偶滴诊断学考前复习笔记（抱佛脚版）
DIAGNOSTICS
名解
主诉：chief complaints. The main pain or the most prominent symptom or sign the patient feels. It is also the main reason why the patient visits.
体征和症状：symptom is the abnormal, discomfortable, or painful sensation the patient feels, or objective pathosis. Sign is the change discovered by the doctor or others in clinical examination.
稽留热：continued fever. T: keeps at 39~40℃ constantly. Circadian variation <1℃. Seen in pneumonia, typhoid fever.
弛张热：remittent fever. T >39℃. Circadian variation >2℃. Seen in rheumatic fever, tuberculosis, septicemia.
牵涉痛：Referred pain. The diffuse pain arise from somatic or visceral structures . It projects to a more superficial region with the same segmental innervation. Pain of coronary insufficiency may be felt along the inner aspect of the arm or in the left interscapular region.
紫绀：Cyanosis is a bluish discoloration of the skin and mucous membranes. It results from reduced hemoglobin or abnormal hemoglobin pigments in the blood perfusing these areas.
隐血：occult. Slight alimentary tract hemorrhage. Without discoloration of the feces. It is only through OBT the hemafecia is discovered.
端坐呼吸：Orthopnea is difficulty in breathing in the supine position. This may be relieved by sitting up, which reduces the degree of pulmonary congestion by pooling blood in the lower extremities and lowering left ventricular filling pressure. It improves the diaphragmatic movement, increasing vital capacity. Seen in left heart failure.
夜间阵发性呼吸困难：Paroxysmal nocturnal dyspnea. The patient awakes short of breath at night, but often obtain relief by sitting up for a period. The supine position for sleep results resorption of extracellular fluid into the intravascular space, causing arising in filling pressure. Seen in left heart failure.
心源性哮喘：cardiac asthma. LHF, paroxysmal nocturnal dyspnea, orthopnea, cyanosis, diaphoresis, wheezing, pink frothy sputum, moist rale on chest button, rapid HR and gallop may occur.
黄疸：jaundice. Accumulation of bilirubin in the bloodstream causes yellow pigmentation of the plasma, leading to discoloration of perfused tissues. Clinically, hyperbilirubinemia appears as jaundice, yellow pigmentation of the skin and sclera.
咯血：Hemoptysis is the expectoration of blood from the airway below larynx. Patients complain of coughing up blood. The nose, mouth and upper respiratory tract must be searched carefully by the mirror examination to rule out the possibility that blood may come from those areas.
眩晕：dizziness vertigo. Vertigo implies the illusory sensation of turning or spinning -- either of the patient himself or his environment. Without conscious disturbance in general. Seen in labyrinth, vestibule and cerebellum disease, and also seen in other systems or systemic disease.
晕厥：faint. Temporary unconsciousness caused by extensive ischemia of brain for a period. The patient can’t keep normal normal position and falls due to loss of tention of muscle. Onset suddenly but recover soon, and sequelae are few.
强迫体位：compulsive position. The patient has to take this position to relieve the pain or discomfort.
垂体性侏儒症：pituitary dwarfism. Abnormal small body caused by hypophyseal growth hormone secretion decreasing. The patient’s intelligence is normal.
蜘蛛痣：spider angioma. Angioma caused by the end of cutaneous arteriolar branches distention. Distribute as same as the superior vena cava does. Estrogen inactivation of liver decreased may be the cause. Seen in hepatitis, cirrhosis.
杵状指：acropachy. The tips of the fingers are bulbous, resembling the ends of drumsticks, and there is excessive curvature of the nails in all directions. When chronic hypoxia, metabolic dysfunction or poisoning, the capillaries of ends of the extremities dilate and the soft tissue hyperplasia, causing enlargement. Seen in respiratory diseases, cardiovascular diseases and malnutrition.
三凹征three depression sign. Include intercostal space, supraclavicular fossa, suprasternal fossa. Indication of upper-respiratory tract obstruction.
库什摩呼吸：Kussmaul breathing. Deep and quick breath could appear during serious metabolic acidosis. The HCO3- in the extracellular fluid is not enough, and PH is lower. For compensation, CO2 is eliminated by the lung to maintain the acid-base balance. Seen in diabetic ketoacidosis and uremic acidosis.
潮式呼吸：Cheyne-Stokes breathing. Respiration waxes and wanes cyclically so that periods of deep breathing alternate with periods of apnea. The periods of tidal breath can last from 30s to 2min. the periods of apnea can persist 5-30s. So only through carefully and long enough observation, the whole process could be realized.
毕奥呼吸：Biot’s breathing. Characterized by unpredictable irregularity. Breaths may be shallow or deep, and stop for a short periods. Mainly seen in CNS disease.
捻发音：crepitus. a very fine and harmonious rale, which occurs at the end of inspiration. It is like the sound when one holds a bundle of hair near your ear and sub it. Caused by reopening of the bronchioles in inspiration, when bronchiolar wall adheres due to secretion in expiration. Seen in bronchiolar and vesicular inflammation or edema, exp. Pulmonary congestion, early pneumonia.
心尖负性搏动：inward impulse. Apex impulses inward in systole. Seen in adhesive pericarditis and severe RVH.
靴状心：shoe-like heart. LVH, the cardiac dullness extends to the left and downward. The heart silhouette is like a shoe. It is frequently seen in AR, hypertension. It is also called aortic heart.
脉搏短绌：pulse deficit. When atrial fibrillation, the premature ventricular beat can’t transport enough blood to peripheral arteries. Then the pulse rate is less than heart rate.
奔马律：gallop. The extra sound presents in the diastolic period, which comprises the three sounds cardiac rhythm. Due to the coexistence of tachycardia, the extra sound and the former S1, S2 produce “gallop” sounds. It reflects the myocardium is severely damaged. Classified into: ①protodiastolic gallop; ②late diastolic gallop; ③summation gallop.
开瓣音：opening snap. This diastolic extra sound occurs after the S2 in MS. It is brief in duration and high in pitch than other gallop sounds. It is due to the vibration of the opening AV valve suddenly stopped during the blood from LA into LV. The OS indicates a flexible valve and an evidence that the mitral commissurotomy is suitable.
期前收缩：premature beat. A sudden extrasystole of the heart in the basis of normal heart rhythm, after which there is a relative long compensative interval.
S1↑,S2↓ Pulse absent Ectopic point at atrium, AV node, ventricle.
周围血管征：peripheral artery sign. Sign of pulse pressure elevated. Include water hammer pulse, pistol shot sound, Duroziez M, capillary pulsation. Seen in severe AI, hyperthyroidism, severe anemia.
水冲脉：water hammer pulse. Ascend and descend steeply, also called collapsing pulse. Caused by peripheral artery distention or blood regurgitation. Indication of pulse pressure increased. Seen in hyperthyroidism, anemia and AI, PDA.
Austin Flint杂音：The diastolic murmur of relative MS may occurs in AI. It is termed Austin Flint murmur. Do not accompanying with loud S1 or opening snap. The mechanism are the blood regurgitating from the aorta into LV striking the MV area up, produce relative MS.
Graham Steell 杂音：The diastolic murmur at this area, most are produced by relative PI. The Grahan Steell murmur is also a relative murmur.
连续性杂音：continuous murmur. Begins after S1, crescendo, peak intensity at S2, envelop S2, decreased at early-middle diastole producing a large diamond sharp. Harsh, mimic the sound of machine rotating. Best heart at second intercostal space. Seen in PDA.
麦氏点：Mcburney point. The outer 1/3 point on the line between the right anterior superior iliac spine and navel. Tenderness at this point indicates the disease of appendix.
移动性浊音：shifting dullness. There is large amount of of fluid in the abdominal cavity(>1000ml). Because fluid always flows downward, change of body position will lead to fluid flowing, and the dullness also variable.
Courvoisier sign: the presence of the carcinoma of head of pancreas cause the stricture of the bile duct. Then jaundice progressively develops. In palpation, it can be felt that the gallbladder prominently enlarged, but without pain.
Murphy sign: The doctor puts the left palm on the button of patient’s right ribs and presses the thumb on the gallbladder point. When the patient takes a deep inspiration, the gallbladder moves downwards to meet the pressing thumb, which causes pain and make the patient stop breathing. It is called Murphy sign. Seen in cholecystitis.
腹膜刺激征：peritoneal stimulation sign. Include rigidity of the abdomen, abdominal tenderness and rebound tenderness. Seen in acute peritonitis.
浅反射：superficial reflex. Include corneal reflex, abdominal reflex, cremasteric reflex, plantar reflex, anal reflex.
病理反射：Pathologic Reflex. When pyramidal tract injury, the brain fails to accomplish its inhibition on the brainstem and spinal cord, then abnormal reflexes appears. Mainly include Hoffmann sign, Babinski sign, Chaddock sign, Oppenheim sign and Gordon sign.
脑膜刺激征：meningeal stimulation sign. Signs appear when meninges was simulated. Seen in meningitis, subarachnoid space hemorrhage and intracranial pressure elevated. Include neck rigidity, Kernig sign and Brudzinski sign.
病理性Q波：pathologic Q wave. Amplitude >=1/4R wave in the same lead, duration >=0.04s. Seen in myocardial infarction. Also called necrotic Q wave.
III度房室传导阻滞：Third-degree (complete) AV block. The atria and ventricle beat independently because stimuli cannot pass through the AV junction. The atrial rate is faster than the ventricular rate; the PR interval constantly changes.
二尖瓣型心脏：heart of mitral valve. In palpation, the cardiac dullness extends in the 2nd and 3rd intercostal space; the cardiac waist dilates; the heart silhouette is like a pear. LAH and RVH caused by MS, pulmonary hypertension.
肺型P波：RAH, amplitude of P wave>0.25mV in II lead, P wave steep and high. Seen in pneumocardial disease.
二尖瓣P波：LAH, duration of P wave>0.12s, interval between two peaks>0.04s, seen in MS.
内生肌酐清除率：Ccr=Ucr/Scr *UV (ml/min). reference value: adult 80~120ml/min. Early index of GFR.
肾小球性蛋白尿：glomerular proteinuria. When glomerular filter membrane is injury and its permeability increased, amounts of plasma protein flow into tubules, which overburden the tubules. Seen in glomerulonephritis, nephrotic syndrome and other primary glomerular injury disease; also in diabetes, hypertension SLE and other secondary glomerular injury disease.
[ 此贴被清风在2008-10-17 20:46重新编辑 ]
