general notions 1 Flashcards
Semiology definition
discipline dealing with the description, study and interpretation of symptoms and signs of human illness.
semiology purpose
diagnosis of a syndrome (syndrome - a complex of symptoms and signs occurring in a similar clinical picture, corresponding to various etiologies).
clinical diagnosis
anamnesis + exam = clinical diagnosis
clinical diagnosis + diagnostic laboratory examinations = final diagnosis
the medical interview is the cornerstone of the diagnostic process – “anamnesis
Definitions
Symptom
Sign
Symptom – a subjective disorder perceived by patients (e.g. pain)
Sign – an obvious change noticed by the patient, the doctor or a person in the patient’s entourage (e.g. paleness, jaundice, cyanosis, edema, etc.)]
THE ANAMNESIS
Definition:
the complete set of information concerning the current disease and other past diseases that the doctor receives from the patient and the patient’s relatives and close ones.
Anamnesis - stages
Age Gender Place of birth and address Occupation and work Heredo-familial antecedents Personal physiological history Living and working conditions The current disease history
Anamnesis - stages age
Some diseases occur more frequently at a certain age
Diseases may develop differently for different ages (for instance, the acute articular rheumatism (ARR), which does not occur after the age of 25, causes, in teenagers, carditis and valvulopaties).
The same clinical picture has different etiologies at different ages (for instance: mitral failure is cause by AAR and mitral valve prolapse (MVP) in the young, and by mitral valve degenerative lesions in the elderly).
in children:
Congenital Diseases
contagious infectious diseases (e.g. chickenpox, measles, scarlet fever, etc.)
in adolescents: streptococcal angina, AAR, acute glomerulonephritis
in adults hypertension, ischemic heart disease, valvulopaties chronic bronchitis, asthma peptic ulcer In the elderly: stroke, Alzheimer's disease pulmonary emphysema Osteoporosis, osteoarthritis cancer
anamnesis stages gender
more common in women: mitral stenosis, asthma, gall stones, primary biliary cirrhosis, hyperthyroidism diseases more common in men: aortic stenosis ischemic cardiomyopathy chronic bronchitis, lung cancer gastric cancer
anamnesis stages
place of birth and adress
Endemic goiter (endemic thyroid dystrophy) more common in areas that are poor in iodine (Maramures, the mountains)
Malaria - Congenital tropical areas - areas with high radioactivity
Congenital malformations – in areas with high radioactivity
anamnesis stages
occupation and work
Miners
silicosis
textile industry
asthma
People who work with animals
zoonoses
People who work under stressful conditions (doctors, businessmen, etc.)
hypertension, ischemic heart disease, peptic ulcer
medical personnel
risk of infection with the hepatitis B or hepatitis C virus
Anamnesis - stages
Heredo-familial antecedents
genetically transmitted diseases (chromosomal abnormalities)
autosomal dominant transmitted diseases
Hereditary spherocytosis, polycystic kidney, achondroplasia
autosomal recessive transmitted diseases
vthalassemia, mucoviscidosis (cystic fibrosis), Wilson’s disease, albinism
gender-related transmitted diseases
Haemophilia, daltonism (occurring mostly in males)
genetically predisposed diseases
one inherits the predisposition to disease and not the disease itself; the risk factors also intervene:
hypertension, ATS, obesity, gall stones, kidney stones, peptic ulcer, type II DM
Familial contagiousness
heredity does not intervene, but the environmental conditions:
parasitary infections (lambliasis, pinworm, ascaridiosis, etc.) tuberculosis type A viral Hepatitis
Anamnesis - stages
Personal physiological history
Female gender
The age when the menarche (first menstruation) occurred
Menstrual rate and duration
Example: common cycles and abundant quantity – anemia
Data on pregnancy, birth, confinement
Example: newborn weighing over 4kg (Big Baby) – DZ risk for mother
Menopause
early onset M leads to osteoporosis, ATS, hy
Anamnesis - stages
Personal pathological antecedents
respiratory diseases
frequent acute bronchitis → chronic bronchitis
chronic bronchitis → pulmonary emphysema → COPD → chronic cor pulmonale
acute pneumonia →lung abscess, pleural effusion
cardiovascular diseases
AAR →valvulopaties → heart failure
hypertension → stroke, heart failure, nefroangiosclerosis
atrial fibrillation → arterial embolism
acute viral miocarditis → (dilatative cardiomyopathy)
Anamnesis - stages
Personal pathological history
renal disorders
repeated urinary infections → chronic pyelonephritis → chronic renal failure
acute glomerulonephritis → chronic glomerulonephritis → chronic renal failure
digestive disorders
gastroduodenal ulcer → upper digestive hemorrhage, pyloric stenosis, perforations, penetrations of
viral hepatitis with B or C virus → chronic hepatitis → liver cirrhosis → hepatocarcinoma
nutritional and metabolic diseases
Diabetes mellitus → hypertension, ATS, microangiopathies (nephropathy, retinopathy), neuropathy
Hyperuricemia → gout, uric acid nephropathy
acute infectious diseases
Diphtheria, typhoid fever → acute miocarditis
chronic infectious diseases
chronic secretions → amyloidosis
chronic infectious outbreaks (dental, tonsil) → kidney and joint disorders
Anamnesis - stages
Living and working conditions
unsanitary living conditions (humidity, cold, crowded)
upper airway infections, tuberculosis, hepatitis A
Toxic conditions
Smoking can cause:
chronic laryngitis, laryngeal cancer
chronic bronchitis, emphysema, lung cancer,
hypertension, ischemic heart disease (angina pectoris, myocardial infarction)
chronic obliterative arteriopathy of the lower limbs
chronic peptic ulcer with pancreatic cancer
Toxic conditions
alcohol can cause:
steatosis, acute hepatitis, liver cirrhosis
gastritis
Acute and chronic pancreatitis, pancreatic cancer
Coffee in excess:
restlessness, insomnia, palpitations, tachycardia, etc..
Drugs (cocaine, hashish, marijuana)
Medicines
cause addiction (morphine, codeine, etc.)
alcohol can cause:
steatosis, acute hepatitis, liver cirrhosis
gastritis
Acute and chronic pancreatitis, pancreatic cancer
toxic cardiomyopathy
Psychiatric disorders
Polyneuropathy
toxic cardiomyopathy
Psychiatric disorders
Polyneuropathy
Anamnesis - stages
The current disease history
onset of disease sudden (e.g. AMI, pulmonary embolism) acute (e.g. acute tracheobronchitis) insidious (e.g. tuberculosis, osteoporosis, cancers, etc.) Chronology of symptoms occurrence Factors that cause the symptomatology evolution of symptoms with / without treatment Reasons of presentation to the doctor
The Examination
Inspection
will be done systematically, thoroughly:
Generally
System by system
Palpation superficial It concerns: the skin, the subcutaneous cellular tissue, muscles, bones, joints, glands profound it concerns the abdomen abdominal organ alterations tumors
Percussion
Inducing vibrations by striking the body surface, acoustically assessing the underlying physical state
Digito-digital percussion
Assess the resilience, the elasticity of the examined area
The examined area
Depth: 5-7 cm
Surface area: 3-6 cm2
Obtained sounds
Flat sound – low intensity, short duration, high tonality due to lack of air (heart, liver, muscles, liquid accumulation in the pleura or the peritoneum etc.)
Resonant sound – high intensity, long duration, low tonality, characteristics according to the quantity, distribution and pressure of air in the examined area (for instance the digestive tract)
Auscultation
the listening of physiological or pathological noise of internal organs (lungs, heart, digestive tube)
can be:
direct (no longer used)
indirect - with stethoscope
Attitudes
A - active:
patient can move around, can move in bed
P - passive:
the patient is lying inert in bed, with no muscle tone, unable to change position (for serious illnesses)
Forced, imposed attitudes
Pain relieving: position of the patient to relieve pain
pleuritis: contralateral decubitus
penetrating ulcer: patient squats, pressing fist on epigastrium
acute peritonitis, acute pancreatitis: dorsal decubitus, hips bent on abdomen, shallow breaths
Pain relieving: position of the patient to relieve pain
Patients with biliary or kidney colic are in search of a position that will relieve pain
Angina pectoris, intermittent claudication: patients stop walking because of pain (“window watcher syndrome”)
