3.10.1 Diagnosing Disease

Diagnosing involves finding out the nature and cause's of a person's ill health. Accurate diagnosis by a health professional will help decide the most appropriate form of treatment for the patients.

What Happens At The GP:

• They take the patients medical history 
• Check if they are taking any medication already
• They ask questions to clarify on the situation
• They make a provisional diagnosis

Key Questions About:

• Persistance
• Duration
• Intensity 

Symptoms are features of an illness that are reported by the patient.

Signs are features of an illness which are visible to the GP.

The GP uses a clinical interview 

Use of Computers:

• Print prescriptions
• Print off notes 
• Update records
• Look at medical history 
• Look at CDSS-clinical decision support system the help diagnosis
• Look at PRODIGY- helps with diagnosis
• Contact colleagues 
• Refer to other professional

The GP might conduct a physical examination in order to detect further signs of disease. The more evidence collected, the more likely that the provisional diagnosis will be correct.

A Physical Examination Can Include:

• Visual examination
• Use of a stethoscope 
• Palpation
• Percussion 
• Reflex testing
• Measuring temperature
• Measuring blood pressure

Visual examination

• This means looking at the affected part of the body, where it is possible (external).
• This can reveal conditions such as arthritis
• swelling/distortion/rashes.
• Patients may need to partially undress for the visual examination to take place, this may be embarrassing for the patient.

The Use of A Stethoscope

• Small metal dish attchched to two flexible hollow tubes.
• Two tubes are placed in the GP's ears.
• The metal dish is placed on the patients body being examined, e.g. chest, back, abdomen.
• No amplification is involved. 
• Sounds travel up the tubes to the GP's ears and they listen for abnormalities.
• Background noise is eliminated. 

Palpation

• The GP will place two fingers or the hand firmly on the part of the body to be examined.
• Pressure will be applied.
• Able to detect swellings/tumors or abnormalities on organs.
• Able to detect pain.

Percussion

• GP places two fingers of one hand against the patients body.
• The GP "taps" these fingers with his other hand.
• Listens to sounds.
• Hollow sound=clear lungs
• Dull/muffled sound=possible fluid present.

Reflex Testing

• Patient sits with one leg crossed over the other on the edge of the bed.
• Dangling leg is relaxed.
• A rubber hammer is used.
• Hammer taps below the patella (kneecap)
• This stretches the tendon and sends a nerve impulse to the spinal cord.
• This triggers another nerve impulse which causes the thigh muscle to contract.
• The lower leg jerks up.
• If this does not happen it may indicate damage or disease to the nerve.

Measuring The Patient's Temperature

• Uses a digital/electronic thermometer.
  
• Place in the ear/mouth/anus/under the arm.
• Left until a beep is heard.
• Reading is recorded.
• Norm is 370c
• Above 390c indicates a fever.

Blood Pressure

• Uses a digital sphygmomanometer.
• Put a cuff around the patients arm above the elbow.
• The cuff is inflated.
• Stops the blood temporarily.
• Pressure is released.
• Reading is given, e.g. 120/80=healthy blood pressure.
• 140/90 indicates hypertension-high blood pressure.
• Top number is the maximum in the artery.
• Bottom number is between beats-heart resting.

The GP may be able to make a diagnosis having taken a medical history, questioned and observed the patient and carried out a physical examination. However there is a huge range of diseases that a GP cannot be expected to make a diagnosis without further help. 

The GP may request one or more diagnostic tests. These can be:

• blood tests
• urine tests

Once taken they would be sent off to laboratories for processing. This is likey to take several days and therefore the patient will need to make a follow-up appointment.

Some tests may require specialist equipment and require the patient to visit a hospital.

These are screening tests/diagnostic testing to allow the doctr to make a diagnosis:

• Tissue biopsy
• Electrocardiography (ECG)
• Body fluid sampling

Tissue Biopsy

A biopsy is a medical procedure that involves taking a small sample of tissue so that it can be examined under a microscope.

Types of biopsy:

• Scraping cells - Removing cells from the surface layer of tissue, such as from the inside the mouth or inside the cervix as part of a cervical screening test.

• Punch biopsy - is for diagnosing skin conditions using a special instrument to punch a small hole in the skin to obtain a skin sample

• Needle biopsy - a special hollow needle, guided by ultrasound, is used to obtain tissue from an organ or from tissue beneath the skin

• Endoscopepic biopsy - where an endoscope is used to remove tissue, such as from the stomach during a gastroscopy ( a diagnostic procedure of the stomach or upper gastrontestinal tract)

Electrocardiography (ECG)

An electrocardiogram, or ECG, is a simple and useful test which records the rhythm and electrical activity of your heart.

• They look at PQRST Pattern

• Small stick patches called 'electrodes' are put on your ankles/legs/arms/wrists

• They are connected by wires to an ECG recording machine

• The electrical activity of the heart is recorded

• It's seen as a wavy line/graph on the screen - sometimes printed out on paper

• Arrhythmias can be seen - irregularities

• PQRST are read by a cardiologist

• The test takes 5 minutes and it is painless

• They sometimes do exercise induced

Body Fluid Sampling

• Urine tests

• Blood tests

• Mucus Tests

• Amniocentesis

• Lumbar puncture

• Synovial Fluid - lubricates joints

• Pleural Fluid - lining of the lungs

(learn top 3)

Urine Tests

• Collected by the patient

• Tested chemically - look for level of glucose

• Tested for infectious agents such as bacteria

• Test for urinary tract infections (UTI)

• Test for diabetes

Procedure

• A torniquet (tight band) is placed around the area above the elbow.
• This causes the veins to swell and fill.
• A needle attached to a syringe is inserted into the swollen vein.
• A sample or samples of blood are drawn into phials/little bottle.
• Needle is removed.
• Pressure is applied.
• A small plaster is applied.

What They're Looking For:

• Full blood count (FBC)- testing for anaemia.
• Electrolyte test- sodium/potassium and chloride/body salts- Used for diabetes/kidney issues.
• Blood sugar test- diagnose diabetes.
• Blood gas test- looking O2/CO2 balance.
• Gene test-cystic fibrosis/sickle cell anaemia
• Cholesterol test
• Blood type A/B/AB/O- Positive/negative Rhesus factor