H2 Medical screening

H2 Medical screening

1. Splenomegaly

   • Percussion + palpatie spleen (milt) US 2, sen ↓, spec ↑
   • Ballottement of spleen US 2, sen ↓, spec ↑
   • Nixons percusion US 3 sen ↓, spec ↑
   • Castell's percussion US 3 sen ↓, spec ↑
   • Percussion test in traube's space US sen ↓, spec ↑
   • Bimunual palpation of spleen US 3 sen ↓, spec ↑
   • Meddleton's menneuvre of splenogmegaly US 3 sen ↓, spec ↑

2. Hepatomegaly

   • Palpation of the liver US 3 sen ↓, spec ↑
   • Percussion of the liver US 3 sen ↓, spec ↑

3. Cholecystitis

   • Murphy's sign US 3 , sen ↓ spec ↑

4. Kidniey size

   • Palpation of kidney US ? sen -, spec -
   • Percussion of the kidney (Murphy) US ? sen - spec -

5. Acute appendicitis

   • Palpation of Mc Burney's point US 2, sen + spec ↑
   • Alvarado's score to predict acute appendicitis US 1 sen ↓, spec ↑
     • 1. the patient reported that pain migrated from epigastric to right lower quadrant
     • 2. Anorexia
     • 3. nausea and vomiting
     • 4. Tenderness in the lower quadrant
     • 5. Positive Blumberg's signs (rebound tenderness) over Mc Burney's point
     • 6. Fever
     • 7. Leucocytosis
     • 8. Shift to left

6. Bladder size

   • Test for Bladder size US 3 sen ↓, spec ↑

7. Cardopul. vascular dis en abdomial aortic aneurisma

   • Test for car.p.d.en abd.aort.aneurysm US 3 sen ↓, spec ↑

8. Vein thrombosis

   • Tests for deep Vein thrombosis US 1 sen ↑, spec ↑
     • 1. Active cancer
     • 2. Paralysis, pareses
     • 3. Recently bedridden
     • 4. Tenderness veneus system
     • 5. Entire swollen leg
     • 6. Calf swelling
     • 7. Pitting edema
     • 8. Colleteral superficial veins
     • 9. Collateral superficial veins
   • Tests for upper extremity US 2 sen ↓, spec ↑
     • 1. presence of venous material (catheter)
     • 2. upper extremity unilateral pitting edema
     • 3. pain
     • other diagnosis

9. Pulmonar Embolism

   • Tests for pulmonary Embolism US 1 sen↑ , spec ↑
     • 1. signs andsymptoms of DVT
       • 2. pulmonary embolism
     • 3. pulse > 100
       • 4. Previous history of DVT or PE
         • 5. Immobilisation or major surgury past 4 wks
           • 6. Hemoptysis
             • 7. Active cancer
   • Geneva criteria US 2 sen ↓, spec ↑
     • 1/8 previous embolism, HR> 100, age> 60, PaCO2, atelactasis, elevated hemidiagram

10. Cardio pulmonary events

    • Trombolysis in myocardial infarction (TIMI) US 1 sen ↓, spec ↑
      • 1.age > 65
        • 2. Known with CAD with stenosis >50%
        • 3. ASA use in past week
          • 4. Severe angina with > 2 episodes in 24 hours
            • 5. ST Changes > 0,5mm
              • 6. Have cardiac marker
                • 7. > 3 known cardiac risk factors
    • US 1 Pagina 87 t/m 99 !!

11. Bone mineral Densitometry

    • Osteoporoses risk assessment instrument (ORAI) US 1 sen ↑ spec↓
      • 1. Age 55-64 > +5,65-74 +9, 75> +15
        • 2. Weight 60-69.9 +3, <60kg +9
          • 3. If not currently taken estrogen +2
            • ORAI scoring: > 9 suggests recommendation for DEXA scanning
    • P.100 t/m 106 US 2 en 3

12. Fracture Assessment

    • Tuning fork test for fracture assesment US 2 sen ↑ spec↓
    • Tests for fracture asessment US 2 sen ↑ spec↓