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Chinese Complete Physical Clinical Exam

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The most reliable clinical sign to detect ascites is checking for bilateral flank dullness. If a patient with ascites is lying supine, fluid accumulates in the flank regions, leading to dullness on percussion. At the same time, the air-filled bowel loops are forced upwards by the free fluid due to buoyancy, resulting in tympanitic percussion. To locate specifically where dullness shifts to tympany, or the air-fluid level, percussion should be performed from the sides towards the middle. To confirm that the dullness is caused by ascites, ask the patient to switch to a lateral decubitus position. If ascites is present, the air-filled bowel loops will shift accordingly and remain at the surface of the fluid. As a result, the air-fluid level will shift as well. This is known as shifting dullness.

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Treating osteoporosis with bisphosphonates, particularly for more than five years, has been linked to some side effects, including atypical femur fractures. Osteoporosis medications are supposed to prevent bone breaks. But if they are taken for too long, the opposite can happen. This video highlights what you need to know as a healthcare professional to educate patients

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Delivery using foreceps

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