Internal Medicine Propedeutics

Goals Dentists don’t treat only healthy people Dental treatments can affect the patient health Dentists can discover some signs of special diseases Emergency treatments in internal medicine Increase the communication skills Give a wider horizon to medicine Help to be more competitive

Dentistry - Internal Medicine Propedeutics 1.Introduction. History taking. The principles of physical examination. 2. Techniques of physical examination. Physical examination of the head and neck region. 3. History taking in chest and lung diseases. 4.Physical examination of the chest and lung. 5.Disorders of the respiratory system (pneumonia, bronchial asthma, pleural diseases, tumors). 6. History taking in cardiovascular diseases. Physical examination of the cardiovascular system. 7. Symptoms and signs of common cardiovascular diseases (ischaemic heart diseases, valvular diseases, heart failure). 8. Symptoms and signs of vascular diseases. Examination of the peripherial vessels. (Hypertension, diseases of the venous system and peripherial arteries). 9. Symptoms of the abdominal diseases. 10. Physical examination of the abdomen. 11. Symptoms and signs of common gastrointestinal disorders (oesophageal diseases, ulcers, gastrointestinal tumors, liver and biliary diseases, pancreatitis). 12. Symptoms and signs of endocrine diseases, diabetes mellitus and metabolic disorders. 13. Physical examination of the kidney and genitourinary system. Symptoms and signs of common renal diseases (glomerulonephritis, nephrotic syndrome, urinary tract infections, nephrolithiasis, renal failure). 14. Symptoms and signs of common haematological diseases.

Barbara Bates Guide to physical examination and history taking Lynn S. Bickley Bates’ guide to physical examination and history taking

Diagnosis – an injured mosaic

The main parts of the diagnosis –Pathological –Etiological –Anatomical –Prognostic

Medical examination Patient history Physical examination Laboratory and instrumental examination

Patient history 0.Introduction Date of the history Identifying data Source of referral Reliability of the history

Patient history 0.Introduction 1.Chief complaint(s)

Patient history 0.Introduction 1.Chief complaint(s) 2.Present illness

Present illness Location Quality Quantity or severity Timing (onset, duration, frequency) Setting in which it developed Factors that aggravated or relieved Associated manifestations Treatments

Patient history 0.Introduction 1.Chief complaint(s) 2.Present illness 3.Past history

Past history Most important diseases in chronological order (hospitalisations) Operations, injuries, accidents Allergies (drug, food, pollens etc.) Transfusion(s) Screening tests

Patient history 0.Introduction 1.Chief complaint(s) 2.Present illness 3.Past history 4.Current health status

Current health status Social circumstances Occupation (recent and past) Enviromental hazards (home, school, workplace) Diet (incl. beverages) Alcohol and illicit drugs (type, amount, frequency, duration of use) Tobacco (type, amount, duration) Current medication Exercise and leisure activities Sleep patterns Sexual history

Patient history 0.Introduction 1.Chief complaint(s) 2.Present illness 3.Past history 4.Current health status 5.Family history

Family history Parents, siblings, spouse, children, other relatives –age; age and cause of death; health status; important diseases Occurence of –Diabetes –Hypertension, heart diseases, stroke –Infective diseases –Malignant diseases –Coagulation disorders –Psychiatric diseases, alcoholism, drug addiction –Symptoms like those the patient

Patient history 0.Introduction 1.Chief complaint(s) 2.Present illness 3.Past history 4.Current health status 5.Family history 6.Review of organ systems

Review of organ systems General –General status –Usual weight, weight change –Fatigue –Fever According to organs Skin, Head, Eyes, Ears, Nose, Mouth, Neck, Breasts, Respiratory, Cardiac, Gastrointestinal, Urinary, Genital etc.

Patient history 0.Introduction 1.Chief complaint(s) 2.Present illness 3.Past history 4.Current health status 5.Family history 6.Review of organ systems