principles of medicine

• COMPONENTS OF ADULT HEALTH HISTORY

  1. Identifying Data
  2. Reliability
  3. Chief Complaints
  4. History of Present Illness
  5. Past Medical History
  6. Family Medical History
  7. Personal & Social History
  8. Review of System
• IDENTIFYING DATA

  — OBTAINED BEFORE THE ACTUAL HISTORY TAKING
• WHO ESTABLISH THE SOURCE OF INFORMATION? (RELIABILITY)

  ○ Patient Itself

  ○ Family Member

  ○ Friend

  ○ Referral Letter/Record
• WHAT ARE SEVEN ATTRIBUTES OF EVERY SYMPTOM?

  1. Location
  2. Quality
  3. Quantity or severity
  4. Timing, including onset, duration, and frequency
  5. Setting in which it occurs
  6. Aggravating and relieving factors
  7. Associated manifestation
• List of adult illnesses in each of four areas:

  1. medical
  2. surgical
  3. ob/gyne
  4. pyschiatric
• Specific illnesses in family:

  hypertension, diabetes, heart attack, stroke, cancer, seizure disorder, allergies
• STEPS IN PREPARING FOR THE PHYSICAL EXAMINATION:

  I. Reflect on your approach to the patient

  II. Adjust the lighting and the environment

  III. Check your equipment.

  IV. Make the patient comfortable.

  V. Observe standard and universal precautions.

  VI. Choose the sequence, scope, and positioning of examination
• Important goal in examination:

  develop your own sequence
• THE COMPREHENSIVE PHYSICAL EXAMINATION

  General Survey

  Vital Signs

  Skin

  HEENT (head, ears, eyes, nose, throat)

  Neck

  Posterior Thorax and Lungs

  Anterior Chest

  Cardiovascular System

  Abdomen

  Lower Extremities
• Normal blood pressure - 12-18 cpm
• Normal blood pressure:

  90/60 mmHg or 120/80 mmHg
• Normal heart rate:

  60-100 bpm
• Normal oxygen levels:

  95%
• Normal body temperature:

  36-37 degrees
• Flat:

  Large pleural effusion
• Dull:

  Lobar pneumonia
• Resonant:

  Healthy lung, simple chronic bronchitis
• Hyperresonant:

  Emphysema, pneumothorax
• Tympanitic:

  large pneumothorax
• Normal breathing sound:

  Vesicular (soft/low)
• Jugular veins pressure or JVP:

  <3-4 cm
• Components of blood:

  ○ Plasma (fluid medium)

  ○ Red blood cells

  ○ White blood cells

  ○ Platelet
• Functions of blood:

  • Vehicle for transport of gases, nutrients, cells & hormones to tissues
  • Formation of clots to prevent excess blood loss
  • Carry cells and antibodies that fight infection
  • Bring waste products to kidneys and liver which filter and clean the blood
• HEMATOPOIESIS

  — Formation of blood cells
• Yolk sac – first 8 weeks of gestation
• Liver and spleen – between 2-7 months of gestation
• Bone marrow – from 7 months of gestation, it becomes the MAJOR SITE

  » Chief source of hematopoiesis throughout adulthood
• Three major functional classes/lineages:

  1. Red Blood Cells (Erythrocytes)
  2. White Blood Cell* (Leukocytes)
  3. Platelets (Thrombocytes)
• HEMATOLOGY

  — The branch of medicine concerned with the study of the cause, prognosis, treatment and prevention of diseases related to the blood
• BASIC LABORATORY EXAMINATIONS IN HEMATOLOGY

  1. Complete Blood Count (CBC)
  2. Peripheral Blood Smear (PBS)
  3. Iron Studies
  4. Bone marrow examination
• COMPLETE BLOOD COUNT (CBC)

  — Readily available blood test that focuses on Red Blood Cells (RBC), White Blood Cells (WBC) and Platelets, and their various parameters.
• Red Blood Cell Count

  • Hemoglobin

  • Hematocrit

  • Reticulocyte count


  Hemoglobin (Hb) — Contains two alpha chains and two beta chains

  Hematocrit (Hct) — Reflects red cell mass divided by the total blood volume — Expressed in percentage

  Reticulocyte Count — Measures erythropoietic activity and response of the bone marrow to anemia

  Reticulocyte production index* — Estimates of marrow production relative to normal
• Red Blood Cell Indices

  • Mean cell volume (MCV)

  • Mean cell hemoglobin (MCH)

  • Red cell distribution width (RDW)

  • Mean Cell Hemoglobin Concentration (MCHC)
• White Blood Cell Count

  – Cell Differential

  – Nuclear segmentation or Neutrophils

  – Lymphocytes

  – Monocytes

  – Eosinophils

  – Basophils
• Mean Corpuscular Volume (MCV)

  -Measures size/volume

  
  

  Microcytic = below normal value

  Macrocytic = above normal value
• Mean Corpuscular Hemoglobin (MCH)

  — Measures average amount of hemoglobin in each mature RBC
• Mean Corpuscular Hemoglobin Concentration (MCHC)

  — Measures the hemoglobin concentration in a given volume of packed RBC

  * Hypochromic = decreased MCHC

  * Normochromic = normal MCHC
• Red Cell Distribution Width (RDW)

  — Measures RBCs of unequal sizes (anisocytosis) 


  * Increased anisocytosis = increased RDW

  * Immature RBCs: larger in size compared to mature RBCs
• Increased RDW in the presence of decreased RBC = active bone marrow 


  Decreased RDW in the presence of decreased RBC = depressed bone marroW
• HYPOCHROMIC, MICROCYTIC:

  Iron deficiency

  Thalassaemia

  Lead poisoning

  Hereditary sideroblastic anemia

  Anemia of chronic disease