Fundamentals of diagnosis
Just because a patient may not volunteer information about certain symptoms it does not mean that he does not have them. A rapid review must be made of the important body systems. In this way, symptoms that may have been forgotten or thought unimportant by the patient will not be overlooked. Every positive answer should be investigated as thoroughly as if it were the chief complaint.
Questions concerning general symptoms
Has there been any recent weight loss or gain? What is the present weight? What has been the best weight? Is there any unusual fatigue (усталость)? Are there sweats or chills (озноб)? Has there been any fever? Has there been any excessive thirst (жажда)? Does the patient sleep well?
Questions concerning respiratory symptoms
Is there a history of frequent colds, sore throats or difficulty in swallowing? What is the condition of the teeth? Is the sense of taste normal? Sense of smell? How much do you smoke? Do you ever have pain in the chest? Are you ever out of breath after walking up the stairs? Is there any hoarseness (охриплость голоса), cough or sputum (мокрота)?
If there is a sputum, what is its volume, appearance and odor? Has there ever been haemoptysis (кровохаркание)? What effect does exercise or altitude have upon breathing? If there is pain in the chest, where is it located? How severe is it? What aggravates it or relieves it? Has there been any exposure to coal or dust? Has there been any contact with active cases of tuberculosis?
Questions concerning cardiovascular system
If there is shortness of breath, is it apt (склонный, способный) to occur while the patient is at rest? Does dyspnea occur while the person is recumbent (лежащий, откинувшийся на что-то) or while lying on the side?
Chest pain must be evaluated cautiously. It is important to have the patient describe it in his own words. Is it promptly relieved by rest? Does the pain radiate, and when is it apt to occur in relation to meals? Does the heart ever seem to beat irregularly or unusually rapidly? If so, it is important to determine the frequency of these episodes, whether the onset is sudden or gradual, and how they disappear.
Careful history taking may be the only key to otherwise unsolvable cardiac problems. It is wise when discussing the symptoms of heart disease with a patient to be careful lest some chance remark give him undue cause for alarm.
Survey of the patient with gastrointestinal symptoms
Every patient with gastrointestinal symptoms should be thoroughly questioned. The physician is to find out if the patient has an increase or a decrease in appetite, nausea, sour eructations (кислая отрыжка), vomiting, belching (отрыжка), abdominal pain, jaundice. He must also know the character and color of the stool. A brief outline of the diet should be obtained.
The physician should never be satisfied to accept the vague term “indigestion”. He is to ask the patient what he means by this term. Some will report a mere uncomfortable sensation in the abdomen after eating, while others under careful interrogation will describe pains typical of peptic ulcer or gallbladder disease.
If there has been vomiting, the physician should know about its appearance. He should ask: Have you vomited? Do you still vomit? Do you vomit blood?
Pain should be localized if possible. To do it the doctor may ask: Have you any pain? In the abdomen? When does it occur? How severe is it? Does the pain radiate? Where does the pain radiate? What type of pain is it (sharp, burning, spasmodic, or a dull ache). In what side? What has been taken for relief – food or soda?
Time spent in obtaining an accurate story may save time and effort later on.
Read the dialogue and speak about boy’s complaints, physical examination made by the doctor and the prescribed treatment.
Dialogue between a Mother (M), her Son (S) and the Doctor (D).
M: Your nose is clogged up, your voice is hoarse and your face flushed. You must have a cold. I’m sure. I hope it’s nothing more. When did you manage to get it?
S: I don’t know myself. I must have caught cold last night after a game of football when I felt so hot that even took my jacket off.
M: How thoughtless (careless) of you, the evening was chilly and windy. Now you’ll have to stay in. Here’s the thermometer, take your temperature.
S: Oh, I’ll be all right in a few hours.
M: Now, you do, what you are told. Put the thermometer under your arm (in the armpit)… Oh, it’s thirty eight point three. You’ll have to stay away from classes today. I’ll call the doctor (I’ll have the doctor in).
(She phones to the local out-patient hospital and is told that the doctor will come while making his daily round of the district).
D: What do you complain of, my boy?
S: I have a bad (splitting) headache and a sore throat. I feel sort of feverish.
D: Let me feel your pulse. Open your mouth, please. I see you tongue is coated and your throat inflamed. Now, strip to the waist, please. (The doctor sounds the boy’s lungs). Take a deep breath… (To the mother). Your son is to keep his bed for three days. Here is the prescription. The medicine is to be taken three times before meals, two tablespoonfuls each time. It will help to keep the fever down. (To the son.) Blow your nose gently, young man, or else you’ll have an earache… Nothing serious, but don’t get up before Wednesday, as there might be complications (bad after-affects).
Notes:
Your nose is clogged up – У тебя заложило нос.
I feel sort of feverish – Меня будто лихорадит.
coated - зд. покрыт налётом.
To strip to the waist – раздеться до пояса.
To keep the fever down – понизить жар, температуру.
Working in pairs use the following variations to make up short dialogues between a doctor and a patient.
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1. D: Well, Mr. Black. What’s brought you along today? What can I do for you? What seems to be the problem?
P: I’ve got a bad flu. terrible headache swollen ankles a pain in my stomach
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2. D: How long has it been bothering you? How long have you had it?
P: Two or three days. A fortnight Since Tuesday For almost a month
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3. D: Where does it hurt? Where is it sore?
P: Here, just under my ribs. Right across here/down here. It’s my chest/back/leg…
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4. D: Can you describe the pain? What is the pain like? What kind of pain is it?
P: It’s like a heavy weight pressing on my chest. It’s a sharp, stabbing (колющая) pain. It’s like a knife. My chest feels raw inside.
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5. D: Does anything make it better/worse?
P: If I stop for a bit, it goes away. If I take a deep breath When I cough, it hurts most. If I eat, it gets better. Food makes it worse. .
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Use the following information and questions from “Fundamentals of diagnosis” to make up dialogues between a patient and a doctor.