Tuesday, June 24, 2025

SCHEME OF EXAMINATION OF SKIN



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

Symptom and diagnosis 2



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:

  1. History – Fever began 3 days ago, productive cough, chest pain when breathing.
  2. General exam – Fever 101°F, normal BP, pale.
  3. Respiratory system exam – Crackles heard on the right side.
  4. Provisional diagnosis – Suspected right lower lobe pneumonia.
  5. Investigation – Chest X-ray confirms pneumonia.
  6. Treatment – Antibiotics, fluids, rest.
  7. 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.

Tuesday, June 3, 2025

Causes of Diabetes

 

Diabetes mellitus is a group of metabolic disorders characterized by high blood sugar levels (hyperglycemia). The causes vary depending on the type of diabetes, but they generally involve a combination of genetic, autoimmune, lifestyle, and environmental factors.


1. Type 1 Diabetes (Autoimmune)

  • Cause: Autoimmune destruction of insulin-producing beta cells in the pancreas.
  • Triggers:
    • Genetic predisposition (HLA genes)
    • Viral infections (e.g., Coxsackievirus)
    • Environmental triggers (possibly cow's milk exposure in infancy)
  • Insulin deficiency is absolute.

2. Type 2 Diabetes (Lifestyle-related and Genetic)

  • Cause: Insulin resistance + progressive beta-cell dysfunction.
  • Major risk factors:
    • Obesity (especially central)
    • Sedentary lifestyle
    • Unhealthy diet (high sugar/refined carbs)
    • Genetics (family history)
    • Age > 40 years (but increasingly seen in younger adults and children)
    • Ethnicity (South Asians, Africans at higher risk)
    • Metabolic syndrome

3. Gestational Diabetes (During Pregnancy)

  • Cause: Hormonal changes during pregnancy leading to insulin resistance.
  • Risk factors:
    • Obesity
    • Family history of diabetes
    • History of PCOS
    • Previous macrosomic baby (>4 kg)
    • Age > 25 years at pregnancy

4. Secondary Diabetes (Due to other conditions)

  • Pancreatic disorders:
    • Chronic pancreatitis
    • Pancreatic cancer
    • Cystic fibrosis
    • Hemochromatosis
  • Endocrine disorders:
    • Cushing's syndrome
    • Acromegaly
    • Pheochromocytoma
    • Hyperthyroidism
  • Drugs:
    • Glucocorticoids
    • Thiazide diuretics
    • Atypical antipsychotics (e.g., olanzapine)
    • Statins (in rare cases)
  • Infections:
    • Congenital rubella
    • CMV

5. Genetic Defects (Monogenic Diabetes)

  • MODY (Maturity Onset Diabetes of the Young): Due to single gene mutations affecting insulin production.
  • Neonatal Diabetes: Appears in the first 6 months of life.

Summary Table:

Type Main Cause Key Features
Type 1 Autoimmune beta-cell destruction Insulin-dependent, early onset
Type 2 Insulin resistance + beta-cell dysfunction Lifestyle-related, gradual onset
Gestational Pregnancy-related insulin resistance Temporary, risk of future T2DM
Secondary Other diseases/drugs affecting glucose Treat underlying condition
Genetic (MODY, NDM) Single gene mutations Rare, diagnosed early or in families


Cardiovascular System History taking and Clinical Examination

  Cardiovascular History Taking 1. Presenting Complaints (PC) Document the main symptom(s) with duration . Chest pain (angina pect...