Illness
•Reaction of the organism to the damaging factor
•The disease is associated with the causative factor
Diagnosis
Short medical conclusion about the disease and condition of the patient expressed in medical scientific terms
Types of diagnosis
I. By character
•Etiological
•Pathogenetic
•Nosological
•Anatomical
II. By construction:
•Direct
•Differential
•Diagnosis «by observation»
•By treatment effect
III. By time:
•Early
•Late Postmortem
IV. By certainty:
•Probable
•Preliminary
•Final
Precise diagnosis
•подразумевает конкретную нозологию
•по-возможности, этиологический
•требует понимания патогенеза болезни и основных
синдромов, её составляющих
Diagnostic mistakes
•From the disease
•From the patient
•From the doctor
•From the environment
Pyramid of clinical competence
Interprets
Can show
Can
Knows
Wass V. Lancet 2001; 357: 945-949
What will you learn today?
•How the medicine is changing at the turn of the century?
•What are the most common illnesses and why?
•Subject «propaedeutics of internal diseases»
•History of physical examination and main diagnostic methods
•Physical examination vs modern medical technologies
Diagnostics before 19th century
•Importance of interviewing
•Collection of the information
–Pulse assessment
–Stool and urine assessment
–External signs of the disease
•Internal processes are inaccessible for evaluation
Percussion
Leopold Auenbrugger
•1761
•Accuracy of the method
•Diagnostics of the pathology of the organs (especially chest)
•Objective confirmation of the disease
•Association between structural changes and external symptoms
Auscultation
•Rene-Theophile-Hyacinthe Laennec
•Paris Clinical School
•1819.
•Stethoscope