Abstract:
An apparatus to enable health care providers to perform a number of diagnostic procedures, including listening to the heart, obtaining electrocardiograms and sonograms. A pocket size instrument displays an EKG tracing on its screen simultaneously upon auscultation of the heart. The abdomen may also be investigated by displaying a sonogram. Wireless broadband technology may provide a closed circuit interface for real-time wireless transmission of acquired data. Examination requires none of a multiplicity of wires to untangle, bulky machines or a technician to be summoned. Regurgitation, heart size, ischemia and heart murmurs can all be evaluated by a visual and auditory methods.

Description:
This application claims priority under 35 U.S.C. §119(e) from U.S. Provisional Patent Application Ser. No. 60/506,851 filed on Sep. 30, 2003, which is incorporated herein by reference in its entirety. 

   BACKGROUND OF THE INVENTION 
   1. Field of the Invention 
   The present invention relates to apparatus that may be used to examine a living body. More particularly, it relates to apparatus that may be used for listening for body sounds and for receiving electrical signals from the body. It also relates to apparatus which have the capability of examining a body with ultrasound. 
   2. Prior Art 
   The stethoscope since its perfection in 1855 by a New York Physician, Dr. George Cammann, has remained relatively unchanged in the last two centuries. Not much has been done or modified from its basic design and function since then. The stethoscope as it is to date, is greatly limited by what it can do. In the examination of the heart, only sound can be appreciated. While helpful in certain limited clinical situation, sound tells the medical practitioner very little about the true characteristic of the heart, such as its conduction or electrical activities and its true physical state. 
   The general shape of the stethoscope underwent some minor improvements. However, what has remained constant for the past 150 years is the appearance. There is probably a good reason for this. Besides the white coat that is so symbolic of a doctor, it is the stethoscope instrument that easily identifies a health care professional. The stethoscope has been revered as a symbol of the medical profession and more specifically for the health care provider. In some ways, in terms of its symbolism, the shape of the stethoscope can be likened to the gavel a judge uses. 
   The entire book of Bates, which is the gold standard physical diagnostic book, stresses the fundamentals of acquiring good clinical skills using the traditional stethoscope. There are clinician that are presently being trained that will prefer the natural appreciation of detecting sound coming from the heart in its pure form, using the traditional method. To enhance this feature, two diaphragms have been used to channel natural heart sound to the right and left ear, respectively. 
   However, it is in the electrical activities of the heart that are most appropriate for detecting signs which tell the practitioner if a heart is healthy, or not. The practitioner searches for pathologies with respect to electrolytes disturbances, heart muscle damage and/or enlargement; conduction abnormalities (such as prolonged Q-T intervals); rate of the heart; rhythm, axis and more. 
   Due to their cumbersome nature (because of bulky machines, complex lead arrangements, or the need for a technician) of obtaining an ECG on the general population, one is not routinely done in common practice. 
   For the most part, an EKG is reserved for age specific population or for people with established or suspected cardiac illnesses. In both cases the study is usually formerly requested and time is the factor that most clinicians have to deal with. 
   Sonogram technology has been adapted to investigate all forms of pathologies within the abdomen and heart. In addition it has been used to access vascular diseases of the extremities such as deep vein thrombosis; which is a rather prevalent condition. As before with an EKG, the clinician is often at the mercy of the sonogram technician in obtaining, and in some cases interpreting sonogram data. 
   SUMMARY OF THE INVENTION 
   It is an object of the invention to incorporate technological advances while preserving the basic design and functionality of the traditional stethoscope. 
   It is another object of the invention to provide an apparatus for obtaining an EKG trace quickly and efficiently. 
   It is yet another object of the invention to provide an apparatus that avoids the need for a multiplicity of electrical leads that are difficult to manage, and may become tangled. 
   It is still another object of the invention to provide new configurations for EKG electrodes that may be used with the apparatus of the invention and with other apparatus. 
   These objects and others are achieved in accordance with the invention in an apparatus for determining a condition of a living body, comprising a first portion for acquiring acoustic signals from said body, said first potion having electrodes for acquiring electric signals from said body; a second portion comprising an elongate housing having conduits for conducting signals from said first portion; and a third portion comprising a headset for listening to said acoustic signals; wherein said third portion is removeably connectable to said second portion. The apparatus may further comprising a communication link between said second portion and said third portion for transferring said signals when said first portion is not connected to said second portion. The communication link is preferably a broadband communications link. It is preferably a wireless communication link. 
   The first portion may further comprise a display for providing a visual indication representative of at least one of said signals. 
   The apparatus may be in combination with an external display coupled to said apparatus with a broadband wireless real-time connection for data originating in said apparatus. 
   The first portion may further comprise an ultrasonic transducer usable for performing an ultrasonic examination of at least a portion of said body. 
   The apparatus may be in combination with an external display coupled to said apparatus with a broadband wireless real-time connection for data originating in said apparatus, said data being derived from at least one of a sonogram, and an electrocardiogram. The second portion is configured with an elongate cavity and at least one cover for covering said cavity. The cover may comprise at least one door swingably mounted to said second portion so that said at least one door swings away from said cavity to expose said cavity. 
   The apparatus may further comprise a plurality of cords extending from said second portion, said cords each having a bundle of wires, each wire being configured at its end for an electrode for acquiring an electrical signal from said body, said cords being capable of bending and folding so as to fit within said cavity. The cords and said wires may be configured to place said electrodes for receiving EKG signals. The plurality may include two cords, a first of said cords being configured so that respective electrodes associated with said first cord receive signals from a first side of the body, and a second of said cords being configured so that respective electrodes associated with said second cord receive signals from a second side of the body. The first and second sides may be the left side and right side of said body. 
   The plurality may includes two cords, a first of said cords being configured so that respective electrodes associated with said first cord receive precordial signals from a body, and a second of said cords being configured so that respective electrodes associated with said second cord receive limb signals from the body. 
   The plurality may comprise three cords, a first of said cords having associated electrodes for receiving signals from both arms, a second of said cord having associated electrodes for receiving precordial signals, and a third one of said cords having associated electrodes for receiving signals from the both legs. 
   The first portion, the second portion and the third portion of the apparatus may each comprise at least one electrode for receiving electrical signals from said body. The apparatus may further comprise at least one adjustable light source on said first portion. 
   The first portion may comprise a diaphragm having a first part and a second part, and said headset may comprise a first earpiece and a second earpiece, said first part of said diaphragm providing signals for said first earpiece, and said second part of said diaphragm providing signals for said second earpiece. 
   The first portion may be releasably connected to said second portion, and said second portion may be releasably connected to and said third portion. 
   The invention is also directed to a method for obtaining an electrocardiogram, by using the apparatus as described herein. Further, the invention is directed to arrangements of leads for electrodes in respective cords, as also described herein. 

   
     BRIEF DESCRIPTION OF THE DRAWINGS 
     The foregoing aspects and other features of the present invention are explained in the following description, taken in connection with the accompanying drawings, wherein: 
       FIG. 1  is a plan view of an apparatus in accordance with the invention. 
       FIG. 2  is a slightly enlarged, side elevational view of a first portion of the apparatus shown of  FIG. 1 . 
       FIG. 3  is a cross-sectional view taken along line  3 - 3  of  FIG. 2 . 
       FIG. 4  is a slightly enlarged plan view of a first portion of the apparatus  FIG. 1 . 
       FIG. 5  is a partial plan view of a second portion of the apparatus of  FIG. 1 . 
       FIG. 6  is a bottom view of a third portion of the apparatus of  FIG. 1 . 
       FIG. 7  illustrates the apparatus in accordance with the invention, and standard positions on a human for placement of EKG leads. 
       FIG. 8  illustrates use of the invention for monitoring twelve lead EKG activity in accordance with a first method in accordance with the invention. 
       FIG. 9  illustrates use of the invention to produce a sonogram. 
       FIG. 10  is a conceptual block diagram of an apparatus in accordance with the invention. 
   

   DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
   Referring to  FIG. 1 , there is shown a perspective view of an apparatus incorporating features of the present invention. Although the present invention will be described with reference to the embodiments shown in the drawings, it should be understood that the present invention can be embodied in many alternate forms of embodiments. In addition, any suitable size, shape or type of elements or materials could be used. 
   In  FIG. 1 , an apparatus shown generally as  10 , in accordance with the invention is being held in the manner which illustrates the portions thereof, and will be discussed again below in terms of its use. 
   Apparatus  10  includes a first portion or head  12  which may be applied to a body to determine the condition thereof, a second portion which is an elongate body  14 , and a third portion  16 , which includes an earpiece assembly  18 , which may be of a conventional type to the extent that has earpieces  20  and  22  for placement in the ears of a practitioner. Head  12  and third portion  16  may both be releasably coupled to body  14 , thus providing a modular assembly, for ease of servicing and ease of use to for various purposes, as described below. 
   Referring to  FIG. 2 , head  12  has a housing  26  configured with an extension  28  that has on a planar underside, a diaphragm  30 . Diaphragm  30  is constructed of suitable materials and in a suitable manner so as to have the acoustic properties of a conventional acoustic stethoscope diaphragm. However, diaphragm  30  may be configured with at least one or more electrodes for acquiring electrical signals from a living body undergoing examination. 
   Diaphragm  30  may be constructed as a split diaphragm, and appropriate arrangements may be provided so that one side of diaphragm  30  provides acoustic signals to one earpiece  20  and the other side of diaphragm  30  provides acoustic signals the other earpiece  22 . These may be actual acoustic signals, or those provided by appropriate transducers, and amplification of electrical signals from those transducers. 
     FIG. 3  shows that extension  28  of housing  26  need not be circular, and in fact may have a generally rectangular shape, although the sides of the rectangle may be curved. Diaphragm  30 , secured about the periphery of the lower end of extension  28  of housing  26 , may have a similar shape. Further, diaphragm  30  may have embedded therein a series of electrodes  32 ,  34  and  36  of the type discussed above. Alternatively, or in addition, there may be other vital sign sensors, such as blood oxygen or blood sugar monitoring sensors disposed on diaphragm  30  so that they can come into contact with, or at least acquire information from a patient when placed on the skin or in close proximity thereto. 
   Referring again to  FIG. 2 , a second housing extension  38  may house one or more ultrasonic transducer elements, as represented by  40 . There may be a single transducer element, or an array of transducer elements, which are useful in ultrasonic diagnosis of conditions within the body. If an array is present, it may be electronically steered in a manner well known in the art. 
   A data display  42  is present at the top of housing  26  so as to be generally visible to the practitioner when apparatus  10  is in use for investigating any one of acoustic, electrical or ultrasound signals from a body. The display, and additional functions of apparatus  10  may be manipulated by use of keys  43  and/or touch screen regions or key pads  68  (also designated A, B, C, and D) on a keypad  44 , also located on a top surface of housing  26 , and as more fully described below with reference to  FIG. 4 . 
   Referring to both  FIG. 2  and  FIG. 3 , housing  26  may have a lamp fixture  46  on one side, and  48  on the other. Thus, it is no longer necessary for clinicians to carry a separate penlight or flashlight to examine, for example, the mouth and throat of a patient. Lamp fixtures  46  and  48  may contain lamps  50  and  52 , respectively, of different colors, or for example, one may provide a white light, while the other provides a green light by, for example, use of appropriate lamp covers or lenses  54  and  56 , respectively. The lamps may be of the same type or of different types, and may include small incandescent lamps, light emitting diodes, or other lamps of a type well known in the art. Preferably, the lamps are chosen so that the amount of energy supplied to them can be varied to vary the intensity of the light produced. A control, such as a rheostat (not shown) operated by a dial  58  ( FIG. 2 ) may be used to control the energy supplied. The control may be configured in the same manner as a conventional radio volume control, with an off position so as to turn off the lights and to save energy. While only one control is shown, it will be understood that separate controls may be provided on housing  26  for each of lamps  50  and  52 . 
     FIG. 4  shows that the display  42  may be used to provide waveform data display  62  and  64 , such as EKG data from various electrodes as described above and as further described below. In addition, alphanumeric data of various kinds can be provided, such as, for example, heart rate, expressed in beats per minute (BPM), or blood sugar level, or blood oxygen level, depending on the types of vitals sensors associated with diaphragm  30 , or placed elsewhere on apparatus  10 , as more fully discussed below. Display  42  may include touch screen buttons for controlling the operation of the display or various other functions of apparatus  10 , as an adjunct to keys  43  of keyboard  44 . Display  10  is preferably a liquid crystal display, but various other display technologies presently known or yet to be developed, may also be used. 
     FIG. 5  illustrates details of the elongate body  14  to which head  12  is attached. While of a solid, generally filled structure, body  14  should be made of flexible materials to promote easy storage or carrying in a white coat pocket or around the neck of a clinician. Body  14  has at least two acoustic conduits  70  and  72  for conducting the acoustic signals received by diaphragm  30  to the earpieces  20  and  22  of earpiece assembly  18 . Body  14  also has at least two electrical conductors  74  and  76 , for conducting electrical signals from various electrodes of vital sign sensors, as more fully explained below. All of these projections from the end of body  14  may be received in correspondingly shaped openings in earpiece assembly  18 , which is thus removeably attached to body  14 . Body  14  is preferably formed with a cylindrical cavity  80 , which may be used for storage, especially for storage of EKG leads or cords. Cavity  80  may be closed by one or two swinging doors  82  and  84 , shown in their opened position so as to expose cavity  80 , but which may close so that edges  86  and  88  meet along a line  83 . Body  14  is also fitted with a communication module  89 , for exchanging signals with the remainder of apparatus  10 , especially when portion  16  is not attached to body  14 . 
   Communication module  89  is conveniently fastened within cavity  80 , such as to a wall thereof, to provide both protection and ease of access for servicing, should that become necessary. Communication module  89  should have facilities for data storage, which may be, for example, a flash memory of suitable size. Communication module  89  should also have the ability to send signal to a nearby display (for simultaneously display the image in a nearby terminal) or to a wireless network connection device via a broadband capability. Thus, the acquired data may be compiled to intelligently compare all of the twelve leads to investigate the heart&#39;s electrical activity, as more fully described below. 
     FIG. 6  illustrates details of earpiece assembly  18 . While earpiece assembly  18  may be similar to those of conventional construction in conducting acoustic signals to the ears, there are some additional unconventional features. Earpiece assembly  18  may be configured with housing extensions  90  and  92  having planar portions on which respective electrodes  94  and  96  are disposed. Electrodes  94  and  96  may be placed against the skin of a patient to receive EKG signals. Third portion  16  also may be configured with a communications module  98  to, for example, exchange data with communication module  89  of body  14 . The communication link established between modules  89  and  98  may be a broadband wireless link. The link need only be active when portion  16  is separated from body  14 , and may otherwise be shut down in response to sensing circuitry (not shown) associated with electrical conductors  74  and  76 , in body  14 , or with electrical contacts in portion  16  for making contact with electrical conductors  74  and  76 , when received in opening in portion  16 . The broadband communication link may also be activated on demand as when simultaneously viewing acquired data on a nearby monitor. The data can be sent simultaneously to a terminal within the vicinity for long-term storage, viewing and possibly for further processing. 
   Variations in placement of the components described above are possible. For example, housing extensions  90  and  92 , having planar portions on which respective electrodes  94  and  96  are found may be a part of third portion  16 , and thus permanently affixed thereto. In this case the distance between electrodes on diaphragm  30  and electrodes  94  and  96  could be varied, as long as body  14  is made of flexible materials, which is preferred, as discussed above. 
   In a conventional twelve-lead electrocardiogram, six of the lead are termed “chest leads, “unipolar leads” or precordial leads.  FIG. 7  shows the arrangement for the six chest components, which by using the apparatus in accordance with the invention, a clinician can obtain at the time of listening to the heart by following a predetermined path. 
   Referring again to  FIG. 1 , signals representative of the other half of the arrangement that makes up the full twelve-lead electrocardiogram (the “limb leads”) may be acquired by using the apparatus of the invention. As illustrated  FIG. 1 , the patient is required to hold two of the electrodes  94  and  96  (RA and LA), while a third electrode, located on diaphragm  30  of apparatus  10  is positioned on the left leg (LL). In this basic arrangement, that conforms to the Einthoven&#39;s triangle to give the basic frame work to register the six limb leads (I, II, III aVF, aVR and aVL) that are generated in standardized methods, which are commonly used in existing EKG practice (with existing machines), are easily and conveniently generated with the apparatus in accordance with the invention. 
   Thus, there are three electrodes, namely: RA; LA and LL that are a permanent part of apparatus  10 . As in  FIG. 1 , a physician can instruct a patient to hold two of the electrodes (RA and LA), while the third permanent electrode located on the diaphragm is placed on the patient&#39;s left leg—forming the Einthoven&#39;s Triangle. In this orientation, each of the six limb leads can be ascertained. This is a benefit of the apparatus in accordance with the invention in that it permits the clinician to non-invasively screen a patient&#39;s heart electrical activities, without the need for the patient to undress. 
   The arrangement that may be obtained using the techniques of  FIG. 1  and  FIG. 7  sequentially is comparable to that discussed in the literature as a screening mode. No additional accessories are required to obtain the full equivalent of a complete twelve lead EKG by using the arrangement in accordance with the invention. A simple two-step approach, with the brief cooperation of the patient to obtain the data, is all that is needed. 
   Thus, in this screening mode, all of the precordial or chest leads are acquired as the heart is auscultated along a choreographed ideal path on the chest wall using the diaphragm portion of the stethoscope. This information when gathered will correspond to the six leads “chest” component from a 12 leads EKG; they are V 1  through V 6 . This process takes advantage of the fact that when listening to the heart to discriminate its sound, a pause is usually required, and this will provide enough time to simultaneously register an electric current originating from the heart. By sequentially positioning the diaphragms that features an electrode over the heart externally, readings that correspond to V 1 -V 6  will be obtained. Also Leads I, II, and III, aVR, aVF and aVL can be determined as part of the screening mode evaluation process. This is obtained with the help of the patient who is instructed to touch two points on the stethoscope while a third part of the stethoscope is placed on the subject&#39;s left leg, thus creating an Einthoven triangle configuration on the test subject. These twelve (12) EKG tracings can be obtained without the usage of special external electrodes-such as silver chloride glues or stickers. A minor disadvantage is that a twelve lead EKG is obtained in two stages instead of one. This minor disadvantage is more than offset by the significant advantages discussed herein. In any event, the study is performed effortlessly with the participation of the test subject. It does not require a multitude of wires or connections or messy glues. It does not require a lengthy period of time to be done. It does not require that the patient undress. The difference is very marked and beneficial for the purpose of screening a patient. 
     FIG. 8  illustrates a new arrangement for the placement of the electrodes in accordance with the invention. In this configuration, only two cords are utilized, a first cord  100  for the right side of the body, and a second chord  102  for the left side of the body. Each cord  100  and  102  includes a bundle of insulated wires, each having an electrode at its end, with the wires leaving the bundle of wires at different points along the length of the cord respective cord  100  and  102 . Thus each cord  100  and  102  has both precordial and limb electrodes. Thus, a shared/mixed system has been described with respect to the cords acquiring various leads. Specifically, cord  100  includes RA and V 1  [which is a precordial lead] and RL bundled on the same branch). Cord  102  includes the remaining leads. 
   The cords  100  and  102  are advantageously stored in cavity  80  of body  14 , until ready for use. The ends of the cords  100  and  102  not having electrodes are connected to wiring internal to apparatus  10  by passing through openings (not shown) in a wall or walls of cavity  80 . Thus, doors  82  and  84  ( FIG. 5 ) are opened to remove the cords for use, and after the procedure has been completed, and the cords  100  and  102  with their attached electrodes returned to cavity  80 , the doors  82  and  84  are closed for convenient storage of the cords  100  and  102 . 
   In a similar manner, it is possible to use a first cord with electrodes arranged at positions for receiving precordial signals from a body, and a second cord with electrodes arranged for receiving limb signals from the body, as in the prior art. 
   In another arrangement in accordance with the invention, a first cord has leads for electrodes for the right and left legs, a second cord has leads for electrodes for signals from the two arms; and a third cord has leads for electrodes for signals from the chest (V 1  to V 6 ), for a total of three cords. 
   In these so-called EKG modes, the apparatus is capable of performing a twelve lead EKG with all of the corresponding data recorded simultaneously. In this second mode, external electrodes (such as silver chloride) are placed at the desired location and the device will record the current traveling through the heart after making the appropriate (ten-points) connections. The device utilizes its concealed two cords electrode system that augments the four limbs leads with the precordial or unipolar leads (undertaking the task from the left and right side of the body respectively). 
   The apparatus in accordance with the invention can be thought of as a still photo camera, that takes individual picture of the heart from one view (that corresponds to V 1  through V 6 ) and serial automatic pictures from two perspectives that correspond to: Lead I and aVL together; lead III and aVR; and lead II and aVF and so on. The first scenario is accomplished by generating a positive electrode within the diaphragm region in order to register a precordial, unipolar EKG tracing. A “snap shot” is taken of the heart&#39;s electrical activity utilizing the positive electrode at these various stages (V 1 -V 6 ), which are perpendicular to the frontal plane (with respect to the heart&#39;s electrical current). This process is conveniently accomplished simultaneously while listening to the heart. Physiologically the electrical impulse from the heart travels anterior towards the chest wall and disseminate throughout the body. By convention it is practical to register an electrical signal traveling perpendicular to the heart by placing a positive electrode in its vicinity (as is done with a standardized twelve-lead EKG apparatus; registering the precordial leads from the chest wall). 
   Obtaining signals corresponding to the other six standardized leads for an EKG requires the usage of the limbs, namely the left arm, left foot and right arm to measure a current differential. The leads here are referred to as bipolar or augmented leads when used to execute this task. The right leg is commonly used as a common ‘ground’ for the EKG reading. For the purpose and function of the apparatus in accordance with the invention, a ‘ground’ can be created within or on the apparatus itself or a lead (not shown) situated in the body  14  can be appropriately placed and utilized, if and when the need arise. The invention is advantageously designed to register this phenomenon with very little adjustment. 
   Similarly to a conventional EKG machines, the apparatus in accordance with the invention utilizes a similar approach to electronically change the direction of the current and electrons to create the desire vectors to obtain its limb leads EKG tracing. As stated before, the device has three exposed electrodes, which can be used to make contact with the three limbs in an alert and cooperating patient. 
   The invention utilizes both traditional and wireless sound detection methods. A microphone and or a Doppler transducer is situated in the area of the diaphragm while the receiver component is situated near the earpieces. A common central processing unit allows for the discrimination of the received sound and also allows for modification and adjustment. The stethoscope is designed with a hollow connecting conduit tube that originates from the inner part of the diaphragms and terminates at the earpieces. This natural sound is totally independent of any electronics-electrical power and preserves the natural quality of sound detectable from a hollow structure or cavity such as the heart, lung and abdomen. In the very unlikely event of lack of power/electricity, the device would still be useful for its basic function. 
   In  FIG. 9 , the apparatus  10  in accordance with the invention is being used on a human subject to investigate an area of concern within the abdominal cavity, by means of ultrasonic transducer  40  ( FIG. 2 ), in a manner well know in the art. The portion  16  having the earpiece assembly  18  may be removed for hygienic reasons. When portion  16  is removed, the communications module  89  ( FIG. 5 ) is activated, and broadband wireless signals may be transmitted to a portable multimedia monitor  106  or to a nearby terminal including a large data storage facility or printing capability or for simultaneous viewing for the display of data (which may also be on the smaller screen  42  of head  12 ). Also, acoustic data may be transmitted to portion  16  for listening with earpiece assembly  18 . 
     FIG. 10  is a grid arrangement highlighting the major components of apparatus  10  and the interactions between them. The grid may be followed in a diagonal direction to best illustrate certain of these arrangements and interactions. All the sub units are intricately connected within the device and there is an established communication link between the device and an external receiving station that will serve the purpose to print/display larger images, process and store data, etc. 
   There are many other additional technical details that may be included which will occur to those skilled in the art after reading the present description. For example, the head  12  may be removeably connected to the body  14  so that they can be separately replaced or serviced, if necessary. Further, a rechargeable battery may be placed in housing  26  ( FIG. 2 ) or in body  14  to provide electrical energy for powering the various electrical components of apparatus  10 . The ultrasonic transducer  40  may operate in any one of several modes including A scan, B scan, Doppler or so called “M” mode. Digital communication with the communication modules  89  and  98  may be compatible with all digital forms of data transmission, display and analysis. The option of downloading the images to a mainframe computer/printer with interconnecting digital ports is available. Also the wireless transfer of data either by phone wires, cable wires, satellite signals or broadband network such as UWB, Bluetooth, Wi-Fi, WiMax, EDGE or 3G are all possible. While the apparatus has been described with a stethoscope portion with acoustic functions and pathways, it will be understood that an electronic stethoscope having a sound/vibration sensor or transducer for providing an electrical signal to amplify, and earpieces responsive to the amplified signal for producing sound for diagnostic or monitoring purposes, may also be used. Finally, one or more microprocessors may be included to process and store data. 
   The apparatus in accordance with the invention provides the following advantages:
     1. All of the benefits of an EKG and sonogram and a diagnostic light source or sources are brought to the “finger tips” of a clinician.   2. Precious time needed to provide an EKG is reduced from hours to virtually seconds.   3. Lives can be saved and abnormalities in the heart can be detected upon an initial encounter.   4. The delivery of life saving care to patients is expedited.   5. Human resources needed to perform sonogram and EKG studies are conserved.   6. The bulky machine and cumbersome, often tangled wires associated with a twelve lead study are eliminated.   7. An excellent and inexpensive screening and diagnostic tool for the chest and abdomen are provided.   8. The most ubiquitous and some would say the most indispensable medical tool (the stethoscope) is modernized and enhanced.   9. Cardiac examination protocols may be revolutionized.   10. Doctors and medical personnel are given the confidence to do more with one comprehensive device.   11. The evolution of one multipurpose vital body-scanner tool has begun.   

   It should be understood that the foregoing description is only illustrative of the invention. Various alternatives and modifications can be devised by those skilled in the art without departing from the invention. Accordingly, the present invention is intended to embrace all such alternatives, modifications and variances which fall within the scope of the appended claims.