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Topic 2: General Inspection of a patient.

Consciousness disorders. Posture of a patient. Facial expression.


Constitutional types, nutritional indexes.

Aim motivation.
The General Inspection has great importance in examination of a patient and in
construction of clinical diagnosis. As the diagnostic method, the General
Inspection plays the key role in different directions of the medicine independently
from laboratory and instrumental diagnostics. Numerous clinical syndromes are
mostly based on the results of General Inspection in comparison with systemic
objective examination. This makes the great implication of the General Inspection.

Independent work of the students and main goals.


Studying the theme independently the students must know the following:
1. Sequence of General Inspection.
2. Value of general condition, condition of consciousness,
3. Differences of consciousness disorders in various diseases
4. Diagnostical meaning of pathological faces.
5. Features of the forced posture in various diseases of internal organs.
6. Significance of anthropometric measurements, thermometry, and value of the
results.

The basic level of knowledge.


To study the theme it is necessary to know:
1. The main constitutional types and specific features of internal organs
development from course of Normal Anatomy.
2. The main functional characteristics of the brain cortex from course of Normal
Physiology.
3. The normal metabolism of glucose, urea, and their disorders from course of
Biochemistry.

Recommended scheme of the study.


1. Value of general condition of a patient.
2. Conformity of the show and age.
3. Clinical significance of show in practice.
4. Study of consciousness of a patient.
5. Classification of consciousness disorders, their concepts, diagnostic meaning.
6. Posture of a patient.
7. Facial expression. Examination of the head, neck.
8. Constitution: how to define, main constitutional types.

Methodical recommendations to study the material.


1. Value of consciousness of a Alert, clouded, stupor, sopor, coma,
p a t i e n t , d i s o r d e r s o f delirium, hallucinations.
consciousness.
2. Determining the type of a coma. Alcoholic, apoplectic, hypoglycemic,
diabetic, hepatic, uremic, epileptic,
anemic coma.
3. Conformity of appearance and a) The show of a patient is in conformity
age. with age; b) looks younger than his age;
c) looks elder than his age.
4. Determining the posture of a Active, passive, forced.
patient.
5. Forced postures. To know description in various diseases
6. Evaluation of the face features. Examination of a head (scull, eyes, nose,
lips, ears), neck, thyroid gland.
7. Evaluation of suffering features a) no features of suffering;
of a face. b) there are features of suffering face.
8. Types of pathological faces. Puffy face, Corvisart's f a c e , facies
febrile, m i t r a l f ace , ao r t i c f a ce ,
acromegalic face, myxoedematous face,
facies basedovica, Itsenko-Cushing
(moon)face, facies leontina, Parkinsons
mask, wax-doll face, rhisus sardonicus,
Hippocratic face, asymmetric face.
9. Anthropometric measurements. Measuring of a weight, high of a patient.
10. Nutritional indexes. Statural-weight value; proportion of
height and girth of the chest; Kettles
(body mass) index.
11. Types of constitution. Normosthenic; asthenic; hypersthenic.
Recommended literature.
Basic:
1. Bates, B. A guide to physical examination and history taking./B. Bates, L.S.,
Bickley, R. A. Hoekelman .-6-th ed.-Philadelphia:J.B. Lippincott
Company,1995.-711 p.:ill.
2. Bickley, L.S. Bates' Guide to physical examination and history taking/L.S.
Bickley, P.G. Szilagyi.-9th ed .-Philadelphia: Lippincott Williams & Wilkins,
2007.-902 p.:ill. + CD-ROM. 3. Bickley, L.S. Psysical examination and history
taking./L.S.Biskley, R.A. Hoekerman.-7-th ed .-Philadelphia:Lippincott, 1999.-
789 p.:ill.
4. The 10-minute diagnosis manual. /Ed.: R.B. Taylor .-Philadelphia:Lippincott
W,2000.-389 p.
5. Ivashkin, V.T. Internal diseases propedeutics
: . ( . .) a textbook for foreign students of
Medical Higher Educational Institutions /V.T.Ivashkin, A.V.Okhlobystin.
Moscow:Geotar-Media,2006.-176 p.:ill.
6. Clinical examination./Ed.: N.J. Talley, C.O'Connor.-Oxford:Blackwell
Scientific Publication.,1995.-185 p.: ill.
Additional:
1. Diagnostic Radiology: Paediatric Radiology= :
/M.Berry, S.Suri, V.Chowdhury.-1-st ed.-New Delhi:Jay-
pee Brothers,1999.-300 p.:il .-(Diagnostic radiology).
2. Diagnostic ultrasound. A logical approach./J.P. McGahan, B.B. Goldberg.-
Philadelphia:Lippincott- Reven,1998.-1288 p.:ill.
3. Oh,J.K. The echo manual./J.K. Oh, J. B. Seward, A.J. Tajik.-2-nd ed.-
Philadelphia:Lippincott W & W,1999.-278 p. : ill.
4. Roberts, G.M. Clinical radiology for medical students./G.M.Roberts, J.P.
Hughes, M.D. Hourihan.-3-rd ed.-Oxford:Butterworth Henemann,1998.-141 p.:il.
5. Macleod's Clinical Examination /Ed. by G. Douglas, F. Nicol, C. Robertson.-
11th ed .-Edinburgh:CHurchill Livingstone,2005.-406 p.:il.

Questions for the self-control.


1. Which types of the general condition of a patient exist?
2. Which condition may be called as satisfactory?
3. Which causes of the gravity of a general condition exist?
4. Why the show of a patient may be in disaccordance with the age, and in
which diseases?
5. Tell the classification of disorders of consciousness.
6. Name the degrees of the consciousness disorders with prevalence of
depression of a cortex.
7. Name the degrees of the consciousness disorders with prevalence of
excitation of a cortex.
8. Give definition of a stupor, and its characteristics.
9. Give definition of a sopor, and its characteristics.
10. Give definition of a coma, and its characteristics.
11. Name types of coma.
12. Describe diabetic and hypoglycemic types of coma.
13. Describe apoplexic and alcoholic types of coma.
14. Describe uremic and hepatic coma.
15. Name types of posture of a patient.
16. Characterize an active posture of a patient.
17. Characterize the forced posture of a patient.
18. Characterize the passive posture of a patient.
19. Name types of the forced posture of a patient.
20. For which diseases is the forced posture on the back specific?
21. The posture lying on the abdomen is the sign of which disease?
22. Forced posture on the healthy (unaffected) side of the chest is specific for
23. Name diseases, characterized by the forced posture on the affected side.
24. Name the forced posture with fixed upper limbs, and for which diseases is it
specific?
25. Describe forced posture in meningitis.
26. Describe forced posture in tetanus.
27. Describe forced posture in epilepsy.
28. Name changes (types) of countenance in pathology.
29. Name facial expression in endocrine diseases.
30. Describe facial expression in eunuchoidism.
31. Describe features of face in thyrotoxicosis.
32. Describe features of face in hypothyroidism.
33. Describe facial expression of a patient with acromegalia.
34. Characterize the face under Itsenko-Cushing syndrome.
35. Features of the face in adrenal incompetence.
36. Name pathological faces of a patient under cardiovascular diseases.
37. Describe facial expression in infectious endocarditis.
38. Describe facial expression in aortic valve defects.
39. Describe facial expression in mitral valve defects
40. Features of a face in myocardial infarction.
41. Describe Corvisart's face, for which pathology is specific.
42. Facial expression of a patient suffering of arterial hypertension.
43. Name diseases characterized by puffy face.
44. Describe a puffy face with Stocks collar.
45. Characterize the facial features in urinary failure.
46. Name countenances in diseases of the respiratory system. Describe each of
them.
47. Name faces in infectious diseases.
48. Facies leontina: a) describe; b) diagnostic meaning.
49. Describe face in tetanus.
50. Describe Parkinsons mask. Explain significance.
51. Describe face in Addison-Biermer's anemia.
52. Describe facies hippocratica.
53. Asymmetric face: a) features; b) diagnostic meaning.
54.What is included in definition of constitutional type of body?
55. Name main constitutional types.
56. Name signs of the constitutional type.
57. Characterize normosthenic, asthenic, and hypersthenic type of constitution.
58. Which nutritional indexes are there?
59. Which degrees of obesity are differentiated?
60. Technique of the thyroid gland palpation.

Obligatory tasks for the self-study.


1. To construct table of consciousness disorders in various diseases.
2. To draw 3 pictures with schematic show of the main constitutional types.
3. To count nutritional indexes for a patient (in therapeutic department), and to
give evaluation of the results.

Supplement:
Terminology (Obligatory terms to memorize).
General inspection; general condition; posture; active posture; passive posture;
forced posture; stupor; sopor; coma; delirium; hallucinations; facial expression;
constitutional type.

List of practical skills for the self-study.


1. Detection of a general condition of a patient.
2. To determine constitutional type of a patient.
4. To detect posture of a patient.
3. To characterize face of a patient.
4. To count nutritional indexes of a patient.