Diagnosing Disease

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Medical History

The GP will ask questions to clarify the situation:

  • "What type of pain is it?"
  • "Where are you experiencing the page?"
  • "How long have you had the pain?"
  • The GP uses an unstructured interview (clinical interview)
  • This means the questions that are asked are influenced by the replies to previous questions

The GP will also ask the patient personal information:

  • This will include previous illness and treatment
  • What current medication the patient is taking
  • The patient lifestye including exercise, smoking status, drug use, alcohol consumption, and occuptation
  • Previous history of disease in other family members
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Physical Examination

  • This is used by the GP to determine symptoms 
  • Reduces the list of possible diagnoses
  • Enables the GP to move towards a definite diagnosis
  • Including: visual examination, use of stethoscope, palpation, testing reflexes, percussion, taking temperature, measuring blood pressure
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Physical Examination - Visual Examination

  • The GP wil observe the apearance of the patient
  • They will look for signs such as pallor
  • Also, evidence of confusion or anxiey for mental health diagnoses
  • As well as noting wheher the patient is overweight or experiencing breathing difficulties                                                                                                                                                                                            
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Physical Examination - Use of a Stethoscope

  • A stethoscope is a simple device that chanels sound from a small metal dish along two tubes connecting to the GP's ears
  • No amplification is involved
  • The GP can listen to the heart, arteries, lungs and digestive system 
  • For example, breathing will sound noisy if the airways are obstructed or if excess fluid is present in the lungs
  • The GP is trained to identify abnormal sounds within these bodily systems
  • This then leads to a diagnosis of a problem
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Physical Examination - Palpation

  • Palpation means feeling part of the patient's body with the fingers
  • This helps the GP to detect abnormalities in organs such as tumours or swellings that be identified through the skin
  • Palpation also enables the GP to identify whether or not the patient feels pain when the organ is subjected to slight pressure
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Physical Examination - Percussion

  • Percussion is a diagnostic technique in which GP holds one or two fingers against the patient's body 
  • The GP will then taps these fingers with the other hand while listening to the resulting sound
  • This is useful to assess the condition of the lungs
  • A hollow sound will indicate that the lung is clesar of fluid
  • A dull and muffled sound will indicate that fluid is present
  • This therefore leads the GP to a dianosis such as pneumonia 
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Physical Examination - Reflex Testing

  • This enables he GP to detect damage to nerve pathways
  • The patellar (knee-jerk) reflex is tested when the leg is relaxed and the weight of the leg is supported entirely by the thigh (the legs are often crossed)
  • A point just beow the patela is tapped using a rubber hammer 
  • This stretches the tendon and sends a nerve impulse to the spinal cord 
  • This then triggers another nerve impulse from the spinal cord, which trigers the thigh muscle to contract 
  • The result is that the lower leg jerks upwards
  • Absence of a reflex response may indicate damage or disease to the nerve pathway or spinal cord
  • This enables the GP to assess whether a person's back pain is caused by a probem with the spine or cased by a muscle strain
  • Neck reflexes and Moro reflex are present in newborn babies but are lost after a few weeks
  • A paediatrician will test these after birth to check that an infant's development is normal
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Physical Examination - Temperature

  • A GP might measure a patient's temperature using a thermometer placed in the mouth 
  • Sme thermometers are in the form of a closed glass tube containing mercury, which expands along the tube when heated
  • Digital electronic thermometer have a probe at the end which is placed under the tongue of the patient and digitally displays the temperature
  • Alternatively, an infrared ear thermometre might be used
  • A reading of around 37 is normal
  • Temperatures of 39 and above indicate fecer, which can occur with a number of infectious diseases such as flu and meningitis
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Physical Examination - Blood Pressure

  • Blood pressure measurements are useful for a GP to assess the condition of the patient's cardiovascular system 
  • High blood pressure (hypertension) is fairly cmmon condition, particularly in older and obese individuals
  • Hypertension increases risk of strokes and kidney disease
  • Low blood pressure (hypotension) is not necessarily a sign of disease 
  • An aerobically fit person is likely to have low restng blood pressure 
  • However, in some cases, hypotension is a sign of diabetes
  • Blood pressure is measure using a sphygmomanometer and is expressed as milimetres of mercury (mHg)
  • A healthy young adult should have a blood pressure reading of 120/80 
  • 120 mmHg systolic, which is created by the contraction of the ventricles of the heart
  • 80 mmHg diastolic pressure is recorded during relaxation of the ventricles between heatbeats
  • The overall reading of blood pressure reflects the resistance of all he small arteries in the body and the load aainst which the heart must work 
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Physical Examination - Blood Pressure

How blood pressure is measured:

  • A hollow rubber cuff is placed around the patient's arm just above the elbow 
  • A pump is used to inflate the cuff
  • This grips the arm tightly and stop blood flowing past the cuff along the artery leading to the hand
  • A tube attached to the cuff leads to a pressure gauge
  • The GP will place a stethoscope on the arm below the cuf
  • Air is slowly let out of the cuff while the GP listens 
  • When the pressure is enough for blood to travel down the artery, a pulse will be heard through the stethoscope
  • The Gp records the pressure reading on the gauge
  • This is the systolic reading, which should be between 90 and 120
  • The GP will let more air out the cuff until the sound of the pulse disappears again
  • This means there is no pressure between the air and the blood and its lowest pressure
  • The pulse increases as more blood is pumped through the artery
  • This reading is the diastolic which should be between 60 and 80
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Diagnostic Tests

After taking a medical history, questioning and observing the patient, and carried out physical examinations, the GP is likely to make a diagnosis.

However, if there is such an enormous range of different disease conditions, the GP cannot always be expected to make a correct diagnosis without additional help.

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Use of Computers

  • GPs can use computers in several different ways to aid diagnosis
  • A GP may look at a database that includes a patient's medical records, to check for previous illnesses and treatments
  • Clinical Decision Suport Sstem (CDSS) is used also by GPs
  • This system is intended to help with diagnosis as well as prescribing treatment
  • They are not intended to replace the rle of the GP
  • CDSS will enable the GP to type in information such as blood pressure, test results and answers to diagnostic questions, in which it will give the GP a range of possible diagnoses
  • This indicates diagnoses that the GP may not have considered 
  • One widely used system is PRODIGY and ISABEL, which specialises in diagnosing childrens conditions
  • CDSS can reduce medical errors in diagnosis and treatment
  • However, practitioners may rely on it too much instead or improving their own knowledge
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When a disease is diagnosed that will require hospital treatment, or in cases where diagnosis is uncertain but a serious medical condition is susoected, the  will refer the patient to a specialist medical consultant. 

A consultant specialises in just one area of medicine, such as cardiology or orthopaedics, where as GP can be consulted about any medical condition, and there knowledge is not as deep as a consultant.

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