Case Sheet in Ayurveda

Scheme of case taking

Particulars (Bio data) Of Patient
Name

:

Age

:

Sex

:

OPD/IPD No:

Religion

:

Bed No

Education

: P/M/HS/GR/PG

DOA/DOD :

:

Marital Status: UM/M/D/W
Occupation

: ML/HW/ST/SO/A

Social Status : BPL/APL/LMC/MC/UMC/R
Postal Address:

The History or History Proper
1. CHIEF COMPLAINTS/CC/ PRESENTING COMPLAINTS/PC/ Pradhana vedana:
A subjective statement made by a patient describing the most significant or serious symptoms or
signs of illness or dysfunction that caused him or her to seek health care. Record the chief complaint
using the patient's words along with time period and avoid replacing the patient’s words with their
diagnostic interpretation. It is considered bad form to proffer a diagnostic impression in a chief
complaint. As a result, the chief complaint usually states the key symptoms that a patient is
experiencing.

2. ASSOCIATED COMPLAINTS/ Anubandi vedana:
Make a list of all the associated symptoms you would ask for certain chief complaints.
For example: For headache as the cc, you would ask: Nausea/vomiting? Jaw claudication? trauma?
dental surgery? Sinusitis? Also: exercise? stress? fatigue? menses? meds?
Dept Of P.G Studies in Roganidana, G.A.M.C Bangalore. ©Private Circulation Only©

Page 1

3. HISTORY OF (H/O) PRESENT ILLNESS/Vedana vrattanta/Adyathana Vyadhi vrattanta:
In chronologic order, starting with the current episode and then filling in the relevant
background information. For example, if a patient with long-standing diabetes is hospitalized in a coma,
begin with the events leading up to the coma and then summarize the past history of the patient’s
diabetes. Add an asterisk or underline important points.

4. HISTORY OF PAST ILLNESS/PAST HISTORY /Poorva vyadhi vrattanta:
Childhood Illnesses

: Measles/chickenpox/scarlet fever /rheumatic fever/etc.

Adult Illnesses

: Medical/Surgical/Ob-gyn/Psychiatric/etc.

Health Maintenance

: Immunizations, Screening tests, etc.

5. FAMILY HISTORY /Kula/ Koutumbika vrattanta:
Obtain the family history by asking open-ended questions.
e.g. 'Are there any illnesses that run in your family? Like asthma, allergic disorder, malignancy, TB, etc.

6. PERSONAL /Atura charya /Vayakthika vrattanta:
Ahara/Diet

: Veg/Nonveg/Mixed!?

Agni/ Appetite

: Manda/Vishama/Teekshana/Sama

Koshta

: Mrudu/Madhyama/Kroora

Nidra

: Alpa/Ati/Sama/Diwaswapna/Ratrijagarana/None

Vyasana/Habits/ Addictions

: Tea/Coffee/Alcohol/Tobacco/None/Others

High risk behavior

: IV drug abuse / Multiple sexual partner /Homosexuality

Mala pravrutti / Bowel

: Regular/constipated.

Mutra pravrutti / Micturition :

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Position during work

: Standing /Sitting/Walking/Stooping

Nature of work

: Hard manual/Moderate manual/Table work
/Household/Sedentary/Others

7. SOCIAL AND OCCUPATIONAL HISTORY/ Udyoga Parisara vrattanta:
Upbringing, Home life, Occupation, Finance, Relationships and domestic circumstances, House,
Community support, Sexual history, Leisure activities.

8. TREATMENT HISTORY /Poorva chikitsa vrattanta/ Chikitsa vrattanta:
Allopathic medicine - Medical
Surgical
Ayurveda -

Medical
Surgical

Others -

9. PSYCOLOGICAL HISTORY/Manasika vrattanta:
Mood of patient /Anxiety /Depression /Irritability /Euphoria /obsession /Neurosis / Depersonalization
are present or not.

10. GYNAECOLOGICAL HISTORY:
a) Menarche / Aarthava pravurthi /Rutumathi :
b) Menopause/ Rajonirvrutti :
c) Menstrual Cycle/Aarthava pravurthi/Arthava chakra: Regular /Irregular
Scanty/normal/excess
Amount of bleeding
Number of days

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Inter Menstrual period
Any associated complaints
d) Menorrhagia
e) Metrorrhagia
f) Leucorrhoca
g) Dysmenorrhoea

h) Ammenorrhea

11 .OBSTRETICAL HISTORY:
a) Gravida

:

b) Para

:

c) Abortion

:

d) Miscarriage

:

e) Still birth

:

f) Number of deliveries

:

g) Nature of delivery

: Normal /Forceps /Surgical

h) Last delivery/Last child birth :


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PHYSICAL EXAMINATION
(Includes -- I. General Survey & II. Systemic Examination)

I. General Survey
1. SAMANYA PAREEKSHA/ GENERAL EXAMINATION:
Vital data/Vital Signs:
Pulse:
Respiratory rate:
B P: Measured on left arm supine position.
Temperature:
General look/ Appearance: Healthy/Ill look/Depressed/Cheerful/Any other
Weight:
Height:
Built/Build : Well-built/Poorly built/Giant/Dwarf/Tall stature
Decubitus: Position of patient on bed.
Nourishment/Nutrition: Average/ under nutrition/obese
Cyanosis:
Pallor/Anaemia : Mild/Moderate/severe
Jaundice/Icterus:
Neck vein/Jugular venous-engorgement, pulsation, pressure: Raised/Not raised
Neck Artery/carotid arteries:
Edema:
Lymph nodes/Lymphadenopathy: Number, Site, Shape/Size-matted or discrete, Surface,
Tenderness, Temperature, Consistency, Mobility, Discharge.


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Clubbing:
Koilonychia:
Thyroid gland:

2. ASHTA STHANA PAREEKSHA
1. Nadi

:

2. Mala

: Baddha / Abaddha / Prakrata / Vikrita

/min

Atisara

Pravahik

Grahini

Any other:

3. Mootra

: Prakrita / Vikrita
Frequency: Day:

Night:

Colour :
Other associated complaints:

4. Jihva

: Coated (lipta)/ Uncoated (alipta)/ Partially coated ( Alpalipta)
Colour: Whitish/pinkish/blackish

5. Shabdha : Prakrita / Vikrita
6. Sparsha : Ushna:

Anushna :

Ruksha:

khara :

7. Drik

: Colour of conjunctiva : white/pink/red/yellow

8. Akrita

Mrudhu :

: Sthula /madhyama/heena

3. DASHAVIDHA PAREEKSHA
1.

Prakruti

2.

Vikruti

3.

Sara

Sharirika:V/P/K/ VP/ VK/ PK/ Sama
Manasika:S/R/T
Dosha:
Dhatu:
Mala:
Twak /Rakta /Mamsa/ Meda /Asthi /Shukra/Majja /Satwa

4.

Samhanana

Susamhita/Madhyama samhita/ Heena Samhita

5.

Pramana

Supramanita /Adhika / Heena


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6.

Satmya

Ekarasa / Sarva rasa / Vyamishra /Rooksha satmya /Snigda
satmya

7.

Satva

Pravara /Madhyama /Avara

8.

Ahara Shakti

a) Abhyavaharana shakti : P/M/A

9.

Vyayam Shakti

b) Jarana shakti : P/M/A
Pravara /Madhyama/ Avara

10.

Vaya

Bala /Madhyama /Vrudda

4. VISHESHA PAREEKSHA
SROTO PAREEKSHA:
Srotas
1.
2.

Pranavaha srotas
Annavaha srotas

3.

Udakavaha srotas

Lakshanas
Kupita abhikshana/ sashabha shoola ucchvasa.
Anannabhilasha/ arochaka/ avipaka/ chardi
Jihwashosha / talushosha/ oshtashosha/ kanta shosha/klomashosha/ Ati
pravridha pipasa

4.

Rasavaha srotas

Asraddha / Aruchi / Asyavairasya / Arasajnata / Hrillasa / Gourava /
Tandra / Angamar / dajwara / Tama / Pandutva / Srotorodha / Klaibya /
Sada /Krishnangata / Agninasa / Akaalavali / Akaalapalitya/ Bhrama/
Glani/ Hritpida/ Trishna/ Shabda asahishnuta/ Kampa/ Shosa/ Rukshata.

5.

Raktavaha srotas

Tilakalaka /dadru /charmadala /switra /pama

/ kota /asramandala/

Amlaprartana / Sheetaprartana/ Tvak rukshata/ Tvak parushy/ Tvak
sputana/ Shira shitilya/ Tvak mlanata/ Mukhapaka / Akshiroga /
Vaivarnya / Agnimandya / Pipasadhikya / Gurugatrata / Santapa /
Dourbalya / Aruchi / Shirashoola / Tiktaamlodhara / Vidahaannapanasya
/ Klama / Lavanasyata / Swedadhikya / Kampa / Swarakshaya / Tandra /
Nidradhikya / Tamapravesha / Kandu /

Pidaka / Pradara /

Gudamedrasyapaka / pleeha / gulma /vidradi /neelika / kamala/ vyanga /
piplava Others.
6.

Mamsavaha srotas

Sandivedana/

Rukshata/

Dhamanishitily/

Toda

/

Grivashuskata/

Urushuskata/ Gatrasadana / Spikshushkata /Adhi mamsa/ arbuda /
keelaka/ gala shaluka/ gala shundika/ puti mamsa/ alaji/ galaganda/

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gandamala/ upajihwika
7.

Medovaha srotas

Asta nindita purusha lakshana/ Prameha purvarupa

8.

Asthivaha srotas

Adhyasthi/ Adhidantha/Dantha bheda/Asthi bhedha
/Vivarnata/Kesha/loma/nakha/smashru dosha

9.

Majjavaha srotas

Ruk parvanam/Bhrama/Moorcha/Tama Dharshana/Arumshika/Sthoula
parva

10 Sukravaha srotas

Klaibhya/Aharshana

11 Mootravaha

Kupitam/sashoola/bhahalam mootrayanti

12 Pureeshvaha

Sashabdhashoola/ atidrava,/atigrathitam/ atibhahu

13 Swedavaha srotas

Aswedana/ atiswedana/ parushanga/ atishlakshna anga/ paridaha/
loma harsha

Vikruthi Pareeksha/Naidanika Samprapthi Pariksha:
Nidana :
Poorva Roopa :
Roopa :
Upashaya :
Anupashaya:
Samprapthi ghatakas:
Dosha: K/P/V
Dushya:Rasa/Rakta/Mamsa/Medha/…
Agni:Jataragni/Dhatwagni
Ama: Jataragni mandhyajaanita/Dhatvagni mandya janita
Srotas:Medovaha/Rasavaha/Annavaha/Mamsavaha/Raktavaha
Srotodushti prakara: Atipravrutti/Sanga/Vimarga gamana/Siragranthi
Udbhavasthana:Amashaya/Pakwashaya
Sanchari sthana:
Vyaktasthana:
Adhistana :
Rogamarga:
Sadhyasadhyata:

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CARDIO VASCULAR SYSTEM/ CVS
(Peripheral CVS and Central CVS)
A. Peripheral CVS
o Radial pulse:
Rate
Rhythm
Volume
Character
Condition of arterial wall
Redio-femoral delay

o Other peripheral pulsations:
o Blood pressure:
o Sign of CCF:
Raised JVP
Tender hepatomegaly
Pedal edema

o Miscellaneous:
Clubbing
Cynossis
Anaemia

B. Central CVS
 Inspection
o Chest wall:
Shape of chest / Shape of precordium: Look tangentially whether there is bulge or
not.


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o Apical impulse/Apex beat: Its best seen or best felt pulsation over the outer lower
most precordium.
o Other pulsations: Epigastric, Sternoclavicular, Sternal notch, cardiac artery pulsation
in neck, pulmonary area, aortic area, other parts of precordium.
o Abnormal bulges: Vessel distension, tumors, aortic dilation
o Raised Jugular Venous Pressure

 Palpation
o Apex beat – (5th inter costal space ½ inch medial to mid clavicular line)
Site –Detected in supine position of patient.
Character-Described in left lateral position. Abnormal characters are
Heaving,Forcible,Tapping.
o Locate the tender areas
o Pulsations in other area- Palpate pulmonary area,palpate aortic area ,palpate left
parasternal area (Preferably by ulnar border). In normal Condition pulsations are not
felt in these areas pulmonary,aortic and parasternal areas.
o Thrills(Palpable murmers)-Systolic(Felt between first and second sound) ,
Diastolic(Felt after second sound),over mitral,pulmonary,aortic,tricuspid ares.

 Percussion
o It is rarely done.
o Normally there will be dull note that means superficial cardiac dullness.
o Stony dull note over precordium due to pericardial effusion.
o Dullness in pulmonary area due to dilatation of pulmonary artery.
o Dullness in the aortic area and upper sternum due to aneurysm of aorta.
o Dullness over lower part of the sternum due to hypertrophied right ventricle.
o Dullness lateral to right sternal border due to gross cardiomegaly and its due to
shifting of right cardiac border to right lateral sternal border.


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 Auscultation : (Position of patient: preferably sitting)
o

Listen the First and second Heart sounds (S1 and S2 ) in all four auscultatory areas

o

Added sounds : Murmurs- #In relation to systolic and diastolic.
#Relation with natural respiration, whether better
heard during inspiration or expiration.
#Pitch of murmer-High or low
#Site of conduction(Each murmers has specific site of
conduction)

o

Pericardial rub: Sound resembling pleural rub heard over the precordium which is

not releted to respiration. But related to cardiac cycle(Heard with each systole and diastole).


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Respiratory System
INSPECTION:


Nose: DNS, Turbinates, Mass, Inflammation,etc



Throat: Inflammation, tonsils,etc



Chest:
o Movement /Type of breathing– Abdomino thoracic in Male and Thoracco abdomen in
Female
o Shape – Elliptical, Flat, Emphysematous(barrel shaped), Rachitic Chest, Rickety rosary
(costochondral beading),Harrison’s sulcus, Pectus excavatum (funnel chest), Pectus
carinatum (Pigeon chest),Kyphosis, Scoliosis,
o Skin Lesions and Discoloration



Movement with respiration: Respiratory Rate & Rhythm.
Normal respiration is regular rhythm
Abnormal rhythm-cheyne stoke breathing



Symmetry of the chest: Normal chest is symmetrical



Cyanosis: Present/Absent. If present- Central/Peripheral.



Pursed-lip breathing:



Accessory muscle: Involved or not involved

PALPATION:
As you palpate the chest, focus on areas of tenderness and abnormalities in the overlying skin,
respiratory expansion, and fremitus.



Chest Expansion/Movement with respiration:

Are Normal and equal on both

sides/Diminished.


Position of mediastinum- 1.Trachea
2. Apex beat



Respiratory expansion:


Page 12



Vocal fremitus/Tactile fremitus: Equal on both side.



Tenderness: In intercostal space



Sinus: Tenderness, Swelling.

PERCUSSION: (Position of patient: preferably sitting)


Resonant-Normal



Superficial cardiac dullness-Normal



Liver dullness-Normal



Dullness in other field indicates -Pleural Effusion or Lobar Pneumonia



Hyper-resonance indicates - Pneumothorax or Emphysema

AUSCULTATION:
Breath Sounds –Vesicular breath sounds,
Bronchovesicular,
Bronchial breathing sounds-Tubular ,Cavernous ,Amphoric.
Intensity of breathing sound- Normal /High / Diminished.
Added Sounds/Adventitious sound – (Inspiration/Expiration, Polyphonic/Monophonic)
1. Wet-Crepitations-coarce,medium,fine
2. Dry- Rhonchi, Pleural rub, Crackles, Wheezes.
Vocal resonance/ whispering pectoriloquy: Normal/High/Diminished
Succession splash/Hippocratic succession:
Coin test: Hydropneumothorax (This test is combination of percussion and auscultation)


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PERCUSSION AND AUSCULTATORY AREAS/ LOCATIONS ON THE CHEST:

Posterior chest

Anterior chest

Supraclavicular—above the clavicles
Clavicular
Infraclavicular—below the clavicles

Anterior

Mammary
Bases of the lungs—the lowermost portions
Upper, middle, and lower lung fields

Suprascapular
Infrascapular—below the scapula
Interscapular—between the scapulae

Posterior

Infrascapular-Upper/Lower
Axillary
Infraxillary


Page 14


GIT / Gastrointestinal System / GI. System
Oral cavity
 Inspection :
o Lips – Fissure or cracks or discoloration
o Teeth – Dental caries
o Tongue – Coating, Fasciculation, Cracks, Wasting
o Tonsils – Enlargement

Per Abdomen
 Inspection:
o Shape of abdomen
o Umbilicus – Inverted / Everted
o Movement with respiration
o Pulsation
o Visible blood vessels- Engorged veins in abdomen which are better appreciated
with patient either sitting or standing than lying down position.
o Visible swelling & erythema.
o Scar/brand marks/ulcers/hypo/hyper pigmented areas describe their site size
number etc.
o Striae
o Hernia orifices

 Palpation
o Tenderness –


Superficial–Try to identify tone of abdominal muscle, guarding, rigidity,
tenderness, mass.



Deep –Evidence of enlarged liver, spleen, kidney, lymph nodes.



Bimanual –Kidney.

Dept. Of P.G Studies in Roganidana, G.A.M.C Bangalore. ©Private Circulation Only© Page 15



Ballottement-



Dipping- In moderate and massive ascities where mass or organomegaly
cannot be appreciated by deep palpation, so that fluid is displaced and
underlying organomegaly or mass be felt. Abdominal aorta, caecum, sacral
prominence, loaded descending colon.

o Swelling :
o Rebound tenderness :

 Percussion:
o Tympanic
o Dull note.
Normally percussion note is tympanic all over the abdomen. But over left hypochondrium and
epigastric area may be resonant due to presence of air.

 Auscultation :


Intestinal peristaltic sounds



Bruit over abdominal aorta



Bruit over the renal artery



Hepatic rub



Splenic rub



CENTRAL NERVOUS SYSTEM
Higher function /Mental Status Examination:


Level of consciousness: Drowsiness, stupor, semi coma, coma.



Intelligence/ Intellectual level:



Memory:



Orientation of Time and Place:



Personal identity:



Mathematical ability:



General behavior:



Hallucinations(False impressions from sense organs) and delusions(false belief and idea):



Speech: Dysarthria/Dysphasia

Gait:
Gait problems are common. Basically, it's either musculoskeletal or neurological (UMN, LMN,
Cerebellar syndrome, Extrapyramidal syndrome, Sensory ataxia). There are many patterns and
types of gaits.
The following patterns are recognized:
Antalgic gait/Ataxic gait / Cerebellar gait / Festinating gait /Frontal(apraxic) gait /Hemiplagic
gait/Helicopod gait / Hip extensor gait /High-stepping / Myopathic gait/ Paraplegic spastic gait/
Parkinsonian gait/Quadriceps gait/Scissor gait /Spastic gait /Sensory Ataxic /stiff-legged gait /
Steppage gait / Stuttering gait/ Tabetic gait /Vestibular gait/ Waddling gait myopathic gait/etc


Examination of unconscious patient:


Stupor, obtundation, and other descriptions such as 'semiconscious' are non-quantitative
descriptions of an altered mental state that is difficult to define precisely.



A rapid initial assessment of the unconscious patient should be performed to correct
immediate threats to life and look for reversible causes of the unconscious state. Airway,
breathing and circulation (ABC) can be rapidly assessed, and critical interventions made as
required.



The Glasgow Coma Scale (GCS) / Glasgow Coma Score. It defines the degree of altered
consciousness as an ordinal score between 3 and 15 - note that the lowest possible score is 3,
not zero. Non-quantitative descriptions should be avoided.

Eye-opening

Best verbal response

Best motor response

Spontaneous

4

Oriented

5

Obeys commands

6

To speech

3

Confused

4

Localizes pain

5

To pain

2

Inappropriate

3

Normal withdrawal

4

None

1

Incomprehensible

2

Abnormal flexion

3

None

1

Abnormal extension

2

None

1

Cranial Nerve Examination:


Cranial nerve I/Olfactory: Parosmia (altered sense of smell) or Anosmia (loss of smell).



Cranial nerve II/Optic : Visual disturbances (Snellen chart), Visual fields , Colour
disturbances



Cranial nerve III, IV, VI /Oculomotor, Trochlear, Abducent : Diplopia, Pupillary
disturbances, Nystagmus



Cranial nerve V/Trigeminal: Mastication difficulties



Cranial nerve VII/Facial: Symmetry in smile, Nasal fold, Blowing of Mouth , Facial
Expression



Cranial nerve VIII/Auditory: Hearing Disturbances, Romberg test




Cranial nerve IX, X/Glosssopheryngeal ,vagus,: Sensation of Taste, Nasal twang to speech,
Nasal regurgitation of food, Gag Reflex.



Cranial nerve XI/Spinal accessory: Difficulty while turning the Head & Shrugging Shoulder



Cranial nerve XII/Hypoglossal: Dysphagia, Tongue Tremor & Dysarthria

Motor function test/Motor system:


Nutrition / Muscle Bulk :



Muscle Power / strength :
Score Description
0

Absent voluntary/visible contraction

1

Feeble contractions that is unable to move a joint

2

Movement with gravity eliminated

3

Movement against gravity

4

Movement against partial resistance

5

Full strength



Muscle Tone: Hypotonia (Flaccidity) / Hypertonia (Rigidity)-Spasticity,Rigidity.



Co-ordination: UL-Finger nose test,finger test ,LL-Knee heal test,



Involuntary/abnormal movement: Fasciculation, Tremors, Chorea,Athetosis, Hemibalismus

 Reflexes/Jerks:
Primitive reflexes:
Glabellar Tap
Superficial reflex:
Corneal and conjunctival reflex
Palatal
Pharyngeal
Abdominal reflex-Upper, Middle ,Lower.
Cremasteric reflex
Plantar Reflex: Babinski’s sign


Deep Tendon Reflexes:
Jaw jerk/reflex
Supinator reflex
Biceps reflex
Triceps reflex
Knee reflex
Ankle reflex
Scores for Reflexes:
0 Absent
1 Hypoactive or present only with reinforcement
2 Readily elicited with a normal response
3 Brisk with or without evidence of spread to the neighboring roots
4 Associated with a few beats of unsustained clonus
5 Sustained clonus

Sensory system:


SuperficialTouch
Pain
Temperature



Deep
Crude touch
Vibration
Joint sense
Sense of position
Sense of pressure



Cortical
Tactile localization
Tactile discrimination
Tactile extinction
Astereognosis
Graphaesthesia


Cerebellar System:
(Signs in disease of cerebellar system are due to hypotonia and inco-ordination)
1. Involuntary Movements
2. Nystagmus
3. Speech
4. Hyptonia
5. Intension tremor
6. Titubation
7. Rebount phenomenon
8. Pendular knee jerk
9. Tandom walking
10. Diadochokinesis
11. Cerebellar gait
12. Coordination Test:


Finger nose test



Heel Shin test



Heel toe walking



Neck stiffness



Kernig’s sign



Brudzunski’s sign

Meningeal signs:



MUSCULOSKELETAL EXAMINATION / LOCOMOTORY
In the Musculo skeletal examination, the physician should ask the patient about the pain
according to Site, Onset, Character, Radiation, Associated factors, Timing (frequency, duration,
periodicity), exacerbating features (exercise, use, etc.) and Severity
Subsequently the affected joint should be examined for the inflammatory signs like
Tenderness, Stiffness, Warmth, Swelling, and Range of movements.

JOINT DISEASE:
• A combination of pain and stiffness, leading to loss of function, is a classic feature of joint
disease.
• Usually one component predominates, as with stiffness in inflammation, and pain in
mechanical joint problems.
• Therefore, specific questions will establish whether symptoms are mechanical (e.g.
degenerative joint disease or meniscal tear) or inflammatory (e.g. rheumatoid arthritis or
gout).

Features of Mechanical Joint Disease:
In degenerative joint disease there may be a feeling of stiffness in the affected joint after resting
which rapidly disappears with activity. This inactivity stiffness typically lasts only a few minutes and
nearly always less than 30 minutes. Pain in the affected joint on activity, usually improving with rest, is
typical.

Features of Inflammatory Joint Disease:
• Early morning stiffness :
Early morning joint stiffness that persists for more than 30 minutes is an important
symptom of active inflammatory joint disease. Ask about redness (rubor), warmth (calor),
tenderness/pain (dolor) and swelling (tumour), the classic features of inflammation.
• Recurrent attacks of joint pain :

• Episodic joint pain :
• Flitting or migratory joint pains:

EXTRA-ARTICULAR FEATURES OF JOINT DISEASE:
Extra-articular features of joint disease:


Cutaneous nodules



Cutaneous vasculitic lesions



Lymphadenopathy Oedema



Tendon sheath effusions



Enlarged bursae



Ocular inflammation



Diarrhoea



Urethritis



Oro-genital ulcer



Gouty tophi caused by urate deposition



Rheumatoid nodules



Vasculitic nodules in SLE and systemic vasculitis



Xanthomataus deposition(hypercholesterolaemia)

Types of subcutaneous nodule:

Other soft tissue swellings:

EXAMINATION OF INDIVIDUAL JOINTS:
Examination of the joints can be summarized simply as 'look, feel and move', i.e. inspection,
palpation, and range of movement

Inspection:
Inflammation is often associated with redness of the joint, and with tenderness and warmth.
Look also for swelling or deformity of the joint. Note whether the distribution is symmetrical.
1. Spine deformities – Kyphosis, Scoliosis, Lordosis
2. Range of Movements according to the Joint:(Inspection and palpation)

Based on comparison with the normal side,or on the examiner's previous experience. For
accurate description the actual range of movement should be measured with a protractor
(goniometer). Both active and passive movement should be assessed.
• Cervical Spine: Extension, flexion, rotation, abduction
• Spine: Flexion, Extension, Lateral Flexion and Rotation.
• Shoulders: External rotation and abduction, internal rotation and adduction,
circumduction
• Elbow: Flexion, extension, Pronation and supination
• Wrist: Flexion, Extension, Adduction, Abduction and Circumduction.
• Hip: Flexion, Extension, Adduction, Abduction, Medial Rotation and Lateral
Rotation.
• Knee: Flexion and Extension • Ankle: Plantar Flexion, Dorsi Flexion, Inversion and Eversion.

Palpation:
On palpation of a joint check first for tenderness and crepitus.
Assessment of joint tenderness:
Grade 1: The patient says the joint is tender
Grade 2: The patient winces
Grade 3: The patient winces and withdraws the affected part
Grade 4: The patient will not allow the joint to be touched
Local rise of temperature: Present/Absent

CREPITUS:
Tendon sheath crepitus: This is a grating or creaking sensation defined by palpating the tendon while
the patient is asked to contract the muscle tendon complex involved. It is particularly common in the
hand and is seen in rheumatoid arthritis and systemic sclerosis


Joint crepitus: This can be detected by feeling the joint with one hand while moving it passively with
the other. This may indicate osteoarthritis, or loose bodies (cartilaginous fragments) in the joint space,
but should be differentiated from non-specific clicking of joints.

1.

Low Back Examination:
o
o

Braggard's Test

o

Femoral nerve stretch test:

o

Flip Test

o

Cross SLR Test

o

Door bell sign:

o

Gaenslen's test

o

Sacro- iliac compression

o

Heel walking Test

o
2.

SLR/Lassegue’s Test

Toe walking Test
Reflexes : Deep tendon reflexes



Skin
Morphology: Inspection and palpation(Use disposable gloves)

o




Texture: Roughness / Smoothness



Temperature: Warm / Cold



Motility & Turgor: Thin/thick



Moisture: dryness / Oiliness/Dry/moist



Any visible sweat in general or local



o

Color: Hypo / Hyper Pigmentation

Elasticity of skin.

Location /distribution/ Arrangement:



Cetripetal/centrifugal



Flexar/extensore



Exposed area of sun /unexposed area



o

Symmetrical/asymmetrical

Genitals involved or not

Configuration of skin lesion/Types of Skin Lesion & its color:
Once the morphology of individual lesion and their distribution has been established, it is
useful to describe their configuration on the skin, means primary or secondary skin lesion.

Primary skin lesion:
1

Macule

7

Bulla

13

Ecchymosis

2

Papule

8

Postule

14

Hemotoma

3

Plaque

9

Wheal

15

Poikiloderma

4

Nodule

10

Telangictasia

16

Erythema

5

Papilloma

11

Petechiae

17

Burrow

6

Vesicle

12

Purpura

18

Comedo


Secondary skin lesion:
1

7

Ulcer

2

Crust

8

Sinus

3

Excoriation

9

Scar

4

Lichenification

10

Keloid

5

Fissure

11

Atrophy

6

o

Scale

Erosion

12

Stria

Some special and specific signs:


Kobner’s sign



Auspitz sign



Candle Greece sign



Nicole’s sign

Nail


Color and Shape:



Lesion:



Nail Fold:

Hair


Color:



Texture:



 Relevant investigation:

 Summary of the case:
(Construct two paragraphs; first: History, second: Brief Examination)

 Differential diagnosis:
 Provisional diagnosis:

IMPORTANT:
It’s just only the schematic outline on case taking, for further detailed
reading please refer authentic and recent edition of clinical examinations/clinical
methods books.
@Mcleod's Clinical Examination.
@Hutchison's Clinical Methods.
@Bate's guide to physical examination.
@Golwalla`s Physical Diagnosis.

“Wherever the art of Medicine is loved, there is also a love of Humanity”
- Hippocrates



Case Sheet in Ayurveda

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