5.PRO Presentation (1)
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Transcript of 5.PRO Presentation (1)
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Pasthistory
Familyhistory
HISTORY TAKING:
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PAST HISTORY...
Information about previous
childhood illnesses
chronic childhood illnesses
adult illnesses
which can help with the diagnosisand management of currentconditions.
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ADULT ILLNESSES...
-Medical illnesses
-Surgical
-Obstetric/gynecologic
-Psychiatric
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Pasthistory
Familyhistory
HISTORY TAKING:
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Family History
Is One of the 9 Items of historytaking.
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It consists of informationabout:
the biological relationships betweenfamily members and the patient .
any medical conditions they mayhave.
Family History
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Why taking family history isimportant?
The strength of the genetic component
in a family may be apparent by thenumber of people affected by aparticular condition
can reveal patterns of inheritance.
may help make or refine a diagnosis
helps assess the likelihood of geneticdisease in relative
Family History
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Key points for taking a familyhistory:The health of parents, brothers andsisters should be asked for. If they arenot living, the cause of death should berecorded.
Similar diseases in the family should beenquired about.
Family History
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Examples of Common diseases withhereditary tendency:
diabetes.
Hypertension.
allergy.
mental diseases. nephritis.
migraine.
degenerative neurological disorders
Family History
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Summary
Family history should Present:the health of the parents, brothersand sisters.
Similar illness or symptoms in family
Family History
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ROLE-PLAY
Doctor: Fatimah Al-
Ghamdi Patient1: Nouf Al-Subaie
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Cough
SYMPTOMS:
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COUG
H
A cough is an action your body takes toget rid of substances that are irritatingto your air passages, which carry the airyou breath in from the nose and mouthto the lungs.
Wha
t?
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COUG
H
A cough occurs when special cellsalong the air passages get irritated andtrigger a chain of events. So, air in your
lungs is forced out under high pressure.You can choose to cough (a voluntaryprocess), or your body may cough on itsown (an involuntary process).
How
?
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Caus
esAcute coughone that beenpresent for less
than 3 weeks
Chronic coughsthose present formore than 3
weeks.
infectio
us
noninfecti
ous
environmental irritants. conditions within thelungs. conditions along the
passages that transmit airfrom the lungs to theenvironment conditions within the
chest cavity but outsideof the lun s
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Sinus
infections
Larynx,trachea,
large airways
InfectionTumors:benign malignant,primary, secondaryAspirationGastro-esophagealrefluxForeign bodyIrritant dusts
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Sinus
infections
Smallairways
AsthmaPost-viral airway reactivityChronic bronchitisBronchiectasisBronchiolitsIrritant dusts
Alveoli
Drugs ( angiotensin-
converting enzymeinhibitors)Infection ( pneumonia,tuberculosis)
AlveolitisLeft ventricular failure
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Indications related to
coughSmokerCough
Dry, painfuland non-productivecough
Paroxysmaldry cough
Chronic dry
cough
Chronic bronchitis
Tracheitis,pneumonia
Asthma associatedwith lung injuries and
bronchitis
Interstitial disease:
cryptogenic fibrosing
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Circumstances of the
coughq Nocturnal cough: common symptom ofasthmaq
Occult gastro-oesophageal reflux :common cause of daytime coughq Angiotensin-converting enzymeinhibitors: cause dry coughq Coughing during or after swallowingliquids: suggests neuromuscular diseaseof the oropharynxq Occupational asthma and exposure to
WHAT DO I ASK THE
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WHAT DO I ASK THEPATIENT ABOUT?
1.What is the frequency of cough?
2.What is the severity of cough?
3.Does it occur on some special time of day or
night?
4.Is the cough precipitated under some special
circumstances?
5.Is cough accompanied with wheeze?
6.Is cough accompanied with hoarseness?
COUGH WITH
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COUGH WITHSPUTUM
What is SPUTUM? Expectorated respiratorysecretions.
Four main types Serous Mucoid Purulent Rusty
HAEMOPTYSIS: the Presence
of blood in sputum
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WHAT DO I ASK THEPATIENT ABOUT?
TASTE/SMELLCOLOUR
AMOUNT SOLIDMATERIAL
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How much phlegm do you cough out each day?
- Small (Teaspoon)
- Large (Tablespoon)
What does it tell you?
Regular coughing of large volumes Bronchiectasis
Sudden production of large amounts on a
single ocassion - Rupture of a lung abcessor em ema into the bronchial tree
1- AMOUNT
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What is the colour of the phlegm?
What does it tell you?
Clear, watery, pink, frothy (Serous)Pulmonary oedema, Alveolar cell cancer
Clear, grey, white, viscid (Mucoid) Chronicbronchitis/COPD, Asthma
Yellow, reen Purulent Broncho ulmonar
2- COLOUR
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How does it taste?
What does it tell you?
Foul/ Smelling Anaerobic bacterial
infection : Bronchiectasis, Lung abscess,empyema
Change in sputum taste Infective
3- TASTE/ SMELL
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Is there any solid material in thephlegm?
What does it tell you?
Asthma Bronchopulmonary aspergillosis
Necrotic tumour
Food, teeth, tablets
4- SOLID
MATERIAL
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ROLE-PLAY
Doctor: Fatimah Al-Ghamdi Patient2: Razan Al-Hadlaq
http://var/www/apps/conversion/current/tmp/scratch767/Primary%20vs.%20Secondary%20Headaches%20?%20-%20YouTube.mp4 -
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Breathlessnes
s
SYMPTOMS:
http://var/www/apps/conversion/current/tmp/scratch767/Primary%20vs.%20Secondary%20Headaches%20?%20-%20YouTube.mp4http://var/www/apps/conversion/current/tmp/scratch767/Primary%20vs.%20Secondary%20Headaches%20?%20-%20YouTube.mp4http://var/www/apps/conversion/current/tmp/scratch767/Primary%20vs.%20Secondary%20Headaches%20?%20-%20YouTube.mp4http://var/www/apps/conversion/current/tmp/scratch767/Primary%20vs.%20Secondary%20Headaches%20?%20-%20YouTube.mp4http://var/www/apps/conversion/current/tmp/scratch767/Primary%20vs.%20Secondary%20Headaches%20?%20-%20YouTube.mp4http://var/www/apps/conversion/current/tmp/scratch767/Primary%20vs.%20Secondary%20Headaches%20?%20-%20YouTube.mp4 -
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BREATHLESS
NESS
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Breathlessness (dyspnoea) is an undueawareness of breathing. It is a naturalconsequence of strenuous physicalexercise. Patients may refer to it asshortness of breath or difficulty ingetting enough air.
Wha
t?
BREATHLESS
NESS
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Breathlessness may be associated witha feeling of light-headache, dizziness,tingling in the fingers and around the
mouth, chest tightness and rarelysyncope.
Sign
s:
BREATHLESS
NESS
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q How are the causes ofbreathlessness presented??
BREATHLESS
NESS
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- Lying flat (orthopnoea): presentwith left ventricular failure andrespiratory muscle weakness.
However, this can be a feature ofsever lung disease
Cause # 1
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Cause # 2
- Paroxysmal nocturnal dyspnoea:due asthma and left ventricularfailure, that wakes patient fromsleep.
Waked from 3-5a.m.with wheezing
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Cause # 3
- (COPD) Chronic obstructive
pulmonary disease. If its worsefirst thing in the morning, and feelsbetter with coughing up sputum.
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Cause # 4
Exercise induced asthma:breathlessness continue to worsenfor 5-10 min after stopping activity.
If suspected (asthma) ask directlyabout:
exposure to any allergens (animals,hoovering, mowing the lawn )
Irritant with smoke , perfumes,
fumes, cold air or drugs(e.g. Aspirin)
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Cause # 5
Occasional asthma:
breathlessness that improve atweekend or holidays/extrinsicallergic alveolitis.
SEVERITY OF
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SEVERITY OFBREATHLESSNESS
WHAT DO I ASK THE
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WHAT DO I ASK THEPATIENT ABOUT?
1. Mode on onsets, duration, progression,variation, aggravating, relieving factors,
severity and associated symptoms.
2. When does it occur? At exercising ? at
sleep ? or at rest?
3. How long does it remain? Is it episodic or
not?
4. Let the patient describe the pain.
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ASSOCIATED SYMPTOMS
Cough
SputumHaemoptysis
Chest pain
And wheeze
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THANK
YOU