Friday, July 11, 2025

Cardiovascular System Examination

I. Preparation & General Inspection

1. Wash hands
→ Maintain hygiene and infection control.

2. Introduce yourself and obtain consent

3. Position the patient
→ Supine at 45° with chest exposed appropriately.

4. General observation from end of bed:

Cyanosis (bluish discoloration — indicates hypoxia)
Pallor (pale skin — suggests anemia)
Dyspnea (difficulty breathing — seen in heart failure)
Use of accessory muscles (suggests respiratory distress often due to left heart failure)
Edema (swelling — usually pedal; suggestive of right heart failure)
Cachexia (wasting — occurs in chronic heart failure)

II. Hands and Arms

1. Look at the hands:

Clubbing (bulbous fingers — seen in infective endocarditis, congenital heart disease)
Splinter hemorrhages (linear bleeding under nails — seen in infective endocarditis)
Osler’s nodes (tender nodules on fingers — due to immune complex in infective endocarditis)
Janeway lesions (painless red macules on palms/soles — septic emboli from endocarditis)
Palmar crease pallor (suggests anemia)

2. Capillary Refill Time (CRT)
→ Press the fingernail bed for 5 seconds and release.
→ Refill time >2 seconds = poor perfusion.
(CRT: delayed refill shows reduced cardiac output or shock)

3. Assess the pulse

Rate (Normal: 60–100 bpm)
Rhythm
- Regular
- Irregularly irregular (Atrial fibrillation — no consistent rhythm)
- Regularly irregular (e.g., sinus arrhythmia — natural variation with breathing)
Character
- Bounding pulse (strong, forceful — seen in aortic regurgitation)
- Collapsing pulse (sharp upstroke, rapid fall — "water hammer pulse", in aortic regurgitation)
- Pulsus parvus et tardus (slow rising, weak — typical of aortic stenosis)

4. Blood Pressure

III. Face and Neck

1. Face:

Malar flush (rosy cheeks — seen in mitral stenosis)
Conjunctival pallor (anemia)
Xanthelasma (lipid plaques near eyes — seen in hyperlipidemia)

2. Eyes:

Arcus senilis (white ring — hypercholesterolemia in young)
Roth spots (retinal hemorrhages — infective endocarditis)

3. Mouth:

Central cyanosis (bluish tongue)
High-arched palate (Marfan syndrome — predisposes to aortic dissection, MVP)

4. Neck:

Jugular Venous Pressure (JVP)
- Raise head to 45°, observe internal jugular vein pulsations.
- Use right side.
- Measure from sternal angle — normal <4 cm.
- Raised JVP → seen in right heart failure, fluid overload, constrictive pericarditis.
- Prominent 'v' wave → tricuspid regurgitation.
  (JVP reflects right atrial pressure; unlike carotid pulse, it is non-palpable)

IV. Precordium (Chest) Examination

1. Inspection:

Scars (CABG, pacemaker)
Visible pulsations
Chest wall deformities
Apex beat — visible in thin individuals

2. Palpation:

Apex Beat Location:
- Normally at 5th intercostal space, mid-clavicular line
- Thrusting apex (forceful & sustained — volume overload as in aortic regurgitation)
- Heaving apex (sustained, forceful — pressure overload like aortic stenosis)
- Displaced apex (seen in cardiomegaly/heart failure)
Parasternal Heave (sustained lift felt along left sternal edge — indicates right ventricular hypertrophy)
Thrills (palpable murmurs — turbulent blood flow as in severe valvular disease)

V. Auscultation

Valves:

Aortic — 2nd Right ICS
Pulmonary — 2nd Left ICS
Tricuspid — 4th Left ICS
Mitral — 5th Left ICS MCL (Apex)

Murmurs:

Pan-systolic murmur (murmur throughout systole — seen in mitral regurgitation, tricuspid regurgitation, VSD)
Ejection systolic murmur (crescendo-decrescendo — seen in aortic or pulmonary stenosis)
Mid-diastolic murmur (seen in mitral stenosis — due to turbulent filling)

Manoeuvres:

Valsalva maneuver (forced expiration against closed glottis — reduces venous return)
→ Helps identify murmurs like HOCM and MVP
Squatting and standing → Used to differentiate murmurs by affecting venous return and afterload

VI. Back, Abdomen, Legs

Back:

Listen for basal crackles (pulmonary edema — left heart failure)
Sacral edema (seen in right heart failure or immobile patients)

Abdomen:

Hepatomegaly (congestive hepatomegaly — right heart failure)
Ascites (fluid accumulation — right heart failure)
Abdominal aortic aneurysm (AAA) — palpate above umbilicus

Legs:

Pedal edema (pitting swelling — right-sided heart failure)
Calf tenderness (DVT — risk of embolism)

VII. Special Conditions & Their CVS Findings

Condition	Key Signs
Heart Failure	Raised JVP, displaced apex, pedal edema, crackles
Mitral Stenosis	Malar flush, tapping apex beat, mid-diastolic murmur
Infective Endocarditis	Fever, murmur, Osler’s nodes, Janeway lesions, splinter hemorrhages
HOCM (Hypertrophic Obstructive Cardiomyopathy)	Ejection murmur ↑ with Valsalva
MVP (Mitral Valve Prolapse)	Mid-systolic click, murmur ↑ on standing
Aortic Dissection	Sudden chest pain, pulse deficit, unequal BP
Coarctation of Aorta	Radiofemoral delay, HTN in upper limbs, weak lower limb pulse
Atrial Fibrillation	Irregularly irregular pulse, loss of 'a' wave in JVP
Sinus Arrhythmia	Pulse varies with respiration (normal in youth)
Bounding Pulse	Wide pulse pressure — aortic regurgitation
Collapsing Pulse	Water-hammer pulse — aortic regurgitation
Pulsus Parvus et Tardus	Weak & slow — aortic stenosis

Thursday, July 3, 2025

Technical Terms - Cardiovascular System Examination

❤️‍🩹 Cardiovascular System Examination — Terminology .

🪞 1. Inspection – Look

Term	Explanation
Precordium	The area on the front of the chest overlying the heart (left chest wall)
Pulsations	Visible throbbing movements — may be normal at the apex but abnormal elsewhere
Apical impulse	Visible or palpable heartbeat in the 5th intercostal space, midclavicular line — normally mild and focused
Heaving impulse	Strong and forceful apical beat — suggests left ventricular hypertrophy (LVH)
Parasternal heave	Outward thrust felt at the left sternal border — suggests right ventricular hypertrophy (RVH)
Jugular venous pulsation (JVP)	Visible wave-like movement in the neck veins caused by blood returning to the right atrium
Cyanosis	Bluish discoloration of lips, tongue, or extremities — indicates low oxygen levels
Clubbing	Bulbous enlargement of fingertips — may occur in congenital heart disease or infective endocarditis
Edema	Swelling, especially in legs — suggests fluid retention, often from heart failure

✋ 2. Palpation – Feel

Term	Explanation
Apex beat	The point where the heart’s contraction is felt most strongly — normally in the 5th intercostal space, midclavicular line
Displaced apex beat	Apex felt more lateral or inferior — indicates enlarged heart (cardiomegaly)
Heaving apex	Sustained and forceful — suggests pressure overload (like in aortic stenosis)
Thrusting apex	Hyperdynamic, tapping, or bounding — seen in volume overload (like mitral regurgitation)
Thrill	A palpable vibration — felt over turbulent blood flow, e.g., over a murmur-producing valve
Parasternal heave	A forceful lifting of the chest wall — indicates right ventricular enlargement
Peripheral pulses	Pulses felt at wrist (radial), neck (carotid), feet (dorsalis pedis/posterior tibial) to assess rhythm, rate, and volume
Pulse deficit	Difference between apical and peripheral pulse rate — seen in atrial fibrillation
Capillary refill time (CRT)	Time taken for color to return after pressing nail bed — normal <2 seconds; delayed in shock

🫳 3. Percussion – Tap

Term	Explanation
Cardiac dullness	Dull sound heard when tapping over the heart — helps estimate heart size (now rarely done due to imaging)
Percussion note	Sound generated when tapping — resonant over lungs, dull over the heart

🎧 4. Auscultation – Listen

Term	Explanation
Heart sounds	Sounds produced by closing of valves
S1 (First Heart Sound)	"Lub" — Closure of mitral and tricuspid valves — marks start of systole
S2 (Second Heart Sound)	"Dub" — Closure of aortic and pulmonary valves — marks end of systole/start of diastole
S3	Extra sound in early diastole — normal in children/athletes; pathological in heart failure
S4	Extra sound in late diastole — indicates stiff ventricle (e.g., hypertension, aortic stenosis)
Murmur	Abnormal, prolonged heart sound due to turbulent flow — can be systolic or diastolic
Ejection click	High-pitched sound just after S1 — heard in aortic or pulmonary stenosis
Opening snap	Sharp sound in early diastole — heard in mitral stenosis
Pericardial rub	Scratching/grating sound — due to inflamed pericardium (pericarditis)
Gallop rhythm	Presence of S3 or S4 — sounds like a horse’s gallop; sign of heart failure

🩺 Auscultation Areas (Valvular Points)

Valve	Location for auscultation
Aortic valve	2nd right intercostal space, just next to sternum
Pulmonary valve	2nd left intercostal space, next to sternum
Tricuspid valve	4th or 5th left intercostal space, close to sternum
Mitral valve	5th left intercostal space, midclavicular line (apex area)

🫀 Pulse Characteristics

Term	Explanation
Bounding pulse	Strong, forceful pulse — in high output states (fever, anemia)
Thready pulse	Weak, thin pulse — seen in shock
Irregularly irregular pulse	No pattern at all — classic in atrial fibrillation
Pulsus paradoxus	Drop in systolic BP during inspiration >10 mmHg — seen in cardiac tamponade
Pulsus alternans	Alternating strong and weak pulse beats — in severe left ventricular failure
Radio-femoral delay	Radial and femoral pulse not felt together — seen in coarctation of the aorta

🧠 Common Pathological Terms in CVS

Term	Explanation
Mitral stenosis	Narrowing of mitral valve — leads to obstructed blood flow from left atrium to left ventricle
Aortic regurgitation	Aortic valve leaks blood back into the left ventricle
Heart failure	Heart’s inability to pump blood effectively
Cardiomyopathy	Disease of the heart muscle affecting function
Pericarditis	Inflammation of the membrane around the heart
Endocarditis	Infection of the inner lining/valves of the heart
Myocardial infarction	Heart attack — damage due to blocked coronary arteries
Congenital heart disease	Heart defect present from birth (e.g., ASD, VSD, TOF)

📚 Summary Tip:

S1 = AV valves close, S2 = semilunar valves close
Systolic murmur between S1–S2 (e.g., aortic stenosis)
Diastolic murmur after S2 (e.g., mitral stenosis)

Technical Terms - Respiratory Examination

🪞 Inspection Terms

Term	Explanation
Tachypnea	Breathing faster than normal (adult >20 breaths/min)
Bradypnea	Breathing slower than normal (adult <12 breaths/min)
Dyspnea	Difficulty in breathing; patient may feel breathless
Orthopnea	Difficulty breathing when lying flat (common in heart failure)
Accessory muscles	Muscles not normally used in breathing (e.g., neck muscles) — used when breathing becomes difficult
Nasal flaring	Widening of the nostrils while breathing — sign of respiratory distress
Barrel-shaped chest	Rounded, bulging chest seen in long-term COPD
Pectus carinatum	Outward protrusion of the chest (pigeon chest)
Pectus excavatum	Sunken chest (funnel chest)
Scoliosis	Sideways curvature of the spine
Kyphosis	Forward hunching of the upper back

✋ Palpation Terms

Term	Explanation
Tracheal deviation	Displacement of the trachea from the midline — suggests lung pathology
Apex beat	The point of maximal impulse (PMI) of the heart, felt in the 5th intercostal space
Chest expansion	The movement of the chest wall during deep breathing; decreased movement may indicate lung disease
Vocal fremitus	Vibrations felt on the chest wall when the patient speaks — reduced in fluid/air-filled lungs

🫳 Percussion Terms

Term	Explanation
Percussion	Tapping the chest with fingers to assess underlying structures
Pleximeter	The finger placed on the patient’s chest while percussing
Plexor	The finger used to tap on the pleximeter
Resonant note	Normal sound heard over air-filled lungs — low-pitched and hollow
Dull note	Thud-like sound over fluid or solid structures (e.g., consolidation or effusion)
Hyperresonant note	Louder, lower-pitched sound heard over extra air (e.g., pneumothorax)
Stony dullness	Extremely dull sound, like tapping on a wall — seen in pleural effusion

🎧 Auscultation Terms

Term	Explanation
Stethoscope diaphragm	The flat side of the stethoscope used to listen to high-pitched sounds like breath sounds
Vesicular breath sound	Normal soft rustling sound heard during breathing over healthy lung tissue
Bronchial breath sound	Loud, harsh, hollow sound — normally heard over the trachea but abnormal if heard over lung fields (suggests consolidation)
Crackles (rales)	Popping or bubbling sounds, like Velcro — indicates fluid in lungs (e.g., pneumonia, fibrosis)
Fine crackles	Short, high-pitched crackles (pulmonary fibrosis)
Coarse crackles	Longer, low-pitched crackles (bronchiectasis)
Wheeze	High-pitched, musical sound due to narrowed airways (e.g., asthma)
Rhonchi	Low-pitched, snoring sounds due to mucus in large airways (e.g., COPD)
Pleural rub	Creaking or grating sound — like walking on snow — caused by inflamed pleura rubbing against each other
Vocal resonance	Sound of spoken words heard through a stethoscope — increased in solid lung (e.g., consolidation), decreased in fluid or air-filled lung (e.g., effusion, pneumothorax)

🫁 Common Pathological Conditions

Term	Explanation
Consolidation	Lung tissue filled with fluid or pus — common in pneumonia
Pleural effusion	Accumulation of fluid in the pleural space between the lungs and chest wall
Pneumothorax	Air in the pleural space causing lung collapse
Fibrosis	Thickening or scarring of lung tissue — reduces elasticity
COPD	Chronic Obstructive Pulmonary Disease — long-term lung damage (e.g., chronic bronchitis, emphysema)
Bronchiectasis	Permanent dilation and damage to the airways due to infection/inflammation

🧠 Nervous System

✅	Symptom	Definition	Why It Happens (Pathogenesis)
☐	Headache	Pain in the head or scalp	Due to tension (muscle contraction), increased intracranial pressure, migraine (vasodilation + neurogenic inflammation), or inflammation of meninges
☐	Dizziness	Lightheadedness or feeling faint	Decreased cerebral perfusion, anemia, hypotension, vestibular imbalance
☐	Vertigo	Illusion of movement or spinning	Disturbance in vestibular system – inner ear, vestibular nerve, or cerebellum
☐	Seizure	Sudden, uncontrolled brain activity	Abnormal neuronal firing due to electrolyte imbalance, tumor, trauma, infection, or epilepsy
☐	Syncope	Temporary loss of consciousness	Global cerebral hypoperfusion caused by cardiac, neurogenic, or orthostatic causes
☐	Paresthesia	Tingling, prickling sensation	Due to nerve injury, ischemia, or peripheral neuropathy (e.g., diabetes)
☐	Weakness	Loss of muscle strength	May be due to stroke (UMN lesion), neuropathy, myopathy, or NMJ disorders
☐	Ataxia	Loss of coordination	Damage to cerebellum or dorsal columns
☐	Aphasia	Inability to speak or comprehend language	Lesions in dominant hemisphere (Broca’s, Wernicke’s areas)

❤️ Cardiovascular System

✅	Symptom	Definition	Why It Happens (Pathogenesis)
☐	Chest Pain	Discomfort in chest	Due to ischemia (angina, MI), pericarditis, aortic dissection
☐	Palpitations	Awareness of heartbeat	Arrhythmia, anxiety, caffeine, thyrotoxicosis
☐	Dyspnea	Shortness of breath	Pulmonary congestion, LV failure, low cardiac output
☐	Orthopnea	Breathlessness on lying down	Pulmonary venous return increases → fluid backs up into lungs
☐	PND	Sudden night-time breathlessness	Reabsorption of interstitial fluid in lungs during sleep
☐	Pedal Edema	Swelling of legs/feet	Right heart failure, hypoalbuminemia, renal causes
☐	Cyanosis	Bluish discoloration of skin	Due to deoxygenated hemoglobin > 5 g/dL in capillaries
☐	Syncope	Sudden loss of consciousness	Drop in cerebral perfusion due to arrhythmias, valve disease

🫁 Respiratory System

✅	Symptom	Definition	Why It Happens (Pathogenesis)
☐	Cough	Sudden forceful expulsion of air	Irritation of airways from infection, allergens, or secretions
☐	Sputum	Expectoration of mucus from lungs	Produced in response to inflammation/infection
☐	Hemoptysis	Coughing up blood	Bronchial vessel rupture due to TB, cancer, bronchiectasis
☐	Wheeze	High-pitched breath sound	Bronchial narrowing in asthma or COPD
☐	Stridor	Harsh inspiratory sound	Upper airway obstruction (e.g., foreign body, croup)
☐	Dyspnea	Difficulty breathing	Reduced oxygen exchange or airflow obstruction
☐	Pleuritic chest pain	Sharp pain on deep breathing	Inflammation of pleura (pleuritis, PE)

🍽️ Gastrointestinal System

✅	Symptom	Definition	Why It Happens (Pathogenesis)
☐	Nausea/Vomiting	Urge or act of expelling gastric contents	Stimulated by vomiting center (toxins, GI irritation, ICP)
☐	Anorexia	Loss of appetite	Cytokine response in infection, malignancy, or GI irritation
☐	Abdominal Pain	Pain in the abdomen	Stretch, inflammation, or ischemia of viscera
☐	Diarrhea	Frequent, loose stools	Increased intestinal motility, secretions (infection, IBS)
☐	Constipation	Infrequent, hard stools	↓ Motility, dehydration, hypothyroidism, obstruction
☐	Dysphagia	Difficulty in swallowing	Obstruction, neurological lesion, esophageal motility disorder
☐	Heartburn	Burning chest pain	Acid reflux irritating esophagus (GERD)
☐	GI bleeding	Blood in vomit or stool	Ulcers, varices, carcinoma, hemorrhoids

🧬 Renal / Genitourinary System

✅	Symptom	Definition	Why It Happens (Pathogenesis)
☐	Dysuria	Pain during urination	UTI, urethritis, inflammation of mucosa
☐	Frequency	Increased urge to urinate	Bladder irritation or reduced capacity
☐	Urgency	Sudden strong urge to urinate	Detrusor instability, cystitis
☐	Hematuria	Blood in urine	Glomerular damage, stones, cancer
☐	Oliguria	<400 mL/day urine output	AKI, dehydration, obstruction
☐	Incontinence	Involuntary urine leakage	Stress, overflow, neurogenic bladder
☐	Flank pain	Pain in loin area	Stone, pyelonephritis, trauma

🧠 Endocrine System

✅	Symptom	Definition	Why It Happens (Pathogenesis)
☐	Weight Loss	Unintended loss of weight	↑ Metabolism (hyperthyroid), malignancy, DM
☐	Weight Gain	Unintended gain	Hypothyroidism, Cushing’s syndrome
☐	Polyuria	Excess urination	Osmotic diuresis in DM, ↓ ADH in DI
☐	Polydipsia	Excess thirst	Dehydration due to polyuria
☐	Fatigue	Lack of energy	Hypothyroid, Addison’s, anemia
☐	Cold Intolerance	Sensitivity to cold	↓ Basal metabolic rate in hypothyroid
☐	Heat Intolerance	Overheating	↑ BMR in hyperthyroid

🦴 Musculoskeletal System

✅	Symptom	Definition	Why It Happens (Pathogenesis)
☐	Joint Pain (Arthralgia)	Pain in joints	Inflammation (RA), cartilage wear (OA)
☐	Morning stiffness	Stiffness after waking	RA, spondyloarthritis (inflammatory)
☐	Muscle Cramps	Painful spasm of muscle	Electrolyte imbalance (low Ca/K), overuse
☐	Back Pain	Pain in lumbar region	Disc herniation, strain, spinal stenosis

🧠 Psychiatric Symptoms

✅	Symptom	Definition	Why It Happens (Pathogenesis)
☐	Insomnia	Inability to sleep	Anxiety, depression, stress, stimulant use
☐	Depression	Persistent low mood and energy	Neurotransmitter imbalance (low serotonin)
☐	Anxiety	Excessive worry or fear	Overactive sympathetic system; GABA imbalance
☐	Delusions	False belief not based on reality	Psychotic disorders like schizophrenia
☐	Hallucinations	Perception without stimulus	Dopamine excess (schizophrenia, drugs)

Wednesday, July 2, 2025

PATIENT HISTORY TAKING TEMPLATE

🏥 PATIENT HISTORY TAKING TEMPLATE

(✅ Tick all that apply. ⬜ Leave blank if not applicable.)

👤 IDENTIFICATION DATA


Name	_______________________
Age	______ yrs
Sex	⬜ Male ⬜ Female ⬜ Other
Marital Status	⬜ Single ⬜ Married ⬜ Widow ⬜ Divorced
Address	_______________________
Occupation	_______________________
Date of Admission	________________
Date of Examination	________________
IP/OP No.	________________
Informant	⬜ Patient ⬜ Relative ⬜ Friend ⬜ Attendant ⬜ Other: ___________
Reliability of Informant	⬜ Good ⬜ Fair ⬜ Poor

🗣️ CHIEF COMPLAINT(S)

Symptom	Duration	Tick if present
⬜ Fever	____ days/weeks	⬜
⬜ Cough	____ days/weeks	⬜
⬜ Breathlessness	____ days/weeks	⬜
⬜ Chest Pain	____ days/weeks	⬜
⬜ Abdominal Pain	____ days/weeks	⬜
⬜ Vomiting	____ days/weeks	⬜
⬜ Headache	____ days/weeks	⬜
⬜ Weakness	____ days/weeks	⬜
⬜ Back Pain	____ days/weeks	⬜
⬜ Swelling	Site: ____________	⬜
⬜ Others (Specify)	__________________	⬜

📜 HISTORY OF PRESENTING ILLNESS

⬜ Onset: ⬜ Sudden ⬜ Gradual
⬜ Duration: ____________
⬜ Progression: ⬜ Increasing ⬜ Decreasing ⬜ Static
⬜ Associated symptoms:
⬜ Nausea ⬜ Diarrhoea ⬜ Loss of appetite ⬜ Weight loss ⬜ Sweating
⬜ Radiation of pain: ______________
⬜ Aggravating Factors: ____________
⬜ Relieving Factors: ____________
⬜ Treatment taken: ⬜ Yes ⬜ No
If yes, specify: ________________________
⬜ Similar complaints in the past: ⬜ Yes ⬜ No

🕰️ PAST MEDICAL HISTORY

Condition	Present	Duration	Treatment
⬜ Hypertension	⬜	______	__________
⬜ Diabetes Mellitus	⬜	______	__________
⬜ Tuberculosis	⬜	______	__________
⬜ Asthma/COPD	⬜	______	__________
⬜ Seizures	⬜	______	__________
⬜ Jaundice	⬜	______	__________
⬜ Surgery (Specify): ________	⬜	______	__________
⬜ Hospitalizations	⬜	______	__________
⬜ Others: _____________	⬜	______	__________

🧬 FAMILY HISTORY

Disease	Present	Relationship
⬜ Hypertension	⬜	__________
⬜ Diabetes Mellitus	⬜	__________
⬜ Heart Disease	⬜	__________
⬜ Stroke	⬜	__________
⬜ Cancer	⬜	__________
⬜ Genetic Disorders	⬜	__________
⬜ TB	⬜	__________
⬜ Others: _______________	⬜	__________

🧠 PERSONAL HISTORY

Item	Details
Diet	⬜ Veg ⬜ Non-Veg ⬜ Mixed
Appetite	⬜ Normal ⬜ Reduced ⬜ Increased
Bowel Habits	⬜ Normal ⬜ Constipation ⬜ Diarrhea
Bladder Habits	⬜ Normal ⬜ Frequency ⬜ Dysuria
Sleep	⬜ Normal ⬜ Disturbed ⬜ Insomnia
Addiction	⬜ Smoking ⬜ Alcohol ⬜ Tobacco ⬜ Drug abuse
Sexual History	⬜ Normal ⬜ Issues (Specify): __________
Occupation-related Exposure	⬜ Yes ⬜ No (If yes, specify): _________

♀️ OBSTETRIC & GYNAECOLOGICAL HISTORY (If applicable)

Parameter	Details
Menarche Age	______ yrs
Cycle	⬜ Regular ⬜ Irregular
LMP	__________
Contraception	⬜ Yes ⬜ No (Type: ________)
Gravida	G:___ P:___ L:___ A:___
Obstetric Complications	⬜ Yes ⬜ No
Menopause	⬜ Pre ⬜ Post (Age: ____ yrs)

💉 IMMUNIZATION HISTORY (if child or relevant)

Vaccine	Received	Age
⬜ BCG	⬜	___
⬜ OPV/DPT	⬜	___
⬜ MMR	⬜	___
⬜ Hepatitis B	⬜	___
⬜ COVID-19	⬜	___
⬜ Others: ____________	⬜	___

⚠️ DRUG HISTORY

Drug Name	Indication	Duration	Side Effects
__________	__________	______	____________
⬜ Known Drug Allergies: __________________

🏠 SOCIOECONOMIC HISTORY

Parameter	Detail
Socioeconomic status	⬜ Low ⬜ Middle ⬜ High
Living conditions	⬜ Pucca ⬜ Kutcha ⬜ Crowded
Water source	⬜ Tap ⬜ Borewell ⬜ Open
Toilet facility	⬜ Present ⬜ Absent
Education	⬜ Illiterate ⬜ School ⬜ Graduate
Monthly Income	₹ __________

🧍‍♂️ GENERAL PHYSICAL EXAMINATION

Parameter	Value	Abnormalities
Built	⬜ Normal ⬜ Thin ⬜ Obese
Nourishment	⬜ Adequate ⬜ Inadequate
Pallor	⬜ Yes ⬜ No
Icterus	⬜ Yes ⬜ No
Cyanosis	⬜ Yes ⬜ No
Clubbing	⬜ Yes ⬜ No
Lymphadenopathy	⬜ Yes ⬜ No
Edema	⬜ Yes ⬜ No
Height	______ cm
Weight	______ kg
BMI	______ kg/m²

🔍 VITAL SIGNS

Vital	Value
Temperature	______ °C
Pulse	______ /min, ⬜ Regular ⬜ Irregular
Respiratory Rate	______ /min
BP	______ mmHg
SpO₂	______ % on ⬜ Room air ⬜ Oxygen
RBS	______ mg/dL

🔎 SYSTEMIC EXAMINATION

1. CVS (Cardiovascular System)

Finding	Present
⬜ Apex beat visible/palpable	⬜
⬜ Thrill	⬜
⬜ S1/S2 Normal	⬜
⬜ Murmur (Specify)	⬜

2. RS (Respiratory System)

Finding	Present
⬜ Trachea central/deviated	⬜
⬜ Breath sounds: ⬜ Vesicular ⬜ Bronchial
⬜ Added sounds: ⬜ Crepitations ⬜ Rhonchi

3. GI (Abdominal)

Finding	Present
⬜ Shape: ⬜ Flat ⬜ Distended
⬜ Tenderness	⬜
⬜ Guarding/Rigidity	⬜
⬜ Organomegaly: ⬜ Liver ⬜ Spleen
⬜ Bowel sounds present	⬜

4. CNS (Central Nervous System)

Finding	Status
Higher functions	⬜ Normal ⬜ Abnormal
Cranial Nerves	⬜ Normal ⬜ Abnormal
Motor	⬜ Normal ⬜ Weakness
Sensory	⬜ Intact ⬜ Loss
Reflexes	⬜ Normal ⬜ Exaggerated
Gait	⬜ Normal ⬜ Ataxic ⬜ Hemiplegic

5. Musculoskeletal

Finding	Present
⬜ Joint swelling	⬜
⬜ Tenderness	⬜
⬜ Deformities	⬜
⬜ Range of motion	⬜ Full ⬜ Restricted

6. Skin

Finding	Present
⬜ Rash	⬜
⬜ Ulcers	⬜
⬜ Pigmentation	⬜
⬜ Itching	⬜

🧪 PROVISIONAL DIAGNOSIS

📋 DIFFERENTIAL DIAGNOSIS

Dx	Features Supporting	Features Against
1.
2.

📌 PLAN OF MANAGEMENT

Aspect	Plan
Investigations	__________________________
Initial Management	__________________________
Medications	__________________________
Referral (if any)	__________________________

Tuesday, June 24, 2025

DETAILED SCHEME OF SKIN EXAMINATION

Parameter	How to Record	If Abnormal / Positive – What to Note
1. Skin Color	Normal / Pale / Cyanosed / Jaundiced / Hyperpigmented / Hypopigmented / Depigmented	Distribution (generalized/localized), intensity, shade (yellow/blue/slate grey)
2. Lesions – Presence	Present / Absent	Type: macule/papule/vesicle/etc. Number: Single/Multiple Distribution: Localized/Generalized Surface: Scaly/etc.
3. Lesion Configuration	Specify: Linear / Annular / Grouped / Reticular / Serpiginous / Targetoid / Zosteriform	Helps infer etiology (e.g., grouped: herpes; linear: Koebner's phenomenon)
4. Lesion Shape	Round / Oval / Irregular / Polycyclic / Umbilicated	Specific patterns e.g., polycyclic in fungal infections, umbilicated in molluscum
5. Symmetry	Symmetrical / Asymmetrical	Symmetry suggests systemic disorder (e.g., SLE, psoriasis)
6. Site of Lesions	Specify clearly: Face / Trunk / Scalp / Flexures / Extensors / Palms / Soles / Genitals	Important for diagnosis (e.g., flexural eczema vs extensor psoriasis)
7. Surface of Lesions	Smooth / Scaly / Crusted / Verrucous / Moist / Dry	Note the nature of scaling or crust
8.Temperature of Skin	Warm / Cool / Normal (Use dorsum of hand)	Warm: inflammation; Cool: ischemia, shock
9. Texture of Skin	Normal / Rough / Dry / Thickened / Atrophic	Rough/dry in ichthyosis; Atrophic in lichen sclerosus
10. Tenderness	Present / Absent	Localized/systemic; Painful lesions suggest inflammation/infection
11. Induration	Present / Absent	Nature: Soft / Firm / Hard
12.Consistency	Soft / Firm / Hard / Fluctuant	Suggests nature of lesion – cystic, solid tumor, abscess
13. Mobility (Skin over Lesion)	Freely mobile / Restricted / Fixed	Fixity suggests deeper or malignant involvement
14. Turgor	Normal / Reduced (Test: pinch over forearm or abdomen)	Decreased in dehydration, age-related skin laxity
15. Diascopy	Blanchable / Non-blanchable	Non-blanching: purpura, petechiae; Blanching: erythema
16. Nikolsky’s Sign	Positive / Negative	Positive in pemphigus vulgaris, SSSS
17. Auspitz Sign	Positive / Negative	Positive: pinpoint bleeding after scale removal – Psoriasis
18. Koebner’s Phenomenon	Present / Absent	Linear lesion at trauma site – Psoriasis, Lichen planus
19. Wood’s Lamp Test	Normal / Fluorescence Present	Color: Green – Tinea / Coral red – Erythrasma / Bright white – Vitiligo
20. Patch Test	Performed / Not performed	Positive allergens (if tested); delayed hypersensitivity indication
21. Hair Examination	Normal / Abnormal	Hair loss: Diffuse / Patchy / Scarring / Non-scarring Texture: Dry / Brittle / Coarse / Silky
22. Nail Examination	Normal / Abnormal	Clubbing / Pitting / Ridging / Discoloration / Onycholysis / Koilonychia
23. Mucosal Examination	Normal / Abnormal	Oral ulcers / Depigmented patches / Vesicles / Lichen planus-like lesions
24. Lymph Nodes	Enlarged / Not palpable	Site: Cervical / Axillary / Inguinal Character: Tender / Non-tender, Mobile / Fixed, Discrete / Matted
25. Systemic Associations	Present / Absent	Fever / Arthralgia / Oral Ulcers / Weight loss / Photosensitivity / Neuropathy (if present – describe)

📝 Example of Recording in a Case Sheet:

Skin examination:
Color: Pale with patchy hypopigmented macules over the extensor surface of both arms.
Lesions: Multiple macules and papules arranged in linear and grouped patterns. Surface dry and scaly.
Temperature: Warm over lesions.
Tenderness: Absent.
Induration: Present, firm in consistency.
Diascopy: Non-blanchable. Nikolsky’s sign: Negative.
Hair and nails: Normal.
Oral mucosa: Normal.
Lymphadenopathy: Absent.
Wood’s lamp: Fluorescent white under UV – suggestive of vitiligo.
Systemic signs: Absent.

Friday, June 13, 2025

21.

Chief Complaint: Dry cough for 3 weeks
Associated Complaints: Low-grade fever, weight loss, fatigue
Pathology: Fungal invasion of lung parenchyma
Diagnosis: Pulmonary Histoplasmosis

22.

Chief Complaint: Breathlessness worsening over 6 months
Associated Complaints: Dry cough, chest tightness
Pathology: Progressive fibrosis of alveolar walls
Diagnosis: Non-Specific Interstitial Pneumonitis (NSIP)

23.

Chief Complaint: Sudden dyspnea following trauma
Associated Complaints: Chest pain, cyanosis
Pathology: Hemorrhage in pleural cavity causing lung compression
Diagnosis: Hemothorax

24.

Chief Complaint: Recurrent wheezing episodes since childhood
Associated Complaints: Cough, especially at night; chest tightness
Pathology: Reversible bronchial hyperreactivity
Diagnosis: Atopic Asthma

25.

Chief Complaint: Progressive exertional breathlessness
Associated Complaints: Chest discomfort, syncope
Pathology: Narrowing of pulmonary arterioles → ↑ pulmonary artery pressure
Diagnosis: Primary Pulmonary Hypertension

26.

Chief Complaint: Productive cough with blood-streaked sputum
Associated Complaints: Night sweats, loss of appetite
Pathology: Reactivation of tuberculosis in upper lobes
Diagnosis: Post-Primary Pulmonary Tuberculosis

27.

Chief Complaint: Dyspnea on lying down (orthopnea)
Associated Complaints: Paroxysmal nocturnal dyspnea, pedal edema
Pathology: Pulmonary venous congestion due to heart failure
Diagnosis: Pulmonary Edema (due to Left Heart Failure)

28.

Chief Complaint: Fever with purulent sputum after aspiration
Associated Complaints: Halitosis, chest pain
Pathology: Lung abscess with necrosis following aspiration
Diagnosis: Lung Abscess

29.

Chief Complaint: Hoarseness of voice for 2 months
Associated Complaints: Dry cough, weight loss
Pathology: Tumor compressing recurrent laryngeal nerve
Diagnosis: Mediastinal Mass (e.g., Bronchogenic Carcinoma)

30.

Chief Complaint: Sudden dyspnea after long travel
Associated Complaints: Chest pain, hemoptysis, anxiety
Pathology: Thromboembolism in pulmonary artery
Diagnosis: Deep Vein Thrombosis with Pulmonary Embolism

31.

Chief Complaint: Chest tightness on exertion
Associated Complaints: Palpitations, fatigue
Pathology: Autoimmune inflammation of lung parenchyma
Diagnosis: Connective Tissue Disease-associated ILD (e.g., SLE, RA)

32.

Chief Complaint: Cough with frothy pink sputum
Associated Complaints: Difficulty breathing, orthopnea
Pathology: Alveolar fluid leakage due to cardiac failure
Diagnosis: Cardiogenic Pulmonary Edema

33.

Chief Complaint: Dyspnea and dry cough for months
Associated Complaints: Digital clubbing, basal crackles
Pathology: Fibrosis due to occupational exposure (coal, silica, asbestos)
Diagnosis: Pneumoconiosis

34.

Chief Complaint: Persistent dry cough
Associated Complaints: Joint pain, fatigue, erythema nodosum
Pathology: Granulomatous inflammation with lymphadenopathy
Diagnosis: Sarcoidosis

35.

Chief Complaint: Severe dyspnea and cough
Associated Complaints: Fever, myalgia
Pathology: Viral infection of alveolar epithelium
Diagnosis: Influenza Pneumonia

36.

Chief Complaint: Wheezing and shortness of breath
Associated Complaints: Use of nasal polyps, aspirin intolerance
Pathology: Aspirin-induced bronchospasm
Diagnosis: Samter’s Triad (Aspirin-Exacerbated Respiratory Disease)

37.

Chief Complaint: Cough with whitish sputum
Associated Complaints: Nasal congestion, facial pain
Pathology: Post-nasal drip causing bronchial irritation
Diagnosis: Upper Airway Cough Syndrome (Post-nasal drip syndrome)

38.

Chief Complaint: Difficulty breathing and noisy respiration
Associated Complaints: Stridor, drooling (esp. in children)
Pathology: Acute inflammation of epiglottis
Diagnosis: Acute Epiglottitis

39.

Chief Complaint: Recurrent chest infections in a child
Associated Complaints: Delayed growth, salty-tasting skin
Pathology: Defective CFTR gene causing thick secretions
Diagnosis: Cystic Fibrosis (repeated for pediatric relevance)

40.

Chief Complaint: Dry cough, breathlessness, especially in young females
Associated Complaints: Butterfly rash, joint pain, low-grade fever
Pathology: Lupus pneumonitis from autoimmune inflammation
Diagnosis: SLE with Pulmonary Involvement

Symptom and diagnosis

1. Symptom: Dry cough, progressive dyspnea

Pathology: Interstitial fibrosis leading to stiff lungs
Disease: Idiopathic Pulmonary Fibrosis

2. Symptom: Productive cough with foul-smelling sputum

Pathology: Permanent dilatation of bronchi with pus accumulation
Disease: Bronchiectasis

3. Symptom: Sudden onset dyspnea, chest pain, hemoptysis

Pathology: Pulmonary artery obstruction by thrombus
Disease: Pulmonary Embolism

4. Symptom: Chronic cough with white sputum, wheezing

Pathology: Chronic inflammation and mucus hypersecretion in bronchi
Disease: Chronic Bronchitis (a type of COPD)

5. Symptom: Exertional dyspnea, wheeze, nocturnal cough

Pathology: Airway hyper-responsiveness with bronchoconstriction
Disease: Bronchial Asthma

6. Symptom: Sudden sharp chest pain, dyspnea, reduced breath sounds

Pathology: Air entry into pleural cavity causing lung collapse
Disease: Pneumothorax

7. Symptom: Fever, productive cough with rust-colored sputum

Pathology: Alveolar consolidation due to bacterial infection
Disease: Lobar Pneumonia (e.g., Streptococcus pneumoniae)

8. Symptom: Hemoptysis, weight loss, night sweats, chronic cough

Pathology: Caseating granulomatous inflammation in lungs
Disease: Pulmonary Tuberculosis

9. Symptom: Progressive exertional dyspnea, dry cough

Pathology: Sarcoid granulomas in lung interstitium
Disease: Pulmonary Sarcoidosis

10. Symptom: Persistent dry cough, hoarseness

Pathology: Recurrent laryngeal nerve involvement or bronchial tumor
Disease: Bronchogenic Carcinoma (Lung Cancer)

11. Symptom: Cough with mucopurulent sputum, fever, crackles

Pathology: Inflammatory infiltrate in alveoli and bronchioles
Disease: Bronchopneumonia

12. Symptom: Snoring, daytime sleepiness

Pathology: Upper airway obstruction during sleep
Disease: Obstructive Sleep Apnea

13. Symptom: Dyspnea, cyanosis, barrel chest

Pathology: Destruction of alveolar walls and loss of recoil
Disease: Emphysema (a type of COPD)

14. Symptom: Tachypnea, use of accessory muscles, hypoxia

Pathology: Inflammatory damage to alveolar-capillary membrane
Disease: Acute Respiratory Distress Syndrome (ARDS)

15. Symptom: Wheezing, digital clubbing, persistent cough in child

Pathology: Defective chloride channels causing thick mucus
Disease: Cystic Fibrosis

16. Symptom: Dry cough, weight loss, fatigue

Pathology: Metastatic cancerous lesions in lung parenchyma
Disease: Secondary Lung Cancer (Metastatic Lung Disease)

17. Symptom: Pleuritic chest pain, dyspnea, dull percussion

Pathology: Fluid accumulation in pleural space
Disease: Pleural Effusion

18. Symptom: Chronic productive cough, breathlessness

Pathology: Smoking-induced chronic airway and parenchymal damage
Disease: Chronic Obstructive Pulmonary Disease (COPD)

19. Symptom: Recurrent cough, sinusitis, situs inversus

Pathology: Defective ciliary motility
Disease: Kartagener's Syndrome

20. Symptom: Cyanosis, clubbing, failure to thrive in infants

Pathology: Right-to-left cardiac shunt causing hypoxemia
Disease: Congenital Cyanotic Heart Disease (e.g., Tetralogy of Fallot with pulmonary effects)

Wednesday, June 11, 2025

Symptoms and spot diagnosis of some common clinical conditions

Symptoms and spot diagnosis of some common clinical conditions

1. Pulmonary Tuberculosis

Symptoms: Persistent cough for more than 2 weeks, weight loss, night sweats, low-grade evening fever, hemoptysis (blood in sputum).
🩺 Spot Diagnosis: Suspect TB in any chronic cough with systemic wasting and evening fever.

2. Typhoid Fever

Symptoms: Gradual rising (step-ladder) fever, coated tongue, abdominal discomfort, constipation or diarrhea, rose spots (faint red skin rashes on abdomen), relative bradycardia (slow pulse despite fever).
🩺 Spot Diagnosis: Typhoid suspected in step-ladder fever with relative bradycardia and abdominal symptoms.

3. Dengue Fever

Symptoms: Sudden high-grade fever, retro-orbital pain (pain behind eyes), severe muscle pain (“breakbone fever”), rash, bleeding gums, petechiae (small red spots), low platelet count.
🩺 Spot Diagnosis: Think dengue with high fever, muscle pain, rash, and thrombocytopenia.

4. Malaria (Vivax/Falciparum)

Symptoms: Intermittent fever with chills and rigors, headache, vomiting, splenomegaly (enlarged spleen), jaundice (yellow eyes/skin in falciparum).
🩺 Spot Diagnosis: Classic chills-fever-sweating cycle + travel to endemic area = Malaria.

5. Leptospirosis

Symptoms: High fever, muscle tenderness (especially calves), jaundice, red conjunctiva (red eyes without discharge), headache, kidney dysfunction (reduced urine).
🩺 Spot Diagnosis: Suspect leptospirosis in fever with calf pain, red eyes, and jaundice.

6. COVID-19 (Moderate to Severe)

Symptoms: Fever, dry cough, breathlessness, loss of smell and taste, fatigue, low oxygen saturation, bilateral pneumonia (on chest X-ray).
🩺 Spot Diagnosis: Fever + anosmia (loss of smell) + breathlessness = suspect COVID.

7. Chikungunya

Symptoms: High fever, severe joint pain (esp. wrists, fingers, ankles), rash, fatigue, headache, conjunctivitis.
🩺 Spot Diagnosis: Fever with disabling joint pain and rash = Chikungunya.

8. Enteric Fever (Paratyphoid)

Symptoms: Similar to typhoid but milder – low to moderate fever, malaise (general tiredness), abdominal discomfort, relative bradycardia.
🩺 Spot Diagnosis: Paratyphoid if milder typhoid-like picture with gradual fever.

9. Acute Viral Hepatitis A/E

Symptoms: Sudden-onset jaundice, fever, nausea, anorexia (loss of appetite), dark urine, clay-colored stool.
🩺 Spot Diagnosis: Suspect hepatitis in young with fever and sudden jaundice.

10. Chronic Hepatitis B/C

Symptoms: Fatigue, low-grade jaundice, right upper quadrant pain, hepatomegaly (liver enlargement), elevated liver enzymes.
🩺 Spot Diagnosis: Think Hepatitis B/C in chronic liver dysfunction with viral risk factors.

11. Acute Appendicitis

Symptoms: Abdominal pain starting in umbilicus then shifting to right lower abdomen (McBurney's point), fever, nausea, rebound tenderness.
🩺 Spot Diagnosis: Suspect appendicitis in periumbilical pain migrating to right iliac fossa with fever.

12. Acute Pancreatitis

Symptoms: Severe epigastric pain radiating to the back, vomiting, fever, history of alcohol or gallstones, raised amylase/lipase.
🩺 Spot Diagnosis: Sudden epigastric pain with vomiting in alcoholic = pancreatitis.

13. GERD (Gastroesophageal Reflux Disease)

Symptoms: Burning chest pain (heartburn), worsens after meals or lying down, sour taste in mouth, regurgitation.
🩺 Spot Diagnosis: Classic post-meal heartburn and sour belching = GERD.

14. Peptic Ulcer Disease

Symptoms: Epigastric pain relieved by food (duodenal) or worsened by food (gastric), bloating, nausea, melena (black tarry stools).
🩺 Spot Diagnosis: Ulcer suspected in periodic epigastric pain with food relation.

15. Acute Gastroenteritis

Symptoms: Sudden onset diarrhea, vomiting, abdominal cramps, fever, dehydration signs (dry tongue, low BP).
🩺 Spot Diagnosis: Diarrhea + vomiting in clusters = acute gastroenteritis.

16. Irritable Bowel Syndrome (IBS)

Symptoms: Recurrent abdominal pain relieved by defecation, altered bowel habits (diarrhea or constipation), bloating, no alarm signs.
🩺 Spot Diagnosis: Think IBS in chronic abdominal discomfort with relief after stools.

17. Ulcerative Colitis

Symptoms: Bloody diarrhea, abdominal cramps, urgency, tenesmus (feeling of incomplete defecation), weight loss.
🩺 Spot Diagnosis: Persistent bloody diarrhea with cramps = Ulcerative colitis.

18. Crohn's Disease

Symptoms: Chronic diarrhea, weight loss, abdominal pain, perianal fistula, growth retardation (in children).
🩺 Spot Diagnosis: Patchy GI involvement + perianal disease = Crohn’s.

19. Iron Deficiency Anemia

Symptoms: Fatigue, pallor (pale skin), pica (eating non-food items), koilonychia (spoon nails), palpitations.
🩺 Spot Diagnosis: Microcytic anemia with fatigue = Iron deficiency.

20. Vitamin B12 Deficiency

Symptoms: Fatigue, glossitis (smooth red tongue), paresthesias (tingling), ataxia (imbalance), megaloblastic anemia.
🩺 Spot Diagnosis: Anemia + neurologic signs = B12 deficiency.

21. Rheumatic Heart Disease

Symptoms: History of sore throat, migratory joint pain (arthritis), murmur, fever, carditis (heart inflammation).
🩺 Spot Diagnosis: Post-strep joint pain + murmur = suspect RHD.

22. Ischemic Heart Disease (Angina/MI)

Symptoms: Chest pain radiating to arm or jaw, sweating, breathlessness, nausea, especially on exertion.
🩺 Spot Diagnosis: Classic exertional chest pain = ischemia; sudden severe pain = MI.

23. Hypertension

Symptoms: Often asymptomatic; may have headache, giddiness, vision changes, nosebleeds.
🩺 Spot Diagnosis: Elevated BP on 2–3 occasions = Hypertension.

24. Stroke (CVA)

Symptoms: Sudden one-sided weakness or paralysis, slurred speech, facial droop, altered consciousness.
🩺 Spot Diagnosis: Acute neurologic deficit = Stroke until ruled out.

25. Epilepsy

Symptoms: Recurrent seizures (involuntary jerking), tongue bite, incontinence, postictal confusion (drowsiness after seizure).
🩺 Spot Diagnosis: Repeated unprovoked seizures = Epilepsy.

26. Parkinson’s Disease

Symptoms: Resting tremor, rigidity, bradykinesia (slow movement), shuffling gait, mask-like face.
🩺 Spot Diagnosis: Triad of tremor, rigidity, bradykinesia = Parkinson’s.

27. Migraine

Symptoms: Recurrent one-sided pulsating headache, photophobia (light sensitivity), nausea, aura (flashing lights).
🩺 Spot Diagnosis: Headache with aura and light sensitivity = Migraine.

28. Tension Headache

Symptoms: Band-like headache around forehead, mild-moderate, no nausea or photophobia, stress-related.
🩺 Spot Diagnosis: Stress-induced dull bilateral headache = Tension headache.

29. Otitis Media (Acute)

Symptoms: Ear pain, fever, hearing loss, ear discharge (if perforated), irritability (in children).
🩺 Spot Diagnosis: Ear pain + fever in a child = Acute otitis media.

30. Pharyngitis (Bacterial)

Symptoms: Sore throat, fever, painful swallowing, red/swollen tonsils with exudates, no cough.
🩺 Spot Diagnosis: Sore throat + fever + no cough = Bacterial pharyngitis.

31. Pneumonia (Community-Acquired)

Symptoms: High fever, productive cough with rusty sputum, pleuritic chest pain (sharp pain on deep breathing), breathlessness, crepitations on chest exam.
🩺 Spot Diagnosis: Fever + cough + crepitations + chest pain = Pneumonia.

32. Bronchial Asthma

Symptoms: Recurrent wheezing (whistling breath sounds), breathlessness, chest tightness, worse at night or early morning, responds to bronchodilators.
🩺 Spot Diagnosis: Recurrent wheezing episodes with reversibility = Asthma.

33. Chronic Obstructive Pulmonary Disease (COPD)

Symptoms: Chronic cough with sputum (>3 months/year for 2 years), progressive breathlessness, wheezing, barrel-shaped chest.
🩺 Spot Diagnosis: Long-term smoker with cough and dyspnea = COPD.

34. Allergic Rhinitis

Symptoms: Sneezing, nasal itching, watery nasal discharge (rhinorrhea), nasal congestion, allergic shiners (dark circles), associated asthma or eczema.
🩺 Spot Diagnosis: Recurrent sneezing with watery discharge = Allergic rhinitis.

35. Scabies

Symptoms: Severe itching worse at night, papular rash in finger webs, wrists, genital area, burrows visible.
🩺 Spot Diagnosis: Nighttime itching + burrows = Scabies.

36. Tinea Corporis (Ringworm)

Symptoms: Circular, red, itchy, scaly lesions with central clearing and raised borders, commonly on body folds.
🩺 Spot Diagnosis: Ring-shaped itchy lesion = Tinea corporis.

37. Vitiligo

Symptoms: White depigmented patches with well-defined borders, symmetrical, no scaling or itching.
🩺 Spot Diagnosis: Symmetrical depigmented patches = Vitiligo.

38. Psoriasis

Symptoms: Red plaques with silvery-white scales, extensor surfaces (elbows, knees), Auspitz sign (pinpoint bleeding when scales removed), nail pitting.
🩺 Spot Diagnosis: Silvery scaling on elbows/knees = Psoriasis.

39. Atopic Dermatitis (Eczema)

Symptoms: Itchy rash, especially in flexures (behind knees, elbows), dry skin, family history of allergies.
🩺 Spot Diagnosis: Itchy flexural dermatitis in child = Atopic dermatitis.

40. Chickenpox (Varicella)

Symptoms: Fever followed by itchy vesicular rash in crops (different stages), trunk > limbs, vesicles on erythematous base (“dew drop on rose petal”).
🩺 Spot Diagnosis: Itchy rash in crops + fever = Chickenpox.

41. Measles

Symptoms: High fever, cough, coryza (runny nose), conjunctivitis, Koplik spots (white spots inside cheeks), maculopapular rash starting behind ears and spreading down.
🩺 Spot Diagnosis: Fever + cough + rash + Koplik spots = Measles.

42. Mumps

Symptoms: Painful swelling of parotid gland (below ear), fever, difficulty opening mouth, may have orchitis (testicular pain) or pancreatitis.
🩺 Spot Diagnosis: Parotid swelling with fever = Mumps.

43. Rubella (German Measles)

Symptoms: Low-grade fever, postauricular lymphadenopathy (swollen nodes behind ear), fine pink rash starting on face and spreading down.
🩺 Spot Diagnosis: Mild fever + rash + lymphadenopathy = Rubella.

44. Typhus (Scrub Typhus)

Symptoms: Fever, eschar (black scab at bite site), lymphadenopathy, rash, delirium, hepatosplenomegaly.
🩺 Spot Diagnosis: Fever + black eschar in endemic area = Scrub typhus.

45. Kala-Azar (Visceral Leishmaniasis)

Symptoms: Chronic fever, weight loss, massive splenomegaly, darkening of skin, anemia.
🩺 Spot Diagnosis: Prolonged fever + splenomegaly + blackish skin = Kala-azar.

46. Rheumatoid Arthritis

Symptoms: Morning stiffness (>1 hour), symmetrical joint swelling (esp. small joints), deformities (swan neck, boutonnière), fatigue.
🩺 Spot Diagnosis: Symmetrical joint pain with morning stiffness = RA.

47. Systemic Lupus Erythematosus (SLE)

Symptoms: Butterfly rash on face, photosensitivity, joint pain, oral ulcers, nephritis, anemia, fatigue.
🩺 Spot Diagnosis: Young female with rash + joint pain + renal signs = SLE.

48. Hypothyroidism

Symptoms: Fatigue, weight gain, cold intolerance, constipation, dry skin, hair loss, slow reflexes, bradycardia.
🩺 Spot Diagnosis: Lethargy + weight gain + dry skin = Hypothyroidism.

49. Hyperthyroidism

Symptoms: Weight loss, heat intolerance, tremors, palpitations, goiter (neck swelling), exophthalmos (bulging eyes), irritability.
🩺 Spot Diagnosis: Weight loss + heat intolerance + bulging eyes = Hyperthyroidism.

50. Diabetes Mellitus (Type 2)

Symptoms: Polyuria (frequent urination), polydipsia (excess thirst), polyphagia (excess hunger), weight loss, non-healing wounds, blurred vision.
🩺 Spot Diagnosis: Classic triad (polyuria, polydipsia, polyphagia) = Diabetes.

Certainly, Dr. Jayaram. Here's the continuation: diseases 51 to 100, following the same clinically efficient format:

Symptoms first
Bracketed explanation of medical terms
Then spot diagnosis

51. Gout

Symptoms: Sudden onset of severe joint pain, usually in big toe (podagra), redness, swelling, tenderness, worsens at night.
🩺 Spot Diagnosis: First metatarsophalangeal joint pain with swelling = Gout.

52. Osteoarthritis

Symptoms: Joint pain worsens with activity, relieved by rest, morning stiffness <30 min, crepitus (grating sound), bony swelling (Heberden's and Bouchard's nodes).
🩺 Spot Diagnosis: Elderly with activity-related knee/hand pain = Osteoarthritis.

53. Ankylosing Spondylitis

Symptoms: Chronic low back pain in young males, morning stiffness >30 min, improves with exercise, reduced spine mobility, sacroiliac tenderness.
🩺 Spot Diagnosis: Young male with inflammatory back pain = Ankylosing spondylitis.

54. Lumbosacral Disc Prolapse

Symptoms: Low back pain radiating to leg (sciatica), numbness, tingling, positive straight leg raise test, may have foot drop.
🩺 Spot Diagnosis: Back pain radiating below knee = Disc herniation.

55. Carpal Tunnel Syndrome

Symptoms: Numbness, tingling in thumb, index, and middle fingers; worse at night, positive Tinel’s and Phalen’s test.
🩺 Spot Diagnosis: Hand tingling in distribution of median nerve = Carpal tunnel.

56. Bell’s Palsy

Symptoms: Sudden onset of one-sided facial weakness, unable to close eye, drooping mouth, no forehead sparing (LMN type).
🩺 Spot Diagnosis: Acute unilateral facial droop involving forehead = Bell's palsy.

57. Trigeminal Neuralgia

Symptoms: Recurrent sharp, electric-shock-like facial pain, triggered by touch or wind, usually unilateral.
🩺 Spot Diagnosis: Sudden facial pain on mild stimulation = Trigeminal neuralgia.

58. Herpes Zoster (Shingles)

Symptoms: Burning pain followed by grouped vesicular rash along a single dermatome, unilateral.
🩺 Spot Diagnosis: Dermatomal pain + vesicles = Herpes zoster.

59. Urinary Tract Infection (UTI)

Symptoms: Burning urination (dysuria), increased frequency, urgency, suprapubic pain, cloudy urine, fever in pyelonephritis.
🩺 Spot Diagnosis: Dysuria + frequency + suprapubic discomfort = UTI.

60. Nephrotic Syndrome

Symptoms: Generalized swelling (anasarca), frothy urine (proteinuria), facial puffiness, especially morning, low albumin.
🩺 Spot Diagnosis: Edema + proteinuria = Nephrotic syndrome.

61. Acute Glomerulonephritis (Post-streptococcal)

Symptoms: Hematuria (cola-colored urine), edema, hypertension, recent sore throat, oliguria (reduced urine).
🩺 Spot Diagnosis: Recent throat infection + cola-colored urine = PSGN.

62. Benign Prostatic Hyperplasia (BPH)

Symptoms: Difficulty urinating, weak stream, nocturia (frequent urination at night), hesitancy, incomplete emptying.
🩺 Spot Diagnosis: Elderly male with obstructive urinary symptoms = BPH.

63. Renal Calculi (Kidney Stone)

Symptoms: Severe flank pain radiating to groin, hematuria, nausea, restlessness, pain comes in waves.
🩺 Spot Diagnosis: Colicky flank pain + hematuria = Urolithiasis.

64. Polycystic Ovary Syndrome (PCOS)

Symptoms: Irregular periods, hirsutism (excess facial hair), acne, obesity, infertility, polycystic ovaries on ultrasound.
🩺 Spot Diagnosis: Irregular cycles + hirsutism + obesity = PCOS.

65. Pelvic Inflammatory Disease (PID)

Symptoms: Lower abdominal pain, fever, abnormal vaginal discharge, dyspareunia (pain during intercourse), cervical motion tenderness.
🩺 Spot Diagnosis: Young female with pelvic pain + fever + discharge = PID.

66. Ectopic Pregnancy

Symptoms: Lower abdominal pain, missed period, vaginal spotting, shoulder tip pain (from internal bleeding), positive pregnancy test.
🩺 Spot Diagnosis: Missed period + pain + bleeding = Rule out ectopic pregnancy.

67. Dysmenorrhea (Primary)

Symptoms: Crampy lower abdominal pain before/during menstruation, normal pelvic exam, no other pathology.
🩺 Spot Diagnosis: Menstrual pain without pelvic abnormality = Primary dysmenorrhea.

68. Endometriosis

Symptoms: Severe dysmenorrhea, dyspareunia, infertility, chronic pelvic pain, tenderness on pelvic exam.
🩺 Spot Diagnosis: Severe cycle-related pain + infertility = Endometriosis.

69. Fibroid Uterus

Symptoms: Heavy menstrual bleeding (menorrhagia), pelvic pressure, mass per abdomen, infertility.
🩺 Spot Diagnosis: Menorrhagia with palpable pelvic mass = Fibroid uterus.

70. Cervical Cancer

Symptoms: Post-coital bleeding, foul-smelling vaginal discharge, pelvic pain, weight loss, irregular bleeding.
🩺 Spot Diagnosis: Post-coital bleeding in middle-aged woman = Suspect cervical cancer.

71. Breast Cancer

Symptoms: Painless hard lump in breast, skin dimpling, nipple retraction, blood-stained nipple discharge, axillary lymph nodes.
🩺 Spot Diagnosis: Breast lump with skin/nipple changes = Suspect breast cancer.

72. Benign Breast Disease (Fibroadenoma)

Symptoms: Mobile, firm, painless breast lump, usually in young women, no skin/nipple changes.
🩺 Spot Diagnosis: Mobile, non-tender breast lump in young female = Fibroadenoma.

73. Tetanus

Symptoms: Trismus (lockjaw), muscle rigidity, painful spasms, risus sardonicus (grimace-like smile), history of wound.
🩺 Spot Diagnosis: Jaw stiffness after injury = Tetanus.

74. Rabies

Symptoms: Hydrophobia (fear of water), aerophobia (fear of air), confusion, spasms, hypersalivation, recent dog bite.
🩺 Spot Diagnosis: Fear of water after dog bite = Rabies.

75. Kala Pani (Chronic Arsenic Poisoning)

Symptoms: Hyperpigmentation ("raindrop" pattern), hyperkeratosis of palms/soles, skin cancers, Mees’ lines on nails.
🩺 Spot Diagnosis: Skin pigment + keratosis in endemic areas = Arsenicosis.

76. Filariasis

Symptoms: Recurrent fever with swelling of limbs/scrotum, lymphedema, elephantiasis, endemic regions.
🩺 Spot Diagnosis: Leg/genital swelling with fever in endemic area = Filariasis.

77. Ascariasis (Roundworm)

Symptoms: Abdominal pain, malnutrition, passage of worms in stool/vomitus, intestinal obstruction in children.
🩺 Spot Diagnosis: Child with worms in stool + GI symptoms = Ascariasis.

78. Hookworm Infestation

Symptoms: Iron deficiency anemia, fatigue, pallor, pica, abdominal pain, eosinophilia.
🩺 Spot Diagnosis: Anemia + barefoot history = Hookworm.

79. Hydatid Disease

Symptoms: Hepatomegaly, cystic liver lesions, history of contact with dogs, may rupture causing anaphylaxis.
🩺 Spot Diagnosis: Liver cyst + dog exposure = Hydatid disease.

80. Neurocysticercosis

Symptoms: Seizures, headache, hydrocephalus signs, ring-enhancing lesions on brain imaging, pork consumption history.
🩺 Spot Diagnosis: Seizures + ring lesion + pork intake = Neurocysticercosis.

81. Toxoplasmosis

Symptoms: In immunocompetent – mild flu. In immunocompromised – seizures, CNS lesions, chorioretinitis.
🩺 Spot Diagnosis: AIDS + ring lesions in brain = Toxoplasmosis.

82. Giardiasis

Symptoms: Chronic foul-smelling diarrhea, bloating, flatulence, weight loss, seen in children.
🩺 Spot Diagnosis: Frothy, greasy diarrhea in child = Giardia.

83. Amoebiasis

Symptoms: Dysentery (bloody-mucoid stool), abdominal pain, liver abscess (fever + RUQ pain), anchovy sauce pus.
🩺 Spot Diagnosis: Bloody stools + liver tenderness = Amoebiasis.

84. Typhlitis (Neutropenic Enterocolitis)

Symptoms: Fever, right lower quadrant pain, diarrhea in immunosuppressed or chemotherapy patients.
🩺 Spot Diagnosis: RLQ pain + fever in neutropenia = Typhlitis.

85. Hemorrhoids (Piles)

Symptoms: Painless rectal bleeding with stool, pruritus ani (anal itching), protruding mass per anus.
🩺 Spot Diagnosis: Bright red bleeding post-defecation = Hemorrhoids.

86. Anal Fissure

Symptoms: Sharp pain during defecation, bleeding streak on stool, spasm of anal sphincter.
🩺 Spot Diagnosis: Painful defecation + blood on wiping = Anal fissure.

87. Pilonidal Sinus

Symptoms: Swelling with pus or blood discharge near natal cleft (top of buttocks), recurrent abscesses.
🩺 Spot Diagnosis: Discharging sinus at tailbone = Pilonidal sinus.

88. Thalassemia Major

Symptoms: Severe anemia in early childhood, bone deformities, hepatosplenomegaly, transfusion dependence.
🩺 Spot Diagnosis: Anemic child + marrow expansion signs = Thalassemia.

89. Hemophilia A

Symptoms: Spontaneous bleeding into joints (hemarthrosis), prolonged bleeding, family history, normal platelets.
🩺 Spot Diagnosis: Recurrent joint bleeds in male child = Hemophilia A.

90. ITP (Immune Thrombocytopenic Purpura)

Symptoms: Petechiae, purpura, bleeding gums, low platelets, usually post-viral in children.
🩺 Spot Diagnosis: Sudden bleeding spots in healthy child = ITP.

91. Leukemia (ALL/AML)

Symptoms: Fatigue, pallor, frequent infections, bleeding gums, bone pain, hepatosplenomegaly, blasts on smear.
🩺 Spot Diagnosis: Child with pallor + bone pain + blasts = Leukemia.

92. Multiple Myeloma

Symptoms: Bone pain (especially back), anemia, renal failure, hypercalcemia, recurrent infections.
🩺 Spot Diagnosis: Elderly with bone pain + anemia + renal issues = Myeloma.

93. Pheochromocytoma

Symptoms: Episodic headache, palpitations, sweating, hypertension.
🩺 Spot Diagnosis: Paroxysmal hypertension + triad = Pheochromocytoma.

94. Addison’s Disease

Symptoms: Fatigue, hyperpigmentation (especially knuckles, gums), hypotension, hyponatremia, vomiting.
🩺 Spot Diagnosis: Darkened skin + hypotension = Addison’s.

95. Cushing’s Syndrome

Symptoms: Moon face, central obesity, purple striae, buffalo hump, hypertension, osteoporosis.
🩺 Spot Diagnosis: Truncal obesity + striae + HTN = Cushing’s.

96. Hyperparathyroidism

Symptoms: Bone pain, kidney stones, abdominal pain, psychiatric disturbances (“bones, stones, groans, moans”).
🩺 Spot Diagnosis: Hypercalcemia + bone/kidney issues = Hyperparathyroidism.

97. Rickets (Nutritional)

Symptoms: Bowing of legs, delayed milestones, widened wrists, rachitic rosary, frontal bossing.
🩺 Spot Diagnosis: Child with bowed legs + delayed walking = Rickets.

98. Scurvy (Vitamin C Deficiency)

Symptoms: Bleeding gums, petechiae, joint pain, poor wound healing, irritability in children.
🩺 Spot Diagnosis: Bleeding gums + malnourishment = Scurvy.

99. Beriberi (Vitamin B1 Deficiency)

Symptoms: Wet: heart failure, edema. Dry: neuropathy, foot drop, muscle wasting.
🩺 Spot Diagnosis: Edema + heart failure in poor nutrition = Beriberi.

100. Night Blindness (Vitamin A Deficiency)

Symptoms: Difficulty seeing in dim light, dry conjunctiva, Bitot’s spots, keratomalacia in severe cases.
🩺 Spot Diagnosis: Child with poor night vision + dry eyes = Vitamin A deficiency.

Clinical methods

🩺 Introduction to Clinical Methods

Clinical methods form the foundation of how healthcare professionals understand, diagnose, and treat patients. These are not just steps but an art that blends science, communication, observation, and judgment. Every good doctor begins with mastering these core skills.

🌟 What Are Clinical Methods?

Definition:
Clinical methods are the standard procedures used by a doctor to study the patient's illness through history-taking, physical examination, investigations, clinical reasoning, and treatment planning.

Simple Sentence: Clinical methods are the steps doctors follow to understand and treat a patient.

Example: A patient comes with stomach pain. The doctor first asks questions (history), checks the belly (examination), and then advises a scan (investigation).

🧩 Why Are Clinical Methods Important?

They help doctors understand the nature and cause of the disease.
They reduce the need for unnecessary tests.
They build trust between the patient and the doctor.
They form the basis of diagnosis and treatment.

Example: If a patient has fever and sore throat, proper clinical methods can help detect simple pharyngitis and avoid costly blood tests.

🪜 The Steps of Clinical Methods

Let’s go step by step, like a flow of how doctors examine a patient.

1️⃣ History Taking

Definition:
It means asking the patient questions to know about their illness in detail.

Simple Sentence: This is the patient’s story of how the disease started and progressed.

Example:
Patient says, “I have had a headache for 3 days.” The doctor then asks:

Where is the pain?
Is it one-sided or both sides?
Does light make it worse?

👉 This helps decide whether it is a migraine, tension headache, or something else.

Parts of History Taking:

Chief Complaint (main problem)
History of Present Illness (how the problem started)
Past History (old illnesses, surgeries)
Family History (genetic diseases)
Personal and Social History (habits, smoking, diet)

2️⃣ General Examination

Definition:
Looking at the patient as a whole, from head to toe.

Simple Sentence: A quick check of the patient’s general health.

What do we look for?

Pallor (paleness → anemia)
Icterus (yellow eyes → jaundice)
Cyanosis (bluish lips → heart/lung disease)
Clubbing (bulging nails → lung or heart problems)
Edema (swelling → kidney, heart, liver issues)
Lymph nodes (infections, cancers)

Example:
If a patient is pale and tired, the doctor may suspect anemia by simply checking under the eyelid.

3️⃣ Vital Signs

Definition:
The basic measurements that show the body’s essential functions.

Temperature (fever?)
Pulse rate (fast/slow?)
Blood pressure (high/low?)
Respiratory rate (normal/fast?)
Oxygen saturation (SpO₂)

Example:
A patient with fever and low oxygen saturation may have pneumonia.

4️⃣ Systemic Examination

Definition:
A detailed examination of each system in the body to look for signs of disease.

Simple Sentence: A focused check of the organs related to the complaint.

🔹 Examples of Systems:

Cardiovascular system – Heart sounds, murmurs
Respiratory system – Breath sounds, wheezing, crackles
Abdomen (Gastrointestinal) – Tenderness, swelling, organ enlargement
Nervous system – Reflexes, sensation, motor strength
Musculoskeletal – Joint pain, stiffness, deformity

Example:
A patient with cough and fever is checked for crepitations in the lungs to diagnose pneumonia.

5️⃣ Provisional Diagnosis

Definition:
The doctor’s initial guess of the disease based on history and examination.

Simple Sentence: It is a temporary diagnosis made before doing tests.

Example:
If a person has chest pain, sweating, and breathlessness, the provisional diagnosis could be a heart attack.

6️⃣ Investigations

Definition:
Tests done to confirm or rule out the diagnosis.

Simple Sentence: Medical tests help to confirm what the doctor suspects.

🔹 Examples:

Blood tests – CBC, sugar, liver function
Urine tests – Infection, protein, sugar
ECG – Heart rhythm
X-ray – Bones, lungs
CT/MRI – Brain, abdomen, spine
Ultrasound – Abdomen, pregnancy, fluid

Example:
If a doctor suspects dengue, he orders a CBC and NS1 antigen test.

7️⃣ Clinical Reasoning

Definition:
Using medical knowledge and logic to connect the symptoms, signs, and test results to reach the correct diagnosis.

Simple Sentence: It is the thinking part of being a doctor.

Example:
Fever + low platelets + travel history to a dengue area = suspect dengue.
But if the patient also has bleeding gums → more likely severe dengue.

8️⃣ Final Diagnosis

Definition:
The confirmed name of the disease after all steps.

Simple Sentence: The real name of the disease after confirmation.

Example:
Final Diagnosis: Typhoid fever, after blood culture test is positive for Salmonella typhi.

9️⃣ Treatment Plan

Definition:
Steps taken to treat the disease and relieve the patient's suffering.

Simple Sentence: Medicines, rest, and procedures advised to cure or control the disease.

Example:
In malaria – give antimalarial drugs + fever control + hydration.

🔟 Follow-up and Monitoring

Definition:
Checking the patient regularly to ensure recovery or manage long-term illness.

Example:
In diabetes, blood sugar is checked regularly and medicines are adjusted.

🧬 Simple Example Case Study

Case:
45-year-old male with fever, cough, and chest pain for 3 days.

Steps:

History – Fever began 3 days ago, productive cough, chest pain when breathing.
General exam – Fever 101°F, normal BP, pale.
Respiratory system exam – Crackles heard on the right side.
Provisional diagnosis – Suspected right lower lobe pneumonia.
Investigation – Chest X-ray confirms pneumonia.
Treatment – Antibiotics, fluids, rest.
Follow-up – Fever gone in 3 days, repeat chest X-ray in 1 week.

❤️ Human and Ethical Touch

Clinical methods also include:

Gaining the patient’s trust.
Ensuring privacy during examinations.
Explaining everything in simple terms.
Getting informed consent.
Being kind and non-judgmental.

Example:
If a patient is scared, take time to explain things calmly.

📝 Summary:

Step	Name	What Happens?
1	History	Ask questions
2	General Exam	Look at overall health
3	Vitals	Check pulse, BP, etc.
4	Systemic Exam	Focused check of organs
5	Provisional Diagnosis	First guess
6	Investigations	Order tests
7	Clinical Reasoning	Use brain + clues
8	Final Diagnosis	Confirmed disease
9	Treatment	Give medicine or advice
10	Follow-up	Check progress

🔚 Final Words

Clinical methods are like detective work in medicine.
You collect clues (history + exam), test your theory (provisional diagnosis), and solve the case (final diagnosis + treatment).

With practice, patience, and care, every student can become an excellent clinician.