診斷學總論醫(yī)學課件

ClinicalDiagnostics2021/4/261Fundamentaltheory

基礎理論/知識

Techniquesofdiagnosingdisease

診斷疾病的技術

Modeofclinicalthinking

臨床思維的方式WhatisClinicalDiagnostics?2021/4/262Instructaconciselogicalapproachtorecognizethegeniusofthediseases

教會一種簡明而又合乎邏輯的步驟去識別疾病的本質(zhì)

Afundamentalcourseofclinicalmedicine

臨床醫(yī)學的基本課程WhatisClinicalDiagnostics?2021/4/263FundamentalelementsofDiagnosticsDiagnosisIdentificationAnalysis2021/4/264Diagnosis

（診斷）DerivedfromGreekwords

distinguish

or

discern識別/鑒別認識☆2021/4/265

Englishterm

DiagnosticThedistinguishingsignandsymptomswithwhichitgerenallybegins,continuesandgoesoff…asitwere,ahistoryofthedisease對疾病特征的識別及對疾病的診斷

In18thcentury:

Nosography（病情學）

通過疾病的表現(xiàn)來識別疾病內(nèi)在本質(zhì)或屬性☆☆2021/4/266Inmodernusage:IdentificationofadiseasebyinvestigationofitssignsandsymptomsMedicalterminology:ClinicaldiagnosisLaboratorydiagnosisX-raydiagnosisElectrocardiographicdiagnosisGenediagnosis☆☆2021/4/267Identification:(識別)InquiryPhysicalexaminationLaboratorytests/SpecialexaminationAnalysis:(分析)BasicknowledgeofmedicineOverallanalysisScientificwayofclinicalthinking

2021/4/268ImportanceofDiagnosticsEssential(基礎）Bridge（橋梁）Tools（工具）BasiccoursesClinicalmedicine2021/4/269ContentofClinicalDiagnosticsSymptomaticdiagnosis(癥狀診斷)Physicaldiagnosis(檢體診斷)LaboratorytestsorclinicalancillarytestsMedicalrecordDiagnosticprocessesandthewayofclinicalthinking2021/4/26109、人的價值，在招收誘惑的一瞬間被決定。2023/2/32023/2/3Friday,February3,202310、低頭要有勇氣，抬頭要有低氣。2023/2/32023/2/32023/2/32/3/20235:00:58PM11、人總是珍惜為得到。2023/2/32023/2/32023/2/3Feb-2303-Feb-2312、人亂于心，不寬余請。2023/2/32023/2/32023/2/3Friday,February3,202313、生氣是拿別人做錯的事來懲罰自己。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、一個人炫耀什么，說明他內(nèi)心缺少什么。。二月232023/2/32023/2/32023/2/32/3/202316、業(yè)余生活要有意義，不要越軌。2023/2/32023/2/303February202317、一個人即使已登上頂峰，也仍要自強不息。2023/2/32023/2/32023/2/32023/2/3Historytaking（病史采集)---Interview(問診）Symptoms(癥狀）---patient‘scomplaints(主訴)SymptomaticDiagnosis(癥狀診斷)SymptomaticDiagnosis2021/4/2612SymptomaticDiagnosisSubjectivesensationthatpatientdescribesFeverCoughRashMassPhysiological&functional

Pathological&morphological

Symptom（癥狀）2021/4/2613PhysicalDiagnosisAbnormalityobservedbythephysicianSign（體征）

Physicalexamination（體格檢查）Inspection(望）Palpation（觸）Percussion（叩）Auscultation（聽）Conductedwiththoroughness,alertnesstodetectevenslightderivationsfromnormal2021/4/2614LaboratorytestorancillarytestsSerum,Urine,StooltestsX-rayfilmEKGEndoscopyUltrasonicimagingCTMRIPET(PositronEmissionTomography)2021/4/2615MedicalrecordMedicalrecordisasystematizedwayofstoringtherequireddata,informationandotherrelevantdocumentsSpecificrequirementintermsofformatandcontent2021/4/2616SpecialtermsinclinicaldiagnosisImpression(初步印象）Tentativediagnosis（可能性診斷）Differentialdiagnosis（鑒別診斷）Evidencebasedmedicine（循證醫(yī)學）2021/4/2617DifferentialdiagnosisPreliminarydiagnosis/Tentativediagnosis

初步診斷可能性診斷

Exclusionofotherdiseases(排除其它疾病)SelectinganumberofpossibilitiestoexplaintheclinicalandlaboratoryfindingsinthecaseinquestionThewayofexclusioniscalledDifferentialdiagnosis2021/4/2618EvidencebasedmedicineItistheconscientious（謹慎的）,explicit（明確的）andjudicious（有見解的）useofcurrent

bestevidence

inmaking

decisionsaboutthe

care

oftheindividual

patient

Itmeansintegratingindividual

clinicalexpertise

（臨床專長）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(癥狀分析)Recognitionofthesyndrome(綜合癥識別)Considerationofdiseasemechanisms(考慮疾病機制)2021/4/2623ImportantaspectsModern&advancedancillarytechniques:havetheirlimitations.Itcan’treducedtheimportanceofcertainpartsoftheclassicP.EItshouldbeavoidedtoneglectfundamentalmethodsInterrogationPhysicalexaminationScientificclinicalthinking2021/4/2624ApproachesBasicknowledgelearning（基礎知識的學習）Clinicalpractice

（臨床實踐）BedsideactivityStandardizedpatient床邊實踐標準化病人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)(體溫計)LudwigHematomanometer(1847)(血壓計)WelcherHematinometer(1854)(血細胞計數(shù)儀)20thcenturyX-rayfilmEKGEndoscopyCTPET2021/4/2633Ultrasonicimaging2021/4/2634CTimaging2021/4/2635MRI2021/4/2636PET2021/4/2637TraditionalChineseMedicineWood

FireEarthMetalWater2021/4/2638Contributionofancientdoctors---Chinese

InspectionInterrogationSmellPulsepalpation《內(nèi)經(jīng)》2021/4/2639Payattentionto:GoodmedicalethicsAttachimportancetoclinicalpracticeUnittheorywithpractice2021/4/2640GoalsInquiry:Independentsystemicinquiry