CONTENTS. Chapter 1. Internal Medicine: Subject Matter, Purpose and Objectives

GENERAL PART....................................................................................................... 11

Chapter 1. Internal Medicine: Subject Matter, Purpose and Objectives......... 11

General Concepts................................................................................................ 11

Admitting Medical Students to the Clinic and Fundamentals of Medical

Deontology................................................................................................................. 17

Chapter 2. History of Diagnosis.............................................................................. 23

A Short History Survey...................................................................................... 23

The Role of Russian and Soviet Scientists in Development of Diagnosis and the

General Therapy of Internal Diseases................................................................... 27

Soviet Public Health System: A New Stage in Medicine.................................... 30

Chapter. 3. Methods of Clinical Examination of Patients and General Symptoma­
tology of Diseases of the Internal Organs............................................................. 32

Inquiry......................................................................................................................... 33

The Present Complaints................................................................................ 34

History of the Present Disease...................................................................... 35

Anamnesis Vitae............................................................................................. 35

Physical Examination................................................................................................ 40

General Inspection......................................................................................... 41

Palpation.......................................................................................................... 53

Percussion........................................................................................................ 54

Auscultation.................................................................................................... 57

Laboratory and Instrumental Methods of Examination.................................. 60

Anthropometry............................................................................................... 61

Thermometry...................................................... ........................................... 63

X-ray Study..................................................................................................... 69

Endoscopy, Biopsy, and Cytological Studies............................................ 71

Instrumental-Functional Methods of Examination................................ 72

Radioisotope Methods.................................................................................. 72

Ultrasound Echography................................................................................ 73

Laboratory Methods of Examination........................................................ 76

Chapter 4. General Methodology of Diagnosis........................................... 77

The Importance of Medical Theory for Development of Diagnostics..... 77

Planning Diagnostic Examination................................................................... 82

Special Features of Diagnostic Examination................................................ 83

Diagnostic Observation and Examination........................................................... 84

Recording Form......................................................................................................... 87

Types of Diagnosis.......................................................... ......................................... 87

Methods and Theory of Diagnosis......................................................................... 87

Prognosis..................................................................................................................... 99

SPECIAL PART......................................................................................................... Ill

Chapter 5. Respiratory System............................................................................... Ill

Methods of Examination........................................................................................ Ill

Inquiry............................................................................................................. Ill

Physical Examination................................................................................... 116

Instrumental and Laboratory Methods..................................................... 143

Main Clinical Syndromes.................................................................................. 159

Special Pathology............................................................................................... 164

Bronchitis........................................................................................................ 165

Contents

Bronchial Asthma................................................................................... 168

Acute Pneumonia.................................................................................... 171

Pulmonary Abscess................................................................................. 178

Pleurisy...................................................................................................... 181

Chronic Pneumonia................................................................................ 186

Bronchiectasis........................................................................................... 187

Emphysema of the Lungs...................................................................... 190

Chapter 6. Blood Circulatory System.......................................................... 192

Methods of Examination.................................................................................. 192

Inquiry...................................................................................................... 192

Physical Examination............................................................................ 195

Physical and Instrumental Studies of the Vessels............................. 220

Instrumental Study of the Heart.......................................................... 234

Major Clinical Syndromes................................................................................ 256

Cardiac Rhythm Disorders (Arrhythmias).......................................... 256

Circulatory Insufficiency....................................................................... 256

Special Pathology............................................................................................... 257

Rheumatism.............................................................................................. 285

Bacterial (Septic) Endocarditis............................................................. 290

Heart Valvular Diseases......................................................................... 292

Myocarditis............................................................................................... 311

Cardiomyopathy..................................................................................... 312

Pericarditis................................................................................................ 314

Essential Hypertension........................................................................... 316

Atherosclerosis......................................................................................... 319

Ischaemic Heart Disease....................................................................... 322

Angina Pectoris......................................................................................... 322

Myocardial- Infarction........................................................................... 325

Cardiosclerosis......................................................................................... 330

Chapter 7. Digestive System............................................................................ 332

Oesophagus.......................................................................................................... 332

Methods of Examination ….............................................................................. 332

Inquiry....................................................................................................... 332

Physical Examination............................................................................. 333

Laboratory and Instrumental Methods.............................................. 334

Special Pathology................................................................................................ 334

Achalasia of the Cardia......................................................................... 334

Oesophagitis............................................................................................. 335

Stomach............................................................................................................... 337

Methods of Examination.................................................................................. 337

Inquiry....................................................................................................... 337

Physical Examination............................................................................. 342

Laboratory and Instrumental Methods.............................................. 345

Special Pathology............................................................................................... 355

Gastritis...................................................................................................... 355

Peptic Ulcer Disease (Gastric and Duodenal Ulcer)........................... 358

Intestine................................................................................................................ 364

Methods of Examination.................................................................................. 364

Inquiry....................................................................................................... 364

Physical Examination............................................................................. 368

Laboratory and Instrumental Methods.............................................. 378

Major Clinical Syndromes..................................................................... 385

The Acute Abdomen............................................................................... 385

Inadequate Digestion Syndrome.......................................................... 387

Contents 9

Malabsorption Syndrome........................................................................... 389

Special Pathology.................................................................................................... 390

Acute Enterocolitis........................................................................................ 391

Chronic Enteritis....................................................................................... 391

Chronic Colitis............................................................................................... 392

Liver and Bile Ducts................................................................................................ 394

Methods of Examination.................................................................................. 394

Inquiry....................................................................................................... 394

Physical Examination............................................................................. 396

Laboratory and Instrumental Methods............................................... 406

Main Clinical Syndromes.................................................................................. 430

Jaundice..................................................................................................... 430

Portal Hypertension................................................................................. 433

Hepatolienal Syndrome............................................................................... 434

Hepatic Insufficiency and Coma......................................................... 435

Special Pathology............................................................................................... 438

Chronic Hepatitis..................................................................................... 438

Cirrhosis of the Liver............................................................................... 441

Cholelithiasis............................................................................................. 447

Cholecystitis.............................................................................................. 452

Pancreas…………………………………………………………………… 456

Methods of Examination ……………………………………………………456

Inquiry....................................................................................................... 456

Physical Examination.................................................................................. 457

Laboratory and Instrumental Methods.................................................... 458

Major Clinical Syndromes................................................................................. 463

Exocrine Pancreatic Insufficiency........................................................ 463

Special Pathology............................................................................................... 464

Pancreatitis................................................................................................... 464

Chapter 8. Urinary System................................................................................... 468

Methods of Examination....................................................................................... 468

Inquiry....................................................................................................... 468

Physical Examination............................................................................. 473

Instrumental and Laboratory Methods.................................................... 478

Main Clinical Syndromes....................................................................................... 495

Renal Oedema.......................................................................................... 495

Nephrotic Syndrome............................................................................... 498

Renal Hypertension....................................................................................... 500

Renal Eclampsia........................................................................................... 503

Renal Failure............................................................................................. 504

Special Pathology............................................................................................... 508

Diffuse Glomerulonephritis.................................................................... 508

Toxic Kidney................................................................................................. 515

Amyloidosis of the Kidney (Amyloid Kidney).................................... 515

Nephrolithiasis.......................................................................................... 517

Pyelonephritis............................................................................................ 520

Chapter 9. Diseases of the Blood.................................................................... 522

Methods of Examination.................................................................................. 522

Inquiry....................................................................................................... 522

Physical Examination................................................................................... 524

Instrumental and Laboratory Methods.................................................... 528

Special Pathology ............................................................................................... 545

Contents

Anaemia …………………………………………………………………545

Haemoblastosis........................................................................................ 559

Haemorrhagic Diathesis......................................................................... 573

Chapter 10. Endocrine System and Metabolism.......................................... 577

Methods of Examination....................................................................................... 577

Inquiry....................................................................................................... 577

Physical Examination............................................................................. 577

Laboratory Studies....................................................................................... 580

Special Pathology.................................................................................................... 583

Diffuse Toxic Goitre..................................................................................... 583

Hypothyroidism............................................................................................ 587

Diabetes Mellitus.......................................................................................... 588

Obesity............................................................................................................ 593

Vitamin Deficiency...................................................................................... 595

Chapter 11. Diseases of Bones, Muscles, and Connective Tissue. Acute Allergoses. 599

Methods of Examination........................................................................................ 599

Inquiry............................................................................................................ 599

Physical Examination................................................................................... 603

Instrumental and Laboratory Methods................................................... 605

Biopsy............................................................................................................. 609

Major Clinical Syndromes. 609

Anaphylactic Shock..................................................................................... 609

Allergic Oedema............................................................................................ 611

Special Pathology..................................................................................................... 612

Rheumatoid Arthritis.............................................................................. 612

Osteoarthrosis................................................................................................ 614

Haemorrhagic Vasculitis............................................................................. 615

Appendix................................................................................................................... 617

Developments in Laboratory Diagnosis.......................................................... 617

Normal Laboratory Findings............................................................................. 627

Name Index......................................................................................................... 633

Subject Index....................................................................................................... 636