碩士生導(dǎo)師 佛山大學(xué)醫(yī)學(xué)院醫(yī)學(xué)系孟紅旗教授

General

examination原南京中大附屬醫(yī)院神內(nèi)科主任、碩士生導(dǎo)師佛山大學(xué)醫(yī)學(xué)院醫(yī)學(xué)系孟紅旗教授、主任醫(yī)師Professor、Doctor

director、NeurologistGeneral

examinationGeneral

examination

is

actually

the

first

step

ofexaminationInspection

is

the

major

method

during

generalexamination,

combining

with

palpation,

auscultatsmellingThe

examiner

should

observe

the

following

aspectsthe

patients:general

appearancebody

habitus（體型）posture(姿勢）state

of

nutritionsymmetry（對稱性）speechGeneral

appearanceSexAgeVital

sign（生命征）Development/habitus（發(fā)育/體型）Nutritional

status（營養(yǎng)狀態(tài)）Consciousness（意識狀況）Speech（tone/voice)(語調(diào)/語態(tài)）Facial

feature/expression（面容/表情）Position/posture（體位/姿勢）Gait（步態(tài)）SexIn

female:estrogen

and

male

hormoneIn

male: male

hormoneSex

is

involved

in

some

specific

diseasefemale:

SLE

thyroid chlorosis

(萎黃病male: haemophilia

(血友病)SexImpacts

of

diseases

on

sex

charactersFemale

patients

will

be

masculinized

in

long

term

use

of

corticosteriod（皮質(zhì)類固醇）

or

adrenocortical

tumor（皮質(zhì)腫瘤）Male

cirrhotic

patient

will

develop

gynecomastia（男性育）

mainly

because

male

hormone

secretion

was

suppresseThe

impacts

of

normal

sex

chromosome

on

the

sex

and

sexcharacters: biasexual

abnormalityklinefelter

syndrome turner

syndromeAgeAge

is

tightly

related

to

some

diseasesmeasles（麻疹）Infant

and

children:rickets（佝僂?。ヾiphtheria（白喉）Children

and

adolescence:tuberculoses（結(jié)核）,

rheumatopyra（風(fēng)濕熱）Elder:

carcinoma

and

sclerosisVital

signVital

signs

are

physical

signs

that

indicate

an

inis

alivebody

temperatureblood

pressurebreath

rate

pulseheart

rateThese

signs

can

be

measured/monitored

to

assess

lephysical

functioning

of

an

individualNormal

ranges

of

measurements

of

vital

signs

maychange

with

age,

sex,

weight,

exercise

tolerance

aconditionBody

temperatureOral（口腔）Rectal（肛門）Axillary（腋下）Body

temperatureOralPlace

the

thermometer

under

the

tongue

and

closethe

mouth

using

the

lips

hold

the

thermometer

tighThe

patient

must

breath

through

the

noseLeave

the

thermometer

in

the

mouth

for

5

minReliable

methodNot

suitable:

infantsunconsciousBody

temperatureRectalUsing

a

rectal

thermometerRecommended

for

infants/small

childrenLubricate

the

bulb

of

the

thermometer

with

apetroleum

jellyPlace

the

small

child

face

down

on

a

flat

surfaceSpread

the

buttocks

and

insert

the

bulb

end

of

ththermometer

about

one-half

to

1

inch

into

the

analAfter

5

min,

remove

the

thermometer

and

readBody

temperatureAxillaryIt

is

the

least

accurate

methodPlace

the

thermometer

in

the

armpit(腋窩）,

with

the

arpressed

against

the

body

for

5

~10

min

before

readingRead

the

thermometer

by

gripping

the

end

opposite

the

bthat

the

numbers

are

facing

youRoll

the

thermometer

back

and

forth

between

your

fingeryou

see

a

silver

reflection

in

the

columnBody

temperatureNormal

valueOral

36.30C~37.20CRectal

36.50C~37.70CAxillary

360C~370CThe

normal

body

temperature

varies

from

person

toperson,

by

age,

and

throughout

dayBeing

lowest

in

the

early

hours

of

the

morning

andhighest

in

the

afternoonThe

variation

may

range

within

10CRectal

T

>Oral

T>

Axillary

T

(each

in

0.50C)Body

temperatureIt

should

be

recorded

on

temperature

recosheet

so

called

“

body

temperature

c(體溫曲線）Fever

type

is

referred

to

those

febrile

（disease

possessing

certain

characters

oftemperature

curveVital

signsBreathThe

breath

rhythm

and

rates

should

berecordedPulseThe

rhythm

and

rates

should

be

recordedVital

signspulse60~100

/minchildhoodEmotionAgedNightVital

signsblood

pressureBlood

pressure

is

a

measurement

of

the

forapplied

against

the

walls

of

arteries

as

hpumps

blood

through

the

bodyBlood

pressure

readings

are

usually

givennumbers:

for

example,

110/70Vital

signsblood

pressureThe

first

number

is

the

systolic

（收縮的

blood

pressure

reading,and

it

representsmaximum

pressure

exerted

when

the

heartcontractsThe

second

number

is

the

diastolic（舒張的

blood

pressure

reading,and

it

representspressure

in

the

arteries

when

the

heart

isVital

signsblood

pressureBP

is

continually

changing

depending

on

tactivity,

temperature,

diet,

emotional

stposture,

physical

state

and

drugsIdeal

BPnormal<120/<80

mmHg<130/<85

mmHghypertension >140/90

mmHgVital

signsblood

pressureDevelopment

&

habitusDevelopment

status

is

evaluated

according

to

the

aintelligence（智力),body

weight

and

sexual

characIn

normal

adult,

they

are

almost

comparableDuring

adolescent

stage,

the

body

experienced

a

ragrowth

periodsIt

is

influenced

by

some

factorsendocrinology(內(nèi)race(種族)

nutritioninheritance(遺傳)

living

conditionphysical

exercisTypes

of

habitusslender,

weak

and

lightweaverage

height

and

muscleAsthenic

type:（無力型）Sthenic

type:（矮胖型）Ortho-sthenic

type:

normal

proportions

w（勻稱型） normal

stature

(身材)Abnormal

habitusGigantism(巨人癥)It

refers

to

the

excessive

liner

growth

that

occurs

wihormone

(GH)excess

when

epiphyseal(骺的)growth

plateopen

during

childhoodAcromegaly(肢端肥大癥)It

indicates

the

disorder

of

GH

excess

in

adulthoodPituitary

dwarfism(垂體性侏儒癥)It

may

be

due

to

dysfunction

of

the

pituitary

causingunderproduction

of

growth

hormonesmall

stature

normal

proportionsGigantismDevelopment

&

habitusCretinism(呆小癥)It

is

characterized

by

arrested

physical

and

mental

devEunuchism(無睪癥)Sex

hormone

control

the

formation/development

of

sexcharactersit

may

also

affect

the

body

development.

If

the

secretiohormone

was

severely

suppressed,

eunuchism

may

occurRachitis(佝僂病)Malnutrition

during

childhood

may

affect

the

developmeinstance,

vitamin

D

deficiency

may

lead

to

rachitisNutritional

statusOne

of

the

most

important

factors

impacting

anindividual’s

health

and

disease

because

it

affecevery

systemIt

can

be

evaluated

mainly

by

skin,

hair,

muscle

ansubcutaneous

fat

in

particularChronic

wasting(消瘦)associated

with

loss

ofsubcutaneous

fat

from

calorie

or

protein

deficienNutritional

statusChanges

in

hair

and

nails

are

also

common

inutritional

deficiencyBlindness

may

result

from

vitamin

A

deficiThe

tongue

may

be

large

in

iodine(碘)orniacin(煙酸)deficiencyNutritional

statusIn

general

the

abnormal

nutritional

status

candescribed

as

obesity(肥胖）

and

emaciation（消瘦)Parameters:body

weight(體重)Body

mass

index

(BMI)(體重指數(shù))

Arm

circumference(上臂周徑)

Skinfold

thickness(皮褶厚度)SkinfoldthicknessMalnutritionIt

is

the

condition

that

develops

when

thedoes

not

get

the

right

amount

of

the

vitaminminerals,

and

other

nutrients

it

needs

to

mhealthy

tissue

and

organ

functionIt

is

caused

by

inadequate

intake

or

inadeqdigestion

of

nutrientsMalnutritionMalnutrition

may

be

mild

enough

to

show

nosymptoms

or

so

severe

that

the

damage

it

hasdone

is

irreversible

even

though

the

indivimay

be

kept

alive

(/view4/M05/06/19/wKh2CVOvernutritionOvernutrition

results

from

eating

too

much

that

exthe

normal

consumption,

not

exercising

enough,

gefactors,

endocrinology,

life

habitsThe

nutritional

status

of

patient

based

on

heightweight

is

interpreted

by

the

body

mass

index

(BMI)(體重指數(shù))BMI

is

an

international

digestion

of

relative

weigstatureBMI=weight

(kg)/height

(meter)2Overnutritionunderweighthealthy

weightoverweightobsessBMI<18.518.5~25.025.1~29.9>30WHO

classificationmale

>27

female>25

obesityConsciousnessIt

is

a

psychological

and

physiological

state

in

which

weof

our

sensations,

perceptions,

feelings,

thoughts

etcDisturbance

of

consciousnessmemory

deficitlanguage

disturbancedisorientationreduced

clarityDuring

interview,

the

examiner

has

already

gained

much

iinto

the

mental

status

of

the

patientThe

examiner

could

evaluate

the

thought,

response,

emotcalculation

ability

and

orientationFacial

feature

&

expressionThe

appearance

of

the

head

and

face,

their

contourand

texture(特征),often

provides

the

first

insigthe

nature

of

illness.Some

facial

appearances

are

pathognomonic(特定的

diseaseThe

appearance

of

the

patient’s

face

may

also

proinformation

regarding

psychological

makeup:

is

thperson

happy,

sad,

angry

or

anxiousSome

typical

facial

features

are

listed

in

textbooPositionIt

refers

to

patient’s

body

statusDivided

into:Active(自主)

Passive(被動(dòng))

Compulsive(強(qiáng)迫)PositionActive

positionThe

patient

can

move

his/her

body

freely,

withourestrictionIt

can

be

seen

in

normal

adult,

patients

with

milddiseases

or

at

earlier

stage

of

the

diseasesPassive

positionThe

patient

can’t

adjust

or

move

his/her

bodyIt

occurs

in

extremely

sick

or

patients

withunconsciousnessCompulsive

positionCompulsive

supine

position(仰臥位）The

patient

lie

down

on

the

beck,

with

two

legs

bending.Acute

peritonitisCompulsive

prostrate

position（俯臥位）in

order

to

relief

the

tenderness

of

back

muscles.Rachis

disease（脊柱病變）Compulsive

side

down

position（側(cè)臥位）in

patients

with

one

sided

pleurisy

or

pleurorrhea(胸腔Compulsive

positionOrthopnea（端坐呼吸）An

abnormal

condition

in

which

a

person

must

keethe

head

elevated

(sit

or

stand)

to

breathe

deeplycomfortably

(orthopnea)

or

wakes

up

suddenly

in

thmiddle

of

the

night

short

of

breath

(paroxysmal

nodyspena)（陣發(fā)性夜間呼吸困難）.

It

can

be

seen

inpatients

with

lung

or

heart

diseaseSquar

down

position（蹲位）It

has

been

seen

in

patients

with

congenital

heardiseaseCompulsive

positionCompulsive

rest

positionWhen

patient

suffers

an

angina

attack

it

willthem

to

rest.

The

heart

is

then

able

to

return

tonormal

working

levelToss

&

turn

position

(alternative

position輾轉(zhuǎn)體位Opisthotonos

(角弓反張）It

is

an

abnormal

posturing

condition

characterizerigidity

and

severe

arching

of

the

back,

with

head

thrbackwardsPosture

&

gaitPosture:the

general

way

of

holding

the

bodyGait

:

a

way

or

manner

of

walkingGait

abnormalities

describe

unusual

and

uncontrollablwith

walkingGait

disturbances

may

occur

for

a

variety

of

reasonsGait

may

be

changed

by

local

pain

in

the

foot,

joint,

cla（跛行）

of

the

hip（臀）

or

leg,bone

disease

etcGaitWaddling

gait

（蹣跚步態(tài)）Characterized

by

a

distinctive

duck-like

walk

that

may

inchildhood

or

later

in

lifeScissor

gait（剪刀式步態(tài)）Characterized

by

legs

flexed

slightly

at

the

hips

and

kngiving

the

appearance

of

crouching（卷縮）,with

the

knethighs（大腿）

hitting

or

crossing

in

a

scissors-like

moGaitSteppage

gait（跨閾步態(tài)）Characterized

by

foot

drop

where

the

foot

hangs

with

the

toespointing

down,

causing

the

toes

to

scrape

the

ground

whilewalkingPropulsive

(Festinating)gait（慌張步態(tài)）Characterized

by

stooped,

rigid

posture

with

head

and

neforwardDrunken

man

gait（醉酒步態(tài)）Characterized

by

unbalanced

trunk,

as

drunken

man

likewalkingGaitAtaxic

gait（共濟(jì)失調(diào)步態(tài)）Characterized

by

an

abnormality

of

muscle

control

or

aninability

to

finely

coordinate

movements,

resulting

in

aand-fro”

unsteady

motionIntermittent

claudication（間隙性跛行）It

is

leg

pain

(most

often

in

the

calves)

that

does

not

cafter

walking

and

is

relieved

by

restIt

is

a

symptom

of

peripheral

artery

disease

(PAD)SkinThe

skin

is

the

largest

organ

of

the

bodyOne

of

the

best

indicators

of

general

healtThe

examination

of

the

skin

is

dependent

oninspection,

but

palpation

of

a

skin

lesionalso

be

performedSkin

colorSkin

coloration

is

determined

by

the

amount

of

pigin

the

skin

and

the

blood

flowing

through

itThe

distribution

of

capillary,

the

thickness

of

thsubcutaneous

fat

（皮下脂肪）may

also

affect

itThe

color

changes

includePallor

（蒼白）Yellow

skin（黃染）Cyanosis（發(fā)紺）Redness（發(fā)紅）Pigmentation（色素沉著）Discoloration（色素脫P(yáng)allorPaleness

may

be

the

result

of

decreased

blood

suppthe

skin

(cold,

fainting,

shock,

hypoglycemia)

ordecreased

number

of

red

blood

cells

(anemia)Fingers

that

turn

paller

when

exposed

to

cold

or

stRaynaud’s

syndrome

may

cause

sudden

change

in

thefinger

colorIt

is

almost

apparent

on

the

face,

lining

of

the

eymouth

and

nailsCyanosisIt

is

a

bluish

discoloration

of

the

skin

and

mouth

membralack

of

oxygenBlood

that

is

saturated

with

oxygen

is

bright

redBlood

that

has

lost

its

oxygen

is

dark

bluish-redPerson

who

has

a

large

quantity

of

their

blood

which

is

deoxygen

tend

to

take

on

a

bluish

discoloration

calle“cyanosis”Cyanosis

is

more

obvious

in

the

mucous

membranes

and

nailparticularly

for

dark-skinned

peopleIt

may

also

appear

on

the

feet,

nose

and

earsCyanosisYellow

skinA

yellow

discoloring

the

skin,

mucousmembranes

and

eyes,

caused

by

too

muchbilirubin

in

the

bloodWith

the

exception

of

physiologic

jaundicenewborn,

all

other

jaundice

indicates

overdamage

to

the

liver

or

inability

to

move

bilfrom

the

liver

through

the

biliary

tract

toYellow

skinA

yellow

to

orange

color

may

be

imparted

to

the

skiexcessive

intake

of

beta

carotenePeople

who

consume

large

quantities

of

carrots

orjuice

or

take

beta

carotene

tablets

may

develop

adistinctly

yellow-orange

cast

to

their

skin.

The

cis

called

hypercarotenemia（高胡蘿卜血癥）Hypercarotenemia

is

easily

distinguished

from

jain

that

the

sclera（鞏膜）

remain

white,

while

peowith

true

jaundice

have

a

yellow

scleraRednessIt

is

due

to

dilation

of

capillary,

accelerating

&increasing

blood

stream

and

increment

of

the

red

bcellsIn

physiological

condition,

it

may

be

seen

after

sdrinkingIn

pathological

condition,

it

may

be

caused

by

lunscarlet

fever,

drug

intoxicationPigmentationMelanin（黑色素）

is

a

pigment

produced

in

the

skicells

that

causes

skin

colorationThe

production

of

melanin

may

be

affected

by

heredheat,

trauma,

solar

or

ionizing

radiation,

heavy

mand

other

factorsChanges

in

any

of

these

factors

can

result

inhyperpigmentation,

hypopigmentation

or

bothThe

changes

may

be

temporary

or

permanentIt

can

be

either

primary

or

secondary

to

other

diseDiscolorationVitiligo(白癜風(fēng)）It

is

a

skin

condition

in

which

there

is

loss

of

pigfrom

areas

of

skin

resulting

in

irregular

white

pawith

normal

skin

textureAssociated

with

pernicious

anemia,

hyperthyroidiAddison’s

diseaseDiscolorationLeukoplakia（白斑）A

precancerous

lesion

that

develops

on

the

tongueinside

of

the

cheek

as

a

response

to

chronic

irritaOccasionaly,

leukoplakia

pathches

develop

on

theexternal

genitaliaDiscolorationAlbinismus（白化病）It

refers

to

a

group

of

related

conditions.

Theseconditions

are

the

result

of

altered

genes

that

cadefect

of

melanin

productionThis

defect

results

in

the

partial

or

full

absencepigment

from

the

skin,

hair

and

eyesMoistureThe

moisture

of

skin

is

tightly

related

with

the

seof

sweat

glandDiaphoresis（大量出汗）

is

a

medical

term

for

prosweatingIt

can

be

normal

brought

on

by

physical

activity,emotional

response,

high

environment

temperaturesymptom

of

an

underlying

diseaseOveractive

thyroid

gland

hypoglycemiaCold

sweat: shock

or

dehydrated

patientsMoisturePeriodic

sweating

at

night

without

an

obvicause

may

be

caused

by

an

underlying

infector

malignancySweat

absent:

abnormal

lack

of

sweat

in

resto

heat.neurologic

disorderscongenital

disordersburnsskin

diseasesome

drugsdehydrationElasticitySkin

elasticity

（皮膚彈性）is

related

winutritional

status,subcutaenous

fat

and

tamount

of

liquid

in

the

interstitial

spaceRashesSkin

rashes

are

frequently

one

of

the

manifestatiosystemic

diseases,

and

hence,

they

are

important

fdiagnosis

of

some

special

diseasesThe

different

rashes

may

occur

in

infectious

diseadermentological

disease,

drug

or

other

allergic

mThe

rashes

have

some

special

regular

patterns

andTypes

of

rashesMacule（斑疹）Roseola（玫瑰疹）Papules（丘疹）Maculopapulae（斑丘疹）Urticaria（蕁麻疹）MaculeA

macule

is

small,

flat,

distinct

colored

area

oDoes

not

include

a

change

in

skin

texture

or

thicRoselaRosela

is

a

skin

lesion

that

is

small,

solid,

andraised.

It

may

be

seen

in

measles,

drug

rashes,eczemaPapuleA

papule

is

defined

as

a

small

(5

millimeters

orless),

solid

lesion

slightly

elevated

above

thesurface

of

the

skin.MaculopapulaeIt

is

plate

lesion

with

redness

around

thepapulesIt

can

be

seen

in

scarlet

fever

and

drug-irashesUrticariaUrticaria

(hive)

are

raised

red

welts

of

variuossize

on

the

surface

of

the

skin,

often

itchy,

whicome

and

go.

It

is

associated

with

allergicreactionDesquamationIt

is

the

detachment

of

cells

from

the

surface

of

aepitheliumIn

physiologic

condition,

it’s

not

easy

to

noticedesquamationIn

pathologic

condition,

lots

of

desquamation

canSubcutaneous

hemorrhageBleeding

into

the

skin

&

subcutaneous

tissuesAccording

to

the

size

of

bleeding,

it

may

be

subdivas

follows:petechia（瘀點(diǎn)）

<2mmpurpura

（紫癜）3~5

mmecchymosis

（瘀斑）