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Medicine can be considered to be the interaction of patient, disease, and doctor. This document aims to crystalise and structure some of the knowledge that must lie in the doctors (and medical students) head. Feedback is appreciated.
The Patient
The doctor takes a history from and examines the patient in order to generate a differential diagnosis. If necessary this directs further investigations which lead to a definitive or presumptive diagnosis.
History
Demographics
Presenting complaint
History of Presenting Complaint
SOCRATES for pain
Appropriate system review
DQs for risk factors
Previous Medical and Surgical History
Drug and Allergy History
Family History
Social History
Systems Review
Examination
General Examination and Observations
Systems Examinations
Cardiovascular Examination
Respiratory Examination
Abdominal Examination
Differential Diagnosis
Investigations
Definitive or Presumptive Diagnosis
Treatment
Disease
A good history is informed by a sound knowledge of disease. The mnemonic DEAP MC is one method of structuring knowledge of a disease.
Definition
Epidemiology
Incidence and prevelance
Race
Age
Sex
Location
Risk factors
Enviromental or personal
Genetic and family
Aetiology
Use sieve if needs be
Pathogenesis
Morphology
Clinical features
Symptoms
Signs
Differential diagnosis
Investigations
basic
haematological
radiological
special
Diagnostic criteria
Management
Prognosis and complications
Complications may be:
Local/Distant
Early/Late
Differential diagnosis
What’s the differential of x?
Common and important causes (if you know them)
Functional units (based on sound knowledge and understanding of anatomy and physiology) Making pictures helps.
Aetiological sieve
Aetiological sieve
Acquired
Vascular
Inflammatory
infective
viral
bacterial
fungal
non-infective
Traumatic/toxic
Autoimmune
Metabolic/endocrine/metastatic
Iatrogenic/idiopathic
Neoplastic
Congenital
Inherited
- inborn errors of metabolism
Developmental
structural malformations
tumours
Transplacental disease
E.g TORCH organisms (Toxoplasmosis, Rubella, Cytomegalovirus, Herpes simplex) and Syphillus
Systems review
General
Weight/appetite
Fever/rigors/night sweats
Sleep disturbance
Fatigue/malaise
Skin: lumps/rashes/bruising
CVS
Chest pain
SOBOE/orthopnoea/PND
Ankle swelling
Palpitation
Dizziness and fainting
Intermittent claudication
Resp
Chest pain
Cough
Sputum, haemoptysis
SOB
Wheeze
GI
Appetite/weight loss
Dysphagia
Nausea and vomiting/haematemesis
Indigestion/heartburn
Abdominal pain
Jaundice
Bowels: change/constipation/diarrhoea/blood/mucus
GUS
Frequency/dysuria/nocturia/polyuria/oliguria
Haematuria
Incontinence/urgency
Prostatic symptoms
Mensturation: Menarche, duration of bleeding, periodicity, mennorhagia, dysmenorrhoea, dyspareunia, menopause, post menopausal bleeding
NS
HA/migraine
Fits/faints/loss of consciousness
Dizziness
Vision - acuity, diplopia
Hearing
Weakness
Numbness/tingling
Loss of memory/personality change
Anxiety/depression
Mskel
Pain/swelling/stiffness - muscles/joints/back
Able to wash and dress without difficulty
Able to climb stairs
Endo
Have you felt more suceptible to hot/cold recently?
Have you been constipated/had diarrhoea?
Change in weight/appetite
Change in periods
Change in energy levels
Change in mood