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.

1. IN
SALYATANTRA
General Case taking

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.

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 ;

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.

22. Physical examination

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)

25. Systemic examination
● Cardio vascular
● Respiratory
● Alimentary
● Genito urinary
● Nervous System.
● Haemopoietic and recticulo endothelial
● Musckulo skeletal
● Endocrine system

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

33. Haemopoietic and
reticulo endothelial system
● State of nutrition
● State of dehydration
● State of immunity

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)

35. Endocrine system
● Any hormonal imbalance

36. Local examination
● Inspection
● Palpation
● Percussion& auscultation
● Movement and measurement
● Lymph node

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 )

41. IN VRANA
A). Type: Nija Aagantu
B). Vranasayas
Twak
Sandhi
Mamsa
Asthi
Sira
Koshtam
Snayu
Marmam

42. In vrana
C) About Vranitopadravas
Visarpam Pakshaghatam Sirasthambha
Apatanakam
Moham Unmadam Vranarujam Jwaram
Thrishna Hanugraham Kasam
Chardi
Athisaram Hikka Swasam
Vepadhu
Arochakam Avipakam Moorcha
D) About Vranopadravas
Gandham Varnam Sravam
Vedana Akrithi

43. For Sadyovranam
Ghrishtam Avakritham vichinnam pravilambi
Nipathitham Vidham bhinnam
vidhalitham

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

48. VIKRITHI PAREEKSHA
(DASAVIDHA PAREESHA)
1) Prakrithithah
2)
Vikrithithah
3)
Saratah
4)
Samhanatah
5)
6) Satmyatah
7) Satvatah
8) Ahara sakthitah
9) Vyayam
sakthitah
10) Vayasathah

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..

51. Prakrithithah
● Deha prakruthi
● Vatha
● Pitha
● Kapha
● Dwantha / sangkara etc
● Desa prakruthi
● Anoopa – kaphadika
● Jangala – vathaathika
● Sadarana – sama dosha

52. Vikrithithah
● Dosha
● Vatha , pitha , kapha , dwi or combined etc
● Dhooshya
● Rasa, raktha, mamsa, medo , asthi, majja, sukra,

53. tridosa’s kshaya lakshana
…………………….Vikrithithah

54. Tridosha vrudhi lakshana
…………………….Vikrithithah

55. Rasadi Prakrutha karma
…………………….Vikrithithah

56. Rasadi kshaya
…………………….Vikrithithah

57. Rasadi Vrudhi lakshana
…………………….Vikrithithah

58. Mala kshaya
…………………….Vikrithithah

59. Mala vrudhi
…………………….Vikrithithah

60. Saratah
● Twak sara
● Lustrous skin, unctous smooth,
tender hair etc
● Raktha sara
● Unctous red, beautiful, dazzling
appearnace , inbility to face
difficulties etc
● Mamsa sara
● Stability, heaviness, happiness,
strength, knoledge etc
● Medo sara
● Abundance of unctousness of
complexion, charity, simplicity,
delicate habit etc
● Asthi sara
● Robust heel, enthusiastic,
active, long lived etc
● Majja sara
● Softness of organ,
strength, progeny,
honour etc
● Sukra sara
● Gentleness, gentle
look, dazzling
appeance , loved by
women etc
● Satva sara
● Excellence of mental
faculties , good
memory, skill,
devotion, gratefulness
etc

61. Relevence of sara

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.

69. Application in treatment
● Pravara = Theekshana (strong )
● Madhya = Madhya (moderate)
● Avara = Mrudu ( mild)

70. Differential Diagnosis
●
DIAGNOSIS POINTS IN FAVOUR POINTS AGAINST
The process of listing out of 2 or more diseases hav

71. ROGAADHISHTANAM
● AVASTHA
Amam Pachyamanam
Pakwam Apakwa

72.  It is also called tentative
diagnosis or working diagnosis.
 It is formed after evaluating
the case history & performing the
physical examination.

73. Investigation
Bood routine
Urine routine
stool
sputum
etc
Etc
Biopsy
X-ray
MRI
CT Scan
Special Investigation

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

84. ● RENAL PROFILE
TEST VALUES RANGE SIGNIFICANCE
Sodium 125 mEq/L 135 - 147 mEq/L LOW
Pre renal failure
Potassium 6 mEq/L 3.5 - 5.2 mEq/L High (dialysis)
Hyperkalemia
Chloride 90 mEq/L 95 - 107 mEq/L LOW
Creatinine
kinase
15 – 190 U/L
Ammonia 56 mcg/dl
20 - 70 mcg/dl

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.

97. Progress

99. Follow up

100. Termination