1、皮肤、淋巴结、头颈部评估Physical assessment of the skin, lymph nodes, head and neck,教学目标Course Objectives,说出皮肤、淋巴结、头及颈部检查的内容。 To describe the content of the physical examination of the skin, lymph nodes, head and neck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)。 To explain the significance of the important ab
2、normal symptoms判断扁桃体、甲状腺肿大分度。 To distinguish the enlargement of tonsil and thyroid gland正确进行皮肤、淋巴结、头颈部检查。 To correctly assess the patients skin, lymph nodes, head and neck,教学内容Topical Outline,皮肤评估 Assessing the skin淋巴结评估 Assessing the lymph nodes 头部评估 Assessing the head颈部评估 Assessing the neck,皮肤评估As
3、sessing the skin（1）,皮肤的结构 The structure of skin皮肤的功能 The function of skin,皮肤评估Assessing the skin（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 skin eruption,皮下出血 subcutaneous hemorrhage蜘蛛痣 spider angioma肝掌 liver palms水肿 edema,颜色color,苍白（pallor）发红（
4、redness）发绀（cyanosis）黄染（stained yellow）色素沉着（pigmentation）色素脱失 (depigmentation),温度temperature,体温升高 body temperature increases 发热 fever甲亢 hyperthyroidism 炎症 inflammation体温降低 body temperature decreases 休克 shock甲减 hypothyroidism 雷诺病 Raynauds Desease,湿度moisture,与汗腺分泌功能有关 is associated with the secretion o
5、f sweat gland多汗 excessive moisture甲状腺功能亢进 hyperthyroidism无汗 excessive dryness脱水 dehydration,弹性 elasticity,手背或上臂内侧 pinching the skin on an extremity正常：富有弹性 when pinched, skin springs back to previous state弹性减弱：老年人、营养不良、脱水患者 skins stays pinched or moves back slowly (e.g., in older, malnutrition，dehydr
6、ation）,皮疹skin eruption,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（herpes simplex）,带状疱疹（Herpes zoster）,皮下出血(subcutaneous hemorrhage),瘀点(petechia)： 直径2毫米紫癜(purpura)： 直径35毫米瘀斑(ecchymosis)： 直径5毫米血肿(hematoma)： 片状出血伴有皮肤显著隆
7、起,蜘蛛痣与肝掌,蜘蛛痣(spider angioma)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(liver palms)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(subcutaneous nodules)瘢痕(scar)毛发(hair),淋巴结评估Assessing the lymph nodes,分布于全身 widely distributedNormal findings: not palpableAbnormal findings: enlarged, palpable, possibly tender (assoc
8、iated with infection and tumors),头部评估Assessing the head（1）,头发(hair)和头皮(scalp)颜色、疏密度、有无脱发、头皮屑 Inspect the evenness, texture and oiliness头颅(skull)大小、外形变化、异常活动Inspect the skull for size, shape and symmetry,头部评估Assessing the head（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(
9、iris)瞳孔(pupil)眼球(eyeball)眼功能,头部评估Assessing the head（3）,颜面及其器官续耳 ear外耳 external ear耳廓 auricle外耳道 external auditory canal乳突 mastoid听力 auditory acuity,头部评估Assessing the head（4）,颜面及其器官续鼻 nose外形 shape鼻腔 nasal cavity 鼻翼煽动 nasal ale flap鼻窦(nasal sinus)额窦上颌窦筛窦蝶窦,头部评估Assessing the head（5）,颜面及其器官续口(mouth)牙齿 t
10、eeth牙龈 gum舌 tongue口腔粘膜 咽部 pharynx 和扁桃体 tonsil I、II、III度扁桃体肿大,度肿大：不超过咽腭弓,度肿大：超过咽腭弓但未达到咽后壁中线度肿大：达到或超过咽后壁中线,颈部评估Assessing the neck（1）,外形 shape分区：颈前三角颈后三角姿势、运动及软硬度 head movement and muscle strength皮肤 skin血管 vessel颈动脉颈静脉肝-颈静脉回流征,颈前三角,颈后三角,颈部评估（2）,甲状腺 thyroid度肿大：不能看出肿大但能触及者度肿大：能看到肿大又能触及，但在胸锁乳突肌以内者度肿大：超过胸锁乳突肌外缘者气管 trachea,
