Examination of the Patient

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: