Fundamentals of Diagnosis & Diagnostic tests Flashcards
What is a diagnosis?
the identification of the nature of an illness or other problem by examination of the symptoms.
WHAT CONTRIBUTES TO DIAGNOSIS?
- Observations
- Physical examination
- Results of diagnostic tests
- Clinical experience & Profession judgement
- Patient history
History taking:
split -
Information gathering”
Split into 8 stages:
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
h) Allergies
i) System review
History taking - a) intro
opening consultation: W I I P P
What should we include here?
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 (2m to help with social distancing)
History taking - b) presenting complaint (PC)
Why has the patient come to see you?
Open questions:
“What has brought you into hospital today?”
“What can I help you with today?”
Points to remember from your communication skills workshop
Active listening
Open body language
Building rapport
Letting the patient speak
History taking - c) (HxPC) presenting complaint
Details relating to the presenting complaint
These questions depend on the presenting complaint or body system being affected
History taking - d) Past Medical / Surgical History (PMHx)
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
Open questions:
“Do you have any medical conditions”
“Have you ever had surgery”
Useful to cross match the PMHx and DHx:
History taking - e) Family History (FHx)
This tends to relate to the presenting complaint (PC)
E.g. Cardiovascular PC
1st degree relatives having hx of heart attacks?
E.g. Hay fever / asthma / eczema
History taking - f) Social hisorty (SHx)
smoking, alcohol, recreational drugs, accommodation and living arrangements, marital status, baseline functioning, occupation, pets and hobbies.
History taking - g) Drug history (DHx)
- name and dose of med
- does patients actually take it
why is f) drug history important?
Side-effects / Adverse drug reactions
Drug – drug interaction
Drug – patient interaction
Drug – disease interaction
Compliance
allergies - nature of the reaction
How do they take their medication?
Does anyone help them?
Nomad box?
Carers?
History taking - h) Systems review
Specific questions relating to all body systems:
1. Cardiovascular
2. Respiratory
3. Gastrointestinal
4. Genitourinary
5. Neurological
6. Locomotor
What is Differential diagnosis?
“ A list of possible conditions or diseases that could be causing the symptoms”
- A plan will then be made to help differentiate between the potential causes e.g. tests needed, treatment required
When a patient presents with a set of symptoms, the practitioner will develop a list of possible causes > differential diagnosis
The list of potential causes will be based off the facts they have obtained from:
Patients history
Observations
Physical examination
Diagnostic tests
Professional Judgement and Diagnosis
“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.”
importance of Professional Judgement and Diagnosis?
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
Steps involved in professional judgement:
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 disadvantages 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
Diagnostic tests – Blood pressure
BLOOD PRESSURE
When would you check BP?
Routine observation in hospital
Routine as part of BP medication check
?High BP = headache
?Low BP = light headed, falls
Diagnostic tests – Heart Rate / Pulse
Number of beats / min
Count number of radial pulses over 60 seconds (30 seconds x 2)
When would you check heart rate:
Routine observation in hospital
Dizziness
Fainting / light headed
Palpitations
Diagnostic tests – Respiratory rate
Number of breaths / min
Count the number of times the patients chest rises in 60 seconds (30 seconds x 2)
When would you check heart rate:
Routine observation in hospital
Shortness of breath
Respiratory assessment (e.g. Asthma)
Diagnostic tests - Temperature
Multiple types of thermometers
When would you want to take a patients temperature?
Routine observation for patients in hospital
? Infection
Diagnostic tests- Oxygen levels / saturations
percentage:
Health patient O2 sat: >95%
Respiratory conditions (COPD): 88 – 92%
How does it work?
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
Diagnostic tests- Oxygen levels / saturations
When would you see it being used?
Routine in hospital setting as part of patients observations
Respiratory clinics / conditions
Covid-19
Diagnostic tests – Ear examination / visualisation
Wouldn’t routinely see this being used in a community pharmacy setting
When would you see it?
Dizziness / ringing / crackling sound in ear
Ear infection
Hearing assessment: hearing loss / changes in hearing
Diagnostic tests- BMI / Weight
equation?
BMI = Weight (kgs)
[Height (m)]2
When would you want to check some ones BMI / weight?
Weight loss clinic
Diabetes or cardiovascular clinic
high BMI is a risk factor
Diagnostic tests- Blood sugar monitoring
Variety of types?
Continuous glucose monitoring – devices fitted under the patients skin which they can scan using smart phone to check BMs
Blood glucose monitoring – single use blood tests used to check BMs where patient pricks finger, collects blood and runs the test
When would you see this being used?
Diabetic patients
Patients who have collapsed
Recurrent urinary tract infections
Diagnostic Tests – Peak Flow
Measures how quickly you can blow air out of your lungs
How to use:
Take a deep breath in
Blow as hard and fast as you can into the peak flow meter = Peak Expiratory Flow (PEF)
Plot on the chart to see where your PEF score sits
Helps identify changes in your airways
When would you see it being used:
Respiratory conditions (e.g. Asthma) – monitor stability , triggers, medication is work etc
Diagnostic tests - Others
1) Throat swabs
2) Urine Dip testing
3) Pregnancy testing / STI home testing kits = chlamydia/gonorrhoea/ syphilis
