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Examination of the Patient
Taking a case history
As soon as the patient is admitted to the in-patient department the ward doctor fills in the patient’s case history. It must include the information about the patient’s parents – if they are living or not. If they died, the doctor must know at what age and of what caused their death. The doctor must know if any of the members of the family has ever been ill with tuberculosis, has suffered from a stoke or heart attack or has had any mental or emotional impairments. This information composes the family history (семейный анамнез).
The patient’s medical history must include the information about the diseases which the patient had both being a child and an adult, about the operations which have been performed, about any traumas he had. These findings compose the past history (жизненный анамнез). The patient’s blood group and his sensitivity to antibiotics must be determined and the obtained information is written down in the case history.
The attending doctor (лечащий врач) must know what the patient’s complaints and symptoms are. He must know how long and how often the patient has had these complaints.
The information on the physical examination of the patient on his admission to the hospital, the results of all the laboratory tests and X-ray examinations, the course of the disease with any changes in the symptoms and the condition of the patient, the administered medicines in their exact doses and the produced effect of the treatment - all these findings which compose the history of the present illness must always be written down in the case history.
The case history must always be written very accurately and consist of exact and complete information.
IX. Read and translate the medical terms:
Aetiology; pathogenesis; mechanism; visual; palpation; percussion; auscultation; cystoscopy; edema; haemorrhage; objective, subjective; inspection; complexion; murmur; crepitations; râle; swelling; pulse rate; blood count; hemoglobin; fever; sputum; haemoptysis.
X. Read the text. Be ready to answer the questions given below:
Before the treatment of a disease it is necessary to make a diagnosis, determine its aetiology (the cause of the disease), pathogenesis i.e. the way and mechanism of its development, as well as the symptoms by which it can be revealed.
A number of different procedures are used to establish a diagnosis: history-taking, physical examination, which includes visual examination, palpation, percussion, auscultation, laboratory studies, consisting of urinalysis, blood, sputum and other analyses, instrumental studies, for example, taking electrocardiograms or cystoscopy, X-ray examination and others.
Very important for determining disease is the knowledge of its symptoms such as breathlessness, edema, cough, vomiting, fever, headache and others. Some of these symptoms are objective, for example, haemorrhage or vomiting, because they are determined by objective study, while others, such as headache or dizziness (головокружение) are subjective, since they are evident only to the patient.
At the conclusion of the examination the doctor usually makes some comments about the impression he or she has formed.
1. Which are the usual methods of examination? (inquiry, inspection, auscultation, palpation, percussion, taking the temperature, feeling the pulse, checking the blood pressure, making X-ray examinations, various laboratory studies).
2. What does inquiry reveal?
(patient’s complaints, the onset of the disease, the past history of the patient and his family history).
3. What does inspection of the patient reveal?
(general appearance of the patient, his build, nourishment, complexion, the state of his tongue, pupils, etc.)
4. What does the physician reveal by auscultation?
(sounds in the heart and lungs, a murmur of the heart and crepitations, and râles in the lungs).
5. What can be determined by palpation?
(heat or cold, edema, moisture or dryness of the skin, elasticity or rigidity of the abdomen, the outlines or the enlargement of an organ, swelling, and the existence of growth).
6. What does percussion reveal?
(dullness or impairment of sound and distribution of fluids in the body).
7. Why is the blood pressure of the patient measured?
(to ascertain whether the patient’s blood pressure is normal, high or low).
8. Why is the patient’s pulse felt?
(to determine whether the pulse rate is normal or accelerated).
9. Which are the usual laboratory studies?
(various blood tests, e.g., a blood count (white blood cells count and red blood cells count), a hemoglobin test, urine analysis, stool studies and sputum examinations, etc.)
10.What are the most common subjective symptoms?
(chill, malaise, weakness, discomfort, restlessness, fatigue, insomnia, dizziness, nausea, anorexia, heartburn, palpitation, shortness of breath).
11.What are the most common objective symptoms?
( fever, anemia, sweating, hoarseness, sore throat, running nose, running eyes, sneezing, cough, vomiting, diarrhoea, constipation, salivation, etc.)
XI. Read the following passages paying attention to how the patient with certain symptoms should be questioned by the doctor:
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