5.pro presentation (1)

8/2/2019 5.PRO Presentation (1)

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Pasthistory

Familyhistory

HISTORY TAKING:


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PAST HISTORY...

Information about previous

childhood illnesses

chronic childhood illnesses

adult illnesses

which can help with the diagnosisand management of currentconditions.


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ADULT ILLNESSES...

-Medical illnesses

-Surgical

-Obstetric/gynecologic

-Psychiatric


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Pasthistory

Familyhistory

HISTORY TAKING:


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Family History

Is One of the 9 Items of historytaking.


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It consists of informationabout:

the biological relationships betweenfamily members and the patient .

any medical conditions they mayhave.

Family History


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Why taking family history isimportant?

The strength of the genetic component

in a family may be apparent by thenumber of people affected by aparticular condition

can reveal patterns of inheritance.

may help make or refine a diagnosis

helps assess the likelihood of geneticdisease in relative

Family History


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Key points for taking a familyhistory:The health of parents, brothers andsisters should be asked for. If they arenot living, the cause of death should berecorded.

Similar diseases in the family should beenquired about.

Family History


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Examples of Common diseases withhereditary tendency:

diabetes.

Hypertension.

allergy.

mental diseases. nephritis.

migraine.

degenerative neurological disorders

Family History


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Summary

Family history should Present:the health of the parents, brothersand sisters.

Similar illness or symptoms in family

Family History


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ROLE-PLAY

Doctor: Fatimah Al-

Ghamdi Patient1: Nouf Al-Subaie


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Cough

SYMPTOMS:


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COUG

H

A cough is an action your body takes toget rid of substances that are irritatingto your air passages, which carry the airyou breath in from the nose and mouthto the lungs.

Wha

t?


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COUG

H

A cough occurs when special cellsalong the air passages get irritated andtrigger a chain of events. So, air in your

lungs is forced out under high pressure.You can choose to cough (a voluntaryprocess), or your body may cough on itsown (an involuntary process).

How

?


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Caus

esAcute coughone that beenpresent for less

than 3 weeks

Chronic coughsthose present formore than 3

weeks.

infectio

us

noninfecti

ous

environmental irritants. conditions within thelungs. conditions along the

passages that transmit airfrom the lungs to theenvironment conditions within the

chest cavity but outsideof the lun s


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Sinus

infections

Larynx,trachea,

large airways

InfectionTumors:benign malignant,primary, secondaryAspirationGastro-esophagealrefluxForeign bodyIrritant dusts


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Sinus

infections

Smallairways

AsthmaPost-viral airway reactivityChronic bronchitisBronchiectasisBronchiolitsIrritant dusts

Alveoli

Drugs ( angiotensin-

converting enzymeinhibitors)Infection ( pneumonia,tuberculosis)

AlveolitisLeft ventricular failure


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Indications related to

coughSmokerCough

Dry, painfuland non-productivecough

Paroxysmaldry cough

Chronic dry

cough

Chronic bronchitis

Tracheitis,pneumonia

Asthma associatedwith lung injuries and

bronchitis

Interstitial disease:

cryptogenic fibrosing


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Circumstances of the

coughq Nocturnal cough: common symptom ofasthmaq

Occult gastro-oesophageal reflux :common cause of daytime coughq Angiotensin-converting enzymeinhibitors: cause dry coughq Coughing during or after swallowingliquids: suggests neuromuscular diseaseof the oropharynxq Occupational asthma and exposure to

WHAT DO I ASK THE


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WHAT DO I ASK THEPATIENT ABOUT?

1.What is the frequency of cough?

2.What is the severity of cough?

3.Does it occur on some special time of day or

night?

4.Is the cough precipitated under some special

circumstances?

5.Is cough accompanied with wheeze?

6.Is cough accompanied with hoarseness?

COUGH WITH


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COUGH WITHSPUTUM

What is SPUTUM? Expectorated respiratorysecretions.

Four main types Serous Mucoid Purulent Rusty

HAEMOPTYSIS: the Presence

of blood in sputum


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TASTE/SMELLCOLOUR

AMOUNT SOLIDMATERIAL


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How much phlegm do you cough out each day?

- Small (Teaspoon)

- Large (Tablespoon)

What does it tell you?

Regular coughing of large volumes Bronchiectasis

Sudden production of large amounts on a

single ocassion - Rupture of a lung abcessor em ema into the bronchial tree

1- AMOUNT


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What is the colour of the phlegm?


Clear, watery, pink, frothy (Serous)Pulmonary oedema, Alveolar cell cancer

Clear, grey, white, viscid (Mucoid) Chronicbronchitis/COPD, Asthma

Yellow, reen Purulent Broncho ulmonar

2- COLOUR


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How does it taste?


Foul/ Smelling Anaerobic bacterial

infection : Bronchiectasis, Lung abscess,empyema

Change in sputum taste Infective

3- TASTE/ SMELL


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Is there any solid material in thephlegm?


Asthma Bronchopulmonary aspergillosis

Necrotic tumour

Food, teeth, tablets

4- SOLID

MATERIAL


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ROLE-PLAY

Doctor: Fatimah Al-Ghamdi Patient2: Razan Al-Hadlaq
http://var/www/apps/conversion/current/tmp/scratch767/Primary%20vs.%20Secondary%20Headaches%20?%20-%20YouTube.mp4


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Breathlessnes

s

SYMPTOMS:
http://var/www/apps/conversion/current/tmp/scratch767/Primary%20vs.%20Secondary%20Headaches%20?%20-%20YouTube.mp4http://var/www/apps/conversion/current/tmp/scratch767/Primary%20vs.%20Secondary%20Headaches%20?%20-%20YouTube.mp4http://var/www/apps/conversion/current/tmp/scratch767/Primary%20vs.%20Secondary%20Headaches%20?%20-%20YouTube.mp4http://var/www/apps/conversion/current/tmp/scratch767/Primary%20vs.%20Secondary%20Headaches%20?%20-%20YouTube.mp4http://var/www/apps/conversion/current/tmp/scratch767/Primary%20vs.%20Secondary%20Headaches%20?%20-%20YouTube.mp4http://var/www/apps/conversion/current/tmp/scratch767/Primary%20vs.%20Secondary%20Headaches%20?%20-%20YouTube.mp4


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BREATHLESS

NESS


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Breathlessness (dyspnoea) is an undueawareness of breathing. It is a naturalconsequence of strenuous physicalexercise. Patients may refer to it asshortness of breath or difficulty ingetting enough air.

Wha

t?

BREATHLESS

NESS


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Breathlessness may be associated witha feeling of light-headache, dizziness,tingling in the fingers and around the

mouth, chest tightness and rarelysyncope.

Sign

s:

BREATHLESS

NESS


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q How are the causes ofbreathlessness presented??

BREATHLESS

NESS


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- Lying flat (orthopnoea): presentwith left ventricular failure andrespiratory muscle weakness.

However, this can be a feature ofsever lung disease

Cause # 1


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Cause # 2

- Paroxysmal nocturnal dyspnoea:due asthma and left ventricularfailure, that wakes patient fromsleep.

Waked from 3-5a.m.with wheezing


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Cause # 3

- (COPD) Chronic obstructive

pulmonary disease. If its worsefirst thing in the morning, and feelsbetter with coughing up sputum.


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Cause # 4

Exercise induced asthma:breathlessness continue to worsenfor 5-10 min after stopping activity.

If suspected (asthma) ask directlyabout:

exposure to any allergens (animals,hoovering, mowing the lawn )

Irritant with smoke , perfumes,

fumes, cold air or drugs(e.g. Aspirin)


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Cause # 5

Occasional asthma:

breathlessness that improve atweekend or holidays/extrinsicallergic alveolitis.

SEVERITY OF


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SEVERITY OFBREATHLESSNESS

WHAT DO I ASK THE


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1. Mode on onsets, duration, progression,variation, aggravating, relieving factors,

severity and associated symptoms.

2. When does it occur? At exercising ? at

sleep ? or at rest?

3. How long does it remain? Is it episodic or

not?

4. Let the patient describe the pain.


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ASSOCIATED SYMPTOMS

Cough

SputumHaemoptysis

Chest pain

And wheeze


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THANK

YOU

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