Transcript Internal Medicine

Internal Medicine
Propedeutics
Goals
• Dentists don’t treat only healthy people
• Dental treatments can affect the patient
health
• Dentists can discover some signs of
special diseases
• Emergency treatments in internal medicine
• Increase the communication skills
• Give a wider horizon to medicine
• Help to be more competitive
Dentistry - Internal Medicine Propedeutics
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Introduction. History taking. The principles of physical examination.
Techniques of physical examination. Physical examination of the head and neck region.
History taking in chest and lung diseases.
Physical examination of the chest and lung.
Disorders of the respiratory system (pneumonia, bronchial asthma,
pleural diseases, tumors).
6. History taking in cardiovascular diseases.
Physical examination of the cardiovascular system.
7. Symptoms and signs of common cardiovascular diseases (ischaemic
heart diseases, valvular diseases, heart failure).
8. Symptoms and signs of vascular diseases. Examination of the
peripherial vessels. (Hypertension, diseases of the venous system and
peripherial arteries).
9. Symptoms of the abdominal diseases.
10. Physical examination of the abdomen.
11. Symptoms and signs of common gastrointestinal disorders (oesophageal
diseases, ulcers, gastrointestinal tumors, liver and biliary diseases, pancreatitis).
12. Symptoms and signs of endocrine diseases, diabetes mellitus and metabolic
disorders.
13. Physical examination of the kidney and genitourinary system.
Symptoms and signs of common renal diseases (glomerulonephritis,
nephrotic syndrome, urinary tract infections, nephrolithiasis, renal failure).
14. Symptoms and signs of common haematological diseases.
• Barbara Bates
Guide to physical examination and history
taking
• Lynn S. Bickley
Bates’ guide to physical examination and
history taking
Diagnosis – an injured mosaic
The main parts of the diagnosis
– Pathological
– Etiological
– Anatomical
– Prognostic
Medical examination
• Patient history
• Physical examination
• Laboratory and instrumental examination
Patient history
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Introduction
Date of the history
Identifying data
Source of referral
Reliability of the history
Patient history
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Introduction
Chief complaint(s)
Patient history
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1. Chief complaint(s)
2. Present illness
Present illness
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Location
Quality
Quantity or severity
Timing (onset, duration, frequency)
Setting in which it developed
Factors that aggravated or relieved
Associated manifestations
Treatments
Patient history
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Introduction
Chief complaint(s)
Present illness
Past history
Past history
• Most important diseases in chronological
order (hospitalisations)
• Operations, injuries, accidents
• Allergies (drug, food, pollens etc.)
• Transfusion(s)
• Screening tests
Patient history
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Introduction
Chief complaint(s)
Present illness
Past history
Current health status
Current health status
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Social circumstances
Occupation (recent and past)
Enviromental hazards (home, school, workplace)
Diet (incl. beverages)
Alcohol and illicit drugs (type, amount, frequency, duration
of use)
Tobacco (type, amount, duration)
Current medication
Exercise and leisure activities
Sleep patterns
Sexual history
Patient history
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Introduction
Chief complaint(s)
Present illness
Past history
Current health status
Family history
Family history
• Parents, siblings, spouse, children, other
relatives
– age; age and cause of death; health status; important
diseases
• Occurence of
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Diabetes
Hypertension, heart diseases, stroke
Infective diseases
Malignant diseases
Coagulation disorders
Psychiatric diseases, alcoholism, drug addiction
Symptoms like those the patient
Patient history
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Introduction
Chief complaint(s)
Present illness
Past history
Current health status
Family history
Review of organ systems
Review of organ systems
• General
– General status
– Usual weight, weight change
– Fatigue
– Fever
• According to organs
• Skin, Head, Eyes, Ears, Nose, Mouth, Neck,
Breasts, Respiratory, Cardiac, Gastrointestinal,
Urinary, Genital etc.
Patient history
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Introduction
Chief complaint(s)
Present illness
Past history
Current health status
Family history
Review of organ systems