Internal MedicinePropedeutics

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 Propedeutics1. 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 history0. Introduction

Date of the historyIdentifying dataSource of referralReliability of the history

Patient history0. Introduction1. Chief complaint(s)

Patient history0. Introduction1. 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 history0. Introduction1. Chief complaint(s)2. Present illness3. Past history

Past history

• Most important diseases in chronological order (hospitalisations)

• Operations, injuries, accidents• Allergies (drug, food, pollens etc.)• Transfusion(s)• Screening tests

Patient history0. Introduction1. Chief complaint(s)2. Present illness3. Past history4. 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 history0. Introduction1. Chief complaint(s)2. Present illness3. Past history4. Current health status5. 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 history0. Introduction1. Chief complaint(s)2. Present illness3. Past history4. Current health status5. Family history6. 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 history0. Introduction1. Chief complaint(s)2. Present illness3. Past history4. Current health status5. Family history6. Review of organ systems