身体评估的基本方法-(Physical-Examination-Techniques)

皮肤、淋巴结、头颈部评估

Physicalassessmentoftheskin,lymphnodes,headandneck

教学目标CourseObjectives说出皮肤、淋巴结、头及颈部检查的内容。

Todescribethecontentofthephysicalexaminationoftheskin,lymphnodes,headandneck解释头、颈部重要异常体征的临床意义。(皮肤损害、皮下出血、巩膜黄染、瞳孔异常、颈静脉充盈等)。

Toexplainthesignificanceoftheimportantabnormalsymptoms判断扁桃体、甲状腺肿大分度。

Todistinguishtheenlargementoftonsilandthyroidgland正确进行皮肤、淋巴结、头颈部检查。

Tocorrectlyassessthepatient’sskin,lymphnodes,headandneck教学内容TopicalOutline皮肤评估

Assessingtheskin淋巴结评估Assessingthelymphnodes头部评估Assessingthehead颈部评估Assessingtheneck皮肤评估Assessingtheskin（1）皮肤的结构

Thestructureofskin皮肤的功能

Thefunctionofskin皮肤评估Assessingtheskin（2）方法method视诊inspection触诊palpation内容content颜色color温度temperature湿度moisture弹性elasticity皮疹skineruption皮下出血subcutaneoushemorrhage蜘蛛痣spiderangioma肝掌liverpalms水肿edema颜色color苍白（pallor）发红（redness）发绀（cyanosis）黄染（stainedyellow）色素沉着（pigmentation）色素脱失(depigmentation)

温度temperature体温升高body

temperatureincreases发热fever甲亢hyperthyroidism炎症inflammation体温降低body

temperaturedecreases休克shock甲减hypothyroidism雷诺病Raynaud’s

Desease湿度moisture与汗腺分泌功能有关

isassociatedwiththesecretion

ofsweatgland多汗excessivemoisture甲状腺功能亢进hyperthyroidism无汗excessivedryness脱水dehydration弹性elasticity手背或上臂内侧

pinchingtheskinonanextremity正常：富有弹性

whenpinched,skinspringsbacktopreviousstate弹性减弱：老年人、营养不良、脱水患者

skinsstayspinchedormovesbackslowly(e.g.,inolder,malnutrition，dehydration）皮疹skineruption斑疹maculae丘疹papules斑丘疹maculopapulae荨麻疹urticaria疱疹herpes斑疹（Maculae）丘疹（papule）荨麻疹（urticaria）水疱（vesicle）脓庖（pustule）单纯疱疹（herpessimplex）带状疱疹（Herpeszoster）皮下出血(subcutaneoushemorrhage)瘀点(petechia)：直径〈2毫米紫癜(purpura)：直径3—5毫米瘀斑(ecchymosis)：直径〉5毫米血肿(hematoma)：片状出血伴有皮肤显著隆起蜘蛛痣与肝掌蜘蛛痣(spiderangioma)皮肤小动脉末端分支性扩张所形成的血管痣，形似蜘蛛，故称为蜘蛛痣。肝掌(liverpalms)慢性肝病患者，手掌大小鱼际发红，压之退色，称为肝掌。水肿(edema)皮下结节(subcutaneousnodules)瘢痕(scar)毛发(hair)淋巴结评估Assessingthelymphnodes分布于全身

widelydistributedNormalfindings:notpalpableAbnormalfindings:enlarged,palpable,possiblytender(associatedwithinfectionandtumors)头部评估Assessingthehead（1）头发(hair)和头皮(scalp)颜色、疏密度、有无脱发、头皮屑

Inspecttheevenness,textureandoiliness头颅(skull)大小、外形变化、异常活动Inspecttheskullforsize,shapeandsymmetry头部评估Assessingthehead（2）颜面及其器官眼

eye眼眉(eyebrow)眼睑(eyelids)结膜(conjunctiva)巩膜(sclera)角膜(cornea)虹膜(iris)瞳孔(pupil)眼球(eyeball)眼功能头部评估Assessingthehead（3）颜面及其器官续耳ear外耳externalear耳廓auricle外耳道externalauditorycanal乳突mastoid听力auditoryacuity头部评估Assessingthehead（4）颜面及其器官续鼻nose外形shape鼻腔nasalcavity鼻翼煽动nasalaleflap鼻窦(nasalsinus)额窦上颌窦筛窦蝶窦头部评估Assessingthehead（5）颜面及其器官续口(mouth)牙齿teeth牙龈gum舌tongue口腔粘膜咽部pharynx和扁桃体tonsilI、II、III度扁桃体肿大Ⅰ度肿大：不超过咽腭弓Ⅱ度肿大：超过咽腭弓但未达到咽后壁中线Ⅲ度肿大：达到或超过咽后壁中线颈部评估Assessingtheneck（1）外形shape分区：颈前三角颈后三角姿势、运动及软硬度headmovementandmusclestr