Internal Medicine
INTRODUCTION
INTERNAL MEDECINE - INTRODUCTION AND GENERAL
DIAGNOSIS.
INTERNAL DISEASES HAVE EVOLVED AS A DISCIPLINE
FROM GENERAL MEDICINE AS ONE OF THE FIRST
SPECIALIZATIONS.
LATER IT WAS DIVIDED INTO A NUMBER OF NEW SPECIALIZED
FIELDS
• CARDIOLOGY
• Pulmonology
• Nephrology
• GASTROENTEROLOGY
• HEMATOLOGY
• Rheumatology
• ENDOCRINOLOGY
• Diabetology ETC.
THE ADVANTAGE OF THIS SHOULD BE BETTER UTILIZATION OF
BOTH TECHNICAL AND HUMAN RECOURCES (QUALIFICATIONS)
THE DISADVANTAGE IS THE LOSS OF THE GENERALIZED
(HOLISTIC) APPROACH TO THE PATIENT.
TRADITIONAL INTERNAL DISEASES ARE DEFINED AS A
FIELD OF DIAGNOSIS AND MEDICAL TREATMENT (AS
OPPOSED TO INTERVENTION/SURGERY).
IN THE LAST FEW YEARS, THIS DEFINITION HAS BEEN
MADE OBSOLETE IN THE FACE OF INTERVENTIONS IN
DIAGNOSTIC AND TREATMENT METHODS:
• Cardiology
• Gastroenterology
• Nephrology
• Pulmonology
BASIC CONCEPTS OF GENERAL DIAGNOSIS OF INTERNAL DISEASES.
THE APPROACH TO THE PATIENT IN INTERNAL DISEASE WARD-
STAGES:
1. EMERGRNCY PROCEDURES
2. DIAGNOSTICS
1. HISTORY (GENERAL INTEGRATED CURRICULUM
EXAMINATIONS, SPECIAL INTERVIEWS CONCERNING
HEALTH, SOCIAL AND PROFESSIONAL STATUS, STYLE OF
LIFE, etc.)
2. PHYSICAL EXAMINATION (DOCTORS AND NURSES)
3. ADDITIONAL TESTS:LABORATORY IMAGE (RTG, CT,
ultrasound, MRI) INVASIVE (GASTROSKOPY,
BRONCHOFIBEROSCOPY, ERCP)
3. TREATMENT:
1. The symptoms
2. SPECIFIC ACCORDING TO DISEASE
3. EVALUATION OF THE USE OF TREATMENT USED
4. REHABILITATION
4. PHYSICAL
5. PSYCHOSOCIAL
5. APPROPRIATE AMBULATORY CARE
6. BASIC HEALTH CARE (GP)
7. SPECIALISTS
8. PSYCHOLOGICAL GUIDANCE
9. SUPPORT GROUPS
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 physical examination
• observation
• palpation
• percussion/tapping
• auscultation
GENERAL APPEARANCE:
1. general features, nutritional status
2. temperature of the body
3. mental state
SKIN
1. color, dye changes
2. exanthema
3. scars
4. hair
5. fatty padding
6. warming, dryness, nails
LYMPH NODES
1. sensible, location
2. mobility , painfulness
FACE , HEAD, SCULL, EYES
1. eye movements, stare, collapse
2. pupils
3. conjunctiva
4. eyelids
5. Vision
EARS
NOSE
MOUTH
CHEST
1. skin, nipples
2. shape
3. movement
4. type of breathing, symmetry,
number of breaths
5. Pain
RESPIRATORY SYSTEM
1. pulmonary tapping
2. physiological and ancillary airborne
rhales/sounds
CIRCULATORY SYSTEM
1. watch the heart area
2. heart rate tapping
3. listening to the murmurs, the tones
4. Heart Rate
5. pressure
6. peripheral vessels
ABDOMEN
1. shape
2. peristalsis
3. Soreness, muscle defense.
4. deep palpation - internal organs
5. tumors
6. percussion/tapping
7. hernia
8. per rectum examination
EXTERNAL GENITAL
1. external genitalia
2. The pubic hair
URINARY TRACT
1. kidney area - the symptom of shaking
2. palpation of the bladder area
MOTION SYSTEM
1. bones and joints
2. edema
3. limitation of motility
4. spine
THE NERVOUS SYSTEM
1. basic symptoms - hypoaesthesia, hyperalgesia
2. symptoms of paralysis-paralysis
3. symptoms of neuralgia, etc.
