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1. History collection: upper gastrointestinal bleeding.
2. Case study: hyperthyroidism, but unfortunately there is no other data.
3. Physical examination: chest tightness, shortness of breath, etc. What physical examinations are needed? Tell me where the heart valve is auscultated.
4. Basic operation: How to change the medicine after the rusty nail is stabbed?
5. Radiological examination: pneumothorax and pleural effusion.
6. Electrocardiogram: atrial/ventricular premature beats.
7. Thoracic auscultation: twisting pronunciation/alveolar breathing sounds, etc.
8. Heart auscultation: rumbling murmur
2. Medical record collection, male, fatigue, hematemesis, black stool for 5 days.
Analysis showed acute glomerulonephritis.
Physical examination, palpation of lymph nodes (armpit. Note the description of lymphadenopathy.
change a medical prescription
Many people adopt artificial respiration and cardiac compression this year.
Electrocardiogram: premature beat, bradycardia chest film: pneumonia, abdominal plain film is normal, medically speaking, about receiving red envelopes.
3. 1. Medical history collection: A 46-year-old male with persistent epigastric pain for 6 days and nausea and vomiting aggravated for 3 hours. He has a history of chronic cholecystitis and cholelithiasis.
2. Medical record analysis: A 25-year-old woman suffered from right thigh pain and dysfunction due to a car accident. Physical examination: the right lower limb is shortened, and the middle and lower part of her right thigh feels bony and has subcutaneous congestion. Knee and hip joints can't move because of pain.
3. Physical examination and basic operation: A 38-year-old male came to see a doctor because of headache and dizziness, and had a history of "sinusitis". All neurological examinations were negative. What physical examinations should I do? Wear off isolation gown.
4. Ventricular systolic murmur in apical region
5.x-ray: normal chest film of gastric cancer
6. ECG: premature atrial myocardial infarction
4. Medical history collection: male, 18 years old, with nausea and vomiting, yellow urine and fever for two days.
First, medical history collection
1. carbon monoxide poisoning
2. Female, 2 1 year old, eyelid edema for 5 days.
3. Male, 35 years old, left upper abdominal distension and abdominal pain with yellow staining for 2 days.
4. Male, 65 years old, fever, cough, expectoration 1 week, disturbance of consciousness for 2 hours, diabetes history 10 years.
5. Paroxysmal chest pain for 3 months
6. Male, 55 years old, with fatigue and abdominal distension for 5 years, hematemesis and black stool for 3 days, and unconsciousness 1 day.
7. Chest pain, breath holding and hemoptysis for 3 days.
8. Fever, chest pain, cough with rusty sputum for 2 days.
9.65-year-old male, progressive dysphagia, emaciation for half a year.
10. Male, 28 years old, with pain in the right lower abdomen 1 day.
Second, the case analysis
1. Chronic renal failure
2. Right colon cancer
3. Three hours after trauma, hospitalized, liver rupture, hemorrhagic shock.
4. Intermittent edema of both lower limbs for 3+ years, general weakness and dizziness for 3 days.
Blood pressure140-150 mmhg/90-100 mmhg, no pulsatile headache, fatigue after exercise, general fatigue in recent 3 days, no history of rheumatoid arthritis, no history of hypertension, no history of allergy, childhood nephritis, depressed edema of PE lower limbs, nothing special. HB: 86g/。
5. Acute peritonitis caused by duodenal perforation
6. Acute pancreatitis
7. Female, 60 years old. Accidentally fell to the right hip and landed 1 day. Examination: Vital signs are normal.
The right hip flexion knee is limited, the right heel hurts, and the right groin is tough.
With midpoint tenderness. There is no swelling locally. Conscious, life can take care of themselves.
8. Swelling and pain in the right upper abdomen for half a year. Physical examination: Spider nevus and hard-touched liver infracostal nodules can be seen. B-ultrasound: liver occupying space
9. Right waist injury, hematuria, blood clot for half an hour.
Physical examination right waist tenderness
Laboratory examination: WBC 10. 1, Hb98, B-ultrasound examination showed that the capsule was incomplete, there was echo around the kidney, and no abnormality was found in the chest radiograph.
A 10。 A 35-year-old male patient developed fever, abdominal pain and diarrhea for 2 days. Blood routine: WBC 15.6× 109, neutral 88% stool routine: full-field white blood cells, red blood cells 20-30/HP.
Third, physical examination
1. Abdominal palpation (Question: What is the difference between inflammatory and neoplastic masses? How much ascites can't be discharged? )
2. Heart palpation
3. Examination of superficial reflex nerve (Question: Concept of lower motor neuron and manifestation of injury)
4. Abdominal auscultation (bowel sounds and vascular murmurs) (Question: What is hyperactivity of bowel sounds? What do you mean the bowel sounds disappear? What diseases do abdominal vascular murmurs see? What tests should I do? )
5. Precardiac palpation (Question: Must touch tremor be a heart attack? )
6. How to check the carotid pulse, capillary pulse, water pulse and shooting sound? What vascular signs does aortic valve insufficiency see? What will happen if bilateral carotid arteries are compressed?
7. Abdominal buckle diagnosis technology, content and operation method. Candidates check each other's bodies and check while talking. The characteristics of abdominal vascular murmur (arteries and veins), how to auscultate? What are the common diseases? Describe bowel sounds (normal, hyperactive, weakened)
8. Heart auscultation
(1) can correctly point out the auscultation area of heart valve;
(2) The auscultation sequence is correct;
Starting from mitral valve area, pulmonary artery area, aortic area, second auscultation area and tricuspid valve area, counterclockwise or inverted 8.
(3) can express the main contents of heart auscultation.
Q: What noises can be heard in the heart area? Is it systolic or diastolic heart rate, rhythm, normal heart sound, heart sound change, heart murmur, pericardial fricative sound?
9. Peripheral vascular examination
10. Cervical trachea and thyroid palpation
Fourth, the basic operation
1. urethral catheterization (question: when urethral catheterization, ask the male that the urethra is two bends and three narrows)
2. Pleural effusion puncture
3. Change the dressing and wear sterile gloves (remember to wear talcum powder when wearing gloves).
4. Abdominal puncture (pay attention to measuring blood pressure before and after puncture and urinating before puncture)
5. Thoracic puncture (why puncture on the upper rib? )
6. Treatment methods and precautions of spinal cord injury
7. Debridement, suture and dressing, gloves and surgical knotting with needle holders.
8. A patient was bitten by a collapsed earth wall three days ago, and the soles of his feet were scratched by sharp tools. After debridement, suture and injection of tetanus antitoxin, come back to change the dressing. What should I prepare and pay attention to?
(Note: Expose the wound, rinse with hydrogen peroxide, rinse with potassium permanganate, and change the dressing! )
9. Mandibular hemostatic bandage (triangle towel)
10. Cardiac defibrillation
1 1. Rescue a drowning boy 12 years old (cardiopulmonary resuscitation)
12 ventilator application
Verb (abbreviation of verb) multimedia
1. Normal electrocardiogram, acute myocardial infarction, atrial premature beats, supraventricular tachycardia, pear-shaped heart, sinus bradycardia, normal heart, boot-shaped heart and third-degree atrioventricular block.
2. X-ray film of infiltrating pulmonary tuberculosis in the left upper lung, perforation of digestive tract (free gas under diaphragm), pneumonia in the right upper lobe, normal chest X-ray, fracture of the left neck, fracture of the right tibia and fibula, intestinal obstruction, premature ventricular contraction, pneumonia in the right middle lobe, pneumothorax in the right side, gastric cancer and right colon cancer.
3. Heart sound auscultation: Diastolic rumbling murmur, no conduction (to know whether it is conduction, you can click the part mentioned in the selection with the mouse during the examination, and if there is heart sound, it means conduction); Pericardial fricative sound, galloping rhythm and rough heart murmur in full systole are widely transmitted to precordial area, patent ductus arteriosus,
4. Auscultation of breath sounds: bronchoalveolar breath sounds, localized dry and wet rales in the left lung, inspiratory wheezing sounds and expiratory wheezing sounds.
Sixth, medical ethics
1. Introduce patients to another hospital for surgery, and choose this method under the pretext of low operation cost.
Doctors can't sit on patients' beds.
3. What should a male doctor pay attention to when examining a female patient?
4. Give the doctor a red envelope
5. The first puncture failed and a second puncture was needed. How to explain it to patients?
6. A doctor examines a patient's abdomen, uncovers his clothes, and someone calls you during the examination. What should you do to the patient? Put the patient's clothes on the last contact before explaining to the patient. )
7. Can patients be asked to do more tests to increase hospital income?
8. How to talk to patients before lumbar puncture?
June 13 exam summary
First, medical history collection
1. Male, 24 years old, coughing for two months and hemoptysis for one week.
2. Male, 65 years old, with diabetes history 10 years, cough and fever 1 week, and suddenly coma for 2 hours. (Diabetic hyperosmolar coma)
3. Hypertension, high heart rate and cardiac insufficiency
4. Male, 65 years old, with progressive dysphagia and emaciation for half a year.
5. Gastric ulcer bleeding
6. Chest pain, breath holding and hemoptysis for 3 days.
7. Fever, chest pain and cough with rust-colored sputum for 2 days.
8.48 years old, abdominal distension for three months, hematemesis and black stool for three days.
9. The patient was a 40-year-old male with epigastric pain and fever for 2 weeks and yellow skin for 4 days.
10. Abdominal pain, abdominal distension and yellow skin for 2 days.
1 1. Male, 28 years old, with pain in the right lower abdomen 1 day.
12. Male, 62 years old, with knees pain for 8 years, aggravated for 2 months.
13. Female, 55 years old, with abdominal pain, chills and fever for 2 days.
14. Abdominal pain with purulent bloody stool recurred 1 week for 5 years.
15. Progressive dysphagia with emaciation for 6 months.
16. fever with knee joint swelling and pain for 2 days.
Second, the case analysis
1. Male, 65 years old, with a change of stool rhythm for half a year, diarrhea and pain in the right lower abdomen for one week.
2. Acute duodenal perforation, total abdominal tenderness, rebound pain and inducement (gargle)
3. Female, 26 years old, with low back pain and hematuria for 2 days!
4. Upper gastrointestinal bleeding
5. Chief complaint: female, married, 32 years old, fever, frequent urination, urgency and dysuria for 2 days.
Two days ago, after fatigue, I had frequent micturition, urgent micturition, painful micturition, body temperature of 37.5 degrees ..., mild tenderness in the middle of the lower abdomen, and tapping pain in the kidney area. Laboratory examination: WBC 10.0, 80% neutrophils. Urine routine: protein, WBC 65438+.
6. Hypertension
7. The right upper abdomen is swollen and painful for half a year. Physical examination: Spider nevus and hard-touched nodules under the liver rib can be seen. B-ultrasound: liver occupying space.
8. Male, 57 years old, had sudden right low back pain and hematuria for 4 hours. (Past history, clinical manifestations, auxiliary examination tips: right ureteral calculi, right hydronephrosis, urinary tract infection)
9. Diabetes 1 ketoacidosis
10. Spleen rupture, hemorrhagic shock
1 1. Bacillary dysentery
12. septic meningitis shock type
13. Male, a few years ago, suffered from measles pneumonia, with cough and expectoration, which became worse recently. The amount of sputum was as high as 300ml, and he had fever and moderate bubbling sound in the right lung base. There is hemoptysis. Check the lungs for unvoiced sounds, barrel chest and chest radiograph for holes.
14. Male, 58 years old, paroxysmal chest pain for 2 years, aggravated for 20 hours;
No previous history of hypertension, coronary heart disease or diabetes.
PE: HR96 beats/min, the mitral valve area can reach Grade III/6 BSM, and it is conducted to the left sternum without abnormality.
Test: CK, CK-MB is elevated, EKG shows that V3-5 ST-T is elevated, and the arch back is upward.
15. Chest trauma
16. After falling above the right waist, hematuria for 6 hours is the rupture of the right kidney.
17. Hemolytic anemia
Third, physical examination
1. lung auscultation sequence/what normal breathing sounds can be heard (where can you hear them respectively)/what breathing sounds can be heard in two stages of lobar pneumonia (consolidation stage/dissipation stage);
2. This part should pay attention to the examiner's questions, such as blood pressure measurement before thoracoabdominal puncture, anesthetic concentration, what anesthetic is better, can normal people have babinski's sign, and is it positive? (Yes,/kloc-babies under 0/year)
Step 3 check your eyes
4. palpation of supraclavicular lymph nodes, inguinal lymph nodes and supratrochlear lymph nodes
5. Corneal reflex exercise, what does it mean to disappear? Dominated by what nerve? Testicular reflex exercise? What are the shallow reflections?
6. Positive manifestations of thyroid palpation, tracheal palpation, thyroid palpation and auscultation in patients with hyperthyroidism.
7. Spinal tract sign
8. Which diseases can strengthen and weaken Tik Tok, and which diseases can cause pleural friction?
9. Chest percussion auscultation (Question: the right lower lung is turbid, what diseases are found, what are the related physical examinations, and the auscultation changes of pleural effusion)
10. Peripheral blood vessel examination
1 1. How to check neck stiffness and its clinical significance. How to do the Kirschner sign and how to do the Papillomavis sign?
12. liver palpation question: how does the voiced world of the liver describe the liver? Is hepatomegaly necessarily pathological?
13. Abdominal percussion includes (tympanic area of gastric bubble, exercise dullness, and percussion pain in the costal angle of spine) Question: Under what circumstances does the tympanic area of gastric bubble appear? What disease do you often see when you knock on the spine and rib angle?
Fourth, the basic operation
1. Abdominal puncture
1 = Position:/Semi-recumbent position, supine position or lateral position;
2 = Choose a suitable puncture point: ① The intersection point between the left lower abdomen umbilicus and the anterior superior iliac spine is 1/3, which is not easy to damage the abdominal artery; ② There are no important organs, and it is easy to heal at 1 point. Ocm and 1.5 cm to the left or right of the midpoint of the umbilical cord and pubic symphysis; (3) lateral position, at the intersection of umbilical horizontal line and axillary front line or axillary middle line, which is often used for diagnostic puncture; ④ A small amount of effusion, especially when there is wrapped separation, should be located and punctured under the guidance of B-ultrasound;
3 = routine disinfection, one wearing sterile gloves, covered with disinfectant towel, and locally anesthetized with 2% lidocaine from the skin to the peritoneal wall;
4 = patients with liver cirrhosis usually have a discharge of less than 3000ml =；;
2. Cardiac compression
3./Kloc-When the drowning teenager aged 0/2 stops breathing and his heart is still beating, pay attention to removing the dirt from the respiratory tract and add one step of pouring water: the abdomen should be raised, the chest and head droop, or the feet should be supported, and the abdomen should be placed on the shoulders of the emergency person to walk or jump to "pour water". You can also put the patient's abdomen on the knees of the rescuer and lower your head to pour water.
4. Appendiceal dressing change: Pay attention to wearing masks and hats, and wear gloves in the direction and length of viscose cloth?
5. Mandibular hemostatic bandage (triangle towel)
6. Cardiac defibrillation
7. Treatment of spinal patients
8. Thyroid surgery disinfection, wearing surgical gown and gloves. Question: the disinfection scope of appendicitis operation
9. Bone perforation and surgical gown
10. Aspiration of sputum
1 1. Application of ventilator
12. Inserting a gastric tube for nasal feeding (Question: What instruments need to be prepared and how to judge whether the gastric tube reaches the stomach)
13. Wear and take off isolation gown
14. Chest perforation
Verb (abbreviation of verb) multimedia
1. ECG is normal, left ventricular hypertrophy, third degree atrioventricular block, atrial fibrillation, ventricular premature beats and myocardial ischemia.
2. X-ray film of left lower lung cancer, intestinal obstruction, lung metastasis (thickening of lung texture and multiple masses in lung), gastrointestinal perforation, Pudaxin, boot heart, pneumonia, humeral fracture, infiltrating tuberculosis of left upper lung, atelectasis of right lung, pleural effusion, femur fracture, tibia and fibula fracture, normal chest film, pear-shaped heart, wrist fracture and ulnar fracture.
3. Heart sound auscultation tricuspid valve auscultation area, diastolic galloping rhythm, systolic blowing murmur, diastolic rumbling murmur, atrial premature beat, myocardial ischemia, patent ductus arteriosus.
4. Breathing sound auscultation right pneumothorax lung auscultation right lung breathing sound weakening (combined with medical history), bronchial breathing sound+wet rale, wet rale, bronchoalveolar breathing sound, wheezing sound.
Sixth, medical ethics
1. Without a superior doctor, interns can't do lumbar puncture by themselves, which is irresponsible to patients.
2. The patient gives a red envelope
3. Don't prescribe drugs indiscriminately.
A doctor examines the patient's abdomen, uncovers his clothes, and someone calls you during the examination. What should you do to the patient? Put the patient's clothes on the last contact before explaining to the patient. )
The video shows that a doctor gave the patient a generous prescription, and the patient argued with the doctor with the prescription. If you were the doctor, what would you do? Answer: According to the patient's condition, prescribe the cheapest medicine to the patient while ensuring the curative effect.
6. Can an unqualified professional doctor do a chest puncture alone?
June 14 Examination Summary
First, medical history collection
1. Male, 29 years old, chest pain, breath holding and hemoptysis for 9 days.
2. Female, 20 years old, with facial edema for 5 days.
3. Female, 35 years old, emaciated, overeating with palpitation for 2 weeks.
4. Male, 40 years old, with intermittent abdominal pain for 8 years and vomiting for 2 days.
5. Male, 60 years old, suffered from repeated joint pain in both knees for 8 years, which was aggravated for 2 months.
6. Male, 26 years old, coughed for 2 weeks and coughed up blood 1 week.
7. Abdominal pain, emaciation for half a year and hematemesis for 3 days.
8.76-year-old male, with fever, cough and expectoration for 65,438+0 weeks, disturbance of consciousness for 2 hours, and history of diabetes for 65,438+00 years.
9. Female, 54 years old, coughing with blood in sputum for 2 months.
10. Male, 56 years old, had paroxysmal chest pain for 3 months.
Second, the case analysis
1. Intermittent edema of both lower limbs for 3+ years, general weakness and dizziness for 3 days.
Blood pressure140-150 mmhg/90-100 mmhg, no pulsatile headache, fatigue after exercise, general fatigue in recent 3 days, no history of rheumatoid arthritis, no history of hypertension, no history of allergy, childhood nephritis, depressed edema of PE lower limbs, nothing special. HB: 86g/。
2. Gastrointestinal perforation
3. Male, 60 years old, abdominal distension and abdominal pain, stopped exhausting and defecating for 2 days.
4. Right chest trauma with right 4. Five broken ribs.
5. Bronchiectasis
6. Male, 58 years old, paroxysmal chest pain for 2 years, aggravated for 20 hours; No previous history of hypertension, coronary heart disease or diabetes. PE: HR96 beats/min, the mitral valve area can reach Grade III/6 BSM, and it is conducted to the left sternum source. Other examinations were normal: CK and CK, CK-MB increased, EKG showed that V3-5 ST-T increased, and the arch back was upward.
7. Duodenal ulcer complicated with perforation and diffuse peritonitis.
8. Spleen rupture
9. Male, with epigastric pain for 3 hours. The patient drank alcohol 3 hours ago, and then felt dull pain, nausea and vomiting, which was stomach contents. After vomiting, the pain is not relieved, the upper and middle abdomen is tender, and there is no rebound pain. Blood amylase 20 1IU/L urine amylase 950 iu/l