4. Urogenital system

(systema urogenitalia)

Lumbar area examination: smoothed edges, protruding, swelling in the lumbar section, dermahemia.

Kidney palpation in the patient’s lying and upright position; localization, size, pain, displaceability, Pasternatskiy symptom (on both sides); palpation along the renal ducts (detection of points of pain); palpation and percussion of the suprapubic section (bladder).

Lacteal glands: for women – level of development, scarring, fistulas, visible and palpated tumors, mastopathy; for men – gynecomasty.

Scrotum, testicles.

5. Nervous and endocrine system

(systema nervosa et endocrinica)

Patient’s personality evaluation. Maintenance of orientation in space, time and specific situations. Communication skills, consistence and accuracy of speech. Interpersonal relations, attitude towards work and difficult experiences; adaptability to changes in circumstances. Susceptibility to influence and induction. Attitude towards own sickness. Psychological and physiological trauma and conflicts. Temper, its persistence and pattern (calm, aggravated, anxious, euphoric etc.). Attention span, memory, intelligence, character pattern.

Endocrine system: thyroid gland, its swelling (with indication of degree of swelling), texture, surface, pain during palpation; thyroid dysfunction symptoms (Greffe, Moebius, Kocher, Schtelvag etc.) and other endocrine glands (obesity, trichauxis, polyuria etc.).

III. Preliminary diagnosis

Diagnostic conclusion is formed based on the analysis of complaints, case history and results of objective research (examination, palpation, percussion and auscultation). A follow-up patient examination plan is formed with indication results acquired from laboratory and instrumental research methods necessary for specification and subsequent detailed justification of diagnostic report.

Research plan:

1. Mandatory research

2. Additional research

1. ADDITIONAL RESEARCH METHODS DATA

Presentation of results acquired from laboratory and instrumental research methods and consultative conclusion.

2. Forming of final diagnosis.

Nosological principle is primary in forming of a diagnosis, according to which the diagnosis must contain the name of a specific disease determinable by a term, established classification and nomenclature.

Clinical diagnosis is formed under the following scheme:

• primary disease with indication of its form, stage, intensiveness etc.;

• complications of the primary disease;

• concommitent diseases.

Once the diagnosis has been formed and treatment has been prescribed, its adequacy is reviewed in the course of the subsequent monitoring of the run of the disease and the effectiveness of treatment. Accordingly, clinical, laboratory and instrumental data confirm, challenge or disprove the diagnosis.

IV. Treatment

Definition (stratification) of risk of the patient with cardiovascular disease.

Regime. Diet.

This section contains methods of the patient’s treatment (individualized treatment) based on the evidentiary medicine.

Presented in the following order:

1. Lifestyle modification.

2. Drug treatment.