诊断学中英文版共21页文档
诊断学疾病部分-英文讲义
• Large PE
jugular venous enlargement hepatomegly hepatojugular reflux positive Ewart sign: (Subscapularis area ) vocal fremitus dullness brochovesicular breath sound paradoxical pulse
apex impulse diminution
• palpation
apex beat is palpated uneasily
• percussion
enlargement of the cardiac dullness bilaterally,changed with posture
• Auscultation
The main symptoms and signs of common diseases of circulatory system
Mitral stenosis
• Causes
RHD--rheumatic heart disease senile retrograde congenital heart disease
• Symptoms
right side heart failure: abdominal distention oliguria anorexia nausea and vomiting
• Signs(LHF) • inspection
Tachypnea,cyanosis, to sit up straight. Pink foam sputum,
诊断学五年制word版
《诊断学》五年制本科课程教学大纲一、课程基本信息课程编号：1010010课程名称：诊断学英文名称：Diagnostics课程性质：专业课总学时：108学时（理论学时：60学时），（实验、实践、讨论学时：48学时）学分：4.0学分适用专业：五年制临床医学本科专业、五年制临床医学本科专业（定向培养）预修课程（编号）：人体解剖学（0101029）组织学与胚胎学（0101070）生理学（010201Y）生物化学与分子生物学（010601P）病理生理学（0102030）病理学（0103010）药理学（0701010）医学影像学（1010031）。
建议教材：“十一五”国家级规划教材《临床诊断学》第七版，陈文彬主编，人民卫生出版社出版。
课程简介：临床诊断学是研究诊断疾病的基础理论、基本知识、基本技能和诊断思维的一门学科，是在学习了基础医学课程之后，为过渡到临床学科而开设的课程。
它论述疾病发生时的临床表现及其发生机制；讲解问诊和体格检查的基本内容和方法技巧；学习如何用科学的逻辑程序和方法去识别、判断疾病，以揭示其本质、获得正确的临床诊断。
临床诊断学是通向临床学科的桥梁，是临床医学专业学生的必修课和主干课。
通过课堂教授与临床实践，使学生逐步掌握诊断疾病的基本理论、基本知识、基本技能和诊断思维方法。
同时培养学生养成良好的职业道德及强烈的爱伤观念，培养与患者沟通的能力。
为医学生学习临床各专业课程奠定基础。
本课程重点讲授问诊、体格检查、心电图检查、诊断思维和病历书写等内容，其它未列入教学大纲中的部分内容，供学生自学参考。
本大纲适用于临床医学五年制专业，总学时数108学时，其中理论课60学时，实验课48学时。
二、教学内容与要求绪论（一）目的要求：1．熟悉《诊断学》的基本内容与要求。
2．了解《诊断学》在临床医学中的重要性地位与作用。
3．了解《诊断学》的学习方法及注意事项。
（二）学时安排：1学时（三）教学内容：1．学习临床诊断的意义。
诊断学英文课件：Clinical Diagnostics
问诊（Inquiry, History Taking ）
定义：医生通过对患者或相关人员的系统询问获 取资料，经过综合分析而做出临床判断的一种诊 法。
单击此处添课程名
有时去治愈；常常去帮助；总是去安慰
Contents of inquiry
1. General data（一般项目） 2. Chief complaint:（主诉） 3. Present illness（现病史） 4. Past history（既往史）
Method to learn -2
• 面临大量的临床资料，如何去粗取精、去伪存真地分析 和思考，正确的临床思维有时不是依靠独立思索而形成 的，临床会诊、讨论（MDT）等均可起到互相启发和取 长补短的作用。
单击此处添课程名 • 一个完整的诊断除需要有解剖学、功能学和影象学的诊 断外，在条件许可的情况下要尽可能作出病理学、细胞 学和病原学的诊断。 • 从一个医学生到一个能提出初步诊断的临床医生，是需
What is Clinical diagnostics ?
*是运用医学基础理论、基本知识 和基本技能, 对疾病进行诊断的一门 学科。
Basic theory, basic knowledge, basic skills for making the diagnosis and reach the therapeutic strategies
单击此处添课程名 5. Review of systems（系统回顾）
6. Personal history（个人史） 7. Menstrual history（月经史） 8. Marital history（婚姻史） 9. childbearing history（生育史） 10. Family history（家族史）
diagnosis七年制中英文
What is diagnosis? 什么叫诊断？Diagnosis is investigation and judgment. 诊断就是诊察和判断Investigation is data collecting. 诊察是收集疾病信息Judgment is synthesis and analyze data to determine the nature of illness. 判断是综合分析信息确定所患疾病The diagnosis is taking about the method of data collecting and how to make a correct judgment. 诊断学讲述收集信息和正确判断疾病的方法Steps of Diagnosis诊断步骤Data collecting history intervewing physical examination laboratory examination assistant examinationData analyzingDetermination of the nature of the illness收集信息资料采集病史体格检查实验室检查辅助检查推理分析判断确定所患疾病Classification of Clinical Diagnosis临床诊断的分类Etiologic diagnosis Virus hepatitis Rheumatic heart disease Pathological-anatomic diagnosis Aortic regurgitation Liver cirrhosisPathophysiologic diagnosis Shock Uremia病因诊断病毒性肝炎风湿性心脏病病理解剖诊断主动脉瓣关闭不全肝硬化病理生理诊断休克尿毒症Inquiry问诊Inquiry is one method from the interview between doctor and patient or relative for disease history, and making the clinical determination by analyzing history.通过对患者或相关人员的询问获取病史资料经过综合分析作出临床判断Contents of Questioning 问诊的内容Identifying informationSource and reliabilityChief complaintsPresent illnessPast medical historyPersonal historyMarital history Menstrual and obstetric history in womenFamily history患者个人信息叙述者和可信度主诉现病史既往史个人史婚姻史月经生育史家族史Identifying Information 患者个人信息NameSex and AgeNative placeBirth placeNationalityMarriageAddress Work placeOccupation 姓名性别和年龄籍贯出生地国籍或民族婚姻住址工作地点职业Others Information其他相关信息Chief Complaint主诉Main discomfort and its durationMake sure to be: concise sequential persisting headache for 3 daysMake sure to avoid using: onset time of the disease diagnostic terms dialects主要痛苦+经过时间书写注意要简明扼要要按时间先后顺序持续头痛3天三不要不要用起病时间不要用诊断术语不要用方言土语Present Illness现病史Further description of the main complaint, including the whole disease processOnset and duration and Predisposing factorsCharacters of the main symptom, progression and evolvementAccompany symptomsManagements and effectsEffects on daily life对主诉的进一步阐述起病情况和诱发因素主要症状特点和疾病的演变伴随症状诊疗经过对日常生活的影响Past Medical History既往史Past health statusPast illnessHistory of injuryHistory of surgeryHistory of allergyHistory of blood transfusionHistory of vaccinationSystemic review既往健康状况既往所患疾病既往外伤史手术史过敏史输血史预防接种史系统回顾Personal History个人史Homeplace, inhabitation place, epidemic disease or travel experience to epidemic areaSmoking and alcohol intakeWorkHousing conditionLifestyleSex history出生地居留地是否到过疫区烟酒嗜好职业特点居住条件生活习惯不洁性交史Marital History婚姻史Marriage age 结婚年龄Health status of the spouse 爱人健康状况Marital attachment 夫妻感情Menstrual and Obstetrical History月经生育史Formula for recording menses intermenstrual period (day)Menarche age ————menopause age menstrual cycle or LMPMenses: volume, color, leucorrhea, dysmenorrhealObstetrical: number of pregnancy and delivery, history of operative delivery, difficult labor, abortion月经记录格式行经期(天)初潮年龄————末次月经日期月经周期或绝经年龄行经情况月经量颜色有无白带痛经孕产情况孕次产次有无手术产流产难产Family History家族史Health status of three sequential generationsCauses of deathExisting the same diseaseHereditary diseasesInfectious diseases三代人健康状况父母兄妹子女(几男几女)死亡原因有无同类疾病遗传病传染病Basic Examination Techniques基本检查法视诊inspection 触诊palpation 叩诊percussion 听诊auscultation 嗅诊olfactory Palpation触诊Light palpation 浅部触诊法Deep palpation 深部触诊法Deep slipping palpation 滑行触诊法Bimanual palpation 双手触诊法Deep press palpation 深压触诊法Ballottement 冲击触诊法Percussion Notes叩诊音Tympany: gas Hyperresonance: increased gas in lung tissue Resonance: lung tissueDullness: gas and tissueFlatness: essential organ or fluid 鼓音: 气体过清音: 肺组织含气增多清音: 肺组织浊音: 气体与组织实音: 实质脏器或液体General Examination一般检查Vital signs 生命体征Development 发育Habitus 体型Nutritional status 营养Consciousness 意识Facial features and expressions 面容和表情Vital Sign (T, P, R) 生命征Temperature Normal axillary T: 36~37℃Fever: T>37℃Hypothermia: T<35℃Pulse Frequency: 60~100/min Rhythm: RegularRespiration Normal: 16~18/min体温正常(腋窝)体温: 36~37℃发热: T>37℃体温不升脉搏脉率: 60~100/min节律: 整齐呼吸频率: 16~18/minDisturbance of Consciousness意识障碍Somnolence 嗜睡Confusion 意识模糊Stupor 昏睡Coma 昏迷Delirium 谵妄Facial Features and Expression面容与表情mitral face二尖瓣面容Acute disease expression 急性病容Chronic disease expression 慢性病容Special face 特殊面容Graves Disease甲亢面容Mooned Face Induced by Cushing’s库兴氏满月脸Hippocratic Facies 恶病质Myxedema粘液水肿Acromegaly肢端肥大症Position体位Relaxed position 自主体位Positive position 被动体位in depletion or unconscious patient 极度衰竭意识丧失Compulsive position 强迫体位to relieve discomfort 减轻痛苦被迫采取的体位Gait步态Normal: calm and pithinessAbnormal:Waddling gaitDrunken man gaitAtaxic gaitFestinating gaitsteppage or footdrop gait scissors gaitIntermittent claudicationspastic hemiparesis正常: 平稳有力异常:蹒跚步态醉酒步态共济失调步态慌张步态跨阈步态剪刀步态间歇性跛行划圈步态、Subcutaneous Hemorrhage皮下出血Wine color and won’t fade when pressed 暗红色压之不褪色Petechia: <2mm 瘀点: <2mmPurpura: 3~5mm 紫癜: 3~5mmEcchymosis: >5mm 瘀斑: >5mmHematoma: 血肿: 片状出血伴皮肤隆起Spider Angioma蜘蛛痣Highly branched stellate arterial lesions which pulsate and blanch on pressure. Distributed commonly on face, neck, or chest. May be associated with pregnancy, chronic liver disease, or estrogen therapy, or may be normal.定义: 小动脉末端分支性扩张特点: 中央受压血管消失机制: 雌激素增多部位: 上腔静脉区域面部颈部和胸部病因: 妊娠慢性肝脏病变雌激素治疗Record content记录内容Normal node: 2~5 mm, soft, smooth, no tenderness and adhesion.Record if enlarged: location, size, number, hardness,tender, mobility, adhesion, superficial skin.正常淋巴结2~5mm 质软光滑无压痛无粘连肿大时记录部位大小数目硬度压痛活动度粘连Pupil Size瞳孔大小Normal: 3~4mm Dilation: glaucoma, atropinizationContraction: organophosphorus poisoning, drug reaction, narcotic takingPlatycoria: dying正常: 3~4mm扩大: 青光眼阿托品中毒缩小: 有机磷中毒药物反应安眠药过量双侧散大: 濒死状态Compare Both Pupil比较双侧瞳孔Normal:SymmetryAnisocoria: Pathology anywhere from the reception of light through the optic nerves to the brain stem, the third cranial nerve, sympathetic, or parasympathetic pathwaysCerebral hernia正常:等大等圆不等大视神经至脑干病变动眼神经受压交感神经受压副交感神经受压脑疝表面皮肤情况Sinuses鼻窦Location 部位frontal sinuses 额窦ethmoid sinuses 筛窦maxillary sinus 上颌窦Sphenoid sinuses tenderness & percussion pain: sinusitis 鼻窦区压痛叩击痛: 鼻窦炎Tongue Size舌体Enlarged: inflammation, myxedema, tumor, acromegaly 舌体肿大: 炎症黏液性水肿肿瘤肢端肥大症Shrinked: severe dehydration 舌体干小: 严重脱水Appearance of Tongue 舌象Geographic and wrinkled or fissured tongue: riboflavin deficiencyStrawberry tongue: long feverBeefy tongue: niacin deficiencySmooth tongue: iron or Vit B12 deficiency Black hairy tongue: fungus infection地图舌和裂纹舌: 黄色斑片和横向裂纹提示核黄素缺乏草莓舌: 舌乳头肿胀长期发热牛肉舌: 舌面绛红菸酸缺乏镜面舌: 光滑红色铁或维生素B12缺乏黑毛舌: 黑黄褐色毛真菌感染Pharynx and Tonsil咽和扁桃体Pharynx 咽Turkey red accompanied by swelling: Acute pharyngitis 红肿: 急性咽炎Wine accompanied by follicle: Chronic pharyngitis暗红滤泡: 慢性咽炎Tonsil 扁桃体degree of tonsil swelling Ⅰ°不超过腭咽弓Ⅱ°超过腭咽弓未达中线Ⅲ°达到超过咽后壁中线purulent 化脓性扁桃体炎Palpation of the Trachea触摸气管位置Indicate the location of mediastinum 指示纵隔位置Location: normally in the middle 正常居中Shifting to the health: large pleural effusion, pneumothorax 移向健侧: 大量胸腔积液气胸Shifting to the disaster: emphysema 移向患侧: 肺不张The Degree of Thyroid Gland Swelling甲状腺肿大的分度Ⅰ: invisible but palpable 不能看到能触到Ⅱ: visible and palpable 能看到又能触到Ⅲ: exceeding the out margin of sterno-mastoid muscle 超过胸锁乳突肌外缘Abnormal Intercostal Space肋间隙改变Recessed or narrowed depressed when inspirating: air way obstruction one-side depression: atelectasis, pleural adhesionWide or swelling general intense when expirating: emphysema, bronchial asthma one-side intense: pleural effusion, pneumothorax凹陷或变窄(容积缩小) 吸气时凹陷:大气道阻塞一侧变窄凹陷: 肺不张胸膜粘连膨隆或增宽(容积增大) 呼气时膨隆: 肺气肿支气管哮喘一侧增宽膨隆: 胸腔积液气胸Abnormal Lung Border肺界异常Kronig’isthmus:Widening: emphysemaNarrowing (unilateral): tuberculosis, tumorInferior border:Lowered: emphysemaRised: atelectasis, increased intra-abdominal pressureUndetectable: Pleural effusion, pneumothorax肺上界增宽: 肺气肿变窄: 肺结核肺肿瘤肺下界下降: 肺气肿升高: 肺不张腹压增高叩不出: 胸腔积液气胸、Abnormal Diaphragmatic Excursion肺下界移动范围异常Decreased: <4cm 减弱: <4cmUnilateral: atalectasis, pleural adhension 单侧: 肺不张胸膜粘连Bilateral: emphysema, lung fibrosis 双侧: 肺气肿肺纤维化Abnormal Intercostal Space肋间隙改变Recessed or narrowed depressed when inspirating: air way obstruction one-side depression: atelectasis, pleural adhesionWide or swelling general intense when expirating: emphysema, bronchial asthma one-side intense: pleural effusion, pneumothorax凹陷或变窄(容积缩小) 吸气时凹陷:大气道阻塞一侧变窄凹陷: 肺不张胸膜粘连膨隆或增宽(容积增大) 呼气时膨隆: 肺气肿支气管哮喘一侧增宽膨隆: 胸腔积液气胸Chest shape胸廓形态Normal: Ap : T=1 : 1.5Abnormal:Flat chest and Barrel chestRachitic chest Pigeon chest Rachitic rosary Funnel chest Harrison grooveRegional transfigurationThorax-vertebrae-malformation-induced胸廓正常形态前后径:横径1 : 1.5胸廓形态异常扁平胸和桶状胸佝偻病胸鸡胸串珠胸漏斗胸肋膈沟局部变形胸椎严重畸形Pathological Conditions异常改变Weaken or disappear: Obstructive atelectasis, emphysema, Pleural effusion, pneumothorax, subcutaneous emphysemaEnhanced: Consolidation of lung tissue: lobar pneumonia, pulmonary infarction. Large cavity in the lung, esp. near the pleura: lung abscess, cavernous pulmonary tuberculosis.减弱或消失阻塞性肺不张肺气肿胸腔积液气胸皮下气肿增强肺实变: 大叶肺炎肺梗死近胸膜肺空洞: 肺脓肿空洞型肺结核Clinical Significance临床意义Localized crackles: regional diseasesBilateral crackles in lower field of the lungs with rhonchi: bronchitis with lung infectionCrackles in bilateral bases of the lungs: pulmonary congestion caused by heart failureGeneralized coarse crackles in bilateral lung fields: acute pulmonary edema局部湿啰音: 肺局部炎症两下肺散在干湿啰音: 支气管炎并感染两肺底对称性湿啰音: 左心功能不全两肺满布湿啰音:急性肺水肿、Emphysema肺气肿Pathology: air trapping in the lung Inspection: barrel chestPalpation: decreased dynamic events of respiration and tactile fremitusPercussion: hyperresonce; Down-shifting of the inferior border of the lungAuscultation: decreased breath sounds and vocal resonance机制双肺含气增多视诊桶状胸触诊呼吸动度减弱语颤减弱叩诊过清音肺下界下移听诊呼吸音减弱语音共振减弱Atelectasis肺不张Pathology: the airway is obstructed and the lung holds no airInspection: the affected chest wall is flattenedPalpation: 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.机制气道阻塞肺不含气视诊患侧胸廓凹陷触诊患侧呼吸动度减弱语颤减弱气管移向患侧叩诊患侧浊音或实音听诊患侧呼吸音消失、语音共振消失Lobar Pneumonia 肺炎性实变Pathology: too much fluid in alveoliInspection: normal chestPalpation: decreased dynamic events of respiration, increased tactile fremitus.Percussion: dullness or flatnessAuscultation: tubular breath sound, crackles, increased vocal resonance机制气道通畅肺泡腔充满液体视诊患侧呼吸运动减弱触诊患侧呼吸动度减弱病变区语颤增强叩诊病变区浊音或实音听诊管状呼吸音湿啰音语音共振增强、、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 机制胸腔气体存积视诊患侧饱满触诊患侧呼吸动度减弱语颤减弱气管移向健侧叩诊患侧鼓音听诊患侧呼吸音消失语音共振消失Pleural Effusion胸腔积液Pathology: fluid 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: dullness or flatnessAuscultation: breath sounds and vocal resonance disappear 机制胸腔液体存积视诊患侧饱满触诊患侧呼吸动度减弱语颤减弱气管移向健侧叩诊患处浊音或实音听诊患处呼吸音消失语音共振消失Abnormal Lung Border肺界异常Kronig’isthmus:Widening: emphysemaNarrowing (unilateral): tuberculosis, tumorInferior border:Lowered: emphysemaRised: atelectasis, increased intra-abdominal pressureUndetectable: Pleural effusion, pneumothorax肺上界增宽: 肺气肿变窄: 肺结核肺肿瘤肺下界下降: 肺气肿升高: 肺不张腹压增高叩不出: 胸腔积液气胸Abnormal Diaphragmatic Excursion肺下界移动范围异常Decreased: <4cm 减弱: <4cmUnilateral: atalectasis, pleural adhension 单侧: 肺不张胸膜粘连Bilateral: emphysema, lung fibrosis 双侧: 肺气肿肺纤维化Classify of Breath Sound呼吸音分类Normal and abnormal 正常和异常呼吸音Bronchial breath sounds 支气管呼吸音Vesicular breath sounds 肺泡呼吸音Bronchovesicular breath sounds 支气管肺泡呼吸音Inspection of the Heart心脏视诊precordium shape 心前区外形normal apical impulse 正常心尖搏动abnormal apical impulse 异常心尖搏动precordial abnormal impulse 心前区异常搏动Precordium Shape心前区外形Precordial bulge 心前区隆起Features: bony bulge 特点:骨骼突起Clinical importance: Congenital heart disease with ventricular enlargement 提示:先天性心脏病右室大Precordial satiety 心前区饱满Features: intercostal region sticking out 特点:肋间软组织外突Clinical importance: mass of pericardial effusion 提示:大量心包积液Normal Apical Impulse正常心尖搏动Location: 0.5~1 cm to the left midclavicular line at the 5th ICS outside LSB. Range: 2~2.5cmDirection: outward when ventricular systole begins位置: 第5肋间左锁骨中线内0.5~1cm范围: 2~2.5cm方向: 收缩时向外搏动意义: 提示心尖位置代表收缩期提示心脏大小Abnormal Dullness Heart Border心界叩诊异常(1)heart variation 心脏改变L.V enlargement: boot-shaped heart 左室扩大: 靴形心L.A enlargement: pear-shaped heart 左房扩大: 梨形心B.V enlargement: general enlarged heart 双室扩大: 普大心R.V enlargement: cor pulmonal 右室扩大: 先心肺心Pericardial effusion: flask-shaped heart心包积液: 烧瓶心、Abnormal Dullness Heart Border心界叩诊异常(2)chest and lung diseases 胸肺疾病Pleural effusion or lung consolidation: dullness border undetectable 胸腔积液或肺实变: 叩不出Emphysema: “shrinked”dullness border 肺气肿: 心浊音界缩小abdominal disorders 腹部疾病Diaphragm elevation: acrossing heart 膈升高: 横位心Boot-shaped Heart靴形心Mechanism: L.V enlargementFeatures: the left border extends to the inferior left, waist of the heart is deepened.Causes: aortic insufficiency, hypertensive heart disease机制: 左室扩大特点: 心左界向左下扩大心腰加深病因: 主动脉瓣关闭不全高血压心脏病Pear-shaped Heart梨形心Mechanism: L.A enlargement and distension of pulmonary arteryFeatures: dullness heart border in the 2nd, 3rd ICS on the LSB extends outside, waist of the heart bulges outCauses: mitral stenosis机制: 左房扩大肺动脉扩大特点: 胸骨左缘2, 3肋间心浊音界向外扩大心腰饱满或膨出病因: 二尖瓣狭窄General Enlarged Heart普大心Mechanism: both left and right ventricle are enlargedFeatures: the dullness border extends to both sides, the left border extends to inferior leftCauses: cardiomyopathy, myocarditis, whole heart failure机制: 左右心室扩大特点: 心浊音界向双侧扩大左界向下扩大病因扩张型心肌病克山病重症心肌炎全心衰竭Flask-shaped Heart烧瓶心Mechanism: pericardial effusionFeatures: Sitting position: triangular dullness borderSupine: widened dullness border of the base机制: 心包积液特点:坐位时心浊音界呈三角形仰卧位心底部浊音区增宽随体位心界改变First Heart Sound, S1 第一心音Signaling the beginning of systole. 提示收缩期开始It has characters of low pitch, long duration. 音调低时间长“咚”It can be heard best in the apex area. 在心尖部听诊最清楚Second Heart Sound, S2第二心音Signaling the beginning of diastole. 提示舒张期开始It is high-pitched, low-intensity, shorter and brisker. 高调低强度时间短轻脆“嗒”It can be auscultated best at the base of the heart. 在心底部听诊最清楚S1 第一心音S2 第二心音Pitch 音调Low 低High 高Intensity 强度High 强Low 弱Quality 音质Blunter 低钝Brisker 清脆Duration 持续时间Long 长Short 短Interval 两者间隔S1-S2 长< S2-S1 短Apical impulse 心尖搏动Concomitant 一致Post 之后Best site 最响部位Apex 心尖Base 心底Changes of Quality 心音性质改变Changes of S1 quality: S1 same as S2 (blankness) 第一心音性质改变: 第一心音与第二心音相同(单调)Diastolic phase shorten: same as systolic (single rule) 舒张时限缩短: 收缩期与舒张期时限相同(单律)Characteristic: pendular rhythm, embryocardia 听诊特点: 钟摆律胎心律Clinical meaning: myocardial damage severely, as acute myocardial infarction, severe myocarditis,. 提示: 心肌严重受损如急性心肌梗塞重症心肌炎Wide Splitting顺分裂Typical at the end of inspiration 吸气末分裂明显Physiologic splitting: deep inspiration 生理分裂: 吸气相回右心血量增加General splitting 通常分裂Delayed P2: pulmonary hypertension, mitral stenosis, pulmonic stenosis, right bundle branch block. 肺动脉瓣关闭延迟: 肺动脉高压二尖瓣狭窄肺动脉瓣狭窄右束支阻滞Early A2: mitral insufficiency, IVSD 主动脉瓣关闭提前: 二尖瓣关闭不全室间隔缺损Fixed Splitting固定分裂Splitting is unaffected by respiration分裂不受呼吸影响Mechanism: delayed closure of the pulmonic valve (output of the right ventricle is greater than that of the left) 机制: 肺动脉瓣关闭延迟Blood flow from left atrium to the right passing through septal defects amortized affection of respiration. 房间隔缺损处血液左向右分流缓冲呼吸影响Common diseases: large atrial septal defects and right ventricular failure. 病因: 大的房间隔缺损并右心功能不全Reversed Splitting逆分裂Typical at the end of expiration 呼气末分裂明显Paradoxical Splitting: P2 occurs firstly, followed by A2 反常分裂: 肺动脉瓣第二音出现在主动脉瓣第二音之前Mechanism: closure of the aortic valve is delayed 机制: 主动脉瓣关闭明显延迟Common diseases: Left bundle branch block, Aortic stenosis. 病因: 左束支传导阻滞主动脉瓣狭窄Extra Heart Sounds额外心音systolic extra heart sounds 收缩期额外心音diastolic extra heart sounds 舒张期额外心音Extra Heart Sounds额外心音SystolicEarly systole: ejection soundsMid-/Late systole: clickDiastolicEarly diastole: opening snap, pericardial knock Mid-diastole: third heart soundLate diastole: fourth heart soundgallop rhythm收缩早期喷射音中晚期喀喇音舒张早期开瓣音心包叩击音中期第三心音晚期第四心音奔马律Gallop奔马律Mechanism: decreased compliance of the ventricle caused by severe myocardial damage 机制: 心肌严重受损致室壁顺应性差Classification: 分类Protodiastolic gallop (Ventricular gallop, S3 gallop) 舒张早期奔马律(室性奔马律第三心音奔马律)Late diastolic gallop (atrial gallop, S4 gallop) 舒张晚期奔马律(房性奔马律第四心音奔马律)Quadruple rhythm and summation sound 四音律和重叠奔马律Physical S3 & Pathological S3生理性与病理性第三心音的区分Quadruple Rhythm and Summation Sound四音律和重叠奔马律Mechanism: pathological S3 & S4. 同时出现病理性第三和第四心音During tachycardia, the diastolic filling time shortens and the S3 and S4 move closer together. 心率加速时舒张期缩短第三和第四心音重叠They sound superimposed in mid-diastole, and one loud, prolonged, summated sound can be heard, often louder than either S1 or S2. 特点: 舒张中期较长响亮心音强于第一或第二心音Characterization of Murmurs杂音听诊要点LocationDurationPitch and QualityIntensity and Timing Transmission or radiationEffect murmurs of factor杂音的部位杂音的时期杂音的性质杂音的强度杂音的传导影响杂音的因素Location杂音部位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杂音出现和最响部位与病变部位血流方向传导介质相关心尖部: 二尖瓣主动脉瓣听诊区: 主动脉瓣肺动脉瓣听诊区: 肺动脉瓣胸骨下端: 三尖瓣胸骨左缘 3 4 肋间: 室间隔胸骨左缘 2 3 肋间: 动脉导管Duration杂音时期Systolic murmur (SM)HolosystolicEarlyMidsystolicLateDiastolic murmur (DM)HolodiastolicEarlyMiddiastolicLate (presystolic)Continuous收缩期杂音全收缩期收缩早期收缩中期收缩晚期舒张期杂音全舒张期舒张早期舒张中期舒张晚期连续性杂音Distinguish Duration时期的区分systolic murmur 收缩期杂音appear between S1 and S2, same as apical impulse 在第一心音与第二心音之间出现与心尖搏动一致diastolic murmur 舒张期杂音appear between S2 and S1, nonsame as apical impulse在第2 心音与第1 心音之间出现与心尖搏动不一致Intensity of Systolic Murmur收缩期杂音强度GradeⅠ: barely audible in quiet room 1 级: 仔细听方可听到GradeⅡ: quiet but clearly audible 2 级: 容易听到但不响亮GradeⅢ: moderately loud 3 级: 较响亮GradeⅣ: loud, associated with thrill 4 级: 粗糙且响亮伴传导震颤GradeⅤ: very loud, thrill easily palpable 5 级: 震耳GradeⅥ: very loud, audible with stethoscope not in contact with chest, thrill palpable and visible 6 级: 离开胸壁亦可闻及Functional and Organic Murmurs收缩期杂音的鉴别Functional功能性Organic器质性Age 年龄Young儿童青少年Unlimited 不定Location 部位Pulmonic/apical 肺动脉瓣或心尖部Any area各部位Character 性质Soft, smooth 柔和Coarse, high pitch粗糙高调Duration 时间Short 短Long (whole systole)长（全收缩期）Intensity 强度<3/6 > or =3/6 Thrill 震颤no 无Yes 有Transmission传导Localized 局限extensive 传导Systolic murmur in left sternum intercostal 3~4: ventricular septal defect 胸骨左缘3 4肋间收缩期杂音: 室间隔缺损Continuous machine-like in left sternum intercostal 2: patent ductus arteriosus 胸骨左缘第2肋间连续型杂音: 动脉导管末闭Peripheral Vascular Sign周围血管征Vascular sign: 征象Water-hammer Pulse 水冲脉Carotid artery impulse 颈动脉搏动Nodding spasm 点头运动Capillary pulsation 毛细血管搏动征Pistol shot sound 枪击音Duroziez double murmur 杜氏双重杂音Clinical meaning: aortic insufficiency, hypertension, Hyperthyroidism提示: 主动脉瓣关闭不全高血压甲状腺机能亢进Heart Disease心脏疾病mitral stenosis 二尖瓣狭窄aortic insufficiency 主动脉瓣关闭不全Mitral Stenosis二尖瓣狭窄(1)L.A enlargement Pulmonary artery dilation R.V enlargement 左房增大→肺动脉扩张→右室增大Inspection: Mitral face (malar flush), apical impulse left 视诊: 二尖瓣面容心尖搏动向左移位Palpation: diastolic thrill at the apex area 触诊: 心尖部舒张期震颤Percussion: pear-shaped heart 叩诊: 梨型心Mitral Stenosis Auscultation二尖瓣狭窄(2)Apex area: 心尖部Heart sounds: Accentuation of S1 第一心音亢进Extra sound: opening snaps 开瓣音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. 舒张中晚期隆隆样杂音Pulmonic area: 肺动脉瓣区Heart sounds: Accentuation and splitting of S2 第二心音亢进分裂Murmur: Graham-steell G-S杂音Aortic Insufficiency主动脉瓣关闭不全(1)Inspection: Apical impulse to left inferior 视诊: 心尖搏动向左下移位carotid artery impulse 颈动脉搏动Palpation: lifting apical impulse 触诊: 抬举性心尖搏动water-hammer pulse 水冲脉Percussion: boot-shaped heart 叩诊: 靴型心Aortic Insufficiency Auscultation 主动脉瓣关闭不全听诊(2)Aortic area:主动脉瓣区Heart sounds: S2↓第二心音减弱Murmur: early diastolic, high pitch, blowing, radiating to the apex 舒张期递减型叹气样杂音Apex area: 心尖部Heart sounds: S1↓第一心音减弱Murmurs: Austin-Flint A-F杂音Distension腹部膨隆Abdominal wall disorders 腹壁改变Tumor: appeared clearly in force 肿物: 腹部用力时肿物明显Incrassation: hilum depressed such as obesity 增厚: 脐部凹陷如肥胖Abdominal cavity increase 腹腔增大Full distension: normal pregnancy and abnormal 全腹膨隆: 正常妊娠和异常Local distension 局部膨隆Measure surround of abdomen 测量腹围Around the abdomen through hilum by soft ruler 仰卧位用软尺绕脐一周Common Causes of Distension常见膨隆原因Fat 肥胖Fluid 腹水Feces 粪块Fetus 妊娠Flatus 胃肠胀气Fibroids 子宫平滑肌瘤Fatal tumor 恶性肿瘤.Remember:5FContour: Protuberant Abdomen全腹膨隆Ascites: frog shape of abdomen, accompanied hilum hernia. 腹水: 蛙状腹常伴脐疝causes: hepatocirrhosis, serious heart failure, pericarditis, renal disease syndrome, peirtoneum cancer. 病因: 肝硬化严重心衰缩窄性心包炎肾病综合征腹膜癌Gases distention of the intestines: sphericity of abdomen 肠胀气: 球形腹causes: ileus, intestinal paralysis. 病因: 肠梗阻肠麻痹Organomegaly: enormous ovary cyst and teratoma. 肿瘤: 巨大卵巢囊肿畸胎瘤Local DistensionDirection of the Blood flow血流方向检查Use two fingers on appeared vein 用两手指并拢压在静脉上Two fingers press and dis part 两手指加压分开Loosen superior finger 松开上端手指Faster show blood flow downwards 充盈快示血流向下Repeat above action 重复以上动作Loosen inferior finger 松开下端手指Faster show blood flow upwards 充盈快示血流向上Obstruction of Vena Cava腔静脉阻塞Varicosity on the flanks曲张静脉在侧腹部Obstruction of superior vena cava: blood stream to downwards. 上腔静脉回流受阻血流方向向下Obstruction of inferior vena cava: blood stream to upwards. 下腔静脉回流受阻血流方向向上Rebound Tenderness (Blumberg sign) 反跳痛Examination method: press deeply and slowly, let slip suddenly. 检查方法: 逐渐深压腹壁突然松开Positive finding: pain prick up in loose. 阳性: 松开时疼痛加剧Clinical meanings: inflammation in the parietal peritoneum. 提示: 炎症波及壁层腹膜Peritoneal Irritation Sign腹膜刺激征Three sign same appear:Tenderness Rebound tendernessGuarding 三联征: 压痛反跳痛腹肌紧张Clinical meaning: acute peritonitis 提示: 急性腹膜炎Measure of Enlarged Spleen肿大脾脏的测量The first line: between costal margin and low edge of spleen in left midclavicular line 1 线(甲乙线): 左锁骨中线上肋缘至脾下缘The second line: between the point of the left midclavicul cross costal margin and the point of spleen apoapsis. 2 线(甲丙线): 左锁骨中线肋缘点至脾最远点The third line: between right side of spleen and midline, express with positive or negative 3 线(丁戊线): 脾右缘至正中线以(＋)(－)表示Spleen Enlargement Degrees脾脏肿大分度Mild enlargement: <2 cm under the rib 轻度肿大: 肋下<2cmModerate enlargement: not exceed the level of umbilicus 中度肿大: 不过脐Severe enlargement: exceed the level of umbilicus or mid line 高度肿大: 过脐或中线Murphy’s Sign莫非氏征Technique: Hold your fingers under the liver border. 手指放于肝脏下缘Positive sign: As the descending liver pushes the inflamed gallbladder onto the examining hand, the person feels sharp pain and abruptly stops inspiration midway. 阳性: 吸气时肝脏和胆囊下移手指触及炎性胆囊时被检者因剧痛中止吸气Characteristics of Palpation 触诊要点Location: relation to organsSize: diameter in long, wide and thickContour: shape, margin and surfaceTexture: soft, firm and hardTenderness: inflammation, liver swelling Pulsation: dilative and conductive Movability: shift by respiration or hand部位: 所在部位与该处脏器多相关连大小: 纵长横宽深厚可用实物比喻轮廓: 形状边缘表面质地: 柔软中等硬度质硬压痛: 炎症肝肿大搏动: 膨胀性和传导性移动度: 随呼吸移动用手推动Fluid Thrill液波震颤Technique: move flank wall by hand 检查方法: 用手推动一侧腹壁Positive: the other hand feels liquid wave 阳性征象: 对侧手掌感到液体波动Meaning: large volume of ascites, usually >3000ml 临床意义: 大量腹水在3~4升以上Percussion of Ascites腹水叩诊Shifting dullness: 移动性浊音free fluid causes air-containing gut to float up to the most superior position 液体流动使含气脏器位于最高位置volume of ascites usually exceeds 1000ml if detectable 腹水量在1000ml以上Puddle sign: 水坑征free fluid in the most inferior position in elbow-knee posture 肘膝位腹水位于最低位a way to detect small amounts of fluid 用于发现少量腹水腹水和卵巢囊肿的鉴别Signs 征象Ascites 腹水Ovarian cyst 卵巢囊肿Dorsal position仰卧位Umbilicus 脐Percussion sound 叩诊音Shifting dullness 移动性浊音Ruler pressing test 尺压试验Side distension 侧腹膨隆Extrude 突出Middle tympany side dullness 中部鼓音两侧浊音Positive 阳性No jumpiness 无跳动Middle distension 中腹膨隆Flat 平坦Middle dullness side tympany 中部浊音两侧鼓音Negitive 阴性Rhythm jumpiness 有节奏跳动Auscultation of Abdomen腹部听诊bowel sounds 肠鸣音vascular sounds 血管杂音friction rub 摩擦音scratch sound 搔弹音splashing sound 振水音Scratch Sound搔弹音Mechanism: sound wave conductive diversity in differ medium made noise alteration. Aids in static border definition 机制: 声波在不同介质中传导的差异致声响改变有助于确定实质脏器或液体边界Technique: put the stethoscope in central and the hand scratch to it, when sound suddenly increased indicate the border. 方法: 听诊器置于中央手边搔弹边向听诊器移动声响突然增强为其边界Meaning: confirm inferior border of the liver and ascites (<120ml) 意义: 确定肝脏下界和小量腹水范围Cirrhosis of Liver肝硬化Small liver to percussion but a hard edge may be palpable under the xiphoid 剑突下触及边钝质硬缩小的肝脏Spleen palpable 脾脏肋缘下可触及Varicosity and ascites 脐周静脉曲张和腹水征palmar erythema, spider angioma and Gynaecomastia 肝掌蜘蛛痣男性乳房发育Gastrointestinal haemorrhage 消化道出血Ascites Sign腹水征Inspection: frog shape of abdomen in dorsal position, hypogastrium region distension with hilum hernia in stand. 视诊: 仰卧位蛙状腹直立位下腹膨隆脐突出Palpation: fluid thrill (ascites large than 3000 ml) 触诊: 液波震颤(腹水量>3000ml)Percussion: shifting dullness (ascites large than 1000 ml), puddle sign (small amounts of fluid) 叩诊: 移动性浊音(腹水量>1000ml) 水坑征(少量腹水)Auscultation: umbilicus scratch sound in elbow-knee posture (ascites<120ml) 听诊: 脐部搔弹音(腹水量<120ml)Acute Perforated Gastric or Duodenal Ulcer急性胃十二指肠穿孔Suddenly epigastric pain, forced supine position and twin lower limbs flection 突发上腹痛强迫仰卧位双下肢屈曲Acute peritonitis signs, tenderness and rebound pain in epigastrium or round umbilicus quarter 急性腹膜炎征象压痛反跳痛位于上腹部和脐周Hepatic dullness region decrease or disappear 肝浊音区缩小消失shifting dullness in abdomen 腹部移动性浊音Physical Examination Point 急性胃肠穿孔检体要点Gas in abdominal cavity: dullness area of liver disappear 腹腔气体: 肝浊音区缩小消失Liquid in abdomen: shifting dullness 腹腔液体: 腹部移动性浊音Inflammation in abdomen: acute peritonitis sign, serious in epigastric and umbilical region. 腹部炎症反应: 急性弥漫性腹膜炎征象压痛反跳痛位于上腹部和脐周forepart: acute ache face, compulsive supine position, lower limbs flection 早期: 急性痛苦面容冷汗强迫仰卧位双下肢屈曲anaphase: high fever, pulse frequence 后期: 高热失水精神萎靡面色灰白眼球凹陷脉搏频数Acute Peritonitis Signs急性腹膜炎征象Inspection: general depression in abdomen, decreased or disappeared abdominal respiration 视诊: 腹部凹陷腹部呼吸运动减弱消失Palpation: tenderness, rebound tenderness, rigid abdominal wall 触诊: 压痛和反跳痛腹壁呈板状硬Percussion: shifting dullness 叩诊: 可有移动性浊音Auscultation: decreased or absence of bowel sounds 听诊: 肠鸣音减弱消失Intestinal Obstruction肠梗阻Symptom: bellyache, vomiting, no defecate and anus exhaust 症状: 腹痛呕吐无排便和肛门排气Inspection: full distension, intestine form and peristaltic wave 视诊: 腹部膨隆肠型可见肠蠕动波Palpation: rigid abdominal wall, tenderness and rebound pain 触诊: 腹肌紧张压痛及反跳痛Percussion: tympany region increased 叩诊: 鼓音范围增大Auscultation: mechanical ileus accompanied sharp bowel sound and decreased or absence of bowel sounds in paralysis ileus 听诊: 机械性肠梗阻肠鸣音亢进麻痹性肠梗阻肠鸣音减弱或消失Muscle Power肌力Force by muscle contraction produced 肌肉收缩产生的力量Muscle power decreasing or disappearing called partial or complete paralysis 肌力下降或消失称为不完全或完全瘫痪Paralysis divided hemiparalysis, crossed paralysis, paraplegia and single limb paralysis by pathologic position 根据瘫痪的部位分为偏瘫交叉瘫截瘫和单瘫Paralysis divided central and peripheral by location of nervous injury 根据神经损伤位置分为中枢性瘫痪和周围性瘫痪The grading of muscle strength肌力分度Absent (0 degree): no contraction detected. 0 级(不动): 完全瘫痪Trace (1 degree): slight contraction detected. 1 级(肌动): 肌肉可收缩不能产生运动Weak (2 degree): movement with gravity eliminated. 2 级(平动): 床面上可移动不能抬离Fair (3 degree): movement against gravity. 3 级(抬动): 能抬离床面不能抗阻力Good (4 degree): move against gravity with some resistance. 4 级(弱抗动): 能抗阻力但较正常差Normal (5 degree): movement against gravity with full resistance. 5 级(正常): 正常肌力Tremor震颤Static tremor: embitter in whisht and mitigate in movement, seen in paralysis agitans 静止性: 静重动轻见于震颤麻痹Intentional tremor: embitter in movement and mitigate in whisht, seen in cerebel disorders 意向性: 动重静轻见于小脑疾患Senile tremor: nodded and hand tremble, seen in arteriosclerosis 老年性: 点头手抖见于动脉硬化Flutter tremor: flicker in wrist and palm, seen in hepatic coma 扑翼样: 腕掌扑动见于肝昏迷Tremor of fingers: fine twitter, seen in hyperthyroidism 手指细颤: 细小抖动见于甲状腺机能亢进症Physical Reflex生理反射Superficial reflex: induced by the stimulation of mucocutaneous receptors 浅反射: 刺激皮肤粘膜感受器引起反应Included: corneal reflex, abdominal reflex, cremasteric reflex, plantar reflex 包括: 角膜反射腹壁反射提睾反射跖反射Deep reflex: induced by the stimulation of periosteal and tendon receptors 深反射: 刺激骨膜肌腱感受器引起反应Included: biceps reflex, triceps reflex, brachioradialis reflex, patellar reflex, achilles tendon reflex 包括: 肱二头肌反射肱三头肌反射桡骨骨膜反射膝(腱)反射跟腱反射Pyramidal Sign锥体束征Upper limbs pathological reflex: Hoffmann Sign usually seen in cervical region disorders of spinal cord 上肢病理反射: 霍夫曼征多见于颈髓病变Lower limbs pathological reflex: Babinski sign, Chaddock sign, Oppenheim sign, Gordon sing 下肢病理反射: 巴宾斯基征查多克征奥本海姆征戈登征Clonus: rhythmical contraction of the muscle made the limb or foot movement by stimulation 阵挛: 刺激使肌肉有节奏的收缩致肢体运动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. 定义: 脑膜病变脑膜炎蛛网膜下腔出血颅内压增高等(除外颈椎疾患) Neck rigidity: resisting in raise neck 颈项强直: 抬颈抵抗Kernig sign: angle of knees joint can be drived up less than 135 degree with bended thigh 克匿格征: 屈腿抬高<135º(正常可达135º)Brudzinski sign: going down on knees when raise neck 布鲁金斯基征: 抬颈时屈膝Grade of Fever发热分度Slight fever 低热37.3~38℃Moderate fever 中等度热38.1~39℃Hyperpyrexia 高热39.1~41℃Ultrahyperpyrexia 超高热>41℃Fever Types高热热型Persistent high feverContinuous feverRemittent feverIntermittent high feverIntermittent feverRecurrent feverUndulant feverIrregular fever持续高热热型稽留热弛张热间断高热热型间歇热回归热波状热不规则热Clinical Types of Edema水肿的临床类型Cardiac EdemaNephritic EdemaHepatic EdemaMalnutritional EdemaDrug-induced EdemaOthers Myxedema Premenarche edema心原性水肿肾原性水肿肝原性水肿营养不良性水肿药物性水肿其他黏液性水肿经前期水肿Clinical Features临床特点Area: related to location of the pathological changesNature: lancinating, drilling, burning, colicOnset: continuous, paroxysmal, intermittentReferred painFactors triggering。
(完整版)诊断学大体题目和名解英文
名解：1.症状symptom2.体征sign3.发热fever4.稽留热continued fever5.弛张热remittent fever6.间歇热intermittent fever7.波状热undulant fever8.回归热recurrent fever9.不规则热irregular fever10.水肿edema11.咳嗽cough12.咳痰expectoration13.咯血hemoptysis14.呕血hematemesis15.放射痛或牵涉痛radiating pain P4116.呼吸困难dyspnea17.心源性呼吸困难或心源性哮喘cardiac asthma18.Kussmaul 呼吸19.Saegesser 征20.腹泻diarrhea21.黄疸jaundice22.Gilbert综合征23.Crigler-Najiar综合征24.Rotor综合征25.Dubin-Johnson综合征26.夏科Charcot三联征27.血尿haematuria28.尿频frequent micturition29.尿急urgent micturition30.尿痛odynuria31.尿路刺激征32.神经源性膀胱33.意识障碍disturbance of consciousness34.嗜睡somnolence35.意识模糊confusion36.嗜睡stupor37.昏迷coma38.谵妄delirium39.问诊inquiry40.主诉chief complaint41.现病史history of present illness42.既往史past history 43.系统回顾review of systems44.月经史menstrual history45.体格检查physical examination46.检体诊断physical diagnosis47.视诊inspection48.触诊palpation49.叩诊percussion50.叩诊音percussion sound51.清音resonance52.浊音dullness53.实音flatness54.鼓音tympany55.过清音hyperresonance56.听诊auscultation57.嗅诊olfactory examination58. 生命征vital sign59.无力型asthenic60.超力型sthenic type61.正力型ortho-sthenic type62.营养不良innutrition63.营养过剩excess nutrient64.精神障碍mental disorders65.自知力insight66.二尖瓣面容mitral facies67.甲亢面容thyrotoxic facies68.体位position69.被动体位passive position70.强迫体位compulsive position71.端坐呼吸orthopnea72.间歇性跛行intermittent claudication73.发绀cyanosis74.色素沉着pigmentation75.斑疹maculae76.玫瑰疹roseola77.丘疹papules78.斑丘疹maculopapule79.荨麻疹urticaria80.瘀点petechia81.紫癜purpura82.瘀斑ecchymosis83.血肿hematoma84.蜘蛛痣spider angioma85.肝掌liver palms86.溃疡ulcer87.糜烂erosion88.瘢痕scar89.落日现象setting sun phenomenon90.眼球震颤nystagmus91.集合反射Convergence reflex92.鼻翼扇动nasal ale flap93.麻疹粘膜斑Koplik斑94.肝颈静脉回流征hepatojugular reflux95.胸骨下角infrasternal angle96.剑突xiphoid process97.气管牵曳Oliver征98.皮下气肿subcutaneous emphysema99.三凹征three depression sigh100.橘皮状orange Peel101.胸腹矛盾呼吸paradixic breathing 102.潮式呼吸tidal breathing103.间停呼吸Biots呼吸104.叹息样呼吸sighing breath105.语音震颤vocal fremitus或触觉震颤tactile fremitus106.空瓮音amphorophony107.异常肺泡呼吸音108.齿轮呼吸音cogwheel breath sound 109.异常支气管呼吸音或管样呼吸音110.湿罗音moist rale 或水泡音111.粗/中/细湿罗音coarse/medium/fine rales 112.捻发音crepitus113.干啰音dry rales/rhonchi114.支气管语音bronchophony115.羊鸣音egophony116.胸膜摩擦音pleural friction rub117.心尖搏动apical impluse118.负性心尖搏动inward impulse119.心尖区抬举性搏动120.震颤thrill121.心脏瓣膜听诊区auscultatory valve area 122.二/三联律bigeminal/trigeminal beats 123.大炮音cannon sound124.钟摆律或胎心音125.固定分裂fixed splitting126.反常分裂paradoxical splitting127.奔马律gallop rhythm128.开瓣音opening snap129.心包叩击音pericardial knock 130.肿瘤扑落音rumor plop131.二尖瓣脱垂综合征132.心脏杂音cardiac murmurs133.收缩期杂音systolic murmur134.舒张期杂音diastolic murmur135.心包摩擦音pericardial friction sound 136.Austin-Flint杂音137.Graham-Steel杂音138.脱落脉dropped pulse139.水冲脉water-hammer pulse140.交替脉pulsus alternans141.奇脉paradoxical pulse142.迟脉tardus pulse143.重搏脉dicrotic pulse144.枪击音pistol shot sound145.毛细血管搏动征capillary pulsation sign 146.周围血管征147.Ewart 征148.肋脊角costovertebral angle149.腹部平坦150.腹部膨隆abdominal protuberance 151.舟状腹scaphoid abdomen152.胃型或肠型gastral or intestinal pattern 153.蠕动波peristalsis154.肠鸣音bowel sound155.胃泡鼓音区Traube semilunar space 156.移动性浊音shifting dullness157.板状腹board-like rigidity158.腹膜刺激症peritoneal irritation sign 159.反跳痛rebound tenderness160.Murphy征161.Courvoisier定律162.液波震颤fluid thrill163.振水音succusion splash164.遗忘amnesia165.痴呆dementia166.失语aphasia167.构音障碍dysphonia168.角膜反射corneal reflex169.瘫痪paralysis170.指鼻试验finger nose test171.指指试验finger finger test172.轮替动作alternate motion173.跟膝胫试验heel-knee-tibia test174.昂白征Romberg’s sign175.痉挛spasm176.抽搐tics177.肌阵孪myoclonus178.浅反射179.腹壁反射abdominal reflexes180.提睾反射cremastetic reflexes181.深反射182.肱二头肌反射biceps183.肱三头肌反射triceps184.桡反射radial periosteal185.膝反射patellar186.跟腱反射Achilles187.霍夫曼征Hoffmann’s sign188.踝阵挛ankle clonus189.髌阵挛patella clonus190.巴宾斯基征Babinski’s sign191.奥本汉姆征Oppenheim’s sign192.凯尔尼格征Kernig’s sign193.布鲁津斯基征Brudzinski’ sign194.脑膜刺激征195.心电轴mean QRS axis196.心律失常arrhythmias197.窦性心律不齐sinus arrhythmia198.窦性停播sinus arrest199.病态窦房结综合征sick sinus syndrome SSS200.期前收缩premature beat201.联律间期coupling interval202.代偿间歇compensatory pause203.文氏现象Wenckebach phenomenon 204.预激综合征pre-excitation syndrome 205.WPW综合征206.LGL综合征207.逸搏208.逸搏心律escape rhythm问答：1、发热的病因与分类和热型、伴随症状和体征2、水肿的分类和伴随症状3、心源性水肿和肾源性水肿的比较4、咳嗽咳痰的病因与发生机制、临床表现、伴随症状、问诊要点5、咯血和呕血的比较6、咯血的临床表现7、胸痛的病因与发生机制、临床表现、问诊要点8、呼吸困难的病因与发生机制和分类9、夜间阵发性呼吸困难的机制10、腹痛的原因和临床表现、问诊要点。
诊断学英文课件：Clinical-Diagnostics全
•No correct diagnosis •No appropriate treatment
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Contents of Clinical diagnostics
单击此处添课程名 5. Review of systems（系统回顾）
6. Personal history（个人史） 7. Menstrual history（月经史） 8. Marital history（婚姻史） 9. childbearing history（生育史） 10. Family history（家族史）
Method to learn -2
• 面临大量的临床资料，如何去粗取精、去伪存真地分析 和思考，正确的临床思维有时不是依靠独立思索而形成 的，临床会诊、讨论（MDT）等均可起到互相启发和取 长补短的作用。
单击此处添课程名 • 一个完整的诊断除需要有解剖学、功能学和影象学的诊 断外，在条件许可的情况下要尽可能作出病理学、细胞 学和病原学的诊断。 • 从一个医学生到一个能提出初步诊断的临床医生，是需
Clinical Diagnostics
单击此处添课程名
General Introduction
• What is Clinical diagnostics ?
• Con单ten击ts o此f c处lini添cal课dia程gn名ostics
• How to learn clinical diagnostics?
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医学诊断学(英文)
For example: ▲sore throat, high fever for
two days ▲chill, fever, right chest pain,
cough for three days ▲recurrent epigastric pain for
eight years, it has been getting
(2) Features of Chief Symptoms
for example: pain location frequency duration intensity quality (blunt colic distention burning ) radiation alleviating and aggravating
late autumn early spring rhythmicity of epigastric pain pain meal relief duodenal ulcer meal pain relief gastric ulcer
★The contents of inquiry
1 general data ﹡2 chief complaints ﹡3 present illness
Precipitating factors (4) Progression of the illness (5) Accompanied symptoms (6) Previous treatment (7) General condition
(1)Onset and Duration
sudden: acute myocardial infarction acute pancreatitis
Heart disease: palpitation short of breath
诊断学-诊断学
疾病诊断过程一般有三个环节： 1、调查研究、收集完整和确实的诊断资 料 2、结合和分析资料，建立初步诊断 3、有需要时作其他有关检查、动态临床 观察、最后验证和修正诊断
绪论
• 临床诊断的要求
病因诊断 病理解剖诊断 病理生理学诊断或功能诊断
临床诊断的方法 （运用归纳法与排除法——直接诊断、
目的---收集有关健康的正确资料 定义
绪论
体格检查
（ physical examination）
是医生运用自己的 感官或借助于传统 的检查器具来了解 机体健康状况的一 组最基本检查方法
通过体格检查结合 临床表现和实验室 检查的结果，可对 大多数疾病作出临 床诊断
绪论
实验室检查
（ Labratory examination）
注意点 定义
是通过物理、化学和生物学 等实验室方法对患者的血液、 体液、分泌物、排泄物、细 胞取样和组织标本等进行检 查，从而获得病原学、病理 形态学或器官功能状态等资 料，结合病史、临床症状和 体征进行全面分析的诊断方 法
实验室检查结果 应结合临床考虑
绪论
辅助检查
（ assistant examination）
如心电图、肺功能和各种内镜检查， 以及临床上常用的各种诊断操作技术 等；这些辅助检查在临床上诊断疾病 时；亦常发挥重要的作用
绪论
近 10年诊断技术显著进步
• 计算机体层扫描 CT 磁共振成像装置 MRI 单光子断层照相机 SPECT 正电子断层照相 PET 聚合酶链反应仪 PCR
绪论
诊断学的学习要领
许多疾病经过详细 的病史来集，配合 系统的体格检查， 即可提出初步诊断