天津醫(yī)科大學(xué)臨床醫(yī)學(xué)概論重點(diǎn)總結(jié)

1、1. arthritis resulting in degeneration of the bones and joints, especially those bearing weight and results in bone rubbing against bone.2. symptoms: pain after repetitive use; morning stiffness < 15 mins3. signs: tenderness, bone crepitus5swelling jointhand: heberden，s node and bouchard nodefoot

2、: hallux valgus4. diagnosis: arthroccntcsis; arthroscopy; joint replacement5. nsaids: aspirin; ibuprofen; nabumetone; naproxen6. rheumatoid arthritis: is an auto immune disorder, may also affect the skin, eyes,lungs, heart, blood or nerves, and ifs a chronic disorde匚7. risk factors: 40-50 years old;

3、 women > men8. morning stiffness > 1 hour; joint pain is often felt on both sides of the body; the fingers (but not the fingertips), wrists, elbows, shoulders, hips, knees, ankles, toes, jaw, and neck may be affected 9. symptoms: chest pain when taking a breath (pleurisy)eye burning, itching,

4、and dischargenodules under the skin (usually a sign of more severe disease)numbness, tingling, or burning in the hands and feetjoint destruction may occur within 1 2 years after the disease appears10. rheumatoid nodules: necrotizing granuloma 壞死性肉芽腫11 sjogren's syndrome; plcuritis; pericarditis;

5、 anemia; felty's syndrome: 1) rheumatoid arthritis;2) an enlarged spleen (splenomegaly);3) an abnomially low white blood count.12. acr 1987 criteria：九 morning stiffness (at least lh)2. arthritis of three or morejoint areas3. arthritis of handjoints (>1 swollen joints)4. symmetrical arthritis5

6、. rheumatoid nodules6. serum rheumatoid factor7. radiographic changes (erosions)13. diagnosis: 1) erythrocyte sedimentation ratc;2) c-rcactivc protein; 3) rheumatoid factor14. medicine: methotrexate15. gout is a common painful form of arthritis. it causes swollen red hot and stiff joints. gout occur

7、s when uric acid builds up in your blood16. causes: hyperuricemia: high levels of uric acid17. symptoms: podagra; tophus (tophi 復(fù)數(shù))：are chalky deposits of uric acid that commonly occur in the elbows and earlobes1& medicine:見5, but can use corticosteroids and colchicine(特有藥)19. spinal disc hernia

8、tion types:1) disc degeneration: chemical changes associated with aging causes discs to weaken, but without a herniation2) prolapse: the posterior longitudinal ligament remains intact but the nucleus pulposus impinges on the anulus fibrosus3) extrusion: the nuclear material emerges through the annul

9、ar fibers but the posterior longitudinal ligament remains intact.4) sequestration: the nuclear material emerges through the annular fibers and the posterior longitudinal ligament is disrupted a portion of the nucleus pulposus has protruded into the epidural space20. treatment: esi: epidural steroid

10、injection; laminotomy and discectomy21 osteoporosis: decrease in bone mass that results in a thinning and weakening of the bone with resulting fractures the bone becomes more porous, especially in the spine and pelvis. 特征：dowager's hump骨質(zhì)減少30%以上才能在x片中看出。補(bǔ)鈣藥物：alendronate22. fracture: r* closed /

11、simple 廠 incomplete ( linear ,greenstick ) open/ compound orcomplete (transverse，obliquespiral,comminutedimpacted , compression ,depressed ,epiphyseal)23.ovary: produce female hormonesestrogen and progesterone.estrogen responsible for appearance of female sexual characteristics and menstrual cycle p

12、rogesterone maintains uterine environment for pregnancy24. fetal appurtenances:placenta; fetal membranes; umbilical cord; amniotic fluid25. functions of placenta: air exchangesupply of nutritionremove the waste from the fetusdefense functionsynthetical function:hcg: human chorionic gonadotropinhpl:

13、human placental lactogenhct: human chorionic thyrotropin estrogenprogestogen26. umbilical cord:length 30-70 cm, average 50-60 cmdiameter: 1.0-2.5 cmat least 32 cm for normal delivery short cord: <30 cmlong cord:> 70cm: cord entanglement27.amniotic fluid: amount:3()0-1000mlpolyhydramnios: >

14、2000mloligohydramnios: < 300mlits function: protect the fetus1 the developing baby to move in the womb, which allows for proper bone growth2. the lungs to develop properly3. keep a relatively constant temperature around the baby, protecting from heat loss4. protect the baby from outside injury by

15、 cushioning sudden blows or movements5. body fluid equilibrium of the fetusprotect the mother1. reduce the discomfort caused by fetal movement2. amniotic sac dilate cervix and vagina3. rinse off the vagina reducing infection27.三個(gè)階段:first trimester: 1-12 weekssecond trimester: 13-27third trimester: 2

16、8-birth2& diagnosis of pregnancy:symptoms: 1 amenorrhea2 morning sickness3. frequency of urinationpe/signs: breast changes 8 wccks:brcast turns bigger tendernesssore nipples montgomery tubercles darkened areolareproductive organ changes: hyperemia of cervix and vaginal wall cervix turns soft一heg

17、ar sign29. auxiliary examinations: b-ultrasound: 5 weeks: gestational ringultrasonic dopplerpregnancy testprogesterone testcervical mucus examinationbasal body temperature31 an ectopic pregnancy （ep） is a condition in which a fertilized egg settles and grows in any location other than the inner lini

18、ng of the uterus.32. tubal pregnancy （最常見）：interstitialisthmusampullar（最常見）infundibularovariancervicalbroad ligamentabdominal33. 給藥：methotrexate34. diagnosis: pregnancy testtransvaginal ultrasoundculdocentesislaparoscopy: indications: patients with unruptured tubal pregnancyearly stage of abortionac

19、ute abdomen with unknown reasons35. treatment: surgery: laparotomy: salpingectomy or conservative surgeiylaparoscopy36. 子宮肌瘤治療:hysterectomy or myomectomy or new: uae: uterine artery embolizationmedication: mifepristone37. abortion is the termination of pregnancy by the removal or expulsion from the

20、uterus of a fetus or embryo prior to viability. pregnancy termination happens when the pregnancy is less than 28 weeks and the weight of fetus is less than looog early abortion < 12 weeks; late abortion > 28 weeks38. types: spontaneous and induced39自然流產(chǎn)分類：threatened: pregnancyinevitable aborti

21、on: completeincomplete40. threatened pregnancy: a condition in which vaginal bleeding is less than in inevitable abortion and the cervix is not dilated, and abortion may or may not occur.41. a missed abortion is when the embryo or fetus has died, but a miscarriage has not yet occurred.42. habitual a

22、bortion: the miscarriage of 3 or more consecutive pregnancies43. septic: an abortion associated with a uterine infection. the infection can occur during or just before or after an abortion.44. induced (before 10 weeks)d&c: dilation and curettaged&e: dilation and evacuation (in the second tri

23、mester of pregnancy, 12 weeks)45. placenta previa: occurs when a baby's placenta partially or totally covers the mother's cervix the doorway between the uterus and the vagina placenta previa can cause severe bleeding before or during delivery.46. types: completepartialmarginallow-lying47. in

24、fluence: postpartum hemorrhageplacenta accrctapuerperal infectionamniotic fluid embolismpremature deliveiy and high mortality of perinatal infant48. placental abruption is the separation of the placenta from the uterine lining this condition usually occurs in the third trimester but can occur any ti

25、me after the 20th week of pregnancy49. types: revealed abruptionconcealedmixed50. edc = (lmp(last men pcrious)-3month/+9month) + 7 days51. premature delivery: 28-37 weeks gestational ageterm delivery: 37- 42postterm delivery: after 42 weeks52. 宮擴(kuò)張10cm53. mechanism of labor: engagementdescentflexioni

26、nternal rotationextentionrestitution and external rotation54. threatened labor: false laborlighteningbloody show55. total stage of labor:the 1st stage一from onset of labor to full dilation of the cervix (about 10 cm);nullipara:! 1-12 hours; multipara: 6-8 hoursthe second stage is the time from full c

27、ervical dilation to delivery of the fetus.nullipara: 1-2 hour; multipara: a few minutes- 1 hourthe 3rd stage of labor begins after delivery of the infant and ends with delivery of the placenta.5-15 minutes (shouldn't be over 30 minutes)56. episiotomy:會(huì)陰功開術(shù)57. acute appendicitis is a rapidly prog

28、ressing inflammation of a small part of the large intestine called the appendix5& mcbumey point is the name given to the point over the right side of the abdomen that is one-third of the distance from the anterior superior iliac spine to the navel. this point roughly con-esponds to the most comm

29、on location of the base of the appendix where it is attached to the cecum.59. types: acute simple appendicitisacute purulent appendicitisgangrenous appendicitis perforationg appendicitis periappendiceal abscess60. symptoms: pain first, vomiting next and fever last; abdominal pain,tenesmus = downward

30、 urge; gastrointestinal symptoms: 11 oss of appetite2. nausea3. vomiting4. constipation or diarrhea5 inability to pass gasgeneral symptoms1 fatigue2. low-grade fever 38°c and chills61. signs: tenderness in mcburneys pointblumbcry sign: rebound tcndcrncss(pcritoncal irritation sign)mass in the r

31、ight lower quandrantother confirmatory peritoneal signs: psoas sign月要大肌試驗(yàn)obturator sign閉孔內(nèi)肌試驗(yàn)rovsing's sign結(jié)腸充氣試驗(yàn)62. differential diagnosis: gastric ulcer perforationright ureteral calculidiseases of obstetrics and gynecology: ectopic pregnancy rupture ovarian follicle rupture corpus lutcum cyst

32、 ruputurc acute salpingitis /acute pelvitis63. calofs triangle： a triangle bounded by inferior border of the liver cystic duct common hepatic duct.64. sphincter of oddi肝胰壺腹括約肌65. symptoms： symptoms of gastrointestinal tractbiliary colicmirizzi syndrome： is a rare cause of acquired jaundice.lt is ass

33、ociated with large gallstones that compress the common hepatic duct.gallbladder effusion: white bile66. 診斷膽曩結(jié)石最準(zhǔn)確的pe是：type-b ultrasound, 96%準(zhǔn)確率67. treatment: laparoscopic cholecystectomy 臨床醫(yī)學(xué)概論urinary system腎病綜合征(nephrotic syndrome)definition:nephrotic syndrome results from increased permeability of

34、 gbm to plasma protein. it is characterized by excessive proteinuria,hypo proteinuria,hyperlipidemia and edema1 )proteinuria(>3.5g/day)2) hypoalbuminemia(<30g/l)3) edcma4) hyperlipidermiasymptom:edema:generalized edema; especially periorbital area ; forthy urine腎衰(renal failure)dcfinition:it i

35、s a pathological process in which the functions of kidney arc severely damaged bilaterally and thus lead to 1 ) accumulation of metabolic products and poisons 2)disorders of water,electrolytes and acid-base imbalance 3)lmpaired renal endocrine functionclassification:(急性腎衰的分類)1 )prcrcnal arf:function

36、al arf(acutc renal failure)腎功能損傷，腎臟沒冇損傷2) interrenal arf3) postrenal arf早期功能性腎衰，對(duì)腎沒有實(shí)質(zhì)損害，晚期腎嚴(yán)重?fù)p傷symptom:the oliguria stage(急性腎衰少尿期的癥狀) 四高一低：1、低：少尿oliguria 水高: 水中毒 water intoxicationk+髙：高鉀血癥hyperkalemiah+高:代謝性酸中毒metabolic acidosisn高：氮質(zhì)血癥azotemia慢性腎衰的分期慢性腎衰的分期：腎小球?yàn)V過率代償期compensatory stage>30%腎功能不全期r

37、enal insufficiency25% 30%腎功能衰竭期renal failure20%-25 %尿毒癥期uremia<20%endocrine system牛長索(growth hormone)infancy :dwarfism(侏儒癥)giantism(巨人癥)adult:acromegaly(肢端肥大癥)甲狀腺素(thyroid hormone)cretinism (呆小癥)糖尿病(metabolic disorders)definition:metabolic disorder is one of multiple etiology (causes) characteriz

38、ed by hyperglycemia with carbohydrates, fat and protein metabolic alterations that result in defects in the secretion of insulin for its action or bothclassification:尿病的四個(gè)分型typekno production of insulintype2:deficient production or improper utilization of insulinother specific types of diabetes:mody

39、(maturity onset diabetes in young)青年人中的成年發(fā)病 型糖尿病gestational diabetes melltius 妊娠期糖尿病definition:gestational diabetes melltius (gdm) is a condition in which women without previously diagnosed diabetes exhibit high blood glucose levels during pregnancy (especially during third trimester)comparison:比較 t

40、ypel 和 type 2typeltype2mechanismno production of insulindeficient production or improper utilization of insulinageinitiatesinchildhoodoradolescencegenerally initiates after 3p years of agetherapyinsulin injectionoral medicine+insulinsymptompolydipsia,polyphagia;polyuria,wei ght lossnot obviousketosi

41、seasily happennot easily happenpancreaspathology10% b-cell left>30% b-cell left胰島素抵抗(insulin resistance)dcfinition:insulin resistance is a condition in which the cells of the body become resistant to the effects of insulin, that is ,the normal response to a given amount of insulin is reduced.as a

42、 result, higher levels of insulin are needed in order for insulin to have its effects.symptom:糖尿病的癥狀三高一低：(三多一少)多渴:polydipsia (very thirsty)多食:polyphagia(very hungry)多床：polyuria(urinating frequently)體重減輕：weight losscomplication:糖尿病的并發(fā)癥acute: 1 > diabetic keto acidosis (dka)糖尿病酮癥酸中毒 hyperosmolar no

43、n-ketonic diabetic coma 高滲性非酮癥糖尿病昏迷 infectionschronic: 1 > macroangiopathy 大血管病變(myocardial infraction 心肌梗死;atherosclerosis 動(dòng) 脈粥樣硬化；coronary heart disease冠心病)2 microangiopathy 微血管病變(diabetic nephropathy 糖尿病腎病;diabetic retinopathy 糖 尿病性視網(wǎng)膜病變)3、neuropathy神經(jīng)病變4、other eye disease (maculopathy 黃斑??；cataract 白內(nèi) 障；glaucoma 青光眼；refractive error 屈光改變)5、diabetes foot 糖尿病足definition： diabetes foot is a foot that exhibits any pathology that results directly from diabetes melltius or any