诊断学总论医学课件

ClinicalDiagnostics2021/4/261Fundamentaltheory

基础理论/知识

Techniquesofdiagnosingdisease

诊断疾病的技术

Modeofclinicalthinking

临床思维的方式WhatisClinicalDiagnostics?2021/4/262Instructaconciselogicalapproachtorecognizethegeniusofthediseases

教会一种简明而又合乎逻辑的步骤去识别疾病的本质

Afundamentalcourseofclinicalmedicine

临床医学的基本课程WhatisClinicalDiagnostics?2021/4/263FundamentalelementsofDiagnosticsDiagnosisIdentificationAnalysis2021/4/264Diagnosis

（诊断）DerivedfromGreekwords

distinguish

or

discern识别/鉴别认识☆2021/4/265

Englishterm

DiagnosticThedistinguishingsignandsymptomswithwhichitgerenallybegins,continuesandgoesoff…asitwere,ahistoryofthedisease对疾病特征的识别及对疾病的诊断

In18thcentury:

Nosography（病情学）

通过疾病的表现来识别疾病内在本质或属性☆☆2021/4/266Inmodernusage:IdentificationofadiseasebyinvestigationofitssignsandsymptomsMedicalterminology:ClinicaldiagnosisLaboratorydiagnosisX-raydiagnosisElectrocardiographicdiagnosisGenediagnosis☆☆2021/4/267Identification:(识别)InquiryPhysicalexaminationLaboratorytests/SpecialexaminationAnalysis:(分析)BasicknowledgeofmedicineOverallanalysisScientificwayofclinicalthinking

2021/4/268ImportanceofDiagnosticsEssential(基础）Bridge（桥梁）Tools（工具）BasiccoursesClinicalmedicine2021/4/269ContentofClinicalDiagnosticsSymptomaticdiagnosis(症状诊断)Physicaldiagnosis(检体诊断)LaboratorytestsorclinicalancillarytestsMedicalrecordDiagnosticprocessesandthewayofclinicalthinking2021/4/26109、人的价值，在招收诱惑的一瞬间被决定。2023/2/32023/2/3Friday,February3,202310、低头要有勇气，抬头要有低气。2023/2/32023/2/32023/2/32/3/20235:00:58PM11、人总是珍惜为得到。2023/2/32023/2/32023/2/3Feb-2303-Feb-2312、人乱于心，不宽余请。2023/2/32023/2/32023/2/3Friday,February3,202313、生气是拿别人做错的事来惩罚自己。2023/2/32023/2/32023/2/32023/2/32/3/202314、抱最大的希望，作最大的努力。03二月20232023/2/32023/2/32023/2/315、一个人炫耀什么，说明他内心缺少什么。。二月232023/2/32023/2/32023/2/32/3/202316、业余生活要有意义，不要越轨。2023/2/32023/2/303February202317、一个人即使已登上顶峰，也仍要自强不息。2023/2/32023/2/32023/2/32023/2/3Historytaking（病史采集)---Interview(问诊）Symptoms(症状）---patient‘scomplaints(主诉)SymptomaticDiagnosis(症状诊断)SymptomaticDiagnosis2021/4/2612SymptomaticDiagnosisSubjectivesensationthatpatientdescribesFeverCoughRashMassPhysiological&functional

Pathological&morphological

Symptom（症状）2021/4/2613PhysicalDiagnosisAbnormalityobservedbythephysicianSign（体征）

Physicalexamination（体格检查）Inspection(望）Palpation（触）Percussion（叩）Auscultation（听）Conductedwiththoroughness,alertnesstodetectevenslightderivationsfromnormal2021/4/2614LaboratorytestorancillarytestsSerum,Urine,StooltestsX-rayfilmEKGEndoscopyUltrasonicimagingCTMRIPET(PositronEmissionTomography)2021/4/2615MedicalrecordMedicalrecordisasystematizedwayofstoringtherequireddata,informationandotherrelevantdocumentsSpecificrequirementintermsofformatandcontent2021/4/2616SpecialtermsinclinicaldiagnosisImpression(初步印象）Tentativediagnosis（可能性诊断）Differentialdiagnosis（鉴别诊断）Evidencebasedmedicine（循证医学）2021/4/2617DifferentialdiagnosisPreliminarydiagnosis/Tentativediagnosis

初步诊断可能性诊断

Exclusionofotherdiseases(排除其它疾病)SelectinganumberofpossibilitiestoexplaintheclinicalandlaboratoryfindingsinthecaseinquestionThewayofexclusioniscalledDifferentialdiagnosis2021/4/2618EvidencebasedmedicineItistheconscientious（谨慎的）,explicit（明确的）andjudicious（有见解的）useofcurrent

bestevidence

inmaking

decisionsaboutthe

care

oftheindividual

patient

Itmeansintegratingindividual

clinicalexpertise

（临床专长）withthe

bestavailableexternal

clinicalevidence

fromsystematicresearch2021/4/2619EvidencebasedmedicineOneneedto:Beconscientious:itrequireseffortandthought.Beexplicit:decisionswillneedtobebackedupbygoodevidenceRelatetospecificproblems:itisnotaboutahypothetical"average"case.Integrateindividualclinicalexperience:itdoesnotdenigrateclinicalskillsinhistorytaking,examinationanddiagnosis.Lookforcurrentbestevidence:theperfectstudymaynotyethavebeenpublished,writtenuporevencommenced.Wemayhavetosettleforsomethinglessrigorous,butbeonthelookoutfornewresearchthatwillsupersedeolderstudies.2021/4/2620Importantaspects---interrogationTogetthehistoryindetailofapatient’sillnessThehistoryistakenatinitialcontactbetweenphysicianandpatientAssomecrucialpointsmightbeoverlookedbythepatients,onewillaskmanysearchingquestionstomakethehistorymoreinformativeandcomplete,whomustatthesametimeavoidsuggestinganswersOccasionallytointerrogatehisfamilymember2021/4/2621OtherimportantaspectsThediagnosticprocessisverycomplexThenumberoffactsthatcanbecollectedinadetailedmedicalhistoryandinthoroughphysicalexaminationarealmostwithoutlimitThelaboratorytestsorspecializedtechnicalproceduresthatcanemployedarenumerousandcostly

2021/4/2622OtherimportantaspectsQuestionsforinterrogation,maneuverinP.E.,laboratorytestshouldbethoughtfullyselectedwiththeviewtoeliminatesomeofthepossiblediagnosisandguidethesearchexpeditiouslytoaspecificdiseaseMethodofapproachingadiagnosis:

Analysisofsymptoms(症状分析)Recognitionofthesyndrome(综合症识别)Considerationofdiseasemechanisms(考虑疾病机制)2021/4/2623ImportantaspectsModern&advancedancillarytechniques:havetheirlimitations.Itcan’treducedtheimportanceofcertainpartsoftheclassicP.EItshouldbeavoidedtoneglectfundamentalmethodsInterrogationPhysicalexaminationScientificclinicalthinking2021/4/2624ApproachesBasicknowledgelearning（基础知识的学习）Clinicalpractice

（临床实践）BedsideactivityStandardizedpatient床边实践标准化病人2021/4/2625DevelopmentalHistoryofclinicaldiagnosticsWesternMedicine:fromancienttomodernTraditionalChineseMedicine2021/4/2626Contributionofancientdoctors---WesternHippocratesBornontheislandofCos,Greece(c.460-377BC)TheFatherofmedicineHippocraticoath

希波克拉底宣言Hippocraticcorpus（文集）:acollectionof70works2021/4/2627Hippocraticoath2021/4/2628Contributionofancientdoctors---WesternGalenc.130-c.200Hisworkinanatomy/physiologyisnotableIdentifiedarteryandveinAddedgreatlytoknowledgeofthebrain,spinalcordandpulse2021/4/2629Contributionofancientdoctors---WesternAuenbruggerBornatthevillageofGraz,Austria(1722)SonofaninnkeeperTheworkingexperienceshelpedhimtofindPercussionAuthorof<InventumNovum>(1761)translatedas‘OnPercussionofthechest’in19362021/4/2630Contributionofancientdoctors---WesternLaennecRTHAFrenchphysicianInventedAuscultationandstethoscope2021/4/2631Contributionofancientdoctors---WesternLaennecRTH18162021/4/2632ContributionofWesternPhysician17th~19thcenturyLeenwenhockMicroscopy(endof17thcentury)FahrenheitThermometer(1724)(体温计)LudwigHematomanometer(1847)(血压计)WelcherHematinometer(1854)(血细胞计数仪)20thcenturyX-rayfilmEKGEndoscopyCTPET2021/4/2633Ultrasonicimaging2021/4/2634CTimaging2021/4/2635MRI2021/4/2636PET2021/4/2637TraditionalChineseMedicineWood

FireEarthMetalWater2021/4/2638Contributionofancientdoctors---Chinese

InspectionInterrogationSmellPulsepalpation《内经》2021/4/2639Payattentionto:GoodmedicalethicsAttachimportancetoclinicalpracticeUnittheorywithpractice2021/4/2640GoalsInquiry:Independentsystemicinquiry