Patient survey

Patient survey (inspectio) is one of the oldest main methods of research of the patient, not lost their importance at the present time.
None of the most advanced modern methods of research cannot replace an experienced eye doctor and give an idea of the sick in General. The systematic description of the methods of the examination, the patient takes the second place after questioning, but in fact he is often precedes the interrogation that starts from the first sight of a doctor to the patient. Registered pathological signs have significant support in the formulation of issues during the collection of anamnesis and sometimes allow you to set the correct diagnosis at first sight (acromegaly, tireotoksicski goitre, multiple bronchiectasis and others). By patient examination (examination) is possible to identify some of the common signs of the disorder various body functions and anatomical changes in organs. Known combinations of these parameters are defined clinical syndromes typical of those or other diseases. In order to use in full all the possibilities O. b., you must follow certain rules O. b., striving for consistency and completeness.
O. B. best performed in daylight or under fluorescent lights that gives the opportunity to discover, for example, yellowish coloration of the skin and eyes, imperceptible by other artificial light sources.
The technique of examination, the patient is simple. We must thoroughly examine the patient in vertical and horizontal position with direct and side lighting. The examination should be systematic. Initially producing General O. b., giving the opportunity to identify the symptoms of common values, and then the local inspection body parts, organs and their systems. The doctor neglecting the procedure and technique O. b., may miss important features, providing the key to diagnosis.
General inspection of the patient, the doctors any speciality is conducted according to the following scheme: 1) gender of the patient; 2) age; 3) the Constitution; 4) the General condition (gait, posture, situation in bed, consciousness); 5) habitus, General nutrition (obesity, weight loss); 6) lymph nodes; 7) the skin, mucous membranes (eyes, mouth, pharynx), hair; 8) the head, face, neck; 9) the trunk (chest, abdomen); 10) bones and joints; 11) sex organs.
Gait and posture of the patient reflect his health, mood. A number of diseases alters gait (hemiplegia, myelitis, sciatica, lesions of the joints, bones, blood circulation in the lower extremities and other).
The position of the patient in bed can be active, passive or involuntary. Active provision shall not prevent the severity of the disease. It can occur in the early stages of a serious and incurable diseases (malignant tumours, leukaemia and other). Passive situation is observed in cases of extreme weakness and loss of consciousness. Forced position can be quite varied; the patient takes it for reduction or termination of existing pain (pain, cough, shortness of breath) when the attacks of asthma, stenocardia, circulatory failure, pleurisy, pericarditis, gastric ulcer, peritonitis, etc.
Consciousness. Some diseases are accompanied by depression of consciousness, expressed in varying from stupor to coma, and some excitement varying degrees - delirium, hallucinations.
The nutritional status of the patient. The development of subcutaneous fat layer can be normal and elevated or reduced to varying degrees. Excessive development of the subcutaneous fat layer can be caused by several reasons: excess diet, sedentary lifestyle, excessive drinking, alcohol abuse, violation of the functions of the endocrine glands (the pituitary gland, sexual glands, thyroid gland). Weight loss may be associated with constitutional features (asthenic type), malnutrition and debilitating diseases. Extremely low total power is cachexia.
On examination, the patient can be detected General or local swelling, elephantiasis, varicose veins, pulsation of vessels, hypertrophy or muscle atrophy, their reduction.
Lymph nodes on examination, the patient can only be detected when they considerably increased (for leukemia, cancer metastasis, tularemia, limfosarkomatoze and others).
Leather. Pay attention to color, elasticity, moisture content of the skin, rashes and scars. Pale skin is observed in case of anemia, cramps skin vessels, and the lack of filling with blood vascular system (narrowing of the aortic, the failure of the valves, the aorta). Overly expressed the red coloration in the skin may be associated with polycythemia, extension of skin vessels in certain diseases in febrile period (pneumonia, tuberculosis), solar radiation, reception nitrite. Bluish coloration of the skin - cyanosis - observed with circulatory failure, chronic lung disease, congenital heart disease and other Yellowish color of skin, different shades can be due to a violation bilirubinometers liver function tests, increased hemolysis or mechanical factors preventing the ingress of bile into the duodenum. Dark-brown or bronze color of skin is observed in case of insufficiency of adrenal function. A sharp increase in the pigmentation of the nipples and peripapillary areas, the appearance of age spots on the face and pigmentation white line of the abdomen are usually characterized by signs of pregnancy. Reduction of skin elasticity observed in old age, in the long exhausting diseases, with dehydration. Skin moisture and perspiration affected individual fluctuations. Sweating happens, for example, when the temperature of a febrile patients, nervousness, and so on, Skin rashes have a great symptomatic importance for a number of diseases (allergic conditions, infectious diseases, drug-disease and others).
The main types of skin rashes - see Primary cells (skin rashes).
The hair. On examination, the patient pay attention to the distribution of hair, balding, gray hair. These data are of diagnostic value in diseases of the endocrine system, and to a certain extent can point to premature aging of the organism.
Further examining the individual parts of the body.
's head. Pay attention to the shape of her face, eyes, nose, ears. Excessive increase in the size of the skull found in congenital or acquired edema in children (hydrocephalus). The increase of the protruding parts of the head is observed in acromegaly. When idiocy child's head is abnormally small size (microcephaly). Head of the square form, flattened on top, with exceptional frontal mounds observed in congenital syphilis and moved rickets. Tower skull (narrow and high) can sometimes be hereditary is a family disease, with a total degeneration. Head position has diagnostic value in many diseases of the nervous system and spine. Involuntary head shake observed in the elderly, and when the shaking palsy and other, pulsation of the head - in case of insufficiency of the valves, the aorta (the symptom Musset). Scars on the head, combined with damage to the bones of the skull, can cause persistent headaches, dizziness, seizures.
Face. Puffy face observed in General edema, local stagnation (with frequent attacks of breathlessness, cough), the compression of the lymphatic ways for large effusions in the cavity of the pleura and pericardium, when pressing the top Vena cava, "the face of Karuizawa"- with circulatory failure. It swollen, yellowish white with bluish tone color. Mouth constantly half-open lips of cyanotic, eyes dull, sleepy eyelids. Feverish face (facies febrilis) is characterized by redness of the skin, shiny eyes, with various diseases has some peculiarities. So, when lobar pneumonia feverish glow brighter expressed on the side of the inflammation process in the lung; when typhus observed a General redness, puffiness of the face, sclera injected. The feverish TB patients attention burning eyes on thin pale with limited flushed face. Changing the facial features and expression at different endocrine disorders: (a) a person with the increase in the outstanding parts (nose, cheekbones, chin) is observed in akromegalia and to a lesser extent in some women during pregnancy; b) in a patient with thyroid goiter face quickly reddening, with moist skin, moving, with dilated eye slits, power shiny eyes, exophthalmos, which gives your face an expression of fear; C) the person in miksedeme evenly swollen, motionless, eye slits narrowed hair on the outer halves of the eyebrows fall, flushed a pale background; all of this makes it look like the face of a doll; g) for eunuchoid typically devoid of vegetation, wrinkled face; d) when the disease Itsenko - Kushinga a moon-shaped face, glossy, intense red colour, women grow a beard. With decompensated valvular diseases butterfly valve is observed cyanosis of the face, lips, nose, ears; failure of the aortic valve - pale color of skin. Leprosy - lion's face, with an extended nose, knobby-knotted thickening of the skin under the eyes and above the eyebrows. Masloobraznyj face with the lack of facial expressions typical of patients with encephalitis. A person with meningitis concentrated, sometimes with a threatening expression; often the pupils unevenly dilated; sometimes there strabismus and ptosis. When the disease down - slanting eyes, hypertelorism, flat nasal bridge, always open mouth. When anemia Addison-Biermer face sharply pale yellow, bloated with translucent skin. Risus sardonicus (sardonic laughter): 's mouth expanded, forehead creases, is observed with tetanus. Kahectina face is pale, haggard, with earthy color - is observed in cancer, especially of the digestive system. When trochaic noted frequent winking, rapidly changing faces, involuntary protrusion of the tongue. When pertussis face puffy, swollen eyelids, sometimes there is bleeding in the conjunctiva. The moribund patients and in patients with severe acute peritonitis or ileus there is a so-called person of Hippocrates - deadly pale color of a person with a bluish tinge, deeply sunken eyes, dim the cornea, pointed nose. When peritonsillar abscess expression fearful, the head of the patient keeps on one side, face painfully distorted when swallowing movements.
It is necessary to pay attention to changes in certain areas of the face (one-sided paralysis or paresis, tumors, tortuous temporal arteries).
The eye. Pay attention to the palpebral and ever, eyeballs, conjunctiva, cornea, and the pupils. Eyelid swelling occurs when the kidney disease, myxedema, malnutrition, trichinosis, anemia, with frequent bouts of coughing. Next, pay attention to the color of age (dark colouring - in graves ' disease, edisonova diseases, tuberculosis), the presence xantom proving violation of cholesterol metabolism. Advanced eye slit with nesmejalsja centuries observed in facial paralysis; persistent drooping eyelid (ptosis) - one of the symptoms of nervous system. The narrowing of the palpebral fissure observed in swelling of the face and miksedeme. Exophthalmia (exophthalmus) is the protrusion of the eyeball is one of the leading features of thyroid goiter, but can appear as an individual feature, severe myopia disturbance, optic tumors. Sunken eyes (enophthalmus)- one of the characteristics of peritoneal person. For myxedema typical violations of the sympathetic innervation eyes. Unilateral retraction eyes, accompanied by a narrowing of eye slits, ptosis of the upper eyelid and constriction of the pupil, is Bernard - Horner syndrome. Form pupils, their uniformity, response to light, on the accommodation and convergence are of great diagnostic value for a number of diseases. Strabismus develops as a result of the paralysis of the eye muscles, it is observed with lead poisoning, botulism, as a complication, diphtheria in various lesions of the brain and its meninges. An important diagnostic significance of jaundice skler, injecting them with acute infections, bleeding in them with high blood pressure.

The nose. The enlargement and thickening of the nose is observed in acromegaly. Retraction of the nose (saddle nose)if it is not caused by trauma, is one of the symptoms of tertiary syphilis. Deformation of soft tissues of the nose is observed in SLE.
His mouth. During the inspection of the mouth pay attention to its form (symmetry angles, always open mouth), painted lips, the presence halasa, heylita, herpes labialis. During the inspection of the mucous membranes of the oral cavity detect the presence of the aft, pigmentation spots Velsky-Filatova - kaplica, bubbles FMD, thrush. Marked changes gums are observed for scurvy, Peoria, acute leukemia, diabetes, intoxication lead, mercury. Examining the teeth, it should be noted irregularities in their development, the absence of a significant amount of carious teeth.
The language. A significant increase occurs in acromegaly, miksedeme. For a number of diseases kind of language has its own characteristics: clean, red and wet ulcers in the stomach; crimson with scarlet fever; dry, cracked and dark brown overlay,with heavy infections and intoxications; overlaid plaque in the center and root and clean at the tip and edges - with typhoid fever; Gontarovsky language - by disease Addison - Biermer; "Arabic language" with smooth papillae - in stomach cancer, chronic colitis, pellagra, sprue, ariboflavinoz; dry tongue - in "acute abdomen"; local thickening of the epithelium language - leukoplakia - common in smokers.
Throat. Examine it with mirrors and reflectors (see Laringoscope), but the duty of the doctor of any field is a simple examination of the throat and tonsils. Acute and chronic inflammation of the tonsils is one of the reasons of diseases of other organs (lungs, heart, stomach, gall bladder and others). It is very important to pay attention to the position of the tongue. If it is located asymmetrically, it is a signal to ensure that the patient be referred to an otolaryngologist. In addition, one should pay attention to the condition of Palat, hard and soft palate.
The neck. When inspecting the neck should pay attention to the ripple of the carotid arteries (the failure of the valves, the aorta, thyrotoxicosis), swelling and pulsating external jugular vein (tricuspid valve insufficiency), lymph nodes, diffuse or partial enlargement of the thyroid gland.
Examination of the chest - see the Chest. Examination of the abdomen - see Belly.
When viewed from the back can be detected curvature, limited mobility of the spine, the backlog of blades (see Spine, Shoulder region).
During examination of the bones and joints pay attention to their configuration, range of motion. Particularly noteworthy spinal deformity, change the shape and position of the pelvis. Disproportionately large brush observed in acromegaly. Short fingers, a broad brush in miksedeme. Excessive mobility metacarpophalangeal joints - with down's syndrome. During the inspection can detect the characteristic change of the end-phalanxes of fingers in the form heberdens knots and drum his fingers. Trembling of fingers of hands takes place with thyrotoxicosis, the elderly, alcoholics, neurotics; in disease Reynaud there are so-called dead fingers.
Can be found a number of changes from the side of the nail (atrophy, hypertrophy, formation of the transverse grooves, white spots, change the shape, color)to have diagnostic value.
Looking limbs, establish violations of movements that can be associated with disease of the joints and the nervous system (paralysis, atrophy, contractures). Unilateral swelling of a limb is indicative of violation of venous outflow (thrombophlebitis, flebotromboz, compression of the veins). Intermittent claudication (claudicatio intermittens) is associated with damage to the arteries and blood circulation in the vessels of the legs. On the shins and thighs you can find varicose veins.
During the inspection of the external genitalia pay attention to anomalies of development, cryptorchidism, inguinal-scrotal hernia, hydrops of the testicle envelopes, vaginal prolapse and other
During the inspection of the anus can detect the loss of the mucous membrane or the entire rectal fissure, fistula, HPV, hemorrhoids.
For special or local inspection of the patient the doctor proceeds after carefully conducted General survey. Cm. also examination of a patient.