TVERSKAYA Peoples' Friendship Order

STATE MEDICAL
ACADEMY

Department of Internal Medicine propaedeutics

CHART HISTORY

Tver 2006

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 Guidelines were: Professor V. Anikin, Associate Professor A. Aleksenko,
Associate Professor IA Nevzorov, PhD AE Karasev, PhD MS Klushantseva.

Edited by Professor Vladimir Anikin

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 I. RATINGS
Surname, first name
Age
Education
Profession
Occupation
Home address
Date of admission to hospital
Diagnosis on admission

Clinical diagnosis:
underlying disease:
complications:
Comorbidities:

II. The main complaint PATIENT

This section begins with a medical history of the list of major (major, major)
complaints that bothered the patient on admission to hospital and were central in -
reason for seeking medical attention or reason for hospitalization. After that the
refinement or detailing all the features neighborhood of each complaint, the data are
systematized and presented in the form of circumstantial characteristics of each major
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complaint.
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 Detailing complaints during questioning aims to get detailed information about
the time of occurrence of the disease tion sensation, quantitative and qualitative
features of this display, the possible causes, of the characteristic features tures
accompanying clinical phenomena, etc.
As an example, we give a general outline follower tion clarify all characteristic
of a frequent complaint of pain as a complaint:

1.Lokalizatsiya pain indicating topographic area

the area of its distribution and irradiation.

2.Harakter pain (sharp, dull, stabbing, aching, burning, squeezing,

pressing, piercing, pulling, etc.).

3.Intensivnost pain - mild, moderate, severe, "knife-like", etc.

4.Prodolzhitelnost - constant, periodic or continuous short

duration (indicating time
in seconds, minutes or hours).

5.Vozmozhnye causes of pain or gain (for dependence on physical activity

and the degree of its intensity,
from mental and emotional stress, the nature, quantity
and (or) mealtime, from body position and movements
the body or its parts and other factors.)
6. Time of occurrence (morning, afternoon, evening, night).

7. Factors contributing to the reduction or disappearance of

pain (rest, exercise, eating or abstaining tion of its use, the changing nature of
food, adoption
specific body position, medication, use of
heat, etc.).

8. Possible symptoms accompanying pain and arising Suitable its

height (weakness, sweating, the appearance of fear, agitation, changes in
respiration, urination or other).
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 III. HISTORY OF THE DISEASE

(Anamnesis morbi)

This section details in chronological order and describes all the features of the
development and course of the disease from the time the first symptoms until
Supervision.
Description of the initial period of the disease is always necessary can start
detailing the following points:
1) time of occurrence and duration of illness (how long it feels sick);
2) initial symptoms (signs of bo Leznov and detailing their features);
3) suspected causes or the circumstances which rye, according to the
patient, may have contributed to
disease (influence working and living conditions, cooling, violation of diet, dietary
errors, poisoning, physical or nervous stress transferred naka Nune infectious
IPT other diseases, etc.).
Further questioning tactics determined by the nature and course of the process
differs in acute and chronic for disease.
Sequence of questioning in acute diseases SRI includes such
features:
- Clarification of the exact date or time of occurrence of a specific disease;
- Sequence of appearance of initial symptoms bo's disease and their changes
over time;
- The first seeking care, where
and by whom it was provided;
- As paramedics assessed the patient's condition,
which were treated (with specification of names of drugs,
the method of their application, the indication of the dose, the type of ongoing
proce dures, etc.);
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 - Examination (Laboratory, radiological, functional, etc.) 7 expert
advice (surgeon, ophthalmologist, neurologist, etc.), information about the
possible results and conclusions;
- Data on the exemption from work or school (bolnich tion sheet, medical
certificate);
- Information on the effectiveness of the treatment, the patient who directed
the hospital and cause of hospitalization (lack of effect of treatment, deterioration,
the appearance of complications, accurate diagnosis, etc.).

I n ch ro n ic d ise a se co n si st e n t l y specified the following features of the

development of the disease.
The clinical picture of the initial period of the disease:

- sequence of appearance of initial symptoms bo Leznov and their

change in the dynamics of this period;
- first recourse, where and by whom it turns out to familiarize;
- which was treated with (outpatient, hospital tion), its nature and
duration;
- rated as the patient's condition, which conducted additional laboratory,
functional, and other research tion, consulting;
- effectiveness of the treatment, the availability of public -
or residual symptoms and phenomena at the end of treatment,
doctors' recommendations, the implementation of the last patient.
Note: A detailed elucidation of the initial period of symptoms yes disease should be
carried out in cases where the patient is called etsya diagnosis established at the first call to the
doctor; anamnestic information received critically compared with clinical symptoms pathology of the
disease called, revealed their compliance or noncompliance; the analysis in some cases allows
retrospectively right properly evaluate the features of becoming a chronic condition in a given
patient, to identify possible mechanisms contributing to this objective or subjective nature and
closer to the correct diagnosis of pathological states that in "opening" of the disease may
occur "under the guise of" clinical symptom tics of other more common diseases.
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 Dynamics of the clinical picture of the disease:
- Change of the leading symptoms in time: wasps Loosening or complete
disappearance, maintain, or progression, the appearance of new symptoms, which may
indicate the occurrence of complications; periodicity or seasonality of the disease, the
clinical picture periods of exacerbation and remission: possible causes, frequency,
duration, severity, changes in clinical cal symptomatology exacerbations in the
dynamics of the disease;
- Treatment of the patient during the illness (inpatient, outpatient Thorne, spa),
duration, volume, efficiency;
- Whether the person is under medical observation,
at what expert (therapist, endocrinologist, cardiologist, gastroenterologist, etc.)
compliance by the recommendations of medical and health ha raktera;
- maintenance therapy with the name of drugs and their dosage,
effectiveness, side effects of the nature, duration of administration (continuous or
intermittent), whether these are assigned a doctor or treatment is uncontrolled and has
the character of self-medication;
- Obtain information on medical history conducted laboratory
diagnostic and functional studies, consultation tions in specialized departments,
centers, etc. Check the results and findings indicating some parameters to that may be
known to the patient (findings of glucose in the blood and urine in patients with diabetes,
blood pressure in patients with arterial tion hypertension, the presence of pathological
changes in the ECG in patients with CHD, etc.);
- The impact of the disease on the patient's ability to work: h Toth and length of
stay on sick leave, the appearance of permanent disability groups, indicating an invalid -
particular, the term and its changes since the last pereosvide telstvovaniya.
The clinical picture of the last (this) exacerbation
disease:
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- Clinical symptomatology last exacerbation,

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Reasons duration;
 - Treatment given its effectiveness, studies performed;
- The reasons that triggered a hundred directions tsionar;
- Length of stay on sick leave (for working patients).

History of present illness, regardless of acute or chronic disease course finishes

questioning following two sections:
- active questioning other possible complaints system Related
destruction (in this regard, this section in the function Mr. status re still not described);
- Changes in the dynamics of clinical symptoms of process from the time of arrival
of the patient to the hospital moments she Supervision.

IV. Functional status (Status functional)

General disorders: general weakness, tiring dependence, reduced disability, weight

loss or weight gain, fever, chills, sweating, etc.

Respiratory: cough, sputum production, hemoptysis, shortness of breath
and asthma attacks, chest pain, shortness of nasal breathing, nasal discharge, the
presence of nasal bleeding.
Circulatory organs: pain in the heart, palpitation tion and disruption of the
heart, shortness of breath and asthma attacks, oschu schenie heaviness in the right
upper quadrant, swelling, signs of higher of blood pressure (headache and
dizziness, tinnitus, flashing "flies" before the eyes, nausea, vomiting), as well as
information about his medical history level.
Digestive organs: the presence of abdominal pain, changes in
appetite (increase, decrease, anorexia) and perversion of appetite. The
emergence of a bitter taste in mouth, blurred chewing, swallowing and passage
of food through the esophagus, heartburn, belching, nausea and
vomiting. Bloating and rumbling, state chair - frequency (constipation or
diarrhea), the nature and availability at impurities (mucus, pus, blood worms).
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 Organs of urination: pain in the lumbar region and abdomen, dizuricheskie
disorders (pain and stinging when mocheis emission of a, frequent urination, difficulty
mocheotdele tion), changes in urine output (polyuria, oliguria, anuria), change tion
in urine color, its transparency and odor; morning puffiness of the face and other
areas.
Nervous system: headache, dizziness, and transient loss of
consciousness seizures; sleep disorders, memory, vision and hearing, smell, skin
sensitivity (tactile, pain, temperature). State of emotional sphere (irritability, anxiety,
tearfulness); violations to coordination of movements; pain along the nerve trunks and
nerve roots.
Endocrine System: thirst, dry mouth, feeling of hunger, obesity, emaciation,
fever or feeling a sense ZYAB bones, hair loss, etc.
Musculoskeletal system: pain in the joints, bones, muscles and along the
spine; muscle weakness, morning stiffness in his movements; volume changes of
the joints, skin color over them and limit the mobility of joints.
Reproductive system: changes in the menstrual cycle in women -
communities, the presence of abnormal discharge and pain. Sexual dysfunction in
men.

V. HISTORY OF LIFE (Anamnesis vitae)

Brief biographical information. Place of birth, social cial position, what

account the child was born, the mother Alno living conditions. PHYSICAL AND
umstven term development in early childhood. Schoolwork, mustache pevaemost,
physical education and sports at this age.
Further training or start work. Males specified military service, branch of
service, possible adverse factors influencing health status, komissovanie on time or
early, causes release of pro walking service.
Labor history. Indicates main profession and its changes, in chronological
order to clarify the conditions of labor, its features, production hazards and
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other adverse effects. In the presence of disability due to illness or work turns its
duration, disability group, change the group disability and term of the last
survey. Pensioners specified period of retirement, the possible continuation of labor
activity completely. Celebrated in the Great Patriotic War and other military operations,
the availability of relevant disability.
Household history. Material living, housing and sledges packaged hygienic
conditions throughout life. Family composition. Feeding habits and lifestyle.
Borne diseases. Chronologically STI lists past illnesses, surgeries, herbs we
are wounded, a brief characterization of clinical singular singularities.
Gynecological history. Women especially are clarified completely menstrual
cycle: the beginning, the nature and cyclic Property in the dynamics. Onset of
sexual activity, the number of pregnant nancy, childbirth or abortion, miscarriage, to -
amount of children, pathology of pregnancy (toxemia, nephropathy,
etc.). Menopause, the time of onset and clinical features.
Family history and heredity. Specify state health or illness of immediate
family: parents teley, brothers, sisters, children. In case of death of any of them
specified the reason, age of the deceased. Particular attention is drawn to the presence
of chronic infections in the family for diseases (tuberculosis, syphilis, AIDS, etc.). It
turns out the presence of a family history or presence burdened hereditary -
governmental diseases (congenital malformations, congenital dennye metabolic
diseases, blood diseases, oncology SCIE disease, neuropsychiatric disease
spread propagation of internal diseases - hypertension, coronary heart disease,
asthma, gastric ulcer and duodenal ulcers, kidney stones, etc.).
Bad habits. Smoking duration and intensity intensity. Alcohol: the use, for how
long, to amount. Drug and substance abuse with specification of the substance,
duration, route of administration and other singular singularities. Long-term use of
drugs, including for the purpose of self-treatment.
Allergic history. Drug intolerance substances, food, vaccines, sera, and other
chemical or biological substances, especially allergic cal manifestations.
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VI. OBJECTIVE RESEARCH

 Current status (Status praesens)

1. GENERAL INSPECTION.
Patient's general condition: satisfactory, moderate, heavy, very heavy.
Consciousness: clear, stupor, stupor, coma, delirium, hallucinations.
Match appearance age: correspondsvyglya DIT younger or older chronological
age.
The patient: active, passive, involuntary indicating features.
Body type: correct, incorrect.
Type of constitution: normostenichesky, asthenic, and hypersthene-mechanical.
Body weight (kg). Height (in cm).
Expression: normal face "feverish pain tion "," mitral "face, the face" Hippocrates
"," crescent-shaped "face" nefritika "the patient's face thyrotoxicosis akromega Leah,
scleroderma, etc.
Head: The pathological changes in the shape, size, polo tion, the range of motion
of the head, soft and bone tissue palpation of the cranial vault, especially body hair on
his head.
Skin and visible mucous membranes: skin and mucous membranes: normal -
mum, paleness, redness, yellowness, cyanosis, gray or bronze paint, areas of
hyperpigmentation and depigmen tation. Humidity: normal, high, low. turgor (elasticity)
of the skin: normal, low. Temperature: normal, hot and cold (indicating
localization).Pathological changes in the skin rash and hemorrhage, tro demographic
changes (ulcers, bedsores), bruises and scars, vascular Distin asterisk
(teleangiaektazii) xanthelasmas, peeling skin. Type of body hair.
Subcutaneous fat layer: zhirootlozhenija severity - mild, low, cachexia, increased
- excess fat deposition or obese I, II, III, IV Art.; especially the location of fat deposition
on the trunk.
Edema. Localization and prevalence of edema (common - heart, kidney, mixed,
local, regional, local and angioedema). Intensity: pastoznost, moderate or severe. Skin
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color and its density in areas of edema. Swelling of the skin and mucous subcutaneous
fat.
Lymph nodes. Sequence studies: for tylochnye and parotid, submandibular and
chin necks ITATION front and rear, on-and subclavian, axillary, elbow, inguinal and
popliteal. Characteristic properties of the lymph nodes: shape, size, density, soreness,
characterized ter surface, mobility, lymph nodes cohesion among themselves and with
the surrounding tissues, skin color changes over the lymph nodes.

Musculoskeletal system.
Musculature: weight (moderately developed, increased lichena or pony wife),
symmetry Development (symmetrical, unilateral or local muscle atrophy), tone (normal,
increased tion or reduced), tenderness and strength of individual muscle groups.
Joints: configuration (right, wrong - de formation, defiguratsiya); changes in the
magnitude, color tissue and skin temperature over the joints; the presence of pain on
movement or palpation; volume of active movements, passive movements in the
volume limitation of active.
Bone: a study of limb bones of the spine and that for (deformation, thickening and
softening, tenderness and effleurage, the presence of "drum" fingers).

2. RESPIRATORY.

Inspection of the nose: nose shape (correct, incorrect), nasal breathing (free or
difficult), nostrils (participating or are not involved in the act of breathing).
Inspection and palpation of the larynx: a form (correct or changed tion) status
(normal, offset to one side), tenderness, mobility of the larynx on fingers dissipation
(normal, limited).
Inspection of the thorax.
a) Static: the shape of the chest (right - normal mostenicheskaya, asthenic,
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hypersthenic; pathological Skye - emphysematous, kifoskolioticheskaya, funnel,

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navicular, paralysis, rachitic); volume or were rank halves of the chest (symmetrical,
increase or decrease of one half); Availability unilateral west tions or protrusions.
b) Dynamic: participation of both halves of the chest in breathing (the same lag of
one half). Type of breathing (abdominal, thoracic, mixed). Respiratory rate (normal,
increased, slowing) with the number of breaths per minute; depth of breathing (normal,
shallow or deep breathing). Respiratory rhythm (rhythmic, neritmich importantly - Biota
breathing, Cheyne-Stokes). Participation in breathing vspo mogatelnoy muscles of the
neck, shoulder girdle, the intercostal muscles, etc.
Palpation of the chest. palpation of tissue structures of the chest wall, the
definition of pain and lesions of the skin and subcutaneous fat layer overlying the rib
cells Coy, the intercostal muscles and nerves, the ribs. elastic chest (normal, stiffness
across the chest or one of its halves). Voice tremor (normal, increased, weakened),
indicating the specific topographic area. On palpation can sometimes be determined
by additional respiratory tional noise (dry rales, pleural friction rub).
Percussion.
a) Comparison of light percussion (percussion sound - clear lung, blunt or dull,
tympanic or boxed, blunted - tympanic) showing that pograficheskih areas over which
the identified change.
b) Topographic percussion lung. Sequence op tain boundaries:
I. Elevation standing apex of the left lung: a) front,
b) at the rear.
II. Elevation standing apex of the right lung: a) front,
b) at the rear.
III. The lower boundary of the right and left lung along the lines:
1) right 2) left
a) okologrudinnoy +
b) mid-clavicular +
c) anterior axillary + +
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g) the average axillary ++

d) posterior axillary + +
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e) Shoulder + +
g) paravertebral + +
IV. Mobility pulmonary edge on inspiration for the mid-axillary line:
a) Right: inspiratory, expiratory, the total;
b) left: inspiratory, expiratory, total.
Auscultation of the lungs.
Balanced over specified portions of both lungs ha rakter respiratory noise. Main
souffles: vesicular breathing with its possible physiological amplification or attenuation
leniem and physiological bronchial (laryngo-tracheal) breath. Vesicular breathing
changes in the pathology of: weakening or strengthening, hard vezikulyar tion breathing,
breathing with prolonged exhalation, saccadic breath. Pathological bronchial
breathing and different liquidity - "infiltration", "amphoric", "metallic", "compression"
bronchial, bronchopulmonary -vesicular.
Additional souffles: wheezing - dry (whistling and buzzing), wet - small-,
medium-and krupnopuzyrcha tye (sonorous - consonant, nezvuchnye -
nekonsoniruyuschie);crepitus; pleural friction rub.
Changes in key respiratory noise and the appearance of patho logical extension of
respiratory noise is described with the obligatory indication of localization in accordance
with general accepted notation topographical areas and lines on the chest.
Bronhofoniya balanced over the rib portions cell ki, its pathological strengthening
or weakening.

3. Circulatory organs.

Inspection of the neck vessels: jugular veins, veins throbbing abnormal

("positive venous pulse") and arteries ("Dance of the carotid").
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Inspection and palpation of the heart. Bulging whole domain STI heart (heart
"hump") or its individual parts. Ver hushechny impetus and its properties: localization
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indicating intercostal space and topographic line area (normal, "spilled", "restricted")
height (mean, "high", "low"), strength (average, "strong", "weak"), negative apical
impulse, bisistoliya. cardiac impulse: absent or is visible. Epigastric pulsation: due to
the right ventricle, transfer or true pulsation of the liver, abdominal aortic
pulsation. Other ripple in serd sample: pulsation of the aorta, pulmonary artery, atrial
aneurysm heart. Palpable vibration definition of soft tissue around the heart ("cat
purring") caused by cargo bymi cardiac murmurs indicating the location and phase of
the cardiac cycle (systole, diastole or combination thereof).
Arterial pulse and research vessels:
Arterial pulse on the radial artery, its characteristic properties: magnitude
blood supply to the radial artery on the right and left hands (pulse the same or
different),rhythm (rhythmic pulse, with spasmodic possible decree tion alleged violation
of rhythm), heart rate (normal, frequent or infrequent pulse ) indicating the number of
gifts per minute filling (normal, full or empty pulse), voltage (normal, hard or soft
pulse), the value (normal, large or small pulse, high pulse thready), speed or
pulse shape of the pulse wave ( normal, fast or slow heart rate), the deficit rate (or no
value is specified for "heart rate which is less than the heart rate for one minute).
Research vessels complemented by inspection and palpation of the arteries other
areas specified feature krovenapol equation arteries, the presence of morphological
changes (aneurysms, periarteritisnodosa). Determined condition of the veins, varicose
revealed signs of their presence or expansion of thrombophlebitis.
Blood pressure is expressed in mm Hg. Art. on the results of a 3-fold
measurements on the right shoulder, compared with the corresponding values of blood
pressure in the left hand; if necessary parameters are compared with the blood
pressure, certain pa lower extremities.
Percussion of the heart:
Sequence determination of the boundaries of the heart.
I. Diaphragm elevation standing right mid-clavicular line.
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II. Border of the relative cardiac dullness:

1) right,
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 2) left,
3) top.
III. Size of the heart:
a) Media Rights in cm
b) the left median in cm
c) the diameter in cm of the heart (the sum of these two dimensions).
IV. Border of cardiac dullness:
1) right,
2) left,
3) top.
V.Granitsy vascular bundle:
1) the right boundary,
2) the left boundary,
3) Width of the vascular bundle.
VI. Configuration heart
- (Normal, "mitral", "aortic", "bullish" heart with pericardial effusion, "drip" heart) clarifies
the definition of contours serd sample by percussion.

Auscultation of the heart.

Listening is conducted sequentially in 5 points: the tip of the heart - the mitral valve, II
intercostal space on the right - the aortic valve, II intercostal space left - pulmonary
valve,the base of the xiphoid process of - the tricuspid valve, the fifth point (III
intercostal Borje left at the edge of the sternum - point-BotkinErba) - aortic
valve. Auscultation auscultation data specified in the horizontal and vertical positions,
after exercise, polo zhenii on the left side, with a single breath you exhale, as well as in
the ground projection of the valves, in other remote locations precordium.
Heart tones: characteristic points on listening volume tones (gain, weakening one
or simultaneously but two tones), Voice ("slamming" the first tone, "metal cal "tone of
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the second tone), splitting or bifurcation of the first or second tone, the appearance of
three-term rhythms ( tripartite physiological rhythm, rhythm "quail" rhythm "canter" -
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protodiastolic, presystolic, systolic sky, mesodiastolic). Rhythm disturbances
determined etsya heart rate per minute and auscultation specified arrhythmia.
Heart murmur: is characterized by the ratio of noise to the phase of the
cardiac activity, the place of maximum sound about domain of intensity, duration,
ramp or decrease the volume of noise and tone, clarifies the effect of the volume of
the noise changes in body position, breathing act of physical load.
Auscultation vessels: the aorta, carotid connected, poor indigenous arteries
(tones Traube double Duroziez noise), veins (noise "top").

4. The digestive organs.

Inspection of the oral cavity. Language: shape (regular, non rect), the value
(normal, increased), humidity (nor mal, high, low), color (normal, change color
equation), the severity of papillae (moderate, severe,

smoothness), plaque (color, prevalence, severity), the presence in the language of

prints, cracks, ulcers, tumors. teeth: dental formula, the nature of occlusion,
caries. Gums:bleeding, loosening, signs of periodontal disease, ulcers, rashes. Soft
and hard palate . Tonsils: size, color, presence of plaque, purulent plugs Scarring.
Inspection of the abdomen. Shape Belly (correct, incorrect). magnitude (overall
increase, the overall decrease IPT retraction). symmetry of both halves (symmetrical,
asymmetry due to the presence of local local bulging or retraction). Navel (normal,
retracted jutting). Participation Act respiration (participates, is not involved). The
presence of abdominal examination sites pigmentation, motility (physiological or
pathological), rashes, scars, hernias, venous collaterals, calculations, hemorrhages.
Superficial palpation. Tonus anterior abdominal wall (soft belly, resistance,
muscle tension, muscle protection). Soreness (painless sore, indicating the intensity
and location of pain). Signs of peritoneal irritation (symptom-Shchetkina Blyum6erga
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symptom-Mendel Razdolsky). Discrepancy recti, identifying hernias, superficial tumors.

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 Deep, moving, methodical, topographic palpation method Obraztsova-
Strazhesko.
Palpation sequence: sigmoid colon, cecum, the final segment of the ileum,
appendix, transverse colon, ascending and descending colon departments, hepatic and
splenic corners of the large intestine, stomach (large and small curvature) and
gatekeeper (palpation of the stomach before being identified its lower bound).
Sequence characteristics of palpable: shape, size, texture, tenderness,
character on the surface, mobility, presence of other signs (rumbling, etc.).

Examination of the liver

1. Percussion liver (absolute stupidity)
a) the upper limit of the right mid-clavicular line (the lower limit of light on this
line, at a certain light percussion);
b) lower bounds :
1) the anterior axillary line on the right
2) mid-clavicular line on the right,
3) okologrudinnoy line right
4) anterior median line,
5) okologrudinnoy line to the left;
c) the size of the liver Kurlov:
I size - the right mid-clavicular line,
II size - the anterior midline
III size - an oblique line on the left costal arch in cm

2. Palpation of the liver consistent with characteristic

all properties (see above). palpation of the gallbladder. palpationfrenikus-definition
symptom symptomOrtner, Kera symptom.
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 Study spleen
1. Palpation of the spleen, when it detects body provides detailed. characteristic of all
properties.
2. Percussion spleen:
a) upper bound on the left mid-axillary line,
b) lower bound on the left mid-axillary line,
c) spleen diameter (in cm)
g) the front boundary of the spleen.
Palpation of the pancreas

5. BODIES urination.
Examination of the lumbar region (smoothing circuits, reddening tion, swelling,
bulging) and the bladder (urinary retention with bulging).
Percussion: effleurage on the lumbar region (painless, positive symptom
Pasternatskogo the presence of pain). Percussion suprapubic if necessary to clarify the
presence of an excess amount of the bladder urine.
Palpation: Palpation of the kidneys in the horizontal and ver upright position,
when it detects the body is given a detailed description (shape, size, texture, surface
haraktep, pain, mobility).
Palpation can chetochnikov. palpation of the bladder.
Auscultation is used to exclude renal artery stenosis.

6.NERVNAYA SYSTEM.
Behavior, intelligence, speech, facial expressions. Reaction of pupils to light
direct and friendly, eye, neck stiffness. Tenderness of nerve trunks with
fingers dissipation.Paralysis, convulsions. Sensitivity to pain, tactile,
thermal. Pathological reflexes. Hand tremor, gait disturbance, stability.
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 7. Endocrine system.
The main symptoms of hyperthyroidism: exophthalmos, symptoms Graefe,
Mobius Shtelvaga. Inspection and palpation of the thyroid gland (right and left lobe,
isthmus) describing the shape, size, consistency, tenderness, presence of
knots. Tremor of the hands, eyelids.
Increased pigmentation of the mucous membranes and skin folds, especially
depigmentation of the skin, stretch marks and their localization. Changes in secondary
sexual characteristics: Institute fantilizm, hypogonadism, eunuchoidism, atypical body
hair (hirsutism) in women, violation of body hair type and the presence of
gynecomastia in men.Increasing the size of the nose, jaw, ears, tongue, hands and
feet values characteristic of acromegaly. In the presence of obesity is indicated by its
type.

VII. LABORATORY DATA

And instrumental methods. PROFESSIONAL ADVICE
Presents the results of research studies showing the date and the conventional
notation.
1. Clinical analyzes of blood, urine, stool, sputum.
2. Biochemical indicators of blood, urine, etc.
3. Studies of gastric juice, duodenal con -extensible.
4. Bacteriological studies of blood, urine, sputum, stool.
5. Kidney function tests: sample Zimnitsky, climate Laurence endogenous
creatinine.
6.Instrumentalnye study: ECG, echocardiography, phonocardiography,
ultrasonic methods kovye research bodies, etc.
7. Radiographic studies, computed tomography, magnetic resonance imaging.
8. Consultations of experts and their findings.
9. Temperature curve (for 5 days at admission).
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 VIII. Clinical diagnosis:
main:

complications:

comorbidities.

IX. RATIONALE primary diagnosis

When justifying the main diagnosis consistently lead the symptoms identified:
1) on questioning, including
a) major complaints with their brief characterization;
b) features of the development and course of the disease;
c) the characteristics of functional status;
d) life history characteristics, clarifying possible causes of the disease, or;
2) during the inspection;
3) an objective study of the affected system and other systems;
4) for additional testing (results indicated appropriate laboratory, functional,
instrumental, X-ray, ultrasound), which are characteristic of the disease and allow
you to put this diagnosis.

X. PRINCIPLES OF TREATMENT
Briefly lists the main principles of this treatment of the underlying disease
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according to the lecture material, educational and supplementary literature (you must
specify the mode, diet, groups of drugs, herbal medicine, physiotherapy).
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 XI. PRINCIPLES OF PREVENTION
Briefly outlined the principles underlying disease prevention.

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