In fact, the so-called universal formula is not omnipotent. It's just to help you clear up your thoughts on seeking medical treatment when your mind is blank and the topic is not common. When you take the exam, you must analyze specific problems, and you can't copy them mechanically. Remember!

Matters needing attention in answering questions in medical history collection:

1. Answer time is tight, so allocate time reasonably:

2. Answer the questions in strict accordance with the format: title, serial number and vertical arrangement.

Write neatly

4 diagnosis is not included in the score, but it cannot be out of line (such as respiratory symptoms diagnosed as urinary system diseases). Will the examiner deduct the impression score?

Case analysis and diagnostic formula

Diagnostic formula of digestive system diseases:

* * * Symptoms are the same: abdominal pain, diarrhea, nausea, vomiting and mass.

1. Acute and chronic gastritis = unclean diet or irritants+epigastric pain, abdominal distension, nausea and vomiting.

2. Gastroesophageal reflux disease = acid regurgitation+burning sensation behind sternum+gastroscopy of red strip erosion zone in lower esophagus (heartburn, acid regurgitation, eating)

3. Peptic ulcer disease

(1) Gastric ulcer = chronic regular epigastric pain (pain after a full meal)+hematemesis and melena.

(2) Duodenal ulcer = hunger pain (more than 4 hours after meals) or night pain+hematemesis and melena.

(3) Peptic ulcer perforation = sudden severe abdominal pain (signs of peritonitis)+X-ray with free gas under the diaphragm.

4. Esophageal and gastric varices = upper gastrointestinal bleeding+previous history of liver disease

5. Bacillary dysentery = unclean diet+abdominal pain+mucus purulent bloody stool+acute diarrhea and then severe diarrhea.

6. Ulcerative colitis = left lower abdominal pain+mucous purulent bloody stool+(defecation, relief after defecation)+antibiotic treatment ineffective treatment: sulfasalazine (SASP)

7. Acute pancreatitis (edema type) = overeating/chronic biliary diseases+persistent epigastric pain+relief of bending pain+amylase detection.

Acute pancreatitis (hemorrhagic necrotic type) = edema symptoms+purple spots around waist and hypochondrium+abdominal meat washing water sample+hyperglycemia+hypocalcemia.

(1) Hemorrhagic necrosis type: the amylase value in hematuria is not necessarily high, but sometimes it decreases. The first choice is to assist the examination of B-ultrasound and CT.

(2) Blood amylase was measured within one week, and lipase was measured for more than one week.

8. Pyloric obstruction = vomiting and eating+vibrating sound.

9. Liver cirrhosis = hepatitis history+portal hypertension (splenomegaly, ascites, spider nevus)+ultrasound (liver atrophy)

10. Cholecystitis = paroxysmal right epigastric colic+Murphy sign positive+nausea and vomiting.

1 1. Cholelithiasis = paroxysmal right epigastric colic+Murphy's sign positive +B super echo light mass and sound shadow.

12. Extrahepatic bile duct stones = Charcot triad (abdominal pain+chills and high fever+jaundice)

Acute infarction (acute obstructive suppurative cholangitis) = Charcot triad+shock manifestations+mental symptoms (such as apathy and coma).

13. Acute abdomen

(1) Appendicitis = metastatic right lower abdominal pain+Macmillan point tenderness (swelling pain, stuffy pain) +WBC =

(2) Intestinal obstruction = abdominal pain+vomiting+abdominal distension+closure +X-ray (banana/liquid level)

Etiology: mechanical (organic) and dynamic (intestinal paralysis, spasm)

Blood supply: simple and strangulation (with or without blood supply disorder, intestinal wall color)

Degree: complete and incomplete

Location: high position (above jejunum, vomiting bile); Low position (terminal ileum and colon, vomit stinks)

(3) Gastrointestinal perforation = history of ulcer+sudden epigastric pain+peritoneal stimulation+free gas under diaphragm.

(4) Ectopic pregnancy = vaginal bleeding+menopausal history+severe pain in lower abdomen (cervical pain)+chorionic gonadotropin (+)

(5) Torsion of ovarian cyst pedicle = posture change+sudden abdominal pain+cystic mass.

(6) Acute pelvic inflammatory disease = history of curettage+abnormal leucorrhea+lower abdominal pain+lower abdominal pain (cervical pain)+purulent secretion.

14. Tumors of digestive system

(1) Gastric cancer = old people+melena+niche shadow+regular change of chronic ulcer pain+epigastric pain+abdominal mass+emaciation+left supraclavicular lymph node enlargement.

(2) Esophageal cancer = progressive dysphagia (middle and late stage)+burning pain behind sternum (early stage)+choking while eating (early stage)

(3) Liver cancer = hepatitis history+liver pain +AFP↑+ hepatomegaly+ascites jaundice +B-ultrasound occupying.

(4) Rectal cancer = rectal irritation+bloody finger diagnosis+purulent bloody stool+emaciation+stool deformation.

(5) Pancreatic cancer (pancreatic head cancer, periampullary cancer) = elderly people+painless progressive jaundice+mud stool+itchy skin.

(6) Colon cancer = old people+emaciation+change of defecation habit +CEA+ abdominal mass (left, ulcer type/right. Quality type)

15. Benign diseases of anus and rectum

(1) Internal hemorrhoid = painless hematochezia+hematochezia+venous mass.

(2) External hemorrhoid = anal pain+bloody stool+anal tenderness lump.

(3) Anal fissure = anal pain after defecation+anal fissure.

16. Closed abdominal injury

Kidney injury = waist injury+hematuria

Liver rupture = right abdominal trauma+peritoneal irritation sign+mobile dullness

Spleen rupture = left waist trauma+total abdominal pain+intra-abdominal bleeding

Intestinal rupture = abdominal trauma+peritoneal irritation sign+egg yellow liquid puncture

17. External abdominal hernia (oblique hernia) = elderly male+increased abdominal pressure+right lower abdominal mass+scrotum.

▲ Further examination of digestive system diseases

1. Gastroscopy, colonoscopy and proctoscopy

2. Gastroenterography

3. Abdominal ultrasound and CT

4. Standing abdominal plain film

5. Feces: routine examination, occult blood, culture and parasite examination.

6. HP Inspection and Measurement

7. Abdominal puncture

8. Lymph node biopsy or liver biopsy (pathological examination)

9. Laboratory inspection:

(1) hematuria amylase-pancreatitis

(2)AFP, CEA, CA 19-9 carbohydrate antigen-tumor

(3) routine examination of hematuria, liver and kidney function, electrolyte and blood gas analysis

▲ Principles of digestive system treatment

First, the reasons for treatment

(1) Ulcer: PPI acid inhibitor is the first choice, and mucosal protective agent can be added if necessary.

Helicobacter pylori infection should be combined with sterilization, triple therapy or quadruple therapy.

PPI and colloidal bismuth combined with two antibiotics.

(2) Use broad-spectrum antibiotics for anti-infection treatment and anti-shock.

(3) Obstruction and peritonitis: fasting and gastrointestinal decompression.

(4) Maintain water, electrolyte and acid-base balance.

Second, symptomatic treatment: antipyretic and analgesic.

Third, surgery: resection or repair

Fourth, tumor.

(1) surgical treatment

(2) radiotherapy+chemotherapy+immunotherapy+traditional Chinese medicine treatment

Diagnostic formula of respiratory diseases:

1. Acute upper respiratory infection = sore throat+cough+fever.

2. Pneumonia

(1) Lobar pneumonia = adult+catching cold+high fever+coughing up rusty phlegm.

(2) Klebsiella pneumoniae = coughing up brick red sputum +X-ray cavity.

(3) Mycoplasma pneumonia = children+irritating dry cough+joint pain+ineffective antibiotics.

(4) bronchopneumonia = infant+fever+dyspnea (alar fan)

Dynamic and concave symbols are positive)

(5) Staphylococcus aureus pneumonia = high fever+chest pain+purulent blood sputum +X-ray flake shadow.

3. Tuberculosis

(1) Tuberculosis = young adults+hemoptysis+low fever in the afternoon+night sweats+antibiotics.

The treatment has no obvious curative effect.

(2) tuberculous pleurisy = tuberculosis+signs of pleural effusion (chest pain+tremor disappeared)

+Knocking sound/breathing sound disappears)

(3) Tuberculous pericarditis = tuberculosis+signs of pericardial effusion (precordial pain+dyspnea+flatulence in upper abdomen+edema in lower limbs)

(4) Intestinal tuberculosis = tuberculosis+abdominal symptoms (abdominal pain, diarrhea, right lower abdominal mass)

(5) Tuberculous peritonitis = tuberculosis+abdominal inflammation (abdominal pain, diarrhea, abdominal elasticity)

(6) Renal tuberculosis = tuberculosis+bladder irritation sign+renal parenchyma thinning and destruction.

4. Bronchiectasis = childhood history of measles, whooping cough or bronchopneumonia+cough+sputum+hemoptysis.

5.COPD= old people (smoking history)+cough, sputum, asthma+bucket chest+lung function examination (one-second rate FEV 1/FVC%50mgHg→ COPD induced.

1 1. Closed chest injury

(1) Tension pneumothorax = history of chest trauma+extensive subcutaneous emphysema (feeling of grasping snow)+organ deviation+percussion drums+disappearance of breathing sounds.

(2) hemothorax = history of chest trauma+organ deviation+dull percussion sound+weakened breathing sound+disappearance of costal diaphragm angle and arc high-density shadow on X-ray film.

(3) Rib fracture = history of chest trauma+bone rubbing sound.

▲ Examination items of respiratory diseases

1. Chest X-ray, chest CT

2.PPD，ESR

3. Sputum culture+drug sensitivity test, sputum to find mycobacterium tuberculosis

4. Lung function

5. Liver and kidney function

6. Blood gas analysis

7. fiberoptic bronchoscope

8. Sputum exfoliated cells examination

9. Lymph node biopsy

10. Blood routine, electrolyte

▲ Principles of respiratory system treatment

1. General treatment: rest, strengthen nutrition, prevent infection and take oxygen.

2. Symptomatic treatment/drug treatment

(1) Anti-infection treatment: use broad-spectrum antibiotics or combination drugs.

(2) Anti-tuberculosis treatment: early, combined, moderate, regular and full course.

(3) Anti-shock: dilating and using vasoactive drugs.

(4) control hemoptysis: pituitrin

(5) antipyretic, antitussive, antiasthmatic and expectorant effects

(6) Correct the acid-base imbalance

3. Tumors (lung cancer)

(1) surgical treatment

(2) radiotherapy+chemotherapy+immunotherapy+traditional Chinese medicine treatment

Diagnostic formula of circulatory system diseases:

1. Coronary heart disease = retrosternal crush pain

(1) angina pectoris = squeezing pain 30 minutes after sternum, which can't be relieved by rest or nitroglycerin in mouth+sweating+feeling of dying+electrocardiogram: st segment back arch is raised upward.

V 1 ~ V6 wide front wall

V 1 ~ V3 front partition

V3 ~ V5 finite front wall

V5 ~ V6 front side wall

Ⅱ, Ⅲ, aVF inferior wall

I. aVL high wall

Killip cardiac function classification: evaluation of cardiac function in patients with acute myocardial infarction

Grade I: no rales in the lungs.

Grade Ⅱ: lung rales less than 50%.

Grade ⅲ: lung rales in lung field are more than 50% (pulmonary edema).

Grade ⅳ: cardiogenic shock.

2. Hypertension = dizziness+palpitation+cardiac tightness+high systolic and diastolic blood pressure.

It is divided into three levels: 1 level: 140- 159/90-99.

Grade ii:160—179/100—109.

Grade III: 180/ 1 10 or above.

High risk and extremely high risk stratification

1 Level II and Level III

No other risk factors, low risk, medium risk and high risk.

1-2 Among the risk factors, medium risk is extremely high risk.

≥3 factors or high risk, high risk and extremely high risk of diabetes or target organ damage.

There are complications, very high risk, very high risk, very high risk

Extremely high risk: complications and grade 3

High risk: Grade 2+target organ damage

3. Heart failure = left lung (circulation), right body (circulation)

Left heart failure = coughing pink foam-like sputum+dyspnea (unable to lie flat at night, sitting up and breathing, after exercise)

Right heart failure = jugular vein dilatation+edema of both lower limbs+hepatomegaly

Classification of cardiac function (chronic heart failure)

New york classification: Level 1: unlimited daily.

Grade II: mild activity limitation.

Grade ⅲ: obviously limited in activity.

Grade Ⅳ: Symptoms appear at rest.

Left heart failure+right heart failure = complete heart failure

arrhythmia

(1) Atrial fibrillation = unequal absolute heart rate+short pulse +f wave+unequal intensity of the first heart sound.

(2) Paroxysmal supraventricular tachycardia = Paroxysmal palpitation+sudden stop+electrocardiogram (retrograde P wave, heart rate 160-250)

(3) Paroxysmal ventricular tachycardia = sudden palpitation+previous attack history+electrocardiogram (QRS wave with rapid and wide deformity for more than three consecutive times+ventricular capture/ventricular fusion wave)

(4) Others: See the ECG section of the third station.

5. Heart valve disease

(1) Mitral stenosis = dyspnea (exertion, paroxysm, nocturnal sitting, acute pulmonary edema)+acute massive hemoptysis, pink foam sputum+pear-shaped heart+rumbling murmur.

(2) Mitral valve insufficiency = acute left heart failure/chronic late left heart failure or complete failure+rough heart opening, full systolic blowlike murmur, which is transmitted to axilla or left scapular angle.

(3) Aortic valve stenosis = dyspnea+angina pectoris+syncope+jet murmur and transmitted to the neck.

(4) Aortic valve insufficiency = palpitation+angina pectoris+paroxysmal dyspnea at night+Austin.

Flint murmur+peripheral vascular sign (water pulse, Musset sign, obvious carotid artery fluctuation, capillary pulsation sign, arterial gunshot and Duroziez sign)

On-off valve murmur during valve appearance

Diastolic opening of mitral stenosis rumbles.

Systolic closure of mitral regurgitation

Systolic open jet for aortic stenosis

Diastolic phase of aortic insufficiency.

6. Signs of shock = P = writing+blood pressure ↓+rapid pulse+cold limbs.

(1) Hemorrhagic shock = shock signs+bleeding.

(2) Cardiogenic shock = shock signs+left heart failure

▲ Cardiovascular system examination

1. electrocardiogram and dynamic electrocardiogram

2. Ultrasonic cardiography

Step 3: chest radiograph

4. Fundus examination (hypertension), radionuclide

5. Myocardial enzyme spectrum

6. Blood gas analysis

7. Blood routine, blood lipid, blood sugar, blood potassium, liver and kidney function

8. Cardiac catheter

9. Coronary angiography

10. Markers of myocardial necrosis (myoglobin, troponin, CK-MB)

▲ Treatment principles of cardiovascular diseases

1. General treatment: pay attention to rest, change lifestyle (such as quitting smoking, low-sodium and low-fat diet, moderate exercise), monitor and care.

2. Hypertension:

(1) diuretics, calcium channel blockers, ACEI (angiotensin converting enzyme inhibitor), angiotensin receptor blockers.

(2) Inhibition of complications, such as heart failure, diabetes, cerebrovascular diseases, renal failure and coronary heart disease.

3. Coronary heart disease:

Symptomatic treatment: control arrhythmia, improve cardiac function and prevent myocardial infarction ⅱ.

Thrombolysis or interventional therapy

Control shock and correct heart failure

Anticoagulant and antiplatelet drug therapy: aspirin, heparin

4. Atrial fibrillation: drug cardioversion, using amiodarone. Slow down the ventricular rhythm and choose cedilanid.

5. Heart failure: diuretics, ACEI, beta blockers, positive inotropic drugs (digitalis: digoxin, cedilanid and non-digitalis, dopamine, milrinone) and pacemakers.

6. Valve diseases: etiological treatment, valve replacement, etc.

Diagnostic formula of urinary system diseases:

1. Glomerular diseases: eyelid/facial edema+adolescence+streptococcal infection +C3 reduction+hematuria, proteinuria+hypertension (compare: the difference between hepatic edema, cardiogenic edema and renal edema).

2. Urinary tract infection

(1) pyelonephritis = female+low back pain+fever+pyuria, leucocyte cast.

(2) Acute attack of chronic pyelonephritis = history of urinary tract injury+recurrent bladder irritation+low back pain+fever+renal percussion pain +WBC =

(3) Lower urinary tract infection = married women+fever+bladder irritation.

3. kidney calculi: hematuria+lumbago+B-ultrasound or X-ray after exercise.

4. Ureteral calculus: hematuria+lumbago+X-ray examination after exercise.

5. Kidney cancer: the elderly+(painless) gross hematuria.

6. Renal failure: many years of nephritis history+hematuria protein hypertension+increased serum creatinine (compensatory stage, long-term stage, failure stage, uremia stage).

7. Benign prostatic hyperplasia: elderly people+frequent urination+progressive dysuria.

▲ Examination of urinary system diseases

1. Abdominal ultrasound and plain film

2. Routine hematuria, erythrocyte sedimentation rate, renal function and blood gas analysis

3. Pyelography

4. Puncture biopsy

5. Gynecological examination

6. Serum creatinine and glomerular filtration rate

7. Renal function

8. Radionuclide renogram

9. Endoscope inside bladder

▲ Treatment principles of urinary system diseases

1. General treatment: pay attention to rest, low sodium/low protein diet.

2. Symptomatic treatment

(1) anti-infection

(2) diuresis and lowering blood pressure

(3) Dialysis

(4) Correct the acid-base imbalance between water and electrolyte.

3. Surgical treatment: surgical resection or incision.

4. Tumor (kidney cancer)

5. Hemodialysis treatment

Diagnostic formula of endocrine system diseases:

1. hyperthyroidism = palpitation+exophthalmos+emotional excitement+hyperhidrosis+goiter.

Examination: T3 \ T4 \ TSH13 Ⅱ thyroid nuclide

2. Thyroid tumor = goiter +B-ultrasound nodule

3. Diabetes = three more and one less, blood sugar measurement: fasting 7.0, after meals 1 1. 1, OGTT.

(1) 1 type diabetes = three more and one less+acute attack+teenagers+rotten apple flavor.

(2) Type 2 diabetes = middle-aged and elderly people+slow onset.

The difference between diabetes and ketoacidosis and hyperosmotic: the glycemic index is 33.3.

Examination: fructosamine, insulin release test, C peptide release test, glycosylated hemoglobin.

General treatment: life guidance, attention to diet, physical exercise, disease monitoring and prevention of complications.

Drug therapy: secretagogue: sulfonylurea -2 type is not obese, and diet and exercise control are not ideal; Biguanides-obese people

Insulin-1 type and type 2 complications

α -glucosidase inhibitor-postprandial hyperglycemia

Diagnostic formula of blood system diseases:

1. Leukemia = fever+bleeding tendency+sternal tenderness+pancytopenia

2. Aplastic anemia = anemia appearance+bleeding tendency+three reduction.

3. autoimmune hemolytic anemia = anemia +Coombs (anti-human globulin reagent) positive+splenomegaly.

4. Iron deficiency anemia = anemia appearance (pale skin and mucous membrane)+menorrhagia or digestive system tumor in women.

5. Idiopathic thrombocytopenic purpura = female+bleeding tendency+thrombocytopenia (

6.DIC= multiple bleeding +PT prolongation +3P test positive.

▲ Examination of blood system diseases

1. Bone marrow biopsy

2. Morphological examination of cells

3. Liver and kidney function, abdominal ultrasound

4. Blood routine

▲ Principles of treatment of hematological diseases

Treatment: general treatment: rest, control infection and choose broad-spectrum antibiotics.

Leukemia: Chemotherapy+Bone Marrow Transplantation

Chemotherapy: acute leukemia, acute lymphocytic-DVLP regimen (daunorubicin, vincristine, L-asparaginase, prednisone)

Acute lymphocyte -DA regimen (daunorubicin, cytarabine)

Promyelocytic retinoic acid

chronic leukemia

Autoimmune hemolytic anemia: glucocorticoid, splenectomy

Aplastic anemia: androgen, immunosuppressant, bone marrow transplantation

Anemia: iron supplement +Vc, and red blood cells can be infused before severe anemia.

Connective tissue and diagnostic formula

* * * Same symptom: swelling and pain of bone and joint+

1. Systemic lupus erythematosus = female+butterfly erythema+photosensitivity+Raynaud phenomenon +ANA positive+proteinuria.

2. Rheumatoid arthritis = single+big joint

3. Rheumatoid arthritis = symmetry (double)+facet joint +RF positive.

4. Suppurative arthritis = adolescence+high fever

5. Osteoarthritis = bone friction sound/bone friction feeling+aggravation after exercise, and pain relief after rest.

6. Compulsory spondylitis = bamboo-like change

Diagnostic formula of toxic diseases

1. carbon monoxide poisoning = coal stove+cherry red +COHb increase.

2. Organophosphorus = pesticide exposure history+pinhole-like changes in pupils+garlic smell+lung auscultation wet rales+cholinesterase activity (ChE)↓

Diagnostic formula of cerebrovascular disease:

1. Cerebral hemorrhage = history of hypertension+acute attack+disturbance of consciousness+limited signs.

2. Cerebral thrombosis = quiet onset (coronary heart disease, hyperlipidemia)

3. Cerebral embolism = acute attack+cardiac embolism (subacute endocarditis)-brain

Pulmonary embolism = dyspnea+chest pain+hemoptysis+embolus of lower limbs (varicose veins/gangrene of lower limbs) ◇ lung.

4. Subarachnoid hemorrhage = acute attack+meningeal irritation sign +CT.

5. Cerebral infarction = history of hypertension+hemiplegia+no lesions found by CT.

Diagnostic formula of meningitis

1. point brain = meningeal irritation sign+tuberculosis symptoms (low fever and night sweats)+ground glass cerebrospinal fluid.

2. Sick brain = meningeal irritation sign+virus infection (fever)+cerebrospinal fluid.

3. Intracranialization = meningeal irritation sign+suppuration (high fever)+cerebrospinal fluid purulence+skin and mucous membrane petechiae.

4.JE = meningeal irritation sign+respiratory failure+clear cerebrospinal fluid in summer and autumn.

Brain diseases

1. concussion = transient loss of consciousness (coma for several minutes)+retrograde amnesia.

2. Acute epidural hematoma = brain injury+intermediate waking period (coma → waking → coma) +CT spindle hematoma.

3. Subdural hematoma = continuous coma

4. Cerebral hernia = dilated pupils/unequal pupils+cardiac and respiratory arrest

Diagnostic formula of infectious diseases:

1. Hepatitis A = fever+jaundice +HAV(+)+ fecal transmission.

2. Hepatitis B = fever+jaundice +HBV(+)+ body fluid transmission.

3. Hepatitis C = fever+jaundice +HCV(+)+ blood transmission.

4. AIDS = travel history+fever+emaciation+lymphadenopathy +HIV(+)

Diagnostic formula of gynecological diseases:

1. Ectopic pregnancy = menopausal history+severe abdominal pain+abdominal mass+vaginal bleeding+cervical lifting pain.

2. Torsion of ovarian tumor pedicle = acute lower abdominal pain+tumor+no shock, no anemia +HCG(-), no history of menopause and vaginal bleeding.

3. Acute pelvic inflammatory disease = severe pain in the lower abdomen (cervical pain)+fever+increased leucorrhea.

4. Cervical cancer = contact bleeding or irregular vaginal bleeding+vegetable-like vegetation (Ⅰ b term in the cervix, Ⅰ b1phase diameter ≤ 4 cm; Phase I ≤ 4 cm; Phase II > 4cm)

5. Ovarian tumor = elderly women+bloating+abdominal mass+emaciation.

6. Uterine fibroids = women of childbearing age+menorrhagia+uterus enlargement+anemia.

Pediatric disease diagnosis formula:

1. Infantile diarrhea (rotavirus infection) = season (autumn and winter)+watery stool and egg drop soup+fever.

Dehydration classification: (1) mild:

(2) Moderate: less tears, less urine and cold limbs.

(3) Severe: cold limbs and no urine, and decreased blood pressure.

Dehydration property: the serum sodium level is130-150:150, which is hypertonic.

Diagnosis: (1) Rotavirus enteritis (severe/mild)

(2) Severe (moderate/mild) hypertonic (isotonic/hypotonic) dehydration

(3) Others, such as metabolic acidosis.

Fluid replacement therapy:

1. Principle:

2. The total amount, speed and type of rehydration on the first day

(1) Total amount:

(2) Speed:

(3) Type:

3. rehydration the next day:

4. Drug therapy: control infection and protect intestinal mucosa.

2. Children have common eruptive diseases.

(1) Measles = fever+upper sensation+systemic papules+measles mucosal spots.

(2) Rubella = low fever+upper sensation+red papule+swelling and tenderness of retroauricular lymph nodes.

(3) Emergency = sudden high fever+rash after fever recedes.

(4) Chickenpox = low fever+pruritic herpes+centripetal distribution

(5) Scarlet fever = fever+sore throat+strawberry tongue+rash is mostly concentrated in the parts where the rash folds are easy to rub.

3. Nutritional vitamin D deficiency rickets = children's irritability+improper feeding+bone changes (rib diaphragm groove, frog belly, O-leg)+low serum calcium and phosphorus.

Diagnostic formula of limb fracture and dislocation of large joint;

Specific signs of fracture: abnormal activity+bone friction+deformity.

1. Humeral surgical neck fracture = shoulder injury+upper limb mobility disorder

2. Humeral shaft fracture = history of trauma+upper arm movement disorder+hanging wrist.

3. Supracondylar fracture of humerus = child+palm landing+normal relationship of posterior elbow triangle+elbow pain.

4. Fracture of distal radius = chest injury+lateral silver fork+frontal bayonet.

5. Periosseous subluxation = children+strong traction of upper limbs

6. Posterior dislocation of hip joint = Erlang leg+severe pain of hip joint+shortening of one lower limb+adduction deformity of affected limb.

7. Anterior dislocation of shoulder joint = palm landing injury+elbow holding on the healthy side+Duchamp's sign positive.

8. Femoral neck fracture = hip trauma+external rotation deformity of the affected limb+upward movement of the greater trochanter of femur +Pauwels sign.

Acute suppurative infection of soft tissue = redness, swelling and heat pain

1. carbuncle = middle-aged and elderly people+fever and chills+skin edema+post-ulcerated honeycomb sores.

2. Subcutaneous acute cellulitis = trauma+swelling and pain+high skin temperature+swelling and ups and downs, unclear boundary+pus discharge.

3. Erysipelas = lower limbs or face+flaky erythema of skin+obviously raised boundary+easy to relapse.

4. Acute lymphangitis/lymphadenitis = subcutaneous red line+swelling and tenderness of local lymph nodes

Diagnostic formula for breast diseases:

1. Acute mastitis = pregnant woman+breast pain+fever+white blood cells =

Acute mastitis+wave sensation = abscess formation

2. Cystic hyperplasia of breast = periodic breast pain+palpable lump+aggravation after fatigue.

3. Breast cancer = high risk factor of tumor+painless hard and unsmooth lump+axillary lymph node enlargement.

Principles of treatment:

1. General treatment: rest, nutrition, health care, etc.

2. Symptomatic treatment/drug treatment/etiological treatment

Step 3: Surgical resection.

4. Tumor treatment

Matters needing attention in case analysis

1. Answer time is tight and allocate time reasonably.

2. Answer questions in strict accordance with the format, serial number and vertical arrangement.

Write neatly

4. The diagnosis should be complete

5. Marking requirements: The diagnosis basis should follow the diagnosis closely and should not be listed in disorder.

6. Write 3-5 disease names of differential diagnosis drugs. Whether to explain the reasons, the scoring standards vary from place to place.

7. Further examination: from three aspects: diagnosis, condition change and exclusion.

8. Treatment is the principle of treatment: this year's marking requirements are detailed. For example, in the treatment of duodenal ulcer, it must be written: "Promoting ulcer healing: PPI acid inhibitor is the first choice, and mucosal protective agent can be added. If there is Helicobacter pylori infection, combined sterilization treatment should be carried out. " Rather than simply "medication."