Fundamentals Of Diagnosis & Diagnosis Tests

Question 1

What is the definition of diagnosis?

Answer 1

“the identification of the nature of an illness or other problem by
examination of the symptoms”

Question 2

What factors contribute to a diagnosis?

Answer 2

*observations
*physical examination
*patient history
*results of diagnostic test
*clinical experience & prof judgement

Question 3

What are the 8 stages of history taking?

Answer 3

a) Introduction
b) PC: Presenting complaint
c) HxPC: History of the presenting complaint
d) PMHx: Past medical (and surgical) history
e) FHx: Family history
f) SHx: Social history
g) DHx: Drug history
* Allergies
h) System review

Question 4

a of history taking

Answer 4

• Wash hands / don correct PPE
• Introduce yourself (name, job role)
• Identify you are speaking to the correct individual (name, address / dob)
• Purpose / permission: explain the purpose of the consultation / history taking
• Position: eye level with the patient, 1m away

Question 5

b of history taking (PC)

Answer 5

• Why has the patient come to see you?
• Open questions:
• “What has brought you into hospital today?”
• “What can I help you with today?”
• “What seems to be the problem”

Question 6

c of history taking (HxPC)

Answer 6

• Details relating to the presenting complaint
• These questions depend on the presenting complaint or body system being affected
  Site
  Onset
  Character
  Radiation
  Associated symptoms
  Time
  Exacerbating or relieving
  factors
  Severity

Question 7

d of history taking (PMHx)

Answer 7

• Identifying what underlying conditions and surgical procedures the patient has had
• Why?
• Risk factors associated with PC
  e.g. Type II diabetes  heart attack risk
• Myocardial infarction
• Jaundice
• Tuberculosis
• Hypertension
• Rheumatic fever
• Epilepsy
• Asthma
• Diabetes
• Stroke
• Cancer
  D) Past Medical / Surgical History (PMHx)

Question 8

e of history taking (FHx)

Answer 8

*family history
* Some conditions have a genetic element

Question 9

f of history taking (SHx)

Answer 9

social history

Question 10

g of history taking (DHx)

Answer 10

• Confirming the name and dose of all the patients medication
• Confirming compliance is also essential  how does the patient actually take the medication

Question 11

Why is DHx important?

Answer 11

• Side-effects / Adverse drug reactions
• Drug – drug interaction
• Drug – patient interaction
• Drug – disease interaction
• Compliance

Question 12

H in history taking

Answer 12

• systems review
• Specific questions relating to all body systems:
  1. Cardiovascular
  2. Respiratory
  3. Gastrointestinal
  4. Genitourinary
  5. Neurological
  6. Locomotor

Question 13

What is meant by professional judgement?

Answer 13

“Professional judgement could be described as the use of accumulated knowledge and
experience, in order to make an informed decision.”
“It takes into account the law, ethical considerations and all other relevant factors related to the
surrounding circumstances.”

Question 14

Why is professional judgement important?

Answer 14

• Needed day to day when working as a pharmacist in all sectors
• Part of the decision making process
• Easy concept to understand but often exercising professional judgement takes consideration

Question 15

What steps are involved in professional judgement?

Answer 15

1. Identify the ethical dilemma / professional problem
2. Gather all the relevant information
3. Obtain advice from support services, seniors
4. Identify the possible options
5. Weight up the risk vs benefits and advantages and disasvantages of each options
6. Make a decision  must be able to justify it
7. Where appropriate or significant document your decision making process and reasoning

Question 16

What are the different diagnostic tests?

Answer 16

• blood pressure
• heart rate/ pulse
• respiratory rate
• temperature
• oxygen levels/ saturation
• ear examination / visualisation
• BMI/ weight
• blood sugar monitoring
• peak flow
• throat swabs
• urine dip testing
• Pregnancy testing /
  STI home testing kits

Question 17

Why would you check BP?

Answer 17

• Routine observation in hospital
• Routine as part of BP medication check
• ?High BP = headache
• ?Low BP = light headed, falls

Question 18

Why would you check heart rate?

Answer 18

• Routine observation in hospital
• Dizziness
• Fainting / light headed
• Palpitations

Question 19

When would you check respiratory rate?

Answer 19

• Routine observation in hospital
• Shortness of breath
• Respiratory assessment (e.g. Asthma)

Question 20

When would you check temperature?

Answer 20

• Routine observation for patients in hospital
• ? Infection

Question 21

How does taking oxygen levels work? + % levels for healthy + unhealthy

Answer 21

• Health patient O2 sat: >95%
• Respiratory conditions (COPD): 88 – 92%
• Shines two types of light through your finger (one red
  light, one infra-red light)
• Red blood cells: Lots of oxygen
•  absorption of infrared light
• Allows red light to pass through
• Red blood cells with low levels of oxygen:
•  absorption of red light
• Allows infrared light to pass through

Question 22

When would you check someones oxygen level?

Answer 22

• Routine in hospital setting as part of patients
  observations
• Respiratory clinics / conditions
• Covid-19

Question 23

When would you do an ear check?

Answer 23

• Dizziness / ringing / crackling sound in ear
• Ear infection
• Hearing assessment: hearing loss / changes in
  hearing

Question 24

When would you do a BMI check/ weight check?

Answer 24

When would you want to check some ones BMI / weight?
* Weight loss clinic
* Diabetes or cardiovascular clinic
* high BMI is a risk factor

Question 25

When would you do a blood sugar monitor check?

Answer 25

* Diabetic patients * Patients who have collapsed * Recurrent urinary tract infections

Question 26

When would you do a peak flow test?

Answer 26

* Respiratory conditions (e.g. Asthma) – monitor stability , triggers, medication is work etc