intro history &examn

8/12/2019 Intro History &Examn.

1/23

Knowledge

Skills

Clinical medicine


2/23

Skills

History taking

Examination

Investigation Management

Common procedures and other interventions

communicaton


3/23

History

Name gender

DOB

Address

Presenting complaint with duration

Other complaints

History of presenting complaint inchronological order

Systemic inquiry


4/23

Previously diagnosed illness(es) and surgeries

Drug history

Medications taken for current illness

Regular medications

Drug allergies Family history

Social history

Menstrual history

Psychic assessment


5/23

Systemic Inquiry-

Important SymptomsCardiovascular System

Chest pain

Breathlessness

Palpitation

Syncope

Ankle swelling


6/23

Respiratory System

Cough

Sputum

Haemoptysis

Breathlessness

Chest pain

Wheeze


7/23

Gastrointestinal Tract Symptoms

dysphagia

nausea

vomiting

epigastric pain

loss of Appetite

bowel habit change

colour of stools


8/23

Central Nervous System headache

fits

faintishness

weakness

numbness

tinkling sensation

hearing problem

visual problems


9/23

Locomotor System

pain in joints and muscle

swelling of joints

Endocrine Systemheat/ cold intolerance

weakness/tiredness

increased thirst


10/23

Genitourinary Tract Symptoms

dysuria

oliguria/polyuria

colour of Urine

urinary Stream

vaginal discharge


11/23

General inquiry

appetite

weight change

malaise

sleep

mood


12/23

Examination

General examination.

Relevant system examination

Cardio vascular system.

Respiratory system.

Abdomen.

Central nervous system.

Locomotor system.

Psychiatric assessment.


13/23

60 y, female with uncontrolled BP for several

years,

WHICH WOULD SUGGEST END ORGAN

DAMAGE

1. Displaced heaving apex

2. Exudate and hemorrhage in fundi

3. LDL C-180mg/dl (130-160)

4. Radio-femoral delay5. K+ 3mmol/l(3.6-5.1)


14/23

Patient management

history taking.

clinical examination

bed side investigations- Urine dip stick,

Hb,CBS,O2 satn.Wt

differential diagnosis

Communication

Patient &Relatives further investigations

Plan of management


15/23

Investigations

E.C.G

Chest X ray

Exercise E.C.G

Electrophysiological investigations.

Echo : Trans Thorasic

Trans esophageal

Nuclear imaging

Cardiac CT

Cardiac MRI

Cardiac catheterization


16/23

Procedures for junior medical staff

ECG Stress ECG

Central venous access

Temporary cardiac pace making

Pericardiocentesis


17/23

THERAPEUTICS

Heart diseases


18/23

Heart diseases

Can affect

Myocardium.

Heart valves.

Pericardium.


19/23

Causes of heart diseases

Congenital heart disease

Rheumatic valvular heart disease

Ischaemic heart disease Hypertensive heart disease

Cardiomyopathy

Thyroid disease(Hyperthroidism)Take Age in to consideration


20/23

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Cardiovascular Systemimportant Symptoms

Chest pain

Breathlessness

Palpitation

Syncope

Ankle swelling


21/23

10 Point analysis of pain

Site

Character

Severity

Duration Radiation

Frequency & Periodicity

Special times of occurrence

Aggravating & relieving factors.

Associated factors


22/23

Pain in

Myocardial Infarction

Retrosternal

Constricting/ Tightening/ Burning/ Heavy

sensation.

Severe pain.

Lasts more than 15 minutes.

Radiates to left upper arm / Back of chestbetween shoulder blades/ up in the neck

The new York heart association


23/23

The new York heart association

grading of cardiac status (NYHA

classifications)

Grade1- No breathlessness Grade 2- Breathlessness on severe exertion

Grade 3- Breathlessness on mild exertion

Grade 4

Breathlessness at rest

intro history &examn

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