Lois & Clark Forums Forums General Discussion Off Topic real world medical question.....

Calling all medical nerds!

Ok, no, I'm not asking about "I've got this lesion on my arm, and...." Nope. Here's the deal: i've mentioned in more than one thread that I do transcription. Inspired by LabRat's comment that L&C fans know everything, I ask the following questions:

1. We've got one doc who continually says "Lungs are clear to auscultation and palpation." I'll say that again. auscultation and PALPATION. as in touchy feely smooshie skwishie with the fingers. How can you smooshie skwishie with your fingers something that is firmly and totally encased by the rib cage? he's one of our better, sharper docs, and he very carefully pays attention to what he dictates, so this isn't a boo-boo. I even checked once by typing the following:

....auscultation and palpation"@@@"percussion??.

and checked the note the next day. "@@@" is the symbol we put in that will sorta lock the note out from being signed until they delete the "@@@" (and presumably fill in the blank or fix the mistake). Sure enough, percussion was deleted and "palpation" was in there. so that is what he wants. what gives? can anyone explain this? he's an M.D., not a specialist, but he has been known to fill in in a pinch if they need a colonoscopy or a general surgeon, but..... he's just examining patients in an outpatient clinic setting.

2. shorter questions, now. can anyone describe "hammertoes" to me? I can't seem to find a definition or description anywhere.

3. Ditto the above with "cogwheeling".

4. Ditto the above once again with "cobblestoning".

From Webster\'s online :

So, it means he's examining the lungs by touch. Not literally the lungs themselves, but the chest. Looking to see how the lungs are doing by feeling the chest, I'd guess.

The toe gets bent into something claw-like.

A cogwheel is a fancy name for a gear. I'd need more context to venture a guess as to how that would be used medically.

Similarly, a cobblestone is a rock used as primitive pavement (but I'm sure you knew that). What that would mean in medical terms is beyond me. I can think of several possibilities, but... *shrug*

Maybe ask the doc?

Paul

I've palpated the chest wall many times, but never the lungs themselves - patients tend to get cranky when you shove your hand through their chest and directly into their lungs. I've also percussed the lungs many times. So, unless he's palpating the chest wall, don't know what he's up to....

Paul got the hammertoe one just fine.

"Cogwheeling" is a term that I've used most often in describing a phenomenon in Parkinson's patients and also a side-effect of some anti-psychotics. They loose smooth range of motion in some of their joints - particularly their wrists - and when you (or they) try to move them in a smooth motion, they catch, then move, then catch then move...kind of like they are catching in the individual little dips in a cogwheel as they're trying to move in a circle. (I don't know if that's a clear way of describing it - it's easier for me to demonstrate).

And then "cobblestoning" I've seen most often used in describing a colonoscopy in Crohn's disease patients - the colon is patchily involved and you have clear areas of normal mucosa and then areas of involved, thickened white and/or bleeding mucosa that ends up giving a topography that looks like a cobblestoned street.

Hope those were helpful,
Jill

hi guys! sorry about the lag in response. my personal box doesn't wanna bring up the board, for some reason, so i go back to the work computer, with a va filter, I might add, and it comes up just fine. once again proving the old maxim, "Computers are Moody." I should rename mine "Moody". or maybe "PMS"....

anyway! but time to explain his "palpation" of the lungs? I don't stand a chance.

so! thanks bunches and gobs! I are now a better transkripshonist becuz of it.