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small fibres are affected. SFN refers to isolated small fibre involvement. About 40-50% of patient with fibromyalgia meet the diagnostic criteria for SFN

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radicular pain, and identifying "red flag" conditions. A decision is then made about whether to go down an investigative pathway to determine the source and cause

fibromyalgia. The peak onset is 20-50 but it can occur at any age. and is about twice as common in women. In clinical practice it is predominantly diagnosed

common structural spinal deformity in children and adolescents. It affects about 2-3% of adolescents, but the prevalence is dependent on the cut-off point

the highest likelihood ratio, but some patients may not be very excited about trying this. Groin pain on hip abduction or adduction, abductor weakness

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the lunocapitate joint. The radial column takes about 75% of load, while the ulnar column takes about 25% of load. Radial and Ulnar Deviation Radial deviation:

topic. Please use your clinical judgement. There is a lot of controversy about examination for posture regarding its validity and reliability. Many clinicians

048. ISSN 1097-6833. PMID 28728811. Check date values in: |date= (help) "About the test | National Screening Unit". www.nsu.govt.nz. Retrieved 2023-03-05

sclerosis experience symptoms resembling TN. Idiopathic TN, constituting about 10% of cases, is diagnosed when no apparent cause for the condition can be

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reflexes Primitive reflexes The reflexes tested during examination come about due to brisk stretch of the muscle, leading to activation of the muscle spindles

is common. See Sacroiliac Joint Precision Treatment for more information about precision treatments for this structure. Main article: Sacroiliac Joint Anatomy

a senior standard (criterion standard, gold standard). To make decisions about patient care the doctor must also comprehend the pre-test probability of

histological confirmation with limb involvement. There were assumptions made about which segment was involved. We now know that sometimes several adjacent levels

vertigo. BPPV can be associated with head trauma but again is best learned about from the external resources. Practice Point Focus on the timing and triggers

and is more common in recreational players. See Hatch et al for discussion about racket grip sizes. Poor prognostic factors High work physical strain, such

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Peripheral nerve fibres when injured can be "sensitised" - i.e. they bring about a intense and prolonged ectopic afferent activity to the central nervous

forces applied at the joint surfaces Tension through muscle forces applied about the joint surfaces. Contact forces larger than muscle forces generally. Combined

the L1 nerve root with a contribution of fibers from the T12 nerve root in about 25% of patients. It provides sensation to the skin of the inguinal region

and number of painful sites. Pain intensity may start to decrease after about 3 weeks of abstinence. However in the surgical literature, postoperative

activity leading to pain perception. A lot is known about possible sources, but not a great amount about actual sources of neck pain. The cause of the pain

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before considering tendinopathy. The common classic sites of enthesopathy about the hip are: Iliopsoas insertion to the lesser trochanter of the femur Rectus

structured mental summary of a doctor's knowledge about a specific disease. It represents a their knowledge about a particular disease, and may be as short as

(plural entheses) is the interface between tendon/ligament and bone. See also about the myotendinous junction, the connection between muscle and tendon The musculoskeletal

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termed noxious. The information about tissue damage is referred to as nociceptive information. Most of what we know about pain relates to the physiology

often reported that there are approximately 7000 rare diseases, of which about 80% are genetic. This figure is an underestimate if you include cancers and

This article is still missing information. Read about the levels of evidence here. ASIPP evidence ratings are preferred when assessing evidence in WikiMSK

bone bruise, ligamentous tear, meniscal tear, and chondral injury. Enquire about the nature of the trauma. Posterior cruciate injuries often occur with a

closely linked to the time of the accident/forces, and the patient is definite about the accident. The pain distribution is highly variable. The pain is significant

muscle filaments to the collagen fibres of the adjoining tendon. See also about entheses, the connection between tendon/ligament and bone. Muscles Synovial

block, and has there is no radiation exposure. The analgesic effect lasts about one week. Theoretically all pain arising from the facet joint, musculature

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studies. Overall the treating doctor can relay optimism, but be guarded about prognosis. A systematic review of 11 studies performed in the US, Australia

musculoskeletal system. The primary purpose is to find objective information about the index condition and it complements the history taking in the process

cancer for nonsmokers.  The relative risk does not provide any information about the absolute risk of the event occurring, but rather the higher or lower

evidence does not support this traditional view. Concerns have been raised about the drift from evidence-based indications, moving from treating permanently

history-taking and the physical exam by defining the problem & sparking ideas about the differential or possible categories of disease. It helps identify important

stic_Decision_Making.pdf Media:Eva2005_What_every_teacher_needs_to_know_about_clinical_reasoning.pdf Media:Monteiro2013_Diagnostic_Reasoning_Where_We've_Been

kinase is usually high, and red blood cell PFK activity is usually reduced by about 50 percent. Patients may have mild hemolytic anemia and mild hyperbilirubinemia

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Sterile cleansing solution Adhesive bandage Patient supine, knee flexed about 90 degrees, with foot flat on the examination table in 30-45 degrees of plantar

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malleolus) is posterior and inferior to the medial portion (medial malleolus)- about 10 degrees in coronal plane AND approximately a 6° angle with the horizontal

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being a tendon of the semispinalis musculature in the lumbar spine. It is about 1-2mm thick. The ligament can be ossified which converts the notch into a

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commercial use, but can be modified. Scapular fractures are rare (incidence: about 10 per 100,000 person-years) and often a consequence of high-energy trauma

needle Insert the needle 1–2 mL into the subcutaneous tissue to a depth of about 4–6 mm. Aspirate to exclude arterial puncture and inject Greater Occipital

surgical procedures, should also be noted. Men should be specifically asked about pain related to sexual activity. Post hernia repair pain can vary greatly

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the researcher who wants to be 95% sure about the outcome of their study is willing to be wrong 5% of the time about the study result. The alpha is the decimal

either strongly or weakly activated by innocuous stimuli. About half of Aδ fibres and about 70% of sensory C fibres are high-threshold units. The mechano-sensitivity

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NMPS. Ask about occupation and any potentially relevant aggravating factors such as sporting activities, driving, prolonged typing, etc. Ask about arm dominance

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levels are not generally required unless there are side-effects, concern about compliance, or breakthrough seizures when used for epilepsy. Also monitor

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COVID-19 through RAT testing. Knowing about the history of medicine can be useful for having a greater understanding about the ideological debates that continue

atlas (C1) rises back up. Flexion-extension is only about 10° (each way), and lateral flexion about 5° (each way). Muscles of the atlas (C1): Levator scapulae:

“fracture line,” as well as the matching appearance in the contralateral knee in about half of all cases. Although non-unions are rare after patellar fractures

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later worsen. Advised to keep active within pain limits, and is reassessed about 10 days later. Repeated injections may be performed Anterior Cutaneous Nerve

small fibres are affected. SFN refers to isolated small fibre involvement. About 40-50% of patient with fibromyalgia meet the diagnostic criteria for SFN

recommendations. Ask about the circumstances of onset, with particular respect to trauma. A spontaneous onset of pain should lead to more careful enquiry about red flag

phalanx bone. Attempt injection. If there is no flow then withdraw the needle about 1mm to achieve flow into the space between the posterior flexor tendon sheath

Multiple synovial joints with strong transverse and alar ligaments provide about half of total movements Movements: C0-1 - nutation, C1-2 - rotation Nerve

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CRP, vitamin D, and/or plain radiographs. Reassure the child and caregiver about the benign nature of the condition. The child should continue usual activities

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should care about the problem Concern: the doctor should take the patient seriously If the patient asks about imaging an explanation is given about why it isn't

ideas (how they perceive their situation), concerns (what they are worried about), and expectations (what they hope to get out of the consultation). It also

keep active within pain limits, and is reassessed about 10 days later. Steroid remains in situ for about 2 weeks. Up to 3-4 injections may be performed before

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pain battery, including static and dynamic tests, and gathering information about participant psychological distress, e.g., anxiety. A 2022 study in Pain journal

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lie parallel to the direction of movement. In each plane, the points move about a centre located in that plane When all the centres of all the planes line

adoption of PROMs in clinical practice. These challenges include cost, concerns about the relevance to patient care, time-consuming processes, bias from practitioners

the incidence is about 5 times higher in women than in men. The left and right feet are equally affected. The typical patient is about 45 years old. Most

visible only with imaging studies. The average diameter of a ganglion cyst is about 2.0 cm, but cysts more than double this size have been observed. The size

of thumb is that the intensity of scatter at 1 metre from the patient is about 1/1000 of that in the incident primary beam. The first few centimetres is

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medially from the longitudinal axis of the foot. Inversion and eversion occur about the longitudinal axis. The oblique axis oriented 52° upward from the horizontal

predilection for females. The patient may report a painful subcutaneous mass in about the posterior superior iliac spine. The pain may radiate to to the buttock

of mean. Standard Deviation is the dispersion of individual observations about the mean. It indicates the variance of data. The findings of a sample with

this is only theoretically true. The assumptions that the formula makes about the independence of rater observations is not well supported, and it may

STJ is approximately 60° of motion for 180° of arm abduction or flexion. About 65% of this range occurs at the SCJ, and 35% at the ACJ. The clavicle functions

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HCQ is orally absorbed (~70%), with a slow clearance from the body, taking about 3 months to reach steady-state concentrations. It is excreted mostly by renal

hyperparathyroidism. Main article: Sacrum The sacrum is a triangular bone and when talking about the broad group of traumatic sacral fractures, the sacrum is viewed as having

fusion rates. Various imaging modalities can provide valuable information about the spinal fusion site, bony structure, surrounding soft tissues, and the

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femur,” hip fractures are indeed associated with a high mortality risk. About one third of elderly patients with a low energy hip fracture are apt to die

constitutes self-care, however it tends to include general advice about methods of reducing strain about the temporomandibular joint, addressing psychosocial stressors

it restricts the swelling of the proteoglycans with water imbibement to about 20% of their maximum. In their relaxed state the aggregates swell as the

vertebral body separation. With traction using a 9kg load, there is only about 0.9mm of separation per intervertebral joint Upon release of traction, but

anterior and posterior horns as loads increase. The inclination angle is about 140° to 150° at birth and gradually reduces to approximately 125°, with a

are the two main differential diagnoses. A particular note must be made about the gold standard for sacroiliac joint pain diagnosis - sacroiliac joint

not synonymous. Most of what we know about these entities comes from research in the lumbar spine. Less is known about the causes and mechanisms of cervical

increasingly acute angles more caudally. The L1 nerve root leaves at about 80°, the L2 at about 70°, L3 and L4 at 60°, and L5 at 45°. Nerve root vertebral body

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burning or deep aching in quality. The patient is usually more concerned about the pain than the sensory deficit. Motor Function: There is often an accompanying

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clinically meaningful effect in terms of pain reduction. It tells us nothing about the diagnosis. For diagnostic validity you want ideally 100% relief, but

really be considered to be a normal feature. Furthermore, there is nothing about the size of a herniation that dictates whether the patient is symptomatic

smoking, alcohol, and drug use. Physical examination findings. Include comment about pain behaviours, VAS/NRS, disability or psychological assessment measures

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Visualise the inflexion point between the SAP and TP, usually this is at about 40 degrees. The target is approximately 1/3 to 1/2 the distance between the

material tries to impress the reader with all the different compounds and about the endocannabinoid system in the body. These are two undisputed material

are no longer indicated for chronic non-cancer pain. Have a conversation about opioid weaning. Negotiate rate of reduction, faster versus slower. The standard

studies have reported prevalence rates of around 30%. This compares to about 40% for disc pain, and 20% for sacroiliac joint pain. In many studies, complete

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the terms inversion and eversion represent motion in the coronal plane about an anterior/posterior axis (this motion is termed abduction/adduction elsewhere

chronic patients, funded by ACC, the proportion seeing a physiotherapist is about the same as acute patients though the median number of sessions is marginally

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With humeral elevation of up to 90°, there is 4° of clavicular elevation about the SCJ with every 10°of humeral elevation. Rigid fixation of the SCJ therefore

the Cochrane analysis. Review authors have repeatedly been explained to about selection criteria and technique being paramount, yet ignore this. Other

segments flex. This results in a sigmoid deformation of the cervical spine at about 110ms after impact. The anterior annulus fibrosis is distracted, and the

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For about 2,390 out of the last 2400 years, non-operative treatment of clavicular fractures was the norm. In 400 BC, Hippocrates wrote this about clavicle

topic display several flaws in logical thinking. They reference information about the very low rate of red flag conditions, and conclude therefore most causes

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Inferior to these are the sacral cornuae. The sacral cornuae are found about 5cm above the tip of the coccyx at the upper end of the natal cleft. The

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be found in association with a distal radius fracture (which also comes about from force applied to the extended wrist). Patients with TFCC injuries may

present, and fine motor skills are particularly impaired. Dystonia occurs in about 10% of cases. This was previously known as causalgia. There is a history

by the sensory cutaneous branch of the median nerve. This branch arises about 6cm proximal to the transverse carpal ligament and passes superficially to

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limited ability to contribute to rotation. Range of motion reduces with age by about 4-7° per decade. Normal values are 44° to each side. Reliability and Validity:

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class of drug, including diuretics. Approximately two thirds of patients about to undergo hemodialysis and approximately 80% of patients on long-term hemodialysis

make up the history of modern surgery Bedside Rounds - Storytelling podcast about medical history and medicine's intersections with society and culture PACS

A mortise view is an AP view with the foot slightly internally rotated (about 15 degrees) which produces a clearer view of the mortise (Figure 7). These

fractures are seen in conjunction with pelvic ring injuries in about 40% of cases; about one quarter of these are associated with neurologic injury, with

post-lumbar fusion patients, the sacroiliac joint is the source of pain about 30-40% of the time. Some of the prevalence rates in this context are 32%

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end plate. Torsional tears to the disc can result from forcible rotation about the facet joint, with the disc most susceptible in flexion-rotation. While

because unlike with the skin, there is nothing that the organism can do about pain in deep areas. It is therefore more economical for the organism to not

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to the genetic factors, one should enquire about any family history of spinal deformity. Also enquire about previous fractures, infections, and neurological

resistance to stretching the muscle with minimal force (isometrically) for about 10 s, while holding their inhaled breath. The patient is then asked to "relax"

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Initiation of treatment may prevent a subsequent fragility fracture. Eponyms about fracture of the distal radius. A Colles’ fracture, though at times used imprecisely

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for diagnosing labral tears which are confirmed by arthroscopy, and are about as accurate as 1.5T MRA. More recently, some authors have proposed that hip

motor skills, agility, and motor dexterity. There are many different ideas about what an ideal posture is. Despite differences in body shapes, every human

concepts that often overlap, but can also exist on their own. We can now talk about the continuum model. There appears to be a continuum of tendon pathology

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causes of anterior neck pain are uncommon, and little has been published about this phenomenon. If a patient complains of anterior neck pain it should be

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remaining stance phase. Lengthens the lever arm of the quadriceps muscle force about the centre of rotation of the knee, increasing the mechanics and efficiency

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depends on interstitial fluid flow and pressurisation. The drag that comes about from interstitial fluid flow is the main contributor to the compressive viscoelastic

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cold saline to run through it. It is cooled, but not cold. i.e. it is not about freezing the tissue. The water cooling with saline decreases charring of

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95%. In the general population HLA-B27 is present in 8-10% of Caucasians. .About 5% of patients with chronic low back pain have a spondyloarthritis. Previously

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movement in a variety of postures and movements show a range of motion of only about 1°. Injury can be caused by axial loading followed by abrupt axial rotation

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of the distal humerus are less common. They make up about one-third of humeral fractures and about 2% of all fractures in adults. Condyle-splitting (intercondylar)

found evidence for significant relief at one week. There is some concern about chondrotoxicity of corticosteroids. A 2017 RCT compared intra-articular triamcinolone

quadriceps contract to stabilise knee and counteract the flexion moment (about the knee). Mid-stance (single limb support): This is the initial period of

osteoarthritis is  a common differential diagnosis for lateral hip pain. Asking about difficulty in manipulating shoes and socks is a useful way to differentiate

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sensitivity. See also: Opioid Deprescribing Many of the long term effects come about from long term use. The evidence is clear that long term opioid use is not

and H2 receptors are predominantly found post-synaptically. Less is known about H3 and H4 receptors. H3 receptors are found mainly in neurons and are present

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first hazard is radiation. The radiation dose of a lumbar spine series is about 15 times greater than a chest x-ray, with an absorbed radiation dose of around

systemic lupus erythematosus, psoriatic arthritis, and gout. If it is unclear about the relevant differential diagnoses to consider, an expert rheumatologist

fashion. An injury to the central slip may initially lead to mild tenderness about the dorsal PIP. One must have a high index of suspicion for this injury and

patient will have severe pain in their leg with shortening of the extremity. About 10% of femur fractures are seen in companion with other fractures or with

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there is no "differential" diagnosis list, per se; the question is either about what other injuries may be present, or whether the fracture was caused by

obtained. Carpal fractures make up nearly one-quarter of hand fractures and about 5% of all fractures. This estimate likely under-represents the true incidence

research question in which the investigator(s) makes a precise, educated guess about a study outcome. This is sometimes called the alternative hypothesis and

inappropriate study design may undermine overall study validity. Critical thinking about the possible study design issues beforehand will ensure that the research

peroneal nerves. He was gradually increasing his activities and was counselled about the risk of osteoarthritis. The tarsometatarsal (TMT) joint complex is comprised

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They note that if 100% relief of pain is used then the prevalence drops to about 5% or less. They continue however that the prevalence appears to be highly

conduction in polyneuropathies. The most important anatomical variation to know about is the Martin-Gruber anastomosis. In this situation fibres pass from the

the pull of the triceps (see Figure 2). Olecranon fractures account for about 5% of upper extremity fractures. The majority of fractures occur in individuals

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prevent avascular necrosis. If only casting is needed, recovery should take about six to eight weeks. After three or four weeks of immobilization, the cast

imaging findings. Wrist pain associated with fever, chills, and erythema about the wrist may be due to underlying infection requiring urgent diagnosis and

The incidence of invasive breast cancer in females in the United States is about 161/100,000 people-year versus the incidence of 1.6/100,000 people-year for

strained and broken somewhere after 3% and 4% of elongation of the fibre. About 4% is the maximum a fibre can sustain without risking microscopic damage

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– ‘‘The doctor prescribed physiotherapy, but didn’t ask at all about what I thought about that. I have tried such treatment several times without any effect

anterior horn cell or proximal peripheral nerve.Tongue fasciculations occur in about one third of patients with amyotrophic lateral sclerosis. The patients symptoms

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fragment of bone accordingly avulses. There is some confusion and debate about the use of the term Dancer’s Fracture as it has also been used to describe

Flexor tendon injuries should be treated surgically expeditiously (within about 7 days of initial injury) to ensure the best results and a functional outcome

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will develop a lower extremity ulcer during the course of their disease and about 1% will develop Charcot arthropathy. The rate of lower extremity amputations

patient care dilemma. After each section the reader is encouraged to think about what they might do next, and what the differential diagnosis is. There is

fracture. Figure 5: A “four-part” fracture Proximal humerus fractures comprise about 5% of all fractures. The incidence is 300,000 per year. Mechanism is either

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decisions to perform surgery as well as intra-operative decision-making about technique and needed implants. MRI is mostly used to detect and quantify

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About 701 702 703 704 705 706 707 708 709 710 711 The Postgraduate Diploma in Musculoskeletal Medicine (PGDipMSM) is specifically aimed at medical practitioners

ABI below 0.9 is concerning for a vascular injury. If there is any doubt about the adequacy of flow, a vascular consult should be obtained urgently. In

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comparison to cases of hanging. However, a hyoid fracture is present in only about a third of all homicides from strangulation. Therefore, it merits noting

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together. The pain is worse in the mornings causing stiffness which lasts about 1-2 hours. He has found certain pain relieving stretches. He works long hours

are important as they related to red flag conditions. A systematic enquiry about red flag symptoms is preferred, which should raise an alert in the doctor's

Decision Making - Klein 2008 - 56 KB (f) What every teacher needs to know about clinical reasoning - Eva 2005 - 130 KB (f) Diagnostic reasoning - Monteiro

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patients thought they should have an imaging study and 2 added questions about reassurance that patients attributed to the imaging study, measured at 12