Dorel Sâmpelean Călin-Vasile Vlad CLINICAL SEMIOLOGY First English edition Bioflux Publishing House, Cluj-Napoca, 2019 ISBN 978-606-8887-48-7 1 Dorel Sâmpelean, Călin-Vasile Vlad, editors Clinical Semiology First English edition 2019 Translated and revised from: ”Semiologie Clinică Medicală”, 2013, ”Iuliu Hațieganu” University Publishing House, Cluj-Napoca, Romania, ISBN: 978-973-693-549-7 Contributing authors: Dorel Sâmpelean Călin Vasile Vlad Lorena Ciumărnean Mircea Vasile Milaciu Mirela-Georgiana Perné Translation: Ioana Robu Scientific reviewers Dr. Ştefan Cristian Vesa, “Iuliu Hațieganu” University of Medicine and Pharmacy Dr. Sonia Irina Vlaicu, “Iuliu Hațieganu” University of Medicine and Pharmacy 2 Author`s affiliation Dorel Sâmpelean Associate Professor, IVth Medical Clinic, Department of Internal Medicine, ”Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania Călin Vasile Vlad Senior Lecturer, IVth Medical Clinic, Department of Internal Medicine, ”Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania Lorena Ciumărnean Senior Lecturer, IVth Medical Clinic, Department of Internal Medicine, ”Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania Mircea Vasile Milaciu Assistant Lecturer, IVth Medical Clinic, Department of Internal Medicine, ”Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania Mirela-Georgiana Perné Assistant Lecturer, IVth Medical Clinic, Department of Internal Medicine, ”Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania 3 Table of Contents CHAPTER 1. GENERAL SEMIOLOGY ................................................................ 8 1.1. INTRODUCTION ........................................................................... 8 1.2. ANAMNESIS (PATIENT HISTORY) ............................................. 9 1.3. GENERAL PHYSICAL EXAMINATION..................................... 19 1.3.1. METHODS AND TECHNIQUES ........................................... 19 1.3.2. CONSTITUTIONAL TYPE .................................................... 25 1.3.3. THE CONSCIOUS STATE AND ITS SYNDROMES ............ 26 1.3.4. ATTITUDE ............................................................................ 29 1.3.5. WALKING DISTURBANCES ............................................... 32 1.3.6. INVOLUNTARY MOVEMENTS .......................................... 33 1.3.7. THE FACIES .......................................................................... 34 1.3.8. THE COLOR OF SKIN AND MUCOSAE ............................. 47 1.3.9. CUTANEOUS HEMORRHAGE (PURPURA) ....................... 64 1.3.10. SKIN LESIONS .................................................................. 68 1.3.11. COLLATERAL CIRCULATION ........................................ 78 1.3.12. TROPHIC DISORDERS ..................................................... 83 1.3.13. EDEMA .............................................................................. 94 1.3.14. THE NUTRITIONAL STATUS ........................................ 102 1.3.15. THE ADENOPATHIES .................................................... 107 1.3.16. THE MUSCULAR SYSTEM ............................................ 113 1.3.17. THE OSTEOARTICULAR SYSTEM ............................... 115 1.3.18. CHANGES OF BODY TEMPERATURE ......................... 122 CHAPTER 2. THE RESPIRATORY SYSTEM ................................................... 127 2.1. ANAMNESIS ................................................................................. 127 2.1.1. CHEST PAIN .......................................................................... 130 2.1.2. DYSPNEA............................................................................... 135 2.1.3. HEMOPTYSIS ........................................................................ 141 2.1.4 COUGH.................................................................................... 145 2.2. GENERAL PHYSICAL EXAMINATION ...................................... 150 2.3. PHYSICAL EXAMINATION OF THE UPPER AIRWAYS........... 153 2.4. PHYSICAL EXAMINATION OF THE CHEST ............................. 153 2.4.1. INSPECTION .......................................................................... 153 2.4.2. PALPATION ........................................................................... 157 2.4.3. PERCUSSION ......................................................................... 160 2.4.4. AUSCULTATION ................................................................... 163 4 CHAPTER 3. CLINICAL RESPIRATORY SYNDROMES .................................. 169 3.1. PULMONARY CONDENSATION SYNDROME .......................... 169 3.1.1. PULMONARY CONDENSATION SYNDROME THROUGH INFILTRATION ............................................................................... 169 3.1.2. PULMONARY CONDENSATION SYNDROME THROUGH ATELECTASIS ................................................................................ 171 3.1.3. PULMONARY CONDENSATION SYNDROME IN PNEUMONIA ................................................................................... 173 3.1.4. SYNDROMES IN LUNG CANCER ........................................ 176 3.2. PLEURAL EFFUSION SYNDROME ............................................ 178 3.3. BRONCHIAL SYNDROME........................................................... 185 3.3.1. BRONCHIAL SYNDROME IN ACUTE BRONCHITIS ......... 186 3.3.2. BRONCHIAL SYNDROME IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE ................................................................. 186 3.3.3. BRONCHIAL SYNDROME IN BRONCHIAL ASTHMA ...... 190 3.4. CAVITARY SYNDROME ............................................................. 194 3.4.1. CAVITARY SYNDROME THROUGH LUNG CAVITIES .... 194 3.4.2. CAVITARY SYNDROME IN PNEUMOTHORAX OPEN INTO A BRONCHUS ................................................................................. 194 3.4.3. BRONCHOPULMONARY SUPPURATIONS ........................ 195 3.4.4. CAVITARY SYNDROME IN LUNG ABSCESS .................... 195 3.4.5. BRONCHIECTASIS ............................................................... 197 3.5. MEDIASTINAL SYNDROME ....................................................... 199 CHAPTER 4. THE CARDIOVASCULAR SYSTEM ........................................... 201 4.1. ANAMNESIS ................................................................................. 201 4.2. CARDIAC SYMPTOMS ................................................................ 206 4.2.1. CARDIAC DYSPNEA ............................................................ 206 4.2.2. PALPITATIONS ..................................................................... 208 4.2.3. CARDIOVASCULAR PAIN ................................................... 208 4.3. PHYSICAL EXAMINATION ........................................................ 211 4.3.1. GENERAL PHYSICAL EXAMINATION ............................... 211 4.3.2. PHYSICAL EXAMINATION OF THE HEART ..................... 213 4.4. SEMIOLOGY OF THE ARTERIES ............................................... 220 4.4.1. ANAMNESIS .......................................................................... 220 4.4.2. PHYSICAL EXAMINATION ................................................. 222 4.5. SEMIOLOGY OF THE VEINS ...................................................... 228 4.5.1. ANAMNESIS .......................................................................... 228 4.5.2. PHYSICAL EXAMINATION ................................................. 229 5 CHAPTER 5. CLINICAL CARDIOVASCULAR SYNDROMES .......................... 233 5.1. MYOCARDIAL SYNDROME ....................................................... 233 5.2. HEART FAILURE ......................................................................... 235 5.2.1. LEFT VENTRICULAR FAILURE .......................................... 239 5.2.2. RIGHT VENTRICULAR FAILURE........................................ 243 5.2.3. GLOBAL HEART FAILURE .................................................. 246 5.3. VALVULAR SYNDROMES .......................................................... 248 5.3.1. MITRAL STENOSIS ............................................................... 248 5.3.2. MITRAL INSUFFICIENCY .................................................... 252 5.3.3. AORTIC STENOSIS ............................................................... 254 5.3.4. AORTIC INSUFFICIENCY .................................................... 257 5.4. PERICARDIAL SYNDROME........................................................ 259 5.4.1. ACUTE FIBRINOUS PERICARDITIS ................................... 259 5.4.2. CHRONIC CONSTRICTIVE PERICARDITIS ........................ 261 5.5. ISCHEMIC HEART DISEASE ....................................................... 262 5.5.1. ANGINA PECTORIS .............................................................. 262 5.5.2. ACUTE MYOCARDIAL INFARCTION................................. 267 5.6. RHYTHM AND CONDUCTION DISORDERS ............................. 272 5.6.1. SUPRAVENTRICULAR TACHYARRHYTHMIA ................. 273 5.6.2. VENTRICULAR TACHYARRHYTHMIA ............................. 275 5.6.3. BRADYARRHYTHMIA ......................................................... 277 5.7. SHOCK, SYNCOPE, LIPOTHYMIA ............................................. 278 5.8. ARTERIAL HYPERTENSION....................................................... 281 5.9. CHRONIC OBLITERATING ARTERIOPATHY OF THE LOWER LIMBS .................................................................................................. 284 5.10. THROMBOTIC SYNDROME .....................................................