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General
examination原南京中大附属医院神内科主任、硕士生导师佛山大学医学院医学系孟红旗教授、主任医师Professor、Doctor
director、NeurologistGeneral
examinationGeneral
examination
is
actually
the
first
step
ofexaminationInspection
is
the
major
method
during
generalexamination,
combining
with
palpation,
auscultatsmellingThe
examiner
should
observe
the
following
aspectsthe
patients:general
appearancebody
habitus(体型)posture(姿势)state
of
nutritionsymmetry(对称性)speechGeneral
appearanceSexAgeVital
sign(生命征)Development/habitus(发育/体型)Nutritional
status(营养状态)Consciousness(意识状况)Speech(tone/voice)(语调/语态)Facial
feature/expression(面容/表情)Position/posture(体位/姿势)Gait(步态)SexIn
female:estrogen
and
male
hormoneIn
male: male
hormoneSex
is
involved
in
some
specific
diseasefemale:
SLE
thyroid chlorosis
(萎黄病male: haemophilia
(血友病)SexImpacts
of
diseases
on
sex
charactersFemale
patients
will
be
masculinized
in
long
term
use
of
corticosteriod(皮质类固醇)
or
adrenocortical
tumor(皮质肿瘤)Male
cirrhotic
patient
will
develop
gynecomastia(男性育)
mainly
because
male
hormone
secretion
was
suppresseThe
impacts
of
normal
sex
chromosome
on
the
sex
and
sexcharacters: biasexual
abnormalityklinefelter
syndrome turner
syndromeAgeAge
is
tightly
related
to
some
diseasesmeasles(麻疹)Infant
and
children:rickets(佝偻病)diphtheria(白喉)Children
and
adolescence:tuberculoses(结核),
rheumatopyra(风湿热)Elder:
carcinoma
and
sclerosisVital
signVital
signs
are
physical
signs
that
indicate
an
inis
alivebody
temperatureblood
pressurebreath
rate
pulseheart
rateThese
signs
can
be
measured/monitored
to
assess
lephysical
functioning
of
an
individualNormal
ranges
of
measurements
of
vital
signs
maychange
with
age,
sex,
weight,
exercise
tolerance
aconditionBody
temperatureOral(口腔)Rectal(肛门)Axillary(腋下)Body
temperatureOralPlace
the
thermometer
under
the
tongue
and
closethe
mouth
using
the
lips
hold
the
thermometer
tighThe
patient
must
breath
through
the
noseLeave
the
thermometer
in
the
mouth
for
5
minReliable
methodNot
suitable:
infantsunconsciousBody
temperatureRectalUsing
a
rectal
thermometerRecommended
for
infants/small
childrenLubricate
the
bulb
of
the
thermometer
with
apetroleum
jellyPlace
the
small
child
face
down
on
a
flat
surfaceSpread
the
buttocks
and
insert
the
bulb
end
of
ththermometer
about
one-half
to
1
inch
into
the
analAfter
5
min,
remove
the
thermometer
and
readBody
temperatureAxillaryIt
is
the
least
accurate
methodPlace
the
thermometer
in
the
armpit(腋窝),
with
the
arpressed
against
the
body
for
5
~10
min
before
readingRead
the
thermometer
by
gripping
the
end
opposite
the
bthat
the
numbers
are
facing
youRoll
the
thermometer
back
and
forth
between
your
fingeryou
see
a
silver
reflection
in
the
columnBody
temperatureNormal
valueOral
36.30C~37.20CRectal
36.50C~37.70CAxillary
360C~370CThe
normal
body
temperature
varies
from
person
toperson,
by
age,
and
throughout
dayBeing
lowest
in
the
early
hours
of
the
morning
andhighest
in
the
afternoonThe
variation
may
range
within
10CRectal
T
>Oral
T>
Axillary
T
(each
in
0.50C)Body
temperatureIt
should
be
recorded
on
temperature
recosheet
so
called
“
body
temperature
c(体温曲线)Fever
type
is
referred
to
those
febrile
(disease
possessing
certain
characters
oftemperature
curveVital
signsBreathThe
breath
rhythm
and
rates
should
berecordedPulseThe
rhythm
and
rates
should
be
recordedVital
signspulse60~100
/minchildhoodEmotionAgedNightVital
signsblood
pressureBlood
pressure
is
a
measurement
of
the
forapplied
against
the
walls
of
arteries
as
hpumps
blood
through
the
bodyBlood
pressure
readings
are
usually
givennumbers:
for
example,
110/70Vital
signsblood
pressureThe
first
number
is
the
systolic
(收缩的
blood
pressure
reading,and
it
representsmaximum
pressure
exerted
when
the
heartcontractsThe
second
number
is
the
diastolic(舒张的
blood
pressure
reading,and
it
representspressure
in
the
arteries
when
the
heart
isVital
signsblood
pressureBP
is
continually
changing
depending
on
tactivity,
temperature,
diet,
emotional
stposture,
physical
state
and
drugsIdeal
BPnormal<120/<80
mmHg<130/<85
mmHghypertension >140/90
mmHgVital
signsblood
pressureDevelopment
&
habitusDevelopment
status
is
evaluated
according
to
the
aintelligence(智力),body
weight
and
sexual
characIn
normal
adult,
they
are
almost
comparableDuring
adolescent
stage,
the
body
experienced
a
ragrowth
periodsIt
is
influenced
by
some
factorsendocrinology(内race(种族)
nutritioninheritance(遗传)
living
conditionphysical
exercisTypes
of
habitusslender,
weak
and
lightweaverage
height
and
muscleAsthenic
type:(无力型)Sthenic
type:(矮胖型)Ortho-sthenic
type:
normal
proportions
w(匀称型) normal
stature
(身材)Abnormal
habitusGigantism(巨人症)It
refers
to
the
excessive
liner
growth
that
occurs
wihormone
(GH)excess
when
epiphyseal(骺的)growth
plateopen
during
childhoodAcromegaly(肢端肥大症)It
indicates
the
disorder
of
GH
excess
in
adulthoodPituitary
dwarfism(垂体性侏儒症)It
may
be
due
to
dysfunction
of
the
pituitary
causingunderproduction
of
growth
hormonesmall
stature
normal
proportionsGigantismDevelopment
&
habitusCretinism(呆小症)It
is
characterized
by
arrested
physical
and
mental
devEunuchism(无睾症)Sex
hormone
control
the
formation/development
of
sexcharactersit
may
also
affect
the
body
development.
If
the
secretiohormone
was
severely
suppressed,
eunuchism
may
occurRachitis(佝偻病)Malnutrition
during
childhood
may
affect
the
developmeinstance,
vitamin
D
deficiency
may
lead
to
rachitisNutritional
statusOne
of
the
most
important
factors
impacting
anindividual’s
health
and
disease
because
it
affecevery
systemIt
can
be
evaluated
mainly
by
skin,
hair,
muscle
ansubcutaneous
fat
in
particularChronic
wasting(消瘦)associated
with
loss
ofsubcutaneous
fat
from
calorie
or
protein
deficienNutritional
statusChanges
in
hair
and
nails
are
also
common
inutritional
deficiencyBlindness
may
result
from
vitamin
A
deficiThe
tongue
may
be
large
in
iodine(碘)orniacin(烟酸)deficiencyNutritional
statusIn
general
the
abnormal
nutritional
status
candescribed
as
obesity(肥胖)
and
emaciation(消瘦)Parameters:body
weight(体重)Body
mass
index
(BMI)(体重指数)
Arm
circumference(上臂周径)
Skinfold
thickness(皮褶厚度)SkinfoldthicknessMalnutritionIt
is
the
condition
that
develops
when
thedoes
not
get
the
right
amount
of
the
vitaminminerals,
and
other
nutrients
it
needs
to
mhealthy
tissue
and
organ
functionIt
is
caused
by
inadequate
intake
or
inadeqdigestion
of
nutrientsMalnutritionMalnutrition
may
be
mild
enough
to
show
nosymptoms
or
so
severe
that
the
damage
it
hasdone
is
irreversible
even
though
the
indivimay
be
kept
alive
(/view4/M05/06/19/wKh2CVOvernutritionOvernutrition
results
from
eating
too
much
that
exthe
normal
consumption,
not
exercising
enough,
gefactors,
endocrinology,
life
habitsThe
nutritional
status
of
patient
based
on
heightweight
is
interpreted
by
the
body
mass
index
(BMI)(体重指数)BMI
is
an
international
digestion
of
relative
weigstatureBMI=weight
(kg)/height
(meter)2Overnutritionunderweighthealthy
weightoverweightobsessBMI<18.518.5~25.025.1~29.9>30WHO
classificationmale
>27
female>25
obesityConsciousnessIt
is
a
psychological
and
physiological
state
in
which
weof
our
sensations,
perceptions,
feelings,
thoughts
etcDisturbance
of
consciousnessmemory
deficitlanguage
disturbancedisorientationreduced
clarityDuring
interview,
the
examiner
has
already
gained
much
iinto
the
mental
status
of
the
patientThe
examiner
could
evaluate
the
thought,
response,
emotcalculation
ability
and
orientationFacial
feature
&
expressionThe
appearance
of
the
head
and
face,
their
contourand
texture(特征),often
provides
the
first
insigthe
nature
of
illness.Some
facial
appearances
are
pathognomonic(特定的
diseaseThe
appearance
of
the
patient’s
face
may
also
proinformation
regarding
psychological
makeup:
is
thperson
happy,
sad,
angry
or
anxiousSome
typical
facial
features
are
listed
in
textbooPositionIt
refers
to
patient’s
body
statusDivided
into:Active(自主)
Passive(被动)
Compulsive(强迫)PositionActive
positionThe
patient
can
move
his/her
body
freely,
withourestrictionIt
can
be
seen
in
normal
adult,
patients
with
milddiseases
or
at
earlier
stage
of
the
diseasesPassive
positionThe
patient
can’t
adjust
or
move
his/her
bodyIt
occurs
in
extremely
sick
or
patients
withunconsciousnessCompulsive
positionCompulsive
supine
position(仰卧位)The
patient
lie
down
on
the
beck,
with
two
legs
bending.Acute
peritonitisCompulsive
prostrate
position(俯卧位)in
order
to
relief
the
tenderness
of
back
muscles.Rachis
disease(脊柱病变)Compulsive
side
down
position(侧卧位)in
patients
with
one
sided
pleurisy
or
pleurorrhea(胸腔Compulsive
positionOrthopnea(端坐呼吸)An
abnormal
condition
in
which
a
person
must
keethe
head
elevated
(sit
or
stand)
to
breathe
deeplycomfortably
(orthopnea)
or
wakes
up
suddenly
in
thmiddle
of
the
night
short
of
breath
(paroxysmal
nodyspena)(阵发性夜间呼吸困难).
It
can
be
seen
inpatients
with
lung
or
heart
diseaseSquar
down
position(蹲位)It
has
been
seen
in
patients
with
congenital
heardiseaseCompulsive
positionCompulsive
rest
positionWhen
patient
suffers
an
angina
attack
it
willthem
to
rest.
The
heart
is
then
able
to
return
tonormal
working
levelToss
&
turn
position
(alternative
position辗转体位Opisthotonos
(角弓反张)It
is
an
abnormal
posturing
condition
characterizerigidity
and
severe
arching
of
the
back,
with
head
thrbackwardsPosture
&
gaitPosture:the
general
way
of
holding
the
bodyGait
:
a
way
or
manner
of
walkingGait
abnormalities
describe
unusual
and
uncontrollablwith
walkingGait
disturbances
may
occur
for
a
variety
of
reasonsGait
may
be
changed
by
local
pain
in
the
foot,
joint,
cla(跛行)
of
the
hip(臀)
or
leg,bone
disease
etcGaitWaddling
gait
(蹒跚步态)Characterized
by
a
distinctive
duck-like
walk
that
may
inchildhood
or
later
in
lifeScissor
gait(剪刀式步态)Characterized
by
legs
flexed
slightly
at
the
hips
and
kngiving
the
appearance
of
crouching(卷缩),with
the
knethighs(大腿)
hitting
or
crossing
in
a
scissors-like
moGaitSteppage
gait(跨阈步态)Characterized
by
foot
drop
where
the
foot
hangs
with
the
toespointing
down,
causing
the
toes
to
scrape
the
ground
whilewalkingPropulsive
(Festinating)gait(慌张步态)Characterized
by
stooped,
rigid
posture
with
head
and
neforwardDrunken
man
gait(醉酒步态)Characterized
by
unbalanced
trunk,
as
drunken
man
likewalkingGaitAtaxic
gait(共济失调步态)Characterized
by
an
abnormality
of
muscle
control
or
aninability
to
finely
coordinate
movements,
resulting
in
aand-fro”
unsteady
motionIntermittent
claudication(间隙性跛行)It
is
leg
pain
(most
often
in
the
calves)
that
does
not
cafter
walking
and
is
relieved
by
restIt
is
a
symptom
of
peripheral
artery
disease
(PAD)SkinThe
skin
is
the
largest
organ
of
the
bodyOne
of
the
best
indicators
of
general
healtThe
examination
of
the
skin
is
dependent
oninspection,
but
palpation
of
a
skin
lesionalso
be
performedSkin
colorSkin
coloration
is
determined
by
the
amount
of
pigin
the
skin
and
the
blood
flowing
through
itThe
distribution
of
capillary,
the
thickness
of
thsubcutaneous
fat
(皮下脂肪)may
also
affect
itThe
color
changes
includePallor
(苍白)Yellow
skin(黄染)Cyanosis(发绀)Redness(发红)Pigmentation(色素沉着)Discoloration(色素脱PallorPaleness
may
be
the
result
of
decreased
blood
suppthe
skin
(cold,
fainting,
shock,
hypoglycemia)
ordecreased
number
of
red
blood
cells
(anemia)Fingers
that
turn
paller
when
exposed
to
cold
or
stRaynaud’s
syndrome
may
cause
sudden
change
in
thefinger
colorIt
is
almost
apparent
on
the
face,
lining
of
the
eymouth
and
nailsCyanosisIt
is
a
bluish
discoloration
of
the
skin
and
mouth
membralack
of
oxygenBlood
that
is
saturated
with
oxygen
is
bright
redBlood
that
has
lost
its
oxygen
is
dark
bluish-redPerson
who
has
a
large
quantity
of
their
blood
which
is
deoxygen
tend
to
take
on
a
bluish
discoloration
calle“cyanosis”Cyanosis
is
more
obvious
in
the
mucous
membranes
and
nailparticularly
for
dark-skinned
peopleIt
may
also
appear
on
the
feet,
nose
and
earsCyanosisYellow
skinA
yellow
discoloring
the
skin,
mucousmembranes
and
eyes,
caused
by
too
muchbilirubin
in
the
bloodWith
the
exception
of
physiologic
jaundicenewborn,
all
other
jaundice
indicates
overdamage
to
the
liver
or
inability
to
move
bilfrom
the
liver
through
the
biliary
tract
toYellow
skinA
yellow
to
orange
color
may
be
imparted
to
the
skiexcessive
intake
of
beta
carotenePeople
who
consume
large
quantities
of
carrots
orjuice
or
take
beta
carotene
tablets
may
develop
adistinctly
yellow-orange
cast
to
their
skin.
The
cis
called
hypercarotenemia(高胡萝卜血症)Hypercarotenemia
is
easily
distinguished
from
jain
that
the
sclera(巩膜)
remain
white,
while
peowith
true
jaundice
have
a
yellow
scleraRednessIt
is
due
to
dilation
of
capillary,
accelerating
&increasing
blood
stream
and
increment
of
the
red
bcellsIn
physiological
condition,
it
may
be
seen
after
sdrinkingIn
pathological
condition,
it
may
be
caused
by
lunscarlet
fever,
drug
intoxicationPigmentationMelanin(黑色素)
is
a
pigment
produced
in
the
skicells
that
causes
skin
colorationThe
production
of
melanin
may
be
affected
by
heredheat,
trauma,
solar
or
ionizing
radiation,
heavy
mand
other
factorsChanges
in
any
of
these
factors
can
result
inhyperpigmentation,
hypopigmentation
or
bothThe
changes
may
be
temporary
or
permanentIt
can
be
either
primary
or
secondary
to
other
diseDiscolorationVitiligo(白癜风)It
is
a
skin
condition
in
which
there
is
loss
of
pigfrom
areas
of
skin
resulting
in
irregular
white
pawith
normal
skin
textureAssociated
with
pernicious
anemia,
hyperthyroidiAddison’s
diseaseDiscolorationLeukoplakia(白斑)A
precancerous
lesion
that
develops
on
the
tongueinside
of
the
cheek
as
a
response
to
chronic
irritaOccasionaly,
leukoplakia
pathches
develop
on
theexternal
genitaliaDiscolorationAlbinismus(白化病)It
refers
to
a
group
of
related
conditions.
Theseconditions
are
the
result
of
altered
genes
that
cadefect
of
melanin
productionThis
defect
results
in
the
partial
or
full
absencepigment
from
the
skin,
hair
and
eyesMoistureThe
moisture
of
skin
is
tightly
related
with
the
seof
sweat
glandDiaphoresis(大量出汗)
is
a
medical
term
for
prosweatingIt
can
be
normal
brought
on
by
physical
activity,emotional
response,
high
environment
temperaturesymptom
of
an
underlying
diseaseOveractive
thyroid
gland
hypoglycemiaCold
sweat: shock
or
dehydrated
patientsMoisturePeriodic
sweating
at
night
without
an
obvicause
may
be
caused
by
an
underlying
infector
malignancySweat
absent:
abnormal
lack
of
sweat
in
resto
heat.neurologic
disorderscongenital
disordersburnsskin
diseasesome
drugsdehydrationElasticitySkin
elasticity
(皮肤弹性)is
related
winutritional
status,subcutaenous
fat
and
tamount
of
liquid
in
the
interstitial
spaceRashesSkin
rashes
are
frequently
one
of
the
manifestatiosystemic
diseases,
and
hence,
they
are
important
fdiagnosis
of
some
special
diseasesThe
different
rashes
may
occur
in
infectious
diseadermentological
disease,
drug
or
other
allergic
mThe
rashes
have
some
special
regular
patterns
andTypes
of
rashesMacule(斑疹)Roseola(玫瑰疹)Papules(丘疹)Maculopapulae(斑丘疹)Urticaria(荨麻疹)MaculeA
macule
is
small,
flat,
distinct
colored
area
oDoes
not
include
a
change
in
skin
texture
or
thicRoselaRosela
is
a
skin
lesion
that
is
small,
solid,
andraised.
It
may
be
seen
in
measles,
drug
rashes,eczemaPapuleA
papule
is
defined
as
a
small
(5
millimeters
orless),
solid
lesion
slightly
elevated
above
thesurface
of
the
skin.MaculopapulaeIt
is
plate
lesion
with
redness
around
thepapulesIt
can
be
seen
in
scarlet
fever
and
drug-irashesUrticariaUrticaria
(hive)
are
raised
red
welts
of
variuossize
on
the
surface
of
the
skin,
often
itchy,
whicome
and
go.
It
is
associated
with
allergicreactionDesquamationIt
is
the
detachment
of
cells
from
the
surface
of
aepitheliumIn
physiologic
condition,
it’s
not
easy
to
noticedesquamationIn
pathologic
condition,
lots
of
desquamation
canSubcutaneous
hemorrhageBleeding
into
the
skin
&
subcutaneous
tissuesAccording
to
the
size
of
bleeding,
it
may
be
subdivas
follows:petechia(瘀点)
<2mmpurpura
(紫癜)3~5
mmecchymosis
(瘀斑)
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