GALS examination GALS: gait, arm, legs, and spine. GSAL may be a more logical order. Screening questions Any pain, swelling, or stiffness in joints/muscles? Any difficulty getting dressed? Any difficulty getting up stairs? Gait Ask them to walk, noting smoothness, heel strike, toe off, arm swing, turn speed (ask them to turn quickly). Normal summary: "Gait was smooth, symmetrical, with a quick turn and good arm swing." Spine With them standing with hands by side, first note if elbows and knees are fully extended. Observe from behind, from back of head down to back of feet, noting any scoliosis, whether iliac crests are equal, muscle wasting including gluteals and calves, Baker's cysts (RA), and feet abnormalities. Gluteal wasting might mean chronic knee problems, and calf wasting might mean chronic ankle problems. Observe from side: any excess kyphosis or lordosis? Check lumbar function: have them touch toes while you have two fingers on lumbar spine; the normal finger sp...

Background  Definition Pathological: Inflammation of lung parenchyma distal to the terminal bronchioles, which includes the respiratory bronchioles, alveolar ducts, and alveoli. Clinical: Lower respiratory tract symptoms AND... {Focal chest signs (e.g. crackles) plus systemic signs (e.g. fever)} OR {unexplained CXR shadowing}. Chest infection: A non-specific term for lower respiratory tract infections, though tends to be used for milder presentations – i.e. acute bronchitis – rather than pneumonia. Acute bronchitis may or may not feature productive cough and fever, but has no focal chest signs and CXR is clear. Unlike pneumonia, antibiotics are not routinely indicated and only provide minimal symptomatic relief. Types Community-acquired pneumonia (CAP) Causes (% of all cases): Common bacteria:  Strep. pneumoniae  (50%) and  H. influenzae  (7%). Other bacteria:  Staph. aureus  (2%),  Moraxella catarrhalis  (2%), and the 'atypicals',  Chla...

Background  Epidemiology Affects around 1/250 UK babies. The vast majority survive until adulthood, and 10% are not even diagnosed until then. Many conditions have a variable presentation, with some apparent at birth or early infancy (poor feeding, lethargy, SOB, heart failure) and others only becoming symptomatic (if at all) later in life. This page describes the commoner conditions, including the three commonest: VSD, ASD, and bicuspid aortic valve. Structures affected Valves: bicuspid aortic valve, aortic stenosis, pulmonary stenosis, tricuspid atresia. Septa: atrial or ventricular. Vessels: coarctation of the aorta, transposition of the great arteries, patent ductus arteriosus, persistent truncus arteriosus. Ventricles: hypoplastic left heart. Atrial septal defect (ASD) Pathophysiology Ostium secundum ('second hole') defects high in septum are the commonest clinically-significant ASD. Usually first present in adulthood, though more significant defects can be detected as ear...