Similar to the medical consultation, each case analysis questions are provided with a summary of the case, based on the content of the summary of the analysis, the discussion. To arrive at the correct answer, first of all, basic clinical medical knowledge and practical experience, but to make a diagnosis in ten minutes, oral answers, but also need to have certain skills, in fact, is the correct logical thinking method. Test-taking physicians should analyze the case according to four steps, briefly answer the relevant questions:
I. Diagnosis and diagnostic basis
(a) Diagnosis This is the most difficult one, but also the most critical first step. In each case summary, there are three main parts: chief complaint, history, physical examination and auxiliary examination, which should be read and analyzed in order.
1. The main complaint is very brief, often only one or two sentences, but this is the main symptoms of the case, is a condensed medical history. After reading the complaint should be examined by the physician on the case of the patient's disease will have a preliminary understanding and a general scope. For example, ? Recurrent episodes of right upper abdominal pain for six months ? , should be associated with a variety of lesions causing right upper abdominal pain: peptic ulcer, hepatobiliary diseases, right hemicolonic lesions and right urinary tract disorders, etc.; if the complaint is ? Chest pain, cough, hemoptysis for 2 months? If the complaint is chest pain, cough, hemoptysis for 2 months, it is natural to consider respiratory system pathology first; and if the complaint is? If the complaint is increased frequency of defecation, blood in the stool for 3 months? The first thing that comes to mind is lower gastrointestinal tract disorders, paying attention to the corresponding manifestations of the colon and rectum; there are also complaints of frequent urination, urinary urgency, urinary pain. Frequent urination, urinary urgency, urinary pain with fever for 1 day? The possibility of urinary tract infection is very high in cases with complaints. So after reading the complaint, the possible site of the case of the disease, the nature of the case to have a preliminary understanding. Sex and age before the chief complaint are also of some significance.
2. The history is a further description and explanation of the complaint, so that the suspicious diagnosis is narrowed. For example, in the case of right upper abdominal pain, the first attack six months ago was caused by a greasy diet, followed by jaundice and fever, the scope of the suspected diagnosis is focused on the biliary system. If the right upper abdominal pain is seasonally related, accompanied by acid reflux, heartburn, and noticeable at night or during hunger, peptic ulcer should be thought of. Tests at other hospitals, and treatment, are also helpful in making the diagnosis.
3. Physical examination and auxiliary examination are specific objective indicators of diagnosis, such as increased frequency of stools, cases of blood in the stool, medical education/network collection of physical examination and touching the right lower abdominal mass, fecal occult blood (+), hemoglobin is too low, then it is likely to be a tumor of the colon. It should be noted that the case summary of the auxiliary examination is incomplete and can only provide circumstantial evidence. If the ancillary tests are comprehensive, the diagnosis can be made directly and no further tests are needed. According to the above three elements, the physician should be able to analyze the case, make a preliminary diagnosis, complete the key step.
(ii) diagnostic basis is to make a diagnosis of the reason and basis, according to the symptoms, signs and auxiliary tests to support the preliminary diagnosis of the order listed.
Second, differential diagnosis
You in the case analysis process has been suspected and ruled out, or can not be completely ruled out the disease, and briefly explain the need to identify the reasons and reasons for preliminary exclusion. For example, perforated ulcer disease should be differentiated from other acute abdominal conditions such as acute cholecystitis, acute pancreatitis, intestinal obstruction or acute appendicitis.
Third, further examination
is the examination that needs to be done for differential diagnosis and clear diagnosis as well as formulation of treatment plan. For example, if the initial diagnosis is gastric cancer, but it needs to be differentiated from gastric ulcer disease, gastric polyp and gastritis, further gastroscopy should be performed. Cough, hemoptysis, fever cases. If lung cancer is suspected in X-ray chest radiography and needs to be differentiated from tuberculosis, pneumonia, bronchitis or benign masses, sputum examination (including bacteriological and cytological examination), chest CT and bronchoscopy should be performed.
Four, treatment principles
Based on the diagnosis and condition, the principles of medication, surgery and other medical and surgical treatment and simple program, such as: the application of antibiotics, anti-infective treatment; blood transfusion, transfusion, anti-convulsive treatment; open abdominal exploration, appendectomy and fracture repositioning, plaster casts external fixation, etc., are listed one by one.