Internal medicine

1. Internal Medicine
Propedeutics

2. Goals
• Dentists don’t treat only healthy people
• Dental treatments can affect the patient
health
• Dentists can discover some signs of
special diseases
• Emergency treatments in internal
medicine
• Increase the communication skills
• Give a wider horizon to medicine
• Help to be more competitive

3. Dentistry - Internal Medicine Propedeutics
1. Introduction. History taking. The principles of physical examination.
2. Techniques of physical examination. Physical examination of the head and neck region.
3. History taking in chest and lung diseases.
4. Physical examination of the chest and lung.
5. Disorders of the respiratory system (pneumonia, bronchial asthma,
pleural diseases, tumors).
6. History taking in cardiovascular diseases.
Physical examination of the cardiovascular system.
7. Symptoms and signs of common cardiovascular diseases (ischaemic
heart diseases, valvular diseases, heart failure).
8. Symptoms and signs of vascular diseases. Examination of the
peripherial vessels. (Hypertension, diseases of the venous system and
peripherial arteries).
9. Symptoms of the abdominal diseases.
10. Physical examination of the abdomen.
11. Symptoms and signs of common gastrointestinal disorders (oesophageal
diseases, ulcers, gastrointestinal tumors, liver and biliary diseases, pancreatitis).
12. Symptoms and signs of endocrine diseases, diabetes mellitus and metabolic
disorders.
13. Physical examination of the kidney and genitourinary system.
Symptoms and signs of common renal diseases (glomerulonephritis,
nephrotic syndrome, urinary tract infections, nephrolithiasis, renal failure).
14. Symptoms and signs of common haematological diseases.

4. • Barbara Bates
Guide to physical examination and history
taking
• Lynn S. Bickley
Bates’ guide to physical examination and
history taking

5. Diagnosis – an injured mosaic

6. The main parts of the diagnosis
– Pathological
– Etiological
– Anatomical
– Prognostic

7. Medical examination
• Patient history
• Physical examination
• Laboratory and instrumental examination

8. Patient history
0. Introduction
Date of the history
Identifying data
Source of referral
Reliability of the history

9. Patient history
0. Introduction
1. Chief complaint(s)

10. Patient history
0. Introduction
1. Chief complaint(s)
2. Present illness

11. Present illness
• Location
• Quality
• Quantity or severity
• Timing (onset, duration, frequency)
• Setting in which it developed
• Factors that aggravated or relieved
• Associated manifestations
• Treatments

12. Patient history
0. Introduction
1. Chief complaint(s)
2. Present illness
3. Past history

13. Past history
• Most important diseases in chronological
order (hospitalisations)
• Operations, injuries, accidents
• Allergies (drug, food, pollens etc.)
• Transfusion(s)
• Screening tests

14. Patient history
0. Introduction
1. Chief complaint(s)
2. Present illness
3. Past history
4. Current health status

15. Current health status
• Social circumstances
• Occupation (recent and past)
• Enviromental hazards (home, school, workplace)
• Diet (incl. beverages)
• Alcohol and illicit drugs (type, amount, frequency, duration
of use)
• Tobacco (type, amount, duration)
• Current medication
• Exercise and leisure activities
• Sleep patterns
• Sexual history

16. Patient history
0. Introduction
1. Chief complaint(s)
2. Present illness
3. Past history
4. Current health status
5. Family history

17. Family history
• Parents, siblings, spouse, children, other
relatives
– age; age and cause of death; health status; important
diseases
• Occurence of
– Diabetes
– Hypertension, heart diseases, stroke
– Infective diseases
– Malignant diseases
– Coagulation disorders
– Psychiatric diseases, alcoholism, drug addiction
– Symptoms like those the patient

18. Patient history
0. Introduction
1. Chief complaint(s)
2. Present illness
3. Past history
4. Current health status
5. Family history
6. Review of organ systems

19. Review of organ systems
• General
– General status
– Usual weight, weight change
– Fatigue
– Fever
• According to organs
• Skin, Head, Eyes, Ears, Nose, Mouth, Neck,
Breasts, Respiratory, Cardiac, Gastrointestinal,
Urinary, Genital etc.

20. Patient history
0. Introduction
1. Chief complaint(s)
2. Present illness
3. Past history
4. Current health status
5. Family history
6. Review of organ systems