By T. Grim. University of Osteopathic Medicine and Health Science.
If your child is infected ceftin 250mg mastercard, it may take 1 to 10 days for Childcare and School: symptoms to start ceftin 500mg cheap. The child - By direct contact with secretions of the nose and should also be healthy throat cheap ceftin. This may happen by kissing buy discount ceftin on-line, sharing food, enough for routine beverages, toothbrushes, or silverware. Call your Healthcare Provider If anyone in your home: ♦ has symptoms of the illness. Prevention The local or state health department will help to determine who has been exposed and will need to take preventive antibiotics. When staph is present on or in the body without causing illness, this is called colonization. When bacteria are resistant to an antibiotic it means that particular antibiotic will not kill the bacteria. These infections commonly occur at sites of visible skin trauma, such as cuts and abrasions, and areas of the body covered by hair (e. A long delay may occur between colonization with staph and the onset of infection. Activities: Children with draining sores should not participate in any activities where skin-to-skin contact is likely to occur until their sores are healed. Childcare/school personnel should notify parents/guardians when possible skin infections are detected. Wash hands thoroughly with soap and warm running water after touching secretions from the nose, tracheostomies, gastrostomies, or skin drainage of an infected or colonized person. When bacteria are antibiotic resistant it means that an antibiotic will not kill the bacteria. These infections Thell your childcare commonly occur where children have cuts and scrapes. This means that the bacteria are Childcare and School: there without causing any infection or any harm. Yes, if draining sores If your child is infected, the time it will take for symptoms are present and cannot to start will vary by type of infection. Contagious Period Activities: Avoid participating in As long as the bacteria are present. A child who has activities where skin-to- draining infections has more bacteria and is more skin contact is likely to contagious than a child who is only colonized. Wash clothes, bed sheets, and blankets in hot water with detergent and dry in a hot dryer. The bumps are usually painless, but, on rare occasions, can be itchy, red, swollen, and/or sore. It may last longer and cover more of the body in people with eczema (skin disease) or those who have a weakened immune system. It can also be spread by contact with contaminated objects such as shared clothes, towels, washcloths, gym or pool equipment, and wrestling mats. Persons with this skin disease can accidentally spread the virus to other parts of their body. Spread can occur by touching or scratching the bumps and then touching another part of the body (autoinoculation). Researchers who have investigated this idea think it is more likely that the virus is spread by sharing towels and other items around a pool or sauna than through water. After that, the bumps will begin to heal and the risk of spreading the infections will be very low. Encourage parents/guardians to cover bumps with clothing when there is a possibility that others will come in contact with the skin. Activities: Exclude any child with bumps that cannot be covered with a watertight bandage from participating in swimming or other contact sports. Wash hands thoroughly with soap and warm running water after touching the bumps or discarding bandages. Contagiosum If you think your child Symptoms has Molluscum Contagiosum: Your child may have bumps on the face, body, arms, or legs. Avoid participating in - By touching or scratching your bumps and then swimming or contact touching another part of your body. After the bumps begin to heal, the risk of spreading the infection will be very low. Contact sports or using shared equipment: Avoid sharing towels, wash cloths, uniforms, clothing, or other personal items. It may take weeks to months to regain energy; however, this will vary from person to person. Less common problems include jaundice (yellowing of the skin or eyes) and/or enlarged spleen or liver. Since this virus does not live long on surfaces and objects, you need to be exposed to fresh saliva to become infected. Because students/adults can have the virus without any symptoms and can be contagious for such a long time, exclusion will not prevent spread. Sports: Contact sports should be avoided until the student is recovered fully and the spleen is no longer palpable. Wash hands thoroughly with soap and warm running water after any contact with saliva or items contaminated with saliva. If you think your child Symptoms has Mono: Your child may have a sore throat, swollen glands, Thell your childcare headache, fever, and sometimes a rash. Childcare and School: Less common problems include jaundice (yellowing of the No, as long as the child skin or eyes) and/or enlarged spleen or liver. Sports: Children with an Spread enlarged spleen should avoid contact sports - By kissing or sharing items contaminated with saliva. Call your Healthcare Provider ♦ If anyone in your home has symptoms of mononucleosis. Your child may need bed rest, to drink plenty of water, and to avoid some physical activities. Prevention Wash hands after touching anything that could be contaminated with secretions from the nose or mouth. Mosquito-borne diseases are viral diseases that are spread by infected mosquitoes. The many viruses have the potential of causing serious disease affecting the brain and central nervous system. Removal of potential breeding sites is important in preventing the spread of mosquitoes. Birdbaths, wading pools, dog bowls, and other artificial containers of water should be emptied weekly to eliminate mosquito-breeding areas. Mosquitoes breed in water and artificial containers, especially flower pots, birdbaths, cans, children’s toys, wading pools, tire swings, old tires, or anything that will hold a small pool of water should be emptied or discarded. Rarely, swelling of the spinal cord and brain (encephalitis), inflammation of the ovaries (oophoritis) or breasts (mastitis), and deafness may occur. Other examples of how the virus can be spread is through sharing toys, beverage containers, eating utensils, and smoking materials (cigarettes), and kissing. Exclusion will last through at least 26 days after the onset of parotid gland swelling in the last person who developed mumps. A blood test specific for mumps antibody should be done as soon as possible after symptoms begin. Sometimes, healthcare providers will obtain a second blood test 2 to 3 weeks later. Encourage parents/guardians to keep their child home if they develop symptoms of mumps. Wash hands thoroughly with soap and warm running water after contact with secretions from the nose or mouth. If you think your child Symptoms has Mumps: Your child may have swollen glands in front of and below the ear.
Some outbursts have no apparent cause and should be considered a consequence of the disease itself generic 250 mg ceftin with visa. Due to the changes in brain function buy 500mg ceftin free shipping, confrontations and ultimatums are rarely productive cheap ceftin 250mg on-line. Irritability may be reduced if the environment is kept as calm and structured as possible order ceftin 250mg free shipping. Caretaker and family support groups can provide emotional support and are a forum for sharing strategies that members have found useful in their own households. Treating Irritability For episodic outbursts, success often results from combining drug therapy with a careful analysis of the context and precipitants of the outburst. A number of medications have been found to be helpful in treating enduring irritability. The optimal doses for treating irritability are not known but one should start at a low dose and increase gradually as in the treatment of depression. These agents may be particularly useful when the irritability seems tied to the person’s obsessive preoccupation with a particular topic. In severe or urgent situations most clinicians would probably start with a neuroleptic, particularly one of the newer agents which tend to have fewer side effects. Long-acting benzodiazepines, such as clonazepam (Klonopin®), starting at low doses, e. Mood stabilizers, such as divalproex sodium and other anticonvulsants, have also been helpful and could be administered as outlined for mania. Particularly when there is a potential for violence, families and clinicians may then become afraid to withdraw medications even when they are ineffective, and this in turn increases the risk for delirium and further aggressive episodes. It is always necessary to revisit the situation and see whether a drug has actually reduced the frequency of outbursts. Irritability, Outbursts and Safety Family members and caregivers should be advised to avoid situations which could compromise safety. The frst priority is to ensure the immediate safety of the person and the caregiver. In cases of serious threat or actual violence, the caregiver should summon police, even if he or she does not intend to fle charges, and should explain to the responders that the individual is suffering from a neuropsychiatric disease and is under a doctor’s care. In some situations, the caregiver may actually want to consider allowing charges to be fled. This may help to reinforce the unacceptability of violence to a person who still retains some insight, or may permit a judge to compel treatment in someone who has previously been resisting it. Delirious individuals may have waxing and waning of consciousness, may be agitated or lethargic, and frequently have disturbed sleep. Clinicians usually expect delirious individuals to exhibit agitation or hyper-arousal, and may overlook the delirious person who is somnolent or obtunded. Subdural hematoma, due to a recognized or unrecognized fall, should also be considered if the person suffers a sudden change in mental status. Delirium may come about gradually as the result of an undiagnosed underlying problem. For example, a dehydrated individual may no longer be able to tolerate his usual medication regimen. Identifcation and correction of the underlying cause is the defnitive treatment for delirium. Low doses of neuroleptics may be helpful in managing the agitation of a delirious individual temporarily. The husband says that his wife falls a lot and could have hit her head in an unwitnessed accident. Anxiety Anxiety is not a single syndrome, but serves as the fnal common pathway for many different psychiatric disorders. For example, some may develop social anxiety in response to their visible symptoms. They may worry for days in advance about what to wear when going to an appointment or what to order at a restaurant. Stopping a job that has become too 78 diffcult may result in a remarkable improvement. Some caregivers fnd it useful to refrain from discussing any anxiety provoking events until the day before they are to occur. Some individuals will not improve with counseling and environmental interventions and will require pharmacotherapy. The clinician should frst assess whether the anxiety is a symptom of some other psychiatric condition, such as a major depression. People with obsessive compulsive disorder may be made anxious by obsessions or if their rituals are interrupted. It is characterized by the acute onset of overwhelming anxiety and dread, accompanied by physiological symptoms such as rapid heartbeat, sweating, hyperventilation, light-headedness, or paraesthesias. Panic attacks usually last only ffteen or twenty minutes, may begin during sleep, and may even result in synocope (tingling or creeping feeling in the skin). Suspected panic attacks require medical evaluation, because some of the other possible explanations for the symptoms are dangerous conditions. This may occur fairly early in the course of the disease, when the individual is still functional in most other ways and can be very frustrating for the spouse or partner. Frank discussion with each person, individually and together, may help to improve understanding and generate compromises. The 79 spouse, usually the wife, may be distressed and apprehensive that the person will become aggressive if sexual demands are not met. Open communication about sex between the doctor and the family can help to de-stigmatize this sensitive topic, and distressing sexual behaviors can sometimes be adapted into more acceptable acts. Interventions can be diffcult in circumstances where impaired judgment is an issue. Keeping the individual awake and active, for example through a day program, may be all that is needed to counteract under-stimulation and achieve restful sleep. Depressed individuals commonly complain of early morning awakening or may appear to sleep most of the night but not feel rested in the morning. There are no ideal hypnotic medications, but agents such as sedating antidepressants (such as trazodone) or neuroleptics (such as quetiapine) may be used judiciously. Benzodiazepine and other prescription sedative-hypnotics are potentially delirogenic and habit forming and should be used cautiously, if at all. This may be acceptable to the person and family if it is understood as a feature of the disease. In situations where harm could result from apathy, for example if the person is not getting out of bed for meals, judicious use of amphetamines may be appropriate. The person experiences the failure of his hopes for the future and the loss of his sense of self worth and begins to experience despair. Demoralization should be considered when the person lacks the full depressive syndrome, and when the feelings of hopelessness have arisen in clear proximity to signifcant losses. Treatment for demoralization requires a combination of psychotherapy and social work to help the individual, and his or her family, solve real world problems, reduce stressors, build a support system, and emphasize the positive factors in life. His disability pension is fairly generous and his wife picks up extra hours at her job to make ends meet. Now that he is home, however, he is not helping with the household chores, is irritable with his wife and children and is beginning to drink excessively in the evenings. He tells his wife that he feels worthless and “half a man” and she is worried because he still owns a revolver. He seems surprised at the question and replies that he would never do such a thing to hurt his family. He discusses his feelings of guilt and worthlessness over not being able to provide for his family. The doctor reminds him that his condition is very mild and that he has many good years ahead of him. He agrees to abstain from alcohol for the time being and, with encouragement, obtains a part time job providing security at a large retail store. With the money he is making, his wife is able to reduce her hours and now that he is feeling less resentful, he begins to pitch in at home, going grocery shopping or doing the laundry. Six months later, at a follow- up visit, he is in excellent spirits and has made a successful transition to his new situation. This may be due to the onset of symptoms in the child before the parent’s onset, the early death of a parent (before the parent’s symptoms were evident), misdiagnosis or lack of diagnosis in a parent who was affected, non-paternity (a biological father who is not the same as the apparent father), or adoption.
However purchase ceftin 250mg on line, some people do develop non-specific symptoms at times when the virus is reproducing and causing liver problems ceftin 500 mg for sale. People with lifelong hepatitis B infection can develop cirrhosis of the liver generic ceftin 500 mg fast delivery, liver cancer order ceftin paypal, and/or liver failure, which can lead to death. An exposure is defined as contact with blood or other body fluids of an infected person. Contact includes touching the blood or body fluids when you have open cuts or wounds (that are less than 24 hours old or wounds that have reopened), splashing blood or bloody body fluids into the eyes or mouth, being stuck with a needle or other sharp object that has blood on it, or having sex or sharing needles with someone with hepatitis B virus. Everyone who has an exposure to a person infected with hepatitis B virus should have blood tests done as soon as possible to determine whether treatment is needed. In some cases, people who have already been vaccinated may be tested and/or revaccinated. If a mother develops hepatitis B during her pregnancy, there is a chance that the baby may also become infected. If the mother develops acute hepatitis in the third trimester of pregnancy or the immediate postpartum period, the risk of infection for the newborn baby may be 60% to 70%. It is very important that the baby receive treatment right after birth to get as much protection as possible. They may have the virus for the rest of their lives and be a source to spread the disease. All pregnant women should be tested for hepatitis B virus early in their pregnancy. Check with your healthcare provider for the schedule for dose 2 and dose 3 of the vaccine. Once the baby has turned 1 year of age, the baby should have a blood test to make sure infection did not occur and that the vaccine is protecting the baby. The blood test for hepatitis B may show that you: Are immune (had hepatitis B disease or vaccine in the past) and have no sign of recent infection. You should receive the hepatitis B vaccine series if you are at risk of blood exposures at your job or through risk behaviors in your personal life. Is there a way I can keep from being infected with hepatitis B during my pregnancy? In adults, the virus is most often spread through sexual contact or by sharing needles. Although it is rare, there are some children who become infected with the virus from their infected mothers during pregnancy, at the time of birth, or through breastfeeding. An exposure is defined as direct contact with the blood or body fluids of an infected person. The test should be repeated 3 months and 6 months after exposure to completely rule out infection. About 25% of babies of infected mothers who do not receive antiretroviral treatment may become infected, whereas, about less than 2% become infected when the mother receives antiretroviral treatment. The infant can become infected anytime during pregnancy, but infection usually happens just before or during delivery. An infant may be tested as early as 48 hours and may be tested periodically for up to 2 years. For this test to be accurate, it should be conducted a minimum of three weeks to three months after a known exposure. Symptoms include generalized skin rash, tiredness, headache, fever, and swollen glands in the area behind the ears and the neck (lymphadenopathy). It is estimated that 25% to 50% of persons infected with rubella may not have any symptoms. However, there may be severe illness in adults who have not had the disease in the past or have not had the vaccine. Joint stiffness and/or joint pain may occur in up to 70% of adult women infected with rubella. Some of the other problems that may occur include a bleeding problem called thrombocytopenia and infection of the brain (encephalitis). After the 20 week of pregnancy if a woman develops rubella, most likely there will not be any problems for either the mother or the unborn baby. If you know that you are immune to rubella (had a blood test to show that you have antibodies to rubella), you do not need to be concerned about the exposure. If you are not immune to rubella and have been exposed to someone with rubella or have developed a rash illness that might be rubella, you should call your healthcare provider. The blood test for rubella may show that you: Are immune (had rubella disease or vaccine in the past) and have no sign of recent infection. You should discuss what the risks are based on your stage of pregnancy with your healthcare provider. If you are not pregnant and not immune, all adults working with children should know their vaccine history or immune status. When you are given the vaccine you should avoid becoming pregnant for at least one month after immunization. Varicella-zoster is a herpes virus that causes chickenpox, a common childhood illness. After a person has had chickenpox, the varicella-zoster virus can remain inactive in the body for many years. The sores commonly occur in batches with different stages (bumps, blisters, and sores) present at the same time. A person with chickenpox is contagious 1-2 days before the rash appears and until all blisters have formed scabs. Children with weakened immune systems may have blisters occurring for a prolonged time period. Shingles occurs when the virus, which has been inactive for some time, becomes active again. Severe pain and numbness along nerve pathways, commonly on the trunk or on the face, are present. The blisters are usually on one side of the body and closer together than in chickenpox. If people who have never had chickenpox have contact with the fluid from the shingles blisters, they can develop chickenpox. About 15%–20% of people who have received one dose of varicella (chickenpox) vaccine do still get chickenpox if they are exposed, but their disease is usually mild. Vaccinated persons who get chickenpox generally have fewer than 50 spots or bumps, which may resemble bug bites more than typical, fluid-filled chickenpox blisters. In one study, children who received two doses of varicella vaccine were three times less likely to get chickenpox than individuals who have had only one dose. The symptoms may be more severe in newborns, persons with weakened immune systems, and adults. Serious problems can occur and may include pneumonia (bacterial and viral), brain infection (encephalitis), and kidney problems. Many people are not aware that before a vaccine was available, approximately 10,600 persons were hospitalized, and 100 to 150 died, as a result of chickenpox in the U. If you have been in contact with someone with chickenpox or shingles, or if you have a rash-associated illness that might be chickenpox or shingles, discuss your situation with your healthcare provider. Blood tests may be done to see if you have become infected with the virus or have had the disease in the past. If you are pregnant and not immune and have been exposed to chickenpox or shingles, call your healthcare provider immediately. Susceptible pregnant women are at risk for associated complications when they contract varicella. Varicella infection causes severe illness in pregnant women, and 10%-20% of those infected develop varicella pneumonia, with mortality (death) reported as high as 40%. July 2011 31 If you are pregnant and have never had chickenpox, and you get chickenpox during the: − First half (about 20 weeks) of your pregnancy, there is a very slight risk (0. The blood test can show that you: Are immune (have already had varicella disease or varicella vaccine) and have no sign of recent infection. You should discuss what the risks are for your stage of pregnancy with your healthcare provider. Yes, make sure all your vaccines are up to date, especially if you are planning a pregnancy. You should avoid becoming pregnant for at least one month after the last vaccination. If you are pregnant, have your healthcare provider give you the varicella vaccine after your baby is delivered.
Awareness of general issues about etiology of psychiatric disorders and methodology used to study etiology of these disorders buy ceftin online now. To know the role of counseling and psychological therapies in treatment of psychiatric disorders buy ceftin 500mg lowest price. Introduction and classification of Psychiatric disorders Concept of psychiatric disorders; need for classification; types of classification e 250 mg ceftin overnight delivery. Aetiology of Psychiatric disorders Overview of contribution of different scientific disciplines to psychiatric aetiology – clinical descriptive studies buy discount ceftin on-line, epidemiology, social sciences e. Bipolar disorders Epidemiology, clinical features, diagnosis, overview of aetiology, course, treatment – pharmacological. Depression Epidemiology, clinical features, diagnosis, overview of aetiology, co-morbidity with organic disorders, course, treatment – pharmacological. Hysterical neurosis (Conversion and Dissociative disorders) Epidemiology, clinical picture, diagnosis, differential diagnosis, aetiology, prognosis, treatment. Personality disorders Concept of personality disorders, epidemiology, classification, assessment, overview of clinical features, aetiology, prognosis. Drug and Alcohol dependence Concept of abuse and dependence, epidemiology of alcohol and opiate dependence; clinical features, withdrawal symptoms including complicated withdrawal, psychosocial complications, aetiology, outcome, treatment. Psychiatric disorders of childhood and adolescence, Classification of childhood psychiatric disorders, epidemiology, clinical features, aetiology, assessment. Counselling and psychological therapies Counselling process, skills, different counseling approaches, behaviour therapy, cognitive therapy and its applications. Psychological testing What are psychological tests, standardization, reliability, validity, intelligence test, personality test, application. Emphasis will be laid on the primary care of the injured, care of comatose, common wounds and ulcers, resuscitation of patient with cardiac arrest, initial care of acute abdominal conditions and other emergencies. Describe aetiology, pathophysiology, principles of diagnosis and management of common surgical problems including emergencies, in adults and children: 2. Define indications and methods for fluid and electrolyte replacement therapy including blood transfusion: 3. Define asepsis, disinfection and sterilization and recommend judicious use of anatibiotics: 4. Describe clinical features and risk factors of common malignancies in the country and their management including prevention. Enumerate different types of anaesthetic agents, their indications, mode of administration, contraindications and side effects. Diagnose common surgical conditions both acute and chronic, in adult and children; 2. Plan various laboratory tests for surgical conditions and interpret the results; 3. Identify and manage patients of haemorrhagic, septicaemic and other types of shock; Surgery 147 4. Be able to maintain patent air-way and resuscitate a - (i) a critically injured patient; (ii) patient with cardio-respiratory failure; (iii) a drowning case. Monitor patients of head, chest, spinal and abdominal injuries, both in adults and children; 6. Acquire principles of operative surgery, including pre-operative, operative and post operative care and monitoring; 8. Treat open wounds including preventive measures against tetanus and gas gangrene; 9. Diagnose neonatal and paediatric surgical emergencies and provide sound primary care before referring the patient to secondary / tertiary centers; 10. Skin: ulcers and wounds, wound infections, burns, skin infections (boils, carbuncle, abcess), cysts (epidermoid cyst, dermoid),skin tumors(basal cell carcinoma, squamous cell carcinoma, melanoma). Head and Neck region: congenital anomalies (cleft lip, cleft palate, branchial cyst and fistula, thyroglossal cyst) swellings of parotid and submandibular glands, oral ulcers, leukoplakia, submucous fibrosis, lichen planus, common jaw tumors, squamous carcinoma of oral cavity, pharynx & larynx. Thyroid swellings (adenomatous goitre, Graves’ Disease, papillary and follicular thyroid cancer). Arteries: Features of limb Ischaemia, noninvasive vascular diagnostic tests, obliterative atheromatous disease, aneurysms, Raynaud’s syndrome, arterial emboli. Stomach and duodenum: Peptic ulcer- stomach and duodenum, carcinoma of the stomach, gastritis. Anus: Haemorrhoids, Pruritus ani, Fissure-in-ano, Anorectal abscesses, Fistula-in-ano, cancer of the anus. Hernias of the abdominal wall: Inguinal hernias, femoral hernia, umbilical and epigastric hernia. Urology: Diagnostic studies and techniques in the urinary tract, trauma to the urinary tract, urinary calculi, urinary tract infection, prostatic hyperplasia, tumours of the kidney, epididymo-orchitis, hydrocele, tumours of the testicle, carcinoma of the penis. In the department we also organize yearly workshop on suturing & knot tying where students get an opportunity to acquire hands-on experience on these important skills. Guidelines for students posted in Department of Surgery 3rd – 4th Semester This is the first introductory posting in surgery to provide orientation, towards the general functioning of the Department and the nature of clinical work performed in the Department of surgery. The learning objectives for this session are to learn : · the art and science of history taking, · general evaluation of overall health; · basic principles of examination of a lump; · examination of hernia, hydrocoele and abdomen; · examination of breast; · examination of head and neck; · evaluation of wounds, ulcers and sinuses. You are required to be properly dressed, wear a white coat, with a name plate (no jeans and no sneaker shoes please! You are required to bring the following:- A pen torch with metal tip, measuring tape, Vernier callipers, stethoscope, patella hammer; Surgery 149 Please read “ Norman Browse- An Introduction to the symptoms and signs surgical diseases” or “Hamilton Bailey- Physical signs”, in order to acquire theoretical background of clinical examination. Please maintain a record of cases seen and surgical skills learnt in a diary/log book. This will help me in learning the diagnosis and in becoming a good doctor so that I may serve the society well). Formulate a diagnostic hypothesis (e) based on the patient’s age, gender, place of living and initial symptoms. Now ask details of the present and past history focused on the initial diagnostic hypothesis. If you have consider piles and cancer rectum as your diagnostic hypothesis, your interrogation should revolve around these two conditions with the objective of proving one and refuting the other. After interrogation revise your diagnostic hypothesis(e) on the basis of historical facts. The next step is to carry out a detailed physical exam of the lump, swelling or ulcer. Make a diagrammatic representation of your findings with colour felt pens on your diary/log book. Go through the following checklist while seeing any lump: number, site, size, shape, margin , surface, skin over it, structures superficial and deep to it, temperature over it, tenderness, consistency, transillumination, thrill or bruit and the regional nodes. The first 12 students of the batch go with Surgical Unit 1 and Unit 3, while the remaining students are posted with Unit 2 and Unit4. You are responsible for seeing all the patients admitted to these beds during your stay of 6 week with us. The learning objectives of this final session is to develop the competency in making a diagnosis, generating a diagnostic decision plan and outlining the therapeutic decision. During this period you have to accompany the patient to the operation theatre, assist in the operation, write postoperative orders and follow the postoperative recovery of the case. Write down the daily progress in your case records till the patient is discharged. Since surgery included several specialties, the weightage often gets distributed amongst the specialties: Ophthalmology, E. This involves breaking up clinical competence in to a series of clinical skills (history taking, performing physical examination, interpreting lab data, differential diagnosis, treatment & follow up), and testing each skill in a separate ‘station’. Each station is provided with a real or simulated patient, mannequin, equipment, X-Ray, or even a question which should be tackled by a student within a prescribed time limit say, 2 – 5 minutes, on rotation basis. The performance is observed by an observer using a predetermined check list for assigning marks. You are being observed by the examiner for your skills in physical examination and your attitude towards the patient. Percusses for dullness over liver and its upper border 2 Station 5 Questions based on station 5: Marks : 5 Q1. Enumerate 2 most probable causes of this condition (mentions obstruction of common bile duct, congestive heart failure) 2 Q3. Describe the abnormality (mentions gastric dilatation, block in duodenum and no filling defect in stomach) 2 3. Name the disease producing these features (mentions chronic duodenal ulcer with gastric outlet obstruction) 3 4.