Discover and read the best of Twitter Threads about #PhysicalExam
Most recents (10)
Landolfi’s sign #Cardiotwitter
#Concussion Week! 🧵
Our first goals – review symptoms and accurate diagnosis.
Make sure to view the whole thread for some great videos to enhance your physical exam!
Symptoms:
Concussion symptoms can be grouped into 4 areas:
- Physical
-Sleep
-Cognitive
-Emotional
Our first goals – review symptoms and accurate diagnosis.
Make sure to view the whole thread for some great videos to enhance your physical exam!
Symptoms:
Concussion symptoms can be grouped into 4 areas:
- Physical
-Sleep
-Cognitive
-Emotional
Symptom Review
Physical: HA, n/v, dizziness, balance and vision problems, photo/phonophobia
Sleep: Difficulty falling/staying asleep, sleeping more
Cognitive: Difficulty concentrating, remembering, feeling slow and foggy
Emotional: irritability, anxiety, depression, mood changes
Physical: HA, n/v, dizziness, balance and vision problems, photo/phonophobia
Sleep: Difficulty falling/staying asleep, sleeping more
Cognitive: Difficulty concentrating, remembering, feeling slow and foggy
Emotional: irritability, anxiety, depression, mood changes
Any robust diagnosis is supported by the physical exam. In #concussion, vestibular testing is critical . One battery is the visio-vestibular exam (VVE). VVE is reliable from the #ED and accurately distinguishes concussed v. non-concussed.
pubmed.ncbi.nlm.nih.gov/32745919/
pubmed.ncbi.nlm.nih.gov/32745919/
OK #VExUS #POCUS enthusiasts, time for another case discussion.
Somebody asked if I ever recommend IV fluid in a patient with #VExUS 3.
Here is one example where I did.
1/ First, let's see the #physicalexam (#IMPOCUS) findings, then will tell about the case. #MedEd #Nephrology
Somebody asked if I ever recommend IV fluid in a patient with #VExUS 3.
Here is one example where I did.
1/ First, let's see the #physicalexam (#IMPOCUS) findings, then will tell about the case. #MedEd #Nephrology
A valvular lesion can be diagnosed right here at the bedside. Based on the nature of the pulse, is it tricuspid regurgitation or aortic regurgitation? And why?
#PhysicalExam #MedEd #MedTwitter #cardiotwitter
#PhysicalExam #MedEd #MedTwitter #cardiotwitter
This is a case of aortic regurgitation with Corrigan's pulse. The most striking feature of this pulse is outward. Quick and sharp. Relatively small breadth. There is only passive retraction back to baseline - no active inward movement. These are the features of an arterial pulse.
Compare the arterial pulse in the video above with the venous pulse in the following video of Lancisi's sign (CV fusion). Here the movement is undulating, large breadth, and there is an active inward component. You can and will distinguish venous from arterial at the bedside.
(1/9) #Physicalexam #Tweetorial @VCU_IMRes Cardiac auscultation is all about identifying normal from abnormal sounds. Like any skill this takes practice. In 1904 Dr Charles W. Larned published how to “mimic” heart sounds
Here is how to practice without a patient or even a heart!
Here is how to practice without a patient or even a heart!
(2/9) Set Up: While listening to your stethoscope, take the diaphragm in the palm of your hand and grasp it firmly
The following runs through how to make some basic cardiac sounds. Sounds where recorded with @thinklabs electronic stethoscope – no hearts used! #meded #medtwitter
The following runs through how to make some basic cardiac sounds. Sounds where recorded with @thinklabs electronic stethoscope – no hearts used! #meded #medtwitter
(3/9) Normal Heart sound: Tap a simple One-Two tap with the first and second fingers – you just made S1 & S2! @audreyBJernigan @chrisyoungmd @DrJaredDyer @JCHillyard @kywaybill @TedRader4MD @fsmalick @Stern_bergler @RabiaQaiser3
(1/8) #PhysicalExam #tweetorial
60 y/o hx of seizures & cirrhosis presenting after seizure & found to have distended abdominal wall veins. What is the cause? @VCU_IMRes @bedsidemedicine @StanfordMed25 @NateWarnerMD @AndreMansoor @PresRCPEdin (Consent was obtained per protocol)
60 y/o hx of seizures & cirrhosis presenting after seizure & found to have distended abdominal wall veins. What is the cause? @VCU_IMRes @bedsidemedicine @StanfordMed25 @NateWarnerMD @AndreMansoor @PresRCPEdin (Consent was obtained per protocol)
(2/8) Bonus: what are the physical exam clues of cirrhosis? Any present here? @liverprof @scall1200 @rvawellmd @cderekleiner @michellebr00ks @medrants @CPSolvers @rabihmgeha @DxRxEdu @eozdalga @jackpenner @cjchiu @thecurbsiders @PaulNWilliamz @mia_bahagry
(3/8) Pay Attention to the direction of Venous Flow -> may suggest site of venous obstruction
JAMA Rational Clinical Examination outlines the technique - venous flow is the direction of most rapid refilling. @JAMAInternalMed @ehlJAMA @DavidLSimel #rationalclinicalexam
JAMA Rational Clinical Examination outlines the technique - venous flow is the direction of most rapid refilling. @JAMAInternalMed @ehlJAMA @DavidLSimel #rationalclinicalexam
A 70 y/o man presents with new exertional dyspnea, orthopnea/PND, wide pulse pressure (~100 mm Hg), and elevated JVP. A physical finding is identified (video). Echo: preserved systolic function, no valvular disease. Thoughts? What would you do next? #PhysicalExam #cardiotwitter
Incredible discussion. Like many here I questioned the echo. Then realized Quincke's pulse = high-output state (not always AR). Sent for RHC to confirm high-output HF. Sure enough, CO was 12.5 L/min (CI 4.8 L/min/m2). Workup for cause underway. #PhysicalExam led to diagnosis.
Physical exam was pivotal in this case. Without it, most of us would have concluded that this was "just another case of diastolic heart failure" and stopped there. Without seeing Quincke's pulse, there is no question that I would have unknowingly marched down the wrong path.
50yo F p/w acute onset fever, diarrhea. On exam is hypotensive and mildly confused. Sx started 2 days after return from Zambia. No malaria ppx. Smear w/ 30% P falciparum parasitemia. MICU concerned for cerebral malaria (CM). How can we confirm on #PhysicalExam ?#IDConsults
Cerebral malaria is defined by WHO as coma with peripheral parasitemia after other causes ruled out. In endemic regions this predominantly affects young kids due to immunologic naivety. Unfortunately, this defn is nonspecific as 40-70% of asymptomatic ppl may be parasitemic 2/
Pathophys of cerebral malaria is related to sequestration of parasitized RBCs in the CNS blood vessels...thanks to Hermann von Helmholtz’s invention of the ophthalmoscope in 1851 (with just a few updates from the original), we have a window to the vasculature of the CNS! 3/
42yo with nasopharyngeal CA (in remission) s/p chemo/rad presents with 3 months of progressive posterior head/neck pain, and slurred speech. On PE, you notice the following. What are you seeing? What’s your ddx? (consent obtained). #PhysicalExam #IDConsults 1/
In this video, you see right sided atrophy, right sided deviation, and fasiculations R>L, indicating a peripheral 12th nerve palsy. He also had some slurred speech. Remainder of neuro exam WNL. Remember: atrophy and fasiculations = LMN process! 2/
This patient had difficulty with certain sounds and with slurring words. Dysarthria means a difficulty producing speech: cranial nerves VII, IX/X, & XII are vital to producing speech and these can be tested by asking the patient to say different sounds. 3/
#PregnancyCardiology Primer courtesy of a fantastic lecture by Dr. Sabrina Phillips from Mayo Clinic. Follow the thread #ACCFIT s for a good overview of considerations. #FelllowsFirst #MedEd
How does plasma volume and erythrocyte volume change during pregnancy? 1/12
How does plasma volume and erythrocyte volume change during pregnancy? 1/12
#PregnancyCardiology Primer
Other important factors in the cycle of volume expansion and decreased SVR
2/12
#FellowsFirst #ACCFIT
Other important factors in the cycle of volume expansion and decreased SVR
2/12
#FellowsFirst #ACCFIT
