回帖：简答
心源性和肾源性水肿的区别
nephrogenic edema cardiogenic edema
location onset from the face then downward onset from the lower part of the body, the upward
progression progress quickly progress slowly
indentity soft and mobile relatively solid, less mobile
other signs Proteinuria, hypertension, impaired renal functional test cardiac enlargement, renous distention, hematomegaly
心肌梗死的ECG表现及分期
ischemic T wave change (ischemic change)
ST segment elevation (injury change)
Abnormal Q wave or QS wave (necrosis change)
常见肺疾患的视触扣听
Inspection Palpation Percussion Auscultation
Chest appearance Respiratory movement Trachea location Vocal fremitus Note Breath sound rale Vocal resonance
Consolidation Symmetrical Diminished on the affected side Central Increased on the affected side Dullness or flatness Bronchial breath sound Moist rale Strengthened
Emphysema Barrel-shaped Diminished on both sides Central Diminished on both sides Hyperresonant note Diminished Always without Diminished
Atelectasis Denting of the affected side Diminished on the affected side Deviate toward the affected side Diminished or disappeared Dullness Disappeared or diminished Moist rale or rhonchi Disappeared or diminished
Pleural effusion Fullness of the affected side Diminished or disappeared on the affected side Deviate toward the normal side Diminished or disappeared dullness Bronchial sound above the effusion Without Diminished or disappeared
Thickened pleura Denting of the affected side Diminished on the affected side Deviate toward the affected side Diminished Dullness Diminished Without Diminished
pneumothorax Fullness of the affected side Diminished or disappearanced on the affected side Deviate toward the normal side Diminish or disappeared Tympany Diminished or dissapeared Without Diminished or disappeared
病理性支气管呼吸音
Bronchial breath sound heard at the locations where vesicular breath sound should be heard. Caused by consolidation of lung tissue (lobar pneumonia), big cavity in the lung (TB or lung abscess), pressed atelectasis (above the effusion region).
心尖搏动区
The apical impulse is occurring early in systole. In adults the apical impulse normally is located in the left fifth intercostal space, 0.5-1.0cm medial to the left midclavicular line and about 2-2.5 cm diameter, it serves the examiner as a marker for the onset of cardiac contraction.
Displacement of the apical impulse seen in heart disease,
Heart disease:
Left and inferior in LVH or both dilation; left laterally in RVH; at right in dixtrocardiac; disappear in massive pericardial effusion.
Thoracic disease:
Toward the normal side in pneumothorax and pleural effusion; toward the affected side in pleuraladhesion and ateleotasis.
Abdominal disease: The apical impulse also can be displaced by large mass, massive ascites.
The apical impulse may have increased amplitued and duration in those persons with a thin chest, anemia, fever, hyperthyroidism and anxiety. The examiner should always observe the shape and contour of patint’s chest. Depressions of the sternum, Kyphosis of dorsal spine, scoliosis often alter the shape and position of the apical impulse.
奇脉
Pulses diminish or disappear during the inspiration, cause by less LV output. during inspiration, blood is pooled in the pulmonary circuit, resulting from the expansion of the lungs and an increase in the negative intrathoracic pressure. In turn this results in a decrease in the return of blood to the left side of the heart, a decrease in left ventricular output, and thus a decrease in arterial blood pressure. Seen in massive pericardial effusion, constrictive pericarditis.
干啰音的产生机制及听诊特点
Rhonchi：

Produced because there presents stricture or partial obstruction of the trachea, bronchi or bronc