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- | *Note, much borrowed from generous, previous IUSM medical students.
| + | b5muSQ You are my breathing in, I own few web logs and occasionally run out from brand . Analyzing humor is like dissecting a frog. Few people are interested and the frog dies of it. by E. B. White. |
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- | afizPK Enjoyed every bit of your post.Really looking forward to read more.
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- | 5Astck Great blog.Really looking forward to read more. Really Cool.
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- | sR9V4Z Major thanks for the blog article.Thanks Again. Really Great.
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- | YbuRcM Thanks so much for the blog.Much thanks again. Great.
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- | S9qz2p Very neat blog.Thanks Again. Much obliged.
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- | ===Chapter 10===
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- | # Describe the actions and innervations of the eye and extraocular muscles.
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- | # Identify the major symptoms of eye disease.
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- | # Interpret the symptoms of the major diseases of the eye and apply them clinically to a patient: loss of vision, eye pain, diplopia, tearing or dryness, discharge, and redness.
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- | # Apply the components of the physical examination of the eye to a patient.
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- | # Clinically correlate the symptoms and physical exam findings pertaining to the eye for the following disease processes: visual field defect, red eye (acute conjunctivitis, acute iritis, narrow-angle glaucoma, and corneal abrasion), diabetes, hypertension, and papilledema.
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- | # Give a differential diagnosis based on symptoms and/or physical exam findings pertaining to the eye.
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- | ===Chapter 11===
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- | ====Ear====
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- | *Describe the structure and innervations of the ear.
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- | **External ear consists of pinna and external auditory canal
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- | **The middle ear or tympanic cavity consists of connections to the mastoid antrum and nasopharyx through the Eustachian tube
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- | **The tympanic membrane forms the lateral boundary of the middle ear, while the cochlea forms the medial boundary
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- | **Sound is conducted from the tympanic membrane to the inner ear by the malleus, incus and stapes
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- | **The tensor tympani [CN V] and the stapedius [CN VII] are also located in the middle ear
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- | **The inner ear is the end-organ for hearing and equilibrium containing the semicircular canals, vestibule and the cochlea
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- | **The hair cells of the organ of corti convert mechanical force into electrochemical signal
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- | *Identify the major symptoms of ear disease and how these symptoms can identify diseases involving the ear: hearing loss, vertigo, tinnitus, otorrhea, otalgia, and itching.
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- | **Hearing loss
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- | ***conductive: blocks transmission of sound waves in external canal or middle ear; caused by wax, effusions, foreign bodies
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- | ***sensorineural: inner ear structures, auditory nerve or brain stem are dibilitated; caused by prenatal rubella, and lots of other causes.
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- | ***'''Patients with sensorineural talk loudly, conductive speak softly.'''
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- | **Vertigo: spinning or turning in position; can be otologic, neurologic, psychological, or iatrogenic.
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- | ***Meniere’s disease: severe paroxysmal vertigo as a result of labyrinthine lesions
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- | **Tinnitus: sensation of hearing sound such as buzzing or ringing
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- | **Otorrhea: bloody discharge associated with carcinoma or trauma
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- | **Otalgia: pain related to inflammatory conditions or may be referred
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- | **Itching: from primary disorder of external ear or discharge from middle ear
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- | *Apply the components of the physical exam of the ear to a patient.
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- | **Inspect external ear structures: tophi, “cauliflower ear” from trauma, cancer, discharge
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- | **Palpate the external ear structures
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- | **Auditory acuity testing: occlude one ear and speak softly into the other; use of 512Hz fork
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- | ***Rinne test: air conduction vs bone conduction using fork; placing stem on mastoid process compared against vibratory hearing; usually AC > BC [Rhine positive]
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- | ***Weber test: compares bone conduction in both ears by placing fork in middle of forehead; sound heard on ipsi side of conductive problem and contra side of a sensorineural problem
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- | ***Example: Rinne positive on both sides -> sensorineural problem; Rinne negative on one side identifies conduction problem on that side
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- | **Otoscopic examination: pull posterior and superior and look at the canal and tympanic membrane (should be pearly gray)
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- | ***Injection: dilation of tympanic vessels
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- | ***Retraction pocket can indicate Eustachian tube blockage and decreased pressure
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- | **Determination of mobility of tympanic membrane: also uses otoscope; useful for middle ear infection possibility (decreased movement will be detected if fluid present)
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- | *Clinically correlate the symptoms and physical exam findings pertaining to the ear for the following disease processes: conductive and sensorineural hearing loss, otitis media, serous otitis media, otitis externa, and vertigo. Interpret the symptoms of diseases of the ear and apply them clinically to patient.
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- | **Acute otitis externa: p. aeruginosa
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- | ***Severe pain accentuated by manipulation of the pinna; lymphadenopathy; fever; normal tympanic membrane
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- | ***Summer time
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- | **Bullous myringitis: localized form of external otitis
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- | ***Acute viral URI; severe pain; lesions on the skin of the deep external ear canal;
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- | ***Self-limited
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- | **Acute otitis media: bacterial infection of the middle ear
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- | ***Usually in children;
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- | ***Pain, malaise, no pain on external manipulation, fiery red tympanic membrane;
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- | ***Winter
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- | **Advanced acute otitis media: rupture of membrane
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- | ***Perforations can be central or marginal (more serious and may dispose to a cholesteatoma)
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- | ***May result from either otitis media or trauma
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- | **Serous otits media:
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- | ***Adults with viral URIs or sudden atmospheric pressure changes
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- | ***Tympanic membrane appears yellowish-orange as a result of the amber-colored fluid
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- | **Partial obstruction of the Eustachian tubes:
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- | ***Air bubbles or an air-fluid level in the middle ear
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- | **Chronic otitis media: rupture and recurrent middle ear infections
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- | ***Foul-smelling, not usually painful
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- | **Retraction pockets: chronic negative pressure within middle ear
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- | ***May progress to an acquired cholesteatoma
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- | ***Treat with T-tube (tympanostomy)
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- | **Deafness:
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- | ***Child: conductive via cerumen, chronic/acute otitis media; sensorinueral via mumps, rubella
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- | ***Adult: conductive via tube blockage, viral myringitis, otosclerosis; sensorineural via Meniere’s, ototoxic drugs, acoustic neuroma
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- | *Generate a diagnosis and/or differential diagnosis based on symptoms and/or physical exam findings of the ear.
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- | ====Nose====
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- | # Describe the structure of the nose.
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- | # Illustrate how the major symptoms of nose diseases are used to identify nose diseases.
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- | # Interpret the symptoms related to the nose and apply them clinically to a patient.
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- | # Apply the components of the physical exam of the nose to a patient.
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- | # Clinically correlate the symptoms and physical exam findings pertaining to the nose for the following disease processes: allergic rhinitis, sinusitis, and nonallergic rhinitis.
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- | # Generate a diagnosis and/or differential diagnosis based on symptoms and/or physical exam findings of the nose.
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- | ===Chapter 12===
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- | *Know the structures of the oral cavity and pharynx.
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- | **http://media-3.web.britannica.com/eb-media/91/74891-004-345232AC.jpg
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- | **http://4.bp.blogspot.com/_hL0QrZsPcvY/SaP_z9urWaI/AAAAAAAAAYM/Djf9xDzyaes/s400/or4.gif
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- | *Know the functions of the pharynx.
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- | **Subdivisions: nasopharynx, oropharynx, hypopharynx.
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- | **Fxn: provides swallowing, speech, and an airway.
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- | *Know the important symptoms of disease of the oral cavity.
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- | **Ulceration, bleeding, mass, halitosis, xerostomia (dry mouth).
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- | *Apply the components of the physical exam of the oral cavity and pharynx to a patient.
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- | **See cd.
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- | *Clinically correlate the signs and symptoms of the following conditions:
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- | **Aphthous ulcer
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- | ***Single canker sore. Most common acute oral ulcer.
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- | ***Relatively superficial w/ raised borders. On buccal or labial mucosa.
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- | **Herpetic ulcer
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- | ***acute multiple ulcers, associated w/ vesicles.
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- | ***On mucocutaneous junction, hard palate, or gingivae.
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- | ***Crusting when bullae break.
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- | **Chancre
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- | ***Painless, single lesion on lips or tongue.
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- | ***Lesion w/o central necrotic material.
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- | ***May have tender lymphadenitis.
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- | **Squamous cell carcinoma:
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- | ***Single indurated sore on lips, tongue, mouth floor, or tongue (esp. on lateral borders)
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- | ***Erythroplakia of mouth floor and soft palate.
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- | ***Raised border, absence of necrotic material in crater.
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- | ***May have painless lymphadenopathy in neck.
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- | **Candidiasis
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- | ***Burning tongue, inside of cheek or throat.
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- | ***Whitish pseudomembrane.
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- | ***Peeled off to reveal raw, red area that may bleed.
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- | **Erythroplakia
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- | ***Painless, red area.
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- | ***Granular, red papules that bleed.
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- | **Leukoplakia
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- | ***Painless, white area.
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- | ***Hyperkeratinized. Can’t be scraped off.
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- | ***Looks like flaking white paint. Often speckled w/ red spots.
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- | ***If associated with adenopathy, could be malignancy.
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- | **Lipoma
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- | ***Painless mass on inner surface of cheek or tongue.
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- | ***Yellowish, soft, freely mobile.
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- | **Lichen planus
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- | ***Usually no symptoms.
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- | ***Erosive form causes burning sores on inner cheeks and tongue.
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- | ***White reticulated papules bilaterally in lace-like pattern.
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- | ***Erosive form is hemorrhagic, ulcerated w/ possible white areas or bullae.
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- | ***May have pseudomembrane covering.
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- | **Mucocele
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- | ***Intermittent painless swelling of lower lip, or inside cheek.
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- | ***Slightly bluish.
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- | ***Dome-shaped, freely-mobile cystic lesion.
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- | **Hairy Tongue
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- | ***Gagging sensation.
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- | ***Large brown or black painless lesion on top of tongue.
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- | ***Elongation of filiform papillae and color change.
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- | ===Chapter 13===
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- | #Describe the topographical landmarks of the chest and utilize that knowledge to describe physical findings of the chest.
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- | #Recognize the main symptoms of pulmonary disease and how these symptoms can identify disease.
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- | #Interpret the symptoms of pulmonary disease and apply them clinically to a patient.
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- | #Apply the components of the physical exam of the chest to a patient.
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- | #Clinically correlate the symptoms and physical exam findings pertaining to the chest:
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- | ##Pulmonary Edema
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- | ##Pneumothorax
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- | ##Asthma
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- | ##Pneumonia
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- | ##Emphysema
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- | ##Pulmonary Embolism
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- | ##Pleural Effusion
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- | #Generate a diagnosis and/or differential diagnosis based on symptoms and/or physical exam findings of the chest.
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- | ===Chapter 17===
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- | # Describe the topographical landmarks of the abdomen and utilize that knowledge to describe physical findings of the abdomen.
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- | # Recognize where abdominal structures are located by topographical quadrants of the abdomen.
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- | # Recognize the main symptoms of abdominal disease and how these symptoms can identify disease.
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- | # Interpret the symptoms of abdominal disease and apply them clinically to a patient.
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- | # Apply the components of the physical examination of the abdomen to a patient.
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- | # Clinically correlate the symptoms and physical exam findings pertaining to the abdomen.
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- | # Generate a diagnosis and/or differential diagnosis based on symptoms and/or physical exam findings.
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- | ===Chapter 21===
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b5muSQ You are my breathing in, I own few web logs and occasionally run out from brand . Analyzing humor is like dissecting a frog. Few people are interested and the frog dies of it. by E. B. White.