Respiratory system.

Inspection: shape of chest (normostenic, hyperstenic, astenic); pathological (emphysematic, paralytic, funnel-shaped, kyphotic, scoliotic; is symmetric or not, expression of above- and subclavicle depressions, position of clavicles, scapulas, peculiarities of intercostals spaces, presence of local protrudes, impressions, vein dilatations. Participation of chest in breathing, falling behind of one part of chest during deep breathing, participation of additional respiratory muscles in breathing process. Type of breathing (thoracic, abdominal, mixed), frequency, depth, rhythm (rhythmical, arhythmical of Biot’s, Chein-Stoks type, big noisy Kussmaul’s type).

Palpation: resistance, pain of chest along ribs, intercostals space, feeling of wheeze, noise of pleura friction, crepitation when ribs are broken. Determination of voice trembling on symmetric areas (equal, in forces, weakened in one side), bronchophonia.

Percussion: comparative characteristics of percussion sound on symmetric areas of thorax (lung, tympanic, dull, box-like, light dull).

Topographic: height of  lungs  apex position in front and behind , inferior  borders of  lungs in right and left on parasternal , middle clavicle, anterior ,middle and posterior axillary, scapular and paravertebral lines.

Auscultation: give characteristics of special breathing noise (vesicular, bronchial, amphoric), strengthened or weakened, hard, with long exhale, interrupted .

Secondary breathing noise-dry wheeze (whistling, buzzing, scretching, small-bubbles noise, crepitation, noise of pleura friction; bronchiphonia on symmetric areas of chest.

Organs of abdominal cavity .

Inspection of abdomen’s shape (is examined in horizontal and vertical position of patient) – usual, protruded, pulled in, hypotonic, bullet-like, frog-like; is symmetric or not, participation in breathing, presence of dilated veins on anterior abdominal wall, of protrudes, peristaltic of stomach, intestines that can  be seen .

Palpation: superficial ( oriental ) – condition of anterior abdominal cavities muscles tone, local or general resistance, painful places, injury of m. rectus abdominis, presence of hernias, tumor formations.

Deep methodic sliding palpation by V.P. Obrazcov and M.D. Strazchesko- determine shape, consistence, sizes, painfulness, mobility (of sigmoid intestine, rectum, appendix, terminal part of ileum; color ascendens, descendens, transversus), position of big stomach curvature (compare to data of percussion, auscultation, determination of squelch sound, mobility, painfulness, presence of indurations), determine  the position of lower liver edge, characterize it (sharp, blunt, soft, solid, smooth, rough, painful, non painful), and characteristic of liver surface (smooth, rough); gallbladder if palpated, than sizes, painfulness; pancreas- painfulness, presence of tumor formations; spleen- if palpated, than peculiarities of lower edge, density, mobility, is rough or not, painfulness; kidney- if palpated, than size, shape, mobility, painfulness, Pasternatskiy symptom, urinary bladder - level of bottom location, painfulness.

Percussion: character of percutory sound, presence of liquid in abdominal cavity, its level, size of liver by Kurlov, sizes of spleen. Auscultation: listen the presence of intestinal sounds, sound of peritoneum friction.