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学习笔记3.17

  • 2026-03-24 16:16:13
学习笔记3.17
首先继续阅读临床思维书
Case 11：左足浸润性红斑肿胀伴疼痛发热5天
典型的感染类疾病主诉
学习一下蜂窝织炎的问诊特点，注意查体淋巴结
Case 12：右胫前水肿性红斑伴疼痛1天
典型的丹毒部位，小腿和面部
注意问破溃的诱因以及机体免疫力的因素
Case 13：左侧面颊水肿性红斑伴疼痛3天
典型丹毒部位
面部丹毒要问是不是挖鼻孔，拔鼻毛
Case 14：头皮，右耳前，右手多个指间关节，右外踝多发性无痛性包块半年余
好嘛，但看主诉以为是肿瘤类，毕竟包块应该挺大的。如果是结节也可能是代谢类的。但是后面人家说还有破溃，那就要考虑感染了。这个问诊思路还是值得学习的。
有无外伤史很重要。感染性皮肤病如果没有明确外伤可能是播散性感染。
细菌感染一般红肿热痛。结核是冷性，无明显疼痛，皮温不高，中央可发生软化，坏死。然后再找可能的诱因，自身免疫病，酗酒，HIV，糖尿病。
抗酸染色还是必要的。尤其是看了这本书竟然那么多麻风和结核。搞的我每个患者都问问感觉有没有减退。这本书12年出的，也不知道那个时候是否流行做NGS
luo,li皮肤结核。我印象去年切活检碰见一个，回去找找，简直是豆腐渣子。忘了做没做抗酸染色了。
接下来第二个活儿，看安德鲁斯教材。P25-36
三：光损伤：日晒伤，雀斑，光老化
日晒伤：UVB，出汗，光敏物质（芹菜，香菜，柠檬；四环素，胺碘酮，磺胺）
光老化：弹力纤维病，Civatte皮肤异色，胶样粟丘疹
四：光敏感：化学性，代谢性，特发性，遗传性
化学性：煤焦油沥青，空气传播，不需要接触；植物性呋喃香豆素
特发性：多形性日光疹（PLE）多发于面颈，V区，臀部；
光化性痒疹；
肱桡瘙痒症（日光诱发，颈椎病易感）；
日光性荨麻疹；
种痘样水疱病，
慢性光化学皮炎
五：放射性皮炎：急性，慢性，放射性癌
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  140. /yingpanguazai/ssd/ssd1/www/no.67808.cn/vendor/topthink/think-trace/src/Html.php ( 4.42 KB )
  1. CONNECT:[ UseTime:0.000916s ] mysql:host=127.0.0.1;port=3306;dbname=no_67808;charset=utf8mb4
  2. SHOW FULL COLUMNS FROM `fenlei` [ RunTime:0.001547s ]
  3. SELECT * FROM `fenlei` WHERE `fid` = 0 [ RunTime:0.011777s ]
  4. SELECT * FROM `fenlei` WHERE `fid` = 63 [ RunTime:0.004919s ]
  5. SHOW FULL COLUMNS FROM `set` [ RunTime:0.001399s ]
  6. SELECT * FROM `set` [ RunTime:0.000616s ]
  7. SHOW FULL COLUMNS FROM `article` [ RunTime:0.001477s ]
  8. SELECT * FROM `article` WHERE `id` = 475154 LIMIT 1 [ RunTime:0.002208s ]
  9. UPDATE `article` SET `lasttime` = 1774452127 WHERE `id` = 475154 [ RunTime:0.040561s ]
  10. SELECT * FROM `fenlei` WHERE `id` = 65 LIMIT 1 [ RunTime:0.007739s ]
  11. SELECT * FROM `article` WHERE `id` < 475154 ORDER BY `id` DESC LIMIT 1 [ RunTime:0.002015s ]
  12. SELECT * FROM `article` WHERE `id` > 475154 ORDER BY `id` ASC LIMIT 1 [ RunTime:0.002639s ]
  13. SELECT * FROM `article` WHERE `id` < 475154 ORDER BY `id` DESC LIMIT 10 [ RunTime:0.001786s ]
  14. SELECT * FROM `article` WHERE `id` < 475154 ORDER BY `id` DESC LIMIT 10,10 [ RunTime:0.006402s ]
  15. SELECT * FROM `article` WHERE `id` < 475154 ORDER BY `id` DESC LIMIT 20,10 [ RunTime:0.001915s ]
0.259243s