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    2023 Introduction To Physical Diagnosis

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    NejibMohe Abagisa
    This document provides an overview of physical diagnosis for medical students. It outlines the components of clinical methods including history taking, physical examination, diagnostic tests, case analysis, diagnosis, treatment and follow up. It describes the objectives of understanding basic history taking and physical examination. It then details the techniques for effective patient interviewing, communication skills, history taking including the chief complaint and review of symptoms. Finally, it discusses the process and techniques for performing a thorough physical examination.

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    2023 Introduction To Physical Diagnosis

    Uploaded by

    NejibMohe Abagisa
    63 views37 pages
    This document provides an overview of physical diagnosis for medical students. It outlines the components of clinical methods including history taking, physical examination, diagnostic tests, case analysis, diagnosis, treatment and follow up. It describes the objectives of understanding basic history taking and physical examination. It then details the techniques for effective patient interviewing, communication skills, history taking including the chief complaint and review of symptoms. Finally, it discusses the process and techniques for performing a thorough physical examination.

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    2023 Introduction to Physical Diagnosis

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    This document provides an overview of physical diagnosis for medical students. It outlines the components of clinical methods including history taking, physical examination, diagnostic tests, case analysis, diagnosis, treatment and follow up. It describes the objectives of understanding basic history taking and physical examination. It then details the techniques for effective patient interviewing, communication skills, history taking including the chief complaint and review of symptoms. Finally, it discusses the process and techniques for performing a thorough physical examination.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    63 views37 pages

    2023 Introduction To Physical Diagnosis

    Uploaded by

    NejibMohe Abagisa
    This document provides an overview of physical diagnosis for medical students. It outlines the components of clinical methods including history taking, physical examination, diagnostic tests, case analysis, diagnosis, treatment and follow up. It describes the objectives of understanding basic history taking and physical examination. It then details the techniques for effective patient interviewing, communication skills, history taking including the chief complaint and review of symptoms. Finally, it discusses the process and techniques for performing a thorough physical examination.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 37

    Introduction to Physical Diagnosis

    For PHO Students


    Outlines

    • Components of clinical methods


    • Interviewing technique.
    • History taking.
    • Physical examination-basics.
    Components of clinical methods

    • History taking
    • Physical examination: regional
    • Diagnostic tests
    • Case analysis
    • Diagnosis
    • Treatment
    • Follow up
    Objectives

    • To know the basic history taking


    • To understand the basic components of
    patient history.
    • To understand the basic components and
    steps in physical examination.
    Interview technique

    Requirements
    Comfortable place
    Ventilation
    Adequate light
    Introduction
    Comfort the patient/client and establish a good
    relationship.
    Remember: “a patient is a person not simply a
    case”.
    Building Rapport

    • Begin with a non-medical interaction.


    • Create an atmosphere that is open and
    supportive.
    • Practice “active listening”.
    • Discuss a detailed agenda of what will
    occur.
    • Answer questions using simple terms the
    patient can understand.
    Communication Skills

    • Maintain good eye contact.


    • Use active listening and watch the
    patient’s nonverbal cues.
    • Have warm and accepting body language.
    • Rely on open ended questions.
    • Avoid interrupting.
    • Use summaries and reflections.
    Non verbal skills

    • Maintain an appropriate eye contact.


    • Listen carefully.
    • Stay as close to the patient as is culturally
    acceptable.
    Verbal Skills

    • Phrase your questions politely and


    respectfully.
    • Use words that the patient understands.
    • Make your questions specific.
    • Avoid double questions at a time.
    • Keep your questions free of moral
    judgments.
    • Avoid leading questions.
    Special verbal skills

    • Facilitation
    • Direction
    – When a patient is confused
    – To start out ideas
    • Summarizing and checking out the facts.
    • Empathy: when dealing with feeling.
    • Reassurance: Shows accepting feelings and
    need not last long.
    • Expressing partnership: commitment to help.
    Adapting the interview to specific situations

    Interview across a language barrier: find an


    interpreter. Ideally a neutral person who
    understands the language & culture.
    Interviewing a confused person: talk to a well
    informed family member.
    Interviewing the disruptive, angry patient: stay
    calm, appear accepting & DO NOT be
    confrontational. SECURITY!
    Sensitive topics: sexual history, mental health
    history, history of substance abuse, family violence
    Components of the history

    1. Identification
     Full name
     Age, sex
     Address, Marital status
     Religion, occupation (Current and previous)
     Educational status
     Historian
     Referral paper if any.
    Previous Admissions: When, Where,
    Reason and out come. Maintain
    chronologic order.
    2. The chief complaint

    • Definition: The main reason that brought


    the patient/ client to the health care
    provider.
    • Components:
    – Type of complaint/s
    – Duration
    • Principles
    – Should be short and clear
    – Use patient’s own words
    The chief complaint

    • Example 1.
    – Cough of two months duration

    • Example 2.
    – Shortness of breathing of three months and
    leg swelling of two weeks duration
    3. History of Present Illness(HPI)

    • Importance:
    – Detailed narration of the chief complaint.
    – Is the most important element to reach at the
    diagnosis and to consider the differential
    diagnosis .
    HPI

    • Components:
    – Details of the chief complaint
    • Date of onset
    • Mode or circumstances of onset
    • Course and duration-maintain chronology
    • Associated symptoms
    – E. g: For pain
    • Character, location, type, radiation, exacerbating
    and relieving factors, position dependency
    HPI

    • Negative and positive statements


    – Helps to rule in or rule out differentials
    • Chronic illness relevant to the chief
    complaint
    HTN, DM, STI, HIV
    • Mode of arrival
    – Tells you severity and urgency
    4. Past Medical and Surgical
    History
    • Accidents, operations, any chronic illness
    and blood transfusion during adult and
    childhood.
    • Duration or date of event.
    • Severity
    • Treatment history and out come.
    MEDICATION S
    5. Personal /Social history

    • Developmental
    • Education
    • Marital status
    • Sexual history
    • Income, living condition
    • Habits
    6. Family history

    • Family status
    – Parents, siblings, spouse and children’s
    health situation.
    – If dead ask for the presumed cause of death
    • Familial diseases: diseases with known
    inheritance pattern/s ( Mendelian or
    polygenic).
    7. Nutritional History

    • Dietary intake and preference


    – Type
    – Quality
    – Amount
    8. Immunization History

    • Vaccines in the EPI( Expanded Program


    in Immunization)
    – Polio, DPT, BCG, Measles, Hepatitis B, H.
    influenzae
    • Others : Meningitis, Influenza,
    pneumococal, rubella, etc
    9. Review of symptoms( functional
    inquiry)
    • Purpose:
    – Double check or reminder on points that may
    have been missed in the HPI.
    – Is a check list.
    • Components:
    – General- fever, weakness, weight change
    – System systematically
    Review of symptoms( functional inquiry)

    • HEENT: head ache, trauma, ear


    discharge, sneezing, tearing, difficulty of
    swallowing
    • Lymphoglandular system(LGS): breast
    pain, lump, discharge, thyroid function
    assessment, lumps in the armpits,
    groin,etc
    • Respiratory: Cough, shortness of
    breathing, chest pain, wheezes
    • CVS: dyspnea, orthopnea, paroxysmal
    nocturnal dyspnea(PND), palpitation
    Review of symptoms( functional enquiry)

    • GIS: vomiting, nausea, pain, diarrhea


    • GUS:
    – Urinary symptoms: dysuria, urgency
    – Genital symptoms: discharge, menstrual
    cycle
    • LOC: muscular pain, swelling, joint
    • Integumentary: discoloration, ulcer, rash
    • CNS: memory, loss of consciousness,
    seizures, vision, weakness of limbs, etc
    Physical Examination

    • Objective
    • Requirement:
    – Illumination
    – Good exposure
    – Position
    – Explanation
    – Meticulous and gentle
    • Goal: To obtain clinical information that
    advances diagnosis and is not merely a token
    repetitive exercise of going through a set of
    given tasks.
    Physical Examination

    • Instruments Required
    The five senses!!!!!
    PROTECTIONS: Alcohol hand rub, gloves, gowns, masks, scrubs
    VITAL SIGNS: Stethoscope, BP cuff, Thermometer, Pulse Oximetry, watch
    Reflex hammer
    Monofilament, tape meter,
    Tuning fork, cotton tip,
    Flashlight,
    Tongue depressor/Spatula
    Ophtalmoscope/
    Otoscope
    Physical Examination

    • Techniques:
    – Inspection
    – Palpation
    – Percussion
    – Auscultation
    Physical Examination

    • General appearance:
    – Healthy looking, sick looking, distressed
    – Consciousness
    – Nutritional status
    • Vital signs:
    – BP
    – Pulse rate
    – Temperature
    – Respiratory Rate ±
    – Oxygen saturation( SaO₂)
    – Anthropometric measurements, BMI
    Vital signs

    • Temperature
    • Pulse rate
    • Blood pressure
    • Respiratory rate
    • Oxygen saturations
    • ??pain
    Temperature

    • Use thermometer
    • Measured at different location
    • Axilla
    • Oral
    • Rectal
    • Aural
    • Of these, axillary is the least and rectal is the most
    accurate
    • Average oral temperature is 37°C with variability of up to
    ±0.5 °C
    • Fever > 37.2 in morning or >37.7 in evening
    Blood Pressure

    • Arterial blood pressure


    • BP cuff or sphygmomanometer
    • Measure usually from arm or
    brachial artery
    • Can be measure supine, standing or sitting
    • Palpate the radial pulse and inflate the cuff until the pulse disappears. This is a rough estimate of
    the systolic pressure
    • Release the pressure slowly, no greater than 5 mmHg per second.
    • Continue to lower the pressure until the sounds muffle and disappear. This is the diastolic pressure

    • 110/70
    Pulse rate

    • It is measure of heart beat


    • Taken from: Radial artery, carotid artery or from
    precordium
    • Count for a full minute

    • Note: rate, rhythm, volume


    • Normal pulses: 60-100
    • Tachycardia if PR greater than 100
    • Bradycardia if PR is less than 60
    Respiratory rate
    • Observe the patient's breathing. Is it normal or labored?
    • Count breaths for 1min ad record breaths per minute
    • In adults, normal resting respiratory rate is between 14-20
    breaths/minute
    • Rapid respiration is called tachypnea
    Systemic/ Regional Examination

    • HEENT
    • Lymphoglandular System(LGS)
    • Respiratory
    • CVS
    • Abdomen
    • GUS
    • Integument
    • Musculoskeletal
    • CNS
    References

    • HUTCHISON’S Physical Diagnosis


    • Bates’ Physical Diagnosis
    THANK
    YOU

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