常用临床医学术语2

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1、13、浅表淋巴结superficial lymph nodes 浅表淋巴结未扪及be no palpable superficial lymph nodes (can not be palpated)淋巴结肿大enlarged lymph nodes (lymphnode enlargement)部位site全身（局部）general (local)耳前（后）淋巴结pre(post)-auricular nodes枕后淋巴结occipital nodes颏下淋巴结submental nodes下颌淋巴结submaxillary nodes颈前（后）淋巴结anterior (posterior)

2、 cervical nodes锁骨上淋巴结supraclavicular nodes滑车上淋巴结epitrochlear nodes腋窝上（内侧，前，后，外侧）淋巴结axillary top(medial,anterior,posterior,lateral)腹股沟淋巴结（横组，纵组） inguinal nodes (transversegroup,longitudinal group) lymphnode大小size42cm 大小4 by 2 cm in diameter (size)米粒（豌豆，核桃，小指，拇指，拳头，手掌，鸡蛋）大小sizeofaricegrain(pea,walnut,

3、small,ringer,thumb,fist,palm,hens egg)针头大小pinhead size苹果大小size of an apple小孩头（成人大小）size of a(n) infants(mans) head形态shape不规则irregular结节（颗粒、纺锤）状的 tuberous (granular,spindle-shaped)光滑（粗糙）的smooth (coarse)平坦（凹凸不平）的flat (uneven)球（椭园，卵园，园）形的 globular (elliptical,oval,circular)硬度和活动度hardness and mobility硬（

4、软）hard (soft)石头（骨）样硬of stone-like (bone-like)可活动（固定）的movable (fixed)与周围组织（结构）固定be fixed to the surrounding tissues(structures)压痛tenderness融合（粘连）fusion (adhesion)肿胀（疤痕）swelling (fistula)第七章第七章体检（头颈部）体检（头颈部）Physical examination(head and neck)Physical examination(head and neck)1、头颅cranium,skull头颅变形defo

5、rming skull头形（围）head contour (circumference) 小颅 （尖颅， 巨颅） microcephalism (acrocephalia,large skull)长（短）头dolichocephalia (brachycephalism)方（塔）颅squared (tower) skull落日现象sitting sun phenomenon颅缝cranial suture前（后）囟门anterior (posterior) fontanel囟门膨出（塌陷）bulging (edpressed) fontanel囟门晚（早）闭delayded (earlier)

6、 closure of the fontanel2、眼球eyeball眼球浮动ocular bobbing眼球破裂eyeball rupture眼球穿孔伤ocular-perforating injury眼球内异物intralcular foreign body眼距增宽（变窄）ocular hypertelorism (hypotelorism)眼球萎缩atrophy of eyeball眼球突出（凹陷）exophthalmos (enophthalmos)眼球震颤nystagmus眼球固定eyeball fixation (stare)眼球活动受限limitation of eye move

7、ment假眼ocular prosthesis眼外肌运动extraocular movements3、眼睑eyelids睑内（外）翻entropion (ectropion)流泪lacrimation上睑下垂ptosis眼睑痉挛（松驰）blepharospasm (blepharo-chalasis) 眼睑水肿 （红肿） edema (redness and swelling) of the eyelids瞬目过少nictitation diminution(lid lag )瞬目过多frequent nictitation (blinking)眼裂缩小（增宽）blepharophimosis

8、 (blepharodia stasis)眼睑充血blepharal hyperemia泪囊lacrimal sac 睫毛反射eyelash reflexes压眶反射reaction to pressure on the supraocular notch皱眉（皱额，闭目）raise eyebrows (wrinkle forehead,forceeyelids closing)4、结膜conjunctive结膜反射conjunctival reflexes充血congestion红（白）redness (pallor)球结膜水肿chemosis结膜滤泡（滤泡增生）conjunctival f

9、ollicle (folliculosis)沙眼trachoma胬肉pterygium水样（脓性）分泌物watery (purulent) discharge5、角膜和巩膜cornea and sclerae角膜反射corneal reflexes角膜混浊cornea opacity透明（不透明）的transparent (opaque)异物foreign body老年环arcus senilis溃疡（穿孔）ulcer (perferation)黄染（无黄染）stained yellow (anicteric)6、瞳孔pupil右眼OD (oculus dextet)左眼OS (oculus

10、sinister)2mm 大小2mm in size等大等园be equal and round 瞳孔大小不一unevenness of pupils (anisocoria)固定fixed瞳孔缩小contraction of pupils (miosis)瞳孔散大dilation of pupils (platycoria)瞳孔畸形（闭锁）deformity (seclusion) of pupils直接（间接）对光反射direct (consensual) response to light瞳孔对光反射（佳） （差）good (poor) light reflex of pupils对光反

11、射存在retain light reflexes调节反射accommodation reflex辐辏反射convergence reflex7、视力和视野Vision and Visual fields视力模糊（减退，差）blurred (impaired, poor) Vision弱视amblyopia复视double vision (diplopia)斜视strabismus麻痹性斜视paralytic squint偏盲hemiscotosis失明amaurosis (blindness)夜盲night blindness色盲color blindness全色盲achromatopsia绿

12、（蓝）色盲achromatopsia green(blue) blindness红-绿色盲red-green blindness色弱color weakness远视far-sightedness (far sighted,hyeropia) 近视short-sightedness (short-sighted,nearsightedness,myopia)右（左）眼 200 度200 degree,OD(OS)左（右）眼视力OS(OD) vision视野完整full (intact) visual fields象限视野缺损tetarfanopia单侧（双颞侧）缺损unilateral (bit

13、emporal) defect视野缺损visual field defect视野缩小contraction of visual field8、眼底和眼压fundus and intraocular pressure眼底镜检查fundoscopy (ophthalmoscopy)眼底清晰fundi are clear小动脉（小静脉）arteriole (venule)小动脉狭窄narrow arteriole小动脉硬化arteriolosclerosis微动脉瘤microaneurysm动静脉压迹A-V nicking点状（头焰样）出血punctate (flame) hemorrhage视乳头

14、色素沉着pigmentation of disc (retina)视神经乳头（视神经）水肿papilledema (papilloedema)视乳头凹陷（苍白）excavation (pallor) of optic disc 视 网 膜 出 血 （ 水 肿 ， 渗 出 ） retinalhemorrhage(edema,exudation)视网膜色素变性pigmentary degeneration of retina视网膜剥离retinodialysis视网膜变性（损伤）retinal degeneration (injury)测眼压intraocular pressure measure

15、ment眼压升高（降低） increase (decrease) of intraocular pressure9、耳廓和外耳道pinna and external canal红（肿、痛，压痛）redness (swelling,pain,tenderness)糜烂（渗出物，脓性分泌物）erosion (exudate,purulentdischarge)疱疹（瘘管，小水疱，血疱） herpes (fistula,visicle,bloodblisters)狭窄（闭锁）stenosis (clausura) 耵 聍 （ 耵 聍 栓 塞 ， 耵 聍 过 多 ） cerumen (cerumina

16、limpaction,ceruminosis)耳疖furuncle of ear 耳化脓（溢脓）otopyosis (otopyorrhea)耳廓假性囊肿pseudocyst of auricle外耳道异物foreign body of external auditory canal耵聍钩（钳）cerumen hook (forceps)10、鼓膜tympanic membrane (drum)光反射light reflex红色（粉红色，苍白）be red (pink,pale)鼓膜内陷otopiesis (indrawing of drum)鼓膜膨出umbo (bulge of drum)鼓

17、膜穿孔（粘连）perforation (adherence) of drum中央（周围）性穿孔central (marginal) perforation鼓膜破裂myringorupture鼓膜增厚（充血，疤痕，疱疹，肉芽）hypertrophy(congestation,scar,herpes,granulation) of drum鼓室积水（血）hydrotympanum (hematotympanum)11、听力audition (hearing)听觉过敏（减退）hyperacusis (hypoacusis) 听觉不良（迟钝，障碍）dysacousis (bradyacusia, dy

18、sacusis)听觉域auditory sensation area听力正常normal hearing听力（觉）迟钝auditus depression (amblyacousia)听力障碍dysaudia听力丧失hearing loss (disability) 传 导 性 （ 神 经 性 ， 感 音 神 经 性 ） 耳 聋 conductive(neural,sensorineural) deafness老年性耳聋presbycusis音叉试验tuning fork test秒表（耳语）听力检查stopwatch (whisper) audiometry韦伯氏试验（骨导偏向试验）Webe

19、rs test任内氏试验（气骨导听力比较试验）Rinnes test施瓦巴赫氏试验（骨导对比试验）Schwabachs test12、鼻nose酒渣鼻rosacea鞍（蛙状）鼻saddle(frog) nose畸形（肿胀，溃疡）deformity (swelling,ulcer)鼻翼扇动flaring (movement) of alae nasi (nasal ala flap)鼻骨骨折fracture of nasal bone鼻疖nasal furuncle鼻道狭窄rhinostenosis (stenosis of nasal canal)流涕running nose鼻粘膜干燥（苍白，

20、红）dry (pale,red ) mucosa鼻腔异物nasal foreign body 鼻 粘 膜 萎 缩 （ 肥 厚 ， 肿 胀 ） nasal mucosa atrophy(hypertrophy,swelling)鼻孔（甲）naris (turbinates)上（中、下）鼻甲superior (middle,inferior ) turbinates鼻塞nasal obstruction鼻 中隔偏移（穿孔，肿胀，血肿，溃疡）deviation(perforation,swelling,hematoma,ulcer) of nasal septum鼻（副鼻）窦nasal (paran

21、asal) sinus 额 （上颌， 蝶， 筛） 窦frontal (maxillary,sphenoid,ethmoid) sinus鼻窦压痛tenderness over sinuses鼻镜检查rhinoscopy13、嗅觉smell (scent)嗅觉减退（敏锐）hyposmia (oxyosmia)嗅觉异常heterosmia嗅觉测定measurement of olfaction嗅觉倒错（嗅幻觉）paraosmia (olfactory hallucination嗅觉缺失anosmia14、口腔粘膜与唇mucosa of mouth and lips口腔（唇）oral cavity

22、(lips)口瘢痕挛缩cicatricial contracture of mouth口疮aphtha口角angle of mouth唇（口角）干裂cheilosis (angular cheilosis)皱裂ehagades口裂oral fissure干燥（湿润）dry (moist)口唇干燥xerocheilia (desiccation fissure)口臭halitosis (ozostomia)口唇（腔）疱疹herpes labialis (of mouth)口唇肥厚lips pachynsis口角糜烂perleche口腔坏疽oral gangrene柯泼力克氏斑Kopliks sp

23、ots口腔白斑（溃疡形成）oral leukoplakia (ulceration)口水（口涎增多）saliva (ptyalism)口周苍白（雀斑）circum-oral pallor (freckle)闭口困难open bite (closure lips irreducible)张口受阻（困难）limitation (difficulty) of mouth opening15、牙齿tooth牙表面tooth surface牙不齐odontoloxy (alignment disorder,malalignment)牙发育不全（异常）metodontiasis (dysplasia de

24、ntalis)牙根折断dental root fracture牙齿缺失anodontia (absence of the tooth)牙脱落odontoptosis (lose a tooth)缺齿missing teeth残根residual root牙松动odontoseisis (loosening of the tooth)牙垫bite-block牙磨损tooth abrasion牙骨质增生hypercementosis牙冠破裂cracking of crown牙石odontolith (tartar,dental calculus)牙列拥挤crowded dentition牙缝宽wi

25、de interdental space牙萌出过迟（早）delayed (premature) eruption of tooth牙线dental floss牙髓腔（炎）pulp cavity (pulpitis)拔牙extract (pull out ,draw out,put out) a tooth假牙false (artificial tooth)假牙prosthesis镶牙insert tooth龋齿decayed teeth (dental caries)龋洞carious cavity牙面色素沉着pigmentation of tooth surface牙关紧闭trismus (

26、lockjaw)牙触（叩击）痛tooth tenderness (percussion pain)牙周囊肿（感染，萎缩）periodontal cyst (infection,atrophy)16、牙龈gum (gingiva) 牙 龈 出 血 （ 囊 肿 ， 坏 疽 ， 撕 裂 ） gingival bleeding(cyst,gangrene,laceration) 牙 龈 充 血 （ 肿 胀 ， 糜 烂 ） gingivalengorgement(swelling,erosion)牙龈萎缩（增生）gingival atropy (hyperplasia)牙龈（牙周）溢脓gingival

27、pyorrhea (peripyema)牙龈脓肿gumboil17、舌tongue舌背静脉dorsal lingual veins舌颤动tremulous tongue (lingual tremor)舌淀粉样变性amyloid degeneration of tongue舌后坠glossocoma舌尖麻木tongue tip numbness舌裂split tongue舌脓肿（溃疡）tongue abscess (ulcer)舌乳头（体，背）papillae (body, dorsum) of tongue舌苔coated (furred) tongue地图（草莓，镜面）舌geographi

28、c (strawberry, marror face)tongue裂纹（牛肉）舌wrinkled (beefy) tongue毛舌hairy tongue舌光滑（粗糙）smooth (rough) tongue舌滤泡lingual follicles舌干燥sausarism舌肌萎缩（肥厚）atrophy (hypertrophy) of tongue muscle舌系带过短tongue tie (ankyloglossia) 舌下囊肿 （溃疡， 脓肿， 肿块） sublingnal cyst (ulcer, abscess,tumor)伸舌困难（偏斜）difficulty (deviation

29、) of tongue extenisonmovement18、咽和扁桃体pharynx and tonsil鼻（口）咽nasal (oral) pharynx扁桃体不肿大no enlargement of tonsil无充血和渗出no injection (congestion) and exudate 脓点 （滤泡， 白色小点） beads of pus (follicle, white particle)扁桃体出血（感染，肥大，溃疡） hemorrhage (infection,hypertrophy, ulcer) of tonsil扁桃体肿大swelling of tonsil扁桃体

30、（后，周围）脓肿tonsillar (retrotonsillar, peritonsillar)abscess扁桃体缺如tonsil deletion扁桃体隐窝（窝）tonsillar crypts (fossa)咽部异物（溃疡，分泌物）pharyneal foreign body (ulcer,secretion)咽后壁淋巴滤泡增生retropharyneal folliculosis咽部干燥（疱疹，充血，水肿） dryness (herpes, congestion,swelling) of throat咽反射pharynx reflex咽下不能dysphagia腮腺肿大enlargem

31、ent of parotid gland19、喉larynx白喉（喉白斑）diphtheritic croup (leukoplakia of larynx)喉闭锁atretolemia喉梗阻laryngemphraxis (laryngeal obstruction)喉痉挛（狭窄）laryngeal spasm(laryngo-stenosis)喉头痉挛laryngospasm喉反射laryngeal reflex喉坏死（钙化）necrosis (calcification)of larynx喉瘘（囊肿，脓肿，息肉，血肿，异物）laryngealfistula(cyst,abscess,po

32、lyp,hematoma,foreign body)喉膨出laryngocele喉缺失absence of largnx喉头水肿laryngeal edema声嘶（哑）hoarseness (dumbness)变（失）声mutation (loss) of voice失音aphonia发音（构音）障碍pararthria (dysarthria)喉部感觉缺失laryngeal anesthesia会厌发育不全（擦伤， 裂，囊肿，脓肿）agenesis (abrasion,fissure, cyst, abscess) of epiglottis会厌分叉（结节）bifid epiglottis(

33、epiglottic tubercle)声带肥厚hypertrophy of vocal cords声带麻痹vocal cord paralysis声带小结vocal nodule声带息肉polyp of vocal cord声门痉挛glottis spasm声门下狭窄subglottic stenosis20、颈部neck颈部创伤neck trauma颈部淋巴结（囊肿）cervical lymph node (cyst)颈动脉窦按摩carotid sinus massage颈强直neck rigidity (stiff-neck rigidity, stiff neck)颈软soft nec

34、k (supple)斜颈torticollis角弓反张opisthotonus颈静脉搏动（曲张）jugular pulse (varicosity)颈静脉怒张jugular vein distention (JVD)颈静脉充盈（怒张）jugular vein is full(distention andprominence)库斯毛氏征Kussmauls sign肝颈反流hepatojugular reflex收缩期（舒张期）囊颤systolic (diastolic) thrill颈动脉搏动异常（增强、减弱、消失）abnormal carotidpulsation (increase, dec

35、rease, disappearance)21、甲状腺thyroid弥漫（局灶，结节）性甲状腺肿大 diffuse (local, nodular)thyroid enlargement甲状腺震颤thyroid tremor震颤thrill甲状腺血管杂音thyroid vascular murmur甲状腺峡部isthmus of thyroid gland甲状旁腺parathyroid gland 甲状腺囊肿 （滤泡、 肿块， 出血） thyroid cyst (follicle, tumor,hemorrhage)22、气管trachea气管插管endotracheal intubation

36、气管痉挛tracheospasm气管囊肿（息肉、狭窄、移位）tracheal cyst (polyp,stenosis ,displacement)气管（向右）偏移 displacement of trachea (tracheal deviationto the right)气管居中trachea is in the midline气管内异物intratracheal foreign body第八章第八章体检（胸腹部）体检（胸腹部）Physical examination(chest and belly)Physical examination(chest and belly)1、肋骨和软组

37、织ribs and soft tissure胸骨上切迹suprasternal notch浮肋free ribs胸壁chest wall扁平（桶状、佝偻、漏头、鸡）胸flat (barrel,rachitic, funnel,pigeon) chest皮下气肿subcutaneous emphysema捻发音Crepitus佝偻病串珠rachitic rosary软骨病chondrosteoma脂肪瘤lipoma软骨发育不全achondroplasia (chondrodysplasia)软组织损伤soft tissue injury 肋 骨 畸 形 abnormality of the ri

38、bs(rib deformity, costalanomaly)肋骨串珠（错位）beading (displacement) of rib肋软骨畸形costochondral deformity肋软骨增生costal cartilage hyperplasia肋下切口subcostal incision肋间隙宽（窄）wide (narrow) intercostal space2、乳房breast对称性symmetry乳头内陷（内缩）crater (retracted) nipple乳头皱裂cracked nipple乳头偏斜（抬高）nipple skewness(elevation)乳头溢液

39、nipple discharge 乳头脓肿（溃疡、血肿）abscess (ulcer, hematoma) of nipple乳头过小hypomastia乳斑milk spots乳房潮红breast flush乳房出血mastorrhagia乳房过早发育premature thelarche乳房肿胀（脓肿）mammary swelling(abscess)乳房湿疹eczema mammae乳房下垂mastoptosis (pendulous breast)乳房萎缩mastatrophy巨乳macromastia乳晕mammary areola乳房硬化zaranthan异常泌乳abnormal

40、lactation男子女性化乳房gynecomastism乳房皮肤红肿erythroswelling of mammary skin乳房桔皮征mammary orange-peel sign乳记局限性凹陷mammary localized pitting乳房瘘管breast fistula正常女性乳房normal female breasts无压痛性肿块nontender mass3、肺lung呼吸缓慢（急促）bradypnea (tachypnea)呼吸浅慢（深快）hypopnea (hyperpnea)呼吸不规则irregular respiration点头呼吸nodding breath

41、ing端坐呼吸orthopnea三凹征retraction sign of three fossae叹息样呼吸sighing respiration浅快shallow and rapid呼（吸）气性呼吸困难expiratory (inspiratory) dyspnea 呼 吸 道 烧 伤 （ 塌 陷 ） burn (collapse) of respiratorytract(airway)呼吸道阻塞respiratory tract obstruction 呼吸均匀 （呼吸加深或加快） eupnea(exaggerated or accleratedrespiratory)呼吸停止apnea

42、呼吸费力respiration is labored语音（触觉）震颤vocal (tactile) fremitus语颤相等（减弱、增强） vocal fremitus is equal(diminished,accentuated)间接（直接）叩诊mediate (immediate) percussion 浊 （实、 鼓、 清、 过清、 金属） 音dullness (flatness, tympany,vesicular resonance, hyperresonance, bell)移动范围range of movement呼吸音消失 （减弱， 增强） absence (diminuti

43、on, exaggeration)of breath sound呼吸音粗（清）sound of breath(SOB) is rough (clear) 支 气 管 （ 支 气 管 肺 泡 ， 肺 泡 ） 音 bronchophony(bronchovesicular sound, vesicular sound)管状呼吸音tubular breath sound捻发音crepitant rales爆裂音crackles干（湿）罗音dry (moist) rales细（中等、粗）罗音fine (medium, coarse) rales呼（吸）气未罗音end-inspiratory (expi

44、ratory) rales胸膜摩擦音pleural friction rub呼（吸）气延长prolonged inspiratory (expiratory)高（低）调鼾音sibilant (sonorous) rhonchi (sonorous rales)哨笛音sibilant rales哮鸣音wheezing小（中、大）水泡音small(middle, big) bubbles支气管语音bronchophony耳语音whispered羊鸣音egophony高（低）音调high (low)-pitched两肺部（右背部）over both lung fields (right back)两

45、（左）肺底over the both (left) lower lung整个肺野the whole lung field左（右）上（下）肺the left (right) upper (lower) lung肺尖（底）apex (base) of lung4、心脏Heart用手掌（指尖）触诊心尖搏动palpate apical area with palmnumbness (fingertips)心前区隆起（凹陷）precordial bulge (retraction)搏动弥漫（局限）diffuse (local) pulsation负性搏动inward inpulse心尖搏动apex be

46、at (apical impulse)剑突下搏动xiphoideusal pulsaton抬举性心尖搏动heaving apex impulse心尖搏动最强点point of maximal impulse (PMI)锁骨中线mid-calvicular line (MCL)肋间intercostal space (ICS)收缩（舒张）期震颤systolic (diastolic) thrill心浊音界the border of cardiac dullnes心绝对（相对）浊音界扩大（缩小）enlarged (diminished)absolute (relative) cardiac dul

47、lness叩诊心脏大小正常heart size is normal on (to) percussion心脏向左（右）扩大cardiac dilation (enlargement) to the left(right)第 1（2、3、4）心音S1(S2,S3,S4) 第 1 心音增强 （减弱， 听不清） first heart sound is exaggerate(decreased, muffled) 生 （病） 理性杂音 （分裂） physiologic (pathological) murmur(splitting) 生理性 （固定、 反常、 逆） 分裂physiologic (fi

48、xed, paradoxical,reversed) splitting肺动脉瓣第 2 心音(=，(=，)A2大炮音connon sound心音消失heart sound is absent (disapeared)心音增强（减弱）accentuated (diminished) cardiac sound心音响亮（遥远）cardiac sound is loud (distant) 收缩期 （舒张期， 连续性） 杂音systolic (diastolic, continuous)murmur收缩（舒张）前（中、晚）期杂音pre-(mid-, post) systolic(diastolic)

49、 murmur全收缩期的holosystolic(pansystolic)全舒张期的holodiastolic (pandiastolic)低（高）音调low (high) pitched递减（递增，递减 -递增）性杂音decrescendo (crescendo,decrescendo-crescendo)murmur呈喷射型be ejection in type级喷射型收缩期杂音grade (I-/6) systolicejection murmur吹风样杂音murmur of puffing character低音调隆隆样low-pitched rumbling quality柔和（粗糙

50、）的soft (harsh or rough)吹风样（喷射性、隆隆样、沙沙声样、搔抓声样、机器声样、 汽笛声样、 倒水声样） 杂音blowing (ejection, rumbling,rustting, scratching, machinary, whistling, pouring )murmur功能性（器质性）杂音functional (organic) murmur血管（静脉）杂音vascular (venous) murmur枪击音pistol shot sound静脉营营音venous hum奔马律gallop rhythm胎心律embryocardia心律齐（不齐）regula

51、r (irregular) rhythm心律不齐arrhythmia二（三）联律bigeminy (trigeminy)早搏premature (extrasystol)喀嗽音click钟摆律pendular rhythm二尖瓣开瓣音mitral opening snap心包摩擦音pericardial friction sound听诊on auscultation 二尖瓣 （主瓣， 肺瓣， 三尖瓣） 听诊区mitral (aortic, pulmonary,tricuspid) valve area心包叩击音pericardial knock肿瘤扑落音tumor plop5、腹部abdome

52、n腹（妊娠）纹abdominal striae (striae gravidarum)腹膨隆abdominal distention (prominence)腹平坦（凹陷）abdominal flatness (retraction) 蛙状 （球状、 舟状） 腹frog(bulbous, scaphoid) belly (abdomen)腹围增大increased abdominal girth肠型intestinal pattern梯形腹ladder-shaped abdomen胃（小肠）蠕动波gastric (intestinal) peristaltic wave静脉曲张varicosi

53、ty (dilated tortuous vein)疤痕scar腹壁紧张（松驰） guarding (abdominal muscular relaxation)腹壁切口（创伤）incision (wound) of abdominal wall腹部分区abdominal region左（右）上（下）腹left (right) upper (lower) quadrant脐膨出projection of the umbilicus腹式呼吸abdominal (diaphragmatic) breathing腹壁松弛lax abdominal wall肝肿大hepatomegaly (enlar

54、gement of the liver)脾肿大splenomegaly (enlargement of the spleen)右肋下 5 厘米5 cm below the right costal margin肿块（肝）质硬firm mass (liver)莫菲氏征murphys sigh肌卫现象muscle guarding (tension)反跳痛rebound tenderness压痛点tenderness point剑突下压痛tenderness beneath the xiphoid process麦氏点压痛McBurneys point tenderness腹肌强直（板状腹，板样强

55、直）rigor of abdominal muscle(wooden belly, board-like rigidity)柔韧感dough kneeding sensation波动感fluctuation腹股沟疝inguinofemoral hernia腹壁反射abdominal reflex腹水征sign of ascites膀胱肿大bladder expansion 膀胱区 （ 脊 肋角） 压 痛 tenderness of bladder region(costovertebral angle)肾（肝）区叩击病percussion tenderness on kidney (liver

56、)region移动性浊音shifting dullness鼓音tympany(tampanitic resonance)肝（脾）浊音区hepatic (splenic)dullness area肠鸣音正常（亢进、减弱、消失）normal (hyperactive,diminished, absent) bowel sound气过水声gurgling振水声succusion (splashing) sound第九章第九章体检（神经、骨骼和肌肉）体检（神经、骨骼和肌肉）PhysicalPhysicalexamination(nerve,skeleton and muscle)examination

57、(nerve,skeleton and muscle)痛（空间、触、视、震动、实体、立体、姿势、光、运动、味、温、色、平衡） pain (space, tactil, visual, vibratory,strereognostic, proprioceptive, posture, light, kinesthetic, taste,thermic, color, equilibrium) sense关节觉arthresthesia震动觉seismesthesia复合感觉synaesthesia听（位置，嗅）觉sense of hearing (position, smell) 感觉异常 （

58、缺失， 过敏， 减退） abnormal sensation (anesthesia,hyperesthesia, hypoesthesia)半身感觉缺失hemisensory defect感觉迟钝（错乱）dysesthesia (paresthesia)感觉障碍（异常）sensory disturbance (paraesthesia)感觉正常intact sensation (euesthesia)痛觉过敏（减退）hyperalgia (hypoalgia)痛觉缺失alganesthesia (analgesia)嗅觉迟钝 （减退 ，过敏）amblyaphia (hypopselaphes

59、ia,hyperpselaphesia)束带状感觉girdle sensation蚁走感formication (creeping sensation)瘫痪（偏瘫、单瘫、截瘫、四肢瘫）paralysis (hemiplegia,monoplegia, 碍 paraplegia, quadriplegia)软（硬）瘫soft (stiff) paralysis周围（中枢）性瘫peripheral (central) paralysis轻瘫paresis交叉性（同向性）瘫alternate (cojugate) paralysis交叉瘫crossed paralysis 痉挛性 （弛缓性、癔病性、

60、小儿）瘫 （麻痹）spastic (flaccid,hysterial, infantile) paralysis重症肌无力bulbospinal paralysis扑翼样震颤asterixis手足搐搦tetany共济失调ataxia手足徐动症athetosis舞蹈样运动choreiform movement (chorea)肌颤muscular fibrillation肌阵挛myoclonus震颤麻痹paralysis agitans (shaking palsy,Parkisons disease)颤动tremor (twitch)随意运动voluntary movement 肌力正常 （

61、减退） muscular power (myodynamia, myosthemic)is normal (decreased)肌力消失loss of power左上肢肌力 III 度3 degree in the left upper extrimity肌无力weakness of the muscle (amyosthenia, myasthenia)肌张力减低hypomyotonia (decreased muscular tone) 痉挛性（强直性）肌张力增高spastic (tonic) hypermyotonia(hypertonia of the muscle, increase

62、d muscular tone)肌弛缓（肌张力缺失）amyotonia折刀现象clasp knife齿轮样强直cogwheel rigidity肌阵挛（痉挛）muscular clonus (spasm)摇摆（蹒跚、剪刀形、鸭走形、酒醉小脑病、摇曳、慌张）步态swaying (reeling, scissors, waddling, drunken, cerebella,cow, festinating)gait共济失调（共济运动，共济失调步态）incoordination(coordinated movement, afaxic gait)跛行步态（间歇性跛行）claudication ga

63、it (intermittentclaudication)闭目难立试验（阳性，阴性）Rombergs sign (positive,negative)摸空征carphology指鼻（指-指）试验finger-nose(finger) test轮替动作alternate motion跟膝胫试验heel-knee-tibia test生理（病理）反射physiologic (pathologic) reflex角膜（张口，结膜，咽，腭，眼睑，咳嗽，吞咽，对光，瞳孔） 反射corneal (gag, conjunctival, pharyngeal, palatal, lid,cough, degl

64、utition, light, pupillary) reflex腹壁反射abdominal wall reflex提睾（肛门）反射cremasteric (anal) reflex肱二（三）头肌反射biceps (triceps) reflex股二（四）头肌反射biceps (quadricels) femories reflex三角肌（伸肌）反射deltoid (extensor) feflex抓握（牵拉，吸吮，防御，条件）反射grasp (stretch,sucking,protective, conditioned) reflex跖（骨膜）反射plantar (periosteal)

65、reflex跟腱反射heel-tap (achilles tendon) reflex拥抱反射clasping (embrace, Moros) reflex深（浅）反射deep (superficial) reflex压眶反射reaction to pressure on the supraocular notch桡骨膜反射radioperiosteal reflex膝（跟腱）反射knee (achilles) jerk反射活动协调coordination of reflex action (activity) 反射亢进 （减弱， 消失） hyperreflexia (hyporeflexi

66、a, areflexia)亢进的hypractive (increased, exaggerated)减弱的hypoactive (decreased, diminished)消失的absent (disappeared)可疑的questionable (equivocal)跟（髌，趾，腕）阵挛ankle (patella, toe, wrist) clonus 巴彬斯基 （克尼格， 奥本海姻， 霍夫曼） 征Babinski (Kernig,Oppenheim, Hoffman) sign 拉塞格 （布鲁金， 戈登， 查多克， 岗达） 征Lasegue (Brudzinski,Gordon,

67、Chaddock, Bonoda) sign眼-心（竖毛）反射oculo-cardiac (pilomotor) reflex皮肤划痕征dermographism脑膜刺激征sign of meningeal irritation颈强直stiff-neck阳性（阴性）postive (negative)未引出be not found (discovered, elicited)失语（声）aphasia (aphony)言语缓慢（不清）bradylalia (barylalia)口吃（声嘶）stuttering (hoarseness)外展（内收）abduction (adduction) 脊柱后

68、 （前， 侧， 前侧， 后侧） 凸kyphosis (lordosis, scoliosis,lordoscoliosis, scoliokyphosis) 屈曲 （前曲， 背曲， 腹侧屈曲） flexion (anteflexion, dorsiflexion,ventriflexion)旋转（旋前，旋后）rotation (pronation, supination)伸直（前弯，后弯，侧弯）extension (forward bending,backward bending, lateral bending)膝内（外）翻genua varum (valgum)髋内（外）翻coxa var

69、a (valga)足内（外）翻pes varus (valgus)X（O）形腿deformed X(O)-shaped leg驼背humpback (kyphosis, rachiocyphosis)多（并）指polydactylia (syndactyly)关节僵硬ankylosis (stiff-joint)骨性强直bony ankylosis爪（扇）形手claw (sector) hand肢端肥大acromegaly杵状指clubbing (clubbed finger)跛行limping平足flat foot (pes planus)静脉曲张varicose vein静脉（蜂窝织）炎p

70、hlebitis (cellulitis)活动受限limitation of motion干（湿）性坏疽dry (moist) gangrene垂腕wrist drop梭形关节fusiform articulus浮髌现象floating patella phenomenon橡皮肿elephantedema肌萎缩muscle atrophy瘘管形成sinus tract formation蹼指（趾）palmature and webbed toe关节挛缩contracture of joint凹陷（非凹陷）性水肿pitting (non-pitting) edema关节变形（融合）joint d

71、eformity (fusion)关节全（半）脱位complete dislocation (subluxation of joint)关节肿大（肿胀）arthrocele (arthroncus)关节活动障碍articular dyskinesia第十章第十章体检（泌尿生殖道与其他）体检（泌尿生殖道与其他）PhysicalPhysicalexamination(urology ,obstetrics and the others)examination(urology ,obstetrics and the others)包皮过长（包茎）prepuce redundant (phimosis

72、)包皮水肿preputial edema包皮嵌顿paraphimosis 阴茎糜烂 （疤疹， 损伤， 折断， 溃疡， 血肿） erosion (herpes,injury, fracture, ulcer, hematoma) of penis阴茎粗大（特小， 缺如）coarseness (hypersmall, absence) ofpenis阴茎发育不全agenesis of penis阴茎软下疳（菜花样肿块）chancroid (cauliflower like mass)of penis阴茎异常勃起styma 阴囊湿疹 （水肿， 血肿， 肿大， 橡皮肿， 溃疡） eczema (ede

73、ma,hematoma, swelling, elephantiasis, ulcer) of scrotum阴囊疝scrotal hernia腹股沟斜疝indirect inguinal hernia阴囊空虚（静脉曲张，肿块）scrotal empty(varices, mass)睾丸不发育（发育不全）agenesis (dysgenesis) of testis睾丸挫伤（损伤）contusion (injury) of testis睾丸畸形teratism of testis 睾丸萎缩 （缺如， 肿大）atrophy (absence, swelling) of testis睾丸过小mic

74、rotestis睾丸未降undescended testicle隐睾cryptorchid睾丸异位parorchidium睾丸扭转torsion of testis睾丸血肿hematoma of testis睾丸鞘膜积液hydrocele腹股沟的inguinal尿道口orifice of urethra尿道下裂 hypospadius尿道出血urethremorrhage尿道脓性分泌物purulent secretion of urethra索状结构cord structure精索静脉曲张varicocele透光试验transillumination test双（三）合诊bimanual (t

75、rimanual) examination阴道指诊vaginal touch外阴白斑干燥 (橡皮肿，囊肿 )vulval leukoplakia(xerosis,elephantiasis, cyst)外阴溃疡（下疳，创伤，过度角化，瘙痒，湿疹，血肿）ulcer(chancre, trauma, hyperkeratosis, pruritus, eczema,hematoma ) of vulva外阴会阴破裂vulvoperineal rupture幼稚型infantile typer已婚外阴marital outlet处女膜完整intact hymen恶露lochia白带leucorrhe

76、a水样（血性，脓性）阴道分泌物 watery (bloody, purulent)vaginal discharge宫颈涂片（活检）cervical smear (biopsy)宫颈触痛cervical tenderness 子宫后位（侧位，下垂）retroposition (latero-location, ptosis)of uterus子宫发育不良hypoplasia of uterus 未产（多产）式子宫 （子宫颈） nulliparous (multipara) uterus(cervix)宫颈糜烂erosion of cervix宫颈刮片cervical scraping smea

77、r宫颈肥大（白斑，裂伤，难产）cervical hypertrophy(leukoplakia, laceration, dystocia)宫颈扩张dilatation of cervix宫颈息肉cervical polyp宫颈视诊cervical inspection前（后）倾位in anteversion (retroversion) position前（后）屈anteflexion (retroflexion)萎缩（肥厚）atrophy (hypertrophy)处女膜闭锁atresia of hymen(imperforate hymen)处女膜裂伤hymenal laceration

78、处女膜破裂repture of hymen 阴道狭窄（血肿、闭锁，囊肿，缺失）stenosis (hematoma,atresia, cyst, absence) of vagina 阴道疤痕 （裂伤、 损伤、 肿瘤） vaginal scar (laceration, injury,tumor)阴道出血colporrhagia (vaginal bleeding) 阴 道 干 燥 （ 积 血 ， 破 裂 ） colpoxerosis(hematocolpos,colporrhexis)阴道尖锐湿疣condyloma acuminata of vagina阴道镜检查colposcopy阴道疝（

79、水肿，脱垂）colpocele (colpedema, vaginocele)阴道壁膨出vaginal wall protruding阴道积液vaginal dropsy第一（二）性征primary (secondary) sex characteristies阴蒂出血（肥大）clitorrhagia (clitoridauxe)巴氏（前庭大）腺增大Bartholins gland enlargement产前检查antenatal care骨盆测量pelvimetry出口横径transverse outlet diameter骨盆入（出）口狭窄contracted pelvic inlet (

80、outlet) 骨盆畸形 （骨折， 损伤） deformity (fracture, injury) of pelvis髂棘间径IS (interspinous diameter)髂嵴间径IC (intercristal diameter)粗隆间径IT (intertrochanteric diameter)骶耻外径EC (external conjugate)骶耻内径DC (diagonal conjugate)坐骨结节间径ischial intertuberal diameter头盆不相称CPD(cephalopelvic disproportion)胎心音（率，律）fetal heart

81、 sound (rate, rhythm)胎位fetal position左（右）枕前位left (right) occipito-anterior (LOA/ROA)左（右）枕横位left (rihgt) occiput transverse (LOT/ROT)左（右）枕后位left (rihgt) occiput posterior (LOP/ROP)左骶（颏，肩）前位left sacrum (mental, acromion) anterior(LSA/LMA/LAA)宫底fundus在脐与耻骨联合之间between the symphysis pubis and theumbilicu

82、s脐上above the umbilicus剑突下below the xiphoid process如妊娠 6 个月大小be enlarged as a 6-mouth gestation胎先露fetal presentation横产位acromio-iliac presentation 头 （面， 足， 膝， 肩， 臀， 臂） 先露head (face, foot ,knee, shoulder,breech, arm, funis) presentation脐带异常abnormality of umbilical cord脐带过长（短）long (short) cord脐带缠绕（绕颈）co

83、rd entanglement (cord aound neck)脐带水肿（打结，扭转，胱垂，缠绕） edema (knot, torsion,prolapse, winding) of umbilical cord前置胎盘placenta previa胎盘早期剥离 premature separation of placenta (placentalabruption)胎盘部分残留placenta remnants胎盘滞留retention of placenta胎盘粘连placenta adherence胎盘嵌顿incarcerated placenta胎头入盆engagement of

84、head胎动fetal movement胎粪（毛、膜）meconium (down, fetal membrane)胎膜早破premature rupture of fetal membrane 宫缩 （乏力， 无力） uterine contraction (uterine inertia, uterineatony)宫缩不良inefficient uterine action过期妊娠prolonged pregnancy (graviditas)分娩delivery (labor, childbirth, parturition)见红bloody show羊水过多（过少）hydramnio

85、s (oligoamnios)死产（宫内死亡）stillbirth (fetal death)双胞胎twins宫外孕ectopic pregnancy 产道异常 （损伤， 裂伤） abnormality (injury, laceration) of birthcanal产后出血postpartum hemorrhage窥阴器speculum穹窿vault (fornix)肛瘘anal fistula肛裂anal fissure 肛门脓肿 （湿疹， 出血） abscess (eczema, hemorrhage) of anus 肛周脓肿 （感染， 瘙痒） perianal abscess (

86、infection, pruritus)肛门反射anal reflex肛门缺如anal agenesis (anus absence)肛门闭锁imperforate anus脱肛proctoptosis直肠内触痛rectum tenderness肛门和直肠内波动感wave sense in anus and rectum直肠指检digital examination of the rectum直肠闭锁rectal atresia直肠（乙状结肠）镜proctoscopy (sigmoidoscopy)直肠（多发性）息肉(multiple) polypus recti (proctopolypus

87、)直肠后间隙脓肿retrorectal abscess直肠瘘（破裂）rectal fistula (rupture)直肠膨出rectocele直肠狭窄rectostenosis直肠阴道隔（瘘）rectovaginal septum (fistula)内（外，混合）痔internal (external, mixed) hemorrhoids括约肌张力正常normal sphincter tone肛管anal canal第十一章第十一章标准化病人体检项目标准化病人体检项目COMPLETE PHYSICALCOMPLETE PHYSICALEXAMINATION CHECKLISTEXAMINAT

88、ION CHECKLIST(standard patient, SP)(standard patient, SP)1、一般检查/生命体征GENERAL EXAMINATION/VITAL SIGNS向病人介绍自己的姓名，职责。通过简短交谈，了解病人的精神状态检查前洗手让病人取坐位检查桡动脉脉搏至少 30 秒，并记录检查脉搏对称性计数呼吸频率至少 30 秒，并记录测量右上臂血压将袖带缚于上臂正确位置触诊肱动脉测量血压两次，记录较低值Introduce yourself to patient, usually last name and title andhave a littleconversa

89、tion to relax the patient and to judge mental state.Wash hands before starting examinagionPatient is seated in a chairPalpate radial (wrist) pulses for at least 30 seconds and recordPalpate both radial (wrist) pulses simultaneously for symmetryMeasure respiratory rate for at least 30 seconds and rec

90、ordMeasure blood pressure on right armPlace cuff in correct location 2-3 cm above the antecubitalcreasePalpate brachial arteryMeasure blood pressure over brachial artery twice and recordthe lower reading2、头部和颈部HEAD AND NECK（1）头颅Skull检查头颅（分开头发观察）Palpate and observe scalp (parting hair, and observing

91、hairdensity, color,lustre and distribution)（2）眼Eyes检查视力检查角膜、下份巩膜、结膜和泪囊：置拇指于下睑中份，轻轻向下按下睑，请病人向上看检查上份巩膜及球结膜：置拇指于上睑中份，轻轻向上牵拉上睑，请病人向下看面神经（第对颅神经）上支运动功能的检查，皱眉、皱额或紧闭双目检查双眼眼外肌六个方向运动功能瞳孔直接对光反射检查调节反射Visual screeningObserve cornea, sclera, conjunctive and lacrimal puncta bygently moving lower eyelids down.Obser

92、ve sclera and bulbar conjunctiva by gently elevatingupper eyelid while patient looks downCheck cranial nerve(cr n) upper division:raised eyebrows,wrinkle forehead or forced eyelid closing.Evaluate extraocular muscle function in both eyes in 6directions (left, upper left, and lower left, right, upper

93、 right,lower right)Observe pupillary direct response to lightObserve pupillary consensual response to lightCheck for convergence and accommodation（3）检眼镜检查OPhthalmoscopic Examination调整病人者坐位高度，以检查者感觉舒适为宜关暗室内光线，以利观察眼内情况正确握持检眼镜右手持检眼镜站在右前方，用右眼检查受检者的右眼左手持镜眼镜站在左前方，用左眼检查受检者的左眼调整方位开始检查用检眼镜检查角膜、晶状体和玻璃体观察眼底视乳头

94、及其周围视网膜检查四个象限的视网膜血管检查黄斑（嘱受检查注视光源）Position patient at height comfortable for examinerDim lights of roomHold ophthalmoscope properly and use index finger to switchlenses To examine patients right eye, examiner holds ophthalmoscopewith right hand and uses right eyeTo examine patients left eye, examiner

95、 holds ophthalmoscopewith left hand and uses left eyePosition to start ophthalmoscopic examinationInspect cornea, lens, and vitreous body for opacity withophthalmoscopeInspect optic disc (color, margin, etc.)Trace retinal vessels in four quadrantsObserve macula (patient asked to look directly at lig

96、ht ofophthalmoscope)（4）耳及颞下颌关节Ears观察和触诊双侧耳廓及周围触诊双侧颞下颌关节，注意有无肿胀及触痛双手指置于耳屏前或稍插入外耳道，检查颞颌关节的运动用手稍向后上方牵拉耳廓，使外耳道变直，以便插入耳镜插入耳镜观察鼓膜使受检查者不感疼痛检查听力用适当方法分别检查双耳听力Observe and palpate the auricles and observe postauricularregions bilaterallyPalpate temporomandibular joint for tenderness and swellingFeel the moveme

97、nt of the TMJ with index fingers insideexaminees ears or over jointGently pull auricle upward and backward to ease insertion ofotoscopeInsert otoscope into external auditory meatus to observetympanic membraneInsert otoscope without causing pain to the patientEvaluate auditory acuityUse proper techni

98、que to check auditory acuity separately ineach ear（5）鼻Nose观察及触诊外鼻有否畸形，压痛等观察鼻前庭（不用鼻镜，可用电筒）插入鼻镜观察前庭、中隔、鼻甲及鼻粘膜。检查过程中，病人头部逐渐后仰分别压闭一侧鼻孔，令病人吸气，检查其通气情况按压双侧上颌窦区，有无肿痛按压双侧额窦区，有无肿痛Inspect and palpate external nose for malformation andinflammationObserve nasal vestibule without otoscopeTurn the tip of the nose

99、upwards and insert the tip of thespeculum to inspect nasal vestibule and anterior part of nasalcavity for ulcer, crust, swelling, discharge, atrophy orperforationTest patency by inhaling through each nostril separately whilethe opposite nostril is held occludedPalpate and/or percuss maxillary sinus

100、for swelling andtendernessPalpate and/or percuss frontal sinus for swelling and tenderness（6）口腔、唇、咽Mouth, Lips, Pharynx检查唇、颊粘膜、牙、牙龈、舌检查口底检查口咽部有无充血、肿胀及溢脓嘱受检者向前伸舌，观察有无偏歪以检查第对颅神经功能嘱受检者露齿、鼓腮或吹口哨，以检查第对颅神经功能检查咬肌肌力，嘱受检者对抗阻力张口检查三叉神经感觉支（至少 2/3 部位）暴露和观察颈部Observe lips, buccal mucosa, teeth, gums and tongueObse

101、rve the floor of mouthInspect the posterior structures of the mouth for congestion,swelling or pus, position of uvula, and elevation of the palateObserve midline protrusion of the tongue(cr n ) Show teeth, puff out cheeks or purse lips (lower division of cr n)Test contraction of masseter (jaw) muscl

102、e or forced opening ofmouth against resistance (motor division cr n V) Test for facial sense of pain and touch (must check at least 2 outof 3 sensory divisions for cr n V)Expose neck correctly to observe appearance and skin of neck（7）淋巴结Lymph nodes触诊耳前淋巴结：双侧耳前区触诊耳后淋巴结：双侧耳后区触诊枕后淋巴结：枕外隆凸下方触诊下颌下淋巴结：屈曲手

103、指于下颌骨内侧触诊触诊颏下淋巴结：屈曲手指于颏下中线处触诊触诊颈前淋巴结浅组：位于乳突下，胸锁乳肌前缘浅表处触诊颈后淋巴结：位于胸锁乳突肌后缘浅表处触诊锁骨上淋巴结：屈曲手指在锁骨与胸锁乳突肌之间的交角处触诊Palpate preauricular nodes (front of ears)Palpate post-auricular nodes (back of ears)Palpate occipital nodes (base of skull)Palpate submaxillary nodes (by bending finger under patientsjaw)Palpate

104、submental nodes (by bending finger under patientschin) Palpate anterior cervical nodes (superficial group undermastoid and the front of sternomastoid muscle)Palpate posterior cervical nodes (behind sternomastoid muscle) Palpate supraclavicular nodes (by bending finger abovepatients collarbone)（8）甲状腺

105、Thyroid gland用双指触摸甲状软骨，检查其移动度及有无疼痛用双手从患者前面或后面在正确部位触诊甲状腺触摸甲状腺狭部、配合吞咽动作触摸甲状腺侧叶、配合吞咽动作 Palpate and/or move thyroid cartilage with two fingers checkingfor malformation and movabilityPalpate thyroid in correct anatomical location in front of orbehind the patient with both handsPalpate isthmus of thyroid

106、with and without swallowingPalpate thyroid gland(lobes) with and without swallowing（9）颈动脉、气管Carotid Artery and Trachea触诊颈动脉检查气管位置Gently palpate carotid artery(bilaterally)Palpate the position of trachea（10）颈椎运动Movement of Cervical Spine屈曲后伸侧弯（耳肩运动）旋转（颏肩运动）嘱受检者对抗阻力作头部旋转或耸肩以检查第对颅神经功能Flexion (actively,

107、 if possible; if abnormal, do passively)Extension (actively, if possible; if abnormal, do passively)Lateral bending ear-to-shoulder; (actively, if possible; ifabnormal, do passively)Rotation (chin-to-shoulder), (actively, if possible; if abnormal,do passively)Test rotation of patients head against r

108、esistance or checkresistance of shrugged shoulders (cr n XI)3、上肢UPPER LIMBS正确暴露上肢Expose upper limbs（1）手Hands观察手掌、手背，触诊双手各关节检查双手及指甲，有无紫绀和杵状指伸展手指弯曲近指间和远指间关节呈爪状握拳拇指对掌运动检查远端肌力Inspect dorsa and palms and palpate all joints of handCheck fingernails for clubbing or cyanosisAsk patient to extend fingersAsk

109、patient to make a clawAsk patient to make a fistCheck patients ability to perform thumb oppositionCheck for distal muscle strength（2）腕Wrist触诊双手腕有无肿块、水肿、畸形和压痛背伸掌曲 Observe and palpate wrist (for lumps, swelling, deformities, andtenderness)Extension of wrist (bend backward)Flexion of wrist (bend forwar

110、d)（3）肘Elbow触诊鹰嘴和肱骨髁状突触诊滑车上淋巴结屈肘检查上臂肌力伸肘旋前和旋后Palpate olecranon process and epicondylesPalpate epitrochlear lymph nodesFlexionCheck for upper arm muscle strengthExtensionPronation and supination (with elbows locked at patients side)（4）肩Shoulder触诊双肩功能检查（三个过筛试验：一手越过头顶触摸对側耳朵；双臂上举， 双手置于后枕； 一手从背后触及对侧肩胛下角）检

111、查上肢近端肌力检查触觉或痛觉（至少 2/3 部位）贝勒氏（Barres）上肢轻瘫试验（闭眼）Palpate both shouldersFunctional examination (3 screening maneuvers: hand overhead to opposite ear, hands behind head, touch lower borderof opposite scapula)Check for proximal muscle strengthTest sense of pain or touch:at least 2 of 3 positions (upper ar

112、m,forearm, & hand) on each upper extremity bilaterally andsymmetricallyBarres upper limb test (test for drift of outstretched arms witheyes closed)（5）腱反射 Deep Tendon Reflexes(The reflexes should bechecked bilaterally and both sides com-pared.)肱二头肌反射肱三头肌反射桡骨骨膜反射Biceps reflexTriceps reflexBrachioradia

113、lis reflex（6）共济运动Coordination快速轮替动作指鼻试验（睁眼）指鼻试验（闭眼）Rapid alternating movementFinger to nose test (with open eyes)Finger to nose test (with closed eyes)4、背部BACK正确暴露背部逐个触诊脊柱棘突，检查有无畸形、压痛逐个叩击脊椎棘突（或用间接叩击法）检查有无叩痛检查肾区压痛和叩击痛检查胸廓活动度和对称性嘱受检者稍前倾，双上肢交叉，双手分别置于对侧肩部叩诊后胸部双侧对称地叩诊后胸部叩诊肺下界移动范围嘱受检者轻微张口作深呼吸听诊后胸部双侧对称地听诊后

114、胸部听觉语音（耳语音）Expose the back correctlyPalpate spinous processes one by one (check for scoliosis andtenderness)Test for percussion pain of spinal column one by one (or byindirect method)Test CVA for kidney tenderness by pressure and indirect fistpercussionPalpate thoracic expansion and symmetryHave pat

115、ient cross arms in front and touch opposite shoulderPercuss posterior lung fieldsPercuss posterior lung fields comparatively and symmetricallyMeasure diaphragmatic excursionInstruct the patient to breathe a little deeply with mouth openslightlyAuscultate posterior lung fieldsAuscultate comparatively

116、 and symmetricallyVocal audible resonance5、乳房（女性）BREASTS (FEMALE)充分暴露双侧乳房坐位（或站立位）观察乳房前倾位观察乳房双臂高举过头观察乳房用手指掌面以适当压力触诊右乳房按内上、外上、尾部、内下、外下顺序触诊右乳房，至少4/5 部位触诊右乳晕及乳头，注意乳头溢液用手指掌面以适当压力触诊左乳房按内上、外上、尾部、内下、外下顺序触诊左乳房，至少4/5 部位触诊左乳晕及乳头，注意乳头溢液教检者作乳房自我检查检查受检者右腋窝触诊右腋窝 5 群淋巴结检查受检者左腋窝触诊左腋窝 5 群淋巴结Expose both breasts comple

117、telyInspect both breasts symmetrically in sitting position Inspect both breasts symmetrically with patient leaning forward Inspect both breasts symmetrically with arms raised above headInspect both breasts symmetrically with hands on hips andsqueezePalpate patients right breast with pads of fingers

118、of right hand,applying gentle pressurePalpate right breast in the 5 following areas;superinternal,superlateral, tail, inferinternal, inferlateral (at least 4 of 5parts of the breast should be palpated)Palpate nipples, areola, attempt to express discharge fromnipplePalpate patients left breast with p

119、ad of fingers and palm,applying gentle pressure. Palpateleftbreastinthefolloingareas:superinternal,superlateral, tail, inferinternal, inferlateral.Palpate nipples, areola, attempt to express discharge fromnipple.Teach patient breast self-examination.Axillary ExaminatonInspect the patients right axil

120、la.Palpate chains of lymph nodes on right:top , medial, anterior,posterior, lateralInspects patients left axillaPalpate chains of lymph nodes on left: tcp, medial, anterior,posterior, lateral.6、前胸和肺ANTERIOR CHEST AND LUNGS视、触胸部双侧对称地叩诊肺尖叩诊前胸和侧胸双侧对称地听诊肺尖听诊前、侧胸部Inspect and palpate configuration and sym

121、metry of chestPercuss supraclavicular fossae bilaterally and symmetricallyPercuss anterior and lateral lung fieldsAuscultate supraclavicular fossae bilatcrally and symmetricallyAuscultate anterior and lateral lung fields.7、心脏HEART嘱受检者仰卧，粗略估计颈静脉压观察心前区（取切线方向）用手掌、手指触诊心尖搏动用手掌触诊心前区叩诊心脏相对浊音界Screening test

122、 for elevated venous pressure.Observe precordium (view tangentially)Palpate apical area with palm and fingertipsPalpate precordial area with palmPercuss relative dullness of the heart（1）用膜型胸件听诊Auscultate with diaphragm肺动脉瓣区（胸骨左缘第 2 肋间隙）主动脉瓣区（胸骨右缘第 2 肋间隙）主动脉瓣第二听诊区（胸骨左缘第 3、4 肋间隙）二尖瓣区（心尖部）三尖瓣区（胸骨左缘第 4、

123、5 肋间隙或胸骨体下端稍偏右）Pulmonary area (second left ICS)Aortic area (second right ICS)Second aortic area (third and fourth left ICS)Mitral area (Apical area)Tricuspid area (fourth, fifth left ICS, LSB and RSB)（2）用钟型胸件听诊Auscultate with bell肺动脉瓣区主动脉瓣区主动脉瓣第二听诊区二尖瓣区三尖瓣区Pulmonary areaAortic areaSecond aortic area

124、Mitral area (Apical area)Tricuspid area8、腹部ABDOMEN正确暴露腹部头下置一小枕，嘱受检者屈膝、尽量放松腹肌、双上肢置于躯干两侧，平静呼吸视诊腹部听诊肠鸣音叩诊腹部叩诊肝浊音界触诊腹部时应注意受检者面部表情及退缩反应浅部触诊深部触诊单手法触诊肝脏双手法触诊肝脏在前正中线触诊肝脏双手法触诊脾脏右侧卧位触诊脾脏双手触诊法检查双侧肾脏检查腹部的触觉和痛觉Expose abdomen completely from just below breasts to justabove pubisPlace pillow under head, bend knees

125、, arms at side, have patientbreathe normally.Observe abdomen.Auscultate for bowel sounds, place stethoscope in area ofumbilicusPercuss abdomenPercuss liver spanWatch patients face and response as you palpate abdomenPalpate superficiallyPalpate deeplyPalpate liver at midclavicular with monomanual met

126、hod.Palpate liver at midclavicular line with bimanual methodPalpate liver at midsternal linePalpate spleen with bimanual methodPalpate spleen with patient rolled toward his right side.Palpate kidneys with bimanual methodTest for pain of light touch on abdominal wall9、下肢LOWER LIMBS充分暴露和视诊双下肢触诊双侧腹股沟浅表

127、淋巴结（横组）触摸双侧腹股沟浅表淋巴结（纵组）触诊双侧股动脉触诊双侧足背动脉检查双下肢水肿检查下肢触觉或痛觉（至少 2/3 部位）Expose and inspect lower limbsPalpate transverse group of superficial groin lymph nodesPalpate longitudinal group of superficial groin lymph nodesFemoral artery (groin)Dorsalis pedis artery (top of foot)Check for pitting edemaTest for

128、sense of pain or light touch in at least 2 or 3 positions（1）髋Hips屈髋内旋和外旋运动检查下肢近端肌力Check flexion of the hipCheck internal/external rotation of the hipCheck proximal muscle strength（2）膝Knee检查髌骨运动屈膝检查膝周肌力触诊膝关节检查膝反射Examine movement of patellaFlexion of kneeCheck for muscle strength around kneePalpate th

129、e knee jointTest knee jerk（3）踝Ankle触诊踝关节（包括跟腱）检查双下肢远端肌力背屈和跖屈内翻和外翻Palpate ankle joint including Achilles tendonCheck for distal muscle strengthCheck movement at tibial-talar joint (dorsiflexion-plantarflexion)Check movement at subtalar joint (eversion-inversion)（4）足Foot屈趾和伸趾检查双足位置觉检查跟腱反射检查跖反射罗姆伯格征（Ro

130、mberg 征即闭目难立征）检查步态观察Flexion of toes (curl toes) and extension of toes (straightentoes)Test position sense in both feetAnkle jerkPlantar reflexPerform Romberg testCheck gait (arms swinging at side)（5）腰椎运动Movement of lumbar spine俯屈仰伸侧弯旋转FlexionExtensionLateral bendingRotation第十二章第十二章实验室检查实验室检查LabLab1、

131、血液细胞学检查（examination of blood cell）全血细胞complete blood cell (CBC)血常规检查blood routine examination红（白）细胞计数red (white) blood cell (RBC/WBC) count 网织红细胞 （血小板， 嗜酸粒细胞） 计数reticulocyte (platelet,eosinocyte) count血红蛋白hemoglobin (HB)红细胞比积hematocrit (HCT)白细胞分类WBC differential count平均红细胞容积mean corpuscular count平均红

132、细胞血红蛋白含量mean corpuscular hemoglobin(MCH)平均红细胞血红蛋白浓度mean corpuscular hemoglobinconcentration (MCHC) 皱缩 （裂片， 棘形， 泪滴状， 球形， 椭圆形） 红细胞crenocyte(schistocyte,acanthocyte,cacryocyte,spherocyte,elliptocyte)靶形（镰刀形）红细胞target (sickle) cell中毒颗粒toxic granulation中性粒细胞核左（右）移neutrophil shift to the left (right)血沉eryt

133、hrocyte sedimentation rate (ESR)空泡（核）变性vacuolation (degeneration of nucleus)卡搏环Cabots ring染色质小体Howell-Jolly body嗜碱性粒细胞basophilic granulocyte单核（淋巴）细胞monocyte (lymphocyte)中性分叶（杆状）核粒细胞 neutrophilic segmented (stab)granulocyte2、骨髓细胞学检查examination of marrow cellmyeloblast原粒细胞promyelocyte早幼粒细胞myelocyte中幼粒

134、细胞metamyelocyte晚幼粒细胞band granulocyte杆状核粒细胞polymorphonuclears多形核粒细胞neutrophil granulocyte中性粒细胞basophil granulocyte嗜碱性粒细胞eosinophil granulocyte嗜酸性粒细胞pronormoblast原红细胞basophilic pronormoblast早幼红细胞polychromatophilic normoblast中幼红细胞orthochromatic normoblast晚幼红细胞lymphoblast原淋巴细胞prolymphocyte幼淋巴细胞lymphocyt

135、e淋巴细胞monoblast原单核细胞promonocyte幼单核细胞monocyte单核细胞plasmablast原浆细胞proplasmacyte幼浆细胞plasmacyte浆细胞megakaryoblast原巨核细胞promegakaryocyte幼巨核细胞granular megakaryocyte颗粒巨核细胞platelet-producing megakaryocyte产血小板巨核细胞iron staining of bone marrow smear骨髓铁染色peroxidase staining megakaryocyte产血小板巨核细胞iron staining of bon

136、e marrow smear骨髓铁染色peroxidase staining(POX)过氧化酶染色Sudan black staining(SB)苏丹黑染色alkaline phosphatase staining(ALP)碱性磷酸酶染色acid phosphatase staining(ACP)酸性磷酸酶染色nonspecific esterase(NSE)非特异性酯酶heated normal saline test热盐水溶解试验ink phagocytosis test墨汁吞噬试验lysozyme staining溶菌酶染色3、贫血的检查examination of anemiaseru

137、m iron assay血清铁测定total iron binding capacity assay总铁结合力测定serum ferritin assay血清铁蛋白测定serum transferrin assay血清转铁蛋白测定vitamin B12 assay维生素 B12测定folic acid assay叶酸测定osmotic fragility test of erythrocytes红细胞渗透脆性试验 biochemical assay of pyruvate kinase丙酮酸激酶的生化测定methemoglobin reduction test高铁血红蛋白还原试验brillia

138、nt cresyl blue reduction test煌焦油蓝还原试验reduced glutathione assay(GSH)还原型谷胱甘肽测定glutathione stability test谷胱甘肽稳定试验Heinz bodies staining变性珠蛋白小体染色heat instability test热不稳定试验isopropanol stability test异丙醇试验RBC sickling test红细胞镰变试验hemoglobin C test血红蛋白 C 试验Hb absorption spectrum determination血红蛋白吸收光谱测定hemogl

139、obin electrophoresis血红蛋白电泳anti human globulin test (Coombs test)抗人球蛋白试验cold agglutinin assay冷凝集素测定cold hemolytic test (Donath-Landsteiner test)冷溶血试验heat hemolysis test热溶血试验 measurement of free Hb levels in plasma血浆游离血红蛋白测定urinary hemosiderin determination (Rous test) 尿含铁血黄素检查4、出血和凝血的检查examination of

140、 hemostasis and coagulationplatelet count血小板计数bleeding time (BT)出血时间capillary fragility test毛细血管脆性试验 examination of capillary in nail fold with microscopy甲床毛细血管镜检查 assay ofmalondaldehyde fordeterminationofplateletlife-span丙二醛法测定血小板寿命platelet adhesiveness test(PAdT)血小板粘附性试验platelet aggregation test (

141、PagT)血小板聚集性试验platelet factor assay血小板因子测定 -thromboglobulin ( -TG)assay -血小板球蛋白测定thromboxane A2(TXA2)assay血小板血栓烷 A2测定clot retraction quantitative assay血块收缩定量测定coagulation time (CT)凝血时间factor coagulant activity 因子凝血活性测定prothrombin time(PT) 凝血酶原时间recalcification time (RT)复钙时间activated coagulation time(

142、ACT)活化的凝血时间kaolin partial thromboplastin time (KPTT)白陶土部分凝血活酶时间stypven time(ST)蛇毒时间测定fibrin peptide A (FPA)纤维蛋白肽fibrin plate test纤维蛋白平板溶解试验plasma plasminogen assay血浆纤溶酶原测定thrombin time (TT)凝血酶时间paracoagulation test副凝试验staphylococcal clumping test (SCT)萄葡球菌聚集试验 immunologicalassayoffibrin-fibrinogende

143、gradationproducts纤维蛋白（原）降解产物的免疫学测定D-dimer fragments assayD-二聚体测定2-macroglobulin (2-MG)assay2-巨球蛋白测定antithrombin (AT-)assay抗凝血酶测定5、肾功能检查nephric function examintionnon-protein nitrogen (NPN)assay非蛋白氮测定urea nitrogen assay尿素氮测定creatinine assay(Cr)肌酐测定endogenous creatinine clearance test内生肌酐清除试验phenolsul

144、fonphthalein excretion test (PSP)酚红排泄试验Masenthals test莫氏试验radionucleorenogram放射性核素肾图6、肝功能检查liver function examinationserum transaminase血清转氨酶glutamic pyruvic transaminase(GPT)谷丙转氨酶glutamic oxalo-acetic transaminase (GOT)谷草转氨酶serum alkaline phosphatase (S-AKP)血清碱性磷酸酶serum alkaline phosphatase isoenzyme血清碱性磷酸酶同功酶serum gamma glutamyltranspeptidase (S-r-GT)血清 r-谷氨酰转肽酶