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西医执业(助理)医师考试培训课件_1

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西医 执业 助理 医师 考试 培训 课件 _1
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单击此处编辑母版标 题样式 单击此处编辑母版副标题样式 1 执 业 医 师 考 试 内 部 辅 导 资 料 体 格 检 查 部 分 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 实践技能考试 n第一站 笔试 n 1 病史采集 11分钟 15分 n 2 病例分析 15分钟 22分 考试方法 笔试 n第二站 操作 口试 n主考医师在考生进行操作时或操作后 提出相关 问题 n 1 体格检查 13分钟 20分 n 2 技能操作 11分钟 20分 考试方法 操作 口试 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial n第三站 电脑操作 n辅助检查结果分析 15分钟 23分 心肺听诊各 分 考试形式 多媒体 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 第二考站内容 体格检查与基本操作技能 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 第二站考试基本要求 顺序清楚 部位准确 方法正确 操作规范 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 全身体检重点考核查体的系统性和触 诊 叩诊的手法 考试方法采用医学教学模拟人 专用 考试设备或考生相互进行操作 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 09年新增内容 n临床操作考试增加试题设计中增加医 德医风 医师职业素质考察 占2分 要注意预先告知 态度和蔼 关心体 贴患者 让病人配合 不要紧张 注 意保暖 保密 给病人检查完要感谢 病人配合 单击此处编辑母版标 题样式 单击此处编辑母版副标题样式 8 体格检查 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 基本检查方法 n 视诊 n 触诊 n 冲击触诊法 腹水 n 深压触诊法 麦氏点 n 双手触诊法 肝 脾 肾 n 叩诊 间接叩诊法 n 听诊 呼吸音 心音 n 嗅诊 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 测血压 l通常测右上肢血压 使患者右上肢裸露伸直并轻度外展 肘部置于心脏同一水平 l气袖均匀紧贴皮肤缠于上臂 约在肘窝以上约3cm处 将 听诊器胸件置于肱动脉搏动处 不能塞在气袖下 l向气袖内充气 边充气边听诊 待肱动脉搏动声消失 水 银柱再升高20 30mmHg后 缓慢放气 双眼观察汞柱下降 平视汞柱表面根据听诊结果读出血压值 l同样的方法测定两次 间歇1分钟左右 取其较低值 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 浅表淋巴结 1 颈部淋巴结检查 l 1 检查时 嘱被检查者头稍低 或偏向检查侧 放松肌肉 有利触诊 l 2 医师手指四指并拢紧贴检查部位 由浅及深进行滑动 触诊 一般顺序 耳前 耳后 乳突区 枕骨下区 颈后 三角 颈前三角 2 锁骨上淋巴结检查 l 1 被检查者取坐位或仰卧位 头部稍向前屈 l 2 检查者用左手触病人右侧 右手触病人左侧 由浅部 逐渐触摸至锁骨后深部 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 浅表淋巴结 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 浅表淋巴结 3 腋窝淋巴结检查 l 1 检查腋窝时面对被检查者 l 2 检查者以右手触诊被检查者左侧腋窝 左手检查右 侧腋窝 并用另一手将被检查者前臂稍外展 l 3 由腋窝顶部自上而下检查 顶部 内 外 前 后壁 4 腹股沟淋巴结检查 l 1 被检者平卧 检查者站在被检者右侧 l 2 右手四指并拢 以指腹触及腹股沟 由浅及深滑动 触诊 l 3 先触摸腹股沟韧带下方水平组淋巴结 再触摸腹股 沟大隐静脉处的垂直组淋巴结 左右腹股沟对比检查 5 触及淋巴结时能表述 部位 大小 质地 数量 活 动度 有无粘连 压痛 局部皮肤变化等八项 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 眼 眼球运动 对光反射 n 对光反射 间接 直接 n 直接对光反射是将光源直接照射被检查者 瞳孔 观察瞳孔变化 n 间接对光反射是指光线照射一眼时 另一 眼瞳孔立即缩小 移开光线 瞳孔扩大 间接对 光反射检查时 应以一手挡住光线 以防光线照 射到要检查之眼而形成直接对光反射 n 集合反射 n 令被检者先注视 m远处目标 然后检查者逐 渐移动目标至眼球稍前方 被检者可出现双眼内 聚 瞳孔缩小 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 眼 n 眼球运动 n 检查者置目标物 如棉签或手指尖 于受检 查者眼前30 40cm 嘱病人头部不动 眼球随目 标物方向移动 一般按左 左上 左下 右 右 上 右下6个方向的顺序进行 n 眼球震颤 n 嘱被检查者头部不动 眼球随医师手指所示 方向垂直 水平运动数次 观察眼球是否出现一 系列有规律的快速往返运动 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 咽 扁桃体 n扁桃体按其大小可分为三度 一度扁桃体肿大不超过咽腭弓 二度扁桃体肿大超过咽腭弓 三度扁桃体肿大超过咽后壁中线 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 颈部 甲状腺 n 1 甲状腺视诊 观察甲状腺的大小 对称性 正常人甲状腺外观不突出 增大时可 随患者的吞咽动作而向上移动 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 颈部 甲状腺 n 2 甲状腺触诊 n 甲状腺峡部触诊 分前面触诊和后面触 诊 前面 检查者站于受检查者前面用拇指 后面 检查者站于受检者后面用示指 从胸骨上切迹向上触摸 可触到气管前软 组织 判断有无增厚 此时请受检者作吞咽动作 可感到此软组 织在手指下滑动 判断有无增大和肿块 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 颈部 甲状腺 n甲状腺侧叶触诊 分为前面触诊和后面触诊 前面触诊 被检者取坐位或仰卧位 检查者站于受检查者前面 一手拇指施压于一叶甲状软骨 将气管推向对侧 另一手示 中指在对侧胸锁乳突肌后缘向前推挤甲状腺 侧叶 拇指在胸锁乳突肌前缘触诊 受检者配合吞咽动作 重复检查 可触及被推挤的甲状 腺 用同样方法检查另一叶甲状腺 注意在前位检查时 检查者拇指应交叉检查对侧 即右拇 指查左侧 左拇指检查右侧 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 颈部 甲状腺 甲状腺侧叶触诊 后面 后面触诊 被检者取坐位 检查者站在被检查者后面 一手示 中指施压于一叶甲状软骨 将气管推向 对侧 另一手拇指在对侧胸锁乳突肌后缘向前推挤甲状 腺 示 中指在其前缘触诊甲状腺 再配合吞咽动作 重复检查 用同样方法检查另一侧甲状腺 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 颈部 甲状腺 n甲状腺触诊内容 肿大程度 对称性 硬度 表面光滑或 有无结节 压痛感等 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 颈部 甲状腺 n 3 甲状腺听诊 当触到甲状腺肿大时 将钟型听诊器 直接放在肿大的甲状腺上 低调的连续静 脉 翁鸣音 对诊断甲状腺功能亢进很有 帮助 在弥漫性甲状腺 肿伴功能亢进者还能 听到收缩期动脉杂音 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 胸部 视诊 l体表标志 胸廓 l呼吸运动 胸式呼吸以肋间肌的运动为主 l呼吸频率 正常人静息状态下12 20次 分 l呼吸节律 正常成人静息状态下 呼吸的节律基 本上是均匀而整齐的 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 胸部 肺 触诊 1 胸部 肺 的触诊内容 胸廓扩张度 语音震颤 胸膜摩擦感 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 胸部 2 触诊手法 胸廓扩张度双手触诊方法 l 前胸廓扩张度的测定 左右拇指分别沿两侧肋 缘指向剑突 拇指尖在前正中线两侧对称部位 两手掌和伸展的手指置于前侧胸壁 l 后胸廓扩张度的测定 则将两手平置于被检查 者背部 约于第10肋骨水平 拇指与中线平行 并将两侧皮肤向中线轻推 嘱被检查者作深呼吸 观察比较两手感触到胸廓的 活动度情况 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 胸部 语音震颤触诊 n 检查者将左右手掌的尺侧缘轻放于被 检查者两侧胸壁的对称部位 然后嘱被检查者用 同等强度重复轻发 yi 长音 n 自上至下 从内到外比较两侧相应部 位 两手感触语音震颤有无异同 增强或减弱 胸膜摩擦感 n 操作手法同胸廓触诊 部位常于胸廓的下前侧 部 当被检查者吸气和呼气时均可触及 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 胸部 胸部 肺 叩诊内容 肺上 下界 肺下界移动度 胸 肺 叩诊手法 n 1 间接叩诊 该法目前最为普遍 以左中指的第一 二节作为叩诊板指 平紧贴于叩击部位表面 右手中指以右腕关节和指 掌关节活动叩击左手中指第二指骨的前端或第一 第二之间的指关节 n 2 直接叩诊手指方法 检查者用中指掌侧或将手指并拢以其指尖对被 检查者胸壁进行叩击 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 胸部 叩诊顺序 前胸 首先检查 由锁骨上窝开始 自第一 肋间隙从上至下逐一肋间隙进行叩诊 侧胸壁 其次检查 嘱被检查者举起上臂置 于头部 自腋窝开始向下叩诊至肋缘 背部 最后叩诊 嘱被检查者向前稍低头 双手交叉抱肘 自上至下进行叩诊 叩诊时应左右 上下 内外对比叩音的变化 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 胸部 肺 肺上 下界的叩诊 n 1 肺上界 自斜方肌前缘中央部开始 叩诊为清音 后分别由中央逐渐叩向外侧 和内侧 当由清音变为浊音时 即为肺上 界的外侧终点 和内侧终点 该清音带的 宽度即为肺尖的宽度 正常为5cm n 2 肺下界 平静呼吸时位于锁骨中线第6 肋间隙上 腋中线第8肋间隙上 肩胛线第 10肋间隙上 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 胸部 肺 肺底移动度的叩诊 背 患者在平静呼吸时 检查者先于被检 查者肩胛线叩出肺下界的位置 然后嘱被检查者作深吸气后并屏住呼吸的同 时 沿该线继续向下叩诊 当由清音变为浊音时 即为肩胛线上肺下界的最低点 并做记号 当患者恢复平静呼吸时 再嘱作深呼气 并屏住呼吸 然后由上向下叩诊 直至清音变为 浊音 即为肩胛线上肺下界的最高点 并做记号 n最高点至最低点间的距离即为肺下界移动度 n正常人肺下界移动范围为6 8cm Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 胸部 肺 n肺部听诊四种主要音 正常呼吸音 异常 呼吸音 罗音 胸膜摩擦音 胸部 肺 听诊 n听诊的顺序一般由肺尖开始 自上而下分 别检查前胸部 侧胸部 背部 而且要在 上下 左右对称部位进行对比 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 胸部 肺 l正常呼吸音 1 支气管呼吸音 正常人于喉部 胸骨上窝 背部第6 7 颈椎及第1 2胸椎附近均可听到支气管呼吸音 且越靠近 气管区 其音响越强 音调亦越低 2 支气管肺泡呼吸音 正常人于胸骨两侧第1 2肋间隙 肩胛区第3 4胸椎水平以及肺尖前后部可听及支气管肺泡 呼吸音 3 肺泡呼吸音 为一种叹息样的或柔和吹风样的 fu fu 声 在大部分肺野内均可听及 l胸膜摩擦音 最常听到的部位是前下侧胸壁 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 胸部 心脏 胸部 心脏 视诊 1 视诊内容 心前区隆起 凹陷 心尖搏动 心前区异 常搏动 并指出其部位 正常心尖搏动位于第5肋间 左锁骨中线内0 5 1 0cm 搏动范围以直径计算为2 0 2 5cm 通常明显可见 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 胸部 u 2 心脏视诊方法 被检查者仰卧位 暴露胸 检 查者在其右侧 开始时检查者视线与被检查者 胸廓同一水平线上 以切线方向观察心前 区有无隆起及异常搏动 然后 视线逐步高于胸廓 全 面观察心前区 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 胸部 心脏 心前区异常搏动 u1 胸骨左缘第3 4肋间搏动 右心室肥 大象征 u2 剑突下搏动 由右心室收缩期搏动产 生的多见于右心室肥大或肺气肿 如由腹 主动脉搏动产生的见于腹主动脉瘤 u3 心底部异常搏动 胸骨左缘第2肋间 肺动脉瓣区 收缩期搏动 多见于肺动脉 扩张或肺动脉高压 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 胸部 心脏 心脏触诊 1 触诊内容 心尖区搏动 震颤 心包摩擦感 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 胸部 心脏 2 触诊手法 l 检查者右手掌置于被检查者心前 区开始触诊 l 然后逐渐以手掌尺侧小鱼际或示 指 中指 环指并拢 以其指腹进行触诊 以确定心尖搏动的准确位置 强度和有无抬 举性 l 触诊时手掌按压力度适当 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 胸部 心脏 l心尖搏动 触诊震颤 心包摩擦感的触诊手法 l 在心尖搏动区 可用单一示指指腹 确认心尖搏 动位置 l 震颤 用手掌或手掌尺侧小鱼际肌平贴于心 前区各个部位 以触知有无微细的震动感 常见于 某些先天性心血管病及狭窄性瓣膜病变 l 心包摩擦感 用上述触诊手法在心前区胸骨左 缘第4肋间触诊 以前倾位 收缩期 呼吸末 摒 住呼吸时更为明显 见于急性心包炎 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 胸部 心脏 n心脏间接叩诊 n 1 心脏叩诊手法 以左手中指为叩诊板指 平置于心 前区拟叩诊的部位 被检查者取平卧位 检查者左手板指 与肋间平行 以右手中指藉由右腕关节活动叩击扳指 以 听到声音由清变浊来确定心浊音界 n 2 心脏叩诊顺序 先叩左界 后右界 由下而上 由 外向内 n 左界叩诊 左侧在心尖搏动外2 3cm处开始叩诊 逐个肋间向上 直至第2肋间 n 右界叩诊 先叩出肝上界 然后于其上一肋间由 外向内 逐一肋间向上叩诊 直至第2肋间 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 胸部 心脏 n正常人心相对浊音界 n右 界 cm 肋 间 左 界 cm n2 3 2 3 n2 3 3 5 4 5 n3 4 5 6 n 7 9 n 左锁骨中线距胸骨中线为8 10cm Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 胸部 心脏 心脏听诊 n心脏瓣膜听诊区 心脏各瓣膜开放与关闭时所产 生的声音传导至体表最易听清的部位称心脏瓣膜 听诊区 n 1 心脏瓣膜各听诊区 5个 位置 二尖瓣区 位于心尖搏动最强点 又称心尖区 肺动脉瓣区 在胸骨左缘第2肋间 主动脉瓣区 位于胸骨右缘第2肋间 主动脉瓣第二听诊区 在胸骨左缘第3肋间 三尖瓣区 在胸骨下端左缘 即胸骨左缘第4 5 肋间 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 胸部 心脏 n 2 听诊顺序 从二尖瓣区开始 肺动脉区 主动脉区 主 动脉第二听诊区 三尖瓣区 逆时针方向 或称倒8字 n 3 心脏听诊主要内容 心率 心律 心音 和额外心音 杂音 及心包摩擦音等 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 外周血管检查 n 脉搏 n 周围血管征 水冲脉 脉搏骤起骤落 急促而有力 将被检者 上肢高举过头 更易触到 多见于主动脉关闭不 全发热 贫血 甲亢等 因脉压增大所致 枪击音 将听诊器体件放在肱动脉或股动脉处 可听到 嗒 嗒 音 见于主动脉关闭不全 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 腹部 腹部视诊 n 1 腹部的体表标志 肋弓下缘 腹上角 腹中线 腹直肌外缘 髂前上棘 腹股沟 脐 n分区 四区分法 九区分法 9区法 上面的水平线 为两侧肋弓下缘连线 下面的水平线 为两侧髂前上棘的连线 通过左右髂前上棘至腹中线连线的中点划两条垂直 线 四线相交将腹部分为左 右季肋部 左 右腹 腰 部 左 右髂窝部 及上腹部 脐部和下腹部9 个区域 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 九分法 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 腹部 2 视诊主要内容 腹部外形 膨隆 凹陷 呼吸运动 腹壁静脉 胃肠型和蠕动波 其他 皮疹 色素 瘢痕 疝等 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very substantial 腹部 3 视诊方法 被检查者平仰卧 充分暴露全腹 双 腿屈曲 嘱被检查者放松腹肌 检查者在 其右侧 检查者视线与被检查者腹平面同水平 自侧面呈切线方向观察 再提高视线自上而下视诊全腹 Five weeks of practice ended in this way and my feelings can only be summed up in eight words although hard but very
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