Tourniquet Test(Help!!! )

Now someone has to help me with the standard definition with a reference. Harrison's doesn't carry a definition it seems.

In one page wiki says:

The test is defined by the WHO as one of the necessary requisites for diagnosis of Dengue fever. A blood pressure cuff is applied and inflated to a point between the systolic and diastolic blood pressures for five minutes. The test is positive if there are more than 20 petechiae per square inch (a petechia is a small red or purple spot on the body, caused by a minor hemorrhage).

This test does not have high specificity. Interfering factors with this test are women who are premenstrual, postmenstrual and not taking hormones, or those with sun damaged skin, since all will have increased capillary fragility.^[1]

In another page wiki says:

The Hess test or Rumpel-Leede test is a medical test used to assess capillary fragility.^[1] It is also called the Tourniquet test.

To perform the test, pressure is applied to the forearm with a blood pressure cuff inflated to between systolic and diastolic blood pressure for 10 minutes. After removing the cuff, the number of petechiae in a 5cm diameter circle of the area under pressure is counted. Normally less than 15 petechiae are seen.^[2] 15 or more petechiae indicate capillary fragility, which occurs due to poor platelet function, bleeding diathesis or thrombocytopenia, and can be seen in cases of scurvy,^[3] and Dengue fever.

Tourniquet Test(Help!!! )

Queen Anne's sign

The Sign of Hertoghe or Queen Anne's sign is a thinning or loss of the outer third of the eyebrows, and is a sign of hypothyroidism.

The association with Anne of Denmark is based on portraiture, and history does not suggest that she suffered an underactive thyroid.^[3] The eponym is disputed by some.

(Source:Wikipedia)

Queen Anne's sign

Papermoney Skin

Numerous small blood vessels that resemble the silk threads in a U.S. dollar

For an awesome list of all the features of cirrhosis: check this link

Papermoney Skin

the JVP

The internal jugular vein although cannot be seen, when the pressure is elevated a diffuse pulsation is visible.

If visible, pulsatile and not obstructed, the external jugular vein(which is more superficial, prominent and generally easier to see) can be used to assess JVP. Although it can be obstructed as it traverses the deep fascia of the neck, this rarely presents a problem. Due to the anatomy of the innominate veins, the JVP is best examined on the patient's right side.

Mean right atrial pressure is normally <7mmHg/9cmH2O). Since the sternal angle is approximately 5 cm above the right atrium the normal jugular venous pulse should extend not more than 4 cm above the sternal angle

The abdomino-jugular reflex

A positive abdominojugular test is best defined as an increase in JVP during 10 s of firm midabdominal compression followed by a rapid drop in pressure of 4 cm blood on release of the compression. The most common cause of a positive test is right-sided heart failure secondary to elevated left heart filling pressures

the JVP

The Arch of Aorta

Coarctation is a congenital narrowing of the aorta, usually distal to the left subclavian artery. In adults, it presents with hypertension and heart failure.

The Arch of Aorta

Collapsing pulse

The collapsing pulse is also referred to as Corrigans or a water-hammer pulse, after a 19th century toy that was a vacuum tube containing water or mercury that was flipped creating a tapping or hammer sensation at the finger tips (a most arcane term – perhaps the Game-Boy rumble would be more recognizable today).. This accentuates the tapping quality of the pulse.

Now check what wiki says about the actual water hammer-Water hammer (or, more generally, fluid hammer) is a pressure surge or wave resulting when a fluid (usually a liquid but sometimes also a gas) in motion is forced to stop or change direction suddenly (momentum change). Water hammer commonly occurs when a valve is closed suddenly at an end of a pipeline system, and a pressure wave propagates in the pipe.

"Watson's water hammer pulse" and "Corrigan's pulse" refer to similar observations. However, the former usually refers to measurement of a pulse on a limb, while the latter refers to measurement of the pulse of the carotid artery

• "Corrigan's pulse" is named for Sir Dominic Corrigan, the Irish physisian, who characterized it in 1832.^[2][3]

• "Watson's water hammer pulse" is named for Thomas Watson, who characterized it in 1844.^[1]

Collapsing pulse