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Your doctor will ask you about your ability to remember time buy leukeran 2mg low price, place, persons, and recent events, and will likely want to speak with a person who knows you well. Your doctor will do a physical examination including the follow- ing: blood pressure, pulse, temperature, breathing rate, mental status exam including orientation and simple calculations, thorough eye 45 Copyright © 2004 by The McGraw-Hill Companies, Inc. In adults, the most common and treatable causes of constipation are the use of certain medications (see below), reliance on laxatives, and a diet high in carbohydrates and low in fiber. Your Doctor Visit What your doctor will ask you about: abdominal pain, blood in stools, pain with defecation, diarrhea alternating with hard stool, weight loss, anxiety, depression. Your doctor will also want to know if you have ever had a barium enema or a colonoscopy, and what they showed. Your doctor will want to know if you or anyone in your family has had any of these conditions: colitis, emotional problems, diver- ticular disease. Your doctor will want to know what you normally eat, and how many bowel movements you have each week. Your doctor will do a physical examination including the fol- lowing: pushing on your abdomen, rectal exam, testing your stool for blood. CAUSE EXAMPLES AND/OR SYMPTOMS Medication use Anticholinergics such as Benadryl, antide- pressants, calcium channel agents used for high blood pressure such as Norvasc Laxative habit Overreliance on laxatives until you depend on them to have a bowel move- ment (can lead to decreased defecation reflex, below) Poor diet Constipation-causing diets are those with high amounts of carbohydrates and low amounts of fiber (found in whole grains and raw vegetables) Inflammation of the anus Pain on defecation, anus is tender Irritable bowel syndrome Chronic history of anxiety in which loose stools and lower abdominal pain alternate with constipation Decreased defecation A result of chronic use of laxatives or reflex habitual constipation Partial bowel obstruction Recent change in bowel habits, can also alternate with loose stools Constipation (Child) What it feels like: an inability to have regular and easy bowel movements. The most common cause of “constipation” in children is concern from caregivers that they should have a bowel movement every day— even though it is normal for children to pass stool as infrequently as once or twice a week. Anxiety from adults about toilet training can also be transmitted to children, which can lead to constipation. Your Doctor Visit What your doctor will ask you about the child: vomiting, excessive urination, crying during bowel movement, change in appetite, abdominal swelling, blood in stool, soiling of underclothes, behav- ioral problems. Your doctor will want to know how many bowel movements the child has each week, how many the child is expected to have, and what kind of diet the child follows, including what kind of formula, if any, is used, how it is diluted, and how much the child eats.
Aortic regurgitation occasionally causes ing 2mg leukeran visa, or numbness or weakness in the legs. In serious cases, it causes the left ventricle of the heart to enlarge Disorders of the chest and lower body and may eventually lead to heart failure. It can cause difficulties in valves, which are the valves that separate the chambers breathing, especially if the heart, spine, and lung have of the heart. It may also cause between the chambers completely, the condition is called concerns about appearance. Infective endocarditis is an ficulties, it can cause embarassment about appearance. In patients with Marfan syndrome, it is the abnor- of their chest and a pectus carinatum on the other. Some patients with Marfan syn- more likely to develop pes planus (flat feet) or so-called drome develop cystic disease of the lungs or recurrent “claw” or “hammer” toes than people in the general spontaneous pneumothorax, a condition in which air population. They are also more likely to have chronic accumulates in the space around the lungs. Disorders of the eyes and face Disorders of the spine Although the visual problems related to Marfan syn- drome are rarely life-threatening, they are important in • Scoliosis. Eye disorders related to the syndrome include the twist out of line from side to side into an S-shape or a following: spiral. Most patients with Marfan of children with Marfan, and the looseness of the liga- develop nearsightedness, usually in childhood. Ectopia lentis is the medical term for dis- • Kyphosis is an abnormal outward curvature of the location of the lens of the eye. Between 65% and 75% spine, sometimes called hunchback when it occurs in of patients with Marfan have dislocated lenses. Patients with Marfan may develop condition is an important indication for diagnosis of the kyphosis either in the upper (thoracic) spine or the syndrome because there are relatively few other disor- lower (lumbar) spine. This condition is much more prevalent in for a forward slippage of one vertebra on the one below patients with Marfan syndrome than in the general pop- it. Positive thumb sign (B) is the apperance of the thumb tip when making a closed fist.
Remember that the patient information you are entrusted with as a health care provider is confidential 2 mg leukeran free shipping. There is a time and place to discuss this sensitive information and public areas such as elevators or cafeterias are not the appropriate location for these discussions. READING Time for reading is at a premium on many services, and it is therefore important to use that time effectively. Unless you can remember everything you learned in the first 20 months of medical school, you will probably want to review the basic facts about the disease that brought your patient into the hospital. These facts are most often found in the same core texts that got you through the preclinical years. Unless specifically directed to do so, avoid the temptation to sit down with MEDLINE/Index Medicus to find all the latest articles on a disease you have not read about for the last 7 months; you do not have the time. The appropriate time to head for the MEDLINE/Index Medicus is when a therapeutic dilemma arises and only the most recent literature will adequately advise the team. You may wish to obtain some direction from the attending, the fellow, or the resident before plunging into “So You Want to Be a Scut Monkey” 5 the library on your only Friday night off call this month. Ask the residents or fellow students for the pocket manuals or PDA downloads that they found most useful for a given rotation. THE WRITTEN HISTORY AND PHYSICAL Much has been written on how to obtain a useful medical history and perform a thorough physical examination, and there is little to add to it. Three things worth emphasizing are your own physical findings, your impression, and your own differential diagnosis. Trust and record your own physical findings, even if other examiners have written things different from those you found. Pavona her fourth rectal examination of the day, and in this circumstance you may write “rectal per resident. Although not always emphasized in physical diagnosis, your clinical impression is probably the most important part of your write-up. Reasoned interpretation of the medical history and physical examination is what separates physicians from the computers touted by the tabloids as their successors. Judgment is learned only by boldly stating your case, even if you are wrong more often than not.
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