詢問病史12casehistoryYouneedtogetadetailedhistoryincludingthetimingandacuityofonset,exacerbatingandalleviatingfactorsandenvironmenttriggerstohelpyouconfirmadiagnosisordiscardotherdiseases/developadifferentialdiagnosis.Askyourpatientwhetherthereisahistoryoftobaccouse,orothertoxicandenvironmentalexposuresandhisoccupationalhistory.

General/biographical[,bai?u'ɡr?fik,-k?l]data傳記,marital婚姻status,nativity出生,occupation,informant提供消息的人,timeofadmissionandrecord,chiefcomplaint,historyofpresentillness,previoushealthstatus(well,ordinaryorbad),anyinfectiousdiseases,allergichistory,historyoftraumaorsurgery,smoking(abouthowmanyyears,averagehowmanypiecesperday,ceasedforhowmanyyears),alcoholintake(occasionalorfrequent),spouse’s[spaus]配偶healthstatus,menorrhea[,men?'ri:?]月經(jīng)(menarche[me'nɑ:ki:,m?-]初潮age,cyclelastingforhowmanydays,menstrualcycle,lastmenstruationperiodorageofmenopause,anymenstrual['menstru?l]月經(jīng)周期painorirregularcycle),childbearingorpregnancy(times,naturallabor,abortions流產(chǎn),premature[,prem?'tju?,,pri:-]delivery早產(chǎn),stillbirths死產(chǎn),difficultlabor,familyhistory(anycongenital先天性diseases,fatherandmother:stillalive,illness,orcauseofdeath,siblings兄弟姐妹andchildren)

常用的癥狀symptoms

fever

Cough咳嗽

Sputum(dry,purulent['pju?rjul?nt]膿性的,copious['k?upi?s]greensputum大量綠色痰，tenacious[ti'nei??s,t?-]yellowsputum黃粘痰，frothywhitesputum白色泡沫痰，rustysputum鐵銹色痰

wheezing

Dyspneaduringexertion[iɡ'z?:??n]oratrest呼吸困難

Orthopnea[?:'θ?pni?]端坐呼吸

Paroxysmal[,p?r?k'sizm?l]nocturnal[n?k't?:n?l]dyspnea夜間陣發(fā)性呼吸困難

Shortnessofbreath（SOB）

Chesttightness胸部緊迫感

Exerciseintolerance

pleuriticchestpain胸膜型胸痛

Pharyngalgia[f?rin'g?ld?i?];pharyngodynia[,f?ri?'ɡ?dini?]咽痛

Hemoptysis咯血

Bucking嗆咳

Sneeze噴嚏

snore打鼾

malaise[m?'leiz]不舒服

myalgia[mai'?ld?i?]肌痛

insomnia[in's?mni?]失眠

hoarseness聲嘶

dysphonia[dis'f?uni?]發(fā)聲困難

常見的體征physicalsigns

clubbedfingers杵狀指:increasedlongitudinal[,l?nd?i'tju:din?l]andtransverse橫向curvature['k?:v?t??]彎曲,lossofconcave['k?nkeiv]凹面的nailfoldangle,bogginessofnailbedandincreasedsofttissuebulkofdistalphalanx['f?l??ks,'fei-]趾骨,指骨,drumstick-like

nicotinestaining

cyanosis[,sai?'n?usis]發(fā)紺:bluediscolourationofmucosalmembranesandskin,causedwhenmeancapillaryconcentrationofdeoxyhemoglobin[di:,?ksi'hem?u,ɡl?ubin]去氧血紅蛋白morethan5g/dl,O2saturationlessthan85%,PaO2lessthan8KPa

peripheral[p?'rif?r?l]外圍的,次要的cyanosis:coldblueperipheries,e.g.nailbedsduetocoldexposures

centralcyanosis:warmperipheries,bluetongueorlips

handflap:duetoCO2retention潴留

asterixis撲翼樣震顫

papilloedema視乳頭水腫

chemosis球結(jié)膜水腫

enlargedsupraclavicula鎖骨上的r[kl?'vikjul?]andaxillary[?k'sil?ri]腋窩lymphnodes

increasedrespiratoryrate

tachycardia心動(dòng)過速

pulsusparadoxus:>10mmHg↓oninspiration(seeninsevereasthma)

barrelchest

hyperexpanded,decreasedexpansion

kyphosis[kai'f?usis]駝背，脊柱后凸

Inspection:

tachypnea[,t?kip'ni:?]呼吸急促

accessorymusclesofrespiration[,resp?'rei??n]:sternocleidomastoid['st?:n?u,klaid?'m?st?id]胸鎖乳突肌muscle,armsupport,alaeflaring

wideornarrowintercostal[,int?'k?st?l]肋間的space

tactile觸覺的vocal聲音的fremitus震顫觸覺語顫

subcutaneouscrepitus皮下捻發(fā)感

Percussion:

resonance清音

dullness濁音

flatness實(shí)音

hyperresonance過清音

tympany/timp2ni/鼓音

lowerborders:scapular['sk?pjul?]肩胛的lineXleft/rightintercostal[,int?'k?st?l]肋間的space

rangeofmobility[m?u'bil?ti]移動(dòng)

Auscultation[,?:sk?l'tei??n]:聽診

vocalresonance語音共振

ronchi:wheeze,stridor['straid?]喘鳴,crackles['kr?kl]發(fā)出細(xì)碎的爆裂聲,Velcro-likesoundes

moistrales:coarse粗的,medium中等的,fine好的,crepitus捻發(fā)音

pleuralfrictionrubs

completeabsenceofbreathsounds

ankleedema

weightloss，cachexia[k?'keksi?]惡病質(zhì)，cachectic[k?'kektik]惡病質(zhì)的

decreasedfoodappetite,lossofappetite,anorexia[,?n?'reksi?]食欲減退dermatomyositis皮肌炎

sarcoidosis結(jié)節(jié)病[,sɑ:k?i'd?usis]

Pulmonaryalveolarproteinosis[,pr?utii'n?usis],PAP肺泡蛋白沉積癥

Idiopathicpulmonaryhemosiderosis['hi:m?u,sid?'r?usis,,hem-]特發(fā)性肺含鐵血黃素沉著病Langerhanscellgranulomatosis朗格漢斯細(xì)胞肉芽腫病['ɡr?nju,l?um?'t?usis]

Eosinophilicgranuloma嗜酸性肉芽腫[,i:?sin?'filik]

HistiocytosisX組織細(xì)胞增多癥X

WegenergranulomatosisWegener肉芽腫

extrinsicallergicalveolitis外源性過敏性肺泡炎

pneumoconiosis塵肺['nju:m?,k?uni'?usis]

drug-inducedlungdisease藥物性肺病

aspergillosis[?,sp?:d?i'l?usis]曲菌?。篴llergicbronchopulmonaryaspergillosis(ABPA)

pleuraldisease胸膜疾病

broncho-pleuralfistula支氣管胸膜瘺['fistjul?]

oralcandidiasis口腔念珠菌病，鵝口瘡[,k?ndi'dai?sis]

osteoporoticbonechange骨質(zhì)疏松樣改變

glaucoma青光眼

cataract白內(nèi)障

acutelunginjury，ALI急性肺損傷

acuterespiratorydistresssyndrome,ARDS急性呼吸窘迫綜合征

urticaria蕁麻疹

eczema濕疹

hypertension高血壓

diabetes糖尿病

常用的藥物drugsoragents

beadministered,treatsb.with

empirical經(jīng)驗(yàn)性的,prophylactic[,pr?fi'l?ktik,,pr?u-]預(yù)防性,remedial[ri'mi:di?l]治療性

Expectorant祛痰藥[eks'pekt?r?nt]

Mucolytics粘液溶解劑[,mju:k?u'litik]

bronchodilator支氣管擴(kuò)張劑[,br??k?udai'leit?]

B2-agonists['?ɡ?nist]興奮劑:short-acting:salbutamol沙丁胺醇[s?l'bju:t?m?(:)l]

long-acting:salmeterol沙美特羅

muscarinic[,m?sk?'rinik]毒蕈堿樣的antagonists[?n't?ɡ?nist]對(duì)抗劑:ipratropiumbromide['br?umaid]異丙托溴胺

aminophylline氨茶堿[?,mi:n?u'fili:n]

steroids['sti?r?id]類固醇inhaled:budesonide布地奈德，beclomethasone[,bekl?u'meθ?s?un]倍氯米松，fluticasone氟替卡松

systemic:prednisolone['pred'nis?l?un]強(qiáng)的松po(peros).,hydrocortisone[,haidr?u'k?:tiz?un]氫化可的松iv.

mastcellstabilizers:cromoglycatesodium色甘酸鈉

leukotriene[,lju:k?u'trai?n]白三烯receptorantagonists:montelukast孟魯司特

respiratorystimulants:

lobeline

nikethamide[ni'keθ?maid,-mid]尼可剎米

cardiactonic強(qiáng)心劑

diuretics利尿劑[,daiju?'retik]

albumin白蛋白['?lbjumin]

antitussiveagents鎮(zhèn)咳藥[,?nti't?siv]

ammoniumchloride氯化銨[?'m?unj?m]銨['kl?:raid]氯化物

ambroxol氨溴索（mucosolvan沐舒坦）Pantoloc潘妥洛克

常用的治療措施

loworhighflowoxygen:nasalcannulae['k?njuli:]鼻導(dǎo)管，Venturi[ven'tju?ri]文里氏face-masknebulizer['nebjulaiz?]噴霧器:finerparticlesize(3to20um)allowstracheobronchialdeposition

metereddoseinhaler(MDI)定量霧化吸入器

continuouspositiveairwaypressure(CPAP)-tight-fittingmask(non-invasive)

intermittentpositive-pressureventilation(IPPV)

non-invasivepositive-pressureventilation(NIPPV)

mechanicalventilation:non-invasiveorinvasive

(viaintubation[,intju:'bei??n]插管，tracheostomy[,tr?ki'?st?mi,,trei-]氣管造口術(shù)，tracheotomy[,tr?ki'?t?mi,,trei-]氣管切開術(shù))

synchronizedintermittentmandatoryventilation,SIMV同步間歇指令通氣

pressuresupportventilation,PSV壓力支持通氣

thoracocentesis胸腔穿刺術(shù)[,θ?:r?k?sen'tesis]

chestdrain/drainage引流術(shù)

chemotherapy化療

radiationtherapy放療

pneumonectomy肺切除術(shù)[,nju:m?u'nekt?mi]

lobectomyoflung，pulmonarylobectomy肺葉切除術(shù)[l?u'bekt?mi]葉切除術(shù)

thoracotomy開胸術(shù)，胸廓切開術(shù)[,θ?:r?'k?t?mi]

pleurodesis胸膜剝脫術(shù)

pleurectomy胸膜切除術(shù)

pleuraladhesion胸膜粘連術(shù)

thromboendarterectomy血栓動(dòng)脈內(nèi)膜切除術(shù)

inferiorvenacavafilter下腔靜脈過濾器

常見的疾病

chornicbronchitis:procuctivecough,mostdaysof3monthsoftheyear,foratleast2consecutiveyears,coughwithwhiteorpurulentsputum

bronchiectasis:

cystic['sistik]囊性的/varicose['v?rik?us]曲張樣/cyclindrical柱狀-tram-tracks軌道樣

hemoptysis

physiotherapy:chestwallpercussionwirhhead-downpostural['p?st??r?l]drainage

longtermoxygeninhalation:topreventcorpulmonale

medical:bronchodilators,mucolytics,rotatingcoursesofantibiotics

surgical:resection,arteryembolizationforhemoptysis

lungabscess

usuallyonrightside,asrightbronchusisshorterandmorevertical;

inthesupine['sju:pain]仰臥patient,abscessdevelopsinapicallowerlobeorposterialupperlobe.

pneumothorax

accumulationofairinpleuralspace,withsecondarypartialcollapseofsubpleural胸膜下的bleb[bleb]大皰rupture['r?pt??]破裂

lactrogenic:positivepressureventilation,bronchoscopy[br??'k?sk?pi]支氣管鏡檢查,esp.biopsy

types:closed,open,tension

mediastinaldeviation:tracheaandapex['eipeks]尖端shiftcontralaterally對(duì)立的旁邊

CXR:translucency[tr?nz'lju:s?nsi]半透明+collapse倒塌:visiblerim邊緣betweenlungandchestwall＞2cm(centimeter)=＞50%lungvolumeloss

aspiration[,?sp?'rei??n]吸引術(shù)，intercostaldrain

refractoryorrecurrent周期性的:pleurodesis胸膜固定術(shù),pleurectomy[plu'rekt?mi]胸膜切除術(shù),bulla['bul?]大皰stapling裝訂orlasering激光

pleuraleffusion

chestpainandprogressivelyworseningofshortnessofbreath

Transudate[,tr?nsju'deit]漏出液：redistributionofStarlingforcesacrossmicrocirculation,diuretics[,daiju?'retik]利尿劑canresultinrapidresolution,protein<30g/L(gram/litre['li:t?])orpleura:serum['si?r?m]血清protein<1/2orpleura:serumLDH<2/3;

oftenseenincardiacfailure,hypoalbuminemia[,haip?u?l,bju:m?'ni:mi?]低蛋白血癥,embolism,superiororinferiorvenacavaobstruction,hypothyroidism.[,haip?u'θair?idiz?m]甲狀腺功能低下

Exudate['eksjudeit]滲出液：capillarypermeability[,p?:mi?'biliti]滲透increasesorlymphdrainagedecreases

oftenseenininfection,neoplasia[,ni:?u'pleizi?,-?i?]瘤形成,surgeryortrauma.

CXR:meniscus[mi'nisk?s]彎液面-shaped,risestowardsaxilla[?k'sil?]腋溫

Appearance:clear,straw淡黃色的-coloured:suggeststransduate

turbid['t?:bid]渾濁的,green:indicatesexudates(pus[p?s]膿cells)orempyema[,empai'i:m?]積膿癥(bacterialinfection)bloody(haemothorax[,hi:m?u'θ?:r?ks]血胸):tumor,pulmonaryembolism,acutepancreatitis['p?nkri?'taitis]胰腺炎,trauma

white(chylothorax[,kail?u'θ?:r?ks]乳糜胸)：lymph,blockedthoracic[θ?:'r?sik,]duct胸導(dǎo)管,usuallyduetotumour

Therapy:transudate:diuretics

exudates:repeateddrainage(thoracocentesis)

intrathoracic[,intr?θ?'r?sik]胸廓內(nèi)的streptokinase[,strept?u'kaineis]鏈球菌激酶viachestdrain:tolyse[lais]溶解fibrinous['faibrin?s]纖維蛋白的adhesions[?d'hi:??n]粘合

pleuraladhesion:tetracycline[,tetr?'saiklain]四環(huán)素.bleomycin[,bli:?u'maisin]博萊霉素

lungcancer

hoarseness:duetoleftrecurrent屢發(fā)的laryngeal[,l?rin'd?i:?l]喉的nervepalsy['p?:lzi]麻痹

dysphagia[dis'feid?i?,-d?i]吞咽困難

pancoasttumorinfiltratesT1stellate['stelit,-leit]星形的ganglion['ɡ??ɡli?n]神經(jīng)節(jié)resultinginHornersyndrome

hypertrophicpulmonaryosteoarthropathy[,?sti?uɑ:'θr?up?θi]骨關(guān)節(jié)病

superiorvenacavaobstruction(SVCO):headache,shortnessofbreath;conjunctivaledema,[,k?nd???k'taiv?]結(jié)膜plethora['pleθ?r?],veindilation,pericardialtamponade[,t?mp?'neid]心包填塞(JVP↑,ABP↓,quietHS

paraneoplasticsyndromes:endocrine(ACTH:Cushing’s;B-HCG:gynaecomastiaandbodyhairloss;PTH:hypercalcaemiaespeciallysquamouscellcarcinoma),

skin（dermatomyositis）

immunocompromisede.g.shingles帶狀皰疹

squamouscellcarcinoma:30%ofallprimarylungtumours,butdecreasingincidence,relativelygoodprognosisiflocalized,squamousmetaplasiawithkeratinwhorls,centrallocation,clubbing,hypercalcemia(PTH-rpsecretion)

adenocarcinoma:30%,increasingincidence,esp.women,lessassociationwithsmoking,poorprognosis,metastasisearly,gland-likeandmucin-secretion,peripherallocation,pleuraleffusions,hypercoagulablestate

smallcellcarcinoma:20%,poorprognosis,metastasisoccurearly,smallAUPDcellswithneurosecretorygranules,centrallocation,paraneoplasticsyndromescommon

bronchoalveolarcellcarcinoma:variantofadenocarcinomathatisassociatedwithchroniclunginflammation,e.g.fibrosing,copiousclearmucoidsputum

NSCLC:surgicalresectionpossibleatfirst,adjuvantchemotherapy

SCLC:radiotherapy+chemotherapy(etoposide+cisplatin)

secondarylungcancer:breast,oesophago/gastric/head-neck(+coloniflivermetastasis),melanoma,bone(sarcoma),thyroid,renal,prostate,ovary,choriocarcinoma,testesetc.

obstructivesleepapnoea

obstructionofupperairwayoccursatnightwithlossofmuscletoneinsleep,snoring,sleepinessduringday,aponeicspells(O2↓,patientawakesfromsleep),awakeningwithnocturia,daytimesomnolence,decreasedmemoryandattention,increasedaccidentrisk,polycythaemia,systemichypertensionandpulmonaryhypertension

Causes:centralobesity(fatdepositionaroundupperairwayleadstoairwaynarrowing,abdominalfatelevatesdiaphragm),structuralfeaturesofupperairway(nasalobstruction:rhinitis,polyps,deviatedsputum;adenotonsillarhypertrophy,micrognathia;macroglossiaduetohypothyrodism/amyloid/Down’s;cervicalmasses:goiter,laryngealstenosis),smoking(exacerabateshypoxia),alcohol(actsasasedativetherebyreducingupperairwaytone),neuromuscularorCNSdiseases

PSG(polysommography):overnightsleepstudy

Therapy:conservative:weightloss,avoidalcohol/smoking/sedatives,avoidsupineposition

continuouspositiveairwaypressure(CPAP)

mandibularadvancementdevice(MAD)

adenoidectomy（curativeinchildren）

uvulopalatopharyngoplasty懸雍垂-腭-咽成形術(shù)

maxillomandibularosteotomy

obesity-hypoventilationsyndrome:collapseofalveoliatend-expiration,decreasedcomplianceduetoweightofabdomenandchestwall,centralrespiratorydrive↓

常用的化療藥

cisplatin順鉑

Gemcitabine吉西他濱：Gemzar(鹽酸吉西他濱注射劑)

paclitaxel;taxinol紫杉醇（Taxol泰素）

docetaxel多西他賽（泰素帝）

常見的抗生素

beta-lactamantibiotics:inhibitcellwallsynthesis

penicillinskintest

amoxicillin阿莫西林

piperacillin/tazobactamsodium哌拉西林/他唑巴坦鈉

ticarcillin/clavulanatepotassium替卡西林/克拉維酸鉀

cephamycin頭孢菌素類

cefradine頭孢拉啶

cefaclor頭孢克洛

cefoperazone/sulbactam頭孢哌酮/舒巴坦

ceftriaxone頭孢曲松

cefpiramide頭孢吡啶

ceftazidime頭孢他定

ceftizoxime頭孢唑污

carbopenems碳青霉烯類

azactam氨曲南

meropenem美羅培南

imipenemandsodiumcilastatin亞胺培南/西司他丁鈉（泰能tienam）

Glycopeptides糖肽類inhibitcellwallassembly

vancomycin萬古霉素

norvancomycin去甲萬古霉素

teicoplanin替考拉林

Macrolides大環(huán)內(nèi)酯類：inhibitproteinsynthesis

roxithromycin羅紅霉素

clarithromycin克拉霉素

azithromycin阿奇霉素

erythromycin紅霉素

Aminoglycosideantibiotics:氨基糖苷類reno-andototoxic

inhibitinitiationandelongationprocessduringproteinsynthesis

amikacin阿米卡星（丁胺卡那）

gentamicin慶大霉素

streptomycin鏈霉素

Sulfamido磺胺類

sulfamethoxazolecompound(SMZ.CO)

Quinolones喹諾酮類：inhibitDNAgyrase

norfloxacin諾氟沙星

ofloxacin氧氟沙星

levofloxacin左氧氟沙星

gatifloxacin加替沙星

moxifloxacin莫西沙星

ciprofloxacin環(huán)丙沙星

Tetracycline四環(huán)素類

minocycline美滿霉素

Nitromidazole硝基咪唑類

metronidazole甲硝唑

tinidazole替硝唑

ornidazole奧硝唑

Antitubercularagents抗結(jié)核藥

rifampicin利福平

rifapentine利福噴丁

isoniazide,isonicotinichydrazideacidINH異煙肼

pyrazinamide吡嗪酰胺

ethambutol乙胺丁醇

Antifungal/antimycoticdrug抗真菌藥

nystatin制霉菌素

amphotericin兩性霉素B

fluconazole氟康唑

voriconazole伏立康唑

itraconazole伊曲康唑

Antivirusagents

ribavirin利巴韋林

oseltamivir奧司他韋

acyclovir阿昔洛韋

ganciclovir更昔洛韋

valaciclovir伐昔洛韋

foscarnetsodium,phosphonoformicacid膦甲酸鈉（可耐）

lamivudine拉米夫定

entecavir恩替卡韋

常見的病原微生物

microorganism,microbe微生物

bacterium細(xì)菌

lipopolysaccharide（LPS）脂多糖

antibiotics抗生素

pyrogen致熱原

exotoxin外毒素

endotoxin內(nèi)毒素

Gramstain革蘭染色

Colonyformingunit,CFU集落形成單位

antibacterialagents抗菌藥

resistance耐藥性

ESBLs：extendedspectrumB-lactamases超光譜B內(nèi)酰胺酶

MRSA：methicillin-resistantstaphylococcusaureus耐甲氧西林金黃色葡萄球菌

bacteremia菌血癥

toxemia毒血癥

endotoxemia內(nèi)毒素血癥

septicaemia敗血癥

pyemia膿毒血癥

pathogen致病原

pathogenicity致病性

virulence毒力

medianlethaldose(LD50)半數(shù)致死量

medianinfectivedose(ID50)半數(shù)感染量

virus病毒

replication復(fù)制

viremia病毒血癥

normalmicrobiota,microflora,normalflora,physiologicalmicrobiota正常微生物群

floradisequilibrium菌群失調(diào)

dysbacteriosis菌群失調(diào)癥

opportunisticinfection機(jī)會(huì)性感染

conditionedinfection條件致病性感染

endogenousinfection內(nèi)源性感染

exogenousinfection外源性感染

antimicrobialsusceptibilitytesting藥物敏感試驗(yàn)

minimuminhibitoryconcentration(MIC)最小抑菌濃度

minimumbactericidalconcentration(MBC)最小殺菌濃度

disinfection消毒

sterilization滅菌

asepsis無菌

aseptictechnique無菌技術(shù)

bacteriostasis抑菌

antisepsis防腐

disinfectant消毒劑

bacteriostaticagent抑菌劑

bactericide殺菌劑

autoclavingorsteamunderpressuresterilization高壓蒸汽滅菌法

ultravioletradiation,UV紫外線

isolationprecaution隔離預(yù)防

artificialactiveimmunization人工主動(dòng)免疫

vaccination疫苗接種

killed/inactivatedvaccine死/滅活疫苗

attentuatedlivevaccine減毒活疫苗

toxoid類毒素

artificialpassiveimmunity人工被動(dòng)免疫

antitoxin抗毒素

gammaglobulin丙種球蛋白

Staphylococcusaureus金黃色葡萄球菌

Coagulase-negativestaphylococci凝固酶陰性葡萄球菌

Staphylococcusepidermidis表皮葡萄球菌

Streptococcuspneumoniae,pneumococcus肺炎鏈球菌

Viridansstreptococci草綠色鏈球菌

Escherichiacoli大腸埃希菌

Klebsiellapneumoniae肺炎克雷伯菌

Pseudomonasaeruginosa銅綠假單胞菌

Haemophilusinfluenzae流感嗜血桿菌

Legionella軍團(tuán)桿菌屬

Enterobactercloacae陰溝腸桿菌

Serratia沙雷菌屬

Proteusvulgaris普通變形桿菌

Acinebacter不動(dòng)桿菌屬

Neisseriameningitis,meningococcus腦膜炎鏈球菌

Neisseriagonorrhoeae,gonococcus淋病奈瑟菌

Shigella,dysenterybacterium痢疾桿菌

Salmonellatyphi傷寒沙門菌

Vibriocholerae霍亂弧菌

Helicobacterpylori幽門螺桿菌

Campyloba