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It is commonly argued that final long summative exams are unfair. The usual view is that students could have a bad day, could be too frightened, and, if the examinations are only once a year, they provide little opportunity for recovery from a failure.

The answer to this I hope is obvious. If there is only one big examination -- maybe with only one essay in it, then there might be the some reason to dismiss summative assessment. But when there is more than one examination taken on at least two different days then low marks due to unfortunate circumstances will be mitigated. Chance is reduced further when there is a variety of examination formats, such as an essay paper, a short answer/structured paper, a multiple choice paper, and a practical examination, as well as a project or extended essay. One bad day is not going to greatly influence the results under such a system.

There are at least seven reasons why continuous assessment and modular examinations are inherently unfair and un-natural.

1. It can take over a year, maybe two years, for students to learn a subject.

This means over a year of constantly struggling both to understand the concepts and to learn fluently the terminology of the subject. Until the concepts and other related concepts are learned then the vocabulary is difficult to grasp. Until the vocabulary is grasped, then you have no way of handling the subject. Frequently in science concepts are interlinked and it is extremely difficult to put an iron box round one part and learn it without reference to other areas of science.

In my experience in my last two years of school physics I only begun to understand all the modules when I reached the final three months of the course. The module tests, every 6-8 weeks were helpful as a means of summarising the module. It would have been disastrous for me if the marks had been counted towards the final grade.

2. An integrated approach to the whole subject is far more important than learning every detail.

It is far better to have summative examinations after two or more years of work and to ask questions which require detailed knowledge across the whole subject. Continuing the physics example, I remember I failed the first nine out of ten modules, then went on to get a good grade in the examinations. Suddenly in the last module many pieces of the jigsaw began to fit together. I could not fully understand the early modules until I had done the later modules. The later modules could not have been attempted without the foundation of the earlier modules. In addition, the last module provided an integrating function that enhanced the details and the overall principles. In the end, it is this integration that has stayed with me and been useful, and it is best measured with a final summative examination.

3. Background reading kicks in best at the end of the course.

Something that even weak students can do is to read widely round a subject. In some school examinations in Britain 'unknown' information is presented and students are required to reason from first principles and apply what they know. Those who have read widely are at an advantage. This area of knowledge only really flourishes and shows itself in final examinations. Continuous assessment would have worked against this reading program in that the focus would have been only for the next test and not allowed time for the reading to have any effect.

4. Assessment scores while someone is in the process of learning are unfair.

There are some skills that take more than a year to learn. Students need time to learn. If a mark for coursework is included in the certification, then the lower competence of the past is rewarded. If a bad grade is given while still learning and is counted in the final award then this is unfair!

This is a true story from my secondary school teaching years. I was a new fourth year teacher of chemistry. A significant part of that year was spent explaining and practicing chemical formulae. Early in the year, a student, struggling, asked me if I could make the lessons simpler and break the material up into smaller easier parts. I replied that I could not. He need not worry though. Most pupils felt that way for at least six months. All he had to do was to keep trying the regular exercises and by the end of the school year he would have learned it.

Evidently he disliked the reply, because later the deputy head received a complaint from his parent. Had I really told a student it would take over six months to understand? Was it really true I could not make the subject any easier? Could I really not break it into smaller more understandable parts? As a young teacher, I remember taking a deep breath and boldly saying that I had made the remark: I stood by what I had said, and if he wanted confirmation, he only had to ask other science teachers.

The basics of chemical formulae and equations of reactions usually take a year to learn. There are no short cuts. Graded coursework would be wrong for such topics.

5. Some students are late starters; they need more time to assimilate knowledge than others do. Continuous assessment unfairly penalises late starters. It seems in Britain that this viewpoint has been largely ignored, especially in the development of half-A levels, where it is possible, though not obligatory, to do separate yearly examinations instead of doing the traditional 'A' level route of examinations after two years of study.

6. Focusing on grading in small steps takes away from the focus on learning.

I view with horror the American university system of small distinct modules and credits. Inevitably if a series of small grades are required this will devalue the subject because people will concentrate on the material and skills best suited to small tests. Postponing the real tests to formal examinations allows questions to be set that range across the whole subject and provides a measure of attainment at the point where a student has finished the studies.

7. The final level alone is important - not the coursework or intermediate test grades.

Source by Ivan Lowe

GMAT (Graduate Management Admission Test) refers to a test tailored made to determine a student's prospective academic success in regards to business studies. This computer-standardized exam seeks to test English language and mathematical aptitude. Business schools normally use the scores to determine admittance of students to graduate programs. GMAT is mainly taken in the U.S, Canada and other English speaking countries.

GMAT consists of three main sections. These are Analytical writing, Quantitative and Basic Verbal. Both quantitative and basic verbal sections are usually multiple choice. Analytical writing on the other hand requires students to write essays.

One of the most common questions regarding GMAT has to do with the use of calculators. Everyday many people visit search engines trying to find out whether the use of calculators is allowed during the test. Well, this article seeks to answer this question.

Both great and sad news exist with reference to the subject. The great news is that calculators are now allowed for GMAT tests. The bad news is that there are conditions attached to the good news. This is in the fact that this device is only applicable in one section (new integrated reasoning) section. What this means simply is that people who dread mental mathematics can now breathe a sigh of relief. However, there is no doubt that calculations will get tough if not tougher.

Calculators come in handy in the two part analytical questions. Here, students have two variables where they have to solve relatively difficult equation. There is a set of data or information that requires two numbers, which answer whether the statements are true or false. Many possible solutions exist but students need to select only one. The other questions are more about logic and analytical reasoning when answering them.

The key to passing any mathematical test or any test for that matter all dawns downs to thorough practice. This calculator used here is very much the same with that on a Mac or personal computer. This calls for spending substantial amounts of time getting familiarized so as to get used before the exam day. This will go miles in avoiding gaffs during the big day.

Many people are always complaining saying that calculators ought to be applied during the whole test. However, most experts have been on record pointing out that logic and analysis is much more important. The good news is that there are many tutors out there who have the skills to instill the necessary knowledge to students to pass their tests. The important thing is to seek advice and do extensive research prior to sitting for this test.

Have information on the rules and techniques of GMAT is very essential. Once one is equipped with these, the main and only challenge that remains is to know which of these to apply in hard questions. GMAT is very easy with adequate preparation but again very difficult without enough preparation.

In conclusion, yes calculators can be used for GMAT tests but in one section only. This is the new integrated reasoning section. All the best on the test!

Source by Kevin B. Terry

The examination of kidneys is impossible without laboratory Urine tests. So in this article, the data of physical examination and interpretation of Urine tests will be located together for convenient use. All symptoms in case of Kidney disorders are divided into renal and extra-renal.

Renal symptoms are such clinical signs that directly show on the disorders of Kidneys and any part of the collecting system. They are lumbar region pains (costovertebral angle tenderness, flank pain), dysuria and syndrome of Urine changes. Only children after 2 years can complain on Lumbar region pains because in this age, cortex tissue and renal capsule reach their mature form. The "Kidney" pain is caused by expanded capsule. This pain can be found by palpation of Kidneys and by pasternasky's sign. Very often, children at 2 till 5 years of age complain on abdominal pain in case of renal problems, In infants, "Kidney" pain can be evident as constant squirming, irritability. Dysuria means problems with urination. This term is most often used like a synonym to painful urination, but it also included such changes as:

• Frequent or infrequent voiding

• Urination urgency

• Incomplete voiding

• Enuresis

Frequency of urination is age- dependent and closely connected with fluid intake and surrounding climate (hot or cold). Voiding of the bladder is more frequent in infancy, when it equals approximately the number of feeding x 3. For example, a 6 months baby approximately empties the bladder 5x3=15 times a day. At the age of 1, Urination frequency ranges from 9 to 12 times a day, later it decreases to 6-8 times at 3 years, 5-6 times at 10 and 3-4 in adolescence. Normal limits range within 1 to 3 times more or less.

Enuresis (urination incontinence) is physiological in children up to 1.5-2 years. Enuresis can be anytime and night time. Toilet trained child can perform incontinence in case of Urinary tract infection or CNS disorders.

Syndrome of Urine changes includes the interpretation of qualitative and quantitative laboratory data of Urine tests. Urine is "a mirros" of renal system. If reflects the changes in functional processes of kidneys and collecting structures as well as some other systems.

Extra-renal symptoms

These are the signs, the cause of which is kidneys disorders, but the developing pathological changes concern other Organs and systems. These are:

• Edema develops as a result of fluid retention and disbalance of intracapillary and tissue hydrostatic pressure. Visual evidence of fluid accumulations appears when the volume of interstitial fluids enlarge more than on 15%. The peculiarities of renal edema are:

1. localization (puffiness of face, especially around the eyes);

2. time of manifestation (they are more apparent in the morning and subsides during the day).

3. spreading (as the patient's condition is getting worse edema spreads to involve extremities and genital organs (labial or scrotal swelling), abdomen (ascites), thoracic cavity (hydrothorax). Edema of intestinal mucosa causes diarrhea, anopexia, poor intestinal absorption. The total edema is called anasarka.

4. surface and consistency (skin above swelling is pale, warm and soft by touch).

• Hypertension

• Cardiac pain

• Skin pallor is often in case of nephritic syndrome and acute poststrptococcal glomerulonephritis. When the chronic kidney disorder develops paleness is connected with decreased production of erythropoietin and developing of anemia

• Intoxication syndrome includes fever, chills, anorexia, fatigue, irritability, lethargy, headaches and vomiting, In infants, kidney disorders can manifest with feeding problems and failure to thrive.

Taking patient's health history is very important and must be done carefully. Pay attention to recent weight gain, renal dysfunction, facts relative to evidence of recent streptococcal infection, exposure to or ingestion of toxic chemicals (including heavy metals, carbon tetrachloride, or other organic solvents; nephrotoxic drugs). Take accurate information about fluid intake and output, feeling of thirst, appearance of Urine, quantity of voiding, child's behaviour during urination or hesitancy, urgency, urine incontinence in toilet-trained children. Unpleasant odor of Urine, direction and force of stream, change in size of scrotum, For adolescent it is important to find out evidence of sexually transmitted disease, type of treatment. Ask adolescent male about testicular self-examination. Report in case history the date of last Urinalysis.

Physical assessment includes visual inspection, palpation and percussion. During visual inspection, detect evidence for:

• Fluid retention: presence of edema, puffiness of face, enlargement of abdominal girth at umbilicus. Examination of swelling is made by pressing with fingertip; on the limbs, face, sacral region, lower abdomen. Observe for prominence, redness, light swelling in lumbar region.

• Pain syndrome: constant squirming, irritability, characterized position (child lies on the sick side with legs bent in hip and knee joints and hold near the body), behavior during voiding.

• Pallor

• Signs of intoxication

• Extrusion of Urinary bladder upon the symphysis in case of bladder neck obstruction.

• Noisy breathing hemorrhages on the skin, nasal bleeding, smell of Urine and ammonium from the mouth, muscle tremor in case of chronic renal failure.

Kidneys must be palpated in vertical and horizontal positions. Normally they are palpable in older in infants and young children. Usually, kidneys are not palpable in infants and young children. Usually, kidneys are not palpable in older children except in cases of their enlargement more than in 1.5-2 times and nephroptosis. Assess shape, size, consistency, mobility, level of ptosis (palpable kidney, mobile kidney,:migrating" Kidney) and painfulness during palpation.

Percussion of renal region helps to assess Pasternasky symptom by light beating in costovertebral angle. Report the results as positive in the right, positive in the left or on both sides, negative. Percuss for the upper border of the bladder starting from umbilicus and going down. Normally the dull sound is not found when the bladder is voided. The opposite finding is evidence of bladder neck obstruction.

Source by Funom Makama

Medical Ultrasound relies on the reflection, refraction and scattering of ultrasound waves by the body structures to produce an image. If it did not occur, none of the Ultrasound energy would return to the ultrasound transducer to be converted in to an image. The strength of reflection of the Ultrasound wave at an interface is partially dependent upon the difference in acoustic impedance of the two structures making up the interface. The greater this difference in impedance, the more of the ultrasound wave is reflected.

At the skin / transducer interface there is a very significant difference in the acoustic impedance of the two structures and therefore virtually all of the Ultrasound energy is reflected. Couple this fact with the observation that the Ultrasound has to pass through this interface twice, once on the way into the body, and once on the way back out to the transducer, and you can easily see that no significant ultrasound energy is going to return to generate an image.

Furthermore, Ultrasound passes through soft tissue at an average speed of 1540 meters per second. In air it is approximately 331meters per second. An Ultrasound machine is unable to correct for this difference, so any air between transducer and body would cause additional issues. This situation is easily alleviated by the use of Ultrasound gel between the transducer probe and the body. This effectively removes the air/skin interface and provides a transition between the transducer and skin which extensively reduces the reflection of the sound waves. Its success in doing so is very easily demonstrated by simply trying to scan with a dry transducer probe on dry skin.

So, what makes a good gel?

A good Ultrasound gel may be blue tinted or clear, but will be non-staining. It will be acoustically correct for the broad range of frequencies used in Diagnostic and Therapeutic ultrasound procedures and in Aqueous suspension. It is also important that it is Hypoallergenic, bacteriostatic, non-sensitizing and non-irritating. There are many medical ultrasound gels on the market and there is very little difference in their constitution except some are runnier than others.

Sonographers vary in whether they prefer a runny variety easily manipulated around the body during the scan, but also tending to spread outside the field of interest and wetting patients clothes; or the less runny variety, which can dry off during an extended scan (requiring additional gel to be applied) but is more easily controlled. A further difference in gel is the choice of clear or blue tinted varieties. The latter does not stain clothes but can make it easier to see where the gel is after the examination, allowing the patient to dry it off more thoroughly.

Source by Kevin Rendell

Passing any type of exam, easy or complicated, depends a lot upon your preparation. The cliché in sales is most applicable to exam taking where it says: "If you work it hard, it will be easy. If you take it easy, it will be hard." After all, whatever questions the exam has, they are things that you are supposed to have already studied and learned. Needless to say, you have to be amply prepared in order to pass the ICC (S1) Bolting Code Exam.

Though the ICC does not require the examinee to have previous experience in order to take the exam, it is still good to have at least some experience to be able to understand what is discussed in your review materials. You can understand the code requirements better if you have actual experience doing the job. It is your practical support for the theory that is being discussed. What is being impressed here is that you have a better chance of passing the ICC (S1) Bolting Code exam if you have actual experience before taking it.

One good thing about this exam is that it is an open book exam most of the way. Therefore if you are very familiar with the required codes used in the ICC (S1) Bolting Exam then you know where to start looking for them. In this regard you need to get hold and study the correct materials referring to these bolting codes and standards. This will assist you in knowing the correct required codes and literatures to study and review to help you answer the questions during the exam.

In studying for the exam, devote more time to topics that have greater weighted average. For instance, High-Strength Bolting has 44% of the total score, and Steel Framing Observation is weighted at 27%. The rest of the topics, General Requirements and Material Sampling, Testing and Verification combined are only 26% of the total score. In other words, you have to prioritize your study and review time according to the importance of the subject.

On the examination day itself, it will be good if you will be there on the examination site at least 30 minutes before the scheduled start. You must have steady your nerves before the exam starts and rushing to get there will only disrupt your normal blood flow which your brain cells will surely need. Important instructions are given before the exam, such as the tutorial instructions before taking a computer-based exam. You really need these instructions in order that your answers will be right on track.

Another way to increase your chances of passing this exam is to sign-up for the ICC (S1) Bolting Exam course. This teaches and mentors the examinee about this particular examination. You will need this especially if you are new to the industry and/or it's been a long time since you took your last exam. This course is good in refreshing your memory and testing you against mock exams. Taking practice exams will also help you control your nerves, a necessary skill in passing exams. Plus taking this course will have you prepared so that you can have a feel of what's going to happen on exam day.

Best of luck on the exam.

Source by Rodger Little

Examination of the abdomen involves the usual four skills, except that the order is significantly changed. Inspection is followed by auscultation, percussion, and then palpation, which may distort the normal abdominal sounds. The medical practitioner in charge must have knowledge of the anatomic placement of the abdominal organs in order to differentiate normal, expected findings from abnormal ones. Inspection may occur at any time during the examination.

The abdominal cavity is the portion of the trunk from directly beneath the diaphragm and thoracic cavity to the region of the pelvic cavity. The abdominal cavity contains the major organs of digestion, and the pelvic cavity houses the internal reproductive organs, the lower parts of the digestive tract, and the urinary bladder. However, in infancy, the bladder is an abdominal organ.

The contour of the abdomen is inspected while the child is erect and supine. Normally the abdomen of infants and young children is quite cylindrical and in the erect position, fairly prominent because of the physiologic lordosis of the spine. In the supine position the abdomen appears flat. During adolescence the usually male and female contours of the pelvic cavity change the shape of the abdomen to form characteristic adult curves, especially in the female.

The size and tone of the abdomen also give some indication of general nutritional status and muscular development. A large, prominent, flabby abdomen is often seen in obese children, whereas a concave abdomen is frequently suggestive of undernutrition. However, careful note is made of a protruding abdomen with spindly extremities and flat, wasted buttocks suggests severe malnutrition that may occur from inadequate nutritional intake such as kwashiorkor or from diseases such as cystic fibrosis. Likewise, a scaphiod abdomen may indicate dehydration or disphragmatic hernia in which the abdominal organs rise into the thoracic cavity, or a "scaphoid-like" abdomen that only appears sunken in relationship to pneumothorax or high intestinal obstruction. A midline protrusion form the xiphoid to the umbilicus or pubic sumphysis is usually diastasis recti, or failure of the rectus abdominis muscles to join in utero. In a healthy child a idline protrusion is usually a variation of normal muscular development. A tense, boardlike abdomen is a serious sign of paralytic ileus and intestinal obstruction.

The medical practitioner also notes the condition of the skin covering the abdomen. It should be uniformly taut, without wrinkles or creases. Sometimes silvery, whitish striae are seen, especially if the skin has been stretched as in obesity or with distention resulting from ascites. Any scars, ecchymotic areas, excessive hair distribution, or distended veins are noted.

Movement of the abdomen is observed. In infants and thin children, peristaltic waves warrant careful evaluation They are best observed by standing at eye level across from the abdomen. Visible peristaltic waves most often indicate athologic states, particularly intestinal obstruction such as pyloric stenosis.

A doctor may observe pulsation of the descending aorta in the epigastric region (midline and below the xiphoid). Although visible pulsations are normally seens, especially in thin children, the nurse should auscultate and palpate the aorta for any evidence of an aneurysm, a sacklike enlargement of the vessel.

In children under 7 or 8 years of age, breathing is primarily abdominal. If the abdomen fails to move during respiration, even in older children, this may indicate serious abdominal problems. Conversely, if the thoracic muscles fail to move, caused by breathing confirmed to abdominal movement, pulmonary problems may be at fault. Normally chest and abdominal movements are synchronous.

The umbilicus is inspected for herniation, fistulas, such as patent urachus (an abnormal connection between the umbilicus and bladder). Discharge, and hygiene, If a herniation is present the sac is palpated for abdominal contents and the approximate size of the opening is estimated. Umbilical hernias are common in infants, especially in black children. Since "home remedies" fro treatment such as taping coins over the umbilicus or using "belly binders" may be harmful to the skin and actually delay natural closure, a doctor should ask parents whether such procedures have been used. Umbilical hernias normally protrude and expand when the child coughs, cries, or strains.

Hernias are looked for elsewhere on the abdominal wall, such as in the inguinal or femoral region. An inguinal hernia is a protrusion of peritoneum through the abdominal wall in the inguinal canal. It most often occurs in males, is frequently bilateral, and may be visible as a mass in the scrotum. It is palpated by sliding the little finger into the external inguinal ring at the base of the scrotum and asking the child to cough. If a hernia is present, ti will hit the tip of the finger.

A femoral hernia, which occurs more frequently in girls, is felt or see as a small mass on the anterior surface of the thigh just below the inguinal ligament in the femoral canal (a potential space medial to the femoral artery). Its location can be estimated by placing the index finger of the right hand on the child's right femoral pulse left hand for left pulse) and the middle ring finger flat against the skin toward the midline. The ring finger lies over the femoral canal, where the herniation occurs. Palpation of hernias in the pelvic region, particularly inguinal ones, is often part of the examination of genitals.

Each of the four quadrants should be ausculatated using the diaphragm and bell chestpieces. Unlike listening to the heart or lungs. In which the stethoscope rests gently on the skin, to hear bowel sounds the stethoscope must be pressed firmly against the abdominal surface. With the bessel chestpiece, especially one with a short cone, the skin may occlude the opening and prevent transmission of sound.

The most important sound to listen for is peristalsis, or bowel sounds, which sound like short metallic clicks and gurgles. Loud grumbling noises, known as borborygmi, are the familiar "stomach growls" usually denoting hunger. A sound may be heard every 10 to 30 seconds and its frequency per minute should be recorded (for example, 5 bowel sounds/minutes). However, the medical practitioner may need to listen for several seconds before audible peristalsis can be heard. Bowel sounds may be stimulated by stroking the abdominal surface with a fingernail. Absent bowel sounds or hyperperistalsis is recorded and reported, since either one usually denotes abdominal disorder.

Various other sounds may be heard in the abdominal cavity. Normally the pulsation of the aorta is heard in the epigastrium. Sounds that resemble murmurs (called bruits), hums, or rubs are always referred for further evaluation.

Source by Funom Makama

When you don't think you owe money in IRS Tax Debt, it can be scary to receive a CP-22E. The entire name of CP22E is "CP-22E Examination Adjustment Notice." The CP 22E lets you know that a correction has been made to your U.S. Tax Return causing a balance due of $5 or more being payable to the IRS. The IRS sends Notice CP 22E from the IRS when alterations are made to an account which causes there to be an unpaid balance being owed when the account wasn't in taxpayer delinquent account (TDA) status before the modifications were made or when the account is going to be filed under TDA status in the present tax cycle.

About IRS Notice CP22E

If adjustments are made to your account causing an unpaid debt due to the IRS, the CP-22E IRS Notice is delivered. The corrections, the balance, and all other relevant facts will be shown in detail in CP-22E. It is vital to understand that the true basis for Notice CP22E from the IRS is to notify you about the debt you owe the IRS. You have to take action fast and work with the IRS as soon as possible to steer clear of huge tax debt.

Making IRS Payments?

The IRS will be expecting full repayment of your IRS Debt immediately. They never care if you didn't make adjustments in your budget, which is generally the case with CP-22E. It's not fair when you get an adjustment notice, such as IRS Notice CP 22E, because you may not have expected having to pay, but the IRS wants you to mail them a payment as soon as possible despite your financial state.

I Should Not Have to Pay the IRS Money, What Should I Do Now?

You, like other individuals who get Notice CP22E from the Internal Revenue Service in the mail, might genuinely believe you do not owe cash to the IRS. You must work quickly and find an expert to help with your case. A tax Debt Specialist will evaluate your specific tax case and see if there are any loopholes to provide you with the best IRS agreement, and possibly even a tax debt settlement deal.

Source by Sandy Hansen

The sequence of examining the abdominal changes according to the age and cooperativeness of the child. Frequently all four types of assessments (inspection, auscultation, percussion and palpation) are performed at different times. For example, the medical practitioner may auscultate for bowel sounds following evaluation of heart and lung sounds at the beginning of the examination when the child is quiet. Percussion usually follows lung percussion, and palpation may be done towards the end of the examination when the child is relaxed and more trusting of the medical practical.

For descriptive purposes the abdominal cavity is divided into four calculations or quadrants by drawing a vertical line midway from the sternum to the pubic symphysis and a horizontal line across the abdomen through the umbilicus. This method of division actually includes the pelvic cavity. Each section is designated as follows: Right upper quadrant (RUQ), Right lower quadrant (RLQ), Left upper quadrant (LUQ), Left lower quadrant (LLQ).

Percussion of the abdomen is performed in the same manner as percussion of the lungs and heart. Normally, dullness or flatness is heard on the right side at the lower cost margin because of the location of the Liver. Tympany is typically heard over the stomach on the left side and usually in the rest of the abdomen. An unusually tympanitic sound, like the beating of a tight drum, usually breathing. However, it can also denote a pathoilogic condition such as low intestinal obstruction or parietal ileus. Lac of tympany may occur normally when the stomach is full after a meal, but in other situations it may denote the presence of fluid or solid masses.

Two types of palpation are performed, superficial and deep. In superficial palpation a doctor lightly places the hand against the skin and feet each quadrant, noting any areas of tenderness, muscle tone, and superficial lesions, such as cysts. Superficial palpation is often perceived as "tickling" by the child. Which can interfere with its effectiveness, The nurse can avoid this problem by having the child "help" with the palpation by placing him with statements such as, "I am trying to feel what you had for lunch". Admonishing the child to stop laughing only draws attention to the sensation and decreements cooperation. Positioning the child in supinated position with the legs flexed at the hips and knee helps relax the abdominal muscles.

Tenderness anywhere in the abdomen during wonderful palpation is always noted. There are two types of abdominal pain:
1. Visceral, which arises from the viscera or internal organs such as the intestines, and
2. Somatic, which arises from the walls or linings of the abdominal cavity such as the peritoneum.

Visceral pain is usually dull, poorly localized, and difficult for the patient to describe. Somatic pain is generally sharp, well localized and more easily described. When assessing abdominal pain, it is important to remember that the child will often respond with an "all-or-none" reaction- either there is no pain or great pain. Therefore all aspects of the examination must be carefully considered when ruling out conditions such as appendicitis.

A special phenomenon called rebound tenderness, or Blumberg's sign, may be performed if the child complains of abdominal pain. It is performed by pressing firmly over the part of the abdomen distal to the area of ​​tenderness. When the pressure is suddenly released, the child feels pain in the original area of ​​tenderness. This response is only found when the peritoneum overlying a diseased visceral or organ is inflamed, such as in appendicitis.

Deep palpation is used for palpating organs and large blood vessels and for detecting masses and tenderness that were not discovered during wonderful palpation. If the child complains of abdominal pain, the area of ​​the abdomen is palpated last. Normally, palpation of the mid-epigastrium causes pain as pressure is exerted over the aorta, but this should not be confused with visceral or somatic tenderness.

The doctor palpates the abdominal organs by pressing them with a free hand, which is placed on the child's back. Palpation begins in the lower quadrants and proceeds upwards. In this way, the edge of an enlarged liver or spleen is not missed. Exception for palpating the liver, successful identification of other organs, such as the spleen, kidney, and part of the colon, requires considering practice with tutored supervision.

The lower edge of the liver is sometimes palpable in infants and young children as a superficial mass 1 to 2cm (1/2 to inch) below the right costal margin (the distance is sometimes measured in fingerbreadths). If the liver is palpable 3cm (1/4 inches) or 2 fingerbreadths below the costal margin, it is considered enlarged and this finding is referred to a physician. Normally the liver descends during inspiration as the diaphragm moves downward. This downward displacement should not have been mistaken for a sign of hepatomegaly. In older children the liver is often not palpable, although its lower edge can be estimated by percussing dullness at the costal margin.

The spleen is palpated by feeling it between the hand placed against the back and the one palpating the left upper quadrant. The spleen is much smaller than the liver and positioned behind the fundus of the stomach. The tip of the spleen is normally felt during inspiration as it descends within the abdominal cavity. It is sometimes palpable 1 to 2 cm below the left costal margin in infants and young children. A spleen that is readily palpated more than 2cm below the right costal margin is enlarged and is always reported for further medical investigation.

Other anatomical structures that are sometimes palpable in children include the cecum, and sigmoid colon. The cecum is a soft, gas-filled mass in the right lower quadran. The sigmoid colon is left as a sausage-shaped mass that is freely movable over the pelvic brim in the left lower quadrant and is normally tender.

Although most of these structures are not routinely felt, one should be aware of their relative location and characteristics in order not to mistake them for abnormal masses. The most common palpable lower quadrant because with constipation the left colon fills with stool and gas until the ileocecal valve is reached. The cecum becomes distended, causing pain, which may be erroneously associated with appendicitis.

Special methods of investigation
Laboratory examination
1. Routine blood examination
2. Urine tests (bile pigments, ketonuria)
3. Biochemical analysis (bilirubin total, unconjugated and conjugated bilirubin, protein, cholesterol, AlAt, AsAt, amylase, trypsin and lipase)
4. Biochemical analysis of Urine for diastase.

1. Syndrome of cholistasis increased level of total and conjugated bilirubin and cholesterol).
2. Syndrome of cytolysis (increased level of AsAt, AlAt, LDG)
3. Syndrome of dysfunction of pancreas (increased level of amylase, trypsin, lipase)
4. Chain polymerizes reaction for virus of hepatitis A, B, C
5. Examination of feces for intestinal parasites (ascarides, lamblia cysts, enterbiosis)
6. Copogram
• Indigested muscular fibers
• Steatorrhea
• Lientery
• Bacteria in the feces

Instrumental methods of examination
1. Esophagogastroduodenoscpy
2. Ultrasound investigation
3. Intragastric pH-metry
4. Colonoscopy
5. Procto (sigmoido) scopy
6. Artificial contrast study of gastrointestinal system
7. Laparoscopy
8. Irrigoscopy and irrigography

Normal laboratory values ​​of biochemical analysis of blood
Glucose 3.33-5.55 mmol / L
Bilirubin total 8.5-2.0 mcmol / L
Unconjugated 2/3 of total
Conjugated 1/3 of total
Protein total 60.0-80.0g / L
ALT 0.1-0.75 mcmol / g / L
AST 0.1-0.45 mcmol / g / L
Amylase 16-32 dye units / L

A number of gastrointestinal disorders are caused by disturbances in motor function. Some such as Hirschsprung's disease, produce typical signs of obstruction and are alternately classified as obstructive disorders.

Source by Funom Makama

Under Section 33 of the Statutory Accident Benefits Schedule (SABS), an auto insurer can request that a person applying for accident benefits (ABs) attend an "examination under oath" (EUO) to determine the facts upon which ABs may be owing or outstanding. Although not required, a lawyer or licensed paralegal may attend with the insured to make sure that the representative of the auto insurer asks only relevant questions.

Because the auto insurer can deny the payment of ABs until the insured person complies with an EUO, the insured's representative has to determine if a request is appropriate, and, if not, what the consequences will be for failing to attend. Although the first reaction of a representative may be to not allow their client to attend an EUO after the commencement of proceedings, failing to do so may jeopardize their client's right to past and future ABs. There is no time limit imposed on an insurer to request an EUO-the insurer may still be entitled to do so even after a claim has been issued or an application for arbitration has been filed.

From the auto insurer's perspective, it would be best to request an EUO at the outset of a claim for SABS, when little is known about the insured's circumstances. More often, however, an auto insurer will request an EUO after benefits have been paid for some period of time and then terminated. This is typically the point at which an application for mediation has been filed with the Financial Services Commission of Ontario (FSCO) or at some stage later in the proceeding. Because of the frequency of this issue arising, both the courts and FSCO have addressed the appropriateness and timeliness of an insurer's request for an EUO.

In the FSCO decision of Balanki and Zurich, the insurer requested that the insured attend an EUO more than two years after the accident and after arbitration proceedings were commenced. In this case, the arbitrator did not allow the EUO-however, this decision was not due to the timing of the request in relation to the arbitration date or the past denial of benefits, but instead on the basis that no new information had come to light, making the examination needless. This decision reveals that an insurer may be risking the opportunity for an EUO if requested at a late stage, when the facts supporting a claim have stabilized.

To avoid being disentitled to an EUO, an insurer needs to make the request timely: ideally, at the outset of the claim and preferably while benefits are still being paid. Should an insurer fail to make the request in a timely manner, a lawyer or paralegal may be properly advising their client when they refuse their attendance.

Source by Wendy Cornacchia

I am in the sunset of my aviation career, as a muse about days past I recall certain times that were sometimes bazaar, sometimes humorous, sometimes insane...and yes, some times somber (I have had first hand experience with crashes; those I intentionally forget). What follows are two of those recollections; a requirement with becoming a pilot will, the FAA Oral Examination.

In the United States there has evolved a standardized procedure involving the FAA and an aspirant aviator, the "Practical Examination", this ritual (Right of Passage if you will) is composed of two parts, the Oral Examination and the Flight Test. In days gone by the standardization was not as it is today, when I was tested for my private pilots license the examiner was at liberty to ask just about anything and everything, such as:

Q: What is the function of the landing gear?

A: It saves wear and tear on the bottom of the plane.

As my aviation career progressed I underwent numerous exams. What follows is a question I was asked during the oral for my CFI (Certified Flight Instructor).

Q: You are flying a J-2 Cub (note J-2, Not J-3), you are about take off, you need to make a 90° turn onto the runway, the wind is right down the runway. Which way do you hold the ailerons?

At the time (during the test) I thought that the check airman was totally full of el poop-po de Toro (male bovine fecal matter). I didn't know the correct answer.

Correct Answer: Opposite the direction of turn i.e. if you are turning left onto the runway, hold the ailerons full right.

My opinion of the examined changed when I flew a J-3 Cub for the first time, guess what, the guy was right! There are some significant differences between the J-3 and the J-2, those differences make the answer to the forgoing question much more relevant. The J-2 doesn't have a tail wheel, it's a skid, and the J-2 doesn't have brakes, the J-3 does.

There is a little jingle that is vanishing under the sands of time, disappearing because in today's airplanes, the pilots think that the rudder peddles are something to rest your feet on. "Stick and rudder, stick and rudder, don't use one without the other".

Why? "Adverse Yaw".

To make the plane turn, you take the stick or yoke and move it in the direction of the desired turn. One aileron goes up, the other goes down, and the plane rolls into a bank and turns. The adverse yaw is caused by the down deflecting aileron, anytime you make lift you also make drag; consequently the aircraft will yaw opposite the direction of turn. It's the drag...If you ever fly a J-3 remember this. It really does make a difference which way you hold the ailerons while you are taxing for take off.

Next is a question for which I tutored, a question that at the time I thought was even more male bovine fecal matter than the above, and also a question that until relatively recently had no provable answer:

Above I have related the story concerning a question I was asked during the oral exam for my CFI (Certified Flight Instructor). step after the CFI is the CFII (Certified Instrument Flight Instructor). At the time, a member of the military could use the GI Bill to fund higher education, this included aviation. I was stationed at Camp Pendleton in southern California and took advantage of this at a GI Bill approved flight school at the Palomar airport (now KCRQ). Since Uncle Sam was providing 90% of the funding, after I passed everything required for the CFI I continued with the CFII.

There is a segment of the academic training that (at the time) didn't have ridged standardization, i.e. the preparation for the oral exam. The question I am about to relate I am sure that you will think I am absolutely out of my mind. But...this is as serious as a heart attack.

A slight digression: There was an examiner at the San Diego GATO who was notorious for asking absurd, irrelevant, inapplicable, etc. etc. questions that had no purpose other than to show off some superior knowledge of an unimportant detail of something that nobody cared about anyway. Such as: Which way does the gyro in the turn needle rotate? I mean...who cares? Is it a pre-flight item? Oh, this particular examiner asked a similar question to an applicant, the applicant answered with "Who cares?", the examiner replied with "I care!" and busted him. So, my instructor asked me a question that was on the list of cacamainy (spelling correct for my usage) questions that I might be asked.

Question: On an ILS approach, how would you track the localizer needle if you flew the approach inverted?

What?? My instructor assured me that if this particular examiner was assigned to me, there was a high probability that I would be asked this question. I suppose that the purpose of the question was an exercise in visualization.

My instructor and me get into a royal urinating contest. Each of us accused the other of being so full of dog stool that he shouldn't be allowed to live. I mean, what are you going to do, get in a plane and fly an ILS upside-down?

Time goes by and a proof positive answer was never found. Then, I build my simulator and I remembered this question. So I asked myself: "Will the planes on this simulator fly upside-down?" Answer: Yes. Next question, "Can I fly an ILS inverted?" Answer: Yes (sort of)...actually, after you practice enough it's really not that difficult. The hard part is when you get to DH, flipping the plane right side up and landing.

The correct answer to the question; "How do you track the localizer needle if you fly an ILS inverted?", demonstrated by computer simulation is: track the localizer normally. The only thing that is reversed are the pitch corrections.

End note: The simulator that I built for myself is based on the Microsoft 2004 Century of Flight program, the planes fly upside-down just fine (I use the CH Products yoke, throttle quadrant and rudder peddles). If you have occasion to take training at SimCom or Flight Safety, their simulators don't fly inverted very well.

Source by Allan Lewicki