Clinical medicine

Knowledge Skills

Skills
History taking Examination Investigation Management Common procedures and other interventions communicaton

History
Name gender DOB Address Presenting complaint with duration Other complaints History of presenting complaint in chronological order Systemic inquiry

 Previously diagnosed illness(es) and surgeries Drug history Medications taken for current illness Regular medications Drug allergies Family history Social history Menstrual history Psychic assessment

Systemic InquiryImportant Symptoms

Cardiovascular System

Chest pain
Breathlessness Palpitation

Syncope
Ankle swelling

Respiratory System
Cough Sputum Haemoptysis Breathlessness Chest pain Wheeze

 Gastrointestinal Tract Symptoms

dysphagia nausea vomiting

epigastric pain
loss of Appetite

bowel habit change

colour of stools

 Central Nervous System

headache
fits

faintishness
weakness

numbness
tinkling sensation

hearing problem
visual problems

 Locomotor System
pain in joints and muscle swelling of joints

Endocrine System
heat/ cold intolerance
weakness/tiredness increased thirst

 Genitourinary Tract Symptoms

dysuria

oliguria/polyuria
colour of Urine urinary Stream vaginal discharge

 General inquiry
appetite

weight change
malaise sleep

mood

Examination
General examination. Relevant system examination
Cardio vascular system. Respiratory system. Abdomen. Central nervous system. Locomotor system. Psychiatric assessment.

1. 2. 3. 4. 5.

60 y, female with uncontrolled BP for several years, WHICH WOULD SUGGEST END ORGAN DAMAGE Displaced heaving apex Exudate and hemorrhage in fundi LDL C-180mg/dl (130-160) Radio-femoral delay K+ 3mmol/l(3.6-5.1)

Patient management
history taking. clinical examination bed side investigations- Urine dip stick, Hb,CBS,O2 satn.Wt

differential diagnosis Communication Patient &Relatives further investigations Plan of management

Investigations
E.C.G Chest X ray Exercise E.C.G Electrophysiological investigations. Echo : Trans Thorasic Trans esophageal Nuclear imaging Cardiac CT Cardiac MRI Cardiac catheterization

Procedures for junior medical staff

ECG Stress ECG Central venous access

Temporary cardiac pace making

Pericardiocentesis

THERAPEUTICS Heart diseases

Heart diseases
Can affect
Myocardium. Heart valves. Pericardium.

Causes of heart diseases

Congenital heart disease Rheumatic valvular heart disease Ischaemic heart disease Hypertensive heart disease Cardiomyopathy Thyroid disease(Hyperthroidism) Take Age in to consideration

Cardiovascular System

important Symptoms Chest pain Breathlessness Palpitation

Syncope
Ankle swelling

10 Point analysis of pain

Site Character Severity Duration Radiation Frequency & Periodicity Special times of occurrence Aggravating & relieving factors. Associated factors

Pain in Myocardial Infarction

Retrosternal Constricting/ Tightening/ Burning/ Heavy sensation. Severe pain. Lasts more than 15 minutes. Radiates to left upper arm / Back of chest between shoulder blades/ up in the neck

The new York heart association grading of cardiac status (NYHA classifications)
Grade1- No breathlessness Grade 2- Breathlessness on severe exertion Grade 3- Breathlessness on mild exertion Grade 4 Breathlessness at rest