examination of spine
颈动脉鞘区节细胞神经瘤1例报告并文献复习
临床神经外科杂志2021年第18卷第3期347 DOI：10.3969/j.issn.1672-7770.2021.03.023-病例报告-颈动脉鞘区节细胞神经瘤1例报告并文献复习费喜峰，沈李奎，陈寒春，蒋栋毅,王之敏!摘要】目的探讨颈部节细胞神经瘤的临床特征、治疗方式及其术后相关并发症。
方法回顾分析1例成人颈动脉鞘区节细胞神经瘤患者的临床资料，并对相关文献进行复习。
结果患者女性,23岁，无异常表现,体检时行颈椎MRI检查发现左侧颈动脉鞘区肿瘤。
在全身麻醉下，行经颈入路显微镜下肿瘤切除术，手术过程顺利;但患者术后出现霍纳综合征。
术后病理检查示颈部节细胞神经瘤。
结合相关文献复习，节细胞神经瘤为少见病例，发生于颈部及成人者罕见，多见于儿童，绝大部分为良性肿瘤；由于其生长缓慢，常无临床症状。
结论成人颈部节细胞神经瘤罕见，常无临床症状，肿瘤长大可出现相应的症状，同时其为良性病变，应行手术治疗，但术后易出现霍纳综合征)!关键词】颈动脉鞘区；节细胞神经瘤；霍纳综合征!中图分类号】R739.41【文献标志码】B【文章编号】1672-7770(2021)03-0347-03Ganglioneuromas of cervical region near carotid sheath(report of one case and review of literature)FEI Xi-feng，SHEN Li-ku-，CHEN Han-chun，et al.Department of Neurosurgery，Kowloon Hospital，Shanghai JiaotongUniversity School of Medicine，Suzhou215000，ChinaCorresponding autOor:WANG Zhi-cucAbstract:Objective To investigate the clinical features，treatment and postoperative complications of cervical ganglioneuroma.Methode The clinical date of a case of neurooia io the sheath of Oe carotid artery were analyzed retrospectively and Oe related literature was reviewed.Results A23-year-old female presented Wth no abnormalfindings.MRI examination of cervical spine revealed leee carotiV sheate tumor.Under general anesthesia，transcervicalmicrosureeiy was performed s uccessfiy；But the patient developed Horners syndrome after operaion.Postoperalvepamologicri examination showed ganglioneuroma in bined with the review of related literature，gangyoneuyImlwas a are case，which occurred in the neck and adults rarely，mosyy in children，most of them were benign tumors.Because of its slow growth，it often had no clinicai symptoms.Conclusions Adult cervical ganglioneuroma is are，oftenwiteout clinicai symptoms.When the tumoo grows up，corresponding symptoms may appear.At the same time，it is abencgn iescon，whcch shouid be eeaed bzsuegeez，bu;Hoeneessszndeomecseasz oappeaeateesuegeez.Key words:carotiO sheath area；ganglioneuromas；Horner syndrome颈动脉鞘区的肿瘤按解剖部位可归属于咽旁间隙肿瘤，此部位肿瘤少见，不到头颈部肿瘤的0.8%，大多数为良性肿瘤，且多为神经源性和涎源性肿瘤^3-。
脊柱与四肢PPT课件
2.第3胸椎棘突 与肩胛冈内侧端平齐。 3.第7胸椎棘突 与肩胛骨下角平齐。图片 4.第4腰椎棘突(或棘间) 与髂嵴最高点平齐。 5.第5腰椎棘突 与髂结节平齐。为菱形窝的上点。 肥胖者为一凹窝，为下背部正中沟的终点。图片
6.第2骶椎棘突 与髂后上棘平齐。为蛛网膜下腔的
终点。
7.尾骨尖 在肛门的后上方，正常有一凹窝。
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第一节 脊柱检查18
脊柱活动度
(一)颈部活动度的检查 1.检查方法 病人取坐位或站立位，头居正中，两眼平视
前方。依次下列动作的检查(图、动画）： (1)屈曲 (2)伸展 (3)侧屈 (4)旋转
2.临床意义 脊柱颈椎段活动受限常见于： (1)颈部肌肉肌纤维炎及颈肌韧带劳损； (2)颈椎增生性关节炎； (3)结核或肿瘤浸润使颈椎骨质破坏； (4)颈椎外伤、骨折或关节脱位。
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第一节 脊柱检查5
第七颈椎棘突
the 7th acanthi of ceቤተ መጻሕፍቲ ባይዱvical
vertebr--ae
第一节 脊柱检查6
返回
第3胸椎棘突：与肩胛冈内端平齐。 第7胸椎棘突：与肩胛骨下角最高点平齐。
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第一节 脊柱检查7
返回
第4腰椎棘突或棘间：与髂嵴最高点平齐。 第5腰椎棘突：与髂结节平齐，为下背部正中沟的下端终点，为 菱形窝的上点。
意大利整骨Cervical spine中英文
assessment
segment C1-C2
Through movements
Rotation flex.
通过旋转屈曲的活
动来测试寰枢关节
段
29
Examination intrinsic muscles (patient sitting)
评估内在肌（患者坐位）
• Flex: SCOM sternocleidomastoid together • 屈曲：胸锁乳突肌 • Extension: deep spine muscles and trapezius • 伸展：脊柱深层肌和斜方肌 • Rotation: sternocleidomastoid • 旋转：胸锁乳突肌 • Lateral bending: scalene muscles ant., Middle and post. • 侧屈：斜角肌前束，中束和后束
23
Palpation of soft parts柔软部位的触诊
patient sitting 患者坐位
patient supine 患者仰卧
24
舌骨 第1环状软骨
甲状软骨
Contact anatomy points
骨性标志点
25
C1: Lateral masses in front of the mastoid process: between the jaw branch and the mastoid we find the lateral mass of the atlas. 颈1：侧块位于乳突的前方。在下颌支与乳突的中间我们可以找到寰椎的两个 侧块
• 旋转：寰枢50%（测试时整骨师位于患者身后，双手置于其肩
• Lateral bending (45°): all cervical vertebrae (Passive test to reach the end-feel) • 侧屈（ 45°）：所有颈椎（被动测试至每一块的末端感觉）
急诊临床思维
三、急诊临床思维要点
4、特别强调对症支持治疗的重要性 因为器官功能障碍或衰竭可迅速致死， 注意快速、紧急处理三种可迅速 致死而又可逆转的严重状况：
通气障碍 循环障碍
未制止的大出血
三、急诊临床思维要点
通气障碍：呼吸道梗阻 呼吸中枢衰竭 呼吸肌疾病 例：昏迷病人呕吐物窒息 肌松药中毒病人 肺部手术病人 颅脑损伤、脑血管意外病人 循环障碍：及时抗休克治疗 未制止的大出血：及时应用各种方法止血
现场止血术常用的有5种：
1、指压动脉止血法
适用于头部和四肢某些部位 的大出血。方法为用手指压 迫伤口近心端动脉，将动脉 压向深部的骨头 （1）头面部指压动脉止血法
A、指压颞浅动脉：适用于一
侧头顶、额部、颞部大出血
B、指压面动脉：
适用于颜 面部大出血
C、指压耳后动脉：
适用于一侧 耳后大出血
D、指压枕动脉：
适用于双眼外伤
（4）头部三角巾十字包扎：
三、急诊临床思维要点
6、扩散性思维
病人的症状可能由不同原因导致，应首先考 虑可致生命危险或严重后果的疾病，再考虑普 通疾病，即安全性原则和首先考虑常见病原则 的思维方法。如胸痛、腹痛病人，若状况欠佳， 应先排除心脏病、宫外孕、急性胰腺炎等严重 疾病，若病人不愿做相关检查，应与其说明病 情严重性，并让其在病历上签字，以保护自己， 避免医疗纠纷。
多发性创伤分阶段治疗顺序
3.第三阶段： 插入带套囊的导尿管、胃管。 问病史（现在史、过去史）。 全身体格检查。 最主要的神经系统检查。 4.第四阶段:辅助性检查(X线、CT、MRI、 B超、简单的诊断性操作)，决定抢救次 序和时间。
多发性创伤分阶段治疗顺序
5.第五阶段:主要损伤的特殊治疗和监护顺序 : 胸部及心脏大血管损伤：胸腔引流管、心包穿 刺、开胸等。 腹部：剖腹术。 颅脑损伤或颅内血肿：紧急情况下与前两个步 骤同时或先后进行。 四肢、颜面和骨盆：骨折的整复、固定、牵引， 可采用石膏固定、手术整复和扩创等。
风湿免疫科入门及关节查体
– 肾上腺轴异常表现
信阳市中心医院风湿免疫科
1.c 风湿病问诊要点－其他病史
既往感染史：结核、乙肝/丙肝、机会性感染 用药史：毒品、PTU、etc. 月经史：经量多、不规律、闭经 婚育史：习惯性流产 家族史：SpA、其它CTD、肾病史、遗传病史
信阳市中心医院风湿免疫科2源自关节查体Examination of Joints
肌力
整体功能
Integrated function
信阳市中心医院风湿免疫科
2. 关节查体
Examination of Joints
视诊 触诊
Inspection Palpation
动诊 Passive and active range of motion 各骨性标志有无异常，检查脊柱有无侧弯可用棘突滑动触诊法
压痛：部位深度、范围、程度和性质 有无异常活动及骨擦感
Muscle strength 局部温度和湿度，双侧对比
包块：部位、硬度、大小、活动度、与临近组织的关系以及有无波动感
肌力
整体功能 Integrated function 有无畸形，如肢体长短、粗细或成角畸形
肌肉有无痉挛或萎缩
– 胸膜性或心包性胸痛
– 浮肿、运动耐量下降 – 肺栓塞、肺高压 肾脏： – 蛋白尿、血尿 – 结石、夜尿增多、软瘫
– 少尿
信阳市中心医院风湿免疫科
1.b 风湿病问诊要点－关节外症状
胃肠道： – 反流、吞咽困难
– 腹痛、腹泻、便血
– 肝功能异常、黄疸 血液： – 血细胞计数：WBC↓、Hb↓、PLT↓
– 出凝血异常：流产、不明原因的DVT或PE
– 异常骨痛 – 血清学：自身抗体
信阳市中心医院风湿免疫科
反省的英语名言
反省的英语名言1、知错就改，永远是不嫌迟的。
Mistakes and just change，forever is not too late。
2、最伟大的胜利，就是战胜自己。
The greatest victory is to conquer yourself。
3、当面怕你的人，背后一定恨你。
He was afraid of you，but must hate you。
4、每个人都知道鞋子挤脚的地方。
Everyone knows that shoe pinches。
5、只有在人群中间，才能认识自己。
Only in the middle of the crowd，to know yourself。
6、反躬自省是通向美德和上帝的途径。
Self-reflection is the way to virtue，and to god。
7、自己的鞋子，自己知道紧在哪里。
Where is his shoes，you know。
8、不会评价自己，就不会评价别人。
Not evaluate yourself and will not judge others。
9、自知之明是最难得的知识。
Self-knowledge is the most rare。
10、最灵繁的人也看不见自己的背脊。
Most people can't see their own spirit of spine。
11、人生是不公平的，习惯去接受它吧。
Life is not fair，get used to it。
12、最困难的事情就是认识自己。
The most difficult thing is to know yourself。
13、给自己唱赞歌的人，听众只有一个。
Sing their praises of the people，the audience is only one。
14、只一自反，天下没有不可了之事。
Only a reflexive，there is no such thing as a thing。
风湿免疫相关关节查体
1.b 风湿病问诊要点－关节外症状
神经肌肉： – PNS：单神经/多发单神经/周围神经病 – CNS：精神病、认知障碍、头痛、视力、 – TIA/卒中、抽搐 – 肌肉：肌痛/压痛、肌无力、呛咳 内分泌： – 甲亢/甲减 – 垂体 – 肾上腺轴异常表现
1.c 风湿病问诊要点－其他病史
既往感染史：结核、乙肝/丙肝、机会性感染 用药史：毒品、PTU、etc. 月经史：经量多、不规律、闭经 婚育史：习惯性流产 家族史：SpA、其它CTD、肾病史、遗传病史
2. 关节查体 Examination of Joints - 下颌关节 Temporomandibular Joint
张口放入三指：涉及 颞下颌关节及下巴 的侧向左右活动。
病理意义：
1、颞下颌关节紊乱； 2、颞下颌关节脱位； 3、颞下颌关节炎症病变（滑膜及关节囊 出现炎症）
2. 关节查体 Examination of Joints - 肩关节 Shoulder
浮髌试验
膝关节活动度（屈曲和伸展） 并且观察有无关节摩擦音
病理意义：
1、内源性疾病：劳损、外伤、 退行性病变；感染性关节炎；风湿病； 肿瘤；
2、外源性疾病：神经源性。
2. 关节查体 Examination of Joints - 足 Foot
背屈 背伸
跟外旋
跟内旋
涉及膝关节前伸、前 屈、外展、内旋外旋 及旋转活动度
2
关节查体
Examination of Joints
2. 关节查体 Examination of Joints
视诊 Inspection 触诊 Palpation 动诊 Passive and active range of motion 肌力 Muscle strength 整体功能 Integrated function
中国非特异性腰背痛临床诊疗指南
中国非特异性腰背痛临床诊疗指南一、本文概述Overview of this article《中国非特异性腰背痛临床诊疗指南》旨在为广大医疗工作者提供一套科学、规范、实用的非特异性腰背痛诊疗流程和方法。
非特异性腰背痛是一种常见的临床症状，其疼痛原因复杂多样，涉及生物力学、神经生理、心理社会等多方面因素。
因此，制定一份全面、系统的临床诊疗指南对于提高诊疗效率、改善患者预后具有重要意义。
The Chinese Clinical Diagnosis and Treatment Guidelines for Non specific Low Back Pain aim to provide a scientific, standardized, and practical process and method for the diagnosis and treatment of non-specific low back pain for medical workers. Non specific low back pain is a common clinical symptom, and its causes are complex and diverse, involving various factors such as biomechanics, neurophysiology, and psychosocial factors. Therefore, developing a comprehensive and systematic clinical diagnosis and treatment guideline is of great significance for improving diagnosis and treatmentefficiency and improving patient prognosis.本指南结合国内外最新研究成果和临床实践经验，对非特异性腰背痛的定义、流行病学、发病机制、临床表现、诊断方法、治疗策略及预防措施等方面进行了详细阐述。
坐骨神经痛 英语
坐骨神经痛（Sciatica）是一种源于坐骨神经的疾病，通常表现为疼痛、麻木或刺痛感，从腰部沿大腿后侧一直延伸到脚踝或脚部。
坐骨神经是人体最长的神经之一，从脊椎穿过臀部，沿着大腿后侧一直延伸到脚。
坐骨神经痛可能是由于椎间盘突出、脊柱狭窄、腰椎管狭窄等情况引起的神经受压，导致疼痛和其他症状。
下面是关于坐骨神经痛的英文介绍。
**Sciatica Overview:**Sciatica is a condition characterized by pain, numbness, or a tingling sensation that originates from the sciatic nerve. The sciatic nerve, one of the longest nerves in the human body, runs from the spine through the buttocks and down the back of the thigh, extending to the ankle or foot. Sciatica typically occurs when the sciatic nerve is compressed or irritated, leading to symptoms that can range from mild discomfort to severe pain.**Causes of Sciatica:**1. **Herniated Disc:** A herniated or slipped disc is one of the most common causes of sciatica. When the soft inner material of a spinal disc leaks out and presses on the adjacent sciatic nerve, it can result in pain and discomfort.2. **Spinal Stenosis:** Spinal stenosis refers to the narrowing of the spinal canal, which can put pressure on the sciatic nerve. This narrowing may be a result of aging, degenerative changes, or other spinal conditions.3. **Piriformis Syndrome:** The piriformis muscle, located in the buttocks, can irritate or compress the sciatic nerve. This is known as piriformis syndrome and can lead to sciatic nerve pain.4. **Spondylolisthesis:** This condition occurs when a vertebra slips forward over the vertebra beneath it, potentially pinching the sciatic nerve.5. **Trauma or Injury:** Injuries to the spine or buttocks, such as fractures or muscle strains, may cause sciatic nerve pain.**Symptoms:**The hallmark symptom of sciatica is pain that radiates along the path of the sciatic nerve. This pain may be sharp, shooting, or even like an electric shock. Other common symptoms include:- Numbness or weakness in the affected leg or foot.- Tingling sensations in the toes or foot.- Difficulty in moving the leg or foot.- Intensified pain while sitting or standing for prolonged periods.**Diagnosis:**If a person experiences symptoms suggestive of sciatica, a healthcare professional will conduct a thorough medical history and physical examination. Imaging tests such as X-rays, MRI (Magnetic Resonance Imaging), or CT (Computed Tomography) scans may be ordered to identify the underlying cause of sciatic nerve compression.**Treatment Options:**1. **Conservative Measures:**- **Rest:** Adequate rest and avoiding activities that exacerbate symptoms.- **Physical Therapy:** Exercises to strengthen the back and improve flexibility.- **Cold or Heat Therapy:** Applying ice or heat to the affected area for pain relief.2. **Medications:**-**Pain Relievers:** Over-the-counter pain medications like ibuprofen or prescription medications for more severe pain.- **Muscle Relaxants:** Medications to alleviate muscle spasms.- **Corticosteroids:** Oral or injected steroids to reduce inflammation.3. **Interventional Treatments:**- **Epidural Steroid Injections:** Injecting corticosteroids directly into the affected area to reduce inflammation and pain.- **Nerve Block:** Blocking pain signals from specific nerves.4. **Surgery:**-In severe cases where conservative measures fail, surgical options like discectomy or laminectomy may be considered to alleviate pressure on the sciatic nerve.**Prevention:**While it may not always be possible to prevent sciatica, certain lifestyle modifications can reduce the risk of developing or aggravating the condition:- **Maintaining Good Posture:** Practicing proper posture while sitting and standing.- **Regular Exercise:** Engaging in activities that strengthen the back and abdominal muscles.- **Lifting Techniques:** Using proper lifting techniques to avoid straining the back.- **Weight Management:** Maintaining a healthy weight to reduce stress on the spine.**Conclusion:**Sciatica can significantly impact an individual's quality of life, causing pain and discomfort that affect daily activities. Understanding the causes, symptoms, and available treatment options is crucial for effectively managing this condition. While many cases of sciatica resolve with conservative measures, consultation with a healthcare professional is essential for an accuratediagnosis and appropriate management plan tailored to each individual's needs. In severe cases, surgical intervention may be considered to address the underlying structural issues contributing to sciatic nerve compression.。
英文脊柱检查
Chapter 3 Examination of the SpineCervical SpineThoracic and Lumbar SpineCervical Spine Examination Look1.General inspectionI n s p e c t t h e n e c k f o r a n y o b v i o u s s w e l l i n g o r d e f o r m-ity from the front, back and sides. The patient maya l s ob e i n o b v i o u s p a i n.2.SkinLook for any evidence of scars, sinuses or colour c h a n g e.There may be congenital webbing of the neck.3.S o f t t i s s u eO b s e r v e t h e m u s c l e s f o r s p a s m o r s h o r t e n i n g.S h o r t-e n i n g o f t h e s t e r n o m a s t o i d m a y b e d u e t o s p a s m,t r a u-m a o r a c o n g e n i t a l c a u s e.T h e l a t t e r m a y r e s u l t i n a t o r t i c o l l i s,i n w h i c h t h e p a t i e n t h o l d s t h e n e c k r o t a t e d t o t h e s i d e o p p o s i t e t h e l e s i o n.A n e n l a r g e d t h y r o i d g l a n d o r c e r v i c a l l y m p h n o d e s may be visible. An abscess may point in part of the n e c k.4.Bone and jointAbnormal posture of the neck may be due to fracture o f a v e r t e b r a,b e t h e r e s u l t o f t r a u m a,o s t e o m y e l i t i s o r a secondary tumour. The neck may also be held in an abnormal posture because of disc prolapse or rheu-m a t o i d a r t h r i t i s.Cervical Spine Examination Congenital webbing of theneckTorticollis or ‘wryneck’ — may besecondary to prolapsed discFeelThe neck should be felt for tenderness and swellings. The front of the neck should be felt for the thyroid, the anterior and pos-terior cervical triangles for lymph nodes, and the back of the neck for tender areas and swellings.Localised areas of tenderness at the base of the neck may be present in cervical spondy-losis. There may also be ‘radiation’ of pain down one or both arms to the fingers.Classically in cervical spondylosis, three tender areas, representing the ‘Huckstep tender triad’, should be felt for. These are:1. At the base of the neck anterior tothe trapezius2. Over the insertion of the deltoid3. In the extensor mass of the forearm (not the origin of the extensors which usually suggests tennis elbow).The consistency of any swelling felt should then be noted. If it is fluctuant then it may be an abscess, if firm, lymph nodes, or if of bony consistency, it is possibly a cervical rib.Cervical Spine Examination ‘Huckstep tender triad’ for cervical spondylosis Base of neckD e l t o i d i n s e r ti o nExtensor musclesTenderness in base ofneck — cervicalspondylosisProminence ofc e r v i c a lr i bMoveThe neck movements to be examined are:1. Rotation2. Flexion and extension3. Lateral flexionRotationRotation should be equal, and about 70°–90°to each side as illustrated. The neck should be straight without either flexion or extension and the patient asked to look as far as possible to one side and then the other. This should be followed by passive rotation to each side.Flexion and extensionFull forward flexion is present when the chin touches the chest. Full extension of at least 30° beyond the horizontal should be possible, and is usually greater in young people.Lateral flexionLateral flexion should be at least 40° to each side. Again starting from the neutral position the head is tilted first to one side and then the other.5°L a t e r a l f l e x io nFlexion and extension40°80°RotationCervical Spine Examination 35°20°30°Cervical Spine Conditions Congenital abnormalitiesCongenital abnormalities of the cervical spine are not common and are usually associated with abnormalities of the cervical vertebrae. These may be fused or deficient. A spina bifida is a deficiency of the laminae and pedicles to a varying degree. An accessory rib may be attached to the 7th cervical ver-tebra and this may be a rudimentary fibrous band, or even a complete rib.Soft tissue abnormalities include a Sprengel's shoulder, with one or both scapulae higher than normal. Both this and congenital webbing of the neck may be asso-ciated with cervical vertebral abnormali-ties or other congenital abnormalities such as cardiac defects.NeoplasiaMost neoplasms of the cervical spine are due to secondary deposits from the breast, thyroid, lung, kidney, prostate or cervix. These may produce vertebral collapse and cord or root compression, with partial or complete paralysis. Radiological examination may show involvement of the vertebral bodies; lami-nae and pedicles may be involved but the disc spaces are usually spared. Neurofibro-mata of the spinal roots may also cause nerve or spinal cord compression. This is in contradistinction to an infection or disc degeneration where the intervertebral discs are initially much more involved than the vertebral bodies.Cervical SpineConditionsTraumaCongenital webbingof the neck X-ray appearance of a secondary depositCongenitalabnormalities Neoplasia X-ray appearance of af r a c t u r e d i s l o c a t i o nTraumaThere may be severe root or spinal cord com-pression following dislocation or fracture dislocation of the cervical vertebrae, in-cluding the odontoid process of C2. InfectionInfection of the cervical spine usually involves the disc spaces, and may later spread to the vertebral bodies (compare with secondary tumours). The onset is usually acute, and in most cases due to a blood borne staphylococcal infection. Infection by other organisms, including the tubercle ba-cillus, may also occur but with a more grad-ual onset and sometimes also with retropha-ryngeal abscess formation. Spasm of the cervical muscles commonly results in marked limitation of neck movements, and cord com-pression may also occur.ArthritisOsteoarthritis and cervicalspondylosisDegeneration of the disc spaces, particu-larly C4/5 and C5/6, is common, and is often associated with narrowing of the intervertebral foramen and osteophyte for-mation. This, in turn, may cause root pres-sure on the C5 and 6 roots on one or both sides. Neck movements are limited, particu-larly rotation to the side affected, lateral flexion to the opposite side and neck extension. The ‘Huckstep tender triad’(tenderness at: base of the neck, insertion of the deltoid muscle and over the extensor muscles of the forearm) is often seen. In the early stages of cervical spondylosis X-rays may appear normal.Miscellaneous conditionsRheumatoid arthritis:limited rotation with muscle spasm Cervical Spine Conditions X-ray appearance oftuberculosis with a‘cold’ abscess X-ray appearance of cervical spondylosisA r t h r i t i s I n f e c t i onRheumatoid arthritis and other conditionsRheumatoid arthritis can cause considerable pain and stiffness of the cervical spine. It may lead to subluxation and dislocation of the vertebrae due to softening of the liga-ments. Nerve root and spinal cord compres-sion may also occur. Other conditions of the neck include spasmodic torticollis, and a sternomastoid ‘tumour’.Thoracic and Lumbar Spine ExaminationLook1.General inspectionNote any obvious abnormality, looking at the back, sides and front of the patient.2.SkinLook for scars, sinuses or colour change. Note the presence of a hair tuft, discolouration or dimpling at the base of the spine indicating a spina bifida.3.Soft tissueLook for any swellings which may be due to infection, trauma, or tumours. Remember that an abscess in the vertebral column may point posteriorly or, if affecting the lower thoracic or lumbar vertebrae, may track down the psoas sheath and present in the groin.Look for spasm of the erector spinae muscles on either side of the spine. This is sometimes a cause of abnormal spinal curvature rather than the presence of a defect in the verte-bral column itself. Scoliosis may be due to muscle spasm, paralysis or to a congenital or idiopathic scoliosis.KyphosisIdiopathickyphoscoliosisThoracic and Lumbar SpineExamination Kyphoscoliosis4.Bone and JointLook from the posterior and lateral aspects of the patient for any increase or decrease in spinal curature i.e. scoliosis or kyphosis. Kyphos and kyphosisA kyphos is a sharp posterior convexity of the spinal column sometimes associated with a fracture. It may also follow collapse of vertebrae due to secondary deposits or in-fection. In the case of a chronic infection such as tuberculosis several vertebrae may be involved with shortening of the spine and possible neurological compression involving the nerve roots, spinal cord or corda equi-na. It is critical to carry out a neurolog-ical assessment of the lower limbs, includ-ing the bladder, in all these patients.A kyphosis is a gradual curve which may be due to paralysis, senile osteoporotic collapse of several vertebrae or Scheuermann’s disease. LordosisA lordosis is a posterior concavity of the spinal column, often in the lumbar region. It may be associated with low back pain, paralysis or spondylolisthesis. In pregnan-cy a compensatory lordosis may be necessary to maintain balance. This, combined with the lax spinal ligaments in later pregnancy, may potentiate low back strain sometimes associated with sciatica.Thoracic and Lumbar SpineThoracic kyphosExcessive lumbarl o r d o s i sFeelAfter inspection, the spine should be palpated gently. It is important to feel the spine for tender areas, both in the midline and laterally.The vertebral spinous processes and interspinal ligaments should be carefully palpated for tenderness and gaps and also percussed gently. The muscles on each side of the spine should also be palpated for spasm. This may be worse on one side than on the other.Any swelling of the spine should be pal-pated. Bony or soft tissue swelling or an abscess may be present. Warmth and tenderness should be noted as well as deformity.If the patient has severe pain or muscle spasm no attempt should be made to sit the patient up. Instead the patient should be rolled over to one or other side to carry out the examination.The patient is rolled into a supine position for a full neurological assessment.A rectal examination should be carried out in all patients with low back pain and sci-atica, where this is indicated; otherwise pelvic causes of low back pain may be missed. These include carcinoma of the rectum, blad-der, prostate and uterus.Feel for muscle spasmPercuss gently for tendernessPalpate Thoracic and Lumbar SpineExaminationMoveThe three main movements of the thoracic and lumbar spine are:1. Rotation2. Lateral flexion3. Flexion and extensionRotationRotation of the spine occurs mainly in the thoracic region. It may be limited or painful if there is an injury, infection, tumour or degenerative changes. The latter may include Scheuermann’s disease in a young patient or osteoarthritis in an older patient.Any pain on rotation should be noted. The exact spot where the pain is felt should be noted as well as any limitation of rotation to one side or the other.Lateral FlexionLateral flexion of the spine occurs mainly in the lumbar region. The patient should be asked to bend first to one side and then to the other.The arms must be kept close to the body and the patient should attempt to touch the lateral side of the knee with the outstretched fingers first on one side and then on the other. Bending should be lateral, not forward. Any difference in the degree of lateral flex-ion can then be noted with a fair degree of accuracy.Lateral flexion is particularly limited in conditions such as low back strain and a prolapsed disc in the lumbar or lumbo-sacral region. In such cases, lateral flexion is often more limited to one side than the oth-er.In conditions such as ankylosing spondylitis, infections and fractures, however, all movements may be restricted.Thoracic and Lumbar SpineExaminationL i m i t e d l a t e r a l f l e x i o n t o l e f tLimited rotation to rightLateral flexion — lumbar spineRotation — thoracic spineFlexion and extensionFlexion and extension occur both in the lumbar region and the hips, but more so in the hips.Forward flexion and backward extension are both limited in prolapse of an intervertebral disc, in severe degenerative arthritis of the spine, and in numerous other conditions. These include fractures, ‘lumbago’, severe bruising, ankylosing spondylitis and sec-ondary tumours.Movement is assessed by asking the patient to stand with the knees and the feet together. The patient should gently bend first for-wards, and then backwards.In some patients limitation of forward flexion is due to tight hamstrings rather than to any intrinsic condition of the spine. In such cases the spine will be seen to flex more than normal while the actual ability to touch the toes is limited. In these patients extension is usually full.Another method of assessing the degree of forward flexion is to mark two points in the upper and lower parts of the thoracic and lumbar spine respectively. The distance between the points is measured as the patient bends both backwards and forwards. This method is not usually used for ordinary assessment of spinal flexion and extension. It may, however, be useful if periodic assessment of the degree of movement is required (eg. in a progressive condition such as ankylosing spondylitis).Thoracic and Lumbar SpineExaminationLimited F u llExtension — lumbar spine and hipsFlexion — lumbar spine and hipsF u l lThoracic and Lumbar Spine ConditionsCongenital abnormalitiesCongenital conditions of the thoracic and lumbar spine are uncommon. They include Sprengel shoulder, where one shoulder is higher than the other, and spina bifida in the lumbar region with or without associated meningomyelocele. Spondylolisthesis may be congenital or acquired. In this condition one vertebra is displaced, usually forward, on another usually in the lower lumbar re-gion.Scoliosis may be due to various conditions. It may be due to incomplete development of one or more vertebrae. The latter may also produce a kyphos.NeoplasiaPrimary spinal neoplasms are rare. Secon-dary deposits, on the other hand, are common and may cause collapse of one or more vertebrae.They are most commonly due to secondary spread from breast, bronchus, thy-roid, kidney, prostate or cervix, but almost any primary neoplasms can metastasise to the spine. Conditions such as multiple myeloma, lymphoma and the leukemias may also cause spinal collapse.In an elderly patient with back pain, the possibility of a secondary deposit from aX-ray appearance of posterior discprolapse at L4/5TraumaThoracic and Lumbar SpineConditionsSpina bifida withmeningomyelocele X-ray appearance of spinal metastasisproducing a kyphosCongenitalabnormalities Neoplasiaprimary carcinoma, particularly of the breast and lung, must always be considered. TraumaInjuries of the spine associated with fractures usually result in a kyphos or sharp curve. In elderly people with osteoporotic spines, several vertebrae may be crushed at one time, particularly in the thoracic re-gion, often resulting in a smooth kyphosis. InfectionInfections of the spine are uncommon. They include blood borne infections which are often seen in patients who are in poor health such as drug addicts. Infections of the disc spaces may follow lumbar puncture or occasionally a spinal operation.Chronic infections of the spine include brucellosis and tuberculosis. A disc and two adjoining vertebrae are initially involved. In time several vertebrae may be affected, with or without evidence of an abscess. An abscess may point posteriorly or in the lum-bar region. It may also track down the psoas sheath and present in the groin.ParalysisParalysis of the spine sometimes leads to a scoliosis and, if it is severe, to a kypho-scoliosis with prominence of the ribs on one side due to rotation of the vertebrae.In the past the most common paralytic disorder causing scoliosis was poliomyelitis.Kyphoscoliosis demonstrated on forwardflexion I d i o p a t h i c c o n d i t i o n s Tuberculous kyphos with ‘cold’abscessI n f e c t i o n Thoracic and Lumbar SpineConditionsThis could lead to a scoliosis by producing asymmetrical spinal muscle paralysis. In a child this could be corrected by lifting the shoulders and upper body. In older patients it is more difficult to correct completely due to fibrosis of the muscles and fascia.Other paralytic conditions include a scoliosis associated with injury to the spinal cord, or associated with cerebral conditions including brain tumours, cerebral palsy, stroke and head injuries.Idiopathic conditionsThis is a scoliosis of unknown aetiology which usually arises in childhood. It is maintained and is exacerbated on forward flexion, unlike a scoliosis due to a short leg which usually disappears on forward flex-ion.Degenerative conditionsDegeneration of the intervertebral discs, particularly in the older patient and par-ticularly in the lumbar spine is common. The L4/L5 and L5/S1 disc spaces are most likely to be narrowed by degeneration of the disc. The disc may protrude laterally or even pos-teriorly with pressure on the L5 and S1 nerve roots respectively. Other nerve roots less commonly compressed and occasionally also the cauda equina.Patients may or may not have neurological signs associated with this. Signs of disc prolapse include limitation of straight legDegenerative conditionsThoracic and Lumbar SpineConditionsX-ray appearance of disc degeneration andprolapse; usually L4/L5 or L5/S1Miscellaneous conditionsraising and diminished or absent reflexes and sensory disturbances in the lower limbs.A central disc prolapse may press on the cauda equina and be associated with bladder symptoms, perineal sensory loss and a lax anal sphincter. This is a surgical emergency and requires immediate decompression or per-manent bladder and sexual dysfunction will result.Scheuermann’s disease is a childhood condition involving the thoracic and lumbar spine. There is herniation of the disc into the adjacent vertebrae and this may be associated with narrowing of the disc space and back pain. There is often a mild kyphosis.Miscellaneous conditionsThese include the rheumatoid group of diseases affecting mainly the spine initially, such as ankylosing spondylitis, through to rheu-matoid arthritis where the spine is often only affected late in the disease. The sac-ro-iliac joints may be involved early in ankylosing spondylitis, and late in rheuma-toid arthritis.。
脊柱骨折法医学鉴定案例范文
脊柱骨折法医学鉴定案例范文英文回答：Case Study of Forensic Examination of Spinal Fracture:Background: Spinal fractures are a common injury, often resulting from traumatic events such as motor vehicle accidents, falls, or sports injuries. Forensic examination of these fractures can provide valuable information inlegal proceedings, such as determining the cause and manner of death, or assessing the extent of injury in personal injury cases.Methods: Forensic examination of spinal fractures typically involves a thorough physical examination, including palpation, percussion, and range of motion testing. Medical imaging techniques, such as X-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI), are used to visualize the fracture and assess its severity. In some cases, additional tests, suchas electromyography (EMG) or nerve conduction studies, may be necessary to evaluate the neurological function of the spine.Interpretation: The interpretation of spinal fractures in a forensic setting is complex and requires consideration of multiple factors, including the mechanism of injury, the location and severity of the fracture, and the presence of any associated injuries. Fractures can be classified as stable or unstable, depending on their likelihood of causing further injury or displacement. Stable fractures are typically treated conservatively with immobilization, while unstable fractures may require surgical intervention.Legal Implications: The forensic examination of spinal fractures can have significant legal implications. In criminal cases, the findings may help determine whether a particular injury was caused by an intentional act or an accident. In personal injury cases, the examination can provide evidence of the extent of the injury and its impact on the victim's life.Case Study: A 25-year-old male was involved in a motor vehicle accident and sustained a spinal fracture at the C6-C7 level. The fracture was classified as unstable and required surgical intervention. The forensic examination documented the severity of the injury, the need for surgery, and the potential long-term consequences.Conclusion: Forensic examination of spinal fractures is a vital tool in legal proceedings, providing valuable information about the cause, severity, and legalimplications of these injuries.中文回答：脊柱骨折法医学鉴定案例范文。
脊柱侧弯检测作文450字
脊柱侧弯检测作文450字英文回答：Scoliosis is a medical condition in which the spine curves to the side. It is a common condition, affecting about 3% of the population. Scoliosis can occur at any age, but it is most common in children and adolescents.There are two main types of scoliosis: idiopathic scoliosis and non-idiopathic scoliosis. Idiopathicscoliosis is the most common type, and it is unknown what causes it. Non-idiopathic scoliosis is caused by another medical condition, such as cerebral palsy or muscular dystrophy.Scoliosis can be diagnosed with a physical examination and an X-ray. The physical examination will check for any curvature of the spine. The X-ray will show the severity of the curvature.Treatment for scoliosis depends on the severity of the curve. Mild curves may not require treatment. Moderate curves may be treated with a brace. Severe curves mayrequire surgery.中文回答：脊柱侧弯是一种脊柱向一侧弯曲的疾病。
学校脊柱侧弯检测作文450字
学校脊柱侧弯检测作文450字英文回答：As part of the comprehensive health screening program implemented by our esteemed educational institution, I recently underwent a thorough scoliosis examination. This assessment, conducted by qualified medical professionals, involved meticulous examination of my spine and posture.The evaluation aimed to detect any potential spinal curvature abnormalities that may require prompt intervention.During the examination, I was instructed to stand in a relaxed and upright position. The examiner carefully inspected my spine from both the front and back, meticulously observing any asymmetry or deviations from the normal curvature. Additionally, I was asked to perform certain movements, such as bending forward and to the sides, to assess the flexibility and range of motion of my spine.Fortunately, the results of my scoliosis examination were reassuring. The examiner found no significant curvature or asymmetry in my spine, indicating that my posture was within the normal range. This positive outcome was attributed to my regular participation in physical activities, which have undoubtedly contributed to maintaining the health and integrity of my spine.The scoliosis screening program has proven to be an invaluable initiative within our school community. By proactively detecting potential spinal issues, the program ensures that students receive timely and appropriate medical attention, helping to prevent the development or progression of scoliosis. Furthermore, the program raises awareness about the importance of maintaining good posture and engaging in physical activity, promoting overall spinal health and well-being among students.中文回答：学校开展脊柱侧弯检测。
颈椎评估方法流程
颈椎评估方法流程Cervical spine assessment is a critical process for evaluating the health and function of the neck. It involves a comprehensive examination of the individual's neck to identify any underlying issues or potential risks. 颈椎评估是评估颈部健康和功能的关键过程。
它涉及对个体的颈部进行全面检查，以确定任何潜在问题或潜在风险。
The assessment process typically begins with a detailed medical history review, which includes any previous injuries, surgeries, or ongoing medical conditions that could impact the cervical spine. 评估过程通常从详细的病史复查开始，包括任何以前的受伤、手术或正在进行的医疗状况，这可能会影响颈椎。
Physical examination is also a crucial part of the cervical spine assessment, as it allows the healthcare provider to evaluate the range of motion, muscle strength, and any signs of tenderness or pain in the neck area. 体格检查也是颈椎评估的重要组成部分，因为它使医疗服务提供者能够评估颈部活动范围、肌肉力量以及颈部区域的任何敏感或疼痛迹象。
In addition to the physical examination, imaging tests such as X-rays, CT scans, or MRIs may be ordered to obtain a more detailed view of the cervical spine's structure and identify any abnormalities or injuries. 除了体格检查外，医生可能还会要求进行影像测试，例如X射线、CT扫描或磁共振成像，以获得对颈椎结构的更详细的视图，并确定任何异常或受伤。
体检项目分类（Classificationofmedicalexaminationitems）
体检项目分类（Classification of medical examination items）General examination A height, systolic blood pressure, diastolic blood pressure, weight, body mass index, through the instrument to measure human height, weight and blood pressure, scientific judgment weight standard, blood pressure is normal.Medical history, lung auscultation, palpation of the liver, family history, medicine, palpation of the spleen, kidney reflex: knee reflex, percussion, rhythm, heart rate, heart sound through visual, touch, knock, listen to the basic situation of the important organs to check the heart lung liver and spleen, found signs of common diseases, or the preliminary elimination of common diseases.Male surgical anal, rectal examination, spine, thyroid (surgery), skin, prostate (surgery), superficial lymph node, breast surgery, limb joints, other external genitalia, through physical examination, check the basic situation of important organs of male skin, thyroid, prostate, limbs, spine external genital, find related symptoms the common surgical disease, or preliminary exclude common surgical disease.Visual acuity, color vision correction, visual acuity (right), corrected vision (left), naked vision (right), naked vision (left), color vision, visual acuity, eye vision, color vision function.External eye, external eye, eye, other examination, eyelid, lacrimal sac, conjunctiva and eyeball.Slit lamp examination, slit lamp examination, through the slitlamp examination sclera, iris, cornea, pupil, vitreous body and so on has the unusual situation.Ophthalmoscopy, ophthalmoscopy, ophthalmoscopy, fundus, optic nerve, papillary, and retinal central vessels were performed.Otorhinolaryngology, nasal septum, tonsil, otorhinolaryngology, other, tympanic membrane, past history, external ear, external auditory canal, pharynx, through the ear, nose, pharynx, almond, larynx and other organs of routine examination, screening of common diseases.Pharyngorhinoscopy pharyngorhinoscopy by epipharyngoscope examination, understand the nasopharynx without exception.Listening (tuning fork) hearing (128HZ tuning fork) uses 128HZ tuning fork to detect hearing.Department of Stomatology, Department of Stomatology, lip, oral mucosa, parotid gland, sublingual gland, tongue, teeth, periodontal, palate, submandibular gland, temporomandibular joint oral examination, a comprehensive understanding of the oral health status, timely detection of common diseases in Department of stomatology.White blood cell count, red cell distribution width coefficient of variation, red cell distribution width standard deviation, erythrocyte count, hematocrit, lymphocyte percentage and absolute value of lymphocyte, mean corpuscular volume, mean corpuscular hemoglobin, mean red cell hemoglobin concentration, mean platelet volume, hemoglobin, platelet distribution width,platelet count, platelet hematocrit, intermediate cell percentage, the absolute value of intermediate cells, percentage of neutrophils, neutrophil absolute value by counting and classification of blood cells and detection of different types of cells, components to reflect the physical condition, such as anemia, infection and so on.Routine urine tube, urine white blood cells, urine specific gravity, Urine Bilirubin, urobilinogen, urine protein, urine microscopic examination of white blood cells, urine microscopic examination of urine protein qualitative, microscopic examination of red blood cells, urine pH, urine sugar, urine ketone, urine nitrite, urine occult blood, epithelial cells, inorganic salts are used to check the urinary system the disease, such as urinary tract infections, tumors, stones and renal function, but also can be used to assist in the inspection of other diseases, such as diabetes, hypertension, hepatitis, etc..Two liver alanine aminotransferase, aspartate aminotransferase can better understand the status of liver function. ALT and AST mainly exist in the cells of liver, heart and kidney, and the larger the injury of liver cells, the higher the ALT and AST. Acute and chronic hepatitis, fatty liver, cirrhosis, liver cancer and other diseases can cause elevated ALT and AST levels.Renal function, three items of creatinine, urea nitrogen, and uric acid were used to assess renal function.Fasting blood glucose (FBG) and fasting blood glucose were usedto assess whether the glucose metabolism in the fasting state was normal, and to assess whether the fasting blood glucose level in diabetic patients was up to standard. Fasting blood glucose is the most common and important index in the diagnosis of glucose metabolism disorders.Four blood lipids of low density lipoprotein cholesterol, triglyceride, high density lipoprotein cholesterol, lipid content in serum total cholesterol, they increase or decrease a great relationship with the formation of atherosclerosis.It was used to evaluate the level of lipid metabolism, the evaluation of dyslipidemia, the prediction of atherosclerotic disease risk and the evaluation of nutrition.Quantification of alpha fetoprotein (AFP) alpha fetoprotein has important clinical significance in the diagnosis, curative effect and prognosis evaluation of primary liver cancer. Ovarian, stomach, pancreatic cancer, testicular cancer and other diseases such as hepatitis, cirrhosis and other diseases have also been found.Carcinoembryonic antigen quantitative (CEA), carcinoembryonic antigen quantitative system and broad spectrum tumor markers have important clinical significance for the screening of colorectal cancer, pancreatic cancer, observation of curative effect and prognosis evaluation. In the stomach, breast, lung cancer, etc. can also be elevated.Abdominal ultrasound gallbladder, liver, spleen, kidney, pancreas of human abdominal organs (liver, gallbladder, spleen,pancreas, kidney) and the status of various diseases (such as cancer, stones, water, fatty liver) to provide color images with high resolution ultrasound dynamic judgment, according to the lesion, blood vessel blood for blood lesions in the differential diagnosis of benign and malignant lesions of renal artery stenosis; judge.Chest chest, chest X-ray examination, two lung, heart, mediastinum, diaphragm, pleura, to determine whether there is no inflammation, tumor and so on.The cervical vertebra and lateral neck were examined by X - ray examination to see whether the vertebral body had congenital malformation, hyperplasia, degeneration, intervertebral disc, Kong Xiazhai, tumor and so on.The electrocardiogram by simultaneous recording and analysis of heart each cardiac cycle produces electrical activity curve changes in specific parts of the surface, provide an important basis for the evaluation of the curative effect of heart disease diagnosis, evaluation, prognosis.Breakfast breakfastAn inspection report inspection report according to the development trend of personal health status and disease, analysis of the major health problems by experts to identify the risk factors, and to provide a complete interpretation of the personalized medical report and basic health improvement guidelines.。
身体全面检查项目（Fullphysicalexaminationitems）
身体全面检查项目（Full physical examination items）[comprehensive examination] which items are included?Best answer1. internal medicine examination: blood pressure, pulse, auscultation of heart and lung, chest, abdomen, touch, percussion and so on.2. surgical examination: lymph skin, limbs, spine, thyroid, anus and anus fingers, breasts, genitalia and so on.3. chest X ray: chest X ray can show the heart, lungs, large vessels and diaphragm position. Usually have a persistent cough, hemoptysis, chest pain or chest trauma, suspected pulmonary tuberculosis, lung lesions or other lung diseases, but the use of chest X ray.4. electrocardiogram: static ECG examination can test cardiac function, including cardiac electrical pulse activity, heart rate, rhythm of heart, atrial and ventricular activity analysis, etc..5. exercise electrocardiogram: record the ability of the heart to move in the body and the amount of oxygen needed. It can identify the causes of irregular heartbeat or chest pain and determine the amount of exercise that can be gained after heart attack or heart surgery.6. B ultrasonic examination: liver, gallbladder, pancreas, spleen, kidney, stomach, thyroid gland, mammary gland. Pelviccavity: male (including bladder, ureter, prostate), female (including uterus, appendix, bladder).7. eye examination: conjunctiva, conjunctiva, sclera, cornea, color vision, retina (fundus) and so onThe 8. Department of ENT examination: auricle and external auditory canal, tympanic, mastoid, nasal, nasal (nasal septum and inferior nasal meatus and inferior turbinate), paranasal sinuses, pharynx, tonsil, pharyngeal, epiglottis, laryngeal etc.9. Department of Stomatology examination: oral mucosa, tongue, palate, teeth, periodontal, glands, jawTenPAT'S cervical smears: women should undergo Pap smears every year after 20 years of age to determine if the uterus cells are normal or have no signs of cancer, with an accuracy ofninety-five percent.Breast examination: 11. women over the age of 35, in addition to the monthly self check, shall accept a professional examination and diagnosis, early detection of abnormal lumps.12. test items1) general examination: blood, blood, urine, fecal occult blood, ESR2) biochemical examination: blood urea creatinine uric acid co2cp total protein albumin globulin combined with bilirubin total bilirubin alanine aminotransferase (GPT) aspartate aminotransferase (GOT) and alkaline phosphatase (AKP) and lactate dehydrogenase (LDH) gamma glutamyl transpeptidase CPK amylase fructosamine3) blood lipid analysis: total cholesterol, glycerin, three fat, high-density lipoprotein, low density lipoprotein, apolipoprotein AI, apolipoprotein B4) electrolytes: blood potassium, sodium, chlorine, calcium, phosphorus, blood magnesium, serum iron, total iron, resultant force5) protein electrophoresis6) immunity: RF, IgG, IgA, IgM, C3, C4, anti O, C reactive protein7) blood viscosity8) HAV is resistant to HAV-IgM9) hepatitis B two, half a HBsAg, HBsAb, HBcAb, HbeAg, HbeAb10) HCV resistant to -HCV11) AIDS against -HIV12) syphilis RPR13) radioimmunoassay: AFP (alpha fetoprotein), CEA (carcinoembryonic antigen), CA19 - 9, PSA (prostate-specific antigen), insulin, thyroid complete set: T3, T4, FT3, FT4, TSH, rT3Estrogen complete: prolactin, estradiol, testosterone, progesterone, luteinizing hormone, follicle stimulating hormoneLaboratory item1. glucose / glucose (Glucose)Blood sugar is one of the important components of the body and also a major source of energy for the body. The liver is the major organ responsible for regulating blood sugar levels, such as liver damage, which affects blood sugar levels.Reference values: 3.9 to 6.1 mmol/LHigher than the reference may be: diabetes, severe dehydration, pancreatic tumors, hyperthyroidism, diuretics, etc..2. creatinine (Creatinine)Creatinine is a metabolic product of muscle breakdown that reflects whether kidney function is sound or not.Reference values: 44 to 103 umol/LHigher than the reference value may be: ureteral obstruction, deterioration of renal function, acute or chronic glomerulonephritis, strong muscle damage after exercise, water shortage, diabetes mellitus, blood pressure changes, etc..3. ureaA nitrogenous waste created by protein metabolism in the blood; helps to assess renal function.Reference values: 2.8 to 8.2 mmol/LMay be higher than the reference value: high protein diet, congestive heart failure, gastrointestinal bleeding, severe dehydration, burn, myocardial infarction, acute glomerulonephritis, chronic nephritis, chronic pelvic inflammatory disease, end-stage renal disease, tight renal failure and toxic nephritis, prostate, urinary calculus, urethral stricture, bladder tumor by urinary tract compression.4. uric acidUric acid is the ultimate product of purine decomposition in the body. Most of them pass through the kidneys. When renal function is impaired, uric acid accumulates and leads to elevated blood levels.This marker is useful in the diagnosis of early nephropathy.Reference values: 0.15 to 0.42 mmol/LHigher than the reference value may be: gout, kidney disease, leukemia, multiple myeloma, polycythemia, chloroform, carbon tetrachloride and lead poisoning5. bilirubin - direct (Bilirubin, direct)Direct bilirubin.Reference values: 1.7 to 6.1 umol/LHigher than the reference may be: cirrhosis, bile duct obstruction, hepatitis, toxic liver disorders and so on.6. total bilirubin (Bilirubin, total)Total bilirubin is a general term for various types of bilirubin in the serum.Reference values: 5.1 to 19 umol/LHigher than the reference value: jaundice caused by various causes.7. alanine aminotransferase (ALT/SGPT)Glutamic pyruvic transaminase mainly exists in the liver cells, followed by myocardial cells, only a small amount of release of blood, only the liver, myocardial lesions, cell necrosis, blood content will increase. Elevated values reflect the extent of liver cell damage and necrosis.Reference values: 0 to 55 U/LMay be higher than the reference value: acute viral hepatitis, chronic active hepatitis, type of activity of liver cirrhosis and hepatocellular carcinoma and biliary diseases such as cholelithiasis caused by obstruction, myocardial infarction, cardiac dysfunction leads to liver congestion, polymyositis, muscle dystrophy, certain drugs or toxic reactions, such as carbon tetrachloride.8. aspartate aminotransferase (AST/SGOT)Ast mainly exists in myocardial cells, followed by liver, the blood content rarely, tissues, blood content increased.Reference values: 0 to 55 U/LHigher than the reference value may be: myocardial infarction, heart dysfunction, all kinds of liver diseases, such as acute and chronic hepatitis, toxic hepatitis, pleurisy, nephritis, taking certain drugs, surgery, deep burns and so on.9. alkaline phosphatase (AKP)Alkaline phosphatase in the bile duct, liver and bone cells content is very high, measuring the blood alkaline phosphatase concentration, you can estimate the degree of destruction of the organ. Children are in the growth stage, alkaline phosphatase is normal on the high side.Reference values: 40 to 150 IU/LMay be higher than the reference value: orthopaedics, osteomalacia, rickets, anemia, leukemia, liver disease, hepatitis, parathyroid overactivity etc..10. lactate dehydrogenase (LDH)Lactate dehydrogenase is found in the heart, liver, kidney, muscle, brain, lung, and this organ cell injury can raise serum LDH. May indicate myocardial infarction, shock, hypoxia, pulmonary infarction, leukemia and other possibilities.Reference values: 114 to 240 U/LMay be higher than the reference value: stroke, heart disease, hemolytic anemia, monocyte excess, intestinal ischemia or necrosis, hepatitis or other liver diseases, muscle damage, muscle atrophy, pancreatitis, pulmonary infarction.11. amylase (Amylase)Amylase is responsible for the digestion of glycogen and starch. When the pancreas is inflamed, amylase is secreted into the blood and used to diagnose and monitor pancreatic disease.Reference values: 80 to 180 U/L;Higher than the reference may be: acute pancreatitis, mumps, gastric ulcer, pulmonary infarction, large amounts of alcohol intake.12. lactulose (Fructosamine)Used as a marker of diabetes, which is less susceptible to diet, is therefore more stable than glucose.Reference values: 2 to 2.8 mmol/L13. total cholesterol (Cholesterol, Toltal)Cholesterol is the body's blood fat, helps the synthesis of cell membranes, is also the main component of all steroid hormones. High cholesterol is directly related to coronary heart disease. Cholesterol levels are influenced by a variety of factors, such as diet, season, lifestyle, age and sex.Reference values: 3.1 to 5.7 mmol/LMay be higher than the reference value: atherosclerosis, pregnancy, familial hypercholesterolemia, fatty liver, nephritis, nephrotic syndrome, hypothyroidism, life stress, diabetes, liver cell jaundice, obstructive jaundice.14. high density lipoprotein cholesterol (Cholesterol, HDL)HDL delivers cholesterol from extrahepatic tissues to the liver, preventing free cholesterol from depositing on extrahepatic tissue cells.High density lipoprotein cholesterol (HDL-C) is a reference marker for clinical diagnosis of coronary heart disease, alsoknown as good cholesterol.Reference values: 0.8 to 2.2 mmol/LBelow reference values possible: coronary aura.15. low density lipoprotein cholesterol (Cholesterol, LDL)Low density lipoprotein contains large amounts of cholesterol, the main function is to transport phospholipids, atherosclerosis, but also the main test mark. Bad cholesterol, too.Reference values: 2.6 to 3.1 mmol/LHigher than the reference may be: risk factors for atherosclerosis, such as hyperlipidemia.16. carrier protein AI (Apolipoprotein, AI)Deliver high density lipoprotein (HDL, good cholesterol), run with the blood, absorb or release into various tissues of the body, or deliver to the liver for metabolism.17. carrier protein B (Apolipoprotein, B)Delivering low density lipoprotein (LDL, bad cholesterol) and phospholipids can harden the arteries and test whether there is any risk factor for coronary heart disease.18. carrier protein AI/B (Apolipoprotein, A1/B)Carrier protein B is high and carrier protein AI is low, which is the precursor of coronary heart disease.19. protein electrophoresis analysisProtein electrophoresis analysis was used to confirm the various protein types, such as albumin and various globulins. Electrophoresis analyses the proteins by separating the positive and negative poles of the current and then observing how much each content is.Reference value: total protein 60 to 80 g/L, albumin 35 to 55 g/L, a 1 (alpha 1) globulin 2 to 6%, a 2 (alpha 2) globulin 6 to 13%, B (beta) globulin 8 to 15%, and C (gamma) globulin 10 to 20%.Acute hepatitis: there is no change in protein electrophoresis at the early stage of the disease. After two weeks, albumin, alpha 2 and beta globulin are decreased, and gamma globulin is increased.Chronic hepatitis: increased gamma globulin, decreased albumin, acute hepatitis significantly.Liver cirrhosis: albumin, alpha 1, alpha 2 globulin were significantly decreased, gamma globulin increased extremely.Hepatocellular carcinoma: protein changes in addition to alpha1 and alpha2 increase, other changes are the same as cirrhosis.A band of alpha fetoprotein could be present between alpha 1and white egg.Other hepatobiliary diseases and extrahepatic diseases, such as congestion, liver, multiple myeloma and nephrotic syndrome, can cause changes in the content of various proteins.TwentyCalcium (Calcium)The main component of the bones and teeth also helps regulate heartbeats and muscle contractions and maintains normal nerve induction. Calcium can run away with age, and osteoporosis, fractures, and bone damage can speed up the loss of calcium.Reference values: 2.08 to 2.6 mmol/LMay be higher than the reference value: hyperthyroidism, acromegaly, large doses of vitamin D treatment, pernicious anemia, sarcoma.May be less than the reference value: inflammation of the pancreas, kidney failure, parathyroid insufficiency, malabsorption, osteoporosis, vitamin D deficiency, inflammation of the pancreas.21. KUsed to diagnose kidney or adrenal disorders, and also to assess the balance of water in the body. The mechanisms responsible for the homeostasis of potassium include insulin, aldosterone,acid-base balance, hypoxia, and other factors.Normal values ranged from 3.5 to 5.5 mmol/LMay be higher than the reference value: the adrenal cortex function in acute or chronic renal failure, reduce, hypoaldosteronemia, application, determination of high potassium diet, oral liquid or injection of potassium excessive, hemolysis, crushing, tissue hypoxia, insulin deficiency, digitalis poisoning.Below reference values: possible vomiting, diarrhea, aldosteronism, diuretics, alkalosis, low potassium diet, cardiac insufficiency, and no potassium fluids.22. chlorine ion (Chloride)The major negative ion outside the body's cells, which maintains electrical ion neutralization, is opposed to sodium in the body. Serum chlorine and sodium can increase and decrease at the same time.Reference values: 96 to 108 mmol/LHigher than the reference may be: alkalosis caused by hyperventilation, Cushing's syndrome, massive dehydration, and renal dysfunction.Lower than the reference value may be: burns, congestive heart failure, excessive sweating, adrenaline secretion disorders, respiratory failure and so on.23. ironIron is the major component of hemoglobin and essential trace minerals for human body. Iron is involved in the transportation of oxygen and the production of red blood cells in the human body.Reference values: 11 to 30 umol/LHigher than the reference value may be: cirrhosis, iron poisoning, iron deposition, hemolytic anemia, etc..Lower than the reference value: iron deficiency, iron deficiency anemia, etc..24. sodiumNormally, sodium intake and discharge should be balanced. Sodium is excreted mainly through the kidneys through urine. Clinically occurring electrolyte abnormalities usually involve sodium dysregulation. Plasma sodium concentration only reflects the balance of extracellular fluid, sodium ion and water, so it should be measured at any time with the change of condition.Reference values: 136 to 145 mmol/LHigher than the reference may be: adrenal cortex hyperfunction, aldosteronism, hemodialysis and so on.Lower than the reference value may be: vomiting, diarrhea, severe pyelonephritis, severe renal tubular damage, renal cortical dysfunction, diabetes, profuse sweating, extensive burns, excessive antidiuretic hormone, and so on.25. total iron binding capacityCheck the blood iron binding capacity, and anemia related.Reference values: 50 to 77 umol/L;Higher than the reference may be: iron deficiency anemia, polycythemia vera, late pregnancy and so on.Lower than the reference value may be: cirrhosis, hemolytic anemia, hypoproteinemia, pernicious anemia, sickle cell anemia, etc..26. triglycerideTriglyceride is one of the components of blood lipids, and is in dynamic balance in human body. Blood lipid content varies greatly with dietary changes. In addition, its content increases with age, especially in middle-aged and older people who are overweight.Reference values: 0.56 to 1.7 mmol/LHigher than the reference value may be: primary, secondary hyperlipidemia, atherosclerosis, diabetes, kidney disease, fatty liver and so on.27. alpha fetoproteinA special protein of liver cells, adults lose the ability to synthesize, so the serum content is minimal. However, in hepatocellular dysfunction, especially in primary hepatocellular carcinoma, there is a repeat of alpha fetoprotein (AFP) in the serum, so the diagnosis of primary hepatocellular carcinoma is often assisted by afp. Primary liver cancer, acute hepatitis, chronic hepatitis and cirrhosis, congenital total bile duct atresia, bone fractures, genital embryonal tumors, and 3 to 5 months of pregnancy are higher than usual. Normal value < 20Ug/ml;28. cancer antigen 125 - ovaryWomen over 40 years of age, ovarian cancer, and most cancers are high in the early stages.29. cancer antigen 15.3 - breastDiagnostic reference index for breast cancer.30. cancer antigen 19.9 - pancreasIt can be used for the diagnosis of clinical pancreatic cancer, colorectal cancer and rectal cancer. It is also used in the observation of drug treatment and operation.31. carcinoembryonic antigen (CEA)CEA is a globular protein found first in the serum of patients with colon cancer,It is detectable in the serum of fetuses between 3 and 6 months, so it is called carcinoembryonic antigen. Primary colon cancer, adenocarcinoma of the pancreas, bile duct cancer, gastric cancer, esophageal cancer, adenocarcinoma, lung cancer, breast cancer, and urinary system tumors are positive. The dynamic observation of serum CEA is helpful for the observation of curative effect and the diagnosis of recurrence. Normal value < 20Ug/ml;32. prostate specific antigen (PSA)Mainly found in male prostate wall cells and prostate secretions. PSA is usually elevated in prostate cancer, prostate enlargement, and inflammation of the reproductive system.33. urine volumeNormal urine should be less than 2 red cells per cubic millimeter. Higher than normal, may be nephritis, tumor, cystitis, prostatitis and so on.34. routine urine testVisual inspection, biochemical tests, and urine sediment microscopy. The use of urine paper contains chemicals to detect specific substances in the urine, including urine sediment test, that is, the use of microscopic observation of urine white bloodcells, red blood cells, epithelial cells and so on. Answer: asb4 - assistant, level 5-10, three 02:07。
运动系统检查
Examination of the Neck
Examination of the Neck
5. Assess lateral flexion （侧弯）to both sides by asking the patient to touch their shoulder with their ear. 6. Assess rotation（旋转） by asking the patient to look over their shoulder, to the left and right. 7. Begin the neurological assessment of the upper limb by examining the motor（运动） system. This involves asking the patient to
瑞-舒（Wright-Schober）测试法
测定脊柱前弯时的伸长率，即嘱受试者
作立正姿势，以髂嵴为中心，在其上 10cm及下5cm处各作一标志，测量两点 间距离。正常人弯腰时的两点距离较直 立时的15cm增加4~8cm(图3-8-3)。该检 查法可对幼年强直性脊柱炎病人进行动 态观察
Examination of the Back
5. Back flexion. （屈）
瑞-舒（WrightSchober）。
6. Bony Excursion: measure the distance between two bony points when standing. 7 Ask the patient to flex forward, the bony points should move at least 5 cm. 8. Lateralflexion
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spine
protecting for the spinal cord holding up the weight maintaining the posture supporting axis of the movement
Spinal examination
Inspection Palpation Percussion
Ballottement for a floating patella
Milk the superpatella pouch
Patella tap
Ballottement for a floating patella
Abnormalty:
•
In the presence of an effusion, a palpable tap and a transmitted impulse will be felt
Inspection （3）
Inspect
• Normal: phyical curves • Abnormality:
• Kyphosis • lordosis
from the side
kyphosis
Definition:Abnormally increased convexity in the curvature of the thoracic spine as viewed from the side .
• Normal: a straight spine
• Abnormal: Scoliosis
Scoliosis
Definition: A lateral curvature of the spine
Scoliosis
Signs of scoliosis
Inspection （2）
Press index and middle finger on the patient’s spinous process from top to bottom rapidly
Fusiform swelling of the joints
. Causes:
•
rheumatoid arthritis
Fusiform swelling of the joints
Rheumatoid arthritis
Dugas sign
Technique: ask the patient put the hand of the injured side on the opposite shoulder
Abnormality: the hand can’t touch the shoulder or the elbow can’t approach the chest normally Signification of abnormality: the dislocation of the shoulder.
Physical curves
The cervical curve: concave backwards, C2T2 The thoracic curve: convex backwards, T2T12 The lumbar curve: concave backwards, T12the lumbosacral joint The pelvic curve: convex backwards and downward, extends from the lumbosacral joint to the tip of the coccyx
Physical curves
The cervical curve: concave backwards The thoracic curve: convex backwards The lumbar curve:, concave backwards The pelvic curve: convex backwards
some spinous processes.
directly percusses every spinous processes with a percussion hammer
indirect percussion
Technique:
Ask patient in a seated position. Place the patient’s left hand on top of their head
direct percussion indirect percussion
Examination of the mobilities of the cervical and lumbar spine
Inspection（1）
Ask the patient in a standing position First, look from beartial fist to percuss on the patient’s left hand with hypothenar eminence. Note the patient’s painful appearance.
Examination of the cervical spine motion:
Inspect the red line the skin shows
This can indicate lateral curvature of the spine(scoliosis).
Press index and middle finger on the patient’s spinous process from top to bottom rapidly.Inspect the red line the skin shows
Late pregnancy
palpation
Technique:
• With
thumb, press firmly on the patient’s spinous processes from top to bottom. to the spinous process.
• Then, palpate the paraspinal muscles laterally
.
flexion
extension
Lateral flexion
rotation
Examination of the lumbar spine motion:
flexion
extension
Lateral flexion
rotation
Limb and joint
Koilonychia（spoon nails）
kyphosis
Changes in spine with age
Lordosis
Definition: an inward curvature of a portion of the vertebral column
Lordosis
lordosis
Causes:
• a large amount of ascites • tumors of the abdominal cavity • tuberculosis of the hip joint • late pregnancy.
Acropachy
Acropachy
Acropachy
Mechanism: end of limbs have chronic hypoxia, metabolism handicap.
Causes:
• lung abscess • Bronchiectasis • lung cancer • some heart diseases.
Normal: no pain.
direct percussion
Technique :directly percusses every spinous processes with a percussion hammer.( mainly used in the lumbar and thoracic vertebra). Normal : No percussion pain. Abnormal: percussion pain appear in
Physical Examination
Spine and Extremities
Skeletal spine
7 cervical vertebrae 12 thoracic(dorsal) vertebrae 5 lumbar vertebrae 5 sacral vertebrae 4 coccygeal vertebrae
Shoulder dislocation
Ballottement for a floating patella
Technique:
•
• •
•
The patient is in a supine position with leg straight and muscles relaxed. Firmly grasp the thigh just above the superior margin of the patella and slide the hand downward along the sides of the femur.(so that any effusion is forced behind the patellar ) When reach the upper pole of the patella ,keep your hand there and maintain pressure Using the index & middle fingers of the other hand, push the patella down gently