Unit 1. Making a diagnosis.

Name: Anyelina Angustia Medina

Enrollment: 1-194675

1-Investigate and write all about the diagnosis. What's a diagnosis?

Diagnosis is the procedure by which the health professional identifies a

disease or the patient's condition with the help of various tools that allow
defining their clinical picture.

2-Investigate and write the differents types of diagnosis. Give details.

Types of diagnosis:

1. Clinical diagnosis:

It is undoubtedly the most common and widespread in the collective

imagination of the general population. This method is based on the
procedure by which the health professional, depending on the symptoms,
identifies a disease (or the absence of it) in the patient with the help of
various tools that allow defining their clinical picture.

A clinical diagnosis are as follows:

*Make an objective summary of the case and order the information about
it.

*Rank symptoms according to their sensitivity, specificity, predictive

value, severity, and many other factors.

*Group the symptoms and signs found into common categories.

*Do not hypertrophy the diagnosis with the creation of artificial

syndromes.

*Link symptoms to the syndrome that presents them.

Take a holistic view (joint analysis) and avoid reductionism.

*There are sick people, not diseases.

From these bases the diagnosis of the patient can be constructed.

 2. Differential diagnosis:

Differential diagnosis is defined as the process by which a certain disease is

identified by excluding other possible causes, since symptoms can be
common to various pathologies.

This type of diagnosis takes into account all the possible diseases that could
produce the patient's clinical picture and often requires the performance of
several tests, as this can rule out causes along the way. For example, when
faced with fevers, headaches or fatigue, a differential diagnosis is required,
since there are an infinity of diseases that manifest with these symptoms.

Thinking tools such as induction, deduction, abduction, analogy and

modeling are necessary for the proposition of the differential hypothesis,
that is, the possible clinical picture of the patient.

3. Etiological diagnosis:

This variant aims to discover the causes or factors that have triggered the
disease in the patient. For example, a person may have severe bronchitis,
but the investigation of why it is the terrain of the etiological diagnosis (for
example, wondering if it is because of their smoking status).

The causes of clinical pictures can be: agent, host or environment, all of
them coupled with other (genetic) factors. Knowing why a disease occurs is
essential, and in cases where the etiological diagnosis fails to find the
underlying reason, we say that the disease is "idiopathic" in nature.

4. Nosological diagnosis:

Nosology is a branch of medicine that tries to name, describe and classify

diseases according to their etiology, pathology, clinical presentation and
evolution. This is, in other words, stating the disease and its characteristics.
This implies a systematization of the entities by the knowledge that is had
of them.

Can you imagine what it would be like to make a diagnosis and name the
disease solely based on the symptoms? "You have the disease of
inflammation of the lining of the bronchial tubes that carry air into and out
of the lungs." Nosology allows us to ensure that we are facing a picture of
bronchitis, since this disease has already been described and combined in a
specific clinical picture. In other words, with this diagnosis, we give the
disease a first and last name.

5. Topographic diagnosis:

In this case, we are facing a diagnostic method that is based on the

localization and identification of the lesions in the different organs and
tissues. In other words, it is about understanding the signs and symptoms
through the anatomical component that is altered during the disease itself.

Other commonly used diagnostic methods:

*Pathogenetic diagnosis: specific determination of the disease. It states the

mechanisms that produce the disease by the action of the causes and the
reaction.

*Presumptive diagnosis: one that the professional considers based on the

data obtained through a patient survey and physical examination.

*Syndromic diagnosis: applied in patients with specific syndromes.

*Symptomatic diagnosis: aims to identify the patient's disease through

symptoms.

*Generic diagnosis: determines only if the individual is sick or not.

3-What's a medical history and when taking?

A medical history is a collection of information about a patient that can be

used to better understand any health problems that he or she may have.

The data in a medical record helps analyze a patient's medical journey. It is

a basic document when making a medical decision, so the data of a medical
record must include all kinds of data about the health of a patient.

Sections that are part of the medical history:

* Patient identification.
*Main problem or reason for consultation.
*Current illness or close anamnesis.
*History or remote anamnesis.
*System review.
4-Write and define the steps for taking a patient's history into the
correct order.

Personal information:

Personal data should be noted at the top of the medical record. The name,
address, telephone number, gender, age, occupation, race, nationality,
religion, marital status, document number and the name of the referring
physician. Each of these data, which frame the patient, and his cultural
customs, provide information of medical use by themselves.

Reasons for Consultation:

It is the motive or reason (Symptom, Sign, Syndrome, Diagnosis or

Problem) that leads the patient to request the opinion of the doctor. It is
what leads you to request an interview with the health professional. It
should be noted as the headline in the news story and in general, with the
terminology used by the patient. (health check, tiredness, shortness of
breath, etc).

Current illness:

The current illness is the narration of the reason for the consultation. In an
orderly, logical, grammatically correct way, the data that mobilized the
doctor's opinion will be described one by one. This must be developed with
the data provided as well as with those that, due to their absence, are
important and contribute to the understanding of the different problems.

Current illness:

The current illness is the narration of the reason for the consultation. In an
orderly, logical, grammatically correct way, the data that mobilized the
doctor's opinion will be described one by one. This must be developed with
the data provided as well as with those that, due to their absence, are
important and contribute to the understanding of the different problems.

Personal history:

In this section of the interrogation, a note is made of all the episodes that
affected the patient's health since his birth. A summary of previous
hospitalizations is made, although without repeating information that was
already included in Current illness.
Personal habits:

In this section, information is obtained on customs (travel) and habits such

as sleep, habitual diet, diuresis and catharsis, cigarettes, alcohol, drugs and
self-medication, use of seat belts, prophylactics in their relationships and
their sexual preferences.

Always ask about aspirin, which is not considered a drug by the population;
It is of interest to inquire about levels of education and occupational
history, with their risk factors (asbestosis, lead, radiation, etc.)

Organ and System Review:

This section of the Medical Record is intended to complete the information

that may have been overlooked in the current Illness. Symptoms and signs
already evaluated should not be repeated. In the review of organs and
systems it is convenient to ask yourself an order of questions, so as not to
lose information. He asks about symptoms and signs of the skin, head,
eyes, ears, nose, paranasal sinuses, oral cavity, neck, lymph nodes, breasts,
cardiorespiratory, digestive, urogenital, endocrine, extremities, central and
peripheral nervous system and hematopoietic.

Family background:

This section asks about all those diseases that may have a hereditary or
genetic link with the patient. Parents, grandparents, siblings, and children
should be questioned. This will be developed more thoroughly if the
patient's illness suggests it, for example about her sexual partners. The
information about the cohabiting partner provides psychosocial and
infectious-contagious data. If a relative died, take note of their age and
cause.

Physical exam:

The physical examination is carried out after the interrogation, following a

methodological order and must be carried out completely. That order is as
follows:

Inspection, Palpation, Percussion, Auscultation, Gynecological and Rectal

Touch, Ophthalmoscopy and Otoscopy.

Nursing Notes and Graphics:

Nursing must have a space to write down their observations, controls, and
schedule of their execution, given the importance of their participation in
the care of the patient.

Epicrisis:
It is a summary of what has been done, including studies carried out,
treatments and results upon discharge of the patient.

5- Write the Socrates mnemonic medicine.

SOCRATES is a mnemonic acronym used by emergency medical services,

physicians, nurses, and other health professionals to evaluate the nature of
pain that a patient is experiencing.

6-Investigate all about the Diabetes and the types of Diabetes.

Diabetes is a disease that occurs when the level of glucose in the blood,
also known as blood sugar, is too high. Glucose in the blood is the main
source of energy and comes from food. Insulin, a hormone produced by the
pancreas, helps glucose from food enter cells to be used for energy.
Sometimes the body does not make enough or no insulin or does not use it
properly and the glucose stays in the blood and does not reach the cells.

Over time, excess glucose in the blood can cause health problems.
Although there is no cure for diabetes, a person with diabetes can take steps
to control their disease and stay healthy.

Types of diabetes

Diabetes type 1:

With type 1 diabetes, the body does not make insulin because the immune
system attacks and destroys the cells in the pancreas that make it. Type 1
diabetes is usually diagnosed in children and young adults, although it can
appear at any age. People with type 1 diabetes have to use insulin every day
to survive.

Type 2 diabetes:

With type 2 diabetes, the body does not make or use insulin properly. Type
2 diabetes can appear at any age, even during childhood. However, this
type of diabetes occurs most often in middle-aged and elderly people. This
is the most common type of diabetes.

Gestational diabetes:

Gestational diabetes affects some women during pregnancy. Most of the

time, this type of diabetes goes away after the baby is born. However, when
a woman has had gestational diabetes, she is more likely to develop type 2
diabetes in the future. Sometimes diabetes diagnosed during pregnancy is
actually type 2 diabetes.

7-Investigate and write all about the Hyperthyroidism, Hemoglobin

HA1C test, and the insulin.

Hyperthyroidism is the overactivity of the thyroid gland, which results in

high concentrations of thyroid hormones and acceleration of vital bodily
functions.

In most cases of hyperthyroidism there is hypertrophy of the thyroid gland

(goiter). The entire gland may enlarge or nodules may appear in certain
areas. In people with subacute thyroiditis, the gland becomes tender and
painful.

The most frequent causes are

Graves disease
Toxic multinodular goiter
Thyroiditis
A single toxic nodule

Hyperthyroidism can mimic other health problems, which can make

diagnosis difficult. It can also cause a wide variety of symptoms, including
the following:

Involuntary weight loss, even when appetite and food consumption remain
the same or reversed.

Fast heartbeat (tachycardia), often more than 100 beats per minute.

Irregular heartbeat (arrhythmia)

Feeling of pounding in the chest (palpitations).
Increased appetite

Nervousness, anxiety, and irritability.

Tremors, usually there are mild tremors in the hands and fingers.

Sweating

Changes in menstruation patterns.

Increased sensitivity to heat.

Change in bowel habits, especially more frequent bowel movements.

An enlarged thyroid gland (goiter), which can appear as a swelling at the

base of the neck.

Fatigue and muscle weakness.

Difficulty to sleep.

Thin skin.

Fine or fragile hair.

Hemoglobin HA1C:

The A1c test, which is also known as the hemoglobin A1c or HbA1c test, is
a simple blood test that measures your average blood sugar levels from the
past three months. It is one of the tests that are commonly used to diagnose
prediabetes and diabetes, and it is also the main test that helps you and your
health care team manage your diabetes. Higher A1c values are linked to
complications of diabetes; so if you have diabetes, it is very important that
you reach and maintain your individual A1c target values.

When sugar enters the bloodstream, it attaches itself to hemoglobin, which

is a protein found within red blood cells. Everyone has some sugar attached
to hemoglobin, but people with higher blood sugar have more. The A1c test
measures the percentage of red blood cells that have hemoglobin covered in
sugar.

Diabetes management:
If you have diabetes, get an A1c test at least twice a year, or more often if
there are changes in your medication or you have other conditions. Ask
your doctor how often is right for you.

Insulin

Insulin is a hormone released by the pancreas in response to the presence of

glucose in the blood. Insulin allows glucose to enter cells to be used as an
energy source. . If insulin does not do this well, glucose accumulates in the
blood producing hyperglycemia.

In type I diabetes, and in some cases in type II, the injection of insulin is
necessary to maintain a correct level of glucose in the blood. There are the
following types of insulins:

Fast acting insulin.

Short-acting insulin called regular.
Insulins of intermediate action or NPH.
Long-acting insulin.
In many cases, treatment with these types of insulin is combined.

Also by their injection area we can classify them as:

Subcutaneous Insulins: Any insulin, either fast acting or delayed.

Intravenous insulin: Only fast-acting insulins that do not have retardants.

Depending on the retardant used, we can classify insulins as follows:

Insulins that use zinc as a retardant.

Insulins that use other proteins such as protamine as retardants.

Do the exercise B on page 2.

B. Put these steps fot taking a patient’s history into the correct order.
Compare your answers with those of a partner.

3 Chief Complaint

5 Family History

2 History of Present Condition

1 Introductory ‘‘small talk’’

8 Medication

4 Past Medical History

7 Physical Examination

6 Social History

Do the exercise A on page 4.

A. Match the questions with the steps for taking a patient’s history.

Questions

A)3c Have you hald similar problems before?

B) 1a When did the problem begin?

C) 2b Are you having any other pain or problems?

D) 4a Are you taking any medication?

E) 2c Are you a smoker?

F) 3a So, how can we help you today?

G) 5c Has anyone in your family had a similar problem?

H) 6c Are you allergic to any medication?

i.) 3c Have you ever had any other medical problems?

J) 7 Do you have a Job that involves a lot of exercise?

K) 5 How’s the rest of the family?

Steps
 1- Introductory ‘‘small talk’’
2- Chief Complaint
3- History of present condition
a) Onset and timing
b) Other symptoms
c) Previous occurrence

4- Past Medical History

5- Family History
6- Medication
7- Social History

Do the exercise A on page 10.

A. Read thet text answer questions below

Refined Sugar in the Diabetic Diet

Before insulin was discovered in the 1930s, it was possible to treat
Diabetes Mellitus Type 1 by strictly controlling carbohydrates in the diet.
Refined* sugar was prohibited because it was thought that it raised blood
glucose level to dangerous levels. Howewer, in 1994, a committe for the
American Diabetes Association, or ADA, published a paper that indicated
that there was little experimental evidence to support this position. They
pointed out that sugar is a form of carbohydrate and all carbohydrates
contain approximately the same amount of energy. So, if a patient eats 100
grams of sugar or 100 grams of unrefined carbohydrates like or potatoes,
the amount of glucose entering the blood will be almost the same.
Therefore the amount of carbohydrates in the diet is important, not
necessarily the type of carbohydrate. However, it should be borne in mind
that unrefined carbohydrates also contain proteins, etc., which are
important in a balanced diet.

The important points to remember are that the patient’s diet should contain
the right number of calories for his or her individual needs and that the diet
should be well-balanced.

1- Before the 1930, how was diabetes treated?

Before insulin was discovered in the 1930s, it was possible to treat

Diabetes Mellitus Type 1 by streetly controlling carbohydrates in the
diet
 2- On what grounds did the ADA change its policy on refined
sugar?

Because there was a lot of evidence to support that position that

sugar is a form of carbohydrate and all carbohydrates contain
roughly the same amount of energy.

3- If a patient asked you if it was all right to substitute 100 grams

of candy for 100 grams of potatoes, would you say?

No, because insulin is to manage glucose levels and if you eat candy you
alter it, it can alter glucose.

4- Should unrefined carbohydrates in the form of sugar be

prohibited from a diabetic diet?

The point is just to have a scale with sugar in diabetics as well as

carbohydrates.

Do the exercise D on page 11

D) Do some of Mark’s calculations

Serving
1.Cornflakes
2.Spaghetti
3.Rice
4.Boiled potatoes
5.Oatmeal

Size of regular serving

35g
300g
300g
300g
350g

Calories per regular serving

130 cals
300 cals
420 cals
210 cals
175 cals

Size of Mark’s mom’s servings

70 g
450 g
400 g
500 g
400g

Calories in one of Mark’s mom’s serving

1) 70/35x 130= 260 cals
2) 450/300x300= 450 cals
3) 400/300x420= 560 cals
4) 500/300x210= 350 cals
5) 400/350x175= 200 cals

Do the exercises A and B on page 12.

A. The following words all appear in the article below. Use the
article and the chart below to work out their meaning.

1. Euthyroidism normal thyroid function

2. Hypothyroidism: too low tyroid fuction
3. Dyslipidemia: abnormal diabetes fuction
4. Glycemic: sugar control and treatment
5. Glucogenesis: production gastrointestinal glucose

Diabetes and Hyperthyroidism

The presence of thyroid dysfunction may affect diabetes control.

Hyperthyroidism is typically associated with worsening glycemic control
and increased insulin reQuirements. There is underlying increased hepatic
glucogenesis, rapid gastrointestinal glucose absorption, and probably
increased insulin resistance. Indeed, thyroid dysfunction may unmask latent
diabetes.

In diabetic patients with hyperthyroidism, physicians need to anticipate

possible deterioration in glycemic control and adjust treatment accordingly.
Restoration of euthyroidism will lower blood glucose level.
Hyperthyroidism is accompanied a variety of abnormalities in plasma lipid
metabolism, including elevated triglyceride and low-density lipoprotein
(LDL) cholesterol concetrations. Even sub-clinical Hyperthyroidism can
exacerbate the coexisting dylipidemia commonly found in type 2 diabetes
and further increase the risk of cardiovascular diseases. AdeQuate
thyroxine replacement will reverse the lipid abnormalities.

Prefix
Hyper-
Hypo-
Eu-
Dys-
Too high
Too low
Normal
Abnormal

Root
-gly-
-em-
Lipid
-ur-
Sugar
Blood
Fat
Urine

Suffix
-ism
-ic
-ia
-genesis
Noun
Adjective
Noun
Production

B. Use the chart yo work out the meaning of these words

1. Euglycemia: Normal
2. Hyperlipidemia: Too high
3. Hyperglycosuria: Too high
4. Dysuria: Abnormal