Dyspnea is defined as an awareness of difficulty in breathing It is therefore a symptom, usually described by the patient as \shortness of breath,\whether the sensation is due to actual difficulty in breathing or is essentially an awareness of hyperventilation. If the symptom becomes striking, it always companies with dilatation of nares, cyanosis, use of accessory muscles of respiration and abnormalities of respiratory rate, depth or rhythm

the present era of technological advances, particularly in the various imaging modalities, there is a growing conception among practicing physicians in cardiovascular medicine that bedside physical examination is unnecessary and does not provide useful information

INTRODUCTION Palpation of the pulse Measurment of arterial blood pressure Auscultation of blood vessels

Fever .Normal body temperature 37°C, Circadian variation oral T00.5> axillary(腋温)

Jaundice Definition Accumulation of yellow pigment in the skin and other tissues bilirubin)

IMPORTANTCE! Despite recent advances in neuroscience and the continuing development of sensitive diagnostic procedures, the essential skill required for the diagnosis remains the clinical neurologic examination Most neurologic diagnosis can be made on the basis of the history alone

Woman complained of tightness in abdomen associated with belching wind which did not relieve feeling. Symptoms usually began between 5 and 6 p.m. lasing several hours. Relieved by White mixture. (D=Doctor, P=Patient)

Definition Peptic Ulcer Disease is defined as an ulcer occurring in a region that touches gastric aci d(胃酸) and pepsin(胃蛋白酶) and usually refers to gastric ulcer(胃溃疡) or duodenal ulcer (十二指肠溃疡)

Importance of Inquiry Gaining clinical information and collecting case history based on systemic inquiry Base of clinical practice *60~80% diagnosis could be induced from interview between patient and physician New form: consultation by phone, in internet

Referred pain Because of this convergence and the fact that the spinal neurons are most often activated by inputs from the skin, activity evoked in spinal neurons by input from deep structures is mislocalized by the patient to a place that is roughly coextensive with the region of skin innervated by