Medical history (anamnesis morbi)

A carefully and competently collected anamnesis, together with the specified complaints of the patient, is the basis for further therapeutic and diagnostic search. It is known that those who question well determine the diagnosis correctly. “The art of collecting anamnesis lies in the skillful rejection of everything false, secondary and the identification of reliable facts that contribute to the correct diagnosis” (R. R. Vreden, 1938). At the same time, the doctor is not an investigator and cannot insist on obtaining data that the victim wants to hide. Anamnesis is collected solely for the purpose of providing maximum medical care.

The following aspects should be paid attention to:

1. What And where did it happen? The circumstances of the injury largely determine the direction of the diagnostic search. At the same time, clarifying the circumstances of the injury, as well as the volume and content of the first

assistance, the nature of limb immobilization and the peculiarities of transporting the patient to a medical institution have not only medical, but also legal significance. All this data, obtained from the words of the victim or from those accompanying him, is recorded in the medical history. Information reported to the doctor about a work-related injury, a traffic accident and car numbers during a traffic accident, the names or characteristics of the people who caused the injury are sometimes very important in determining the extent of liability. officials or individual citizens and the appointment of financial assistance to the victim. Collecting such information and recording it in medical records is the responsibility of medical personnel, the implementation of which must be carried out responsibly.

2. How did the damage occur? Determining the mechanism of injury and the duration of the post-traumatic period determine the tactics of examining the patient. The doctor has the opportunity to familiarize himself in detail with how the victim fell, what he felt, and was able to get up on his own. When questioning the victim, it is necessary to pay attention to the strength of the traumatic impact, the position of the patient at the time of injury, the state of his psyche and consciousness after the injury; there was direct or indirect injury.

There are a number of typical mechanisms of injury, on the basis of which one or another type of injury can be suspected, and they are often encountered. Almost every anatomical region of the musculoskeletal system has its own typical mechanism of injury. Knowledge of typical mechanisms of injury allows you to correctly focus the diagnostic search and avoid many mistakes.

3. date And time of injury. Knowing the period that has passed since the injury can greatly facilitate diagnosis and development of treatment tactics. Thus, information about whether pronounced swelling of the foot developed “lightning fast”, within half an hour after the injury, or gradually increased over the course of a week, already allows us to assess the severity of the injury. Long time(more than two weeks) that has passed since the injury significantly influences, for example, the assessment of the possibility of closed reduction of dislocations, repositioning of fractures, and performing the primary suture of nerves and tendons.

4. The nature of the previously provided medical care or treatment. Providing (or not providing) medical care to the victim in the first minutes and hours after injury significantly affects the clinical picture. When providing inadequate or delayed first aid, symptoms may appear that are associated with the development of early complications - disturbances of peripheral blood supply and innervation due to compression by an incorrectly applied splint or bandage, the formation of epidermal blisters (phlycten) due to swelling that increases, perforation of the skin of bones fragments when immobilization fails, etc. Timely management of dislocation and precise reposition of bone fragments can significantly change the nature of the patient’s complaints, reduce or almost eliminate the intensity of pain.

It is important to get a complete picture of how the patient was treated before in order to maintain the consistency of treatment or make its correction.

Story (anamnesis vitae)

Traditionally, mandatory data collected regardless of the nature of the pathology (date of birth, development, previous diseases, allergy history, bad habits, working and living conditions, etc.).

At the same time, when examining orthopedic and traumatology patients, special attention should be paid to:

The state of health and disease lead or may lead to disorders and changes in reparative capacity ( diabetes, thyrotoxicosis, collagenosis, tuberculosis, hormone therapy, menopause, pregnancy, occupational hazards)

Bad habits (especially systematic use of alcohol and drugs) can lead to the development of osteoporosis, mental and neurological disorders, etc.;

Previous injuries, their consequences, functional results after treatment;

Working and living conditions (sports) associated with microtraumas, increased or significantly reduced physical and functional loads on the musculoskeletal system;

For allergic reactions caused by general and local analgesics, antibiotics (as medications most often used in traumatology), as well as skin diseases (eczema, contact dermatitis);

Previous operations, blood transfusions;

Diseases of tuberculosis, viral hepatitis, HIV infection.

Work history - if the patient is unable to work, he must be issued a sick leave certificate; if the incapacity continued, note the duration of sick leave, change in working conditions due to injury or the presence of disability. It is also important to find out the social status of the patient, on which the patient’s conscious cooperation with the doctor in the treatment process, motivation to restore or maintain working capacity and quality of life depend. It is advisable to study the patient’s medical documents about previous illnesses and operations.

Patient status (status praesens)

General overview and physical examination At the beginning of the review, it is necessary to note the characteristics of the patient’s behavior, his appearance, facial expression, gait, figure, body proportions. evaluate:

General condition (satisfactory, moderate, severe, terminal)

Level of consciousness and degree of mental adequacy (pay attention to possible drug or alcohol intoxication- if such a situation is suspected, an appropriate clinical and laboratory examination is carried out and a report is drawn up)

Body type and body weight characteristics (normosthenic, asthenic, hypersthenic type, cachexia, obesity);

Description of organs by system (skin and subcutaneous tissue, respiration, blood circulation, digestion, genitourinary, endocrine, nervous systems).

If any of the listed systems is damaged, its description is included in the description of the damage location (status localis).

Inspection and examination of the damage site (status localis)

A thorough and systematic review helps to avoid many diagnostic errors. By general appearance and the position of the patient, the expression of his face, the color of the skin, one can assess the severity general condition patient and the predominant localization of the pathology focus. Based on the typical posture and characteristic position of the limb, an experienced doctor can make a diagnosis “at one glance.” But this does not exclude the need for a full examination. The passive position of the limb can be a consequence of slaughter, fracture, paresis, or paralysis. A forced position is observed in cases of severe pain (gentle placement) in the area of ​​the fracture, the source of inflammation, in cases of impaired mobility in the joints (dislocation, contracture), as a result of compensation for the shortening of the limb (pelvic distortion, scoliosis).

Upon examination, irregularities in the shape and contours of the limbs, joints and body parts are revealed. Violation of the axis of the limb segment, angular and rotational deformation indicate a fracture. A patient with an “acute injury” can be examined in a standing, sitting or lying position, depending on the nature of the injury and his general condition. Be sure to compare symmetrical areas of the torso and limbs. The review can be considered complete if it is carried out with the patient completely exposed.

The position of the diseased or damaged segment at the time of examination can be active, passive or forced. The active position usually indicates relative well-being, when the damage does not significantly affect the function of the musculoskeletal system. A passive position means complete immobility and most often indicates severe damage to the brain (coma) or spinal cord (paralysis). The passive position of an individual segment can be so characteristic that it is considered, as a rule, in a number of typical symptoms of a particular injury (for example, the passive position of the foot when the peroneal nerve is damaged - “horse foot”). The patient accepts the forced position of the entire body or a separate segment consciously or unconsciously to reduce or stop pain.

There are forced positions that can be caused by:

Pain syndrome - “gentle position” (for example, the position of the upper limb in case of shoulder dislocation, semi-sitting position and restrictions on chest excursion in case of rib fractures)

Morphological changes in tissues (contractures, improperly healed fractures, large skin scars)

Compensatory and pathological settings, which are often far from the affected area (hyperlordosis of the lumbar spine with flexion contracture hip joint, pelvic distortion due to improperly healed fractures of the leg bones).

Inspection of the skin is carried out in comparison with intact parts of the body, paying attention to the presence of damage (wounds, abrasions, ulcers, fistulas, scars, epidermal blisters, traumatic skin detachment), bruises (for example, paraorbital hematoma can appear in severe traumatic brain injury, hematoma in the perineal area - if the pelvis is damaged), skin rashes (for example, petechial rashes due to fat embolism, asymmetry of skin folds.

In some bone fractures, especially those located superficially, the distribution and localization of hemorrhage are so typical that the nature of the fracture can be almost unmistakably determined from them.

Palpation is a very important and informative examination method. It is carried out with the entire hand, the fingertips of one or both hands, and the tip of one finger. Particular attention should be paid to the presence of pain upon palpation. In some cases, palpation pain allows one to determine the location of the damage during a clinical examination. The pain can be local or diffuse, pronounced or insignificant, constant or associated with a certain position of the body or segment. Using palpation, in some cases, it is possible to determine the presence of bone fragments under the skin, the nature of their displacement, the presence of pathological mobility, and monitor the effectiveness of reposition. By the displacement of individual bone protrusions or articular ends, it is possible to decide the presence and nature of bone displacements; it is not determined during examination and is not palpated through its deep position. The presence of local bone pain after injury causes the doctor to suspect a fracture even in the absence of radiological evidence. Palpation of joints and para-articular tissues allows you to determine the presence of fluid in the joint (hydrarthrosis), identify changes in the contours of the joint and the relationship of anatomical landmarks.

Information about the administration of painkillers at the prehospital stage is also important.

Of great importance is the identification of crepitus, the nature and intensity of which differ significantly in different conditions.

The causes of crepitus can be:

Friction of bone fragments among themselves during fractures;

Inflammatory and cicatricial changes in tendon sheaths and joint capsules (tenosynovitis, bursitis)

Deforming arthrosis of the joints, the presence of intra-articular lesions and foreign bodies;

The presence of air in the subcutaneous tissue - subcutaneous emphysema (chest injury with lung damage, gas gangrene).

A decrease or absence of transmission of percussion sound to the phonendoscope during auscultation and percussion on the bone may indicate a fracture. However, with the advent of modern highly informative research methods (primarily radiological), auscultation and percussion are used very limitedly in the diagnosis of fractures. These methods are extremely important for diagnosing complications of hemopneumothorax, pneumonia, the presence of free fluid in the abdominal cavity, etc.

Clinical signs of fractures. There are reliable (absolute) and indirect (relative) signs of bone fractures, which are determined by a doctor during a clinical examination of the victim.

Reliable (absolute) signs include those characteristic only of fractures, which cannot be observed without it:

Pathological mobility of fragments in the area of ​​suspected damage;

Crepitus of bone fragments;

Pathological deformation of the axis of the long tubular bone with a change in its length;

Palpation of bone fragments under the skin;

Protrusion of bone fragments into the wound in open fractures.

The presence of at least one reliable (absolute) sign is sufficient to confirm the diagnosis of a fracture. It should be remembered that artificially inducing pathological mobility and crepitus of bone fragments can cause additional trauma to tissues, increase pain, and cause a number of serious complications - damage to peripheral vessels and nerves. Therefore, such symptoms can only appear involuntarily during the examination of a patient in a state of fainting, his

rekladannya or when applying transport tires and transportation. Specifically cause symptoms of crepitus, pathological mobility of bone fragments in order to establish a diagnosis unacceptable!

Indirect (relative) signs can be caused not only by a fracture, but also by other injuries or diseases.

The diagnosis of a fracture can be made only on the basis of a combination of several indirect (relative) signs of fractures, which are most often found:

Local pain (at rest, with movement or functional activity, with palpation or percussion)

Impaired function;

Change in segment contours, soft tissue edema (swelling), change in skin color, local hyperthermia, presence of epidermal blisters (phlycten)

The presence of wounds, abrasions, bruises, subcutaneous and intradermal hematomas;

Disorders of peripheral circulation and innervation;

Asymmetry of the body (may be associated not only with damage, but also with a painful pathological setting).

The symptom of axial load (local pain in the area of ​​the intended fracture with a light load directed along the axis of the bone), although it occurs most often with fractures, also refers to indirect signs, since it can also occur with local pathological processes (tumor, osteomyelitis).

With dislocations and fracture-dislocations (a combination of a fracture and a dislocation) in the joints, symptoms of elastic resistance can be detected when attempting to move in the joint, accumulation of fluid in the joint cavity (hydrarthrosis, hemarthrosis), as well as a violation of the symmetry of external landmarks.

Each location of damage has its own characteristic symptoms, which will be described in the relevant sections of the textbook. The following techniques are used: assessment of the course, anatomical contours, palpation, percussion, auscultation, study of peripheral blood supply and innervation of the limbs, determination of deformations and range of motion in the joints.

2. HISTORY OF INJURY

As with any injury to the musculoskeletal system, elucidation of the mechanism of injury is important and should always precede clinical examination of the patient and radiological examination. You should try to determine the position of the foot at the time of injury and the direction of the stressor (traumatic) force, as well as clarify all other data that allows you to recreate the most likely mechanism of injury. It is also helpful to determine whether there was any crunching at the time of injury, which may indicate a ligament tear, bone subluxation or dislocation, or tendon dislocation. In addition, the dynamics of the development of pain should be clarified (i.e., the doctor should ask the victim whether the onset of pain was sudden or whether it gradually increased, whether swelling appeared immediately after the injury) and the timing of disability (i.e., whether it was delayed or immediate ). The history should include information about previous ankle injuries and their treatment.

3. CLINICAL EXAMINATION

Clinical examination of the patient should always precede radiological examination. If the contours of the ankle joint are deformed and instability of the joint is obvious, then an x-ray examination should be performed only after the doctor is convinced that there are no disturbances in the innervation of the affected area. In the absence of significant joint deformity, the extent of soft tissue swelling is assessed, and subcutaneous hematomas are identified, which may indicate the presence of a fracture or ligament damage. Palpation determines the area of ​​maximum pain, crepitus and disappearance or change (displacement) of anatomical landmarks.

The range of motion in the damaged joint should be assessed and the positions of the foot at which the pain increases or decreases should be determined. Manipulations must be carried out very carefully to avoid additional damage. After examining the damaged joint, it is necessary to evaluate the range of possible movements in the normal ankle joint of the other leg for comparison. In this case, again, the available anamnestic data on previous injuries should be taken into account.

X-ray examination

X-rays can identify fractures and determine their severity. X-ray images of the area of ​​injury allow us to make an indirect conclusion about possible injuries to the ligaments and tendons, as well as establish the presence of foreign bodies and bone diseases, which is important for preventing complications. Finally, the doctor may use x-rays to evaluate treatment results.

The correct choice of projections is important when examining any injury to the ankle joint. It is necessary to obtain the following x-rays: in the anteroposterior projection with the foot adducted by 5-15°; in the lateral projection including the base of the fifth metatarsal bone; in an oblique (internal) projection at an angle of 45° with dorsiflexion of the ankle joint. Radiographs in all of the above projections must be of sufficient quality, which will allow the trabecular structure of the bones to be assessed. For a comparative study, it is advisable to obtain an image of the intact joint of the other leg, especially in children. To accurately determine the contours of small bones and detect soft tissue swelling, the doctor should use a powerful lamp (bright light).

4. DAMAGE TO THE ANKLE LIGAMENTS

Ligament tears account for approximately 75% of all ankle injuries. In more than 90% of cases, the external ligaments are damaged; deltoid ligament injuries account for less than 5%; with the same frequency (5%) the anterior or posterior tibiofibular ligament, as well as the anterior and posterior sections of the capsule, are damaged. Among injuries to the external ligaments, 90% are ruptures of the anterior talofibular ligament (65% of them are isolated, and 25% are combined with damage to the calcaneofibular ligament). The posterior talofibular ligament (or the third component of the external collateral ligament) is resistant to posterior displacement of the talus and is therefore rarely injured except in cases of complete dislocation of the foot. Because the anterior talofibular and calcaneofibular ligaments are two separate structures, the standard classification of first, second, and third degree ligament injuries is unlikely to be applicable. Therefore, an injury to these ligaments is defined as either damage to one ligament or damage to both of them. When only one of these ligaments ruptures, only a unilateral violation of the integrity of the joint occurs, which does not necessarily lead to its instability. These ligaments usually tear in a specific order, from front to back, so that the anterior talofibular ligament is torn first, followed by the calcaneofibular ligament.

Damage to the anterior talofibular ligament

The weakness of this ligament can be assessed quite fully with an objective examination. In this case, the most appropriate test is to move the foot forward. If the ligament is damaged, then such protrusion leads to anterior external subluxation of the talus from the fork of the joint with obvious deformation and crepitus while limiting the excursion of the foot. This technique is performed in all patients with suspected collateral ligament injuries.

With one hand, grab the foot by the heel, placing the thumb and index finger behind the ankles, and with the other, stabilize the anterior outer part of the lower leg in the lower third. The foot is slightly plantar flexed and turned inward, which is the normal position of its relaxation. Then the foot is directed forward, keeping the shin in a fixed position. Anterior displacement of the talus of more than 3 mm can be considered significant; a displacement of more than 1 cm is certainly significant. During testing, both false-positive and false-negative results are noted, but the greatest difficulties are caused by the doctor’s insufficient familiarity with the procedure for conducting this study.

If the tear extends posteriorly to the calcaneofibular portion of the collateral ligament, a certain roll of the talus is observed.

If the tear extends posteriorly to the calcaneofibular portion of the collateral ligament, then a certain roll of the talus is observed, since the lateral ankle joint now becomes unstable not only in the anteroposterior plane, but also in the medial-lateral plane. This can be determined by placing the foot in 20 to 30 degrees of plantar flexion with slight adduction and checking the inclination or movement of the talus relative to the distal articular surface of the tibia. This is then compared to normal mobility on the other side.

To correctly assess the condition of the ligaments, good muscle relaxation is important. If the diagnostic techniques performed cause pain, then the protective muscle contraction that occurs (voluntarily or involuntarily) prevents the examination. It is advisable to use ice or local anesthetic infiltration.

In cases of posterior talofibular ligament injury, ankle instability is evident with positive signs on anterior foot displacement testing and marked talar roll. Most injuries to this ligament involve a dislocation of the ankle, so there is no need to perform any tests.

Injury to the internal collateral ligament

Isolated injury to the internal collateral ligament is rare. Her injury is usually combined with a fracture of the fibula or rupture of the tibiofibular syndesmosis. Such damage is most often the result of forced turning of the foot outward. The condition of the internal collateral ligament is assessed when the foot deviates from the inside to the outside.

Damage to the tibiofibular syndesmosis

The interfibular ligaments are a continuation of the interosseous ligaments in the distal part of the tibia and fibula. Injuries to this ligament system occur due to excessive dorsiflexion and eversion of the foot. The talus is usually pushed upward, wedging between the tibia and displacing the fibula outward, which leads to partial or complete rupture of the syndesmosis. Diastasis is not always detectable on radiographs or upon examination of the patient, since the interosseous membrane above the syndesmosis usually holds the tibia and fibula together.

The history is often unremarkable, but patients often report that at the time of injury they felt a clicking sensation when dorsiflexing and everting the foot. There is slight swelling, as well as pain in the anterosuperior and posterosuperior parts of the ankle joint. The patient prefers walking with support on his toes. The examination reveals a painful point above the anterior or posterior ligaments. Some pain may also be detected in the medial part of the ankle, which is due to concomitant damage to the internal collateral ligament. In case of severe damage, tension in the distal part of the fibula and tibia is also determined. In addition, bilateral compression of the ankles causes pain as well as some movement in the injured area. Radiographic changes may only reflect soft tissue swelling at or above the medial malleolus and over the lateral malleolus to the mid-shaft of the fibula. This is a very serious injury with significant long-term consequences. It is advisable to conduct a test with forced dorsiflexion of the foot with the patient lying on his back or standing. In this case, pain and divergence of the tibia bones occur.

X-ray changes in ankle ligament damage

Standard radiographs are always taken to evaluate ankle injuries, but radiographic findings may be quite unexpected. If standard films show an avulsion, oblique or spiral fracture, or a transverse or diaphyseal fracture in the distal tibia, there is also a rupture of the corresponding ligaments. In such cases, there is no need to conduct an X-ray examination of the ankle joint with a forced change in the position of the foot. However, such a study is indicated if instability is suspected or if it is radiologically detected by asymmetry of the articular line and other signs.

The sign of anterior displacement of the bone in the early stages can be determined by X-ray or fluoroscopic examination. There are certain difficulties in establishing landmarks to identify displacement of the talus. Although different authors use different correlative points, it is generally accepted that its displacement anteriorly relative to the posterior edge of the calcaneus by more than 3 mm is significant. A displacement of more than 1 cm is an absolute indication for reduction. In case of any doubt, a comparative study is carried out, obtaining radiographs of the contralateral ankle joint in similar projections and positions, provided that this joint has not been injured in the past.

The talus displacement test for injuries to the medial or lateral ligament system is also not very sensitive due to the variability of talus displacement between individuals. healthy people and even in two normal ankle joints in one person. In addition, pain, spasm, and swelling may interfere with adequate assessment of the joint. In addition, the physician's effort during this test, as with anterior displacement testing, cannot be standardized. However, if the talus displacement exceeds 5°, the test can be considered positive. If the displacement is more than 25°, then pathology definitely occurs. A 5-10° difference in talar displacement between the injured and uninjured joints can probably be considered significant in most cases.

Ankle arthrography, when performed by an experienced specialist, is simple and quick. The study should be carried out within 24-48 hours, since late formation of clots may prevent the contrast agent from leaving the joint cavity. Finding contrast outside the joint usually indicates a tear. However, in healthy people, filling of the tendon sheaths of the long flexor fingers and thumb with contrast agent is observed in 20% of cases, the sheaths of the peroneal muscles - in 14% of cases, and filling of the space of the talocalcaneal joint - in 10%. Assessment of the calcaneofibular ligament using standard arthrographic methods is associated with a high incidence of non-negative results.

Classification of ligament injuries

There are three degrees of ligament damage. A first-degree injury is a sprain or microscopic tear of the ligament, causing local tenderness and minimal swelling. In this case, the load is quite bearable, and there are no deviations from the norm on radiographs.

A second-degree injury involves a severe sprain and partial tear of the ligament, which causes significant tenderness, mild swelling, and moderate pain with weight bearing. Radiographs in standard projections are not very informative. However, when the position of the foot changes, a loss of ligament function is detected, which is determined by the abnormal relationship of the talus and fork of the joint.

The third degree of damage is established when the ligaments are completely torn. The patient is unable to bear weight; There is severe pain and swelling, and sometimes deformation of the joint. Standard radiographs reveal a violation of the relationship between the talus and the articular fork. X-rays taken while the joint is under weight are usually not necessary, but if there is a complete tear, they are almost always positive if testing is done correctly.

The problem of treating ankle injuries is widely discussed. Grade 1 ligament injuries can be treated with tight bandaging, elevation of the limb, and ice packing. Application of ice for 15 minutes causes local anesthesia, allowing a number of movements in the joint; after exercise, ice is applied again for 15 minutes. Such applications are prescribed up to four times a day until the patient regains painless normal function in the joint. The decision on the load is made individually. In the case of first-degree ligament damage in athletes, full resumption of normal activities is not allowed until the victim can jog short distances without limping, run at normal speed in circles or figure-eight tracks without feeling pain, and finally, will be able to bend the foot at a right angle without experiencing pain.

Second-degree ligament injuries are best treated with cold applications as described above and immobilization. In cases of extensive edema, splints, crutches, ice packing and appropriate positioning of the limb are used until the edema subsides; Immobilization with a gait splint for 2 weeks, followed by 2 weeks of a hinged splint, is then usually recommended.

Treatment of third-degree ligament injuries is controversial. The question of conservative or surgical treatment should be decided individually with the participation of specialists. It is necessary to conduct a series of consultations with a traumatologist; this will ensure appropriate diagnosis and appropriate treatment and prevent adverse long-term consequences of injury.

The groups increased their step rate and estimated walking speed more significantly. All this indicates that the level of physical fitness achieved as a result of physical rehabilitation in patients after treatment of ankle joint injuries contributed to the acquisition of more stable walking skills. In general, at the end of the pedagogical experiment, 7 patients in the control group walked...

The presence of a parallel articular shell and smooth bone surfaces forming the joint. This is achieved by immobilization or surgical correction. In most cases, ankle injuries respond well to conservative treatment. The initial indication for surgical treatment is the inability to hold the talus in an anatomical position. correct position in relation to the cost...

To a limb. It is recommended to wear orthopedic shoes and an elastic bandage. Working capacity is usually restored after 5-6 months. Treatment of fresh ankle injuries using skeletal traction. Skeletal traction is used to treat ankle fractures with large displacement of fragments and swelling, in which closed reduction is not possible and surgical treatment is hindered...

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2. HISTORY OF INJURY

As with any injury to the musculoskeletal system, elucidation of the mechanism of injury is important and should always precede clinical examination of the patient and radiological examination. You should try to determine the position of the foot at the time of injury and the direction of the stressor (traumatic) force, as well as clarify all other data that allows you to recreate the most likely mechanism of injury. It is also helpful to determine whether there was any crunching at the time of injury, which may indicate a ligament tear, bone subluxation or dislocation, or tendon dislocation. In addition, the dynamics of the development of pain should be clarified (i.e., the doctor should ask the victim whether the onset of pain was sudden or whether it gradually increased, whether swelling appeared immediately after the injury) and the timing of disability (i.e., whether it was delayed or immediate ). The history should include information about previous ankle injuries and their treatment.

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Huntington's chorea (choric dementia) is a hereditary disease. Choreic hyperkinesis appears at the age of 30-40 years, and later progressive dementia occurs, reaching the complete collapse of the personality. When differentiating from senile chorea, family history is of decisive importance. anamnesis; at the onset of the disease, diagnosis is facilitated by the administration of L-DOPA, which leads to a sharp increase in hyperkinesis.

Etiology. The vast majority of cases (more than 95%) are of rheumatic etiology. Overt rheumatic anamnesis can be collected from 50-60% of patients. Almost always debuting before the age of 20 years, after 10-30 years the defect becomes clinically pronounced. Non-rheumatic cases of the defect include severe calcification of the cusps and annulus of the mitral valve, congenital anomalies (for example, Lutembasche syndrome - 0.4% of all congenital heart diseases), neoplasms and blood clots in the mitral valve area and...

Risk factors. Gluten enteropathy. Family anamnesis dermatitis herpetiformis. Oncological diseases. Insolation. Clinical picture. Skin changes.. True polymorphic rashes: urticarial, erythematous elements, tense blisters on an edematous erythematous background (can also occur on unaltered skin) with a pronounced tendency to group and herpetiform arrangement.. The cover of the blisters is dense, the contents are first serous, then becomes cloudy...

Anamnesis. Contact with a patient with SI (hospital patients or care staff with inflammatory changes on the skin, mucous membranes or other organs, definitely or presumably of staphylococcal etiology) 1-10 days before the present illness. Consumption of food products infected with staphylococcus. The development of a purulent-inflammatory disease in a hospital setting, most often after 3 days from the moment of hospitalization. Surgical intervention with...

Clinical picture. Anamnesis. Chronic diseases of the stomach, duodenum, liver, blood. Complaints of weakness, dizziness, drowsiness, fainting, thirst, vomiting of fresh blood or coffee grounds, tarry stools. Objective data. Pale skin and visible mucous membranes, dry tongue, rapid and soft pulse, blood pressure with minor blood loss is initially increased, then normal.

to subepicardial, which can lead to the development of secondary MI. The mechanism of rupture of the heart wall during blunt trauma is a sharp increase in pressure in the chambers of the heart during its anterior-posterior compression or a sharp influx of blood from the inferior vena cava during a seat belt injury. Clinical picture and diagnosis. . Complaints and anamnesis.. The main complaints in case of heart contusion are pain in chest, shortness of breath and interruptions in heart function.. Often numerous complaints...

Anamnesis. Indication of the consumption of thermally unprocessed products, home-canned products and those preserved under anaerobic conditions, mainly vegetables and mushrooms, as well as sausage, ham, smoked and salted fish, contaminated with bacteria. With wound botulism - lacerated or crushed wounds with significant tissue necrosis. Periods of illness. Incubation, lasting from 2 hours to 7 days (rarely up to 14 days).

. Acute form Hirschsprung's disease manifests itself in newborns in the form of low congenital intestinal obstruction. Anamnesis. Hirschsprung's disease, unlike other forms of megacolon (tumor, megacolon against the background of atonic constipation in the elderly, toxic megacolon with ulcerative colitis), is characterized by the appearance of constipation from birth or early childhood. Parents often note the presence of endocrine, mental and neurological abnormalities.

HSV-1 infection in people over 4 years of age in the population is more than 80% (European countries and the USA). Anamnesis. Indication of contact with a patient with a clinically manifest form of herpes infection during the last 2 weeks. If perinatal infection is suspected, information about the presence of herpetic infection in the pregnant woman in various clinical forms (including latent). Classification. Localized form. Disseminated form. Latent form. Clinical picture.

Clinical picture. Anamnesis. Contact with a patient with chickenpox or herpes zoster 11-21 days before illness; Direct contact is not required. . Periods of the disease.. Duration of the incubation period - 11-21 days.. Prodromal period (optional) - up to 1 day.. Period of rashes (main clinical manifestations) - 4-7 days.. Convalescence period - 1-2 weeks. . Clinical symptoms.. Intoxication syndrome: usually a 3-5 day fever with...

Diagnostics. Anamnesis. Visual field examination. Visual acuity study. Ophthalmoscopy. Treatment is etiotropic. Course and prognosis. With a stagnant disc, normal visual functions are maintained for a long time, even with severe swelling. Subsequently, the field of view narrows.

Classification. Latent (subclinical) form. Congenital form.. Acute form.. Chronic form. Acquired form. Anamnesis. Indication of possible infection (fact of maternal infection according to laboratory data, miscarriage, stillbirth, blood transfusions and parenteral interventions in the past, sexual and/or close household contact with an infected or sick person, organ and tissue transplantation). Presence of possible primary manifestations...

Differential diagnosis. Carefully assembled anamnesis, establishing the possibility of professional or household intoxication, taking into account the epidemiological situation in identifying the nature and cause of the disease. In unclear cases, you should first think about viral hepatitis. The detection of the so-called Australian antigen is characteristic of serum hepatitis B (it is also detected in virus carriers, rarely in other diseases).

Diagnostics. Anamnesis life (obstetric and postnatal) - the course of pregnancy, toxicosis, maternal diseases; course of labor, duration of the anhydrous interval, use of obstetric aids; monthly weight gain of the child, previous diseases in the early neonatal period. Social anamnesis(housing and living conditions, socio-economic condition of the family). Hereditary anamnesis- metabolic, endocrine diseases, enzymopathies in family members...

The clinical picture of the primary septic or primary pulmonary form is not fundamentally different from the secondary forms, but the primary forms often have a shorter incubation period - up to several hours. Diagnosis. The most important role in diagnosis in modern conditions plays epidemiological anamnesis. Arrival from zones endemic for plague (Vietnam, Burma, Bolivia, Ecuador, Turkmenistan, Karakalpak Autonomous Soviet Socialist Republic, etc.), or from anti-plague stations of a patient with the above...

Anamnesis: contact with a patient with polio 3 weeks before the onset of the first symptoms of the disease, stay in a region unfavorable for the incidence of polio. The fact of vaccination with live polio vaccine one month before the onset of the first symptoms of the disease or contact with a vaccinated person within the last two months (situations associated with a vaccine-associated form of the disease).