, oo | Lynn S. Bickley ra xe AN @iwotterskiuwer Braves’A6—6(4IR CQ EEE pil / Nhan xét vé ban dich “Bates’ Guide to Physical Examination and History Taking” 1S.8S. Pham Nguyén Quy Khoa Ung thi N6i khoa Bénh vign Trung Uong Kyoto Miniren Bénh vign Dai hoc Kyoto ‘Su tién bé vuot bac cla y hoc duong dai, vai sy phé bién cia nhiéu ky thuat t6i tan da gidp phat hién va mé ta nhiéu an bénh 6 that ky s6m han nhiéu so vai trudc day. Cac ky thuat xét nghiém mau cé thé gitip nghingd/chdn dodn suy tim, thuyén tc dng mach phéi, tiéu duéng...W giai doan khéng c6 tritu chiing. Céc ky thudt ndi sol va phuong phap. chin doan hinh anh khdc a3 gidp béc si phat hign khdi ung thu & gi2i doan sdm-cyc sm ma thim khém lim sing théng thuding khang thé phat hién ra, 0 mot s6 bénh vién tai Nhat Ban, viéc dua bénh nhan di chup CT/MRI nao con chor chin doan nhanh hon la ng6i chi bic si tham kham thdn kinh! Vi nhng ly do nay, nhiéu bac si khéng cdn ty tin vao ky ning lm sing cia minh va khéng cn manh dan chi day thé hé tigp theo vé tm quan trong cua tham kham trén nguéi bénh. Ong nghe khéng con la céng cu chan doan tin dy nia va vig mang 6ng nghe dang dan trd thanh biéu tugng lich st cda nghé nghiép. Khong may bic sicon danh. thdi gian thm khém 4 mé tA chi tiét nhung dc tinh cia tiéng tim nhu vi tri, cudng 9, dm sc, hubng lan,..dé suy ingdm, bién ludn visiéu am c6 thé cho thay cdc thong $6 16 rang, chdc chin han vé céu tru va chdc nang cia catim. ‘Tuy nhién, viéc tham kham vn phal duge chd trong vi nhng xét nghiém cén lam sang va khdo sat hinh anh khong thé thay thé quan sat tryc tiép cla bic si, BS c6 nhiéu bai hoc dau king vé sal lm nghiém trong xdy ra trong qué trinh chén dodn-diéutri do sudya dim/phu thudc qua nhiéu vio may méc hay vio ngudi"khong hé dung tdi benh nhan” Tiéu chudn chdn dodn nhiing cn bénh “kinh dién” nhuViém ndi tam mac nhiém khudn, Viém khdp dang thdp,...van inh&n manh théng s6 lam sing cn bic si thm kham ti mi mdi phat hign dugc. ‘Trong qué trinh thyc hanh va ging day tai Nhat Ban, toi con nh§n ra rng déi vdi bénh nhan, viéc thm kham lam sang la cuc ky quan trong vi dé la ky vong ciia ho, va cling la dau hiéu cho thay béc si cé quan tam tdi ho. Khong chi giip Ich cho chin doan, giup benh nhén tiét kim chi phi y té nha han ché xét nghiém thisa, viée ‘cham vao bénh_ nhan" c6 gia tri an Ui, gidp ngudi bénh an tam hon rét nhigu. (Mot trong nhiing cuén sich da giip t6i nhan ra nhiing gié tri cua y hoc 8m sing ma dén git’ ti vin con tran quy |i “Bates’ Guide to Physical Examination and History Taking’. ©4y la cudn sch n6i tiéng, dugc tai ban nhiéu Iin va duge tin ding rong rai Gnhiéu noi trén thé gidi. Tai ligu quy bu nay cing 3 dugc dich sang tiéng Nhét vio nim 2008 va da that su dép cing mong mdi cdi thién chat lvong gidng day va thuc hanh y khoa tai Nh8t Ban trong nhiéu nam qua. Nghién ngim cuén séch nay qua phién bin tigng Anh Ian tiéng Nhat, toi da thm uéc mong sa0.c6 thém phién ban tiéng Viet dé cing d6ng nghiép tai Viet Nam cp nhit ting va kién thuc c6 tinh he théng, diy dé, ding quy chudn thé gidi vé tham khan lam sang, Toi that sv vui miing khi nghe BS. Nguyén Quan Vinh n6i vé dy én dich séch “Bates? Guide to Physical Examination and History Taking” sang tiéng Viét va han hanh duge cho xem nhiing phién ban. Su tién trong qua trinh soan thao. Nhé né luc khéng ngiing cia han 40 dich gid hgp tc xuyén lye dia, bin dich 6 +a di vi dinh dang than thién nhu bén géc, véi nhiéu néi dung phong phi dugc trinh bay chuyén nghiép, dé hiéu véi ngudi ding. Toitin fang cuén sich nay sé dugc chao dén tai Viét Nam va tigp tuc tw thanh tai iéu"g6i du givng” cua nhiéu thé he y bac sf s¥ dung tigng Vist trén toan thé gidi. Xin cém on su tan tam cla cic dich gid va cia ban diéu phd: trong inhing thing nam qua dé bin dich dugc chdo dai vai cht lugng cao trén nhiéu phuong dién. Kyoto, ngay 20 thing 8 nam 2020Huong dan Kham Lam Sang & HOI BENH SU BATES Bates’ Guide to Physical Examination and History Taking AN BAN TIENG ViET DAU TIEN 2020 BOI HELVIETMED Lynn S. Bickley, MD, FACP Clinical Professor of internal Medicine School of Medicine University of New Mexico Albuquerque, New Mexico Peter G. Szilagyi, MD, MPH Professor of Pediatrics and Executive Vice-Chair Department of Pediatrics University of California at Los Angeles (UCLA) Los Angeles, California Guest Editor Richard M. Hoffman, MD, MPH, FACP Professor of Internal Medicine and Epidemiology Director, Division of General Internal Medicine University of lowa Carver College of Medicine Iowa City, lowa @.wolters Kluwer Philadelphia » Baltimore » New York + London Buenos Aires » Hong Kong « Sydney » TokyoLOI TUA CHO LAN TAI BAN TIENG VIET THU NHAT NAM 2021 ‘Than chao quy dng nghiép ‘Than chao céc ban sinh vién Nhieng dong chi nay, t6i xin dai dign tit cd nhimg thanh vién, bac st Helvietmed giti dén quy ban. Dé cdm on qué ban da wu ai quyén sach Bates, 43 dugc bin gin 2000 ban trong hai thang dau xuan 2021. Mua sch 43 qui, ph6 bign sach quy hon, nhung doe sch va sir dung séch lalla diéu tran quy nhat vi no gitip nhimng tac gia va dich gia xac dinh vé gid tri thuc cia kign thie nim trong quyén sach. Mt quyén sich hay gidng nhur mét con réng dep chwra diém nhan. Ban 4 mua sdch, ban da vé rong. Hay diém nhan dé rng bay. ‘Tran trong mdi cac ban doc sich dé gidp sach thing hoa. Thuy Si, Xuan 2021, Bac SI Nguyén Quan-Vinh HELVIETMEDNha Trang, Thang Ba, 2021, ‘Than chao Bac si Nguyén Quan-Vinh. Cém on anh da tang sch va c6 nha ¥ mdi i voi anh, quy dng nghiép va céc em sinh vién vé kinh aghiém str dung va gidng day quyén séch "Hwéng dan kham lam sang va hoi bénh sir Bates”. T6ivao Dai hoc ¥ - Duge thanh phé HO Chi Minh nim 1994, va bat dau di thyc tap ndim thit 3 v8 wrigu cheng hoc nOi khoa tai Bénh vién nhan dan Gia Dinh nim 1996-1997, Cac Thay CO day rat hay va co ban ve cach hdi bénh strva kham lam sang. ‘Thay Thuy da gidi thiéu va khuyén toi nén doc quyén “A guide to Physical examination and history taking” ca téc gia Barbara Bates. Toi da vao thy vién Dai hye Y - Dirge thanh phd Hd Chf Minh photocopy quyén sch, dn ban lan thir 6 nim 1995, Lic dé gid sach 1a 150.000 dong, trong khi 1 chi vang c6 gid 300.000 ding. Toi da dgc va tiép thu duoc nhing kién thirc vé hoi bénh sir va khdm lam sang rat hitu fch va rat gidng voi cdch céc Thay C6 trong trurtng day. Toi vin ap dung cic kién thitc nay trong thyrc hanh lam sang mbi ngay tir 46 d€n nay va ging day sinh vien y khoa nam thé 6 cia trudng Bai hgc Tay Nguyén dén thirc tap tai Ben vién éa khoa tinh Khanh Hoa tir nm 2010. ‘Thang 12 nam 2020, ngoai séch anh tang, toi cing mua 3 quyén sdch “Hwéng din kham lam sang va hoi bénh sir Bates” dich tir ban géc “BATES Guide to Physical Examination and History Taking” dn ban lan thir 12 ndm 2017 do anh dai dién HOi Helvietmed chii bién cho cdc bac sf trong khoa cling dgc. TOi doc va nghién ngim nhing kién thitc nay, cang doc thay cang hay. TOl da dem nhimg kién thite trong sch ciing nhw kinh nghiém lam sing da tich lay tir nhong nam thang sinh vién cho dén khi hanh nghe y gidng day cho sinh vien y khoa nam thir 6 trong Dai hoc Tay Nguyén va Dai hoc Budn Ma Thuot. Toi cang Khuyén khich cac em sinh vién mua quyén séch nay dé doc va c6 kién thie hoi bénh sit khdm lam sang rit hay va hu fch dé dang ap dung vao thuc hanh. Hau hét sinh vién va bac si & Viet Nam khi hoc y Khoa déu mua quyén “Atlas Giai phdu ngwoi" do Bac st Frank H, Netter bién soan duge GS.BS.Nguyén Quang Quyén dich dé hoc giai phdu hoc vi quyén nay vé hinh giai phdu rat dep va rat quan trong khi hoc giai phdu hoc. Téi nghi rang quyén “Huong dan kham lam sang va hoi bénh sir Bates” cing quan trong nhu quyén “Atlas Giai phau nguoi” ma mdi sinh vién va bac sican co dé c6 thé khdm 1am sang dling va bai ban nham phat hién chan doan bénh chinh xac. Kign that trong sach that sur vO gid ma gia thanh sach khéng cao chi co 629.000 dng, moi sinh vién va bac sf déu c6 thé mua dugc, Toi da gidi thiéu va khuyén khich cac ban sinh vién mua sach nay dgc dé cing c6 Jal kién thitc va ap dung vao thyc hanh lam sang. ‘Tol thanh that gii loi cam on dén anh, Hoi Helvietmed cing cc Thay CO, dng nghiép va cdc ban sinh vién a day cong tham gia dich va bién tap quyén sach, mot tai ligu rat hay va quy gid cho sinh vién va bac si c6 thé cap nhgt dirgc nhing kién thérc hau ich, méi nhat cita y hoc nhaim nang cao trinh 46 kham chira bénh phuc vy bénh nhan ngay cang tot hon. 6 [a digu mong mudn ciia tat ca sinh vién y khoa va bac sT tai Viét Nam. Kinh chic anh, quy dong nghiép trong Helvietmed sire khée, hanh phic, thanh céng hon nia trén buée duong truyén tai kién thie y khoa. ‘Toi hi vong trong twong lai Hoi Helvietmed sé tiép tyc t6 chic dich nhing tai ligu y khoa hitu ich cho sinh vign va bac si Viet Nam, ‘Tran trong. Bac si Mac Van Hoa ‘Trudng khoa Noi C4n bé Bénh vién da khoa Tinh Khanh Hoa.TUYEN BO MIEN TRU TRACH NHIEM Day 1a ban dich éng Vigt dau tién cia nguyén tac. ‘ates Guide to Physical Examination and History Taking, 12th Edition Copyright® 2017 Wolters Kluwer, Copyright© 2013, 2009 by Wolters Kluwer Health/Lippincott Williams & Wilkins. Copyright® 2007, 2003, 1999 by Lippincott Williams& Wilkins. Copyright® 1995, 1991, 1987, 1983, 1979, 1974 by J.B. Lippincott Company. All rights reserved. This ‘book is protected by copyright. No part ofthis book may be reproduced or transmitted ‘any form orby any means, including as photocopies orscanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner. Xudt bin theo théa thuiin voi ‘Wolters Klawer at Two Commerce Square, 2001 Market Street, Philadelphia, USA. ‘Wolters Kluwer Health did not participate in the translation ofthis title and therefore it does not take any responsibility for the inaccuracy or errors of this translation. Cac dich gid 64 tan luc dién giai, chuyén tai ndi dung mét cée trang thye nhdt. Tuy nnbién, c&cdich gid va nha xudt ban HELVIETMED: © Tir ch6i tat cd cic bao dim, v8 tinh chinh xic, tinh toan dién cha néi dung tac pham nay. © Khong cung edp ldt khuyén hodc hong dain y té: yéu cau céc dc gid coi tac phém la mét tai liéu tham khdo thuan ty, va tham khio cdc ngun kha 48 di chiéu. © Khong chiu bat ky trach nhiém nao d6i voi bat ky thuong tich, thiét hai nao déi véi ngwéi hoac tai san, sdn sinh tir tham chiéu hodc st dung ndi dung ban dich.Swiss-Vietnamese Medical Association HELVTETMED Boulevard de Pérolles 10, 1700 Fribourg: Switzerland. buaps://elvietmed ong/ ‘Ba dang kj ban quyén. ‘Caén sich nay duroc bio vé b6% bin quyn. Khong c6 phlin nio ella cun sich nay 6 thé duge sa0 chép, truytn taf duét bit ley hinh thée, phuong tign ndo, KE ed dud dang ban sao chyp, ‘bin scan (hay hinh chic khae), hod duve sir dung boi bat ky he thong lu tra va truy xuat ‘hong tin ndo ma khdng co sw cho phép bang van ban cia chi s6 hiu bin quyén, ngoai trircac trich dn ngéin gon trong céc bai bao va danh gid quan trong, Disclaimer from the original English version: ‘This work is provided “as is" and the pulisher disclaims any and all warranties, expross or implied, including any warranties as to accuracy, comprehensiveness, or currency of the content ofthis work, This work is no substitute for individual patient assessment based upon healthcare professionals’ examination of each patient and consideration of, among other things, age, ‘weight, gender, current or prior medical conditions, medications history, laboratory data and, other factors unique to the patlent. The pulisher does not provide medical advice or guidance and this work is merely a reference tool. Healthcare professionals, and not the pulisher, are solely responsible for the use of this work including all medical judgments and for any resulting diagnosis and treatments. Given continuous, rapid advances in medical science and health infomations, independent professional verification of medical diagnoses, indications, appropriate pharmaceutical selections and dosages, and treatments options should be made and healthcare professionals should consult a variety of sources. When prescribing medication, healthcare professionals are advised to consult the product infomation sheet (the manufacturer's package insert) accompanying each the drug to verily, among other things, conditions of use, warnings and side effects and identify any changes in dosage schedule or contraindications, particularly ifthe medication to be administered is new, infrequently used or has a narrow therapeutic ‘range. To the maximum extent permitted under applicable law, no responsibility is assumed bythe pullsher for any injury and/or damage to persons or property, as amatter of products ability, negligence law or otherwise, or from any reference to or use by any person of this work.PREFACE TO THE FIRST VIETNAMESE EDITION “Bates’ physical examination and history taking” is a well-known and widely used book in the USA and many parts of the world, Since its first edition in 1974, this work has been edited twelve times with the last version dating in 2017. The copyrightholder was Lippincott, Williams, and Wilkins (1974, 1979, 1983, 1987, 1991, 1995, 1999, 2003 and 2007. Since 2009, the right holder is Wolters Klugers (2009, 2013, 2017), Translations have repeatedly been undertaken into several languages, of which French (10th and 11th American edition) in 2010, 2014 and, Spanish in 2013 (11th American edition). In our knowledge, a systematic and complete guide is not available in Vietnamese. Some partial translation of books with similar content may exist, but not in conformity with the copyright regulations so that widespread and official use is not possible. As practicing physicians and medical teachers, we all acknowledge the foremost importance of careful history taking and thorough physical examination as the basis of any interaction with the patients. Mastering these abilities should, therefore, be acquired as early as possible and refined as oftenasone can, Bates,as.a standard book, provesitselfasanexcellent candidate to provide our students with these skills. From a Vietnamese point of view and with the tendency to introducing more English in Vietnamese Medical schools, some may argue that medical students should learn the content directly in English so that a translation may not be necessary. Another argument that may be raised against translating medical books is that the tanslated version may rapidly lose its value due to quickly changing medical knowledge. As physicians and researchers, we are, however of the opinion that, the fundamental, basic knowledge contained in “Bates” is quite solid and had withstood the test of time. Adaptations have been regularly adopted, but it seems that most of the changes concerned the layout, the restructuration, the rearrangement of the chapters for didactical reasons. The content was hardly affected. So once correctly performed, the translated version may remain valid for several years, maybe more than 15-20 years. Another argument is, at least for the next ten years to come, the English level of the medical students in Vietnam is not expected to improve abruptly. Their teachers should first be trained.The translation of “Bates” is also a response to a need, the one to know that the medical content taught in Vietnam has the same international standard, Mastering “Bates” may help increase self-confidence for Vietnamese Physicians in their daily activities while treating English speaking patients and when they are movingon an international dance floor. ‘The Swiss-Vietnamese Medical Association (HELVIETMED) is composed of physicians versed both in English and Vietnamese, besides their competences/ expertise in several medical fields. They were willing to launch ané to fund the translation project. Their availability in time was limited. This disadvantage, however, could be overcome by including other experienced Vietnamese physicians with solid English knowledge from different medical faculties and hospitals in Vietnam, from the USA, Canada, Australia, and Japan. Close collaboration with the School of Medicine of the Vietnam National University at Ho Chi Minh City allowed us to recruit a first competent staff to cover most of the chapters of the book. The additional staff could be enrolled from other faculties in Saigon for practical reasons. We preferred one junior first- translator and one senior-reviewer for each chapter. To promote young talent, wealso involved outstanding advanced students from medical faculties, ‘The participation ofnumerous members of the Vietnamese Medical Community {s an outstanding aspect of this project. We have been able to demonstrate that knowledge and commitment can be mobilized; a robust network can be built up in preparation for other meaningful projects in the future,ACKNOWLEDGMENTS On behalf of the Swiss-Vietnamese Medical Association, | would like to thank all the translators for their commitment. 1 also would like to emphasize the critical role of the coordination committee composed of Dr, Nguyen An Binh, Dr. Nguyen Minh Dung, Dr. Le Khac Tien. With significant contributions from Dr Nguyen Huu Thanh, Mr. Nguyen Dinh Thuong (Medical Student), and Mr. Do Thanh Binh (professional designer) - they have assured the coherence of the project, the technical quality of the book. WZ MEDICALE Beauied Helvietmed is thankful to our colleagues from the Société Médicale de Beaulieu, Geneva, who, besides granting scholarships to many medical studentsin Vietnam for years, has financially contributed to the printing of the book. Lastly, but most importantly, we would like to thank you, dear readers, and users for your welcoming the book as a source of meaningful and delightful knowledge. For Helvietmed Dr. Quan-Vinh Nguyen, presidentLOI NOI BAU - LOI TRI AN Loi noi dau “Bates’ physical examination and history taking” 1a cudn sch néi tiéng, durgc sir dung rong rai & Hoa Ky va nhiu noi trén thé gigi, Ké tir phién ban dau tién nam 1974, tac phdm nay da dugc tai ban mudi hai Ran vi phién ban My cubi cing vao nam 2017, Sé hiru bn quyén la nha xust ban Lippincott, Williams, va Wilkins (1974, 1979, 1983, 1987, 1991, 1995, 1999, 2003 va 2007) va tir nam 2009 14 Wolters Klugers (2009, 2013, 2017). CAcban djch da durge thiyc hién nhiu lan qua nhiéu ngon nga; trong dé c6 tiéng Phap (phién ban My 10 va 11) vio nam 2010, 2014 va cé tiéng Tay Ban Nha vao nim 2013 (phién ban My 11). Theo thign kign, ching ta khéng cé mt quyén sich tuong tu, dy diva e6 hé théng viét bang tiéng Viet béi tac gid Vigt. Co thé ton tai mot s6 ban dich ciia nhimng sach cing noi dung, nhung hoac khong hoan hao, hoc thiéu higu dinh, lai khong tuan thi céc quy dinh vé ban quyn nén nhimng ban dich d6 khéng thé sit dung réng rai va chinh thitc. Lanhiing bac sildm sang hoc c6 trach nhigm dao tgo sinh vién trong thuc hanh lam sang, tat cd ching ta déu § thie va cOng nhan tim quan trong hang du cita nghé thuat héi va khém bénh trong moi trong tac véi b@nh nan, Nhiing kp ming lin hé, do d6, nén dat durge cang som cing tét trong qué trinh dio tao bie sf, va nén duc tinh luyén thug xuyén. Bates, mt cudn sach tiéu chun, theo chiing tai lA mét chon Iya tét dé cung cap cho sinh vién cia ching ta nhiing ky nang nay. Véi xu hwéng sik dung tiéng Anh nhigu hon trong cic trémg Y & Vigt Nam, mét s6 dong nghiép trong Y gi6i cé thé cho rang sinh vién y khoa nén hoc try tiép ndi dung bang tiéng Anh ma khéng can phai dich. Mét lip luan khéc c6 thé duge néu ra la phién ban dich cé thé nhanh chéng mat gid trj dé kin thére y hoe thay di khdng ngirng. Tuy nhién, véi tw cach Ia béc sf va nha nghién ctu , ching t6i cho rng kién thirc nn tang, co-ban trong “Bates” la kha viing chic va da kinh qué thir thich ciia thei gian, Sach Bates 43 dug tai ban nhitu lan, nhung dirdng nhu hau hét cdc thay d6i trong nhitng phién ban mdi, lién quan nhi8u hon dén bé cuc, su tai cdu tric, sdp xép lai cdc chuong dé ting hiéu qua chuyéa tai, truyBn dat. NOi dung khéng bj anh hudng. Vi vay, mdt ban dich hoan chinh cé thé bao tin gid tr] trong niu nam, c6 1 hon 15-20 nam. Chiing t0i cling mao mudi nghi rang, trong mudi nam ti, trinh d6 tiéng Anh cia sinh vién y khoa tai Viet Nam sé khdng c6 tién bé dt bién. Trude dé, trinh d6 cia ede gidng vién phai duge céi thign déng ké. Ban djch “Bates” cing dap eng mot nhu cu: dc gia hoan toan c6 thé chic chin rng ndi dung doc ging day phi hop véi tidu chudn quéc té. Thanh thao “Bates” cé thé gitip tng cwtng surtu tin cho cac bic sT Vigt Nam trong cdc hoat déng diéu tri hang ngay cho bénh nhin néi tiéng Anh va trén cdc din dan Khoa gc quéc té.Higp h6i Bac si Thuy Si-Viét Nam (HELVIETMED) cé nhiéu thanh vién thong thao tiéng Anh va tigng Viét Y-khoa, nngoai nang luc chuyén mn trong nhiu Iinh vycy t&. Ho sn sing tai trg va tham gia tryctiép trong dyn dich thudtndy. Tuy nhién, sy tham gia cita cdc bac si Viétgidi tiéng Anh tir nhiéu chuyén khoa khdc nhau te VietNam va hai ngoai gp phan nang cao tinh than cng déng clia div 4n va cia Helvietmed, Sw hop téc mit thiét v6i Khoa Y, Dai hoc Quéc gia Thanh phé Hd Chi Minh cho phép chiing téi chon duge nhitu dich gia phy trach cho nhi@u chuong clia cu6n séch. Cac dich gia khéc d€n tir My, Canada, Uc, Nhat va tir céc dai hoc khac 6 Sai gon. Chting téi theo nguyén tac: mét dich gid va métchuyén gia hiéu dinh cho m6i chuong, véi mot vai ngoai lé. DE c6 va tai nang tré, ching t6i cing tao diéu kién cho cacsinh vién tai nang tham dy. Surtham gla dong dao cla cac thanh vién ca Cong dong Y khoa Viet Nam la mot dac diém, mot trong nhimng diém sng cia dy 4n nay. Chiing tot d3 ching minh rang kin thife va tinh thin céng hién 6 thé huy d6ng durgc tircOng dng. Mt mang hua tri thite vig trai da duoc xay dung trong qu trinh hgp téc: tin dé cho cée diy An. 6 ¥ nghia khac trong tuong lai. Loi Tri An ‘Thay mat Hiép hdi Bac si Thuy Si-Viét Nam, t6i xin cam on sy tan tam clia cdc dich gia. T6i cing xin nhdn manh vai trd quan trong cla ban diéu phéi bao gdm TiGn si Nguyén An Binh, Bac si Nguyén Minh Daing, Bac si Lé Khac Tign. Thém vao sy déng gép dang ké ciia Bac si Nguyén Hiru Thanh, anh Nguyén Dinh Thuong (sinh vién y Khoa), va anh Dé Thanh Binh (thiét ké sach) - ban diéu phét 44 dam bao duoc tién a6 cia dur an, chat hong kf thuat va su thaém m9 ciia cuén sich. Helvietmed xin tri an nhang dong nghiép tir Higp hOl Société Médicale de Beaulieu, Geneva, Ngoai vite cp hoc béng cho nhiéu sinh vién y khoa nghéo tai Viét Nam trong nhiéu nim qua, Société Médicale de Beaulieu 43 déng 6p tai chinh vao vige in dn cia cudn sch. Cu6i cing, nhung quan trong nhat, ching tdi xin cam on nhimg doc gia: diéu dwong, ky thuat vién, sinh vién Y hoa, béc si, gidng vién... Hy vong, cOng dong Y khoa Viét Nam sé chao dén cudn sch nhurmét ngudn kign thire § nghia va thi vi. ‘Thuy Si, Dau thu 2020 Bac SiNguyén Quan-Vinh HELVIETMEDDANH SACH DICH GIA THEO THU TU Nguyén Huynh Kim Ngan * Sint vign, Nin khéa ¥ 2016-2022, Khoa ¥, Bal hoc ‘Que gia Thanh pho H6 Chi Minh, viet Nam Tién siNguyén An Binh * Totnghiep nganh Dugc st (2005, Bal hoc Otago, Dunedin, New Zealend) + Tétnghiép Tién si(2012, Bai hee Otago, Dunedin, New Zealand) * Giang vin, Bai hoc Qué gia Thanh phd H6 Chi Minh, viet Nam Bacsi Nguyén Thanh Cong * Tot nghiép Bac sta khoa (2015, Bai hoc Y Dugc, ‘Thanh pho H6 Chi Minh, Viet Nam) * Tet nghigp Tien s!¥ Khoa (du dinh 2021, at hoc Y toa Shiga, Nhat Ban) Tién si- BSc sf Nguyén Quan-Vinh + T6t nghigp Bac 51(1991, University of Bern, Switzerland) + TiénSTY Khoa (2001, University of Bem, Switzerland) ‘Chuyén Khoa Noi Téng quat (2001), NOi Than (2003), Hi BécsiThuy SiFMH * Chaigé d'enseignement clinique, Institut de Médecine ‘Ge Famille, Université de Fribourg, Suisse + Médecin agrée © Centre de Transplantation dorganes, Hépital universitaire du Canton de Vaud, Suisse * Service de Néphrologie et Dialyse, Hopital Fribourgeois, Fribourg, Suisse Dr. Tuan V. Nguyen + FAHMS | Senior Principal Research Fellow * Laboratory Head, Genetic Epidemiology of Osteoporosis Garvan, Institute of Medical Research * Professor, St Vincent's Clinical School, UNSW Medicine, UNSW Sydney * Professor of Predictive Medicine, University of Technology, Sydney (UTS) Bécsi Mai Vin Higu ‘Tt nghiép Bac si Da khoa (2017, Knos ¥, Dai hoc Qué ja Thanh ph HO Chi Minh, Vigt Nam) * Giang vién b6 mon Sinh hod - SHPT, Khoa ¥, Bai hoc ‘Quéc gla Thanh phd H6 ChiMinh, Viet Nam * Nghién cu sinh Tién si (Metabolomics - Khoa Dugc, ‘Bai hoc Quoc gia Seoul, Han Qué) CAC CHUONG SACH (Ban Tiéng Wiét Bau Tién 2020) Bic siNguyén Binh Vin © Tot nghi¢p Bai hoc ¥ Duge, Thanh ph H6 Chi Minh, vigt Nam (1980) * “Tee nghite Chuyén khoa Gy Mé Hi Sic (1987) * Tot nghiép Chuyén vién May Thé va Gay Me (Vanier College, Montreal, 1995) © Tot nghigp Dieu duding dai hoc (University of Ottawa, 2000) Bic si Trin Dim Nghi = Tétnghiép Bic sf Ba khoa (2017, Khoa Y, Bai hoc Qué gia Thanh phé H6 Chi Minh, Viet Nam) © Sinh vide Thac Si nganh Khoa hoc Than Kinh (2019-2021, Pohang University of Science and Technology, South Korea) Bicsi Doan Thanh Huy * Tot nghitp Bic s1 Ds khos (2020, Khoa Y Opi hoc Quéc gia Thanh phd H6 Chi Minh, Vietnam) Bac si Trén Thuy Huong Quynh '* Tot nghiép Bic si Da khoa (2019, Khoa Y, Dai hoc Quéc gia Thanh phé H6 Chi Minh, Viet Nam) © Nghien cuu sinh Tién si (03/2020-nay, Bai hoc Y khos Kansai, Nhat Bin) Bic siTrén Duy Tam © "TEenghitp Béc si (1993, Bai hoc ¥ Dusk, Thanh ph HS Chi Minh, Viet Nam) © Bac sichiic danh N6i tnd Tam thin (1997, Dai hoc Henri Poincaré, Nancy | Pap) * B&c sichuyeén khoa | Tam Than (2001, Bai hoc Due, ‘Thanh ph6 #6 Chi Minn, viet Nam) ‘+ Bic sichuyén khos I Tarn Tn (2013, Datboc¥ Hus) ‘© Bic sitruting phong Ké hoach Téng hop (2007, Binh vin Tam Thén, Thanh phé Hé Chi Minh) Duong Hai ‘* Tét nghiép Bac si Ba khoa (2018, Khoa Y, Dai hoc Quéc {gia Thanh pho H6 Chi Minh, Vigt Nam) * Giang vien 89 mon ¥ Hoc Cong Bing - Dich Te Hoc, Khoa ¥, Bai hoe Quée gia Thanh phé Hé Chi Minh, Vidt Nam (2018 - nay) Dr. Wynn Huynh Tran, MD, DPD, Mse. © Assistant Professor of Medicine and Pharmacy at Western University and California Northstate University © Residency Program Director, Advanced Clinical Pharmacist Practitioner * Consultant at Methodist Hospitalof Southern California * Rheumatologst and Dermatologist at Wyrin Medial CenterBéc si Nguyén Minh Nhyt * Toinghiép Bic sa khoa (2020, Khoa Y, Bat hoc Quéc gia “Thinh phd Hé Chi Minh, Vit Narn} Bée sI Nguyén HauThanh © Téenghiép Bic s1®2 khos (2020, Khoa Y, Dai hoc Quéc gia Thinh phé Hé Chi Minh, Vide Nam) Prof. Trén Phan Chung Thiy, MD; PhD President of Vietnamese ENT Society *® Vice President of Vietnamese Society Sleep Medicine *® Head ENT department, Faculty of Medicine, Vietnam National University: Ho Chi Minh City Béc siLy Minh Tang * Totnghiep Bac si Ba khoa (2008, Bathoc ¥ Ougc, Thanh [ph H6 Chi Minh, Viet Narn) = Thac sTY khoa, chuyén nginh Ngoal khea (2011, Bai hocY ‘Dua, Thinh phé Hé Chi Minh, Vigt Nam) *® Chuyén khoa 2 Ngoai khoa (2019, Dai hoc Y khoa Pham Ngoc Thach, Thanh phé H6 Chi Minh, Vigt Nam) ‘Thac st-Bac siH6 Hoang Phuong * Tétnghip Béc si (2001, Bai hoc Y Dugc, Thanh phé H6 Chi Minh, VietNam) * FFibenh wien Saint Antoine, Bai hoc Paris Vi, 2007. * Tétnghlép Thac s1Y khoa (2008, Dai hoc Y Ouge. Thanh phé H6 Chi Minh, Vigt Nam) © Gidng vién Bai hoe Y Duge, Thanh phé Hé Chi Minh, Vige ‘Nam (2002-2020) * Trubng khoa Chin dosn Hinh nh - Bénh vien Cap cus Trung Vuong Thanh phé Hé Chi Minh (2009-2015) ‘= Pho Truéng khoa Chan dosn Hinh anh -Bénh vien Bai hoc Y Duge Thanh ph6 H Chi Minh - Co s& 2 (2017-2020) * Glam ¢6c Trung tam Chin dodn Hinh an - Ben vien Tam Anh Thanh phé Hé Chi Minh (2020) Nguyn Dinh Thuong ‘= Sinh vien. Nign khéa ¥ 2016-2022. Khoa ¥, Bai hoc Quiic gia Thanh phé H6 Chi Minh, Viet Nam Bac siL@ Minh Hing © Totnghiép Bac siDa khoa (2020, Dai hoc ¥ Duge, Thanh pho Hé Chi Min, Viet Nam) Giso sut-Tién si- Bac si Dang Van Phuc Trung khoa ¥, Ba! hoc Quéc gla Thanh phé Hé Chi Minh, wet Nam ® Chi tich Hi 66ng Gido su NganhY © Chi tich H6i Tim Mach Viet Nam Bac siLai Khanh van * Tétnghiép Béc si Ba khoa (2016, Bal hoc ¥ khoa Pham: Ngoc Thach, Thanh phé Hé Chi Minh, Vidt Nom) © Tétnighiép Bée siNéi tri nginh Sin phu khoa (2016-2019, ‘Dai hoc ¥ Duoc, Thanh phé Hé Chi Minh, Viet Nam) © Tétnghigp Thac si¥ hoc nganh San phy khoa (2017-2019, ‘Dail hoc ¥ Duge, Thanh phé Hé Chi Minh, Viet Nam) Phé Gido su-Tién si- Bic si Lé Vin Quang © Glang wien Cao ef, bd man Ngos) téng quit, 831 hoe Duige. Thanh ph6 Hé Chi Minh, Viet Nam * Ph6 Trung khoa Y, Bai hoc Quéc gia Thinh ph H6 Chi ‘Minh, Vigt Nam * Nguyén Phd Trudng khoa Y, Bai hac Y Duc, Thanh pho 16 Chi Minh, VietNam Thae si - Bac si Nguyén Long-Quée * Tét nghiép Bac Ba kha (2007, Bai hoc ¥ Duge Cin Tha, WigtNam) * Thac SiY Khoa Chuyén Khoa NOi Téng qust (2017, Dai hoc Y.Duge Cn Tha, Viet Nam) © Chuyén Khoa Huyét hoc (2014 Centre Universitaire Hospitalier Vaudois.CHUW, theo chung tinh FMM, Thuy SD Bac siNguyén Hai Nam * Tt aghiep Bac sia khos (2012, Bal hoc Duo, Thanh ph H6 Chi Minh, Viet Nam) * Tot aghiép Bac si NO) tru Benh vien Chuyén nganh Ngoai ‘hos (2016, Bat hoc ¥ Owac, Thanh pho H6 Chi Minh, Viet Nam) + Nghidn edu sinh Tién sIY hoc, chuyén nginh Phau thust ‘Gan Mat Tuy va Ghép Tang, Bai hoc Kyoto, Nhat Bén. Bac siT6 dng Kha * Tet nghiep Bac sida khos (2019, Khoa ¥, Bai hoc Quée gia ‘Thanh pho H6 Chi Minh, Vigt Nam) © Chuyén vién phong Khoa hoe cng nghé va Quan he ‘auéc té. Khoa ¥, Bai hoc Quéc gia Thénh phé Hé Chi Minh, \Vigt Nam (2019 - nay) * Bac si, hoa Ngoai Chéinthuang chinh hinh, benh vién Th6ng Nhat, Thanh phd Chi Minh (2019 - nay) Dr. HS Thwigng Ding, MD, PhD, FACC, FSCAI. Assistant Professor at University of Medicine and Pharmacy of Ho Chi Minh City * President, Vietnam Society of Cardiovascular Intervention * Director, Cardiovascular Center, Thong Nhat Hospital, Ho Chi Minh City * Cardiacinterventionist at Emergent and Interventional Cardiology Department ‘Thac si- Bae si Duong C20 Tri ‘Tt nghigp Bac siBa khoa (2016, Khoa Y, Bal hoc Quéc gia ‘Thanh pho H6 Chi Minh, Viet Nam) * Tot nghiep Thec s1Y Khoa (2079, Bal hoc Dugg, Thanh ‘phOH Chi Minh, Viet Nam) Béc si L¢VGTAn * Tt nghiép Bac si Da khoa (2009, Bai hoc khoa Pham Ngoc Thach, Thanh ph Hé ChiMinh, Viét Nam) * Tétnghiép nd trd Nooal Niu, Dai hoc Y Duge, Thanh phs 16 Chi Minh, Vigt Nam (2013) * Bac si diéu tri tai khoa Nam Hoc, Benh vien Binh Dan, “Thdnh ph6 H6 Chi Minh, Viet Nam (2013-2018) * Tot nghiép fellowship chuyén nganh Nam Khos tai ai hoc ¥ khoa Tulane, Lousiana, Hoa Kj (gio b6 sung (Am phy): Nguyén nhanva tinh chat 338 Bing®-8: —_Déu higu thyc thé trong ting bénh fy nguc 339 Chung 9 HeTim Mach 33 Bing 9-1: Phinloai nhip va téns6 tim 400 Nhip khong déu 401 Bat thudng vé mach va s6ng 4p luc 402 Céc thay 46i va bat thuéng cia dién dap tam that 403 Su bién di trong tiéng tim thd nhat-T1 404 Su bién d6i trong tiéng tim thu hai-T2 405 Tiéng tim thém vao trong thi tim thu 406 ing tim thém vao thi tim trugng 407 ‘Am théi git tam thu 408 ‘Am théi to’n tam thu 410 ‘Am théi tam truong au Tiéng tim mach v6i cd hal thanh phén tém thu va t&m truong 42Chuoing 10) Tuyén viva vung Nach Chuong 11 Chuong 12 Chuong 13 Chuong 14 Chuong 15 Bing 10-1: Céc khéiu wi thutng gp Bing 10-2: Cac dau higu cé thé nhin thy cla ung thu vd Bung Bang 11-1: Bau bung (coining) Bing 11-2: khé nut Bing 11-3: Tiéu chay Bing 11-4: To bén Bing 11-5; Phin den vé Phancé mau Bang 11-6: Tiéu lit nhdt, tiéu dém, eéunhiéu Bang 11-7; Tiéu khong kiém ché Bang 11-8: Cc kh6i phéng khu trd thanh bung Bing 11-9: — Céc khdithanh bung Bing 11-10: Cac am ving bung Bang 11-11: Bau bung (thye thé) Bang 11-12; Gan to: RO rang va thuc sv Hé Mach Mau Ngoai Bién: Bing 12-1: Cécdang phi ngoai bién Bing 12-2: Banh mach méu ngosi bién gay dau va nhing bénh Wy tvong ty Bing 123: Strdyng chis6 c6 chan -cénh tay Bing 12-4: Thiéumau man déng mach va tink mach Bang 125: Lott thudng gép & cSchin va ban chin, He Sinh Duc Va Céc Thostv 6 Nam Gio 4c bénh lay truyén qua dung tinh dyc 6 nam gidt Cée bit thuding & dong vat va biv 4c bit thuting cia tinh hon ac bit thudng vé mao tinh va thing tinh Céch thc, biéuhién va sy khéc nhau cla thot vid viing ben Co Quan Sinh Duc NE Bing 14-1: Cac tén thudng viing am ho Bing 14-2: Syphéng va sung viing 4m h6, 4m zo va nibu dao Bing143: Khihu Bang 144: Cac bién thé trong bé mit <6 ti'cung Bing 145: Hinh dng ca W <6 wrcung Bang 146: Cac bét thuong cia c6 wa cung Bang147: Wwiclawcung Bang 148: Batthvong coatwcung Bing 149: —_Khdiuphén phy Hau Mén, Truc Trang va Tuyén Tién Lit Bang 15-1; Thang diém danh gia trigu chuing BPH: Higp HOV Tiét Nigu Hoa Ky Bang15-2: Cac bat thudng 6 Hau mon, Bang 15-3: \Viing da xung quanh hau mon va Truc tring Cac bit thuéng cia tuyén tién ligt 49 449 490 494 495 496 497 500 501 502 504 533 534 536 337 z S8ees 88 sssesggess geChung 16 Chuong 17 Chuong 18 Chuong 20 H8 Co Xuong Khép Bing 16-1: Bau bén trong va xung quanh khép Bing 162: Baucé Bing 163: Bau lung Bing 164: Bau vai Bing 165: Dau va sung khuyu tay Bing 166: Viémcackhépé ban tay Bing 167: Sungva bién dang ban tay Bing 168: Nhiém tring ngén tay, khodng gan tay va bao gan Bing 16-9: Bat thuéng tai ban chan Bing 16-10; Bét thudng tai ngén chan vi vét chai He Thén Kink ‘Céc 16 lognhé thén kinh Trung wong va Ngoai bién Céclovi dot quy Naat va cécSiloan twang ty Cogiat Run va cac ct dong khong tu chit (Céc r6i loan véngon agit Rung giat nhan cu - Nystagmus ‘Ci loai Het mat Cic r6i oan vé truong luc co (Céc bit thuting dng di va tu thé Hon mé thy thé va chuyén hos Thang diém dénh gia hén mé Glasgow - GCS Bing 17-13: Béng ti. bénh nhan hon me Bing 17-14: Céctu thé bit thutng & bénh nhan hon me Dinh Gia Tré:TirTré NbG Nhi Dén Tré VI Thanh Nit Bing 18-1: Cac bit thudng vé nhip tim va huyét 4p Bing 18-2: Cac ban va bat thutng da hay gp 6 tré so sinh va nd nh Bing 18-3: Mun c6c. cdc tén thuang giéng mun cbc va céc tén thuong nhé cao khéc Bing 18-4: Tén thuong da phé bign 6 thos the Su Bing 18-5: Cc bSt thudng cia du Bang 18-6: Céc khudn mat bénh iy é nh ni va tré ahd Bing 18-7: Ce bit thudng cia tai mai hong Bing 188: Cc bat thudng cila ring, hong vac6 Bing 189: Tim étreem Bing 18-10. Am théitimbm sinh Bing 18-11: Cée du higu thye thé cia lym dung tinh dye Bing 18-12 Hénigudyenam Bing 18-13: Cac bie thudng caxuang khép phé bién & tré nha Bing 18-14: Se manh cia su phéng ngita: Céc bénh nga dugc bing vaccine Ngutdi Cao Tu6i Bing 20-1; Hi binh ngudi cao tub: Chim s6c phi hgp vél vin hoe Bang 202; Mésing va ching mét wt Bang 203: Tam soat ching mat tri:The Mini-Cog Bang 20-4: Tém sodt ching mét tri: Banh gid nhgn tha Montreal - ‘The Montreal Cognitive Assessment (MOA) 25 96 698 9 700 702 703 704 705 706 707 a 912 912 313, 14 216 a7 oa 921 922 922 923 955 1000 1007 1002 1003NHONG NEN TANG = BE BANH GIA SUC KHOE Cs 2 CL NHONG CO SO DE PHONG VAN ‘DANH GIA LAM SANG HIEU QUA 3 VA KHAI THAC BENH Sit Pat td LUONG GIA BANG CRUNG LAM SANG 45NHONG CO SO DE DANH GIA LAM SANG HIEU QUA é higuré hon chugng nay, mdi ban tham khéo thém: | Bates Pocket Guide to Physical Examination and History Taking, tdi ban Kdn thar 8. "© Bates’ Visual Guide to Physical Examination (All Volumes) ®@ Nquén théng tin y khoa danh cho sinh vién y khoa va cin bO giding trén website: ‘httpu/thepoint iww.com ky thuat kham bénh va héi bénh st, diéu ma cdc ban ~ nhirng nguéi ban tré dang bat dau burée chan vao nghé y cing nhw cic ban ddng nghiép ~ dang mong muén hoc tp thém tir cudn s4ch nay, bao gdm cdc ky ning cin thiét lién quan dén qué trinh chim séc va chifa trj cho ngudi bénh. Kp ning thu thap cdc théng tin da dang, nhiéu sc thai ttr bénh nhan qua vige hdi bénh sir va céc buée kham bénh ton dign, chinh xéc gidp ban lay dugc long tin tir phia ngubi bénh, khu tra cde van dé bénh tat va dura ra nhimng dinh huéng chan doan phi hgp (hinh 1-1). Chat long ciia bénh sir va viéc kham bénh sé quyét dinh sy dénh gid tinh trang cla bénh nhin sau dé, chi dinh thém ede xét nghiém chuyén su hon vi dua ra hudng diBu tri tip theo. Trong suét qué trinh phan dau dé tré thanh mot thay thudc lanh nghé, voi tém long hét minh vi bénh nhan va tinh than hgc tap sudt doi, cdc ky nang lam sang nay ciia ban sé dan durgc mai dila va hoan thién theo thdvi gian ‘Trong qua trinh hoc tap, ban c6 thé sé gip khé khan khi phai hoc cc ky ning, yeu cau can thiét én quan dén bénh nhan nhu: sy lang nghe dong cam, kha nang tham hoi va trao 46i, trd chuyén véi bénh nhan & moi lita tudi, voi tam trang cling nhu hoan canh khac nhau; cdc kj ning kham bénh & ahitu co quan khéc nhau, anh gia mite 46 bénh t3t va cudi cing, phan tich, bién lun dira trén c4e thong tin thu duge dé dwa ra chin doan va ké hoach tiép theo. Mét khi kinh nghiém, cling nhu cdc ky nang hdi bénh si va kham bénh cia ban dan hoan thién, cac buéc danh gia, phan tich sé bat dau ngay thivi diém dau tién ban gap bénh nhan: phat hign cdc trigu ching, déu hiéu bat thuéng, lién két ning th6ng tin minh tim due vei céc co ché sinh ly bénh hoc thé chat va tém ly, dura ra nhing chin doan va cic b6 xét nghiém can thiét dé ly gidi_ cho nhitng digu bat thudng dé. Nhé nhiing ky ning nay, ban c6 thé nhan ra durge mOt ci nhin da chiéu, mot bite tranh lam sang ve bénh nhan ~ nguoi dang hét long tin tréng vao sw chim s6c cila ban. Viéc kham bénh lim sang khong chi don thuan la mot phuong tign dé thu thap thdng tin, dua ra chdn doan va cic xét nghiém c&n thiét, kj ning nay cén gitip ban hinh thanh mt sgi day lién két, mot méi quan hé tét dep giGa ban va bénh nhan, mét trong nhimg yéu t6 quyét dinh dén sy thinh cng ciia qué trinh diéu tri va lanh bénh ciia nguivi bénh (hinh 1-2)? HIN 1-1. Tém quan trong vide thigt ap méi quan HiME 1-2. Tham khém bénb mot chch thudn thue.Chuong iu tién, dugc chinh sira trong ln tai ban nay, sé cung cp dén ban nhing hwong dan cu thé dé dat duoc higu qua khi thim kham chita bénh, bao gim bén phan: Bénh str; Kham bénh; Bién ludn lam sing: Banh gid va xdy dung kéhogch vi Gach viét mot bénh dn t6t. Ching t6i sé cung cp cho cdc ban thong tin ve cc thanh phn cia bénh sir va céch t6 chit bénh sir d6 cing niur tng quan vé cic buéc kham bénh thé chat theo m6t trinh ty, dam bao sur hai long, thoai mai cho bénh nhdn, théng qua viéc giéi thiéu dén ban céc ky nang kham bénh ting ving tir tng quat dén hé théng. Trong lan tai ban nay, chuwng dau tién sé bao gbm thém phin: Bién ludn ldm sdng; Danh gid va lén kéhoach diéu tri va Chat lugng cita m6t bénh dn t6t. Churong 2, Dinh gid chirng cir lim sang, sé d2 c§p dén cic ky nang phan tich dé danh gid két qua cdc xét nghiém, cdc huéng dan va cicy van lign quan dén vin dé cia bénh nhan, tir d6 gitip ting cuémg va dim bao cho qué trinh thyc hanh tt nbat va hoc tap sudt doi cita ngudvi baci. Chuong 3, Ky nang héi bénh sit, hoan thanh nhikng churong dau co ban nay sé gidp ban chudn bi tét hon cho viéc khdm bénh thé chat sau d6. Tir chong 4 dén chong 17, cacky nang kham bénh voi mdi co quan khacnhau sé durgc 48 cap 4én, méi churong déu cung cp nhimg dérligu c6 chimg ctt rd rang va dong thoi cung cp cic ngudn tham Khao dé ban cé thé mé rdng thém kién thirc cha minh. Bat dau tir chong 4, méi churong s8 bao gém thém phin Néng cao strc khée va tham van: Bang chitng va khuyén cdo sé nhac lai cac hwéng din, dé hwong dan cho vige dieu tr} dy phong benh tat. Cudn sich nay durec sp xép theo trinh ty sau: © Chwong 2, Panh gié ching cit lam sang, d® cap dén vide hot benh sit va khém bénh nhw nhimg cong cu chan dodn; danh gid gid tri, higu qua cua cdc xétnghiém chin doan, nang cao sirc khde; inh gid nhimng nghién ciru lim sng va cac tiéu chun chia grade cho cdc huéng dan. © Churong 3, Ky néing hdi bénh sir, bao gdm nhiing ky nang phirc tap, da dang va an thiét dé xdy dung bénh sir cling nhu mdi quan hé voi bénh nhan. Cac ky ning nay tiy co bin dén nang cao, sé gitip ban tiép xiic véi nhitu Adi tong bénh nhdn khdc nhau vé vin héa va nghé nghi © Churong 4 dén chwong 17 a8 cap dén cic kj nang kham bénh tirng ving: lién ‘quan dén giai phdu, sinh ly; kj nding khai thac bénh sir; cdc huéng dan dura trén bing ching nang cao sire khée, cic ky thuat khim bénh va viét bénh 4n. Cc chong nay ciing bao gdm nhigu bing so san sv khdc biét gitta che trigu chimg va céc du higu thire thé gin gidng nhau thong gap, cing nh cc trich dan tly y vin. © Chung 18 dén cheng 20 sé lien quan dén vige hai bénh sir va vide khim bénh trén nhing di trong dac biét nhw so sinh, nhd nhi, tré em, thanh thiéu nién, phu nit co thai va nhiing d6i turyng nguii lon khac dya trén viée mérréng, thay d6i céc thanh phan cla mOtbénh an ngwoi én trudng than, Mot khi ban ndm 6 cc kj nang vé hdi bénh str cing nhur khém bénh, ban sé 6 thé danh gid bénh nhan mot céch cha dng hon, dan dan ban sé wy tin va chuyén nghiép hon, Sy két hop cdc yéu t6: long tin, syrt6n trong lan nhau va su thanh thao cac ky nang kim sing sé tao nén nhiing kién thitc, ky ning v6 gid cho nhimg bac sTlam sing.ANH GIA BENH NHAN: TOAN DIEN VA KHU TRU Se SS Ct Xac dinh pham vi danh gia Mi ln ban gp bénh nhan, ban sé thurdng phai d6i dién voi mot s6 cau hoi phé bién nhur: Minh nén khém bénh & mite d6 nd0? Minh nén khdm bénh todn dign hay chi khu tré mt co quan nao 46? B61 v6i bénh nhan ban gap Tan dau tién tai bénh vién hogc phong khdm, thudng thi ban sé chon khém bénh toan ign bao gm tat cd cdc thanh phan cua mét bénh sit va kham bénh toan than, ‘Trong nhiéu tinh huding Kehdc, ban cé thé danh gid bénh nhan mbt cach khu trih hay djnh huéng dua crén van dé mot cach linh dong hon, dac biét trén nhirng bénh nhin ma ban da biét ré qua kham bénh dinh ky hoac trong nhing trudng hop cin chm s6c “khin cp” nhu dau hong hoc dau iu g6i. Ban sé phat diéu chinh mie 46 pham vi kham bénh va hdi bénh sir cia minh tay vao tinh hudng ‘cy thé tay theo: mc dO nang cha bénh nhan; yéu cau cn than, ti mi ca bénh nhan; hoan cénh lam sing ~ n6i tra hay ngoai tra; cham séc co ban hay dic i6% han thdi gian cia ban. Tir nhieng ky nding trong phn danh gid toan dién, ban cé thé chon nhimg phan khu tra lién quan, phi hgp véi cdc van dé strc khoe cia bénh nhan dé héi bénh sit va khém bénh nhanh hon nhung van dap tng di c4ctiéu chudn lam sang ding va chinh xéc. Hol bénh si va khdm bénh: tan dign hay khu tri? Toan ditn Khu tea Thich hgp véi nhing bénh nhin méié Phat trién dy di nhiing kj nang Khim bénh vien hodc phong kham bénh thyc thé. CCung cp nhiing thong cé nhén, cabin Thich hop vei nhdng bénh nhén da va vé bénh nhan. dang theo déi, dac biét | trong tinh Ging ¢6 xy dng m6i quan he bic si- ‘hudng kham dinh ky hode bénh nhin. “khan cép* Gldp ghi nhan va loa! tis che nguyen Ch tam vo nhiing vin 48 va vigu nnhin én quan dén vin 6€ sic khde chang kh trd. ca bénh nan, Danh gid trigu chung gidi han 6 mét he Cung cdp céc thong tin co bin cho viée coquannio 46, Kham bénh trong tuong lai. SU dung ky nng kham bénh khu ted Tao nén ting cho vige ning cao sue pphit hgp vai vin dé stic khbe cla khée qua viée gido dyc va tu vin. bénh nhan mot cach cdn than vatoan dign abit <6 thé. Ban cé thé thay ring, viéc khdm bénh toan dign con bao gdm nhiéu phin, khong chi don thuln la vige danh gia cdc hé cor quan cla co thé. D6 con 1d mot ngudn thong tin corban vé cd nhan ngwoi bénh, gidp bac si xay dung, cling c6 mét quan hé glia thay thudc va bénh nhan. Hau hét moi ngudi tim dén sy chim soc y té khi c6 trigu ching hodc ¢6 ly do lo lang 4én sire khée ciia minh. Khdm bénh toan dign s@ cung cp nhiing thong tin co ban gitip ban hoan thién céc @inh gid va trd ld cdc edu hdi cua bénh nhan.ANH GIA BENH NHAN: TOAN DIEN VA KHU TRO 0 phn khdm bénh khu trd, ban chi cin chon céc ky nang trong ting voi van de bénh tétcda bénh nhan. Tir bénh sir, trigu chime va d6 tudi sé gitip ban xéc dinh pham victa viéckham bénh khu trd, cing nhurkién thie cia ban lin quan dén vin dé sire khée cla ngudi bénh. Vi dy, khi gip nhing bénh nhén dau hong, ban sé cin phai xac dinh ngwoi nao cé tang bach cau don nhan nhiém khudn {infectious mononucleosis) va can than sé gan, lich, Trong khi dé, nhimg ngudi cim lanh théng thu’mg, ban chi cin khim bénh Khu tri ving diu mat 8. Phin bign luan Kim sing sé giip ban dva ra nhirng quyét dinh trong nhimng tinh hudng nay, s duoc trinh bay sau & chong nay. Ve vige kiém tra sitc khde dinh kj, c6 rat nhiéu nghién ciru 3 duoc thee hién va xom xét cn than vai trd tia khdm bénh dinh ky hang nm d6i véi sing loc va phong ngira bénh tat. Trong khi d6, vai tro cia dnh gid trigu chimng lai chura c6 ‘mot Ong thuan théng nhat ro rang trong khdm bénh dinh kj.*~° Su phat trién ita y hoc thu chimg cing ghi nhdn vai tré cia céc ky nang kham bénh trong, vie dura ra quyét dinh chin doan va cé thé giap bénh nhan tiét kiém hon thong qua vige gidm cac xét nghigm khéng cin thiét.'~# Nhing ky thuat duge xem la 6 gid tr] bao gdm: do huyét 4p, dinh gié ap lye tinh mach trung wong tir mach canh, nghe tiéng tim, phat hign gan lach to va khém bénh ving chau kém phét méng c6 tir cung (Papanicolaou smear - Pap's smear). Nhiéu hi dong chuyén mén va cdc chuyén gia cling d3 dura ra nhiing khuyén c4o chuyén siu hon v8 viée khém va sang loc bénh, chi tiét sé duoc trinh bay 6 nhirng chong sau. Nhiing nghién ciru gan day cho thay rang cdc ddu higu thyc thé ghi nhén duge sau khi kam bénh duge xem nhur 1a mOt céng cy chin dodn va khang dinh gid trj cla chiing bing céch sir dung dinh ly Baye's va céng cu khac dya trén y hoc thye chimng, chi éts® duge trinh bay & chuong 2.” Qua thoi gian, tam quan trong cia vigckham bénh lam sang dugc hiéu ro hon, gitp cai thign vige dua ra quyét dinh chin dodn, Digu nay duoc thé hign trong nhiing huéng dan chudn cp quéc gia va ndi dung dio tao ve vai tra cita cdc kj ning kham bénh cing dugc dé cao tai nhitng trong dio tao y khoa tét nhat hign nay.™!* Viée kham bénh lam sang “va danh nhieu théi gian giao tiép voi bénh nhan sé mang lai nhiGu gid tr] tim tang", tao nén mOtméi quan hé diBu tri dc biét, gidp chin. doan chinh xéc hon, dénh gid va lén ké hoach diéu tri cham séc bénh nhan c6 chon loc hon. Khi ban hoc tép céc kj ming 46 héi bénh st va Kham bénh, clin dic bigt hru y 4€n six khdc biét gitra nhimng théng tin chi quan va khdch quan duge liét ke trong bang sau day. Thong tin chit quan 1a nhiing diéu bénh nhan ké voi ban - nhieng trigu ching co nang (symptoms), trong khi dé nhieng digu ban kham bénh va ghi nhdn ~ nhiing trigu chirng thuc thé (signs) duoc xem 1a nhimng théng tin khéch quan. Biét rd thong tin nay gidp ban ghi nhan va kélai cdc thong tin tirbénh nhan mor cach logic va d8 hiéu hon,