A medicine primer

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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?

  1. Common and important causes (if you know them)

  2. Functional units (based on sound knowledge and understanding of anatomy and physiology) Making pictures helps.

  3. Aetiological sieve

Aetiological sieve

Acquired

Vascular

Inflammatory

  • infective

    1. viral

    2. bacterial

    3. fungal

  • non-infective

Traumatic/toxic

Autoimmune

Metabolic/endocrine/metastatic

Iatrogenic/idiopathic

Neoplastic

Congenital

Inherited

  1. inborn errors of metabolism

Developmental

  1. structural malformations

  2. 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

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