The list of questions for Propaedeutics on internal diseases examination for 3rd year students Part 1. Theoretical questions A scheme of Medical History. A general examination. 1. A scheme of Medical History. Subjective and objective methods of examination. A sequence for a patient’s interview. Life history (anamnesis vitae): components, sequence for collecting, clinical significance. 2. A general examination of a patient. Key principles and sequence for general examination. Evaluation of general condition, consciousness, and levels of their disturbances. Diagnostic relevance of condition and consciousness disorders. 3. A general examination of a patient. Key principles and sequence for general examination. Assessment of a patient’s posture. Types of patient’s posture. 4. A general examination of a patient. Key principles and sequence for general examination. Assessment of patient’s constitution and nutrition. Classification of body weight disorders by body mass index (BMI). 5. A general examination of a patient. A general examination sequence. The examination of skin, hair and nails: sequence for performing, description in medical history, its clinical significance. 6. A general examination of a patient. Key principles and sequence for general examination. Oedemas: their types, pathogenesis, and diagnostic relevance. Cardiovascular system examination 1. Common complaints and peculiarities of a general examination of a patient with cardiovascular system diseases, and their detailed description in Medical History. 2. Palpation as an objective method of a patient’s examination. An order of precordial area palpation. A cardiac impulse: its formation, features, and clinical significance of changes. 3. Palpation as an objective method of a patient’s examination. An order of precordial area palpation. An apex impulse: its formation, features, and clinical significance of changes. 4. Palpation as an objective method of a patient’s examination. An order of precordial area palpation. Palpable thrills: locations, clinical significance. 5. Palpation of an arterial pulse: definition, a procedure, its properties and clinical significance of examination findings. 6. Percussion as an objective method of a patient’s examination. Physical basics of percussion. Types of percussion. Topographic percussion of a heart: a procedure, rules, and normal location of relative and absolute cardiac dullness. Clinical significance of relative and absolute cardiac dullness shifts. 7. Auscultation as an objective method of a patient’s examination. Heart auscultation: its order and clinical significance. 8. Heart murmurs: classification, mechanism of formation, points of auscultation, clinical significance of examination findings. Characteristics of functional and organic murmurs. Respiratory system examination 1. Common complaints and peculiarities of a general examination of a patient with respiratory system diseases and their detailed description in Medical History. 2. Examination of a chest: a procedure and an order of description in Medical History. Physiological and pathological variants of a chest shape. 3. Palpation of a chest. A sequence of chest palpation. Vocal fremitus: genesis, rules for performing, and clinical significance of examination findings. 4. Percussion as an objective method of a patient’s examination. Physical basics of percussion. Types of percussion. Topographic percussion of lungs: normal values and clinical significance of changes. 5. Percussion as an objective method of a patient’s examination. Physical basics of percussion. Types of percussion. Comparative percussion of lungs: aims, rules for performing, and clinical significance of examination findings. 6. Auscultation of lungs: physiological and pathological variants of main breath sounds. The mechanism of a main breath sounds formation. Clinical significance of harsh breathing and decreased vesicular breathing. 7. Auscultation of lungs. Laryngo-tracheal breathing: mechanism of formation and points of auscultation. Causes for a bronchial and amphoric breathing formation. Additional breath sounds. Classification. Differential diagnostics of additional breath sounds. Clinical significance of examination findings. Digestive system examination 1. Common complaints and peculiarities of a general examination of a patient with gastrointestinal tract diseases and their detailed description in Medical History. 2. Common complaints of a patient with liver diseases. Peculiarities of patient’s complaints and general examination in acute and chronic liver diseases, and liver cirrhosis. 3. Symptoms, clinical and laboratory signs of bleedings from different parts of a gastrointestinal tract: oesophagus, stomach, duodenum, large intestine. Causes of gastrointestinal bleedings. 4. Differential diagnostics of examination, and laboratory tests. jaundice types by symptoms, general 5. A general examination of a patient. A sequence and key principles of general examination. Typical observations from general examination of a patient with liver cirrhosis. 6. An examination of an abdomen. Superficial palpation of an abdomen: a procedure, an order of description in Medical History. Causes of painful abdomen. 7. Palpation as an objective method of the patient’s examination. The deep palpation of the abdomen: procedure, order of description in the Medical History, and diagnostic relevance. 8. Percussion as an objective method of a patient’s examination. Physical basics of percussion. Types of percussion. Topographic percussion of a liver and a spleen: normal values and clinical significance of examination findings. Part 2. Laboratory and instrumental research methods 1. Blood tests: Full Blood Count (FBC). Indexes in analysis, reference values and diagnostic relevance. Anemia: diagnostics and anemia degrees classification by FBC. Laboratory features of iron deficiency anemia. Diagnostics of inflammation by FBC. 2. Blood tests: biochemical tests. Diagnostics of myocardial infarction by biochemical tests. Cardiac biomarkers. Kidneys’ function assessment by biochemical tests. Glomerular filtration rate (GFR): definition, methods for calculation, diagnostic relevance. 3. Sputum analyses. Types of sputum analyses and their interpretation. Typical results of sputum analyses in bronchial astma, pneumonia, acute bronchitis, chronic obstructive pulmonary disease, lung’s abscess, lung’s gangrene, tuberculosis. 4. Spirometry: indications and contraindications, a procedure, respiratory volumes and flows, its diagnostic relevance. 5. Electrocardiography (ECG): a procedure of registration, indications to perform, and diagnostic relevance of ECG changes. A main time parameters measurement of ECG. An electrical heart axis. Physiological and pathological electrical positions of a heart axis. 6. Premature heart contractions (PHC). Definition, types, and clinical symptoms of PHC. Diagnostics of PHC by electrocardiography (ECG). 7. Diagnostics of myocardial infarction with ST elevation (STEMI) by ECG: stages, location, and extent. 8. Pleural fluid analyses. Types of pleural effusion: transudate, exudate and their causes. Distinctions between transudate and exudate by analysis of pleural fluid. 9. Urinalysis. A procedure, types of analyses, indications, main parameters and diagnostic relevance. Proteinuria, hematuria, casts: types and diagnostic relevance. 10. Scatological study (stool analysis): indications, main parameters, their diagnostic relevance. Diagnostics of maldigestion, malabsorbtion and colitis by stool analysis. 11. Differential diagnostics of jaundice types by laboratory tests (full blood count, biochemical tests, urinalysis, stool analysis). Part 3. Clinical cases with syndromal diagnosis 1. Syndromes in cardiovascular system diseases: - Valvular heart disorders (mitral stenosis, mitral regurgitation, aortic stenosis, aortic regurgitation), - Arterial hypertension syndrome, - Acute coronary syndrome (incl. unstable angina, myocardial infarction), - Chronic coronary syndrome (stable angina pectoris), - Acute heart failure syndrome, - Chronic heart failure syndrome, - Acute circulatory failure syndrome. 2. - Syndromes in respiratory system diseases: Airspace consolidation syndrome (incl. pneumonic consolidation syndrome), Airflow obstruction syndrome, Emphysema syndrome, Pulmonary cavity syndrome, Pleural syndrome (incl. dry pleurisy, pleural effusion, pleural empyema, pneumothorax), - Respiratory failure syndrome. 3. Syndromes in digestive system diseases: - Dyspepsia syndrome (incl. reflux-like dyspepsia, ulcer-like dyspepsia, nonulcer dyspepsia), - Maldigestion syndrome, - Malabsorption syndrome, - Large intestine disorders syndrome (incl. organic lesions, functional disorders), - Hepatomegaly, splenomegaly, hepatosplenomegaly syndrome, - Hypersplenism syndrome, - Jaundice (icterus) syndrome, - Portal hypertension syndrome, - Ascites syndrome, - Hepatorenal syndrome, - Syndrome of “liver signs”, - Liver failure syndrome, - Hepatic encephalopathy syndrome. 4. - Syndromes in kidneys and urinary tract diseases: Urinary syndrome, Urinary tract infection syndrome, Acute nephritic syndrome, Nephrotic syndrome, Acute kidney injury syndrome, Chronic kidney disease, Renal colic. 5. - Syndromes in blood system diseases: Anemic syndrome, Blood malignancies syndromes (incl. myeloid and lymphoid origins), Bleeding disorders. Example of clinical case: A 34-year woman presented with dyspnea at rest, ankle swelling, hoarseness and dysphagia. In childhood the patient had suffered from acute tonsillitis many times, the valvular heart disease was diagnosed at the age of 14 years. On examination, her condition is grave, her posture is forced, and her skin is with blue tint of fingers and extremities. There are pitting oedema on her feet and legs. During her heart auscultation loud S1, opening snap and diastolic murmur in 1st point of auscultation, split S2 in 3rd point of auscultation, and accentuation of the S2 above the pulmonary trunk are revealed. 1. What is the most likely syndromal diagnosis? What is the most likely valvular heart disease? 2. Describe the patient’s heart percussion data. 3. Describe the patient’s pulse peculiarities. 4. Explain the pathogenesis of hoarseness (dysphonia) and dysphagia. 5. Explain the term «opening snap».