This document provides guidelines for case taking in Ayurveda. It outlines the objectives of case taking as establishing a relationship with the patient, obtaining medical and personal history, and gathering information needed for diagnosis. It describes collecting data on the chief complaint, history of present illness, past history, drug history, family history, physical exam including inspection, palpation, percussion and auscultation of various body systems. It provides "dos and don'ts" of case taking and rules for conducting the physical exam. The document emphasizes collecting subjective and objective findings in the patient's own words to accurately understand the case.
Approach to internship (mbbs in bangladesh perspective)Pritom Das
Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.
Approach to internship (mbbs in bangladesh perspective)Pritom Das
Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.
History taking
In veterinary medicine, history taking is most important from a clinical point of view because animals are unable to describe their pain and problems (symptoms).
History taking (History of Physical Examination)pankaj rana
A History of Physical Examination Texts and the Conception of Bedside Diagnosis. ... Throughout this paper we construct a difference between a “bedside diagnosis,” made when the physician and patient are in each other's presence, and a “remote diagnosis,” made when the patient and physician are separated.
History taking
In veterinary medicine, history taking is most important from a clinical point of view because animals are unable to describe their pain and problems (symptoms).
History taking (History of Physical Examination)pankaj rana
A History of Physical Examination Texts and the Conception of Bedside Diagnosis. ... Throughout this paper we construct a difference between a “bedside diagnosis,” made when the physician and patient are in each other's presence, and a “remote diagnosis,” made when the patient and physician are separated.
History Taking
1.Name, age, sex, marital status, occupation, address (Demographics)
2. Presenting complaints
3. History of present illness
4. Systemic inquiry
5. Past history
6. Menstrual history
7. Treatment history
8. Family history
9. Personal and social history
10. Occupational history
Why regular health check-ups are vital for your well-being.pptxRahul Khanna
Maintaining good health is essential for leading a happy and productive life. However, many people tend to ignore their health until they fall sick. Regular health check-ups are an effective way to identify any underlying health issues and prevent them from turning into more severe problems.
Depression is a common illness worldwide, with an estimated 3.8% of the population affected, including 5.0% among adults and 5.7% among adults older than 60 years.
The concept of pain in Ayurveda is very closely related with its concept of health and disease. Life is a structure as well as function. So abnormalities of the structure and functions of life are mutually contributory. Life is a flow and when there is obstruction in the path of flow there will be turbulence and the smooth flow of life is disturbed, and if the obstructions are in the vital area that will be critical and may fatal.
Marma therapy (vital point injury treatments)It is a well-respected treatment modality known to be helpful and safe for a wide range of conditions. For these reasons, it is rapidly achieving international goodwill. Marma therapy involves a wide range of technical tissue stimulations conducted by a practitioner’s finger, hand, elbow, knee, or foot applied to muscle or soft tissue at vital points with some altered pressure variations and also with thermal stimulation. often uses manual techniques such as pushing, rubbing, kneading, or high-intensity, high-frequency
Revitalizing Ayurveda through integrated scientific research and development initiatives is very much important in terms of improving the health care standard quality of life and also in view of enormous potentials and benefits this system could offer to the field of sports medicine.
The traditional system of medicine that includes marma therapy and kalari chikitsa is very much correlated with sports medicine. Marma chikitsa –the treatment of vital spots-in Kerala as Nadee- marma chikitsa and in southern Tamil nadu as adimurai. In Kerala from the time immemorial, every sports related injuries were managed with Marma and Kalari chikitsa; integral part of Ayurveda. The West better recognizes the ancient Indian medicine system now. It is less known that great strides were made in the field of surgery too. These holistic approaches have not been scientifically evaluated yet, but now it has become the need of the 21st century.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
2. Objectives
To establish a positive professional relationship.
To provide the clinician with information concerning
the patient’s past medical / surgical & personal history.
To provide the clinician with the information that
may be necessary for making a diagnosis.
3. History taking Physical examination
Personal -data General survey
Chief complaint Local examination
History of present illness General examination
Past history
Drug history
Allergic history
Personal history
Family history
Immunization history.
Provisional diagnosis
Special investigation
Diagnosis
Treatment
Progress
Follow up
Termination.
4.
5. Do’s and Don’ts of case
taking:
● The symptoms should be written from
different sources like patient himself,
attendants, physician’s own
observations.
● Data should be collected in patient’s own
words.
● At the beginning the physician should
advise the patient to speak slowly.
● Physician should record important points
what patient narrates.
6. ● Physician should begin a fresh line with every new
circumstances mentioned one below the other and
subsequently when more explicitly (Precisely and
clearly communicated) explained, be added up.
● The physician is to remind the patient in general
terms when in his narration he omits to say anything
about several parts and functions of his body or
about his mental state.
● Special questions are to be asked only when the
physician feels that the peculiar, uncommon
symptoms of the case has not yet come out in the
case taking. Finally the physician has to note down
his own observations about the individual peculiarity
of the patient in disease and health.
7. ● Don’t interrupt unless patient or his attendant
wanders of to the other matters.
● Don’t ask any direct question that can be
answered by yes or no OR don’t ask any leading
question that suggest an answer.
● If patient coming from other physician In chronic
cases the original disease picture is to be
obtained by referring to the original symptoms
appearing before taking medicine or after
discontinuing it for several days when the
medicinal effects go away
8. Rules of Case taking
● Confidential, Concised, complete, concrete
questions must be asked.
● Accurate questions must be ask
● Selective questions must be ask
● Encouragement to answer must be given
● Tactful and Truthful questions should be asked.
● Analytical study
● Keen questions
● Impersonal relationship must be kept.
● Negations should be avoided.
9. ● Gentle approach is necessary
● Relevancy of questions and reminder question
should be kept.
● Repetition should be avoided
● Unscientific word should be avoided
● Leading words should be avoided
● Experimental approach
● Self expression
10. Personal -data
● Name Case no
● Age Ward No
● Sex Bed No
● Religion DOA
● Social status DOD
● Occupation
● Residence
● Nearest relative ;
11.
12.
13.
14.
15. Chief complaint
● Presenting complaints with duration
● Listing of presenting complaints in the order of
severity.
● What are your complaint
● What bring you here
● How long you are suffering
● Were you perfectly well before this symptoms.● Brief
● Exact nature and
duration
● Support –friends/
relative etc
● Time of last health
16. History of present illness
● History of presenting complaints in Chronological
order:-
● Site,
● Mode of onset of the symptoms,
● Cause of onset if any.
● Course of the disease - (progressive / static /
decreasing - continuous or intermittent)
● Associated symptoms., Aggravating factors, Relieving
factors.
● Treatment History.
● These should be recorded on patient’s own
language and not in scientific terms
● Avoid leading questions.
17. Past history
● In chronological order with duration.
● Mention the treatment /surgical procedures the
patient has undergone.
● Diseases
● Injuries
● Childhood disease
● Treatment history
● Toxicity
● Abode – area of residence
● Travelling history
● Operations
● Repetition of disease
18. Drug history
● About all the drugs he was on
● About steroids, anti hypertensive, insulin, hormone
therapy, contraceptive pills etc.
● It is essential to note both systemic and topical
medications, including prescription and over-the-
counter products. Some medications are more likely to
cause rashes than others,
● but drug reactions are common and almost any agent
may be implicated. How long has
● the patient been using each medication? If any were
recently discontinued, when?
● Although new medications (taken for day or weeks)
are the most likely to cause drug reactions, even those
taken continuously for years may cause reactions.
19. Allergic history
● Allergic to any medicine
● It should be noted in red on the cover of the case
sheet.
● Inquire about known allergic reactions to
medications, foods and
● topical agents (i.e., cosmetics, soaps) as well as
about fever and asthma.
20. Personal history
● Marital history
● Occupational,
● Environmental, Social,
● food (ingestive and digestive) capacity,
● Recreation,
● Exercise,
● Habits,
● Bowels,
● Micturition,
● Addictions,
● Sleep and
● Menstrual - Sex life.
21. Family history
● History of familial diseases
● Position of patient in the family
● No of persons I family, their age
● Hereditary disorders in family, if any
● State health of family members
● Cause of death of immediate relatives.
Immunization history.
23. General survey
● General assessment of illness (seriously or
moderately ill,)
● Mental state and intelligence
(oriented/disoriented)
● Mental status- level of consciousness.
● State of nutrition (well nourished, moderately
nourished or poorly nourished)
● Attitude (restless Or still),
● Decubitus (patient lying curled up or lying on his
side, back etc.
● Colour of the skin (pallor - cyanosed),
● Eruption if present (macules, papules, vesicles,
pustules) also should be noted.
24. Vital data
● Blood pressure Respiration
● Temperature
● Pulse rate Rhythm Volume Tension
Regular or Large or Soft or
irregular Small Hard.
Intermittent, normal
abnormal
Normal resting respiratory rate 14-20
breaths/minute.
Rapid respiration is called tachypnea.six classic vital signs (blood pressure, pulse, temperature, respiration, height, and weight)
26. Cardio vascular System
● Pulse : frequency and character.
● Cyanosis.
● Heart : palpate, percuss, auscultate.
● Listen for 1st and 2nd sounds ;
each should be clear "lub-dub.
27. Respiratory System
● Dyspnoea; frequency of respiratory
● movements ; laryngeal stridor, spasm, or obstruction.
● Warmth or coldness of breath. Cough.
● Inspection ; signs of collapse at bases and clavicular regions.
● Palpation ;ronchi may sometimes be felt. Percussion.
● Auscultation.
● Puerile respiration.—Normal in children
● Harsh respiration.—In moderate degrees of consolidation and in
Emphysema.
● Bronchial respiration.—Indicates slight condensation of lung
substance.
● Tubular respiration.— in pneumonia.
● Cavernous respiration.—Indicates probable cavity from phthisis;
dilated bronchus.
28. ● Inspection
● Respiratory rate 19/min.
● Shape of Chest Normal
● Movement Bilaterally symmetrical
● Palpation
● Percussion
● Auscultation Hearts sounds Murmur
● Intensity of respiratory sounds S1S2 Normal None
● Type of respiratory sounds Normal
● Adventitial sounds None
● Vocal resonance Normal
29. Alimentary system
● Digestive System, Tongue, lips, throat ; state of
dentition.
● Appetite and liking for food ; how it is fed.
● Vomiting.
● State of bowels.
● Abdomen : whether full or empty ; palpate ; note
size of liver and spleen.
● State of umbilicus. Pain after food ; flatulence ;
abdominal tenderness; griping of bowels.
30. Alimentary system
● Inspection
● Contour Normal
● Movement of abdominal
wall WNL
● Veins Not Visible
● Umbilicus Central,
Inverted
● Scar None
● Palpation
● Superficial NAD
● Deep
● Liver WNL
● Spleen WNL
● Kidney WNL
● Gall Bladder
WNL
● Bowels WNL
● Lymph nodes Palpable
● Other mass None
● Fluid Thrill
Absent
● Bimanual
● Percussion
● Upper border of liver
Normal
● Shifting dullness
Normal
● Other lumps Absent
● Auscultation
● Bowel sounds WNL
31. Nervous System
● General condition. Note the amount of movement of
limbs, hands, and feet, or whether this is absent.
● Intelligence, as indicated by movements of face and eyes
directed towards objects noticed.
● Sleep ; making noises ; consciousness ; exhaustion ;
coma. Paralysis ;
● Examine each limb. Spasm ; tremor ; contraction.
Motor Power.—Reflex action on tickling hands, putting
finger in mouth, etc. Playfulness ; ability to laugh.
● Power over large joints, small joints, movements of
fingers, etc.
Cranial Nerves.—Movements of eyes and face.
● Head. — Its shape and circumference. Fontanelle is
patent, prominent, or depressed. State of other sutures.
● Ophthalmoscope.
32. ● Mental State
● Consciousness Fully Conscious / conscious/ unconscious
● Memory Good / moderate/ bad
● Intelligence Normal / abnormal
● Mood Highly changeable / changeable/
● Fear, Anxiety etc. Fear of storms
● Delusions/ illusions None
● Temperament Irritable
● Others
● Orientation
● Time Normal
● Place Normal
● Person Normal
● Behaviour Normal
● Speech Normal
● Involuntary Movement None
34. Musculo- skeletal
● Limbs Normal
● Upper
● Right
● Left
● Lower
● Right
● Left
● Skull Normal
● Spine Normal
● Sternum Normal
● Ribs
Normal
● Inspection
● Palpation
● Range of Motion
● active range of
motion (joints
moved by
patient).
● passive range of
motion (joints
moved by
examiner)
37. General examination
● For diagnosis and deferential diagnosis
● For selecting the type of anesthesia
● To determine the nature of operation
● To determine the prognosis
۞ Head and neck
۞ Upper limb
۞ Thorax
۞ Abdomen
۞ Lower limb
۞ External genitalia
38. HEAD AND NECK: Cranial nerves, eyes, mouth and
pharynx, movements of the necks, carotid pulse,
thyroid gland.
UPPER LIMB: - Power, tone, wasting of muscles
reflexes and sensation axilla and lymph nodes, finger
nails.
● Deformities and contracture
● Local swelling
● Oedema
● Lymph nodes
● Muscles , bones , Joints
● Hand – handwriting/ abnormal movements /
deformities etc
● Blood vessels
39. THORAX: Type of chest - examination of breast,
presence of any dilated vessels, and pulsations, apex
beat, examination of lungs and heart.
ABDOMEN: Position of umbilicus, scars, dilated vessels,
abdominal reflexes visible peristalsis, hernial orifices,
genitalia, inguinal glands, rectal examination,
gynecological examination, if required.
LOWER LIMBS: Power, tone, wasting of muscles,
reflexes, sensations, varicose veins, oedema, and
joints.
● Deformities and contracture
● Local swelling
● Oedema
● Lymph nodes
● Muscles , bones , Joints
● Blood vessels
● Toes
● Nails shape /appearance / lesions
40. SPECIFIC EXAMINATION
● In vrana (dushta vrana / sadyovrana/ dagda vrana
)
● In Bagandara (fistula / sinus )
● In bagna (sandhimoktha/ kandabagna )
44. II) IN VARNA PAREEKSHA /
BHAGANDARA PAREEKSHA
(I) Size and shape
(II) Number
(III) Position
(IV) Edge
(V) Floor
(VI) Base
(VII) Discharge
(VIII) Surrounding area
(IX) Tenderness
(X) Depth
(XI) Bleeding
(XII) Relations with
deeper structures
45. III) In BHANGA
a). Type: Sandhibhangam /Asandhibhangam
b) 1. TYPE OF SANDHIBHANGAM
Utpishtam Vislishtam Vivarthitam
Avakshiptam Athikshiptam
Tiryakshiptam
b) 2.) TYPE OF ASANDHIBHANGAM
Karkatakam Aswakarnam
Choornitham Picchitham
Asthichallitham Kandabhagnam
Majjanugatham Athipathitham Vakram
Chinnam Patitham Sphutitham
46. c) BHANGA PAREEKSHA
(I) Deformity'
(II) Shortening
(III) Skin changes
(IV) Bony Tenderness
(v) Swelling
(VI) Abnormal mobility
(VII) Crepitus
(VIII) Absence of transmitted movements
(IX) Movements of Proximal and distal joints
(X) Injuries to arteries/ nerves/ tendons/ viscera
47. IV) FOR ANO RECTAL
EXAMINATION
● Inspection
● Per rectal examination
● Digital examination
● Proctoscopic examination
● Probing
● Other examination
49. Relevance
● Karya desa – chikitsa purusha
● Regarding the span of life, individual strength,
● intensity of morbidity and dosage of medicine
Cha Vi -94
50. Relevance ………..
● Strong medicine in a weak patient leads to patient
death.
● It depends with agni and vayuvadi dosha
predominance..
62. Samhanatah
● PRAVARA
● MADHYAMA
● AVARA.
● Examination of the compactness of the organ and
structure
● Symmetrical well divided bone structure
● Well knee joint
● Well bound muscle and healthy vascularity
63. Pramanatha
● Anthropometric consideration in examination of
patient
● PRAVARA
● MADHYAMA
● AVARA.
No Organ Height Length Breadth Circum Other
1 FEET 4 14 6 - -
2 CALF 18 16
3 THIGH 18 30
4 ABDOMEN 12 10
5 CHEST 12 24
6 WHOLE
BODY
84 84
64. Satmyatah
● AHARA
● VIHARA
● ADDICTION
● Examination of the homologation.
● Habituated with ghee , milk, oil or such other
factor.
● That are wholesome are naturally endowed with
strength.
● This strength could be expressed either in
resisting the incidence of the disease.
65. Satvatha ( satva pareeksha )
● SATWA
● RAJA
● TAMA
● Examination of the pscychological level of mental
faculties of the patient
● Inter relatedness of the mind and body
● Psychic disease/ somatic disease/ or combined.
● Satvika – brahma, aarsa, aindra, yaamya, varuna,
kauveera, gandarva.
● Rajasa – aasura, raakshasa, paisaacika, sarpa,
praita, sakuna,
● Tamasa – pasava, matsya, vanaspatya.
66. Ahara sakthitah
● MANDA
● VISHAMA
● TEEKSHNA
● Examination of the digestive capability of the patient.
● Food intake and digestive capability.
● Concept of agni
● Samagni – vatha pitha and kapha samavesha
● Visamagni – Vata
● Tikshnagni – Pitha
● Mandagni – Kapha
67. Vyayama sakthitha
● BALISHTA
● MADHYAMABALA
● DURBALA
● Examination of the endurance level of the patient.
● Capacity of exercise
● Determined by ability to do work
● For helps in categorisation of the strength of the the
individual.
● Strength is the basic requisite for maintenance of
health.
● Vyadikshamatwa.
68. Vayasatha
● BALYA (>16)
● MADHYAMA(16-
70)
● JEERNA (70<)
● Examination of the chronological age and
lifespan.
● With ref to his age , which represents the state of
his body depending upon the length of time that
passed since birth.
● For determining the probable lifespan of a person
based on the nature of physique, type of
constitution and rishta lakshana.
72. It is also called tentative
diagnosis or working diagnosis.
It is formed after evaluating
the case history & performing the
physical examination.
74. INVESTIGATIONS
● Routine blood investigation
● Routine urine investigation
● Diabetes test
● Cholesterol test
● LFT
● RFT
● Cardiac test
● Thyroid function test
● Arterial investigations
● Culture and sensitivity test
75. ● FULL BLOOD COUNT
TEST VALUE RANGE SIGNIFICANCE
Total WBC count 12000/mm3 5000- 10000/mm3 HIGH
Neutrophil 84.8% 40-80% HIGH
Lymphocytes 44% 20-40% High
Lymphocytosis
Monocytes 12% 2.0-10.0% High
Monocytosis
Basophils 7.6% 0.0-2.0% HIGH
(basophilia)
Eosinophils 7.3% 1.0-6.0% HIGH
Eosinophelia
RBC count 4.5xm /mm3 4.3-6million/mm3 NORMAL
Platlet count 120000/mm3 150000-400000/mm3 LOW
Thrombocytopenia
76. ● FULL BLOOD COUNT
TEST VALUE RANGE SIGNIFICANCE
Hb Concentration 12.4g/dL 13.5-16.5g/dL
12-15 g/dl (F)
NORMAL
Hematocrit(PCV) 35.7% 35-50% NORMAL
Mean Corpuscular
Volume(MCV)
78.9fl 80.0-97.0fl NORMAL
Mean Corpuscular
Hemoglobin (MCH)
27.4 pg 26.0-32.0 pg NORMAL
Mean Corpuscular
Hemoglobin
Concentration(MCHC)
34.7g/dL 31.0-36.0 g/dL NORMAL
Red Cell Distribution
Width(RDW)
13.2% 11.5-14.5% NORMAL
ESR 14/hr 0-15 M
0-20 F
NORMAL
MPV 6.8 – 10 fl
77. Blood Biochemistry
TEST VALUE RANGE SIGNIFICANCE
Serum magnesium 4 mg/dl 2-3 mg/dl HIGH (renal
deficiancy)
Serum phosphorus 8mg % 2.5-4.8 mg% HIGH (RD, hypo
parathyroidism)
S.Calcium 4% 2.1-2.6m mol/L High
Hyper parathyroidsm
S. Chlorides 32% 98-109m mol/L Low
Renal failure
S.Sodium 76 135-150 Meq/L HIGH
(diabetes insipidus )
S albumin 7.3% 3.5 – 5.3 gm% HIGH
Shock
S globulin 55mg/dl 23-40 mg/dl HIGH
Hepatic disease
S. Fibrinogen 1 gm/100ml 0.2 – 0.4 gm/100ml HIGH
Rheumatic fever
TEST VALUE RANGE SIGNIFICANCE
Serum magnesium 4 mg/dl 2-3 mg/dl HIGH (renal
deficiancy)
Serum phosphorus 8mg % 2.5-4.8 mg% HIGH (RD, hypo
parathyroidism)
S.Calcium 4% 2.1-2.6m mol/L High
Hyper parathyroidsm
S. Chlorides 32% 98-109m mol/L Low
Renal failure
S.Sodium 76 135-150 Meq/L HIGH
(diabetes insipidus )
S albumin 7.3% 3.5 – 5.3 gm% HIGH
Shock
S globulin 55mg/dl 23-40 mg/dl HIGH
Hepatic disease
S. Fibrinogen 1 gm/100ml 0.2 – 0.4 gm/100ml HIGH
Rheumatic fever
78. Urine Routine
TEST VALUE RANGE SIGNIFICANCE
Serum magnesium 4 mg/dl 2-3 mg/dl HIGH (renal
deficiancy)
Serum phosphorus 8mg % 2.5-4.8 mg% HIGH (RD, hypo
parathyroidism)
S.Calcium 4% 2.1-2.6m mol/L High
Hyper parathyroidsm
S. Chlorides 32% 98-109m mol/L Low
Renal failure
S.Sodium 76 135-150 Meq/L HIGH
(diabetes insipidus )
S albumin 7.3% 3.5 – 5.3 gm% HIGH
Shock
S globulin 55mg/dl 23-40 mg/dl HIGH
Hepatic disease
S. Fibrinogen 1 gm/100ml 0.2 – 0.4 gm/100ml HIGH
Rheumatic fever
TEST VALUE Test VALUE
Colour CLEAR Glocuse NIL
Reaction ACIDIC Ketones NIL
Specific gravity 1.01-1.025
albuminurea
Bile salts / pigments NIL
Volume 1000-2500
ML/day
Epithelial cells NIL
Transparency clear and
transparent
Crystals NIL
Odour AROMATIC Casts NIL
Protein less than
.1 gm %
Blood NIL
79. Diabetes test
TEST VALUE RANGE SIGNIFICANCE
FASTING BLOOD SUGAR 120 mg/dl 70-110mg/dl High
PPBS 150 mg/dl 80-140 mg /dl High
RBS 180 mg /dl 80-160 mg/dl High
HB A1C Normal 4-6 %
Good control 6-7 %
Fair control 7-8%
Poor control 9 > 8% High
80. Cholestrol test
TEST VALUE RANGE SIGNIFICANCE
S. Cholesterol 210 mg/dl 130-200 mg/dl High
HDL 90 mg/dl 30-80 mg /dl Good
LDL 180 mg /dl 100-150 mg/dl Bad
VLDL 4-6 %
S. Triglycerides 280 45-160 mg/dl High
Normal: < 150 mg/dL.
Borderline-high: 150 to 199
mg/dL
High: 200 to 499 mg/dL
Very High: >499 mg/dL
81. Body mass index (BMI)
BMI = (Weight in pounds) / (height in inches
squared) x 703
● BMI < 18.5 Underweight
BMI 18.5-24.9 Normal weight
BMI 25.0 – 29.9 Overweight
BMI 30 and above Obese
82. Comprehensive Metabolic Panel(CMP)
Panel of 14 tests that gives
● kidneys and liver,
● electrolyte and acid/base balance
● levels of blood glucose
● blood proteins.
● Glucose
● Calcium
● Albumin
● serum
● Total Protein
● Sodium
● Potassium
● Chloride
● BUN (blood urea nitrogen
● Creatinin
● ALP (alkaline phosphatase) - liver
disease
● ALT (alanine amino transferase,
SGPT
● AST (aspartate amino transferase
SGOT
● Bilirubin
83. TEST VALUES RANGE SIGNIFICANACE
Total protein 79g/L 6.6 – 8.7gm/dl NORMAL
Albumin 15g/L 3.2-5 mg/dl LOW
Globulin 64g/L 2.3-3.5 mg/ HIGH
Albumin/Globulin ratio 0.23 - -
Total bilirubin 3mg/dl 0.1-1.2 mg/dl HIGH
Direct bilirubin 1 mg/dl <.3 mg/dl HIGH
AST (SGOT) aspartate
aminotransferase
5 – 45 U/L heart and muscle
diseases
ALT(SGPT) alanine
aminotransferase
5-41 IU/L
ALP Alkaline phosphatase 33-131 U/L liver and non-liver
related diseases.
GGT (gamma glutamyl
transpeptidase)
0-45 U/L. alcohol or other liver-
toxicity
LIVER FUNCTION TEST
85. TEST VALUES RANGE SIGNIFICANCE
Uric
acid (male)
9.2 mg /dl 2.0 - 8.0 mg/dl
High
Gout
(female) 2.0 - 7.5 mg/dl
Creatinine 1.5 mg/dl .5- 1.4 mg/dl High (RA,
Heart failure)
Urea 48mg/L <40 mg/L High
BLOOD UREA
NITROGEN
(BUN)
7 - 20 mg/dl
Pre renal failure
● Azo
● Azotemia
86. CARDIAC ENZYME
TEST VALUES RANGE SIGNIFICANCE
Creatinine
Kinase(CK)
539 U/L 30-200 U/L HIGH
Aspartate
Transaminase (AST)
137 U/L 5-34 U/L HIGH
Lactate
Dehydrogenase
(LDH)
774 U/L 125-243 U/L HIGH
MPO
myeloperoxidase.
Goal: <400 pmol/L
Low risk: 400 - 480
pmol/L
High risk: ≥480
pmol/L
87. Infection scrutinize test
TEST VALUES RANGE SIGNIFICANCE
CRP normal 9 mg/L < 5.0 mg/l HIGH (CVD)
0 – day in child 7 U/L <3.2 mg /l HIGH
1 week 4 U/L <1.6 mg/l HIGH
CPK Creatine
phosphokinase
200 iu/l 8 - 150 IU/L HIGH
CEA Non smokers 3.4ng/ml
Smokers 5.2ng/ml
CPK MB Upto 24 U/L
LDH 53-134 U/L
Amylase Upto 95U/L
88. Arthritis test
TEST VALUES RANGE SIGNIFICANCE
RA factor 40 lu/mL < 20 lu/ml +ve
ASO titer 7 U/L <200 lu /ml HIGH
4 U/L <1.6 mg/l HIGH
CRP 5mg/dl
GTT
ANA
Anti-nuclear antibody
autoimmune
disorder
C-reactive protein
(CRP)
Inflammatory
HLA-B27 Ankylosing
spondylitis
Cyclic Citrullinated
Peptide Antibody
RA
89. Thyroid function test
TEST VALUES RANGE SIGNIFICANCE
T3 60-181ng/dl Thyrotoxicosis
Greave’s disease
T4 4.5-12.5 ng/dl Hyper and hypothyroidsm
TSH .3-4 .4-4 euthyroidsm
.1-.4 preclinical
hypothyroidsm
<.1 hyper thyroidsm
4-20 sub clinical
hypothyroidsm
>20 primary hypothyroidsm
90. ● ARTERIAL BLOOD GAS
TEST VALUES RANGE SIGNIFICANCE
pH 7.470 7.320-7.420 HIGH
Partial Carbon
Dioxide
32.2mmHg 40.0-51.0mmHg LOW
Partial Oxygen 65.6mmHg 72.0-90.0 mmHg LOW
Bicarbonate 22.9mmol/L 24.0-28.0mmol/L LOW
Base Exces 0.2mmol/L -2.0-3.0mmol/L NORMAL
Total Hb 16.2g/dL 11.5-17.4g/dL NORMAL
91. ● COAGULATION SCREEN
TEST VALUES RANGE SIGNIFICANCE
Prothrombin Time(PT) 14.4sec 9.1-12.6 sec HIGH
International
Normalised Ratio
(INR)
1.36 0.9 – 1.2
Activated Partial
Prothrombin
Time(APTT)
29.9 sec 25.4-38.4 sec NORMAL
Bleeding time 4 m 2.5 minute High
Clotting time 10 m 5-8 minute High
(leukaemia )
Thrombin clotting
time (TCT)
11-18 sec
92. ● CULTURE & SENSITIVITY – URINE
No growth after overnight incubation
● CULTURE & SENSITIVITY – TRACHEAL
ASPIRATE
No growth after overnight incubation
● AFB STAIN – TRACHEAL ASPIRATE
No AFB seen
93. ● CULTURE & SENSTIVITY – BLOOD
Bactec Result (Aerobic) Positive
Gram Stain
Culture :
Growth was obtained, full identification
and antimicrobial testing result to be followed.
Gram negative rods seen
Organism
PPMI
COMENT
Burkholderia pseudomallei
ANTIBIOTIC
Gentamicin
Cefoperazone
Ceftazidime
Imipenem
Meropenem
Amikacin
Cefepime
Cefoperazone/Sulbactam 30µg/75µg
Ciprofloxacin
Piperacillin/Tezobactam
Ceftriaxone
Erythromycin
SENSITIVITY
R
S
S
S
S
I
S
S
S
S
S
R
94. SEROLOGICAL TEST
● WIDAL TEST – TYPHOID
● ROSE WALLER TEST- RA
● TUBERCULIN SKIN TEST - TB
● SHICK TEST – DIPTHERIA
● CASONI’S TEST – HYDATID DISEASE
95. Diagnosis
The final diagnosis can usually be reached
following chronologic organization and critical
evaluation of the information obtained from the :
- patient history
- physical examination and
- the result of radiological and laboratory examination.
96. Treatment
• The formulation of treatment plan will depend on both
knowledge & experience of a competent clinician and
nature and extent of treatment facilities available.
Evaluation of any special risks posed by the
compromised medical status in the circumstance of the
planned anesthetic diagnostic or surgical procedure.