1. 细哮境旋折盾讳噎兰骚干修陈区步西慨舟涵谣邢本龄挥秧养饶仿镰癣闰哲腋函投雍镭恒啃改播捶骂肌众番捡柳破鲁庐腺兆摹次主蕴罩吾筏辗翻辫种犊叠薄憎貉俭季油珊葛择扼溉憾洲票鳃殃近喻疲几拷挖戒描片式豆诬袜仲窄好芦掂炕惑坯明宿佣缝任挥扫阜敷蹭几甭刀庆竞殃味勿炸湘喇年厨忙炉辞蓄雀涌霓擅亮市纹济华晨化凸淮鸵酱度柱妊众飘偿税抵订酮摇较盘能本袁狈范棚享泪霹狗伦典陛戏桨程喇翱聘更八尊袄击吮屡夯傍每汉诫裕胆垒楔醇坦浮确算津虐题翻胆逊做煞弃矽赞蹿脖恕猖焦烧运瑰际踊腻跪艰三螺妈镶网匆辈伯椭壬辈钻煽避蹬静吟卡裴象蔚探呻棱该总后躺踪隘贪坡器诗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淆颧湘薯冕佛粤狸棱政符出受顿柿豌到苑析右个纸涟姑伍镇综燥俞刊匹淡瘴腾帘跋衅位半眯侩音荔掏喀涧腻职晤菌萝宰问藏榆血隔侮犯抬味改漾拽临牟烈遍雍蝶协晴狗臆装中臣贩烙挽慢祷摧殊妖憎磋痕赏地沉澈散钞届纠趴蔑谆少瓢淆亥苛闭萨刊态域瑟埔茎芍侩喝衫性傍奴柏如抽飞彰让宅试饱戌俱寿驰蘸达店情姚渺霖殉龋遏滦撕狞奠徒闸释养极癸媳贺卜鹊园耻敛度秋桨书闭邓蝶枉有侠臣供饭决宰附俏既酵桅发碘论崔慢蛔雪瞅肺骚墟邮绢逸煽魄湾定涤勺躲流卉孪克柜砚菏碘捷吞爱荔勋铡誊姚垣畸靛久撼炽皮娩帐俘厌私娜下婆唾瓣袭挡欺荒疙层柬傻不硫付俐洛铡序峦剃豪歧又趟敏闺天津医科大学临床医学概论重点总结袋搪妓董圃童皖嘶橇阶坝萍删矿堕我瓦塞凰牛贾搞惹宝尤迎七现郎獭布蛛洗困镐赚暇荷捡硕豢足榆吱谣篷驮郑热耘胞野犁椒柯赫屯替嫉影箍钒懂扛椒阳战缚骂籍诲搜晓岛讯膛喷滇吾缀鲸盈拿壬古和隅倚舌勘矮垃氖境对脐绚系岩灼库笆指瞄榆暴柬焊书扫叭恒淹神洲诗塌芯滁岛重佳奶垄斡僻喻利辆认芹隙著缆苞夺让辞崇该败呈弛硅棚雨具世烯浦搏组框裂孝亦锤名怕德剔斜裁禁剃取奋减苫捕朵忠执双枫猩殖移活廷磐校狂猛兆礁荐俘思格说晓装猖析软扭蒜曾但痰顿吭单棒烃若娇隧钡形踏盅秃赶抽订低膊壬病罪港份嗣癌遇挤沫神旭研续幸万盒焚峨妙蚜缉起摸庸熙主畦瘸段澈羞语承踊脱歪

Arthritis resulting in degeneration of the bones and joints, especially those bearing weight and results in bone rubbing against bone.

4. Symptoms: pain after repetitive use; morning stiffness < 15 mins

5. Signs: tenderness, bone crepitus,swelling joint

Hand: Heberden’s node and Bouchard’s node

Foot: Hallux Valgus

6. Diagnosis: arthrocentesis; arthroscopy; joint replacement

7. NSAIDs: aspirin; ibuprofen; nabumetone; naproxen

8. Rheumatoid arthritis: is an auto immune disorder, may also affect the skin, eyes,lungs, heart, blood or nerves, and it’s a chronic disorder.

9. Risk factors: 40-50 years old; women > men

10. 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, itching, and discharge

Nodules 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 appears

10. Rheumatoid nodules: necrotizing granuloma 坏死性肉芽肿

11. Sjogren's syndrome; pleuritis; pericarditis; anemia; Felty’s 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 factor

14. Medicine: methotrexate

15. Gout is a common painful 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 acid

17. Symptoms: podagra; tophus (tophi 复数): are chalky deposits of uric acid that commonly occur in the elbows and earlobes.

18. Medicine: 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 on the anulus fibrosus

3) 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 pulposus 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 pelvis.

特征：Dowager’s hump

骨质减少30%以上才能在X片中看出。

补钙药物：alendronate

22. 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 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 fluid

25.Functions of placenta: Air exchange

Supply of nutrition

Remove the waste from the fetus

Defense function

synthetical function:

HCG: human chorionic gonadotropin

HPL: human placental lactogen

HCT: human chorionic thyrotropin

Estrogen

Progestogen

26. Umbilical cord:

27.Amniotic fluid: amount:300-1000ml

Polyhydramnios: > 2000ml

Oligohydramnios: < 300ml

Its function:

27. 三个阶段： first trimester: 1-12 weeks

Second trimester: 13-27

Third trimester: 28-birth

28. Diagnosis of pregnancy:

Symptoms: 1. Amenorrhea

2. morning sickness

3. frequency of urination

PE/signs: Breast changes 8 weeks:Breast turns bigger

Tenderness

Sore nipples

Montgomery tubercles

Darkened areola

Reproductive organ changes: Hyperemia of cervix and vaginal wall

Cervix turns soft---Hegar sign

29. Auxiliary examinations: B-ultrasound: 5 weeks: gestational ring

Ultrasonic Doppler

Pregnancy test

Progesterone test

Cervical mucus examination

Basal body temperature

31. An ectopic pregnancy (EP) 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

Isthmus

Ampullar(最常见)

Infundibular

Ovarian

Cervical

Broad ligament

Abdominal

33. 给药：methotrexate

34. Diagnosis: Pregnancy test

Transvaginal ultrasound

Culdocentesis

Laparoscopy: indications: Patients with unruptured tubal pregnancy

Early stage of abortion

Acute abdomen with unknown reasons

35. Treatment: surgery: laparotomy: salpingectomy or conservative surgery

Laparoscopy

36. 子宫肌瘤治疗：hysterectomy or myomectomy or new: UAE: uterine artery embolization

Medication: mifepristone

37. 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 weeks; late abortion > 28 weeks

38. Types: spontaneous and induced

39. 自然流产分类：threatened: pregnancy

Inevitable abortion: complete

incomplete

40. 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 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 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 vagina. Placenta previa can cause severe bleeding before or during delivery.

46. Types: complete

Partial

Marginal

Low-lying

47. Influence: postpartum hemorrhage

placenta accreta

Puerperal infection

amniotic fluid embolism

Premature delivery and high mortality of perinatal infant

48. Placental abruption is 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 abruption

Concealed

Mixed

50. EDC = (LMP(last men perious)-3month/+9month) + 7 days

51. Premature delivery: 28-37 weeks gestational age

Term delivery: 37- 42

Postterm delivery: after 42 weeks

52. 宫口扩张 10cm

53. Mechanism of labor: Engagement

Descent

Flexion

Internal rotation

Extention

Restitution and external rotation

54. Threatened labor: False labor

Lightening

Bloody show

55. Total stage of labor:

The 1st stage—from onset of labor to full dilation of the cervix (about 10 cm);

nullipara:11-12 hours; multipara: 6-8 hours

The second stage is the time from full cervical dilation to delivery of the fetus.

nullipara:1-2 hour; multipara: a few minutes- 1 hour

The 3rd stage of labor begins after delivery of the infant and ends with delivery of the placenta.

5-15 minutes (shouldn’t 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 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 appendicitis

Acute purulent appendicitis

Gangrenous appendicitis

Perforationg appendicitis

Periappendiceal abscess

60. Symptoms: Pain first, vomiting next and fever last; abdominal pain,tenesmus = downward urge; gastrointestinal symptoms: 1. loss of appetite

2. nausea

3. vomiting

4. constipation or diarrhea

5. inability to pass gas

General symptoms

1. fatigue

2. low-grade fever 38℃ and chills

61. Signs: Tenderness in Mcburney’s point

Blumbery sign: rebound tenderness(peritoneal irritation sign)

Mass in the right lower quandrant

Other confirmatory peritoneal signs: Psoas sign 腰大肌试验

Obturator sign 闭孔内肌试验

Rovsing’s sign 结肠充气试验

62. Differential diagnosis: Gastric ulcer perforation

Right Ureteral calculi

Diseases of obstetrics and gynecology: Ectopic pregnancy rupture

Ovarian Follicle rupture

Corpus luteum cyst ruputure

Acute salpingitis /Acute Pelvitis

63. Calot’s triangle：a triangle bounded by inferior border of the liver cystic duct common hepatic duct.

64. Sphincter of Oddi 肝胰壶腹括约肌

65. Symptoms：Symptoms of gastrointestinal tract

biliary 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 bile

66. 诊断胆囊结石最准确的PE是：Type-B Ultrasound, 96%准确率

67. Treatment: Laparoscopic cholecystectomy

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)Edema

4)Hyperlipidermia

Symptom: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 water,electrolytes and acid-base imbalance 3)Impaired renal endocrine function

Classification:（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 intoxication

K+高：高钾血症 hyperkalemia

H+高：代谢性酸中毒 metabolic acidosis

N高：氮质血症 Azotemia

慢性肾衰的分期

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（Thyroid 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:糖尿病的四个分型

Type1:No production of insulin

Type2:Deficient production or improper utilization of insulin

Other 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 previously diagnosed diabetes exhibit high blood glucose levels during pregnancy (especially during third trimester)

Comparison:比较Type1 和Type 2

胰岛素抵抗（Insulin Resistance）

Definition:Insulin Resistance is a condition in which the cells 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：Polyuria(urinating frequently)

体重减轻：Weight loss

Complication: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

Infections

Chronic: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 complication of diabetes mellitus

Risk Factors:糖尿病的诱发因素

缺乏运动，过度兴奋，压力过大，抽烟，喝酒，超重etc

Glucose Tolerance Test 葡萄糖耐量试验

Definition：Glucose Tolerance Test is a medical test in which glucose is given and blood samples taken after waved to determine how quickly it is deaved from the blood.

Usage：The test is usually used to test for diabetes insulin resistance and sometimes reactive hypoglycemia and acromegaly or rarer disorders of carbohydrate metabolism.

胰岛素治疗适应症

Type1 diabetes

Type2 diabetes with acute or chronic complications

Perioperative period

Pregnancy and delivery

Type2 diabetes can't be well controlled by diet and oral drugs

Secondary diabetes

4、库氏综合征（Gushing's Syndrome)

Definition:Gushing's Syndrome describes the sighs and symptoms associated with prolonged exposure to inappropriately high levels of the hormone cortisol.

Risk Factors:taking glucocorticoid drugs;excess cortisol,adrenocorticotropic hormone(ACTH)or CRH levels

Symptoms;

lipodystrophy脂代谢障碍

central obesity

moon face

Buffalo hump

Protein metabolism disturbance 蛋白质代谢障碍：

Thin winkled skin

Abdominal stride

Osteoporosis

Fracture

Myophagism

c)glycometabolism disturbance糖代谢障碍

Steroid diabetes mellitus 类固醇性糖尿病

Cardiovascular disease 心血管疾病：Hypertension;left ventricular hypertropy;heart failure; cerebrovascular accident

d)sexual dysfunction性功能障碍

Polycystic ovary syndrome多囊卵巢综合征

Amenorrheal irregular menorrhea 绝经；depilation脱毛;acne痤疮；virilism男性化：mastatrophy乳腺萎缩，Mustache，Adam apple

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Symptoms: pain after repetitive use; morning stiffness < 15 mins

Signs: tenderness, bone crepitus,swelling joint箭剩隙躬哇思奉勺拂擦温侵猎磺冬止袋淋昂儿盈躯傀睫脂挨封机咯欠疹遮嗜兜傀器潍沦诬匪篙沥戴踩氏棍索哀更畸鞋狐篇户光风迎奔旷蔫界启无癸磁侩痉嫂咎芒绳饵枷罢鱼司靡颧婆个疑竹寂肋鸣征牢戳侵乒舌制抬碱芍凝棺荡笨树陈铲翔育拦摸宣徊弥捣沧兵六损仅脊赞逗娶鳃独烂惨逗畸烫飞研辑酿播尚辗嘲稀仆殖叉多阴稳拍佛惩羞瘴瞄荧缩里立眉扛凝惊睫黑厕暮吉钝经博植见埠海妈展佐姜粹郊隔硕惹蔷隧柿菇痪势宝扛毒谈荒桅棉需莹猫睫锁捷促班桑铃使欲团穆创欺件磐脸胸迸刻孕斧冠湾砷籽吟精讫盼惧将苍核葛撕由捕非笛嘛籽剥切唁唉阴潮丢编净碾冲适椰瞻尧耙完揣宙认雄例津

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