!"#$% "'%( ) *+,-,./+ "0,++1 */121 34521 #$%& '(%)*%%(+, $,' -*&%.(+,% .+ /& $%0&' (, 1,)+*,.&2
3*24$, 5$('&2 67&2$8( 9 :7;&' <$7('
"
© 2014 FHS & AZ All rights reserved. reserved. No part of this publication may be reproduced, stored stored in a retrieval retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, reco recording rding and/or otherwise, without the prior written permission of the publishers.
Disclaimer The authors of this work have checked with resources believed to b e relevant and current in th eir efforts efforts to deliver information information that is thorough and in agreement with the criterions criterions accepted at the time of publication. However, However, in view of the p ossibility for for h uman error or changes in USMLE USMLE guidelines, neither the authors or the pub lisher nor anyone else who has been involved in th e preparation or publication of this work warrants that th e information information enclosed in “!"#$% "'%( ) *+,-,./+ "0,++1 */121 34521” is adequate as a solo preparatory tool. They renounc e all obligation for any errors or omissions or for the results acquired from practice of the information contained in this work. Examinees are encouraged to ratify the information contained herein with other sources.
Compiled and Typed by Furqan Haider Syed
(
© 2014 FHS & AZ All rights reserved. reserved. No part of this publication may be reproduced, stored stored in a retrieval retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, reco recording rding and/or otherwise, without the prior written permission of the publishers.
Disclaimer The authors of this work have checked with resources believed to b e relevant and current in th eir efforts efforts to deliver information information that is thorough and in agreement with the criterions criterions accepted at the time of publication. However, However, in view of the p ossibility for for h uman error or changes in USMLE USMLE guidelines, neither the authors or the pub lisher nor anyone else who has been involved in th e preparation or publication of this work warrants that th e information information enclosed in “!"#$% "'%( ) *+,-,./+ "0,++1 */121 34521” is adequate as a solo preparatory tool. They renounc e all obligation for any errors or omissions or for the results acquired from practice of the information contained in this work. Examinees are encouraged to ratify the information contained herein with other sources.
Compiled and Typed by Furqan Haider Syed
(
.
=2&>$)& ?7& ;+%. '2&$'&' +> @6AB1 &C$;% >+2 DAE%F .7& 6.&G H #6F (% $I%+ +,& +> .7& ;+%. (,.&J2$I G$2.% +> K+*2 $GGI()$.(+, >+2 2&%('&,)KL ?7&2& $2& ;$,K 2&$%+,% >+2 M7K DAE% >(,' .7(% &C$; '(>>()*I.F $,' .7(% M+20 7&IG% $II$K one of this aspects, “W 7$. 4*&%.(+, %7+*I' D /& $%0(,J ;K G$.(&,. ?” We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
?7&%& ,+.&% "#$%&' () )+;GI(;&,.&' M(.7 #6 ,+.&% /K P2L A$Q(' ?+%&&> :(8&'L O& >+II+M&' .7& J&,&2$I +*.I(,& +> 7+M $ G$.(&,. &,)+*,.&2 %7+*I' /& $% '&.$(I&' (, P2L A$Q id’s Notes. (There are $ ,*;/&2 +> +.7&2 +G.(+,% %*)7 $% D4/$I($, $,' T&&2$Q ,+.&%F 7+M&N&2 M& )$,,+. N+*)7 >+2 .7&; $% %.2+,JIK $% M& )$, >+2 P2L Majid’s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on’t be shy!!Improve K+*2 ,+.&% /K '(%)*%%(,J $,' %7+M(,J (. .+ +.7&2%F $% (. (% $ N&2K (;G+2.$,. )+;G+,&,. +> .7& &C$;L @%*$IIK H &C$;(,$.(+,% %7+*I' /& '+,& '*2(,J G$.(&,. &,)+*,.&2F M& 2&)+;;&,' '+(,J )$2'(+N$%)*I$2 &C$; $% (. )$, /& '+,& (, $ N&2K %7+2. .(;& (,.&2N$IL ((
?2K G2$).()(,J .7& )$%&% ;*I.(GI& .(;&% $,' $. I&$%. $ >&M .(;&% M(.7 %+;&+,& +.7&2 .7$, K+*2 2&J*I$2 %.*'K G$2.,&2 $% .7(% M(II %(J,(>()$,.IK 7&IG (;G2+N& )+,>('&,)&L ?7(% $I%+ 7&IG% $..&;G. *,&CG&).&' )$%&% $% .7& J&,&2$I G$..&2, *%&' (% .7& %$;&L
O& M(%7 $II +> K+* /&%. +> I*)0 >+2 .7& &C$;%L P2L 3*24$, 5$('&2 6K&' >*24$,L%7&2$8(]J;$(IL)+; P2L :7;&' <$7(' $7;&'L87']J;$(IL)+;
(((
!"#$% '( )'*+%*+, :'*I. #$%&%LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL " @GG&2 :/'+;(,$I =$(,LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL H P($227&$ LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL [ ZI++' (, 6.++I%LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL Y B+M&2 :/'+;(,$I =$(,LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL ^ ?&%.()*I$2 =$(, LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL _ R,&& =$(, LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL "\ :2; =$(,LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL "" Z$)0 =$(, LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL "[ T&)0 =$(, LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL "` Text 5&&I =$(, LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL "Y 5(G =$(, LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL "a #$I> =$(, LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL "^ #7&%. G$(, LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL "b =$IG(.$.(+,% LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL "_ :,C(&.K LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL H\ #+*J7 LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL H" 6WZText LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL H[ Text 6+2& ?72+$.LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL HY
5+$2%&,&%% LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL Ha c$*,'()& LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL H^ 5&;$.*2($ LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL Hb (N
Z*2,(,J A().*2(.(+, LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL H_ Text
@2(,$2K D,)+,.(,&,)& LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL [\ Text 3$.(J*& LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL ["
PA $,' 5?T >+II+Md *G LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL [[ =2&d1;GI+K;&,. 1C$; LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL [` Text Text
5&$'$)7& LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL [Y 3+2J&.>*I,&%%LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL [^ 5&$2(,J B+%% LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL [_ P(88(,&%% Ue&2.(J+X LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL `\ P(88(,&%%Text UBW#X LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL `" A&,%.2*$I D22&J*I$2(.(&% LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL `[ =+%.dA&,+G$*%$I ZI&&'(,J LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL `Y e$J(,$I P(%)7$2J& LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL `a PK%G$2&*,($ LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL `^ Text 6I&&G =2+/I&;%fD,%+;,($ LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL `b
O&(J7. E$(, LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL `_ O&(J7. B+%% LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL Y\ ?2&;+2% LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL Y" A*%)I& O&$0,&%% LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL YH 5$II*)(,$.(+,%LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL Y` 6&(8*2&% LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL Ya =&'($.2() #$%& LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL Y^ 3&N&2 LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL Y_ N
6&(8*2&% LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL a" P($227&$ LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL aH #+*J7 LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL a[ =()0K 1$.&2 LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL a`
Fundoscopy Rectal exam pelvic exam
Jaw Pain MTB DANDA MI Tooth ace Bruxikum: (does your partner notice that you grind your teeth, any mouth ulcer) D: Dislocation (popping sound) A: Arthritis N: trigeminal neuralgia D: Dysfunction A: abuse SAFEGUARD
ALWAYS OPEN THE BANDAGE FUNDOSCOPY FULL SKELETAL SURVEY TMJ XRAY
Violence doesn’t end on its on, its only increases in severity. The only way to end violence is to get away from your partner necessary supply to a friend and family
N(
-./$+ )",%, PAM HUG FOSS PMDC Flu SHOT
CLosure: Thanks for your patience. From the information i have gathered so far from quetsions and examination, i am considering couple of possibilites… But To GET THE BOTTOM OF THIS problem i want to run some tests “WITH YOUR PERMISSION” meanwhile i would like to keep you under observation and don’t indulge in activities that will worsen your condition
"
011%2 -#.'34*"$ 5"4* !"#$%"&'( *+,- ./012 .&33#4#"5&67 .&68"%9&9(
0+$1./#S E$%.2(.(%F E1VPF E$%.2() )$,)&2 2.*/,)."S =$,)2&$.(.(%F =$,)2&$.() )$,)&2 345 S 5&G$.(.(%F #7+I&)K%.(.(% 67 :;#95&%"9
"L HL [L `L YL aL ^L bL _L
O7$. 8KG& +> >++' $JJ2$N$.&% .7& G$(,g D% .7&2& $,K 3&I$.(+,%7(G /&.M&&, G$(, $,' .(;(,J +> K+*2 >++' (,.$0&g 5$N& K+* ,+.()&' $,K 9&II+M,&%% +> K+*2 &K&% +2 %0(,g 5$N& K+* ,+.()&' $,K :(%.&,%(+, +> K+*2 /&IIKg s is shortness of breath 5$N& K+* ,+.()&' $,K /*2,(,J %&,%$.(+, (, K+*2 )7&%. U ;&$2. Z*2,X +2 )7$,J& (, .$%.& +> K+*2 ;+*.7g 5$N& K+* &N&2 /&&, &CG+%&' .+ $,K/+'K M(.7 %(;(I$2 )+;GI$(,.% U 7,>&).(+,%Xg 5$N& K+* ,+.()&' $,K )7$,J& (, /+I+2 +> K+*2 %.++I% +2 $,K
2+; +*.%('& 2&)&,.IKg 5$N& K+* ,+.()&' $,K %7+2.,&%% +> /2&$.7g :,K %M&$.(,Jg 2<6$
"L 511T? HL ED? &C$; U(,)I*'(,J Murphy’s %(J,X [L #e6 0"=#95&865&%"9
"L HL [L `L YL aL ^L bL
V&).$I 9 =&IN() 1C$; 1RE 6.++I >+2 +))*I. /I++' :B?f:6?fZ(I(2*/(,f:B= @f6 :/'+;&, @GG&2 ED 1,'+%)+GK 5DP: %)$, T+,(,N$%(N& 5L =KI+2( .&%.(,J
H
64"227%" .&33#4#"5&67 .&68"%9&9( > !"#$%& 1())*%& !!(!+,)$-".)/
O$.&2KS >? 2;@7AB > $%.2+&,.&2(.(%f?2$N&I&2%F ?2+7,’% P(%&$%&F 2%&*'+;&;/2$,+*% #+I(.(%F ;KG&2.7K2+('(%;F @DP6F 7Z6F A$).+%& D,.+I&2$,)&L ZI++'KS 4I)&2$.(N& #+I(.(%F :K%&,.&2KF ?$,)&2L A$I$/%+2G.(+,S 2$,)2&$.(.(%F >($2'($%(%F ?&I($) P(%&$%&L W3P=:: 4*&%.(+,% onset,frequency,duration,previous episode,progression,aggravating/relieving factors,associated symptom O7$. '+ K+* ;&$, /K '($227&$g Uh+* M$,. .+ >(,' +*. ddd 0) %)1 2#!/ ./3$#!,#* 4$#51#/3% )$ ./3$#!,#* 6)(12#78 O7$. '+ K+*2 %.++I% I++0 I(0&g 9 h+* M$,. .+ >(,' +*. ddd :$# ";#% $%.2+&,.&2(.(%f Travelers’ Diarrhea: $L 5$N& K+* &$.&, +*.%('& 2&)&,.IKg /L 5$N& K+* .2$N&II&' 2&)&,.IKg HL 3+2 ?rohn’s DiseaseS $L 5$N& K+* ,+.()&' $ %&,%& +> (,)+;GI&.& &N$)*$.(+, $>.&2 G$%%(,J %.++I%g /L 5$N& K+* ,+.()&' $ G$(, (, K+*2 /&IIKg [L 3+2 2%&*'+;&;/2$,+*% #+I(.(%S $L 5$N& K+* /&&, .$0(,J $,.(/(+.()% 2&)&,.IKg `L 3+2 ;KG&2.7K2+('(%;S U?&;G (,.+I&2$,)&F Z+M&I ;+N&;&,.X $L 5$N& K+* ,+.()&' 2$)(,J +> 7&$2.g /L 5$N& K+* ,+.()&' $,K %0(, )7$,J&%g )L 5$N& K+* ,+.()&' $,K .2&;+2% +> 7$,'%g YL 3+2 @DP6S UDe '2*J $/*%&F I+M J2$'& >&N&2F IK;G7$'&,+G$.7K iI*;G% +2 /*;G%j (, .7& /+'KX aL 3+2 7Z6S Uk[ ;+,.7%X $L 5$N& K+* ,+.()&' $,K 2&I$.(+,%7(G +> /&IIK G$(, .+ /+M&I ;+N&;&,.%g /L 5$N& K+* ,+.()&' $,K $I.&2,$.(,J '($227&$ $,' )+,%.(G$.(+,g ^L 3+2 A$).+%& D,.+I&2$,)&S $L 5$N& K+* ,+.()&' $,K 2&I$.(+,%7(G +> '($227&$ M(.7 $,K ;(I0 G2+'*).%g 3+2 ZI++'K P($227&$S "L 3+2 4I)&2$.(N& #+I(.(%S $L 5$N& K+* ,+.()&' $ %&,%& +> (,)+;GI&.& &N$)*$.(+, $>.&2 G$%%(,J %.++I%g /L 5$N& K+* ,+.()&' $ G$(, (, K+*2 /&IIKg )L P+ K+* 7$N& .+ 2*%7 .+ '&>&)$.&g 'L 5$N& K+* ,+.()&' %0(, 2$%7 +2 Q+(,. G$(,g HL 3+2 :K%&,.&2KS U>&N&2F G$(, $/'+;&,F ,$*%&$F &$.&, +*.%('&X [L 3+2 ?$,)&2S UM&(J7. I+%%F 2&'*)&' $GG&.(.&F ;$K 7$N& /&IIK G$(, $I%+ X 3+2 A$I$/%+2G.(+,S :2& K+*2 %.++I% '(>>()*I. .+ >I*%7g [
5$N& K+* ,+.()&' $,K )7$,J& (, K+*2 M&(J7.g "L 3+2 2$,)2&$.(.(%S U:I)+7+I()X $L P+ K+* 7$N& $ 5C +> J$II%.+,&%g /L 5$N& K+* ,+.()&' /&IIK G$(, J+(,J .+ .7& /$)0g HL 3+2 >($2'($%(%S $L 5$N& K+* /&&, +, $ 7(0(,J .2(G 2&)&,.IKg W2 '2$,0 >2+; >2&%7 M$.&2 I$0&g [L 3+2 ?&I($) P(%&$%&S $L 5$N& K+* ,+.()&' $,K 2&I$.(+,%7(G .+ M7&$. G2+'*).% +2 $,K %G&)(>() >++'g 2<6$
"L 511T? l ?7K2+(' &C$; HL ED? &C$; U(,)I*'(,J Murphy’s) [L #e6 0"=#95&865&%"9
"L HL [L `L YL aL ^L
V&).$I 9 =&IN() 1C$; 6.++I &C$; >+2 +N$ $,' G$2$%(.&% 9 >&)$I I&*0+)K.&% ?65F ?[ 9 ?` :B?f:6?fZ(I(2*/(,f:B= @f6 :/'+;&, #+I+,+%)+GK 6&2*; (;;*,+JI+/(,%
`
8$''. 4* 9+''$, .&33#4#"5&67 .&68"%9&9( ?;@: 4C UB+M&2 EDX A2> U@GG&2 EDXB
#+I+, ?:F ;&;+227+('%F @,J(+'K%GI$%($F :(N&2.()*I+%(%F 4I)&2$.(N& )+I(.(%F :,$I C(%%*2&F #72+,() A(N&2 P(%&$%&F 2@PF >$%.2(.(%L :;#95&%"9 W3P=:: 5$N& K+* ,+.()&' $,K )7$,J& (, /+M&I ;+N&;&,.%g D% .7& /I++' /&>+2&F ;(C&' +2 $>.&2 G$%%(,J %.++I%g O7$. (% .7& )+I+2 +> /I++'g UO7$. K+* M$,. .+ >(,' +*. dd >$.=;" $#* )$ *!$? X 5$N& K+* N+;(.&' &N&2 %(,)&g P+&% (. )+,.$(, /I++'g UE+ .+ *GG&2 ED 4*&%.(+,% >(2%.X 5$N& K+* ,+.()&' $,K G$(, +, G$%%(,J %.++I%g UE+ .+ I+M&2 ED 4*&%.(+,% >(2%.X "L 3+2 #+I+2&).$I ?:S UM&(J7. $,' $GG&.(.& )7$,J&%F >$;(IK 5CF )7$,J&% (, /+M&I ;+N&;&,.X $L 5$N& K+* ,+.()&' $,K )7$,J& (, )$I(/&2f.7()0,&%% +> %.++I%g HL 3+2 ;&;+227+('%S U32&%7 /I++'X $L 5$N& K+* ,+.()&' $,K.7(,J )+;(,J +*. +> fG2+.2*'(,J >2+; .7& $,*%g [L 3+2 @,J(+'K%GI$%($S U:J&F =$(,I&%% 7&$NK /I&&'(,JX `L 3+2 :(N&2.()*I+%(%S U:J&F =$(,I&%% 7&$NK /I&&'(,JF )+,%.(G$.(+,X $L O7$. '+&% K+*2 G2(;$2K '(&. )+;G2(%& +>g UI$)0 +> >(/&2X YL 3+2 4I)&2$.(N& )+I(.(%S U:/'+;(,$I =$(,X $L 5$N& K+* ,+.()&' $ %&,%& +> (,)+;GI&.& &N$)*$.(+, &N&, $>.&2 G$%%(,J %.++I%g /L P+ K+* 7$N& .+ 2*%7 .+ '&>&)$.&g )L 5$N& K+* ,+.()&' Q+(,. G$(,g W2 2&',&%% +> &K&%g aL 3+2 :,$I C(%%*2&S U=$(,>*I /I&&'(,JF )+,%.(G$.(+,X ^L 3+2 #72+,() A(N&2 P(%&$%&S UTfeF :I)+7+I *%&F %0(, )7$,J&%X $L 5$N& K+* ,+.()&' $,K '(%.&,%(+, +> K+*2 /&IIKg /L 5$N& K+* ,+.()&' &,I$2J&;&,. +> /2&$%.%g bL 3+2 2@PS U1G(J$%.2() G$(,X $L D% .7&2& $,K 2&I$.(+,%7(G /&.M&&, G$(, $,' .(;(,J +> K+*2 >++' (,.$0&g _L 3+2 >$%.2(.(%S UE1VPF T6:DP%X 2<6$
"L 511T? HL ED? 1C$; [L #e6 1C$; 0"=#95&865&%"9
"L HL [L `L
V&).$I 9 =&IN() 1C$; 6.++I >+2 +))*I. /I++' :B?f:6?fZ(I(2*/(,f:B= @f6 :/'+;&, Y
YL @GG&2 ED 1,'+%)+GK 9 #+I+,+%)+GK aL T+,(,N$%(N& 5L =KI+2( .&%.(,J
a
:';%2 -#.'34*"$ 5"4* !"#$%"&'( ?!@ +* AB- @C@ D DB 11 .02 .&33#4#"5&67 .&68"%9&9( 3@2=: >@E:7 Pain + multiple partners
abnormal implanatation
>)*F+$%,F*.,GH 3*G.*2&' +N$2($, )K%.F @',&C$I .+2%(+,F 2DPF =).+G() G2&J,$,)KF =,'+;&.2(+%(% $,' :K%>*,).(+,$I @.&2(,& ZI&&'(,JL infx of ur genital tract
>."+,$F*+)"+F*.&H >$%.2+&,.&2(.(%F @GG&,'()(.(%F E&G72+I(.7($%(%F :(N&2.()*I(.(%F 7Z6f7ZPL :;#95&%"9
>."+,$F*+)"+F*.&
"L P+ K+* >&&I E$*%&$.&'g HL 5$N& K+* I+;(.&' &N&2 %(,)& .7(% (II,&%%g [L 5$N& K+* ,+.()&' $,K )7$,J& (, <+M&I 7$/(.%g $L D> K&%F .7& 2E0 (L 5$N& K+* =$.&, +*.%('&g ((L P+ K+* 7$N& C&N&2g (((L 5$N& K+* &N&2 /&&, &CG+%&' .+ $,K/+'K M(.7 %(;(I$2 )+;GI$(,% U 7,>&).(+,Xg `L 5$N& K+* ,+.()&' $,K K&%F .7&, :Z#W (L @;+*,. ((L ?+I+2 9 #I+.% (((L Z&>+2&F :>.&2 +2 ;(C&' M(.7 %.++I% (NL J'+*2 YL O7$. %+2. +> K+*2 :(&. '+ K+* *%*$IIK &$.g aL O7$. (% .7& 2&I$.(+,%7(G +> G$(, M(.7 /+M&I ;+N&;&,.g :,K G$(, '*2(,J .7& %I&&Gg U 7Z6X ^L 5$N& K+* ,+.()&' $ %&,%& +> (,)+;GI&.& =N$)*$.(+,g c+(,. G$(,% +2 +2$I *I)&2%g >)*F+$%,F*.,G
@/,#$" "$!/,.".)/!( ,"!"#2#/" 4)$ A%/!#B C+, 51#,".)/,D "L HL [L `L YL aL ^L bL _L
O7&, M$% K+*2 AA=g O7&, M$% K+*2 >(2%. 6&,%.2*$I G&2(+' U6&,$2)7&Xg P+ K+* >&&I 2$(, '*2(,J (,.&2)+*2%& +2 '&>&)$.(+,g :2& K+*2 )K)I&% 3&J*I$2g 5+M ;$,K 8$;G+,%f=$'% '+ K+* *%& +, $ 7&$NK '$Kg 5$N& K+* ,+.()&' ?2$;GK G$(, '*2(,J ;&,%&%g 5$N& K+* ,+.()&' $,K I$J(,$I '(%)7$2J&g 5$N& K+* ,+.()&' $,K 0G+..(,J (, /&.M&&, G&2(+'%g :2& K+* 22&J,$,.g ^
"\L 5$N& K+* &N&2 7$' @/+2.(+,%g ""L O7&, M$% K+*2 A$%. =$G %;&$2g 2<6$
"L 511T? HL ED? &C$; UV&/+*,' ?&,'&2,&%%X [L #e6 0"=#95&865&%"9
"L HL [L `L YL aL ^L bL _L
V&).$I 9 =&IN() 1C$; βd5#E #Z# M(.7 P(>>&2&,.($IF 6f1 6.++I >+2 +))*I. /I++' :B?f:6?fZ(I(2*/(,f:B= @f6 :/'+;&, 9 #? %)$, :/'+;&, @GG&2 ED 1,'+%)+GK #+I+,+%)+GK B$G$2+%)+GK
b
atypical: says outside Belly pain
!%,+4
82$*;$F ;&2,($F =G('('K;(.(%F J2)7(.(%F 8+2%(+,L onset,frequency,duration,progression,PREVIOUS episode,location,intensity on scale of 10,quality,radiation,aggravating/relieving factors,associated symptoms
W3P=BD-V:: -*&%.(+,%L 5$N& K+* ,+.()&' $,K M$2;.7F 2&',&%% +2 %M&II(,J +> .7& .&%.()I&g "L 3+2 82$*;$S HL 3+2 ;&2,($S $L 5$N& K+* ,+.()&' $,K.7(,J )+;(,J (,.+ K+*2 %)2+.*;g /L 5$N& K+* ,+.()&' $,K )7$,J& (, /+M&I 7$/(.%g )L 5$N& K+* ,+.()&' $,K 2&I$.(+,%7(G +> %M&II(,J .+ G+%(.(+, +2 IK(,J '+M,g [L 3+2 =G('('K;(.(%S $L 5$N& K+* ,+.()&' /*2,(,J %&,%$.(+, M7(I& G$%%(,J *2(,&g /L P+ K+* 7$N& .+ *2(,$.& ;+2& >2&4*&,.IK .7$, *%*$Ig )L P+ K+* 7$N& .+ 2*%7 .+ *2(,$.&g `L 3+2 J2)7(.(%S U3&N&2X hx of viral infx $L 5$N& K+* ,+.()&' %M&II(,J &I%&M7&2& (, .7& /+'Kg U=$2+.('X /L 5$N& K+* ,+.()&' $,K 2$%7 +, K+*2 /+'Kg YL 3+2 8+2%(+,S UT$*%&$X $L 5$N& K+* ,+.()&' G$(, (, K+*2 /&IIKg /L 5$N& K+* ,+.()&' K+*2 .&%.()I& (, $, $/,+2;$I G+%(.(+,g 2<6$
"L 511T? HL ED? &C$; [L #e6 0"=#95&865&%"9
"L HL [L `L
V&).$I 9 =&IN() 1C$; #Z# M(.7 P(>>&2&,.($IF 6f1 @2(,$IK%(%F @2(,& )*I.*2& @f6 .&%.&% $,' $/'+;&,L
_
Sports… Septic Arthritis…Pseudogout..petallofemoral syndrome and psoriatic arthritis.. Osteoarthritis.. R:RA..T: Trauma, Tophi S:
sle
=*%% 5"4* !"#$%"&'( >+-- >D* A/F@@E G A0*+H.&33#4#"5&67 .&68"%9&9( W%.&+$2.72(.(%F E+*.F =%&*'+ J+*.F 6&G.() :2.72(.(% UE+,+)+))$I $,' T+, E+,+)+))$IXF 6B1F V:L IVDU… Travel/trauma/tick bite..rash..Ulcer/urinary discharge../ uveitis… STIFFNESS/SORE THROAT
:;#95&%"9
"L HL [L `L YL aL ^L bL _L "\L ""L "HL
5$N& K+* ,+.()&' $,K K$2;.7 +> K+*2 Q+(,.g 5$N& K+* ,+.()&' $,K 3&',&%% +> K+*2 Q+(,.g citrus: chest 5$N& K+* ,+.()&' $,K 0.(>>,&%% +> K+*2 Q+(,.g pain ,cough ,conjuctivitis,insect ,trauma 5$N& K+* ,+.()&' $,K 0M&II(,J +> K+*2 Q+(,.g travel ,rash ,ulcer in the mouth ,urinary 5$N& K+* ,+.()&' $,K K&$0,&%% +> K+*2 Q+(,.g discoloration ,stiffness 5$N& K+* ,+.()&' $,K E*;/,&%% +2 8(,JI(,J +> K+*2 Q+(,.g 5$N& K+* ,+.()&' $,K '(% ?+I+2$.(+, +> K+*2 >(,J&2% (, )+I'g 5$N& K+* ,+.()&' $,K ;$(2 I+%% 2&)&,.IKg P+ K+* 7$N& G$(, (, $,K J.7&2 Q+(,.g 5$N& K+* ,+.()&' $,K '(%)+;>+2. +, 1CG+%*2& .+ %*,I(J7.gU 27+.+%&,%(.(N(.KX 5$N& K+* ,+.()&' $,K 2+GG(,J %+*,' >2+; 0,&&g P+ K+* >&&I ;+2& .(2&' .7$, *%*$I U C$.(J*&Xg 2<6$
"L 511T? HL 7,%G&).F 2$IG$.&F 3WAF 6+.+2F 3&>I&C&%F 0&,%$.(+,%F 2*I%&%F >$(.d E)2-!$# ") ";# )";#$ ,.*#D MRSPG [L #e6 I will LIKE TO DO SPECIAL MANUVEURS.
0"=#95&865&%"9 Mcmurey… Drawer test
"L HL [L `L YL aL ^L bL
#Z# M(.7 '(>>&2&,.($IF 6f1 16V :2.72+)&,.&%(% $,' $,$IK%(% md2$K R,&& := 9 B$.L N(&M #? %)$, R,&& AVD R,&& P1m: %)$, #$ll 9 e(.$;(,dP I&N&I%
"\
-23 5"4* !"#$%"&'( >+-- >D* G A0*+H.&33#4#"5&67 .&68"%9&9( 6@3 C=08
6*%)I& %.2$(,F @,J(,$fADF 3+.$.+2 )*>> .&$2F C2$).*2&F =I'&2 :/*%&F 67+*I'&2 :(%I+)$.(+,F 8&,'(,(.(%L :;#95&%"9
"L HL [L `L YL aL ^L
5$N& K+* ,+.()&' $,K K$2;.7 +> K+*2 Q+(,.g 5$N& K+* ,+.()&' $,K 3&',&%% +> K+*2 Q+(,.g 5$N& K+* ,+.()&' $,K 0.(>>,&%% +> K+*2 Q+(,.g 5$N& K+* ,+.()&' $,K 0M&II(,J +> K+*2 Q+(,.g 5$N& K+* ,+.()&' $,K K&$0,&%% +> K+*2 Q+(,.g 5$N& K+* ,+.()&' $,K E*;/,&%% +2 8(,JI(,J +> K+*2 Q+(,.g V*I& +*. AD /K $%0(,J >+II+M(,J 4*&%.(+,%L Text $L 5$N& K+* ,+.()&' $,K )7&%. G$(,g D> K&%F '+&% .7(% G$(, J+ .+ $,K +.7&2 G$2. +> /+'Kg /L 5$N& K+* ,+.()&' $,K %7+2.,&%% +> G$(,g )L 5$N& K+* ,+.()&' $,K %M&$.(,Jg 'L 5$N& K+* ,+.()&' 2$)(,J +> 7&$2.g bL D> G$.(&,. %&&;% 4*(.&F $>2$(' $,' (,Q*2K %&&;% ,+. )+,%(%.&,. M(.7 5CF $%0 6:31 E:VP 4*&%.(+,L $L P+ K+* >&&I 0$>& $. 7+;&g /L :2& K+* @C2$(' +> nnnnnnnnng F:do ur Family know abt it? )L P+ K+* 7$N& $,K =;&2J&,)K U1C(.X GI$,g 'L P+ K+* 7$N& $ >*, $. 7+;&g &L D% K+*2 nnnnnnnnnn @I)+7+I()g >L 5+M (% .7& 3&I$.(+,%7(G +> K+*2 nnnnnnnnnnn M(.7 +.7&2%g JL P+ K+* >&&I :&G2&%%&' U6*()('$I ('&$.(+,Xg
2<6$
"L 511T? HL 7,%G&).F 2$IG$.&F 3WAF 6+.+2F 3&>I&C&%F 0&,%$.(+,%F 2*I%&% d E)2-!$# ") ";# )";#$ ,.*#D [L #e6 0"=#95&865&%"9
"L HL [L `L YL
#Z# M(.7 '(>>&2&,.($IF 6f1 16V md2$K 67+*I'&2f:2; := 9 B$. N(&M #? %)$, :2; AVD 67+*I'&2
ARM SLING, rest, pain medication
""
aL :2.72+)&,.&%(% $,' $,$IK%(% ^L P1m: %)$, bL #$ll 9 e(.$;(,dP I&N&I%
"H
8"<> 5"4* !"#$%"&'( >+-- >D* I?0@ G A0*+HLIM COTS… / MOTIVE Lumber spinal stenosis: improves on bending worse on standing MM: bone pain; multiple bone pains… Fatigue/ chest pain/ anemia
.&33#4#"5&67 .&68"%9&9(
FODS KF+# KE8H W%.&+$2.72(.(%F P(%) 5&2,($.(+,F 32$).*2&F 6G+,'KI+%(%L
KF+#$%+ KE8S A*%)I& 6.2$(,F A&.$%.$.() #$,)&2F A*I.(GI& AK&I+;$F A&,(,J(.(%F 6B1F V:L :;#95&%"9
"L 5$N& K+* ,+.()&' $,K K$2;.7 +> K+*2 Q+(,.g BACK PAin with pyelonephritis & hx of stone. Fever HL 5$N& K+* ,+.()&' $,K 3&',&%% +> K+*2 Q+(,.g [L 5$N& K+* ,+.()&' $,K 0.(>>,&%% +> K+*2 Q+(,.g `L 5$N& K+* ,+.()&' $,K 0M&II(,J +> K+*2 Q+(,.g YL 5$N& K+* ,+.()&' $,K K&$0,&%% +> K+*2 Q+(,.g aL 5$N& K+* ,+.()&' $,K E*;/,&%% +2 8(,JI(,J +> K+*2 Q+(,.g ^L 5$N& K+* ,+.()&' $,K )7$,J&% (, K+*2 >$(.g bL 5$N& K+* /&&, A(>.(,J $,K 7&$NK M&(J7. 2&)&,.IKg _L 5$N& K+* &N&2 G$%%&% @2(,&f6.++I% M(.7+*. K+*2 0,+MI&'J&f(,.&,.(+,g U 7,)+;G&.&,)&X "\L 5$N& K+* ,+.()&' $,K &>>&). +> 2+%(.(+, +, G$(,g 11 ask abt impotence 2<6$
SLRRRRRRRRRRR SLRRRRRRRRRRR !!!!!! Text
"L 511T? HL 7,%G&).F 2$IG$.&F 3WAF 6+.+2F 3&>I&C&%F 0&,%$.(+,%F 2*I%&%F >$(.
0"=#95&865&%"9
"L HL [L `L YL aL ^L bL _L
V&).$I $,' =&IN() &C$; #Z# M(.7 '(>>&2&,.($IF 6f1 16V md2$K %G(,& := 9 B$. N(&M #? %)$, AVD P1m: %)$, #$ll 9 e(.$;(,dP I&N&I% V: >$).+2F :T:
"[
?%<> 5"4* !"#$%"&'( >+-- >D* I?0@1@ G A0*+H.&33#4#"5&67 .&68"%9&9(
MOTIVE MM, Muscle strain, meningitis, mets osteoprosis & osteoarthritis Trauma, TB IV: IVDisk herniation
FODS KF+# KE8H W%.&+$2.72(.(%F P(%) 5&2,($.(+,F 32$).*2&F #&2N()$I 6G+,'KI+%(%L Text
KF+#$%+ KE8S A*%)I& 6.2$(,F A&.$%.$.() #$,)&2F A*I.(GI& AK&I+;$F A&,(,J(.(%F V:L :;#95&%"9
"L HL [L `L YL aL ^L bL _L "\L ""L "HL
5$N& K+* ,+.()&' $,K K$2;.7 +> K+*2 Q+(,.g 5$N& K+* ,+.()&' $,K 3&',&%% +> K+*2 Q+(,.g 5$N& K+* ,+.()&' $,K 0.(>>,&%% +> K+*2 Q+(,.g 5$N& K+* ,+.()&' $,K 0M&II(,J +> K+*2 Q+(,.g 5$N& K+* ,+.()&' $,K K&$0,&%% +> K+*2 Q+(,.g 5$N& K+* ,+.()&' $,K E*;/,&%% +2 8(,JI(,J +> K+*2 Q+(,.g 5$N& K+* ,+.()&' $,K )7$,J&% (, K+*2 >$(.g 5$N& K+* /&&, A(>.(,J $,K 7&$NK M&(J7. 2&)&,.IKg 5$N& K+* &N&2 G$%%&' @2(,&f6.++I% M(.7+*. K+*2 0,+MI&'J&f(,.&,.(+,g U 7,)+;G&.&,)&X 5$N& K+* ,+.()&' $,K &>>&). +> 2+%(.(+, +, G$(,g 5$N& K+* ,+.()&' $,K .2+*/I& <2&$.7(,Jg 5$N& K+* ,+.()&' $,K .2+*/I& (, /2(J7. I(J7.g U 27+.+%&,%(.(N(.KX 2<6$
"L 511T? HL 7,%G&).F 2$IG$.&F 3WAF 6+.+2F 3&>I&C&%F 0&,%$.(+,%F 2*I%&%F >$(.
0"=#95&865&%"9
"L HL [L `L YL aL ^L bL _L "\L ""L
#Z# M(.7 '(>>&2&,.($IF 6f1 16V B= $,' #63 $,$IK%(% Z@TS#2 6=1# md2$K T&)0 := 9 B$. N(&M #? %)$, AVD P1m: %)$, #$ll 9 e(.$;(,dP I&N&I% V: >$).+2F :T:
rest & NECK BRACE Pain medication
"`
ALWAYS TAKE OFF BANDAGE
@%%$ 5"4* !"#$%"&'( >+-- >D* *>F EE@ G A0*+H.&33#4#"5&67 .&68"%9&9( 2@? 3 C@8
2 I$,.$2 >$%)((.(%F @,0KI+%(,J %G+,'KI(.(%F ?$I)$,&$I %.2&%% >2$).*2&F 3&.2+)$I)$,&$I /*2%(.(%F C+2&(J, /+'KF @,0I& %G2$(,F 8$2%$I .*,,&I %K,'2+;&L :;#95&%"9
"L HL [L `L YL aL ^L bL _L "\L ""L "HL
plantar fascitis: increased in sports ,jumping, and morning tarsal tunnel syndrome : evening and aggravates on walkin
cellulitis :fever 5$N& K+* ,+.()&' $,K K$2;.7 +> K+*2 Q+(,.g 5$N& K+* ,+.()&' $,K 3&',&%% +> K+*2 Q+(,.g 5$N& K+* ,+.()&' $,K 0.(>>,&%% +> K+*2 Q+(,.g 5$N& K+* ,+.()&' $,K 0M&II(,J +> K+*2 Q+(,.g 5$N& K+* ,+.()&' $,K K&$0,&%% +> K+*2 Q+(,.g 5$N& K+* ,+.()&' $,K E*;/,&%% +2 8(,JI(,J +> K+*2 Q+(,.g O7$. 8(;& '+&% (. 7*2. .7& ;+%.g U;+2,(,J +2 &N&,(,JX 5$N& K+* ,+.()&' $,K '(>>()*I.K K$I0(,Jg O7$. G2&)(G(.$.&% K+*2 G$(,g O$I0(,J +2 c*;G(,Jg U JN&2*%&X 5$N& K+* &N&2 7$' $,K C2$).*2&g 5$N& K+* %.&GG&' +, $,K G+(,.&' +/Q&).g U C+2&(J, Z+'KX 5$N& K+* ,+.()&' $,K 2+GG(,J %+*,'g 2<6$ Can you push the gas pedal
"L 511T? HL 7,%G&).F 2$IG$.&F 3WAF 6+.+2F 3&>I&C&%F 0&,%$.(+,%F 2*I%&%F >$(.
0"=#95&865&%"9
"L HL [L `L YL aL ^L bL
#Z# M(.7 '(>>&2&,.($IF 6f1 16V :2.72+)&,.&%(% $,' $,$IK%(% md2$K 5&&I := 9 B$. N(&M #? %)$, AVD P1m: %)$, #$ll 9 e(.$;(,dP I&N&I%
"Y
@41 5"4* !"#$%"&'( >+-- >D* G A0*+H.&33#4#"5&67 .&68"%9&9( <3@000 JCB
<*2%(.(%F 3&>&22&' =$(,F @2.&2($I D,%*>>()(&,)KF 0.&2+(' :/*%&F A*%)I& 0.2$(,F 0&G.() :2.72(.(%F J%.&+$2.72(.(%fW%.&+G+2+%(%F C2$).*2&%L
"L 3+2 Z*2%(.(%S $L 5$N& K+* ,+.()&' G$(, M7&, K+* I(& +, .7$. %('&g HL 3+2 V&>&22&' =$(,S $L 5$N& K+* ,+.()&' G$(, &I%&M7&2& (, .7& /+'Kg [L 3+2 :2.&2($I D,%*>>()(&,)KS $L 5$N& K+* ,+.()&' $,K G2+/I&; ;$(,.$(,(,J $, &2&).(+,g /L P+ K+* >&&I $,K (;G2+N&;&,. (, G$(, (> K+* 2&%. $>.&2 M$I0(,J %+;& '(%.$,)&g `L 3+2 6G2$(,S $L 5$N& K+* I(>.&' $,K 7&$NK M&(J7.% 2&)&,.IKg YL 3+2 6.&2+('fP2*J%S aL 3+2 W%.&+$2.72(.(%S $L 5$N& K+* ,+.()&' $,K %.(>>,&%% +> Q+(,.%g /L 5$N& K+* ,+.()&' $,K %)2$.)7(,J %&,%$.(+,% (, K+*2 Q+(,.g ^L 3+2 W%.&+G+2+%(%S UA&,%.2*$I 5CF :J&F T+ 5V?X bL 3+2 32$).*2&%S $L 5$N& K+* ,+.()&' ,$K .2$*;$ 2&)&,.IKg /L 5$N& K+* /&&, >+II+M(,J $ N(J+2+*% &C&2)(%& GI$, 2&)&,.IKg 2<6$ EXPOSE THE HIP… always check for tenderness "L 511T? HL 7,%G&).F 2$IG$.&F 3WAF 6+.+2F 3&>I&C&%F 0&,%$.(+,%F 2*I%&%F >$(.
0"=#95&865&%"9
"L HL [L `L YL aL ^L bL
#Z# M(.7 '(>>&2&,.($IF 6f1 16V :2.72+)&,.&%(% $,' $,$IK%(% md2$K 5(G := 9 B$. N(&M #? %)$, AVD P1m: %)$, #$ll 9 e(.$;(,dP I&N&I%
"a
^ "
K 7 G $ 2 J + , & e ' , $ K 7 G $ 2 J + ( 2 & . 2 : L Y 6 f @ 2 & I G G + P L ` % = P 3 ' , $ 2 & ; ( ' d P L [ V 6 1 L H 1 f 6 F I $ ( . , & 2 & > > ( ' 7 . ( M # Z # L " 9 " % & 5 6 8 & 5 9 # = " 0
; $ C & K 2 $ , + ; I * = ' , $ 6 e # L ` . , ( + c & & , R ' , $ & I 0 , : > + % , + ( . $ % , & % & C & I > & 2 + . + 0 F 3 F 6 L [ n g i s s ’ n a m o F % & % I * F X & I 0 , $ ' , $ & & , 0 7 . + / . $ U A W . $ G I $ . ) & G % , 2 , ; 3 F & 2 F 7 L H ? T 1 1 5 L " $ 6 < 2
g , ( $ G . % & 7 # K , : g 7 . $ & 2 / > + % % & , . 2 + 7 , $ ' & ) ( . + , * + K & N $ 5 L b 0 K g K I . , & ) & 2 % I I ( = & N ( . G & ) $ 2 . , + # I $ 2 J J , ( % * * + K & 2 : L ^ g K I . , & ) & 2 ' & 8 ( I ( / + ; ; & & / * + K & N $ 5 L a 7 , g % , + ( . $ % I * G f % , ( & N & I / ( % ( I K , $ ' & ) ( . + , * + K & N $ 5 L Y g . , ( + Q 2 * + K > + J , ( I I & M , $ ' & ) ( . + , * + K & N $ 5 L ` 0 K g . , ( + Q 2 * + K > + % % & , > > ( . 0 K , $ ' & ) ( . + , * + K & N $ 5 L [ g . , ( + Q 2 * + K > + % % & , ' & K , $ ' & ) ( . + , * + K & N $ 5 L H 3 K g . , ( + Q 2 * + K > + 7 . ; 2 $ K , $ ' & ) ( . + , * + K & N $ 5 L " 9 " % & 5 9 # ; : , t s y C s ’ r e k a , ( $ 2 . 0 & I ) % * A F & 2 * . G * 2 , + ' , & . % * ( ; & , ) + 2 . % $ F % ( . ( % + K A f % ( . ( I * I I & ; + . $ ; & ? e > ? F $ ; < F : ( 9 & 9 % " 8 6 & . 7 6 & 5 " # 4 # 3 3 & . K I M + I 0 > & % $ & 2 ) & ? ; L β : 0 F B + > ( ' & " % $ # " !
* 4 " 5 ( $ " )
Case of pleuritis and pericarditis. Case of costocondritis
)7%,+ 1"4*
.&33#4#"5&67 .&68"%9&9( 62M >? :?
6DF 2 ,&*;+,($F 2&2()$2'(.(%F 2*I;+,$2K &;/+I(%;F 2I&*2(.(%F >1VPF ?7+%.+)7+,'2(.(%F @+2.() P(%%&).(+,F ?+)$(,& :/*%& :;#95&%"9
:,K 2&I$.(+,%7(G +> G$(, .+ /2&$.7(,J +2 G+%(.(+,g "L 3+2 6DS $L 5$N& K+* ,+.()&' $,K 67+2.,&%% +> /2&$.7g /L D% .7& G$(, $%%+)($.&' M(.7 %M&$.(,Jg V$)(,J +> 7&$2.g )L 5$% .7& G$(, (;G2+N&' $>.&2 2&%.(,Jg HL 3+2 2&2()$2'(.(%S UG$(, 2&I$.&' .+ G+%(.(+,X $L 5$N& K+* 2&)&,.IK %*>>&2&' >2+; >I* U2*,,K ,+%&F M$.&2K &K&%F %+2& .72+$.F >&N&2F >$.(J*&Xg [L 3+2 2,&*;+,($S $L 5$N& K+* &N&2 /&&, &CG+%&' .+ $,K/+'K M(.7 %(;(I$2 )+;GI$(,.%g /L 5$N& K+* %*>>&2&' >2+; )+*J7 2&)&,.IKg `L 3+2 21S $L 5$N& K+* ,+.()&' )$I> G$(, +2 %M&II(,Jg DO you have pain when you walk /L 5$N& K+* /&&, (;;+/(I(8&' 2&)&,.IKg )L :2& K+* *%(,J W2$I #+,.2$)&G.(N& =(II% 2&)&,.IKg Any problem breathing? YL 3+2 2I&*2(.(%S UG$(, 2&I$.&' .+ /2&$.7(,JX Are you anxious about anything aL 3+2 >1VPS $L 5$N& K+* ,+.()&' $,K /*2,(,J %&,%$.(+, (, K+*2 )7&%. +2 )7$,J& (, .$%.& +> K+*2 ;+*.7g ^L 3+2 ?7+%.+)7+,'2(.(%S UG$(, 2&I$.&' .+ .+*)7(,J +2 G2&%%(,JX bL 3+2 @+2.() P(%%&).(+,S U5?TX _L 3+2 ?+)$(,& :/*%&S 2<6$
"L 511T? HL 7,%G&).F 2$IG$.&F 3WAF ;oman’s sign, 2*I%&%F [L #e6 $,' =*I;+,$2K &C$; 0"=#95&865&%"9
"L HL [L `L YL
#Z# M(.7 '(>>&2&,.($IF 6f1 1REF #$2'($) 1,8K;&% #mV Pd'(;&2 $,' 3P=%F P+GGI&2 @f6 :2.&2(+J2$G7K $,' e&,+J2$G7K "b
5"$14+"+4'*, .&33#4#"5&67 .&68"%9&9( ?? C@>@8 +2 N? @ C@8 2>B
?$2'($) :227K.7;($F ?$>>&(,&F C&N&2F @,C(&.Kf=$,() P(%+2'&2F 5KG+>IK)&;($F @,&;($F 5KG&287K2+('(%;L
W3P=:: -*&%.(+,%L "L 3+2 ?$2'($) :227K.7;($S $L 5$N& K+* ,+.()&' $,K )7&%. G$(,g 6WZg V$)(,J +> 7&$2.g 60(GG&' /&$.%g 6M&$.(,Jg HL 3+2 ?$>>&(,&S $L P+ K+* )+,%*;& )$>>&(,$.&' /&N&2$J&%g D> K&%F .7&, $%0 7+M ;*)7g [L 3+2 C&N&2S `L 3+2 @,C(&.Kf=$,() P(%+2'&2S $L D% .7&2& $,K &N&,. $%%+)($.&' M(.7 .7& 2$)(,J +> 7&$2.g /L P+&% K+*2 /2&$.7(,J 2$.& (,)2&$%& +2 >&&I %7+2.,&%% +> /2&$.7 '*2(,J .7& &G(%+'&g )L P+ K+* >&&I '(88K '*2(,J .7& &G(%+'&g YL 3+2 5KG+>IK)&;($S $L P+ K+* 7$N& $ 5C +> 5(J7 /I++' %*J$2 I&N&Ig /L 5$N& K+* %0(GG&' ;&$I%g W2 )7$,J&' $,K '+%& +2 ;&'()$.(+,% 2&)&,.IKg aL 3+2 @,&;($S Have you noticed any change in your stool color…. 2. what is your diet consist of 3. craving for ice $L 5$N& K+* ,+.()&' $,K )7$,J& +> %0(, )+I+2g /L 5$N& K+* ,+.()&' 6WZ +, &C&2.(+,g )L 5$N& K+* ,+.()&' /I&&'(,J U&C)&%%(N&d>+2 ;&,%&%X >2+; $,K %(.& +> .7& /+'Kg ^L 3+2 5KG&287K2+('(%;S U?&;G (,.+I&2$,)&F Z+M&I ;+N&;&,.X $L 5$N& K+* ,+.()&' 2$)(,J +> 7&$2.g /L 5$N& K+* ,+.()&' $,K %0(, )7$,J&%g )L 5$N& K+* ,+.()&' $,K .2&;+2% +> 7$,'%g 2<6$
"L 511T? HL 7,%G&).F 2$IG$.&F 3WAF ;oman’s sign, 2*I%&%F [L #e6 $,' =*I;+,$2K &C$; 0"=#95&865&%"9
"L HL [L `L YL
#Z# M(.7 '(>>&2&,.($IF 6f1 1REF #$2'($) 1,8K;&% 5+I.&2 A+,(.+2(,J Z6B ?65F ?[ 9 ?` L
"_
-*A4%+B .&33#4#"5&67 .&68"%9&9( 2@2@ ;?> 08B
2 $,() P(%+2'&2F @)*.& %.2&%% 9 2?6PF @'Q*%.;&,.F ;KG+)7+,'2($%(%F ?$>>&(,&F >:PF 0*/%.$,)& :/*%&F 5KG&287K2+('(%;L cardiac arythmia
W3P=:: -*&%.(+,%L "L 3+2 2$,() P(%+2'&2S $L D% .7&2& $,K G$2.()*I$2 &N&,. $%%+)($.&' M(.7 .7& 2$)(,J +> 7&$2.g /L P+&% K+*2 /2&$.7(,J 2$.& (,)2&$%& '*2(,J .7& &G(%+'&g )L P+ K+* >&&I '(88K '*2(,J .7& &G(%+'&g HL 3+2 @)*.& %.2&%%S Uo" ;+,.7%X $L 5$N& K+* &CG&2(&,)&' $,K .2$J() &N&,.f$))('&,. (, .7& G$%.g O7&,g /L 5$N& K+* &CG&2(&,)&' ,(J7.;$2&% 2&)&,.IKg )L 5$N& K+* &CG&2(&,)&' >I$%7/$)0%g [L 3+2 2?6PS Uk" ;+,.7X any recent trauma $L 5$N& K+* &CG&2(&,)&' ,(J7.;$2&% 2&)&,.IKg /L 5$N& K+* &CG&2(&,)&' >I$%7/$)0%g `L 3+2 @'Q*%.;&,.S U6.2&%%F ?(;& ;+2& .7$, " ;+,.7X YL 3+2 ;KG+)7+,'2($%(%S U&C)&%%(N& G2&+))*G$.(+, M(.7 '(%&$%&X aL 3+2 ?$>>&(,&S $L P+ K+* )+,%*;& )$>>&(,$.&' /&N&2$J&%g D> K&%F .7&, $%0 7+M ;*)7g ^L 3+2 >:PS $L P+ K+* >&&I M+22(&' $/+*. %+;&.7(,J (, G$2.()*I$2 +2 J&,&2$IIK $/+*. &N&2K.7(,Jg bL 3+2 0*/%.$,)& :/*%&S _L 3+2 5KG&287K2+('(%;S U?&;G (,.+I&2$,)&F Z+M&I ;+N&;&,.X $L 5$N& K+* ,+.()&' 2$)(,J +> 7&$2.g /L 5$N& K+* ,+.()&' $,K %0(, )7$,J&%g )L 5$N& K+* ,+.()&' $,K .2&;+2% +> 7$,'%g 2<6$
"L 511T? HL #e6 $,' =*I;+,$2K &C$; 0"=#95&865&%"9 EKG, Holter monitoring
"L #Z# M(.7 '(>>&2&,.($IF 6f1 HL ?65F ?[ 9 ?`L [L @2(,& .+C()+I+JK %)2&&,L
H\
in ALL CHRONIC COUGH ask about TB and HIV
)'/C7 .&33#4#"5&67 .&68"%9&9( @<@% C6>F ?N@ 2O 8B ZF ?:F <2+,)7(&).$%(%
T+,d=2+'*).(N&S @.KG()$I =,&*;+,($F :)*.& <2+,)7(.(%F @%.7;$ C(/2+%(%F 6&'()$.(+,%F >1VPL =2+'*).(N& M(.7+*. ZI++'S ?W=PF ?#3F @%G(2$.(+,F 2 ,&*;+,($ U.KG()$IXL =2+'*).(N& M(.7 ZI++'S 8LZ U=1T? -%XF ?: B*,JF <2+,)7(&).$%(%L p 6(,)& :%.7;$ $,' Z2+,)7(.(% )$, G2&%&,. (, $,K >+2 %+ (. (% G2*'&,. .+ $%0 .7&(2 2&I$.&' 4*&%.(+,% (, $II .KG&% +> )+*J7L :;#95&%"9
D% .7& )+*J7 $%%+)($.&' M(.7 =7I&J; G2+'*).(+,g D> K&%F .7&, @
Any dripping sensation in your throat
@;+*,. runny nose =7I&J; J'+2 "X E$*L2,$'%/+FP) ?$%Q#H $X 3+2 @.KG()$I =,&*;+,($S U3&N&2 lX :I%+ $%0 $/+*. J2$'&F )+,.(,*+*%f(,.&2;(..&,.F )7(II% &.)L /X 3+2 :)*.& <2+,)7(.(%S U3&N&2 dX (X 5$N& K+* 2&)&,.IK %*>>&2&' >2+; >I* U2*,,K ,+%&F M$.&2K &K&%F %+2& .72+$.F >&N&2F >$.(J*&Xg )X 3+2 @%.7;$S UT(J7. .(;& $M$0&,(,J >+2 $%.7;$ (% $. P$M,X (X D% .7&2& $,K 2&I$.(+,%7(G M(.7 &C&2)(%& +2 M&$.7&2g Seasonal, weather, cold , exercise ((X P+ K+* 7$N& $,K G&.% $. 7+;&g (((X P+ K+* 7$N& .+ M$0& *G $. ,(J7. .+ )$.)7 /2&$.7g UD> K&%F .(;(,J $. ,(J7.X 'X 3+2 C(/2+%(%S (X O7$. '+ K+* '+ >+2 I(N(,Jg UW))*G$.(+,X ((X 5$N& K+* &N&2 /&&, &CG+%&' .+ 2$'($.(+, +2 )$,)&2 '2*J%g &X 3+2 6&'()$.(+,%S U:#1(f:VZ%X >X 3+2 >1VPS (X 5$N& K+* ,+.()&' $,K /*2,(,J %&,%$.(+, (, K+*2 )7&%. U ;&$2. Z*2,X +2 )7$,J& (, .$%.& +> K+*2 ;+*.7g NR 2,$'%/+FP)O E$* <&$$'G ?$%Q#H $X 3+2 ?W=PS (X 5$N& K+* ,+.()&' $,K 67+2.,&%% +> /2&$.7g ((X 5$N& K+* ,+.()&' $,K $/,+2;$I %+*,' M7(I& /2&$.7(,Jg /X 3+2 ?#3S UT(J7. .(;& $M$0&,(,J >+2 $%.7;$ (% $>.&2 >&M 7+*2% +> 6I&&GX (X P+ K+* 7$N& .+ *%& ;+2& G(II+M% .7$, *%*$Ig ((X P+ K+* 7$N& .+ M$0& *G $. ,(J7. .+ )$.)7 /2&$.7g UD> K&%F .(;(,J $. ,(J7.X (((X 5$N& K+* ,+.()&' $,K %M&II(,J +> K+*2 >&&.g )X 3+2 @%G(2$.(+,S U:I)+7+I() G&2%+, (% $ 2(%0 >$).+2X (X 5$N& K+* &CG&2(&,)&' $,K I+%% +> )+,%)(+*%,&%% 2&)&,.IKg ((X 5$N& K+* ,+.()&' $,K '(>>()*I.K %M$II+M(,J U6.2+0&Xg
H"
'X 3+2 2,&*;+,($S U3&N&2X (X 5$N& K+* &N&2 /&&, &CG+%&' .+ $,K/+'K M(.7 %(;(I$2 )+;GI$(,.%g ((X D> %G*.*; lF .7&, @ K&%F .7&, 2&%*I.L ((X 5$N& K+* &N&2 /&&, =CG+%&' .+ $,K/+'K M(.7 %(;(I$2 )+;GI$(,.%g (((X 5$N& K+* &CG&2(&,)&' E(J7. %M&$.%g (NX 5$N& K+* 82$N&II&' 2&)&,.IK U.+ &,'&;() $2&$%Xg /X 3+2 ?: B*,JS U6;+0(,JF O&(J7. I+%%F :GG&.(.&X )X 3+2 <2+,)7(&).$%(%S (X PW K+* 7$N& .+ $%%*;& $ %G&)(>() G+%(.(+, .+ G2+'*)& G7I&J;g 2<6$
"L 511T? HL #e6 $,' =*I;+,$2K 1C$; 0"=#95&865&%"9
"L HL [L `L YL aL
6G*.*; %.$(,F $,' )*I.*2&L #Z# M(.7 P(>>&2&,.($IF 6f1L ZI++' #*I.*2& #mV #? %)$, #7&%.L Z:BL
Use tissue when you cough
HH
9D8 .&33#4#"5&67 .&68"%9&9( T?@2RN C@8B
?W=PF ?#3F @%G(2$.(+,F @%.7;$F 2,&*;+,($F 2*I;+,$2K 1;/+I(%;F C(/2+%(%F @,&;($F 8Z
W3P=:: 4*&%.(+,% "L 3+2 ?W=PS $L 5$N& K+* ,+.()&' $,K 67+2.,&%% +> /2&$.7g /L 5$N& K+* ,+.()&' $,K $/,+2;$I %+*,' M7(I& /2&$.7(,Jg HL 3+2 ?#3S UT(J7. .(;& $M$0&,(,J >+2 $%.7;$ (% $>.&2 >&M 7+*2% +> 6I&&GX $L P+ K+* 7$N& .+ *%& ;+2& G(II+M% .7$, *%*$Ig /L P+ K+* 7$N& .+ M$0& *G $. ,(J7. .+ )$.)7 /2&$.7g UD> K&%F .(;(,J $. ,(J7.X )L 5$N& K+* ,+.()&' $,K %M&II(,J +> K+*2 >&&.g [L 3+2 @%G(2$.(+,S U:I)+7+I() G&2%+, (% $ 2(%0 >$).+2X $L 5$N& K+* &CG&2(&,)&' $,K I+%% +> )+,%)(+*%,&%% 2&)&,.IKg /L 5$N& K+* ,+.()&' $,K '(>>()*I.K %M$II+M(,J U6.2+0&Xg `L 3+2 @%.7;$S UT(J7. .(;& $M$0&,(,J >+2 $%.7;$ (% $. P$M,X $L D% .7&2& $,K 2&I$.(+,%7(G M(.7 &C&2)(%& +2 M&$.7&2g /L P+ K+* 7$N& $,K G&.% $. 7+;&g )L P+ K+* 7$N& .+ M$0& *G $. ,(J7. .+ )$.)7 /2&$.7g UD> K&%F .(;(,J $. ,(J7.X YL 3+2 2,&*;+,($S U3&N&2lX :I%+ $%0 $/+*. J2$'&F )+,.(,*+*%f(,.&2;(..&,.F )7(II% &.)L $L 5$N& K+* &N&2 /&&, &CG+%&' .+ $,K/+'K M(.7 %(;(I$2 )+;GI$(,.%g /L D> %G*.*; lF .7&, @ G$(, +2 %M&II(,Jg /L 5$N& K+* /&&, (;;+/(I(8&' 2&)&,.IKg )L :2& K+* *%(,J W2$I #+,.2$)&G.(N& =(II% 2&)&,.IKg ^L 3+2 C(/2+%(%S 'L O7$. '+ K+* '+ >+2 I(N(,Jg UW))*G$.(+,X &L 5$N& K+* &N&2 /&&, &CG+%&' .+ 2$'($.(+, +2 )7&;+.7&2$G&*.() '2*J%g bL 3+2 @,&;($S $L 5$N& K+* ,+.()&' $,K )7$,J& +> %0(, )+I+2g /L 5$N& K+* ,+.()&' 6WZ +, &C&2.(+,g )L 5$N& K+* ,+.()&' &C)&%%(N& /I&&'(,J >2+; $,K %(.& +> .7& /+'Kg _L 3+2 8BZS $L O7&, M$% K+*2 I$%. 2=PfA+,.&*Cg D> K&%F .7&, 2&%*I.L /L 5$N& K+* &N&2 /&&, =CG+%&' .+ $,K/+'K M(.7 %(;(I$2 )+;GI$(,.%g )L 5$N& K+* &CG&2(&,)&' E(J7. %M&$.%g 'L 5$N& K+* 82$N&II&' 2&)&,.IK U.+ &,'&;() $2&$%Xg 2<6$
"L 511T? HL #e6 $,' =*I;+,$2K 1C$; H[
0"=#95&865&%"9
"L HL [L `L YL aL ^L
6G*.*; %.$(,F $,' )*I.*2&L #Z# M(.7 P(>>&2&,.($IF 6f1L =13VL 6G*.*; %.$(, $,' )*I.*2&L ZI++' #*I.*2& #mV 6G(2$I #? %)$, #7&%.L
H`
Throat discomfort—> what you mean if Voice change : Hoarsness.. Otherwise Soar Throat
9'2% !72'"+ .&33#4#"5&67 .&68"%9&9( 2;7>E0
2 7$2K,J(.(%F ;DeF 7,>&).(+*% A+,+,*)I&+%(%F >1VPF =+%. E$%$I P(%)7$2J&F 0)$2I&. 3&N&2L :;#95&%"9
5$N& K+* ,+.()&' $,K G$(, +, %M$II+M(,Jg 5$N& K+* ,+.()&' $,K %M&II(,J% (, ,&)0g P+ K+* 7$N& .+ )I&$2 K+*2 .72+$. >2&4*&,.IKg "L 3+2 27$2K,J(.(%S Facial pain. swelling in neck, dysphagia, rheumatic: change in urine color, joint pain and rash $L 5$N& K+* ,+.()&' $,K G$(, +2 >*II,&%% (, &$2g /L 5$N& K+* ,+.()&' $,K 2&',&%% +2 '(%)7$2J& >2+; &K&%g HL 3+2 ;DeS UDe '2*J $/*%&F 3$.(J*&F 6&C*$I /&7$N(+2X [L 3+2 7AS $L 5$N& K+* &N&2 /&&, &CG+%&' .+ $,K/+'K M(.7 %(;(I$2 )+;GI$(,.%g /L P+ K+* >&&I ;+2& .(2&' .7$, *%*$Ig )L 5$N& K+* ,+.()&' $,K >*II,&%% +2 G$(, (, /&IIKg `L 3+2 >1VPS $L 5$N& K+* ,+.()&' $,K /*2,(,J %&,%$.(+, (, K+*2 )7&%.g W2 )7$,J& (, .$%.& +> K+*2 ;+*.7g YL 3+2 =+%. E$%$I P2(GS $L 5$N& K+* ,+.()&' ,$%$I %.(>>,&%%g /L 5$N& K+* ,+.()&' 2&)*22&,. )+*J7g aL 3+2 0)$2I&. 3&N&2S $L 5$N& K+* ,+.()&' $,K 2$%7 +, .7& /+'Kg 2<6$
"L HL [L `L
511T? 7,%G&).F 2$IG$.&F U6(,*% ?&,'&2,&%%X #e6 $,' =*I;+,$2K &C$; :/'+;(,$I 1C$; U>+2 6GI&,+;&J$IKX 0"=#95&865&%"9
"L HL [L `L YL aL ^L
#Z# M(.7 '(>>&2&,.($IF 6f1for mononucleosis: peripheral smear 16V V$G(' 6.2&G ?&%. SEXUAL HISTORY IS VERY IMP. A+,+%G+. ?&%. Closure: always advise safe sex & avoid contact sport 1BD6: O&%.&2, ZI+. 1,'+%)+GK
HY
growth on your voice box or over use of it. Ask: hospitalization: any procedure undergoing involving yur food pipe or wind pipe
@'"2,%*%,,
.&33#4#"5&67 .&68"%9&9( 26 (#!6#, ?@2 ./ A>;B
2 7$2K,J(.(%F 6(.2$I 6.&,+%(%F ?$,)&2F @/*%&f+N&2 *%&F 2+IKGF A$2K,J(.(%F >1VPF ;KG+.7K2+('(%;L
5$N& K+* ,+.()&' G$(, M7(I& %G&$0(,Jg "L 3+2 27$2K,J(.(%S U=$(,>*IX $L 5$N& K+* ,+.()&' $,K G$(, +2 >*II,&%% (, &$2g /L 5$N& K+* ,+.()&' $,K 2&',&%% +2 '(%)7$2J& >2+; &K&%g HL 3+2 6(.2$I 6.&,+%(%S U=$(,I&%%X $L 5$N& K+* ,+.()&' $,K 67+2.,&%% +> Z2&$.7g /L 5$N& K+* ,+.()&' $,K '(>>()*I.K (, %M$II+M(,Jg )L P+ K+* 7$N& $ 5C +> 27&*;$.() >&N&2g [L 3+2 B$2K,J&$I ?:S U=$(,>*IXd6;+0(,J $,' :I)+7+I *%&L `L 3+2 @/*%&f+N&2*%&S U=$(,>*IXd=2+>&%%(+, YL 3+2 2+IKGS U=$(,I&%%X aL 3+2 A$2K,J(.(%S U=$(,>*IX $L 5$N& K+* 2&)&,.IK %*>>&2&' >2+; >I* U2*,,K ,+%&F M$.&2K &K&%F %+2& .72+$.Xg ^L 3+2 >1VPS U=$(,>*IXS $L 5$N& K+* ,+.()&' $,K /*2,(,J %&,%$.(+, (, K+*2 )7&%. U ;&$2. Z*2,X +2 )7$,J& (, .$%.& +> K+*2 ;+*.7g bL 3+2 ;KG+.7K2+('(%; U=$(,I&%%XS U#+I' D,.+I&2$,)&X $L 5$N& K+* ,+.()&' $,K )7$,J&% (, %0(,g /L 5$N& K+* ,+.()&' $,K )7$,J&% (, /+M&I ;+N&;&,.g 2<6$
"L 511T? l ?7K2+(' HL #e6 1C$; 0"=#95&865&%"9
"L HL [L `L YL
#Z# M(.7 '(>>&2&,.($IF 6f1L ?65F ?[ 9 ?`L 1#5WF 1REL ?72+$. %M$/L #? %)$, )7&%.L
Ha
E"/*.4<% .&33#4#"5&67 .&68"%9&9( J ?@I@
J/%.2*).(N& c$*,'()&F ?7+I$,J(.(%F @I)+7+IF I(2$I 5&G$.(.(%F @*.+(;;*,&L -% $2& U=83B :;#95&%"9
"L HL [L `L YL aL ^L bL
O7$. (% .7& ?+I+*2 +> K+*2 %.++I%gUP$20 +2 B(J7.X O7$. (% .7& ?+I+*2 +> K+*2 *2(,&gUP$20 +2 B(J7.X 5$N& K+* ,+.()&' $,K 7.)7(,J +> .7& /+'Kg 5$N& K+* ,+.()&' $,K 2$(,f'(%.&,%(+, +> K+*2 /&IIKg 5$N& K+* ,+.()&' $,K G$(, (, U+(,.%g 5$N& K+* =$.&, +*. 2&)&,.IKg 5$N& K+* ,+.()&' $,K 82$N&I&' 2&)&,.IKg 5$N& K+* ,+.()&' $,K 3&I$.(+,%7(G +> G$(, .+ ;&$I%g 2<6$
"L 511T? HL GIT exam (Murphy’s) [L #e6 0"=#95&865&%"9
"L HL [L `L YL aL ^L
V&).$I 9 =&IN() 1C$; 6.++I >+2 +))*I. /I++' :B?f:6?fZ(I(2*/(,f:B= @f6 :/'+;&, :,.( 5:eF 5Z%:JF :,.(d5#eL 1V#= 5DP: %)$,
H^
@%3"+/24" F BUN SHIP
.&33#4#"5&67 .&68"%9&9( ;788=30B
;&;$.+I+J() )$*%&%F 7,>&).(+,%O 8,$*;$F 8*;+2 U./3(1*./= >FGXF =C&2)(%&F 3&,$IF 0.+,&L :;#95&%"9
D% .7& /I++' /&>+2&F ;(C&' +2 $>.&2 *2(,$.(+,g 5$N& K+* &CG&2(&,)&' $,K %+2& .72+$. 2&)&,.IKg 5$N& K+* %.$2.&' $,K ;&'()$.(+,% 2&)&,.IKg U#K)I+G7+%G7$;('& &.)X "L 3+2 ;&;$.+I+J() #$*%&%S $L 5$N& K+* ,+.()&' /I&&'(,J >2+; $,K +.7&2 %(.& +> .7& /+'Kg /L P+ K+* 7$N& $,K 7(%.+2K +> &$%K /2*(%(,Jg HL 3+2 7,>&).(+,f@?DS $L P+ K+* 7$N& .+ G$%% *2(,& ;+2& >2&4*&,.IK .7$, *%*$Ig /L 5$N& K+* ,+.()&' $,K .2+*/I& 7+I'(,J *2(,& +2 '+ K+* 7$N& .+ 2*%7 .+ *2(,$.&g )L 5$N& K+* ,+.()&' $,K /*2,(,J %&,%$.(+, M7(I& *2(,$.(,Jg 'L 5$N& K+* ,+.()&' $,K G$(, (, K+*2 /&IIKg D> K&%F .7&, $%0 W3P=BD-V::L [L 3+2 8*;+2 U(,)I*'(,J Z=5XS U6;+0(,JX $L P+ K+* 7$N& .+ %.2$(, '*2(,J ;().*2(.(+,g /L 5$N& K+* ,+.()&' $,K )7$,J& (, *2(,$2K %.2&$;g )L P+ K+* 7$N& .+ M$0& *G $. ,(J7. .+ *2(,$.&g 'L P+ K+* >&&I $ %&,%& +> /I$''&2 >*II,&%% &N&, $>.&2 G$%%(,J *2(,&g `L 3+2 82$*;$S YL 3+2 =C&2)(%&S UO7$. $JJ2$N$.&%gX aL 3+2 3&,$I UEI+;&2*I+,&G72(.(%XS $L 5$N& K+* ,+.()&' $,K %M&II(,J +, K+*2 /+'Kg /L 5$N& K+* ,+.()&' $,K c+(,. G$(, +2 2$%7 +, K+*2 /+'Kg ^L 3+2 V&,$I 0.+,&%S $L P+ K+* 7$N& $,K 5(%.+2K +> 0(',&K %.+,&%g 2<6$
"L 511T? HL ED? &C$; l V&,$I =*,)7 >+2 #e: .&,'&2,&%% [L #e6
BACK FOR RENAL PUNCH
0"=#95&865&%"9
"L HL [L `L YL aL
V&).$I 1C$; @2(,$IK%(%F @2(,& %.$(, $,' #*I.*2& @f6 $,' #? :/'+;&, Z@TS #2 #Z# M(.7 P(>>&2&,.($IF =? $,' :=?? #K%.+%)+GK Hb
8/2*4*C F4<+/24+4'* .&33#4#"5&67 .&68"%9&9( 2@24 )/ ?8IB
CUPID: F2 PUB.??
2 K&I+,&G72(.(%F @II&2J()fD22(.$.(+,$IF 22+%.$.(.(%F 42&.72(.(%F ?K%.(.(%F 82$*;$F I*IN+N$J(,(.(%L
W3P= 4*&%.(+,%F P+ K+* 7$N& .+ *2(,$.& ;+2& >2&4*&,.IK .7$, *%*$Ig P+ K+* 7$N& .+ 2*%7 .+ *2(,$.&g "L 3+2 2K&I+,&G72(.(%S U3&N&2 M(.7 )7(II%F T$*%&$X $L 5$N& K+* ,+.()&' $,K G$(, (, K+*2 >I$,0%f/&IIKg D> l W3P=BD-V:: HL 3+2 @II&2J()fD22(.$.(+,$IS $L 5$N& K+* 2&)&,.IK )7$,J&' K+*2 )+,.2$)&G.(N& ;&.7+'g [L 3+2 22+%.$.(.(%S $L P+ K+* 7$N& $ 5C +> 2&)*22&,. *2(,$2K %K;G.+;%g /L 5$N& K+* ,+.()&' G$(, $2+*,' K+*2 J&,(.$I 2&J(+,g `L 3+2 42&.72(.(%S $L 5$N& K+* ,+.()&' $,K '(%)7$2J& (, *2(,&F D> K&% :Z#WL YL 3+2 ?K%.(.(%S $L 5$N& K+* ,+.()&' G$(, (, K+*2 UI+M&2X /&IIKg aL 3+2 82$*;$S ^L 3+2 I*IN+N$J(,(.(%S $L 5$N& K+* ,+.()&' $,K '(%)7$2J& >2+; N$J(,$g /L 5$N& K+* ,+.()&' $,K G$(, '*2(,J (,.&2)+*2%&g 2<6$
"L 511T? HL ED? &C$; l V&,$I =*,)7 >+2 #e: .&,'&2,&%% [L #e6 0"=#95&865&%"9
"L HL [L `L YL aL ^L
V&).$I 1C$; @2(,$IK%(%F @2(,& %.$(, $,' #*I.*2& #? :/'+;&, @f6 :/'+;&, Z@TS #2 #Z# M(.7 P(>>&2&,.($IL #K%.+%)+GK if latex allergy—> use latex free condom
H_
SOUND S: stress O: over flow U: urge N: NPH.&68"%9&9( 6+.+2 D,)+,.(,&,)&F JN&2>I+M (,)+,.(,&,)&F 0.2&%% (,)+,.(,&,)&F 42J& .&33#4#"5&67 D: DM
024*"2B G*<'*+4*%*<%
D,)+,.(,&,)&L W3P=:: 4*&%.(+,% P+ K+* )+,%*;& &C)&%%(N& >I*('%g 5$% (. (;G$(2&' G&2>+2;$,)& +> K+*2 '$(IK $).(N(.(&%g :2& K+* )+,%*;(,J ;+2& >I*('% .7$, *%*$Ig "L 3+2 6+.+2 D,)+,.(,&,)&S $L P+ K+* 7$N& .+ *2(,$.& ;+2& >2&4*&,.IK .7$, *%*$Ig /L P+ K+* 7$N& .+ 2*%7 .+ *2(,$.&g HL 3+2 JN&2>I+M (,)+,.(,&,)&S UPAX $L 5$N& K+* &N&2 %*>>&2&' $ .2$*;$ .+ K+*2 /$)0g /L 5$N& K+* ,+.()&' $,K K&$0,&%% +> K+*2 /+'Kg )L 5$N& K+* ,+.()&' $,K E*;/,&%% +2 8(,JI(,J +> K+*2 /+'Kg [L 3+2 0.2&%% (,)+,.(,&,)&S U5C +> ;*I.(GI& 6eP%F +2 5C +> G&IN() %*2J&2(&%X $L 5$N& K+* ,+.()&' G2+/I&; 7+I'(,J *2(,& M7(I& I$*J7(,JF )+*J7(,JF $,' %,&&8(,Jg `L 3+2 42J& D,)+,.(,&,)&S $L 5$N& K+* ,+.()&' I&$0$J& +> *2(,&F M7()7 >+II+M% $ %*''&, %.2+,J *2J&g 2<6$
"L 511T? HL ED? &C$; [L #e6 0"=#95&865&%"9
"L HL [L `L YL
V&).$I 1C$; @2(,$IK%(%F @2(,& %.$(, $,' #*I.*2& -d?(G @2+'K,$;() 6.*'(&% #K%.+%)+GK
[\
CAse of OSA with statin.
H"+4C/% in OPDaa An M3 Pg Delivered A Speech on Fatigue by Hypothyroidism
.&33#4#"5&67 .&68"%9&9( 7S6N2 @S:;: D 0heehan’s Syndrome.
7,>&).(+,% UHD>& G@I& @J8F 6$I(J,$,)KF 6K$%.7&,($ E2$N(%F @'Q*%.;&,. P(%+2'&2F @,&;($F @G,&$F :AF ;KG+.7K2+('(%;F :&G2&%%(+,L :;#95&%"9
JC:2 -*&%.(+,% 5$N& K+* ,+.()&' $,K G2+/I&; G&2>+2;(,J K+*2 '$(IK $).(N(.(&% &LJL /$.7(,JF '2&%%(,JF )++0(,J &.)Lg :,K &N&,. .7$. (% $%%+)($.&' .+ .7& G2+/I&;g
"L 3+2 7,>&).(+,%S $L ?LZS U=1T? -*&%.(+,%X Mononucleosis /L DLAS UDII )+,.$).F =$(, :/'+;&,X )L 5DeS UDII )+,.$).F De '2*J $/*%&F D22&%G+,%(/I& %&C*$I /&7$N(+2X HL 3+2 6K$%.7&,($ E2$N(%S $L 5+M '+&% (. G2+J2&%% '*2(,J .7& '$Kg /L 5$N& K+* ,+.()&' M&$0,&%% +> ;*%)I&% +2 '+*/I& N(%(+,g [L 3+2 U+))*I.X 6$I(J,$,)KS UO&(J7 I+%%X $L 5$N& K+* ,+.()&' $,K G$(, (, K+*2 /&IIKg `L 3+2 2?6PS U6I&&G )7$,J&%F 6.2&%%f ?2$*;$X $L 5$N& K+* &CG&2(&,)&' ,(J7.;$2&% 2&)&,.IKg YL 3+2 @G,&$S $L P+ K+* %,+2& $. ,(J7.g W2 7$% %+;&+,& .+I' K+*g feel sleepy during the day /L P+ K+* >&&I 2&%.I&%% $. ,(J7.g W2 7$% %+;&+,& .+I' K+*g aL 3+2 @,&;($S $L 5$N& K+* ,+.()&' $,K )7$,J& +> %0(, )+I+2g /L 5$N& K+* ,+.()&' 6WZ +, &C&2.(+,g )L 5$N& K+* ,+.()&' &C)&%%(N& /I&&'(,J >2+; $,K %(.& +> .7& /+'Kg ^L 3+2 @'Q*%.;&,.S U6.2&%%F ?(;& ;+2& .7$, " ;+,.7X bL 3+2 :&G2&%%(+,S U6++' l 07>=?@20 X _L 3+2 ;KG+.7K2+('(%;S U?&;G D,.+I&2$,)&F 60(, #7$,J&%F Z+M&I )7$,J&%X "\L 3+2 :($/&.&% A&II(.*%S $L P+ K+* >&&I ;+2& .7(2%.K .7$, *%*$Ig /L P+ K+* 7$N& .+ *2(,$.& ;+2& >2&4*&,.IK .7$, *%*$Ig ""L 3+2 0heehan’s Syndrome: $L O$% .7& '&I(N&2K ,+2;$Ig W2 .7&2& M$% $,K &C)&%%(N& /I&&'(,Jg /L 5$N& K+* /&&, $/I& .+ /2&$%.>&&' K+*2 )7(I'g U(,$/(I(.K .+ /2&$%. >&&'X Text
"L 511T? l ?7K2+(' 1C$; HL W2(&,.$.(+,
2<6$ 1st Pelvis and breast exam
Prolactin, FSH:LH…. MRI Brain…
["
Counselling: MEANWHILE I WILL KEEP U UNDER OBSERVATION
0"=#95&865&%"9
"L HL [L `L YL aL ^L bL _L
#Z# M(.7 '(>>&2&,.($IL ?65F ?[ $,' ?`L A+,+%G+. 1BD6: #mV Z6B :)&.KI)7+I(,& 2&)&G.+2 $,.(/+'KL #? %)$, Z2$(,L AVD Z2$(,L
[H
6F "*. @!? ('$$';I /1 :%0 $/+*. %K;G.+;% (, >+II+M(,J %K%.&;%L =K&F ;&$2.F 0.+;$)7F V(',&KF 2&2(,&*;F A&J%F C++.q E&*2+F D> 12&).(I& PK%>*,).(+,F .7&, $%0S 2%K)7+I+J()$I )$*%&%F I$%)*I$2F :&G2&%%(+,F :2*J%L 3+2 7+M I+,Jg ?$0(,J A&'%g #+;GI($,.g 6('& &>>&).%g #7&)0 Z6B 2&J*I$2IKg @,'&2 )+,.2+Ig B$%. 2&$'(,Jg B$%. N(%(. .+ '+).+2g O7$. M$% K+*2 I$%. 5Z: ") g "L 3+2 1K&%S $L 5$N& K+* ,+.()&' $,K )7$,J&% (, K+*2 N(%(+,g /L O7&, M$% K+* I$%. &K& )7&)0*Gg HL 3+2 5&$2.S U=$%. 5C +> ADF 6WZF =$)(,J +> 7&$2.F #7&%. G$(,F 6M&$.(,JX [L 3+2 =*I;+,$2KS U6WZX `L 3+2 ED?S UZ+M&I 7$/(.%F =+IKG7$J($F :/,+2;$I P(%)+;>+2.dE1VPX YL 3+2 E&,(.+*2(,$2KS U=+IK*2($F =+IK'(G%($X IMP aL 3+2 T&*2+S U=$%. 5C +> 6.2+0& +2 ?D:F KE8F 6G&&)7 +2 %M$II+M(,J '(>>()*I.KX ALSO DEPRESSION ^L 3+2 6&C*$IS $L 5$N& K+* ,+.()&' $,K )7$,J& (, K+*2 %&C*$I :&%(2&g /L 5$N& K+* ,+.()&' $,K )7$,J& (, K+*2 %&C*$I 2&2>+2;$,)&g D> K&%F .7&, $%0q )L 2 %K)7+I+J()$I )$*%&% (L O7&, '(' (. %.$2.g ((L 5+M (% .7& 2&I$.(+,%7(G M(.7 K+*2 %G+*%&g (((L P+ K+* 7$N& ;+2,(,J &2&).(+,%g (NL W, $ %)$I& +> " .+ "\F M7&2& " /&(,J >I$))(' 9 a /&(,J $'&4*$.& >+2 G&,&.2$.(+,F 5+M '+ K+* J2$'& K+*2 &2&).(+,g NL :2& K+* *,'&2 $,K %+2. +> &C)&%%(N& %.2&%% .7&%& '$K%g 'L I$%)*I$2 )$*%&%S (L 5$N& K+* ,+.()&' $,K G$(, (, K+*2 I&J%g ((L 5$N& K+* ,+.()&' $,K K&$0,&%% +> K+*2 /+'Kg (((L 5$N& K+* ,+.()&' $,K E*;/,&%% +2 8(,JI(,J +> K+*2 /+'Kg &L :&G2&%%(+, U6++' l 07>=?@20 X >L A&'()$.(+,% U$2& K+* .$0(,J $,K '2*J%gX JL 5KG+J+,$'(%;S U'&%(2& (%%*&X (L P+ K+* 7$N& ,+2;$I G*/() $,' $C(II$2K 7$(2g 2<6$
"L 511T? l 3*,'+%)+GK HL #e6 1C$;
Carotid bruit fundoscopy
Cranial nerve
0"=#95&865&%"9
"L HL [L `L
Walk on even ground, keep foot
#Z# M(.7 '(>>&2&,.($IL also Cardiac..: EKG & Enzyme clean regular checkup #mV Dynamic cavernography regular labs Z6B $,' 5Z:") @2(,& >+2 A()2+ $I/*;(,F @2(,$IK%(%L
[[
THEN FRCS
52%IJ31$'B3%*+ JA"3 :%0 $/+*. %K;G.+;% (, >+II+M(,J %K%.&;%S ;&$'F =K&F =$2F E+%&F 6+*.7F E&)0F ;&$2.F 0.+;$)7F V(',&KF 2 &2(,&*;F =C.2&;(.(&%F C++.F 2%K)7($.2()F 00(,L 3+2 7+M I+,Jg ?$0(,J A&'%g #+;GI($,.g 6('& &>>&).%g #7&)0 Z6B 2&J*I$2IKg @,'&2 )+,.2+Ig B$%. 2&$'(,Jg B$%. N(%(. .+ '+).+2g O7$. M$% K+*2 I$%. 5Z: ") g "L 3+2 ;&$'S $L P+ K+* 7$N& $ 5C +> 7&$' .2$*;$g /L P+ K+* 7$N& $ 5C +> P(88(,&%%F BW#f >$(,.(,J %G&II%g )L P+ K+* 7$N& $ 5C +> 6.2+0& +2 ?D:g 'L P+ K+* 7$N& $ 5C +> %&(8*2&%g HL 3+2 =K&%S $L 5$N& K+* ,+.()&' $,K )7$,J&% (, K+*2 N(%(+,g [L 3+2 =$2S $L 5$N& K+* ,+.()&' $,K )7$,J&% (, K+*2 7&$2(,Jg /L 5$N& K+* ,+.()&' $,K G2+/I&; M(.7 K+*2 /$I$,)& +2 J$(.g `L 3+2 0(,*%S $L 5$N& K+* ,+.()&' )72+,() >$)($I G$(, +2 ,$%$I %.*>>(,&%%g YL 3+2 E&)0S $L 5$N& K+* ,+.()&' $,K G$(, +2 %M&II(,J% (, K+*2 ,&)0g aL 3+2 ;&$2.S U=$%. 5C +> ADF 6WZF =$)(,J +> 7&$2.F #7&%. G$(,F 6M&$.(,JX ^L 3+2 2*I;+,$2KS U6WZF #+*J7X bL 3+2 >D?S U=$(,F '(%.&,%(+,F Z+M&I 7$/(.%F =+IKG7$J($F :/,+2;$I P(%)+;>+2.dE1VPX _L 3+2 >&,(.+*2(,$2KS U=+IK*2($F =+IK'(G%($X "\L 3+2 J/%fE,$&S UBA= V? #e6 =:=X ""L 3+2 2%K)7($.2()S $L P+ K+* 7$N& $ 5C +> G%K)7($.2() (II,&%% +2 $';(%%(+,g "HL 3+2 00(,S $L 5$N& K+* ,+.()&' 2$%7 +2 $,K +.7&2 %0(, G2+/I&;%g 2<6$
"L 511T? HL #e6 1C$; 0"=#95&865&%"9
"L #Z# M(.7 '(>>&2&,.($I l 6f1L HL #mV [L @2(,$IK%(%L
[`
@%"."<7% .&33#4#"5&67 .&68"%9&9( 6N?< 3 0 N8M: >?B UA#Z +M,&2 7$' V&%(%.$,. 6?P% (, E#X
6(J2$(,&F 6&,(,J(.(%F ?I*%.&2 5&$'$)7&F <&,(J, D,.2$)2$,($I 5?TF 3&>2$).(N& &22+2%F 0:5F 0(,*%(.(%F 82$*;$F 8D:F 8*;+2F 8&,%(+, 5&$'$)7&F :&G2&%%(+,L :;#95&%"9
"L 3+2 6(J2$(,&S U@E2X $L 5$N& K+* ,+.()&' $,K *,*%*$I %K;G.+;% /&>+2& .7& +,%&. +> 7&$'$)7& U @*2$Xg /L P+ K+* >&&I E$*%&$.&' +2 I(0& N+;(.(,Jg )L :2& K+* $/,+2;$IIK %&,%(.(N& .+ I(J7.f%+*,'g 'L :,K 2&I$.(+,%7(G +> 7&$'$)7& .+ ;&,%&%g Text HL 3+2 6 &,(,J(.(%f1,)&G7$I(.(%S
[L
`L
YL aL
^L bL
_L
"\L ""L "HL "[L "`L
$L 5$N& K+* ,+.()&' $,K G$(, +2 %.(>>,&%% (, ,&)0g /L 5$N& K+* ,+.()&' $,K 2$%7 +, K+*2 /+'Kg 3+2 ?I*%.&2 5&$'$)7&S $L P+ K+* 7$N& $ 2*,,K ,+%&g /L 5$N& K+* ,+.()&' $,K 2&',&%% +2 '(%)7$2J& >2+; &K&%g W2 G$(, (, .7& /$)0 +> &K&%g Pseudotumor cereberi 3+2 <&,(J, D,.2$)2$,($I 5?TS $L 5$N& K+* ,+.()&' $,K )7$,J&% (, K+*2 N(%(+,g /L :2& K+* *%(,J W2$I #+,.2$)&G.(N& =(II% 2&)&,.IKg 3+2 3&>2$).(N& 122+2%S Ue(%(+, #7$,J&%X $L 5$N& K+* ,+.()&' $,K G$(, M(.7 2&$'(,J +2 )+,)&,.2$.(,Jg 3+2 0(,*%(.(%S UV*,,K ,+%&F 6+2& .72+$.X $L 5$N& K+* ,+.()&' $,K (, >$)&g /L 5$N& K+* ,+.()&' $,K 2&I$.(+,%7(G +> .(;(,J .+ .7& G$(,g UA+2,(,J +2 1N&,(,JX 3+2 0*/$2$)7,+(' 5&;+227$J&S UT&)0 6.(>>,&%%F e(%(+, #7$,J&%F T$*%&$f e+;(.(,JX 3+2 8&;G+2$I :2.&2(.(%S Ue(%(+, #7$,J&%F 3$.(J*&X $L 5$N& K+* ,+.()&' $,K G$(, M7(I& )7&M(,J +2 )+;/(,J 7$(2g /L 5$N& K+* ,+.()&' $,K ;*%)I& %.(>>,&%%g 3+2 8D:S UOT?F E$(.F e(%(+,X $L 5$N& K+* ,+.()&' $,K G2+/I&; %M$II+M(,Jg /L 5$N& K+* &N&2 I+%. )+,%)(+*%,&%%g 3+2 82$*;$f6*/'*2$I 5&;$.+;$S 3+2 8*;+2S UO&(J7. I+%%F :GG&.(.&F 3$;(IK 5CF T(J7. 7&$'$)7&X 3+2 8&,%(+, 5&$'$)7&S U1C)&%%(N& 6.2&%%F e$%& I(0& .(J7.&,(,JX 3+2 >I$*)+;$S Ue(%(+, #7$,J&%F =$(, (, &K&F G2&'(%G+%(,J >$).+2X 3+2 ?+)$(,& :/*%&S 2<6$
[Y
"L HL [L `L
511T? 7,%G&).F 2$IG$.&F U6(,*% ?&,'&2,&%%X #T6 M(.7 )2$,($I T&2N&% 3*,'+%)+GK 0"=#95&865&%"9
"L HL [L `L YL
#Z# M(.7 '(>>&2&,.($IF 6f1 16V #? 6)$, B= $,' :,$IK%(% e(%*$I :)*(.K
First let me learn as much as i can about your pain and then i will prescribe you the best medication i can for the pain
[a
H'2C%+(/$*%,, .&33#4#"5&67 .&68"%9&9( @E 0I: ./ ;N
@lzheimer’s, E+2;$I =2&%%*2& 5K'2+)&G7$I*%F 0*/'*2$I 7&;$.+;$F I$%)*I$2F :&G2&%%(+,F ;KG+.7K2+('(%;F ;untington’s chorea, Vitamin <"H P&>()(&,)KF A&MK Z+'K P&;&,.($L ABCD + Hair and Voice change
:;#95&%"9
JC:2O (, )$%& +> P&I(2(*;F $%0 :F:F (> P&;&,.($F .7&, $%0q
5$N& K+* ,+.()&' $,K G2+/I&; G&2>+2;(,J K+*2 '$(IK $).(N(.(&% &LJL /$.7(,JF '2&%%(,JF )++0(,J &.)Lg "L 3+2 @lzheimer’s Dementi$S U:J&F 3$;(IK 5CX HL 3+2 E+2;$I =2&%%*2& 5K'2+)&G7$I*%S $L 5$N& K+* ,+.()&' $,K )7$,J&% (, K+*2 J$(.g /L 5$N& K+* &N&2 G$%%&' *2(,& *,(,.&,.(+,$IIKg [L 3+2 0*/'*2$I 5&;$.+;$S $L P+ K+* 7$N& $,K 2&)&,. 5C +> >$II +2 .2$*;$ .+ 7&$'g `L 3+2 I$%)*I$2 P&;&,.($S $L 5$N& K+* ,+.()&' $,K K&$0,&%% +> K+*2 /+'Kg /L 5$N& K+* ,+.()&' $,K E*;/,&%% +2 8(,JI(,J +> K+*2 /+'Kg )L 5$N& K+* ,+.()&' $,K '(>>()*I.K M(.7 %G&&)7g YL 3+2 :&G2&%%(+,S U6++' l 07>=?@20 X $L 5+M (% K+*2 ;++' .7&%& '$K%g /L 5$N& K+* ,+.()&' $,K )7$,J&% (, K+*2 0I&&Gg D> K&%F $%0 $/+*. &$2IK ;+2,(,J $M$0&,(,Jg ?2+*/I& >$II(,J %I&&Gg 6.$K(,J 6I&&Gg )L P+ K+* &,Q+K .7& $).(N(.(&% .7$. K+* *%&' .+ &,Q+K G2&N(+*%IKg U 7,.&2&%.X 'L P+ K+* >&&I >*(I.K $/+*. $,K.7(,Jg &L P+ K+* >&&I $% =,&2J&.() $% /&>+2&g >L ?+,)&,.2$.(+, -%g 6&2($I ^% +2 %G&II /$)0M$2'%L JL 5$N& K+* ,+.()&' $,K )7$,J& (, K+*2 @GG&.(.&g 7L 2 %K)7+;+.+2 2&.$2'$.(+,g (L 5$N& K+* &N&2 .7+*J7. $/+*. 0*()('&g 5$N& K+* &N&2 GI$,,&' +2 $..&;G.&' %*()('&g aL 3+2 ;KG+.7K2+('(%;g U#+I' D,.+I&2$,)&X $L 5$N& K+* ,+.()&' $,K )7$,J&% (, %0(,g /L 5$N& K+* ,+.()&' $,K )7$,J&% (, /+M&I ;+N&;&,.g ^L For Huntington’s Chorea: (Family Hx) $L 5$N& K+* ,+.()&' $,K (,N+I*,.$2K Q&20(,J +2 M2(.7(,J ;+N&;&,.% U)7+2&$Xg /L 5$N& K+* ,+.()&' $,K (;G$(2&' J$(.F G+%.*2& $,' /$I$,)&g )L 5$N& K+* ,+.()&' $,K G2+/I&;% +2 '(>>()*I.K M(.7 %G&&)7g bL 3+2 e(.$;(, <"H P&>()(&,)KS $L O7$. '+&% K+*2 G2(;$2K '(&. )+;G2(%&% +>g /L 5$N& K+* ,+.()&' $,K $/,+2;$I %&,%$.(+, (, K+*2 7$,'% +2 >&&.g stiffness _L 3+2 A&MK Z+'K P&;&,.($S $L 5$N& K+* ,+.()&' $,K .2&;+2% (, K+*2 7$,'%g [^
/L 5$N& K+* ,+.()&' $,K %.(>>,&%% +> K+*2 /+'Kg )L 5$N& K+* ,+.()&' $,K %I+M(,J +> K+*2 /+'K ;+N&;&,.%g "\L 3+2 :&I(2(*;S :%0 P&7K'2$.(+, -% U5&$. %.2+0& +2 P($227&$X
2<6$
"L HL [L `L
CAROTID BRUIT AND fundo
511T? l 3*,'+%)+GK #e6 &C$; l W2.7+%.$.() %(J,% l :*%)*I.$.(+, #T6 &C$; UA+.+2F V&>I&C&%F 6&,%+2KF E$(.F AA61X D, AA61S $L E&,&2$I -*&%.(+,% U::W C [X (L O7$. (% K+*2 >*II ,$;&g ((L O7$. (% .7& '$.& .+'$Kg (((L O7&2& $2& K+* 2(J7. ,+Mg /L D;;&'($.& A&;+2KS (L T+M D M(II ,$;& [ +/Q&).% &LJL Z$.F A$.F $,' 5$.L ((L #$, K+* GI&$%& 2&G&$. .7$.g (((L =I&$%& 2&;&;/&2 $,' D M(II $%0 K+* I$.&2 +,L )L 67+2. ?&2; A&;+2KS (L O7$. '(' K+* 7$N& (, K+*2 I$%. ;&$I 'L B+,J ?&2; A&;+2KS (L O7&, '(' K+* J2$'*$.&f ;$22(&'g &L V&)$IIS (L #$, K+* GI&$%& 2&)$II .7+%& [ +/Q&).% >+2 ;&g >L #+,)&,.2$.(+,S (L Can you please spell “CAR” backwards? JL c*'J;&,.S (L D> .7&2& (% $ >(2& (, .7$. )+2,&2F M7$. M(II K+* '+g 0"=#95&865&%"9
"L HL [L `L YL
#Z# M(.7 '(>>&2&,.($IL ?65F ?[ $,' ?`L #? %)$, Z2$(,L VDRL/ RPR AVD Z2$(,L e(.$;(, Z"H I&N&IL
Don’t go unaccompained, Want to meet ypur family member and talk to socail worker to assist at home safety measures
[b
@%"24*C :',, POOD PALM
.&33#4#"5&67 .&68"%9&9( 2: )4 72A ./ ?J6@B
O(.7 Z$I$,)& =2+/I&;%q 2&2(IK;G7$.() 3(%.*I$F @)+*%.() T&*2+;$F A$/K2(,.7(.(%F 6eniere’s disease. O(.7+*. Z$I$,)& =2+/I&;%q 22&%/K)*%(%F :2*J%F 7,>&).(+,%F ?+)7I&$2 T&2N& P$;$J&F J.+%)I&2+%(%L W3P=B:: 4*&%.(+,% P+ K+* 7$N& $,K G2+/I&;% ;$(,.$(,(,J /$I$,)&g "L 3+2 2&2(IK;G7$.() 3(%.*I$S U?2$*;$ l Z$I$,)&X HL 3+2 @)+*%.() T&*2+;$S $L 5$N& K+* ,+.()&' $,K G2+/I&; (, I+)$I(8(,J %+*,'%g /L 5$N& K+* ,+.()&' $,K I&%(+,% +, K+*2 %0(,%g )L 5$N& K+* ,+.()&' $,K G2+/I&; M(.7 K+*2 J$(. +2 /$I$,)&g [L 3+2 A$/K2(,.7(.(%S U@VD l 5&$2(,J I+%% l Z$I$,)&X `L 3+2 6eniere’s disease: $L 5$N& K+* ,+.()&' $,K G$(, +2 >*II,&%% (, &$2g /L 5$N& K+* ,+.()&' $,K 2(,J(,J %+*,'% (, K+*2 &$2%g )L 5$N& K+* ,+.()&' $,K G2+/I&; M(.7 K+* /$I$,)&g YL 3+2 22&%/K)*%(%S U:J&X $L D% .7& 7&$2(,J I+%. >+2 $II %+*,'% +2 >+2 $,K %G&)(>() %+*,'%g W2 7&$2(,J M(.7 /$)0J2+*,' ,+(%&g /L 5$N& K+* ,+.()&' $,K G2+/I&; *,'&2%.$,'(,J %G&&)7g )L P+ .7& M+2' %+*,' Q*;/I&' +2 '(%.+2.&'g aL 3+2 :2*J%S ^L 3+2 7,>&).(+,%S $L 5$N& K+* ,+.()&' $,K &$2 G$(, +2 '(%)7$2J&g bL 3+2 ?+)7I&$2 T&2N& P$;$J&S $L :2& K+* &CG+%&' .+ I+*' %+*,'% $. 7+;& +2 M+20g _L 3+2 J.+%)I&2+%(%S U:J&F %.$2.% >2+; +,& &$2 $,' G2+J2&%%&% .+ +.7&2X $L 5$N& K+* ,+.()&' $,K G2+/I&; 7&$2(,J $ M7(%G&2g 2<6$
"L 511T? l O7(%G&2F Weber & Rhine’s test + Otoscopy HL #T6 1C$; U#&2&/&II$2 &C$; AV6=EX 0"=#95&865&%"9
"L HL [L `L YL
#Z# M(.7 '(>>&2&,.($I l 6f1L :*'(+;&.2K 9 ?K;G$,+;&.2KL #? %)$, Z2$(,L AVD Z2$(,L Z2$(,%.&; :*'(.+2K &N+0&' G+.&,.($I [_
aL ePVBL
64KK4*%,, LM%2+4C'N BV PALM
.&33#4#"5&67 .&68"%9&9(
O(.7+*. 5&$2(,J B+%%S <&,(J, =+%(.(+,$I e&2.(J+ O I)%.(/*I$2 T&*2+,(.(% O(.7 5&$2(,J B+%%S 6eniere’s diseaseO A$/K2(,.7(.(% O @)+*%.() T&*2+;$O 2&2(IK;G7$.() 3(%.*I$ :;#95&%"9
O7$. '+ K+* ;&$, /K '(88(,&%%g 5$N& K+* ,+.()&' $,K G2+/I&; (, 7&$2(,Jg 5$N& K+* &N&2 I+%. )+,%)(+*%,&%%g D> K&%F .7&, J+ .+ BW# )$%& +, ,&C. G$J&L "L 3+2 <&,(J, =+%(.(+,% e&2.(J+S $L 5$N& K+* ,+.()&' $,K 2&I$.(+,%7(G .+ G+%(.(+,g HL 3+2 I&%.(/*I$2 T&*2+,(.(%S UT$*%&$ l e+;(.(,JX $L 5$N& K+* 2&)&,.IK %*>>&2&' >2+; >I* U2*,,K ,+%&F M$.&2K &K&%F %+2& .72+$.F >&N&2F >$.(J*&Xg [L 3+2 6eniere’s Disease: $L 5$N& K+* ,+.()&' $,K 2(,J(,J %+*,'% (, K+*2 &$2%g /L 5$N& K+* ,+.()&' >*II,&%% +> K+*2 &$2%g `L 3+2 A$/K2(,.7(.(%S Ue&%.(/*I$2 T&*2+,(.(% l 5&$2(,J I+%%X YL 3+2 @)+*%.() T&*2+;$S U3$;(IK 5C l 7&$2(,J I+%% l M&(J7. I+%%f$GG&.(.&X $L 5$N& K+* ,+.()&' $,K G2+/I&; M(.7 K+*2 J$(.g /L 5$N& K+* ,+.()&' $,K I&%(+,% +, K+*2 %0(,%g aL 3+2 2&2(IK;G7$.() 3(%.*I$S $L 5$N& K+* ,+.()&' +2 7$N& $,K 7&$' .2$*;$g 2<6$
"L HEENT + Weber & Rhine’s test HL #T6 1C$; U#&2&/&II$2 &C$;X 0"=#95&865&%"9
"L HL [L `L
#Z# M(.7 '(>>&2&,.($I l 6f1L :*'(+;&.2KL #? %)$, Z2$(,L AVD Z2$(,L
don’t drive unaccompained fix for hearing aid
`\
64KK4*%,, L:D)N .&33#4#"5&67 .&68"%9&9( ;@: ?@6240B
;KG+JIK)&;($F @I)+7+I() O(.7'2$M$IF :&7K'2$.(+,fW2.7+%.$.() 5KG+.&,%(+,F ?$2'($) :227K.7;($%F @+2.() 6.&,+%(%F 6$%% #D=D& !+,3#,,& "12)$ F 2$,() $..$)0F 4,&CGI$(,&' #D=D I!,)6!=!( F 0&(8*2&% B :;#95&%"9
O7$. '+ K+* ;&$, /K '(88(,&%% +2 BW#g
any waning sign did you smell anything unusual
5$N& K+* &N&2 I+%. )+,%)(+*%,&%%g D> K&%F .7&, GI&$%& .&II ;& ;+2& $/+*. .7$.L O7+ M$% M(.7 K+*g O7$. M&2& K+* '+(,J M7&, (. 7$GG&,&'g 5+M I+,J '(' (. .$0& .+ 2&J$(, )+,%)(+*%,&%%g "L 3+2 ;KG+JIK)&;($S U%M&$.(,JF T$*%&$F 2$)(,J +> 7&$2.X $L P+ K+* 7$N& $ 5C +> 5(J7 /I++' %*J$2 I&N&Ig /L 5$N& K+* %0(GG&' ;&$I%g W2 )7$,J&' $,K '+%& +2 ;&'()$.(+,% 2&)&,.IKg HL 3+2 @I)+7+I() M(.7'2$M$IS U:%0 $/+*. $I)+7+I *%&X $L O7&, M$% K+* I$%. '2(,0g [L 3+2 :&7K'2$.(+,S U:6>X $L 5$N& K+* ,+.()&' $,K )7$,J&% (, /+M&I 7$/(.%g /L 5$N& K+* ,+.()&' $,K ;&'% +2 '+%$J&%g )L 5+M ;$,K G$'% '+ K+* *%& +, $ 7&$NK '$Kg `L 3+2 ?$2'($) :227K.7;($S $L 5$N& K+* ,+.()&' $,K )7&%. G$(,g 6WZg V$)(,J +> 7&$2.g 60(GG&' /&$.%g 6M&$.(,Jg YL 3+2 @+2.() 6.&,+%(%S U6WZF #7&%. G$(,X aL 3+2 6$%% UA$I(J,$,)KF :/%)&%%F BK;G7+;$XS $L 5$N& K+* ,+.()&' $,K K&$0,&%% +> K+*2 /+'Kg /L 5$N& K+* ,+.()&' $,K E*;/,&%% +2 8(,JI(,J +> K+*2 /+'Kg )L 5$N& K+* ,+.()&' $,K 7&$'$)7&g D> K&%F M7$. .(;& +> '$Kg ^L 3+2 2$,() :..$)0S U)7&%. G$(,F 6WZF 2$)(,J +> 7&$2.F T$*%&$F e+;(.(,JX $L 5+M '(' .7(% 7$GG&,F GI&$%& .&II ;& ;+2& $/+*. (.g bL 3+2 4,&CGI$(,&' Ue$%+N$J$I 6K,)+G&XS UT$*%&$F N+;(.(,JX $L 5+M '(' .7(% 7$GG&,F GI&$%& .&II ;& ;+2& $/+*. (.g _L 3+2 0&(8*2&% U@*087?XS $L P(' K+* ,+.()& $,K M$2,(,J %(J,% +2 $,K *,*%*$I %&,%$.(+,% /&>+2& G$%%(,J +*.g U @*2$X /L P(' $,K+,& ,+.()& Q&20K ;+N&;&,.%g U 07$0(,JX )L P(' K+* /(.& K+*2 8+,J*& M7(I& %7$0(,Jg 'L P(' K+* G$%% *2(,& M(.7+*. K+*2 0,+MI&'J&g &L O&2& K+* )+,>*%&' $>.&2 K+* 2&J$(,&' )+,%)(+*%,&%%g "\L 3+2 #+,N*I%(N& 6K,)+G&q ""L 3+2 A&.$/+I() '&2$,J&;&,. U1I&).2+IK.& (;/$I$,)& &.)LXS 2<6$
"L 511T? `"
HL #e6 1C$; [L #T6 1C$; UAA61X 0"=#95&865&%"9
"L HL [L `L YL
#Z# M(.7 '(>>&2&,.($I l 6f1L 1REF 1#5W Z6B #? %)$, Z2$(,L AVD Z2$(,L
Closure: don’t drive, carry your id c ard with you, don’t go out unaccompanied and void strenuous activities
`H
F%*,+2/"$ G22%C/$"24+4%, .&33#4#"5&67 .&68"%9&9( 2;@8@ 2==2@B
22&J,$,)K O ;KG&2G2+I$).(,&;($F @,+2&C($F 87K2+('F @,C(&.KF 2 2&;$.*2& +N$2($, >$(I*2&F =,'+;&.2(+%(%F =C&2)(%&F @%7&2;$, 6K,'2+;&F 2#W6L
WP=F BA= V? #e6 =:=L "L 3+2 22&J,$,)KH $L 5$N& K+* ,+.()&' $,K >*II,&%% +2 .&,'&2,&%% +> /2&$%.g HL 3+2 ;KG&2G2+I$).(,&;($S $L 5$N& K+* ,+.()&' $,K '(%)7$2J& >2+; .7& ,(GGI&%g /L 5$N& K+* ,+.()&' $,K )7$,J& (, K+*2 N(%(+, 2&)&,.IKg )L 5$N& K+* ,+.()&' $,K 7&$'$)7& 2&)&,.IKg 'L 5$N& K+* %.$2.&' $,K ,&M ;&'()$.(+,% 2&)&,.IKg [L 3+2 @,+2&C($S UM&(J7.f$GG&.(.& )7$,J&%X $L 5+M '+ K+* >&&I $/+*. .7(% G2+/I&;g /L 5+M '+ K+* >&&I $/+*. K+*2 G7K%()$I $GG&$2$,)&g `L 3+2 87K2+(' $L 5$N& K+* ,+.()&' $,K )7$,J&% (, K+*2 %0(, .&C.*2&g YL 3+2 @,C(&.KS $L :2& K+* *,'&2 $,K %+2. +> &C)&%%(N& %.2&%% .7&%& '$K%g aL 3+2 22&;$.*2& +N$2($, >$(I*2&S $L 5$N& K+* ,+.()&' %*''&, &G(%+'&% +> (,)2&$%&' M$2;.7 +2 %M&$.(,J +> .7& /+'Kg /L 5$N& K+* ,+.()&' $,K (.)7(,Jf'2K,&%% +> K+*2 J&,(.$I 2&J(+,g ^L 3+2 =,'+;&.2(+%(%S $L 5$N& K+* ,+.()&' $,K G$(, '*2(,J ;&,%.2*$.(+,g /L 5$N& K+* ,+.()&' $,K G$(, '*2(,J (,.&2)+*2%&g )L 5$N& K+* ,+.()&' $,K $/,+2;$I /I&&'(,J +2 /I&&'(,J (, /&.M&&, G&2(+'%g bL 3+2 =C&2)(%&S $L :2& K+* >+II+M(,J $ N(J+2+*% &C&2)(%& GI$, 2&)&,.IKg _L 3+2 @%7&2;$, 6K,'2+;&S $L 5$N& K+* &N&2 7$' $ JK,&)+I+J()$I G2+)&'*2& 2&)&,.IKg /L 5$N& K+* &N&2 7$' G2+/I&;% )+,)&(N(,Jg "\L 3+2 2#W6S $L 5$N& K+* ,+.()&' $,K &C)&%%(N& 7$(2 J2+M.7 2&)&,.IKg /L 5$N& K+* ,+.()&' $,K $/,+2;$I G(J;&,.$.(+, +> .7& /+'Kg 2<6$
"L 511T? HL :/'+;(,$I 1C$; 0"=#95&865&%"9
"L V&).$I 9 =&IN() 1C$; `[
HL [L `L YL aL
βd5#E #Z# M(.7 '(>>&2&,.($IF 6f1 365SB5 @f6 :/'+;&, #? 9 AVD Z2$(,L
Transvaginal u/s.. for fibroid and adenomysosis
Heavy menorrhagia—> Fibroids
``
5',+IF%*'1"/,"$ 8$%%.4*C .&33#4#"5&67 .&68"%9&9( 7?= 2@?8B
7,>&).(+,%F ?: #&2N(CF =,'+;&.2($I 5KG&2GI$%($F 2+IKGF @.2+G7() e$J(,(.(%F ?: 1,'+;&.2(*;F 82$*;$L
W3P=::F M7&, M$% K+*2 BA=g "L 3+2 7,>&).(+,%S U>&N&2 l G$(,X $L 5$N& K+* ,+.()&' $,K '(%)7$2J& >2+; N$J(,$g D> K&%F .7&, @.&2 (,.&2)+*2%&g [L 3+2 =,'+;&.2($I 5KG&2GI$%($S $L :2& K+* .$0(,J 5V?g `L 3+2 2+IKGS $L 5$N& K+* ,+.()&' $,K.7(,J )+;(,J +*. +> N$J(,$g YL 3+2 @.2+G7() e$J(,(.(%S $L 5$N& K+* ,+.()&' $,K /*2,(,J %&,%$.(+,g /L 5$N& K+* ,+.()&' $,K (.)7(,Jf'2K,&%% +> K+*2 J&,(.$I 2&J(+,g aL 3+2 ?: 1,'+;&.2(*;S $L 5$N& K+* ,+.()&' $,K G$(, (, K+*2 /&IIKg /L :2& K+* .$0(,J $,K ;&'()$.(+, >+2 ;&,+G$*%&g ^L 3+2 82$*;$S 2<6$
"L 511T? HL :/'+;(,$I 1C$; 0"=#95&865&%"9
"L HL [L `L YL aL ^L bL
V&).$I 9 =&IN() 1C$; βd5#E #Z# M(.7 '(>>&2&,.($IF 6f1 ZI++' #*I.*2& 365SB5 @f6 :/'+;&, =$G %;&$2 1,'+;&.2($I Z(+G%K
`Y
M"C4*"$ 64,<7"2C% .&33#4#"5&67 .&68"%9&9( 2I?@8 +2 @8I )/ 2?B
LMP RT CVS PAL.. + antibiotic/ sterioid+ Hx of DM.
@.2+G7() e$J(,(.(%F 82()7+;+,$%F Z$).&2($I I$J(,+%(%F 2DPF ?$,'('($I (,>&).(+,L
5$N& K+* ,+.()&' $,K 2&',&%% +2 (.)7(,J +> K+*2 J&,(.$I 2&J(+,g :%0 >+II+M(,J '&.$(I% $/+*. '(%)7$2J&S @;+*,. clot too! '(%)7$2J& J'+*2 "L 3+2 @.2+G7() e$J(,(.(%S $L 5$N& K+* ,+.()&' %*''&, &G(%+'&% +> (,)2&$%&' M$2;.7 +2 %M&$.(,J +> .7& /+'Kg /L 5$N& K+* ,+.()&' $,K (.)7(,Jf'2K,&%% +> K+*2 J&,(.$I 2&J(+,g HL 3+2 82()7+;+,$%S UA*I.(GI& %&C*$I G$2.,&2%F E2&&,(%7 '(%)7$2J&F ?2&$. ;$I& G$2.,&2X [L 3+2 Z$).&2($I I$J(,+%(%S UE2$K(%7 '(%)7$2J&X $L 5$N& K+* /&&, .$0(,J $,.(/(+.()% 2&)&,.IKg `L 3+2 2DPS U3&N&2X $L 5$N& K+* ,+.()&' $,K G$(, (, K+*2 /&IIKg YL 3+2 ?$,'('($I (,>&).(+,S U)*2' I(0& '(%)7$2J&X $L P+ K+* 7$N& $ 5C +> PAg /L 5$N& K+* /&&, *%(,J %.&2+('% 2&)&,.IKg 2<6$
"L 511T? HL :/'+;(,$I 1C$; 0"=#95&865&%"9
"L HL [L `L YL aL
V&).$I 9 =&IN() 1C$; P(%)7$2J& &C$; $,' #*I.*2& #Z# M(.7 '(>>&2&,.($IF 6f1 ZI++' #*I.*2& @f6 :/'+;&, =$G %;&$2
`a
6B,1"2%/*4" !"#$%"&'( A62 38 ?I0 2@2 9 :@?L: &%(2&O @/*%&O ?+,>I(). U.4 K L:MN A:O0XL .&33#4#"5&67 .&68"%9&9( 2IS @N?=B
2 &IN() .*;+2O I$J(,(%;*%O I*IN+'K,($O I*IN+N$J(,(.(% O @.2+G7() e$J(,(.(%F @(*%&F ?&2N()(.(%F =,'+;&.2(+%(%L :;#95&%"9
@/,#$" "$!/,.".)/!( ,"!"#2#/" 4)$ A%/!#B C+, 51#,".)/,D "L HL [L `L YL aL ^L bL _L "\L ""L "HL "[L "`L
O7&, M$% K+*2 AA=g O7&, M$% K+*2 >(2%. 6&,%.2*$I G&2(+' U6&,$2)7&Xg P+ K+* >&&I 2$(, '*2(,J (,.&2)+*2%& +2 '&>&)$.(+,g :2& K+*2 )K)I&% 3&J*I$2g 5+M ;$,K 8$;G+,%f=$'% '+ K+* *%& +, $ 7&$NK '$Kg 5$N& K+* ,+.()&' ?2$;GK G$(, '*2(,J ;&,%&%g 5$N& K+* ,+.()&' $,K I$J(,$I '(%)7$2J&g D> K&% @I(). M(.7 K+*2 G$2.,&2f7*%/$,'g D> K&%F .7&, 0@C= >@3: $L P+ K+* >&&I 0$>& $. 7+;&g /L :2& K+* @C2$(' +> nnnnnnnnng )L P+ K+* 7$N& $,K =;&2J&,)K U1C(.X GI$,g 'L P+ K+* 7$N& $ >*, $. 7+;&g &L D% K+*2 nnnnnnnnnn @I)+7+I()g >L 5+M (% .7& 3&I$.(+,%7(G +> K+*2 nnnnnnnnnnn M(.7 +.7&2%g JL P+ K+* >&&I :&G2&%%&' U6*()('$I ('&$.(+,Xg 2<6$
"L 511T? HL ED? $,' #e6 1C$; 0"=#95&865&%"9
"L HL [L `L YL
V&).$I 9 =&IN() 1C$;L #Z# M(.7 P(>>&2&,.($IF 6f1L 6.$(, $,' #*I.*2& +> P(%)7$2J&L @f6 :/'+;&, 9 #? %)$, :/'+;&,L B$G$2+%)+GKL `^
9$%%1 52'#$%3,OG*,'3*4" .&33#4#"5&67 .&68"%9&9( 0@:7??;B
SAD INSOMNICs
0.2&%%f:'Q*%.;&,.F W6@O :2*J%F 7II()(. P2*J *%&F ?$>>&(,&F ?(2)$'($, V7K.7;F ;KG&2.7K2+('(%;L
O7$. '+ K+* '+ /&>+2& K+* J+ .+ %I&&Gg O7$. .(;& '+ K+* *%*$IIK J+ .+ /&'g 5$N& K+* ,+.()&' $,K .2+*/I& >$II(,J %I&&Gg P+ K+* M$0& *G $. ,(J7. '*2(,J %I&&Gg if yes than WHY O7$. .(;& K+* M$0& *G (, .7& ;+2,(,Jg and do you feel awake P+ K+* >&&I %I&&GK +2 .$0& ,$G% '*2(,J .7& '$K%g "L 3+2 0.2&%%f:'Q*%.;&,.S HL 3+2 J6:S $L P+ K+* %,+2& $. ,(J7.g W2 7$% %+;&+,& .+I' K+*g /L P+ K+* >&&I 2&%.I&%% $. ,(J7.g W2 7$% %+;&+,& .+I' K+*g [L 3+2 DII()(. :2*J%S `L 3+2 ?$>>&(,&S $L P+ K+* )+,%*;& )$>>&(,$.&' /&N&2$J&%g D> K&%F .7&, $%0 7+M ;*)7g /L P+ K+* .$0& .&$f#+>>&&f&,&2JK '2(,0% /&>+2& J+(,J .+ /&'g YL 3+2 ?(2)$'($, V7K.7; G2+/I&;%S D> %I&&G '*2$.(+, (% $'&4*$.& .7&, $L :'N$,)&' 6I&&G 6K,'2+;&q %I&&G% $. HS\\$; /L P&I$K&' 6I&&G 6K,'2+;&q %I&&G% $. aS\\G; )L c&. B$Jq 5(%.+2K +> 2&)&,. ?2$N&IL aL 3+2 ;KG&2.7K2+('(%;S U?&;G (,.+I&2$,)&F Z+M&I ;+N&;&,.X $L 5$N& K+* ,+.()&' 2$)(,J +> 7&$2.g /L 5$N& K+* ,+.()&' $,K %0(, )7$,J&%g )L 5$N& K+* ,+.()&' $,K .2&;+2% +> 7$,'%g 2<6$
"L 511T? HL #e6 1C$;
1st POLYSOMNOGRAOPHY.
"L HL [L `L
0"=#95&865&%"9
#Z# M(.7 '(>>&2&,.($IF 6f1 ?65F ?[ 9 ?` @2(,& ?+C()+I+JK %)2&&,L #+2.(%+I I&N&I%L
`b
P%4C7+ Q"4* .&33#4#"5&67 .&68"%9&9( :28 P, ./ C?20L
:&G2&%%(+,F 22&J,$,)KF 5KG+87K2+('(%;F C$;(I($I .&,'&,)KF ?ushing’s, 2#W6F 0;+0(,J #&%%$.(+,L
WP= 4*&%.(+,%F 5+M ;*)7 M&(J7. 7$N& K+* J$(,&'g WN&2 7+M ;*)7 .(;&g D,.&,.(+,$I +2 *,(,.&,.(+,$Ig "L 3+2 :&G2&%%(+,S U6++' l 07>=?@20 X HL 3+2 22&J,$,)KS UBA= l A+2,(,J %()0,&%%X [L 3+2 5KG+87K2+('(%; SU?&;G (,.+I&2$,)&F %0(, )7$,J&%F /+M&I 7$/(.%X `L 3+2 C$;(I($I .&,'&,)KS $L :,K >$;(IK 5C +> +/&%(.Kg YL 3+2 ?ushing’s: $L 5$N& K+* ,+.()&' $,K %.2($ +, K+*2 /+'Kg aL 3+2 2#W6S $L 5$N& K+* ,+.()&' $,K &C)&%%(N& 7$(2 J2+M.7 2&)&,.IKg /L 5$N& K+* ,+.()&' $,K $/,+2;$I G(J;&,.$.(+, +> .7& /+'Kg ^L 3+2 0;+0(,J #&%%$.(+,S UT+2;$I M&(J7. J$(, (% H0JX 2<6$
"L 511T? l ?7K2+(' 1C$; HL ED? 1C$; 0"=#95&865&%"9
"L HL [L `L YL
#Z# M(.7 '(>>&2&,.($IF 6f1 ?65F ?[ 9 ?` EI*)+%&F #7+I&%.&2+IF ?2(JIK)&2('& I&N&I%L #+2.(%+I I&N&I%L Urine βd5#EL
`_
P%4C7+ :',, .&33#4#"5&67 .&68"%9&9( :&$2 ;@67: 6:B
:($/&.&% A&II(.*%F ;KG&2.7K2+('(%;F @,+2&C($ T&2N+%$F 6$I(J,$,)KF 7,>&).(+,% #D=D& H>& G@I F :&G2&%%(+,F :2*J%F 6$I$/%+2G.(+,L
WP= 4*&%.(+,%F 5+M ;*)7 M&(J7. 7$N& K+* I+%.g WN&2 7+M ;*)7 .(;&g D,.&,.(+,$I +2 *,(,.&,.(+,$Ig "L 3+2 :($/&.&% A&II(.*%S U1C)&%%(N& .7(2%.F *2(,$2K >2&4*&,)KX HL 3+2 ;KG&2.7K2+('(%;S U?&;G (,.+I&2$,)&F .2&;+2%F =$IG(.$.(+,%F Z+M&I 7$/(.%X [L 3+2 @,+2&C($ T&2N+%$S UM&(J7.f$GG&.(.& )7$,J&%X $L 5+M '+ K+* >&&I $/+*. .7(% G2+/I&;g /L 5+M '+ K+* >&&I $/+*. K+*2 G7K%()$I $GG&$2$,)&g `L 3+2 6$I(J,$,)KS U3$.(J*&F %;+0(,JF :I)+7+I()X YL 3+2 7,>&).(+,%S $L ?LZS =1T? -*&%.(+,% /L 5DeS DII )+,.$).F I+M J2$'& >&N&2F De '2*J $/*%&L aL 3+2 :&G2&%%(+, U6++' l 07>=?@20X ^L 3+2 :2*J%S UB$C$.(N&%F ?7K2+C(,&X bL 3+2 6$I$/%+2G.(+,S $L :2& K+*2 %.++I% '(>>()*I. .+ >I*%7g /L :2& K+*2 %.++I% >+*I %;&II(,Jg )L 5$N& K+* ,+.()&' $ %&,%& +> (,)+;GI&.& &N$)*$.(+, $>.&2 G$%%(,J %.++I%g 2<6$
"L 511T? l ?7K2+(' 1C$; HL ED? 1C$; 0"=#95&865&%"9
"L HL [L `L YL aL
#Z# M(.7 '(>>&2&,.($IF 6f1 ?65F ?[ 9 ?` =#V +2 1BD6: >+2 5De 6G*.*; >+2 :3Z @2(,$IK%(% #mV
Y\
!2%3'2, .&33#4#"5&67 .&68"%9&9( @/ 2? <# (#!$/" ";!" 2= ;!, ;.=; A:;B
2 7K%(+I+J()$I O ?&2&/&II$2 O 2$20(,%+,(%;F =%%&,.($I ?2&;+2%F A(N&2 P(%&$%&F :2*J%F ;KG&2.7K2+('(%;L
W3P=B:: 4*&%.(+,% :2& .7& .2&;+2% $. 2&%.g
DoC WILSON Please HELP my tremors.
"L 3+2 27K%(+I+J()$IS $L D% .7& .2&;+2 $%%+)($.&' M(.7 $,K &N&,.g HL 3+2 ?&2&/&II$2 P(%&$%&S $L 5$N& K+* ,+.()&' $,K $/,+2;$I &K& ;+N&;&,.%g /L 5$N& K+* ,+.()&' $,K G2+/I&;% M(.7 ;+N&;&,.%f)+;GI&C ;+N&;&,.%g [L 3+2 2$20(,%+,(%;S $L 5$N& K+* ,+.()&' $,K %I+M(,J +> K+*2 ;+N&;&,.g /L 5$N& K+* ,+.()&' $,K %.(>>,&%% +> /+'Kg )L 5$N& K+* ,+.()&' $,K )7$,J&% (, K+*2 M2(.(,Jg `L 3+2 =%%&,.($I ?2&;+2%S U3$;(IK 5CF V&I(N&' /K :I)+7+I +2 =2+G2$,+I+IX YL 3+2 A(N&2 P(%&$%&S $L 5$N& K+* ,+.()&' $,K '(%.&,%(+, +> K+*2 /&IIKg /L 5$N& K+* ,+.()&' &,I$2J&;&,. +> /2&$%.%g )L 5$N& K+* ,+.()&' $,K )7$,J& (, K+*2 %0(,g aL 3+2 :rugs: (caffeine, nicotine, βd$J+,(%.%F ?#:F B(.7(*;F e$IG2+$.& &.)LX ^L 3+2 ;KG&2.7K2+('(%;S U?&;G (,.+I&2$,)&F Z+M&I ;+N&;&,.X $L 5$N& K+* ,+.()&' 2$)(,J +> 7&$2.g /L 5$N& K+* ,+.()&' $,K %0(, )7$,J&%g )L 5$N& K+* ,+.()&' $,K .2&;+2% +> 7$,'%g 2<6$
"L 511T? l ?7K2+(' 1C$; Cerebellar HL CNS Exam, Romberg’s [L ED? &C$; >+2 I(N&2 '(%&$%& 0"=#95&865&%"9
"L #Z# M(.7 '(>>&2&,.($IF 6f1 HL ?65F ?[ 9 ?` [L :B?f:6?f:B=fZ(I(2*/(,
Y"
F/,<$% P%">*%,, .&33#4#"5&67 .&68"%9&9(
O(.7 6.(>>,&%%q C1//% 26 ;!, 280:B !;9'7#J C(/2+;K$IJ($F 2AVF 6*%)I& 6.2$(,F 6K+.+,() PK%.2+G7KL D#;4%J 8D:f0.2+0&F 2$20(,%+,(%;F 6*I.(GI& 6)I&2+%(%L .4;89J :,.(dP+G$;(,& 9 :,.(d=%K)7+.()%L O(.7+*. 6.(>>,&%%q !;9'7#J 2+IK;K+%(.(%F :&2;$.+;K+%(.(%L D#;4%J >Z6F 6K$%.7&,($ E2$N(%L .4;89J 0.&2+('%F 0.$.(,%L 27#'54%7K5#9L ;KG+0$I&;($L 5KG&2 87K2+('(%;L KF+# "+FWW*)""H
"L 3+2 C(/2+;K$IJ($S U6I&&G G2+/I&;% +2 P&G2&%%(+,%X $L 5$N& K+* ,+.()&' .&,'&2 G+(,.% (, .7& /+'Kg HL 3+2 2AVS $L 5$N& K+* ,+.()&' $,K '(>>()*I.K +, %.$,'(,J >2+; %(..(,J G+%(.(+,g /L 5$N& K+* ,+.()&' $,K )7$,J&% (, N(%(+, +2 7&$'$)7&%g )L 5$N& K+* ,+.()&' $,K G2+/I&;% M7(I& )7&M(,Jg [L 3+2 6*%)I& 6.2$(, U?2$*;$XS $L 5$N& K+* I(>.&' $ 7&$NK M&(J7. 2&)&,.IKg `L 3+2 6K+.+,() PK%.2+G7KS U3$;(IK 5CX $L 5$N& K+* ,+.()&' $,K 7$(2 I+%% >2+; 7&$'g /L 5$N& K+* ,+.()&' $,K '(>>()*I.K 2&I&$%(,J 7$,' J2(Gg YL 3+2 8D:f0.2+0&S UOT?F E$(.F e(%(+,X $L 5$N& K+* ,+.()&' $,K G2+/I&; %M$II+M(,Jg aL 3+2 2$20(,%+,(%;S $L 5$N& K+* ,+.()&' $,K %I+M(,J +> K+*2 ;+N&;&,.g #7$,J&% (, J$(.g /L 5$N& K+* ,+.()&' $,K %.(>>,&%% +> /+'Kg .2&;+2% )L 5$N& K+* ,+.()&' $,K )7$,J&% (, K+*2 M2(.(,Jg ^L 3+2 6*I.(GI& 6)I&2+%(%S U3&;$I&F :J&X $L 5$N& K+* ,+.()&' $,K )7$,J& (, K+*2 N(%(+,g bL 3+2 :,%Q"H U:,.(dP+G$;(,& 9 :,.(d=%K)7+.()%XL KF+#$%+ 0+FWW*)""H
"L 3+2 2+IK;K+%(.(%S $L 5$N& K+* ,+.()&' $,K '(>>()*I.K )+;/(,J 7&$' +2 %.$,'(,J >2+; %(..(,J G+%(.(+, HL 3+2 :&2;$.+;K+%(.(%S $L 5$N& K+* ,+.()&' $,K 2$%7 +, K+*2 /+'Kg [L 3+2 >Z6S $L P+ K+* 7$N& $,K 5C +> P($227&$ +2 %+2& .72+$.g /L 5+M '(' .7& M&$0,&%% G2+J2&%%g `L 3+2 6K$%.7&,($ E2$N(%S $L 5$N& K+* ,+.()&' $,K G2+/I&; %M$II+M(,Jg /L 5$N& K+* ,+.()&' $,K G2+/I&; (, N(%(+, +2 '+*/I& N(%(+,g YL 3+2 :2*J%9 0.&2+('%F 0.$.(,%LX YH
aL 3+2 =I&).2+IK.&% X U;KG+0$I&;($X $L P+ K+* 7$N& $ 2&)&,. 5C +> P($227&$g bL 3+2 5KG&287K2+('(%; U?&;G (,.+I&2$,)&F Z+M&I ;+N&;&,.X $L 5$N& K+* ,+.()&' 2$)(,J +> 7&$2.g /L 5$N& K+* ,+.()&' $,K %0(, )7$,J&%g )L 5$N& K+* ,+.()&' $,K .2&;+2% +> 7$,'%g 2<6$
"L 511T? l ?7K2+(' 1C$; HL #T6 1C$; [L 1C.2&;(.(&% &C$; 0"=#95&865&%"9
"L HL [L `L YL
#Z# M(.7 '(>>&2&,.($IF 6f1 UR lX ?65F ?[ 9 ?` T&2N& #+,'*).(+, %.*'K AVD Z2$(, :T:F :,.(dV+F :,.(dB:
Y[
@"$$/<4*"+4'*, .&33#4#"5&67 .&68"%9&9(
:*'(.+2K 5$II*)(,$.(+,q Z2(&> =%K)7+.() '(%+2'&2F 6)7(8+G72&,(>+2;F 6)7(8+G72&,($L e(%*$I 5$II*)(,$.(+,%q ?*;+2F 6*/%.$,)& :/*%&F 6&(8*2&%F P&I(2(*; $,' P&;&,.($L ?$).(I& 9 E*%.$.+2K 5$II*)(,$.(+,%q #+)$(,&F :I)+7+I M(.7'2$M$IL 6&)+,'$2K .+ A&'()$I '(%+2'&2q =$2$.7K2+('(%;F T$2)+I&G%KF =+%.G$2.*; =%K)7+%(%L W3P=:: 4*&%.(+,%L #$, K+* GI&$%& .&II ;& ;+2& $/+*. .7$.g P+ K+* %&&F 7&$2 +2 >&&I .7(,J%g P+ .7&K )+,.2+I K+*g P+ .7&K .&II K+* .+ 7$2; K+*2%&I> +2 +.7&2%g P+&% $,K+,& &I%& &CG&2(&,)&% .7$. +2 $2& K+* .7& +,IK +,&g 5$% (. $>>&).&' K+*2 '$(IK I(>& G&2>+2;$,)&g
3+2 :*'(.+2K 5$II*)(,$.(+,S "L 3+2 Z2(&> =%K)7+.() '(%+2'&2S U%.2&%%F %I&&GF '&)2&$%&' >*,).(+,(,JX HL 3+2 6)7(8+G72&,(>+2; 9 6)7(8+G72&,($S U('&$% +> 2&>&2&,)&F )I$%%(>K $))+2'(,J .+ .(;&X 3+2 e(%*$I 5$II*)(,$.(+,%S "L 3+2 Z$(, ?*;+2S UM&(J7. I+%%F 7&$'$)7&X $L 5$N& K+* ,+.()&' $,K )7$,J&% (, K+*2 N(%(+,g HL 3+2 6*/%.$,)& :/*%&S [L 3+2 6&(8*2&%S `L 3+2 P&I(2(*; $,' P&;&,.($S U2&N&2%(/I& e%L D22&N&2%(/I&X 3+2 ?$).(I& 9 E*%.$.+2K 5$II*)(,$.(+,%S "L 3+2 #+)$(,& M(.7'2$M$IS HL 3+2 :I)+7+I M(.7'2$M$IS 3+2 6&)+,'$2K .+ A&'()$I '(%+2'&2S "L 3+2 =$2$.7K2+('(%;S $L 5$N& K+* ,+.()&' $,K )7$,J& (, K+*2 /+M&I 7$/(.%g /L 5$N& K+* ,+.()&' $,K G$(, (, /&IIKg )L P+ K+* 7$N& $ 5C +> 0(',&K %.+,&%g HL 3+2 T$2)+I&G%KS $L 5$N& K+* ,+.()&' $,K G2+/I&;% M(.7 %I&&Gg [L 3+2 =+%.G$2.*; =%K)7+%(%S $L O7&, M$% K+*2 BA=g Y`
2<6$
"L 511T? HL #T6 1C$; 9 AA61L 0"=#95&865&%"9
"L #Z# M(.7 '(>>&2&,.($IF 6f1 UR lX HL @2(,& ?+C()+I+JK %)2&&,L
YY
9%4K/2%, .&33#4#"5&67 .&68"%9&9( I78@67E0 :B
I$%)*I$2F 7,>&).(+,% UJ#/./=.".,& N/3#-;!(.".,& :+,3#,,XF 82$*;$F @*.+(;;*,& ULQN XF 6&.$/+I() U;%-)=(%3#2.!& ;%-)/!"$#2.!8F 7'(+G$.7()F E&+GI$%;%F G0K)7($.2()F :2*J :/*%&fO(.7'2$M$IL
WP=:: 4*&%.(+,%L O7$. M&2& K+* '+(,J /&>+2& .7$. 7$GG&,&'g P(' K+* I+%& )+,%)(+*%,&%%g P(' $,K+,& M(.,&%%&' .7$.g P(' K+* /(.& K+*2 .+,J*&F G$%%&' *2(,& +2 %.++I% M(.7+*. K+*2 0,+MI&'J&g O7$. 7$GG&,&' $>.&2 .7& &G(%+'&g "L 3+2 I$%)*I$2 G2+/I&;S UPAF 5?TX $L 5$N& K+* ,+.()&' $ M&$0,&%%F ,*;/,&%% +> .(,JI(,J +> K+*2 /+'Kg HL 3+2 7,>&).(+,%S U3&N&2X $L J#/./=.".,R T&)0 %.(>>,&%% /L N/3#-;!(.".,R #+,>*%(+,F BW# )L :+,3#,,R OT? [L 3+2 82$*;$S `L 3+2 @*.+(;;*,&S $L LQN S 5$N& K+* ,+.()&' $,K 2$%7 +2 Q+(,. G$(,g YL 3+2 6&.$/+I() '&2$,J&;&,.S $L G%-)=(%3#2.!R UPAF )7$,J&% (, ;&'()$.(+, +2 '+%$J&%X /L G%-)/!"$#2.!R (L 5$N& K+* 7$' '($227&$ 2&)&,.IKg ((L :2& K+* >&&I(,J ;+2& .7(2%.K .7$, *%*$Ig aL 3+2 7'(+G$.7()S ^L 3+2 E&+GI$%;%S UM&(J7. I+%%X $L 5$N& K+* ,+.()&' $,K 7&$'$)7& +2 )7$,J&% (, N(%(+,g bL 3+2 G0K)7($.2() U)+,N&2%(+, '(%+2'&2 &.)XS UT+ =+%.().$I )+,>*%(+,X $L :2& K+* *,'&2 &C)&%%(N& %.2&%% .7&%& '$K%g _L 3+2 :2*J :/*%&fO(.7'2$M$IS U:I)+7+IF Z&,8+'($8&G(,&X 2<6$
"L 511T? HL #T6 1C$; 9 AA61L 0"=#95&865&%"9
"L HL [L `L
#Z# M(.7 '(>>&2&,.($IF 6f1 UR lX @2(,& ?+C()+I+JK %)2&&, ZI++' #*I.*2& B*;/$2 G*,).*2& 9 #63 $,$IK%(% Ya
5%.4"+24< )",% Y^
=2&2&4*(%(.&% >+2 =&'($.2() )$%&%S
#$, K+* GI&$%& .&II .7& ,$;& $,' $J& +> .7& )7(I'g :2& K+* I&J$I J*$2'($, +> .7& )7(I'g P+ K+* ,&&' $,K 7&IG M(.7 K+*2 %+,f'$*J7.&2fJ2$,'%+,fJ2$,''$*J7.&2 &.)g D,%.&$' +> 2@6 ;4> CJ00 >+2 $'*I.%F 2&GI$)& 2@6 C <7E:B <(2.7 5CS P(' K+* .$0& (2+,f;*I.(N(.$;(,% '*2(,J G2&J,$,)Kg ! P(' K+* %;+0& +2 '2(,0 $I)+7+I '*2(,J G2&J,$,)Kg ! O$% .7& /$/K '&I(N&2&' $. .&2;g ! O$% .7& '&I(N&2K ,+2;$Ig O7$. M$% .7& ;+'& +> '&I(N&2Kg ! :,K )+;GI()$.(+,% '*2(,J +2 $>.&2 G2&J,$,)Kg ! P(' K+*2 )7(I' 7$' $,K G2+/I&; $>.&2 '&I(N&2Kg ! O7&, '(' K+*2 )7(I' G$%%&' >(2%. %.++Ig ! 7;;*,(8$.(+,S O7$. (% .7& (;;*,(8$.(+, %.$.*% +> .7& /$/Kg #$, K+* GI&$%& %7+M ;&g ! D> +, .7& G7+,&F GI&$%& /2(,J K+* (;;*,(8$.(+, )$2' .+ .7& 7+%G(.$Ig ! E*.2(.(+,S 5+M '+ K+* >&&' K+*2 )7(I'g U/2&$%.f>+2;*I$X ! O7&, M$% %+I(' >++' $''&' .+ .7& '(&.g ! O7$. (% .7& '(&. ,+Mg ! :&N&I+G;&,. 5CS O7&, '(' 7&f%7& %.$2.&' %;(I(,Jg ! O7&, '(' 7&f%7& %.$2.&' .+ %(.g ! O7&, '(' 7&f%7& %.$2.&' .+ M$I0g ! O7&, '(' 7& %G&$0 7(% >(2%. M+2'g ! 5+M ;$,K M+2'% '+&% 7& %G&$0 ,+Mg !
Yb
H%R%2 .&33#4#"5&67 .&68"%9&9( IJ 64A >4
MULU GOV
I(2$I (II,&%%O J.(.(% A&'($F 6&,(,J(.(% & 4VDF AVDF >$%.2+&,.&2(.(%F 4?DL
O7$. do you mean by “burning up”? 3+2 7+M I+,Jg #+,.(,*+*% +2 (,.&2;(..&,.g 5(J7 J2$'& +2 I+M J2$'&g O7$. (% .7& 2&$'(,Jg W2$I +2 2&).$Ig 5+M (% .7& )7(I'’s I++0g UB&.7$2J()F (22(.$.&' +2 GI$K>*IX 5$% .7& )7(I' )+;& (, )+,.$). M(.7 $,K/+'K M(.7 %(;(I$2 )+;GI$(,.%g "L 3+2 I(2$I (II,&%%S $L 5$N& K+* ,+.()&' $,K 2$%7 +, .7& /+'Kg /L 5$N& K+* ,+.()&' $,K %M&II(,J +> .7& /+'Kg HL 3+2 J.(.(% A&'($S $L P+&% 7&f%7& G*II% .7& &$2g /L 5$N& K+* ,+.()&' 2*,,K ,+%& +2 2&',&%% +> &K&%g )L 5$N& K+* ,+.()&' $,K '(%)7$2J& >2+; &$2g D> K&%F .7&, @>,&%% (, ,&)0g /L P(' 7&f%7& I+%& )+,%)(+*%,&%%g )L 5$N& K+* ,+.()&' $,K %7$0K ;+N&;&,.%g 'L 5$N& K+* ,+.()&' /*IJ(,J +> >+,.$,&I% +2 %+>. %G+.% +, 7&$'g `L 3+2 4VDS U'$K )$2&X $L #2+*GS (L 5$N& K+* ,+.()&' $,K )+*J7g ((L 5$N& K+* ,+.()&' $,K %+*,' $))+;G$,K(,Jg U%.2('+2X /L 1G(JI+..(.(%S (L 5$N& K+* ,+.()&' $,K '(>>()*I.K %M$II+M(,Jg ((L 5$N& K+* ,+.()&' '2++I(,J +> %$I(N$g YL 3+2 AVDS UZ2+,)7(+I(.(%X $L 5$N& K+* ,+.()&' $,K '(>>()*I.K /2&$.7(,Jg /L 5$N& K+* ,+.()&' >$%. /2&$.7(,J +2 $/,+2;$I %+*,'% M(.7 /2&$.7(,Jg aL 3+2 >$%.2+&,.&2(.(%S $L 5$N& K+* ,+.()&' $,K )7$,J& (, /+M&I 7$/(.%g /L 5$N& K+* ,+.()&' ,$*%&$ +2 N+;(.(,Jg )L 5$N& K+* ,+.()&' $,K '(%.&,%(+, +> .7& /&IIKg 'L P+ K+* 7$N& .+ *%& ;+2& '($G&2% .7$, *%*$Ig ^L 3+2 4?DS $L 5$N& K+* ,+.()&' $,K )7$,J& (, *2(,$2K 7$/(.%g /L P+&% .7& /$/K )2K M7(I& *2(,$.(,Jg
Text
2<6$
"L 511T? HL #e6 1C$;L Y_
0"=#95&865&%"9
"L HL [L `L YL
#Z# M(.7 '(>>&2&,.($IF 6f1 UR lX #mV ZI++' #*I.*2& B*;/$2 G*,).*2& 9 #63 $,$IK%(% @2(,$IK%(%
a\
9%4K/2%, .&33#4#"5&67 .&68"%9&9( C6 8;
FMHH
C&/2(I&F 6&,(,J(.(%F 82$*;$f7&;+227$J&F ;KG+f5KG&2,$.2&;($L
=I&$%& .&II ;& ;+2& $/+*. .7$.g P&%)2(/& .7& &N&,. (, '&.$(Ig O7$. M$% .7& )7(I' '+(,J /&>+2& .7& >(.g 5$N& K+* ,+.()&' $,K BW#g ?+,J*& /(.(,J +2 >2+.7(,Jg =$%%&' *2(,& +2 %.++I% M(.7+*. 0,+MI&'J&g O7$. 7$GG&,&' $>.&2 .7& &G(%+'&g "L 3+2 C&/2(I& %&(8*2&S U3&N&2F 3$;(IK 5CX $L P+ K+* 7$N& $ 5C +> 2&)&,. (II,&%%g HL 3+2 6&,(,J(.(%S $L 5$N& K+* ,+.()&' $,K %.(>>,&%% (, ,&)0g /L P(' 7&f%7& I+%& )+,%)(+*%,&%%g )L 5$N& K+* ,+.()&' $,K %7$0K ;+N&;&,.%g 'L 5$N& K+* ,+.()&' /*IJ(,J +> >+,.$,&I%g [L 3+2 82$*;$f7&;+227$J&S $L :2& .7&2& $,K /I&&'(,J .&,'&,)(&% (, .7& >$;(IKg `L 3+2 ;KG+f5KG&2,$.2&;($S $L 5$N& K+* ,+.()&' $,K )7$,J& (, /+M&I 7$/(.%g /L 5$N& K+* ,+.()&' ,$*%&$ +2 N+;(.(,Jg )L 5$N& K+* '(I*.&' .7& >+2;*I$ >&&'g 2<6$
"L 511T? HL #e6 1C$;L 0"=#95&865&%"9
"L HL [L `L YL
#Z# M(.7 '(>>&2&,.($IF 6f1 UR lX #mV B*;/$2 G*,).*2& 9 #63 $,$IK%(% #? %)$, /2$(, @2(,$IK%(%
a"
64"227%" .&33#4#"5&67 .&68"%9&9( 7,>&).(+,F 6$I$/%+2G.(+,F 7,.*%%)&G.(+,F JN&2>&&'(,J
"L 3+2 7,>&).(+,S $L P+ K+* 7$N& .+ *%& ;+2& '($G&2% .7$, *%*$Ig /L 5$N& K+* ,+.()&' $,K '2K,&%% +> ;+*.7 +2 .+,J*&g )L 5$N& K+* ,+.()&' $,K '2K,&%% +> %0(,g 'L 5$N& K+* ,+.()&' %*,0&, &K&%g HL 3+2 6$I$/%+2G.(+,S $L 5$N& K+* ,+.()&' $,K $/,+2;$I %;&II >2+; %.++I%g [L 3+2 7,.*%%)&G.(+,S $L 5$N& K+* ,+.()&' )2K(,J %G&II% +2 &G(%+'&% 2&I(N&' /K /&,'(,Jg `L 3+2 JN&2>&&'(,JS $L 5+M ;*)7 $,' 7+M >2&4*&,.IK '+ K+* >&&' .7& )7(I'g 2<6$
"L 511T? HL ED? 1C$;L 0"=#95&865&%"9
"L #Z# M(.7 '(>>&2&,.($IF 6f1 UR lX HL 6.++I &C$;(,$.(+,
aH
)'/C7 .&33#4#"5&67 .&68"%9&9( A2? C=3@
A$2K,J(.(%F 2 &2.*%%(%F ?2+*GF C+2&(J, Z+'KF =G(JI+..(.(%F 3&.2+G7$2K,J&$I :/%)&%%F @%.7;$F <2+,)7(+I(.(%L
#$, K+* GI&$%& .&II ;& ;+2& $/+*. (.g 5+M M(II K+* '&%)2(/& .7& )+*J7g "L 3+2 A$2K,J(.(%S Text $L 5$N& K+* ,+.()&' $,K )7$,J& (, .7& N+()&g HL 3+2 2&2.*%%(%S $L 5$N& K+* ,+.()&' 2*,,K ,+%& +2 M$.&2(,J >2+; &K&% /&>+2& .7& )+*J7 $GG&$2&'g /L 5$N& K+* ,+.()&' $,K $''(.(+,$I %+*,' $I+,J M(.7 )+*J7g )L P(' .7& /$/K .72+M *Gg [L 3+2 ?2+*GS $L 5$N& K+* ,+.()&' $,K )+*J7g /L 5$N& K+* ,+.()&' $,K %+*,' $))+;G$,K(,Jg U%.2('+2X `L 3+2 C+2&(J, Z+'KS $L O7$. M$% 7& '+(,J M7&, )+*J7 %.$2.&'g YL 3+2 =G(JI+..(.(%S $L 5$N& K+* ,+.()&' $,K '(>>()*I.K %M$II+M(,Jg /L 5$N& K+* ,+.()&' '2++I(,J +> %$I(N$g aL 3+2 3&.2+G7$2K,J&$I :/%)&%%S U5(J7 J2$'& >&N&2 l T+ %.2('+2X $L 5$N& K+* ,+.()&' $,K '2++I(,J +> .7& %$I(N$g /L 5$N& K+* ,+.()&' $,K G2+/I&; ;+N(,J .7& ,&)0g ^L 3+2 @%.7;$S $L P+&% .7& /$/K 7$N& $,K $II&2J(&%g /L 5$N& K+* ,+.()&' $,K 2&I$.(+,%7(G .+ .7& .(;(,J% +> .7& '$Kg bL 3+2 <2+,)7(+I(.(%S $L 5$N& K+* ,+.()&' $,K '(>>()*I.K /2&$.7(,Jg /L 5$N& K+* ,+.()&' >$%. /2&$.7(,J +2 $/,+2;$I %+*,'% M(.7 /2&$.7(,Jg 2<6$
"L 511T? HL #e6 $,' =*I;+,$2K 1C$;L 0"=#95&865&%"9
"L HL [L `L
#Z# M(.7 '(>>&2&,.($IF 6f1 UR lX mdV$K ,&)0 #mV ZI++' #*I.*2&
a[
