1、询问病史 12case historyYou need to get a detailed history including the timing and acuity of onset, exacerbating and alleviating factors and environment triggers to help you confirm a diagnosis or discard other diseases /develop a differential diagnosis. Ask your patient whether there is a history of to
2、bacco use, or other toxic and environmental exposures and his occupational history.General/biographical,baiurfik,-kl data 传记,marital 婚姻 status, nativity 出生, occupation, informant 提供消息的人 , time of admission and record, chief complaint, history of present illness, previous health status(well, ordinary
3、 or bad), any infectious diseases, allergic history, history of trauma or surgery, smoking (about how many years, average how many pieces per day, ceased for how many years), alcohol intake(occasional or frequent),spousesspaus 配偶 health status, menorrhea,menri:月经 (menarchemen:ki:, m- 初潮 age , cycle
4、lasting for how many days, menstrual cycle, last menstruation period or age of menopause, any menstrualmenstrul月经周期 pain or irregular cycle), childbearing or pregnancy( times , natural labor, abortions 流产 ,premature,premtju, ,pri:- delivery 早产, stillbirths 死产, difficult labor, family history (any co
5、ngenital 先天性 diseases, father and mother: still alive, illness ,or cause of death, siblings 兄弟姐妹 and children)常用的症状 symptomsfeverCough 咳嗽Sputum (dry, purulentpjurjulnt脓性的, copiouskupis green sputum 大量绿色痰，tenacioustineis, t- yellow sputum 黄粘痰，frothy white sputum 白色泡沫痰，rusty sputum 铁锈色痰wheezingDyspnea
6、 during exertioniz:n or at rest 呼吸困难Orthopnea:pni 端坐呼吸Paroxysmal,prksizml nocturnalnkt:nl dyspnea 夜间阵发性呼吸困难Shortness of breath （SOB）Chest tightness 胸部紧迫感Exercise intolerancepleuritic chest pain 胸膜型胸痛Pharyngalgiafringldi ; pharyngodynia,fridini 咽痛Hemoptysis 咯血Bucking 呛咳Sneeze 喷嚏snore 打鼾malaise mleiz不
7、舒服myalgiamaildi 肌痛insomnia insmni 失眠hoarseness 声嘶dysphonia disfuni发声困难常见的体征 physical signsclubbed fingers 杵状指 : increased longitudinal ,lnditju:dinl and transverse 横向 curvature k:vt弯曲 ,loss of concave knkeiv凹面的 nail fold angle, bogginess of nail bed and increased soft tissue bulk of distal phalanx f
8、lks, fei-趾骨, 指骨, drumstick- likenicotine stainingcyanosis ,sainusis发绀:blue discolouration of mucosal membranes and skin ,caused when mean capillary concentration of deoxyhemoglobin di:,ksihemu,lubin去氧血红蛋白 more than 5g/dl, O2 saturation less than 85%,PaO2 less than 8KPaperipheral prifrl外围的, 次要的 cyano
9、sis: cold blue peripheries, e.g. nail beds due to cold exposurescentral cyanosis: warm peripheries, blue tongue or lipshand flap: due to CO2 retention 潴留asterixis 扑翼样震颤papilloedema 视乳头水肿chemosis 球结膜水肿enlarged supraclavicula 锁骨上的 r klvikjul and axillary ksilri腋窝 lymph nodesincreased respiratory ratet
10、achycardia 心动过速pulsus paradoxus: 10 mmHg on inspiration (seen in severe asthma)barrel chesthyperexpanded, decreased expansionkyphosis kaifusis 驼背，脊柱后凸Inspection:tachypnea ,tkipni: 呼吸急促accessory muscles of respiration,resprein: sternocleidomastoidst:nu,klaidmstid 胸锁乳突肌 muscle, arm support, alae flari
11、ngwide or narrow intercostal,intkstl 肋间的 spacetactile 触觉的 vocal 声音的 fremitus 震颤 触觉语颤subcutaneous crepitus 皮下捻发感Percussion:resonance 清音dullness 浊音flatness 实音hyperresonance 过清音tympany/timp2ni/鼓音lower borders: scapularskpjul肩胛的 line X left/right intercostal,intkstl 肋间的 spacerange of mobilitymubilti移动Au
12、scultation,:skltein:听诊vocal resonance 语音共振ronchi: wheeze , stridorstraid 喘鸣 , crackleskrkl发出细碎的爆裂声, Velcro-like soundesmoist rales : coarse 粗的, medium 中等的, fine 好的, crepitus 捻发音pleural friction rubscomplete absence of breath soundsankle edemaweight loss，cachexiakkeksi恶病质，cachectickkektik恶病质的decrease
13、d food appetite, loss of appetite, anorexia,nreksi食欲减退常做的检查 examinations or laboratory findings(to take ,undergo, perform ,receive or have)temperature charts 体温图 (take ones body temperature)sputum pot 痰盂Blood/urine/stool routine, occultklt/ blood test 潜隐血试验Blood biochemistrySputum /blood culture and
14、 drug sensitivity testsputum cytologysaitldi细胞学Pulse oximeterksimit 脉氧计：continuous monitoring of blood oxygen saturationArterial blood gas analysis(ABG): arterial blood sampling , radial/ femoralfemrl股骨的 artery puncture 穿刺PaCO2: partial pressure of carbon dioxide in arterial blood hypercarbia PaO2:
15、partial pressure of oxygen in arterial blood hypoxemia,haipksi:mi血氧不足respiratory failure:type 1: decreased O2 supply, PaO260 mmHg(millimeters of mercury m:kjuri汞)due to diffusion failure or V/Q dismatch (ventilation-perfusion(quotient)ratio)pulmonary edema, pneumonia, infarction, fibrosis,or pulmona
16、ry embolism，pulmonary hypertension, shunttype 2: decreased CO2 removal, PaCO250 mmHg(millimeters of mercury)due to alveolar ventilation failureobstructive: COPD, asthma, bronchiectasisrestrictive: neuromuscular,njurumskjul神经肌肉 (sedativessdtiv镇静剂 myasthenia,maisi:ni肌无力), structuralstrktrl结构的 (ankylos
17、ing spondylitis,kiluzi,spndilaitis强直性脊柱炎), pleural diseases ,obesityChest X-ray/radiograph:reticulo-nodular shadowing (reticularritikjul网状的, linearlini线状的, military nodules粟粒样结节)coin lesions 硬币样cavities 空腔：amphoricmfrik 空翁音的(breathing like blowing over a bottle top)opacificationu,psifikein浑浊：consoli
18、dation (air space infiltrate):confluentknflunt支流的, 汇合的 shadowing and air bronchogramf 支气管造影collapse: lobar(upper, middle/lingual, lower)segmental atelactasis 肺不张pleural effusionmediastinal,mi:distainl纵隔 mass: thyroid ,thymomaaimum胸腺瘤, teratoma,tertum畸胎瘤, TB lymph nodes,terrible diagnoses including l
19、ymphomalimfum淋巴瘤 and aneurysm 动脉瘤Chest CT scan( computed tomography)Head MRI(magnetic resonance imaging)PET-CT of the whole body(positron-emission tomography) pzitrn正电子Abdominal ultrasoundltrsaund超声skin prick test 皮肤点刺试验（ dust mites 尘螨，pollen 花粉，cockroach 蟑螂）tuberculin skin test (purified protein de
20、rivativedirivtiv 纯蛋白衍生物(of tuberculin) test, PPD test)Pulmonary function test : Spirometry spairmitri呼吸量测定法，肺量测定法obstructive lung diseases: airflow limitationFEV1/FVC FVC RV and TLC KCO0.75 extraparenchymal variable normalFEV1: forced expiratoryikspairtri/ volume in 1 secondFVC: force vital capacity
21、TLC: total lung capacityRV: residual volumeKCO: transfer factor ( diffusion rate)PEFR: peak expiratory flow rateflow-volume loop ( inspiration and expiration,ekspirein)bronchoprovocation/challenge test,prvkein 支气管激发试验：histaminehistmmin 组胺 or methacholine 乙酰甲胆碱-inhalation,inhleinbronchodilatation,dai
22、ltein支气管舒张试验: salbutamol 沙丁胺醇slbju:tm(:)lfiberoptic bronchoscopybrkskpi: biopsybai,psi活组织检查 bronchial brush samples for pathological examation, bronchial washings)bronchoalveolar lavage (BAL)protected specimen brush (PStransthoracic,trnsrsik,经胸廓的 percutaneous needle aspiration,sprein吸引术percutanous n
23、eedle biopsy under CT guidance ( for peripheral tumours)video-assisted thoracoscopic-guidedrkskup 胸腔镜 lung biopsyopen lung biopsypleural biopsybiopsy of enlarged lymph nodesD-Dimerselectrocardiogram (ECG)心电图echocardiogram 超声心动图V/Q isotopeaisutup 同位素 scan ( ventilation/perfusion scanning)spiral 螺旋 CT
24、/MRA (Magnetic Resonance Angiography,ndirfi血管造影术)pulmonary angiographyDopplerdpl 多普勒 USS thighai大腿 and pelvispelvis 骨盆 (USS: ultrasound scanning)cardiac monitorPSG( polysommography)常见的病名 diseasesacute upper respiratory tract infection 急性上呼吸道感染common cold 普通感冒influenza 流感,influenzpharynigitis 咽炎 phar
25、yngalgiafringldi 咽痛acute broncho-bronchitis 急性气管-支气管炎pneumonia 肺炎community acquired pneumonia (CAP) 社区获得性肺炎hospital acquired pneumonia (HAP) 医院获得性肺炎nosocomical pneumonia (NP) 医院内肺炎bronchiectasis 支气管扩张chornic bronchitis 慢性支气管炎pulmonary emphysema 肺气肿chronic obstructive pulmonary disease (acute exacerb
26、ating) AECOPD COPD 急性发作bronchial asthma 支气管哮喘allergic rhinitisrainaitis过敏性鼻炎respiratory failure 呼吸衰竭lung abscess 肺脓肿pulmonary tuberculosis 肺结核病lung cancer: 肺癌primary bronchogenic carcinoma 原发性支气管肺癌squamousskweims cell carcinoma 鳞癌adenocarcinoma 腺癌dnu,k:sinumbronchoalveolar cell carcinoma 支气管肺泡细胞癌sma
27、ll cell lung carcinoma （SCLC）小细胞肺癌pulmonary metastasis 肺转移瘤mtstsispulmonary embolism （PE） 肺栓塞pulmonary thromboembolism (PTE) 肺血栓栓塞症,rmbuemblizmpulmonary infarction 肺梗死deep venous thrombosis ,DVT 深静脉血栓形成empyema 脓胸,empaii:mpneumothorax 气胸pyopneumothorax 脓气胸 paiu,nju:mu:rkschronic suppurative disease 慢
28、性化脓性疾病spjurtiv, -reitivcongenital cyanotic disease 先天性紫绀性心脏病,saintikcor pulmonale 肺源性心脏病 k:,pumnlipulmonary hypertension 肺动脉高压pulmonary encephalopathy 肺性脑病en,seflpiright heart failure; right-sided heart failure 右心衰竭pulmonary vascular diseases 肺血管疾病interstitial lung disease, ILD 弥漫性间质性肺疾病idiopathic p
29、ulmonary fibrosis, IPF 特发性肺纤维化,idipikcryptogenic,kriptudenik 隐源性的 fibrosing alveolitis, CFA 隐源性纤维化性肺泡炎connective tissue related lung diseases 结缔组织相关性肺疾病systemic lupuslju:ps狼疮 erythematosus, SLE 系统性红斑狼疮rheumatoid arthritis, RA 类风湿性关节炎systemic sclerosis, SSc 系统性硬化scleroderma 硬皮病sjorens syndrome 感知综合征p
30、olymyositis 多发性肌炎dermatomyositis 皮肌炎sarcoidosis 结节病,s:kidusisPulmonary alveolar proteinosis,prutiinusis, PAP 肺泡蛋白沉积症Idiopathic pulmonary hemosiderosis hi:mu,sidrusis, ,hem-特发性肺含铁血黄素沉着病 Langerhans cell granulomatosis 朗格汉斯细胞肉芽肿病rnju,lumtusisEosinophilic granuloma 嗜酸性肉芽肿,i:sinfilikHistiocytosis X 组织细胞增
31、多症 XWegener granulomatosis Wegener 肉芽肿extrinsic allergic alveolitis 外源性过敏性肺泡炎pneumoconiosis 尘肺nju:m,kuniusisdrug-induced lung disease 药物性肺病aspergillosis ,sp:dilusis 曲菌病：allergic bronchopulmonary aspergillosis (ABPA)pleural disease 胸膜疾病broncho-pleural fistula 支气管胸膜瘘fistjuloral candidiasis 口腔念珠菌病，鹅口疮,
32、kndidaisisosteoporotic bone change 骨质疏松样改变glaucoma 青光眼cataract 白内障acute lung injury ，ALI 急性肺损伤acute respiratory distress syndrome , ARDS 急性呼吸窘迫综合征urticaria 荨麻疹eczema 湿疹hypertension 高血压diabetes 糖尿病常用的药物 drugs or agentsbe administered, treat sb. withempirical 经验性的, prophylactic,prfilktik, ,pru-预防性, re
33、medialrimi:dil治疗性Expectorant 祛痰药ekspektrntMucolytics 粘液溶解剂,mju:kulitikbronchodilator 支气管扩张剂 ,brkudaileitB2-agonistsnist兴奋剂 : short-acting :salbutamol 沙丁胺醇slbju:tm(:)llong-acting: salmeterol 沙美特罗muscarinic,mskrinik 毒蕈碱样的 antagonistsntnist对抗剂: ipratropium bromidebrumaid 异丙托溴胺aminophylline 氨茶碱,mi:nufil
34、i:nsteroidsstirid类固醇 inhaled: budesonide 布地奈德， beclomethasone,beklumesun倍氯米松，fluticasone 氟替卡松systemic: prednisolone prednislun 强的松 po(per os)., hydrocortisone,haidruk:tizun 氢化可的松 iv.mast cell stabilizers: cromoglycate sodium 色甘酸钠leukotriene ,lju:kutrain白三烯 receptor antagonists: montelukast 孟鲁司特respi
35、ratory stimulants:lobelinenikethamidenikemaid, -mid尼可刹米cardiac tonic 强心剂diuretics 利尿剂,daijuretikalbumin 白蛋白lbjuminantitussive agents 镇咳药,ntitsivammonium chloride 氯化铵munjm铵kl:raid 氯化物ambroxol 氨溴索 （mucosolvan 沐舒坦）Pantoloc 潘妥洛克常用的治疗措施low or high flow oxygen: nasal cannulaeknjuli:鼻导管， Venturiventjuri文里氏
36、 face-mask nebulizernebjulaiz喷雾器: finer particle size (3 to 20um) allows tracheobronchial depositionmetered dose inhaler (MDI)定量雾化吸入器continuous positive airway pressure (CPAP)-tight-fitting mask (non-invasive)intermittent positive-pressure ventilation ( IPPV)non-invasive positive-pressure ventilatio
37、n (NIPPV)mechanical ventilation: non-invasive or invasive(via intubation,intju:bein插管 ，tracheostomy ,trkistmi, ,trei-气管造口术，tracheotomy,trkitmi, ,trei-气管切开术)synchronized intermittent mandatory ventilation, SIMV 同步间歇指令通气pressure support ventilation, PSV 压力支持通气thoracocentesis 胸腔穿刺术 ,:rksentesischest dr
38、ain/drainage 引流术chemotherapy 化疗radiation therapy 放疗pneumonectomy 肺切除术,nju:munektmilobectomy of lung，pulmonary lobectomy 肺叶切除术lubektmi叶切除术thoracotomy 开胸术，胸廓切开术,:rktmipleurodesis 胸膜剥脱术pleurectomy 胸膜切除术pleural adhesion 胸膜粘连术thromboendarterectomy 血栓动脉内膜切除术inferior vena cava filter 下腔静脉过滤器常见的疾病chornic br
39、onchitis: procuctive cough, most days of 3 months of the year, for at least 2 consecutive years, cough with white or purulent sputumbronchiectasis:cystic sistik囊性的/varicosevrikus曲张样/cyclindrical 柱状-tram-tracks 轨道样hemoptysisphysiotherapy: chest wall percussion wirh head-down posturalpstrl drainagelon
40、g term oxygen inhalation : to prevent cor pulmonalemedical: bronchodilators, mucolytics, rotating courses of antibioticssurgical: resection, artery embolization for hemoptysislung abscessusually on right side, as right bronchus is shorter and more vertical;in the supine sju:pain 仰卧 patient , abscess
41、 develops in apical lower lobe or posterial upper lobe.pneumothoraxaccumulation of air in pleural space, with secondary partial collapse of subpleural 胸膜下的 bleb bleb大疱 rupture rpt破裂lactrogenic: positive pressure ventilation, bronchoscopy brkskpi支气管镜检查 ,esp. biopsytypes: closed, open, tensionmediasti
42、nal deviation :trachea and apex eipeks尖端 shift contralaterally 对立的旁边CXR: translucency trnzlju:snsi 半透明+collapse 倒塌: visible rim 边缘 between lung and chest wall2 cm(centimeter) =50% lung volume lossaspiration ,sprein吸引术，intercostal drainrefractory or recurrent 周期性的: pleurodesis 胸膜固定术, pleurectomyplure
43、ktmi胸膜切除术, bulla bul 大疱 stapling 装订 or lasering 激光pleural effusionchest pain and progressively worsening of shortness of breathTransudate ,trnsjudeit漏出液：redistribution of Starling forces across microcirculation, diuretics,daijuretik利尿剂 can result in rapid resolution, protein 30g/L(gram/litreli:t) or
44、 pleura: serumsirm血清 protein 1/2 or pleura: serum LDH2/3;often seen in cardiac failure, hypoalbuminemia,haipul,bju:mni:mi低蛋白血症, embolism, superior or inferior vena cava obstruction, hypothyroidism . ,haipuairidizm甲状腺功能低下Exudateeksjudeit渗出液：capillary permeability,p:mibiliti 渗透 increases or lymph drai
45、nage decreasesoften seen in infection ,neoplasia,ni:upleizi, -i瘤形成, surgery or trauma.CXR: meniscusminisks弯液面-shaped,rises towards axillaksil腋温Appearance: clear ,straw 淡黄色的-coloured: suggests transduateturbidt:bid浑浊的, green: indicates exudates(pusps脓 cells) or empyema,empaii:m积脓症 (bacterial infectio
46、n)bloody( haemothorax,hi:mu:rks血胸): tumor ,pulmonary embolism, acute pancreatitispnkritaitis胰腺炎, traumawhite( chylothorax,kailu:rks乳糜胸) ：lymph ,blocked thoracic:rsik, duct胸导管, usually due to tumourTherapy: transudate: diureticsexudates: repeated drainage (thoracocentesis)intrathoracic,intrrsik 胸廓内的 streptokinase,streptukaineis 链球菌激酶 via chest drain: to lyselais溶解 fibrinousfaibrins 纤维蛋白的 adhesionsdh
