Diagnostic process Flashcards
What are the sections of the diagnostic process?
Observation
History taking
Physical examination
Investigations
What can influence the disease process and the patient’s clinical presentation?
- psychological state
- personality
- socioeconomic status
- domestic/work environment
- beliefs
What are the major factors we can observe at first sight about a patient?
- age/milage
- gender
- nationality
- occupation
- skin / hair / eyes
- demeanour
- gait, BMI, deformities
Which is the most important part of patient assessment?
history
• gives 70-90% of information used in diagnosis
What are the sections of the patient History?
Chief complaint Past health issues Social / occupational history Family history Systems review
What questions do you ask in the chief complain section of patient Hx?
- onset
- location
- duration
- character, course
- allieving/aggaraving
- radiation
- treatment
- frequency, severity, activities affected, associated symptoms
What questions do you ask in the past health issues section of patient Hx?
- surgery (hospitalisation, x-rays, scans)
- allergies
- medication, supplements, immunizations
- pertinent medical history (obstetric, psychiatric, illnesses)
- last GP appointment
- events: accidents, fractures, dislocations
What questions do you ask in the social/occupational Hx section of patient Hx?
- Smoking
- Hobbies, home environment
- Alcohol
- Drugs (social)
- Occupation
- Nutrition
- Exercise (sex), environment
What questions do you ask in the family Hx section of patient Hx?
- parents health / age of death, from what
- children health
- family history of diseases
What is the definition of a red flag?
- fact of patient Hx indicative of omnious condition that requires immediate care
- bloody stools, unplanned weight loss
What is the definition of a yellow flag?
- fact of patient Hx that might influence perception or management of disease process
- stress, depression, poor support system
What is a systems review?
Answers may tell us:
• how the pathology may have affected other systems as well as the main complaint
• indication of another separate pathology going on simultaneously
• may encourage a new lead
• red and yellow flags
What questions do you ask in a systems review?
- Vascular
- Infectious
- Neoplasm
- Drugs
- Inflammatory/Idiopathic
- Congenital
- Autoimmune
- Trauma
- Endocrine/Metabolic
What are the 3 different methods for conducting the physical examination?
- in turn -examine each system seperately
- top to toe
- signs -search for physical signs which would confirm diagnosis (not for novice)
What do you look for with palpation?
- superficial vs deep
- texture
- heat
- firmness
- tenderness
Why do you do investigations?
- screening (breast cancer)
- confirm diagnosis
- monitoring (post fracture)
What are the classifications of medical investigations?
Removal of fluid/tissue and examined in lab
Creating an image
Direct exam
List examples of tests that use Removal of fluid/tissue and examined in lab
- blood tests for …
- urine examination
- MCS
- faecal exam
- CSF exam
- tissue biopsy (bone marrow)
- semen
- amniocentesis
List examples of tests that create and image
- radiography
- ultrasonography
- computerized tomography
- magnetic resonance imaging
- nuclear scanning
- positron emission tomography
List examples of tests that use direct examination of a body part
- gastroscopy
- colonoscopy
- laparoscopy (key hole surgery)
- esophagoscopy
- cystoscopy (bladder)
- colposcopy (cervix)
List examples of extra investigations
- electrical studies (ECG, EEG, EMG, nerve conduction studies)
- pulmonary function tests
- tests of absorption (lactose tolerance test, Schilling’s test)
List different types of blood tests
- full blood count
- electrolytes
- ESR, CRP
- iron studies
- blood glucose
- lipoprotein studies
- cardiac enzymes / markers
- kidney function tests
- hormone assays (pregnancy test)
- tumour markers
- serological testing
- blood typing
- clotting and coagulation tests
MCS
microscopy, culture, sensitivity test
