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1、. .呼吸科常用英文询问病史 case historyYou need to get a detailed history including the timing and acuity of onset, exacerbating and alleviating factors and environment triggers to help you confirm a diagnosis or discard other diseases /develop a differential diagnosis. Ask your patient whether there is a histo
2、ry of tobacco use, or other toxic and environmental exposures and his occupational history.General/biographical data,marital status, nativity, occupation, informant, time of admission and record, chief plaint, history of present illness, previous health status(well, ordinary or bad), any infectious
3、diseases, allergic history, history of trauma or surgery, smoking (about how many years, average how many pieces per day, ceased for how many years), alcohol intake(occasional or frequent),spouses health status, menorrhea (menarche age , cycle lasting for how many days, menstrual cycle, last menstru
4、ation period or age of menopause, any menstrual pain or irregular cycle), childbearing or pregnancy( times , natural labor, abortions ,premature delivery, stillbirths, difficult labor, family history (any congenital diseases, father and mother: still alive, illness ,or cause of death, siblings and c
5、hildren)常用的病症 symptomsfeverCough 咳嗽Sputum (dry, purulent脓性的, copious green sputum大量绿色痰，tenacious yellow sputum 黄粘痰，frothy white sputum白色泡沫痰，rusty sputum 铁锈色痰wheezingDyspnea during exertion or at rest 呼吸困难Orthopnea 端坐呼吸Paroxysmal nocturnal dyspnea 夜间阵发性呼吸困难Shortness of breath SOBChest tightness 胸部紧迫感
6、Exercise intolerancepleuritic chest pain 胸膜型胸痛Pharyngalgia ; pharyngodynia 咽痛Hemoptysis 咯血Bucking 呛咳Sneeze喷嚏snore 打鼾malaise 不舒服myalgia 肌痛insomia 失眠hoarseness声嘶dysphonia 发声困难常见的体征 physical signsclubbed fingers杵状指 : increased longitudinal and transverse curvature ,loss of concave nail fold angle, bogg
7、iness of nail bed and increased soft tissue bulk of distal phalanx, drumstick- likenicotine stainingcyanosis:blue discolouration of mucosal membranes and skin ,caused when mean capillary concentration of deoxyhemoglobin more than 5g/dl, O2 saturation less than 85%,PaO2 less than 8KPaperipheral cyano
8、sis: cold blue peripheries, e.g. nail beds due to cold exposurescentral cyanosis: warm peripheries, blue tongue or lipshand flap: due to CO2 retentionasterixis 扑翼样震颤papilloedema 视乳头水肿chemosis球结膜水肿enlarged supraclavicular and axillary lymph nodesincreased respiratory ratetachycardia 心动过速pulsus parado
9、xus: 10 mmHg on inspiration (seen in severe asthma)barrel chesthyperexpanded, decreased expansionkyphosis 驼背，脊柱后凸Inspection:tachypnea 呼吸急促accessory muscles of respiration: sternocleidomastoid muscle, arm support, alae flaringwide or narrow intercostal spacetactile vocal fremitus 触觉语颤subcutaneous cre
10、pitus 皮下捻发感Percussion:resonancedullnessflatnesshyperresonancetympanylower borders: scapular line X left/right intercostal spacerange of mobilityAuscultation:vocal resonance 语音共振ronchi: wheeze , stridor , crackles, Velcro-like soundesmoist rales : coarse, medium, fine, crepitus捻发音pleural friction rub
11、splete absence of breath soundsankle edemaweight loss，cachexia恶病质，cachectic恶病质的decreased food appetite, loss of appetite, anorexia食欲减退常做的检查 examinations or laboratory findings(to take ,undergo, perform ,receive or have)temperature charts 体温图 (take ones body temperature)sputum pot 痰盂Blood/urine/stool
12、 routine, occult blood testBlood biochemistrySputum /blood culture and drug sensitivity testsputum cytologyPulse oximeter 脉氧计：continuous monitoring of blood oxygen saturationArterial blood gas analysis(ABG): arterial blood sampling , radial/ femoral artery puncturePaCO2: partial pressure of carbon d
13、ioxide in arterial blood hypercarbiaPaO2: partial pressure of oxygen in arterial blood hypoxemiarespiratory failure:type 1: decreased O2 supply, PaO260 mmHg(millimeters of mercury)due to diffusion failure or V/Q dismatch (ventilation-perfusion(quotient)ratio)pulmonary edema, pneumonia, infarction, f
14、ibrosis,or pulmonary embolism，pulmonary hypertension, shunttype 2: decreased CO2 removal, PaCO250 mmHg(millimeters of mercury)due to alveolar ventilation failureobstructive: COPD, asthma, bronchiectasisrestrictive: neuromuscular (sedatives, myasthenia), structural (ankylosing spondylitis), pleural d
15、iseases ,obesityChest X-ray/radiograph:reticulo-nodular shadowing (reticular, linear, military nodules粟粒样结节)coin lesions 硬币样cavities空腔：amphoric 空翁音的(breathing like blowing over a bottle top)opacification浑浊：consolidation (air space infiltrate):confluent shadowing and air bronchogramcollapse: lobar(up
16、per, middle/lingual, lower)segmental atelactasispleural effusionmediastinal mass: thyroid ,thymoma, teratoma, TB lymph nodes,terrible diagnoses including lymphoma and aneurysmChest CT scan( puted tomography)Head MRI(magnetic resonance imaging)PET-CT of the whole body(positron-emission tomography)Abd
17、ominal ultrasoundskin prick test 皮肤点刺试验dust mites尘螨，pollen花粉，cockroach蟑螂tuberculin skin test (purified protein derivative(of tuberculin) test, PPD test)Pulmonary function test : Spirometry 呼吸量测定法，肺量测定法obstructive lung diseases: airflow limitationFEV1/FVC FVC RV and TLC KCO0.75 extraparenchymal varia
18、ble normalFEV1: forced expiratory volume in 1 secondFVC: force vital capacityTLC: total lung capacityRV: residual volumeKCO: transfer factor ( diffusion rate)PEFR: peak expiratory flow rateflow-volume loop ( inspiration and expiration)bronchoprovocation/challenge test 支气管激发试验：histamine or methacholi
19、ne-inhalationbronchodilatation支气管舒X试验: salbutamol沙丁胺醇fiberoptic bronchoscopy: biopsies, bronchial brush samples for pathological examation, bronchial washings)bronchoalveolar lavage (BAL)protected specimen brush (PStransthoracic percutaneous needle aspirationpercutanous needle biopsy under CT guidan
20、ce ( for peripheral tumours)video-assisted thoracoscopic-guided lung biopsyopen lung biopsypleural biopsybiopsy of enlarged lymph nodesD-Dimerselectrocardiogram (ECG)echocardiogram超声心动图V/Q isotope scan ( ventilation/perfusion scanning)spiral CT/MRA (Magnetic Resonance Angiography)pulmonary angiograp
21、hyDoppler USS thigh and pelvis (USS: ultrasound scanning)cardiac monitorPSG( polysommography)常见的病名 diseasesacute upper respiratory tract infection 急性上呼吸道感染mon cold 普通感冒influenza 流感pharynigitis 咽炎acute broncho-bronchitis 急性气管-支气管炎pneumonia 肺炎munity acquired pneumonia (CAP) 社区获得性肺炎hospital acquired pn
22、eumonia (HAP) 医院获得性肺炎nosoical pneumonia (NP) 医院内肺炎bronchiectasis 支气管扩Xchornic bronchitis 慢性支气管炎pulmonary emphysema 肺气肿chronic obstructive pulmonary disease (acute exacerbating) AECOPD COPD急性发作bronchial asthma 支气管哮喘allergic rhinitis过敏性鼻炎respiratory failure 呼吸衰竭lung abscess 肺脓肿pulmonary tuberculosis 肺
23、结核病lung cancer: 肺癌primary bronchogenic carcinoma 原发性支气管肺癌squamous cell carcinoma 鳞癌adenocarcinoma 腺癌bronchoalveolar cell carcinoma 支气管肺泡细胞癌small cell lung carcinoma SCLC小细胞肺癌pulmonary metastasis 肺转移瘤pulmonary embolism PE 肺栓塞pulmonary thromboembolism (PTE) 肺血栓栓塞症pulmonary infarction 肺梗死deep venous th
24、rombosis ,DVT 深静脉血栓形成empyema 脓胸pneumothorax气胸pyopneumothorax 脓气胸chronic suppurative disease 慢性化脓性疾病congenital cyanotic disease 先天性紫绀性心脏病cor pulmonale 肺源性心脏病pulmonary hypertension 肺动脉高压pulmonary encephalopathy 肺性脑病right heart failure; right-sided heart failure 右心衰竭pulmonary vascular diseases 肺血管疾病int
25、erstitial lung disease, ILD 弥漫性间质性肺疾病idiopathic pulmonary fibrosis, IPF 特发性肺纤维化cryptogenic fibrosing alveolitis, CFA 隐源性纤维化性肺泡炎connective tissue related lung diseases 结缔组织相关性肺疾病systemic lupus erythematosus, SLE 系统性红斑狼疮rheumatoid arthritis, RA 类风湿性关节炎systemic sclerosis, SSc 系统性硬化scleroderma 硬皮病sjoren
26、s syndrome 感知综合征polymyositis 多发性肌炎dermatomyositis 皮肌炎sarcoidosis 结节病Pulmonary alveolar proteinosis, PAP 肺泡蛋白沉积症Idiopathic pulmonary hemosiderosis 特发性肺含铁血黄素沉着病Langerhans cell granulomatosis 朗格汉斯细胞肉芽肿病Eosinophilic granuloma 嗜酸性肉芽肿Histiocytosis X 组织细胞增多症XWegener granulomatosis Wegener肉芽肿extrinsic aller
27、gic alveolitis 外源性过敏性肺泡炎pneumoconiosis 尘肺drug-induced lung disease 药物性肺病aspergillosis 曲菌病：allergic bronchopulmonary aspergillosis (ABPA)pleural disease 胸膜疾病broncho-pleural fistula 支气管胸膜瘘oral candidiasis 口腔念珠菌病，鹅口疮osteoporotic bone change 骨质疏松样改变glaua 青光眼cataract白内障acute lung injury ，ALI 急性肺损伤acute r
28、espiratory distress syndrome , ARDS 急性呼吸窘迫综合征urticaria 荨麻疹eczema 湿疹hypertension 高血压diabetes 糖尿病常用的药物 drugs or agentsbe administered, treat sb. withempirical 经历性的, prophylactic预防性, remedial治疗性Expectorant 祛痰药Mucolytics 粘液溶解剂bronchodilatorB2-agonists: short-acting :salbutamol沙丁胺醇long-acting: salmeterol
29、 沙美特罗muscarinic antagonists: ipratropium bromide 异丙托溴胺aminophylline 氨茶碱steroids inhaled: budesonide 布地奈德， beclomethasone倍氯米松，fluticasone氟替卡松systemic: prednisolone po., hydrocortisone iv.mast cell stabilizers: cromoglycate sodium色甘酸钠leukotriene receptor antagonists: montelukast孟鲁司特respiratory stimula
30、nts:lobelinenikethamidecardiac tonic 强心剂diuretics 利尿剂albumin 白蛋白antitussive agents 镇咳药ammonium chloride 氯化铵ambroxol 氨溴索 mucosolvan 沐舒坦常用的治疗措施low or high flow oxygen: nasal cannulae鼻导管， Venturi face-masknebulizer喷雾器: finer particle size (3 to 20um) allows tracheobronchial depositionmetered dose inhal
31、er (MDI)continuous positive airway pressure (CPAP)-tight-fitting mask (non-invasive)intermittent positive-pressure ventilation ( IPPV)non-invasive positive-pressure ventilation (NIPPV)mechanical ventilation: non-invasive or invasive(via intubation插管 ，tracheostomy 气管造口术，tracheotomy气管切开术)synchronized
32、intermittent mandatory ventilation, SIMV 同步间歇指令通气pressure support ventilation, PSV 压力支持通气thoracocentesis 胸腔穿刺术chest drain/drainage 引流术chemotherapy 化疗radiation therapy 放疗pneumonectomy 肺切除术lobectomy of lung，pulmonary lobectomy肺叶切除术thoracotomy 开胸术，胸廓切开术pleurodesis胸膜剥脱术pleurectomy 胸膜切除术pleural adhesion
33、胸膜粘连术thromboendarterectomy血栓动脉内膜切除术inferior vena cava filter 下腔静脉过滤器常见的疾病chornic bronchitis: procuctive cough, most days of 3 months of the year, for at least 2 consecutive years, cough with white or purulent sputumbronchiectasis:cystic囊性的/varicose曲X样/cyclindrical柱状-tram-tracks轨道样hemoptysisphysiothe
34、rapy: chest wall percussion wirh head-down postural drainagelong term oxygen inhalation : to prevent cor pulmonalemedical: bronchodilators, mucolytics, rotating courses of antibioticssurgical: resection, artery embolization for hemoptysislung abscessusually on right side, as right bronchus is shorte
35、r and more vertical;in the supine patient , abscess develops in apical lower lobe or posterial upper lobe.pneumothoraxaccumulation of air in pleural space, with secondary partial collapse of subpleural bleb ruputurelactrogenic: positive pressure ventilation, bronchoscopy ,esp. biopsytypes: closed, o
36、pen, tensionmediastinal deviation :trachea and apex shift contralaterallyCXR: translucency +collapse: visible rim between lung and chest wall2 cm =50% lung volume lossaspiration吸引术，intercostal drainrefractory or recurrent: pleurodesis, pleurectomy, bulla stapling or laseringpleural effusionchest pai
37、n and progressively worsening of shortness of breathTransudate漏出液：redistribution of Starling forces across microcirculation, diuretics can result in rapid resolution, protein 30g/L or pleura: serum protein 1/2 or pleura: serum LDH2/3;often seen in cardiac failure, hypoalbuminemia, embolism, superior
38、 or inferior vena cava obstruction, hypothyroidism .Exudate渗出液：capillary permeability increases or lymph drainage decreasesoften seen in infection ,neoplasia, surgery or trauma.CXR: meniscus-shaped,rises towards axillaAppearance: clear ,straw-coloured: suggests transduateturbid, green: indicates exu
39、dates(pus cells) or empyema (bacterial infection)bloody( haemothorax血胸): tumor ,pulmonary embolism, acute pancreatitis, traumawhite( chylothorax乳糜胸)：lymph ,blocked thoracic duct, usually due to tumourTherapy: transudate: diureticsexudates: repeated drainage (thoracocentesis)intrathoracic streptokina
40、se via chest drain: to lyse fibrinous adhesionspleural adhesion: tetracycline. bleomycinlung cancerhoarseness: due to left recurrent laryngeal nerve palsydysphagiapancoast tumor infiltrates T1 stellate ganglion resulting in Horner syndromehypertrophic pulmonary osteoarthropathysuperior vena cava obs
41、truction (SVCO): headache, shortness of breath; conjunctival edema, plethora, vein dilation, pericardial tamponade( JVP,ABP,quiet HSparaneoplastic syndromes: endocrine( ACTH: Cushings; B-HCG:gynaeastia and body hair loss; PTH: hypercalcaemia especially squamous cell carcinoma),skindermatomyositisimm
42、unopromised e.g. shingles 带状疱疹squamous cell carcinoma: 30% of all primary lung tumours, but decreasing incidence ,relatively good prognosis if localized, squamous metaplasia with keratin whorls, central location, clubbing, hypercalcemia( PTH-rp secretion)adenocarcinoma: 30%,increasing incidence, esp
43、. women, less association with smoking, poor prognosis, metastasis early, gland-like and mucin-secretion, peripheral location, pleural effusions, hypercoagulable statesmall cell carcinoma:20%,poor prognosis, metastasis occur early, small AUPD cells with neurosecretory granules, central location, par
44、aneoplastic syndromes monbronchoalveolar cell carcinoma: variant of adenocarcinoma that is associated with chronic lung inflammation , e.g. fibrosing , copious clear mucoid sputumNSCLC: surgical resection possible at first, adjuvant chemotherapySCLC: radiotherapy + chemotherapy ( etoposide + cisplatin)secondary lung cancer: breast, oesophago/gastric/head-neck(+colon if liver metastasis), melanoma, bone (sara), thyroid, renal, prostate, ovary, choriocarcinoma, testes etc.obstructive sleep apnoeaobstruction of upper airway occurs at night with loss of muscle ton