诊断学：实习指导(英文).doc

诊断学：实习指导(英文)THE AIDED T_TBOOK OF DIAGNOSTICS THE PRACTICING GUIDANCE OF DIAGNOSTICS GRADE：CLASS：GROUP：THE DIAGNOSITICS DEPARTMENT OF SUN YAT-SEN UNIVERSITY 20 12.2 CATALOGUE CHAPTER 1 The report of normal physical e_amination General e_amination and the e_amination of head and neck 1 The normal thora_ and lung e_amination 3 The normal cardiovascular e_amination 4 The normal abdomen, spine and e_tremities and nervous refle_ed 5 CHAPTER 2 Laboratory test Hematological test 6 Bone marrow test 7 Urinanalysis 17 The report of blood and urine test 22 CHAPTER3 Case Discussion The teaching on case discussion 27 Case discussion 29 CHAPTER 1 the Report of Normal Physical E_amination General E_amination and the E_amination of Head, Neck General inspection ：Development: ；Body type ；Nutrition ；Mental status ；Facial e_pression ; Position: ；Gait Skin: Color ; Temperature ; Moisture ; Elasticity ， ，Rashes ，Pigmentation: ; Subcutaneous bleeding: ; Purpura: ; Spider angioma: ; Scar: .Lymph nodes: .The enlarged lymph node: Head: E_terior earance ; Shape ; Hair ; Color ;gloss Face: Color ; Tenderness ; Abnormal motion Eye: Eyebrow ; Eyelids: ; The movement of eyeballs , Proptosis ; Recession: : Conjunctiva: ; Sclera: ; Cornea: ; Iris: ; Convergence refle_: Pupils: Size ; Shape: ; Symmetry: ; Light refle_: ; Acmodation response: Ear: E_terior earance: ; Hearing acuity: ; The tenderness of mastoid: ; Abnormal secretion: Nose: E_terior earance: ; Abnormal secretion: ; The tenderness of nasal vestibule: ; The nasal passage: Mouth: Odor: ; Llip: , Cranny: ; Breakage: ; Herpes: Tongue: Thrills: ; Deviation: ; Fur: Gingival: Color: ; Edema: ; Purulence: ; Bleeding: ; Breakage: ; Blue line: ; Others: Teeth: Mucosa of mouth: ; Herpes: ; Pigmentation: ; Breakage: ; Others: Oropharyn_: Palatum: ; Palatal ach: ; Uvular: ; Tonsil: ; Retropharyngeal back wall: Right Left (upward) Neck: E_terior earance: ; Malformation: ; The movement: ; The venous in a sitting position: ; The pulse of jugular vessel: ; The thyroid gland: ; The trachea: E_aminer: E_aminer: Date: The Report of E_amination of Normal Chest and Lungs Inspection: Palpation: Percussion Auscultation E_aminer: Date: The Report of E_amination of Cardiovascular System Inspection: Palpation: The Relative Cardiac Dullness of Healthy Adult Right (cm) Chest interspace Left (cm) II III IV V Percussion Auscultation E_aminer: Date: The Report of E_amination of Normal Abdomen and Neurological Refle_ Inspection: Palpation: Percussion Auscultation Spine and e_tremities Neurological refle_es E_aminer: Date: CHAPTER 2 Laboratory e_amination Laboratory e_amination of hematology Differential white blood cell count (differential leukocyte count) 1.Principle: A smear was prepared directly from a drop of blood, and then was stained with a stain.The blood cells were distinguished from others and the differential was performed with microscope according to their tinctorial property.The changes of their relative proportion and earance or shape have diagnostically significance.2.Reagents and equipment: Wright-Giemsa&rs;s stain, microscope, cedar oil, aether, alcohol (75V/V), slide, sterile disposable lancet, cotton ball or cotton swab, lens paper, sterile forceps, suction bulb.3.Procedure: 1) Obtaining capillary blood: Obtain capillary blood from third fingertip, disinfect the skin surface on and around the intended puncture site with 75 alcohol, dry the site, and puncture skin with sterile disposable lancet None deeper than 3 mm to result in free bleeding, squeezing should be avoided.Wipe away the intial drop of blood with dry cotton swab.2) Preparing a smear: Touch the slide to second drop, transferring a small drop of blood to the slide about 2.5 cm from one end.Hold the slide containing the drop of blood firmly with left hand.Hold the spreader with right hand and place the end of the spreader on the surface of the other slide.Raise the other end of the spreader to an angle none greater than 30 degrees, in front of the drop of blood.Pull the spreader back into the drop of blood.When the blood has spread along two third of the width, push the spreader forward with a steady even motion.3) Air-dry the smear.Do not blow on it.4) Staining: Place the blood smear on the staining rack, blood side up, and flooded with Wright- Giemsa stain.Leave on for 1 minute.Then once again flooded with an equal voume of buffer solution.Blow gently on the smear to mi_.Let the smear stand for 15-20 minutes (the optimum time is determined by trail and error).Rinse thoroughly with a stream of running tap.Wipe the back of the slide with a cotton ball and stand them on the end to dry.5) Microscopic e_amination: At first, scan the smear under low power lens.Observe the distribution of leukocytes and choose that portion of the smear, usually near the thin end, where there is no overling of erythrocytes.Then add a drop of cedar oil on the smear and shift to the oil immersion objective.Counting and classifying each leukocyte in the successive fields.At least 100 nucleated cells should be classified when the leukocyte count is normal.Report the percentage of each kind of leukocytes you have recorded.4.Remarks: 1) Wipe away the initial drop of blood to avoid contaminating the endothelial cells from the impaired blood vessel.Dry adequately the smear before the staining.Otherwise, the blood film will fall off.2) The concentration of stain solution, room temperature, and the number of cells on the smear all is involved with the optimum staining time.Generally, scan the slide and judge the quality of staining under the low power lens.3) lying adequate stain solution on the smear to prevent from the precipitation of a little dye spot.4) Rinse with the stream of running tap.Do not discard the stain before rinsing.5) Do not leave the tailing of blood film out staining because there are some large cells (megakaryocyte and some specific pathologic cells for instance tumor cells) in this portion.6) To avoid accidentally counting the same field twice, move the microscope stage in a consistent direction, straight up or straight down, and when near the edge of the smear, move the stage to the right, skipping an entire field.Then continue in the opposite direction.Table 1 Normal Values of Hemogram Adults Children male female Red blood cell count (RBC, 10 12 /L) 4.05.5 3.55.0 Newborn 6.07.0 White blood cell count (WBC, 10 9 /L) 4.010.0 Newborn 1520, 624 mo 1112 Hemoglobin(Hb, g/L) 120160 110150 Newborn 17020_Reticulocyte count 0.51.5 Newborn 26 Differential leukocyte count Neutrophils Band neutrophils 15 Segmented neutrophils 5070 Eosinophils 0.55 Basophils 01 Lymphocytes 2040 monocytes 38 No.Practical report Practical report of differential leukocyte count Cell type Normal value 10 10 10 10 10 10 10 10 10 10 Total of cells Neutrophilic Granulocyte myelocyte 0 Meta- myelocyte 0 Band neutrophils 15 Segmented neutrophils 5070 Basophils 01 Eosinophils 0.55 Lymphocyte 2040 Monocyte 38 Morphologic e_amination of the bone marrow cells Bone marrow e_amination is used for the diagnosis or the differential diagnosis of a number of hematologic disorders (definite diagnosis,).And bone marrow aspiration is usually contraindicated in the precence of hemophilia and other serious coagulation disorders.Procedure and objects to be observed: 1.Morphologic e_amination of the bone marrow cells 1) E_mination with low power lens: scan the whole slides to determine 2) Whether the preparation of the smear (collection of pattern, smearing, and staining) is satisfactory.3) Proliferative degree of bone marrow nucleated cells(shown in table 2).4) Number of the megakaryocyte on the whole slide.5) Presence or absence of specific cells.2.E_mination with oil immersion lens: 1) Differentiate and count at least 20_nucleated cells, note the number and the shape(morphous) of these nucleated cells.2) Calculate the percent of hemaoietic cells (different stages from g ranulocytic, erythrocytic, lymphocytic, and monocytic series).3) Calculate the G: E ratio (granulocyte to erythroid ratio) or M: E (myeloid to erythroid ratio).4) View the m第 7 页 共 7 页