General clinical examination methods

Patients always begins with the definition of complaints of the patient and his medical history (see), as their features largely determine the order further objective research, which can be different. In some cases, you immediately begin to study the General state of the organism (status praesens communis) by research systems and organs, held in the famous sequence. This procedure is necessary in cases of diseases that are not accompanied by a pronounced the election or primary defeat of one of some authority (area), or in cases where local pathological focus is not shown distinct local symptoms, attracting the attention of the patient. An example of this can be many common infectious diseases, diseases of the blood, metabolism, sometimes deep, hidden current purulent processes (for example, liver abscess) or malignant tumors and other diseases in which local symptoms is scarce and can be seen and correctly evaluated only with changes in the General condition of the patient. This order surveys often use in clinic of internal diseases, Pediatrics, as well as the impossibility of obtaining subjective data (for example, when unconscious patient and the lack of historical information).
In other cases, objective research should begin with a review of the available local changes (status localis), and then, completely having identified them, move on to posistemes study patient for the establishment of the General condition. Such a sequence of rational, if the presence and localization of local pathological changes become obvious to the doctor from the first moment of examination of the patient (e.g., injury of one or another part of the body) or if complaints of the patient is clearly focused on the local manifestations of the disease (for example, acute pain in the abdomen, joint, throat, ears and so on, swelling in any field and so on). In these cases, a clear picture about local changes makes more focused studies General condition of the patient or facilitates the interpretation find the total changes. Start examination of the patient with a study of local changes often dermatologists, surgeons and physicians of allied with surgery specialties. However, in such cases (and, in particular, with injuries) sharp, conspicuous, violations of the General condition of the patient (the phenomenon of shock, blood loss, severe intoxication, asphyxia) must be seen primarily as sometimes detailed examination of the patient, you need to Preface urgent measures available against formidable General disorders. Therefore, the assessment of the overall appearance of the patient, his pulse, respiration, and temperature measurement should be carried out simultaneously with the survey.
Having received the data about local developments, and turning to the study of systems, a doctor should remember not only about the General assessment of the functional state of the organism, but also on the possibility of hidden local foci, sometimes has a more important value than the one that has already been discovered and investigated.
Local changes can have secondary origin (for example, metastasis hidden flowing cancer) or, conversely, explicit local focus can lead to terrible, but hidden current secondary changes in other, very remote, organ. Such relationships are revealed only when posistemes O. B.
To obtain objective data initially use the basic kinds of medical research, which do not require sophisticated technical equipment and is based on using only vision, touch, and hearing the doctor. It is the physical methods of research: survey (see patient Survey), which includes the study of active movements; palpation (see) with the definition of the limits of passive mobility; percussion (see) and auscultation (see), which holds a doctor of any specialization. The research is usually conducted in the following order: General inspection, evaluation of peripheral pulse and respiration. Then move to the survey: 1) the oral cavity and pharynx; 2) the chest and thoracic cavity organs; 3) the abdomen (abdominal wall, abdominal cavity and retroperitoneal space); 4) the peripheral blood vessels, simpaticas nodes, thyroid gland; 5) locomotive system (spine, limbs); 6) the nervous system; 7) perineum and vulva, rectum, women - internal genital organs. It is clear that this sequence may vary, if there anamnesticescimi indications of a disease (for example, if suspected of hemorrhoids, research pussy and rectum will take not the seventh, and the second place).
Data about the state of the nervous system in the survey conducted by the doctor, not having special neurological training, limited historical information (headaches, sleep, memory, emotion, and so on), check the sensitivity of skin on the legs, pharyngeal and knee reflexes, the reaction of pupils on light. They checked facial symmetry when grin teeth or even when facial movements, the deviation of the tongue, symptom Romberg. Special neurological study (see below) is shown depending on the intended diagnosis (for example, it is mandatory to trauma of a skull), or if the elementary techniques of examination detect deviations from the norm. In respect of vision and hearing the doctor a layman can be limited to data from the survey of the patient.
Digital examination of the rectum (see Rectal examination) is required during any pathological phenomena of the abdomen, lower spine, pelvis, men of advanced age (prostate), and all patients, complaints and state which suggest acute or chronic intoxication, outgoing from obscure source, not manifesting himself local symptoms, pain or other (deep abscess pelvis, malignant tumor, and so on).
In these cases, and when the instructions on the disease of the endocrine system in the study of common condition in women included gynecological examination (see). When defining local change enjoy the same basic methods of the research, applying them in the same order (first inspection, then feeling, and so on). In addition, in some cases, the study concludes with a test specific symptoms typical of nosological forms, which make us think, localization and character of local changes. This check is performed visually (for example, a symptom Gref goiter), palpation - painful symptoms Blomberg-Shchetkina, Rosinha, menicus is a symptom of acute abdominal pain (in the Appendix, peritonitis, cholecystitis), a painful kick in the heel when koxie and other special symptoms reveal the special samples for example, the sample Dobrovolskaya with traumatic aneurysms, Troyan-Trendelenburg of varicose veins of the lower leg, etc.
The great value has a rigorous systematic research. You cannot, for example, to start feeling or percussion, not completely finished the inspection; switching attention from one method to another, the doctor often misses check of some important component of local paintings. This rule is, however, an exception: in any case of injury (especially if the wound) limbs at the level of the passage of major vessels of local research must not start with a tour of the place of damage, and feeling the pulse on foot or wrist affected limb, determining the sensitivity and motility of fingers and auscultation on a course of vascular bundle on the site of injury, and on either side of him. If this is not done immediately, then the doctor (especially found the signs of fracture and concentrating attention on them) can forget about these techniques and not recognize existing damage the nerve trunk or, more importantly, large vessels.
Examination of a patient would include a number of additional studies that require special, sometimes highly complex, technical equipment and special training, as many nosological forms cannot be confidently recognized and even detected using just basic medical research. Some of the additional research required in the examination of each patient regardless of presumptive diagnosis, others are appointed for certain indications.
To the number required for each patient laboratory studies include: common urine analysis; analysis of a feces on eggs of worms; smear microscopy; General clinical blood analysis and protrombinovogo index; serological test for syphilis; in patients older than 30 years - determination of cholesterol in the blood. These tests can be assigned at arrival of the patient in hospital even before visiting his doctor. Other laboratory tests, biochemical, microbiological, immunological, and so on - are assigned individually.


X-ray examination. Each patient must produce x-rays of the chest cavity, and in case of injury or changes in the musculoskeletal system - radiography relevant bones or joints. Other types of x-ray examinations prescribed by indications. Cm. also x-Ray examination.
Functional - diagnostic tests. One of the simplest and most accessible methods of research is the sample Rod (see the Preoperative period), which can be conducted for each patient. Of the more complex is mandatory in all cases, measurement of blood pressure (see Blood pressure) and in patients older than 30 years electrocardiography (see).
Endoscopic examinations and sensing internal organs for registration of their movements, changes in electric potential or the introduction of a radiopaque substance, etc. are not included in the complex of diagnostic measures required in the examination of each patient. They are applied individually to clarify the status of this or that body, in search of the hidden hearth of the pathological process, most of us - for a detailed, comprehensive study of local changes. In some clinical specialties (especially in urology, cardiology, ENT) these methods are indispensable for the recognition and detail of the diagnosis of a number of important diseases.
Biopsy (see) is also included in the examination of the patient for special reasons, mainly in Oncology.
Modern opportunities of inspection of the patient using a variety of additional methods of research is extremely expanded and continues to expand at the expense of use in medicine advances in technology, radiology, electronics, biochemistry, etc. Using these methods, you can not only detect and track the number of available eye, touch and ear doctor violations of the structure and function of an organ or tissue, but also to reveal many of the changes occurring at the molecular level and featuring the most intimate mechanisms of pathological process. However, with all the tremendous value and the need for additional research cannot be reduced examination of a patient only to them, no matter how they are diverse and accurate. A physician should see the sick person, and not complex of organs, tissues, cells, molecules, nucleic acids, etc., in which violated biochemical and other processes. A holistic view of the patient and his disease gives a survey carried out by means of the basic methods with the utmost care, systematic and thoughtfulness.
Along with General clinical O. B. often required in-depth study of the status of a specific organ or system, pathology of which can only be determined by a physician to a specific profession.
Obstetric and gynaecological examination - see Midwifery research. Gynecological examination.
Psychiatric examination - see the Mentally ill.