introduction to medicine

1. › INTRODUCTION TO
MEDICINE
Dr. Bilal Natiq Nuaman, MD
C.A.B.M. , F.I.B.M.S. , D.I.M.
Assistant Professor of Medicine,
Al-Iraqia Medical College
2019-2020

2. Internal Medicine
The branch of medicine that deals
with the prevention, the
diagnosis and non-surgical
treatment of diseases affecting
adults within its scope .
Doctors specializing in internal
medicine are called internists or
physicians
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3. Scope of Subspecialties of Internal Medicine
› Allergy and Immunology (immune system)
› Cardiovascular disease (heart and vascular
system)
› Endocrinology, Diabetes, and
Metabolism (diabetes and other glandular and
metabolic disorders)
› Gastroenterology (gastrointestinal system, liver
and gall bladder)
› Hematology (blood)
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4. Infectious Disease (bacterial, viral, fungal, and
parasitic infections)
Nephrology (kidneys)
Oncology (cancer)
Pulmonary Disease (lungs and respiratory system)
Rheumatology (joints and musculoskeletal system)
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5. › Symptom vs. sign
› • A symptom(complaint) is subjective feeling from
the patient point of view.
› • A symptom is what the patient experiences about the
disease.
› • Symptoms can only be experienced, they are not able to
be observed or measured objectively.
› • Pain is a symptom. I do not know you are having pain
unless you tell me. Nausea is also a symptom, as are:
chills, numbness, fatigue, vertigo, malaise, itching,
stomach cramps, burning on urination, etc. 5

6. A sign is an objective physical manifestation of
disease.
› •It is an objective finding, something one can observe
and measure.
› •A rapid pulse, a high temperature, a low blood
pressure, an open wound, bruising, etc. are all signs.
› •Signs give a more definite indication of the presence
of a particular disease to the physician.
› So in the simplest form, signs are
observations of the doctor and symptoms are
the experiences of the patient.
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7. › Internal Medicine ,
Management ,
sequence of roles
› 1-DIAGNOSIS
› 2-TREATMENT
› 3-PREVENTION
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8. Medical Diagnosis
• Sequence of Diagnosis
1--Historytaking from patient (record
patient symptoms like: dyspnea, chest pain,
vomiting, ankle swelling, weight loss,
cough,…..etc )
2--Examinationof the patient (looking
for physical signs like: hepatomegaly,
murmur, rhonchi, tachycardia, Exopthalmos,
facial palsy…..etc )
3--Investigations (ECG, CXR, RBS, abdominal
US, Echo, sputum for AFB……etc)
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9. › Patients commonly have complaints
(symptoms). These symptoms may or may
not be accompanied by abnormalities on
examination (signs) or on laboratory
› testing.
› Conversely, asymptomatic patients may have
signs or laboratory abnormalities, and
laboratory abnormalities can occur in the
absence of symptoms or signs.
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10. Want big impact?
USE BIG IMAGE
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Only with a correct diagnosis, or a
short-list of possible diagnoses, can you:
• formulate an appropriate sequence of
investigations
• begin correct treatment and assess its
effectiveness
• give an informed prognosis and make
follow-up arrangements.

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Frequently the identification of an abnormality
is only the first step in the diagnostic process
and additional assessment is required to
characterize a condition in greater detail or
search for an underlying cause.
For example, in a middle-aged man presenting
with fatigue, you might identify anemia as the
cause of his symptoms, but the diagnostic
process would not stop there.

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The
next step would be to establish the cause of
the anemia. If subsequent laboratory investigations
revealed evidence of iron deficiency, you
need to determine the cause. Gastrointestinal
investigations might uncover a gastric tumour
but, even then, further assessment would still
be required to establish a tissue diagnosis and
stage the tumour (Biopsy, CT abdomen).

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The eventual ‘final diagnosis might be of iron-deficiency
anemia secondary to blood loss from a gastric
carcinoma with metastasis to liver and peritoneum.
Clearly, the diagnosis of ‘anemia’ would have been
grossly inadequate.

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Some conditions, especially functional disorders
such as irritable bowel syndrome, lack a
definitive confirmatory test; here diagnosis relies
upon recognizing characteristic clinical features
and ruling out alternative diagnoses – especially
serious or life-threatening conditions. Such
disorders are often referred to as diagnoses of
exclusion.

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24. THANKS!
Any questions?
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