Zatchot L1 to L3

Question 1

what is the Five classical methods of direct patient
examination

Answer 1

1. patient’s interview,
2. inspection,
3. palpation,
4. percussion,
5. auscultation

Question 2

what is The DF of Symptom

Answer 2

-Symptom: is a separate sign of the disease

Question 3

what is The DF of Syndrome

Answer 3

-Syndrome: is a combination of symptoms, combined with a common pathogenesis (the
mechanism of development)

Question 4

what is The DF of Diagnosis

Answer 4

-Diagnosis is a short medical conclusion about the nature of the disease and the
patient’s condition, expressed in medical terms

Question 5

what is the Pulmonary consolidation syndrome ?

Answer 5

Significant decrease or complete absence of lungparenchyma airiness. This syndrome includes thefollowing symptoms:
* Dyspnea,
* Chest pains enhancing in deep inhalation,
* Asymmetric chest motions in respiration,
* Dull percussion note,
* Vesicular breath sound changes,
* Local shadow on the roentgenogram

Question 6

what is the structure of medical case report

Answer 6

1- I. The patient identification data (ID).
2- II. Medical history
3- III. Physical examination
4-IV. Scheme of investigation
5-V. Investigation data
6-VI. Сlinical diagnosis
7- VII. Treatment

Question 7

what is the DF of The medical history

Answer 7

The medical history : is the foundation upon which diagnosis and treatment are made.
Without a medical history, the clinician works in a vacuum.

Question 8

what is the COMPONENTS OF THE (ADULT) MEDICAL
HISTORY (The patient interview)

Answer 8

• I. Introductory information (identifying data) – ID.
• II. Chief complaint – CC.
• III. History of the present illness – HPI.
• IV. Life history: 1.Past medical history – PMH
• 2. Family history – FH.
• 3. Psychosocial history – PSH.
• 4. Medications and habits – MH.
• VIII. Review of systems – ROS

Question 9

explain the I. Introductory information

Answer 9

• the patient’s name
• age (date of birth)
• occupation =What is your profession?
• address
• date of admission = When were you hospitalized?

Question 10

explain the II. Chief complaint and its duration – CC

Answer 10

—* The chief complaint (CC) :complaints refer to important symptoms of the disease, most typical for that disease, which shows to some extent the localization of the process.

ex: * What made you to come to the hospital?

Question 11

what Chief complaints (CC) of respiratory,

Answer 11

— Respiratory
* Cough (dry, wet, paroxysmal)
* Sputum (mucous, purulent ,rusty)
* Hemoptysis
* Chest pain
* Breathlessness (dyspnea)
* Suffocation

Question 12

what Chief complaints (CC) of Cardiovascular

Answer 12

–. Cardiovascular
* Pain in the region of
the heart
* Breathlessness
* Heart rhythm
disturbances
* Edema
* Headache

Question 13

what is the chief complement of * . Alimentary system

Answer 13

—Alimentary
* Appetite disorders
* Swallowing disorders
* Heartburn
* Eructation
* Nausea, vomiting
* Abdominal pains
* Diarrhea
* Constipation

Question 14

Chief complaints (CC) of urinary

Answer 14

–Urinary
* Fever
* Painful urination
* Pain in loin region
* Red urine
* Edema
* Altered urine volume

Question 15

explain the Secondary complaints

Answer 15

The secondary complaints are pertained subjective sensations, declared only presence of disease, but does not specific for certain diseases (e.g. weakness, fever, decreased ability to work, fatiguability and etc),

• or that complaints, which are connected to
  accompanied disease.

Question 16

explain History of the present illness – HPI.

Answer 16

• Beginning of the illness, First manifestations
• Possible reasons of its origin (in the opinion of the
  patient)
• Development of symptoms
• Sequence, reinforcement, weakening or
  disappearance earlier appeared or appearance of new
  disease’s symptoms

Question 17

explain the Life history

Answer 17

1-Past medical history – PMH : :
A. Other medical problems = acute diseases
* B. Allergies -specific allergic reaction,
* C. Epidemiological history-tuberculosis, hepatitis, malaria,
* D. Injuries, hospitalizations, and operations
* E. Immunizations
2-Family history – FH. :
* A. The age and health of the patient’s parents, siblings, and children. If a family member is deceased, the cause of death is noted.
* B. The occurrence of any disease like that described in the patient’s HPI is sought in other family members.
3. Psychosocial history – PSH. :
A. Infancy, childhood, adolescence
B. Lifestyle
D. Occupational life : 1. Nature of work 2. Toxic exposures
E. Sexual history
4-. Medications and habits – MH :
A. Medications : Name, dosage
B. Habits : Tobacco smoking , Alcohol consumption

Question 18

explain the VIII. Review of systems (ROS)

Answer 18

VIII. Review of systems (ROS)
* Systematic questioning about different organ systems
* At the end of the ROS, it is useful to ask two questions:
* (1) “Is there anything else bothering you?”
* (2) “Is there anything you would like to ask
about before I give you a physical exam?

Question 19

explain the General inspection , and what is Patient’s general condition

Answer 19

–The rules:
 1. The patient must be examined successively
 2. The patient should be examined fully.
–The conditions:
1. The room should be warm.
 2. Lighting - natural light is desired
———-
 satisfactory,
 medium gravity,
 grave
 extremely grave

Question 20

explain the General inspection , and what is Patient’s general condition

Answer 20

–The rules:
 1. The patient must be examined successively
 2. The patient should be examined fully.
–The conditions:
1. The room should be warm.
 2. Lighting - natural light is desired
———-
 satisfactory,
 medium gravity,
 grave
 extremely grave

Question 21

explain the Body temperature

Answer 21

 In a healthy human being body temperature
fluctuates in a narrow range: from 36,0°C to 37,0°C.

1. Continued fever (febris continua): long-term body
   temperature increase with diurnal fluctuations not
   exceeding 1°C.
2. Remittent fever (febris remittens): long term body temperature increase with diurnal fluctuations exceeding 1°C.
3. Intermittent fever (febris intermittens): high fever changed by normal body temperature (below 37°С) for 1-2 days and then rising again up to 38-40°С.
4. Hectic fever (febris hectica): sufficient temperature increase up to 39-41°С (more often by the evening) changed by normal temperature within 24 hours. Increase of temperature is accompanied by pronounced chill, and its increase - by emaciating sweating

Question 22

explain the Consciousness

Answer 22

– Three grades of consciousness disturbance are distinguished :
1. Torpor : is a state of stunning out of which the patient may be taken out for a short time by speaking to him. The patient is poorly oriented in the surrounding situation, answers the questions slowly and late

2. Sopor (sleep) : is more pronounced consciousness disturbance. The patient does not react to surrounding people, although sensitivity, including pain sensitivity, is preserved, reacts to examination.
3. Coma :
   is more pronounced consciousness disturbance.
   The patient does not react to surrounding people, although sensitivity,
   including pain sensitivity, is preserved, reacts to examination.

Question 23

Types comatose states

Answer 23

 alcoholic coma
 hypoglycaemic coma
 diabetic (hyperglycaemic) coma
 hepatic coma
 uremic coma
 epileptic coma
 cerebral coma
 artificial coma

Question 24

what Forced position during a bronchia
asthma attack

Answer 24

(asthma accompanied by sharp difficulty of expiration) the patient takes forced sitting position leaning with his hands on the back of a chair, edge of a bed, his knees, etc. This position gives a possibility to fix the shoulder girdle and to switch additional respiratory musculature, specifically, muscles of the neck, back and breast enabling expiration

Question 25

explain Forced position during cardiac
asthma attack

Answer 25

During cardiac asthma attack and pulmonary edema
caused by blood congestion in lesser circulation circle
vessels the patient is eager to take vertical (sitting)
position with legs dropped down which decreases
blood inflow to the right cardiac chambers and gives a
possibility to unload lesser circulation circle to some
extent (orthopnea position)

Question 26

explain the body Constitution

Answer 26

1- Normosthenic type : is characterized by correct habitus with proportional parts of body, well-developed somatic musculature, correct chest shape with costal angle approaching straight angle
2-Asthenic type :
 predominant body development in length,
 muscles are weakly developed,
 shoulders are sloping,
 long neck,

3-Hypersthenic type:
 predominant body development in width;
 medium height or lower,
 enhanced nutrition,
 muscles are well-developed.
 shoulders are wide, neck is short.
 the abdomen is enlarged in volume.
 the chest in is wide,

Question 27

what is the Facial inspection :

Answer 27

-they are several types :
1-Facies mitralis : (face of a patient with mitral valve stenosis)
2-Acromegaly :The increased growth hormone of acromegaly produces enlargement of both bone and soft tissues. of the head
3-Facies nephritica : (face of a patient with renal diseases) pain, puffy, with upper and lower eyelids edema,
4-Facies leonine : (face of patient with leprosy)
5-Facies Corvisari : is characteristic for patients with pronounced cardiac insufficiency..
6-Facies micsedemica : face of a patient with thyroid gland hypofunction (myxedema).
7-Facies Basedovica : (face of a patient with thyrotoxicosis): anxious, exasperated or frightened face expression is marked,
8-hirsutism facies : Face of a female patient with hirsutism developed due to excessive testosterone in the organism

Question 28

explain the GENERAL INSPECTION of a skin ( while we are examine the patient )

Answer 28

1-color
2- humidity (moisture)
3-elasticity (turgor)
4-skin rashes and lesions

Question 29

explain the skin color

Answer 29

-there are 5 types we can distinguished while we examine the patient :
1- Paleness = -anemias - peripheral circulation pathology:
2-Redness = 2-1peripheral vessels dilation: fever 2-2erythrocytosis, polycythemia
3-Cyanosis (bluish) = :
3-1Central cyanosis – diffuse, warm: develops in result of insufficient blood oxygenation in the lungs in various respiratory organs diseases
3-2. Peripheral cyanosis (acrocyanosis), cold : appears in case of slowing down of peripheral
circulation, in venous congestion in patients with cardiac insufficiency.
3-3. Limited, local cyanosis :develops in result of peripheral veins congestion due to their compression with tumor,
4-Jaundice ; three kinds of jaundice are distinguished = :
1. parenchymal (in hepatic parenchyma lesion);
2. mechanical (in obturation of common bile duct with a concernment or its compression with a tumor);
3. hemolytic (in enhanced hemolysis of erythrocytes)
5-Bronze (brown) = Bronze (brown) skin color is usually seen in adrenal insufficiency.

Question 30

explain the humidity of the skin (Moisture)

Answer 30

–they are several types :
1-Moderate (normal)
2-Excessive (sweating) – diabetes mellitus (especially when blood sugar is low)
3- Dry (dryness) -renal failure, skin diseases
4-Peeling - , «uremic powder»

Question 31

explain the Elasticity (turgor) of the skin

Answer 31

1-Decrease in elasticity of skin - patients of old age, dehydration (vomiting, diarrhea).
2-Increase in turgor and tension of skin - liquid delay.

Question 32

explain the Skin rashes

Answer 32

1–Hemorrhagic
1-petechiae,
2-ecchymosis,
3- purpura
2–Non-hemorrhagic:
1-erythema (including erythema nodosum),

Question 33

explain the general inspection of the Hair

Answer 33

1- Dull, brittle, hair loss, premature hair graying
2-Type of growth (malepattern, femalepattern)

Question 34

explain the general inspection of the Nails
and give example of a disease we can diagnose it through the nails

Answer 34

1-Form
2-Color
3-Brittleness
4-Deformation
5- Striation
—-Watch-glasses symptom and drumsticks the main causes:
1-long purulent lung diseases (abscesses, bronchiectasis),
2-congenital heart defects (with severe tissue hypoxia),
3-bacterial endocarditis

Question 35

explain the general inspection of the Subcutaneous fat
and give example of a disease we can diagnose it through the Subcutaneous

Answer 35

1-development (moderate, weak, excessive),
2-largest deposition sites,
3-presence of edema,
4-thickness of the fat fold at the lower angle of the scapula and on the abdomen at the level of the navel
——(obesity) ; Primary (exogenous constitutional, or alimentary-metabolic) obesity based on energetic imbalance (absolute or relative increase of energy income with food or decrease of its waste due to hypodinamia)
–the opposite of the obesity is the chexcia

Question 36

explain the general inspection of the Edema

Answer 36

1-Prevalence(local, general)
2-Sites (extremities, abdomen, face)
3-Degree of severity (pastiness, severe)
4-Consistency(soft, dense)
5- Skin color in edema sites
-Local edema :
the main causes :
1. regional lesion of venous outflow
2-. acute inflammatory reaction of skin and subcutaneous fat
3-. local cutaneous allergic reaction, Quincke’s edema.
-Diffuse or general edema : in cardiac, renal and other visceral organs diseases
are, caused by combination of lesions of numerous
mechanisms taking part in water-electrolytic balance
in the organism.
ex : Ascites = is the accumulation of fluid in the peritoneal cavity
Hydrothorax = is the accumulation of fluid in the pleural cavity
—The following methods are used for disclosure of peripheral edemas:
1. palpation method
2. follow-up of bodymass dynamics;

Question 37

explain the general inspection of the lymph nodes
and give example of a disease we can diagnose it through the lymph nodes

Answer 37

–Normally peripheral lymph nodes :
present round or oval formations from 5 to 20 mm in size. They are not elevated above the skin level and that is why not disclosed during examination.
–location of lymph nodes :
1. Pre-auricular 2. Posterior auricular 3. Tonsillar 4. Submaxillary
5. Submental 6. Cervical 7. Supra- and subclavian 8. Anconeal (elbow) and
9. Inguinal
– we should exam the lymph nodes for distinguish :
a) size b) shape c) consistency d) painless
e) movability f) adhered
—-diseases : there are two types
1- Diffuse, systemic lymph nodes lesion
-inflammatory changes (for example, in certain infections)
2. local enlargement of regional lymph nodes
-inflammatory (local suppurative processes)