临床诊断48题

1.Contens of questioning(问诊):identifying information,source and reliability,chief complaints,present illness,past medical history,personal history,marital history,menstrual and obstetric history in women,family history 2.The degree of thyroid gland（甲状腺肿大分级）:swelling1:invisible but palpable;2:visible and palpable;3:exceeding the out margin of sterno-mastoid muscle 3.Peripheral vascular（周围血管征）:vascular sign:water hammer pulse,carotid artery impulse,nodding spasm,capillary pulsation,pistol shot sound,duroziez double murmur;clinical meaning:aortic insufficiency,hypertension,hyperthyroidism 4.Mitral stenosis（二尖瓣狭窄）:L.A enlargement-pulmonary artery dilation-R.V enlargement;inspection:mitral face ,apical impulse-left;palpation:diastolic thrill at the apex area;percussion:pear-shaped heart;Apex area:heart sounds:accentuation of S1;extra sound:opening snaps;murmurs:mid- or late-diastolic rumbling in quality,decrescendo-crescendo,usually localized,heard more clearly with the patient recumbent or on his left side or after moderate exercise.Pulmonic area:heart sounds:accentuation and splitting of S2;murmurs:Graham-Steell 5.Aortic insufficiency（主动脉瓣关闭不全）：inspection:apical impulse to left interior,carotid artery impulse;palpation:lifting apical impulse,water-hammer pulse;percussion:boot-shaped heart;aortic area:heart sounds:S2 decrease;Murmur:early diastolic,high pitch,blowing,radiating to the apex;apex area:heart sounds:S1 decrease;murmurs:Austin-flint 6.Grade of fever（发热的分度）:slight fever:37.3-38;moderate fever:38.1-39;hyperpyrexia:39.1-41;ultrahyperpyrexia:>41 7.Subcutaneous hemorrhage:wine color and won’t fade when pressed.petechia:<2mm;purpura:3-5mm;ecchymosis>5mm;hematoma 8.Superficial lymph node: sequence of examination: preauricular LN,postauricular LN,mastoid LN,occipital LN,posterior cervical LN,anterior cervical LN,supraclavicular LN,axillary LN,epitrochlear LN,lnguinal LN,popliteal LN. 9.Localized enlargement（局部淋巴结肿大）: lymphnoditis:soft,tenderness,smooth,no adhesion.tuberculosis:multiple,varied sizes,tough,adhesive.lymphatic metastasis of carcinoma:hard,no tenderness,smooth,adhesion.Right supraclavicular LN:lung cancer.left supraclavicular LN:gastric or esophagus carcinoma. 10.Generalized enlargement（全身淋巴结肿大）:lymphoma,leukemia,SLE(systemic lupus erythematous),infectious mononucleosis. 11.The grading of muscle strength（肌力的分级）:absent(0 degree):no contraction detected;Trace (1 degree):slight contraction detected;Weak （2 degree）:movement with gravity eliminated;Fair (3 degree):movement against gravity;Good (4 degree):move against gravity with some resistance;Normal (5 degree):movement against gravity with full resistence. 40.Ascites Sign腹水征Inspection: frog shape of abdomen in dorsal position, hypogastrium region distension with hilum hernia in stand.    Palpation: fluid thrill (ascites large than 3000 ml) >3000ml)Percussion: shifting dullness (ascites large than 1000 ml), puddle sign (small amounts of fluid) Auscultation: umbilicus scratch sound in elbow-knee posture (ascites<120ml) 12,percussion of the heart border（心界叩诊）: Percussion technique:force:light percussion for the relative dullness border.postion:supine:parallel the middle finger to intercostals;sitting:plumb the middle finger.steps:from left to right,lower to upper,outward to inward.left border:2-3cm from the apical impulse,right border:ICS next to the upper border of the liver.measure:the distance from dullness border to anterior midline Right(cm)       ICS     left(cm) 2-3              2          2-3 2-3                 3          3.5-4.5 3-4                4          5-6                    5          7-9 The distance between left midclavicular line and anterior midline is 9cm\ 13.protuberant abdomen（腹部膨隆）: ascites:frog shape of abdomen,accompanied hilum hernia;causes:hepatocirrhosis,serious heart failure,pericarditis,renal disease syndrome,peritoneum cancer.Gases distention of the intestines:sphericity of abdomen;causes:ileus,intestinal paralysis.Organomegaly:enormous ovary cyst and teratoma. 14,palpation（触诊）: light palpation,deep palpation:deep slipping palpation, bimanual palpation,deep press palpation,ballottement. 15,chief complaint（主诉）:main discomfort and its duration.make sure to be :concise,sequential,such as persisting headache for 3 days.make sure to avoid using:onset time of the disease,diagnostic terms,and dialects. 16.present illness:（现病史） further description of the main complaint,including the whole disease process.onset and duration,predisposing factors;characters of the main symptom,progression and evolvement;accompany symptoms;managements and effects;effects on daily life 17,pleural effusion（胸腔积液）:pathology:fluid is trapped in pleural cavity;inspection:over-inflation of the affected sid;palpation:decreased dynamic events of respiration and tactile fremitus,the trachea is shifted to the unaffected side;percussion:dullness or flatness;auscultation:breath sounds and vocal resonance disappear. 18.fever types（热型）: continuous fever;remittent fever;intermittent fever;recurrent fever;undulant fever;irregular fever 19,basic examination techniques（一般检查）:inspection palpation percussion auscultation olfactory examination 20,vital sign（重要征象）:temperature:normal axillary T 36-37,fever T >37,hypothermia T <35 pulse:frequency 60-100/min,rhythm regular.respiration:normal 16-18/min 21.contents of liver palpation（肝脏触诊）: size,quality (soft,firm,hard);surface:smooth,irregular,nodular;margin:sharp,blunt,tenderness;hepatojugular reflux. 22,acute peritonitis signs:(腹膜炎)general depression in abdomen,decreased or disappeared abdominal respiration;palpation:tenderness,rebound tenderness,rigid abdominal wall;percussion:shifting dullness;auscultation:decreased or absence of bowel sounds 23，disturbance of consciousness(意识障碍):somnolence,confusion,stupor,coma,delirium 24,inquiry point of diarrhea(腹泻问诊要点)rise and course of disease,times and stool character,relation between diarrhea and pain,accompanied symptoms. 25，peritoneal irritation sign(腹膜刺激征):three sign same appear:tenderness,rebound tenderness,guarding.clinical meaning:acute peritonitis. 26,ascites sign inspection（腹水）:frog shape of abdomen in dorsal position,hypogastrium region distension with hilum hernia in stand.palpation:fluid thrill(>3000ml);percussion:shifting dullness(>1000ml),puddle sign(small amounts of fluid);auscultation:umbilicus scratch sound in elbow-knee posture(<120ml) 27,abnormal dullness heart border:（异常心浊音界） heart variation.L.V enlargement:boot-shaped heart;L.Aenlargement:pear-shaped heart;B.V enlargement:general enlarged heart;R.V enlargement:cor pulmonale;pericardial effusion:flask-shaped heart. 28.rachitic chest（佝偻病）:pigeon chest,rachitic rosary,funnel chest,Harrison groove; 29. Percussion Notes Tympany叩诊音: gas Hyperresonance: increased gas in lung tissue Resonance: lung tissueDullness: gas and tissueFlatness: essential organ or fluid 30.Emphysema肺气肿Pathology: air trapping in the lung  Inspection: barrel chest Palpation: decreased dynamic events of respiration and tactile fremitusPercussion: hyperresonce; Down-shifting of the inferior border of the lungAuscultation: decreased breath sounds and vocal resonance 31.Atelectasis肺不张Pathology: the airway is obstructed and the lung holds no airInspection: the affected chest wall is flattened.Palpation: decreased dynamic events of respiration and tactile fremitus;The trachea is shifted to the affected sidePercussion: dullness or flatnessAuscultation: breath sounds and vocal resonance disappear. 32.Pneumothorax气胸Pathology: air is trapped in pleural cavityInspection: over-inflation of the affected sidePalpation: decreased dynamic events of respiration and tactile fremitus; the trachea is shifted to the unaffected sidePercussion: tympanyAuscultation: breath sounds and vocal resonance disappear 33.Meningeal Stimulation Sign脑膜刺激征Definition: signs induced by disorders with meninges such as pathological changes, inflammation, arachnoid low cavity bleeding, encephalic hypertension, etc.  Neck rigidity: resisting in raise neck    Kernig sign: angle of knees joint can be drived up less than 135 degree with bended thigh  Brudzinski sign: going down on knees when raise neck 35. Clinical Types of Edema水肿类型Cardiac EdemaNephritic EdemaHepatic EdemaMalnutritional EdemaDrug-induced EdemaOthers  Myxedema    Premenarche edema 36.Characterization of Murmurs杂音听诊要点LocationDurationPitch and QualityIntensity and Timing Transmission or radiationEffect murmurs of factor Location Apical area: mitral valveAortic area: aortic valvePulmonic area:        pulmonic valveInferior sternum:      tricuspid valve3rd, 4th ICS, LSB:  ventricular septal defect2nd, 3rd ICS, LSB:      patent ductus arteriosus 37. Aortic Insufficiency Auscultation 主闭听诊 (2)Aortic area: Heart sounds: S2↓  Murmur: early diastolic, high pitch, blowing, radiating to the apex    Apex area: Heart sounds: S1↓  Murmurs: Austin-Flint  38. Arterial Pulse Abnormalities脉搏异常Infrequent pulse  Alternating pulse    Water-hammer pulse  Dicrotic pulsePulsus paradoxusAlternating Pulse 39.Murphy’s Sign莫非氏征 Technique: Hold your fingers under the liver border.  Positive sign: As the descending liver pushes the inflamed gallbladder onto the examining hand, the person feels sharp pain and abruptly stops inspiration midway.     41.Acute Perforated Gastric or Duodenal Ulcer急胃肠穿孔Suddenly epigastric pain, forced supine position and twin lower limbs flection  Acute peritonitis signs, tenderness and rebound pain in epigastrium or round umbilicus quarter    Hepatic dullness region decrease or disappear      shifting dullness in abdomen    42.Acute Peritonitis Signs急腹膜炎征Inspection: general depression in abdomen, decreased or disappeared abdominal respiration    Palpation: tenderness, rebound tenderness, rigid abdominal wall    Percussion: shifting dullness    Auscultation: decreased or absence of bowel sounds  43.Intestinal Obstruction肠梗阻Symptom: bellyache, vomiting, no defecate and anus exhaust      Inspection: full distension, intestine form and peristaltic wave    Palpation: rigid abdominal wall, tenderness and rebound pain    Percussion: tympany region increased  Auscultation: mechanical ileus accompanied sharp bowel sound and decreased or absence of bowel sounds in paralysis ileus 44.心界叩诊异常 (1)heart variation L.V enlargement: boot-shaped heart    L.A enlargement: pear-shaped heart  B.V enlargement: general enlarged heart  R.V enlargement: cor pulmonal  Pericardial effusion: flask-shaped heart 45. Valve Auscultation Section瓣膜听诊区Mitral valve: in the apex area  Pulmonic valve: in the 2nd ICS, LSBAortic valve: in the 2nd ICS, RSB  The 2nd of aortic valve: in the 3rd ICS, LSB  Tricuspid valve: in the inferior sternum    46.杂音性质Pitch: depends on pressure and rate of blood flowhigh, medium and low Quality: depends on degree of valve compromise, force of contractions and blood volumeHarsh or raspy Machine-like vibratory Musical Blowing Rumbling signing sound Warble sound 47.LocationandDurationtoDiagnos杂音部位时期    systolic  insufficiency stenosismitral valve  aortic valve tricuspid valve  pulmonic valve stenosis insufficiencyGraham-Steell    diastolic  Austin-Flint    Systolic murmur in left sternum intercostal 3~4:      ventricular septal defect     Continuous machine-like in left sternum intercostal 2:    patent ductus arteriosus 48.Identification of haemoptysis hematemesis Identification haemoptysis hematemesis Cause disease Tuberculosis, bronchiectasis disease, pneumonia, lung abscess, lung cancer, heart disease, etc Peptic ulcer disease, liver cirrhosis, acute erosive out, gastritis, biliary tract bleeding, etc. Bleeding symptoms before Throat itch, bosom frowsty, cough, etc Epigastric discomfort, nausea, vomiting, etc Color bright red brown black, dark red, sometimes red mixed in blood phlegm, foam food scraps, gastric juice alkaline acid Black stool nless swallow, did not have, but the stomach asphalt, hematemesis continued for several days after the stop the sputum traits after Bleeding Often bloody sputum for several days. No sputum The way of bleeding Cough up Vomiting 1.Contens of questioning(问诊) 2.The degree of thyroid gland（甲状腺肿大分级）: 3.Peripheral vascular（周围血管征） 4.Mitral stenosis（二尖瓣狭窄）: 5.Aortic insufficiency（主动脉瓣关闭不全） 6.Grade of fever（发热的分度） 7.Subcutaneous hemorrhage（皮下出血）: 8.Superficial lymph node: sequence of examination:（颈部淋巴结检查） 9.Localized enlargement（局部淋巴结肿大） 10.Generalized enlargement（全身淋巴结肿大） 11.The grading of muscle strength（肌力的分级） 40.Ascites Sign腹水征Inspection 12,percussion of the heart border（心界叩诊）: 13.protuberant abdomen（腹部膨隆）: 14,palpation（触诊）:  15,chief complaint（主诉） 16.present illness:（现病史） 17,pleural effusion（胸腔积液）: 18.fever types（热型）: 19,basic examination techniques（一般检查）: 20,vital sign（重要征象）: 21.contents of liver palpation（肝脏触诊） 22,acute peritonitis signs:(腹膜炎) 23，disturbance of consciousness(意识障碍) 24,inquiry point of diarrhea(腹泻问诊要点) 25，peritoneal irritation sign(腹膜刺激征) 26,ascites sign inspection（腹水） 27,abnormal dullness heart border:（异常心浊音界）  28.rachitic chest（佝偻病）表现 29. Percussion Notes Tympany叩诊音 30.Emphysema肺气肿Pathology: 31.Atelectasis肺不张Pathology: 32.Pneumothorax气胸Pathology: 33.Meningeal Stimulation Sign脑膜刺激征Definition: 35. Clinical Types of Edema水肿类型 36.Characterization of Murmurs杂音听诊要点 37. Aortic Insufficiency Auscultation 主闭听诊 38. Arterial Pulse Abnormalities脉搏异常 39.Murphy’s Sign莫非氏征 41.Acute Perforated Gastric or Duodenal Ulcer急胃肠穿孔 42.Acute Peritonitis Signs急腹膜炎征43.Intestinal Obstruction肠梗阻Symptom 44.Heart border percussion心界叩诊异常 45. Valve Auscultation Section瓣膜听诊区M 46.杂音性质Pitch: 47.LocationandDurationtoDiagnos杂音部位时期 48.Identification of haemoptysis hematemesis咯血、呕血鉴别 文档已经阅读完毕，请返回上一页！