Propedeutics of Internal Diseases. Basics of Clinical Examination of Patients = Пропедевтика внутренних болезней. Основы клинического обследования пациентов

ПРОПЕДЕВТИКА ВНУТРЕННИХ БОЛЕЗНЕЙ
ОСНОВЫ КЛИНИЧЕСКОГО 
ОБСЛЕДОВАНИЯ ПАЦИЕНТОВ
PROPEDEUTICS OF INTERNAL DISEASES
BASICS OF CLINICAL 
EXAMINATION OF PATIENTS
УЧЕБНОЕ ПОСОБИЕ
Допущено 
Министерством образования Республики Беларусь 
в качестве учебного пособия для иностранных студентов 
учреждений высшего образования по специальности 
«Лечебное дело»
 
Москва 
Гомель
 
ИНФРА-М 
ГомГМУ
2027
МИНИСТЕРСТВО ЗДРАВООХРАНЕНИЯ РЕСПУБЛИКИ БЕЛАРУСЬ
УЧРЕЖДЕНИЕ ОБРАЗОВАНИЯ
«ГОМЕЛЬСКИЙ ГОСУДАРСТВЕННЫЙ МЕДИЦИНСКИЙ УНИВЕРСИТЕТ»
Л.И. ДРУЯН
И.В. ПАЛЬЦЕВ

УДК 616-071-052(075.8)=111
ББК 53.43я73=432.1
 
Д76
Друян Л.И.
Д76  
Пропедевтика внутренних болезней. Основы клинического обследования пациентов = Propedeutics of Internal Diseases. Basics of Clinical 
Examination of Patients : учебное пособие / Л.И. Друян, И.В. Пальцев. — 
Москва : ИНФРА-М ; Гомель : ГомГМУ, 2027. — 146 с. : ил. 
ISBN 978-5-16-022393-3 (ИНФРА-М, print)
ISBN 978-5-16-115107-5 (ИНФРА-М, online)
ISBN 978-985-588-488-1 (ГомГМУ)
В учебном пособии представлена методика физикального обследования пациента в тезисно-схематической форме изложения материала. Визуализированы основные методы пальпации, перкуссии и аускультации 
внутренних органов. Имеются разделы о сущности диагностики, основных жалобах, субъективных и объективных методах исследования органов дыхания, кровообращения, пищеварения, мочеотделения, крови и др. 
Имеются приложения со справочной информацией по ряду лабораторных 
и инструментальных методов исследования. Представленный материал содержит необходимые сведения для написания учебной истории болезни. 
Разработано на основе учебно-программной документации по учебной 
дисциплине «Пропедевтика внутренних болезней» и предназначено для 
иностранных студентов 2 и 3 курсов, обучающихся на английском языке 
по специальности «Лечебное дело».
УДК 616-071-052(075.8)=111
ББК 53.43я73=432.1
Р е ц е н з е н т ы:
Немцов Л.М., доктор медицинских наук, профессор, профессор кафедры пропедевтики внутренних болезней Витебского государственного ордена Дружбы народов медицинского университета;
Пронько Т.П., кандидат медицинских наук, доцент, заведующий 
кафедрой пропедевтики внутренних болезней Гродненского государственного медицинского университета;
Голикова Т.И., кандидат филологических наук, доцент, доцент кафедры современных технологий перевода Минского государственного 
лингвистического университета
ISBN 978-5-16-022393-3 (ИНФРА-М, print)
ISBN 978-5-16-115107-5 (ИНФРА-М, online)
ISBN 978-985-588-488-1 (ГомГМУ)
© Гомельский государственный 
медицинский университет, 

CONTENTS
Preface  ..............................................................................5
Chapter 1. Definition and structure of the 
propedeutics of internal diseases. Structure of diagnostics. 
Diagnosis and its basic methodological approaches 
in the formation of clinical diagnosis .....................................6
Chapter 2. Basic principles of medical ethics 
and deontology .......................................................................12
Chapter 3. General plan of examining a patient ...........15
Chapter 4. Methods to examine respiratory system ......36
Chapter 5. Methods to examine cardiovascular system ...53
Chapter 6. Methods to examine digestive system .........66
Chapter 7. Methods to examine hepatobiliary system, 
pancreas, spleen .....................................................................85
Chapter 8. Methods to examine urinary system ............91
Chapter 9. Methods to examine blood 
and hematopoiesis system .....................................................97
Chapter 10. Methods to examine endocrine system ......99
Chapter 11. Methods to examine nervous system 
and sensory organs .............................................................. 102
Chapter 12. Methods to examine 
musculoskeletal system ....................................................... 104
References ...................................................................... 106
Subject index .................................................................. 108
Appendix A. Definition of the main diseases 
and syndromes of internal organs studied in the 
propedeutics of internal diseases ........................................ 110
Appendix B. Blood test (Complete Blood Count): 
Normal Ranges. .................................................................... 117
Appendix C. Some indicators of biochemical
blood test .............................................................................. 119
Appendix D. Blood coagulation factors  ........................ 123

Appendice E. Some indicators of the hemostasis 
system ................................................................................... 124
Appendice F. Phase structure of the cardiac cycle ...... 125
Appendice G. Classification of blood pressure (BP) levels 
(EOAH/EOC, 2018) .............................................................. 127
Appendice H. Indicators of acid-base balance
of blood (ABB) ....................................................................... 128
Appendice I. Classifications of human age
(WHO, 2021) ......................................................................... 129
Appendice J. Table of vitamins ..................................... 130
Appendice K. Main parameters 
of the ECG ............................................................................ 140
Appendice L. Main parameters of the spirogram ........ 143
Appendice M. Bile ducts anatomy scheme  .................. 144
Appendice N. Differential diagnostics of different
types of jaundice (ICTERUS) .............................................. 145
4
Appendix
Appendix
Appendix
Appendix
 Appendix J. Characterictics of vitamins
Appendix
Appendix
Appendix
Appendix
Appendix

PREFACE
The objective of the textbook is to reduce the existing shortage of textbooks in English on the subject of propedeutics of 
internal diseases for foreign students studying in English.
The textbook has a practical focus on describing physical methods of examining a patient, enabling some of them 
to be visualized by photographing the actions of experienced 
teachers during the examination of a patient. It will provide a 
student with a significant assistance in mastering the implementation of practical skills in the process of self-training and 
understanding the essence of the research methods. Most of 
the presented pictures and diagrams are made by the author. 
Since the main goal of a clinical study is to establish a diagnosis and formalize it in the form of a medical history, the manual provides a description of its main sections. There are also 
appendices presenting blood indicators, the main parameters 
of acid-base balance, characteristics of vitamins, hormones, 
blood pressure levels, parameters of the phase structure of the 
cardiac cycle, with the modern definitions of diseases of the 
internal organs studied in the course of propedeutics of the 
internal diseases. It will guide future doctors in the need for 
knowledge of physiology, physics, chemistry and other disciplines to understand diseases of the internal organs.
Certain attention is paid to explaining medical terminology, issues of medical ethics and deontology, the psychological 
and legal aspects of the “doctor-patient” relationship, which is 
of an international significance. A comprehensive assessment 
of the presented information will permit students to realize 
propedeutics of internal diseases to be a basic subject for all 
clinical disciplines. This textbook will not replace a textbook 
of propedeutics of the internal diseases, but it will be useful 
and in demand as a supplement.

DEFINITION AND STRUCTURE  
OF THE PROPEDEUTICS  
OF INTERNAL DISEASES. 
STRUCTURE OF DIAGNOSTICS. 
DIAGNOSIS AND ITS BASIC 
METHODOLOGICAL APPROACHES 
IN THE FORMATION OF CLINICAL 
DIAGNOSIS
Propedeutics of internal diseases is an introduction or an 
introduction course in to Internal medicine. It contains two 
sections: a diagnostics and a private pathology.
Diagnostics (from the Greek “diagnosticos” – capable of 
recognizing)  is a section of medicine, a separate science that 
studies research methods for recognizing a disease and a patient’s condition in order to prescribe the necessary treatment 
and preventive measures [7].
The structure of diagnostics as a scientific discipline includes:
1. Medical diagnostic technics is a section of diagnostics 
that studies methods for obtaining information about a patient. It includes the study of methods for examining a patient.
2. Semiotics or semiology (from the Greek “semeion» – a 
sign) is a section of diagnostics that studies the symptoms revealed during the examination of a patient, the doctrine of the 
diagnostic significance and origin of individual symptoms and 
syndromes of diseases.
3. Methodology of diagnosis (medical logic) is a section of 
diagnostics that includes the study of the peculiarities of doctor’s thinking when making a diagnosis and a disease based on 
the data obtained during the examination of the patient [14].
Private pathology. This section of the propedeutics of 
internal diseases studies the main diseases of the internal or6

gans. The causes (etiology), mechanism of development (pathogenesis), clinical picture (symptoms, syndromes and their development), basic principles of the treatment and prevention 
of diseases are considered. It is important to emphasize here 
that special attention in the propedeutics of internal diseases is paid to considering the significance of a symptom and a 
syndrome for diagnosing a specific disease. In addition, it is 
important to give an accurate modern definition of the disease 
and begin its study with it.
Semiotics (symptomatology)
Symptom (from Greek “symptomos” – “the sign”, “coincidence”) is a sign of any disease, statistically significant deviation from norm or occurrence of qualitatively new, not a 
characteristic phenomenon of a healthy organism [7, 14].
Types of symptoms by the importance:
1. Diagnostic symptoms are peculiar only to one disease.
2. Specific symptoms are characteristic of a group of diseases of one organ or one system.
3. Nonspecific symptoms are characteristic of many diseases of various organs and systems of organs.
4. Symptoms, not characteristic of the given disease – never observed in the suspected disease.
Types of symptoms by a method of revealing:
1. Subjective symptoms are symptoms revealed on the basis of the patient’s description of the sensations arising in a 
disease process. Symptoms are revealed by inquiring patients, 
i.e. a subjective method of the research.
2. Objective symptoms. These are the symptoms revealed 
by the methods of the objective research of the patient: survey, palpation, percussion, auscultation, laboratory tests and 
instrumental studies.
Types of symptoms by time of occurrence:
1. Early (initial) – arise at early, initial stages of the development of the disease.

2. Late – arise in a heat of the disease or in recovery.
Types of symptoms by prognostic value:
1. Favorable symptoms – indicate an easy or usual current of the disease, and also on its solution.
2. Adverse (menacing) – testify the severe form of the disease, about probability of unfavorable outcome.
Syndrome (from Greek “syn” – “together”, “dromos” – “to 
move”, “to run together”) are groups of the symptoms with 
general pathogenesis.
Definition and types of diagnoses.  
Basic methodological approaches  
in the formation of clinical diagnosis
Diagnosis (from Greek “diagnosis” – “recognition”) is a 
short medical conclusion about the essence of a disease and a 
condition of the patient, expressed in terms of a modern medical science [7].
Diagnosis structure:
1. The basic disease is a disease which has forced the patient to address for medical aid, has served as an occasion 
for hospitalization or disease threatening patient’s life; it is 
able to lead to death or physical inabilities of the patient independently or through complications.
2. Complications of the basic disease are diseases of other 
character and etiology, but connected with it by the development mechanisms.
3. Accompanying diseases – are the diseases found out in 
the patient simultaneously with the main one, but they are 
not interconnected with it.
Types of diagnoses:
I. By character and the maintenance:
1. Anatomical.
2. Pathoanatomical.
3. Pathophysiological (functional).
4. Pathogenetic.

5. Nozological.
6. Etiological. 
These types of diagnoses are components used in defining 
the diagnosis of the disease.
II. By the way of construction and substantiation:
1. The direct diagnosis (or the diagnosis by analogy). The 
diagnosis is set by the method of comparing clinical manifestation of the disease available for the patient, with a typical 
clinical picture characteristic of the given disease.
2. The differential diagnosis (diagnosis differentialis). It 
is the diagnosis by means of comparing several similar diseases. Here it is necessary to exclude less probable diseases, 
leaving more probable ones. It is the diagnosis by means of 
exception (diagnosis per exclusionem).
3. The diagnosis by means of observation (diagnosis per 
observatione). The diagnosis is set while observing the patient 
on occurrence of new symptoms of the disease or reception of 
additional results of the research.
4. The diagnosis by a medical effect (diagnosis ex juvantibus). The diagnosis is set on the basis of favorable result of 
treatment with the preparations specifically working at the 
given disease.
5. The diagnosis by the result of a harmful action (diagnosis ex nonentibus). It is based on applying medical products 
or other factors provoking occurrence of symptoms of the disease (allergic tests, physical exertion in stenocardia).
6. The diagnosis by operation (diagnosis sub operatione).
III. By the time of disease revealing:
1. Preclinical diagnosis. It is an attempt to distinguish 
and determine the condition of the organism, boundary between the norm and pathology.
2. Early diagnosis. Disease is distinguished in its early 
onset.
3. Late diagnosis. It is set at the height of the development of the disease or on a section table.
4. Retrospective diagnosis. It is set on the basis of the 
data revealed earlier, but for some reason have not been tak9

en into account, on the basis of the analysis of the medical 
documentation, etc.
5. Post mortal diagnosis. It is set after the patient’s 
death; it is recorded in post mortal epicrisis.
IV. By the degree of reliability:
1. The rough diagnosis is a working hypothesis arising 
at the initial stage of the examination of the patient by the 
doctor; it determines the direction of diagnostic search.
2. The preliminary diagnosis is set by the results of the 
inquiry and the physical examination of the patient. This diagnosis is the basis for administering preliminary treatment 
and determining the plan of a laboratory tests and instrumental studies of the patient.
3. The clinical diagnosis is set after a laboratory tests 
and instrumental studies of the patient and observation of the 
patient during the preliminary treatment.
4. The final diagnosis is set by the results of the observation of the patient during the treatment.
5. The hypothetical diagnosis (in doubt).
6. The incomplete or uncertain diagnosis.
7. The erroneous diagnosis. 
Methodology of diagnostic process
There are allocated two basic methods of a diagnostic process.
Direct (symptomatological) – the diagnosis is set by proceeding from any basic or most obvious symptom through a 
short additional research. This way is applied in cases demanding the urgent help. However in this case the probability of diagnostic errors is high, and the diagnosis, as a rule, 
incomplete.
Methodical (synthetic) – the diagnosis is set by the results 
of finding out patient’s complaints, collecting the anamnesis, 
specifying constitutional features, household and professional 
factors, research of all organs and systems of the patient in 
a certain order. This way is more difficult, long, labour-consuming, but more correct, essentially reduces probability of 
diagnostic errors.