internal minimals 1st dep. debrecen

Family
Social and environmental
Previous diseases
Present complaints
Other questions

Inspection
Palpation
Percussion
Auscultation

The temperature of the body is between 37 C – 37.5 C

The temperature of the body is higher than 37.6 C

infectious disease
necrosis
damage of the heat centre
heat congestion
immune diseases
metabolic diseases

Continuously high fever, the daily difference of temperature is less than 1oC

Changing fever, the daily changes are higher than 1.5 oC, the minimum temperature is continuously higher than 37oC

Alternating fever, the daily changes are higher than 1.5oC, the minimum temperature is normal

Ideal weight = height (in cm) – 100

Quantity
Colour
Odour
Consistency

The number of breathing is 16-18/min, with symmetric distension of the thorax

Frequent breathing
The number of breathing > 18/min

Physical examination
Radiological laboratory and morphological examinations
Functional tests

Comparative auscultation on both sides on the same places
First the apical regions, then the middle parts and finally the supradiaphragmic regions of the lungs should be examined
In case of bronchial murmurs the pathological regions should be auscultated before and after coughing. Wheezing can be examined without phonendoscope if the patient is breathing with opened mouth

Sharp, full, not tympanic

Right front in the medioclavicular line at the lower edge of the 6th rib
Both sides, in the medioclavicular line at the 8th rib
Both sides in the scapular line at the 9th rib
Both side paravertebral the processus spinosus of the 11th vertebra

Ideal position of the patient
Do not percuss above bones
The percussion sound may differ at different regions of the thorax

Exercise induced
Rest dyspnoe
Orthopnoe
Paroxysmal dyspnoe

The frequency of pulse is over 100/min

The frequency of pulse is lower than 60/min

The central one is rather generalized and the extremities are warm
The peripherial one is localised and the extremities are rather cool

Upper border: parasternally the upper ridge of the 3rd rib
Left border: The apex beat or 1 finger medial from the left medioclavicular line
Right border: The right edge of the sternum

The closure of the mitral- and tricuspidal valves and the sound of the heart muscle

The closure of the aortic and pulmonary valves

The filling sound

Praesystolic sound (atrial)

In case of volume overload of the heart

At the beginning of the systole

At the middle of the systole

The murmur is audible at the entire systole

At the end of the diastole just before the systole

Either the III. or the IV. sound or both become stronger and their intensity will be the same as that of the intensity of the I. or II. sound

The murmur is caused by structural changes of the big blood vessels, valves, or orificiums

In which phase of the heart function does it appear
Intensity
Where is the punctum maximum
Propagation of the murmur

Left side: from up downward. Aorta, art.pulmonalis, left atrium,left ventricle
Right side: from up downward aorta, vena cava superior, right atrium

Art. femoralis
Art. poplitea
Art. tibialis posterior
Art. dorsalis pedis

The frequency of the heart is higher than that of the peripheral pulse. The difference between the two data is the pulse deficit

Frequency
Rhythmicity
Altitude
Velocity
Equality
Compressibility

Low extremity is blended, a rapid dorsalflexion causes pain in the muscle of the leg

Two ( righ and left) hypochondrium
Epigastrium
Umbilical
Two (right and left) lumbar
Pubic( hypogastrium)
Two (right and left) inguinal

The tension of the abdominal muscles, diffuse or circumscribed muscle defence

Air in the abdominal cavity due to perforation of the stomach or gut

Between the IX.-XI. ribs, between the anterior and medial axillary line

Pain and urgency at urination, frequently a small amount of urine

The amount of the daily urine is less than100 ml

The amount of daily urine is less than 500 ml

Specific gravity - osmolality
Protein
Sugar
Urobilinogen
Aceton content
Bilirubin content
Microscopic examination of the sediment

The excretion of a particular material by the kidney during 1 min

Detectable amount of protein in the urine

Detectable leucocytes in the urine

Detectable bacteria in the urine (10^5/ml or more)

Dilution and concentration capacity of the kidney: pH, excretion, phosphate, glycose reabsorption, excretion of amino acids and sodium

Red blood cells in the urine sediment

Red blood cells of different size and shape in the sediment of the urine

The process to indentify diseases

Differentiation of diseases from each other

The healthy patient pretends to be sick

Aggravating of an existing sickness - symptom

Neglecting or diminishing complaints, symptoms

Complete recovery
Partial recovery
Relapse
Death

Latency period from the beginning of the disease till the development of complaints
Morbid stage (from the appearance of signs and symptoms till their disappearance)
Recovery

Administrative part (data of the patient)
Case history
Physical examination
Laboratory data
Radiological, histological… results
Epicrisis

By the disappearance of the dullness of the liver

Location
Quality
Quantity or severity
Time-relations
The setting in which it occurs
Factors that make it better or worse
Associated symptoms

Left ventricular failure or mitral stenosis
Obstructive lung disease

Retrosternal, sometimes radiating to the shoulders, arms, neck, lower jaw (mainly left side) or epigastrial

Precordial

Chest wall overlying the process

Retrosternal, may radiate to the back

Anterior chest, radiating to the neck, back or abdomen

Upper sternal or on either side of the sternum

The visual loss involves the temporal half of each field

The visual loss in both eyes is similar (homonymous) and involves half of each field (hemianopsia)

Vertical from the midpoint of the clavicle

Vertical from the anterior axillary fold

Vertical from the inferior angle of the scapula

Low, soft, inspiratory sound, located over the lung fields away from the trachea and large bronchi

Identification of tender areas
Assessment of observed abnormalities
Further assessment of respiratory expansion
Assessment of tactile fremitus

Crackles at lung bases, sometimes wheezes

Crackles

Upper inner
Upper outer
Lower inner
Lower outer

At walking, after a certain distance, crampy pain in the legs, which disappears after rest

About the stage of venae perforantes and the permeability of the deep veins

Protein content of transsudatum is: 1-2g%, while that of exsudatum is more than 4g%

The amount of maximally expired air after a deep inspiration

Right edge of the sternum at the second intercostal space

Left edge of the sternum at the second intercostal space

Above the apex of the heart and left edge of the sternum at the IV. intercostal space

Two medioclavicular lines the subcostal line and the interspinal lines

Elevated anterior wall of the abdomen due to increased gas content of the bowels

Obesity, meteorism, ascites, pregnancy, filled urinary bladder

Congenital or acquired weakness or ruption of the abdominal wall (muscles). Due to increased intraabdominal pressure the content of the abdominal cavity (bowels, omentum maius) protrudes pushing forward the abdominal peritoneum

Mail: above the mons pubis convex border line, may grow up to the umbilicus. Female: above the mons pubis a horizontal sharp border

Superficial, medium deep, deep, bimanual and balloting

By localisation, shape, surface, consistency, mobility, tenderness. Whether it follows the breathing or not, whether it is fixed to its environment or not.

Tympanic

Right side in the medioclavicular line from the lower edge of the VI. rib till the costal margine

Vomiting blood

Digested blood in the stool (tar-like stool)

Undigested blood in the stool

Greyish-white, shiny (due to the obstruction of the biliary ducts)

Extensive vomitus

The patient lies on his right side, left arm over the head

Slight jaundice. Icterus of the sclera is detectable, concentration of bilirubin about 35 umol/l

In the right iliacal region, we divide the line between the umbilicus and the right spina iliaca anterior superior into 3 equal parts, - at the border of the lateral and medium segment

Press deeply in the left lower quadrant of the abdomen then quickly withraw your fingers pain in the right lower quadrant during left sided pressure suggests - appendicitis

In the left iliacal region, we divide the line between the umbilicus and the spina iliaca anterior superior into 3 equal parts, at the border of the lateral and the medium segment

Increase of the interstitial fluid
Generalised or local
Cardiac edema: according to the gravitation (feet, legs, sacral region)
Renal edema (periorbital - generalized)
Hypoproteinaemic edema (generalized)
Deep vein thrombosis (on the effected extremity)

With a moderately sharp object such as a key, stroke the lateral aspect of the sole from the heel to the ball of the foot, curving medially across the ball. Use the lightest stimulus that will provoke a response. Dorsalflexion of the great toe with fanning of the other toes (Babinski response) indicates upper motor neuron disease.

Are they round, symmetric, sharp edged, central? Their consensual reaction to light and convergention

Somnolence, sopor, coma

Radius, ulnar, biceps, triceps

Patella, Achilles

Vomitus, nausea, fixed occiput, bradycardy, Brudzinki,s and Kernig,s positivity

Patient lying on his back feels pain, while elevating his legs, to 90 degrees

The metacarpophalangeal articulation of the big toe

Sense of smell, vision, pupillary constriction, elevation of the upper eyelid and most of the extraocular movements respectively

137-145 mmol/l

3.5-4.5 mmol/l

3.6-6.0 mmol/l

4.8-9.0 G/l

12.0-150.0 g/l