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….
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Approach to Low Back Pain
Definition of Low Back Pain Low back pain (LBP) is defined as pain, muscle tension or stiffness localized below the costal margin and above the inferior gluteal folds, with or without leg pain (sciatica). “Diagnostic triage” after excluding non-spinal causes of low back pain classifies LBP into 3 broad categories:…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Radiation cystitis : Diagnosis, prevention and management
Cause of radiation cystitis: Bladder in the radiation field (treatment of pelvic malignancies like prostate, cervical, colorectal) Epidemiology of radiation cystitis: Incidence: 23% to 80% (variability due to variability in type and dosing of radiotherapy among different medical subspecialities) Incidence of severe hematuria: 5-8% Mean duration for developing radiation cystitis:…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Surgical Anatomy of Stomach
GASTROESOPHAGEAL JUNCTION (CARDIA) It is the junction between esophagus and cardia of stomach Histologically: Mucosal transition from squamous to columnar epithelium Functionally: High pressure zone (Lower esophageal sphincter or LES) – Normally, LES is intraperitoneal, >2 cm long, and has a resting pressure >6 mmHg; not an anatomical sphincter but a…
Clinical Skills and Approaches 
Head trauma fluid resuscitation
Peculiarities of cerebral circulation: 1. Brain and spinal cord is isolated from endothelium by BBB composed of continuous capillaries that limits movement of proteins and electrolytes 2. Fluid movement is primarily determined by osmolar gradient (in contrast to peripheral tissues – transcapillary gradient of large macromolecules) 3. Hence, administration of…
Clinical Skills and Approaches 
Burn Fluid Resuscitation
A) Clinical endpoints suggesting adequacy of burn fluid resuscitation: B) Pathophysiology of Burn:
Clinical Skills and Approaches 
Perioperative Fluid Management
Author: Sulabh Kumar Shrestha, KISTMCTH A) RELEVANT ANATOMY AND PHYSIOLOGY Details of the body fluid compartments are described here Microvessels for fluid exchange: The Exchange Vessels – capillaries and most proximal part of the venules Sinusoidal capillaries (liver, spleen, bone marrow): freely permeable to all solutes Fenestrated capillaries (glands, glomeruli, GIT):…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Axillary Lymph Node Dissection
A) Indications: Clinical or radiological evidence of involvement of axillary nodes Microscopically positive sentinel node(s) due to metastasis from primary malignant tumor In sentinel node negative: 98 % accurate in predicting that the other nodes are negative In sentinel node positive: possibility of microscopic disease in any of the remaining lymph nodes is 15–30…