15 Jun 2008 - PSDAS 專業服務發展資助計劃

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Restricted use for members only Dizziness 頭暈 Adapted from Lindsay M. Dizziness. In Wong WCW, Lindsay M, Lee A (Ed). Diagnosis and Management in Primary Care: Problem Based Approach. The Chinese University Press, <strong>2008</strong>. 參考書目 :《基層醫療裡的診斷和治理 : 以問題為基礎的方法》 The first way is by subdividing into systemic categories such as: 第一步是做系統性的分類 , 例如 : 1. Ear (inner and middle) 耳朵 ( 內耳及中耳 ) 2. Cardio-vascular 心血管 3. Cervical Spine 頸椎 4. Brain itself 腦部 5. Anxiety-Hyperventilation 焦慮性換氣過度 6. Vaso-vagal 血管迷走神經 7. Drug 藥物 8. Other 其他 Inner Ear 內耳 Acoustic Neuroma 聽神經瘤 Middle Ear 中耳 Otitis media/externa including Ramsay-Hunt Syndrome 中耳炎 / 外耳炎 , 包括 Ramsay-Hunt 綜合癥 Wax 耳垢 Auditory Tube Dysfunction 咽鼓管功能失調 Cardio-vascular 心血管 Anaemia 貧血 Arrhythmias 心律不齊 Aortic Stenosis 主動脈狹窄 Myocardial Infarction 心肌梗塞 Hypertension or Hypotension 高血壓或低血壓 Cervical Spine 頸椎 Cervical Spondylosis causing Vertebro-Basilar Insufficiency (VBI) 脊椎關節炎 , 引致椎骨基底動脈缺血 Brain 腦部 • (TIA)/Cerebro-Vascular Accident (CVA) TIA / 心腦血管意外 (CVA) • Any Space-Occupying Lesion e.g. tumours, abscesses 佔位性病變 , 例 : 腫瘤、膿腫 • Multiple Sclerosis (rare amongst Chinese) 多發性硬化 ( 華人中比較罕見 ) Drug 藥物 • Alcohol 酒精 • Ototoxic drugs e.g. aspirin/NSAI, gentamycin, antidepressants, antihypertensives, anti-psychotics, anti-epiletics 耳毒性藥物 , 例如 : 阿史匹靈 / 非甾體抗炎藥、慶大霉素、抗抑鬱劑、降壓藥、抑制精神藥物、抗癲癇藥 • Other: Hypoglycaemia 其他 : 低血糖 4
Restricted use for members only Syncope 暈厥 Is loss of consciousness. 喪失知覺 Cardiovascular causes 心血管的原因 : • Anaemia 貧血 • Hypertension 高血壓 • Postural hypotension 姿勢性低血壓 • Vaso-vagal 血管迷走神經 • TIA/CVA TIA / CVA( 心腦血管意外 ) • Arrhythmia 心律不齊 • Aortic Stenosis 主動脈狹窄 Other 其他原因 : • Anxiety-hyperventilation 焦慮性換氣過度 • Head injury 頭部受傷 • Drugs 藥物 Giddiness “ 頭昏眼花 ” • A non-specific term. Sensation of ill-defined light headedness 用以形容癥狀不確定 ; 一種 “ 頭輕輕 ” 的不舒服感覺 The elderly are more likely to have wax in their ears causing dizziness, whilst young women who forget breakfast and become hypoglycaemic around mid-morning or have a vasovagal attack in hot, stuffy places. 老年人通常是因為耳朵裡積聚耳垢而產生頭暈 ; 年輕女性則通常因為沒有吃早餐引致血糖下降 , 或者因為身處悶熱場所而出現血管迷走神經性發作 Giddiness “ 頭昏眼花 ” The most likely causes are (and subdivided into age related risk) 常見的原因 ( 再以與年齡相關之風險分類 ): ENT 耳鼻喉的問題 : ‣ Otitis media/externa including Ramsay-Hunt Syndrome 中耳炎 / 外耳炎 , 包括 Ramsay-Hunt 綜合癥 ‣ Auditory Tube Dysfunction 咽鼓管功能失調 ‣ Viral Labyrinthitis or Neuronitis 病毒性內耳炎或神經炎 ‣ Benign Paroxysmal Positional Vertigo 良性陣發性姿態性暈眩 ‣ Wax* 耳垢 * ‣ Meniere‘s disease* 耳水不平衡 * * Especially the elderly 特別是老年人 Giddiness “ 頭昏眼花 ” The most likely causes are 常見的原因 : Cardio-vascular 心血管毛病 : Anaemia 貧血 Arrhythmias* 心律不齊 * Postural Hypotension* 姿勢性低血壓 * Hypertension 高血壓 Neck 頸部 : Cervical Spondylosis*/VBI* 頸椎關節炎 * / 椎基底動脈供血不足 (VBI)* Other 其他 : Drugs including Alcohol 藥物引發 , 包括酒精 Anxiety-Hyperventilation 焦慮性換氣過度 • Especially the elderly 特別是老年人 Especially the Young (usually women) 特別是年輕人 ( 通常是女性 ): Vaso-vagal 血管迷走神經 Hypoglycaemia 血糖過低 The important possibilities that (may) need to be excluded: 需要 ( 或可能要 ) 排除的一些重要的可能性 : 1. Space-Occupying Lesions inc acoustic neuroma & other cancers, abscesses 佔位性病變 , 包括腫瘤及其他癌癥、膿腫 2. Aortic Stenosis 主動脈狹窄 3. Myocardial Infarction 心肌梗塞 4. TIA / CVA( 心腦血管意外 ) The Assessment Standard 評估標準 Programmes offered by the CUHK in promoting Quality General Practice 香港中文大學在促進優質全科醫療實踐方面提供的課程 Sustenance in doing 持續性實踐 Ability of doing 有能力實踐 Knowing 認識 Learning 學習 AM Fellows 家庭醫學專科 Conjoint Fellows 家庭醫學院士 FM Diplomats 文憑班畢業生 5
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15 Jun 2008 - PSDAS 專業服務發展資助計劃

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