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Adolph Lorenz wrote about this in his autobiography buy 60 caps mentat amex medications xerostomia, My Emil Hauser was born on February 22 discount mentat 60caps on-line medications ending in ine, 1897, in Life and Work, as follows: “I am afraid that my Freeland, Pennsylvania, the seventh of ten excellent pupil knew better how to perform the children, the son of Reverend Karl Hauser and operation than to ask a fee worthy of the occa- Wilhelmina Volkert. He was educated at the sion, which would have freed him from care for University of Minnesota, where he received his the rest of his life. In 1934 he was invited to make American–Scandinavian Fellowship in Orthope- a trip to India and while there he operated on dic Surgery and spent the year of 1925–1926 vis- several maharajas and Indian princes. Hass did not feel able to adjust his life ued interest in the conservative treatment of low- and that of his family to the customs and climate back problems, scoliosis, and talipes. It is needless to He returned to the United States in 1926 and say that both trips offered Hass the opportunity of was accepted as a first assistant and permanent indulging his favorite pastime of hunting. In 1927 he 129 Who’s Who in Orthopedics received his MS degree in orthopedic surgery and was a devoted husband to his wife, the former moved to Chicago, Illinois, taking a position as Mary Frances Thomas, whom he married on July Assistant Professor with the University of Illinois 28, 1930, and who survived him. In produced five children, two of whom are physi- 1930 he became an Attending Surgeon at Passa- cians. Three nephews are physicians as well, two vant Hospital in Chicago and an Assistant Pro- of them practicing orthopedic surgeons. Besides fessor of Bone and Joint Surgery at Northwestern his good fortune in choosing his wife, Dr. He maintained these affiliations was lucky to have outstanding women supporting for the rest of his professional life, finally retiring him in his practice. His sister Adele Hauser in 1965 as Associate Professor Emeritus in North- Donlin and physical therapists Mildred Elson and western’s Orthopedic Department. He maintained especially Louise Reinecke were vitally impor- a busy and successful practice in Chicago and tant to him. Emil Hauser died at the age of 85 in Sun liosis culminated in his book Curvatures of the City, Arizona, on November 18, 1982, of coro- Spine, published in 1962, and his continued nary heart disease. He rowed against the stream of surgical inter- Clopton HAVERS vention in many orthopedic problems, and his conservative approach to bone and joint disease 1657–1702 was uniquely his own. The Hauser bar for treat- ment of pes valgo-planus, the Hauser brace for The name of Clopton Havers has been associated treatment of talipes equinovarus, and the treat- for 160 years with the spaces or canals that tra- ment of scoliosis by progressive recasting are verse the compact bone tissue. In view of the fact some of his original contributions to the treatment that Haversian canals are known to every student of bone and joint disease. He added to surgical of anatomy, it is somewhat surprising that so little treatment as well with an operation for correction is known about the man who described them. Hauser was an active advisor for orthope- for a time to the Earl of Warwick and was vicar dics for the National Foundation for Infantile of Chipping Ongar about the year 1643. He was Paralysis, and served on the medical advisory later appointed minister at Fifield (1649–1650) board for the Chicago chapters of both the and rector of Stambourne in 1651. After the National Multiple Sclerosis Society and the restoration of Charles II in 1662, he was ejected United Cerebral Palsy Association. Morton honors and appointments came to him, includ- was also a nonconformist divine and he had ing membership in the American College of served as chaplain at New College, Oxford. He Surgeons, the American Board of Orthopedic was forced to give up his clerical post when the Surgery, and the Clinical Orthopedic Society. In Act of Uniformity was passed in 1662 and he 1958 he served as Chief of Staff of the Passavant then entered the medical profession. Morton, therefore, that Clopton ing acknowledgment of his great debt to his Havers was most indebted in the early stages of former tutor: his career. In 1668 he was enrolled as a student at Catharine Hall, Cambridge, and he studied there I do therefore, as an expression of that Respect and for a time. He left the university, however, Gratitude which are due from me, humbly present you without taking a degree and the next known fact with these Discourses: and although I shall never be able to satisfy that Debt which I have contracted; yet of his life is that on July 28, 1684, he was ad- this will be a demonstration of my inclinations to be mitted as an Extra-licentiate of the College of Just and Grateful. This meant that he had ble how far I am in Justice bound to render to you that, authority to practice medicine anywhere in which is an account of the Talent, which you, Sir, have England except in the city of London or within 7 intrusted me with, and so far as I am capable, taught miles of it, with the further proviso that he could me to improve. The book was very well received both in In the following year, 1685, Havers, according to England and on the continent, and three editions the “Album Studiosorum,” was enrolled as a in Latin (Frankfurt 1692, Amsterdam 1731, and student at the University of Utrecht and presented Leyden 1734) are some evidence of the esteem a thesis entitled “De Respiratione,” which gained with which it was regarded. Lilly Butler, Minis- him the degree of Doctor of Medicine of that uni- ter of St. This work was dedicated to his father and work in the sermon that he delivered at the funeral to Richard Morton. Baglivi, Havers received the distinction of being elected a when he stood for Anatomy Professor in the Fellow of the Royal Society and he was admitted Sapienza at Rome, took his Lecture.

Hence individual or combined lesions of the glossopharyngeal and vagus nerves depress the gag reflex buy cheap mentat 60caps line medicine disposal, as in neurogenic bulbar palsy order mentat 60caps otc medications similar to abilify. 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. Journal of Neurology, Neurosurgery and Psychiatry 1996; 61: 96-98 Cross References Bulbar palsy; Dysphagia Gait Apraxia Gait apraxia is a name given to an inability to walk despite intact motor systems and sensorium. Patients with gait apraxia are often - 133 - G Ganglionopathy hesitant, seemingly unable to lift their feet from the floor (“magnetic gait”) or put one foot in front of the other. Arms may be held out at the sides to balance for fear of falling; fear may be so great that the patient sits in a chair gripping its sides. These phenomena may be observed with lesions of the frontal lobe and white matter connections, with or without basal ganglia involvement, for example in diffuse cere- brovascular disease and normal pressure hydrocephalus. A syndrome of isolated gait apraxia has been described with focal degeneration of the medial frontal lobes. In modern classifications of gait disorders, gait apraxia is subsumed into the categories of frontal gait disorder, frontal disequilibrium, and isolated gait ignition failure. Gait apraxia is an important diagnosis to establish since those afflicted generally respond poorly, if at all, to physiotherapy; moreover, because both patient and therapist often become frustrated because of lack of progress, this form of treatment is often best avoided. Human walking and higher- level gait disorders, particularly in the elderly. Neurology 1993; 43: 268-279 Rossor MN, Tyrrell PJ, Warrington EK, Thompson PD, Marsden CD, Lantos P. Progressive frontal gait disturbance with atypical Alzheimer’s disease and corticobasal degeneration. Journal of Neurology, Neurosurgery and Psychiatry 1999; 67: 345-352 Cross References Apraxia Ganglionopathy - see NEUROPATHY Ganser Phenomenon The Ganser phenomenon consists of giving approximate answers to questions which can at times verge on the absurd (Q: “How many legs does a cow have? This may occur in psychiatric disease, such as depression, schizophrenia, and malingering, and sometimes in neurological disease (head injury, epilepsy). A Ganser syndrome of hallucinations, conver- sion disorder, cognitive disorientation and approximate answers is also described but of uncertain nosology. London: Arnold, 2001: 74-94 Gaping Gaping, or involuntary opening of the mouth, may occur as a focal dystonia of the motor trigeminal nerve, also known as Brueghel syn- drome after that artist’s painting De Gaper (“Yawning man,” ca. Afflicted individuals may also - 134 - Gegenhalten G demonstrate paroxysmal hyperpnea and upbeating nystagmus, sug- gesting a brainstem (possibly pontine) localization of pathology. The condition should be distinguished from other cranial dystonias with blepharospasm (Meige syndrome). Neurology 1996; 46: 1767-1769 Cross References Blepharospasm; Dystonia; Nystagmus Gaze-Evoked Phenomena A variety of symptoms have been reported to be evoked, on occasion, by alteration of the direction of gaze: ● Amaurosis: lesion, usually intraorbital, compressing central retinal artery ● Laughter ● Nystagmus: usually indicative of cerebellar lesion; may occur as a side-effect of medications; also convergence-retraction nystagmus on upgaze in dorsal midbrain (Parinaud’s) syndrome ● Phosphenes: increased mechanosensitivity in demyelinated optic nerve ● Segmental constriction of the pupil (Czarnecki’s sign) following aberrant regeneration of the oculomotor (III) nerve to the iris sphincter ● Tinnitus: may develop after resection of cerebellopontine angle tumors, may be due to abnormal interaction between vestibular and cochlear nuclei ● Vertigo Cross References Leopold NA. Journal of Neurology, Neurosurgery and Psychiatry 1977; 40: 815-817 Gaze Palsy Gaze palsy is a general term for any impairment or limitation in conjugate (yoked) eye movements. Preservation of the vestibulo-ocular reflexes may help dif- ferentiate supranuclear gaze palsies from nuclear/ infranuclear causes. Cross References Locked-in syndrome; Supranuclear gaze palsy; Vestibulo-ocular reflexes Gegenhalten Gegenhalten, or paratonia, or paratonic rigidity, is a resistance to pas- sive movement of a limb when changing its posture or position, which is evident in both flexor and extensor muscles (as in rigidity, but not spasticity), which seems to increase further with attempts to get the patient to relax, such that there is a resistance to any applied movement - 135 - G Gerstmann Syndrome (German: to counter, stand ones ground). However, this is not a form of impaired muscle relaxation akin to myotonia and paramyotonia. For instance, when lifting the legs by placing the hands under the knees, the legs may be held extended at the knees despite encouragement on the part of the examiner for the patient to flex the knees. Gegenhalten is a sign of bilateral frontal lobe dysfunction, espe- cially mesial cortex and superior convexity (premotor cortex, area 6). It is not uncommon in elderly individuals with diffuse frontal lobe cerebrovascular disease. Cross References Frontal release signs; Myotonia; Paramyotonia; Rigidity; Spasticity Gerstmann Syndrome The Gerstmann syndrome, or angular gyrus syndrome, consists of acalculia, agraphia (of central type), finger agnosia, and right-left dis- orientation; there may in addition be alexia and difficulty spelling words but these are not necessary parts of the syndrome.

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This is a metabolic disorder that occurs when excess cor- tisol circulates in the bloodstream mentat 60caps with amex shinee symptoms. All the key indicators were found in Pedro’s notebook: the round face and extra fatty tissue in the neck; the thinning skin (which accounted for the bright red stretch marks); the excess beard growth; his obesity mentat 60 caps online symptoms xanax addiction, weakness, and fatigability. In fact, Pedro’s metabolic condition causes a certain pecu- liar pattern of obesity that results in a round (moon) face and obesity around the trunk (centripetal obesity). He explained that Pedro’s adrenal glands were producing too much cor- tisol, which in turn caused all his symptoms. The CT scan revealed a small 144 Diagnosing Your Mystery Malady adrenal adenoma, or benign tumor. This tumor was subsequently removed and eventually all Pedro’s symptoms, including his obesity, disappeared. Case Study: Lincoln Fifty-two-year-old Lincoln was a middle school math teacher. Toward the end of the school year, he began to feel sluggish and generally run down. He noticed he was having problems focusing on his lesson plans and was randomly forgetting things. He attributed it to simply needing his summer vacation after a long, tough year. What he couldn’t explain, though, was his gradual weight gain over the past three months. He knew that he had stopped exercising since his heart attack in March, and even though the doctors told him it was perfectly fine for him to start exercising again, he was a little anxious about resuming any activity that required a lot of exertion. He thought this might be the reason for his weight gain, but it just wouldn’t level off and the pounds kept slowly creeping on. He recalled that when he had stopped smoking years earlier, he had gained weight but even that had leveled off after a couple of months. At the last school health fair, he was checked out and was told he was fine. Several times, he visited the hospital clinic where he’d been treated for his heart attack; they drew his blood and even checked for thyroid disease. Lincoln was told it was anxiety after his heart attack, but he knew there was really something wrong with his body. When summer vacation finally arrived, Lincoln made a concerted effort to get back into his weight lifting and daily two-mile walks around the river in the city where he lived. But after two months of this regimen with no abatement of his symptoms and no weight loss, he decided to take matters into his own hands. He was given a copy of the Eight Steps by a teacher friend and decided to try to solve his mystery malady. He filled up a notebook, precisely answering all the questions posed by all Eight Steps. He called some of his fellow teachers to get recommenda- tions for the best family doctor on the school’s health plan. Several of his colleagues suggested a very bright woman only a few years out of medical school. He made an appointment with her and took his notebook to the appointment. After taking a brief history, the doctor knew her new patient had had a heart attack and mentioned with concern that he really needed to lose weight. He said he couldn’t seem to take off the weight, and he enumerated his other symptoms. She said it sounded like he had developed thyroid disease but dismissed it when Lincoln told her he had been tested for this several times at the clinic and the results were negative. She said that maybe he just needed to find a different way to lose weight and the other symptoms would disappear.

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In the criterion-referenced approach de- scribed above cheap mentat 60 caps free shipping medicine quiz, the objectives are embedded in the assessment tasks discount 60 caps mentat overnight delivery medicine synonym, so if students focus on assessment, they will be learning what the objectives say they should be learning. This is a positive solution to the common problem of the negative impact of assessment. ASSESSMENT METHODS In planning your assessment, it is necessary to be aware of the variety of methods available to you. It is impossible to be comprehensive for reasons of space so we will restrict ourselves to some common methods. We will also include information about some innovative approaches developed recently, which may be of interest. We do this deliberately in an attempt to encourage you to become subversive! With your new-found knowledge of assessment you will soon be involved in situations where it is obvious that inappropriate methods are being used. The first two you may be able to influence by rational argument based on the type of information we provide in this book. TYPES OF ASSESSMENT 1 Essay Short-answer 2 Structured 3 Objective tests 4 Direct observation 5 Oral 6 Structured clinical/practical assessment 7 Self-assessment 8 Learning portfolio 9 1. ESSAY We suggest caution in the use of the essay, except in situations where its unique attributes are required. The essay is the only means we have to assess the students’ ability to compose an answer and present it in effective 134 prose. Of particular importance in higher education seems to be the assumption that the production of written language and the expression of thought are scholarly activities of considerable worth and that essays encourage students to develop more desirable study habits. Though they are relatively easy to set, essays are time- consuming to mark. The widespread use of multiple- choice tests and the advent of computer scoring has lifted the marking burden from many academics, few of whom would wish to take it up again. Excluding such selfish reasons, there are other grounds for being concerned about using essays. Several studies have shown significant differences between the marks allocated by difference examiners and even by the same examiner re-marking the same papers at a later date. In the extended response question the student’s factual knowledge and ability to provide and organise ideas, to substantiate them and to present them in coherent English are tested. The extended essay is useful for testing knowledge objectives at the higher levels such as analysis and evaluation. Another type of essay question is the restricted response, an example of which is shown in Figure 8. The restricted response form sets boundaries on the answer required and on its organisation. An advantage of the more restricted format is that it can decrease the scoring problems (and hence be more reliable). If you intend to set and mark essay questions in an examination, then we suggest that you keep in mind the points in Figure 8. For essays, or other written assignments required during a course of study, you should take steps to improve the quality of feedback to students. Not only can such an attachment provide very useful individual feedback, but used early in a course with a model answer, it can show students the standards you expect fromthem, and also help you in awarding marks. SHORT-ANSWER AND SIMPLE COMPUTATION QUESTIONS Short-answer tests have been surprisingly little used in recent years, yet another casualty of the multiple-choice boom. However, we have found them increasingly useful as our concerns about the limitations of the objective type tests have become more apparent. Though easy to mark, it is essential that markers are provided with a well constructed marking key, especially if more than one correct answer is possible, or if several processes are involved in answering the question (See Figure8. Obviously more short-answer questions than essays can be fitted into a fixed time period. If one of the purposes of the assessment is to cover a wide content area, then short- answer questions have distinct advantages. Much of the same may be said about multiple-choice questions but short-answer questions have the advantage of avoiding cueing and requiring students to supply an answer, rather than to select or to guess from a fixed number of options. The major limitation of the short-answer test is that it is not suitable for testing complex learning outcomes. If you wish to employ short-answer questions you should take account of the point in Figure 8.

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