《诊断学》课程教学大纲.doc

Outline of Diagnostics课程名称：Diagnostics授课专业：五年制英文班临床医学专业学分和学时：理论课66学时，见习课68学时一、 理论课教学内容及基本要求Introduction【Objective and emphasis 目要求】1To master the basic contents of Diagnostics 掌握诊断学基本内容2To understand the ways of learning 理解诊断学学习方法【Instruction contents教学内容】1Definition of Diagnostics诊断学定义2The importance of learning Diagnostics学习诊断学重要性3Basic contents of Diagnostics诊断学基本内容4The ways of learning学习方法【The times教学时数】 0.5 hour ，0.5小时【Teaching methods教学方法】instruction, multiple media presenting, 讲授,多媒体History collection (Inquisition) 病史采集【Objective and emphasis 目要求】1To master the contents of inquistion掌握问诊内容2To understand the inquisition skill理解问诊技巧【Instruction contents教学内容】 general data, chief complaint, history of the present illness, past history,review of systems, personal history, Marital history, Menstrual and reproductive history family history.一般项目 主诉 现病史 既往史 系统回顾 个人史 婚姻史 月经和生育史 家族史【The times教学时数】1.5 hour，1.5小时【Teaching methods教学方法】 instruction, multiple media presenting, case-presenting 讲授，多媒体，临床实习History record 病史记录【Objective and emphasis 目要求】1. To master how to make a history record掌握怎样记录病史2. To understand the basic requirement for the history record理解病史记录基本要求【Instruction contents 教学内容】（一）Outline of case record 病史记录提纲1. Biographical data 一般资料2. chief complaint 主诉3. History of present illness (HPI) 现病史4. Past history (PH) 既往史6. Personal history 个人史7. Marital history 婚姻史8. Menstrual history ( for female patients) 月经史9. Childbearing (reproductive) history 生育史10. Family history (FH) 家族史11. Physical examination (PE) 体格检查12. Laboratory tests and instrumental examination 实验室检查和仪器检查13. Primary diagnosis 初步诊断（二）Example of case record 病历示范【The times 教学时数】 2 hours ，2小时【Teaching methods 教学方法】 instruction, power point showing, case-presenting 讲授,多媒体，临床实习Common symptoms 常见症状 Fever发热【Objective and emphasis 目要求】 1To master the type of fever and clinical classification掌握发热类型和临床分类2To understand the mechanism of fever and etiology理解发热机制和病因【Instruction contents 教学内容】1Physiology 生理机制2Mechanism of fever发热机制3Etiology 病因4Clinical classification:临床分类5Clinical manifestation临床症状6Type of fever热型（1）Continuous(continued) fever 稽留热（2）Remittent fever弛张热（3）Intermittent (periodic) fever周期性发热（4）Undulant fever波状热（5）Relapsing (recurrent)fever间歇热（6）Irregular fever不规则发热7Symptoms and signs of fever发热症状和体征【The times 教学时数】 2 hour 2小时【Teaching methods教学方法】 instruction, multiple media presenting, 讲授,多媒体Abdominal pain腹痛【Objective and emphasis目要求】1To master the contents of abdominal pain掌握腹痛内容2To understand the significance of abdominal pain了解腹痛意义【Instruction contents 教学内容】1Inquisition technique问诊技巧2Contents of inquisition for abdominal pain腹痛问诊内容（1）Where is the pain located? (Site)疼痛部位?（2）Where does the pain radiate to(referred pain), or does it originate elsewhere and move to the abdomen?疼痛放射到哪里?或疼痛原发于别部位然后转移至腹部?（3）whar kind of pain is it? (Character)疼痛性质?（4）How sever is it? (Severity)疼痛程度?（5）What other symptoms accompany the pain?疼痛伴随哪些症状?（6）What factors bring it about? 什麽原因导致疼痛发生?（7）What factors cause relief of pain? (Aggravating and Relieving factors) 什麽原因可减轻疼痛?（8）In chronic abdominal pain inquire about the patients day. 慢性腹痛病人要问诊疼痛时间（9）Again in chronic pain it is useful to inquire about the periodicity of the pain. 慢性腹痛病人问诊疼痛周期性3Clinical Significance临床意义【The times 教学时数】 2 hours 2小时【Teaching methods教学方法】instruction, multiple media presenting， 讲授，多媒体Cough ,sputum production and dyspnea咳嗽,咳痰和呼吸困难【Objective and emphasis 目要求】1To master the causes and mechanism of sputum production and dyspnea掌握痰液产生和呼吸西困难机制和原因2To understand the clinical significance of sputum and dyspnea理解痰液产生和呼吸西困难临床表现【Instruction contents教学内容】 1Definition of cough and dyspnea咳嗽和呼吸困难定义2Causes and mechanism病因和机制respiratory disorders呼吸疾病pleural diseases胸膜疾病cardiovascular disorders心血管疾病central nervous system disorders中枢神经系统疾病3Sputum production痰液产生Transudates漏出液Exudates渗出液Mucus黏液Dusts aspirated吸入灰尘Infracted tissues坏死组织4Causes and significance of dyspnea呼吸困难病因和临床表现【The times教学时数】2 hours教学时数 2小时【Teaching methods教学方法】instruction, power point showing, case-presenting讲授,幻灯片,病例分析CHAPTER 1. Basic methods for physical examination 体检基本方法【Objective and emphasis 目要求】1To master the basic methods of physical examination掌握体格检查基本方法2To understand the significance of these physical examination理解体格检查意义【Instruction contents 教学内容】1Inspection: the definition of inspection and give some examples视诊: 视诊定义并举例2Palpation: the definition of palpation and the kinds of palpation, to master the maneuver of palpation and their significance.触诊: 触诊定义和分类,掌握触诊方法和意义3Percussion: the definition of percussion and the kinds of percussion, to master the maneuver and the different sounds produced by percussion.叩诊：叩诊定义和分类,掌握叩诊方法和意义4Auscultation: the definition and the significance of auscultation. Know how to use stethoscope.听诊: 听诊定义意义.掌握怎样使用听诊器5Olfactory examination: know some special odors that could provide valuable clues in clinic.嗅诊：掌握一些在临床上提供有意义线索特殊气味.【The times 教学时数】2 hours 2小时【Teaching methods教学方法】instruction, power point showing讲授,幻灯片CHAPTER 2. General examination 一般检查【Objective and emphasis 目要求】1To master the basic methods and the contents of general examination掌握一般检查基本方法和内容2To master measurement of the temperature, blood pressure and examination of sequence and maneuver of lymph nodes掌握体温测量,血压测量方法和淋巴结检查顺序和方法3To understand the significance of the physical examination and master the normal and abnormal signs and clinical significance理解体格检查意义,掌握正常和异常体征及临床意义【Instruction contents教学内容】 Vital signs: the normal range and abnormal conditions of Temperature, Blood pressure, Pulse, Respiration. To master measurement of the temperature, blood pressure. 生命体征：正常范围,体温血压,脉搏,呼吸异常情况.掌握体温血压测量方法Sex：know some sex-related disease such as hemophilia, systemic lupus erythematous.性别：知道哪些性别相关性疾病,如血友病,系统猩红斑狼疮Age年龄Development and habitus: know the judgments about the normal development and three types of habitus.发育和姿势:掌握正常发育和三种姿势Nutrition: how to judge the state of nutrition.营养:怎样判定营养状态State of consciousness: the definition of the Somnolence, Confusion, Stupor, Coma.意识状态:嗜睡,昏睡,木僵和昏迷定义Position and posture: the three types of position including active position, passive position and compulsive position.体位和体态:主动体位,被动体位,强迫体位Gait步态Facial (features) characteristics: know the abnormal sign and clinical significance about the facial面容特征:掌握异常面容体征和临床意义如急性面容,慢性面容,肝病面容,甲状腺功能减低面容,满月脸,二尖瓣面容feature such as Acute facial feature, Chronic facial feature, Hepatic face, Hyperthyroidism face, Moon face, Mitral face.Skin: to master the definition of spider angioma and its clinical significance.皮肤:掌握蜘蛛痣定义和临床意义Edema: the definition and kinds of edema and its significance.水肿:水肿定义和意义Subcutaneous nodules and hair 皮下结节和毛发Lymphatic node: to master examination of sequence and maneuver of lymph node. Significance of lymphatic node if be palpated.淋巴结:掌握淋巴结检查顺序和方法,可触到淋巴结意义【The times教学时数】 2 hours 2小时【Teaching methods教学方法】instruction, power point showing 讲授,幻灯片CHAPTER 3. Head and neck 头颈【Objective and emphasis 目要求】1To master the methods and the contents of head and neck examination掌握头颈检查方法和内容2To master the significance of the physical examination: especially measurement of sequence and maneuver of carotid artery, jugular vein, thyroid and trachea掌握体格检查意义:颈动脉,颈静脉甲状腺和气管检查顺序和方法3To understand the examination of sequence and maneuver of head理解头部检查顺序和方法【Instruction contents 教学内容】1Head: to master the contents of examination of the head and the maneuver of the detection of the cranium, to know certain deformities of the skull, such as头部：掌握头部检查内容和颅部检查方法,知道头颅畸形,例如Microcephalus头颅过小 Squared skull方型颅Deforming skull畸形颅Oxycephalia (tower skull, steeple skull)尖颅Macrocephalus头颅过大 2Eyes：to master the normal and abnormal signs and their significance in clinic眼：掌握正常和异常体征及其临床意义（1）Eyebrow:眉毛（2）Eyelids眼睑1）Disturbance of closure of the eyelids:眼睑关闭异常2）Ectropion 睑外翻3）Entropin睑内翻4）Eyelid edema 眼睑水肿5）Eyelid ptosis睑下垂（3）Conjunctiva：结膜（4）Eyeball:眼球l）Exophthalmos：眼球突出2）Enophthalmos：眼球内陷3）Eyeball movements眼球运动（5）Sclera：yellow sclera often was seen in jaundice巩膜:巩膜黄染常见于黄疸（6）Cornea：角膜（7）Iris and pupil：虹膜和瞳孔l）Pupillary shape：瞳孔形状 2）Pupillary direct and consensual response to light: to master the contents of examination, the maneuver and significance 瞳孔光反射：掌握检查内容,方法和意义 3）Convergence and accommodation集合反射4）Functional ocular examinations, including vision (acuity), color sensation:. 眼功能检查，包括视力，色觉3Ears耳4Nose：to master the examinations contents, the maneuver and significance of paranasal sinuses鼻：掌握检查内容,方法和意义5Mouth (Oral cavity)口腔1）Inspect the lips: to know the abnormal signs such as Pallor, Redness, Cyanosis and pigmentation视诊口唇：异常体征如苍白,紫绀和色素沉着2）Inspect oral mucous membrane: to know the abnormal signs such as Pallor, Redness, Cyanosis and pigmentation视诊口黏膜：掌握异常体征如苍白,红润,紫绀和色素沉着3）Examine the teeth and gingiva (gum): Method for counting the teeth检查牙齿和牙龈:牙齿计数方法4）The tongue: 舌5）Pharynx and larynx: Method for examining the Pharynx and larynx. To master the Degree of the enlarged tonsil咽喉：咽喉检查方法.掌握扁桃体肿大程度6. Neck: to learn the anatomy of the neck and the contents of physical examinations.颈部：掌握颈部解剖和检查内容1）Cervical vessels: to master the definition and significance of distended cervical vein 颈部血管：掌握颈静脉扩张定义和意义2）Thyroid gland: to master the palpation of the thyroid gland and the degree of thyroid gland enlargement. Know how to describe the thyroid gland when you palpate and auscultate the thyroid gland甲状腺：掌握甲状腺触诊方法和肿大程度.掌握甲状腺触诊和听诊描述3）Trachea: to master the contents of examination, the maneuver and significance 气管：掌握检查内容,方法意义 【The times教学时数】 2 hours 2小时【Teaching methods教学方法】 instruction, power point showing, case-presenting. 讲授，幻灯片，临床实习CHAPTER 4. Abdominal examination 腹部检查【Objective and emphasis 目要求】1To master the markers and the lines of body surface, the areas and important viscera underlying these regions.掌握体表线和体表标志，分区和这些区域重要内脏器官2To master inspection, palpation, percussion, auscultation of abdomen. Especially palpation of liver and spleen. 掌握腹部视,触,叩听方法,特别是肝脾触诊3To understand the symptoms and signs of common abdominal diseases理解常见腹部疾病症状和体征【Instruction contents 教学内容】1. the markers and the lines of body surface, the areas and inoportant viscera underlying these regions. 掌握体表线和体表标志,分区和这些区域重要内脏器官2.examination of abdomen腹部检查(1)Inspection: symmetry, abdominal pulsation, shape, scars, sinuses, fistuas, engorged vein, flank haemorrhages, Visible peristalsis.视诊:对称性,腹部搏动,形状,瘢痕,窦道,瘘管,扩张静脉,胁腹出血，胃肠蠕动波(2)Palpation: direct tenderness and resistance of muscle, rebound tenderness, palpation of liver, spleen, gallbladder, kidney, atrtributes of masse, fluid trills, succusion splash, tender spots of kidney and ureter.触诊:直接压痛和腹壁紧张度,反跳痛,肝脏,脾脏,胆囊,肾脏,包块,液波震颤，振水音,肾脏和输尿管压痛点(3)Percussion: Traubes space, regions of liver, spleen, bladder and kidney.叩诊:胃泡鼓音区，肝脾，膀胱和肾脏区域(4)Ascultation: bowel sound abdominal bruits, friction rubs.听诊:肠鸣音和摩擦音3. The symptom and sings of common abdominal diseases: Peptic ulcer diseases and the complications, hepatic cirrhosis and portal hypertention, intestinal obstruction, acute peritonitis, appendicitis.常见腹部疾病症状和体征:消化性溃疡和并发症,肝硬化和门脉高压,肠梗阻,急性腹膜炎,阑尾炎【The times教学时数】14 hours (Instruction 6 hours, practice 8 hours) 14小时【Teaching methods教学方法】instruction, power point showing ,case-presenting. 讲授,幻灯片,临床实习CHAPTER 5. Physical examination of the thorax 胸部体检【Objective and emphasis 目要求】1To master the methods and the contents of thorax examination 掌握胸部体检方法和内容2To master the mechanism and clinical significance of tactile fremitus and abnormal percussion掌握触觉语颤机制和临床意义3To understand the physical examination and positive signs of some common pulmonary diseases了解常见肺部疾病体格检查和阳性体征【Instruction contents 教学内容】1the markers and the lines of body surface, the areas and imoportant viscera underlying these regions.掌握体表线和体表标志，分区和这些区域重要内脏器官2examination of thorax胸部检查（1）Inspection of the lung and pleura肺和胸膜视诊（2）Palpation of the lung and pleura肺和胸膜触诊（3）Percussion of the lung and pleura肺和胸膜叩诊（4）Auscultation of the lung and pleura肺和胸膜听诊3The symptom and sings of common respiratory diseases: pneumothorax,emphysema,Pleural effusion, pneumonia常见胸部疾病症状和体征【The times教学时数】 14hours（Instruction 6 hours, practice 8 hours）14小时（讲授6小时,实习8小时）【Teaching methods教学方法】 instruction, power point showing,case-presenting. 讲授,幻灯片,临床实习CHAPTER 6. Cardiovascular system 心血管系统【Objective and emphasis 目要求】1To master the examining sequence and methods of  heart，including inspection, palpation, percussion and auscultation. 掌握心脏检查顺序和方法包括: 视,触,叩,听方法2To master the producing mechanism of heart murmurs and their clinical significance. Mastering the key points of auscultation of heart murmurs and differential diagnosis of physical and pathological heart murmurs. 掌握心脏杂音产生机制和他们临床意义.掌握杂音听诊关键点和生理性杂音和病理性杂音鉴别诊断3understand the symptoms and sings of common heart diseases . 理解常见心脏疾病症状和体征【Instruction contents 教学内容】1Heart 心脏Inspection 视诊1）Observing precordium 观察心前区2）The location, intensity and scope of normal apical impulse and clinical value of its displacement. 正常心尖搏动部位,强度和范围,异常临床意义3）Abnormal pulsations in the other areas and their clinical values其他区域异常搏动和临床意义Palpation触诊 1）The location, intensity and scope of normal apical impulse and clinical value of its displacement.正常心尖搏动部位,强度和范围. 异常临床意义2）The precordial pulsations location and its amplitude, duration and intensity. 心前区搏动部位,强度,持续时间和强度.3）The producing mechanism of thrills and location, intensity and quality of thrills. 震颤产生机制和部位强度和性质4）Pericardial friction rub 心包摩擦感Percussion 叩诊1）The percussion method of the heart. 心脏叩诊方法2）The heart borders and their constituents. 心界大小3）Normal relative dullness of the heart and changing cardiac dullness.心脏相对浊音界和绝对浊音界Auscultation 听诊It includes rate, rhythm, heart sound, murmur and pericardial friction sound. 包括心率,心律,心音,杂音和心包摩擦音1）Auscultatory Valve Areas 听诊瓣膜区2）The producing mechanism of heart sound and differential diagnosis of normal heart sounds（S1 and S2）. 心音产生机制和正常心音鉴别诊断3）Heart rate and heart rhythm. 心率和节律4）The producing mechanism and characteristics of heart murmurs (Location, timing, quality, radiation, and intensity).心脏杂音产生机制和性质(部位,时期,性质,放射和强度)5）The producing mechanism and its clinical values of pericardial friction rub. 心包摩擦音产生机制和临床意义2Blood Vessels 血压1）The arterial pulse and its rate, rhythm, intensity and tension. 动脉脉搏和频率,节律,强度和张力2）The producing mechanism and characteristics of wave forms (Water hammer pulse, P