Write them on the premises where the session took place. Ask the open question:Do you par- ticularly dislike either hot or cold weather? Rebound tenderness from movement of inamed vis- cera of peritonitis against parietal peritoneum. Is there any illness that you are particularly worried about? Does it affect your job, home or social life? Hypothyroid patients put on weight without increase in ap- petite, dislike cold weather, have dry skin and thin, dry hair, a puffy face, a croaky voice, are usually calm and may be depressed. Disorientation suggests acute organic state or dementia. Score A Eye opening 1 Eyes remain closed 2 Eyes open to pain 3 Eyes open to command 4 Spontaneous with normal blinking B Verbal response 1 No response 2 Incomprehensible, moaning sounds only 3 Inappropriatewords spoken but no conversation 4 Confused speech 5 Normal speech C Motor response 1 No response 2 Extensor reex response to painadduction and internal rotation at shoulder, extension at elbows, pronation of forearms 3 Flexor reex response to pain 4 Withdrawal of limb 5 Localizing: attempts to protect site of pain 6 Voluntary: responds normally to commands Higher Cerebral Functions 113 122. Bullae Blisters due to burns, infection of the skin, allergy or, rarely, autoimmune diseases affecting adhesion within epidermis pemphigus or at the epidermal—dermal junction pemphigoid. Does it get worse or better on sitting up? A patient who is mostly sitting will have ankle oedema while a patient who is lying will have predominantly sacral oedema.
Gives you a systematic approach and understanding of the process. A history from a person who has witnessed a sud- den event is often helpful. There is nothing inherently difcult about clinical medicine. Obstruction of the bowel gives hyperactive tinkling bowel sounds. Due to: streptococcal infection, e. Murmur is louder after exercise, e. Problem patients Angry patients Inordinate anger is often symptomatic of another problem.
If during the functional enquiry a positive answer is obtained, 10 Chapter 1:HistoryTaking 19. Arthritisswollen, hot, tender, painful joint. Summary of Common Illnesses 71 Infectious endocarditis diagnosis made from blood cultures febrile, unwell, anaemia clubbing splinter haemorrhages Oslers nodes cardiac murmur splenomegaly haematuria Rheumatic fever itting arthralgia erythema nodosum or erythema marginatum tachycardia murmurs Sydenhams chorea irregular, uncontrollable jerks of limbs, tongue Clues to diagnosis from facial appearance Downs syndrome from 21 trisomy ventricular septal defect patent ductus arteriosus thyrotoxicosisatrial brillation myxoedema from hypothyroidcardiomyopathy dusky, congested face superior vena cava obstruction red cheeks in infra-orbital region in mitral facies from mitral stenosis Clues to diagnosis from general appearance Turners syndrome from sex chromosomes X0 female, short stature, web of neck coarctation of aorta Marfans syndrome tall patient with long, thin ngers aortic regurgitation 80. Percussion 93 Masses Carefully palpate the whole of the abdomen. Acknowledgements We are grateful to many colleagues and students who have made sugges- tions.
Can he convalesce satisfactorily at home and at what stage? A more complete assessment of mental state is given in Chapter 6. Keep object within binocular eld as nystagmus is often normal in extremes of gaze. Robert Turner was an outstanding clinical scientist and clinician and most of the content and avour of the book remain his. Fits or faints:Have you had any funny episodes? Other defects occurring in absence of motor or sensory dysfunction Dyslexiainappropriate difculty with reading. Have you had any operations or admissions to hospital? Measure height and span are all limbs, spine and skull of normal size and shape? Lungs: carcinoma of the bronchus chronic infection: abscess; bronchiectasis, e. No history of rheumatic fever, nephritis or hypertension. Always evaluate what important information is needed: to obtain the diagnosis to give appropriate therapy to ensure continuity of care at home Many mistakes are made by being side-tracked by aspects that are not important.
Medicine is a practical subject and rst-hand experience is invaluable. Inability to look in particular direction, usually upwards intranuclear lesion: convergence normal but cannot adduct eyes on lateral gaze Cranial Nerves 125 Looking ahead Normal Looking up Supranuclear palsy if patient sees double in all directions may be third-nerve palsy thyroid muscle diseaseworse in morning myasthenia gravis worse in evening manifest strabismus Ptosis Drooping of upper eyelid can be: completethird-nerve palsy incomplete partial third-nerve palsy muscular weakness, e. There is tem- porarily more blood in the right ventricle than the left ventricle, and the right ventricle takes fractionally longer to empty. Understand the scientic background of disease, including the ad- vances that are being made and how these could be applied to improve care. Obtain a wide experience of clinical diseases, how they affect patients and how they are managed.
If vocal resonance is gross, whispering pectoriloquy can be elicited by asking the patient to whisper:1, 2, 3, 4. If only all books were as easy to learn from. What do you do then? The main focus of the book is careful history taking and clinical examination. Has anything happened in your life to make you depressed? Approach on the same horizontal plane as patients equator of their eye. It is helpful to have the back- ground knowledge to allow evaluation of new information, clinical trials and techniques. Clear sputum daily during winter months suggests chronic bronchitis.
The date and source of such information should be written in the notes. Palpate all over the precordium with the at of hand for thrills palpable murmurs. Abdominal pain: Where is the pain? Let the patient tell his story in his own words as much as possible. HolmesAdie pupil: large, slowly reacting to light. Author s : National Open University of Nigeria Community health Nursing is the synthesis of nursing and public health practice applied to promote and protect the health of population. You may choose a different order from those suggested if it helps you. Reasoning abstract thought What would you do if you found a stamped addressed envelope on the ground? Frothy sputum suggests left heart failure.
Palsy of the nerve causes deviation of the jaw to the side of the lesion. These markings are at full inspiration. Inspection Inspect the joints before you touch them. How many cigarettes do you smoke? Check characteristics of the spleen: site shape? Common in congestive cardiac failure right heart failure. Red, scaly plaques with vesicles in acute stages. More reviews Description Lecture Notes on Clinical Medicine has a long-standing reputation for excellence and is a must-have in the run-up to final examinations and throughout the clinical years.