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RESPIRATORY SYSTEM
- Introduction
Name: Age: Sex: Handedness: Resident of:
Education: Occupation: Religion: Informant: Reliability: - Chief Complaints (in chronological order)
- HOPI
- Cough- Onset, Dry/Wet, Day/Night/ Postural/seasonal variation, associated with, aggravated by / relieved by, present status
- Expectoration- Color, Consistency, Quantity, Smell, Diurnal/ Postural variation, More in the early morning, Aggravated by / Relieved by, Present status
- Hemoptysis- Color, Quantity, Frequency, Postural variation, Associated with, Last episode, Postural symptoms, Aggravated by / Relieved by, Present status
- Dyspnoea Onset, Progression (describe wrt activities), Associated with, Aggravated by / Relieved by, Present status, MMRC grading (0-4), PND, Orthopnoea
- Wheeze Duration, Periodicity, Seasonal/Diurnal variation, Associated allergic features like allergic rhinitis, urticaria, recurrent sneezing, Aggravated by / Relieved by, Present status
- Chest pain-(OLD CAARTS) Onset, Location, Duration, Character, Associated features, Aggravating and Relieving factors, Radiation, Time, Severity
- Fever- Grade, Max Temp, Type, Associated with chills& rigors, Diurnal variation, Evening rise of temp., night sweats, relieved by, present status
- Anorexia
- Weight loss- Quantified/Unquantified, Intentional /Unintentional, Significant/insignificant
- Hoarseness of voice
- Ptosis
- Recurrent respiratory infection
- History suggestive of Collagen Vascular Disease-Joint pain/rash/oral ulcers/seizures/excessive hairfall
- Palpitation /Easy fatiguability
- Bladder/Bowel symptoms
- Swelling of face/ edema
- CNS symptoms-LOC/Head ache/weakness/vomiting
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- Past History
DM/ HTN/ TB/ Bronchial asthma/IHD
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Jaundice/Blood Txn
Allergies/FB inhalation
Trauma/ Surgeries/ similar illness in the past - Personal History
Smoking - pack years/smoking index/ Chula smoking--- Content provided by FirstRanker.com ---
Alcohol/Tobacco
Veg/Non veg
Marital status/ Children/Menstrual history in detail
High risk behavior/Bladder/Bowel/Sleep
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Socio-economic status/ over crowding - Family history
TB/Similar illness in the family - Treatment history
- Summary at the end of the history
- Impression/DD
General physical examination
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- Conscious/oriented/comfortable
- Ht- Weight- BMI- Temp-
- Pulse- (Rate, Rhythm, Volume, Character, Peripheral pulses. R-R/ R-F delay, Pulse deficit, Vessel wall, Carotid bruit)
- BP- mmHg, Respiration - Rate, Rhythm, Type (Abdomino-Thoracic / Thoraco-Abdominal)
- SpO2- BCG scar
- P/J/CY/CI/LNE/PE/JVP/rash/facial plethora/neck veins/puffiness of face/Pemberten sign/Lt supra clavicular LN /Voice/asterixis
- Signs of Malnutrition- Temporal / Buccal fat wasting, Hollowness of supraclavicular – infraclavicular fossae, Emaciated look
- Nicotine stain- lips, Nail, teeth, gums, Vitamin deficiencies
- Spine - Kyphosis / Scoliosis /Gibbus, Skull
- Peripheral signs of TB / Sarcoid / HIV
- Marfanoid features, Thyroid, Testes, Low hair line, Horners Features, Congenital anomalies
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Systemic Examination
Respiratory System:
Upper Respiratory Tract
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- Ear, Nose (polyps, postnasal drip, DNS)
- Throat (tonsils, oral hygiene, nicotine stain)
Inspection
- Chest symmetry, Pectus excavatum/ Carinatum
- Shape of chest
- Respiratory movements - equal / decreased
- Tracheal position / Trail sign
- Signs of volume loss – shoulder droop/wasting (supra/infra clavicular)/Nipple position/
- Spino scapular distance/ Rib crowding/Intercostal spaces
- Intercostal space indrawing / Hoover's sign/Respiratory paradox/ Respiratory alternans
- Accessary muscles of respiration
- Apical impulse
- Dilated veins/Scars/Sinuses/Visible pulsations/Skin
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Palpation
- Inspiratory findings confirmed
- Tracheal position
- Apical impulse
- Rib crowding
- Chest wall tenderness/ Crepitus / SC emphysema/ Nodules / LNE
- Harrison's sulcus / Hoover's sign
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Measurements
| Chest Circumferance | Expansion | Hemithorax | Hemithorax expansion | Spino Scapular Distance | Antero-Posterior Diameter | Transverse Diameter | |
|---|---|---|---|---|---|---|---|
| Right | |||||||
| Left |
| Supra Clavicular | Infra clavicular | Mammary | Axillary | Infra Axillary | Supra Scapular | Inter Scapular | Infra Scapular | ||
|---|---|---|---|---|---|---|---|---|---|
| Respiratory Movement | Rt | ||||||||
| Lt | |||||||||
| Percussion | Rt | ||||||||
| Lt | |||||||||
| Kronig's | Rt | ||||||||
| Isthmus | Lt | ||||||||
| Percussion over clavicle | Rt | ||||||||
| Lt | |||||||||
| Percussion over Traube Space | |||||||||
| Liver Dullness, Tidal Percussion | |||||||||
Auscultation
| Supra Clavicular | Infra clavicular | Mammary | Axillary | Infra Axillary | Supra Scapular | Inter Scapular | Infra Scapular | ||
|---|---|---|---|---|---|---|---|---|---|
| Air Entry | Rt | ||||||||
| Lt | |||||||||
| VF, VR | Rt | ||||||||
| Lt | |||||||||
| VBS | Rt | ||||||||
| Lt | |||||||||
| Bronchial Breathing | Rt | ||||||||
| Lt | |||||||||
| Wheeze/ Rhonchi | Rt | ||||||||
| Lt | |||||||||
| Crackles | Rt | ||||||||
| Lt | |||||||||
| Whispering Pectroloquy | |||||||||
| Aegophony | |||||||||
| Pleural Rub | |||||||||
Cardio-Vascular System
- Apical Impulse
- Precardial buldge, Parasternal heave
- Palpable sounds, Thrill
- S1,S2,S3,S4
- Murmurs
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Abdomen
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- Symmetry/Distension
- All quadrants moves with respiration
- Soft, Tenderness, Liver, Spleen, Any mass, Bowel sounds, Hernial orifices
Central Nervous System
- Consciousness, Orientation
- FND, Horner's Syndrome, Planters
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Summary after Examination
Diagnosis/DD
Investigation
Treatment
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This download link is referred from the post: MBBS Lecture Notes for all subjects (updated for 2021 syllabus) - All universities