Diagnosing and Treatment

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Medical History

Asking questions using an unstructured interview technique. The questions are influenced by previous answers.

The GP will ask:

                          Duration, Percistance and Intensity

- Previous illness/ treatment

- If they are currently taking/ recieving any treatment/ medication

- Lifestyle choices

- Family history of choice

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Physical examination

- Visual examination

- Use of stethoscope

- Palpatation

- Percussion

- Reflex testing

- Measuring temperature

- Measuring blood pressure

Detects other symptoms of disease to help make accurate diagnosis

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Viual examination

- Involves looking at the affected part of the body

- Can reveal arthritis (swelling and distortion) or skin rashes

- The patient may be asked to remove clothing which may cause embaressment

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Stethoscope

This device channels sound from a small metal dish through two tubes to the GP's ears.

No amplication is used.

It allows you to listen to the heart, lungs, arteries, and digestive system.

it can detect heart arrythmias, breathing will sound noisy if airways are obstructed with excess fluid, it's also used to measure blood pressure.

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Palpation

- Involves feeling parts of the patients body with the fingers

- Can detect abnormalities such as tumours or swellings

- Also allows them to apply pressure to the organs to idnetify whether the patient feels pain

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Percussion

- Involves the GP holding one or two fingers on the patients body and then tapping.

- This then results in a sound

- Used to acess the condition of the lungs

- Hallow sound indicates clear lungs

- Dull or muffled = fluid present, could be a sign of pneumonia

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Reflex testing

It can detect damage to the nerve pathways

The patellar reflex test is used by tapping the rubber hammer agaisnt the patellar.

This then stretches the tendon and nerve impulse is triggered causing muscles to contract, resulting in the knee jerking upwards.

Abscense of response may idnetify damage/disease to nerve pathway or spinal cord. Also assess whether the patient is recieving back ache from muscle strain or the spinal cord.

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Measuring temperature

A glass thermometer is placed into the patients mouth. The liqued in the thermometer expands when heated.

Digital electronic devices are used with a probe at the end which is also placed under the tongue.

Infra red ear thermometer may also be used to measure temperature.

37 C is normal body temperature

Temperatures of 39 C indicates fever.

Infectious diseases - Flu and meningitis

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Blood pressure

Helps assess the condition of the cardiovascular system.

High blood pressure (hypertension) is common n elderly and obese people

Hypertension increases the risk of CHD, stroke and kidney disease

Low blood pressure (hypotension) is common in aerobically fit people

Hypotension can be a sign of diabetes

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Features of illness

Signs: Objective and can be observed by the GP

Symptoms: Subjective and only accesible by the patient

GP will observe:

                         - Pallor

                         - Overweight

                         - Breathing difficulties

                         - Evidence of anxiety

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Use of computers

GP's will use it to aid diagnosis

Computers are used to look at patient medical records to see any previous illness's

They use the Clinical Decision Support System (CDSS)

PRODIGY and ISABEL are examples

It has a greater knowledge of different diseases within help to diagnose and prescribe medication.

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X-Rays

X-rays are a type of electromagnetic radiation. They have short wavelengths which enables them to penetrate materials.

An x-ray machine produces invisible beams of x-rays which are directed to the part of the body being x-rayed.

They can penetrate through body tissues but not metal or bones.

The part of the body being exposed to x-ray beams is placed on a sheet of photographic paper.

More x-rays can pass through less dense objects (tissue) then dense objects (bone and metal) therefore a contrast is left and produced.

A photographic negative is made: dense objects show as white and less dense objects show as dark.

The photographic negative is placed on a illuminated panel to be examined.

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Computer Tomography scan vs X-ray

- CAT requires patient to be slid into a cylinder tube which contains a scanner. The scanner rotates the around the patient emuting and recieving any X-rays.

- CT produces a digital image rather than a photopraphic image.

- The image can be stored electronically, viewed on a computer and printed out.

- CT scan produce cross sections and 3D images of the body

- CT produces clearer images

- CT can image of organs incased in bone

- The radiation is limited in comparison to conventional x-ray

- CT scanning is expensive

- A CT scanner is much larger than a conventional x-ray

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Mammography

A radiology technician will ask the client to undress to the waist where she will then be asked to place one breast at a time upon the platform of the mammogram unit.

The breast will be slightly compressed. An x-ray beam will pass through the breast where the images are taken and recorded.

This process will be repeated three more times to ensure taht there are four images taken in total.

The compression will even out the breast thickness where it will identify if there are nay areas or patterns of calcium to identify change in breast tissue.

The patients reproductive organs will need to be covered using a lead aprong as exposure to x-rays can cause infertility and birth defects.

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Contrast X-rays

X-rays can also be used to examine softer tissue structures. Although hallow fluid-fuled organs e.g. the digestive tract  are difficult to image.

A contrast medium is put into the figestive tract, the liqued contains metal salts which are opaque to x-rays.

The patient can swallow the liqued: barium swallowed or barium meal.

Used to monitor the stomach, barium sulphate may be injected into the rectum; barium enema. For the digestive tract.

It can be used to examine the circulatory system where iodine is injected into the circulatory system vis a catheter.

An x-ray of the heart using the method is called an angiogram.

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Ultrasound

The radiographer will ask the pregnnat women to uuncover her abdomen.

Oil or gel is placed onto the abdomen to ensure good contact and to enable sound waves to penetrate through the skin.

A transducer produces a beam of high frequency sound waves.

The frequency is higher than human hearing range.

the high frequency sound waves penetrate through soft tissues and reflect of denser objects e.g. bone and dense tissues

The transducer will also recieve the detected sounds and reflection from the different boundries in the abdomen.

Computer software can process the data to produce a real time or 2D image.

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Radionucide scanning

- Radionuclides are radioactive forms of isotapes

- Radioactive isotapes : Carbon, Nitrogen, Oxygen, Iodine and Fluorine are used.

- The isotapes decay quickly- decreases radioactivity to ensure it doesn's pose a large risk to the enviroment.

- Combined with other elements e.g. glucose to make it easier to be absorbed.

- They're placed into the body via a drip into the vein.

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Positron Emission Tomography (PET)

- Positrons have a positive charge
- They're emmited from radioactive decay
- It allows the study from metabolic processes within the body
- It's inserted via injection or swallowed

- The patient lies on the bed and is slid into the scanner
- A reciever within the scanner detects the radiation emuted from a slice or cross section
- A computer analysis the data creating a coloured image
- Brightest colours (yellow+red) indicate the highest amount of radioactivity
- These are areas with the greatest amount of glucose
- It is particularly useful at looking at brain activity
- Drak areas show inactivity, dysfunction or less blood present
- It can identify alzheimers or a stroke
- It can also monitor heart function

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MRI imaging

1. Scanning takes place in a large, horizontal cylinder where the patient lies still and is slowely pushed in

2. The machine is equipped with a strong electromagnet

3. It passes through a current to produce a strong magnetic feild.

4. The change causes the hydrogen atoms to align in parallel

5. A strong pulse of radiowaves is sent which knocks them out of alignment

6. The radiowaves are stopped which then causes them to re-align

7. This produces a detectable radio signal as they fall back into alignment

8. This is detected by the reciever

9. Using data manipulation the computer produces a 3D image

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Endoscopy

A technique used to observe relatively inaccesible parts of the body

It's a long tube equipped with optical fibres which is inserted through a body opening

Equipped with a light and a camera through the optic fibre cables enables image to be produced and shown on a screen.

Advantages:- examines tissue causing little damage

                    - Enables easy acess inside lungs and stomach

                    - Can be carried out at an outpatient visit as no incision is required

Disadvantages:- Invasive                                          Techniques used:- Bronchoscopy-airways

  - Can cause distress and discomfort                              - Gastroscopy-stomach

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