FOREWORD ...........................................................................................................................7
LIST OF ABBREVIATIONS ....................................................................................................8
CHAPTER 1. General examination of a child.................................................................... 10
Assessment of general condition..................................................................................................................10
Main principles of physical development evaluation of a child older than 1 month ............................12
Patterns of physical development of a child................................................................................................17
Assessment of physical development of a newborn...................................................................................22
Rules of anthropometric indicators measuring..........................................................................................24
Semiotics of disorders of physical development ........................................................................................25
CHAPTER 2. Diagnostics and semiotics of skin diseases.............................................. 30
Clinical anatomy and physiology of the skin............................................................................................. 30
Anatomical and physiological features of the skin in children ................................................................32
Skin characteristics in the neonatal period.............................................................................................34
Clinical examination......................................................................................................................................36
Main (physical) methods of examination ...................................................................................................36
Survey and examination ........................................................................................................................36
Palpation ..................................................................................................................................................43
Additional methods of examination.......................................................................................................44
General semiotics and differential diagnosis of skin diseases..................................................................45
Skin dysplasia and dystrophy..................................................................................................................45
Infectious diseases of the skin..................................................................................................................46
Allergic and toxicoallergic diseases.........................................................................................................57
Skin changes in non-infectious diseases..................................................................................................58
Principles of differential diagnosis of infectious and allergic rashes......................................................64
Hemorrhagic rash syndrome...................................................................................................................65
Skin vascular formations.........................................................................................................................67
Skin pigmentation disorders....................................................................................................................68
CHAPTER 3. Diagnostics and semiotics of peripheral lymph nodes lesions ............... 72
Clinical anatomy and physiology of lymph nodes.....................................................................................72
Clinical examination of lymph nodes .........................................................................................................76
Main (physical) methods of examination...............................................................................................76
Examination ............................................................................................................................................76
Palpation ..................................................................................................................................................76
General semiotics of lymph nodes lesions..................................................................................................78
CHAPTER 4. Diagnostics and semiotics of skeletal system diseases........................... 81
Anatomical and physiological features of the skeletal system..................................................................81
Clinical examination of the skeletal system................................................................................................87
Main (physical) methods of examination...............................................................................................87
Palpation of the skeletal system ............................................................................................................96
General semiotics of skeletal system disorders ..........................................................................................97
Dental pathology .....................................................................................................................................98
Microcephaly............................................................................................................................................98
Craniosynostosis (craniostenosis) ..........................................................................................................99
Macrocephaly.........................................................................................................................................100
Rickets....................................................................................................................................................101
Hip dysplasia..........................................................................................................................................102
CHAPTER 5. Diagnostics and semiotics of muscular system diseases...................... 105
Anatomical and physiological features of the muscular system.............................................................105
Clinical examination and semiotics of the muscular system disorders................................................107
CHAPTER 6. Diagnostics and semiotics of respiratory system diseases................... 113
Clinical anatomy and physiology of the respiratory system...................................................................113
Clinical examination of the respiratory system........................................................................................120
Main (physical) methods of examination.............................................................................................120
Survey.....................................................................................................................................................120
Examination ..........................................................................................................................................123
Palpation ................................................................................................................................................135
Percussion..............................................................................................................................................137
Auscultation ..........................................................................................................................................141
Additional methods of investigation.....................................................................................................154
X-ray diagnostics..................................................................................................................................154
Spirometry .............................................................................................................................................159
Peak flow metry ....................................................................................................................................163
General semiotics of respiratory diseases in children .............................................................................165
ARVI ......................................................................................................................................................165
Acute laryngotracheitis..........................................................................................................................169
Acute tonsillitis. Tonsillopharyngitis.....................................................................................................170
Acute bronchitis.....................................................................................................................................172
Bronchial asthma...................................................................................................................................173
Pneumonia.............................................................................................................................................176
Pleurisy ..................................................................................................................................................179
Respiratory failure .................................................................................................................................181
Chapter 7. Diagnostics and semiotics of cardiovascular system diseases ................ 183
Clinical physiology of cardiac work...........................................................................................................183
Anatomical and physiological features of the cardiovascular system in children ...............................188
Antenatal fetal circulation.....................................................................................................................189
Clinical examination of the cardiovascular system .................................................................................191
Main (physical) methods of examination.............................................................................................191
Survey.....................................................................................................................................................191
Examination ..........................................................................................................................................194
Palpation ................................................................................................................................................196
Heart auscultation ................................................................................................................................206
Additional methods of examination.....................................................................................................219
Electrocardiography .............................................................................................................................219
Heart X-ray............................................................................................................................................239
General semiotics of the cardiovascular system diseases in children ...................................................240
CHAPTER 8. Diagnostics and semiotics of the urinary system diseases ................... 249
Clinical physiology of the renal function..................................................................................................249
Anatomical and physiological features of the urinary system in children ...........................................255
Clinical examination of the urinary system..............................................................................................256
Main (physical) methods of examination.............................................................................................256
Survey.....................................................................................................................................................256
Examination ..........................................................................................................................................257
Palpation and percussion.....................................................................................................................259
Additional methods of examination.....................................................................................................261
Laboratory methods.............................................................................................................................261
Instrumental methods .........................................................................................................................275
General semiotics of the urinary system diseases....................................................................................279
CHAPTER 9. Diagnostics and semiotics of gastrointestinal diseases ........................ 286
Clinical physiology of the gastrointestinal tract.......................................................................................286
Anatomical and physiological features of the gastrointestinal tract in children..................................291
Clinical examination of the gastrointestinal tract....................................................................................293
Main (physical) methods of examination.............................................................................................294
Survey.....................................................................................................................................................294
Examination ..........................................................................................................................................302
Auscultation of the abdominal area ...................................................................................................310
Percussion..............................................................................................................................................312
Palpation ................................................................................................................................................315
Additional methods of examination.....................................................................................................320
Laboratory methods.............................................................................................................................320
Instrumental methods..........................................................................................................................324
General semiotics of GIT organs diseases in children ............................................................................327
CHAPTER 10. Diagnostics and semiotics of ENT-organs diseases............................. 336
Clinical anatomy of ENT-organs and hearing physiology......................................................................336
Main methods of ENT-organs examination.............................................................................................344
Additional methods of ENT-organs examination....................................................................................355
CHAPTER 11. Diagnostics and semiotics of the nervous system diseases................ 358
Clinical physiology of the nervous system................................................................................................358
Clinical assessment of the neurological status and semiotics of disorders
in newborns and infants..............................................................................................................................360
Approximate dynamics of the psychomotor development of a child during the first years of life ......372
Clinical assessment of the neurological status and semiotics of disorders in
older children and adolescents...................................................................................................................373
Stigmas of dysembryogenesis.....................................................................................................................379
Semiotics of the nervous system diseases in children .............................................................................380
Meningitis..............................................................................................................................................380
Encephalitis............................................................................................................................................383
Hydrocephaly .........................................................................................................................................383
Cerebral palsy ........................................................................................................................................385
CHAPTER 12. Diagnostics and semiotics of the endocrine system diseases ............ 387
Clinical physiology of the endocrine system............................................................................................387
Clinical examination of the endocrine system.........................................................................................404
Semiotics of main endocrine glands diseases...........................................................................................407
Growth disorders in children ................................................................................................................407
Diseases of the hypothalamic-pituitary system ....................................................................................414
Thyroid diseases.....................................................................................................................................416
Adrenal gland diseases ..........................................................................................................................418
Pancreatic diseases ................................................................................................................................421
Diseases of gonads.................................................................................................................................423
CHAPTER 13. Diagnostics and semiotics of the blood system diseases.................... 425
Clinical physiology of the blood system....................................................................................................425
Clinical examination of the blood system.................................................................................................429
Additional methods of examination.....................................................................................................431
Laboratory methods.............................................................................................................................431
Semiotics of blood diseases.........................................................................................................................447
Syndrome of anemia..............................................................................................................................447
Iron-deficiency anemia ........................................................................................................................448
В12- and folate-deficiency anemia.......................................................................................................450
Hemolytic anemias...............................................................................................................................450
Iron overload syndrome ........................................................................................................................451
Hemorrhagic syndrome.........................................................................................................................451
Myelodysplastic syndrome.....................................................................................................................456
CHAPTER 14. Possibilities of ultrasound investigation in clinical examination......... 458
Main principles of ultrasound investigation.............................................................................................458
Ultrasound investigation of the skin .....................................................................................................460
Ultrasound investigation of lymph nodes.............................................................................................464
Ultrasound investigation of the musculoskeletal system......................................................................466
Ultrasound diagnostics of respiratory system diseases.........................................................................472
Ultrasound diagnostics of heart diseases (echocardiography).............................................................475
Ultrasound diagnostics of urinary system diseases..............................................................................476
Ultrasound diagnostics of gastrointestinal diseases .............................................................................479
Ultrasound diagnostics of brain diseases (neurosonography) .............................................................480
Ultrasound diagnostics of endocrine system diseases ..........................................................................483
CHAPTER 15. Clinical examination of a child in the critical condition ........................ 489
BIBLIOGRAPHY................................................................................................................. 496