Diagnosis and history taking in the pharmacy. General Rules-1 Who is the patient? You or absent? Why...
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Transcript of Diagnosis and history taking in the pharmacy. General Rules-1 Who is the patient? You or absent? Why...
Diagnosis and history taking in the pharmacy
General Rules-1 Who is the patient? You or absent? Why absent? If absent- uncertain about severity and
nature of disease self-treatment unwise Child? Open-ended: ‘What is the problem?’ ‘How
do you feel?’ Observe: ‘does the patient look ill?’ (body
language, esp. babies)
General Rules-2 Any current or recent medicines? (OTC and
Rx)
Later in the interview: Personal or family history, occupational or social habits (e.g. drinking, smoking, and exercise)
The description of the illness can be expanded by asking more specific and structured questions
SIT DOWN SIR!
A reminder of questions to ask about symptoms
S Site or locationI Intensity or severityT Type or natureD DurationO OnsetW With (other symptoms)N aNnoyed or aggravated byS Spread or radiationI Incidence or frequency patternR Relieved by
Site/Location
e.g. Abdominal pain: ???appendicitis(Central pain, moving to the right iliac fossa)
????Renal colic (pain in the right or left loin or iliac fossa)
???Peptic ulcer (central or epigastric)
???Biliary colic (right hypochondrium)
Appendicitis pain
Biliary Colic pain
Site/Location
e.g. Headache Unilateral migraine
Frontal migraine, sinusitis or tension
Occipital tension, muscle spasm, or subarachnoid hemorrhage
e.g. skin rash Localised reaction to a watchstrap Whole body allergy to an antibiotic
pimple
Papule
pustuleblackheads
whiteheads
Descriptive Dermatologic Terms
Intensity/severity Of e.g. skin rash, pain or bleeding
from a wound Gives information not only about the
likely diagnosis but also about the urgency of situation (monitor, give OTC or refer to doctor)
Type or nature
e.g. abdominal pain Cramp like or colicky involvement of a hollow organ
bowel or ureter ‘gnawing’ peptic ulcer Throbbing stabbing
e.g. skin rash Flat or raised Single or multiple Blistering or dry
Skin
Duration Helps to differentiate conditions: e.g.
migraine (few hours) from tension HA (few days or weeks)
Helps to decide when to refer: e.g a baby with 3 days diarrhea doctor. A baby with few hours diarrhea may respond adequately to hydration with a simple electrolyte mixture
Onset
Provides clues to its likely cause
E.g. abdominal pain or diarrhea that starts
soon after overindulgence in a restaurant
E.g. Headache occurs on awakening after
a long night
reassurance, empathy and OTC drug
Accompanying symptoms
Usually not volunteered by the patient Crucial to differentiate many symptoms
e.g. productive cough with/without bloode.g. diarrhea with/without bloode.g. red eye with itching or with pain and
photophobia
Aggravating Factors Valuable for some conditions: e.g. pain of peptic ulcer can be worsened by a
heavy meal or alternatively by fasting- while pain of gallstones worsened by fatty meal
e.g. headaches: raised ICP worse by lying down (mornings) while tension headaches maybe better in the mornings but worsen as the day goes by
Spread or radiation
e.g. referred pain Appendicitis (central, radiates to the right iliac
fossa), angina (radiates to arm or jaw), biliary colic (pain in the upper abdomen that is referred to the back and felt between the shoulder blades)
Skin rash- single discrete lesion in one part of the body before spreading elsewhere, while others present in more generalized way
Incidence or frequency Sometimes the pattern is
characteristice.g. classic migraine: rarely occurs twice in
same week, whereas cluster migraine occurs everyday, same time of the day for several weeks
e.g. hayfever versus common cold: differentiate by months of the year
Relieving Factorse.g. pain of peptic ulcer-> relieved by
small snacks
e.g. migraine attack can be terminated by vomiting
e.g. medicines relieve/diagnose: GTN can relieve anginal attack, while antacid can relieve reflux dyspepsia but NOT VICE VERSA!
Why clinicians must be familiar with OTC products?
1. Many OTC products are effective in treating common ailments and at less cost,
2. Many active ingredients contained in OTC drugs may worsen existing medical conditions or interact with prescription medication. E.g. antacids bind many drugs, thus reduce absorption. Cimetidine inhibits hepatic microsomal drug-metabolizing enzymes.
3. Misuse or abuse of OTC products may actually produce significant medical complications
Note: Many of the more potent OTC ingredients are
hidden in products where their presence would not ordinarily be expected:
Examples:1. Alcohol (% ethanol) in cough syrups, cold
preparations, and mouthwashes 2. Antihistamines in analgesics, menstrual
products, sleep aids,3. Aspirin & other salicylates: in antidiarrheals,
cough/allergy preparations4. Caffeine in analgesics, menstrual products and
stimulants
5. Benzocaine in antitussives/lozenges, dermatologic preparations, hemorrhoidal products, toothache, cold sore and teething products
6. Sodium in analgesics, antacids and laxatives
7. Sympathomimetics in analgesics, asthma products, cough, cold and allergy preparations, hemorrhoidal products and sore throat products