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[ACCM]

[ACCM]

Angel’s
CONCISE CLINICAL METHODS
Second Edition

Author
Dr. Angel Magar

Co-authors
Ajay Dhakal Raj Krishna Shrestha
Sarensa Palikhey Suvash Shrestha

Contributors
Sanju Lama Khushboo Priya Nisha K. C.
Pratikshya Chalise Sarwada Tuladhar Trishna Shrestha
Surya Prasad Rimal Sushant Yadav Suman Prasad Adhikari

Acknowledgement
Dr. Chanda Karki, Dr. Arpana Neopane
Dr. Udaya Koiral, Dr. Eva Gauchan, Dr. Merina Shrestha
Dr. Raju Dhakal, Dr. Niraj Pandey, Kabit Thapa, Arun Kumar Rai
Jyoti Bhaju Lama, Soniya Dulal, Namrata Gupta

[ACCM]

PREFACE TO THE SECOND EDITION

There is always a good reason to write a new book when there are already a number on the market. It seemed to me that none of those currently available adequately conveyed the concise information needed for surviving clinical posting and final exams.

I published the first edition when I was a final year medical student with no real expectation that I would come up with second edition so early in my professional life. The great encouragement by the readers made me to bring out the second edition with more concise and user friendly tools. No amount of appreciation is sufficient to them because without their support this edition would never have seen the light of the day.

I am happy by the success of first edition as it was appreciated by many renowned teachers and eminent physicians of Nepal as well as reviews published in the journals and National Daily News papers which started the era of medical publication in Nepal.

First edition was co-authored by Dr. Dipendra Chaudhary my batch mate and best friend when we were medical student. Therefore in this edition also I have kept the tradition of having medical students as co-author because I feel that they know where an author has to emphasize in its contents as they are the readers. I am glad to have multitalented medical student as co-authors who have an intense desire to change the way of tomorrow’s practice of clinical medicine. And I do assure our reader that the tradition will be followed unconditionally in future editions in the quest of a more concise and user friendly book. Because of these reasons the title from this edition has been changed to make it more relevant to its contents.

In this edition most of the matter has been re-written and revised thoroughly especially history taking and clinical examination. A new chapter like sample history in each specialty has been added to help the new comer in the clinical science. Another addition to this edition is the flow chart, which will help a medical student to get a more scientific approach to reach the final diagnosis.

I pay my hearty feelings of appreciation to them who have advised me to reedit the book with the changes required. I am grateful to all the medical students and readers who appreciated the previous work. I also express my gratitude to Makalu Publication House (MPH), Printer and others who are connected for bringing out the second edition of the book.

Finally, I would generously appreciate and heartily accept healthy suggestions as well as constructive criticisms from the thoughtful readers for future editions and from this edition royalty of this book will be used in the treatment of poor patient.

Dr. Angel Magar
Kathmandu, Nepal
angel@xenomed.com

1st December, 2006
World AIDS Day
“Stop AIDS, Keep the Promise”

[ACCM]

PREFACE TO THE FIRST EDITION

“Most persons would succeed in small things now if they were not troubled with great ambitions.”------ Longfellow

Keeping aside the exponential advancement in medicine and talking about the basics, it is where many of us get flunked. Students just striding the clinical phase are in even more quandary about what to read and where to read. Well, there are many standards book for that inspite of it many of us fail to stress on the basic clinical aspects noting this deficiency we have attempted to put before the students a concise and must know the text covering many clinical topics (history taking, examination, x-ray, instruments, clinical procedure, FAQs etc.)

Our clear, easy to follow texts and instructions walk you through each page from beginning to end.

We want to thank you for purchasing this concise manual in what we feel is the cheapest thing money can buy. We sincerely hope that this book will come up to the expectation of the students.

We hope you enjoy reading this book as much as we enjoyed creating it!!!
We are really overwhelmed as this book was adequately reviewed by our faculty members in KMC-TH.

In the preparation of this book we gratefully acknowledge help received from various quarters. We are in particular, indebted to: Prof. O. K. Malla HOD, Dept. of Ophthalmology, Dr. Toran K. C. Asst. Prof. Dept. of Otorhinolaryngology, Dr. Arvind Verma Dept. of Otorhinolaryngology (Nepalgunj Medical College, Nepalgunj), Dr. Harihar Wasti, Dept. of Forensic Medicine, Dr. Yam Psd. Dwa SHO, Dept. of Anesthesiology, Dr. Kalyan Paudel SHO, Dept. of Orthopaedics, Dr. Deep Adhikari, Department of Surgery.
We thank Intern (Dr. Rages Pant, Dr. Nirmal Bastola, Dr. Arun Giri, Dr. Keshav Pandey Dr. Gunraj Poudel & Dr Kabir Thakali NMC) for their invaluable suggestions. Our sincere thanks to Poonam Rijal, Smita Joshi, & Subhani Gurung for their immense help during the preparation. We would also like to thank our colleagues Prasan, Tirtha, CM Aryal, Suresh M., Bhaskar, Som, Rupendra, Sandeep from 2nd Batch, Krishna Murari Adhikari, Sanjay Raj Thapa, Keshav Budhathoki & Jeevan Pradhan from 3rd Batch.

Finally, we’ll generously appreciate and heartily accept healthy suggestions as well as constructive criticisms from the thoughtful readers.

A.M.
D.C.

[ACCM]

When I first came to clinical, I was confused as all the books were so voluminous and very difficult to find out what to study. Then my eyes went through this book and found out very easy and precise things that I needed for my bedside. I am glad that 2nd edition of this book is coming very soon and I am looking forward that this book will prove to be as beneficial to my juniors as it was for me.
Dr. Niraj Pandey (Intern) MBBS 5th Batch, KMC

This book was a real help during my clinicals as it has concise and precise information. I hope that my juniors too will get themselves benefited by this book and congratulation for the second edition. The book is worth reading.
Dr. Raju Dhakal (Intern), MBBS 5th Batch, KMC

The first edition was a great help for me since it contained all the materials for the clinicals. I found it very handy for the exam and hope the second edition will live up to the expectation too.
Vishal Prateek, MBBS, 2nd Batch, NMC Birgunj

The previous edition of the book was a vade mecum for all the medical students in their clinical phase. The book provides insight into the clinical history taking, general examination, all presented in compressive and concise manner. The past questions and gamut of data pertaining to national health unavailable in foreign books is what marks the book run at the forefront. It is a must read for all the clinical students.
Anup Shrestha, MBBS, 7th Batch, KMC

Firstly, I would like to congratulate you for such an excellent book. It is presented in a concise and well informative way. I am highly motivated and impressed by this book.
Mohan Saud, MBBS, 7th Batch, KMC

First of all I would like to thank Dr. Angel for giving us such a wonderful book in the clinicals where we were lost in the lines of those heavy books very difficult to understand. I found my clinicals easy with this book and I am waiting eagerly for the second edition.
Kabit Thapa, MBBS, 7th Batch, KMC

[ACCM]

Dedicated to all
the medical students
of
Past, Present & Future

[ACCM]

CONTENTS


Medicine 1-138

History taking 1

History taking in Medicine 5

Clinical Examination 13

General Examination

General Characterisitcs 13

Vitals 13

Presentation of a normal case 14

Blood Pressure 15

Respiration 16

Temperature 17

Systemic Examination 18

Respiratory System 19

Cardiovascular System 23

Alimentary System 27

CNS examination 32

How to read a Chest X-Ray 38

Presentation of a normal X-Ray 40

Pulse 42

Jugular Venous Pressure 50

Anemia (Pallor) 53

Jaundice (Icterus) 59

Lymphadenopathy 65

Cyanosis 69

Clubbing 73

Koilonychia 77

Oedema 78

Dehydration 83

Ascites 87

Tuberculosis 100

Asthma protocol in Nepalese context 102

Sample History-Liver Cirrhosis 103

Sample History-Chronic Obstructive Pulmonary Disease 107

Sample History-Hyperthyroidism 111

Sample History-Enteric Fever 115

Sample History- Congestive Cardiac Failure 119

Viva Questions 137

Psychiatry 139-144

History Taking & Clinical Examination 139

Surgery 145–223

History Taking & Clinical Examination 145

Sample History– Pre Operative Case of Appendicitis 151

Sample History– Post Operative Case of Cholecystectomy 155

Sample History– Benign Prostatic Hyperplasia 160

Sample History– Hernia 164

Sample History– Ureteric Colic 168

Fluid & Electrolyte Balance 172

Frequently Asked Questions 175

Gastrointestinal System 180

Renal System 191

Differential Diagnosis 194

Imaging 197

Abdominal X-Ray (Supine) 197

Erect AP film 199

Instruments and Procedures 203

Suture & Suture Material 215

Orthopedics 221–223

History taking and examination 221

Gynaecology & Obstetrics 224–264

Gynaecological History Taking 224

Obstetric History Taking 230

Sample History– Antenatal Care 237

Sample History– Puerperium 241

Sample History– Caesarean Section 245

Sample History– Fibroid 250

Sample History– Genital Prolapse 255

Important Instruments 260

Viva Questions 263

Pediatrics 265–305

History Taking & Clinical Examination 265

Examination of newborn 271

Examination at birth 272

Few important guidelines 274

Common developmental milestones 277

Some definitions 280

Sample History 281

Sample History Bronchiolitis 281

Sample History Pneumonia 286

Sample History Enteric Fever 291

Sample History Nephrotic Syndrome 296

Sample History Febrile Seizure 301

Viva question 305

Community Medicine 307-344

National health policies and plans 307

National Health Policy, 1991 307

Second Long Term Health Plan, 1997-2017 307

Tenth Five Year Plan (2059/60-2063/64) 308

Millennium Development Goals 308

Institutional framework of the Department of Health Services 310

Organizational chart of DoHs 311

National Programmes 312

Child Health 312

Reproductive health 312

Disease control 313

Supporting programmes 313

EPI 313

Nutrition programme 314

CB-IMCI 317

Control of ARI programme 318

Family plamiy programme 319

Safe motherhood 321

Malaria control 321

Kala-azar control 323

National Tuberculosis Control Programme 324

HIV/AIDS & STI control Programme 325

Leprosy Control Programme 329

Multilateral Partners of health services of Nepal 329

Bilateral Partners of health services of Nepal 329

International Non-Governmental Organisations 330

National Non-Governmental Organisations 330

Useful acronyms 331

Probable spotters 333

Viva questions 335

Forensic Medicine 336-346

Introduction 336

Nepal Medical Council 337

Duties and rights of physicians 339

Medical negligence 340

Crime investigation system in Nepal 342

Courts in Nepal 343

Medico legal acts in Nepal 343

Geneva declaration 344

Viva Questions 345

Ophthalmology 347-368

History Taking & Clinical Examination 347

Ocular Examination 350

Sample History Immature Senile Cataract 360

Common conditions in ophthalmology 365

Viva Questions 368

ENT 370-393

History Taking & Clinical Examination 370

Ear Examination 374

Nose Examination 377

Oral Cavity Examination 379

Neck Examination 381

Sample History Chronic Suppurative Otitis Media 383

Instruments 388

Viva Questions 392

[ACCM]

INDEX

1st trimester, 230
2nd trimester, 231
3rd trimester, 231
5% dextrose, 173

A
Abdominal anatomy, 188
Abdominal paracentesis, 97
Abdominal x-ray, 197
Abscess, 205
Absent radial pulse, 48
Absolute bone conduction, 377
Absorbable sutures, 216
Accessory nerve, 33
Acute appendicitis, 194, 187
Acute perianal pain, 186
Adynamic ileus, 188
Alimentary system, 27
Allis tissue forceps, 261, 204
Alvarado’s scoring, 186
Anacrotic, 48
Anal pain, 147
Anemia, 53
Angioneurotic oedema, 81
Antenatal care, 236
Antenatal history, 266
Anterior chamber, 356
Anterior fontanelle, 274
Anterior rhinoscopy, 377
Anthropometric, 275, 270
AP films, 197
Apgar score, 279
Appellate court, 343
Appendicitis, 185
Appendicular lump, 186
Appropriate for dates, 280
Artery forceps, 204
Ascites in cirrhosis, 96
Ascites, 87
Asthma, 102
Attention and concentration, 142
Aural speculum, 389
Aural syringe, 390
Auscultation. See alimentary system. See cardiovascular system. See respiratory system
Axillary lymph nodes, 66

B
Babcock’s forceps, 205, 262
Ballenger’s swivel knife, 391
Bard-parker, 206
BCG, 277, 333
Benign prostatic hyperplasia, 160
Bilirubin, 60
Bimanual examination, 229
Biopsy, 179
Birth history, 266
Bleeding per rectum, 146
Blood pressure, 15
Bluish discolouration of body, 71
Bowel sounds, 181
Boyle davis mouth gag, 390
B-P knife, 206
Brachial pulse, 43
Bradycardia, 45
Braided polyester suture, 220
Breast, 228
Breastfeeding, 315
Breathlessness, 7
Bronchiolitis, 281
Brudzinski’s sign, 37

C
Caesarean section, 245
Calot’s triangle, 182
Cardiovascular system, 23
Carotid pulse, 43
Catacrotic, 48
Catgut, 217
Causes facial puffiness, 80
Causes of jaundice, 62
Causes of pedal oedema, 80
Causes of clubbing See clubbing
Central cyanosis, 70
Central venous technique, 213
Cerebellar function test, 36
Charcot’s triad, 183
Chest circumference, 276
Chest tube, 214
Child health, 312
Cholecystectomy, 155
Chronic obstructive pulmonary disease, 107
Chronic suppurative otitis media, 383
Chronic venous insufficiency, 193
Chylous ascites, 95
Classification of jaundice, 60
Clinical features of ascites, 89
Clubbing, 73
CNS examination, 32
Coarctation of aorta, 49
Colloids, 174
Colour of the iris, 356
Colour vision, 351
Common bile duct, 184
Community medicine, 306
Complications of ascites, 90
Composition of NMC. 337
Condition of erasure, 339
Condoms, 334
Cone of light, 375
Congestive cardiac failure, 119
Conjunctiva, 355
Constipation, 10
Contraceptive prevalence rate, 320
Contraceptive, 226, 334
Control of anaemia, 315
Convergence, 353
Co-ordination, 34
Copper t, 334
Cornea, 355
Corrugated rubber drain, 209
Cortical sensation, 36
Cough, 8
Course of ureter, 202
Court, 342
Cover/uncover test, 351
Cranial nerves examination, 32
Criminal investigation, 342
Cryptorchidism, 193
Crystalloids, 173
Curved artery forcep, 262
Cyanosis, 69

D
Deaver retractor, 207
Deaver’s retractor, 261
Deep reflex. See reflexes
Degree of clubbing. See clubbing
Dehydration, 83, 279
Depo provera, 334
Developmental history, 267
Developmental reflexes, 279
Dexon, 218
Diarrhea, 10
Diarrhoea in nepal, 318
Dicrotic, 49
Dietary history, 267
Disciplinary function, 339
Disease control, 313
Dissecting forceps, 206
Dissecting scissors, 206
Distant direct ophthalmoscopy, 359
District court, 343
DNS, 173
Dorsalis pedis, 44
Doyen’s retractor, 260
DPT, 277, 333
Drain, 209
Drunken gait, 35
Duodenal ulcer, 182
Duties of the physician, 340
Dysphagia, 10

E
Ear examination, 374
Ear symptoms, 370
Early neonatal, 280
Ectopic beat, 45
Electrocautery, 213
ENT, 370
Enteric fever, 115, 291
Epitrochlear lymph node, 66
Erect antero-posterior film, 199
Erosion, 178
Etiological factors of clubbing, 75
Examination of motor system, 34
Examination of sensory system, 35
Expanded programme on immunisation (EPI), 313
External auditory canal, 375
Exteroceptive, 35
Extrahepatic obstruction, 63
Extra-ocular movement, 352
Exudative, 95
Eye balls, 354
Eye lids, 353
Eyebrows, 354

F
Face, 273
Facial nerve, 33
Facial symmetry, 353
Family planning programme, 319
Febrile seizure, 301
Feel, 222
Femoral pulse, 43
Femoral swelling, 196
Femoral vein puncture, 213
Festinant gait, 35
Fever, 7
Fibroid, 250
Fine motor development, 278
Flatulant dyspepsia, 190
Floor of mouth, 380
Flow chart, 123
Fluid & electrolyte, 172
Fluid requirement, 172
Fluid thrill, 91
Foley’s self retaining urinary catheter, 210
Fontanelle, 275
Forensic medicine, 336
Fresh outlet bleed, 208
Functions of NMC. See Nepal Medical Council
Fundus examination, 358

G
Gait, 35
Gall bladder, 182
Gall stone, 183, 193
Gastric carcinoma, 187
Gastrinoma triangle, 188
General knowledge, 143
Geneva declaration, 344
Genital prolapse, 255
Glossopharyngeal nerve, 33
Government attorney, 342
Green armytage, 261
Griffith point, 188
Grommet, 391
Gross motor development, 277
Gums, 27
Gynaecology, 224

H
Haematuria, 146
Hard palate, 380
Head circumference, 276
Head mirror, 388
Head postures, 353
Hearing test, 376
Height, 276
Hematemesis, 9
Hematochezia, 208
HEmolytic jaundice, 61
Hemoptysis, 9
Hemostatic forceps, 204
Hepatitis B, 277
Hepato-cellular jaundice, 62
Hernia repair, 181
Hernia, 164
High stepping gait, 35
Higher mental function test, 32
Hilton’s method, 205
Hip joint, 222
HIV/AIDS and STI control, 325
Hookworm infestation, 56
Humpby’s knife, 207
Hyperbilirubinaemias, 63
Hyperthyroidism, 111
Hypoglossal nerve, 34
Hypopharyngoscope, 391

I
Icterus, 59
IDD, 316
Imaging, 197
Immature senile cataract, 360
Immunization history, 267
Impairment of hearing, 372
Incomplete testis descent, 193
Indirect laryngoscopy, 381
Infant and young child, 316
Inguinal lymph nodes, 66
Inguinoscrotal swelling, 195
Input out put chat, 149
Insight, 143
Inspection. See alimentary system. See cardiovascular system. See respiratory system, See obstetric examination. See pelvic examination. See breast
Instruments, 260, 388
Intelligence, 143
Intestinal obstruction, 185
Intra ocular pressure, 356
Involuntary movements, 35
Iodine deficiency disorders, 314
Iris, 356
Iron deficiency anemia, 56
Irregularities in the rhythm, 46
IUCD, 334
IVP, 192
IVU, 192
LYCF, 316

J
Jackson’s veil, 188
Jaeger’s chart, 351
Japanese encephalitis control, 323
Jaundice, 11
Jaundice, 59
Jobson – horne probe, 390
Judgement, 143
Jugular venous pressure, 17, 50

K
Kala-azar control, 323
Katamenios, 11
Kernig’s sign, 37
Kidney tray, 260
Kidneys, 31
Killan’s nasal speculum, 389
Knee joint, 222
Kocher’s forcep, 262, 205
Koilonychia, 77
KUB x-ray, 202

L
Lack’s tongue depressor, 388
Lacrimal apparatus, 354
Langenbeck’s, 207, 261
Language & sense development, 278
Large for dates, 280
Laryngeal mirror, 388
Laryngeal symptoms, 371
Laryngoscope, 390
Lashes, 354
Late neonatal, 280
Latent jaundice, 59, 63
LBW baby, 280
Lens, 358
Leprosy control, 329
Lichtwitz antral trochar, 391
Lid margin, 354
Light perception, 351
Light projection, 351
Lip, 27, 379
Liver cirrhosis, 103
Liver, 30
Local examination, 150
Look, 221
Low birth weight, 315
Lymphadenopathy, 65

M
Macula, 359
Malaria control programme, 321
Mantrels, 186
Maxon, 218
MDR TB, 325
Measles, 277, 333
Mechanisms of oedema, 80
Medical negligence, 340
Medico-legal acts, 343
Melena, 208
Memory, 142
Meningeal sign, 36
Menstrual, 225
Micturation, 146
Mid arm circumference, 276
Midline swelling of neck, 195
Millennium development goals, 308
Missed stone in CBD, 184
Mollison’s self retaining, 391
Mood, 142
Mosquito forceps, 204
Move, 222
Muluki ain, 340
Myringotome, 391

N
Nasal discharge, 372
Nasal dressing forcep, 389
Nasal foreign body hook, 390
Nasal obstruction, 372
Nasal symptoms, 371
Nasogastric tube, 211
Natal history, 266
National health policies, 307
National programmes, 312
National tuberculosis control, 324
Near vision, 351
Neck examination, 381
Neck stiffness, 36
Needle holder, 206, 261
Needles, 207, 215
Neonatal, 280
Nepal medical council, 337
Nephrotic syndrome, 296
Newborn, 271
NMC committees, 337
Nonabsorbable sutures, 216
Normal arterial pulse, 49
Normal saline, 174
Norplant, 334
Nose examination, 377
NPI, 277
Nutrition programme, 314

O
Obstetric examination, 234
Obstetric, 225, 230
Obstructive jaundice, 61, 183
Ocular examination, 350
Oculomotor nerve, 33
Oedema in heart failure, 81
Oedema, 78
Olfactory nerve, 32
Onychodermal angle, 73
Ophthalmology, 347
Optic disc, 358
Optic nerve, 32
Oral cavity examination, 379
Oral cavity, 28
Oral contraceptive pills, 334
Oral mucosa, 379
Orientation, 143
Orthocyanosis, 72
Orthopedics, 221
Otalgia, 371
Otorrhea, 372
Otoscope, 389

P
Pack years, 2
Pain around loin, 147
Pain, 7
Painful clubbing. See
Painful per rectal bleeding, 208
Painless per rectal bleeding, 209
Pallor without anemia, 54
Pallor, 53
Palpation, 380
Palpation. See alimentary system. See alimentary system. See cardiovascular system. See respiratory system
Palpation. See obstetric examination. See breast
Palpitation, 8
Paralytic ileus, 189
Paroxysmal tachycardia, 44
Patency of nose, 379
Pathogenesis of clubbing, 76
Pediatrics, 265
Pelvic examination, 229
Pelvic grip, 235
Per rectal bleeding, 208
Per rectal examination, 186
Perception, 142
Percussion. See alimentary system. See alimentary system. See respiratory system
Perforation, 200
Perinatal, 280
Peripheral cyanosis, 69
Peripheral vein puncutre, 212
Personal & social development, 278
Pharyngeal symptoms, 371
PILLCCOD, 269
Pinna, 374
Plans, 307
Pneumonia, 286
Polio, 277, 333
Polycythemia, 57
Popliteal pulse, 43
Post - operative fever, 175
Post aural region, 375
Post cholecystectomy syndrome, 184
Posterior pharyngeal wall, 380
Posterior rhinoscopy, 378
Posterior tibial, 43
Postnatal history, 266
Post-operative care, 176
Post-operative confusion, 176
Post-operative ileus, 181
Post-term, 280
Power, 34
Pre operative case of appendicitis, 151
Presentation of a normal case, 14
Presentation of a normal chest x-ray, 40
Presentation of normal abdominal x-ray, 200
Pre-syncope and syncope, 8
Pre-term baby, 280
Proctoscope, 208
Professional misconduct, 337
Prolene, 219
Proprioceptive, 36
Protein energy malnutrition, 275, 314
Pseudoclubbing, 75
Psychiatry, 139
Puddle sign, 93
Puerperium, 231, 241
Pulse at various sites, 43
Pulse deficit, 45
Pulse volume, 47
Pulse, 14, 42
Pulsus alternans, 49
Pulsus bigeminus, 49
Pulsus bisferians, 49
Pulsus paradoxus, 49
Pupil, 357
Pupillary light reflexes, 357
Pus, 177

R
Rabies, 333
Radial pulse, 43
Radio-femoral delay, 48
Radio-radial delay, 48
Raised JVP, 51
Red eye, 365
Reflexes, 36
Refractory ascites, 96
Relative bradycardia, 45
Relative tachycardia, 44
Renal stone, 193
Reproductive health, 312
Respiration, 16
Respiratory system, 19
Retina, 358
Retromolar trigone, 380
Reynold’s pentad, 183
Right angle retractor, 207, 261
Right iliac fossa mass, 195
Right paracolic gutter phenomenon, 189
Rights of physician, 339
Ringers lactate, 174
Rinne’s test, 376
Rubber catheter, 210
Ryle’s tube, 210

S
SAAG, 96
Safe motherhood programme, 321
Saint’s triad, 183
Same sided shifting dullness, 93
Scalpel with blade, 206
Scalpel, 260
Scissors, 261
Scrotal swellings, 196
Second long term health plan, 307
Sense of smell, 379
Serum-ascites albumin gradient, 96
Sherren’s triangle, 185
Shifting dullness, 91
Shoulder joint, 223
Sigel’s pneumatic speculum, 390
Silent gall stone, 184
Silk suture, 219
Sinus arrhythmia, 46
Sinus bradycardia, 45
Sinus forceps, 204
Sinus tachycardia, 44
Skin grafting knife, 207
Skin, 273
Skull, 273
Small amount of free fluid, 93
Small curved artery forcep, 262
Small for dates, 280
Soft palate, 380
Space of rolan, 188
Spastic gait, 35
Special court, 343
Speculum examination, 229
Spine, 273
Spleen, 30
Sponge holder, 260
Stamping gait, 35
Straight scissors, 206
Subphrenic abscess, 200
Sudeck’s point, 188
Superficial reflex. See reflexs
Supporting programmes, 313
Supreme court, 343
Surgery, 145
Surgical maneuvers, 188
Suture material, 215
Suture size, 216
Suture, 215
Swab holding forceps, 205
Systemic review, 147

T
Talk, 142
Teeth, 27
Temperature, 17
Tenth five year plan, 308
Term baby, 280
Theodor kocher, 205
Thought, 142
Thready pulse, 47
Thudichum’s nasal speculum, 388
Tilleys forcep, 389
Tinnitus, 372
Tone, 34
Tongue, 28
Tongue, 380
Tonsil, 28
Tonsil, 380
Total fertility rate, 320
Towel clip, 261
Tracheostomy tube, 391
Tragus, 375
Transudative, 95
Treve’s folds, 188
Trigeminal nerve, 33
Troisier’s sign, 181
Tube insertion, 211
Tuberculosis, 100
Tumor markers, 178
Tuning fork, 390
Tympanic membrane, 375
Types of clubbing. See clubbing
Types of drain, 209
Types of IV fluids, 173

U
UGI bleeding, 182
Ulcer, 178
Unidigital clubbing, 75
Unilateral shifting dullness, 93
Ureter, 191
Ureteric calculi, 168
Urinary obstruction, 192
Uvula, 380

V
Vaccines, 333
VAD, 316
Vaginal contraceptive, 334
Variations in pulse rate, 44
Variations in pulse, 15
Venous cut down, 212
Vertigo, 372
Vestibule, 377
Vestibulocochlear nerve, 33
Vicryl, 218
Virchow’s node, 181
Vision & hearing, 278
Visual acuity, 350
Vital signs in children, 269
Vitals, 13
Vitamin a deficiency disorders, 314
Vitreous examination, 358
Viva, 137, 263, 305, 335, 345, 368, 392
VLBW:, 280
Vomiting, 9
VVLBW, 280

W
Waddling gait, 35
Water-hammer, 49
Watery eye, 365
Waxing and waning jaundice, 190
Weber test, 376
Weight, 276
White line of hilton, 188
White line of toldt, 188
Wound infection, 176

X
X-ray, 38, 197

[Dipen]

Feels great seeing the second edition of this book. Great job KMCians!
Keep the spirit high!!