WCS01 History Taking And General Examination

Question 1

Etiology of diseases

Answer 1

1. Congenital (developmental defect)
   - ASD, VSD, PDA
2. Hereditary
   - Thalassaemia
   - Polycystic kidney
3. Metabolic
   - Calcium —> Osteoporosis, Hyperparathyroidism
   - Amino acid —> Diabasic amino acid (Cystinuria)
   - Purine —> Gout
   - Lipid
4. Endocrine
   - Pancreas —> DM
   - Pituitary —> Anterior: Cushing, Acromegaly; Posterior: Diabetes Insipidus
   - Adrenal —> Cortical: Hyperaldosteronism; Medulla: Phaeochromocytoma
   - Reproductive system
5. Immunological
   - Disorder of immune system
   - SLE
   - RA
   - CT disorder
6. Degenerative (part of aging process)
   - Atherosclerosis
   - Vascular system
   - MSS system
   - Neurological
7. Neoplastic
8. Infective
   - Viral
   - Bacterial
   - Fugal
   - Parasitic
9. Iatrogenic

Question 2

Effects on the host

Answer 2

1. Derangement of **functions
   - disturbance of internal environment (homeostasis)
   - disturbance of physiological function of body
   —> **Symptoms
2. Derangement of **structures
   - derangement of normal anatomical structure —> **Signs

Question 3

***Examples of internal environment disturbance

Answer 3

1. Weakness of extremities
   - Hypokalaemia (Hyperaldosteronism)
   - Hyperkalaemia (Chronic renal failure)
   - Hypercalcaemia (Parathyoid adenoma)
2. Polyuria + Polydipsia
   - Hyperglycaemia (DM —> ↑ Osmotic load to renal tubules)
   - ADH loss (Diabetes insipidus)
3. Sweating + Palpitation
   - Hypoglycaemia (stimulate production of Adrenaline)
   - ↑ Thyroid hormone (Hyperthyroidism)
   - Phaeochromocytoma
4. Dyspnea
   - Hypoxia (stimulate respiratory centre)
   - Acidosis
5. Edema of lower extremities
   - Hypoalbuminaemia

Question 4

Edema of lower extremities

Answer 4

Reduction in Oncotic pressure in capillaries

1. Reduced intake (Dietary malnutrition, Addict, Old age)
2. Nephrotic syndrome (Massive proteinuria)
3. Liver disease (Impaired production)
4. Protein losing enteropathy (Excessive loss in GI)
5. Malabsorption syndrome / IBD (Impaired absorption in GI)

Increase in Hydrostatic pressure in venules
Heart
1. Congestive heart failure
2. Constrictive pericarditis
3. Pericardial effusion

Lungs

4. ↑ Intrathoracic pressure
5. Chronic lung disease
6. COAD
7. Fibrosing alveolitis

Question 5

3 basic principles in clinical practice

Answer 5

1. Observation
2. Critical analysis
3. Logical deduction

Question 6

4 Principles in clinical bedside diagnosis

Answer 6

1. Exclusion / Inclusion
2. Symptoms: Internal environment + Normal physiological functions derangement
3. Signs: Anatomical structure derangement
4. Common diseases always come commonly

Question 7

Investigations

Answer 7

1. Blood / Body fluid
   - detect changes in body fluid composition as a result of disease
   - confirmation of diagnosis
   - severity of disease process
2. Function tests
   - LFT
   - RFT
   - Respiratory
   - GI
   - Endocrine
   - Metabolic
   - Assess degree of impairment of function by diseases
3. Imaging
   - Radiological: Conventional + Interventional
   - US: Internal organs (e.g. Echocardiography, Doppler for blood flow)
   - CT: Static + Dynamic
   - MRI: Static + Functional
   - Nuclear scan: Isotope (Cardiac + Renal)
   - Position Emission Tomography (PET): Malignancy + Infection