The document provides information on the diagnosis of diseases. It discusses diagnosis methods in conventional medicine including lab investigations and radiological investigations. It defines medical diagnosis as the identification of a disease based on objective and subjective symptoms. The document also outlines different types of medical diagnoses such as clinical, laboratory, radiology diagnoses as well as differential, pre-natal, and self-diagnoses. It describes the process of taking a patient's history, including chief complaints, present illness, past medical history, and social history, which are important for making an accurate diagnosis.

1. DIAGNOSIS OF
DISEASES
MADE BY
NIKITA SHARMA

2. CONTENT
INTRODUCTION : DIAGNOSIS
DIAGNOSIS METHODS ACCORDING TO
CONVENTIONAL MEDICINE
 LAB INVESTIGATIONS
 RADIOLOGICAL INVESTIGATIONS

3. ORIGIN OF TERM DIAGNOSIS
• The word is derived through Latin from Greek word :

4. INTRODUCTION
• Diagnosis is a part of internal medicine
• As we all, know “internal medicine is medical speciality
dealing with the prevention, diagnosis & treatment of adult
diseases”.

5. MEANING OF MEDICAL
DIAGNOSIS
• DEFINITION- Identification of a disease on objective
(measurable) & subjective (non-measurable) symptoms.

6. APPROACH TO PATIENT

7. FUNDAMENTAL OF DIAGNOSIS
• DIAGNOSIS: Identification of a disease by investigation of its signs
and symptoms.
• IDENTIFICATION
Inquiry
Physical examination
Laboratory tests/Special examination
• ANALYSIS
Basic knowledge of medicine
Overall analysis
Scientific way of clinical thinking

8. CLASSIFICATION OF DIAGNOSIS
IN MEDICINE

9. 1.MOLECULAR DIAGNOSIS

10. CONT.
• Molecular Diagnosis is a collection of techniques used to
analyse biological markers in the individual genetic
code[genome & proteome] & how their cells express their
genes as proteins.
• Used to diagnose & monitor diseases, detects risk &
decide which therapies will works best for the individual
patient.
• Useful in range of med. Specialism,including-infectious
diseases, oncology, pharmacogenomics –the genetic
prediction of which drugs will work the best.

12. MOLECULAR DIAGNOSIS ACROSS MEDICAL DISCIPLINE
1.INFECTIOUS DISEASES
• Pathogen identification; eg- MTB(Mycobacterium tuberculosis)
• Pathogen quantification; eg- HIV Load
• Drug resistance status; eg- MRSA(methicillin resistant staphylococcus aureus)
2. ONCOLOGY
• Predictive testing; e.g.- BRSA(bilirubin rat serum albumin)
• Comparison diagnostics; e.g.-EGFR(epidermal growth factor)
• Disease monitoring; e.g.- BCR-ABL(fusion genes found in myelogenous leukemia)
• Prognostic testing; e.g.- Oncotype 𝐷 𝑋
3. ENDOCRINOLOGY
Eg- Neonatal diabetes, Congenital adrenal hyperplasia
4. HAEMATOLOGY
• Blood disorders; e.g.- thalassemia
5. IDENTITY
• Transplantation; eg- HLA Typing
6. PRENATAL TESTING
• Eg- Trisomy 21 testing by aminocentesis, CVS or NIPD

13. 1.MEDICAL DIAGNOSIS(𝐷 𝑋 OR 𝐷𝑆)
• Process of determining ,which disease or condition explains a
person’s symptoms & signs.
• Information required for diagnosis is typically collected from a
history of patient & physical examination.
• It is often challenging because many signs & symptoms are non-
specific . Eg-redness of skin (erythema) by itself is a sign of disorder
& thus doesn’t tell the health care professional the exact cause .

14. HISTORY OF MEDICAL DIAGNOSIS
• First recorded examples are of Imhotep in ancient Egypt.
• Empiricism, logic & rationality in diagnosis of a disease was
introduced by Esagil-kin-apli in Babylon medical textbook i.e.
Diagnostic Handbook
• Huang di nei jing described 4 diagnostic methods which are used in
TCM till now they are- Inspection, auscultation- olfaction,
interrogation & palpation.
• Father of medicine, Hippocrates was known to make diagnosis by
evaluating his patient’s urine & sweat.

15. MEDICAL USES
• Diagnosis is an attempt at classification of an individual’s condition
into separate & distinct categories that allow medical decision
about treatment & prognosis to be made.
• It is often described in terms of disease & other condition .
• Diagnostic procedure does not necessarily involve elucidation of
etiology (cause) of the diseases.
• Diagnosis is initial task to detect a medical indications.

16. CONT.
INDICATIONS INCLUDES:
Detection of any deviation from normal
For eg- anatomically (structure of body)
Physiologically (how body works)
Psychologically (thought & behaviour)
Knowledge of what is normal & measuring of patients current
condition against those norms.

17. DIAGNOSTIC CRITERIA
• The term designates the specific combination of signs
,symptoms & test results that physician uses to attempt to
determine the correct diagnosis.
• And accordingly treatment should be given.

18. POSSIBLE ADVERSE EFFECTS
I. OVERDIAGNOSIS
• Diagnosis of diseases that will never cause symptoms.
• It is a major problem because it turns people into patient.
• Lead to economic waste (overutilisation) & treatments that
may cause harm.

19. II.ERRORS
• According to 2015 report of “NATIONAL ACADEMIES OF
SCIENCES,ENGINEERING & MEDICINE’’:
Most of the people experiences atleast 1 diagnostic errors in their life
time .
• Causes & factors of errors:
1. Manifestation of disease are not suffciently noticeable.
2. Disease is omitted from consideration.

20. CONT.
3. Too much significance is given to some aspect of the diagnosis.
4.Rare diseases with symptoms suggestive of many other conditions.
III. LAG TIME
• It is a delay time until a step towards diagnosis of disease or
condition is made.

21. CONT.
TYPES:
1.Onset to medical encounter lag time- The
time from onset of symptoms until visiting a
health care provider.
2.Encounter to diagnosis lag time-Time from
first medical encounter to diagnosis.

22. TYPES OF MEDICAL DIAGNOSIS
MAIN TYPES
1. CLINICAL
2. LABORATORY
3. RADIOLOGY
4. PRINCIPAL
5. ADMITTING
OTHER TYPES
1. DIFFERENTIAL
2. PRE-NATAL
3. DIAGNOSIS OF
EXCLUSION
4. SELF-DIAGNOSIS
5. REMOTE
6. NURSING
7. COMPUTER-AIDED

23. CLINICAL DIAGNOSIS
Content of Clinical Diagnostics:
• Symptomatic diagnosis
• Physical diagnosis
• Lab/clinical ancillary tests
• Medical record
• Diagnostics processes & the way of clinical thinking

24. SYMPTOMATIC DIAGNOSIS
I. History taking –Interview
II. Symptoms –Patients complaints
III. Symptomatic diagnosis

25. HISTORY TAKING
Introduction and
Describing Aim
&Objectives
Chief complaint
History of present
illness
Past medical history
Systemic enquiry
Family history
Drug history Social history

26. INTRODUCTION
Aim:
• At the end of the session students should know fundamentals of
history taking and take a history of a simple disease
Objectives:
• At the end of the session students should record:
• Chief complaint
• Present illness
• Past medical history
• Systemic enquiry
• Family history
• Drug history
• Social history

27. CHIEF COMPLAINTS
• The main reason push the point to seek for visiting a physician or for
help.
• Usually a single symptoms, occasionally more than one complaints eg:
chest pain, palpitation, shortness of breath, ankle swelling etc.
• The patient describe the problem in their own words.
• It should be recorded in points own words.
• What brings your here? How can I help you? What seems to be the
problem?

28. CHIEF COMPLAINTS
SHOULD BE:
• Short/specific in one clear sentence communicating present/major
problem/issue.
• Timing – fever for last two weeks or since Monday
• Recurrent –recurring episode of abdominal pain/cough
• Any major disease important with PC e.g. DM, asthma, HT, pregnancy.
• Note: CC should be put in patient language.

29. PRESENT ILLNESS
• Elaborate on the chief complaint in detail
• Ask relevant associated symptoms
• Have differential diagnosis in mind
• Lead the conversation and thoughts
• Decide and weight the importance of minor complaints

30. PAIN{OPQRST}
• Onset of disease
• Position/site
• Quality, nature, character-burning sharp, stabbing, crushing & also
explain depth of pain –superficial or deep
• Relationship to anything or other bodily functions /position
• Radiation-where moved to
• Relieving on aggravating factors –any activities or position

31. CONT.
• Severity –how it affects daily work/physical activities ; unable
to sleep,unable to do any work
• Timing-mode of onset [abrupt/gradual] ,
progression[cont./intermittent; if intermittent ask frequency &
nature]
• Treatment received or outcome

32. PAST MEDICAL HISTORY
• Start by asking the patient if they have any medical problems
• Heart Attack/DM/Asthma/HT/TB/Jaundice .E.g. if diabetic- mention
time of diagnosis/current medication/clinic check up
• Past surgical/operation history
E.g. time/place/ and what type of operation. Note any blood transfusion
and blood grouping.
• History of trauma/accidents
E.g. time/place/ and what type of accident

33. DRUG HISTORY
• Always use generic name or put trade name in brackets with
dosage, timing and how long. Example: Ranitidine 150 mg BD
PO
• Note: do not forget to mention OCP/Vitamins/Traditional
medicine/KAP

34. DRUG HISTORY
• bd (Bis in die) - Twice daily (usually morning and night)
• tds (ter die sumendus)/tid (ter in die) = Three times a day mainly 8 hourly
• qds (quarter die sumendus)/qid (quarter in die) = four times daily mainly
6 hourly
• Mane/(om – omni mane) = morning
• Nocte/(on – omni nocte) = night
• ac (ante cibum) = before food
• pc (post cibum) = after food
• po (per orum/os) = by mouth
• stat – statim = immediately as initial dose
• Rx (recipe) = treat with

35. SOCIAL HISTORY
• Smoking history - amount, duration and type. A strong risk factor
for heart disease
• Drinking history - amount, duration and type. Cause
cardiomyopathy, vasodilatation
• Occupation, social and education background, family social
support and financial situation

36. OTHER RELEVANT HISTORY
Gyanae/Obstetrics history [if female]
Immunization if small child
Travel and sexual history if suspected STD or infectious disease
Note
If small child, obtain the history from the care giver. Make sure; talk to
right care giver.
If some one does not talk to your language, get an interpreter(neutral
not family friend or member also familiar with both language)ask simple
& straight question but do not go for yes or no answer

37. GENERAL SYSTEM REVIEW
• Weakness
• Fatigue
• Anorexia
• Change of weight
• Fever
• Lumps
• Night sweats

38. GASTROINTESTINAL/ALIMENTARY
SYSTEM REVIEW
• Appetite (anorexia/weight change)
• Diet
• Nausea/vomiting
• Regurgitation/heart burn/flatulence
• Difficulty in swallowing
• Abdominal pain/distension
• Change of bowel habit
• Haematemesis, haematophagia
• Jaundice

39. CARDIOVASCULAR SYSTEM REVIEW
• Chest pain
• Paroxysmal Nocturnal Dyspnoea
• Orthopnoea
• Short Of Breath(SOB)
• Cough/sputum (pinkish/frank blood)
• Swelling of ankle(SOA)
• Palpitations
• Cyanosis

40. RESPIRATORY SYSTEM REVIEW
• Cough(productive/dry)
• Sputum (colour, amount, smell)
• Haemoptysis
• Chest pain
• SOB/Dyspnoea
• Tachypnoea
• Hoarseness
• Wheezing

41. URINARY SYSTEM REVIEW
• Dysuria
• Urgency
• Hesitancy
• Terminal dribbling
• Nocturia
• Back/loin pain
• Incontinence
• Character of urine color/ amount (polyuria) & timing
• Fever
• Frequency

42. NERVOUS SYSTEM REVIEW
• Visual/Smell/Taste/Hearing/Speech problem
• Head ache
• Fits/Faints/Black outs/loss of consciousness(LOC)
• Muscle weakness/numbness/paralysis
• Abnormal sensation
• Tremor
• Change of behaviour or psyche

43. GENITAL SYSTEM REVIEW
• Discharge
• Unusual bleeding
• Sexual history
• Menstrual history – menarche/ LMP/ duration & amount of cycle/
Contraception
• Obstetric history – Para/ gravida/abortion
• Pain/discomfort/itching

44. MUSCULOSKELETAL SYSTEM
REVIEW
• Weakness/movement
• Pain – muscle, bone, joint
• Deformities
• Gait
• Swelling

45. SOAP
• Subjective: how patient feels/thinks about him. How does he
look. Includes PC and general appearance/condition of patient
• Objective – relevant points of patient complaints/vital
sings, physical examination/daily weight,fluid
balance,diet/laboratory investigation and interpretation
• Assessment – address each active problem after making a
problem list. Make differential diagnosis.
• Plan – about management, treatment, further
investigation, follow up and rehabilitation

46. SYMPTOMS & SIGNS
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.

47. CONT.
Subjective sensation that patient describes
Physiological &
functional
Pathological &
morphological
Fever Cough Rash Mass

48. CONT.
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.

49. LAB INVESTIGATIONS

50. LAB/CLINICAL ANCILLARY TESTS
• Serum test
• Urine test
• Blood test
• stool test
• Sputum test
• Serous membrane fluid
• CSF test

51. LABORATORY TEST
• Laboratory tests check a sample of blood, urine, or body tissues.
• A technician or doctor analyses the test samples to see if results fall
within the normal range.
• The tests use a range because what is normal differs from person to
person. Many factors affect test results. These include:-
 Sex, age and race
 What to eat and drink
 Medicines
 How well the pre-test instructions are followed

52. CONT.
• It is often useful in comparing the results to results from previous tests.
• Laboratory tests are often part of a routine check-up to look for
changes in the health.
• It also help doctors diagnose medical conditions, plan or evaluate
treatments and monitor diseases.

53. A1C/GLYCOHEAMOGLOBIN/Hb
A1C TEST
• It is used to test for type 2 diabetes & prediabetes
• It measures –Average blood glucose or blood sugar level over past 3
months
• This is often used to see how well one is managing diabetes
• It is different from blood sugar checks that people with diabetes do
everyday

54. CONT.
• CLINICAL VALUES OF A1C TEST
NORMAL VALUE= Below 5.7%
PRE-DIABETES=B/W 5.7 -6.4%
TYPE 2 DIABETES= Above 6.5%
• Done twice in a year for diabetic patients
• May need to retests every year for pre-diabetic patients

55. RECENT CLINICAL TRIALS
[BY U.S. National institutes of Health]
1. Designer functional foods on parameters of metabolic & vascular
in pre-diabetes
 condition=pre-diabetes
Interventions= dietary supplements:functional ingredient group,
dietary supplements:conrol ingredients group

56. 2.Effects of RBC survival on a commonly
used diabetes lab test HbA1C
Condition= diabetes mellitus,impaired fasting glucose, pre-diabetes
Interventions= biological: re-infusion of biotin labelled cells,
behavioural: diabetes education & medication adjustments.

57. 3.USING PEER MENTORS TO SUPPORT
PACT TEAM EFFORTS TO IMPROVE
DIABETES CONTROL
Condition= type 2 diabetes mellitus
Interventions= Behavioural: peer mentoring

58. BLOOD COUNT TESTS
• Also known as- CBC, complete blood count, hematologic tests
• Blood contains –RBC,WBC,& platelets
• This test measures no. & types of cells present in blood
• Tests can diagnose disease conditions such as-anaemia, infections,
clotting problems, blood cancer, & immune system disorders

59. COMPOSITION OF BLOOD

60. 7 SPECIFIC TYPES INCLUDES TESTS FOR:
RBC- The no., size & types of RBC in blood
WBC- The no. & types of WBC in blood
PLATELETS- The no. & size of platelets
Hb- iron rich protein in RBC that caries oxygen
HEAMATOCRIT – total space occupied by RBC in blood
RETICULOCYTE COUNT –No. of young blood cells in blood
MEAN CORPUSCULAR VOLUME(MCV)-Average size of RBC

64. DIFFERNTIAL COUNT
• Absolute neutrophil count
• A measure of the number of neutrophil granulocytes

65. CLINICAL VALUES OF ANC
• Normal – ANC = 1500 - 8000 cells/µL
• Neutropénie - ANC < 500 cells/µL
• Neutrophilia – ANC > 8000 cells/µL.

66. PLATELET COUNT
• NORMAL= 150,000-400,000/ml
• Thrombocytopenia –platelet count less than 150,000/ml
• Mild thrombopenia= 100,000-150,000/ml
• Severe thrombopenia=less than 50,000/ml

67. PLATELET & AGING

68. HAEMOGLOBIN

69. HAEMOCRIT [Ht OR HCT]
• “Packed cell volume (PCV)” or
“Erythrocyte volume fraction (EVF)”
• It is the volume percentage (%) of RBC
in blood.
• It is normally 45% for men and 40% for
women.

70. MEAN CORPUSCULAR VOLUME
• It is average volume of a RBC.
• The normal range is : 80-100 fL
An elevated MCV is termed as Macrocytic & is associated with:
• Alcoholism
• Folic acid deficiency
• Vit. B12 Deficiency
A low MCV is termed as Microcytic & is also associated with:
• Iron deficiency
• Thalassemia
• Chronic disease

71. MEAN CORPUSCULAR Hb
• It is the average mass of Hb per RBC
• A normal value is 27 - 31 pg./cell
Hypochromic:
• MCH < 27 pg/cell
Hyper chromic:
• MCH > 31 pg/cell

72. RETICULOCYTE COUNT
• Normal “Reticulocyte Count” value = 1% of the red blood cell.
• Reticulocyte count can sometime be misleading because it is
not really a count but rather a percentage

73. RETICULOCYTE VALUE

75. TESTS FOR HEMOSTASIS
• Platelet count
• Capillary resistance/ fragility test
• Bleeding time
• Clotting time
• Clot retraction test

76. CONT.
• Prothrombin time (PT)
• Activated partial thromboplastin time (APTT)
• Thrombin time (TT)
• Tests for DIC

79. BONE MARROW EXAMINATION:
• Type of examination-
– Bone marrow aspiration.
– Trephine biopsy.

80. SITE FOR BONE MARROW
ASPIRATION
• Sternum
• Posterior superior iliac spine
• Spinous process of vertebrae
• Shin of tibia ( <2 years of age)
• Anterior superior iliac spine

81. CAUSES OF FAILURE OF
ASPIRATION
• Dry tap-Failure to aspirate any material at all is referred to as Blood
tap
• Aspiration of blood without any marrow particles is referred to as
blood tap.
(A) Faulty technique
(B) Pathological factors

82. PATHOLOGICAL FACTORS FOR BLOOD
GROUP
1. Increased connective tissue in bone marrow
• Myelofibrosis.
• Hairy cell leukaemia
• Other myeloproliferative disorders.
• Lymphoma.
• Metastatic carcinoma.
• Tuberculosis.
2. Bone marrow hyperplasia
3. Localization of needle tip in neoplastic tissue
• Metastatic carcinoma.
• Lymphoma.
• Multiple myeloma.
4. Idiopathic

83. TESTS FOR URINARY SYSTEM
• URINE ROUTINE TEST[URT]
• RFT
• CREATENINE LEVEL
• BLOOD UREA NITROGEN

84. URT
CONTENT OF URT
• General properties
• Chemical tests
• Microscopic examinations
GENERAL PROPERTIES
• URINE VOLUME
• APPEARANCE/COLOUR
• URINE PH
• SPECIFIC GRAVITY
• OSMOTIC PRESSURE

85. URT

86. URINE VOLUME
• Daily urine produced -1.5 L/day
• Polyuria - >3L/24 hr
• Oliguria- <400ml/24hr
• Anuria - <100ml/24hr

87. APPEARANCE /COLOUR
• Normal, fresh urine is pale to dark yellow of
colour
Abnormal appearance:
• Haematuria
• Hemoglobinuria
• Pyuria
• Bilirubinuria
• Crystalluria

88. CONT.
1.HEMATURIA:
• Macroscopic haematuria-frank blood in the urine
• Microscopic haematuria-RBC is seen only by the help of microscope

89. CONT.
• HEMOGLOBINURIA-Colour is like
strong tea or wine due to presence of
free Hb
• Pyuria-presence of WBCs, cloudy ,eg-
UTI

90. CONT.
• BILIRUBINURIA- Presence of direct bilirubin, dark yellow colour
• CRSTALLURIA-Presence of salt crystals, cloudy

91. CONT.
• We can see urine for clarity:

92. URINE 𝑝 𝐻
• Normal urine pH: 6 - 6.5
• Aciduria- gout, meat consumption,etc.
• Alkauria-UTI

93. SPECIFIC GRAVITY
• SPECIFIC GRAVITY
-Ratio of the density of a substance to density of a
reference substance (H2O).
-Directly proportional to solute concentration of
urine
• NORMAL SPECIFIC GRAVITY-1.003-1.03
• LOWER SG-chronic renal failure, diabetes
insipidus, etc.
• HIGH SG-acute nephritis ,diabetes mellitus, etc.

94. OSMOTIC PRESSURE
• Normal value-250mosmol-300mosmol

95. URT-CHEMICAL TESTS
• Urine protein
• Urine glucose
• Urine ketone

96. URINE PROTEIN
• Normal : (-) or 20-80 mg/24 hrs
• Abnormal : (+ ) or > 150 mg / 24 hrs

97. URINE GLUCOSE
Normal : (-) or <15mg/Dl

98. URT –MICROSCOPIC
EXAMINATION
• Cells
• Casts
• Crystal bodies
• Pathogen

100. CRYSTALS FINDINGS
• Calcium oxalate crystals
• Phosphate crystals
• Urate
• Cystine
• Yeast

101. RENAL FUNCTION TEST
• Also known as “Kidney Function Test”
• Kidney function test is a collective term for a variety of
individual tests and procedures that can be done to evaluate
how well the kidneys are functioning.

102. RFT
• Can be divided into two categories:
Test for function of Glomerulus
• GFR
Test for Function of Tubule
• Reabsorption
• secretion

103. TEST INVOLVES IN RFT

104. RENAL CLEARANCE
• Renal clearance of a substance is the volume of plasma that is
cleared of the substance by the kidneys per unit time.
• It is the measurement of the renal excretion ability
• Substances used for estimating kidney condition-INULIN
,CREATININE ,PAH

105. INULIN
• Inulin Clearance Can Be Used to Estimate GFR (eGFR)
Inulin is :
• Freely filtered
• Neither reabsorbed
• Nor secreted
• Whatever, inulin is filtered, all of it is excreted in the urine.

106. INULIN EXCRETION

107. CREATININE
• Also known as- serum creatinine, urine creatinine
• Waste product in blood comes from protein [taken as food] & from
the normal breakdown of muscles protein
• Elimination of it is done by kidney through urine
• Test can diagnose –creatinine level in blood which shows how well
your kidneys are working

108. CREATININE
• Creatinine Clearance Can Be Used to Estimate GFR.
• It is not practical to measure urine creatinine level to estimate GFR, so
many scientist has given many ways to calculate GFR by being based
upon only blood creatinine.

109. eGFR
• Also, used to stage the Chronic Kidney Disease (CKD)

110. SERUM CREATININE(SCr)
• Normal range( Highly Variable) - 0.5 to 1.0 mg/dl
• If, GFR < 50% normal, SCr will increase markedly
• But it is not an early marker of kidney disease

111. BLOOD UREA NITROGEN (BUN)
• The normal range is 6 - 20 mg/dL.
Increased BUN
• Azotaemia
• Uraemia
• Azotaemia is used when the abnormality can be measured
chemically but is not yet so severe as to produce symptoms.
Uraemia is the pathological manifestations of severe
azotaemia.

112. MECHANISM OF BUN

113. BUN
BUN increased in:
• Renal failure
• Urinary tract obstruction
• Nephrotoxic drugs
• Shock, Burn, GI bleeding, Dehydration
BUN is decreased in :
• Hepatic failure
• NS(normal saline)
• Cachexia (low-protein and high-carbohydrate diets)

114. BUN:CREATININE RATIO
• Normal Value= 12-20
• The principle behind this ratio is the fact that both urea (BUN) and
creatinine are freely filtered by the glomerulus, however urea
reabsorbed by the tubules can be regulated (increased or
decreased) whereas creatinine reabsorption remains the same
(minimal reabsorption).

115. BUN: Cr RATIO IN KIDNEY INJURY

116. OTHER ORGAN FUNCTION TESTS
1. LIVER FUNCTION TEST
2. THYROID FUNCTION TEST
3. KIDNEY FUNCTION TEST

117. LFT
• Helps to determine liver condition by measuring
levels of Liver enzymes ,proteins, & bilirubin in
blood
• Often used:
To screen liver (hepatitis c)
To monitor effects of medications
To measure degree of liver cirrhosis

118. WHICH TEST MAKES LFT COMPLETE
•ALT(alanine transaminases)
•AST(aspartate transaminases)
•Albumin
•Bilirubin
•ALP(alkaline phosphatases)

119. ALBUMIN
• Protein made by liver
• Has important clinical value:
Prevents fluid leakage from blood vessels
 nourishes tissues
 transports hormones, vitamin, minerals& other nutrient
substances throughout the body

• albumin level decreased= impaired liver functioning

120. BILIRUBIN
• Waste product obtained by breakdown of RBC
•
• Increased level of bilirubin = impaired liver functioniong
• Normal range =Highly variable
• Normal adult = Total Bilirubin < 17µmol/L (1mg/dl)
• Out of which, around 30% is Direct bilirubin
• Normal Direct Bilirubin < 5.1µmol/L (0.3mg/dl)

122. HOW AST OR ALT INCREASES ?
LIVER DAMAGE
HEPATOCYTES
BECOME MORE
PERMEABLE
ENZYMES LEAK
IN BLOOD

123. ALT
• It is used up by your body to metabolise protein
• Liver damage = ALT released in blood
• Female ≤ 34 IU/L
• Male ≤ 52 IU/L
• Formerly known as serum glutamate-pyruvate transaminase
(SGPT).

124. AST
• Type of enzyme found in several body parts such as liver, heart,&
muscles
Increased AST= liver infections
• Male 8 - 40 IU/L
• Female 6 - 34 IU/L
• Formerly known as serum glutamic oxaloacetic transaminase (SGOT).

125. AST/ALT RATIO
• Also known as "De Ritis Ratio"
• Specially used for alcoholic liver disease.
• It is AST to ALT ratio of 2:1 or greater, particularly with
increased Gamma-Glutamyl Transferase.

126. LACTATE DEHYDROGENASE(LDH)
• Found in many body tissues, including the liver.
• Elevated levels of LDH may indicate liver damage.
Elevated LDH maybe due to,
• Cancer
• Meningitis
• Encephalitis
• Acute pancreatitis
• HIV

127. ALKALINE PHOSPHATASE
•Found in bones, bile ducts,& liver
•Increased ALP = liver damage,
blockage of bile duct & bone
disorders

128. ALKALINE PHOSPHATASE
•Normal = 20 to 140 IU/L
•Although higher in children and
pregnant
•Concomitant increases of ALP with
GGT should raise the suspicion of
hepatobiliary diseases

129. THYROID FUNCTION TEST

130. TFT : AN OVERVIEW
• Thyroid is a small gland located in lower front part of neck
• Helps to regulate – metabolism, energy generation, & mood
• It mainly produces 2 hormones: triiodothyronine(T3) &
thyroxine (T4)
• TFT are series of blood test used to measure how well your
thyroid gland is working
• Test includes-T3, T3RU, T4, & TSH

131. SECRETIONS
• As we all know secretions are of 2 forms – more or less i.e.
hyper or hypo resp.
• According to secretion of hormones thyroid is of 2 types
1. hyperthyroidism
2.hypothyroidism

132. HYPER & HYPO ??
HYPERTHYROIDISM HYPOTHYROIDISM
WEIGHT LOSS WEIGHT GAIN
TREMORS LACK OF ENERGY
INCREASED ANXIETY DEPRESSION

133. UNDERSTANDING RESULTS
• High levels of T4 = hyperthyroidism
symptoms = anxiety, unplanned wt. less, tremors, diarrhoea
• TSH indicates = normal 0.4-4.0 m IU/L of blood
if value ranges - above 2.0 mIU/L of blood
• T4 & TSH- routine performed on new-born babies to identify a
low functioning thyroid gland which can lead to
developmental abnormalities
• T3 RESIN UPTAKE RESULTS- measures hormone called thyroxine-
binding globulin(TBG)

134. CONT.
•If T3↑ = TBG↓
•abnormal increase in TBG = kidney
problems = body is not getting
sufficient amount of protein
•↑TBG = ↑ estrogen = pregnancy /
obesity

135. TOTAL THYROXINE
• Total thyroxin includes free as well as protein bound thyroxin.
• Normal levels:5 to 12.5ug/dL, largely bound to transport
protein esp. TBG(Thyroid binding globulin )
• T4 combined with TSH gives the best measurement of thyroid
function.

136. THYROXINE
INCREASE
• Hyperthyroidism
• Factitious
hyperthyroidism
• Pituitary TSH
secreting pituitary
tumour
• Raised TBG
DECREASE
• Primary hypothyroidism
• Secondary/pituitary
hypothyroidism
• Severe non thyroidal
illness
• Decrease TBG

137. ADVANTAGES OF THYROID
SCANNING
• Distinguishes diffuse glandular activity from patchy pattern seen
in goitre
• Functional classification of nodules: warm, hot, cold
• In association with thyroid suppression regimes, TSH dependent
or autonomous nature of hot nodules
• Information regarding size, shape, position of gland
• Identification & localisation of functioning thyroid tissue in
ectopic or metastatic sites
• Helps on differentiating various causes of thyrotoxicosis

138. INDICATIONS &
CONTRAINDICATIONS
INDICATIONS
1.Thyroid nodule(s)
2. Diffuse or multinodular goitre
3. Clinical hyper- or hypothyroidism
4. Evaluation of sub-sternal mass
5. Sub-acute thyroiditis, early phase
6. Patient with previously treated with radiation
Contraindications:
1.Pregnancy
2.Lactation

139. FINE NEEDLE ASPIRATION CYTOLOGY
(FNAC) THYROID
Indications:
• Diagnosis of diffuse non toxic goitre
• Diagnosis of solitary or dominant thyroid nodule
• Confirmation of clinically obvious malignancy
• To obtain material for special laboratory investigations aimed
at defining prognostic parameters.
Main limitation: Inability to distinguish between follicular
adenoma & carcinoma.

140. Complications:
• Haematoma.
• Transient laryngeal nerve paresis
• Tracheal puncture
• Rarely, needling causes formation of a hot nodule

141. CEREBRAL SPINAL FLUID

142. CSF
• Test to analyse condition which affects brain & spine
• CSF is the clear fluid which cushions & delivers nutrients
to CNS (brain & spine)
• CSF is produced in the brain & then reabsorbed into
blood stream
• CSF has a direct contact with our brain & spine therefore,
it is more effective than a blood test to understand CNS
• Sample is collected by the method of LUMBAR
PUNCTURE

143. CSF

144. LP[LUMBAR PUNCTURE]
• Also known as spinal tap
• Useful in examination for – proteins, glucose, RBC, fluid
pressure, WBCs, chemicals, bacteria etc.
• Procedure to collect & look at the fluid(cerebrospinal fluid)
surrounding the brain & spinal cord
• It should be performed only after a neurologic examination
but should never delay

145. LP
• Most accurate test is culture.
• Most sensitive test for acute bacterial meningitis is elevation of
protein in CSF. (Not elevated protein Rules out Acute bacterial
meningitis)
• Increase in WBC is the indicator to start treatment.

146. INDICATIONS & CONTRAINDICATIONS
INDICATIONS:
• Suspicion of meningitis
• Suspicion of subarachnoid haemorrhage(SAH)
• Suspicion of CNS, E.g.-carcinomatous meningitis
• Therapeutic relief of pseudotumor cerebri
CONTRAINDICATIONS:
• Increased intra cranial pressure
• Brain abscess
• Loss of suprachiasmatic & basilar cisterns

147. WIDELY USED IN
• Multiple sclerosis is a chronic condition
In this body’s own immune system destroys the protective
coverings of nerves i.e. myelin
• Abnormal results in CSF is seen when there is: infections,
encephalitis,
•
• Reye’s syndrome- rare fatal disease in children & is associated
with viral infections & aspirin ingestion
• Scarcoidosis- granulomatous condition of unknown cause
affecting many organs such as lungs, joints, & skin

148. SEROUS MEMBRANE FLUID
• Also known as serosa, is a layer of tissues that wraps around organs
& helps to lubricate them so they don’t get rubbed raw.
• Made up of squamous epithelium or mesothelium

149. TRANSUDATE VS, EXUDATE
Transudate
• It is extravascular fluid with low protein content and a low specific
gravity (< 1.012)
•
• It results from increased fluid pressures or diminished colloid oncotic
forces in the plasma.
Exudate
• It is a fluid emitted by an organism through pores or a wound, a process
known as exuding.
• Composition of an exudate varies, but generally includes water and the
dissolved solutes of the main circulatory fluid such as sap or blood.

155. STOOL TEST
• Appearance
• Consistency
• Odour
• Chemical tests
• Microbiology tests
• Faecal Occult Blood Test

156. SPUTUM
• Mucus coughed up from the lower airways is called as sputum.
• Phlegm: Same sputum when it is within body.
Appearance
• Microbiological investigations
• Cytological investigations

157. SPUTUM
Sputum can be:
Bloody(Haemoptysis)
• lung cancer;
• Alveoli
• Pulmonary TB
• Lung abscess
• Bronchiectasis
Rusty coloured - pneumococcal bacteria
Greenish coloured – Pseudomonas
Purulent - containing pus.
Thick purulent : staphylococcus
Thin purulent : Streptococcus pyogenes
Frothy pink - pulmonary embolism

158. RADIOLOGICAL
EXAMINATION

159. OBJECTIVES
• To provide a guide to selecting the appropriate imaging
studies in common emergency settings

183. NATURAL DIAGNOSIS METHODS

184. CONTENT
1. FACIAL DIAGNOSIS
2. IRIS DIAGNOSIS
3. TONGUE DIAGNOSIS
4. NAIL DIAGNOSIS
5. URINE DIAGNOSIS
6. STOOL DIAGNOSIS
7. PULSE DIAGNOSIS
8. PALPATION & PERCUSSION
9. AUSCULTATION & OLFACTION

185. NO CONFUSION !!
•Diagnosis is mentioned in
various systems of medicine
but the aim of each system
is same

186. IN ALL SYSTEMS OF HOLISTIC MEDICINE
FOLLOWING IS THE SEQUENCE:
• INSPECTION(LOOKING)
• AUSCULTATION(LISTENING)
• OLFACTION(SMELLING)
• INTERROGATION(ASKING)
• PALPATION(EXAMINATION OF PATIENT BY
TOUCH)
• PERCUSSION(ACT OF TAPPING/STRIKING)

188. ACCORDING TO GREEK
VISUAL
FACIAL
TONGUE
AUSCULTATION
& OLFACTION
PULSE
URINE
PAPITATION
&PERCUSSION
STOOL

189. ACCORDING TO TCM
PALPATION INSPECTION
PALPATION AUSCULTATION
4 DIAGNOSTIC
METHODS

190. ACCORDING TO NATUROPATHY
•FACE
•NAIL
•TONGUE

191. ACCORDING TO NATUROPATHY
•EYE
•IRIS
•PULSE

192. FACIAL DIAGNOSIS
• FATHER- LOUIS KUHNE
• IN MEDICAL TERMINOLOGY this art is known as
physiognomy
• In this physician examines patient’s facial
expressions & signs
• As chief function of face is expression, which is
the giving of visible outer form/ manifestations of
inner state of physical & mental being

193. FACIAL DIAGNOSIS
As we all know face has following things to
express:
• Spirit & countenance
• Forehead
• Temples
• Eyebrows
• Eyes
• Nose
• Glabella region
• Mouth & Lips

194. FACIAL DIAGNOSIS
• COUNTENANCE- traditional term for overall presentation of
the face
• SPIRIT- radiates from countenance
• bright /radiant = overall healthy
• dull muddled/confused = mental & emotional

196. FOREHEAD
• Primarily responsible for expressing - spiritual radiance
• Transverse line /wrinkles = worries, anxieties, insomnia, stress, &
stress
• vertical lines = on Rt. side = liver problems &
vertical lines on Lt. side = spleen problems

197. TEMPLES
• Hollow indentations on the lateral side of the forehead
• unduly/sunken/hollowed out = dehydration, general state of
malnutrition & emaciation(↓to excessive)
• prominent blood vessels = ↑ B.P.
• Red inflamed = migraine (sometimes hot)

198. EYEBROWS
• Rooftops of the eye
• Thick /heavy eyebrows = strong , robust constitution
• Missing in lateral 1∕3rd = blood sugar problems(diabetes)
• heavy prominent /beetle brow with cheek bone/elongated chin
= acromegaly

199. NOSE
• protruding part of face that bears nostrils
• Deep horizontal furrow at nose = prone to
allergies, bronchial asthma
• Red nose tip = overload on heart, common
cold, anger

200. EYES
• Pair of organ of sight
• Commonly we diagnose bags above or below eyes
above eyes= impaired function of adrenal gland
• Rings around eyes (semilunar Rt. below the eyes)= high
cholesterol, metabolic disorder

201. EYES

202. EYES
• slanting lines at the core of eyes = weak liver, deficiency of
vitamin A, eye problems, headache

203. SIGNS, SYMPTOMS ⇰DIAGNOSIS
SIGNS & SYMPTOMS DIAGNOSIS
1.TOTALLY WHITE EYE CHRONIC MTB
2.PUPIL SINKS & BECOMES SMALL OPIUM EATER
3.SWELLING IN EYES ARTHIRITIS, SPONDYLOSIS
4.DULLNESS OF EYES ILL HEALTH
5.RAPID EYE MOVEMENT IMPROPER MENTAL STATE
6.AVOIDING EYE CONTACT LYING
OVER BLINKING MENTALLY CONFUSE,TENSED,
LYER,HESITANT

204. CHEEKS
• either sides of the face below eyes
• Tender area at the centre of the
cheek = sinus congestion, digestive
problems

205. MOUTH
• Opening & cavity present in face & is
surrounded by lips
• Deep line by side of the mouth = sex
problems
• Line at the corners of the mouth = weak
respiratory system

206. LIPS
• Dark spots on lips - colon problems
• spots, whitish discoloration -
parasites in colon
• blue/purple discoloration- poor
circulation

207. LIPS
• Portrays condition of digestive system
• UPPER LIP- associated with stomach, liver, spleen, lungs, thorax
• LOWER LIP- intestine
CONDITION /SYPMPTOMS DIAGNOSIS
PALE LIPS ANEMIA
BLUE/PURPLE LIPS ↓INNATE HEAT ,EXTREME COLD,CYANOSIS,
FREQUENT CANKER SORES LUNG INFECTION
BROWN LIPS ADRENAL FUNCTION IS IMPAIRED
ANGULAR STOMATITIS INFLAMMATION & EROSION OF CORNERS OF LIPS-
VIT. B12 DEFICIENCY

208. ACCORDING TO TCM

209. ACCORDING TO GREEK

210. ACCORDING TO AYURVEDA

211. TONGUE DIAGNOSIS
•Muscular organ present in mouth
used for tasting, swallowing & in
articulating speech

212. ACCORDING TO TCM

213. ACCORDING TO NATUROPATHY

214. REAL VIEWS !!

215. NAIL DIAGNOSIS
• Nail is a horn like envelope covering the tip of
the finger
• Made up of tough protective protein- keratin
• similar to claws of animals

216. ACCORDING TO AYURVEDA

217. ACCORDING TO AYURVEDA

218. ACCORDING TO CONDITION

230. PULSE DIAGNOSIS
• Pulse represents tactile arterial palpation of
heartbeat
• Important basis of pulse diagnosis:
movement/gathi
Rate/vega
Rhythm/tala
Force/bala etc.

231. ACCORDING TO AYURVEDA

232. ACCORDING TO TCM

233. IRIS DIAGNOSIS
• FATHER - BERNARD JENSEN
• Thin, circular structure of the eye
• Responsible for controlling diameter & size of pupil
HOW IT WORKS: ACCORDING TO Dr. BERNARD JENSEN
• The iris is connected to every organ and tissue of the body by
way of the brain and nervous system. The nerve fibers receive
their impulses by way of their connections to the optic nerve,
optic thalami and spinal cord
• They are formed embryologically from mesoderm and neuro-
ectoderm tissues.
• Both sympathetic and parasympathic nervous systems are
present in the iris

234. STUDY OF IRIS=IRIDOLOGY
• Nerve fibres in the iris respond to changes
in body tissues by manifesting a reflex
physiology that corresponds to specific
tissue changes and locations
• IRIS CHART – chart represents the
placement of organs and tissues as would
a map. There are signs and features in the
iris that are in-explainable and unknown at
this time

238. IRIDOLOGY
• Iridology does not name diseases; instead,
it reads tissue condition, From that
information, predispositions, tendencies
and directions toward or away from these
conditions are noted. Levels of toxic
settlement and accumulation are
observable

239. 7 ZONES OF IRIS

240. DRUG DEPOSITION

241. LESIONS ,CRYPT

242. DISEASE STAGE ACCORDING TO
IRIDOLOGY
THE FOUR STAGES AS THEY A PPEAR IN THE IRIS
1-ACUTE
2 -SUBACUTE,
3-CHRONIC
4-DEGENERATIVE NUMBER
5 DESIGNATES THE AUTONOMIC NERVE WREATH
6 IS THE PUPILLARY MARGIN.

243. NERVE RINGS IN BROWN IRIS

244. TOXIN SKIN= SCURF RIM

245. WHITE RINGS IN PERIPHERY
=LYMPHATIC CONGESTION

246. METABOLIC IMBALANCE =
SODIUM RING

248. SMALL TIGHT PUPIL =
EXTREME NERVOUS TENSION

249. REAL CASES (varicose vein)
R
I
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H
T
S
I
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L
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F
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I
D
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250. THANK YOU
BE HAPPY & BE HEALTHY