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头颅 skull
头发 头皮
头颅外形和运动
颜面器官
眼 eye
耳 ear
鼻 nose
口腔 mouth
Skull
Contour: ellipse-shaped
Size (Normal):
Neonatal: 34cm
Adult: > 53cm
Large skull巨颅
(hydrocephalus脑积水):
sunset phenomenon
Microcephaly小颅:
囟门过早闭合
头颅外形——形状异常
Acrocephaly尖颅the
尖颅 coronal and
sagittal suture fuses
prematurely矢状缝与冠状缝过早
闭合
Squared skull方颅rickets
方颅 佝偻病,
佝偻病
congenital syphilis先天性梅毒
Delichochocephalia长颅Marfan综
合征acromegaly
合征
Deforming skull变形颅变形性骨炎
(Paget病)
Movement 头颅运动
Normal: free
Limited运动受限
diseases of cervical vertebrae 颈椎病变
Involuntary movement不随意颤动
Parkinson’s disease震颤麻痹
Nodding movement点头运动:
Aortic insufficiency动脉瓣关闭不全
Organs in the Head
Eyes
Ears
Color: white
耳廓 Pinna
外耳道
external auditory canal
鼓膜 Tympanic membrane
乳突 mastoid process
External Auditory Canal
Skin: Swelling, redness, and pain when
the auricle is pulled: inflammation
Exudate and discharge:
Yellow: inflammation
Purulent: tympanitis中耳炎
Blood or cerebrospinal fluid: basicranial
fracture 颅底骨折
Cerumen: ceruminal impaction耵聍阻塞
Ear drum:
External ear
Pinna: Hard white discrete
nodules 痛性小结:
gouty tophus痛风
Redness, swelling, hot, pain:
infection
Tympanic membrane
Change of color
Red or yellow
Perforation: Tympanitis
Mastoid Process
Middle Ear
Mastoid Process
Tenderness, skin redness,
swelling, fistula: mastoiditis
Hearing:
The nose
External examination
Internal examination
External examination
Shape Frog-shaped
Frog-shaped : polyps
Saddle
Saddle nose鞍鼻 :
destruction of basal nose:
bones 鼻梁塌陷
Color
Rhinophyma (Acne Rosacea):
Prominent hypertrophy of the
sebaceous glands of the nose
with over growth of the soft
tissue.
Lupus蝶形红斑: SLE皮肤狼疮
Nostril 鼻腔
Obstruction : Rhinitis, Nasal Polyps
Discharge( rhinorrhea) 分泌物增多:
Rhinitis鼻炎, sinusitis鼻窦炎
Epistaxis鼻出血
hematopoietic diseases.
Nasal septum鼻中隔: deviation, perforation
Movement
Frontal sinuses额窦
Ethmoid sinuses筛窦
Maxillary sinus上颌窦
Sphenoid sinuses
Tenderness &
percussion pain EthmoidMaxillary Maxillary
Sinusitis
sinusessinus sinus
The Oral Cavity and Pharynx
Teeth
Abnormal
Caries 龋齿
Residual root残根
Artificial teeth义齿
Malocclusion缺齿
Quadrant description
上
右 左
下
Gingivae/Gums
Swelling and pyorrhea水肿溢脓:
水肿溢脓
Chronic periodontitis慢性牙周炎
Haemorrhage出血:
出血
dental calculus牙石,
牙石 hemorrhagic diseases,
Vit C deficiency
Pigmentation游离点线状色素沉着:
游离点线状色素沉着
heavy metal intoxications
Grey-black蓝灰色:
蓝灰色 lead铅
Black-brown黑褐色: bismuth铋, mercury汞, arsenic
Tongue
Size舌体
Enlarged肿大
Inflammation,
Myxedema,
Tumor,
Acromegaly
Shrinked干小
Severe dehydration
Appearance of tongue舌象
Geographic Tongue地图舌:黄色斑片 提示核黄素缺乏
Smooth Tongue镜面舌:光滑红色 铁或维生素B12缺乏
Fissured Tongue草莓舌:舌乳头肿胀 长期发热
Black Hairy Tongue黑毛舌:黑黄褐色毛 真菌感染
Extensive Oral Thrush: Oral candidiasis
Tremor舌体震颤
hyperthyroidism
Deviation伸舌偏斜
hypoglossal nerve palsy
舌下神经麻痹
Pharynx
Pharynx:
Turkey red accompanied by swelling:
Acute pharyngitis Ⅱ Ⅰ
Wine accompanied by follicle:
Chronic pharyngitis
Tonsil
Degree of Tonsil Swelling
Ⅰ°不超过腭咽弓
Ⅱ°超过腭咽弓未达中线 Ⅲ
Ⅲ°达到超过咽后壁中线
Purulent
——化脓性扁桃体炎
口腔气味
烟味
酒味
口臭味———牙龈炎
烂苹果味——酮症酸中毒
尿味————尿毒症
肝臭味———肝坏死
大蒜味———有机磷中毒
Parotid Gland腮腺
Gland swelling腮腺肿大
以耳垂为中心肿胀
——炎症或肿瘤
用压舌板观察
Stensen’s duct颊粘膜导
管口
Discharge increase分泌
物增多
Inflamation
The Neck
颈部检查
cervical vein颈静脉
carotid artery beat
颈动脉搏动
Bronchi 气管
Thyroid甲状腺
Blood vessels颈部血管
Distended cervical vein颈静脉怒张
Right heart failure,
Pericardial effusion,
Loeffer’s endocarditis
Hypertension 高血压
Hyperthyroidism甲状腺功能亢进
severe anemia严重贫血
Systolic bruit血管杂音
Artery narrowing动脉狭窄
Carotid artery颈动脉
Vertebral artery椎动脉
Subclavian artery锁骨下动脉
Trachea
Palpation of the Trachea
Location: normally in the middle
Indicate the location of mediastinum
Clinical significance:
Deviation may caused by mediastinum and/or
thyroid shifting
移向健侧
——胸腔纵隔推移
大量胸腔积液
气胸
移向患侧
——肺胸膜牵拉
肺不张
Thyroid gland
Size, shape 大小 形状
Symmetry 对称性
Nodule 表面有否结节
Tenderness 硬度与压痛
Tremor 震颤
Movement 随吞咽移动
Murmurs 杂音
Method of examination
Inspection 视诊
Palpation 触诊
Palpation
of the thyroid gland
Thyroid gland swelling
Ⅰ Invisible but palpable
Ⅱ Visible and palpable
ⅢExceeding the out
margin of sterno-mastoid
muscle
Abnormality
Enlarged Thyroid gland
Markedly : simple goiter
W/ thrill, bruit:
hyperthyroidism
W/ fever, pain:
thyroiditis
Hard w/ nodule:
thyroid carcinoma
Movement of the Neck
Limited and accompanied with pain:
soft tissue inflammation
Head tilt: muscle spasm
Diminished muscle strength:
myasthenia gravis
Rigidity: meningeal stimulus sign
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胸廓检查
肺部检查
视触叩诊
A CASE REPORT
A lady, aged twenty, became affected with some symptoms
which were supposed to be hysterical…. After she had been
in this nervous state about three months it was observed
that her pulse had become singularly rapid…. She next
complained of weakness on exertion and began to look pale
and thin…. It was observed that the eyes assumed a
singular appearance, for the eyeballs were apparently
enlarged. In a few months… a tumour, of a horseshoe shape,
appeared on the front of the throat and exactly in the
situation of the thyroid gland.
ROBERT JAMES GRAVES
1796-1853