干燥症-马偕纪念医院.PPT

(Rheumatoid arthritis) (Rheumatoid arthritis) C spine AP view (open mouth) * A.I.R. Orientation For new staff Staff Dr. 李修身 Dr. 陳天令 Dr. 黃章喜(R5) Allergy, Immunology, Rheumatology Study: Teaching: Morning meeting ( W3 and W5, 7:45 am at 6F MICU meeting room) 2. Radiology-Rheuma combined meeting (once a month, W4, 4:00 pm at Radiology Department 4F meeting room) 3.病房主任 teaching (at least 4 times a month, 2 months /year) 4. Clerk teaching (usually W4, W5 W6, scheduled by 醫教部) 5.Bed side teaching (any time) 免疫風濕疾病相關症狀 a)??關節症狀: 觀察病人是否真的關節腫或是軟組織腫？是否有紅腫熱痛，是否有關節液？ (bulge sign). 是否有晨僵大於一小時情形？是否symmetric？受影響之關節區域(Mono/Oligo/poly)？發作的情形？持續或陣發性?是周邊或中樞關節？急性或慢性(持續存在六星期)？ b)??皮膚症狀: 觀察病人是否有 Malar Rash, Discoid rash, Photosensitivity, Oral ulcer, Skin ulcer, Genital ulcer, Heliotrope’s sign, Shawl’s sign, Pitting nail, Gottron’s papule, Mechanic hands, Raynaud‘s phenomenon, psoriasis. c)?掉髮、 眼睛乾燥、 口乾、 血管炎。 d)?持續不明原因的發燒， 肌肉疼痛或乏力。 e) 最近使用之藥物及過敏史, 相關疾病之家族史。 After admission # Infection or inflammation? ===? priority: the one which is life- threatening # If no old chart ===? 病歷查詢 , 報告查詢(OPD and Lab) # Rx may as OPD unless contraindication (e.g. drug adverse effects) 1. Hypersensitivity: NSAID’s, DMARD’s, antibiotics, …… (anaphylaxis, urticaria, angioedema, Steven-Johnson syndrome…) ** [dilantin, bactrium, tegretal, allopurinol] 2. Idiosyncratic reaction: antithyroid drugs, immunosuppressants 3. Discomfort: any drug 4. Overdose: hypoglycemic agents, hypnotics, acetaminophen…… Routine Examination a)?WBC-DC, Hb, Hct, MCV, platelet, ESR, CRP b)?Sugar, BUN, Cr, Na, K, GOT, GPT, Albumin, TG, Chol, U.A. (MAR) c) Urine routine , CCr, Daily urine protein d) STS-RPR, stool OB e)?Chest PA, 12-lead EKG f) Heart echo: pericardial effusion時或其它CV問題。 g)?腹部 Echo: ascites, serositis, 肝脾腫大, 排除感染。 h)?肺功能: Vasculitis, S