临床医学专业04级八年制内科学教案.doc

啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊大环内酯类(红霉素,阿奇霉素,克拉霉素)Macrolide(erythromycin, Azithromycin, Clarithromycin)氨基糖苷类(阿米卡星)Aminoglycoside (amikacin).啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊临床医学专业04级八年制内科学教案啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊临床医学专业04级八年制内科学教案姓名胡必杰业务职称教授聘任授课职位授课教授授课题目肺炎pneumonia学时数2授课班级2004级八年制班授课日期2007年9月一、教学目的（掌握、熟悉、了解的具体内容）ObjectivesTo understand the definition, classification (mainly community-acquired pneumonia and hospital-acquired pneumonia), common etiological pathogens, pathology, clinical manifestation, X-ray and CT imaging, clinical and etiological diagnosis, antimicrobial therapy and prevention of pneumonia. Contents Requested points: 1. Definition and classifications of pneumonia: including community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP) or nosocomial pneumonia (NP), typical and atypical pneumonia, immune-compromised host pneumonia, ventilator associated pneumonia (VAP).2. Common etiologic agents of CAP and HAP 3. Clinical manifestation, X-ray and CT imaging4. Main points for clinical diagnosis, differential diagnosis, methods for etiological diagnosis 5. Principal of antimicrobial therapyUnderstand:1. Pathogenesis, focus on possible routes of CAP2. Pathogens of atypical Pneumonia3. Criteria for severe community acquired pneumonia4. Main points of etiologic pathogens and antibiotic choice for 6 CAP groups (I, II, IIIa, IIIb, IVa, IVb)5. Main items for prevention of HAP二、执行方案：(一) 内容及时间分配1Epidemiology and definition of pneumonia 5min2Classifications & Terminology 6min3Pathogenesis, pathophysiology and pathology 6min4Epidemiology and pathogens of CAP 8min5Manifestation and General Lab Examinations of CAP 10min6Clinical and microbiological diagnosis of CAP 10min7Treatment of CAP 10min8Prophylaxis for CAP 2min8Epidemiology and pathogens of HAP 8min9Pathogenesis and risk factors of HAP 5min10Etiological pathogens of HAP 7min11Diagnosis and differential diagnosis of HAP 5min12Antibiotic treatment and prevent of HAP 8min(二)重点和难点1Classifications of pneumonia2Characteristics of CAP and HAP3Microbiological diagnosis of pneumonia4Main points of etiologic pathogens and antibiotic choice5Possible routes for microorganisms from outside to the lung(三)中文和英文关键词社区获得性肺炎Community Acquired Pneumonia医院内肺炎Nosocomial Pneumonia OR Hospital Acquired Pneumonia呼吸机相关肺炎Ventilator Associated Pneumionia大叶性肺炎Lobar (segmental) Pneumonia节段性肺炎 segmental Pneumonia小叶性（支气管肺炎）lobular （bronchopneumonia) Pneumonia间质性肺炎Interstitial Pneumonia非典型肺炎Atypical Pneumonia免疫功能受损宿主肺炎Immune-compromised Host Pneumonia (ICHP)细菌，病毒，真菌，寄生虫 Bacterial, viral, fungal, parasitic肺炎链球菌Streptococcus pneumoniae青霉素不敏感肺炎链球菌Penicillin-Nonsensitive Streptococcus Pneumoniae 流感嗜血杆菌Haemophilus influenza 甲氧西林敏感金黄色葡萄球菌methicillin-sensitive staphylococcus aureus,MSSA甲氧西林耐药金黄色葡萄球菌methicillin-resistance staphylococcus aureus, MRSA肺炎克雷伯杆菌Klebsiella Pneumoniae大肠埃希杆菌Escherichia coli肠杆菌属,变形杆菌,沙雷菌Enterobacter, Proteus, Serratia铜绿假单胞菌Psuedomonas aeroginosa不动杆菌Acinetobacter厌氧菌Anaerobic bacteria肺炎衣原体Chlamydia Pneumoniae 分枝杆菌Mycobacterium 肺炎链球菌肺炎Pneumococcal Pneumonia金葡菌肺炎Staphylococcal Pneumonia克雷伯杆菌肺炎Klebsiella Pneumonia支原体肺炎Mycoplasma Pneumonia军团菌肺炎Legionella Pneumonia肺孢子菌肺炎 Pneumocystis pneumonia （PCP）经气管穿刺吸引Transtracheal aspiration （TTA）气管内吸引Endotracheal aspiration （ETA）防污染双套管毛刷Protected specimen brush （PSB）支气管肺泡灌洗Bronchial alveolar lavage （BAL）经胸壁肺穿刺吸引Lung aspiration （LA）细胞学筛查Cytological screening 抗菌药物Antimicrobial Agents青霉素G penicillin G, 苯唑西林Oxicillin 阿莫西林/克拉维酸Augmentin,氨苄西林/舒巴坦ampicillin/sulbactam头孢菌素（头孢唑啉，头孢呋辛，头孢曲松）cephalosporins大环内酯类（红霉素,阿奇霉素，克拉霉素）Macrolide（erythromycin, Azithromycin, Clarithromycin）氨基糖苷类（阿米卡星）Aminoglycoside （amikacin）四环素（强力霉素）Tetracycline（Doxycycline）克林霉素clindamycin氟喹诺酮类（左氧沙星、莫西沙星、加替沙星）Fluroquinolone (levofloxacin, moxifloxacin, gatifloxacin) 碳青霉烯类carbepenem万古霉素Vancomycin(四)复习和思维题（请用英文出两道选择题，一道简答题。）1. Which one is most suitable choice for treating pneumonia caused by MRSA among the following antimicrobial agents?AOxicillinBAmpicillin/sulbactamC1st cepholasporinsD3rd cepholasporinsEVancomycin 2. Which description about Pneumococcal pneumonia is wrong? Agenerally occurs sporadically but most frequently in winter Bthe most common identifiable cause of bacterial pneumonia Caccounts for 2/3 of bacteremic CAPDmost commonly in persons at age extremesEalmost no healthy persons are carriers of pneumococci3. Describe the main methods that might be used for microbiological diagnosis of pneumonia.三、参考书及文献目录1Harrisons Principle of internal medicine. - 16th Ed. (2005)2实用内科学陈灏珠主编，人民卫生出版社2005，第12版啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊啊临床医学专业04级八年制内科学教案啊啊啊啊啊啊啊啊啊啊啊啊