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Hernia, Inguinal: An abdominal hernia with an external bulge in the Groin region. It can be classified by the location of herniation. Indirect inguinal hernias occur through the internal inguinal ring. Direct inguinal hernias occur through defects in the Abdominal wall (transversalis fascia) in Hesselbach's triangle. The former type is commonly seen in children and young adults; the latter in adults.

Abdominal Exam IV: Acute Abdominal Pain Assessment

JoVE 10120

Source: Joseph Donroe, MD, Internal Medicine and Pediatrics, Yale School of Medicine, New Haven, CT

Abdominal pain is a frequent presenting concern in both the emergency department and the office setting. Acute abdominal pain is defined as pain lasting less than seven days, while an acute abdomen refers to the abrupt onset of severe abdominal pain with features suggesting a surgically intervenable process. The differential diagnosis of acute abdominal pain is broad; thus, clinicians must have a systematic method of examination guided by a careful history, remembering that pathology outside of the abdomen can also cause abdominal pain, including pulmonary, cardiac, rectal, and genital disorders. Terminology for describing the location of abdominal tenderness includes the right and left upper and lower quadrants, and the epigastric, umbilical, and hypogastric regions (Figures 1, 2). Thorough examination requires an organized approach involving inspection, auscultation, percussion, and palpation, with each maneuver performed purposefully and with a clear mental representation of the anatomy. Rather than palpating randomly across the abdomen, begin palpating remotely from the site of tenderness, moving systematically toward the tender region, and thi


 Physical Examinations II

Ovine Lumbar Intervertebral Disc Degeneration Model Utilizing a Lateral Retroperitoneal Drill Bit Injury

1Department of Surgery, Monash University, 2Department of Neurosurgery, Monash University, 3The Ritchie Centre, Hudson Institute of Medical Research, 4Proteobioactives, Pty Ltd, 5Department of Neurosurgery, St Vincent's Hospital, 6Australian Institute for Bioengineering and Nanotechnology, University of Queensland, 7School of Chemical Engineering, University of Queensland, 8Department of Neurosurgery, Monash Health

JoVE 55753


 Medicine

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Lymph Node Exam

JoVE 10061

Source: Richard Glickman-Simon, MD, Assistant Professor, Department of Public Health and Community Medicine, Tufts University School of Medicine, MA

The lymphatic system has two main functions: to return extracellular fluid back to the venous circulation and to expose antigenic substances to the immune system. As the collected fluid passes through lymphatic channels on its way back to the systemic circulation, it encounters multiple nodes consisting of highly concentrated clusters of lymphocytes. Most lymph channels and nodes reside deep within the body and, therefore, are not accessible to physical exam (Figure 1). Only nodes near the surface can be inspected or palpated. Lymph nodes are normally invisible, and smaller nodes are also non-palpable. However, larger nodes (>1 cm) in the neck, axillae, and inguinal areas are often detectable as soft, smooth, movable, non-tender, bean-shaped masses imbedded in subcutaneous tissue. Lymphadenopathy usually indicates an infection or, less commonly, a cancer in the area of lymph drainage. Nodes may become enlarged, fixed, firm, and/or tender depending on the pathology present. For example, a soft, tender lymph node palpable near the angle of the mandible may indicate an infected tonsil, whereas a firm, enlarged, non-tender lymph


 Physical Examinations II

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Proper Adjustment of Patient Attire during the Physical Exam

JoVE 10147

Source: Jaideep S. Talwalkar, MD, and Joseph Donroe, MD, Internal Medicine and Pediatrics, Yale School of Medicine, New Haven, CT

In order to optimize the predictive value of the physical examination, the provider must perform maneuvers correctly. The proper use of drapes is an important component of correctly performing physical examination maneuvers. Skin lesions are missed when "inspection" occurs through clothing, crackles are erroneously reported when the lungs are examined through a t-shirt, and subtle findings on the heart exam go undetected when auscultation is performed over clothing. Accordingly, the best practice standards call for examining with one's hands or equipment in direct contact with the patient's skin (i.e., do not examine through a gown, drape, or clothing). In addition to its clinical value, the correct draping technique is important for improving the patient's comfort level during the encounter. Like all other aspects of the physical exam, it takes deliberate thought and practice to find the right balance between draping, which is done to preserve patient modesty, and exposure, which is necessary to optimize access to the parts that need examination. Individual provider styles in the use of gowns and drapes vary consider


 Physical Examinations I

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In Vivo Model for Testing Effect of Hypoxia on Tumor Metastasis

1Department of Biochemistry and Molecular & Cellular Biology, Georgetown University Medical Center, 2Department of Nursing, Georgetown University, School of Nursing and Health Studies, 3Department of Human Science, Georgetown University, School of Nursing and Health Studies, 4School of Medicine, Georgetown University Medical Center, 5Department of Pathology and Neuropathology, Medical University of Gdańsk, 6Department of Oncology, Georgetown University Medical Center, 7Department of Pathology, Georgetown University Medical Center

JoVE 54532


 Cancer Research

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Central Venous Catheter Insertion: Femoral Vein

JoVE 10240

Source: James W Bonz, MD, Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA

Central venous access is necessary in a multitude of clinical situations, including vascular access, vasopressor and caustic medication delivery, central venous pressure monitoring, volume resuscitation, total parental nutrition, hemodialysis, and frequent phlebotomy. There are three veins in the body that are accessed for central venous cannulation: the internal jugular, the subclavian, and the femoral. Each of these vessels has distinct advantages and disadvantages with unique anatomical considerations. Femoral vein cannulation can be easily performed both under ultrasound guidance and using the surface landmarks; therefore, femoral access is often used when emergent placement of a central venous catheter (CVC) is needed (such as in the case of medical codes and trauma resuscitations). In addition, cannulation of the femoral artery allows one to simultaneously perform other procedures needed for stabilization, such as cardiopulmonary resuscitation (CPR) and intubation. Successful placement of a femoral CVC requires working understanding of the target anatomy, access to with procedural ultrasound, and fluidity in the Seldinger technique. Seld


 Emergency Medicine and Critical Care

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A Quantitative Sensory Testing Paradigm to Obtain Measures of Pain Processing in Patients Undergoing Breast Cancer Surgery

1Department of Anesthesiology, Pain, and Palliative Medicine, Radboud University Medical Center, 2Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, 3Medical Technology & Clinical Physics, Radboud University Medical Center

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JoVE 56918


 JoVE In-Press

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Pelvic Exam III: Bimanual and Rectovaginal Exam

JoVE 10163

Source:

Alexandra Duncan, GTA, Praxis Clinical, New Haven, CT

Tiffany Cook, GTA, Praxis Clinical, New Haven, CT

Jaideep S. Talwalkar, MD, Internal Medicine and Pediatrics, Yale School of Medicine, New Haven, CT

A bimanual exam is a thorough check of a patient's cervix, uterus, and ovaries. It can tell an experienced provider a great deal, as it may lead to the discovery of abnormalities, such as cysts, fibroids, or malignancies. However, it's useful even in the absence of such findings, as it allows the practitioner to establish an understanding of the patient's anatomy for future reference. Performing the bimanual exam before the speculum exam can help relax patients, mentally and physically, before what is often perceived as the "most invasive" part of the exam. A practitioner already familiar with the patient's anatomy can insert a speculum more smoothly and comfortably. However, lubrication used during the bimanual exam may interfere with processing certain samples obtained during the speculum exam. Providers must be familiar with local laboratory processing requirements before committing to a specific order of examination. This demonstration begins


 Physical Examinations II

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Utilizing the Modified T-Maze to Assess Functional Memory Outcomes After Cardiac Arrest

1Department of Neurology, Louisiana State University Health Science Center, 2Department of Cellular Biology and Anatomy, Louisiana State University Health Science Center, 3Department of Neurology, Cerebral Vascular Disease Research Laboratories, University of Miami Miller School of Medicine, 4Department of Biomedical Sciences, West Virginia Medicine Osteopathic of School

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JoVE 56694


 JoVE In-Press

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Initiation of Metastatic Breast Carcinoma by Targeting of the Ductal Epithelium with Adenovirus-Cre: A Novel Transgenic Mouse Model of Breast Cancer

1Tumor Microenvironment and Metastasis Program, Wistar Institute, 2Department of Pathology and Lab Medicine, Perelman School of Medicine, University of Pennsylvania, 3Department of Microbiology and Immunology and Department of Genetics, Geisel School of Medicine at Dartmouth, 4Division of Endocrine and Oncologic Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, 5Rena Rowan Breast Center, Abramson Cancer Center, University of Pennsylvania, 6Center for Advanced Medicine, University of Pennsylvania

JoVE 51171


 Medicine

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Use of a Piglet Model for the Study of Anesthetic-induced Developmental Neurotoxicity (AIDN): A Translational Neuroscience Approach

1Department of Anesthesiology, Ohio State University College of Medicine, 2Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, 3Department of Anaesthesia and Critical Care Medicine, University of Toronto, 4Department of Biomedical Sciences, Section of Anatomic Pathology, Cornell University College of Veterinary Medicine, 5Department of Pathology and Anatomy, Ohio State University College of Medicine, 6Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital

JoVE 55193


 Medicine

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Abdominal Exam I: Inspection and Auscultation

JoVE 10088

Source: Alexander Goldfarb, MD, Assistant Professor of Medicine, Beth Israel Deaconess Medical Center, MA

Gastrointestinal disease accounts for millions of office visits and hospital admissions annually. Physical examination of the abdomen is a crucial tool in diagnosing diseases of the gastrointestinal tract; in addition, it can help identify pathological processes in cardiovascular, urinary, and other systems. As physical examination in general, the examination of the abdominal region is important for establishing physician-patient contact, for reaching the preliminary diagnosis and selecting subsequent laboratory and imaging tests, and determining the urgency of care. As with the other parts of a physical examination, visual inspection and auscultation of the abdomen are done in a systematic fashion so that no potential findings are missed. Special attention should be paid to potential problems already identified by the patient's history. Here we assume that the patient has already been identified, and has had history taken, symptoms discussed, and areas of potential concern identified. In this video we will not review the patient's history; instead, we will go directly to the physical examination. Before we get to the examination, let's briefly review s


 Physical Examinations II

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Orthotopic Hind Limb Transplantation in the Mouse

1Department of Plastic and Reconstructive Surgery, Vascularized Composite Allotransplantation (VCA) Laboratory, Johns Hopkins University School of Medicine, 2Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, 3Center for Vascularized Composite Allotransplantation, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and School of Medicine, 4Department of General, Visceral and Transplant Surgery, Charite Berlin

JoVE 53483


 Medicine

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Generation of Organ-conditioned Media and Applications for Studying Organ-specific Influences on Breast Cancer Metastatic Behavior

1London Regional Cancer Program, London Health Sciences Centre, 2Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, Western University, 3Department of Biochemistry, Schulich School of Medicine & Dentistry, Western University, 4Department of Oncology, Schulich School of Medicine & Dentistry, Western University, 5Lawson Health Research Institute

JoVE 54037


 Medicine

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Induction of Paralysis and Visual System Injury in Mice by T Cells Specific for Neuromyelitis Optica Autoantigen Aquaporin-4

1Department of Neurology, University of California, 2Program in Immunology, University of California, 3Department of Neurology and Neurological Sciences, Stanford University, 4Department of Pathology, Stanford University

JoVE 56185


 Immunology and Infection

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Vein Interposition Model: A Suitable Model to Study Bypass Graft Patency

1Transplant and Stem Cell Immunobiology Lab, University Heart Center Hamburg, 2Department of Surgery, Transplant and Stem Cell Immunobiology Lab, University of California San Francisco (UCSF), 3Cardiovascular Research Center (CVRC) and DZHK German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, 4Cardiovascular Surgery, University Heart Center Hamburg

JoVE 54839


 Medicine

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Combined Intravital Microscopy and Contrast-enhanced Ultrasonography of the Mouse Hindlimb to Study Insulin-induced Vasodilation and Muscle Perfusion

1Laboratory for Physiology, Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, 2Department of Internal Medicine, Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center

JoVE 54912


 Medicine

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