Indication: Anterior shoulder dislocation Position of patient: Supine Position of physician: Standing on the side of the dislocated shoulder Steps: Physician holds the wrist of the patient with both the arms keeping elbow of the patient extended and forearm in neutral position Arm is slowly abducted in brief oscillating movement…
Category: Clinical Skills and Approaches
History taking and examination skills and Flowchart approaches to commonly encountered medical conditions and diseases.
Clinical Skills and Approaches 
New Ballard Score: How to use it correctly?
Assessment of gestational age can be made postnatally by either Dubowitz Score or New Ballard Scoring system. In sick infants, examination of Anterior lens canpsule vascularity with a +20D lens can be useful in assessing gestation and it needs to be carried out within 24 hours of birth. Dr Jeanne…
Clinical Skills and Approaches 
Hyponatremia Correction: Rules and Mnemonics
Corrected sodium level When hyperglycemia is present, the underlying sodium concentration (corrected sodium concentration) can be estimated by adding 1.6-2.4 mEq/L (average of 2 mEq/L) to the reported sodium concentration for every 100 mg/dl increase in plasma glucose above 100 mg/dl. E.g. In a patient with Na+ level, 145 and…
Clinical Skills and Approaches 
Costovertebral or Renal angle tenderness
Synonyms: Murphy’s kidney punch, CVA tenderness (CVAT) Anatomy of Costovertebral angle or Renal angle: Costovertebral angle is formed by the junction of the 12th, or lowermost, rib with the paravertebral muscles, which run parallel to and on both sides of the vertebral column. Eliciting costovertebral angle tenderness: Position of patient:…
Clinical Skills and Approaches 
Murmurs Made Easy
Mnemonic: SSSS Stenotic lesion of Semilunar valve and Septal defect cause Systolic murmur. From this, you should also be able to remember that regurgitant lesions of semilunar valve causes Diastolic murmur. The stenotic lesions of atrio-ventricular valve causes diastolic murmur and regurgitant lesions cause systolic murmur. Causes of systolic murmur:…
Clinical Skills and Approaches 
Koilonychia
Synonyms: Spoon-shaped nails, Concave nails Definition of koilonychia: Loss of longitudinal and lateral convexity of the nail, with thinning and fraying of the distal portions. Conditions associated with koilonychia: Normal variant Soft nails with occupational damage Iron deficiency anemia Hemochromatosis Raynaud’s syndrome Psoriasis (Koilonychia with subungual keratosis) Mechanism of koilonychia in…
Clinical Skills and Approaches 
Eliciting Smoking and Alcohol History
Smoking History Ask: Have you ever smoked? If yes – Further ask: For how long? What form? (cigarettes, cigars, pipe, chewed) How much? Quantify smoking history: A ‘pack year’ is smoking 20 cigarettes a day (1 pack for one year) (Number of cigarettes smoked per day X Number of years…
Clinical Skills and Approaches 
Fever : Definition, Mechanism and Types
Definition of Fever Studies have found that the maximum normal oral temperature is 37.2ºC (98.9ºF) at 6 A.M. and 37.7ºC (99.9ºF) at 4 P.M.; these values define the 99th percentile for healthy individuals. Hence, an A.M. temperature of >37.2ºC (>98.9ºF ) or a P.M. temperature of >37.7ºC (>99.9ºF) would define…