INTRODUCTION TO

MEDICINE

Dr.Bilal Natiq Nuaman

C.A.B.M. , F.I.B.M.S. , D.I.M. , M.B.Ch.B.

Lecturer in Ibn-Sina Medical College

2013 -2014

Basic Vs Clinical • Basic• Examples• Cytology ,

Biochemistry , Microbiology , Histology , Pathology

deal with samples from patients for diagnostic purposes

Basic VS Clinical• Clinical• Examples• Internal Medicine ,

General Surgery , Ophthalmology, Orthopedics ,Urosurgery, ENT, etc….

Deal with the patient directly for diagnosis , treatment , and counseling .

Internal MedicineThe branch of medicine that deals with the diagnosis and nonsurgical treatment of diseases affecting adults within its scope.

is the medical specialty dealing with the prevention, diagnosis, and treatment of adult diseases .

Doctors specializing in internal medicine are called internists, or physicians

Scope of Subspecialties of Internal Medicine

Cardiology, dealing with disorders of the heart and blood vessels

Endocrinology, dealing with disorders of the endocrine system and its specific secretions called hormones

Gastroenterology, concerned with the field of digestive diseases

Hematology, concerned with blood, the blood-forming organs and its disorders.

Infectious Diseases, concerned with disease caused by a biological agent such as by a virus, bacterium or parasite

Nephrology, dealing with the study of the function and diseases of the kidney

Pulmonology, dealing with diseases of the lungs and the respiratory tract

Rheumatology, devoted to the diagnosis and therapy of rheumatic diseases.

Neurology dealing with diseases of nervous system

Medical Oncology, dealing with the chemotherapeutic (chemical) treatment of cancer

Poisoning and Critical Care

Internal Medicine , Management , sequence of roles

1-DIAGNOSIS

2-TREATMENT

3-PREVENTION

Medical Diagnosis• Sequence of Diagnosis

• 1-History taking from patient (record patient symptoms)

• 2-Examination of the patient (looking for physical signs )

• 3-Investigations (done in lab. ,etc..)

Approach to patient = Management of patient

Symptom vs sign• A symptom(complaint) is subjective feeling from

the patient point of view. • A symptom is what the patient experiences about the

disease. • Symptoms can only be experienced, they are not able to

be observed or measured objectively. • Pain is a symptom. I do not know you are having pain

unless you tell me. Nausea is also a symptom, as are: chills, numbness, fatigue, vertigo, malaise, itching, stomach cramps, burning on urination, etc.

• A sign is an objective physical manifestation of disease.

• It is an objective finding, something one can observe and measure.

• A rapid pulse, a high temperature, a low blood pressure, an open wound, bruising, etc. are all signs.

• Signs give a more definite indication of the presence of a particular disease to the physician.

So in the simplest form, signs are observations of the doctor and symptoms are the experiences of the patient.

Dyspnea; Breathlessness; Shortness of Breath(SOB)

• ‘’Dyspnea’’

Dys: difficult, painfulPneumea:breath

• Breathlessness or dyspnoea can be defined as the feeling of an uncomfortable need to breathe.

DEFINITION OF DYSPNEA

• Clinical : A subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity.

• Physiological: The stimulation of pulmonary and extrapulmonary afferent receptors and the transmission of afferent information to the serebral kortex,where the sensation is perceived as uncomfortable or unpleasant

Patients perceptions:

Unsatisfied inspiration

Chest tightness

Sensation of feeling breathless

Cannot get enough air

Hunger for air

Incomplete exhalation

THE PNEA’S• DYSPNEA – SOB : ACUTE – (PULMONARY EMBOLISM,

PNEUMOTHORAX, PULMONAR EDEMA)<30 days

CHRONIC – (COPD, CHF)>30 days

• TACHYPNEA – RR>20 BR/MIN(PNEUMONIA)• • BRADYPNEA - RR< 8 BR/MIN (DRUGS, AGONAL)

Stages of Cardiac dyspnea

1-EXERTIONAL DYSPNEA- Dyspnea due to exercise

2-ORTHOPNEA – SOB LYING FLAT AND BETTER SITTING UP (CHF, pregnancy, resp.muscle weakness)

3-PND - PAROXYSMAL NOCTURNAL DYSPNEA characterized by acute shortness of breath almost always

accompanied by coughing and wheezing. This respiratory distress usually occurs when a person is already sleep in a reclining position (HEART FAILURE-early night , ASTHMA-late night )

4-Resting dyspnea- dyspnea at rest

• Pathophysiology : Respiratory diseases can stimulate breathing and

dyspnoea by: stimulating intrapulmonary sensory nerves (e.g. pneumothorax, interstitial inflammation and pulmonary embolus)

• increasing the mechanical load on the respiratory muscles (e.g. airflow obstruction or pulmonary fibrosis)

Causing hypoxia, hypercapnia or acidosis, stimulating chemoreceptors.

• In cardiac failure, pulmonary congestion reduces lung compliance and can also obstruct the small airways. In addition, during exercise, reduced cardiac output limits oxygen supply to the skeletal muscles, causing early lactic acidaemia and further stimulating breathing via the central chemoreceptors.

Etiologies: Pulmonary Causes

Common Pulmonary Causes

• Obstructive lung disease• Asthma/COPD (Chronic Bronchitis ,Emphysema)

• Pneumonia

• Pulmonary embolism

• Pneumothorax

Common Cardiac Causes

• Acute coronary syndromes

• CHF

• Dysrhythmias

• Valvular heart disease

Common Miscellaneous Causes

• Metabolic acidosis

• Severe anemia

• Pregnancy

• Hyperthyroidsm

• Hyperventilation syndrome

ACUTE VE CHRONIC DYSPNEA

• Acute: Dyspnea (AP4) <30 days

that develops over hours or days :

• Asthma

• Pulmonary edema

• Pneumothorax

• Pulmonary embolism

• Pneumonia

•

• Chronic: Dyspnea >30 daysthat develops over weeks, months or years.• COPD• Left ventricular failure• Interstitial fibrosis• Asthma• Pleural effusion•

CHARACTERISTICS OF HISTORY

• Persistence and variability• Intermittent

• Persistent

• Nocturnal

• Seasonal

• Occupational ( work,home ...etc.)

History Taking

nature of onset (acute, chronic) , duration ,

evolution over time

associated symptoms (cough, sputum ,wheeze, ) physiologic vs. pathologic

• Exposures• Sick contacts• Tobacco• Occupational• Hobbies• Pets• Drugs• Radiation

Physical signs in dyspnic patient

Investigations

Chest radiograph (CXR): weather cardiac or pulmonary

Cardiac Causes!

ECG

(abnormally significant)

Echo

(abnormally significant)

Coronary angiography

Pulmonary causes!

Pulmonary function test(PFT)

(abnormally significant)

CT scan of chest

(abnormally significant)

Lung Biopsy

CXR

TreatmentNon-Drug Treatments

• Positioning - sitting up• Relaxation• Humidified air• Noninvasive positive pressure mask

Oxygen Specific treatment according to diagnosis

Asthma------- Bronchodilators + anti inflammatoryPneumonia--------AntibioticsPneumothorax ------Chest tube

Heart failure------- Diuretics + nitrate

THANK YOU