诊断学学习资料：实习指导(英文).doc

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THEPRACTICINGGUIDANCEOFDIAGNOSTICS
GRADE:
CLASS:
GROUP:
THEDIAGNOSITICSDEPARTMENT
OFSUNYAT-SENUNIVERSITY

CATALOGUE
CHAPTER1Thereportofnormalphysicalexamination
Generalexaminationandtheexaminationofheadandneck1
Thenormalthoraxandlungexamination3
Thenormalcardiovascularexamination4
Thenormalabdomen,spineandextremitiesandnervousreflexed5
CHAPTER2Laboratorytest
Hematologicaltest6
Bonemarrowtest7
Urinanalysis17
Thereportofbloodandurinetest22
CHAPTER3CaseDiscussion
Theteachingoncasediscussion27
Casediscussion29
CHAPTER1theReportofNormalPhysicalExamination
GeneralExaminationandtheExaminationofHead,Neck
Generalinspection:Development:;Bodytype;Nutrition;Mentalstatus;Facialexpression;Position:;Gait
Skin:Color;Temperature;Moisture;Elasticity,Rashes,Pigmentation:;Subcutaneousbleeding:;Purpura:;Spiderangioma:;Scar:.
Lymphnodes:.
Theenlargedlymphnode:
Head:Exteriorappearance;Shape;Hair;Color;gloss
Face:Color;Tenderness;Abnormalmotion
Eye:Eyebrow;Eyelids:;Themovementofeyeballs,Proptosis;Recession::Conjunctiva:;
Sclera:;Cornea:;Iris:;Convergencereflex:
Pupils:Size;Shape:;Symmetry:;Lightreflex:;
Accommodationresponse:
Ear:Exteriorappearance:;Hearingacuity:;Thetendernessofmastoid:;Abnormalsecretion:
Nose:Exteriorappearance:;Abnormalsecretion:;Thetendernessofnasalvestibule:;Thenasalpassage:
Mouth:Odor:;Llip:,Cranny:;Breakage:;Herpes:
Tongue:Thrills:;Deviation:;Fur:
Gingival:Color:;Edema:;Purulence:;Bleeding:;Breakage:;Blueline:;Others:
Left(upward)
Right
Teeth:
Mucosaofmouth:;Herpes:;Pigmentation:;Breakage:;Others:
Oropharynx:Palatum:;Palatalach:;Uvular:;Tonsil:;Retropharyngealbackwall:
Neck:Exteriorappearance:;Malformation:;Themovement:;Thevenousinasittingposition:;Thepulseofjugularvessel:;Thethyroidgland:;Thetrachea:Examiner:
Examiner:
Date:
TheReportofExaminationofNormalChestandLungs
Inspection:
Palpation:
Percussion
Auscultation
Examiner:
Date:
TheReportofExaminationofCardiovascularSystem
Inspection:
Palpation:
TheRelativeCardiacDullnessofHealthyAdult
Right(cm)
Chestinterspace
Left(cm)
II
III
IV
V
Percussion
Auscultation
Examiner:
Date:
TheReportofExaminationofNormalAbdomenandNeurologicalReflex
Inspection:
Palpation:
Percussion
Auscultation
Spineandextremities
Neurologicalreflexes
Examiner:
Date:
CHAPTER2Laboratoryexamination
Laboratoryexaminationofhematology
ⅠDifferentialwhitebloodcellcount(differentialleukocytecount)
:
Asmearwasprepareddirectlyfromadropofblood,.
:Wright-Giemsa’sstain,microscope,cedaroil,aether,alcohol(75%V/V),slide,steriledisposablelancet,cottonballorcottonswab,lenspaper,sterileforceps,suctionbulb.
:
1)Obtainingcapillaryblood:Obtaincapillarybloodfromthirdfingertip,disinfecttheskinsurfaceonandaroundtheintendedpuncturesitewith75%alcohol,drythesite,andpunctureskinwithsteriledisposablelancetNonedeeperthan3mmtoresultinfreebleeding,.
2)Preparingasmear:Touchtheslidetoseconddrop,,,pushthespreaderforwardwithasteadyevenmotion.
3)Air-.
4)Staining:Placethebloodsmearonthestainingrack,bloodsideup,andfloodedwithWright--20minutes(theoptimumtimeisdeterminedbytrailanderror)..
5)Microscopicexamination:Atfirst,,usuallynearthethinend,.
:
1)Wipeawaytheinitialdropofbloodtoavoidcontaminatingtheendothelialcellsfromtheimpairedbloodvessel.
,thebloodfilmwillfalloff.
2)Theconcentrationofstainsolution,roomtemperature,,scantheslideandjudgethequalityofstainingunderthelowpowerlens.
3)Applyingadequatestainsolutiononthesmeartopreventfromtheprecipitationofalittledyespot.
4).
5)Donotleavethetailingofbloodfilmoutstainingbecausetherearesomelargecells(megakaryocyteandsomespecificpathologiccellsforinstancetumorcells)inthisportion.
6)Toavoidaccidentallycountingthesamefieldtwice,movethemicroscopestageinaconsistentdirection,straightuporstraightdown,andwhenneartheedgeofthesmear,movethestagetotheright,.
Table1NormalValuesofHemogram
Adults
Children
male
female
Redbloodcellcount
(RBC,1012/L)
~
~
~
Whitebloodcellcount
(WBC,109/L)
~
Newborn15~20,6~24mo11~12
Hemoglobin(Hb,g/L)
120~160
110~150
Newborn170~200
Reticulocytecount(%)
~
Newborn2~6
Differential
leukocyte
count
(%)
Neutrophils
Band
neutrophils
1~5
Segmented
neutrophils
50~70
Eosinophils
~5
Basophils
0~1
Lymphocytes
20~40
monocytes
3~8

Practicalreportofdifferentialleukocytecount
Celltype
Normalvalue(%)
10
10
10
10
10
10
10
10
10
10
Totalofcells
NeutrophilicGranulocyte
myelocyte
0
Meta-
myelocyte
0
Bandneutrophils
1~5
Segmentedneutrophils
50~70
Basophils
0~1
Eosinophils
~5
Lymphocyte
20~40
Monocyte
3~8
ⅡMorphologicexaminationofthebonemarrowcells
Bonemarrowexaminationisusedforthediagnosisorthedifferentialdiagnosisofanumberofhematologicdisorders(definitediagnosis,).Andbonemarrowaspirationisusuallycontraindicatedintheprecenceofhemophiliaandotherseriouscoagulationdisorders.
Procedureandobjectstobeobserved:

1)Exminationwithlowpowerlens:scanthewholeslidestodetermine
2)Whetherthepreparationofthesmear(collectionofpattern,smearing,andstaining)issatisfactory.
3)Proliferativedegreeofbonemarrownucleatedcells(shownintable2).
4)Numberofthemegakaryocyteonthewholeslide.
5)Presenceorabsenceofspecificcells.
:
1)Differentiateandcountatleast200nucleatedcells,notethenumberandtheshape(morphous)ofthesenucleatedcells.
2)Calculatethepercentofhematopoieticcells(differentstagesfromgranulocytic,erythrocytic,lymphocytic,andmonocyticseries).
3)CalculatetheG:Eratio(granulocytetoerythroidratio)orM:E(myeloidtoerythroidratio).
4)Viewthemegakaryocyteandplatelet.
5)Notethepresenceorabsenceofparasiteandspecificcells().
6)Observetheshapeofmatureerythrocyte.
7)Morphologicexaminationofthebloodcells:asdescribedabove.
Table2TheCategoryofProliferativeDegreesofBoneMarrow
Proliferativedegree
Erythrocytes:nucleatedcells
Usualcause
Extremeactiveproliferation
1:1
Leukemia,erythroleukemia
Obviousactiveproliferation
10:1
Leukemia,hyperplasticanemia
Activeproliferation
20:1
Normalbonemarroworsomeanemia
hypoplasia
50:1
Somehypoplasticanemia
Extremehypoplasia
200:1
Acuteaplasticanemia
Normalfeaturesofbonemarrow
:activeproliferation.
%-60%,inallnucleatedcells,myeloblastsacountforlessthan2%,promyelocytesacountforlessthan5%,myelocytes,andmetamyelocytesaccountforlessthan15%and15%%and1%respectively.
%(pronormoblast)andbasophilicerythroblasts(normoblast)accountforlessthan1%and5%(normoblast)andorthochromaticerythroblasts(normoblast)accountforabout10%.Theshapeofmatureerythrocytesisnormalinbonemarrow.
:Eratioisabout2:1~4:1.
,allarethenormalmaturelymphocytes,accountforabout20%.%and2%respectively
,thereareafewnormalnon-hematopoieticcells.
.