CLINICAL APPROACH CLINICAL THERAPEUTICS | PRELIMS (1st Sem)
Dr. Magnolia Reyes
OUTLINE
I. APPROACH TO CLINICAL PROBLEM
II. HISTORY TAKING
III. REVIEW OF SYSTEMS
IV. COMPREHENSIVE PHYSICAL EXAMINATION
V. DIAGNOSTICS
VI. CLINICAL APPROACH TO PROBLEM SOLVING
I. APPROACH TO CLINICAL PROBLEM
A. APPROACH TO THE PATIENTS
 The first step is gathering information, also known as
establishing the database. This includes taking the history,
performing the physical examination, and obtaining
selective laboratory and/ or imaging tests. Of these, the
historical examination is the most important and useful.
Sensitivity and respect should always be exercised during
the interview of patients.
 The history is the single most important tool in obtaining a
diagnosis. All physical findings and laboratory and imaging
studies are first obtained and then interpreted in the light
of the pertinent history.
II. HISTORY TAKING
1. Basic information
 Age – some conditions are more common at
certain ages; for instance, chest pain on an elderly
patient is more worrisome for CAD than the same
complaint in a teenager.
 Gender – some disorder are more common in men
such as abdominal aortic aneurisms. In contrast,
women more commonly have autoimmune
problem such as chronic idiopathic
thrombocytopenic or SLE. Also, the possibility of
pregnancy must be considered in any woman of
childbearing age.
 Ethnicity - some disease are more common in
certain ethnic groups, such as Type 2 DM in the
Hispanic population
*Family medicine illustrates the importance of
longitudinal care that is, seeing the patient in
various phases and stages of life.
2. Chief Complaint
 What is it that brought the patient into the
hospital or clinic?
 Has there been a change in a chronic or
recurring condition or is this a completely new
problem?
 The duration and character of the complaint,
associated symptom, and exacerbating /relieving
factors should be recorded.
 The CC engenders a DDX and the possible
etiologies should be explored by further inquiry.
The patient’s own words should be used if
possible.
 The chief complaint, or real reason for seeking
medical attention, may not be the first subject
the patient talks about (in fact, it may be the last
thing), particularly if the subject is embarrassing,
such as a sexually transmitted disease, or highly
emotional, such as depression. It is often useful
to clarify exactly what the patient’s concern is,
DURAN | GAVINO, J. | OCAMPO | PAGDILAO
for example, they may fear their headaches
represent an underlying brain tumor.
*The first line of any presentation should include age,
ethnicity, gender, marital status, and CC. Example: A
32yo married white man complains of lower
abdominal pain in 8hr duration.
3. History of Present Illness
 This is the most crucial part of the entire database.
 The duration and character of the primary complaint,
associated symptoms, and exacerbating/ relieving
factors should be recorded.
 This section is a complete, clear, and chronologic
account of the problems prompting the patient to seek
care. It should include the problem’s onset, the setting
in which it has developed, its manifestations, and any
treatments.
 Every principal symptom should be well characterized,
with descriptions of the seven features listed below
and pertinent positives and negatives from relevant
areas of the Review of Systems that help clarify the
differential diagnosis. List medications, including
name, dose, route, and frequency of use.
The Seven Attributes of Every Symptom
Location
Quality
Quantity or severity
Timing, including onset, duration, and frequency
Setting in which it occurs
Aggravating and relieving factors
Associated manifestations
 Some patients will be poor historians because of
dementia, confusion, or language barriers; recognition
of these situations and querying of family members is
useful. When little or no history is available to guide a
focused investigation, more extensive objective
studies are often necessary to exclude potentially
serious diagnoses.
4. Past Medical History
 Major illnesses such as hypertension, diabetes,
reactive airway disease, CHF, angina or stroke should
be detailed:
- Age of onset, severity end-organ involvement
- Medications taken for the particular illness,
including any recent changes to medications and
reason for the changes.
- Last evaluation of the condition (e.g. when was
the last stress test or cardiac catheterization
performed in the patient with angina).
 Which physician or clinic is following the patient for
the disorder?
o Minor illnesses such as recent upper
respiratory infections.
o Hospitalizations, no matter how trivial, should
be queried.
o Blood transfusion. Transfusions with any
blood products should be listed, including
any adverse reactions.
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5. Past Surgical History
 The year and type of surgery performed and its
indication should be elucidated and any complications
documented.
 The type of incision and any untoward effects of the
anesthesia or the surgery should be noted.
 Laparoscopy vs. laparotomy should be distinguished.
 Surgeon and hospital name/location should be listed.
This information should be correlated with the surgical
scars on the patient/’s body, any complications should
be delineated including anesthetic complications,
difficult intubations, and so on.
6. Allergies
 Reactions to medications should be recorded,
including severity and temporal relationship to
medication. Immediate hypersensitivity should be
distinguished from an adverse reaction.
7. Medications
 Current and previous medications should be listed,
including dosage, route, frequency, and duration of
use.
 Prescription, OTC, supplements, and herbal
medicines are all relevant.
 If the patient is currently taking antibiotics, it is
important to note what type of infection is being
treated.
 Patients often forget their complete medication list;
thus, asking each patient to bring in all their
medications— both prescribed and non-prescribed—
allows for a complete inventory.
8. Immunization History
 Vaccination and prevention of disease is a principal
goal of the family physician; hence, recording the
immunizations received including dates, age, route,
and adverse reactions, if any, is critical.
9. Screening History
 Cost effective surveillance for common diseases or
malignancy is another cornerstone responsibility of
the family physician.
 An organized record keeping is important to a time
efficient approach to this area.
10. Family history
 Many major medical problems are genetically
transmitted, inherited or are predisposed in family
members (e.g hemophilia, sickle cell disease. The
age and health of siblings, parents, grandparents, and
others can provide diagnostic clues.
 For instance, an individual with first-degree family
members with early onset coronary heart disease is at
risk for cardiovascular disease and a family history of
breast cancer can be a risk factor for the development
of disease.
11. Social History
 This is one of the most important parts of the history
in that the patient’s functional status at home, social
and economic circumstances, and goals and
aspirations for the future are often the critical
determinant in what the best way to manage a
patient’s medical problem is.
DURAN | GAVINO, J. | OCAMPO | PAGDILAO
Prelims (1st Sem) Clinical Approach
Dr. Magnolia Reyes
CLINICAL THERAPEUTICS· September 4, 2020
 Occupation, marital status, family support and tendencies
toward depression or anxiety are important.
 Use of abuse of illicit drugs, tobacco, or alcohol should
also be recorded.
 Marital stressors, sexual dysfunction and sexual
preference is also important.
 Living arrangements, economic situations, and religious
affiliations may provide important clues for puzzling
diagnostic cases, or suggest the acceptability of various
diagnostic.
 Patients, especially older patients or those with chronic
illnesses should be asked about medical power of
attorney and advanced directives.
III. REVIEW OF SYSTEMS
 A few questions about each major body system ensure
that problems will not be overlooked. The clinician should
avoid the mechanical ―rapid-fire‖ questioning technique
that discourages patients from answering truthfully
because of fear of ―annoying the doctor.‖
 A systemic review should be performed but focused on
life-threatening and the more common diseases. For
example: A young man with the testicular mass, trauma
to the area, weight loss and infectious symptoms are
important to note. In an elderly woman with generalized
weakness, symptoms suggestive of cardiac disease
should be elicited, such as chest pain, shortness of
breath, fatigue or palpitations.
 Ask questions which are relevant to chief complaint that
will help you in your differential diagnosis.
General: Usual weight, recent weight change, clothing
that it’s more tightly or loosely than before; weakness,
fatigue, fever.
Skin: Rashes, lumps, sores, itching, dryness, color
change; changes in hair or nails; changes in size or
color of moles.
Head, Eyes, Ears, Nose, Throat (HEENT).
Head: Headache, head injury, dizziness,
lightheadedness.
Eyes: Vision, glasses or contact lenses, last
examination, pain, redness, excessive tearing, double
or blurred vision, spots, specks, glaucoma, and
cataracts.
Ears: Hearing, tinnitus, vertigo, earache, infection,
discharge. If hearing is decreased, use or nonuse of
hearing aid.
Nose and sinuses: Frequent colds, nasal stuffiness,
discharge or itching, hay fever, nosebleeds, sinus
trouble.
Throat (or mouth and pharynx): Condition of teeth and
gums; bleeding gums; dentures, if any, and how they
eat; last dental examination; sore tongue; dry mouth;
frequent sore throats; hoarseness
Neck: Lumps, ―swollen glands,‖ goiter, pain, stiffness.
Breasts: Lumps, pain or discomfort, nipple discharge,
self-examination practices.
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Respiratory: Cough, sputum (color, quantity),
hemoptysis, dyspnea, wheezing, pleurisy, last chest x-
ray. You may wish to include asthma, bronchitis,
emphysema, pneumonia, and tuberculosis.
Cardiovascular: ―Heart trouble,‖ hypertension,
rheumatic fever, heart murmurs, chest pain or
discomfort, palpitations, dyspnea, orthopnea,
paroxysmal nocturnal dyspnea, edema, past
electrocardiographic or other cardiovascular tests.
Gastrointestinal: Trouble swallowing, heartburn,
appetite, nausea. Bowel movements, color and size of
stools, change in bowel habits, rectal bleeding or
black or tarry stools, hemorrhoids, constipation,
diarrhea. Abdominal pain, food intolerance, excessive
belching or passing of gas. Jaundice, liver or
gallbladder trouble, hepatitis.
Peripheral Vascular: Intermittent claudication; leg
cramps; varicose veins; past clots in veins; swelling in
calves, legs, or feet; color change in fingertips or toes
during cold weather; swelling with redness or
tenderness.
Urinary: Frequency of urination, polyuria, nocturia,
urgency, burning or pain on urination, hematuria,
urinary infections, kidney stones, incontinence; in
males, reduced caliber or force of urinary stream,
hesitancy, dribbling.
Genital Male: Hernias, discharge from or sores on
penis, testicular pain or masses, history of sexually
transmitted infections (STIs) and treatments, testicular
self-examination practices. Sexual habits, interest,
function, satisfaction, birth control methods, condom
use, problems. Concerns about HIV infection.
Female: Age at menarche; regularity, frequency, and
duration of periods; amount of bleeding, bleeding
between periods or after intercourse, last menstrual
period; dysmenorrhea, premenstrual tension. Age at
menopause, menopausal symptoms, postmenopausal
bleeding.
Musculoskeletal: Muscle or joint pain, stiffness,
arthritis, gout, backache. If present, describe location
of affected joints or muscles, any swelling, redness,
pain, tenderness, stiffness, weakness, or limitation of
motion or activity; include timing of symptoms (e.g.,
morning or evening), duration, and any history of
trauma. Neck or low back pain. Joint pain with
systemic features such as fever, chills, rash, anorexia,
weight loss, or weakness.
Psychiatric: Nervousness; tension; mood, including
depression, memory change, suicide attempts, if
relevant.
Neurologic: Changes in mood, attention, or speech;
changes in orientation, memory, insight, or judgment;
headache, dizziness, vertigo; fainting, blackouts,
seizures, weakness, paralysis, numbness or loss of
sensation, tingling or ―pins and needles,‖ tremors or
other involuntary movements, seizures.
DURAN | GAVINO, J. | OCAMPO | PAGDILAO
Prelims (1st Sem) Clinical Approach
Dr. Magnolia Reyes
CLINICAL THERAPEUTICS· September 4, 2020
Hematologic: Anemia, easy bruising or bleeding, past
transfusions, transfusion reactions.
Endocrine: ―Thyroid trouble,‖ heat or cold intolerance,
excessive sweating, excessive thirst or hunger,
polyuria, change in glove or shoe size.
IV. COMPREHENSIVE PHYSICAL EXAMINATION
General Survey: Observe the patient’s general state
of health, height, build, and sexual development.
Obtain the patient’s height and weight. Note posture,
motor activity, and gait; dress, grooming, and personal
hygiene; and any odors of the body or breath. Watch
the patient’s facial expressions and note manner,
affect, and reactions to people and the environment.
Listen to the patient’s speech, and note the state of
awareness or level of consciousness.
Vital Signs: Measure the blood pressure. Count the
pulse and respiratory rate. If indicated, measure the
body temperature.
Skin: Observe the skin of the face and its
characteristics. Assess skin moisture or dryness and
temperature. Identify any lesions, noting their location,
distribution, arrangement, type, and color. Inspect and
palpate the hair and nails. Study both surfaces of the
patient’s hands. Continue your assessment of the skin
as you examine the other body regions.
Head, Eyes, Ears, Nose, Throat (HEENT):
Head: Examine the hair, scalp, skull, and face. Eyes:
Check visual acuity and screen the visual fields. Note
the position and alignment of the eyes. Observe the
eyelids and inspect the sclera and conjunctiva of each
eye. With oblique lighting, inspect each cornea, iris,
and lens. Compare the pupils, and test their reactions
to light. Assess the extraocular movements. With an
ophthalmoscope, inspect the ocular fundi.
Ears: Inspect the auricles, canals, and drums. Check
auditory acuity. If acuity is diminished, check
lateralization (Weber test) and compare air and bone
conduction (Rinne test).
Nose and sinuses: Examine the external nose; using
a light and a nasal speculum, inspect the nasal
mucosa, septum, and turbinates. Palpate for
tenderness of the frontal and maxillary sinuses.
Throat (or mouth and pharynx): Inspect the lips, oral
mucosa, gums, teeth, tongue, palate, tonsils, and
pharynx. *You may wish to assess the cranial nerves
during this portion of the examination.
Neck: Inspect and palpate the cervical lymph nodes.
Note any masses or unusual pulsations in the neck.
Feel for any deviation of the trachea. Observe the
sound and effort of the patient’s breathing. Inspect
and palpate the thyroid gland.
Back: Inspect and palpate the spine and muscles of
the back. Observe shoulder height for symmetry.
Posterior Thorax and Lungs: Inspect and palpate the
spine and muscles of the upper back. Inspect,
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palpate, and percuss the chest. Identify the level of
diaphragmatic dullness on each side. Listen to the
breath sounds; identify any adventitious (or added)
sounds, and, if indicated, listen to the transmitted
voice sounds.
Breasts, Axillae, and Epitrochlear Nodes: In a woman,
inspect the breasts with her arms relaxed, then
elevated, and then with her hands pressed on her
hips. In either sex, inspect the axillae and feel for the
axillary nodes. Feel for the epitrochlear nodes.
Palpate the breasts, while at the same time continuing
your inspection.
Anterior Thorax and Lungs: Inspect, palpate, and
percuss the chest. Listen to the breath sounds, any
adventitious sounds, and, if indicated, transmitted
voice sounds.
Cardiovascular System: Observe the jugular venous
pulsations and measure the jugular venous pressure
in relation to the sternal angle. Inspect and palpate the
carotid pulsations. Listen for carotid bruits. Elevate the
head of the bed to ∼30º for the cardiovascular
examination, adjusting as necessary to see the jugular
venous pulsations. Inspect and palpate the
precordium. Note the location, diameter, amplitude,
and duration of the apical impulse. Listen at each
auscultatory area with the diaphragm of the
stethoscope. Listen at the apex and the lower sternal
border with the bell. Listen for the first and second
heart sounds and for physiologic splitting of the
second heart sound. Listen for any abnormal heart
sounds or murmurs.
Abdomen: Inspect, auscultate, and percuss the
abdomen. Palpate lightly, then deeply. Assess the
liver and spleen by percussion and then palpation. Try
to palpate the kidneys. Palpate the aorta and its
pulsations. If you suspect kidney infection, percuss
posteriorly over the costovertebral angles.
Lower Extremities: Examine the legs, assessing three
systems while the patient is still supine. Each of these
three systems can be further assessed when the
patient stands.
With the patient supine:
Peripheral vascular system. Palpate the femoral pulses and,
if indicated, the popliteal pulses. Palpate the inguinal lymph
nodes. Inspect for lower extremity edema, discoloration, or
ulcers. Palpate for pitting edema.
Musculoskeletal system: Note any deformities or enlarged
joints. If indicated, palpate the joints, check their range of
motion, and perform any necessary maneuvers.
Nervous system: Assess lower extremity muscle bulk, tone,
and strength; also assess sensation and reflexes. Observe
any abnormal movements.
With the patient standing:
Peripheral vascular system: Inspect for varicose veins.
Musculoskeletal system: Examine the alignment of the spine
and its range of motion, the alignment of the legs, and the
feet.
Genitalia and hernias in men: Examine the penis and scrotal
contents and check for hernias.
DURAN | GAVINO, J. | OCAMPO | PAGDILAO
Prelims (1st Sem) Clinical Approach
Dr. Magnolia Reyes
CLINICAL THERAPEUTICS· September 4, 2020
Nervous system: Observe the patient’s gait and ability to
walk heel-to-toe, walk on the toes, walk on the heels, hop in
place, and do shallow knee bends. Do a Romberg test and
check for pronator drift.
Nervous System: The complete examination of the
nervous system can also be done at the end of the
examination. It consists of the five segments: mental
status, cranial nerves (including funduscopic
examination), motor system, sensory system, and
reflexes.
Mental Status: If indicated and not done during the
interview, assess the patient’s orientation, mood,
thought process, thought content, abnormal
perceptions, insight and judgment, memory and
attention, information and vocabulary, calculating
abilities, abstract thinking, and constructional ability.
Cranial Nerves: If not already examined, check sense
of smell, strength of the temporal and masseter
muscles, corneal reflexes, facial movements, gag
reflex, and strength of the trapezia and
sternocleidomastoid muscles.
Motor System: Assess muscle bulk, tone, and
strength of major muscle groups. Cerebellar function:
rapid alternating movements (RAMs), point-to-point
movements, such as finger-to-nose (F → N) and heel-
to-shin (H → S), gait.
Sensory System: Assess pain, temperature, light
touch, vibration, and discrimination. Compare right
with left sides and distal with proximal areas on the
limbs.
Reflexes: Including biceps, triceps, brachioradialis,
patellar, Achilles deep tendon reflexes; also plantar
reflexes or Babinski response.
Additional Examinations. The rectal and genital
examinations are often performed at the end of the
physical examination. Patient positioning is as
indicated.
Genital and Rectal Examination in Men: Inspect the
sacrococcygeal and perianal areas. Palpate the anal
canal, rectum, and prostate. If the patient stand,
examine the genitalia before doing the rectal
examination.
Genital and Rectal Examinations in Women: Examine
the external genitalia, vagina, and cervix, with a
chaperone when needed. Obtain a Pap smear.
Palpate the uterus and adnexa bimanually. Perform
the rectal examination if indicated.
V. DIAGNOSTICS
 Learn to apply the principles of reliability, validity,
sensitivity, specificity, and predictive value to your
clinical findings and the tests you order.
It depends upon what you think your patient has. You don’t ask
everything for Laboratory.
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A. LABORATORY ASSESSMENT DEPENDS ON THE
CIRCUMSTANCES
 Complete Blood count (CBC)
o Can assess for anemia, leukocytosis (infection)
and thrombocytopenia.
 Basic metabolic panel:
o Electrolytes, Glucose, Blood Urea Nitrogen
(BUN) and Creatinine (Renal Function).
 Urinalysis and/or Urine culture
o Assess for hematuria, pyuria or bacteriuria. A
pregnancy test is important as well in women of
childbearing age.
 Aspartate Aminotransferase (AST), Alanine
Aminotransferase (ALT), Bilirubin, Alkaline Phosphatase
(ALP)
o Assess Liver function.
 Cardiac markers:
o Creatine Kinase-myocardial band (CK-MB),
Troponin, Myoglobin to assess for coronary
artery disease or other cardiac dysfunction.
 Drug levels such as acetaminophen level in possible
overdose.
 Arterial blood gas measurements give info about
oxygenation, carbon dioxide and pH reading.
B. DIAGNOSTIC ADJUNCTS
 Electrocardiogram (ECG) if cardiac ischemia,
dysrhythmia or other cardiac dysfunction is suspected.
 Ultrasound examination is useful in evaluating:
o Pelvic processes in female patients such PID
and Tuboovarian abscess
o Diagnosing gallstones and other gallbladder
disease.
o The addition of color flow Doppler for the
evaluation of deep venous thrombosis and
ovarian/testicular torsion.
 Computed Tomography (CT) which is useful in
assessing:
o The Brain for masses, bleeding, stroke and skull
fractures
o The chest to evaluate for masses, fluid
collections, aortic dissections and pulmonary
emboli.
o Abdominal CT’s can detect infection such as
abscess, appendicitis and diverticulitis, masses,
aortic aneurysms and ureteral stones.
 Magnetic Resonance Imaging (MRI) helps to identify
soft tissue planes very well. This most commonly used to
rule out spinal cord compression, cauda equina syndrome
and epidural abscess or hematoma.
C. SCREENING TESTS
 Fasting lipid panel
o Demonstrate the cholesterol level including Low
density Lipoproteins (LDL) levels which have
prognostic significance in coronary heart disease
 Fasting glucose and thyroid tests
 Dual energy X-ray absorptiometry (DEXA)
o Test of choice to monitor Bone mineral density
 Mammogram
o Examination of choice to assess for subclinical
breast cancer
 Fecal Occult Blood Testing (FOBT), Double contrast
Barium enema, and Colonoscopy
o Screen for colon cancer.
DURAN | GAVINO, J. | OCAMPO | PAGDILAO
Prelims (1st Sem) Clinical Approach
Dr. Magnolia Reyes
CLINICAL THERAPEUTICS· September 4, 2020
VI. CLINICAL APPROACH TO PROBLEM SOLVING
 A comprehensive health history and physical examination
build the foundation of your clinical Assessment.
 Assessment:
o You go beyond description and observation to
analysis and interpretation wherein you select
and cluster relevant pieces of information,
analyze their significance, and try to explain
them logically
 Plan:
o Must include the patient’s responses to the
problems identified and to the diagnostic and
therapeutic interventions that you recommend.
 Identify abnormal findings:
o Identification of an abnormality may be the first
step in the diagnostic process. Make a list of the
patient’s symptoms, the signs you observed
during the physical examination
 Localize these findings anatomically:
o When localizing findings, be as specific as your
data allow.
 Interpret the findings in terms of the probable process:
o Patient problems often stem from a pathologic
process involving diseases of a body structure.
 Make hypotheses about the nature of the patient’s
problem:
o Draw on all the knowledge and experience you
can muster, and it is most useful for learning
about patterns of abnormalities and diseases
that help you cluster your patient’s findings.
 Test your hypotheses:
o You are likely to need further history, additional
maneuvers on physical examination, or
laboratory studies or x-rays to confirm or rule out
your tentative diagnosis or to clarify which of two
or three possible diagnoses are most likely.
 Establish a working diagnosis:
o Make this at the highest level of explicitness and
certainty that the data allow
THE FOUR DISTINCT STEPS THAT THE FAMILY
PHYSICIAN UNDERTAKES TO SYSTEMATICALLY SOLVE
MOST CLINICAL PROBLEMS ARE THE FOLLOWING
1. Making the Diagnosis
 The first step in clinical problem solving
 This is achieved by carefully evaluating the patient
o Analyzing the information
o Assessing Risk factors
o Developing a list of Possible Diagnoses (The
Differentials)
 The Differentials
o A stepping stone to the final diagnosis
o A list of Diagnoses, usually placed in order of
likelihood, which may be causing the presentation
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o Based on the clinician’s knowledge, experience,
assessment of the likelihood of having the
condition (Pretest probability) and selective
testing.
 Working Diagnosis:
o When one Diagnosis begins to stand out from
the rest as the most likely cause
 Investigations are directed toward confirming or refuting
the working diagnosis, thus arriving to a Final
diagnosis
A patient who complains of upper abdominal pain and
has a history of nonsteroidal anti-inflammatory drug
use (NSAIDS) may have Peptic ulcer disease.
A patient who has abdominal pain, fatty food
intolerance and abdominal bloating may have
Cholelithiasis.
Another individual with a 1-day history of periumbilical
pain that now localizes to the right lower quadrant may
have Acute Appendicitis.
You have to make a Differential from the most common to
the least common.
2. Assessing the severity of the disease
 The second step is to establish the severity or stage of
the disease as this affects prognosis and treatment
 Characterize the severity of the disease process or in
other cases, a more informal staging may be used
 To describe ―how bad‖ a particular disease is
This may be as simple as determining whether a
patient is “sick” or “not sick”.
Cancer staging is used for the strict assessment of
the extent of malignancy.
DURAN | GAVINO, J. | OCAMPO | PAGDILAO
Prelims (1st Sem) Clinical Approach
Dr. Magnolia Reyes
CLINICAL THERAPEUTICS· September 4, 2020
3. Treating based on the stage of the Disease
 Tailoring the treatment to fit the severity or stage of the
disease
A formerly healthy young man with pneumonia
and no respiratory distress may be treated with
oral antibiotics at home.
An older person with emphysema and pneumonia
would probably be admitted to the hospital for IV
antibiotics.
A patient with pneumonia and respiratory failure
would likely be intubated and admitted to the
intensive care unit for further treatment.
4. Following the patient’s response to the treatment
- What are the medications?
- How much are you supposed to take?
- While giving all of these treatments, you find out
if the patient is getting better or not
 The final step in the approach to disease is to monitor the
treatment response or efficacy
 This may be measured in different ways such as:
o Symptomatically
o Based on physical examination, vital signs,
oxygenation, urine output and mental status
o Based on other testing
 The clinician must be prepared to know what to do if the
patient does not respond as expected
Some responses are clinical such as improvement
or lack of improvement.
Some may be followed by testing such as
monitoring the anion gap in a patient with diabetic
ketoacidosis.
References
 Toy, E., & Patlan, J. (2017). Case Files Internal
Medicine. United States: McGraw-Hill Education.
 Ppt. Doc Magnolia Reyes. 2020
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