General Medical Semiology Guide Part II

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GENERAL MEDICAL SEMIOLOGY GUIDE PART II
Copyright
About the Author
	MANUELA STOICESCU
Motto
Thank you all my students!
Scientific Activity
	ACCOMPLISHMENTS
		Publications 51
	BOOKS 7
	PUBLICATIONS 56
		CONFERENCES 2018
		CONFERENCES 2019
Introduction
	The History of the Patient
	1 PERSONAL DATA
	2 PLACE OF BIRTH AND HOME (ADDRESS)
	3 ALLERGY?
	4 THE REASON FOR HOSPITALIZATION
		4 Example No. 1
		4 Example No. 2
		4 Example No. 3
		4 Example No. 4
	5 THE HISTORY OF THE CURRENT DISEASE
	6 FAMILY HISTORY
	7 PERSONAL PATHOLOGICAL HISTORY
	8 PERSONAL PHYSIOLOGICAL ANTECEDENTS
	9 LIFE CONDITIONS
		A The housing conditions
		B Eating
		Toxic consumptions
	10 WORKING CONDITIONS
	11 GENERAL MANIFESTATIONS
1 -
Skin Lesions
	1.1 Primary Skin Lesions
	1.2 Secondary Skin Lesions
2 -
Changes in Hair
3. The Nails
	3.1 Clubbed Fingers
		3.1.1 Clubbed Fingers Close-up Image
	3.1 Clubbed Fingers
	3.1 Clubbed Fingers
		3.1.2 Morphological Changes
		3.1.3 Causes of Clubbed Fingers
			3.1.3.1 Respiratory Diseases—Pulmonary Causes
			3.1.3.2 Cardiovascular Diseases
			3.1.3.3 Digestive Diseases
			3.1.3.4 Hematological Disease
	3.2 Hypertrophic Osteoarthropathy, Bamberger–Marie Disease
		3.2.1 Bamberger–Marie Disease
	3.3 Spoon Nails—Koilonychia
		Suggests Iron Deficiency
	3.3 Spoon Nails—Koilonychia
	3.4 Mycosis of the Nails—Onychomycosis
	3.5 The Appearance of the Nails After Frostbite
	3.6 Nail Changes in Peripheral Arterial Disease
	3.7 Onychomycosis in Patients With Cardiac Failure
4 -
Nutritional Status
	4.1 Obesity
	4.2 Cushing Syndrome
	4.3 Abdominal Obesity and White Stretch Marks
	4.4 Cachexia
5 - Subcutaneous Edema
	5.1 Indentations—Pitting Edema
	5.2 Increased Hydrostatic Pressure in the Capillary
	5.3 Decreased Colloid Osmotic (Oncotic) Pressure in the Capillary
	5.4 Colloid Osmotic (Oncotic) Pressure increases in the Interstitial Space Because of Obstruction by the protein-rich Lymphatic ...
	5.5 Generalized Edema
		5.5.1 Anasarca
		5.5.1 Anasarca
	5.6 Ascites and Orange Peel Sign
	5.6 Ascites and Orange Peel Sign
	5.7 Orange Peel Sign Suggests Edema of the Abdominal Wall
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	5.8 Ascites—Orange Peel Sign
	5.8 Ascites—Orange Peel Sign
	5.8 Ascites—Orange Peel Sign
	5.8 Ascites—Orange Peel Sign
	5.8 Ascites—Orange Peel Sign
	5.9 Edema of the Lower Limbs
	5.10 Edema of the Lower Limbs in the Same Patient—Indentation
	5.11 Cardiac Edema
	5.11 Cardiac Edema
		5.11.1 Clinical Case Presentation
		5.11.2 Clinical Case Presentation
	5.12 Clinical Case Presentation
		5.12.1 Cardiac Edema and Varices
	5.13 Stasis Dermatitis Pigmentation
		5.13.1 Cardiac Edema and Varices
		5.13.2 Cardiac Edema and Left DVT
		5.13.3 Cardiac Edema and Left DVT
		5.13.4 Cardiac Edema—Blue and Cold
		5.13.5 Cardiac Edema—Blue and Cold
		5.13.6 Cardiac Edema—Right DVD
		5.13.7 Cardiac Edema—Skin Infection
		5.13.8 Cardiac Edema—Varicose Scarred Ulcer—Cellulite
		5.13.9 Cardiac Edema
		5.13.10 Cardiac Edema
		5.13.11 Cardiac Edema—Cellulitis
		5.13.11 Cardiac Edema—Cellulitis
		5.13.12 Pitting Edema—Soft Edema
		5.13.13 Indentation
		5.13.12 Pitting Edema—Soft Edema
		5.13.13 Indentation
		5.13.14 Cardiac Edema—Right Ventricular Failure
		5.13.15 Pitting Edema
		5.13.16 Indentation
	5.14 Renal Edema
		5.14.1 Swelling of the Eyelids in the Morning
		5.14.2 First Day
		5.14.3 Second Day
		5.14.1 Swelling of the Eyelids in the Morning
		5.14.4 Eyelid Edema in a Girl—Nephrotic Syndrome
		5.14.5 Graph of a Patient With Renal Edema
		5.14.6 Edema of the Lower Limbs
		5.14.7 Proteinuria—Edema
		5.14.8 Nephritic Urine
		5.14.9 Nephrotic Syndrome
		5.14.10 Swollen Morning Eyelids—Edema—Nephritic Syndrome
		5.14.11 White Soft Edema—Proteinuria
		5.14.12 Pitting Edema
		5.14.13 macroscopic hematuria proteinuria—less than 3.5 g/dL—acute glomerulonephritis
		5.14.14 Nephrotic Syndrome—Anasarca
		5.14.15 Edema of the Lower Limbs
		5.14.16 White, Soft, Edema
		5.14.17 Pitting Edema
		5.14.18 Indentation
		5.14.19 Proteinuria ﹥3.5 mg/dL
		5.14.20 Abdominal Ultrasound Ascites—Anasarca
		5.14.21 Morning Eyelid Edema
		5.14.22 Hypoproteinemic Edema—White and Soft—Pitting Edema
	5.15 Hepatic Edema
	5.15 Hepatic Edema
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		5.15.1 Hepatic Edema—Cirrhosis of the Liver
		5.15.2 Hypoproteinemic Edema in Liver Cirrhosis
		5.15.3 Pitting Edema
	5.16 Endocrine Edema
		5.16.1 Myxedema
		5.16.2 Hyperfoliculism
	5.17 Localized Edema
		5.17.1 Venous Edema
			5.17.1.1 Phlegmasia Cerulea Dolens
			5.17.1.2 Phlegmasia Alba Dolens
			5.17.1.3 Homan’s Sign
			5.17.1.4 Lisker’s Sign
			5.17.1.5 Pitting Edema
			5.17.1.6 Indentation
			5.17.1.7 Phlegmasia Alba Dolens
			5.17.1.8 Phlegmasia Cerulea Dolens
			5.17.1.9 Venous Edema
				Femoral Vein Thrombophlebitis
			5.17.1.10 Left Femoral Deep Vein Thrombosis
			5.17.1.10 Left Femoral Deep Vein Thrombosis
			5.17.1.11 Swelling of the Left Thigh and Left Leg
			5.17.1.12 Deep Vein Thrombosis After Orthopedic Knee Surgery
			5.17.1.13 Pitting Edema—Indentation
			5.17.1.14 Swelling of the Left Leg—Scar After Surgery on the Left Knee
			5.17.1.15 Indentation
			5.17.1.16 Homan’s Sign Positive
			5.17.1.17 Lisker’s Sign Positive
				Deep Vein Thrombosis—Oral Contraceptive Pills
				Homan’s Sign Positive deep vein thrombosis
				Homan’s Sign Positive deep vein thrombosis
				Lisker’s Sign Positive deep vein thrombosis
				Left deep vein thrombosis In Neoplastic Context
			5.17.1.22 Indentation—Pitting Edema
			5.17.1.23 Pitting Edema—Soft
			5.17.1.24 Left Deep Vein Thrombosis
			5.17.1.25 Homan’s Sign Positive
			5.17.1.26 Lisker’s Sign Positive
			5.17.1.27 Check the Temperature of the Skin—Warm
			5.17.1.28 Deep Vein Thrombosis—Uterine Carcinoma
			5.17.1.29 Pitting Edema
				Indentation
				Pitting Edema
				Indentation
			5.17.1.30 Indentations
			5.17.1.31 Asymmetric Edema
			5.17.1.32 Right Deep Vein Thrombosis
			5.17.1.33 Homan’s Sign Positive
			5.17.1.33 Homan’s Sign Positive
			5.17.1.33 Homan’s Sign Positive
			5.17.1.34 Lisker’s Sign Positive
			5.17.1.34 Lisker’s Sign Positive
			5.17.1.35 Pitting Edema
			5.17.1.36 Indentation
			5.17.1.37 Ankle Edema
			5.17.1.35 Pitting Edema
			5.17.1.36 Indentation
			5.17.1.37 Ankle Edema
			5.17.1.38 Cardiac Edema—Right Deep Vein Thrombosis
			5.17.1.39 Phlegmasia Cerulea Dolens
			5.17.1.40 The Face of the Previous Patient—Mitral Face
			5.17.1.41 Cyanosis of the Cheeks, Nose, Lips, and Chin
			5.17.1.42 Cyanosis of the Lips
			5.17.1.43 Cyanosis of the Tongue
			5.17.1.44 Lower Limbs After Resorption of Edema
			5.17.1.45 Obstruction of the Superior vena Cava
				Stockes’s “Collar”
			5.17.1.46 Obstruction of the Inferior vena Cava
			5.17.1.47 Thrombosis of the Portal Vein
		5.17.2 Lymphedema
			5.17.2.1 Elephantiasis—Thick Arm
			5.17.2.2 Lymphedema After Mastectomy
			5.17.2.2 Lymphedema After Mastectomy
			5.17.2.2 Lymphedema After Mastectomy
			5.17.2.2 Lymphedema After Mastectomy
			5.17.2.2 Lymphedema After Mastectomy
		5.17.3 Inflammatory Edema
		5.17.3 Inflammatory Edema
		5.17.3 Inflammatory Edema
			5.17.3.1 Inflammatory Edema Around a Plaque With Pus
		5.17.4 Allergic Edema
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				Quincke
			5.17.4.1 Clinical Case Presentation
				Allergic (Quincke) Edema
				Very Swollen Eyelids Due to Edema
			5.17.4.2 Allergic Edema After a Bee Sting in the second and fourth Metacarpophalangeal Joints
				5.17.4.3 Allergic Edema After a Bee Sting comparing Both Hands
			5.17.5 Orange Peel sign Suggesting Edema of the Abdominal Walls
			5.17.5.1 Orange Peel Sign
			5.17.5.2 Orange Peel Sign—Ascites—Edema of the Abdominal Wall
			5.17.5.2 Orange Peel Sign—Ascites—Edema of the Abdominal Wall
			5.17.5.1 Orange Peel Sign
			5.17.5.2 Orange Peel Sign—Ascites—Edema of the Abdominal Wall
			5.17.5.3 Abdomen After Paracentesis
			5.17.5.1 Orange Peel Sign
6 - Collateral Circulation
	6.1 Cyanosis—Edema in Cape
	6.2 Arterial Collateral Circulation
	6.3 Venous Collateral Circulation
	6.3 Venous Collateral Circulation
		6.3.1 Ascites—Collateral Circulation
			Alcoholic Liver Cirrhosis
		6.3.2 Ascites—Collateral Circulation
			Viral Liver Cirrhosis HBsAg+
		6.3.3 Ascites Collateral Circulation—Alcoholic Liver—Cirrhosis
		6.3.4 Repermeabilization of Umbilical Vein
		6.3.4 Collateral Circulation—Viral Liver Cirrhosis–hepatitis Virus C Positive
		6.3.5 Venous Collateral Circulation and Ascites and Umbilical Hernia
		6.3.6 Liver Cirrhosis—Collateral Circulation
		6.3.6 Liver Cirrhosis—Collateral Circulation
		6.3.7 Ascites—Umbilical Hernia—Collateral Circulation
		6.3.7 Ascites—Umbilical Hernia—Collateral Circulation
		6.3.8 Liver Cirrhosis—Ascites—Umbilical Hernia—Collateral Circulation—Bandage After Paracentesis
		6.3.8 Liver Cirrhosis—Ascites—Umbilical Hernia—Collateral Circulation—Bandage After Paracentesis
		6.3.9 Liver Cirrhosis—Ascites—Umbilical Hernia—Collateral Circulation
		6.3.9 Liver Cirrhosis—Ascites—Umbilical Hernia—Collateral Circulation
		6.3.9 Liver Cirrhosis—Ascites—Umbilical Hernia—Collateral Circulation
		6.3.10 Collateral Circulation
		6.3.10 Collateral Circulation
		6.3.11 Liver Cirrhosis—Ascites—Umbilical Hernia—Collateral Circulation—Bandage After Paracentesis
		6.3.12 Liver Cirrhosis—Ascites—Umbilical Hernia—Collateral Circulation
		6.3.13 Collateral Circulation—Spider Naevi
		6.3.13 Collateral Circulation—Spider Naevi
		6.3.14 Liver Cirrhosis—Ascites—Collateral Circulation
7 - Lymph Node System
	7.1 Superficial Lymph Node System
	7.2 Deep Lymph Node System
	7.3 Adenomegaly
	7.4 Mediastinal Lymph Nodes
	7.4 Mediastinal Lymph Nodes
	7.5 Abdominal Lymph Node
	7.6 The Objective Examination
		7.6.1 Submandibular Lymph Nodes
		7.6.2 Inspection—Swelling of the Right Submandibular Lymph Node
		7.6.3 Palpation of Lymph Node
		7.6.3 Palpation of Lymph Node
		7.6.4 Lymph Node at Intersection of Submandibular and Retroauricular Area
		7.6.5 Subauricular Lymph Node
		7.6.6 Retroauricular Lymph Node
		7.6.6 Retroauricular Lymph Node
		7.6.7 Lateral Cervical Lymph Nodes
		7.6.8 Left Lateral Cervical Lymph Node
		7.6.8 Left Lateral Cervical Lymph Node
		7.6.8 Left Lateral Cervical Lymph Node
		7.6.8 Left Lateral Cervical Lymph Node
		7.6.9 Palpation—Left Lateral Cervical Lymph Node
		7.6.10 Scrofulous Sequela After TBC Lymph Nodes
		7.6.11 Supraclavicular Lymph Nodes—Virchow–Troisier’s Sign
		7.6.12 Axillary Lymph Nodes—Very Important in Breast Cancer
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				Very Important in Breast Cancer
		7.6.13 Bleeding From the Left Nipple in Cancer of the Left Breast
		7.6.14 Scar After The Removal of Axillary Lymph Nodes
		7.6.15 Methods of Palpation of the Axillae
			7.6.15.1 Palpation of the Internal Wall of the Axilla
				Palpation of the Posterior and Lateral Walls of the Axilla
				Palpation of the Anterior Wall and Apex of the Axilla
				Palpation of the Axilla’s Apex
				Palpation of the Internal Wall of the Axilla With Two Fingers
		7.6.16 Palpation of the Breast
		7.6.16 Palpation of the Breast
		7.6.16 Palpation of the Breast
		7.6.17 Lymph Nodes in the Inguinal Area
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				Inguinal lymph nodes
			7.6.17.1 Palpation of Inguinal Lymph Nodes
			7.6.17.2 Inspection—Swelling of the Left Inguinal Lymph Node
			7.6.17.3 Swelling of the Left Inguinal Lymph Node
			7.6.17.4 Inspection
			7.6.17.5 Palpation—Soft Consistency
		7.6.18 Popliteal Lymph Nodes
		7.6.19 Epitrochlear Lymph Nodes
8 -
The Osteoarticular System
9 - Fever
	9.1 Body Temperature Measurement
		9.1.1 Continuous Fever
			This is the Graph of a Continuous Fever
		9.1.2 Intermittent Fever
			This is the Graph of Intermittent Fever
		9.1.3 Reverse Fever
		9.1.4 Erratic Intermittent Fever—tertian, quartan, quintan
		9.1.5 Remittent Fever
		9.1.6 Recurrent Fever
		9.1.7 Biphasic Fever
		9.1.8 Hypothermia
10 - The Semiology of the Breast
	10.1 Questionnaire
	10.2 The Topographic division of the Breast into Four Quadrants
	10.3 The Objective Examination of the Breast
		10.3.1 Inspection
			10.3.1.1 Sitting Position—Normal Breasts
			10.3.1.2 The Arms Bent on Hips
			10.3.1.3 The Arms Up
			10.3.1.4 Pathologic Situations—Asymmetric Breasts—Right Breast Tumor
			10.3.1.5 Enlarged Right Breast compared With Left Breast
			10.3.1.6 White Palms—Neoplastic Anemia
			10.3.1.7 Vitiligo on the Nipples
			10.3.1.8 Small Nodules on the Left Breast
			10.3.1.9 PapillomaVirus Infection
			10.3.1.10 Small Nodules—PapillomaVirus Infection
			10.3.1.11 Scar After Burn on the Breast and Right Arm
			10.3.1.12 Scar After Burn on the Right Breast and Right Arm
			10.3.1.13 Many Small Nodules on the Breasts and Skin—Von Recklinghausen Disease
			10.3.1.13 Many Small Nodules on the Breasts and Skin—Von Recklinghausen Disease
			10.3.1.14 Left Mastectomy for Malignant Breast Tumor
			10.3.1.15 Left Mastectomy for Malignant Breast Tumor—Lymphatic Edema Left Arm
			10.3.1.15 Left Mastectomy for Malignant Breast Tumor—Lymphatic Edema Left Arm
			10.3.1.16 Lymphatic Edema Left Arm
			10.3.1.17 Radiotherapy of Left Breast—Lymphatic Edema Left Arm
			10.3.1.17 Radiotherapy of Left Breast—Lymphatic Edema Left Arm
			10.3.1.17 Radiotherapy of Left Breast—Lymphatic Edema Left Arm
			10.3.1.18 Posterior Incidence
			10.3.1.19 Melanoma of Breast Areola
			10.3.1.19 Melanoma of Breast Areola
			10.3.1.20 Supernumerary Nipple
			10.3.1.21 Hirsutism—Hair on Areolas
			10.3.1.22 Scars on the Areola After Hair Was Plucked With Tweezers
			10.3.1.23 Big Ecchymosis on the Right Breast After Trauma
			10.3.1.24 Purple Ecchymosis on the Right Breast After Trauma
			10.3.1.24 Purple Ecchymosis on the Right Breast After Trauma
			10.3.1.25 Melanoma on the Right Areola
			10.3.1.26 Psoriasis of the Breast
			10.3.1.27 Ulcerative–Necrotic Breast Carcinoma in Advanced Stage (Disappears on Both Breasts)
			10.3.1.27 Ulcerative–Necrotic Breast Carcinoma in Advanced Stage (Disappears on Both Breasts)
			10.3.1.28 The Semiology of the Breast in Men—Supernumerary Nipple
			Gynecomastia
			Symmetrical Gynecomastia
			Asymmetrical Gynecomastia
		10.3.2 The Method of Palpation of the Breast
		10.3.2 The Method of Palpation of the Breast
		10.3.2 The Method of Palpation of the Breast
		10.3.2 The Method of Palpation of the Breast
		10.3.2 The Method of Palpation of the Breast
		10.3.2 The Method of Palpation of the Breast
		10.3.3 The Method of Palpation of the Axilla
			10.3.3.1 Palpation of the Lateral Wall
			10.3.3.2 Palpation of the Anterior Wall
			10.3.3.3 Palpation of the Internal Wall
			10.3.3.4 Palpation of the Apex
			10.3.3.4 Palpation of the Apex
		10.3.4 Palpation of the Right Supraclavicular Area
		10.3.5 Complementary Investigations of the Breast
			10.3.5.1 Ultrasound of the Breast
			10.3.5.2 MAMMOGRAPHY IMAGES
			10.3.5.3 Biopsy of the Breast
		10.3.6 Clinical Cases of the Breast
Index
	A
	B
	C
	D
	E
	F
	G
	H
	I
	K
	L
	M
	N
	O
	P
	Q
	R
	S
	T
	U
	V
	W
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