Example of Patients' History – Basic Diagnostic Techniques

00:01 Let’s look at a typical patient who has atherosclerotic or arteriosclerotic peripheral arterial disease of the legs.

00:09 This man is 54 years old. He’s obese. He has a long-term smoking history – still smoking. He complains of cramps and discomfort in his calves after walking for 10 minutes and this discomfort goes away when he rests.

00:26 When you examine him, you find that the pulses in both of his legs are markedly decreased.

00:31 You don’t feel them very powerful compared, for example, to the radial pulse in the arm.

00:38 And then you want to make sure you’ve identified all of the atherosclerotic risk factors for this man.

00:45 Some can’t be modified. For example, the risk of atherosclerosis goes up with age.

00:51 Nothing you can do about that. It’s more common early on in men. It becomes quite common in women after menopause. And also is there a family history of atherosclerosis? Some factors can be modified, such as whether they’re smoking. Their high blood pressure can be treated. Their hyperlipidaemia – or high blood lipid levels – can be treated with drugs. They can reduce weight and get out of the obese situation. They can start exercising. If their diabetes has been poorly controlled, that can be controlled much better, often with medical therapy and also diet and exercise. And finally life stresses: are there some ways to avoid some of the life stresses that contribute to the atherosclerotic process? So we’ve done the history. Let’s talk about the physical exam.

01:45 The physical exam often reveals clues also to the diagnosis. So what should the physical exam include? Well, first of all, you want to just look at the patient – inspection. Then you want to listen to various parts of the patient’s anatomy. We’re going to talk about which parts and what you might expect to find. And finally you want to feel parts of the anatomy. For example, can you feel the liver? Is the liver enlarged? So let’s talk about the physical