Synonyms: Spinal tap Definition: Puncture of subarachnoid space in the lumbar region of the spinal cord to withdraw cerebrospinal fluid (CSF) for diagnostic or therapeutic purpose or inject drugs for anesthetic purpose. Indications: A. Diagnostic: CNS infections: Bacterial, viral, fungal, parasitic or TB meningitis Subarachnoid hemorrhage Carcinomatosis meningitis (CNS involvement…
Tag: Internal medicine
Clinical Skills and Approaches 
Vestibular examination : Dix-Hallpike Maneuver for BPPV
Benign Paroxysmal Positional Vertigo (BPPV) is the commonest cause of episodic vertigo and is characterized by acute attacks of transient vertigo initiated by certain head positions, lasting seconds to minutes, accompanied by nystagmus that fatigues on repeated testing. Important terminologies linked with pathogenesis of BPPV: Otoconia: Calcium carbonate crystals released…
Clinical Skills and Approaches 
Examination of Gait
Definitions Gait: Gait is the cyclical pattern of musculoskeletal motion that carries the body forwards. It involves a cyclic loss and regaining of balance by a shift of the line of gravity in relation to the center of gravity. Normal gait is smooth, symmetrical and ergonomically economical. Gait cycle: The…
Clinical Skills and Approaches 
Examination of Facial Nerve (7th Cranial Nerve)
The anatomy of facial nerve has already been discussed in detail earlier. It is essential to have proper knowledge of anatomy to understand this section of clinical examination of facial nerve. A) Inspection: Observe: Face at rest for any facial asymmetry Any facial tics, symmetry of eye blinking or eye…
Clinical Skills and Approaches 
Hearing tests with Tuning fork
Tuning fork Parts of a tuning fork 1. Foot piece 2. Stem 3. Prongs How to use tuning fork? Hold the stem of the tuning fork between the index finger and thumb of your right hand without touching the prongs. Strike the junction of superior 1/3 and inferior 2/3 of the…
Case Reports 
Case Discussion on Central Diabetes Insipidus
A 12 year old female patient came to OPD with the chief complaints of increased thirst and increased frequency of urination for last 1 year. She drank about 10-11 liters of water everyday and passed similar amount of urine with a frequency of 10-12 episodes on daytime and 3-4 episode…
Clinical Skills and Approaches 
Digital Clubbing
Synonyms: Hippocratic fingers, Acropachy, Dysacromelia, Drumstick fingers, Watch glass nails, Parrot beak fingers, Serpent head nails, Lovibond’s sign Definition Focal and bulbous enlargement of the distal phalanges due to proliferation of connective tissue between the fingernail and the bone with increase in both the longitudinal and transverse curvatures of the…
Clinical Skills and Approaches 
Edema – Physical Examination
Synonyms: Oedema, Swelling Definition of Edema Accumulation of excessive amount of fluid in the extravascular interstitial space of the body. Interstitial space is the extravascular compartment of the extracellular fluid and surrounds the cells of a given tissue. Anasarca is a severe and generalized edema with profound subcutaneous tissue swelling. Further…