Examination is an important factor, perhaps
the main stage of the work of the therapist because it pretty much decide the
success or failure of the treatment works: Working doctor may do good new
findings are true and complete to the symptoms can be an accurate diagnosis and
adequate, then the prognosis is that the new regulations, treatment and
prevention for correctness.
This is a work:
Science: In addition to medical knowledge
that all physicians are required to have full, there must be a listing of the man
is a dialectical unity in which each department are organically related to each
other, so not only single examination department that patients should always
check the entire body.
Technique: Must regularized examination and
examination techniques to detect it properly symptoms (eg, to hear the sound
unusual in heart, lung, spleen or liver touching peek out from costal margin,
or when type tendon reflexes ...)
None of the show, it was a work:
Politics: How meticulously thorough medical
examination by a physician in addition to helping physicians detect disease
properly reinforces the confidence of stable patients thought their pessimistic
fears, giupho confidence in treatment in the cure this: essential elements for
the treatment to be good.
Today, despite the progress and development
of preclinical methods, the role of the clinical examination is important
because it gives the direction from which the diagnostic designated as
preclinical tests required, avoid making widespread or vice versa does not do the
necessary tests. So medical examination should be carried out like?
How to conduct medical examinations
place of examination
It should be:
Clean, fresh air but avoid drafts.
Warm, especially in winter.
There is enough light.
Discreet, especially those where women used
to examine patients.
means
In addition to the furniture necessary for
the physician and patient visits to the sick bed is examined, where care needs
to be equipped with a minimum of means:
Medical stethoscope.
Sphygmomanometer.
Tools for pressing the tongue: to visit the
sick throat.
Reflex hammer and needle to neurological
examination.
How fingers or gloves (doigtier) Rubber: for
rectal or vaginal examination when necessary. If you have an extra flashlight
to check the pupillary reflexes needed the better.
physician
It should be noted to dress: clothes dirty,
angry black collar, long fingernails dirty, unkempt hair will reduce the
confidence of the patient to the physician lot.
Attitudes need to intimate, warm to the
patient at risk of exposure, easy revealed the secret of his problems. Avoid
the attitude of patients misunderstand the physician "grace" for
them.
When asked patients to use straightforward
language, avoid using the word medicine that the disease is difficult to know
(royal sure, hematuria ...) and especially patience to exploit the subjective
symptoms of the disease, if necessary do not hesitate to ask questions or to
change the way the questions to capture all of the patients.
When the doctor should have gentle style,
meticulous, avoid rough, avoid sick day or more without the need for the most
seriously ill. The physician, physician especially men, need to pay attention
to the nature of the woman shy to ask and how to avoid the most indecent manner
doctor too revealing, self-injure the patient's women, so they do not say what
needed to diagnose and treat.
Upon receipt of the required objective
symptoms and caution: there should be no prejudice before, especially for older
patients, physicians are more likely to have thought the old disease
recurrence. Need to appreciate the symptoms, especially the subjective symptoms
of the disease: the identification, analysis, evaluation of symptoms that must
be based on a scientific basis.
Be careful while talking with patients about
their condition; in general, to think before talking to did not say what issues
can make them fear, panic or pessimism with their patients; to explain to
uplifting, thought for their stability assured treatment in the healing
message.
For the families of patients, we can tell the
truth in a certain range, that is, depending on the problem, depending on the
person's relationship to the patient.
patients
Should be examined in a comfortable position.
If health conditions permit, the patient should check the way to go.
Should reveal the need to check. Best of all,
the sick men wearing only underwear when a medical examination if place to
ensure adequate warmth. The sick woman should reveal part: chest, abdomen, and
limbs ... In winter, Notes prompts the patient removed because scarf scarves
can hide some very important issues in the neck: tumors borders, the jugular
vein float, the cost-neck scar ...
Content doctor
After asking technical part history (see
above), the doctor usually conducted in three parts:
Full body examination.
Check each department.
Check more waste.
Body Check
It should be observed:
Gait, standing by the patient:
After first contact with the patient, we can
immediately notice a few ways and located, walking, standing by the patient
immediately suggests to us a direction of certain diseases or syndromes:
How is "trigger", facing the dark
side in patients with meningeal disease.
How high is the top or half-recumbent (Fowler
position) of the patients dyspnea.
Getting stiff, body like a log of people with
Parkinson's disease.
How di "grass" a convulsive hand to
the chest of the patient paralyzed from the waist, can cramp.
How to walk hugging the right upper quadrant
of the liver abscess patients.
The spirit of the disease:
Noting see patients in the state:
Awake: The disease can be patient
self-reports, statements and answers are obvious questions of the physician.
Delirium: the patients are not identified and
does not answer the question correctly, not only that the patient was in a
state of panic, mumble, even when running or destroying wild. It is the mental
condition of the patient:
Sort entered hepatic coma.
Any fever for what reasons, but the most
common in our country is fierce bout of malaria.
Mental Illness.
Coma: the disease is not identified nor
answer my question.
But here the patients do not panic, do not
mumble but left more or less lost contact with the external environment, even
in the case of coma:
The patient does not know the pain when
pinched.
Do not swallow the water poured into their
mouths.
Loss of corneal reflex.
Coma is a very serious incident, the
consequences of infectious diseases and poisoning of many parts, should be
examined carefully and ask discovered why.
General shape:
Need to identify the disease:
- Slim or fat, skinny means: The gaunt,
sunken cheeks, the facial bones protruding, especially cheekbones. Ribs,
scapula highlighted. Flat belly, belly skin commandments rang. Total weight
less than the average weight of 20% (with an average weight of feces than 100
meters of height; eg, a 1m62 high, the average weight of 62 kg).
- Slim common in these cases:
Undernutrition by: Eating a lack of quality
or quantity. Eating enough but the department does not use digest and absorb,
esophageal, pyloric stenosis, chronic bowel disease, chronic pancreatitis ...).
Eating relative but not enough to meet the needs of the body increases due to
overwork or disease. Chronic diseases: tuberculosis, liver cirrhosis, cancer
... Some endocrine diseases: diabetes, Basedow.
- Obesity means:
Face swollen, bulging cheeks, chin droop.
Stock usually not seen retracted. Limbs rounded and grooved. Abdominal skin
with thick layers of fat and sagging to make the abdomen. Total weight is
higher than the average weight of 15%.
- Fat normally are:
Nutritional Causes: The most common,
especially when eating more and less active. Endocrine causes: Women of all age
kinh.Nam world after losing testicles. Cushing's disease caused by pituitary or
adrenal glands due to intensity.
Causes Mental: a sometimes occur due to
strong mental trauma.
- High or low. Need to pay attention to two
cases of disease:
The medium to medium high oversized alone or
in combination added to the first phenomenon and expenses: this is huge disease
(gigantisme), a disease of the pituitary gland.
The medium low and too small: as well as a
case of pituitary disease, patients calculation (infantilisme).
The balance between these parts: often there
is a certain balance between the parts of the body, head and limbs. In some
pathological cases, we find that balance disappear:
To early disease (hydrocephalie): the first
is to not match the entire body.
Acromegaly (acromegalie): head and especially
the hands and feet are oversized, not commensurate with the expenditure and
body rest.
Teo an amputation, a chi chi or both
symmetric: common in neurological diseases such as amyotrophic the fiber column
(sclerose laterale). Flute marrow disease (syringommylelie) and is the most
common sequelae of poliomyelitis children (PAA). But when the patient's body:
Both parties chest unbalanced by a party
effusion or pneumothorax as stretch or vice versa due to pleurisy thick and
sticky traction as falling.
The color of skin and mucosa:
Some medical conditions shown on the color of
the skin and mucous membranes such as:
- Skin and mucosal cyanosis: demonstrates the
lack of oxygen normally found in:
Some congenital heart disease, chronic
pulmonary heart disease and heart failure cases.
The lung disease causing breathing difficulty
levels: bronchopneumonia in children, pneumothorax severe asthma.
The airway disease causing suffocation bar:
bar almost paralyzed by diphtheria.
In these diseases, cyanosis cases appear in
the environment, in the human eye diseases, acute cyanosis new to the place,
even when the whole body.
In contrast, in some other disease, cyanosis
confined to one area, for example in:
Inflammation of the arteries: cyanosis in the
toes, fingers, sometimes the feet, hands or even an amputation so that the
dominant artery.
Capillary vascular disorders: cyanosis all
extremities especially the fingers.
- Skin and mucous membranes pale. Status pale
sometimes evident on the countenances of the disease, but the secret to looking
at the lining of the eyes, mucous membrane of mouth, tongue or hands feet. It
is shown clinical acute or chronic anemia due to many reasons.
- Yellow skin and mucous membranes: the skin
of patients with various forms of gold:
Golden straw: in cancer.
Yellow belly: in severe anemia.
Bright yellow more or less: by drinking
plenty quinacrin or santonon. Sometimes there is the yellow pigment in the
palms of the hands and feet.
In this situation, the current situation can
only yellow skin or the palms, soles of the feet. By contrast in jaundice. Gold
status can present both in the lining eyes, mouth, tongue: these are symptoms
of a very valuable suggestions diagnosis, because yellow is an almost
nonspecific symptoms of hepatobiliary system.
- Skin and mucosal gray (m LANO ermie): this
is not a normal case of tanned outdoor workers, but also a case of having the
disease pathology:
Addison's disease (Addison's disease).
Accumulation of melanin (Melannose de Richl).
- A pale skin, if that area has more cool
feeling stinging pain when we must think carefully and find the cause of style.
Mucocutaneous condition:
Need findings:
- The skin lesions: detection purposes other
skin diseases identified the need to pay attention to the scarring sequelae of
certain diseases in the history of the disease and surgery, because the lesions
are resolving It is the cause of the current turmoil as:
Scars do think music colon atopic workers.
Scars "moved climb" (shingles) on
the chest, may be the cause of pain intercostal nerves now.
Scars caused by bullets in the chest towards
the cause was thought to cough up blood now.
- The bleeding note: often a manifestation of
blood diseases and expression in many forms:
Arrays ecchymosis (ecchymose).
Ban bleeding (purpura).
Dot bleeding (petechre).
- The exhaustion of water. Represented by:
Dry skin, warning rang even have patches of
psoriasis.
The existence of the leopard skin wrinkles
ssau.
Often seen in the following cases:
Severe diarrhea or diarrhea level takes a
long time.
Severe nausea.
Fever, infection lasts.
- Status fluid: represented by: compliance
with concave publications (soft line) or without pressing concave (hard line),
to detect the face (especially the eyelids), in the leg ankle (look for signs
of publications concave side of the tibia and ankle).
Often seen in the following cases:
Level or chronic glomerulonephritis,
nephrotic patients grease.
heart Failure
Cirrhosis.
Undernutrition.
Be wet beriberi.
Artery or vein inflammation of lymph nodes.
System Status and hair coat:
There may be pathological phenomenon as
follows:
- Too many men in fur or hair growth in
places where no ordinary woman (beard): one case of adrenal disease intensity
(Cushing).
- No hair growth or hair loss, hair loss.
Expression of:
A condition can be debilitating disease
caused by an infection or poisoning.
A spot disease of the skin and scalp.
An endocrine disorders: ovarian disorders,
thyroid insufficiency.
Check each department
Often the doctor immediately should stay
patient department, the question carefully braided initially associated with
the review body will help us think about organ disease.
Then check the other parts, the first is the
part related to physiological or anatomical parts with thin, then visit the
rest of the parts and should go sequentially from top to bottom (top , neck,
chest, abdomen, limbs ...) in order not to miss.
Back to search contents of each department,
we do not speak carefully here, because there are separate articles in the
latter case, we only emphasize the issues that need attention in every department
including:
At the top:
In addition to comments skin, mucosa and
skull, hair mentioned above, check:
12 cranial nerves (the program will tell
nerve), especially if the person has a mental illness experience.
Teeth, tongue, throat: the program will tell
digestion.
In stock:
Attention to:
Thyroid.
The scar in the neck or neck scar colon
music.
Jugular vein: OC veins stand to be a
manifestation of the right heart failure.
In the chest:
It should be observed:
Morphology and the operation of the chest to
the rhythm of breathing.
The ribs and intercostal spaces.
Check the heart and lungs.
Do not forget the two breast and axillary
lymph nodes.
In the stomach:
Morphology and activity of the abdominal wall
under the breath.
Check belly general (discussed in the first
chapter of) and the abdominal viscera.
Attention to the rectal and vaginal is a
simple gesture made mandatory for all patients with pathological findings in
the abdomen, especially in the lower abdomen.
In men, do not forget to check the penis,
scrotum sex, spermatic cord, and the hernia hole.
In the limbs and spine:
Attention to:
Malformation or disfigurement of the limbs
and spine by:
The spine is curved, hunchback or pure: a
harsh pain in the spine, especially at the base of the spine to the wood, to
make us think of a vertebral tuberculosis.
Sequelae of fractures and an old disease of
bone.
The joints: one or more swollen joints, to
make us think of arthritis as:
Rheumatic fever.
Chronic arthritis.
Lao joints.
Purulent inflammation of the joints.
The fingers and nails: nail "watch
glass" means nail cupped round like a watch glass, is a manifest need
attention. The phenomenon that at first alone, later combined with additional
fingers to friends as drumstick to a symptom called Hippocrates finger
instance:
Some congenital heart disease (disease
Fallot).
Heart disease - chronic lung.
Chronic infections in organ, common in
subacute endocarditis Oxle and chronic lung abscess or bronchiectasis, chronic
infections.
Some cases of lung tumors: Pierre Marie
syndrome.
Cholestatic cirrhosis Primary: Hannot
disease.
After careful examination of the body and
parts combined with thoughtful questions disease, we must never ending clinical
examination by checking the weather and some waste can translate.
Check the weather Waste
This is only a preliminary review of
clinical, should be supplemented by the results of preclinical testing of these
substances. However, the preliminary remarks are great because it gives us
right at the bedside of the factors necessary for diagnosis.
Urine:
Yellow slots: define for us a jaundice.
Red: We identified patients for blood in the
urine.
Coating: could be a urinary tract infection.
Analysis:
Red blood slimy nose: dysentery syndrome.
Black as coffee grounds: suggest a
gastrointestinal bleed.
sputum:
There rays and blood clots in the blood or
hemoptysis.
Pus in the lung abscess.
Purulent sputum chocolate in lung abscess
caused by amoeba.
Vomit:
You need to consider the composition and color
vomit.
In the spirit as for the more waste, we can
get some volume in the probe tips, depending on the clinical picture.
There pleural effusion or pericardial:
Amniocentesis right pleural or pericardial.
Ascites, to tapping ascites.
Meningeal syndrome: to tapping cerebrospinal
water.
Like the more waste, what this translates
immediately with preliminary remarks on the bed, was able to make the correct
diagnosis:
Amniocentesis pleural pus, making diagnosis
even a purulent pleurisy; if pus-colored chocolate makes me think of the cause
by amoeba.
Amniocentesis cerebrospinal see turbid water,
make a diagnosis as soon as meningitis. By examined above, there are cases:
It can be diagnosed immediately, but not in
sufficient detail.
But they have not even been able to have
diagnosed that only a certain direction. Therefore need to use additional
methods of subclinical.
The method of subclinical
The progress of science in all fields has
contributed to the development of sub-clinical methods to help medical diagnosis
more certain. The phuoong it more convenient, more accurate and sophisticated.
The probe can subclinical against 4 types of purposes:
To identify morphological
Often, it is the method:
Radiology; projectors and shoot, shoot often
or dye.
Soi organs.
Radioisotopes.
To identify lesions
This is the viscera biopsy (biopsy or better
blind biopsy under the control of the eye) to remove a sample held the test.
Micro: find the lesion pathology, diagnosis
is often worth the surest.
Biochemical model was applied in countries
with scientific progress.
To find pathogens
Pathology tests mentioned above as well as a
method to find the causative agent (biopsy of an enlarged lymph nodes for
pathogens as cancer or tuberculosis, depending on the pathological anatomy with
tumor cells or international giant cells of tuberculosis).
There's also another method to directly or
indirectly:
Bacteria, viruses.
Parasite.
Mushrooms ...
In the humoral and more waste.
To probe the function
A large part of this approach is that the
biochemical tests. Also the method used machinery (due to underlying metabolic
exploration of thyroid function to probe ECG heart function ...) and more
recently using the radioisotope method.
The necessity of subclinical
So far, no one has dared to deny the
necessity of the method for practical clinical approach of this method of
diagnosis helps to find:
It's accurate.
It's full.
And especially very early, when the disease
is diagnosed while still in the preclinical period. But it is inevitable
downside.
Disadvantages of subclinical
The validity of the method of subclinical
depends on many factors:
Qualities of machinery or chemicals used in
it.
How to obtain and ensure specimens from
disease prevention to the test site.
Nheim accountability and professional
competence of testing. So the method for preclinical us:
We need not rely on the clinical examination
is indicated to the right to avoid making unnecessary spill has wasted
chemicals, machinery and labor power of the test, just wasting disease is the
blood thnah and blood of patients with fatigue when patients do not need.
Based on clinical need to identify these
results, ie to compare the results of preclinical and clinical situations: if
not appropriate then check again, both clinical and subclinical if necessary
then repeat the test for subclinical.
In this way we obtain the correct
documentation of clinical and subclinical, the factors necessary for us to go
to the section diagnosis.
diagnose
The document clinical and subclinical above
should be incorporated into the syndrome: a person may have one or more
symptoms. Based on the syndrome that we will make the definitive diagnosis,
differential diagnosis, diagnose the cause and assess prognosis.
In the diagnosis, need to respect some rules:
Must be based on the symptoms of the disease,
clearly, clearly no one can deny, clinical and subclinical.
Consider first of all to those patients most
often and must be based on the specific symptoms diagnostic value of this
disease.
So try to find a diagnosis may include all of
the symptoms and the patient's symptoms. If it can not be considered as new
patients with 2 or 3 patients at the same time.
conclude
Diagnosis is a difficult task. Want to
properly diagnose patients to get an attitude and preventive treatment
appropriate, the physician should have:
Medical Knowledge fully comprehensive.
Thorough examination style, meticulous.
Scientific reasoning methods and dialectics.
The spirit of loving parents to their
patients.
This is the fourth major requirement that
each student must train yourself in the process in clinical practice.
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