Examination of the cardiovascular system

Visual inspection has not revealed cardiac hump, pathological pulsation and skin change of the precordial area.

Apex beat is localized in the 5^th intercostal space 1,5 cm right from the left midclavicular line. Its area is 1,5 cm², not strong and average height.

“Cat’s purr” is not determinated.

Epigastric pulsation is produced by the abdominal aorta. Pulsation of the right ventricle is absent.

Percussion. Borders of relative and absolute cardiac dullness

	Relative cardiac dullness	Absolute cardiac dullness
Right border	4th intercostal space near the right edge of the sternum	4th intercostal space near the left edge of the sternum
Upper border	Upper edge of the 4th rib on the left parasternal line	4th intercostal space on the left parasternal line
Left border	5th intercostal space 1.5 cm medially of the left midclavicular line	5th intercostal space 2 cm medially of the left midclavicular line

Auscultation of the heart

Heart sounds are rhythmical. They are clear. Heart murmurs are not determined.

Investigation of the pulse and arterial pressure

Pulse is equal on the both hands. It is rhythmical, pulse rate is 90 per min., the pulse tension, filling is satisfactory. Its value is sufficient.

Arterial blood pressure is 120/70 mm Hg on the both hands.

Assessment of the cardiovascular system examination

During examination of the cardiovascular system tachycardia was revealed as a sign of inflammation and intoxication syndrome. Other pathological changes are absent.

Examination of the Abdomen

Inspection of the abdomen: It is oval shape, small size, symmetrical, participates in the breathing. Umbilicus is not protruded. The subcutaneous veins, scars, eruptions, scratches, pulsation, peristalsis, teleangioectasia are not seen.

Superficial tentative oriental palpation of the abdomen: It is soft, painless. Muscular resistance, abdominal tenderness, diastesis recti are not determinated. The fluctuation sign, Shchetkin-Blumberg and Mendel signs are negative.

Deep palpation: The sigmoid is palpated in the left invaginal region as a smooth, solid elastic, painless, slight mobility cylinder without rumbling sounds. Its diameter is 3 cm.

The caecum is palpated in the right invaginal region as a smooth, elastic, painless, mobility cylinder with rumbling sounds. Its diameter is 4 cm.

The ascending colon is palpated in the right lateral region as a smooth, elastic, painless, immobility cylinder with rumbling sounds. Its diameter is 2,5 cm.

The descending colon palpated in the left lateral region as a smooth, elastic, painless, immobility cylinder with rumbling sounds. Its diameter is 3 cm.

Lower border of stomach was founded by percussion-auscultation, percussion and palpation methods. Its position is 4 cm above the umbilicus. Its surface smooth, even, painless, elastic.

The transverse colon is not palpated.

The lower edge of the liver, the spleen and the pancreas are not palpated.

Percussion of the liver according to M.G. Kurlov:

The first size – 11 cm

The second size – 9 cm

The third size – 8 cm.

Gallbladder affecting signs: theKerr’s, the Ortner’s, the Lepene-Vasylenko’s, the Mussy-Georgyevskiy’s, the Merphy’s are negative.

Assessment of the abdomen examination

During examination of the abdomen the pathological changes have not been revealed.

FORMULATING SUGGESTED (PRIMARY) DIAGNOSIS.

The patient’s symptoms: a moderate stabbing, chest pain in the right side without irradiation that increases due to cough and deep breathing, mixed dyspnea which increase due to physical exertion, a permanent cough with purulent sputum without smell; the moderate severe general condition, pale cyanotic wet and hot skin, flash on the right cheek, lagging right part of the chest from the left one, tachypnea (36 per min), participating accessory muscles (neck, back and nose muscles) in breathing by visual inspection, amplifying vocal fremitus over the right lung, painful point along the right axillary line from 4^th till 7^th intercostals spaces, the positive Potenzher’s sign of the right side by palpation; dull sound over the right lung, upward shift of the right lower border of the lung, limiting excursion of the right lungs edge by percussion; the pathological bronchial breathing is heard over the right lung by auscultation allow suggesting the syndrome of the consolidation of the lung tissue.

The patient’s symptoms: mixed dyspnea which increase due to physical exertion, the moderate severe general condition, pale cyanotic skin, tachypnea (36 per min), participating accessory muscles (neck, back and nose muscles) in breathing by visual inspection, tachycardia by examination of the cardiovascular system allow suggesting the syndrome of the severe respiratory failure.

The patient symptoms: light headache, malaise, fever with body temperature 38,0-38,8 °C during a day, and chill which developed during a couple of days; the moderate severe general condition, body temperature 38,2°C pale cyanotic wet and hot skin by visual inspection are the symptoms and signs of the acute inflammation. Taking into account the three described syndromes the community-acquired pneumonia of the lower lobe of the right lung may be diagnosed.