2. 5. Answer the questions (Ответьте на вопросы)

1. What may there be when the liver is greatly enlarged?

2. Does muscular development prevent palpation of the lower hepatic border?

3. What does palpation of the liver supplemented by percussion demonstrate?

4. Does the liver in the young child extend well beyond the limits of the right hypochondrium?

5. Where do three quarters of the liver lie in the adult?

6. How may enlargements of the liver be demonstrated?

7. May an enlarged liver be felt to descend on deep inspiration?

8. May an enlarged liver be felt to retract on deep expiration?

3. Physical examination of the chest

3. 1. Study the vocabulary to the text (Изучите лексику к тексту)

unconstrained position [Ankqn'streInd pq 'zISn] – свободное (непринуждённое) положение

loosely ['lHslI] – свободно

somewhat elevated ['sAmwOt 'elIveItId] – слегка приподнятый

muscular rigidity ['mAskjulq rI 'GIdItI ] – мышечная ригидность

lateral ['lxtqrql] – боковой; laterally – сбоку

posterior [pq'stJrIq] – задний; posteriorly – сзади

anterior [xn'tIqrIq] – передний; anteriorly – спереди

be exposed to [Ik'spquzd] – подвергаться воздействию

recumbent posture [rI'kAmbqnt 'pOsCq] – положение лёжа

corresponding side [kqrqs'pOndIN]— соответствующая сторона

3. 2. Read and translate the text (Прочитайте и переведите текст)

The patient must be in a natural and unconstrained position. It is preferable when the patient is in the erect posture, the hands hanging naturally at the sides.

If the standing posture is not possible, the next choice is the sitting posture. The patient is to sit erect, the arms hanging loosely at the sides, head somewhat elevated, but muscular rigidity should be carefully avoided. When the lateral surface of the chest is inspected, the patient’s hands should be clasped behind his head, allowing free exposure. In a very sick patient the recumbent posture is the only possible one, the patient lying entirely relaxed. When lateral and posterior views are required of such a patient he should be gently turned from one side to the other, the facial expression being meanwhile noted for any signs of pain or distress. The effect upon respiration should also be observed during this procedure.

The chest is examined anteriorly, laterally and posteriorly with equal care and attention. The colour of the skin, general development, musculature, and the size, shape and symmetry of the thorax are to be noted. First the chest is studied as a whole, and then the regions of the one side are compared with the corresponding regions on the opposite side.

The whole chest should be exposed to a strong steady light, preferably daylight, so as to avoid confusing shadows. The surface of the chest under examination should always be turned towards the examiner.

During the examination respiration should be uninterrupted, the respirator rate and rhythm and the degree of the chest expansion being observed. The movements of one side of the chest should be compared anteriorly, laterally and posteriorly with those of the corresponding part of the other side.