医学知识双语阅读
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医学知识双语阅读：口腔检查
Examination of the oral cavity is part of every general physical examination. Oral findings in many systemic diseases are unique, are sometimes pathognomonic, and may be the first sign of the disease. Early detection of oral cancer may be possible. 口腔检查是全身检查的一部分.在许多系统性疾病中,口腔表现是独特的,有时是病征性的,可以是疾病的首先征兆.口腔癌的早期发现是可能的.
A dental history is obtained first. It may indicate a particular dental problem or neglect of dental care. A complaint of difficulty in chewing food suggests insufficient teeth for proper mastication, loose or painful teeth, poorly fitting dental appliances, or disorders of the temporomandibular joint or the masticatory muscles. Slight bleeding after brushing suggests mild gingivitis; frequent, spontaneous, or profuse bleeding may indicate a blood dyscrasia. Recurring oral infections may indicate diabetes mellitus (the most common cause), agranulocytosis, neutropenia, leukemia, immunoglobulin defects, or disorders of leukocyte function. Immunosuppressed persons may experience painful reactivation of oral herpes simplex or other infections, with pain, oral ulcerations, and consequent interference with food intake. 首先采集口腔科病史,可提示一个特别的口腔问题或被忽略的口腔保健.主诉咀嚼食物困难提示能行使咀嚼功能的牙齿缺失或疼痛,或颞颌关节及咀嚼肌群功能紊乱.刷牙后轻度出血,提示轻度牙龈炎;经常的,自发的,大量出血,表示血液病.反复出现的口腔感染,可能存在糖尿病(此为最常见原因),粒细胞缺乏症,中性粒细胞减少症,白血病,免疫球蛋白缺乏病或白细胞功能紊乱.免疫抑制者可经历口腔单纯疱疹的疼痛反应,并伴有口腔溃疡而导致妨碍摄食.
A thorough evaluation requires good illumination, a tongue blade, gloves, and a gauze pad. A dental or laryngeal mirror, if available, is helpful. 全面的评估需要良好的照明,压舌板,手套和纱布垫.口镜或咽喉镜有助于口腔检查.
The examiner initially looks at the face for appreciable asymmetry, skin lesions, and other abnormalities, such as restricted movement during speech, as occurs in scleroderma or acromegaly. Numerous congenital syndromes produce characteristic facies. For example, a very thin upper lip suggests the fetal alcohol syndrome or Prader-Willi syndrome. Trauma in youth, particularly blunt trauma to the point of the chin, can damage growth centers in the condyles and lead to unilateral or bilateral impairment of mandibular growth. Idiopathic hypertrophy of one or both sides of the mandible or other parts of the face may distort the face, as may acromegaly or a salivary gland or jaw tumor. If the posterior teeth or dental prostheses are missing, the cheeks may be sunken, producing a prematurely aged or cachectic appearance. One or both cheeks may appear swollen due to cherubism, parotitis, Sjögren's syndrome, tumor, an excessively thick denture flange, or cellulitis from an abscessed tooth. Multiple basal cell carcinomas on the face may indicate the nevoid basal cell carcinoma syndrome, which alerts the examiner to look for multiple odontogenic keratocysts on x-rays. 检查者首先观察面部有无明显的不对称,皮肤病损和其他的不正常,如当说话时运动受限常出现于硬皮病或肢端肥大症.许多先天性综合征均产生特殊的面貌.例如,很薄的上唇提示胎儿酒精综合征或Prader-Willi综合征,青少年时期的创伤,特别是颊部的钝伤,能伤及髁状突的生长中心和导致下颌骨单侧或双侧生长发育受损.下颌一侧或双侧自发性肥大,或面部其他部分自发性肥大,如肢端肥大症或涎腺肿瘤或颌骨肿瘤均可破坏面部外貌.如果后牙或义齿缺失,颊部会凹陷而形成早老的或恶病质样的面貌.由于颌骨增大症,腮腺炎,SjÖgren综合征,肿瘤,过厚的义齿突缘,或牙槽脓肿引致的蜂窝织炎,均可使一侧或双侧颊部肿起.面部多发性基底细胞肉瘤可表现痣样基底细胞肉瘤综合征,这可使检查者留心地在X线片上寻找多发性牙源性角化囊肿.
The lips are palpated. With the patient's mouth open, the buccal mucosa and vestibules are examined using a tongue blade; then the hard and soft palates, uvula, and oropharynx are viewed. The patient is asked to extend the tongue as far as possible, exposing the dorsum, and to move the extended tongue as far as possible to each side, so that its posterolateral surfaces can be seen. If a patient does not extend the tongue far enough for the circumvallate papillae to be seen, the examiner uses a gauze pad to grasp the tip of the tongue and extend it to the desired position. The tongue is then raised to view the ventral surface and the floor of the mouth. The teeth and gingivae should be viewed. 对唇部作扪诊,同时令患者张口,用舌板检查颊粘膜和口腔前庭;然后巡检硬软腭,悬雍垂和口咽部.请患者尽快地伸出舌,暴露舌背,并且尽快地向每侧移动舌,这样就可看到舌的后侧表面.如果患者不能将舌伸出足够以使轮状乳头能被看见时,检查者可用纱布垫拉住舌尖,使其伸出到所需的体位.然后巡检舌腹部表面和口底,再检视牙齿和牙龈.
With gloved hand, the examiner palpates the vestibules and the area over the roots of the teeth with one finger and the cheek with two fingers. The index finger of the dominant hand is inserted inside the mouth, and the contents of the floor of the mouth are compressed gently between it and the fingers of the other hand. To make palpitation more comfortable, the examiner asks the patient to relax the mouth, keeping it open just wide enough to allow access. The cervical lymph nodes should also be palpated. 检查者用戴手套的手指对口腔前庭进行扪诊并用一个指头扪所有牙齿的根部,用两个指头核对.主检手的示指放入口内,另个手的几个手指置于口外相当部位,轻柔地触扪口底.为了使扪诊更舒适些,可请患者将口腔放松,维持一定的开口度以使手指能进入口腔.对颈部淋巴结也应作扪诊.
The temporomandibular joint (TMJ) is assessed by looking for jaw deviation during opening and by palpating the head of the condyle, anterior to the ear. The examiner then places his little fingers intrameatally while the patient opens widely and closes three times. The patient should be able to comfortably open wide enough to fit three fingers between the incisors. Trismus, the inability to open the mouth, may indicate scleroderma, arthritis, ankylosis of the TMJ, dislocation of the temporomandibular disk, tetanus, or tonsillar abscess. Unusually wide opening suggests subluxation or type III Ehlers-Danlos syndrome. 颞下颌关节(TMJ)的检查为当开口时在耳前方扪诊髁状突的头,检视颌骨的偏向.然后检查者将小指深入置于外耳道内,请患者张大口和闭口3次.患者能舒适地张大口,足以使上下切牙之间能放进三个手指.不能张口的牙关紧闭提示可能为硬皮病,关节炎,颞下颌关节强直,颞下颌关节盘脱位,破伤风或扁桃体脓肿.异常的大开口提示关节盘半脱位或Ehlers-Danlos综合征的Ⅲ型(先天性遗传性综合征,特征为关节过度伸长,皮肤弹性脆弱等---译者注).
Malodor of exhaled breath may have many causes. Fetor oris originates in the mouth. Most commonly, it is caused by volatile sulfur compounds resulting from bacterial metabolism, particularly when oral hygiene is poor or xerostomia is present. Halitosis may follow eructation from the GI tract or may be caused by systemic metabolic conditions--eg, an acetone odor with diabetes mellitus, a mousy odor with liver failure, and a urinous odor with kidney failure. Halitosis may also originate from the nose, sinuses, nasopharynx, and lungs, particularly when infections or necrotic neoplasms are present. A patient whose breath frequently smells of mouthwash may be masking halitosis or may have parosmia (a perversion of the sense of smell, usually involving smelling unpleasant odors that do not exist). 呼吸气味的恶臭可由许多原因引起.口臭起源于口腔.最多的原因是来自于细菌代谢产生的易挥发的硫化物,尤其是口腔卫生不良或口干症时.口臭也可随胃肠道的嗳气而来或由系统性代谢性疾病引起,也即丙酮味与糖尿病有关,鼠臭味与肝功能衰竭有关,尿味与肾功能衰竭有关.口臭也可起源于鼻部,上颌窦,鼻咽部和肺,尤其当这些部位有感染或坏死性肿瘤时.经常散发着漱口液气息的患者常感觉有潜在的口臭或可能是个嗅觉倒错者(嗅觉反常,常自己感到不适的臭味,而事实上此味是不存在的).
医学知识双语阅读：盗汗
Night sweats are drenching sweats that require a change of bedding. 盗汗为淋透性出汗，需换床单。
I. Approach. The first priority is to exclude night sweats caused by fever. Sweating associated with fever is a separate evaluation. Before the 20th century, night sweats implied infection with tuberculosis. Now, many other ailments are associated with this symptom. Night sweats are often the mark of a known condition such as diabetes (especially with nocturnal hypoglycemia), cancer, head trauma, and rheumatologic disorders. Night sweats can also be a symptom of a new disorder. The investigation of a patient reporting night sweats requires a review of past illnesses and new symptoms. I. 诊断。首先要排除发烧引起的出汗。发烧性出汗应另行诊断。20世纪前，盗汗通常提示有结核菌感染。现在，其他很多不适都与此症状相关。盗汗通常是某已知病症的标志，如糖尿病(特别是伴夜间低血糖者)、癌症、头外伤和各种风湿病。盗汗也可能是新的疾病的一种症状，在给盗汗报告病人进行检查时，需检查既往病史及新的症状。
II. History. Night sweats can be characterized by determining onset, frequency, exacerbations, and remissions of symptoms. Question patients about the current state of known disorders. Excessive sweating is associated with poor nocturnal glycemic control. Flares of rheumatologic disorders (rheumatoid arthritis, lupus, juvenile rheumatoid arthritis, and temporal arteritis) cause sweating too. Pregnancy temporarily changes the intrinsic thermostat in many women who perspire excessively. Patients who are immuno-compromised are at increased risk for infections, especially with atypical agents. Patients with a history of substance abuse need to be asked about needle use and contaminants. II. 病史。盗汗可通过确认发作时间、次数、加剧及症状消退加以确定。询问病人已知疾病。多汗也与夜间血糖控制不良有关。风湿性疾病(如类风湿关节炎、狼疮、幼儿性类风湿性关节炎、颞关节炎等)也导致出汗，妇娠也会暂时的改变很多妇女的体温状况，导致出汗过多。免疫代偿病人感染风险增加，特别是非典型性病原体感染。有药物滥用史病人需询问其针头使用及其他接触状况。
A. Review of systems. Other symptoms that can accompany night sweats include flushing (carcinoid syndrome, pheochromocytoma), joint pain, sleep apnea, menstrual irregularities, reflux, cough, headache, dysuria, dyspnea, rashes, fatigue, palpitations, and weight and bowel habit changes. A. 系统检查。伴随盗汗的其他症状包括潮红(类癌综合症、嗜铬细胞瘤)、关节痛、睡眠性呼吸暂停、月经不调、反流、咳嗽、头痛、排尿困难、睡眠困难、皮疹、疲乏、心悸及体重与排便习惯改变。
B. Exposure factors. Inquire about recent immunizations or new medicines such as antidepressants, cholinergics, meperidine, estrogen inhibitors, gonadotropin inhibitors, niacin, steroids, stimulants, over-the-counter preparations, antipyretics, and naturopathic therapies. Question patients about exposure to sexually transmitted diseases (STDs), human immuno-deficiency virus (HIV), hepatitis, tuberculosis, or occupational and travel-related exposures. Also ask about increases in general changes in the ambient night temperature. B. 暴露因素。询问最近免疫及新药使用情况，如抗抑郁剂、胆碱能药、哌替定、雌激素抑制剂、促性腺激素抑制剂、烟酸、类固醇、兴奋剂、非处方制剂、解热剂和自然疗法。询问病人有无接触性传染病(STD)、HIV、肝炎、结核病，有否职业性及旅游相关性接触。也应询问周围夜间体温总体变化增多情况。
C. Psychological factors. Anxiety, nightmares, and psychoactive preparations can precipitate night sweats in healthy individuals. C. 精神因素。焦虑、噩梦及兴奋剂可导致健康个体盗汗。
D. Family history. Patients who report a family history of hereditary disorders and possible malignancies should have appropriate screening. D. 家庭史。有遗传疾病及可能的恶性肿瘤家庭史病人应进行适当的筛检。
III. Physical examination. The physical examination should address the pertinent positives noted in the patient's medical history. Note the patient's weight and temperature. Examination of the head, eyes, ears, nose, and throat (HEENT) should focus on common types of infection: sinusitis, pharyngitis, and otitis. A thorough examination of lymph nodes is helpful to identify infection or lymphatic abnormalities. The cardiopulmonary examination can also signal infection, valvular disease, and stimulant use. Patients should be examined for abscesses, skin ulcers, septic joints, phlebitis, and osteomyelitis. III. 身体检查。身体检查应针对病人医疗史中的相关阳性记录。注意病人体重体温。头、眼、耳、鼻及喉检查的重点是普通类型的感染：鼻窦炎、喉炎和耳炎。淋巴结彻底检查有助于确认感染及淋巴病变。心肺检查也可提示感染、辨膜疾病及兴奋剂使用情况。应检查病人是否有脓肿、皮肤溃疡、关节脓肿、静膜炎和骨髓炎。
IV. Testing
IV. 检验。
A. Clinical laboratory testing. For patients with a known condition, testing for exacerbations is appropriate: erythrocyte sedimentation rate (infection, osteomyelitis, and temporal arteritis), C-reactive protein (rheumatologic disorders), and hemoglobin AiC (diabetes mellitus). Depending on the patient's symptoms or exposures, other appropriate tests can include purified protein derivative skin test for tuberculosis, free T4 level to rule out thyrotoxicosis, complete blood count with differential (infection), and follicle-stimulating hormone to investigate the possibility of menopause. Special tests may be required of patients with travel-related or STD exposures. A. 临床实验室检查。对有已知病症病人，应检测病症是否加剧：血沉(感染、骨髓炎和颞关节炎)、C反应蛋白(风湿性疾病)和血红蛋白AIC(糖尿病)。根据病人症状及暴露情况决定是否进行其他检查，包括结合病纯蛋白衍生物皮肤测试、排除甲状腺机能亢进的游离T4水平检验、全血计数及分类(感染)、促卵泡激素检查停经可能性。有旅游相关及STD接触病人可能需要进行特种检验。
B. Imaging. Chest x-ray studies are useful in the evaluation of night sweats in patients with a smoking history, industrial exposure, or a cough. These patients need to be screened for occult malignancy. Computed tomography scans are generally not appropriate unless other signs or symptoms dictate further evaluation. B. 影像检查。胸部X线检查对评估有下列情况病人的盗汗很有用：吸烟史、工业性接触或咳嗽。这些病人需要进行潜在恶性肿瘤筛检。CT扫描通常并不合适，除非其他症状或体征提示要作进一步检查。
V. Diagnostic assessment. Night sweating as a single entity is not worrisome. V. 诊断评估。盗汗作为单一征状并不令人担心。
Explore the likelihood of exacerbation of known conditions or the onset of a new disease process. The history is the most helpful part of the patient encounter. A new medication, with perspiration as a side effect, is the culprit. Patients may need cessation of the medication as well as a washout period. Night sweats might be an early symptom of a developing illness so watchful waiting is useful. Patients need to be instructed to watch for weight changes, fevers, and sleep and mood changes. Patients can complete a symptom diary, which is very helpful to the clinician in determining the need for additional evaluation. Consider illnesses that tend to be present in the patient's age group. Screening for common malignancies through mammograms, pap smears, and fecal occult blood testing is appropriate health maintenance as well as often being a part of the evaluation of the presenting complaint of night sweats. 检查已知疾病加剧可能性或所得疾病过程的发作情况。病史在病人疾病中最有帮助。有出汗副作用的新药常常是盗汗的魁首。病人可能需要停药及给予一段药物清除时间。盗汗也可能是某种疾病发展的早期症状，因此观察等待是有用的。应指导病人留意体重变化、发烧及睡眠和情绪变化。病人可填写一份症状日誌，它对临床医师确定是否作进一步检查很有帮助。考虑该病人年龄组常见的疾病。通过乳房X线、巴氏涂片及粪便潜血试验筛检常见恶性肿瘤，既适于健康维持，也是当前盗汗主诉检查的内容之一。