Author: anonymous Reposted from: Web Hits: 942 Article Entry: Member's Contribution
1. History: upper gastrointestinal hemorrhage
2. Case study: hyperthyroidism, but unfortunately, there is no other data
3. Physical examination: chest tightness, shortness of breath, etc., need to do the physical examination. Name the site of heart valve auscultation
4. Basic operation: how to change the medicine after rusty nail puncture
5. Radiography: pneumothorax, pleural effusion
6. Electrocardiography: atrial premature/ventricular premature
7. Chest auscultation: twisting sound/alveolar breath sound, etc.
8. Cardiac auscultation: rumbling murmur
2. Medical records Collection, male, weakness, vomiting blood, black stools for 5 days
Analysis, it is acute glomerulonephritis
Physical examination, lymph node palpation (axilla. Subclavian) note the description of lymph node enlargement
Change of medication
This year, many people test artificial respiration and cardiac compression
EKG: premature beats, bradycardia Chest radiographs: pneumonia, Normal abdominal plain radiographs, the medical ethics said about the collection of the red packet
3. 1. History taking: male, 46 years old, persistent epigastric pain for 6 days, aggravated by nausea, vomiting for 3 hours. History of chronic cholecystitis and cholelithiasis
2. History analysis: 25-year-old female, right thigh pain and dysfunction caused by a car accident. Physical examination: shortening of the right lower limb, bone sassafras sensation in the middle and lower part of the right thigh, subcutaneous bruising. The knee and hip joints were immobilized due to the pain.
3. Physical examination and basic operation: male 38 years old, headache, dizziness, with a history of sinusitis. Did neurological physical examination are negative, you should do what physical examination. Put on and take off the isolation gown.
4. Apical mitral systolic wind murmur
5. X-ray: normal chest X-ray gastric cancer\
6. ECG: atrial premature myocardial infarction
4. History taking: Male, 18 years old, nausea, vomiting, yellow urine, fever for two days.
I. History taking
1. Carbon monoxide poisoning
2. Female, 21 yrs old, eyelid edema for 5 days
3. Male, 35 yrs old, left upper abdominal distension, abdominal pain with yellowish stains for 2 days
4. Male, 65 yrs old, fever, coughing and sputum for 1 week, impaired consciousness for 2 hrs. history of diabetes mellitus for 10 years
5. Episodic chest pain for 3 months
6. Male, 55 years old, weakness and bloating for 5 years, vomiting blood and black stool for 3 days, unconsciousness for 1 day
7. Chest pain, breathlessness, hemoptysis for 3 days
8. Fever, chest pain, coughing rust-colored sputum for 2 days
9. A male, 65 years old, with progressive dysphagia with wasting for 6 months
10. Male, 28 years old. with right lower abdominal pain for 1 day
II. CASE ANALYSIS
1. chronic renal failure
2. right hemicolon carcinoma
3. trauma admitted for 3 hours with rupture of the liver and hemorrhagic shock
4. intermittent bilateral lower extremity edema for 3+ years,panicky,dizziness for 3 days.
Blood pressure 140-150 MMHG/90-100 MMHG, no throbbing headache, exertion after activity, pan-energy, dizziness for the last 3 days, previous rheumatoid arthritis, no history of hypertension, no history of allergy, nephritis in early childhood, PE bilateral lower extremity depressed edema, the rest is not special.HB:86g/L, SCR and BUN elevated
5. duodenal perforation Acute peritonitis
6. Acute pancreatitis
7. Female, 60 years old. She fell and landed on her right hip for 1 day. Findings: vital signs are normal
limited right hip flexion, right heel buckling pain, right inguinal ligament
pressure pain at the midpoint of the inguinal ligament. There was no localized swelling. He was conscious and able to take care of himself.
8. right epigastric distension and pain for half a year, physical examination: see spider nevus, hepatic subcostal hardness and nodules. ultrasound: intrahepatic occupancy
9. right lumbar arrest trauma for half an hour with hematuria and blood clots
physical examination of the right lumbar pain
laboratory examination: WBC10.1, Hb98, ultrasound showed incomplete peripheral membrane peripheral renal echogenicity, chest radiographs did not show any abnormality.
10. 35-year-old male patient with acute onset of fever, abdominal pain and diarrhea for 2 days. Blood routine: WBC15.6×109, neutral 88% Stool routine: leukocytes full field of vision, erythrocytes 20-30/HP.
Three, physical examination
1. Abdominal palpation (question: the difference between inflammatory masses and tumor masses? How much more than a small amount of ascites should not be released?)
2. cardiac palpation
3. superficial reflex neurological examination (question: the concept of lower motor neuron and the manifestation of injury)
4. abdominal auscultation (bowel sounds and vascular murmurs) (question: what is meant by bowel sounds hyper? What is meant by absent bowel sounds? Abdominal vascular murmurs are seen in those diseases? What tests should be done?)
5. palpation of the precordial region (question: is palpation of tremor necessarily associated with heart disease?)
6. How are carotid artery pulsations, capillary pulsation signs, watery pulse, gunshot sounds examined? Ask what vascular sign is seen with aortic insufficiency? Ask what is caused when compression is applied to the bilateral carotid arteries.
7. Abdominal clasping maneuvers, content, and method of operation. Candidates examine each other as they talk. Characterize abdominal vascular murmurs (arterial and venous) and how to auscultate them? What are the common diseases? Describe the bowel sounds, (normal, excessive, attenuated)
8. Cardiac Auscultation
(1)Correctly point out the auscultation zones of the heart valves;
(2)Correct order of auscultation;
Starting from the mitral valve zone, pulmonary artery zone, aorta zone, aorta second aortic auscultation zone, tricuspid valve zone, anticlockwise or inverted figure of eight.
(3) Can express the main elements of cardiac auscultation.
Q: What murmurs can be heard in the intercardiac area, whether systolic or diastolic heart rate, rhythm, normal heart sounds, heart sound changes, heart murmurs, pericardial friction
9. Peripheral vascular examination
10. Palpation of the cervical trachea and the thyroid gland
Four basic operations
1. Catheterization (Q: When catheterizing, ask for the male urethra's Two curves and three stenosis)
2. pleural effusion puncture
3. drug change with sterile gloves (gloves must remember to play talcum powder)
4. abdominal puncture (pay attention to the advance and after the completion of the measurement of blood pressure, and the need for urination before the puncture)
5. thoracic puncture (why puncture in the supracostal margin?)
6. spinal cord injury handling methods and notes
7. debridement suture dressing with gloves and surgical knot with needle holder
8. a patient was bitten by a collapsed earth wall 3 days ago, the soles of his feet were cut by a sharp instrument, debridement suture was given and tetanus antitoxin was given and he came back for a change of medication, what do you have to prepare and what do you look out for.
(Note: Expose the wound, hydrogen peroxide rinse, potassium permanganate wash and change the dressing Remember!)
9. jaw bandage to stop bleeding (triangular towel)
10. cardiac defibrillation
11. resuscitation of a 12-year-old boy drowning (cardiopulmonary resuscitation)
12. respiratory application
V. Multimedia
1. electrocardiogram Normal electrocardiogram, acute myocardial infarction, atrial premature, atrial fibrillation, supraventricular tachycardia, pear-shaped heart, sinus bradycardia, prandial heart, bootstrap heart, third-degree atrioventricular block
2. X-rays Infiltrative tuberculosis of the left upper lung, gastrointestinal perforation (free gas under the diaphragm), right upper lobe pneumonia, normal chest X-ray, left cervical fracture, right tibiofibular fracture, intestinal obstruction, ventricular prematureness, right middle lobe pneumonia, right pneumothorax, gastric cancer, right hemicolonial carcinoma
3. Auscultation of heart sounds: diastolic rumbling sounds, no diastolic rumbling sounds. Diastolic rumbling murmur, not conduction (to know whether the conduction, you can use the mouse to click on the site proposed in the selection of the examination, there is a heart sound that is conduction); pericardial friction, prancing rhythm, full systolic rough heart murmur to the anterior region of the heart wide conduction, arterial ductus arteriosus,
4. Breath sound auscultation: bronchial alveolar respiratory sounds, the left lung confined dry and wet rhonchi, inhalation croup, expiratory rales
6. Medical ethics
1. Referring patients to outside hospitals for surgery, with the excuse of low surgical fees, choose to choose the bad points of this practice
2. Doctors can not sit on the patient's bed
3. Male doctors to examine female patients What do I need to pay attention to?
4. Giving red packets to doctors
5. How to explain to a patient when the first puncture fails and a second one is needed
6. How to deal with a patient who is being examined by a doctor in the abdominal area and whose clothes have been removed, and who has been called in the course of the examination. (First, reround the patient's clothes and then explain to the patient)
7. Whether you can ask the patient to do more tests to increase the hospital's income
8. How to talk to the patient before lumbar puncture.
June 13th exam summary
I. History taking
1. male, 24 years old, cough for two months, hemoptysis for one week
2. male, 65 years old, history of diabetes mellitus for 10 years, coughing, fever for one week, sudden coma for two hours. (Diabetic hypertonic coma)
3. hypertension, hypercardia, cardiac insufficiency
4. male,65 years old,progressive dysphagia with wasting for six months
5. bleeding gastric ulcer
6. chest pain,breathlessness,hemoptysis for three days
7. fever,chest pain,coughing rusty sputum for two days
8. 48 years old,abdominal bloating Three months,vomiting blood,black stool for 3 days
9. male,40 years old,epigastric pain with fever for 2 weeks,yellowish skin for 4 days
10. abdominal pain,abdominal distension,yellowish skin for 2 days
11. male,28 years old,right lower abdominal pain for 1 day
12. male,62 years old,pain in both knees for 8 years,aggravated for 2 months
13. female. 55 years old, abdominal pain, chills and fever for 2 days
14. abdominal pain with pus and blood in stool for 5 years, recurrence for 1 week
15. progressive dysphagia with emaciation for 6 months
16. fever with swelling and pain in knee joint for 2 days
II. CASE ANALYSIS
1. male, 65 years old, change in stool rhythm for 6 months, diarrhea and right lower abdominal pain for 1 week
2. Acute duodenal perforation with full abdominal pressure and rebound pain with trigger (gargling)
3. Female, 26 years old, lumbar pain with hematuria for 2 days!
4. Upper gastrointestinal bleeding
5. Complaint: female, married, 32 years old, fever, urinary frequency, urgency, urinary pain for 2 days.
2 days ago after exertion, frequent urination, urinary urgency, urinary pain, body temperature 37.5 degrees ......
6. hypertension
7. right upper abdominal distension and pain for six months, physical examination: see the spider nevus, the hepatic subcostal touch hard and nodules. ultrasound: intrahepatic occupation.
8. male, 57 years old, sudden right lumbar pain with hematuria for 4 hours. (Present history, pro forma, ancillary tests suggesting: right ureteral stone, right hydronephrosis, urinary tract infection)
9. diabetes mellitus type 1 with ketoacidosis
10. splenic rupture with hemorrhagic shock
11. bacillary dysentery
12. septic meningitis of the shock type
13. male, who presented with measles-pneumonia a few years ago. Cough with sputum, recently aggravated, coughing up to 300 ml of sputum, with fever and moderate vesicular sounds in the right lung base. There was hemoptysis. On examination, the lungs were over-cleared, barrel chest, and there was a small cavity on chest radiograph
14. Male, 58 years old, paroxysmal chest pain for 2 years, aggravated for 20 hours;
No history of hypertension, coronary heart disease, or diabetes mellitus
PE: HR 96 beats/min, grade III/6 BSM was detectable in the mitral valve area, conduction to the left source of the sternum, and the rest of the body had no abnormality
Laboratory tests: CK , CK-MB elevated, EKG showed V3-5 ST-T elevated, bow-backed up
15. chest trauma
16. right kidney rupture after high out fall, right lumbar trauma, hematuria for 6 hours
17. hemolytic anemia
Third, physical examination
1. Lungs auscultation in order/which normal respiration can be heard The first part of the examination is to pay attention to the questions asked by the examiner, such as blood pressure before thoracic and abdominal puncture, the concentration of anesthesia, what anesthesia is better, whether babinski's sign can occur in a normal person, and the positive signs? (Yes, in infants and children up to 1 year of age)
3. eye examination
4. palpation of supraclavicular lymph nodes, inguinal and supratrochlear lymph nodes
5. corneal reflexes, what does their disappearance mean? What is the innervation? Tibial reflex practice? What are the other superficial reflexes?
6. anterior and posterior thyroid palpation, tracheal palpation, positive thyroid palpation and auscultation in hyperthyroidism
7. vertebral fasciculations
8. what diseases enhance and diminish vibratory speech, and what diseases cause pleural friction
9. chest percussion, auscultation (question: what diseases are associated with cloudy percussion of the lower right lung, what are the associated physical examinations? and aural changes in pleural effusion)
10. Peripheral vascular examination
11. How to check for cervical stiffness and clinical significance. How to do Kirschner's sign and how to do Bartholomew's sign?
12. Liver palpation Q. How do you describe the liver, how do you describe the liver, is hepatomegaly always pathologic?
13. Abdominal palpation including (gastric vesicular bullae, mobile turbidities, sphenopalatine angle percussion) Q: When is the gastric vesicular bullae present? What conditions are most often associated with sphenopalatine angle tenderness?
Four, the basic operation
1. abdominal puncture
1 = position: / semirecumbent position, lying position or lateral position;
2 = selection of appropriate puncture point: ① left lower abdomen umbilicus and pre-skeletal superior spine line in the middle, the outer 1 / 3 intersection, where it is not easy to damage the abdominal artery; ② umbilicus and the pubic symphysis joint line above the mid-point of the 1. ocm, to the left or to the right of the 1. 5cm, there is no vital organs and easy to heal. Here there is no vital organs and easy to heal; ③ side lying position, in the umbilical level line and the axillary line or axillary midline intersection, this is often used for diagnostic puncture; ④ small amount of fluid, especially when there is a wrapped segregation, ultrasound under the guidance of the localization of the puncture;
3 = routine disinfection, a wear sterile gloves, covered with disinfected towels, from the skin to the peritoneal wall layer to 2% lidocaine for local anaesthesia;
4 = Cirrhosis patients with a single release of fluids generally not more than 3000ml =;
2. cardiac compression
3. 12-year-old drowning teenager respiratory arrest, heartbeat is still in the artificial respiration, pay attention to a little removal of respiratory dirt, plus a step of pouring water: should be taken to abdominal cushioning, chest and head down, or to hold its feet, abdomen on the shoulders of the first aiders walking or jumping in order to "pouring water". Can also be the patient's abdomen lying prone in the resuscitator kneeling on the thigh, head down to pour water.
4. Appendice change: pay attention to the mask hat, sticky tape direction, length of gloves?
5. mandibular bandage for hemostasis (triangular towel)
6. cardiac defibrillation
7. spinal patient handling
8. thyroid surgery disinfection with gown and gloves. Question: scope of sterilization for appendicitis surgery
9. bone dressing and gowning
10. aspiration
11. ventilator application
12. insertion of gastric tube Nasogastric feeds (Question: appliances to be prepared, how to determine that gastric tube reaches the stomach)
13. donning and doffing of isolation gowns
14. chest dressings
V, Multimedia
1. electrocardiogram normal electrocardiogram, left ventricular hypertrophy, third degree atrioventricular block, atrial fibrillation, ventricular premature, myocardial ischemia
2. X-ray left lower lung cancer, intestinal obstruction, lung metastasis (thickening of the lung texture, multiple masses in the lungs), perforation of the stomach and intestines, Pudendal heart, boot heart, pneumonia, humeral bone fracture, invasive pulmonary tuberculosis of the left upper lung, the right pulmonary atelectasis, pleural effusion, femur fracture, tibia fracture, tibiafibulae fracture, and the left upper lung ischemic. Fracture, tibiofibular fracture, normal chest piece, pear-shaped heart, wrist fracture, ulna fracture
3. Heart sound auscultation Tricuspid valve auscultation area, diastolic gallop rhythm, systolic blowing murmur, diastolic rumbling murmur, atrial premature, myocardial ischemia, arterial catheterization
4. Respiratory sound auscultation Right pneumothorax lung auscultation right lung respiratory sound is weakened (in conjunction with the history of the case), bronchial respiratory sound + Wet rhonchi, wet rhonchi, bronchoalveolar respiratory sounds, rales
6. Medical ethics
1. Interns cannot do lumbar puncture on patients alone without the presence of the supervising doctor, which is irresponsible to the patients
2. Patients send red packets
3. Don't prescribe medicines indiscriminately
4. A doctor who performs abdominal examination on a patient A doctor who is examining a patient's abdomen, removes his clothes, and during the examination someone calls for you, what should you do with the patient. (First, the patient's clothes round, and then explain to the patient)
5. The video shows a doctor to the patient prescribed a generous, the patient with this prescription and the doctor's theory. Ask if you are this doctor what to do? Answer: according to the patient's condition, in order to ensure the efficacy of the case to the patient to prescribe the cheapest medicine
6. not taken by the occupational physician's qualification can be alone chest puncture
June 14th examination summary
I. history taking
1. male, 29 years old, chest pain, breathlessness, hemoptysis for 9 days
2. female, 20 years old, facial edema for 5 days.
3. Female, 35 years old, lethargy, polyphagia with palpitations for 2 weeks
4. Male, 40 years old, intermittent pain in the mid-abdomen for 8 years, accompanied by vomiting for 2 days.
5. M, 60, recurrent bilateral knee pain for 8 years, aggravated for 2 months
6. M, 26, cough for 2 weeks, coughing up blood for 1 week
7. Abdominal pain and lethargy for half a year, vomiting of blood for 3 days
8. M, 76, fever, cough and sputum for 1 week, impaired consciousness for 2 hours, history of diabetes for 10 years
9. F, 54. Cough with blood in sputum for 2 months
10. Male, 56 years old, episodic chest pain for 3 months.
II. CASE ANALYSIS
1. Intermittent bilateral lower extremity edema for 3+ years, panulectasis, dizziness for 3 days.
Blood pressure 140-150MMHG/90-100MMHG, no throbbing headache, exertion after activity, pan-energy, dizziness for the last 3 days, previous rheumatoid arthritis, no history of hypertension, no history of allergy, nephritis in early childhood, PE bilateral lower extremity depressed edema, the rest is not special.HB:86g/L, SCR and BUN are elevated.
2. Gastrointestinal perforation
3. M, 60 yrs old with abdominal distension and pain, stopped defecation for 2 days.
4. Right thoracic trauma with right 4. 5 rib fractures.
5. bronchiectasis
6. Male, 58 years old, paroxysmal chest pain for 2 years, aggravated for 20 hours; no previous history of hypertension, coronary artery disease, diabetes mellitus.PE: HR 96 beats/min, grade III/6 BSM is detectable in mitral valve area, conduction to left source of sternum, no other abnormalitiesLabs: CK, CK-MB elevated, EKG shows elevated V3-5 ST-T with a bowed back upward.
7. duodenal ulcer complicating perforation, diffuse peritonitis
8. splenic rupture
9. male, epigastric pain for 3 hours, the patient consumed alcohol 3 hours ago, then felt a dull pain in the abdomen, nausea, vomiting, for the gastric contents, the pain did not decrease after vomiting, pressure pain in the middle-upper abdomen, no rebound pain. Blood amylase 201 IU/L. urine amylase 950 IU/L.