Short estimation of anamnesis data.

 Group main anamnesis symptoms into syndromes, estimate their diagnostic value, make a conclusion about the localization, character, probable causative factors of affection in organs and systems.

Objective conditions of patient (status presence objectives).

General conditions of patient: satisfactory, middle heaviness, heavy, very heavy.

Appearance of patient: is equal to age or no.

Consciousness: clear, lost, stupor, sopor, coma, hallucinations.

Position in bed: active, passive, constrained (active, passive), not quiet.

Posture: straight, bent, “proud”.

Walk: normal, of “old man”, ataxia, and spastic, paretic.

Height: high, middle, low.

Weight: estimate in kg and compare with normal.

BMI.

Skin: color ( natural, pale, red, cyanotic, yellow, ground – grey, bronze etc); areas of  pigmentation or depigmentation; humidity (normal, high, dry skin, desquamation); separately – humidity of palms ( hands ), rash (erythematic, resoles, papullose, pustullose , vesicular, urticar, hemorrhagic, petehial ); scratches ( localization, intensity ); scars (localization, origin, morphologic peculiarities, trophic changes ( bedsores, ulcers).

Hair: way of hair growth (male, female), bald areas, is a person’s hair touched with grey, hypertrichosis, growth of hair in unusual places.

Nails: color, shape (“of watch glass”, with humps).

Subcutaneous adipose tissue: level of expression (high, normal, low), thickness of fold in rib arc area; is distributed evenly, or not (in what places).

Edemas: level of expression, localization, area of localization.

Lymphatic nodes: submandible, neck, axillar, cubital – can(can not) be palpated, their size, painfulness, mobility, consistence, connection one with another and with subcutaneous tissue, presence of fistulas.

Head: sizes (are proportional or not to body), shape, symmetrical or not.

Face expression: smart, cheerful, quiet, concentrated, exited, apatic, mask-like, suffer expression, sad, face of Hypocrites.

Appearance of face: usual, moon-like, pastose, edematous, face covered with cold sweat; sizes and peculiarities of nose shape.

Ears: peculiarities of shape and sizes, cyanosis.

Eyes: appearance, nistagm, exophthalmos. Color of corneas, conjunctivas, presence of hemorrhages; size of pupillas, reaction on light, convergation (fast, low, absent).

Thyroid gland: sizes, shape, consistence, mobility, painful or not.

Oral cavity: color of mucosa, its humidity, presence of chaps, scars, ulcers, herpetic rash, enantemas, hemorrhages; color of dents, their disposition to hemorrhages, friability, condition of teeth, peculiarities of tongue (color of mucosa, condition of papillar apparatus, presence of teeth impressions, stain) tonsil  (size, condition, presence of puss), smell from mouth, its characteristics.

Neck: is proportional or not, peculiarities of shape, pulsation of carotid arteries, vein pulsation (negative or positive venous pulse).

Cardiovascular system.

 Inspection: presence of pulsation is second intercostal space to left or right from sternum, on heart apex, under xyphoid appendix (processus xyphoideus); heart hump; pulsation of cubital arteries, width of their walls, width of  temporal artery.

 Palpation: apical push, its localization, expression (normal, amplified, weakened) height (high, low), resistance (not resistant, resistant) presence of systolic or diastolic trembling, positive, negative or doubled heart push.

 Determine borders of relative and absolute heart dullness:

Borders of dullness	Relative	absolute
Right
Upper
Left

Determine width of vascular bundle in II intercostal space. Auscultation: determine rhythm and frequency of heart contractions, loudness of heart tones (amplified, weakened); timbre (clapping, velvet I tone; metal II tone);presence of splitting or doubling of I and II tones on aorta, pulmonary artery; presence of additional pathological tones (systolic extratone, rhythm of gallopl).

Auscultation of rhythm, tones, murmurs (systolic, diastolic and their variants; noise of pericardium friction), determine character (soft, rude, blowing-like, scretching); timbre (high, low), force (weak, intensive), duration (short, long, increasing rhomb-like, decreasing), direction of conduction, changes according to body position.

Listen to abdominal aorta and jugular vein. Characterize arterial pulse, is equal (same)on left and right hand, determine its frequency (frequent-p. frequent, rare - p. rarus); rhythm (regular - p.regularis, not regular - p.irregularis), strong pulse or not (normal - p. plenus, empty - p.vagualaris), size (big - p.magnus, small - p.parvus , high - p.altus, thread-like -p.filiformis, even - p.aequalis , non-even - p.inaequalis), tension (solid - p.durus, soft-p.mollis), shape (quick - p.celer, slow - p.tardus, dicrotic-p.dicroticus), deficit of pulse-p.deficiens, paradox pulse - p.paradoxus.

Properties of pulse on  carotid arteries, on vessels of the back foot surface and behind the ankle. Arterial pressure – by Korotkov’s method – determine systolic and diastolic AP on shoulder arteries in mm. Hg.