PRACTICUM - repo.knmu.edu.uarepo.knmu.edu.ua/bitstream/123456789/16320/1/... · 4 12.Study of arterial pulse and blood pressure. Content 4. Instrumental methods of cardiovascular

KHARKIV NATIONAL MEDICAL UNIVERSITY

DEPARTMENT OF PROPEDEUTICS OF INTERNAL MEDICINE N1

PRACTICUMin Propedeutics of Internal Medicine

for 3rd year students of 6th medical faculty

Part 1:

“Main methods of the patient’s examination in internal medicine”

Student ______________________

Group ________

Teacher ______________________

_____________________________

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Practicum in Propedeutics of Internal Medicine. Part 1: “Main methods of the patient’sexamination in internal medicine”: Меthod. instr. for students / Authors. Т.V. Ashcheulova,O.N. Kovalyova, G.V. Demydenko, S.O. Shapovalova, O.A. Kochubiei, O.V. Honchar, S.V.Ivanchenko, A.V. Kozhemyaka, M.A. Vizir. – Kharkiv: KhNMU, 2017. – 63 с.

Authors: Т.V. Ashcheulova O. N. Kovalyova A.V. Demydenko O.A. Kochubiei O.V. Honchar S.V. Ivanchenko A.V. Kozhemyaka M.A. Vizir

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THEMATIC PRACTICAL CLASSES PLAN of Propedeutics to Internal Medicine

Part 1: “Main methods of the patients examination in internal diseases clinics”

Content 1. Introduction to internal medicine. Main rules of inquiry and inspection of the

patients

1. Case history scheme. Inquiry of the patient: patient’s complaints, their detailed

description, questioning on organs and systems.

2. Anamnesis morbi. Anamnesis vitae.

3. General inspection of the patients. Diagnostic significance of symptoms revealed during

patient inspection.

4. Inspection of separate body parts: head, neck, trunk, extremities.

Content 2. Physical and instrumental examination methods of the broncho-pulmonary

system

5. Main complaints and general inspection of the patients with respiratory organs pathology.

Palpation of the chest.

6. Percussion as method of physical examination of the lungs. Comparative percussion of the

lungs technique. Topographic percussion of the lungs.

7. Auscultation as method of physical examination of the lungs. Auscultation of the lungs

technique. The main respiratory sounds.

8. Auscultation of the lungs: additional respiratory sounds (rales, crepitation, pleural friction

sound). Laboratory sputum and pleural fluid analysis. Instrumental methods of respiratory

organs examination.

Content 3. Physical methods of cardiovascular system examination

9. Physical methods of cardiovascular system examination. Inquiry and general inspection of

the patients with cardiovascular pathology. Inspection and palpation of precordial area.

10. Percussion of the heart.

11. Auscultation of the heart. Normal heart sounds, reduplication of the sounds, additional

sounds (triple rhythm, gallop rhythm). Auscultation of the heart: organic and functional heart

murmurs.

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12. Study of arterial pulse and blood pressure.

Content 4. Instrumental methods of cardiovascular system examination

13. Electrocardiographic method of cardiac function examination. Technique of ECG registration

and reading.

14. ECG signs of hypertrophy of heart atriums and ventricles.

15. The main ECG syndromes of the myocardium damage (ischemia, injury, necrosis). ECG in

myocardial infarction.

16. Electrocardiographic examination of patients with automaticity and excitability function

alterations.

17. Electrocardiographic examination of patients with conductivity function alterations.

Content 5. Main examination methods of digestive organs and kidneys.

18. Inquiry and inspection of the patients with digestive organs diseases. Inspection and

superficial palpation of the abdomen.

19. Deep, sliding, methodic palpation of intestines and stomach.Deep, sliding, methodic

palpation of liver, spleen. Liver percussion.

20. Inquiry and inspection of the patients with renal diseases. Instrumental and laboratory

methods of examination of urinary system.

21. Analysis of urine

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Part 1:

“Main methods of the patients examination in internal diseases clinics”

Content 1. Introduction to internal medicine. Main rules of inquiry and inspection.

Topic 1. Case history scheme. Inquiring of the patient

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Propedeutics (Gk propos – introduction) to internal diseases is_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Diagnostics (Gk dia – through, gnosis – knowledge) is___________________________________________________________________________________________________________________________

Diagnosis is____________________________________________________________________________________________________________________________________________________________Preliminary diagnosis is based on_______________________________________________________________________________________________________________________________________________Clinical diagnosis is based on__________________________________________________________________________________________________________________________________________________Final diagnosis is based on____________________________________________________________________________________________________________________________________________________

Diagnosis has the following structure:1. ______________________________________________________________________2. ______________________________________________________________________3. ______________________________________________________________________

Symptom___________________________________________________________________________Subjective and objective symptoms are differentiated.

Subjective symptoms are those that_____________________________________________________________________________________________________________________________________________Objective symptoms are those that______________________________________________________________________________________________________________________________________________

The symptoms are divided into pathological symptoms (pain, elevated temperature) andcompensatory symptoms (tachycardia, tachypnoea, hypertrophy).

According significance symptoms can be ______________________________________________. According to time symptoms are _____________________________________________________According to prognosis symptoms are _________________________________________________.

Syndrome is defined as_________________________________________________________________________________________________________________________________________________Symptomocomlex is defined as____________________________________________________

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_____________________________________________________________________________________

CASE HISTORYA. SUBJECTIVE EXAMINATION1) __________________________________________________________________________________2) __________________________________________________________________________________3) __________________________________________________________________________________4) __________________________________________________________________________________5) __________________________________________________________________________________6) __________________________________________________________________________________B. OBJECTIVE EXAMINATION1) ___________________________________________________________________________________2) ___________________________________________________________________________________3) ___________________________________________________________________________________4) ___________________________________________________________________________________5) ___________________________________________________________________________________C. BACKGROUND FOR THE PRELIMINARY DIAGNOSISD. PATIENT’S ADDITIONAL EXAMINATION PLAN AND ANALYSIS RESULTSE. BACKGROUND AND STATEMENT OF CLINICAL DIAGNOSIS

Passport part 1. ______________________________________________________2. ______________________________________________________3. ______________________________________________________4. ______________________________________________________5. ______________________________________________________6. ______________________________________________________7. ______________________________________________________

Patient’s present complains

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Questions about general condition

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Questions on organs and systems

1. CENTRAL NERVOUS SYSTEM_______________________________________________________________________________________________________________________________________________________

2. RESPIRATORY SYSTEM________________________________________________________________________________________________________________________________________________________

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Questions on organs and systems

3. CENTRAL NERVOUS SYSTEM____________________________________________________________________________________________________________________________________________

4. RESPIRATORY SYSTEM________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

3. CARDIOVASCULAR SYSTEM__________________________________________________________________________________________________________________________________________________________________________________________________________________

4. DIGESTIVE SYSTEM__________________________________________________________________________________________________________________________________________________________________________________________________________________

5. URINARY SYSTEM____________________________________________________________________________________________________________________________________________

8. LOCOMOTOR SYSTEM____________________________________________________________________________________________________________________________________________

Topic 2. Anamnesis morbi. Anamnesis vitae.

Anamnesis morbi

1. _______________________________________________________________________________________________________________________________________________________________________________________________________________________

2. _______________________________________________________________________________________________________________________________________________________________________________________________________________________

3. _______________________________________________________________________________________________________________________________________________________________________________________________________________________

4. _______________________________________________________________________________________________________________________________________________________________________________________________________________________

Anamnesis vitae

1) _____________________________________________________________________________________________________________________________________________________________________________________________________________________________

2) _____________________________________________________________________________________________________________________________________________________________________________________________________________________________

3) ____________________________________________________________________________________________________________________________________________________________________________________________________________________________

4) _____________________________________________________________________________________________________________________________________________________________________________________________________________________________

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Topic 3-4.General inspection of the patients.

GENERAL INSPECTION

Status praesens is:__________________________________________________________________________________________________________________________The criteria of patient’s condition are ________________________________________________________________________________________________________________________________________________________________________________Good patient’s condition is characterized______________________________________________________________________________________________________________________________________________________________________________Satisfactory patient’s condition (status morboacili) is characterized:__________________________________________________________________________________________________________________________________________________________Moderate condition (status ingravescens) is characterized:________________________________________________________________________________________________________________________________________________________________Severe condition (status morbogravi) is characterized:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Extremely Severe condition (status gravissimus) is characterized:________________________________________________________________________________________________________________________________________________________________________________________________________________________________Consciousness (sensorium) may be:________________________________________The deranged consciousness is divided into____________________________________________________________________________________________________________________________________________________________________________Possible causes of deranged consciousness are:___________________________________________________________________________________________________The forms of excited consciousness:________________________________________Twilight state is characterized:__________________________________________________________________________________________________________________Delirium is characterized:______________________________________________________________________________________________________________________The forms of excited consciousness are:__________________________________________________________________________________________________________Complete the following table:

The forms of depressed consciousnessForms Definition State

Cloudiness

Stupor

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GENERAL INSPECTION

Sopor

Coma

What kinds of coma do you know? Give examples.____________________________________________________________________________________________________________________________________________________________________

Define and mark the type of forced posture for each patient

______________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________

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______________________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________

GENERAL INSPECTION

Gait. Gait is________________________________________________________________________________________________________________________________Spastic gait is characterized:________________________________________________________________________________________________________________________________________________________________________________________Paretic gait is characterized:_______________________________________________________________________________________________________________________________________________________________________________________Hemiplegic/circumductive gait is characterized:____________________________________________________________________________________________________Doll’s/puppet gait is characterized:___________________________________________________________________________________________________________________________________________________________________________________Peroneal gait is characterized:_______________________________________________________________________________________________________________________________________________________________________________________Cerebellar gait (wobbly/tottering/reeling gait) is characterized:_________________________________________________________________________________________Describe the face in patients with diseases of respiratory system:_________________facies pneumonica___________________________________________________________________________________________________________________________facies tuberculous___________________________________________________________________________________________________________________________facies asthmatica____________________________________________________________________________________________________________________________facies adenoidea_______________________________________________________

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GENERAL INSPECTION

_____________________________________________________________________Describe the face in patients with diseases of cardiovascular system:______________facies aortale__________________________________________________________facies mitrale_________________________________________________________________________________________________________________________facies Corvisari_____________________________________________________________________________________________________________________________facies plethorica_____________________________________________________________________________________________________________________________Describe the face in patients with endocrine disorders:__________________________facies acromegalica____________________________________________________________________________________________________________________facies in patients with Cushing’s syndrome__________________________________________________________________________________________________facies myxoedemica___________________________________________________________________________________________________________________facies basedovica____________________________________________________________________________________________________________________Describe the face in patients with diseases of kidney:___________________________facies nefritica______________________________________________________________________________________________________________________________Describe the face in patients with diseases of digestive system:__________________facies Hyppocratica_______________________________________________________________________________________________________________________________________________________________________________________________Describe the face in patients with diseases of nervous system:___________________facies amimica________________________________________________________risus sardonicus_____________________________________________________________________________________________________________________________facies asymmetrica_____________________________________________________Describe the face in patients with infectious disease:___________________________facies fibrilis________________________________________________________________________________________________________________________________facies in patients with parotitis:_________________________________________________________________________________________________________________Describe the face in patients with diseases of blood system:_____________________facies anemic_______________________________________________________________________________________________________________________________facies as a “wax-doll”____________________________________________________

Define and mark a facies in patients with different diseases

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GENERAL INSPECTION

____________________________________________________________________________________________________________________________Color of the skin. Give examples of diseases which are characterized by the followingchanges in skin color:Pale color of the skin (cutis pallida)___________________________________________________________________________________________________________________________________________________________________________________Red color of the skin (cutis rubra, erythema)______________________________________________________________________________________________________Cyanosis (cutis cyanotica)_____________________________________________________________________________________________________________________Yellow skin and mucosa (cutis icterica, s. icterus)___________________________________________________________________________________________________Brown or bronze skin__________________________________________________________________________________________________________________Eruption of the skin. Herpetic lesions (herpes) is_______________________________________________________________________________________________________________________________________________________________________Hemorrhage lesions are of different forms:___________________________________Hematoma is_______________________________________________________________________________________________________________________________Erythema_____________________________________________________________Teleangioectasia is__________________________________________________________________________________________________________________________Ulcer (ulcus) is______________________________________________________________________________________________________________________________Abscess is_________________________________________________________________________________________________________________________________Scars is___________________________________________________________________________________________________________________________________Turgor and elasticity of the skin.Turgor (turgor) of the tissue depends on__________________________________________________________________________________________________________

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GENERAL INSPECTION

_____________________________________________________________________Moisture of skin: the reasons of alteration (dryness / swetness)____________________________________________________________________________________The skin derivates. The following pathological changes of nails are of great diagnosticmeaning:_____________________________________________________________Nails in a form of “watch glass” are characterized___________________________________________________________________________________________________Hair. Abnormally excessive hair growth may be present:_____________________________________________________________________Deficient hair growth is characteristic of:__________________________________________________________________________________________________________Subcutaneous fat. Where to measure:__________________________________________________________________________________________________________In normosthenic person thickness of skinfold_________________________________Ginoid type of obesity is characterized___________________________________________________________________________________________________________Android type of obesity is characterized__________________________________________________________________________________________________________Edema. According to the pathogenic and location factors, edema may be:_______________________________________________________________________________The main reasons of general edema are:_________________________________________________________________________________________________________General edema is characterized:________________________________________________________________________________________________________________The main reasons of local edema are:____________________________________________________________________________________________________________

Identify and write the possible cause of edema in pictures

__________________________________________________________________________________________________________________________________________

_____________________________________________________________________

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_____________________________________________________________________Lymph nodes. Groups of regional lymph nodes include:_____________________________________________________________________________________________The examination of lymph nodes in definite order:______________________________________________________________________________________________________________________________________________________________________The main causes of enlargement of the lymph nodes:________________________________________________________________________________________

Diagnostic meaning of enlarged lymph nodes localization.

Localization DiseasesOccipital

Submandibular

Axillary

Inguinal

Cubital (local)

Thyroid gland. Inspection_______________________________________________Palpation__________________________________________________________________________________________________________________________________Muscular system. _____________________________________________________Development__________________________________________________________sex and age correspondence_____________________________________________tenderness____________________________________________________________muscular tone_________________________________________________________Muscular dystrophy is_______________________________________________________________________________________________________________________Causes of muscular weakness are______________________________________________________________________________________________________________Cramps (spasmus) is_________________________________________________________________________________________________________________________Paralysis is________________________________________________________________________________________________________________________________Bones and joints system. Symmetry of joints, shape; Configuration (normal, deformed, edema);Hyperemia of skin and local hyperthermia; Movements (active, passive, free or limited); Palpable tenderness related to passive movements (indicate joints);Crackles, fluctuation._________________________________________________________________________________________________________________________________

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GENERAL INSPECTION

Content 2. Physical and instrumental examination methods of the broncho-pulmonarysystem Topic 5-8.

Inquiring___________________________________________________________________The main complaints of the patients with disease of the respiratory system are: ______________________________________________________________________________________________________________________________________Additional complaints: _______________________________________________________________________________________________________________________________________________________________________________________Dyspnoea: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Conditions causing dyspnoea classified by rate of onset№ Categories Causes 1. Dramatically sudden: over

minutes

2. Acute:over hours

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3. Subacute:over weeks

4. Chronic:over month or years

5. Intermittent:Episodic breathlessness

Cough_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Haemoptysis__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Chest pain____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

INSPECTIONOF THE CHEST

Position of the patient: ______________________________________________________________________________________________________________________________________________________________________________________Sputum analysis:

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________________________________________________________________________________________________________________________Complete the anatomy points of the chest wall. Anterior view

Complete the anatomy points of the chest wall. Posterior view

Write down topographical lines:Anterioir surface: 1

2

3

4

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Lateral surface:1

2

3


Posterior surface:1

2

3

Point apex of the lung and lobes

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Write down regions: ______________ region – above clavicles;

_______________region – below clavicle;

______________ region – above scapulae;

_________ region – between the scapulae;

_____ _________ region – below scapular;

____________________the lowerst points;

________________________ lungs fields.

Static inspection

Static inspection includes:____________________________________________________________________________________________________________________________________________________________________________________The shape of the chest is described in that order:____________________________1._________________________________________________________________2. ________________________________________________________________3. ________________________________________________________________4. ________________________________________________________________5. ________________________________________________________________6.

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________________________________________________________________7.

Physiological shapes of the chest: 1________________________________________________________________________________________________________________________________________________________________________________________________________2______________________________________________________________________________________________

_______________________________________ 3_____________________________________________________________________________________________________________________________________________________________________________________________________Pathological shapes of the chest __________________________________________________________________________________________________________

Static inspection

Name and describe the shapes of the chest____________________________________

___________________________________________________________________________________________________________________________________________________________________________________

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__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Types of spine deformities are distinguished:Scoliosis – _________________________________________________________.Kyphosis – _________________________________________________________.Lordosis – _________________________________________________________.Kyphoscoliosis – ___________________________________________________._________________________________________________________________________________________________________________________________________________________________________________________________________The symmetry of the chest. ________________________________________________________________________________________________________________Enlarged volume of one half of the chest ____________________________________________________________________________________________________________

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__________________________Decreased volume of the one part of the chest ______________________________________________________________________________________________________________________________________

Dynamic inspection of the chest

Dynamic inspection of the chest

Dynamic inspection includes____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Types of respiration: _____________________________________________________________________________________________________________________Normal breathing rate:____________________________________________________________________________________________________________________Specify the breathing type______________________________________________

__________________________________________________________________

__________________________________________________________________

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PALPATION OF THE CHEST

PERCUSSION OF THE LUNGS

Describe type of breathing and pathological state, when it observed

_________________________________________________________________________________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________________________________________________________________________________________

___________________________________________________________________

PALPATION OF THE CHESTPalpation of the chest has four potential uses:

1. ______________________________________________________;

2. ______________________________________________________;

3. ______________________________________________________;

4. ______________________________________________________.

Vocal fremitus is increased____________________________________________

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PERCUSSION OF THE LUNGS

______________________________________________________________________________________________________________________________________Vocal fremitus is decreased______________________________________________________________________________________________________________Vocal fremitus can be absent_____________________________________________________________________________________________________________

PERCUSSION OF THE LUNGSThe task of comparative percussion is _______________________________________________________________________________________________________Numerate the order of comparative percussion in anterior, lateral, posterior view.

Anterior view Posterior view Lateral view

Comparative percussion helps to determine whether theunderlying tissues are air-filled, fluid-filled, or solid. The commoncause of percussion changes include: ______________________________________________________

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______________________________________________________________________________________________________________________________________________________________________________________________________________________

Characteristics of the percussion soundsSound Relative

intensityRelative

pitchRelativeduration

Examplelocation

Pathologicalexamples

Clearpulmonary(resonance)

Loud Low LongNormallungs

---

Intermediate

Higher

Bandbox(hyper-resonance)

Longer

Dullness Soft (Medium)

High (Medium)

Tympany

Metallic

Cracked-pot

Intermediate pulmonary sound causes include:1. ________________________________________

__________________;2. ________________________________________

__________________;3. ________________________________________

__________________;4. ________________________________________

__________________;5. ________________________________________

__________________;Dullness appear when solid tissue replaces air-containing lungs inconditions as:

1. ____________________________________________________________;

2. ____________________________________________________________;

3. ____________________________________________________________;

4. ____________________________________________________________.Bandbox sound____________________________________________________.

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Tympany suggests __________________________________________________

Topographic percussion of the lungs: _____________________________________________________

_______; _____________________________________________________

_______; _____________________________________________________

_______.Lower borders of the lungs in normosthenic persons.

Topographic lines Right lung Left lungParasternal Midclavicular Anterior axillaryMidaxillary 8th interspacePosterior axillaryScapular Paraspinal

AUSCULTATION OF THE LUNGS

AUSCULTATION OF THE LUNGSAuscultation includes:

1.

____________________________________________________________;2.

____________________________________________________________.

Lung sounds

Main respiratory (breath) sounds Adventitious (added) sounds

Specify the type of breathing and its changes.

Pathologically decreased vesicular breathing observes in:I. abnormal generation of breath sounds occurs in:

______________________________________________________

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____________________________________________________________________________________________________________

__________________________________II. abnormal transmission of breath sounds results

from:

______________________________________________________________________________________________________________________________________

Pathologically increased vesicular breathingoccurs______________________

__________________________________________________________________

Specify the breathing and conditions when it observed ____________________________________________________________________________________________________________________________________________________________________________________________________________________

Specify the breathing, points of auscultation, origin ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Pathological bronchial breathing is observed in consolidation of the pulmonary tissue in:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________;in formation of an empty cavity in the lung communicated with alarge bronchus:_________________________________________________________________________________________________________________________________________________________________________________________________________Amphoric respiration is heard in the presence

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of_________________________________________________________________________________________________________________________________________________________________Bronchovesicular or mixed breathing___________________________________ __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Sound Duration Intensity ofthe

expiratorysound

Pitch ofthe

expiratory sound

Examplelocation

Pathologicexample

Vesicular

Inspiratory soundslastlongerthanexpiratory one

Soft Low

Over mostof bothlungs

Decreased

vesicular

Increased

vesicular

Cogwheel

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SPUTUM ANALYSIS

Bronchial

Broncho-vesicular

Adventitious (added) sounds are:____________________________________________________________________________________________________________________________________________________________________________Differential diagnosis of adventitious sounds

Signs ……..rales ……..rales Crepitation

Relation to therespiratory

phases

Best heardduring expiration

Change duringcough

Pressure withthe stethoscope

Without changes

Breathing movement with close nose and mouth

Absent

SPUTUM ANALYSISClinical sputum analysis includes: _________________________________________________________________________________________________________In macroscopic study assessed __________________________________________

Sputum revealed in macroscopic examination

Character

Consistency

Color Odor Layerness

Disease

Mucous Glass-like

Muco-purulent

Odorless

Puro-mucous Purulent

Mucous Absent

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bloody

Muco-purulentbloodyBloody Liquid,

foamyOdorless Absent Pulmonary

hemorrhage: in tuberculosis, wounds, lung tumor

Serous Transpa-rentyellowish

Odorless

Absent Pulmonary edema

Sputum elements in microscopic study

Cellular elements Fibrous elements Crystal elements

Bacterioscopic study______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Disease Sputumamount

Sputumcharacter

Macroscopic study

Microscopic study

Acutebronchitis

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STUDY OF THE PLEURAL FLUID

STUDY OF THE PLEURAL FLUID

Chronicbronchitis

Various Leucocytes – large amount; erythrocytes, macrophages

Bronchi-ectasis

Bronchialasthma

Mucous

Lobarpneumoni

a

Fibrin clots, changed blood

Pulmonary abscess

Pulmonary

tuberculosis

Broncho-pulmonary tumor

STUDY OF THE PLEURAL FLUIDMacroscopic

study:______________________________________________________________________________________________

______________________________________________________________

_____________Character. _____________________________________________________________________________________________________________________________Transudates____________________________________________________________________________________________________________________________Exudates_______________________________________________________________________________________________________________________________Transparency__________________________________________

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________________________________________________________________________________Color____________________________________________________________________________________________________________________________________________________________________________________________________Consistency______________________________________________________________________________________________________________________________________________________________________________________________

Odor__________________________________________________________________________________________________________________________________Relative density________________________________________________________________________________________________________________________

Chemical study Protein level____________________________________________________________________________________________________________________________Rivalt’s reaction_______________________________________________________________________________________________________________________Lucaerini test._________________________________________________________________________________________________________________________

Microscopic studyErythrocytes______________________________________________________

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_____________________________________________________________________Leucocytes___________________________________________________________________________________________________________________________Mesothelium cells______________________________________________________________________________________________________________________Tumor cells.__________________________________________________________________________________________________________________________

Cytology Neutrophils____________________________________________________________________________________________________________________________Lymphocytes__________________________________________________________________________________________________________________________Eosinophils___________________________________________________________________________________________________________________________Macrophages__________________________________________________________________________________________________________________________Mesothelial cells______________________________________________________________________________________________________________________Malignant cells.________________________________________________________________________________________________________________________

Bacterioscopic studyTransudates______________________________________________________

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_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Exudates_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Content 3. Physical methods of cardiovascular system examination. Topic 9-12.

INQUIRY The main complaints of the patients with cardiovascular pathology are:____________________________________________________________________________________________________________________________________________________________________________________________________________________Additional complaints: _______________________________________________________________________________________________________________________________________________________________________________________Pain in the heart region___________________________________________________________________________________________________________________Typical anginal pain:______________________________________________________________________________________________________________________Atypical anginal pain:_____________________________________________________________________________________________________________________Non-anginal pain:________________________________________________________________________________________________________________________Intermissions____________________________________________________________________________________________________________________________Palpitation______________________________________________________________________________________________________________________________Dyspnea_______________________________________________________________________________________________________________________________Asphyxia_______________________________________________________________________________________________________________________________Cough______________________________________________________________

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___________________________________________________________________Hemoptysis_____________________________________________________________________________________________________________________________Edema________________________________________________________________________________________________________________________________Syncope_______________________________________________________________________________________________________________________________

GENERAL INSPECTION

Position of the patient:______________________________________________________________________________________________________________________________________________________________________________________Coloration of the skin:___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Specific signs:________________________________________________________Facies mitrale___________________________________________________________________________________________________________________________Facies Corvisarti:________________________________________________________________________________________________________________________Stokes’ collar:___________________________________________________________________________________________________________________________

Edema________________________________________________________________________________________________________________________________

Cardiac edema Renal edemaTypical location

Palpatory characteristicsSkin in edematous areaTime of appearence

INSPECTION OF PRECORDIAL REGION

Cardiac hump___________________________________________________________________________________________________________________________Cardiac beat____________________________________________________________________________________________________________________________Apex beat______________________________________________________________________________________________________________________________Visible pathological pulsations_________________________________________________________________________________________________________________________________________________________________________________

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___________________________________________________________________

PALPATION OF PRECORDIAL REGION

Apex beat______________________________________________________________________________________________________________________________

1 - left midclavicular line; 2 – left anterior axillary line; 3 – line of displacement.Sign the variants of AB location and describe their diagnostical significance:A:____________________________________________________________________________________________________________________________________B:__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________C:__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________D:_______________________________________________________________________________________________________________________________________________________________________________________________________ Area of the AB: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Height of the AB: ________________________________________________________________________________________________________________________

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______________________________________________________________________________________________________________________________________Strength of the AB: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Cat’s purr symptom: ___________________________________________________

Systolic DiastolicApex of the heart

2nd right intercostal space

2nd left intercostal space

Lower right sternal edge

PERCUSSION OF THE HEART

Mark the areas of different percussion sounds:1 - ___________________________________________________________________2 - ___________________________________________________________________3 - ___________________________________________________________________

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RELATIVE CARDIAC DULLNESS

Fill in the normal borders position:

Dislocation of relative cardiac dullness borders:To the right: ________________________________________________________________________________________________________________________________________________________________________________________________________To the right and upward: _________________________________________________________________________________________________________________________________________________________________________________________________________To the right and upward: ________________________________________________________________________________________________________________________________________________________________________________________________________To the left: ________________________________________________________________________________________________________________________________________________________________________________________________To the left and downward: _________________________________________________________________________________________________________________________________________________________________________________________________________To all sides: _________________________________________________________________________________________________________________________________________________________________________________________________________

Mark the structures forming the cardiac contour:1 - ______________________________2 - ______________________________3 - ______________________________4 - ______________________________5 - ______________________________6 - ______________________________7 - ______________________________8 - ______________________________

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Waist of the heart: ______________________________________________________________________________________________________________________________________Sign the variants of cardiac contour and their diagnostical significance:

_________________________________________________________________________________________________________________________________________________________________________________________________________

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HEART SOUNDS

Sign the components of normal heart sounds:

Sign the heart valves projections and points of optimal auscultation:1 - ________________________ ________________________2 - ________________________ ________________________3 - ________________________ ________________________4 - ________________________ ________________________5 - ________________________ ________________________

1 - __________________________2 - __________________________3 - __________________________4 - __________________________5 - __________________________6 - __________________________7 - __________________________8 - __________________________

1 - __________________________2 - __________________________3 - __________________________4 - __________________________

S1

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HEART MURMURS

Sign the components of auscultation patterns with additional heart sounds and their diagnostical significance:

____________________________ _______________________________

____________________________ _______________________________

S2

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Mark the variants of heart murmurs in relation to cardiac cycle:

____________________________________________________________________________________________

____________________________________________________________________________________________

Sign the diastolic significance of main variants of cardiac murmurs:

Auscultatoryareas

Murmur Heart valvular disease

Heart apex

Systolic

Diastolic

________________________

________________________

Second intercostal space at the right sternal edge

Systolic

Diastolic

________________________

________________________

Second intercostal space at the left sternal edge

Systolic

Diastolic

________________________

________________________

Base of the xiphoid

Systolic

Diastolic

________________________

________________________

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ARTERIAL PULSE

Fill in the table – define the charachteristics that are evaluated during arterial pulse study, describe the normal findings and possible pathology:

Examinationsequence

Factors thatcause pulse

characteristicsNorm Pathology

Symmetry

Rhythm

Rate (PR)

Relation between PR and HR

Tension

Volume

Size

Speed

Shape

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BLOOD PRESSURE

Describe the technique of blood pressure measurement, mark (with the arrows) the points of SBP and DBP detection ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Finish the classification of blood pressure according to WHO (fill in the table):

Level of blood pressure SBP (mmHg) DBP (mmHg)

< 120 < 80

< 130 < 85

130-139 85-89

Hypertension:

I grade (________________________________)

Subgroup: _____________________________

II grade (_______________________________)

III grade (______________________________)

_______________________________________

Subgroup: _____________________________

140-159

140-149

160-179

≥ 180

≥ 140

140-149

90-99

90-94

100-109

≥110

≤ 90

< 90

Content 4. Instrumental methods of cardiovascular system examination. ECG. Topic 13-17.

ECG is___________________________________________________________________________________________________________________________________________________________________________________________________Fillthe parts of the conduction pathways by numbers

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1_________________________________________________2_________________________________________________3_________________________________________________4________________________________________________5____________________________________________________________________________6______________________________________________________________________________________________________________________________Automacity_________________________________________________________________________________________________________________________________________________Conductivity___________________________________________________________________Refractoriness ________________________________________________________________________________Depolarization____________________________________________________________________________________________________________Repolarization____________________________________________________________________________________________________________

ECG Registration 12 leads:3______________________________________________________________________________________________3______________________________________________________________________________________________6_____________________________________________________________________________________________________________________________________________

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________________________________________V1__________________________________________________________________________________V2_____________________________________________________________________________________V3_____________________________________________________________________________________V4_______________________________________________________________________________V5______________________________________________________________________V6______________________________________________________________________________________________________________________________________________________________________________________________________________________Normal ECG

_________Right leads______________________________Left leads_______________________________________________________________________________________________________________________________________________________________________________________________________________________

Speed of ECG recording______________________________________________

Specify the ESC recording speed________________________________________

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___________50 mm/sec________25 mm/secECG

Wright down all the waves, intervals, segments on ECG

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________________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________________________

P wave

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

PQ segment -______________________________

______________________________________________________________________________________PQ interval_________________________________________________________________________________________________________________________________________________________________

QRS complex -_______________________________________________________________________________________________________________QRSinterval________________________________________________________________________

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__________________________________________________________________________________

STsegment_______________________________

____________________________________________________________________________________________________________________________________________________________________________________________________________

Twave__________________________________

____________________________________________________________________________________________________________________________________________________________________________________________________________

Interpretation of the ECG1.___________________________________________________________________________2. ___________________________________________________________________________3. ___________________________________________________________________________4.___________________________________________________________________________5.___________________________________________________________________________6.___________________________________________________________________________7.___________________________________________________________________________8.___________________________________________________________________________

Determine regularity of the rhythm

_____________________________________________________________________________

Sinus rhythm criteria

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_______________________________________________________________________________________________________________________________________Nonsinus rhythm (possible types)_-_____________________________________________________________________________________________________________________________Measurement of the ECG Amplitude (voltage)____________________________________________________________________________________________________________________

Determine the amplitude._left________________________right_______________________Specify electrical axis of the hearta)_______________________b)________________________c)______________________

P-mitrale-___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

P-pulmonale-_______________________________________________________________________________

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__________________________________________________________________________________________________________________________________________

P-cardiale-_______________________________________________________________________________________________________________________________________________Common signs of ventricular hypertrophy_________________________________________________________________________________________________________________________________________________________Left Ventricular Hypertrophy

LV Hypertrophy criteria_________________________________________________________________________________________________________________________________________________________________________________________________________________Right Ventricular Hypertrophy

RV Hypertrophy criteria_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Coronary Artery DiseaseStages of MI: ischemia, injury, necrosisMyocardial infarction: what, when, where

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Ischemiasigns________________________________________________________________Injurysigns___________________________________________________________________Necrosissigns_________________________________________________________________Stages of the myocardial infarction:Acute________________________________________________________________Evolutionary__________________________________________________________Recovery_____________________________________________________________Stabilized_____________________________________________________________Location of the myocardial infarction:Anterior______________________________________________________________Septal________________________________________________________________Posterior_____________________________________________________________Apical________________________________________________________________Lateral_______________________________________________________________Diafragmal____________________________________________________________

Cardiac ArrhythmiasNormal Sinus Rhythm Cardiac Arrhythmias

1. The SA node is pacemaker. Heartrate: _______beats per minute.

1.

2. Regular cardiac rhythm: 2. ____________ cardiac rhythm: the R-R intervals ________________________

3. The P waves originate from 3. The P waves originate from

4. The relationship of the P wave andthe QRS complex:

4.

5. The conduction to the ventricles is1:1 (equal amount).

5.

6. Constant and normal duration ofP_________________________________________

6.

Abnormalities of the Impulse Formation

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A. Altered Automaticity of the Sinoatrial Node (NomotopicArrhythmias).

• 1.__________________________________________________________________

• 2.__________________________________________________________________

• 3.__________________________________________________________________

• 4.__________________________________________________________________

B. Increased Automaticity of an Ectopic Pacemaker• 1._____________________________________________________

_____________• 2._____________________________________________________

_____________• 3._____________________________________________________

_____________• 4._____________________________________________________

_____________C. Ectopic (heterotopic) Arrhythmias caused by increasedexcitability of the myocardium

• __________________________________________________________________• __________________________________________________________________• __________________________________________________________________

II. Abnormalities of Conduction• 1._____________________________________________________

___________• 2._____________________________________________________

___________• 3.

_______________________________________________________________• 4.

_______________________________________________________________:• ________________________________________

______________• ________________________________________

______________

Altered Automaticity of the Sinoatrial Node (NomotopicArrhythmias)Sinus Tachycardia

• 1.________________________________________________________________________

• 2.________________________________________________________________________

• 3._______________________________________________________________________

• 4._______________________________________________________________________

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Sinus Bradycardia

• 1.________________________________________________________________________

• 2.________________________________________________________________________

• 3._______________________________________________________________________

• 4._______________________________________________________________________

Sinus Arrhythmia

• 1.________________________________________________________________________

• 2.________________________________________________________________________

• 3._______________________________________________________________________

• 4._______________________________________________________________________

Sick Sinus Syndrome• 1._____________________________________________________

___________________• 2._____________________________________________________

___________________• 3.

_______________________________________________________________________• 4.

_______________________________________________________________________

Increased Automaticity of an Ectopic PacemakerAtrial Rhythm• 1._____________________________________________________

___________________• 2._____________________________________________________

___________________• 3.

_______________________________________________________________________• 4.

____________________________________________________________________________________________________________________________________________________

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Junctional (AV) Rhythm

• 1.________________________________________________________________________

• 2.________________________________________________________________________

• 3._______________________________________________________________________

• 4._______________________________________________________________________

_____________________________________________________________________________Ventricular or Idioventricular Rhythm

• 1.________________________________________________________________________

• 2.________________________________________________________________________

• 3._______________________________________________________________________

• 4._______________________________________________________________________

_____________________________________________________________________________Wandering Pacemaker• 1._____________________________________________________

___________________• 2._____________________________________________________

___________________• 3.

_______________________________________________________________________• 4.

_______________________________________________________________________

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Ectopic (heterotopic) Arrhythmias caused by increasedexcitability of the myocardium

Re-entry mechanism________________________________________

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Premature Atrial Contraction______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Junctional Premature Contractions_____________________________________

____________________________________________________________________________________________________________________________________________________Ventricular Premature Contractions____________________________________

________________________________________________________________________________________________________________________________________________

Unifocal PVC__________________________________________________________________________________________________________________________________________________________Multifocal PVC__________________________________________________________________________________________________________________________________________________________Ventricular bigeminy_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________Ventricular Trigeminy_____________________________________________________________________________

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__________________________________________________________________________________________________________________________________________________________Group Ventricular Premature Contractions_______________________________________________________________________________________________________________________

-_________________________________________________________________________________________________________________________________________________________________________________________________________________

Paroxysmal Tachycardia1____________________________________________________________________________2____________________________________________________________________________3____________________________________________________________________________Write down what kind of paroxysmal tachycardia is that&_____________________________________________________________________________

Ventricular Flutter and Fibrillation

1___________________________________2___________________________________3_______________________________________________________________________Atrial Flutter1____________________________________________________________________________2____________________________________________________________________________3____________________________________________________________________________

Atrial fibrillation1____________________________________________________________________________2____________________________________________________________________________3____________________________________________________________________________

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Abnormalities of the Impulse ConductionHeart block________________________________________________________________________________________________________________________________________________________Incomplete block________________________________________________________________________________________________________________________________________________________Complete heart block________________________________________________________________________________________________________________________________________________________Sinoatrial Block

________________________________________________________________________________________________________________________________________________________Atrioventricular Block________________________________________________________________________________________________________________________________________________________The First-Degree AV Block _____________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________________________________

Second-Degree AV Block________________________________________________________________________________________________________________________________________________________Mobitz (Wenchenbach) typeI.__________________________________________________

____________________________________________________________________________________________________________________________________________________________

Mobitz type II_______________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________________________________

Type III second-degree AV block or incomplete AV

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block______________________________________________________________

_____________________________________________________________________________________________________________________________

Third-Degree AV block or complete AVblock_____________________________________

__________________________________________________________________________________________________________________________________________________________________________________________Bundle-branch block

_______________________________________________________________________________________________________________________________ Right BBBLeft BBB___________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Find outRight BBBAndLeft BBB←

Differences between Bundle branch block and ventricular rhythm________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Ventricular PreexcitationSyndromes_____________________________________________ECG signs of CLC syndrome____________________________________________________________________________________________________________________________________________________ECG signs of WPW syndrome____________________________________________________________________________________________________________________________________________________The long QT-syndrome__________________________________________________________________________

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__________________________________________________________________________

Give a conclusion about ECG

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Content 5. Main examination methods of digestive organs and kidneys.

The most common complaintsof the patients with the diseases of digestive organs are:

1.___________________________________________________________________________2.___________________________________________________________________________3.___________________________________________________________________________4.___________________________________________________________________________5.___________________________________________________________________________6.___________________________________________________________________________7.___________________________________________________________________________8.___________________________________________________________________________9.___________________________________________________________________________10.__________________________________________________________________________

Overview of approach to patients with common gastrointestinal disorders

Site of disorder Common symptoms Possible physical signs

EsophagusDysphagia Odynophagia Heartburn, chest painHematemesis/melena

Stomach

PancreasMass Jaundice

Duodenum

Jejunum

Ileum

Colon

Rectum

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Dysphagia_______________________________________________________________________________________________________________________________________________________Aphagia_________________________________________________________________________________________________________________________________________________________Odynophagia_________________________________________________________________________________________________________________________________________________________Globus pharyngeous_________________________________________________________________________________________________________________________________________________________Misdirection of food_________________________________________________________________________________________________________________________________________________________Phagophobia

Dysphagia

Process and Problem

Timing Factors that Aggravate Factors that Relieve AssociatedSymptoms andConditions

Transfer Dysphagia, due to motor disorders affectingthe pharyngeal muscles

Esophageal DysphagiaMechanical Narrowing

Mucosal rings and webs

Esophageal stricture

Esophageal cancer

Motor disorders

Diffuse esophagealspasm

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Scleroderma

Achalasia

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Regurgitation

Causes of nausea

Vomiting

Heartburn____________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Regurgitation____________________________________________________________________________________________________________________________________________________________________________________________________________________________________

By air

(eructation)

By food or by gas

(regurgitatio)

Cause Motor dysfunction of the stomach with increased formation of gas due to abnormal

or

Odour

Disease

Nausea__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Nausea can be due to

Vomiting____________________________________________________________________________________________________________________________________________________________________________________________________________________________

Vomiting etiology

Central Peripheral (of visceral etiology,

Hematogenic and toxic

Other causes-

-

-

-

Gastric diseases

-

-

-

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Topic 20-21. Inquiry and inspection of the patients with renal diseases. Instrumental and laboratory methods of examination of urinary system.

FUNCTIONALAND

CLINICALANATOMY

Kidney anatomy

The functional units of the kidney are the nephronsThe formation of urine :1)__________________________________

____________________________________2)__________________________________________________________________________________________________________3)__________________________________________________________________________________________________________4)__________________________________________________________________________________________________________________________________________________________________________________

The primary urinary system functions____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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Inquiring The most common complaints of the patients with renal diseases are: ____________________________________________________________________________________

Pain in selected urinary diseases.Disease Location

RadiationCharacter

Nephrolithiasis

Pyelonephritis

Renal abscess

Renal infarction

Nephroptosis (movable kidney)

Acute glomerulonephritis

Congestive kidney

Cystitis

Urethritis

Healthy person excretes approximately ____ liters of urine in 24 hours; urination rate is ______ times a 24 hours; ratio of daily and nightly amount of excreted urine is ____ accordingly. Urination is free and painless.

Deranged urination:Term Definition Causes

1 2 3Polyuria Oliguria

Anuria

Ishuria

Nocturia

Pollakiuria Ollakiuria Enuresis

Dysuria

Isuria Stranguria

Edema (varying degrees) is the common symptom, Local: edema of face (facial edema), edema around eyes (periorbital swelling), in lower extremities Generalized (__________),

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edema of penis and scrotum

General inspection

General condition _________________________________________________________Consciousness ____________________________________________________________Posture _________________________________________________________________Skin __________________________________________________________________Facies nephritica _____________________________________________________________________________________________________________________________

Palpation

Palpation of the kidneys according to Obraztsov-Strazhesko

Palpation of the kidneys according to S. Botkin

Palpation is used to diagnose ptosis of the kidneys. Three degrees of the nephroptosis are differentiated I degree – palpable kidney (Ren palpabilis): __________________________________________________________________________________II degree – movable kidney (Ren mobilis): __________________________________________________________________________________

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III degree – wandering kidney (Ren migrans) __________________________________________________________________________________

Palpation of the urine bladderIn palpation you can detect following tenderness points:1.________________________ point – the site of kidney projection, is placed in the anglebetween the 12th rib and the longissimus thoracis muscles;2._________________________point is placed at the lateral edge of the rectus abdominal muscle at the umbilicus level;3.___________________ is placed at the intersection of linea biiliaca with the vertical line passing the spina ossis pubis (pubic tubercle).

Percussion Pasternatsky’s symptom.

Pain with percussion in the costovertebral angle suggests ______________________________________________ ______________________________________________ _______________________________________________

Laboratory methods

Collection of the urine_________________________________________________________________________________________________________________________________________________________________________________________________Macroscopic study includes assessment of physical properties of the urine: ________________________________________________________________________________Clinical significance of urine color changes.

Color Pathological condition CauseDark yellow

Pale, water-like

Dark

Dark, almost black

Red

Appearance of“meat wastes”

Greenish-brown

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(beer-like)Greenish-yellow

Whitish

Milky

Cloudiness of the urine. _______________________________________________________________________________________________________________________________________________________________________________________________Smell of the urine. _________________________________________________________________________________________________________________________________________________________________________________________________Specific gravity of the urine is ___________________________________________________________________________________________________________________________________________________________________________________________Zimnitsky’s test______________________________________________________________________________________________________________________________________________________________________________________________________Isosthenuria is ________________________________________________________________________________________________________________________________Hyposthenuria is_______________________________________________________________________________________________________________________________

Chemical study includes assessment of reaction of the urine (urine pH),protein, glucose, ketone bodies, and bile pigments.

Clinical significance of urine pH changes.Urine reaction

Acid NeutralFeebly acid

Alkaline

Physiological conditions:

Pathological conditions: diabetes

Norm Physiological conditions:

Pathological conditions:

Proteinuria _____________________________________________________________________________________________________________________________________Selective proteinuria ______________________________________________________________________________________________________________________________Depend on protein- amount in the urine, ___________________-– 30-300 mg/24h, and proteinuria (_________________________) – more than 300 mg/24h are distinguished.

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Functional proteinuria ____________________________________________________________________________________________________________________________Organic proteinuria ______________________________________________________________________________________________________________________________Glycosuria____________________________________________________________________________________________________________________________________________________________________________________________________________Ketone bodies (acetone, acetoacetic and β2-oxybutyric acid) _____________________________________________________________________________________________________________________________________________________________________Bilirubin. _____________________________________________________________________________________________________________________________________Urobilinoids: ____________________________________________________________________________________________________________________________________Macroscopic studyThe presence of erythrocytes in the urine is called ____________________. Microhaematuria_________________________________________________________________________________________________________________________________Macrohaematuria________________________________________________________________________________________________________________________________Leucocyturia ____________________________________________________________________________________________________________________________________Epithelium cellsTubular (renal) epithelium cells ___________________________________________________________________________________________________________________________________________________________________________________________Squamous epithelium cells ________________________________________________________________________________________________________________________Cylinders (casts). _______________________________________________________________________________________________________________________________________________________________________________________________________Nechiporenko’s method allows counting formed elements in 1 ml of urine, normally:o Leucocytes – __________;o Erythrocytes –__________;o Casts – ___________. Crystals. _____________________________________________________________________________________________________________________________________Mucus. ______________________________________________________________Bacterioscopic studyBacteriuria_____________________________________________________________________________________________________________________________________

Instrumental methods

Plain radiography of the urinary tract_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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_______________________________________________________________________Excretion urography (synonyms: intravenous pyelography; IVP; IVU) __________________________________________________________________________________________________________________________________________________________Retrograde pyelography/ureterography__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Renal arteriography. ___________________________________________________________________________________________________________________________________________________________________________________________________Renal venography______________________________________________________________________________________________________________________________________________________________________________________________________Computed tomography (CT scanning) _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Ultrasonography. _________________________________________________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________________________________Nuclear renal imaging__________________________________________________________________________________________________________________________________________________________________________________________________

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