Absolute contraindications to Ascitic Tapping (Paracentesis) While some authors have claimed ascitic paracentesis to be free from absolute contraindications, others have listed following as absolute contraindications: Clinically evident fibrinolysis Disseminated Intravascular Coagulation (DIC) Clinically apparent oozing from needle sticks Acute abdomen requiring surgery Relative contraindications to Blind Paracentesis Ultrasound guided…
Category: Clinical Skills and Approaches
History taking and examination skills and Flowchart approaches to commonly encountered medical conditions and diseases.
Clinical Skills and Approaches 
Prescribing Opioids for Chronic Pain
Recommendations for Prescribing Opioid in Chronic pain 1. 1st line of therapy in chronic pain outside of active cancer, palliative or end of life care must be nonpharmacologic therapy and nonopioid pharmacologic. Consider opioid therapy in combination with nonpharmacologic or nonopioid pharmacologic therapy if benefits outweighs risk. 2. Ordinarily 2…
Clinical Skills and Approaches 
Gower’s sign
Synonyms: Gower’s maneuver, Myopathic walking, Butt-first maneuver Identifying Gower’s sign To check for Gower’s sign, place the patient in the supine position and ask him to rise. A positive Gower’s sign – an inability to lift the trunk without using the hands and arms to brace and push – indicates…
Clinical Skills and Approaches 
Eschar
Synonyms Tache noire Definition of Eschar An eschar is a local skin lesions coated by a thick coagulated crust or slough that usually results from burn or infection. Causes of Eschar Tick bite fever Scrub typhus Anthrax Tularaemia Spider bites Disseminated fungal infection Post-burn Diagnostic Clues Cigarette-burn Sign In scrub…
Clinical Skills and Approaches 
Lhermitte’s Sign
Synonym: Lhermitte’s phenomenon, Barber chair phenomenon Definition of Lhermitte’s Sign Lhermitte’s sign (pronounced Ler-meets) is an electric shock-like sensations, spreading along the spine in a cervico-caudal direction and into the arms and legs felt upon active or passive flexion of the neck. Reverse Lhermitte’s Sign is defined when symptoms are…
Clinical Skills and Approaches 
Mnemonic based approach to grading and planning treatment for BPH
MNEMONIC: FUNWISE During the last 1 month, how often/many times you had to – 1. Frequency: Urinate again <2 hours after you finished urinating ? 2. Urgency: Difficulty in postponing the urine ? 3. Nocturia: Get up to urinate from bedtime to wakeup ? 4. Weak stream: Weak urinary stream…
Clinical Skills and Approaches 
Pronator Drift (Barre’s sign) : Neurological Examination
Components of pronator drift Progress from distal to proximal: Downward arm drift Forearm pronation Flexion of the wrist and elbow Method of assessment for pronator drift When the patient extends both arms upright in the supinated position and hold them at shoulder height for atleast 10 seconds (Patients should be…
Clinical Skills and Approaches 
Clonus : Clinical Examination and Mechanism
Definition of clonus Clonus is a rhythmic sustained involuntary muscular contraction (generally 5-8 Hz) evoked by sudden passive stretch of the muscle and tendon. Eliciting Clonus Clonus is commonly elicited in gastrocnemius (ankle clonus). Other sites where clonus can be elicited are quadriceps (patellar clonus), finger flexors and jaw. 1….