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).
New top-level tab (positioned after Catch-Up Schedule) combining two
functions:
1. Study reference — for each (age group, system) shows OSCE-style
components with technique, expected normal finding, and abnormal-
feature watch-list.
2. Documentation generator — physician marks each component
Normal / Abnormal (with free-text detail) / Skip; AI produces a
two-section report (Technique + Findings), narrative or structured
list format.
Scope v1: MSK + Neuro × 6 age groups (newborn, infant, toddler,
preschool, school-age, adolescent). More systems can be added to the
embedded PE_DATA in peGuide.js without route changes.
Files:
- src/routes/peGuide.js — POST /api/generate-pe-narrative (mirrors
milestone-narrative pattern: AppRole-level
injection guard, clinical audit category,
PHI redaction upstream already in place)
- src/utils/prompts.js — peGuideNarrative + peGuideList prompts,
structured two-section output
- public/components/pe-guide.html — demographics bar + sub-pills + cards
- public/js/peGuide.js — embedded PE_DATA (all clinical content),
render + state + AI call
- public/index.html — tab button, section, script include
- server.js — mount route at /api
No schema change. No PHI stored — findings live in memory only, exported
via existing copy/read-aloud/Nextcloud actions.
