Bedside insonation: improvement in the diagnostic accuracy of anamnesis and physical examination by the undergraduate medical student
DOI:
https://doi.org/10.34019/1982-8047.2021.v47.33999Keywords:
Physical Examination, Ultrasonography, Kidney DiseasesAbstract
Introduction: Anamnesis and physical examination are considered the pillars of clinical evaluation. However, there is often a need to request additional tests, particularly imaging exams, to complete the diagnostic process. The increasingly frequent use of ultraportable ultrasound devices, some with artificial intelligence, can improve the diagnostic accuracy of anamnesis and traditional physical examination during medical consultation. Objective: To report how bedside insonation allows medical students to expand the collection of additional clinical data for more appropriate decision-making when attending to a patient with kidney disease. Clinical Case: A 49-year-old man was referred for nephrological evaluation due to edema in the lower limbs, asthenia, an episode of isolated macroscopic hematuria, anuria, and anasarca. At the time of the consultation, he was asymptomatic. He reported long-standing controlled hypertension with antihypertensive medications and previous bariatric surgery. Physical examination: Blood pressure of 170x110 mmHg, cardiopulmonary auscultation within the normal limits, abdominal scar, and edema in the lower limbs. The patient's lab tests showed chronic kidney disease category 5, anemia, hypovitaminosis D, and proteinuria at urinalysis. The electrocardiogram showed a sinus rhythm and signs of overload of the left ventricle. IBL performed by medical students after two-hour training on kidneys, heart, lung, and inferior vena cava allowed for additional clinical findings. Conclusion: The bedside insonation permitted identifying additional renal, abdominal, cardiac, and pleuropulmonary findings that allowed more appropriate decision-making by the medical students.
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References
Kirch W, Schafii C. Misdiagnosis at a university hospital in 4 medical eras report on 400 cases. Medicine. 1996; 75:29-40.
Burton EC, Troxclair DA, Newman WP 3rd. Autopsy diagnoses of malignant neoplasms: how often are clinical diagnoses incorrect? JAMA. 1998; 280:1245-8.
Bordage G. Where are the history and the physical? CMAJ. 1995; 152:1595-8.
Bordage G. Why did I miss the diagnosis? Some cognitive explanations and educational implications. Acad Med. 1999; 74:S138-43.
Narula J, Chandrashekhar Y, Braunwald E. Time to add a fifth pillar to bedside physical examination: inspection, palpation, percussion, auscultation, and insonation. JAMA Cardiol. 2018; 3:346-50.
Rao S, van Holsbeeck L, Musial JL, Parker A, Bouffard JA, Bridge P et al. A pilot study of comprehensive ultrasound education at the Wayne State University School of Medicine: a pioneer year review. J Ultrasound Med. 2008; 27:745-9.
Fox JC, Chiem A, Rooney K, Maldonado. Web-based lectures, peer instruction and ultrasound-integrated medical education. Med Educ. 2012; 46:1109-10.
Hoppmann RA, Rao VV, Bell F et al. The evolution of an integrated ultrasound curriculum (iUSC) for medical students: 9-year experience. Crit Ultrasound J. 2015; 7:1-15.
Steinmetz P, Dobrescu O, Oleskevich S, Lewis J. Bedside ultrasound education in Canadian medical schools: a national survey. Can Med Edu J. 2016; 7:e78-8.
Bastos MG, Ronzani FAT, Carmo WB, Toledo GC, Paula RB. Integração do ensino da ultrassonografia point of care no currículo de graduação em medicina: um relato de experiência. HU Rev. 2019; 45:98-103.
Kobal SL, Trento L, Baharami S et al. Comparison of effectiveness of hand-carried ultrasound to bedside cardiovascular physical examination. Am J Cardiol. 2005; 96:1002-6.
Mouratev G, Howe D, Hoppmann R et al. Teaching medical students ultrasound to measure liver size: comparison with experienced clinicians using physical examination alone. Teach Learn Med. 2013; 25:84-8.
Olson APJ, Trappey B, Wagner M, Newman M, Nixon LJ, Schnobrich B. Point-of-care ultrasonography improves the diagnosis of splenomegaly in hospitalized patients. Crit Ultrasound J. 2015; 7:13.
Bastos MG, Vieira ALS, Pazeli Jr JM. Uso da ultrassonografia point-of-care na prática nefrológica: transpondo os limites do trato urinário. HU Rev. 2019; 45:341-51.
Koratala A, Teodorescu V, Niyyar VD. The nephrologist as an ultrasonographer. Adv Chronic Kidney Dis. 2020; 27:243-52.
Kimura B. Point-of-care cardiac ultrasound techniques in the physical examination: better at the bedside. Heart. 2017; 103:987-94.
Lang RM, Badano LP, Mor-Avi V et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an up-date from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015; 28:1-39.e14.
Volpicelli G, Elbarbary M, Blaivas M et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med. 2012; 38:577-91.
Hubert A, Girerd N, Le Breton H et al. Diagnostic accuracy of lung ultrasound for identification of elevated left ventricular filling pressure. Int J Cardiol. 2019; 28:62-8.
Bastos MG, Vieira AL, Pazeli Jr JM, Galil AS. Diastolic dysfunction for nephrologists: diagnosis at the point of care. Rev Assoc Med Bras. 2020; 66:1750-6.
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Copyright (c) 2021 Paula Ribeiro Pena, Matheus Müller Martins, Geandra Martins de Freitas, Barbara Loures Peralva, Marcus Gomes Bastos
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