5.1 anglès. Cas 1 abp en angles Claudia is 6 months pregnant. For the moment, everything is going well, but today he has a visit with her gynaecologist because of a slight pain in her hip. PDF

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5.1 anglès. Cas 1 abp en angles "Claudia is 6 months pregnant. For the moment, everything is going well, but today he has a visit with her gynaecologist because of a slight pain in her hip. "...

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Claudia is 6 months pregnant. For the moment, everything is going well, but today he has a visit with her gynaecologist because of a slight pain in her hip. The gynaecologist gives her a complete examination to know what she has and orders a complete blood count and a test for gestational diabetes. They told her that a result higher than 140mg/dL would indicate a pathological problem. Claudia wonders how the validity of this type of test is measured. She finds a couple of graphs online (see the additional information), but she does not know what they are or how to interpret them. Once again, the nurse reminds her that pregnant women need to be more careful and lead a healthier lifestyle, so that everything turns out for the best. ADDITIONAL INFORMATION:

Anatomy: slight pain in her hip, complete examination Healthy person: pregnant, healthier lifestyle, blood count Epidemiology: validity of the test, graphs, roc curve, sensibility and specificity, true and false positive rate

Objectives: Objective 14: Describe, explain and interpret physiologically the parameters or variables evaluated in a haemogram (complete blood count)

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Hemat ocr i t ,t hepr opor t i onofr edbl oodc el l st ot heflui dc omponent ,or pl as ma,i ny ourbl ood

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Descriu l’exploració del sistema esquelètic en una persona en edat adulta i anomena quines tècniques d’exploració utilitzes Objective 15: Describe the exploration of the skeletal system in an adult and name what exploration techniques you use. The musculoskeletal system is formed by two systems: Bone system: It is the passive element, it is made up of bones, cartilage and articular ligaments. Muscular system: Formed by the muscles that join the bones and therefore when contracting they cause the movement of the body The primary methods used for physical examination of musculoskeletal system are inspection and palpation. Percussion and auscultation are only used in special situations such as percussion pain of vertebrae, auscultation for bone crepitus. The examination should include assessment of muscle strength and range of motion and maneuvers to test joint function and stability. Both active movements (where the patient moves the joint themselves) and passive movements (where the examiner moves the joint) should be performed. Notice the symmetry, looking for symmetry of involvement and noting any joint deformities or malalignment of joints or bones. Examination should

also include assessment of surrounding tissues, noting skin changes, subcutaneous nodules and muscle atrophy, and assessment of inflammation especially redness, swelling, warmth and tenderness. Use the back of your fingers to compare the involved joint with its unaffected contralateral joint, or with nearby tissues if both joints are involved.

A few general comments about the musculoskeletal exam Historical clues when evaluating any joint related complaint:      

What is the functional limitation? Symptoms within a single region or affecting multiple joints? Acute or slowly progressive? If injury, what was the mechanism? Prior problems with the affected area? Systemic symptoms?

Common approach to the examination of all joints:    

    

Make sure the area is well exposed - no shirts, pants, etc covering either side - gowns come in handy Carefully inspect the joint(s) in question. Are there signs of inflammation or injury (swelling, redness, warmth)? Deformity? As many joints are symmetric, compare with the opposite side Must understand normal functional anatomy - what does this joint normally do? Observe the joint while patient attempts to perform normal activity what can't they do? What specifically limits them? Was there a discrete event (e.g. trauma) that caused this? If so, what was the mechanism of injury? Palpate the joint in question. Is there warmth? Point tenderness? If so, over what anatomic strucutres? Assess the range of motion, both active (patient moves it) and passive (you move it) if active is limited/causes pain. Strength, neuro-vascular assessment. Specific provocative maneuvers related to pathology occurring in that joint (see descriptions under each joint). In the setting of acute injury and pain, it's often very difficult to assess a joint as patient "protects" the affected area, limiting movement and thus your examination. It helps to examine the unaffected side first (gain patient's confidence, develop sense of their normal).

Ankl eandFootExami nat i on Ankle and feet complaints are common presentations in Accident and Emergency, general practice, and orthopaedic clinics. The most common presentation is pain, such as acute fractures, plantar fasciitis and tendonitis. The ankle and foot examination, along with all other joint examinations, is commonly tested on in OSCEs. You should ensure you are able to perform this confidently. The examination of all joints follows the general pattern of “look, feel, move” as well as an assessment of function, in this case gait.

El bow Exami nat i on Elbow complaints are often related to pain, such as epicondylitis (tennis and golfer’s elbow), fractures, and bursitis. Complaints can also be skin related with regards to other medical conditions, such as psoriasis and rheumatoid arthritis. Occasionally elbow problems can also cause ulnar nerve entrapment. The elbow examination, along with all other joint examinations, is commonly tested on in OSCEs. You should ensure you are able to perform this confidently. The examination of all joints follows the general pattern of “look, feel, move” and occasionally some special tests.

HandandWr i stExami nat i on Hand and wrist complaints are common presentations to Accident and Emergency, general practice, orthopaedic and rheumatoid clinics. Some hospitals may have special "hand" clinics. Common acute problems include fractures, tendonitis and trigger finger. Common chronic problems include carpal tunnel syndrome, ganglions and arthritis. There are three main conditions commonly examined on in this station – osteoarthritis, rheumatoid arthritis and psoriatic arthritis. This is due to the availability of patients with these conditions as well as the changes specific to each, for example: swan neck deformity, Bouchard’s nodes and Heberden’s nodes. You should therefore be familiar with the changes that each of these conditions can cause.

The hand and wrist examination, along with all other joint examinations, is commonly tested on in OSCEs. You should ensure you are able to perform this confidently. The examination of all joints follows the general pattern of “look, feel, move” and occasionally some special tests.

Hi pExami nat i on Hip complaints in adults are often related to pain, such as arthritis or bursitis. In children however, it can occur in a well child for issues such as irritable hip, or in more serious conditions, such as Perthes disease or slipped upper femoral epiphysis. Hip pain can also be referred pain from another joint, most commonly knee and spine. The hip examination, along with all other joint examinations, is commonly tested on in OSCEs. You should ensure you are able to perform this confidently. The examination of all joints follows the general pattern of “look, feel, move” and occasionally some special tests.

KneeExami nat i on Knee complaints are very common presentations to Accident and Emergency, general practice, and orthopaedic clinics. Some hospitals will also have special knee clinics. Common presenting complaints are pain in the knee, the knee locking, or the knee giving way. Common conditions that cause these symptoms include arthritis, ligament, and/or cartilage injuries. The knee examination, along with all other joint examinations, is commonly tested on in OSCEs. You should ensure you are able to perform this confidently. The examination of all joints follows the general pattern of “look, feel, move” and occasionally some special tests.

Shoul derExami nat i on Shoulder complaints are fairly common presentations to Accident and Emergency, general practice, and orthopaedic clinics. Common acute problems include fractures, dislocation of the shoulder joint, and rotator cuff injuries. Common chronic problems include frozen shoulder and arthritis. The shoulder examination, along with all other joint examinations, is commonly tested on in OSCEs. You should ensure you are able to perform this confidently.

The examination of all joints follows the general pattern of “look, feel, move” as well as occasionally special tests, in which this station has many.

Spi neExami nat i on Back pain is one of the most common presentations to Accident and Emergency and general practice. Common causes of back pain include arthritis, prolapsed disc, and muscular injuries. Occasionally it can be the underlying cause of other conditions such as sciatica. The spine examination, along with all other joint examinations, is commonly tested on in OSCEs. You should ensure you are able to perform this confidently. The examination of all joints follows the general pattern of “look, feel, move” as well as occasionally special tests.

Consideracions durant l’embaràs: El dolor articular a les zones properes a la pelvis durant el primer i d’embaràs és fisiològic degut a l’augment de relaxina, que fa que les articulacions siguin més laxes i així permeten el creixement del nadó. Durant el segon trimestre, degut a l’augment de pes de l’úter, la dona pot referir dolor relacionat amb l’elongació dels lligaments uterins que subjecten l’úter, com els lligaments rodons, o els lligaments amples. Per altra banda, el dolor de maluc duran Per altra banda, el dolor de maluc durant l’embaràs també podria estar relacionat amb la compressió del nervi ciàtic (que transcorre des de les arrels ciàtiques a L4, L5, S1 i S2, abandonant la pelvis pel forat ciàtic major per sota del múscul piriforme, per baixar per tota l’extremitat inferior). -  No sé si cal que ho sàpiguen tot això... - Macdonald S, Magill-Cuerden J. Mayes’ Midwifery. 4ª ed. London: Elseiver; 2011.

Objective 16: Understand how to generate an ROC curve associated with a diagnostic test based on continuous analytical determination The receiver operating characteristic (ROC) curve is frequently used for evaluating the performance of binary classification algorithms. It provides a graphical representation of a classifier’s performance, rather than a single value like most other metrics. First, let’s establish that in binary classification, there are four possible outcomes for a test prediction: true positive, false positive, true negative, and false negative.

The ROC curve is produced by calculating and plotting the true positive rate against the false positive rate for a single classifier at a variety of thresholds. For example, in logistic regression, the threshold would be the predicted probability of an observation belonging to the

positive class. Normally in logistic regression, if an observation is predicted to be positive at > 0.5 probability, it is labeled as positive. However, we could really choose any threshold between 0 and 1 (0.1, 0.3, 0.6, 0.99, etc.) — and ROC curves help us visualize how these choices affect classifier performance.

The true positive rate, or sensitivity, can be represented as:

where TP is the number of true positives and FN is the number of false negatives. The true positive rate is a measure of the probability that an actual positive instance will be classified as positive. The false positive rate, or 1 — specificity, can be written as:

where FP is the number of false positives and TN is the number of true negatives.

Objective 17: Know how to interpret an ROC curve

Demonstrates how some theoretical classifiers would plot on an ROC curve. The gray dotted line represents a classifier that is no better than random guessing — this will plot as a diagonal line. The purple line represents a perfect classifier — one with a true positive rate of 100% and a false positive rate of 0%. Nearly all realworld examples will fall somewhere between these two lines — not perfect, but providing more predictive power than random guessing.

Typically, what we’re looking for is a classifier that maintains a high true positive rate while also having a low false positive rate — this ideal classifier would “hug” the upper left corner of Figure 1, much like the purple line.

Objective 18: Interpret the AUC statistic (area under the ROC curve) as an index for overall test accuracy

AUC stands for area under the (ROC) curve. Generally, the higher the AUC score, the better a classifier performs for the given task. shows that for a classifier with no predictive power (i.e., random guessing), AUC = 0.5, and for a perfect classifier, AUC = 1.0. Most classifiers will fall between 0.5 and 1.0, with the rare exception being a classifier performs worse than random guessing (AUC < 0.5). Video:

https://youtu.be/4jRBRDbJemM...