Differential Diagnosis
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• In deciding which disease to include in the differential, consider: - What's
the most life-threatening disease the patient could have? - Could this be a
common disease presenting with unusual features? - What diseases present
with misleading symptoms? - What rare diseases could be causing these
signs and symptoms?
,Comprehensive History
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• The comprehensive history is to be performed on all non-emergent, new
patients who will be receiving ongoing primary care from a particular
provider or group. • It is also expected within the hospital setting.
Patient Identifiers Reliability Chief Complaint HPI
Past Medical History Family History Social History Review of Systems (ROS)
Procedure used to diagnose clinical problem
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Assessment is though questioning the patient on their symptoms, when
they start, what makes them worse or better
Physical Exam
Inspect inside of of the nares with otoscope
may be pale, bluish, or red
Nasal polyps
Diagnostic Studies
Radioallergosorbent test preformed on blood will indicate the increased
eosinophilia associated with allergies
Skin test will identify specific allergens
Special Considerations pregnant women
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, Striaegravidarum(stretch marks) • Telangiectasias/hemangiom as •
Cutaneous tags • Increased pigmentation • Palmar erythema • Itching •
Altered hair growth
Lymph nodes
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CN IV Trochlear
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CN IV Trochlear downward inward rotation of eyes
Techniques of Examination - Legs
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, Compare one foot and leg with the other • Check for pitting edema •
Severity of edema graded on four-point scale (slight to very marked)
• If edema is present, look for causes - Recent deep venous thrombosis -
Chronic venous insufficiency - Lymphedema • Note color of skin - Local
area of redness - Brownish areas near ankles - Ulcers and where -
Thickness of skin (Venous ulcers are wet in appearance, Arterial ulcers are
dry)
• Femoral pulse - Press deeply below inguinal ligament, midway between
anterior superior iliac spine and symphysis pubis
• Popliteal pulse - Flex knee some, leg relaxed - Place fingertips of both
hands to meet midline behind knee and press deeply into popliteal fossa
• Dorsalis pedis pulse - Feel dorsum of foot, lateral to extensor tendon of
great toe
• Posterior tibial pulse - Curve fingers behind and slightly below medial
malleolus of ankle
Otitis Media
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Acute otitis media: the diagnosis of fluids/rapid onset of infection in the
middle ear, multiple symptoms.
Otitis media with effusion: the diagnosis is otitis media with effusion, there is
evidence of fluid in the middle ear, but when there are presently no signs
or symptoms of infection.
Chronic suppurative otitis media: persistent ear infection can result in
tearing or perforation of the eardrum.
CN VI Abducens
Give this one a try later!
Give this one a try later!
• In deciding which disease to include in the differential, consider: - What's
the most life-threatening disease the patient could have? - Could this be a
common disease presenting with unusual features? - What diseases present
with misleading symptoms? - What rare diseases could be causing these
signs and symptoms?
,Comprehensive History
Give this one a try later!
• The comprehensive history is to be performed on all non-emergent, new
patients who will be receiving ongoing primary care from a particular
provider or group. • It is also expected within the hospital setting.
Patient Identifiers Reliability Chief Complaint HPI
Past Medical History Family History Social History Review of Systems (ROS)
Procedure used to diagnose clinical problem
Give this one a try later!
Assessment is though questioning the patient on their symptoms, when
they start, what makes them worse or better
Physical Exam
Inspect inside of of the nares with otoscope
may be pale, bluish, or red
Nasal polyps
Diagnostic Studies
Radioallergosorbent test preformed on blood will indicate the increased
eosinophilia associated with allergies
Skin test will identify specific allergens
Special Considerations pregnant women
Give this one a try later!
, Striaegravidarum(stretch marks) • Telangiectasias/hemangiom as •
Cutaneous tags • Increased pigmentation • Palmar erythema • Itching •
Altered hair growth
Lymph nodes
Give this one a try later!
CN IV Trochlear
Give this one a try later!
CN IV Trochlear downward inward rotation of eyes
Techniques of Examination - Legs
Give this one a try later!
, Compare one foot and leg with the other • Check for pitting edema •
Severity of edema graded on four-point scale (slight to very marked)
• If edema is present, look for causes - Recent deep venous thrombosis -
Chronic venous insufficiency - Lymphedema • Note color of skin - Local
area of redness - Brownish areas near ankles - Ulcers and where -
Thickness of skin (Venous ulcers are wet in appearance, Arterial ulcers are
dry)
• Femoral pulse - Press deeply below inguinal ligament, midway between
anterior superior iliac spine and symphysis pubis
• Popliteal pulse - Flex knee some, leg relaxed - Place fingertips of both
hands to meet midline behind knee and press deeply into popliteal fossa
• Dorsalis pedis pulse - Feel dorsum of foot, lateral to extensor tendon of
great toe
• Posterior tibial pulse - Curve fingers behind and slightly below medial
malleolus of ankle
Otitis Media
Give this one a try later!
Acute otitis media: the diagnosis of fluids/rapid onset of infection in the
middle ear, multiple symptoms.
Otitis media with effusion: the diagnosis is otitis media with effusion, there is
evidence of fluid in the middle ear, but when there are presently no signs
or symptoms of infection.
Chronic suppurative otitis media: persistent ear infection can result in
tearing or perforation of the eardrum.
CN VI Abducens
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