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interview
inspection
palpation
percussion
auscultation
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4. The past patient's history (Anamnesis vitae)
a.) General biographical information
- Birth place, number of the children in the family
- Patients health at birth, his physical and mental development
- Conditions of life, well-being, income
- Patients diet
- Physical activity (sports, exercises)
- Unfavorable labor conditions, industrial hazards (harmful dusts, radiation, cold, noise, vibration)
b.) Past illnesses. Ask about acute infections ( tbc, HIV, hepatitis), operations, trauma.
c.) Family history (health of parents, grand -, sisters, brothers; tbc, syphilis, hereditary diseases).
d.) Allergological anamnesis: ask about the type of allergy (rhinitis, nett1-rash, Quincke's edema,
anaphylactic shock) and the possible allergens (foods, medicines, perfumes, pollen).
e.) Sexual anamnesis (women's number of pregnancies and parturitions; duration and amount of
menstruation).
f.) Harmful habits - alcoholism; smoking, narcotics.
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- desquamation
- abnormal growth of hair
- the size, form and pathological changes of the nails .
12. Visible mucosa
- Color (pallid, earth-like, yellowish, cyanosis)
- humidity (moisture)
- elasticity (turgor)
- eruptions
- ulcers
13. Subcutaneous fat
- type of location (male type, female type, pathological (in Kushing syndrome etc.).
- grade of the thickness of skin fold hold in inguinal region (female) or Traube region (male). Should be
normally 1-2,5 cm.
Grade of nutrition
Excessive (Obesity)
Good
Satisfactory grade
Reduced
Insufficient (Cachexia)
MALE
More than 2.0 cm
1.5 -2.0 cm
1.0 -1.5 cm
0.5 -1.0 cm
Less than 0.5 cm
FEMALE
More than 2.5 cm
2.0-2.5 cm
1.5 -2.0 cm
1.0 -1.5 cm
Less than 1.0 cm
14. Presence of peripheral edema. Edema is subcutaneous liquid accumulation due to heart or renal
failure. It could be appreciated by pressing the fingers over the region where the bones are placed close to
the skin.
15. Palpation of the lymph nodes. Should be appreciated:
- location,
- form,
- dimensions,
- consistence(elasticity),
- surface,
- mobility,
- painful or not,
- stick with surrounding tissues.
The order of lymph nodes palpation: occipital, postauricular, preauricular, submandibular,
mentonier, anterior-cervical,posterior-cervical, supraclavicular, subclavicular, axillary, cubital, femoral,
patellar ones.
16. Muscular system. Should be appreciated:
- Muscles development
- Local atrophy, hypertophy
- Strength (Tonus), symmetry of tonus for flexors and extensors; right and left)
16. Bones
- Defects
- Deformities
- Painful on palpation and percussion
17. Joints
The presence of inflammation signs:
- shape - edema (tumor)
- Tenderness (dolor)
- Red color
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- Higher temperature over them
- Active and passive movement (functio laesae)
Right
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+
+
+
+
+
+
Left
+
+
+
+
+
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2 Inspection of Heart and Vessels area
) inspection of the heart region ( cardiac humpback)
b) inspection of apical impulse (location, sistolic retraction in apical post)
c) ventricular movements (cardiac beat of right ventrical)
d) inspection of atipical pulsation in pericardiac region (jugular fossa, II interspace (right , left),
epigastric).
PALPATION
1 Palpation of apical impulse, its characteristics
- location,
- intensity,
- amplitude,
- diameter (surface),
- resistence;
diastolic cat purring .
So, in the hypertrophy of the left ventricle we'll have a diffuse, high, forced and resistant apex beat.
2 Palpation of right ventricular area (cardiac impulse) (presence, intensity).
So-called cardiac beat, due to contractions of the enlarged right ventricle.
3 Atipical pulsation in pericardiac region ( jugular fossa, II interspace (right , left
(systolic fremitus)), epigastric (subxiphoid) area.
PERCUSSION
Is used to determine: the size, position and the shape of the heart; the length of vascular bundle.
Determinate the hearts borders.
1 borders of relative cardiac dullness (-right, -left, -upper)
2 borders of vascular bundle (in 2-nd inerspace)
3 cardiac configuration (in interspaces).
Interspace
I
II
III
IV
V
Right
left
1 cm laterally of the right edge of sternum 3-4 cm medially left midclavicular line
2 3
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2
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