Examination of the Patient

Before treating the patient it is necessary to make a correct diagnosis of the disease and to determine its aetiology, i.e. the causes of the disease. The examining doctor must know well the pathogenesis of any disease, i.e. the way and mechanism of its development, as well as the symptoms revealing it.

A number of different procedures is 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.

For determining a disease it is very important to know its symptoms, i.e. the signs of a disease. They are breathlessness, edema, cough, chill, vomiting, fever, haemorrhage, headache, rash, swelling 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 are subjective, since they are evident only to the patient.

Physical examination is the first objective stage in examination of a patient. It must be carried on in a large and warm consulting room with day light. The light is very important: it allows to estimate the colour of the patient’s skin, conjunctiva, oral cavity.

The scheme of the physical examination includes three stages:

- general examination;

- local examination;

- examination of body systems.

On general examination the patient is properly examined from head to toes: this helps the doctor to estimate the physical and mental state of his patient. The examiner also determines the patient’s weight and height, observes his facial expression, movements, speech, state of lymphatic nodes, muscles, bones, joints.

On local examination the doctor examines the patient’s head, eyes, nose, ears, oral cavity, neck, thyroid gland, etc. to estimate the functional state of particular parts of the body.

Examination of body systems includes the study of the respiratory, endocrine, nervous and other systems. On this stage the doctor applies the technique of palpation and percussion to determine whether the borders of internal organs are normal or abnormal. By means of auscultation the examiner can reveal rales in the lungs in case of pneumonia or bronchitis, or heart murmurs if a patient suffers from cardio-vascular diseases.

Laboratory analyses are important as well. Blood analysis revealing leukocytosis immediately indicates the presence of inflammation in the body. Urinalyses help to reveal the presence of urinary tract infections such as cystitis, nephritis or pyelonephritis. Analysis of sputum is performed to confirm the diagnosis of tuberculosis.

Instrumental procedures also help to determine health problems. Electrocardiograms are necessary to monitor the heart work. X-ray usually shows the borders and structure of the internal organs, fractures and fissures, accumulation of liquid in the lungs, etc.

So, examination of the patient is a complex procedure helping to timely reveal diseases or dysfunctions of any organs and start their treatment.

Exercise 8. Answer the questions:

1. What is it necessary to know to make a correct diagnosis?

2. What kind of procedures are used to establish a diagnosis?

3. What groups can symptoms be divided into?

4. What is the difference between the objective and subjective symptoms?

5. What does the scheme of the physical examination include?

6. What is examined during each stage of physical examination?

7. Why are laboratory analyses important?

8. What does X-ray help to reveal?

Exercise 9. Match the symptoms with their explanations:

Exercise 10. Guess what disease is described:

Model: inflammation of the lungs is pneumonia.

1. inflammation of the kidneys

2. inflammation of the lungs

3. inflammation of the urinary bladder

4. inflammation of bronchi

5. inflammation of the eye conjunctiva

6. pus accumulation around the kidneys

7. lesion in the stomach

8.infection caused by Mycobacteria

Exercise 11. Translate the following word-combinations into English:

Комплексна процедура, поставити правильний діагноз (2 синоніми), причина захворювання, походження хвороби, збирання анамнезу, проводити аналіз сечі та мокротиння, задуха та припухлість, перший етап в огляді хворого, оглядати з голови до п’ят, оцінити фізичний та психічний стан хворого, дихальна та ендокринна системи, техніка прощупування та простукування, за допомогою прослуховування, виявити хрипи у легенях, спостерігати за роботою серця.

Exercise 12. Translate the words in italics:

1. Хрипи в легенях usually appear in case of пневмонії чи бронхіту.

2. Increased leukocytosis indicates наявність запалення в організмі.

3. If a patient suffers from серцево-судинних захворювань, he may have шуми у серці.

4. Аналіз сечі helps виявити the presence of urinary tract infections such as цистит та нефрит.

5. On general examination the doctor observes the patient’s вираз обличчя, рухи, мовлення, стан лімфатичних вузлів, м’язів, суглобів.

6. The local examination includes the examination of the patient’s голови, очей, вух, носу, ротової порожнини, шиї, щитовидної залози.

7. Огляд систем організму is carried out by means of прощупування, простукування, прослуховування.

8. Examination of the patient is a комплексна процедура that helps вчасно виявити diseases.

Exercise 13. Translate the word combinations with Participle I:

Model: examining doctor – оглядаючий лікар (який? – дієприкметник)

the doctor examining the patient – лікар, що/який оглядає хворого (підрядне речення)

лікар, оглядаючи хворого… (що роблячи? – дієприслівник)

boiling water, the girl standing at the door, a running man, a picture hanging on the wall, a physician examining patients, a child waiting for his parents, a crying baby, a smiling boy, a dying person, a working person, students waiting for the professor, symptoms determining a disease.

Exercise 14. Translate the word combinations with Participle I into English:

Діти, які граються; ліки, які приносять полегшення; людина, яка спить; спостерігаючи феномен; вживаючи знеболююче; виконуючи вказівки лікаря; охолоджуючий ефект; спостерігаючи стан хворого; рана, яка кровоточить; прилад, який контролює серцеву діяльність; стомлююча робота; люди, які відвідують хворого у лікарні.

Exercise 15. Give Participle II of the following verbs:

To make, to give, to get, to tell, to know, to take, to keep, to feel, to find, to cut, to have, to be, to sleep, to put, to come, to become, to choose, to draw, to fall, to feed, to fight, to go, to leave, to meet, to rise, to say, to see, to spread, to teach, to undergo, to write.

Exercise 16. Translate the following word combinations with Participle II into Ukrainian:

Increased blood pressure, repeated analysis, received results, broken arm, prescribed medicine, dislocated shoulder, confirmed diagnosis, marked improvement, subsided fever, extracted tooth, examined patient, injured man, transfused blood.

Exercise 17. Choose the proper variant of Participle I or Participle II. Translate sentences into Ukrainian:

1. The prescribed/prescribing drug was ineffective.

2. The surgeon observed marked/marking improvement in patient’s condition.

3. Children sleeping/slept in their beds are recovering.

4. Symptoms, accompanying/accompanied flue are fever, muscular pain, vomiting.

5. The wounded/wounding arm was bandaged.

6. These drugs left/leaving in a dry, dark place are best to be used during 1 year.

7. The blood come/coming through the lungs is rich in oxygen.

8. Scarlet fever is characterized by rash covering/covered the whole trunk.

Exercise 18. Put the verbs in brackets into the correct tense form. Translate the sentences into Ukrainian:

1. The cause of the disease (to call) aetiology.

2. Yesterday the students (to learn) the pathogenesis of pneumonia.

3. Tomorrow I (to take) the ECG to monitor my heart work.

4. If blood analysis (to reveal) leukocytosis, the patient (to administer) antibiotics.

5. The medical examination (to carry) out twice a year, as a rule.

6. The stomach troubles of the patient (to determine) by vomiting.

7. In a week, students (to observe) the professor examine his patients.

8. Good day light (to allow) to estimate the colour of the patient’s skin, conjunctiva, oral cavity.

Exercise 19. Put questions to the underlined words:

1. To make a diagnosis the doctor needs the findings of blood analysis.

2. Any disease is usually revealed by its symptoms.

3. The patient was administered uninalysis to confirm cystitis.

4. Objective symptoms include haemorhage, vomiting, cough, etc.

5. She felt dizziness and nausea after taking these pills.

6. Physical examination is the first objective stage in examination of a patient.

7. By means of auscultation the examiner can reveal rales in the lungs heart murmurs.

8. The diagnosis of TB will be confirmed after analysis of sputum.

Exercise 20. Translate the sentences into English:

1. Електрокардіограма показує роботу серця.

2. Перед лікуванням лікар має ретельно обстежити хворого.

3. Шлях та механізм розвитку хвороби називається патогенез.

4. Хірург, що оглядає цього хворого, є найкращим в нашому місті.

5. Йому поставили діагноз бронхіту на основі результатів аналізу та аускультації.

6. Симптоми – це ознаки хвороби, які допомагають встановити правильний діагноз.

7. Межі внутрішніх органів можна встановити за допомогою пальпації та перкусії.

8. Фізичний огляд хворого включає три етапи: загальний та місцевий огляд, а також огляд систем організму.

Exercise 21. Arrange the following sentences in order to describe the term “symptom”:

1. They include cough, haemorrhage, vomiting, swelling, etc.

2. Subjective symptoms are the symptoms evident to the patient only.

3. Symptom is a sign of a disease.

4. They are headache, dizziness, so on. It is very important to know symptoms as they allow to determine the disease.

5. Objective symptoms are the symptoms which can be revealed by the physician during the physical examination of the patient.

6. The symptoms can be divided into two groups: objective and subjective.

Exercise 22. Discuss the physical examination of the patient following the plan:

Завдання для самостійної роботи студентів (СРС)

Exercise 1. Topic vocabulary:

Exercise 2. Read correctly:

u [ˈʝu:]: due, use, excuse, duty, usually, unit, attitude, future, computer;

u [u:]: blue, fluid, include, rule, true, fruit, cruise, juice, June;

u [ʌ]: insult, ulcer, lung, gut, gullet, buttock, cuspid, muscle, intramuscular, ultrasound;

ow [au] in mid position: down, town, gown, crowd, brown, shower + allow, now, how;

ow [ou] in end position: below, flow, grow, know, low, show, snow, throw, blow

Exercise 3. a) Form different parts of speech. Explain the meaning of affixes. Translate the pair of words into Ukrainian:

1. form nouns and verbs with the help of the prefix over-: production, heat, dosage, weight, to eat, to sleep, to react, to estimate;

2. form adjectives with the help of the prefix un-: favourable, clear, likely, conditioned, controllable, duly, safe, comfortable;

3. form adjectives with the help of the prefix intra-: muscular, venous, abdominal, hepatic, intestinal, nasal, oral;

4. form verbs with the help of the prefix re-: to write, to make, to play, to produce, to generate, to bandage, to form, to gain.