique for hip examination. More content can be found at www.surgeryandmedicine.com  

In this video Miss Scammell Demonstrates how to examine the knee joint. More content can be found at www.surgeryandmedicine.com  

In this video Mr Alaistair Pace demonstrates an effective technique for examination of the shoulder joint. More content can be found at www.surgeryandmedicine.com