Tropical medicine sheet 1.

Personal Data A _____ years old male/female patient named _________________________ working as a ____________, currently living in ____________ is a single/married with ____ off springs/divorcee and a smoker/non smoker for __________time came to the outpatient clinic in tropical medicine department complaining from____________ He/she was admitted on __ /_______/20__ 2. C/O 3. Present Hx The condition started with sudden/acute/chronic/ onset of ___________________ with progressive/retrogressive/stationary/ ___ course for ___mins/hrs/days/weeks/months/years. ____________________ weeks/months/years later, the patient started to develop ___________________________________________________. The condition is associated with ___________________________________________. Patient reported NO ________________ ,NO ________________, NO ________________ (systemic review)

4. Past history 1. BHF 2. HCV 3. HBV 4. Hx of dental procedure 5. Hx of blood transfusion 6. Operative Hx - type of operation = _____________________________________ - type of anesthesia = ____________________________________ - where = ______________________________________________ - blood transfusion - post operative course = _________________________________ - medical hx = ___________________________________________ - ____________________________________________________________ 5. Family Hx Relevant to disease 6. Drug Hx OCP Antidiuretics (sulphonylurea) Anti-TB (isoniazide) Acetominophine Halathone __________________________________ __________________________________ __________________________________ 7. Menstrual Hx *Hormonal disturbance in female leads to early amonorrhea Last menstrual date = ___________________ Irrelevant

ANALYSIS OF COMPLAINTS 1. Vomiting of blood 2. Black tarry stool 3. Abd distension 4. Swelling of lower limb 5. Yellowish discoloration of the sclera 6. Bleeding tendency; per nose 7. Discomfort related to meds 8. Easy fatigubility 9. Loss of conciousness 10. Weight loss 11. Abdominal pain per gum per rectum

2. Melena = black tarry stool a. Onset : ____________________________ b. Duration :_________________________ c. Course :___________________________ 3. Abdominal distension a. Generalized (5F) : Localized (organ) : _______________________ b. Onset : __________________________ c. Duration : ______________________ d. Course :_________________________ e. Relieving factor : ______________________________________ f. Aggravating factor : ___________________________________ g. Association with abd pain : yes/no h. Association with lower limb edema : yes/no 4. Lower limb edema (lower limb swelling) a. Onset : b. Duration : c. Course : 5. Jaundice (yellowish discoloration of the sclera) a. Onset : b. Duration : c. Course : d. Color of urine : e. Color of stool : f. Itchiness : yes/no g. Fever : yes/no if yes due to complication of cholangitis, hep E, yellow fever h. Recurrency : 6. Bleeding tendency pernose (epistaxis)/pergum/pergenital (menorrhagia)/perskin (echimotic patch) a. Onset : b. Duration : c. Course :

1. Hametemesis = vomiting of blood a. Onset : _______________________________ b. Duration : ____________________________ c. Course : ______________________________ d. Confirmation Hametemesis Color Bright red Food content Yes Frothy No Melena No association pH Acidic

Hemoptysis Coffee ground No Yes Yes alkaline

e. Severity of attack : i. Hemodynamic of a patient : _________________________ ii. Amount of attack : ___________________________________ iii. Amount of blood unit needed for transfusion : ____ iv. Frequency : ___________________________________________ f. Investigation done to find the causes : endoscopic procedure

7. Dyspepsia (Discomfort related to meds) a. Onset : b. Duration : c. Course : d. Causes i. Organic early satiety splenomegaly ii. Congestiveflatulence, heartburn, epigastric discomfort, nauseacomplication of PHTN 8. Easy fatiguibility a. Onset : b. Duration : c. Course : 9. Loss of conciouseness a. Onset : b. Duration : c. Course : d. Causes : i. Hypoglycemic ii. Shock iii. Sedative hypnotics iv. Bleeding tendency v. Hepatic encephalopathy (after excluding the above 4) Frequency : Precipitative factor : Relieving factor : Associating & behavioral disorders : Sleep disturbancy : Tremors (early sign) : 10. Weight loss (>10 % in 3 months time ) a. Onset : b. Duration : c. Course :

11. Abd pain a. Onset : b. Duration : c. Course : d. Site (dermatome) i. Somatic : superficial, sharp, strictly localized ,static ii. Visceral : deep, diffuse, dull-aching, dynamic, referred e. Organ by asking pain attribution i. Function ii. Sensory (referral pain) Pathological character 1. Dull-achingcant determine the nature of the painpain of solid organenlargement/stretching of organ capsule 2. Dragging feeling of heavinesstraction of ligament (spleen) 3. Stabbing knives feeling (sakiin)ischemic/infarction 4. Stitching pin (shakah) serous cavity 5. Throbbing pulsating (dahn) abscess 6. Colicky interrupted cramp pain (maghas) pain of tube (intestine) Provisional diagnosis : _________________

General Examination General Look 1. Inspection i. ii. iii. iv. v. vi. vii. viii. ix. x. 2. Palpation

Local Examination

1. Level of consciousness alert, conscious, cooperative (who, where,what time) 2. Body built average body weight & built special gait Vital Signs

1. Pulse = 2. Bp = 3. Temp. = 4. RR = Head & Neck

Contour Flanks Subcostal angle Divarication of recti Umbilicus site, shape, discharge, dilated veins, pigmentationEpigastric pulsation Skin striae, stretch marks, scars, pigmentation, purpura, temperature & tender, colour-

1. Head - Colour : pallor/jaundice/cyanosis - Parotid swelling - Wasting of buccal pad of fat - Sign of vitamin deficiency 2. Neck - Thyroid - LNs - Neck veins : pulsating/non-pulsating Extremeties

Liver site size surface consistency upper border/pole -normal anat lower border/pole - normal anat tenderness move with resp methods smooth/nodular soft/firm/hard

Spleen

1. UL - clubbing - palmar erythema - flappy tremors 2. LL - LL edema Heart & Chest

3. Percussion