Methods of Propaedeutics of Internal Diseases

Subject and Tasks of Propaedeutics

Propaedeutics teaches the physician basic patient-care skills. The main goal is to learn how to move from identifying disparate symptoms to formulating a preliminary and then final clinical diagnosis, taking into account the underlying disease, its complications, and comorbid conditions. An important step is learning to interpret laboratory and instrumental data that complement the clinical picture.

The process of gathering patient information serves five key objectives:

• Diagnostic — obtaining reliable facts to establish a diagnosis.
• Prognostic — assessing the expected severity of the condition.
• Source finding — gathering additional information (from relatives, colleagues, or medical records).
• Deontological — adhering to ethical principles and establishing a trusting contact (compliance) with the patient.
• Psychological — assessing the individual's personality and their perception of their own "internal picture of the disease".

Classical Examination Scheme

The examination is always built on the general principles of clinical medicine. In 1978, Professor V.O. Marx formulated an important rule: abandoning traditional clinical examination in favor of modern equipment is a step backward, as no technology can completely replace the physician.

The standard workflow algorithm includes the following stages:

1. Eliciting current complaints.
2. Taking the history: history of the present illness (anamnesis morbi) and life history (anamnesis vitae).
3. Assessing the current state: general objective status (status praesens) and targeted examination of the affected area (status localis).

Physical Methods

Objective examination always begins with a general inspection, which is necessarily complemented by a localized examination (primarily visual assessment of the skin). Following or concurrently with this, the physician sequentially applies the remaining methods:

• Palpation: a method based on the sense of touch. It provides information about the physical properties of tissues and organs. The palpation technique is strictly specific to each organ system.
• Percussion: tapping to assess the density of underlying structures based on the character of the sound.
• Auscultation: listening to sound phenomena inside the body.

Clinical Example: Pulmonary Consolidation Syndrome

The comprehensive use of propaedeutic skills is clearly demonstrated in the identification of focal pulmonary tissue consolidation syndrome (occurring in pneumonia, pulmonary infarction, or tuberculosis).

During the interrogation stage, complaints of shortness of breath (due to a decrease in respiratory surface area), cough (e.g., with "rusty" sputum in croupous pneumonia), and chest pain are identified. During the objective examination, the physician records:

• On inspection — tachypnea and lag of the affected half of the chest during breathing.
• On palpation — enhanced vocal fremitus over the lesion.
• On percussion — shortening (dullness) of the sound.
• On auscultation — the appearance of pathological bronchial breathing. Normally, laryngotracheal sounds are dampened by spongy air-filled tissue, forming soft vesicular breathing. In consolidation, the airless dense medium excellently conducts sound from the large bronchi directly to the chest wall.

In the initial and final stages of the inflammatory process, crepitation is auscultated (crepitatio indux and crepitatio redux) — a specific sound arising from the partial filling of alveoli with exudate. In addition, moist resonant fine crackles and enhanced bronchophony may be detected over the lesion area.

To confirm the diagnosis, functional methods are utilized. For example, spirometry shows a decrease in forced vital capacity with a normal Tiffeneau index (restrictive pattern). Radiological findings reveal lobar consolidation or alveolar infiltrates.

Specifics of Methods in Specialized Disciplines

Propaedeutics serves as the basis for all branches of medicine, including traumatology and orthopedics. In this field, in addition to basic methods, the physician additionally assesses posture, gait, anatomical body contours, range of motion, and the presence of any deformities. Special attention is paid to examining the state of peripheral blood supply and limb innervation.

Trauma epidemiology shows that treatment requires enormous human resources (over 12.5 million cases are registered annually in the Russian Federation). Therefore, prevention becomes a critical task. Injuries are categorized into types:

• Occupational: depends on safety compliance control.
• Non-occupational: road traffic accidents account for the major share, with over 90% of injuries caused by human error.
• Intentional and military: their increase is driven by political events.

In pediatric practice, injury statistics are tracked by age groups: infancy (under 1 year), toddlerhood (1 to 3 years), preschool (3 to 7 years), and school age (7 to 16 years).

Class and exam questions

What else to study on this topic

• Palpation Technique for Various Organ Systems
• Mechanism of Pathological Bronchial Breathing Formation
• Radiological and Spirometric Signs of Pulmonary Consolidation
• Specifics of Taking a Traumatological History
• Deontology in Medicine: Establishing Trusting Contact with the Patient
• Pathogenesis of Arterial Hypoxemia in Extensive Pulmonary Tissue Consolidation

Other topics in the "Additional Topics" section

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.