佛山大学医学院教学大纲
诊断学双语教学
Syllabus of Clinical
Diagnostics
佛山大学医学院诊断学教研室
Introduction
Purpose and Requirements
The clinical diagnosis serves as a bridge between premedical and clinical medicine.
It includes physical diagnosis, Laboratory diagnosis and some instrumental
examination. Formerly these are taught separately but now our country they are
combined to form one course, which is now called clinical diagnosis. Physical
diagnosis deals with such information through the two most fundamental skills, the
interrogation and physical examination. Students should study hard and try to master
the techniques.
Teaching Contents
1. Expounding the properties of clinical diagnosis and its clinical significance.
2. Explaining the contents of clinical diagnosis and its clinical types and emphasizing
the combination of theory and practice.
3. Presenting the purpose and requirements of clinical diagnosis and asking the
students to master the mechanisms or pathogenesis of common symptoms and signs,
inquire the patient's history, do proper physical examination and write case history.
4. Explaining the principles of and approaches to ECG and ultrasonic examination.
Class-hour: 1
Teaching Approaches: theoretical teaching
Requirements
1. Mastering the mechanisms or pathogenesis of common symptoms.
2. Mastering the approaches to and techniques of asking the patient's history.
3. Mastering the common methods of physical examination.
4. Mastering the mechanisms of typical signs and their clinical values.
5. Mastering the principles of laboratory examination and its clinical values as well as
its application indications.
6. Being familiar with the principles of ECG and mastering the features of normal and
abnormal patterns of ECG.
7. Cultivating the ability to analyze and synthesize clinical data, write complete
in-patient case history, and present the initial diagnosis.
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Teaching Contents and Time Distribution (1 class-hour: 40 minutes)
Total Class-hour: 122
Theoretical Teaching: 69
Practical Teaching: 53
Content
Theoretical Teaching
Class-hour: (40 min./1
class-hour)
Practical teaching
Class-hour: (40 min./1
class-hour)
Introduction
1
Common symptoms
16
2
Physical examination
36
18
Asking and writing case
history
2
2
ECG
4
2
function test
37
Total
96
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2
Part 1 Common Symptoms
Purpose and Requirements
1. Expounding the characteristics of symptoms.
2. Asking the students to master the clinical manifestations and pathogenesis of
common symptoms and their clinical significance.
Teaching contents
Including: fever; pain; edema; cough and expectoration; dyspnea; cyanosis;
palpitation; hemoptysis; gastrointestinal bleeding; diarrhea; jaundice; hematuria;
incontinence of urine; urinary frequency, urgency and dysuria ; retention of urine;
vertigo; unconsciousness; seizure
1) Fever
a) General introduction of fever
b) Pathogenesis of fever
c) Etiology and classification of fever
d) Clinical manifestations of fever
e) Associated symptoms to fever
f) Diagnostic points
2) Pain
1. Analysis of pain
a) Pathological physiology of pain
b) Clinical characteristics
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Character of pain
Localization of pain
Quality and intensity of pain
Referred pain
Aggravating and relieving factors
2. Features of common types of pain
a) Headache
b) Chest pain
c) Abdominal pain
Key points: the etiology and pathogenesis of pain; the characteristics of pain
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3) Edema
a) Definition of edema
b) Pathogenesis of edema
c) Etiology and clinical appearances of edema
Generalized Edema
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Cardiogenic edema
Nephrogenic edema
Hepatogenic edema
Malnutrition
Idiopathic edema
Miscellaneous
Localized edema
d) Approach to the patient with edema
4) Cough and expectoration
a) Etiology
b) Clinical presentation
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Character of cough
The duration and pattern of cough
The tone quality of cough
The character and volume of sputum
c) Accompanying symptom
5) Dyspnea
a) Etiology
b) Mechanism and clinical features (Key points)
Respiratory dyspnea
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Inspiratory dyspnea
Expiratory dyspnea
Mixed dyspnea
Cardiac dyspnea
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The dyspnea caused by right-sided heart failure
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The dyspnea caused by left-sided heart failure
Paroxysma nocturnal dyspnea (Key point)
6) Cyanosis
a) Definition
b) Mechanism
c) Etiology (Key points)
Four principal forms of cyanosis:
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Central cyanosis
Peripheral cyanosis
Mixed cyanosis
Cyanosis resulting from abnormal hemoglobin pigments in the blood
d) Accompanying symptoms
7) Palpitation
Important causes of palpitation (Key points)
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Extrasystole
Ectopic tachycardias
Thyrotoxicosis
Anemia
Acute infections
Hypoglycemia
8) Hemoptysis
a) Etiology
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Bronchial diseases
Lung diseases
Cardiovascular diseases
Constitutional diseases
b) Clinical manifestations (The patient's age; The amount of coughing up blood;
Color and character)
9) Gastrointestinal bleeding
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a) Causes of GI bleeding (Key points)
b) Hematemesis
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The most common causes of hematemesis
peptic ulcer
esophagogastric varices
acute mucosal lesions
benign and malignant neoplasms
Mallory_weiss tear
The differential diagnosis between hematemesis and hemoptysis
c) Hematochezia
d) Symptoms of GI bleeding (Key points)
e) Diagnostic Procedures
10) Diarrhea
a) Etiology
Ⅰ.Acute Diarrhea
Ⅱ.Chronic Diarrhea
b) Pathophysiological mechanisms
Ⅰ. Secretory diarrhea (increased intestinal secretion)
Ⅱ.Osmotic diarrhea
III. Decreased intestinal surface area and/or intestinal absorption
Ⅳ. Rapid transit of intestinal contents (shortened transit time)
c) Symtoms
d) Diagnostic procedures
11）constipation
a) Etiology
Ⅰ.Functional constipation
Ⅱ.Pathological constipation
b) Pathophysiological mechanisms and clinical manifestations
c) Accompanying symptoms and key inquiry points
12) Jaundice
a) The basic concept of jaundice and its bilirubin metabolism
b) Classification of jaundice and its etiology, pathogenesis and clinical manifestations
(Hemolytic jaundice; Obstructive jaundice; Hepatic jaundice)
Congenital non-hemolytic jaundice(Gilert syndrome, Crigler-Nariar syndrome, Rotor
syndrome, Dubin-Johnson syndrome)
c) Accompanying symptoms and key inquiry points
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13) Abnormal Urination
Incontinence of urine; Urinary frequency, urgency and dysuria; retention of urine
a) Definition
b) Etiology and clinical appearances
14) Hematuria
a) Definition
b) Etiology
Ⅰ. Diseases of the urinary system
Ⅱ. System disorders
III. Diseases of adjacent organs to urinary tract
IV. Drug and chemical agents
V. Miscellaneous
c) Clinical features
15) Vertigo
a) Etiology and clinical manifestation
1. Periphral Vertigo ( otological vertigo)
2. Central Vertigo
b) Accompanying symptoms
16) Seizure
a) Etiology of seizure
· Medical conditions
· Neurological conditions
· Other causes of seizure
b) Clinical manifestation
17) Unconsciousness
a) Mechanisms
b) Clinical manifestation
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Part 2
Inquisition
a) Mastering the importance of inquisition (asking history)
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Inquisition is an important part of diagnostic procedure through the
conversation between the patient and doctor.
It is useful to understand the actual history of an illness, no other diagnostic
technology can take its place.
For an experienced physician with profound knowledge, diagnosis or
impression can be made simply by inquisition. As the diseased organ would
give some clue by its pathophysiological changes.
An inaccurate or rough history would lead you to make a wrong diagnosis.
b) Method of inquisition
c) Contents of inquisition
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General data
Chief complaints
History of present illness
Past history
Systems review
Personal history
Marital history
Family history
d) History writing
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Basic requirement
Forms and contents of the history
General steps in history writing
Teaching periods: lecture 3, clinical practice 6
Teaching methods: Clinical practice
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Part 3
Physical Examination
Purpose and Requirements
1. Mastering the basic methods of inspection, palpation, percussion and auscultation.
2. Mastering the contents of general examination and the significance of both normal
and abnormal signs.
Teaching Contents
1. Examining methods of inspection, palpation, percussion and auscultation.
2. Mastering the relationship between sex as well as age and diseases.
3. Analyzing the clinical significance of body temperature, pulse, respiration, and
blood pressure.
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The examining methods of body temperature
Normal range and variation of body temperature
4. Mastering the evaluation of growth and nutrition as well as the relationship
between disease and disturbance of consciousness, psychosis, facial expression,
posture, body movements and gait.
5. Identifying the color, shape, skin eruption, muculae, roseolae papulaes wheals,
maculopqpulaes wheals, maculopapulaes spider angioma, petechia, purpura,
ecchymosis and hematoma and knowing their respective significance.
6. Examining the lymph nodes, their distribution and significance.
Teaching Periods: lecture 2, clinical practice 2
Teaching Methods: Examining methods and the significance of signs should be
emphasized. The general examining methods, especially the examination of lymph
nodes, should be learned through clinical practice and mutual examination of
students.
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Head
Purpose and Requirements
1. Mastering the examining sequence and methods of head.
2. Being familiar with the significance of both normal and abnormal signs.
Teaching Contents
1. The general examination of head, hair and scalp.
2. The general examination of eyes, ears and noses.
3. Examining methods of oral cavity including lips, buccal mucosa, teeth, gums,
tongue, pharynx and larynx.
4. The clinical significance of abnormal signs.
Teaching Periods: lecture 1; clinical practice 1/2
Teaching methods:
1. The general examining methods should be learned through clinical practice and
mutual examination of students.
2. Students should master the sequence of examination and know the normal signs.
3. Students should identify the abnormal signs and analyze their clinical significance.
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Neck
Purpose and Requirements
1. Mastering the examining sequence and methods of head.
2. Being familiar with the significance of both normal and abnormal signs.
Teaching Contents
1. The examination of blood vessels( auscultation), jugular veins and their respective
clinical significance.
2. The examination of thyroid gland and clinical significance of abnormal signs.
3. Examining methods of trachea and its significance of being displaced laterally.
Teaching Periods: lecture 1; clinical practice 1/2
Teaching Methods:
1. The examining methods of thyroid gland and trachea should be learned through
clinical practice and mutual examination of students.
2. Students should master the sequence of examination and know the normal signs.
3. Students should identify the abnormal signs and analyze their clinical significance.
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Chest
Purpose and Requirements
1. Mastering the examining sequence and methods of chest including inspection,
palpation, percussion and auscultation.
2. Knowing the landmarks on chest wall and on bone, vertical line landmarks, natural
fossa and anatomic region, and boundary of lung and pleura.
3. Being familiar with the significance of both normal and abnormal signs of common
diseases as well as the pathogenesis of symptoms.
Teaching Contents
1. The landmarks on chest wall and on bone, vertical line landmarks, natural fossa and
anatomic region, and boundary of lung and pleura and their respective clinical
significance.
2. The examination of chest wall, chest framework, and breast.
3. The examination of lung and pleura:
1) Inspection
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respiratory movement
respiratory rate
change of the breath depths
rhythm of the breath
2) palpation
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The examining methods of vocal fremitus and its clinical significance.
The mechanism and characteristics of normal and abnormal vocal fremitus.
3) percussion
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The method of percussion(mediate and immediate percussion)
Classification of the percussion notes (Resonance, Hyperresonance, Tympany,
Dullness, Flatness )
Percussion of the pulmonary boundary
Movement range of the lower pulmonary boundary
4) auscultation
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Normal breath sounds (vesicular breath sound, bronchial breath sound, and
bronchovescicular breath sound)
Abnormal breath sounds (abnormal vesicular breath sound: decreased or
absent vesicular breath sound, increased alveolar breath sound, elongated
expiratory breath sound, interrupted breath sound, and hoarse breath sound )
and their respective significance.
Abnormal bronchial breath sound and its significance.
Abnormal bronchoalveolar breath sound and its significance.
The pathogenesis, classification, qualities, and significance of rales and
rhonchi. (Classification of rales: loud or unloud rale; coarse, medium and fine
ones and even crepitations; classification of rhonchi: sibilant rhonchi;
sonorous rhonchi).
The pathogenesis, qualities, and significance of pleural friction rub.
The examining methods and clinical significance of vocal resonance.
4. The major symptoms and signs of common respiratory diseases and differentiation.
1) Lobar pneumonia
2) Chronic bronchitis complicated with emphysema
3) Bronchial asthma
4) pleural effusion
5) Pneumothorax
Teaching Periods: lecture 6; clinical practice 8
Teaching Methods:
1. The examining methods should be learned through clinical practice and mutual
examination of students.
2. Students should master the sequence of examination and know the normal signs.
3. Students should identify the abnormal signs and analyze their clinical significance.
4. Students should be familiar with the symptoms and signs of common respiratory
diseases and differentiation.
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Heart
Purpose and Requirements
1. Mastering the examining sequence and methods of heart including inspection,
palpation, percussion and auscultation.
2. Mastering the producing mechanism of heart sound S1and S2.
3. Knowing the differentiation between S1 and S2 and clinical signification of change
in loudness, quality and splitting of heart sounds.
4. Mastering the producing mechanism of heart sound S3 and S4.
5. Mastering the producing mechanism of extra sounds.
6. Mastering the producing mechanism of heart murmurs and their clinical
significance. Mastering the key points of auscultation of heart murmurs and
differential diagnosis of physical and pathological heart murmurs.
7. Being familiar with the significance of both normal and abnormal signs of common
diseases as well as the pathogenesis of symptoms.
Teaching Contents
1. Heart
Inspection
1) Observing precordium
2) The location, intensity and scope of normal apical impulse and clinical value of its
displacement.
3) Abnormal pulsations in the other areas and their clinical values.
Palpation
1) The location, intensity and scope of normal apical impulse and clinical value of its
displacement.
2) The precordial pulsation’s location and its amplitude, duration and intensity.
3) The producing mechanism of thrills and location, intensity and quality of thrills.
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4) Pericardial friction rub
Percussion
1) The percussion method of the heart.
2) The heart borders and their constituents.
3) Normal relative dullness of the heart and changing cardiac dullness.
Auscultation
It includes rate, rhythm, heart sound, murmur and pericardial friction sound.
1) Auscultatory Valve Areas
2) The producing mechanism of heart sound and differential diagnosis of normal heart
sounds (S1 and S2).
3) Heart rate and heart rhythm.
4) The producing mechanism and characteristics of heart murmurs (Location, timing,
quality, radiation, and intensity).
5) The producing mechanism and its clinical values of pericardial friction rub.
2. Blood Vessels
1) The arterial pulse and its rate, rhythm, intensity and tension.
2) The producing mechanism and characteristics of wave forms (Water hammer pulse,
Pulsus alternans, Dicrotic pulse, Paradoxical pulse)
3) The measurement of arterial pressure and its significance.
4) Pistol-shot sound and Duroziez's sign.
3. Common symptoms and signs of cardiovascular diseases.
Teaching Periods: lecture 8; clinical practice 8
Teaching Methods:
1. The examining methods should be learned through clinical practice and mutual
examination of students.
2. Students should master the sequence of examination and know the normal signs.
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3. Students should identify the abnormal signs and analyze their clinical significance.
4. Students should be familiar with the symptoms and signs of common
cardiovascular diseases and differentiation.
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Abdomen
Purpose and Requirements
1. Knowing abdominal landmarks and mapping.
2. Mastering the method and content of abdominal inspection, palpation, percussion,
and auscultation
3. Being familiar with main symptoms, signs, and clinical significance of common
abdominal diseases.
Teaching Contents
1) Topographic anatomy and two commonly used methods of subdividing the
abdomen and their respective clinical significance.
2) Inspection
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abdominal contour (abdominal flatness, abdominal fullness, and abdominal
lowness; Abdominal bulge and abdominal retraction)
Respiratory movements
The flowing directions of abdominal veins and their values.
Gastral or intestinal pattern and peristalsis.
3) palpation
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The principle of palpation.
Tenderness and rebound tenderness.
The methods of palpation of liver and spleen as well as gall bladder, kidney
and other viscera.
Succession splash
4) percussion
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Percussion of the upper border of liver
Percussion of liver span
Percussion of the spleen
Percussion of the stomach
The methods and clinical values of percussion for shifting dullness.
5) auscultation
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Bowel sounds(borhorygmus)
17
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Murmurs or bruits
Friction rubs over the liver and spleen
6) The major symptoms and signs of common abdominal diseases and differentiation.
Teaching Periods: lecture 6; clinical practice 8
Teaching Methods:
1. The examining methods should be learned through clinical practice and mutual
examination of students.
2. Students should master the sequence of examination and know the normal signs.
3. Students should identify the abnormal signs and analyze their clinical significance.
4. Students should be familiar with the symptoms and signs of common abdominal
diseases and differentiation.
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Part 4
ECG
Purpose and Requirements
1. Understanding the definition of ECG, basic cardiac electrophysiology, electrical
stimulation of the heart, cardiac conductivity and automaticity
2. Understanding the mechanism of cardiac electrical stimulation (depolarization and
repolarization)
3. Grasping basic ECG complexes (P, QRS, ST, T, and U waves) QRS nomenclature、
basic ECG measurements and some normal values、calculation of heart rate and
the normal ECG
4. Being familiar with ECG leads、electrical Axis and axis deviation.
5. Taking an ECG and make an diagnosis
6. Understanding the definition of atrial and vertricular enlargement and its
mechanism of enlargement.
7. Mastering the diagnosis of atrial and ventricular enlargement in ECG.
8. Mastering the ECG diagnosis of Myocardial ischemia and infarction.
9. Mastering the ECG diagnosis of Supraventricular Arrhythmias and Ventricular
Arrhythmias and AV Heart Block.
Teaching Contents
1) The genesis of the normal ECG., (keep in mind) Three basic “laws” of
electrocardiography
2) Direction of atrial depolarization with normal sinus rhythm, direction of atrial
depolatizarion with AV Junctional Rhythm, Orientation of P waves with AV
Junctional rhythm, normal ventricular depolarization.
3) Mean QRS Axis、right and left axis deviation、normal horizontal QRS Axis and
normal vertical QRS Axis and normal intermediate QRS Axis.
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4) The normal P, QRS complex, ST segment and T wave.
5) The ECD shows and differentiation.
6) Right atrial enlargement (RAE); Left atrial enlargment (LAE); Left atrial
abnormality (LAA); Right ventricular hypertrophy (RVH); Left ventricular
hypertrophy (LVH)
7) Myocardial ischemia, transmural and subendocardial ischemia [Transmural MI.
(the ECG sequence with different parts of heart wall infarction, QRS changes-Q
waves of transmural infarction); Localization of infacts; Sequence of Q waves and
ST-T changes with transmural infarcts; Normal and abnormal Q waves; Ventricular
aneurysm; Multiple infarctions; Silent MI; Diagnosis of MI in the presence of bundle
branch block].
8) The ECG changes in Supraventricular Arrhythmias, Ventricular Arrhythmias, and
AV Heart Block.
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Part 5
Ultrasound
Purpose and Requirements
1. Understanding the physical characteristics of ultrasound.
2. Being familiar with the concepts of Acoustic Impedance, Reflection, Absorption
and Attenuation, Doppler effect, etc.
3. Being familiar with mode and properties of ultrasonography.
4. Grasping clinical application of the diagnostic ultrasound.
5. Mastering abnormal echocardiography.
6. Mastering abdominal Sonography.
7. Getting to know some small parts sonography.
8. Getting to know gynecologic and obstetric ultrasound.
Teaching Periods: lecture 8; clinical practice 4
Teaching Methods:
1. To give the lectures with powperpoint assisted with ultrasound images and notes to
show the characteristics of imageology.
2. Using interactive teaching mode to arouse the initiative thinking of the students.
3. Clinical practice: by watching how to complete an ultrasonographic examination
and learning how to write a report to understand the whole progress of ultrasound
examination, features of ultrasound images and clinical applications.
Teaching Contents
1) Physics of ultrasound and related concepts (Acoustic Impedance, Reflection,
Absorption and Attenuation, Doppler effect, etc.).
2) Mode and properties of ultrasonography
a) A-mode ultrasound
b) M-mode ultrasound
c) B-mode ultrasound
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d) Doppler ultrasound
3) The principles of diagnostic ultrasound
4) Clinical application of the diagnostic ultrasound
a) Echocardiography and abnormal echocardiography (Mitral stenosis, Atrial septal
defect)
b) Abdominal Sonography (Liver cirrhosis, Liver cyst, Liver abscess, Liver
hemangioma, Primary liver carcinoma, Metastatic liver disease, Cholelithiasis, Acute
cholecystitis, Acute pancreatitis, Pancreatic carcinoma, spleen, kidney, etc.)
c) Small parts Sonography (Thyroid, Breast)
d) Gynecologic and Obstetric Ultrasound (Uterus, Leiomyoma, Ovarian cystadenoma,
Normal early pregnancy )
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