Flashcards in Clinical examination and history taking Deck (19):
What is intuitive reasoning?
"Gut feeling" - what you feel to be true even without conscious reasoning.
What is transparent reasoning?
Based on knowledge.
Clinical assessment - why do we do it?
To narrow down what could be wrong with the patient (e.g. Microbiology - have they been traveling recently).
Clinical assessment - why do we need a diagnosis?
- to determine best treatment.
- allows appropriate monitoring of complications.
- enables prognosis (to forecast the likely outcome).
- to allow the protection of others where needed.
What does clinical assessment involve?
- Clinical examination.
(Note: not always in this order - e.g. If emergency often management comes first).
What is the most important part of clinical assessment?
When taking a patients history what do you need to know?
- Patient details (name, D.O.B, mode of referral).
- Presenting complaint (important to know history of this - time period, site + onset, character: sharp/dull).
- Past medical/surgical history.
- Drug history (allergies, antibiotics affect which tests carried out).
- Family history (genetic component?).
- Social history (ethnicity, location).
* look for red flag symptoms *
When taking a family history in genetics what do you need to think about?
- Diseases in parents/siblings?
- Age of onset (crucial).
- Consanguinity (highly promotes the risk of autosomal recessive diseases).
- Family tree should be drawn up.
When completing a history what should you do?
Summarise key points to the patient.
What difficulties may be faced during a consultation?
- Barriers to communication.
- Social/cultural attitudes (only want female doctor).
- Effect of disease/medications.
What is a clinical examination for?
- To confirm/exclude differential diagnoses.
- To find other signs of disease process/aetiology.
- All clinical examinations are different (focussed v general - depending on what the patient comes in for).
When requesting tests what do you need to do?
- Ensure you have correct patient details.
- Explain what tests you are requesting.
- Give enough clinical info for accurate interpretation of results and so that the correct test is selected (e.g. Tests may differ if patient pregnant, if they have routine medication or hormonal cycle/sex).
Investigations don't always take place in the ward, where may they be carried out?
Samples may be sent to Biochemistry, haematology, microbiology, histopathology for investigation.
Why are investigations carried out?
- To confirm or exclude differential diagnoses in symptomatic patients (unexpected results may require review of history/examination).
- screening tests for disease (mammogram: offered every three years for woman over 50y to check for breast cancer.
- surveillance tests for disease in high risk population.
The diagnostic accuracy of a test depends on?
The sensitivity and specificity of the test.
What do we mean by test sensitivity?
Proportion of actual positives correctly identified (if test has 100% sensitivity then all the patients with the condition will test positive).
What do we mean by test specificity?
Proportion of actual negatives correctly identified (if test has 100% specificity all patients without the condition will test negative).
What is meant by reference range of a test?
- The values most prevalent in a reference group taken from the general population (this is known as the general reference range).
- There are also optimal health ranges (ranges that appear to have the optimal health impact).
- And there are ranges for particular conditions (such as pregnancy reference ranges for hormone levels)