hi there welcome to hippos shorts in this segment we're going to talk about vosdek sign and true so sign so these are the classic physical exam findings we see in patients with hypocalcemia so let's take a look at vosdek sign what we see here is twitching of the facial muscles in response to tapping over the facial nerve area unfortunately this test is neither is sensitive nor specific it's absent in about 30% of patients with hypocalcemia and present and 10% of patients with normal levels of calcium let's take a look though at this next test this is true so sign what we see here is the development of carpal pedal spasm that results from ischemia one way we can induce that ischemia is application of a blood pressure cuff so that gets inflated over the arm and then we see this gradual flexion of the fingers and thumb and then we also see a flexion at the wrist and then some degree of pronation so this test is actually more sensitive and specific its present in ninety four percent of the patients with hypocalcemia and only occurs in about one percent of patients with normal calcium that wraps it up for this section of hippo shorts for more information on this or other topics come on down to hippo education com we'll see you next time [Music]