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新澳门葡萄京74222留学生临床实习大纲
发布时间: 2018-11-01   信息来源: 新澳门葡萄京   浏览次数: 13

新澳门葡萄京74222

FUJIAN MEDICAL UNIVERSITY

留学生临床实习教学大纲

Student Internship Program

  

  

  


Contents

内科学(含急救)Internal Medicine(Including Emergency)…..1

外科学Surgery…………………………………………………..

妇产科学Gynecology & Obstetrics……………………………..

儿科学Pediatrics………………………………………………...

神经病学Neurology………………………………………………..


  

临床实习是医学生在完成基础医学和临床医学专业理论常识学习以后,进行的临床医疗实践学习,是培养临床医学专业学生的重要学习阶段。在上级医师的引导下,通过门诊、急诊、病房床边教学,了解医院接待、诊治病人的工作程序和医疗法规,掌握常见病、多发病、急症的诊断和治疗原则,熟悉临床工作中常用的诊疗技术,培养临床思维和医疗工作能力。通过临床实习培养医学生的职业精神,学会人文关怀、医患沟通,养成优良的医疗作风和职业道德,为毕业后从事医疗工作打下基础。

  

临床实习共安排48周,其中内科实习16周(含急救2周)、外科实习16周、妇产科实习6周、儿科实习6周、神经内科实习2周。

  

  

Internship is an important phrase for medical students to learn practical skills of medicine, after the study of basic and major theoretical courses. With the guidance of supervisors, interns will participate in the practical activities in the inpatient department, the outpatient department and the emergency room to learn diagnosis and treatment for common diseases, frequently-occurring diseases and acute diseases, to get familiar with common used clinical techniques, to develop clinical thought and to practice medical skills. Through the internship, interns will also develop medical ethnics, treating with patients with patient, and prepare themselves for their own work in the course of saving patients’ lives and treating diseases after graduation.

  

The 48-week internship includes 16 weeks for Internal Medicine (2 weeks for emergency), 16 weeks for Surgery, 6 weeksfor Gynecology & Obstetrics, 6 weeks for Pediatrics, 2 weeks for Neurology.


内科实习大纲

总体要求

. 实习时间与安排

实习共16周。轮转8个三级学科,心脏、消化、呼吸、肾科、血液、风湿免疫、内分泌、门急诊,每学科2周,实习医师在上级医师引导下分管至少2-4张床。各三级学科每周进行一次英语教学查房,并有记录。

. 掌握疾病要求

掌握疾病基本诊断思路、诊断、诊断依据、鉴别诊断、处理原则、急症危重病人抢救,愈后及预防。

  1. 呼吸系统疾病:慢性支气管炎、肺气肿、肺心病、支气管哮喘、支气管扩张、大叶性肺炎、肺化脓症。

  2. 循环系统疾病:心力衰竭、心源性休克、风湿热、风湿性心瓣膜病、感染性心内膜炎、高血压、冠心病、心肌炎、心肌病、心包炎、心律失常(室上性心律失常、房颤、房扑、室性心律失常、传导阻滞、病窦综合征)

  3. 消化系统疾病:胃炎、消化性溃疡、肝硬化及其并发症(腹水、食道静脉曲张出血、肝昏迷)、原发性肝癌、肠结核、黄疸的鉴别诊断。

  4. 泌尿系统疾病:急慢性肾小球肾炎、急慢性肾盂肾炎、肾病综合征、急慢性肾功能不全。

  5. 血液系统疾病:缺铁性贫血、再生障碍性贫血、巨幼细胞性贫血、急慢性白血病、淋巴病、多发性骨髓瘤。

  6. 内分泌系统及代谢疾病:甲亢、糖尿病、皮质醇增多症、垂体瘤、尿崩症。

  7. 风湿免疫科:系统性红斑狼疮。

    三.基础技能训练要求:

  8. 病历书写:实习医师应于24小时内完成完整病历的采集、书写,内容要求完整、准确、重点深入、条理分明、字迹清楚整齐,不能随意涂改。内科实习结束前上交英文病历8份(2份大病历,6份简要病历),需有上级医师修改及签字。

  9. 体格检查:熟练掌握系统检查方法,手法要规范,各种手法要做到位。

  10. 病程记录,出院记录,死亡记录:要求写全各种记录,能正确反映病程变化和三级查房上级医师的意见,不能把病程记录写成流水帐,作好阶段总结,并练习写出院记录、死亡记录等,要有上级医师签字,不能随意涂改。

  11. 实验室检查:掌握血、尿、便三大常规正常值和临床意义;掌握血沉、出凝血时间、网织红细胞计数、体腔液(胸腹水)常规生化检查、脑脊液常规生化检查;掌握肝、肾功能检查,血液流变学检查,免疫全项,风湿抗体检查,血、尿、便培养等临床意义,了解一些特殊实验室检查结果及临床意义。

  12. X线检查:掌握正确系统的阅片方法,全面有层次的阅片,不遗漏应观察的任何部位,能写出X光报告。掌握心、肺、骨正常X线表现。肺部渗出、纤维化、钙化、空洞,肿块性病变,心脏、大血管影像,胃、十二指肠溃疡、消化道肿物等疾病。

  13. 特殊检查:

  1. 心电图:能掌握正常心电图和典型的心律失常、传导阻滞及心室、心房肥大、冠心病、心绞痛、心肌梗死的心电图变化。

  2. 血液学检查;能掌握正常血像。了解急慢性白血病骨髓像,常见缺铁性贫血,巨幼细胞贫血,再生障碍性贫血的骨髓特点。了解细胞化学染色的临床意义,急性白血病、淋巴病等免疫分型。

  3. 基本掌握一些特殊检查的适应症、禁忌症。如胃镜、肠镜、肺功能、超声心动图等的方法及报告的辨认。

  4. 基本诊疗技能操作:

  1. 掌握皮下注射、肌肉注射、皮内注射、静脉穿刺、取血、输血、输液。

  2. 掌握胸穿、骨穿、腹穿等穿刺。

  3. 掌握吸氧、吸痰、洗胃、人工呼吸、体外心脏按压等方法。

  4. 掌握心电图基本方法及典型波形辨认识别。

  5. 正确开医嘱及处方,掌握内科常用药物剂量、给药途径及给药时间,掌握药物的作用,了解副作用。

    .内科常见危重症抢救及一些新技术了解

  1. 呼吸衰竭、肺梗塞、大咯血。

  2. 参加急性左心衰、急性心肌梗死、严重室性心律失常、心肺复苏的抢救,会使用除颤器,了解起搏器的安装,心脏介入治疗情况等。

  3. 了解消化道大出血的抢救,了解静脉结扎的过程,了解胃镜检查。

  4. 掌握DIC的诊断及治疗,对输血反应能及时判断并正确处理。

  5. 掌握急性肾衰治疗,肾衰透析治疗的指征。

  6. 掌握甲亢危象、糖尿病酮症酸中毒、高渗昏迷的处理。
    Internship Requirements for Internal Medicine

General requirements

I. Time and arrangements

The total time of internship rotation in internal medicine amounts to 16 weeks in more than 4 departments (cardiology, gastroenterology, nephrology, hematology, pulmonary medicine, rheumatology and immunology, endocrinology, out-patient clinic and emergency medicine). The time of internship in each department amounts to 2 weeks, and each intern is in charge of at least 2-4 beds under the instruction of senior staff. English teaching ward rounds conducted once a week should be documented.

II. Mastery of the following diseases

Interns should develop clinical reasoning, and master diagnosis, differential diagnosis, treatment principles, emergency treatments, long-term follow-ups, and prevention of the following diseases:

  1. Respiratory diseases: chronic bronchitis, pulmonary emphysema, cor pulmonale, asthma, bronchiectasis, lobar pneumonia, lung abscess.

  2. Circulatory system diseases: heart failure, cardiac shock, rheumatic fever, rheumatic valvular heart disease, infective endocarditis, hypertension, coronary atherosclerotic heart disease, myocarditis, cardiomyopathies, pericarditis, cardiac arrhythmias (supraventricular arrhythmia, atrial fibrillation, atrial flutter, ventricular arrhythmia, conduction blocks, sick sinus syndrome).

  3. Gastrointestinal diseases: gastritis, peptic ulcer, liver cirrhosis and its complications (ascites, esophageal variceal hemorrhage, hepatic encephalopathy), primary carcinoma of the liver, intestinal tuberculosis, and the differential diagnosis of jaundice.

  4. Renal diseases: acute and chronic glomerulonephritis, rapidly progressive glomerulonephritis, latent glomerulonephritis (IgA nephropathy), nephrotic syndrome, acute and chronic renal insufficiency.

  5. Hematologic disorders: iron deficiency anemia, aplastic anemia, megaloblastic anemia, hemolytic anemia, acute and chronic leukemia, lymphoma, multiple myeloma.

  6. Endocrine disorders: hyperthyroidism, diabetes mellitus, hypo-pituitary states and diabetes insipidus.

  7. Rheumatic diseases and immune disorders: systemic lupus erythematosus.

III. Requirements for basic skill training

    1. Medical record writing: Within 24 hours, complete medical records should be finished with accurate contents, clear points, fine clear handwriting and no alteration. Upon completion of the rotation in Internal Medicine, 8 English medical records (2 complete records and 6 brief records) revised and signed by supervising doctors must be submitted.

  1. Physical examination: Interns should be skilled in the systemic PE method, making a standardized and competent performance.

  2. Course record, discharge record and death record: Course record, which is a summary of the medical problems and treatment rather than a day-to-day account, must reflect the changes of an illness state as well as the analysis and advice of the supervising physician. The discharge record and death record without alteration should be signed by the supervising physician.

  3. Laboratory tests: Master normal values and clinical significance of the three conventional tests (blood, urine and stool); master clinical significance of erythrocyte sedimentation rate (ESR), bleeding/coagulation time, reticulocyte count, routine biochemical tests of pleural and peritoneal effusion, routine biochemical tests of cerebrospinal fluid; master clinical significance of liver and renal function tests, hemorheology tests, immunological tests, rheumatoid antibody test, and bacterial cultures of blood, urine and stool. Understand some specific laboratory findings and their respective clinical significance.

  4. X-ray examination: Can analyze the parts of the X-ray correctly and systematically, without omission of any suspicious areas and write an X-ray report; master the normal X-ray appearance of the heart, lungs, and bones; can identify infiltration, fibrosis, calcification, cavity, and tumor-like pathological changes of the lungs and features of the heart and large blood vessels, gastric ulcers, duodenol ulcers, and digestive tract tumors.

  5. Special tests

    1. EKG: Interns should know how to interpret normal EKG findings and representative changes of the EKG with arrhythmias, conduction blocks, atrial ventricular hypertrophy, coronary atherosclerotic heart disease, angina pectoris, and myocardial infarction.

  6. Hematologic test: Interns should know the characteristics of normalblood, bone marrow findings in acute and chronic leukemia and the characteristics of bone marrow in iron deficiency anemia, aplastic anemia, and megaloblastic anemia. The clinical meaning of coloration of cytochemistry and the immunophenotype of acute leukemia and lymphoma should be mastered as well.

  7. Know the indications and contraindications of some special examinations, such as gastric endoscopy, colon endoscopy, lung function examination and echocardiography.

    1. Basic diagnostic and procedural skills

  8. Master subcutaneous injection, intramuscular injection, intracutaneous injection, venipuncture, blood drawing, blood transfusion and intravenous infusion.

  9. Master thoracentesis, bone marrow aspiration and abdominal paracentesis.

  10. Master oxygen administration, sputum aspiration, gastric lavage, artificial respiration, external cardiac compression, etc.

  11. Master the analysis of ECG and the clinical significance of a common abnormal ECG.

    1. Write doctor’s orders and prescriptions correctly. Master the dosage, the route and time of administration, the effects and the side-effects of the drugs commonly used in Internal Medicine.

      IV. Common emergency treatments and new techniques

  1. Master the treatment of respiratory failure, lung infarction, and severe hemoptysis.

  1. Participate in the emergency treatment of acute left heart failure, acute myocardial infarction, severe ventricular arrhythmia and cardio-pulmonary resuscitation. Know how to use defibrillator and understand the installation of pacemakers and the interventional treatment of cardiovascular diseases.

  2. Know the emergency treatment of gastrointestinal bleeding; know esophageal variceal ligation and gastroscopy.

  3. Master the diagnosis and treatment of DIC (disseminated intravascular coagulation); know the potential reactions to transfusions, and can perform a quick judgment and treatment on it.

  4. Master the treatment of acute renal failure, the indications of renal dialysis.

  5. Master the treatment of hyperthyroidism crisis, diabetic ketoacidosis and hyperosmolar coma.


各学科具体要求

呼吸科实习大纲

实习共2周:均在病房,实习医师在上级医师引导下分管至少2-4张床。

. 呼吸科对实习医师具体需掌握疾病如下

慢性支气管炎、肺气肿、肺心病、支气管哮喘、支气管扩张、大叶性肺炎、肺化脓症

. 基础技能训练要求:

  1. 实验室检查:掌握血、尿、便三大常规正常值和临床意义,并掌握血沉,出凝血时间,网织红细胞计数,胸水常规生化检查;掌握肝、肾功能检查,血液流变学检查,免疫全项,风湿抗体检查,血、痰培养等临床意义;了解一些特殊实验室检查结果及临床意义。

  2. X线检查:掌握正确系统的阅片方法,全面有层次的阅片,不遗漏应观察的任何部位,能写出X光报告。掌握心、肺、骨正常X线表现。肺部渗出、纤维化、钙化、空洞、肿块性病变,心脏、大血管影像特殊检查。

  3. 心电图:能掌握肺心病的心电图变化。

  4. 肺功能:了解支气管哮喘和慢性喘息性支气管的肺功能表现

  5. 基本掌握特殊检查如支气管的适应症,、禁忌症

  6. 基本诊疗技能操作:

      1. 掌握皮下注射、肌肉注射、皮内注射、静脉穿刺、取血、输血、输液。

      2. 掌握胸腔穿刺技术。

      3. 掌握吸氧、吸痰、人工呼吸、体外心脏按压等方法。

  7. 正确开医嘱及处方,掌握呼吸科内科常用药物剂量、给药途径及给药时间,掌握药物的作用,了解副作用。

    1. 呼吸内科常见危重症抢救及一些新技术了解。

  8. 呼吸衰竭、肺梗塞、大咯血的抢救。

  9. 了解有创及无创机械通气技术


Individual Department Requirements

Internship Requirements for Respiratory Medicine

During 2-week internship in the in-patient department, each intern will be in charge of at least 2-4 beds under the instruction of the supervising physician.

I. Mastery of the following diseases

Chronic bronchitis, pulmonary emphysema, cor pulmonale, asthma, bronchiectasis, lobar pneumonia, lung abscesses

II. Requirements for basic skill training

  1. Laboratory tests: Master normal values and clinical significance of the three conventional tests (blood, urine and stool); master clinical significance of erythrocyte sedimentation rate (ESR), bleeding/coagulation time, reticulocyte count, routine biochemical tests of pleural effusion; master clinical significance of liver and renal function tests, hemorheology tests, immunological tests, rheumatoid antibody test, and bacterial cultures of blood and sputum. Understand some specific laboratory findings and their respective clinical significance.

  2. X-ray examination: Can analyze the parts of the X-ray correctly and systematically, without omission of any suspicious areas and write an X-ray report; master the normal X-ray appearance of the heart, lungs, and bones; can identify infiltration, fibrosis, calcification, cavity, and tumor-like pathological changes of the lungs and features of the heart and large blood vessels.

  3. EKG: Can interpret the representative changes of cor pulmonale.

  4. Lung function examination: Understand the characteristic manifestations of asthma and chronic asthmatic bronchitis.

  5. Grasp the indications and contraindications of bronchoscopy.

  6. Basic diagnostic and procedural skills

    (1) Subcutaneous injection, intramuscular injection, intracutaneous injection, venipuncture, blood drawing, blood transfusion and intravenous infusion.

(2)Thoracentesis

(3) Oxygen administration, sputum aspiration, artificial respiration and external cardiac compression, etc.

  1. Write doctor’s orders and prescriptions correctly. Master the dosage, the route and time of administration, the effects and the side-effects of the drugs commonly used in Internal Medicine.

    III. Common emergency treatments and new techniques

  2. The emergency treatment of respiratory failure, lung infarction, severe hemoptysis.

  3. The invasive and non-invasive techniques of mechanical ventilation.


心脏科实习大纲

选择实习心脏监护病房或心脏普通病房,实习时间均为2周。实习医师在上级医师引导下分管至少2-4张床。

. 对实习医师具体需掌握疾病如下

心力衰竭、心源性休克、风湿性心瓣膜病、感染性心内膜炎、高血压、冠心病、心肌炎、心肌病、心包炎、心律失常(室上性心律失常、房颤、房扑、室性心律失常、传导阻滞、病窦综合征)

. 基础技能训练要求

  1. 实验室检查:掌握血、尿、便三大常规正常值、临床意义,并掌握血沉、出凝血时间,心肌酶升高的意义和鉴别诊断。

  2. X线检查:掌握正确系统的阅片方法,全面有层次的阅片,不遗漏应观察的任何部位,能写出X光报告。掌握心脏,大血管影像。

  3. 特殊检查:

  4. 心电图:能掌握正常心电图和典型的心律失常、传导阻滞、心室心房肥大、冠心病、心绞痛、心肌梗死的心电图变化。

  5. 基本了解超声心动图,24小时心电监护(HOLTOR),冠脉造影,心脏ECT等检查的方法,掌握其报告的临床意义。

  6. 基本诊疗技能操作:

  7. 掌握皮下注射、肌肉注射、皮内注射、静脉穿刺、取血、输血、输液、动脉血气取血。

  8. 了解心包穿刺的方法。

  9. 掌握吸氧、吸痰、人工呼吸、体外心脏按压等方法。

  1. 正确开医嘱及处方,掌握心脏科常用药物剂量,给药途径及给药时间,掌握药物的作用,了解副作用。

    . 内科常见危重症抢救及一些新技术了解。

    参加急性左心衰、急性心肌梗死、严重室性心律失常、心肺复苏的抢救,会使用除颤器了解起搏器的安装,心脏介入治疗情况等。


Internship Requirements for Cardiac Department

The interns can choose to practice the 2-week internship in the CCU or normal wards. The intern should take charge of at least 2-4 beds under the instruction of the supervising doctor.

I. Mastery of the following diseases

Heart failure, cardiac shock, rheumatic valvular heart disease, infective endocarditis, hypertension, coronary atherosclerotic heart disease, myocarditis, cardiomyopathies, pericarditis, cardiac arrhythmias (supraventricular arrhythmias, atrial fibrillation, atrial flutter, ventricular arrhythmias, conduction blocks and sick sinus syndrome)

II. Requirements for basic skill training

  1. Laboratory tests: Master normal values and clinical significance of the three conventional tests (blood, urine and stool); master clinical significance of erythrocyte sedimentation rate (ESR), bleeding/coagulation time; master the signification and differential diagnosis of cardiac enzymes.

  2. X-ray examination: Can analyze the parts of the X-ray correctly and systematically, without omission of any suspicious areas and write an X-ray report; master the normal X-ray appearance of the heart and large blood vessels.

  3. Special tests

    (1) EKG: Can interpret normal EKG findings and representative changes of the EKG with arrhythmias, conduction blocks, atrial ventricular hypertrophy, coronary atherosclerotic heart disease, angina pectoris, and myocardial infarction.

    (2) Can interpret the clinical significance of examination report of UCG, HOLTER, coronary arteriongraphy, cardio ECT.

  4. Basic diagnostic and procedural skills

    (1) Subcutaneous injection, intramuscular injection, intracutaneous injection, venipuncture, blood drawing, blood transfusion and intravenous infusion.

    (2) Paracentesis of the pericardium

(3) Oxygen administration, sputum aspiration, artificial respiration and external cardiac compression, etc.

  1. Write doctor’s orders and prescriptions correctly. Master the dosage, the route and time of administration, the effects and the side-effects of the drugs commonly used in Cardiac Department.

    III. Common emergency treatments and new techniques

    Participate in the emergency treatment of acute left heart failure, acute myocardial infarction, severe ventricular arrhythmia and cardio-pulmonary resuscitation. Know how to use defibrillator and understand the installation of pacemakers and the interventional treatment of cardiovascular diseases.

      

      

      

      


消化科实习大纲

实习时间2

  1. 对实习医师具体需掌握疾病如下:

    胃炎、胃食道反流症、消化性溃疡、肝硬化及其并发症(腹水、食道静脉曲张出血、肝昏迷)、原发性肝癌、肠结核、黄疸的鉴别诊断。

  2. 基础技能训练要求:

  3. 实验室检查:掌握血、尿、便三大常规正常值和临床意义;掌握血沉、出凝血时间、网织红细胞计数、体腔液(胸腹水)常规生化检查、脑脊液常规生化检查;掌握肝、肾功能检查,血液流变学检查,免疫全项,风湿抗体检查,血、尿、便培养等临床意义,了解一些特殊实验室检查结果及临床意义。

  4. X线检查:掌握正确系统的阅片方法,全面有层次的阅片,不遗漏应观察的任何部位,能写出X光报告。掌握胃、十二指肠溃疡,消化道肿物等疾病。

  5. 特殊检查:基本掌握一些特殊检查的适应症、禁忌症。如胃镜、肠镜等的方法及报告的辨认。

  6. 基本诊疗技能操作:掌握胸穿、腹穿穿刺。掌握胃肠减压、下胃管等方法。

  7. 正确开医嘱及处方。掌握内科常用药物剂量、给药途径及给药时间,掌握药物的作用,了解副作用。

  8. 了解结核性腹膜炎,消化道大出血的抢救,了解食管静脉曲张结扎及硬化剂注射的过程。


Internship Requirement for Gastroenterology

The total time of practice in the Gastroenterology Department amounts to 2 weeks.

I. Mastery of the following diseases

Gastritis, gastroesophageal reflux disease, peptic ulcers, liver cirrhosis and its complications (ascites, esophageal variceal hemorrhage, hepatic encephalopathy), primary carcinoma of the liver, tuberculosis of the intestine, tuberculous peritonitis, and the differential diagnosis of jaundice

II. Requirements for basic skill training

  1. Laboratory tests: Master normal values and clinical significance of the three conventional tests (blood, urine and stool); master clinical significance of erythrocyte sedimentation rate (ESR), bleeding/coagulation time, reticulocyte count, routine biochemical tests of pleural and peritoneal effusion, routine biochemical tests of cerebrospinal fluid; master clinical significance of liver and renal function tests, hemorheology tests, immunological tests, rheumatoid antibody test, and bacterial cultures of blood, urine and stool. Understand some specific laboratory findings and their respective clinical significance.

  2. X-ray examination: Can analyze the parts of the X-ray correctly and systematically, without omission of any suspicious areas and write an X-ray report; master the features of gastric ulcers, duodenol ulcers, and digestive tract tumors.

  3. Special tests: Know the indications and contraindications of special examinations such as gastric endoscopy and colon endoscopy.

  4. Basic diagnostic and procedural skills: Thorcentesis and abdominal paracentesis; gastrointestinal decompression and gastric intubation.

  5. Write doctor’s orders and prescriptions correctly. Master the dosage, the route and time of administration, the effects and the side-effects of the drugs commonly used in Internal Medicine.

III. Understand the emergency treatment of tuberculous peritonitis and gastrointestinal bleeding; understand the procedure of esophageal variceal ligation and sclerosant injection.

  


肾科实习大纲

实习病房2周,实习医师在上级医师引导下分管至少2-4张床。

. 实习医师具体需掌握疾病如下

急慢性肾小球肾炎、急进性肾小球肾炎、隐匿性肾炎(IgA肾病)、泌尿系统感染、肾病综合征、急慢性肾功能不全。

. 基础技能训练要求

  1. 实验室检查:掌握血、尿、便三大常规正常值和临床意义;掌握肾功能、免疫功能检查的临床意义;主要了解肾科一些特殊实验室检查结果及临床意义。

  2. 基本诊疗技能操作:

    皮下注射、肌肉注射、皮内注射、静脉穿刺、取血、输血、输液。

    3. 掌握胸穿、骨穿、腹穿等穿刺。

    4. 掌握吸氧、吸痰、洗胃、人工呼吸、体外心脏按压等方法。

    5. 正确开医嘱及处方。掌握肾内科常用药物剂量、给药途径及给药时间,掌握药物的作用,了解副作用。

    .常见危重症抢救及一些新技术了解

    1. 掌握急性慢性肾衰透析治疗的指征。

    2. 掌握肾脏活检的适应症。


Internship Requirements for Renal Department

During 2-week internship in the in-patient department, each intern will be in charge of at least 2-4 beds under the instruction of the supervising physician.

I. Mastery of the following diseases

Acute and chronic glomerulonephritis, rapidly progressive glomerulonephritis, latent glomerulonephritis (IgA nephropathy), urinary tract infection, nephrotic syndrome, acute and chronic renal insufficiency

II. Requirements for basic skill training

  1. Laboratory tests: Master normal values and clinical significance of the three conventional tests (blood, urine and stool); master clinical significance of renal function tests, immunological tests; understand some specific laboratory findings and their respective clinical significance.

  2. Basic diagnostic and procedural skills: Subcutaneous injection, intramuscular injection, intracutaneous injection, venipuncture, blood drawing, blood transfusion and intravenous infusion.

  3. Master the methods of thoracentesis, abdominal paracentesis and bone marrow aspiration.

  4. Master the methods of oxygen administration, sputum aspiration, artificial respiration, gastric lavage and external cardiac compression, etc.

  5. Write doctor’s orders and prescriptions correctly. Master the dosage, the route and time of administration, the effects and the side-effects of the drugs commonly used in Renal Department.

III. Common emergency treatments and new techniques

  1. Understand the indication of renal dialysis for acute and chronic renal failure.

  2. Understand the indication of renal biopsy.


内分泌科实习大纲

实习2周,实习医师在上级医师引导下分管至少2-4张床。

. 具体需掌握疾病如下

甲状腺机能亢进症、原发性慢性肾上腺皮质功能减退症、糖尿病、尿崩症、皮质醇增多症、垂体前叶功能低下

. 基础技能训练要求

4. 实验室检查:掌握甲状腺功能、OGTT检查结果正常值和临床意义,了解肾上腺皮质功能、垂体激素和性激素检查结果及临床意义。

5. X线检查:掌握心、肺、骨正常X线表现。

6. 特殊检查:

ECT:能基本掌握甲状腺、甲状旁腺和骨扫描等特殊检查的适应症。

骨密度:能基本掌握检查结果的临床意义。

7. 基本诊疗技能操作:掌握皮下注射、肌肉注射、皮内注射、静脉穿刺、取血、输血、输液;掌握胸穿、骨穿、腹穿等穿刺;掌握人工呼吸、体外心脏按压等方法。

8. 正确开医嘱及处方。掌握内分泌科常用药物剂量、给药途径及给药时间,掌握药物的作用,了解副作用。

. 内分泌科常见危重症抢救及一些新技术了解

1. 掌握糖尿病酮症酸中毒、高渗昏迷的处理。

2. 了解甲亢危象、高钙危象的处理原则。

  

  

  

  

  

  


Internship Requirement for Endocrinology Department

During 2-week internship in the in-patient department, each intern will be in charge of at least 2-4 beds under the instruction of the supervising physician.

I. Mastery of the following diseases

Hyperthyroidism, primary hypocortisolism, diabetes mellitus, diabetes insipidus, hypercortisolism, hypo-pituitarium anterius

II. Requirements for basic skill training

  1. Laboratory tests: Master the normal values and clinical significance of thyroid function tests and OGTT. Understand the function of the adrenal cortex and clinical significance of test result for pituitary hormones and sex hormone.

  2. X-ray examination: Master the normal X-ray appearance of the heart, lungs, and bones.

  3. Special tests:

    ECT: Understand the indications and contraindications of thyroid, parathyroid and bone scan

    Bone density: Understand the clinical significance of the examination

  4. Basic diagnostic and procedural skills: Subcutaneous injection, intramuscular injection, intracutaneous injection, venipuncture, blood drawing, blood transfusion and intravenous infusion; thoracentesis, bone marrow aspiration and abdominal paracentesis; artificial respiration and external cardiac pressure.

  5. Write doctor’s orders and prescriptions correctly. Master the dosage, the route and time of administration, the effects and the side-effects of the drugs commonly used in Endocrinology Department.

      

    III. Common emergency treatments and new techniques

  6. The treatment of diabetes melltitus ketoacidosis and hyperosmolar coma.

  7. The treatment principles of hyperthyroidism crisis and hypercalcemia crisis.


血液科实习大纲

血液科实习共2周,实习医师在上级医师引导下分管至少2-4张床。

. 血液科对实习医师具体需掌握的疾病如下

各种贫血,包括:缺铁性贫血、再生障碍性贫血、巨幼细胞性贫血、溶血性贫血,急、慢性白血病,淋巴瘤,多发性骨髓瘤,出血性疾病,特发性血小板减少性紫癜,DIC等。

. 基础技能训练要求

  1. 实验室检查:掌握血、尿、便三大常规正常值和临床意义;并掌握血沉、出凝血时间、网织红细胞计数、胸腹水常规生化检查、脑脊液常规生化检查;掌握肝、肾功能检查。

  2. 特殊检查:能掌握正常骨髓像。了解急慢性白血病骨髓像,常见缺铁性贫血、巨幼细胞贫血、再生障碍性贫血的骨髓特点。了解细胞化学染色的临床意义,急性白血病、淋巴病等免疫分型。

  3. 基本诊疗技能操作:掌握骨穿操作。

  4. 正确开医嘱及处方。掌握血液科常用药物剂量、给药途径及给药时间,掌握药物的作用,了解副作用。

    . 重症抢救及一些新技术了解

    1. 掌握DIC的诊断及治疗。

    2. 对输血反应能及时判断并正确处理。

    3. 了解骨髓移植的进展。


Internship Requirement for Hematology Department

During 2-week internship, each intern will be in charge of at least 2-4 beds under the instruction of the supervising physician.

I. Mastery of the following diseases

Anemia, including iron deficiency anemia, aplastic anemia, megaloblastic anemia, hemolytic anemia, acute and chronic leukemia, lymphoma, multiple myeloma, bleeding diseases, idiopathic thrombocytopenic purpura, DIC etc.

II. Requirements for basic skill training

  1. Laboratory tests: Master normal values and clinical significance of the three conventional tests (blood, urine and stool); master clinical significance of erythrocyte sedimentation rate (ESR), bleeding/coagulation time, reticulocyte count, routine biochemical tests of pleural and peritoneal effusion, routine biochemical tests of cerebrospinal fluid; master clinical significance of liver and renal function tests.

  2. Special examinations: Understand the characteristics of normal bone marrow, bone marrow findings in acute and chronic leukemia and the characteristics of bone marrow in iron deficiency anemia, aplastic anemia, and megaloblastic anemia. The clinical meaning of coloration of cytochemistry and the immunophenotype of acute leukemia and lymphoma should be masteded as well.

  3. Basic diagnostic and procedural skills: bone marrow aspiration.

  4. Write doctor’s orders and prescriptions correctly. Master the dosage, the route and time of administration, the effects and the side-effects of the drugs commonly used in Hematology Department.

    III. Common emergency treatments and new technologies

  5. The diagnosis and therapy of DIC (disseminated intravascular coagulation).

  6. The potential reactions to transfusions, and correct judgment and treatment.

  7. The development of bone marrow transplantation.


风湿免疫科实习大纲

实习共2周:均在病房,实习医师在上级医师引导下分管至少2-4张病床。

. 风湿免疫科对实习医师需掌握疾病的具体要求

掌握系统性红斑狼疮、类风湿关节炎、成人still’s病、干燥综合征、炎性肌病、系统性血管炎、血清阴性脊柱关节病等常见风湿免疫性疾病的诊断与鉴别诊断、临床正确处理和基本治疗原则;了解疾病的研究进展和前沿热点问题;掌握发热待查的诊断思维方法。此外通过实习还应掌握医院感染的概念、抗菌药物的临床正确应用、常见耐药细菌的耐药机制及其在治疗中应掌握的原则。

. 基础技能训练要求:

  1. 实验室检查:正确掌握血、尿、便常规,血沉,出凝血时间,网织红细胞计数,肝肾功能检查等基本实验室检查的正常值和在临床诊断中的正确应用;对胸腹水、脑脊液常规生化的结果应能正确分析病熟悉其临床意义;掌握血液、骨髓及其他体液、分泌物培养阳性结果及其临床意义,能够正确读懂及运用细菌药物敏感试验引导临床合理用药;掌握免疫全项、常见自身抗体检查在风湿免疫病诊断中的价值,了解一些特殊实验室检查结果及临床意义。

  2. 特殊检查:

    1. 心电图:能熟练操作心电图机,掌握正常心电图和典型的心律失常、传导阻滞、心室心房肥大、冠心病、心绞痛、心肌梗死的心电图变化。

    2. X线检查:掌握正确的阅片方法,能识别心、肺、骨的常见异常X线表现。

    3. 掌握胃镜、肠镜和各种穿刺的适应症和禁忌症。

  3. 基本诊疗技能操作:

  4. 掌握皮下注射、肌肉注射、静脉穿刺、取血、输血、输液。

  5. 掌握胸穿、腰穿、骨穿、腹穿等穿刺。

  6. 掌握吸氧、吸痰、人工呼吸、体外心脏按压等方法。

  7. 正确开医嘱。掌握常用药物剂量、给药途径及给药时间,掌握药物的适应症、禁忌症和副作用。

    . 了解风湿免疫科常见危重症抢救及一些新技术

    1. 暴发性狼疮、重症流行性出血热、颅内压增高的抢救。

    2. 鞘内注射MTX治疗狼疮脑病。


Internship Requirements for Rheumatology and Immunology Department

During 2-week internship in the in-patient department, each intern will be in charge of at least 2-4 beds under the instruction of the supervising physician.

I. Mastery of the following diseases

        1. Master the diagnosis, differential diagnosis and the treatment principles of the main rheumatic diseases and immune disorders, such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), adult onset Still’s disease (AOSD), sicca syndrome (Sj?gren’s syndrome), inflammatory myopathy, systemic vasculitis, seronegative spondyloarthropathy.

        2. Learn the newest developments in clinical immunology and anti-infectious therapy.

        3. Comprehend the diagnostic algorithm for Fever of Unknown Origin (FUO).

        4. Understand the concept of nosocomial infection, the principle of appropriate use of antibiotics and the antibiotic resistant mechanisms.

          II. Requirements for basic skill training

        1. Laboratory tests: Master normal values and clinical significance of the three conventional tests (blood, urine and stool); master clinical significance of erythrocyte sedimentation rate (ESR), bleeding/coagulation time, reticulocyte count, liver and renal function tests; master clinical significance of routine biochemical tests of pleural and peritoneal effusion, routine biochemical tests of cerebrospinal fluid; master clinical significance of the positive results of blood, marrow and other body fluid cultures; can select proper antibiotics based on the antibiotic sensitivity test; understand the clinical significance of immunologic examinations and autoantibody test in diagnosing rheumatic diseases and immune disorders. Understand some specific laboratory findings and their respective clinical significance.

        2. Special Instrument Examination

          1. EKG: Can operate electrocardiograph machine skillfully; can interpret normal EKG findings and representative changes of the EKG with arrhythmias, conduction blocks, atrial ventricular hypertrophy, coronary atherosclerotic heart disease, angina pectoris, and myocardial infarction.

          2. X-ray examination: Can analyze the parts of the X-ray correctly and systematically, without omission of any suspicious areas and write an X-ray report; master the normal X-ray appearance of the heart, lungs, and bones.

          3. Understand the indications and contraindications of special examinations such as gastric endoscopy, colon endoscopy and common puncture.

        3. Basic diagnostic and procedural skills

          1. Subcutaneous injection, intramuscular injection, intracutaneous injection, venipuncture, blood drawing, blood transfusion and intravenous infusion.

          2. Thoracentesis, lumbar puncture, bone marrow aspiration and abdominal paracentesis.

          3. Oxygen administration, sputum aspiration, artificial respiration and external cardiac compression, etc.

        4. Write doctor’s orders and prescriptions correctly. Master the dosage, the route and time of administration, the effects and the side-effects of the drugs commonly used.

          III. Common emergency treatments and new techniques

          1. The emergency treatment of fulminant systemic lupus erythematosus, epidemic hemorrhagic fever, intracranial hypertension.

2. The treatment of lupus encephalopathy by using intrathecal injection of MTX.

  


急诊科实习大纲

实习时间为2周。一周在急诊室跟班实习,一周在急诊观察室分管床位,并安排参加急诊科的值班跟班。或结合各实习医院的实际情况酌情安排急诊的实习工作。

. 急诊科对实习医师需掌握疾病的具体要求

高热、昏迷、晕厥、休克、上消化道出血、咯血、急性心率失常,急性心肌梗塞、急性功能不全、急腹症、急性中毒、脑血管意外、气胸、紫绀、低血糖、癫痫发作等。

. 基础技能训练要求:

  1. 给氧、吸痰、洗胃、人工呼吸、胸外心脏按压。

  2. 心电图检查操作、腰椎穿刺、插胃管或三腔管。

  3. 条件允许让学生参加心肺复苏的抢救工作,了解呼吸机的使用和适应症。


Internship Requirements for Emergency Room

The 2-week internship includes studying with supervising doctors for one week and taking on-call duty and charging of beds in observation room for the other week. Teaching hospital can make arrangement according to the condition of its emergency room.

I. Mastery of the following diseases

High fever, coma, syncope, shock, upper gastrointestinal bleeding, severe hemoptysis, severe ventricular arrhythmia, acute myocardial infarction, acute cardiac insufficiency, acute abdominal diseases, acute intoxication, stroke, pneumothorax, cyanosis, hypoglycemia, epilepsy.

II. Requirements for basic skill training

  1. Oxygen administration, sputum aspiration, stomach lavage, artificial respiration and external cardiac compression, etc.

  2. EKG operation, lumbar puncture, gastric intubation, and triple cavities intubation

  3. Participate in the cardio-pulmonary resuscitation according to the situation; know the operation and indications of ventilator.


外科学实习大纲

总体要求

实习生外科轮转共16周。实习科室包括普通外科8周(具体科室根据各医院具体情况安排)、骨科2周、心外科与胸外科二选一实习2周、泌尿外科2周、神经外科2周。

通过上级医师的传、帮、带以及实习医师提问、自学等方式,理论联系实践,熟悉外科常见病、多发病的诊断和治疗。学会阅读胃肠道造影、胸腹平片、CTMR及其在疾病诊断中的价值。掌握外科无菌术、换药、手术基本操作等技能。

在外科实习过程中,要求实习生参加住院医生24小时值班,对《医师法》进行了解。书写完整版英文病历2份(各专科最好写一份简要病历,包括首程、手术记录及病程记录等)。在上级医师引导下分管2~6张床病人。

实习期间,每周安排实习小讲课一次,英语教学查房一次,每周参加1台以上手术,要求应用英语教学,安排指定医师带教。各专科实习结束时进行口试、理论考试、病例分析及操作考试。实习医生实习期间,要求参加学科组织的学术讲座、病例讨论等学术活动。


Surgery Practice Outline

General requirements:

There are 16 weeks for the interns to accomplish the surgical rotation. The arrangements are as follows: department of general surgery for 8 weeks (Specific departments arranged according to the specific circumstances of each hospital), department of orthopedic for 2 weeks, either in the department of cardiac surgery or department thoracic surgery for 2 weeks; department of urologic surgery for 2 weeks; department of neurosurgery for 2 weeks.

Through the senior doctor’s teaching and self-study by the intern, the student should integrate theory with practice and become acquainted with the diagnosis and treatment of common surgical diseases. The intern should learn how to read gastrointestinal contrast films, abdominal plain films, CT, MR, and know their usage in the diagnosis of various diseases. The procedures of surgical asepsis, dressing changes, and some basic operation skills should be mastered.

The intern should be engaged in 24-hour duty during the internship, and learn the basic principles of medical care. The intern should finish 2 English medical records (Each specialist is best to write a brief medical history, including the first process, surgical records and progress notes, etc.) and manage 2 to 6 inpatients under the senior doctor’s instruction.

There will be a short lecture and instructional teaching rounds in English with the attending physician once a week. Interns will participate in more than 1 surgery, once a week. There will be a designated physician serving as a teacher, and teaching will be English. At the end of specialist the internship, the intern will receive an oral examination, a written examination paper, a case analysis and a test of procedural skills. Interns are also required to take part in academic activities organized by the department, such as lectures and case discussions.


各学科具体要求

普外科

普通外科轮转8周,对实习医师要求如下:

  1. 通过临床诊治工作,熟悉外科病人常见症状、体征及其意义,掌握初步诊断疾病的轻重缓急及病态大致部位。

  2. 熟悉普外病人术前常规准备方法以及术后饮食、抗菌素、胃肠减压、腹腔引流的处理及补液原则。

  3. 了解B超、X线检查结果,内窥镜检查,同位素检查以及各项常规化验结果在临床外科的诊断意义。

  4. 通过病房及急诊实践,掌握抽血、换药、脓肿切开、导尿、胃肠减压,掌握外科无菌概念。在上级医师引导帮助下,学会外科手术的基本操作。

  5. 对阑尾炎、疝、大隐静脉曲张、甲状腺瘤、肛门疾病从诊断、术前准备、手术治疗原则到术后处理要求较全面的掌握,并参加这一类手术。

  6. 对一般胆囊炎、胆石症、消化道溃疡、消化道肿瘤,甲状腺肿大、甲亢、乳腺等疾病,要求掌握临床表现、体征、辅助检查方法选择,特殊术前准备以及手术原则。

  7. 对直肠癌、门脉高压、肝脏疾病、胰腺疾病、复杂胆道疾病等复杂的外科病,要求了解临床表现和诊断方法的选择,掌握治疗原则。

  8. 对抢救工作,尤其是外科较多见的出血及中毒性休克,了解补充血容量,纠正水电解质紊乱和酸碱平衡失调的原则。

  9. 熟悉外科营养的目的、途径、需要量的计算,并发症的预防和处理。


Individual Department Requirements

General Surgery Practice Outline

The intern should work in the department of general surgery for 8 weeks. The requirements are as follows:

1. Become acquainted with common symptoms and signs of patients with general surgical diseases and know their significance by clinical work. Learn how to approximate the extent and location of the diseases.

2. Be acquainted with routine preparation for preoperative patients and basic postoperative management, such as diet, antibiotic treatment, principles of fluid replacement, nasogastric suction, and abdominal drainage.

3. Understand the diagnostic significance of B-ultrasound, X-ray films, endoscopy, isotopic examinations and routine laboratory reports.

4. Master some procedures such as venipuncture for blood draws, dressing changes, abscess incision, urethral catheterization, nasogastric suction, and understand surgical aseptic technique; master basic operation skills under the instruction of senior doctors.

5. Master the diagnosis, preoperative preparation, and operative principles for appendicitis, hernia, varicose great saphenous veins, thyroid tumor, and diseases of the anus. Participate in these operations.

6. Master the clinical presentation, selection of accessory examinations, special preoperative preparations, and operative principles for cholecystitis, cholecystolithiasis, peptic ulcers, digestive tract tumors, thyromegaly, hyperthyroidism, and diseases of the breast.

7. Understand the clinical presentation and selection of diagnostic methods, and master the treatment principles for some complicated surgical diseases, such as rectal cancer, portal hypertension, liver diseases, diseases of the pancreas and complicated diseases of the biliary tract.

8. Understand the principles of blood volume replacement, correction of water-electrolyte disturbances, and acid-base imbalance during emergencies, especially in hemorrhagic shock and toxic shock.

9. Be acquainted with the purpose, route, calculation of requirements, and prevention and management of complications of surgical nutrition.


骨科

骨科轮转2周,对实习医师要求如下:

  1. 通过骨科实习后,熟悉掌握骨科物理学诊断方法,尤其掌握上、下肢的肌力检查方法,脊柱及骨关节的检查方法,并应了解一些特殊的骨科物理诊断方法。

  2. 初步掌握骨科常见病的诊断及处理原则,如:创伤(骨折、脱位),骨关节感染、结核,关节炎等常见病的诊断和处理方法。初步掌握一些常见的骨折、脱位(如股骨颈骨折, COLLes骨折、锁骨骨折、肩关节脱位等)的诊断和治疗原则。

  3. 了解骨科的一些基本操作技术方法,如:皮牵引、骨牵引固定、小夹板应用、关节穿刺、各种造影技术、局部封闭等技术。

  4. 了解严格的无菌概念对骨科的特殊重要性,必须掌握要求更高的无菌操作及消毒、灭菌原则。

  5. 熟悉骨科常见病多发病,腰椎间盘突出症的诊断及鉴别诊断,脊柱结核的临床表现,治疗原则及手术指征,慢性化脓性骨髓炎的成因、诊断及治疗原则,骨肿瘤的分类、良恶性骨肿瘤的鉴别和治疗原则。了解腰腿痛及颈肩痛的病因、发病机理、诊断、鉴别诊断及治疗原则,髋及膝关节结核的临床表现和治疗原则。

  6. 正确开医嘱,掌握骨科常见病术前准备及术后处理;常用药物剂量、给药途径及方法,掌握药物的适应症、禁忌症和副作用。

  7. 了解骨外科常见急重症的抢救技术,如手外伤、多发伤、多发骨折、创伤性失血性休克等。


Orthopedic Surgery Practice Outline

Guidelines for 2 weeks of clinical practice in the Orthopedics Department

  1. Master the basic physical examination techniques required to make a diagnosis of diseases of the musculoskeletal system, for example the examination of muscle strength and motion of the spine or joints. Also try to obtain knowledge of some special physical examination techniques.

  2. Acquire an intimate knowledge of the principles of diagnosis and treatment for some common disorders of the bones and joints. Such as traumatic surgery (fracture and dislocation), infectious diseases, and aseptic arthritis, etc.

  3. Learn some basic therapeutic techniques, such as traction, fixation with splint or cast, arthrocentesis, arthrography, and local injection techniques to treat joint pain.

  4. Understand the special importance of aseptic technique during orthopedic surgery, and to learn more strict sterile techniques.

  5. Learn the basic knowledge of key points for some common disorders such as the diagnosis and differential diagnosis for lumbar disc herniation, the clinical manifestations and principles of treatment of tuberculosis of the spine, the classification, differential diagnosis, and principles of treatment of bone tumors.

  6. Learn how to write the correct medical documentation and physician orders, to give a proper plan for preoperative and postoperative treatment, and to know the correct medications to prescribe, and their effects and side effects.

  7. Take part in procedures for the management of some emergency and critical cases, such as multiple injuries, compound fractures, traumatic and hemorrhagic shock.


心胸外科

心胸外科轮转2周,对实习医师要求如下:

  1. 了解胸部创伤的诊断及初步处理。

  2. 了解食管疾病,肺部疾病的检查方法,能对食管癌、肺癌做出诊断。

  3. 了解胸透、胸穿操作方法及观察胸腔引流在疾病诊治中的作用。

  4. 了解低温、体外循环的机理。

  5. 根据心前区杂音能判断出先天性心脏病、二尖瓣病变。

  6. 了解冠状动脉性心脏病的外科治疗;

  7. 了解常见先天性心脏病:继发孔型房间隔缺损、室间隔缺损的外科治疗;

  8. 了解常见心脏瓣膜病:二尖瓣狭窄/关闭不全、主动脉瓣狭窄/关闭不全的外科治疗。


Cardiothoracic Surgery Practice Outline

The intern should work in the department of cardiothoracic surgery for 2 weeks and the requirements are as follows:

  1. Understand the diagnosis and initial treatment of chest trauma.

  2. Understand the examination methods for diseases of the oesophagus and lung. Be able to determine the diagnosis for oesophageal cancer and lung cancer.

  3. Understand the procedures of chest fluoroscopy and thoracic puncture, and observe the effects of thoracic drainage in diagnosis and treatment.

  4. Understand the mechanism of hypothermia and extracorporeal circulation.

  5. Diagnose congenital heart diseases and bicuspid valve lesions according to the precordial region murmur.

  6. Understand surgical treatment of coronary heart disease.

  7. Understand surgical treatment of common congenital heart diseases, atrial septal defect, and ventricular septal defect.

  8. Understand surgical treatment of common heart valve diseases, such as mitral valve stenosis, mitral valve incompetence, aortic valve stenosis, and aortic valve incompetence.


泌尿外科

泌尿外科轮转2周,对实习医师要求如下:

  1. 初步掌握泌尿科常见病多发病包括泌尿系感染、前列腺炎、泌尿系结石、尿路梗阻及泌尿系损伤的诊断及处理原则,尤其对泌尿系统诊断方法,如:膀胱镜、泌尿系造影、肾功能检查血管造影等的选择及适应症有初步认识,并能阅读影象学资料。

  2. 了解泌尿科的一些基本操作技术,前列腺按摩、导尿技术、包皮环切术、鞘膜积液及膀胱造瘘等手术操作。

  3. 了解泌尿外科的一些特殊检查:体外冲击破碎石、尿流率、膀胱镜、尿道扩张术适应症。

  4. 熟悉门诊常见病的诊治方法(前列腺、附睾、泌尿结石),泌尿系统外科常见病的临床表现、诊断、治疗原则及手术指征。

  5. 熟悉泌外科常见病术前、术后的医嘱处理。


Urologic Surgery Practice Outline

Practice in urology will be for 2 weeks, with the requirements as follows:

  1. Master the diagnosis and management principles of some common diseases in urology, including urinary tract infection, prostatitis, urinary stones, obstruction of the urinary system and urologic injury. The student should especially know the methods of diagnosis, for instance: cystoscopy, urography, renal function examination, and angiography. Understand the information from radiology.

  2. Understand some basic procedures, for instance: prostatic massage, phimosiectomy, and the operative procedures for hydrocele, tunica vaginalis, and cystis stoma.

  3. Understand the indications of some special examinations: extracorporeal shock wave lithotripsis, urine flow rate measurement, cystoscopy, and dilation of the urethra.

  4. Know the diagnosis and treatment of common diseases (diseases of the prostate gland, epididymis, urinary calculus), and know the clinical manifestation, diagnosis, therapeutic principles, and operative indications of common diseases in urology.

  5. Know the physician orders for preoperative and postoperative care for the common diseases in urology.


神经外科

神经外科轮转2周,对实习生医师要求如下:

  1. 了解头皮损伤和颅骨骨折处理原则,参加头皮清创手术。

  2. 了解颅脑损伤的现场急救。

  3. 熟悉颅脑损伤病人的观察事项:包括意识、瞳孔、肢体活动以及生命征变化。

  4. 了解典型的颅内血肿、脑出血、脑梗死、脊髓神经压迫症、颅脑及椎管内肿瘤的临床表现、诊断依据及处理原则。

  5. 了解颅脑手术前、后处理原则。掌握术前头皮备皮。

  6. 了解颅脑损伤、脑血管疾病及常见神经系统肿瘤的CTMRI影像学特征性改变。

  7. 掌握腰穿的适应症、禁忌症及操作要点。


Neurosurgery Practice Outline

Practice in neurosurgery department will be for 2 weeks, with the requirements as follows:

  1. Understand the management principles of scalp injury and skull fracture. Join in the activities of debridement and suture of scalp injury.

  2. Understand the emergency treatment of traumatic brain injury.

  3. Know the observation items of traumatic brain injury patient: state of consciousness, pupil, physical activity and vital signs.

  4. Understand the clinical manifestation, diagnosis and treatment of the typically diseases: intracranial hematoma, cerebral hemorrhage, cerebral infarction,spinal neuronal compression syndrome, brain tumor and intraspinal tumor.

  5. Understand the Principles for Preoperative and Postoperative Management of brain surgery. Master the preoperative hair removal.

  6. Understand the significant CT and MRI findings of Craniocerebral Trauma, cerebral vascular disease and common tumor of brain.

  7. Master the indications, contraindications and operational essentials of lumbar puncture.


妇产科学实习大纲

总体要求:

共实习6周,其中妇科2周、产科2周、计划生育1周、门诊1周。通过临床实习,掌握妇产科病史的采集、病历的书写和体格检查,尤其是妇产科专科检查及特殊检查。掌握妇产科常见病、多发病的诊断,鉴别诊断,治疗及其预防措施。学会住院病人的病情观察,并书写病程记录、各种医疗文件。初步掌握妇产科急症病人的急救方法。实习期间,每周安排实习小讲课一次,教学查房一次,要求应用英语教学和学习。实习结束时进行口试、理论考试、病例分析及操作考试。实习医生实习期间,要求参加学科组织的学术讲座,病例讨论等学术活动。


Gynecology & Obstetrics Practice Outline

General requirements:

The six-week practice in the department of obstetrics and gynecology includes 2 weeks in the Gynecology Department,2 weeks in the Obstetrics Department, 1 week in the Family Planning Department, and 1 week in the Outpatient Department. Through clinical practice, students should master how to obtain a case history, write case files, and carry out physical examinations, especially pelvic examinations. In addition, the diagnosis, differential diagnosis, treatment and preventive measures of the common and frequently-occurring diseases should be understood. The student should learn how to survey the patient’s condition, and write progress notes and the various required medical documents. The student should also master the preliminary emergency treatment of acute patients. During the time of practice, there will be a small-scale practice lectures and clinical rounds for teaching in English once a week. Students will be taught bilingually, and physicians will be provided to teach students. At the end of the rotation, the students will have an oral examination, written examination, case analysis, and a procedural exam. During the period of practice, the trainees are asked to take part in the science lectures, case discussions, and other learning activities organized by the department.


各学科具体要求

产科

产科实习2周,通过产科实习,掌握产科病历书写、基本操作及常规检查技术。

  1. 了解产前检查的意义,掌握产科普通病历的书写及产科入院记录的书写。熟练掌握产科四步触诊法、骨盆外测量。要求实习生所分配的病理产科患者书写英文病历2份,正常孕妇写产科入院记录。每日参加主治医师查房、整理病历、记录病程、填写医疗文件、抄写并张贴化验报告,发现异常情况及时向上级医师汇报。

  2. 学会观察产程,在上级医师的引导下初步掌握正常分娩接生的方法及步骤。要求在助产士的带领下上台接生1~2次。

  3. 了解产钳助娩的适应症、条件和操作步骤。

  4. 了解病理产科常见病与多发病的诊断、鉴别诊断和处理原则,如:妊娠高血压综合征、胎盘早剥、前置胎盘、妊娠合并心脏病、糖尿病、贫血、产后出血、胎儿窘迫、胎膜早破和异常分娩等。认识围产期保健及母乳喂养的重要意义。每周组织教学查房1次。

  5. 了解胎儿电子监测仪在预测胎儿宫内储备力的应用,掌握胎心监护包括NSTOCTCST的操作及其临床意义。

  6. 了解正常及异常产褥的诊断和处理。

  7. 掌握新生儿窒息的抢救。

  8. 参加剖宫产术,掌握刷手、消毒、铺巾、穿手术衣、切皮、打结、剪线及缝皮等操作,熟悉剖宫产术的适应症和手术步骤。

  9. 学会引产的适应症及方法,掌握异常情况的处理。


Individual Department Requirements:

Obstetric Department Practice Outline

Students should master obstetric-case documentation, some basic operation procedures, and routine examination techniques, during the two weeks in the Obstetric Department.

The following will be expected of the students:

  1. Understand the aspects of antenatal care; understand how to write routine obstetric-case notes, and resident-admission notes. To proficiently master the four maneuvers of Leopold and external pelvic measurements. An intern must write two ordinary case files, including 2 English cases of all the arranged pathological obstetric patients and admit notes of normal gravidas. Every day the intern must participate in physician clinical rounds, write the case files they are responsible for, write the progress notes, and report unusual conditions to the supervising doctor in a timely manner.

  2. Learn how to follow the patient during labor, preliminarily master the method and procedure of a normal pregnancy delivery, supervised by a senior level physician, and deliver a normal parturition guided by midwives, one or two times during the rotation.

  3. Understand the indication, and manipulation steps of using obstetrical forceps.

  4. Understand the diagnosis, differential diagnosis, and treatment principles of the common and frequently-occurring pathological obstetric diseases, for example pregnancy induced hypertension syndrome, placental abruption, placenta previa, pregnancy complicated with cardiac disease, diabetes during pregnancy, anemia, postpartum hemorrhage, fetal distress, premature rupture of memberanes, abnormal labor, and so on. To know the significance of peripartum care and breast feeding. Every week a teaching clinical rounds lecture will be organized.

  5. Understand how to apply a fetal electronic monitor, to forecast fetal reserve capability. Master NST, OCT, CST, and the manipulation and clinical meaning of fetal heart monitoring.

  6. Understand the diagnosis and treatment of normal and abnormal puerperium.

  7. Understand the emergency treatment of neonatal asphyxia.

  8. Participate in a caesarean section; master the procedure of scrubbing, sterilization, drapes, wearing an operating gown, cutting the skin, ligature, shearing thread and making skin sutures, and to be familiar with the indication and the operative procedure of a caesarean section.

  9. Learn the indication and methods of induced abortion, and master the treatment of abnormal conditions.


妇科

妇科实习2周。通过妇科实习,掌握妇科病历书写、基本操作及常规检查技术。

  1. 熟悉妇科病历的书写特点,要求实习生书写英文病历2份。掌握妇科检查方法(包括双合诊、三合诊及肛查)。掌握妇科常用特殊检查方法,如宫颈刮片。掌握阴道镜、宫腔镜、腹腔镜的适应症。

  2. 每周参加主任教学查房、报告病历、参与讨论。

  3. 学会妇科常见病的诊断、鉴别诊断与处理原则,如子宫肌瘤、卵巢肿瘤、异位妊娠、女性生殖系统炎症、子宫内膜异症、妊娠滋养细胞疾患、宫颈癌等。

  4. 掌握化疗的适应症,熟悉化疗方案的制定。

  5. 熟悉妇科手术前后病人的处理原则。

  6. 参加妇科手术,掌握刷手、消毒、铺巾、穿手术衣、切皮、打结、剪线及缝皮等操作,熟悉子宫切除术、附件切除术的适应症和手术步骤。


Gynecology DepartmentPractice Outline

Students should master gynecologic case documentation, basic procedures and routine examination techniques, during the 2 weeks in the Gynecologic Department practice.

  1. Be familiar with the documentation of gynecologic cases. The trainees are asked to write 2 English case files. Master gynecologic examination methods (including the bimanual examination, vagino-recto-abdominal examination and anus examination). Understand specific gynecologic examinations that are frequently used, such as cervical scraping smear (PAP smear). Understand the indications for use of the colposcope, hysteroscope and laparoscope.

  2. Participate in the consultant teaching clinical rounds every week, report the case files, and participate in the discussion.

  3. Learn the diagnosis, differential diagnosis, and treatment principles of common gynecologic diseases, such as hysteromyomas, ovarian tumors, ectopic pregnancy, genital system inflammation, endometriosis, gestational trophoblastic disease, cervical cancer, and so on.

  4. Master the indication for chemotherapy, and be familiar with the institution of chemotherapy programs.

  5. Be familiar with pre-operative and post-operative treatment principles in gynecologic patients.

  6. Participate in gynecologic operations, master the procedure of scrubbing, sterilization, drapes, wearing an operating gown, cutting skin, ligature, shearing thread, skin sutures, and so on, and be familiar with the indication and the operative procedure of uterectomy and adnexectomy.


计划生育

    1. 掌握早孕的诊断,掌握人工流产、药物流产的适应症、禁忌症。

    2. 学会口服避孕药、避孕工具(避孕套、宫内节育器)的适应征、用法及副作用的处理。

    3. 在上级医师的引导下,参加人工流产、上环、取环、中期引产几输卵管绝育术的操作。学习药物流产的方法。


Family Planning Department Practice Outline

The following will be expected of students:

  1. Master the diagnosis of early pregnancy, and understand the indications, and contraindications of artificial and medical abortion.

  2. Learn the indications, usage, and the adverse reactions to treatment with oral contraceptives, and contraceptive devices (condom, intrauterine contraceptive device (IUD)).

  3. Take part in the procedure of artificial abortion, placement and displacement of an IUD, induction of labor in the second trimester, and tubal sterilization procedures, guided by a senior level supervising doctor, and to learn the method of medically-induced abortion.


妇产科门诊

    1. 门诊实习包括产科门诊、妇科门诊。在上级医师引导下诊治门诊病人、书写门诊病历、做产前检查、妇科检查、刮片。学习妇产科超声检查。

    2. 学会门诊常见病,如流产、炎症、不孕症等诊治。

    3. 熟悉诊断性刮宫、输卵管通气、宫颈活检、宫腔镜的指征和步骤。

    4. 学习宣传母乳喂养的重要性。


Outpatient Department Practice Outline

The following will be expected of students:

  1. The practice in the Outpatient Department includes the obstetrical service, gynecologic service. Students will be expected to diagnose and treat outpatients, directed by a senior level doctor, to write outpatient case reports, to carry out antenatal examinations, gynecologic examinations, a cervical scraping smear (PAP smear), and to learn about an obstetric and gynecologic ultrasonic examination.

  2. Learn how to treat the common problems in the Outpatient Department, for example abortion, inflammation, infertility and so on.

  3. Be familiar with diagnostic curettage, cervical biopsy, and the indications and procedure for hysteroscopy.

  4. Promotethe importance of breast feeding.


儿科实习大纲

一、目的要求

1. 巩固和提高儿科的基本理论、基本常识和基本技能,树立认真负责的良好医德医风,培养学生自主学习、终生学习以及相互协作的能力。

2. 掌握儿童剖解生理特点、生长发育规律、喂养及护理基本常识。

3. 掌握儿科病史采集和体格检查的特点和方法。

4. 初步掌握儿科常见疾病的诊断、鉴别诊断、处理及预防原则。

5. 基本掌握儿科常见诊疗技术。

6. 熟悉儿科常用检查的正常值及常用药物剂量。

7. 熟悉各种检验的正常数据和临床判读。

二、实习时间安排

儿科实习时间共6周(包括病房和门诊)。

1. 根据实习病区情况,每人分管2~4张病床。

2. 实习期间用英语教学,每周安排查房一次,每2周安排儿科医学实习小讲课1次,由主治医师或高年住院医师主讲,内容包括:

1儿科用药原则。

2儿科常见症状的诊断思路。

3儿科急救处置。

4儿科常见病毒感染的诊治。

3. 定期安排临床典型病例讨论,一般每两周一次

4. 实习考核安排在实习的最后一周,考核设计重在理论和临床实践的结合,重点考核临床思维,临床分析问题和解决问题能力。出科考核成绩结合日常查房提问、出科笔试和口试成绩。

5. 儿科门诊实习期间安排2次儿童保健门诊实习。

6. 参加科室业务学习、疑难病历讨论和死亡病历讨论等。

  1. 实习内容要求

    1. 在上级医师引导下,通过临床实践结合教科书和参考书,学习和初步掌握正确的临床思维方法,培养独立分析和处理临床问题的能力。

    2. 在上级医师引导下,参加儿科临床工作,书写所经管病人的医疗文件。书写完整病历每周至少1份。通过临床实践,熟练掌握儿科疾病的病史采集、体格检查和诊治方案的制定(包括相关的实验室检查)及儿童基本护理。

    3. 学习和掌握正常儿童生长发育特点、喂养;掌握儿科各年龄分期,小儿生长发育规律,测量方法及正常值和计算评价方法等。掌握计算婴儿乳方及辅助食品的添加原则,熟悉母乳喂养的好处,熟悉不同年龄小儿及患病儿童的饮食安排。学习和了解儿童保健特点及保健流程;掌握儿童计划免疫以及预防接种实施程序。

    4. 熟悉常见化验的正常值、临床意义及其结果的说明。

    5. 熟悉常用药物的应用原则及剂量。

    6. 学习掌握下列儿科常见疾病的病史采集、诊断要点、鉴别诊断和处理原则。

    ⑴ 新生儿疾病:新生儿黄疸、新生儿溶血症、新生儿败血症、新生儿肺炎、新生儿窒息、呼吸窘迫综合征、新生儿缺血缺氧性脑病、新生儿颅内出血、冰冷损伤综合征等;熟悉新生儿分类、新生儿特殊状态、护理要点。

    ⑵ 呼吸系统疾病:急性上呼吸道感染、急性支气管炎、毛细支气管炎、肺炎、支气管哮喘等。

    ⑶ 营养性疾病:蛋白质-热能营养不良、单纯性肥胖症、营养性维生素D缺乏性佝偻病等。

    ⑷ 消化系统疾病:腹泻病、婴儿肝炎综合征等。掌握小儿液体疗法的基本理论,计算方法及实施。

    ⑸ 泌尿系统疾病:急性肾炎、肾病综合症、尿路感染。

    ⑹ 造血系统疾病:营养性贫血、G-6-PD缺乏症、白血病等。

    ⑺ 循环系统疾病:先天性心脏病(房间隔缺损,室间隔缺损,动脉导管未闭,法洛四联症)、病毒性心肌炎等。

    ⑻ 神经肌肉系统疾病:化脓性脑膜炎、癫痫、热性惊厥、脑性瘫痪、化脓性脑膜炎、病毒性脑炎等。

    ⑼ 免疫系统疾病:过敏性紫癜、川崎病等。

    ⑽ 内分泌遗传代谢疾病:先天性甲低、21-三体综合征、矮小症、儿童糖尿病、性早熟等;熟悉先天性遗传代谢疾病的诊断、鉴别诊断及处理原则。

    ⑾ 发育行为疾病:抽动障碍、注意缺陷多动障碍、孤独症等。

    ⑿ 感染性疾病:常见发疹性疾病(麻疹、风疹、幼儿急症、水痘、猩红热、手足口病),流行性腮腺炎等。

    熟悉儿科常见急症及危重症的诊治原则,如感染性休克,小儿心力衰竭,小儿肾功能衰竭,小儿呼吸衰竭,心跳骤停,昏迷,出血、腹痛、惊厥,发热等。掌握儿科心肺复苏方法。

    7. 掌握儿科常见诊疗技术操作:吸氧,鼻胃插管术,吸痰,物理降温,头皮静脉穿刺,颈、股静脉抽血,腰椎穿刺,胸腔穿刺,骨髓穿刺术。

    新澳门葡萄京74222儿科教研室

    201434日 修订

      


Pediatric Practice Outline

Objectives and requirements:

  1. Enhance students’ medical knowledge and skills to continuously serve needs of children with compassionate hearts, self-discipline and professional conduct.

  2. Understand and master basic theory and knowledge of common pediatric diseases.

  3. Master pediatric basic clinical techniques and general good manipulative procedures.

  4. Master the history taking and writing.

  5. Master the physical examination of sick-kids at various ages.

  6. Be familiar with the dosage and indication of drugs used for sick kids.

  7. Be familiar with the normal value and the significance of lab studies.

    Clinical practice time and arrangements:

        1. There are six weeks for clinical practice, including inpatients and outpatients.

  8. Arrange English ward rounds once a week and English clinical practice lectures every two week. This is taught by the attending or senior resident. The content is:

  9. Principles for pediatric drug use.

  10. Differential diagnosis for symptoms of common pediatric diseases.

  11. Treatment for pediatric emergencies.

  12. Diagnosis and treatment for pediatric common viral infections diseases.

    1. Organize a clinical practice doctor to analyze and discuss typical clinical cases regularly (usually once per two weeks)

    2. An examination method for the clinical-practice doctor is designed, so that the students are encouraged to closely combine theory with clinical practice, attaching importance to the opportunity for clinical practice. The score is combined from questions in the clinical rounds with the oral test score obtained when leaving the department. In addition, one typical case analysis will be part of the written examination.

    3. Strengthen English clinical rounds for the intern (regardless of formalities)

    4. The clinical-practice doctor is required to participate in a professional lecture every Friday afternoon (including analysis for difficult cases, conveying information from science meetings both at home and overseas, and from new medical developments.

    5. Didactical clinical rounds by experienced Professors periodically. (Or difficult-case discussions)

      Basic technique and manipulation requirements:

  1. Master the ability to obtain and write information about the patient, observe the changes in the diseases, write daily progress notes, sign out summery, acceptance note and discharge summery and organize paperwork for the case at the time of discharge. Written information is stored in the medical records department. Two cases should be written up when leaving the department.

  2. Master characteristics of a pediatric physical examination as well as examination methods for various systems (including a physical examination and measurement for intelligence development).

  3. Master the general principles for nurturing children (cleanliness, heart preservation, disinfection, isolation method of feeding, calculation for nutrition amount) and nursing children.

  4. Master pediatric fluid therapeutics and common drug dosages.

  5. Master the application and diagnosis of a pediatric electrocardiogram, the methods of lowering body temperature of children using physical methods, and use of a pediatric inhaler pulverization treatments etc. generally. Understand common manipulations used for children, venipuncture, injections in the elbow and femoral sites; intramuscular injection, subcutaneous injection, intradermic injection, lumbar puncture etc.

  6. Master diagnosis and treatment of the following diseases

  1. Growth and development

    1. Master the characteristics of the different stages of children’s development.

    2. Use the formula for weight and height, calculate head circumference, fontanel size, age of ossific center of the bone and development of teeth.

  2. Nutrition & its disorders

    1. Infant feeding: master character of metabolism and nutrition requirements, importance and method for breast feeding; understand how to mix milk and the sequence of adding supplements to the diet.

    2. Protein-energy malnutrition: master its etiology, clinical manifestations, diagnosis, treatment and prevention

    3. Rickets of vitamin D deficiency: master its clinical manifestations, diagnosis, treatment, and prevention

    4. Tenany of vitamin D deficiency: master its clinical manifestations, diagnosis and treatment.

  3. Newborn diseases:

    1. Basic concept and category for the newborn: master newborn categories, understand the level of the ward neonatal

    2. Characteristics of nursing for full-term infants and preterm infants: master physical and appearance characteristics of nursing for a full-term infant and preterm infant

    3. Asphyxia of the newborn: master clinical manifestations, Apgar score, complications and treatment

    4. Hypoxic-ischemic encephalopathy of the newborn: master clinical manifestations, diagnosis, differential diagnosis and prognosis

    5. Respiratory distress syndrome: master clinical manifestations, laboratory findings, diagnosis, differential diagnosis and treatment

    6. Newborn jaundice: master differential diagnosis and treatment for physiological and pathologic jaundice

    7. Neonatal cold injury syndrome: master its clinical manifestations, diagnosis, and treatment

  4. Digestive diseases

    1. Infantile diarrhea: master its etiology, clinical manifestations, diagnosis and treatment

    2. Infantile diarrhea: master its etiology, degree of dehydration, type of dehydration, fluid and electrolyte management

  5. Respiratory tract disease

    1. Master anatomic and physiologic characteristics of the respiratory system for children, master clinical manifestations and treatment of severe upper respiratory infections

    2. Master clinical manifestations and treatment for general pneumonia and serious pneumonia, master auscultation for all kinds of abnormal respiratory sound and rale in the lung and clinical characteristics of the four kinds of special pneumonia

    3. Master clinical manifestations of bronchial asthma, criteria for diagnosis and treatment of children asthma

  1. Cardiovascular disease

  2. Congenital heart disease: understand the characteristics of the fetal circulation and change of the blood dynamics after birth, master clinical manifestation, murmur characteristics and common complications of four kinds of common congenital heart diseases.

  3. Myocarditis: the symptoms, diagnosis and differentiate diagnosis, lab study and treatment of myocarditis.

  1. Kidney & urinary tract

  2. Acute glomerulonephiritis: master clinical manifestations and treatment of general cases and severe cases.

  3. Nephrotic syndrome: master the main clinical manifestations, differential diagnosis of the simple type of nephrotic syndrome and the nephritis type of nephrotic syndrome and principles of treatment.

  4. Urinary tract infection.

  1. Hematologic disorders

  2. Nutritional iron deficiency anemia: master stages of this disease and main laboratory findings.

  3. Nutritional megaloblastic anemia: master the special clinical manifestations, laboratory findings, prevention and treatment.

  4. Acute leukemia

  1. Neurologic & muscular disorders

  2. Purulent meningitis: master its clinical manifestations, differential diagnosis of celebrospinal fluid findings and treatment.

  3. Acute viral encephalitis: master its special clinical manifestations, laboratory findings and treatment.

  4. Cerebral palsy

  5. The diagnosis of seizure disorder

  1. Endocrine disorders: master clinical manifestations, laboratory findings, diagnosis and treatment

  2. Congenital hypothyroidism.

  3. Down’s syndrome

  4. Diabetes

  1. Behavioral disorder: tic disorder, Attention-deficit hyperactivity disorder (ADHD), autism, and etc.

  2. Infective disease: common eruptive disease, including measles, rubella, infantile acute diseases, chicken pox, scarlet fever, Hand foot and mouth disease (HFMD), and epidemicparotitis.

  3. Principles of emergency treatment for: infantile emergent diseases

  4. Infective shock, infantile heart failure, infantile kidney failure, infantile respiratory failure, infantile cardiac arrest, coma, bleeding, abdominal pain, convulsion and fever.

  5. Infantile cardio-pulmonary resuscitation

  1. Common procedural skills: oxygen administration, nasal and gastric intubation, sputum attraction, physical cooling, scalp intravenous injection, femoral vein puncture, lumbar puncture, thoracentesis, bone marrow puncture.

      

      

    Department of Pediatrics

    Fujian Medical University

    2014-3-4


神经内科学实习大纲

实习时间2周,其中包括病房和门急诊。实习期间,每周安排实习英语小讲课一次,安排英文查房一次。实习医生实习期间,要参加学科组织的学术讲座,病例讨论等学术活动。实习结束时进行口试,理论考试, 病例分析及操作考试。

基本技能的训练

  1. 掌握神经科病例的问诊、神经科查体的步骤和方法、病例分析要点和查房记录等。要求书写神经内科英文病历1份。

  2. 认识神经科各种常见的阳性体征。

  3. 掌握腰椎穿刺及该项检查的适应症和禁忌症。

  4. 了解脑电图、肌电图、诱发电位、经颅多普勒超声检查的临床用途及意义。

  5. 了解格林-巴利综合征呼吸衰竭、重症肌无力危象等气管切开的护理和呼吸机使用方法。

    实习病种

    . 脑血管病

  6. 脑血管病的分类

  7. 短暂脑缺血发作。颈内动脉系统TIA和椎-基底动脉系统TIA发作的临床表现、CTMRITCDPETDSA等检查特点和治疗。

  8. 动脉血栓性脑梗死:颈内动脉系统包括大脑中动脉的皮层支和深穿支、大脑前动脉的皮层支和深穿支梗死的临床表现、CTMRIDSATCD等改变特点。椎-基底动脉系统:椎-基底动脉血栓形成。其中应见到的病种有:基底动脉主干的梗塞:闭锁综合症;延髓背外侧综合症;大脑后动脉血栓形成;小脑梗死。小脑上动脉、小脑前下动脉和小脑后下动脉梗塞的CT特点。

  9. 脑栓塞:心源性脑栓塞临床特点和治疗原则

  10. 腔隙性脑梗塞。各型腔隙性脑梗塞的临床表现和头颅CT的变化。

  11. 脑出血:壳核出血、丘脑出血、脑干出血、小脑出血、脑室出血等临床和CT的表现及治疗。

  12. 蛛网膜下腔出血CTDSA的表现。

  13. 脑血管性痴呆的临床表现和诊断方法及治疗。

    . 脊髓病

  14. 脊髓病的临床表现、各段脊髓损害的定位诊断。

  15. 急性脊髓炎。此病应作为重点,掌握其临床表现、体征、辅助检查(包括CSF变化特点、MRI的改变)以及治疗原则,并与脊髓压迫症等相鉴别。

  16. 脊髓亚急性联合变性。应掌握其临床表现、辅助检查和治疗。

  17. 脊髓蛛网膜炎应掌握其临床表现、辅助检查和治疗。

    . 癫痫

  18. 掌握脑部不同的病变部位造成相应的临床表现和体征。

  19. 部分性发作:单纯部分性发作,应实习到单纯运动型发作;单纯感觉型发作;复杂部分性发作,应实习到颞叶单纯意识障碍性发作;情感障碍性发作;精神感觉型发作;精神运动型发作。

  20. 全身性发作:癫痫大发作,应作为重点,掌握其临床表现、脑电图改变特征;失神发作;肌阵挛性发作。

  21. 癫痫持续状态。要掌握一般处理、控制发作、维持治疗的三项处理原则。

  22. 各型癫痫的用药原则。

    . 运动紊乱疾病(锥体外系疾病)

  1. 锥体外系疾病的临床表现。静止性震颤、舞蹈样动作、肌强直、手足徐动症、抽动症、扭转痉挛、半身投掷运动。

  2. 帕金森病。临床表现即震颤、肌僵直、运动减少和姿势反射减退、药物治疗原则。了解帕金森病、特发性震颤、帕金森综合征、帕金森附加征等疾病的诊断与鉴别。

  3. Wilson病。临床表现特点、诊断和治疗。

    . 脱髓鞘疾病

  4. 多发性硬化。掌握多发性硬化视神经炎、感觉障碍、脑干功能障碍、小脑症状、自主神经异常等各种临床表现、诊断标准,尤其是辅助检查如头颅MRICT检查脑白质多灶损害的形态和部位以及诱发电位等方面的变化等。

  5. 视神经脊髓炎。应掌握临床表现、辅助检查和治疗。

    . 神经-肌肉接头病与肌病

  1. 重症肌无力

    1. 根据 Osserman分型的各型临床表现。

    2. MG的诊断标准,学习做疲劳试验和新斯的明试验。

    3. 治疗原则。

    4. 了解重症肌无力危象、胆碱能危象和反拗危象,三种危象的临床表现及抢救性治疗措施。

  2. 肌营养不良。了解其分类,以Duchine肌营养不良为例,熟悉肌营养不良的肌肉假肥大,特殊步态以及肌电图和血清肌酶的变化特点。

  3. 强直性肌营养不良症。掌握临床表现和治疗原则。

  4. 多发性肌炎。此病在皮肤科或免疫科也能见到,故把临床表现与其他肌病的鉴别作为重点。

    . 周围神经病

  5. 应掌握周围神经病共性的临床表现。

  6. 急性感染性多发性神经根神经炎。此病应为重点,其临床表现是以近端为主的四肢无力,感觉特点是主观感觉重,客观检查感觉体征轻,脑脊液检查的最佳时间是2-3周,并发呼吸衰竭时的临床表现,观察指标以及抢救原则和措施。

  7. 面神经炎。能够识别周围面瘫的临床特点,并与中枢面瘫相鉴别及治疗原则。

    . 神经系统变性病

  1. Alzhermer disease检查方法和诊断标准,与其他类型的痴呆的鉴别,以及治疗原则

  2. 运动神经元病。了解其分类,主要是肌萎缩侧索硬化的上下运动神经元同时损害的临床特点,辅助检查的变化,以及与其他类型之间的鉴别诊断。

    . 中枢神经系统感染

  3. 病毒性脑。主要是单纯疱疹性脑炎其临床特点和常见的实验室检查,并与其它病毒性脑炎如带状疱疹病毒性脑炎,肠道病毒性脑炎,呼吸道病毒性脑炎,进行性多灶性白质脑病,亚急性硬化性全脑炎相鉴别,也要与结核性脑膜脑炎,细菌性脑炎,霉菌性脑炎,AIDS等相鉴别。要掌握病毒性脑炎的治疗原则。


Neurology Practice Outline

Interns will have two-week practice for Neurology, including practical activities in the inpatient department, the outpatient departments and the emergency room. There will be a lecture and also clinical rounds for teaching, in English, once a week. Interns are requested to participate in the professional lectures and case discussions during internship. Interns will take an oral test, a written test, case analysis testing, and a test of procedural skills in the end of internship.

The training of fundamental skills must include:

  1. Medical history taking, physical examination, analysis of a neurological case, and documentation during clinical rounds. One case file written in English is required.

  2. Recognize common presenting symptoms of neurologic diseases.

  3. Perform a lumbar puncture, and understand the indications and contraindications of this procedure.

  4. Understand the usage and significance of the electroencephalogram, electromyography, evoked potentials, and transcranial Doppler.

  5. Understand the nursing care of a tracheostomy which would develop in respiratory failure caused by Guillain-Barré Syndrome or Myasthenic Crisis, as well as utilization of an artificial ventilator.

    The neurologic diseases that must be covered are:

    Cerebrovascular diseases (CVD)

  6. The classification of CVD

  7. Transient ischemic attack (TIA). The clinical findings of TIA in the internal carotid artery system and the vertebrobasilar artery system, the investigative studies of CT, MRI, TCD, PET and DSA, and the treatments of those TIA are required.

  8. Atherosclerotic thrombosis: the clinical findings and features of CT, MRI, DSA and TCD on the occlusion of the middle cerebral artery (including cortical and penetrating branches) and the anterior cerebral artery (including cortical and penetrating branches) should be understood. The interns should also be familiar with clinical findings of vertebrobasilar artery occlusion.When atherosclerotic thrombosis has developed, such diseases could be encountered, including the occlusion of the vertebrobasilar artery trunk, the locked-in syndrome, Wallenberg syndrome. Atherosclerotic thrombosis of posterior cerebral artery should be understood.Cerebeller infarction should be understood. The CT scan features of thrombosis of the superior cerebellar artery, the anterior inferior cerebellar artery, and the posterior inferior cerebellar artery should be understood.

  9. Embolism: The clinical findings and treatment principles of cardiogenic embolism should be understood.

  10. The clinical findings and changes on the CT scan for each type of lacunar infarction should be understood.

  11. Intracerebral hemorrhage: The clinical findings, CT scan presentations and treatments of hemorrhage in different locations within the putamen, lobe of the brain, brain stem, cerebellum and cerebral ventricles should be understood.

  12. The features of CT scan and DSA in subarachnoid hemorrhage should be understood.

  13. The clinical findings, diagnosis, and treatment of vascular dementia should be understood.

    Myelopathy:

    1. The clinical findings of myelopathy and location of the lesion should be understood.

    2. Acute myelitis is emphasized in our curriculum: The clinical findings, investigative studies including changes of the CSF and MRI, and the therapeutic principles, and the differential diagnosis with compressive myelopathy need to be understood.

    3. The clinical findings, investigative studies, and treatments of subacute combined degeneration should be understood.

    4. The clinical findings, investigative studies, and treatments of arachnoiditis of the spinal cord should be understood.

      Epilepsy:

      1. The clinical findings of seizures within different locations should be understood.

      2. Partial seizures including simple partial seizures and complex partial seizures should be understood. We will deal with simple partial seizures with motor or sensory findings, as well as the simple temporal lobe seizures with conscious disturbance, affective disturbances during psychomotor seizures, and psychosensory seizures.

      3. Generalized seizures: The clinical findings and the changes of the EEG of tonic – clonic seizures (Grand mal) are emphasized.

        Understand absence seizures and myoclonic seizures.

  14. Status epilepticus. The interns are requested to master the principles of general management, control of the seizures, and ongoing treatments.

  15. Principles of antiepileptic drug usage for different types of seizures.

    Movement disorders (sometimes called extrapyramidal disorders)

  1. The clinical findings of Movement disorders including static tremor, choric movement, rigidity, athetosis, torsion spasm and hemiballismus should be understood.

  2. Parkinson’s disease. The clinical findings of tremor, rigidity, hypokinesia and abnormal posture, as well as principles of drug usage for this disease, are required. Interns should understand the diagnosis and differential diagnosis of Parkinson’s disease, an idiopathic tremor, Parkinson’s syndrome and Parkinsonism.

  3. The clinical features, diagnosis and treatments of Wilson’s disease should be understood.

    Demyelinating disease

  4. Multiple sclerosis. The clinical findings and the criteria for diagnosis of optic neuritis, sensory disorders, dysfunction of the brain stem, symptoms related to the cerebellum and abnormalities of the autonomic nervous system should be understood. Especially, the investigative studies of MRI and CT which can show the shape and location of the impairment in brain white matter should be understood.

  5. The clinical findings, investigative studies, and treatments of ophthalmoneuromyelitis should be understood.

    Diseases of the neuromuscular junction and muscular diseases

  1. Myasthenia gravis:

  2. Osserman’s classification and the clinical findings of each type..

  3. The criteria for diagnosis, performance of the Jolly’s test, and neostigmine test.

  4. The principles of treatment.

  5. Understand the clinical findings, and emergency management of myasthenia crisis, cholinergic crisis, and brittle crisis.

  1. Understand the classification of muscular dystrophy, and be familiar with the features of muscular pseudo-hypertrophy, gait, alterations of the EMG and the serum CK in cases of Duchenne muscular dystrophy.

  2. The clinical findings and treatment principles of myotonic dystrophy should be understood.

    4. The clinical findings of polymyositis which can be seen in the Departments of Dermatology and Immunology, as well as the differential diagnosis with other myopathies should be understood.

    Peripheral neuropathy

  3. The common clinical findings of peripheral neuropathy

  4. Acute inflammatory polyradiculoneuropathy is emphasized in our curriculum. Patients generally present with weakness of all limbs usually more proximally than distally. The clinical findings are subjective sensory complaints, although objective sensory disturbances are usually far less than motor deficits. The CSF often shows a characteristic abnormality at 2-3 weeks after onset.

  5. Facial neuritis: recognize the clinical features of peripheral facial palsy and the differential with central facial palsy. The principles of treatment should also be understood.

    Neurological degenerative diseases

  1. The examination and criteria for diagnosis of Alzheimer’s disease, as well as the differential diagnosis with other forms of dementia, and principles of treatment should be understood.

  2. Understand the classification of motor neuron diseases. The clinical findings, investigative studies and differential diagnosis with other types, when upper and lower motor neurons impair simultaneously in amyotrophic lateral sclerosis are emphasized.

    Infections of the central nervous system

  3. Herpes simplex virus encephalitis is emphasized in viral encephalitis. The clinical findings, common investigative studies and differential diagnosis with other viral encephalitis such as herpes zoster virus encephalitis, enterovirus encephalitis, respiratory viral encephalitis, progressive multifocal leucoencephalopathy, and subacute sclerosing panencephalitis, as well as the tuberculosis related meningitis and encephalitis, bacterial encephalitis, mycotic encephalitis, and AIDS should be understood. The principles of treatment in viral encephalitis should also be understood.


  


 
 
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