ie after the onset of the general state of

skills to operate
§ The first station (written)
§ (1) history taking 15 hours 11 minutes § (2) Case of 20 hours 15 minutes 22 minutes this year, the second leg of § (operation + Oral)
§ (1) Physical examination 18 points 20 points this year, time 13 minutes § (2) skills to operate 20 hours 11 minutes § The third station (computer) § 27 sub-tests this year, multimedia 23 hours 15 minutes 2 8 marks cardiopulmonary auscultation
Image 3 of 6 marks
Question 7 points 2 ECG
Scoring 2 points
medical ethics】:
hands of each examiner has a standard answer manual, the first leg of the methods used by one to the sub.
Examiner will answer one by one according to the standard found on the responses of candidates,
find give the corresponding points,
incomplete answers to the appropriate points,
can not find do not give points,
and answer not be deducted.

1) history collection
history collection problem is the disease based on the outline requirements together, and generally have more than 50 questions to the candidates pumping channel. Answer to have skills, making the collection of any symptoms are the following
1, is history: includes the following 5
◎ causes, incentives
the characteristics of the main symptoms
◎
◎ associated symptoms
◎ body condition, ie after the onset of the general state of
◎ treatment after
2. Past history
◎ ◎ history of drug allergy-related medical history, surgical history (be sure to mention, the annual assessment criteria are the)

The following format is a one size fits all, answer the following format
(a) of the history
1. According to complaints and inquiries related to identification
①
②
③
④
⑤
2. Clinic after
① ever been to hospital for treatment, made those checks
② treatment how
(b) of the relevant history
1. with or without history of drug allergy
2. others associated with the disease history:
【inquiry must be rational when strong, like a good write, do not increase again after the chaos and therefore lost points. complaints to ask around, and sometimes complained of is not simply to make a diagnosis, but still have a tendency to nature,
such as: inclinations differ, these still rely on accumulated knowledge,
more than two sub-sub-section must be written,
Because the examiner workload, see written a bunch of, not in the mood slowly find Beginning of a book is not neat, sloppy handwriting, especially at a disadvantage.
There are two points is structured and whether the inquiry is focused on the chief complaint asked. Is to see people completely changed the mood to roll divided.

first question to ask incentives. Most of the candidates on the cough, vomiting asked a chief complaint of these more comprehensive, but forget to ask incentives. This referred to the sub-standard as long as the word incentive to all to the point.
The main symptoms and associated symptoms
The development of the disease and then asked, scope and requirements will not exceed the top of the fifth edition of diagnosis about the symptoms accompanying each interrogation point.
After the next clinic to ask, generally two hours, almost half of the candidates forget that as long as the reference to the sub-standard is Check if asked to do anything, what drugs used, give all divided.
Finally, 2 general, relevant medical history
mainly refers to the past history of family and personal history some of the elements of the disease, such as upper gastrointestinal bleeding, she asked whether or not cirrhosis, blood-sucking insects (This is easy to forget), drinking history, etc..
have to ask each disease history of drug allergy, or the minutes to the white buckle.
syllabus
body condition: fever, pain, weight loss, disturbance of consciousness, shock
Respiratory: dyspnea, cough and sputum production, hemoptysis
digestive system: nausea, vomiting, vomiting blood, blood in the stool, diarrhea, jaundice
Other: heart palpitations, seizures, oliguria, polyuria, hematuria
fever Zhenti example
Brief history: Male, 56 years old, fever and right lower limb skin red, painful day
requirements: you as a resident, according to the standard admission cases, to focus on the above complaints, please How to write a history of asking the patient and relevant content is.

Total: 15 First, the interrogation content (13 points) (a) The history (10 points) 1. According to complaints and inquiries related differential (8 points) ① predisposing factors, whether the athlete's foot, skin damage, etc. (1 point) ② fever cases, the specific temperature, with or without chills (2 points) ③ lower limb skin red, pain characteristics, such as clarity of the scope of the border, has swelling, fluid flow, the nature of pain, for walking with no effect (2 points) ④ associated symptoms: whether the symptoms of systemic poisoning (2 points) ⑤ the two will be, diet, sleep (1 point) 2. After treatment (2 points) ① ever been to hospital for check off those (1 point) ② how the treatment (1 point) (b) relevant history (3 points) 1. with or without history of drug allergy (1 point) 2. others associated with the disease history : whether a similar attack, with or without diabetes, liver disease, filariasis (2 points)
case analysis
Answering Skills?? Difficulties in diagnosis and differential diagnosis ---
Difficulties --- auxiliary examination and further treatment
Diagnosis is based on scoring points ---
--- Usually a solid foundation of basic points
Breakthroughs over the years Zhenti ---
answer format
a preliminary diagnosis and diagnosis is based
(a) the initial diagnosis
(b) the diagnosis is based
Second, the differential diagnosis
Third, further examination
four treatment principles
full diagnosis must write to the primary and secondary order. Secondary inspection should pay attention to history and clues provided in each of the various systems are not many diseases, it is easy to judge them, especially in surgery and obstetrics and gynecology, less disease, once drawn, then what can be concluded immediately disease. basically are all the first diagnosis, but the risk of hypertension should be graded sub-group to sub-type 1 diabetes type 2, type of angina should be . To ensure clear diagnosis of the left and right, acute, chronic, diffuse, limitations, etc.
Secondary diagnosis to write the whole, the value of some basic laboratory tests should also be aware, Hb low will write anemia, low potassium will write hypokalemia. Rather more not less.
diagnosis to write with no penalty, but not too far, otherwise the impression may be deducted points, resulting in a later review in the strict points.
diagnosis is based on: if more than the initial diagnosis, diagnostic evidence in answer, we should answer separately for each diagnosis is based on an initial diagnosis based on
diagnosis according to symptoms, signs, laboratory examinations points stated below .
is not based on diagnosis, please put the contents of the conversation most probably taking on a sub-item answer.
Differential diagnosis should focus on the lesion location and characteristics of written several diseases, generally have three or four, if you really do not understand, it will be several similar diseases to write it. There is no easy way out of the way, to see the usual accumulation.
Do not write short! Eg: MDS, RCC and other, medical examiners may not know the abbreviation of surgery, the same surgical medical instructors do not necessarily know the abbreviation.
Further examination: easy to answer incomplete,
such as pancreatitis, pancreatic B-do, CT is no doubt, but the blood to see, the electrolyte is to measure the calcium indicator of disease severity, it. There is no organ damage secondary to liver and kidney function also depends, ECG it .
If not sure, to open temporary medical advice in accordance with disease, three conventional, ECG chest ........ something to think about as long as they are written on. The most important auxiliary examination, but also the highest score , but also change the volume of people looking for, please write in the first. Key to write the treatment principles of treatment, and must have priorities. Note Do not forget to support the treatment, and some relapse prevention, health education and other projects dealing with principles. It can not write, but also write general treatment, rest, oxygen and other nonsense, partakers of.
If the history all wrong, the wrong diagnosis may also followed the wrong treatment, but the treatment was on the stick side can get the standard answer to the little score, if the entire deduction, and helpless. --- Syllabus Respiratory Medicine: Pneumonia ; lung cancer; tuberculosis; chronic obstructive pulmonary disease, bronchial asthma
Digestive system: peptic ulcer; gastrointestinal tumors; cirrhosis and primary liver cancer
circulatory system: heart disease, hypertension, heart failure
blood system: anemia; leukemia;
Urinary System: urinary tract infection, acute and chronic glomerulonephritis, chronic renal failure
Endocrine system: diabetes mellitus, hyperthyroidism
Other: acute toxicity, systemic lupus erythematosus surgery gallstones, cholecystitis;
Acute abdomen (intestinal obstruction, gastrointestinal perforation, pancreatitis, acute appendicitis)
Blunt abdominal injury (gallbladder, liver, spleen, intestine, kidney rupture);
Urolithiasis;
Closed chest injuries (rib fracture, hemothorax, and pneumothorax);
Extremity long bone fracture and dislocation of large joints;
Bone and joint disease (osteoarthritis, septic arthritis) and infectious pediatric closed head injury in children with diarrhea, ######ually transmitted diseases, viral hepatitis; bacillary dysentery;
Purulent meningitis (meningococcal meningitis) For example
female, 64 years old, intermittent abdominal distension, stop defecation, discharge with abdominal pain 2 months, adding to 5 days of emergency admission. Patients with more than 2 months, no obvious incentive to intermittent episodes of abdominal pain bloating, stop defecation, each episode a week or so, the medication and symptomatic treatment, or after infusion can still be mitigated. 5 days ago, the re-attack, the symptoms get worse, medication is invalid, and the previous increase, no bowel movement recently, no exhaust, vomiting one, and vomiting as the stomach contents, can not eat. Since the onset, fatigue, weight loss, no fever. No previous history of tuberculosis and surgical. examination: T 37.4 ℃, P 70 beats / min, R 20 beats / min, BP 140/90mmHg chronic tolerance, Shen Qing, the skin a little relaxation, flexibility can still, superficial lymph nodes not touched, no scleral jaundice. The cardiopulmonary examination was normal. Whole abdomen was bulging, and no gastrointestinal type, call-in drums, liver and spleen not palpable, the whole abdomen with mild tenderness, no muscle tension. Faintly deep left lower abdomen and mass, about 5cm diameter, real ######y , mass mild tenderness. Shifting dullness (-), bowel sounds active. Auxiliary examination: Hb 130g / L, WBC 5.3 × 109 / L x ray abdominal plain film: right upper quadrant shows liquid-gas surface
§ (a) diagnosis
§ 1. bowel obstruction (Incomplete). (3 points)
§ 2. left the possibility of large colon. (2 points)
§ (b) the diagnosis is based
§ 1. abdominal distension, intermittent exhaust stop defecation and vomiting. (1 point)
§ 2. whole abdominal swelling, left lower abdominal mass, bowel sounds active. (1 point)
§ 3. abdominal plain film shows liquid-gas surface, suggesting intestinal obstruction. (1 point)
§ Second, the differential diagnosis: 5 points
§ 1.Corhn disease. (2 points)
§ 2. sigmoid reversed. (2 points)
§ 3. intestinal tuberculosis. (1 point)