1HVWHFDStWXORHQIDWL]DUHPRVDDYDOLDomRFOtQLFDGHFDGDJUXSRSHGLiWULFRFRPHoDQGRFRPRV

SULQFtSLRV JHUDLV GH GHVHQYROYLPHQWR H RV FRPSRQHQWHV FUXFLDLV GD SURPRomR GH VD~GH (P
VHo}HV VHSDUDGDV GHVFUHYHUHPRV UHFpPQDVFLGRV ODFWHQWHV SUpHVFRODUHV H FULDQoDV HP LGDGH
HVFRODU H DGROHVFHQWHV FRP GLVFXVV}HV UHOHYDQWHV VREUH GHVHQYROYLPHQWR DQDPQHVH SURPRomR
GHVD~GHHRULHQWDomRHWpFQLFDVGHH[DPHHVSHFtILFDVSDUDFDGDJUXSRHWiULR

Guia das seções do capítulo

3ULQF¯SLRVJHUDLVGRGHVHQYROYLPHQWRLQIDQWLO

3URPR©¥RGHVD¼GHHRULHQWD©¥R_&RPSRQHQWHVFUXFLDLV

$YDOLD©¥RGRUHF«PQDVFLGR

$YDOLD©¥RDOJXPDVKRUDVDSµVRQDVFLPHQWR

$YDOLD©¥RGRODFWHQWH

$YDOLD©¥RGRSU«HVFRODUHGDFULDQ©DHPLGDGHHVFRODU

$YDOLD©¥RGHDGROHVFHQWHV
 5HJLVWURGRVDFKDGRV

&RP IUHTXrQFLD R HVWXGDQWH H DWp PHVPR R SURILVVLRQDO GH VD~GH H[SHULHQWH VHQWHVH
DPHGURQWDGR TXDQGR VH DSUR[LPD GH XP UHFpPQDVFLGR PXLWR SHTXHQR RX GH XPD FULDQoD
DERUUHFLGDVREUHWXGRVRERROKDUFUtWLFRGHSDLVDQVLRVRV(PERUDDSULQFtSLRVHMDGLItFLOWRGRV
RVSURILVVLRQDLVGHVD~GHDFDEDPDSUHFLDQGRTXDVHWRGDVDVFRQVXOWDVSHGLiWULFDV

5HYHMD R &DStWXOR  SDUD OHPEUDUVH GRV PpWRGRV H GD VHTXrQFLD GR H[DPH GRV DGXOWRV 1R
H[DPH GH FULDQoDV D VHTXrQFLD GHYH YDULDU VHJXQGR D LGDGH H R QtYHO GH FRQIRUWR GD FULDQoD
5HDOL]HDVPDQREUDVTXHQmRFDXVDPGHVFRQIRUWRQRLQtFLRHDVSRWHQFLDOPHQWHGHVFRQIRUWiYHLV
SUy[LPRDRILQDOGRH[DPH3DOSHDFDEHoDHRSHVFRoRHDXVFXOWHSXOP}HVHFRUDomRQRFRPHoR
SRUH[HPSORHGHL[HSDUDH[DPLQDURUHOKDVHERFDHSDOSDURDEGRPHSUy[LPRDRILQDOGRH[DPH
6HDFULDQoDUHIHULUGRUHPDOJXPDUHJLmRGHL[HHVVDSDUWHSDUDH[DPLQDUSRU~OWLPR

2IRUPDWRGRUHJLVWURGDVLQIRUPDo}HVpLJXDOSDUDFULDQoDVHDGXOWRV(PERUDDVHTXrQFLDGR
H[DPH ItVLFR SRVVD YDULDU RV DFKDGRV FOtQLFRV GHYHP VHU UHJLVWUDGRV GD PDQHLUD FRQYHQFLRQDO
SRUHVFULWRRXHPSURQWXiULRHOHWU{QLFR
 3ULQFtSLRVJHUDLVGRGHVHQYROYLPHQWRLQIDQWLO

$LQIkQFLDpXPSHUtRGRGHFUHVFLPHQWRItVLFRFRJQLWLYRHVRFLDOPDUFDQWHV±VHPVRPEUDGH
G~YLGD R PDLRU GXUDQWH WRGD D YLGD GH XPD SHVVRD 1R GHFRUUHU GH DOJXQV DQRV GH YLGD DV
GLPHQV}HV ItVLFDV GDV FULDQoDV DXPHQWDP HP  YH]HV H HODV DGTXLUHP OLQJXDJHP H UDFLRFtQLR
VRILVWLFDGRVGHVHQYROYHPFRPSOH[DVLQWHUDo}HVVRFLDLVHWUDQVIRUPDPVHHPDGXOWRVPDGXURV

$ FRPSUHHQVmR GR GHVHQYROYLPHQWR ItVLFR FRJQLWLYR H VRFLDO QRUPDO GD FULDQoD IDFLOLWD D
HQWUHYLVWDHRH[DPHItVLFRVHQGRIXQGDPHQWDOSDUDGLIHUHQFLDURVDFKDGRVQRUPDLVGRVDQRUPDLV

Os quatro princípios do desenvolvimento infantil

2GHVHQYROYLPHQWRLQIDQWLOHYROXLGHPRGRSUHYLV¯YHO

$IDL[DGHYDULD©¥RQRUPDO«DPSOD

'LYHUVRVIDWRUHVI¯VLFRVVRFLDLVHDPELHQWDLVEHPFRPRGRHQ©DVSRGHPFRPSURPHWHURGHVHQYROYLPHQWRHDVD¼GHGDFULDQ©D

2Q¯YHOGHGHVHQYROYLPHQWRGDFULDQ©DLQIOXHQFLDDPDQHLUDFRPRDDQDPQHVHHRH[DPHI¯VLFRV¥RUHDOL]DGRV

‡ 2 SULPHLUR SULQFtSLR GR GHVHQYROYLPHQWR LQIDQWLO p TXH HOH HYROXL GH PRGR SUHYLVtYHO
UHJXODGRSHORFpUHEURHPSURFHVVRGHDPDGXUHFLPHQWReSRVVtYHODYDOLDUPHWDVHVSHFtILFDV
 SDUDDIDL[DHWiULDHXWLOL]iODVSDUDFDUDFWHUL]DURGHVHQYROYLPHQWRFRPRQRUPDORXDQRUPDO
'HSRLVTXHXPDFULDQoDDWLQJHXPDPHWDHODSDVVDSDUDDPHWDVHJXLQWH9LVWRTXHDFRQVXOWDH
R H[DPH ItVLFR RFRUUHP HP XP PRPHQWR HVSHFtILFR GR WHPSR p SUHFLVR GHWHUPLQDU RQGH D
FULDQoD VH HQFDL[D QD WUDMHWyULD GH GHVHQYROYLPHQWR 2 IDWR GH D FULDQoD QmR DWLQJLU RV
PDUFRVGHGHVHQYROYLPHQWRJHUDSUHRFXSDomR

‡ 2 VHJXQGR SULQFtSLR p TXH D YDULDomR GR GHVHQYROYLPHQWR QRUPDO p DPSOD $V FULDQoDV
DPDGXUHFHPFRPYHORFLGDGHVGLIHUHQWHV2GHVHQYROYLPHQWRItVLFRFRJQLWLYRHVRFLDOGHFDGD
FULDQoDWHQGHDUHFDLUHPXPDDPSODJDPDGHGHVHQYROYLPHQWR

‡ 2WHUFHLURSULQFtSLRUHFRQKHFHTXHGLYHUVRVIDWRUHVItVLFRVVRFLDLVHDPELHQWDLVEHPFRPR
GRHQoDV SRGHP DIHWDU R GHVHQYROYLPHQWR H D VD~GH GD FULDQoD $V GRHQoDV FU{QLFDV RV
PDXVWUDWRV H D SREUH]D SRU H[HPSOR SURYRFDP DQRUPDOLGDGHV ItVLFDV GHWHFWiYHLV H
PRGLILFDP D YHORFLGDGH H D WUDMHWyULD GR GHVHQYROYLPHQWR $V FULDQoDV FRP LQFDSDFLGDGHV
ItVLFDV RX FRJQLWLYDV SRGHP QmR VHJXLU R SHUFXUVR GH GHVHQYROYLPHQWR HVSHFtILFR HVSHUDGR
SDUDDLGDGH

‡ 8P TXDUWR SULQFtSLR HVSHFtILFR GR H[DPH SHGLiWULFR p TXH R QtYHO GH GHVHQYROYLPHQWR GD
FULDQoDDIHWDDPDQHLUDFRPRVmRIHLWRVDDQDPQHVHHRH[DPHItVLFR $ HQWUHYLVWD GH XPD
FULDQoDGHDQRVSRUH[HPSORpIXQGDPHQWDOPHQWHGLIHUHQWHGDHQWUHYLVWDGHXPDGROHVFHQWH
7DQWRDVHTXrQFLDTXDQWRRHVWLORGLIHUHPGDTXHOHVGRH[DPHGHXPDGXOWReSUHFLVRDMXVWDUR
H[DPH ItVLFR DR QtYHO GH GHVHQYROYLPHQWR GD FULDQoD H VLPXOWDQHDPHQWH WHQWDU DYDOLDU HVVH
QtYHO GH GHVHQYROYLPHQWR $ FRPSUHHQVmR GR GHVHQYROYLPHQWR GH XPD FULDQoD QRUPDO p
HVVHQFLDOSDUDDWLQJLUHVVHVREMHWLYRV
 3URPRomRHRULHQWDomRGDVD~GH_&RPSRQHQWHV
FUXFLDLV

2 FRQVHOKR GH %HQMDPLQ )UDQNOLQ GH TXH ³p PHOKRU SUHYHQLU TXH UHPHGLDU´ p HVSHFLDOPHQWH
YHUGDGHLURQRFDVRGHFULDQoDVHDGROHVFHQWHVSRLVDSUHYHQomRQDLQIkQFLDSRGHJHUDUGHVIHFKRV
PHOKRUHV GH VD~GH YiULDV GpFDGDV DGLDQWH 2V SHGLDWUDV GHGLFDP XP WHPSR VXEVWDQFLDO GH VXD
SUiWLFDDFRQVXOWDVGHDFRPSDQKDPHQWRGHVD~GHHDWLYLGDGHVGHSURPRomRGDVD~GH

9iULDV RUJDQL]Do}HV QRUWHDPHULFDQDV H LQWHUQDFLRQDLV LGHQWLILFDUDP GLUHWUL]HV SDUD SURPRomR

GD VD~GH HP FULDQoDV± 2V FRQFHLWRV DWXDLV VREUH D SURPRomR GD VD~GH LQFOXHP QmR DSHQDV
Do}HVSDUDGHWHFWDUHSUHYHQLUGRHQoDVPDVWDPEpPDSURPRomRDWLYDGREHPHVWDUGDVFULDQoDV
HGHVXDVIDPtOLDVHQJOREDQGRDVD~GHItVLFDFRJQLWLYDHPRFLRQDOHVRFLDO

&DGD LQWHUDomR FRP D FULDQoD H VXD IDPtOLD p XPD RSRUWXQLGDGH GH SURPRomR GD VD~GH
'XUDQWHWRGDDHQWUHYLVWDHRH[DPHItVLFRpLPSRUWDQWHSHQVDUQDVLQWHUDo}HVFRPRRSRUWXQLGDGHV
SDUDGHWHFWDUSUREOHPDVFOtQLFRVHSURPRYHUDVD~GH

2 SURILVVLRQDO GH VD~GH GHYH DSURYHLWDU R H[DPH SDUD RIHUHFHU RULHQWDomR DGHTXDGD SDUD D
IDL[DHWiULDVREUHRGHVHQYROYLPHQWRGDFULDQoD'rVXJHVW}HVVREUHOHLWXUDFRQYHUVDVP~VLFDV
HRWLPL]DomRGDVRSRUWXQLGDGHVSDUDRGHVHQYROYLPHQWRPRWRUILQRHJHUDO

2ULHQWHRVSDLVVREUHRVHVWiJLRVGHGHVHQYROYLPHQWRIXWXURVHDVHVWUDWpJLDVSDUDHVWLPXODUR
GHVHQYROYLPHQWR GR ILOKR 2V SDLV VmR RV SULQFLSDLV DJHQWHV GH SURPRomR GD VD~GH SDUD DV
FULDQoDVHDVUHFRPHQGDo}HVGRVSURILVVLRQDLVGHVD~GHVmRLPSOHPHQWDGDVSRUPHLRGHOHV

$$PHULFDQ$FDGHP\RI3HGLDWULFV$$3SXEOLFDGLUHWUL]HVSDUDDVFRQVXOWDV GH VXSHUYLVmR

GHVD~GHHFRPSRQHQWHVFKDYHDGHTXDGRVDFDGDLGDGHQHVVDVFRQVXOWDVYHMDHPZZZDDSRUJ
eSUHFLVROHPEUDUTXHFULDQoDVHDGROHVFHQWHVSRUWDGRUHVGHGRHQoDVFU{QLFDVHPIDPtOLDVRXHP
DPELHQWHV GH DOWR ULVFR SURYDYHOPHQWH QHFHVVLWDUmR GH FRQVXOWDV PDLV IUHTXHQWHV H GH PHGLGDV
PDLV LQWHQVLYDV GH SURPRomR GD VD~GH 2V DVSHFWRV H HVWUDWpJLDV HVVHQFLDLV QD SURPRomR GD
VD~GHDMXVWDGRVSDUDDVIDL[DVHWiULDVHVSHFtILFDVVHUmRDQDOLVDGRVQRGHFRUUHUGHVWHFDStWXOR

e LQWHUHVVDQWH LQWHJUDU H[SOLFDo}HV VREUH R H[DPH ItVLFR FRP DV PHGLGDV GH SURPRomR GD
VD~GH 2ULHQWDU SRU H[HPSOR VREUH DV DOWHUDo}HV GH PDWXUDomR HVSHUDGDV RX FRPR RV
FRPSRUWDPHQWRV VDXGiYHLV SRGHP LQIOXHQFLDU RV DFKDGRV ItVLFRV S H[ D SUiWLFD GH H[HUFtFLRV
ItVLFRVUHGX]RVQtYHLVGHSUHVVmRDUWHULDOHDREHVLGDGH1XQFDGHL[HGHHQIDWL]DUDUHODomRHQWUH
HVWLORVGHYLGDVDXGiYHLVHDVD~GHItVLFD2SURILVVLRQDOGHVD~GHSRGHSRUH[HPSORIRUQHFHU
DRVSDLVXPDFySLDGRtQGLFHGHPDVVDFRUSRUDO,0&GDFULDQoDMXQWRFRPXPD³SUHVFULomR´GH
KiELWRVGHYLGDVDXGiYHLV

$LPXQL]DomR LQIDQWLO FRQVWLWXL XP GRV SLODUHV GD SURPRomR GD VD~GH H IRL DFODPDGD FRPR D
FRQTXLVWDPpGLFDPDLVVLJQLILFDWLYDGDVD~GHS~EOLFDHPWRGRRPXQGR2HVTXHPDGHYDFLQDomR
LQIDQWLOPXGDDQXDOPHQWHHDVDWXDOL]Do}HVVmRDPSODPHQWHSXEOLFDGDVHGLYXOJDGDVHPVLWHV GR
&HQWHUVIRU'LVHDVH&RQWURODQG3UHYHQWLRQHGD$PHULFDQ$FDGHP\RI3HGLDWULFV±$$3

2V SURFHGLPHQWRV GH UDVWUHDPHQWR VmR UHDOL]DGRV HP IDL[DV HWiULDV HVSHFtILFDV HOHV LQFOXHP
SDUkPHWURV GH FUHVFLPHQWR H R UDVWUHDPHQWR GR GHVHQYROYLPHQWR HP WRGDV DV IDL[DV HWiULDV
DIHULomR GD SUHVVmR DUWHULDO DSyV RV  DQRV GH LGDGH GHWHUPLQDomR GR ,0& DSyV RV  DQRV GH
LGDGHHWHVWHGHUDVWUHDPHQWRGHYLVmRHDXGLomRHPGHWHUPLQDGDVLGDGHVFRQVLGHUDGDVFUXFLDLV
2V SURFHGLPHQWRV GH UDVWUHDPHQWR HVSHFLDOPHQWH UHFRPHQGDGRV SDUD SDFLHQWHV GH DOWR ULVFR
LQFOXHPWHVWHVSDUDLQWR[LFDomRSRUFKXPERH[SRVLomRjWXEHUFXORVHDQHPLDQtYHLVVDQJXtQHRV
GHFROHVWHUROLQIHFo}HVXULQiULDVHGRHQoDVVH[XDOPHQWHWUDQVPLVVtYHLV'67([LVWHPYDULDo}HV
QDV UHFRPHQGDo}HV VREUH WHVWH GH UDVWUHDPHQWR HQWUH RV SDtVHV PDV DV UHFRPHQGDo}HV GD $$3
SRGHPVHUHQFRQWUDGDVQRVLWHZZZDDSRUJ

$ RULHQWDomR DQWHFLSDWyULD FRQVWLWXL XP FRPSRQHQWH IXQGDPHQWDO GD FRQVXOWD SHGLiWULFD $V

iUHDVFUXFLDLVGHVVDVRULHQWDo}HVVmRPRVWUDGDVDVHJXLUHFREUHPXPDDPSODJDPDGHWySLFRV
GHVGHDVD~GHHVWULWDPHQWH³FOtQLFD´DWpDVD~GHVRFLDOHHPRFLRQDO7RGRVHVVHVIDWRUHVDIHWDPD
VD~GHGDFULDQoD

&RPSRQHQWHVFUXFLDLVGDSURPR©¥RGDVD¼GHSHGL£WULFD

 'HVHQYROYLPHQWRDSURSULDGRSDUDDLGDGHGDFULDQ©D

)¯VLFRPDWXUD©¥RFUHVFLPHQWRSXEHUGDGH

0RWRUKDELOLGDGHVPRWRUDVJURVVHLUDVHILQDV

&RJQLWLYRPDUFRVGHGHVHQYROYLPHQWROLQJXDJHPGHVHPSHQKRHVFRODU

(PRFLRQDODXWRHILF£FLDDXWRHVWLPDLQGHSHQG¬QFLDPRUDOLGDGH

6RFLDOFRPSHW¬QFLDVRFLDOUHVSRQVDELOLGDGHLQWHJUD©¥RFRPDIDP¯OLDHDFRPXQLGDGH

 &RQVXOWDVGHVXSHUYLV¥RGHVD¼GH

$YDOLD©¥RSHULµGLFDGDVD¼GHFO¯QLFDHEXFDO

&ULDQ©DVFRPQHFHVVLGDGHVHVSHFLDLVGHDVVLVW¬QFLDGHVD¼GHSUHFLVDPFRPIUHTX¬QFLDGHDJHQGDPHQWRDLQWHUYDORVPHQRUHV

 ,QWHJUD©¥RHQWUHRVDFKDGRVQRH[DPHI¯VLFRFRPHVWLORVGHYLGDVDXG£YHLV

 ,PXQL]D©·HV

 3URFHGLPHQWRVGHUDVWUHDPHQWR

 2ULHQWD©¥RDQWHFLSDWµULD
 +£ELWRVVDXG£YHLV

1XWUL©¥RHDOLPHQWD©¥RVDXG£YHLV

6HJXUDQ©DHSUHYHQ©¥RGHOHV·HV

$WLYLGDGHI¯VLFD

'HVHQYROYLPHQWRVH[XDOHVH[XDOLGDGH

$XWRUUHVSRQVDELOLGDGHHHILF£FLD

5HODFLRQDPHQWRVIDPLOLDUHVLQWHUD©·HVSRQWRVIRUWHVDSRLR

6D¼GHHPRFLRQDOHPHQWDO

6D¼GHEXFDO

5HFRQKHFLPHQWRGHGRHQ©D

‹SRFDGHUDVWUHDPHQWR

3UHYHQ©¥RGHFRPSRUWDPHQWRVGHULVFR

(VFRODHYRFD©¥R

5HODFLRQDPHQWRVFRPFROHJDV

,QWHUD©·HVQDFRPXQLGDGH

 3DUFHULDHQWUHRSURILVVLRQDOGHVD¼GHHDFULDQ©DRDGROHVFHQWHHDIDP¯OLD

$YDOLDomRGRUHFpPQDVFLGR

2SULPHLURDQRGHYLGD±DIDVHGHODFWHQWH±pGLYLGLGRHPSHUtRGRQHRQDWDORVSULPHLURV
GLDVHRSHUtRGRSyVQDWDOGHGLDVDDQRGHLGDGH

'LFDVSDUDRH[DPHGHUHF«PQDVFLGRV

([DPLQHRUHF«PQDVFLGRQDSUHVHQ©DGRVSDLV

&RORTXHHUHWLUHDVSH©DVGHURXSDGRUHF«PQDVFLGRFRQIRUPHRH[DPHIRUSURVVHJXLQGR

'LPLQXDDVOX]HVHHPEDOHRUHF«PQDVFLGRSDUDHVWLPXODUDDEHUWXUDGRVROKRV

2EVHUYHDDOLPHQWD©¥RVHSRVV¯YHOSULQFLSDOPHQWHDDPDPHQWD©¥R

'HPRQVWUHDVPDQREUDVSDUDDFDOPDUDFULDQ©DDRVSDLVSH[FRPRHQURODUQDPDQWD
 2EVHUYHHRULHQWHRVSDLVVREUHDVWUDQVL©·HVTXDQGRRUHF«PQDVFLGRHVWLYHUDFRUGDGR

$VHTX¬QFLDP¯QLPDGHH[DPHGRUHF«PQDVFLGRLQFOXL
2EVHUYD©¥RFXLGDGRVD
&DEH©DSHVFR©RFRUD©¥RSXOP·HVDEGRPHVLVWHPDJHQLWXULQ£ULR
0HPEURVLQIHULRUHVGRUVR
2UHOKDVERFD
2OKRVVHPSUHTXHHVWLYHUHPDEHUWRVHVSRQWDQHDPHQWH
3HOHDRORQJRGRH[DPH
6LVWHPDQHXUROµJLFR
4XDGULV

2 SULPHLUR H[DPH SHGLiWULFR p UHDOL]DGR LPHGLDWDPHQWH DSyV R SDUWR SHOR REVWHWUD RX SHOR
SHGLDWUD 8P H[DPH SHGLiWULFR PHWLFXORVR FRVWXPD VHU UHDOL]DGR QDV SULPHLUDV  K DSyV R
QDVFLPHQWR 2V H[DPHV ItVLFRV VXEVHTXHQWHV VmR UHDOL]DGRV D LQWHUYDORV UHJXODUHV RX TXDQGR R
ODFWHQWHDGRHFH$VWpFQLFDVGHDYDOLDomRVmRGHVFULWDVFRPGHWDOKHVQDVSUy[LPDVVHo}HV

6H IRU SRVVtYHO UHDOL]H R H[DPH ItVLFR GLDQWH GRV SDLV SDUD TXH HOHV SRVVDP LQWHUDJLU H ID]HU
SHUJXQWDV 2V SDLV DSUHVHQWDP FRP IUHTXrQFLDG~YLGDV HVSHFtILFDV VREUH D DSDUrQFLD ItVLFD GR
EHEr 3RU LVVR D HQXPHUDomR GRV DFKDGRV QRUPDLV SRGH WUDQTXLOL]DU RV SDLV e LPSRUWDQWH
REVHUYDU D IRUPDomR GR YtQFXOR GRV SDLV FRP R UHFpPQDVFLGR H TXmR EHP R UHFpPQDVFLGR VH
DFRSOD DR PDPLOR H VXJD GXUDQWH D PDPDGD 2 DOHLWDPHQWR PDWHUQR p R LGHDO GR SRQWR GH YLVWD
ILVLROyJLFR H SVLFROyJLFR PDV PXLWDV PmHV SUHFLVDP GH DMXGD H VXSRUWH QR LQtFLR $ GHWHFomR
SUHFRFH GH GLILFXOGDGHV H D RULHQWDomR DQWHFLSDWyULD DMXGDP D SURPRYHU H SUHVHUYDU D R
DOHLWDPHQWRPDWHUQR

2V UHFpPQDVFLGRV DSUHVHQWDP JUDX PDLRU GH UHVSRVWD XPD D GXDV KRUDV DSyV PDPDUHP
SHUtRGR HP TXH QmR HVWmR VDFLDGRV GHPDLV R TXH RV GHL[D PHQRV UHVSRQVLYRV QHP IDPLQWRV
GHPDLVRTXHRVGHL[DDJLWDGRV2H[DPHpLQLFLDGRFRPRUHFpPQDVFLGRHQYROWRQDPDQWDH
FRQIRUWiYHO DV SHoDV GH URXSD VmR UHWLUDGDV H UHFRORFDGDV DR ORQJR GR H[DPH ItVLFR SDUD
SURPRYHUHVWLPXODomRJUDGDWLYD6HRUHFpPQDVFLGRILFDUDJLWDGRSRGHVHUXVDGDXPDFKXSHWDRX
XPDPDPDGHLUDVHQmRDPDPHQWDomRPDWHUQD8PDRSomRpSHUPLWLUTXHRUHFpPQDVFLGRVXJXH
R VHX GHGR HQOXYDGR 7RUQH D HQYROYHU R UHFpPQDVFLGR QD PDQWD SRU WHPSR VXILFLHQWH SDUD
FRQFOXLUDVSDUWHVGRH[DPHTXHSUHFLVDPVHUUHDOL]DGDVFRPRHOHWUDQTXLOR
 $9$/,$d­2,0(',$7$$21$6&,0(172


2H[DPHORJRDSyVRQDVFLPHQWRpLPSRUWDQWHSDUDGHWHUPLQDUDVFRQGLo}HVJHUDLVRHVWDGRGH
GHVHQYROYLPHQWRTXDLVTXHUDQRUPDOLGDGHVGHGHVHQYROYLPHQWRJHVWDFLRQDOHHYHQWXDLVDOWHUDo}HV
FRQJrQLWDV 2 H[DPH SRGH UHYHODU GRHQoDV GH RULJHP FDUGtDFD UHVSLUDWyULD RX QHXUROyJLFD
$XVFXOWHDSDUWHDQWHULRUGRWyUD[FRPRHVWHWRVFySLRSDOSHRDEGRPHHLQVSHFLRQHDFDEHoDR
URVWR D FDYLGDGH RUDO RV PHPEURV D JHQLWiOLD H R SHUtQHR &RQVXOWH D VHomR $YDOLDomR GR
ODFWHQWHSDUDPDLVLQIRUPDo}HVVREUHRH[DPHItVLFRFRPSOHWR

Escala de Apgar. $ SRQWXDomR QD HVFDOD GH $SJDU p HVVHQFLDO DSyV R QDVFLPHQWR 6HXV FLQFR
FRPSRQHQWHVFODVVLILFDPDUHFXSHUDomRQHXUROyJLFDGRUHFpPQDVFLGRHVXDDGDSWDomRLPHGLDWDj
YLGDH[WUDXWHULQD$SRQWXDomRGHFDGDUHFpPQDVFLGRVHJXQGRRER[HDVHJXLUGHYHVHUIHLWDH
PLQDSyVRQDVFLPHQWR(VVDSRQWXDomREDVHLDVHHPXPDHVFDODGHSRQWRVRXSDUDFDGD
FRPSRQHQWH$SRQWXDomRWRWDOSRGHYDULDUGHD'HYHVHGHWHUPLQDUDSRQWXDomRDLQWHUYDORV
GHPLQDWpTXHHODDWLQMDRXPDLV6HDSRQWXDomR$SJDUHPPLQIRUGHRXPDLVSURVVLJD
SDUDXPH[DPHPDLVFRPSOHWR

6LVWHPDGHSRQWXD©¥R$SJDU

 3RQWXD©¥RDWULEX¯GD

6LQDOFO¯QLFR   

)UHTX¬QFLDFDUG¯DFD $XVHQWH  !

(VIRU©RUHVSLUDWµULR $XVHQWH /HQWRHLUUHJXODU %RPIRUWH

7¶QXVPXVFXODU )O£FLGR $OJXPDIOH[¥RGHEUD©RVHSHUQDV 0RYLPHQWRDWLYR

,UULWDELOLGDGHUHIOH[D $XV¬QFLDGHUHVSRVWD &DUHWD &KRURYLJRURVRHVSLUURRXWRVVH

&RORUD©¥R $]XODGDS£OLGD &RUSRUµVHRH[WUHPLGDGHVD]XODGDV 5µVHDHPWRGDDH[WHQV¥RGRFRUSR

3RQWXD©¥R$SJDUHPPLQ 3RQWXD©¥R$SJDUHPPLQ

D 1RUPDO D 1RUPDO

$OWRULVFRGHGLVIXQ©¥RVXEVHTXHQWHGR
 D $OJXPDGHSUHVV¥RGRVLVWHPDQHUYRVR D VLVWHPDQHUYRVRHGHRXWURVVLVWHPDVGH
µUJ¥RV

'HSUHVV¥RJUDYHH[LJLQGRPDQREUDVGH
D  
UHDQLPD©¥RLPHGLDWDV

5HD©¥R¢DVSLUD©¥RGDVQDULQDVFRPVHULQJDGHEXOER

Idade gestacional e peso ao nascimento. 2V UHFpPQDVFLGRV VmR FODVVLILFDGRV VHJXQGR VXD LGDGH
JHVWDFLRQDO GH PDWXULGDGH H R SHVR DR QDVFLPHQWR (VVDV FODVVLILFDo}HV DMXGDP D SUHYHU
SUREOHPDVFOtQLFRVHPRUELGDGH$OJXPDVGLUHWUL]HVGHSUiWLFDFOtQLFDVmRGLUHFLRQDGDVSDUDIHWRV
DQWHV GH XPD GHWHUPLQDGD LGDGH JHVWDFLRQDO RX DEDL[R GH SDUkPHWURV HVSHFtILFRV GH SHVR DR
QDVFLPHQWR

$LGDGHJHVWDFLRQDO,*EDVHLDVHHPVLQDLVQHXURPXVFXODUHVHVSHFtILFRVHHPFDUDFWHUtVWLFDV
ItVLFDVTXHPXGDPFRPDPDWXULGDGHJHVWDFLRQDO26LVWHPD GH 3RQWXDomR GH %DOODUG HVWLPD D
LGDGH JHVWDFLRQDO FRP XPD YDULDomR GH  VHPDQDV PHVPR HP IHWRV H[WUHPDPHQWH SUHPDWXURV
9HMDQDSiJLQDR6LVWHPDGH3RQWXDomRGH%DOODUGFRPSOHWRFRPLQVWUXo}HVSDUDDYDOLDUD
PDWXULGDGHQHXURPXVFXODUHItVLFD

&ODVVLILFD©¥RVHJXQGRLGDGHJHVWDFLRQDOHSHVRDRQDVFLPHQWR
,GDGHJHVWDFLRQDO  (;(03/26'($1250$/,'$'(6
&ODVVLILFD©¥R ,GDGHJHVWDFLRQDO

3U«WHUPR VHPDQDV 5HF«PQDVFLGRVSUHPDWXURVFRUUHPULVFRGH

FRPSOLFD©·HVDFXUWRSUD]RSULQFLSDOPHQWH
3U«WHUPRWDUGLR GHDVHPDQDV UHVSLUDWµULDVHFDUGLRYDVFXODUHVHGHVHTXHODVD
ORQJRSUD]RSH[FRPSURPHWLPHQWRGR
7HUPR GHDVHPDQDV QHXURGHVHQYROYLPHQWR

3µVWHUPR !VHPDQDV
3UHPDWXURVWDUGLRVFRUUHPULVFRFRQVLGHU£YHOGH
3HVRDRQDVFLPHQWR  FRPSOLFD©·HVUHODFLRQDGDVFRPD
SUHPDWXULGDGH
&ODVVLILFD©¥R 3HVR

3HVRH[WUHPDPHQWHEDL[RDRQDVFLPHQWR J
5HF«PQDVFLGRVSµVWHUPRFRUUHPULVFR
3HVRPXLWREDL[RDRQDVFLPHQWR J
DXPHQWDGRGHPRUWDOLGDGHRXPRUELGDGH
SHULQDWDOFRPRSRUH[HPSORDVIL[LDH
3HVREDL[RDRQDVFLPHQWR J
DVSLUD©¥RGHPHF¶QLR
3HVRQRUPDODRQDVFLPHQWR !J

8PD FODVVLILFDomR ~WLO PRVWUDGD D VHJXLU p GHULYDGD GD LGDGH JHVWDFLRQDO H GR SHVR DR
QDVFLPHQWRQDFXUYDGHFUHVFLPHQWRLQWUDXWHULQR

&ODVVLILFD©¥RGRUHF«PQDVFLGR
 &DWHJRULD $EUHYLDWXUD 3HUFHQWLO

3HTXHQRSDUDDLGDGHJHVWDFLRQDO 3,* R

$GHTXDGRSDUDDLGDGHJHVWDFLRQDO $,* DR

*UDQGHSDUDDLGDGHJHVWDFLRQDO *,* !R

$ ILJXUD D VHJXLU PRVWUD DV FXUYDV GR FUHVFLPHQWR LQWUDXWHULQR SDUD R R H R R SHUFHQWLV H
GHVWDFD DV GLIHUHQWHV FDWHJRULDV GH PDWXULGDGH SDUD UHFpPQDVFLGRV EDVHDGDV QD LGDGH
JHVWDFLRQDOHQRSHVRDRQDVFLPHQWR

)HWRV*,*SRGHPDSUHVHQWDU
GLILFXOGDGHVGXUDQWHRSDUWR
)LOKRVGHPXOKHUHVGLDEpWLFDV
IUHTXHQWHPHQWHVmR*,*H
SRGHPHYLGHQFLDU
DQRUPDOLGDGHVPHWDEyOLFDV
ORJRDSyVRQDVFLPHQWREHP
FRPRDQRPDOLDVFRQJrQLWDV

8PDFRPSOLFDomRFRPXPGRV
IHWRV*,*pDKLSRJOLFHPLDTXH
SRGHUHVXOWDUHPWUHPRUHV
LUULWDELOLGDGHFLDQRVHRXRXWUDV
DOWHUDo}HVFOtQLFDV

(PERUDHPPXLWRVIHWRV3,*
QmRVHMDGHWHFWDGDXPD

HWLRORJLDVmRFRQKHFLGRV
YiULRVIDWRUHVIHWDLV
 SODFHQWiULRVHPDWHUQRV

1tYHOGHFUHVFLPHQWRLQWUDXWHULQREDVHDGRQDLGDGHJHVWDFLRQDO
HQRSHVRDRQDVFLPHQWRGHUHFpPQDVFLGRVYLYRV~QLFRVHEUDQFRV2SRQWR$UHSUHVHQWDXPUHFpP
QDVFLGRSUHPDWXURHQTXDQWRRSRQWR%LQGLFDXPUHFpPQDVFLGRFRPSHVRDRQDVFLPHQWRVHPHOKDQWH
TXH p PDGXUR PDV SHTXHQR SDUD D LGDGH JHVWDFLRQDO 3,* $V FXUYDV GH FUHVFLPHQWR VmR
UHSUHVHQWDWLYDVGRRHGRRSHUFHQWLVGHWRGRVRVUHFpPQDVFLGRVGDDPRVWUD$GDSWDGDGH6ZHHW
<$&ODVVLILFDWLRQRIWKHORZELUWKZHLJKWLQIDQW,Q.ODXV0+)DQDURII$$&DUHRIWKHKLJKULVNQHRQDWH
UGHG3KLODGHOSKLD:%6DXQGHUV5HSURGX]LGRFRPDXWRUL]DomR


2V WUrV SUHPDWXURV PRVWUDGRV DGLDQWH QDVFHUDP FRP  3UHPDWXURV$,*VmRPDLV

VHPDQDV H SHVDUDP  J 3,*  J $,* H  J SURSHQVRVjVtQGURPHGH
*,* &DGD XPD GHVVDV FDWHJRULDV WHP WD[DV GH DQJ~VWLDUHVSLUDWyULDDSQHLD
PRUWDOLGDGH GLIHUHQWHV PDLRU SDUD RV IHWRV 3,* H *,* SHUVLVWrQFLDGHFDQDODUWHULDO
FRPVKXQWHVTXHUGDGLUHLWDH
SUHPDWXURVHPHQRUSDUDRV$,*DWHUPR LQIHFomR3UHPDWXURV3,*SUp
  WHUPRVmRPDLVSURSHQVRVD
DSUHVHQWDUDVIL[LDKLSRJOLFHPLD
 HKLSRFDOFHPLD

5HSURGX]LGD FRP DXWRUL]DomR GH .RURQHV 6% +LJK5LVN 1HZERUQ ,QIDQWV 7KH %DVLV IRU ,QWHQVLYH
1XUVLQJ&DUHWKHG6W/RXLV&90RVE\
1RYRVLVWHPDGHSRQWXDomRGH%DOODUGSDUDGHWHUPLQDomRGHLGDGHJHVWDFLRQDOHP
VHPDQDV
5HFpPQDVFLGRV FRP DVIL[LD RX REQXELODGRV SRU DJHQWHV DQHVWpVLFRV RX VXEVWkQFLDV SVLFRDWLYDV
DSUHVHQWDUmRSRQWXDo}HVPHQRUHVQRVFULWpULRVGHPDWXULGDGHQHXURPXVFXODU1HVVHVFDVRVRH[DPH
GHYH VHU UHSHWLGR  D  K DSyV R QDVFLPHQWR $ VRPD GDV SRQWXDo}HV SDUD WRGRV RV LWHQV GH
PDWXULGDGHQHXURPXVFXODUHItVLFDIRUQHFHXPDHVWLPDWLYDGDLGDGHJHVWDFLRQDOHPVHPDQDVXWLOL]DQGR
DHVFDODGHSRQWXDomRGHPDWXULGDGHQDSDUWHLQIHULRUGLUHLWDGDILJXUD5HGHVHQKDGDDSDUWLUGH%DOODUG
-/HWDO-3HGLDWU

$YDOLDomRDOJXPDVKRUDVDSyVRQDVFLPHQWR
'XUDQWH DV SULPHLUDV  K GH YLGD RV UHFpPQDVFLGRV GHYHP VHU VXEPHWLGRV D XP H[DPH
DEUDQJHQWH'HYHVHHVSHUDUXPDRXGXDVKRUDVDSyVDDPDPHQWDomRTXDQGRRUHFpPQDVFLGRp
PDLV UHDWLYR H VROLFLWDU DRV SDLV TXH SHUPDQHoDP QD VDOD GH H[DPH $ VHTXrQFLD GH H[DPH
PRVWUDGDDQWHULRUPHQWHGHYHVHUREHGHFLGD9HMDHP7pFQLFDVGHH[DPHSiJLQDRVGHWDOKHV
GRH[DPHItVLFRGHUHFpPQDVFLGRVHODFWHQWHV

2EVHUYH R UHFpPQDVFLGR VHP URXSDV 2EVHUYH D FRU R 1DDSUHVHQWDomRSpOYLFD

WDPDQKR DV SURSRUo}HV FRUSRUDLV DV FRQGLo}HV FRPSOHWDSHOYLSRGiOLFDRV
QXWULFLRQDLV H D SRVWXUD GR UHFpPQDVFLGR EHP FRPR DV MRHOKRVHVWmRIOH[LRQDGRVLQ
XWHURHQTXDQWRQD
LQFXUV}HV UHVSLUDWyULDV H RV PRYLPHQWRV GD FDEHoD H GRV
DSUHVHQWDomRSpOYLFD
PHPEURV$PDLRULDGRVUHFpPQDVFLGRVQRUPDLVHDWHUPR LQFRPSOHWDRVMRHOKRVHVWmR
DGRWD SRVLFLRQDPHQWR VLPpWULFR FRP RV PHPEURV HVWHQGLGRVLQXWHUR
VHPLIOH[LRQDGRV H DV SHUQDV SDUFLDOPHQWH DEGX]LGDV QD
DOWXUDGRTXDGULO

2EVHUYH D DWLYLGDGH PRWRUD HVSRQWkQHD GR EHEr FRP 7UHPRUHVHPUHSRXVRGLDV

DOWHUQkQFLDHQWUHIOH[mRHH[WHQVmRGHEUDoRVHSHUQDV2V DSyVRQDVFLPHQWRLQGLFDP
GHGRVGDVPmRVFRVWXPDPSHUPDQHFHUIOH[LRQDGRVFRPRV GRHQoDGRVLVWHPDQHUYRVR
FHQWUDOGHGLYHUVDVFDXVDV
SXQKRV FHUUDGRV PDV SRGHP VHU HVWLFDGRV FRP OHQWRV
SRVVtYHLVTXHYDULDPGHDVIL[LD
PRYLPHQWRVGHSRVWXUDDWHWRLGH%UHYHVWUHPRUHVGRFRUSR DDEVWLQrQFLDGHGURJDV
H GRV PHPEURV SRGHP VHU REVHUYDGRV GXUDQWH R FKRUR
YLJRURVRHDWpPHVPRHPUHSRXVR

(VWXGRV UHDOL]DGRV SHOR 'U 7 %HUU\ %UD]HOWRQ 0RYLPHQWRVDVVLPpWULFRVGH

GHPRQVWUDUDP D DPSOD JDPD GH FDSDFLGDGHV GRV UHFpP SHUQDVHEUDoRVHPTXDOTXHU
QDVFLGRV GHVFULWDV DGLDQWH 2V SDLV ILFDUmR PXLWR IHOL]HV PRPHQWRVXJHUHPGpILFLWV
QHXUROyJLFRVFHQWUDLVRX
HPFRQKHFrODV
SHULIpULFRVWRFRWUDXPDWLVPR
FRPRIUDWXUDGHFODYtFXODRX
 OHVmRGHSOH[REUDTXLDORX
DQRPDOLDVFRQJrQLWDV


'RTXH«FDSD]RUHF«PQDVFLGR

(OHPHQWRVFHQWUDLV 

2VUHF«PQDVFLGRVXWLOL]DPRVFLQFRVHQWLGRV3RUH[HPSORSUHIHUHPILWDURURVWRKXPDQRHYLUDPRURVWRDRRXYLUDYR]GRSDLRX
GDP¥H 5HF«PQDVFLGRVTXHQ¥RDSUHVHQWDPPXLWRV
 5HF«PQDVFLGRV V¥R LQGLY¯GXRV ¼QLFRV FRP DFHQWXDGDV GLIHUHQ©DV HP WHPSHUDPHQWR SHUVRQDOLGDGH FRPSRUWDPHQWR H GHVVHVFRPSRUWDPHQWRVSRGHPWHUGRHQ©D
DSUHQGL]DGR QHXUROµJLFDDEVWLQ¬QFLDGHGURJDVRXDOJXPD
GRHQ©DJUDYHFRPRXPDLQIHF©¥R
2VUHF«PQDVFLGRVLQWHUDJHPGLQDPLFDPHQWHFRPTXHPFXLGDGHOHVɥXPDYLDGHP¥RGXSOD

([HPSORVGRFRPSRUWDPHQWRFRPSOH[RGRUHF«PQDVFLGR

&DSDFLGDGHGHEORTXHDUGHPDQHLUDVHOHWLYDHSURJUHVVLYDHVW¯PXORV
+DELWXD©¥R
QHJDWLYRVSH[XPVRPUHSHWLWLYR

8PSURFHVVRUHF¯SURFRHGLQ¤PLFRGHLQWHUD©¥RHFULD©¥RGHY¯QFXORFRPR
9¯QFXOR
FXLGDGRU

5HJXOD©¥R
&DSDFLGDGHGHPRGXODURQ¯YHOGHYLJ¯OLDFRPRUHVSRVWDDGLIHUHQWHVJUDXVGH
GH
HVW¯PXORSH[DXWRFRQVROD©¥R
VLWXD©¥R

&DSDFLGDGHGHROKDUSDUDURVWRVYLUDUSDUDRXYLUYR]HVILFDUWUDQTXLOR
3HUFHS©¥R TXDQGRRXYHP¼VLFDDFRPSDQKDUREMHWRVFRORULGRVUHVSRQGHUDRWRTXHH
UHFRQKHFHUFKHLURVIDPLOLDUHV

$YDOLDomRGRODFWHQWH

 '(6(192/9,0(172

Desenvolvimento físico.2FUHVFLPHQWRItVLFRGXUDQWHRSULPHLURDQRGHYLGDpPDLVUiSLGRGRTXHHP
TXDOTXHURXWUDLGDGH$WpDQRGHLGDGHRSHVRDRQDVFLPHQWRWULSOLFDHDDOWXUDDXPHQWDHP


$SUy[LPDILJXUDPRVWUDDLPSUHVVLRQDQWHSURJUHVVmRGRGHVHQYROYLPHQWRQRODFWHQWH0HVPR
UHFpPQDVFLGRV WrP FDSDFLGDGHV VXUSUHHQGHQWHV FRPR IL[DU R ROKDU H DFRPSDQKDU URVWRV
KXPDQRV2GHVHQYROYLPHQWRQHXUROyJLFRSURJULGHGRFHQWURSDUDDSHULIHULD$VVLPRVUHFpP
QDVFLGRVDSUHQGHPRFRQWUROHGDFDEHoDDQWHVGRFRQWUROHGRWURQFRHRXVRGHEUDoRVHSHUQDV
DQWHVGRXVRGHPmRVHGHGRV

$DWLYLGDGHDH[SORUDomRHDPDQLSXODomRGRDPELHQWHFRQWULEXHPSDUDRDSUHQGL]DGR$WpRV
PHVHV ODFWHQWHV QRUPDLV OHYDQWDP D FDEHoD H EDWHP SDOPDV $Wp RV  PHVHV URODP QD FDPD
WHQWDPDOFDQoDUREMHWRVYROWDPDFDEHoDHPGLUHomRDYR]HVHjVYH]HVVHQWDPVHFRPDSRLR
&RPRFUHVFHQWHDXPHQWRGDFRRUGHQDomRSHULIpULFDWHQWDPSHJDUREMHWRVSDVViORVGHXPDPmR
SDUD RXWUD HQJDWLQKDU ILFDU GH Sp VHJXUDQGR HP DSRLRV H EULQFDU FRP REMHWRV EDWHQGR QHOHV H
DJDUUDQGRRV8PEHErGHDQRMiHVWiGHSpHFRORFDQGRWXGRRTXHYrQDERFD
Desenvolvimento cognitivo e da linguagem.$H[SORUDomRIDYRUHFHRDXPHQWRGRHQWHQGLPHQWRVREUHVL
PHVPR H R DPELHQWH 2V ODFWHQWHV DSUHQGHP UHODo}HV HQWUH FDXVD H HIHLWR S H[ EDODQoDU XP
FKRFDOKRSURGX]EDUXOKRGHVFREUHPDSHUPDQrQFLDGRVREMHWRVHRXVRGHXWHQVtOLRV$WpRV
PHVHV SRGHP UHFRQKHFHU R H[DPLQDGRU FRPR XP HVWUDQKR TXH PHUHFH XPD FRRSHUDomR
GHVFRQILDGD EXVFDP FRQIRUWR FRP RV SDLV GXUDQWH R H[DPH H PDQLSXODP DWLYDPHQWH REMHWRV DR
DOFDQFH S H[ R HTXLSDPHQWR GR PpGLFR 2 GHVHQYROYLPHQWR GD OLQJXDJHP SURVVHJXH GHVGH
UXtGRVVHPVLJQLILFDGRDRVPHVHVDWpEDOEXFLRDRVPHVHVHXPDDWUrVSDODYUDVDWpDQR

Desenvolvimento social e emocional. $ FRPSUHHQVmR VREUH VL PHVPR H D IDPtOLD WDPEpP HYROXL $V
WDUHIDVVRFLDLVLQFOXHPDIRUPDomRGHYtQFXORDOLJDomRFRPRVFXLGDGRUHVHDFRQILDQoDGHTXH
HOHV DWHQGHUmR jV QHFHVVLGDGHV GR EHEr 2V WHPSHUDPHQWRV YDULDP $OJXQV ODFWHQWHV VmR
SUHYLVtYHLV DGDSWiYHLV H UHVSRQGHP GH PDQHLUD SRVLWLYD D HVWtPXORV QRYRV RXWURV QmR VmR
DPLJiYHLV H UHVSRQGHP GH PRGR LQWHQVR RX QHJDWLYR 8PD YH] TXH R DPELHQWH DIHWD R
GHVHQYROYLPHQWRVRFLDOREVHUYHDVLQWHUDo}HVGRODFWHQWHFRPTXHPFXLGDGHOH

0DUFRVGRGHVHQYROYLPHQWRGXUDQWHRSULPHLURDQRGHYLGD
 

'LUHWUL]HVJHUDLV

(PSUHJXHPpWRGRVDGHTXDGRVDRJUDXGHGHVHQYROYLPHQWR 6HYRFrQmRFRQVHJXLUGLVWUDLU
FRPR GLVWUDomR H EULQFDGHLUD SDUD H[DPLQDU R ODFWHQWH RODFWHQWHDFRUGDGRRXLQGX]L
&RPR RV ODFWHQWHV SUHVWDP DWHQomR D XPD FRLVD GH FDGD ORDSUHVWDUDWHQomRHPDOJXP
YH] p UHODWLYDPHQWH IiFLO FRQFHQWUDU D DWHQomR GR ODFWHQWH REMHWRVHXURVWRRXXPVRP
FRQVLGHUHDSRVVLELOLGDGHGH
HPDOJXPDFRLVDDOpPGRH[DPHTXHHVWiVHQGRUHDOL]DGR GpILFLWYLVXDORXDXGLWLYR
'LVWUDLD R ODFWHQWH FRP XP REMHWR HP PRYLPHQWR XPD
ODQWHUQDXPMRJRGHHVFRQGHHVFRQGHFyFHJDVRXTXDOTXHU
WLSRGHEDUXOKR

'LFDVSDUDRH[DPHGHODFWHQWHV

$SUR[LPHVHGRODFWHQWHGHPRGRJUDGXDOHXVHXPEULQTXHGRRXREMHWRSDUDGLVWUD¯OR

5HDOL]HJUDQGHSDUWHGRH[DPHFRPRODFWHQWHQRFRORGRSDLRXGDP¥H

)DOHEDL[RFRPREHE¬HLPLWHRVVRQVGREHE¬SDUDDWUDLUDDWHQ©¥R

6HREHE¬HVWLYHUɪHVWUDQKRɫVROLFLWHSDUDHOHVHUDOLPHQWDGRDQWHVGHSURVVHJXLU

6ROLFLWHLQIRUPD©·HVDRVSDLVVREUHRVSRQWRVIRUWHVGRODFWHQWHSDUDREWHUGDGRVVREUHRGHVHQYROYLPHQWRHRVFXLGDGRVGRVSDLV

1¥RHVSHUHID]HUXPH[DPHɪGRVS«V¢FDEH©DɫHPXPDVHTX¬QFLDSUHGHWHUPLQDGD'HL[HRH[DPHGDERFDHGDVRUHOKDVSDUDRILQDO
 &RPHFHFRPRODFWHQWHVHQWDGRRXGHLWDGRQRFRORGHXP 0XLWDVFRQGLo}HVQHXUROyJLFDV
GRV SDLV 6H R ODFWHQWH HVWLYHU FDQVDGR FRP IRPH RX SRGHPVHUGLDJQRVWLFDGDV
GRHQWHVROLFLWHDRSDLTXHVHJXUHREHErFRQWUDRSUySULR GXUDQWHHVVDSDUWHJHUDOGR
H[DPHItVLFReSRVVtYHOSRU
WyUD[ 1mR VH HVTXHoD GH GHL[DU EULQTXHGRV XP FREHUWRU
H[HPSORGHWHFWDUKLSRWRQLD
RX RXWURV REMHWRV IDPLOLDUHV j PmR 8P EHEr FRP IRPH FRQGLo}HVDVVRFLDGDVD
SUHFLVDVHUDOLPHQWDGRSULPHLUR LUULWDELOLGDGHRXVLQDLVGH
SDUDOLVLDFHUHEUDOYHMDH[DPH
QHXUROyJLFRDGLDQWH

$REVHUYDomRFXLGDGRVDGHXPODFWHQWHDFRUGDGRHVHQWDGRQRFRORGRSDLRXGDPmHFRQVHJXH
GHWHFWDU DQRUPDOLGDGHV SRWHQFLDLV WDLV FRPR KLSRWRQLD RX KLSHUWRQLD FRQGLo}HV DVVRFLDGDV D
DOWHUDomR GD FRORUDomR GD SHOH FRPR LFWHUtFLD RX FLDQRVH DEDORV PXVFXODUHV RX SUREOHPDV
UHVSLUDWyULRV

e LPSRUWDQWH REVHUYDU DV LQWHUDo}HV HQWUH RV SDLV H R $REVHUYDomRGDFRPXQLFDomR

ODFWHQWH 2 SDL H D PmH VmR DIHWXRVRV FRP R ODFWHQWH" GRODFWHQWHFRPRVSDLVSRGH
9HULILTXH D PDQHLUD FRPR RV SDLV VHJXUDP PRELOL]DP UHYHODUDQRUPDOLGDGHVFRPR
UHWDUGRGRGHVHQYROYLPHQWR
YHVWHP H FRQIRUWDP R ODFWHQWH $YDOLH H FRPHQWH DV
UHWDUGRGDOLQJXDJHPGpILFLWV
LQWHUDo}HV SRVLWLYDV WDLV FRPR R RUJXOKR HYLGHQWH QD IDFH DXGLWLYRVRXYtQFXOR
GDPmHYHMDLPDJHPDQWHULRU LQDGHTXDGRFRPRVSDLV'D
PHVPDPDQHLUDHVVDV
2VODFWHQWHVGHPRGRJHUDOQmRID]HPREMHo}HVDVHUHP REVHUYDo}HVSRGHPLGHQWLILFDU
GHVSLGRV3DUDQmRWHUVXUSUHVDVHVHYHUPROKDGRYDOHD SDGU}HVGHFXLGDGRPDO
DGDSWDGRVTXHSRGHPGHULYDU
SHQDQmRWLUDUDIUDOGDGXUDQWHDPDLRUSDUWHGRH[DPHHVy
GHGHSUHVVmRRXVXSRUWHVRFLDO
ID]rORSDUDH[DPLQDUDJHQLWiOLDRUHWRHRVTXDGULV LQDGHTXDGRGDPmH

Avaliação dos marcos do desenvolvimento

8PDYH]TXHYRFrGHVHMDWHUDFHVVRDRPHOKRUGHVHPSHQKR 0XLWDVGRHQoDVSURYRFDP
GR ODFWHQWH R LGHDO p YHULILFDU VH HOH DOFDQoRX RV PDUFRV UHWDUGRVHPXPRXPDLV
GR GHVHQYROYLPHQWR DR ILQDO GD HQWUHYLVWD LPHGLDWDPHQWH PDUFRVGRGHVHQYROYLPHQWR
1DPDLRULDGDVFULDQoDVFRP
DQWHVGRH[DPH(VVHLQWHUO~GLRGH³EULQFDGHLUDV´WDPEpP UHWDUGRGRGHVHQYROYLPHQWRDV
DXPHQWDDFRRSHUDomRGXUDQWHRH[DPH2VSURILVVLRQDLVGH FDXVDVQmRVmRFRQKHFLGDV
$OJXPDVFDXVDVFRQKHFLGDV
VD~GH H[SHULHQWHV FRQVHJXHP LQWHUFDODU R H[DPH GR
LQFOXHPDQRUPDOLGDGHGR
GHVHQYROYLPHQWR FRP RXWUDV SDUWHV GR H[DPH ItVLFR $ GHVHQYROYLPHQWRHPEULRQiULR
ILJXUD0DUFRVGRGHVHQYROYLPHQWRGXUDQWHRSULPHLURDQR SH[DJUDYRSUpQDWDO
GH YLGD QD SiJLQD  PRVWUD DOJXQV PDUFRV GR GRHQoDVKHUHGLWiULDVH
JHQpWLFDVSH[HUURVLQDWRV
GHVHQYROYLPHQWR ItVLFR RX PRWRU FRJQLWLYR RX GH
DQRUPDOLGDGHVJHQpWLFDV
OLQJXDJHP H VRFLRHPRFLRQDO GXUDQWH R SULPHLUR DQR GH SUREOHPDVDPELHQWDLVHVRFLDLV
YLGD &RPR H[HPSOR R ODFWHQWH QD LPDJHP DGLDQWH SH[HVWLPXODomR
FRQVHJXH VHQWDU VHP DSRLR ID]HU D SLQoD FRP SROHJDU H LQVXILFLHQWHSUREOHPDVGD
GHGR H LQGLFD R TXH GHVHMD ± XP QtYHO FRPSDWtYHO FRP  JUDYLGH]RXSHULQDWDLVSH[
LQVXILFLrQFLDSODFHQWiULD
PHVHV SUHPDWXULGDGHHGRHQoDGD
LQIkQFLDSH[LQIHFomR
 WUDXPDWLVPRGRHQoDFU{QLFD

$ $$3 SUHFRQL]D TXH RV SURILVVLRQDLV GH VD~GH

HPSUHJXHPXPDIHUUDPHQWDSDGURQL]DGDGHUDVWUHDPHQWRGRGHVHQYROYLPHQWRGHVGHRVSULPHLURV
PHVHVGHYLGD

8PDIHUUDPHQWDWUDGLFLRQDOSDUDGHWHUPLQDURVPDUFRVGR 6HXPODFWHQWHFRRSHUDWLYRQmR
GHVHQYROYLPHQWRQDIDVHGHODFWHQWHHQDLQIkQFLDpRWHVWH FRUUHVSRQGHUDDOJXQVLWHQVGR
GH UDVWUHDPHQWR GR GHVHQYROYLPHQWR GH 'HQYHU 'HQYHU ''67pSRVVtYHOTXHKDMD
'HYHORSPHQWDO 6FUHHQLQJ 7HVW ± ''67 (OH IRL DOJXPUHWDUGRGR
GHVHQYROYLPHQWR,VVRH[LJHD
HODERUDGR SDUD GHWHFWDU UHWDUGRV GR GHVHQYROYLPHQWR HP DSOLFDomRGHWHVWHVHDYDOLDo}HV
TXDWURGRPtQLRVGHVGHRQDVFLPHQWRDWpRVDQRVGHLGDGH PDLVSUHFLVRV
SHVVRDO±VRFLDO PRWRU ILQR±DGDSWDWLYR OLQJXDJHP H PRWRU
JURVVHLUR 2 ''67 QmR PHGH LQWHOLJrQFLD VHQGR XPD
PHGLGD GDV FRQTXLVWDV GH GHVHQYROYLPHQWR QHVVDV TXDWUR FDWHJRULDV 7UDWDVH GH XP WHVWH PXLWR
HVSHFtILFR GH PRGR TXH FULDQoDV QRUPDLV VHUmR FODVVLILFDGDV FRPR QRUPDLV HPERUD QmR VHMD
PXLWRVHQVtYHORXVHMDPXLWDVFULDQoDVFRPUHWDUGROHYHGRGHVHQYROYLPHQWRVmRFODVVLILFDGDV
FRPRQRUPDLV
 0XLWDV RXWUDV IHUUDPHQWDV GH UDVWUHDPHQWR GR 8PODFWHQWHRXXPDFULDQoD
GHVHQYROYLPHQWRPDLVQRYDVMiIRUDPSURSRVWDVHWHVWDGDV SHTXHQDFXMDVKDELOLGDGHVGH
HP YiULDV SRSXODo}HV (QWUH DV IHUUDPHQWDV ~WHLV HVWmR R GHVHQYROYLPHQWRWHQKDP
$JHV DQG 6WDJHV 4XHVWLRQQDLUH D (DUO\ /DQJXDJH DWLQJLGRXPSODW{RXTXH
HVWHMDPIRUDGHVHTXrQFLDSRGH
0LOHVWRQH 6FDOH (/0 6FDOH D 0RGLILHG &KHFNOLVW IRU WHUDXWLVPRRXSDUDOLVLD
$XWLVP LQ 7RGGOHUV 0&+$7 H D 3DUHQWV¶ (YDOXDWLRQ RI FHUHEUDO
'HYHORSPHQWDO 6WDWXV 3('6 'H PRGR JHUDO HVVDV
IHUUDPHQWDV DSUHVHQWDP VHQVLELOLGDGH H HVSHFLILFLGDGH HP
WRUQRGHDYHMDR&DStWXORTXHDLQGDpPDLVEDL[DGRTXHDVFDUDFWHUtVWLFDVGHH[DPHV
FOtQLFRV WtSLFRV ,VVR VH GHYH j DPSOD JDPD GR GHVHQYROYLPHQWR QRUPDO j GLILFXOGDGH GH
DYDOLDomRGRGHVHQYROYLPHQWRHjHVFDVVH]GHLQWHUYHQo}HV

(VVDV IHUUDPHQWDV GH UDVWUHDPHQWR VmR XWLOL]DGDV FRPR FRPSOHPHQWR DR H[DPH DEUDQJHQWH GR
GHVHQYROYLPHQWR $ VXVSHLWD GH UHWDUGR MXVWLILFD XP DSURIXQGDPHQWR GD DYDOLDomR 1R FDVR GH
SUHPDWXURVpSUHFLVRDMXVWDURVPDUFRVGHGHVHQYROYLPHQWRHVSHUDGRVSDUDDLGDGHJHVWDFLRQDO
DWpDSUR[LPDGDPHQWHRVPHVHVGHLGDGH

)OX[RJUDPDGHUDVWUHDPHQWRGRGHVHQYROYLPHQWRSHGLiWULFR
 

3URPRomRHRULHQWDomRGDVD~GH_(YLGrQFLDVH
UHFRPHQGDo}HV

$$$3HXPJUXSRGHHVSHFLDOLVWDVR%ULJKW)XWXUHVUHFRPHQGDPRDJHQGDPHQWRGHFRQVXOWDVGH
VXSHUYLVmRGHVD~GHSXHULFXOWXUDDRQDVFLPHQWRDRVDGLDVGHYLGDHDRVH
PHVHV $V FRQVXOWDV GH SXHULFXOWXUD FRQVWLWXHP RSRUWXQLGDGHV SDUD UHVSRQGHU DRV
TXHVWLRQDPHQWRV GRV SDLV DYDOLDU R FUHVFLPHQWR H R GHVHQYROYLPHQWR GR ODFWHQWH UHDOL]DU R
H[DPHItVLFRFRPSOHWRHIRUQHFHURULHQWDomRDQWHFLSDWyULD$RULHQWDomRDQWHFLSDWyULDDSURSULDGD
SDUDDLGDGHLQFOXLKiELWRVHFRPSRUWDPHQWRVVDXGiYHLVFRPSHWrQFLDVRFLDOSDUDRVFXLGDGRUHV
UHODFLRQDPHQWRVIDPLOLDUHVHLQWHUDo}HVFRPDFRPXQLGDGH
 (VVDV FRQVXOWDV UHSUHVHQWDP XPD RSRUWXQLGDGH GH H[SRU D HYROXomR GR GHVHQYROYLPHQWR
VDXGiYHO H EHPVXFHGLGR 2 IDWR GH RV ODFWHQWHV HP JHUDO HVWDUHP EHP GXUDQWH HVVDV FRQVXOWDV
DXPHQWDDTXDOLGDGHGDH[SHULrQFLD2VSDLVFRVWXPDPVHUUHFHSWLYRVDVXJHVW}HVVREUHSURPRomR
GHVD~GHTXHSRGHPWHULQIOXrQFLDVLPSRUWDQWHVHDORQJRSUD]RSDUDDFULDQoDHDIDPtOLD6mR
QHFHVViULDVKDELOLGDGHVEHPVHGLPHQWDGDVGHHQWUHYLVWDSDUDFRQYHUVDUFRPRVIDPLOLDUHVVREUH
DV HVWUDWpJLDV SDUD RWLPL]DU D VD~GH H R EHPHVWDU GRV ODFWHQWHV 8PD UHYLVmR GRV FRPSRQHQWHV
FUtWLFRV GH XPD FRQVXOWD GH SXHULFXOWXUD GHYH VHU IHLWD TXDQGR R ODFWHQWH WHP  PHVHV 'HYHVH
DGHTXDURFRQWH~GRDRQtYHODSURSULDGRGRGHVHQYROYLPHQWRGRODFWHQWH

&RPSRQHQWHVGDFRQVXOWDGHSXHULFXOWXUDSDUDRODFWHQWHFRPPHVHVGHYLGD

2ULHQWD©¥RDQWHFLSDWµULD

+¡ELWRVHFRPSRUWDPHQWRVVDXG¡YHLV
&RQYHUVDFRPRVSDLV 3UHYHQ©¥RGHOHV·HVHDJUHVV¥R
$ERUGHSUHRFXSD©·HVTXHVWLRQDPHQWRVGRV
&DGHLUDHVSHFLDOSDUDWUDQVSRUWHHPDXWRPµYHODQGDGRU
SDLV
YHQHQRVH[SRVL©¥RDWDEDFR
2IHUH©DRULHQWD©¥R ([DPHI¯VLFR
1XWUL©¥R
&ROKDKLVWµULDVRFLDO 5HDOL]HH[DPHFXLGDGRVRLQFOXLQGRSDU¤PHWURVGH
FUHVFLPHQWRFRPSHUFHQWLVSDUDDLGDGH $PDPHQWD©¥R RX DOLPHQWD©¥R SRU PDPDGHLUD
$YDOLHGHVHQYROYLPHQWRVHJXUDQ©DVD¼GHRUDO DOLPHQWRV VµOLGRV UHVWUL©¥R GH VXFRV SUHYHQ©¥R GD
UHODFLRQDPHQWRVIDPLOLDUHVFRPXQLGDGH 5DVWUHDPHQWR DVIL[LDH[FHVVRGHDOLPHQWD©¥R

9LV¥RHDXGL©¥RPHGLDQWHH[DPHSRVVLYHOPHQWH 6D¼GHEXFDO

$YDOLD©¥RGRGHVHQYROYLPHQWR
KHPDWµFULWRHQ¯YHLVVDQJX¯QHRVGHFKXPERVHKRXYHU
8WLOL]HXPIRUPXO£ULRSDGURQL]DGRSDUD
GHWHUPLQDUVHRODFWHQWHDWLQJLXRVPDUFRVGH
GHVHQYROYLPHQWR
$YDOLHSRQWXD©¥RSDUDPDUFRVGHUHIHU¬QFLD
SHODDQDPQHVH
'HWHUPLQHSRQWXD©¥RSDUDPDUFRVGHUHIHU¬QFLD
SHORH[DPHI¯VLFR

DOWRULVFRSHVTXLVDUIDWRUHVGHULVFRVRFLDLV 2ULHQWH SDUD R ODFWHQWH Q¥R VHU DOLPHQWDGR FRP
PDPDGHLUDQREHU©RIO¼RUHVFRYD©¥RGHQW£ULD
,PXQL]D©¥R
,QWHUD§£RSDLVǾODFWHQWH
9HULILTXHFDUW¥RGHYDFLQD©¥R
3URPRYDGHVHQYROYLPHQWR
5HOD§µHVIDPLOLDUHV
7HPSRSDUDVLPHVPRVEDE£V
,QWHUD§£RFRPDFRPXQLGDGH
&UHFKHVUHFXUVRV
 

7pFQLFDVGHH[DPH

Ectoscopia e sinais vitais

$GHWHUPLQDomRGDVGLPHQV}HVFRUSRUDLVHDDYDOLDomRGRV 9DORUHVDFLPDGHGRLVGHVYLRV
VLQDLVYLWDLVVmRFUXFLDLV([LVWHPWDEHODVFRPRVSDGU}HV SDGUmRSDUDDLGDGHRXDFLPD
GRRSHUFHQWLORXDEDL[RGR
GH SUHVVmR DUWHULDO FRPSULPHQWRDOWXUD SHVR FRUSRUDO
RSHUFHQWLOFRQVWLWXHP
tQGLFH GH PDVVD FRUSRUDO ,0& D SDUWLU GRV  DQRV GH LQGLFDomRSDUDXPDDYDOLDomR
LGDGH H FLUFXQIHUrQFLD FUDQLDQD 2V VLQDLV YLWDLV H DV PDLVGHWDOKDGD(VVHVGHVYLRV
SURSRUo}HV FRUSRUDLV GD FULDQoD H[DPLQDGD GHYHP VHU SRGHPVHURVSULPHLURVH
FRPSDUDGRVFRPRVSDGU}HVHVSHFtILFRVSDUDDLGDGHSRLV ~QLFRVLQGLFDGRUHVGHGRHQoD
YHMDH[HPSORVQDLQWHUQHW
HOHV PXGDP GUDVWLFDPHQWH FRQIRUPH D FULDQoD FUHVFH 0XLWRVHVSHFLDOLVWDV
$OJXQV SHGLDWUDV WDPEpP DYDOLDP UHJXODUPHQWH D UHFRPHQGDPDXWLOL]DomRGH
RFRUUrQFLDGHGRUXVDQGRHVFDODVSDGURQL]DGDV GRLVGHVYLRVSDGUmRQRV
JUiILFRVGHFUHVFLPHQWRGD
 206SDUDDYDOLDUR
FUHVFLPHQWR
Crescimento somático.$VPHGLGDVGRFUHVFLPHQWRVmRXPGRV
PDLV LPSRUWDQWHV LQGLFDGRUHV GD VD~GH QR ODFWHQWH 2V GHVYLRV SRGHP IRUQHFHU XPD LQGLFDomR
SUHFRFHGHXPSUREOHPDVXEMDFHQWH&RPSDUHRVSDUkPHWURVGHFUHVFLPHQWRFRPYDORUHVQRUPDLV
SDUDVH[RHLGDGHDVVLPFRPRDVPHGLGDVSUpYLDVGDPHVPDFULDQoDSDUDDYDOLDUDVWHQGrQFLDV

2V SDUkPHWURV GH FUHVFLPHQWR GHYHP VHU DIHULGRV 8PDFDXVDFRPXPGHGHVYLR

PHWLFXORVDPHQWH HPSUHJDQGR WpFQLFD FRQVLVWHQWH H DSDUHQWHGRFUHVFLPHQWR
LGHDOPHQWH DV PHVPDV EDODQoDV SDUD YHULILFDU R SHVR VRPiWLFRVmRRVHUURVGH
FRUSRUDOHDDOWXUD PHGLGDHPSDUWHDWULEXtYHLVj
GLILFXOGDGHGHREWHQomRHP
EHErVRXFULDQoDVLQTXLHWDV$

DQRUPDOLGDGHGHYHVHU
FRQILUPDGDSRUXPDVHJXQGD
 PHGLGD

$V IHUUDPHQWDV PDLV LPSRUWDQWHV SDUD DYDOLDU R (PERUDPXLWRVODFWHQWHV

FUHVFLPHQWR VRPiWLFR VmR DV WDEHODV GH FUHVFLPHQWR QRUPDLVFUX]HPRVSHUFHQWLV
SXEOLFDGDVSHOR1DWLRQDO&HQWHUIRU+HDOWK6WDWLVWLFVYHMD QRVJUiILFRVGHFUHVFLPHQWR
R VLWH QD LQWHUQHW H SHOD 2UJDQL]DomR 0XQGLDO GD 6D~GH XPDPRGLILFDomRDEUXSWDRX
VLJQLILFDWLYDGRFUHVFLPHQWR
ZZZZKRLQW 7RGRV RV JUiILFRV LQFOXHP DOWXUD SHVR H SRGHLQGLFDUGRHQoDVLVWrPLFD
FLUFXQIHUrQFLDFUDQLDQDVHJXQGRDLGDGHFRPXPFRQMXQWR HPGLYHUVRVVLVWHPDVGH
SDUDFULDQoDVGHDWpPHVHVHXPVHJXQGRFRQMXQWRSDUD yUJmRV
DV LGDGHV GH  D  DQRV ([LVWHP WDPEpP JUiILFRV SDUD (QWUHDVDQRUPDOLGDGHVTXH
SORWDJHP GH SHVR VHJXQGR DOWXUD EHP FRPR WDEHODV GH SRGHPFDXVDUGHVYLRGRV
,0& (VVHV JUiILFRV GH FUHVFLPHQWR DSUHVHQWDP OLQKDV GH SDGU}HVGHFUHVFLPHQWRQRUPDO
SHUFHQWLO TXH LQGLFDP D SRUFHQWDJHP GH FULDQoDV QRUPDLV HVWmRVtQGURPHGH'RZQH
SUHPDWXULGDGH([LVWHP
DFLPDHDEDL[RGDPHGLGDQDFULDQoDHVSHFtILFDVHJXQGRD
JUiILFRVGHFUHVFLPHQWR
LGDGH FURQROyJLFD ([LVWHP JUiILFRV GH FUHVFLPHQWR HVSHFtILFRVSDUDFULDQoDVFRP
HVSHFLDLVSDUDSUHPDWXURVTXHFRUULJHPRVUHVXOWDGRVSDUD FRQGLo}HVHVSHFLDLVFRPR
DSUHPDWXULGDGH VtQGURPHGH'RZQHVtQGURPH
GH7XUQHU
$WXDOPHQWH D $$3 R 1,+ H R &'& SUHFRQL]DP TXH RV
SHGLDWUDVXWLOL]HPRVJUiILFRVLQWHUQDFLRQDLVGHFUHVFLPHQWR
GHGD206SDUDFULDQoDVFRPDPHVHVGHYLGD2VJUiILFRVGHFUHVFLPHQWRGR&'&
GHYHPVHUXWLOL]DGRVQRV(8$SDUDDDYDOLDomRGHFULDQoDVFRPDDQRVGHLGDGH

Comprimento | Altura.1RFDVRGHFULDQoDFRPPHQRVGH 5HGXomRGDYHORFLGDGHGH

DQRVGHWHUPLQDVHRFRPSULPHQWRGRFRUSRFRORFDQGRVHD FUHVFLPHQWRHYLGHQFLDGDSRU
FULDQoD HP GHF~ELWR GRUVDO HP XP TXDGUR RX EDQGHMD GH TXHGDGRSHUFHQWLOGHDOWXUDQD
FXUYDGHFUHVFLPHQWRSRGH
PHGLGD FRQIRUPH PRVWUDGR D VHJXLU $ PHQVXUDomR GLUHWD
LQGLFDUGRHQoDFU{QLFD$
GRODFWHQWHXVDQGRXPDILWDPpWULFDpLQH[DWDDPHQRVTXH FRPSDUDomRFRPRVSDGU}HV
XPDVVLVWHQWHVHJXUHDFULDQoDSDUDGDFRPRVTXDGULVHRV QRUPDLVpHVVHQFLDOSRLVD
MRHOKRVHPH[WHQVmR YHORFLGDGHGHFUHVFLPHQWR
FRVWXPDVHUPHQRUQRVHJXQGR
 DQRGHYLGDGRTXHQRSULPHLUR

'RHQoDVFU{QLFDVTXH
 SURYRFDPUHGXomRGDDOWXUDRX
GRFRPSULPHQWRLQFOXHP
GRHQoDVQHXUROyJLFDVUHQDLV
FDUGtDFDVHHQGyFULQDV

$V FXUYDV GH YHORFLGDGH GH FUHVFLPHQWR VmR ~WHLV HP 5HWDUGRGRGHVHQYROYLPHQWR

FULDQoDVPDLVYHOKDVHVSHFLDOPHQWHQDTXHODVFRPVXVSHLWD GHVFUHYHRJDQKRLQDGHTXDGR
GHWUDQVWRUQRVHQGyFULQRV GHSHVRSDUDDLGDGH2V
LQGLFDGRUHVFRPXQVVmRD
Peso corporal. 3HVH RV ODFWHQWHV GLUHWDPHQWH HP XPD FUHVFLPHQWRDEDL[RGRR
SHUFHQWLOSDUDDLGDGHE
EDODQoD HVSHFtILFD SDUD HVVD IDL[D HWiULD 2V ODFWHQWHV
GHYHP HVWDU YHVWLGRV DSHQDV FRP XPD IUDOGD RX VHU TXHGDVXSHULRUDTXDUWLVHP
SHVDGRVVHPURXSD PHVHVRXFUD]mR
SHVRFRPSULPHQWRDOWXUD
6H R SHVR GR ODFWHQWH IRU LQHVSHUDGR H DEDL[RGRRSHUFHQWLO$V
FDXVDVLQFOXHPIDWRUHV
VLJQLILFDWLYDPHQWHGLIHUHQWHGRHVSHUDGRWRUQHDUHDOL]DU DPELHQWDLVHSVLFRVVRFLDLV
DPHQVXUDomRSDUDJDUDQWLUVXDH[DWLGmR DOpPGHGLYHUVDVGRHQoDV
JDVWULQWHVWLQDLVQHXUROyJLFDV
 FDUGtDFDVHQGyFULQDVUHQDLVH
RXWUDV


Circunferência craniana.$FLUFXQIHUrQFLDFUDQLDQDGHYHVHU 7DPDQKRSHTXHQRGDFDEHoD

PHGLGD GXUDQWH RV SULPHLURV  DQRV GH YLGD PDV HVVD SRGHVHUGHYLGRDIHFKDPHQWR
PHGLGD SRGH VHU ~WLO HP TXDOTXHU LGDGH SDUD DYDOLDU R SUHPDWXURGDVVXWXUDVRX
PLFURFHIDOLD$PLFURFHIDOLD
FUHVFLPHQWR GD FDEHoD $ FLUFXQIHUrQFLD FUDQLDQD QRV
SRGHVHUIDPLOLDURXVHFXQGiULD
ODFWHQWHV UHIOHWH D YHORFLGDGH GH FUHVFLPHQWR GR FUkQLR H DYiULDVDQRUPDOLGDGHV
GRFpUHEUR FURPRVV{PLFDVLQIHFo}HV
FRQJrQLWDVGRHQoDV
PHWDEyOLFDVPDWHUQDVHOHV}HV
QHXUROyJLFDV

7DPDQKRH[FHSFLRQDOPHQWH
JUDQGHGDFDEHoD!R
SHUFHQWLORXGHVYLRVSDGUmR
DFLPDGDPpGLDLQGLFD
PDFURFHIDOLDTXHSRGHVHU
VHFXQGiULDDKLGURFHIDOLD
KHPDWRPDVXEGXUDORX
FRQGLo}HVUDUDVFRPRWXPRU
Sinais vitais
FHUHEUDORXVtQGURPHV
KHUHGLWiULDV$PHJDORHQFHIDOLD
Pressão arterial. $ REWHQomR GH OHLWXUDV DFXUDGDV GH IDPLOLDUpXPDFRQGLomR
SUHVVmR DUWHULDO QRV ODFWHQWHV FRQVWLWXL XP GHVDILR PDV IDPLOLDUEHQLJQDDVVRFLDGDD
DLQGDDVVLPHVVDPHGLGDpLPSRUWDQWHHGHYHVHUUHDOL]DGD FUHVFLPHQWRHQFHIiOLFRQRUPDO
SHOR PHQRV XPD YH] GXUDQWH HVVD IDVH GD YLGD 6HUi
QHFHVViULR HPSUHJDU DV KDELOLGDGHV GH GLVWUDomR RX
EULQFDGHLUDVFRQIRUPHPRVWUDGRQDIRWRDRODGR

$ PHGLGD PDLV IDFLOPHQWH XWLOL]DGD GD SUHVVmR DUWHULDO VLVWyOLFD QRV ODFWHQWHV p SHOR PpWRGR
'RSSOHU TXH GHWHFWD YLEUDo}HV GR IOX[R VDQJXtQHR DUWHULDO FRQYHUWHDV HP QtYHO GH SUHVVmR
DUWHULDOVLVWyOLFDHGHSRLVDVWUDQVPLWHSDUDXPGLVSRVLWLYRGHOHLWXUDGLJLWDO
 $SUHVVmRDUWHULDOVLVWyOLFDDXPHQWDJUDGXDOPHQWHGXUDQWH $VFDXVDVGHKLSHUWHQVmR
D LQIkQFLD $ SUHVVmR VLVWyOLFD QRUPDO GR VH[R PDVFXOLQR DUWHULDOSHUVLVWHQWHHPUHFpP
SRU H[HPSOR p GH FHUFD GH  PP+J DR QDVFLPHQWR  QDVFLGRVLQFOXHPGRHQoDGD
DUWpULDUHQDOHVWHQRVH
PP+J FRP  PrV GH YLGD H  PP+J DRV  PHVHV YHMD
WURPERVHPDOIRUPDo}HV
VLWHV GR &'& RX GD 2UJDQL]DomR 0XQGLDO GD 6D~GH QD UHQDLVFRQJrQLWDVHFRDUWDomR
LQWHUQHW GDDRUWD

Frequência de pulso. $ IUHTXrQFLD FDUGtDFD GRV ODFWHQWHV p

PDLVVHQVtYHODRVHIHLWRVGHGRHQoDH[HUFtFLRHHPRomRGRTXHDGRVDGXOWRV

)UHTX¬QFLDVFDUG¯DFDVGRQDVFLPHQWRDW«DQR
,GDGH )UHTX¬QFLDFDUG¯DFDP«GLD 9DULD©¥R (PERUDDtaquicardia sinusalSRVVDVH
DFRPSDQKDUGHIUHTX¬QFLDGHSXOVR
'RQDVFLPHQWRDP¬V  'HD PXLWRHOHYDGDDW«ESPXPD
IUHTX¬QFLDGHSXOVRU£SLGDGHPDLVSDUD
VHUFRQWDGDJHUDOPHQWH!ESP
'HDPHVHV  'HD
LQGLFDtaquicardia supraventricular
paroxística.

%UDGLFDUGLDSRGHVHUGHYLGDDLQJHVW¥R
GHVXEVW¤QFLDVSVLFRDWLYDVKLSR[LD
'HDPHVHV  'HD GRHQ©DVLQWUDFUDQLDQDVRXQHXUROµJLFDV
RXUDUDPHQWHDUULWPLDFDUG¯DFDFRP
EORTXHLRDWULRYHQWULFXODU%$9

0XLWDVYH]HVpGLItFLOGHWHUPLQDUFRPH[DWLGmRDIUHTXrQFLDGRSXOVRHPXPODFWHQWHTXHHVWHMD
VHFRQWRUFHQGR$PHOKRUHVWUDWpJLDpSDOSDUDVDUWpULDVIHPRUDLVQDUHJLmRLQJXLQDORXDVDUWpULDV
LQJXLQDLVQDIRVVDDQWHFXELWDORXHQWmRDXVFXOWDURFRUDomR

Frequência respiratória. $ IUHTXrQFLD UHVSLUDWyULD GRV )UHTXrQFLDVUHVSLUDWyULDV

ODFWHQWHVWHPXPDIDL[DGHYDULDomRPDLRUHUHVSRQGHFRP H[WUHPDPHQWHUiSLGDVRX
PDLRULQWHQVLGDGHDGRHQoDH[HUFtFLRHHPRomRDH[HPSOR VXSHUILFLDLVVmRREVHUYDGDVHP
UHFpPQDVFLGRVFRP
GR TXH DFRQWHFH FRP D IUHTXrQFLD FDUGtDFD HP
FDUGLRSDWLDFLDQyWLFDHVKXQW
FRPSDUDomRFRPDGRVDGXOWRV$IUHTXrQFLDGHLQFXUV}HV GLUHLWD±HVTXHUGDHDFLGRVH
UHVSLUDWyULDV SRU PLQXWR YDULD HQWUH  H  QR UHFpP PHWDEyOLFD
QDVFLGR
 

$IUHTXrQFLDUHVSLUDWyULDYDULDFRQVLGHUDYHOPHQWHDFDGD )HEUHSRGHHOHYDUDV
PRPHQWRQRUHFpPQDVFLGRFRPDOWHUQkQFLDHQWUHSHUtRGRV IUHTXrQFLDVUHVSLUDWyULDVQRV
GHUHVSLUDomRUiSLGDHOHQWD$IUHTXrQFLDUHVSLUDWyULDFRP ODFWHQWHVHPDWpLQFXUV}HV
D FULDQoD GRUPLQGR p D PDLV FRQILiYHO 'XUDQWH R VRQR UHVSLUDWyULDVSRUPLQXWRSDUD
FDGDJUDXFHQWtJUDGRGHIHEUH
5(0 FRPSDUDWLYDPHQWH DR VRQR WUDQTXLOR D IUHTXrQFLD
UHVSLUDWyULD SRGH VHU DWp  LQFXUV}HV SRU PLQXWR PDLV
UiSLGD 2 SDGUmR UHVSLUDWyULR GHYH VHU REVHUYDGR SRU XP PtQLPR GH  V 1R ODFWHQWH H QD
SULPHLUD LQIkQFLD SUHGRPLQD D UHVSLUDomR GLDIUDJPiWLFD H D PRYLPHQWDomR WRUiFLFD p
PtQLPD7DTXLSQHLDpDIUHTXrQFLDUHVSLUDWyULDDFLPDGDYDULDomRQRUPDO

2VSRQWRVGHFRUWHFXWRIIVSDUDGHILQLomRGHWDTXLSQHLD 7DTXLSQHLDHDXPHQWRGR

GR QDVFLPHQWR DWp  PHVHV GH YLGD VmR IUHTXrQFLDV HVIRUoRUHVSLUDWyULRQRODFWHQWH
UHVSLUDWyULDVVXSHULRUHVDSRUPLQXWRHGRVPHVHVDRV VmRVLQDLVGHGRHQoDGDVYLDV
UHVSLUDWyULDVEDL[DVWDLVFRPR
 PHVHV IUHTXrQFLDV UHVSLUDWyULDV VXSHULRUHV D  SRU
EURQTXLROLWHRXSQHXPRQLD
PLQXWR

Temperatura.&RPRDIHEUHpPXLWRFRPXPQDVFULDQoDVp )HEUH!ƒ&HPODFWHQWHV

FUXFLDO GHWHUPLQDU D WHPSHUDWXUD H[DWD TXDQGR H[LVWH D FRPPHQRVGHDPHVHVGH
VXVSHLWD GH LQIHFomR FRODJHQRVH RX GRHQoD PDOLJQD 2V YLGDSRGHVHUXPVLQDOGH
LQIHFomRJUDYHRXGRHQoD
UHJLVWURVGDWHPSHUDWXUDD[LODURXGDSHOHFRPILWDWpUPLFD
(VVHVODFWHQWHVGHYHPVHU
QRVODFWHQWHVHQDVFULDQoDVQmRVmRDFXUDGRVHQTXDQWRDV SURQWDPHQWHDYDOLDGRV
WHPSHUDWXUDVQRPHDWRDF~VWLFRRVmR

$ WpFQLFD SDUD GHWHUPLQDU D WHPSHUDWXUD UHWDO p UHODWLYDPHQWH VLPSOHV 8P GRV PpWRGRV p
LOXVWUDGRDVHJXLU&RORTXHRODFWHQWHHPGHF~ELWRYHQWUDODIDVWHDVQiGHJDVFRPRSROHJDUHR
LQGLFDGRU GH XPD GDV PmRV H FRP D RXWUD LQWURGX]D FXLGDGRVDPHQWH XP WHUP{PHWUR UHWDO EHP
OXEULILFDGRDWpXPDSURIXQGLGDGHGHDFP0DQWHQKDRWHUP{PHWURQRORFDOSRUSHORPHQRV
PLQ

$ WHPSHUDWXUD FRUSRUDO HP ODFWHQWHV H FULDQoDV p PHQRV $QVLHGDGHSRGHHOHYDUD

FRQVWDQWH GR TXH QRV DGXOWRV $ WHPSHUDWXUD UHWDO PpGLD p WHPSHUDWXUDFRUSRUDOGH
PDLRU QR ODFWHQWH H QD SULPHLUD LQIkQFLD JHUDOPHQWH QD FULDQoDV2DJDVDOKDPHQWR
H[FHVVLYRGHODFWHQWHVSRGH
IDL[DGHƒ&DWpDSyVRVDQRVGHLGDGH$WHPSHUDWXUD
HOHYDUDWHPSHUDWXUDGDSHOH
FRUSRUDO SRGH IOXWXDU DWp ƒ& HP XP ~QLFR GLD PDVQmRDWHPSHUDWXUDFHQWUDO
DSUR[LPDQGRVH GH ƒ& HP FULDQoDV QRUPDLV
SULQFLSDOPHQWHDRILQDOGDWDUGHHDSyVDWLYLGDGHYLJRURVD


 $LQVWDELOLGDGHWpUPLFDHPXP
UHFpPQDVFLGRSRGHVHU
FRQVHTXrQFLDGHVHSVH
DQRUPDOLGDGHVPHWDEyOLFDVH
RXWUDVDIHFo}HVJUDYHV
/DFWHQWHVPDLRUHVUDUDPHQWH
PDQLIHVWDPLQVWDELOLGDGHGD
WHPSHUDWXUDFRUSRUDO

/DFWHQWHVIHEULVFRPPHQRVGH
 PHVHVGHYLGDH
SRWHQFLDOPHQWHHQIHUPRV
 SRGHPWHULQIHFomREDFWHULDQD
JUDYHHGHYHPWHUVXD
WHPSHUDWXUDFRUSRUDO

GHWHUPLQDGDFRPXP
WHUP{PHWURUHWDO


Pele
Inspeção.([DPLQHDSHOHGRUHFpPQDVFLGRRXODFWHQWHFRP $OJXQVUHFpPQDVFLGRVFRP
FXLGDGR SDUD LGHQWLILFDU PDUFDV QRUPDLV H RXWUDV SROLFLWHPLDDSUHVHQWDPSHOH
SRWHQFLDOPHQWH DQRUPDLV $V ILJXUDV QR ER[H $FKDGRV FRPFRORUDomRUR[R
DYHUPHOKDGD
FXWkQHRVGRUHFpPQDVFLGRSiJLQDVHPRVWUDPDV
PDUFDV QRUPDLV $ SHOH GR UHFpPQDVFLGR WHP
FDUDFWHUtVWLFDVGHWH[WXUDHDVSHFWR~QLFDV4XDQWRjWH[WXUDpPDFLDHOLVDSRLVpPDLVILQDGR
TXH D SHOH GH FULDQoDV PDLV YHOKDV 1RV SULPHLURV  PLQ DSyV R QDVFLPHQWR R UHFpPQDVFLGR
QRUPDOVRIUHHYROXomRGHFLDQRVHJHQHUDOL]DGDDWpFRORUDomRUyVHD1RVUHFpPQDVFLGRVFRPSHOH
PDLVFODUDpFRPXPQDVSULPHLUDVDKGHYLGDXPDYHUPHOKLGmRHULWHPDWRVDTXHFRQIHUHj
SHOH R DVSHFWR GH XPD ³ODJRVWD IHUYLGD´ )LQGR HVVH SHUtRGR SUHGRPLQD D FRU UyVHD SiOLGD
QRUPDO

$V DOWHUDo}HV YDVRPRWRUDV QD GHUPH H QR WHFLGR &XWLVPDUPRUDWDpSURHPLQHQWH

VXEFXWkQHR ± XPD UHVSRVWD DR UHVIULDPHQWR RX H[SRVLomR HPSUHPDWXURVHHPUHFpP
FU{QLFD DR FDORU UDGLDQWH ± SRGHP SURYRFDU XP DVSHFWR QDVFLGRVFRPKLSRWLUHRLGLVPR
PRVTXHDGR UHWLFXODGR H D]XODGR FXWLV PDUPRUDWD FRQJrQLWRHVtQGURPHGH'RZQ
6HDDFURFLDQRVHQmR
SULQFLSDOPHQWH QR WURQFR QRV EUDoRV H QRV PHPEURV GHVDSDUHFHUQDVSULPHLUDVK
LQIHULRUHV (VVD UHVSRVWD DR IULR SRGH GXUDU PHVHV HP DSyVRQDVFLPHQWRRXFRPR
ODFWHQWHV QRUPDLV $ DFURFLDQRVH XPD FRORUDomR D]XODGD DTXHFLPHQWRGHYHVHU
GH PmRV H SpV DR VHUHP H[SRVWRV DR IULR p PXLWR FRPXP DYHQWDGDFDUGLRSDWLDFRQJrQLWD
FLDQyWLFD
QRVQRVSULPHLURVGLDVGHYLGDHSRGHWRUQDUDRFRUUHUQR
LQtFLR GD IDVH GH ODFWHQWH ¬V YH]HV DSDUHFH QRV UHFpP
QDVFLGRVLQWHQVDPXGDQoDGDFRUGDSHOHGLVFURPLDGHDUOHTXLPDVVRFLDGDDFLDQRVHWUDQVLWyULD
GH PHWDGH GR FRUSR RX GH XP PHPEUR SRVVLYHOPHQWH VHFXQGiULD D LQVWDELOLGDGH YDVFXODU
WHPSRUiULD

2EVHUYH TXH D TXDQWLGDGH GH PHODQLQD QD SHOH GRV &LDQRVHFHQWUDOHPXPODFWHQWH

UHFpPQDVFLGRV YDULD H DIHWD D SLJPHQWDomR 2V UHFpP RXFULDQoDGHTXDOTXHULGDGH
QDVFLGRVQHJURVSRGHPH[LELUGHLQtFLRSHOHPDLVFODUDGR OHYDQWDDVXVSHLWDGH
TXH PDLV WDUGH QD YLGD H[FHWR QRV OHLWRV XQJXHDLV H QD FDUGLRSDWLDFRQJrQLWD$PHOKRU
iUHDSDUDSHVTXLVDUFLDQRVH
JHQLWiOLD TXH Mi VmR HVFXURV DR QDVFLPHQWR 8PD FHQWUDOpDOtQJXDRXDPXFRVD
SLJPHQWDomR HVFXUD RX D]XODGD QDV QiGHJDV H QD UHJLmR RUDOHQmRRVOHLWRVXQJXHDLV
ORPEDU p FRPXP HP UHFpPQDVFLGRV GH DVFHQGrQFLD RXDVH[WUHPLGDGHVGRV
DIULFDQD DVLiWLFD H PHGLWHUUkQHD (VVD DOWHUDomR GD PHPEURV
FRORUDomR DQWLJDPHQWH GHQRPLQDGD PDQFKD PRQJyOLFD
UHVXOWDGHFpOXODVSLJPHQWDGDVQDVFDPDGDVSURIXQGDVGDSHOHWRUQDPVHPHQRVSHUFHSWtYHLVFRP
D LGDGH H FRVWXPDP GHVDSDUHFHU GXUDQWH D LQIkQFLD e LPSRUWDQWH GHVFUHYHU HVVDV UHJL}HV
SLJPHQWDGDVSDUDHYLWDUSUHRFXSDo}HVIXWXUDVFRPHTXLPRVHV

$RQDVFLPHQWRWRGRRFRUSRpUHYHVWLGRSRUSHORILQRH /HV}HVSLJPHQWDGDVFDVWDQKR
UDOR GHQRPLQDGRODQXJHP HVSHFLDOPHQWH RV RPEURV H DV FODUDVDFPDR
FRVWDV(VVHVSHORVFDHPQDVSULPHLUDVVHPDQDVGHYLGDH QDVFLPHQWRFRQVWLWXHPDV
PDQFKDVFDIpFRPOHLWH/HV}HV
VmR PDLV DFHQWXDGRV QRV SUHPDWXURV $ HVSHVVXUD GR
LVRODGDVQmRVmRLPSRUWDQWHV
FDEHORYDULDPXLWRHQWUHUHFpPQDVFLGRVHQmRpLQGLFDWLYD SRUpPOHV}HVP~OWLSODVFRP
GRFUHVFLPHQWRIXWXURGRVFDEHORV7RGRRFDEHORRULJLQDO ERUGDVOLVDVVXJHUHP
FDL HP DOJXQV PHVHV H p VXEVWLWXtGR SRU FDEHOR QRYR jV QHXURILEURPDWRVHYHMDR
YH]HVGHFRUGLIHUHQWH 4XDGUR(UXSo}HVH
DFKDGRVFXWkQHRVFRPXQVHP
UHFpPQDVFLGRVHODFWHQWHV


,QVSHFLRQH DWHQWDPHQWH R UHFpPQDVFLGR j SURFXUD GH 'HVFDPDomRFXWkQHDp

YiULRVTXDGURVFXWkQHRVFRPXQV$RQDVFLPHQWRRFRUSRp UDUDPHQWHVLQDOGH
UHFREHUWR SRU XP PDWHULDO EUDQFR FDVHRVR GHQRPLQDGR LQVXILFLrQFLDFLUFXODWyULD
YpUQL[ FDVHRVR FRPSRVWR SRU VHER H FpOXODV HSLWHOLDLV SODFHQWiULDRXLFWLRVH
FRQJrQLWD
GHVFDPDGDV$OJXQVUHFpPQDVFLGRVDSUHVHQWDPHGHPDQDV
PmRVQRVSpVQDVSHUQDVQRS~ELVHQRVDFUR(VVHHGHPD
GHVDSDUHFH HP DOJXQV GLDV 8PD GHVFDPDomR VXSHUILFLDO GD SHOH p REVHUYDGD FRP PXLWD
IUHTXrQFLDHQWUHHKDSyVRQDVFLPHQWRSULQFLSDOPHQWHQRVUHFpPQDVFLGRVSyVWHUPR!
VHPDQDVGHJHVWDomR


 

2 SURILVVLRQDO GH VD~GH GHYH VHU FDSD] GH LGHQWLILFDU 7DQWRRHULWHPDWy[LFRTXDQWR

TXDWUR DIHFo}HV GHUPDWROyJLFDV FRPXQV QRV UHFpP DPHODQRVHSXVWXODUSRGHPWHU
QDVFLGRV PLOLiULD UXEUD HULWHPD Wy[LFR PHODQRVH XPDVSHFWRVHPHOKDQWHj
HUXSomRYHVLFXORSXVWXORVD
SXVWXODU H PLOLiULD 7RGDV VmR HQFRQWUDGDV QR ER[H
SDWROyJLFDGDLQIHFomRSHOR
$FKDGRV FXWkQHRV GR UHFpPQDVFLGR SiJLQDV  H  YtUXVKHUSHVVLPSOHV+69RX
1HQKXPDGHODVWHPLPSRUWkQFLDFOtQLFD GDLQIHFomRFXWkQHDSRU
6WDSK\ORFRFFXVDXUHXV


3HVTXLVH HYHQWXDLV VLQDLV GH WUDXPDWLVPR SHOR SURFHVVR 7XIRVGHSHORVQDOLQKDPpGLD

GH SDUWR H XVR GH IyUFHSV RX DVSLUDomR HVVHV VLQDLV VREUHDUHJLmRORPERVVDFUD
GHVDSDUHFHPPDVFRQVWLWXHPLQGLFDomRSDUDXPFXLGDGRVR VXJHUHPGHIHLWRGDPHGXOD
HVSLQDO
H[DPHQHXUROyJLFR

Icterícia. ([DPLQH H SDOSH FRP FXLGDGR D SHOH GR UHFpP ,FWHUtFLDQDVSULPHLUDVKGH

QDVFLGR SDUD DYDOLDU R QtYHO GH LFWHUtFLD $ LFWHUtFLD YLGDSRGHVHUVHFXQGiULDD
³ILVLROyJLFD´ QRUPDO TXH RFRUUH HP  GRV UHFpP GRHQoDKHPROtWLFDGRUHFpP
QDVFLGR
QDVFLGRV DSDUHFH QR VHJXQGR RX WHUFHLUR GLD GH YLGD
DWLQJH VXD LQWHQVLGDGH Pi[LPD QR TXLQWR GLD GH YLGD H $LFWHUtFLDGHDSDUHFLPHQWR
FRVWXPD GHVDSDUHFHU QR SUD]R GH  VHPDQD $ PHOKRU WDUGLRRXLFWHUtFLDTXHSHUVLVWH
PDQHLUD GH GHWHFWDU D LFWHUtFLD p VRE D OX] QDWXUDO GR GLD DOpPGHDVHPDQDVOHYDQWD
DVXVSHLWDGHGRHQoDKHSiWLFD
HP YH] GD OX] DUWLILFLDO $ LFWHUtFLD GR UHFpPQDVFLGR RXREVWUXomRELOLDU
SDUHFH HYROXLU GD FDEHoD DWp RV SpV FRP LFWHUtFLD PDLV
LQWHQVD QD UHJLmR VXSHULRU GR FRUSR H FRORUDomR DPDUHOD
PHQRVLQWHQVDQRVPHPEURVLQIHULRUHV

3DUDGHWHFWDULFWHUtFLDDSHOHGHYHVHUFRPSULPLGDYHMD 8PDFDXVDIUHTXHQWHGH

DV ILJXUDV D VHJXLU SDUD GHVWDFDU D FRU UyVHD RX LFWHUtFLDGXUDQWHDVGXDV
DFDVWDQKDGD QRUPDO 8P ³FODUHDPHQWR´ DPDUHODGR LQGLFD SULPHLUDVVHPDQDVGHYLGDpR
DOHLWDPHQWRPDWHUQRPDV
LFWHUtFLD
JHUDOPHQWHGHVDSDUHFH
HVSRQWDQHDPHQWH

 2XWUD WpFQLFD FRQVLVWH HP FRPSULPLU XPD OkPLQD GH YLGUR FRQWUD D SHOH SDUD HVYD]LDU R OHLWR
FDSLODUHREVHUYDURFRQWUDVWHGHFRU

$FRPSUHVVmRGDSHOHSRVVLELOLWDRPHOKRUUHFRQKHFLPHQWRGDFRORUDomRDPDUHODGDLFWHUtFLD2UHFpP
QDVFLGRjHVTXHUGDQmRDSUHVHQWDLFWHUtFLDGLJQDGHQRWDHQTXDQWRRUHFpPQDVFLGRjGLUHLWDDSUHVHQWD
QtYHO VDQJXtQHR GH ELOLUUXELQD GH  PJGO  NjPROO 'H )OHWFKHU 0 3K\VLFDO 'LDJQRVLV LQ
1HRQDWRORJ\3KLODGHOSKLD/LSSLQFRWW5DYHQ


Marcas vasculares.8PDGDVPDUFDVYDVFXODUHVFRPXQVpD 8PDOHVmRHVFXUDRXYLROiFHD

³SODFDHPVDOPmR´WDPEpPFRQKHFLGDFRPRQHYRVLPSOHV XQLODWHUDO³PDQFKDGRYLQKR
QHYR WHODJLHFWiVLFR RX KHPDQJLRPD FDSLODU (VVDV SODFDV GR3RUWR´VLWXDGDQD
GLVWULEXLomRGRUDPRRIWiOPLFR
UyVHDV FODUDV LUUHJXODUHV H FKDWDV YHMD SiJLQD 
GRQHUYRWULJrPHRSRGHVHU
FRVWXPDP VHU REVHUYDGDV QD UHJLmR SRVWHULRU GR SHVFRoR XPVLQDOGHVtQGURPHGH
³ELFDGD GH FHJRQKD´ QDV SiOSHEUDV VXSHULRUHV QD WHVWD 6WXUJH:HEHUTXHHVWi
RX QR OiELR VXSHULRU ³EHLMR GH DQMR´ 1mR VmR QHYRV DVVRFLDGDDFULVHVFRQYXOVLYDV
YHUGDGHLURV PDV VmR FRQVHTXrQFLD GH GLVWHQVmR FDSLODU KHPLSDUHVLDJODXFRPDH
UHWDUGRPHQWDO
(PJHUDOFRVWXPDPGHVDSDUHFHUDWpDQRGHLGDGHHVmR
UHFREHUWRVSRUSHORV

Palpação. $ SHOH GR UHFpPQDVFLGR RX ODFWHQWH GHYH VHU (GHPDVLJQLILFDWLYRGDVPmRVH

SDOSDGD SDUD DYDOLDU R JUDX GH KLGUDWDomR WXUJRU 8PD SpVHPXPDUHFpPQDVFLGDp
SUHJDGHSHOHIURX[DPHQWHDGHULGDGDSDUHGHDEGRPLQDOp VXJHVWLYRGHVtQGURPHGH
7XUQHU
URODGDHQWUHRSROHJDUHRLQGLFDGRUSDUDGHWHUPLQDUDVXD
FRQVLVWrQFLD $ SHOH GH UHFpPQDVFLGRV H ODFWHQWHV EHP 'HVLGUDWDomRpXPSUREOHPD
KLGUDWDGRVUHWRUQDjVXDSRVLomRQRUPDOGHLPHGLDWRDRVHU FRPXPHPODFWHQWHV$VFDXVDV
OLEHUDGD $ GHPRUD QR UHWRUQR RFRUUH HP JHUDO HP XVXDLVVmRLQJHVWmR
LQVXILFLHQWHRXSHUGDH[FHVVLYD
FULDQoDVFRPGHVLGUDWDomRVLJQLILFDWLYD GHOtTXLGRVSRUGLDUUHLD

$FKDGRVFXW¤QHRVGRUHF«PQDVFLGR
 $FKDGRVGHVFUL©¥R $FKDGRVGHVFUL©¥R

$IHF©·HVQ¥RSDWROµJLFDVFRPXQV 

,FWHU¯FLD

$FURFLDQRVH
$WRQDOLGDGHD]XODGDDSDUHFHHPJHUDOQDVSDOPDVGDVP¥RVHVRODVGRVS«V$
FDUGLRSDWLDFRQJªQLWDFLDQ³WLFDSRGHHYLGHQFLDUVHFRPLQWHQVDDFURFLDQRVH
$LFWHU¯FLDILVLROµJLFDRFRUUHHQWUHRVHJXQGRHRTXLQWRGLDVGHYLGDHHYROXLGDFDEH©DDW«
RVS«VDW«DWLQJLUVXDLQWHQVLGDGHP£[LPD$LFWHU­FLDH[WUHPDSRGHLQGLFDUSURFHVVR
KHPRO­WLFRRXGRHQ§DELOLDURXKHS¡WLFD

(UXS©·HVFXW¤QHDVEHQLJQDVFRPXQV 

(ULWHPDWµ[LFR
0LOL£ULDUXEUD
$SDUHFHHPJHUDOHQWUHRRHRRGLDVGHYLGDHFRQVLVWHHPP£FXODVHULWHPDWRVDV
9HV¯FXODVGLVSHUVDVVREUHXPDEDVHHULWHPDWRVDHPJHUDOQRURVWRHQRWURQFR
FRPYHV¯FXODVFHQWUDLVSXQWLIRUPHVGLVSHUVDVGLIXVDPHQWHSRUWRGRRFRUSR7HPXP
GHFRUUHQWHVGDREVWUX©¥RGRVGXFWRVGDVJO¤QGXODVVXGRU¯SDUDVHVVHTXDGURGHVDSDUHFH
DVSHFWRVHPHOKDQWHDRGHSLFDGDVGHPRVTXLWR$VXDHWLRORJLD«GHVFRQKHFLGDPDV
HVSRQWDQHDPHQWHHPDOJXPDVVHPDQDV
GHVDSDUHFHPHPDW«VHPDQDDSµVRQDVFLPHQWR

0LOL£ULD
0HODQRVHSXVWXODU
ƒUHDVHOHYDGDVEUDQFDVHOLVDVGRWDPDQKRGHFDEH©DVGHDOILQHWHVHPHULWHPD
2EVHUYDGDFRPPDLRUIUHTX¬QFLDHPUHF«PQDVFLGRVHODFWHQWHVQHJURVHVWDHUXS©¥R FLUFXQGDQWHVLWXDGDVQRQDUL]QRTXHL[RHQDWHVWD5HVXOWDGDUHWHQ©¥RGHVHERQDV
PDQLIHVWDVHDRQDVFLPHQWRFRPRSHTXHQDVYHV¯FXODVRXS¼VWXODVVLWXDGDVVREUHXPD DEHUWXUDVGDVJO¤QGXODVVHE£FHDV(PERUDRFDVLRQDOPHQWHVHMDHQFRQWUDGDM£SRU
EDVHPDFXODUDFDVWDQKDGDSRGHGXUDUY£ULRVPHVHV RFDVL¥RGRQDVFLPHQWRFRVWXPDVXUJLUQDVSULPHLUDVVHPDQDVGHYLGDHGHVDSDUHFHUQR
GHFRUUHUGHPDLVDOJXPDVVHPDQDV

0DUFDVGHQDVFLPHQWREHQLJQDV 

3ODFDSDOSHEUDO
3ODFDHPVDOP¥R
(VVDPDUFDGHQDVFLPHQWRGHVDSDUHFHHPJHUDOQRSULPHLURDQRGHYLGD
7DPE«PGHQRPLQDGDɪELFDGDGHFHJRQKDɫHVVDPDUFDUµVHDHVSDOKDGDGHVDSDUHFH
 FRPDLGDGH

0DQFKDVFDI«FRPOHLWH
0DQFKDVPRQJµOLFDV
/HV·HVSLJPHQWDGDVFDVWDQKRFODUDVTXHHPJHUDODSUHVHQWDPERUGDVEHPGHILQLGDVH
V¥RXQLIRUPHV2EVHUYDGDVHPPDLVGHQRVUHF«PQDVFLGRVQHJURV6HKRXYHUPDLV 0DLVFRPXQVHPUHF«PQDVFLGRVGHSHOHHVFXUD‹LPSRUWDQWHUHJLVWUDUVXDRFRUU¬QFLD
GHFLQFRPDQFKDVFDI©FRPOHLWHFRQVLGHUHRGLDJQ³VWLFRGHQHXURILEURPDWRVH9HMD SDUDTXHQ¥RVHMDPGHSRLVFRQIXQGLGDVFRPHTXLPRVHV
WDPE©PR4XDGUR(UXS©·HVHDFKDGRVFXW¤QHRVFRPXQVHPUHF«PQDVFLGRVH
ODFWHQWHV

Cabeça
$FDEHoDGRUHFpPQDVFLGRSRGHSDUHFHUPXLWRJUDQGHQD $IRQWDQHODSRVWHULRU
YHUGDGH HOD UHSUHVHQWD  GR FRPSULPHQWR GR FRUSR H DXPHQWDGDSRGHVHUREVHUYDGD
XP WHUoR GH VHX SHVR (VVDV SURSRUo}HV PXGDP GH PRGR QRKLSRWLUHRLGLVPRFRQJrQLWR
TXH DR DWLQJLU D LGDGH DGXOWD D FDEHoD UHSUHVHQWD  GR $VREUHSRVLomRGRVRVVRV
FRPSULPHQWRGRFRUSRHFHUFDGHGRSHVRFRUSRUDO FUDQLDQRVQDVVXWXUDVDR
QDVFLPHQWRGHQRPLQDGD
 DFDYDOJDPHQWRPROGLQJ
UHVXOWDGDSDVVDJHPGDFDEHoD
 GRIHWRSHORFDQDOGRSDUWR
GHVDSDUHFHQRSUD]RGHGLDV


Suturas e fontanelas. (VSDoRV GH WHFLGR PHPEUDQiFHR $IRQWDQHODWHQVDHDEDXODGDp

GHQRPLQDGRVVXWXUDVVHSDUDPRVRVVRVGRFUkQLRXQVGRV REVHUYDGDHPODFWHQWHVFRP
RXWURV $V iUHDV RQGH DV SULQFLSDLV VXWXUDV ID]HP DXPHQWRGDSUHVVmR
LQWUDFUDQLDQDHSRGHVHU
LQWHUVHFomRQDVSRUo}HVDQWHULRUHSRVWHULRUGRFUkQLRVmR
SURYRFDGDSRULQIHFo}HVGR
FRQKHFLGDV FRPR IRQWDQHODV IRQWtFXORV VHJXQGR D VLVWHPDQHUYRVRFHQWUDO
7HUPLQRORJLD $QDW{PLFD e HVVHQFLDO R H[DPH FXLGDGRVR GRHQoDQHRSOiVLFDRX
GDVVXWXUDVHIRQWDQHODVYHUDILJXUDDVHJXLU KLGURFHIDOLDREVWUXomRGD
FLUFXODomRGROtTXLGR
$V VXWXUDV DSDUHFHP j SDOSDomR FRPR FKDQIUDGXUDV FHUHEURVSLQDOQRVYHQWUtFXORV
FHUHEUDLVYHMDR4XDGUR
HQTXDQWR DV IRQWDQHODV VHULDP FRPR FRQFDYLGDGHV PROHV
$QRUPDOLGDGHVGDFDEHoD
$R QDVFLPHQWR D IRQWDQHOD DQWHULRU IRQWtFXOR DQWHULRU
VHJXQGR D 7HUPLQRORJLD $QDW{PLFD WHP  D  FP GH
GLkPHWUR H FRVWXPD IHFKDU HQWUH  H  PHVHV GH LGDGH  HQWUH  H  PHVHV $ IRQWDQHOD
SRVWHULRU IRQWtFXOR SRVWHULRU VHJXQGR D 7HUPLQRORJLD $QDW{PLFD WHP  D  FP GH GLkPHWUR DR
QDVFLPHQWRHFRVWXPDIHFKDUDWpRVPHVHVGHYLGD

2IHFKDPHQWRSUHFRFHGDV
IRQWDQHODVIRQWtFXORVSRGH
VHUFRQVHTXHQWHDPLFURFHIDOLD
DFUDQLRVVLQRVWRVHRXD
DOJXPDVDQRUPDOLGDGHV
PHWDEyOLFDV

2IHFKDPHQWRWDUGLRGDV
IRQWDQHODVIRQWtFXORV
FRVWXPDVHUXPDYDULDQWH
QRUPDOPDVSRGHVHU
FRQVHTXHQWHDKLSRWLUHRLGLVPR
PHJDORFHIDOLDDXPHQWRGD
 SUHVVmRLQWUDFUDQLDQDRX
UDTXLWLVPR
$V IRQWDQHODV $IRQWDQHODDQWHULRUGHSULPLGD
IRQWtFXORV GHYHP pXPVLQDOGHGHVLGUDWDomR
VHU FXLGDGRVDPHQWH
H[DPLQDGDVSRLVVXD
SOHQLWXGHUHIOHWHDSUHVVmRLQWUDFUDQLDQD$IRQWDQHODGHYHVHUSDOSDGDHQTXDQWRRUHFpPQDVFLGR
RX R ODFWHQWH HVWLYHU WUDQTXLODPHQWH VHQWDGR RX VHQGR VHJXUDGR HP SRVLomR HUHWD 2V SHGLDWUDV
H[SHULHQWHV FRVWXPDP SDOSDU D IRQWDQHOD QR LQtFLR GR H[DPH 1RV UHFpPQDVFLGR H ODFWHQWHV
QRUPDLVDIRQWDQHODDQWHULRUpPDFLDHSODQD$IRQWDQHODDQWHULRUSRGHHVWDUGLVWHQGLGDSRUFDXVD
GHDXPHQWRGDSUHVVmRLQWUDFUDQLDQDTXDQGRRUHFpPQDVFLGRRXRODFWHQWHFKRUDRXYRPLWD$V
SXOVDo}HVGDIRQWDQHODUHIOHWHPRSXOVRSHULIpULFR

$V YHLDV GR FRXUR FDEHOXGR GHYHP VHU LQVSHFLRQDGDV 9HLDVGLODWDGDVQRFRXUR

FXLGDGRVDPHQWHjSURFXUDGHGLODWDomR FDEHOXGRVmRLQGLFDWLYDVGH
SUHVVmRLQWUDFUDQLDQD
Simetria do crânio e circunferência craniana.$VHJXLUpDYDOLDGD DXPHQWDGDGHORQJDGDWD
FXLGDGRVDPHQWH DVLPHWULD GR FUkQLR 'LYHUVDV FRQGLo}HV
SRGHP SURYRFDU DVVLPHWULD $OJXPDV FRQGLo}HV VmR EHQLJQDV HQTXDQWR RXWUDV UHIOHWHP XPD
SDWRORJLDVXEMDFHQWH

8PWLSRFRPXPGHDXPHQWR
YROXPpWULFRORFDOL]DGRGR
FRXURFDEHOXGRpR
FHIDOHPDWRPDFDXVDGRSRU
KHPRUUDJLDVXESHULRVWHDOSHOR
WRFRWUDXPDWLVPR(VVH
 DEDXODPHQWRQmRFUX]DDV
OLQKDVGHVXWXUDHUHJULGHQR
SUD]RGHVHPDQDV&RPD
UHVROXomRGDKHPRUUDJLDHVXD
FDOFLILFDomRUHVWDPjVYH]HV
FKDQIUDGXUDVyVVHDVSDOSiYHLV
FRPXPFHQWURDPROHFLGR

'HYHVH WDPEpP SURFXUDU WXPHIDo}HV DVVLPpWULFDV QD FDEHoD GR UHFpPQDVFLGR 2 FRXUR
FDEHOXGR GR UHFpPQDVFLGR SRGH HVWDU WXPHIHLWR QD UHJLmR RFFLSLWRSDULHWDO (VWH IHQ{PHQR p
GHQRPLQDGR FDSXW VXFFHGDQHXP ERVVD VHURVVDQJXLQROHQWD H GHYHVH D GLVWHQVmR FDSLODU H
H[WUDYDVDPHQWR GH VDQJXH H OtTXLGR FRPR FRQVHTXrQFLD GR HIHLWR GH YiFXR GD UXSWXUD GR VDFR
DPQLyWLFR(VVDWXPHIDomRFUX]DWLSLFDPHQWHDVOLQKDVGHVXWXUDHUHJULGHHPDGLDV

$ FDEHoD GR SUHPDWXUR DR QDVFLPHQWR p UHODWLYDPHQWH ORQJD QR GLkPHWUR RFFLSLWRIURQWDO H
HVWUHLWDQRGLkPHWURELWHPSRUDOGROLFRFHIDOLD2IRUPDWRGRFUkQLRQRUPDOL]DVHHPJHUDOHP
D  DQRV (VVD FRQGLomR SRGH VHU SUHYHQLGD SHOD PXGDQoD IUHTXHQWH GD SRVLomR GD FDEHoD GR
UHFpPQDVFLGR OHPEUDQGR GH FRORFDU R ODFWHQWH HP GHF~ELWR YHQWUDO HQTXDQWR HOH HVWLYHU
DFRUGDGR

$VVLPHWULDGDFDORWDFUDQLDQDSODJLRFHIDOLDSRVLFLRQDO 3ODJLRFHIDOLDWDPEpPSRGH

SRGH RFRUUHU TXDQGR R ODFWHQWH SDVVD D PDLRU SDUWH GR UHIOHWLUGRHQoDVFRPRWRUFLFROR
WHPSRGHLWDGRGHXPVyODGRSURYRFDQGRRDFKDWDPHQWRGD SRUOHVmRGRP~VFXOR
UHJLmR SDULHWRRFFLSLWDO GR ODGR GH EDL[R H SURHPLQrQFLD HVWHUQRFOHLGRPDVWyLGHRDR
QDVFLPHQWRRXDXVrQFLDGH
GD UHJLmR IURQWDO QR ODGR RSRVWR (VVD SURHPLQrQFLD HVWLPXODomRGRUHFpPQDVFLGR
GHVDSDUHFHTXDQGRRODFWHQWHWRUQDVHPDLVDWLYRHSDVVDD RXGRODFWHQWH
GHVSHQGHU WHPSR PHQRU HP XPD ~QLFD SRVLomR 4XDVH
VHPSUH D VLPHWULD p UHVWDXUDGD e LQWHUHVVDQWH PHQFLRQDU
TXHDWHQGrQFLDDWXDOGHRVUHFpPQDVFLGRVGRUPLUHPHPGHF~ELWRGRUVDOSDUDUHGX]LURULVFRGH
VtQGURPHGDPRUWHV~ELWDGRODFWHQWHSURYRFRXXPDXPHQWRGRVFDVRVGHSODJLRFHIDOLDSRVLFLRQDO

$ FLUFXQIHUrQFLD FUDQLDQD p PHGLGD YHMD SiJLQD  2IHFKDPHQWRSUHPDWXURGDV

SDUD TXH VH GHWHFWHP FDEHoDV DQRUPDOPHQWH JUDQGHV VXWXUDVFUDQLDQDVSURYRFD
PDFURFHIDOLD RX SHTXHQDV PLFURFHIDOLD ± TXH SRGHP FUDQLRVVLQRVWRVH4XDGUR
LPSOLFDUXPWUDQVWRUQRHQFHIiOLFRVXEMDFHQWH FRPXPFUkQLRGH
IRUPDWRDQRUPDO$VLQRVWRVH
GDVXWXUDVDJLWDOSURYRFD
3DOSHHQWmRDVOLQKDVGHVXWXUD8PDFKDQIUDGXUDyVVHD
HVWUHLWDPHQWRGDFDEHoDSRU
HOHYDGDQDOLQKDGHVXWXUDVXJHUHFUDQLRVVLQRVWRVH DXVrQFLDGHFUHVFLPHQWRGRV
RVVRVSDULHWDLV



2 FUkQLR GR UHFpPQDVFLGR GHYH VHU SDOSDGR FRP 1DFUDQLRWDEHVRVRVVRV
FXLGDGR ¬ SDOSDomR RV RVVRV GR FUkQLR WrP FRQVLVWrQFLD FUDQLDQRVVmRPXLWRPDOHiYHLV
³DPROHFLGD´ RX HOiVWLFD QRUPDOPHQWH D FRQVLVWrQFLD VH $FUDQLRWDEHVSRGHVHU
WRUQDPDLVILUPHFRPRDXPHQWRGDLGDGHJHVWDFLRQDO VHFXQGiULDDDXPHQWRGH
SUHVVmRLQWUDFUDQLDQDFRPRQD
KLGURFHIDOLDGLVW~UELRV

PHWDEyOLFRVFRPRUDTXLWLVPR
HLQIHFomRFRPRVtILOLV
 FRQJrQLWD

Simetria facial. $ IDFH 0LFURJQDWLDWDPEpPSRGHVHU

GRV UHFpPQDVFLGRV SDUWHGHXPDVtQGURPHFRPRD
H GRV ODFWHQWHV GHYH VtQGURPHGH3LHUUH5RELQ
VHU H[DPLQDGD j
SURFXUDGHDVVLPHWULDV2SRVLFLRQDPHQWRLQXWHURSRGHSURYRFDUDVVLPHWULDVIDFLDLVWUDQVLWyULDV
6H D FDEHoD HVWDYD IOH[LRQDGD VREUH R HVWHUQR SRGH RFRUUHU HQFXUWDPHQWR GR TXHL[R
PLFURJQDWLD $ FRPSUHVVmR GR RPEUR VREUH D PDQGtEXOD SRGH SURYRFDU GHVORFDPHQWR ODWHUDO
WHPSRUiULRGHVWD

([DPLQHFXLGDGRVDPHQWHRURVWRGRUHFpPQDVFLGRSDUDREWHUXPDLPSUHVVmRJHUDOGDIiFLHV
YDOH D SHQD FRPSDUDU FRP R URVWR GRV SDLV $ DYDOLDomR VLVWHPiWLFD GH FULDQoDV FRP IiFLHV GH
DSDUrQFLDDQRUPDOFRQVHJXHLGHQWLILFDUVtQGURPHVHVSHFtILFDV1RER[HDVHJXLUVmRPRVWUDGDV
DVHWDSDVGHDYDOLDomRGDIiFLHV

$YDOLD©¥DRGHUHF«PQDVFLGRRXFULDQ©DFRPSRVV¯YHOI£FLHVDQRUPDO

5HYLV¥RFXLGDGRVDGDDQDPQHVHHPHVSHFLDO

+LVWµULDIDPLOLDU $PDLRULDGDVV¯QGURPHVGRGHVHQYROYLPHQWRH
JHQ«WLFDVFRPI£FLHVDQRUPDLVWDPE«PVH
*UDYLGH] DFRPSDQKDPGHRXWUDVDQRUPDOLGDGHV

+LVWµULDSHULQDWDO

9HULILTXHDQRUPDOLGDGHVHPRXWUDVSDUWHVGRH[DPHI¯VLFRHPHVSHFLDO 

&UHVFLPHQWR

'HVHQYROYLPHQWR
 2XWUDVFDUDFWHU¯VWLFDVVRP£WLFDVGLVPµUILFDV 8PUHF«PQDVFLGRFRPhipotireoidismo congênito
SRGHWHUWUD©RVIDFLDLVJURVVHLURVHRXWURVWLSRV
)D©DDDIHUL©¥RHSORWDJHPGRVSHUFHQWLVHPHVSHFLDOGH GHI£FLHVDQRUPDOYHMDR4XDGURFácies
diagnósticas no primeiro ano de vida e na infância
&LUFXQIHU¬QFLDFUDQLDQD

$OWXUD

3HVR

&RQVLGHUHRVWU¬VPHFDQLVPRVGHGLVPRUIRJ¬QHVHIDFLDO
&ULDQ©DFRPIRUPDWRRXFRPSULPHQWRDQRUPDO
'HIRUPLGDGHVSRUUHVWUL©·HVLQWUDXWHULQDV
GDVILVVXUDVSDOSHEUDLVYHMDR4XDGUR
'HVHVWUXWXUD©¥RSRUEDQGDVDPQLµWLFDVRXGRWHFLGRIHWDO Fácies diagnósticas no primeiro ano de vida e na
infânciaSHQVHHP
0DOIRUPD©·HVSRUDQRUPDOLGDGHVLQWU¯QVHFDVGRURVWRFDEH©DRXGRF«UHEUR

([DPLQHSDLVHLUP¥RV

$VHPHOKDQ©DFRPXPGRVSDLVSRGHVHUWUDQTXLOL]DGRUDSH[FDEH©DJUDQGHPDVWDPE«PSRGHVXJHULUXPGLVW¼UELRGH

FDU£WHUIDPLOLDU )LVVXUDVSDUDFLPDsíndrome de Down
)LVVXUDVSDUDEDL[Rsíndrome de Noonan
7HQWHGHWHUPLQDUVHDVFDUDFWHU¯VWLFDVIDFLDLVVHHQFDL[DPHPXPDV¯QGURPHGHVFULWDFRPSDUDQGRFRP
(QFXUWDGDVefeitos do álcool sobre o feto
5HIHU¬QFLDVLQFOXVLYHPHGLGDVHUHWUDWRVGHSHVVRDVFRPDV¯QGURPH

4XDGURVEDVHGHGDGRVGHFRPELQD©·HVGHFDUDFWHU¯VWLFDV

Sinal de Chvostek.3HUFXWDDERFKHFKDSDUDSHVTXLVDURVLQDO 2VLQDOGH&KYRVWHNFRQVLVWH

GH&KYRVWHNHQFRQWUDGRHPDOJXQVWUDQVWRUQRVPHWDEyOLFRV HPFDUHWDVFDXVDGDVSRU
H jV YH]HV HP ODFWHQWHV QRUPDLV 3HUFXWD FRP D FRQWUDomRUHSHWLGDGRV
P~VFXORVIDFLDLV6LQDOGH
H[WUHPLGDGH GR GHGR LQGLFDGRU RX GR GHGR PpGLR D SDUWH
&KYRVWHNSRVLWLYRpGHWHFWDGR
GH FLPD GD ERFKHFKD ORJR DEDL[R GR RVVR ]LJRPiWLFR j HPFDVRVGHWHWDQLD
IUHQWHGDRUHOKD KLSRFDOFrPLFDWpWDQRHWHWDQLD
SRUKLSHUYHQWLODomR


Olhos 2UHFpPQDVFLGRTXHQmR
FRQVHJXHDEULUXPGRVROKRV
Inspeção. 2V UHFpPQDVFLGRV PDQWrP RV ROKRV IHFKDGRV PHVPRTXDQGRDFRUGDGRRX
VDOYRGXUDQWHVHXVEUHYHVSHUtRGRVGHGHVSHUWDU6HDOJXpP DOHUWDSRGHVHUSRUWDGRUGH
SWRVHFRQJrQLWD$VFDXVDV
WHQWDU VHSDUDU DV SiOSHEUDV HODV VHUmR DLQGD PDLV
LQFOXHPWRFRWUDXPDWLVPR
FRQWUDtGDV$VOX]HVEULOKDQWHVID]HPRVODFWHQWHVSLVFDUHP SDUDOLVLDGRWHUFHLURQHUYR
3RU LVVR GHYHVH XVDU XPD LOXPLQDomR WrQXH 6H R FUDQLDQR1&,,,HSUREOHPDV
H[DPLQDGRU DFRUGDU R UHFpPQDVFLGR GHOLFDGDPHQWH PHFkQLFRV
GLPLQXLU D LQWHQVLGDGH GD OX] DPELHQWH H VHJXUiOR HP
SRVLomRVHQWDGDFRPIUHTXrQFLDRUHFpPQDVFLGRDEULUiRVROKRVHVSRQWDQHDPHQWH
 

eSUHFLVRVHUDVWXWRSDUDH[DPLQDURVROKRVGHODFWHQWHVH +HPRUUDJLDVVXEFRQMXQWLYDLV
FULDQoDV SHTXHQDV 0XLWDV YH]HV YDOH D SHQD XVDU WUXTXHV VmRXPDFKDGRFRPXPHP
SDUD TXH HOHV FRRSHUHP 3HTXHQRV EULQTXHGRV FRORULGRV UHFpPQDVFLGRVHPFDVRGH
SDUWRSRUYLDYDJLQDO
VmR~WHLVFRPRUHFXUVRVGHIL[DomRDRH[DPLQDURVROKRV

2V UHFpPQDVFLGRV ROKDP SDUD R URVWR GR H[DPLQDGRU H 3HUVLVWrQFLDGRQLVWDJPR

VHJXHP XPD OX] EULOKDQWH VH HVWLYHUHP DFRUGDGRV $OJXQV PRYLPHQWRVGHRVFLODomRRX
UHFpPQDVFLGRV FRQVHJXHP DFRPSDQKDU RV PRYLPHQWRV GR GHVYLRVSHUVLVWHQWHVGRVROKRV
URVWRGRH[DPLQDGRUHJLUDPDFDEHoDƒSDUDDGLUHLWDH DSyVDOJXQVGLDVGHYLGDRX
DSyVDUHDOL]DomRGDPDQREUDj
SDUD D HVTXHUGD 2V PRYLPHQWRV RFXODUHV GR UHFpP HVTXHUGDSRGHLQGLFDUGpILFLW
QDVFLGRGHYHPVHUREVHUYDGRV6HJXUHRHPSRVLomRHUHWD YLVXDORXGRHQoDGRVLVWHPD
GDQGRVXSRUWHSDUDDFDEHoD*LUHRFRUSRGHOHOHQWDPHQWH QHUYRVRFHQWUDO
HP XPD GLUHomR ,VVR HP JHUDO SURYRFD D DEHUWXUD GRV
ROKRV GR UHFpPQDVFLGR SRVVLELOLWDQGR R H[DPH GDV
HVFOHUyWLFDV HVFOHUDV VHJXQGR D 7HUPLQRORJLD $QDW{PLFD GDV SXSLODV GDV tULV H GRV
PRYLPHQWRVRFXODUHV2UHFpPQDVFLGRYROWDRVROKRVQDGLUHomRTXHYRFrHVWiJLUDQGR4XDQGRD
URWDomRpLQWHUURPSLGDHOHROKDQDGLUHomRRSRVWDDSyVDOJXQVPRYLPHQWRVQLVWDJPRLGHV

6HRUHFpPQDVFLGRQmRILWDU
GLUHWDPHQWHRH[DPLQDGRUQHP
DFRPSDQKDURURVWRGHOHQRV
SHUtRGRVHPTXHHVWLYHU
DFRUGDGRpSUHFLVRGDUDWHQomR
HVSHFLDODRUHVWDQWHGRH[DPH
RFXODU$FULDQoDSRGHVHU
QRUPDOSRUpPDSUHVHQWDU
GpILFLWYLVXDO


1RV SULPHLURV  GLDV GH YLGD RV ROKRV GD FULDQoD $SHUVLVWrQFLDGHHVWUDELVPR
SRGHP ILFDU IL[RV ILWDQGR XPD ~QLFD GLUHomR VH D FDEHoD DOWHUQDQWHFRQYHUJHQWHRX
GHODIRUJLUDGDVHPPRYLPHQWDURFRUSRUHIOH[R GH ROKRV GLYHUJHQWHDOpPGHPHVHVRX
GHTXDOTXHUWLSRGHHVWUDELVPR
GHERQHFD
SRGHLQGLFDUSDUHVLDPRWRUD
 1RV SULPHLURV PHVHV GH YLGD DOJXQV ODFWHQWHV RFXODURXRXWUDDQRUPDOLGDGH
DSUHVHQWDP HVWUDELVPR LQWHUPLWHQWH HVWUDELVPR GRVLVWHPDYLVXDO
FRQYHUJHQWH DOWHUQDQWH LQWHUPLWHQWH RX H[RWURSLD RX
GHVYLRODWHUDOGRVROKRVHVWUDELVPRGLYHUJHQWHDOWHUQDQWHLQWHUPLWHQWHRXH[RWURSLD

3HVTXLVH DQRUPDOLGDGHV RX SUREOHPDV FRQJrQLWRV QDV 2VFRORERPDVVmRREVHUYDGRV

HVFOHUyWLFDVHQDVSXSLODV$VKHPRUUDJLDVVXEFRQMXQWLYDLV PHVPRVHPDSDUHOKRVH
VmRFRPXQVHPUHFpPQDVFLGRV2VROKRVGHPXLWRVUHFpP UHSUHVHQWDPGHIHLWRVGDtULV
QDVFLGRVHVWmRHGHPDFLDGRVSRUFDXVDGRSDUWR

2EVHUYHUHDo}HVSXSLODUHVSHODUHVSRVWDjOX]RXFXEUDXPROKRSRUYH]HGHSRLVGHVFXEUDR
(PERUDH[LVWDDVVLPHWULDLQLFLDOQDVGLPHQV}HVGDVSXSLODVFRPRWHPSRHODVWHQGHPDDSUHVHQWDU
WDPDQKRHUHDomRIRWRPRWRUDHTXLYDOHQWHV

3HVTXLVHPHWLFXORVDPHQWHDQRUPDOLGDGHVQDtULV 0DQFKDVGH%UXVKILHOGVmRXP
DQHOGHSRQWLOKDGREUDQFRQD
([DPLQHDVFRQMXQWLYDV SHVTXLVDQGR HGHPD RX HULWHPD tULVYHMDR4XDGUR¬V
1D PDLRULD GRV EHUoiULRV GH UHFpPQDVFLGRV p DSOLFDGD YH]HVVmRREVHUYDGDVHP
SRPDGD RIWiOPLFD GH DQWLELyWLFR SDUD SUHYHQLU LQIHFomR FULDQoDVQRUPDLVSRUpPVmR
IRUWHPHQWHVXJHVWLYDVGH
RIWDOPROyJLFDJRQRFyFLFD VtQGURPHGH'RZQ

1mRpSRVVtYHOGHWHUPLQDUDDFXLGDGHYLVXDO HP UHFpP 6HFUHomRRFXODUH

QDVFLGRVRXODFWHQWHV3RGHVHXVDURVUHIOH[RVYLVXDLVSDUD ODFULPHMDPHQWRSHUVLVWHQWHV
DYDOLDU LQGLUHWDPHQWH D YLVmR FRQVWULomR SXSLODU GLUHWD H GHVGHRQDVFLPHQWRSRGHPVHU
FRQVHQVXDO FRPR UHVSRVWD j OX] SLVFDGD FRPR UHVSRVWD j GHYLGRVDGDFULRFLVWLWHRX
REVWUXomRGRGXFWR
OX] EULOKDQWH UHIOH[R GH SLVFDGHOD H SLVFDGD FRPR QDVRODFULPDO
UHVSRVWD j PRYLPHQWDomR UiSLGD GH XP REMHWR HP GLUHomR
GRROKR1RSULPHLURDQRGHYLGDDDFXLGDGHYLVXDOWRUQD
VH PDLV DJXoDGD H D FDSDFLGDGH GH IRFR PHOKRUD 2V ODFWHQWHV DWLQJHP RV VHJXLQWHV PDUFRV GR
GHVHQYROYLPHQWRYLVXDLV

0DUFRVGHUHIHU¬QFLDYLVXDLVQRSULPHLURDQRGHYLGD
1DVFLPHQWR 3LVFDHQFDUDURVWRV

P¬V )L[DRROKDUHPREMHWRV
$LQFDSDFLGDGHGHHYROXLUQHVVHVPDUFRVGH
DPHVHV 0RYLPHQWRVRFXODUHVFRRUGHQDGRV GHVHQYROYLPHQWRYLVXDOSRGHLQGLFDUretardo da
maturidade visual
PHVHV 2OKRVFRQYHUJHPEHE¬HVWLFDREUD©RSDUDDOFDQ©DUREMHWRV

PHVHV $FXLGDGHHPWRUQRGH
Exame oftalmoscópico. 1R H[DPH RIWDOPRVFySLFR UHDOL]DGR
FRPREHErDFRUGDGRHGHROKRVDEHUWRVH[DPLQHRUHIOH[R *ODXFRPDFRQJrQLWRWDPEpP
YHUPHOKR GD UHWLQD IXQGR GH ROKR DMXVWDQGR R SRGHSURYRFDUWXUYDomRGD
FyUQHD8PUHIOH[ROXPLQRVR
RIWDOPRVFySLR SDUD  GLRSWULD H ID]HQGR D DYDOLDomR GD HVFXURSRGHVHUFRQVHTXrQFLD
SXSLODDXPDGLVWkQFLDGHFP1RUPDOPHQWHH[LVWHXP GHFDWDUDWDUHWLQRSDWLDGD
UHIOH[R YHUPHOKR RX DODUDQMDGR TXH HPDQD GR IXQGR GH SUHPDWXULGDGHRXRXWUDV
ROKRDWUDYpVGDSXSLOD GRHQoDV8PUHIOH[RUHWLQLDQR
EUDQFROHXFRFRULDQmRp
QRUPDOHGHYHVHVXVSHLWDUGH
2H[DPHRIWDOPRVFySLFRPLQXFLRVRGHFULDQoDVSHTXHQDV
FDWDUDWDGHVFRODPHQWRGH
p PXLWR GLItFLO SRUpP SRGH VHU QHFHVViULR VH IRUHP UHWLQDFRULRUUHWLQLWHRX
REVHUYDGDV DQRUPDOLGDGHV RFXODUHV RX QHXUROyJLFDV (P UHWLQREODVWRPD
JHUDO p SRVVtYHO REVHUYDU D FyUQHD FRP  GLRSWULDV R
FULVWDOLQR FRP  GLRSWULDV H R IXQGR GH ROKR FRP 
GLRSWULD

([DPLQH D UHJLmR GR GLVFR ySWLFR FRPR R IDULD HP XP 3RGHPRFRUUHUSHTXHQDV

DGXOWR 1RV ODFWHQWHV R GLVFR ySWLFR DSUHVHQWD FRU PDLV KHPRUUDJLDVUHWLQLDQDVHP
FODUDFRPPHQRVSLJPHQWDomRPDFXODU2UHIOH[ROXPLQRVR UHFpPQDVFLGRVQRUPDLV
+HPRUUDJLDVH[WHQVDVSRGHP
GDIyYHDSRGHQmRVHUYLVtYHO9HULILTXHFXLGDGRVDPHQWHVH
VXJHULUDQR[LDJUDYH
KiKHPRUUDJLDUHWLQLDQD2SDSLOHGHPDpUDURHPODFWHQWHV KHPDWRPDVXEGXUDO
SRLVDVIRQWDQHODVHDVVXWXUDVDEHUWDVDFRPRGDPHYHQWXDLV KHPRUUDJLDVXEDUDFQyLGHDRX
DXPHQWRV GH SUHVVmR LQWUDFUDQLDQD SRXSDQGR RV GLVFRV WUDXPDWLVPR
ySWLFRV

Orelhas
2H[DPHItVLFRGDVRUHOKDVGHUHFpPQDVFLGRVHODFWHQWHVpLPSRUWDQWHSRLVYiULDVDQRUPDOLGDGHV
SRGHPVHUGHWHFWDGDVGHVGHSUREOHPDVHVWUXWXUDLVDWpRWLWHPpGLDHSHUGDDXGLWLYD

2V SULQFLSDLV REMHWLYRV VmR D GHWHUPLQDomR GD SRVLomR 2UHOKDVH[WHUQDVSHTXHQDV

GRIRUPDWRHGDVFDUDFWHUtVWLFDVGDVRUHOKDVSDUDGHWHFWDU GHIRUPDGDVHGHLPSODQWDomR
DQRUPDOLGDGHV 2EVHUYH D SRVLomR GD RUHOKD HP UHODomR EDL[DLQGLFDPGHIHLWRV
DRVROKRV8PDOLQKDLPDJLQiULDWUDoDGDGRVFDQWRVLQWHUQRV FRQJrQLWRVDVVRFLDGRV
HVSHFLDOPHQWHQHIURSDWLD
HH[WHUQRVGRVROKRVGHYHDWUDYHVVDUDRUHOKDH[WHUQD6HD
RUHOKD H[WHUQD HVWLYHU DEDL[R GHVVD OLQKD LPDJLQiULD D
LPSODQWDomR GDV RUHOKDV GHVVH UHFpPQDVFLGR p EDL[D 3DUD WUHLQDU WUDFH HVVD OLQKD LPDJLQiULD
DWUDYpVGDIDFHGRUHFpPQDVFLGRPRVWUDGRQDSiJLQDREVHUYHTXHHODFUX]DDRUHOKDH[WHUQD

2 H[DPH RWRVFySLFR GR UHFpPQDVFLGR Vy FRQVHJXH 8PSHTXHQRDFURFyUGRQXPD

GHWHFWDU VH R PHDWR DF~VWLFR HVWi GHVREVWUXtGR SRUTXH R IHQGDRXXPDGHSUHVVmR
YpUQL[ FDVHRVR DFXPXODGR RIXVFD D PHPEUDQD WLPSkQLFD GHWHFWDGRORJRjIUHQWHGR
WUDJRFRUUHVSRQGHDXP
QRVSULPHLURVGLDVGHYLGD UHVTXtFLRGDSULPHLUDIHQGD
EUDQTXLDOHQmRFRVWXPDVHU
 LPSRUWDQWH

2PHDWRDF~VWLFRGRODFWHQWHHVWiGLUHFLRQDGRSDUDEDL[R 2WLWHPpGLDYHMDSiJLQD

D SDUWLU GD SDUWH H[WHUQD SRUWDQWR SRGH VHU QHFHVViULR SRGHRFRUUHUHPODFWHQWHV
WUDFLRQDU FRP FXLGDGR D RUHOKD H[WHUQD SDUD EDL[R H QmR
SDUD FLPD SDUD REWHU D PHOKRU YLVmR GR WtPSDQR
PHPEUDQD WLPSkQLFD VHJXQGR D 7HUPLQRORJLD $QDW{PLFD 8PD YH] YLVXDOL]DGD D PHPEUDQD
WLPSkQLFDREVHUYHTXHRUHIOH[ROXPLQRVRpGLIXVRHVyDGTXLUHRIRUPDWRGHFRQHDSyVDOJXQV
PHVHVGHYLGD

2UHIOH[RDF~VWLFRpDSLVFDGHODGRUHFpPQDVFLGRHGR 3UREOHPDVSHULQDWDLVTXH
ODFWHQWH FRPR UHVSRVWD D XP VRP DJXGR V~ELWR 3RGHVH HOHYDPRULVFRGHGHIHLWRV
SURYRFDU HVVH UHIOH[R HVWDODQGR RV GHGRV RX XVDQGR XPD DXGLWLYRVLQFOXHPSHVRDR
FDPSDQKLD EX]LQD RX RXWUR GLVSRVLWLYR TXH SURGX]D QDVFLPHQWRJDQR[LD
WUDWDPHQWRFRPPHGLFDomR
EDUXOKR D XPD GLVWkQFLD GH FHUFD GH  FP GD RUHOKD GR SRWHQFLDOPHQWHRWRWy[LFD
UHFpPQDVFLGR RX GR ODFWHQWH e SUHFLVR WHU FXLGDGR SDUD LQIHFo}HVFRQJrQLWDV
QmR SURGX]LU GHVORFDPHQWRV GH DU TXH SRVVDP SURYRFDU D KLSHUELOLUUXELQHPLDJUDYHH
SLVFDGHOD QR ODFWHQWH 3RGH VHU GLItFLO GHVHQFDGHDU HVVH PHQLQJLWH
UHIOH[R QRV SULPHLURV  D  GLDV GH YLGD $SyV HOH VHU
GHVHQFDGHDGRYiULDVYH]HVGXUDQWHXPFXUWRSHUtRGRGHVDSDUHFH(VVHpXPIHQ{PHQRFRQKHFLGR
FRPRKDELWXDomR(VWHWHVWHJURVVHLURGDDXGLomRFHUWDPHQWHQmRpGLDJQyVWLFR$WHQGrQFLDDWXDO
p SHOD UHDOL]DomR GH UDVWUHDPHQWR DXGLWLYR XQLYHUVDO HP WRGRV RV UHFpPQDVFLGRV H QmR DSHQDV
QRVGHDOWRULVFRSDUDSUREOHPDVDXGLWLYRV

6LQDLVGHTXHXPUHF«PQDVFLGRRXODFWHQWHFRQVHJXHHVFXWDU

,GDGH 6LQDO
&RPRRUDVWUHDPHQWRDXGLWLYRQ¥R«UHDOL]DGR
$VVXVWDVHHSLVFDFRPRUHVSRVWDDXPEDUXOKRV¼ELWR HPWRGRVRVUHF«PQDVFLGRVHODFWHQWHVPXLWDV
DPHVHV FULDQ©DVFRPdéficits auditivosVµV¥R
$FDOPDVHFRPYR]WUDQTXLOL]DGRUDHP¼VLFD
GLDJQRVWLFDGDVTXDQGRFKHJDPDRVDQRV
0XGDQ©DQRVPRYLPHQWRVFRUSRUDLVFRPRUHVSRVWDD ,QG¯FLRVGHG«ILFLWGHDXGL©¥RLQFOXHP
DPHVHV VRP SUHRFXSD©¥RGRVSDLVTXDQWR¢DXGL©¥RDWUDVR
GDIDODHDXV¬QFLDGHLQGLFDGRUHVGH
0XGDQ©DQDH[SUHVV¥RIDFLDOFRPVRQVIDPLOLDUHV GHVHQYROYLPHQWRGHDXGL©¥R
DPHVHV 9LUDDFDEH©DHRVROKRVHPGLUH©¥RDRVRP

DPHVHV 9LUDVHSDUDRXYLUYR]HVHFRQYHUVDV 
Nariz e seios paranasais $VYLDVQDVDLVGRVUHFpP
QDVFLGRVSRGHPHVWDU
2 FRPSRQHQWH PDLV LPSRUWDQWH GR H[DPH GR QDUL] GRV REVWUXtGDVQDDWUHVLDGHFyDQRV
UHFpPQDVFLGRVpRWHVWHGHGHVREVWUXomRGDVIRVVDVQDVDLV VHJXQGRD7HUPLQRORJLD
(OH SRGH VHU UHDOL]DGR PHGLDQWH D RFOXVmR FXLGDGRVD GH $QDW{PLFD1RVFDVRVJUDYHV
DREVWUXomRQDVDOSRGHVHU
FDGD XPD GDV QDULQDV GH PRGR DOWHUQDGR HQTXDQWR R
DYDOLDGDSHODWHQWDWLYDGH
UHFpPQDVFLGRODFWHQWHpPDQWLGRFRPDERFDIHFKDGD,VVR LQWURGX]LUXPWXERGH
QRUPDOPHQWH QmR SURYRFD DQJ~VWLD SRUTXH D PDLRULD GRV DOLPHQWDomRQRSHODVQDULQDV
ODFWHQWHV UHVSLUD SHOR QDUL] 1D YHUGDGH DOJXQV ODFWHQWHV DWpDSDUWHSRVWHULRUGDIDULQJH
VmRUHVSLUDGRUHVQDVDLVREULJDWyULRVHWrPGLILFXOGDGHGH
UHVSLUDU SHOD ERFD 1mR VH GHYH RFOXLU DV GXDV QDULQDV
VLPXOWDQHDPHQWH±LVVRFDXVDUiXPWUDQVWRUQRFRQVLGHUiYHO

,QVSHFLRQH R QDUL] SDUD DVVHJXUDUVH GH TXH R VHSWR QDVDO VH HQFRQWUD QD OLQKD PpGLD 8P
HVSpFXORQDVDOFDOLEURVRGRRWRVFySLRSRGHVHULQVHULGRGHOLFDGDPHQWHQRQDUL]GRUHFpPQDVFLGR
HRXGRODFWHQWH

4XDQGRREHErQDVFHDSHQDVDVFpOXODVHWPRLGDLVHRVHLRPD[LODUHQFRQWUDPVHGHVHQYROYLGRV
SRUWDQWRDSDOSDomRGRVVHLRVSDUDQDVDLVQRVUHFpPQDVFLGRVQmRWHPXWLOLGDGH

Boca e faringe
,QVSHFLRQH FRP DEDL[DGRU GH OtQJXD H ODQWHUQD H SDOSH 5DUDPHQWHVmRREVHUYDGRV
SDUDH[DPLQDUDERFDHDIDULQJH$ERFDGRUHFpPQDVFLGR GHQWHVVXSUDQXPHUiULRV(OHV
QmR WHP GHQWHV H D PXFRVD DOYHRODU p OLVD FRP ERUGDV HPJHUDOVmRGLVPyUILFRVH
ILQDPHQWH VHUULOKDGDV ¬V YH]HV REVHUYDPVH FLVWRV GH FDHPHPDOJXQVGLDVPDVVmR
H[WUDtGRVSDUDHYLWDUDVSLUDomR
UHWHQomR SHUROiFHRV DFRPSDQKDQGR DV FKDQIUDGXUDV
DOYHRODUHV TXH VmR IDFLOPHQWH FRQIXQGLGRV FRP GHQWHV ±
HVVHVFRVWXPDPGHVDSDUHFHUQRSUD]RGHDPHVHV$VSHWpTXLDVWDPEpPVmRDFKDGRVFRPXQV
QRSDODWRPROHDSyVRQDVFLPHQWR

3DOSH R SDODWR GXUR VXSHULRU SDUD YHULILFDU VXD &LVWRVSRGHPVHUREVHUYDGRV

LQWHJULGDGH $V SpURODV GH (SVWHLQ FLVWRV GH UHWHQomR QDOtQJXDRXQDERFD&LVWRVGH
PXFRVRV DUUHGRQGDGRV PLQ~VFXORV GH FRU EUDQFD RX GXFWRWLUHRJORVVRSRGHP
GHVHPERFDUVREDOtQJXD
DPDUHOD ORFDOL]DPVH QD OLQKD PpGLD SRVWHULRU GR SDODWR
GXURHGHVDSDUHFHPHPDOJXQVPHVHV
 2V ODFWHQWHV SURGX]HP SRXFD VDOLYD QRV SULPHLURV  PHVHV GH YLGD 'HSRLV GHVVD LGDGH
SURGX]HPEDVWDQWHVDOLYDHEDEDPFRPPXLWDIUHTXrQFLD

,QVSHFLRQH D OtQJXD 2 IUrQXOR GD OtQJXD VHJXQGR D (PERUDQmRVHMDFRPXPOtQJXD

7HUPLQRORJLD$QDW{PLFDWHPWDPDQKRYDULiYHOHjVYH]HV SURHPLQHQWHSURWUXVDSRGH
HVWHQGHVHTXDVHDWpDSRQWDGDOtQJXDHPRXWURVFDVRVp LQGLFDUKLSRWLUHRLGLVPR
FRQJrQLWRRXVtQGURPHGH
JURVVR H FXUWR UHVWULQJLQGR D SURWUXVmR GD OtQJXD
'RZQ
DQTXLORJORVVLD RX OtQJXD SUHVD HVVDV YDULDo}HV
GLILFLOPHQWH LQWHUIHUHP QD IDOD RX QD IXQFLRQDOLGDGH GD
OtQJXD

e PXLWR IUHTXHQWH REVHUYDU XPD FDPDGD HVEUDQTXLoDGD $FDQGLGtDVHRUDOVDSLQKRp

VREUHDOtQJXD6HHVVDFREHUWXUDIRUFRQVHTXrQFLDGHOHLWH FRPXPQRVODFWHQWHV$VOHV}HV
pIiFLOUHPRYrODUDVSDQGRDHHQ[XJDQGRD VmRGLItFHLVGHUHPRYHUHWrP
XPDEDVHPXLWRHULWHPDWRVD
$ PHOKRU PDQHLUD GH REVHUYDU D IDULQJH GR EHEr p YHMDR4XDGUR
$QRUPDOLGDGHVGRVROKRVGDV
GXUDQWH R FKRUR e SURYiYHO TXH YRFr WHQKD GLILFXOGDGH RUHOKDVHGDERFD
SDUDXVDURDEDL[DGRUGHOtQJXDSRLVHVWHSURYRFDXPIRUWH
UHIOH[R IDUtQJHR GR Y{PLWR 1mR HVSHUH FRQVHJXLU
YLVXDOL]DU DV WRQVLODV /DFWHQWHV QmR WrP WHFLGR OLQIRLGH SURHPLQHQWH 2 WDPDQKR GDV WRQVLODV
DXPHQWDjPHGLGDTXHDFULDQoDFUHVFH

2XoDRFKRURGREHErHVXDVFDUDFWHUtVWLFDV2VODFWHQWHV $PDFURJORVVLDHVWiDVVRFLDGD
QRUPDLV WrP XP FKRUR IRUWH H YLJRURVR 2 ER[H D VHJXLU DGRHQoDVVLVWrPLFDVJUDYHV
HQXPHUDDOJXQVWLSRVSRXFRFRPXQVGHFKRUR 4XDQGRDVVRFLDGDD
KLSRJOLFHPLDHRQIDORFHOHR
 GLDJQyVWLFRSURYiYHOpGH
VtQGURPHGH%HFNZLWK
:LHGHPDQQ

)tVWXODSDODWLQDpXPDItVWXOD
 FRQJrQLWDQDOLQKDPHGLDQDGR
SDODWR
 

&KRURVDQRUPDLVGRODFWHQWHVHSHUVLVWHQWHV
7LSR 3RVV¯YHODQRUPDOLGDGH 

$XPHQWRGDSUHVV¥RLQWUDFUDQLDQD7DPE«PHP
*ULWRRXWRQDOLGDGHDJXGD UHF«PQDVFLGRVFXMDVP¥HVV¥RGHSHQGHQWHVGH 
QDUFµWLFRV

5RXFR 7HWDQLDKLSRFDOF¬PLFDHKLSRWLUHRLGLVPRFRQJ¬QLWR

2EVWUX©¥RGDVYLDVUHVSLUDWµULDVVXSHULRUHVSRUY£ULRV (VWULGRULQVSLUDWµULRGHVGHRQDVFLPHQWRVXJHUH
WLSRVGHOHV·HVSH[SµOLSRRXKHPDQJLRPD XPDDQRUPDOLGDGHFRQJ¬QLWDFRPRDGHVFULWD
(VWULGRULQVSLUDWµULRHH[SLUDWµULRFRQW¯QXR ODULQJHUHODWLYDPHQWHSHTXHQDHVWULGRUODU­QJHR QRER[HDRODGR2HVWULGRUTXHVXUJHDSµVR
LQIDQWLORXUHWDUGRQRGHVHQYROYLPHQWRGHFDUWLODJHQV QDVFLPHQWRSRGHVHUVHFXQG£ULRDLQIHF©¥R
GRVDQ«LVWUDTXHDLVWUDTXHRPDODFLD FRPRFUXSHFRUSRHVWUDQKRRXUHIOX[R
JDVWUHVRI£JLFR
'RHQ©DJUDYHSDUDOLVLDGHFRUGDYRFDORXOHV¥R
$XV¬QFLDGHFKRUR
FHUHEUDOSURIXQGD

2 SDGUmR GH HUXSomR GRV GHQWHV p SUHYLVtYHO PDV 'HQWHVQDWDLVVmRHQFRQWUDGRV

YDULiYHO &RPR UHJUD JHUDO XPD FULDQoD JDQKD XP GHQWH QDFDYLGDGHEXFDOSRURFDVLmR
SRUPrVHQWUHRVHPHVHVGHYLGDFRPSRQGRXPWRWDO GRQDVFLPHQWR*HUDOPHQWHVmR
GHGHQWHVSULPiULRV DSHQDVGHQWHVQRUPDLVTXH
LUURPSHUDPSUHFRFHPHQWHPDV
SRGHPID]HUSDUWHGHDOJXPDV

VtQGURPHV

Pescoço
3DOSH RV OLQIRQRGRV GR SHVFRoR H DYDOLH VH Ki PDVVDV &LVWRVGHIHQGDEUDQTXLDOWrPR
DGLFLRQDLVFRPRFLVWRVFRQJrQLWRV&RPRRVSHVFRoRVGH DVSHFWRGHSHTXHQRVSRQWRV
ODFWHQWHV VmR FXUWRV R LGHDO p SDOSDU RV SHVFRoRV GH RXDEHUWXUDVVLWXDGRVjIUHQWH
GDSRUomRPpGLDGRP~VFXOR
ODFWHQWHV HP GHF~ELWR GRUVDO HQTXDQWR FULDQoDV PDLV
HVWHUQRFOHLGRPDVWyLGHR
YHOKDVSRGHPVHUH[DPLQDGDVVHQWDGDV9HULILTXHDSRVLomR 3RGHPHVWDUDVVRFLDGRVD
GDFDUWLODJHPWLUHyLGHDHGDWUDTXHLD WUDMHWRVILVWXORVRV

&LVWRVHVHLRVSUpDXULFXODUHV
VmRGHSUHVV}HVFRPXQVGR
WDPDQKRGHFDEHoDVGHDOILQHWH
 HHPJHUDOVLWXDGDVjIUHQWH
GDKpOLFHGDRUHOKD&RVWXPDP
VHUELODWHUDLVHjVYH]HVHVWmR
DVVRFLDGRVDGpILFLWGHDXGLomR

&LVWRVGRGXFWRWLUHRJORVVR
ILFDPORFDOL]DGRVQDOLQKD
PpGLDGRSHVFRoRORJRDFLPD
GDFDUWLODJHPWLUHyLGHD
VHJXQGRD7HUPLQRORJLD
$QDW{PLFD$SUHVHQWDPVH
FRPRPDVVDVILUPHVSHTXHQDV
HPyYHLVTXHVHGHVORFDPSDUD
FLPDFRPDSURWUXVmRGDOtQJXD
 RXFRPDGHJOXWLomR(VVHV
FLVWRVFRVWXPDPVHU
GHWHFWDGRVDSyVRVDQRV

7RUFLFRORFRQJrQLWRp
 VHFXQGiULRDRVDQJUDPHQWR
SDUDRP~VFXOR
 HVWHUQRFOHLGRPDVWyLGHRSRU
HVWLUDPHQWRGXUDQWHRWUDEDOKR
 GHSDUWR8PDPDVVDILEURVD
ILUPHpSDOSDGDQRLQWHULRUGR
 P~VFXORDVHPDQDVDSyVR
QDVFLPHQWRHFRVWXPD
GHVDSDUHFHUHPDOJXQVPHVHV


3DOSHDVFODYtFXODVHSHVTXLVHHYLGrQFLDVGHIUDWXUDQRV 'XUDQWHRSDUWRSRGHRFRUUHU
UHFpPQDVFLGRV 6H KRXYHU VHUi SRVVtYHO VHQWLU IUDWXUDGHFODYtFXOD
GHVFRQWLQXLGDGH QR FRQWRUQR GR RVVR KLSHUVHQVLELOLGDGH SULQFLSDOPHQWHTXDQGRD
OLEHUDomRGHXPEUDoRIRUGLItFLO
FUHSLWDomR QR ORFDO GH IUDWXUD H UHVWULomR GRV PRYLPHQWRV
RXQDH[WUDomRGRRPEUR
GREUDoRQRODGRDIHWDGR

Tórax e pulmões
2 WyUD[ GR ODFWHQWH p PDLV DUUHGRQGDGR GR TXH R GRV 2VGRLVWLSRVGHDQRUPDOLGDGH
DGXOWRV $OpP GLVVR D SDUHGH WRUiFLFD p ILQD H WHP SRXFD GDSDUHGHWRUiFLFDREVHUYDGRV
PXVFXODWXUD DVVLP RV UXtGRV SXOPRQDUHV H FDUGtDFRV VmR QDLQIkQFLDVmRWyUD[HVFDYDGR
WUDQVPLWLGRV FRP FODUH]D $ FDL[D WRUiFLFD yVVHD H ³SHLWRHPIXQLO´HWyUD[
FDUWLODJLQRVD p PROH H GHSUHVVtYHO $ H[WUHPLGDGH GR FDUHQDGR³GHIRUPLGDGHHP
SURFHVVR [LIRLGH PXLWDV YH]HV SURMHWDVH DQWHULRUPHQWH SHLWRGHSRPER´
ORJRDEDL[RGDSHOH

Inspeção. $YDOLH FRP FXLGDGR D UHVSLUDomR H RV SDGU}HV $SQHLDpDLQWHUUXSomRGD

UHVSLUDWyULRV 2V UHFpPQDVFLGRV SULQFLSDOPHQWH RV UHVSLUDomRSRUPDLVGHV
SUHPDWXURV HYLGHQFLDP SHUtRGRV GH IUHTXrQFLD 0XLWDVYH]HVDFRPSDQKDVHGH
EUDGLFDUGLDHSRGHLQGLFDU
UHVSLUDWyULD QRUPDO  D  SRU PLQ DOWHUQDGRV FRP
GRHQoDUHVSLUDWyULDGRHQoDGR
³UHVSLUDomR SHULyGLFD´ GXUDQWH D TXDO D IUHTXrQFLD VLVWHPDQHUYRVRFHQWUDORX
UHVSLUDWyULDFDLPXLWRHSRGHDWpVHULQWHUURPSLGDSRUD UDUDPHQWHXPTXDGUR
V FDUGLRSXOPRQDU$DSQHLDpXP
IDWRUGHDOWRULVFRSDUD
1mR WHQKD SUHVVD HP XVDU R HVWHWRVFySLR $QWHV VtQGURPHGDPRUWHV~ELWDGR
ODFWHQWH606/
REVHUYHFRPFXLGDGRRODFWHQWHFRPRGHPRQVWUDGRDGLDQWH
$LQVSHomRpPDLVIiFLOTXDQGRREHErQmRHVWiFKRUDQGR
DVVLP FRRSHUH FRP RV SDLV SDUD DFDOPiOR 'HSRLV GH REVHUYDU SRU WDOYH]  PLQ YRFr SRGHUi
GHVFUHYHURDVSHFWRJHUDODIUHTXrQFLDUHVSLUDWyULDDFRURFRPSRQHQWHQDVDOGDUHVSLUDomRRV
UXtGRVUHVSLUDWyULRVDXGtYHLVHRHVIRUoRUHVSLUDWyULRFRQIRUPHGHVFULWRDVHJXLU

&RPRRVODFWHQWHVUHVSLUDPREULJDWRULDPHQWHSHORQDUL] (PUHFpPQDVFLGRVHODFWHQWHV
REVHUYH R QDUL] HQTXDQWR UHVSLUDP $YDOLH RV EDWLPHQWRV SHTXHQRVEDWLPHQWRVGHDVD
GD DVD GR QDUL] 2EVHUYH D UHVSLUDomR GR ODFWHQWH FRP D GRQDUL]SRGHPVHU
FRQVHTXrQFLDGHLQIHFo}HV
ERFDIHFKDGDRXGXUDQWHDDPDPHQWDomRSDUDYHULILFDUVHR
UHVSLUDWyULDVVXSHULRUHVFRP
QDUL]HVWiREVWUXtGR3HVTXLVHUXtGRVUHVSLUDWyULRVREVHUYH SRVWHULRUREVWUXomRGDV
JUXQKLGRV VLELORV DXGtYHLV RX DXVrQFLD GH UXtGRV QDULQDV(QWUHWDQWRSRGHP
UHVSLUDWyULRVREVWUXomR WDPEpPVHUFDXVDGRVSRU
SQHXPRQLDRXRXWUDVLQIHFo}HV
2EVHUYHGRLVDVSHFWRVGDUHVSLUDomRGRODFWHQWHUXtGRV UHVSLUDWyULDVJUDYHV
UHVSLUDWyULRV DXGtYHLV H HVIRUoR UHVSLUDWyULR (VVHV GRLV
VmR SDUWLFXODUPHQWH UHOHYDQWHV SDUD DYDOLDU GRHQoDV UHVSLUDWyULDV DOWDV H EDL[DV 2V HVWXGRV HP
SDtVHVFRPDFHVVRGHILFLHQWHDUDGLRJUDILDVGHWyUD[FRQVWDWDUDPTXHHVVHVVLQDLVVmRSHORPHQRV
WmR~WHLVTXDQWRDDXVFXOWDGDVYLDVUHVSLUDWyULDVVXSHULRUHVHLQIHULRUHV

2EVHUYD©¥RGDUHVSLUD©¥R_$QWHVGHWRFDUDFULDQ©D
4XDOTXHUGDVDQRUPDOLGDGHVOLVWDGDV¢HVTXHUGD
7LSRGHDYDOLD©¥R 3DWRORJLDREVHUYDGDHVSHF¯ILFD GHYHVHUPRWLYRSDUDSUHRFXSD©¥RTXDQWRD
XPDSDWRORJLDUHVSLUDWµULDVXEMDFHQWH

$VSHFWRJHUDO ,QFDSDFLGDGHGHFRPHURXGHVRUULU 

 'LILFXOGDGHSDUDVHUDFDOPDGR

)UHTX¬QFLDUHVSLUDWµULD 7DTXLSQHLDYHMDS£JLQD Infecções respiratórias das vias respiratórias

 inferioresGHILQLGDVFRPRLQIHF©·HVVLWXDGDV
&RU 3DOLGH]RXFLDQRVH
DEDL[RGDVFRUGDVYRFDLVV¥RFRPXQVHP
%DWLPHQWRGDVDVDVGRQDUL]DXPHQWRGDVGXDVIRVVDV ODFWHQWHVHLQFOXHPbronquioliteHpneumonia
&RPSRQHQWHQDVDOGDUHVSLUD©¥R
QDVDLVGXUDQWHDLQVSLUD©¥R

5X¯GRVUHVSLUDWµULRVDXG¯YHLV *UXQKLGRVUX¯GRH[SLUDWµULRFXUWRHUHSHWLWLYR 

6LELORVUX¯GRH[SLUDWµULRPXVLFDO
 (VWULGRUUX¯GRLQVSLUDWµULRGHWRQDOLGDGHDJXGD 2HVWULGRUDJXGR«XPDFRQGL©¥R
2EVWUX©¥RDXV¬QFLDGHUX¯GRVUHVSLUDWµULRV SRWHQFLDOPHQWHJUDYHDVFDXVDVLQFOXHP
laringotraqueobronquite (crupe), epiglotite,
%DWLPHQWRGDVDVDVGRQDUL]PRYLPHQWD©¥RH[FHVVLYD traqueíte bacteriana, corpo estranhohemangioma
7UDEDOKRUHVSLUDWµULR GDVQDULQDV RXXPanel vascular

*UXQKLGRVUX¯GRVUHVSLUDWµULRV

5HWUD©·HVPRYLPHQWD©¥RGRWµUD[SDUDGHQWUR
1RVODFWHQWHVXPHVIRU©RUHVSLUDWµULRDQRUPDO
6XSUDFODYLFXODUHVWHFLGRPROHDFLPDGDVFODY¯FXODV DVVRFLDGRDDFKDGRVDQRUPDLVQDDXVFXOWD
 FRQVWLWXHPRVPHOKRUHVVLQDLVSDUDVHVXVSHLWDU
,QWHUFRVWDLVUHWUD©¥RLQWHUQDGDSHOHHQWUHDVFRVWHODV GHpneumonia2PHOKRUVLQDOSDUDdescartar
SQHXPRQLD«DDXV¬QFLDGHWDTXLSQHLD
6XEFRVWDLVORJRDEDL[RGDUHERUGDFRVWDO

$V FRVWHODV QmR VH PH[HP PXLWR GXUDQWH D UHVSLUDomR 0RYLPHQWDomRDVVLPpWULFDGR

WUDQTXLOD QRV ODFWHQWHV VDXGiYHLV 7RGR PRYLPHQWR SDUD WyUD[SRGHLQGLFDUOHVmR
IRUDpSURGX]LGRSHODGHVFLGDGRGLDIUDJPDTXHFRPSULPH H[SDQVLYD3QHXPRSDWLDV
RV FRQWH~GRV DEGRPLQDLV H FRQVHTXHQWHPHQWH SURMHWD DV SURYRFDPDXPHQWRGD
UHVSLUDomRDEGRPLQDOHSRGHP
FRVWHODVLQIHULRUHVSDUDIRUD SURGX]LUUHWUDo}HVPRYLPHQWR
GRWyUD[SDUDGHQWURXPD
 LQGLFDomRGHGRHQoDSXOPRQDU
DQWHVGHDQRVGHLGDGH$
 UHWUDomRWRUiFLFDpR
PRYLPHQWRGDSHOHHGDV
 FRVWHODVSDUDGHQWURGXUDQWHD
LQVSLUDomR2VPRYLPHQWRVGR
 GLDIUDJPDDIHWDPEDVLFDPHQWH
DUHVSLUDomRFRPSRXFD
 DVVLVWrQFLDGRVP~VFXORV
WRUiFLFRV&RPRPHQFLRQDGR
QRER[HGDSiJLQDSRGHP

VHUREVHUYDGRVWUrVWLSRVGH
UHWUDomRQRVODFWHQWHV
 VXSUDFODYLFXODULQWHUFRVWDOH
VXEFRVWDO


$GRHQoDREVWUXWLYD
UHVSLUDWyULDHPODFWHQWHVSRGH
UHVXOWDUQRVLQDOGH+RRYHURX
 UHVSLUDomRSDUDGR[DOHP
YDLYpPQDTXDORDEGRPH
PRYHVHSDUDIRUDHQTXDQWRR
WyUD[PRYHVHSDUDGHQWUR
GXUDQWHDLQVSLUDomR

2 SDUDGR[R WRUDFRDEGRPLQDO TXH FRUUHVSRQGH j (PFULDQoDVFRPIUDTXH]D

PRYLPHQWDomRGRWyUD[SDUDGHQWURHGRDEGRPHSDUDIRUD PXVFXODURSDUDGR[R
GXUDQWH D LQVSLUDomR p XP DFKDGR QRUPDO HP UHFpP WRUDFRDEGRPLQDOILFDHYLGHQWH
QDVFLGRV 3HUVLVWH GXUDQWH R VRQR DWLYR RX 5(0 PHVPR HPYiULDVLGDGHV
TXDQGR Mi QmR p REVHUYDGR FRP R EHEr DFRUGDGR RX QR
VRQRWUDQTXLOR,VVRVHGHYHjGLPLQXLomRGRW{QXVPXVFXODUQRVRQRDWLYR¬PHGLGDTXHDXPHQWD
D IRUoD PXVFXODU H GLPLQXL D FRPSODFrQFLD GD SDUHGH WRUiFLFD FRP D LGDGH D UHVSLUDomR
DEGRPLQDOGHL[DGHVHUREVHUYDGD6HIRUREVHUYDGDLPSOLFDGRHQoDUHVSLUDWyULD

Palpação. 9HULILTXH R IUrPLWR WRUDFRYRFDO SRU SDOSDomR (PIXQomRGDH[FHOHQWH

&RORTXH D PmR VREUH R WyUD[ TXDQGR R ODFWHQWH FKRUDU RX WUDQVPLVVmRGRVVRQVSHOR
HPLWLU UXtGRV 'HSRLV FRORTXH D PmR RX DV SRQWDV GRV WyUD[TXDOTXHUDQRUPDOLGDGH
QRIUrPLWRWRUDFRYRFDORXQD
GHGRV GH FDGD ODGR GR WyUD[ H SHVTXLVH D VLPHWULD GDV
SHUFXVVmRVXJHUHGRHQoD
YLEUDo}HV WUDQVPLWLGDV $ SHUFXVVmR QmR WHP XWLOLGDGH QRV JUDYHFRPRXPDJUDQGH
ODFWHQWHVH[FHWRHPFDVRVH[WUHPRV2WyUD[GRODFWHQWHp FRQVROLGDomRSQHXP{QLFD
KLSHUWLPSkQLFR HP WRGD D VXD H[WHQVmR H p GLItFLO GHWHFWDU
DQRUPDOLGDGHVjSHUFXVVmR

Ausculta.$SyVUHDOL]DUHVVDVPDQREUDVYRFrHVWDUiSURQWR 5XtGRVELIiVLFRVLPSOLFDP
SDUDDDXVFXOWD2VUXtGRVUHVSLUDWyULRVVmRPDLVLQWHQVRV REVWUXomRJUDYHSRU
HJURVVHLURVGRTXHRVGRVDGXOWRVSRLVRHVWHWRVFySLRILFD HVWUHLWDPHQWRLQWUDWRUiFLFRGDV
YLDVUHVSLUDWyULDVRXREVWUXomR
PDLV SUy[LPR j RULJHP GRV VRQV 0XLWDV YH]HV p GLItFLO
JUDYHSRUHVWUHLWDPHQWR
GLIHUHQFLDU RV UXtGRV WUDQVPLWLGRV SHODV YLDV UHVSLUDWyULDV H[WUDWRUiFLFRGDVYLDV
VXSHULRUHV GRV UXtGRV RULJLQDGRV QR WyUD[ 2V UXtGRV GDV UHVSLUDWyULDV
YLDVVXSHULRUHVWHQGHPDVHUPDLVLQWHQVRVWUDQVPLWLGRVGH
PRGR VLPpWULFR SRU WRGR R WyUD[ H PDLV DOWRV TXDQGR R
HVWHWRVFySLR p PRYLPHQWDGR QD GLUHomR GR SHVFRoR (P JHUDO VmR UXtGRV LQVSLUDWyULRV H
JURVVHLURV 2V UXtGRV GDV YLDV UHVSLUDWyULDV LQIHULRUHV VmR PDLV LQWHQVRV QR ODGR GD GRHQoD
FRVWXPDPVHUDVVLPpWULFRVHIUHTXHQWHPHQWHRFRUUHPGXUDQWHDH[SLUDomR

'LIHUHQFLD©¥RHQWUHUX¯GRVGHYLDVUHVSLUDWµULDVVXSHULRUHVHLQIHULRUHVQRVODFWHQWHV
7«FQLFD 9LDVUHVSLUDWµULDVVXSHULRUHV 9LDVUHVSLUDWµULDVLQIHULRUHV 
 &RPSDUHUX¯GRVQRQDUL]HVWHWRVFµSLR 6RQVLG¬QWLFRV )UHTXHQWHPHQWHVRQVGLIHUHQWHV 

$WHQWHSDUDUXGH]DGRVVRQV 5XGHDLQWHQVR 9DUL£YHO 

2EVHUYHVLPHWULDHVTXHUGDGLUHLWD 6LP«WULFR )UHTXHQWHPHQWHDVVLP«WULFR

$UHGX©¥RGRVUX¯GRVUHVSLUDWµULRVHP
5X¯GRVPDLVLQWHQVRVFRQIRUPHR XPKHPLWµUD[GRUHF«PQDVFLGRVXJHUH
&RPSDUHUX¯GRVHPGLIHUHQWHVORFDLVPDLV HVWHWRVFµSLR )UHTXHQWHPHQWHUX¯GRVPDLVLQWHQVRVQD OHV·HVXQLODWHUDLVSH[hérnia
LQWHQVRVRXPHQRVLQWHQVRV UHJL¥RLQIHULRUGRWµUD[SUµ[LPRDRDEGRPH diafragmática congênita
«PRYLPHQWDGRSDUDFLPDQRWµUD[

,QVSLUDWµULRYHUVXVH[SLUDWµULR 4XDVHVHPSUH«LQVSLUDWµULR )UHTXHQWHPHQWHWHPIDVHH[SLUDWµULD 

2V UXtGRV H[SLUDWyULRV FRVWXPDP RULJLQDUVH GH XPD $VLQIHFo}HVGDVYLDV

IRQWH LQWUDWRUiFLFD HQTXDQWR RV UXtGRV LQVSLUDWyULRV UHVSLUDWyULDVVXSHULRUHVQmR
GHULYDPWLSLFDPHQWHGDVYLDVUHVSLUDWyULDVH[WUDWRUiFLFDV VmRJUDYHVHPODFWHQWHVPDV
FRPR D WUDTXHLD 2 GLkPHWUR GDV YLDV UHVSLUDWyULDV SRGHPSURYRFDUUXtGRV
LQVSLUDWyULRVDOWRVTXHVmR
LQWUDWRUiFLFDV GLPLQXL GXUDQWH D H[SLUDomR SRLV DV IRUoDV WUDQVPLWLGRVSDUDRWyUD[
UDGLDLV GR SXOPmR FLUFXQGDQWH QmR ³LPRELOL]DP´ DV YLDV
UHVSLUDWyULDV DEHUWDV FRPR RFRUUH QD LQVSLUDomR $V WD[DV
GHIOX[RPDLVHOHYDGDVGDLQVSLUDomRSURGX]HPXPIOX[RWXUEXOHQWRTXHSURYRFDRVXUJLPHQWRGH
UXtGRVSHUFHSWtYHLV

$V FDUDFWHUtVWLFDV GRV UXtGRV UHVSLUDWyULRV FRPR R 6LELORVHPODFWHQWHVVmR

YHVLFXODU H R EURQFRYHVLFXODU H GRV UXtGRV SXOPRQDUHV FRPXQVQDDVPDRXQD
DGYHQWtFLRV FRPR HVWHUWRUHV VLELORV H URQFRV VmR DV EURQTXLROLWH
PHVPDV GRV DGXOWRV H[FHWR SRU VHUHP PDLV GLItFHLV GH 
GLIHUHQFLDU QR ODFWHQWH H RFRUUHP FRP IUHTXrQFLD MXQWDV
2V VLELORV H URQFRV VmR PDLV IUHTXHQWHV HP ODFWHQWHV 2V (VWHUWRUHVSRGHPVHU
DXVFXOWDGRVQDSQHXPRQLDHQD
VLELORVFRVWXPDPVHUDXGtYHLVVHPHVWHWRVFySLRHPRVWUDP EURQTXLROLWH
VHPDLVIUHTXHQWHVHPIXQomRGRWDPDQKRPHQRUGDiUYRUH
WUDTXHREU{QTXLFD 2V URQFRV UHIOHWHP REVWUXomR GDV
JUDQGHVYLDVUHVSLUDWyULDVRXEU{QTXLRV2VHVWHUWRUHVVmRUXtGRVGHVFRQWtQXRVYHMDSiJLQD
SUy[LPRV DR ILQDO GD LQVSLUDomR FRVWXPDP VHU FDXVDGRV SRU GRHQoDV SXOPRQDUHV H WrP
SUREDELOLGDGH EHP PHQRU GH LQGLFDUHP LQVXILFLrQFLD FDUGtDFD QRV ODFWHQWHV GR TXH QRV DGXOWRV
$OpPGLVVRVmRPDLVUXGHVQRVDGXOWRV

Coração
Inspeção. $QWHV GH H[DPLQDU R FRUDomR SURSULDPHQWH GLWR &LDQRVHFHQWUDOVHPVLQDLVH
REVHUYHFRPFXLGDGRRODFWHQWHHYHULILTXHVHKiFLDQRVH VLQWRPDVUHVSLUDWyULRVDJXGRV
$ DFURFLDQRVH GR UHFpPQDVFLGR IRL DQDOLVDGD QD SiJLQD VXJHUHGRHQoDFDUGtDFD9HMDR
eLPSRUWDQWHGHWHFWDUDH[LVWrQFLDGHFLDQRVH FHQWUDO 4XDGUR&LDQRVHHP
FULDQoDVHR4XDGUR
YHMD R 4XDGUR  &LDQRVH HP FULDQoDV SRLV HOD 6RSURVFDUGtDFRVFRQJrQLWRV
VHPSUH WHP FRQRWDo}HV SDWROyJLFDV H SRUTXH PXLWDV
DQRUPDOLGDGHV FDUGtDFDV FRQJrQLWDV EHP FRPR GRHQoDV
UHVSLUDWyULDVPDQLIHVWDPVHSRUFLDQRVH

2UHFRQKHFLPHQWRGRVJUDXVPtQLPRVGHFLDQRVHH[LJHDWHQomR([DPLQHDVSDUWHVLQWHUQDVGR
FRUSRFRPRDUHJLmRLQWHUQDGDERFDDOtQJXDRXDVFRQMXQWLYDVHPYH]GHVyGDUXPDROKDGDQD
SHOH $ FRU UyVHD GH PRUDQJR p QRUPDO HQTXDQWR XPD FRU GD WRQDOLGDGH GD DPRUD RX GD XYD
VXJHUHGHVVDWXUDomR

$GLVWULEXLomRGDFLDQRVHWDPEpPGHYHVHUDYDOLDGD$R[LPHWULDFRQILUPDUiDGHVVDWXUDomR

&DXVDVFDUG¯DFDVGHFLDQRVHFHQWUDOHPODFWHQWHVHFULDQ©DV

,GDGHGHLQ¯FLR &DXVDFDUG¯DFDSRWHQFLDO

7UDQVSRVL©¥RGHJUDQGHVDUW«ULDV
$WUHVLDGHYDOYDSXOPRQDU
,PHGLDWDPHQWHDSµVRQDVFLPHQWR
(VWHQRVHJUDYHGHYDOYDSXOPRQDU
3RVVLYHOPHQWHPDOIRUPD©¥RGH(EVWHLQ

7RGDVDVDFLPDDO«PGH

5HWRUQRYHQRVRSXOPRQDUDQ¶PDORWRWDO

$OJXQVGLDVDSµVRQDVFLPHQWR 6¯QGURPHGDVF¤PDUDVHVTXHUGDVKLSRSO£VLFDV

7UXQFXVDUWHULRVXV¢VYH]HV

9DULDQWHVGHYHQWU¯FXOR¼QLFR

7RGDVDVDFLPDDO«PGH
6HPDQDVPHVHVRXDQRVGHYLGD
'RHQ©DYDVFXODUSXOPRQDUFRPVKXQWDWULDOYHQWULFXODURXGHJUDQGHYDVR

2EVHUYH RV VLQDLV JHUDLV GH VD~GH GR ODFWHQWH $V 7DTXLSQHLDWDTXLFDUGLDH

FRQGLo}HV QXWULFLRQDLV DV UHDo}HV D WUDQTXLOLGDGH H D KHSDWRPHJDOLDHPODFWHQWHV
LUULWDELOLGDGHGRODFWHQWHVmRLQGtFLRV~WHLVSDUDDYDOLDomR VXJHUHPLQVXILFLrQFLDFDUGtDFD
GHGRHQoDFDUGtDFD2EVHUYHTXHFULDQoDVFRPFDUGLRSDWLD
SRGHPDSUHVHQWDUDFKDGRVQmRFDUGtDFRV

$FKDGRVQ¥RFDUG¯DFRVFRPXQVHPODFWHQWHVFRPFDUGLRSDWLD

3UREOHPDVGHDOLPHQWD©¥R 7DTXLSQHLD 0DXHVWDGRJHUDO

 5HWDUGRGRGHVHQYROYLPHQWR +HSDWRPHJDOLD )UDTXH]D

,UULWDELOLGDGH %DTXHWHDPHQWRGLJLWDO 

2EVHUYH D IUHTXrQFLD H R SDGUmR UHVSLUDWyULRV SDUD 8PDEDXODPHQWRGLIXVRSDUD

DMXGDUDGLIHUHQFLDURJUDXGHGRHQoDHID]HURGLDJQyVWLFR IRUDGRODGRHVTXHUGRGRWyUD[
GLIHUHQFLDOHQWUHSDWRORJLDFDUGtDFDHSXOPRQDU2DXPHQWR VXJHUHFDUGLRPHJDOLDGHORQJD
GR HVIRUoR UHVSLUDWyULR p HVSHUDGR QDV GRHQoDV GDWD
SXOPRQDUHV DR SDVVR TXH QD FDUGLRSDWLD SRGH RFRUUHU
WDTXLSQHLD(QWUHWDQWRVyRFRUUHDXPHQWRGRHVIRUoRUHVSLUDWyULRTXDQGRDLQVXILFLrQFLDFDUGtDFD
pVLJQLILFDWLYD

Palpação.2VSULQFLSDLVUDPRVGDDRUWDSRGHPVHUDYDOLDGRV $DXVrQFLDRXGLPLQXLomRGRV
SHOD DIHULomR GRV SXOVRV SHULIpULFRV 1R SULPHLUR H[DPH SXOVRVIHPRUDLVLQGLFD
DSyV R QDVFLPHQWR WRGRV RV SXOVRV SHULIpULFRV GHYHP VHU FRDUWDomRGDDRUWD&DVRQmR
VHMDSRVVtYHOGHWHFWDURVSXOVRV
DYDOLDGRV 1RV UHFpPQDVFLGRV H ODFWHQWHV R SXOVR GD
IHPRUDLVGHWHUPLQHDV
DUWpULDEUDTXLDOQDIRVVDDQWHFXELWDOpPDLVIiFLOGHSDOSDU SUHVV}HVDUWHULDLVQRVPHPEURV
GR TXH R SXOVR GD DUWpULD UDGLDO QR SXQKR $PEDV DV VXSHULRUHLQIHULRU6HHODV
DUWpULDVWHPSRUDLVGHYHPVHUSDOSDGDVjIUHQWHGDRUHOKD IRUHPLJXDLVRXPHQRUHVQR
PHPEURLQIHULRUpSURYiYHO
3DOSH RV SXOVRV IHPRUDLV TXH ILFDP VLWXDGRV QD OLQKD TXHH[LVWDFRDUWDomR
PpGLDORJRDEDL[RGDSUHJDLQJXLQDOHQWUHDFULVWDLOtDFDH
DVtQILVHS~ELFD1mRWHQKDSUHVVDDRSHVTXLVDURVSXOVRVIHPRUDLV±HOHVVmRGLItFHLVGHGHWHFWDU
HP EHErV JRUGXFKRV H TXH HVSHUQHLDP 6H YRFr IOH[LRQDU SULPHLUR DV FR[DV GR EHEr VREUH R
DEGRPHSRGHVXSHUDURUHIOH[RGHIOH[mRTXHRFRUUHTXDQGRHVWLFDDVSHUQDVDVHJXLU

2VSXOVRVSHGLRVRGRUVDODUWpULDGRUVDOGRSpVHJXQGRD 8PSXOVRIUDFRRXILOLIRUPHH

7HUPLQRORJLD $QDW{PLFD H WLELDO SRVWHULRU YHMD D ILJXUD GLItFLOGHSDOSDUSRGHUHIOHWLU
SRGHP VHU GLItFHLV GH SDOSDU D PHQRV TXH KDMD XPD GLVIXQomRPLRFiUGLFDH
LQVXILFLrQFLDFDUGtDFD
DQRUPDOLGDGHHQYROYHQGRRHVFRDPHQWRDyUWLFR2VSXOVRV
SULQFLSDOPHQWHTXDQGR
QRUPDLV GHYHP HYLGHQFLDU XPD HOHYDomR EUXVFD H VHU DVVRFLDGRDXPJUDXLQFRPXP
ILUPHVHEHPORFDOL]DGRV GHWDTXLFDUGLD

2VSXOVRVDUWHULDLVQRVSpVGH
UHFpPQDVFLGRVHODFWHQWHV
FRVWXPDPVHUGpEHLVSRUpP
GLYHUVRVTXDGURVSRGHP
SURYRFDUSXOVRVFKHLRVFRPR
SHUVLVWrQFLDGRFDQDODUWHULDORX
WURQFRDUWHULRVR
&RQIRUPH DQDOLVDGR QDV SiJLQDV  H  D
GHWHUPLQDomRFXLGDGRVDGDSUHVVmRDUWHULDOGRVODFWHQWHVHFULDQoDVID]SDUWHGRH[DPHFDUGtDFR
 

2LFWXVFRUGLV SRQWR GH LPSXOVR Pi[LPR RX 3,0 QHP 8PIUrPLWR³URODQWH´QDERUGD

VHPSUH p SDOSiYHO QR ODFWHQWH VHQGR DIHWDGR SRU SDGU}HV HVWHUQDOHVTXHUGDVXJHUH
UHVSLUDWyULRVHVW{PDJRFKHLRHSRVLFLRQDPHQWRGRODFWHQWH DXPHQWRGRWUDEDOKR
YHQWULFXODUGLUHLWRHQTXDQWRR
(P JHUDO QRV SULPHLURV DQRV GH YLGD ILFD XP HVSDoR
PHVPRWLSRGHPRYLPHQWR
LQWHUFRVWDO DFLPD GD VLWXDomR QRV DGXOWRV SRLV R FRUDomR PDLVSUy[LPRDRiSLFHVXJHUH
WHPORFDOL]DomRPDLVKRUL]RQWDOQRWyUD[ DXPHQWRGRWUDEDOKRGR
YHQWUtFXORHVTXHUGR
$SDOSDomRGDSDUHGHWRUiFLFDSHUPLWHDYDOLDUDOWHUDo}HV
GH YROXPH QR LQWHULRU GR FRUDomR 2 SUHFyUGLR
KLSHUGLQkPLFRSRUH[HPSORUHIOHWHJUDQGHPXGDQoDGHYROXPH

2V IUrPLWRV VmR SDOSiYHLV TXDQGR Ki WXUEXOrQFLD QR 3XOVDo}HVWRUiFLFDVYLVtYHLVH

LQWHULRU GR FRUDomR RX GRV JUDQGHV YDVRV H HVWD p SDOSiYHLVVXJHUHPXPHVWDGR
WUDQVPLWLGD SDUD D VXSHUItFLH 2 FRQKHFLPHQWR GDV KLSHUGLQkPLFRSRUDXPHQWRGD
HVWUXWXUDV GR SUHFyUGLR DMXGD D GHILQLU FRP H[DWLGmR D WD[DPHWDEyOLFDRX
ERPEHDPHQWRLQHILFLHQWH
RULJHP GR IUrPLWR e PDLV IiFLO SDOSDU R IUrPLWR FRP D VHFXQGiULRDXPGHIHLWR
SDOPDGDPmRRXDEDVHGRVGHGRVGRTXHFRPDSRQWDGRV FDUGtDFRVXEMDFHQWH
GHGRV 2V IUrPLWRV VmR FDUDFWHULVWLFDPHQWH JURVVHLURV H
YLEUDQWHV$ILJXUDDGLDQWHPRVWUDDORFDOL]DomRGHIUrPLWRV
SDUDGLYHUVDVDQRUPDOLGDGHVFDUGtDFDVREVHUYDGDVHPODFWHQWHVHFULDQoDV

3XOVDo}HVWRUiFLFDVYLVtYHLVH
SDOSiYHLVVXJHUHPXPHVWDGR
KLSHUGLQkPLFRSRUDXPHQWRGD
WD[DPHWDEyOLFDRX
ERPEHDPHQWRLQHILFLHQWH
VHFXQGiULRDXPGHIHLWR
FDUGtDFRVXEMDFHQWH

/2&$/,=$d­2'()5Ç0,726(0/$&7(17(6(&5,$1d$6

Ausculta. 9RFr SRGH DYDOLDU R ULWPR FDUGtDFR FRP PDLV $DUULWPLDPDLVFRPXPQR

IDFLOLGDGH QDV FULDQoDV DR DXVFXOWDU R FRUDomR GR TXH DR ODFWHQWHpDWDTXLFDUGLD
SDOSDU RV SXOVRV SHULIpULFRV QDV FULDQoDV PDLV YHOKDV DV VXSUDYHQWULFXODUSDUR[tVWLFDRX
WDTXLFDUGLDDWULDOSDUR[tVWLFD
GXDVPDQREUDVVmRVDWLVIDWyULDV
7693RX7$33RGHRFRUUHU
HPTXDOTXHULGDGHLQFOXVLYHQD
2V ODFWHQWHV H FULDQoDV FRVWXPDP WHU DUULWPLD VLQXVDO YLGDLQWUDXWHULQDe
QRUPDOFRPDXPHQWRGDIUHTXrQFLDFDUGtDFDQDLQVSLUDomR VXUSUHHQGHQWHPHQWHEHP
H GLPLQXLomR jV YH]HV EUXVFD QD H[SLUDomR (VWH DFKDGR WROHUDGDSRUDOJXQVODFWHQWHVH
QRUPDO SRGH VHU LGHQWLILFDGR SRU VXD QDWXUH]D UHSHWLWLYD FULDQoDVVHQGRGHWHFWDGDDR
VXD FRUUHODomR FRP D UHVSLUDomR H VXD RFRUUrQFLD HP H[DPHHPFULDQoDVFRP
YiULRVEDWLPHQWRVHPYH]GHXP~QLFR DVSHFWRSHUIHLWDPHQWH
VDXGiYHOGLVFUHWDPHQWHSiOLGR
RXFRPWDTXLSQHLD(QWUHWDQWR
0XLWRV UHFpPQDVFLGRV H DOJXPDV FULDQoDV PDLV YHOKDV
DFULDQoDDSUHVHQWDIUHTXrQFLD
DSUHVHQWDP H[WUDVVtVWROHV DWULDLV RX YHQWULFXODUHV PXLWDV FDUGtDFDUiSLGDSHUVLVWHQWHH
YH]HVSHUFHELGRVFRPR³VDOWRV´GHEDWLPHQWRVeSRVVtYHO WRWDOPHQWHUHJXODUGHESP
HP JHUDO HUUDGLFiORV DR DXPHQWDU D IUHTXrQFLD VLQXVDO 2XWUDVFULDQoDVHVSHFLDOPHQWH
LQWUtQVHFD SRU H[HUFtFLR GXUDQWH R FKRUR QR ODFWHQWH RX UHFpPQDVFLGRVSDUHFHPWHU
GRHQoDJUDYH(PHVFRODUHV
SHGLQGR D FULDQoDV PDLV YHOKDV SDUD VDOWLWDUHP (VVDV HVVDDUULWPLDWHQGHDVHU
H[WUDVVtVWROHV WDPEpP SRGHP VHU PDLV IUHTXHQWHV QR YHUGDGHLUDPHQWHSDUR[tVWLFD
SHUtRGRSyVH[HUFtFLR(PXPDFULDQoDWRWDOPHQWHVDXGiYHO FRPHSLVyGLRVGHGXUDomRH
FRVWXPDPVHUEHQLJQDVHGLILFLOPHQWHSHUVLVWHP IUHTXrQFLDYDULDGRV

Bulhas cardíacas.$YDOLHFRPFXLGDGRDVEXOKDV FDUGtDFDV $UULWPLDVSDWROyJLFDVHP

% H % 1RUPDOPHQWH HODV VmR EHP DXGtYHLV (P JHUDO p FULDQoDVSRGHPVHUGHYLGDVD
SRVVtYHO DXVFXOWDU RV GRLV FRPSRQHQWHV GD VHJXQGD EXOKD OHV}HVFDUGtDFDVHVWUXWXUDLV
PDVWDPEpPDRXWUDVFDXVDV
%QDEDVHVHSDUDGDPHQWHPDVDVGXDVEXOKDVIXQGHPVH
FRPRLQJHVWmRGHGURJDV
HP XP ~QLFR VRP QD UHVSLUDomR SURIXQGD 1R UHFpP DQRUPDOLGDGHVPHWDEyOLFDV
QDVFLGR YRFr GHYH VHU FDSD] GH GHWHFWDU XP GRHQoDVHQGyFULQDVLQIHFo}HV
GHVGREUDPHQWR GH % VH H[DPLQDU R ODFWHQWH TXDQGR HOH JUDYHVHHVWDGRVSyV
HVWLYHU FRPSOHWDPHQWH WUDQTXLOR RX GRUPLQGR $ GHWHFomR LQIHFFLRVRVRXWUDQVWRUQRVGD
FRQGXomRVHPFDUGLRSDWLD
GHVWHGHVGREUDPHQWRHOLPLQDDSRVVLELOLGDGHGHRFRUUrQFLD HVWUXWXUDO
GH PXLWDV FDUGLRSDWLDV FRQJrQLWDV PDLV JUDYHV PDV QXQFD
GHWRGDV

&DUDFWHU¯VWLFDVGHYDULDQWHVQRUPDLVGRULWPRFDUG¯DFRHPFULDQ©DV
([WUDVV¯VWROHVDWULDLV(6$RX $V(69H[WUDVV¯VWROHVYHQWULFXODUHV
&DUDFWHU¯VWLFDV $UULWPLDVVLQXVDLVQRUPDLV
H[WUDVV¯VWROHVYHQWULFXODUHV(69 FRVWXPDPRFRUUHUHPODFWHQWHVVHP
$SµVDIDVHGHODFWHQWH RXWURVSUREOHPDVGHVD¼GHPDV
5HF«PQDVFLGRVSRGHRFRUUHUDTXDOTXHU SRGHPWDPE«PVHUHQFRQWUDGDV
,GDGHPDLVFRPXP 'XUDQWHWRGDDLQI¤QFLDPHQRVFRPXPQRV TXDQGRH[LVWHPGRHQ©DVFDUG¯DFDV
PRPHQWR
&RUUHOD©¥RFRPDUHVSLUD©¥R
DGXOWRV VXEMDFHQWHVSULQFLSDOPHQWH
miocardiopatiasHcardiopatias congênitas
6LP$XPHQWRQDLQVSLUD©¥R 7UDQVWRUQRVHOHWURO¯WLFRVRX
1¥R
PHWDEµOLFRVV¥RRXWUDVFDXVDV
'LPLQXLQDH[SLUD©¥R

'HVDSDUHFHFRPRH[HUF¯FLR
(IHLWRGRH[HUF¯FLRVREUHDWDTXLFDUGLD 'HVDSDUHFH 
3RGHVHUPDLVIUHTXHQWHDSµVH[HUF¯FLR
 )DOKDGHEDWLPHQWR 0DLVU£SLGRHPJHUDOFRPDLQVSLUD©¥R
&DUDFWHU¯VWLFDGRULWPR
2FRUU¬QFLDLUUHJXODU +LSRIRQHVHVXEVWDQFLDOGDVEXOKDV
'HVDFHOHUD©¥RV¼ELWDIUHTXHQWHQDH[SLUD©¥R
FDUG¯DFDVVXJHUHderrame pericárdico
EXOKDVFDUG¯DFDVLQGLVWLQWDVVXJHUHP
9£ULRVEDWLPHQWRVLQFOXVLYHHPFLFORV
1¼PHURGHEDWLPHQWRV *HUDOPHQWHEDWLPHQWRVDQRUPDLV¼QLFRV disfunção miocárdica
UHSHWLWLYRV

*UDYLGDGH *HUDOPHQWHEHQLJQDV %HQLJQDSRUGHILQL©¥R

$OpPGHWHQWDUGHWHFWDURGHVGREUDPHQWRGH% REVHUYH 8PFRPSRQHQWHSXOPRQDU3

DLQWHQVLGDGHGH$H32FRPSRQHQWHDyUWLFRRSULPHLUR PDLVLQWHQVRGRTXHRQRUPDO
FRPSRQHQWH GD VHJXQGD EXOKD QD EDVH p HP JHUDO PDLV SULQFLSDOPHQWHTXDQGRPDLV
LQWHQVRGRTXHRSXOPRQDURXRVHJXQGRFRPSRQHQWHGH% LQWHQVRTXHRFRPSRQHQWH
DyUWLFRVXJHUHKLSHUWHQVmR
SXOPRQDU


2GHVGREUDPHQWRSHUVLVWHQWH
GH%LQGLFDVREUHFDUJD
YROXPpWULFDQRYHQWUtFXOR
GLUHLWRFRPRFRPXQLFDomR
LQWHUDWULDODQRPDOLDVGR
UHWRUQRYHQRVRSXOPRQDURX
DQHPLDFU{QLFD
¬V YH]HV p $WHUFHLUDEXOKDFDUGtDFD%
GHWHFWDGD XPD SUHFLVDVHUGLIHUHQFLDGDGHXP
WHUFHLUD EXOKD JDORSHFRPWHUFHLUDEXOKDGH
FDUGtDFD%(VWip PDLRULQWHQVLGDGHTXHpXP
VLQDOGHSDWRORJLDVXEMDFHQWH
XPD EXOKD
SURWRGLDVWyOLFD GH
WRQDOLGDGHJUDYHTXHFRVWXPDVHUDXVFXOWDGDQDERUGDHVWHUQDOHVTXHUGDLQIHULRURXQRiSLFHe
IUHTXHQWHDXVFXOWiODHPFULDQoDVHHODpQRUPDOHUHIOHWHUiSLGRHQFKLPHQWRYHQWULFXODU

$ TXDUWD EXOKD FDUGtDFD % UDUDPHQWH DXVFXOWDGD QDV 4XDUWDEXOKDFDUGtDFD

FULDQoDV p XP UXtGR WHOHGLDVWyOLFR GH EDL[D IUHTXrQFLD UHSUHVHQWDGLPLQXLomRGD
TXHRFRUUHORJRDQWHVGDSULPHLUDEXOKDFDUGtDFD FRPSODFrQFLDYHQWULFXODU
VXJHULQGRLQVXILFLrQFLD
  FDUGtDFD

9RFr WDPEpP SRGH GHWHFWDU XP JDORSH DSDUHQWH 8PULWPRGHJDORSH±

GHVGREUDPHQWR DPSOR H YDULiYHO GH % QD YLJrQFLD GH WDTXLFDUGLDDVVRFLDGDD%HRX
ULWPR H IUHTXrQFLD FDUGtDFRV QRUPDLV (VVH DFKDGR %±pSDWROyJLFRHLQGLFD
IUHTXHQWHpQRUPDOHPFULDQoDVVHPGRHQoDV LQVXILFLrQFLDFDUGtDFDIXQomR
YHQWULFXODUGHILFLHQWH


Sopros cardíacos. 8P GRV DVSHFWRV PDLV GHVDILDGRUHV GR H[DPH FDUGtDFR QDV FULDQoDV p D
DYDOLDomRGRVVRSURVFDUGtDFRV$OpPGHWHQWDUDXVFXOWDUFULDQoDVTXHHVSHUQHLDPHjVYH]HVQmR
FRRSHUDP XP GHVDILR LPSRUWDQWH p GLIHUHQFLDU VRSURV EHQLJQRV FRPXQV GH VRSURV DQRUPDLV RX
SDWROyJLFRV &DUDFWHUL]H RV VRSURV FDUGtDFRV HP ODFWHQWHV H FULDQoDV SHOD REVHUYDomR GH VXD
ORFDOL]DomR HVSHFtILFD S H[ ERUGD VXSHULRU HVTXHUGD GR HVWHUQR H QmR DSHQDV ERUGD HVWHUQDO
HVTXHUGDFURQRORJLDLQWHQVLGDGHHFDUDFWHUtVWLFDV6HFDGDVRSURIRUEHPGHILQLGRHPJHUDOp
SRVVtYHO UHDOL]DU R GLDJQyVWLFR SRU PHLR GD VLPSOHV FRQILUPDomR H DPSOLILFDomR SRU H[DPHV
FRPSOHPHQWDUHVFRPR(&*UDGLRJUDILDGHWyUD[HHFRFDUGLRJUDILD

2V VRSURV EHQLJQRV HP FULDQoDV SRU GHILQLomR QmR VH 4XDOTXHUGRVDFKDGRVQmR

DVVRFLDP D RXWURV DFKDGRV DQRUPDLV 4XDVH WRGDV DV FDUGtDFRVTXHIUHTXHQWHPHQWH
FULDQoDV FRP PDOIRUPDo}HV FDUGtDFDV JUDYHV DSUHVHQWDP DFRPSDQKDPDGRHQoDFDUGtDFD
HPFULDQoDVHOHYD
VLQDLV H VLQWRPDV DOpP GR VRSUR FDUGtDFR GHVFREHUWR QD
DFHQWXDGDPHQWHD
DQDPQHVH RX QR H[DPH FXLGDGRVR 0XLWRV DSUHVHQWDP SRVVLELOLGDGHGHXPVRSUR
RXWURV VLQDLV H VLQWRPDV H[WUDFDUGtDFRV LQFOXVLYH DSDUHQWHPHQWHEHQLJQRVHU
HYLGrQFLDV GH DOWHUDo}HV JHQpWLFDV TXH VmR LQGtFLRV SDWROyJLFR
GLDJQyVWLFRV~WHLV

$ PDLRULD GDV FULDQoDV VHJXQGR DOJXQV DXWRUHV TXDVH 0XLWRVVRSURVSDWROyJLFRVGH

WRGDVDSUHVHQWDPXPRXPDLVVRSURVFDUGtDFRVIXQFLRQDLV FDUGLRSDWLDVFRQJrQLWDVMi
RXEHQLJQRVDQWHVGDIDVHDGXOWDeLPSRUWDQWHLGHQWLILFDU H[LVWHPSRURFDVLmRGR
QDVFLPHQWR2XWURVVy
VRSURVIXQFLRQDLVPDLVSRUVXDVFDUDFWHUtVWLFDVGRTXHSRU
DSDUHFHPPDLVWDUGH
VXDV LQWHQVLGDGHV HVSHFtILFDV &RP D SUiWLFD p SRVVtYHO GHSHQGHQGRGHVXDJUDYLGDGH
UHFRQKHFHU RV VRSURV IXQFLRQDLV FRPXQV QD ODFWkQFLD H QD GDTXHGDQDUHVLVWrQFLD
LQIkQFLD TXH QD PDLRULD GRV FDVRV QmR H[LJHP DYDOLDomR YDVFXODUSXOPRQDUDSyVR
DGLFLRQDO QDVFLPHQWRRXGHDOWHUDo}HV
DVVRFLDGDVDRFUHVFLPHQWRGD
FULDQoD24XDGURPRVWUD
 $ ILJXUD D VHJXLU FDUDFWHUL]D GRLV VRSURV FDUGtDFRV H[HPSORVGHVRSURV
EHQLJQRV HP ODFWHQWHV VHJXQGR VXDV ORFDOL]Do}HV H SDWROyJLFRVQDLQIkQFLD
SULQFLSDLVFDUDFWHUtVWLFDV

'RLVVRSURVEHQLJQRVFRPXQVQRVODFWHQWHV

,GDGHW¯SLFD 1RPH &DUDFWHU¯VWLFDV 'HVFUL©¥RHORFDOL]D©¥R

(MH©¥RWUDQVLWµULRVXDYH
5HF«PQDVFLGR &DQDODUWHULDOHPSURFHVVRGHIHFKDPHQWR
%RUGDHVWHUQDOHVTXHUGDVXSHULRU

6XDYHGLVFUHWDPHQWHGHHMH©¥RVLVWµOLFR
5HF«PQDVFLGRDDQR 6RSURSHULI©ULFRGHIOX[RSXOPRQDU ‚HVTXHUGDGDERUGDHVWHUQDOVXSHULRUH
QRVFDPSRVSXOPRQDUHVHD[LODV

(P DOJXQV ODFWHQWHV p GHWHFWDGR VRSUR VXDYH GH HMHomR 8PVRSURGHIOX[RSXOPRQDUQR

QmRVLWXDGRQRSUHFyUGLRPDVQRVFDPSRVSXOPRQDUHVHP UHFpPQDVFLGRFRPRXWURV
HVSHFLDO QDV D[LODV (VWH p XP VRSUR SHULIpULFR GD DUWpULD VLQDLVGHGRHQoDWHPPDLRU
SXOPRQDU VHQGR SDUFLDOPHQWH VHFXQGiULR DR FUHVFLPHQWR SUREDELOLGDGHGHVHU
SDWROyJLFR$VGRHQoDVSRGHP
LQDGHTXDGR GD DUWpULD SXOPRQDU QR ~WHUR RQGH Ki SRXFR LQFOXLUVtQGURPHGH:LOOLDPV
IOX[RVDQJXtQHRSXOPRQDUHDRkQJXORGHFXUYDWXUDDJXGR VtQGURPHGHUXEpRODFRQJrQLWD
GD DUWpULD SXOPRQDU QR VHQWLGR SRVWHULRU 6H QmR KRXYHU HVtQGURPHGH$ODJLOOH
DFKDGRV ItVLFRV DGLFLRQDLV VXJHVWLYRV GH RXWUDV GRHQoDV
VXEMDFHQWHVHVWHVRSURGHIOX[RSXOPRQDUSHULIpULFR SRGH
VHUFRQVLGHUDGREHQLJQRHFRVWXPDGHVDSDUHFHUDQWHVGHDQRGHLGDGH

%DVHILVLROµJLFDGHDOJXQVVRSURVFDUG¯DFRVSDWROµJLFRV

$OWHUD©¥RGDUHVLVW¬QFLDYDVFXODUSXOPRQDU

2VVRSURVFDUG¯DFRVTXHGHSHQGHPGDTXHGDSµVQDWDOGDUHVLVW¬QFLDYDVFXODUSXOPRQDUɥTXHSHUPLWHRGLUHFLRQDPHQWRGRIOX[R
WXUEXOHQWRGRVFLUFXLWRVVLVW¬PLFRVGHDOWDSUHVV¥RSDUDRFLUFXLWRSXOPRQDUGHEDL[DSUHVV¥RɥVRPHQWHV¥RDXG¯YHLVTXDQGRHVVD
TXHGDRFRUUH3RUWDQWRVDOYRHPSUHPDWXURVRVVRSURVGDFRPXQLFD§£RLQWHUYHQWULFXODURXGDSHUVLVWªQFLDGRFDQDODUWHULDOWHQGHPD
Q¥RVHUDXVFXOWDGRVQRVSULPHLURVGLDVGHYLGDHHPJHUDOWRUQDPVHDXG¯YHLVDSµVVHPDQDDGLDV

/HV·HVREVWUXWLYDV

$VOHV·HVREVWUXWLYDVFRPRHVWHQRVHSXOPRQDUHD³UWLFDV¥RFDXVDGDVSHORIOX[RQRUPDOGHVDQJXHDWUDY«VGDVGXDVSHTXHQDV
YDOYDVHSRUWDQWRQ¥RGHSHQGHPGHTXHGDGDUHVLVW¬QFLDYDVFXODUSXOPRQDU3RULVVRM£V¥RDXG¯YHLVDRQDVFLPHQWR
8PUHF«PQDVFLGRFRPXPVRSURFDUG¯DFRH
'LIHUHQ©DVQRJUDGLHQWHGHSUHVV¥R FLDQRVHFHQWUDOSURYDYHOPHQWHDSUHVHQWD
FDUGLRSDWLDFRQJ¬QLWDHQHFHVVLWDGHDYDOLD©¥R
2VVRSURVGDUHJXUJLWD§£RYDOYDUDWULRYHQWULFXODUV¥RDXG¯YHLVSRURFDVL¥RGRQDVFLPHQWRHPIXQ©¥RGRHOHYDGRJUDGLHQWHGHSUHVV¥R FDUG¯DFDXUJHQWH
HQWUHRYHQWU¯FXORHVHX£WULR

0XGDQ©DVDVVRFLDGDVDRFUHVFLPHQWRGDFULDQ©D

$OJXQVVRSURVQ¥RREHGHFHP¢VUHJUDVDFLPDSRU«PUHVXOWDPGHDOWHUD©·HVQRIOX[RVDQJX¯QHRQRUPDOHRFRUUHPRXPXGDPFRPR
FUHVFLPHQWR2VRSURGDHVWHQRVHD³UWLFDSRUH[HPSORHPERUDVHMDXPGHIHLWRREVWUXWLYRVµ«DXVFXOWDGRGHSRLVGHWHURFRUULGRXP
FUHVFLPHQWRFRQVLGHU£YHO1DYHUGDGHHFRPIUHTX¬QFLDVµ«DXVFXOWDGRQDYLGDDGXOWDHPERUDDUHVSRQV£YHOVHMDXPDYDOYDFRP
DQRUPDOLGDGHFRQJ¬QLWD'RPHVPRPRGRRVRSURGHIOX[RSXOPRQDUGDFRPXQLFD§£RLQWHUDWULDO¢VYH]HVVRPHQWH«DXVFXOWDGR
GHSRLVGHDQRRXPDLVSRLVDFRPSODF¬QFLDGRYHQWU¯FXORGLUHLWRHRVKXQWDXPHQWDPJUDGXDOPHQWHWHUPLQDQGRSRUSURGX]LUXP
VRSURSURYRFDGRSHODSDVVDJHPGHH[FHVVRGHVDQJXHSHODYDOYDSXOPRQDUQRUPDO

4XDQGR GHWHFWDGR XP VRSUR HP XPD FULDQoD p $VFDUDFWHUtVWLFDVGHVRSURV

IXQGDPHQWDO YHULILFDU DV FDUDFWHUtVWLFDV GHVFULWDV QR FDUGtDFRVSDWROyJLFRV
&DStWXOR  SDUD DMXGDU D GLIHUHQFLDU VRSURV SDWROyJLFRV HVSHFtILFRVHPFULDQoDVVmR
GRVVRSURVEHQLJQRVTXHDFDEDPRVGHGHVFUHYHU2VVRSURV GHVFULWDVQR4XDGUR
SDWROyJLFRVTXHUHIOHWHPFDUGLRSDWLDVXEMDFHQWHHVWUXWXUDO
VmRPDLVIiFHLVGHDYDOLDUTXDQGRVHWHPXPERPFRQKHFLPHQWRGDDQDWRPLDLQWUDWRUiFLFDHGDV
DOWHUDo}HV IXQFLRQDLV FDUGtDFDV DSyV R QDVFLPHQWR H VH FRPSUHHQGH EHP D EDVH ILVLROyJLFD GRV
VRSURVFDUGtDFRV2FRQKHFLPHQWRGHVVDVPXGDQoDVILVLROyJLFDVSRGHDMXGDUDGLIHUHQFLDUVRSURV
SDWROyJLFRVGHVRSURVFDUGtDFRVEHQLJQRVQDVFULDQoDV

Mamas
$V PDPDV GH UHFpPQDVFLGRV VHMDP HOHV GR VH[R 1DWHODUFDSUHPDWXUDRFRUUH
PDVFXOLQR RX IHPLQLQR PXLWDV YH]HV HVWmR DXPHQWDGDV HP GHVHQYROYLPHQWRPDPiULRHP
IXQomR GR HIHLWR GR HVWURJrQLR PDWHUQR (VVH HIHLWR SRGH JHUDOHQWUHPHVHVHDQRV
1mRKiRXWURVVLQDLVGH
SHUGXUDU YiULRV PHVHV $V PDPDV WDPEpP SRGHP VHU
SXEHUGDGHQHPDQRUPDOLGDGHV
LQJXUJLWDGDVHFRQWHUXPOtTXLGREUDQFRGHQRPLQDGR³OHLWH KRUPRQDLV
GHEUX[D´TXHjVYH]HVSHUVLVWHSRURXVHPDQDV

Abdome
Inspeção.,QVSHFLRQHRDEGRPHFRPRODFWHQWHHPGHF~ELWRGRUVDOHGHSUHIHUrQFLDGRUPLQGR2
DEGRPH GR ODFWHQWH p SURWUXVR HP GHFRUUrQFLD GR GHVHQYROYLPHQWR LQFLSLHQWH GD PXVFXODWXUD
DEGRPLQDOeIiFLOSHUFHEHURVYDVRVVDQJXtQHRVGDSDUHGHDEGRPLQDOHDSHULVWDOVHDEGRPLQDO

,QVSHFLRQH R FRUGmR XPELOLFDO GR UHFpPQDVFLGR SDUD $DUWpULDXPELOLFDO~QLFDSRGH

GHWHFWDU DQRUPDOLGDGHV 1RUPDOPHQWH H[LVWHP GXDV HVWDUDVVRFLDGDDRXWUDV
DUWpULDV XPELOLFDLV GH SDUHGHV HVSHVVDV H XPD YHLD DQRPDOLDVFRQJrQLWDVRXVHU
XPDDQRPDOLDLVRODGD
XPELOLFDO GH SDUHGH ILQD SRUpP GH FDOLEUH PDLRU TXH
FRVWXPDHVWDUORFDOL]DGDQDSRVLomRGHK

2 XPELJR GR UHFpPQDVFLGR SRGH DSUHVHQWDU XPD ORQJD 2JUDQXORPDXPELOLFDOQDEDVH

SRUomRFXWkQHDUHFREHUWDSRUSHOHXPELOLFXVFXWLVRXXPD GRXPELJRLQGLFDR
SRUomR DPQLyWLFD LPELOLFXV DPQLRWLFXV FREHUWD SRU XPD GHVHQYROYLPHQWRGHWHFLGRGH
JUDQXODomRUyVHRIRUPDGR
VXEVWkQFLD JHODWLQRVD ILUPH $ SRUomR DPQLyWLFD UHVVHFD H
GXUDQWHRSURFHVVRGH
FDLQRSUD]RGHVHPDQDVDRSDVVRTXHDSRUomRFXWkQHD FLFDWUL]DomR
UHWUDLVHHILFDFRQWLGDQDSDUHGHDEGRPLQDO

,QVSHFLRQH D UHJLmR HP WRUQR GR XPELJR j SURFXUD GH $LQIHFomRGRFRWRXPELOLFDO

HULWHPDRXWXPHIDomR RQIDOLWHSRGHVHUXPD
FRQGLomRJUDYH


$V KpUQLDV XPELOLFDLV VmR GHWHFWiYHLV FRP DOJXPDV +pUQLDVXPELOLFDLVQRV

VHPDQDVGHLGDGH$PDLRULDGHVDSDUHFHDWpDQRGHLGDGH ODFWHQWHVVmRSURYRFDGDVSRU
HTXDVHWRGDVDWpRVDQRV GHIHLWRVQDSDUHGHDEGRPLQDO
SRGHPWHUDWpFPGH
(P DOJXQV ODFWHQWHV QRUPDLV REVHUYDVH GLiVWDVH GRV GLkPHWURHWRUQDPVHEDVWDQWH
SURWXEHUDQWHVTXDQGRD
UHWRV$GLiVWDVHFRQVLVWHHPVHSDUDomRGRVGRLVP~VFXORV SUHVVmRLQWUDDEGRPLQDO
UHWRVGRDEGRPHHSURYRFDRVXUJLPHQWRGHXPDHOHYDomR DXPHQWD
OLQHDUQDOLQKDPpGLDTXHpPDLVHYLGHQWHTXDQGRRODFWHQWH
FRQWUDL D PXVFXODWXUD DEGRPLQDO 1D PDLRULD GRV FDVRV
HVVH p XP TXDGUR EHQLJQR TXH UHJULGH QD SULPHLUD LQIkQFLD $ GLVWHQVmR DEGRPLQDO FU{QLFD
WDPEpPSRGHSUHGLVSRUDHVVDFRQGLomR

Ausculta. $ DXVFXOWD GR DEGRPH GH XP ODFWHQWH WUDQTXLOR p $XPHQWRQDWRQDOLGDGHRXQD

IiFLO 1mR VH VXUSUHHQGD VH DXVFXOWDU XPD RUTXHVWUD GH IUHTXrQFLDGRVUXtGRV
UXtGRV LQWHVWLQDLV PXVLFDLV DR FRORFDU R HVWHWRVFySLR QR LQWHVWLQDLVpDXVFXOWDGRQD
JDVWUHQWHULWHRXUDUDPHQWHQD
DEGRPHGRODFWHQWH
REVWUXomRLQWHVWLQDO


Percussão e palpação. 9RFr SRGH SHUFXWLU R DEGRPH GR 2DEGRPHVLOHQFLRVR
ODFWHQWHFRPRRIDULDFRPXPDGXOWRPDVQmRVHHVSDQWHVH WLPSkQLFRGLVWHQGLGRH
SHUFHEHUUXtGRVWLPSkQLFRVPDLVLQWHQVRV(OHVVHGHYHPj GRORURVRVXJHUHSHULWRQLWH
SURSHQVmRGRODFWHQWHGHHQJROLUDU$SHUFXVVmRp~WLOSDUD
GHWHUPLQDURWDPDQKRGRVyUJmRVHDH[LVWrQFLDGHPDVVDVDEGRPLQDLV

e IiFLOSDOSDU R DEGRPH GRV ODFWHQWHV SRUTXH HOHV JRVWDP GH FRQWDWR ItVLFR 8PD WpFQLFD ~WLO
SDUDUHOD[DURODFWHQWHPRVWUDGDDVHJXLUFRQVLVWHHPVHJXUDUDVSHUQDVIOH[LRQDGDVQRVMRHOKRVH
QRVTXDGULVFRPXPDGDVPmRVHSDOSDURDEGRPHFRPDRXWUD9RFrSRGHWDPEpPXVDUWDPEpP
XPDFKXSHWDSDUDPDQWHUREHErWUDQTXLORQHVVDSRVLomR

,QLFLH VXD SDOSDomR FRP FXLGDGR SHOR ItJDGR VLWXDGR 2ItJDGRGRORURVRHDXPHQWDGR

HP SRVLomR PDLV EDL[D QR DEGRPH GHVORFDQGR RV GHGRV SRGHVHUGHYLGRDLQVXILFLrQFLD
SDUD FLPD (VVD WpFQLFD DMXGD D HYLWDU TXH SDVVHP FDUGtDFDRXDGRHQoDGH
DUPD]HQDPHQWRKHSiWLFR(QWUH
GHVSHUFHELGDV DV KHSDWRPHJDOLDV H[WUHPDV FRP H[WHQVmR
UHFpPQDVFLGRVDVFDXVDVGH
SDUD DOpP GD SHOYH 0HGLDQWH XP H[DPH FXLGDGRVR p KHSDWRPHJDOLDLQFOXHP
SRVVtYHOGHWHFWDUDERUGDKHSiWLFDQDPDLRULDGRVODFWHQWHV KHSDWLWHGRHQoDVGH
DDFPDEDL[RGRUHERUGRFRVWDOGLUHLWR DUPD]HQDPHQWRFRQJHVWmR
YDVFXODUHREVWUXomRELOLDU
8PD GDV WpFQLFDV SDUD DYDOLDU R WDPDQKR GR ItJDGR GR
ODFWHQWH p D SHUFXVVmR H D DXVFXOWD VLPXOWkQHD 3HUFXWD H
DXVFXOWHVLPXOWDQHDPHQWHHREVHUYHPRGLILFDo}HVQRVRPjPHGLGDTXHIRUSHUFXWLQGRDUHJLmRGR
ItJDGRHDViUHDVDOpPGHOH

2EDoRFRPRRItJDGRpIiFLOGHSDOSDUQDPDLRULDGRV 'LYHUVDVGRHQoDVSRGHP
ODFWHQWHV (OH WDPEpP p PROH DSUHVHQWD ERUGDV EHP SURYRFDUHVSOHQRPHJDOLD
GHILQLGDV H SURMHWDVH SDUD EDL[R FRPR XPD OtQJXD SRU LQFOXVLYHLQIHFo}HVDQHPLDV
KHPROtWLFDVGRHQoDV
GHEDL[R GR UHERUGR FRVWDO HVTXHUGR 2 EDoR p PyYHO H
LQILOWUDWLYDVGRHQoDV
GLILFLOPHQWH XOWUDSDVVD  D  FP DEDL[R GR UHERUGR FRVWDO LQIODPDWyULDVRXDXWRLPXQHVH
HVTXHUGR KLSHUWHQVmRSRUWDO


 3DOSH DV RXWUDV HVWUXWXUDV DEGRPLQDLV 6HUi FRPXP
REVHUYDU SXOVDo}HV QR HSLJiVWULR SURYRFDGDV SHOD DRUWD 0DVVDVDEGRPLQDLVDQRUPDLV
HPODFWHQWHVSRGHPDVVRFLDU
(VWDV SRGHP VHU SHUFHELGDV j SDOSDomR SURIXQGD j VHDULPSH[KLGURQHIURVH
HVTXHUGDGDOLQKDPpGLD EH[LJDSH[REVWUXomR
XUHWUDOLQWHVWLQRSH[
¬VYH]HVpSRVVtYHODWpSDOSDURVULQVGRODFWHQWHVHYRFr GRHQoDGH+LUVFKVSUXQJRX
SRVLFLRQDUFRPFXLGDGRRVGHGRVGHXPDGDVPmRVjIUHQWH LQWXVVXVFHSomRHWXPRUHV
HRVGDRXWUDSRUWUiVGRULP2FRORGHVFHQGHQWHpPDVVD
VHPHOKDQWHDXPDVDOVLFKDVLWXDGDQRTXDGUDQWHLQIHULRUHVTXHUGR

8PD YH] LGHQWLILFDGDV DV HVWUXWXUDV QRUPDLV GR DEGRPH 1DHVWHQRVHSLOyULFDD

GR ODFWHQWH XWLOL]H D SDOSDomR SDUD LGHQWLILFDU PDVVDV SDOSDomRSURIXQGDGR
DQRUPDLV TXDGUDQWHVXSHULRUGLUHLWRGR
DEGRPHRXGDOLQKDPpGLD
 SRGHUHYHODUXPD³D]HLWRQD´RX
PDVVDSLOyULFDFRP
FRQVLVWrQFLDILUPHGHFP

'XUDQWHDDPDPHQWDomR
DOJXQVODFWHQWHVFRPHVVD
 FRQGLomRDSUHVHQWDPRQGDV
SHULVWiOWLFDVYLVtYHLVTXH
 DWUDYHVVDPRDEGRPH
VHJXLGDVGHY{PLWRVHPMDWR


7DPDQKRGRI¯JDGRHPUHF«PQDVFLGRVVDXG£YHLVDWHUPR

3RUSDOSD©¥RHSHUFXVV¥R 0«GLDsFP

3URMH©¥RDEDL[RGRUHERUGRFRVWDOGLUHLWR 0«GLDsFP

Genitália masculina
,QVSHFLRQH RV yUJmRV JHQLWDLV H[WHUQRV FRP R ODFWHQWH HP 2FRUUHKLSRVSDGLDTXDQGRR
GHF~ELWR GRUVDO REVHUYDQGR R DVSHFWR GR SrQLV GRV yVWLRH[WHUQRGDXUHWUDILFD
WHVWtFXORV H GR HVFURWR 2 SUHS~FLR UHFREUH WRWDOPHQWH D VLWXDGRHPDOJXPSRQWRQD
JODQGHGRSrQLV$RQDVFLPHQWRQmRpUHWUiWLOHPERUDVHMD VXSHUItFLHYHQWUDOGDJODQGHRX
GRFRUSRGRSrQLVYHMDR
SRVVtYHO UHWUDtOR R VXILFLHQWH SDUD YLVXDOL]DU R PHDWR 4XDGUR6LVWHPDVJHQLWDO
XUHWUDO H[WHUQR $ UHWUDomR GR SUHS~FLR QR EHEr QmR HXULQiULRQRVH[RPDVFXOLQR
FLUFXQFLGDGR RFRUUH PHVHV D DQRV GHSRLV $ WD[D GH 2SUHS~FLRDSUHVHQWDIRUPDomR
FLUFXQFLV}HV QD $PpULFD GR 1RUWH FDLX UHFHQWHPHQWH H LQFRPSOHWDQDUHJLmRXUHWUDO
YDULDSRUWRGRRPXQGRGHSHQGHQGRGHSUiWLFDVFXOWXUDLV
 

,QVSHFLRQHRFRUSRGRSrQLVjSURFXUDGHDQRUPDOLGDGHV 2SrQLVFXUYRFRQJrQLWRSRGH
QDVXSHUItFLHYHQWUDO2SrQLVGHYHVHUUHWR DFRPSDQKDUKLSRVSDGLD

,QVSHFLRQH R HVFURWR REVHUYDQGR VH Ki UXJDV TXH Mi

GHYHP H[LVWLU QD D VHPDQD GH JHVWDomR (GHPD HVFURWDO SRGH SHUVLVWLU SRU DOJXQV GLDV DSyV R
QDVFLPHQWRSRUFDXVDGRHIHLWRGRHVWURJrQLRPDWHUQR

'HYHVHSDOSDURVWHVWtFXORVQRHVFURWRDYDQoDQGRSDUD (PUHFpPQDVFLGRVFRP
EDL[RDSDUWLUGRDQHOLQJXLQDOH[WHUQR6HIRUSDOSDGRXP FULSWRUTXLGLDRHVFURWRPXLWDV
WHVWtFXOR QR FDQDO LQJXLQDO GHYHVH WHQWDU OHYiOR SDUD R YH]HVWHPDVSHFWR
KLSRGHVHQYROYLGRHWHQVRHD
HVFURWR 2V WHVWtFXORV GR UHFpPQDVFLGR GHYHP WHU
SDOSDomRUHYHODTXHRV
DSUR[LPDGDPHQWH  PP GH ODUJXUD H  PP GH WHVWtFXORVQmRVHHQFRQWUDPQR
FRPSULPHQWRHGHYHPSHUPDQHFHUQRHVFURWRDPDLRUSDUWH HVFURWRYHMDR4XDGUR
GRWHPSR 6LVWHPDVJHQLWDOHXULQiULRQR
VH[RPDVFXOLQR
(PGRVUHFpPQDVFLGRVQmRpSRVVtYHOSDOSDUXPRX
RV GRLV WHVWtFXORV QR HVFURWR RX QR FDQDO LQJXLQDO ,VVR
OHYDQWDDSRVVLELOLGDGHGHFULSWRUTXLGLD(PGRLVWHUoRVGHVVHVFDVRVRVGRLVWHVWtFXORVGHVFHP
DWpDQRGHLGDGH

9HULILTXHVHKiHGHPDGRVWHVWtFXORVQRHVFURWRHVREUHR 'XDVPDVVDVHVFURWDLV
DQHOLQJXLQDO6HGHWHFWDUHGHPDHVFURWDOWHQWHGLIHUHQFLi HQFRQWUDGDVQRHVFURWRGRV
OR GRV WHVWtFXORV 2EVHUYH VH R WDPDQKR GD PDVVD PXGD UHFpPQDVFLGRVVmRDV
KLGURFHOHVHKpUQLDVLQJXLQDLV
TXDQGRREHErFKRUDHDSUHVVmRLQWUDDEGRPLQDOGREHEr
FRPIUHTXrQFLDDVGXDV
DXPHQWD 9HULILTXH VH RV GHGRV FRQVHJXHP SHQHWUDU DFLPD FRH[LVWHP$PEDVVmRPDLV
GD PDVVD UHWHQGRD QR HVFURWR $SHUWH D PDVVD FRP FRPXQVjGLUHLWD$KLGURFHOH
FXLGDGRSDUDWHQWDUUHGX]LUVXDVGLPHQV}HVHREVHUYHVHKi ILFDVLWXDGDVREUHRWHVWtFXORH
KLSHUVHQVLELOLGDGH9HULILTXHWDPEpPVHDPDVVDpSDVVtYHO RFRUGmRHVSHUPiWLFRIXQtFXOR
HVSHUPiWLFRVHJXQGRD
GHWUDQVLOXPLQDomR 7HUPLQRORJLD$QDW{PLFDQmR
SRGHVHUUHGX]LGDPDVSRGHVHU
WUDQVLOXPLQDGDYHMDDILJXUDj
HVTXHUGD$PDLRULDUHJULGH
DWpRVPHVHV$VKpUQLDV
ILFDPVHSDUDGDVGRVWHVWtFXORV
QmRFRVWXPDPVHUUHGXWtYHLVH
IUHTXHQWHPHQWHQmRVmR
WUDQVLOXPLQDGDVDOpPGHQmR
UHJUHGLUHP¬VYH]HVSDOSDVH
75$16,/80,1$d­2'(80$+,'52&(/( XPHVSHVVDPHQWRGRFRUGmR
HVSHUPiWLFRGHQRPLQDGRVLQDO
'H)OHWFKHU03K\VLFDO'LDJQRVLVLQ1HRQDWRORJ\ GDVHGD
3KLODGHOSKLD/LSSLQFRWW5DYHQ
Genitália feminina
eLPSRUWDQWHHVWDUIDPLOLDUL]DGRFRPRVyUJmRVJHQLWDLVH[WHUQRVGDUHFpPQDVFLGDHGDODFWHQWH
$UHFpPQDVFLGDHDODFWHQWHGHYHPVHUH[DPLQDGDVHPGHF~ELWRGRUVDO

1D UHFpPQDVFLGD RV yUJmRV JHQLWDLV H[WHUQRV ILFDP *HQLWiOLDDPEtJXDHQYROYHQGR

SURHPLQHQWHVHPIXQomRGRVHIHLWRVGRHVWURJrQLRPDWHUQR PDVFXOLQL]DomRGRVyUJmRV
2V OiELRV PDLRUHV H PHQRUHV GR SXGHQGR DSUHVHQWDP JHQLWDLVIHPLQLQRVH[WHUQRVp
XPDFRQGLomRUDUDSURYRFDGD
FRORUDomR UyVHD IRVFD HP FULDQoDV GH SHOH FODUD H SRGHP
SRUGRHQoDVHQGyFULQDVFRPR
VHU KLSHUSLJPHQWDGRV QDV UHFpPQDVFLGDV GH SHOH HVFXUD KLSHUSODVLDFRQJrQLWDGDV
1DVSULPHLUDVVHPDQDVGHYLGDSRGHH[LVWLUXPDVHFUHomR JOkQGXODVVXSUDUUHQDLV
EUDQFD OHLWRVD WLQJLGD GH VDQJXH QR ORFDO (VWH DVSHFWR
HVWURJHQL]DGRGDJHQLWiOLDGLPLQXLQRSULPHLURDQRGHYLGD

([DPLQH GH PDQHLUD VLVWHPiWLFD DV GLIHUHQWHV HVWUXWXUDV $GHUrQFLDVODELDLVQmRVmR

LQFOXVLYHRWDPDQKRGRFOLWyULVDFRORUDomRHDVGLPHQV}HV UDUDVWHQGHPDWHUHVSHVVXUD
GRV OiELRV PDLRUHV GR SXGHQGR H TXDLVTXHU HUXSo}HV GHXPDIROKDGHSDSHOH
HTXLPRVHV RX OHV}HV H[WHUQDV (P VHJXLGD HP ODFWHQWHV FRVWXPDPGHVDSDUHFHUVHP
WUDWDPHQWR
SHTXHQDV DIDVWH RV OiELRV PDLRUHV GR SXGHQGR QD VXD
UHJLmR PpGLD FRP R SROHJDU GH FDGD PmR FRQIRUPH
PRVWUDGRQDSiJLQDSDUDDIDVHLQLFLDOHWDUGLDQDLQIkQFLD$VSDFLHQWHVQmRVHLPSRUWDPFRP
RH[DPHSRLVHVWmRDFRVWXPDGDVjWURFDGHIUDOGDVHjODYDJHPGRFRUSR
 ,QVSHFLRQHRyVWLRH[WHUQRGDXUHWUDHRVOiELRVPHQRUHV 2KtPHQLPSHUIXUDGRSRGHVHU
GR SXGHQGR $YDOLH R KtPHQ TXH HP UHFpPQDVFLGDV H REVHUYDGRDRQDVFLPHQWR
ODFWHQWHV p XPD HVWUXWXUD YDVFXODU HVSHVVDGD FRP XP
RULItFLRFHQWUDOTXHUHFREUHDDEHUWXUDYDJLQDO3HVTXLVHD
DEHUWXUDYDJLQDOHPERUDRKtPHQSRVVDHVWDUHVSHVVDGRHUHGXQGDQWH9HULILTXHVHKiVHFUHomR

Exame retal
(P JHUDO QmR p UHDOL]DGR H[DPH UHWDO HP ODFWHQWHV H 8PDFDXVDIUHTXHQWHGH
FULDQoDVDPHQRVTXHKDMDG~YLGDVTXDQWRjSHUYLHGDGHGR VDQJXHQDVIH]HVGHODFWHQWHVp
kQXV RX VHMD HQFRQWUDGD PDVVD DEGRPLQDO 1HVVHV FDVRV XPDILVVXUDDQDO$ILVVXUDDQDO
QmRpXPDOHVmRJUDYH
IOH[LRQH RV TXDGULV GR ODFWHQWH H GREUH DV SHUQDV DWp D
FDEHoD 8VH R GHGR PtQLPR HQOXYDGR H OXEULILFDGR QR
H[DPH

Sistema musculoesquelético
2FRUUHPHQRUPHVPXGDQoDVQRVLVWHPDPXVFXORHVTXHOpWLFR $LQVSHomRFXLGDGRVDSRGH
GXUDQWH R SULPHLUR DQR GH YLGD *UDQGH SDUWH GR H[DPH UHYHODUGHIRUPLGDGHV
FRQFHQWUDVH QD GHWHFomR GH DQRUPDOLGDGHV FRQJrQLWDV IODJUDQWHVFRPRQDQLVPR
SDUWLFXODUPHQWH GH PmRV TXDGULV SHUQDV H SpV &RP XP DQRUPDOLGDGHVFRQJrQLWDVGRV
PHPEURVRXGHGRVHIDL[DV
SRXFR GH SUiWLFD YRFr FRQVHJXLUi FRPELQDU R H[DPH DQXODUHVTXHSURYRFDP
PXVFXORHVTXHOpWLFR FRP RV H[DPHV QHXUROyJLFRV H GR FRQVWULomRGHXPGRVPHPEURV
GHVHQYROYLPHQWR

$VPmRVGRVUHFpPQDVFLGRVVmRFHUUDGDV(PIXQomRGR $FURFyUGRQVUHVTXtFLRVGH
UHIOH[R GH SUHHQVmR SDOPDU YHMD D DQiOLVH GR VLVWHPD GtJLWRVSROLGDFWLOLDGHGRV
QHUYRVR YRFr SUHFLVDUi DMXGDU R ODFWHQWH D HVWLFDU RV H[WUDQXPHUiULRVRXVLQGDFWLOLD
GHGRV ,QVSHFLRQH RV GHGRV FRP FXLGDGR REVHUYDQGR XQLmRGHGRLVRXPDLVGHGRV
VmRGHIHLWRVFRQJrQLWRV
HYHQWXDLVDQRUPDOLGDGHV REVHUYDGRVSRURFDVLmRGR
QDVFLPHQWR


3DOSH WRGD D H[WHQVmR GD FODYtFXOD REVHUYDQGR VH Ki $IUDWXUDGHFODYtFXODSRGH

LUUHJXODULGDGHV KLSHUVHQVLELOLGDGH RX FUHSLWDomR TXH RFRUUHUGXUDQWHXPSDUWR
SRGHPLQGLFDUIUDWXUD GLItFLO
 

,QVSHFLRQH D FROXQD YHUWHEUDO FRP FXLGDGR (PERUD $HVSLQKDEtILGDRFXOWDXP

GHIHLWRV LPSRUWDQWHV GD FROXQD YHUWHEUDO FRPR GHIHLWRGRVFRUSRVYHUWHEUDLV
PHQLQJRPLHORFHOH VHMDP HYLGHQWHV H PXLWDV YH]HV SRGHDVVRFLDUVHDGHIHLWRVGD
GHWHFWDGRV QD XOWUDVVRQRJUDILD DQWHV GR QDVFLPHQWR PHGXODHVSLQDOTXHSRGHP
SURYRFDUGLVIXQomRQHXUROyJLFD
DQRUPDOLGDGHV VXWLV SRGHP LQFOXLU PDQFKDV SLJPHQWDGDV JUDYH
SODFDV SLORVDV RX GHSUHVV}HV SURIXQGDV (VVDV
DQRUPDOLGDGHVTXDQGRREVHUYDGDVDXPDGLVWkQFLDGHDWp
FPGDOLQKDPpGLDSRGHPHVWDUHQFREULQGRDDEHUWXUDH[WHUQDGHWUDMHWRVILVWXORVRVTXHFKHJDP
DWp R FDQDO YHUWHEUDO 1mR WHQWH VRQGDU WUDMHWRV ILVWXORVRV SRU FDXVD GR ULVFR SRWHQFLDO GH
LQWURGX]LU LQIHFomR 3DOSH D FROXQD YHUWHEUDO QD UHJLmR ORPERVVDFUD REVHUYDQGR HYHQWXDLV
GHIRUPLGDGHVGDVYpUWHEUDV

([DPLQHFRPFXLGDGRRVTXDGULVGRUHFpPQDVFLGRHGR 8P³FOLTXH´VXDYHDXGtYHOFRP
ODFWHQWHDFDGDH[DPHjSURFXUDGHVLQDLVGHOX[DomR$V HVVDVPDQREUDVQmRFRPSURYD
ILJXUDVDGLDQWHPRVWUDPGXDVGDVSULQFLSDLVWpFQLFDV±XPD DH[LVWrQFLDGHOX[DomRGH
TXDGULOPDVGHYHVHUPRWLYR
SDUD SHVTXLVDU OX[DomR SRVWHULRU GR TXDGULO WHVWH GH
SDUDXPH[DPHFXLGDGRVR
2UWRODQL H RXWUD SDUD WHVWDU D FDSDFLGDGH GH VXEOX[DomR
RXOX[DomRGHXPTXDGULOLQVWiYHOSRUpPtQWHJURWHVWH GH
%DUORZ

7(67('(2572/$1,
 7(67('(%$5/2:

0DQWHQKD R EHEr UHOD[DGR SDUD D H[HFXomR GDV GXDV 1DGLVSODVLDGHTXDGULOp

WpFQLFDV 1R FDVR GR WHVWH GH 2UWRODQL SRVLFLRQH R EHEr SRVVtYHOSHUFHEHUXP³UXtGR´
HP GHF~ELWR GRUVDO FRP DV SHUQDV DSRQWDQGR HP VXD TXHFRUUHVSRQGHjFDEHoDGR
IrPXUVLWXDGDSRVWHULRUPHQWH
GLUHomR)OH[LRQHDVSHUQDVGHPRGRDIRUPDUkQJXORVUHWRV
DRDFHWiEXORTXDQGRVH
QR TXDGULO H QRV MRHOKRV FRORFDQGR R LQGLFDGRU VREUH R HQFDL[DQRDFHWiEXOR8P
WURFDQWHU PDLRU QRV GRLV IrPXUHV H FRP R SROHJDU PRYLPHQWRSDOSiYHOGDFDEHoD
SRVLFLRQDGR QRV WURFDQWHUHV PHQRUHV 5HDOL]H D DEGXomR GRIrPXUUHWRUQDQGRDVHX
VLPXOWkQHD GRV GRLV TXDGULV DWp TXH DV IDFHV ODWHUDLV GH ORFDOGHRULJHPFRQVWLWXLRVLQDO
SRVLWLYRGH2UWRODQL
FDGDMRHOKRWRTXHPDPHVDGHH[DPH
eLPSRUWDQWHGHWHFWDUD
GLVSODVLDFRQJrQLWDGHTXDGULO
RWUDWDPHQWRSUHFRFH
DGHTXDGRDVVRFLDVHD
H[FHOHQWHVGHVIHFKRV

2VLQDOGH%DUORZSRVLWLYRQmR
7(67('(2572/$1, pGLDJQyVWLFRGHGLVSODVLDGH
TXDGULOSRUpPLQGLFDIURX[LGmR
 HOX[DomRSURJUHVVLYDGR
TXDGULO2EHErSUHFLVDUiVHU
 UHH[DPLQDGRQRIXWXUR6H
TXDQGRSDOSDGDDFDEHoDGR
 IrPXUGHVOL]DSDUDIRUDQR
VHQWLGRGROiELRSRVWHULRUGR
 DFHWiEXORKiVLQDOGH%DUORZ
SRVLWLYR6HSHUFHEHUHVVH
 PRYLPHQWRGHOX[DomRIDoD
XPDDEGXomRSURJUHVVLYDGR
 TXDGULOFRPSULPLQGRFRPR
LQGLFDGRUHRGHGRPpGLRSDUD
WUiVHSDUDGHQWURHWHQWH

SHUFHEHURPRYLPHQWRGD
FDEHoDGRIrPXUUHWRUQDQGR
 SDUDDIRVVDGRDFHWiEXOR

3DUD R WHVWH GH %DUORZ FRORTXH DV PmRV QD PHVPD &ULDQoDVFRPPDLVGHPHVHV
SRVLomRTXHSDUDRWHVWHGH2UWRODQL'HVWDYH]FRPSULPD SRGHPWHUVLQDOGH2UWRODQLRX
QDGLUHomRRSRVWDFRPRVSROHJDUHVPRYLPHQWDQGRRVSDUD %DUORZQHJDWLYRHDLQGDDVVLP
DSUHVHQWDUOX[DomRGHTXDGULO
EDL[RQDGLUHomRGDPHVDHSDUDIRUD3HUFHEDVHKiDOJXP
HPIXQomRGDFRQWUDomRGD
PRYLPHQWR GD FDEHoD GR IrPXU HP GLUHomR ODWHUDO PXVFXODWXUDHGRVOLJDPHQWRV
1RUPDOPHQWH QmR Ki PRYLPHQWDomR H RV TXDGULV GRTXDGULO
SHUPDQHFHP³HVWiYHLV´

7(67('(%$5/2:

9HULILTXHHQFXUWDPHQWRIHPRUDOSRUPHLRGRWHVWHGH*DOHD]]LRXGH$OLFH$SUR[LPHRVSpVH
YHULILTXHVHKiGLIHUHQoDQDDOWXUDGRVMRHOKRV

eLPSRUWDQWHH[DPLQDURVPHPEURVLQIHULRUHVHRVSpVGR 2DUTXHDPHQWRVLJQLILFDWLYR
UHFpPQDVFLGR RX ODFWHQWH SDUD GHWHFWDU DQRUPDOLGDGHV GR GRVMRHOKRVSRGHVHUQRUPDO
GHVHQYROYLPHQWR $YDOLH VLPHWULD DUTXHDPHQWR H WRUomR PDVWDPEpPSRGHVHU
GRV PHPEURV LQIHULRUHV 1mR GHYH KDYHU GLVFUHSkQFLD QR FRQVHTXHQWHDUDTXLWLVPRRX
GRHQoDGH%ORXQW
FRPSULPHQWR GRV PHPEURV LQIHULRUHV e FRPXP KDYHU
SUHJDV FXWkQHDV DVVLPpWULFDV QDV FR[DV HP ODFWHQWHV
QRUPDLVPDVVHGHWHFWDUDVVLPHWULDQmRVHHVTXHoDGHUHDOL]DURVWHVWHVGHLQVWDELOLGDGHSRLVDV
OX[Do}HVGHTXDGULOFRPXPHQWHVHDVVRFLDPDHVWHDFKDGR

$ PDLRULD GRV UHFpPQDVFLGRV WHP MRHOKRV YDURV TXH UHIOHWHP VXD SRVLomR LQWUDXWHULQD
HQFXUYDGD

$OJXQV ODFWHQWHV QRUPDLV DSUHVHQWDP WRUVmR GR HL[R $WRUomRSDWROyJLFDGDWtELD

ORQJLWXGLQDO GD WtELD SDUD GHQWUR H SDUD IRUD 2V SDLV VRPHQWHRFRUUHDVVRFLDGDD
SRGHPILFDUSUHRFXSDGRVFRPDURWDomRGRVGHGRVGRVSpV GHIRUPLGDGHGHSpVRXTXDGULV
SDUDGHQWURRXSDUDIRUDHFRPDPDUFKDLQFRRUGHQDGDHP
JHUDO DFKDGRV QRUPDLV $ WRUomR WLELDO UHJULGH HVSRQWDQHDPHQWH QR VHJXQGR DQR GH YLGD DSyV
DOJXQVPHVHVGHFDUJDGHSHVRGRFRUSR

([DPLQHDJRUDRVSpVGHUHFpPQDVFLGRVHODFWHQWHV$R $VGHIRUPLGDGHVYHUGDGHLUDV
QDVFLPHQWR RV SpV SRGHP SDUHFHU GHIRUPDGRV SRU FDXVD GRVSpVQmRUHWRUQDPjSRVLomR
GD PDQXWHQomR GR SRVLFLRQDPHQWR LQWUDXWHULQR 0XLWDV QHXWUDPHVPRFRPD
YH]HVHVWmRYROWDGRVSDUDGHQWURFRPRPRVWUDGRDRODGR PDQLSXODomR
8PSpQRUPDOSHUPLWHDVXDFRUUHomRIiFLOSDUDDSRVLomR
QHXWUDRXDWpPHVPRXPDFRUUHomRH[FHVVLYD9RFrWDPEpPSRGHHVWLPXODUDERUGDH[WHUQDSDUD
YHUVHRSpDVVXPHXPDSRVLomRQRUPDO

2 Sp GR UHFpPQDVFLGR QRUPDO DSUHVHQWD GLYHUVDV $GHIRUPLGDGHGHSpFRQJrQLWD

FDUDFWHUtVWLFDV EHQLJQDV TXH SRGHP GH LQtFLR FDXVDU JUDYHPDLVFRPXPpRSpWRUWR
SUHRFXSDomR 2 UHFpPQDVFLGR DSUHVHQWD Sp FKDWR HP HTXLQRYDURSpWRUWR
IXQomR GR FR[LP JRUGXURVR SODQWDU 0XLWDV YH]HV Ki FDOFDQHRYDUR
LQYHUVmR GR Sp FRP HOHYDomR GD ERUGD PHGLDO 2XWURV 
EHErV DSUHVHQWDP DGXomR GD SDUWH DQWHULRU GR Sp VHP

LQYHUVmR R FKDPDGR PHWDWDUVR DGX]LGR 2XWURV DLQGD
DSUHVHQWDPDGXomRGRSpLQWHLUR)LQDOPHQWHDPDLRULDGDV 9HMDR4XDGUR$FKDGRV
PXVFXORHVTXHOpWLFRVFRPXQV
FULDQoDVSHTXHQDVDSUHVHQWDSURQDomRQDVIDVHVLQLFLDLVGH
HPFULDQoDVSHTXHQDV
FDUJD GR SHVR FRP HYHUVmR GR Sp (P WRGDV HVVDV
YDULDQWHV QRUPDLV p IiFLO FRUULJLU D SRVLomR DQRUPDO
LQFOXVLYHDOpPGDOLQKDPpGLD7RGRVHVVHVTXDGURVWHQGHPDUHJUHGLUQRSUD]RGHDDQRV

Sistema nervoso
2 H[DPH GR VLVWHPD QHUYRVR HP ODFWHQWHV LQFOXL WpFQLFDV 6LQDLVGHGRHQoDQHXUROyJLFD
TXH VmR PXLWR HVSHFtILFDV QHVVD LGDGH $OpP GLVVR DR JUDYHLQFOXHPLUULWDELOLGDGH
FRQWUiULRGHPXLWDVDQRUPDOLGDGHVQHXUROyJLFDVQRVDGXOWRV H[WUHPDDVVLPHWULDSRVWXUDO
SHUVLVWHQWHH[WHQVmR
TXH SURYRFDP DFKDGRV ORFDOL]DGRV DVVLPpWULFRV DV
SHUVLVWHQWHGRVPHPEURV
DQRUPDOLGDGHV QHXUROyJLFDV QRV ODFWHQWHV PXLWDV YH]HV VH URWDomRFRQVWDQWHGDFDEHoD
PDQLIHVWDP FRPR DQRUPDOLGDGHV GR GHVHQYROYLPHQWR WDLV SDUDXPODGRH[WHQVmR
FRPR LQFDSDFLGDGH GH UHDOL]DU WDUHIDV DSURSULDGDV SDUD D DFHQWXDGDGDFDEHoDGR
SHVFRoRHGRVPHPEURV
LGDGH 3RUWDQWR RV H[DPHV QHXUROyJLFRV H GR RSLVWyWRQRIODFLGH]H[WUHPD
GHVHQYROYLPHQWR SUHFLVDP VHU IHLWRV ODGR D ODGR $ HUHVSRVWDOLPLWDGDjGRU

GHWHFomR GH XPD DQRUPDOLGDGH GR GHVHQYROYLPHQWR GHYH

VHUPRWLYRSDUDDXPHQWDUDDWHQomRQRH[DPHQHXUROyJLFR

2H[DPHGHUDVWUHDPHQWRQHXUROyJLFRGHWRGRVRVUHFpP &RPSRUWDPHQWRVQHRQDWDLV
QDVFLGRV LQFOXL D DYDOLDomR GDV FRQGLo}HV PHQWDLV GR VXWLVFRPRWUHPRUHVILQRV
IXQFLRQDPHQWR PRWRU JURVVHLUR H ILQR GR W{QXV GR FKRUR LUULWDELOLGDGHHDXWRUUHJXODomR
LQVDWLVIDWyULDSRGHPVHUXP
UHIOH[RV WHQGLQRVRV SURIXQGRV H UHIOH[RV SULPLWLYRV 2V
VLQDOGHDEVWLQrQFLDGHQLFRWLQD
H[DPHVPDLVGHWDOKDGRVGDIXQomRGHQHUYRVFUDQLDQRVGD VHDPmHIXPRXGXUDQWHD
IXQomR VHQVLWLYD H GRV UHIOH[RV SULPLWLYRV PHQRV FRPXQV JUDYLGH]
HVWmR LQGLFDGRV QD VXVSHLWD GH DQRUPDOLGDGHV D SDUWLU GD
DQDPQHVHRXGRUDVWUHDPHQWR

2 H[DPH QHXUROyJLFR SRGH UHYHODU GRHQoD H[WHQVD PDV QmR GHILQH GpILFLWV IXQFLRQDLV
HVSHFtILFRVRXDVOHV}HVGHPHQRUSRUWH

Estado mental. $YDOLH R HVWDGR PHQWDO GR UHFpPQDVFLGR ,UULWDELOLGDGHSHUVLVWHQWHQR

REVHUYDQGR PXLWDV GDV DWLYLGDGHV DQDOLVDGDV QR ER[H GD UHFpPQDVFLGRSRGHVHUXP
SiJLQD1mRVHHVTXHoDGHWHVWDURUHFpPQDVFLGRQRV VLQDOGHDJUDYRQHXUROyJLFRRX
SRGHVHUFRQVHTXHQWHD
SHUtRGRV HP TXH HOH HVWLYHU DFRUGDGR 8PD GHVFULomR
GLYHUVDVDQRUPDOLGDGHV
GHWDOKDGD GD DYDOLDomR GR GHVHQYROYLPHQWR p PRVWUDGD PHWDEyOLFDVLQIHFFLRVDVRX
DGLDQWH RXWUDVVLVWrPLFDVRXHQWmR
TXDGURVDPELHQWDLVFRPR
Função motora e tônus. $YDOLH R W{QXV PRWRU GH UHFpP DEVWLQrQFLDGHGURJDV
QDVFLGRV H ODFWHQWHV GH LQtFLR PHGLDQWH D REVHUYDomR
FXLGDGRVD GD VXD SRVLomR H UHSRXVR H SHOR WHVWH GD
UHVLVWrQFLDjPRYLPHQWDomRSDVVLYD

(P VHJXLGD DYDOLH R W{QXV HQTXDQWR PRYLPHQWD FDGD 5HFpPQDVFLGRVFRPKLSRWRQLD

XPDGDVSULQFLSDLVDUWLFXODo}HVSRUWRGDVXDDPSOLWXGHGH PXLWDVYH]HVILFDPHPSRVLomR
PRYLPHQWR 9HULILTXH VH Ki HVSDVWLFLGDGH RX IODFLGH] GHUmFRPRVEUDoRV
IOH[LRQDGRVHDVPmRV
0DQWHQKD R EHEr HP VXDV PmRV FRPR PRVWUDGR DR ODGR SUy[LPDVjVRUHOKDV$
SDUD GHWHUPLQDU VH R W{QXV HVWi QRUPDO DXPHQWDGR RX KLSRWRQLDSRGHVHUSURYRFDGD
SRUGLYHUVDVDQRUPDOLGDGHVGR
GLPLQXtGR 7{QXV DXPHQWDGR RX GLPLQXtGR SRGH LQGLFDU
VLVWHPDQHUYRVRFHQWUDOH
GRHQoDLQWUDFUDQLDQDHPERUDHVVDVGRHQoDVJHUDOPHQWHVH WUDQVWRUQRVGDXQLGDGHPRWRUD
DFRPSDQKHPGHYiULRVRXWURVVLQDLV

Função sensorial. $ IXQomR VHQVRULDO GR UHFpPQDVFLGR Vy 6HRHVWtPXORiOJLFRIRU

SRGH VHU DYDOLDGD GH PRGR OLPLWDGR 3HVTXLVH D DFRPSDQKDGRGHDOWHUDo}HVQD
VHQVLELOLGDGHjGRUGDQGRVXDYHVSHWHOHFRVQDSDOPDRXQD H[SUHVVmRGRURVWRRXFKRUR
SRUpPQmRRFRUUHUUHWLUDGDp
VROD GR EHEr FRP VHX GHGR 2EVHUYH VH HOH DFRUGD
SRVVtYHOTXHH[LVWDSDUDOLVLD
GHVSHUWDRXPXGDDH[SUHVVmRIDFLDO1mRXVHDOILQHWHSDUD
WHVWDUGRU

Nervos cranianos.2VQHUYRVFUDQLDQRVGRUHFpPQDVFLGRRXGRODFWHQWHSRGHPVHUWHVWDGRV2ER[H
DVHJXLUIRUQHFHHVWUDWpJLDV~WHLV

(VWUDW«JLDVSDUDDYDOLDURVQHUYRVFUDQLDQRVHPUHF«PQDVFLGRVHODFWHQWHV
1HUYRVFUDQLDQRV_1& (VWUDW«JLD $QRUPDOLGDGHVQRVQHUYRVFUDQLDQRV 
VXJHUHPOHV¥RLQWUDFUDQLDQDFRPR
, 2OIDWµULR 'LI¯FLOGHWHVWDU hemorragiaRXmalformação congênita 

3RVLFLRQHREHE¬ROKDQGRVHXURVWRH
,, $FXLGDGHYLVXDO YHULILTXHVHK£UHVSRVWDVIDFLDLVHVHHOH  
WHQWDDFRPSDQK£OR

(VFXUH©DRDPELHQWHOHYDQWHREHE¬SDUDD
SRVL©¥RVHQWDGDHYHMDVHHOHDEUHRVROKRV

8WLOL]HOX]HWHVWHRUHIOH[RGDSLVFDGHOD
,,,,, 5HVSRVWD¢OX]  
SLVFDUFRPRUHVSRVWD¢OX]

8VHRRWRVFµSLRVHPRHVS«FXORSDUD

DYDOLDUDVUHVSRVWDVSXSLODUHV

2EVHUYHVHREHE¬DFRPSDQKDRVHXURVWR
,,,,99, 0RYLPHQWRVRFXODUHV VRUULQGR
8VHOX]VHQHFHVV£ULR
7HVWHRUHIOH[RGHEXVFD
9 0RWRU 7HVWHRUHIOH[RGHVXF©¥RREVHUYHREHE¬
PDPDUWRPDQGRPDPDGHLUDRXXVDQGR

Paralisia congênita do nervo facialSRGH
VHUFRQVHTXHQWHDWRFRWUDXPDWLVPR
RXGHIHLWRVGRGHVHQYROYLPHQWR

FKXSHWD

2EVHUYHREHE¬FKRUDQGRHVRUULQGR
9,, )DFLDO  
YHULILTXHDVLPHWULDGRURVWRHGDWHVWD

7HVWHRUHIOH[RGHSLVFDGHODSLVFDURVGRLV
ROKRVFRPRUHVSRVWDDUX¯GRLQWHQVR
 2EVHUYHVHREHE¬EXVFDDRULJHPGRVRP
DRRXYLUXPEDUXOKR

2EVHUYHDFRRUGHQD©¥RGXUDQWHD
,;; 'HJOXWL©¥R DisfagiaGLILFXOGDGHGHGHJOXWL©¥R« 
GHJOXWL©¥R
FDXVDGDRFDVLRQDOPHQWHSRUOHV¥RGRV
1&,;;,,
 9¶PLWR 7HVWHRUHIOH[RIDU¯QJHRUHIOH[RGRY¶PLWR 

;, $FHVVµULR 2EVHUYHDVLPHWULDGRVRPEURV  

2EVHUYHDFRRUGHQD©¥RGDVXF©¥R
GHJOXWL©¥RHSURMH©¥RGDO¯QJXD
;,, +LSRJORVVR &RPSULPDGHOLFDGDPHQWHDQDULQDREVHUYH  
DDEHUWXUDUHIOH[DGDERFDFRPDSRQWDGD
O¯QJXDQDOLQKDP«GLD

Reflexos tendinosos profundos. 2V UHIOH[RV WHQGLQRVRV $H[DFHUEDomRSURJUHVVLYDGRV

SURIXQGRV VmR YDULiYHLV QRV UHFpPQDVFLGRV H QRV UHIOH[RVWHQGLQRVRVSURIXQGRV
ODFWHQWHVSRLVDVYLDVFRUWLFRHVSLQDLVQmRHVWmRSOHQDPHQWH QRSULPHLURDQRGHYLGDSRGH
LQGLFDUGRHQoDGRVLVWHPD
GHVHQYROYLGDV $VVLP VXD RFRUUrQFLD H[DJHUDGD RX VXD
QHUYRVRFHQWUDOFRPRSDUDOLVLD
DXVrQFLDWHPSRXFDLPSRUWkQFLDGLDJQyVWLFDDPHQRVTXHD FHUHEUDOSULQFLSDOPHQWHVHIRU
UHVSRVWD VHMD GLIHUHQWH GH UHVXOWDGRV GH WHVWHV SUpYLRV RX DFRPSDQKDGDGHDXPHQWRGR
VHMDPREVHUYDGDVUHVSRVWDVH[WUHPDV W{QXV

8VH DV PHVPDV WpFQLFDV TXH XVDULD FRP DGXOWRV SDUD &RPRQRDGXOWRUHIOH[RV
SHVTXLVDU RV UHIOH[RV WHQGLQRVRV SURIXQGRV 9RFr SRGH DVVLPpWULFRVVXJHUHPOHVmRGRV
VXEVWLWXLU XP PDUWHOR GH 'HMHULQH SHOR LQGLFDGRU RX GHGR QHUYRVSHULIpULFRVRXGHXP
PpGLRFRPRPRVWUDGRDVHJXLU VHJPHQWRHVSLQDO

2V UHIOH[RV WULFLSLWDO EUDTXLRUUDGLDO H DEGRPLQDO VmR $XVrQFLDGHUHIOH[RDQDOVXJHUH

GLItFHLVGHHVWLPXODUDQWHVGRVPHVHVGHLGDGH2UHIOH[R SHUGDGDLQHUYDomRGRP~VFXOR
DQDO H[LVWH SRU RFDVLmR GR QDVFLPHQWR H p LPSRUWDQWH HVILQFWHUH[WHUQRGRkQXV
SURYRFDGDSRUDOJXPD
SHVTXLViORVHKRXYHUVXVSHLWDGHOHVmRUDTXLPHGXODU
DQRUPDOLGDGHGDPHGXOD
SHVTXLViORVHKRXYHUVXVSHLWDGHOHVmRUDTXLPHGXODU DQRUPDOLGDGHGDPHGXOD
HVSLQDOFRPRXPDDQRPDOLD
(PERUD  GRV ODFWHQWHV WHQKDP UHVSRVWD SODQWDU HP FRQJrQLWDSH[HVSLQKD
EtILGDWXPRURXOHVmR
IOH[mR QRUPDO jV YH]HV REVHUYDVH UHVSRVWD GH %DELQVNL
SRVLWLYD j HVWLPXODomR SODQWDU GRUVLIOH[mR GR SULPHLUR
DUWHOKRHUHWUDomRGRVGHPDLVHPDOJXQVEHErVQRUPDLVDWpRVDQRVGHLGDGH

9RFr SRGH WHQWDU GHVHQFDGHDU R UHIOH[R DTXLOHX FRPR R 4XDQGRDVFRQWUDo}HVVmR

IDULD HP DGXOWRV SHUFXWLQGR R WHQGmR GH $TXLOHV PDV p FRQWtQXDVFO{QXVDTXLOHX
FRPXP QmR REWHU UHVSRVWD 2 RXWUR PpWRGR PRVWUDGR D SHUVLVWHQWHGHYHVHVXVSHLWDU
GHGRHQoDGRVLVWHPDQHUYRVR
VHJXLU p VHJXUDU R PDOpROR GR ODFWHQWH FRP XPD PmR H
FHQWUDO
UHDOL]DU D GRUVLIOH[mR EUXVFD GR WRUQR]HOR 1mR VH
VXUSUHHQGDVHREVHUYDUXPDIOH[mRSODQWDUUiSLGDHUtWPLFD 8PUHFpPQDVFLGRLUULWiYHO
GRSpGREHErFO{QXVGHWRUQR]HORFRPRUHVSRVWDDHVVD LQTXLHWRHFRPWUHPRUHV
KLSHUWRQLFLGDGHHUHIOH[RV
PDQREUD $Wp  EDWLPHQWRV VmR QRUPDLV HP UHFpP KLSHUDWLYRVSRGHHVWDU
QDVFLGRV H FULDQoDV SHTXHQDV HVWH FRQVLVWH HP XP FO{QXV DSUHVHQWDQGRVtQGURPHGH
QmRVXVWHQWDGRGRFDOFDQKDU DEVWLQrQFLDGHDOJXPD
VXEVWkQFLDSVLFRDWLYDXVDGD
 SHODPmHGXUDQWHDJUDYLGH]

$VtQGURPHGHDEVWLQrQFLD
QHRQDWDOUHVXOWDGRXVRGH
RSLRLGHVSHODPmHGXUDQWHD
JUDYLGH]$OpPGRVVLQDLV
DUURODGRVDQWHULRUPHQWHR
UHFpPQDVFLGRWDPEpPSRGH
DSUHVHQWDUVLQDLVDXW{QRPRV
FRPRFULVHVFRQYXOVLYDVH
DOLPHQWDomRLQVDWLVIDWyULD


Reflexos primitivos. $YDOLH R VLVWHPD QHUYRVR FHQWUDO HP 6XVSHLWDVHGHDQRUPDOLGDGH

GHVHQYROYLPHQWR QRV UHFpPQDVFLGRV H ODFWHQWHV SHOD QHXUROyJLFDRXGR
SHVTXLVD GH DXWRPDWLVPRV LQIDQWLV GHQRPLQDGRV UHIOH[RV GHVHQYROYLPHQWRVHRVUHIOH[RV
SULPLWLYRVHVWLYHUHP
SULPLWLYRV (OHV DSDUHFHP GXUDQWH D JHVWDomR FRVWXPDP
VHU HYLGHQFLDGRV DR QDVFLPHQWR H GHVDSDUHFHP HP LGDGHV $XVHQWHVQDLGDGHDSURSULDGD
3UHVHQWHV SRU WHPSR PDLRU TXH R
GHILQLGDV $V DQRUPDOLGDGHV QHVVHV UHIOH[RV SULPLWLYRV QRUPDO
VXJHUHP GRHQoD QHXUROyJLFD H PHUHFHP XPD LQYHVWLJDomR $VVLPpWULFRV
 2VUHIOH[RVSULPLWLYRVPDLVLPSRUWDQWHVVmRLOXVWUDGRVQR
ER[HVHJXLQWH

Desenvolvimento. &RQVXOWH RV PDUFRV GR GHVHQYROYLPHQWR ([LVWHPPXLWDVFDXVDVGH

GHVFULWRVQDSiJLQDHRVUHVXOWDGRVGHXPDIHUUDPHQWD UHWDUGRGRGHVHQYROYLPHQWRH
GH UDVWUHDPHQWR GR GHVHQYROYLPHQWR SDUD DSUHQGHU DV FRPIUHTXrQFLDQmRp
WDUHIDV GHVHQYROYLPHQWDLV HVSHFtILFDV GH FDGD LGDGH D LGHQWLILFDGDXPDFDXVD$V
HWLRORJLDVSRGHPVHUSUpQDWDLV
VHUHP DYDOLDGDV 3HOD REVHUYDomR H EULQFDGHLUD FRP R JHQpWLFDVVLVWHPDQHUYRVR
ODFWHQWH p SRVVtYHO UHDOL]DU WDQWR R H[DPH GH UDVWUHDPHQWR FHQWUDOKLSRWLUHRLGLVPR
GR GHVHQYROYLPHQWR TXDQWR DYDOLDU DV FRQTXLVWDV PRWRUDV FRQJrQLWRSHULQDWDLV
JURVVHLUDV H ILQDV 3HVTXLVH HVSHFLILFDPHQWH IUDTXH]D SUHPDWXULGDGHDVIL[LD
LQIHFomRWUDXPDWLVPRHSyV
PXVFXODU REVHUYDQGR D SRVLomR VHQWDGD GH Sp H GDV QDWDLVWUDXPDWLVPRLQIHFomR
WUDQVLo}HV 2EVHUYH R SRVLFLRQDPHQWR HVWiWLFR RX D WR[LQDVPDXVWUDWRV
SRVWXUDDRVHQWDURXOHYDQWDU$WHQWHWDPEpPFRPFXLGDGR
SDUDDPDUFKDGDFULDQoDSHTXHQDLQFOXVLYHHTXLOtEULRHD
IOXrQFLD GRV PRYLPHQWRV 2 GHVHQYROYLPHQWR PRWRU ILQR SRGH VHU DYDOLDGR GD PHVPD PDQHLUD
SHODFRPELQDomRGRVH[DPHVQHXUROyJLFRHGRGHVHQYROYLPHQWR2VPDUFRVIXQGDPHQWDLVLQFOXHP
RGHVHQYROYLPHQWRGDSUHHQVmRHPSLQoDFDSDFLGDGHGHPDQLSXODUREMHWRVFRPDVPmRVHWDUHIDV
GHPDLRUSUHFLVmRFRPRHPSLOKDUWRUUHVGHFXERVRXUDELVFDUjPHGLGDTXHRGHVHQYROYLPHQWR
PRWRUILQRHYROXLQRVHQWLGRSUR[LPDOSDUDGLVWDO

$YDOLHRGHVHQYROYLPHQWRFRJQLWLYRHVRFLRHPRFLRQDOGR 5HWDUGRGRGHVHQYROYLPHQWR
ODFWHQWH DR ORQJR GR H[DPH QHXUROyJLFR H GR HPPDLVGHXPGRPtQLRSH[
GHVHQYROYLPHQWR DEUDQJHQWH $OJXPDV DQRUPDOLGDGHV PRWRUHFRJQLWLYRVXJHUH
QHXUROyJLFDV SURYRFDP GpILFLWV RX UHGXomR GD YHORFLGDGH GRHQoDPDLVJUDYH
GR GHVHQYROYLPHQWR FRJQLWLYR H VRFLDO &RPR Mi
REVHUYDGRRODFWHQWHFRPUHWDUGRGRGHVHQYROYLPHQWRSRGHDSUHVHQWDUDQRUPDOLGDGHVQRH[DPH
QHXUROyJLFRSRLVJUDQGHSDUWHGRH[DPHEDVHLDVHQRVSDGU}HVHVSHFtILFRVSDUDDLGDGH

5HIOH[RSULPLWLYR

5HIOH[RSULPLWLYR  0DQREUD ,GDGH 

&RORTXHVHXVGHGRVQDP¥RGR
EHE¬HID©DSUHVV¥RFRQWUDDV
5HIOH[RGHSUHHQV¥RSDOPDU VXSHUI¯FLHVSDOPDUHV
2EHE¬IOH[LRQDWRGRVRVGHGRV
SDUDDJDUUDURVVHXV
$SHUVLVW¬QFLDDO«PGHPHVHV
VXJHUHGLVIXQ©¥RGRWUDWR
SLUDPLGDO
3HUVLVW¬QFLDGHP¥RVFHUUDGDV
1DVFLPHQWRDW«DPHVHV DO«PGHPHVHVVXJHUHOHV¥R
GRVLVWHPDQHUYRVRFHQWUDO
SULQFLSDOPHQWHTXDQGRRV
GHGRVVHVXSHUS·HPDR
 2EHE¬IOH[LRQDWRGRVRVGHGRV
SDUDDJDUUDURVVHXV
7RTXHDVRODGRS«QDEDVHGRV
5HIOH[RGHSUHHQV¥RSODQWDU DUWHOKRV
2VDUWHOKRVVHHQFXUYDP
(VWLPXOHDSHOHSHULRUDOQRVFDQWRV
GDERFD
5HIOH[RGHEXVFD
$ERFDDEUHREHE¬JLUDDFDEH©D
SDUDRODGRHVWLPXODGRHVXJD
6HJXUHREHE¬HPGHF¼ELWRGRUVDO
DSRLDQGRVXDFDEH©DDVFRVWDVH
1DVFLPHQWRDW«DPHVHV
1DVFLPHQWRDW«DPHVHV
GRVLVWHPDQHUYRVRFHQWUDO
SULQFLSDOPHQWHTXDQGRRV
GHGRVVHVXSHUS·HPDR
SROHJDU
$SHUVLVW¬QFLDDO«PGHPHVHV
VXJHUHGLVIXQ©¥RGRWUDWR
SLUDPLGDO
$DXV¬QFLDGRUHIOH[RGHEXVFD
LQGLFDGRHQ©DJHQHUDOL]DGDRX
GRVLVWHPDQHUYRVRFHQWUDO
3HUVLVW¬QFLDDO«PGHPHVHV
VXJHUHGRHQ©DQHXUROµJLFDS
DVSHUQDV$EDL[HEUXVFDPHQWH H[SDUDOLVLDFHUHEUDODO«P
WRGRRFRUSRFHUFDGHFP GRVPHVHV«IRUWHPHQWH
5HIOH[RGH0RURɫUHIOH[RGR VXJHVWLYDGHGRHQ©D
1DVFLPHQWRDW«PHVHV
VXVWRɬ QHXUROµJLFD
2VEUD©RVID]HPDEGX©¥RH
H[WHQV¥RDVP¥RVVHDEUHPHDV
5HVSRVWDDVVLP«WULFDVXJHUH
SHUQDVVHIOH[LRQDP2EHE¬SRGH
IUDWXUDGHFODY¯FXODRX¼PHUR
FKRUDU
RXOHV¥RGRSOH[REUDTXLDO

&RPREHE¬HPGHF¼ELWRGRUVDO
YLUHDFDEH©DGHOHSDUDXPGRV
ODGRVVHJXUDQGRDPDQG¯EXOD 3HUVLVW¬QFLDDO«PGHPHVHV
VREUHRRPEUR VXJHUHGHVHQYROYLPHQWR
5HIOH[RVW¶QLFRVDVVLP«WULFRV DVVLP«WULFRGRVLVWHPD
2EUD©RHDSHUQDGRODGRSDUDR 1DVFLPHQWRDW«PHVHV
GRSHVFR©R QHUYRVRFHQWUDOH¢VYH]HV«
TXDODFDEH©D«JLUDGDHVWLFDP
SUHGLWLYRGRVXUJLPHQWRGH
HQTXDQWRREUD©RHDSHUQD
SDUDOLVLDFHUHEUDO
RSRVWRVIOH[LRQDP

5HSHWLUQRODGRRSRVWR

6HJXUHREHE¬HPGHF¼ELWRYHQWUDO
FRPXPDP¥RHHVWLPXOHXPGRV
5HIOH[RGHFXUYDWXUDGRWURQFR ODGRVGDVFRVWDVDFPGDOLQKD
P«GLDGRRPEURDW«DVQ£GHJDV
$VXDSHUVLVW¬QFLDSRGHLQGLFDU
DWUDVRQRGHVHQYROYLPHQWR

1DVFLPHQWRDW«PHVHV
UHIOH[RGH*DODQW
$VXDDXV¬QFLDVXJHUHXPD
$FROXQDVHHQFXUYDU£QDGLUH©¥R OHV¥RRXDJUDYRUDTXLPHGXODU
GRODGRHVWLPXODGR WUDQVYHUVR

/HYDQWHREHE¬HPGHF¼ELWR
YHQWUDOFRPXPDGDVP¥RV
$VXDSHUVLVW¬QFLDSRGHLQGLFDU
5HIOH[RGH/DQGDX 1DVFLPHQWRDW«PHVHV
$FDEH©DVHOHYDQWDU£DFROXQD UHWDUGRGRGHVHQYROYLPHQWR
ILFDU£UHWLILFDGD

/HYDQWHREHE¬HPGHF¼ELWR
YHQWUDOHOHQWDPHQWHDEDL[HD
2DWUDVRQRDSDUHFLPHQWR
FDEH©DGHOHHPGLUH©¥R¢
SRGHVHUSUHGLWLYRGHIXWXURV
5HIOH[RGRSDUDTXHGDV VXSHUI¯FLH DPHVHVHQ¥RGHVDSDUHFH
DWUDVRVQRGHVHQYROYLPHQWR
2VEUD©RVHDVSHUQDVVHHVWLFDPGH PRWRUYROXQW£ULR
PDQHLUDSURWHWRUD
 XPDVXSHUI¯FLHOLVD 1DVFLPHQWRRXPHVHVDW«RR ([WHQV¥RHDGX©¥RIL[DGDV
5HIOH[RGHDSRLRSRVLWLYR P¬V SHUQDVHPWHVRXUDVXJHUHP
2VTXDGULVMRHOKRVHWRUQR]HORVVH
HVSDVWLFLGDGHSRUGRHQ©D
HVWLFDPREHE¬ILFDGHS«
QHXUROµJLFDFRPRSDUDOLVLD
VXVWHQWDQGRSDUFLDOPHQWHRSHVR
FHUHEUDO
PDVFHGHDSµVDVHJXQGRV

6HJXUHREHE¬GHS«SRUWU£VFRPR
QRUHIOH[RGHDSRLRSRVLWLYR $XV¬QFLDGRSRVLFLRQDPHQWR
&RORTXHXPDGDVVRODVGRVS«VHP SRGHLQGLFDUSDUDOLVLD
FRQWDWRFRPRWDPSRGDPHVD
5HIOH[RGHSRVLFLRQDPHQWRH
PDUFKD 2TXDGULOHRMRHOKRGDTXHOHS«LU¥R
VHIOH[LRQDUHRRXWURS«GDU£XP
SDVVRSDUDDIUHQWH2EVHUYDPVH
SDVVRVDOWHUQDGRV
1DVFLPHQWRPHOKRUDSµVGLDV
,GDGHYDUL£YHOSDUDGHVDSDUHFHU

%HE¬VQDVFLGRVGHSDUWRGH
FµFRUDVSRGHPQ¥RWHU
UHIOH[RVGHSRVLFLRQDPHQWR

8PD PHGLGD QRUPDWLYD GR GHVHQYROYLPHQWR p R FRHILFLHQWH GH GHVHQYROYLPHQWR PRVWUDGR D

VHJXLU

$YDOLHRGHVHQYROYLPHQWRGHXPODFWHQWHRXFULDQoDXWLOL]DQGRDVHVFDODVSDGUmRSDUDFDGDWLSR
GH GHVHQYROYLPHQWR $ FDGD FULDQoD p DWULEXtGR XP FRHILFLHQWH GH GHVHQYROYLPHQWR PRWRU
JURVVHLUR XP FRHILFLHQWH GH GHVHQYROYLPHQWR PRWRU ILQR XP FRHILFLHQWH GH GHVHQYROYLPHQWR
FRJQLWLYRHDVVLPSRUGLDQWH

&RHILFLHQWHGHGHVHQYROYLPHQWR

! 1RUPDO

D 3RVV¯YHOUHWDUGRQHFHVV£ULRDFRPSDQKDPHQWR

 5HWDUGR

([HPSORVGHFDVRVGHGHVHQYROYLPHQWRPRWRUJURVVHLURHILQR

'HVHQYROYLPHQWRPRWRUJURVVHLUR 'HVHQYROYLPHQWRPRWRUILQR

8PDFULDQ©DGHPHVHVFRQVHJXHWUDQVIHULUREMHWRVGHXPDP¥RSDUDDRXWUDLGDGHGH
 8PDFULDQ©DGHPHVHVFRQVHJXHWUDQVIHULUREMHWRVGHXPDP¥RSDUDDRXWUDLGDGHGH
8PDFULDQ©DGHPHVHVTXHVHHVIRU©DSDUDILFDUGHS«GHVHQYROYLPHQWRPRWRU GHVHQYROYLPHQWRPRWRUILQRGHPHVHVH[SORUDREMHWRVFRPDVSDOPDVGDVP¥RV
JURVVHLURGHPHVHVGHLGDGHPRYLPHQWDVHDHVPRSHORDPELHQWHPHVHVHDQGD PHVHVHSX[DREMHWRVPHVHV1¥RFRQVHJXHVHJXUDUEORFRVQDVGXDVP¥RVHQ¥R
TXDQGRVXDVGXDVP¥RVV¥RVXVWHQWDGDVPHVHVDSUHVHQWDLGDGHGH DSUHVHQWDSUHHQV¥RGHSROHJDUHGRVGHGRVDPHVHV
GHVHQYROYLPHQWRPRWRUJURVVHLURGHPHVHV2FRHILFLHQWHGHGHVHQYROYLPHQWRPRWRU
JURVVHLURGHVWDFULDQ©D« $FULDQ©DDSUHVHQWDUHIOH[RVSULPLWLYRVQRUPDLVDPDLRULDDXVHQWHDXPHQWRGRW¶QXV
SHUQDVHPWHVRXUDTXDQGR«VXVWHQWDGDHVSDVWLFLGDGHHUHWDUGRQRVHJPHQWRPRWRU
JURVVHLURGR''67

2FRHILFLHQWHGRGHVHQYROYLPHQWRPRWRUILQRGHVWDFULDQ©D«
$FULDQ©DHVW£QD]RQDFLQ]HQWDHSURYDYHOPHQWHHYROXLU£EHPVHPLQWHUYHQ©¥RPDV
SUHFLVDGHDFRPSDQKDPHQWRDWHQWR

$FULDQ©DDSUHVHQWDUHWDUGRGRGHVHQYROYLPHQWRPRWRUILQRHVLQDLVGHSDUDOLVLDFHUHEUDO

$YDOLDomRGHSUpHVFRODUHVHHVFRODUHV

 '(6(192/9,0(172

Primeira infância | De 1 a 4 anos

Desenvolvimento físico.$SyVRSULPHLURDQRGHYLGDDYHORFLGDGHGHFUHVFLPHQWRItVLFRGLPLQXLHP
FHUFDGHPHWDGH$SyVRVDQRVDVFULDQoDVJDQKDPFHUFDGHDNJHFUHVFHPFPDRDQR$V
DOWHUDo}HV ItVLFDV VmR LPSUHVVLRQDQWHV $V FULDQoDV JRUGXFKLQKDV H GHVDMHLWDGDV WUDQVIRUPDPVH
HPSUpHVFRODUHVDWHQWRVHPDLVPXVFXORVRV

$VKDELOLGDGHVPRWRUDVJURVVHLUDVWDPEpPVHGHVHQYROYHPUDSLGDPHQWH$PDLRULDGDVFULDQoDV
DQGD DQWHV GRV  PHVHV FRUUH EHP DQWHV GRV  DQRV H SHGDOD XP YHORFtSHGH EHP FRPR SXOD
DQWHV GRV  $V KDELOLGDGHV PRWRUDV ILQDV GHVHQYROYHPVH JUDoDV D PDWXUDomR QHXUROyJLFD H D
PDQLSXODomR DPELHQWDO $ FULDQoD GH  PHVHV TXH UDELVFD WUDQVIRUPDVH HP XPD FULDQoD GH 
DQRVTXHGHVHQKDOLQKDVHXPDGHTXHpFDSD]GHGHVHQKDUFtUFXORV

Desenvolvimento cognitivo e da linguagem.$VFULDQoDVSHTXHQDVSDVVDPGRDSUHQGL]DGRVHQVRULPRWRU

SHORWRTXHRXROKDUSDUDRSHQVDPHQWRVLPEyOLFRUHVROXomRGHSUREOHPDVVLPSOHVOHPEUDQoDV
YHORFLGDGHH[WUDRUGLQiULD8PDFULDQoDGHPHVHVFRPDSDODYUDVWUDQVIRUPDVHHPXPD
GH  DQRV FRP IUDVHV GH WUrV SDODYUDV H HP VHJXLGD HP XPD FULDQoD GH  DQRV TXH FRQYHUVD
SHUIHLWDPHQWH $RV  DQRV RV SUpHVFRODUHV FRQVHJXHP IRUPDU VHQWHQoDV FRPSOH[DV (QWUHWDQWR
DLQGDVmRSUpRSHUDFLRQDLVVHPSURFHVVRVGHSHQVDPHQWROyJLFRSHUPDQHQWH

Desenvolvimento social e emocional. $V QRYDV FRQTXLVWDV LQWHOHFWXDLV Vy VmR VXSHUDGDV SHOR LPSXOVR
HPHUJHQWHGHLQGHSHQGrQFLD&RPRDVFULDQoDVSHTXHQDVVmRLPSXOVLYDVDWDTXHVGHPDXKXPRU
VmRFRPXQV

0DUFRVGRGHVHQYROYLPHQWRSDUDRSUpHVFRODU

Escolar | De 5 a 10 anos
2SHUtRGRGRVDRVDQRVGHLGDGHpXPSHUtRGRDWLYRGHFUHVFLPHQWRHGHVHQYROYLPHQWR$
H[SORUDomR RULHQWDGD SRU REMHWLYRV DXPHQWR GD FDSDFLGDGH ItVLFD H FRJQLWLYD H FRQTXLVWDV SRU
WHQWDWLYDHHUURFDUDFWHUL]DPHVVHHVWiJLR2H[DPHItVLFRpPDLVREMHWLYRPDVFRQVLGHUHVHPSUH
RVHVWiJLRVGHGHVHQYROYLPHQWRHDVWDUHIDVGHVHQYROYLPHQWDLVTXHDVFULDQoDVHPLGDGHHVFRODU
SUHFLVDPDWLQJLU

Desenvolvimento físico.$VFULDQoDVFUHVFHPGHPRGRFRQWtQXRSRUpPPDLVOHQWDPHQWH$LQGDDVVLP
D IRUoD H D FRRUGHQDomR DXPHQWDP GUDVWLFDPHQWH FRP PDLV SDUWLFLSDomR HP DWLYLGDGHV (VWH
WDPEpP p R PRPHQWR HP TXH FULDQoDV FRP LQFDSDFLGDGHV ItVLFDV RX GRHQoDV FU{QLFDV VH
FRQVFLHQWL]DPGHVXDVOLPLWDo}HV
Desenvolvimento cognitivo da linguagem.$VFULDQoDVWRUQDPVH³RSHUDFLRQDLVFRQFUHWDV´FDSD]HVGH
OyJLFDOLPLWDGDHGHDSUHQGL]DGRPDLVFRPSOH[R(ODVSHUPDQHFHPHQUDL]DGDVQRSUHVHQWHFRP
SRXFD FDSDFLGDGH GH HQWHQGHU FRQVHTXrQFLDV RX DEVWUDo}HV $ HVFROD D IDPtOLD H R DPELHQWH
LQIOXHQFLDP PXLWR R DSUHQGL]DGR 8PD WDUHID GHVHQYROYLPHQWDO LPSRUWDQWH p D DXWRHILFiFLD RX
FDSDFLGDGHGHVDLUVHEHPHPVLWXDo}HVGLIHUHQWHV$OLQJXDJHPWRUQDVHFDGDYH]PDLVFRPSOH[D

Desenvolvimento social e emocional. $V FULDQoDV WRUQDPVH SURJUHVVLYDPHQWH PDLV LQGHSHQGHQWHV

LQLFLDQGR DWLYLGDGHV H VDWLVID]HQGRVH FRP FRQTXLVWDV $V FRQTXLVWDV VmR IXQGDPHQWDLV SDUD D
DXWRHVWLPD H SDUD R GHVHQYROYLPHQWR GH XP ³DMXVWH´ jV SULQFLSDLV HVWUXWXUDV VRFLDLV ± IDPtOLD
HVFRODHDWLYLGDGHVGHJUXSRFRPFRPSDQKHLURV&XOSDHEDL[DDXWRHVWLPDWDPEpPVXUJHPQHVVD
IDVH $ IDPtOLD H R DPELHQWH FRQWULEXHP HQRUPHPHQWH SDUD D DXWRLPDJHP GD FULDQoD 2
GHVHQYROYLPHQWRPRUDOSHUPDQHFHVLPSOHVHFRQFUHWRFRPXPDLGHLDFODUDGH³FHUWRHHUUDGR´

7DUHIDVGHVHQYROYLPHQWDLVGXUDQWHDIDVHLQWHUPHGL£ULDGDLQI¤QFLD

7DUHID &DUDFWHU¯VWLFD 1HFHVVLGDGHGHFXLGDGRVGHVD¼GH

5DVWUHDPHQWRGRVSRQWRVIRUWHVDYDOLD©¥RGHSUREOHPDV

$XPHQWRGDIRU©DHFRRUGHQD©¥R
)¯VLFD
&RPSHW¬QFLDHPGLYHUVDVWDUHIDVHDWLYLGDGHV
(QYROYLPHQWRGRVSDLV
6XSRUWHQRFDVRGHLQFDSDFLGDGHV
2ULHQWD©¥RDQWHFLSDWµULDVHJXUDQ©DSU£WLFDGHH[HUF¯FLRVHRULHQWD©¥R
QXWULFLRQDO

ɪ2SHUDFLRQDOFRQFUHWRɫIRFRQRSUHVHQWH ŒQIDVHQDVFRQVHTX¬QFLDVDFXUWRSUD]R

&RJQLWLYD
 &RQTXLVWDVGHFRQKHFLPHQWRHKDELOLGDGHVDXWRHILF£FLD $SRLRUDVWUHDPHQWRGHKDELOLGDGHVHGHVHPSHQKRHVFRODU

2EWHQ©¥RGHXPɪERPDMXVWHɫQDIDP¯OLDFRPRVDPLJRVHQD
$YDOLD©¥RDSRLRDFRQVHOKDPHQWRVREUHLQWHUD©·HV
HVFROD
6RFLDO 6XSRUWH¬QIDVHQRVSRQWRVIRUWHV
0DQXWHQ©¥RGDDXWRHVWLPD
&RPSUHHQV¥RRULHQWD©¥RDSRLR
$XWRLGHQWLGDGHHPHYROX©¥R

$1$01(6(


8PDVSHFWR~QLFRHLPSRUWDQWHGRH[DPHGDFULDQoDpTXHRVSDLVFRVWXPDPREVHUYDUHSDUWLFLSDU
QD LQWHUDomR FRP LVVR p SRVVtYHO REVHUYDU D LQWHUDomR H[LVWHQWH HQWUH RV SDLV H DV FULDQoDV
2EVHUYH VH D FULDQoD H[LEH FRPSRUWDPHQWR DSURSULDGR SDUD D LGDGH $YDOLH D ³DGHTXDomR GR
DMXVWH´ HQWUH SDLV H FULDQoDV $OJXPDV LQWHUDo}HV DQRUPDLV SRGHP UHVXOWDU GR DPELHQWH SRXFR
IDPLOLDU GR FRQVXOWyULR PDV RXWUDV SRGHP VHU FRQVHTXrQFLDV GH SUREOHPDV GH LQWHUDomR $
REVHUYDomRFXLGDGRVDGDVLQWHUDo}HVHQWUHDFULDQoDHRVSDLVQDVEULQFDGHLUDVQmRHVWUXWXUDGDV
GDFULDQoDQRFRQVXOWyULRSRGHPUHYHODUDQRUPDOLGDGHVGRGHVHQYROYLPHQWRItVLFRFRJQLWLYRH
VRFLDO

$V FULDQoDV SHTXHQDV QRUPDLV jV YH]HV ILFDP DSDYRUDGDV RX LUULWDGDV FRP R H[DPLQDGRU e
FRPXPTXHPHODVVHMDPWRWDOPHQWHQmRFRRSHUDWLYDV3RUILPDPDLRULDVHWRUQDPDLVGyFLO6H
HVWHFRPSRUWDPHQWRSHUVLVWLURXQmRIRUDGHTXDGRSDUDRGHVHQYROYLPHQWRpSRVVtYHOTXHH[LVWD
XPDDQRUPDOLGDGH VXEMDFHQWH VHMD FRPSRUWDPHQWDO RX GR GHVHQYROYLPHQWR $V FULDQoDV PDLV
YHOKDVHPLGDGHHVFRODUWrPPDLVDXWRFRQWUROHHH[SHULrQFLDSUpYLDFRPPpGLFRVHFRVWXPDPVHU
PDLVFRRSHUDWLYDVQRH[DPH

$QRUPDOLGDGHVGHWHFWDGDVDRREVHUYDUEULQFDGHLUDV

&RPSRUWDPHQWDLV

,QWHUD©·HVLQVDWLVIDWµULDVHQWUHRVSDLVHDFULDQ©D

5LYDOLGDGHFRPLUP¥RV

'LVFLSOLQDLQDGHTXDGDSHORVSDLV

ɪ7HPSHUDPHQWRGLI¯FLOɫ

'HVHQYROYLPHQWDLV

5HWDUGRPRWRUJURVVHLUR

5HWDUGRPRWRUILQR

5HWDUGRGHOLQJXDJHPGHH[SUHVV¥RUHFHS©¥R
 $WUDVRVHPWDUHIDVVRFLDLVRXHPRFLRQDLV

6RFLDLVRXDPELHQWDLV

(VWUHVVHGHSUHVV¥RGRVSDLV

5LVFRGHPDXVWUDWRVRXQHJOLJ¬QFLD

1HXUROµJLFDV

)UDTXH]DPXVFXODU

3RVWXUDDQRUPDO

(VSDVWLFLGDGH

,QFRRUGHQD©¥R

3UREOHPDVGHDWHQ©¥RHKLSHUDWLYLGDGH

&DUDFWHU¯VWLFDVDXWLVWDV

$QRUPDOLGDGHVPXVFXORHVTXHO«WLFDV

2EVHUYD©¥R2FRPSRUWDPHQWRGDFULDQ©DGXUDQWHDFRQVXOWDSRGHQ¥RFRUUHVSRQGHUDRFRPSRUWDPHQWRW¯SLFRPDVVXDVREVHUYD©·HV
VHUYHPFRPRSRQWRGHSDUWLGDSDUDFRQYHUVDUFRPRVSDLV

Avaliação de pré escolares

8P GHVDILR DR ID]HU R H[DPH ItVLFR GH FULDQoDV GHVVD IDL[D HWiULD p HYLWDU XP FRQIURQWR ItVLFR
XPD FULDQoD EHUUDQGR RX XP SDL LQVDWLVIHLWR $WLQJLU HVVHV REMHWLYRV FRP VXFHVVR WUD] LPHQVD
VDWLVIDomRHFRQVWLWXLXPDGDVIDFHWDVGD³DUWHGDPHGLFLQD´QDSUiWLFDGDSHGLDWULD

e HVVHQFLDO WHQWDU FRQTXLVWDU D FRQILDQoD H DIDVWDU RV WHPRUHV GD FULDQoD GHVGH R LQtFLR GD
FRQVXOWD$DERUGDJHPYDULDGHDFRUGRFRPDVFLUFXQVWkQFLDV8PDFRQVXOWDGHDFRPSDQKDPHQWR
GHVD~GHSDUDXPDFULDQoDTXHHVWHMDEHPSHUPLWHXPHVWDEHOHFLPHQWRGHYtQFXORPHOKRUGRTXHD
FRQVXOWDFRPXPDFULDQoDTXHDSUHVHQWHGRHQoDDJXGD

'HL[HDFULDQoDSHUPDQHFHUYHVWLGDGXUDQWHDHQWUHYLVWDSDUDPLQLPL]DUDDSUHHQVmRGHOD,VVR
SHUPLWH TXH HOD LQWHUDMD FRP YRFr GH PDQHLUD PDLV QDWXUDO H GHL[H YRFr REVHUYiOD EULQFDQGR
LQWHUDJLQGRFRPRVSDLVHWLUDQGRHFRORFDQGRDURXSD

$VFULDQoDVSHTXHQDVHQWUHHPHVHVDSUHVHQWDPDQVLHGDGHHPUHODomRDHVWUDQKRVRPHGR
GRVHVWUDQKRVTXHpQRUPDOQHVVDIDVHGRGHVHQYROYLPHQWR,VVRLQGLFDDSHUFHSomRFUHVFHQWHGD
FULDQoD GH TXH XP HVWUDQKR p XP ³HQWH QRYR´ 9RFr QmR GHYH DSUR[LPDUVH FRP UDSLGH] QHVVH
FDVR'HL[HDFULDQoDILFDUWUDQTXLODPHQWHQRFRORGRVSDLVGXUDQWHDPDLRUSDUWHGRH[DPH
 $OJXPDVGLFDVSDUDH[DPLQDUSU«HVFRODUHVGHDDQRV

(VWUDW«JLDV¼WHLVSDUDRH[DPH %ULQTXHGRVHUHFXUVRV¼WHLV

([DPLQHDFULDQ©DVHQWDGDQRFRORGHXPGRVSDLV7HQWHPDQWHUVHQRQ¯YHOGRVROKRVGD
FULDQ©D
6RSUHSDUDɪDSDJDUɫDOX]GRRWRVFµSLR
([DPLQHSULPHLURREULQTXHGRRXXUVLQKRGDFULDQ©DHGHSRLVDSUµSULDFULDQ©D
)D©DEULQFDGHLUDVFRPRHVWHWRVFµSLRQRVHXSUµSULRQDUL]
'HL[HDFULDQ©DUHDOL]DUSDUWHGRH[DPHSH[PH[HUQRHVWHWRVFµSLR'HSRLVUHWRUQH
SDUDɪEXVFDURVOXJDUHVTXHQ¥RROKDPRVɫ )D©DERQHTXLQKRVFRPRDEDL[DGRUGHO¯QJXD

6ROLFLWH¢FULDQ©DTXHHVW£HPSXUUDQGRYRF¬SDUDɪVHJXUDUVXDP¥Rɫ'HSRLVFRQVLJDTXH 8VHRVSUµSULRVEULQTXHGRVGDFULDQ©DQDVEULQFDGHLUDV
HODɪDMXGHYRF¬ɫQRH[DPH
%DODQFHVXDVFKDYHVSDUDWHVWDUDDXGL©¥R
$OJXPDVFULDQ©DVDFKDPTXHVHHODVQ¥RHQ[HUJDUHPYRF¬«VLQDOGHTXHYRF¬Q¥RHVW£
O£5HDOL]HRH[DPHFRPDFULDQ©DGHS«QRFRORGHXPGRVSDLVROKDQGRSDUDHOHV /LJXHRRWRVFµSLRVREUHDSRQWDGRVHXGHGRɪDFHQGHQGRRGHGRɫHGHSRLVH[DPLQH
FRPHOHDVRUHOKDVGDFULDQ©D
&DVRXPDFULDQ©DGHDQRVHVWHMDVHJXUDQGRDOJRHPFDGDXPDGDVGXDVP¥RVFRPRR
DEDL[DGRUGHO¯QJXDHODQ¥RFRQVHJXLU£UHVLVWLURXOXWDUFRPYRF¬ 8VHOLYURVDSURSULDGRV¢LGDGHGDFULDQ©D

(QWUHJXH¢FULDQ©DXPOLYURDSURSULDGRSDUDDLGDGHGHODHDHQYROYDQDOHLWXUD

7HQWH WUDYDU XPD FRQYHUVD DGHTXDGD SDUD D LGDGH GD FULDQoD )DoD SHUJXQWDV VLPSOHV VREUH D
GRHQoD RX EULQTXHGRV (ORJLH VHX DVSHFWR H FRPSRUWDPHQWR FRQWH XPD KLVWyULD RX MRJXH DOJXP
MRJRVLPSOHVSDUD³TXHEUDURJHOR´6HDFULDQoDIRUWtPLGDYROWHVXDDWHQomRSDUDRVSDLVSDUD
SHUPLWLUTXHDFULDQoDUHOD[HJUDGXDOPHQWH

&RPDOJXPDVH[FHo}HVRH[DPHItVLFRQmRH[LJHRXVRGDPHVDGHH[DPH±RH[DPHSRGHVHU
UHDOL]DGR QR FKmR RX FRP D FULDQoD QR FROR GRV SDLV 2 VHJUHGR p FRQVHJXLU TXH D FULDQoD
FRRSHUH1RFDVRGHFULDQoDVSHTXHQDVTXHUHVLVWDPDWLUDUDURXSDH[SRQKDDSHQDVDSDUWHGR
FRUSR TXH HVWLYHU VHQGR H[DPLQDGD (QTXDQWR HVWLYHU H[DPLQDQGR LUPmRV FRPHFH FRP R PDLV
YHOKRTXHWHPXPDWHQGrQFLDPDLRUDFRRSHUDUHGDUXPERPH[HPSOR$SUR[LPHVHGDFULDQoD
GHPDQHLUDDJUDGiYHO([SOLTXHFDGDHWDSDHQTXDQWRDIRUUHDOL]DQGR&RQWLQXHDFRQYHUVDUFRPD
IDPtOLDSDUDGLVWUDLUDFULDQoD

3ODQHMHRH[DPHGHPRGRDFRPHoDUSHORVSURFHGLPHQWRVPHQRVDQJXVWLDQWHVHWHUPLQHFRPRV
TXH SURYRFDP PDLRU GHVFRQIRUWR HP JHUDO RV TXH HQYROYHP D IDULQJH H DV RUHOKDV 6HPSUH
FRPHFHFRPDVSDUWHVTXHSRGHPVHUUHDOL]DGDVFRPDFULDQoDVHQWDGDFRPRRH[DPHGRVROKRV
RXDSDOSDomRGRSHVFRoR4XDQGRDFULDQoDHVWiGHLWDGDHODVHVHQWHYXOQHUiYHOGHPRGRTXHp
SUHFLVRPXGDUDVSRVLo}HVFRPFXLGDGR4XDQGRWLYHUFRQVHJXLGRTXHDFULDQoDILTXHGHLWDGDGH
FRVWDV FRPHFH R H[DPH SHOR DEGRPH GHL[DQGR DV RUHOKDV RX D JHQLWiOLD SRU ~OWLPR 3RGH VHU
QHFHVViULD D DMXGD GR SDL RX GD PmH SDUD FRQWHU D FULDQoD GXUDQWH R H[DPH GDV RUHOKDV H GD
IDULQJH (QWUHWDQWR R XVR GH FRQWHQo}HV IRUPDLV p WRWDOPHQWH LQDGHTXDGR 3DFLrQFLD GLVWUDomR
EULQFDGHLUDIOH[LELOLGDGHQDRUGHPGRH[DPHHXPDDERUGDJHPDWHQWDSRUpPILUPHFRQVWLWXHPRV
IXQGDPHQWRVGHXPH[DPHEHPVXFHGLGRQDFULDQoDSHTXHQD

0DLVGLFDVSDUDH[DPLQDUFULDQ©DVSHTXHQDV

)DOHFRPWUDQTXLOLGDGHGXUDQWHWRGRRH[DPH

'HL[HDFULDQ©DYHUHSHJDURVLQVWUXPHQWRVGHH[DPHTXHVHU¥RXWLOL]DGRV

1¥RVROLFLWHSHUPLVV¥RSDUDH[DPLQDUXPDSDUWHGRFRUSRSRLVYRF¬YDLID]¬ORGHTXDOTXHUPRGR(PYH]GLVVRSHUJXQWHDFULDQ©DTXH
RUHOKDRXTXHSDUWHGRFRUSRHODTXHUTXHYRF¬H[DPLQHɪSULPHLURɫ

([DPLQHDFULDQ©DQRFRORGRSDLRXGDP¥H'HL[HTXHRVSDLVWLUHPDURXSDGDFULDQ©D

6HYRF¬Q¥RFRQVHJXLUFRQVRODUDFULDQ©DG¬XPWHPSRSDUDHODVHFRQWURODU

7UDQVIRUPHRH[DPHHPXPDEULQFDGHLUD3RUH[HPSORɪ9DPRVYHUVHYRF¬WHPXPDO¯QJXDJUDQGHɫRXɪ20LFNH\HVW£QDVXDRUHOKD"
9DPRVYHUɫ

7UDQTXLOL]H RV SDLV GH TXH D UHVLVWrQFLD DR H[DPH ID] SDUWH GR GHVHQYROYLPHQWR DGHTXDGR
$OJXQVSDLVFRQVWUDQJLGRVEULJDPFRPDFULDQoDSLRUDQGRRSUREOHPD(QYROYDRVSDLVQRH[DPH
$SUHQGDTXHWpFQLFDVHDERUGDJHQVIXQFLRQDPPHOKRUHVmRPDLVFRQIRUWiYHLVSDUDYRFr

Avaliação de escolares
2H[DPHGHFULDQoDVDSyVDWLQJLUHPDLGDGHHVFRODULPS}HSRXFDVGLILFXOGDGHV$OJXPDVFULDQoDV
SRGHPWHUPHPyULDVGHVDJUDGiYHLVGHLGDVDQWHULRUHVDRSHGLDWUDSRUpPDPDLRULDUHVSRQGHEHP
TXDQGRRH[DPLQDGRUHVWi³DILQDGR´FRPRHVWiJLRGRGHVHQYROYLPHQWRGHODV

0XLWDV FULDQoDV GHVVD LGDGH WrP XP UHFDWR FXULRVR )RUQHFHU R URXSmR H GHL[iODV PDQWHU D
URXSDGHEDL[RSHORPDLRUWHPSRSRVVtYHOVmRDERUGDJHQVViELDV6XJLUDTXHDFULDQoDVHGLVSD
SRU WUiV GR ELRPER &RQVLGHUH D KLSyWHVH GH GHL[DU R FRQVXOWyULR HQTXDQWR HOD VH WURFD FRP D
DMXGDGRVSDLV$OJXPDVFULDQoDVSRGHPSUHIHULUTXHLUPmRVGRVH[RRSRVWRVDLDPPDVDPDLRULD
SUHIHUHTXHRSDLRXDPmHSHUPDQHoDQRFRQVXOWyULR2VSDLVGHFULDQoDVFRPPHQRVGHDQRV
GHYHPSHUPDQHFHUFRPDFULDQoD

$VFULDQoDVFRVWXPDPHVWDUDFRPSDQKDGDVGHXPGRVSDLVRXGHXPFXLGDGRU0HVPRTXDQGR
VR]LQKDVIUHTXHQWHPHQWHSURFXUDPDWHQGLPHQWRSRUVROLFLWDomRGRVSDLV±QDYHUGDGHRSDLRXD
PmHJHUDOPHQWHHVWiVHQWDGRQDVDODGHHVSHUD$RHQWUHYLVWDUDFULDQoDpSUHFLVRFRQVLGHUDUDV
QHFHVVLGDGHVGHSHUVSHFWLYDVWDQWRGDFULDQoDTXDQWRGHTXHPFXLGDGHOD

Como estabelecer um vínculo.&RPHFHDHQWUHYLVWDFXPSULPHQWDQGRHHVWDEHOHFHQGRXPYtQFXORFRP

FDGDSHVVRDSUHVHQWH5HILUDVHjFULDQoDSHORQRPHHPYH]GH³HOH´RX³HOD´(VFODUHoDRSDSHO
H R UHODFLRQDPHQWR GH WRGRV RV DGXOWRV H FULDQoDV SUHVHQWHV FRP D FULDQoD TXH YRFr HVWi
H[DPLQDQGR ³%RP D VHQKRUD p DYy GH -LPP\"´ ³3RU IDYRU DMXGHPH GL]HQGR TXDO R
UHODFLRQDPHQWRGHYRFrVFRPHOH´'LULMDVHDRVSDLVFRPR³6UD6PLWK´RX³6U6PLWK´HPYH]
GHFKDPiORVSHORQRPHRXFRPR³PmH´RX³SDL´4XDQGRDHVWUXWXUDIDPLOLDUQmRILFDUFODUDGH
LPHGLDWR YRFr SRGHUi HYLWDU DOJXQV FRQVWUDQJLPHQWRV VH IL]HU SHUJXQWDV GLUHWDV VREUH RXWURV
FRPSRQHQWHVGDIDPtOLD³4XHPPDLVYLYHFRPYRFrHPFDVD"´³4XHPpRSDLGH-LPP\"´³9RFrV
PRUDP MXQWRV"´ 1mR SUHVXPD TXH SRUTXH RV SDLV VmR VHSDUDGRV DSHQDV XP GHOHV WHP
HQYROYLPHQWRDWLYRQDYLGDGDFULDQoD$WXDOPHQWHpUHODWLYDPHQWHFRPXPSDLVGRPHVPRVH[R

3DUD HVWDEHOHFHU XP YtQFXOR FRQKHoD D FULDQoD QR SUySULR QtYHO GHOD 8VH D VXD H[SHULrQFLD
SHVVRDOFRPFULDQoDVSDUDRULHQWDUDPDQHLUDFRPRLQWHUDJLUFRPHODVHPVLWXDo}HVGHVD~GH2
FRQWDWRYLVXDOQRPHVPRQtYHODSDUWLFLSDomRHPEULQFDGHLUDVHFRQYHUVDUVREUHRTXHLQWHUHVVDD
HODV VmR VHPSUH ERDV HVWUDWpJLDV )DoD SHUJXQWDV VREUH URXSDV QRYDV XP GRV EULQTXHGRV TXH
OLYURRXSURJUDPDVGH79HODVSUHIHUHPRXVREUHRDFRPSDQKDQWHDGXOWRGHPDQHLUDHQWXVLiVWLFD
SRUpPJHQWLO'HGLFDUXPWHPSRQRLQtFLRGDHQWUHYLVWDSDUDDFDOPDUHID]HUXPDOLJDomRFRPXPD
FULDQoDDQVLRVDGHL[DWDQWRDFULDQoDTXDQWRRFXLGDGRUPDLVjYRQWDGH

Interação com os familiares.8PGRVGHVDILRVTXDQGRKiYiULDVSHVVRDVSUHVHQWHVQDFRQVXOWDpGHFLGLU

D TXHP ID]HU GLUHWDPHQWH DV SHUJXQWDV 0HVPR TXH YRFr SUHFLVH REWHU LQIRUPDo}HV WDQWR GD
FULDQoDTXDQWRGRVSDLVYDOHDSHQDFRPHoDUFRPDFULDQoD)DoDSHUJXQWDVVLPSOHVHDEHUWDVGR
WLSR ³9RFr HVWi GRHQWH"« 'LJD FRPR HVWi VH VHQWLQGR´ DFRPSDQKDGDV GH SHUJXQWDV PDLV
HVSHFtILFDV (VVD HVWUDWpJLD FRP IUHTXrQFLD IRUQHFH JUDQGH SDUWH GRV GDGRV FOtQLFRV 2V SDLV
SRGHPHQWmRFRQILUPDUDVLQIRUPDo}HVDFUHVFHQWDUGHWDOKHVTXHGmRDYRFrXPDLGHLDGRFRQWH[WR
PDLVDPSORHLGHQWLILFDURXWUDVTXHVW}HVTXHSUHFLVHPVHUDERUGDGDV&DUDFWHUL]HRVDWULEXWRVGRV
VLQWRPDV GR PHVPR PRGR TXH R IDULD FRP DGXOWRV $OJXPDV YH]HV DV FULDQoDV ILFDP WtPLGDV QR
LQtFLRPDVTXDQGRRVSDLVLQLFLDUHPDFRQYHUVDGLULMDGHYROWDDVSHUJXQWDVjFULDQoD

‡ ³6XDPmHPHGLVVHTXHYRFrHVWiFRPGRUQRHVW{PDJR)DOHPHXPSRXFRGLVVR´
‡ ³0RVWUHPHRQGHILFDDGRU&RPRTXHVHSDUHFHDGRU"´
‡ ³eFRPRVHIRVVHXPDDJXOKDGDRXXPSHVR"´
‡ ³)LFDVHPSUHQRPHVPROXJDURXVHPH[H"´
‡ ³2TXHID]HODLUHPERUD"2TXHSLRUD"´
‡ ³2TXHYRFrDFKDTXHHVWHMDFDXVDQGRHVVDGRU"´
$ SUHVHQoD GH IDPLOLDUHV QD FRQVXOWD SRVVLELOLWD D REVHUYDomR GH FRPR HOHV LQWHUDJHP FRP D
FULDQoD $ FULDQoD SRGH FRQVHJXLU ILFDU VHQWDGD SDUDGD RX ILFDU LQTXLHWD H FRPHoDU D VH PH[HU
2EVHUYHFRPRRVSDLVHVWDEHOHFHPRXQmRHVWDEHOHFHPOLPLWHVTXDQGRLVVRVHID]QHFHVViULR

Agendas múltiplas. &DGD SHVVRD QR FRQVXOWyULR LQFOXVLYH R SURILVVLRQDO GH VD~GH SRGH WHU XPD
LGHLDGLIHUHQWHVREUHDQDWXUH]DGRSUREOHPDHRTXHSUHFLVDVHUIHLWRHPUHODomRDHOH$WDUHID
GRSURILVVLRQDOGHVD~GHpGHVFREULUDPDLRUTXDQWLGDGHSRVVtYHOGHVVDVSHUVSHFWLYDVHDJHQGDV
2V IDPLOLDUHV TXH QmR HVWmR SUHVHQWHV QD FRQVXOWD XP SDL RX DYy DXVHQWHV WDPEpP SRGHP WHU
SUHRFXSDo}HV3HUJXQWHWDPEpPVREUHHODV³6HRSDLGH6X]LHHVWLYHVVHDTXLKRMHTXHSHUJXQWDV
RXSUHRFXSDo}HVHOHWHULD"´³6UD-RQHVMiGLVFXWLXLVVRFRPDVXDPmHRXDOJXPDRXWUDSHVVRD"´
2TXHHODDFKD"´

$ 6UD -RQHV SRU H[HPSOR WUD] 6X]LH j FRQVXOWD HP IXQomR GH GRU DEGRPLQDO SRUTXH ILFRX
SUHRFXSDGDFRPDSRVVLELOLGDGHGH6X]LHWHUXPD~OFHUDHWDPEpPSHORVKiELWRVDOLPHQWDUHVGD
FULDQoD6X]LHQmRHVWiSUHRFXSDGDFRPDGRUQDEDUULJDPDVGHVFRQIRUWiYHOFRPDVPXGDQoDVQR
VHX FRUSR H D SRVVLELOLGDGH GH HQJRUGDU $ 6UD -RQHV DFKD TXH 6X]LH QmR HVWi GDQGR DWHQomR
VXILFLHQWHDRVWUDEDOKRVHVFRODUHV2SURILVVLRQDOGHVD~GHSUHFLVDHTXLOLEUDUHVVDVSUHRFXSDo}HV
FRP R TXH Yr HP XPD FULDQoD GH  DQRV VDXGiYHO QR LQtFLR GD SXEHUGDGH FRP GRU DEGRPLQDO
GLVFUHWDIXQFLRQDO2VREMHWLYRVSUHFLVDPLQFOXLUDMXGDUDIDPtOLDDVHUUHDOLVWDVREUHDIDL[DGH
³QRUPDOLGDGH´HGHVFREULUTXDLVVmRDVSUHRFXSDo}HVGRVSDLVGH6X]LHHGDSUySULD6X]LH
A família como recurso.'HPRGRJHUDORVPHPEURVGDIDPtOLDVmRRVTXHGLVSHQVDPDPDLRUSDUWH
GRV FXLGDGRV H FRQVWLWXHP DOLDGRV QDWXUDLV QD SURPRomR GD VD~GH GD FULDQoD 2 IDWR GH HVWDU
DEHUWR D XPD DPSOD JDPD GH FRPSRUWDPHQWRV IDPLOLDUHV DMXGD D ILUPDU HVVD DOLDQoD &ULDU XPD
FULDQoD UHIOHWH SUiWLFDV FXOWXUDLV VRFLRHFRQ{PLFDV H IDPLOLDUHV e LPSRUWDQWH UHVSHLWDU D JUDQGH
YDULDomRGHVVDVSUiWLFDV8PDERDHVWUDWpJLDpFRQVLGHUDURVSDLVFRPRHVSHFLDOLVWDVQRFXLGDGR
GHVHXVILOKRVHRSURILVVLRQDOGHVD~GHFRPRFRQVXOWRUGHOHV(VVDDERUGDJHPGHPRQVWUDUHVSHLWR
SHOR FXLGDGR GRV SDLV H PLQLPL]D D SUREDELOLGDGH GH HOHV GHVFRQVLGHUDUHP RX LJQRUDUHP RV
FRQVHOKRVGRVSURILVVLRQDLVGHVD~GH2VSDLVVHYHHPGLDQWHGHPXLWRVGHVDILRVSDUDFULDUVHXV
ILOKRV GH PRGR TXH RV SURILVVLRQDLV GH VD~GH SUHFLVDP GDU DSRLR H QmR HPLWLU MXOJDPHQWRV
&RPHQWiULRV GR WLSR ³3RU TXH QmR WURX[H HOH DQWHV"´ RX ³2 TXH IRL TXH YRFr IH] SDUD LVVR
DFRQWHFHU"´QmRPHOKRUDPRUHODFLRQDPHQWRFRPRVSDLV'HFODUDo}HVTXHUHFRQKHoDPRWUDEDOKR
GXUR TXH p FXLGDU GRV ILOKRV H HORJLRV SHODV FRQTXLVWDV VmR VHPSUH DSUHFLDGRV ³6U 6PLWK R
VHQKRU HVWi ID]HQGR XP yWLPR WUDEDOKR FRP R %REE\ 6HU SDL p PXLWR WUDEDOKRVR H R
FRPSRUWDPHQWR GR %REE\ DTXL KRMH FODUDPHQWH GHPRQVWUD VHXV HVIRUoRV´ 2X SDUD R ILOKR
³%REE\YRFrWHPPXLWDVRUWHGHWHUXPSDLWmRPDUDYLOKRVR´

Agendas ocultas.)LQDOPHQWHGRPHVPRPRGRTXHFRPRVDGXOWRVDTXHL[DSULQFLSDOSRGHQmRWHU
UHODomRFRPRPRWLYRUHDOGDFRQVXOWD$TXHL[DSRGHVHUXPDGHVFXOSDSDUDSUHRFXSDo}HVTXH
SRGHPQmRSDUHFHUVXILFLHQWHPHQWHOHJtWLPDVSDUDPRWLYDUHPXPDLGDDRPpGLFR7HQWDUFULDUXPD
DWPRVIHUDGHFRQILDQoDTXHSHUPLWDDRSDLRXjPmHYHUEDOL]DUHVVDVSUHRFXSDo}HVpLPSRUWDQWH
)DoDSHUJXQWDVIDFLOLWDGRUDVGRWLSR

7HPDOJXPDRXWUDSUHRFXSDomRFRP5DQG\"
+iDOJRPDLVTXHJRVWDULDGHPHGL]HUSHUJXQWDUKRMH"

35202d­2(25,(17$d­2'$6$Ò'(_(9,'Ç1&,$6
 (5(&20(1'$d®(6

Crianças com 1 a 4 anos de idade

2V HVTXHPDV GH SHULRGLFLGDGH GD $33 H GD %ULJKW )XWXUHV SDUD FULDQoDV LQFOXHP FRQVXOWDV GH
VXSHUYLVmRGHVD~GHDRVHPHVHVHGHSRLVFRQVXOWDVDQXDLVTXDQGRDFULDQoDWLYHU
 H  DQRV 8PD FRQVXOWD DGLFLRQDO DRV  PHVHV WDPEpP p UHFRPHQGDGD SDUD DYDOLDU R
GHVHQYROYLPHQWRGDFULDQoD

'XUDQWH HVVDV FRQVXOWDV GH VXSHUYLVmR GH VD~GH RV SHGLDWUDV DERUGDP SUHRFXSDo}HV H
SHUJXQWDV GRV SDLV DYDOLDP R FUHVFLPHQWR H R GHVHQYROYLPHQWR GD FULDQoD UHDOL]DP XP H[DPH
ItVLFRDEUDQJHQWHHRIHUHFHPRULHQWDomRDQWHFLSDWyULDVREUHKiELWRVHFRPSRUWDPHQWRVGHVD~GH
FRPSHWrQFLDVRFLDOGRVFXLGDGRUHVUHODFLRQDPHQWRVIDPLOLDUHVHLQWHUDo}HVFRPDFRPXQLGDGH

(VVD p XPD LGDGH FUtWLFD SDUD SUHYHQLU D REHVLGDGH GD LQIkQFLD 0XLWDV FULDQoDV LQLFLDP VXD
WUDMHWyULD GH REHVLGDGH HQWUH RV  H  DQRV 7DPEpP p LPSRUWDQWH DYDOLDU DGHTXDGDPHQWH R
GHVHQYROYLPHQWRGDFULDQoD4XHVWLRQiULRVGHUDVWUHDPHQWRGHGHVHQYROYLPHQWRSDGUmRFDGDYH]
PDLVVmRUHFRPHQGDGRVSDUDDYDOLDUDVGLIHUHQWHVGLPHQV}HVGRGHVHQYROYLPHQWRLQIDQWLOYHMDD
SiJLQD  'R PHVPR PRGR p LPSRUWDQWH GLIHUHQFLDU FRPSRUWDPHQWRV QRUPDLV SRUpP
SRWHQFLDOPHQWH GHVDILDGRUHV GD FULDQoD GH FRPSRUWDPHQWRV DQRUPDLV RX SUREOHPDV GH VD~GH
PHQWDO

2ER[HDVHJXLUPRVWUDRVSULQFLSDLVFRPSRQHQWHVGHXPDFRQVXOWDGHVXSHUYLVmRGHVD~GHSDUD
XPDFULDQoDGHDQRVFRPrQIDVHQDSURPRomRGDVD~GH1mRpSUHFLVRHVSHUDUXPDFRQVXOWDGH
VXSHUYLVmR GH VD~GH SDUD DERUGDU YiULRV GHVVHV DVSHFWRV GD SURPRomR GD VD~GH ± p SRVVtYHO
ID]rORGXUDQWHRXWURVWLSRVGHFRQVXOWDPHVPRVHDFULDQoDHVWLYHUOHYHPHQWHGRHQWH

&RPSRQHQWHVGHXPDFRQVXOWDGHVXSHUYLV¥RGHVD¼GHHPXPDFULDQ©DGHDQRV

&RQYHUVDVFRPRVSDLV

$ERUGHDVSUHRFXSD©·HVGRVSDLV

)RUQH©DRULHQWD©¥R

)DOHGRVFXLGDGRVFRPDFULDQ©DHVFRODVRFLDLV

$YDOLHDVSULQFLSDLV£UHDVGHLQWHUHVVHGHVHQYROYLPHQWRQXWUL©¥RVHJXUDQ©DVD¼GHEXFDOUHODFLRQDPHQWRVIDPLOLDUHVFRPXQLGDGH

$YDOLD©¥RGRGHVHQYROYLPHQWR

$YDOLHRVPDUFRVGRGHVHQYROYLPHQWR''67PRWRUJURVVHLURHILQRVRFLDOɥSHVVRDOOLQJXDJHPXWLOL]HXPWHVWHGHUDVWUHDPHQWR

([DPHI¯VLFR

5HDOL]HXPH[DPHFXLGDGRVRLQFOXVLYHSDU¤PHWURVGHFUHVFLPHQWRFRPSHUFHQWLVSDUDDLGDGH

7HVWHVGHUDVWUHDPHQWR

9LV¥RHDXGL©¥RWHVWHIRUPDODRVDQRVKHPDWµFULWRHQ¯YHOVDQJX¯QHRGHFKXPERFDVRGHDOWRULVFRRXQDVLGDGHVGHDDQRV

UDVWUHDPHQWRSDUDIDWRUHVGHULVFRVRFLDLV

,PXQL]D©·HV
 9HMDHVTXHPDGHLPXQL]D©¥RDFHVVDQGRROLQNSRUWDOGDVDXGHVDXGHJRYEU

2ULHQWD©¥RDQWHFLSDWµULD

+¡ELWRVHFRPSRUWDPHQWRVVDXG¡YHLV

3UHYHQ©¥RGHOHV·HVHGRHQ©DV

&DGHLUDHVSHFLDOSDUDRFDUURYHQHQRVH[SRVL©¥RDWDEDFRVXSHUYLV¥R

1XWUL©¥RHSU£WLFDGHH[HUF¯FLRV

$YDOLD©¥RGHREHVLGDGHUHIHL©·HVHODQFKHVVDXG£YHLV

6D¼GHEXFDO

(VFRYD©¥RGRVGHQWHVLGDDRGHQWLVWD

,QWHUD§£RSDLǾODFWHQWH

/HLWXUDHPRPHQWRVGHOD]HU79

5HODFLRQDPHQWRVIDPLOLDUHV

$WLYLGDGHVEDE£V

,QWHUD§£RQDFRPXQLGDGH

&XLGDGRVFRPDFULDQ©DUHFXUVRV

Crianças de 5 a 10 anos
2VHVTXHPDVGHSHULRGLFLGDGHGD$$3HGD%ULJKW)XWXUHVSDUDFULDQoDVUHFRPHQGDPFRQVXOWDV
GHVXSHUYLVmRGHVD~GHDQXDLVGXUDQWHHVVHSHUtRGR&RPRQDVLGDGHVDQWHULRUHVHVVDVFRQVXOWDV
VmR RSRUWXQLGDGHV PDUDYLOKRVDV SDUD DYDOLDU D VD~GH ItVLFD H PHQWDO H R GHVHQYROYLPHQWR GD
FULDQoD H D UHODomR HQWUH RV SDLV H D FULDQoD 0DLV XPD YH] D SURPRomR GD VD~GH GHYH VHU
LQFRUSRUDGD HP WRGDV DV LQWHUDo}HV FRP DV FULDQoDV H IDPtOLDV ± QmR GHL[H HVFDSDU QHQKXPD
RSRUWXQLGDGHSDUDSURPRYHUVD~GHHGHVHQYROYLPHQWRLGHDLV

$VFULDQoDVPDLVYHOKDVJRVWDPGHFRQYHUVDUGLUHWDPHQWHFRPRH[DPLQDGRU$OpPGHGLVFXWLU
DVSHFWRVGHVD~GHVHJXUDQoDGHVHQYROYLPHQWRHRULHQWDomRDQWHFLSDWyULDFRPRVSDLVDFULDQoD
GHYH VHU LQFOXtGD QHVVDV FRQYHUVDV XVDQGR OLQJXDJHP H FRQFHLWRV DSURSULDGRV SDUD D LGDGH
'LVFXWDDH[SHULrQFLDHDVSHUFHSo}HVTXHDFULDQoDWHPGDHVFRODEHPFRPRRXWUDVDWLYLGDGHV
FRJQLWLYDVHVRFLDLV1HVVDVFRQYHUVDVHQIDWL]HKiELWRVVDXGiYHLVFRPRERDQXWULomRH[HUFtFLR
OHLWXUDDWLYLGDGHVHVWLPXODQWHVHVHJXUDQoD
 &HUFDGHDGDVFULDQoDVDSUHVHQWDPDOJXPWLSRGHFRQGLomRItVLFDFU{QLFDDIHFomRGR
GHVHQYROYLPHQWR RX DIHFomR PHQWDO $OpP GLVVR DOJXQV FRPSRUWDPHQWRV TXH VH HVWDEHOHFHP
QHVVD LGDGH SRGHP SURYRFDU RX H[DFHUEDU TXDGURV FU{QLFRV FRPR REHVLGDGH RX WUDQVWRUQRV
DOLPHQWDUHV3RUWDQWRDSURPRomRGDVD~GHpFUXFLDOSDUDRWLPL]DUKiELWRVVDXGiYHLVHPLQLPL]DU
RV KiELWRV QmR VDXGiYHLV $MXGDU DV IDPtOLDV H DV FULDQoDV FRP GRHQoDV FU{QLFDV D OLGDUHP GH
PDQHLUDPDLVHIHWLYDFRPHVVDVGRHQoDVFRQVWLWXLXPDSDUWHIXQGDPHQWDOGDSURPRomRGDVD~GH

3DUD WRGDV DV FULDQoDV D SURPRomR GD VD~GH HQYROYH D DYDOLDomR H D SURPRomR GD VD~GH GD
IDPtOLDFRPRXPWRGR

2VHOHPHQWRVHVSHFtILFRVGDFRQVXOWDHGHVXSHUYLVmRGDVD~GHHPFULDQoDVPDLVYHOKDVVmRRV
PHVPRV TXH RV FRPSRQHQWHV SDUD FULDQoDV PDLV QRYDV PRVWUDGRV QR ER[H GD SiJLQD DQWHULRU
(QIDWL]H R GHVHPSHQKR H DV H[SHULrQFLDV HVFRODUHV DOpP GH HVSRUWHV H DWLYLGDGHV VHJXURV H
DSURSULDGRV

 7e&1,&$6'((;$0(

$RUGHPGRH[DPHDJRUDVHJXHDHPSUHJDGDHPDGXOWRV([DPLQHiUHDVGRORURVDVSRU~OWLPRH
DYLVHjFULDQoDFRPDQWHFHGrQFLDDVUHJL}HVDVHUHPH[DPLQDGDV6HDFULDQoDUHVLVWLUDXPDSDUWH
GRH[DPHYRFrSRGHYROWDUSDUDHVWDSDUWHQRILQDO

Ectoscopia e sinais vitais

Crescimento somático
$V ILJXUDV D VHJXLU PRVWUDP DOJXQV SDGU}HV GH FUHVFLPHQWR VRPiWLFR GH GLYHUVRV VLVWHPDV GD
FULDQoD

Altura.$FULDQoDFRPPDLVGHDQRVGHYHWHUVXDDOWXUD %DL[DHVWDWXUDGHILQLGDFRPR
PHGLGDGHSpLGHDOPHQWHXVDQGRHVWDGL{PHWURVHPEXWLGRV DOWXUDDEDL[RGDQRUPDOSDUDD
QDV SDUHGHV 6ROLFLWH j FULDQoD TXH ILTXH GH Sp FRP RV LGDGHSRGHVHUXPDYDULDQWH
QRUPDORXSURYRFDGDSRU
FDOFDQKDUHVDVFRVWDVHDFDEHoDFRQWUDDSDUHGHRXDSDUWH
GRHQoDVHQGyFULQDVRXSRU
GD IUHQWH GR HVWDGL{PHWUR 6H XVDU XPD SDUHGH FRP XPD RXWUDVSDWRORJLDV$VYDULDQWHV
UpJXDPDUFDGDQmRVHHVTXHoDGHFRORFDUXPDSUDQFKDRX QRUPDLVLQFOXHPHVWDWXUDEDL[D
VXSHUItFLH OLVD FRQWUD R WRSR GD FDEHoD GD FULDQoD H D IDPLOLDUHUHWDUGR
kQJXORVUHWRVFRPDUpJXD$VHVFDODVGHSHVRHPSpFRP FRQVWLWXFLRQDO$VGRHQoDV
FU{QLFDVLQFOXHPGHILFLrQFLDGR
XPDQH[RGHDOWXUDQmRVmRPXLWRDFXUDGDV KRUP{QLRGHFUHVFLPHQWR
RXWUDVGRHQoDVHQGyFULQDV
 GRHQoDJDVWULQWHVWLQDOGRHQoD
UHQDORXPHWDEyOLFDH
 VtQGURPHVJHQpWLFDV


&XUYDVGHYHORFLGDGHSDUDFRPSULPHQWRHDOWXUDGHPHQLQRVHPHQLQDVEDVHDGDVHPLQWHUYDORVGH
DQR'H/RZUH\*+*URZWKDQGGHYHORSPHQWRIFKLOGUHQWKHG&KLFDJR0RVE\
$SyVRVDQRVDVFULDQoDVSUHFLVDPFUHVFHUSHORPHQRV 2VSUpHVFRODUHVSRGHP
 FP DR DQR 'XUDQWH D DGROHVFrQFLD R FUHVFLPHQWR p DSUHVHQWDUJDQKRGHSHVRH
DFHOHUDGR DOWXUDLQDGHTXDGRVVHVXD
LQJHVWmRFDOyULFDIRU
Peso.&ULDQoDVSUpHVFRODUHVTXHFRQVHJXHPILFDUGHSpH LQVXILFLHQWH$VHWLRORJLDVGR
UHWDUGRGHGHVHQYROYLPHQWR
HVFRODUHV GHYHP VHU SHVDGDV FRP D URXSD GH EDL[R H XP LQFOXHPGRHQoDVSVLFRVVRFLDLV
DYHQWDOHPXPDEDODQoDGHSp8VHDVPHVPDVEDODQoDVQDV GHLQWHUDomRJDVWULQWHVWLQDLVH
VXFHVVLYDV FRQVXOWDV SDUD RWLPL]DU D FDSDFLGDGH GH HQGyFULQDV
FRPSDUDomR

Circunferência craniana.'HPRGRJHUDODFLUFXQIHUrQFLDFUDQLDQDpPHGLGDRVPHVHVGHYLGD
'HSRLVGLVVRDPHGLGDGDFLUFXQIHUrQFLDGRFUkQLRSRGHDMXGDUVHKRXYHUVXVSHLWDGHGRHQoDGR
VLVWHPDQHUYRVRFHQWUDORXJHQpWLFD

Índice de massa corporal para a idade. ([LVWHP DWXDOPHQWH $PDLRULDGDVFULDQoDVFRP

JUiILFRVHVSHFtILFRVSDUDLGDGHHVH[RSDUDDYDOLDURtQGLFH REHVLGDGHH[yJHQDpWDPEpP
GH PDVVD FRUSRUDO QDV FULDQoDV $V PHGLGDV GH ,0& DOWDSDUDDLGDGH$VFULDQoDV
FRPFDXVDVHQGyFULQDVGH
DMXGDPQDGHWHFomRSUHFRFHGHREHVLGDGHHPFULDQoDVFRP
REHVLGDGHWHQGHPDVHUEDL[DV
PDLVGHDQRV2VJUiILFRVGH,0&SDUDDVFULDQoDVOHYDP $REHVLGDGHLQIDQWLOpXPD
HPFRQVLGHUDomRGLIHUHQoDVGHLGDGHHVH[R$WXDOPHQWHD HSLGHPLDLPSRUWDQWHGDV
FULDQoDVQRV(8$WrP,0&
REHVLGDGHpXPDLPSRUWDQWHHSLGHPLDHFRPIUHTXrQFLDWHP
DFLPDGRRSHUFHQWLOH
LQtFLRDQWHVGRVDDQRV$VFRQVHTXrQFLDVGDREHVLGDGH WrP,0&•RSHUFHQWLO$
LQIDQWLO LQFOXHP KLSHUWHQVmR DUWHULDO GLDEHWHV PHOLWR PRUELGDGHGDREHVLGDGHQD
VtQGURPH PHWDEyOLFD H EDL[D DXWRHVWLPD $ REHVLGDGH QD LQIkQFLDDORQJRSUD]RHQYROYH
LQIkQFLD FRP IUHTXrQFLD SURYRFD REHVLGDGH QR DGXOWR H PXLWRVVLVWHPDVGHyUJmRV
LQFOXVLYHFDUGLRYDVFXODU
GLPLQXLomR GD H[SHFWDWLYD GH YLGD 9DOH D SHQD IRUQHFHU
HQGyFULQRUHQDO
DRVSDLVRVUHVXOWDGRVGR,0&MXQWDPHQWHFRPLQIRUPDo}HV PXVFXORHVTXHOpWLFRGLJHVWyULR
VREUH R LPSDFWR GD DOLPHQWDomR VDXGiYHO H GD DWLYLGDGH HSVLFROyJLFR,QGLFDPVH
ItVLFD SUHYHQomRGHWHFomRSUHFRFHH
PDQHMRDJUHVVLYRFRQIRUPHD
 QHFHVVLGDGH

,QWHUSUHWD©¥RGR,0&HPFULDQ©DV

*UXSR ,0&SDUDD,GDGH

$EDL[RGRSHVR RSHUFHQWLO

3HVRVDXG£YHO 'RRDRRSHUFHQWLO

6REUHSHVR 'RRDRRSHUFHQWLO

2EHVLGDGH ʞRSHUFHQWLO

Sinais vitais
Pressão arterial. $ KLSHUWHQVmR QD LQIkQFLD p PDLV FRPXP GR TXH VH DFUHGLWDYD H p LPSRUWDQWH
UHFRQKHFrODFRQILUPiODHWUDWiODGHPRGRDSURSULDGR

$V FULDQoDV SRGHP DSUHVHQWDU HOHYDo}HV GD SUHVVmR 8PDFDXVDPXLWRFRPXPGH

DUWHULDO GXUDQWH D SUiWLFD GH H[HUFtFLRV ItVLFRV FKRUR H DSDUHQWHKLSHUWHQVmRDUWHULDOp
DQVLHGDGH 4XDQGR R SURFHGLPHQWR p H[SOLFDGR H DQVLHGDGH³KLSHUWHQVmRGR
GHPRQVWUDGR FRP DQWHFHGrQFLD D PDLRULD GDV FULDQoDV MDOHFR´$³FDXVD´PDLV
IUHTXHQWHGHHOHYDomRGH
FRRSHUD 6H D SUHVVmR DUWHULDO HVWLYHU HOHYDGD QR LQtFLR SUHVVmRDUWHULDOHPFULDQoDV
XPD VHJXQGD DIHULomR SRGH VHU IHLWD DR ILQDO GR H[DPH SURYDYHOPHQWHpXPH[DPH
'HL[H D EUDoDGHLUD QR EUDoR GHVLQVXIODGD H UHSLWD D UHDOL]DGRGHPDQHLUD
DIHULomR PDLV WDUGH 2 DFKDGR GH QtYHLV WHQVLRQDLV LQDGHTXDGDPXLWDVYH]HVFRP
XPDEUDoDGHLUDGHWDPDQKR
HOHYDGRV WHP GH VHU FRQILUPDGR SRU DIHULo}HV
LQFRUUHWR
VXEVHTXHQWHV

8PDEUDoDGHLUDGHWDPDQKRDSURSULDGRpIXQGDPHQWDOSDUDGHWHUPLQDo}HVH[DWDVGDSUHVVmR
DUWHULDO QDV FULDQoDV $ EUDoDGHLUD GR HVILJPRPDQ{PHWUR GHYH VHU HVFROKLGD FRPR VH ID] QR
DGXOWR(ODGHYHVHUVXILFLHQWHPHQWHODUJDSDUDFREULUGRLVWHUoRVGDSDUWHVXSHULRUGREUDoRRXGD
SHUQD8PDEUDoDGHLUDPDLVHVWUHLWDHOHYDIDOVDPHQWHDOHLWXUDGHSUHVVmRDUWHULDOHQTXDQWRXPD
PDLV ODUJD GLPLQXL D SUHVVmR H SRGH LQWHUIHULU QR SRVLFLRQDPHQWR DGHTXDGR GR GLDIUDJPD GR
HVWHWRVFySLRVREUHDDUWpULD

1DVFULDQoDVDH[HPSORGRVDGXOWRVRSULPHLURVRPGH.RURWNRIILQGLFDDSUHVVmRVLVWyOLFDHR
SRQWR HP TXH R UXtGR GH .RURWNRII GHVDSDUHFH FRQVWLWXL D SUHVVmR GLDVWyOLFD ¬V YH]HV
SULQFLSDOPHQWHHPSUpHVFRODUHVJRUGXFKRVQmRpIiFLODXVFXOWDURVUXtGRVGH.RURWNRII1HVVDV
FLUFXQVWkQFLDV SRGHVH UHFRUUHU j SDOSDomR SDUD GHWHUPLQDU D SUHVVmR DUWHULDO VLVWyOLFD
OHPEUDQGRVH GH TXH D SUHVVmR VLVWyOLFD p DSUR[LPDGDPHQWH  PP+J PDLV EDL[D GR TXH QD
DXVFXOWD

8PD PDQHLUD UHODWLYDPHQWH LQH[DWD GH GHWHUPLQDU D 1DVFULDQoDVFRPRHPDGXOWRV

SUHVVmR p D ³LQVSHomR´ 2EVHUYH D DJXOKD GR PRVWUDGRU DVDIHULo}HVGHSUHVVmRDUWHULDO
RVFLODUPP+JDFLPDGDGHWHFomRGRUXtGRQDDXVFXOWD QDFR[DVmRDSUR[LPDGDPHQWH
PP+JDFLPDGDTXHODV
(PERUD HVVD WpFQLFD QmR VHMD D LGHDO jV YH]HV p D ~QLFD
REWLGDVQRPHPEURVXSHULRU
DOWHUQDWLYDTXDQGRDFULDQoDVHPH[HPXLWR 6HIRUHPLJXDLVRXPHQRUHV
GHYHVHVXVSHLWDUGHFRDUWDomR
 GDDRUWD

$KLSHUWHQVmRDUWHULDO
WUDQVLWyULDHPFULDQoDVSRGH
VHUSURYRFDGDSRUDOJXQV
PHGLFDPHQWRVGHXVRFRPXP
LQFOXVLYHRVSUHVFULWRVSDUD
WUDWDUDVPDSH[SUHGQLVRQD
HWUDQVWRUQRGHGpILFLWGH
DWHQomRHKLSHUDWLYLGDGH
7'$+SH[PHWLOIHQLGDWR

 $VFDXVDVGHKLSHUWHQVmR
DUWHULDOSHUVLVWHQWHQDLQIkQFLD
(P  R 1DWLRQDO +HDUW /XQJ DQG %ORRG ,QVWLWXWH¶V LQFOXHPKLSHUWHQVmRSULPiULD
1DWLRQDO +LJK 3UHVVXUH :RUNLQJ *URXS RQ +\SHUWHQVLRQ VHPHWLRORJLDVXEMDFHQWHH
KLSHUWHQVmRVHFXQGiULDFRP
&RQWURO LQ &KLOGUHQ DQG $GROHVFHQWV GHILQLX SUHVVmR HWLRORJLDFRQKHFLGD$VFDXVDV
QRUPDO QRUPDO DOWD H DOWD GD VHJXLQWH PDQHLUD FRP GHKLSHUWHQVmRDUWHULDO
PHGLGDVHPSHORPHQRVWUrVRFDVL}HVVHSDUDGDV VHFXQGiULDLQFOXHPGRHQoDV
UHQDLVHQGyFULQDVH
 QHXUROyJLFDVXVRGH
PHGLFDPHQWRVGURJDVLOtFLWDVH
 FDXVDVSVLFROyJLFDV

3UHVV¥RDUWHULDO
3UHVV¥RDUWHULDOVLVWµOLFDHRXGLDVWµOLFDP«GLDSDUD $HSLGHPLDGHREHVLGDGHLQIDQWLOWDPE«P
&DWHJRULDGHSUHVV¥RDUWHULDO
LGDGHVH[RHDOWXUD UHVXOWRXHPSUHYDO¬QFLDFUHVFHQWHGH
1RUPDO RSHUFHQWLO KLSHUWHQV¥RDUWHULDO

3U«KLSHUWHQVR 'RRSHUFHQWLODRRSHUFHQWLO 

+LSHUWHQVR !RSHUFHQWLO 

(VW£JLR 'RRSHUFHQWLODW«PP+JDFLPDGRRSHUFHQWLO 

(VW£JLR !RSHUFHQWLOPP+J 

$V FULDQoDV FRP KLSHUWHQVmR DUWHULDO GHYHP VHU EHP 7DPEpPpLPSRUWDQWHQmR

DYDOLDGDVSDUDGHWHUPLQDUDFDXVD1RFDVRGHODFWHQWHVH URWXODUHUUDGDPHQWHXPD
SUpHVFRODUHV JHUDOPHQWH p SRVVtYHO GHILQLU XPD FDXVD FULDQoDRXXPDGROHVFHQWH
HVSHFtILFD 8PD SURSRUomR FUHVFHQWH GH HVFRODUHV H FRPRSRUWDGRUGHKLSHUWHQVmR
DUWHULDOWHQGRHPYLVWDR
DGROHVFHQWHV FRQWXGR DSUHVHQWD KLSHUWHQVmR HVVHQFLDO RX HVWLJPDGRUyWXORRSRWHQFLDO
SULPiULD (P WRGRV RV FDVRV p LPSRUWDQWH UHSHWLU DV GHOLPLWDomRGHDWLYLGDGHVHRV
PHGLGDV SDUD UHGX]LU D SRVVLELOLGDGH GH TXH D HOHYDomR SRVVtYHLVHIHLWRVFRODWHUDLVGR
UHIOLWD D DQVLHGDGH ¬V YH]HV D UHSHWLomR GD PHGLGD QD WUDWDPHQWR
HVFRODpXPDIRUPDGHREWHUOHLWXUDVHPXPDPELHQWHPDLV
UHOD[DGR$KLSHUWHQVmRDUWHULDOHDREHVLGDGHFRPIUHTXrQFLDFRH[LVWHPQDVFULDQoDV

Pulso. $V IUHTXrQFLDV FDUGtDFDV H YDULDo}HV PpGLDV GR QRUPDO VmR PRVWUDGDV QR ER[H D VHJXLU
9HULILTXHDIUHTXrQFLDFDUGtDFDGXUDQWHV

)UHTX¬QFLDFDUG¯DFDP«GLDQDVFULDQ©DVHPUHSRXVR
,GDGH )UHTX¬QFLDP«GLD 9DULD©¥RGRLVGHVYLRVSDGU¥R $EUDGLFDUGLDVLQXVDO«DIUHTX¬QFLD
FDUG¯DFDESPSDUDFULDQ©DVFRP
DDQRV  D PHQRVGHDQRVHESPHP
FULDQ©DVFRPDDQRV

DDQRV  D 

DDQRV  D 
 

Frequência respiratória. $ IUHTXrQFLD GDV LQFXUV}HV &ULDQoDVFRPGRHQoDV

UHVSLUDWyULDV SRU PLQXWR YDULD GH  D  QR LQtFLR GD UHVSLUDWyULDVFRPR
LQIkQFLD GH  D  QR ILQDO GD LQIkQFLD H DWLQJH QtYHLV EURQTXLROLWHRXSQHXPRQLD
DSUHVHQWDPUHVSLUDomRUiSLGD
DGXOWRVSRUYROWDGRVDQRV
DWpDLQFXUV}HVSRU
PLQXWRPDVWDPEpPDXPHQWR
(P SUpHVFRODUHV REVHUYH RV PRYLPHQWRV GD SDUHGH GRWUDEDOKRUHVSLUDWyULRFRPR
WRUiFLFDGXUDQWHGRLVLQWHUYDORVGHVRXXPLQWHUYDORGH JUXQKLGRVEDWLPHQWRGHDVDV
 PLQ GH SUHIHUrQFLD DQWHV GH HVWLPXOiODV $ DXVFXOWD GRQDUL]RXXVRGHPXVFXODWXUD
GLUHWDGRWyUD[RXDFRORFDomRGRHVWHWRVFySLRjIUHQWHGD DFHVVyULD
ERFD WDPEpP VmR ~WHLV SDUD FRQWDU DV LQFXUV}HV
UHVSLUDWyULDV PDV DV PHGLGDV SRGHP ILFDU IDOVDPHQWH HOHYDGDV VH D FULDQoD ILFDU DJLWDGD 1R
HVFRODUXVHDVPHVPDVWpFQLFDVHPSUHJDGDVQRDGXOWR

2 SRQWR GH FRUWH FRPXPHQWH DFHLWR SDUD WDTXLSQHLD HP 2PHOKRUVLQDOItVLFRLVRODGR

FULDQoDV FRP PDLV GH  DQR GH LGDGH p D IUHTXrQFLD SDUDGHVFDUWDUSQHXPRQLDpD
UHVSLUDWyULDVXSHULRUDLQFXUV}HVUHVSLUDWyULDV DXVrQFLDGHWDTXLSQHLD

Temperatura.1DVFULDQoDVRVUHJLVWURVGHWHPSHUDWXUDQR &ULDQoDVFRPPHQRVGHDQRV
PHDWRDF~VWLFRVmRSUHIHUtYHLVSRLVSRGHPVHUREWLGRVGH GHLGDGHTXHDSUHVHQWDPXP
PDQHLUDUiSLGDHHVVHQFLDOPHQWHVHPGHVFRQIRUWR DVSHFWRGHGRHQoDPXLWRJUDYH
HIHEUHGHYHPVHUDYDOLDGDV
 TXDQWRjSRVVLELOLGDGHGH
VHSVHLQIHFomRXULQiULD
SQHXPRQLDRXRXWUDVLQIHFo}HV

JUDYHV

Pele
$SyV R SULPHLUR DQR GH YLGD DV WpFQLFDV GH H[DPH VmR DV PHVPDV XVDGDV QR DGXOWR YHMD R
&DStWXOR

Cabeça
1RH[DPHGDFDEHoDHGRSHVFRoRDMXVWHRH[DPHDRHVWiJLRGHFUHVFLPHQWRHGHVHQYROYLPHQWR
GDFULDQoD

0HVPRDQWHVGHWRFDUDFULDQoDREVHUYHFRPFXLGDGRRIRUPDWRGDFDEHoDVXDVLPHWULDHVH
H[LVWH IiFLHV DQRUPDO $ IiFLHV DQRUPDO SRGH Vy ILFDU HYLGHQWH HP XPD IDVH PDLV DGLDQWDGD GD
LQIkQFLD3RUWDQWRpHVVHQFLDORH[DPHFXLGDGRVRGRURVWRHGDFDEHoDGHTXDOTXHUFULDQoD
 ([LVWHP IiFLHV GLDJQyVWLFDV QD LQIkQFLD R 4XDGUR  1DVtQGURPHDOFRyOLFDIHWDO
)iFLHV GLDJQyVWLFDV QR SULPHLUR DQR GH YLGD H QD SRGHPVHUHQFRQWUDGDVIiFLHV
LQIkQFLD PRVWUD YiULDV TXH UHIOHWHP DQRUPDOLGDGHV DQRUPDO4XDGURH
PLFURFHIDOLDDVVLPFRPR
FURPRVV{PLFDV GHIHLWRV HQGyFULQRV GRHQoD FU{QLFD H
UHWDUGDPHQWRGR
RXWURVGLVW~UELRV GHVHQYROYLPHQWR

Olhos
2VGRLVFRPSRQHQWHVPDLVLPSRUWDQWHVGRH[DPHRFXODUHP 2HVWUDELVPRYHMDR4XDGUR
FULDQoDVSHTXHQDVGHWHUPLQDPVHH[LVWHROKDUFRQMXJDGRRX $QRUPDOLGDGHVGRVROKRV
VLPpWULFRRXWHVWDPDFXLGDGHYLVXDOHPFDGDROKR GDVRUHOKDVHGDERFDQDV
FULDQoDVH[LJHWUDWDPHQWRSRU
 RIWDOPRORJLVWD

Olhar conjugado.(PSUHJXHRVPpWRGRVGHVFULWRVQR&DStWXOR 7DQWRRHVWUDELVPRTXDQWRD

SDUDDGXOWRVSDUDDYDOLDURROKDUFRQMXJDGRRXDSRVLomR DQLVRPHWURSLDRFXODUROKRV
H R DOLQKDPHQWR GRV ROKRV H D IXQomR GD PXVFXODWXUD FRPHUURVGHUHIUDomR
VLJQLILFDWLYDPHQWHGLIHUHQWHV
H[WUDRFXODU2WHVWHGRUHIOH[ROXPLQRVRGDFyUQHDHRWHVWH
SRGHPSURYRFDUDPEOLRSLDRX
GHFREHUWXUDVmRHVSHFLDOPHQWH~WHLVQRVSUpHVFRODUHV UHGXomRGDYLVmRHPROKRVVHP
RXWURVSUREOHPDV$DPEOLRSLD
SRGHLQGX]LURVXUJLPHQWRGH
³ROKRSUHJXLoRVR´FRP
UHGXomRSHUPDQHQWHGD
DFXLGDGHYLVXDOTXDQGRQmRp
UHDOL]DGDDFRUUHomRSUHFRFH
HPJHUDODWpRVDQRV


2WHVWHGHFREHUWXUDFRYHUWHVWGRVROKRVSRGHVHUIHLWR $VIRUPDVFRPXQVGH

FRPRXPMRJRVROLFLWDQGRDRSUpHVFRODUSDUDROKDUSDUDR HVWUDELVPRQDVFULDQoDV
QDUL] GR H[DPLQDGRU H GL]HU VH HOH HVWi ULQGR RX QmR HQYROYHPGHVYLRKRUL]RQWDO
PDQWHQGRFREHUWRXPGRVROKRVGDFULDQoD QDVDO³HVR´RXWHPSRUDO
³H[R´(VWUDELVPRODWHQWH
³IRULD´RFRUUHTXDQGRD

SHVVRDURPSHDIL[DomR
HVWUDELVPRPDQLIHVWR
 ³WURSLD´RFRUUHVHP
LQWHUUXSomRHpGHWHFWDGRSHOR
 WHVWHGHFREHUWXUDFRYHUWHVW
GRVROKRV

 

Acuidade visual.3RGHQmRVHUSRVVtYHOGHWHUPLQDUDDFXLGDGH $UHGXomRGDDFXLGDGHYLVXDO

YLVXDOHPFULDQoDVFRPPHQRVGHDQRVTXHQmRFRQVLJDP WHPPDLRUSUREDELOLGDGHGH
LGHQWLILFDU GHVHQKRV HP XPD FDUWHOD SDUD H[DPH RFXODU RFRUUHUHPFULDQoDVQDVFLGDV
SUHPDWXUDVHQDTXHODVFRP
1HVVDVFULDQoDVRH[DPHPDLVVLPSOHVFRQVLVWHHPDYDOLDU
RXWURVWUDQVWRUQRV
D SUHIHUrQFLD GH IL[DomR UHFREULQGR GH IRUPD DOWHUQDGD QHXUROyJLFRVRXGH
FDGD XP GRV ROKRV D FULDQoD FRP YLVmR QRUPDO QmR IDUi GHVHQYROYLPHQWR
REMHomRPDVXPDFULDQoDFRPYLVmRUXLPHPXPGRVROKRV
IDUiREMHomRjRFOXVmRGRROKRERP(PWRGRVRVWHVWHVGH
DFXLGDGHYLVXDOpLPSRUWDQWHTXHRVGRLVROKRVPRVWUHPRPHVPRUHVXOWDGR

$FXLGDGHYLVXDO

,GDGH $FXLGDGH 4XDOTXHUGLIHUHQ©DQDDFXLGDGHYLVXDOHQWUHRV

ROKRVSH[¢HVTXHUGDH¢
PHVHV 2OKRVFRQYHUJHPRODFWHQWHEXVFDDOFDQ©DUREMHWRV GLUHLWD«DQRUPDO

PHVHV &HUFDGH 

0HQRVGHDQRV  

DQRVHDFLPD  

$ DFXLGDGH YLVXDO HP FULDQoDV FRP  DQRV RX PDLV HP 2GLVW~UELRYLVXDOPDLVFRPXP

JHUDO SRGH VHU WHVWDGD IRUPDOPHQWH FRP XPD FDUWHOD SDUD QDLQIkQFLDpDPLRSLD
H[DPH FRP XP GH GLYHUVRV RSWyWLSRV FDUDFWHUHV RX IDFLOPHQWHGHWHFWDGDXVDQGR
VtPERORV 8PD FULDQoD TXH QmR FRQKHoD DV OHWUDV RX RV VHHVWDWpFQLFDGHH[DPH
Q~PHURV GH PRGR FRQILiYHO SRGH VHU WHVWDGD XVDQGR
ILJXUDV VtPERORV RX D FDUWHOD GH ³(´ &RP R XVR GDV FDUWHODV GH ³(´ D PDLRULD GDV FULDQoDV
FRRSHUDGL]HQGRDYRFrHPTXHGLUHomRR(HVWiDSRQWDQGR

$OJXPDVFULDQoDVGHVHQYROYHP
DQRUPDOLGDGHVQDYLVmRGH
SHUWRTXHSRGHPUHVXOWDUHP
GLILFXOGDGHGHOHLWXUDFHIDOHLDH
SUREOHPDVHVFRODUHVDVVLP
FRPRGLSORSLDYLVmRGXSOD

Campos visuais. 2V FDPSRV YLVXDLV SRGHP VHU H[DPLQDGRV HP ODFWHQWHV H SUpHVFRODUHV SHTXHQRV
FRPDFULDQoDVHQWDGDQRFRORGRSDLRXGDPmH2VROKRVGHYHPVHUWHVWDGRVXPSRUYH]FRPR
RXWUR ROKR UHFREHUWR 0DQWHQKD D FDEHoD GD FULDQoD QD OLQKD PpGLD H WUDJD R REMHWR FRPR XP
EULQTXHGRSDUDRFDPSRYLVXDODSDUWLUGDSDUWHGHWUiVGDFULDQoD2PpWRGRQRJHUDOpLGrQWLFR
DRXVDGRHPDGXOWRVH[FHWRSHORIDWRGHYRFrWHUTXHID]HURH[DPHSDUHFHUXPDEULQFDGHLUDSDUD
VHXSDFLHQWH

Orelhas
2 H[DPH GR PHDWR DF~VWLFR H GR WtPSDQR PHPEUDQD WLPSkQLFD VHJXQGR D 7HUPLQRORJLD
$QDW{PLFD SRGH VHU GLItFLO HP FULDQoDV SHTXHQDV TXH ILFDP FRP PHGR SRU QmR FRQVHJXLUHP
REVHUYDURSURFHGLPHQWR&RPXPSRXFRGHSUiWLFDpSRVVtYHOGRPLQDUHVWDWpFQLFD,QIHOL]PHQWH
PXLWRV SUpHVFRODUHV SUHFLVDP VHU FRQWLGRV GXUDQWH HVWH H[DPH H HVWH p R PRWLYR SHOR TXDO HOH
GHYHVHUGHL[DGRSDUDRILQDO

$VRUHOKDVSRGHPVHUH[DPLQDGDVFRPDFULDQoDVHQWDGDQRFRORGHXPGRVSDLVVHDFULDQoD
QmRHVWLYHUPXLWRWHPHURVD9DOHDSHQDWUDQVIRUPDURH[DPHRWRVFySLFRHPXPDEULQFDGHLUDSRU
H[HPSORILQJLUTXHHVWiWHQWDQGRORFDOL]DUXPREMHWRLPDJLQiULRQDRUHOKDGDFULDQoDRXFRQYHUVDU
GH PDQHLUD EULQFDOKRQD SDUD GLPLQXLU R PHGR 3RGH YDOHU D SHQD SRVLFLRQDU FRP FXLGDGR R
HVSpFXORGRRWRVFySLRQRPHDWRDF~VWLFRH[WHUQRGHXPDGDVRUHOKDVHGHSRLVUHWLUiORSDUDTXH
DFULDQoDVHDFRVWXPHFRPRSURFHGLPHQWRDQWHVGHFRPHoDUGHIDWRDUHDOL]DURH[DPH

3HUJXQWHDRSDLRXjPmHTXDOVHULDDSUHIHUrQFLDHPUHODomRDRSRVLFLRQDPHQWRGDFULDQoDSDUD
H[DPH([LVWHPGXDVSRVLo}HVFRPXQV±FRPDFULDQoDGHLWDGDHFRQWLGDHFRPDFULDQoDVHQWDGD
QRFRORGRSDLRXGDPmH6HDFULDQoDIRUPDQWLGDHPGHF~ELWRGRUVDOVROLFLWHDRSDLRXjPmH
SDUDPDQWHURVEUDoRVHVWLFDGRVRXSUy[LPRVjVODWHUDLVGDFULDQoDSDUDUHVWULQJLURVPRYLPHQWRV
6HJXUH D FDEHoD H DIDVWH R WUDJR FRP XPD GDV PmRV H FRP D RXWUD VHJXUH R RWRVFySLR 6H D
FULDQoDHVWLYHUQRFRORGRSDLRXGDPmHDVSHUQDVGHODGHYHPVHUFRQWLGDVHQWUHDVSHUQDVGRSDL
RX GD PmH 2V SDLV SRGHP DMXGDU HQYROYHQGR R FRUSR GD FULDQoD FRP XP GRV EUDoRV H XVDQGR
RXWUREUDoRSDUDVHJXUDUDFDEHoD

Membranas timpânicas. 0XLWRV HVWXGDQWHV WrP GLILFXOGDGH HP YLVXDOL]DU D PHPEUDQD WLPSkQLFD GD
FULDQoD1RVSUpHVFRODUHVRPHDWRDF~VWLFRH[WHUQRpGLUHFLRQDGRSDUDFLPDHSDUDWUiVDSDUWLU
GDSDUWHH[WHUQDVHQGRSUHFLVRSX[DUDRUHOKDH[WHUQDSDUDFLPDSDUDIRUDHSDUDWUiVSDUDREWHUD
PHOKRUYLVmR6HJXUHDFDEHoDGDFULDQoDFRPXPDGDVPmRVDPmRHVTXHUGDVHYRFrIRUGHVWUR
HFRPDPHVPDPmRSX[HDRUHOKDH[WHUQD&RPDRXWUDPmRSRVLFLRQHRRWRVFySLR

'LFDVSDUDFRQGX]LURH[DPHRWRVFµSLFR

8VHRPHOKRU¤QJXORGRRWRVFµSLR

8VHRPDLRUHVS«FXORSRVV¯YHO

8PHVS«FXORPDLRUSHUPLWHPHOKRUYLVXDOL]D©¥RGDPHPEUDQDWLPS¤QLFD

8PHVS«FXORPHQRUSRGHQ¥RIRUQHFHUYHGD©¥RDGHTXDGDSDUDRRWRVFµSLRSQHXP£WLFR
 1¥RVHGHYHDSOLFDUPXLWDSUHVV¥RSRLVLVVRSRGHID]HUDFULDQ©DFKRUDUHJHUDUUHVXOWDGRVIDOVRSRVLWLYRVQDRWRVFRSLDSQHXP£WLFD

,QWURGX]DRHVS«FXORHQWUHHFPQRPHDWRDF¼VWLFR

,GHQWLILTXHSULPHLURRVPDUFRVGHUHIHU¬QFLD

‚VYH]HVRPHDWRDF¼VWLFRDVVHPHOKDVH¢PHPEUDQDWLPS¤QLFDQ¥RVHGHL[HHQJDQDU

9HULILTXHVHDPHPEUDQDWLPS¤QLFDHVW£DOWHUDGD

5HPRYDRFHUXPHVHHOHHVWLYHUEORTXHDQGRDYLV¥RFRPRXVRGH

&XUHWDVSO£VWLFDVHVSHFLDLV

8PFRWRQHWHFRPSRQWDSHTXHQDXPHGHFLGR

/DYDJHPGDVRUHOKDVQRFDVRGHHVFRODUHV

,QVWUXPHQWRVHVSHFLDLVTXHWDPE«PSRGHPVHUDGTXLULGRV

([LVWHPGRLVPRGRVGHVHJXUDURRWRVFySLRFRPRLOXVWUDPDVIRWRJUDILDVDVHJXLU

‡ 2 SULPHLUR PpWRGR FRVWXPD VHU XVDGR QRV DGXOWRV FRP R FDER GRRWRVFySLR DSRQWDQGR SDUD
FLPDRXODWHUDOPHQWHHQTXDQWRVHWUDFLRQDDRUHOKDH[WHUQD$SDUWHODWHUDOGDPmRTXHVHJXUDR
RWRVFySLR GHYH VHU DSRLDGD QD FDEHoD GD FULDQoD SDUD IRUQHFHU SURWHomR FRQWUD D
PRYLPHQWDomRV~ELWDGRSDFLHQWH

‡ $ VHJXQGD WpFQLFD p XVDGD SRU PXLWRV SHGLDWUDV HP IXQomR GR kQJXOR GLIHUHQWH GR PHDWR
DF~VWLFRQDVFULDQoDV6HJXUHRRWRVFySLRFRPRFDERDSRQWDQGRSDUDEDL[RQDGLUHomRGRVSpV
GDFULDQoDHVLPXOWDQHDPHQWHWUDFLRQHDDXUtFXOD6HJXUHDFDEHoDHWUDFLRQHDDXUtFXODSDUD
FLPDFRPXPDGDVPmRVHPDQWHQKDRRWRVFySLRQDRXWUDPmR

$RWLWHPpGLDDJXGDpXP
TXDGURFRPXPQDLQIkQFLD
8PDFULDQoDVLQWRPiWLFD
DSUHVHQWDWLSLFDPHQWH
PHPEUDQDWLPSkQLFDYHUPHOKD
HDEDXODGDFRPUHIOH[R
  OXPLQRVRIRVFRRXDXVHQWHH
UHGXomRGRPRYLPHQWRFRP
 XVRGDRWRVFRSLDSQHXPiWLFD
2EVHUYDVHWDPEpPPDWHULDO
 SXUXOHQWRSRUWUiVGD
PHPEUDQDWLPSkQLFD9HMDR
4XDGUR$QRUPDOLGDGHV

GRVROKRVGDVRUHOKDVHGD
ERFD2VLQWRPDPDLV~WLOSDUD
 UHDOL]DURGLDJQyVWLFRpDGRU
FDVRHVWHMDDVVRFLDGDDRV
 VLQDLVDFLPD

$SUHQGDDXVDURRWRVFySLRSQHXPiWLFRSDUDDXPHQWDUD ¬VYH]HVRFRUUHUXSWXUDGD
H[DWLGmR GR GLDJQyVWLFR GH RWLWH PpGLD HP FULDQoDV &RP PHPEUDQDWLPSkQLFDGXUDQWH
LVVR YRFr FRQVHJXH DYDOLDU D PRELOLGDGH GD PHPEUDQD RWLWHPpGLDDJXGDFRPVDtGD
GHSXVSHORPHDWRDF~VWLFR
WLPSkQLFDHQTXDQWRDXPHQWDRXGLPLQXLDSUHVVmRQRPHDWR
1HVVHVFDVRVQmRpSRVVtYHO
DF~VWLFR H[WHUQR DR DSHUWDU R EXOER GH ERUUDFKD GR HPJHUDOYLVXDOL]DUD
RWRVFySLRSQHXPiWLFR PHPEUDQDWLPSkQLFD

$PHPEUDQDWLPSkQLFDQmRVH
PRYHTXDQGRH[LVWHOtTXLGRQD
RUHOKDPpGLDRWLWHPpGLD
DVVRFLDGDDGHUUDPH

(PSULPHLUROXJDUYHULILTXHVHKiYD]DPHQWRVQRRWRVFySLRSQHXPiWLFRFRORFDQGRRGHGRVREUH
DH[WUHPLGDGHGRHVSpFXORHDSHUWDQGRREXOER2EVHUYHDSUHVVmRQREXOER'HSRLVLQWURGX]DR
HVSpFXORGHPRGRDJDUDQWLUXPDERDYHGDomRLVVRpFUXFLDOSRLVDYHGDomRLQVXILFLHQWHSRGH
SURGX]LUDFKDGRVIDOVRSRVLWLYRVIDOWDGHPRYLPHQWDomRGDPHPEUDQDWLPSkQLFD

4XDQGR VH LQWURGX] DU QR PHDWR DF~VWLFR QRUPDO D 3HUGDDXGLWLYDWHPSRUiULDH

PHPEUDQDWLPSkQLFDHVHXUHIOH[ROXPLQRVRPRYHPVHSDUD VLJQLILFDWLYDGXUDQWHYiULRV
GHQWUR 4XDQGR R DU p UHWLUDGR D PHPEUDQD WLPSkQLFD PHVHVSRGHDFRPSDQKDUDRWLWH
GHVORFDVH SDUD IRUD QD GLUHomR GR H[DPLQDGRU (VVH PpGLDFRPGHUUDPH
PRYLPHQWRGHYDLYpPGDPHPEUDQDWLPSkQLFDpjVYH]HV 1DRWLWHH[WHUQDPDVQmRQD
FRPSDUDGR DR GH XPD YHOD QiXWLFD TXH VH HQFKH 6H D RWLWHPpGLDRPRYLPHQWRGD
PHPEUDQD WLPSkQLFD QmR DSUHVHQWDU XP PRYLPHQWR RUHOKDH[WHUQDSURYRFDGRU
SHUFHSWtYHO TXDQGR YRFr LQWURGX] SUHVVmR SRVLWLYD RX
QHJDWLYD HQWmR p SURYiYHO TXH D FULDQoD DSUHVHQWH GHUUDPH GH RUHOKD PpGLD 8PD FULDQoD FRP
RWLWHPpGLDDJXGDSRGHUHFODPDUPXLWRGDPDQREUDSRUFDXVDGDGRUVHFXQGiULDjSUHVVmRGRDU

'HVORTXHFRPFXLGDGRHWUDFLRQHDRUHOKDH[WHUQD DQWHV 1DPDVWRLGLWHDJXGDDRUHOKD

H GXUDQWH R H[DPH RWRVFySLFR e IXQGDPHQWDO D LQVSHomR H[WHUQDSRGHSURMHWDUVHSDUD
FXLGDGRVD GD UHJLmR SRU WUiV GD RUHOKD H[WHUQD VREUH R IUHQWHHDUHJLmRVREUHRRVVR
PDVWRLGHILFDHULWHPDWRVD
RVVR PDVWRLGH (P PXLWDV XQLGDGHV GH VD~GH XWLOL]DVH
GRORURVDHHGHPDFLDGD
DWXDOPHQWHXPWLPSDQ{PHWURXPDSDUHOKRTXHGHWHUPLQDD
FRPSODFrQFLD GD PHPEUDQD WLPSkQLFD H DMXGD D
GLDJQRVWLFDUGHUUDPHQDRUHOKDPpGLD

Teste de audição formal. (PERUD VHMD QHFHVViULR XP WHVWH 3UpHVFRODUHVTXHQmRSDVVDP

IRUPDO GH DXGLomR SDUD GHWHFWDU FRP SUHFLVmR GHIHLWRV QHVVHVWHVWHVGHUDVWUHDPHQWR
DXGLWLYRV HP SUpHVFRODUHV YRFr SRGH UHDOL]DU XP WHVWH RXDSUHVHQWDPDWUDVRGDIDOD
GHYHPVHUVXEPHWLGRVDWHVWHV
JURVVHLURGHDXGLomRFRPXPWHVWHGDYR]VXVVXUUDGD3DUD
DXGLRPpWULFRV(VVDVFULDQoDV
ID]rOR ILTXH GH Sp SRU WUiV GD FULDQoD SDUD TXH HOD QmR SRGHPWHUGpILFLWVGHDXGLomR
FRQVLJDOHUVHXVOiELRVFXEUDXPGRVPHDWRVDF~VWLFRVGD RXWUDQVWRUQRVFHQWUDLVGR
FULDQoDHPRELOL]HRWUDJRXVDQGRXPPRYLPHQWRFLUFXODU SURFHVVDPHQWRDXGLWLYR
6XVVXUUH OHWUDV Q~PHURV RX XPD SDODYUD H SHoD j FULDQoD
SDUDUHSHWLODVHPVHJXLGDWHVWHDRXWUDRUHOKD(VVDWpFQLFDWHPVHQVLELOLGDGHHHVSHFLILFLGDGH
UHODWLYDPHQWHDOWDVTXDQGRFRPSDUDGDDRWHVWHIRUPDO

$WpGDVFULDQoDVHPLGDGH
HVFRODUDSUHVHQWDPSHUGD
DXGLWLYDSHORPHQRVOHYHRTXH
HQIDWL]DDLPSRUWkQFLDGR
UDVWUHDPHQWRDXGLWLYRDQWHVGR
LQJUHVVRQDHVFROD

 2VGRLVWLSRVGHSHUGDDXGLWLYD
TXHRFRUUHPQDLQIkQFLDVmR
 QHXURVVHQVRULDOHGHFRQGXomR

$VFDXVDVGHSHUGDDXGLWLYDGH
 FRQGXomRLQFOXHP
DQRUPDOLGDGHVFRQJrQLWDV
 WUDXPDWLVPRRWLWHPpGLD
UHFRUUHQWHHSHUIXUDomRGD
  PHPEUDQDWLPSkQLFD

$$PHULFDQ$FDGHP\RI3HGLDWULFVUHFRPHQGDTXHWRGDV $VFDXVDVGHSHUGDDXGLWLYD
DV FULDQoDV FRP PDLV GH  DQRV VHMDP VXEPHWLGDV D XP QHXURVVHQVRULDOLQFOXHP
WHVWH GH UDVWUHDPHQWR DF~VWLFR FRPSOHWR FRP R XVR GH LQIHFo}HVFRQJrQLWDV
KHUHGLWiULDVXVRGHIiUPDFRV
HTXLSDPHQWR SDGUmR &DVR YRFr UHDOL]H XP WHVWH GH
WySLFRVRWROyJLFRV
UDVWUHDPHQWR DF~VWLFR QmR GHL[H GH WHVWDU WRGD D JDPD WUDXPDWLVPRHDOJXPDV
DF~VWLFDLQFOXVLYHDIDL[DGDIDODD+]2ER[H LQIHFo}HVFRPRPHQLQJLWH
D VHJXLU PRVWUD XPD GDV FODVVLILFDo}HV SDUD IDL[DV
DXGLWLYDV

)DL[DVGHDXGL©¥RHPWHVWHVGHUDVWUHDPHQWRDF¼VWLFRIRUPDLV

$XGL©¥RQRUPDO DG%

3HUGDDXGLWLYDP«GLD DG%

3HUGDDXGLWLYDPRGHUDGD DG%

3HUGDDXGLWLYDJUDYH DG%

3HUGDDXGLWLYDSURIXQGD !G%

Nariz e seios paranasais

,QVSHFLRQH D SRUomR DQWHULRU GR QDUL] FRP XP HVSpFXOR 0XFRVDVQDVDLVSiOLGDVH
JUDQGH GR RWRVFySLR ,QVSHFLRQH DV PXFRVDV QDVDLV HGHPDFLDGDVVmRREVHUYDGDV
REVHUYDQGRVXDFRUHFRQGLomR9HULILTXHVHKiGHVYLRGR HPFULDQoDVFRPULQLWHDOpUJLFD
VHSWRQDVDOHSyOLSRV FU{QLFDSHUHQH

$ULQLWHSXUXOHQWDpFRPXPQDV
YLURVHVPDVSRGHLQWHJUDUR
FRQMXQWRGHVLQDLVHVLQWRPDV
GDVLQXVLWH

6HFUHomRQDVDOSXUXOHQWD
XQLODWHUDOHGHRGRUIpWLGRSRGH
VHUGHYLGDDXPFRUSRHVWUDQKR
 QDVDO(VVHTXDGURp
HVSHFLDOPHQWHFRPXPHPSUp
HVFRODUHVTXHWHQGHPD
FRORFDUREMHWRVHPTXDOTXHU
RULItFLRGRFRUSR

3yOLSRVQDVDLVVmR
FUHVFLPHQWRVFRPFRORUDomRGH
FDUQHREVHUYDGRVQRLQWHULRU
GDVQDULQDV&RVWXPDPVHU
DFKDGRVLVRODGRVSRUpPHP
 DOJXQVFDVRVLQWHJUDPXPD
VtQGURPH


2VVHLRVPD[LODUHVVmRREVHUYDGRVQDVUDGLRJUDILDVDRV &ULDQoDVFRPULQRUUHLD
DQRV GH LGDGH 2V VHLRV HVIHQRLGDLV DRV  H RV VHLRV SXUXOHQWDHPJHUDOXQLODWHUDO
IURQWDLV HQWUH  H  2V VHLRV SDUDQDVDLV GH FULDQoDV HTXHWDPEpPDSUHVHQWHP
FHIDOHLDGRUGHJDUJDQWDH
HVFRODUHV SRGHP VHU SDOSDGRV FRPR R GRV DGXOWRV j
KLSHUVHQVLELOLGDGHVREUHRV
SURFXUD GH GRU ORFDOL]DGD $ WUDQVLOXPLQDomR GRV VHLRV VHLRVSDUDQDVDLVSRGHPWHU
SDUDQDVDLV GH SUpHVFRODUHV WHP VHQVLELOLGDGH H VLQXVLWH
HVSHFLILFLGDGHEDL[DVSDUDRGLDJQyVWLFRGHVLQXVLWHRXGH
OtTXLGRQRVVHLRVSDUDQDVDLV

Boca e faringe
1RFDVRGHFULDQoDVDQVLRVDVRXPXLWRSHTXHQDVpPHOKRUGHL[DUHVWDSDUWHGRH[DPHSDUDRILQDO
SRLV HOD SRGH H[LJLU FRQWHQomR GD FULDQoD SHORV SDLV $ FULDQoD SHTXHQD H FRRSHUDWLYD SRGH
VHQWLUVHPDLVjYRQWDGHVHQWDGDQRFRORGRSDLRXGDPmHFRPRPRVWUDGRDGLDQWH

e PDLV SURYiYHO TXH FULDQoDV VDXGiYHLV FRRSHUHP FRP HVWD SDUWH GR H[DPH ItVLFR GR TXH DV
FULDQoDVDGRHQWDGDVVREUHWXGRVHHODVYLUHPRDEDL[DGRUGHOtQJXDRXMiWLYHUHPH[SHULrQFLDFRP
FROHWDGHPDWHULDOSDUDFXOWXUDGHRURIDULQJH

$ILJXUDDRODGRPRVWUDDOJXQVWUXTXHVSDUDFRQVHJXLUTXHDVFULDQoDVDEUDPDERFD$FULDQoD
TXH p FDSD] GH GL]HU ³DKKK´ HP JHUDO RIHUHFH XPD YLVmR VXILFLHQWH HPERUD EUHYH GD SDUWH
SRVWHULRUGDIDULQJHRTXHWRUQDGHVQHFHVViULRRXVRGRDEDL[DGRUGHOtQJXD

6HIRUQHFHVViULRXVDURDEDL[DGRUGHOtQJXDHPSXUUHRSDUDEDL[RHSX[HXPSRXFRSDUDIUHQWH
QD VXD SUySULD GLUHomR HQTXDQWR D FULDQoD GL] ³DKKK´ 7HQKD FXLGDGR SDUD QmR SRVLFLRQDU R
DEDL[DGRU GH OtQJXD PXLWR SDUD GHQWUR H SURYRFDU R UHIOH[R IDUtQJHR GH Y{PLWR ¬V YH]HV
FULDQoDVSHTXHQDVHDQVLRVDVSUHFLVDPVHUFRQWLGDVHFHUUDPRVGHQWHVHIHFKDPDERFD1HVVHV
FDVRV GHVOL]H FRP FXLGDGR R DEDL[DGRU GH OtQJXD HQWUH RV GHQWHV QD GLUHomR GD OtQJXD ,VVR
SHUPLWLUi TXH YRFr HPSXUUH D OtQJXD SDUD EDL[R RX GHVHQFDGHLH R UHIOH[R GH Y{PLWR R TXH
SHUPLWLUi XPD EUHYH ROKDGD QD SDUWH SRVWHULRU GD IDULQJH H QDV WRQVLODV /HPEUHVH GH TXH XPD
DERUGDJHPIURQWDOGLUHWDVHPSODQHMDPHQWRQRVGHQWHVGDIUHQWHVySRGHWHUPLQDUHPIUDFDVVRH
XPDEDL[DGRUGHOtQJXDTXHEUDGRVmRQHFHVViULRVSODQHMDPHQWRFXLGDGRVRHDDMXGDGRVSDLV

([DPLQH RVGHQWHV TXDQWR j VHTXrQFLD H j FURQRORJLD GH HUXSomR TXDQWLGDGH FDUDFWHUtVWLFDV

VLWXDomRHSRVLomR$VDQRUPDOLGDGHVGRHVPDOWHSRGHPUHIOHWLUGRHQoDORFDORXJHUDO

&RPRFRQVHJXLUTXHDFULDQ©DDEUDDERFDɫ9RF¬SRGHGL]HUɨ$KKKKKKKɩ"ɬ
7UDQVIRUPHLVVRHPXPMRJR

ɪ$JRUDYDPRVYHUVXDERFDɫ

ɪ9RF¬FRQVHJXHERWDUWRGDVXDO­QJXDSDUDIRUD"ɫ

ɪ$SRVWRTXHYRF¬Q¥RFRQVHJXHDEULUVXDERFDEHPDEHUWDɫ Cáries dentáriasV¥RRSUREOHPDGHVD¼GHPDLV

FRPXPQDVFULDQ©DV(ODVV¥RHVSHFLDOPHQWH
ɪ'HL[HPHYHURODGRGHGHQWURGHVHXVGHQWHVɫ SUHYDOHQWHVHPSRSXOD©·HVSREUHVHSRGHP
SURYRFDUSUREOHPDVDFXUWRHORQJRSUD]RV$V
ɪ6HU£TXHR0LFNH\HVW£DTXLGHQWUR"ɫ F£ULHVV¥RIDFLOPHQWHWUDW£YHLV

1¥RPRVWUHRDEDL[DGRUGHO¯QJXDDPHQRVTXHVHMDHVVHQFLDO

)D©DXPDGHPRQVWUD©¥RSULPHLURFRPXPLUP¥RPDLVYHOKRRXDW«FRPXPGRVSDLV

(ORJLHLQWHQVDPHQWHXPDSHTXHQDDEHUWXUDGDERFDHHVWLPXOHDFULDQ©DDDEULODPDLVHPDLV

,QVSHFLRQH FRP FXLGDGR RV GHQWHV GD DUFDGD VXSHULRU &iULHVGHQWiULDVVmR

FRPRPRVWUDGRQDIRWR(VVDpXPDORFDOL]DomRFRPXPGH SURYRFDGDVSRUDWLYLGDGH
EDFWHULDQD7HQGHPDRFRUUHU
FiULHV FDXVDGDV SHOR XVR GD PDPDGHLUD $ WpFQLFD PDLVHPFULDQoDVSHTXHQDV
PRVWUDGD QD IRWR GHQRPLQDGD ³OHYDQWDPHQWR GR OiELR´ DOLPHQWDGRVSRUPDPDGHLUDSRU
PXLWRWHPSR³FiULHVGD
IDFLOLWDDYLVXDOL]DomRGDVFiULHVGHQWiULDV PDPDGHLUD´9HMDQR4XDGUR
$QRUPDOLGDGHVGRV
GHQWHVGDIDULQJHHGR
SHVFRoRRVGLIHUHQWHVHVWiJLRV
GDVFiULHV

9LVXDOL]HDSDUWHLQWHUQDGRVGHQWHVVXSHULRUHVVROLFLWDQGRjFULDQoDTXHROKHSDUDRWHWRFRPD
ERFDEHPDEHUWD

2 ER[H D VHJXLU PRVWUD XP SDGUmR FRPXP GH HUXSomR 0DQFKDVQRVGHQWHVSRGHPVHU

GHQWiULD'HXPPRGRJHUDORVGHQWHVLQIHULRUHVLUURPSHP LQWUtQVHFDVRXH[WUtQVHFDV$V
XPSRXFRDQWHVGRVVXSHULRUHV PDQFKDVLQWUtQVHFDVSRGHPVHU
VHFXQGiULDVDRXVRGH
 WHWUDFLFOLQDDQWHVGRVDQRV
PDQFKDVDPDUHODVFLQ]DRX
FDVWDQKDV$VIRUPXODo}HV

FRQWHQGRIHUURPDQFKDV
SUHWDVHRIO~RUPDQFKD
 EUDQFDVmRH[HPSORVGH
PDQFKDVH[WUtQVHFDV$V
 PDQFKDVH[WUtQVHFDVSRGHPVHU
UHWLUDGDVMiDVLQWUtQVHFDVQmR
 SRGHPYHMDR4XDGUR
$QRUPDOLGDGHVGRVGHQWHVGD
 IDULQJHHGRSHVFRoR

7LSRVGHGHQWHVHLGDGHGHHUXS©¥R

 ,GDGHDSUR[LPDGDGHHUXS©¥R

7LSRGH'HQWHV 3ULP£ULRVPHVHV 3HUPDQHQWHVDQRV

,QFLVLYRFHQWUDO D D

 ,QFLVLYRODWHUDO D D

&DQLQRV D D

3ULPHLURVELF¼VSLGHV ɥ D

6HJXQGRVELF¼VSLGHV ɥ D

3ULPHLURVPRODUHV D D

6HJXQGRVPRODUHV D D

7HUFHLURVPRODUHV ɥ D

3HVTXLVHDVDQRUPDOLGDGHVGDSRVLomRGRVGHQWHV(VWDV 0iRFOXVmRHGHVDOLQKDPHQWR
LQFOXHP Pi RFOXVmR SURWUXVmR PD[LODU VREUHPRUGLGD H GRVGHQWHVSRGHPVHUGHYLGRV
SURWUXVmR PDQGLEXODU VXEPRUGLGD $V GXDV ~OWLPDV jSUiWLFDGHFKXSDURSROHJDU
SRGHPVHUKHUHGLWiULRVRX
SRGHP VHU GHPRQVWUDGDV SHGLQGRVH j FULDQoD TXH PRUGD
VHFXQGiULRVjSHUGDSUHPDWXUD
FRP IRUoD HQTXDQWR YRFr RX D FULDQoD DIDVWD RV OiELRV GHGHQWHVSULPiULRV
2EVHUYH D PRUGLGD YHUGDGHLUD (P FULDQoDV QRUPDLV RV
GHQWHV LQIHULRUHV ILFDP FRQWLGRV QR DUFR IRUPDGR SHORV
VXSHULRUHV

,QVSHFLRQH FRP FXLGDGR D OtQJXD LQFOXVLYH D SDUWH GH $QRUPDOLGDGHVFRPXQVLQFOXHP

EDL[R$PDLRULDGDVFULDQoDVFRORFDDOHJUHPHQWHDOtQJXD OtQJXDVDEXUURVDQDVYLURVHV
SDUDIRUDPRYHDGHXPODGRSDUDRXWURHPRVWUDDFRUGD OtQJXDJHRJUiILFDFRQJrQLWDH
OtQJXDHPIUDPERHVD
OtQJXDDFRUD]XOGDOtQJXDPRVWUDGDDGLDQWHpGHFRUUHQWH
HQFRQWUDGDQDHVFDUODWLQD
GDVEDODVFKXSDGDVSHODFULDQoD

$OJXQVSUpHVFRODUHV
DSUHVHQWDPIUrQXORGDOtQJXD
HQFXUWDGR$VFULDQoDVTXHWrP
³OtQJXDSUHVD´JUDYHSRGHPWHU
GLILFXOGDGHVGHIDOD6ROLFLWDVH
jFULDQoDTXHWRTXHFRPD
OtQJXDRSDODWRGXURSDUD
GLDJQRVWLFDUHVVHTXDGURTXH
FRVWXPDVHUIiFLOGHWUDWDU

$OtQJXDJHRJUiILFDJORVVLWH
 PLJUDWyULDpXPDFRQGLomR
EHQLJQDPDVSHUPDQHQWHQD
 TXDOXPDSDUWHGDOtQJXDWHP
DVSHFWRLQFRPXP


2EVHUYHRWDPDQKRDSRVLomRDVLPHWULDHDDSDUrQFLDGDVWRQVLODV2SLFRGHFUHVFLPHQWRGR
WHFLGR GDV WRQVLODV p HQWUH  H  DQRV YHMD D ILJXUD QR $IDULQJLWHHVWUHSWRFyFLFD
4XDGUR  $V GLPHQV}HV GDV WRQVLODV YDULDP SURYRFDWLSLFDPHQWHR
FRQVLGHUDYHOPHQWH HQWUH DV FULDQoDV H PXLWDV YH]HV VmR DSDUHFLPHQWRGH³OtQJXDHP
IUDPERHVD´H[VXGDWRVEUDQFRV
FODVVLILFDGDVHPXPDHVFDODGHDFRPGHQRWDQGR
RXDPDUHODGRVQDVWRQVLODVRX
IiFLOYLVLELOLGDGHHRHVSDoRHQWUHDVWRQVLODVHWRQVLODV QDSDUWHSRVWHULRUGDIDULQJH
TXHVHWRFDPQDOLQKDPpGLDTXDQGRDERFDILFDEHPDEHUWD SRVWHULRU~YXODYHUPHOKRYLYD
$VWRQVLODVQDVFULDQoDVPXLWDVYH]HVWrPXPDVSHFWRPDLV HSHWpTXLDVQRSDODWR
REVWUXWLYRGRTXHGHIDWRVmR

$V WRQVLODV LQIDQWLV FRVWXPDP DSUHVHQWDU FULSWDV 2GLDJQyVWLFRGHDEVFHVVR

SURIXQGDV HP VXDV VXSHUItFLHV H HVWDV IUHTXHQWHPHQWH WrP SHULWRQVLODUpVXJHULGRSHOR
FRQFUHo}HV EUDQFDV RX SDUWtFXODV GH DOLPHQWR HP VXDV DXPHQWRDVVLPpWULFRGDV
WRQVLODVHGHVORFDPHQWRODWHUDO
SURIXQGH]DV,VVRQmRLQGLFDGRHQoD
GD~YXOD


3HVTXLVH LQGtFLRV GH IHQGD SDODWLQD VXEPXFRVD FRPR $HSLJORWLWHDJXGDp

FKDQIUDGXUDVQDPDUJHPSRVWHULRUGRSDODWRGXURRX~YXOD DWXDOPHQWHUDUDQRV(8$HP
EtILGD&RPRDPXFRVDHVWitQWHJUDpIiFLOQmRSHUFHEHUR IXQomRGDLPXQL]DomRFRQWUD
+DHPRSKLOXVLQIOXHQ]DHWLSR%
GHIHLWRVXEMDFHQWH
eXPDFRQWUDLQGLFDomRDR
H[DPHGDIDULQJHHPIXQomR
 GRSRWHQFLDOGHHQJDVJRH
REVWUXomRODUtQJHD


0XLWR UDUDPHQWH H[DPLQDVH XPD FULDQoD FRP GRU GH 7UDTXHtWHEDFWHULDQDSRGH

JDUJDQWD H GLILFXOGDGH SDUD HQJROLU D VDOLYD H TXH ILFD SURYRFDUREVWUXomRGDVYLDV
VHQWDGD ULJLGDPHQWH HP XPD SRVLomR ³GH WULSp´ YHMD UHVSLUDWyULDV
&ULDQoD HP DQJ~VWLD UHVSLUDWyULD SiJLQD  SRU FDXVD
GDREVWUXomRGDJDUJDQWD1mRVHGHYHDEULUDERFDGHVVDFULDQoDSRLVpSRVVtYHOTXHHODWHQKD
HSLJORWLWHDJXGDRXREVWUXomRGHRXWUDHWLRORJLD

3UHVWH DWHQomR QDV FDUDFWHUtVWLFDV GD YR] GD FULDQoD 7RQVLOLWHSRGHVHUSURYRFDGD

'HWHUPLQDGDV DQRUPDOLGDGHV SRGHP PXGDU D WRQDOLGDGH H SRUEDFWpULDVFRPR
DVFDUDFWHUtVWLFDVGDYR] 6WUHSWRFRFFXVRXSRUYtUXV$
YR]GH³RYRQDERFD´p
 DFRPSDQKDGDSRUDXPHQWRGDV
WRQVLODVHH[VXGDWR

 $OWHUD©·HVGDYR]_'LFDVGHDQRUPDOLGDGHVVXEMDFHQWHV
$OWHUD©¥RGDYR] 3RVV¯YHODQRUPDOLGDGH 

)DODKLSHUQDVDODGD )HQGDSDODWLQDVXEPXFRVD

9R]DQDVDODGDPDLVURQFR +LSHUWURILDGHDGHQRLGH &RPDHSLGHPLDGHREHVLGDGHQDLQI¤QFLDK£

PXLWDVFULDQ©DVTXHURQFDPHW¬Papneia do
9R]URXFDPDLVWRVVH ,QIHF©¥RYLUDOFUXSH sono
ɪ2YRQDERFDɫ 7RQVLOLWH

8P KiOLWR DQRUPDO SRGH DMXGDU D FRQGX]LU D XP +DOLWRVHHPXPDFULDQoDSRGH

GLDJQyVWLFRHVSHFtILFR VHUFDXVDGDSRULQIHFomRGDV
YLDVUHVSLUDWyULDVVXSHULRUHVGD
 IDULQJHRXGDFDYLGDGHRUDO
FRUSRHVWUDQKRQRQDUL]
 GRHQoDGHQWiULDHUHIOX[R
JDVWUHVRIiJLFR


Pescoço
)LQGDDIDVHGHODFWHQWHDVWpFQLFDVXVDGDVSDUDH[DPLQDUR /LQIDGHQRSDWLDpHPJHUDO
SHVFRoRVmRDVPHVPDVTXHDVGRDGXOWR/LQIDGHQRSDWLDp VHFXQGiULDDLQIHFo}HVYLUDLVRX
LQFRPXPQRODFWHQWHSRUpPpPXLWRFRPXPQDLQIkQFLD2 EDFWHULDQDVYHMDR4XDGUR
$QRUPDOLGDGHVGRV
VLVWHPDOLQIiWLFRGDFULDQoDDWLQJHVHXiSLFHGHFUHVFLPHQWR
GHQWHVGDIDULQJHHGR
DRV  DQRV H RV OLQIRQRGRV FHUYLFDLV RX DPLJGDOLDQRV SHVFRoR
DWLQJHPXPSLFRHQWUHHDQRV

$JUDQGHPDLRULDGDVOLQIDGHQRSDWLDVHPFULDQoDVGHYH $SUREDELOLGDGHGHGRHQoD
VH D LQIHFo}HV HP JHUDO YLUDLV PDV FRP IUHTXrQFLD PDOLJQDDXPHQWDTXDQGRR
EDFWHULDQDVHDGRHQoDPDOLJQDHPERUDDGRHQoDPDOLJQD OLQIRQRGRWHPPDLVGHFPp
GXURRXIL[DGRjSHOHRXDR
VHMDPRWLYRGHSUHRFXSDomRSDUDPXLWRVSDLVeLPSRUWDQWH
WHFLGRVXEMDFHQWHRXVHMDQmR
GLIHUHQFLDU OLQIRQRGRV QRUPDLV GH OLQIRQRGRV DQRUPDLV RX pPyYHOHDFRPSDQKDVHGH
GHFLVWRVFRQJrQLWRVGRSHVFRoR VLQDLVVLVWrPLFRVJUDYHVFRPR
SHUGDGHSHVR
9HMDQDSiJLQDDILJXUDTXHPRVWUDDVORFDOL]Do}HV
DQDW{PLFDV WtSLFDV GRV OLQIRQRGRV H FLVWRV FRQJrQLWRV GR
SHVFRoR

9HULILTXH VH Ki PRELOLGDGH FHUYLFDO e LPSRUWDQWH (PSUpHVFRODUHVFRPSHVFRoRV

DVVHJXUDUVH HP TXDOTXHU FULDQoD GH TXH D QXFD HVWHMD SHTXHQRVSRGHVHUGLItFLO
OLYUHHVHMDIDFLOPHQWHPRYLPHQWDGDHPWRGDVDVGLUHo}HV GLIHUHQFLDURVOLQIRQRGRV
,VVRWHPHVSHFLDOLPSRUWkQFLDTXDQGRRSDFLHQWHPDQWpPD FHUYLFDLVSRVWHULRUHVEDL[RVGRV
FDEHoD VXVWHQWDGD GH PDQHLUD DVVLPpWULFD H TXDQGR Ki OLQIRQRGRVVXSUDFODYLFXODUHV
TXHTXDVHVHPSUHVmR
VXVSHLWD GH GRHQoD GR VLVWHPD QHUYRVR FHQWUDO FRPR DQRUPDLVHOHYDQWDPDVXVSHLWD
PHQLQJLWH GHGRHQoDPDOLJQD

1DV FULDQoDV D ULJLGH] GH QXFD FRQVWLWXL XP LQGLFDGRU 5LJLGH]GHQXFDpDUHVLVWrQFLD

PDLV FRQILiYHO GH LUULWDomR PHQtQJHD GR TXH R VLQDO GH DFHQWXDGDjPRYLPHQWDomRGD
%UXG]LQVN\RXRVLQDOGH.HUQLJ 3DUD GHWHFWDU ULJLGH] GH FDEHoDHPTXDOTXHUGLUHomR
6XJHUHLUULWDomRPHQtQJHDSRU
QXFD HP HVFRODUHV VROLFLWDVH j FULDQoD TXH VHQWH FRP RV
PHQLQJLWHVDQJUDPHQWRWXPRU
PHPEURV LQIHULRUHV HVWLFDGRV QD PHVD GH H[DPH RXRXWUDVFDXVDV(VVDV
1RUPDOPHQWHDVFULDQoDVGHYHPVHUFDSD]HVGHVHQWDUFRP FULDQoDVVmRH[WUHPDPHQWH
DV FRVWDV UHWLILFDGDV H WRFDU R TXHL[R QR WyUD[ 2V SUp LUULWiYHLVHGLItFHLVGHDFDOPDUH
HVFRODUHV SRGHP VHU SHUVXDGLGRV D IOH[LRQDU R SHVFRoR SRGHPHYLGHQFLDU
³LUULWDELOLGDGHSDUDGR[DO´±
TXDQGR VH SHGH D HOHV SDUD DFRPSDQKDU XP EULQTXHGR RX DXPHQWRGDLUULWDELOLGDGH
IHL[HGHOX]7DPEpPVHSRGHWHVWDUULJLGH]GHQXFDFRPD TXDQGRILFDPQRFROR
FULDQoDGHLWDGDQDPHVDGHH[DPHFRPRPRVWUDGRDRODGR
+DYHQGRLUULWDomRPHQtQJHDD
4XDVH WRGDV DV FULDQoDV FRP ULJLGH] GH QXFD HVWDUmR
FULDQoDDGRWDXPDSRVLomRGH
H[WUHPDPHQWHGRHQWHVLUULWiYHLVHGLItFHLVGHH[DPLQDU(P WULSpHQmRFRQVHJXHDVVXPLU
SDtVHVGHVHQYROYLGRVDLQFLGrQFLDGHPHQLQJLWHEDFWHULDQD XPDSRVLomRHUHWDSOHQDSDUD
FDLXHQRUPHPHQWHSRUFDXVDGDYDFLQDomR UHDOL]DUDPDQREUDTXHL[R
WyUD[

Tórax e pulmões
¬PHGLGDTXHDFULDQoDFUHVFHRH[DPHGHSXOPmRVHWRUQD 1DREVWUXomRGDVYLDV
VHPHOKDQWH DR GRV DGXOWRV $ FRRSHUDomR p FUXFLDO $ UHVSLUDWyULDVVXSHULRUHVFRPR
DXVFXOWDFRVWXPDVHUPDLVIiFLOVHDFULDQoDPDOSHUFHEHUR QRFUXSH
ODULQJRWUDTXHREURQTXLWH
TXHHVWiVHQGRIHLWRFRPRTXDQGRHODHVWiQRFRORGHXP
RFRUUHSURORQJDPHQWRGD
GRV SDLV 6H D FULDQoD HVWLYHU FRP PHGR GHL[H TXH HOD LQVSLUDomRDFRPSDQKDGRSRU
EULQTXH FRP R HVWHWRVFySLR DQWHV GH HQFRVWiOR QR WyUD[ RXWURVVLQDLVFRPRHVWULGRU
GHOD WRVVHRXURQFRV

$YDOLH D SURSRUomR UHODWLYD GH WHPSR JDVWR HP LQVSLUDU 1DREVWUXomRGDVYLDV

YHUVXV H[SLUDU $ UD]mR QRUPDO p GH FHUFD GH  $V UHVSLUDWyULDVLQIHULRUHVFRPR
LQVSLUDo}HV RX H[SLUDo}HV SURORQJDGDV FRQVWLWXHP XP QDDVPDDH[SLUDomRWRUQDVH
PDLVSURORQJDGDH
LQGtFLRGDORFDOL]DomRGDGRHQoD2JUDXGHSURORQJDPHQWR
IUHTXHQWHPHQWHDFRPSDQKDVH
HHVIRUoRRX³WUDEDOKRUHVSLUDWyULR´HVWiUHODFLRQDGRFRP GHVLELORV
DJUDYLGDGHGDGRHQoD

4XDQGRVHVROLFLWDDXPSUpHVFRODUTXH³UHVSLUHIXQGR´ 3QHXPRQLDHPSUpHVFRODUHV
pFRPXPHOHSUHQGHUDUHVSLUDomRFRPSOLFDQGRDLQGDPDLV FRVWXPDPDQLIHVWDUVHFRPR
D DXVFXOWD e PDLV IiFLO PDQWHU SUpHVFRODUHV UHVSLUDQGR IHEUHWDTXLSQHLDGLVSQHLDH
DXPHQWRGRHVIRUoR
QRUPDOPHQWH)DoDXPDGHPRQVWUDomRSDUDRVHVFRODUHVGH
UHVSLUDWyULR
FRPRUHVSLUDUGHPDQHLUDSURIXQGDHWUDQTXLOD7UDQVIRUPH
LVVRHPXPMRJR3DUDUHDOL]DUXPDPDQREUDGHH[SLUDomR (PERUDDVLQIHFo}HV
IRUoDGD VROLFLWH j FULDQoD TXH VRSUH DV YHODV GH XP EROR UHVSLUDWyULDVDOWDVFDXVDGDVSRU
YtUXVSRVVDPFRQIHULUDRV
LPDJLQiULR ODFWHQWHVSHTXHQRVXPDVSHFWR
GHGRHQoDJUDYHDVLQIHFo}HV
 UHVSLUDWyULDVDOWDVHPFULDQoDV
PDQLIHVWDPVHSHORVPHVPRV
 VLQDLVTXHQRVDGXOWRVH
JHUDOPHQWHKiERPHVWDGR
 JHUDOVHPVLQDLVGH
FRPSURPHWLPHQWRGDVYLDV
 UHVSLUDWyULDVLQIHULRUHV

$DVPDGDLQIkQFLDpXP
TXDGURH[WUHPDPHQWHFRPXP
QRPXQGRWRGR$VFULDQoDV
 FRPDVPDDJXGDDSUHVHQWDP
TXDGURVGHJUDYLGDGHV
YDULiYHLVHIUHTXHQWHPHQWH
HYLGHQFLDPRDXPHQWRGR
HVIRUoRUHVSLUDWyULR6LELORV
H[SLUDWyULRVHSURORQJDPHQWR
GDIDVHH[SLUDWyULDFDXVDGRV
SRUEURQFRVSDVPRUHYHUVtYHO
SRGHPVHUDXVFXOWDGRVVHPR
HVWHWRVFySLRHVmRHYLGHQWHVj
DXVFXOWD2VVLELORV
IUHTXHQWHPHQWHDFRPSDQKDP
2V HVFRODUHV WHQGHP D VHU FRRSHUDWLYRV FRP R H[DPH VHGHURQFRVLQVSLUDWyULRV
UHVSLUDWyULRHSRGHPDWpUHDOL]DUDVPDQREUDVGHDYDOLDomR SURYRFDGRVSHORVYtUXVTXH
GHVHQFDGHDUDPDDVPD
GR IUrPLWR RX GH HJRIRQLD YHMD SiJLQDV  D  ¬
PHGLGD TXH DV FULDQoDV FUHVFHP D DYDOLDomR FRPR D GR
HVIRUoRUHVSLUDWyULREDWLPHQWRGHDVDVGHQDUL]HURQFRVFRPHoDDWHUPHQRVXWLOLGDGHQDDQiOLVH
GH SDWRORJLD UHVSLUDWyULD 3DOSDomR SHUFXVVmR H DXVFXOWD WrP PDLRU LPSRUWkQFLD HP XP H[DPH
FXLGDGRVRGHWyUD[HSXOP}HV

$VFULDQoDVHPDQJ~VWLDUHVSLUDWyULDSRGHPDGRWDUD³SRVLomRGHWULSp´QDTXDOHODVVHLQFOLQDP
SDUDIUHQWHSDUDRWLPL]DUDSRWrQFLDVGDVYLDVUHVSLUDWyULDV(VVDPHVPDSRVLomRSRGHVHUFDXVDGD
SRUREVWUXomRIDUtQJHDGHVFULWDDQWHULRUPHQWH

&5,$1d$(0$1*Ò67,$5(63,5$7Ï5,$
Coração
2 H[DPH GR FRUDomR H GR VLVWHPD YDVFXODU HP ODFWHQWHV H $QRUPDOLGDGHVJHUDLVSRGHP
FULDQoDVpVHPHOKDQWHDRGRDGXOWRPDVRUHFRQKHFLPHQWR DXPHQWDUDSUREDELOLGDGHGH
GHTXHHODVWrPPHGRGHVXDLQFDSDFLGDGHGHFRRSHUDUH FDUGLRSDWLDFRQJrQLWDFRPR
HP PXLWRV FDVRV GH VHX GHVHMR GH EULQFDU WRUQD R H[DPH RFRUUHQDVtQGURPHGH'RZQ
RXQDVtQGURPHGH7XUQHU
PDLV IiFLO H PDLV SURGXWLYR e IXQGDPHQWDO XVDU R
FRQKHFLPHQWR GR HVWiJLR GH GHVHQYROYLPHQWR GH FDGD
FULDQoD 8PD FULDQoD GH  DQRV SRGH VHU PDLV IDFLOPHQWH H[DPLQDGD TXDQGR HOD HVWi GH Sp RX
VHQWDGDQRFRORGDPmHFRPRURVWRYROWDGRSDUDRRPEURGDPmHRXVHQGRVHJXUDGDFRQIRUPH
PRVWUDGRDQWHULRUPHQWH$RVSUpHVFRODUHVSRGHVHURIHUHFLGRXPEULQTXHGRSDUDVHJXUDUHPHP
FDGDPmR(OHVILFDPVHPVDEHUFRPRGHL[DUFDLURREMHWRHDVVLPILFDPVHPDVPmRVOLYUHVSDUD
HPSXUUiOR )DODU VHP SDUDU FRP R SUpHVFRODU DWUDL D DWHQomR H HOH FRPHoD D HVTXHFHU R TXH
YRFrHVWiID]HQGR3RGHVHSHUPLWLUTXHDSUySULDFULDQoDPRYDRHVWHWRVFySLR

Pressão arterial.$SUHVVmRDUWHULDOGHYHVHUDIHULGDQRVGRLV 1DFRDUWDomRGDDRUWDD

PHPEURVVXSHULRUHVHHPXPGRVPHPEURVLQIHULRUHVSHOR SUHVVmRDUWHULDOpPHQRUQRV
PHQRV XPD YH] DRV  D  DQRV GH LGDGH SDUD SHVTXLVDU PHPEURVLQIHULRUHVGRTXHQRV
VXSHULRUHV
SRVVtYHO FRDUWDomR GD DRUWD 'HSRLV GLVVR VRPHQWH p
SUHFLVRGHWHUPLQDUDSUHVVmRQREUDoRGLUHLWR

Sopros benignos.&ULDQoDVSUpHVFRODUHVHHPIDVHHVFRODUIUHTXHQWHPHQWHDSUHVHQWDPVRSURVYHMDD

ILJXUDQRER[HGDSiJLQD2PDLVFRPXPGHOHVVRSURGH6WLOOpXPVRSURSURWRGLDVWyOLFRD
PHVRGLDVWyOLFR YLEUDWyULR PXVLFDO JUDX ,,,,9 FRP VREUHWRQV P~OWLSORV ORFDOL]DGR QD ERUGD
HVWHUQDO HVTXHUGD LQIHULRU RX PpGLD H FRP IUHTXrQFLD WDPEpP p DXVFXOWDGR VREUH DV DUWpULDV
FDUyWLGDV $ FRPSUHVVmR GD DUWpULD FDUyWLGD JHUDOPHQWH SURYRFD R GHVDSDUHFLPHQWR GR VRSUR
SUHFRUGLDO (VVH VRSUR SRGH VHU H[WUHPDPHQWH YDULiYHO H ILFDU PDLV DFHQWXDGR TXDQGR R GpELWR
FDUGtDFRDXPHQWDFRPRRFRUUHQDIHEUHHQRH[HUFtFLR2VRSURGLPLQXLTXDQGRDFULDQoDSDVVD
GRGHF~ELWRGRUVDOSDUDDSRVLomRVHQWDGDHGHVWDSDUDDSRVLomRRUWRVWiWLFD

7DPEpPQRSUpHVFRODUHQRHVFRODUjVYH]HVpGHWHFWDGR 1RVSUpHVFRODUHVVRSURVVHP
XP ]XPELGR YHQRVR (VVH p XP VRP FRQWtQXR VXUGR H DVFDUDFWHUtVWLFDVUHFRQKHFtYHLV
VXDYHPDLVLQWHQVRQDGLiVWROHHDXVFXOWDGRORJRDEDL[RGD GRVWUrVVRSURVEHQLJQRVPDLV
FRPXQVSRGHPLQGLFDU
FODYtFXOD GLUHLWD (OH p FRPSOHWDPHQWH HOLPLQDGR SRU
PDQREUDV TXH DIHWDP R UHWRUQR YHQRVR FRPR ILFDU HP FDUGLRSDWLDVXEMDFHQWHHGHYHP
GHF~ELWR GRUVDO PXGDU D SRVLomR GD FDEHoD RX QD VHUPLQXFLRVDPHQWHDYDOLDGRV
SRUXPFDUGLRORJLVWDSHGLiWULFR
FRPSUHVVmR GD YHLD MXJXODU (OH WHP DV PHVPDV
FDUDFWHUtVWLFDV GRV UXtGRV UHVSLUDWyULRV H SRUWDQWR PXLWDV
YH]HVQHPpSHUFHELGR

$OJXQVVRSURVSDWROyJLFRV
GHQRWDWLYRVGHFDUGLRSDWLD
SRGHPVXUJLUDSyVDIDVHGH
ODFWHQWHHGXUDQWHDLQIkQFLD
2VH[HPSORVLQFOXHPHVWHQRVH
DyUWLFDHYDOYRSDWLDPLWUDO

2VRSURDXVFXOWDGRQDUHJLmRGDDUWpULDFDUyWLGDORJRDFLPDGDVFODYtFXODVpFRQKHFLGRFRPR
VRSUR FDURWtGHR e SURWRVVLVWyOLFR RX PHVRVVLVWyOLFR H GLVFUHWDPHQWH UXGH (P JHUDO p PDLV
LQWHQVR j HVTXHUGD H SRGH VHU DXVFXOWDGR LVRODGDPHQWH RX DVVRFLDGR DR VRSUR GH 6WLOO FRPR
GHVFULWRDQWHULRUPHQWH3RGHVHUWRWDOPHQWHHUUDGLFDGRSHODFRPSUHVVmRGDDUWpULDFDUyWLGD

/RFDOL]D©¥RHFDUDFWHU¯VWLFDVGHVRSURVFDUG¯DFRVEHQLJQRVHPFULDQ©DV
 ,GDGHW¯SLFD 1RPH &DUDFWHU¯VWLFDV 'HVFUL©¥RHORFDOL]D©¥R

*UDX,,,9,PXVLFDOYLEUDWµULR
0¼OWLSORVVREUHWRQV
3U«HVFRODURXLQ¯FLRGDIDVH
6RSURGH6WLOO 3URWRVVLVWµOLFRHPHVRVVLVWµOLFR
HVFRODU
%RUGDHVWHUQDOP«GLDLQIHULRUHVTXHUGD
)UHTXHQWHPHQWHWDPE«PK£VRSURFDURW¯GHR

3U«HVFRODURXLQ¯FLRGDIDVH
HVFRODU
3U«HVFRODUHGHSRLV
6XDYHVXUGRFRQW¯QXR
=XPELGRYHQRVR 0DLVLQWHQVRQDGL£VWROHVXEFODYLFXODU
3RGHVHUHOLPLQDGRSRUPDQREUDV
3URWRVVLVWµOLFRHPHVRVVLVWµOLFR
6RSURFDURW­GHR *HUDOPHQWHPDLVLQWHQVR¢HVTXHUGD
(OLPLQDGRSRUFRPSUHVV¥RFDURW¯GHD

BBBBBBBBBB
9HMDQRER[HGDS£JLQDDORFDOL]D©¥RHDVFDUDFWHU¯VWLFDVGRVVRSURVFDUG¯DFRVEHQLJQRVHPHVFRODUHVHDGROHVFHQWHV

Abdome
3UpHVFRODUHVTXHHVWHMDPFRPHoDQGRDDQGDUPXLWDVYH]HV 8PDEDUULJDH[FHVVLYDPHQWH
DSUHVHQWDP DEGRPH SURWXEHUDQWH PDLV HYLGHQWH TXDQGR SURWUXVDSRGHLQGLFDUPi
HOHVHVWmRGHSp2H[DPHSRGHVHJXLUDPHVPDRUGHPTXH DEVRUomRVHFXQGiULDDGRHQoD
QRVDGXOWRVH[FHWRSHODSRVVtYHOQHFHVVLGDGHGHGLVWUDLUD FHOtDFDILEURVHFtVWLFD
FRQVWLSDomRLQWHVWLQDORX
FULDQoDGXUDQWHRH[DPH DHURIDJLD

$ PDLRULD GDV FULDQoDV VHQWH FyFHJDV TXDQGR YRFr 8PTXDGURFRPXPGDLQIkQFLD

FRORFD D PmR QR DEGRPH GHODV GXUDQWH D SDOSDomR (VVD TXHRFDVLRQDOPHQWHSURYRFD
UHDomR WHQGH D GHVDSDUHFHU SULQFLSDOPHQWH VH YRFr SURWUXVmRGRDEGRPHpD
FRQVWLSDomRLQWHVWLQDO2
FRQYHUVDU FRP D FULDQoD RX FRORFDU D PmR LQWHLUD QD DEGRPHFRVWXPDVHUWLPSkQLFR
VXSHUItFLH DEGRPLQDO SRU DOJXQV PRPHQWRV VHP ID]HU jSHUFXVVmRHjVYH]HVp
QHQKXP PRYLPHQWR 1R FDVR GH FULDQoDV PXLWR VHQVtYHLV SRVVtYHOSDOSDUDVIH]HVQR
TXH FRQWUDHP D PXVFXODWXUD DEGRPLQDO FRPHFH R H[DPH LQWHVWLQRGXUDQWHRH[DPH
DEGRPLQDO
FRORFDQGR D PmR GD FULDQoD SRU EDL[R GD VXD 1R ILQDO p
SRVVtYHOUHWLUDUDPmRGDFULDQoDHSDOSDUFRPOLEHUGDGHR
DEGRPH

9RFr SRGH WDPEpP WHQWDU IOH[LRQDU RV MRHOKRV H RV 'RUDEGRPLQDOFU{QLFDRX

TXDGULVSDUDUHOD[DUDSDUHGHDEGRPLQDOGDFULDQoDFRPR UHFRUUHQWHpUHODWLYDPHQWH
PRVWUDGRDVHJXLU3ULPHLURSDOSHVXSHUILFLDOPHQWHWRGDVDV FRPXPQDLQIkQFLD$VFDXVDV
LQFOXHPFRQGLo}HVIXQFLRQDLVH
UHJL}HV H GHSRLV SURIXQGDPHQWH GHL[DQGR RV ORFDLV FRP
FRQGLo}HVRUJkQLFDV
SRVVtYHOSDWRORJLDSRU~OWLPR

&RQGLo}HVIXQFLRQDLVTXH
SURYRFDPGRUDEGRPLQDO
LQFOXHPVtQGURPHGRLQWHVWLQR
LUULWiYHOGLVSHSVLDIXQFLRQDOH
VtQGURPHGHGRUDEGRPLQDO
IXQFLRQDOQDLQIkQFLD

$VFDXVDVRUJkQLFDVGHGRU
DEGRPLQDOFU{QLFDRX
UHFRUUHQWHHPFULDQoDVLQFOXHP
JDVWULWHRX~OFHUDUHIOX[R
JDVWUHVRIiJLFRFRQVWLSDomR
LQWHVWLQDOHGRHQoDLQIODPDWyULD
 LQWHVWLQDO

0XLWDVFULDQoDVDSUHVHQWDPGRU
'LPHQV·HVHVSHUDGDVGRI¯JDGRHPFULDQ©DV¢SHUFXVV¥R DEGRPLQDOHVSRQWkQHDSRU
FDXVDGHJDVWUHQWHULWHDJXGD
$SHVDUGDGRURH[DPHItVLFRp
UHODWLYDPHQWHQRUPDOH[FHWR
SHORDXPHQWRGDSHULVWDOVHj
DXVFXOWDHSRUGRUGLVFUHWDj
SDOSDomR

 'LPHQV¥RHVWLPDGDP«GLDGRI¯JDGRFP
 ,GDGHHP$QRV 0HQLQRV 0HQLQDV

   $HSLGHPLDGHREHVLGDGHQDLQI¤QFLD

SURYRFRXRVXUJLPHQWRGHabdomes
   extremamente obesosHPPXLWDV
FULDQ©DV(PERUDVHMDGLI¯FLOH[DPLQDU
  
FRPDFXU£FLDHVVDVFULDQ©DVDVHWDSDV
   GRH[DPHV¥RLG¬QWLFDV¢VGHFULDQ©DV
QRUPDLV
  

  

  

8P GRV PpWRGRV SDUD GHWHUPLQDU D SRVLomR GD ERUGD +HSDWRPHJDOLDHPFULDQoDV

KHSiWLFD LQIHULRU p R WHVWH GD HVFDULILFDomR VFUDWFK WHVW SHTXHQDVQmRpFRPXP3RGH
PRVWUDGR D VHJXLU 2 H[DPLQDGRU FRORFD R GLDIUDJPD GR VHUSURYRFDGDSRUILEURVH
HVWHWRVFySLRORJRDFLPDGRUHERUGRFRVWDOGLUHLWRQDOLQKD FtVWLFDPiDEVRUomRGH
SURWHtQDVSDUDVLWRVHWXPRUHV
KHPLFODYLFXODU OLQKD PHGLRFODYLFXODU VHJXQGR D
7HUPLQRORJLD $QDW{PLFD &RP D XQKD DUUDQKDQGR
VXDYHPHQWH D SHOH GR DEGRPH DFRPSDQKH D OLQKD KHPLFODYLFXODU LQGR GD UHJLmR DEDL[R GR
XPELJRHPGLUHomRDRUHERUGRFRVWDO4XDQGRRGHGRTXHID]HVVHPRYLPHQWRDWLQJLUDERUGDGR
ItJDGRVHUiDXVFXOWDGDXPDPXGDQoDQRVRPSDVVDQGRDWUDYpVGRItJDGRDWpRHVWHWRVFySLR

6HDKHSDWRPHJDOLDIRU
DFRPSDQKDGDSRU
HVSOHQRPHJDOLDGHYHPVH
FRQVLGHUDUKLSHUWHQVmRSRUWDO
GRHQoDVGHDUPD]HQDPHQWR
2 EDoR D H[HPSOR GR ItJDGR p IDFLOPHQWH SDOSiYHO QD LQIHFo}HVFU{QLFDVHGRHQoDV
PDOLJQDV
PDLRULDGDVFULDQoDV6XDFRQVLVWrQFLDWDPEpPpPROHFRP
D ERUGD EHP GHILQLGD H SURMHWDVH SDUD EDL[R FRPR XPD 'LYHUVDVGRHQoDVSRGHP
OtQJXDDSDUWLUGRUHERUGRFRVWDOLQIHULRU2EDoRpPyYHO SURYRFDUHVSOHQRPHJDOLD
H GLILFLOPHQWH VH HVWHQGH SRU PDLV GH  D  FP DEDL[R GR LQFOXVLYHLQIHFo}HVSURFHVVRV
KHPDWROyJLFRVFRPRDQHPLDV
UHERUGRFRVWDO KHPROtWLFDVSURFHVVRV
LQILOWUDWLYRVHGRHQoDV
 LQIODPDWyULDVRXDXWRLPXQHV
EHPFRPRFRQJHVWmRSRU
 KLSHUWHQVmRSRUWDO


 

3DOSH DV RXWUDV HVWUXWXUDV DEGRPLQDLV 1mR p UDUR 0DVVDDEGRPLQDOGHVFREHUWDj

REVHUYDU SXOVDo}HV QR HSLJiVWULR SURYRFDGDV SHOD DRUWD SDOSDomRSRGHVHUIH]HVSRU
(VVDVVmRPDLVIiFHLVGHVHQWLUjHVTXHUGDGDOLQKDPpGLD FDXVDGHFRQVWLSDomRLQWHVWLQDO
RXXPDFRQGLomRJUDYHFRPR
jSDOSDomRSURIXQGD
XPWXPRU

$ SHVTXLVD GH GRU j SDOSDomR GR DEGRPH QR HVFRODU p 1DFULDQoDFRPDEGRPHDJXGR

LGrQWLFD j GRV DGXOWRV HQWUHWDQWR DV FDXVDV GH GRU FRPRQDDSHQGLFLWHDJXGD
DEGRPLQDO FRVWXPDP VHU GLIHUHQWHV H FRPSUHHQGHP XP YHULILTXHVHKiULJLGH]
LQYROXQWiULDGHVFRPSUHVVmR
DPSOR HVSHFWUR GH GRHQoDV DJXGDV H FU{QLFDV $
GRORURVDVLQDOGH5RYVLQJH
ORFDOL]DomR GD GRU j SDOSDomR SRGH DMXGDU D GHILQLU DV VLQDOGRSVRDVRXREWXUDGRU
FDXVDVPDLVSURYiYHLV SRVLWLYRYHMDSiJLQDVH
*DVWUHQWHULWH
 FRQVWLSDomRLQWHVWLQDOH
REVWUXomRJDVWULQWHVWLQDO
 SRGHPVHUDVFDXVDV

Genitália masculina
,QVSHFLRQH R SrQLV 2 WDPDQKR DQWHV GD SXEHUGDGH WHP 1DSXEHUGDGHSUHFRFHYHULILFD
SRXFDLPSRUWkQFLDDPHQRVTXHVHMDDQRUPDOPHQWHJUDQGH VHRDXPHQWRGRSrQLVHGRV
(PPHQLQRVREHVRVRFR[LPJRUGXURVRSRUVREUHDVtQILVH WHVWtFXORVDOpPGHVLQDLVGH
PXGDQoDVDVVRFLDGDVj
S~ELFDSRGHREVFXUHFHURSrQLV
SXEHUGDGH(VWHpXPTXDGUR
FDXVDGRSRUYiULDVDIHFo}HV
$SDOSDomRGRHVFURWRHGRVWHVWtFXORVGHSUpHVFRODUHV DVVRFLDGDVDH[FHVVRGH
GHPDQGD KDELOLGDGH SRLV PXLWRV DSUHVHQWDP XP UHIOH[R DQGURJrQLRVLQFOXVLYHWXPRUHV
FUHPDVWpULFR H[WUHPDPHQWH DWLYR TXH SURYRFD D UHWUDomR GDVJOkQGXODVVXSUDUUHQDLVRX
GR WHVWtFXOR SDUD FLPD SDUD GHQWUR GR FDQDO LQJXLQDO ,VVR GDKLSyILVH7DPEpPSRGHP
RFRUUHURXWUDVDOWHUDo}HVGD
SRGHULDOHYDQWDUXPGLDJQyVWLFRLQFRUUHWRGHFULSWRUTXLGLD
SXEHUGDGH
2 PHQLQR GHYH VHU H[DPLQDGR TXDQGR HVWLYHU UHOD[DGR
SRLV D DQVLHGDGH HVWLPXOD R UHIOH[R FUHPDVWpULFR &RP DV
PmRV DTXHFLGDV SDOSDVH D UHJLmR LQIHULRU GR DEGRPH HYROXLQGR SDUD EDL[R QD GLUHomR GR
HVFURWRDRORQJRGRFDQDOLQJXLQDO,VVRPLQLPL]DDUHWUDomRGRVWHVWtFXORVSDUDRFDQDO

8PD WpFQLFD ~WLO p SHGLU DR PHQLQR TXH FUX]H DV SHUQDV 1HVVDLGDGHSRGHVHU
QD PHVD GH H[DPH FRPR PRVWUDGR DTXL 2 H[DPLQDGRU REVHUYDGDFULSWRUTXLGLDTXH
WDPEpPSRGHGDUDHOHXPEDOmRSDUDHQFKHURXXPREMHWR H[LJHFRUUHomRFLU~UJLFDHGHYH
VHUGLIHUHQFLDGDGHWHVWtFXOR
SDUDOHYDQWDUSURYRFDQGRDVVLPDXPHQWRGDSUHVVmRLQWUD
UHWUiWLO
DEGRPLQDO 6H IRU HQFRQWUDGR R WHVWtFXOR QR HVFURWR HOH
WHUi GHVFLGR PHVPR VH SDVVDU JUDQGH SDUWH GR WHPSR QR 'RUXQLODWHUDOQRWHVWtFXOR
FDQDOLQJXLQDO H[LJHWUDWDPHQWRUiSLGRDV
FDXVDVFRPXQVLQFOXHP
LQIHFo}HVFRPRHSLGLGLPLWHRX
RUTXLWHWRUomRGHWHVWtFXORRX
WRUomRGRDSrQGLFHWHVWLFXODU

e SRVVtYHO WHVWDU R UHIOH[R FUHPDVWpULFR HVIUHJDQGR DV 0DVVDHVFURWDOLQGRORUHPXP

XQKDVQDIDFHPHGLDOGDFR[D2WHVWtFXORGRODGRTXHHVWi PHQLQRSHTXHQRFRQVLVWH
VHQGRHVWLPXODGRGHVORFDVHSDUDFLPD KDELWXDOPHQWHHPKLGURFHOHRX
KpUQLDLQJXLQDOQmR
 HQFDUFHUDGD&DXVDVUDUDV
LQFOXHPYDULFRFHOHRXXP
WXPRU


([DPLQHRFDQDOLQJXLQDOFRPRQRVDGXOWRVSHVTXLVDQGR +pUQLDVLQJXLQDLVHPHVFRODUHV
WXPHIDomR TXH SRVVD UHIOHWLU KpUQLD LQJXLQDO 6ROLFLWH DR PDQLIHVWDPVHFRPRQRV
PHQLQR TXH DXPHQWH D SUHVVmR DEGRPLQDO FRPR GHVFULWR KRPHQVDGXOWRVSRUWXPHIDomR
QRFDQDOLQJXLQDOTXHVH
DQWHULRUPHQWH H REVHUYH VH R DEDXODPHQWR QR FDQDO
DFHQWXDFRPDPDQREUDGH
LQJXLQDODXPHQWD 9DOVDOYD

Genitália feminina
2 H[DPH JHQLWDO SRGH SURYRFDU DQVLHGDGH QDV HVFRODUHV H 2VXUJLPHQWRGHSHORVS~ELFRV
QDV DGROHVFHQWHV SULQFLSDOPHQWH VH R H[DPLQDGRU IRU GR DQWHVGRVDQRVGHYHVHU
VH[R PDVFXOLQR DVVLP FRPR QRV SDLV (QWUHWDQWR TXDQGR FRQVLGHUDGRLQGLFDWLYRGH
HOH QmR p UHDOL]DGR SRGHVH GHL[DU GH SHUFHEHU VLQDLV SXEHUGDGHSUHFRFHHH[LJH
LQYHVWLJDomRSDUDGHWHUPLQDUD
VLJQLILFDWLYRV'HSHQGHQGRGDIDVHGHGHVHQYROYLPHQWRGD FDXVD
FULDQoD H[SOLTXH DV SDUWHV GR FRUSR TXH H[DPLQDUi H TXH
LVVRLQWHJUDRH[DPHGHURWLQD

$SyV R SULPHLUR DQR GH YLGD RV OiELRV PDLRUHV H (UXSo}HVQDJHQLWiOLDH[WHUQD

PHQRUHV GR SXGHQGR FRVWXPDP DFKDWDUVH D PHPEUDQD SRGHPWHUGLYHUVDVFDXVDV
KLPHQDOILFDILQDWUDQVO~FLGDHYDVFXODUHVXDVERUGDVVmR FRPRLUULWDomRItVLFDVXGRUHVH
HLQIHFo}HVSRU&DQGLGDRX
IDFLOPHQWHLGHQWLILFDGDV
EDFWpULDVLQFOXVLYHSRU
HVWDILORFRFRV


2 H[DPH JHQLWDO p R PHVPR HP WRGDV DV FULDQoDV GHVGH R ILP GD IDVH GH ODFWHQWH DWp D
DGROHVFrQFLD$DERUGDJHPGHYHVHUWUDQTXLODHJHQWLOHLQFOXLUXPDH[SOLFDomRDSURSULDGDSDUDR
HVWiJLRGHGHVHQYROYLPHQWRGDFULDQoDDRID]HURH[DPH8PDIRQWHGHOX]LQWHQVDpIXQGDPHQWDO
$PDLRULDGDVFULDQoDVSRGHVHUH[DPLQDGDHPGHF~ELWRGRUVDOQDSRVLomRGHUm

6HDFULDQoDUHOXWDUYDOHDSHQDVROLFLWDUDRSDLRXjPmH 3UXULGRHHULWHPDYXOYRYDJLQDLV
TXH VH VHQWH j PHVD GH H[DPH FRP D FULDQoD 8PD SRGHPVHUFDXVDGRVSRU
DOWHUQDWLYD FRQVLVWLULD HP UHDOL]DU R H[DPH FRP D FULDQoD DJHQWHVWySLFRVLUULWDWLYRVVDLV
GHEDQKRDWLYLGDGH
VHQWDGD QR FROR GRV SDLV 1mR VH GHYH XVDU HVWULERV SRLV
PDVWXUEDWyULD7ULFKXULV
HOHVSRGHPDVVXVWDUDFULDQoD2GLDJUDPDDVHJXLUPRVWUD WULFKLXUDLQIHFomRSRU&DQGLGD
XPD FULDQoD GH  DQRV VHQWDGD QR FROR GD PmH FRP HOD RXGRHQoDVVH[XDOPHQWH
VHJXUDQGRRVMRHOKRVHVWLFDGRV WUDQVPLVVtYHLV

([DPLQH D JHQLWiOLD GH PRGR HILFLHQWH H VLVWHPiWLFR

,QVSHFLRQHDJHQLWiOLDH[WHUQDjSURFXUDGHSHORVS~ELFRVRWDPDQKRGRFOLWyULVDFRUHRWDPDQKR
GRVOiELRVPDLRUHVGRSXGHQGRHYHULILTXHVHKiHUXSo}HVHTXLPRVHVRXRXWUDVOHV}HV

$ VHJXLU VmR YLVXDOL]DGDV DV HVWUXWXUDV PHGLDQWH R 6HFUHomRYDJLQDOQRVSULPHLURV

DIDVWDPHQWR FRP RV GHGRV GRV OiELRV GR SXGHQGR FRPR DQRVGHYLGDSRGHVHUGHYLGDj
PRVWUDGRDGLDQWH7DPEpPSRGHVHUDSOLFDGDWUDomRVXDYH LUULWDomRSHULQHDOSH[
HVSXPDSDUDEDQKRRX
VHJXUDQGR RV OiELRV GR SXGHQGR HQWUH RV SROHJDUHV H RV
VDERQHWHFRUSRVHVWUDQKRV
LQGLFDGRUHV GH FDGD PmR H VHSDUDQGR ODWHUDO H YDJLQLWHRXGRHQoD
SRVWHULRUPHQWH RV OiELRV PDLRUHV GR SXGHQGR SDUD VH[XDOPHQWHWUDQVPLVVtYHOSRU
DEXVRVH[XDO
H[DPLQDUDVHVWUXWXUDVLQWHUQDVFRPRPRVWUDGRDVHJXLUj
GLUHLWD $V DGHUrQFLDV ODELDLV RX D IXVmR GRV OiELRV 6DQJUDPHQWRYDJLQDOVHPSUHp
PHQRUHVGRSXGHQGRSRGHPVHUQRWDGDVHPFULDQoDVDQWHV PRWLYRGHSUHRFXSDomR$V
HWLRORJLDVLQFOXHPLUULWDomR
GD SXEHUGDGH H GLILFXOWDU D YLVXDOL]DomR GD YDJLQD H GD
YDJLQDOWUDXPDWLVPRDFLGHQWDO
XUHWUD,VWRFRUUHVSRQGHDXPDYDULDQWHQRUPDO DEXVRVH[XDOFRUSRHVWUDQKRH
WXPRUHV$SXEHUGDGHSUHFRFH
 SRGHLQGX]LUPHQVWUXDomRHP
PHQLQDVSHTXHQDV


6HFUHomRSXUXOHQWDSURIXVD
IpWLGDHFRPUDLRVGHVDQJXH
GHYHVHUDYDOLDGDSDUD
GLDJQRVWLFDULQILOWUDomRFRUSR
HVWUDQKRRXWUDXPDWLVPR

2EVHUYHRVOiELRVPHQRUHVGRSXGHQGRDXUHWUDRKtPHQ 2DEXVRVH[XDOLQIHOL]PHQWHp
HDSDUWHSUR[LPDOGDYDJLQD6HQmRIRUHPYLVXDOL]DGDVDV PXLWRFRPXPQRPXQGR$Wp
ERUGDV GR KtPHQ VROLFLWH j FULDQoD TXH UHVSLUH IXQGR QR GDVPXOKHUHVUHODWDP
DEXVRVH[XDOHPERUDPXLWRV
LQWXLWR GH UHOD[DU D PXVFXODWXUD DEGRPLQDO 8PD RXWUD
HSLVyGLRVQmRHQYROYDP
WpFQLFD~WLOpSRVLFLRQDUDFULDQoDHPSRVLomRJHQXSHLWRUDO WUDXPDWLVPRItVLFRJUDYHHP
FRPR PRVWUDGR j GLUHLWD (VVDV PDQREUDV DEUHP FRP DOJXQVFDVRVLVVRRFRUUH
IUHTXrQFLD R KtPHQ 7DPEpP SRGHP VHU XVDGDV JRWDV GH
VROXomR VDOLQD SDUD GLPLQXLU D DGHUrQFLD GDV ERUGDV GR
KtPHQ
 1mRVHGHYHWRFDUQDVPDUJHQVKLPHQDLVSRLVRKtPHQp $EUDV}HVRXVLQDLVGH
PXLWR VHQVtYHO TXDQGR QmR HVWi VXEPHWLGR DRV HIHLWRV WUDXPDWLVPRGDJHQLWiOLD
SURWHWRUHVGRVKRUP{QLRV9HULILTXHVHDSDFLHQWHDSUHVHQWD H[WHUQDSRGHPWHUFDXVDV
EHQLJQDVFRPRPDVWXUEDomR
VHFUHomR DGHUrQFLDV ODELDLV OHV}HV HVWURJHQL]DomR TXH
DJHQWHVWySLFRVLUULWDWLYRVRX
LQGLFDPRLQtFLRGDSXEHUGDGHYDULDo}HVGRKtPHQFRPR WUDXPDWLVPRDFLGHQWDOPDV
KtPHQVHSWDGRRXLPSHUIXUDGRTXHVmRUDURVHDKLJLHQH WDPEpPOHYDQWDPD
&RPIUHTXrQFLDH[LVWHVHFUHomRILQDHEUDQFDOHXFRUUHLD SRVVLELOLGDGHGHDEXVRVH[XDO
1mRpQHFHVViULRUHDOL]DURH[DPHHVSHFXODUGDYDJLQDHGR 9HMDR4XDGUR6LQDLV
ItVLFRVGHDEXVRVH[XDO
FRORGR~WHURQDFULDQoDDQWHVGDSXEHUGDGHDPHQRVTXH
KDMDVXVSHLWDGHWUDXPDWLVPRJUDYHRXFRUSRHVWUDQKR &RQIRUPHPRVWUDGRQR4XDGUR
6LQDLVItVLFRVGHDEXVR
VH[XDORVVLQDLVIRUWHPHQWH
VXJHVWLYRVGHDEXVRVH[XDO
LQFOXHPODFHUDo}HVHTXLPRVHV
HOHV}HVUHFpPFLFDWUL]DGDVQR
KtPHQDXVrQFLDGHWHFLGR
KLPHQDOQDVSRVLo}HVGHDK
HWUDQVHFo}HVKLPHQDLV
FLFDWUL]DGDV2XWURVVLQDLV
2 KtPHQ QRUPDO HP ODFWHQWHV H SUpHVFRODUHV SRGH WHU VXJHVWLYRVVmRFRUULPHQWR
YiULDVFRQILJXUDo}HVFRPRPRVWUDRER[HVHJXLQWH SXUXOHQWRHOHV}HVKHUSpWLFDV

2 H[DPH ItVLFR SRGH UHYHODU VLQDLV VXJHVWLYRV GH DEXVR

VH[XDOHWHPHVSHFLDOLPSRUWkQFLDVHKRXYHUVXVSHLWDGHVVHIDWRQDDQDPQHVH0HVPRQRFDVRGH
DEXVRFRQKHFLGRDJUDQGHPDLRULDGRVH[DPHVQmRFKDPDDDWHQomRSRUWDQWRXPH[DPHJHQLWDO
QRUPDO QmR GHVFDUWD DEXVR VH[XDO 3UHJDV FKDQIUDGXUDV H UHGXQGkQFLDV QR KtPHQ VmR WRGDV
YDULDQWHVQRUPDLV2WDPDQKRGRRULItFLRSRGHYDULDUFRPDLGDGHHDWpFQLFDGHH[DPH2KtPHQp
SURYDYHOPHQWH QRUPDO FDVR DV VXDV ERUGDV HVWHMDP OLVDV H VHP LQWHUUXSomR QD PHWDGH LQIHULRU
(QWUHWDQWR GHWHUPLQDGRV VLQDLV ItVLFRV VXJHUHP D SRVVLELOLGDGH GH DEXVR VH[XDO H H[LJHP XPD
DYDOLDomRPDLVFRPSOHWDSHORJLQHFRORJLVWD9HMDR4XDGUR6LQDLVItVLFRVGHDEXVRVH[XDO

&RQILJXUD©·HVQRUPDLVGRK¯PHQHPPHQLQDVSU«S¼EHUHVHDGROHVFHQWHV

0HQLQDGHDQRVFRPK¯PHQVHSWDGRREVHUYDQGRVHRDSDUHFLPHQWRGHGRLVRULI¯FLRV
0HQLQDGHDQRVFRPµVWLRGDYDJLQDHPIRUPDWRGHFUHVFHQWH
‹QHFHVV£ULRWUD©¥RSDUDYLVXDOL]DUDVGXDVDEHUWXUDV
 0HQLQDGHDQRVFRPµVWLRGDYDJLQDDQXODUGHORFDOL]D©¥RGHVFHQWUDOL]DGDYLV¯YHO 0HQLQDGHDQRVFRPWHFLGRODELDOUHGXQGDQWH7UD©¥RPDLRUHPSRVL©¥RJHQXSHLWRUDO
PHGLDQWHWUD©¥RODELDO UHYHODULDXPRULI¯FLRQRUPDO

0HQLQDGHDQRVFRPµVWLRGDYDJLQDGHIRUPDWRDQXODUHLQIOX¬QFLDKRUPRQDOGDSXEHUGDGHSURYRFDQGRVXUJLPHQWRGHWHFLGRUµVHRHHVSHVVDGR

2ULJHPGDVIRWRV5HHFH5/XGZLJ6HGV&KLOG$EXVH0HGLFDO'LDJQRVLVDQG0DQDJHPHQWQG3KLODGHOSKLD/LSSLQFRWW:LOOLDPV

:LONLQV

Exame retal
2 H[DPH UHWDO QmR p UHDOL]DGR FRPR URWLQD PDV GHYH VHU IHLWR VHPSUH TXH KRXYHU VXVSHLWD GH
GRHQoDLQWUDDEGRPLQDOSpOYLFDRXSHULUUHWDO

2H[DPHUHWDOGHSUpHVFRODUHVSRGHVHUUHDOL]DGRFRPD $FURFyUGRQVDQDLVVmR
FULDQoD HP GHF~ELWR ODWHUDO RX HP SRVLomR GH OLWRWRPLD HQFRQWUDGRVQDGRHQoD
3DUDPXLWRVSUpHVFRODUHVDSRVLomRGHOLWRWRPLDpPHQRV LQIODPDWyULDLQWHVWLQDO
FRQWXGRPDLVIUHTXHQWHPHQWH
DPHDoDGRUDHPDLVIiFLOGHUHDOL]DU$FULDQoDpFRORFDGD
VmRXPDFKDGRLQFLGHQWDO
HPGHF~ELWRGRUVDOFRPRVMRHOKRVHTXDGULVIOH[LRQDGRVH
RV PHPEURV LQIHULRUHV DEGX]LGRV 'HYH VHU XVDGR XP 
OHQoRO SDUD FREULU D FULDQoD GD FLQWXUD SDUD EDL[R $ 
FULDQoD GHYH VHU WUDQTXLOL]DGD FRP IUHTXrQFLD GXUDQWH R
'RUDRH[DPHUHWDOHPXPD
H[DPH VROLFLWH D HOD TXH LQVSLUH H H[SLUH SHOD ERFD QR
FULDQoDFRVWXPDLQGLFDUFDXVD
LQWXLWR GH UHOD[DU $IDVWH DV QiGHJDV H LQVSHFLRQH R kQXV LQIHFFLRVDRXLQIODPDWyULD
8WLOL]HRLQGLFDGRUHQOXYDGRHOXEULILFDGRPHVPRHPSUp FRPRDEVFHVVRRXDSHQGLFLWH
HVFRODUHV 3DOSH R DEGRPH FRP D RXWUD PmR WDQWR SDUD
GLVWUDLU D FULDQoD TXDQWR SDUD REVHUYDU DV HVWUXWXUDV
DEGRPLQDLVHQWUHDVPmRV$SUyVWDWDQmRpSDOSiYHOHPSUpHVFRODUHV

Sistema musculoesquelético
1RV HVFRODUHV p PXLWR GLItFLO REVHUYDU DQRUPDOLGDGHV QRV 3UpHVFRODUHVSRGHP
PHPEURVVXSHULRUHVVHQmRKRXYHUOHVmR DSUHVHQWDURFRWRYHORGHEDEi
XPDVXEOX[DomRGDFDEHoDGR
2SUpHVFRODUQRUPDODSUHVHQWDDXPHQWRGDFRQFDYLGDGH UiGLRFDXVDGDSHODVXDWUDomR
ORPEDUHUHGXomRGDFRQYH[LGDGHWRUiFLFDHPFRPSDUDomR SDUDFLPDSHOREUDoR

FRPRDGXOWRHPXLWDVYH]HVRDEGRPHpSURWUXVR

'HYHVH REVHUYDU D FULDQoD GH Sp H DQGDQGR GHVFDOoD $FDXVDGHFR[HDGXUDDJXGDQD

$OpP GLVVR VROLFLWH D HOD TXH WRTXH RV GHGRV GRV SpV LQIkQFLDpKDELWXDOPHQWH
OHYDQWHVHDSDUWLUGDSRVLomRVHQWDGDFRUUDSRUXPDFXUWD WUDXPDWLVPRRXOHVmRHPERUD
GLVWkQFLD H SHJXH REMHWRV QR FKmR $ PDLRULD GDV GHYDVHUDYHQWDGDD
SRVVLELOLGDGHGHLQIHFomR
DQRUPDOLGDGHV SRGH VHU GHWHFWDGD SHOD REVHUYDomR yVVHDDUWLFXODURXPXVFXODU
FXLGDGRVD WDQWR GH IUHQWH TXDQWR GH WUiV 3DUD DYDOLDU
LQGLUHWDPHQWH R SDGUmR GD PDUFKD GD FULDQoD SRGHVH
H[DPLQDUDVVRODVGRVVDSDWRVSDUDYHUTXDOGRVODGRVHVWiPDLVJDVWR

'XUDQWH RV SULPHLURV PHVHV GH YLGD Ki SURJUHVVmR 2DUTXHDPHQWRVLJQLILFDWLYR

FRPXPHQRUPDOGDSRVLomRGHMRHOKRYDURYHMDDGLDQWHj GRVPHPEURVLQIHULRUHVMRHOKR
HVTXHUGD TXH FRPHoD D GHVDSDUHFHU HP WRUQR GRV  YDURSRGHFRUUHVSRQGHUDXP
DUTXHDPHQWRILVLROyJLFRFRP
PHVHVGHLGDGHFRPIUHTXrQFLDDFRPSDQKDGDSRUWUDQVLomR
UHVROXomRHVSRQWkQHD2
SDUD MRHOKR YDOJR 2 SDGUmR GH MRHOKR YDOJR PRVWUDGR DUTXHDPHQWRH[WUHPRRX
DGLDQWHjGLUHLWDFRVWXPDDWLQJLUVHXSLFRDRVDDQRVH XQLODWHUDOSRGHWHUFDXVDV
pFRUULJLGRJUDGXDOPHQWHDWpRVRXDQRV SDWROyJLFDVFRPRUDTXLWLVPR
RXWtELDYDUDGRHQoDGH
%ORXQW

$WRUomRWLELDOSRGHVHUDYDOLDGDGHGLYHUVDVPDQHLUDV $GRHQoDPDLVFRPXPGH
XP GRV PpWRGRV p PRVWUDGR DTXL &RORTXH D FULDQoD HP PHPEURVLQIHULRUHVQDV
GHF~ELWR YHQWUDO QD PHVD GH H[DPH FRP RV MRHOKRV FULDQoDVpDOHVmRFDXVDGDSRU
DFLGHQWH$VOHV}HVDUWLFXODUHV
IOH[LRQDGRV DWp ƒ FRQIRUPH PRVWUDGR 2EVHUYH R HL[R
IUDWXUDVHQWRUVHV
FR[DSp (P JHUDO Ki URWDomR LQWHUQD RX H[WHUQD GH HVWLUDPHQWRVHOHV}HVJUDYHV
DSUR[LPDGDPHQWHƒGHWHFWDGDSHORIDWRGHRSpDSRQWDU QRVOLJDPHQWRVFRPR
XP SRXFR SDUD IRUD 9HULILTXH D SRVLomR GRV PDOpRORV ± ODFHUDo}HVGROLJDPHQWR
HOHVGHYHPVHUVLPpWULFRV FUX]DGRDQWHULRUGRMRHOKRVmR
PXLWRFRPXQVQHVVDLGDGH

&R[HDGXUDFU{QLFDQDLQIkQFLD
SRGHVHUFDXVDGDSHODGRHQoD
GH%ORXQWSRUGLVW~UELRVGR
TXDGULOFRPRQHFURVHDYDVFXODU
GRTXDGULOGLVFUHSkQFLDQR
FRPSULPHQWRGRVPHPEURV
LQIHULRUHVWUDQVWRUQR
UDTXLPHGXODUHGRHQoD
VLVWrPLFDJUDYHFRPROHXFHPLD
$V FULDQoDV SRGHP YROWDU D DSUHVHQWDU D URWDomR GRV
GHGRVGRVSpVSDUDGHQWURTXDQGRFRPHoDPDDQGDU,VVR
SRGHH[DFHUEDUVHDWpRVDQRVGHLGDGHHGHSRLVJUDGXDOPHQWHGHVDSDUHFHUDQWHVGRVDQRV

9HULILTXH D RFRUUrQFLD GH HVFROLRVH HP TXDOTXHU FULDQoD TXH FRQVLJD ILFDU GH Sp XVDQGR DV
WpFQLFDVGHVFULWDVQRWySLFR$GROHVFHQWHV

'HWHUPLQH VH Ki HQFXUWDPHQWR GR PHPEUR LQIHULRU TXH SRGH DFRPSDQKDU DV GRHQoDV GH
TXDGULOSHODFRPSDUDomRGDGLVWkQFLDHQWUHDFULVWDLOtDFDDQWHURVVXSHULRUHRPDOpRORPHGLDOHP
FDGDXPGRVODGRV3ULPHLUDPHQWHFRORTXHDFULDQoDGHLWDGDHSX[HFRPGHOLFDGH]DRVPHPEURV
LQIHULRUHV $ VHJXLU FRPSDUH RV PDOpRORV PHGLDLV )DoD XP SHTXHQR SRQWR FRP D FDQHWD QRV
PDOpRORVHDSUR[LPHRVSDUDUHDOL]DUXPDPHGLGDGLUHWD

3HoDHQWmRjFULDQoDTXHILTXHHPSRVLomRRUWRVWiWLFDHFRORTXHDVPmRVHPSRVLomRKRUL]RQWDO
VREUH DV FULVWDV LOtDFDV D SDUWLU GD SDUWH GH WUiV &RP LVVR SRGHVH SHUFHEHU SHTXHQDV
GLVFUHSkQFLDV6HIRUREVHUYDGDDOJXPDDQRUPDOLGDGHHKRXYHUVXVSHLWDGHGLVFUHSkQFLDHQWUHR
FRPSULPHQWRGRVPHPEURVLQIHULRUHVFRPXPDFULVWDLOtDFDPDLVHOHYDGDTXHDRXWUDXPWUXTXH
LQWHUHVVDQWH p FRORFDU XP OLYUR SRU EDL[R GR PHPEUR LQIHULRU PDLV FXUWR LVVR GHYH FRUULJLU D
GLVFUHSkQFLD

9HULILTXH VH Ki IRUPD JUDYH GH GRHQoD GH TXDGULO FRP SDUHVLD DVVRFLDGD GR P~VFXOR JO~WHR
PpGLR2EVHUYHDFULDQoDSRUWUiVHQTXDQWRHODWUDQVIHUHRSHVRGHXPDSHUQDSDUDRXWUD$SHOYH
TXHSHUPDQHFHQLYHODGDTXDQGRRSHVRpWUDQVSRUWDGRSDUDRODGRQmRDIHWDGRFRQVWLWXLXPVLQDO
GH7UHQGHOHQEXUJQHJDWLYR4XDQGRKiVLQDODQRUPDOSRVLWLYRFRPRpRFDVRQDGRHQoD JUDYH
GRTXDGULODSHOYHVHLQFOLQDQDGLUHomRGRTXDGULOQmRDIHWDGRGXUDQWHDPDQREUDGHVXVWHQWDomR
GHSHVRSHORODGRDIHWDGRVLQDOGH7UHQGHOHQEXUJSRVLWLYR
 6,1$/'(75(1'(/(1%85*1(*$7,92

6,1$/'(75(1'(/(1%85*326,7,92

Sistema nervoso
2H[DPHQHXUROyJLFRDSyVRSULPHLURDQRGHYLGDSDVVDD &ULDQoDVFRPGLVSOHJLDV
LQFOXLU RV FRPSRQHQWHV DYDOLDGRV QRV DGXOWRV 'HYHVH HVSiVWLFDVFRPIUHTXrQFLD
FRPELQDU D DYDOLDomR QHXUROyJLFD FRP D DYDOLDomR GR DSUHVHQWDPKLSRWRQLDMiQR
SULPHLURDQRGHYLGDVHJXLGD
GHVHQYROYLPHQWR H ID]HU FRP TXH LVVR VH WUDQVIRUPH HP
SRUW{QXVH[FHVVLYRFRP
MRJR SDUD D FULDQoD QR LQWXLWR GH FRQVHJXLU DYDOLDU VH R HVSDVWLFLGDGHPDUFKDHP
GHVHQYROYLPHQWRHRGHVHPSHQKRQHXUROyJLFRHVWmRGHQWUR WHVRXUDHjVYH]HVSXQKRV
GRHVSHUDGR FHUUDGRVQDSULPHLUDLQIkQFLD

5HDOL]H UDVWUHDPHQWR HVWUXWXUDO GR GHVHQYROYLPHQWR $V 3UREOHPDVGHLQWHUDomRVRFLDO

FULDQoDV FRVWXPDP JRVWDU GHVVD SDUWH GR H[DPH 0XLWDV FRPXQLFDomRYHUEDOHQmR
FRQGLo}HV QHXUROyJLFDV QD LQIkQFLD VH DFRPSDQKDP GH YHUEDOOLPLWDomRGHLQWHUHVVHV
HFRPSRUWDPHQWRVUHSHWLWLYRV
DQRUPDOLGDGHVGRGHVHQYROYLPHQWR
SRGHPVHUVLQDLVGHDXWLVPR

Sensibilidade.2H[DPHVHQVRULDOSRGHVHUUHDOL]DGRFRPXPDERODGHDOJRGmRRXID]HQGRFyFHJDV
QDFULDQoD2PHOKRUpID]HULVVRFRPRVROKRVGDFULDQoDIHFKDGRV1mRXVHDOILQHWHV

Marcha, força e coordenação.2EVHUYHDPDUFKDGDFULDQoDFRP 6HDFULDQoDDSUHVHQWDUPDUFKD

HOD DQGDQGR H LGHDOPHQWH FRUUHQGR 9HULILTXH VH Ki VHPFRRUGHQDomRpQHFHVViULR
DVVLPHWULDV IUDTXH]DV TXHGDV LQH[SOLFiYHLV RX GLIHUHQFLDUFDXVDVRUWRSpGLFDV
FRPRGHIRUPLGDGHVGDSRVLomR
LQFRRUGHQDomR$FRPSDQKHRVPDUFRVGHGHVHQYROYLPHQWR
GRTXDGULOGRVMRHOKRVRXGRV
SDUD DSOLFDU DV PDQREUDV DSURSULDGDV FRPR DQGDU FRP R SpVGHDQRUPDOLGDGHV
DUWHOKR WRFDQGR R FDOFDQKDU GR RXWUR Sp YHMD D LPDJHP QHXUROyJLFDVFRPRSDUDOLVLD
VDOWLWDUHSXODU8PEULQTXHGRGHYHVHUXWLOL]DGRSDUDWHVWDU FHUHEUDODWD[LDRXFRQGLo}HV
DFRRUGHQDomRHDIRUoDGRVPHPEURVVXSHULRUHV QHXURPXVFXODUHV

6H KRXYHU DOJXPD G~YLGD TXDQWR j IRUoD PXVFXODU GD (PGHWHUPLQDGDVIRUPDVGH

FULDQoD SRGHVH SHGLU D HOD SDUD GHLWDU QR FKmR H GHSRLV GLVWURILDPXVFXODUDVVRFLDGDD
OHYDQWDU 2V HVWiJLRV GHVVH PRYLPHQWR GHYHP VHU IUDTXH]DGRVP~VFXORVGD
FLQWXUDSpOYLFDFtQJXORGR
REVHUYDGRV DWHQWDPHQWH $ PDLRULD GDV FULDQoDV QRUPDLV
PHPEURLQIHULRUVHJXQGRD
SULPHLUR VHQWD GHSRLV IOH[LRQD RV MRHOKRV H HVWLFD RV 7HUPLQRORJLD$QDW{PLFDDV
EUDoRVGRVGRLVODGRVGRFRUSRSDUDGDULPSXOVRGRFKmR FULDQoDVSUHFLVDPSDUDVH
DWpDSRVLomRGHSp OHYDQWDUURODUSDUDDSRVLomR
GHGHF~ELWRGRUVDOHID]HUIRUoD
SDUDVHOHYDQWDUGRFKmRFRP

RVEUDoRVHQTXDQWRPDQWrPDV
SHUQDVHVWLFDGDVVLQDOGH
 *RZHU

$ODWHUDOLGDGHILFDHYLGHQWHQDPDLRULDGDVFULDQoDVDRV
DQRV6HXPDFULDQoDPDLVQRYDDSUHVHQWDUODWHUDOLGDGHQtWLGDGHYHVHUSHVTXLVDGDSDUHVLDQR
RXWURPHPEURVXSHULRU

Reflexos tendinosos profundos. 2V UHIOH[RV WHQGLQRVRV &ULDQoDVFRPIRUPDVOHYHVGH

SURIXQGRV SRGHP VHU WHVWDGRV FRPR QRV DGXOWRV SDUDOLVLDFHUHEUDOSRGHP
3ULPHLUDPHQWHGHYHVHPRVWUDUDXWLOL]DomRGRPDUWHORGH DSUHVHQWDUW{QXVGLVFUHWDPHQWH
DXPHQWDGRHKLSHUUHIOH[LD
'HMHULQH QD PmR GD FULDQoD WUDQTXLOL]DQGRD GH TXH LVVR
QmRLUiPDFKXFiOD$VFULDQoDVDGRUDPYHUDSHUQDVXELU
TXDQGR RV UHIOH[RV SDWHODUHV VmR WHVWDGRV $ FULDQoD SUHFLVD PDQWHU RV ROKRV IHFKDGRV GXUDQWH
SDUWHGHVVHH[DPHSRLVDWHQVmRDWUDSDOKDRVUHVXOWDGRV

Desenvolvimento. 3RGHVH VROLFLWDU jV FULDQoDV DFLPD GH  eSUHFLVRGLIHUHQFLDUUHWDUGRV

DQRV TXH IDoDP XP GHVHQKR H FRSLHP REMHWRV FRPR LVRODGRVHPXPGRVDVSHFWRV
UHDOL]DGRQR''67HGHSRLVGLVFXWLURVGHVHQKRVSDUDXP GRGHVHQYROYLPHQWRSH[
FRRUGHQDomRRXOLQJXDJHPGH
WHVWH VLPXOWkQHR GH FRRUGHQDomR PRWRUD ILQD FRJQLomR H
UHWDUGRVPDLVJHQHUDOL]DGRV
OLQJXDJHP TXHHQYROYHPYiULRVDVSHFWRV
2UHWDUGRJHQHUDOL]DGRUHIOHWH
3DUD DV FULDQoDV HP LGDGH HVFRODU R PHOKRU WHVWH GH FRPPDLRUIUHTXrQFLD
GHVHQYROYLPHQWRpRGHVHPSHQKRHVFRODUGHODV9RFrSRGH WUDQVWRUQRVQHXUROyJLFRV
VROLFLWDU RV UHJLVWURV HVFRODUHV GRV UHVXOWDGRV GH WHVWHV JOREDLVFRPRUHWDUGRPHQWDO
TXHSRGHWHUGLYHUVDV
SVLFROyJLFRV HYLWDQGR DVVLP D QHFHVVLGDGH GH WHVWHV
HWLRORJLDV
IRUPDLVGRGHVHQYROYLPHQWRGDFULDQoD

Função cerebelar. 2 H[DPH GR FHUHEHOR SRGH VHU UHDOL]DGR XVDQGRVH PRYLPHQWRV DOWHUQDQWHV
UiSLGRVRXGHGR±QDUL]FRPDVPmRVRXGHGRV$VFULDQoDVJRVWDPGHVVHMRJR&ULDQoDVFRPPDLV
GH  DQRV GHYHP VHU FDSD]HV GH GLIHUHQFLDU R ODGR GLUHLWR GR HVTXHUGR SRUWDQWR p SRVVtYHO
VROLFLWDU D UHDOL]DomR GH WDUHIDV GH GLVFULPLQDomR GLUHLWD±HVTXHUGD FRPR R IDULD QR SDFLHQWH
DGXOWR

$OJXPDVFULDQoDVFRP
WUDQVWRUQRGHGpILFLWGH
DWHQomRHKLSHUDWLYLGDGH
7'$+DSUHVHQWDPPXLWD
 GLILFXOGDGHHPFRRSHUDUFRPR
H[DPHQHXUROyJLFRHGH
GHVHQYROYLPHQWRSRLVWrP
SUREOHPDVGHFRQFHQWUDomR
(VVDVFULDQoDVFRVWXPDPWHU
PXLWDHQHUJLDQmRFRQVHJXHP
ILFDUSDUDGDVSRUORQJRV
SHUtRGRVHH[LVWHRUHODWRGH
GLILFXOGDGHQDHVFRODRXHP
VLWXDo}HVHVWUXWXUDGDV

5HWDUGRRXFRPSURPHWLPHQWR
GRGHVHQYROYLPHQWRQDIDVH
LQLFLDOGDLQIkQFLDSRGHP
UHVXOWDUHPIUDFDVVRHVFRODU
DVVLPFRPRSUREOHPDVVRFLDLV
FRPSRUWDPHQWDLVHHPRFLRQDLV

Nervos cranianos. 2V QHUYRV FUDQLDQRV SRGHP VHU H[DPLQDGRV GH PRGR EDVWDQWH UD]RiYHO
HPSUHJDQGRVHHVWUDWpJLDVDGHTXDGDVSDUDRGHVHQYROYLPHQWRPRVWUDGDVQRER[HDVHJXLU

(VWUDW«JLDVSDUDDYDOLDURVQHUYRVFUDQLDQRVHPFULDQ©DVSHTXHQDV
1HUYRVFUDQLDQRV (VWUDW«JLD
, 2OIDWµULR 3RGHVHUWHVWDGRHPFULDQ©DVPDLRUHV
8VHFDUWHODGH6QHOOHQDSµVRVDQRV
,, $FXLGDGHYLVXDO 7HVWHRVFDPSRVYLVXDLVFRPRGHXPDGXOWR
3RGHVHUQHFHVV£ULRTXHRVSDLVVHJXUHPD
FDEH©DGDFULDQ©D
6ROLFLWHDFULDQ©DTXHDFRPSDQKHXPDOX]RX
2VVLQDLVQHXUROµJLFRVGHORFDOL]D©¥R
V¥RUDURVQDVFULDQ©DVPDVSRGHPVHU
SURYRFDGRVSRUWUDXPDWLVPRWXPRU
FHUHEUDOKHPRUUDJLDLQWUDFUDQLDQDRX
LQIHF©¥R$VFULDQ©DVFRPaumento da
pressão intracranianaSRGHPDSUHVHQWDU
DQRUPDOLGDGHVGRVQHUYRVFUDQLDQRV
DVVLPFRPRSDSLOHGHPDHDOWHUD©¥RGR
XPREMHWRGHSUHIHU¬QFLDXPEULQTXHGR HVWDGRPHQWDO
,,,,99, 0RYLPHQWRVRFXODUHV
3RGHVHUQHFHVV£ULRTXHXPGRVSDLVVHJXUH
DFDEH©DGDFULDQ©D

)D©DXPDEULQFDGHLUDFRPXPDERODGH
DOJRG¥RSDUDWHVWDUDVHQVLELOLGDGH
9 0RWRU
6ROLFLWH¢FULDQ©DTXHFHUUHRVGHQWHVH
PDVWLJHRXHQJXODDOJXPDOLPHQWR
$VFULDQ©DVFRPPHQLQJLWHHQFHIDOLWH
RXDEVFHVVRFHUHEUDOSRGHPDSUHVHQWDU
DQRUPDOLGDGHVGRVQHUYRVFUDQLDQRV
HPERUDWDPE«PSRVVDPDSUHVHQWDU
DOWHUD©¥RGRQ¯YHOGHFRQVFL¬QFLDH
RXWURVVLQDLV

6ROLFLWH¢FULDQ©DTXHID©DFDUHWDVRXLPLWH
(PERUDDSDUDOLVLDGRQHUYRIDFLDO
FDUHWDVTXHYRF¬IL]HULQFOXVLYHPH[HUFRP
9,, )DFLDO SRVVDVHUFRQJ¬QLWDFRPIUHTX¬QFLD«
DVVREUDQFHOKDVHREVHUYHDVLPHWULDGRV
FDXVDGDSRUWUDXPDWLVPRRXLQIHF©¥R
PRYLPHQWRVIDFLDLV

5HDOL]HWHVWHDXGLWLYRDSµVRVDQRV
9,,, &DSDFLGDGHDXGLWLYD 6XVVXUUHXPDSDODYUDRXFRPDQGRSRUWU£V 
GDFULDQ©DHSH©DDHODSDUDUHSHWLOD
 6ROLFLWH¢FULDQ©DTXHɪSRQKDDO¯QJXDWRGD
SDUDIRUDɫRXɪGLJDDKɫ

,;; 'HJOXWL©¥RHY¶PLWR 2EVHUYHRPRYLPHQWRGD¼YXODHGRSDODWR 

PROH

7HVWHRUHIOH[RIDU¯QJHRUHIOH[RGRY¶PLWR

6ROLFLWH¢FULDQ©DTXHHPSXUUHVXDP¥R
DIDVWDQGRDGDFDEH©DGHOD6ROLFLWH¢
;, $FHVVµULR FULDQ©DTXHHQFROKDRVRPEURVHQTXDQWR 
YRF¬RVHPSXUUDSDUDEDL[RFRPDVP¥RV
SDUDɪYHUVHDFULDQ©D«IRUWHɫ

6ROLFLWH¢FULDQ©DDɪSRQKDDO¯QJXDWRGDSDUD
;,, +LSRJORVVR 
IRUDɫ

$YDOLDomRGHDGROHVFHQWHV

'(6(192/9,0(172_'26$26$126


$DGROHVFrQFLDSRGHVHUGLYLGLGDHPWUrVHVWiJLRVLQLFLDOLQWHUPHGLiULDHWDUGLD$DQDPQHVHHDV
WpFQLFDV GH H[DPH YDULDP PXLWR GHSHQGHQGR GRV QtYHLV GH GHVHQYROYLPHQWR ItVLFR FRJQLWLYR H
VRFLRHPRFLRQDOGRDGROHVFHQWH

Desenvolvimento físico. $ DGROHVFrQFLD p XPD IDVH GH WUDQVLomR GD LQIkQFLD SDUD D YLGD DGXOWD $
WUDQVIRUPDomRItVLFDRFRUUHHPJHUDODRORQJRGHDOJXQVDQRVFRPLQtFLRHPPpGLDDRVDQRV
SDUD DV PHQLQDV H DRV  SDUD RV PHQLQRV 1D PpGLD R GHVHQYROYLPHQWR SXEHUDO GDV PHQLQDV
DFDEDFRPXPHVWLUmRGHFUHVFLPHQWRDWpRVDQRVHRGRVPHQLQRVDWpRVDQRVGHLGDGH$
LGDGHGHLQtFLRHDGXUDomRGDSXEHUGDGHYDULDPPXLWRHPERUDRVHVWiJLRVREHGHoDPjPHVPD
VHTXrQFLD HP WRGRV RV DGROHVFHQWHV 2 DGROHVFHQWH PDLV MRYHP ILFD SUHRFXSDGR FRP HVVDV
DOWHUDo}HVItVLFDV

Desenvolvimento cognitivo. $V DOWHUDo}HV FRJQLWLYDV GD DGROHVFrQFLD VmR WmR GUiVWLFDV TXDQWR DV
ItVLFDVHPERUDPHQRVHYLGHQWHV$PDLRULDGRVDGROHVFHQWHVSDVVDSRUHYROXomRGRSHQVDPHQWR
FRQFUHWR SDUD R SHQVDPHQWR IRUPDO H DGTXLUH D FDSDFLGDGH GH UDFLRFLQDU GH PRGR OyJLFR H
DEVWUDWR DOpP GH FRQVLGHUDU DV LPSOLFDo}HV IXWXUDV GDV Do}HV DWXDLV (PERUD D DQDPQHVH H R
H[DPH ItVLFR DVVHPHOKHPVH DRV UHDOL]DGRV QRV DGXOWRV p SUHFLVR WHU HP PHQWH D HQRUPH
YDULDELOLGDGH QR GHVHQYROYLPHQWR FRJQLWLYR GRV DGROHVFHQWHV H VXDV FDSDFLGDGHV PXLWDV YH]HV
HUUiWLFDV H DLQGD OLPLWDGDV GH HQ[HUJDU DOpP GH VROXo}HV VLPSOHV 2 SHQVDPHQWR PRUDO WRUQDVH
VRILVWLFDGRHPXLWRWHPSRpJDVWRGHEDWHQGRRVWySLFRVDERUGDGRV
Desenvolvimento social e emocional.$DGROHVFrQFLDpXPSHUtRGRWXPXOWXDGRPDUFDGRSRUWUDQVLo}HV
GH LQIOXrQFLDV GD IDPtOLD SDUD D FUHVFHQWH DXWRQRPLD H LQIOXrQFLDV GH FROHJDV $ OXWD SHOD
LGHQWLGDGHLQGHSHQGrQFLDHSRUILPLQWLPLGDGHSURYRFDJUDQGHHVWUHVVHSUREOHPDVGHVD~GHH
IUHTXHQWHPHQWH FRPSRUWDPHQWRV GH DOWR ULVFR (VVH HPEDWH WDPEpP p XPD LPSRUWDQWH
RSRUWXQLGDGHGHSURPRomRGDVD~GH

7DUHIDVGHVHQYROYLPHQWDLVGDDGROHVF¬QFLD

7DUHID &DUDFWHU¯VWLFD $ERUGDJHQVGHFXLGDGRVGHVD¼GH

,Q¯FLRGDDGROHVF¬QFLDDDQRV

)¯VLFR 3XEHUGDGH)D0DYDUL£YHO &RQILGHQFLDOLGDGHSULYDFLGDGH

&RJQLWLYR ɪ2SHUDFLRQDOFRQFUHWRɫ ŒQIDVHDFXUWRSUD]R

6RFLDO  

,GHQWLGDGH (XVRXQRUPDO",PSRUW¤QFLDFUHVFHQWHGRVDPLJRV 7UDQTXLOL]D©¥RHDWLWXGHSRVLWLYD

,QGHSHQG¬QFLD $PELYDO¬QFLDIDP¯OLDVLPHVPRFROHJDV $SRLRDRGHVHQYROYLPHQWRGHDXWRQRPLD

$GROHVF¬QFLDLQWHUPHGL£ULDDDQRV

)¯VLFR 0R©DVPDLVFRQIRUW£YHLVUDSD]HVGHVDMHLWDGRV $SRLRVHKRXYHUYDULD©¥RHPUHOD©¥RDRɪQRUPDOɫ

&RJQLWLYR 7UDQVL©¥RPXLWDVLGHLDV 6ROX©¥RGHSUREOHPDVWRPDGDGHGHFLV¥R

6RFLDO  

4XHPVRXHX"*UDQGHLQWURVSHF©¥RSUREOHPDV
,GHQWLGDGH $FHLWD©¥RLPSDUFLDO
JOREDLV
 ,QGHSHQG¬QFLD 7HVWHVUHVWULWRVFRPSRUWDPHQWRVɪH[SHULPHQWDLVɫ &RQVLVW¬QFLDGHILQL©¥RGHOLPLWHV
QDPRUR

$GROHVF¬QFLDWDUGLDDDQRV

)¯VLFR 'RHQ©DVFRPDVSHFWRDGXOWR 0¯QLPDVH[FHWRDVGRHQ©DVFU¶QLFDV

&RJQLWLYR ɪ2SHUDFLRQDOIRUPDOɫ $ERUGDJHPFRPRGRDGXOWR

6RFLDO  

,GHQWLGDGH 3DSHOHPUHOD©¥RDRVRXWURVVH[XDOLGDGHIXWXUR (VWLPXODUDLGHQWLGDGHSDUDSHUPLWLUFUHVFLPHQWR

6HSDUD©¥RGDIDP¯OLDDFDPLQKRGDLQGHSHQG¬QFLD
,QGHSHQG¬QFLD $SRLRRULHQWD©¥RDQWHFLSDWµULD
UHDO

$1$01(6(


$FKDYHSDUDXPH[DPHEHPVXFHGLGRGRVDGROHVFHQWHVpFRQWDUFRPXPDPELHQWHFRQIRUWiYHOH
FRQILGHQFLDO ,VVR GHL[D R H[DPH PDLV WUDQTXLOR H LQIRUPDWLYR 2 GHVHQYROYLPHQWR FRJQLWLYR H
VRFLDOGRDGROHVFHQWHGHYHVHUOHYDGRHPFRQWDDRWRPDUGHFLV}HVVREUHTXHVW}HVGHSULYDFLGDGH
SDUWLFLSDomRGRVSDLVHFRQILGHQFLDOLGDGH

'H PRGR JHUDO RV DGROHVFHQWHV UHVSRQGHP GH PDQHLUD SRVLWLYD D TXDOTXHU SHVVRD TXH
GHPRQVWUH JHQXtQR LQWHUHVVH QHOHV 'HPRQVWUH HVVH WLSR GH LQWHUHVVH Mi QR LQtFLR GR HQFRQWUR H
PDQWHQKDHVVDOLJDomRSDUDTXHKDMDXPDFRPXQLFDomRHIHWLYD

ePDLVSURYiYHOTXHRVDGROHVFHQWHV³VHDEUDP´TXDQGRDHQWUHYLVWDVHFRQFHQWUDPDLVQHOHVGR
TXHQRVVHXVSUREOHPDV$RFRQWUiULRGDPDLRULDGDVRXWUDVHQWUHYLVWDVRSURILVVLRQDOGHVD~GH
GHYH LQLFLDU FRP SHUJXQWDV HVSHFtILFDV SDUD DXPHQWDU D FRQILDQoD H R YtQFXOR H PDQWHU D
FRQYHUVD HP DQGDPHQWR 2 SURILVVLRQDO GH VD~GH WHUi TXH IDODU PDLV TXH R KDELWXDO GHVGH R
LQtFLR8PDERDPDQHLUDGHLQLFLDUpFRQYHUVDULQIRUPDOPHQWHVREUHFROHJDVHVFRODSDVVDWHPSRV
HIDPtOLD1mRpERPXVDURVLOrQFLRQDWHQWDWLYDGHID]HUFRPTXHRDGROHVFHQWHIDOH

eHVSHFLDOPHQWHLPSRUWDQWHXWLOL]DUUHVXPRVHDVIUDVHVWUDQVLFLRQDLVSDUDH[SOLFDURTXHVHUi
IHLWR D VHJXLU GXUDQWH R H[DPH ItVLFR 2 H[DPH ItVLFR WDPEpP SRGH VHU XPD RSRUWXQLGDGH GH
JDQKDUDDWHQomRGHVVHVMRYHQV8PDYH]HVWDEHOHFLGRRYtQFXORUHWRUQHDSHUJXQWDVPDLVDEHUWDV
(VVHpRPRPHQWRGHSHUJXQWDUVREUHSUHRFXSDo}HVRXG~YLGDVTXHRDGROHVFHQWHSRVVDWHU9LVWR
TXH IUHTXHQWHPHQWH RV DGROHVFHQWHV UHOXWDP HP ID]HU DV SHUJXQWDV PDLV LPSRUWDQWHV TXH
IUHTXHQWHPHQWH VmR VREUH WySLFRV GHOLFDGRV SHUJXQWH VH HOH WHP TXDOTXHU RXWUR DVVXQWR TXH
TXHLUDGLVFXWLU8PDIUDVH~WLOVHULD³FRQWHPHDVG~YLGDVTXHYRFrWHPVREUHLVVR´

2 FRPSRUWDPHQWR GR DGROHVFHQWH HVWi UHODFLRQDGR FRP VHX HVWiJLR GR GHVHQYROYLPHQWR H QmR
QHFHVVDULDPHQWH FRP D LGDGH FURQROyJLFD RX R JUDX GH PDWXULGDGH ItVLFD $ LGDGH H R DVSHFWR
SRGHPFRQIXQGLURSURILVVLRQDOGHVD~GHHID]rORSUHVXPLUTXHRDGROHVFHQWHHVWiPDLVRULHQWDGR
SDUDRIXWXURHPDLVUHDOLVWDGRTXHUHDOPHQWHp,VVRWHPHVSHFLDOYDOLGDGHQRFDVRGRVTXHVH
GHVHQYROYHPPXLWRFHGRHTXHSDUHFHPPDLVYHOKRVGRTXHVmRSDUDDLGDGH2RSRVWRWDPEpP
SRGH VHU YHUGDGHLUR SULQFLSDOPHQWH QRV DGROHVFHQWHV FRP UHWDUGR GD SXEHUGDGH RX GRHQoD
FU{QLFD

$V TXHVW}HV UHODFLRQDGDV FRP D FRQILGHQFLDOLGDGH VLJLOR VmR LPSRUWDQWHV QD DGROHVFrQFLD
([SOLTXH DRV DGROHVFHQWHV H DRV SDLV TXH D PHOKRU IRUPD SDUD FXLGDU GD VD~GH FRQVLVWH HP
FRQIHULU DR DGROHVFHQWH DOJXP JUDX GH LQGHSHQGrQFLD H FRQILGHQFLDOLGDGH 3RGH YDOHU D SHQD
VROLFLWDUDRVSDLVTXHGHL[HPRFRQVXOWyULRGXUDQWHSDUWHGDHQWUHYLVWDTXDQGRDFULDQoDWHPHQWUH
HDQRV,VVRSUHSDUDRVSDLVHRVDGROHVFHQWHVSDUDDVFRQVXOWDVIXWXUDVTXDQGRRSDFLHQWH
SDVVDUiPDLVWHPSRDVyVFRPRSURILVVLRQDOGHVD~GH

$QWHV GH R SDL RX D PmH VDtUHP FROKD FRP HOHV D SDUWH UHOHYDQWH GD KLVWyULD FOtQLFD FRPR
DOJXQV FRPSRQHQWHV GD KLVWyULD SUHJUHVVD (VFODUHoD WDPEpP D DJHQGD GRV SDLV SDUD DTXHOD
FRQVXOWD2VDGROHVFHQWHVSUHFLVDPVDEHUTXHRSURILVVLRQDOGHVD~GHPDQWHUiRVLJLORVREUHRTXH
IRU FRQYHUVDGR QD FRQVXOWD HQWUHWDQWR QXQFD WUDQVIRUPH D FRQILGHQFLDOLGDGH HP XP DWULEXWR
LOLPLWDGR6HPSUHVHGHYHH[SOLFDUH[SOLFLWDPHQWHTXHSRGHVHUQHFHVViULRDJLUVHGHWHUPLQDGDV
LQIRUPDo}HV LPSOLFDUHP SUHRFXSDomR TXDQWR j VHJXUDQoD ³1mR IDODUHL QDGD D VHXV SDLV GR TXH
IRUFRQYHUVDGRDTXLDPHQRVTXHYRFrPHGrSHUPLVVmRRXTXHHXILTXHSUHRFXSDGRFRPDVXD
VHJXUDQoD±SRUH[HPSORVHYRFrPHGLVVHUTXHYDLVHPDWDUHHXDFKDUTXHH[LVWHXPULVFRGH
IDWRVHUiQHFHVViULRGLVFXWLULVVRFRPRXWUDVSHVVRDVSDUDSRGHUDMXGiOR´

8PREMHWLYRLPSRUWDQWHpDMXGDURVDGROHVFHQWHVDYHUEDOL]DUVXDVSUHRFXSDo}HVRXG~YLGDVDR
FRQYHUVDUFRPRVSDLV2VDGROHVFHQWHVGHYHPVHUHQFRUDMDGRVDGLVFXWLUTXHVW}HVGHOLFDGDVFRP
RVSDLVHRSURILVVLRQDOGHVD~GHSRGHVHRIHUHFHUSDUDHVWDUSUHVHQWHGXUDQWHHVVDVFRQYHUVDV
(PERUD RV MRYHQV DFUHGLWHP TXH RV SDLV ³RV PDWDULDP VH VRXEHVVHP´ R SURILVVLRQDO GH VD~GH
SRGHSURPRYHUXPGLiORJRPDLVDEHUWR,VVRGHSHQGHGHDYDOLDomRFXLGDGRVDGDSHUVSHFWLYDGRV
SDLVHGRFRQVHQWLPHQWRSOHQRHH[SOtFLWRGRMRYHP

&RPRQDIDVHLQWHUPHGLiULDGDLQIkQFLDDVTXHVW}HVGHSXGRUVmRLPSRUWDQWHV2SDFLHQWHGHYH
SHUPDQHFHUYHVWLGRDWpRLQtFLRGRH[DPH2H[DPLQDGRUGHYHVDLUGDVDODGHH[DPHHQTXDQWRR
DGROHVFHQWH FRORFD R URXSmR $ PDLRULD GRV DGROHVFHQWHV DFLPD GRV  DQRV SUHIHUH VHU
H[DPLQDGD VHP D SUHVHQoD GRV SDLV QR FRQVXOWyULR PDV LVVR GHSHQGH GR QtYHO GH
GHVHQYROYLPHQWR GD IDPLOLDULGDGH FRP R H[DPLQDGRU GR UHODFLRQDPHQWR FRP RV SDLV H GH
TXHVW}HV FXOWXUDLV 1R FDVR GH DGROHVFHQWHV PDLV MRYHQV SHUJXQWH VREUH DV SUHIHUrQFLDV GR
DGROHVFHQWHHGRVSDLV6HPSUHpUHFRPHQGiYHOTXHRVSURILVVLRQDLVGHVD~GHGRVH[RPDVFXOLQR
PDQWHQKDPXPDDX[LOLDUQDVDODGXUDQWHRH[DPHGDVPDPDVRXGDJHQLWiOLDGHSDFLHQWHVGRVH[R
IHPLQLQR

$ VHTXrQFLD H R FRQWH~GR GR H[DPH ItVLFR GR DGROHVFHQWH VmR VHPHOKDQWHV DRV GR DGXOWR
(QWUHWDQWR QmR VH HVTXHoD GH FRQVLGHUDU DV TXHVW}HV HVSHFtILFDV GD DGROHVFrQFLD FRPR
SXEHUGDGH FUHVFLPHQWR GHVHQYROYLPHQWR UHODo}HV FRP D IDPtOLD H FRPSDQKHLURV VH[XDOLGDGH
WRPDGDGHGHFLVmRHFRPSRUWDPHQWRVGHDOWRULVFR

35202d­2(25,(17$d­2'$6$Ò'(_(9,'Ç1&,$6
 (5(&20(1'$d®(6

$ $$3 UHFRPHQGD FRQVXOWDV GH VXSHUYLVmR GH VD~GH DQXDLV SDUD DGROHVFHQWHV e LPSRUWDQWH
LQFOXLU DVSHFWRV GH SURPRomR GD VD~GH HP WRGDV DV FRQVXOWDV FRP RV MRYHQV $OpP GLVVR RV
DGROHVFHQWHV FRP SUREOHPDV FU{QLFRV RX FRPSRUWDPHQWRV GH DOWR ULVFR SRGHP QHFHVVLWDU GH
FRQVXOWDVH[WUDVSDUDSURPRomRGDVD~GHHRULHQWDomRDQWHFLSDWyULD

$PDLRULDGDVGRHQoDVFU{QLFDVHPDGXOWRVWHPVHXVDQWHFHGHQWHVQDLQIkQFLDRXDGROHVFrQFLD
$REHVLGDGHDVGRHQoDVFDUGLRYDVFXODUHVDDGLomRVXEVWkQFLDVSVLFRDWLYDViOFRRORXWDEDFRH
D GHSUHVVmR VmR WRGDV LQIOXHQFLDGDV SRU H[SHULrQFLDV GH LQIkQFLD H DGROHVFrQFLD RX SRU
FRPSRUWDPHQWRVHVWDEHOHFLGRVGXUDQWHDDGROHVFrQFLD4XDVHWRGRVRVDGXOWRVTXHVHYLFLDPHP
WDEDFR LQLFLDP R XVR DQWHV GRV  DQRV 3RUWDQWR XP FRPSRQHQWH LPSRUWDQWH GH SURPRomR GD
VD~GHGRVDGROHVFHQWHVVmRDVGLVFXVV}HVVREUHFRPSRUWDPHQWRVHKiELWRVVDXGiYHLV$SURPRomR
GHVD~GHHIHWLYDSRGHDMXGDURVSDFLHQWHVDGHVHQYROYHUHPKiELWRVHHVWLORVGHYLGDVDXGiYHLV
DOpPGHHYLWDUGLYHUVRVSUREOHPDVGHVD~GHFU{QLFRV

&RPR DOJXQV WySLFRV GH SURPRomR GD VD~GH HQYROYHP DVSHFWRV FRQILGHQFLDLV FRPR VD~GH
PHQWDO LQGHSHQGrQFLD FRPSRUWDPHQWR VH[XDO H WUDQVWRUQRV DOLPHQWDUHV p GHVHMiYHO FRQYHUVDU
FRP RV DGROHVFHQWHV SULQFLSDOPHQWH PDLV YHOKRV HP SDUWLFXODU GXUDQWH SDUWH GD FRQVXOWD TXH
HQYROYHVXSHUYLVmRGHVD~GH

2VTXHVWLRQiULRVGHUDVWUHDPHQWRSRGHPVHUFRPSOHWDGRVSHORSDFLHQWHDQWHVGDFRQVXOWDSDUD
IDFLOLWDU D DYDOLDomR DEUDQJHQWH GRV FRPSRUWDPHQWRV GH ULVFR MXYHQLV (VVD DERUGDJHP SRXSD
WHPSR TXH SRGH VHU PDLV EHP DSURYHLWDGR QD FRQYHUVD VREUH RV FRPSRUWDPHQWRV GH ULVFR
HVSHFtILFRV GR DGROHVFHQWH GXUDQWH D FRQVXOWD 8PD IHUUDPHQWD H[FHOHQWH p R *$36 *XLGHOLQHV
IRU$GROHVFHQW3UHYHQWLYH6HUYLFHV

&RPSRQHQWHVGDFRQVXOWDGHVXSHUYLV¥RGHVD¼GHHPDGROHVFHQWHVFRPDDQRV

&RQYHUVDVFRPRVSDLV

$ERUGHDVSUHRFXSD©·HVGRVSDLV

)RUQH©DDFRQVHOKDPHQWR

,QWHUD©·HVQDHVFRODDWLYLGDGHVVRFLDLV

&RPSRUWDPHQWRVHK£ELWRVVD¼GHPHQWDOGRMRYHP

&RQYHUVDVFRPRDGROHVFHQWH

'HVHQYROYLPHQWRVRFLDOHHPRFLRQDOVD¼GHPHQWDODPLJRVIDP¯OLD

'HVHQYROYLPHQWRI­VLFRSXEHUGDGHDXWRFRQFHLWR

&RPSRUWDPHQWRVHK¡ELWRV QXWUL©¥R H[HUF¯FLR WHPSR DVVLVWLQGR ¢ 79 RX XVDQGR R FRPSXWDGRU FRQVXPR GH GURJDV LO¯FLWDV£OFRRO
HW¯OLFR

5HODFLRQDPHQWRVHVH[XDOLGDGHQDPRURDWLYLGDGHVH[XDOVH[RIRU©DGR

)XQFLRQDPHQWRIDPLOLDUUHOD©·HVFRPRVSDLVHLUP¥RV
 'HVHPSHQKRHVFRODUDWLYLGDGHVSRQWRVIRUWHV

([DPHI¯VLFR

5HDOL]HXPH[DPHI¯VLFRFXLGDGRVRREVHUYHRVSDU¤PHWURVGHFUHVFLPHQWRDYDOLD©¥RGHPDWXULGDGHVH[XDO

7HVWHVGHUDVWUHDPHQWR

9LV¥R H DXGL©¥R SUHVV¥R DUWHULDO FRQVLGHUH D VROLFLWD©¥R GH KHPDWµFULWR DYDOLD©¥R GH VD¼GH HPRFLRQDO H IDWRUHV GH ULVFR XVH
IHUUDPHQWDVYDOLGDGDV

,PXQL]D©·HV

9HMDHVTXHPDGHLPXQL]D©¥RDFHVVDQGRROLQNSRUWDOGDVDXGHVDXGHJRYEU

2ULHQWD©¥RDQWHFLSDWµULD_$GROHVFHQWH

3URPR§£RGHK¡ELWRVHFRPSRUWDPHQWRVVDXG¡YHLV

3UHYHQ©¥RGHOHV·HVHGRHQ©DV
&LQWRGHVHJXUDQ©DGLUH©¥RHFRQVXPRGH£OFRROFDSDFHWHH[SRVL©¥RDRVRODUPDV
1XWUL©¥R
5HIHL©·HVODQFKHVVDXG£YHLVSUHYHQ©¥RGDREHVLGDGH
6D¼GHRUDOGHQWLVWDHVFRYD©¥R

$WLYLGDGHI¯VLFDHRULHQWD©¥R

6H[XDOLGDGH

&RQILGHQFLDOLGDGHFRPSRUWDPHQWRVVH[XDLVSU£WLFDGHVH[RVHJXURFRQWUDFHS©¥RVHQHFHVV£ULR

$EXVRGHVXEVW¤QFLDVSVLFRDWLYDV

(VWUDW«JLDVGHSUHYHQ©¥R

,QWHUD©¥RHQWUHRVSDLVHRDGROHVFHQWH

&RPXQLFD©¥RUHJUDV

&RQTXLVWDVVRFLDLV

$WLYLGDGHVHVFRODIXWXUR

,QWHUD©¥RQDFRPXQLGDGH

5HFXUVRVHQYROYLPHQWR

2ULHQWD©¥RDQWHFLSDWµULD_3DLV

,QWHUD©·HVSRVLWLYDVDSRLRVHJXUDQ©DGHILQL©¥RGHOLPLWHVYDORUHVIDPLOLDUHVFRPSRUWDPHQWRVPRGHOR
 7e&1,&$6'((;$0(


Ectoscopia e sinais vitais

Crescimento somático. 2V DGROHVFHQWHV GHYHP YHVWLU URXS}HV 7DQWRDREHVLGDGHTXDQWRRV
WUDQVWRUQRVDOLPHQWDUHVVmR
SDUD VHUHP SHVDGRV ,VVR WHP HVSHFLDO LPSRUWkQFLD HP
LPSRUWDQWHVSUREOHPDVGH
PHQLQDV DGROHVFHQWHV TXH HVWmR VHQGR DYDOLDGDV SRU VD~GHS~EOLFDHPPHQLQDV
SUREOHPDV GH EDL[R SHVR ,GHDOPHQWH DV GHWHUPLQDo}HV DGROHVFHQWHVTXHH[LJHP
VHTXHQFLDLV GR SHVR H GD DOWXUD GHYHP GHU UHDOL]DGDV QDV DYDOLDo}HVIUHTXHQWHVGHSHVR
PHVPDVEDODQoDV

Sinais vitais. $V DYDOLDo}HV VLVWHPiWLFDV GD SUHVVmR DUWHULDO $VFDXVDVGHKLSHUWHQVmR

VmR LPSRUWDQWHV QR DGROHVFHQWH $ IUHTXrQFLD FDUGtDFD DUWHULDOSHUVLVWHQWHQHVWDIDL[D
PpGLDDSDUWLUGHDDQRVGHLGDGHpGHESPFRP HWiULDLQFOXHPKLSHUWHQVmR
DUWHULDOSULPiULDGRHQoDGH
YDULDo}HVGHDESPVHQGRFRQVLGHUDGDVQRUPDLV$
SDUrQTXLPDUHQDOHXVRGH
IUHTXrQFLD FDUGtDFD )& PpGLD QRV DGROHVFHQWHV FRP  GURJDVLOtFLWDV
DQRVRXPDLVpGHDESP

Pele
([DPLQH FRP FXLGDGR D SHOH GR DGROHVFHQWH 0XLWRV $DFQHQRDGROHVFHQWHXP
DGROHVFHQWHV WrP SUHRFXSDo}HV FRP OHV}HV FXWkQHDV TXDGURFXWkQHRPXLWRFRPXP
GLYHUVDV FRPR DFQH GHSUHVV}HV PDQFKDV H QHYRV e WHQGHDVHUHVROYHUFRPR
SUHFLVR GDU DWHQomR HVSHFLDO j IDFH H DR GRUVR QR H[DPH WHPSRPDVPXLWDVYH]HVVH
EHQHILFLDGHWUDWDPHQWR
GRVDGROHVFHQWHVjSURFXUDGHDFQH DGHTXDGR$FQHWHQGHD
DSDUHFHUQDPHWDGHDWpRILQDO
 GDDGROHVFrQFLD

0XLWRV DGROHVFHQWHV SDVVDP XP WHPSR FRQVLGHUiYHO DR 1HYRVEHQLJQRVSRGHP

VRO H HP VDO}HV GH EURQ]HDPHQWR ,VVR SRGH VHU GHWHFWDGR DSDUHFHUQDDGROHVFrQFLD$V
GXUDQWH XPD DQDPQHVH DEUDQJHQWH RX SHOD REVHUYDomR GH FDUDFWHUtVWLFDVTXHRV
VLQDLVGHEURQ]HDPHQWRGXUDQWHRH[DPHItVLFR(VVDpXPD GLIHUHQFLDPGHQHYRVDWtSLFRV
VmRGHVFULWDVQRV4XDGURV
ERD RSRUWXQLGDGH GH RULHQWDU RV DGROHVFHQWHV VREUH RV H
ULVFRV GD H[SRVLomR H[FHVVLYD j UDGLDomR XOWUDYLROHWD D
QHFHVVLGDGH GH XVDU ILOWUR VRODU H RV ULVFRV GRV VDO}HV GH
EURQ]HDPHQWR
 2ULHQWHRVDGROHVFHQWHVDFRPHoDUHPDUHDOL]DUXPDXWRH[DPHUHJXODUGDSHOHFRPRpPRVWUDGR
QDVSiJLQDVH

Cabeça, orelhas, nariz, garganta e pescoço

2H[DPHGHVVDVSDUWHVGRFRUSRFRVWXPDVHULJXDODRGRV 8PDGROHVFHQWHFRPIHEUH
DGXOWRV SHUVLVWHQWHIDULQJLWHWRQVLODUH
OLQIDGHQRSDWLDFHUYLFDOSRGHWHU
2VPpWRGRVXWLOL]DGRVSDUDH[DPLQDURVROKRVLQFOXVLYH PRQRQXFOHRVHLQIHFFLRVD
FRP YHULILFDomR GD DFXLGDGH YLVXDO VmR RV PHVPRV
XWLOL]DGRV QR DGXOWR 2V HUURV GH UHIUDomR WRUQDPVH PDLV
FRPXQVHpLPSRUWDQWHWHVWDUDDFXLGDGHYLVXDOPRQRFXODUDLQWHUYDORVUHJXODUHVFRPRGXUDQWHD
FRQVXOWDGHVXSHUYLVmRGHVD~GHDQXDO

$IDFLOLGDGHHDVWpFQLFDVGHH[DPHGDVRUHOKDVHGDDXGLomRVmRVHPHOKDQWHVjVGRVDGXOWRV
1mRH[LVWHPDQRUPDOLGDGHVQDRUHOKDRXYDULDo}HVGDWpFQLFDQRUPDOQHVWDIDL[DHWiULD

Coração
$VWpFQLFDVHDVVHTXrQFLDVGRH[DPHVmRDVPHVPDVXVDGDVQRVDGXOWRV2VVRSURVUHSUHVHQWDP
XPDTXHVWmRSHUPDQHQWHQDDYDOLDomRFDUGLRYDVFXODU

/RFDOL]D©¥RHFDUDFWHU¯VWLFDVGHVRSURVFDUG¯DFRVEHQLJQRVHPDGROHVFHQWHV

,GDGHW¯SLFD 1RPH &DUDFWHU¯VWLFDV 'HVFUL©¥R

&ULDQ©DPDLRUDGROHVF¬QFLDHDSµV
*UDX,,,9,VXDYHQ¥RUXGH
'HHMH©¥R
6RSURGHIOX[RSXOPRQDU
%RUGDHVWHUQDOVXSHULRUHVTXHUGD
3QRUPDO
 2 VRSUR GH IOX[R SXOPRQDU EHQLJQR p XP VRSUR VXDYH 2VRSURGHIOX[RSXOPRQDU
QmR UXGH GH JUDX ,±,,9, FRP FDUDFWHUtVWLFDV FURQROyJLFDV DFRPSDQKDGRGH
GHXPVRSURGHHMHomRFRPLQtFLRDSyVDSULPHLUDEXOKDH GHVGREUDPHQWRIL[RGD
ILQDO DQWHV GD VHJXQGD SRUpP VHP D FDUDFWHUtVWLFD GH VHJXQGDEXOKDFDUGtDFDVXJHUH
VREUHFDUJDGHYROXPHGDV
FUHVFHQGR±GHFUHVFHQGR GR VRSUR GH HMHomR RUJkQLFR 6H FkPDUDVGLUHLWDVFRPRQD
HVVH VRSUR IRU DXVFXOWDGR p LPSRUWDQWH DYDOLDU VH R UXtGR FRPXQLFDomRLQWHUDWULDO
GH IHFKDPHQWR SXOPRQDU WHP LQWHQVLGDGH QRUPDO H VH R
GHVGREUDPHQWR GD VHJXQGD EXOKD FDUGtDFD p HOLPLQDGR
GXUDQWH D H[SLUDomR 8P DGROHVFHQWH FRP XP VRSUR GH HMHomR SXOPRQDU EHQLJQR DSUHVHQWDUi
LQWHQVLGDGHQRUPDOHGHVGREUDPHQWRQRUPDOGDVHJXQGDEXOKD

(VWHVRSURGHIOX[RSXOPRQDUWDPEpPSRGHVHUDXVFXOWDGRHPTXDLVTXHUFRQGLo}HVDVVRFLDGDVD
VREUHFDUJDGHYROXPHGHTXDOTXHUHWLRORJLDFRPRDQHPLDFU{QLFDHDSyVDSUiWLFDGHH[HUFtFLRV
ItVLFRV3RGHSHUVLVWLUDWpDYLGDDGXOWD

Mamas
$V DOWHUDo}HV ItVLFDV QDV PDPDV GH XPD MRYHP VmR RV 2DSDUHFLPHQWRGHEURWRV
SULPHLURV VLQDLV GH SXEHUGDGH $ H[HPSOR GD PDLRULD GDV PDPiULRVPDVVDVGH
RXWUDV PXGDQoDV GR GHVHQYROYLPHQWR YHULILFDVH XPD FRQVLVWrQFLDILUPHGRWDPDQKR
SURJUHVVmR VLVWHPiWLFD (P JHUDO QR GHFRUUHU GH XP GHHUYLOKDVVRERVPDPLORV
VmRFRPXQVHPPHQLQDVH
SHUtRGRGHDQRVDVPDPDVSURJULGHPSRUFLQFRHVWiJLRV PHQLQRVSRXFRDQWHVGD
GHQRPLQDGRVHVWiJLRVGH7DQQHURXHVWiJLRVGHDIHULomRGH SXEHUGDGHRXQDIDVHLQLFLDOGD
PDWXULGDGH VH[XDO $06 GH 7DQQHU FRPR p PRVWUDGR QD SXEHUGDGH
SiJLQD2VEURWRVPDPiULRVQRHVWiJLRSUpDGROHVFHQWH
SURJULGHPSDUDDXPHQWRVXEVHTXHQWHHSDUDDPXGDQoDQR
FRQWRUQR GDV PDPDV H GD DUpROD (VVHV HVWiJLRV DFRPSDQKDPVH GR GHVHQYROYLPHQWR GH SHORV
S~ELFRVHGHRXWUDVFDUDFWHUtVWLFDVVH[XDLVVHFXQGiULDVFRPRpPRVWUDGRQRER[HGDSiJLQD
$PHQDUFDFRVWXPDRFRUUHUTXDQGRDMRYHPHQFRQWUDVHQRVHVWiJLRVPDPiULRVRXHDWpHVVD
DOWXUDDMRYHPMiDSUHVHQWRXHVWLUmRGHFUHVFLPHQWRYHMDSiJLQD

'XUDQWH DQRV D IDL[D GH YDULDomR QRUPDO GR VXUJLPHQWR $VVLPHWULDPDPiULDpXP

GHGHVHQYROYLPHQWRPDPiULRIRLFRQVLGHUDGDHQWUHH DFKDGRFRPXPQD
DQRV PpGLD  DQRV H VXUJLPHQWR DQWHULRU D HVVH HUD DGROHVFrQFLDVREUHWXGRHQWUH
FRQVLGHUDGR DQRUPDO $OJXQV HVWXGRV VXJHUHP TXH R RVHVWiJLRVHGH7DQQHU
,VVRpTXDVHVHPSUHXPD
SRQWR GH FRUWH GHYHULD VHU PDLV EDL[R FRP  DQRV SDUD FRQGLomREHQLJQD
PHQLQDV EUDQFDV H  SDUD PHQLQDV DIURDPHULFDQDV H
KLVSkQLFDV2GHVHQYROYLPHQWRGDVPDPDVYDULDGHDFRUGR
FRPDLGDGHDUDoDHDHWQLD$VPDPDVVXUJHPDYHORFLGDGHVGLIHUHQWHVHPDSUR[LPDGDPHQWH
GDVPHQLQDVFRPFRQVHTXHQWHDVVLPHWULDGHWDPDQKRRXHVWiJLRGH7DQQHU7UDQTXLOL]DURV
SDLVGHTXHLVVRHPJHUDOPHOKRUDHVSRQWDQHDPHQWHpXPDPHGLGD~WLO

$V DGROHVFHQWHV PDLV YHOKDV GHYHP VHU VXEPHWLGDV D XP H[DPH GH PDPD DEUDQJHQWH FRP
RULHQWDo}HVSDUDRDXWRH[DPHSiJLQD8PDFRPSDQKDQWHXPGRVSDLVRXXPDHQIHUPHLUD
GHYHHVWDUSUHVHQWHGXUDQWHRH[DPHUHDOL]DGRSRUSURILVVLRQDLVGHVD~GHGRVH[RPDVFXOLQR

$V PDPDV GRV PHQLQRV FRQVLVWHP HP XP SHTXHQR 0XLWRVUDSD]HVDSUHVHQWDP

PDPLOR H DUpROD 'XUDQWH D SXEHUGDGH FHUFD GH XP WHUoR JLQHFRPDVWLDDXPHQWRGDV
GRVPHQLQRVGHVHQYROYHXPERWmRILUPHGHWHFLGRGHFP PDPDVXQLODWHUDORXELODWHUDO
(PERUDHVVDJLQHFRPDVWLDVHMD
RX PDLV GH GLkPHWUR JHUDOPHQWH HP XPD ~QLFD PDPD 2V
KDELWXDOPHQWHGLVFUHWDSRGH
UDSD]HVREHVRVSRGHPDSUHVHQWDUPXLWRWHFLGRPDPiULR JHUDUHPEDUDoR&RVWXPD
GHVDSDUHFHUHPDOJXQVDQRV


(VFDODVGHPDWXULGDGHVH[XDOHPPHQLQDV_0DPD

(VW£JLR  

3U«DGROHVFHQWH$SHQDVHOHYD©¥RGRPDPLOR 

(VW£JLR (VW£JLR 

0DVVDVRXQµGXORVQDVPDPDVGHPHQLQDV
DGROHVFHQWHVGHYHPVHUH[DPLQDGRVFRP
FXLGDGR(PJHUDOV¥Rfibroadenomas benignosRX
FLVWRVHWLRORJLDVPHQRVSURY£YHLVLQFOXHP
abscessosRXlipomas2FDUFLQRPDPDP£ULR«
H[WUHPDPHQWHUDURQDDGROHVF¬QFLDHTXDVH
(VW£JLRGHEURWDPHQWRPDP£ULR(OHYD©¥RGDPDPDHGR VHPSUHRFRUUHHPIDP¯OLDVFRPIRUWHKLVWµULD
PDPLORFRPRXPSHTXHQRPRQWHDXPHQWRGRGL¤PHWUR
$XPHQWRDGLFLRQDOGDHOHYD©¥RGDPDPDHGDDU«RODVHP IDPLOLDUGDGRHQ©D
VHSDUD©¥RGHVHXVFRQWRUQRV
DUHRODU

(VW£JLR (VW£JLR 

(VW£JLRPDGXURDSHQDVSURMH©¥RGRPDPLOR$DU«RODUHWUDLVH
3URMH©¥RGDDU«RODHGRPDPLORSDUDFRQVWLWXLUXPDHOHYD©¥R SDUDIRUPDURFRQWRUQRJHUDOGDPDPDHPERUDHPDOJXPDV
VHFXQG£ULDDFLPDGRQ¯YHOGDPDPD PXOKHUHVQRUPDLVFRQWLQXHDFRQVWLWXLUXPDHOHYD©¥R
VHFXQG£ULD

BBBBBBBBBB

)RWRVXWLOL]DGDVFRPSHUPLVV¥RGD$PHULFDQ$FDGHP\RI3HGLDWULFV$VVHVVPHQWRI6H[XDO0DWXULW\6WDJHVLQ*LUOV
 

Abdome
$VWpFQLFDVGHH[DPHGRDEGRPHVmRDVPHVPDVXWLOL]DGDV $KHSDWRPHJDOLDHP
QRV DGXOWRV $V GLPHQV}HV GR ItJDGR DSUR[LPDPVH GDV DGROHVFHQWHVSRGHVHU
GLPHQV}HVGRDGXOWRDSyVDSXEHUGDGHHWHPUHODomRFRPD VHFXQGiULDDLQIHFo}HVFRPR
DOWXUD ILQDO GR DGROHVFHQWH 1mR H[LVWHP GDGRV VREUH D KHSDWLWHRXPRQRQXFOHRVH
LQIHFFLRVDGRHQoDLQIODPDWyULD
XWLOLGDGH GDV GLIHUHQWHV WpFQLFDV GH DYDOLDomR GR WDPDQKR LQWHVWLQDORXWXPRUHV
GR ItJDGR PDV p SURYiYHO TXH VH DSOLTXHP DV HYLGrQFLDV
RULJLQDGDV HP HVWXGRV GH DGXOWRV SULQFLSDOPHQWH QR FDVR
GHDGROHVFHQWHVPDLVYHOKRV$VVLPSDOSHRItJDGR&DVRHVVHQmRVHMDSDOSiYHODSRVVLELOLGDGH
GH KHSDWRPHJDOLD p PXLWR EDL[D &DVR VHMD SRVVtYHO SDOSDU D ERUGD LQIHULRU XVH SHUFXVVmR OHYH
SDUDDYDOLDUDVGLPHQV}HVKHSiWLFDV

Genitália masculina
2 H[DPH JHQLWDO GR DGROHVFHQWH HYROXL GD PHVPD PDQHLUD TXH R H[DPH GR DGXOWR GR VH[R
PDVFXOLQR7HQKDDWHQomRHVSHFLDODRFRQVWUDQJLPHQWRGHPXLWRVUDSD]HVFRPUHODomRDHVVDSDUWH
GRH[DPH

,PSRUWDQWHVPXGDQoDVDQDW{PLFDVGDJHQLWiOLDPDVFXOLQD 3XEHUGDGHWDUGLDGHYHVHU
DFRPSDQKDP D SXEHUGDGH H DMXGDP D DQDOLVDU VHX VXVSHLWDGDHPPHQLQRVTXH
SURJUHVVR 2 SULPHLUR VLQDO FRQILiYHO GH SXEHUGDGH FRP QmRDSUHVHQWHPVLQDLVGH
LQtFLR HQWUH  H  DQRV p R DXPHQWR GR WDPDQKR GRV GHVHQYROYLPHQWRSXEHUDODWp
RVDQRVGHLGDGH
WHVWtFXORV (P VHJXLGD VXUJHP RV SHORV S~ELFRV
DFRPSDQKDGRV SRU DXPHQWR SURJUHVVLYR GR SrQLV $
PXGDQoDFRPSOHWDGDSUpDGROHVFrQFLDSDUDDDQDWRPLDDGXOWDGHPRUDFHUFDGHDQRVFRPXPD
YDULDomRGHDDQRV

$RH[DPLQDURDGROHVFHQWHGRVH[RPDVFXOLQRpSUHFLVR $FDXVDPDLVFRPXPGH
DYDOLDU VXD PDWXULGDGH VH[XDO 2V FLQFR HVWiJLRV GH SXEHUGDGHWDUGLDQRVH[R
GHVHQYROYLPHQWRVH[XDOLQLFLDOPHQWHGHVFULWRVSRU7DQQHU PDVFXOLQRpRUHWDUGR
VmRHVERoDGRVHLOXVWUDGRVDVHJXLU (QYROYHP PXGDQoDV FRQVWLWXFLRQDOIUHTXHQWHPHQWH
XPTXDGURIDPLOLDUTXHHQYROYH
QRSrQLVQRVWHVWtFXORVHQDEROVDHVFURWDO$OpPGLVVRHP DWUDVRGDPDWXUDomRyVVHDH
FHUFD GH  GRV KRPHQV RV SHORV S~ELFRV DODVWUDPVH ItVLFDSRUpPQtYHLVKRUPRQDLV
SDUD DV UHJL}HV PDLV DFLPD QR DEGRPH H DGTXLUHP XP QRUPDLV
IRUPDWR WULDQJXODU DSRQWDQGR QR VHQWLGR GR XPELJR HVVD
IDVHVyVHFRQFOXLDWpDWHUFHLUDGpFDGDGHYLGD

8P D[LRPD GR GHVHQYROYLPHQWR p TXH DV DOWHUDo}HV GD (PERUDDHMDFXODomRGLXUQDRX

SXEHUGDGH HYROXHP DFRPSDQKDQGR XPD VHTXrQFLD EHP QRWXUQDWHQGDDVHLQLFLDUQR
HVWDEHOHFLGDYHMDDGLDQWH$VIDL[DVHWiULDVGHVGHRLQtFLR (VWiJLRGH0DWXUDomR6H[XDO
DWpDFRQFOXVmRVmREHPDPSODVPDVDVHTXrQFLDSDUDFDGD RUHODWRGHVHFUHomRSHQLDQDQD
DQDPQHVHRXQRH[DPHItVLFR
UDSD] p DLQGD DVVLP LGrQWLFD ,VVR DMXGD D RULHQWDU SRGHLQGLFDUGRHQoD
DGROHVFHQWHVSUHRFXSDGRVHPUHODomRjVXDPDWXUDomRDWXDO VH[XDOPHQWHWUDQVPLVVtYHO
H IXWXUD EHP FRPR j QRUPDOLGDGH GDV PXGDQoDV GD
SXEHUGDGH FRQVLGHUDQGR XPD YDULDomR GH LGDGH PDLV
DPSOD

$OpPGRUHWDUGRFRQVWLWXFLRQDO
DVFDXVDVPHQRVFRPXQVGH
UHWDUGRGDSXEHUGDGHQRV
PHQLQRVLQFOXHP
KLSRJRQDGLVPRSULPiULRRX
KLSRJRQDGLVPRVHFXQGiULR
DVVLPFRPRGHILFLrQFLD
FRQJrQLWDGH*Q+5

$GROHVFHQWHVGRVH[RPDVFXOLQRRVQ~PHURVDEDL[RGDVEDUUDV
LQGLFDPDVIDL[DVHWiULDVQDVTXDLVDVPXGDQoDVRFRUUHP

(VFDODVGHPDWXULGDGHHPPHQLQRV

$RDWULEXLUDSRQWXD©¥R¢PDWXULGDGHVH[XDOHPPHQLQRVREVHUYHFDGDXPDGDVWU¬VFDUDFWHU¯VWLFDVHPVHSDUDGRSRLVHODVSRGHP
GHVHQYROYHUVHHPYHORFLGDGHVGLIHUHQWHV5HJLVWUHGXDVSRQWXD©·HVVHSDUDGDVSHORVS¼ELFRVHµUJ¥RVJHQLWDLV6HRS¬QLVHRV
WHVW¯FXORVDSUHVHQWDUHPHVW£JLRVGLIHUHQWHVGHYHVHID]HUDP«GLDGRVGRLVHDWULEXLUXPYDORU¢SRQWXD©¥RJHQLWDO
  3HORVS¼ELFRV 3¬QLV 7HVW¯FXORV

3U«DGROHVFHQWHɥDXV¬QFLDGHSHORV 3U«DGROHVFHQWHɥPHVPR
3U«DGROHVFHQWHɥPHVPRWDPDQKRHSURSRU©·HV
(VW£JLR  S¼ELFRVH[FHWRSRUILQRVSHORVFRUSRUDLV WDPDQKRHSURSRU©·HVTXHQD
TXHQDLQI¤QFLD
SHQXJHPVHPHOKDQWHVDRVGRDEGRPH LQI¤QFLD

&UHVFLPHQWRHVFDVVRGHSHORVORQJRV
GLVFUHWDPHQWHSLJPHQWDGRVHILQRVUHWRV
(VW£JLR
RXDSHQDVOHYHPHQWHFXUYRV
SULQFLSDOPHQWHQDEDVHGRS¬QLV
7HVW¯FXORVDXPHQWDPHVFURWRDXPHQWDGRXP
$XPHQWRGLVFUHWRRXDXVHQWH
SRXFRDYHUPHOKDGRHFRPWH[WXUDDOWHUDGD

3HORVPDLVHVFXURVFUHVSRV
$XPHQWDGRSULQFLSDOPHQWHHP
(VW£JLR HQFDUDFRODGRVHHVFDVVRVHVSDOKDGRV $XPHQWRDLQGDPDLRU
FRPSULPHQWR
VREUHDV¯QILVHS¼ELFD

3HORVFUHVSRVHHQFDUDFRODGRVFRPRQR
DGXOWRDUHJL¥RUHFREHUWDSRUSHORV
(VW£JLR H[FHGHDGRHVW£JLRSRU«PQ¥R«W¥R
JUDQGHTXDQWRQRDGXOWRHDLQGDQ¥R
LQFOXLDVFR[DV
$XPHQWRDLQGDPDLRUGH
$XPHQWRDGLFLRQDOHVFXUHFLPHQWRGDSHOHGR
FRPSULPHQWRHODUJXUDFRP
HVFURWR
GHVHQYROYLPHQWRGDJODQGH

4XDQWLGDGHHFDUDFWHU¯VWLFDVVHPHOKDQWHV
¢VGRDGXOWRHVSDOKDGRVSDUDDV
(VW£JLR )RUPDWRHWDPDQKRGRDGXOWR )RUPDWRHWDPDQKRGRDGXOWR
VXSHUI¯FLHVPHGLDLVGDVFR[DVSRU«P
DLQGDQ¥RSDUDRDEGRPH
 BBBBBBBBBB
$VIRWRJUDILDVIRUDPUHSURGX]LGDVGH3HGLDWULF(QGRFULQRORJ\DQG*URZWKQGHG:DOHV :LWFRPSHUPLVV¥RGH(OVHYLHU

Genitália feminina
2 H[DPH H[WHUQR GRV yUJmRV JHQLWDLV GD DGROHVFHQWH 6HFUHomRYDJLQDOHPXPD
SURJULGH GD PHVPD PDQHLUD TXH R GDV PHQLQDV HP LGDGH DGROHVFHQWHMRYHPGHYHVHU
HVFRODU6HIRUQHFHVViULRUHDOL]DUXPH[DPHJLQHFROyJLFR WUDWDGDFRPRQDPXOKHUDGXOWD
FRPSOHWR QD DGROHVFHQWH D WpFQLFD GH H[DPH p D PHVPD $VFDXVDVLQFOXHPOHXFRUUHLD
ILVLROyJLFDGRHQoDV
XVDGD QD PXOKHU DGXOWD LQFOXVLYH R WRTXH UHWDO 8PD VH[XDOPHQWHWUDQVPLVVtYHLVSRU
H[SOLFDomRFRPSOHWDGDVHWDSDVGRH[DPHDGHPRQVWUDomR DWLYLGDGHVH[XDOFRQVHQVXDORX
GRV LQVWUXPHQWRV H XPD DERUGDJHP WUDQTXLOD H FXLGDGRVD DEXVRVH[XDOYDJLQRVH
VmR QHFHVViULDV SRUTXH D DGROHVFHQWH FRVWXPD ILFDU EDFWHULDQDFRUSRHVWUDQKRH
DJHQWHVLUULWDQWHVH[WHUQRV
EDVWDQWH DQVLRVD e IXQGDPHQWDO TXH D SDFLHQWH WHQKD XPD
DFRPSDQKDQWH D PmH RX XPD HQIHUPHLUD 2 SULPHLUR
H[DPHSpOYLFRGHXPDDGROHVFHQWHGHYHVHUUHDOL]DGRSRUXPJLQHFRORJLVWDH[SHULHQWH

2V VLQDLV LQLFLDLV GH SXEHUGDGH IHPLQLQD VmR DOWHUDo}HV 2GHVHQYROYLPHQWRSXEHUDO

GR KtPHQ VHFXQGiULDV DR HVWURJrQLR DODUJDPHQWR GRV DQWHVGDIDL[DHWiULDQRUPDO
TXDGULV H R LQtFLR GR HVWLUmR GH FUHVFLPHQWR HPERUD VHMD SRGHVLJQLILFDUSXEHUGDGH
GLItFLO GHWHFWDU HVVDV PXGDQoDV 2 SULPHLUR VLQDO SUHFRFHTXHWHPGLYHUVDV
FDXVDVHQGyFULQDVHGRVLVWHPD
IDFLOPHQWH GHWHFWiYHO GH SXEHUGDGH FRVWXPD VHU R QHUYRVRFHQWUDO
VXUJLPHQWRGRVEURWRVPDPiULRVHPERUDjVYH]HVRVSHORV
S~ELFRV DSDUHoDP SULPHLUR $ LGDGH PpGLD GH
DSDUHFLPHQWR GRV SHORV S~ELFRV GLPLQXLX QRV ~OWLPRV DQRV H R FRQVHQVR DWXDO p GH TXH R
VXUJLPHQWRGHSHORVS~ELFRVHPLGDGHVWmRSUHFRFHVTXDQWRDQRVSRGHVHUFRQVLGHUDGRQRUPDO
SULQFLSDOPHQWH HP PHQLQDV GH SHOH HVFXUD TXH GHVHQYROYHP FDUDFWHUtVWLFDV VH[XDLV VHFXQGiULDV
PDLVSUHFRFHPHQWH

'HYHVHUDWULEXtGDXPDSRQWXDomRGHPDWXULGDGHVH[XDOD $SXEHUGDGHWDUGLDDXVrQFLD

WRGDV DV SDFLHQWHV LQGHSHQGHQWHPHQWH GH VXD LGDGH GHPHQDUFDDWpRVDQRVGH
FURQROyJLFD$DYDOLDomRGDPDWXULGDGHVH[XDOGDVPHQLQDV LGDGHpKDELWXDOPHQWH
FDXVDGDSRUVHFUHomR
WHP FRPR EDVH WDQWR R FUHVFLPHQWR GRV SHORV S~ELFRV
LQDGHTXDGDGHJRQDGRWURILQD
TXDQWRRGHVHQYROYLPHQWRPDPiULR$DYDOLDomRHVWiJLR SHODDGHQRKLSyILVHHPUD]mR
GH7DQQHUGRFUHVFLPHQWRGRVSHORVS~ELFRVpPRVWUDGDQR GHSURGXomRKLSRWDOkPLFD
ER[H D VHJXLU 9HMD QD SiJLQD  D DYDOLDomR GR GHIHLWXRVDGH*Q5+
GHVHQYROYLPHQWR PDPiULR 2ULHQWH DV PHQLQDV VREUH HVWD 2EYLDPHQWHH[LVWHPFDXVDV
PDLVUDUDVYHMDSiJLQD
VHTXrQFLDHVHXHVWiJLRDWXDO

(VFDODVGHPDWXULGDGHVH[XDOHPPHQLQDV_3HORVS¼ELFRV

(VW£JLR   

3U«DGROHVFHQWHVɥDXV¬QFLDGHSHORVS¼ELFRVH[FHWRSRUILQRVSHORVFRUSRUDLVSHQXJHPVHPHOKDQWHVDRVHQFRQWUDGRVQR


DEGRPH

(VW£JLR (VW£JLR 

$amenorreiaQDDGROHVF¬QFLDSRGHVHUSULP£ULD
RXVHMDDXV¬QFLDGHPHQDUFDDW«RVDQRVGH
LGDGHRXVHFXQG£ULDVXVSHQV¥RGD
PHQVWUXD©¥RHPDGROHVFHQWHVTXHDQWHV
&UHVFLPHQWRHVSDUVRGHSHORVORQJRVGLVFUHWDPHQWH
SLJPHQWDGRVHILQRVRXDSHQDVGLVFUHWDPHQWH
HQFDUDFRODGRVSULQFLSDOPHQWHDFRPSDQKDQGRRVO£ELRV
PDLRUHVGRSXGHQGR
PHQVWUXDYDP(PERUDDDPHQRUUHLDSULP£ULD
WHQKDKDELWXDOPHQWHFDXVDVDQDW¶PLFDVRX
JHQ«WLFDVDDPHQRUUHLDVHFXQG£ULDSRGHWHU 
LQ¼PHUDVHWLRORJLDV
3HORVPDLVHVFXURVFUHVSRVHHQFDUDFRODGRVTXHVHHVSDOKDP
GHPRGRHVSDUVRVREUHDV¯QILVHS¼ELFD

(VW£JLR (VW£JLR  

 

3HORVFUHVSRVHHQFDUDFRODGRVFRPRHPDGXOWRVUHJL¥R 4XDQWLGDGHHFDUDFWHU¯VWLFDVGRVSHORVVHPHOKDQWHV¢VGR
UHFREHUWDPDLRUTXHQRHVW£JLRSRU«PDLQGDQ¥R«LJXDO¢ DGXOWRHVSDOKDPVHQDVVXSHUI¯FLHVPHGLDLVGDFR[DPDV
GLVWULEXL©¥RGRDGXOWRQHPLQFOXLDVFR[DV DLQGDQ¥RSDUDRDEGRPH

BBBBBBBBBB
 
)RWRJUDILDVXWLOL]DGDVFRPSHUPLVV¥RGD$PHULFDQ$FDGHP\RI3HGLDWULFV$VVHVVPHQWRI6H[XDO0DWXULW\6WDJHVLQ*LUOV

(PERUD H[LVWD XPD DPSOD YDULDomR QD LGDGH GH LQtFLR H $SXEHUGDGHWDUGLDQD
FRQFOXVmRGDSXEHUGDGHpSUHFLVROHPEUDUTXHRVHVWiJLRV DGROHVFHQWHDEDL[RGRR
REHGHFHP D XPD VHTXrQFLD SUHYLVtYHO FRPR PRVWUDGR D SHUFHQWLOHPDOWXUDSRGHVHU
VHJXLU GHFRUUrQFLDGHVtQGURPHGH
7XUQHURXGRHQoDFU{QLFD$V
GXDVFDXVDVPDLVFRPXQVGH
GHVHQYROYLPHQWRVH[XDOWDUGLR
HPPHQLQDVDGROHVFHQWHV
H[WUHPDPHQWHPDJUDVVmR
DQRUH[LDQHUYRVDHGRHQoD
 FU{QLFD

2EHVLGDGHQDVPHQLQDVSRGH
HVWDUDVVRFLDGDDRFRUUrQFLD
SUHPDWXUDGHSXEHUGDGH

$GROHVFHQWHV GR VH[R IHPLQLQR RV YDORUHV DEDL[R GDV EDUUDV LQGLFDP DV IDL[DV HWiULDV QDV TXDLV DV
DOWHUDo}HVRFRUUHP

Sistema musculoesquelético
$DYDOLDomRGHHVFROLRVHHRVH[DPHVSDUDSDUWLFLSDomRHPDWLYLGDGHVHVSRUWLYDVYHMDSiJLQDV
DFRQWLQXDPVHQGRRVFRPSRQHQWHVPDLVFRPXQVGRH[DPHHPDGROHVFHQWHV2VGHPDLV
VHJPHQWRVGRH[DPHPXVFXORHVTXHOpWLFRVmRLGrQWLFRVDRVGRVDGXOWRV

Avaliação de escoliose. e SUHFLVR FHUWLILFDUVH GH TXH DV FULDQoDV VH FXUYHP SDUD IUHQWH FRP RV
MRHOKRV UHWLILFDGRV WHVWH GD LQFOLQDomR GH $GDPV $YDOLH HQWmR HYHQWXDLV DVVLPHWULDV GH
SRVLomRRXPDUFKD$HVFROLRVHHPXPSUpHVFRODUpLQFRPXPHDQRUPDOGLVFUHWDHVFROLRVHHP
XPDFULDQoDPDLVYHOKDQmRpUDUD

6H SHUFHEHU HVFROLRVH XVH XP HVFROL{PHWUR SDUD 'LYHUVRVWLSRVGHHVFROLRVH

YHULILFDU R JUDX GH HVFROLRVH &RP R SDFLHQWH HP SRVLomR SRGHPVHUHQFRQWUDGRVQD
RUWRVWiWLFDYHULILTXHVHKiDVVLPHWULDQDVHVFiSXODVRXQDV LQIkQFLD$HVFROLRVHLGLRSiWLFD
SUHJDV JO~WHDV 6ROLFLWH DR DGROHVFHQWH TXH VH FXUYH SDUD GRVFDVRVHQFRQWUDGD
SULQFLSDOPHQWHHPPHQLQDV
IUHQWHFRQIRUPHGHVFULWR9HULILTXHVHKiSURHPLQrQFLDGDV FRVWXPDVHUGHWHFWDGDQRLQtFLR
FRVWHODV SRVWHULRUHV 2 HVFROL{PHWUR p DSRLDGR QD FROXQD GDDGROHVFrQFLD&RPRVHSRGH
YHUWHEUDO QR SRQWR GH SURHPLQrQFLD Pi[LPD DVVHJXUDQGR YHUQDILJXUDDRODGRRRPEUR
VH GH TXH D FROXQD ILTXH SDUDOHOD DR FKmR QHVVH SRQWR GLUHLWRpJHUDOPHQWHRPDLV
SURHPLQHQWH2XWURVWLSRVGH
FRPR PRVWUDGR QD IRWRJUDILD 6ROLFLWH DR DGROHVFHQWH TXH
HVFROLRVHVmRRQHXURPXVFXODU
VH LQFOLQH WRWDOPHQWH SDUD IUHQWH GH PRGR D SHUPLWLU D HRFRQJrQLWR
DYDOLDomR GD HVFROLRVH ORPEDU H TXH VH LQFOLQH XP SRXFR
PHQRVQDDYDOLDomRGDHVFROLRVHWRUiFLFD
 

3RGHVHWDPEpPXWLOL]DUXPSUXPR±XPILRFRPXPSHVR (VFROLRVHDSDUHQWHLQFOXVLYH
HP VXD SRQWD ± SDUD DYDOLDU D DVVLPHWULD GDV FRVWDV XPWHVWHGHSUXPRDQRUPDO
&RORTXH R SUXPR QD VpWLPD YpUWHEUD FHUYLFDO & 9,, H SRGHVHUFDXVDGDSRU
GLVFUHSkQFLDQRFRPSULPHQWR
VROLFLWHjFULDQoDTXHILTXHHPSRVLomRRUWRVWiWLFD$OLQKD
GDVSHUQDVYHMDSiJLQD
GR SUXPR GHYH HVWHQGHUVH DWp D SUHJD JO~WHD QmR
PRVWUDGDDTXL

$HVFROLRVHpPDLVHQFRQWUDGDHPFULDQoDVHDGROHVFHQWHVFRPDQRUPDOLGDGHVQHXUROyJLFDVRX
PXVFXORHVTXHOpWLFDV

Exame musculoesquelético anterior à participação em atividades 2VIDWRUHVGHULVFRLPSRUWDQWHV

esportivas. 0DLV GH  PLOK}HV GH DGROHVFHQWHV QRV (8$ H SDUDPRUWHFDUGLRYDVFXODU
HP PXLWRV RXWURV SDtVHV SDUWLFLSDP GH DWLYLGDGHV V~ELWDGXUDQWHDWLYLGDGH
HVSRUWLYDLQFOXHPHSLVyGLRVGH
HVSRUWLYDV RUJDQL]DGDV H PXLWDV YH]HV QHFHVVLWDP GH
WRQWHLUDRXSDOSLWDo}HV
³OLEHUDomR PpGLFD´ 3ULPHLUR p SUHFLVR ID]HU XPD VtQFRSHSUpYLDSULQFLSDOPHQWH
PLQXFLRVD DQDPQHVH FRQFHQWUDQGRVH HP IDWRUHV GH ULVFR VHDVVRFLDGDjSUiWLFDGH
FDUGLRYDVFXODUHVLQWHUYHQo}HVFLU~UJLFDVHOHV}HVSUpYLDV H[HUFtFLRVItVLFRVRXKLVWyULD
RXWURV SUREOHPDV FOtQLFRV H KLVWyULD IDPLOLDU 2 H[DPH IDPLOLDUGHPRUWHV~ELWDHP
SDUHQWHVMRYHQVRXGHPHLD
ItVLFRTXHSUHFHGHDSDUWLFLSDomRHPDWLYLGDGHVHVSRUWLYDV LGDGH
PXLWDV YH]HV p R ~QLFR PRPHQWR HP TXH XP DGROHVFHQWH
VDXGiYHO VHUi H[DPLQDGR SRU XP SURILVVLRQDO PpGLFR 'XUDQWHDDYDOLDomRSUpYLDj
SUiWLFDGHDWLYLGDGHV
$VVLP VHQGR p LPSRUWDQWH LQFOXLU DOJXPDV SHUJXQWDV GH
HVSRUWLYDVSHVTXLVH
UDVWUHDPHQWR H RULHQWDomR DQWHFLSDWyULD YHMD D GLVFXVVmR FXLGDGRVDPHQWHVRSURV
HP 3URPRomR H RULHQWDomR GD VD~GH )LQDOPHQWH p FDUGtDFRVHVLELORVQRV
UHDOL]DGR XP H[DPH ItVLFR JHUDO FRP DWHQomR HVSHFLDO DR SXOP}HV$OpPGLVVRVHR
DGROHVFHQWHVMiVRIUHX
FRUDomR H SXOP}HV H DR UDVWUHDPHQWR YLVXDO H DXGLWLYR
WUDXPDWLVPRFUDQLRHQFHIiOLFR
,QFOXD XP H[DPH PLQXFLRVR H IRFDOL]DGR GR VLVWHPD RXFRQFXVVmRpSUHFLVRUHDOL]DU
PXVFXORHVTXHOpWLFR SHVTXLVDQGR SDUHVLD OLPLWDomR GD XPH[DPHQHXUROyJLFR
DPSOLWXGHGHPRYLPHQWDomRHHYLGrQFLDVGHOHV}HVSUpYLDV FXLGDGRVRHIRFDOL]DGR

2 H[DPH GH UDVWUHDPHQWR PXVFXORHVTXHOpWLFR SUpYLR D

SDUWLFLSDo}HVHPDWLYLGDGHVHVSRUWLYDVUHFRPHQGDGRDWXDOPHQWHpUHDOL]DGRHPGRLVPLQXWRV
([DPHGHUDVWUHDPHQWRPXVFXORHVTXHO«WLFRSDUDDWLYLGDGHVHVSRUWLYDV

3RVL©¥RHRULHQWD©¥RDR
 $QRUPDOLGDGHVFRPXQVSRUOHV·HVSU«YLDV
SDFLHQWH

(WDSDILFDUHPSRVL©¥R
(WDSDPRYLPHQWDURSHVFR©RHPWRGDVDVGLUH©·HV
RUWRVW£WLFDROKDQGRSDUDIUHQWH

(WDSDDVVLPHWULDHGHPDGDVDUWLFXOD©·HV

(WDSDSHUGDGDDPSOLWXGHGHPRYLPHQWD©¥R

(WDSDHQFROKHURVRPEURV
(WDSDHVWLFDURVEUD©RVSDUDIRUDHSDUDRVODGRVFRQWUDUHVLVW¬QFLD
FRQWUDUHVLVW¬QFLD

(WDSDIUDTXH]DGRVP¼VFXORVGRRPEURGRSHVFR©RRXWUDS«]LR

(WDSDSHUGDGHIRU©DGRP¼VFXORGHOWRLGH

(WDSDHVWLFDURVEUD©RVSDUDRV
ODGRVFRPRVFRWRYHORV (WDSDHVWLFDURVEUD©RVSDUDIRUDGREUDUHHVWLFDUFRPSOHWDPHQWH
IOH[LRQDGRVHPrHOHYDUH RVFRWRYHORV
DEDL[DURVDQWHEUD©RV

(WDSDSHUGDGDURWD©¥RH[WHUQDHOHV¥RGDDUWLFXOD©¥RGRRPEUR
JOHQRXPHUDO

(WDSDUHGX©¥RGDDPSOLWXGHGHPRYLPHQWD©¥RGRFRWRYHOR

(WDSDFHUUDURSXQKRHGHSRLVDEULUDP¥RHDIDVWDURVGHGRV

(WDSDFRORFDURVEUD©RVSDUD
EDL[RGREUDURVFRWRYHORVHP
rHUHDOL]DUSURQD©¥RH
VXSLQD©¥RGRVDQWHEUD©RV (WDSDUHGX©¥RGDDPSOLWXGHGHPRYLPHQWD©¥RSRUFDXVDGHOHV¥R
GRDQWHEUD©RGRFRWRYHORRXGRSXQKR
 (WDSDSURWUXV¥RGDVDUWLFXOD©·HVPHWDFDUSRIDO¤QJLFDVUHGX©¥RGD
DPSOLWXGHGHPRYLPHQWRGRVGHGRVSRUHQWRUVHVRXIUDWXUDVSU«YLDV

(WDSDILFDUHPSRVL©¥RRUWRVW£WLFDFRPRVEUD©RVDRODGRGRFRUSR
(WDSDILFDUGHFµFRUDVHGDU ROKDQGRGHWU£V
TXDWURSDVVRV

(WDSDLQFDSDFLGDGHGHIOH[LRQDUWRWDOPHQWHRVMRHOKRVHGLILFXOGDGH
GHOHYDQWDUVHDSDUWLUGHVVDSRVL©¥RSRUOHV¥RSU«YLDGRMRHOKRRX
WRUQR]HOR

(WDSDDVVLPHWULDSRUHVFROLRVHGLVFUHS¤QFLDQRFRPSULPHQWRGRV
PHPEURVLQIHULRUHVRXIUDTXH]DPXVFXODUSRUOHV¥R

(WDSDLQFOLQDURWURQFRSDUD
IUHQWHFRPRVMRHOKRVUHWRVH (WDSDILFDUQDSRQWDGRVGHGRV
WRFDURVGHGRVGRVS«V

(WDSDDVVLPHWULDSRUFDXVDGHHVFROLRVHHORPEDOJLD

(WDSDDWURILDGRVP¼VFXORVGDSDQWXUULOKDSRUFDXVDGHOHV¥RGR
WRUQR]HORRXGRWHQG¥RGH$TXLOHV

Sistema nervoso
2H[DPHQHXUROyJLFRGRDGROHVFHQWHpLGrQWLFRDRGRDGXOWR2GHVHQYROYLPHQWRGRDGROHVFHQWH
HQWUHWDQWR GHYH VHU DYDOLDGR VHJXQGR RV PDUFRV GH UHIHUrQFLDV HVSHFtILFRV SDUD D LGDGH
FRQIRUPHGHVFULWRQDVSiJLQDVH

5HJLVWURGRVVHXVDFKDGRV

2EVHUYHTXHGHLQtFLRYRFrXVDUiIUDVHVLQWHLUDVSDUDGHVFUHYHUVHXVDFKDGRVPDLVWDUGHSDVVDUi
DDGRWDUDQRWDo}HVPDLVFXUWDV2H[HPSORDVHJXLUFRQWpPH[SUHVV}HVDGHTXDGDVjPDLRULDGDV
DQRWDo}HV¬PHGLGDTXHIRUOHQGRRUHJLVWURYRFrLUiSHUFHEHUDOJXQVDFKDGRVDWtSLFRV7HVWHD
VLPHVPRYHQGRVHFRQVHJXHLQWHUSUHWDUHVVHVDFKDGRVQRFRQWH[WRGHWXGRRTXHDSUHQGHXVREUHR
H[DPHSHGLiWULFRDWpDTXL9RFrWDPEpPLUiREVHUYDUDVPRGLILFDo}HVQHFHVViULDVSDUDDFRPRGDU
UHODWRVGRVSDLVGHFULDQoDVSHTXHQDVFXMDLQIRUPDomRHVSRQWkQHDpOLPLWDGD

Registro dos seus achados | O paciente pediátrico



%ULDQ«XPPHQLQRGHPHVHVDWLYRTXHFKHJD¢FRQVXOWDDFRPSDQKDGRGDP¥H(ODDQGDSUHRFXSDGDFRPRGHVHQYROYLPHQWRHR
FRPSRUWDPHQWRGRPHQLQR

(QFDPLQKDPHQWR1¥RKRXYH

)RQWHHFRQILDELOLGDGH0¥H

4XHL[DSULQFLSDO'HVHQYROYLPHQWROHQWRHFRPSRUWDPHQWRGLI¯FLO

'RHQ©DDWXDO%ULDQSDUHFHHVWDUVHGHVHQYROYHQGRPDLVGHYDJDUGRTXHDLUP¥PDLVYHOKD6µXVDSDODYUDVHIUDVHVVLPSOHVGLILFLOPHQWH
FRPELQDSDODYUDVHSDUHFHILFDUIUXVWUDGRFRPRIDWRGHQ¥RFRQVHJXLUVHFRPXQLFDU$VSHVVRDVHQWHQGHPFHUFDGHGRTXHHOHIDOD2
GHVHQYROYLPHQWRI¯VLFRSDUHFHQRUPDOFRQVHJXHODQ©DUXPDERODFKXWDUUDELVFDUHVHYHVWLUVHPSUREOHPDV1¥RVRIUHXWUDXPDWLVPR
FUDQLRHQFHI£OLFRQ¥RDSUHVHQWDGRHQ©DVFU¶QLFDVFRQYXOV·HVQHPUHJUHVV¥RGRVVHXVPDUFRVGRGHVHQYROYLPHQWR

$P¥HHVW£SUHRFXSDGDWDPE«PFRPRFRPSRUWDPHQWRGH%ULDQ2PHQLQR«PXLWRWHLPRVRWHPFULVHVGHUDLYDIUHTXHQWHVILFDLUULWDGR
FRPIDFLOLGDGHSULQFLSDOPHQWHFRPDLUP¥PDLVYHOKDMRJDREMHWRVPRUGHHEDWHHPRXWUDVSHVVRDVTXDQGRQ¥RFRQVHJXHRTXHTXHU2
VHXFRPSRUWDPHQWRSDUHFHSLRUDUTXDQGRHVW£SHUWRGDP¥HTXHUHIHUHTXHHOHILFDɪµWLPRɫQDFUHFKH/£HOHSDVVDGHXPDDWLYLGDGHSDUD
RXWUDH«LQFDSD]GHILFDUVHQWDGRTXLHWRSDUDOHURXMRJDUXPMRJR

%ULDQ«H[WUHPDPHQWHɪHQMRDGRɫSDUDFRPHUFRQVRPHPXLWDFRPLGDGHODQFKRQHWHVHTXDVHQHQKXPRXWURDOLPHQWR1¥RFRPHQHP
IUXWDVQHPYHJHWDLVHEHEHPXLWRVXFRHUHIULJHUDQWHV$P¥HM£WHQWRXGHWXGRSDUDTXHHOHFRPDDOLPHQWRVVDXG£YHLVVHPVXFHVVR

$IDP¯OLDYHPSDVVDQGRSRUVLJQLILFDWLYDVWHQV·HVQR¼OWLPRDQRSRLVRSDLGH%ULDQHVW£GHVHPSUHJDGR%ULDQDJRUDWHPGLUHLWRDR
0HGLFDLG PDVRVSDLVQ¥RW¬PSODQRGHVD¼GH

0HGLFD§£R&RPSOH[RPXOWLYLWDP¯QLFRXPFRPSULPLGRGL£ULR

+LVWµULDSUHJUHVVD

Gravidez6HPLQWHUFRUU¬QFLDVDP¥HUHGX]LXRVFLJDUURVSDUDPHLRPD©RDRGLDHLQJHULXEHELGDDOFRµOLFD¢VYH]HV1HJDXVRGHRXWUDV
GURJDVRXLQIHF©·HV

Período neonatal.1DVFLGRGHSDUWRYDJLQDOFRPVHPDQDVWHYHDOWDHPGLDV3HVRDRQDVFLPHQWRGHNJ0¥HQ¥RVDEHLQIRUPDU
RPRWLYRSHORTXDO%ULDQHUDSHTXHQRDRQDVFLPHQWR

Doenças.$SHQDVGRHQ©DVWULYLDLVVHPLQWHUQD©·HV

Acidentes.3UHFLVRXVHUVXWXUDGRQRDQRSDVVDGRSRUFDXVDGHXPDODFHUD©¥RIDFLDOVHFXQG£ULDDXPDTXHGDQDUXD

Cuidados preventivos.%ULDQID]FKHFNXSVSUHYHQWLYRVUHJXODUHV2¼OWLPRDFRQWHFHXK£PHVHVHRP«GLFRGLVVHTXH%ULDQHVWDYDXP
SRXFRDWUDVDGRQRVPDUFRVGRGHVHQYROYLPHQWRHVXJHULXXPDFUHFKHTXHDFKDYDH[FHOHQWHDO«PGHPDLRUDWHQ©¥RGRVSDLVDIDODOHLWXUD
EULQFDGHLUDVHHVW¯PXORV$VYDFLQDVHVW¥RHPGLD2Q¯YHOVDQJX¯QHRGHFKXPERHVWDYDGLVFUHWDPHQWHHOHYDGRDW«DQRSDVVDGRHDP¥H
UHIHUHTXHHOHWHPɪSRXFRVDQJXHɫ2SHGLDWUDUHFRPHQGRXVXSOHPHQWRVHDOLPHQWRVULFRVHPIHUURPDV%ULDQQ¥RWROHUDHVVHVDOLPHQWRV
 +LVWµULDIDPLOLDU

,PSRUWDQWHKLVWµULDIDPLOLDUGHGLDEHWHVPHOLWRGRLVDYµVQHQKXPGHOHVFRPGLDEHWHVMXYHQLOHKLSHUWHQV¥RDUWHULDO0¥HQHJDKLVWµULD

IDPLOLDUGHGRHQ©DVGRGHVHQYROYLPHQWRLQIDQWLOSVLTXL£WULFDVRXFU¶QLFDV

História do desenvolvimento:6HQWRXVHDRVPHVHVHQJDWLQKRXDRVHDQGRXDRVPHVHV3ULPHLUDVSDODYUDVɪPDPDɫHɪFDUURɫ

IRUDPGLWDVHPWRUQRGHDQR

História pessoal e social:2VSDLVV¥RFDVDGRVHPRUDPFRPGRLVILOKRVHPXPDSDUWDPHQWRDOXJDGR2SDLQ¥RWHPXPHPSUHJRIL[R

K£DQRHID]ELVFDWHVHPFRQVWUX©¥RFLYLO$P¥HWUDEDOKDFRPRJDU©RQHWHGXUDQWHRWHPSRTXH%ULDQSDVVDQDFUHFKH

$P¥HWHYHGHSUHVV¥RQRSULPHLURDQRGHYLGDGH%ULDQHIRLDDOJXPDVVHVV·HVGHWHUDSLDPDVLQWHUURPSHXDVSRUQ¥RFRQVHJXLUSDJ£ODVH
DRVUHP«GLRV&RQWDFRPRDSRLRGDP¥HTXHPRUDDPLQGHGLVW¤QFLDHGHPXLWRVDPLJRVTXH¢VYH]HVILFDPFRPDFULDQ©DSDUDHOD

$SHVDUGDVXEVWDQFLDOWHQV¥RIDPLOLDUDP¥HGHVFUHYHXPDIDP¯OLDFDULQKRVDHEHPIRUPDGD7HQWDPMDQWDUMXQWRVWRGRVRVGLDVUHVWULQJHP
RVKRU£ULRVGH79OHHPSDUDDVGXDVFULDQ©DVDSHVDUGH%ULDQQ¥RILFDUSDUDGRHY¥RDXPSDUTXHSUµ[LPRSDUDEULQFDU

([SRVL§µHVDPELHQWDLV2VSDLVIXPDPHPERUDHPJHUDOIRUDGDFDVD

6HJXUDQ§D$P¥HUHIHUHTXHHVVH«XPSRQWRGHSUHRFXSD©¥RLPSRUWDQWHGLILFLOPHQWHSRGHGHL[DU%ULDQVDLUGHVXDYLVWDVHPTXHHOH
ɪDSURQWHDOJXPDDUWHɫ7HPPHGRGHTXHHOHVHMDDWURSHODGRDP¥HHVW£SHQVDQGRHPJUDGHDURSHTXHQRTXLQWDO%ULDQILFDVHQWDGRHP
VXDFDGHLULQKDQRFDUURDPDLRUSDUWHGRWHPSRK£GHWHFWRUHVGHIXPD©DHPFDVD$VDUPDVGRSDLILFDPWUDQFDGDVRVPHGLFDPHQWRV
ILFDPQRDUP£ULRQRTXDUWRGRVSDLV

5HYLV¥RGHVLVWHPDV

Geral.6HPGRHQ©DVLPSRUWDQWHV

Pele.5HVVHFDGDHSUXULJLQRVD1RDQRSDVVDGRXVRXKLGURFRUWLVRQDSDUDHVVHSUREOHPD

Cabeça, olhos, orelhas, nariz e garganta.&DEH§D$XV¬QFLDGHWUDXPDWLVPR2OKRV%RDYLV¥R2UHOKDV0¼OWLSODVLQIHF©·HVQRDQR

SDVVDGR&RPIUHTX¬QFLDLJQRUDRVSHGLGRVGRVSDLVHOHVQ¥RVDEHPGL]HUVH«GHSURSµVLWRRXVHRPHQLQRQ¥RRXYHEHP1DUL]&RUL]D
IUHTXHQWHDP¥HQ¥RVDEHGL]HUVHHOHWHPDOHUJLDV%RFD$LQGDQ¥RIRLDRGHQWLVWD(VFRYDRVGHQWHV¢VYH]HVRXWUDIRQWHIUHTXHQWHGH
EULJDV

Pescoço.$XV¬QFLDGHQµGXORV2VOLQIRQRGRVFHUYLFDLVSDUHFHPDXPHQWDGRV

Respiratório.7RVVHHVLELORVQRWµUD[IUHTXHQWHV$P¥HQ¥RFRQVHJXHLGHQWLILFDURVIDWRUHVGHVHQFDGHDQWHVWHQGHPDGHVDSDUHFHU2
PHQLQRFRUUHRGLDLQWHLURVHPSDUHFHUFDQVDGR

Cardiovascular.$XV¬QFLDGHFDUGLRSDWLDFRQKHFLGD7LQKDXPVRSURTXDQGRPHQRUTXHGHVDSDUHFHX

Gastrintestinal.$SHWLWHHK£ELWRVDOLPHQWDUHVGHVFULWRVDQWHULRUPHQWH3HULVWDOVHUHJXODU(VW£VHQGRWUHLQDGRSDUDLUDREDQKHLURHXVD
IUDOGDV¢QRLWHPDVQ¥RQDFUHFKH

Urinário.%RPMDWR1¥RK£UHODWRGHLQIHF©·HVXULQ£ULDVSU«YLDV

Genital.1RUPDO

Musculoesquelético.‹GRWLSRɪUDSD]LQKRɫHQXQFDVHFDQVD‚VYH]HVDOJXQVKHPDWRPDVHHVFRULD©·HV

Neurológico.'HDPEXODHFRUUHEHPSDUHFHWHUERDFRRUGHQD©¥RSDUDDLGDGH6HPULJLGH]FRQYXOV·HVRXGHVPDLRV$P¥HGL]TXHD
PHPµULDGH%ULDQ«µWLPDPDVTXHHOHSUHVWDSRXFDDWHQ©¥R
Psiquiátrico.'HPRGRJHUDOSDUHFHIHOL]&KRUDFRPIDFLOLGDGHRVFLODHQWUHWHQWDUVHULQGHSHQGHQWHHDQHFHVVLGDGHGHDIDJRHFRQIRUWRGD
P¥H

([DPHI¯VLFR

%ULDQ«XPPHQLQRFRPPHVHVGHYLGDDWLYRHFKHLRGHHQHUJLD%ULQFDFRPRPDUWHORGH'HMHULQHTXHILQJHVHUXPFDPLQK¥R3DUHFHVHU
PXLWROLJDGR¢P¥H¢VYH]HVROKDQGRSDUDHODSDUDVHVHQWLUVHJXUR$P¥HSDUHFHSUHRFXSDGDFRPDSRVVLELOLGDGHGH%ULDQTXHEUDU
DOJXPDFRLVD$VURXSDVGRPHQLQRHVW¥ROLPSDV

Sinais vitais.$OWXUDFPRSHUFHQWLO3HVRNJ!RSHUFHQWLO,0&!RSHUFHQWLO&LUFXQIHU¬QFLDFUDQLDQDFPR

SHUFHQWLO3$PP+J)UHTX¬QFLDFDUG¯DFDGHESPUHJXODU)UHTX¬QFLDUHVSLUDWµULDGHLQFXUV·HVSRUPLQXWRYDULDFRPD
DWLYLGDGH7HPSHUDWXUDRUHOKDr&(YLGHQWHPHQWHVHPGRU

Pele.1RUPDOH[FHWRSRUHTXLPRVHQDVSHUQDVHSODFDVGHSHOHVHFDQDVXSHUI¯FLHH[WHUQDGRVFRWRYHORV

Cabeça, orelha, nariz, olhos e garganta.&DEH§D1RUPRFHI£OLFRDXV¬QFLDGHOHV·HV2OKRV'LI¯FHLVGHH[DPLQDUSRUTXHRPHQLQRQ¥R

SDUD0RYLPHQWRVH[WUDRFXODUHVVLP«WULFRVHQRUPDLV3XSLODVFRPFRQVWUL©¥RDPP'LVFRVµSWLFRVGHGLI¯FLOYLVXDOL]D©¥RDXV¬QFLDGH
KHPRUUDJLDV2UHOKDV3DYLOK¥RDXGLWLYRQRUPDODXV¬QFLDGHDQRUPDOLGDGHVH[WHUQDV0HDWRVDF¼VWLFRVH[WHUQRVHPHPEUDQDVWLPS¤QLFDV
07QRUPDLV1DUL]1DULQDVQRUPDLVVHSWRQDOLQKDP«GLD%RFD'LYHUVRVGHQWHVHVFXUHFLGRVVXSHUI¯FLHLQWHUQDGRVLQFLVLYRVVXSHULRUHV
8PDF£ULHQRLQFLVLYRGLUHLWRVXSHULRU/¯QJXDQRUPDO3DGU¥RGHSDUDOHOHS¯SHGRQDSDUWHSRVWHULRUGDIDULQJHDXV¬QFLDGHH[VXGDWR
7RQVLODVDXPHQWDGDVSRU«PFRPHVSD©RDGHTXDGRFPHQWUHHODV

Pescoço./LYUHWUDTXHLDQDOLQKDP«GLDDXV¬QFLDGHWLUHRLGHSDOS£YHO

Linfonodos/LQIRQRGRVWRQVLODUHVIDFLOPHQWHSDOS£YHLVDFPELODWHUDOPHQWH3HTXHQRVOLQIRQRGRVFPELODWHUDOPHQWHQRFDQDO

LQJXLQDO7RGRVRVOLQIRQRGRVPµYHLVHLQGRORUHV¢SDOSD©¥R

Pulmões.%RDH[SDQV¥R$XV¬QFLDGHWDTXLSQHLDRXGLVSQHLD&RQJHVW¥RDXG¯YHOPDVDSDUHQWHPHQWHGHULYDGDGDVYLDVUHVSLUDWµULDV
VXSHULRUHVPDLVLQWHQVDVSUµ[LPR¢ERFDVLP«WULFD$XV¬QFLDGHURQFRVHVWHUWRUHVHVLELORV3XOP·HVOLPSRV

Cardiovascular.3,0LFWXVFRUGLVQRTXDUWRRXTXLQWRHVSD©RLQWHUFRVWDOHQDOLQKDP«GLDHVWHUQDO%H%QRUPDLV$XV¬QFLDGHVRSURVH

EXOKDVFDUG¯DFDVDQRUPDLV3XOVRVIHPRUDLVQRUPDLVSXOVRVSHGLRVRVGRUVDLVELODWHUDOPHQWHSDOS£YHLV

Mamas.1RUPDLVFRPDOJXPDJRUGXUDVREDVGXDV

Abdome.3URWUXVRSRU«PGHSUHVV¯YHODXV¬QFLDGHPDVVDVRXGRU¢SDOSD©¥R)¯JDGRFPDEDL[RGRUHERUGRFRVWDOGLUHLWR5&'LQGRORU

%D©RHULQVQ¥RSDOS£YHLV

Genitália.3¬QLVFLUFXQFLVDGR7DQQHU,DXV¬QFLDGHSHORVSHQLDQRVOHV·HVRXVHFUH©·HV7HVW¯FXORVGHVFLGRVGHGLI¯FLOSDOSD©¥RHPIXQ©¥R
GHUHIOH[RVFUHPDVW«ULFRVDWLYRV(VFURWRQRUPDOELODWHUDOPHQWH

Musculoesquelético$PSOLWXGHGHPRYLPHQWD©¥RGRVPHPEURVVXSHULRUHVHLQIHULRUHVHGHWRGDVDVDUWLFXOD©·HVQRUPDO&ROXQDUHWD
0DUFKDQRUPDO

Neurológico.(VWDGRPHQWDO&ULDQ©DIHOL]HFRRSHUDWLYD'HVHQYROYLPHQWR''670RWRUJURVVHLURɥ3XODHMRJDREMHWRV0RWRUILQRɥ,PLWD

OLQKDYHUWLFDO/LQJXDJHPɥ1¥RFRPELQDSDODYUDVDSHQDVSDODYUDVLVRODGDVDREVHUYDGDVQRH[DPH3HVVRDOVRFLDOɥ/DYDRURVWR
HVFRYDRVGHQWHVHYHVWHDFDPLVD*HUDOɥ1RUPDOH[FHWRSHODOLQJXDJHPTXHSDUHFHDWUDVDGD3DUHVFUDQLDQRVQWHJURVHPERUDGLI¯FHLVGH
H[DPLQDU&HUHEHODU0DUFKDQRUPDOERPHTXLO¯EULR5HIOH[RVWHQGLQRVRVSURIXQGRV1RUPDLVHVLP«WULFRVFRP%DELQVNLQHJDWLYR6HQVLWLYR
1¥RUHDOL]DGR
%LEOLRJUDILD

&LWDo}HV
 /HYLQH 0' &DUH\ :% &URFNHU $& 'HYHORSPHQWDO±%HKDYLRUDO 3HGLDWULFV UG HG 3KLODGHOSKLD :%
6DXQGHUV
 $PHULFDQ $FDGHP\ RI 3HGLDWULFV *XLGHOLQHV IRU +HDOWK 6XSHUYLVLRQ ,,, UHYLVHG HG (ON *URYH 9LOODJH ,/
$XWKRU
 $PHULFDQ $FDGHP\ RI 3HGLDWULFV %ULJKW )XWXUHV $YDLODEOH DW
KWWSEULJKWIXWXUHVDDSRUJZHEDERXW%ULJKW)XWXUHVDVS$FFHVVHG)HEUXDU\
 $PHULFDQ 0HGLFDO $VVRFLDWLRQ *XLGHOLQHV IRU $GROHVFHQW 3UHYHQWLYH 6HUYLFHV *$36 $YDLODEOH DW
KWWSZZZDPDDVVQRUJDPDXSORDGPPJDSVPRQRSGI$FFHVVHG)HEUXDU\
 8QLWHG 6WDWHV 'HSDUWPHQW RI +HDOWK DQG +XPDQ 6HUYLFHV 86 3UHYHQWLYH 6HUYLFHV 7DVN )RUFH 86367)
$YDLODEOHDWKWWSZZZDKUTJRYFOLQLFXVSVWIL[KWP$FFHVVHG)HEUXDU\
 &HQWHUV IRU 'LVHDVH &RQWURO DQG 3UHYHQWLRQ 5HFRPPHQGDWLRQV DQG *XLGHOLQHV  &KLOG  $GROHVFHQW
,PPXQL]DWLRQ 6FKHGXOHV $YDLODEOH DW KWWSZZZFGFJRYYDFFLQHVUHFVVFKHGXOHVFKLOGVFKHGXOHKWP
$FFHVVHG)HEUXDU\
 $PHULFDQ$FDGHP\RI3HGLDWULFV&RPPLWWHHRQ,QIHFWLRXV'LVHDVHV5HFRPPHQGHG,PPXQL]DWLRQ6FKHGXOHV
IRU&KLOGUHQDQG$GROHVFHQWV²8QLWHG6WDWHV3HGLDWULFV±
 $+5$*XLGHWR&OLQLFDO3UHYHQWLYH6HUYLFHV$YDLODEOHDWKWWSZZZDKUDJRYFOLQLFFSVGL[KWP $FFHVVHG
-XO\
 $PHULFDQ$FDGHP\RI3HGLDWULFVDQG$PHULFDQ&ROOHJHRI2EVWHWULFLDQVDQG*\QHFRORJLVWV*XLGHOLQHVIRU
3HULQDWDO&DUHWKHG:DVKLQJWRQ'&$PHULFDQ$FDGHP\RI3HGLDWULFV
 )XORULD0.UHLWHU67KHQHZERUQH[DPLQDWLRQSDUW(PHUJHQFLHVDQGFRPPRQDEQRUPDOLWLHVLQYROYLQJWKH
VNLQKHDGQHFNFKHVWDQGUHVSLUDWRU\DQGFDUGLRYDVFXODUV\VWHP$P)DP3K\V±
 %DOODUG-/.KRXU\-&:HGLJ.%DOODUGVFRULQJV\VWHPIRUGHWHUPLQLQJJHVWDWLRQDODJHLQZHHNV-3HGLDWU

 %UD]HOWRQ 7% :RUNLQJ ZLWK IDPLOLHV RSSRUWXQLWLHV IRU HDUO\ LQWHUYHQWLRQ 3HGLDWU &OLQ 1RUWK $P
±
 -RKQVRQ&3%ODVFR3$,QIDQWJURZWKDQGGHYHORSPHQW3HGLDWU5HY±
 &ROVRQ(5'ZRUNLQ3+7RGGOHUGHYHORSPHQW3HGLDWU5HY±
 &RSHODQ-1RUPDOVSHHFKDQGGHYHORSPHQW3HGLDWU5HY±
 ,GHQWLI\LQJLQIDQWVDQG\RXQJFKLOGUHQZLWKGHYHORSPHQWDOGLVRUGHUVLQWKHPHGLFDOKRPH$QDOJRULWKPIRU
GHYHORSPHQWDOVXUYHLOODQFHDQGVFUHHQLQJ3HGLDWULFV±
 )UDQNHQEXUJ:.'RGGV-$UFKHU3HWDO7KH'HQYHU,,$PDMRUUHYLVLRQDQGUHVWDQGDUGL]DWLRQRIWKH'HQYHU
'HYHORSPHQWDO6FUHHQLQJ7HVW3HGLDWULFV±
 )RQJ&7&OLQLFDOGLDJQRVLVRIJHQHWLFGLVHDVHV3HGLDWU$QQ±
 +\YDULQHQ/$VVHVVPHQWRIYLVXDOO\LPSDLUHGLQIDQWV2SKWKDOPRO&OLQ1RUWK$P
 /HHV0+&\DQRVLVRIWKHQHZERUQLQIDQWUHFRJQLWLRQDQGFOLQLFDOHYDOXDWLRQ-3HGLDWU
 *HVVQHU,+:KDWPDNHVDKHDUWPXUPXULQQRFHQW"3HGLDWU$QQ±
 &DOODKDQ&:-U$OSHUW%6LPXOWDQHRXVSHUFXVVLRQDXVFXOWDWLRQWHFKQLTXHIRUWKHGHWHUPLQDWLRQRIOLYHUVSDQ
$UFK3HGLDWU$GROHVF0HG±
 5HLII0,2VERUQ/0&OLQLFDOHVWLPDWLRQRIOLYHUVL]HLQQHZERUQLQIDQWV3HGLDWULFV±
 %XUJHU %- %XUJHU -' %RV &) HW DO 1HRQDWDO VFUHHQLQJ DQG VWDJJHUHG HDUO\ WUHDWPHQW IRU FRQJHQLWDO
GLVORFDWLRQRUG\VSODVLDRIWKHKLS/DQFHW±
 =DIHLULRX ', 3ULPLWLYH UHIOH[HV DQG SRVWXUDO UHDFWLRQV LQ WKH QHXURGHYHORSPHQWDO H[DPLQDWLRQ 3HGLDWU
1HXURO±
 6FKRWW -0 5RVVRU 01 7KH JUDVS DQG RWKHU SULPLWLYH UHIOH[HV - 1HXURO 1HXURVXUJ 3V\FKLDWU\
±
 /XL] '0 )R[FURIW &' 6WHZDUW 5 7KH FRQVWUXFW YDOLGLW\ RI WKH *ULIILWKV 6FDOHV RI 0HQWDO 'HYHORSPHQW
&KLOG&DUH+HDOWK'HY±
 1HZDFKHFN3:6WULFNODQG%6KRQNRII-3HWDO$QHSLGHPLRORJLFSURILOHRIFKLOGUHQZLWKVSHFLDOKHDOWKFDUH
QHHGV3HGLDWULFV±
 2JGHQ&/&DUUROO0'&XUWLQ/5HWDO3UHYDOHQFHRIRYHUZHLJKWDQGREHVLW\LQWKH8QLWHG6WDWHV±
-$0$±
 1DWLRQDO+LJK%ORRG3UHVVXUH(GXFDWLRQ3URJUDP:RUNLQJ*URXSRQ+LJK%ORRG3UHVVXUHLQ&KLOGUHQDQG
$GROHVFHQWV 7KH )RXUWK 5HSRUW RQ WKH 'LDJQRVLV (YDOXDWLRQ DQG 7UHDWPHQW RI +LJK %ORRG 3UHVVXUH LQ
&KLOGUHQDQG$GROHVFHQWV3HGLDWULFV±
 6KDPLV',&ROOHFWLQJWKH³IDFWV´YLVLRQDVVHVVPHQWWHFKQLTXHVSHULOVDQGSLWIDOOV$P2UWKRS-
 5RWKPDQ52ZHQV76LPHO'/'RHVWKLVFKLOGKDYHDFXWHRWLWLVPHGLD"-$0$±
 %ORPJUHQ.3LWNDUDQWD$&XUUHQWFKDOOHQJHVLQGLDJQRVLVRIDFXWHRWLWLVPHGLD,QWO-3HG2WRUKLQRODU\QJRO
±
 3LUR]]R63DSLQF]DN7*ODV]LRX3:KLVSHUHGYRLFHWHVWIRUVFUHHQLQJIRUKHDULQJLPSDLUPHQWLQDGXOWVDQG
FKLOGUHQV\VWHPDWLFUHYLHZ%0-
 :ROI*$QGHUKXEHU:.XKQ)'HYHORSPHQWRIWKHSDUDQDVDOVLQXVHVLQFKLOGUHQLPSOLFDWLRQVIRUSDUDQDVDO
VLQXVVXUJHU\$QQ2WRO5KLQRO/DU\QJRO±
 6HOZLW]5+,VPDLO$,3LWWV1%'HQWDOFDULHV/DQFHW±
 /XQW 5& /DZ '% $ UHYLHZ RI WKH FKURQRORJ\ RI HUXSWLRQ RI GHFLGXRXV WHHWK - $P 'HQW $VVRF

 (EHOO0+6PLWK0$%DUU\+&HWDO'RHVWKLVSDWLHQWKDYHVWUHSWKURDW"-$0$±
 &HQWHUVIRU'LVHDVH&RQWURODQG3UHYHQWLRQ1DWLRQDO6XUYHLOODQFHIRU$VWKPD²8QLWHG6WDWHV±
 00:50RUE0RUWDO:NO\5HS±
 7XFNHU :1 6DDE 6 /HODQG 65 HW DO 7KH VFUDWFK WHVW LV XQUHOLDEOH IRU GHWHUPLQLQJ WKH OLYHU HGJH - &OLQ
*DVWURHQWHURO±
 $VKFUDIW.:&RQVXOWDWLRQZLWKWKHVSHFLDOLVWDFXWHDEGRPLQDOSDLQ3HGLDWU5HY±
 +\PHO.3-HQQ\&&KLOGVH[XDODEXVH3HGLDWU5HY±TXL]±
 6FKHUO6&RPPRQORZHUH[WUHPLW\SUREOHPVLQFKLOGUHQ3HGLDWU5HY±
 %UXFH5:7RUVLRQDODQGDQJXODUGHIRUPLWLHV3HGLDWU&OLQ1RUWK$P±
 (OVWHU$%.X]QHWV0-$0$*XLGHOLQHVIRU$GROHVFHQW3UHYHQWLYH6HUYLFHV*$365HFRPPHQGDWLRQVDQG
5DWLRQDOH%DOWLPRUH0':LOOLDPV :LONLQV
 +HUPDQ*LGGHQV0(6ORUD(-:DVVHUPDQ5&HWDO6HFRQGDU\VH[XDOFKDUDFWHULVWLFVDQGPHQVHVLQ\RXQJ
JLUOV VHHQ LQ RIILFH SUDFWLFH D VWXG\ IURP WKH 3HGLDWULF 5HVHDUFK LQ 2IILFH 6HWWLQJV 1HWZRUN 3HGLDWULFV
±
 %LUR)0*DOYH]03*UHHQVSDQ/&HWDO3XEHUWDODVVHVVPHQWPHWKRGDQGEDVHOLQHFKDUDFWHULVWLFVLQDPL[HG
ORQJLWXGLQDOVWXG\RIJLUOV3HGLDWULFV>RQOLQH@$XJXVWGRLSHGV±
 $&2* &RPPLWWHH 2SLQLRQ QR  1RYHPEHU  %UHDVW FRQFHUQV LQ WKH DGROHVFHQW 2EVWHW *\QHFRO
±
 0HW]O-'3UHSDUWLFLSDWLRQH[DPLQDWLRQRIWKHDGROHVFHQWDWKOHWHSDUW3HGLDWU5HY±
 0HW]O-'3UHSDUWLFLSDWLRQH[DPLQDWLRQRIWKHDGROHVFHQWDWKOHWHSDUW3HGLDWU5HY±

5HIHUrQFLDVDGLFLRQDLV
$PHULFDQ $FDGHP\ RI 3HGLDWULFV %ULJKW )XWXUHV *XLGHOLQHV IRU +HDOWK 6XSHUYLVLRQ RI ,QIDQWV &KLOGUHQ DQG
$GROHVFHQWVUGHG(ON*URYH9LOODJH,/$PHULFDQ$FDGHP\RI3HGLDWULFV
%HUJHQ ' +XPDQ 'HYHORSPHQW 7UDGLWLRQDO DQG &RQWHPSRUDU\ 7KHRULHV 8SSHU 6DGGOH 5LYHU 1-
3HDUVRQ3UHQWLFH+DOO
%XUQV&('XQQ$0%UDG\0$HWDO3HGLDWULF3ULPDU\&DUH$+DQGERRNIRU1XUVH3UDFWLWLRQHUVUGHG6W
/RXLV6DXQGHUV
&RO\DU05:HOOFKLOG$VVHVVPHQWIRU3ULPDU\&DUH3URYLGHUV3KLODGHOSKLD)$'DYLV
'L[RQ6'6WHLQ07(QFRXQWHUVZLWKFKLOGUHQSHGLDWULFEHKDYLRUDQGGHYHORSPHQWWKHG3KLODGHOSKLD0RVE\

(PDQV 6- /DXIHU 05 *ROGVWHLQ '3 3HGLDWULF DQG $GROHVFHQW *\QHFRORJ\ WK HG 3KLODGHOSKLD /LSSLQFRWW
:LOOLDPV :LONLQV
)HQLFKHO*&OLQLFDO3HGLDWULF1HXURORJ\$6LJQVDQG6\PSWRPV$SSURDFKWKHG3KLODGHOSKLD6DXQGHUV
)XORULD 0 .UHLWHU 6 7KH QHZERUQ H[DPLQDWLRQ 3DUW  (PHUJHQFLHV DQG FRPPRQ DEQRUPDOLWLHV LQYROYLQJ WKH
DEGRPHQSHOYLVH[WUHPLWLHVJHQLWDOLDDQGVSLQH$P)DP3K\V±
*UXPPHU6WUDZQ /0 5HLQROG & .UHEV 1) 8VH RI :RUOG +HDOWK 2UJDQL]DWLRQ DQG &'& JURZWK FKDUWV IRU
FKLOGUHQDJHG±PRQWKVLQWKH8QLWHG6WDWHV00:5UU±
.LQJ 70 7DQGRQ 6' 0DFLDV 00 HW DO ,PSOHPHQWLQJ GHYHORSPHQWDO VFUHHQLQJ DQG UHIHUUDOV /HVVRQV OHDUQHG
IURPDQDWLRQDOSURMHFW3HGLDWULFV±
/RXJKOLQ&(3XOPRQRORJ\,Q5REHUWVRQ-6LONRIVNL1HGV7KH+DUULHW/DQH+DQGERRNWKHG3KLODGHOSKLD
 (OVHYLHU±
1HLQVWHLQ/6$GROHVFHQW+HDOWK&DUH$3UDFWLFDO*XLGHWKHG3KLODGHOSKLD/LSSLQFRWW:LOOLDPV :LONLQV

5DMX 71. +LJJLQV 5' 6WDUN $5 HW DO 2SWLPL]LQJ FDUH DQG RXWFRPHV IRU ODWHSUHWHUP QHDUWHUP LQIDQWV $
VXPPDU\ RI WKH ZRUNVKRS VSRQVRUHG E\ WKH 1DWLRQDO ,QVWLWXWH RI &KLOG +HDOWK DQG +XPDQ 'HYHORSPHQW
3HGLDWULFV±
6DVV3+DVVDQ*/RZHUH[WUHPLW\DEQRUPDOLWLHVLQFKLOGUHQ$P)DP3K\V±
6FKRQZDOG$+XQWLQJWRQ1&KDQ(HWDO5RXWLQHGHYHORSPHQWDOVFUHHQLQJLPSOHPHQWHGLQXUEDQSULPDU\FDUH
VHWWLQJV0RUHHYLGHQFHRIIHDVLELOLW\DQGHIIHFWLYHQHVV3HGLDWULFV±
6WHOOZDJHQ/%RLHV(&DUHRIWKHZHOOQHZERUQ3HGLDWU5HY±
6ZDLPDQ .) $VKZDO 6 )HUULHUR '0 1HXURORJLF H[DPLQDWLRQ RI WKH WHUP DQG SUHWHUP LQIDQW ,Q 3HGLDWULF
1HXURORJ\3ULQFLSOHV 3UDFWLFHWKHG3KLODGHOSKLD0RVE\(OVHYLHU±
=LWHOOL%-'DYLV+:$WODVRI3HGLDWULF3K\VLFDO'LDJQRVLVWKHG6W/RXLV0RVE\

4XDGUR 

 $QRUPDOLGDGHGRULWPRFDUG¯DFRHGDSUHVV¥RDUWHULDO

7DTXLFDUGLDVXSUDYHQWULFXODU

$WDTXLFDUGLDVXSUDYHQWULFXODUSDUR[¯VWLFD7693«DDUULWPLDPDLVFRPXPHPFULDQ©DV$OJXPDVFULDQ©DVFRP7693SDUHFHPHVWDUEHPRX

DSUHVHQWDPGLVFUHWDSDOLGH]FRPWDTXLSQHLDPDVDSUHVHQWDPIUHTX¬QFLDFDUG¯DFDLJXDORXVXSHULRUDESPESP2XWUDVFULDQ©DV
HVW¥RHPHVWDGRJUDYHHHPFRODSVRFDUGLRYDVFXODU$VRQGDV3W¬PPRUIRORJLDGLIHUHQWHVRXQ¥RV¥RREVHUYDGDV

'HPRGRJHUDOD7693HPODFWHQWHV«SHUVLVWHQWHH[LJLQGRWHUDSLDPHGLFDPHQWRVDSDUDUHYHUV¥RDIUHTX¬QFLDHDRULWPRFDUG¯DFRV
QRUPDLV1DVFULDQ©DVPDLRUHV«PDLVSURY£YHOTXHD7693UHDOPHQWHVHMDSDUR[¯VWLFDFRPHSLVµGLRVGHGXUD©¥RHIUHTX¬QFLDYDUL£YHLV

+LSHUWHQV¥RDUWHULDOQDLQI¤QFLD_8PH[HPSORW¯SLFR
 $KLSHUWHQV¥RDUWHULDOSRGHVXUJLUQDLQI¤QFLD(PERUDVHMDPDLVSURY£YHOTXHDHOHYD©¥RGRVQ¯YHLVWHQVLRQDLVHPFULDQ©DVSHTXHQDV
WHQKDFDXVDVUHQDLVFDUG¯DFDVRXHQGµFULQDVFULDQ©DVPDLVYHOKDVHDGROHVFHQWHVFRPKLSHUWHQV¥RDUWHULDOW¬PPDLVSURYDYHOPHQWH
KLSHUWHQV¥RDUWHULDOSULP£ULDRXHVVHQFLDO

(VVDFULDQ©DGHVHQYROYHXKLSHUWHQV¥RDUWHULDOTXHSHUVLVWLXDW«DYLGDDGXOWD$VFULDQ©DVWHQGHPDSHUPDQHFHUQRPHVPRSHUFHQWLOGH
SUHVV¥RDUWHULDOHQTXDQWRFUHVFHP(VVHSHUFHQWLOGHKLSHUWHQV¥RDUWHULDOVHPDQW«PDW«DYLGDDGXOWDDSRLDQGRRFRQFHLWRGHTXHD
KLSHUWHQV¥RDUWHULDOHVVHQFLDOGRDGXOWRFRPH©DIUHTXHQWHPHQWHGXUDQWHDLQI¤QFLD

$VFRQVHTX¬QFLDVGDKLSHUWHQV¥RDUWHULDOQ¥RWUDWDGDSRGHPVHUJUDYHV

4XDGUR 

 (UXS©·HVHDFKDGRVFXW¤QHRVFRPXQVHPUHF«PQDVFLGRVHODFWHQWHV

Acne neonatal Seborreia

Eritema tóxico
3£SXODVYHUPHOKDVHS¼VWXODVV¥RPDLV $HUXS©¥RFXW¤QHDGHVFDPDWLYDGHFRORUD©¥RDYHUPHOKDGD
(VVDVS¼VWXODVDPDUHODVRXEUDQFDVV¥R SURHPLQHQWHVQDVERFKHFKDVHQRQDUL]GHDOJXQV IUHTXHQWHPHQWH«HQFRQWUDGDQDIDFHQRSHVFR©RQDVD[LODVQD£UHD
FLUFXQGDGDVSRUXPDEDVHDYHUPHOKDGD UHF«PQDVFLGRVQRUPDLV FREHUWDSHODVIUDOGDVHDWU£VGDVRUHOKDV
 Dermatite atópica (Eczema)

(VVDFRQGL©¥R«FDUDFWHUL]DGDSRUHULWHPDGHVFDPD©¥RUHVVHFDPHQWRGDSHOHHLQWHQVRSUXULGR

Neurofibromatose

$VFDUDFWHU¯VWLFDVGHVVDFRQGL©¥RLQFOXHPPDLVGHPDQFKDVFDI«FRP
OHLWHHVDUGDVD[LODUHV2VDFKDGRVWDUGLRVLQFOXHPQHXURILEURPDVH
Dermatite por Candida na região coberta pelas
fraldas
(VVDHUXS©¥RGHFRORUD©¥RYHUPHOKREULOKDQWH«
QµGXORVGH/LVKQ¥RPRVWUDGRV
Dermatite de contato na região coberta pelas
fraldas
Impetigo
(VVDHUXS©¥RLUULWDWLYD«VHFXQG£ULDDGLDUUHLDRX
(VVDLQIHF©¥R«FDXVDGDSRUEDFW«ULDVHSRGHVHUEROKRVDRXFURVWRVD
LUULWD©¥RVHQGRHQFRQWUDGDDRORQJRGDV£UHDVGH
FRPDVSHFWRDPDUHODGRSRUFDXVDGRSXV
HQFRQWUDGDQDVSUHJDVLQWHUWULJLQRVDVFRP FRQWDWRQHVVHFDVRDUHJL¥RFREHUWDSHODVIUDOGDV
SHTXHQDVɪOHV·HVVDW«OLWHVɫDRORQJRGDVERUGDV

4XDGUR 

 9HUUXJDVOHV·HVVHPHOKDQWHVDYHUUXJDVYHUUXFLIRUPHVHRXWUDVOHV·HVHOHYDGDV

Verruga vulgar Verruga plana Verrugas plantares

9HUUXJDV£VSHUDVHVHFDVQDVP¥RV 3HTXHQDVYHUUXJDVSODQDV 9HUUXJDVGRORURVDV¢FRPSUHVV¥RQRVS«V

 Acne do adolescente
Molusco contagioso
$DFQHQDDGROHVF¬QFLDLQFOXHPFRPHG·HVDEHUWRVFUDYRVSUHWRVHFRPHG·HVIHFKDGRVFUDYRVEUDQFRV¢HVTXHUGDH
/HV·HVFRUGHFDUQHHOHYDGDVDEREDGDGDVHFRP S¼VWXODVLQIODPDGDV¢GLUHLWD
XPDGHSUHVV¥RFHQWUDO

4XDGUR 

 /HV·HVFXW¤QHDVFRPXQVGXUDQWHDLQI¤QFLD

Tinha da cabeça (Tinea capitis)

Picadas de inseto Urticária
3HUGDGHFDEHORDVVRFLDGDDGHVFDPD©¥RH
(VVDVOHV·HVV¥RFDUDFWHUL]DGDVSRUS£SXODVEHP IRUPD©¥RGHFURVWD«REVHUYDGDQRFRXURFDEHOXGR (VVDUHD©¥RDO«UJLFDSUXULJLQRVDPXGDGHDVSHFWRUDSLGDPHQWH
GHILQLGDVYHUPHOKDVHLQWHQVDPHQWHSUXULJLQRVDV MXQWDPHQWHFRPXPDSODFDGRORURVDTX«ULRQH
OLQIRQRGRRFFLSLWDOVHWD

Escabiose
Tinha do corpo (Tinea corporis) Pitiríase rósea
9HV¯FXODVHS£SXODVLQWHQVDPHQWHSUXULJLQRVDV
(VVDOHV¥RDQXODUDSUHVHQWDFHQWURFODURHS£SXODV /HV·HVRYDLVQRWURQFRHPFULDQ©DVPDLRUHV¢VYH]HVFRPOHV¥R
DOJXPDVYH]HVFRPHVFDYD©·HVHPIRUPDWRGH
DRORQJRGDERUGD SUHFXUVRUD
Y¯UJXODPDLVIUHTXHQWHPHQWHQRVPHPEURV

)RQWHGDVIRWRJUDILDVGHSLFDGDVGHLQVHWRVWLQKDGDFDEH§DHWLQKDGRFRUSRɥ*RRGKHDUW+$3KRWRJXLGHRI&RPPRQ6NLQ'LVRUGHUV
%DOWLPRUH:LOOLDPV :LONLQV

4XDGUR 
  $QRUPDOLGDGHVGDFDEH©D

Cefaloematoma

2FHIDORHPDWRPDDSHVDUGHQ¥RH[LVWLUSRURFDVL¥RGRQDVFLPHQWRVXUJHQDVSULPHLUDV
KGHYLGDHPFRQVHTX¬QFLDGHKHPRUUDJLDVXESHULRVWHDOTXHHQYROYHDW£EXDH[WHUQD
GHXPGRVRVVRVGRFU¤QLR2DXPHQWRYROXP«WULFRLQGLFDGRSHODVHWDQ¥RFUX]DDV
VXWXUDVHPERUDRFDVLRQDOPHQWHDSµVSDUWRVGLI¯FHLVVHMDELODWHUDO$WXPHID©¥R«QR
LQ¯FLRPROHHGHSRLVGHVHQYROYHXPDERUGDµVVHDHOHYDGDQRGHFRUUHUGHDOJXQVGLDV
VHFXQG£ULDDGHSµVLWRVGHF£OFLRQDVERUGDVGRSHULµVWHR7HQGHDUHJUHGLUHPDOJXPDV
VHPDQDV

Hidrocefalia

1DKLGURFHIDOLDDIRQWDQHODDQWHULRUIRQW¯FXORDQWHULRUVHJXQGRD7HUPLQRORJLD
$QDW¶PLFDILFDDEDXODGDHRVROKRVHVW¥RGHVYLDGRVSDUDEDL[RUHYHODQGRDSDUWH
VXSHULRUGDVHVFOHUµWLFDVHRULJLQDQGRRɪVLQDOGRVROSRHQWHɫFRPRPRVWUDGRDOODGR2
VLQDOGRVROSRHQWHWDPE«PSRGHVHUREVHUYDGRSRUXPFXUWRSHU¯RGRHPDOJXQVUHF«P
QDVFLGRVQRUPDLV'H=LWHOOL%-'DYLV+:$WODVRI3HGLDWULF3K\VLFDO'LDJQRVLVUGHG6W
/RXLV0RVE\ɥ<HDU%RRN&RUWHVLDGH'U$OEHUW%ULJODQ&KLOGUHQɨV+RVSLWDORI
3LWWVEXUJK

Craniossinostose

$FUDQLRVVLQRVWRVHFRQVLVWHQRIHFKDPHQWRSUHPDWXURGHXPDRXPDLVVXWXUDVFUDQLDQDV
UHVXOWDQGRHPFUHVFLPHQWRHIRUPDWRDQRUPDLVGRFU¤QLR2FUHVFLPHQWRRFRUUHQDV
VXWXUDVTXHQ¥RIRUDPDIHWDGDVHQ¥RQDVVXWXUDVTXHIRUDPDIHWDGDV

$VILJXUDVPRVWUDPGLIHUHQWHVIRUPDWRVGHFU¤QLRDVVRFLDGRVDRVY£ULRVWLSRVGH
FUDQLRVVLQRVWRVH$OLQKDGHVXWXUDSUHPDWXUDPHQWHIHFKDGD«DVVLQDODGDSHODDXV¬QFLD
GHXPDOLQKDGHVXWXUDHPFDGDILJXUD$VPDLVFRPXQVV¥RHVFDIRFHIDOLDHSODJLRFHIDOLD
IURQWDO2VRPEUHDPHQWRD]XODGRPRVWUD£UHDVGHDFKDWDPHQWRP£[LPR$VVHWDV
YHUPHOKDVPRVWUDPDGLUH©¥RGRDYDQ©RGRFUHVFLPHQWRDWUDY«VGDVVXWXUDVTXH«
QRUPDO

4XDGUR 

 )£FLHVGLDJQµVWLFDVQRSULPHLURDQRGHYLGDHQDLQI¤QFLD

+LSRWLUHRLGLVPRFRQJ¬QLWR
6¯QGURPHDOFRµOLFDIHWDO

$FULDQ©DFRPKLSRWLUHRLGLVPRFRQJ¬QLWRFUHWLQLVPRDSUHVHQWDFDUDFWHU¯VWLFDVIDFLDLV

JURVVHLUDVOLQKDGHLPSODQWD©¥REDL[DGRFDEHORVREUDQFHOKDVUDODVHDXPHQWRGR
2VILOKRVGHPXOKHUHVFRPDOFRROLVPRFU¶QLFRFRUUHPULVFRDXPHQWDGRGHDSUHVHQWDU YROXPHGDO¯QJXD$VFDUDFWHU¯VWLFDVDVVRFLDGDVLQFOXHPFKRURURXFRK«UQLDXPELOLFDO
GHILFL¬QFLDGRFUHVFLPHQWRPLFURFHIDOLDHUHWDUGRPHQWDO$VFDUDFWHU¯VWLFDVIDFLDLV H[WUHPLGDGHVVHFDVHIULDVPL[HGHPDSHOHPRVTXHDGDHUHWDUGRPHQWDO$PDLRULDGRV
LQFOXHPILVVXUDVSDOSHEUDLVHQFXUWDGDVDODUJDPHQWRHUHWLILFD©¥RGRILOWURGRO£ELR UHF«PQDVFLGRVFRPKLSRWLUHRLGLVPRFRQJ¬QLWRQ¥RWHPHVWLJPDVI¯VLFRV,VVRPRWLYRXR
VXSHULRURVXOFRYHUWLFDOVLWXDGRQDOLQKDP«GLDGRODGRVXSHULRUHO£ELRVILQRV UDVWUHDPHQWRSDUDKLSRWLUHRLGLVPRFRQJ¬QLWRGHWRGRVRVUHF«PQDVFLGRVQRV(8$HQD
PDLRULDGRVRXWURVSD¯VHVGHVHQYROYLGRVɪWHVWHGRSH]LQKRɫ

6¯ILOLVFRQJ¬QLWD

3DUDOLVLDGHQHUYRIDFLDO

$LQIHF©¥RLQWUDXWHULQDSHOR7UHSRQHPDSDOOLGXPFRVWXPDRFRUUHUDSµVDDVHPDQDGH
JHVWD©¥RHDIHWDSUDWLFDPHQWHWRGRVRVµUJ¥RVIHWDLV&DVRQ¥RVHMDWUDWDGDGRV
$SDUDOLVLDSHULI«ULFDGRQHXU¶QLRPRWRULQIHULRUGRQHUYRIDFLDOSRGHVHUFRQVHTXHQWH
IHWRVLQIHFWDGRVPRUUHPDQWHVGHQDVFHUHRXWURVORJRDSµV2VVLQDLVGDGRHQ©D
DOHV¥RGRQHUYRSRUFRPSUHVV¥RGXUDQWHRSDUWRHRWUDEDOKRGHSDUWRVHU
DSDUHFHPQRVVREUHYLYHQWHVM£QRSULPHLURP¬VGHYLGD2VHVWLJPDVIDFLDLVDTXL
FRQVHTXHQWHDLQIODPD©¥RGRUDPRGDRUHOKDP«GLDGRQHUYRGXUDQWHHSLVµGLRVGHRWLWH
PRVWUDGRVLQFOXHPDEDXODPHQWRGRVRVVRVIURQWDLVHGHSUHVV¥RGDSRQWHQDVDOQDUL]HP
P«GLDDJXGDHFU¶QLFDRXWHUFDXVDVGHVFRQKHFLGDVSDUDOLVLDGH%HOO$SUHJD
VHODDPERVVHFXQG£ULRV¢SHULRVWLWHULQLWHRXOHV·HVH[VXGDWLYDVGDPXFRVDQDVDOH
QDVRODELDOGRODGRDIHWDGRILFDDFKDWDGDHRROKRQ¥RIHFKD2IHQ¶PHQRDFHQWXDVH
HUXS©¥RFXW¤QHDFLUFXPRUDO$LQIODPD©¥RPXFRFXW¤QHDHILVVXUDVQDERFDHO£ELRV
GXUDQWHRFKRURFRPR«PRVWUDGRDTXL(PPDLVGHGDVFULDQ©DVDIHWDGDVRFRUUH
U¡JDGHVQ¥RPRVWUDGDVDTXLWDPE«PV¥RHVWLJPDVGHV¯ILOLVFRQJ¬QLWDGRPHVPR
UHFXSHUD©¥RSOHQD
PRGRTXHDSHULRVWLWHSRUFUDQLRWDEHVWLELDOW­ELDHPVDEUHHDGLVSODVLDGHQW£ULDGHQWHV
GH+XWFKLQVRQɥYHMDS£JLQD

6¯QGURPHGDFULDQ©DHVSDQFDGD

6¯QGURPHGH'RZQ
 $FULDQ©DFRPV¯QGURPHGH'RZQWULVVRPLDGRFRVWXPDDSUHVHQWDUFDEH©DSHTXHQDH $FULDQ©DY¯WLPDGHYLRO¬QFLDI¯VLFDHVSDQFDGDSRGHDSUHVHQWDUHTXLPRVHVDQWLJDVH
DUUHGRQGDGDDFKDWDPHQWRGDSRQWHQDVDOILVVXUDVSDOSHEUDLVREO¯TXDVSUHJDV QRYDVQDFDEH©DHQRURVWRHWHUXPDDSDU¬QFLDWULVWHHPLVHU£YHORXEXVFDUDWLYDPHQWH
HSLFDQWDLVSURHPLQHQWHVRUHOKDVSHTXHQDVVHPHOKDQWHVDFRQFKDVHGHLPSODQWD©¥R DJUDGDUDOJXPDVYH]HVDW«DVSHVVRDVHVSHFLILFDPHQWHHQYROYLGDVHDWHQWDDR
EDL[DHO¯QJXDUHODWLYDPHQWHJUDQGH$VFDUDFWHU¯VWLFDVDVVRFLDGDVLQFOXHPKLSRWRQLD SHUSHWUDGRUGRDEXVR2XWURVHVWLJPDVLQFOXHPHTXLPRVHVHPUHJL·HVD[LODHYLULOKDV
JHQHUDOL]DGDSUHJDVSDOPDUHVWUDQVYHUVDVOLQKDVVLPLHVFDVHQFXUWDPHQWRH TXHHPJHUDOQ¥RVRIUHPOHV¥RHPYH]GHSURHPLQ¬QFLDVµVVHDVHYLG¬QFLDV
HQFXUYDPHQWRGRVTXLQWRVGHGRVFOLQRGDFWLOLDPDQFKDVGH%UXVKILHOGYHMDR4XDGUR UDGLROµJLFDVGHIUDWXUDVGHFU¤QLRFRVWHODVHRVVRVORQJRVHPY£ULRVHVW£JLRVGH
HUHWDUGRPHQWDO FRQVROLGD©¥RHOHV·HVFXW¤QHDVPRUIRORJLFDPHQWHVHPHOKDQWHVDRVLPSOHPHQWRV
XWLOL]DGRVSDUDLQIOLJLURWUDXPDWLVPRP¥RVILYHODGHFLQWRFRUGDFDELGHRXFLJDUUR
DFHVR

5LQLWHDO«UJLFDSHUHQH +LSHUWLUHRLGLVPR

$FULDQ©DSRUWDGRUDGHULQLWHDO«UJLFDSHUHQHDSUHVHQWDERFDDEHUWDSRUTXHQ¥RFRQVHJXH $WLUHRWR[LFRVHGRHQ§DGH*UDYHVRFRUUHHPDSUR[LPDGDPHQWHDFDGDFULDQ©DV

UHVSLUDUSHORQDUL]DO«PGHHGHPDHDOWHUD©¥RGDFRUGRVVXOFRVRUELWRSDOSHEUDLV DEDL[RGRVDQRV$VFULDQ©DVDIHWDGDVDSUHVHQWDPKLSHUPHWDEROLVPRHDFHOHUD©¥RGR
LQIHULRUHVɪROKHLUDVDO«UJLFDVɫ(VVDFULDQ©DIUHTXHQWHPHQWHHPSXUUDRQDUL]SDUDFLPDH FUHVFLPHQWROLQHDU$VFDUDFWHU¯VWLFDVIDFLDLVW¯SLFDVPRVWUDGDVQHVWDFULDQ©DGHDQRVV¥R
SDUDWU£VFRPDP¥RɪVDXGD©¥RDO«UJLFDɫID]HQGRFDUHWDVIUDQ]HRQDUL]HDERFDSDUD RVROKRVɪHVEXJDOKDGRVɫTXHQ¥RV¥RXPDH[RIWDOPLDYHUGDGHLUDIHQ¶PHQRUDURHP
DOLYLDURSUXULGRHDREVWUX©¥RQDVDLV FULDQ©DVHRDXPHQWRGDJO¤QGXODWLUHRLGHE³FLR

4XDGUR 

 $QRUPDOLGDGHVGRVROKRVGDVRUHOKDVHGDERFD
Manchas de Brushfield Estrabismo

2HVWUDELVPRGHVDOLQKDPHQWRRFXODUSRGHFRPSURPHWHUDYLV¥R$HVRWURSLDDTXL

(VVHVSRQWLOKDGRVDQRUPDLVQD¯ULVVXJHUHPV¯QGURPHGH'RZQ
PRVWUDGDFRQVLVWHQRGHVYLRGRVROKRVSDUDDOLQKDPHGLDQDGDIDFH

Otite média

$RWLWHP«GLD«XPGRVTXDGURVPDLVFRPXQVHPFULDQ©DVSHTXHQDV2HVSHFWURGDRWLWHP«GLD«PRVWUDGRDTXL$2WLWHP«GLDDJXGDW¯SLFDFRPPHPEUDQDWLPS¤QLFDYHUPHOKD
GLVWRUFLGDHDEDXODGDHPXPDFULDQ©DFRPVLQDLVHVLQWRPDVVLJQLILFDWLYRV%2WLWHP«GLDDJXGDFRPIRUPD©¥RGHEROKDVHO¯TXLGRYLV¯YHOSRUWU£VGDPHPEUDQDWLPS¤QLFD&2WLWHP«GLD
FRPGHUUDPHHYLGHQFLDQGRO¯TXLGRDPDUHODGRSRUWU£VGHXPDPHPEUDQDWLPS¤QLFDUHWUD¯GDHHVSHVVDGD

Candidíase oral (“sapinho”)

(VVDLQIHF©¥R«FRPXPQRVODFWHQWHV Estomatite herpética

8OFHUD©·HVGRORURVDVQDPXFRVDRUDOFLUFXQGDGDVSRUHULWHPD
$VSODFDVEUDQFDVDGHUHP¢PXFRVD

)RQWHGDVIRWRV2WLWHP©GLDɥ&RUWHVLDGH$OHMDQGUR+REHUPDQ&KLOGUHQɨV+RVSLWDORI3LWWVEXUJK8QLYHUVLW\RI3LWWVEXUJK

4XDGUR 

 $QRUPDOLGDGHVGRVGHQWHVGDIDULQJHHGRSHVFR©R

Cáries dentárias

$VF£ULHVGHQW£ULDVFRQVWLWXHPXPLPSRUWDQWHSUREOHPDGHVD¼GHSHGL£WULFDJOREDO$VIRWRJUDILDV¢HVTXHUGDPRVWUDPDVGLIHUHQWHVFDUDFWHU¯VWLFDV
GDVF£ULHV

Manchas dentárias
 Manchas dentárias

([LVWHPGLYHUVDVFDXVDVSDUDRVXUJLPHQWRGHPDQFKDVQRVGHQWHVGHFULDQ©DVLQFOXVLYHPDQFKDVLQWU¯QVHFDVSRUFDXVDGRXVRGHWHWUDFLFOLQD 
GLUHLWDRXPDQFKDVH[WU¯QVHFDVFRPRKLJLHQHRUDOSUHF£ULDQ¥RPRVWUDGDV$VPDQFKDVH[WU¯QVHFDVSRGHPVHUUHPRYLGDV

Faringite estreptocócica

(VWDLQIHF©¥RFRPXPGDLQI¤QFLDPDQLIHVWDVHFODVVLFDPHQWHFRPR
HULWHPDGDSDUWHSRVWHULRUGDIDULQJHHSHW«TXLDVQRSDODWRHVTXHUGD
8PH[VXGDGRI«WLGRGLUHLWDWDPE«P«FRPXPHQWHREVHUYDGR

Linfadenopatia

2DFKDGRGHOLQIRQRGRVFHUYLFDLVDXPHQWDGRVHGRORURVRV«FRPXPQDVFULDQ©DV$VFDXVDVPDLVSURY£YHLVV¥RLQIHF©·HVYLUDLVHEDFWHULDQDV2
DXPHQWRGRVOLQIRQRGRVSRGHVHUELODWHUDOFRPRPRVWUDGRDTXL

)RQWHGDVIRWRV&¡ULHVGHQW¡ULDVHPDQFKDVQRVGHQWHVɥ&RUWHVLDGD$PHULFDQ$FDGHP\RI3HGLDWULFV

4XDGUR 

 &LDQRVHHPFULDQ©DV

‹LPSRUWDQWHUHFRQKHFHUDFLDQRVH2PHOKRUORFDOSDUDVHYHULILFDUFLDQRVHV¥RDVPXFRVDV$FLDQRVHFXUVDFRPXPDFRUGHɪDPRUDɫTXH
FRQWUDVWDFRPDFRORUD©¥RɪPRUDQJRɫGDPXFRVDQRUPDO7HQWHLGHQWLILFDUFLDQRVHQHVVDVIRWRJUDILDVDQWHVGHOHUDVOHJHQGDV

&LDQRVHJHQHUDOL]DGD
&LDQRVHSHULRUDO

(VWHEHE¬DSUHVHQWDUHWRUQRYHQRVRSXOPRQDUDQ¶PDORWRWDOFRPWD[DGHVDWXUD©¥RGH
(VWHEHE¬DSUHVHQWDFLDQRVHOHYHDFLPDGRVO£ELRVPDVDVPXFRVDVFRQWLQXDPUµVHDV
R[LJ¬QLRGH
/£ELRVD]XODGRVFRQIHULQGRDDSDU¬QFLDGHFLDQRVH $FURFLDQRVH

'HSµVLWRQRUPDOGHSLJPHQWRQDERUGDGRVO£ELRVFRQIHUHDHOHVXPDWRQDOLGDGHD]XODGD $SDUHFHFRPXPHQWHQRVS«VHQDVP¥RVORJRDSµVRQDVFLPHQWR(VWHIHWRQDVFHXGH
PDVDVPXFRVDVSHUPDQHFHPUµVHDV VHPDQDV

)RQWHGDVIRWRVH[FHWRFLDQRVHJHQHUDOL]DGD)OHWFKHU03K\VLFDO'LDJQRVLVLQ1HRQDWRORJ\3KLODGHOSKLD/LSSLQFRWW5DYHQ

4XDGUR 

 6RSURVFDUG¯DFRVFRQJ¬QLWRV

$OJXQVVRSURVFDUG¯DFRVUHIOHWHPFDUGLRSDWLDVVXEMDFHQWHV6HYRF¬HQWHQGHUDVFDXVDVILVLROµJLFDVFRQVHJXLU£LGHQWLILF£ORVFRPPDLV
IDFLOLGDGHHGLIHUHQFL£ORVGHVRSURVFDUG¯DFRVLQRFHQWHV$VOHV·HVREVWUXWLYDVRFRUUHPTXDQGRRVDQJXHIOXLSRUYDOYDVSHTXHQDVGHPDLV
&RPRHVWHSUREOHPDQ¥RGHSHQGHGDTXHGDGDUHVLVW¬QFLDYDVFXODUSXOPRQDUDSµVRQDVFLPHQWRRVVRSURVM£V¥RDXG¯YHLVDRQDVFLPHQWR
2VGHIHLWRVFRPVKXQWVGDHVTXHUGDSDUDGLUHLWDSRURXWURODGRGHSHQGHPGHTXHGDGDUHVLVW¬QFLDYDVFXODUSXOPRQDU5932VVKXQWVGH
DOWDSUHVV¥RFRPRFRPXQLFD©¥RLQWHUYHQWULFXODU&,9SHUVLVW¬QFLDGRFDQDODUWHULDO3&$HWURQFRDUWHULDOVµV¥RDXVFXOWDGRVVHPDQDRX
PDLVDSµVRQDVFLPHQWR2VVKXQWVGHEDL[DSUHVV¥RGDHVTXHUGDSDUDGLUHLWDFRPRFRPXQLFD©·HVLQWHUDWULDLV&,$SRGHPQ¥RVHU
DXVFXOWDGRVSRUXPWHPSRFRQVLGHUDYHOPHQWHPDLRUHHPJHUDOVµV¥RGHWHFWDGRVTXDQGRDFULDQ©DWHPDQRGHLGDGHRXPDLV0XLWDV
FULDQ©DVFRPGHIHLWRVFDUG¯DFRVFRQJ¬QLWRVDSUHVHQWDPFRPELQD©·HVGHGHIHLWRVSRUYDULD©·HVGHDQRUPDOLGDGHVHGHVVHPRGRRV
DFKDGRVQRH[DPHFDUG¯DFRQ¥RVHJXHPRVSDGU·HVFO£VVLFRV(VWHTXDGURPRVWUDXPDVHOH©¥ROLPLWDGDGHDOJXQVGHIHLWRVFRPXQV

'HIHLWRFRQJ¬QLWRHPHFDQLVPR &DUDFWHU¯VWLFDVGRVRSUR $FKDGRVDVVRFLDGRV

(VWHQRVHYDOYDUSXOPRQDU
(PJHUDOXPDQHOYDOYDUQRUPDOFRPIXV¥RGH
DOJXQVRXDPDLRULDGDVY£OYXODVGDYDOYDTXH
UHVWULQJHRIOX[RDWUDY«VGDYDOYD (PJHUDOXPFOLTXHGHHMH©¥RSURWRVVLVWµOLFRSURHPLQHQWH
/RFDOL]D§£R%RUGDHVWHUQDOHVTXHUGDVXSHULRU
/HYH 2FRPSRQHQWHSXOPRQDUGDVHJXQGDEXOKD3QDEDVHVHWRUQDWDUGLR
,UUDGLD§£R1RVJUDXVOHYHVGHHVWHQRVHRVRSUR
HPDLVVXDYHGHVDSDUHFHQGRFRPRDJUDYDPHQWRGDREVWUX©¥R$
SRGHVHUDXVFXOWDGRQRWUDMHWRGDVDUW«ULDV
LQVSLUD©¥RSRGHLQWHQVLILFDURVRSURDH[SLUD©¥RSRGHLQWHQVLILFDUR
SXOPRQDUHVQRVFDPSRVSXOPRQDUHV
FOLTXH
,QWHQVLGDGH$XPHQWRVGDLQWHQVLGDGHHGDGXUD©¥R
2FUHVFLPHQWRHPJHUDO«QRUPDO
DFRPSDQKDPDXPHQWRVQRJUDXGHREVWUX©¥R
5HF«PQDVFLGRVFRPHVWHQRVHJUDYHSRGHPVHUFLDQµWLFRVSRUFDXVD
*UDYH &DUDFWHU­VWLFDV(MH©¥RFRPSLFRWHOHVVLVWµOLFR¢
GRVKXQWGLUHLWDɥHVTXHUGDDWULDOHGHVHQYROYHUUDSLGDPHQWH
PHGLGDTXHDXPHQWDDREVWUX©¥R
LQVXILFL¬QFLDFDUG¯DFD

(VWHQRVHYDOYDUDµUWLFD
/RFDOL]D§£R0HGLRHVWHUQDOERUGDHVWHUQDOVXSHULRU
(PJHUDOYDOYDELF¼VSLGHFRPREVWUX©¥R GLUHLWD 3RGHKDYHUXPFOLTXHGHHMH©¥RDVVRFLDGR
SURJUHVVLYDPDVSRGHKDYHUYDOYDGLVSO£VLFDOHV¥R
SRUIHEUHUHXP£WLFDRXGRHQ©DGHJHQHUDWLYD
,UUDGLD§£R3DUDDVDUW«ULDVFDUµWLGDVHLQFLVXUD
VXSUDHVWHUQDOSRGHWDPE«PH[LVWLUIU¬PLWR
,QWHQVLGDGH9DULDPDLVLQWHQVRFRPRDJUDYDPHQWR
GDREVWUX©¥R
&DUDFWHU­VWLFDV8PVRSURVLVWµOLFRGHHMH©¥R
IUHTXHQWHPHQWHUXGH
3RGHKDYHUXPFOLTXHGHHMH©¥RDVVRFLDGR
2UX¯GRGHIHFKDPHQWRDµUWLFRSRGHWHULQWHQVLGDGHDXPHQWDGD3RGH
KDYHUVRSURGLDVWµOLFRGHUHJXUJLWD©¥RYDOYDUDµUWLFD2VUHF«P
QDVFLGRVFRPHVWHQRVHJUDYHSRGHPWHUSXOVRVDUWHULDLVIUDFRVRX
DXVHQWHVHLQVXILFL¬QFLDFDUG¯DFDJUDYH3RGHVHUDXG¯YHODSHQDVQD
YLGDDGXOWDDSHVDUGDVDQRUPDOLGDGHVFRQJ¬QLWDVGDYDOYD

7HWUDORJLDGH)DOORW
'HIHLWRFRPSOH[RFRPFRPXQLFD©¥RLQWHUYHQWULFXODU
REVWUX©¥RGRIOX[RGHVD¯GDLQIXQGLEXODUHHPJHUDO
YDOYDUQRYHQWU¯FXORGLUHLWRP£URWD©¥RGDDRUWDH
VKXQWGLUHLWDɥHVTXHUGDQDDOWXUDGRVHSWR
LQWHUYHQWULFXODU
&RPHVWHQRVHSXOPRQDU
&RPDWUHVLDSXOPRQDU
*HUDO&LDQRVHYDUL£YHOTXHVHH[DFHUEDFRPD
DWLYLGDGHI¯VLFD 3XOVRVQRUPDLV
/RFDOL]D§£R%RUGDHVWHUQDOHVTXHUGDSRU©¥RP«GLD 2UX¯GRGHIHFKDPHQWRSXOPRQDUQ¥RFRVWXPDVHUDXVFXOWDGR3RGHP
DVXSHULRU6HKRXYHUDWUHVLDSXOPRQDUSRGHQ¥R H[LVWLUHSLVµGLRVDEUXSWRVGHKLSHUFLDQRVHFRPV¼ELWRDJUDYDPHQWRGD
KDYHUVRSURVLVWµOLFRSRU«PRVRSURFRQW¯QXRGD FLDQRVHGLVSQHLDDOWHUD©¥RGRQ¯YHOGHFRQVFL¬QFLD
SHUVLVW¬QFLDGRFDQDODUWHULDOQDERUGDVXSHULRU
,QFDSDFLGDGHGHJDQKDUSHVRDVVRFLDGDDSHUVLVW¬QFLDRXDJUDYDPHQWR
HVTXHUGDGRHVWHUQRRXQRGRUVR
GDFLDQRVH
,UUDGLD§£R3RXFDSDUDDERUGDHVWHUQDOHVTXHUGD
3HUVLVW¬QFLDSURORQJDGDGDFLDQRVHDFRPSDQKDGDSRUEDTXHWHDPHQWR
VXSHULRURFDVLRQDOPHQWHFDPSRVSXOPRQDUHV
GRVGHGRVGDVP¥RVHGRVS«V
,QWHQVLGDGH(PJHUDO,,,,9
+LSR[HPLDSHUVLVWHQWHTXHSURYRFDSROLFLWHPLDTXHDFHQWXDDFLDQRVH
&DUDFWHU­VWLFDV3LFRPHVRVVLVWµOLFRVRSURGHHMH©¥R

*HUDO&LDQRVHJHQHUDOL]DGDHLQWHQVD
7UDQVSRVL©¥RGDVJUDQGHVDUW«ULDV
'HIHLWRVLJQLILFDWLYRDVVRFLDGRDDXV¬QFLDGHURWD©¥R
GRVJUDQGHVYDVRVID]HQGRFRPTXHDDRUWDVH
RULJLQHQRYHQWU¯FXORGLUHLWRHDDUW«ULDSXOPRQDUVH
RULJLQHQRYHQWU¯FXORHVTXHUGR
6HJXQGDEXOKD%¼QLFDHKLSHUIRQ«WLFDHPGHFRUU¬QFLDGDYDOYD
/RFDOL]D§£R$XV¬QFLDGHVRSURFDUDFWHU¯VWLFR6H
DµUWLFDDQWHULRU
KRXYHUVRSURSRGHUHIOHWLUXPGHIHLWRDVVRFLDGR
FRPR&,9 )UHTXHQWHGHVHQYROYLPHQWRU£SLGRGHLQVXILFL¬QFLDFDUG¯DFD
,UUDGLD§£RHFDUDFWHU­VWLFDV'HSHQGHPGDV 'HIHLWRVDVVRFLDGRVIUHTXHQWHVFRPRGHVFULWR¢HVTXHUGD
DQRUPDOLGDGHVDVVRFLDGDV
/RFDOL]D§£R%RUGDHVWHUQDOLQIHULRUHVTXHUGD
,UUDGLD§£R3RXFD 4XDQGRRVVKXQWVV¥RJUDQGHVSRGHH[LVWLUXPVRSURPHVRGLDVWµOLFRGH
&RPXQLFD©¥RLQWHUYHQWULFXODU&,9
2VDQJXHTXHIOXLGRYHQWU¯FXORHVTXHUGRGHDOWD
SUHVV¥RDWUDY«VGHXPGHIHLWRQRVHSWRSDUDR
WRQDOLGDGHJUDYHGHYLGRDHVWHQRVHPLWUDOUHODWLYDQR£SLFH
,QWHQVLGDGH9DUL£YHODSHQDVSDUFLDOPHQWH
GHWHUPLQDGDSHORWDPDQKRGRVKXQW2VVKXQWV ‚PHGLGDTXHDXPHQWDDSUHVV¥RGDDUW«ULDSXOPRQDURFRPSRQHQWH
SHTXHQRVFRPDOWRVJUDGLHQWHVGHSUHVV¥RHVW¥R
YHQWU¯FXORGLUHLWRGHEDL[DSUHVV¥RFULDWXUEXO¬QFLD
DVVRFLDGRVDVRSURVPXLWRLQWHQVRV2VGHIHLWRVGR
HPJHUDOGXUDQWHWRGDDV¯VWROH
VHSWRLQWHUYHQWULFXODUJUDQGHVDVVRFLDGRVD
/HYHDPRGHUDGR
UHVLVW¬QFLDYDVFXODUSXOPRQDUHOHYDGDSRGHPQ¥R
VHDVVRFLDUDVRSURV*UDXV,,,99,V¥R
DFRPSDQKDGRVSRUIU¬PLWRVHRJUDXIRULJXDOD
,99,RXPDLRU
&DUDFWHU­VWLFDV6RSURKRORVVLVWµOLFRHPJHUDOUXGH
SRGHRIXVFDU%H%VHIRUVXILFLHQWHPHQWHLQWHQVR
/RFDOL]D§£R%RUGDHVWHUQDOVXSHULRUHVTXHUGDH¢
SXOPRQDUGDVHJXQGDEXOKD3QDEDVHDXPHQWDHPLQWHQVLGDGH
4XDQGRDSUHVV¥RGDDUW«ULDSXOPRQDU«LJXDO¢SUHVV¥RDµUWLFDSRGH
Q¥RKDYHUVRSURH3VHU£PXLWRLQWHQVR
2FUHVFLPHQWR«QRUPDOQRVVKXQWVGHEDL[RYROXPH
(PVKXQWVPDLRUHVSRGHRFRUUHULQVXILFL¬QFLDFDUG¯DFDDW«DDDD
VHPDQDVEDL[RJDQKRGHSHVR
'HIHLWRVDVVRFLDGRVV¥RIUHTXHQWHV
3XOVRVFKHLRVDF«OHUHV
3HUVLVW¬QFLDGRFDQDODUWHULDO3&$
)OX[RFRQW¯QXRGDDRUWDSDUDDDUW«ULDSXOPRQDU
GXUDQWHRFLFORFDUG¯DFRTXDQGRRFDQDODUWHULDO
SHUVLVWHDSµVRQDVFLPHQWR
/HYHDPRGHUDGD
HVTXHUGD
,UUDGLD§£R‚VYH]HVSDUDRGRUVR
,QWHQVLGDGH9DULDGHSHQGHQGRGRWDPDQKRGR
VKXQWHPJHUDOJUDX,,ɥ,,,9,
&DUDFWHU­VWLFDV6RSUR¢VYH]HVHPPDTXLQDULD
FRQW¯QXRSRUWRGRRFLFORFDUG¯DFR2FDVLRQDOPHQWH
TXDVHLQDXG¯YHOQDWHOHGL£VWROHQ¥RLQWHUURPSLGR
SHODVEXOKDVFDUG¯DFDVPDLVLQWHQVRQDV¯VWROH
$XVFXOWDGRDRQDVFLPHQWRQRSUHPDWXURTXHSRGHWHUSXOVRVF«OHUHV
SUHFµUGLRKLSHUGLQ¤PLFRHVRSURDW¯SLFR
2EVHUYDGRPDLVWDUGHQRUHF«PQDVFLGRDWHUPR¢PHGLGDTXHFDLD
UHVLVW¬QFLDYDVFXODUSXOPRQDU
3RGHVXUJLULQVXILFL¬QFLDFDUG¯DFDHQWUHDDHDDVHPDQDVGHYLGD
TXDQGRRVKXQW«JUDQGH
*DQKRLQVDWLVIDWµULRGHSHVR¢PHGLGDTXHDXPHQWDRVKXQW
$KLSHUWHQV¥RSXOPRQDUDIHWDRVRSURFRPRDFLPD

&RPXQLFD©¥RLQWHUDWULDO&,$
'HVGREUDPHQWRDPSORGDVHJXQGDEXOKDHPWRGDVDVIDVHVGD
 VHSWRLQWHUDWULDOSRGHRFRUUHUHPY£ULRVQ¯YHLV UHVSLUD©¥RLQWHQVLGDGHQRUPDO
,UUDGLD§£R3DUDRGRUVR
(PJHUDODXVFXOWDGRVRPHQWHDSµVDQRGHLGDGH
,QWHQVLGDGH9DUL£YHOHPJHUDOJUDX,,,,,9,
5HGX©¥RJUDGXDOGRJDQKRGHSHVR¢PHGLGDTXHRVKXQWDXPHQWD
&DUDFWHU­VWLFDV6RSURGHHMH©¥RPDVQ¥R«UXGH
5HGX©¥RGDWROHU¤QFLDDRVHVIRU©RVI¯VLFRVVXWLOHQ¥RGUDP£WLFD
,QVXILFL¬QFLDFDUG¯DFD«UDUD

4XDGUR 

 6LQDLVI¯VLFRVGHDEXVRVH[XDO

3RVV¯YHLVLQGLFD©·HV

'LODWD©¥RDFHQWXDGDHLPHGLDWDGR¤QXVHPSRVL©¥RGHJHQXIOH[¥RVHPFRQVWLSD©¥RLQWHVWLQDOIH]HVQDF¼SXODRXWUDQVWRUQRV
QHXUROµJLFRV

)HQGDRXDEDXODPHQWRKLPHQDOTXHVHHVWHQGHSRUPDLVGHGDERUGDLQIHULRUGRK¯PHQFRQILUPDGRQDSRVL©¥RJHQXSHLWRUDO

&RQGLORPDVDFXPLQDGRVHPFULDQ©DVFRPPDLVGHDQRV

(TXLPRVHVDEUDV·HVODFHUD©·HVRXPDUFDVGHPRUGLGDVQRVO£ELRVPDLRUHVHPHQRUHVGRSXGHQGRRXQRWHFLGRSHULKLPHQDO

+HUSHVQDUHJL¥RDQRJHQLWDOGHSRLVGRSHU¯RGRQHRQDWDO

6HFUH©¥RYDJLQDOSXUXOHQWDRXI«WLGDHPPHQLQDSHTXHQDUHDOL]DUFXOWXUDHREVHUYDUWRGDVDVVHFUH©·HVVREPLFURVFµSLREXVFDQGR
HYLG¬QFLDVGHGRHQ©DVVH[XDOPHQWHWUDQVPLVV¯YHLV

)RUWHVLQGLFD©·HV

/DFHUD©·HVHTXLPRVHVHFLFDWUL]D©·HVUHF«PRFRUULGDVQRK¯PHQRXQDI¼UFXODSRVWHULRU

$XV¬QFLDGHWHFLGRKLPHQDOQDVSRVL©·HVGHDKFRQILUPDGDHPY£ULDVSRVL©·HV

7UDQVHF©·HVKLPHQDLVFLFDWUL]DGDVHVSHFLDOPHQWHHQWUHDVSRVL©·HVHKIHQGDFRPSOHWD

/DFHUD©·HVSHULDQDLVTXHVHHVWHQGHPDW«RHVI¯QFWHUH[WHUQR

8PDFULDQ©DFRPVLQDLVI¯VLFRVSUHRFXSDQWHVWHPGHVHUDYDOLDGDSRUXPHVSHFLDOLVWDHPDEXVRVH[XDOTXHIDU£XPD
DQDPQHVHFRPSOHWDHUHDOL]DU£XPH[DPHHVSHF¯ILFRSDUDDEXVRVH[XDO

4XDOTXHUVLQDOI¯VLFRSUHFLVDVHUDYDOLDGR¢OX]GDKLVWµULDFRPRXPWRGRGRUHVWDQWHGRH[DPHI¯VLFRHGHH[DPHVODERUDWRULDLV

+HPRUUDJLDDJXGDHHTXLPRVHVGRVWHFLGRV (ULWHPDHDEUDV·HVVXSHUILFLDLVGRVO£ELRVPHQRUHV ,QWHUUXS©¥RFLFDWUL]DGDQDPHPEUDQDGRK¯PHQQDSRVL©¥RGHK

ODFWHQWHGHPHVHV GRSXGHQGRFULDQ©DGHDQRV FULDQ©DGHDQRV

$QHOSRVWHULRUHVWUHLWDGRFRQW¯QXRFRPRDVVRDOKR 6HFUH©¥RYDJLQDOFRSLRVDHHULWHPDFULDQ©DGH

&RQGLORPDVDEXQGDQWHVHPWRUQRGR¤QXVFULDQ©DGHDQRV
GDYDJLQDFULDQ©DGHDQRV DQRV

)RQWH5HHFH5/XGZLJ6HGV&KLOG$EXVH0HGLFDO'LDJQRVLVDQG0DQDJHPHQWQGHG3KLODGHOSKLD/LSSLQFRWW:LOOLDPV :LONLQV

1579HMDQRVLWHGR0LQLVW«ULRGD6D¼GHDQRUPDW«FQLFD3UHYHQ©¥RH7UDWDPHQWRGD9LRO¬QFLD6H[XDO&RQWUD0XOKHUHVH$GROHVFHQWHV

4XDGUR 

 6LVWHPDVJHQLWDOHXULQ£ULRQRVH[RPDVFXOLQR

+LSRVSDGLD
&ULSWRUTXLGLD

$KLSRVSDGLD«DDQRUPDOLGDGHSHQLDQDFRQJ¬QLWDPDLVFRPXP2PHDWRXUHWUDOVHDEUH
‹SUHFLVRGLIHUHQFLDUDFULSWRUTXLGLDPRVWUDGDDFLPDFRPRVWHVW¯FXORVQRVFDQDLV
GHPDQHLUDDQ¶PDODQDVXSHUI¯FLHYHQWUDOGRS¬QLV8PDGDVDSUHVHQWD©·HV«PRVWUDGD
LQJXLQDLVɥYHMDDVVHWDVGHWHVW¯FXORVH[WUHPDPHQWHUHWU£WHLVHVWLPXODGRVSRUUHIOH[R
DFLPDPRGDOLGDGHVPDLVJUDYHVHQYROYHPDEHUWXUDVQDSDUWHLQIHULRUGRFRUSRGRS¬QLV
FUHPDVW«ULFRPXLWRDWLYR
RXQRHVFURWR

)RQWHGDVIRWRV+LSRVSDGLDɥ&RUWHVLDGH:DUUHQ6QRGJUDVV0'87ɥ6RXWKZHVWHUQ0HGLFDO&HQWHUDW'DOODV&ULSWRUTXLGLDɥ)OHWFKHU0
3K\VLFDO'LDJQRVLVLQ1HRQDWRORJ\3KLODGHOSKLD/LSSLQFRWW5DYHQ

4XDGUR 

 $FKDGRVPXVFXORHVTXHO«WLFRVFRPXQVHPFULDQ©DVSHTXHQDV
 3©VSODQRVSRUFDXVDGHIURX[LG¥RGDVHVWUXWXUDVGHWHFLGRVPROHVGR 0HWDWDUVRDGXWRHPXPDFULDQ©D$SDUWHDQWHULRUGRS«HVW£DGX]LGD
,QYHUV¥RGRS«YDUR HQ¥RLQYHUWLGD
S«

3URQD©¥RHPFULDQ©DFRPDDQRVGHLGDGH$4XDQGRREVHUYDGDSRUWU£VSHUFHEHVHHYHUV¥RGDSDUWHSRVWHULRUGRS«%4XDQGRREVHUYDGDSHODIUHQWHDSDUWHDQWHULRUGRS«
HQFRQWUDVHHYHUWLGDHDEGX]LGD

4XDGUR 

 2SRGHUGDSUHYHQ©¥R_'RHQ©DVSUHYHQ¯YHLVSRUYDFLQD

(VWHTXDGURPRVWUDIRWRJUDILDVGHFULDQ©DVFRPGRHQ©DVTXHSRGHPVHUSUHYHQLGDVSRUYDFLQD$YDFLQD©¥RLQIDQWLO«FRQVLGHUDGDD
LQWHUYHQ©¥RP«GLFDLVRODGDPDLVLPSRUWDQWHGRPXQGRHPWHUPRVGHLQIOX¬QFLDVREUHDVD¼GHS¼EOLFD(PIXQ©¥RGDYDFLQD©¥RWHPRVD
HVSHUDQ©DGHQXQFDPDLVYHUPXLWRVGHVVHVTXDGURVFRQWXGR«LPSRUWDQWHVDEHULGHQWLILF£ORV7HQWHLGHQWLILFDUDVGRHQ©DVDQWHVGHOHUDV
OHJHQGDV

3ROLRPLHOLWH
6DUDPSR 5XE«ROD

$SHUQDGHIRUPDGDGHVWDFULDQ©D«FRQVHTX¬QFLD
(UXS©¥RFDUDFWHU¯VWLFDGRVDUDPSR (UXS©¥RFXW¤QHDGDUXE«RODQRGRUVRGHVVDFULDQ©D
GHSROLRPLHOLWH

7«WDQR ,QIHF©¥RSRUHaemophilus influenzaeGRWLSR%

9DULFHOD
7«WDQR ,QIHF©¥RSRUHaemophilus influenzaeGRWLSR% 9DULFHOD

5LJLGH]GHUHF«PQDVFLGRTXHDSUHVHQWDW«WDQR &HOXOLWHSHULRUELW£ULDSURYRFDGDSRUHVVDGRHQ©D /DFWHQWHFRPIRUPDJUDYHGHYDULFHOD

QHRQDWDO EDFWHULDQDLQYDVLYD

&¤QFHUGHFRORXWHULQR

0HQLQJLWH &RTXHOXFKH &¤QFHUSDVV¯YHOGHSUHYHQ©¥RSHODYDFLQDFRQWUDRSDSLORPDY¯UXV

KXPDQR+39

)RQWHGDVIRWRV3ROLRPLHOLWHɥ&RUWHVLDGD2UJDQL]D©¥R0XQGLDOGD6D¼GH,QIHF§£RSRU+DHPRSKLOXVLQIOXHQ]DHɥ&RUWHVLDGD$PHULFDQ
$FDGHP\RI3HGLDWULFV9DULFHODɥ&RUWHVLDGH%DUEDUD:DWVRQ0'$OEHUW(LQVWHLQ0HGLFDO&HQWHUDQG'LYLVLRQRI'LVHDVH&RQWURO
3KLODGHOSKLD'HSDUWPHQWRI+HDOWK7©WDQRɥ&RUWHVLDGR&HQWHUVIRU'LVHDVH&RQWURODQG3UHYHQWLRQ&RTXHOXFKHɥ&RUWHVLDGD,PPXQL]DWLRQ
$FWLRQ&RDOLWLRQ
BBBBBBBBBBBBBBBBB
157&RQVXOWHRVLWHGR0LQLVWpULRGD6D~GHDUHVSHLWRGDYDFLQDomRLQIDQWLO1RYDVYDFLQDVIRUDPLQFRUSRUDGDV
DRFDOHQGiULRUHFHQWHPHQWH
1570HGLFDLGpXPSURJUDPDIHGHUDOQRUWHDPHULFDQRSDUDIDPtOLDVGHEDL[DUHQGD