Mantoux Test In Tuberculosis

The Mantoux test is very widely used test for tuberculosis. Its interpretation however complex. It is also called tuberculin test.

Tuberculin is a glycerol extract of the tubercle bacillus. Purified protein derivative (PPD) tuberculin is a precipitate of non-species-specific molecules obtained from filtrates of sterilized, concentrated cultures.

The test is named after Charles Mantoux, a French physician who developed on the work of Koch.

Procedure

A standard dose of 5 Tuberculin units (0.1 mL) is injected intradermally and read 48 to 72 hours later. A person who has been exposed to the bacteria is expected to mount an immune response in the skin containing the bacterial proteins. Read more

Approach to patient With Rheumatic Pains

Good history and Physical Examination,

A good history and physical examination, coupled with knowledge of musculoskeletal anatomy, is most important when evaluating a patient with a rheumatic disorder.

this perhaps most important aspect of any patient evaluation. Not only it tells about the disease that a patient has but also about the problems that he is facing in day to day life. This information is very helpful in individualizing the treatment.

Investigations

Investigations should support your clinical examination and should be individualized on basis of patient profile. Read more

How To Examine An Abdominal Lump

General Physical Examination

Appearance: Anemic, jaundiced or emaciated, Lymph nodes, especially supraclavicular.

Local Examination

Inspection:

• Overlying skin
• Position, size, shape and surface of the swelling
• Movement of swelling  on respiration
• Check sites of hernia
• Observe scrotum for any fullness

Palpation: Read more

Examination Of Abdomen-Auscultation

The patient is positioned comfortably in the supine position.

The stethoscope is used to listen over several areas of the abdomen for several minutes for the presence of bowel sounds. The diaphragm of the stethoscope should be applied to the abdominal wall with firm but gentle pressure.

It is often helpful to warm the diaphragm in the examiner’s hands before application, particularly in ticklish patients. When bowel sounds are not present, one should listen for a full 3 minutes before determining that bowel sounds are, in fact, absent.

Auscultation for abdominal bruits is the next phase of abdominal examination. Bruits are “swishing” sounds heard over major arteries during systole or, less commonly, systole and diastole. The area over the aorta, both renal arteries. and the iliac arteries should be examined carefully for bruits. Read more

Examination Of Abdomen-Percussion

Uniform enlargement of the abdomen may be because of gas or fluid in the abdomen. In the former there is tympanic note on percussion while in the latter there is dullness.

Because the fluid accumulates in the flanks, the areas of dullness on both sides resembles a horse-shoe shape.If  fluid is suspected-

• Perform percussion with the patient lying on his back
• Then change patien to lateral position and percuss on each side.

Read more

Examination of Abdomen-Palpation

The  patient lies on  back, shoulders raised slightly and legs flexed to relax the abdomen. With He should keep his mouth open and breathe quietly and deeply. The abdomen is palpated with the flat of the hand initially and the fingers are used to locate the margins of any viscera or tumour.

The patient should have an empty bladder.

Tenderness

Tenderness  is commonly found in inflammatory lesions of the viscera and the surrounding peritoneum.

The site of tenderness often suggests the diagnosis. Read more

Examination Of Abdomen-Inspection

Examination of the abdomen begins with inspection. The shape of the abdomen in most normal persons with normal musculature is  boat-shaped i.e. the abdominal wall sinks slightly within the bony margins of the abdominal surface.

In a very muscular person, the lateral margin of the rectus muscle is visible in the center. Usually the medial edges of both the recti are contiguous. However they may be separated as a congenital defect, after pregnancy or with obesity and ascites. This is called divarication of recti.

Scaphoid or sunken abdomen is seen with starvation and malignancy especially of stomach and esophagus. Read more

How To Measure Blood Pressure Using Mercury Sphygmomanometer

Method

Clothing should be removed from the arm. If it cannot be removed, it is better to leave it as it is, rather than fold the clothing into tight constricting bands.

The cuff should be encircled around the arm. If the bladder of the cuff does not encircle the arm completely, the centre of the bladder should be over the brachial artery. The rubber tubes from the bladder are usually placed inferiorly at the site of the brachial artery, but it would be better to place it superiorly or posteriorly so that the antecubital fossa is easily accessible for auscultation.
The bell of the stethoscope gives better sound reproduction but a diaphragm is easier to secure with the finger of one’s hand and covers a large area.

To measure BP in the legs a thigh cuff containing a large bladder (18 x 24 cms) for adults should be wrapped around the thigh of the prone patient and the Korotkoff sounds auscultated in the popliteal fossa in the usual way.

BP in the legs is equal to that in the arms provided the bladder is adequate in size.

Read more

How To Go About Joint Examination

Before proceeding to examination in any joint pathology, it is important to take a good history of the illness. It begins with questions like when did it begin, where is the pain or is there any swelling. History of trauma, tuberculosis, typhoid, exposure to venereal disease is important.

A note about any previous diseases like pneumonia, bacillary dysentery, bleeding tendencies, renal colic.  should be made.

Family history of hemophilia, tuberculosis gout, etc should be taken in detail.

Examination

Before you examine joints, one must perform a systemic examination. Joint examination begins by inspection of the joint followed by palpation. Then movements and measurements are tested.

A. Inspection:

1. Joints affected
2. Position of the joint and fixed deformity
3. Swelling
4. Signs of inflammation over the joint
5. Muscular wasting just above the joint

B. Palpation:

1. Local temperature
2. Tenderness
3. Swelling-fluctuant or non-fluctuant
4. Bony components and its relation to the joint

C. Movements

Both active and passive joint movements must be done.

1. Pain on movement
2. Restriction of movement
3. Excessive mobility
4. Protective muscular spasms
5. Grafting on movement

D. Measurements:

1. Length of the limb
2. Circumference of the limb
3. Relations of various bony points

Schamroth Test or Schamroth Window Test

This test was originally demonstrated by South African cardiologist Dr Leo Schamroth on himself and is a popular test for clubbing.

When the distal phalanges (bones nearest the fingertips) of corresponding fingers of opposite hands are directly apposed (placed against each other back to back), a small diamond-shaped “window” is normally apparent between the nailbeds.

If this window is obliterated, the test is positive and clubbing is present.

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