ГОСУДАРСТВЕННОЕ ОБРАЗОВАТЕЛЬНОЕ УЧРЕЖДЕНИЕ

ВЫСШЕГО ПРОФЕССИОНАЛЬНОГО ОБРАЗОВАНИЯ

«КАЗАНСКИЙ ГОСУДАРСТВЕННЫЙ МЕДИЦИНСКИЙ УНИВЕРСИТЕТ
ФЕДЕРАЛЬНОГО АГЕНСТВА ПО ЗДРАВООХРАНЕНИЮ
И СОЦИАЛЬНОМУ РАЗВИТИЮ»

КАФЕДРА ПРОПЕДЕВТИКИ ВНУТРЕННИХ БОЛЕЗНЕЙ

Схема истории болезни

Учебно-методическое пособие

Scheme of medical case report

Manual

Казань, 2010
УДК 616 – 09
ББК 54.1
Печатается по решению учебно-методического совета по преподаванию на
английском языке Казанского государственного медицинского университета

Составители:
кандидат медицинских наук, доцент кафедры пропедевтики внутренних
болезней Садыкова Аида Рифгатовна,
кандидат медицинских наук, ассистент кафедры пропедевтики внутренних
болезней Шамкина Айгуль Робертовна

Рецензенты:
руководитель Центра практических умений КГМУ, доктор медицинских наук,
профессор кафедры общей хирургии
Булатов Сергей Александрович
кандидат медицинских наук, доцент кафедры госпитальной терапии
Шнайдер Лариса Леонидовна

Схема истории болезни. Учебно-методическое пособие. Scheme of medical case

report. Manual. / Садыкова А.Р., Шамкина А.Р. – Казань: КГМУ, 2010. - 18 с.

Учебно-методическое пособие составлено в соответствии с Государственным

образовательным стандартом высшего профессионального образования,
Государственными требованиями к минимуму содержания и уровню подготовки
выпускника вуза по специальности 040100 «Лечебное дело», типовой и рабочей
программами по дисциплине «Пропедевтика внутренних болезней» (2003). В
учебно-методическом пособии приводится последовательность изложения
истории болезни, принятая в клинике внутренних болезней, с использованием
соответствующей терминологии, краткой характеристикой подразделов,
обоснованием диагноза и патогенезом симптомов. Пособие предназначено для
иностранных студентов III курса медицинских вузов.

© Казанский государственный медицинский университет, 2010

 CONTENT

1. Structure of educational medical case report …………………………………4

2. Form of educational medical case report……………………………………...8
3. References…………………………………………………………………...18
 4 5

STRUCTURE OF EDUCATIONAL MEDICAL CASE REPORT III. Physical examination

Physical examination or clinical examination is the process by which a doctor
A medical case report, a medical record, health record, or medical chart in general investigates the body of a patient for signs of disease. It generally follows the taking of
is a systematic documentation of a single patient's long-term individual medical history the medical history — an account of the symptoms as experienced by the patient.
and care. Together with the medical history, the physical examination aids in determining the
A patient's individual medical record identifies the patient and contains correct diagnosis and devising the treatment plan. This data then becomes part of the
information regarding the patient's entire case history. medical record.
Medical case report generally includes the following parts. General examination. A systematic examination generally starts at the head and
I. The patient identification data (ID). finishes at the extremities. General examination includes
II. Medical history. • estimation of general patient's status,
The medical history or anamnesis of a patient is information gained by a • patient's consciousness, position, constitution,
physician by asking specific questions, either of the patient or of other people who • taking temperature,
know the person and can give suitable information (in this case, it is sometimes called • defining of face expression peculiarities characteristic of certain diseases,
heteroanamnesis), with the aim of obtaining information useful in formulating a • as well as estimation of status of skin, nails, hair, observed mucous
diagnosis and providing medical care to the patient. The medically relevant complaints membranes, subcutaneous fat, lymph nodes, muscles, bones and joints.
reported by the patient or others familiar with the patient are referred to as symptoms, Data obtained by the clinician during general examination have a great diagnostic
in contrast with clinical signs, which are ascertained by direct examination on the part importance giving a possibility on one hand, to disclose characteristic (although often
of medical personnel. non-specific) signs of disease, on the other hand, to give a preliminary estimation of
A practitioner typically asks questions to obtain the following information about pathologic process extent and functional disturbances degree.
the patient: Respiratory system.
Identification and demographics: name, age, height, weight. Examination includes 4 parts: observation, auscultation, palpation, percussion
The "chief complaint (CC)" - the major health problem or concern, and its time Observation involves observing the respiratory rate which should be in a ratio of
course (e.g. chest pain for past 4 hours). 1:2 inspiration:expiration. It is best to count the respiratory rate under pretext of some
History of the present illness (HPI) - details about the complaints, enumerated in other exam, so that patient does not sub consciously increase his baseline respiratory
the CC. (Also often called 'History of presenting complaint' or HPC.) rate. Also observe for retractions seen in asthmatics. Retractions can be supra-sternal,
Past Medical History (PMH) (including major illnesses, any previous where the accessory muscles of respirations of the neck are contracting to aid
surgery/operations, any current ongoing illness, e.g. diabetes). inspiration. Retractions can also be intercostal, there is visible contraction of the inter
Allergies - to medications, food, latex, and other environmental factors costal muscles (between the ribs) to aid in respiration. This is a sign of repiratory
Childhood diseases - this is very important in pediatrics. distress. Observe for barrel-chest (increased AP diameter) seen in COPD. Observe for
Family history (diseases) - especially those relevant to the patient's chief shifted trachea or one sided chest expansion, which can hint pneumothorax.
complaint. For palpation, place both palms or medial aspects of hands on the anterior and
Psychosocial history (medicine) (PSH) - including living arrangements, posterior lung fields. Ask the patient to count 1-10. The point of this part is to feel for
occupation, marital status, number of children, drug use (including tobacco, alcohol, vibrations (tactile fremitus) and compare between the right/left lung field. If the pt has
other recreational drug use), recent foreign travel, and exposure to environmental a consolidation (maybe caused by pneumonia), the vibration will be louder at that part
pathogens through recreational activities or pets. of the lung. This is because sound travels faster through denser material than air.
Sexual history, obstetric/gynecological history, and so on, as appropriate. On comparative percussion, you are testing mainly for pleural effusion or
Medications and habits (MH) regular and acute medications (including those pneumothorax. The sound will be more tympanic if there is a pneumothorax because
prescribed by doctors, and others obtained over-the-counter or alternative medicine) air will stretch the pleural membranes like a drum. If there is fluid between the pleural
Review of systems (ROS) Systematic questioning about different organ systems membranes, the percussion will be dampened and sound muffled.
History-taking may be comprehensive history taking (a fixed and extensive set of If there is pneumonia, palpation may reveal increased vibration and dullness on
questions are asked, as practiced only by health care students such as medical students, percussion. If there is pleural effusion, palpation should reveal decreased vibration and
physician assistant students, or nurse practitioner students) or iterative hypothesis there will be 'stony dullness' on percussion.
testing (questions are limited and adapted to rule in or out likely diagnoses based on Lung auscultation is listening to the lungs bilaterally at the anterior chest and
information already obtained, as practiced by busy clinicians). posterior chest. First of all, identify the main breath sound. Then specify an
 6 7

adventitious breath sounds. Wheezing is described as a musical sound on expiration or stool), hematemesis - gastric bleed, esophageal varices, caput medusae (rare) - venous
inspiration. It is the result of narrowed airways. Coarse crackles are bubbly sounds distension, ascites.
similar to blowing bubbles through a straw into a sundae. They are heard on expiration Auscultation is sometimes done before percussion and palpation, unlike in other
and inspiration. It is the result of viscous fluid in the airways. Fine crackles or examinations. It may be performed first because vigorously touching the abdomen may
crepitation are only heard during inspiration. It is the result of alveoli popping open disturb the intestines, perhaps artificially altering their activity and thus the bowel
from increased air pressure. sounds. To conclude that bowel sounds are absent one has to listen for 5 minutes.
Cardiovascular system. Growling sounds may be heard with obstruction. Absence of sounds may be caused by
The precordial exam, also cardiac exam, is performed as part of a physical peritonitis.
examination. The exam includes several parts: inspection, palpation, percussion and Palpation in all 9 regions - light (superficial) then deep.
auscultation. In light palpation, note any palpable mass, hernial orifices if positive cough
General Inspection: - inspect the patient status whether he or she is comfortable at impulses, assessing muscle tone- there are 3 reactions that indicate pathology: guarding
rest or obviously short of breath. (muscles contract as pressure is applied), rigidity (rigid abdominal wall indicates
- inspect the neck for increased jugular venous pressure (JVP)or abnormal waves peritoneal inflammation) and rebound (release of pressure causes pain) – positive
Then inspect the precordium for: visible pulsations, apical impulse (apex beat), Shchetkin-Blumberg's sign. The lght palpation also includes examination for ascites:
masses, scars, lesions, signs of trauma and previous surgery (e.g. median sternotomy), bulging flanks, fluid wave test (fluctuation sign), shifting dullness test.
permanent Pace Maker, praecordial bulge. In deep palpation, detail examination of the mass, found in light palpation, bowel,
Palpation: the valve areas are palpated for abnormal pulsations (known as thrills) liver and gallbladder and spleen. Special maneuvers include complementary (Cair's,
and precordial movements (known as heaves). Heaves are best felt with the heel of the Murphy's, Ortner's, Lepene's, Mussis') signs of cholecystitis.
hand at the sternal border.The apex beat is typically palpable in the left fifth intercostal Urinary system examination includes inspection of the kidneys area, kidneys deep
space and 1 cm medial to the mid-clavicular line. It is not palpable in some patients palpation, percussion of the lumbar region (Pasternatsky's sign), palpation of the
due to obesity or emphysema. To accurately determine the location of an apex beat ureteral algesic points, and palpation and percussion of the urinary bladder.
which can be felt across a large area, feel for the most lateral and inferior position of IV. INVESTIGATIONS DATA
pulsation. An apex beat in the axilla would indicated cardiomegaly or mediastinal shift. After the main organ systems have been investigated by inspection, palpation,
Percussion of the heart allows to define relative and superficial cardiac dyullness percussion and auscultation, specific tests may follow.
borders and to make idea about the heart configuration and its diameter. The results of testing, such as blood tests (e.g., complete blood count), radiology
Auscultation of the heart: one should comment on S1 and S2 - if the splitting is examinations (e.g., X-rays), pathology (e.g., biopsy results), or specialized testing
abnormal or louder than usual. Should sound like [lub-dub lub-dub] and the presence (e.g., pulmonary function testing, ECG) are included. Often, as in the case of X-rays, a
of S3 - like [lub de dub] sound, S4 - like [T lub-dub]. If S4 S1 S2 S3 were all present it written report of the findings is included in lieu of the actual film.
would sound like [T-lub-de-dub], also known as a quadruple gallop rhythm; diastolic V. СLINICAL DIAGNOSIS
murmurs (e.g. aortic insufficiency, mitral stenosis), systolic murmurs (e.g. aortic The assessment is a written summation of what are the most likely causes of the
stenosis, mitral regurgitation), pericardial rub (suggestive of pericarditis). patient's current set of symptoms. The diagnosis documents the expected course of
Vessels examination includes blood pressure, pulse rate and rhythm, jugular disease, its severity, complications and accompanied diseases according to
venous pressure (JVP) and pulse defining, palpation of peripheral arteries. comprehensive classification of illnesses.
Gastrointestinal tract. VI. SUBSTANTIATION OF BASIC DIAGNOSIS
The exam includes several parts: inspection, auscultation, percussion and List the typical (pathognomonic or specific) symptoms and signs, changes in the
palpation. laboratory and instrumental diagnostic methods data which prove your diagnosis.
On inspection the patient should be examined for masses, scars, sinuses, lesions, VII. PATHOGENESIS OF SYMPTOMS AND SIGNS
signs of trauma, bulging flanks - best done from the foot of the bed, jaundice/scleral Describe pathogenesis of symptoms and signs found in the course of patient’s
icterus, abdominal distension, caput medusae - dilated blood vessels radiating from the examination. Try to find ―cause-consequence‖ relationships within found signs,
umbilicus (may be present in liver failure). Especially pay attention on stigmata of grouping them in the syndromes typical of established disease.
liver disease: fetor hepaticus, asterixis (flapping tremor); on hands: clubbing,
Dupuytren's contracture, palmar erythema; and estrogen related: spider nevi, testicular
atrophy, gynecomastia; associated with portal hypertension: hematochezia (blood in
 8 9

FORM of MEDICAL CASE REPORT History of recent admission______________________________________________

THEME_______________________________________________________________ ______________________________________________________________________
Student name_______________________________________________________ ______________________________________________________________________
Group №__________________ Date____________________________ ______________________________________________________________________
I. PATIENT'S ID. ______________________________________________________________________
1. Name_______________________________________________________________ ______________________________________________________________________
2. Age (date of birth)_____________________________________________________ 3. PMH
3. Occupation__________________________________________________________ A. Other medical problems________________________________________________
4. Home address_______________________________________________________ ______________________________________________________________________
5. Date of admission___________________________________________________ ______________________________________________________________________
______________________________________________________________________
II. MEDICAL HISTORY ______________________________________________________________________
1. CC________________________________________________________________ ______________________________________________________________________
______________________________________________________________________ ___________________________________________________________________
______________________________________________________________________ B.
______________________________________________________________________ Allergies______________________________________________________________
___________________________________________________________________ ______________________________________________________________________
Symptoms analysis (location, quality, quantity, chronology, setting, aggravating- ______________________________________________________________________
alleviating.factors, associated manifestations)_________________________________ ___________________________________________________________________
______________________________________________________________________ C. Major childhood illnesses_______________________________________________
______________________________________________________________________ ______________________________________________________________________
______________________________________________________________________ ______________________________________________________________________
______________________________________________________________________ ______________________________________________________________________
______________________________________________________________________ D. Injuries, hospitalizations, and operations___________________________________
______________________________________________________________________ ______________________________________________________________________
______________________________________________________________________ ______________________________________________________________________
______________________________________________________________________ ______________________________________________________________________
______________________________________________________________________ ______________________________________________________________________
___________________________________________________________________ E. Immunizations (hemotransfusion)________________________________________
Secondary complaints___________________________________________________ ______________________________________________________________________
______________________________________________________________________ ______________________________________________________________________
______________________________________________________________________ 4. FH
______________________________________________________________________ ______________________________________________________________________
__________________________________________________________________ ______________________________________________________________________
2. HPI______________________________________________________________ ______________________________________________________________________
______________________________________________________________________ ______________________________________________________________________
______________________________________________________________________ ______________________________________________________________________
______________________________________________________________________ ______________________________________________________________________
______________________________________________________________________ ______________________________________________________________________
______________________________________________________________________ ______________________________________________________________________
______________________________________________________________________ ______________________________________________________________________
______________________________________________________________________ ______________________________________________________________________
______________________________________________________________________ ______________________________________________________________________
______________________________________________________________________ ______________________________________________________________________
 10 11
5 PSH
A. Infancy, childhood, adolescence. Date of birth________________, in time (before 6. MH
term), from_______________pregnancy. Age of parents in the time of child birth: Medications (name, dosage, and regimen of each drug the patient is using)__________
father's_______y., mother's___________y. Breast-feeded or not (underline the ______________________________________________________________________
necessary). Began walking at ____ y., speaking at______ y., gone to school at_____y., ______________________________________________________________________
had______________marks. In intellectual and physical growth and development didn't ______________________________________________________________________
(did) delay from coevals (underline the necessary). ______________________________________________________________________
B. Lifestyle. Habits. Tobacco smoking_________________________________________________
Typical day for the patient________________________________________________ ______________________________________________________________________
______________________________________________________________________ ______________________________________________________________________
Recreation the patient engages in__________________________________________ Alcohol consumption____________________________________________________
______________________________________________________________________ ______________________________________________________________________
______________________________________________________________________ ______________________________________________________________________
____________________________________________________________________ ______________________________________________________________________
Sports________________________________________________________________ Illicit drugs using_______________________________________________________
______________________________________________________________________ _____________________________________________________________________4
Religious beliefs patient holds_____________________________________________
______________________________________________________________________ III. PHYSICAL EXAMINATION FINDINGS
Patient’s school experience________________________________________________ General condition_________________________, t______°С.
After graduating school___________________________________________________ Patient's position_______________, level of consciousness _____________________
______________________________________________________________________ Face expression_________________________________________________________
______________________________________________________________________ ______________________________________________________________________
Patient’s military experience_______________________________________________ ______________________________________________________________________
______________________________________________________________________ Constitutional type_____________________. Height________cm, weight_______kg,
Clothes and footwear: (non) hygienic, (not) correspond to the season (underline the BMI______kg/m2. WC……cm. HC……..cm. WC/HC………cm.
necessary). Gait and bearing abnormalities_____________________________________________
Feeding: (not) full, (not) regular (underline the necessary), prefers_________________ ______________________________________________________________________
______________________________________________________________________ Skin:
Apartment: ___rooms, separate (communal), (un)comfortable, with all (partial) Color: physiologic, pale, cyanosis, hyperemia, icterus, other
facilities (underline the necessary). changes_________________ (underline the necessary)
C. Homelife. Emotional atmosphere at home__________________________________ Moisture_________________elasticity__________ state of the hair_______________
Marriage status________________________ Family___________________________ presence of exanthema, hemorrhages, vascular changes,
______________________________________________________________________ scars_______________________________________________________________
D. Occupational life. Nature of the occupation________________________________ ______________________________________________________________________
______________________________________________________________________ Nails_________________________________________________________________
______________________________________________________________________ _____________________________________________________________________
Toxic exposures________________________________________________________ Subcutaneous fat: degree of its development __________________________________
______________________________________________________________________ Distribution (places of biggest fat deposition)_________________________________
______________________________________________________________________ ______________________________________________________________________
E. Sexual history. Pubertal period had gone without (with) complications at ______y. Thickness of cutaneous fold below the scapula______cm, presence of
Had sexual contacts from______y, has (not) _____childs (underline the necessary). edema____________________________________________(point the level of edema)
Menstrual function. Menarche from_____y, cycle length______d, (ir)regular, duration Thyroid gland__________________________________________________________
of bleeding___d, amount of bleeding_______. Menopause from_________y. Lymph nodes (size, shape, consistency, motility tenderness, adhesions with each other
Amount of pregnancies: deliveries_____, abortions_____, misbirths________. and surrounding tissues __________________________________________________
______________________________________________________________________
 12 13

______________________________________________________________________ Lower lung borders:

______________________________________________________________________
______________________________________________________________________ Topographic lines Right Left
______________________________________________________________________ Parasternal
______________________________________________________________________ Midclavicular
Muscles: general development_____________________________________________ Anterior axyllary
Tenderness on palpation__________________________________________________ Midaxyllary
Muscular tone__________________________________________________________ Posterior axyllary
Muscle strength_________________________________________________________ Scapular
Bones. On examination of skull, chest, spine, extremities tenderness and deformations Paravertebral
are (not) revealed (underline the necessary)___________________________________ Defining of diaphragmatic excursion
______________________________________________________________________
____________________________________________________________________ Topographic lines Right (cm) Left (cm)
Joints_________________________________________________________________
inhal. exhat. total inhal. exhat. total
___________________________________________________________________
Midclavicular
______________________________________________________________________
Midaxyllary
______________________________________________________________________
______________________________________________________________________ Scapular

Respiratory system Lung auscultation_______________________________________________________

Nasal breathing is (not) laboured. Nasal form____________________________ ______________________________________________________________________
Chest shape___________________________constitutional type__________________ ______________________________________________________________________
Deformities__________________, symmetry_________________, respiratory ______________________________________________________________________
pattern_______________Respiration is (ir)regular, respiration rate__________per ______________________________________________________________________
min. ______________________________________________________________________
Chest respiratory motions of both sides of the chest: (un)even, (a)symmetric, there is ______________________________________________________________________
(no) a lag in motion on___________side of the thorax. Bronchophony__________________________________________________________
Additional respiratory muscles_______________________________(don't) participate ______________________________________________________________________
in respiration. ____________________________________________________________________
Tenderness on palpation______________________________, elasticity____________ Cardiovascular system
Tactile fremitus_________________________________________________________ Inspection of precordium________________________________________________
______________________________________________________________________ ______________________________________________________________________
___________________________________________________________________ ______________________________________________________________________
On comparative percussion________________________________________________ ___________________________________________________________________
______________________________________________________________________ Apical impulse (location, area, height, strength, resistance_______________________
______________________________________________________________________ ______________________________________________________________________
______________________________________________________________________ ______________________________________________________________________
Topographic percussion data: ______________________________________________________________________
Height of apices pulmones standing: from the front: on the right – ________cm above ______________________________________________________________________
clavicle, on the left – ________cm above clavicles; ___________________________________________________________________
from the rear: on the level of _______vertebra. Cardiac impulse_______________________Epigastric pulsation_________________
Krenig's areas width: on the right – _______cm, on the left – _______cm. Other pulsations________________________________________________________
______________________________________________________________________
______________________________________________________________________
 14 15

Thrills________________________________________________________________ Gastrointestinal tract.

______________________________________________________________________ Fetor oris______________________________________________________________
___________________________________________________________________ Visible mucous of oral cavity______________________________________________
Heart percussion ______________________________________________________________________
Cardiac relative dullness borders: righ_______________________________________ Tonsills_______________________________________________________________
______________________________________________________________________ ______________________________________________________________________
left___________________________________________________________________ Gums_________________________________________________________________
______________________________________________________________________ Carious tooth___________________________________________________________
upper_________________________________________________________________ Tongue_______________________________________________________________
______________________________________________________________________ ______________________________________________________________________
The heart diameter:___+____ = ____cm ______________________________________________________________________
Heart configuration__________________________________ Abdomen shape: flat, rounded. protruded [(un)even], scaphoid (underline the
Cardiac superficial dullness borders: right____________________________________ necessary)
______________________________________________________________________ Respiratory motions of abdominal wall______________________________________
left___________________________________________________________________ ______________________________________________________________________
_____________________________________________________________________ Auscultation data_______________________________________________________
upper_________________________________________________________________ ______________________________________________________________________
______________________________________________________________________ ______________________________________________________________________
Superficial dullness diameter: ________cm. Percussion data_________________________________________________________
Vascular bundle width________cm Superficial palpation data_________________________________________________
Heart auscultation ______________________________________________________________________
Heart sounds___________________________________________________________ ______________________________________________________________________
______________________________________________________________________ ______________________________________________________________________
______________________________________________________________________ Shchetkin-Blumberg's sign _______________________________________________
______________________________________________________________________ ______________________________________________________________________
Murmurs______________________________________________________________ Sigmoid colon__________________________________________________________
______________________________________________________________________ ______________________________________________________________________
______________________________________________________________________ ______________________________________________________________________
______________________________________________________________________ Cecum________________________________________________________________
______________________________________________________________________ ______________________________________________________________________
Heart rate – ______per 1 min,. (ir)regular____________________________________ ______________________________________________________________________
______________________________________________________________________ Transverse colon________________________________________________________
______________________________________________________________________ ______________________________________________________________________
Vessels examination ______________________________________________________________________
Arterial pulse_____per 1 min, (ir)regular, filling_______________, Ascending and descending colon___________________________________________
strain_________________, contour______________, (un)equal on both arms. ______________________________________________________________________
Arteries palpation and auscultation__________________________________________ ______________________________________________________________________
______________________________________________________________________ ______________________________________________________________________
______________________________________________________________________ Using percussion, auscultopercussio, auscultoaffriction, splashing sound methods the
______________________________________________________________________ lower stomach border is defined at the level__________________________________
______________________________________________________________________ Gastric greater curvature__________________________________________________
______________________________________________________________________ Pylorus_______________________________________________________________
BP on the left arm____________mm Hg, on the right arm_____________mm Hg.. Pancreas______________________________________________________________
Venous pulse: negative, positive. Central venous pressure_____________cm. Inspection of the liver area________________________________________________
 16 17

______________________________________________________________________ ______________________________________________________________________
Signs of ascites_________________________________________________________ ______________________________________________________________________
______________________________________________________________________ ______________________________________________________________________
Liver span after Kurlov___________________________________________________ ______________________________________________________________________
______________________________________________________________________ ______________________________________________________________________
Liver palpation_________________________________________________________ ______________________________________________________________________
______________________________________________________________________
______________________________________________________________________ V. СLINICAL DIAGNOSIS
Gallbladder____________________________________________________________ Main_________________________________________________________________
______________________________________________________________________ ______________________________________________________________________
Complementary signs____________________________________________________ ______________________________________________________________________
______________________________________________________________________ ______________________________________________________________________
_____________________________________________________________________ ______________________________________________________________________
Inspection of the spleen area_______________________________________________ ______________________________________________________________________
______________________________________________________________________ Accompanied__________________________________________________________
Spleen percussion _______________________________________________________ ______________________________________________________________________
______________________________________________________________________ ______________________________________________________________________
______________________________________________________________________
Spleen palpation________________________________________________________ VI. SUBSTANTIATION OF BASIC DIAGNOSIS
______________________________________________________________________ Diagnosis is based on____________________________________________________
______________________________________________________________________ ______________________________________________________________________
______________________________________________________________________
Urinary system ______________________________________________________________________
Inspection of the kidneys area______________________________________________ ______________________________________________________________________
______________________________________________________________________ ______________________________________________________________________
______________________________________________________________________ ______________________________________________________________________
Kidneys palpation_______________________________________________________ ______________________________________________________________________
______________________________________________________________________ ______________________________________________________________________
______________________________________________________________________ ______________________________________________________________________
Pasternatsky's sign______________________________________________________ ______________________________________________________________________
Ureteral algesic points____________________________________________________ ______________________________________________________________________
Urinary bladder________________________________________________________ ______________________________________________________________________

IV. INVESTIGATIONS DATA VII. PATHOGENESIS OF SYMPTOMS AND SIGNS

______________________________________________________________________ ______________________________________________________________________
______________________________________________________________________ ______________________________________________________________________
______________________________________________________________________ ______________________________________________________________________
______________________________________________________________________ ______________________________________________________________________
______________________________________________________________________ ______________________________________________________________________
______________________________________________________________________ ______________________________________________________________________
______________________________________________________________________ ______________________________________________________________________
______________________________________________________________________ ______________________________________________________________________
______________________________________________________________________ ______________________________________________________________________
______________________________________________________________________ ______________________________________________________________________
 18

REFERENCES

1. A Guide to physical examination. Third Edition./B. Bates, R. A. Hoekelman.-

J.B. Lippincott Company, Philadelphia, 1995, 539p.
2. Introduction to clinical medicine./J.L.Willms, J.Lewis. – Williams and
Wilkins, Baltimore, 1991, 260p.
3. Manual of Introductory Clinical Medicine./R.M.Maclis, M.E.Mendelson,
G.H.Mudge.- Little. Brown and Company, Medical division, Waltham, 1997,
251p.
4. Схема истории болезни./В.Н.Ослопов, А.Р.Садыкова, А.Р.Шамкина. –
М.; МЕДпресс, 2001, 32с.
5. Пропедевтика внутренних болезней Учебно-методическое пособие.
Часть I. Introduction to Internal Diseases. Manual Part I. /В.Н.ослопов,
А.Р.Садыкова, И.В.Карамышева. Казань, 2005, 65 с.
6. Пропедевтика внутренних болезней Учебно-методическое пособие.
Часть II. Introduction to Internal Diseases. Manual Part II. /В.Н.ослопов,
А.Р.Садыкова, И.В.Карамышева. Казань, 2005, 86 с.
7. Пропедевтика внутренних болезней Учебно-методическое пособие.
Часть III. Introduction to Internal Diseases. Manual Part III. /В.Н.ослопов,
А.Р.Садыкова, Л.А.Ануфриева. Казань, 2005, 77c.
8. Пропедевтика внутренних болезней Учебно-методическое пособие.
Часть IV. Introduction to Internal Diseases. Manual Part IV. /В.Н.ослопов,
А.Р.Садыкова, Л.А.Ануфриева. Казань, 2005, 103 c.