Four changes rolled together:
1. REAL AUDIO from Wikimedia Commons (CC BY-SA 3.0, attribution to follow
in privacy policy per Daniel). Embedded in /public/audio/ — synthesis
stays as fallback for sounds not available from Wikimedia.
respiratorySounds.js now tries the real OGG first; falls back to Web
Audio synthesis if file missing.
2. REAL APTM IMAGE from Daniel's Nextcloud share, placed at
/public/images/pe-guide/aptm.png (134 KB PNG). Replaces the inline SVG.
Kept the side legend with A/P/E/T/M colour-coded points.
3. INNOCENT MURMUR REFERENCE PANEL below the APTM diagram with the 5
classic innocent murmurs (Still's, pulmonary flow, venous hum, carotid
bruit, PPS) — age, location, character, confirming maneuver — plus
the 7 "S" criteria summary.
4. ALL-AGE RESP + CV DATA. Before: only adolescent. Now every age group
has age-appropriate resp + cv content (newborn through adolescent).
Newborn: Silverman, pre/postductal sats, duct-dependent lesion screen.
Infant: bronchiolitis, CHF diaphoresis, VSD, early CHD.
Toddler: croup/FB/epiglottitis, innocent murmur peak age.
Preschool + school-age: adult-pattern transition, sports screening.
Third PE system added. Adolescent respiratory fully fleshed out with
the same teaching-focused depth as neuro: overview, grading scales,
per-component significance + pearls, detailed step methods with HOW
and NORMAL labels, and a watch-for red-flag block.
New respiratorySounds.js uses the Web Audio API to synthesize 8 classic
breath sounds on demand — no network, no audio files, no licensing:
- Normal vesicular
- Wheeze (two-partial + vibrato, filtered sawtooth)
- Stridor (inspiratory, bandpass-filtered sawtooth sweep)
- Fine crackles (dense brief high-freq noise bursts, late inspiration)
- Coarse crackles (sparser, longer, lower-freq bursts)
- Rhonchi (low-pitched warbled sawtooth, expiratory)
- Pleural friction rub (bandpass noise, biphasic)
- Expiratory grunting (square-wave short grunts)
Sounds are synthesised approximations intended to teach the pattern
(what makes a wheeze a wheeze vs a stridor). Labelled as such in the UI.
Controls: one play at a time, auto-stop ~3s.
Respiratory-specific grading scales:
- RR by age (WHO tachypnea cutoffs)
- Pulse ox (SpO2) with hypoxemia thresholds
- Silverman–Andersen (neonatal retractions, 0–10)
- Westley croup severity score
Components in adolescent respiratory:
1. Inspection (observation-first — RR, pattern, WOB, audible sounds,
chest shape, colour, clubbing with Schamroth sign)
2. Palpation (trachea, expansion symmetry, tactile fremitus,
tenderness, subcutaneous emphysema)
3. Percussion (technique + systematic zones + cardiac/hepatic
dullness + diaphragmatic excursion)
4. Auscultation — normal breath sounds (vesicular, bronchovesicular,
bronchial) with systematic side-to-side comparison
5. Auscultation — adventitious sounds with per-sound listen buttons
linking directly to the sounds library
6. Special maneuvers — bronchophony, egophony, whispered pectoriloquy
Older age groups (newborn through school-age) will get their own resp
blocks incrementally — v1 focused on adolescent for the quality bar.
UI: new sub-tab pill "Respiratory" with lung icon, sky-blue accent.
renderSystem refactored to use accent/icon maps instead of per-system
if/else — scales to future systems (cardiovascular coming next).
