天津医科大学临床医学概论重点总结

Arthritisresultingindegenerationofthebonesandjoints,especiallythosebearingweightandresultsinbonerubbingagainstbone.Symptoms:painafterrepetitiveuse;morningstiffness<15minsSigns:tenderness,bonecrepitus,swellingHand:nodeandnodeFoot:HalluxValgusDiagnosis:arthrocentesis;arthroscopy;jointreplacementNSAIDs:aspirin;ibuprofen;nabumetone;naproxenRheumatoidarthritis:isan autoimmunedisorder,mayalsoaffecttheskin,eyes,lungs,heart,bloodornerves,andachronicdisorder.Riskfactors:40-50yearsold;women>menMorningstiffness>1hour;Jointpainisoftenfeltonbothsidesofthebody;Thefingers(butnotthefingertips),wrists,elbows,shoulders,hips,knees,ankles,toes,jaw,andneckmaybeaffected.Symptoms:Chestpainwhentakingabreath(pleurisy)Eyeburning,itching,anddischargeNodulesundertheskin(usuallyasignofmoreseveredisease)Numbness,tingling,orburninginthehandsandfeetJointdestructionmayoccurwithin1-2yearsafterthediseaseappearsRheumatoidnodules:necrotizinggranuloma坏死性肉芽肿Sjogren'ssyndrome;pleuritis;pericarditis;anemia;syndrome:1)rheumatoidarthritis;2)anenlargedspleen(splenomegaly);3)anabnormallylowwhitebloodcount.ACR1987criteria:Diagnosis:1)erythrocytesedimentationrate;2)C-reactiveprotein;3)rheumatoidfactorMedicine:methotrexateGoutisacommonpainfulformofarthritis.Itcausesswollenredhotandstiffjoints.Goutoccurswhenuricacidbuildsupinyourblood.Causes:hyperuricemia:highlevelsofuricacidSymptoms:podagra;tophus(tophi复数):arechalkydepositsofuricacidthatcommonlyoccurintheelbowsandearlobes.Medicine:见5,butcanusecorticosteroidsand特有药)Spinaldischerniationtypes:pulposusdiscdegeneration:chemicalchangesassociatedwithagingcausesdiscstoweaken,butwithoutaherniationpulposusanulusfibrosusprolapse:theposteriorlongitudinalligamentremainsintactbutthenucleusimpingesontheanulusfibrosusextrusion:thenuclearmaterialemergesthroughtheannularfibersbuttheposteriorlongitudinalligamentremainsintact.sequestration:thenuclearmaterialemergesthroughtheannularfibersandtheposteriorlongitudinalligamentisdisrupted.Aportionofthenucleuspulposushasprotrudedintotheepiduralspace.Treatment:ESI:epiduralsteroidinjection;laminotomyanddiscectomyOsteoporosis:Decreaseinbonemassthatresultsinathinningandweakeningofthebonewithresultingfractures.Thebonebecomesmoreporous,especiallyinthespineandpelvis.特征：Dowager’shump30%以上才能在X补钙药物：alendronateFracture: Closed/simple Incomplete(Linear,Greenstick)Open/compoundor Complete(Transverse,Oblique,Spiral,ComminutedImpacted,Compression,Depressed,Epiphyseal)Ovary:Producefemalehormones---estrogenandprogesterone.Estrogenresponsibleforappearanceoffemalesexualcharacteristicsandmenstrualcycle.Progesteronemaintainsuterineenvironmentforpregnancy.Fetalappurtenances:Placenta;Fetalmembranes;Umbilicalcord;Amniotic25.Functionsofplacenta:AirexchangeSupplyofnutritionRemovethewastefromthefetusDefensefunctionsyntheticalfunction:HCG:humanchorionicHPL:humanplacentallactogenHCT:humanchorionicthyrotropinEstrogenProgestogenUmbilicalcord: -70cm,average50-6027.Amnioticfluid:amount:300-1000-l.5cmPolyhydramnios:>2000mlOligohydramnios:<300mlItsfunction: :cordentanglementThedevelopingbabytomoveinthewomb,whichallowsforproperbonegrowth三个阶段2.Tirtetel-rly.etltisrlrotbaby,protectingfromheatloss.rttinijariycushioningsuddenblowsormovementsDiagnosis.:iirutifetifectionSymptoms: 1.AmenorrheamorningsicknessfrequencyofurinationPE/signs: Breastchanges8weeks:BreastturnsbiggerTendernessSorenipplesMontgomerytuberclesDarkenedareolaReproductiveorganchanges:HyperemiaofcervixandvaginalwallCervixturnssoft---HegarsignAuxiliaryexaminations:B-ultrasound:5weeks:gestationalringUltrasonicDopplerPregnancytestProgesteronetestCervicalmucusexaminationBasalbodytemperatureAnectopicpregnancy(EP)isaconditioninwhichafertilizedeggsettlesandgrowsinanylocationotherthantheinnerliningoftheuterus.TubalyIsthmusInfundibularOvarianCervicalBroadligamentAbdominal给药：methotrexate34.Diagnosis:PregnancyTransvaginalultrasoundCuldocentesisLaparoscopy:indications:PatientswithunrupturedtubalpregnancyEarlystageofabortionAcuteabdomenwithunknownreasons35.Treatment:surgery:laparotomy:salpingectomyorconservativesurgeryLaparoscopy子宫肌瘤治疗：hysterectomyormyomectomyornew:UAE:uterinearteryMedication:mifepristoneAbortioistheterminatifpregnancybytheremovalorexpulsiofromtheuteruofafetusorembryopriortoviability.Pregnancyterminationhappenswhenthepregnancyislesstha28weeksandtheweightof28weeksTypes:spontaneousandinduced

than1000g.Earlyabortion<12weeks;lateabortion>自然流产分类：threatened:pregnancyInevitableabortion:completeincompleteThreatenedpregnancy:Awhichvaginalbleedingislessthanininevitableabortionandthecervixisnotdilated,andabortionmayormaynotoccur.Amissedwhentheembryoordied,butanotyetoccurred.Habitualabortion:Themiscarriageof3ormoreconsecutivepregnanciesSeptic:Anabortionassociatedwithauterineinfection.Theinfectioncanoccurduringbeforeorafteranabortion.Induced(before10weeks)D&C:dilationandcurettageD&E:dilationandevacuation(inthesecondtrimesterofpregnancy,12weeks)Placentaprevia:occurswhenababy'splacentapartiallyortotallycoversthemother's—thedoorwaybetweentheuterusandthevagina.Placentapreviacancauseseverebleedingbeforeorduringdelivery.Types:completePartialMarginalLow-lyingInfluence:postpartumhemorrhageplacentaaccretaPuerperalinfectionamnioticfluidembolismPrematuredeliveryandhighmortalityofperinatalinfantPlacentalabruptionistheseparationoftheplacentafromtheuterinelining.Thisconditionusuallyoccursinthethirdtrimesterbutcanoccuranytimeafterthe20thweekofpregnancy.Types:revealedabruptionConcealedMixedEDC=(LMP(lastmenperious)-3month/+9month)+7daysPrematuredelivery:28-37weeksgestationalTermdelivery:37-42Posttermdelivery:after42weeks10cmMechanismoflabor:EngagementDescentFlexionInternalrotationExtentionRestitutionandexternalrotationThreatenedlabor:FalselaborLighteningBloodyshowTotalstageoflabor:The1ststage—fromonsetoflabortofulldilationofthecervix(about10cm);nullipara:11-12hours;multipara:6-8hoursThesecondstageisthetimefromfullcervicaldilationtodeliveryofthefetus.nullipara:1-2hour; multipara:afewminutes-1hourThe3rdstageoflaborbeginsafterdeliveryoftheinfantandendswithdeliveryoftheplacenta.5-15minutes(shouldn’tbeover30minutes)Episiotomy:会阴切开术Acuteappendicitisisarapidlyprogressinginflammationofasmallpartofthelargeintestinecalledtheappendix.McBurney'spointisthenamegiventothepointovertherightsideoftheabdomenthatisone-thirdofthedistancefromtheanteriorsuperioriliacspinetothenavel.Thispointroughlycorrespondstothemostcommonlocationofthebaseoftheappendixwhereitisattachedtothececum.Types:AcutesimpleappendicitisAcutepurulentappendicitisGangrenousappendicitisPerforationgappendicitisPeriappendicealabscessSymptoms:Painfirst,vomitingnextandfeverlast;abdominalpain,tenesmus=downwardurge;gastrointestinalsymptoms:1.lossofappetitenauseavomitingconstipationordiarrheainabilitytopassgasGeneralsymptomsfatiguelow-gradefeverandchillsSigns:TendernessinpointBlumberysign:reboundtenderness(peritonealirritationsign)MassintherightlowerquandrantOtherconfirmatoryperitonealsigns:Psoassign 腰大肌试验Obturatorsign 闭孔内肌试验Rovsing’ssign 结肠充气试验Differentialdiagnosis:GastriculcerperforationRightUreteralcalculiDiseasesofobstetricsandgynecology:EctopicpregnancyruptureOvarianFollicleruptureCorpusluteumcystruputureAcutesalpingitis/AcutePelvitisCalot’striangleboundedbyinferiorborderofthelivercysticductcommonhepaticduct.SphincterofOddi肝胰壶腹括约肌Symptoms：SymptomsofgastrointestinalbiliarycolicMirizzisyndrome：isararecauseofacquiredjaundice.Itisassociatedwithlargegallstonesthatcompressthecommonhepaticduct.Gallbladdereffusion:whitebile诊断胆囊结石最准确的PE：Type-BUltrasound,准确率Treatment:Laparoscopiccholecystectomy临床医学概论UrinarySystem肾病综合征（NephroticSyndrome)Definition:NephroticSyndromeresultsfromincreasedpermeabilityofGBMtoplasmaprotein.Itischaracterizedbyexcessiveproteinuria,hypoproteinuria,hyperlipidemiaandedema.1)Proteinuria(>3.5g/day)2)Hypoalbuminemia(<30g/L)3)Edema4)HyperlipidermiaSymptom:Edema:Generalizededema;especiallyperiorbitalarea;Forthyurine肾衰（RenalFailure）Definition:Itisapathologicalprocessinwhichthefunctionsofkidneyareseverelydamagedbilaterallyandthusleadto1）Accumulationofmetabolicproductsandpoisons2)Disordersofwater,electrolytesandacid-baseimbalance3)ImpairedrenalendocrinefunctionClassification:（急性肾衰的分类）prerenalARF:FunctionalARF(AcuteRenal肾功能损伤，肾脏没有损伤interrenalARFpostrenalARF早期功能性肾衰，对肾没有实质损害，晚期肾严重损伤Symptom:TheOliguria急性肾衰少尿期的症状oliguria水高：水中毒waterintoxicationK+高：高钾血症hyperkalemiaH+高：代谢性酸中毒metabolicacidosisN高：氮质血症Azotemia慢性肾衰的分期慢性肾衰的分期：慢性肾衰的分期：代偿期 compensatory肾功能不全期renalinsufficiency肾功能衰竭期renalfailure尿毒症期 uremia肾小球滤过率>30%25%~30%20%~25%<20%EndocrineSystem生长素（GrowthInfancy:dwarfism(侏儒症）giantism(巨人症）Adult:acromegaly(肢端肥大症）甲状腺素（ThyroidHormone)—cretinism（呆小症）糖尿病（MetabolicDisorders)Definition:MetabolicDisorderisoneofmultipleetiology(causes)characterizedbyhyperglycemiawithcarbohydrates,fatandproteinmetabolicalterationsthatresultindefectsinthesecretionofinsulinforitsactionorboth.Classification:糖尿病的四个分型Type1:NoproductionofinsulinType2:DeficientproductionorimproperutilizationofinsulinOtherSpecifictypesofdiabetes:MODY(maturityonsetdiabetesinyoung)型糖尿病GestationalDiabetesMelltius妊♘期糖尿病Definition:GestationalDiabetesMelltius(GDM）isaconditioninwhichwomenwithoutpreviouslydiagnoseddiabetesexhibithighbloodglucoselevelsduringpregnancy(especiallyduringthirdtrimester)Comparison:比较Type1Type2Type1 Type2Mechanism NoproductionofinsulinAge Initiates in

Deficientproductionorimproperutilizationofinsulinor Generallyinitiatesafter3pyearsofageTherapySymptomKetosisPancreasPathology

adolescenceInsulininjectionPolydipsia,polyphagia;polyuria,weightlossEasilyhappen10%B-cellleft

Oralmedicine+insulinNotobviousNoteasilyhappen>30%B-cellleft胰岛素抵抗（InsulinResistance）Definition:InsulinResistanceisaconditioninwhichthecellsofthebodybecomeresistanttotheeffectsofinsulin,thatis,thenormalresponsetoagivenamountofinsulinisreduced.Asaresult,higherlevelsofinsulinareneededinorderforinsulintohaveitseffects.Symptom:糖尿病的症状（三多一少）多渴：Polydipsia(verythirsty)多食：Polyphagia(veryhungry)多尿：Polyuria(urinatingfrequently)体重减轻：WeightlossComplication:糖尿病的并发症Acute:1、diabeticketoacidosis（DKA）糖尿病酮症酸中毒hyperosmolarnon-ketonicdiabeticcoma高渗性非酮症糖尿病昏迷InfectionsChronic:1、macroangiopathy大血管病变（myocardialinfraction心肌梗死；atherosclerosis脉粥样硬化；coronaryheartdisease冠心病）2、microangiopathy微血管病变（diabeticnephropathy糖尿病肾病；diabeticretinopathy糖尿病性视网膜病变）3、neuropathy神经病变4othereyedisease(maculopathyerror屈光改变）5、diabetesfoot糖尿病足Definition：DiabetesFootisafootthatexhibitsanypathologythatresultsdirectlyfromdiabetesmelltiusoranychroniccomplicationofdiabetesmellitusRiskFactors:糖尿病的诱发因素缺乏运动，过度兴奋，压力过大，抽烟，喝酒，超重etcGlucos