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学习笔记3.16

  • 2026-03-26 04:19:14
学习笔记3.16
继续读临床思维书
Case 5：躯干四肢暗红斑2月余
竟然是靠家族史秒杀，不过思路值得学习
诱因，自觉症状和伴随症状（发热，关节痛，口腔溃疡，脱发注意自身免疫病），瘙痒提示过敏性疾病可能性大。
转归和治疗经过也很重要。皮损如果既往出现红斑渗出倾向皮炎湿疹类；抗过敏无效注意感染和肿瘤性。
还是麻木感得问到，得问。还有就是如果真的确诊，可以去友谊医院热带病研究所。
顺便温习了麻风的类型，未定型，TT,BT,BB,BL,LL
Case 6：躯干四肢多发斑疹结节破溃伴关节畸形3年，眉毛脱落1年
这个眉毛脱落还是有迷惑性的，我以为SLE呢，没想到麻风也能掉眉毛。
此外还有多中心网状组织细胞增生症。
Case 7：躯干散在结节10月余
需要考虑感染性（孢子丝菌病，马尔尼菲蓝，HIV，麻风）还有组织细胞增生性皮肤病，黄瘤病，结节病，淋巴瘤等
Case 8：全身反复红斑脓疱伴疼痛8年，加重1周
来学习学习慢性红斑脓疱都有啥病，急性的话就（GPP,AGEP,脓疱疮 我很菜，也就想到这些）
慢性的竟然还有Sweet，这个不是急性发热性嗜中性皮病吗？
哈哈，没想到吧，竟然还是麻风。而且是麻风II型反应
顺便又复习了两个麻风反应
这本书不愧是古董，现在麻风已经不常见了。
Case 9：下颌外伤4天，全身红斑伴疼痛发热2天
一看这个主诉，外伤后的8成是感染。然后还是小朋友，直接4S秒了。但是，也可能是SJS-TEN
这个Case还是很有用的。SSSS和TEN鉴别的几个点
是否有用药史，发疹顺序，水疱深度
最重要的是口腔黏膜是否受累。
4S眼睑口腔黏膜受累轻微，不影响进食；而SJS-TEN黏膜受累严重
这一点我深有体会，我当初在病房管的最后一个病人就是SJS-TEN。患者早期真的是吃不下去东西啊，全靠营养科的老师给配的营养粉喝，甚至喝都费劲。丙球＋激素，1周就挺过来了。说句题外话，那一周可是QN的副主任医师查房hhhh，记忆深刻。最后患者出院那天也是我离开病房的那天，天空中还下着小雪。
8年2版写的还是差一些，最好做个表格
Case 10：面部浸润性红斑肿胀伴疼痛、发热3天余
这种急性病程的，八成是感染，估计丹毒或者蜂窝织炎
还是需要注意面部的蜂窝织炎也要喉头水肿窒息
治疗就是抗生素，波动感明显可以切开引流。这个Case缺个图。
开始阅读安德鲁斯，我发现我只需要每天阅读5页，就能在毕业考试前读完。今日17-22页
物理性皮肤病：
一：热损害
热烧伤，电击伤，痱子，火激红斑
（一）热烧伤
I度表皮红斑；浅II度血清渗出，浅表组织水肿，不留瘢痕；深II度累及真皮；III度累及皮肤全层部分皮下组织；IV度累及深部肌腱
III和IV度需要植皮
（二）痱子
白痱，红痱，脓痱，深痱
通风降温，凉爽干燥；外用炉甘石，有感染用夫西地酸。瘙痒口服抗组胺药
二：冷损害
肢端青紫症，冻疮，冻伤，浸渍足综合征
（一）肢端青紫症：遇冷整个手足变为青紫色，与雷诺阵发性不同，无组织损伤(溃疡）。
1.神经性厌食常表现为肢端青紫，冻疮
2.肢端血管综合征（坏疽，雷诺，肢端青紫等）具有副肿瘤性，尤其是没有使用缩血管药物
（二）冻疮：受冷后局部发红肿胀，常发生于手足面耳
1.患者常未感觉寒冷损伤，但后来的红肿痒感觉得到。SLE,DLE，白血病
2.多穿衣服，戒烟，扩血管（硝苯地平，己酮可可碱
（三）冻伤：组织受冻，局部失去血供
1.温水浴恢复温度，抗凝，止痛。患者不再受冻前推迟复温。
最后一个项目，背单词

Mycosis

Tinea capitis

Tinea alba

Black-dot tinea

Tinea favosa

Kerion

Tinea coporis

Tinea crutis

Manus

Tinea manus

Tinea pedis

Unguium

Tinea versicolor

Candidiasis

intertrigo

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  1. CONNECT:[ UseTime:0.001010s ] mysql:host=127.0.0.1;port=3306;dbname=no_67808;charset=utf8mb4
  2. SHOW FULL COLUMNS FROM `fenlei` [ RunTime:0.001722s ]
  3. SELECT * FROM `fenlei` WHERE `fid` = 0 [ RunTime:0.001168s ]
  4. SELECT * FROM `fenlei` WHERE `fid` = 63 [ RunTime:0.000459s ]
  5. SHOW FULL COLUMNS FROM `set` [ RunTime:0.000808s ]
  6. SELECT * FROM `set` [ RunTime:0.000318s ]
  7. SHOW FULL COLUMNS FROM `article` [ RunTime:0.000528s ]
  8. SELECT * FROM `article` WHERE `id` = 474836 LIMIT 1 [ RunTime:0.002445s ]
  9. UPDATE `article` SET `lasttime` = 1774507379 WHERE `id` = 474836 [ RunTime:0.007058s ]
  10. SELECT * FROM `fenlei` WHERE `id` = 65 LIMIT 1 [ RunTime:0.000253s ]
  11. SELECT * FROM `article` WHERE `id` < 474836 ORDER BY `id` DESC LIMIT 1 [ RunTime:0.000429s ]
  12. SELECT * FROM `article` WHERE `id` > 474836 ORDER BY `id` ASC LIMIT 1 [ RunTime:0.000323s ]
  13. SELECT * FROM `article` WHERE `id` < 474836 ORDER BY `id` DESC LIMIT 10 [ RunTime:0.001474s ]
  14. SELECT * FROM `article` WHERE `id` < 474836 ORDER BY `id` DESC LIMIT 10,10 [ RunTime:0.003853s ]
  15. SELECT * FROM `article` WHERE `id` < 474836 ORDER BY `id` DESC LIMIT 20,10 [ RunTime:0.005861s ]
0.180708s