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

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壞死性肉芽腫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復(fù)數(shù)):arechalkydepositsofuricacidthatcommonlyoccurintheelbowsandearlobes.Medicine:見5,butcanusecorticosteroidsand特有藥)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補(bǔ)鈣藥物：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三個階段2.Tirtetel-rly.etltisrlrotbaby,protectingfromheatloss.rttinijariycushioningsuddenblowsormovementsDiagnosis.:iirutifetifectionSymptoms: 1.AmenorrheamorningsicknessfrequencyofurinationPE/signs: Breastchanges8weeks:BreastturnsbiggerTendernessSorenipplesMontgomerytuberclesDarkenedareolaReproductiveorganchanges:HyperemiaofcervixandvaginalwallCervixturnssoft---HegarsignAuxiliaryexaminations:B-ultrasound:5weeks:gestationalringUltrasonicDopplerPregnancytestProgesteronetestCervicalmucusexaminationBasalbodytemperatureAnectopicpregnancy(EP)isaconditioninwhichafertilizedeggsettlesandgrowsinanylocationotherthantheinnerliningoftheuterus.TubalyIsthmusInfundibularOvarianCervicalBroadligamentAbdominal給藥：methotrexate34.Diagnosis:PregnancyTransvaginalultrasoundCuldocentesisLaparoscopy:indications:PatientswithunrupturedtubalpregnancyEarlystageofabortionAcuteabdomenwithunknownreasons35.Treatment:surgery:laparotomy:salpingectomyorconservativesurgeryLaparoscopy子宮肌瘤治療：hysterectomyormyomectomyornew:UAE:uterinearteryMedication:mifepristoneAbortioistheterminatifpregnancybytheremovalorexpulsiofromtheuteruofafetusorembryopriortoviability.Pregnancyterminationhappenswhenthepregnancyislesstha28weeksandtheweightof28weeksTypes:spontaneousandinduced

than1000g.Earlyabortion<12weeks;lateabortion>自然流產(chǎn)分類：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:會陰切開術(shù)Acuteappendicitisisarapidlyprogressinginflammationofasmallpartofthelargeintestinecalledtheappendix.McBurney'spointisthenamegiventothepointovertherightsideoftheabdomenthatisone-thirdofthedistancefromtheanteriorsuperioriliacspinetothenavel.Thispointroughlycorrespondstothemostcommonlocationofthebaseoftheappendixwhereitisattachedtothececum.Types:AcutesimpleappendicitisAcutepurulentappendicitisGangrenousappendicitisPerforationgappendicitisPeriappendicealabscessSymptoms:Painfirst,vomitingnextandfeverlast;abdominalpain,tenesmus=downwardurge;gastrointestinalsymptoms:1.lossofappetitenauseavomitingconstipationordiarrheainabilitytopassgasGeneralsymptomsfatiguelow-gradefeverandchillsSigns:TendernessinpointBlumberysign:reboundtenderness(peritonealirritationsign)MassintherightlowerquandrantOtherconfirmatoryperitonealsigns:Psoassign 腰大肌試驗Obturatorsign 閉孔內(nèi)肌試驗Rovsing’ssign 結(jié)腸充氣試驗Differentialdiagnosis:GastriculcerperforationRightUreteralcalculiDiseasesofobstetricsandgynecology:EctopicpregnancyruptureOvarianFollicleruptureCorpusluteumcystruputureAcutesalpingitis/AcutePelvitisCalot’striangleboundedbyinferiorborderofthelivercysticductcommonhepaticduct.SphincterofOddi肝胰壺腹括約肌Symptoms：SymptomsofgastrointestinalbiliarycolicMirizzisyndrome：isararecauseofacquiredjaundice.Itisassociatedwithlargegallstonesthatcompressthecommonhepaticduct.Gallbladdereffusion:whitebile診斷膽囊結(jié)石最準(zhǔn)確的PE：Type-BUltrasound,準(zhǔn)確率Treatment:Laparoscopiccholecystectomy臨床醫(yī)學(xué)概論UrinarySystem腎病綜合征（NephroticSyndrome)Definition:NephroticSyndromeresultsfromincreasedpermeabilityofGBMtoplasmaprotein.Itischaracterizedbyexcessiveproteinuria,hypoproteinuria,hyperlipidemiaandedema.1)Proteinuria(>3.5g/day)2)Hypoalbuminemia(<30g/L)3)Edema4)HyperlipidermiaSymptom:Edema:Generalizededema;especiallyperiorbitalarea;Forthyurine腎衰（RenalFailure）Definition:Itisapathologicalprocessinwhichthefunctionsofkidneyareseverelydamagedbilaterallyandthusleadto1）Accumulationofmetabolicproductsandpoisons2)Disordersofwater,electrolytesandacid-baseimbalance3)ImpairedrenalendocrinefunctionClassification:（急性腎衰的分類）prerenalARF:FunctionalARF(AcuteRenal腎功能損傷，腎臟沒有損傷interrenalARFpostrenalARF早期功能性腎衰，對腎沒有實質(zhì)損害，晚期腎嚴(yán)重?fù)p傷Symptom:TheOliguria急性腎衰少尿期的癥狀oliguria水高：水中毒waterintoxicationK+高：高鉀血癥hyperkalemiaH+高：代謝性酸中毒metabolicacidosisN高：氮質(zhì)血癥Azotemia慢性腎衰的分期慢性腎衰的分期：慢性腎衰的分期：代償期 compensatory腎功能不全期renalinsufficiency腎功能衰竭期renalfailure尿毒癥期 uremia腎小球濾過率>30%25%~30%20%~25%<20%EndocrineSystem生長素（GrowthInfancy:dwarfism(侏儒癥）giantism(巨人癥）Adult:acromegaly(肢端肥大癥）甲狀腺素（ThyroidHormone)—cretinism（呆小癥）糖尿?。∕etabolicDisorders)Definition:MetabolicDisorderisoneofmultipleetiology(causes)characterizedbyhyperglycemiawithcarbohydrates,fatandproteinmetabolicalterationsthatresultindefectsinthesecretionofinsulinforitsactionorboth.Classification:糖尿病的四個分型Type1:NoproductionofinsulinType2:DeficientproductionorimproperutilizationofinsulinOtherSpecifictypesofdiabetes:MODY(maturityonsetdiabetesinyoung)型糖尿病GestationalDiabetesMelltius妊?期糖尿病Definition:GestationalDiabetesMelltius(GDM）isaconditioninwhichwomenwithoutpreviouslydiagnoseddiabetesexhibithighbloodglucoselevelsduringpregnancy(especiallyduringthirdtrimester)Comparison:比較Type1Type2Type1 Type2Mechanism NoproductionofinsulinAge Initiates in

Deficientproductionorimproperutilizationofinsulinor Generallyinitiatesafter3pyearsofageTherapySymptomKetosisPancreasPathology

adolescenceInsulininjectionPolydipsia,polyphagia;polyuria,weightlossEasilyhappen10%B-cellleft

Oralmedicine+insulinNotobviousNoteasilyhappen>30%B-cellleft胰島素抵抗（InsulinResistance）Definition:InsulinResistanceisaconditioninwhichthecellsofthebodybecomeresistanttotheeffectsofinsulin,thatis,thenormalresponsetoagivenamountofinsulinisreduced.Asaresult,higherlevelsofinsulinareneededinorderforinsulintohaveitseffects.Symptom:糖尿病的癥狀（三多一少）多渴：Polydipsia(verythirsty)多食：Polyphagia(veryhungry)多尿：Polyuria(urinatingfrequently)體重減輕：WeightlossComplication:糖尿病的并發(fā)癥Acute:1、diabeticketoacidosis（DKA）糖尿病酮癥酸中毒hyperosmolarnon-ketonicdiabeticcoma高滲性非酮癥糖尿病昏迷InfectionsChronic:1、macroangiopathy大血管病變（myocardialinfraction心肌梗死；atherosclerosis脈粥樣硬化；coronaryheartdisease冠心病）2、microangiopathy微血管病變（diabeticnephropathy糖尿病腎??；diabeticretinopathy糖尿病性視網(wǎng)膜病變）3、neuropathy神經(jīng)病變4othereyedisease(maculopathyerror屈光改變）5、diabetesfoot糖尿病足Definition：DiabetesFootisafootthatexhibitsanypathologythatresultsdirectlyfromdiabetesmelltiusoranychroniccomplicationofdiabetesmellitusRiskFactors:糖尿病的誘發(fā)因素缺乏運(yùn)動，過度興奮，壓力過大，抽煙，喝酒，超重etcGlucos