①①

Gynaecology & Obstetrics Clerkship

Date:
1. ID:
a. Name, Sex (F), Address
b. Referral status; (self-referral from home/referred from hospital + reason for referral)
c. Gravidity; condition of pregnancy regardless of outcome (primigravida/ multigravida)
d. Parity; how many births (primipara/ multipara)
e. How many children living; alive?, well?
Gx Pa+b
f. Last normal menstrual period (LNMP)
x: total #of pregnancies (including index one)
g. Expected date of delivery (EDD)
a: total #of births beyond 28 weeks of gestation (or
h. Gestation age; by:
≥1kg body weight)
i. Dates: Naegele’s Rule
b: total #of births of miscarriages/ termination of
ii. Fundal height
pregnancies <28 weeks of gestation
iii. Ultrasound
i. Any previous scar(s)?
Naegele’s Rule:
j. Known chronic illnesses (for how long)
𝐸𝐷𝐷 = (𝐿𝑁𝑀𝑃 + 7 𝑑𝑎𝑦𝑠) − 3𝑀𝑜 (LNMP: April – Dec)
± medication (regular/irregular) 𝐸𝐷𝐷 = (𝐿𝑁𝑀𝑃 + 7 𝑑𝑎𝑦𝑠) + 9 𝑀𝑜 (LNMP: Jan – March)
± clinic attendance (regular/irregular) Gives EDD at 40 weeks of gestation
k. When the patient was admitted this time
l. If IDS (for how long, baseline CD4 count
& current CD4 count, ART regimen?,
TMP-SXT prophylaxis?)
m. Ask for any documentation (e.g. discharge summaries, ANC & CTC card)
n. Ask for any medication that the patient/relative has with them

2. Chief Complaints (C/C):

a. SOCRATES; Site, Onset, Character, Radiation,
b. Associated factors, Timing (duration, periodicity,
frequency), Exacerbating/alleviating factors, Severity
3. History of Presenting Illness (HPI):
a. Amplify complaints DOPPARA; Duration, Onset, Periodicity, Progression,
b. Complications Associated factors, Relieving factors, Aggravating
c. Risk factors factors
d. Obs/Gyn hx
e. Course of illness

4. Review of Systems (ROS):

a. HEENT; Head, ears, eyes, nose and throat
i. Pain
ii. Bleeding
iii. Discharge
b. Central Nervous System
i. Fever
ii. Loss of consciousness (LOC)/ collapse/ blackouts
iii. Seizures
iv. Headache/ dizziness/ loss of balance
v. Problems in vision/ hearing
vi. Tingling (paraesthesiae)
vii. Spasms/ involuntary movements/ tics
c. Cardiovascular System
@ i. Awareness of heartbeat (palpitations)
ii. Shortness of breath (dyspnoea, SOB)
“ iii. Difficulty in breathing on lying flat (orthopnoea)
iv. 'Air-hunger' at night (paroxysmal nocturnal dyspnoea, PND)
v. Lower limb, ankle swelling/ facial puffiness
vi. History of bluish discolouration? (cyanosis)
d. Respiratory System
i. Chest pain
ii. Difficulty in breathing (rapid breathing?, mouth-breathing?)
iii. Cough ± sputum
iv. Haemoptysis

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e. Gastrointestinal
i. Abdominal pain (site: lower/upper, sides/centrally)
ii. 'Heart-burn' (dyspepsia)
iii. Difficulty swallowing (dysphagia); of solids ± liquids?
iv. Painful swallowing (odynophagia); of solids ± liquids?
v. Nausea ± vomiting
vi. Change in appetite (loss: anorexia)
vii. Weight loss / gain
viii. Bowel pattern and any change; hard-stools (constipation), diarrhoea
ix. Bloody stools; streaks/gross blood, fresh/digested
x. History of yellowish discolouration (jaundice)?
f. Genitourinary System
i. Painful urination (dysuria)
ii. Blood in urine/bloody urine (haematuria)
iii. Waking up to urinate at night (nocturia)
iv. Urgency; an overwhelming desire to micturate
v. Incontinence; inability to control urination
1. Total incontinence; absolute loss of control of urination, continuous leakage of
urine
2. Stress incontinence; the involuntary leakage of urine from the full bladder
when the intra-abdominal pressure is raised (e.g. coughing/sneezing).
3. Urge incontinence; leakage of urine due to over-activity of detrusor muscle
4. Overflow incontinence; urine leakage secondary to retention of urine
vi. Change in frequency
g. Musculoskeletal System: (limbs, back, joints)
i. Weakness
ii. Pain/ stiffness
iii. Swelling
h. Haematopoietic System
i. Easy bruising
ii. Bleeding tendencies (ask how long it takes for bleeding to stop if injured)

5. Index Pregnancy: health of mother during current pregnancy (ask to see RCH card)
a. ANC (antenatal clinic); date of first visit at ANC, age of pregnancy at first visit to ANC
frequency of attendance (ask to see ANC/RCH card)
b. Illnesses during pregnancy; febrile?, vomiting?, bleeding?, complications?
c. Any tests during pregnancy; (haemoglobin, ABO, Rh, BP, BMI: weight (kg)/ height (m2),
PITC, VDRL, B/S, urinalysis, urine protein, stool analysis), when?, repeated later?
d. Medication use during pregnancy; what, route, duration, compliance
i. Sulphadoxine-Pyrimethamine (SP) for malaria (white tablets)?
ii. Antihelminthic treatment (mebendazole)?
iii. Iron (red tablets)?
iv. Folate (yellow tablets)?
v. Tetanus toxoid injection?
e. Radiation exposure
f. Foetal kicks (quickening in primigravidae:20-24 wks, in multigravidae:16-18 wks)

6. Past Obstetric History: list all previous pregnancies in chronological order (first → last) and for each:
a. How many total pregnancies (including terminations)
b. Age at first pregnancy
c. Mode of Delivery; if IOL, C/s why?
i. Spontaneous vaginal delivery (SVD)
ii. Induction of labour; uterotonic drugs/ artificial rupture of membranes (amniotomy)
iii. Caesarean Section (C/s)
d. Duration of pregnancy; pre-term (<37wks), term (37-42 wks), post-term (>42 wks)
e. Place of delivery; hospital/ home (why?)
f. Age, sex of child(ren); (if many, ask for first & last pregnancies)
g. Single pregnancy/ twins?
h. Weight of lightest, heaviest babies
i. Complications to mother? (before, during, after delivery)
i. Illnesses during pregnancy; febrile?, vomiting?, bleeding?, complications?
ii. Use of any medication during pregnancy; what, route, duration, compliance
iii. Prolonged duration of labour (active phase of 1st stage: normal is <18hrs)
HOODA, Faisal Hasnain
 iv. Abnormal pregnancy; ectopic pregnancy/ molar pregnancy/ ③
v. Termination of pregnancy; spontaneous abortion/ induced abortion
j. Complications to child?
i. Birth-weight; (Normal: 2.5-3.5kg, low: 1.5-2.5kg, very low: 1.5-1.0kg, extremely low
<1.0kg)
ii. State of neonate at birth; any problems during newborn period; jaundice?, breathing
problems?, feeding difficulties?
iii. Resuscitation; required?, how long resuscitated?
iv. Delayed onset of first cry
v. Serious illnesses after birth; congenital malformations?, pallor?, jaundice?, convulsions?
vi. Difficulty in sucking, feeding difficulties?, weight loss?
vii. Rashes

7. Gynaecologic History:
a. Age at first period? (menarche: prolonged oestrogen exposure risks endometrial hyperplasia± Ca)
b. Last normal menstrual period (LNMP: ask specifically for first day of last menses)
c. Average duration of menstrual cycle (normal is 21-35 days)
d. Duration of bleeding in menstrual periods (normal is <7 days)
e. Amount of bleeding in menstrual periods (how many pads/ tampons/ khangas used, partially-/
fully-soaked) (bleeding >80mls/>3 fully-soaked pads is abnormal)
f. Any abnormal bleeding between periods? (intermenstrual bleeds)
(menorrhagia: heavy (>80mls) regular periods/ lasting long (>7 days), metrorrhagia: irregular and
frequent uterine bleeding, polymenorrhoea: abnormally frequent <21-day intervals,
oligomenorrhoea: abnormally frequent cycle >35-day intervals)
i. How much?
ii. When it occurs?
iii. Contact bleeding (after cleaning-oneself/ intercourse)?
g. Pain during menstruation (dysmenorrhoea)
h. Contraceptive use: oestrogen/progesterone pill (combined oral contraception, COC)/
progesterone-only pill (POP)/ injectable progestogens/ intrauterine contraceptive devices/
progestogen-containing vaginal rings
i. Vaginal discharge; duration, quantity, smell, colour, associated blood, rash, itchiness, any
symptom in partner
j. Feeling of bulge at the introitus (prolapse)
i. Feeling of something coming down; stays/goes away overnight or when lying down
ii. Leak urine if sneeze, cough
iii. Associated backache?

8. Sexual History:
a. Nature of sexual relationship; none/ single partner/ multiple partners
b. Pain during coitus (dyspareunia; deep pain, and due to endometriosis, PID)
i. Severity; does intercourse have to stop?
ii. Frequency; sometimes (how often?)/at every intercourse
iii. Location; superficial (near outside)/ deep on the inside
iv. Any other pains in pelvic region other than that caused by sexual activity
c. Post-coital bleeding?
9. Past Medical History (PMHx):
a. Chronic illnesses; Epilepsy, DM, HTN, Cardiac problems, TB, SCD, SLE?
b. Previous admissions; number, reason, when
c. History of trauma/surgical intervention; number, reason, when
d. History of blood transfusions; number, reason, when
e. Medication use; what? (drugs, herbal medication), route, duration, compliance
f. Allergies; food/drugs
10. Family Social History (FSHx):
a. Marital status (single/ cohabiting/ married/ separated)
b. Occupation (her + partner/spouse)
c. Education level (her + partner/spouse)
d. Smoking; how many packs (20 cigarettes)?, duration (years)
e. Alcohol use; quantity, frequency of use
f. Home; water source (boiled water?), toilets?, insecticide-treated nets?, ventilation?
g. Hereditary familial illnesses; Epilepsy, DM, HTN, SCD, haemophilia, thalassemia, heart problems
h. Plans for delivery, breastfeeding
11. Summary 1:

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Physical Exam
JACCOLYN; Jaundice, Anaemia, Cyanosis, finger Clubbing, Oedema, LYmphadeNopathy
12. General Exam:
a. Consciousness; (alert/ lethargic/ irritable/ unconscious)
b. Orientation to person, place and time
c. Physique & nutrition (obese/average-build/ wasting/abnormal fat distribution)
d. Febrile/ afebrile (fever?)
e. Dyspnoeic/ not dyspnoeic
f. Anaemia: subconjunctival pallor, tongue, palmar pallor
g. Jaundice: scleral jaundice, earlobes, tongue, nailbed
h. Cyanosis: sublingual frenulum, nailbed
i. Oedema; pitting/non-pitting, location (pedal/ pre-tibial/ sacral/ anasarca)
j. Superficial lymph node enlargement
i. Site & size
ii. Discrete (solitary) /matted (joined)
iii. Tenderness
iv. Surface, edge, consistency (hard/firm/soft, smooth/nodulated)
v. Mobility (mobile/fixed)
k. Back; normal/kyphosis? (forward bending)/ scoliosis? (lateral bending) /kyphoscoliosis?
l. Signs of hyperandrogenism: excess hair growth (hirsutes), male pattern baldness, acne, ↑muscle

13. Vitals;
a. Temperature: °C
b. Pulse;
i. Rate: beats per minute
ii. Rhythm: (regularly regular, regularly irregular, irregularly irregular)
iii. Synchronicity; (synchronised/de-synchronised) with (contralateral limb/femoral pulse)
c. Respiratory rate; breaths per minute
d. Blood pressure; mmHg (sitting, standing, MAP =1/3 SBP + 2/3DBP)
e. O2 saturation; % in room air/ x lts of O2
f. BMI: weight (kg)/ height (m)2
g. Foetal heart rate (FHR): beats per minute (normal is 120-160)

14. Systemic Exam:

a. Per Abdomen;
i. On inspection
1. Shape; (scaphoid/ flat/distended: generalized/local, symmetric/asymmetric)
2. Umbilicus (inverted/everted)
3. Movement of abdominal wall; (diminished, aortic pulsation, peristalsis)
4. Skin; (surgical scars, traditional marks, stretch marks/shininess, superficial
veins)
a. Linea nigra (dark pigmented line stretching from the xiphi-sternum
≈midline through the umbilicus to the suprapubic area)
b. Striae gravidarum (recent stretch marks are purplish in colour)
c. Striae albicans (old stretch marks are silvery-white)
5. Dilated superficial abdominal Veins; (caput medusae)
ii. On palpation
1. Superficial: tenderness?
2. Deep: tenderness
3. Obstetric Leopold’s Manoeuvres; applicable from >28 weeks of gestation
a. 1st: Fundal grip: facing the patient’s head, use ulnar border of left
palm to palpate from xiphisternum going down.
i. Fundal masses:
1) Buttocks: soft, irregular, moves with trunk
2) Head: hard, round, moves independent of trunk
ii. Symphysis-fundal height (SFH): measure height from
symphysis pubis upwards
At umbilicus is 20-22 weeks
At xiphisternum is 36 weeks
1) At <20 weeks: palpate
2) At >20 weeks: measure in cm
b. 2nd: Lateral grip: facing the patient’s head, use both palms, one on
either side of the abdomen. At any one time, one palm is stationary
and the other moves around (i.e. scanning abdomen using fingers)

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i. Foetal poles: estimated number of foetuses
1) Back: smooth, hard
2) Limbs (knees, elbows): numerous angular
nodulations
ii. Foetal lie: assess where the back is in relation to L/R of
mother
1) Longitudinal: head/ breech palapable over pelvic
inlet
2) Oblique: head/breech palpable over iliac fossa
3) Transverse: head/breech palpable over flanks
c. 3rd: Paulick’s grip: facing the patient’s head, gently grasp the lower
portion of the abdomen just above the symphysis pubis, using the
thumb and fingers of one hand.
i. Presentation: the part lying over the pelvic inlet
1) Head
2) Shoulder
3) Breech
4) Compound
ii. Position: where the foetus is facing (LOA is most common)
1) Rearward (occipitoposterior): face is toward the
woman's back—that is, face down when the
woman lies on her back
2) Forward (occipitoanterior): face is upwards
d. 4th: Pelvic grip: facing the patient’s feet, gently move fingers of both
hands (starting at the level of the umbilicus) down the sides of the
uterus toward the pubis to find area of greatest resistance
i. Engagement: level of presenting part measure in 5ths
engaged. Place fingers to cover head above pelvic brim.
Nulliparous: engaged by 37 weeks
Multiparous: may occur just before labour
1) Unengaged (5,4,3 fifths): a moveable body will be
noted which may be gently balloted
2) Engaged (2,1,0 fifths): the presenting body part is
immobile i.e. fixed in pelvis
ii. Attitude: relationship of the foetus' body parts to one
another. The cephalic prominence is where the greatest
resistance is felt.
1) Flexed head: is normal. Sinciput is felt on
opposite side of foetal back
2) Extended head: is abnormal. Sinciput is felt on
same side as foetal back (face presentation)
e. Other Parameters
i. Foetal movements
ii. Foetal weight estimation; is done at term or around the
time of delivery. Multiply fundal height (cm) by the
maximal abdominal girth (cm) to estimate weight (gm)
4. Deep: tenderness?
a. Left kidney
b. Spleen; (palpable, span below costal margin)
c. Right kidney
d. Liver;
i. Span
ii. Surface; (soft/firm/hard, regular/irregular, tender/non-
tender, nodular/smooth)
e. Gallbladder (murphy’s sign?)
f. Urinary bladder
g. Aorta
h. Rectus abdominis muscle
i. Abdominal mass(es)
i. Site, size & shape
ii. Surface, edge, consistency (hard/soft, irregular/regular,
nodular/smooth, round, tender/non-tender)
iii. Mobility
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 ⑥

iv. Pulsation
j. Guarding / rebound tenderness
iii. On percussion; tympanic note/dullness (don’t do for gravid uterus)
1. Liver; span
2. Spleen; span
3. Urinary Bladder
4. Other masses
5. Ascites; chest-knee position dullness/ shifting dullness/ fluid thrill
iv. On auscultation;
1. Foetal Heart rate; heard from >24
weeks of gestation (normal is 110-160)
a. Place one hand of radial
artery to differentiate
between maternal and foetal
pulses
b. Listen over the foetal back to
the foetal heart sounds
c. Rate and the rhythm of the
should be determined over 1
min.
2. Vascular bruits
b. Pelvic (Vaginal & Perineal) Exam
i. Inspection;
1. Note
Inflammation, swelling, soreness, ulceration or neoplasia of the vulva,
perineum or anus
a. Small warts (condylomata acuminata) appearing as papillary
growths may occur scattered over the vulva; these are due to
infection with the human papilloma virus (HPV)
b. Clitoris and urethra are inspected
c. Patient is asked to strain and then to cough to demonstrate
uterovaginal prolapse or stress incontinence

ii. Palpation;
1. Locate cervix
2. Bimanual palpation; allows palpation of the ovaries and fallopian tubes,
although these can be difficult to feel in healthy women
3. Pelvic tenderness
4. Pelvic masses
5. Assessment of uterus (position, mobility)
6. Lateral fornix
7. Ovaries and fallopian tubes
iii. Speculum examination;
a. Sim’s (single-bladed); for display vaginal wall
b. Cusco’s (duck-bill/ bivalve type); for displaying the cervix
1. Cervix
2. Vaginal walls
iv. During labour
1. Dilatation and effacement of the cervix
2. Presence or absence of amniotic membranes and the state of the liquor
3. Level of the presenting part; measured from ischial spine
a. Above (-)
b. At (0) 'the station'
c. Below (+)
4. Absence of a pulsating umbilical cord, especially if the membranes are ruptured
5. Degree of moulding of the foetal head/presence of caput succedaneum
(oedema of the foetal scalp)

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6. Size and shape of the maternal bony pelvis
a. True (anatomical) conjugate: 11.5 cm. From the upper margin of the
symphysis pubis to the sacral promontory
b. Obstetric conjugate: 11cm. From the innermost part of the
symphysis pubis to the sacral promontory
c. Diagonal conjugate: 12.5cm. From the lower part of the symphysis to
the sacral promontory. Can be measured only at patients with a
contracted pelvis
Alert
c. Central Nervous System:
Response to voice (lethargic)
i. Central Nervous System
Response to pain (obtunded)
ii. Higher Centres
Unconscious
1. Mental State
2. Level of Consciousness; AVPU/ GCS
Glasgow Coma Scale
Eye Opening Best Verbal Best Motor
6 Obeys command
5 Oriented Localises to pain
4 Spontaneously Confused speech Withdraws from pain
3 To voice Inappropriate response Flexes to pain
2 To pain Incomprehensible sound Extends to pain
1 None None None
iii. Orientation
1. Speech
2. Memory
d. Short-term; name, time of day, place of admission
e. Long-term; first president of the country, birthday of the patient
iv. Cranial Nerves
Cranial Nerve Test
I (Olfactory) Observe grimacing when a pungent odour is brought under nostril
II (Optic) Test visual fields or Use Snellen chart
III, IV, VI (Oculomotor, Trochlear,
Have patient track light/object in an ‘H’ shape track.
Abducens)
V Sensation: test sensation by moving soft cotton ball along all three branches
(trigeminal) Motor: have the patient clench teeth, chew/swallow food.
VII Facial, forehead, nasolabial fold symmetry, blinking, squinting eyes, raising eyebrows against
(facial) resistance when closed, grimacing, smiling, blowing-out cheeks
VIII (vestibulocochlear) Whisper a word/command behind the patient’s back and have them repeat it
IX, X (glossopharyngeal, vagus) Have the patient say ‘ah’. Observe movement of uvula, soft palate. Test gag reflex
XI The patient shrugs their shoulders, and turns their face to the other side while resistance is
(accessory) applied against the movement
XII Ask the patient to stick out their tongue all the way. Note any wasting, fasciculation, tremors
(hypoglossal) of tongue
v. Meningeal Signs
1. Neck stiffness
2. Kernig's sign
3. Brudzinski's sign
vi. Motor/Reflexes;
1. Bulk: (normal/wasted)
2. Tone: (normal/increased/decreased/rigid/spastic)
3. Power: (grade 0 - 5)
a. Upper limbs
b. Lower limbs
4. Superficial Reflexes: (present/absent)
c. Pupillary Light Reflex; (CN II, III) observe direct and consensual
constriction of pupils as light is shone into eye(s).
d. Occulocephalic Reflex; (CN III, VI, VIII) movement of the eyes in an
opposite direction to head movement.
e. Corneal Reflex; (CN V, VII) blinking of eyes on contact with cotton
f. Gag Reflex; (CN IX, X) gag/choking induced as tongue is depressed
using tongue spatula.
g. Apnoea Reflex; for a ventilated patient, switching-off ventilator
evokes a gasping response.

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 ⑧
h. Abdominal Reflex; stroke abdomen gently from flanks → inward.
Observe the contraction of the abdominal muscles resulting in
deviation of umbilicus towards the area stimulated.
i. Anal Reflex; reflexive contraction of the external anal sphincter
upon stroking of the skin around the anus
j. Babinski Reflex; (down-going/up-going/equivocal)
5. Deep Reflex; (grade 0-4)
a. Biceps (C5, C6)
b. Brachioradialis (C5, C6)
c. Triceps (C6, C7)
d. Finger (C8)
e. Adductor (L2, L3)
f. Knee (L3, L4)
g. Ankle (S1)
6. Sensory System;
h. Pin-prick
i. Temperature
j. Light touch
k. Vibration sense
l. Joint position sense
m. 2-point discrimination
7. Co-ordination, Gait & Balance;
n. Co-ordination: Finger-to-nose, rapid alternating movement of the
hand, heel-shin test
o. Gait
p. Balance/Stance
d. Cardiovascular System; (inverted J)
i. Hand/palm;
1. Warmth of extremities
2. Cyanosis: at rest? (check nail-bed, circumorally, tongue)
3. Digital (finger/toe) clubbing
4. Capillary refill (<3 secs)
5. Signs of Infective endocarditis; (dermal infarcts, Janeway lesions: painless
haemorrhagic cutaneous lesions on the palms and soles, Osler's nodes: painful
subcutaneous lesions in the distal fingers, Roth's spots: on the retina)
6. Arterial Pulses
a. Radial
b. Brachial
c. Carotid
d. Femoral
e. Popliteal
f. Pedal (dorsalis pedis)
g. Middle maleolar
7. Rate: bpm
a. Rhythm: (regularly regular/ regularly irregular/irregularly irregular)
b. Character: (good/poor volume)
c. Synchronicity: with contralateral limb
ii. Arm; blood pressure
iii. Neck;
1. Jugular Venous Pressure: (normally <4cm)
2. Hepatojugular reflux
iv. Precordium;
1. Inspection
a. Traditional marks/surgical scars
b. Precordial bulging (protrusion of the chest around heart)
c. Precordial hyperactivity
2. Palpation
a. Thrills (palpable murmurs in all 4 areas of auscultation)
b. Heaves (indicative of chamber enlargement: Apical/ Rt parasternal/
Lt parasternal)
c. Apex beat (5th ICS along lt MCL)

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 3. Auscultation: (4 areas of auscultation. apex area: mitral area, lower left
⑨
sternal edge: tricuspid area, upper left sternal edge: pulmonary area, upper
right sternal edge: aortic area)
a. Heart Sounds
v. S1, S2 ± Extra heart sounds (gallop rhythm: S3/S4)
vi. Murmurs
1. Loudness; grade (1-6)
2. Quality; pitch(low/medium/high)
3. Location; best hear (aortic/ pulmonary/
tricuspid/ mitral) area
4. Timing; (systolic/diastolic/ continuous)
v. Other areas (report only if necessary)
1. Lungs; bibasilar crackles (≡pulmonary oedema)
2. Liver; enlarged, tender, hepatojugular reflux (≡hepatic congestion)
3. Oedema; pitting/non-pitting (periorbital, lower limb)

e. Respiratory System;
i. On inspection;
1. Respiratory rate: Rate (breaths per minute, dyspnoeic), Rhythm (regular/
irregular)
2. Respiratory distress; nasal flaring, mouth-breathing, use of accessory muscles
of respiration, head-nodding
3. Skin; (scars/lesions/lumps)
4. Spine; (normal/kyphosis/scoliosis)
5. Ribcage: (normal/barrel-shaped/ pigeon-chest /sunken-chest)
6. Movement
a. Expansion, symmetrical movement:
b. Intercostal recessions, lower chest wall in-drawing
ii. On palpation;
1. Lymph node enlargement:
2. Swelling/tenderness
3. Position of trachea (deviated/centrally-located)
4. Asymmetry during chest expansion
5. Tactile vocal fremitus (normal/ increased /reduced)
iii. On percussion;
1. Resonance; (normal/ increased /reduced)
iv. On auscultation;
1. Breath sounds
a. Intensity; (normal/ loud/ diminished)
b. Quality; (vesicular/ bronchial/ bronchovesicular)
c. Added breath sounds; (wheezes, crackles, stridor, pleural rub)
2. Vocal resonance; (increased/ normal/ reduced)

15. Summary 2:

16. Provisional Diagnosis & Differentials:

a.
Rule out
b.
Rule out

17. Investigations:
a.
b.

18. Management:
a. Pharmacologic
b. Non-pharmacologic

19. Prognosis:

20. Follow-up & Other Remarks:

HOODA, Faisal Hasnain