1, carefully check your ID card, admission ticket and other documents before the exam; 2B Tools such as pencils, erasers, pens (blue, black) or ballpoint pens, and ensure that the tools are effective. It is suggested to put the above items in a transparent briefcase, which is convenient for carrying and viewing. ?
2. Ensuring adequate sleep and eating breakfast before the exam is conducive to a clear head. ?
3. Arrive at the examination room half an hour to one hour in advance to avoid being late for the exam due to traffic jams or other minor accidents. If you have motion sickness or other health reasons, it is recommended to stay near the test center. ?
4. After entering the examination room, read the examination rules carefully and fill in the answer sheet and personal information on the examination paper according to the examination room prompts. ?
5. After the exam begins, answer questions according to personal habits. It is recommended to answer in order and not to leave out. You can mark the answer on the test paper first, and then paint the answer sheet after the answer is finished. Draw a card to check whether the answer is correct. ?
6. If you encounter an uncertain problem, don't think hard first. You can choose a reasonable answer first and mark it on the paper with a pencil. After all the questions are answered, you can go back and think about this question to save time. ?
7. Trust the first feeling, because a lot of knowledge has already formed an impression in your mind. If you are still uncertain after repeated thinking, answer according to your first feeling. ?
8. Draw the answer sheet according to the requirements. Don't alter it repeatedly, so as not to affect the computer marking. ?
9. Arrange the time reasonably, do the questions first, then check, and ensure that all the questions are answered within the specified time, and stamp the card. ?
10, remember not to cheat.
Medical history collection skills
Template:
Brief medical history: xx years × months × days × months × days × months × days × months × days × months × days × months × days × months × days × months × days × months × days × days × months × days × days × months × days × months × days × months × days × months × months × days × months × months × months × days × months × months × months × months × days × months × months ×
Contents of negotiation: XX, XX, XX, XX, XX, XX, XX, XX, XX, XX, XX, XX, XX, XX, XX, XX.
Current disease history
1, according to the chief complaint and related identification.
(1) ×× symptoms (cold, rain, fatigue, diet, drugs, mood, trauma, etc. ).
② Symptoms: (intensity, type, location, personality, frequency, time sequence, aggravating and mitigating factors, etc. ).
③ Accompanying symptoms (changes related to symptoms, main positive symptoms and negative symptoms related to differential diagnosis).
2. After diagnosis and treatment
(1) Have you ever been to a hospital, and what tests have you done (for example, the tests done in the hospital)?
② Treatment (specific treatment "drug", method, dosage, curative effect, disease evolution and curative effect).
3. General situation (diet, sleep, defecation, weight, mental state, etc. Since the onset).
Other related medical history
(1) Do you have a history of drug allergy, surgery, infectious diseases, swimming, etc.
(2) Whether there is any relevant medical history (whether there is a history of similar attacks, whether there is a history of XX, whether there is a family history of XX, and if necessary, female patients should ask about menstrual history and infant feeding history).
Case analysis answering skills
1, take the time to answer questions, and the answer time is only 15 minutes;
2. Diagnosis: including main diagnosis and auxiliary diagnosis. The attending only tests the contents required by the syllabus. And both must be written in full, otherwise you won't get full marks;
3, diagnosis basis: each diagnosis needs to write a diagnosis basis;
4. Differential diagnosis: only write the name of differential diagnosis, not the reason;
5. Treatment: Detailed treatment principles, including treatment principles, specific measures, supportive treatment, adjuvant treatment measures, health education, surgical treatment, etc.
physical examination
general inspection
1, temperature measurement
A. Thermometer reading before inspection
B. dry the armpits;
2. Blood pressure measurement
A. Turn on the sphygmomanometer, and the mercury column should return to 0;
B. The air sleeve should be tight enough to put a finger, and its lower edge should be placed 2 ~ 3 cm above the cubital fossa;
C. Do not put the stethoscope under the cuff, but on the brachial artery;
D. After the measurement, report the blood pressure value to the examiner;
3. Skin
A. When examining the spider nevus, press the center of the spider nevus with a cotton swab or matchstick, and its radial small blood vessels disappear, and the spider nevus reappears after removing the pressure;
B. petechiae: the diameter of subcutaneous hemorrhage point is 5 mm.
4. Lymph nodes
A. Lymph node examination sequence: submandibular → neck → supraclavicular → armpit → pulley → groin (from top to bottom);
B. The order of head and neck lymph node examination: before ear → behind ear → mastoid region → suboccipital region → submaxillary → submental region → anterior cervical triangle → posterior muscular triangle → supraclavicular lymph nodes;
C axillary lymph node examination order: axillary apex group → central group → pectoral muscle group → subacromial group → lateral group;
Head and neck examination
1, eye
A. Left side → left top → left bottom → right side → right top → right bottom, showing "H";
B. When the eyeball moves in six directions, the fingertip is 30 ~ 40cm； away from the subject;
C. When checking the collective reflex, the index finger moves outward from 1m to 5 ~ 10 cm away from the eyeball;
D. When checking indirect light reflection, cover the light with your hands;
2, tonsil graduation
I degree: no more than pharyngeal arch and maxillary arch; Second degree: exceeding pharyngeal arch and maxillary arch; ⅲ degree: reaching or exceeding the midline of posterior pharyngeal wall;
Chest examination
1, chest examination
A. A sign for counting ribs and intercostal spaces in the chest Louis sternal angle, with both sides connected with the second rib;
B the sign of the number of vertebral bodies in the back chest is the spinous process of the seventh vertebra, that is, the most prominent part when the client bends his head;
C. The sign of the number of ribs in the posterior chest is the lower corner of the acromion, and the seventh or eighth posterior rib is flat;
2, lung percussion
A. Percussion skill of lung apex: find trapezius muscle, locate the midpoint of its leading edge, tap 2.5cm outward, mark it, tap 2.5cm inward, mark it, and the connecting line between them is the width of lung apex;
B. Percussion skill of lower margin of lung: find the right nipple and percussive the second intercostal space (i.e. the sixth intercostal space) along the clavicle midline; Percussion at the midline of armpit, from top to bottom, along the right nipple, between the 4 ribs; Below the scapular line, that is, the eighth intercostal plane, tap down the intercostal plane, that is, the lower edge of the lung; The left clavicle midline does not attack the left side.
3. Heart palpation
A. The best conditions for examining pericardial fricative sound are sitting position, slightly leaning forward, end expiratory period and systolic period;
B. Pericardial fricative sounds are rough in both diastole and systole, but they are obvious in systole;
4, heart percussion
A. Left heart boundary: the median line of sternum between the fifth, fourth, third and second intercostal ribs of normal adults is 8cm, 6cm, 4cm and 2cm respectively, and it is marked about 65438±0cm on the vertical line of the fifth nipple;
B. Right cardiac boundary: from the fourth intercostal branch, that is, the intercostal branch where the right nipple is located, about 2 cm away from the right edge of the sternum; The third and second intercostal spaces are the right edge of sternum;
5. Some concepts about ascites
Positive moving voiced sounds indicate that the ascites volume is greater than 1000ml, the puddle sign is greater than 120ml, and the liquid wave tremor is greater than 3000 ~ 4000 ml.
6. Several reflex centers
Upper abdominal wall reflex -T7-8, middle abdominal wall reflex -T9- 10, lower abdominal wall reflex-T112, biceps brachii reflex -C5-6, knee reflex -L2-4, ankle reflex -S66.
Basic operation
1, disinfection sequence of common parts
From the inside out, from top to bottom; Special (such as infection, stoma, etc. ) parts from outside to inside disinfection;
Step 2 wash your hands with soap
Three-stage brushing technique is adopted, with each stage lasting 3 minutes, with a total time of *** 10 minute. Brush to elbow 10cm, soak to elbow 6cm, soak for 5 minutes; When another operation needs to be performed continuously, if the gloves are not broken, you don't need to brush your hands, just soak them in 70% alcohol or 0. 1% benzalkonium bromide solution for 5 minutes, and then wear sterile surgical gown and sterile gloves. If the previous operation is contaminated, you should brush your hands again before continuing the operation.
3, surgical gown wear sterile area.
Chest below shoulder and above waist, axillary midline on both sides, hands and arms;
Step 4 take off your surgical gown
Take off the surgical gown first, then the gloves, and wear sterile surgical gown in the relatively empty area of the operating room;
Step 5 wear gloves
A. choose gloves that suit you. Too big or too small gloves are not conducive to operation;
B before wearing gloves, hands should not touch the outside of gloves, and after wearing gloves, the outside of gloves should not touch the skin;
C. If there is talcum powder outside the gloves, clean them with sterile saline;
D before the operation, put your hands on your chest in the open area;
6, dressing change and stitches
A. aseptic operation principle?
B the principle of "three first and three later" is to disinfect the wound first, and then pollute the wound; Contaminate the wound first, then infect the wound; Infect common wounds first, and then infect special wounds, such as gas gangrene, tetanus, tuberculosis, drug-resistant Staphylococcus aureus, etc.
7. Oxygen inhalation
A. Strictly abide by the operating rules, pay attention to the safety of oxygen use, and do a good job of "four precautions", that is, fire prevention, earthquake prevention, oil prevention and heat prevention;
B. In the process of oxygen inhalation, when the oxygen flow needs to be adjusted, the patient's nasal catheter should be removed first, and then connected with the patient after the oxygen flow is adjusted. When stopping oxygen inhalation, unplug the nasal catheter first, and then turn off the flowmeter;
C. When taking oxygen, observe whether the patient's pulse, blood pressure and mental state have improved, and adjust the oxygen concentration in time;
D. The humidifying bottle must be cleaned and disinfected after each use;
E. Pay attention to record the information and start time of oxygen inhalation patients after completion;
8, sputum suction
A. strictly implement aseptic operation;
B. Aspiration should be gentle to prevent damage to mucous membrane;
C. When the sputum is sticky, it can be diluted by methods such as back-buckling, steam inhalation and atomized inhalation. If there are anoxic symptoms such as cyanosis and decreased heart rate during sputum aspiration, the patient should stop sputum aspiration immediately and suck again after the symptoms are relieved;
D. When children suck sputum, the sputum suction tube should be thinner and the suction force should be smaller;
9. Indications for primary suture of open wound
A. 6-8 hours after injury;
B. The wound pollution is light, not exceeding 8 ~ 12 hours;
C. Head and face injuries usually occur 24-48 hours after injury;
D. If the above conditions are not met, only debridement is performed, and no suture is performed;
10, gastric tube placement
A. intubation should be light and steady. When inserting 14 ~ 16 cm, please ask the patient to swallow, which is convenient for operation;
B. When intubating a coma patient, the patient's head should lean back. When the gastric tube is inserted into epiglottis, it is about 15cm. Lift the head with the left hand, make the mandible close to the sternum handle, increase the radian of pharyngeal passage, and make the tube end slide along the back wall and insert to the required length;
1 1, three-cavity and two-sac tube hemostasis method
A. The insertion depth of gastric tube is 45 ~ 45~55cm, and the insertion depth of three-cavity and two-sac tube is 50 ~ 65cm；;
B. The inflation rate of esophageal sac 100 ~ 150~200ml, the inflation rate of gastric tube sac 150~200ml, and the tube end traction weight of 0.5kg；;
C, inflating the gastric balloon first, and then inflating the esophageal balloon;
D, put the esophageal balloon first, and then put the gastric balloon;
12, catheterization
A. The average urethral catheterization for male patients 15 ~ 20 cm, and hemostatic forceps was loosened. After seeing urine, it will be pulled out until there is no urine and then inserted 2 cm;
B male patient 15 ~ 20 cm insert Foley catheter and loosen hemostatic forceps. After the urine is seen, draw it out until there is no urine, then insert 7 ~ 10 cm, and inject water into the balloon15 ~ 20 ml;
C. The female patient with common urethral catheterization is inserted into the urethra for about 6 ~ 8 cm, and the hemostatic forceps is loosened. After seeing urine, draw it out until there is no urine, and then insert it for 2 cm;
D female patients insert Foley catheter into urethra 6 ~ 8 cm, and loosen hemostatic forceps. After the urine is seen, draw it out until there is no urine, then insert 7 ~ 10 cm, and inject water into the balloon15 ~ 20 ml;
13, thoracic puncture
A. Thoracic puncture and aspiration: the 7th-8th intercostal space in the lower angle of scapula or the posterior axillary line, the 6th-7th intercostal space in the medial axillary line and the 5th intercostal space in the anterior axillary line;
B. Thoracic puncture and aspiration: the second intercostal space of clavicle midline or the fourth to fifth intercostal space of axillary midline;
14, abdominal puncture point
A supine position:1/3 of the line connecting the left lower abdomen umbilicus and the left anterior superior iliac spine;
B supine position: about 1cm,1.5 cm above the midpoint of the umbilical cord and pubic symphysis; Left or right;
C lateral position: the intersection of umbilical horizontal line and axillary front line or axillary middle line extension line;
15, bone marrow puncture
A. Puncture point of the anterior superior iliac spine: The patient lies supine at the iliac crest 1 ~ 2 cm behind the anterior superior iliac spine, and the bone surface is wide and flat;
B) Puncture point of the posterior superior iliac spine: the patient takes the lateral position and the most prominent part of the posterior superior iliac spine;
C. Puncture point of sternum: The patient takes lateral position, with the sternal midline at the second intercostal level;
16, lumbar puncture
A the puncture point corresponds to the space between the spinous processes of the 3rd and 4th lumbar vertebrae;
B. The depth of needle penetration is about 4~6cm for adults and 2 ~ 4cm； for children;
C. instruct the patient to lie on his back for 4-6 hours;
17, arteriovenous puncture
A strict aseptic operation must be carried out to prevent infection;
B. If puncture fails once, don't repeat puncture to avoid damaging blood vessels;
C. If dark black blood is drawn, it means that the vein is mistaken, and the puncture point should be immediately drawn and pressed for 3 ~ 5 minutes;
18, management of spinal injury:
When handling, the spine must be kept straight, and it can't bend or twist. Three or four people use the method of flat support to make the simulated person move to the board smoothly (cuddling or one person raising his head and one lifting his feet is forbidden);
19, artificial respiration
A. During mouth-to-mouth artificial respiration, hold the patient's nostril with one hand, thumb and forefinger and block it to avoid air leakage;
B. The compression ventilation ratio is 30: 2. For infants and children, the ratio of 15: 2 can be used by two people in cardiopulmonary resuscitation.
C. Pressing frequency and intensity: the rate is 80- 100 times/minute, and the pressing depth is 3-5 cm; ;
20, limb fracture field first aid external fixation technology
A. If there is a wound, stop bleeding, disinfect, bandage and fix it;
B when fixing the splint with bandage, it should be bandaged from the lower part of the fracture to reduce the congestion and edema of the affected limb;
C splint should be placed below or on both sides of the fracture site to fix a joint from top to bottom;
D. Patients with thigh, calf and spine fractures should not move at will, and should be temporarily fixed in place;
E. The fixation should be flexible and appropriate, so as not to affect the blood supply of the distal limb;
Multimedia computer examination
1, cardiac auscultation
A. Mitral valve auscultation area: the point with the strongest apical pulsation, that is, 0.5 ~ 1.0 cm of the fifth intercostal and left clavicle midline;
B auscultation area of pulmonary artery: the second intercostal space of left sternum;
C Auscultation area of aorta: the second intercostal space on the right edge of sternum;
D. The second auscultation area of aorta: the third intercostal space of left sternum;
E. Auscultation area of tricuspid valve: the 4th ~ 5th intercostal space on the left edge of sternum;
2, electrocardiogram reading formula
Bradycardia of small three major five sinuses-RR interval of the same lead; The five major cases are sinus bradycardia;
There is no change between three and five-the RR spacing of the same lead is normal between three and five grids;
The patients with I-degree and III-degree atrioventricular block showed regular heart rate, that is, RR interval was equal;
ST- myocardial ischemia in ischemic infarction is characterized by ST-segment depression, while acute myocardial infarction is characterized by ST-segment elevation and pathological Q wave.
The absence of P wave is difficult to keep the heart rate tidy-supraventricular tachycardia is characterized by the absence of P wave, and a few junctional premature beats turn into P wave inversion;
V 1 and V5 distinguish left and right-distinguish left and right bundle branch block and left and right ventricular hypertrophy, see QRS wave of V 1 and V5 respectively;
On V 1, the wave direction is left-V1r on V5, which is right bundle branch block or right ventricular hypertrophy, and on V5, it is left bundle branch block or left ventricular hypertrophy.
The width indicates that the complete bundle branch -QRS wave is wider in V 1 or V5 lead, and the R wave is M-shaped, which is a complete bundle branch block.
Vertex is ventricular fat-V1or the apex of R wave in lead V5 is ventricular hypertrophy; V 1 with R wave apex greater than 1.0mV(2 grids) is right ventricular hypertrophy, and V5 with R wave apex greater than 2.5mV(5 grids) is left ventricular hypertrophy.
Written test skills
1, carefully check the requirements of the stem.
Some topics require choosing the right option, some require choosing the wrong option, some require choosing the incorrect option, and sometimes require choosing the impossible option. Candidates are advised not to be too flustered when reading the questions and see the requirements of the questions clearly.
2. You can't choose the option of absolute mood.
It is almost wrong to choose the answer with completely positive or negative words, such as must be correct or must be yes. These very absolute statements are unscientific in academic circles.
3. The option with the most words is often correct.
Among the five options, the candidate answer with the most words is often correct. Because questioners generally don't make great efforts to give a wrong answer code word.
If the answers to several questions are the same, you should pay attention.
When answering questions, you can't have the same answers to several questions. For example, for questions 4-6, your answers are all C, and for questions 5, the answers are vague. You'd better not be vague about C.
5. Trust first feelings
If you are not sure about the topic, it is strongly recommended to trust your first feeling. For example, you are not sure about this question. At first, you chose A, but as soon as you turned around, it seemed that B was right. When this happens, you choose one .. don't change B for the time being, because this is an uncertain topic, and it is meaningless to entangle yourself, which will only waste time.
6. Sometimes the most impossible answer is the correct answer.
For some difficult questions, candidates are advised to do the opposite and choose the most impossible answer.
7. It can be reviewed, but only for typographical errors.
If there is still some time to complete the topic, it is recommended to check your name, test number, answer sheet and other information. Don't pay too much attention to the choice of the topic, it will be useless.
Source-Beijing Medical University Li Rui Physical Examination:/