Excepting questions examinations, we will short stop on difficulties and the general equipments of practically important examination «health and working capacity». On this way we can meet the phenomena opposite: aspiration to convince the doctor available a nonexistent disease state (or to exaggerate existing) or, on the contrary, aspiration to hide or underestimate available painful phenomena. We only mention possibility of a malingering, a perseveration and buy cipro a dissimulation, as about difficulties of daily practical work, not stopping neither on their roots, nor on methods of their recognition. It is necessary to notice, that in the Soviet medicine this section of expert work already has lost appreciably an urgency. Nevertheless, considering possibility of such difficulties and now, we should concern first of all with known care subjective data of research. ^Однако excessive distrustfulness to complaints of the patient, their ignoring in case of absence or negligibility of objective changes, is very dangerous moment. Errors of diagnostics as a result of underestimation of complaints of the patient meet quite often. It is necessary to remember, that in some cases the symptom-complex of complaints is so typical, that in effect it one defines the diagnosis.
The most expedient is the statement of complaints of the patient as the free independent story. More detailed расспрашивание is inevitable, but it should be made cautiously, whenever possible without leading questions. To “frame” the symptom-complex of complaints typical for any disease, at the inspired subject sometimes it is easy. All know, with what readiness of the patient sometimes agrees with presence at it this or that symptom if at it to ask: «instead of whether happens at you?», whether or «you feel?» More correctly to demand from the sick detailed description of its disorder. For example, it is not necessary to ask the patient noting attacks, whether he sleeps after them, and to ask, that to it happens after an attack etc. Clearly, that is frequent without direct questions to manage it is not possible, as far such vigilance concerning complaints of the patient, and only in some special cases not always is required. It is necessary to remember, that diversity, an abundance, uncertainty of the complaints, sometimes at once adjusting the doctor on the critical relation to them, can characterise serious forms of a neurosis or speak inability of the patient is sensible to state the. Sometimes vague, sensations. Extremely essential there is an interrogation of the patient when complaints to the periodic disorders which are not accompanied by any pathological changes in light intervals when the patient is investigated are shown. Position is facilitated, if at complaints to attacks, under the description of hysterical type, are available, for example, it is available lines of hysterical character, neurotic symptoms etc., or at complaints to cramps of tetanic type the raised mechanical and electric excitability of nervous trunks etc. becomes perceptible
Example when on the basis of only one complaints the doctor should take out the certain conclusion of purely expert character, those cases of an epilepsy when the patient tells about typical attacks under the description are. Data on a current and lines of an attack of the patient informs according to eyewitnesses as itself them, as a rule, does not remember. If attacks are extremely rare (for example. Not every month), a direction on test in a hospital irrationally. Practically not always it appears possible to collect and a testimony about attacks. And nevertheless in these cases the certain conclusion concerning the validity of the patient to this or that kind of work should be drawn.
Considering quite often expert kind of work of military and civil doctors, we will mention some parties of research which demand certain care in buy rimonabant sense of entering of the least subjectivity. In this case research of sensitivity and an estimation of pains are meant.
The plan stated in this chapter and volume of neurologic research of the patient is simple enough, not enough time demands and can be easily mastered doctors of other specialities.
DIFFERENTIAL DIAGNOSTICS OF FEVERS
The fervescence is one of the most frequent and characteristic implications of many infectious diseases. Quite often practical doctors, having taped at the patient the raised body temperature, already assume at it an infectious disease. However wide prevalence of a fever which can be almost at all infectious diseases, causes difficulties of differential diagnostics of this syndrome as the fervescence is one of the precursory symptoms when still there are no other clinical implications of illness, including many parametres of a fever having differentsialno-diagnostic value (duration, character of a temperature curve, etc.).

Close eyes; spend a heel of the right foot from a knee of the left foot from top to bottom on an anticnemion; now make the same the left foot - research of coordination of movements of the bottom extremities (the indicating thus is useful: «it is not necessary to lean strongly a heel against a forward surface of other anticnemion: it is necessary to spend a heel« easily », only concerning with it slightly skins of a forward surface of an anticnemion»).
Kneel across a couch, a back order ultram to me; arms lean about a wall, let stops hang freely, do not strain them - research ахилловых reflexes.
At first sight such way of research can seem superficial and insufficient, but experience shows, that under condition of accuracy and accuracy he gives the chance to notice even the initial form of organic disease of nervous system, allows not to spend more than several minutes for each research, spares time for interrogation of the patient and final conversation with it. But such minimum of objective research is already absolutely obligatory in all kinds of medical work.
At the slightest suspicion on this or that deviation from norm of the patient should undergo to already detailed research in this or that direction, depending on the found out changes.
Certainly, such lowered demands of research are inapplicable when the doctor should be approached to the patient with a problem of definition of the exact diagnosis. However in practical out-patient work, whether there is it as polyclinic reception, in the medical-control commission or at mass surveys, etc., quite often it is necessary to meet known limitation in time. It obliges to the concentrated and rationally constructed method of research.
Interrogation should begin with auscultation of complaints of the patient. The history taking should not be constructed on the stereotypic sample. Those parties of social, professional and other conditions which get value in connection with complaints and painful changes are subject to more detailed finding-out. Always, naturally, data on development and disease history are necessary.
Objective research of nervous system under any conditions cannot be limited by that volume which would be based only on complaints of the patient. Sometimes very detailed research of the bottom extremities at complaints to gods in feet does not give anything, reactions of pupils (for example, there can be onychalgias in early stages spinal сухотки when still there are changes knee and ахилловых no reflexes) will not be investigated yet. The nervous system should be investigated in whole (at least and roughly). Even at complaints sometimes purely neurotic character essential organic changes of nervous system («neurasthenic complaints» can be unexpectedly found out objective research at an initial sclerosis of cerebral vessels). It is practically enough for basic orientation to be limited to the program-minimum of research offered above. Proceeding from it, research is detailed further depending on character of complaints or from changes found out during research. For example at neurotic complaints after fast rough survey when organic changes are excluded, sosudisto-warm excitability, a sweating, a tremor and other symptoms characterising a condition of a neurosis in detail is estimated and tested.
At complaints, for example, on a scelalgia, after the general survey of nervous system, the attention specially addresses on nervous trunks, arteries, joints of a sick extremity.
Often character of complaints vpxl obliges to a number of such researches of nervous system which are not included into the usual scheme: for example to an ophthalmoscopy at suspicious concerning rising of intracranial pressure headaches; to research of a pulsation of arteries at complaints to an alternating lameness etc.
Not concerning the treatment-and-prophylactic parties of work of the doctor at out-patient survey, we will stop on questions of medical examination, but not in the narrow sense of the word. In essence, examination questions arise not only at the neuropathologist at the medical control or examination; all kinds of medical activity are bound to the right of remission of work and have, hence, expert character. In a peer measure work and the military doctor, whether occurs it on outpatient reception hours, in a part or by the ship, in a hospital, base or garrison out-patient department, in the invocatory or selection commission inseparably linked with questions of definition of time partial or full unfitness of the military man to carriing by it of military service.