By U. Abe. Reinhardt College.

Journal of Neurology 250mg cefadroxil, Neurosurgery and Psychiatry 2002; 73: 241-245 Cross References “Arm drop”; Babinski’s trunk-thigh test; Belle indifférence; Collapsing weakness; Hoover’s sign; Sternocleidomastoid test Funnel Vision - see “TUNNEL VISION” - 132 - G Gag Reflex The gag reflex is elicited by touching the posterior pharyngeal wall, ton- sillar area, or the base of the tongue, with the tip of a thin wooden (“orange”) stick. Depressing the tongue with a wooden spatula, and the use of a torch for illumination of the posterior pharynx, may be required to get a good view. There is a palatal response (palatal reflex), consisting of upward movement of the soft palate with ipsilateral devi- ation of the uvula; and a pharyngeal response (pharyngeal reflex or gag reflex) consisting of visible contraction of the pharyngeal wall. Lesser responses include medial movement, tensing, or corrugation of the pharyngeal wall. In addition there may be head withdrawal, eye water- ing, coughing, and retching. Some studies claim the reflex is absent in many normal individuals, especially with increasing age, without evident functional impairment; whereas others find it in all healthy individuals, although variable stimulus intensity is required to elicit it. The afferent limb of the reflex arc is the glossopharyngeal (IX) nerve, the efferent limb in the glossopharyngeal and vagus (X) nerves. Hence individual or combined lesions of the glossopharyngeal and vagus nerves depress the gag reflex, as in neurogenic bulbar palsy. Dysphagia is common after a stroke, and the gag reflex is often performed to assess the integrity of swallowing. Some argue that absence of the reflex does not predict aspiration and is of little diagnos- tic value, since this may be a normal finding in elderly individuals, whereas pharyngeal sensation (feeling the stimulus at the back of the pharynx) is rarely absent in normals and is a better predictor of the absence of aspiration. Others find that even a brisk pharyngeal response in motor neurone disease may be associated with impaired swallowing. A video swallow may be a better technique to assess the integrity of swallowing.

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A useful practical guide to implementing PBL is Problem Based Learning in Medicine by T purchase cefadroxil 250 mg free shipping. A source of written examples of clinical problems suitable for pre-clinical and clinical courses is Clinical Problem- Based Learning: A Workbook for Integrating Basic and Clinical Science by R. It is also recommended that examples are sought from other PBL schools, some of which are available on the Web. The New Mexico experiment: educational innovation and institutional change. Additional references The following is a selection of references which will be a good starting point for someone wishing to become more informed about the research evidence for PBL. Problem-based learning: why curri- cula are likely to show little effect on knowledge and clinical skills. Generally, teachers take such involvement quite seriously but, sadly, the quality of many assessment and examination procedures leaves much to be desired. The aim of this chapter, therefore,will be to help you to ensure that the assessments with which you are involved do what they are supposed to do in a fair and accurate way. We will provide some background information about the purposes of assessment and the basic principles of education measurement. We will then detail the forms of assessment with which you should be familiar in order that you can select an appropriate method. THE PURPOSE OF ASSESSMENT When faced with developing an assessment you must be quite clear about its purpose. This may appear to be stating the obvious but try asking your colleagues and students what they think is the purpose of the assessment with which you are concerned. Purposes of assessment may be described as follows: Judging mastery of essential skills and knowledge. Though it may be possible for one assessment method to achieve more than one of these purposes, all too often assessments are used for inappropriate purposes and consequently fail to provide valid and reliable data. It must never be forgotten how powerfully an assessment affects students, particularly if it is one on which their future may depend.

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The X-ray on the right shows appearance at 1 year postoperative a b Fig buy generic cefadroxil 250 mg. Gray columns show force required to produce failure of fixation; white columns show rigidity of fixation. Dall Augmentation of Screw Fixation in Soft Bone In a bench study by Schmotzer et al. The cerclage cable therefore becomes a very useful adjunct to screw or screw-plate fixation in patients with osteopenia or osteoporosis. Dall DM, Miles AW (1990) Results of fixation of the greater trochanter using the Dall–Miles Cable Grip System. Presented as a scientific exhibit, SICOT, September 9– 14, 1990 Montreal 3. McCarthy JC, Bono JV, Turner RH, et al (1999) The outcome of trochanteric reattach- ment in revision total hip arthroplasty with a Cable Grip System: mean 6-year follow- up. Ritter MA, Eizember LE, Keating EM, et al (1991) Trochanteric fixation by cable grip in hip replacement. Silverton CD, Jacobs JJ, Rosenberg AG, et al (1996) Complications of a cable grip system. Kelley SS, Johnson RC (1992) Debris from cobalt-chrome cable may cause acetabular loosening. Schmotzer H (1994) Protocol for determining fatigue strength of multifilament cable. Dall DM (1986) Exposure of the hip by anterior osteotomy of the greater trochanter. Chandler HP, King D, Limbird R, et al (1993) The use of cortical allograft struts for fixation of fractures associated with well-fixed total joint prostheses. Schmotzer H, Tchejayan G, Richardson S, et al (1994) Augmentation of screw fixation using cerclage cables. Test data on file at Stryker Orthopaedics Index abductor muscle weakness 24 Bombelli 164 abuse of alcohol 130 bone grafts 11, 118 acetabular dysplasia 164 bone marrow 173 acetabular implant designs 206 bone scintigraphy 30, 109 acute on chronic type 28 Boyer’s classifications 35–37 additional bone formation 132 buoy flap 109 additional surgery 65 AHI 167 alcohol 118, 126 cable cerclage 239 alendronate 108 capital drop 165 allograft fixation 247 careful postoperative management 68 anterior rotational osteotomy (ARO) 81 cementless hip stems 206–207 AO 90° double-angled blade-plate 21 ceramic modular heads 206 apparent collapse 90 cerclage 249 approach technique 189 Charnely’s 163 approaches 185 Chiari’s pelvic osteotomy 167 arthroplasty 245 chondrocytes 174 aseptic necrosis of the femoral head 47 chondroid plug 176 augmentation of screw fixation 250 chondrolysis 4, 35, 43 avascular necrosis 35 chronic type 28 avascular necrosis of the femoral head 15, classification 106 43 classification of remodeling by Jones 63 AVN 58 clinical endpoint 126 AVN, avascular necrosis 58 clinical evaluations 10, 22 clinical performance 241 clinical results 126, 131, 197 Bicontact hip system 207 collapse 30, 79, 110, 125–128, 130–133 Bicontact N 208 color Doppler ultrasonography 109 bilateral SCFE 10 complications 172 biological function 98 congenital dislocation of the hip 221 biological regenerative capacity 178 conserve plus 196 biomechanical 239 core 99 biomechanical environment 174 core decompression 107, 118, 122 biomechanical support 98 correct lateral radiographs 90 body mass index 71 corrective osteotomy (CO) 33, 38 251 252 Index Crowe classification 221 greater trochanter 245 Crowe group III 227 Crowe group IV 225 half-wedged fragment 21 hammer toe 102 Dall–Miles 239 Harris hip score 120 Dall–Miles plate 247 head-preserving 107 deep iliac circumflex artery and vein 127 head–shaft angle 70 deep infection 23 high congenital dislocation of the hip 221 deep vein thrombosis 122 high density polyethylene (HDP) 222 demarcation line 24 hinge adduction 167 destructive phase 178 hip navigation 207 developmental dislocation of the hip (DDH) hip resurfacing 195 164 histological findings 173 DEXA 208 hospitalization 22 dome depression 110 double floor 165 Drehmann’s sign 59 idiopathic osteonecrosis of the femoral head dynamic method 3 (ION) 125 Imhäuser 39 Imhaeuser’s method 47 early diagnosis 75 Imhaeuser’s osteotomy 47, 54 early-stage 133 impaction bone grafting 108 enlargement of the femoral medullary canal in situ pinning 9, 32, 38–39, 47, 61, 71 231 in situ single-screw fixation 3 enlargement of the medullary canal of the incorporation 111, 132 femur 221 intentional varus angle 90 enlargement of the true acetabulum 221, intertrochanteric flexion osteotomy 3 227 intertrochanteric osteotomy 39 epiphysiodesis 9 etiological factors 97 etiology 100 Japanese Orthopedic Association (JOA) 58 extensive lesions 90 Japanese Orthopaedic Association (JOA) hip extent of the viable area 93 scoring system 22 JOA Hip Score 169 JOA scores 128–129, 132 fastening 240 joint preservation 95 fastening method 241 joint regeneration 176 fatigue strength 244 joint regenerative surgery 179 femoral fractures 249 joint-preserving operation 19 femoral head 117, 130–131 Jones’s classification 34, 36–37 femoral head osteonecrosis 89 femoral necrosis 4 femoral osteotomies 95 Kaplan–Meier analysis 128 Ficat stage 121 Kaplan–Meier method 172 first-stage operation 236 flat stem 206 fluoroscopy 21 lateral decubitus position 20 fractures 103 lateral femoral circumflex artery 99 Frankel’s free-body technique 175 lateral head index 19 Index 253 limping 23 position 132 long-term results 19 posterior rotational osteotomy 89, 96 loosening 222 posterior tilt angle (PTA) 27–28, 31, 34–36, low-friction arthroplasty 163 38 L-shaped osteotomy 225 posterior tilting angle 70 postoperative complications 10, 16 magnetic resonance angiography 109 postoperative intact ratio 84–85 manual reduction 3 postoperative limp 24 manual reduction technique 5 postoperative management 93 mechanical property 132 potential 189 metal-on-metal 195 potential benefits 183 microporous stem coating 208 preoperative collapse 103 microscope 99 preoperative planning 167 mini-incision posterior 189 preoperative stage 100 minimally invasive technique 190 preoperative type 100 minimally invasive total hip arthroplasty preservation of the joint 89 surgery 187 press-fit cup designs 206 MIS 183–185 principle of OA treatment 176 MIS techniques 189 prognosis 106 monofilament 240 progressive joint space narrowing 94 monofilament wire 242 progressive slippage 64 multifilament 240 prophylactic fixation 10 multifilament cable 242 prophylactic fixation of the unaffected side muscle-pedicle-bone graft 122 15 prophylactic pinning 34, 75 natural course 106 prophylaxis 16 neck-shaft angle 54 proximal load transfer 208 necrotic lesion 19 pulmonary embolism 23 nonprimary OA 196 non-union 22 nonvascularized bone graft 123 radiographic evaluation 10 nonvascularized bone grafting 107 radiographic outcome 93 nonvascularized fibular grafts 105 radiographic progression 97, 100, 102–103 NVFG 108 radiographic results 197 radiologic endpoint 128 original plate 34 range of motion (ROM) 47, 95, 129 osteoarthritic (OA) change 59, 127, 133 recollapse 94 osteoarthritis (OA) 33, 35, 59 regenerated bone 111 osteonecrosis 30, 105, 117 regeneration 174 osteonecrosis after manipulative reduction regenerative phase 178 62 rehabilitation program 169 osteonecrosis of the femoral head 19, 79 relay-type treatment 177 osteotomy 9, 29, 79, 117 remodeling 5, 33, 38, 96, 173 remodeling and degree of slip 66 pain 129 remodeling and triradiate cartilage 67 patency of the artery 111 resphericity 94 Pauwels’ 163 resultant force (RF) 175 periprosthetic fracture 247 revascularization 98, 121 physeal fixation 36 risk factors 132, 195 physeal stability 39 rotational angle 91 254 Index S-100 protein 173 three-dimensional osteotomy 47 Safranin-O 173 time-saving surgery 125, 133 sclerotic change 24 tissue engineering 111 screw fixation 249 total hip arthroplasty (THA) 101, 122, 123, second stage of the operation 236 184, 186, 205, 221 secondary OA 164 transtrochanteric anterior rotational secondary osteoarthritis 79 osteotomy (ARO) 24, 80 short hip stem 207 transtrochanteric posterior rotational shortening of the leg 23 osteotomy (PRO) 80 simple flexion osteotomy 7 transtrochanteric rotational osteotomy 27, single-screw fixation 6 107, 123 slender femur 230 treat 230 slipped capital femoral epiphysis (SCFE) 9, treat narrow acetabulum 223 27, 28, 33, 37–39 treatments 9, 15 slipping of the femoral capital epiphysis Trendelenburg’s sign 234 (SFCE) 47 trochanter grip 245 small incision 184 trochanteric osteotomy 4 Southwick intertrochanteric osteotomy 71 true acetabulum 222 Southwick procedure 7 two-stage procedure 225 stage 126 type of ION 126 staging 106 steroid 118, 126 unilateral SCFE 10 steroid-induced osteonecrosis 97, 100–101, 103 strategy of treatment for SCFE 15 valgus-extension osteotomy (VEO) 164 strength 240 valgus-flexion osteotomy (VFO) 164 stress risers 243 varus correction 20 strut 130 varus intertrochanteric osteotomy 19 subcapital femoral neck osteotomy 4 vascularized fibular grafting 97, 98, 103, Sugioka 122 105, 107 Sugioka’s femoral osteotomy 28 vascularized iliac bone 130, 131 Surface Arthroplasty Risk Index 195 vascularized iliac bone graft (VIBG) 125, surgical approach 186 127 survival rates 101, 128, 130–132 venous occlusions 102 survivorship 110, 195 VFG 108 survivorship analysis 171 weight-bearing 132 T-shaped osteotomy 225 weight-bearing portions 20 tensioning 243 THA navigation 207 three-dimensional corrective osteotomy 32 young patients 90 .