天津医科大学临床医学概论重点总结

1、1. Arthritis resulting in degeneration of the bones and joints, especially those bearing weight and results in bone rubbing against bone.2. Symptoms: pain after repetitive use; morning stiffness < 15 mins 3. Signs: tenderness, bone crepitus,swelling joint Hand: Heberdens node and Bouchards node F

2、oot: Hallux Valgus4. Diagnosis: arthrocentesis; arthroscopy; joint replacement5. NSAIDs: aspirin; ibuprofen; nabumetone; naproxen6. Rheumatoid arthritis: is an auto immune disorder, may also affect the skin, eyes,lungs, heart, blood or nerves, and its a chronic disorder.7. Risk factors: 40-50 years

3、old; women > men8. Morning stiffness > 1 hour; Joint pain is often felt on both sides of the body; The fingers (but not the fingertips), wrists, elbows, shoulders, hips, knees, ankles, toes, jaw, and neck may be affected.9. Symptoms: Chest pain when taking a breath (pleurisy) Eye burning, itch

4、ing, and dischargeNodules under the skin (usually a sign of more severe disease) Numbness, tingling, or burning in the hands and feet Joint destruction may occur within 1 - 2 years after the disease appears10. Rheumatoid nodules: necrotizing granuloma坏死性肉芽肿11. Sjogren's syndrome; pleuritis; peri

5、carditis; anemia; Feltys syndrome: 1) rheumatoid arthritis;2) an enlarged spleen (splenomegaly);3) an abnormally low white blood count. 12. ACR 1987 criteria:13. Diagnosis: 1) erythrocyte sedimentation rate;2) C-reactive protein; 3) rheumatoid factor14. Medicine: methotrexate 15. Gout is a common pa

6、inful form of arthritis. It causes swollen red hot and stiff joints. Gout occurs when uric acid builds up in your blood.16. Causes: hyperuricemia: high levels of uric acid17. Symptoms: podagra; tophus (tophi 复数): are chalky deposits of uric acid that commonly occur in the elbows and earlobes.18. Med

7、icine: 见5, but can use corticosteroids and colchicine(特有药)19. Spinal disc herniation types: 1) disc degeneration: chemical changes associated with aging causes discs to weaken, but without a herniation 2) prolapse: the posterior longitudinal ligament remains intact but the nucleus pulposus impinges

8、on the anulusfibrosus3) extrusion: the nuclear material emerges through the annular fibers but the posterior longitudinal ligament remains intact.4) sequestration: the nuclear material emerges through the annular fibers and the posterior longitudinal ligament is disrupted. A portion of the nucleus p

9、ulposus has protruded into the epidural space.20. Treatment: ESI: epidural steroid injection; laminotomy and discectomy 21. Osteoporosis: Decrease in bone mass that results in a thinning and weakening of the bone with resulting fractures. The bone becomes more porous, especially in the spine and pel

10、vis.特征：Dowagers hump骨质减少30%以上才能在X片中看出。补钙药物：alendronate22. Fracture: Closed / simple Incomplete ( Linear ,Greenstick ) Open/ compound or Complete (Transverse , Oblique,Spiral,Comminuted Impacted , Compression ,Depressed ,Epiphyseal )23.Ovary: Produce female hormones-estrogen and progesterone.Estrogen

11、 responsible for appearance of female sexual characteristics and menstrual cycle. Progesterone maintains uterine environment for pregnancy.24.Fetal appurtenances:Placenta; Fetal membranes; Umbilical cord; Amniotic fluid25.Functions of placenta: Air exchangeSupply of nutritionRemove the waste from th

12、e fetusDefense functionsynthetical function:HCG: human chorionic gonadotropinHPL: human placental lactogenHCT: human chorionic thyrotropinEstrogenProgestogenvLength 30-70 cm, average 50-60 cmvDiameter: 1.0-2.5 cmvAt least 32 cm for normal delivery vShort cord: <30 cmvLong cord:> 70cm: cord ent

13、anglement26. Umbilical cord: 27.Amniotic fluid: amount:300-1000mlPolyhydramnios: > 2000mlvProtect the fetus1. The developing baby to move in the womb, which allows for proper bone growth 2. The lungs to develop properly 3. Keep a relatively constant temperature around the baby, protecting from he

14、at loss 4. Protect the baby from outside injury by cushioning sudden blows or movements5. body fluid equilibrium of the fetusOligohydramnios: < 300mlIts function: vProtect the motherv1. Reduce the discomfort caused by fetal movementv2. Amniotic sac dilate cervix and vagina 3. Rinse off the vagina

15、 reducing infection 27. 三个阶段： firsttrimester: 1-12 weeks Second trimester: 13-27 Third trimester: 28-birth28. Diagnosis of pregnancy: Symptoms: 1. Amenorrhea2. morning sickness3. frequency of urination PE/signs: Breast changes 8 weeks:Breast turns biggerTendernessSore nipplesMontgomery tuberclesDark

16、ened areola Reproductive organ changes: Hyperemia of cervix and vaginal wallCervix turns soft-Hegar sign29. Auxiliary examinations: B-ultrasound: 5 weeks: gestational ring Ultrasonic Doppler Pregnancy test Progesterone test Cervical mucus examination Basal body temperature31. An ectopic pregnancy (E

17、P) is a condition in which a fertilized egg settles and grows in any location other than the inner lining of the uterus. 32. Tubal pregnancy (最常见)：interstitial IsthmusAmpullar(最常见)Infundibular Ovarian Cervical Broad ligament Abdominal 33. 给药：methotrexate34. Diagnosis: Pregnancy testTransvaginal ultr

18、asoundCuldocentesisLaparoscopy: indications: Patients with unruptured tubal pregnancy Early stage of abortion Acute abdomen with unknown reasons 35. Treatment: surgery: laparotomy: salpingectomy or conservative surgery Laparoscopy36. 子宫肌瘤治疗：hysterectomy or myomectomy or new: UAE: uterine artery embo

19、lization Medication: mifepristone37. Abortion is the termination of pregnancy by the removal or expulsion from the uterus of a fetus or embryo prior to viability.Pregnancy termination happens when the pregnancy is less than 28 weeks and the weight of fetus is less than 1000g. Early abortion < 12

20、weeks; late abortion > 28 weeks38. Types: spontaneous and induced 39. 自然流产分类：threatened: pregnancy Inevitable abortion: complete incomplete40. Threatened pregnancy: A condition in which vaginal bleeding is less than in inevitable abortion and the cervix is not dilated, and abortion may or may not

21、 occur.41. A missed abortion is when the embryo or fetus has died, but a miscarriage has not yet occurred.42. Habitual abortion: The miscarriage of 3 or more consecutive pregnancies 43. Septic: An abortion associated with a uterine infection. The infection can occur during or just before or after an

22、 abortion. 44. Induced (before 10 weeks) D&C: dilation and curettage D&E:dilation and evacuation (in the second trimester of pregnancy, 12 weeks)45. Placenta previa: occurs when a baby's placenta partially or totally covers the mother's cervix the doorway between the uterus and the v

23、agina. Placenta previa can cause severe bleeding before or during delivery. 46. Types: completePartialMarginalLow-lying47. Influence: postpartum hemorrhage placenta accretaPuerperal infectionamniotic fluid embolism Premature delivery and high mortality of perinatal infant 48. Placental abruption is

24、the separation of the placenta from the uterine lining. This condition usually occurs in the third trimester but can occur any time after the 20th week of pregnancy. 49. Types: revealed abruptionConcealedMixed 50. EDC = (LMP(last men perious)-3month/+9month) + 7 days51. Premature delivery: 28-37 wee

25、ks gestational ageTerm delivery: 37- 42Postterm delivery: after 42 weeks52. 宫口扩张 10cm53. Mechanism of labor: EngagementDescentFlexionInternal rotationExtentionRestitution and external rotation54. Threatened labor: False laborLightening Bloody show55. Total stage of labor:The 1st stagefrom onset of l

26、abor to full dilation of the cervix (about 10 cm); nullipara:11-12 hours; multipara: 6-8 hoursThe second stage is the time from full cervical dilation to delivery of the fetus. nullipara:1-2 hour; multipara: a few minutes- 1 hourThe 3rd stage of labor begins after delivery of the infant and ends wit

27、h delivery of the placenta.5-15 minutes (shouldnt be over 30 minutes)56. Episiotomy: 会阴切开术57. Acute appendicitis is a rapidly progressing inflammation of a small part of the large intestine called the appendix.58. McBurney's point is the name given to the point over the right side of the abdomen

28、 that is one-third of the distance from the anterior superior iliac spine to the navel. This point roughly corresponds to the most common location of the base of the appendix where it is attached to the cecum. 59. Types: Acute simple appendicitisAcute purulent appendicitisGangrenous appendicitisPerf

29、orationg appendicitisPeriappendiceal abscess60. Symptoms: Pain first, vomiting next and fever last; abdominal pain,tenesmus = downward urge; gastrointestinal symptoms: 1. loss of appetite2. nausea3. vomiting4. constipation or diarrhea5. inability to pass gas General symptoms 1. fatigue2. low-grade f

30、ever 38 and chills 61. Signs: Tenderness in Mcburneys point Blumbery sign: rebound tenderness(peritoneal irritation sign)Mass in the right lower quandrantOther confirmatory peritoneal signs: Psoas sign 腰大肌试验Obturator sign 闭孔内肌试验Rovsings sign 结肠充气试验62. Differential diagnosis: Gastric ulcer perforatio

31、n Right Ureteral calculiDiseases of obstetrics and gynecology: Ectopic pregnancy ruptureOvarian Follicle rupture Corpus luteum cyst ruputureAcute salpingitis /Acute Pelvitis 63. Calots triangle：a triangle bounded by inferior border of the liver cystic ductcommon hepatic duct.64. Sphincter of Oddi肝胰壶

32、腹括约肌65. Symptoms：Symptoms of gastrointestinal tractbiliary colic Mirizzi syndrome：is a rare cause of acquired jaundice.It is associated with large gallstones that compress the common hepatic duct.Gallbladder effusion: white bile66. 诊断胆囊结石最准确的PE是：Type-B Ultrasound, 96%准确率67. Treatment: Laparoscopic c

33、holecystectomy 临床医学概论Urinary System肾病综合征（Nephrotic Syndrome)Definition:Nephrotic Syndrome results from increased permeability of GBM to plasma protein. It is characterized by excessive proteinuria,hypo proteinuria,hyperlipidemia and edema.1)Proteinuria(>3.5g/day)2)Hypoalbuminemia(<30g/L)3)Edem

34、a4)HyperlipidermiaSymptom:Edema:Generalized edema; especially periorbital area ; Forthy urine肾衰（Renal Failure）Definition:It is a pathological process in which the functions of kidney are severely damaged bilaterally and thus lead to 1）Accumulation of metabolic products and poisons 2)Disorders of wat

35、er,electrolytes and acid-base imbalance 3)Impaired renal endocrine functionClassification:（急性肾衰的分类） 1)prerenal ARF:Functional ARF(Acute Renal Failure)肾功能损伤，肾脏没有损伤 2)interrenal ARF 3)postrenal ARF 早期功能性肾衰，对肾没有实质损害，晚期肾严重损伤Symptom:The Oliguria Stage(急性肾衰少尿期的症状）四高一低：1、低：少尿 oliguria水高：水中毒 water intoxicat

36、ionK+高：高钾血症 hyperkalemiaH+高：代谢性酸中毒 metabolic acidosisN高：氮质血症 Azotemia慢性肾衰的分期 慢性肾衰的分期：肾小球滤过率代偿期 compensatory stage >30%肾功能不全期 renal insufficiency25%30%肾功能衰竭期 renal failure20%25%尿毒症期 uremia<20%Endocrine System生长素（Growth Hormone）Infancy:dwarfism(侏儒症） giantism(巨人症）Adult:acromegaly(肢端肥大症）甲状腺素（Thyro

37、id Hormone)cretinism（呆小症）糖尿病（Metabolic Disorders)Definition:Metabolic Disorder is one of multiple etiology (causes) characterized by hyperglycemia with carbohydrates, fat and protein metabolic alterations that result in defects in the secretion of insulin for its action or both.Classification:糖尿病的四个

38、分型Type1:No production of insulinType2:Deficient production or improper utilization of insulinOther Specific types of diabetes:MODY(maturity onset diabetes in young)青年人中的成年发病型糖尿病Gestational Diabetes Melltius 妊娠期糖尿病Definition:Gestational Diabetes Melltius (GDM）is a condition in which women without pre

39、viously diagnosed diabetes exhibit high blood glucose levels during pregnancy (especially during third trimester)Comparison:比较Type1 和Type 2Type1Type2MechanismNo production of insulinDeficient production or improper utilization of insulinAgeInitiates in childhood or adolescenceGenerally initiates aft

40、er 3p years of ageTherapyInsulin injectionOral medicine+insulin SymptomPolydipsia,polyphagia;polyuria,weight lossNot obviousKetosisEasily happenNot easily happenPancreas Pathology10% B-cell left >30% B-cell left胰岛素抵抗（Insulin Resistance）Definition:Insulin Resistance is a condition in which the cel

41、ls of the body become resistant to the effects of insulin, that is ,the normal response to a given amount of insulin is reduced.As a result, higher levels of insulin are needed in order for insulin to have its effects.Symptom:糖尿病的症状三高一低：（三多一少）多渴：Polydipsia (very thirsty)多食：Polyphagia(very hungry)多尿：

42、Polyuria(urinating frequently)体重减轻：Weight lossComplication:糖尿病的并发症Acute: 1、diabetic keto acidosis（DKA）糖尿病酮症酸中毒hyperosmolar non-ketonic diabetic coma 高渗性非酮症糖尿病昏迷InfectionsChronic:1、macroangiopathy 大血管病变（myocardial infraction心肌梗死；atherosclerosis动脉粥样硬化；coronary heart disease 冠心病） 2、microangiopathy 微血管病

43、变（diabetic nephropathy糖尿病肾病；diabetic retinopathy糖尿病性视网膜病变） 3、neuropathy 神经病变 4、other eye disease (maculopathy黄斑病；cataract白内障；glaucoma青光眼；refractive error屈光改变） 5、diabetes foot糖尿病足Definition：Diabetes Foot is a foot that exhibits any pathology that results directly from diabetes melltius or any chronic com