【正文】 esonant to percussion 2. The chest shows increased resonance to percussion over the left side 3. Dullness to percussion appears in left lung,第七十九頁，共九十三頁。,肺 lung （Auscultation）： 支氣管音： bronchophony 支氣管肺泡音： bronchovesicular sounds 空洞語音： caverniloquy 粗大羅音： coarse (medium, fine) rale 捻發(fā)音： crepitant rales 支氣管語音： egophony 吸氣末細(xì)濕羅音： fine endinspiratory rales 濕羅音： moist（bubbling）rales 胸膜摩擦音： pleural friction rub 咳嗽(k233。 s242。u)后： posttussive 鼾音： rhonchi； sonorous rales 粗糙呼吸音： rough breath sound,第八十頁，共九十三頁。,肺 lung （Auscultation）： 哮鳴音： wheezes。 wheezing 飛箭音： sibilant rales 管狀（支氣管）呼吸音： tubular (bronchial) breath sounds 肺泡呼吸音： vesicular breath sounds 整個(zhěngg232。)肺野： entire (or whole) lung field 右上肺： the right upper lung 中前胸部： the middle of the chest anteriorly 左肺上1/3處：the upper onethird of the left chest,第八十一頁，共九十三頁。,肺 lung （Auscultation）： 1. Diminished (exaggerated) breath sounds on auscultation appear in the right upper lung 2. There are tubular breath sounds over the left lower lung 3. There are large moist rales in the right between the 4th and 8th ribs anreriorly 4. Scattered high pitched rhonchi over both lung fields,第八十二頁，共九十三頁。,心臟 heart （Inspection）： 隆起： bulge；heave 彌散的： diffuse 肋間隙： ICS= intercostal space 鎖骨中線： MCL=mid calvicular line 最強(qiáng)搏動點： PMI= point of maximum impulse 心尖(xīnjiān)搏動： apical impulse；apex beat 震顫： (systolic) diatolic thrill,四、胸部(xiōnɡ b249。) Chest,第八十三頁，共九十三頁。,心臟(xīnz224。ng) heart （Palpation）： 1. The apex beat can be felt in the 5th interspace 1 cm inside the left mammilary line 2. Apex beat is forceful and enlarged 3. Apical impulse is difficult to feel 4. Apical impulse displaced significantly to the left and down 5. Systolic thrill is palpated at the second intercostal space of left sternal border,第八十四頁，共九十三頁。,心臟 heart （Percussion）： 心臟絕對(ju233。du236。)（相對）濁音界：Absolute (relative) cardiac (dullness) 1. The heart size is normal on percussion 2. Cardiac dullness to percussion is diminished 3. Percussion: enlarged on the left side, extending to the anterior axillary line 4. Left absolute cardiac duUness is located 1. 5 cm to the left of the mid clavicular line,第八十五頁，共九十三頁。,心臟 heart （Auscultation）： 心音： cardiac sounds 生理性分裂： physiologic splitting 二尖瓣第一(d236。yī)（二）音： M1 (M2) = mitral first (second) sound 主動脈瓣第一（二）音： A1(A2)=aortic first(second) sound 肺動脈瓣第一（二）音： P1 (P2)= pulmonary first (second) 雜音： Murmur 生理性（病理性）雜音： physiologic (pathological) munnur,第八十六頁，共九十三頁。,心臟 heart （Auscultation）： 收縮期前（早期、中期、晚期、期后）的： pre (early，mid, late，port) systolic 全收縮期的： holosystolic (pansystolic) 舒張期前（早期、中期、晚期、期后）的： pre(early、mid、late、post) diastoiic 連續(xù)性雜音： continuous murmur 消失(xiāoshī)的： absent；disappeared 增強(qiáng)的： accentuated；exaggerated 減弱的： diminished；decreased 遙遠(yuǎn)的： distant 響亮的： loud,第八十七頁，共九十三頁。,心臟 heart （Auscultation）： 吹風(fēng)(chuī fēng)樣： blowing；puffing 噴射性： ejection 粗糙的： harsh；rough 高音調(diào)的: highpitched 倒水聲： pouring 沙沙聲： rustling 隆隆聲： rumbling 搔抓聲： scratching 汽笛聲： whistling 微弱的： faint 柔和的： soft,第八十八頁，共九十三頁。,心臟 heart （Auscultation）： 心律不齊： arrhythmia 二重音： bigeminy 三重音： trigeminy 奔馬律： gallop rhythm 二尖瓣拍擊(pāi jī)音： mitral snap 開放拍擊音： opening snap 心包摩擦音： pericardial friction sound 早搏： premature beat 期外收縮： extrasystole,第八十九頁，共九十三頁。,心臟(xīnz224。ng) heart （Auscultation）： 1. Examination of the heart reveals no rubs,thrills,gallops or murmurs 2. Cardiac rhythm is regular at 60 per minute,S1 nonml, S2 physiologically split 3. On auscultation, the first heart sound is loud and snapping in quality at the apex 4. The second sound in the pulmonic area is greatly accentuated in comparison with the second aortic sound,第九十頁，共九十三頁。,心臟(xīnz224。ng) heart （Auscultation）： 1. Low pitched, rumbling, crescendo presystolic murmur is near the apex 2. At the apex, there is a highpitched systolic murmur of puffing character transmitting outwards to the axilla 3. The murmur is localized to an area about 2 cm in diameter just inside the apex, and it is best brought out in the left lateral decubitus position.,第九十一頁，共九十三頁。,心臟(xīnz224。ng) heart （Auscultation）： 1. There is a loud (grade IV) systolic murmur, being ejection in type, most prominent to the right of the sternum in the 2nd to the 3rd intercostal spaces and transmitting to the neck. 2. A grade IV systolic ejection murmur is in the left 2nd intercostal space and it extends up along the left sternal border. 3. A diastolic decrescendo murmur is heard at the tricuspid area, it has lowpitched rumbling quality.,第九十二頁，共九十三頁。,內(nèi)容(n232。ir243。ng)總結(jié),A. 一般項目 General Items。絕經(jīng)(ju233。 jīnɡ) menostasis。枕部的： occipital 頸部的： cervical 鎖骨上的： supraclavicular 腋窩的： axillary 腹股溝的： inguinal,第九十三頁，共九十三頁