Hx & Ex introduction

1. Hx & Ex introduction Ghassan A. Barayan

2. What is the doctor work Ghassan A. Barayan

3. Diagnosis Ghassan A. Barayan

4. Role in hospital • الإعتناء بالمظهر • حسن الخلق • الأمانة • احترام الزملاء • احترام الاكبر • التعامل مع الزميلات والممرضات • المحافظة على مرافق المستشفى Ghassan A. Barayan

5. dealing with patients • احترام سرية المريض • التعاطف مع المرضى • أجر عيادة المريض • الدعاء له • ابداء الاهتمام بمشاكل المرضى وهمومهم • الروح الإنسانية في التعامل • التواضع • الاستئذان و الشكر Ghassan A. Barayan

6. Breaking the fear • الاستعداد الجيد والتحضير • لست الوحيد الذي سيخطأ • هي الخطوة الأولى • كل دقه بتعليمة • لا تخجل من الخطأ • عالم جديد • تعامل ببساطه وبدون تكلف • خذها ببساطة Ghassan A. Barayan

7. Hx components • Personal data • Chief complaints • History of presenting illness • Systemic review • Past history • Drugs • Allergy • Blood transfusion • Social Hx • Family Hx • summery Ghassan A. Barayan

8. Personal data • Name • Nationality • Sex ( M - F ) • Age • Occupation ?? • Admission : ( ER - OPD ) • Duration Ghassan A. Barayan

9. Chief complaint + duration • In patient words Ghassan A. Barayan

10. History of presenting illness • Chronic illness • Analysis of chief complaint • Associated symptoms • Related systemic review • Previous episodes Ghassan A. Barayan

11. Pain analysis • SDN OPERA • S: site & severity • D: duration • N: nature • O: onset • P: precipitating factor & Progression • E: end • R: reliving factor , radiation & referred pain • A: aggravating factor & associated symptom Ghassan A. Barayan

12. Past Hx • Past medical: ( DM, HTN, IHD, TB, Asthma ) • Previous admissions. • Previous important investigations • Past surgical: Any previous surgery Ghassan A. Barayan

13. Blood transfusion • Where • When • Why • Complications of transfusion. • Amount Ghassan A. Barayan

14. Allergy • Food • Medication • Animals • Etc. Ghassan A. Barayan

15. Drugs • Name • Dose • Frequency • Side effects Ghassan A. Barayan

16. Social Hx • Smoking : “pack year= no. of cigarettes per day × years of smoking “ • Alcohols • Drugs abuse • Marriage & any sexual contacts. • Occupation • Education • Financial • Living : place & type • Travel • Animal contacts Ghassan A. Barayan

17. Family Hx • Similar disease • Other disease : cancer - IHD • Death in young age relative Ghassan A. Barayan

18. Systemic Review • CVS • Respiratory • GIT • Genitourinary • Hematology • Rheumatology • Endocrine • CNS

19. CVS • Chest pain or heaviness • Dyspnea ( extertional – orthopnea - PND) • Palpitation ( rate-regularity-time) • Syncope • Fatigue • Intermittent claudication • Cyanosis • Cold extremities • Ankle swelling Ghassan A. Barayan

20. Respiratory sys. • Chest pain • Cough • Sputum • Hemoptesis • Dyspnea • Wheezing • Strider • Night sweat • Fever • Hoarseness • Sore throat • Nasal discharge Ghassan A. Barayan

21. GIT • Appetite • Weight change • Lethargy • Water brash • Heart burn • Acid regurgitation • Dysphagia • Odinophagia • Nausea • Vomiting • hematemesis Ghassan A. Barayan

22. Jaundice • Pruritis • Color of stool & urine • Abdominal pain • Abdominal swelling • Bowel habit change (constipation , diarrhea, alternative) • stool: color, consistency, bulk • Bleeding (melena, hematochezia) • Anal pain or hemorrhoid Ghassan A. Barayan

23. Urinary Upper UT: • High fever • Chills • Mass • Hematuria • Pain ( flank – lion –groin) • Nausea Ghassan A. Barayan

24. Lower tact : • Irritative symptoms “FUNDUS” • Frequency • Urgency • Noctoria • Dysuria • Urge incontinence • Small void volume Ghassan A. Barayan

25. Obstructive symptoms • Hesitancy • straining • Disrupted stream • terminal Dribbling • Incomplete empty • overload incontinence • anuria Ghassan A. Barayan

26. Genital Male: • Impotance Female: • Menses • Amount - frequency -regularity -duration- pain - LMP Both: • Discharge • Rash Ghassan A. Barayan

27. Hematology • Symptoms of anemia Fatigue –palpitation – dizziness -sweating • Bleeding tendency • bleeding through any orifice (nose- mouth-anus-urethra) • Easy bruising • Puerpera • Thrompotic tendency • Infection • Fever • L.N. enlargement • Bone pain • Skin rash • Weight loss Ghassan A. Barayan

28. Rheumatology local : • joint pain • joint swelling • morning stiffness • loss of function • Instability • weakness • change in sensation • deformity • myalgia • neck pain • back pain Ghassan A. Barayan

29. Systemic: • rash • fever • fatigue • weight loss • diarrhea • mucosal ulcer • Photosensitivity • Rheanoid phenomena “white-red-blue” • Dry eye • Dry mouth • Redness Ghassan A. Barayan

30. Endocrine • Appetite • Weight change • Change bowel habit • Sweating • Hair distribution • Lethargy • Skin change • Pigmentation • Stature • Erectile dysfunction • Polyuria • Polydepsia • Lump in neck ( goiter ) • Weather sensitivity • Tremor • Psychogenic change • Menstruation Ghassan A. Barayan

31. CNS • Headache • Dizziness • Vertigo • Vision ( visual failed – acquit) • Hearing • Smell • Speech • Taste • Swallowing • Gait • Loss of sensation • Motor function • Tremor • Involuntary movement • Sphincter control • fits Ghassan A. Barayan