Articles

ECG Made Simple

Amrit Sampalli Tutorials

ECG Made Simple (EMS) is a comprehensive web-based ECG learning program that teaches the art and science of electrocardiogram (ECG) interpretation. It addresses the needs of various groups of learners, including medical students, post-graduate medical trainees, and practicing physicians who need a refresher.

The ECG Made Simple tutorials utilize animations extensively to illustrate the often difficult to explain time-based concepts inherent in ECG understanding.

The practice section is populated with ECG tracings of increasing level of difficulty (5 levels). The ECGs could be accessed through the practice lists or by using the “Search Module”, which allows users to search for specific ECGs based on the diagnosis and level of difficulty.

The glossary provides a list of ECG statements with the corresponding diagnostic criteria. These can also be viewed in all ECG cases by pointing the mouse cursor at the active terms

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Register now and gain instant access to all tutorials, practice ECGs and other features.

Registration is FREE!

ECGMadeSimple.com

Case 3 – Amenorrhea

Tim Milligan Women's Health

You are seeing Cindy Albrecht, a 19 year old female, for amenorrhea. Please take a focused history for her complaint.

History

  • Distinguishes primary vs. secondary amenorrhea (patient has had previous menstrual periods)
  • Age of menarche
  • Onset of last menstrual period
  • Amount and changes in flow in recent menstrual periods
  • Length of menstrual period
  • Menorrhagia
  • Dysmenorrhea
  • Current use of birth control pills or other oral hormones
  • Presence of vaginal discharge/itching
  • Morning sickness
  • Abdominal pain/discomfort
  • Recent dieting
  • Recent fractures
  • Excessive exercise
  • Galactorrhea
  • Symptoms of hyperthyroidism (sweating, palpitations, heat intolerance)
  • Symptoms of hypothyroidism (feels slow, cold intolerance, constipation)
  • Symptoms of hypoestrogen state (hot flashes, night sweats, vaginal dryness)
  • Personal history of chronic disease
  • Pregnancy history
  • Current and past sexual history, including partners, method of intercourse, and contraception
  • Smoking and alcohol history
  • Family history of genetic abnormalities and infertility

Case 2 – Vaginal Discharge

Tim Milligan Women's Health

You are seeing Stacey Holland, a 23 year old female, for vaginal discharge. Please take a focused history for her complaint.

History

  • Onset and duration of vaginal discharge
  • Appearance of discharge
  • Association with menstruation
  • Presence of blood
  • Itching
  • Dyspareunia
  • Pain on defecation
  • Fever
  • Nausea/vomiting
  • Perineal/vaginal sores
  • Abdominal pain/discomfort
  • Rash or other lesions
  • Swollen joints
  • Vision changes
  • Dysuria
  • Hematuria
  • Increased frequency of urine
  • Last menstrual period
  • Menorrhagia
  • Dysmenorrhea
  • Regularity of menstruation
  • Past abdominal surgery
  • Pregnancy history
  • Current and past sexual history, including partners, method of intercourse, and contraception
  • Smoking and alcohol history
  • Medications – especially oral contraceptive pill
  • Allergies
  • Personal history of sexually transmitted infections and related investigations/treatment
  • Last Pap smear and result

Case 1 – Breast Mass

Tim Milligan Women's Health

You are seeing Mrs. Thompson, a 56 year old woman, in your outpatient clinic today. She is worried about a left breast mass, and would like your reassurance that it isn’t cancer. Take a focused history of her complaint and perform a focused physical exam.

History

  • Onset of awareness of mass
  • Size of the mass and change in size
  • How mass was identified
  • Mastalgia
  • Associated discharge, including pus and blood (none)
  • Size/tenderness association with menstrual cycle
  • Nipple changes
  • Skin changes (on affected breast)
  • Systemic symptoms – weight loss, low energy, anorexia
  • Associated shortness of breath or chest pain
  • Changes in personality – suggestive of brain metastases
  • Bone pain – suggestive of bone metastases
  • Inquires about date of menopause
  • Pregnancy history
  • Breastfeeding history
  • History of chest radiation
  • Age of menarche
  • Alcohol history
  • Smoking history (quantity in pack-years)
  • Past and current use of hormone replacement and oral contraceptive pills
  • Family history of breast, ovarian, or colon cancer
  • Past history of breast masses
  • Past mammography results
  • Addresses patient’s concerns regarding the mass

Physical Examination

Inspection

  • Drapes patient appropriately
  • Inspects breast skin for discoloration, retraction, peau d’orange, or bruising
  • Comments on presence of asymmetry
  • Examines nipples, commenting on absence of discharge, irregularities, or retraction
  • Examines areolas (no abnormalities)

Palpation

  • Uses radial or strip method to palpate both breasts,
  • Comments on texture, size, firmness, and mobility of any palpated masses
  • Palpates axillary nodes bilaterally
  • Palpates infraclavicular and supraclavicular nodes