SYSTEM OF BODIES MOCHEOTDELENIJA

Complaints

Pain: its{her} localization (in lumbar area, in the bottom of a stomach, on a course мочеточника); иррадиация; character of a pain (sharp or stupid{blunt}, constant or приступообразная); duration of a pain; conditions of occurrence of a pain (physical loading, change of position of a body, reception of a spicy food, alcohol, water loading, etc.), than are stoped to a pain.

Мочеиспускание: Quantity{Amount} wet for a day (presence полиурии, олигурии, анурии or delays of urine - ишурии).

Дизурические frustration: complicated мочеиспускание (a thin jet, drops, faltering): presence involuntary мочеиспускания; false desires on мочеиспускание; резь, burning, pains during time мочеиспускания (in the beginning, in the end or during the certificate{act} мочеиспускания): учащенное мочеиспускание (поллакиурия); night мочеиспускание (никтурия).

Urine: Color wet (straw-coloured, is sated yellow, dark, color of " beer", red, colors " meat помоев ", etc.); a transparency wet. Presence of an impurity of blood in urine (in the beginning or in the end мочеиспускания, in all portions).

Hypostases: localization; time of occurrence (in the morning, in the evening, during day); conditions of occurrence or amplification{strengthening} of hypostases (drinking loading, superfluous reception salt, etc.); speed of increase of hypostases;

The factors promoting reduction or disappearance of hypostases.

Survey

Lumbar area: presence гиперемии leather{skin}, swellings, smoothings of contours of lumbar area.

Надлобковая area: presence limited выбухания in надлобковой areas.

Перкуссия

Lumbar area: definition of symptom Пастернацкого.

Надлобковая area: character перкуторного a sound above лобком; at increase in a bladder - a level of an arrangement of a bottom of a bladder.

Пальпация

Kidneys: пальпируемость kidneys in a prone position and costing{standing}; at increase in kidneys - their morbidity, a consistence, size, the form, mobility, presence of a symptom of balloting.

Bladder: пальпируемость a bladder; at increase in a bladder - a level of an arrangement of a bottom of a bladder, morbidity at пальпации.

Painful points: presence of morbidity at пальпации in реберно-позвоночной to a point and on a course мочеточников (мочеточниковые points).

SYSTEM OF GENITALS

Complaints

Pain: presence be ill in the bottom of a stomach, in a groin, a waist, крестце, мошонке, in the field of external genitals. Character be ill, localization, иррадиация, conditions of occurrence, than are copied.

Менструальный a cycle: a regularity; duration менструального a cycle; duration менструаций, quantity{amount} менструальных branches, morbidity. Маточные bleedings, others of allocation (бели).

Sexual function: normal, it is raised{increased}, reduced, no.

Survey and пальпация

Secondary sexual attributes: type оволосения (man's, female), a scalp in axillary hollows, on the person, on a stomach, in лобковой areas. Presence гинекомастии. A voice (high, low). Attributes гирсутизма, евнухоидизма, вирилизма, feminism.

Dairy железы (at women) and chest железы (at men):

Degree of development, condition of integuments, pigmentation, local hypostasis as " citric корки ", втяжения. Symmetry желез. The form сосков, presence of erosion and ulcers, deformation желез. Condensation, тяжистость and tumoral formations{educations} at пальпации желез.

External genitals (at men): the size мошонки, яичек, a hypostasis мошонки, morbidity at пальпации яичек, presence of tumoral formations{educations}. Недоразвитие яичек (anarchism, крипторхизм). Erosion and ulcers of a sexual member. Anomalies and uglinesses of a sexual member.

Предстательная iron (at men): the size, a consistence, пальлаторная morbidity предстательной железы at ректальном research.

Gynecologic research (at women) ': a condition ка-ружных genitals, a vagina, a uterus, appendages at survey in mirrors and бимануапьной пальпации.

ЭНДОКРИННАЯ SYSTEM

Complaints

Infringement of growth, constitution, increase in weight of a body, похудание, thirst, feeling of famine, constant sensation heat, потливость, ознобы, spasmes, muscular weakness, rise in temperature of a body. The detailed characteristic of these complaints.

Survey and пальпация

Infringements of growth, constitution and proportionality of separate parts of a body.

Adiposity: a degree of expressiveness, primary localization of fat. Исхудание, кахексия.

Condition of integuments: humidity, истончение or огрубение; hyperpigmentation of a leather{skin}, skin складок (localization), presence стрий; атиличное оволосение; лунообразное the person.

Increase in the sizes of language, nose, челюстей, auricles, brushes of hands and stop.

Пальпация a thyroid gland: localization, size and a consistence, morbidity, mobility.

NERVOUS SYSTEM AND SENSE ORGANS

Complaints

Headache: localization, intensity, periodicity, character of a headache, time and the reason of occurrence, than is stoped.

Dizziness: character of dizziness, a condition of his{its} occurrence (at walking, at change of position of a body and a head, etc.). The accompanying phenomena.

Condition of mentality: Serviceability, memory, attention, dream, his{its} depth, duration, a sleeplessness.

Emotional - strong-willed sphere: mood, features of the character, the raised{increased} irritability, slackness, apathy, disturbing suspiciousness, depression, euphoria. Suicide ideas and moods.

Impellent sphere: Weakness in finitenesses, trembling, spasmes, other involuntary movements.

Sensitive sphere: Infringements of skin sensitivity (гипестезии, гиперестезии, парестезии), pains on a course of nervous trunks, корешковые pains. Sight, taste, sense of smell, hearing.

Survey

Condition of mentality: Consciousness. Orientation in a place, time and a situation.

Intelligence: Easing of intellectual functions (easing, attention, decrease{reduction} in memory, infringement of criticism, decrease{reduction} in a circle of interests) corresponds{meets} or does not correspond{meet} to a level of development.

Behaviour of the patient in clinic, a degree of sociability, steadiness, fussiness, impellent anxiety.

Research of craniocereberal nerves: Visual acuity, doubling in eyes (диплопия); птоз, volume of movements of eyeballs, reaction of pupils to light. Symmetry носогубных складок at a grin of a teeth. Frustration of swallowing. Дисфония. Position of language at высовывании.

Менингеальные symptoms: ригидность occipital muscles, symptoms Кернига and Брудзинского.

Impellent sphere: character of gait with the open and closed eyes (usual, атактическая, паретическая, other forms).

Stability at standing with the open and closed eyes (test Ромберга).

Finger - носовая and коленно-calcaneal tests.

Spasmes: клонические and tonic, фибриллярные twitchings, trembling (tremor), etc. involuntary movements. Контрактуры muscles (localization). Volume of movements and force in finitenesses.

Sensitive sphere: Пальпаторная morbidity on a course of nervous trunks and корешков. Infringements of skin and deep sensitivity (localization). Symptoms of a tension, symptom Лассега.

Reflexes: Corneal, pharyngeal.

Сухожильные reflexes: knee, ахиллов.

Pathological reflexes: symptoms Бабинского and Россолимо. Speech: афазия (motor or touch), дизартрия.

Vegetative nervous system:

Eye symptoms: width of an eye crack, width of a pupil, экзофтальм or анофтальм. Symptom Горнера.

Leather{Skin}: a kind дермографизма, temperature asymmetry, гипертрихоз, облысение, trophic ulcers, infringement потоотделения.

VII. THE DIAGNOSIS (PRELIMINARY) AND HIS{ITS} SUBSTANTIATION

The preliminary diagnosis is formulated right after the terminations{endings} of interrogation and objective research of the patient on the basis of the analysis of complaints, анамнестических the data and results objective физи-кального researches of the patient.

In the formulation of the preliminary diagnosis should be allocated:

а) The diagnosis of the basic disease;

б) The diagnosis of complications of the basic disease;

в) The diagnosis of accompanying disease.

Further the brief substantiation of the preliminary diagnosis is resulted:

1) Listing{Transferring} and analyzing the basic complaints of the patient, it is expedient to make the conclusion about primary defeat of this or that body or system;

2) On the basis of the analysis of all available clinical data it is necessary to allocate the basic pathological symptoms and syndromes, to give their characteristic and to describe features of displays at the given patient;

3) Analyzing pathogenetic interrelation of separate pathological symptoms and syndromes to make the conclusion about their possible{probable} unity and an accessory{a belonging} to this or that disease (i.e. to furnish proofs нозологического the diagnosis);

4) According to the accepted classifications it is necessary to prove whenever possible the individual diagnosis, namely to furnish proofs:

а) The clinical, клинико-morphological or pathogenetic form of disease,

б) Character of current (sharp, подострое, chronic, рецидивирующее, long, slowly progressing, quickly progressing, etc.),

в) Stages, phases, degrees of activity of pathological process,

г) Presence of complications,

д) Degrees (stage) of functional frustration and-or weights of disease.

5) Briefly, by transfer of the basic symptoms to prove the diagnosis of accompanying diseases if those are available.

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