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Guidelines for Internal Medicine

(Temporary edition for Nepalese students)

Department of Internal Medicine, Weifang Medical College

2006-1-6
Outline of Diagnostics

The clinical diagnosis serves as a bridge between premedical and clinical medicine. It
includes physical diagnosis, laboratory diagnosis and some instrumental examination.

General teaching aims: Through theoretical teaching and clinical practice let
students grasp or know well the basic theory, basic knowledge and basic technique,
initially correct thoughtway in clinical diagnosis, establish the foundation for the
further study of clinical curriculums.

General requirements:

1. Mastering the characteristic of common symptoms.

2. Mastering the mechanisms or pathogenesis of common symptoms.


3. Mastering the approaches to and techniques of asking the patient's history.
4. Mastering the common methods of physical examination.
5. Mastering the mechanisms of typical signs and their clinical values.
6. Mastering the principles of laboratory examination and its clinical values as well as
its application indications.
7. Being familiar with the principles of ECG and mastering the features of normal and
abnormal patterns of ECG.
8. Cultivating the ability to analyze and synthesize clinical data, write complete in-
patient case history, and present the initial diagnosis.
Teaching contents and time distribution (1 class-hour: 40

minutes)

Total class-hour: 160


Theoretic: 80
Experimental: 40
Practical: 60

Content Theoretical Experimental Practical

Introduction 2  

Common symptoms 12

Physical examination 36 20 30

History Inquiry 4 8 10

ECG 10 6 10

Laboratory Diagnosis 16 6 10

Total 80 40 60

Introduction
Purpose and requirements

1.Understad the important role and significance of Diagnostics in clinical medicine.

2.Know the basic content of Diagnostics.


3.Understand the method and notes to learn the Diagnostics.
Teaching contents

1.Explaining the concepts and property of clinical diagnosis and its clinical
significance.
2. Explaining the contents of clinical diagnosis and its clinical types.

3. Explaining the principles of laboratory diagnosis and some instrumental


examination, and its relation with symptoms and signs.

4. Emphasizing building and how to culture correct thoughtway in clinical diagnosis.


5. Emphasizing the importance of basic medical knowledge in the Diagnostics
learning.

6. Emphasizing the combination of theory with clinical practice.

Class-hour: 1

Teaching approaches: theoretical teaching

Unit 1 Common Symptoms

Purpose and Requirements

1. Expounding the characteristics of symptoms.


2. Asking the students to master the clinical manifestations and pathogenesis of
common symptoms and their clinical significance.

Teaching contents

Including: fever; edema; cough and sputum expectoration; hemoptysis; dyspnea; pain
(chest pain, precardial pain, abdominal pain and headache); cyanosis; syncope;
diarrhea; changes of consciousness; vertigo; seizures.

1) Fever

a) General introduction of fever


b) Pathogenesis of fever
c) Etiology and classification of fever
d) Clinical manifestations of fever
e) Associated symptoms to fever
f) Diagnostic points
 

2) Edema

a) Definition of edema
b) Pathogenesis of edema
c) Etiology and clinical appearances of edema
*Generalized Edema

• Cardiogenic edema
• Nephrogenic edema
• Hepatogenic edema
• Malnutrition
• Idiopathic edema
• Miscellaneous

*Localized edema

d) Approach to the patient with edema

3) Cough and expectoration

a) Etiology
b) Clinical presentation

• Character of cough
• The duration and pattern of cough
• The tone quality of cough
• The character and volume of sputum

c) Accompanying symptom
 

4) Dyspnea

a) Etiology
b) Mechanism and clinical features (Key points)
*Respiratory dyspnea

• Inspiratory dyspnea
• Expiratory dyspnea
• Mixed dyspnea
*Cardiac dyspnea

• The dyspnea caused by right-sided heart failure


• The dyspnea caused by left-sided heart failure

Paroxysma nocturnal dyspnea (Key point)


 

5) Pain

1. Analysis of pain

a) Pathological physiology of pain


b) Clinical characteristics

• Character of pain
• Localization of pain
• Quality and intensity of pain
• Referred pain
• Aggravating and relieving factors

2. Features of common types of pain

a) Headache: cause and mechanism, clinical findings, accompany finding

b) Chest pain: cause and mechanism, clinical findings, accompany finding

c) Precardial pain: the characteristics of angina pectoris

Abdominal pain: cause and mechanism, clinical findings, accompany finding


Key points: the etiology and pathogenesis of pain; the characteristics of pain
 

6) Hemoptysis

a) Etiology

• Bronchial diseases
• Lung diseases
• Cardiovascular diseases
• Constitutional diseases
b) Clinical manifestations (The patient's age; The amount of coughing up blood; Color
and character)
c) accompany finding

7) Cyanosis

a) Definition
b) Mechanism
c) Etiology (Key points)
Four principal forms of cyanosis:

• Central cyanosis
• Peripheral cyanosis
• Mixed cyanosis
• Cyanosis resulting from abnormal hemoglobin pigments in the blood

d) Accompanying symptoms

8) Syncope

a) Definition
b) characteristic of syncope

c) Etiology: cardiac syncope

9) Diarrhea

a) Etiology
Ⅰ.Acute Diarrhea
Ⅱ.Chronic Diarrhea

b) Pathophysiological mechanisms
Ⅰ. Secretory diarrhea (increased intestinal secretion)
Ⅱ.Osmotic diarrhea
III. Decreased intestinal surface area and/or intestinal absorption
Ⅳ. Rapid transit of intestinal contents (shortened transit time)

c) Symtoms
d) Diagnostic procedures
10) changes of consciousness

a) Mechanisms
b) Clinical manifestation

11) Vertigo

a) Etiology and clinical manifestation


1. Periphral Vertigo ( otological vertigo)
2. Central Vertigo
b) Accompanying symptoms

12) Seizure

a) Etiology of seizure
· Medical conditions
· Neurological conditions
· Other causes of seizure
b) Clinical manifestation

Teaching periods: lecture 12, Clinical practice 8

Teaching methods: theory study and clinical practice

Unit 2 History collection (Inquisition) and Case


record
a) Mastering the importance of inquisition (asking history)

• Inquisition is an important part of diagnostic procedure through the


conversation between the patient and doctor.
• It is useful to understand the actual history of an illness, no other diagnostic
technology can take its place.
• For an experienced physician with profound knowledge, diagnosis or
impression can be made simply by inquisition. As the diseased organ would
give some clue by its pathophysiological changes.
• An inaccurate or rough history would lead you to make a wrong diagnosis.
b) Method of inquisition

c) Contents of inquisition

• General data
• Chief complaints
• History of present illness
• Past history
• Systems review
• Personal history
• Marital history
• Family history

d) History writing

• Basic requirement
• Forms and contents of the history
• General steps in history writing

Teaching periods: lecture 4

Teaching methods: theory study and clinical practice

Unit 3 Physical Examination

General principles an basic techniques of physical examination

Purpose and Requirements

1. Understanding the concepts of physical examination and its clinical


significance
2. Mastering the basic methods of inspection, palpation, percussion and
auscultation and their clinical significance.

Teaching contents

1. The concepts of physical examination and its clinical significance


2. The basic methods of inspection, palpation, percussion and auscultation and
their clinical significance.

Teaching periods: lecture 2


teaching methods: theory study and clinical practice

General examination

Purpose and Requirements

Mastering the contents of general examination and the significance of both normal
and abnormal signs.

Teaching contents

1. Mastering the relationship between sex as well as age and diseases.

2. Analyzing the clinical significance of body temperature, pulse, respiration, and


blood pressure.

• The examining methods of body temperature


• Normal range and variation of body temperature

3. Mastering the evaluation of growth and nutrition as well as the relationship


between disease and disturbance of consciousness, psychosis, facial expression,
posture, body movements and gait.

4. Identifying the color, shape, skin eruption, muculae, roseolae papulaes wheals,
maculopqpulaes wheals, maculopapulaes spider angioma, petechia, purpura,
ecchymosis and hematoma and knowing their respective significance.

5. Examining the lymph nodes, their distribution and significance.

Teaching periods: lecture 6, clinical practice 3

Teaching methods: Examining methods and the significance of signs should be


emphasized. The general examining methods, especially the examination of
lymph nodes, should be learned through clinical practice and mutual examination
of students.

Head

Purpose and Requirements


1. Mastering the examining sequence and methods of head.

2. Being familiar with the significance of both normal and abnormal signs.

Teaching contents

1. The general examination of head, hair and scalp.

2. The general examination of eyes, ears and noses.

3. Examining methods of oral cavity including lips, buccal mucosa, teeth, gums,
tongue, pharynx and larynx.

4. The clinical significance of abnormal signs.

Teaching periods : lecture 1; clinical practice 1

Teaching methods:

1. The general examining methods should be learned through clinical practice and
mutual examination of students.

2. Students should master the sequence of examination and know the normal signs.

3. Students should identify the abnormal signs and analyze their clinical significance.

Neck

Purpose and Requirements

1.Mastering the examining sequence and methods of head.

2. Being familiar with the significance of both normal and abnormal signs.

Teaching contents

1. The examination of blood vessels( auscultation), jugular veins and their respective
clinical significance.

2. The examination of thyroid gland and clinical significance of abnormal signs.

3. Examining methods of trachea and its significance of being displaced laterally.


Teaching periods: lecture 1; clinical practice 1

Teaching methods:

1. The examining methods of thyroid gland and trachea should be learned through
clinical practice and mutual examination of students.

2. Students should master the sequence of examination and know the normal signs.

3. Students should identify the abnormal signs and analyze their clinical significance.

Chest

Purpose and Requirements

1. Mastering the examining sequence and methods of chest including inspection,


palpation, percussion and auscultation.

2. Knowing the landmarks on chest wall and on bone, vertical line landmarks,
natural fossa and anatomic region, and boundary of lung and pleura.

3. Being familiar with the significance of both normal and abnormal signs of
common diseases as well as the pathogenesis of symptoms.

Teaching contents

1. The landmarks on chest wall and on bone, vertical line landmarks, natural fossa
and anatomic region, and boundary of lung and pleura and their respective clinical
significance.

2. The examination of chest wall, chest framwork, and breast.

3. The examination of lung and pleura:

1) Inspection

• respiratory movement
• respiratory rate
• change of the breath depths
• rhythm of the breath

2) palpation
• The examining methods of vocal fremitus and its clinical significance.
• The mechanism and characteristics of normal and abnormal vocal fremitus.

3) percussion

• The method of percussion(mediate and immediate percussion)


• Classification of the percussion notes (Resonance, Hyperresonance, Tympany,
Dullness, Flatness )
• Percussion of the pulmonary boundary
• Movement range of the lower pulmonary boundary

4) auscultation

• Normal breath sounds (vesicular breath sound, bronchial breath sound, and
bronchovescicular breath sound)
• Abnormal breath sounds (abnormal vesicular breath sound: decreased or
absent vesicular breath sound, increased alveolar breath sound, elongated
expiratory breath sound, interrupted breath sound, and hoarse breath sound )
and their respective significance.
• Abnormal bronchial breath sound and its significance.
• Abnormal bronchoalveolar breath sound and its significance.
• The pathogenesis, classification, qualities, and significance of rales and
rhonchi. (Classification of rales: loud or unloud rale; coarse, medium and fine
ones and even crepitations; classification of rhonchi: sibilant rhonchi;
sonorous rhonchi).
• The pathogenesis, qualities, and significance of pleural friction rub.
• The examining methods and clinical significance of vocal resonance.

4. The major symptoms and signs of common respiratory diseases and differentiation.

1) Lobar pneumonia

2) Chronic bronchitis complicated with emphysema

3) Bronchial asthma

4) pleural effusion

5) Pneumothorax

Teaching periods: lecture 16; clinical practice 4

Teaching methods:

1. The examining methods should be learned through clinical practice and mutual
examination of students.
2. Students should master the sequence of examination and know the normal signs.

3. Students should identify the abnormal signs and analyze their clinical significance.

4. Students should be familiar with the symptoms and signs of common respiratory
diseases and differentiation.

Heart

Purpose and Requirements

1. Mastering the examining sequence and methods of heart including inspection,


palpation, percussion and auscultation.

2. Mastering the producing mechanism of heart sound S1and S2.

3. Knowing the differentiation between S1 and S2 and clinical signification of


change in loudness, quality and splitting of heart sounds.

4. Mastering the producing mechanism of heart sound S3 and S4.

5. Mastering the producing mechanism of extra sounds.

6. Mastering 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.

7. Being familiar with the significance of both normal and abnormal signs of
common diseases as well as the pathogenesis of symptoms.

Teaching contents

1. Heart

Inspection

1) Observing precordium

2) The location, intensity and scope of normal apical impulse and clinical value of its
displacement.

3) Abnormal pulsations in the other areas and their clinical values.

Palpation
1) The location, intensity and scope of normal apical impulse and clinical value of its
displacement.

2) The precordial pulsation’s location and its amplitude, duration and intensity.

3) The producing mechanism of thrills and location, intensity and quality of thrills.

4) Pericardial friction rub

Percussion

1) The percussion method of the heart.

2) The heart borders and their constituents.

3) Normal relative dullness of the heart and changing cardiac dullness.

Auscultation

It includes rate, rhythm, heart sound, murmur and pericardial friction sound.

1) Auscultatory Valve Areas

2) The producing mechanism of heart sound and differential diagnosis of normal heart
sounds (S1 and S2).

3) Heart rate and heart rhythm.

4) The producing mechanism and characteristics of heart murmurs (Location, timing,


quality, radiation, and intensity).

5) The producing mechanism and its clinical values of pericardial friction rub.

2. Blood Vessels

1) The arterial pulse and its rate, rhythm, intensity and tension.

2) The producing mechanism and characteristics of wave forms (Water hammer pulse,
Pulsus alternans, Dicrotic pulse, Paradoxical pulse)

3) The measurement of arterial pressure and its significance.

4) Pistol-shot sound and Duroziez's sign.

3. Common symptoms and signs of cardiovascular diseases.


Teaching periods: lecture 18; clinical practice 12

Teaching methods:

1. The examining methods should be learned through clinical practice and mutual
examination of students.

2. Students should master the sequence of examination and know the normal signs.

3. Students should identify the abnormal signs and analyze their clinical significance.

4. Students should be familiar with the symptoms and signs of common


cardiovascular diseases and differentiation.

Abdomen

Purpose and Requirements

1. Knowing abdominal landmarks and mapping.

2. Mastering the method and content of abdominal inspection, palpation,


percussion, and auscultation

3. Being familiar with main symptoms, signs, and clinical significance of common
abdominal diseases.

Teaching contents

1) Topographic anatomy and two commonly used methods of subdividing the


abdomen and their respective clinical significance.

2) Inspection

• abdominal contour (abdominal flatness, abdominal fullness, and abdominal


lowness; Abdominal bulge and abdominal retraction)
• Respiratory movements
• The flowing directions of abdominal veins and their values.
• Gastral or intestinal pattern and peristalsis.

3) palpation
• The principle of palpation.
• Tenderness and rebound tenderness.
• The methods of palpation of liver and spleen as well as gall bladder, kidney
and other viscera.
• Succession splash

4) percussion

• Percussion of the upper border of liver


• Percussion of liver span
• Percussion of the spleen
• Percussion of the stomach
• The methods and clinical values of percussion for shifting dullness.

5) auscultation

• Bowel sounds(borhorygmus)
• Murmurs or bruits
• Friction rubs over the liver and spleen

6) The major symptoms and signs of common abdominal diseases and


differentiation.

Teaching periods: lecture 12; clinical practice 6

Teaching methods:

1. The examining methods should be learned through clinical practice and mutual
examination of students.

2. Students should master the sequence of examination and know the normal signs.

3. Students should identify the abnormal signs and analyze their clinical significance.

3. Students should be familiar with the symptoms and signs of common


abdominal diseases and differentiation.

Spine and extremities and joints


Purpose and Requirements

1. Mastering the physiologic curvatures and the type of pathologic curvatures


and the method of examination of spine curvatures.
2. Understanding the physiologic movement range of spine and the causes of
restriction of activity of spine.
3. Mastering the methods of palpation and percussion of the spine to check the
tenderness and percussion pain of the spine.
4. Mastering the examining methods of extremities and joints: inspection and
palpation.

Teaching Contents

1. The physiologic curvatures and the type of pathologic curvatures and the
method of examination of spine curvatures.
2. The physiologic movement range of spine and the causes of restriction of
activity of spine.
3. The methods and value of palpation and percussion of the spine.
4. The examining methods of extremities and joints: inspection and palpation.
5. The abnormal manifestation of extremities and joints.

Teaching periods: lecture; clinical practice

Teaching methods:

1. The examining methods of spine and extremities and joints should be learned through
clinical practice and mutual examination of students.

2.Students should be familiar with the signs of common spine and extremities and joints
diseases.

Nervous system

Purpose and Requirements

1. Mastering the examining methods of motor function.


2. Mastering the examining methods of nervous reflexes.
3. Mastering the examining methods of common pathological reflexes and
understanding their clinical significance.

Teaching Contents

1. The examining methods of motor function: muscle power and muscle tone.
2. Abnormal muscle tone: increased and decreased.
3. Superficial reflex: emphasized on examining methods of the corneal reflex and the
normal and pathologic reflex. The examining methods of the abdominal wall
reflex, the cremasteric reflex and plantar reflex.
4. Deep reflex: the examining methods of the biceps reflex, triceps reflex,
radioperiosteal reflex, knee jerk and Achilles jerk.
5. Pathological reflex: the examining methods of the Babinski sign, Oppenheim sign,
Cordon sign, Chaddock sign and Conda sign and their clinical meaning.
6. Pathological reflex: Hoffmann sign, Ankle clonus and patella clonus.
7. Meningeal irritation sign: Stiffness of neck, Kernig sign and Brudzinski sign.

Teaching periods: lecture clinical practice:

Teaching methods:

1. The examining methods of superficial reflex, deep reflex, pathological reflex


should be learned through clinical practice and mutual examination of students.

2. Students should be familiar with the signs of normal and abnormal manifestation
of the nervous reflexes.

Unit 4  ECG

Purpose and Requirements

1. Understanding the definition of ECG, basic cardiac electrophysiology, electrical


stimulation of the heart, cardiac conductivity and automaticity.

2. Understanding the mechanism of cardiac electrical stimulation (depolarization and


repolarization).

3. Grasping basic ECG complexes (P, QRS, ST, T, and U waves) QRS nomenclature,
basic ECG measurements and some normal values, calculation of heart rate and
the normal ECG.

4. Being familiar with ECG leads、electrical Axis and axis deviation.

5. Taking an ECG and make an diagnosis.

6. Understanding the definition of atrial and vertricular enlargement and its


mechanism of enlargement.

7. Mastering the diagnosis of atrial and ventricular enlargement in ECG.

8. Mastering the ECG diagnosis of Myocardial ischemia and infarction.

9. Mastering the ECG diagnosis of Supraventricular Arrhythmias and Ventricular


Arrhythmias and AV Heart Block.
Teaching Contents

1) The genesis of the normal ECG., (keep in mind) Three basic “laws” of
electrocardiography

2) Direction of atrial depolarization with normal sinus rhythm, direction of atrial


depolatizarion with AV Junctional Rhythm, Orientation of P waves with AV
Junctional rhythm, normal ventricular depolarization.

3) Mean QRS Axis、right and left axis deviation、normal horizontal QRS Axis and
normal vertical QRS Axis and normal intermediate QRS Axis.

4) The normal P, QRS complex, ST segment and T wave.

5) Right atrial enlargement (RAE); Left atrial enlargment (LAE); Left atrial
abnormality (LAA); Right ventricular hypertrophy (RVH); Left ventricular
hypertrophy (LVH)

6) Myocardial ischemia, transmural and subendocardial ischemia [Transmural MI.


(the ECG sequence with different parts of heart wall infarction, QRS changes-Q
waves of transmural infarction); Localization of infarcts; Sequence of Q waves and
ST-T changes with transmural infarcts; Normal and abnormal Q waves; Ventricular
aneurysm; Multiple infarctions; Silent MI; Diagnosis of MI in the presence of bundle
branch block].

7) The ECG changes in Supraventricular Arrhythmias, Ventricular Arrhythmias, and


AV Heart Block.

Teaching periods: lecture 12; clinical practice 8

Teaching methods:

1. The examining methods should be learned through clinical practice as well as


lectures.

2. Students should learn to measure ECG and differentiate various ECG’s


representations.

Unit 5 Laboratory Diagnosis


Introduction
Purpose and Requirements

1. Understanding the concept of laboratory diagnosis.


2. Understanding why to study laboratory diagnosis.
3. Understanding how to learn laboratory diagnosis.

Teaching Contents

1. What is the laboratory diagnosis?


2. Why to study laboratory diagnosis?
3. How to learn laboratory diagnosis?

Teaching periods: lecture 1

Teaching methods: slides and multimedia CD

Part 1 Blood Test

Chapter 1 Blood Routine Test

Purpose and Requirements

1. Mastering the content of blood routine test.


2. Mastering the referential values of BRT.
3. Being familiar with morphology of blood cell.
4. Mastering the clinical significance of RBC and Hb abnormalities.
5. Mastering the clinical significance of WBC and DC abnormalities.

Teaching Contents

1. The content of blood routine test: WBC, RBC, PLT, Hb, DC and the items in
automatic blood cell analyzer.
2. The referential values of BRT: WBC (N st, N se, LYM, Mo, Eo, B), RBC, PLT.
3. The morphology of blood cell.
4. RBC and Hb abnormalities and etiology: a. decrease of RBC and Hb, etiology and
pathogenesis classification of anemia; b. increase of RBC and Hb: comparative
and absolute increase; etiology. c. morphology abnormalities in RBC: size, shape,
chromatism and structure.
5. WBC and DC abnormalities: neutrophil granulocyte(granulocytosis
granulocytopenia, changes of nucleus, abnormal morphology); lymphocyte
(lymphocytosis, lymphocytopenia); monocyte (monocytosis); eosinophil
granulocyte(eosinophilia); basophil granulocyte(basophilia).

Teaching periods: lecture:3, laboratory: 2

Teaching methods: slides and multimedia CD, laboratory test

Chapter 2 Other Tests for Red Blood Cells

Purpose and Requirements

1. Mastering the referential value of reticulocyte count(RC) and the clinical


significance of reticulocytosis and reticulocytopenia.
2. Mastering the referential value of hematocrit(Hct) and the clinical significance of
increase and decrease of Hct.
3. Being familiar with the mean values of RBC and the morphological classification
of anemia.
4. Being familiar with the tests for hemolytic anemia.
5. Mastering the referential value of ESR and the clinical significance of higher
ESR.

Teaching Contents

1. The referential value of reticulocyte count(RC) and the clinical significance of


reticulocytosis and reticulocytopenia.
2. The referential value of hematocrit(Hct) and the clinical significance of increase
and decrease of Hct.
3. The mean values of RBC and the morphological classification of anemia: MCV,
MCH, MCHC; normocytic anemia, macrocytic anemia, microcytic anemia,
microcytic hypochromic anemia.
4. The tests for hemolytic anemia: erythrocyte osmotic fragility test, acid hemolysis
test, sucroselysis test, Rous test, Coombs test.
5. The referential value of ESR and the clinical significance of higher ESR: infection
and inflammation, malignant tumors, anemia, etc.

Teaching periods: lecture:1, laboratory: 1

Teaching methods: slides and multimedia CD, laboratory test.


Chapter 3 Bone Marrow Examination

Purpose and Requirements

1. Mastering the diagnostic significance and indications, contraindications and


methods of the marrow examination.
2. Being familiar with the blood cell development process and morphology of bone
marrow cells..
3. Being familiar with the contents, step and common cytochemical stains in marrow
examination.
4. Mastering the normal myelogram and hemogram.
5. Being familiar with the characters of common blood diseases in microscope.

Teaching Contents

1. The diagnostic significance, indications, contraindications and methods of the


marrow examination.
2. The blood cell development process and morphology of bone marrow cells:
erythrocytic series, granulocytic series, monocytic series, megakaryocytic series,
lymphocytic series.
3. The contents, step and common cytochemical stains in marrow examination:
microscopy of myelogram, hemogram; POX, SB,PAS,FIS,NAP,NSE.
4. The normal myelogram and hemogram.
5. The characters of common blood diseases in microscope: IDA, AA, AL, CML,
ITP.

Teaching periods: lecture: 1, laboratory:1

Teaching methods: slides and multimedia CD, laboratory test.

Chapter 4 Bleeding and Clotting Test

Purpose and Requirements

1. Understanding the mechanisms of hemostasis and coagulation.


2. Mastering the referential values of bleeding and clotting tests and their clinical
significance.
3. Being familiar with the screening tests for bleeding diagnosis.
4. Being familiar with the tests for DIC.

Teaching Contents

1. The mechanisms of hemostasis: blood vessel, platelet, coagulation factors.


2. The mechanisms of coagulation: process of coagulation; intrinsic and extrinsic
pathway; anti-coagulation system.
3. The referential values of bleeding and clotting tests and their clinical significance:
BT, PC, CRT, CT, APTT, PT, TT.
4. The screening tests for bleeding diagnosis: PT, APTT,TT, BT.
5.The tests for DIC: PC, PT, Fibrinogen, 3P test, FDP, D-dimer.

Teaching periods: lecture: 1, laboratory:1

Teaching methods: slides and multimedia CD, laboratory test.

Part 2 Urine Tests and Renal Function Tests

Chapter 1 Urine Routine Test

Purpose and Requirements

1. Understanding the clinical significance of urine routine test.


2. Mastering the methods of urine collection and sending.
3. Mastering the contents of urine routine test and its clinical significance.

Teaching Contents

1. The clinical significance of urine routine test.


2. The methods of urine collection and sending.
3. The contents of urine routine test and its clinical significance: general property,
chemical tests and microscopic examination.

Teaching periods: lecture: 2, laboratory:1

Teaching methods: slides and multimedia CD, laboratory test.

Chapter 2 Renal Function Tests


Purpose and Requirements

1. Understanding the purpose of renal function tests.


2. Understanding the classification and the clinical meaning of renal function tests.
3. Mastering the items of tests of glomerular function.
4. Familiar with the items of tests of renal tubule function.
5. Familiar with the application and item choice of renal function tests in clinic.

Teaching Contents

1. The purpose of renal function tests.


2. The classification and the clinical meaning of renal function tests: tests of
glomerular function and tests of renal tubule function.
3. The items of tests of glomerular function: Ccr, Cr, BUN.
4. The items of tests of renal tubule function: CDT, PSP.
5. The application and item choice of renal function tests in clinic.

Teaching periods: lecture:1, laboratory:1

Teaching methods: slides and multimedia CD, laboratory test.

Part 3 Liver Function Tests

Purpose and Requirements

1. Understanding the variety of liver function and the purpose of liver function tests.
2. Understanding the sorts of liver function tests and their clinical meaning
accordingly.
3. Mastering the items of tests of protein metabolism and its clinical significance.
4. Mastering the items of tests of bilirubin metabolism and its clinical significance.
5. Mastering the items of serum enzyme tests and its clinical significance.
6. Mastering the hepatic neoplasm markers and its clinical significance.
7. Mastering the items of tests of viral hepatitis and its clinical significance.
8. Familiar with the application and item choice of liver function tests in clinic.

Teaching Contents

1. The variety of liver function and the purpose of liver function tests.
2. The sorts of liver function tests and their clinical meaning accordingly.
3. The items of tests of protein metabolism and its clinical significance: TP, A, G and
A/G.; serum protein electrophoresis.
4. The items of tests of bilirubin metabolism and its clinical significance: STB,SDB,
SIB and SDB/SIB; URO;UBI; the differentiation of jaundice: haemolytic,
hepatocellular and obstructive jaundice.
5. The items of serum enzyme tests and its clinical significance: ALT,AST, ALT/AST,
ALP, r-GT.
6. The hepatic neoplasm markers and its clinical significance: AFP, CEA, APT.
7. The items of tests of viral hepatitis and its clinical significance: anti-HAV, IgM
type and IgG type; HBsAG, HBeAG, HBsAb, HBcAb HbeAb; HCVAb, HDVAb.
8. The application and item choice of liver function tests in clinic.

Teaching periods: lecture:3, laboratory:2

Teaching methods: slides and multimedia CD, laboratory test.

Part 4 Stool Tests

Purpose and Requirements

1. Understanding the clinical significance of stool tests


2. Mastering the general property and microscopic test of normal and abnormal
stool.
3. Mastering the method of occult blood test and its clinical value.
Teaching Contents

1. The clinical significance of stool tests


2. The general property and microscopic test of normal and abnormal stool.
3. The method of occult blood test and its clinical value.

Teaching periods: lecture:1, laboratory:1

Teaching methods: slides and multimedia CD, laboratory test.

Part 5 Examination of Sputum


Purpose and Requirements

1. Understanding the clinical significance of examination of sputum.


2. Mastering the methods of sputum collection.
3. Mastering the general property and microscopic test of normal and abnormal
sputum.
4. Being familiar with the isolation and culture of sputum, and its clinical
significance.

Teaching Contents

1. The clinical significance of examination of sputum.


2. The methods of sputum collection.
3. The general property and microscopic test of normal and abnormal sputum.
4. The isolation and culture of sputum; antimicrobial susceptibility tests; the
identification of infecting organism.

Teaching periods: lecture:1, laboratory:1

Teaching methods: slides and multimedia CD, laboratory test.

Part 6 Examination of Cerebrospinal Fluids and Serous

Membrane Fluids

Purpose and Requirements

1. Mastering the indications of the examination of cerebrospinal fluids.


2. Mastering the general property, chemical examinations and microscopic tests of
normal cerebrospinal fluids, and the changes of abnormal cerebrospinal fluids and
their clinical significance.
3. Mastering the general property, chemical examinations and microscopic tests of
normal and abnormal serous membrane fluids, and their clinical significance.
4. Mastering the main differential points of transudate and exudates, understanding
their producing mechanisms and the clinical significance.

Teaching Contents

1. The indications of the examination of cerebrospinal fluids.


2. The general property, chemical examinations and microscopic tests of normal
cerebrospinal fluids, and the changes of abnormal cerebrospinal fluids and their
clinical significance.
3. The general property, chemical examinations and microscopic tests of normal and
abnormal serous membrane fluids, and their clinical significance.
4. The producing mechanisms and the clinical significance of transudate and
exudates.
5. The main differential points of transudate and exudates.

Teaching periods: lecture:1, laboratory:1

Teaching methods: slides and multimedia CD, laboratory test.

Part 7 Immunological tests.

Purpose and Requirements

1. Understanding the classification and the clinical significance of immunological


tests.
2. Familiar with the general immunological tests of evaluation on immunological
status.
3. Familiar with the examining item on autoimmune-disease related Ab or activated
T.
4. Familiar with the examining item on pathogen specific Ab or Ag.
5. Familiar with the examining item on tumor related Ag.

Teaching Contents

1. The classification and the clinical significance of immunological tests.


2. The general immunological tests of evaluation on immunological status: serum
protein electrophoresis; complement: total, C3, C4; serum IgG; T-cell subpopulation
counting, etc.
3. The examining item on autoimmune-disease related Ab or activated T: ANA, RF,
TRAb, etc.
4. The examining item on pathogen specific Ab or Ag: HBeAb, anti-HAV-IgM, Widal
test

5. The examining item on tumor related Ag: CEA, AFP, etc.

Teaching periods: lecture:2, laboratory:1

Teaching methods: slides and multimedia CD, laboratory test.