By Dr. Zahoor 1. Look confident Welcome the patient saying Asalam O Alaikum Shake hand with...
-
Upload
sheila-lamb -
Category
Documents
-
view
218 -
download
2
Transcript of By Dr. Zahoor 1. Look confident Welcome the patient saying Asalam O Alaikum Shake hand with...
![Page 1: By Dr. Zahoor 1. Look confident Welcome the patient saying Asalam O Alaikum Shake hand with patient Introduce yourself – I am so and so medical.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649db25503460f94aa0cae/html5/thumbnails/1.jpg)
1
HISTORY TAKING & GENERAL EXAMINATIONBy Dr. Zahoor
![Page 2: By Dr. Zahoor 1. Look confident Welcome the patient saying Asalam O Alaikum Shake hand with patient Introduce yourself – I am so and so medical.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649db25503460f94aa0cae/html5/thumbnails/2.jpg)
2
History TakingImportant Points
Look confident
Welcome the patient saying Asalam O Alaikum
Shake hand with patient
Introduce yourself – I am so and so medical student
![Page 3: By Dr. Zahoor 1. Look confident Welcome the patient saying Asalam O Alaikum Shake hand with patient Introduce yourself – I am so and so medical.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649db25503460f94aa0cae/html5/thumbnails/3.jpg)
3
Important Points
Explain that you wish to ask some questions to find out what happened
Make sure patient is comfortable and curtains are in place
Confirm patient’s name, age, occupation
![Page 4: By Dr. Zahoor 1. Look confident Welcome the patient saying Asalam O Alaikum Shake hand with patient Introduce yourself – I am so and so medical.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649db25503460f94aa0cae/html5/thumbnails/4.jpg)
4
Importance of History
Ask principal symptoms and allow the patient to describe
Inquiry about the sequence of symptoms and events
Don’t ask leading questions in the beginning
![Page 5: By Dr. Zahoor 1. Look confident Welcome the patient saying Asalam O Alaikum Shake hand with patient Introduce yourself – I am so and so medical.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649db25503460f94aa0cae/html5/thumbnails/5.jpg)
5
Usual Sequence of History
Chief complaint with duration History or present illness Past history e.g. past illness,
admission, surgery Drug history including allergies Family history Personal and social history –
smoker/not, travel, animal contact
![Page 6: By Dr. Zahoor 1. Look confident Welcome the patient saying Asalam O Alaikum Shake hand with patient Introduce yourself – I am so and so medical.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649db25503460f94aa0cae/html5/thumbnails/6.jpg)
6
History of Present Illness
With all symptoms obtain details like - Duration - One set – acute or gradual - Constant or periodic - Frequency - Precipitating or relieving factors - Associated symptoms
![Page 7: By Dr. Zahoor 1. Look confident Welcome the patient saying Asalam O Alaikum Shake hand with patient Introduce yourself – I am so and so medical.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649db25503460f94aa0cae/html5/thumbnails/7.jpg)
7
Example
Chest pain – 2 monthsAsk Site of pain
Character – feeling pressure, dull, stabbing, shooting
Radiation
![Page 8: By Dr. Zahoor 1. Look confident Welcome the patient saying Asalam O Alaikum Shake hand with patient Introduce yourself – I am so and so medical.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649db25503460f94aa0cae/html5/thumbnails/8.jpg)
8
Example (cont)
Severity – interfere with work or sleep
H/O this pain before
Pain associated with nausea, sweating e.g. angina
Note – When patient is unable to give history, then get necessary information from friends, relative
![Page 9: By Dr. Zahoor 1. Look confident Welcome the patient saying Asalam O Alaikum Shake hand with patient Introduce yourself – I am so and so medical.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649db25503460f94aa0cae/html5/thumbnails/9.jpg)
9
Usual Sequence of Events in Patient Care
History Examination – General Examination – Systemic
Examination Problem list Differential diagnosis and most likely
diagnosis Investigations Diagnosis confirmed Treatment
![Page 10: By Dr. Zahoor 1. Look confident Welcome the patient saying Asalam O Alaikum Shake hand with patient Introduce yourself – I am so and so medical.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649db25503460f94aa0cae/html5/thumbnails/10.jpg)
10
General Examination
![Page 11: By Dr. Zahoor 1. Look confident Welcome the patient saying Asalam O Alaikum Shake hand with patient Introduce yourself – I am so and so medical.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649db25503460f94aa0cae/html5/thumbnails/11.jpg)
11
General Examination
General Examination includes - General appearance - Alertness, mood, general
behavior - Hands and nails - Radial pulse and blood pressure - Lymph node – axillary, cervical - Face, eyes, tongue - Peripheral oedema
![Page 12: By Dr. Zahoor 1. Look confident Welcome the patient saying Asalam O Alaikum Shake hand with patient Introduce yourself – I am so and so medical.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649db25503460f94aa0cae/html5/thumbnails/12.jpg)
12
General Examination
General appearance
Does the patient look ill ? Alert, confused, drowsy Co-operative, happy, sad Obese, muscular, wasted In pain or distressed
![Page 13: By Dr. Zahoor 1. Look confident Welcome the patient saying Asalam O Alaikum Shake hand with patient Introduce yourself – I am so and so medical.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649db25503460f94aa0cae/html5/thumbnails/13.jpg)
13
General Examination
Hands and nails
Hands Unduly cold, warm, cold and sweaty (anxiety,
sympathetic over activity) Peripheral cyanosis Nicotine staining Raynaud’s Palms – palmer Erythema may be normal, also occurs with chronic liver
disease, pregnancy Dupuytren’s contracture – thickened palmer skin to
the flexor tendons of fingers (fourth finger)
![Page 14: By Dr. Zahoor 1. Look confident Welcome the patient saying Asalam O Alaikum Shake hand with patient Introduce yourself – I am so and so medical.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649db25503460f94aa0cae/html5/thumbnails/14.jpg)
14
General Examination
NailsClubbing The tissue at the base of nail are thickened The angle between the base of nail and adjacent
skin of finger is lost Nails become convex both transversely and
longitudinally
Causes - heart – infective endocarditis - lung – carcinoma bronchus, Bronchiectasis, fibrosing alveolitis - liver cirrhosis - Crohn’s disease
![Page 15: By Dr. Zahoor 1. Look confident Welcome the patient saying Asalam O Alaikum Shake hand with patient Introduce yourself – I am so and so medical.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649db25503460f94aa0cae/html5/thumbnails/15.jpg)
15
General Examination
Nails (Cont)
Koilonychia – Concave nail (iron deficiency anemia)
Leukonychia – white nails (cirrhosis liver) Splinter hemorrhages - Infective endocarditis Pitting – psoriasis Onycholysis – separation of nail from nail
bed Psoriasis, Throtoxicosis
![Page 16: By Dr. Zahoor 1. Look confident Welcome the patient saying Asalam O Alaikum Shake hand with patient Introduce yourself – I am so and so medical.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649db25503460f94aa0cae/html5/thumbnails/16.jpg)
16
Finger clubbing
![Page 17: By Dr. Zahoor 1. Look confident Welcome the patient saying Asalam O Alaikum Shake hand with patient Introduce yourself – I am so and so medical.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649db25503460f94aa0cae/html5/thumbnails/17.jpg)
17
Koilonychia – spoon shaped nail from iron deficiency
![Page 18: By Dr. Zahoor 1. Look confident Welcome the patient saying Asalam O Alaikum Shake hand with patient Introduce yourself – I am so and so medical.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649db25503460f94aa0cae/html5/thumbnails/18.jpg)
18
Leuconychia
![Page 19: By Dr. Zahoor 1. Look confident Welcome the patient saying Asalam O Alaikum Shake hand with patient Introduce yourself – I am so and so medical.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649db25503460f94aa0cae/html5/thumbnails/19.jpg)
19
Splinter Hemorrhage in fingernails in bacterial
endocarditis
![Page 20: By Dr. Zahoor 1. Look confident Welcome the patient saying Asalam O Alaikum Shake hand with patient Introduce yourself – I am so and so medical.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649db25503460f94aa0cae/html5/thumbnails/20.jpg)
20
Pitting of nails in Psoriasis
![Page 21: By Dr. Zahoor 1. Look confident Welcome the patient saying Asalam O Alaikum Shake hand with patient Introduce yourself – I am so and so medical.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649db25503460f94aa0cae/html5/thumbnails/21.jpg)
21
Dupuytren’s contracture- association Diabtes
![Page 22: By Dr. Zahoor 1. Look confident Welcome the patient saying Asalam O Alaikum Shake hand with patient Introduce yourself – I am so and so medical.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649db25503460f94aa0cae/html5/thumbnails/22.jpg)
22
General Examination
Face, eyes, tongue Mouth – look at the tongue moist or dry - Cyanosed (central) Central cyanosis – blue tongue Cause: - Congenital heart disease e.g. fallot’s
tetralogy - Lung disease e.g. obstructive airway disease Peripheral cyanosis – blue fingers denotes inadequate peripheral circulation, tongue will be pink
![Page 23: By Dr. Zahoor 1. Look confident Welcome the patient saying Asalam O Alaikum Shake hand with patient Introduce yourself – I am so and so medical.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649db25503460f94aa0cae/html5/thumbnails/23.jpg)
23
General Examination
Face, eyes, tongue (cont)
Mouth Look at the teeth – dental hygiene,
caries Look at the gums – bleeding, swollen Smell patient’s breath - Ketosis – diabetes (sweet smelling
breath) - Foetor – hepatic failure (musty
smell) - Alcohol
![Page 24: By Dr. Zahoor 1. Look confident Welcome the patient saying Asalam O Alaikum Shake hand with patient Introduce yourself – I am so and so medical.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649db25503460f94aa0cae/html5/thumbnails/24.jpg)
24
General Examination
Face, eyes, tongue (cont)
Eyes Look at the sclera – for jaundice (yellow
sclera) Look at lower lid conjunctiva – anemia (pale,
mucous membrane of conjunctiva) Eye lid – yellow deposit (Xanthelasma) Puffy eyelid e.g. general oedema (Nephrotic
syndrome) , thyroid eye disease (myxoedema)
![Page 25: By Dr. Zahoor 1. Look confident Welcome the patient saying Asalam O Alaikum Shake hand with patient Introduce yourself – I am so and so medical.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649db25503460f94aa0cae/html5/thumbnails/25.jpg)
25
General Examination
Eyes (cont)
Red eye – Iritis, conjunctivitis, episcleritis White line around cornea, Arcus senilis –
suggest hyperlipidaemia in younger patient, but has little significance in elderly
White band keratopathy – hypercalcaemia - Sarcoid - Parathyroid – hyperplasia - Lung oat – cell tumor - Vitamin D excess intake
![Page 26: By Dr. Zahoor 1. Look confident Welcome the patient saying Asalam O Alaikum Shake hand with patient Introduce yourself – I am so and so medical.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649db25503460f94aa0cae/html5/thumbnails/26.jpg)
26
Central Cyanosis of tongue
![Page 27: By Dr. Zahoor 1. Look confident Welcome the patient saying Asalam O Alaikum Shake hand with patient Introduce yourself – I am so and so medical.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649db25503460f94aa0cae/html5/thumbnails/27.jpg)
27
Peripheral Cyanosis
hand and feet
![Page 28: By Dr. Zahoor 1. Look confident Welcome the patient saying Asalam O Alaikum Shake hand with patient Introduce yourself – I am so and so medical.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649db25503460f94aa0cae/html5/thumbnails/28.jpg)
28
Jaundice
![Page 29: By Dr. Zahoor 1. Look confident Welcome the patient saying Asalam O Alaikum Shake hand with patient Introduce yourself – I am so and so medical.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649db25503460f94aa0cae/html5/thumbnails/29.jpg)
29
Puffy eyes
![Page 30: By Dr. Zahoor 1. Look confident Welcome the patient saying Asalam O Alaikum Shake hand with patient Introduce yourself – I am so and so medical.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649db25503460f94aa0cae/html5/thumbnails/30.jpg)
30
Xanthelasmata
![Page 31: By Dr. Zahoor 1. Look confident Welcome the patient saying Asalam O Alaikum Shake hand with patient Introduce yourself – I am so and so medical.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649db25503460f94aa0cae/html5/thumbnails/31.jpg)
31
Arcus senilis
![Page 32: By Dr. Zahoor 1. Look confident Welcome the patient saying Asalam O Alaikum Shake hand with patient Introduce yourself – I am so and so medical.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649db25503460f94aa0cae/html5/thumbnails/32.jpg)
32
Kayser Fleischer rings(Copper deposition in Wilson’s
disease)
![Page 33: By Dr. Zahoor 1. Look confident Welcome the patient saying Asalam O Alaikum Shake hand with patient Introduce yourself – I am so and so medical.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649db25503460f94aa0cae/html5/thumbnails/33.jpg)
33
Myopathic face
![Page 34: By Dr. Zahoor 1. Look confident Welcome the patient saying Asalam O Alaikum Shake hand with patient Introduce yourself – I am so and so medical.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649db25503460f94aa0cae/html5/thumbnails/34.jpg)
34
Severe pitting edema of the legs
![Page 35: By Dr. Zahoor 1. Look confident Welcome the patient saying Asalam O Alaikum Shake hand with patient Introduce yourself – I am so and so medical.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649db25503460f94aa0cae/html5/thumbnails/35.jpg)
35
Erythema nodosum (Sarcoidosis, Inflammatory Bowel
Disease)
![Page 36: By Dr. Zahoor 1. Look confident Welcome the patient saying Asalam O Alaikum Shake hand with patient Introduce yourself – I am so and so medical.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649db25503460f94aa0cae/html5/thumbnails/36.jpg)
36
Pyoderma gangrenosum(Inflammatory Bowel Disease
– Crohn’s and Ulcerative Colitis)
![Page 37: By Dr. Zahoor 1. Look confident Welcome the patient saying Asalam O Alaikum Shake hand with patient Introduce yourself – I am so and so medical.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649db25503460f94aa0cae/html5/thumbnails/37.jpg)
37
Please remember to cover the patient and THANK him/ her at the end of examination.
![Page 38: By Dr. Zahoor 1. Look confident Welcome the patient saying Asalam O Alaikum Shake hand with patient Introduce yourself – I am so and so medical.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649db25503460f94aa0cae/html5/thumbnails/38.jpg)
38
Thank you