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MEDICAL SEMIOLOGY

BIBLIOGRAPHY
● MEDICAL SEMIOTICS by MirelaTomescu-
Bordejevic
● Bate's guide to physical examination
● http://meded.ucsd.edu/clinicalmed/introduction.htm
● The Merck manual
http://www.merckmanuals.com/home/index.html
● Harrison's Priciples of Internal Medicine
● Cecil Textbook of Medicine
● http://www.learnerstv.com/medical.php (video
courses)
DEFINITION
= The science of the symptoms and signs of
diseases
SYMPTOM
● any sensation that is experienced by a patient
and is associated with a particular disease
● it is subjective
SIGN
● any abnormality, such as a change in
appearance, observed by the physician when
evaluating a patient, which indicates a
disease process
● It is objective
-SYMPTOMS: headache, nausea,
itching

- SIGNS: pallor, oedema (edema),


coma
SYNDROME
= Combination of symptoms and signs which
together represent a disease process
● One syndrome can be found in several
diseases

Icteric syndrome (fatigue, jaundice, ↑ bilirubin):


hepatitis, cirrhosis, hemolytic anemia
DIAGNOSIS = 1+2+3

1. THE HEALTH HISTORY = ANAMNESIS


(symptoms)
● good interview = 50% diagnosis !!!
● ''Listen to your patient they are telling you the
diagnosis“ is a much quoted aphorism

2. THE PHYSICAL EXAMINATION (signs)

3. INVESTIGATIONS: blood tests, radiographies,


ECG, CT, MRI, etc
THE COURSE STRUCTURE
● INTERVIEWING AND THE HEALTH HISTORY

● DETAILED TECHNIQUES FOR EXAMINING


THE DIFFERENT BODY SYSTEMS
(PHYSICAL EXAMINATION): general
appearance, the respiratory, cardio-vascular,
gastrointestinal, renal, hematologic systems
ANAMNESIS (TAKING HISTORY,
HEALTH HISTORY)

● IDENTIFYING DATA
● CHIEF COMPLAINT(S)
● PAST PERSONAL HISTORY
● FAMILY HISTORY
● LIVING AND WORKING (SOCIAL HISTORY)
● HISTORY OF THE PRESENT ILLNESS
IDENTIFYING DATA
● Age, gender, occupation, marital status

● Source of history: patient, family members,


friends, past medical record, etc

● Reliability (varies according to the patient's


memory, trust, and mood)
CHIEF COMPLAINT(S)

● SYMPTOMS OR CONCERNS CAUSING THE


PATIENT TO SEEK CARE
● EXAMPLE: fever, headache, pressure over left
chest, cough, etc
PAST HISTORY
● 1. PSYSIOLOGICAL : obstetric history
(gestations, parturitions), menstrual history
(menarche, periodicity, blood loss)

● 2. MEDICAL
- CHILDHOOD ILLNESSES: measles, rubella,
whooping cough, chicken pox, rheumatic fever,
polio, etc
- ADULT ILLNESSES (medical, surgical,
psychiatric)
FAMILY HISTORY
● SPECIFIC ILLNESSES IN FAMILY (siblings,
parents, grandparents, children, grandchildren)

● E.g.: hypertension, coronary artery disease,


elevated cholesterol level, diabetes, renal
disease, cancer, lung disease, etc
LIVING AND WORKING
● LIFESTYLE (diet, coffee, tea, tobacco use,
alcohol and drugs use, home conditions)

● OCCUPATION (working conditions)

● SOURCE OF STRESS
HISTORY OF THE PRESENT
ILLNESS
● AMPLIFIES THE CHIEF COMPLAINT
(describes each symptom in detail)

● MEDICATION (name, dose, route, frequency of


use)

● ALLERGIES
THE SEVEN ATTRIBUTES OF A
SYMPTOM
● LOCATION + RADIATION
● QUALITY
● SEVERITY
● TIMING (onset, duration, frequency)
● SITUATIONS IN WHICH SYMPTOM OCCURS
● REMITTING OR EXACERBATING FACTORS
● ASSOCIATED MANIFESTATIONS
PHYSICAL EXAMINATION
- THE COMPREHENSIVE EXAMINATION OF
THE BODY SYSTEMS
4 TOOLS:
● INSPECTION
● PALPATION (feeling with the hands)
● PERCUSSION
● AUSCULTATION (listening with a stethoscope)
!!! WASH YOUR HANDS !!!