Download Internal Medicine

THE SYLLABUS OF INTERNAL MEDICINE
Applicable Students: Six-year system oversea students in the department of
clinical medicine.
Class Hours: It takes 194 hours to study this course. The study of theory consists
of 106 hours and the clinical practice take up 88 hours.
Course Introduction:
Internal medicine is an important clinical subject, which has the characteristics of
broad scope and consolidated integrity. It’s the base of all the other clinical subjects
and associated with many basic and clinical materials. Internal medicine does with
physiology and pathophysiology of every system and organ of human being, and
concerns about etiology, pathogenesis, clinical feature, diagnosis, treatment and
prevention, which has the general senses in clinical theories and practices and
therefore be the foundation of learning and mastering other clinical subjects.
In the present syllabus, materials will include: Introduction, Respiratory System,
Circulatory System, Nephrology System, Endocrine System, Digestive System,
Hematology System and Immunology System.
The Basic Objectives:
The mission of teaching internal medicine includes basic theories and knowledge
of prevalent internal diseases, training in basic skills and introduction of seldom but
classic diseases. For the terms “master”, “be familiar with” and “understand”, teachers
will give “detailed”, “general” and “key pointed” explanation. During the teaching
course, teachers will introduce some advancements of modern medicine, will
encourage students, in accordance to Practices, to learn by themselves and exchange
their opinions, will culture students to think, analyze, and solve problems
independently.
Teaching – learning methodology：The method includes lecture, ward visit,
and laboratory practice. Teachers will prepare teaching plan previously and use
multimedia teaching-tools to accentuate simplicity and improve teaching effects.
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PART ONE INTRODUCTION
[Objectives]
1. Master the definition and scope of internal medicine.
2. Master the aims and methodology of learning internal medicine.
3. Understand the advancements of internal medicine.
[Teaching Hours]
Lecture: 2 teaching hours
[Contents]
1. Understand the changes of internal medicine materials in new medical mode.
2. Understand the sense of culturing correct medical thinking mode
PART TWO RESPIRATORY SYSTEM
[Objectives]
This part can provide a solid understanding and knowledge of the structure and
function of the respiratory system, provide an understanding of the mechanisms of
common respiratory disease states and their treatment, enable students to become
aware of the public health issues e.g. cigarette smoking, environmental pollution,
primary health care, disease prevention, as they relate to the respiratory system and
foster the professional development of students to become doctors responsive to the
needs of the community as well as the individual patient.
Teaching Hours Distribution
No.
Contents
lecture
Practice
Chapter 1
Introduction of respiratory system
1
Chapter 2
Acute upper respiratory tract infection
1
1
Chapter 3
Asthma
2
1
75
Chapter 4
Chronic bronchitis and
obstructive emphysema
3
1
Chapter 5
Chronic pulmonary heart disease
2
1
Chapter 6
Pneumonia
2
1
Chapter 7
Lung abscess
2
Chapter 8
Tuberculosis
3
Chapter 9
Respiratory failure
2
1
Total
18
6
CHAPTER 1: INTRODUCTION OF RESPIRATORY
SYSTEM
[Objectives]
1. Master the structure and function of respiratory system, know status in quo of the
respiratory diseases and expect future of respiratory disease treatment
2. Enable students to be familiar with the physiology and pathophysiology of the
respiratory system in health and disease.
3. Detailed understanding of the development, structure and function of the
respiratory tract.
4. Master the knowledge of the aetiology and the pathogenesis of all acute and
chronic diseases of the respiratory system.
5. Master the knowledge of and skill in the various specialized diagnostic methods
for examination of the respiratory tract.
6. Master the knowledge of and skill in the various specialized therapeutic methods
for treating respiratory disorders.
COURSE CONTENTS
Theory
1. Structure and function of respiratory system, know status in quo of the respiratory
diseases and expect future of respiratory disease treatment.
2. The physiology and pathophysiology of the respiratory system in health and
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disease.
3. Detailed knowledge of the development, structure and function of the respiratory
tract.
4. Knowledge of the aetiology and the pathogenesis of all acute and chronic
diseases of the respiratory system.
5. Knowledge of and skill in the various specialized diagnostic methods for
examination of the respiratory tract.
6. Knowledge of and skill in the various specialized therapeutic methods for treating
respiratory disorders.
7. Knowledge of the prevalence and the epidemiology of respiratory disorders,
including the long-term prognosis of chronic diseases.
8. Knowledge of the organizational aspects of care for chronic respiratory diseases,
including rehabilitation programs, as well as relevant psychosocial aspects.
9. Various legal aspects of respiratory disease.
10. Knowledge of and practical experience in planning, conducting, evaluating and
publishing research projects.
11. The ethical aspects.
Practice
1. Clinical history, symptoms, signs, lab examinations, diagnosis, treatment and
prevention principles of common respiratory diseases
2. The trainee should master the assessment of lung function testing, including:
Airway resistance, Bronchoprovocation testing, Long-term monitoring of
breathing.
CHAPTER 2: ACUTE UPPER RESPIRATORY
TRACT INFECTION
[Objectives]
1. Master the clinical character, diagnosis and differential diagnosis of common cold,
viral pharyngitis, laryngitis, bronchitis, herpangina, pharynx-conjunctiva fever,
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bacilus pharynx-tonsillitis.
2. Understand the etiology, pathogenesis and treatment.
3. Understand the main virus and bacillus causing this disease, preventive
measurement.
COURSE CONTENTS
Theory
Definition, the etiology and pathogenesis, epidemiology: droplet infection way,
pathology, clinical presentation, laboratory examination, complication, diagnosis and
differential diagnosis, treatment, prevention.
Practice
The clinical character, diagnosis and differential diagnosis of common cold, viral
pharyngitis, laryngitis, bronchitis, herpangina, pharynx-conjunctiva fever, bacilus
pharynx-tonsillitis.
CHAPTER 3: ASTHMA
[Objectives]
1. Master the etiologic mechanism of asthma, know its pathological traits.
2. Understand the difference between endogenous and extraneous asthma.
3. Be familiar with lung function test for this disease
COURSE CONTENTS
Theory
1. Diagnosis and differential diagnosis:
2. Treatment:
3. Prevention:
Practice
Lung function test for this disease
CHAPTER 4: CHRONIC BRONCHITIS AND
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OBSTRUCTIVE EMPHYSEMA
[Objectives]
1. Master the definition of the two diseases; understand the important significance
of prevention and treatment.
2. Be familiar with the etiology, mechanism and regular rule of development.
3. Master clinical features, prevention and treatment methods of the two diseases.
4. Understand the prevention of chronic bronchitis and emphysema; understand the
significance of stop smoking
5. Understand the X-ray examination: Need something like: Perform or use to make
it clear radiographic evidence of chronic bronchitis and emphysema.
6. Understand the laboratory examination: routine test of sputum and blood, sputum
culture and drug-sensitive test
7. Understand the lung function characteristics of chronic bronchitis and
emphysema.
COURSE CONTENTS
Theory
1. Etiology and mechanism: Indicate that it is unknown completely the etiology and
mechanism of chronic bronchitis; it is probably due to interaction of multiple
factors internal or external organisms emphasize the relationship between onset
and internal as well as external factors.
2. Pathology: Primary pathologic changes of chronic bronchitis and emphysema.
Indicate intimate relationship between them.
3. Pathophysiology:
Emphasize
ventilation-perfusion
ratio
to
elucidate
mismatching
and
ventilation
dysfunction,
pulmonary
hypertension
development
4. Clinical features: Three primary symptoms: cough, sputum, dyspnea and
correlated signs
5. Complications: Cor pulmonale: acute lung infection, primary pneumothorax etc.
6. Associated examination
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7. Treatment of pneumonia
8. Staphylococcal pneumonia
(1) Elucidate clinical type, pathologic characterization, clinical features,
diagnosis point and treatment of gold staphylococcal pneumonia
(2) K lebsiella pneumonia
(3) The one is the most common disease in the gram-negative bacillus
pneumonia, pathologic characterization, clinical features, diagnosis point and
treatment
(4) Legionnaire’s pneumonia
(5) Elucidate legionnaire’s pneumonia is a systemic disease with predominant
pneumonia’s symptoms, it is caused by gram-negative bacillus legionella
pneumophila, clinical features, diagnosis point and treatment
(6) Mycoplasma pneumonia
(7) Briefly introduce pathologic characterization, diagnosis point and treatment
of Mycoplasma pneumonia
Practice
1. Clinical features
2. Three primary symptoms: Cough sputum, dyspnea and correlated signs.
3. Complications
4. Cor pulmonale: acute lung infection, primary pneumothorax etc.
5. Associated examination
CHAPTER 5: CHRONIC PULMONARY
HEART DISEASE
[Objectives]
1. Master the clinical character, diagnosis and management to heart failure of
chronic pulmonary heart disease during exacerbation and remission period, the
importance and specific measurement to prevent and cure during remission
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period.
2. Understand the episode principle of pulmonary hypertension, the principle of
acid-base imbalance and electrolyte disturbance within chronic pulmonary heart
disease.
3. Understand that it is a general disease of pulmonary dysfunction; understand the
prevention and care.
4. Master the reasons of pulmonary hypertension:
(1) Lung arteriole spasm and contraction(function factor), hypoxia and acidosis
are major factor
(2) Lung capillary bed decreased, lung arteriole sclerosis inflammation
emphraxis, pneumatocele damaged lung capillary bed (dissection factor)
(3) Blood volume increased is complementation factor
COURSE CONTENTS
Theory
1. Etiological factor
2. Incidence prognosis and pathology
3. The reasons of pulmonary hypertension
4. The resons of right ventricle hypertrophy, dilatation and failure
5. Clinical situation
6. Lung Cardiac function compensation period
7. Decompensate period of lung Cardiac function
8. Laboratory examination
9. Diagnosis and differential diagnosis
10. Therapy
11. Prevention
Practice
1. Laboratory examination
2. Blood test, X-ray, ECG, vector, ultrasonic cardiogram, function of liver and kidney,
blcod gas analysis, blood biochemical examination.
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CHAPTER 6: PNEUMONIA
[Objectives]
1. Master the etiology, pathology, clinical
presentation and diagnosis of
pneumococcus pneumonia.
2. Be familiar with the important point of staphylococcal pneumonia, klebsiellar
pneumonia, mycoplasmal pneumonia and diagnosis of legionella pneumonia
3. Master the prevention and cure of the various types of pneumonia.
COURSE CONTENTS
Theory
1. Introduction
2. Etiological factor and pathology
3. Clinical situation
4. Complication
5. Diagnosis and differential diagnosis
6. Therapy
Practice
1. Laboratory examination and X-ray manifestation:
2. Characteristics of sputum,special X-ray manifestation
CHAPTER 7: LUNG ABSCESS
[Objectives]
1. Master clinical features, diagnosis, prevention and treatment of lung abscess
2. Be familiar with the etiology, pathogenesis and mechanism.
3. Master the types of lung abscess:
(1) Aspiration lung abscess is mostly caused by Anaerobium
(2) Gold staphylococcus is the common organism of lung abscess blooded-from
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(3) Secondary lung abscess
COURSE CONTENTS
Theory
1. Introduction
(1) Lung abscess formation
(2) Etiology and mechanism
2. The onset of lung abscess has three types
(1) Aspiration lung abscess is mostly caused by Anaerobium
(2) Gold staphylococcus is the common organism of lung abscess blooded-from
(3) Secondary lung abscess
3. Pathology
4. Clinical features: Fever, character and quantity of expectoration, sign of lung
consolidation, chronic lung abscess finger (toe) clubbing
5. Laboratory examination: Character of sputum, culture of bacteria culture and
X-ray examination
6. Diagnosis: Clinical features and character of X-ray examination
7. Treatment: Antibiotics and surgery
Practice
Clinical features and character of X-ray examination
CHAPTER 8: TUBERCULOSIS
[Objectives]
1. Master the process of occurrence and development, the relation with immunity
forces and abnormality reaction, diagnosis and differential diagnosis.
2. Be familiar with the characteristics of chest X-ray of tuberculosis and with the
relation of pathology variety, the examine method of the tubercle bacillus, the
principle and method of preventing the tuberculosis, the inoculating of BCG
vaccine.
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3. Understand the tuberculin test: the dose of tuberculin, the significance of positive
and negative reaction
4. Understand phlegm tubercle bacillus examination
5. Understand chest X-ray and CT check of the disease.
COURSE CONTENTS
Theory
1. Introduction
2. Etiology and mechanism
3. Pathology
4. Clinical features: Commonly symptom (whole body, breath way) and features,
should notice parts of patients have and no the typical clinical performance
5. Laboratory examination
6. Diagnosis and differential diagnosis
7. Treatment
8. Prevention
Practice
1. Laboratory examination:
2. Tuberculin test: the dose of tuberculin, the significance of positive and negative
reaction
3. Phlegm tubercle bacillus examination
4. Chest X-ray, CT check.
CHAPTER 9: RESPIRATORY FAILURE
[Objectives]
1. Master etiology and the pathologic physiology changes.
2. Master blood gas analysis, the principle of acid-base imbalance and electrolyte
disturbance.
3. Master respiratory failure clinical presentation treatment principle.
4. Be familiar with the types of respiratory failure: I, II
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COURSE CONTENTS
Theory
1. Introduction: Definition of respiratory failure
2. Etiology and class
3. Pathophysiology
4. Clinical features: Present every systems of the body
5. Diagnosis: Blood gas analysis
6. Treatment
7. Prevention: Prevent primary disease
Practice
1. Clinical features: Present every systems of the body
2. Diagnosis: Blood gas analysis
PART THREE CIRCULATION SYSTEMIC
DISEASE
[Objectives]
This course includes cardiomyopathy, hypertension, coronary artery disease,
myocarditis, heart failure, arrhythmia, pericardial disease, endocarditis, valvular heart
disease. Through the study, the students should:
1. Master the diagnosis and medicine therapy of hypertension; diagnosis, therapeutic
principle and complication of angina pectoris and myocardial infarction; diagnosis
and medicine therapy of heart failure; electrocardiogram character and therapeutic
principle of arrhythmic emergency.
2. Understand the manifestation of cardiomyopathy, pericardial disease, valvular
heart disease, some arrhythmia, and some progresses in coronary artery disease,
arrhythmia therapy, for example interventional therapy.
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TEACHING HOURS DISTRIBUTION
No.
Contents
Theory
Practice
Chapter 1
Heart failure
2
1
Chapter 2
Arrhythmia
4
1
Chapter 3
Hypertension
2
1
Chapter 4
Coronary artery disease
5
1
Chapter 5
Valvular heart disease
3
1
Chapter 6
Pericardial disease
2
Chapter 7
Endocarditis
1
Chapter 8
Cardiomyopathy and myocarditis
2.5
Chapter 9
Common congenital heart disease
0.5
Total
22
1
6
CHAPTER 1: HEART FAILURE
[Objectives]
1. Master clinical feature, diagnosis and differential diagnosis of heart failure.
2. Master the therapeutic principle of chronic heart failure, the treatment of acute
heart failure, especially the medical treatment.
3. Understand etiology and pathophysiologic character of heart failure.
COURSE CONTENTS
Theory
1. Definition:
2. Classification: chronic and acute heart failure, left and right heart failure, left, right
and whole heart failure.
Practice
Diagnosis and treatment of chronic left heart failure
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1.1 CHRONIC HEART FAILURE
CONTENTS
1. Etiology: myocardial lesion systolic dysfunction, diastolic dysfunction, pressure
overload, filling constriction.
2. Provocation: infection, overwork, emotional excitation, severe arrhythmia, anemia,
pregnancy, and parturition, abnormal metabolism, and concomitant disease,
iatrogenic factor.
3. Pathophysiology: mechanism, neuroendocrine, remodeling.
4. Clinic manifestation:
5. Examination:
6. Diagnosis:
7. Differential diagnosis:
8. Prevention and treatment
1.2 ACUTE LEFT HEART FAILURE
CONTENTS
1. Etiology: acute myocardial infarction, hypertension emergency, acute myocarditis,
severe arrhythmia
2. Pathophysiology: left ventricular output decreases, LVEDP increases, pulmonary
capillary wedge pressure increases
3. Clinic manifestation: abrupt dyspnea, orthopnea, sweat, anxious, cough, pink
frothy sputum, high/low BP, tachycardia, gallop, pulmonary rales
4. Examination: chest X-ray, blood gas analysis, hemodynamic monitor
5. Diagnosis and differential diagnosis: bronchial asthma, pulmonary embolism
6. Therapy
CHAPTER 2: COMMON ARRHYTHMIA
87
[Objectives]
1. Master etiology, clinical character, diagnosis and treatment principle of arrhythmia,
ECG character and diagnosis.
2. Understand the treatment of pacemaker, radiofrequency catheter ablation.
3. The use of defibrillator
COURSE CONTENTS
Theory
1. Definition, etiology, mechanism, diagnosis, clinic manifestation, principle of
treatment of common and malignant arrhythmia
2. The use of defibrillator, the indication of pacemaker
3. The common arrhythmia:
(1) Sinus arrhythmia: sinus tachycardia, sinus bradycardia, sick sinus syndrome,
sinus arrhythmia
(2) Atrial arrhythmia: atrial tachycardia, atrial fibrillation, atrial flutter
(3) PSVT
(4) Ventricular
arrhythmia:
premature
ventricular
contraction,
ventricular
tachycardia, ventricular fibrillation
(5) Atrioventricular block
(6) Bundle branch block
4. Therapy:
(1) The principle of tachycardia and bradycardia arrhythmia
(2) The common antiarrhythmia drugs
(3) Nonmedical therapy: electrical defibrillator, RFCA, pacemaker, surgery, ICD
Practice
1. Sinus tachycardia
2. Sick sinus syndrome
3. Atrial flutter / fibrillation
4. Ventricular tachycardia
5. Premature atrial / ventricular contraction
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6. Atrial ventricular block
7. Coronary artery disease (angina pectoris, myocardial infarction)
8. Paroxysmal supraventricular tachycardia
CHAPTER 3: ESSENTIAL HYPERTENSION
[Objectives]
1. Master the classification, the diagnosis and therapy of the essential hypertension.
2. Master the treatment of hypertensive crisis.
3. Understand the etiology, differential diagnosis, risk classification, prognosis,
target organ damage.
COURSE CONTENTS
Theory
1. Definition
2. Epidemiology
3. Differential diagnosis: hypercortisolism, pheochromocytoma, aldosteronism,
glomerular nephritis, coarctation of aorta, renal artery stenosis
4. Classification:
5. Target organ demage
6. Tharepy
(1) Target blood pressure
(2) Nonmedical treatment: relax, avoiding excessive stress, sodium restriction,
physical training, weight reduction, quit smoking
(3) Antihypertensive medicines:
(4) treatment of hypertensive emergency
Practice
Diagnosis and treatment of essential hypertension
CHAPTER 4: ATHEROSCLEROSIS AND CORONARY
89
ARTERY DISEASE
[Objectives]
1. Master the risk factor, classification of coronary artery disease.
2. Master the classification, clinic manifestation, diagnosis, treatment of angina
pectoris.
3. Master the diagnosis, clinic manifestation, complication, treatment of myocardial
infarction.
COURSE CONTENTS
Theory
1. Pathogenic factor: atherosclerosis, coronary spasm, abnormal coronary origin,
embolism
2. Risk factor: hypertension, hyperlipemia, diabetes mellitus, cigarette, age, gender,
family history
3. Classification: angina pectoris, myocardial infarction, latent coronary artery
disease, heart failure, sudden death,arrhythmia
4. Acute coronary syndrome: STEACS, NSTEACS
5. Angina pectoris:
(1) Mechanism
(2) Clinic manifestation
(3) Classification: stable and unstable angina pectoris (initial onset angina pectoris,
accelerated angina pectoris, angina decubitus, Prinzmetal’s variant angina
pectoris, postinfarction angina pectoris)
(4) Examination: ECG, cardiac enzyme, CAG, nuclide imagine, UCG, exercise test
(5) Diagnosis
(6) Therapy: general therapy, medicine, PCI, CABG
6. Acute myocardial infarction
(1) Manifestation
(2) Examination: ECG, cardiac enzyme, CAG
(3) Diagnosis and differential diagnosis: pulmonary embolism, aortic dissection,
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cardiomyopathy, etc
(4) Complication: cardiac rupture, arrhythmia, heart failure, sudden death, chest
pain
(5) Therapy: thrombolysis, medicine (nitrate, heparin, ACEI, β blocker,
antiplatelet drugs, statin), PCI, CABG; the methods of revascularization,
indication and contraindication
(6) Treatment of complication
7. Therapeutic principle by the classification of ACS
Practice
Diagnosis and treatment of angina pectoris and acute myocardial infarction
CHAPTER 5: VALVULAR HEART DISEASES
[Objectives]
1. Master the pathophysiology, manifestation, complication of mitral stenosis, aortic
stenosis, mitral regurgitation, aortic regurgitation.
2. Understand the etiology and diagnostic methods of the valvular heart diseases.
3. Understand the therapeutic principle of valvular heart disease.
COURSE CONTENTS
Theory
1. The epidemiology of valvular heart disease
2. Common valvular heart disease
(1) Mitral stenosis:
(2) Mitral regurgitation:
(3) Aortic stenosis
(4) Aortic regurgitation:
3. Main complication:
(1) Congestive heart failure
(2) Infective endocarditis
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(3) Arrhythmia
(4) Embolism
4. Therapy
(1) Medical
(2) Surgery
5. Multivalvular heart disease
CHAPTER 6: PERICARDIAL DISEASE
[Objectives]
1. Master the clinical manifestation, diagnosis and the principle of management of
the acute pericarditis.
2. Understand the etiology and pathology of pericarditis.
COURSE CONTENTS
Theory
1. Etiology: bacterial infection, fungal infection, viral infection, parasite infection,
noninfective, rheumatic, uremia, neoplastic, autoimmune disorders, trauma and
chemic causes, idiopathic.
2. Acute pericarditis: manifestation, chest pain, pericardial friction rubs and sound,
ECG
3. Pericardial effusion: chest pain, cough, nausea; cardiac dullness border enlarge,
cardiac impulse decrease and cardiac sound lessens, Kussmaul sign, dilation of
liver, ascites, edema
4. Pericardial tamponade:
(1) Etiology: acute pericarditis, acute myocardial infarction, ventricular wall
rupture, trauma, rupture of aortic sinus aneurysm, aortic dissection
(2) Manifestation: chest pain, low blood pressure, shock, tachycardia, dyspnea,
cough, nausea
(3) Therapy: pericardiocentesis, management of protopathy
5. Constrictive pericarditis:
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(1) Etiology
(2) Manifestation: dyspnea, cough, anorexy, fatigue, pericardial knock, dilation of
jugular veins, Kussmaul sign, paradoxical pulse, dilation and tenderness of
liver
(3) Diagnosis and differential diagnosis: portal cirrhosis, cardiac cirrhosis, right
heart failure constrictive cardiomyopathy
CHAPTER 7: INFECTIVE ENDOCARDITIS
[Objectives]
1. Master the pathogen, manifestation and therapeutic principle of endocarditis
2. Understand the pathophysiology, laboratory examination of endocarditis
COURSE CONTENTS
Theory
1. Definition and classification
2. Etiology, pathogen, and pathophysiology: common bacteria, structure features of
vegetations , embolism and abscess caused by falling off of the vegetations
3. Manifestation: infective symptom, new cardiac murmur, embolism, Osler node,
petechia
4. Laboratory examination: hemoculture, UCG, blood and urine routine
5. Diagnosis and differential diagnosis
6. Treatment: choice of antibiotics and surgical operation indication
CHAPTER 8: CARDIOMYOPATHY AND
MYOCARDITIS
[Objectives]
1. Master the clinical manifestation, diagnosis and treatment principle of idiopathic
cardiomyopathy and myocarditis.
2. Master the classification of cardiomyopathy and myocarditis.
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3. Understand the pathology of cardiomyopathy.
COURSE CONTENTS
Theory
1. Definition and clinical classification of idiopathic cardiomyopathy
2. Dilated cardiomyopathy
3. Hypertrophic cardiomyopathy
4. Myocarditis
Practice
Diagnosis and treatment of dilated cardiomyopathy
CHAPTER 9: COMMON CONGENITAL HEART
DISEASE
[Objectives]
1. Understand the classification, clinical manifestation and treatment of congenital
heart disease.
2. Understand the prognosis of congenital heart disease.
COURSE CONTENTS
The classification, manifestation, and therapeutic principle of congenital heart disease
PART FOUR GASTROENTEROLOGY
[Objectives]
The main characteristic of the gastrointestinal tract is to form the ability of binding the
medical theory with the Practice and compound comprehension of the students. The
course content includes the etiology, pathogenesis, diagnostic, therapy, prognosis and
the novel development of the common disease and the frequent disease of the
gastrointestinal tract. Such as peptic ulcer, inflammatory bowel disease, irritable
bowel syndrome, cirrhosis, liver cancer and hepatic encephalopathy, etc.
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TEACHING HOURS DISTRIBUTION
No.
Contents
Theory
Practice
1
Introduction
1
2
Gastritis
2
0.5
3
Peptic ulcer
2
1
4
Functional Gastrointestinal Disease
2
0.5
5
Intestinal Tuberculosis
Peritonitis
2
0.5
6
Cirrhosis of the Liver
3
1
7
Hepatic Encephalopathy
2
0.5
8
Primary Carcinoma of the Liver
1
0.5
9
Ulcerative Colitis
2
1
10
Crohn’s disease
2
0.5
Total
18
6
and
Tuberculous
Chapter 1: INTRODUCTION
[Objectives]
1. Grasp the diagnosis principle and treatment for gastroenterology diseases.
2. To be familiar with the field of clinical gastroenterology, relation to other clinical
departments and clinical importance of gastroenterology diseases.
3. Understand the development and direction of gastroenterology in the world.
COURSE CONTENTS
1. The physiology and pathophysiology of gastroenterology.
2. The etiology and pathology of gastroenterology diseases.
3. The diagnostics and differential diagnostics of gastroenterology diseases.
4. The prevention and cure principle of gastroenterology diseases.
CHAPTER 2: GASTRITIS
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[Objectives]
1. Grasp the clinical symptoms, diagnosis and treatment.
2. Be familiar with the classification of chronic gastritis and the etiology, clinical
symptoms, diagnosis, treatment of acute gastritis.
3. Understand the mechanism, pathology and prognosis.
2.1 ACUTE GASTRITIS
COURSE CONTENTS
1. Introduction: The most common type is acute simple gastritis, which is often
companied with acute gastroenteritis or general infection.
2. Etiological factors and mechanisms: Chemical and physical factors, microbial
infection, or bacterial toxin. The pathologic change of gastric mucosa is mainly
hyperemia, edema, exudation, mild erosion spot hemorrhage, leucocyte infiltrating
in the mucosa.
3. Clinical symptoms: General symptoms and ones in the digestive tract. Enteritis
can be seen when the causes are bacteria infection or their toxin. The course is
self-limited and can disappear in days.
4. Diagnosis: The course, the symptoms and the signs
5. Differentiation
2.2 CHRONIC GASTRITIS
COURSE CONTENTS
1. Introduction: Definition, incidence rate and type
2. Etiological factors and mechanisms: Possible factors: The continue from acute
gastritis; Duodenogastric reflux; Immune factors; Infective factors (such as H.
pylori)
3. Pathology: The features of chronic erosive inflammation and chronic atrophic
gastritis
4. Clinical symptoms: Many cases have no typical symptoms or signs, and part of
the patients no symptoms. Corpus gastritis has different manifestation and
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pathophysiological processes from antrum gastritis, the latter are more often than
the former.
5. Lab findings
(1) Analysis of gastric juice: pentagastrin stimulating test
(2) Serum assay: Gastrin in chronic atrophic corpus gastritis is often increased
moderately, while gastric acid, pepsinogen, and intrinsic factor excretion
decreased. Serum PCA often positive (>75%); In contrast, gastrin in antrum
gastritis is decreased.
(3) Digestive tract X-ray findings of Barium: That of antrum gastritis may be
similar with gastric cancer.
(4) Endoscope and biopsy
6. Diagnosis: Mainly depending on endoscope and biopsy, while the course,
symptoms and X-ray findings no specificity.
7. Prevention and treatment
(1) Eliminate the etiological factors
(2) Drugs
(3) Operation
CHAPTER 3: PEPTIC ULCER
[Objectives]
1. Grasp the clinical situation, diagnosis and treatment.
2. Be familiar with the methods of eradicate H. pylori and the preventive principle of
ulcer recurrence.
3. Understand the etiological factor and episodic mechanism of the disease.
COURSE CONTENTS
1. Introduction: Definition, incidence of disease and epidemiology
2. Etiological factor and episodic mechanism
(1) The increasing of invasive factor
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(2) The decreasing of mucosal defense factor
(3) Other factors
3. Pathology: Common locus; quantity and size; pathological anatomy and
development of ulcer
4. Clinical situation
5. Complications: Massive hemorrhage, Penetration, Pyloric obstruction, canceration,
mainly massive hemorrhage
6. Lab exam
7. Diagnosis
8. Differential diagnosis
(1) Functional dyspepsia
(2) Chronic gastritis and duodenal bulb inflammation
(3) Gastrinoma
(4) Carcinomatous ulcer
(5) Ancylostomiasis
(6) Gastric mucosal prolapse syndrome
9. Treatment
CHAPTER4: FUNCTIONAL GASTROINTESTINAL
DISEASE
[Objectives]
1. Grasp the clinical situation and diagnosis of FD and IBS.
2. Be familiar with the treatment principle of FD and IBS.
3. Understand the etiological factor of the disease.
COURSE CONTENTS
1. Introduction: Definition, classification and epidemiology
2. Etiology and Mechanism: The exact cause of FGD is unknown.
3. Clinical features
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4. Diagnosis procedure and ROME-III
5. Treatment principle
CHAPTER 5: INTESTINAL TUBERCULOSIS AND
TUBERCULOUS PERITONITIS
[Objectives]
1. Grasp the clinical features and diagnosis.
2. Be familiar with the mechanism.
3. Understand the complications and treatment.
5.1 INTESTINAL TUBERCULOSIS
COURSE CONTENTS
Theory
1. Etiology and Mechanism
2. Pathology
3. Clinical features
4. Complications: Tuberculous Peritonitis, obstruction, hemorrhage, perforation
5. Assistant Examination
6. Diagnosis and Differential diagnosis
(1) Diagnosis: age, clinical features, extraintestinal tuberculosis.
(2) Differential diagnosis: Crohn’s disease, carcinoma, lymphoma, amoebiasis.
7. Treatment
5.2 TUBERCULOUS PERITONITIS
COURSE CONTENTS
Theory
1. Etiology and Mechanism
99
2. Pathology
3. Clinical features
4. Assistant Examination
5. Diagnosis and Differential diagnosis
(1) Diagnosis: age, clinical features, extraintestinal tuberculosis, diagnostic
treatment
(2) Differential diagnosis: mass, fever, ascites, abdominal pain
6. Treatment
CHAPTER 6: CIRRHOSIS OF LIVER
[Objectives]
1. Grasp the etiology, clinical features and diagnosis.
2. Be familiar with the differential diagnosis and complications.
3. Understand the mechanism and the principle of therapy.
COURSE CONTENTS
1. Introduction: Definition, classification and epidemiology
2. Etiology and Mechanism
3. Pathology
4. Clinical features
5. Complications
6. Assistant Examination
7. Diagnosis: Diagnosis is difficult in compensation period, and mainly depends on
the causes, the history, liver function, hypertention of portal vein, exams,
esophagus X-ray findings of barium meal and BUS, sometimes hepatic
penetration and biopsy, laparoscope is necessary.
8. Differential diagnosis
(1) Hepatomegaly: chronic hepatitis, hepatocarcinoma
(2) Ascites: tuberculous peritonitis (exudation type), Carcinomatous exudation,
constrictive pericarditis, massive ovarian cyst;
100
(3) Upper digestive tract hemorrhage: peptic ulcer
(4) Hepatic coma: hypoglycemic coma, uremia,and other toxic coma etc.
(5) Different types of Cirrhosis of Liver. primary biliary cirrhosis
9. Treatment
CHAPTER 7: HEPATIC ENCEPHOLOPATHY
[Objectives]
1. Grasp clinical features, stage, diagnosis and differential diagnosis.
2. Be familiar with etiology, pathogenesis, prevention and therapy.
3. Understand the mechanism of Hepatic Encepholopathy.
COURSE CONTENTS
1. Introduction
2. Etiology and Pathogenesis
3. Pathology: Explain briefly the changes of brain tissue under microscopy.
4. Clinical Features
5. Diagnosis and Differential Diagnosis
(1) Basis of diagnosis
(2) Necessary examinations must be taken on patients with liver diseases who
have mental symptom in order to rule out HE.
(3) Differentiate other kinds of coma such as infection of CNS, stroke, uremia,
diabetic coma, hypoglycemia, hypnotic poisoning and brain-spinal tumor, etc.
6. Treatment
(1) Get rid of the causes
(2) Eliminate production and absorbance of toxicant in intestinal tract.
(3) Remove the toxicant
(4) Correct hydro-electrolytes and acid-base disorder especially hypokalemia.
(5) Others: Good nursing and symptomatic treatment are very important.
7. Prevention
101
CHAPTER 8: PRIMARY CARCINOMA OF LIVER
[Objectives]
1. Grasp the clinical features and the points of diagnosis .
2. Be familiar with the differentiation and therapy.
3. Understand the pathology and metastasis.
COURSE CONTENTS
1. Introduction
2. Etiology and Pathogenesis: No definite pathogeny, perhaps relate to hepatic virus,
Aflatoxin B1 and the other chemical carcinogenic substances.
3. Pathology
4. Clinical Features
5. Complication: Hepatic encephalopathy, upper gastrointestinal hemorrhage ,
rupture of carcerous nodules and secondary infection.
6. Assistant Examination
7. Diagnosis: According to clinical features and assistant examination, we must pay
great attention to early diagnosis and general investigation of liver carcinoma.
8. Differential diagnosis: Differentiate among liver abcess and liver cirrosis, etc
cautiously, and to eclucide the main points.
9. Treatment
CHAPTER 9: ULCERATIVE COLITIS
[Objectives]
1. Grasp the clinical symptoms, diagnosis and therapy of ulcerative colitis.
2. Be familiar with the relative etiological factors and mechanisms.
3. Understand the relative diagnosis and differentiation.
COURSE CONTENTS
102
1. Introduction
2. Etiological factors and mechanisms
3. Pathology
4. Clinical symtoms
(1) Intestinal symptoms: diarrhea; abdominal pain; Signs of abdomen
(2) General symptoms: fever; thinness; anemia
(3) Symptoms out of intestine: eyes; arthron; jaundice
(4) Types: mild type; heavy type; fulminant type
(5) Complication: Toxic megacolon; colorectal carcinomatous change; colorectal
massive hemorrhage; acute penetration and obstruction
5. Lab findings
6. Diagnosis and differentiation
(1) Diagnosis
(2) Differentiation: Chronic bacillary dysentery; amebic dysentery; Crohn’s
disease; colonic cancer; radiation colitis; intestinal tuberculosis; hemic
distomiasis; Ischemic colitis; IBS
7. Treatment
CHAPTER 10: CROHN’S DISEASE
[Objectives]
1. Grasp the clinical symptoms and diagnosis of Crohn’s Disease.
2. Be familiar with the differentiation.
3. Understand the therapy.
COURSE CONTENTS
Theory
1. Etiological factors and mechanisms
2. Pathology
3. Clinical symptoms
(1) Intestinal symptoms: diarrhea; abdominal pain; fistula cannulas; signs of
103
abdomen
(2) Lesion around rectum and anus
(3) General symptoms
(4) Symptoms out of intestine: eyes; arthron; sclerosing cholangitis; sclerosing
cholangitis; splenomegalia
4. Complication: Intestinal obstruction; abdominal abscess; malabsorption syndrome;
occational acute penetration or massive hemorrhage
5. Lab findings
6. Diagnosis and differentiation
(1) Diagnosis: Standard of WHO
(2) Differentiation: Intestinal tuberculosis; Ulcerative colitis; Acute appendicitis;
Acute hemorrhagic cholecystitis; Cecal cancer; Hemic distomiasis; Chronic
bacillary dysentery; Amebic dysentery and other infective Enteritis.
7. Treatment
PART FIVE NEPHROLOGY
[Objectives]
Nephrology is part of internal medicine and clinical basic course. Because of the close
correlation between the nephrology and other internal medicine, the students should
not only grasp the basic theory prior to learn the general etiology and pathogenesis
about urologic system, but also they should know the presentation, the laboratory
findings, diagnosis and differentiation and treatment in order to be intern.
The course mainly consist of the diagnosis and therapy of the common diseases,
including primary glomerular diseases, secondary glomerular diseases, urinary tract
infection(UTI), cute renal failure(ARF), chronic renal failure and dialysis therapy.
TEACHING HOURS DISTRIBUTION
No.
Chapter 1
Contents
General Introduction
Theory
0.5
104
Practice
Chapter 2
Primary Glomerular Disease
4.5
2
Chapter 3
Secondary Glomerular Disease
1
1
Chapter 4
Acute Interstitial Nephritis
Chapter 5
Urinary Tract Infection
1
1
Chapter 6
Acute Renal Failure
2
1
Chapter 7
Chronic Renal Failure
2.5
1
Total
12
6
0.5
CHAPTER 1: GENERAL INTRODUCTION
[Objectives]
1. Master the main structure and function of kidney, be familiar with the common
symptoms and pathogenesis of the renal diseases.
2. Master the clinical classifications, diagnosis methods and demands, and principle
of prevention and treatment.
3. Understand the latest progress development of the subject.
COURSE CONTENTS
Theory
1. General conditions
2. The main construction and function of kidney
(1) Anatomy
(2) Subtle structure of the kidney
(3) Physical functions of the kidney
(4) Special structure and endocrine function of the kidney
3. Common clinical manifestations of urinary diseases: Edema, hypertension, pain of
renal region, abnormal urination
4. Diagnosis of urinary system diseases
(1) Requests of diagnosis: etiology, position, pathology, and function.
(2) Methods: including special examinations, image examination and kidney
105
biopsy.
5. Principle of prevention and treatment: general treatment, medicine therapy, kidney
replacement therapy.
6. Extended content: progress of the subject (Domestic and foreign).
CHAPTER 2: PRIMARY GLOMERULAR DISEASE
[Objectives]
1. Master the principles of clinical and pathologic classification and the pathogenesis,
clinical manifestations of the primary glomerular disease.
2. Master the manifestations of the nephrotic syndrome, the traits of different
pathologies, be familiar with the pathophysiology and complication of the
nephritic syndrome, and know the relation of the pathology and treatment effect.
3. Master the treatment principle of Chronic Glomerulonephritis and nephrotic
syndrome; be familiar with the principium, indication, administration method,
points for attention of the corticoid, immune suppressive drug, etc.
4. Master the diagnosis of the Rapidly Progressive Glomerulonephritis, IgA
nephropathy, be familiar with the differentiation and treatment principle of the
Rapidly Progressive Glomerulonephritis.
5. Be familiar with the clinical manifestations of the post-streptococcal
glomerulonephritis
(PSGN),
chronic
glomerulonephritis,
latent
glomerulonephritis.
COURSE CONTENTS
Theory
1. General conditions: Understand the definition and classification of the primary
glomerular disease.
2. Nephrotic syndrome
(1) Definition
(2) Etiology and pathogenesis
(3) Pathology: teach the common pathologic types, emphasis is the minimal
106
change nephropathy
(4) Clinical manifestations (Heavy proteinuria, hypoalbuminemia, high edema,
hyperlipidemia) and complications (infection, thrombosis, acute renal failure
etc)
(5) Diagnosis and Differentiation: Primary and secondary: Systemic Lupus
Erythematosus, Diabetic Nephropathy, Hepatitis B virus associated Nephritis,
Anaphylactoid Purpura, Multiple myeloma, and amyloidosis.
(6) Treatment: General treatment, traditional Chinese herbal medicines, Treatment
of complications. Focal point is to introduce how to use the drugs
(corticosteroid and cytotoxic drug)
(7) Prognosis Prognosis
3. Glomerulonephritis
(1) General conditions: Introduce the conception of the “serious diseases” of the
nephritis
(2) Etiology and pathogenesis: Identify the immune reaction of the body to
disease; be familiar with the immune reaction in disease, non-immune and
non-inflammation lesion, local factors reaction of kidney
(3) The emphasis is the definition, classification, the pathological manifestations,
diagnosis
and
treatment
principle
of
the
rapidly
progressive
glomerulonephritis
(4) Pathological and clinical manifestation, diagnosis, differentiation and
treatment principle of IgA Nephropathy
(5) Definition, clinical manifestation, diagnosis, differentiation and treatment
principle of the latent and the chronic glomerulonephritis
(6) The acute glomerulonephritis: Make the general lecture
(7) Prognosis and prevention of the glomerulonephritis: The prognosis is
changeable; emphasize the importance of the prevention of the etiology and
inducement
Practice
1. Show the typical cases of the PSGN, RPGN, chronic glomerulonephritis, IgA
107
nephropathy, identify the differentiation.
2. Show the different cases of the primary nephritic syndrome with different
pathologic types.
CHAPER3: SECONDARY GLOMERULAR DISEASE
[Objectives]
1. Master the etiology of the secondary glomerular disease according to the
pathogenesis.
2. Master the pathogenesis, clinical manifestations, is familiar with the pathologic
manifestations, and treatment principle of the diabetic nephropathy.
3. Master the clinical manifestation, diagnosis standard, is familiar with the
pathologic manifestations, and treatment principle of the lupus nephritis.
COURSE CONTENTS
Theory
1. Introduce the common cause of disease of the secondary glomerular disease.
2. Pathogenesis, pathologic manifestations, clinical manifestations stages, diagnosis
and differentiation, treatment principle of the diabetic nephropathy.
3. Clinical manifestation, pathologic traits and classifications, diagnosis standard and
treatment principle of the lupus nephritis.
Practice
Show the typical cases of the secondary glomerular diseases such as diabetic
nephropathy, lupus nephritis.
CHAPTER 4: ACUTE INTERSTITIAL NEPHRITIS
[Objectives]
1. Master the clinical manifestations, diagnosis, differentiation of acute interstitial
nephritis.
2. Be familiar with the impotence of the acute interstitial nephritis in clinic.
108
3. Be familiar with the etiologic classification and the brief pathogenesis.
4. Be familiar with the prevention principle.
CONTENTS
1. General conditions: definition, emphasize the importance.
2. Etiology
and
pathogenesis:
Drug
allergy,
infection,
immune-induced,
accompanied by systemic disease, exclusive reaction of renal transplantation, HIV
infection and atopy.
3. Pathology: Introduce the pathologic manifestations of acute and chronic
interstitial nephritis, emphasize the pathology is the key point of the diagnosis.
4. Clinical manifestation and diagnosis:
5. Differentiation:
6. Treatment:
7. Prognosis and prevention:
CHAPTER 5: INFECTION OF URINARY TRACT
[Objectives]
1. Master the typical clinical manifestations, complication and the main laboratory
diagnostic methods of the acute and chronic pyelonephritis.
2. Master diagnosis evidence, differentiation and treatment principle of the acute and
chronic pyelonephritis.
3. Be familiar with the etiology, infection approach, sensitive factors, difference
between relapse and reinfection of the pyelonephritis.
4. Understand the definition and content of the urinary tract infection.
COURSE CONTENTS
Theory
1. Definition: Identify the direct infection of the bacteria, the definition of the upper
and lower urinary tract infections
2. Etiology and Pathogenesis: Causative bacterium, infection approach, sensitive
109
factors
3. Pathology: Purulent inflammation
4. Clinical Manifestation: Different manifestations with different infective position
and duration.
5. Complications
6. Laboratory examinations: Urinary routine, urinary bacterial examination, urinary
cellular counts, renal function, intravenous pyelography, et al.
7. Diagnosis and Differentiation
8. Treatment: Antibacterial treatment in acute period is most important, emphasize
thorough treatment. Improvement of the general state is also important except
antibacterial treatment in chronic period.
9. Prognosis and prevention: Good prognosis with thorough treatment in acute
period, the measurement to remove the inducement and prevent acute or chronic
infection and its importance
Practice
Show typical cases of acute and chronic pyelonephritis: Understand the differentiation
of the upper and lower urinary tract infection further.
CHAPTER 6: ACUTE RENAL FAILURE
[Objectives]
1. Master the clinical manifestation of the acute tubular necrosis, and know the
mechanism of the oliguria.
2. Master the diagnostic basis, differentiation, prevention principle of the acute
tubular necrosis, is familiar with the main treatment methods.
3. Be familiar with the acute renal failure: the common etiology and classification of
the prerenal azotemia, postrenal azotemia and intrinsic renal failure. Understand
the conception and the pathogenesis of the acute tubular necrosis.
4. Understand the important position of the acute renal failure in clinic.
5. Understand the replacement technology of acute renal failure.
110
COURSE CONTENTS
Theory
1. General: The definition of the acute renal failure and the importance in clinic.
2. Etiology and Classification: Briefly introduce the common etiology and
classification of acute renal failure; identify the definition and pathogenesis of
acute tubular necrosis (renal intoxication and hypoxia).
3. Pathology: Briefly introduce the pathologic manifestation of acute tubular
necrosis.
4. Pathogenesis: Emphasize the pathogenesis of acute tubular necrosis—vessel
relaxation and contraction obstacle, glomerular filtration rate decrease, tubular
fluid reflux and tubular block, etc.
5. Manifestation: The beginning and duration of ATN, the trait of the oliguria and
polyuria, complications (emphasis is Hyperkalemia) and chemical test.
6. Diagnosis and Differentiation:
7. Prevention: Emphasize the prevention principle; rectify reversible factors,
treatment of fluid and electrolyte disorders and acid-base disorders (emphasis is
Hyperkalemia), dietary treatment and controlling infection. Know the sign of
emergent dialysis and various new technology of replacement therapy.
Practice
Show typical cases by different causes, emphasize the differentiation further.
CHAPTER 7: CHRONIC RENAL FAILURE
[Objectives]
1. Master the clinical manifestation, diagnostic basis, main differentiation of uremia.
2. Be familiar with the common etiology and pathogenesis of chronic renal failure,
the stage of the chronic renal failure.
3. Be familiar with the non-dialysis treatment about the principle and measurement.
Be familiar with the principle of renal transplantation and various kinds of
dialysis.
111
4. Understand the importance of the prevention of renal failure; avoid the primary
disease and the inducement actively.
COURSE CONTENTS
Theory
1. General: The definition of chronic renal failure, common etiology and incidence.
2. Pathogenesis: Mainly introduce the degeneration of renal failure and the theories
of the “survival nephron”, the “trade-off hypothesis” and the “high pressure, high
perfusion, high filtration”.
3. Clinical manifestation
4. Diagnosis and Differentiation
5. Treatment
Practice
Show chronic renal failure cases by different causes; emphasize the differentiation of
the acute and chronic renal failure.
PART SIX HEMATOLOGY
[Objectives]
Hematology is important part of internal medicine. At the end of the course the
student should be able to master the presentation, the laboratory findings, diagnosis,
differentiation and treatment about common hematological diseases and know the
latest progress developments and trends of hematology.
TEACHING HOURS DISTRIBUTION
Chapter
Chapter 1
Contents
General introduction
112
Lecture
Practice
1
0
Chapter 2
Anemia: General Aspects
1
0
Chapter 3
Iron Deficiency Anemia
1
0.5
Chapter 4
Megaloblastic Anemia
0
0.5
Chapter 5
Aplastic Anemia
2
0.5
Chapter 6
Hemolytic Anemia
2
0.5
Chapter 7
Myelodysplastic Syndromes
2
1
Chapter 8
Leukemia
4
1
Chapter 9
Lymphoma
2
1
Chapter 10
Plasma Cell Dyscrasia
1
0.5
Chapter 11
Hemorrhagic Disease
1
0
Chapter 12
Idiopathic Thrombocytopenic Purpura
1
0.5
Total
18
6
CHAPTER 1: GENERAL INTRODUCTION
[Objectives]
1. Master the diagnostic method of hematological diseases.
2. Be familiar with the therapeutic principle of hematological diseases.
3. Understand the generation of blood cell and the clinical classifications of
hematological diseases.
4. The diagnostic method and procedure of hematological diseases..
COURSE CONTENTS
Theory
1. General Aspects
(1) Genesis, differentiation, maturity and release of blood cell and hematopoietic
system.
(2) The clinical classifications of hematological diseases: the white blood cell
diseases, the red blood cell diseases, hemorrhagic diseases and so on.
2. The diagnostic method of hematological diseases:
113
(1) (1).History
(2) (2).Physical Examination
(3) (3).The laboratory findings
3. Therapeutic principle of hematological diseases
(1) Anemia:
(2) (2).Leukemia and Lymphoma:
(3) Hemorrhagic diseases
CHAPTER 2: ANEMIA: GENERAL ASPECTS
[Objectives]
1. Master the definition of anemia and the important significance of etiological
diagnosis.
2. Be familiar with pathogenesis, classification and therapeutic principle of anemia.
3. Understand the clinical features of anemia.
4. The diagnostic method and procedure of anemia
COURSE CONTENTS
Theory
1. General Aspects: normal value and definition
2. Classification:
3. Clinical features
4. Diagnosis
(1) Diagnostic procedure
(2) Diagnostic method
5. Therapeutic principles
(1) Etiological treatment
(2) Symptomatic treatment
CHAPTER 3: IRON DEFICIENCY ANEMIA（IDA）
114
[Objectives]
1. Master the diagnostic method and therapeutic principle of IDA
2. To be familiar with ferric metabolism and pathogenesis, clinical features and the
laboratory findings of IDA.
3. Understand incidence and precaution.
4. The morphological character of IDA
COURSE CONTENTS
Theory
1. General Aspects: definition of IDA and morphological character of RBC.
2. Ferric metabolisms:
3. Etiology and pathogenesis
4. Clinical features
5. The laboratory findings
6. Diagnosis and differential diagnosis
7. Treatments
8. Precaution
9. Prognosis
Practice
1. Show the typical cases of IDA
2. Know the morphological character of IDA by microscope
CHAPTER 4: MEGALOBLASTIC ANEMIA
[Objectives]
1. The definition of Megaloblastic Anemia.
2. Etiology and pathogenesis
3. Clinical features, diagnosis and treatment
COURSE CONTENTS
Practice
115
1. Show the typical cases of Megaloblastic Anemia.
2. Know the morphological character of Megaloblastic Anemia by microscope
CHAPTER 5: APLASTIC ANEMIA
[Objectives]
1. Master the clinical features, diagnosis and differential diagnosis of Aplastic
Anemia
2. Get familiar with etiology, pathogenesis and precaution of Aplastic Anemia.
3. Understand incidence, pathological change and prognosis.
4. The morphological character of Aplastic Anemia
COURSE CONTENTS
Theory
1. General Aspects: definition and character of Aplastic Anemia
2. Etiology: primary and secondary
3. Pathogenesis
4. Pathology：pathological change of spleen and bone marrow
5. Clinical Features: clinical character；difference between acute AA and chronic AA
6. Laboratory finding
7. Diagnosis and differential diagnosis
8. Therapeutic principle
9. Precaution
10. Prognosis
Practice
1. Show the typical cases of Aplastic Anemia
2. Know the morphological character of Aplastic Anemia by microscope
CHAPTER 6: HEMOLYTIC ANEMIA
[Objectives]
116
1. Master definition, clinical features and laboratory finding of Hemolytic Anemia
2. Master classification, clinical features, laboratory finding, diagnosis and treatment
of auto immune hemolytic anemia.
3. Get familiar with classification and diagnostic procedure
4. Understand pathogenesis of Hemolytic Anemia
5. The morphological character of Hemolytic Anemia a
COURSE CONTENTS
Theory
1. General Aspects: definition
2. Classification
3. Pathogenesis
4. Clinical Features：clinical character；difference between acute type and chronic
type
5. Laboratory finding
6. Diagnosis
7. Differential diagnosis
8. Treatment
9. Classification, Clinical Features, Laboratory findings, Diagnosis and Treatment of
auto immune hemolytic anemia.
Practice
1. Show the typical cases of auto immune hemolytic anemia.
2. Know the morphological character of auto immune hemolytic anemia by
microscope
CHAPTER 7: MYELODYSPLASTIC SYNDROMES
(MDS)
[Objectives]
1. Master clinical features, laboratory finding and diagnostic standard of MDS
117
2. Get familiar with FAB classification, differential diagnosis and treatment of MDS
3. Understand WHO’s classification, etiology, pathogenesis and prognosis of MDS
4. The morphological character of MDS
COURSE CONTENTS
Theory
1. General Aspects: definition
2. Etiology and Pathogenesis
3. Clinical Features: clinical character
4. Laboratory finding
5. Diagnosis and Differential diagnosis
6. Treatment
7. FAB and WHO’s Classification,
Practice
1. Show the typical cases of MDS
2. Know the morphological character of MDS by microscope
CHAPTER 8: LEUKEMIA
[Objectives]
1. Master etiology, classification, clinical features, laboratory finding and diagnostic
standard of leukemia
2. Get familiar with therapeutic principle of leukemia
3. The morphological character of leukemia
8.1 INTRODUCTION
COURSE CONTENTS
Theory
1. Definition
2. Classification
3. Epidemiology
118
4. Etiology and Pathogenesis
8.2 ACUTE LEUKEMIA
COURSE CONTENTS
Theory
1. Classification: FAB classification, MIC type
2. Clinical Features
3. Laboratory findings
4. Diagnosis
5. Differential diagnosis
6. Treatment
7. Prognosis
8.3 CHRONIC MYELOGENOUS LEUKEMIA
COURSE CONTENTS
Theory
1. Clinical Features
2. Laboratory findings
3. Diagnosis
4. Differential diagnosis
5. Course Stage
6. Treatment
8.4 CHRONIC LYMPHOCYTIC LEUKEMIA
COURSE CONTENTS
Theory
1. Clinical Features
2. Laboratory findings
3. Diagnosis
4. Treatment
5. Course and Prognosis
119
Practice
1 Show the typical cases of leukemia
2 Know the morphological character of leukemia by microscope
CHAPTER 9: LYMPHOMA
[Objectives]
1. Master classification, clinical features, stage and diagnostic standard of lymphoma
2. Get familiar with diagnostic method, differential diagnosis, therapeutic principle
and IPI of lymphoma
3. Correct position of lymph node
COURSE CONTENTS
Theory
1. General Aspects: definition and epidemiology
2. Etiology and Pathogenesis
3. Pathology and Classification
4. Clinical Features: clinical character
5. Laboratory finding
6. Diagnosis and Differential diagnosis
7. Treatment
8. Prognosis
Practice
1. Show the typical cases of lymphoma
2. Know correct position of lymph node
CHAPTER 10: PLASMA CELL DYSCRASIA
[Objectives]
1. Master definition, clinical features, laboratory findings and special test of Multiply
Myeloma. (MM)
120
2. Get familiar with classification, diagnosis and treatment of Multiply Myeloma
3. The morphological character of MM
COURSE CONTENTS
Theory
1. General Aspects: definition and epidemiology
2. Etiology and Pathogenesis
3. Clinical Features: clinical character
4. Laboratory finding
5. Diagnosis and Differential diagnosis
6. Treatment
7. Prognosis
Practice
1. Show the typical cases of lymphoma
2. Know the morphological character of MM by microscope
Chapter 11: Hemorrhagic Disease
[Objectives]
1. Master definition, hemorrhagic character and classification of hemorrhagic
disease
2. Get familiar with normal hemostasis and clotting mechanism
3. The diagnostic procedure and therapeutic principle of hemorrhagic disease
COURSE CONTENTS
Theory
1. General Aspects: definition, hemorrhagic character and classification of
hemorrhagic disease
2. Normal hemostasis and clotting mechanism
3. Diagnosis
(1) History
121
(2) Physical Examination
(3) Laboratory findings
4. Therapeutic principle
Chapter 12: Idiopathic Thrombocytopenic Purpura (ITP)
[Objectives]
1. Master definition, common cause, diagnosis and therapeutic principl of ITP
2. Be familiar with classification, clinical features, laboratory findings and
differential diagnosis of ITP
3. The morphological character of ITP
COURSE CONTENTS
Theory
1. General Aspects: definition and normal platelet count
2. Etiology and Pathogenesis
3. Clinical Features: clinical character
4. Laboratory finding
5. Diagnosis and Differential diagnosis
6. Treatments
Practice
1. Show the typical cases of ITP
2. Know the morphological character of ITP by microscope
PART SEVEN
ENDOCRINOLOGY
[Objectives]
Endocrinology is an important system of Internal Medicine. The aims of
Endocrinology are to learn the principles and methods for the diagnosis and
management, such as hyperthyroidism, hypothyroidism, diabetes mellitus, primary
122
chronic hypercortisonism and hypocortisonism. There are 16 teaching hours. Teaching
methods include lecture and clerkship. There are 12 lecture hours. In lecture hours
students learn diagnosis and management of common endocrinology diseases such as
hyperthyroidism,
hypothyroidism,
diabetes
mellitus,
primary
chronic
hypercortisonism and hypocortisonism. There are 4 clerkship hours. In clerkship
hours students learn the following clinical skills, include taking the history of
endocrinology, physical examination and writing the history. Students also learn to
management the following endocrinology diseases, such as hyperthyroidism,
hypothyroidism,
diabetes
mellitus,
primary
chronic
hypercortisonism
and
hypocortisonism.
TEACHING HOURS DISTRIBUTION
Chapter
Contents
Lecture
Practice
Chapter 1
Introduction
2
0
Chapter 2
Thyroid disease
4
2
Chapter 3
Diabetes mellitus
4
2
Chapter 4
Hypercortisonism
1
0
Chapter 5
Primary chronic hypocortisonism
1
0
Total
12
4
CHAPTER 1: INTRODUCTION
[Objectives]
1. Master the basic theory of endocrinology system’s physiology and biochemistry,
endocrinology hormone’s physiology characters and relationship to the clinic
2. Master the diagnosis principle and treatment for endocrinology disease
3. Be familiar with the field of clinical endocrinology, relation to other clinical
departments and clinical importance of endocrinology diseases.
4. Under the development and direction of endocrinology in the world
5. Endocrinology hormone’s physiology characters and relationship to the clinic
123
6. Diagnosis principle and treatment for endocrinology disease
COURSE CONTENTS
Theory
1. Summarize the physiological actions and relationship to the clinic of the mainly
hormone.
2. Summarize the signification of endocrinological system, introduce the survey of
endocrinology of gland, tissue and molecule.
3. Explain how does the neural endocrinological system regulate the homeostasis, the
connection between the endocrinological gland with neural system.
4. Summarize the regulation of the axis of hypothalamus-pituitary-target’s gland,
elucidate the action of the modulation and feedback of the hormones.
5. Classification and physiology of the endocrinology diseases, the diseases can
divide into hyperfunction, hypofunction and normal by function. The diseases can
also divide into primary and secondary by pathological part.
6. Particularly explain the diabetes insipidus, hypothyroidism, parathyroid disease,
adrenal cortex disease and adrenal medullary disease in the basis of the physiologic
characters of hormone connection with the narrow classification of endocrinology.
7. Principle of diagnosis: diagnosis of function, pathology, location and etiology.
Emphasize the value of lab examination. Briefly introduce the signification of
radio-immunology, immunology and image in the diagnosis of endocrinology
diseases.
8. Principles of prevention and therapy to endocrinology diseases: brief introduce
three principles. Summarize the characters of operation, radiation and drugs for
example with thyroid, pituitary and adrenal diseases.
CHAPTER 2: THYROID DISEASE
[Objectives]
Knowledge
124
1. Hyperthyroidism
(1) Master the pathological and physiological changes when the thyroid secret
more hormone, classification with etiology, pathogenesis of diffuse goiter with
hyperthyroidism.
(2) Master the manifestation, including specific clinical phenomena, points of
diagnosis and differential diagnosis.
(3) Master the treatment principles for hyperthyroidism crisis.
(4) Be familiar with well the treatment principles by drugs.
(5) Understand the characters of specific clinical types.
2. Hypothyroidism
(1) Master the etiologic classification.
(2) Master the manifestation; include hypothyroidism of adult type, manifestation
of cretinism, points of diagnosis and differential diagnosis.
(3) Master the principles of treatment to the coma of the myxedema.
(4) Understand well the replacement therapy by drug.
Skills
1. Hyperthyroidism
(1) The manifestation and physical examination.
(2) The normal values and clinical significance of thyroid function tests.
(3) Special examinations ECT indications for thyroid.
(4) Well the treatment principles by drugs.
(5) The treatment principles for hyperthyroidism crisis.
2. Hypothyroidism
(1) The manifestation and physical examination
(2) The normal values and clinical significance of thyroid function tests
(3) Well the replacement therapy by drugs and the principles of treatment to the
coma of the myxedema
COURSE CONTENTS
Theory
125
1. Hyperthyroidism
(1) Definition and clinical characters, classification by etiology,emphasize thyroid
hyperthyroidism, etiology and pathogenesis of Graves disease,introduce the
nearly viewpoints of how does the autoimmune affect the hyperthyroidism.
(2) Pathology: briefly introduce the changes of pathology
(3) Manifestation: connect with the physiological action of thyroxine, elucidate
the effect of high thyroxine to the hypothalamus-pituitary-target gland and
other systems. Emphasize the hyperthyroidism syndrome and the characters of
examination to the goiter of Graves’ disease.
(4) Specific clinical manifestation: emphasize the hyperthyroid heart disease,
hyperthyroidism crisis, apathetic hyperthyroidism, T3 hyperthyroidism,
hyperthyroidism
in
gestation,
myxedema
of
pretibia
and
Graves’ophthalmopathy with norm thyroid function.
(5) Lab exam: thyroid
I131 uptake,serum FT3, FT4（or TT3,TT4）and TSH,T3
(6) Suppressive test, TRH stimulation test
(7) Diagnosis and differential diagnosis: emphasize the value of illness history
and signs. The diagnosis of atypical and specific type must depend on the lab
examination. Differentiate with simple goiter, neurosis, heart disease,
pulmonary tuberculosis and carcinoma.
(8) Therapy: commonly treatment, rest, nutrition, drugs, include pharmacological
action, indication, dosage and duration, side effect, the problem of stop drugs
and recrudescence. Briefly introduce the indication and point’s attention of
radiology and operation and the treatment to the hyperthyroidism crisis.
2. Hypothyroidism
(1) Summarize the definition and clinical character, classification by etiology.
(2) Pathology: briefly introduce the pathological changes of thyroid
(3) Manifestation: clinical character of hypothyroidism of adult type and cretinism
(4) Lab exam: serum FT3,FT4（or TT3, TT4）TSH,TRH stimulation test
(5) Diagnosis and differential diagnosis: manifestation, lab exam and location.
Differentiate with pituitary tumour, nephropathy syndrome and coronary heart
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disease. Diagnosis of Low T3 syndrome.
(6) Treatment: common treatment, replacement therapy and treatment of coma of
myxedema
Practice
1. Hyperthyroidism
(1) Definition and manifestation emphasize the hyperthyroidism syndrome and
the characters of examination to the goiter of Graves’ disease
(2) Lab exam: thyroid
I131 uptake,serum FT3, FT4（or TT3, TT4）and TSH
(3) Diagnosis and differential diagnosis
(4) Common drugs and the treatment to the hyperthyroidism crisis
2. Hypothyroidism
(1) Summarize the definition and Manifestation
(2) Diagnosis and differential diagnosis and diagnosis of Low T3 syndrome
(3) Treatment: common treatment, replacement therapy and treatment of coma of
myxedema.
CHAPTER 3: DIABETES MELLITUS
[Objectives]
1. Master the etiology and classification of DM.
2. Master the process and means of diagnosis, principles of prevention and treatment
to the DM, the principles of usage of oral hypoglycemic agents and insulin.
3. Be familiar with well the manifestation, diagnosis and differential diagnosis and
principles of treatment for Diabeteic Ketoacidosis.
4. Understand the pathologic physiology of DM; grasp the manifestation, rules of
development and ordinary complications of DM.
5. Means of diagnosis.
6. The normal values and clinical significance of OGTT.
7. Oral hypoglycemic agents and insulin: elucidate the pharmacological action,
indication, dosage, means, drug-resistance and side effect of sulfonylurea and
127
biguanide.
8. How to deal with diabetes melltitus ketoacidosis and hyperosmolar coma.
COURSE CONTENTS
Theory
1. Summarize: briefly introduce the basic definition. DM is a group clinical syndrome,
but not simple disease. Introduce the situation, classification. Emphasize how to
differentiate the type 1 DM with type 2 DM.
2. Etiology and pathogenesis: is still unknown. Gene and environment maybe the
main factors lead to DM. briefly introduce the value of virus infection ,
autoimmune, fat, stress and gestation in the DM. emphasize the connection
between the virus infection and autoimmune with type 1 DM. fat relate to type 2
DM. introduce the theory of insulin resistance.
3. Pathological physiology: the turbulence of glucose, protein and fat cause by insulin
hyposecretion.
4. Manifestation:
emphasize metabolism syndrome, the specific clinical characters
of type 1 and 2 DM. chronic complications include heart-blood vessel, kidney, eye
and nervous system.
5. Lab exam: briefly introduce the norm standard, factors of affection and clinical
signification of glucose in urine, blood glucose and OGTT. The value of OGTT
to classification of DM. introduces the signification of Hba1c.
6. Diagnosis and differential diagnosis: diagnosis depends on family history, present
history, manifestation and lab exam. Differentiate with secondary DM and renal
glucosuria.
7. Treatment
(1) General treatment: Patients learn the basic information of DM and
self-management.
(2) Dietotherapy: grasp how to calculate the quantity of heat.
(3) Oral hypoglycemic agents and insulin: elucidate the pharmacological action,
indication, dosage, means, drug-resistance and side effect of sulfonylurea and
128
biguanide.
8. Diabetes ketoacidosis
(1) Predisposing factors, pathological and physiological characters, introduce the
turbulence of glucose, protein and fat. Emphasize the pathological physiology
of the turbulence of water, salt and electrolyte.
(2) Introduce the manifestation. Emphasize the differentiation with hyperosmotic
nonketonic coma, hypoglycemic coma and lactic acidosis. Especially
emphasize the clinical characters of hyperosmotic nonketonic coma.
(3) Importance of rectifying the predisposing factors in the treatment to DKA.
(4) Principle of using insulin, the means to correct the turbulence of
water-electrolyte and acid-base balance.
Practice
1. Manifestation: emphasize metabolism syndrome, the specific clinical characters of
type 1 and 2 DM. chronic complications include heart-blood vessel, kidney, eye
and nervous system
2. Lab exam: the norm standard, factors of affection and clinical signification of
glucose in urine, blood glucose and OGTT. The value of OGTT to classification
of DM. introduces the signification of Hba1c
3. Diagnosis and differential diagnosis
4. Treat by oral hypoglycemic agents and insulin
5. Manifestation and treatment of DKA
CHAPTER 4: HYPERCORTISONISM
[Objectives]
1. Master the pathology and manifestation.
2. Master the gist of diagnosis and diseases of differential diagnosis.
3. Get familiar with well with the etiology and pathogenesis.
4. Understand the principles of treatment.
COURSE CONTENTS
129
Theory
1. Clinical character
2. Four etiologies include: pituitary secrete excessive ACTH,primary adrenal gland
cortex tumor,ectopic ACTH syndrome,independent-ACTH bilatery small node
hyperplasia or hypogenesis
3. Pathology, physiology and manifestation: Concentric obesity, turbulence of protein,
fat, glucose, water and salt. Hypertension, resistance weaken to infection, change
of blood, drawback of sex function and skin pigmentation
4. Diagnosis and differential diagnosis: Emphasize the important meaning of
symptom sign, the value of cortisol in blood and urine. Differentiate with obesity
and type 2 DM
5. Treatment: Operation, radioactivity treatment, drugs block synthesize cortin
CHAPTER 5: PRIMARY CHRONIC
HYPOCORTISONISM
[Objectives]
1. Master the main etiology.
2. Master the clinical characters.
3. Get familiar with well with the means of treatment.
4. Understand the main points of pathologic physiology.
5. Well with the means of hormone replacement and how to treat hypocortisonism
crisis.
COURSE CONTENTS
Theory
1. Summarize: Definition, Emphasize differentiation of primary and secondary
hypocortisonism
2. Etiology and pathology
3. Manifestation
130
4. Lab examination
5. Diagnosis and differential diagnosis: Skin pigmentation, fatigue, thin, biochemistry
and hormone measurement are important evidence for diagnosis. Differentiate with
chronic consume disease.
6. Treatment
PART EIGHT RHEUMATOLOGY
Introduction
This course introduces the students to rheumatology, a subspecialty of internal
medicine that is comprised of diseases that directly or indirectly affect the joints. The
conception of rheumatic diseases may be difficult to grasp. For the students, it is
important to know the principle of the common rheumatic disease. Some diseases,
such as the vasculitis or the Still’s disease, were not mentioned in this course because
of the difficulty in the diagnosis. These diseases need the students to learn by
themselves in future practice.
Objectives
1. The conception of the modern conception and the classification of the rheumatic
disease
2. The clinical manifestation and the principle of diagnosis of the common rheumatic
disease
3. The relationship of auto-antibodies to rheumatic diseases
4. The principle of the management of the common rheumatic disease. The common
medicines in treating the rheumatic disease.
TEACHING HOURS DISTRIBUTION
Chapter
Contents
Lecture
Practice
Chapter 1
Rheumatoid Arthritis
1
1
Chapter 2
Systemic Lupus Erythematosus
1
1
Total
2
2
131
CHAPTER 1: RHEUMATOID ARTHRITIS
[Objectives]
1. Master the epidemiologic feature and pathologic changes of the rheumatoid
arthritis
2. Be familiar with the clinical manifestation, the diagnosis and the differential
diagnosis of RA
3. Understand the management principle of RA
COURSE CONTENTS
Theory
1. The conception of RA; the epidemiologic feature; the public health problem or
social-economic burden produced by RA
2. Etiology of RA: unknown, maybe associated to genetic or infectious causes, et al.
3. Pathogenesis and pathology: RA is autoimmune disease; the pathologic change is
basically the synovitis. The HLA-DR molecular, rheumatoid factor (RF) and
cytokines (including IL—l, TNFa, IL—6, IL—8) may play important roles in RA.
4. clinical manifestation
5. Lab test
6. Diagnosis and differential diagnosis: 1988 revised ARA Criteria for classification
of RA. Differential diagnosis with Ankylosing Spondylitis; Psoriatic Arthritis, SLE,
et al.
7. Management of RA
Practice
1. Clinical manifestation of RA, the cases demonstration
2. The principle of RA management
CHAPTER 2: SYSTEMIC LUPUS ERYTHEMATOSUS
132
(SLE)
[Objectives]
1. Master the epidemiologic feature and pathologic changes of SLE; the etiology and
pathogenesis of SLE, the pathologic classification for lupus nephritis (LN) by
WHO
2. Be familiar with the clinical manifestation, the diagnosis and the differential
diagnosis of SLE, the auto-antibody profile of SLE
3. Understand the management principle of SLE, the drug therapy of SLE
COURSE CONTENTS
Theory
1. SLE is an auto-immune disease with multiple organ involvement, and varies
auto-antibodies patterns in the course of the disease
2. Etiology and pathogenesis: the etiology of SLE is unknown, maybe associated to
genetic factors, environmental factors, and gonadal hormone, et al.
The SLE
among the population, the age and gender features.
3. Pathogenesis of SLE: SLE associated to multiple factors, including hereditary,
environmental; abnormal immune responses, including T cells and B cells, immune
tolerance, and inadequate clearing of immune compleses.
4. Pathology: the pathologic classification for LN by WHO
5. Clinical manifestations: SLE is a disease with a complex set of abnormalities and
follows a relapsing and remitting course. The common symptom includes fever,
skin rash, musculoskeletal manifestation, hydrymenitis, nephropathy, et al.
6. Lab test: blood cell count, urine screen, and auto-antibodies. Including the
immunoglobulin, CIC, complements, ANA (anti-dsDNA, anti- ENAs, including
Sm, SSA, SSB, ulRNP, rRNP, Jo—l, Scl—70). Kidney biopsy in SLE
7. Diagnosis and differential diagnosis: the criteria by ARA in 1982. How to define
the disease activity. The differential diagnosis includes MCTD, chronic nephritis.
8. Management of SLE: the principles, and the strategies of drug therapy.
9. Prognosis: factors involve in estimating the prognosis
133
Practice
1. Cases demonstration, including the symptom of SLE, and the lab tests findings
2. The Classification criteria for SLE, and how to determine the activity of the
disease
3. The treatment of SLE, the principle and the medicines
4. The prognosis of SLE and the related factors
134