內(nèi)科學(xué) 呼吸系統(tǒng)總論瞿介明

第一頁(yè)，共五十六頁(yè)，編輯于2023年，星期日IntroductionTheRespiratorySystemStructureDetail

2第二頁(yè)，共五十六頁(yè)，編輯于2023年，星期日Introduction3第三頁(yè)，共五十六頁(yè)，編輯于2023年，星期日IntroductionDeathRateof10MainDiseasesinCertainRegionin2006(China)

Rank

City

County

CauseDeathRate1/100000

%

CauseDeathRate1/100000

%

12345678910MalignantNeoplasmsCerebrovascularDiseaseHeartDiseaseDiseasesoftheRespiratorySystemInjury&PoisoningEndocrine,Nutritional&MetabolicDiseasesDiseasesoftheDigestiveSystemDiseaseoftheGenitourinarySystemDiseaseoftheNervousSystemMentalDisorders

144.5793.6990.7269.2932.3617.5915.617.284.953.4427.2517.6617.1013.066.103.322.941.370.930.65MalignantNeoplasmsCerebrovascularDiseaseDiseasesoftheRespiratorySystemHeartDiseaseInjury&PoisoningDiseasesoftheDigestiveSystemEndocrine,Nutritional&MetabolicDiseasesDiseaseoftheGenitourinarySystemDiseaseoftheNervousSystemMentalDisorders

130.23105.4884.9471.8446.1217.008.166.654.163.7725.1420.3616.4013.878.903.281.571.280.800.73Total90.41Total92.324第四頁(yè)，共五十六頁(yè)，編輯于2023年，星期日Majortasks:

Whatdisease?(disease’sdiagnosis)Howtodealwithit?(disease’smanagement)5第五頁(yè)，共五十六頁(yè)，編輯于2023年，星期日ClinicalPresentation6第六頁(yè)，共五十六頁(yè)，編輯于2023年，星期日Commonpresentingsymptoms:Dyspnea(shortnessofbreath)CoughLesscommonsymptoms:Hemoptysis(thecoughingupofblood)Chestpain(oftenwithapleuriticcharacteristics)History7第七頁(yè)，共五十六頁(yè)，編輯于2023年，星期日Acute(overaperiodofhourstodays):

AcuteattackofasthmaAcutepulmonaryedemaBacterialpneumoniaPneumothoraxPulmonaryembolusHistoryDyspnea8第八頁(yè)，共五十六頁(yè)，編輯于2023年，星期日Subacute(overdaystoweeks):AsthmaChronicbronchitisPleuraleffusionCongestiveheartfailurePneumocystiscariniipneumoniainpatientswithAIDSWegener'sgranulomatosis,eosinophilicpneumonia,BronchiolitisobliteranswithorganizingpneumoniaGuillain-Barresyndrome,myastheniagravis

HistoryDyspnea9第九頁(yè)，共五十六頁(yè)，編輯于2023年，星期日Chronic(overmonthstoyears):

COPDChronicinterstitiallungdiseaseChroniccardiacdiseaseHistoryDyspnea10第十頁(yè)，共五十六頁(yè)，編輯于2023年，星期日

Acuteorchronic?

Seasonalorassociatedwithwheezing?Associatedwithsymptomssuggestiveofpostnasaldriporgastroesophagealreflux?Associatedwithfeverorsputum?Anyassociateddiseasesorriskfactorsfordisease(e.g.,cigarettesmoking,riskfactorsforinfectionwithHIV,environmentalexposures)?HistoryCough11第十一頁(yè)，共五十六頁(yè)，編輯于2023年，星期日Originatingfromtheairways:

Bronchitis,Bronchiectasis,Cysticfibrosis,Bronchogeniccarcinoma,BronchialcarcinoidtumorsOriginatingfromthepulmonaryparenchyma:Pneumonia,Lungabscess,Tuberculosis,InfectionwithAspergillus,Goodpasture’ssyndrome,Idiopathicpulmonaryhemosiderosis(IPH)Originatingfromthevasculature:Thromboembolicdiseases,ArteriovenousmalformationsHistoryHemoptysis12第十二頁(yè)，共五十六頁(yè)，編輯于2023年，星期日Usuallyoriginatingfrominvolvementoftheparietalpleura:PleuritisPneumothoraxNeoplasmPulmonaryembolismPneumoniaHistoryChestpain13第十三頁(yè)，共五十六頁(yè)，編輯于2023年，星期日

ThenumberofyearsofsmokingTheintensity(i.e.,numberofpacksperday)TheintervalsincesmokingcessationAhistoryofsignificantsecondhand(passive)exposuretosmokeHistoryHistoryofsmoking14第十四頁(yè)，共五十六頁(yè)，編輯于2023年，星期日Respiratorydisordersassociatedwithsmoking:ChronicobstructivelungdiseaseNeoplasiaSpontaneouspneumothoraxRespiratorybronchiolitis-interstitiallungdiseaseEosinophilicgranulomaofthelungPulmonaryhemorrhagewithGoodpasture'ssyndromeHistoryHistoryofsmoking15第十五頁(yè)，共五十六頁(yè)，編輯于2023年，星期日

Occupational(detailedoccupationalandpersonalhistories)orAvocational(hobbies,homeenvironment)

Inorganicdusts(asbestos,silicadusts)associatedwithpneumoconiosiswhileorganicantigens(molds,animalproteins)associatedwithhypersensitivitypneumonitisHistoryExposuretoinhaledagents16第十六頁(yè)，共五十六頁(yè)，編輯于2023年，星期日

Systemicrheumaticdiseases

RiskfactorsforAIDS

Treatmentofnonrespiratorydisease(immunosuppressiveagents,cancerchemotherapy,radiationtherapy,amiodarone,?-blockingagents,angiotensin-convertingenzymeinhibitors(ACEI))

HistoryCoexistingnonrespiratorydiseases17第十七頁(yè)，共五十六頁(yè)，編輯于2023年，星期日Geneticcomponent:

Cysticfibrosisα1-antitrypsindeficiencyPulmonaryhypertensionPulmonaryfibrosisAsthmaHistoryFamilyhistory18第十八頁(yè)，共五十六頁(yè)，編輯于2023年，星期日

TherateandpatternofbreathingThedepthandsymmetryoflungexpansionPhysicalExaminationInspection19第十九頁(yè)，共五十六頁(yè)，編輯于2023年，星期日

Thesymmetryoflungexpansion,confirmingthefindingsobservedbyinspectionVibrationproducedbyspokensoundsFocaltendernessPhysicalExaminationPalpation20第二十頁(yè)，共五十六頁(yè)，編輯于2023年，星期日

TherelativeresonanceordullnessofthetissueunderlyingthechestwallPhysicalExaminationPercussion21第二十一頁(yè)，共五十六頁(yè)，編輯于2023年，星期日

ThequalityandintensityofthebreathsoundsThepresenceofextra,oradventitioussoundsTheprimaryadventitious(abnormal)soundsthatcanbeheardincludecrackles(rales),wheezes,andrhonchiOtheradventitioussoundsincludepleuralfrictionrubsandstridorPhysicalExaminationAuscultation22第二十二頁(yè)，共五十六頁(yè)，編輯于2023年，星期日PhysicalExaminationTypicalChestExaminationFindingsinSelectedClinicalConditionsPercussionTactileFremitusBreathSoundsVocalResonanceAdventitiousSoundsConsolidationoratelectasis(withpatentairway)DullIncreasedBronchialBronchophony,whisperedpectoriloquy,egophonyCracklesConsolidationoratelectasis(withblockedairway)DullDecreasedDecreasedDecreasedAbsentAsthmaResonantNormalVesicularNormalWheezingInterstitiallungdiseaseResonantNormalVesicularNormalCracklesEmphysemaHyperresonantDecreasedDecreasedDecreasedAbsentorWheezingPneumothoraxHyperresonantDecreasedDecreasedDecreasedAbsentPleuraleffusionDullDecreasedDecreasedDecreasedAbsentorpleuralfrictionrub23第二十三頁(yè)，共五十六頁(yè)，編輯于2023年，星期日AdditionalDiagnosticEvaluation24第二十四頁(yè)，共五十六頁(yè)，編輯于2023年，星期日

Collectedeitherbyspontaneousexpectorationorafterinhalationofanirritatingaerosol,suchashypertonicsalineQualifiedsample:Squamousepithelialcells<10/HP,WBC>25/HPorWBC/Squamousepithelialcells>2.5

CollectionofSputum25第二十五頁(yè)，共五十六頁(yè)，編輯于2023年，星期日

Stainingandcultureformycobacteriaorfungi

Cultureforviruses

StainingforPneumocystiscarinii(especiallyinapatientinfectedwithHIV)

CytologicstainingformalignantcellsTheuseofpolymerasechainreaction(PCR)amplificationandDNAprobesCollectionofSputum26第二十六頁(yè)，共五十六頁(yè)，編輯于2023年，星期日ArterialBloodGasesMechanismsofhypoxemia:AdecreaseininspiredPO2HypoventilationShuntingV/Qmismatching27第二十七頁(yè)，共五十六頁(yè)，編輯于2023年，星期日ArterialBloodGasesMechanismofhypercapnia:IncreasedCO2productionDecreasedventilatorydrive("won'tbreathe")Malfunctionoftherespiratorypumporincreasedairwaysresistance("can'tbreathe")Inefficiencyofgasexchange(increaseddeadspaceorV/Qmismatch)28第二十八頁(yè)，共五十六頁(yè)，編輯于2023年，星期日RoutineRadiographyPosteroanterior(PA)DIL29第二十九頁(yè)，共五十六頁(yè)，編輯于2023年，星期日RoutineRadiographyAnteroposterior(AP)ARDS30第三十頁(yè)，共五十六頁(yè)，編輯于2023年，星期日ChestRadiographyRheumatoidnodule(oneorseveralnodules):Vascularmalformation,BronchogeniccystLocalizedopacification(infiltrate):Pneumonia(bacterial,atypical,mycobacterial,orfungalinfection),Neoplasm,Radiationpneumonitis,Bronchiolitisobliteranswithorganizingpneumonia(BOOP),Bronchocentricgranulomatosis,PulmonaryinfarctionMajorRespiratoryDiagnoseswithCommonChestRadiographicPatterns(1)31第三十一頁(yè)，共五十六頁(yè)，編輯于2023年，星期日ChestRadiography

MajorRespiratoryDiagnoseswithCommonChestRadiographicPatterns(1)

Diffuseinterstitialdisease:Idiopathicpulmonaryfibrosis,Pulmonaryfibrosiswithsystemicrheumaticdisease,Sarcoidosis,Drug-inducedlungdisease,Pneumoconiosis,Hypersensitivitypneumonitis,Infection(Pneumocystis,viralpneumonia),Eosinophilicgranuloma32第三十二頁(yè)，共五十六頁(yè)，編輯于2023年，星期日ChestRadiographyDiffusealveolardisease:Cardiogenicpulmonaryedema,AcuterespiratorydistresssyndromeDiffusealveolarhemorrhage:Infection(Pneumocystis,viralorbacterialpneumonia),SarcoidosisDiffusenodulardisease:Metastaticneoplasm,Hematogenousspreadofinfection(bacterial,mycobacterial,fungal),Pneumoconiosis,EosinophilicgranulomaMajorRespiratoryDiagnoseswithCommonChestRadiographicPatterns(2)33第三十三頁(yè)，共五十六頁(yè)，編輯于2023年，星期日ComputedTomography

DistinguishingvariousdensitiesParticularlyvaluableinassessinghilarandmediastinaldiseaseIdentifyingareasoffatdensityorcalcificationinpulmonarynodulesAssessmentinthestagingoflungcancerDistinguishingvascularfromnonvascularstructures34第三十四頁(yè)，共五十六頁(yè)，編輯于2023年，星期日CTscandemonstratingamediastinalmassComputedTomography35第三十五頁(yè)，共五十六頁(yè)，編輯于2023年，星期日High-resolutionCTscanfromapatientwithidiopathicpulmonaryfibrosis.scatteredreticulardensities(arrows)ComputedTomography36第三十六頁(yè)，共五十六頁(yè)，編輯于2023年，星期日Idiopathicpulmonaryfibrosis.High-resolutionCTimageshowsbibasal,peripheralpredominantreticularabnormalitywithTractionbronchiectasisandhoneycombingComputedTomography37第三十七頁(yè)，共五十六頁(yè)，編輯于2023年，星期日exudativephaseofARDSinwhichdependentalveolaredemaandatelectasispredominateComputedTomography38第三十八頁(yè)，共五十六頁(yè)，編輯于2023年，星期日ComputedTomography

HelicalCTscanningCTangiographyHigh-resolutionCT(HRCT),thethicknessofindividualcrossisapproximately1to2mmVirtualbronchoscopy39第三十九頁(yè)，共五十六頁(yè)，編輯于2023年，星期日PET

Positronemissiontomographic(PET)scanning

isincreasinglybeingusedtoidentifymalignantlesionsinthelungbasedontheirincreaseduptakeandmetabolismofglucoseThetechniqueinvolvesinjectionofaradiolabeledglucoseanalogue,18F-fluoro-2-deoxyglucose

(FDG),whichistakenupbymetabolicallyactivemalignantcells40第四十頁(yè)，共五十六頁(yè)，編輯于2023年，星期日PulmonaryAngiography

ThepulmonaryarterialsystemcanbevisualizedIncasesofpulmonaryembolism,pulmonaryangiographydemonstratestheconsequencesofanintravascularclot—eitheradefectinthelumenofavessel(a"fillingdefect")oranabrupttermination("cutoff")ofthevesselWithadvancesinCT1scanning,traditionalpulmonaryangiographyisincreasinglybeingreplacedbyCTangiography41第四十一頁(yè)，共五十六頁(yè)，編輯于2023年，星期日ThoracentesisEffusiontobeclassifiedaseitherexudativeortransudativeExudativepleuraleffusionsmeetatleastoneofthefollowingcriteria:pleuralfluidprotein/serumprotein>0.5pleuralfluidLDH/serumLDH>0.6

pleuralfluidLDHmorethantwo-thirdsnormalupperlimitforserum42第四十二頁(yè)，共五十六頁(yè)，編輯于2023年，星期日PulmonaryFunctionTestThetwomeasurementsoflungvolumecommonlyusedforrespiratorydiagnosis:Totallungcapacity(TLC)Residualvolume(RV)ThevolumeofgasthatisexhaledfromthelungsingoingfromTLCtoRVisthevitalcapacity(VC)DisturbancesinVentilatoryFunction43第四十三頁(yè)，共五十六頁(yè)，編輯于2023年，星期日PulmonaryFunctionTestLungvolumes,shownbyblockdiagrams(left)andbyaspirographictracing(right)*Totallungcapacity(TLC)*Vitalcapacity(VC)*Residualvolume(RV)*Inspiratorycapacity(IC)*Expiratoryreservevolume(ERV)*Functionalresidualcapacity(FRC)DisturbancesinVentilatoryFunction44第四十四頁(yè)，共五十六頁(yè)，編輯于2023年，星期日PulmonaryFunctionTestanormaltracing(A)obstructive(B)parenchymalrestrictive(C)Disease*Forcedvitalcapacity(FVC)*Forcedexpiratoryvolume(FEV)*Forcedexpiratoryflow(FEF)DisturbancesinVentilatoryFunction45第四十五頁(yè)，共五十六頁(yè)，編輯于2023年，星期日PulmonaryFunctionTestThreemaincategoriesofdiseaseareassociatedwithloweredDLCO:InterstitiallungdiseaseEmphysemaPulmonaryvasculardiseaseAnelevatedDLCOmaybeusefulinthediagnosisofalveolarhemorrhage,asinGoodpasture'ssyndromeDiffusingCapacity46第四十六頁(yè)，共五十六頁(yè)，編輯于2023年，星期日PulmonaryFunctionTestFlow-volumecurvesindifferentconditions:O,obstructivedisease;R(P),parenchymalrestrictivedisease;

R(E),extraparenchymalrestrictivediseasewithlimitatio