Interrogation on systems
Cardiovascular system:
Pain in the field of heart ____________________________________________________________
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Palpitation ___________________________________________________________________ Faults in the robot of heart _______________________________________________________
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Edemas ________________________________________________________________________
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Rising or dropping of arterial pressure ________________________________________________
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System of respiration:
Respiration __________________________________________________________________________
Dyspnea___________________________________________________________________
________________________________________________________________________________ Attacks of a dyspnea _______________________________________________________________
Tussis ___________________________________________________________________________
________________________________________________________________________________
Stethalgia _______________________________________________________________________
Pneumorrhagia ____________________________________________________________________
System of digestion:
Appetite _________________________________________________________________________ Thirst ___________________________________________________________________________ the Heartburn _____________________________________________________________________ the Eructation ____________________________________________________________________
Nausea ______________________________ the Vomiting ________________________________ the Swallowing ___________________________________________________________________
Gas ___________________________________________________________________________ the Pain at a defecation ____________________________________________________________
Constipations ______________________________________________________________________
the Bleeding from a rectum _________________________________________________
Genitourinary system:
Pain in lumbar area ___________________________________________________________
Uropoiesis ______________________________ How many time for a day ___________________
Color wet ________________________________________________________________________
Total wet for a day ______________________________________________________
Swell a century ___________________________ Edemas on the face _______________________
Nervous system:
Mood __________________________ Character _____________________________________
Working capacity ____________________________ the Dream ____________________________
Cramps, attacks ________________________________________________________________
Sense organs:
Unpleasant sensations in opinion of ___________________________________________________
Dacryagogues ___________________________________________________________________ Depression of hearing ___________________ the Pain in ears _____________________________
Sense _______________________________ Taste ______________________________________
Locomotorium:
Joint pain, bones, a backbone
________________________________________________________________________________
Movements in joints _______________________________________________________________
Numbness_______________________________ the Numbness of extremities _________________
The compelled periodic stoppings during walking ________________________________
Pain in muscles ___________________________________________________________________
Endocrine system:
Thirst ___________________________________ the Polyuria _____________________________
Augmentation of mass of a body ______________________________________________________
The anamnesis of disease _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
The anamnesis of a life ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Virus hepatitis ______________________ the Tuberculosis _______________________________
Veins. Diseases __________________________________ the Malaria _______________________
Allergic reactions _____________________________________________________________
Objective inspection
The general condition of the patient __________________________________________________________
Position in bed _______________________________________________________________
Consciousness ___________________________________________________________________
Skin and mucosas __________________________________________________________
________________________________________________________________________________ Thickness of a dermal cord ______________________
Birthmarks and formations_______________________________________________________
Hypodermic fat _______________________________________________________________
Peripheric lymphonoduses
Cervical _____________________________________________________________________
__________________________________________________________________________ Occipital ___________________________ Supraclavicular _______________________________
Axillary ________________________ Inguinal ____________________________________
Survey of area of a neck and palpation of a thyroid gland ______________________________
____________________________________________________________________________
Survey of a thorax _____________________________________________________________
________________________________________________________________
Palpation of a thorax ___________________________________________________________
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Percussion of a thorax ___________________________________________________________
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Height of standing of apexes of lungs _________________________________________________________
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Width water Grening _____________________________________________________________________
Topographical percussion of lungs
|
Place of a percussion |
Right easy |
The Left lung |
|
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______________________________________________________________________________________________________ |
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At auscultation in lungs respiration ________________________________________________________________
________________________________________________________________________________
Rhonchuses ________________________________________________________________________________
Crepitation ______________________________________________________________________________
Pleural rub ________________________________________________________________________
Palpation of area of heart ___________________________________________________________________
________________________________
Borders of heart (relative dullness)
|
Border |
Localization |
|
______________________________________________________ |
____________________________________________________________________________________________________________________________________________________________________________________ |
Auscultation of heart
Tones ________________________________________________________________________________
________________________________________________________________________
Pulse ____________ beats in minutes, rhythmical _________________________________________
Filling _______________________________ a strain _____________________________________
BP ____________________ mm of Hg.
The dental formula
Fauces _____________________________________________________________________________
Tongue ________________________________________________________________________________
Survey of a stomach{belly} ________________________________________________________________
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Palpation of a stomach{belly} ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Peristalsis ____________________________________________________________________________
Signs a boring of a peritoneum (what and where) ____________________________________________
The liver ______ is palpated: indurations tuberous; edge: acute blunt, below a costal arch on _______ see
Morbid ____________________________
Cholic bubble __________________________________________________________________________
Other changes in a liver __________________________________________________________________
Lien ________________________________________________________________________________
Kidneys _______ are palpated (on the right, at the left), mobile, enlarged, morbid ________________________________________________________________________________
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Sign Pasternats (+-) on the right, at the left. __________________________________________________
Mammary glands ________________________________________________________________________________________________________________________________________________________________
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Peripheric vessels (a pulsation, auscultation) _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
The local status ________________________________________________________________________________
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Other additional data ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
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The preliminary diagnosis
The basic ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Complications _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Accompanying ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Date ___________________________ The Signature ________________________