Ch. 5

• What are the 3 questions patient's ask that physicians should respond to?

  -What's happening to me and why?

  -What does this mean for my future?

  -What can be done about it, how will that change my future?
• What are 2 effective strategies of saving lives form cancer?

  prevention & early detection

  (early detection and effective screening = increased survival)
• sign vs symptom

  sign is objective; symptom is subjective
• syndrome


  set of signs and symptoms that arise from a common cause
• diagnosis can be subjective (complaints and medical history)or objective (preliminary diagnosis with no hard evidence i.e. tissue biopsy)
• diagnosis definition


  identification of a disease or condition
• differential diagnosis


  wide range of possible diagnoses
• initial interview 


  chronological report event and symptoms of the patient's illness

  physician asks questions, patient answers

  physician obtains current status and medical and psychosocial history
• What are some responses that hinder the interview?

  social cliches: "You'll feel better soon" "Don't worry, everything will be alright"

  imposing values: "You should not be having sex outside of marriage"

  devaluing feelings or responses: "I wish I had a nickel for every time I heard this."
• How do physicians provide an adequate environment for the interview?


  ?
• Medical Records and History contains

  medical history, results of lab tests and procedures, progress notes, copies of consent forms, correspondence, and images
• Define medical records and history


  legal public document available to medical staff
• demographic data


  age, race, gender, martial status, and current occupation

  important because certain diseases may be more prevalent for groups according to these demographics
• chief complaints


  symptoms, current illness, current condition
• medical history


  childhood illnesses, allergies, immunizations, injuries, prior hospitalizations, psychological problems, and medications
• family history 


  illnesses, causes of death, genetic disorders, and mental disorders
• personal history


  occupation, lifestyle, and sexual activity and preferences
• premalignant


  physiological characteristics or predisposing factors that may lead to malignancy
• paraneoplastic syndrome


  collections of symptoms that result from substances or hormones produced by the tumor, and they occur remotely from the tumor

  Very rare, and usually results in diagnosis of lung cancer
• inspection 


  =use of sight to observe

  -Color of skin: dark, pale, gray, flushed, jaundice, or cyanotic

  -Scarring or lesions: warts, moles, ulcerations, tumors, and asymmetry (asymmetry could indicate edema, thrombosis, hematoma, injury, or underlying tumor)

  -Olfactory: breath, sputum, vomitus, feces, urine, and pus
• edema


  swelling of the tissue caused by accumulation of excessive amounts of fluid
• palpation


  =use of touch to acquire information

  physician tries to differentiate between hard and soft, rough and smooth, and warm and dry

  if palpation causes pain
• lymphadenopathy


  swelling of lymph nodes

  assessed by palpating lymph node areas such as neck, axilla, or groin
• examples of palpation


  pelvic exams

  rectal exams
• percussion


  act of striking or tapping patient gently

  purpose: determine pain or cause vibrations

  example: kidney infection
• auscultation 


  act of listening to sounds within the body

  example: stethoscope to hear bowels, breathing, etc
• baseline (vital signs)


  initial values at various times to establish the patient's norm
• oral temperature 


  96.8F-98.6F (36C-37C)
• rectal temperature 


  99.6F
• axillary temperature 


  97.6F
• Pulse

  60-100 beats per minute
• respirations

  12-18 breaths per minute
• blood pressure 


  90-140/ 60-80mmHg
• temperature can be measured in what 5 ways?

  1.oral

  2. rectal

  3. in ear

  4. on the skin

  5. axilla
• pulse measures what?

  rate, rhythm(pattern of beats), size (of pulse waves and volume of blood during heart contraction), tension (compressibility of artery)
• respiration evaluates what?

  rate, depth (how shallow), rhythm (tempo fast or slow), character (labored or normal)
• blood pressure measures what?

  systolic (contraction of heart), diastolic (relaxation of heart)
• Where is the most common spot to measure blood pressure?

  the brachial artery
• 20% of cancers are caused by a combination of excess body weight, physical inactivity, excess alcohol consumption, and poor nutrition
• What is screening?

  testing asymptomatic individuals for a particular disease