Significance of Carnett's sign

The idea of Carnett's sign is that (acute) abdominal pain remains unchanged or increases when the muscles of the abdominal wall are tensed.So, if Pain source is Intra-Abdominal (Negative Carnett's Sign),Abdominal Pain decreases with tensing abdomen.
And in Abdominal Muscle Wall Pain (Positive Carnett's Sign), Pain increases or remains unchanged

Technique

A- Patient lies supine
B- Patient tenses abdominal wall by
-asking the patient  to lift the head and shoulders from the examination table to tense the abdominal muscles
-An alternative is to ask the patient to raise both legs with straight knees.

Carnett's sign for patients with pelvic pain. The examiner places his or her finger on the tender area of the patient's abdomen and asks the patient to raise both legs off the table. An increase in the patient's pain during this maneuver is considered a positive test.

Grades of deep tendon reflexes

 Which of the following grades of deep tendon reflexes best describes a patient with transient
and intermittent clonus?

• a.Grade 0
• b.Grade 1+
• c.Grade 2+
• d.Grade 3+
• e.Grade 4+

The answer is (e).
Clonus is rapidly alternating involuntary contraction and relaxation of skeletal muscle. Using a reflex hammer deep tendon reflex (DTR) response is graded on a scale from 0 to 4+:

In a normal person, when a muscle tendon is tapped briskly, the muscle immediately contracts due to a two-neuron reflex arc involving the spinal or brainstem segment that innervates the muscle. The afferent neuron whose cell body lies in a dorsal root ganglion innervates the muscle or Golgi tendon organ associated with the muscles; the efferent neuron is an alpha motoneuron in the anterior horn of the cord.

Eliciting Chvostek’s sign

Chvostek's sign is contraction of the muscles of the eye, mouth or nose, elicited by tapping along the course of the facial nerve. The examiner taps gently over the facial nerve in front of the ear.

This sign usually suggests hypocalcemia but can occur normally in about 25% of patients. Typically, it precedes other signs of hypocalcemia and persists until the onset of tetany. It can’t be elicited during tetany because of strong muscle contractions.
Normally, eliciting Chvostek's sign is attempted only in patients with suspected hypocalcemic disorders. However, because the parathyroid gland regulates calcium balance, Chvostek's sign may also be tested in patients before neck surgery to obtain a baseline.

Anatomy of ear drum as seen on examination

Normal eardrum : Notice the light reflex on the anterior-inferior portion of the eardrum.

20 Examples Of Cardiac And Pulmonary Auscultation - Littman

01 – Normal Heart Sound-Apex

02 – Third Heart Sound,S3(physiological-Apex)

03 – Fourth Heart Sound,S4-Apex

04 – Aortic Stenosis-Right Base

05 – Mitral Regurgitation-Apex

06 – Midsystolic Click-Apex

07 – Ventricural Septal Defect-Left Base

08 – Atrial Septal Defect-Lowewr Left Sternal Border

09 – Mitral Stenosis-Apex

10 – Aortic Regurgitation-Mid Left Sternal Border(3rd Intercostal Space)

11 – Normal Tracheal Sound-Trachea Interscapular

12 – Normal Vesicular Sound-Right Lower Lobe,Left Lower Lobe

13 – Fine Crackles with Deciduous Bronchial Sound-Right Middle Lobe

14 – Coarse Crackles-Right Lower Lobe

15 – Bronchial Sound-Left Lower Lobe

16 – Inspiratory Stridor-Trachea

17 – Rhonchus-Right Lower Lobe

18 – Wheezing-Left Lower Lobe

19 – Fine Crackles-Lung Basis

20 – Pleural Friction-Right Middle Lobe

Babinski Response

Babinski Response: Note upgoing great toe upon stimulation of lateral foot in patient with
upper motor neuron lesion.

Cranial Nerve Examination

Ascites And Shifting Dullness

Abdomen symetrically distended secondary to fluid build up in peritoneal cavity.
Note bulging flanks as fluid distributes to most dependent areas of abdomen. skin is also yellowed
due to hyperbilirubinemia.


Ascites with Shifting Dullness: Ascitic fluid will flow to the most dependent portions of the abdomen.
The air-filled intestines will float on top of this liquid. The technique of shifting dullness makes use of
this relationship in order to detect the presence of ascitic fluid.

Chest Examination from the back