Ab main apni knowledge se ye detailed format dunga - yeh standard clinical medicine format hai jo Harrison's, Davidson's aur clinical medicine textbooks mein established hai.
Respiratory Department - Complete Case Taking Format
(Har point ke saath: Patient se kaise pucho + Medical meaning)
1. BIODATA (Patient ki Basic Information)
| Point | Patient se kaise puchein | Medical Significance |
|---|
| Naam | "Aapka naam kya hai?" | Identity |
| Umra | "Aapki age kya hai?" | Young = TB, asthma; Old = COPD, cancer, pneumonia |
| Sex | - | Males mein COPD zyada; females mein asthma zyada |
| Occupation | "Aap kya kaam karte ho?" | Miner = pneumoconiosis; farmer = hypersensitivity pneumonitis; smoker = COPD/Ca lung |
| Address | "Aap kahan rehte ho?" | Industrial area = pollution exposure; slum = TB |
| Religion/Socioeconomic | "Ghar mein kitne log hain, kaisa ghar hai?" | Overcrowding = TB transmission |
2. CHIEF COMPLAINT (Mukhya Shikayat)
Patient se: "Aaj aap kyun aaye ho? Sabse zyada kya takleef hai? Kitne dino se hai?"
Medical format: Complaint + Duration
- Example: "Khansi - 3 hafte se" / "Saans lene mein takleef - 2 din se"
Respiratory ke main chief complaints:
- Khansi (Cough)
- Saans phoolna (Dyspnea/Breathlessness)
- Khoon aana khansi mein (Hemoptysis)
- Seene mein dard (Chest pain)
- Ghargharahat (Wheeze)
- Bukhaar (Fever)
3. HISTORY OF PRESENT ILLNESS (HPI) - Har Complaint ki Detail
A. KHANSI (Cough)
Patient se puchne wale sawaal:
| Sawaal | Patient ki Bhasha | Medical Point |
|---|
| Kab se hai? | "Yeh khansi kab se shuru hui?" | Duration - acute (<3 wk), subacute (3-8 wk), chronic (>8 wk) |
| Din mein kab zyada? | "Subah zyada hoti hai ya raat ko?" | Morning = COPD/bronchiectasis; Night = asthma/GERD; posture change = bronchiectasis |
| Sukhi ya balagam? | "Khansi ke saath kuch nikalti hai ya sukhi hai?" | Dry = viral, ILD, ACE inhibitor; Productive = bacterial, bronchiectasis |
| Balagam kaisi? | "Jo nikalti hai woh kaisi hai - safed, peeli, hari, ya khoon?" | Mucoid (white) = chronic bronchitis; Purulent (yellow/green) = infection; Rusty = pneumococcal pneumonia; Pink frothy = pulmonary edema |
| Balagam kitni? | "Ek din mein kitni nikalti hai - thodi ya zyada?" | >200ml/day = bronchiectasis |
| Kisi cheez se badhe/ghatey? | "Khansi kab zyada hoti hai - late ne par ya kuch khaane par?" | Lying flat worse = GERD/LVF; cold air = asthma |
B. SAANS PHOOLNA (Dyspnea / Breathlessness)
Patient se puchne wale sawaal:
| Sawaal | Patient ki Bhasha | Medical Point |
|---|
| Kab se? | "Yeh saans phoolna kab se shuru hua?" | Sudden onset = pneumothorax, PE, asthma attack; Gradual = COPD, ILD, pleural effusion |
| Kitna kaam karne par? | "Seedhi zameen par kitna chal lete ho? Chadh sakte ho? Kapde pehn lete ho khud?" | MRC Dyspnea Scale (Grade 1-5) - important for COPD staging |
| Raat ko? | "Raat ko neend mein achanak saans phoolti hai? Uthna padta hai?" | PND (Paroxysmal Nocturnal Dyspnea) = Left Heart Failure |
| Litne par? | "Flat let sakte ho ya takiye lagane padte hain?" | Orthopnea = LVF; Platypnea (better lying) = hepatopulmonary syndrome |
| Achanak ya dheere dheere? | "Yeh achanak hua ya dheere dheere badha?" | Acute = emergency; Chronic = COPD/ILD |
| Kisi cheez se? | "Khansi, dhool, janwar ke paas jaane se saans phoolti hai?" | Allergen triggered = asthma |
MRC Scale (Patient ko samjhao):
- Grade 1: Bahut mehnat karne par - "Pahad chadh rahe ho tab"
- Grade 2: Seedhi zameen par tez chalte waqt - "Jaldi chalte ho tab"
- Grade 3: Seedhi zameen par normal chal ne par ruk jaate ho
- Grade 4: 100 meter chalke ruk jaate ho
- Grade 5: Ghar se nahi nikal sakte / kapde pehnte waqt
C. KHOON AANA KHANSI MEIN (Hemoptysis)
Patient se: "Khansi ke saath kabhi khoon aaya? Kaisa tha - thoda sa ya zyada? Sirf khoon tha ya balagam ke saath? Laal tha ya kaala?"
| Point | Medical Significance |
|---|
| Bright red, fresh blood | Active bleeding - TB, bronchiectasis, Ca lung |
| Rusty/brown | Pneumococcal pneumonia |
| Pink frothy | Pulmonary edema (LVF) |
| Blood streaked sputum | TB, bronchitis, Ca lung |
| Massive (>200ml/24hr) | Emergency - TB cavity, bronchiectasis, aspergilloma |
Important: Haemoptysis ko haematemesis (ulti mein khoon) se alag karna - "Khanste waqt aaya ya ulti mein?"
D. SEENE MEIN DARD (Chest Pain)
Patient se: "Seene mein dard hota hai? Kahan? Kaisa dard - jalan, chubhan, bhaari? Saans lene par badh jaata hai? Kisi jagah jaata hai yeh dard?"
| Characteristic | Patient Bhasha | Medical Meaning |
|---|
| Site | "Dard kahan hai? Ek jagah ya poore seene mein?" | Lateral = pleuritic; Central = pericarditis/cardiac |
| Character | "Kaise dard hai - chhura chubhne jaisa, jalan, ya bhaari?" | Sharp stabbing = pleurisy/pneumothorax; Dull ache = malignancy |
| Radiation | "Dard kahan jaata hai - haath mein, peeth mein?" | Shoulder tip = diaphragmatic pleura irritation |
| Aggravation | "Saans lete waqt badh jaata hai?" | Worse on inspiration = Pleuritic pain (TB pleuritis, PE, pneumothorax, pneumonia) |
| Relief | "Kuch karne se kam hota hai?" | Bending forward = pericarditis |
E. GHARGHARAHAT (Wheeze)
Patient se: "Saans lete waqt ya chhodte waqt seene se awaaz aati hai? Siti jaisi? Kab hoti hai?"
| Point | Medical Meaning |
|---|
| Expiratory wheeze | Asthma, COPD (lower airway obstruction) |
| Inspiratory stridor | Upper airway obstruction (epiglottitis, foreign body, tracheal stenosis) |
| Episodic | Asthma |
| Constant | COPD |
| Positional | Tracheal compression by tumor |
F. BUKHAAR (Fever)
Patient se: "Bukhaar aata hai? Kitna? Kaante lagakar check kiya? Raat ko paseena aata hai? Subah kam hota hai?"
| Pattern | Medical Meaning |
|---|
| Night sweats + evening fever | TB (classic B-symptom) |
| High fever + rigors | Bacterial pneumonia |
| Low grade, continuous | Malignancy, chronic infection |
| Hectic/swinging fever | Lung abscess, empyema |
4. SYSTEMIC REVIEW - Respiratory Related
Patient se ek ek puchein:
| Sawaal (Patient Bhasha) | Medical Point |
|---|
| "Wajan kam hua pichle kuch mahino mein?" | Weight loss = TB, malignancy |
| "Bhook lagti hai?" | Anorexia = TB, Ca lung |
| "Raat ko paseena aata hai?" | Night sweats = TB |
| "Pair sooje hain?" | Pedal edema = Cor pulmonale (right heart failure due to lung disease) |
| "Neend mein kharraate aate hain? Neend ke baad thake rahe ho?" | OSA (Obstructive Sleep Apnea) |
| "Awaaz baith gayi?" | Hoarseness = recurrent laryngeal nerve palsy (Ca lung, mediastinal mass) |
| "Nigalne mein takleef?" | Dysphagia = mediastinal compression |
| "Haath pair mein sunn ya jhanjhanahat?" | Peripheral neuropathy = TB drugs, paraneoplastic |
5. PAST HISTORY (Pichli Bimariyan)
Patient se: "Pehle kabhi aisi takleef hui? Hospital mein bharte hue? Koi bada operation hua? Koi bimari hai jo pehle se hai?"
| Puchne wali Cheez | Medical Significance |
|---|
| "Pehle TB hua?" | Previous TB = reactivation risk, bronchiectasis sequel |
| "Bachpan mein asthma tha?" | Atopy, childhood asthma history |
| "Dil ki bimari?" | Cardiac cause of breathlessness |
| "Sugar/BP?" | DM = susceptibility to infections, pneumonia |
| "Kabhi pneumonia hua?" | Recurrent pneumonia = bronchiectasis, immunodeficiency |
| "Koi bone disease?" | Sarcoidosis can cause hypercalcemia + bone involvement |
6. FAMILY HISTORY (Khandaan ki Bimari)
Patient se: "Ghar mein kisi ko yahi takleef hai? Ghar mein kisi ko TB hai ya tha? Ghar mein kisi ko asthma, allergy hai?"
| Cheez | Medical Significance |
|---|
| TB in family | Close contact = infection source |
| Asthma/Allergy in family | Atopy runs in families |
| Ca lung in family | Genetic predisposition |
| Alpha-1 antitrypsin deficiency | Familial emphysema in young non-smokers |
7. PERSONAL HISTORY (Aadatein aur Lifestyle)
Smoking - MOST IMPORTANT in Respiratory
Patient se: "Aap cigarette/bidi peete ho? Kitne saalon se? Ek din mein kitni?"
Medical: Calculate Pack Years
Pack Years = (Cigarettes per day ÷ 20) × Years smoked
-
20 pack years = high risk COPD, Ca lung
- Ex-smoker? Kab chhooda?
| Habit | Patient Bhasha | Medical |
|---|
| Smoking | "Bidi/cigarette/hookah?" | COPD, Ca lung, chronic bronchitis |
| Alcohol | "Sharaab peete ho?" | Aspiration pneumonia, TB risk |
| Diet | "Khana kaisa khate ho?" | Malnutrition = TB risk |
| Exercise | "Koi kaam karte ho ya bed par rehte ho?" | Functional status |
| Sleep | "Raat ko sone par saans ki takleef?" | OSA, PND |
8. OCCUPATIONAL HISTORY - Bahut Important!
Patient se: "Aap kya kaam karte ho? Pehle kya kaam kiya? Kaam ki jagah par dhool, dhuan, chemical aata hai?"
| Occupation | Exposure | Disease |
|---|
| Coal miner | Coal dust | Coal worker's pneumoconiosis |
| Stone cutter/mason | Silica dust | Silicosis |
| Asbestos worker | Asbestos | Asbestosis, Mesothelioma |
| Farmer | Mouldy hay/bird droppings | Hypersensitivity Pneumonitis |
| Painter/welder | Chemical fumes | Occupational asthma |
| Poultry worker | Bird droppings | Bird fancier's lung |
| Healthcare worker | TB patients | TB exposure |
9. DRUG HISTORY (Dawaiyan)
Patient se: "Koi dawa le rahe ho? Pehle se koi dawa chal rahi hai? Kisi dawa se allergy hai?"
| Drug | Respiratory Side Effect |
|---|
| ACE inhibitors (Enalapril, Ramipril) | Dry cough (10-15% patients) |
| Beta blockers | Bronchospasm in asthma/COPD |
| Amiodarone | Pulmonary fibrosis |
| Methotrexate | Pneumonitis |
| Bleomycin | Pulmonary fibrosis |
| NSAIDs/Aspirin | Aspirin-sensitive asthma |
10. SOCIOECONOMIC & ENVIRONMENTAL HISTORY
Patient se: "Ghar mein chulha jalate ho? Kerosene ya LPG? Ghar mein kitne log rehte hain? Ghar mein koi anda/pinjra mein parinda hai?"
| Cheez | Medical Significance |
|---|
| Biomass fuel (chulha, wood, cow dung) | Indoor air pollution = COPD in rural women |
| Overcrowding | TB transmission |
| Pet birds | Bird fancier's lung |
| Damp house | Mould exposure = hypersensitivity pneumonitis |
| Industrial area residence | Environmental pollution |
11. GENERAL PHYSICAL EXAMINATION
Patient dekh ke note karo (bina chhuye):
| Finding | Patient mein kaise dikhe | Medical Meaning |
|---|
| Built/Nourishment | Dubla-patla ya mota? | Cachexia = TB/Ca; Obesity = OSA |
| Pallor | Aankhon ki neechi palak andar se safed? | Anaemia = worsens dyspnea |
| Cyanosis | Honth/nakhoon neele? | Central = respiratory failure (SaO2 <85%) |
| Clubbing | Unglion ke nakhoon ke neeche ka angle badha? | Bronchiectasis, ILD, Ca lung, lung abscess |
| Lymph nodes | Gale mein ya kaankhon mein gaanth? | TB lymphadenitis, malignancy |
| JVP | Gale ki nason mein ubhaar? | Cor pulmonale, SVC obstruction |
| Edema | Paon sooje? | Cor pulmonale |
| Respiratory rate | Kitni baar saans lete hain 1 min mein? | Normal 12-18/min; Tachypnea = any respiratory pathology |
Quick Reference Card
RESPIRATORY CASE = "C-D-H-C-W + SOAP-FED"
Complaints:
C - Cough
D - Dyspnea
H - Hemoptysis
C - Chest pain
W - Wheeze
History:
S - Smoking (Pack Years)
O - Occupation
A - Allergy/Atopy
P - Past illness (TB, asthma)
F - Family history
E - Environment (chulha, birds, damp house)
D - Drugs (ACE inhibitor, beta blocker)
Agar koi ek section aur detail mein chahiye (jaise COPD ka specific history, ya TB ka, ya examination findings) toh batao - woh alag se cover kar dunga.