Download Guideline of physical examination Blood pressure [Objectives

Guideline of physical examination
Blood pressure
[Objectives]
1. Should master definition of normal and abnormal blood pressure levels.
2. Should familiarize the structure of sphygmomanometer.
3. Should master the indirect measurement of blood pressure.
Should learn about the direct measurement of blood pressure.
4. Should learn about the mechanism of arterial blood pressure and the factors
affecting it .
[Contents]
1. Different kinds of sphygmomanometer: such as mercury sphygmomanometer
2. The accurate measurement of blood pressure:
1) To introduce direct measurement simple.
2) To explain details of indirect measurement: preparations before measure
blood pressure, position of patients, securing the cuff accurately, placing the
stethoscope, inflating and deflating, recording the reading of SBP (systolic
blood pressure) and DBP (diastolic blood pressure). Repeating and averaging
the readings.
3. Definition of normal and abnormal blood pressure.
Classification of Blood
Systolic (mmHg)
Diastolic (mmHg)
pressure ( adults)
Optimal
<120
<80
Normal
<130
<85
High normal
130~139
85~89
Hypertension
Stage 1
140~159
90~99
Stage 2
160~179
100~109
Stage 3
≥180
≥110
[ Training]:
Divided into several groups for training.
[Tools]
1. Multimedia video
2. Students practicing on each other.
The Lymph nodes and the breasts
[Objectives]:
1) should master the techniques of examining superficial lymph nodes.
2) Should be familiar with the contents and techniques of examination of the breasts.
3) Should learn about the clinical manifestations of the breast diseases.
[ Contents]:
1) the superficial lymph nodes.
1)the sequence of the examiantion
2) the techniques of examination: Palpate lymph nodes bilaterally, be sure to keep
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the skin and muscles relaxed, examine the lymph nodes with the pads of the
index ,middle and ring fingers, move the skin over the underlying tissues in each area.
2) examination of the breasts:
1) Inspection: symmetry, superficial appearance, nipple,skin retraction, axilla
fossa and supraclavicular fossa.
2) Palpation: consistency and elasticity, tenderness and mass( note the location,
size, contour, consistency, tenderness and mobility. After palpation of the
breasts, the axilla, supraclavicular region and neck should be palpated
carefully, to detect any enlargement of lymph nodes.
[ Training]:
Divided into several groups for training.
[ Tools]
1.Multimedia video
2. Standardized patients (SP)
3 breast models
Examination of the chest: inspection and palpation
[Objectives]:
1) Should master the landmarks on the chest wall.
2) Should master the contents and techniques of inspection and palpation.
[ Contents]:
1) chest wall
Vein, Subcutaneous emphysema, Tenderness and Intercostal spaces
2) the shape of the thorax: normal and abnormal
3) Lung and pleura:
1. inspection: breathing movement, respiratory rate, breath depths and rhythm of
breathing.
2. palpation: Thoracic expansion, Vocal fremitus and pleural friction rub.
4) the heart
1. inspection: the precordium, apical impulse and abnormal pulsations of the
precordium.
2. palpation: apical impulse and abnormal pulsations, thrills, pericardial friction
rub
[ Training]:
Divided into several groups for training.
[ Tools]
1.Multimedia video
2. Standardized patients (SP)
Percussion and auscultation of the lung
[ Objectives]
1) Should master the contents and techniques of percussion.
2) Should master normal breath sounds.
3) Should be familiar with main abnormal breath sounds.
4) Should learn about abnormal percussion notes of the thorax.
[ Contents]:
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1) techniques of percussion:direct percussion and indirect percussion
2) factors affecting percussion
3) percussion of the lung
① normal percussion notes of the lung.
② percussion of the pulmonary boundaries: the upper pulmonary boundary, the
anterior pulmonary boundary and the inferior pulmonary boundary
③range of movement the lower pulmonary boundary.
4) Abnormal percussion notes of the thorax.
5) Normal breath sounds:
bronchial breath sound, bronchovescicular breath sound and vesicular breath sound.
6) Abnormal breath sounds
abnormal vesicular breath sound, abnormal bronchial breath sound, abnormal
bronchovescicular breath sound, rales and rhonchi and pleural friction rub.
[ Training]:
Divided into several groups for training.
[ Tools]
1. Multimedia video
2. Standardized patients (SP)
Inspection, Palpation and Percussion of the Heart
[Objectives]
1. Should master the contents of the inspection, palpation and percussion.
2. Should master the techniques of examination.
3. Should be familiar with normal and abnormal apical impulse.
4. Should be familiar with the clinical significance of thrills.
5. Should learn about abnormal border of cardiac dullness and its clinical
significance.
[Contents]
1. Inspection of the heart
1) precordial bulge 2) apical impulse 3) abnormal pulsations of the precordium
2. palpation of the heart
1) apical impulse and abnormal precordial pulsations
2) thrills
3) Pericardial friction rub
3. percussion of thecardiac outline
1) the technique of examination: percuss the left border of the heart first, then
percuss the right border.
2) Normal cardiac dullness border
Right (cm)
Intercostal space
Left (cm)
2-3
II
2-3
2-3
III
3.5-4.5
3-4
IV
5-6
V
7-9
In normal person the distance from the midsternal line to the left midclavicular is
about 8-10 cm.
3) abnormal border of cardiac dullness
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① displacement of the heart
② heart diseases: left ventricular enlargement, right ventricular
enlargement,, bi-ventricular enlargement, left atrial enlargement, aortic
dilation, aneurysm of aorta, pericardial effusion
[ Training]:
Divided into several groups for training.
[Tools]
1. Multimedia video
2. Standardized patients (SP)
Auscultation of the Heart
[Objectives]
1. Should master auscultation of the various valve areas, the sequence and contents
of auscultation.
2. Should be familiar with normal heart sounds, abnormalities of the heart sounds
and certain kinds of important murmurs.
3. Should learn about the mechanism of abnormal heart sounds.
[Contents]
1. Auscultation of different valve areas
mitral valve area, pulmonic valve area, aortic valve area, the second auscultatory
area of AV and tricuspid valve area.
2. Auscultatory sequence
Start at the apex, then move to the PV area , AV area, second AV area, TV area.
3. Contents of auscultation
Heart rate, Heart rhythm, heart sounds, abnormalities of the heart sounds,
murmurs and pericardial friction rub.
4. Abnormalities of the heart sounds
1) Abnormal intensities of S1 and S2
2) Abnormal splitting of S1 and S2
3) Extra heart sounds: gallop rhythm, mid and late systolic click and opening
snap.
5. Murmurs
1) Characteristic of murmurs: location, timing, quality, radiation, intensity and
physiological maneuver
2) classification: systolic murmurs (MI, AS, VSD), diastolic murmurs (MS, AI)
and continous murmurs (PDA)
[ Training]:
Divided into several groups for training.
[Tools]
1. Multimedia video
2. simulators
The abdomen (inspection, palpation, percussion and auscultation)
[ Objectives]
1) Should master the sequence of abdominal examination
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2) Should master the contents of abdominal examination
3) Should master the techniques of abdominal examination
4) Should be familiar with the abdominal topographic anatomy
[Contents]
1 topographic anatomy
1）For descriptive purposes, the abdomen is often divided by imaginary lines crossing
at the umbilicus, forming the right upper, right lower, left upper, and left lower
quadrants。
Another system divides the abdomen into nine sections。
2 The sequence of the abdominal examination：inspection, auscultation, percussion
and palpation.
3) Inspection of the abdomen:
1) The contour of the abdomen
2) Movements with breathing.
3) Dilated veins.
4 )Visible peristalsis
5) Pulsations
5) abdominal wall
4）Auscultation of the abdomen
1) Listen to the abdomen before performing percussion or palpation, since these
maneuvers may alter the frequency of bowel sounds.
2) Listen for bowel sounds and note their frequency and character.
3) Listen for bruits over the aorta, renal arteries and the iliac arteries
5) percussion of the abdomen
1) Percuss the abdomen lightly in all four quadrants.
2) estimating the size of the liver and spleen
3) shifting dullness
4) Briefly percuss the lower anterior chest, between lungs above and costal margins
below
6) palpation of the abdomen
1) Light Palpation:identifying abdominal tenderness, muscle guarding, and some
superficial organs and masses.
2) Deep Palpation: Again using the palmar surfaces of your fingers, feel in all four
quadrants. Identify any masses and note their location, size, shape, consistency,
tenderness,
pulsations, and any mobility with respiration.
3) Assessment for Peritoneal Inflammation: look for tenderness and rebound
tenderness.
4) palpation of the liver
5) palpation the spleen
6) palpation of the kidney
7) palpation of the bladder
[ Training]:
Divided into several groups for training
[Tools]
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1) multimedia video
2) standardized patients (SP)
The spine ,extremities and joints
[Objectives]:
1) Should master the contents and techniques of the examination.
2) Should be familiar with the examination of certain joints.
3) Should learn about the common abnormal signs of the spine ,extremities and
joints.
[Contents]
1) examination of the spine:
physiologic curvature of the spine, activity of the spine, palpation and percussion
for tenderness of the spine.
2) examination of the extremities:
the measurement of length and circumference for the upper extremity and lower
extremity, abnormal shape of the extremities, abnormal movements of the extremities.
3) examination of the joints:
abnormal shape of the joints, the mobility of the joints and the range of the motion.
[ Training]:
Divided into several groups for training.
[Tools]
1) multimedia video
2) standardized patients (SP)
The head and the related cranial nerves
[ Objectives]:
1) Should master the contents and techniques of the examination.
2) Should be familiar with the function and clinical significance of the cranial nerves
that are related to the head.
[ Contents]:
a)
the head: size, shape and abnormal motions
b)
the eyes and the related cranial nerves ( the cranial nervesⅡ,Ⅲ,Ⅳ,Ⅴ,Ⅵ and
Ⅶ)
1) eyelids
2) conjunctiva and sclera
3) cornea
4) iris and pupils: the shape and size of the pupils, pupillary reactions to light
and accommodation.
5) extraocular movements
6) function of the eyes: visual acuity, visual fields and color vision.
7) fundi: the use of ophthalmoscope, normal fundi and the common
abnormalities
3) the ears and the related cranial nerves (the cranial nerve Ⅷ)
1) the auricle, ear canal, drum and mastoid
2) auditory acuity, the tuning fork test (including Rinne,Weber and Schwabach
test)
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4) the nose and the related cranial nerves ( the cranial nerveⅠ)
1) the shape of the nose, nasal ala, nasal septum, nasal mucosa and nasal sinus
2) the examination of olfactory sensation
5) the face and the related cranial nerves ( the cranial nerves Ⅴ and Ⅶ)
1) the facial sensation of touch ,pain and temperature, strength of the masseter
muscle, Corneal reflex
2) Check the movement of facial muscle: frown, close the eyes, show the teeth,
whistle and puff out the cheeks
6) the mouth and the related cranial nerves (cranial nerves Ⅸ,Ⅹ and Ⅻ)
including: the lips, the oral mucosa, the gums and teeth, the tongue and floor of
the mouth, tonsil, pharynx and parotid gland
[ Training]:
Divided into several groups for training.
[Tools]
1) multimedia video
2) standardized patients (SP)
The neck and the cranial nerves
[Objectives]
1. Should master the techniques of examination. (especially the thyroid gland and the
trachea)
2. Should be familiar with the function of the cranial nerve XI.
[Contents]
1. the shape of the neck and the examination of the jugular blood vessels
(1)
the carotid arteries and jugular veins: pay attention to the jugular venous
distention and abnormal pulsations of the carotid arteries and jugular
veins.
(2)
Auscultation of the neck: bruits of blood vessels.
2. examination of the cranial nerve XI: shrug both shoulders upward against your
hands, ask the patient to turn the head to each side against your hand.
3. examination of the thyroid gland.
(1)
inspection: the contour and symmetry
(2)
palpation: note the size, shape and consistency of the gland
4. examination of the trachea
(1)
inspection: note any deviation from its usual midline position.
(2)
Palpation: feel for any deviation.
[ Training]:
Divided into several groups for training.
[Tools]
1. Multimedia video
2. Standardized patients (SP)
The nervous system
[ Objectives]:
1) should master the techniques of examination of reflexes and Meningeal Irritation
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Sign and also should master the clinical significance.
2) Should be familiar with the contents and techniques of examination of the motor
system.
3) Should be familiar with contents and techniques of examination of the sensory
system.
[ Contents]:
1) muscle strength : muscle strength is graded on a 0 to 5 scale
2) muscle tone: increased or decreased
3) Coordination:rapid alternating movements, point-to--point movements ( such as
Finger-to-nose test and Heel-to-knee-to-shin test), Romberg test.
4) abnormal movements
5) the sensory system:
This can be divided into examination of superficial sensation, deep sensation and
combined sensation. Sensory testing is usually done with patient’s eyes closed.
Compare the sensation of the two sides
7) reflex:
① Superficial reflexes: the abdominal reflex, the cremasteric reflex and the anal
reflex
②Deep tendon reflexes: the biceps reflex, the triceps reflex, the brachioradialis
reflex and the knee reflex and the ankle reflex.
③ Pathologic reflex: Babinski,s sign and Oppenheim,s sign
8) Meningeal Irritation Sign: Neck rigidity, Kernig,s sign and Brudzinski,s sign
[ Training]:
Divided into several groups for training.
[Tools]
1) multimedia video
2) standardized patients (SP)
The anus, rectum and prostate
[ Objectives]:
1) should master the techniques and clinical significance of anal and rectal palpation.
2) Should master the contents and clinical significance of palpation of the prostate
3) Should be familiar with the anatomy of the male and female external genitalia.
[ Contents]:
1) Palpate the anus and rectum
① Position: modified lithotomy position, left lateral position, the knee-chest
position, bent over the table.
② Techniques: Insert the gloved right indexed finger into the anus and rectum.
Palpate the lateral, posterior and anterior anal and rectal wall.
③ Clinical significance
2) Palpate the prostate:
① The size, surface, consistency, sensitivity to pressure and shape of the
prostate gland shoul be assessed.
② Clinical significance
3) anatomy of the male and female external genitalia: such as the penis, scrotum and
the vulva of the female genitalia.
[ Training]:
Divided into several groups for training.
[Tools]
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1) multimedia video
2) simulators
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Guideline of history taking and medical record
1) Components of history taking
2) Symptom of cough and expectoration
[Objectives]
1. Should master components of a complete history taking.
2. Should master concept and clinical manifestations of cough and expectoration.
3. Should master how to take history of cough and expectoration.
4. Should learn about the common causes of cough and expectoration.
[Contents]
1) Components of a complete history taking.
identification of the patient, history of present illness, past medical history, review
of systems, social history and family history
2) Concept and clinical manifestations of cough and expectoration.
3) how to take history of cough and expectoration?
① when did it start?
② How severe is it?
③ Are you coughing anything up? Are you coughing up any phlegm or mucus?
④ What color is your phlegm?
⑤ Have you noticed blood in your phlegm?
⑥ Is the cough keeping you up at night?
⑦ Is there anything that makes the cough better or worse?
⑧ Associated symptom: have you had a fever? Have you experienced any
discomfort in your chest? Have you experienced any difficulty with your
breathing? Has there been a change in your weight?
[ Training]:
Divided into several groups for training.
[Tools]
1. Multimedia video
2. Standardized patients
1) The techniques of history taking
2) Symptom of diarrhea and vomiting
[Objectives]
1. Should master the basic techniques of history taking.
2. Should master how to take history of diarrhea.
3. Should be familiar with history taking of vomiting.
4. Should be familiar with the mechanism and the common causes of diarrhea.
5. Should learn about the mechanism and the common causes of vomiting.
[Contents]
a) The techniques of history taking
1. Greeting the patient and establishing rapport
2. active listening and Inviting the patient, s story
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3. adaptive questioning
4. nonverbal communication: communication that does not involve speech
5. facilitation : use facilitation by posture, acions and words
6. echoing
7. empathic responses
8. validation, reassurance, summarization and highlighting transitions
9. Negotiating a plan, planning for Follow-Up and Closing
2) How to take history of diarrhea
1. When did your diarrhea start?
2. How long have you had diarrhea?
3. What is the color and consistency of your stool?
4. Do you have blood in your stool?
5. Are you passing large amounts of mucus with your stool?
6. What other symptoms do you have?
7. Do you have abdominal pain or severe cramping with the diarrhea? What makes
your pain worse? Stress? Specific foods?
8. Do you have fever or chills?
9. Are any other family members sick?
10. Have you recently traveled out of the country?
11. Have you had abdominal surgery?
12. What medications do you take?
3)History taking of vomiting
1) how long have you had vomiting?
2) what is the color of the vomitus?
3) is there any foul odor to the vomitus?
4) how often do you vomit?
5) is vomiting related to eating? How soon after eating do you vomit? Do you vomit
only after eating certain foods?
6) do you have other symptoms? ( abdominal pain, ringing in you ear, a change in
your hearing ability? A change in the color of your urine, diarrhea)
7) ( if the patient is a woman ), when was your last period?
4)The mechanism and the common causes of diarrhea
5) The mechanism and the common causes of vomiting.
[ Training]:
Divided into several groups for training.
[Tools]
1) Multimedia video
2) Standardized patients
Edema
[Objectives]
1. Should master the etiology and clinical manifestations of edema.
2. Should master how to take history of edema.
3. Should learn about the the common causes of edma.
[Contents]
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1. The etiology, common causes and clinical manifestations of edema.
1) general edema and local edema.
General edema can be caused by cardiac failure, renal desease, liver desease and
hypoalbuminemia,. Local edema will occur as part of inflammation or in
lymphedema.
2) Symptoms vary depending on the cause of edema. In general, weight gain, puffy
eyelids, and swelling of the legs may occur as a result of excess fluid volume. Pulse
rate and blood pressure may be elevated.
2. History taking of edema
Focus your questions on the location, timing and setting of the swelling, and on
associated symptoms.
1) have you had any swelling anwhere? Where? Anywhere else?
2) When does it occur?
3) Is it worse in the morning or at night?
4) Are the rings tight on your fingers? Are your eyelids puffy or swollen in the
morning? Have you had to let out your belt?
5) associated symptoms: dyspnea, cyanosis, cough, jaundice, dermatorrhagia, any
change of the urine.
6) Did you ever take any special medicaton?
7) For female patients, should ask about the menstrual cycle.
[ Training]:
Divided into several groups for training.
[Tools]
1) Multimedia video
2) Standardized patients
Pain ( Chest pain and abdominal pain )
[Objectives]
1. Should master the concept , clinical manifestations and associated symptoms of
chest pain and abdominal pain.
2. Should master how to take history of chest pain and abdominal pain.
3. Should learn about the the common causes of chest pain and abdominal pain.
[Contents]
1. The concept , clinical manifestations and associated symptoms of chest pain.
1) Concept: chest pain usually refers to pain in the anterior thorax.
2) Clinical manifestations: note the process, location, quality, severity, timing,
factors of aggravate and relieve.
3) Associated symptoms: dyspnea, nausea, vomiting, sweating, weakness, cough,
dysphagia
2. History aking of chest pain.
1) when did the chest pain start?
2) Hiw severe is it?
3) How would you describe the pain?
4) Where is the pain? Does the pain radiate to elsewhere?
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5) Is it constantly present or does it come and go? Has it changed at all since it
started?
6) Is there anything that makes the pain better or worse?
7) Does it hurt when you breathe or cough?
8) Do have other symptoms when you have chest pain?
9) have you taken any medication for you pain? Has it helped?
10) Dou you have a history of hypertension, diabetes, heart or lung disease?
3. The concept , clinical manifestations and associated symptoms of abdominal pain.
1) Concept: Abdominal pain is pain that you feel anywhere between your chest
and groin.
2) Clinical manifestations: Note the process, location, quality, severity, timing,
factors of aggravate and relieve. Note the characteristics of visceral pain,
somatic pain and refered pain.
3) Associated symptoms: fever, chill, jaundice, diarrhea, nausea, vomiting,
hematuria
4. History taking of abdominal pain.
1)Is the pain all over (diffuse or generalized) or in a specific location?
2)What part of the abdomen is affected? Lower or upper? Right, left or middle?
Around the navel?
3)Is the pain severe, sharp or cramping, persistent or constant?
4)Does the pain awaken you at night?
5)Have you had similar pain in past? How long has each episode lasted?
6)How often do you have the pain?
7)Does it occur within minutes following meals? Within 2 to 3 hours after meals?
8)Is it getting increasingly more severe?
9)Does it occur during menstruation (dysmenorrhea)?
10)Does the pain go into elsewhere?
11)Does the pain get worse after lying on the back?
12)Does the pain get worse after eating or drinking? After greasy foods, milk products,
or alcohol?
13)Does the pain get worse after stress?
14)Does the pain get better after eating or a bowel movement?
15)Does the pain get better after antacids?
16)What medications are you taking?
17)Have you had a recent injury?
18)Are you pregnant?
19)What other symptoms are occurring at the same time?
5.The common causes of chest pain and abdominal pain.
[ Training]:
Divided into several groups for training.
[Tools]
1) Multimedia video
2) Standardized patients
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Medical record ( a complete history and physical findings write-up)
[Objectives]
1. Should master the contents and format of a complete history and physical findings
write-up.
2. Should learn about other kinds of medical documents.
[Contents]
1. the contents and format of a complete history and physical findings write-up.
1) Identification
2) History record
chief complaint, history of present , past medical history, review of systems,
personal and social history, family history.
3) Physical examination findings
Vital signs, skin, heent, neck, lymph nodes,breasts, thorax and lungs, heart,
abdomen, spine and exremities, neurological examination, pelvic and rectal
examination.
4) LAB tests
5) Formulation
6) Impression
2. Other kinds of medical documents.
[ Training]:
Divided into several groups for training.
[Tools]
1) Multimedia video
2) Standardized patients
Hemoptysis and dyspnea
[Objectives]
1. Should master the concept and mechanism of hemoptysis.
2. Should mster the history taking of hemoptysis and dyspnea.
3. Should learn about the common causes of hemoptysis and dyspnea.
[Contents]
1.The concept ,mechanism and common causes of hemoptysis.
Hemoptysis is the coughing up of blood from the respiratory tract. It can include
clots of blood as well as blood-tinged sputum. Clots of blood are usually indictive of a
cavitary lung leision, a tumor of the lung, certain cardiac diseases, or pulmonary
embolism. Blood-tinged sputum is usually associated with smoking or minor
infections, but it can be seen with tumors and more serious diseases as well.
2.History taking of hemoptysis.
1) Did it begin suddenly? How many times have you coughed up blood?
2) how long have you noticed the blood? Has it increased recently?
3) Can you see blood when you cough up something? What seems to bring on the
coughing up of blood? Vomiting? Coughing? Nauses?
4) Are you coughing up large amounts of blood (massive hemoptysis)?
5) Is the sputum blood-tinged, or are there actual clots of blood?
6) Is the cough worse at night?
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7) What other symptoms do you have? ( night sweats, shortness of breath,
palpitations, irregular heartbeats, hoarseness, weight loss, sweeling in your leg)
8) Do you smoke?
9) Have you ever had tuberculosis?
10) Is there a family history of coughing up blood?
3. The etiology of dyspnea
Dyspnea involves a sensation of difficult or uncomfortable breathing or a feeling of
not getting enough air. Dyspnea has many different causes. Obstruction of the air
passages of the nose, mouth, or throat may lead to difficulty breathing. Heart disease
can cause breathlessness if the heart is unable to pump enough blood to supply
oxygen to the body. Sometimes emotional distress, such as anxiety also can lead to
difficulty breathing.
4. History taking of dyspnea.
1) How long has the breathing difficulty been present?
2) Did it begin recently? Did it begin suddenly? Did it slowly progress over weeks
to months?
Did it come on slowly (gradual onset)? Is there a sequence of separate
occurrences (episodes)? How long does each last, and does each episode have a
similar pattern?
3) Has the breathing difficulty worsened recently?
4) Does breathing difficulty cause you to awaken at night (paroxysmal nocturnal
dyspnea)?
5) Does breathing difficulty occur at rest? With exertion? Lying flat? Sitting up?
Is it worse with a change in body position?
6) what makes the shortness of breath worse? What relieve it?
7) Did it develop within several hours after exposure to something that you are or
may be allergic to (antigen)? Does shortness of breath occur only when wheezing?
8) What other symptoms are also present? ( fever, cough, coughing up blood, chest
pain, palpitations, hoarseness)
9) Do you smoke? If so, how much? For how long?
[ Training]:
Divided into several groups for training.
[Tools]
1) Multimedia video
2) Standardized patients
Jaundice
[Objectives]
1. Should master the concept, clinical manifestations and history taking of jaundice.
2. Should be familiar with the mechanism of jaundice.
3. Should learn about the common causes of jaundice.
[Contents]
1. the concept, mechanism and clinical manifestations of jaundice
1) concept: Jaundice, also referred to as icterus, is the yellow staining of the skin and
scleraby abnormally high blood levels of the bilirubin.
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2) mechanism and clinical manifestations: the presence of jaundice can be caused
either by liver parenchymal disease or an obstruction to bile flow. Obstruction to bile
flow can result from intraheptic biliary obstruction or from extrahepatic biliary
obstruction. Jaundice can be accompanied by abdominal pain, loss of appetite, fever,
chills, nauses, vomiting, weight loss and the changes of color in urine and stools.
2. History taking of jaundice.
1. How long have you been jaundiced?
2. Did the jaundice develop rapidly?
3. Is the jaundice associated with abdominal pain ? loss of appetite? Nausea?
Vomiting? Fever? Chills? Weight loss?
4. Do you eat any raw shellfish?
5. Have you been jaundiced before?
6. Has your urine changed color since you noticed that you were jaundiced?
7. What is your color of your stools?
8. Ddo you have any friends or relations who are also jaundiced?
3. The common causes of jaundice.
Cirrhosis Of The Liver, Gallstones , viral hepatitis, Liver Cancer , Pancreatic Cancer
Pancreatitis, Primary Biliary Cirrhosis , Gallbladder Cancer.
[ Training]:
Divided into several groups for training.
[Tools]
1) Multimedia video
2) Standardized patients
Hematuria
[Objectives]
1. Should master the concept and clinical manifestations of hematuria.
2. Should master the history taking of hematuria.
3. Should learn about the common causes of hematuria.
[Contents]
1. The concept, clinical manifestations of hematuria.
Hematuria means blood in the urine. Microscopic hematuria indicates that the
blood is only seen when the urine is examined under a microscope, while gross (or
macroscopic) hematuria means that there is enough blood in the urine so that it can be
seen with the naked eye.
2) History taking of hematuria.
1. How long have you noiced red urine?
2. Have you had red urine previously?
3. Have you noticed that urine starts red and then clear? Starts clear and then turns
red? Is red thoughout?
4. Have you noticed clots of blood in the urine?
5. Have you done any severely strenuous physical activity recently?
6. Did you have respiratory infection or a sore throat a few weeks ago?
7.Is the red urine associated with flank pain? Abdominal pain? Burning on
urination?fever? weight loss?
16
8. Are you taking any medications?
3) The common causes of hematuria.
Since blood in the urine must come from one of the organs involved in making or
transporting the urine, the evaluation of hematuria requires that we consider the entire
urinary tract that includes the kidneys, ureters (the tubes that carry the urine from the
kidneys to the bladder), bladder, prostate, and urethra (the tube transporting urine out
of the bladder). There are multiple causes of blood in urine. Some are serious,
including cancers, trauma, stones, infections, and obstructions of the urinary tract.
Others are less important and may include viral infections, nonspecific inflammations
of the kidney, medications which thin the blood's clotting ability, and benign prostate
enlargement.
[ Training]:
Divided into several groups for training.
[Tools]
1) Multimedia video
2) Standardized patients
Fever
[Objectives]
1. Should master the concept and clinical manifestations of fever.
2. Should master the history taking of fever.
3. Should learn about the common causes of he fever.
[Contents]
1) The concept and clinical manifestations of fever.
Normal body temperature varies by person, age, activity, and time of day. The average
normal body temperature is 98.6°F (37°C). Fever means elevated body temperature.
Fever is part of the body's own disease-fighting arsenal. Rising body temperatures
apparently are capable of killing off many disease-producing organisms. Fever may
occur with almost any type of infections and some noninfective diseases.
2) History taking of fever.
1. How long has the fever lasted?
2. Is it increasing? Is it increasing rapidly?
3. Has the fever gone away?
4. How long did it take for the fever to go away?
5. Do you have alternating chills and fever?
6. How frequently does it alternate (days, hours)?
7. Did it occur within four to six hours after exposure to something that you might be
allergic to?
8. Does the fever follow an up-and-down pattern (is it high, then lower, then high)?
9. Did it develop suddenly?
10. Does the temperature go up and down suddenly (spike) or does it change slowly?
11. Does it go away and then come back again daily?
12. associated symptoms: cough and expectoration, hemoptysis, chest pain,
abdominal pain, vomiting, diarrhea, frequent urination, headache. joint pain.
3) The common causes of fever.
17
Infective fever: infections are the most common causes of fever, such as Bacterial
Infection, Virus Infection, Parasite Infection, mycoplasma Infection, choamydiae
infection.
Noninfective fever: fevers have a long list of other noninfective causes such as cancer,
rheumatic fever, hyperthyroidism, cerebral hemorrhage. Fever can occur in infants
who are in hot weather or a hot environment.
[ Training]:
Divided into several groups for training.
[Tools]
1) Multimedia video
2) Standardized patients
Seizure
[Objectives]
1. Should master the concept and clinical manifestations of seizure.
2. Should master the history taking of seizure.
3. Should learn about the common causes of seizure.
[Contents]
1) The concept and clinical manifestations of seizure.
A seizure is a sudden change in behavior due to an excessive electrical activity in
the brain. There are a wide variety of possible symptoms of seizures, depending on
what parts of the brain are affected. Many types of seizures cause loss of
consciousness with twitching or shaking of the body. Occasionally, seizures can cause
temporary abnormal sensations or visual disturbances. Seizures can generally be
classified as either "simple" (no change in level of consciousness) or "complex"
(change in level of consciousness). Seizures may also be classified as generalized
(whole body affected) or focal (only one part or side of the body is affected).
2) The history taking of seizure.
1. Did it occur or start on one side of the body?
2.Was there movement of the muscles and if so, what was the pattern?
3.Are there any risk factors (such as recent head injury)?
4. Was consciousness maintained during the seizure? How long did you lose
consciousness?
5.How long did the seizure last?
6. What are the frequency of the seizures?
7. Was there any warning (aura) of the seizures?
8. Were there any other symptoms present (visual changes, abnormal smells, nausea,
headache)?
9. How did you feel after the episode? Did you notice that you wet your pants
afterwards?
10. Did you have anything like this before?
3)The common causes of seizure.
Any condition that results in abnormal electrical excitation of the brain may result in a
seizure, including:Epilepsy , Injury or trauma to the head , Infection (brain abscess,
18
meningitis) , Brain tumor , Stroke. Also, any medical condition that irritates brain
cells may result in a seizure.
[ Training]:
Divided into several groups for training.
[Tools]
1) Multimedia video
2) Standardized patients
1. History taking under specific situations
2. Symptom:change in consciousness
[Objectives]
1. Should master the adaptive techniques to specific situations.
2. Should master the concept and clinical manifestations of change in consciousness.
3. Should master the history taking of change in consciousness.
4. Should learn about the common causes of change in consciousness.
[Contents]
1. The adaptive techniques to specific situations.
Interviewing patients may precipitate several behaviors and situations that seem
particularly perplexing which need adaptive techniques such as: the silent patient,
the talkative patient, the anxious patient, the crying patient, the confusing patient,
the angry or disruptive patient, the patient with a language barrier, the patient with
limited intelligence, the patient with coma.
2. The concept and clinical manifestations of disturbance of consciousness.
Changes in consciousness may be related to changes in attention span, perception,
arousal, or a combination. In confused states, the patient has the ability to receive
information normally, but the processing is disturbed.
3. The history taking of change in consciousness.
1. Did the change occur suddenly?
2. Have there been other symptoms associated with the change in consciousness?
3. Do you use any medications? ( depressant, insulin )
4. Is there a history of psychiatric illness?
5. Is there a history of kidney disease? Liver disease? Thyroid disease?
6. Have you ever had an injury to your head?
4. The common causes of change in consciousness.
[ Training]:
Divided into several groups for training.
[Tools]
1) Multimedia video
2) Standardized patients
19
Guideline of Clinical Procedures
Introduction, Cardiopulmonary Resuscitation (CPR), Electric Defibrillation
[Objectives]
1. Should master indications, contraindications and performance of cardiopulmonary
resuscitation (CPR) and electric defibrillation.
2. Should familiarize Cardiopulmonary Resuscitation Criteria. Should familiarize
different kinds of defibrillators and their characteristic. Should familiarize the
announcements of cardiopulmonary resuscitation (CPR) and electric defibrillation.
3. Should learn about the basic principles and purposes of clinical procedures.
[Hours]: Theory 1 hour, Practice 2 hours
[Contents]
1. Indications, contraindications, performance, clinical significance and
announcements of cardiopulmonary resuscitation (CPR).
2. Different kinds of defibrillators. Indications, contraindications, performance and
announcements of electric defibrillation.
3. Demonstrate cardiopulmonary resuscitation (CPR) and electric defibrillation.
4. Divided into several groups for training.
[Tools]
1. Multimedia video
2. Medical simulated devices
Endotracheal Intubation, Thyrocricocentesis,
Hand-Compressible Breathing Bag Method
[Objectives]
1. Should master the performance of endotracheal intubation, thyrocricocentesis and
hand-compressible breathing bag method.
2. Should familiarize the indications and contraindications of hand-compressible
breathing bag method.
3. Should learn about the clinical significance and clinical application of endotracheal
intubation and thyrocricocentesis.
[Hours]: Theory 1 hour, Practice 2 hours
[Contents]
1. Indications, contraindications, performance, announcements and clinical alert of
endotracheal intubation and thyrocricocentesis.
2. Performance, announcements and clinical significance of hand-compressible
breathing bag method.
3. Demonstrate endotracheal intubation, thyrocricocentesis and hand-compressible
breathing bag method.
4. Divided into several groups for training.
[Tools]
1. Multimedia video
2. Medical simulated devices
20
Sputum Suction, Oxygen Therapy, Aerosol Inhalation
[Objectives]
1. Should master performance and announcements of sputum suction, oxygen
therapy and aerosol inhalation.
2. Should familiarize the indications, contraindications and clinical alert of sputum
suction, oxygen therapy and aerosol inhalation.
3. Should familiarize the guiding principles of acute and chronic oxygen therapy.
Should familiarize the clinical significance of oxygen intoxication.
4. Should learn about common complications of sputum suction, hypoxia causes,
kinds of aerosol inhalation and its clinical application.
[Hours]: Theory 1 hour, Practice 2 hours
[Contents]
1. Indications, contraindications, performance, clinical alert and announcements of
oxygen therapy
2. Demonstrate oxygen therapy
3. Divided into several groups for training.
[Tools]
1. Multimedia video
2. Medical simulated devices
Urinary Catheterization, Indwelling Catheter
[Objectives]
1. Should master performance of urinary catheterization and indwelling catheter.
2. Should familiarize the indications, contraindications and clinical alert of urinary
catheterization and indwelling catheter.
3. Should learn about the clinical significances and clinical application of urinary
catheterization and indwelling catheter.
[Hours]: Theory 1 hour, Practice 2 hours
[Contents]
1. Indications, contraindications, performance and clinical alert of urinary
catheterization and indwelling catheter.
2. Demonstrate urinary catheterization and indwelling catheter.
3. Divided into several groups for training.
[Tools]
1. Multimedia video
2. Medical simulated devices
Gastric Intubation, Gastrointestinal Decompression, Venopuncture, Arteriopuncture
[Objectives]
1. Should master performance of gastric intubation, gastrointestinal decompression,
venopuncture and arteriopuncture.
2. Should familiarize the indications, contraindications, performance and clinical alert of
gastric intubation, gastrointestinal decompression, venopuncture and arteriopuncture.
3. Should learn about the clinical significances and clinical application of gastric
intubation, gastrointestinal decompression, venopuncture and arteriopuncture.
21
[Hours]: Theory 1 hour, Practice 2 hours
[Contents]
Indications, contraindications, performance and clinical alert of gastric intubation,
gastrointestinal decompression, venopuncture and arteriopuncture.
2. Demonstrate gastric intubation, gastrointestinal decompression, venopuncture and
arteriopuncture.
1.
3. Divided into several groups for training.
[Tools]
1. Multimedia video
2. Medical simulated devices
Thoracentesis, Lumbar Puncture
[Objectives]
1. Should master performance of thoracentesis, lumbar puncture.
2. Should familiarize the indications, contraindications, clinical application and clinical
alert of thoracentesis, lumbar puncture.
3. Should learn about related preclinical medical knowledge of thoracentesis, lumbar
puncture.
[Hours]: Theory 1 hour, Practice 2 hours
[Contents]
1. Indications, contraindications, performance and clinical alert of thoracentesis, lumbar
puncture.
2. Demonstrate thoracentesis, lumbar puncture.
3. Divided into several groups for training.
[Tools]
1. Multimedia video
2. Medical simulated devices
Abdominal Paracentesis, Bone Marrow Puncture
[Objectives]
1. Should master performance of abdominal paracentesis, bone marrow puncture
2. Should familiarize the indications, contraindications, clinical application and clinical
alert of abdominal paracentesis, bone marrow puncture
3. Should learn about related preclinical medical knowledge of abdominal
paracentesis, bone marrow puncture
[Hours]: Theory 1 hour, Practice 2 hours
[Contents]
1. Indications, contraindications, performance and clinical alert of abdominal
paracentesis, bone marrow puncture
2. Demonstrate abdominal paracentesis, bone marrow puncture
3. Divided into several groups for training.
[Tools]
1. Multimedia video
2. Medical simulated devices
22
Gynecology Examination, Obstetric Examination
[Objectives]
1. To master the inspection, use of vaginal speculum, bimanual examination, vaginal
discharge examination, Papanicolaou smears of cervical exfoliative in cytology,
etc. in gynecology examination. To master series of examination methods in
obstetric examination in learning the status of fetus and obstetric canal, including
height of uterus, abdominal circumference, fetal heart tones, Leopold's maneuver
and external pelvimetry.
2. To familiar with matters needing attention and key operation point in gynecology
examination and obstetric examination
3. To learn the objectives of gynecology examination and obstetric examination.
[Hours]: Theory 1 hour, Practice 2 hours
[Contents]
Objectives of gynecology examination and obstetric examination, Matters needing
attention, examination method and procedure
[Tools]
1. Multimedia video
2. Medical simulated devices
Electrocardiogram I (ECG I )
[Objectives]
1. Should master the mechanism of cardiac electrical stimulation (depolarization and
repolarization)
2. Should master basic ECG complexes and basic ECG measurements.
3. Should familiarize the operation of electrocardiograph.
4. Should familiarize the ECG diagnosis of first degree and second degree
atrioventricular block (I AVB, II AVB).
5. Should learn about the ECG diagnosis of third degree atrioventricular block (III
AVB).
6. Should learn about the clinical significances of ECG diagnosis.
[Hours] Theory 1 hour, Practice 2 hours
[Contents]
1. The mechanism of cardiac electrical stimulation and its clinical application.
2. Basic ECG complexes and basic ECG measurements.
1) P, QRS, ST and T waves, PR interval, QT interval
2) Normal Sinus Rhythm
3) Electrical Axis and axis deviation
3. Taking an ECG and make an diagnosis
4. ECG diagnosis of atrioventricular block (AVB I, II, III)
5. Divided into several groups for reading the ECG pictures.
[Tools]
1. Multimedia video
2. Electrocardiograph
23
3. ECG pictures
ECG ( II )
[Objectives]
1. Mastering the ECG diagnosis of premature atrial contraction (PAC) and premature
ventricular contraction (PVC).
2. Mastering the ECG diagnosis of atrial fibrillation (af) and ventricular fibrillation
(vf).
3. Familiarizing the ECG diagnosis of supraventricular tachycardia (SVT) and
ventricular tachycardia (VT),
[Hours] Theory 1 hour, Practice 2 hours
[Contents]
1. ECG characteristics and diagnostic basis of premature atrial contraction (PAC) and
premature ventricular contraction (PVC).
2. ECG characteristics of atrial fibrillation (af) and ventricular fibrillation (vf) and its
clinical significance.
3. ECG characteristics of supraventricular tachycardia (SVT) and ventricular
tachycardia (VT).
4. Divided into several groups for reading the ECG pictures.
[Tools]
1. Multimedia video
2. ECG pictures
ECG (III)
[Objectives]
1. Mastering the ECG diagnosis of myocardial ischemia.
2. Mastering the ECG diagnosis of acute myocardial infarction (AMI).
3. Mastering localization and period of acute myocardial infarction
4. Learning about the mechanism of myocardial ischemia and acute myocardial
infarction
[Hours]
Theory 1 hour, Practice 2 hours
[Contents]
1. ECG characteristics of myocardial ischemia.
2. ECG characteristics of transmural acute myocardial infarction.
3. ECG changes of acute myocardial infarction and its analysis.
4. The mechanism of myocardial ischemia and acute myocardial infarction.
5. Divided into several groups for reading the ECG pictures.
[Tools]
1. Multimedia video
2. ECG pictures
24
Urine and Kidney Function Test
1. Uronoscopy
[Objectives]
1) Familiar with the uronoscopy clinical application, urine specimen collection and
deliver.
2）Grasp urine characteristics,the content of chemical and microscopy, reference
values and its clinical significances.
[Hours] Theory 2 hours
[Contents]
Uronoscopy application, urine specimen collection and storage.
1) General trait test: volume, color, odors, specific gravity.
2) Chemical examination: protein, glucose, ketobody.
3) Microscopy: leucocytes, erythrocytes, epithelial cells, cast, crystalline solid.
4) Others: appearance of erythrocytes, protein electrophoresis, immunoglobulins, B2
microglobulin, urinary amylase.
2. Kidney Function Test
[Objectives]
Familiar with the kidney function test’s principles, grasp its reference values and its
clinical significances.
[Hours] Theory 2 hours
[Contents]
1) detection the function of kidney glomerulus
(1) renal clearance rate: endogenous creatinine clearance rate
(2) serum creatinine and urea nitrogen assay.
(3) glomerular filtration rate assay, serum B2 microglobulin assay, serum uric acid
assay.
2) Tubular function test: renal concentration and dilution test
3) The selection and application principles of Kidney Function Tests
Liver Function Tests
[Objectives]
Handle liver function tests concept and clinical significance.
[Hours] 2 hours.
[Contents]
1. Basic concept
2. Tests of protein metabolism: TP Alb
3. Serum protein electrophoresis
4. Liver enzymes: Alanine Aminotransferase, Aspartate Aminotransferase,
Retio of ALT and AST
5. Markers of Cholestasis: Alkaline Phosphatase, Gamma Glutamic Transpeptidase
6. Markers of alcohol use
7. Bilirubin
8. Prothrombin time
25
9. Viral hepatitis: Hepatitis A, Hepatitis B, Hepatitis C
10. Case analysis
CBC Tests
[Objectives]
Handle the concept of CBC tests and its clinical significance.
[Hours]
2 hours
[Contents]
1. RBC examination: The clinical significance of RBC counts and Hemoglobin
detection
2. The clinical significance of morphology of RBC and RBC index
3. The Clinical significance of Reticulocyte and blood sedimentation
4. WBC examination: WBC counts and differentiate counts significance
Clinical Pathogen Examination
[Objectives]
1. Mastery learning of the basic procedure of clinical pathogen examination including
gathering, transmission and test for report.
2. Understand the methods for in-vitro antibiotic susceptibility testing and the
principals of antibiotic use in clinic.
3. Know well common pathogen of community-acquired Infection, nosocomial
infection and sexually transmitted diseases, test items and their clinical significance.
[Hours] Theory 2 hours
[Contents]
1. Fundamental procedure of clinical pathogen (blood, serum, cerebrospinal fluid,
urine, Nasopharyngea swab, stool，genitourinary tract specimens and abscesses
specimens, serum etc) check including collection, transport and medical evaluation of
clinical laboratories
2. Common clinical pathogens tests (bacteria, mycoplasma, chlamydia, richettsia,
leptospira, virus, fungi, parasite, etc)
3. Immunological methods of infection etiological examination
4. Pathogen detection of sexually transmitted disease (gonorrhea, syphilis, AIDS,
Non-neisseria gonorrhoeae urethritis, herpes progenitalis, verruca acuminata )
5. The mechanism of bacterial drug resistance, methods for in-vitro antibiotic
susceptibility testing with the explaination of the results and the principals of
antibiotic use in clinic.
6. Epidemiology of nosocomial infections (hospital acquired infection) and the
detection of the common pathogen that can lead to nosocomial infections.
[Methods]
1. Identify the fundamental procedure of clinical pathogen check (sample Collection
and transport and important notice ). Make clear the importance of the collectting and
transporting of sample for the clinical pathogen diagnosis.
2. Explain the common pathogen of community-acquired Infection, nosocomial
26
infection and sexually transmitted diseases, detection of pathogen and the clinical
significance.
3. Give a presentation about the mechanism of bacterial drug resistance, methods for
in-vitro antibiotic susceptibility testing, the results of the testing and the principals of
antibiotic use in clinic.
4. Multimedia teaching.
Clinical biochemistry examination
[Objectives]
1. Familiar with the commonly used chemical examination
2. Familiar with the reference value and clinical significances.
[Hours] 2 hours
[Contents]:
1. Detection of blood glucose and its metabolites: Oral glucose tolerance test(OGTT);
Detection of serum c-peptide; Detection of glycosylated hemoglobin.
2. Detection of serum lipid and lipoprotein: total cholesterol; Triglyceride; High
density lipoprotein cholesferol; Low density lipoprotein cholesterol;
Apolipoprotein a1; Apolipoprotein B.
3. Detection of serum electrolyte: K,NA,Cl,Ca,P，Anion equivalent test.
4. Enzyme and myocardial protein detection: creatine kinase and isoenzyme,
Creatine kinase heterotypic, lactate dehydrogenase and isoenzyme, troponin T,
troponin I, myoglobin.
5. Others: acid phosphatase, diastase, choline esterase.
Morphous of Hematocyte
[Objectives]
1. To recognize the morphous of erythrocyte in the blood slide.
2. To grasp the differential count of leukocyte and recognize the morphous of
leukocyte (normal and abnormal ones).
[Hours] 3 hours.
[Contents]
1. The preparation and dyeing of peripheral blood slide.
2. The differential count of leukocyte.
Routine and biochemistry examination of choline esterase hydrops,
cerebrospinal fluid
1 Examination of choline esterase hydrops:
[Objectives]
Grasp the dropsy of serous cavity`s indications and its clinical significances,
authentication of the transudate and diffusate.
27
[Hours]:1 hour.
[Contents]:
1) conception of the dropsy of serous cavity, indications and its clinical significances.
2) Detection content
(1) General trait test: volume, color, pellucidity, coagulability, specific gravity.
(2) Chemical examination: mucoprotein qualitation, albumen quantitation ,
glucose quantitation, enzymatic activity.
(3) Microscopy: cell Count, cell divide, examination of castoff cell.
(4) Bacteriology
3) authentication of the transudate and transudate, transudate features.
2 Examination of cerebrospinal fluid
[Objectives]
Grasp the dropsy of cerebrospinal fluid `s indications and its clinical significances,
cerebrospinal fluid features.
[Hours] 1 hour.
[Contents]
1) CSF indication and contraindication, the request of CSF specimen collection and
deliver.
2) Detection content
(1) General trait test: color, pellucidity, coagulability.
(2) Chemical examination: albumen equalizations and quantization, glucose
quantitation, chlorides quantitation and enzyme labeled compound assay.
(3) Microscopy: cell Count and divide.
(4) Bacteriology
3 Common feature of CSF
General Immunologic Test
[Objectives]
Familiar with the immunologic test and clinical application.
[Hours] 2 hours
[Contents]
1. Introduce immunologic test overview and progress.
2. immunologic tests and its clinical significances.
(1) humoral immunity examination: serum immune globulin, complement
examination.
(2) cellular immunity examination: T cell, B cell, NK cell, IF examination.
(3) tumor marker detection
(4) autoimmunity
28
Bone Marrow Cytomorphologic Examination
[Objectives]
1. To understand the indication, contraindication, clinical significance and
sending-examination-request of bone marrow cytomorphologic examination.
2 .To understand the morphous and differential count of bone marrow cell.
[Hours] 3 hours.
[Contents]
1. Clinical significance of bone marrow cytomorphologic examination.
2. The general morphous developing rules in the maturation process of haemocyte.
3. The normal morphous of erythroid cells, granular leukocytes, megacaryocyte,
plasmocyte and reticulum cell.
4. Normal bone marrow appearance.
[Methods]
1. Teaching way: teach the morphous and clinical significance of bone marrow cell
using teaching aid.
2. Microscope demonstration: 1) the younger age of erythroid cells and granular
leukocytes, megacaryocyte, plasmocyte and reticulum cell; 2) bone marrow
appearance of high accrementition and low accrementition; 3)bone marrow
appearance of AML, CML, aplastic anemia and hyperplasia anemia.
3. Observation of the normal bone marrow slides.
[Self-study contents] Hematology character of common blood disease, immunology
grouping of leukemia and cell genetics analysis.
Syllabus of the basic surgical skills
Probation and demonstration in the operation room
[Purpose and requirement]
1. To learn the rules and procedures of entering the operating room
2. To be familiar with the division of work, responsibility and security precaution of surgical
personnel.
3. To master the aseptic requirements of the operating room, surgical personnel and patients.
4. To be familiar with anesthesia and the common methods, and learn the significance of
intraoperative monitoring.
[Teaching hours]
4 hours
[Introduction of lecture content]
Grouping probation by the teachers and the operating room staff
1. Washing hands, wearing aseptic surgical gowns, disinfection and draping.
2. Division of work and responsibility of surgical staff, the position of different surgical staff on
the operation table
3. Aseptic technique during the operation
4. Co-operation between the main surgeon and other surgeons, between instrument nurse and
circuit nurse
29
[Content for self-study]
<The Surgery Basic Operation> page 33~49
Asepsis and Isolation technique
[Purpose]
1. To know the role and difference of asepsis and isolation technique
2. To be familiar with the role of asepsis during the operation or various maneuvers.
3. To grasp the common ways of washing hands
4. To grasp the methods of wearing the barrier gown on and undressing.
[Teaching hours]
Four
[Teaching and training content]
1. Aseptic technique and Isolation technique. The division of the surgical region, and isolation
and asepsis regulation.
2. to introduce the common ways of washing hands(Hand-washing method by soap and soaking
with ethanol, Hand-washing method by Soap and soaked with bromogeramine, Hand-washing
method by iodophor, Hand-washing method by swashes，hand-washing method during
consecutive operation , hand-washing method for emergent operation). Practice the
hand-washing method by soap and soaking with ethanol.
3. Practice wearing sterile surgical clothing and gloves
4. Introduce the methods of wearing the barrier gown on and undressing, and practicing.
[Content for self-study]
1. <The Surgery Basic Operation> page 33~34
2. <The operational procedures of Clinical Basic Skills> page 75~85
The basic surgical skills I
[Purpose]
1. To know the name of commonly used surgical instruments, and their structural features and
the proper practicing methods.
2. To be familiar with knotting and delivering suture, and classification of knots
3. To understand the methods of surgical knotting.
[Teaching hours]
Four hours
【Learning contents】
1. To introduce scalpel, surgical scissors, forceps, surgical pliers, needle forceps and other nip
apparatuses, suture needle, surgical suture, ecarteur, suction.
2. To explain the use of the general apparatus and try to practice.
3. To recognize various kinds of knots（mon-knot, square knot, triplication knot or multiplication
knot, surgical knot, false knot, running knot）.
4. To practice three common methods used for surgical square-knot tying: one-hand tying,
two-hand tying, and the instrument-tying technique.
30
【self-learning contents】
1. 《Essential Surgical Skills》page 12~28，50~56.
2. 《Essential Clinical Skills Regulations》page 92~95.
The basic surgical skills 2
【learning objectives】
1. To know the basic surgical skills (incision, separation, suture, homeostasis, ligation) through
teaching video.
2. To understand the principle of surgical skills (incision, separation, suture, homeostasis,
ligation).
3. To master the skills of the incision, separation, suture, ligation, dermal suture out, detaining
and removing drainage tube in vitro tissue.
【learning time】
Four hours.
【learning contents】
1. To explain the principles of surgical skills (incision, separation, suture, homeostasis, ligation).
2. To practice the skills of the incision, separation, suture, ligation, dermal suture out, detaining
and removing drainage tube in vitro tissue.
3. To use surgical instruments correctly after mastering surgical skills.
4. To practice the correct method of dermal suture out.
【self-learning contents】
1.《Essential Surgical Skills》page 59~66.
2.《Essential Clinical Skills Regulations》page 85~92.
The basic surgical skills 2
【learning objectives】
1. To know the skills of microsurgery (micro-incision, micro-separation, micro instrument-tying
technique, micro-traction and exposion technique, micro-homeostasis, micro-debridement).
2. To understand the basic skills of microsurgery, the principles of microsuture,
microneuroanastomosis and free flap transplantation.
【learning time】
Four hours.
【learning contents】
1. The surgical features of operating microscope.
2. The skills of micro-operative technique.
3. know how to do microsuture, microneuroanastomosis and free flap transplantation.
4. Practice the skills of micro-incision, micro-separation, micro instrument-tying technique,
micro retracting and exposing technique, micro homeostasis, micro debridement.
Animal operation 1
31
Teaching Objective
1 To understand the clinical role and indications about intravenous and tracheotomy incision
operation
2 To be familiar with equipment and operating methods about intravenous and tracheotomy
incision operation
3 To master operating steps and precautions about intravenous and tracheotomy incision
operation
Teaching hours
4 hours
Teaching and training content
1 To explain the clinical indications, operating steps and precautions about intravenous and
tracheotomy incision operation
2 to practice surgical operation about catch and fixed, anesthesia and intravenous and tracheotomy
incision operation on the dog
Own learning content
< Basic surgical operation> in page from 79 to 86.
Animal operation 2
Teaching Objective
1 To understand Clinical application about debridement suture and rib resection
2 To be familiar with the basic principles and surgical points of debridement suture and rib
resection
3 To master operating steps and precautions about debridement suture and rib resection
Teaching hours
4 hours
Teaching and training content
1 To explain the basic principles, surgical points, operating steps and precautions about
debridement suture and rib resection
2 To practice debridement suture and rib resection using animal model in wound
Self-study content
< Basic surgical operation> in page 87and 88.
Animal operation 3
Teaching Objective
1 To understand Clinical application about Appendectomy (on dog) and surgical repair for
gastrointestinal perforation
2 To be familiar with surgical points and operating steps about Appendectomy (on dog) and
surgical repair for gastrointestinal perforation
3 To master operating steps and precautions about Appendectomy (on dog) and surgical repair for
gastrointestinal perforation
4 To learn how to write operative records (Appendectomy for example)
Teaching hours
4 hours
32
Teaching and training content
1 To explain surgical points, operating steps and precautions about Appendectomy (on dog) and
surgical repair for gastrointestinal perforation
2 To practice appendectomy surgery in dog and surgical repair for gastrointestinal perforation
using animal models of gastrointestinal perforation
Self-study content
Animal operation 4
[Teaching objectives]
1. To know the anatomy of the intestine.
2. To familiarize the basic method and operative steps of the intestinal anastomosis.
3. To master various methods of suturing with intestine tissue in vitro.
[Teaching hours] 4 hours
[Contents of lecture and training]
1. To know the basic methods and operative steps of the intestinal anastomosis.
2. Various methods of suturing with intestine tissue in vitro. (whole layer inversion suture of
posterior wall, interrupted whole layer inversion suture of anterior wall, interrupted inversion
suture of anterior and posterior seromuscular layer)
[Self-study contents]
Page 89~91 in 《Basic operation of surgery》
Animal operation 5
[Teaching objectives]
1. To know the clinical application of intestinal resection and end-to-end anastomosis.
2. To familiarize the methods and notice of intestine resection and end-to-end anastomosis.
3. To master the methods and the operative steps of intestinal resection and end-to-end
anastomosis.
[Teaching hours] 4 lectures
[Contents of lecture and training]
1 To explain the methods, the operative steps and the notice of intestine resection and end-to-end
anastomosis.
2. operation of intestine resection and end-to-end anastomosis on dogs.
[Self-culture contents]
Page 94~95 in 《Basic operation of surgery》
Basic skills of celioscope surgery
[Teaching objectives]
1. To know the equipments and clinical application of celioscope operation.
2. To be familiar with the instruments and basic skills of celioscope operation..
3. To master the basic methods of celioscope operation.
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[Teaching hours] 4 lectures
[Contents of lectures and training]
1. To know the equipments, instruments, basic skills and clinical application of celioscopic
operation.
2. Training the basic procedures of celioscope operation on dummy celioscopic equipments.
[Self-study contents]
Page 329~333 in 《Surgery》for 7-year master
The application of basic skills on various majors.
[Teaching objectives]
1. To be familiar with the managements and characteristics of basic operative skills in various
majors.
2. To be familiar with the operative characteristics of various majors.
3. To know the application of the microsurgery and celioscopic operation
[Teaching hours] 4 lectures
[Contents of lecture and training]
1. To explain the characteristics of common operations in various departments.
2. To select the operative video of various specialty on internet. To view the common and
different steps of basic operations, for example, laparotomy, thoracotomy，craniotomy,
ophthalmotomy，plastic surgery, and so on.
[Self-culture contents] To browse the surgical video on internet of 《 Clinical skill 》
(http://202.192.145.9)
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