History taking and examination of swelling

For beginners of medical school art of history taking in clinics, point wise history taking, examination of swellings

1. History Taking And Examination of swelling

2. Purpose of History Taking It is said that over 80% of diagnosis are made on history alone By taking a proper history we can reach to exact diagnosis and able to know about course of the disease.

3. ART OF HISTORY TAKING   'Listen to your patient; they are telling you the diagnosis'

4. From Where should we start? Right from patient enters Observation - Gives some idea about General condition of the patient Its helpful to have a attendant with patient – gives valuable information about patient’s recent health

5. Comprehensive History Includes:- Particulars of patients Cheif complaints History of presenting illness Past history Family history Personal history Drug history History of allergy

6. 1. Particulars of patient NAME AGE SEX RELIGION OCCUPATION SOCIAL STATUS

7. A. NAME Making Rapport Psychology benefits to the patient B. AGE Some diseases are common in particular age groups Congenital anomalies – since birth BPH, Osteoarthritis – Old age Carcinoma affect mostly who have passed age of 40 but they should not be excluded by age alone

8. C. SEX As our body is built differently, disease/Malignancy is sex specific also. Beside these other diseases are seen in certain sex predominantly Oral Carcinoma in males Lung Carcinoma in males Breast Carcinoma in females Heamophilia in males

9. D. Religion Diseases are also associated with religious customs - Ca penis hardly occur in Jews and Muslims E. Occupation Ca lung- mining industry Ca scrotum – chimney sweeper Ca urinary bladder- Aniline dye industry

10. 2. Cheif complaints Chronological order In patients own words If complaints start simultaneously then in order of severity “we should always ask when He/She was perfectly well”

11. 3. History of presenting illness Begins with the first symptom and extend to the time of examination. Includes Mode of onset Progression Treatment “Recorded in patient’s language”

12. 4. Past History All diseases suffered by patient, previous to present one Recorded in chronological order 5. Family History Many diseases recurs in family Heamophilia Diabetes Hypertension Ca Breast

13. 6. Personal History patient‘s habits – smoking, Alcohol In women – menstrual and obs history 7. Drug history Ask about all drugs patient was on. specially about steroids, Insulin, antihypertensive, hormonal drugs, anti epileptics 8. History of Allergy

14. 9. Physical Examination General assessment – GC Mental status Build and state of nutrition Gait Pallor

15. 6. Cyanosis - central and peripheral 7. Icterus 8. Edema 9. Temperature

16. EXAMINATION OF SWELLING “Any enlargement or protuberance in the body due to any cause”

17. Types of swelling According to the cause Congenital Traumatic Inflammatory Neoplastic

18. Local Examination of swelling – We should proceed as Inspection Palpation Percussion Auscultation Examination of pressure effect

19. A. Inspection Site/ location- Idea about its origin Colour –Black, Red/purple, Bluish Shape Size Number – solitary , multiple Pulsation

20. 7. Movement on deglutition 8. Movement with protrusion of tongue 9. Skin over swelling – Red & edematous, tense and glossy, peau-d-orange

21. B. Palpation Temperature Tenderness Size shape & extent Consistency Fluctuation- liquid or gas containing

22. Fluctuation test Size measurement

23. 5. Translucency 6. Reducibility 7. Fixity to overlying skin 8. Relation to surrounding structures

24. Translucency test

25. C. Percussion To find out gaseous content of the swelling. Eg: resonant note in hernia. Hydatid thrill- 3 fingers test

26. D. Auscultation All pulsatile swelling should be auscultated to hear any bruits

27. E. Examination of pressure effect Artery Nerve Bone

28. THANK YOU