CHAPTER

INSTRUMENTS
17
‘When you no longer know what headache, heartache or stomachache
means without cistern punctures, electrocardiograms and six x-ray plates, you are slipping’.
—Martin H. Fischer

INSTRUMENT 01: BONE MARROW ASPIRATION NEEDLE

Q:What is this instrument?

A: Bone marrow aspiration needle (also called sternal puncture needle).
Q:What are its parts?
A: Three parts:
• Trocar.
• Cannula.
• Adjustable guard.
Q:Mention the sites of use.
A: As follows:
• Manubrium sterna or body of the sternum.
• Posterior superior iliac crest.
• Other sites: Upper part of the medial surface of tibia just below the tibial tuberosity in children.
Rarely, spinous process of lumbar vertebrae.
Q:How can you confirm that the needle has reached the cavity?
A: When the needle is in the bone marrow cavity, there is sudden loss of resistance and marrow
material is seen at the tip of the trocar.

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e214 COMMON INTERPRETATIONS IN MEDICINE

Q:What are the indications of bone marrow study?

A: As follows:
• Aplastic anaemia.
• Megaloblastic anaemia.
• Macrocytic anaemia as a result of any cause.
• Multiple myeloma.
• Leukaemia.
• Myelofibrosis.
• Pancytopaenia as a result of any cause.
• Idiopathic thrombocytopenic purpura (ITP).
• Kala-azar to see Leishman–Donovan (LD) bodies.
Q:What are its contraindications?
A: As follows:
• Local infection or sepsis.
• Bleeding disorders such as haemophilia.
• Platelet count ,40,000/cmm.
Q:What are the causes of dry or blood tap?
A: As follows:
• Faulty technique.
• Myelosclerosis or myelofibrosis.
• Marrow hypoplasia.
• Sometimes in marrow hyperplasia or leukaemia, if the marrow is heavily packed with cells.
• Tumour infiltration, e.g., lymphoma, secondary malignancy.
Q:What are its complications?
A: As follows:
• Suction pain.
• Vasovagal attack as a result of fear or pain.
• Bleeding and localized haematoma.
• Injury to the underlying structure as a result of overpenetration.
• Infection, e.g., osteomyelitis.
Q:What is trephine biopsy?
A: Trephine biopsy shows histological section that contains bony trabeculae, haemopoietic tissue,
fat cells and blood vessels.
Q:What are the indications of trephine biopsy?
A: As follows:
• Dry or blood tap.
• In aplastic anaemia: For better assessment of cellularity.
• Myelofibrosis or myelosclerosis.
• If bone marrow aspiration fails to establish a diagnosis.
• Diagnosis and staging of lymphoma.
• Secondary deposits.
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INSTRUMENT 02: LUMBAR PUNCTURE NEEDLE

Q:What is this instrument?

A: Lumbar puncture (LP) needle.
Q:What are its parts?
A: As follows:
• Cannula with a cap.
• Trocar.
Q:What are its uses?
A: As follows:
1. Diagnostic:
• Meningitis.
• Encephalitis.
• Subarachnoid haemorrhage.
• Guillain–Barré syndrome.
• Multiple sclerosis.
2. Therapeutic:
• Intrathecal methotrexate in acute lymphoblastic leukaemia (ALL).
• Spinal anaesthesia.
• Removal of cerebrospinal fluid (CSF) in benign intracranial hypertension.
Q: Mention the anatomical sites of using this instrument. Why these sites are chosen?
A: In the space between L3 and L4 or L4 and L5. These sites are chosen because the spinal cord is
absent at these spaces. So, there is no chance of injury.

N.B. The line between the highest points of both iliac crests runs through the spinous process of the
fourth lumbar vertebra.
Q:What are its contraindications?
A: As follows:
• Raised intracranial pressure (clinically detected if there is papilloedema).
• Localized infection.
• Bleeding disorder (e.g., haemophilia, Christmas disease etc.).
Q:What clinical examination would you do before LP? Why?
A: Ophthalmoscopy to see papilloedema, which indicates raised intracranial pressure. If LP is done in
such a case, there may be herniation of cerebellar tonsil through the foramen magnum and may
compress the vital centre in medulla oblongata and cause sudden death.
e216 COMMON INTERPRETATIONS IN MEDICINE

Q:What are its complications?

A: As follows:
• Post-LP headache.
• Infection (causing meningitis, arachnoiditis).
• Bleeding.
• Herniation of cerebellar tonsil.
• Persistent CSF leaking.
• Injury to local structures such as intervertebral disc, vessels, nerves etc.
Q:What is post-LP headache? How to manage it?
A: Headache usually occurs if LP is done in normal intracranial tension. It results from low intracranial
tension as a result of withdrawal of CSF, which causes traction on the meningeal blood vessel,
resulting in headache.
Treatment is as follows:
• Increased fluid intake.
• The patient should lie flat for 8–24 hours.
• Foot end should be raised and the head pillow should be removed.
• Analgesics.
Q: How much CSF is drawn during LP?
A: For diagnostic purpose, 5–8 mL; for therapeutic purpose, 10–20 mL is drawn.
Q:What are the causes of dry tap?
A: As follows:
• Faulty technique.
• Spinal subarachnoid block (e.g., as a result of meningioma, neurofibroma, epidural abscess
etc.).
Q:What should be seen in CSF?
A: As follows:
• Pressure.
• Physical character: Colour (clear, purulent, haemorrhagic, straw). If the fluid is kept for
8–12 hours, there may be a cobweb appearance. Also xanthochromia may be seen.
• Biochemistry: Protein, sugar, chloride.
• Cytology: Cell count, differential count.
• Microbiology: Gram stain, culture and sensitivity, acid-fast bacilli (AFB).
• Serology: Viral serology, Venereal Disease Research Laboratory (VDRL), Cryptococcus etc.
• Polymerase chain reaction (PCR) done in herpes simplex virus, Mycobacterium tuberculosis etc.
• Oligoclonal band on protein electrophoresis.
Q:What are the characteristics of normal CSF?
A: As follows:
• Amount: 100–150 mL.
• Pressure: 50–150 mm H2O on lying; 150–250 mm H2O on sitting.
• Colour: Clear.
• Protein: 20–40 mg/dL.
• Glucose: 50–80 mg/dL (two-thirds of blood glucose level).
• Chloride: 720–750 mg/dL.
• Cytology: 0–5 cells/cmm (all are lymphocytes).
 INSTRUMENTS e217

Q: What are the causes of raised intracranial pressure?

A: As follows:
• Meningitis.
• Encephalitis.
• Intracranial space-occupying lesion.
• Benign intracranial hypertension.
• Intracranial haemorrhage.
• Intracranial sinus thrombosis.
• Hydrocephalus.
• Hypertensive encephalopathy.
Q: What are the causes of decreased intracranial pressure?
A: As follows:
• Dehydration.
• Spinal block.
Q: What are the different colours of CSF?
A: As follows:
• Clear: Normal, viral encephalitis.
• Haemorrhagic: As a result of blood (see below).
• Yellow: Xanthochromia (see below).
• Straw: Tuberculosis (cobweb is formed when kept overnight).
• Turbid or cloudy: Pyogenic meningitis.
Q: What are the causes of blood-stained CSF?
A: As follows:
• Trauma.
• Subarachnoid haemorrhage.
• Blood leakage from cerebral tumour
• Coagulation disorder (haemophilia, Christmas disease, excess use of anticoagulants etc.).
Q: How can you differentiate traumatic bleeding from subarachnoid haemorrhage?
A: Usually, three samples are taken.

Points Traumatic Bleeding Subarachnoid Bleeding

Colour Initially red but becomes faint, red or clear in later samples All the samples are uniformly red
Clot Present Absent
Xanthochromia Absent Present when kept for sometime

Q:What are the causes of xanthochromia (yellow colour)?

A: As follows:
• Old subarachnoid haemorrhage.
• Froin syndrome.
• Deep jaundice.
e218 COMMON INTERPRETATIONS IN MEDICINE

Q: What are the causes of increased protein in CSF?

A: As follows:
• Guillain–Barré syndrome.
• Spinal block.
• Acoustic neuroma.
• Froin syndrome.
• Tubercular meningitis.
• Pyogenic meningitis.
• Neurosyphilis (rarely).
• Carcinomatosis.

N.B. Protein level is very high in the first four indications.

Q: What are the causes of raised g-globulin in CSF?
A: As follows:
• Multiple sclerosis.
• Neurofibromatosis.
• Connective tissue disorder.
Q: What are the causes of decreased sugar in CSF?
A: As follows:
• Tubercular meningitis.
• Pyogenic meningitis.
• Hypoglycaemia.
• Carcinomatous meningitis.
Q: What are the causes of raised sugar in CSF?
A: Hyperglycaemia (diabetes mellitus).
Q: What are the causes of increased lymphocyte count in CSF?
A: As follows:
• Tubercular meningitis.
• Viral meningitis or encephalitis.
• Neurosyphilis.
Q: What is the cause of increased neutrophil count in CSF?
A: Pyogenic meningitis.
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INSTRUMENT 03: LIVER BIOPSY NEEDLE

Q:What is this instrument?

A: Vim Silverman liver biopsy needle.
Q:What are its parts?
A: As follows:
• Cannula.
• Trocar.
• Split needle.
Q:Name different types of instruments for liver biopsy.
A: As follows:
• Vim Silverman needle (commonly used).
• Menghini needle.
• Trucut needle.
Q:What are the indications of liver biopsy?
A: As follows:
• Chronic liver disease (CLD) (cirrhosis of liver, chronic hepatitis).
• Space-occupying lesions:
• Hepatic carcinoma.
• Secondary deposits in the liver.
• Metabolic disorder:
• Haemochromatosis.
• Wilson disease.
• Infiltrative disease:
• Sarcoidosis.
• Lymphoma.
• Amyloidosis.
• Storage diseases (e.g., glycogen storage disease).
• Unexplained hepatomegaly.
Q:What are the contraindications of liver biopsy?
A: As follows:
• Bleeding disorders, e.g., haemophilia, Christmas disease.
• Hydatid cyst.
• Passive venous congestion of liver.
• Extrahepatic cholestasis or biliary obstruction.
• Severe jaundice.
• Hepatic encephalopathy (the patient may fall into coma).
e220 COMMON INTERPRETATIONS IN MEDICINE

Q: What prerequisites should be taken before doing liver biopsy?

A: As follows:
• The patient should be cooperative; consent should be taken.
• To be excluded: Biliary obstruction, marked ascites, severe anaemia and high bilirubin.
• Prothrombin time should not be .4 of control.
• Platelet count should not be ,100,000/cmm.
• Blood grouping and cross-matching.
Q:How to be sure that the needle is in the liver?
A: After introducing the needle, the patient is asked to take deep breath in and out. The needle will
move with respiration.
Q:What are the causes of failure of liver biopsy?
A: As follows:
• Faulty technique.
• Severe fibrosis of liver.
Q:How to do the follow-up after biopsy?
A: As follows:
• The patient should be in complete bed rest for 24 hours.
• Regular monitoring of pulse, blood pressure (BP).
• Blood should be kept ready for transfusion.
Q:What are the complications?
A: As follows:
• Bleeding.
• Shock.
• Secondary infection.
• Injury to colon and other viscera.
• Pleurisy.
• Pneumothorax.
• Biliary peritonitis.
• May precipitate hepatic encephalopathy in preexisting liver disease.
• Intrahepatic arteriovenous (AV) fistula.
Q:What are the methods of liver biopsy?
A: As follows:
• Percutaneous (better ultrasonography [USG] guided).
• Transjugular.
• Laparoscopic or laparotomy (if done for other reason).
Q:What are the indications of transjugular liver biopsy?
A: It is done if there is massive ascites, coagulation abnormality or a small, shrunken liver.

N.B. Remember the following:

• If bilirubin is high (.3 mg%), biopsy specimen should not be taken, as the liver tissue does not
take stain.
• If prothrombin time is prolonged, it can be corrected by vitamin K 10 mg daily for 3 days.
• Fine-needle aspiration cytology (FNAC) under USG guidance is more preferred nowadays.
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INSTRUMENT 04: PLEURAL BIOPSY NEEDLE

Q: What is this instrument?

A: Abrams pleural biopsy needle.
Q: What are its parts?
A: As follows:
• The outer part with a cutting groove into which tissue is taken.
• A solid stylet.
• A cutting trocar.
Q: What is the procedure?
A: Pleural biopsy specimen should be taken during aspiration of pleural fluid with this needle. Under
local anaesthesia, the needle is introduced after giving a small incision through the skin at the in-
tercostal space. Stylet is removed and pleural fluid is aspirated. Then the cutting trocar is introduced
and parietal pleura is cut. The needle is then removed, reopened and the specimen is taken out for
histopathology.
Q: What are its indications?
A: As follows:
• Malignant pleural effusion.
• Tuberculous pleural effusion.
• Pleural effusion of an unknown aetiology.

N.B. In tuberculosis, AFB is positive in pleural fluid in 20% of cases and pleural biopsy is positive in
80% of cases. In malignancy, pleural biopsy is positive in 40% of cases (may be up to 60% of cases).
e222 COMMON INTERPRETATIONS IN MEDICINE

INSTRUMENT 05: ASPIRATION NEEDLE WITH RUBBER TUBE

Q: What is this instrument?

A: Aspiration needle with a rubber tube.
Q: What are its parts?
A: Wide-bore needle with a rubber tube.
Q: What are its uses?
A: Aspiration of pleural fluid, ascitic fluid, pericardial fluid, liver abscess etc.

N.B. If aspiration needle is not available, aspiration can be done by a wide-bore blood-set needle
connected to any rubber tube, which is connected to an empty saline bag. Fluid comes out easily by
negative suction.

PLEURAL FLUID ASPIRATION

Q:What are the sites of aspiration of pleural fluid?
A: It is usually done through the sixth intercostal space in the midaxillary line or eighth intercostal
space in the posterior scapular line. Clinically, it should be done at the site of maximum dullness.
Q:What are the indications of pleural fluid aspiration?
A: As follows:
1. Diagnostic: To diagnose the cause of pleural effusion (tuberculosis, malignancy).
2. Therapeutic:
• Massive effusion, especially with severe respiratory distress or cardiorespiratory embarrassment.
• Introduction of drugs such as talc, kaoline, tetracycline etc. for chemical pleurodesis (to prevent
recurrence of effusion or pneumothorax).
• Introduction of bleomycin in malignant effusion.
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Q: What are the complications of pleural fluid aspiration?

A: As follows:
• Iatrogenic pneumothorax (hydropneumothorax).
• Infection may cause empyema.
• Acute pulmonary oedema.
• Injury to neurovascular bundle.
• Vasovagal attack as a result of fear or severe pain (pleural shock).
Q: How to avoid injury to neurovascular bundle?
A: The needle should be inserted near the upper border of the lower rib.
Q: How to avoid acute pulmonary oedema?
A: To avoid pulmonary oedema, more than 1 L of fluid should not be removed.

N.B. Remember the following:

• If more than 1–1.5 L of fluid is taken out or fluid is taken out very rapidly, there may be
pulmonary oedema. It results from rapid expansion of the compressed lung that causes leakage
of fluid from the pulmonary vessels.
• If the patient complains of cough or respiratory distress or tightness of the chest, aspiration
should be stopped.
• After aspiration, a check X-ray should be done to see the amount of fluid or any development
of pneumothorax.

Q: What are the causes of failure of aspiration of pleural fluid?

A: As follows:
• Faulty technique.
• Encysted effusion (in such a case, USG- or computed tomography [CT]-guided aspiration is
more preferable).
• Thick fluid such as empyema.
Q: What should be done after aspiration of the pleural fluid?
A: As follows:
• Physical character: Colour (clear, straw, haemorrhagic, purulent, chylous).
• Gram staining, cytology (routine) and exfoliative cytology (malignant cell).
• Biochemistry: Protein, sugar (simultaneous blood sugar, protein and lactate dehydrogenase
[LDH] may be done).
• Culture and sensitivity (C/S).
• AFB and mycobacterial C/S (in some cases).
• Adenosine deaminase (ADA).
• Other tests according to suspicion of cause (amylase, cholesterol, LDH).

ASCITIC FLUID ASPIRATION

Q:What is the site of aspiration of ascitic fluid?
A: At the right iliac fossa, just outside the spinoumbilical line or at the flank.
e224 COMMON INTERPRETATIONS IN MEDICINE

Q: How much fluid can be removed?

A: About 3–5 L of fluid may be drained daily.
Q: What are the indications of ascitic fluid aspiration?
A: As follows:
• Diagnostic: To find the cause of ascites such as tuberculosis, malignancy, infection etc.
• Therapeutic: Tense ascites causing cardiorespiratory embarrassment, resistant ascites refractory
to medical therapy.
Q: What are the contraindications of ascitic fluid aspiration?
A: As follows:
• Bleeding disorder.
• Hepatic encephalopathy.
Q: What are its complications?
A: As follows:
• Hypovolaemia leading to shock.
• Infection.
• Injury to viscera.
• Hepatic encephalopathy.
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INSTRUMENT 06: INTRAVENOUS CANNULA

Q: What is this instrument?

A: Intravenous cannula.
Q: Mention its uses.
A: Administration of any intravenous fluid, intravenous injection, TPN (total parenteral nutrition) and
blood products.
Q: What are the complications?
A: As follows:
• Thrombophlebitis.
• Sepsis.
Q: What precautions should be taken to prevent venous thrombosis and embolism?
A: The cannula should be changed every 3–4 days. If kept for more than 3 days, heparin wash should
be given.
e226 COMMON INTERPRETATIONS IN MEDICINE

INSTRUMENT 07: FOLEY CATHETER

Q: What is this instrument?

A: Bichannel Foley catheter.
Q: What are its uses?
A: As follows:
• Retention of urine.
• Spastic paraplegia.
• Neurogenic bladder.
• Incontinence of urine.
• Unconscious patient.
• Postoperative patient (major abdominal, pelvic or perineal surgery).
• Urinary bladder irrigation.
Q: What are its complications?
A: As follows:
• Trauma.
• Infection.
• Blockage of catheter.
• Stone formation, if kept for a long time.
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INSTRUMENT 08: NASOGASTRIC TUBE (RYLE TUBE)

Q:What is this instrument?

A: Nasogastric tube.
Q:What are its uses?
A: As follows:
1. Therapeutic:
• Nasogastric feeding.
• Nasogastric suction (e.g., intestinal obstruction, acute abdomen, acute dilatation of stomach,
postoperative).
• Nasogastric medication in a comatose patient.
• Gastric lavage (noncorrosive poisoning).
2. Diagnostic:
• Aspiration of gastric juice for gastric juice analysis.
• Aspiration of gastric fluid for toxicological screening.
• Fasting gastric lavage for AFB in a child with a suspicion of pulmonary tuberculosis.
Q: How can you test whether the instrument has reached the correct site or not?
A: By the following:
• Aspiration of gastric content.
• Listening to the sound with a stethoscope over the epigastrium made by injecting 20–30 mL of
air through the tube.
• Emersion of the tube in water and looking for any bubble (which appears if the tube is in the
airway).
• Also, if the tube enters the airway, the patient will cough violently.
e228 COMMON INTERPRETATIONS IN MEDICINE

Q: Why there is a metallic bead at the tip?

A: It helps in smooth passage of the tube by gravitational force. It also helps to localize the position of
the tube in the stomach by X-ray.
Q: What are the contraindications of insertion of a nasogastric tube?
A: As follows:
• Tracheoesophageal fistula.
• Oesophageal atresia.
Q: If nasogastric tube cannot be inserted, what else should be done?
A: Gastrostomy tube should be inserted.
Q: What are the complications of nasogastric tube insertion?
A: As follows:
• Cough.
• Aspiration pneumonia.
• Haemorrhage.
• Injury.
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INSTRUMENT 09: AIRWAY TUBE

Q: What is this instrument?

A: Airway tube (oropharyngeal tube).
Q: What is its use?
A: As follows:
• To maintain a clear airway.
• To prevent tongue from falling back in an unconscious patient.
• To prevent tongue bite in an epileptic or unconscious patient.
Q: What are its complications?
A: Injury to lip, gum, tongue, palate, pharynx, etc.
e230 COMMON INTERPRETATIONS IN MEDICINE

INSTRUMENT 10: ESR TUBE

Q:What is this instrument?

A: Westergren erythrocyte sedimentation rate (ESR) tube with ESR stand.
Q:What are the markings in this tube?
A: It is graduated from 0 to 200 mm.
Q:What are the methods of measuring ESR?
A: As follows:
• Westergren method.
• Wintrobe method.
Q:What is the normal value of ESR?
A: 0–8 mm in the first hour in males and 0–12 mm in the first hour in females.
Q:What are the causes of raised ESR?
A: As follows:
• Physiological: Pregnancy.
• Tuberculosis.
• Multiple myeloma.
• Aplastic anaemia.
• Connective tissue disorder:
• Systemic lupus erythematosus (SLE).
• Acute rheumatic fever.
• Rheumatoid arthritis.
• Polymyalgia rheumatica.
• Giant cell arteritis.
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Q: What are the causes of a very high (.100) ESR?

A: As follows:
• Multiple myeloma.
• Giant cell arteritis.
• Polymyalgia rheumatica.
• SLE.
• Acute rheumatic fever.
Q: What are the causes of a decreased ESR?
A: As follows:
• Polycythaemia as a result of any cause.
• Afibrinogenaemia.
Q: What is the significance of ESR?
A: As follows:
• ESR has no specific diagnostic significance. However, it can support a diagnosis.
• It may indicate response to therapy and prognosis.
e232 COMMON INTERPRETATIONS IN MEDICINE

INSTRUMENT 11: METERED-DOSE INHALER

Q:What is this instrument?

A: Metered-dose inhaler.
Q:What are its parts?
A: As follows:
• Canister.
• Actuator.
• Nozzle.
Q:Name two important conditions where this device is used.
A: As follows:
• Bronchial asthma.
• Chronic obstructive pulmonary disease (COPD).
Q:Name some important drugs delivered through this device.
A: As follows:
• Salbutamol.
• Steroid.
• Ipratropium bromide.
Q:Name one complication of the use of a steroid inhaler.
A: Oral candidiasis (also husky voice).
Q:How would you prevent it?
A: Advise the patient to wash oral cavity after using inhaler containing steroid preparation.
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INSTRUMENT 12: ACCUHALER

Q: What is this instrument?

A: Accuhaler.
Q: Name two conditions where this device is used.
A: As follows:
• Bronchial asthma.
• COPD.
Q: Name some important drugs delivered through this device.
A: As follows:
• Salmeterol.
• Fluticasone.
• Salmeterol plus fluticasone.
Q: What are its advantages over metered-dose inhalers?
A: As follows:
• This device is easier to use than conventional metered-dose inhalers, which require careful co-
ordination.
• A numerical dose counter helps monitor the asthma therapy.
• More environment friendly.
Q: What are its disadvantages?
A: It may be difficult to use in young children or adults who are short of breath.
e234 COMMON INTERPRETATIONS IN MEDICINE

INSTRUMENT 13: EVOHALER

Q: What is this instrument?

A: Evohaler.
Q: Name two conditions where this device is used.
A: As follows:
• Bronchial asthma.
• COPD.
Q: Name some important drugs delivered through this device.
A: As follows:
• b-Agonist such as salmeterol, salbutamol.
• Steroid such as fluticasone.
• Combination.
Q: What are its advantages over conventional metered-dose inhalers?
A: Evohaler uses HFA 134a as a propellant instead of chlorofluorocarbon (CFC). So this is more en-
vironment friendly.
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INSTRUMENT 14: PEAK FLOWMETER

Q: What is this instrument?

A: Peak flowmeter.
Q: What are its uses?
A: It is used to monitor the progress and treatment of the following diseases:
• Bronchial asthma.
• COPD.

N.B. Regular measurement of peak expiratory flow rate (PEFR) on waking from sleep, in afternoon
and before going to bed demonstrates the wide diurnal variation of airflow limitation in bronchial
asthma.
e236 COMMON INTERPRETATIONS IN MEDICINE

INSTRUMENT 15: AMBU BAG

Q: What is this instrument?

A: AMBU bag with a face mask.
Q: Name its parts.
A: As follows:
1. Inlet:
• Air inlet.
• Oxygen inlet.
2. Bag proper/rubber bag.
3. Safety valve/one-way valve.
4. Outlet.
Q: Name some indications for its use.
A: As follows:
• Cardiopulmonary resuscitation.
• Any respiratory distress.
• Temporarily, it can be used before intubation.
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INSTRUMENT 16: TONGUE DEPRESSOR

Q: What is this instrument?

A: Metallic tongue depressor.
Q: What are its types?
A: Metallic, plastic and wooden.
Q: What are its parts?
A: As follows:
• Depressor part (broad part, used to depress anterior two-thirds of the tongue).
• Holding part.
Q: What are its uses?
A: As follows:
• Diagnostic:
• To examine the oral cavity: Oral ulcer, cleft palate, Koplik spot etc.
• To examine the throat: Tonsillitis, pharyngitis, diphtheria etc.
• To collect throat swab.
• Therapeutic: Removal of foreign body from the posterior part of the tongue and throat.
Q: What are the causes of white patch in throat?
A: As follows:
• Acute follicular tonsillitis.
• Diphtheria.
• Oral candidiasis.
• Vincent angina.
• Agranulocytosis.
• Infectious mononucleosis.
e238 COMMON INTERPRETATIONS IN MEDICINE

ORAL REHYDRATION SALT

Q: What is it?
A: This is oral rehydration salt (ORS).
Q: What is its composition?
A: As follows:

Content Amount
Sodium chloride 3.5 g/L
Potassium chloride 1.5 g/L
Trisodium citrate 2.9 g/L
Glucose 20 g/L

Water to be added: 1 L
Q:What are its indications?
A: As follows:
• Acute watery diarrhoea.
• Correction of dehydration.
Q:How long can it be preserved?
A: It can be preserved for up to 12 hours. It should be discarded after this time.
Q:What is the function of glucose?
A: It helps in absorption of sodium chloride.
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Q: What are the composition of rice ORS?

A: As follows:
• Sodium chloride: 3.5 g.
• Potassium chloride: 1.5 g.
• Sodium bicarbonate: 2.5 g.
• Rice powder: 50 g.
• Water to be added: 1100 mL.

‘Now, this is not the end. It is not even the beginning of the end.
But it is perhaps, the end of the beginning’.
—Winston Churchill