Saroj Kumar Jha

General observation: Drowsiness                                     Audible wheezes or stridor All vitals + PILCyClOD In head to toe examination : Neck: JVP (d/t cor pulmonale) Head: Horner’s (d/t pancoast tumor) Oral: candidiasis (immunosuppression or prolonged use of inhaled steroids) Upper airway examination: Nose:             External: external nasal framework             Vestibular: position of nasal septum Polyps Signs of inflammation over the skin Congestion Discharge Paranasal sinuses: Tenderness over sinuses Oral cavity and oropharynx: Oral hygiene, halitosis Teeth (caries) Tonsils Post nasal drip Polyps(antrochoanal) Lower airway examination/ C...

All vitals + PICyClO [in head to toe examination: examine hands, nails and skin for splinter hemorrhage, vasculitic rash or petechiae, osler nodes, janeway lesions, cold extremities, erythema marginatum Also examine face and eyes for corneal arcus, malar flush, xanthalesma, conjunctival petechiae, roth spots in fundoscopy] JVP measurement with hepatojugular reflex Precordial examination Inspection: (patient supine with head 30-45 degree with chest exposed) Shape: any deformity or Bulging Pulsations: apical impulse/ mitral area                         Aortic, pulmonary and tricuspid area                         Suprasternal and parasternal area                ...

Anthropometry: (use WHO chart for inference) Weight: Height for > 2 yrs(stadiometer), length( infantometer): OFC: Chest circumference(at mid inspiration or mid expiration): MUAC (11.5-12.5 cm) Arm span: BMI Subcutaneous fat: US/LS: (for achondroplasia)

Vitals: Ø   Temperature: (for 5mins) …….degree Fahrenheit/ celcius in…..site Ø   Pulse: (Neonate: upto 160, from 10 years : 60-100) peripheral(radial, dorsal pedis) central (carotid, femoral, brachial) Rate: Bradycardia(sleep, hypothyroid, hypothermia, heart block, increased ICP),             Tachycardia(Dehydration, shock, fever, exercise, anxiety, anemia, hyperthyroid,             tachyrhythmias, PSVT) Rhythm Character Volume (in central pulse): increased (water hammer in AR), decreased(shock) Peripheral pulses are palpable? Delay: radio radial and radio femoral delay Condition of arterial wall Ø   BP: (For systolic hypotension… neonate<60, 1 yr<70, 1 to 10 yrs 70-90, above 10 yrs<90) …../……mmHg in ……arm on…..position with/out postural drop Ø   Breathing rate(for 1 min): Rate, rhythm and breathing pattern o ...

General appearance: (to act immediately) Alert/ conscious: interacting or not? Comfortable Signs of respi distress Irritable (decreased O2 supply to brain) Toxic Restless Crying lethargic Colour Built Attitude Posture Evidence of meningeal irritation Iv cannula, O2 mask,   cather/drains in situ

Tell handedness of the patient in the history. In general observation, mention about GCS All vitals + PILCCOD In head to toe examination, you may mention about abnormal body movements or it may be included in motor examination. Higher mental functions: @ABCDE-MOS Appearance: well dressed, groomed, hygiene, facial expression? Behavior: cooperative/ irritable Consciousness and communication: GCS/AVPU Delusions/illusions/hallucinations: +/- Emotions: excited or depressed, any change in mood Memory: immediate(tell and ask), recent(last meal taken, ask to reverse number), past/remote(bday,              vacation) Orientation: time, place and person(can recognize mother?) Speech and language: Articulation: say PASHUPATINATH Fluency : assessed in spontaneous conversation Comprehension : tell to do a task like show where is the door or close your eyes Disturbance in naming:ask to name an object D...

In general examination, look for nutritional state( height, weight, BMI), confusion, fetor hepaticus. All vitals and PILCCOD Signs of CLD: Clubbing, leukonychia, koilonychia, palmar erythema, dupuytrens contracture, flapping tremor Loss of hair, Icterus, pallor Parotid swelling, angular stomatitis, cheilitis Spider naevi, gynecomastia, breast atrophy, testicular atrophy Ascites, caput medusa, hepatosplenomegaly, bruising UPPER GI TRACT: EXAMINE ORAL CAVITY AND OROPHARYNX -use torch and tongue depressor                        EXAMINE  Lips, teeth, gum, cheek, tongue, tonsils, palate, oropharynx {look for ulcer, erythema, signs of malnutrition, angular stomatitis} ABDOMEN EXAMINATION : Inspection : (legs should be extended at this point) Shape: scaphoid Flanks: concave/ full Movement with respiration: all quadrants or not? Umbilicus: position? Everted/inverted? Slit like? Perist...