Okay, this is the first presentation in the skeletal system.

And the skeletal system is my

favorite part of anatomy. My background is in biological anthropology and forensic
anthropology. And I spend hours and hours looking at bones, and what they can tell us.
One of the main things that we would look at is a biological profile, and you can
determine age, sex, ancestry, stature, pathology, trauma. Everything from bone. So
we're going to are going to spend quite a bit of time on this, because really
understanding the bones and where they are located will really give you an indication
of the other organs, where they're located. A lot of times, arterial supply is named after
the bones that they are in close proximity to. So we're going to introduce the concept of
the skeletal system. We'll talk a little bit about the tissue and bone development. Then
we'll talk about the actual, discrete bones and some of the landmarks on them. So
when we talk about bone, the main thing that I want to get across is that it is a dynamic
organ. And what I mean by that is, that it changes throughout life. Yes bone will stop
growing in terms of length, but it will constantly be changing as you go through life.
Either adding bone as you move muscles, or actually loosing bone in the case of
certain pathology such as osteoporosis. Now, when we talk about the entirety of the
skeletal system, we're talking about more than just bone. But when you think about
bone, typically we're thinking about osseous tissue. And that is the hard stuff, okay. So
the bone actually will harden through organic materials, as well as minerals. And so
when we think of the dry bone that you typically think of when you think of a skeleton,
you're thinking of the osseous tissue. So we'll talk a lot more about what that actually is
composed of. Importantly also, part of the skeletal system is articular cartilage. And
you'll find articular cartilage wherever you have a joint. And when I talk about joints,
that's where two bones meet up together. So very important in terms of shock
absorption, and allowing for ease of movement at these joints. Additionally, you're
going to have dense connective tissue. So you'll see me abbreviating CT quite a bit.
That just means connective tissue. Now this dense irregular or dense regular
connective tissue you'll find in certain areas, particularly in terms of the periosteum.
And this is just a layer that surrounds all the bone except for in the articular cartilage
region that's really providing additional protection. It's also an important area where
you're going to have cells differentiating to allow for bone growth. Also, connective
tissue will connect to the bone. So when we're talking about ligaments and tendons,
those are going to be a type of density regular connective tissue. You'll also have
epithelial tissue. This is particularly important in terms of paranasal sinuses. So if you
think of my sinuses are acting up, it's typically an inflammation of this epithelial tissue.
And we'll talk about that a lot more when we talk about the skull. Lastly, I want to talk
about adipose tissue and the neurovasculature. Anytime I use the term neovasculature,
that's going to mean nerve, artery, and vein. So nerves are important in terms of
communicating with your central nervous system, so your brain and your spinal cord.
Artery is what's bringing the supply to bones, so blood supply. And then veins are
going to drain the blood, so returning to the heart. And in terms of adipose tissue, if you
look at this frontal section of the bone, you'll have what's referred to as the marrow
cavity or the medullary cavity. And within that, in a living individual, you can have that
yellow fat marrow. That's very important in terms of energy storage. So that's just a
quick introduction. Key here is that we're talking about a dynamic structure. It changes
throughout life. So not static like the dry bone that we typically think of. So we're going
to continue this discussion in terms of the functions, not only of the bone, but of the
entirety of the skeletal system.
 PRESENT PERFECT TENSE (FORMS OF THE VERBS

Full infinitive Base form Third person Present participle Simple past Past participle form
form (endings (present form (present form (ING) form (simple (perfect tenses and
to spanish ar, simple simple tense) (Progressive past tense. passive voices
er ir.) usually tense) tense) (endings to (endings to spanish
in the spanish ando, ado, ido, ito, etc.,)
complement. endo)
To be Be I am, Is he, she being Was I, he, she it. Been.
you, we, and it.
they are.
To talk Talk Talks Talking Talked Talked
To Write Write Writes Writing Wrote written
To do Do Does Doing Did Done
To have Have Has Having Had Had
To come Come Comes coming Came Come
To read Read Reads Reading Read Read
To learn Learn Learns Learning Learned/learnt Learned/learnt
To get Get Gets Getting Got Got/gotten
EXAMPLES

Full infinitive form and base form of the verb. .

They read a book every month to summarize it.

Third person form

He likes fruits.

Present participle (ING FORM) Present continuous/ Present progressive

You are working too much lately.

Simple past tense

He read that book.
 PRESENT PERFECT TENSE

SENTENCES S Aux Verb VPPF COMPLEMENT

Have/has
(+) He has (he’s) met his wife at the university.
(-) He has not met his wife at the university.
( hasn’t)

(ˀ) Aux Verb S VPPF COMPLEMENT

Have/has
Has he met his wife at the university?
(=) Yes, has
No, he hasn’t

I Have heard A lot of good things about the medicine school.

He has to come back Tomorrow.
 he human body is a complex organism composed of various systems that work
together to maintain its functions and keep it alive. These systems are made up
of organs, tissues, and cells that collaborate to perform specific functions. Here
are some of the major human body systems:

1. Nervous System: This system controls and coordinates the body's activities by
transmitting signals between different parts of the body. It includes the brain,
spinal cord, and peripheral nerves.
2. Circulatory System: Also known as the cardiovascular system, it transports
oxygen, nutrients, hormones, and waste products throughout the body. It
comprises the heart, blood vessels (arteries, veins, and capillaries), and blood.
3. Respiratory System: Responsible for the exchange of gases (oxygen and
carbon dioxide) between the body and the external environment. It includes the
lungs and the airways.
4. Digestive System: Breaks down and absorbs nutrients from food and
eliminates waste products. It consists of the mouth, esophagus, stomach,
intestines, liver, pancreas, and more.
5. Muscular System: Enables movement and provides support and stability to the
body. It includes skeletal muscles, smooth muscles, and cardiac muscles.
6. Skeletal System: Provides structure, support, and protection to the body's
organs. It is made up of bones, cartilage, ligaments, and tendons.
7. Endocrine System: Produces hormones that regulate various bodily functions,
such as growth, metabolism, and reproduction. It includes glands like the
pituitary, thyroid, adrenal, and pancreas.
8. Immune System: Defends the body against pathogens (bacteria, viruses, etc.)
and harmful substances. It includes white blood cells, lymph nodes, and the
spleen.
9. Integumentary System: Composed of the skin, hair, and nails, this system
provides a protective barrier against the external environment, regulates body
temperature, and eliminates waste through sweat.
10. Urinary System: Removes waste products and excess fluids from the body
through urine. It includes the kidneys, ureters, bladder, and urethra.
11. Reproductive System: Responsible for reproduction and sexual development.
In males, it includes the testes, prostate, and penis. In females, it includes the
ovaries, fallopian tubes, uterus, and vagina.
12. Lymphatic System: Works with the immune system to help remove toxins,
waste, and other unwanted materials from the body. It includes lymph nodes,
lymphatic vessels, and the thymus.
13. Hormonal System (Secondary Endocrine System): In addition to the major
endocrine glands, there are smaller hormone-producing tissues and organs
scattered throughout the body, contributing to various regulatory processes.
These systems are intricately interconnected and work together to maintain
homeostasis, the body's state of internal balance. Any disruption or dysfunction
within one system can affect the functioning of other systems, highlighting the
importance of their harmonious operation for overall health and well-being.
 USEFUL EXPRESSSIONES

Let’s go, let’s do it, let’s write, let’s sing, let’s listen to music

Let me see it, let me help you, let me explain it. Etc.

How About changing the prescription?, how about asking him?

Zero conditional sentences

With every conditional sentence, there are two parts. The

condition, or the situation, and the result of that situation.
The situation usually starts with ‘if’.

There are different types of conditionals depending on what the

situation is. Zero and 1st conditional sentences were used, so
that is what we shall focus on.

The zero conditional is used to talk about general truths or

scientific facts. Examples:

If + present simple present simple

If people eat too much, they get fat. (general truth)

If you are not sure, ask the doctor. (instruction)

 If you heat water to 100 degrees, it boils. ...

 If public transport is efficient, people stop using their cars. ...
 If you cross the line, you are in our country. ...
 If children study, then their parents are happy. ...
 Plants die if they don't get enough water.
 Ask the doctor if you are not sure.
First conditional sentences
The first conditional is used to talk about what could
happen if something else happened. For example, what
may happen ‘If it rains..’. They are used throughout
healthcare to give advice and warnings.

They are often used with ‘will’ but can be used with a range of
modal verbs.

will + bare infinitive (infinitive without

If + present simple,
‘to’)

If you get some rest, you will feel better.

If you take the medicine, you will get better.

You will get better if you take the medicine.

If children become sick, it is easy for their parents and others in

the community to become sick.

If we do create educational flyers, we will be able to reach a

wider range of people.

If we do not educate the public, this situation will only get

worse.

 If I need help, I will tell you.

FUTURE WILL

S + WILL + V + C

https://www.facebook.com/voalearningenglish/videos/everyday-
grammar-the-simple-future/150652403580279/

https://www.manythings.org/voa/health/4059.html
Unit 3

3.1 3.2 Common pains, aches, hurts, sores, injuries sick , ill, sickness, illness diseases

0:10Skip to 0 minutes and 10 secondsIn this section, you will see

how pain is classified. Ari Contos will be used as an example to
describe how pain is detected or perceived in the body and to
show how pain signals are taken from around the body to the
brain. Pain is normally classified into two main types,
nociceptive, arising from being sensed by pain receptors called
nociceptors, and neuropathic, neuro meaning nerve and pathic
meaning disease or condition. Nociceptive pain can be acute,
such as touching a hot surface, or chronic, such as most back
pain. In addition, it is possible to have a mixture of nociceptive
and neuropathic pain. Sometimes the cause of the pain is not
nociceptive or neuropathic, and such pain is termed idiopathic.
1:07Skip to 1 minute and 7 secondsSome types of chronic pain
may be idiopathic. In this section, we will focus on nociceptive
pain. Nociceptive pain arises from activation of pain neurons,
that is neurons that carry pain signals in response to a noxious
stimulus that may be some sort of injury, disease, or
inflammation. Nociceptive pain is caused by the activation of
nociceptors. Nociceptors are receptors that respond to a
number of stimuli. When they respond to chemicals, they are
called chemoreceptors. Receptors that respond to temperature
changes are called thermoreceptors. And receptors that
respond to mechanical stimulation or movement are called
mechanoreceptors. Individual nociceptors can sometimes
respond to more than one type of stimuli. For example, there
are nociceptive called Transient Receptor Potential Vanilloid
type one, or TRPV1 receptors.
2:14Skip to 2 minutes and 14 secondsTRPV1 receptors exist all
over the body and respond to heat, but also to the chemical
capsaicin, which is the chemical in hot tasting foods like chilli
that causes a hot sensation when eaten. So eating foods
containing chilli causes a hot painful sensation because of the
activation of TRPV1 receptors. Thus, TRPV1 receptors are both
thermoreceptors because they respond to heat, and
chemoreceptors, because they respond to the chemical,
capsaicin. There’s a whole family of TRP receptors. And the
first of these nociceptors were only discovered in late 1980s.
And prior to this, it was not known how nociceptive pain was
detected. TRPV1 receptors are often found on neurons. And
their activation then leads to activation of the neuron.
3:15Skip to 3 minutes and 15 secondsThe neuron sends electrical
signals to the spinal cord, as we will see in a moment. The
effective TRPV1 receptor activation is felt very quickly in order
to alert a person to the source of the pain, so that hopefully it
can be alleviated. Chemoreceptors such as TRPV1 receptors
can be activated by chemicals that come into contact with the
skin, such as accidentally pouring acid onto the skin, or by
chemicals produced in the body. When tissues become
inflamed due to disease or injury, many different chemicals are
released from the inflamed tissue. These chemicals activate
various chemoreceptors in order to activate neurons that send
painful messages to the brain. As mentioned earlier, there are
nociceptors that are activated by movement called
mechanoreceptors.
4:09Skip to 4 minutes and 9 secondsThere are a number of
different types of structures that contain mechanoreceptors.
Some structures detect light touch, whereas others are
responsible for the detection of vibration or skin stretching. So
the are nociceptors in the sense of detecting painful stimuli, but
they can also sense non-painful sensations. So what about Ari’s
back pain? It may be the result of a strain in any of the
interconnecting structures in the back, such as the tendons,
muscles, and spinal discs. Straining of these structures can
cause inflammation, which produces heat and chemicals that
active TRPV1 receptors, or other similar receptor types. Ari’s
back pain may also be the result of mechanoreceptor
stimulation.
5:05Skip to 5 minutes and 5 secondsOften after an accident, there
is structural damage that means that mechanoreceptors are
activated by simple movement of the body that would not
normally cause pain. The precise way in which
mechanoreceptors sense movement of tissue is yet to be
completely identified. Mechanoreceptors may be similar in
structure to TRPV1 receptors. And their activation may, in fact,
involve the TRPV1 receptors as well. So when Ari feels pain in
his back, it is nociceptors on neurons in the area that he feels
the pain that are activated. These neurons are generally silent
in that they fire much less frequently when they are not being
stimulated.
5:54Skip to 5 minutes and 54 secondsOnce activated, these
sensory neurons transmit electrical signals much more
frequently from the site of the pain in the back to the spinal
cord. Here, the sensory neurons release neurotransmitters that
activate a secondary neuron that projects to the brain. This area
in the spinal cord is an important target for drugs used to treat
pain, called analgesics, as we’ll see in a later recording. These
secondary neurons transmit pain information via electrical
signals to various brain regions, and eventually to a brain region
called the somatosensory cortex. Let’s now look at the
somatosensory cortex in more detail. The somatosensory
cortex is a strip of tissue across the top of the brain where pain,
as well as touch and temperature, is actually felt.
6:51Skip to 6 minutes and 51 secondsEach part of the
somatosensory cortex represents a different part of the body.
This is perhaps better represented by this model called the
sensory homunculus. This shows what a person’s body would
look like if each part grew in proportion to the area of the
somatosensory cortex concerned with its sensory perception.
This highlights how some parts of the body are various
sensitive, such as the hands and lips, and how other parts of
the body are less sensitive, such as the arms and legs. So to
recap, you’ve seen how pain is classified, how pain is detected,
how pain signals are taken from around the body to the brain,
and how this pain is perceived in people experiencing pain, like
Ari.
0:10Skip to 0 minutes and 10 secondsDANIEL MALONE: In this
section, you’ll look at how drugs, such as morphine, can reduce
pain, but how they’re also addictive. You’ll also briefly see what
some non-drug options are to relieve pain in people like Arie.
Before we look at how morphine works to reduce pain, let’s look
at the receptors morphine binds to in order to exert its effects. In
the last section, you learned that pain transmission involves the
release of neurotransmitters and that the spinal cord is an
important point where modulation of pain signals occurs. As
David mentioned in the chemistry module, morphine is an
opioid and, as such, binds to opioid receptors. Opioid receptors
are G protein-coupled receptors, or GPCRs.
1:03Skip to 1 minute and 3 secondsAs we mentioned in the
introductory week, GPCRs are called this because they couple
to G proteins in order to transmit a signal into a cell. Opioid
receptors are located on neurons, particularly in the spinal cord,
that transmit pain signals. They’re also present on neurons in
the brain. Different opioid receptors exist. And we’re going to
look at the mu receptor, which is the most abundant opioid
receptor. When this resistor is activated, relief of pain is
produced. So when morphine binds to mu opioid receptors on
neurons, G proteins are activated, and this leads to a reduction
in the amount of neurotransmitter released from neurons. So
where are these mu receptors that morphine activates?
1:54Skip to 1 minute and 54 secondsThe answer is that they are
located mostly in regions of the brain and spinal cord that
contain large numbers of mu receptors. Activation of mu
receptors in the brain sends messages back down to the spinal
cord, which decreases pain single transmission and reduces the
perception of pain. In the spinal cord, mu receptor activation
also inhibits transmission of pain signals up to the brain.
Combined mu receptor activation in the brain, spinal cord, and
also in other parts of the body, results in pain relief. But those in
the brain and spinal cord play a much bigger role than those
around the body. You’ve previously learned that the body’s own
natural chemicals, called enkephalins activate opioid receptors.
2:47Skip to 2 minutes and 47 secondsInterestingly, some pain
relieving techniques, such as acupuncture and relaxation, don’t
use drugs and actually act to increase enkephalin levels. Other
non-drug options for reducing pain include suppressing
inflammation, for example, by applying a cold pack to a sore
area. So you learned earlier that opioids like morphine activate
mu receptors in the brain and the spinal cord to decrease pain.
But pain relief is not the only effect of opioids such as morphine
when they are given to patients like Arie. One reason why
pleasurable activities, such as relaxation, exercise, or good
food, are pleasurable is because enkephalins are released.
This occurs in the limbic system of the brain. Thus, the limbic
system acts to encourage activities that are rewarding to us.
3:51Skip to 3 minutes and 51 secondsMu receptor activation in
the limbic system results in the release of the neurotransmitter
dopamine. It is thought that this release of dopamine is why
pleasurable activities are rewarding. Morphine activates mu
receptors in the limbic system that also results in the release of
dopamine. This is potentially beneficial for pain relief because
morphine produces a powerful sense of contentment and well
being, thus reducing agitation and anxiety that may be caused
by pain. However, this hijacking of the brain’s natural reward
system by morphine produces euphoria. This is why morphine
is highly addictive and is the reason many people taking
morphine do not want to stop taking it.
4:48Skip to 4 minutes and 48 secondsThe brain stem regulates
the rate of breathing. When morphine activates mu receptors in
the brain stem, the breathing rate decreases. This is called
respiratory depression. Respiratory depression, due to
activation of mu receptors in the brain stem, is the main reason
why death is possible when a person takes an overdose of
morphine. Morphine acts on mu receptors in other brain stem
regions to cause nausea and vomiting. And this occurs in up to
40% of patients. Mu receptor activation by morphine in the gut
increases tone and reduces motility. This causes constipation,
which may be severe and troubling. It is known that morphine
can cause drowsiness.
5:40Skip to 5 minutes and 40 secondsBut it has also been
reported that morphine decreases rapid eye movement sleep,
or REM sleep, and sleep efficiency. This sleep disturbance is
probably due to activation of opioid receptors in multiple brain
regions. So in summary, you’ve seen where mu opioid
receptors are in the body and how opioids like morphine
activate mu receptors to reduce pain, but can also cause
addiction.
Figure 1.4 The body's organ systems and their major functions.
 BOOKSMEDICOS ORG.

SYSTEM CONNECTIONS
Homeostatic Interrelationships between the lntegumentary
System and Other Body Systems

Skeletal System
• Skin protects bones; skin synthesizes a vitamin D precursor
needed for normal calcium absorption and deposit of bone
(calcium) salts, which make bones hard.
• Skeletal system provides support for skin.
Muscular System
• Skin protects muscles.
• Active muscles generate large amounts of heat, which
increases blood flow to the skin and may activate sweat glands in
skin.

Nervous System
• Skin protects nervous system organs; cutaneous sensory
receptors for touch, pressure, pain, and temperature located in
skin.
• Nervous system regulates diameter of blood vessels in skin;
activates sweat glands, contributing to thermoregulation;
interprets cutaneous sensation; activates arrector pili muscles.

Endocrine System
• Skin protects endocrine organs; converts some hormones to
their active forms; synthesizes a vitamin D precursor
• Androgens produced by the endocrine system activate
apocrine and sebaceous glands and are involved in regulating
hair growth.

Cardiovascular System
• Skin protects cardiovascular organs; prevents fluid loss from
body; serves as blood reservoir
• Cardiovascular system transports oxygen and nutrients to skin
and removes wastes from skin; provides substances needed by
skin glands to make their secretions.
Lymphat ic System/ Immunity
• Skin protects lymphatic organs; prevents pathogen invasion;
dendritic cells and macrophages help activate the immune
system.
• Lymphatic system prevents edema by picking up excessive
leaked fluid; immune system protects skin cells.

Respiratory System
• Skin protects respiratory organs; hairs in nose help filter out
dust from inhaled air.
• Respiratory system furnishes oxygen to skin cells and removes
carbon dioxide via gas exchange with blood.

Digestive System
• Skin protects digestive organs; provides vitamin D needed for
calcium absorption; performs some of the same chemical
conversions as liver cells.
• Digestive system provides needed nutrients to the skin.

Urinary System
• Skin protects urinary organs; excretes salts and some
nitrogenous wastes in sweat.
• Kidneys activate vitamin D precursor made by keratinocytes;
dispose of nitrogenous wastes of skin metabolism.
Reproductive System
• Skin protects reproductive organs; cutaneous receptors
respond to erotic stimuli; highly modified sweat glands
(mammary glands) produce milk
• During pregnancy, skin stretches to accommodate growing
fetus; changes in skin pigmentation may occur

BOOKSMEDICOS ORG.
 The Doctor’s problem
The doctor wants to know the meaning of the patient’s
symptoms and of the signs which are elicited, in order to
recognise the disease or diseases from which the patient is
suffering (diagnosis). Knowledge of the disease and of its course
in others allows the doctor to forecast the outlook (prognosis)
and to prescribe treatment (therapy).
Pre-symptomatic diagnosis: In many patients the presence of
disease may be detected as a result of population screening, or
the targeted population of specific groups. This is a major role of
General Practice in the UK and includes, for example, recording
of blood pressure in all registered patients, cervical screening
and breast screening of selected patient groups. Routine testing
of patients with a family history, for example, of colonic
carcinoma or adult polycystic kidney disease, is another strategy.
Increasingly this may involve genetic testing.
Patients may also engage in screening at their own initiative, and
often at their own cost. For example, patients may obtain a
whole body CT scan or, perhaps in the future, a whole genome
scan and present with the results of the investigation. This is
likely to increase in the future and produces challenges for
clinicians.
Diagnosis: An interpretation of symptoms and signs leading to
identification of a disease (or diseases). A complete description
involves knowledge of the causation (aetiology) and of the
anatomical and functional changes which are present.
It depends on the assembly of all the relevant facts concerning
the past and present history of the illness, together with the
condition of the patient, as shown by a full clinical examination.
Simple laboratory tests, such as examination of the urine or
estimation of the haemoglobin content of the blood, can be
carried out by the doctor himself. For most patients referred to
hospital, more elaborate special investigations are necessary,
such as radiological examination and special biochemical
investigations.
Prognosis: (outcome of an illness): This depends on the nature of
the disease, on its severity and on the stage of the disease
reached in the particular patient. It also depends on the
constitution, occupation and economic status of the individual
patient, as well as his motivation and ability to collaborate in
treatment. Prognosis may be expressed statistically in terms of
percentage chances of recovery or of death in acute illness, or of
average expectation of life in chronic diseases. These estimates
must be based on experience gained by the study of large
numbers of comparable patients and must be applied with the
greatest caution to individual patients.
Syndrome: A syndrome is a combination of symptoms and/or
signs which commonly occur together, e.g. malabsorption
syndrome, consisting of chronic diarrhoea with fatty stools and
multiple nutritional deficiencies.Doctors' problems.docxDoctors'
problems.docxDoctors' problems.docxDoctors' problems.docx

Patient Safety and Comfort History taking and physical

examination can be a very exhausting experience for the patient.
Remember, also, that the patient may already have been seen by
other students. For these reasons it is essential, before taking a
history or conducting a physical examination, to ask if the patient
feels able and willing to cooperate. Throughout the examination
the patient’s comfort should be kept constantly in mind.
Movement of the patient should be restricted as much as
possible; for example when the patient is sitting forward the
opportunity should be taken to palpate the neck, examine the
chest posteriorly and look for sacral oedema and spinal
deformity, e.g. kyphosis and scoliosis.
Note: If you retain a patient history, or submit it as a teaching
case, it must not be identifiable to third parties. The patient’s
confidentiality must be retained. Thus, it is common practice to
use the initials and a Hospital Number. When recorded in the
Hospital Case record, the full details should be written down. In
many hospitals, electronic records or admission pro-formas are
used. However, all students should be able to take a full history
and examination, and not to be reliant (or limited) to the use of
electronic resources.

Forecast

prognosis)

CT computed tomography; computerized tomography.

cognitive therapy
Introduction

The History of the Patient

The history of the patient represents the first contact and discussion of the physician with the
patient and is very important. Taking a superficial history because of a lack of time is not
excusable because it can generate mistakes. A serious and careful history of the patient will aid
in a successful diagnosis. We must always ask a few typical questions, which are presented
next. Look at me how carefully I am talking to the patient and take notes!

In the first instance I will ask about personal information: name, age, gender.

What is your name? How old are you? I observe if the patient is a man or a woman, because I
know that some diseases are more common in women and other diseases appear more often
in men.

2. PLACE OF BIRTH AND HOME (ADDRESS)

Where were you born? Where do you live? What is your address? What is your phone
number?

3. ALLERGY?

I will ask my patient if he or she is allergic to any drugs. If the answer is yes, I will ask what
drugs have caused allergy in the past and I will mark it with red color in the personal papers of
the patient. Very important! The administration of these drugs must to be avoided to prevent
anaphylactic shock, Quincke edema, or sudden death. For example, I noticed:

allergy to aspirin allergy to penicillin

So, I will never give this patient aspirin or penicillin!

4. THE REASON FOR HOSPITALIZATION

The reason for hospitalization represents the main symptoms about which the patient came
for consultation. There is always a major symptom; this is the leading symptom. The patient
may also present with other symptoms. These must be put in order per anatomy and system.

Example No. 1

- Syncope is the leading symptom - Dyspnea - Chest pain - Palpitations

Example No. 2

Hematuria is the leading symptom - Pollakiuria - Dysuria - Chills - Fever

Example No. 3

- Hemoptysis is the leading symptom - Dyspnea - Chills - Fever

Example No. 4
- Abdominal pain - Nausea - Vomiting

5. THE HISTORY OF THE CURRENT DISEASE

In this section we need to describe in detail the history of the current disease of the patient.
First, we need to specify: How did the disease start? Was it sudden or insidious? How long ago
did it begin? What are the symptoms? What was the patient’s attitude toward the disease?
Has the patient presented him- or herself to a doctor or stayed at home? Did the patient begin
medical treatment on the advice of a physician or did he or she begin treatment alone? Or did
the patient not follow any treatment? Did he or she start a drug treatment that had an
influence on the disease? Was there improvement, aggravation, or any influence? Is this the
first episode or have there been other similar episodes in the past? In this section it is
necessary to describe in detail the actual history of the patient as regards what he or she is
being hospitalized for, as complete as possible. If the patient currently has more than one
disease, we have to take a history of each one, following the same elements presented before.

6. FAMILY HISTORY

In this section we need to describe what diseases are in the patient’s family. What diseases
have the mother, father, brothers, sisters had? This is because there exists a risk for genetic
transmission, for example, arterial hypertension, diabetes mellitus, cancers at various
locations, and genetic diseases with dominant or recessive transmission. These diseases are
important because the patent has a genetic risk for developing these diseases at any point in
time.

7. PERSONAL PATHOLOGICAL HISTORY

In this section we need to describe all the diseases that the patient had in the past and also
surgical procedures, in chronological order, except for the current illness.

8. PERSONAL PHYSIOLOGICAL ANTECEDENTS

In this section we need to describe all the physiological antecedents in women regarding
menstrual cycles and pregnancies. At what age did the first cycle (menarche) occur? Normal
age is between 12 and 14 years. Have menstrual cycles been regular? Once per month?
Normal cycle is 28 days. How many days does the flow take? Normal is between 3 and 5 days.
How do you estimate the amount of blood lost during the menstrual cycle? Normal is between
300 and 500 mL of blood. Have you ever had cycles longer than 10 days? This is called
menorrhagia. This is specific for uterine fibroids. Have you ever had bleeding between
menstrual cycles? This is called metrorrhagia. This is specific for uterine fibroids Have you had
abnormal menstrual cycles with a quantity more than 500 mL? This is called hypermenorrhea.
This is specific for uterine fibroids Have you had abnormal menstrual cycles with increased
quantity and with blood clots and prolonged duration of more than 5 days? This is specific for
uterine fibroids. How do you describe the color of the blood? Normal is fresh red. Have you
ever had a dark bleeding that looks like coffee or coffee grounds? This is specific for uterine
carcinoma. Have you ever had bleeding like juice in which meat was washed? This is specific
for uterine carcinoma. Are you in menopause? At what age did menopause begin? Normal age
for menopause is between 45 and 50 years. Are you in early menopause or artificial
menopause after ovariectomy, radiotherapy, or chemotherapy? This is a risk factor for
ischemic heart disease, because the woman has lost the protection of estrogen hormones
against atherosclerosis. Have you had bleeding in menopause? This is specific for uterine
carcinoma. Have you been pregnant, and how many times? Was the delivery at normal time, 9
months, or early or late? Have you had any abortions, and how many? Were the abortions
spontaneous or induced? What did your babies weigh after delivery? Normal weight is
between 3 and 4 kg. A baby bigger than 4 kg is a “big baby” or has macrosomia and represents
a risk factor for diabetes mellitus of the mother in the future. A baby less than 3 kg is
premature.

9. LIFE CONDITIONS

The life conditions of the patient are very important. Especially important are the housing
conditions, eating, and toxic consumptions.

A. The housing conditions

The housing conditions are very important because people spend most of their time at home.
It is important to know how many persons live in a room and how many rooms are in the
house. The infectious contagious diseases such as viruses, pneumonia, and tuberculosis are
transmitted when the people cohabit. Another important condition is the cleanliness of the
house. Is it a clean house or not? Is it an overcrowded house or not? Are people living together
with cats, dogs, a parrot? Because animals can transmit diseases to the persons who live with
the animals. Room air conditioning is a risk factor for respiratory tract infections and allergies
as well.

B. Eating

A person’s diet is very important. It must be nutritionally balanced in accordance with the
physical effort. A normal diet should be varied and balanced in the content of proteins,
carbohydrates, lipids, and vitamins. A unilateral diet excessive in glucoses and carbohydrates
represents a risk factor for diabetes mellitus. A unilateral diet increased in animal lipids
represents a risk factor for dyslipidemia, atherosclerosis, ischemic heart diseases, angina
pectoris, and heart attack. Also, excess calories together with sedentary habits are a risk factor
for obesity, high blood pressure, and diabetes mellitus. Deficiency in diet leads to weight loss.
Failure to eat regular meals is a risk factor for the occurrence of gastritis and gastric or
duodenal ulcers.

C. Toxic consumptions

In this section, the patient should be asked about the toxic consumption of alcohol, smoking,
coffee, and drugs.

Alcohol consumption In terms of alcohol consumption the patient should be asked how often
he or she consumes alcohol: every day or occasionally? The truth is that alcohol is often not
recognized by the person concerned; usually the family is the one who informs the doctor
about alcohol consumption. It is important to know the amount consumed and what kind of
alcoholic beverages are consumed, hard alcohol or light alcohol, like beer or wine? Persons
with chronic alcohol consumption have risks for many diseases, such as chronic alcoholic
hepatitis, liver cirrhosis, gastric or duodenal ulcers, mental illnesses such as alcoholic
dementia, and others.
Smoking Smoking is another risk factor for many diseases. It is really important to ask the
patient at what age he or she began smoking (how long?). What type of cigarette, with filter or
without filter? How often? Daily? How many cigarettes per day? Pipe smokers are at risk for lip
cancer. Smoking is an important risk factor for cardiovascular diseases such as ischemic heart
disease, angina pectoris, acute myocardial infarction, cardiac arrhythmias, and sudden death;
respiratory diseases such as chronic tobacco bronchitis, COPD, and bronchusepulmonary
cancer; and digestive diseases such as gastric ulcer or duodenal ulcer. We must consider the
state of the passive smoker. This is represented by peopledinnocent victimsdwho passively
inhale cigarette smoke because they are around a person who smokes. The most innocent
victims are children. Passive smokers are at risk for the aforementioned diseases in a
percentage almost as great as active smokers! The younger the age at which smoking started,
and the higher the number of cigarettes a day, the higher is the risk for the diseases
mentioned.

Coffee Coffee consumption has been known from the earliest times. This small daily vice is
practiced around the world. Abuse of coffee consumption can cause palpitations, tachycardia,
irritability, nervousness, and insomnia. It is also a risk factor for the occurrence of high blood
pressure and dangerous arrhythmias.

Drugs Drug consumption represents a risk factor for dangerous arrhythmias, myocardial
infarction at a young age, and sudden death. Bacterial endocarditis represents another risk
after drug consumption. Drug consumption must to be stopped, especially because many
victims are young people.

10. WORKING CONDITIONS

Working conditions represent another important part of the history of the patient. Many risk
factors are present at the workplace. For this reason it is very important to ask and to know
the profession of the patient. How many hours are worked per day? Risk factors from work
include dust, humidity, and noise. Does the patient work during the night? Work
supplementary hours? How are his or her relationships with colleagues? Relationship with the
boss? Everything is important!

11. GENERAL MANIFESTATIONS

The history of the patient finishes with a few important questions regarding general
manifestations such as:

Appetite The weight curve - increasing? - decreasing? - stationary? The stool The urine
Frequency of urination in 24 h? Diuresis? Sleep Do you sleep during the night? Do you have
insomnia?

The history of the patient is finished with these general manifestation questions.

I'm really happy! We're done with patient history!