Principles Of Diagnosis And Treatment Flashcards
What is the difference between a symptom and a sign?
Symptom = Is a subjective feeling reported by the patient (WHAT THE PATIENT FEELS…) eg. pain /dry mouth
Sign = Is an objective change that is observable (WHAT YOU AS THE CLINICIAN SEES…) eg. erythema (redness) / swelling / ulcers
When taking a history, what do we start with?
Take note of age and occupation of patient and make note of who made the referral
What is second step of taking a history?
Presenting complaint (Pt C/O):
– This a record of patient’s problem in their own words
• History of presenting complaint (HPC):
– Details of the patient’s problem (s) and related symptoms recorded in a chronological order
• !Patients do not necessarily report their history in a logical / chronological manner
• !Essential to listen to the patient and then record their history in an order way
• There is then a skill in summarising this for presentation
How do we take a pain history?
SOCRATES
Site, onset , character, radiation, associated factors, timing, exacerbating / relieving factors, severity
See slide 8 for what each of these mean
What is involved in previous dental history ( PDH )?
• Regular or irregular attender
• Previous dental treatment
• Treatment modality
– LA / IV sedation / GA
What is involved in previous medical history?
e.g. Hypertension
Angina
Diabetes
Asthma
Review of systems?
– Eyes / Ears / Nose / Mouth / Throat
– Cardiovascular
– Respiratory
– Gastrointestinal
– Musculoskeletal
– Endocrine
– Haematological
– Neurological
– Psychiatric
What do we need to know about medications?
– Current medications and dose
– As required medications
– Relevant previous medications
Update at each appointment
What do we need to know about patient allergies?
– Allergen and reaction
– Particularly to antibiotics
Family history (FH)
• Can be helpful to enquire as to whether or not there is a family history of any medical conditions
• Or to chart those affected by a certain problem, eg. recurrent oral ulcers
Social history? (SH)
Smoking
– Cigarettes / tobacco / filtered / no filter
– Number (cigarettes per day or grams/ounces per week)
– Duration (pack years = number of packs/day x number of years)
• Alcohol
– Units per week
– Number of days abstinent
• Illicit substances
– If relevant
• Relationship status
• Social network
Examination?
From end of the bed’
• Important to observe patient from initial introduction and throughout history taking
• Many signs may be evident before officially start examination
General Appearance
– Unwell / pale
– Habitus/gait
– Dishevelled
– Shortness of breath / wheezy
– Exposed skin sites including hands
• Extra-oral
• Intra-oral
Examination - extra oral?
Bony symmetry
• Ears
• Nose
• Soft tissues
– Lacerations / Ecchymosis
• Lips
– Competency / Contour / Fissuring
• Lymph nodes
– Submental / Submandibular / Preauricular / Postauricular / Occipital / Cervical / Supraclavicular
• Salivary glands
– Parotid / Submandibular / Sublingual
•General
–Temperature / Pulse rate / Blood pressure / Respiratory rate
• Cranial nerves - Should be confident and competent in examining all 12 cranial nerves
Swelling?
Swelling
– Site
– Size
– Shape
– Colour
– Consistency
– Hard/Soft/Fluctuant
– Fixed/Mobile
– Outline/Border
– Surrounding tissues
– Broad based/Pedunculated
– Transillumination
Examination – Intra oral?
Mucous membranes
– Buccal mucosa / Labial mucosa / Palate / Floor of mouth / Oropharynx / Retromolar fossa
• Tongue
– colour, texture
• Salivary gland ducts
• Tonsilar tissue
• Periodontal tissues
• Teeth
• Edentulous ridges
• Occlusion
• Dentures
