Summary: According to the statistics of medical practitioners' examinations over the years, the passing score is between 50 and 60, and last year it was 52 (including comprehensive written examination), with little change every year. The examination of clinical practical skills is divided into three parts. The first stop is medical history collection and analysis, the second stop is surgery, and the third stop is auscultation, electrocardiogram, X-ray and ct newly added this year. Of the three stops, the first stop and the second stop are the easiest to score. The first stop scored 35 points easily and the second stop scored 40 points. Together, these two stations can reach 75 points, which is enough to pass the exam. The last stop was miscellaneous and the score was small. Don't worry too much about the wrong answer. The following focuses on the first and second stop exams:
(1) medical history collection The medical history collection question is the symptom combination required by the root outline. There are generally more than 50 questions for candidates to take. The answer is very skillful. If you apply the following formula to collect any symptoms, you can get 80% marks.
1. Asking about medical history: including the following five parts ◎ Etiology, inducement ◎ Main symptom characteristics ◎ Accompanied symptoms ◎ General state, that is, general state after onset ◎ Diagnosis and treatment process.
2. Past history ◎ Related medical history ◎ History of drug allergy and surgery (it must be mentioned that this is included in the annual scoring standard).
You must be organized when consulting, think carefully before you start writing, and don't add anything later, so you will lose points.
It is impossible to make a diagnosis only by a chief complaint, but there is still this tendency. For example, 24-year-old women are more likely to cough up blood and get tuberculosis, while 45-year-old men are considered to have lung cancer. The two have different collection tendencies, and they still rely on knowledge accumulation. I always know that most of the scores in this year's exam have been improved by several symptoms if collected in the above way:
Skin mucosal bleeding: Consider: leukemia, aplastic anemia, thrombocytopenia, hemophilia and other bleeding and coagulation disorders.
Constipation and diarrhea: tumor, colitis, Crohn's disease and some infectious diseases.
Masses: I mainly know about neck masses and abdominal masses, and I won't go into details about others.
(2) There are generally 60 medical records for candidates to choose from, and three points should be paid attention to in medical record analysis: diagnosis, diagnosis basis and further examination.
1. The diagnosis must be complete and orderly. Such as chronic bronchitis medical record diagnosis write:
1) Chronic bronchitis complicated with infection
2) Obstructive emphysema
3) Pulmonary heart disease
4) Several levels of cardiac function
Pay attention to every clue provided by medical history and auxiliary examination. There are not many diseases in each system, which is easy to judge, especially in surgery and obstetrics and gynecology. Once you draw it, you can immediately determine what disease it is. In short, the diagnosis must be written in full. You should also know some basic laboratory values. If blood potassium is low, hypokalemia should be added to the diagnosis. It is necessary to master the basic characteristics of some diseases, such as subphrenic free gas, which is digestive tract perforation; Post-traumatic coma and intermediate waking period are epidural hematoma. If there is pupil change, brain hernia should be considered, and brain trauma should be added before diagnosis. Spleen rupture may have subcapsular hemorrhage, and hemorrhagic shock symptoms only appear one week after injury, which should be paid attention to.
2. Diagnostic basis: Be sure to list the information given in the medical history and auxiliary examination in the order of diagnosis. Some of the above-mentioned specific disease characteristics are important basis for diagnosis.
3. Differential diagnosis: write several diseases around the lesion site and characteristics, generally three or four. If you really don't understand, write more similar diseases.
Step-by-step test: Give some examples of your experience:
Gastric cancer: further ct (see liver and abdominal metastasis)
Chest X-ray examination (with or without lung metastasis)
Angina pectoris: 24-hour dynamic electrocardiogram and dynamic monitoring of serum myocardial enzymes.
Abdominal closed injury (spleen rupture): abdominal puncture, abdominal B-ultrasound and abdominal X-ray.
5. Treatment: Pay attention to the principle of treatment, but also have priorities. Be careful not to forget to support treatment and some projects such as relapse prevention and health education.