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学习笔记3.08-3.09

  • 2026-03-10 13:08:03
学习笔记3.08-3.09
连着三天没更新了。周六去外面溜达了，没咋学习。这几天倒是把前几天中的两个Case proof 弄完了。然后又投了别的杂志。也不算是一点没干。
一：周末先复习上周学习的内容。（重点复习涂老师的书，写的太好啦）
1.关于基底细胞癌，尽管临床有多种类型，但基本特点是损害周边有一个线状或断续性隆起的边缘，质地硬，表面光滑。但不同类型的发病过程不同。结节型初期是一个黑色或粉红色结节，逐渐增大，此后中央破溃，出现上述典型的边缘表现。而浅表播散型，早期即表现为褐色或淡红色斑片，表面渗出、结痂，遗留萎缩，边缘损害更细一些，逐渐向外周扩张。
2.双下肢紫癜鉴别：根据表现需要鉴别过敏性紫癜，变应性血管炎，ITP，药疹，湿疹。ITP是出血性斑疹斑片，不是可触及性的小丘疹；湿疹有渗出倾向，有小水泡，红色丘疹有片状聚集倾向；变应性血管炎：浸润性小结节，常有坏死，溃疡，萎缩等。
3.血小板减少性紫癜，主要损害是出血性斑疹、斑片，容易发生在关节附近等受磕破部位，与本病例的分布特点出入较大。其次就是压力性紫癜，面部也是好发部位，多发生在儿童剧烈咳嗽或呕吐后，眼周面颊发生对称多发性出血点，很容易排除掉。老年性紫癜很常见，况且本患者长期口服阿司匹林等抗凝药物。压力性紫癜发生的可能性还是很大的。但压力性紫癜主要发生在受挤压或磕破等机械性损伤的部位，非对称性分布。
4.头面部红斑性皮疹，首先考虑炎症，如各种皮炎、银屑病、丹毒等。少数情况是血管性疾病，如鲜红斑痣等。红斑无鳞屑、无渗出、无结痂，不符合常见的染发皮炎、脂溢性皮炎、银屑病。
5.小腿溃疡常见于：淤积性溃疡、硬红斑血管炎类、某些感染性疾病及坏疽性脓皮病。淤积性溃疡的基础是下肢静脉曲张和淤积性皮炎，皮肤暗红褐色、肿胀、硬化，部分发展为溃疡。硬红斑多发性，深在性结节或肿块，愈合后常有萎缩；部分血管炎，如结节性血管炎、变应性血管炎、结节性多动脉炎、青斑样血管病等均可有溃疡。但与本病例不同的是，前者常是多发性小溃疡。多数在数周内愈合。
6.口腔黏膜糜烂伴眼部黏膜损害考虑：多形红斑，白塞病，疱病（寻常天，黏膜天，PNP）。多形红斑急性病程；白塞病是反复发作的疼痛性溃疡，不是持续发展的糜烂。
7.外阴溃疡类常见于：固定型药疹，生殖器疱疹，白塞，硬下苷。固定性药疹：水肿性红斑，严重时出现水疱，继发表皮脱失，形成糜烂或者浅溃疡，境界清楚；生殖器疱疹：簇集性小水疱，但就诊时多表现为多点状溃疡；白塞：溃疡又深又疼
二：今天学习一下病毒疣基层指南（2022）
1.HPV，DNA病毒，感染有增殖性感染，亚临床感染（醋酸白+)和潜伏感染（醋酸白-）
2.发病机制：皮肤破损＋免疫功能缺陷
3.临床表现
1）细小的丘疹表面角化粗糙，乳头瘤样增生，皮纹破坏。（以后病历查体可以按照这个描述）
2）小黑点是毛血管破裂出血形成
3）面部需于皮赘鉴别
角质层取出后才能看见真皮乳头层血管破裂形成的出血点，凝固后形成小黑点。门诊上会有患者问为啥血是黑色，还有问为啥我这个是黄的没有黑点。
指南中没写与鸡眼和胼胝鉴别，这块可以看八年2版教材
看皮纹，看好发部位
浅褐色表面光滑扁平丘疹
4.疣状表皮发育不良
5.尖锐湿疣
三：读一读八年2版教材细菌性皮肤病，还是得先看一遍教材再做题
门诊病毒疣的患者比毛囊炎多很多，如果算上痤疮这二者差不太多。
1.细菌性毛囊炎与马拉色菌毛囊炎鉴别
2.头部的痈需要与头癣鉴别，后者红中国痈状斑块上多发小脓疱，患处头发常易折断和拔出。
3.疖痈还需要和表皮样囊肿，化脓性汗腺炎，囊肿性痤疮鉴别
1）表皮样囊肿内容物是角质物，疖痈内容物是脓性分泌物
2）HS是硬性结节，潜行溃疡，交通性漏道，好发于腋窝和腹股沟
3）囊肿性痤疮破溃后流出带血的胶冻状脓液，且伴有黑头粉刺，炎性丘疹
4.丹毒鉴别诊断
1）接触性皮炎；2）类丹毒；3）蜂窝织炎
——————————————————————————
3.09
1.完成了科普任务，写了一份科普文章
2.完成了伦理修改
下夜班后又上了一下午班，累累，就先干这么多了。
小水文见刊啦
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  1. CONNECT:[ UseTime:0.000871s ] mysql:host=127.0.0.1;port=3306;dbname=no_67808;charset=utf8mb4
  2. SHOW FULL COLUMNS FROM `fenlei` [ RunTime:0.000951s ]
  3. SELECT * FROM `fenlei` WHERE `fid` = 0 [ RunTime:0.000400s ]
  4. SELECT * FROM `fenlei` WHERE `fid` = 63 [ RunTime:0.000263s ]
  5. SHOW FULL COLUMNS FROM `set` [ RunTime:0.000489s ]
  6. SELECT * FROM `set` [ RunTime:0.000201s ]
  7. SHOW FULL COLUMNS FROM `article` [ RunTime:0.000538s ]
  8. SELECT * FROM `article` WHERE `id` = 473560 LIMIT 1 [ RunTime:0.004701s ]
  9. UPDATE `article` SET `lasttime` = 1773187800 WHERE `id` = 473560 [ RunTime:0.013620s ]
  10. SELECT * FROM `fenlei` WHERE `id` = 65 LIMIT 1 [ RunTime:0.000279s ]
  11. SELECT * FROM `article` WHERE `id` < 473560 ORDER BY `id` DESC LIMIT 1 [ RunTime:0.000577s ]
  12. SELECT * FROM `article` WHERE `id` > 473560 ORDER BY `id` ASC LIMIT 1 [ RunTime:0.001483s ]
  13. SELECT * FROM `article` WHERE `id` < 473560 ORDER BY `id` DESC LIMIT 10 [ RunTime:0.001117s ]
  14. SELECT * FROM `article` WHERE `id` < 473560 ORDER BY `id` DESC LIMIT 10,10 [ RunTime:0.002287s ]
  15. SELECT * FROM `article` WHERE `id` < 473560 ORDER BY `id` DESC LIMIT 20,10 [ RunTime:0.007349s ]
0.102094s