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					     Diagnostics
 2nd Affiliated Hospital
China Medical University



     内科 郑长青
  What is Diagnostics?
Diagnostics is a bridge subject,
this subject is in a position
between
  preclinical medicine
  and clinical medicine.
The contents of diagnostics
include
  symptomatology
※ inquiry
※ physical examination
  laboratory
  electrocardiogram
  ultrasonic
          Inquiry
history taking
by questioning to take a history
★The importance of inquiry
   for example:
   peptic ulcer
     gastric ulcer
     duodenal ulcer
Peptic ulcer has three clinical
characteristics
chronicity several years
periodicity special seasons
                late autumn
                early spring
rhythmicity of epigastric pain
pain meal relief duodenal ulcer
meal pain relief gastric ulcer
★The contents of inquiry
 1 general data
﹡2 chief complaints
﹡3 present illness
 4 past medical history
 5 systems review
 6 personal history
 7 marital history
 8 menstrual history
 9 childbearing history
 10 family history
1 General Data
Name         Native place
Sex          Working unit
Age          Date of admission
Race         Date of record
Occupation   Narrator
Marriage     Reliability
Address
2 Chief Complaints
The chief complaints should
constitute in a few simple
words: symptom(s) plus time.
The main reasons why the
patient consults a doctor.
The chief complaints should be
stated as nearly as possible in
the patient’s own words.
For example:
▲sore throat, high fever for
  two days
▲chill, fever, right chest pain,
  cough for three days
▲recurrent epigastric pain for
  eight years, it has been getting
  worse over the past two weeks.
The chief complaint should not
include diagnostic terms
        or disease entities
such as:
    diabetes
    heart disease
    hypertension
Diabetes: polydipsia
           polyphagia
           polyuria
           weight loss
Heart disease: palpitation
               short of breath
Hypertension: dizziness
               headache
3 History of Present Illness
 (1) Onset and Duration
 (2) Features of chief symptoms
 (3) Causes of illness and
     Precipitating factors
 (4) Progression of the illness
 (5) Accompanied symptoms
 (6) Previous treatment
 (7) General condition
(1)Onset and Duration

  sudden: acute myocardial
          infarction
          acute pancreatitis
 insidious: cancer of the
            colon
Duration minutes
          hours
          days
          months
          years
for example:
Severe precardiac pain for
  twenty minutes
--acute myocardial infarction
(2) Features of Chief Symptoms
for example: pain
  location     frequency
  duration     intensity
  quality (blunt colic distention
           burning )
  radiation
  alleviating and aggravating
  factors.
(3) Causes of Illness and
    Precipitating Factors
causes: infection trauma
precipitating factors:
  climate change
  environmental change
  emotive change
  irregular meals
(4) Progression of the Illness
the development of main symptom
and appearance of new symptoms.
pulmonary emphysema(short of
breath)     severe dyspnea
       pneumothorax
 angina pectoris (severe chest pain)
       myocardial infarction
(5) Accompanied Symptoms

for example:
diarrhea accompanied by
vomiting     food poisoning
diarrhea accompanied by
tenesmus      dysentery
(6) Previous Treatment
medication dosage effects

(7) General Conditions
mental state after illness
appetite       body weight
sleeping       urine
bowel movement
4 Past Medical History
past health status
past illness
mainly indicate
infections
contagious diseases
such as Tuberculosis(TB)
         Hepatitis
any illness relevant to
present illness,
such as
  operations
  injuries
  vaccinations
  allergies
5 Systems Review
(1) respiratory system
(2) cardiovascullar system
(3) gastrointestinal system
(4) urinary systems
(5) hematopoietic system
(6) endocrine system
(7) neurological system
(8) musculoskeletal system
(1) Respiratory System
cough
character of the cough
  dry cough pleurisy
            bronchial TB
  productive cough
           chronic bronchitis
           bronchiectasis
time of cough
morning and going to bed at
night: chronic bronchitis
at night:
   pulmonary congestion
     due to left heart failure or
     mitral stenosis
Sputum: amount
           consistency color
hemoptysis: amount color
dyspnea: nature intensity
            onset of time
chest pain location nature
            intensity
duration …
(2) Cardiovascullar System
palpitation: time
the pain of precordial region
  feature extent radiation
  precipitating factors
edema: location lower extremities
         congestive heart failure
breath lessness: on exertion
                 heart failure
(3) Gastrointestinal System
vomiting: time
        precipitating factors
        the contents of vomiting
hematemesis: amount color
hematochezia: diarrhea
                constipation
(4) Urinary Systems
amount of urine
    increased polyuria
    diminished oliguria anuria
bladder involvement
     urinary frequency
     urgency
     burning on urination
(5) Hematopoietic System

             fatigue
             lassitude
             palpitation
             dizziness
             anorexia
(6) Endocrine System
diabetes mellitus
typical symptoms
 polyguria
 polydipsia
 polyphagia
 weight loss
(7) Neurological System
common symptoms
 convulsion
 vertigo
 headache
 paresthesia
 paralysis
(8) Musculoskeletal System
muscular pain
swelling
deformity
disability of joints
6 Personal History
  place of birth
  current residence
  educational background
  economic status
  living conditions
  professional
  working conditions
habits and hobbies:
such as
sleeping     eating
drinking     smoking
alcohol consumption
       amount      duration
drugs (including sedative
             or narcotics)
7 Marital History
  married or unmarried
  marriage age
  relations of couple
8 Menstrual History
age of onset
interval between periods
duration
amount of flow
date of last menstrual period(LMP)
age of menopause
record menstrual history as
follows
          menstrual
           duration
Age of                   LMP
 onset     interval
         between periods
9 Childbearing History
age of pregnancy and
         childbirth
times of artificial or natural
         abortions
stillbirth operative delivery
puerperal fever
method of family planning
10 Family History
ages and health status of parents
family history of illness
    similar to patients
family incidence of
    infectious diseases
   TB hepatitis
genetic illness such as hemophilia
★The methods and skills of
   inquiry
1 The organization of inquiry
 introduction
     introduce yourself and explain
     your role
 the body of interview
     chief complaints
     present illness
     past medical history
 the end of interview
2 The sequence of inquiry
        to begin with complaints
for example:
a patient complains he has a headache
you can ask
  When did you begin to have headache?
  Have you ever had this kind of
                       headache before?
  Where is the pain?
  How long dose the pain last?
3 The types of question
 to begin with general questions

for example:
 what brings you here today?
 What’s the matter with you?
 Tell me about your general
 health.
4 To avoid leading questions
  for example:
  Your chest pains have
  radiated to left arm? Right?
5 To avoid medical terms and
  jargon
  for example:
  palpitation epistaxis
  tenesmus
6 Documentation
 you must document the
 information given to you
 by the patient
 If the patient tell you I
 have hypertension,
 you should ask patient
 How did you know that you
 had hypertension?
       Summary
Inquiry
★The importance of inquiry
★The contents of inquiry
 ﹡chief complaints
 ﹡history of present illness
★The methods and skills of
 inquiry

				
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