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影像
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笔记
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影像—重点笔记+真题,影像,重点,笔记
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影像学focal lesionfociattenuationshort-term follow-up Computer Tomography （CT）Magnetic Resonance Imaging（MRI）Interventional radiologyECT，include SPECT ，PECTsingle photon emission computed tomography，SPECTpositron emission computed tomography，PET or PECTultrasound,USfissureexcretioncatheterdispensespatial resolutiondensity resolutionpixelinstillation, BolusTR (repetition time)TE (echo time)PDWI(proton density weighted image) PACS，Picture Archiving and Communication Systems图像存档与传输系统DSA digital subtraction angiography数字减影血管造影衰衰减减attenuationattenuation声声影影acousticacoustic shadowshadow多普勒效应Doppler effect骨骨质质疏疏松松osteoporosisosteoporosis骨质破坏bone destruction骨质坏死osteonecrosis骨膜反应（periostealproliferation）又称骨膜增生（periosteal reaction）关关节节脱脱位位dislocationdislocation ofof jointjoint关关节节强强直直（ankylosisankylosis ofof jointjoint） 继发的骨化中心secondary ossification center 骺骺线线epiphysealepiphyseal lineline 急急性性化化脓脓性性骨骨髓髓炎炎pyogenicpyogenic osteomyelitisosteomyelitis强直性脊柱炎ankylosingspondylitis,AS、类风湿性关节炎rheumatoid arthritis骨骨气气鼓鼓spinaspina ventosaventosa骨囊肿bone cyst骨肉瘤osteosacroma骨巨细胞瘤giant cell tumor of bone肺实变consolidation结节nodule与肿块mass肺间质病变interstitial lung disease空洞cavity空空腔腔airair containingcontaining spacespace结核球tuberculoma原发综合征primary complex肺门hilar印戒征Signet-ring sign肺肺大大疱疱BullaeBullae肺肺气气肿肿emphysemaemphysema肺肺不不张张atelectasisatelectasis气气胸胸pneumothoraxpneumothorax大大叶叶性性肺肺炎炎lobarlobar pneumoniapneumonia小小叶叶性性肺肺炎炎/ /支支气气管管肺肺炎炎lobularlobular pneumoniapneumonia肺脓肿lung abscess支支气气管管扩扩张张bronchiectasisbronchiectasis肺野lung field肺叶lobe气气管管隆隆嵴嵴carinacarina ofof tracheatrachea肺充血/肺血增多pulmonary congestion肺血减少/肺缺血pulmonary oligemia肺淤血congestion肺水肿pulmonary edema肺栓塞pulmonary embolism肺循环高压（肺高压）pulmonary hypertention法洛四联症tetralogy of fallot，TOF主动脉夹层aortic dissection,AD肺肺动动脉脉栓栓塞塞征征象象pulmonarypulmonary embolismembolism龛影niche或壁龛crater充盈缺损filing defect半半月月综综合合征征meniscusmeniscus signsign憩憩室室(Diverticula)(Diverticula)假肿瘤征（pseudotumor sign）咖啡豆征（coffee bean sign）三明治征（sandwich sign）肠梗阻intestinal obstruction机械性肠梗阻intestinal obstruction胃肠道穿孔perforation食管静脉曲张esophageal varices胃溃疡gastric ulcer，GU十二指肠溃疡duodenal ulcer，DU肝海绵状血管瘤(cavernous hemangioma)软藤征（soft rattan sign）超声（ultrasonogram，USG）自自截截肾肾autonephrectomyautonephrectomy孤立肾（先天性孤立肾）solitary kidney输尿管结石ureteral lithiasis肾癌/肾细胞癌renal cell carcinoma膀胱癌bladder cancer肾盂癌 renal pelvic cancer肾肾血血管管平平滑滑肌肌脂脂肪肪瘤瘤renalrenal angiomyolipomaangiomyolipoma子子宫宫肌肌瘤瘤uterinuterin leiomyomaleiomyoma子子宫宫体体癌癌carcinomacarcinoma ofof uterineuterine bodybody脑脑积积水水（hydrocephalushydrocephalus）小脑扁桃体下疝畸形）Chiari malformation脑脑膜膜尾尾征征（duraldural tailtail signsign垂体瘤（pituitary adenoma）脑出血Cerebral hemorrhage脑梗塞cerebral infarction星型细胞瘤astrocytoma脑膜瘤meningioma垂体瘤pituitary adenoma脑转移瘤metastatic tumor脑脓肿（brain abscess）结核性脑膜炎tuberculous meningitis脑萎缩（brain atrophy）DWI：弥散成像（diffusion weighted imaging）SWI：磁敏感加权成像（susceptibility weighted imaging，SWI）MR血管成像（magnetic resonance angiography，MRA）时间飞跃（time of flight，TOF）相位对比（phase contrast，PC）视网膜母细胞瘤retinoblastoma,RBGraves眼病/突眼性甲状腺肿 甲状腺腺瘤thyroid adenoma、甲状腺腺癌thyroidcarcinoma鼻咽癌nasopharyngeal carcinoma眼部炎性假瘤inflammatory pseudoumor结结构构扭扭曲曲architecturalarchitectural distortiondistortion乳腺纤维腺瘤fibroadenoma of breast肾上腺皮质腺瘤adrenocortical adenoma肾肾上上腺腺嗜嗜铬铬细细胞胞瘤瘤pheochromocytomapheochromocytoma介入放射学interventional radiology,IVR经经导导管管血血管管灌灌注注术术transcathetertranscatheter vascularvascular infusion,TVIinfusion,TVI经导管血管栓塞术transcatheter arterial embolization,TAE局部病变病灶衰减短期随访计算机断层扫描磁共振介入放射学发射型计算机断层显影单光子发射型计算机断层显像正电子发射型计算机断层显像超声裂隙排泄导管空间分辨率密度分布率像素灌注，药丸临床诊断学SymptomatologyHistory taking Physical examination Medical recordclinical ancillary testsPhysiological PathologicalInterview，interrogationchief complaintsSignInspectionPalpationPercussionAuscultationImpressionTentative diagnosis Differential diagnosis Evidence based medicineclinical expertiseStandardized patientbedside activitySimulationstethoscopeThermometerHematomanometerfeverHeat dissipation Circadian rhythmpostprandialHypothalmic injuryHeat strokedehydrationHyperthyroidismPyrogenic fever endogenous pyrogens Malignant Hyperthermia，MHOnset of fever Persistent of fever Subsidence of feverFever typesContinued fever Remittent fever Intermittent fever Undulant fever Recurrent feverIrregular fever rat-bite feverBrucellosis, typhoidChills or rigorCongestion of conjunctivaHerpes simplexBleeding tendencyArthralgiaHepatomegaly & spleenomegalyComaFever of Unexplained OriginPhysical Examination，PEInspectionPalpation Percussion AuscultationStethoscopeTongue bladesPenlight Tape measureReflex hammerSafety pins Gauze padsLubricant gelNasal speculumOto-ophthalmoscopegroggyconsistencytexturemuscle relaxationmuscle rigidityvoluntary muscular spasm board-likerebound tendernessResonanceTympanyHyperresonanceDullnessFlatnesspulmonary emphysemabowel soundsordorexudatesGeneral examination Vital signDevelopment/habitusNutritional statusConsciousnessState of mind tone/voiceFacial feature/expressionPosition/postureGaitcorticosteriodgynecomastiaRicketsDiphtheriarheumatopyraRectalAxillarybody temperature curveAsthenic typeSthenic typeOrtho-sthenic typenormal stature Sexual precocity CretinismPituitary dwarfismGigantismAcromegalyArm circumference Skinfold thicknesscachexiaExtraversion ObesityVisceral ObesitySommolence Confusion Stupor Coma Delirium Dysphonia DysarthriaphonationarticulationCompulsive positionOrthopneaparoxysmal nocturnal dyspenaalternative positionCompulsive supine positionCompulsive prostrate positionCompulsive side down positionOpisthotonos CyanosisYellow skinPigmentationDiscolorationJaundice HypercarotenemiaMelaninVitiligo LeukoplakiaAlbinismusMaculeRoseolaPapulesMaculopapulaeUrticariapetechiapurpura ecchymosis hematomaSpider angiomaLiver palmsPitting edemakeloidInquiry 问诊get pertinentOnce all the clues have been gathered and the assimilated(消化),diagnoses is easyStructure of the historyGeneral dataChief complaint Symptom+time periodHistory of present illnessPast historyReview of systemsPersonal historyMarital historyMenstrual historyFamily historygeneral data Name Gender Age Birth place Native place Nation Marital status Mail address Profession Data of admission Data of record Source Reliability History of present illnessChronology（按年月次序的排列） is the most practical frameworks（框架） for organizing the historyrelief (缓解因素)or provoke factors（触发因素）episodes（发作） Past medical history Parameters including:general state of healthpast illnessinjuries hospitalizationssurgeryallergiesimmunizationssubstance abusedietsleep patternscurrent medicationsalternative therapiesreview of systems (ROS）下面的单词了解Respiratory system cough: identity frequency sputum production: quantity appearance coughing up blood shortness of breathCardiovascular system chest pain shortness of breath with exertion palpitations shortness of breath lying flat sudden shortness of breath while sleeping history of heart attackGI system appetite excessive hunger excessive thirst nausea constipation diarrhea heartburn vomiting abdominal pain change in stool color/caliber/consistency frequency of bowel movements vomiting blood rectal bleeding black tarry stoolsUrinary system frequency urgency incontinence difficulty in the starting the stream excessive urination pain on urination burning blood in the urine bed-wetting flank pain history of retention urine color urine odor Hematological system pallor yellow skin petechia purpura ecchymosis hematomaEndocrinological system and metabolite weakness profound sweating abnormal appetite weight changeNeurologic system fainting dizziness mood changes loss of memory speech disorders general behavioral change disorientationMusculoskeletal weakness paralysis muscle stiffness limitation of movement joint pain joint stiffness arthritis gout deformitiesPersonal history Social experiences birth place living area and duration particularly those epidemical areas education living condition hobbyProfession and working place/conditionHabit smoking (amount and duration) anesthetic drug（麻醉药）Unhealthy sexual history: Sexually transmitted diseaseMarital history: single or married age of marriage heath condition of partnerMenstrual history age of menarche (first menstrual cycle) cycles and flow lasting amount of vaginal bleeding/discharges menopause and age of menopauseBasic interviewing techniquesQuestioning（询问）Silence (沉默)Facilitation（简单化）Confrontation（面对面）Interpretation（解释）Reflection（反省)Support (支持)Precipitating factors触发因素Palliating factors 缓解因素Radiation 放射痛accusation (谴责)Medical jargon(医学术语)The writing of clinical record 病史书写avoid nonstandard abbreviations（缩写）not scratchy (潦草) Clinical records during hospitalization Case record 住院病历 Record of admission 入院录 First record of admission 首次病程录 Record of the course of disease 病程录 Record of consultation 会诊记录 Record for transferring to new department 转科录 Record of discharge 出院小结 Record of death 死亡小结 Record of surgery 手术记录obscure（不清楚的）, lethargy（昏睡）Physical examinationSkin and mucous: color (reddish, paler, cyanosis, yellowish, pigmentation) swelling, moisture, elasticity, bleeding, rashes, subcutaneous nodular, spider angioma（蜘蛛痣）, ulceration, scar. The location, size and shape should be recorded.Lymph note: systemic or localized lymph notes (submaxillary, 下颚；posterior auricular, 耳后的；neck, armpit, 腋窝；groin，腹股沟). Its size, number, tenderness, hardness, mobility, fistula（漏管）, scar etc. Head and organsHead: its size, shape, tenderness, mass, hairEye: eyebrow（眉毛）, eyelash（睫毛）, eyelid,（眼睑） eyeball (protrude/突出, sunk/凹陷, movement, tremble/震动, strabismus/斜视), conjunctiva（结膜）, sclera(巩膜）, cornea/角膜 (size, shape, symmetry, light reflex, near reflex).Ear: discharge, hearing, mastoid（乳突）.Nose: abnormality; tenderness of maxillary sinus（上颌窦）,ethmoid sinus（筛窦）, frontal sinus（额窦）; exudation（分泌）,bleeding. Oral cavity: odor, lips (color, swelling, ulceration, herpes simplex,pigmentation); teeth; gingival（齿龈）; tongue (mass, ulceration，coating of the tongue, mucus (rash, bleeding, ulceration); tonsils（扁桃腺）; pharynx（咽） etc.Neck: symmetry; texture (slightly flexed and cradled in the examiners hands); thyroid gland (size, hardness, tenderness, nodular, tremble, murmur); superficial venous distention; the position of the trachea. Chest: configuration; symmetry; local protrude; tenderness; respiratory rate and pattern; abnormal pulsate（异常搏动）; breast (size, mass); venous distentionLung: Inspection: respiratory movement; interspace of ribs; Palpation: the extent of chest excursion（移动）; vocal fremitus（语颤）; Speech creates vibrations that can be heard when one listens to the chest and lungs. These vibrations are termed vocal fremitus. When one palpates the chest wall while an individual is speaking, these vibrations can be felt and are termed tactile fremitus（触觉语颤）. Pleura friction（胸膜摩擦音）; subcutaneous crepitus（捻发音）. Percussion: resonance tympany hyperresonance dullness flatness diaphragmatic movement Auscultation: breath sounds tracheal bronchial bronchovesicular vesicular Heart: Inspection: apical impulse, or its location, area and intensity Palpation: assessing point of maximum impulse, thrills,fremitus Percussion: percuss the hearts borders, the relative dullness or absolute dullness borders Auscultation: the heart rates, rhythm, heart sounds, murmur（杂音）, abnormalities of the S1, S2, splitting of S2, systolic clicks, diastolic openingsnaps, vocal fremitus, premature beats（早搏） Radial artery (桡动脉): pulse rate, rhythm (regular or irregular), pulse deficit（脉搏短绌）. The pulse may be described as normal, diminished, increased, or double-peaked. Peripheral vascular signs: capillary strike signs bruits（杂音） abnormal artery movement. Abdomen Inspection: symmetry, size, abdominal distention, pitting (concave abdomen), respiratory movement, skin lesion, pigmentation, surgical scar, umbilicus, hernia（疝）, body hair, venous distention and direction of blood flow, peristaltic waves（蠕动波); ecchymoses (淤斑) Palpation: the tenderness of abdominal wall, rebound tenderness, mass (location, size, shape, texture, tenderness, motion, mobility) Liver: size, character, surface, edge, tenderness, motion. Gallbladder: size, shape, tenderness Spleen: size, character, tenderness, surface, edge Kidney: size, shape, character, tenderness, mobility Bladder: distention (膨胀) costovertebral（肋椎的) angle tenderness Percussion: liver dullness borders, hepatic tenderness over the right upper quadrant, shifting dullness (移动性浊音) Auscultation: bowel sounds(肠鸣音), vascular bruitsAnus and rectum: anal fissure (肛裂) anal fistula (肛瘘 ) pile(痔) digital rectal examination(肛指检查) Genitalia Male: pubes(阴毛), penis(阴茎), glans(龟头) scrotum (阴囊), testicles (睾丸), epididymis(副睾), Female: External: pubes, vagina(阴道), urethral meatus(尿道口), hymen(处女膜), labia minora (小阴唇), labia majora (大阴唇), clitoris(阴蒂) Internal: ovary(卵巢), uterus(子宫), fallopian tube (输卵管) Spine: tenderness, abnormal spinal extension/rotation, lateral deviation (侧弯） Extremities: deformity, venous distention, stiffness, limitation of motion, joint, strength Nervous system: biceps tendon reflex (二头肌反射) triceps tendon reflex (三头肌反射) patellar tendon reflex (膝腱反射) Achilles tendon reflex (跟腱反射) abdominal superficial reflex (腹部反射) cremasteric superficial reflex(提睾反射) test for abnormal reflexes: babinski sign, chaddocks sign, hoffmanns sign Specialized subject: such as: surgery ophthalmology (眼科) gynecology (妇产科)perspicuity(简明) written concisely(简明) or compendiously(简要)Hypothesis(假设) Impression(印象) Primary diagnosis(初步诊断)Verification of preliminary diagnosis Evidence Based MedicinePertinent positives 相关的积极因素 The ways of clinical thinking 临床思维方法 Clinical practice Scientifically clinical thinking The basic rules of clinical thinking The rules of seeking the truth from facts 实事求是原则 The rules of monism 一元论原则 The rules of using the prevalence and spectrum of the disease tomake the diagnostic decision 用发病率和疾病谱观点优选诊断原则 The diagnosis of organic diseases (器质性疾病) is in priority, thefunctional diseases (功能性疾病) are considered only those organicdiseases have been ruled out The curable diseases are in priority The rules of simplifying thinking procedure症状学病史采集体格检查病理临床辅助检查生理病理问诊主诉体征望触叩听初步印象可能性诊断鉴别诊断循证医学临床专长标准化病人床边实践模仿听诊器体温计血压计散热昼夜节律餐后下丘脑损伤中暑脱水甲亢致热源性发热内源性致热原恶性高热体温上升期高热期体温下降期热型稽留热弛张热间隙热波状热回归热不规则热鼠咬热布氏杆菌病 伤寒畏寒，寒战结膜充血单纯疱疹口唇出血倾向关节肿痛肝脾肿大昏迷发热待查发热待查发热待查体格检查(望诊)(触诊)(叩诊)(听诊)听诊器压舌板小手电筒皮尺反射锤安全别针纱布垫润滑油鼻镜检眼耳镜昏昏沉沉平滑度质地肌肉放松肌肉僵硬自主性肌肉痉挛板样强直反跳痛清音鼓音过清音浊音实音肺气肿大便声音？肠鸣音气味分泌物一般检查生命征发育/体型营养状态意识状况精神状况语调/语态面容/表情体位/姿势步态皮质类固醇男性乳房发育佝偻病白喉风湿热肛门腋下体温曲线无力型矮胖型匀称型身材性早熟呆小症垂体性侏儒症巨人症肢端肥大症上臂周径 (皮褶厚度)恶病质外向性肥胖 内脏性肥胖 (嗜睡)(意识模糊)(昏睡) (昏迷)谵妄)(发声困难 (构音障碍发声分节发音强迫性体位端坐呼吸阵发性夜间呼吸困难辗转体位 仰卧位俯卧位侧卧位角弓反张发绀黄染色素沉着色素脱失黄疸高胡萝卜血症黑色素(白癜风）白斑白化病（斑疹）（玫瑰疹）（丘疹）（斑丘疹）（荨麻疹）（瘀点（紫癜（瘀斑）血肿蜘蛛痣肝掌凹陷性(疤痕疙瘩(相关的) should answer “Yes” or “no”消化系统摄食 Ingestion消化 Digestion吸收 Absorption排泄 Excretion免疫 Immune内分泌 Endocrine粘膜Mucosa上皮 Epithelium 复扁 Stratified squamous epithelium 单柱 Simple columnar epithelium固有层 Lamina propria 黏膜腺 Mucosa glands黏膜肌层 Muscularis mucosa黏膜下层 Submucosa 黏膜下腺（食管腺、十二指肠腺） Subucosa glands 黏膜下神经丛：神经元 + 无髓神经纤维 Submucosa nerveplexus皱襞 Plicae 黏膜 + 部分黏膜下层向管腔突起 mucosa + submucosa 肌层 Muscle layer 骨骼肌 Skeletal muscle 平滑肌 Smooth muscle 肌间神经丛Myenteric nerve plexus 外膜Adventitia： 纤维膜 Fibrosa（L.C.T） 浆 膜 Serosa （L.C.T + 间皮）食管腺 Esophageal gland stomach贲门 cadia胃底 fundus胃体 body幽门 pylorus表面粘液细胞 surface mucous cell胃小凹 gastric pit胃腺 gastric gland胃底腺 fundic gland贲门腺 cadiac gland幽门腺 pyloric gland胃黏膜屏障 Stomach-mucosal barrier胃底腺 壁细胞 (parietal cell) 泌酸细胞(oxyntic cell) 主细胞 (chief cell) 胃酶细胞(zymogenic cell) 颈黏液细胞 (neck mucous cell) 内分泌细胞 (endocrine cell) 未分化细胞 (undifferentiated cell)壁细胞 强嗜酸性 acidophilia 细胞内分泌小管Intracellular secretory canaliculi 微绒毛 Microvilli 微管泡系统 Tubulovesicular system 大量线粒体 盐酸 (HCL) 内因子(intrinsic factor) 组胺 (histamine)主细胞 嗜碱性 basophilia 酶原颗粒 zymogenic granules 胃蛋白酶原 (pepsinogen)微绒毛（纹状缘）microvilli striated border小肠腺 intestine gland 吸收细胞 absorptive cell 杯状细胞 goblet cell 潘氏细胞 Paneth cell 未分化细胞 undiffentiated cell 内分泌细胞 endocrine cell绒毛 villi 十二指肠腺 duodenal gland回肠集合淋巴小结 accumulated lymphoid nodules绒毛中轴 有孔毛细血管 fenestrated capillary 中央乳糜管 central lacteal 散在平滑肌 diffuse smooth muscle肠淋巴相关组织gut-associated lymphoid tissue , GALT 弥散淋巴组织 diffuse lymphoid tissue 孤立淋巴小结 isolated lymphoid nodules 集合淋巴小结 accumulated lymphoid nodulesM细胞（微皱褶细胞 Microfold cell ） 分泌型免疫球蛋白A (secretory immunoglogbuin A, sIgA)胃肠道内分泌细胞 基底颗粒细胞 basal granular cell 颗粒具嗜铬性 chromaffin 或嗜银性 argyophilic 大唾液腺 (Large salivary glands) 腮腺pirotid gland 颌下腺submandibular gland 舌下腺sublingual gland复管泡状腺 Compound tubuloacinar glands 腺泡acini 导管ducts浆液性腺泡：胞质着色深，核圆Serous acinus黏液性腺泡：胞质着色浅，核扁圆Mucous acinus混合性腺泡 ：半月(demilune)Mixed acinus 导管 duct 闰管 Intercalated duct 纹状管 striated duct胰腺pancreas外分泌部 exocrine portion 腺泡 acinus 导管 duct 泡心细胞 centroacinar cell胰淀粉酶amylase胰脂肪酶lipase胰蛋白酶原 trypsinogen胰糜蛋白酶原 chymotrypsinogen胰蛋白酶抑制因子 trypsinogen inhibitor内分泌部 endocrine portion 胰岛 pancreatic islet 高血糖素glucagon 胰岛素insulin 生长抑素somatostatin肝小叶hepatic lobule 肝板 (hepatic plate) 肝血窦 (hepatic sinusoid) 中央静脉(central vein)门管区portal area 小叶间动脉 (interlobular arteries) 小叶间静脉 (interlobular veins) 小叶间胆管 (interlobular bile ducts)肝细胞 (hepatocyte)胆小管（bile canaliculus）枯否（kupffer）细胞窦周隙（Disse 隙） 贮脂细胞 Fat-storing cell消化系统发生原始消化管 (primitive gut) 盲肠突 caecal bud生理性脐疝 Physiological umbilical hernia泄殖腔 cloaca 尿生殖窦 Urogenital sinus 肛直肠管 Anorectal canal尿直肠隔 Urorectal septum泄殖腔膜 cloacal membrane 尿生殖膜 Urogenital membrane 肛膜 anal membrane肝憩室 Hepatic diverticulum背胰芽 Dorsal pancreatic bud腹胰芽 Ventral pancreatic bud消化管狭窄 Digestive tract stenosis消化管闭锁 Digestive tract atresia先天脐疝 Congenital umbilical hernia卵黄蒂瘘（脐粪瘘） Viteline fistula (umbilical fistula)回肠憩室（Meckel憩室） Meckel diverticulum不通肛 imperforate anus 肛门闭锁先天巨结肠 Congenical megacolon胆道闭锁 Hepatic biliary atresiapepsinamylase, lipase, trypsin, chymotrypsin淀粉酶，脂肪酶，胰蛋白酶，糜蛋白酶lactase, sucrase, maltase乳糖酶，蔗糖酶，麦芽糖酶secretin, gastrin分泌素，胃泌素Receptive relaxation容受性舒张Muscle tone肌紧张basic electrical rhythm基本电节律interstitial cells of Cajal (ICCCajal间质细胞Types of motility Tonic contractions(紧张性收缩) Propulsive peristalsis (蠕动) Reverse peristalsis (antipropulsion, 逆蠕动) Mass movements (集团运动)，见于大肠 Nonpropulsive segmentation (分节运动） Haustration(袋状运动) nonpropulsive contraction of thelarge intestine Migrating motor complex (移行性复合运动)occurs infasted states =migrating myoelectric complexSecretory functions - Exocrine secretion(digestive juices)Saliva: -amylase breaks down starch; taste; antimicrobialGastric juice HCl denatures protein & facilitates Fe2+ absorption; Pepsin hydrolyzes protein but not essential; Intrinsic factor protects VitB12 & facilitates its absorption; Mucus & HCO3- protects the epitheliumPancreatic juice: Enzymes for sugar, protein & fats; essentialfor chemical digestion of nutrients.Bile: bile acid facilitates digestion & absorption of fatsIntestinal juice: enterokinase to activate pancreatic enzymesBrush border enzymes: final digestion of nutrientsStimulatory & inhibitory events occur in three phasesCephalic phase: prior to food entryGastric phase: once food enters the stomachIntestinal phase: as partially digested food enters theduodenum主要在胃液和胰液分泌中有叙述。sphincter 括约肌Abdominal Pain Hematemesis and Hematochezia 呕血便血Diarrhea 腹泻Jaundiceintermittent间歇性, colicky绞痛periumbilical(脐周）supraumbilical（脐上）infraumbilial area （脐下） IBS and constipation 肠易激综合征和便秘Associated manifestations伴随症状PQRST：provocative-palliative factors诱因和缓解因素 quality性质 region部位 severity严重程度 temporal characteristics持续时间EsophagitisMallory-Weiss tearsEsophageal carcinoma 食管炎，食管贲门粘膜撕裂症Mallory-Weiss tears，食管癌Hematemesis（呕血）Melena（黑便）Hematochezia（便血）Faecal occult blood（粪便隐血）Ruptured AAA （abdominal aortic aneurysm）腹主动脉瘤破裂Peptic ulcer 消化道溃疡Acute gastric mucosal lesions 急性胃粘膜出血Alcohol, aspirin, NSAIDs, stressGE varices胃底，食管 静脉曲张Mallory-Weiss tears 食管喷门粘膜撕裂症Dieulafoys lesionorthostatic hypotension体位性低血压Tenesmus 里急后重 sepsis 败血症Miscellaneous 其他Osmotic 渗透性Secretory分泌性Exudation渗出性Abnormal motility 动力性腹泻Occult jaundice ：17.134.2mol/LClinical jaundice: 34.2mol/L xiphoid (ensiform) process(剑状突起) of sternum(胸骨) costal margin肋弓缘 umbilicus脐 anterior superior iliac spine髂前上棘 inguinal ligament 腹股沟韧带 superior margin of os pubis耻骨上缘 anterior midline/midabdominal line 腹中线 lateral border of rectus muscles 腹直肌外缘 symphysis pubis (耻骨联合) Left upper quadrant，LUQ 左上腹Left lower quadrant，LLQ 左下腹Right hypochondrial region 右季肋部Right lumber region 右腰部Right iliac region 右髂部Epigastric region上腹部Umbilical region脐部Hypogastric region下腹部 abdominal contour 腹部外形 Normal abdominal flatness(腹部平坦) abdominalfullness(腹部饱满) abdominal lowness(腹部低平) abdominal protuberance (bulge) 腹部膨隆 Overall/ generalized abdominal protuberance/bulge 全腹膨隆 ascites腹水umbilical hernia肚脐鼓出（脐疝） Peritoneal air 腹腔积气 Pneumoperitoneum气腹 Local abdominal bulge局部膨隆Abdominal concavity/ retraction 腹部凹陷 overall abdominal retraction and local abdominal retraction全副凹陷和局部凹陷Scaphoid abdomen 舟状腹腹壁Cullen signGrey-Turner signabdominal wall varicosis(腹壁静脉曲张 Auscultation of Abdomen：bowel sound Normal 正常：4-5次/分 Active 活跃：10次/分 Hyperactive 亢进：次数多、调高 Decreased 减弱：少于1次/分 Disappeared 消失：3-5分Tympany(鼓音)the upper border of liver(肝上界)/the relative dullness border ofliver(肝相对浊音界). : along the right midclavicular line(右锁骨中线), right midaxillary line(右腋中线), and right scapular line(右肩胛线).from resonance downward into dullness 清音变浊音absolute dullness border of liver(肝绝对浊音界), without lungcovering, and also called the lower border of lung(肺下界）from dullness into flatness(实音)along the right midclavicular line or anterior midline正中线. 移动性浊音shifting dullness水坑试验Puddle testpalpation触诊palpate all areas counterclockwise and superficially from leftlower quadrant screening for tenseness(紧张度), tenderness(压痛), masses肿块, etc. 浅部触诊(light palpation) 深部触诊(deep palpation) 深部滑行触诊(deep slipping palpation)：腹腔包块、器官 双手触诊(bimanual palpation)：肝、脾、肾、腹腔肿物。 深压触诊 (deep press palpation): 确定腹腔压痛点与反跳痛 冲击（浮沉）触诊(ballottement): 适用于腹部大量积液时肝脾及腹腔包块难以触及者rebound tenderness反跳痛abdominal tenseness腹壁紧张度abdominal tenseness腹壁紧张度Board-like rigidity 板状腹 Dough kneading sensation 揉面感；柔韧感 tuberculosis peritonitis or cancerous peritonitis 结核性腹膜炎、肿瘤腹膜转移peritoneum(壁层腹膜) appendicitis(阑尾炎压痛(tenderness) 反跳痛(rebound tenderness)局限性腹膜炎circumscribed peritonitis腹膜刺激征（peritoneal irritation sign)腹部检查Abdominal Examinationxiphoid (ensiform) process(剑状突起) of sternum(胸骨) costal margin肋弓缘 umbilicus脐 anterior superior iliac spine髂前上棘 inguinal ligament 腹股沟韧带 superior margin of os pubis耻骨上缘 anterior midline/midabdominal line 腹中线 lateral border of rectus muscles 腹直肌外缘 symphysis pubis (耻骨联合)Right upper quadrant 右上腹Left lower quadrant左下腹腹部九分法Right hypochondrial region右季肋部Right lumber region右腰部Right iliac region右髂部Epigastric region上腹部Umbilical region脐部Hypogastric region下腹部Normal abdominal flatness(腹部平坦) abdominal fullness(腹部饱满) abdominal lowness(腹部低平) abdominal protuberance (bulge) 腹部膨隆 Overall/ generalized abdominal protuberance/bulge 全腹膨隆 ascites腹水umbilical hernia肚脐鼓出Local abdominal bulge局部膨隆 Abdominal concavity/ retraction 腹部凹陷 Overall abdominal concavity/retraction 全腹凹陷Scaphoid abdomen 舟状腹cachexia(恶病质) abdominal wall varicosis(腹壁静脉曲张 the head of medusa(水母) caput medusae(海蛇神头) gastral or intestinal pattern(胃型或肠型) and peristalsis(蠕动波)肠鸣音 Normal 正常：4-5次/分 Active 活跃：10次/分 Hyperactive 亢进：次数多、调高 Decreased 减弱：少bowel sound于1次/分 Disappeared 消失：3-5分Tympany(鼓音the upper border of liver(肝上界) : along the right midclavicularline(右锁骨中线), right midaxillary line(右腋中线), and rightscapular line(右肩胛线). relative dullness border of liver(肝相对浊音界).flatness(实音absolute dullness border of liver(肝绝对浊音界), without lungcovering, and also called the lower border of lung(肺下界). Shifting dullness 移动性浊音Elbow-knee position - puddle test 水坑试验Huge ovarian cyst 巨大卵巢囊肿Ruler pressing test 压尺试验rebound tenderness 反跳痛 tenderness压痛abdominal tenseness 腹壁紧张度 abdominal softness (腹壁柔软).Board-like rigidity 板状腹Dough kneading sensation 揉面感；柔韧感 Texture/quality质地 Three grades: softness(质软), toughness(质韧), andhardness(质硬). Normal: soft and tender, like the pouted(撅嘴) lip In acute hepatitis / fatty liver: slightly tough. chronic hepatitis: more tough, usually as tough as apexnasi(鼻尖) liver cirrhosis: hard. liver carcinoma: extremely hard, even as hard as forehead(前额) Pulsation搏动unidirectional(单向性) or expansile(扩张性)Jugular Vein Distention（颈静脉怒张） and HepatojugularReflux Sign （肝颈静脉回流征）chronic myelocytic leukemia (CML) (慢性粒细胞性白血病)Myelofibrosis(骨髓纤维化)angioma(血管瘤)Courvoisier sign. Murphys sign尿路感染的5个压痛点前3hypochondriac point 季肋点：第十肋骨前端【肾病变】point of upper ureter上输尿管点：脐水平线腹直肌外缘Middle ureteral point 中输尿管点：髂前上棘水平腹 肌外缘 ）【输尿管结石、结核或化脓性炎症】；后2vertebrocostal point 肋脊点：第12肋骨与 脊柱的夹角顶点costolumbar point 肋腰点：第12肋与腰肌外缘的夹角顶点）【压痛：炎症肾盂肾炎、肾脓肿、肾结核；叩击痛：炎症深隐于实质内】Fluid wave thrill (液波震颤)Succussion Splash振水音pericarditis(心包炎)pericardiac tamponade(心包压塞) glomerulonephritis(肾小球肾炎)of thoracic duct(胸导管) or cisterna chyli (乳糜池)Fallopian tube(输卵管) myxedema(粘液性水肿)exudate(渗出液) and transudate(漏出液) Serum-Ascites Albumin Gradient, SAAG (血清-腹水白蛋白梯度) Anal fissure（肛裂）Hemorrhoids 痔Internal hemorrhoidsExternal hemorrhoidsmixed hemorrhoids Proctoptosis（直肠脱垂Digital rectal examination (直肠指检肛外检查：observing whether there is an induration, lump,tenderness, or fluctuation; and scrutinizes whether there is asubcutaneous fistula on the externa anus.有无硬结、肿物和压痛，有无波动感，并检查肛外皮下有无瘘管等肛内检查：Anus and anal sphincter tone, anal internal wall,tenderness, mucosal smoothness, lump fluctuation, prostate ,cervix , etc. 肛门及括约肌紧张度、内壁、压痛、粘膜光滑度，肿块波动感、前列腺、子宫颈等Digestive System and Drug Therapy消化系统与药物治疗Pharmacologic agents 药物抗酸药Antacids 西米替丁 cimetidine 雷尼替丁 ranitidine奥美拉唑omeprazole质子泵抑制剂H+-K+-ATPase inhibitor(proton pump inhibitor) 硫糖铝 sucralfate5-氨基水杨酸 5-aminosalicylic acid 水飞蓟素 silymarin奥曲肽（octreotide）神经系统，ppt里边有很多英文语句，复习时必须要扫来看axon轴突axon hillock轴丘synaptic cleft突触间隙spinal cord脊髓cortex皮质medulla髓质fasciculus纤维束reticular formation网状结构cauda equina马尾cerebrospinal fluid，CSF脑脊液Brain stem脑干Medulla oblongata 延髓Pons 脑桥Midbrain 中脑Decussation of pyramid 锥体交叉Anterolateral sulcus 前外侧沟Olive 橄榄Retroolivary sulcus 橄榄后沟Gracile tubercle 薄束结节Cuneate tubercle 楔束结节Inferior cerebellar peduncle 小脑下脚Basilar part 基底部Basilar sulcus 基底沟Bulbopontine sulcus 延髓脑桥沟Middle cerebellar peduncle 小脑中脚Trigeminal nerve 三叉神经Pontocerebellar triagone 脑桥小脑三角Superior cerebellar peduncle 小脑上脚Superior medullary velum上髓帆Trochlear nerve 滑车神经Crus cerebri 大脑脚Interpeduncular fossa 脚间窝 Posterior perforated substance 后穿质Brachium of superior colliculi 上丘臂Brachium of inferior colliculi 下丘臂Median sulcus 正中沟Facial colliculus 面神经丘Medial eminence 内侧隆起Sulcus limitans 界沟Locus ceruleus 蓝斑Vestibular area 前庭区 Acoustic tubercle 听结节Striae medullares 髓纹Hypoglossal triangle 舌下神经三角Vagal triangle 迷走神经三角:Funiculus separans 分隔索Area postrema 最后区Obex 闩Fourth ventricle 第四脑室Median aperture of fourth ventricle 第四脑室正中孔lateral apertures of fourth ventricle 第四脑室外侧孔General somatic motor nuclei 一般躯体运动核oculomotor nucleus 动眼神经核trochlear nucleus 滑车神经核abducent nucleus 展神经核hypoglossal nucleus 舌下神经核Special visceral motor nuclei 特殊内脏运动核motor nucleus of trigeminal n. 三叉神经运动核facial nucleus 面神经核nucleus ambiguus 疑核 spinal accessory nucleus 副神经核General visceral motor nuclei 一般内脏运动核D:Daccessory oculomotor nucleus 动眼神经副核superior salivatory nucleus 上泌涎核inferior salivatory nucleus 下泌涎核dorsal nucleus of vagus n. 迷走神经背核Visceral sensory nuclei ( general and special )一般、特殊内脏感觉核nucleus of solitary tract 孤束核General somatic sensory nuclei 一般躯体感觉核mesencephalic nucleus of trigeminal n. 三叉神经中脑核pontine nucleus of trigeminal n. 三叉神经脑桥核spinal nucleus of trigeminal n. 三叉神经脊束核Special somatic sensory nuclei 特殊躯体感觉核cochlear nuclei 蜗神经核vestibular nuclei 前庭神经核Relay nuclei 中继核gracile nucleus 薄束核cuneate nucleus 楔束核inferior olivary nucleus 下橄榄核superior olivery nucleus 上橄榄核pontine nucleus 脑桥核nucleus of inferior colliculus 下丘核gray matter of superior colliculus 上丘灰质red nucleus 红核substantia nigra 黑质pretectal area 顶盖前区decussation of medial lemniscus 内侧丘系交叉 medial lemniscus 内侧丘系accessaory cuneate nucleus 楔束副核 nucleus of lateral lemniscus 外侧丘系核inferior colliculus 下丘核 gray matter of superior colliculus 上丘灰质 pretectal region 顶盖前区 substantia nigra 黑质 substantia nigra pars compacta 黑质致密部 substantia nigra pars reticulata 黑质网状部ventral tegmental area 腹侧被盖区 Ascending tractsMedial lemniscus 内侧丘系Spinal lemniscus 脊髓丘系(Spinothalamic tract 脊髓丘脑束)Trigeminal lemniscus 三叉丘系Lateral lemniscus 外侧丘系Descending tractsCorticospinal tract 皮质脊髓束Rubrospinal tract红核脊髓束Tectospinal tract顶盖脊髓束Vestibulospinal tract前庭脊髓束Reticulospinal tract 网状脊髓束Ascending reticular activating system (ARAS) 上行网状激动系统Decussations of pyramid 锥体交叉Tegmentum of pons 脑桥被盖Basis Pontis 基底部pontine nuclei 脑桥核Inferior colliculus 下丘Superior colliculus上丘Medial (basal) medullary syndrome 延髓内侧综合征Lateral medullary, or Wallenbergs, syndrome 延髓外侧综合征Basal pontine syndrome 脑桥基底部综合征 alternating abducens hemiplegia 展神经交叉性偏瘫Dorsal pons syndrome 脑桥背侧部综合征Peduncular syndrome 大脑脚底综合征alternating oculomotor hemiplegia动眼神经交叉性偏瘫(Weber s, syndrome)Benedikts syndrome 本尼迪克特综合征 Cerebellum 小 脑cerebellar hemisphere 小脑半球vermis 小脑蚓Tonsil of cerebellum 小脑扁桃体 Dentate nucleus 齿状核medullary center 髓体Fastigial nucleus 顶核Globose nucleus 球状核Emboliform nucleus 栓状核Interposed nucleus 中间核Primary fissure 原裂Posterolateral fissure 后外侧裂Flocculonodular lobe 绒球小结叶 Archicerebellum 原小脑Paleocerebellum 旧小脑 Neocerebellum 新小脑 Vestibulocerebellum 前庭小脑Flocculonodular lobeSpinocerebellum 脊髓小脑Vermis and intermediate zoneCerebrocerebellum 大脑小脑Lateral zoneThe Diencephalon 间 脑Dorsal thalamus 背侧丘脑Metathalamus 后丘脑Epithalamus 上丘脑Subthalamus 底丘脑Hypothalamus 下丘脑anterior thalamic tubercle 丘脑前结节 ,Pulvinar 枕interthalamic adhesion 丘脑间粘合 internal medullary lamina （内髓板）. YAnterior nuclear group 前核群Medial nuclear group 内侧核群Lateral nuclear group 外侧核群Internal medullary lamina 板内核 Med. nuclear group 内侧核群 Ant. nuclear group 前核群Ventral anterior 腹前核Ventral intermediate 腹中间核 Ventral posterolateral (VPL) 腹后外侧核 Ventral posteromedial (VPM ) 腹后内侧核Lateral geniculate body (LGN) 外侧膝状体Medial geniculate body (MGN) 内侧膝状体Pulvinar 丘脑枕Dorsal nuclear group 背侧核群Nonspecific relay nuclei 非特异性中继核团（古丘脑）Midline nucleus group 第三脑室侧壁上的中线核Intralaminar nuclear group 内髓板中的板内核Thalamic reticular nucleus 外髓板外的网状核 接受嗅脑、脑干网状结构传入，传出至下丘脑、纹状体； 上行激动系统至大脑，参与醒觉Association nuclei 联络核团（新丘脑）Anterior nuclear group 前核群Medial nuclear group 内侧核群Dorsal tier of lateral nuclear group 外侧核群的背层 与大脑皮质有往返的纤维联系 与情感、学习记忆有关Special relay nuclei 特异性中继核团（旧丘脑）Vent. anterior nucleus (VA) 腹前核Vent. intermediate nucleus (VI) 腹中间核 Receiving dentate nucleus, globus pallidus and substantianigra to motor cortexVentral posterior nucleus (VPN) 腹后核:Vent. posteromedial nucleus (VPM) 腹后内侧核receives trigeminal lemniscus and teste fibersVent. posterolateral nucleus (VPL) 腹后外侧核receives medial lemniscus and spinal lemniscus Projects to first somatic sensory area via central thalamicradiation传导感觉； 皮质下感觉中枢，可能感知粗略痛觉 optic radiation 视辐射acoustic radiation 听辐射Epithalamus 上丘脑IncludesThalamic medullary stria 丘脑髓纹Habenular trigone 缰三角含缰核Habenular commissure 缰连合Pineal body 松果体 属内分泌器官，产生褪黑素，posterior commissure 后连合Hypothalamus 下丘脑Superiorly: hypothalamic sulcusInferiorly:optic chiasma 视交叉tuber cinereum 灰结节Infundibulum 漏斗hypophysis 垂体mamillary body 乳头体Anterior: lamina terminalis 终板Posterior: continues with midbrain tegmentumSupraoptic nucleus 视上核produce vasopressin 加压素Paraventricular nucleus 室旁核produce oxytocin 催产素Infundibular nucleus 漏斗核Mamillary nucleus 乳头体核hypophysial portal veins 垂体门脉Telencephalon 端 脑Cerebral cortex大脑皮质Sulcus 沟 Gyrus 回Cerebral longitudinal fissure 大脑纵裂Corpus callosum 胼胝体Cerebral transverse fissure 大脑横裂Central sulcus 中央沟Parietooccipital sulcus 顶枕沟Lateral sulcus 外侧沟Central sulcus 中央沟frontal lobe 额叶Parietal lobe 顶叶Occipital lobe 枕叶Temporal lobe 颞叶Insular lobe 岛叶The gyri and sulci of the frontal lobe 额叶的脑沟和脑回Precentral sulcus 中央前沟Precentral gyrus 中央前回Superior frontal sulcus 额上沟Inferior frontal sulcus 额下沟Superior,middle and inferioe frontal Gyri 额上、中、下回The gyri and sulci of the parietal lobe 顶叶的脑沟和脑回 Postcentral sulcus 中央后沟Superior parietal lobule 顶上叶Intraparietal sulcus 顶内沟Supramarginal gyrus 缘上回Angular gyrus 角回Postcentral gyrus 中央后回The gyri and sulci of the temporal lobe 颞叶的脑沟和脑回Superior temporal sulcus 颞上沟 Inferior temporal sulcus 颞下沟Inferior temporal gyrus 颞下回Superior temporal gyrus 颞上回 Middle temporal gyrus 颞中回The gyri and sulci of the medial surfaces of the hemisphere半球内侧面的脑沟和脑回Paracentral lobule 中央旁小叶Corpus callosum 胼胝体Callosal sulcus 胼胝体沟Paracentral lobule 中央旁小叶Parietooccipital sulcus 顶枕沟Cuneus 楔叶Calcarine sulcus 距状沟Lingual gyrus 舌回Hippocampal sulcus 海马沟Collateral sulcus 侧副沟Lateral occipitotemporal gyrus 枕颞外侧回Medial occipitotemporal gyrus 枕颞内侧回Parahippocampal gyrus 海马旁回Uncus 钩Cingulate sulcus 扣带沟cingulate gyrus 扣带回fornix 穹隆Hippocampal formation 海马结构Dentate gyrus 齿状回Hippocampus 海马Limbic lobe 边缘叶: 包括隔区、扣带回、海马旁回、海马和齿状回、岛叶前部和颞极The gyri and sulci of the inferior surface of the hemisphere 半球下面的脑沟和脑回Olfactory bulb 嗅球olfactory tract 嗅束orbital gyri 眶回olfactory trigone 嗅三角anterior perforated substance 前穿质first somatic motor area 第1躯体运动区Located in precentral gyrus and anterior portion of paracentrallobule 中央前回、中央旁小叶前半，视觉区 visual area Lie on either side of calcarine sulcus inmedial surface of occipital lobe 距状沟两侧的皮质听觉区 auditory area Located in transverse gyri 颞横回 嗅觉区 olfactory area: 海马旁回钩的内侧部味觉区 gustatory area: 岛盖皮质、岛叶皮质前部平衡觉区 vestibular area运动性语言中枢 motor speech area书写中枢 writing area听觉性语言中枢 auditory speech area视觉性语言中枢 visual speech arealateral ventricles 侧脑室 interventricular foramen 室间孔 basal nuclei 基底核 caudate nucleus 尾状核（头、体、尾）amygdaloid 杏仁体lenticular nucleus 豆状核claustrum 屏状核lenticular nucleus 豆状核Putamen 壳Globus pallidus 苍白球neo-Striatum 新纹状体pale- Striatum 旧纹状体cerebral white matter 大脑髓质 Commissural fibers 连合纤维corpus callosum (rostrum , genu, body and splenium) 胼胝体、anterior commissure前连合 、fornix穹隆 ,fornical commissure穹隆联合 ssociation fibers联络纤维a: 短的联络纤维：arcuate fibers 弓状纤维;长的联络纤维：uncinate fasciculus 钩束、superior longitudinal fasciculus 上纵束 、inferior longitudinal fasciculus 下纵束、扣带Projecting fibers 投射纤维 ：internal capsule 内囊anterior limb 前肢genu 膝posterior limb 后肢 Limbic system 边缘系统 septal area 隔区basal forebrain 基底前脑 sensory pathway 感觉传导通路 (ascending pathway上行传导通路 )deep sensation 深感觉 conscious proprioceptive and fine touch pathway of trunk andlimbs 躯干、四肢意识性本体感觉和精细触觉传导通路中央后回 postcentral gyrus 的中上部和中央旁小叶paracentral lobule后部、中央前回 precentral gyrus 内囊后肢 posterior limb of internal capsule第三级神经元（背侧丘脑腹后外侧核ventral posterolateralnucleus） 内侧丘系 medial lemniscus 内侧丘系交叉 decussation of medial lemniscus第二级神经元（薄束和楔束核 gracile nucleus cuneate nucleus） 脊髓薄束和楔束 fasciculus gracilis fasciculus cuneatus 脊神经后根的内侧部 中枢突 central process第一级神经元（脊神经节spinal ganglia） 周围突 peripheral process 躯干四肢的肌腱关节等处的深部感受器 Proprioceptor of muscle, tendon, periosteum and joint和精细触觉感受器 proprioception, fine touch information非意识性本体感觉传导通路 unconscious proprioceptivepathway躯干、四肢痛温觉、粗触觉和压觉传导通路 pain, temperatureand simple touch pathway of trunk and limbs中央后回中、上部和中央旁小叶的后部 cortex of the superiorand middle parts of the postcentral gyrus, and cortex of theposterior part of the paracentral lobule 内囊后肢 posterior limb of internal capsule第三级神经元（丘脑腹后外侧核 ventral posterolateral nucleus 脊髓丘脑侧束（痛、温觉） 脊髓丘脑前束（粗略触觉） thalamocortical tract 斜越1-2脊髓节段交叉 anterior white commisure （白质前连合）第二级神经元（ posterior horn of the spinal cord 第I , IV -层） 后根外侧部（痛、温觉） 后根内侧部（粗略触觉） 背外侧束 dorsal lateral tract 中枢突 central process第一级神经元（脊神经节） dorsal root ganglion 周围突 peripheral process 躯干四肢皮肤内的感受器 receptor on the trunk and limbs头面部的痛温觉和触压觉传导通路 pain, temperature andsimple touch pathway of head and face 中央后回的中下1/3部 cortex of the inferior parts of thepostcentralgyrus 内囊后肢 posterior limb of internal capsule第三级神经元（丘脑腹后内侧核 ventral posteromedial nucleusof thalamic ） 形成三叉丘系 trigeminal lemniscus 交叉到对侧decussation第二级神经元（三叉神经脑桥核 trigeminal potine nucleus和三叉神经脊束核trigeminal spinal nucleus ） 升支（触压觉）和降支（痛温觉 trigeminal spinal tract ） 三叉神经感觉根sensory root of trigeminal nerve 中枢突central process 第一级神经元（三叉神经节 trigeminal ganglion ） 周围突 peripheral process 三叉神经 trigeminal nerve的感觉支头面部皮肤 口鼻腔粘膜的浅部感受器Peripheral receptor onthe head and face 视觉传导通路 visual pathway 感受器（视锥和视杆细胞rod cell cone cell）第一级神经元（双极细胞 bipolar cell）第二级神经元（节细胞 ganglionic cell）视神经 optic nerve视交叉 optic chiasma（鼻侧半纤维交叉，颞侧半不交叉）视束 optic tract第三级神经元（外侧膝状体lateral geniculate body）视辐射optic radiation内囊后肢 posterior limb of internal capsule距状沟 calcarine sulcus 周围皮质视觉传导通路的不同部位损伤所引起的视野 visual field的变化： a.一侧视神经optic nerve损伤-患侧视野全盲total blindness。 b.视交叉optic chiasma.中央部（交叉纤维）损伤-双侧视野颞侧半偏盲bitemporal hemianopsia。 c.一侧视束视辐射或视觉中枢optic tract, optic radiation or opticcentre损伤-双眼视野对侧同向性偏盲homonymoushemianopsia（即患侧视野鼻侧半偏盲和健侧视野颞侧半偏盲） d.视交叉外侧部损伤- 患侧视野鼻侧偏盲nasal hemianopsia。瞳孔对光反射 pupillary light reflex光线视网膜retina视神经optic nerve视交叉optic chiasma视束optic tract部分纤维经上丘臂 brachium of superiorcolliculus顶盖前区 pretectal center双侧动眼神经副核 accessory nucleus of oculomotor nerve,Edinger-Westphals nucleus动眼神经 oculomotor nerve睫状神经节 ciliary ganglion瞳孔扩约肌 sphincter pupillae直接对光反射direct pupillary light reflex间接对光反射indirect pupillary light reflex听觉传导通路 auditory pathway平衡觉传导通路 equlibrium pathway嗅觉区 olfactory area: 海马旁回钩的内侧部运动传导通路 motor pathway（下行传导通路 descendingpathway ）锥体系 pyramidal system上运动神经元 upper motor neurons下运动神经元 lower motor neurons 皮质脊髓束 corticospinal tract皮质核束 corticonuclear tract痉挛性瘫痪 spastic paralysis弛缓性瘫痪 flaccid paralysisextrapyramidal system 锥体外系脑和脊髓被膜、血管及脑脊液循环脊髓的被膜 The meninges of spinal cordspinal dura mater 硬脊膜spinal arachnoid mater 脊髓蛛网膜spinal pia mater 软脊膜epidural space 硬膜外隙Position: lies between spinal dura mater and periosteum ofvertebral canalContents: a quantity of loose connective tissue, fat, lymphaticvessels and vertebral venous plexus, the spinal nerves oneach side pass through the epidural space which is applicablefor block anesthesiasubdural space 硬膜下隙Subarachnoid space 蛛网膜下隙Terminal cistern 终池Denticulate ligament 齿状韧带: extending from spinal cord oneach side between anterior and posterior roots of spinal nervesto spinal dura mate; these ligaments help to fix position ofspinal cord.脑的被膜 the meninges of brainCerebral dural mater 硬脑膜Cerebral arachnoid mater 脑蛛网膜Cerebral pia mater 软脑膜硬脑膜外层骨内膜层 endosteal layer，内层脑膜层 meningeal layerIt is in loose contact with calvaria颅骨, and most stronglyadherent to base of skull颅底septa of cerebral dural matercerebral falx 大脑镰tentorium of cerebellum 小脑幕in front there is a gap, thetentorial incisure 幕切迹, for passage of midbraincerebellar falx 小脑镰diaphragma sellae 鞍隔sinuses of dura mater 硬脑膜窦Superior sagittal sinus 上矢状窦Inferior sagittal sinus 下矢状窦Straight sinus 直窦Confluence of sinus 窦汇 Transverse sinus 横窦Sigmoid sinus 乙状窦Superior petrosal sinuses 岩上窦inferior petrosal sinuses 岩下窦Cavernous sinus 海绵窦Position: lies on each side of sella turcicaRelations of cavernous sinus:internal carotid artery and abducent nerve run through thesinusoculomotor and trochlear nerves and ophthalmic and maxillarydivisions of trigeminal nerve lie in the lateral 脑蛛网膜 cerebral arachnoid materCharacters: a delicate membrane covering brain loosely,passing over sulci and entering only cerebral longitudinal andtransverse fissuresArachnoid granulations 蛛网膜粒 project into sinuses of dura mater, serve as sites wherecerebrospinal fluid diffuses into bloodstreamSubarachnoid cisterns 蛛网膜下池Cerebellomedullary cistern 小脑延髓池arteries of brainTwo sourcesInternal carotid artery: supplies anterior 2/3 of cerebralhemisphere and parts of diencephalonVertebral artery: supplies postterior 1/3 of cerebral hemisphereand parts of diencephalon, brain stem and cerebellum颈内动脉 internal carotid artery Anterior cerebral artery 大脑前动脉 Middle cerebral artery 大脑中动脉 Anterior choroidal artery 脉络丛前动脉 Posterior communicating artery 后交通动脉Anterior cerebral artery 大脑前动脉Joined by the anterior communicating arteryCortical branches: supply medial surface of the cerebral cortexCentral branches: supply caudate nucleus, anterior part oflentiform nucleus and anterior limb of internal capsulemiddle cerebral artery 大脑中动脉Cortical branches: supply most of superolateral surface ofcerebral hemisphere and insular lobeCentral branches: supply lentiform and caudate nuclei, genuand posterior limb of internal capsule (lenticulostriate artery)anterior choroidal artery 脉络丛前动脉 It supplies lateral geniculate body, posterior limb of internalcapsule, middle 1/3 of crus cerebri,and globus pallidus posterior communicating artery后交通动脉:vertebral artery 椎动脉anterior and posterior spinal arteries 脊髓前、后动脉posterior inferior cerebellar artery 小脑下后动脉basilar artery 基底动脉 branches ： labyrinthine artery 迷路动脉 anterior inferior cerebral artery 小脑下前动脉 pontine arteries 脑桥动脉 superior cerebellar artery 小脑上动脉 posterior cerebral artery 大脑后动脉 posterior cerebral artery 大脑后动脉 Cortical branches: supply medial and inferior surfaces oftemporal lobe and occipital lobe Central branches: supply dorsal thalamus, medial andlateral geniculate bodies, hypothalamus and subthalamuscerebral arterial circle ( circle of Willis )Formation: formed by anterior communicating artery, bothanterior cerebral arteries, internal carotid arteries, posteriorcommunicating arteries, and posterior cerebral arteriesPosition: lies on sella turcica around optic chiasma, tubercinereum and mamillary bodies veins of brain 脑的静脉1）external cerebral veins (superficial cerebral veins)Superior, middle, inferior cerebral veinsempty into adjacent sinuses of dura mater2）internal cerebral veins (deep cerebral veins) form great cerebral vein which enter straight sinus脊髓的动脉arteries of spinal cord Two sources Anterior and posterior spinal arteries Branches of segmental arteries: radicular arteries of posterior intercostals arteries, lumbararteries, and lateral sacral arteries脊髓的被膜 The meninges of spinal cordspinal dura mater 硬脊膜spinal arachnoid mater 脊髓蛛网膜spinal pia mater 软脊膜epidural space 硬膜外隙subdural space 硬膜下隙Subarachnoid space 蛛网膜下隙脑的被膜 the meninges of braincerebral dural mater 硬脑膜Cerebral arachnoid mater 脑蛛网膜Cerebral pia mater 软脑膜硬脑膜 cerebral dural mater外层为骨内膜层 endosteal layer，内层为脑膜层 meningeallayer.It is in loose contact with calvaria颅骨, and most stronglyadherent to base of skull颅底cerebral falx 大脑镰tentorium of cerebellum 小脑幕in front there is a gap, thetentorial incisure 幕切迹, for passage of midbraincerebellar falx 小脑镰diaphragma sellae 鞍隔sinuses of dura mater 硬脑膜窦Superior sagittal sinus 上矢状窦Inferior sagittal sinus 下矢状窦Straight sinus 直窦Confluence of sinus 窦汇Transverse sinus 横窦Sigmoid sinus 乙状窦Superior petrosal sinuses 岩上窦inferior petrosal sinuses 岩下窦Cavernous sinus 海绵窦Position: lies on each side of sella turcicaRelations of cavernous sinus:internal carotid artery and abducent nerve run through thesinusoculomotor and trochlear nerves and ophthalmic and maxillarydivisions of trigeminal nerve lie in the lateral wall Cerebellomedullary cistern 小脑延髓池Interpeduncular cistern 脚间池颈内动脉 internal carotid artery Anterior cerebral artery 大脑前动脉 Cortical branches: supply medial surface of the cerebralcortex Central branches: supply caudate nucleus, anterior part oflentiform nucleus and anterior limb of internal capsule Middle cerebral artery 大脑中动脉 Cortical branches: supply most of superolateral surface ofcerebral hemisphere and insular lobe Central branches: supply lentiform and caudate nuclei,genu and posterior limb of internal capsule (lenticulostriateartery) Anterior choroidal artery 脉络丛前动脉 It supplies lateral geniculate body, posterior limb ofinternal capsule, middle 1/3 of crus cerebri,and globus pallidus Posterior communicating artery 后交通动脉椎动脉 vertebral arteryanterior and posterior spinal arteries 脊髓前、后动脉posterior inferior cerebellar artery 小脑下后动脉basilar artery 基底动脉branches ： labyrinthine artery 迷路动脉 anterior inferior cerebral artery 小脑下前动脉 pontine arteries 脑桥动脉 superior cerebellar artery 小脑上动脉 posterior cerebral artery 大脑后动脉 Cortical branches: supply medial and inferior surfaces oftemporal lobe and occipital lobe Central branches: supply dorsal thalamus, medial andlateral geniculate bodies, hypothalamus and subthalamuscerebral arterial circle ( circle of Willis )Formation: formed by anterior communicating artery, bothanterior cerebral arteries, internal carotid arteries, posteriorcommunicating arteries, and posterior cerebral arteriesPosition: lies on sella turcica around optic chiasma, tubercinereum and mamillary bodies 脑的静脉 veins of brain1) external cerebral veins (superficial cerebral veins)Superior, middle, inferior cerebral veins 2) internal cerebral veins (deep cerebral veins) form great cerebral vein which enter straight sinus脊髓的血管 The blood vessels of the spinal cordTwo sources Anterior and posterior spinal arteries Branches of segmental arteries: radicular arteries of posterior intercostals arteries, lumbararteries, and lateral sacral arteries脊髓的静脉 veins of spinal cord : drain into internal vertebral venous plexus 脑脊液及其循环 the cerebrospinal fluid (CSF) circulation (blood-brain barrier (BBB) 血-脑屏障(blood-CSF barrier) 血脑脊液屏障神经系统疾病ghost cell鬼影细胞central chromatolysis中央性尼氏小体溶解waller degenerationWaller变性gitter cell格子细胞microglial node小胶质细胞结节neuronophagia噬神经细胞现象Corpora amylacea淀粉小体satellitosis卫星现象Epidemic cerebrospinal meningitis流行性脑脊髓膜炎Epidemic encephalitis B流行性乙型脑炎Alzheimer disease阿尔茨海默病senile plaque老年斑neurofibrillary tangles，NFTs神经原纤维缠节Parkinsons disease,PD帕金森病药理学Sedative-hypnotic Drugs镇静催眠药diazepam地西泮benzodiazepine drugs, BZD)苯二氮卓类 barbiturates巴比妥类 Insomnia失眠Sedation and amnesia记忆缺失Epilepsy癫痫initial treatment 首选药Muscle relaxation中枢性肌肉松弛polysynaptic reflexes多突触反射Hangover effects (宿醉): 嗜睡、头昏、乏力及记忆力下降、精细运动不协调Rebound insomnia on discontinuation:停药困难Depress respiration (呼吸抑制)Tolerance（耐受性）Withdrawal syndrome（戒断症状） flumazenil氟马西尼(Barbiturates (巴比妥类Phenobarbital (苯巴比妥general anesthesia (全麻Preanesthetic medication (麻醉前给药Convulsions (惊厥Seizures (大发作status epilepticus (癫痫持续状态)Chloral hydrate (水合氯醛Antiepileptic Drugs(抗癫痫药)失神性发作(小发作, petit mal)强直阵挛性发作 (大发作, grand mal)(status epilepticus)癫痫持续状态 Phynotonin Sodium(苯妥英钠PTP (post tetanic potentiation, 强直后增强)Carbmazepine (卡马西平) Phenobarbital (苯巴比妥) Ethosuximide (乙琥胺Sodium Valproate (丙戊酸钠，德巴金)Magnesium Sulfate (硫酸镁Parkinsons disease (帕金森病，PD) Resting tremor (静止性震颤) Rigidity (肌强直) Bradykinesia (运动迟缓) Dementia (痴呆) Excessive salivationsubstantia nigra (黑质Levodopa ()左旋多巴, L-dopadopa-decarboxylase (多巴脱羧酶Sinemet (心宁美)carbidopa (卡比多巴Madopar (美多巴 On/off phenomenon “开-关”现象Antipsychotic drugs (抗精神病药Bromocriptine (溴隐亭Selegiline (司来吉兰Entacapone (恩他卡朋Trihexyphenidyl (苯海索，安坦Drugs for Alzheimers Disease阿尔茨海默病治疗药物 hippocampus (海马basal forebrain (前脑基底部amyloid plaques老年斑excitotoxicity兴奋性神经毒性Tacrine (他克林Donepezil ，Aricept 多奈哌齐 安理申Huperzine A石杉碱甲，双益平Memantine (美金刚,易倍申Xanomeline占诺美林Agents Against Psychiatric Disorders (抗精神失常药)Psychiatric Disorders(精神失常)Schizophrenia (精神分裂症) Depression (抑郁症) Mania (躁狂症) Anxiety (焦虑症) Representative DrugsSchizophrenia 氯丙嗪(chlorpromazine)Depression 氟西汀(fluoxetine)Mania 碳酸锂(lithium carbonate)Anxiety 苯二氮卓类(BZD)Antidepressive Drugs (抗抑郁药)Tricyclic Antidepressants (TCAs) 三环类抗抑郁药Imipramine (米帕明, 丙米嗪)了解即可选择性5-HT再摄取抑制药 (SSRIsFluoxetine (氟西汀, 百优解SNRIs (5-HT及NA再摄取抑制剂)Venlafaxine (文拉法辛)了解即可去甲肾上腺素和特异性5-羟色胺能抗抑郁药noradrenergic andspecific serotonergic antidepressant，NaSSAsMirtazapine (米氮平了解即可Deanxit (黛力新) 氟哌噻吨美利曲辛片Antianxiety Agent (抗焦虑药)Antipsychotic Drugs (抗精神病药)Conventional antipsychotic drugs（典型）：氯丙嗪=冬眠灵（wintermine)Atypical antipsychotic drugs(非典型)：氯氮平 Extrapyramidal syndromes (锥体外系反应)Parkinsonian-like syndrome (帕金森综合症) Akathisia (静坐不能)Acute dystonia (急性肌张力障碍)：W1，斜颈抗胆碱药可缓解Tardive dyskinesia (迟发性运动障碍)：1年后。 吸吮、舔舌等动作。停药后不易消失, 抗胆碱药可加重DA受体上调所致Antimanic Drugs (抗躁狂药)治疗药物 抗精神病药: Chlorpromazine (氯丙嗪) 抗癫痫药: Carbamazepine (卡马西平) Lithium carbonate (碳酸锂)Opioid Analgesics (镇痛药)快痛（sharp pain锐痛）：感觉清晰、定位明确、速发速退。慢痛（dull pain钝痛）：定位模糊、缓发缓退。绞痛（colic）：内脏平滑肌痉挛性收缩，难忍受。Morphine (吗啡)镇痛 analgesic effectSedation and euphoria 镇静和欣快感Cardiac asthma心源性哮喘 Antidiarrhea (止泻Codeine（可待因,甲基吗啡）Pethidine (哌替啶)=Dolantin (度冷丁)Methadone（美沙酮）Fentanyl (芬太尼) Pentazocine (喷他佐辛, 镇痛新) Naloxone（纳洛酮）Naltrexone (纳曲酮)Nonsteroidal Anti-inflammatory Drugs,(NSAIDs) (解热镇痛抗炎药),恩赛类药物解热(antipyretic)、镇痛(analgesic)，大多数还有抗炎(anti-inflammatory)Salicylates 水杨酸类Aspirin (阿司匹林)=Acetylsalicylic acid (乙酰水杨酸)Suppress platelet adhesion and aggregation (抑制血小板聚集)Acetaminophen (对乙酰氨基酚, 扑热息痛)Indomethacin (吲哚美辛) Celecoxib (塞来昔布)Nimesulide (尼美舒利)Local Anesthetics (局部麻醉药)Procaine, Tetracaine普鲁卡因,丁卡因Lidocaine, Bupivacaine 利多卡因,布比卡因 General Anesthetics(全身麻醉药)The neurophysiologic state produced by general anesthetics ischaracterized by five primary effects: unconsciousness,amnesia(记忆缺失), analgesia(痛觉缺失), inhibition ofautonomic reflexes, and skeletal muscle relaxation.Inhaled anesthetics (吸入性麻醉药)Intravenous anesthetics (静脉麻醉药)Minimum alveolar concentration, MAC(最小肺泡浓度，Vol%): Enflurane (恩氟烷), Isoflurane(异氟烷)Pentothal Sodium (硫喷妥钠)Propofol (丙泊酚)Ketamine (氯胺酮，K粉)分离麻醉 (dissociative anesthesia)Balanced Anesthesia (复合麻醉)Use combinations of intravenous and inhaled drugs to takeadvantage of the favorable properties of each agent whileminimizing their adverse effects. Premedication (麻醉前给药)Basal anesthesia (基础麻醉)Induction of anesthesia (诱导麻醉)Hypothermal anesthesia (低温麻醉)Controlled hypotension (控制性降压)Neuroleptanalgesia (神经安定镇痛术migraine 偏头痛Tension-type Headache 紧张性头痛Cluster Headache集群性头痛Papilledema 视神经乳头水肿DIZZINESS 头晕 rotationhorizontalverticalBenign Paroxysmal Positional Vertigo良性发作性位置性Dix-Hallpike TestPCI(5-D sign) post-cycle ischemia Dizziness 头晕 Dysarthria 构音障碍 Dystaxia 共济失调 Dysphagia 吞咽困难 Diplopia 复视意识内容：谵妄（delirium）、模糊（vague） 意识水平：嗜睡（Somnolence）、昏睡（Stupor）、昏迷（Coma）Decorticated state去皮质状态Decerebrate rigidity 去脑强直SEIZURE胞体Soma 突起 树突(Dendrite) 轴突(Axon) 轴丘(Axon hillock) 始段(Initial segment) 突触小体(Synaptic knob)（1）兴奋性突触后电位 Excitatory postsynaptic potential, EPSP（2）抑制性突触后电位 Inhibitory postsynaptic potential, IPSP突触的可塑性（Synaptic plasticity)递质的共存(Neurotransmitter Co-existence)两种或以上递质可共存于同一神经元 神经调质neuromodulator循环系统BT: brachiocephalic trunk头臂干CC: common carotid A颈总动脉S: subclavian A锁骨下动脉AA: aortic A主动脉弓cardiac cycle心动周期systole收缩期 diastole舒张期period of isovolumic contraction等容收缩期period of rapid ejection 快速射血期aortic valve动脉瓣period of reduced ejection 减慢射血期period of isovolumic relaxation 等容舒张期period of rapid filling 快速充盈期 period of reduced filling 减慢充盈期 period of atrial systole心房收缩期 heart sound心音stroke volume SV每搏输出量End diastolic volume EDV舒张末期容量End systolic volume ESV收缩末期容量ejection fraction EF射血分数minute volume=cardiac output CO每分输出量=心输出量cardiac index心指数stroke work每搏功minute work每分功initial length初长度preload前负荷ventricular function curve心室功能曲线end-diastolic pressure心室舒张末期压heterometric autoregulation异长自身调节compliance心室顺应性myocardial contractility心肌收缩能力homometric regulation等长调节positive staircase正性阶梯现象cardiac reserve心力储备transmembrane potential跨膜电位specialized conduction system特殊传导系统Na+ background currentNa背景电流 resting potential静息电位 depolarization去极化voltagegated Na channel电压门控通道threshold potential阈电位repolariztion复极化spike potential锋电位plateau平台期 long-lasting calcium channelL型钙通道inward rectifier K+ channel内向整流钾通道 Ik1delayed rectifier K+ channelIk通道-延迟整流钾通道action potential duration APD动作电位时程phase 4 spontaneous depolarization4期自动去极化maximal diastolic potential最大舒张电位 hyperpolarization-activated inward ion current，If超极化激活的内向离子电流pacemaker current起搏电流sinoatrial node，SAN窦房结autorhythmicity自律性effective refractory period， ERP有效不应期absolute refractory period， ARP绝对不应期local response period局部反应期relative refractory period，RRP相对不应期supranormal period，SNP超长期premature systole=extrasystole期前收缩=期外收缩compensatory pause代偿间歇sinus rhythm窦性节律latent pacemaker潜在起搏点ectopic pacemaker异位起搏点escape rhythm逸搏节律overdrive suppression超速驱动压抑 atrioventricular delay房室延搁preferential pathway优势传导通路electrocardiogram ECG心电图Windkessel vessel弹性贮器血管precapillary resistance vessel毛细血管前阻力血管precapillary sphincter毛细血管前括约肌arteriole微动脉exchange vessel交换血管postcapillary resistance vessel毛细血管后阻力血管venule微静脉capacitance vessel容量血管shunt vessel短路血管ateriovenous shunt动静脉短路hemodynamics血流动力学velocity of blood flow血流速度laminar flow层流turbulence湍流resistance of blood flow血流阻力 blood viscosity血液黏滞度hematocrit血细胞比容shear rate血流的切率distensibility可扩张性compliance顺应性mean circulatory filling pressure循环系统平均充盈压peripheral resistance外周阻力systolic pressure收缩压diastolic pressure舒张压pulse pressure脉搏压central venous pressure, CVP中心静脉压peripheral venous pressure外周静脉压transmural pressure跨壁压hydrostatic pressure静水压metarteriole后微动脉precapillary sphincter毛细血管前括约肌thoroughfare channel直捷通路filtration滤过reabsorption重吸收hydrostatic pressure 静水压colloid osmotic pressure胶体渗透压interstitial fluid组织液effective filtration pressure EFP有效滤过压cardiac sympathetic nerve心交感神经positive chronotropic action正性变时作用(positive inotropic action正性变力作用positive dromotropic action正性变传导作用cardiac sympathetic tone心交感紧张cardiac vagal tone心迷走紧张vasoconstrictor fiber缩血管神经纤维vasodilator fiber舒血管神经纤维sympathetic vasomotor tone交感缩血管紧张cardiovascular center心血管中枢rostral ventrolateral medulla RVLM延髓头端的腹外侧部caudal ventrolateral medulla CVLM延髓尾端的腹外侧部 nucleus tractus solitarius NTS延髓孤束核cardiovascular reflx心血管反射baroreceptor reflex压力感受性反射depressor reflex降压反射or减压反射reninangiotensin system RAS肾素-血管紧张素系统Reninangiotensinaldosteronesystem，RAAS肾素血管紧张素醛固酮系统epinephrine；adrenaline肾上腺素 norepinephrine，NE； noradrenaline ，NA去甲肾上腺素vasopressin VP；antidiuretic hormone, ADH血管升压素；抗利尿激素endothelin,ET内皮素bradykinin缓激肽kallidin胰激肽或血管舒张素coronary circulation冠脉循环adenosine腺苷循环病理atherosclerosis动脉粥样硬化ischemia缺血fobrous cap纤维帽arteriosclerosis动脉硬化hyperlipemia高脂血症fatty streak脂纹fibrous plaque纤维斑块ateromatous plaque粥样斑块Aorta Dissecting Aneurisms夹层动脉瘤形成coronary arteriosclerotic heart disease冠状动脉硬化性心脏病=ischemic heart disease,IHD缺血性心脏病angina pectoris心绞痛mocardial infarction心肌梗死ventricular aneurysm室壁瘤hypertension高血压chronic hypertension缓进型高血压rheumatism风湿病Aschoff body风湿小结vegetation赘生物chronic valvular disease慢性风湿性心瓣膜病cor villosum绒毛心rheumatic pericarditis纤维素性心包炎erythema ammullare环形红斑subcutaneous nodules皮下结节infective endocarditis感染性心内膜炎valvular vitium of the heart心瓣膜病valvular insufficiency瓣膜关闭不全valvular stenosis瓣膜口狭窄mitral stenosis二尖瓣狭窄cardiomyopathy心肌病myocarditis心肌炎诊断学midsternal line前正中线midclavicular lines锁骨中线anterior, middle, and posterior
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