• Data Integration - combining data from different sources into a unified view
• Dependency Injection - a software design pattern where dependencies are passed into objects rather than created inside them
• Digital Input - a binary signal input in electronics/automation

• Deionized (water) - water with mineral ions removed, used in labs and manufacturing
• Direct Injection - fuel delivery system in engines (GDI = Gasoline Direct Injection)

• Diabetes Insipidus - a condition where the kidneys can't conserve water properly
• Drug Interaction - how two or more drugs affect each other
• Diagnostic Imaging - imaging used to diagnose conditions (X-ray, MRI, CT)

• Due Diligence - research done before a business deal (sometimes abbreviated DI, though DD is more common)
• Disability Insurance - insurance covering income loss due to disability

• Defense Intelligence - military intelligence function
• Directorate of Intelligence - intelligence agency division

Decking a Patient in OPD

1. Patient Registration

• Collect patient's name, age, sex, address, contact number
• Assign a unique OPD registration number / UHID (Unique Hospital ID)
• Check if the patient is a new or revisit case
• Collect relevant ID proof (Aadhaar, hospital card, etc.)

2. Creating/Pulling the OPD Card / File

• New patient: Create a new OPD card/folder with demographics
• Old patient: Retrieve previous records from the file room using UHID
• Affix a sticker or label with patient details and date

3. Vital Signs Recording (Pre-Decking)

• Blood pressure, pulse rate, temperature, respiratory rate
• Weight and height (especially for pediatric and endocrine OPDs)
• Blood glucose if relevant (diabetic OPD)
• SpO2 if relevant
• Document all vitals on the OPD sheet

4. Chief Complaint Documentation

• Write down the presenting complaint briefly
• Note duration of symptoms
• Flag any allergies prominently

5. Triaging

• Identify urgent vs. routine cases
• Send emergencies to the casualty/emergency department
• Assign priority number/token for waiting

6. Directing to the Correct Department/Doctor

• Direct patient to the appropriate specialty clinic (medicine, surgery, gynae, etc.)
• Hand the decked file to the nurse/doctor's assistant

7. Documentation in Hospital System

• Enter data into the Hospital Information System (HIS) or EMR
• Generate a token number or queue number
• Issue the patient a consultation slip

Key Points

• "Decking" essentially means readying the complete patient file so the doctor can begin consultation without delay
• In busy government hospitals, this is often done by nursing staff or paramedics at the OPD reception
• Good decking reduces doctor's clerical burden and improves patient flow

History Taking & Physical Examination of a Surgical Patient

PART 1: HISTORY TAKING

1. Patient Identification

• Name, age, sex, occupation
• Date and time of consultation
• Referral source

2. Chief Complaint (CC)

• The main symptom in the patient's own words
• Record the duration (e.g., "pain in abdomen for 3 days")
• Avoid medical jargon at this stage

3. History of Present Illness (HPI)

4. Past Medical History (PMH)

• Previous illnesses, hospitalizations, surgeries
• Known comorbidities: diabetes, hypertension, cardiac disease, TB, jaundice
• Previous anaesthesia and any complications (important pre-operatively)
• Surgical history: previous abdominal surgeries (adhesions risk)

5. Drug History

• Current medications (especially anticoagulants, steroids, NSAIDs, antihypertensives)
• Allergies (especially to drugs, latex, contrast media) - flag prominently
• Herbal/OTC medicines

6. Family History

• Relevant genetic conditions (colorectal cancer, breast cancer, multiple endocrine neoplasia)
• Bleeding disorders
• Anaesthetic problems (malignant hyperthermia is inherited)

7. Social History

• Smoking (pack-years - affects wound healing, anaesthesia)
• Alcohol (units/week - affects liver function, bleeding)
• Occupation (exposure history, functional requirements post-surgery)
• Living situation (who will care for the patient post-op?)
• Travel history (relevant for tropical diseases, infections)

8. Review of Systems (Systemic Enquiry)

• Cardiovascular: chest pain, palpitations, breathlessness, oedema
• Respiratory: cough, wheeze, haemoptysis, shortness of breath
• GI: appetite, weight loss, nausea, vomiting, bowel habits, rectal bleeding
• Urinary: frequency, dysuria, haematuria, incontinence
• Neurological: headache, fits, weakness, sensory changes
• Endocrine: heat/cold intolerance, polydipsia, polyuria
• Gynaecological (in females): LMP, menstrual history, pregnancies

PART 2: PHYSICAL EXAMINATION

General Approach - "IPPA"

Inspection → Palpation → Percussion → Auscultation

Step 1: General Inspection (End of Bed Assessment)

• Level of consciousness and orientation
• Nutritional status: thin/cachectic/obese
• Pallor, jaundice, cyanosis (the 3 classical signs)
• Posture and body habitus
• Obvious deformities, wounds, drains, IV lines
• Distress level: is the patient in pain? Comfortable?

Step 2: Vital Signs

Step 3: Hands and Upper Limbs

• Nails: clubbing (GI/resp disease), koilonychia (anaemia), leukonychia (hypoalbuminaemia)
• Palmar erythema: liver disease
• Dupuytren's contracture: alcoholic liver disease, familial
• Pulse: rate, rhythm, character, volume
• Capillary refill time: < 2 seconds normal
• IV access sites

Step 4: Face and Neck

• Eyes: jaundice (scleral icterus), anaemia (conjunctival pallor), xanthelasma
• Mouth: hydration status (dry tongue = dehydrated), ulcers, Virchow's node
• Neck: thyroid swelling, lymphadenopathy, JVP (jugular venous pressure)

Step 5: Chest Examination

• Inspection: chest wall symmetry, scars, chest movement
• Palpation: trachea position, apex beat, tenderness
• Percussion: dullness (effusion, consolidation), resonance
• Auscultation: breath sounds, added sounds (wheeze, crackles), heart sounds

Step 6: Abdominal Examination (Key for Surgical Patients)

• Scars (previous surgery)
• Distension (gas, fluid, mass, fat, faeces - "5 Fs")
• Visible peristalsis (obstruction)
• Hernial orifices
• Pulsations (aortic aneurysm)

• Light palpation first - tenderness, guarding, rigidity
• Deep palpation - organomegaly (liver, spleen, kidneys)
• Specific signs: Murphy's sign, Rovsing's sign, rebound tenderness

• Liver span, splenic dullness
• Ascites (shifting dullness, fluid thrill)

• Bowel sounds: normal, absent (ileus), hyperactive (obstruction)
• Bruits (vascular disease)

• Hernial orifices (inguinal, femoral, umbilical)
• Genitalia (when relevant)
• Digital rectal examination (DRE) - essential in surgical patients
• Pr/Pv examination in gynaecological conditions

Step 7: Lower Limbs

• Oedema: pitting - cardiac/renal/hepatic
• Varicose veins, skin changes (venous disease)
• Peripheral pulses: femoral, popliteal, dorsalis pedis, posterior tibial
• DVT assessment: calf tenderness, Homan's sign (now less used)

Step 8: Neurological Assessment (if indicated)

• Tone, power, reflexes
• Sensation
• Cranial nerves (for head and neck surgical patients)

Summary: The Surgical "Deck" Checklist for OPD