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Q: How do most patients get referred to a rheumatologist in the first place? Kremer: Usually, it’s the pain that’s perceived to be arthritis pain. Sometimes it’s muscle pain. Other times it can just be a nagging pain from anywhere that the primary care provider cannot diagnose. It’s more helpful to be referred to a rheumatologist when there are other symptoms along with the pain, such as early joint swelling. Q: What does the rheumatologist do when they see a referred patient? Kremer: We’ll take a history. Do you have morning stiffness? Fatigue? How long has this been going on? Do you have any family history of these same symptoms? After history, you do a physical exam looking for impaired joint movement, which joints are swollen, warm to the touch, difficult to move. Q: When do you take lab tests? And which tests do you start with first? Kremer: It depends on where the initial history and exams lead you. You many test for Rheumatoid factor (...
Definition Swollen gums are abnormally enlarged, bulging, or protruding. Alternative Names Swollen gums; Gingival swelling Considerations Gum swelling is quite common and may involve one or many of the triangular-shaped bits of gum between nearby teeth. These sections are called papillae. Occasionally, the gums swell significantly, blocking the teeth completely. Common Causes Gingivitis Infection by a virus or fungus Malnutrition Poorly fitting dentures Pregnancy Sensitivity to toothpaste or mouthwash Scurvy Side effect of a drug such as Dilantin or phenobarbital
While I’m sitting on the exam table with my legs dangling, the neurologist reaches for a metal object. He’s already poked me several times with the safety pin so I’m wondering what he plans to do with this larger pointy thing. He grasps my foot and scraps the object on the bottom of my foot along the outermost side and under the toes. My big toe jumps and the other toes look like they are trying to get away from the torture device. I have just demonstrated a positive Babinski sign.
During a standard neurological exam, the doctor will test many reflexes, or involuntary responses to stimuli. Much of that is done with a rubber mallet as the doctor taps various tendons and measures the response. However not all reflex tests involve the rubber mallet. One very important reflex test involves scraping the bottom of the foot.
“When the doctor scraps the bottom of my feet, what is he looking for?”
You should know
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