診斷學(xué)雙語(yǔ)講義

上海交通大醫(yī)學(xué)院診學(xué)雙語(yǔ)教材Clinical（臨床診斷學(xué)仁濟(jì)臨床醫(yī)學(xué)診斷學(xué)研室

ClinicalDiagnosticsAfterfinishyourcourses,younowtouchpatients.Theclinicalservesbridgebetweenclinicalmedicine.Itincludesdiagnosis,someexamination.FormerlytaughtseparatelybutcountrytoformnowclinicalThemedicalareoftomorrow,asyouneedinformationfromeverysourcetounravelthemysterythepatients’illness.Physicalwithinformationthroughtheskills,theinterrogationandphysicalexamination.Interrogationmeanstogetthehistoryindetailofapatient’sillnessandthebestwayletpatienttellhisstoryinhisAssomecrucialbeoverlookedbythepatients,youwillmanyquestionsthehistoryOccasionallyapatientwillorgiveastraightstory,youmayhisorfriendsgetdate.Thenextstepisdoaexamination.ThebodyofwillbeexaminedinwaybyalloffiveAphysicalexaminationusuallyincludesinspection,percussion,Hereourdoctorsgivencontributions.Almostthousandyearstheydevelopedinspection,smellandpalpationmakedevelopsyndromeswhichareclinicallyAfterthatyoucanmakeawithinvolvedevensetdownaitanbutnotdefiniteAdefinitewillbewiththehelpofotherspecialinvestigativeaidssuchasXrayfilms,EKG,endoscopy,ultrasonicimaging,CTscanningetc,furtherorthefirstfromdiagnosis.them,onlylaboratorydiagnosisandinstrumentalexaminationsinofclinicalasaidsaretooareusuallyadealingwithoflaboratoryexaminationsandtests.Aslaboratorydiagnosissoitistoapplyallitscontentssinglepatient,shouldtheonestotheimpressionyoufromphysicalThelaboratoryusuallycontainstwoparts,thespecialexaminationsblood,stoolexaminationsandspecialusuallytospecialorgans.Theaboveyouwillayougototheward.Infactthisiskindofmedicine.YoutrymasterBythisyouwillunderstandwhatisdisease.Bywayyouwilllearnprocedurestoclinicalanalysiswhichbedialecticthatis,inFurther,alwayskeepinmindyouaredealingwiththemanthesoyougivesympathytoandloftymindofpeopleheart1

ooooooooPartISymptomsChapter1Thecorebodyisconstantcircumstances,itistightlywithcircadianoverrangethatusuallydoesexceed1

Cavalueof37

C(thenormalpoint‖).FeveranofcoreabovetheIttothatnotanelevatedbuttoanTheforintheAlocalsensingofisofautonomicdischarge.Twoofpyrogen1.Exogenouspyrogen:asendotoxin),polysaccharides,causecontractionandrigor.2.Endogenous:myelocytesmonocytes,activatedbypyrogen,cytokines,whichoffromThebelievedtothehypothalamiccenterbypromptingelevationinbodytemperature.Etiologyand1.Infectivefever:Afterinfection,metabolitesfromfromWBCcausefever.2.Non-infectivefever:1).Absorptionofinjury;ischemicnecrosis;2).Allergy3).Endocrineandmetabolicdisturbances:dehydration4).Decreasedeliminationofheatfromskin:heatfailure5).ofa:Physical,b:,asbarbituratepoisoning;c:Mechanical,cerebralhemorrhage.6).ofvegetativenervousastheofsympatheticmanifestations:1.offeverLowfever:C2

ooooooooModeratefever:38~39fever:39.1~41Hyperthermiafever:over41

C2.clinicalcourseandofTheclinicaloffeverareoffollowing1).ofa:onset:feverwithinhours,pneumonia,to39~40b:feverforfewas2).Persistenceofbea:continuedb:remittentc:intermittentd:recurrente:undulantf:3).offever:maybebycrisisorlysis1.Chillsorrigor:asinanyacute2.Congestionofconjunctiva:asinhemorrhagic3.byvirus,inoflobar4.Bleedingininfectionashepatitisblooddyscrasialeukemia5.nodeenlargement:incasesoflymphoma,ofmetastasisofcancer6.Enlargementofliverinofleukemia7.inrheumticdisease8.Rash:drugmeasles9inpoisoning,cerebralhemorrhagefeveroftwoofwithaninflammatoryfocus.orwouldshowsuggestivepointsthecauseof3

Chapter2PainPainisofsymptomsforphysicianProperevaluationofpainknowledgeofqualitiesofpain,ofpain.physiologyDuringinjuryoftissue,proteolyticenzymeswhichonglobulintoliberatesubstancesthatstimulatehistamine,otheroracidmetabolitescausethenervefromisthroughofcrosstospinothalamictract,intoparietalisindistribution,ofheadthroughtrigeminal,theisthroughfirsttofourthnerve,andupperabdomen6th-8ththoracicDifferentorgansrespondtostimuli.stimuli,atofoftouch,warmth,ortickle.Whenstimulitotheapproachingdestruction,painadded.stimuliwhichsensitivenotbeinofGIsystem,whichinflammation,ischemia,whiletocutting,burn.Thesensitiveacutejointtosaline,aretwoofprimarynociceptors(pain1.fiber:2-4μmdiameter,conductsslowlyadullfromheartandviscera.2.A-deltafiber:6-8indiameter,asfromreferspainfromThepaindiseasedinternalimpulsespinalimpulseofintegument,coronarypainradiatessideoffingers,weresuppliedby6th–8th(orT1-2)theleftcharacteristics1.Characterofusuallyintermittent,andinflammatorypersisting.2.Localizationofusuallyinitmaybereferred,asappendicitisoverinstage.3.Qualityandintensityofpain:Thepainofapepticulcermaybe‖,‖.painshowedprecordialdistressofquality.Ifofpainworse,itthattheprocessgoingon.theseverity,specialtimesofofalsoimportant.4.Referredpain:diffusefromdeepsomaticorvisceralbeprojectedtosuperficialregionwiththesamereferredpain.Painofcoronaryinsufficiencybefeltalongtheaspectofintheleftinterscapularregion5.relievingAnginalpainbebyexertion,bynitroglycerine.painrelievedbyingestionoffood.4

HeadacheNearlyeveryoneisheadachefromtimetotime.Althoughmostacondition,headacheofmaybetheprincipalofsystemicorintracranialdisease1.Intracranialdiseases(1)Infection:Meningitis,Brain(2)VascularDisease:SubarachnoidHmorrhage,CerebralEmbolism,CerebralThrombosis,HypertensiveArterialVenous(3)PrimaryMetastaticBrainInfection,etc.(4)Trauma:CerebralCerebralContusionEpiduralHematoma,Intra-cerebraletc.(5)Migraine,ClusterHeadache,2.Extracranialdiseases(1)Skulletc.(2)SpineCraniovertebralDisease,suchas,etc.(3)Neuralgia:TrigeminalNeuralgia,etc.(4)as,Glaucoma,Iritis;3.(1)Acuteinfection:Influenza,typhoid,ordiseases.(2)Hypertension,Heart(3)chemicalordrugtoxication.(4)Hypoglycemia,Anemia,HeatStroke,SLE,4.HystericHeadache[Mechanism]Headacheistraction,displacement,ofpain-sensitivestructurestheheadorinvolvementofbonyskull,mostoforofproduceThepainsensitivewithinvaultincludeduraattheskulltrigeminal,glossopharyngeal,proximalofthearterynearCircleofthenucleiofthalamus.Extracranialpainsensitivestructuresincludetheofthethesubcutaneousmuscles,neckthesecondandthirdtheeyes,sinuses,andoropharynx,andofnasalcavity.[Clinical5

1.thatindifferentfromthehasexperiencedcommonlysymptomofthereforedemandevaluation.2.overaperiodoftomonths.alsosignifymedicaldisorders,painprogressiveitdevelopsinpatients.3.Chronicthathaveforhavea4.CharacteristicsPain:Headacheisoftenthrobbing;ache;orpain.isfrequentlyascribedtomigraine.Asteadysensationoftightnesspressureiscommonlyseenwithheadache.painproducedintracranialistypicallydullItisimportantrememberthatthecharacterthedoesnotprovideetiologicguide.5.LocationofheadacheaninvariableofclusterheadachemostmigraineOcularorheadacheaprimarydisorderglaucoma,toorseveralofHeadachedueintracranialmaybebutwillbebioccipitaltheintracranialbecomes6.AssociatedFeverchillsmayindicateorVisualdisturbancessuggestanoculardisorder,anintracranialinvolvingvisualpathways.NauseainmigraineandbeseeninthecourseofmassPapilledemawillbefoundthepressureisincreased.[History1.Itisimportantknowhowoftheheadache,whetherareprecipitatingfactors.2.Iftheiswithintracranialbeexcluded.A35yrsoldmanhasheadacheinthepastHeitasa―dull‖headache.Andhisheadacheworsenedinthepastmonth.Duringexamination,papilledemawasfound.ACTrevealedabigtumorat6

hisheadachewascausedbythispressureisthatpapilledemawasChestpainpainisofEtiologyandAnystimulustofromheart,lung,oraortawillchestpain.arelistedas1.ofwall:ascostalchondritis,walltumors.2.vesselmyocardialischemiamyocardialinfarction,aortic，3.lungcancer4.disease:mediastinitis5.Others:refluxmanifestations1.Localization:zosterblisterintercostalnerve,ercostalneuralgiawithpricklinglocalanginawithprecordial3.Factorstochestpain:usuallyinducedeffortormentalstressby4.withcough,lungcancerwithbloodyhistory:quality,localization,associatedE:especiallynecknodeschestexamination.Laboratoryinstrumentalup:especiallysputumX-rayfilm.7

AbdominalpainpainisofcomplaintsforwhichmedicalItmaybeclassifiedintoabdominalpainEtiologyandpathogenesis:1.peritonealinflammation:contaminationappendix)andchemical(e.g.,perforatedulcer,pancreatitis).2.Acuteofabdominalorgans:enteritis.3.ofhollowobstructionoftheorlargeintestine.4.Vascularvasculartorsionofthe5.Referredpain:pneumonia,occlusion.6.Abdominalwell:trauma7.Metabolictoxicallergicfactorsmanifestations1.Localization:usuallywithoverorgan2.severity:perforationwithdullpainoverupperRenalwithsevereoverbacktolowerabdomen.3.Provocationandrelief:acutearebyeatingorrawfoods,andaftervomitingdischarge.4.manifestations:jaundicefavorsliver,gallbladderpancreaticistorenalThehistoryemphasizedqualityetiologicfactoroftheabdominalpain.examinationofchestimportant.X-rayexamination,intestinalfibroscopyneeded.Ifthediagnosisremainedindefinite,laparotomyindicated.ChronicEtiologyandpathogenesis:1.Chronicofabdominalorgans:refluxchroniccolitis.2.Peptic3.Distentionofsurfaces:hepaticcapsules.4.Metabolictoxicuremia5.Infiltrationof6.Neurogenic:irritableneurosis.manifestations:1.Pasthistory:ofabdominalmaycausechronicoforgans.8

2.Localization:Painisusuallywith3.ulcerrelatedhunger,liveriswithpersistentpain.4.Painofbody:Ptosisofstomachorkidneyforlong5.Whenassociatedwiththeyareusuallytochronicinfection,tumorofabdominalWhenassociatedwithofesophagus,stomach,billarybeindicated.asinacute9

Chapter3Edema1.Definitionclinicallyapparentincreaseinthefluidvolume.oncausemechanism,edemamaybehavegeneralizeddistribution.hydrothoraxrefertoofexcessfluidinthepleuralrespectively,areconsideredtobespecialof2.Thehydrostaticpressurethesystemthecolloidoncoticintheinterstitialfluidamovementoffluidfromthetheextravascularspace.Incolloidoncoticbythehydrostaticpressuretheinterstitial,referredtoastension,promotetheoffluidintovascularcompartment.aofthereisalargeofsolutesfromvascularspaceatarterialofmicrocirculationandintothevascularcompartmentatend.Theseforcesusuallybalancedsothatasteadystateintheoftheyetalargeexchangebetweenthemispermitted.anyofbealteredaoffluidbetweentwocomponentsoftheextracellularspacewillofthen3.EtiologyandClinicalAppearances(1)Generalizeda.Cardiogenic：especiallythemanifestationofrightheartfailure.It’sbeenevidencedthatreductionofthecirculatorybloodvolumebloodvolume,aswelldecreasedglomerularfiltrationinthiswithsecondaryelevationofsecretion,Nareabsorptionandsodiumretention.Theincrementaccumulatesincirculation,capillarylymphatichydrostaticpressurereductionoffluidreabsorptiontheofedema.Imonlytheofasbasilarrales,distentionetc.b.Nephrogenic：TheprimaryalternationinisadiminishedcolloidoncoticpressuretoofintoandofwaterbytheEdemausuallyfromthetendstobemostinthemorning,accompaniedbyhypertensionorHepatogenicedemaandclinicalevidenceofsuggestoffromanklebutinvolvingthehead,faceupperbyoutflowblockade,whichinturncausesofthesplanchnicbloodvolumeformation.Thesealternationsfrequentlycomplictedbysecondaryreducedhepaticreduce10

arterialbloodvolumeevenfurtherofRAAsystem.d.MalnutritionAgrosslyinproteinaperiodprotein-losingsevereproducehypoproteinemiaedema.Beforefromextremities,theremaybeofweighte.IdiopathicedemaThiswhichalmostinischaracterizedbyperiodicofmenstrualaccompaniedbydistention.f.Miscellaneousincludehypothyroidism,inwhichedema(myxedema)belocatedtypicallyinpretibialwhichmaybeassociatedwithpuffiness.Exogenousadministrationofestrogensandvasodilators,particularlycalciumantagonistnifedipine,also(2)originatesfromlocalvenousororincreasethecapillaryasinflammation,thrombosis,filariasis,4.ApproachtoAnquestioniswhethertheedemaislocalizedorIfitlocalized,thatbeshouldbeascitesareoflocalizededema.Eithermaybeoflocalorlymphaticobstruction,asinIfisitbefirst,ifthereisserioushypoalbuminemia,albumin<2.5g/dl.Ifthephysicalexamination,urinalysis,datawillthequestionofcirrhosis,severeprotein-losinggastroenteropathy,thenephrotictheIfnotpresent,itshouldbedeterminedifthereofcongestiveofgeneralizededema.Finally,itshoulddeterminedthepatienthasanadequateifthereiseven11

Chapter4Mucocutaneoushemorrhageistoofcoagulation.Theclinicalspontaneousinormucocutaneous,hemorrhageafterdamage.EtiologyPathogenesisThebasicmucocutaneoushemorrhage1wall2abnormalofplateletorCoagulationabsenceoractivitiesreduce.4factorsincreasewithintheblood.Theofofabovewillcauseofleadmucocutaneous1walldefectNormally,thetodamagedendotheliumflowsoonasthecapillarytrauma.Then,thecapillarycontinuouslyroleofhemostasiswhichasplateletofasvasoconstrictor.Whenthecapillarywallhascongenitaldefectorcamage,can’tnormallyplayroleofthentomucocutaneoushemorrhage.’susuallyseenin:(1)capillary(2)Anaphylactoidpurpurasenilispurpura.(3)infection,chemicalordrugsabnormalsuchasvitamindeficiency,arteriosclerosis.2PlateletPlateletplaythemainroleprocess.andinvessel,formthrombiwound.ofplateletmembranescanactuatetoformAwhichfurtheraggregatesandtoamplifylocalPlatelettheandthrombocytinserveclottingprocessconstriction,thehemostasiseffection.ofplateletnumberorfunctionwillthemucocutaneoushemorrhage.It’softenseen:(1)Thrombocytopenia:①primarysuchprimarythrombocytopenicneonatorum②secondarythrombopenia:likedrugs,infection,anemia,etc.dysfunction:thrombasthenia,giantsyndrom,andalsodrugs,uremia.(3)Thrombocytosis:thereprimarythrombocythemiasecondarytoofinfection,mylocytic3Coagulationprocessiscomplex,inwhichtherearemanycoagulationfactors.It’sthechainreactionactivatedbypre-enzyme.’llcausecoagulationdisordermucocutaneoushemorragethatanyoffactorsdefectoftenseeninclinic①congenital:hypofibrinogenemia,offactor②secondary,ofvitaminK,severe4Anticogulantinbloodcirculationanticogulantsincreasedof12

Redofredblotchmucocutaneoushemorrhage.Usually,itisn’taboveskinandnotfadeafterstressed.That’scalledInvasculardefectsabnormalities,hemorrhageiscutaneousmucosal,whichpetechiae,ecchymosis.Whileinternalorgansarerare.Inclottingfactorsdeficiency,hemorrhageinternalorgans,intra-muscleorsofttissuehematoma,andfamilyhistoryinhemorrhageofdisorders.Accompanimentsymptom1oflimbwitharthralgiaofusuallyin2Generalcutaneomucouswithulemorrhsagia,orhemafecia,commonprimary3Purpurawithjaundiceisofteninofdiseases.4Hemophiliashouldbewithexcessiveafterfromachild,hemorrhagefamily13

Chapter5isanawarenessofdifficultyinbreathing.Itisthereforeasymptom,usuallydescribedbythepatientasofbreath,‖whethertheistoactualdifficultyinoranofIfthesymptomstriking,italwayswithdilatationofnares,useofmusclesofrespirationofrate,rhythm.EtiologyTheofdyspneaItcanbebytheSuchhematologic.Intheofabdominalpressureascites,pregnancyetc)candevelopmayexperiencethedyspneaduringheavyMechanismclinicalfeaturecanaccordingtofollows:1.Respiratorydyspneaisbyabnormalventilationgasexchange,reductioninventilatoryhypercapniaandresultingfromcandividedthreeclinical(1)InspiratorydyspneaInspiratorydyspneatendstoprimarilythereisobstruction,asinflammation,inlarynx,majorItcharacterizedtheinwhichvisibleindrawingoversternalnotch,supraclavioularspaces,intercostaltheepigastriumincanbeoftenthisaccompaniedbyalowpitchedinspiratorywheezingdrycough.Itiscommonlyinandobstructionoftrachea,and(2)ExpiratoryExpiratoryistheoflungspasmnarrowingofbronchiinemphysema,bronchialasthmaticExpirationprolongedandlabouredwithwheezing.(3)dyspneadyspneaoccurswithlungdisease,suchasseverepulmonaryfibrosis,massiveatelectasis,pleuralresultingintheofandgasexchangecapacity.isdifficultduringbothexpiration.2.dyspneaCardiacdyspneaisattributablevascularcongestionresultingfromleftand/orright14

ThedyspneacausedbyfailureislessthanthatonecausedbyLeft-sidedfailuretoimpairedgasComplianceisventilationisdecreasedregionsvitalAlveolistiffmoreworkistoelasticrecoil,thehighwillstretchinitiateinflationreflexresultinginturningoffofanincreaseinRight-sidedheartcausescirculation.Theincludes(1)theofatrialsuperiorcavaisthenaturalstimulusofrespitatorycenter.Theofcontentandoftheacidsuchlactic,(3)ofbyofliverresultingfrompleuralofheartfailurecannocturnalwhenelevated-fillingpressureisOrthopneaisdifficultyinbreathinginthethismayberelivedbyup,whichreducesthedegreeofcongestionpoolinginloweringleftventricularfillingimprovingvitalcapacity.Paroxysmadyspneaisaspecificsymptom.Thepatientawakesofbreathbutoftenreliefsittingforaoftime.Itisbelivedinthatassumptionofforsleepresorbtionofextracellarfluidintotheintravascularcausingariseinfillingthemostadvancedcases,thebecomeacutelyveryfrequentlyproducefoanytingedwithblood.physicalexamination,moistralesatbothbases,wheezingbronchospasm.Themarkedlyaccentuatedsecondheartsoundinthepulmonicdyspneatermedaswhichcanbeinthehypertensiveheartdiseasecoronaryheartdisease.3.Toxicdyspnea.InthemetabolicdiabeticmetabolitesthedeeprespirationTheofcandepressrespiratorycenterdeeprespirationCheyne-Stokessrespiration.4.Neuro-Psychogenicdyspnea.mayinthepatientsfromcerebrodiseases(intraintracerebralpressure).centerlosesthebloodorrespirationbecomesslowirregular.Insomethedyspneapsychogenic,whichcharacterizedbyrepetitiverespirationwithoforlips,Thesearemanifestationshypocapnia5.dyspneaInseveremethaemoglobinemiatheofcapacitycontent15

developrespirationincreasedrate.respirationrateinwhichstimulatesrespirationofAccompanyingsymptoms1.dyspneaItinbronchialandasthma.severedyspneainacutelarynxedema,foreignbodymassivepulmonaryembolism,spontaneous2.withchestpain.Itfrequentlyinpneumonia,pulmonaryinfarction,spontaneousacuteacutemyocardialinfarction,carcinoma.3.withItiscommonlynotedinpneumonia,lungabscess,pulmonaryacutepericarditis,nervoussystem4.coughandpurulentsputum.Itisinchronicobstructivewithinfection,pneumonia,lungwithlargeamountoffoanyoftenseeninacuteleftventricularheartfailureandpoisoning.5.withcoma.Itsuggestshemorrhage,meningitis,withketoacidosis,andpoisoning.16

Chapter6CoughandExpectorationthecommonestofrespiratorysymptoms.Itisathatvoluntarilyinvoluntarilyagainstinfectionofdust,noxiousgases,varyinseverityftheoccasionalofthethroat‖thateveryoneperformsasevere,hacking,coughthatafflictedindividualevenlifeCoughingpersemaycomplications,includingribfractures,pneumomediastinum,emphysema,abdominalhernias.Acoughrestandsleep,bronchialandcausesirritationtobronchiallarynxsothatcoughtendstoself-perpetuating.fromstimulationorofpharynx,larynx,trachea,stimuliproducemaybeinflammatory,mechanical,thermal.Occasionally,coughresultsfrompleuralirritationtheabsenceofevenreputedarisefromstimulationofofvagalnerve.EtiologyThecoughreflexcanbeinitiatedavarietyof1.reflexcoughareinthefromthethesmallbronchi,intheThebronchieleandalveolirelativelyinsensitivetoirritants.usuallybygasforeignbody,inflammation,bleeding2.Pleuraldisease:alsobestimulatedbyimpulseresultingfrompleurisyorirritationofpleuralmembrane.3.LeftventricularcausespulmonarycongestionalveolartransudationoffluidisassociatedwithSometimesfailurealsocough.4.factor:canalsofromthecortexthetransmittedfromthemedullacoughwhichsendstomuscularsystemofthelarynx,acoughExpectoration:Ciliaryactivitymacrophagesonthemucouslininglayerstheepitheliumlargerbronchiwherecoughreflexintheirpropelledupwardtoglottis.thecilisathinlayerofsecretionthewhichproducedbythesubmucosalbronchialsomewhatbythemucuskeeptheairwaymembraneAninthevolumeofinassociationwithinfectionoftheinducethecongestionofofthepermeabilityofcapillary.Ininfectionofvirus,mycoplasma,pathogenicbacteria,fromtheIncongestionbloodfrompulmonary17

capillarycaninitiatepinkwaterysecretionischaracteristicfortheedema.presentation1.Characterofwithoutisdrycoughunproductive.Itusuallycausedbypharyngitis,ofandwithisItischronicpharyngitis,chroniclungcavitious2.Thepatternofcough:ismostlydevelopedbyacuteairwayintracheaChroniccoughisassociatedwithchronicbronchialtuberculosis.Paroxysmalisseeninadenopathyorbroncusbytumor.Periodicinchronicbronchitisorbronchiectasis.Itrelatedtobodyposition.coughassociatedwithasthma,chronicIthasassociationwithvagal3.ThequalityItthesoundsuggestlocationofForexample,"breaking"a"brassy"isassociatedwithtrachealairway,andor"cleaningthroat"isoftencausedbyapostnasaldischarge.Awithcoughingsuggestsbronchitisimpairedfunctionoftherecurrentlaryngealnerve,asfromaneurysmtheaorta,leftatrialmalignancy.Inspiratorystridoranairwayobstruction.4.ThevolumeofClear,white,orischaracteristicallypresentinofchronicbronchitis.In‖casesofemphysema,thecoughisoftennonproductive.Tenaciousstickymucoidoccasionallywithbronchialcasts,commonlyinasthmatics.Foul-smellingpurulentsuggestsExpectorationofcalcificparticlesdiagnosticofbroncholithiasis.alsoofaprocess,lungabscess,chronic(Accompanying1.Coughwithfever:Itisindicativeofacuteinfectionrespiratorysystemsuchinfluenza,abscess,pleurisyetc.2.Coughwithchestpain:Itthepluralcavitybeinvolvedmaybetheheartdiseasepneumonia,bronchialwithdyspneaItisintheoflarynx,larynxtumor,chronicobstructivepulmonarypneumonia,massivepleuraleffusion，18

pulmonarypulmonary4.CoughwithamountItcommonlyinlungabscess,andfistula.5.CoughwithhemoptysisItcarcinoma,abscess,mitral6.CoughwithfingersItcommonlyinlungabscess,carcinoma,thoracicempyema.7.CoughwithItinbronchialasthma,cardiacasthma,andforeigninbronchi.19

Chapter7Hemoptysistheexpectorationofbloodfromairwaylarynx.ofupblood,mouthandtractbecarefullybytheexaminationtorulethepossibilitythatbloodmayfromthoseareas.quantityofinquantityandinthetomassivehemorrhages,bleedingmayanearlyoftheofseriousofmoderatedegreebelifethreatening.Inapproximatelyofpatientswithhemoptysis,thestandardchestnoonlyminimalchanges.betheofbronchopulmonarydisease,theofitsadiagnosticproblem.Etiology1.mayin(TBornon-TB),chronictuberculosisItcanbeinbroncholithiasis,body,bronchogenicnonspecificprocessesleadstotheofpermeabilityofcapillaryofinbronchialoccursinof2.Theofpneumococcalisasinappearance.Pulmonarytuberculosis