PROPEDEUTIC OF INTERNAL MEDICINE

LECTURE: GENERAL ISPECTION OF THE PATIENT

PLAN OF THE LECTURE

1. ROLE OF INSPECTION IN DIAGNOSTIC PROCESS 2. GENERAL INSPECTION OF THE BODY 2.1. Rules of inspection 2.2. Maine parameters of inspection 3. INSPECTION OF SEPARATE PART OF THE BODY 3.1. The head 3.2. The skin 3.3. The face 3.4. The neck 3.5. The chest 3.6. The abdomen 3.7. The hands 3.8. The legs

ROLE OF INSPECTION IN DIAGNOSTIC ROLE OF INSPECTION IN DIAGNOSTIC PROCESSPROCESS

Overview of

the patient

allows to

choose tactic

further

treatment.

Overview of the Overview of the patient allows to patient allows to estimate the acute estimate the acute problem of the problem of the patient.patient.

Effectiveness of Effectiveness of review review determined by determined by doctor erudition. doctor erudition. You can only see You can only see what you know.what you know.

Inspection is Inspection is carried out in carried out in daylight in daylight in warm roomwarm room

The physical The physical examination starts examination starts as soon as you see as soon as you see

the patient.the patient.

Often your general Often your general observations point to observations point to a specific diagnosis a specific diagnosis

or to the system or to the system causing problems.causing problems.

GENERAL CONDITION

Satisfactory ModerateSevere Very severe

The general condition of the patient includes the following indicators: state of consciousness,

position in bed, motor activity. Depending on these parameters is determined by the priority of the

diagnostic and therapeutic manipulations.

Incorrect evaluation of the general

condition is not only professional but

also a legal problem

State of consciousness

Clear consciousness: the patient is oriented in time, space and person

Stupor: partial loss of consciousness with preservation of verbal contact. Moderate sleepiness, slowed commands are executed

Sopor: loss of consciousness and lack of verbal contact. Saved response to pain

State of consciousness

Coma: loss of consciousness with total loss of perception of the environment and himself. With severe systemic and neurological disorders

Delirium: severe disturbance of consciousness with disorientation in the environment and the person. There is alcoholism, diabetic coma, as well as metastatic tumors in the brain.

State of consciousness

Twilight disorders of consciousness it appears disorientation, appearance horrific hallucinations, anger, fear, agitation with aggression. Occurs in patients with schizophrenia

Talking of the patient

Changed talking most often occurs when palsy.

In multiple sclerosis conversation becomes a chopped up into individual words or parts of words

Hoarseness indicates recurrent nerve paresis. The resulting inflammation or cancer of the mediastinum, aortic aneurysm, myxedema

Gait (walking) of the patient

Unsteadiness of gait - lesions of the cerebellum, significant hypertension, aortic defect, severe anemia, fever

Slow, tired gait when the patient barely pulls his legs, and head and shoulders lowered, indicating physical fatigue

Duck Walk indicate congenital dislocation of the hip

Gait of the patient

Hemiplegia - the patient drags up or assigns it to the side, describing a semicircle on the ground. After brain stroke.

Posture proud man - with ascites

Posture of the petitioner - when the disease Byehtyeryeva

Gait of the patient

Posture clodhopper at

arthritis

Provisions in bed.

Active. Passive. Involuntary: active

and passive

Attack of dispnea

Paine in right hypochondria

Type figure. Constitutional type

ASTENIC

NORMOSTENIC

HYPERSTENICThin man, epigastric angle less than 90

A man of average build,

epigastric 90

A man with a broad chest,

epigastric angle of more than 90

Type figure. Constitutional type

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Definition of epigastric

angle

Pathological forms of chest

a - emphysematous;b - paralytic;c - rachitic;d - funnel;e - scaphoid;f - kyphoscoliosis.

a b

cd

ef

Leonardo da Vinci. The ideal human body

The skin

Wrinkled and dry skin occurs in severe chronic diseases of the cardiovascular system, respiratory, endocrine diseases.

Pale skin is often observed in diseases of the cardiovascular system, kidney disease, anemia. Cyanosis - bluish, gray-blue, dark blue or blue-red color of the skin and mucous membranes due to enrichment of reduced hemoglobin levels.

• Redness of the skin is observed in a significant increase hemoglobin level and number of red blood cells (polycythemia), but such phenomena are rare. Often redness (hyperemia) of the skin is limited and temporary. Redness of the face observed in fever, limited congestion occurs in inflammatory processes (abscess, erysipelas, dermatitis). One of the cutaneous manifestations of systemic lupus is the appearance of red spots on the face that is shaped like butterfly wings is placed on the cheeks, and the body - the back of the nose

• Based jaundice color of skin and visible mucous membranes (mouth, eye sclera) in clinical practice diagnosed with jaundice. Jaundice - a symptom that occurs in various diseases due to excessive accumulation of bilirubin in the blood

• On examination, the patient's skin can detect areas of hyperpigmentation or depigmentation, commonly observed in endocrine disorders

• On examination, the patient's skin can detect scarring, the presence of which indicates postponed surgery, trauma, purulent skin and subcutaneous tissue, which in some cases can help in the diagnosis of internal diseases

Swelling

Swelling called excessive accumulation of fluid in the tissues, the extracellular space. Edema may be obvious, detected by palpation or hidden. At the press of a finger in the area of edema appears fossa, which then slowly turns. Water retention in the body accompanied by an increase in body weight of the patient, reducing the volume of daily urine output. Swelling observed in severe diseases of the heart and kidneys. The degree of severity varies - from mild swelling under the eyes in the morning after waking up to anasarca (swelling of the body). In severe cases fluid accumulates in the pleural cavity (hydrothorax) in the pericardial cavity (hydropericardium) and so on.

Swelling

In severe debilitating diseases, protein deficiency, malignant tumors arising swelling.

Slight swelling in both legs appear when hormonal fluctuations associated with the menstrual cycle, pregnancy, treatment of sex hormones or hormones of the adrenal cortex.

It should also be remembered that after a long stay on his feet in both feet or legs at the end of the day formed static edema (mainly in people who are overweight).

The head - pay attention to its shape, facial expression of the

patient, his eyes, nose shape. Facial expression is the mirror of the physical and mental condition of the patient. For example, suffering facial expression indicates the severity of the disease. In agonizing patients and in patients with inflammation of the peritoneum (peritonitis) observed the so-called Hippocratic face, characterized by pale skin, deep, sunken eyes, sharp facial features. The skin of the patient is cold with sticky sweat

The head

Cyanotic rosy cheeks, bluish color of the mucous lips and nose, lehkozhovtushni sclera stenosis of the left atrioventricular opening (facies mitralis).

Abnormal facial expressions

Features Diagnosis  Poverty of expression Parkinsonism  Startled expression Hyperthyroidism  Apathy, with poverty Depression of expression and poor eye contact Apathy, with pale and Hypothyroidismpuffy skin   Lugubrious expression Myotonic dystrophywith bilateral ptosis 

The face

The face is the most revealing area of the body, showing the features of its physical and psychological well-being and disease. In no other part of the body can one find so many signs of clinical disorders. Face-to-face contact is often the first interaction with the patient and thus forms an essential part of the clinical examination.

Abnormal faciesThe face may show one or

more of the many characteristic

features associated with diseases

The face

acromegaly

Hypothyroidism:Note a

noncommunicativeaffect

Lipodystrophy:prominent muscular

contours due todeficient

subcutaneous fat

Cushing's syndromeMoon face

The face and eyes

Upper lid retraction

Acropachy

Graves' disease=Bazedow’s disease=Hyperthyroidism Pretibial myxoedema

The face and eyes

Hypothyroidism: hair lossClinical features of

hypothyroidism

The eyes are not shining,

noncommunicativeaffect

Hypothyroidism

The mouth It is possible to detect signs of inflammation of the mucosa

(stomatitis), rash - enantema that appears when measles, hemorrhagic diathesis. Pale mucous membranes of the mouth occurs with anemia and ochrodermia palate - with jaundice. During the inspection of the oral cavity should pay attention to the tongue of the patient, which can be coated in feverish conditions, diseases of the digestive tract. In some diseases can detect color changes and atrophy of tongue papillae. For example, in scarlet fever tongue is crimson, liver cirrhosis - red, looks like patent leather, at vit. B-12 deficiency anemia is marked atrophy of the mucosa with inflammatory hyperemia tip and edges of the tongue (Hanter’s glossitis).

The neck

On examination, the patient's neck draw attention to the condition of the thyroid gland, lymph nodes, pulsation of vessels. Increased thyroid observed in thyrotoxicosis, endemic goitre.

The neck

Cervical lymph nodes may increase in acute lymphadenitis, tuberculosis, syphilis, infectious mononucleosis, measles, lymphosarcoma, leukemia

At hypertension, aortic aneurysm, aortic insufficiency, thyrotoxicosis even at rest possible dancing cervical arteries. In patients with right ventricular heart failure can be detected swollen neck veins, indicating congestion in the superior vena cava

The abdomen

Inspection of the abdomen performed in the supine and standing positions of the patient. You determine the shape of the abdomen, the size, the mobility of the abdominal wall, the presence of abnormal protrusion. Normally, the stomach symmetrical, flat, depending on the constitution may be slightly protruding in hyperstenic and caught - in astenik.

The abdomen

The abdomen may increase in ascites, obesity, flatulence, the formation of large cysts in the abdominal cavity (cyst of the pancreas, ovaries). Shape of abdomen with ascites : in standing position fluid accumulates in lower abdomen,it has the shape of the bag. In the supine position – the expanding belly sides and flat in the middle part (the frog’s belly). When flatulence stomach is globular shape, with no bulging navel as in ascites.

The abdomen

In some parts of the abdomen (white line, navel, groin) hernia can be detected in a soft and rounded protrusion that better determined upright, scars of pregnancy.

Caput medusae

Musculoskeletal system

Bone changes are observed in fractures, bone tumors, osteomyelitis. During the inspection of joints pay attention to their shape, amplitude movements, skin’s condition over the joints

In severe chronic lung and heart disease, in patients can change terminal phalanges of fingers typing appearance drum sticks and nails - watch glass

Who has a question.

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