Professional Documents
Culture Documents
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:
Dept Of P.G Studies in Roganidana, G.A.M.C Bangalore. ©Private Circulation Only© Page 1
Scheme of case taking
Ahara/Diet : Veg/Nonveg/Mixed!?
Koshta : Mrudu/Madhyama/Kroora
Nidra : Alpa/Ati/Sama/Diwaswapna/Ratrijagarana/None
Dept Of P.G Studies in Roganidana, G.A.M.C Bangalore. ©Private Circulation Only© Page 2
Scheme of case taking
Upbringing, Home life, Occupation, Finance, Relationships and domestic circumstances, House,
Community support, Sexual history, Leisure activities.
Ayurveda - Medical
Surgical
Others -
Dept Of P.G Studies in Roganidana, G.A.M.C Bangalore. ©Private Circulation Only© Page 3
Scheme of case taking
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 :
Dept Of P.G Studies in Roganidana, G.A.M.C Bangalore. ©Private Circulation Only© Page 4
Scheme of case taking
PHYSICAL EXAMINATION
Dept Of P.G Studies in Roganidana, G.A.M.C Bangalore. ©Private Circulation Only© Page 5
Scheme of case taking
Clubbing:
Koilonychia:
Thyroid gland:
1. Nadi : /min
3. DASHAVIDHA PAREEKSHA
1. Prakruti Sharirika:V/P/K/ VP/ VK/ PK/ Sama
Manasika:S/R/T
2. Vikruti Dosha:
Dhatu:
Mala:
3. Sara Twak /Rakta /Mamsa/ Meda /Asthi /Shukra/Majja /Satwa
4. Samhanana Susamhita/Madhyama samhita/ Heena Samhita
5. Pramana Supramanita /Adhika / Heena
Dept Of P.G Studies in Roganidana, G.A.M.C Bangalore. ©Private Circulation Only© Page 6
Scheme of case taking
4. VISHESHA PAREEKSHA
SROTO PAREEKSHA:
Lakshanas
Srotas
1. Kupita abhikshana/ sashabha shoola ucchvasa.
Pranavaha srotas
2. Annavaha srotas Anannabhilasha/ arochaka/ avipaka/ chardi
Dept Of P.G Studies in Roganidana, G.A.M.C Bangalore. ©Private Circulation Only© Page 7
Scheme of case taking
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
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:
Dept Of P.G Studies in Roganidana, G.A.M.C Bangalore. ©Private Circulation Only© Page 8
Scheme of case taking
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.
Dept Of P.G Studies in Roganidana, G.A.M.C Bangalore. ©Private Circulation Only© Page 9
Scheme of case taking
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.
Dept Of P.G Studies in Roganidana, G.A.M.C Bangalore. ©Private Circulation Only© Page 10
Scheme of case taking
Dept Of P.G Studies in Roganidana, G.A.M.C Bangalore. ©Private Circulation Only© Page 11
Scheme of case taking
Respiratory System
INSPECTION:
PALPATION:
As you palpate the chest, focus on areas of tenderness and abnormalities in the overlying skin,
respiratory expansion, and fremitus.
Dept Of P.G Studies in Roganidana, G.A.M.C Bangalore. ©Private Circulation Only© Page 12
Scheme of case taking
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)
Dept Of P.G Studies in Roganidana, G.A.M.C Bangalore. ©Private Circulation Only© Page 13
Scheme of case taking
Suprascapular
Infrascapular—below the scapula
Interscapular—between the scapulae Posterior
Infrascapular-Upper/Lower
Axillary
Infraxillary
Dept Of P.G Studies in Roganidana, G.A.M.C Bangalore. ©Private Circulation Only© Page 14
Scheme of case taking
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
Scheme of case taking
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
Hepatic rub
Splenic rub
Dept. Of P.G Studies in Roganidana, G.A.M.C Bangalore. ©Private Circulation Only© Page 16
Scheme of case taking
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.
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
Dept. Of P.G Studies in Roganidana, G.A.M.C Bangalore. ©Private Circulation Only© Page 17
Scheme of case taking
Dept. Of P.G Studies in Roganidana, G.A.M.C Bangalore. ©Private Circulation Only© Page 18
Scheme of case taking
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
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
Dept. Of P.G Studies in Roganidana, G.A.M.C Bangalore. ©Private Circulation Only© Page 19
Scheme of case taking
Sensory system:
Superficial-
Touch
Pain
Temperature
Deep
Crude touch
Vibration
Joint sense
Sense of position
Sense of pressure
Cortical
Tactile localization
Tactile discrimination
Tactile extinction
Astereognosis
Graphaesthesia
Dept. Of P.G Studies in Roganidana, G.A.M.C Bangalore. ©Private Circulation Only© Page 20
Scheme of case taking
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
Meningeal signs:
Neck stiffness
Kernig’s sign
Brudzunski’s sign
Dept. Of P.G Studies in Roganidana, G.A.M.C Bangalore. ©Private Circulation Only© Page 21
Scheme of case taking
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).
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.
Dept. Of P.G Studies in Roganidana, G.A.M.C Bangalore. ©Private Circulation Only© Page 22
Scheme of case taking
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)
Dept. Of P.G Studies in Roganidana, G.A.M.C Bangalore. ©Private Circulation Only© Page 23
Scheme of case taking
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
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
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
Dept. Of P.G Studies in Roganidana, G.A.M.C Bangalore. ©Private Circulation Only© Page 24
Scheme of case taking
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.
Dept. Of P.G Studies in Roganidana, G.A.M.C Bangalore. ©Private Circulation Only© Page 25
Scheme of case taking
Skin
Dept. Of P.G Studies in Roganidana, G.A.M.C Bangalore. ©Private Circulation Only© Page 26
Scheme of case taking
Nail
Color and Shape:
Lesion:
Nail Fold:
Hair
Color:
Texture:
Dept. Of P.G Studies in Roganidana, G.A.M.C Bangalore. ©Private Circulation Only© Page 27
Scheme of case taking
Relevant investigation:
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.
Dept. Of P.G Studies in Roganidana, G.A.M.C Bangalore. ©Private Circulation Only© Page 28