1、詢問病史 12case 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 history of to

2、bacco use, or other toxic and environmental exposures and his occupational history.General/biographical ,baiu' g rfik-kl data 傳 記，marital 婚 姻 status, nativity 出生 , occupation, informant 提供消息的人, time of admission andrecord, chief complaint, history of present illness, previous health status(well,

3、 ordinary or bad), any infectious 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),spouse s spaus 配偶 health status, menorrhea ,men'ri: 月經 (menarche me'n

4、 a :ki:, m-初潮 age , cycle lasting for how many days, menstrual cycle, last menstruationperiod or age of menopause, anymenstrual 'menstrul 月經周期 pain or irregular cycle), childbearing or pregnancy( times , natural labor, abortions 流產 ,premature ,prem'tju, ,pri:- delivery 早產 , stillbirths 死產 ,

5、difficult labor, family history (any congenital 先天性 diseases, father and mother: still alive, illness ,or cause of death, siblings 兄弟姐妹 and children) 常用的癥狀symptomsfeverCough 咳嗽Sputum （dry, purulent 'pjurjulnt 膿性的 , copious 'kupis green sputum 大量綠色痰， tenacious ti'neis, t- yellow sputum 黃粘

6、痰， frothy white sputum白色泡沫痰， rusty sputum 鐵銹色痰wheezingDyspnea during exertion i g 'z:n or at rest呼吸困難Orthopnea :' 0 pn籟坐呼吸Paroxysmal ,prk'sizml nocturnal nk't:nl dyspnea 夜間陣發性呼吸困難Shortness of breath（ SOB）Chest tightness 胸部緊迫感Exercise intolerancepleuritic chest pain 胸膜型胸痛Pharyngalgia

7、frin'gldi ; pharyngodynia ,fri' g dini咽痛Hemoptysis 咯血Bucking 嗆咳Sneeze 噴嚏snore 打鼾malaise m'leiz 不舒服myalgia mai'ldi 肌痛insomnia in'smni 失眠hoarseness 聲嘶dysphonia dis'funi 發聲困難常見的體征physical signsclubbed fingers 杵 狀 指 : increased longitudinal ,lndi'tju:dinl and transverse 橫向 cu

8、rvature 'k:vt 彎曲 ,loss of concave 'knkeiv 凹面的 nail fold angle, bogginess of nail bed and increased soft tissue bulk of distal phalanx 'flks, 'fei- 趾骨 ,指骨 , drumstick- likenicotine stainingcyanosis ,sai'nusis 發紺 :blue discolouration of mucosal membranes andskin ,caused when mean c

9、apillary concentration of deoxyhemoglobin di:,ksi'hemu, g lubin醫氧血紅蛋白 more than 5g/dl, O2 saturation less than85%,PaO2 less than 8KPaperipheral p'rifrl 外圍的,次要的cyanosis: cold blue peripheries, . nailbeds due to cold exposurescentral cyanosis: warm peripheries, blue tongue or lipshand flap: du

10、e to CO2 retention 潴留asterixis 撲翼樣震顫papilloedema 視乳頭水腫chemosis 球結膜水腫enlarged supraclavicula 鎖骨上的 r kl'vikjul and axillary k'silri 腋窩 lymph nodesincreased respiratory ratetachycardia 心動過速pulsus paradoxus: >10 mmHg J on inspiration (seen in severe asthma)barrel chesthyperexpanded, decreased

11、 expansionkyphosis kai'fusis 駝背，脊柱后凸Inspection:tachypnea ,tkip'ni: 呼吸急促accessorymusclesofrespiration ,resp'rein :sternocleidomastoid 'st:nu,klaid'mstid 胸鎖乳突肌muscle, arm support, alaeflaringwide or narrow intercostal,int'kstl 肋間的spacetactile 觸覺的vocal 聲音的fremitus 震顫觸覺語顫subcutan

12、eous crepitus 皮下捻發感Percussion:resonance 清音dullness 濁音flatness 實音hyperresonance 過清音tympany/timp2ni/ 鼓音lower borders: scapular 'skpjul 肩 胛 的 line X left/rightintercostal ,int'kstl 肋間的 spacerange of mobility mu'bilti 移動Auscultation ,:skl'tein : 聽診vocal resonance 語音共振'krkl 發出細碎的爆裂聲,r

13、onchi: wheeze , stridor 'straid 喘鳴 , cracklesVelcro-like soundesmoist rales : coarse 粗的 , medium 中等的 , fine 好的 , crepitus 捻發音pleural friction rubscomplete absence of breath soundsankle edemak'kektik 惡病質的,n'reksi 食欲減退weight loss ， cachexia k'keksi 惡病質， cachecticdecreased food appetite

14、, loss of appetite, anorexia常做的檢查 examinations or laboratory findings(to take ,undergo, perform ,receive or have)temperature charts 體溫圖 (take one s body t emperature)'klt/ blood test 潛隱血試驗sputum pot 痰盂Blood/urine/stool routine, occultBlood biochemistrySputum /blood culture and drug sensitivity t

15、estsputum cytology sai'tldi 細胞學Pulse oximeter k'simit 脈氧計： continuous monitoring of blood oxygen saturationArterial blood gas analysis(ABG): arterial blood sampling , radial/femoral 'femrl 股骨的 artery puncture 穿刺PaCO2:partial pressure of carbon dioxide in arterial blood hypercarbiaPaO2: p

16、artial pressure of oxygen in arterial blood hypoxemia,haipk'si:mi 血氧不足respiratory failure:type 1: decreased O2 supply,PaO2V 60 mmHg(millimeters ofmercury 'm:kjuri 汞)due to diffusion failure or V/Q dismatch (ventilation-perfusion(quotient)ratio)pulmonary edema, pneumonia, infarction, fibrosis

17、,or pulmonary embolism ， pulmonary hypertension, shunttype 2: decreased CO2 removal,PaCO2> 50 mmHg(millimeters ofmercury)due to alveolar ventilation failureobstructive: COPD, asthma, bronchiectasisrestrictive: neuromuscular ,njuru'mskjul 神經肌肉 (sedatives 'sdtiv 鎮靜齊Umyasthenia ,mais' 0

18、i:ni幾無力)，structural 'strktrl結構的(ankylosing spondylitis ,ki'luzi,spndi'laitis 強 直 性 脊 柱 炎 ), pleural diseases ,obesityChest X-ray/radiograph:reticulo-nodular shadowing (reticularri'tikjul 網狀的 , linear 'lini線狀的 , military nodules 粟粒樣結節 )coin lesions 硬幣樣cavities 空腔： amphoric 'mf

19、rik 空翁音的 (breathing like blowing over a bottle top)opacification u,psifi'kein 渾 濁 ： consolidation (air spaceinfiltrate):confluent 'knflunt 支流的 ,匯合的 shadowing and air bronchogramf 支 氣管造影collapse: lobar(upper, middle/lingual, lower)segmental atelactasis 肺不張pleural effusionmediastinal ,mi:dis&#

20、39;tainl 縱隔 mass: thyroid ,thymoma 0 ai'mum胸腺瘤, teratoma ,ter'tum 畸胎瘤 , TB lymph nodes,terrible diagnoses including lymphoma lim'fum 淋巴瘤 and aneurysm 動脈瘤Chest CT scan( computed tomography)Head MRI(magnetic resonance imaging)PET-CT of the whole body(positron-emission tomography)'pzitr

21、n正電子Abdominal ultrasound 'ltrsaund 超聲skin prick test 皮膚點刺試驗( dust mites 塵螨， pollen 花粉， cockroach 蟑螂)tuberculin skin test (purified protein derivativedi'rivtiv 純蛋白spai'rmitri 呼吸量測定法，肺衍生物 (of tuberculin) test, PPD test)Pulmonary function test : Spirometry量測定法obstructive lung diseases: airf

22、low limitationFEV1/FVC FVC RV and TLC KCO< J t Jrestrictive lung diseases: decreased lung compliance and smalllung volumesintraparenchymal > J J J Jextraparenchymal variable J J J normalFEV1: forced expiratory iks'pairtri/ volume in 1 secondFVC: force vital capacityTLC: total lung capacity

23、RV: residual volumeKCO: transfer factor ( diffusion rate)PEFR: peak expiratory flow rateflow-volume loop ( inspiration and expiration,ekspi'rein )bronchoprovocation/challenge test ,prv'kein 支 氣 管 激 發 試 驗 ：histamine 'histmmin 組胺 or methacholine 乙酰甲膽堿-inhalation ,inh'leinbronchodilatat

24、ion ,dail'tein 支氣管舒張試驗: salbutamol 沙丁胺醇sl'bju:tm(:)lfiberoptic bronchoscopy br'kskpi : biopsy 'bai,psi 活 組 織 檢 查bronchial brush samples for pathological examation, bronchial washings)bronchoalveolar lavage (BAL)protected specimen brush (PSpercutaneous needletransthoracic ,trns 0 '

25、;rsik,輕胸 廓 的 aspiration ,sp'rein 吸引術percutanous needle biopsy under CT guidance ( for peripheral tumours)video-assisted thoracoscopic-guided 0 'rkskup胸腔鏡 lung biopsy open lung biopsypleural biopsybiopsy of enlarged lymph nodesD-Dimerselectrocardiogram (ECG) 心電圖echocardiogram 心動圖V/Q isotope &

26、#39;aisutup 同 位 素 scan ( ventilation/perfusion scanning)spiral 螺旋 CT/MRA (Magnetic Resonance Angiography ,ndi' g fi血管造 影術 )pulmonary angiographyDoppler 'dpl多普勒 USS thigh 0 aic腿 and pelvis 'pelvis骨盆(USS: ultrasound scanning)cardiac monitorPSG( polysommography)常見的病名 diseasesacute upper res

27、piratory tract infection 急性上呼吸道感染common cold 普通感冒influenza 流感 ,influ'enz pharynigitis 咽炎 pharyngalgia frin'gldi 咽痛acute broncho-bronchitis 急性氣管 - 支氣管炎pneumonia 肺炎community acquired pneumonia (CAP) 社區獲得性肺炎hospital acquired pneumonia (HAP) 醫院獲得性肺炎nosocomical pneumonia (NP) 醫院內肺炎bronchiectasis

28、支氣管擴張chornic bronchitis 慢性支氣管炎pulmonary emphysema 肺氣腫chronic obstructive pulmonary disease (acute exacerbating) AECOPDCOP電性發作bronchial asthma支氣管哮喘allergic rhinitisrai'naitis 過敏性鼻炎respiratory failure呼吸衰竭lung abscess 肺膿腫pulmonary tuberculosis 肺結核病lung cancer: 肺癌primary bronchogenic carcinoma 原發性支氣

29、管肺癌squamous'skweims cell carcinoma 鱗癌支氣管肺泡細胞癌adenocarcinoma 腺癌'dnu,k a :si'num bronchoalveolar cell carcinoma(SCLC小細胞肺癌small cell lung carcinoma pulmonary metastasis 肺轉移瘤 m'tstsispulmonary embolism ( PE)肺栓塞pulmonary thromboembolism (PTE)肺血栓栓塞癥 ,0 rmbu'emblizmpulmonary infarction

30、肺梗死deep venous thrombosis ,DVT 深靜脈血栓形成empyema 膿胸 ,empai'i:mpneumothorax 氣胸pyopneumothorax 膿氣胸'paiu,nju:mu' 0 :rkschronic suppurative disease 慢性化膿性疾病'spjurtiv, -reitivcongenital cyanotic disease 先天性紫紺性心臟病,sai'ntikcor pulmonale 肺源性心臟病'k:,pum'nlipulmonary hypertension 肺動脈高壓p

31、ulmonary encephalopathy肺性腦病en, sef'lp 0 iright heart failure; right-sided heart failure右心衰竭pulmonary vascular diseases 肺血管疾病interstitial lung disease, ILD 彌漫性間質性肺疾病idiopathic pulmonary fibrosis, IPF特發性肺纖維化,idi'p 0 ikcryptogenic ,kriptu'denik 隱源性的 fibrosing alveolitis, CFA 隱源性纖維化性肺泡炎conne

32、ctive tissue related lung diseases結締組織相關性肺疾病systemic lupus 'lju:ps 狼瘡 erythematosus, SLE 系統性紅斑狼瘡rheumatoid arthritis, RA類風濕性關節炎systemic sclerosis, SSc 系統性硬化scleroderma 硬皮病sjoren s syndrome 感知綜合征polymyositis 多發性肌炎dermatomyositis 皮肌炎sarcoidosis 結節病,s a :ki'dusisPulmonary alveolar proteinosis ,

33、prutii'nusis , PAP 肺泡蛋白沉積癥Idiopathic pulmonary hemosiderosis 'hi:mu,sid'rusis, ,hem- 特發性肺含鐵血黃素沉著病Langerhans cell granulomatosis朗格漢斯細胞肉芽腫病 'g rnju,lum'tusisEosinophilic granuloma 嗜酸性肉芽腫,i:sin'filikHistiocytosis X 組織細胞增多癥 XWegener granulomatosis Wegener 肉芽腫extrinsic allergic al

34、veolitis 外源性過敏性肺泡炎pneumoconiosis 塵肺 'nju:m,kuni'usisdrug-induced lung disease 藥物性肺病aspergillosis ,sp:di'lusis 曲 菌 病 ： allergic bronchopulmonaryaspergillosis (ABPA)pleural disease 胸膜疾病broncho-pleural fistula 支氣管胸膜瘺'fistjul,kndi'daisisoral candidiasisosteoporotic bone change 骨質疏松樣改

35、變glaucoma 青光眼cataract 白內障acute lung injuryALI 急性肺損傷acute respiratory distress syndrome , 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 drugs or agentsbe administered, treat sb. withempirical 經 驗 性 的 , prophylactic,prfi'lktik, ,pru- 預 防 性 ,remedial ri'mi:dil 治療性Expector

36、ant 祛痰藥 eks'pektrntMucolytics 粘液溶解劑 ,mju:ku'litikbronchodilator 支氣管擴張劑 ,brkudai'leitB2-agonists ' g nist興 奮 齊U : short-acting:salbutamol 沙 丁 胺 醇sl'bju:tm(:)llong-acting: salmeterol沙美特羅muscarinic ,msk'rinik異丙托溴胺毒蕈堿樣的 antagonists n't g nist對抗劑:ipratropium bromide 'bruma

37、idaminophylline 氨茶堿 ,mi:nu'fili:nsteroids 'stirid 類 固 醇 inhaled: budesonide 布 地 奈 德beclomethasone ,beklu'me 0 sun氯米松，fluticasone氟替卡松systemic:prednisolone 'pred'nislun 強 的 松 po(per os).,hydrocortisone ,haidru'k:tizun 氫化可的松iv.mast cell stabilizers: cromoglycate sodium色甘酸鈉leukot

38、riene ,lju:ku'train 白三烯 receptor antagonists: montelukast孟魯司特respiratory stimulants:lobelinenikethamide ni'ke 0 maidjmid尼可剎米cardiac tonic 強心劑diuretics 利尿劑 ,daiju'retikalbumin 白蛋白 'lbjuminantitussive agents 鎮咳藥,nti'tsivammonium chloride 氯化銨 'munjm 銨 'kl:raid 氯化物ambroxol 氨溴

39、索 ( mucosolvan 沐舒坦)Pantoloc 潘妥洛克常用的治療措施low or high flow oxygen: nasal cannulae 'knjuli: 鼻 導 管 ， Venturi ven'tjuri 文 里 氏 face-mask nebulizer 'nebjulaiz 噴 霧 器 : finer particle size (3 to 20um) allows tracheobronchial depositionmetered dose inhaler (MDI) 定量霧化吸入器continuous positive airway pr

40、essure (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 ,intju:'bein 插管 ， tracheostomy ,trki'stmi, ,trei- 氣管造口術， tracheotomy ,trki'tmi

41、, ,trei- 氣管切開術)synchronized intermittent mandatory ventilation, SIMV 同步間歇指令通氣pressure support ventilation, PSV 壓力支持通氣thoracocentesis胸腔穿刺術,0 :rksenesischest drain/drainage 引流術chemotherapy 化療radiation therapy 放療pneumonectomy 肺切除術 ,nju:mu'nektmilobectomy of lung ， pulmonary lobectomy 肺葉切除術lu'be

42、ktmi 葉切除術thoracotomy 開胸術，胸廓切開術,0 :r'ktmipleurodesis 胸膜剝脫術pleurectomy 胸膜切除術pleural adhesion 胸膜粘連術下腔靜脈過濾器thromboendarterectomy 血栓動脈內膜切除術inferior vena cava filter常見的疾病chornic bronchitis: procuctive cough, most days of 3 months of theyear, for at least 2 consecutive years, cough with white or purule

43、nt sputum bronchiectasis:cystic 'sistik 囊 性 的 /varicose 'vrikus 曲 張 樣 /cyclindrical 柱 狀-tram-tracks 軌道樣hemoptysisphysiotherapy: chest wall percussion wirh head-down postural 'pstrl drainagelong term oxygen inhalation : to prevent cor pulmonalemedical: bronchodilators, mucolytics, rotatin

44、g courses of antibioticssurgical: resection, artery embolization for hemoptysislung abscessusually on right side, as right bronchus is shorter and morevertical;in the supine 'sju:pain 仰臥 patient , abscess develops in apicallower lobe or posterial upper lobe.pneumothoraxaccumulationof air in pleu

45、ral space, with secondary partialcollapse of subpleural 胸膜下的 bleb bleb 大皰 rupture 'rpt 破裂lactrogenic:positive pressure ventilation, bronchoscopy br'kskpi 支氣管鏡檢查 ,esp. biopsy types: closed, open, tensionmediastinal deviation :trachea and apex 'eipeks 尖 端 shift contralaterally 對立的旁邊CXR: tr

46、anslucency trnz'lju:snsi 半透明 +collapse 倒塌 : visible rim邊緣 between lung and chest wall >2 cm(centimeter) =>50%lung volume lossaspiration ,sp'rein 吸引術， intercostal drainrefractory or recurrent 周 期 性 的 : pleurodesis 胸 膜 固 定 術 , pleurectomy plu'rektmi 胸 膜 切 除 術 , bulla 'bul 大 皰 sta

47、pling 裝 訂 or lasering 激光pleural effusionchest pain and progressively worsening of shortness of breathTransudate ,trnsju'deit 漏出液： redistribution of Starling forcesacross microcirculation, diuretics,daiju'retik 利尿劑 can result in rapidresolution, protein <30g/L(gram/litre 'li:t ) or ple

48、ura: serum'sirm 血 清 protein <1/2 or pleura: serum LDH<2/3;often seen in cardiac failure, hypoalbuminemia,haipul,bju:m'ni:mi低 蛋 白 血 癥 , embolism, superior or inferior vena cava obstruction, hypothyroidism . ,haipu' 0 airidizm甲狀腺功能低下Exudate 'eksjudeit 滲出液： capillary permeability

49、,p:mi'biliti 滲透 increases or lymph drainage decreasesoften seen in infection ,neoplasia ,ni:u'pleizi, -i 瘤形成 , surgery ortrauma.CXR: meniscus mi'nisks 彎液面 -shaped,rises towards axilla k'sil 腋溫Appearance: clear ,straw 淡黃色的 -coloured: suggests transduateturbid 't:bid 渾濁的 , green: i

50、ndicates exudates(pus ps 膿 cells) or empyema,empai'i:m 積膿癥 (bacterial infection)bloody( haemothorax ,hi:mu' 0 :rkSL 胸)： tumor ,pulmonary embolism, acute pancreatitis 'pnkri'taitis 胰腺炎 , traumawhite( chylothorax ,kailu' 0 :rkS糜胸)：lymph ,blockedthoracic 0 :'rsik, duct 胸導管,usual

51、ly due to tumourTherapy: transudate: diureticsexudates: repeated drainage (thoracocentesis)intrathoracic ,intr O'rSjk廓內的 streptokinase ,streptu'kaineis 鏈 球菌激酶 via chest drain: to lyse lais 溶解 fibrinous 'faibrins 纖維蛋白的 adhesions d'hi:n 粘合pleural adhesion: tetracycline ,tetr'saikla

52、in 四 環 素 . bleomycin ,bli:u'maisin 博萊霉素lung cancerhoarseness: due to left recurrent屢發的 laryngeal ,lrin'di:l 喉的nerve palsy 'p:lzi 麻痹dysphagia dis'feidi,-di 吞咽困難pancoast tumor infiltrates T1 stellate 'stelit, -leit 星 形 的ganglion ' g g lin申經節 resulting in Horner syndrome hypertr

53、ophic pulmonary osteoarthropathy ,stiu a :' 0 rupB蕭節病 superior vena cava obstruction (SVCO): headache, shortness ofbreath; conjunctival edema, ,kndk'taiv結膜 plethora 'ple 0, rvein dilation, pericardial tamponade ,tmp'neid心包 填塞(JVP t ,ABPj ,quiet HSparaneoplastic syndromes: endocrine(

54、ACTH: Cushing s; B-HCG:gynaecomastia and body hair loss; PTH: hypercalcaemia especially squamous cell carcinoma), skin ( dermatomyositis ) immunocompromised . shingles 帶狀皰疹 squamous cell carcinoma: 30% of all primary lung tumours, but decreasing incidence ,relatively good prognosis if localized, squ

55、amous metaplasia with keratin whorls, central location, clubbing, hypercalcemia( PTH-rp secretion)adenocarcinoma: 30%,increasing incidence, esp. women, less association with smoking, poor prognosis, metastasis early, gland-like and mucin-secretion, peripheral location, pleural effusions, hypercoagul

56、able statesmall cell carcinoma:20%,poor prognosis, metastasis occur early,small AUPD cells with neurosecretory granules, central location, paraneoplastic syndromes commonbronchoalveolar cell carcinoma: variant of adenocarcinoma that isassociated with chronic lung inflammation , . fibrosing , copious

57、 clearmucoid sputumNSCLC:surgical resection possible at first, adjuvant chemotherapy SCLC: radiotherapy + chemotherapy ( etoposide + cisplatin)secondarylungcancer:breast,oesophago/gastric/head-neck(+colon if liver metastasis), melanoma, bone(sarcoma), thyroid, renal, prostate, ovary, choriocarcinoma

58、, testes etc.obstructive sleep apnoeaobstruction of upper airway occurs at night with loss of muscletone in sleep, snoring, sleepiness during day, aponeic spells (O2J ,patient awakes from sleep), awakening with nocturia, daytime somnolence, decreased memory and attention, increased accident risk, polycythaemia, systemic hypertension and pulmonary hypertensionCauses: central obesity( fat deposition around upper a