Foreign

CONTENTS
“Traditional Chinese Medicine” Course Syllabus...............................................................1

“Diagnostics” Course Syllabus..............................................................................................9
“Bone and Joint System Radiology” Course Syllabus.......................................................16
“Respiratory System Radiology” Course Syllabus............................................................29
“X-ray diagnosis of Abdomen” Course Syllabus...............................................................40
“Imaging of the Circulatory System” Course Syllabus.....................................................49
“CT diagnosis of Head” Course Syllabus...........................................................................54
“CT Diagnosis in Chest” Course Syllabus..........................................................................59
“CT Diagnosis in Abdomen” Course Syllabus...................................................................63
“MRI Diagnosis”Course Syllabus.......................................................................................67
“Internal Medicine” Course Syllabus.................................................................................73
“Surgery” Course Syllabus................................................................................................126
“Gynecology” Course Syllabus..........................................................................................149
“Obstetrics” Course Syllabus............................................................................................157
“Pediatrics” Course Syllabus.............................................................................................166
“Lemology”Course Syllabus..............................................................................................186
“Neurology” Course Syllabus............................................................................................191
“Ophthalmology” Course Syllabus...................................................................................196
“Otorhinolaryngology–Head and Neck Surgery ” Course Syllabus.............................200
“Stomatology” Course Syllabus.........................................................................................203
“Dermatology & Venereology” Course Syllabus..............................................................206
“Psychiatry” Course Syllabus............................................................................................210
“Emergency Medicine” Course Syllabus..........................................................................214
“Traditional Chinese Medicine” Course Syllabus
Course name: Traditional Chinese Medicine
Hours: 76 (60 Lecture; 16 Clinical practice)
Intended audience: Foreign Medical Students
Prerequisite courses: Anatomy
Textbooks and references:
1. Cao Hongxin. General introduction to TCM theory. Science Press. 2011.
2. Chen Zinong. Chinese acupuncture and moxibustion. Foreign Press. 2010.
I. Course type and purpose
“Traditional Chinese medicine” (TCM) is an introductory course that covers the basic
theory, basic features, diagnostic methods, and dialectical methods of traditional Chinese
medicine. It uses a holistic concept and treatment method based on syndrome differentiation
in the light of TCM and acupuncture theory. It takes into account the etiology and
pathogenesis of disease, patient constitution, and anatomical points to establish the
foundational TCM treatment principles, prescription selection, and comprehensive clinical
application.
Student evaluation: 60% of the final grade will be determined by a written test covering
the theory portion of the course. The remainder 40% will be comprised of other non-written
evaluations.
II. Course Introduction
This course covers the basic theory and basic knowledge of TCM, internal medicine
disease, and acupuncture. Emphasis will be placed on the basic theory of TCM, diagnosis,
the basic theory of meridian-collaterals and acupoints, manipulation methods, acupuncture
treatment, and Chinese massage. The basic theory of TCM is composed of the basic concepts
of Yin and Yang, the theory of the five elements, the theory of five-zangs and six-fus, and the
theory of qi, xue, bodily fluids, and blood. Time will also be spent understanding and
applying the basic diagnostic principles of TCM, the four diagnostic methods, the
differentiation of the eight principal syndromes, and the differentiation of visceral
syndromes. We also introduce the general theory of channels and colleterals and the
commonly used acupoints. We show the basic theory of meridian-collaterals and Chinese
massage and introduce how to use acupuncture to treat disease.
III. Goals and Objectives
1. Cultivate an interest in TCM.
2. Master the basic theory of traditional Chinese medicine。
3. Master the syndrome differentiation method of TCM, which can be used in treatment
decisions.
1
4. Master the commonly used acupoints.
5. Master the basic method of acupuncture/massage treatments to treat disease.
IV. Teaching contents and arrangements
Chapter 1: The Basic Theory of TCM
1．Beginning, formation, and development of the theoretical system of TCM
2．Basic characteristics of TCM
Methods of Instruction
Classroom time distribution Outside Classroom
Chapter Lecture Practice Discussion Assignments Independent Study Project Others
1.1 1
1.2 1 √
Chapter 2: The Theory of Yin and Yang and the Five Elements
1. The theory of Yin and Yang
2. Uses of the theory of Yin and Yang in TCM
3. The theory of the Five Elements
4. Application of the theory of the Five Elements in TCM
2.1 2 √
2.2 2 √
Chapter 3: The theory of the 5-zangs and 6-fus.

1. The functions of each organ.
2. The relationship between 5-zangs; The relationship between 6-fus; the relationship
between 5-zangs and 6-fus.
3.1 5 √ √
Chapter 4: Theory of qi, body fluid and blood.

1． The concept, functions, formation and classification of Qi.
2． The relationship between Qi and blood.
2
4.1 1 √ √
4.2 1 √
Chapter 5: Pathogenic factors

1. The pathogenic characteristics of the 6 exogenous factors (wind, cold, summer-heat,
dampness, dryness, and fire) in TCM.
5.1 1 √
5.2 1 √ √
Chapter 6: Diagnostic methods of TCM

1. The four diagnostic methods.
2. Differentiation of syndromes.
6.1 6 4 √ √
6.2 10 4 √
Clinical Practice
1. Lecture
Review key content (1 h)
Know the inspection of spirit, identify the five morbid complexions, identify the
characteristics and clinical significance of an abnormal tongue and pulse.
2. Photos (0.5 h)
Enhance study of the diagnostic methods with patients’ photos.
3. Case analysis (teacher-student interaction) (1 h)
Analysis of common cases, further understanding of the clinical significance of the four
diagnostic methods.
Students to discuss; Teachers provide comments
4. Clinical Practice (1.5 h)
Divide students into four groups; each group practices interviewing, observation of the
inspirit, complexion, tongue coating, tongue shape, and tongue body; learn the method
of pulse-taking by palpating patients’ pulses.
3
Chapter 7 Principles of Treatment
1. Etiology and pathology
2. Principles of Treatment
7.1 0.5 √
7.2 0.5
Chapter 8 General Introduction to Meridians

1. Composition
2. Physiological functions and pathogenic changes
3. Clinical application
Independent
Chapter Lecture Practice Discussion Assignments Project Others
Study
8.1 2 4 √
8.2 0.5 √
8.3 0.5
Chapter 9 General introduction to acupoints

1. Classification of acupoints
2. Functions of acupoints
3. Methods for locating acupoints
9.1 0.5 √
9.2 0.5 √
9.3 1 √
Chapter 10 Meridians and points

1. The lung meridian of hand–taiyin
2. The large intestine meridian of hand–yangming
3. The stomach meridian of foot–yangming
4. The spleen meridian of foot–taiyin
5. The heart meridian of hand–shaoyin
4
6. The small intestine meridian of hand–taiyang
7. The bladder meridian of foot–taiyang
8. The kidney meridian of foot–shaoyin
9. The pericardium meridian of hand–jueyin
10. The sanjiao meridian of hand–shaoyang
11. The gallbladder meridian of foot–shaoyang
12. The liver meridian of foot–jueyin
10.1-10.4 1 √
10.5-10.8 1 √
10.9-10.12 1 √
Chapter 11: Manipulation Methods

1. The structure，specification and storage of filiform needle
2. Preparations Prior to Acupuncture Treatment
3. Needling Methods
4. Manipulations and Arrival of Qi
5. Reinforcing and Reducing Methods
6. Management of possible accidents and Cautions
11.1 0.5 √
11.2 0.5
11.3 1 0.5 √
11.4 0.5 √
11.5 0.5 √
11.6 0.5 √
Chapter 12: Acupuncture treatment

1． Examination and syndrome differentiation
2． General Principles of Acupuncture Treatment
3． Therapeutic effect of acupuncture and moxibustion
4． Selection and Compatibility of acupoints
5． Acupuncture Therapy of the Common Diseases
5
12.1 0.5
12.2 0.5 √
12.3 0.2
12.4 0.8 √
12.5 2 √ √
Practices
1. Lecture (1 h)
Review key content: Master the main content of acupuncture treatment, such as
needling methods, general principles of acupuncture treatment, indications for acupuncture
treatment, precautions and management of possible accidents, commonly used acupuncture
points.
2. Simulation exercises (1h)
Let the students practice the needling methods with paper.
3. Clinical Practice (2 h)
Pick two or three patients who need acupuncture treatment, tell the patients’ condition
to the students, explain to the students how to select the points on the patients, and show
them how to manipulate the needle.
Chapter 13 General Introduction to Chinese Massage
13 0.2
Chapter 14 Acting Principle
14 0.2 √
Chapter 15 Therapeutic Principles of Reinforcement and Reduction in Chinese

Massage
1. Therapeutic principles
2. Reinforcement and reduction in massage
3. Indications, contraindications, and important points in massage
6
15 0.6
Chapter 16 Commonly Used Manipulations in Massage

1. Manipulations used in adult massage
2. Manipulations used in infant massage
16.1 3 √
16.2 1 √
Chapter 17 Clinical Treatment with Chinese Massage
17 3 √
V. Clinical Practice
1. Lecture Review key content (1 h)
Master the main content of Chinese Massage, such as the Acting principle of Chinese
Massage; Therapeutic principles of reinforcement and reduction in Chinese Massage;
Reinforcement and reduction in Chinese Massage; Indications, contraindications, and
important points of consideration in Chinese Massage; Commonly used Chinese Massage
manipulation techniques.
2. Chinese Massage exercises (1h)
Let the students practice Chinese Massage manipulations with each other.
3. Clinical Practice (2 h)
Select three or four patients who need Chinese Massage treatment,
tell the patients’ condition to the students, explain to the students how to select the Chinese
Massage manipulations, and show them how to manipulate .
VI. Exam patterns

Closed-book examination；
Closed-book exam score counts for 60% of the grade; Regular assignments count for
40%.
7
Note: The contribution levels of professional courses are determined according to the
professional requirements of knowledge, ability, and quality cultivation. The contribution
levels of basic courses are determined according to the University requirements of
knowledge, ability, and quality cultivation.
Syllabus Editor: Liu Yi

Syllabus Reviewer: Liu Yong Hui
8
“Diagnostics” Course Syllabus
Course name: Diagnostics
Hours: 158 (90 lecture; 68 clinical practice)
Prerequisite courses: none
Yang Lan, Wei Xiaohong. Diagnostics, Dean’s Office of Xi’an Jiaotong University,
November 2004
Type: Basic theory and Basic skill
Purpose: To study the basic theory and basic skill of inquiry and physical examination,
to help students grasp the fundamental principles and methods of diagnosing disease.
Diagnostics is both a basic theory, basic knowledge, basic skill course and a bridge
course for medical students from foundational academic medicine to clinical medicine.
Diagnostics includes interviewing, common symptoms, physical examination (general
examination, head and neck, thorax examination, lung examination, heart examination,
abdominal examination, spine, extremities examination, nervous system examination),
electrocardiogram, laboratory diagnosis (blood, bone marrow tests, bleeding and clotting
tests, urine and stool tests, liver and kidney function tests, examination of CSF and body
fluid), ultrasonic diagnosis (abdomen, echocardiography), and medical record writing.
Students are taught using multimedia lectures. Clinical practice is taught through practicing
physical examination skills on fellow students, patient demonstrations, analyzing laboratory
results and electrocardiograms, and writing medical records.
1．Multimedia teaching
2．Clinical practice
IV. Course Content and Schedule
Section I: Introduction
1. The importance of learning Diagnostics
2. Basic contents of Diagnostics
3. The ways of learning
9
Classroom time distribution Outside classroom
Independent
Chapters Lecture Practice Discussion Assignments Project Other
Study
1 1
Section II: Interviewing

* 1. The importance of interviewing
**2. The ways of interviewing
*3. The outline for a medical interview
Independent
Study
1 1 4 √ √ √ √
Section III: Common Symptoms

*1. The causes, mechanism and clinical significance of fever, edema and dyspnea
2. The effects of the analysis of symptoms to the diagnosis of illness
Independent
Study
1 2 √ √ √
Section IV: Physical Examination

Chapter 1 General Principles
*1. The Importance of physical examination
**2. The technique of inspection, palpation, percussion, and auscultation
Chapter 2 General Examination
*1. The normal and abnormal signs and clinical significance of development and
habitus, nutrition, facial feature and expression, position and posture, skin and lymph nodes
**2. Measurement of temperature
*3. The contents of general examination
**4. Differentiation of jaundice
**5. Measurement of sequence and maneuver of lymph nodes
Chapter 3 Head, Eyes, Nose, and Throat
1. The contents of examination of head, eyes, nose, and throat
*2. The normal and abnormal signs and clinical significance
*3. Measurement sequence and head maneuvers
Chapter 4 Neck
1. The contents of examination of neck
10
*2. The normal and abnormal signs and clinical significance for carotid artery, jugular
vein, thyroid and trachea
*3. Measurement of sequence and maneuver of carotid artery, jugular vein, thyroid and
trachea
Chapter 5 Thorax
A. Anatomic consideration
**1. The landmarks of the chest
*2. The underlying anatomy of the lungs
B. Chest wall, thorax and breast
Inspection and palpation for the chest wall, thorax and breast
C. Lungs and pleura
**1. The sequence, contents and methods of inspection, palpation, percussion and
auscultation for lungs
2. The palpation and auscultation for the pleura
**3. The mechanism and clinical significance of tactile fremitus and abnormal
percussion
*4. The features and distinguish of various breath sounds
*5. The features of various rales
6. The physical examination and positive signs of common pulmonary diseases
7. Writing record
D. Heart and blood vessels
auscultation for heart
**2. The mechanism and distinguish of S1 and S2
*3. The features of splitting and extra heart sound
*4. The mechanism and clinical significance of cardiac murmur
**5. Auscultation of systolic and diastolic murmur
*6. The auscultation of common arrhythmias
**7. The measurement of blood pressure
8. Inspection, palpation, and auscultation for blood vessels
*9. The physical examination and positive signs of some common cardiovascular
diseases
10. Writing record
Chapter 6 Abdomen
A. Anatomic considerations
* The division of abdomen and the structures located in each areas
B. Physical examination
auscultation for the abdomen, particularly for liver, gall bladder and spleen
**2. The normal and abnormal signs and clinical significance of inspection, palpation,
percussion and auscultation for the abdomen, particularly for liver, gall bladder and spleen
11
*3. The physical examination and positive signs of some common cardiovascular
diseases
4. Writing records
Chapter 7 Spine and extremities
A. Spine
*1. The sequence, contents and methods of examination for spine
*2. The normal and abnormal signs and clinical significance of examination for spine
B. Extremities
*1. The sequence, contents and methods of examination for extremities
*2. The abnormal signs and clinical significance of spoon nails and clubbed fingers
Chapter 8 Nervous system
1. The methods for testing muscle strength
*2. The sequence, contents and methods of examination for nervous reflex, including
physical (superficial and deep tendon reflex), pathologic, and meningeal irritation signs
*3. The normal and abnormal signs and clinical significance of examination for nervous
reflex, including physical (superficial and deep tendon reflex), pathologic and meningeal
irritation signs
Independent
Study
1 2 1 √ √ √ √
2 2 1 √ √ √ √
3 4 1 √ √ √ √
4 2 1 √ √ √ √
5 22 32 √ √ √ √
6 10 4 √ √ √ √
7 2 2 √ √ √ √
8 2 2 √ √ √ √
Section V: Ultrasonic examination

Chapter 1 Basic knowledge
The basic knowledge of ultrasonic examination
Chapter 2 Abdomen
1. The clinical application of ultrasonic examination for liver, spleen, biliary tract
system, pancreas and kidney
2. The ultrasonic examination in Gynecology and Obstetrics
Chapter 3 Echocardiography
1. Introduction of M-mode, 2D-echo and Doppler in clinical application
2. Some abnormal echocardiogram in cardiovascular disorders
12
……
Independent
Study
1 1 √ √ √
2 3 2 √ √ √ √
3 4 2 √ √ √ √
Section VI: Electrocardiogram

Chapter 1 Basic knowledge
*1. The basic knowledge, electrophysiological bases and theory of ECG
*2. The clinical application and significance of ECG
**3. Correct operation of ECG machine
Chapter 2 Normal ECG
*1. The waves, segment, and durations of normal ECG
*2. The normal values of the waves, segment, and periods of ECG
Chapter 3 Abnormal ECG
*1. The characteristics of the abnormal ECG of atrial and ventricular enlargement,
myocardial infarction, and common arrhythmias
2. Introduction of clinical application of Holter and exercise test
Independent
Study
1 1 √ √ √
2 1 4 √ √ √ √
3 6 8 √ √ √ √
Section VII: Laboratory diagnosis

Chapter 1 Blood test
*1. Reference values and clinical significance of red blood cell count, hemoglobin
determination, white blood cell count, and differential count (DC)
*2. Reference values and clinical significance of reticulocyte and erythrocyte
sedimentation rate (ESR)
3. Testing skill for RBC count, WBC count, DC and reticulocyte (RC) count
4. Morphological classification of anemia, hematocrit (Hct), MCT, MCH and MCHC
5. Common laboratory tests for hemolytic anemia
Chapter 2 Bone marrow examination
*1. Indication of bone marrow examination and clinical significance of cytological
13
examination of bone marrow
2. Classification and proportion of normal bone marrow cells
3. Blood and bone marrow characters of common blood diseases(aplastic anemia, iron
deficiency anemia, acute leukemia, chronic leukemia and idiopathic thrombocytopenic
purpura)
4. Differential diagnosis value of common cytochemical staining in acute leukemia
(POX, SB, NSE, NAP, PAS and iron staining)
Chapter 3 Bleeding and clotting tests(examination of hemostasis and coagulation
disorders)
1. Common causes of hemostasis and coagulation disorders
*2. Reference values and clinical significance of common tests in hemostasis and
coagulation disorders(bleeding time, platelet count, capillary resistance test, clot retraction
test, clotting time, kaolin partial thromboplastin test, prothrombin time and thrombin time)
3. Principles of common tests in hemostasis and coagulation disorders
4. Application rule and test steps in bleeding disorders
5. Basic test for DIC
Chapter 4 Urine test and renal function tests
1. Urine routine tests (general property, chemical examination and observation under
the microscope)
*2. Reference values and clinical significance of urine routine test
3. Principles and clinical significance of common renal function tests (renal glomerular
function, renal tubular function, renal blood flow and acid-base balance)
4. Requirement of urine sample’s collection and sending
Chapter 5 Liver function tests
1. Common tests used in hepatic disease (protein metabolism, bilirubin metabolism,
intake and excretion of dye, serum enzymes and virus hepatitis tests)
2. Principles and clinical significance of common liver function tests
*3. Reference values and clinical significance of common tests used in hepatic disease
Chapter 6 Stool test
1. Method of stool tests (general property, occult blood test and bacteriological tests)
*2. Reference values of stool test
*3. Clinical significance of stool occult test and requirement for sample’s collection and
sending
Chapter 7 Examination of cerebrospinal fluid (CSF) and serous membrane fluid (SMF)
*1. Reference values, clinical significance and application of CSF test
2. Characters of common cerebral and cerebromeningeal diseases
*3. Reference values and clinical significance of CMF test
*4. The main differential points between transudates and exudates
14
Independent
Study
1 4 2 √ √ √ √
2 4 2 √ √ √ √
3 64 √ √ √
4 2 √ √ √
5 4 √ √ √
6 2 √ √ √
7 2 √ √ √
*: The contents should be familiar.

**: The main points should be known very well.
V．Clinical Practice
1．68 clinical practice hours
……
VI. Exam patterns
Closed-book exam；
Closed-book exam score counts for 60%, Regular assignments count for 10%；Clinical
practical exam score counts for 30%.
Syllabus Editor: Yan Lan

Syllabus Reviewer: Bai Ling
15
“Bone and Joint System Radiology” Course Syllabus
Course name: Bone and Joint System Radiology
Hours: 20 (10 lecture; 10 clinical practice
Prerequisite courses: Anatomy, pathology
[1] Zhang Yun, Li Miaoling, Qiang Yongqian. Radiology, 2004, Xi’an Jiaotong
University
[2] A.T. Ahuja, G.E. Antorio, K.T. Wong, et al. Case studies in medical imaging
radiology for students and trainees. New York, Cambridge University Press, 2006.
Type: To study the normal features, basic signs and common disease imaging feature, to
include two parts (lecture and practice).
Purpose: Through the bone and joint system imaging study, let the students understand
bone and joint system imaging diagnosis value, and to master the common diseases imaging
diagnosis and differential diagnosis.
One of the most common x-ray examinations is that of the skeletal system. Skeletal
radiographs constitute the second largest group of films seen in a busy radiology practice.
Analysis of the skeletal radiographs can provide considerable information regarding patients.
In addition to obvious abnormalities of the skeleton itself, bone radiography may provide
clues to the presence of occult inflammatory, metabolic, and neoplastic diseases.
1.Master
 Basic signs of bone and joint system
 The X-rays and CT features of common site fracture and spine disc lesion
 The imaging features of bone and joint infection(pyogenic and TB)
 The common bone tumor imaging features , benign tumor and malignant tumors
differential diagnosis
2.Understand
 Bone and joint trauma imaging
 The imaging of common benign tumor and malignant tumors
 The imaging of degenerative joint disease
Chapter one: NORMAL FEATURES
1．Methods of Examination
16
Ordinary Radiography called conventional X-ray films, Plain film. Technique: routine
two views in the most positions—anterioposterior (AP) and lateral (L), e.g. long bones,
joints of limbs, spine, skull, etc. routine one view in a few of positions, e.g. only AP in
pelvis, hip, shoulder, etc. necessarily add to other views in some positions, e.g. oblique view
in hand, foot, spine; tangential view in skull; axial view in patella.
Points of attention: overlapping image. including the soft tissue around the bones and
joints. Purpose—observing soft tissue changes. including adjacent to a joint in long
bones. Purpose—acquainting long bones. including the lower thoracic spine or sacral
spine in the lumbar spine. Purpose—calculating the number of the lumbar spine. necessarily
including the opposite in both symmetric bones and joints. Purpose—comparing the
observation.
 Computed Tomography, CT
CT scanning can provide diagnostic information of bones and soft tissues in another
dimension. CT imaging is sectional imaging. Main indications: lumbar and cervical disc
lesion such as herniated nucleus pulposus, fractures of the vertebral body, fractures of the
pelvic bones, bone tumor and tumor-like lesion.
 Magnetic Resonance Imaging, MRI
MR imaging is three-dimension imaging, such as TRA,COR and SAG plane. It has
become especially helpful recently in demonstration internal derangements of joints
(meniscal tear) and disc disease (degeneration, prolapse).It can show the lesion of tumor,
such as the lesion size, shape, et al.
2． Normal X-ray Features
 Anatomy of the bone
There are four types of bone, based on their shapes: ①Long bones, which have two
ends and a shaft (femur, humerus, phalanges). ②Short bones, which are six sides, as a rule
(carpal and tarsal bones). ③Flat bones (calvaria, ribs, sternum). ④Irregular bones, which
have many sides (vertebrae).
Bone may be of two architectural types: compact (dense) bone and cancellous (spongy)
bone.
 Structure of the bone
Bone and cartilage are belong to the connective tissue. Bone is composed of mineral
salts (calcium, phosphate), bone cells (osteocyte, osteoblast and osteoclast), bone matrix
(collagen) and fiber. It’s high density (radioopaque) on x-ray film. Cartilage is composed of
cartilage cell (chondrocyte), matrix and fiber. It’s lower density (radiolucent) on x-ray film.
In children, cartilage (non-ossification) includes epiphyseal cartilage and cartilaginous
epiphyseal plate. In adult, cartilage has only articular cartilage.
Compact bone is composed of many Haversian system. Its density is high on x-ray film.
It is the cortex of long bones and the internal and external plate of flat bones.
Spongy bone is composed of many trabeculae (trabeculated bones). Its density is lower
and network.
 Long bones of the extremities
17
A. Child bones have four parts: diaphysis, metaphysis, epiphysis and epiphyseal plate.
Main characteristics of child bones is epiphyseal cartilage and bone age.
Diaphysis: a relative thickness of the cortex in young children. Metaphysis: Sponge
bone. It is remarkably broad relatively to the middle of the diaphysis. The end of the
metaphysis is normally convex. Epiphysis: Having epiphyseal cartilage, joint space is wide.
Secondary center (epiphyseal nucleus) appears first as one or more tiny granular opacities.
These rapidly fuse, and enlarge into a round or oval mass of cancellous bone, which
normally is an irregular, nodular, contour similar to the end of the metaphysis. Epiphyseal
plate: Cartilage cannot be seen. Transverse radiolucent line on the x-ray film. So it is called
as the epiphyseal line.
Bone age is the time of appearance and fusion of the various epiphyseal centers
(secondary ossification center). Bone age depends on the age of a child, but no complete
equality between them. The standard films provide an indication of skeletal maturation. For
the measurement of bone age, it is usually most convenient to take a film of the hand and
wrist, but in the neonatal period films of the knee provide the most accurate assessment..
 Adult bones have two parts: diaphysis and bone ends.
In the shaft: The cortex shows a uniform opacity with a regular subperiosteal margin
and a less-defined but easily visible internal limit where it blends with the underlying
cancellous tissue. The cortex is the thickest in the middle zone of the shaft, and diminishes
evenly in thinest towards the ends of the shaft, where it becomes continuous with the delicate
cortex of the ends of the bone. The cancellous bone forms a comparatively thin layer in the
shaft, enclosing the medullary canal. Its mesh-like trabeculation can be see through the
cortical shadow. The medullary canal is often invisible, or show only as a poorly defined
zone of translucency running along the center of the shaft. The normal periosteum is not
seen.
In the ends: The cortex is an extremely thin shell of compact bone, covering an
expanded mass of cancellous bone. It is thinnest and has smooth regular contour under the
articular cartilage. The extra-articular portions tend to show mild irregularity of contour at
the sites of ligamentous attachment.
 Joint of the extremities
Joints of the limbs are mainly synovial joint. It includes three parts – bone end, articular
cartilage and capsule. On the x-ray film, articular cartilage, synovium, synovial fluid and
capsule can’t be showed because they are the same radiodensity as the soft tissue. So the
space between two bone ends is hemi-hyaline, it is called as articular space. Articular space
on x-ray film includes articular cartilage, really articular space and a few of synovial fluids.
The articular space is wider in a child and thinner in adult. The articular cortex forms a thin,
well-defined line which merges smoothly with the remainder of the cortex of the bone.
 Common anatomical variants (normal variants)
accessory bone: is non-union of multiple ossification centers in a bone during the
development, or a additional independent ossification center. It is common in carpal and
tarsal bones. sesamoid bone: is a small bone within the tendon. It is common in hand and
18
foot bones. moving spine: sacralization of L5, lumbarization of S1, etc. spinal bifida: This is
a congenital defect in spinal arch or plate. It shows as a radiolucent space on X-ray film.
Often occurs in L5 or S1.
Independent
Study
1.1 1 √ √
1.2 1 √ √
Chapter two: BASIC SIGNS

1．Basic Signs Of Bone
The radiological responses of bone to any pathological process are limited, so similar
x-ray signs occur in different conditions. One disease maybe has many basic signs and one
basic sign maybe present in many diseases. Basic sign is not one disease.
 Decrease in bone density
Mainly refer to generalized decreased in bone density .The radiographic density of bone
is dependent on the amount of calcium present in the bone. This may be reduced duo to a
disorder of calcium metabolism as in osteomalacia or hyperparathyroidism, or to a reduction
in the protein matrix as in osteoporosis. Decrease in bone density includes also bone
destruction. It may be localized or generalized.
(1)Osteoporosis (OP)
Definition: Bone mass decreases, when a balance between the bone resorption and the
bone formation is not adequate, because of the abnormality of the bone metabolism.
Mechanism: OP is duo to a deficiency of the protein matrix. Because the cortex is
reduced in quantity, there is necessarily a reduction in calcium content.
Histological change: is thinning of the cortex, enlargement of Haversian canal and
reduction of the trabeculae.
Radiological feature: is decrease in bone density, thinning of the cortex and reduction in
the number of trabeculae. The contour of the cortex and trabeculae is clear.
Causes:
Generalized OP has many kinds, e.g. senile, postmenopausal, malnutrition, and the
abnormality of the metabolism or the endocrine.
Localized OP is mainly disuse, e.g. fracture, infection, malignant tumor, etc.
(2)Osteomalacia (OM)
Definition: OM is lack of calcium in the bone tissue with poor mineralization of
osteoid. If this occurs before epiphyseal closure ,the condition is known as rickets – in adults
,it is known as osteomalacia.
Radiological features: are decrease or loss of bone density, thinning of the trabeculae
and the cortex, and Looser’s zones (salo called pseudofractures line).
Looser’s zones are short lucent bands running through the cortex at right angles and
19
usually going only part way across the bone. They may have a sclerotic margin. They are the
commonest in the scapulae, medial aspects of the femoral necks and shafts and the pubic
rami.
The important features of OM are blurred contour of the cortex and the trabeculae, and
bone deformity duo to bone softening. In the spine the vertebral bodies are biconcave, the
femora may be bowed, and the pelvis and chest cage may have deformity.
The causes of OM: are vitamin D deficiency. These mainly have dietary deficiency of
vitamin D or lack of exposure to sunlight, malabsorption and renal disease.
(3)Destruction of bone
Definition: The normal bone is replaced by the pathological tissue. It causes the
disappearance of bone tissue. Both sponge and compact bones may be occur bone
destruction.
Radiological features: are localized decrease in bone density, thinning and shortness of
the trabeculae, bone defect, and no bone structure in the area of bone destruction.
Clear contour in the chronic lesions, benign tumor. Blur contour in the acute lesions or
malignant tumor.
Bone destructing lesion may be osteolytic, osteoblastic, or, a mixture of the two. There
are three forms of osteolytic bone destruction: geographic, moth-eaten, and permeative.
Geographic destruction implies that large areas of bone have been destroyed and are
easily visible with the unaided eye.
A moth-eaten appearance is one in which there are many discrete small holes
throughout the bone, and suggests a more aggressive lesion.
A permeative pattern is one in which there is fine bony destruction. Pathologically, this
represents a lesion diffusely infiltrating bone through the Haversian system. In many
instances a magnifying lens is required to see the bone destruction. Permeative destruction
implies a very aggressive process.
Causes of bone destruction: infection, granuloma, tumor or tumor-like lesion. Localized
lesion in the most cases, while generalized lesion in the few cases.
 Increase in bone density
(1)osteosclerosis (OS)
Definition: increase in bone mass. It is duo to increase in the bone formation and / or
decrease in the bone resorption. It also includes the hyperostosis.
Histological changes: thickness of the cortex, increase and widening of the trabeculae.
Radiological features: increase in bone density, thickness of the cortex, increase and
widening of the trabeculae. May accompany with enlargement in the shape of a bone.
Causes of the osteosclerosis: The most cases are localized osteosclerosis, e.g. chronic
infection, trauma, some benign bone tumors, osteosarcoma, osteogenic (sclerotic)
,metastasis. The few cases are generalized osteosclerosis, e.g. metabolic or endocrine
diseases.
(2)Periosteal Reaction ( PR)
The periosteum is not normally present on a radiography. The term “periosteal reaction”
20
refers to excess bone produced by the periosteum which occurs in response to such
conditions as neoplasm, inflammation or trauma.
The periosteal reaction (PR) may take several forms:
a. solid (length > 2mm) smooth lamellar PR in trauma or inflammation.
b. spiculated PR in osteogenic sarcoma.
c. laminated or onion skin PR in Ewing’s sarcoma or any type of repetitive injury to
bone.
d. Codman’s triangle PR in osteogenic sarcoma. At the edge of the lesion the periosteal
new bone is lifted up to form a cuff. But the individual pattern is not specific enough to state
the precise cause. Although often seen in highly malignant primary bone tumors, a Codman’s
triangle is also found in other aggressive conditions.
2.Basic Signs Of Joint
 Swelling of joint
Swelling of the soft tissues around a joint may be seen in any arthritis accompanied by a
joint effusion or periarticular inflammation. It is, therefore, a particular feature of
inflammatory and infective arthritis.
X-ray features are all the soft tissue swelling and increased density around a joint. A
large amount of joint effusion may have the widening of joint space. The thickened
synovium in synovial tumors and hemophilia may give rise to striking soft tissue swelling.
 Destruction of joint
Joint space narrowing
This is duo to destruction of articular cartilage. It occurs in practically all forms of joint
disease except avascular necrosis.
Bone erosions
An erosion is an area of destruction of the articular cortex and the adjacent trabecular
bone. Bone erosion is usually accompanied by destruction of the articular cartilage. Main
feature of erosions is bone defect.
Causes of joint erosions:
duo to infection: pyogenic arthritis and TB.
duo to the deposition of urate crystal in gout.
duo to repeated hemorrhage in hemophilia and related bleeding disorders.
duo to neoplastic overgrowth of synovium, e.g. synoviosarcoma.
 Degeneration of joint
Degeneration of joint is practically degenerative changes of the articular cartilage. X-
ray features: Early phase is blurring, breaking and disappearance of the bony surface. Middle
and later phases are joint space narrowing. These changes are the features of osteoarthritis
and neuropathic arthropathy, etc.
 Ankylosis of joint
Articular ankylosis is a clinical term. It is a lose of the function following obvious joint
destruction. Bony ankylosis: X-ray feature is obvious narrowing or lose of articular space,
and passing joint of trabeculae. Fibrous ankylosis: X-ray feature is only joint space
21
narrowing.
 Dislocation of joint
Dislocation of joint is the displacement of articular ends. It is classified as complete
dislocation and subluxation dislocation according to the degree. It is also classified as
traumatic, congenital and pathological dislocation according to the various causes. Ilium
neck line: the outside margin of ilium connect with the outside margin of neck.
Independent
Study
2.1 1 √ √
2.2 1 √ √
Chapter three :TRAUMA OF THE SKELETON

1.Basic Concept
 The Method of X-rays Analysis of the Skeleton
This routine of study – a systematic evaluation of the soft tissues, periosteum, compact
cortex, medullary portion of bone, the joints, the alignments of fragments, the appropriate
modeling of the bone, and the overall density – is applicable not only in cases of trauma but
also in metabolic and other bone disease.
Terminology and Definitions in Fractures and Dislocations
Dislocation: disruption of a joint with no remaining contact between articulating
surfaces of bones
Subluxation: partial dislocation, with some remaining contact between articulating
surfaces of bones
Apposition: contact of ends of fracture fragments
Alignment: relationship of axes of fracture fragments of a long bone
Malalignment: anatomically improper alignment
Union: healing of fracture by bony callus
Non-union: failure of fracture fragments to be united by bony callus, often because of
improper immobilization or lack of apposition
Pseudarthrosis: false joint between the ends of the fracture fragments in case of non-
union
 Types of Fractures
transverse, longitudinal, oblique, spiral or screw-like: according to orientation of
fracture line;
comminuted: more than two fragments;
impacted: the fracture fragments are driven together, also including compression
fracture.
avulsion(chip-type): a small fragment or cortical bone torn off at the insertion of a
tendon or ligament. Avulsion fractures are often seen with ankle injuries, but also at many
22
other sites.
Greenstick: incomplete fracture, seen in children
Epiphysiolysis: separation of epiphysis and metaphysis, seen in children fracture line
not obviously to see, the cortex bucking, the normal straight line loss at site of fracture. The
bone is soft like willow stick, so called greenstick fracture.
pathological fracture: fracture through diseased bone
stress fracture: fracture from repeated mechanical stress (fatigue fracture). It is also
called insufficiency fracture. Used to be seen in soldiers on march ( “march fracture”), but it
occurs in runners and joggers also.
2.Common Fractures
Colles’ fracture: the transverse or comminuted fracture of 2-3 cm segment within the
distal radius, the dorsal and radial displacement of the distal fracture end, and may
accompany with the fracture of styloid process of the ulna.
Monteggia fracture: fracture of the proximal 1/3 segment of the ulna with the
dislocation of radial head.
supracondylar fracture of the humerus: common in the children. Fractural line
transverses over the coronoid fossa or olecranon fossa, often dorsal displacement of the
distal fracture end.
humeral fracture of the surgical neck: fracture of 2-3 cm segment under the anatomical
neck of the humerus, easily complicated with tear of the greater tubercle.
fracture of the femoral neck: common in the elderly. Fracture has often marked
displacement and impacted. The healing of the fracture is slow. Serious fracture may cause
avascular necrosis of the femoral head.
fracture of the distal tibia and fibula: may involve the ankle, complicated with fractures
of the medial, lateral or posterior malleolus.
spinal fracture: is mainly compression fracture of the vertebral body. Common in the
lower thoracic and the super lumbar spines. Serious fracture may occur the kyphosis or
displacement of the body, and compress the spinal cord which may cause paralysis or
paraplegia.
fracture of the rib: may be the single or multiple fractures of the ribs, and may
complicate with pneumothorax and blood thorax.
fracture of the pelvic bone: is often the multiple fractures, and may accompany with the
pelvic deformity.
fracture of the skull bone: the cranial fracture may be classified as line fracture,
depressed fracture, perforating fracture (open fracture) and comminuted fracture.
Independent
Study
23
3.1 1 √ √
3.2 1 √ √
Chapter four INFECTIONS OF BONE

1. Pyogenic Osteomyelitis(PO)
Osteomyelitis from pyogenic organisms was a bad disease with bad consequences
before antibiotics became available. The widespread use of antibiotics has altered the X-rays
diagnosis and medical treatment of pyogenic osteomyelitis. Actually, the spread of infections
to adjacent joints is no longer as serious a problem, since antibiotic therapy markedly aborts
or modifies the course of the disease.
Osteomyelitis is most often caused by staphylococcus aureus and usually affects infants
and children.
Bone is infected in two ways: may be primary, through hematogenous dissemination of
organisms, or secondary to directly soft tissue infection adjoining the bone.
Clinical features: the symptoms and signs may be local (pain, tenderness, swelling, etc.)
and systemic (fever, increased WBC).
 Acute pyogenic osteomyelitis(APO)
The initial X-rays film are normal (“x-ray negative”) as bone changes are not visible
until 7 to 14 days after the onset of the infection. Hence, if one suspects osteomyelitis on
clinical grounds (local pain, tenderness, swelling, etc.) normal x-rays do not rule out this
condition.
The soft tissue swelling and fat line blurring in the muscle spaces are the earliest X-ray
findings. The earliest bone changes are bone destruction in the metaphysis with a periosteal
reaction, which eventually may become very extensive and surround the bone to form an
involucrum. A part of the original bone may die and form a separate dense fragment known
as a sequestrum, with a zone of radiolucency duo to adherent pus or infected granulation
tissue.
Acute Pyogenic Osteomyelitis X-rays features classify as two phases
Less than 2 weeks X-rays features:
The soft tissue swelling
Fat line blurring in the muscle spaces
The bone structure is normal
More than 2 weeks X-rays features:
bone destruction in the metaphysis (rich blood supply and slow blood flowing, the
bacterium easy to settle at the location)
periosteal reaction
a part of the original bone may die and form a separate dense fragment known as a
sequestrum
slight soft tissue swelling
 Chronic pyogenic osteomyelitis(CPO)
APO is not treatment recovery and become chronic pyogenic osteomyelitis. The bone
24
becomes thickened and sclerotic with loss of differentiation between cortex and medulla and
within the bone there may be sequestration and areas of destruction.
Occasionally Brodie’s abscess (chronic bone abscess) and sclerosing osteomyelitis may
be seen. The former is a lucency surrounded by an area of sclerosis. The latter is mark
hyperostosis and osteosclerosis.
CPO X-rays features
Cortex thickness around lesion
Medulla cavity disappear
Bone deformity
Bone OS
Strip-like sequestra present in lesion
Slight destruction and not obvious PR
 Pyogenic arthritis
1. Early stage: the surface of joint becoming blurred, the swelling of joint
Middle stage: the surface of joint destruction(initial erosion in center surface of joint)
and accompany with the narrow of joint space
Later stage: articular bony ankylosis
2. Skeletal Tuberculosis
Tuberculosis of bone and joints is always secondary to an established focus of
tuberculosis elsewhere in the body – most commonly in the lungs. There are three forms of
skeletal tuberculosis: arthritis, spondylitis, bones.
 Bone tuberculosis
Bone destruction in metaphysis of long bone
Round or round-like lesion
Salt-shape small sequestra in lesion
Common to see OP adjoining the bone
PR is not common to see
 Tuberculosis of arthritis
Swelling of joint
The joint surface destruction ,(outside margin erosion in early stage)
The joint space narrow
OP around the joint
Later stage shows fibrous ankylosis
 Tuberculosis spondylitis
The spinal destruction
The disc space narrow
The abscess around the lesion
Common to see kyphosis of spinal curve
25
Independent
Study
4.1 1 √ √
4.2 1 √ √
Chapter five BONE TUMORS

Bone tumors are rarely encountered in clinical practice, but because of their malignant
potential, they should be seriously considered whenever the potential exists. The precise
diagnosis of a bone tumor is often notoriously difficult both for the radiologist and the
pathologist. Bone tumors may be primary or secondary. Metastasis malignant tumors are by
far the commonest outnumbering many times primary malignant tumors. There is no entirely
satisfactory classification of primary malignant tumors, but the easiest one to comprehend is
based on the tissue of origin some conditions, e.g. fibrous dysplasia are included in this
classification although they are not true tumors.
1.Malignant tumors
 Primary malignant tumors
Primary malignant tumors usually have poorly defined margins, often with a wide zone
of transition between the normal and abnormal bone. The lesion may destroy the cortex of
the bone. A periosteal reaction is often present and an additional feature is that a soft tissue
mass may be seen.
Osteosarcoma (osteogenic sarcoma) occurs mainly in the 5 to 20-year-old age group,
but is also seen in the elderly from malignant change in Paget’s disease. The tumor usually
arises in the metaphysis, most commonly around the knee. There is usually bone destruction
with new bone formation and typically a florid periosteal reaction is present producing
spiculation (“sun ray appearance”). The tumor may elevate the periosteum to form a
Codman’s triangle. The tumor often involves in the adjacent soft tissue and forms a soft
tissue mass as well as tumor bones, which are single or multiple abnormal opacity
(ossification-like or calcification-like lesion of no normal bone structure) formed by tumor
tissue.
Osteosarcoma is classified as three forms: osteoblastic, osteolytic, and mixture.
Osteoblastic osteosarcoma is mainly osteoblastic changes, e.g. large and many tumor bone
formations, obviously periosteal reactions. Osteolytic osteosarcoma is mainly osteolytic
changes often accompanied with the pathological fracture, while a few or no tumor bones
and periosteal reactions. Mixture is about equalization in osteoblastic and osteolytic changes.
Tumor bone is called as matrix production. Matrix is a substance produced by certain
bone tumors. It may be chondroid (cartilaginous), osteoid (bony), or mixed. Chondroid
matrix appears as fine stippled calcification or multiple popcorn-like calcifications. Quite
often it occurs in bulky masses of tumor within the soft tissues. Osteoid matrix, on the other
hand, is dense and usually of the same radiographic density as bone. It occurs most often in
osteogenic sarcoma, but also may be seen in the benign ossifying condition myositis
ossificans.
 Metastatic bone tumors (metastases)
26
Metastases are by far the commonest bone tumor outnumbering many times primary
bone tumors. Primary malignant tumors originating elsewhere often metastasize to bones,
those bones containing red marrow are the ones mainly affected—spine, skull, ribs, pelvis,
humeri and femora. Metastases may be sclerotic, lytic or a mixture of lysis and sclerosis.
Lytic metastases in adults most commonly arise from a carcinoma of the bronchus,
breast, kidney and thyroid and in children from neuroblastoma and leukemia. Lytic
metastases give rise to well-defined or ill-defined areas of bone destruction without a
sclerotic rim. The lesions may vary from small holes to large areas of bone destruction. In
the long bones metastases usually arise in the medulla and as they grow they enlarge and
may destroy the cortex.
Metastases and myeloma (myeloma may resemble metastases with widely scattered
lytic lesions. They often tend to be better defined and may cause expansion of the bone.
Diffuse marrow involvement may give rise to generalized loss of bone density producing a
picture similar to that of osteoporosis.) are virtually the only cause of multiple lytic lesions.
Expansion of the bone is uncommon with metastases but when present suggests secondary
deposits from a thyroid or renal carcinoma. A periosteal reaction is uncommon with
metastases except in neuroblastoma.
Sclerotic metastases appear as ill-defined areas of increased density of varying size with
ill-defined margins. In men they are most commonly duo to metastases from carcinoma of
the prostate, and in women from carcinoma of the breast.
Mixed lytic and sclerotic metastases are not uncommon. They are often seen with
carcinoma of the breast.
2.Benign tumors and tumor-like conditions
They include benign tumors such as osteochondroma and chondroma, and certain
conditions not regarded as tumors such as fibrous dysplasia, bone cyst, histiocytosis X.
Benign lesions usually have an edge which is well demarcated from the normal bone by a
sclerotic rim. They cause expansion but rarely breach the cortex. There is no soft tissue
mass. A periosteal reaction is invariably absent unless there has been a fracture through the
lesion.
 Osteochondroma
Osteochondroma is the commonest in benign tumors. It has characteristic x-ray features
and is diagnosed easily. The tumor mainly grows in the metaphysis (adjoining to epiphyseal
line) of the long bones. The features show as a outward protrusion of bony mass. Thus
osteochondroma is also called as exostosis. It usually grows in the opposite direction with
the epiphysis. Tumor may relate with the bony cortex by a fine stem or wide base. Larger
tumor may compress adjacent bone and cause bone deformity and bone dysplasia.
 Giant cell tumor of bone
A giant cell tumor has features of both malignant and benign tumors. It is locally
invasive but rarely metastases. It occurs most commonly the bony ends around the knee and
at the wrist after the epiphyses have fused. It is an eccentric and expanding destructive lesion
which is subarticular in position. The destructive area has many different sizes of bony crests
27
and cells, so the destruction is called as “feature of soap bubbles”. The margin is fairly well
defined but the cortex is thin and may in places be completely destroyed. It easily occurs
pathological fracture, but it uneasily causes periosteal reactions.
IV. Methods of Instruction

Independent
Study
5.1 1 √ √
5.2 1 √ √
1.Normal features，2 study hours
2.Basics signs，2 study hours
3. Trauma of the skeleton, 2 study hours
4. Infections of bone, 2 study hours
5. Bone tumors, 2 study hours
VI. Exam patterns
Closed-book exam；
Closed-book exam score counts for 90%; Regular performances count for 10%; Other
exam patterns can be self-designed based on individual courses.
Syllabus editor: Qiang Yongqian

Syllabus reviewer: Qiang Yongqian
28
“Respiratory System Radiology” Course Syllabus
Course name: Respiratory System Radiology
Prerequisite courses: Anatomy, pathology
[1] Zhang Yun, Li Miaoling, Qiang Yongqian. Radiology, 2004, Xi’an Jiaotong
University
[2] A.T. Ahuja, G.E. Antorio, K.T. Wong, et al. Case studies in medical imaging
radiology for students and trainees. New York ,Cambridge University Press, 2006.
Type: To study the normal features, basic signs and common disease imaging feature, to
include two parts (lecture and practice).
Purpose: Through the respiratory system imaging study, let the students understand
respiratory system imaging diagnosis value, and to master the common diseases imaging
diagnosis and differential diagnosis.
To introduce brief principle of X-ray and common examinations of the respiratory
system. Analysis of the respiratory radiographs can provide considerable information
regarding patients.
1.Master
 Normal X-ray signs of respiratory system
 Basic disorder X-ray signs of respiratory system
 X-ray signs of the commoner diseases for respiratory system include pneumonia,
lung abscess, pulmonary tuberculosis, carcinoma of the bronchus
2.Understand
 Methods of radiographic examination in respiratory system
Chapter one: NORMAL FEATURES
1．Methods of Examination
Routine methods of examination in respiratory system include chest fluoroscopy and
usual films. Special methoda of examination include tomography and bronchography.
 Chest fluoroscopy is useful to examine the patient by observing the X-ray image on a
fluoroscopic screen.
29
 Posteroanterior (PA or Frontal) are routine diagnostic imaging of the chest.
 Lateral view is other usual diagnostic method of the chest It is often necessary to take
at least two views (PA and lateral view) to gain information about the third dimension
 Apical lordotic film can examine the apices of lungs
 Oblique films are obtained regularly in first examination for heart disease.
 Tomography and bronchography are replaced by Computed tomography
 Computed Tomography can provide diagnostic information of chest, include showing
abnormalities, demonstrating enlarged lymph nodes, knowing the shape and the precise
location may make a particular diagnosis highly likely and distinguishing vascular from
nonvascular structures
2．Normal X-ray Features
 Diaphragm
The upper surfaces of the diaphragm should be clearly visible. On a good inspiratory
film the level of the right hemidiaphragm is usually near the anterior end of the sixth rib or
near the posterior segment of the tenth rib.On the lateral view, the diaphragm shows dome.
 Costophrenic Angles
The angle is made of the chest wall and the diaphragm. The costophrenic angle must be
sharp. In the lateral view, the posterior costophrenic angles are the deepest in the
costophrenic sinuses
 Thoracic Cage
 Various soft tissues: In the female the breast shadows obscure the lower lung fields to
increase the density of the areas. The nipple shadows are looked like pulmonary nodes In the
male the pectoralis major muscle shadows increase the density of the upper lung fields.
 Bony components: We can observe about 10 ribs in the frontal film. Lower ribs
especial 11th. 12th ribs are obscured by diaphragm shadow. The rib is divided into posterior
segment, axillary segment and anterior segment. Rib cartilage is not visible on the
radiograph. The calcified rib cartilage is visible. The scapulae and clavicle obscure the upper
lung fields. The clavicles appear symmetrically on either side of the mid-line. The sternum,
manubrium and thoracic spine are clearly identified on the lateral view
 Trachea.
 The trachea begins at the level of the cricoid cartilage that generally is at the level of
the sixth cervical vertebra. In adults, the trachea ranges 9 to 15 cm in length and has a
maximum transverse diameter of 16 mm
 On the PA view, the trachea is seen in the midline up to the thoracic inlet. The obtuse
angulation of the right main bronchus with respect to the trachea is noted. Cradled between
the trachea and the right main bronchus is a curvilinear shadow spoken of as the "azygous
node" or "azygous arch"
 Right upper lobe bronchi gives rise to the segmental bronchi: apical, posterior and
anterior segments bronchus (B1, B2, and B3).
 Right middle lobe bronchi giving rise to the lateral and medial segmental bronchi
(B4 and B5).
30
 Right lower lobe bronchi giving rise to the superior (apical) segmental bronchus (B6)
,the medial basal bronchus (B7), anterior, lateral and posterior ( B8, B9, and B10)
 Left upper lobe bronchi giving rise to B1+2, and B3 and the descending lower
division, which gives rise to the lingular segmental bronchi, B4 and B5.
 Left lower lobe bronchi giving rise to the B6 (superior segmental bronchus), anterior
medial bronchus (B7+B8), lateral and posterior (B9 and B10)
 Position of heart
 One third of the heart is at right of the midline, two thirds of the heart is at left of the
midline
 Lung hili
 The hilar shadows are consists of pulmonary arteries, veins and major bronchi. The
left hilum is usually slightly higher in position than the right
 Pleura
 The right lung is divided into three lobes and the left lung into two lobes by deep
pleural fissures.
 In the frontal plane only the horizontal fissure
 The normal oblique fissures (major interlobar fissure between the upper and lower
lobe) can be seen on good lateral views.
 The normal apical pleura is often visible.
 A some-what similar shadow in the lower axillary line runs parallel to the medial
border of the ribs just above the costophrenic recess
 Lung fields
 The lung fields are studied and divided into three zones, spoken of as the inner or A
zone; the middle or B zone; and the outer or C zone
 The lung fields are also divided into upper, middle and lower fields
 Lungs and Anatomic position of pulmonary lobe.
 The right lung has three lobes. The right upper lobe has apical (or S1 segment),
posterior (S2) and anterior (S3) segments. The right middle lobe has lateral segment (S4) and
S5 (medial segment). The right lower lobe has five segments, the superior (apical, S6) and
four basal segments: the medial basal segment (S7), an anterior medial basal segment (S8),
the lateral basal segment (S9), and the posterior basal segment (S10).
 The left lung has two lobes. (S1+2) represents a combination of the two separate
(apical and posterior) segments seen on the right upper lobe. It is referred to as the apical
posterior segment. The lingual lobe include the superior lingular segment (S4) and the
inferior lingular segment (S5).The left lower lobe segmental architecture is the superior
(apical, S6), anterior medial basal segment (S7+8), the lateral basal segment (S9) and the
posterior basal segment (S10)
 Mediastinum
 The mediastinum is situated between the pleural cavities and extends from the
sternum anteriorly to the vertebral column posteriorly. The upper limit is formed by the
thoracic inlet and the lower border is the diaphragm
31
 An imaginary plane extending from the manubrium sterin to the lower border of the
fourth dorsal vertebra divides the mediastinum into an upper and lower division. The
superior and inferior mediastinum is subdivided into three spaces. They are anterior, middle
and posterior areas
 The anterior part is a shallow space bounded anteriorly by the manubrium sterni and
posteriorly by the trachea and ascending aorta. It contains the thymus.
 The middle mediastinum contains the trachea, part of aortic arch, superior vena cava
and a lot of lymph nodes.
 The posterior mediastinum between the esophagus to the dorsal spine is occupied by
the esophagus and some never tissues.

Independent
Study
2.1 1 √ √
2.2 1 √ √
Chapter two: Basic Disorder X-ray Signs of Respiratory System

1．Basic signs of lung
The basic disorder X-ray signs of respiratory system can be grouped increased density
shadows and increased radiolucency shadows. The increased density shadows include air-
space filling (consolidation or exudation), spherical shadows, line shadows, widespread
small shadows, cavitation, calcification and collapse. The increased radiolucency shadows
include emphysema, penumothorax, bullae et al.
 Air-space Filling
 Air-space filling means the replacement of air in the alveoli by fluid and cells, or
rarely, by other materials.
 Air-space Filling is high density with ill-defined borders except where the disease
process is in contact with a fissure (have a well-defined edge).
 Air bronchogram can see the bronchi shadow in the air-space filling.
 Pulmonary edema
 There are two forms of pulmonary edema: interstitial and alveolar.
 The shadow of alveolar edema is one of the air-space filling.
 Alveolar edema is almost always bilateral, involving all the lobes and called the
"butterfly pattern" or the "bat's wing pattern"
 Consolidation
 Consolidation of a whole lobe is virtually diagnostic of bacterial pneumonia.
 The lobar consolidation produces an opaque lobe, except for air in the bronchi (air
bronchogram )
 Patchy Shadows
 Patchy shadow means small consolidation which is one or more patches of ill-
32
defined shadowing up to the size of one or more segments
 It is usually due to either infection (for example, bronchopneumonia), infarction or,
less commonly allergy.
 Spherical Shadows (lung mass)
 Solitary Spherical Shadows
Mass Benign Malignant
Age ＜30 ＞40
Shape Regular rounded, egg-shaped Irrgular Lobulated notched infiltrating
Edge Clear or smooth Ill-defined
Size ＜ 3cm ＞3cm
Adjacent lung Calcification or fibrosis -
Other lesion Pleural thickening Second lesion, effusion
Comparison with previous
Lack of change changed
films
 Line Shadows
The term "line shadow" refers to a line, usually no thicker than an ordinary pencil line,
traversing the lung.
 Septal Lines
The pulmonary septa are connective tissue planes containing lymph vessels. They are
normally invisible.
（1）Kerley A lines which radiate towards the hili in the middle and upper zones.
These lines are much thinner than the adjacent blood vessels and do not reach the lung edge.
（2）Kerley B lines which are horizontal, never more than 2 cm in length and are seen
best at the periphery of the lung bases.
（3）Kerley C lines look like net in low zones surrounding heart
 Pleuropulmonary Scars (fibrosis)
（1）These scars from previous infection or infarction are common causes of line
shadows.
（2）They usually reach the pleura and are often associated with visible pleural
thickening.
 The Edge of Emphysematous Bullae
（1）The wall of bullae is often bounded and traversed by very thin line shadow
without normal vessels within them
 The Pleural Edge in A Pneumothorax
（1）The pleural edge is seen as a line approximately parallel with the chest wall.
（2）No lung vessels will be seen beyond the pleural line.
 Widespread Small Shadows
 Nodular and Reticular Shadows
（1）Chest films with widespread small pulmonary shadows (2 - 5 mm)
33
（2）Nodular to signify discrete small round shadows
（3）Reticular to describe a net-like pattern of small lines
（4）Often there are both nodular and reticular elements and this is called
reticulonodular.
 Multiple Ring Shadows
（1）Multiple ring shadows of 1 cm or larger are diagnostic of bronchiectasis.
（2）The shadows represent dilated thick-walled bronchi
（3）Air-flue level can be seen
 Cavitation
 Cavitation (abscess formation) within the consolidated areas in the lung may occur
with many bacterial infections
 Cavitation or abscess formation is only recognizable once the abscess communicates
with the bronchial tree allowing the liquid center of the abscess to be coughed up and
replaced by air.
 The air is then seen as a translucency within the opacity of the consolidation, In the
erect position an air-fluid level will be visible.
 If the center of the mass undergoes necrosis and is coughed up, air is seen in the mass
 Air-fluid level will be also visible on erect films.
 Calcification
 Calcification is a common finding in hamartomas and tuberculosis.
 Tomography is of great value in detecting small calcification.
 Calcification is the highest density in the lung lesion.
 The shape of calcification is irregular vary.
 The edge is very well defined.
 Collapse (atelectasis)
 Collapse means loss of volume of a lung or lobe,.
 The signs of collapse are high density shadow, loss of volume of lobe or lobes,
silhouette sign and displacement of adjacent structures to take up the space normally
occupied by the collapsed lobe.
 Increased Radiolucency of Lungs
 Generalized increased radiolucency of the lungs is one of the signs of emphysema.
2. Pleural Pathology
 Pleural Effusion
 Free Pleural Fluid
（1）Costophrenic angle disappears
（2）If fluids enlarge, free fluid shows high density shadow, "running up" all sides of
the lung and chest wall, and appears as a concave edge
（3）Very large effusions run over the top of the lung.
 Loculated Pleural Fluid
（1）Loculations may either be at the periphery of the lung or within the fissure
between the lobes.
34
（2）Loculated interlobar effusions can be made by noting that on the lateral film the
effusion is lens-shaped, lying within the oblique or horizontal fissure.
 Pleural thickening (pleural fibrosis)
（1）The appearances are similar to pleural fluid but always smaller than the original
shadow, often much smaller.
（2）The costophrenic angle remains obliterated
 Pleural Calcification
Irregular plaques of calcium may be seen with or without accompanying pleural
thickening
 Pneumothorax
One hemothorax appears increased radiolucency, the line of pleura forming the lung
edge separates from the chest wall, mediastinum or diaphragm by air, the blood vessel
shadows disappear outside this line
 Hydropneumothorax
The diagnostic feature of hydropneumothorax is the air-fluid level

Independent
Study
2.3 1 √ √
Chapter three : X-ray Signs of the Commoner Diseases for Respiratory System
1 Pneumonia
Pneumonia is parenchymal inflammation. Parenchyma consists of the alveoli, the
alveolar walls and the immediately adjoining structures. According to anatomic area of the
inflammation, pneumonia is classified into lobar pneumonia, lobular pneumonia or
bronchopneumonia and interstitial pneumonia.
 Lobar Pneumonia
 Lobar pneumonia is characterized by inflammatory consolidation of segments or
lobes.
 Classical consolidation exhibits successive stages: active congestion, red and gray
hepatization, resolution, and finally, restoration to the normal state.
 Radiological Features
（1）Faint and poorly outlined haziness of the involved pulmonary segment is the first
X-ray manifestation of lobar pneumonia.
（2）Homogeneous well demarcated density of a large segment, a lobe or entire lung,
due to the uniform intra-alveolar consolidation
（3）The silhouette sign and air bronchogram can be seen.
（4）In the stage of resolution, the involved segment shows irregular areas and streaks
of haziness and density.
 Bronchopneumonia
35
 Bronchopneumonia is a non-specific infection caused by virus, streptococcus,
 Radiological Features
（1）Bronchopneumonia shows patchy, poorly defined, irregular areas of haziness or
density.
（2）The distribution is usually bilateral though asymmetrical and loss of clarity of the
vascular markings
（3）The radiological abnormality may persist for many weeks after clinical recovery.
2. Lung Abscess
 Pathological and Clinical Features
The course of lung abscess is some degree of bronchial occlusion by infected aspirate,
segmental pneumonia, tissue necrosis, suppuration and cavitation with the sloughing out of
necrotic, purulent material via bronchus.
 Radiological Features
The position of the acute aspiratory lung abscess is usually in the apical segments of
the lower lobes or in the posterior segments of the upper lobes.
In early stage, homogeneous density due to the zone of pneumonia
The density usually shows a central area of increased radiolucency, often with an air-
fluid level---the evidence of cavitation forming.
The inner wall of the cavity tends to be smooth and sharply.
The outer wall of the cavity is not seen because homogeneous density of pneumonia surrounding
the cavity
Lung abscess Tuberculosis Carcinoma
Position center of pneumonia center of lesion deviating center
Size large small ‹3cm large or small
Shape regular regular irregular
Air-fluid level + ― ―
Inner wall smooth smooth or irregular irregular
outer wall invisible smooth or invisible lobulated,
pneumonia surrounding some patchy, fibrosis,
Ajacent lung notching and infiltrating
the cavitation and calcification
3. Pulmonary Tuberculosis
Pulmonary tuberculosis is divided into five types. Ⅰtype is primary tuberculosis, Ⅱtype
is disseminated (miliary) tuberculosis, Ⅲ type is post-primary tuberculosis, and Ⅳ type is
pleural tuberculosis. Ⅴtype is extrapulmonary tuberculosis.
Primary Pulmonary Tuberculosis
In the early stages, the primary infection may show an area of haziness to
homogeneous density, known as the Ghon focus (primary lesion), develop in the periphery
of the lung, usually in the middle or upper zones.
Usually, the pulmonary shadows is small, sometimes the pulmonary patchy is so
small that it is nearly invisible
36
The patchy is often accompanied by visible enlarged hilar or mediastinal lymph
nodes.
This combination of pulmonary consolidation and lymphadenopathy is known as the
primary complex (Ghon complex) 4.6.2 Disseminated (miliary) Tuberculosis
Miliary pulmonary tuberculosis
The miliary pulmonary tuberculosis is widespread small (several millimeters in
diameter) shadows and uniformly distributed throughout the lungs.
The densities are of the same character and size
Hilar lymphadenopathy may be present particularly in children.
Pleural fluid may appear as part of the polyserositis
Post-primary Pulmonary Tuberculosis
Radiologically secondary tuberculosis is usually confined to the lung in the apical and
posterior segments of the upper lobes and the apical segment of the lower lobes
Early incipient pulmonary tuberculosis presents as a patch of poorly defined haziness
or density.
The patchy may be multiple and small areas, often bilateral
Cavities are seen as rounded air spaces completely surrounded by patchy and fibrosis
shadows. Cavities of various sizes, single or multiple are usually sharply outlined. Their
walls may be thickness or thin
Tuberculoma refer to a tuberculous granuloma in the form of a spherical mass;
usually less than 3 cm in diameter. The edge is usually sharply defined and these lesions are
often partly calcified. Tomography may be needed to demonstrate the calcium. Some fibrosis
and calcification may be in adjacent lung
Healing occurs by fibrosis and often calcification, but both fibrosis and calcification
may be seen in the presence of continuing activity.
Pleural effusion may be visible.
The blood stream resulting in miliary tuberculosis.
Pleural tuberculosis
Pleural tuberculosis usually presents as a unilateral, exudative, predominantly
lymphocytic, pleural effusion often associated with ipsilateral pulmonary tuberculosis.
Extrapulmonary Tuberculosis
Extrapulmonary tuberculosis can occur with or without concurrent active pulmonary
tuberculosis.
4. Carcinoma of the Bronchus
Most classifications, including the one by the World Health Organization, divide
bronchial carcinoma into four major cell types: squamous cell carcinoma, adenocarcinoma,
undifferentiated large cell carcinoma, small cell carcinoma. Squamous carcinoma,
adenocarcinoma and large cell carcinoma are often all grouped under the term non-small cell
lung cancer.
According to the position of bronchial carcinoma, the bronchial carcinoma is divided
into three types, there are central bronchial carcinoma, peripheral bronchial carcinoma and
37
bronchioalveolar carcinoma on X-ray film.
Signs of Central Bronchial Carcinoma
The cancer itself may present as a hilar mass and / or narrowing of a major bronchus.
The narrowing may be irregular or smooth.
The obstruction of bronchus and filling defect
The effect of obstruction by the tumor is usually a combination of collapse and
consolidation
Obstructive emphysema is occasionally seen with a centrally situated carcinoma.
 Signs of Peripheral Bronchial Carcinoma
A peripheral carcinoma usually presents as a solitary pulmonary mass.
The signs of a peripheral primary carcinoma are:
(1)A rounded shadow with irregular border, lobulation, notching and infiltrating edges
is the common pattern
(2) Cavitation within the mass: peripheral squamous cell carcinoma shows a particular
tendency for cavitation
(3)The wall of the cavity is classically thick and irregular, but thin-walled smooth
cavities due to carcinoma do occur.
 Signs of Bronchioalveolar Carcinoma
A chest radiograph may show single irregular mass or widespread small nodule
Single or multiple consolidation with an air bronchogram, meaning that the
surrounding lung is opaque and is outlining the air-filled bronchi
 Signs of Spread of Bronchial Carcinoma
 Hilar and mediastinal lymph nodes enlarge due to lymphatic spread of tumor.
 Pleural effusion may be due to malignant involvement of the pleura, or may be
secondary to associated infection of the lung
 Elevation of the diaphragm is visible.
 Rib metastases.
 Pulmonary metastasises.

Independent
Study
2.4 2 √ √
V．Practices
1.Normal features，2 study hours
2.Basics signs，4 study hours
3. Common disease, 4 study hours
VI. Exam patterns
Closed-book exam；
38
Syllabus editor: Niu Gang

39
“X-ray diagnosis of Abdomen” Course Syllabus
Course name: X-ray diagnosis of Abdomen
Prerequisite courses: Anatomy/ Physiology/ Pathology/Pathophysiology/ Internal
medicine/ Surgery
[1] Zhang Yun, Li Miaoling, Qiang Yongqian. Radiology, Dean’s Office Xi’an Jiaotong
University, 2004
[2] David Allen Lisle. Imaging for students (3rd Revised edition), Hodder Arnold,2007
[3] Fred A. Mettler Jr. Essentials of Radiology ( 3rd Revised edition), Saunders, 2013
[4] William Herring. Learning Radiology: Recognizing the Basics. Saunders , 2011
[5] Grainger and Allisons. Diagnostic Radiology: A Text book of Medical Imaging ( 4th
edition). Churchill Livingstone, 2001
I. Course Type and Purpose
Type: Professional course
Purpose: Let the students understand the examination methods of the plain abdomen
and gastrointestinal tract, master the normal X-ray features, basic X-ray signs and the X-ray
features of the common diseases of plain abdomen and gastrointestinal tract.
The course of “X-ray diagnosis of Abdomen” includes two parts: X-ray diagnosis of the
plain abdomen and gastrointestinal tract. We introduce the normal X-ray features, basic X-
ray signs and the X-ray features of the common diseases of the plain abdomen and
gastrointestinal tract.
1. Master
 Basic X-ray signs of the plain abdomen.
 The X-ray features of the intestinal obstruction.
 Basic X-ray signs of the gastrointestinal tract.
 The X-ray features of common diseases of the gastrointestinal tract.
2. Understand
 The examination methods of the plain abdomen.
 The examination methods of the gastrointestinal tract.

Chapter 1 The Plain Abdomen
Part 1 Methods of Examination
40
Fluoroscopy, Flat film and erect film of the abdomen are used.
The standard plain films of the abdomen are the supine AP view and the erect AP view
and decubitus view (i.e. an AP film taken with the patient lying on his left side) . The main
purpose of horizontal beam films is to detect air-fluid levels and free intraperitoneal air.
Part 2 Normal X-ray Features
In a normal abdomen film we can see: solid organs, their size, shape, and position; gas
containing organs (stomach, small bowel, colon), we only find some gas shadow, but from
the position, shape of the shadow, we can construe which organ; Bone tissues, lower part of
rib, lumbar vertebra, and pelvis.
Part 3 Basic X-ray signs of abnormal plain abdomen
1) Abnormal calcifications
2) Gas in the bowel
3) Gas out of the bowel
pneumoperitoneum, gas in an abscess
4) Ascites
5) Enlargement of the solid organs:
hepatomegaly, splenomegaly
Part 4 X-ray Features of Common Diseases
1. Intestinal Obstruction
1) Mechanical obstruction of the small bowel
Radiological features: Mechanical obstruction of the small bowel causes small bowel
dilatation with a normal or reduced caliber to the large bowel. In dilated small bowel, a large
amount of gas and many gas-fluid levels should be found
2)Obstruction of the large bowel
Radiological features:
 Obstruction of the large bowel causes dilatation of the colon down to the point of
obstruction.
 may be accompanied by small bowel dilatation if the ileocaecal valve becomes
incompetent.
 In elder patient, this always caused by colonic tumor.
 3) Paralytic ileus
 Radiological features:
 In generalized paralytic ileus both the large and the small bowel will be dilated.
 The dilatation often extends down into the sigmoid colon and gas may be present in
the rectum.
 Gas is much more than liquid.
 4) Closed loop obstructions
 Radiological features:
 The dilated loop is seen filled with gas in a characteristic shape, COFFEE-BEAN
SIGN, HORSE-SHOE CURVE, or PSEUDOMASS SIGN.
 In sigmoid volvulus, a barium enema shows the characteristic sign, bird– beak at the
41
point of the volvulus.
 If the small bowel and mesentery twist together, and the degree of the wring is 180 or
540, it shows the small bowel dilated and the position of the jejunum and ileum changed.
If the degree is 360,then we only find the dilated small bowel.
2. Intussusception
Radiological features:
The ileum, the cecum even the ascending colon may invaginate into the near colon, and
form some characteristic signs, cup-mouth sign and spring sign

Independent
Study
pt 1-2 0.5 h √
pt 3 0.5 h √ √
pt 4 1h √ √
Chapter 2 The Gastrointestinal Tract

Part 1 Methods of Examination
Fluoroscopy, Flat film of the abdomen, Radiography
Radiography: We always use barium sulfate and gaseous medium as contrast agents in
radiography, producing the so called "double-contrast studies".
The radiography includes: Esophagram, upper gastrointestinal series, hypotonic
duodenography, small bowel series, and double-contrast study of colon.
Part 2 Normal X-ray features
1. The Normal appearance s of PHARYNX
The anterior borders, from above downwards are: the valleculae, piriform fossae. They
are symmetrical organs.
The posterior border is prevertebral soft tissue, and should be from 0.5-1.8 cm in
thickness.
The contours of all are smooth.
2. The normal ESOPHAGUS
The cervical esophagus
Thoracic esophagus:
 Three physiological impressions: the impression caused by the arch of the aorta, left
bronchus and left auricle.
 Three sites of narrowing: the entrance of esophagus posterior to the cricoids
cartilage, the site of the aortic arch, the esophageal hiatus in the diaphragm.
 Three kinds of peristaltic waves of the esophagus: (1) a primary wave, (2) A
secondary superimposed smaller peristaltic wave, (3) Tertiary contractions
 The phrenic ampulla----The phrenic ampulla is the name given to a temporary
dilation, which occurs at the lower end of the esophagus.
42
 The mucosal pattern of the esophagus is usually defined as to three longitudinal
folds(width < 3mm ).
3. The normal appearance s of STOMACH
1）Four general types of stomach with different habitus:
 In hypertonus the stomach is "steer horn" in shape
 In orthotonus the stomach is J-shaped,
 In the hypotonic stomach its form is fishhook.
 The cascade stomach is a variation of shape seen in the hypersthenia .
2) Three part: the gastric fundus, body and antrum. The cardiac orifice, Pylorus; Two
curves: the lesser curve and the greater curve.
3) The CONTOUR of the filled stomach is smooth, especially in the lesser curve. The
greater curve, is more variable in its contour.
4) The classic description of the RUGAE is as follows:
 Longitudinal rugae ,the width of the rugae in the gastric body < 5mm.
 The rugae become increasingly irregular nearer to the greater curve, and show a
tendency to become broken up into secondary transverse and oblique rugae.
 The rugae show mesh-liked in the fundus of the stomach.
 The rugae always show as small trivialities and small ditches in the antrum.
 The size and distribution of rugae are to some extent influenced by some factors: the
contractions of the stomach wall and the degree of stomach filled by barium meal.
4. The normal appearance s of DUODENUM
The first portion consists of the bulb duodena, or duodenal cap, and a variable amount
of feathery duodenum. The normal bulb when filled should be uniform and regular; the
normal duodenum beyond the bulb should be feathery.
 Ampulla of Vater ---In a small percentage of cases this fills with a barium cream, and
is visible as a small rounded shadow, the size of a green pea, close to the inner border of the
second portion of the duodenum.
5. The normal appearance s of the small intestine: JEJUNUM, ILEUM
The jejunum and ileum may be considered together, though each has special
characteristics. They are continuous; the width of the coils of the jejunum is 2.5 to 3.0cm,
those of the ileum 2.0 to 2.5 cm.
The jejunum occupies, for the most part, the upper left portion of the abdomen; The
ileum lies, principally, in the right half of the lower abdomen and empties into the cecum
through the ileocecal valve.
One of the characteristics differentiating them is the mucosal pattern. In the jejunum,
the valvulae conniventes are prominent, resembling a cross hatching of herringbone design,
but these gradually disappear so that the terminal ileum is smooth on ordinary
roentgenograms.
6. The normal appearance s of APPENDIX
The classical appearance of the appendix in a barium meal is that of a blind tube, 3 to 4
inches in length, 2 to 4 mm in caliber, and showing a gentle single or double curve. Its length
43
may vary from 1/2 inch to 9 inches.
7. The normal appearance s of COLON
Shape, length , and position vary with the habitus.
Proximal to the left colic flexure, the colon is indented at intervals by haustra. Distal to
the left colic flexure, the colon is relatively smooth, haustra being much less marked. There
is no haustra in the rectum.
The rugae of the colon are crisscross formed by longitudinal, transverse and oblique
rugae. They are indented gradually.
Part 3 Basic X-ray Signs of abnormal Gastrointestinal Tract
X-ray diagnosis of disease of the gastrointestinal tract is based on the alterations of the
contour, mucosa and rugae, position and motility.
1. ALTERATION of the CONTOUR:
consists of narrowing, dilatation, or deformity.
 general narrowing: occurs in some strictures of the esophagus, some new growths of
the stomach (leather bottle stomach), and some inflammatory diseases of the colon.
 general dilatation: examples of this are achalasia of the esophagus, gastric dilatation
secondary to pyloric or duodenal stenosis, and megacolon.
 local narrowing: takes place in some caustic strictures and new growths of the
esophagus, certain gastric tumors, some duodenal ulcers, and in inflammatory and neoplastic
diseases of the colon.
2. PROTRUSION
is an alteration in which the contrast medium projects beyond the normal limits of the
organ.
DIVERTICULUM, NICHE, PERFORATION, and FISTULA are protrusions.
 Roentgenologically, diverticula and niche are similar in that they are outpouchings,
but they differ structurally. A diverticulum contains all the coats of an organ. A niche,
because it follows erosion of one or more coats, is made up of less than the normal number
of layers.
 Perforation: the creation of a hole in an organ. This may occur in ulcer, diverticulitis
and cancer, allow the contents of the intestine to enter the peritoneal cavity or other organs.
 Fistula: an abnormal communication between two hollow organ or between a hollow
organ and the exterior.
3. INTRUSION
is an alteration in which the outline of the organ does not extend as far as it should.
Filling defect, incisura and impression are intrusions.
 FILLING DEFECT--- is a localized area of the tract from which the opaque medium
is excluded because some pathologic tissue extends into the lumen.
4. ALTERATION of the MUCOSA and RUGAE
 Widen, thicken, tortuous rugae. Occur in varices and inflammation of gastrointestinal
tract. In these diseases, the wall is flex, the boundary is not clear.
 Shallow rugae or absent. Occur in inflammation and malignant diseases. The
44
differentiation between them is the wall is flex in inflammation and those are stiff in later.
 Symmetrically radiating mucosal folds occur in benign ulcer. It is the pathognomonic
sign of benign ulcer.
 Distorted or absent. Occur in malignant disease, and is the pathognomonic sign.
5. ALTERATION of MOTILITY.
Motility is the time required for the opaque meal to pass from one portion of the tract to
another. Variations from the normal are: DELAY and ACCELERATION.
The cause of the delay or acceleration may be either functional or organic.
6. ALTERATION IN POSITION
It implies displacement of an organ due to some external cause. It is often associated
with or causes an alteration in the normal contour.
Part 4 X-Ray features of Common Diseases
1. ESOPHAGEAL VARICES
Radiological Features:
 In the advanced case the lumen of the esophagus will be found widened and slightly
tortuous;
 The normal shallow longitudinal folds are obliterated either partially or completely
by varicosities of varying shapes and sizes.
 These swellings have been described as wormlike, cirsoid and globular and they will
produce filling defects in the barium column similar to their contour.
 Sometimes the varices run in columns and may produce defects that resemble a
string of beads. The lateral contours instead of being smooth become scalloped or
mamillated.
2. CARCINOMA OF THE ESOPHAGUS
The type of growth is generally classified as infiltrating, proliferative or ulcerating.
Radiological Features based on type of tumor
(1) A Hold-up of the Barium Stream. At the affected site the lumen is narrowed and
eccentric, the wall appear rigid, and irregular filling defects replace the normal smooth
mucosa. A soft tissue shadow denoting the thickness of the affected area may be visible. The
length and breadth of the tumor may thus be roughly assessed. Above the growth, the
esophagus may be dilated.
(2) An ulcer crater-The barium may depict the crater projecting from the lumen when a
profile view is obtained. The wall of esophagus surrounding the ulcer is thickened and
produces a filling defect within the lumen.
(3) Superficial ulceration. This is a rare type in which the lumen is slightly narrowed,
the margin are slightly irregular and spiky, the normal mucosal folds being absent.
3. ULCER OF STOMACH
Ulcers have been classified as mucous erosions, penetrating ulcers, and perforating
ulcers.
 The pathognomonic alteration of contour in gastric ulcer is the NICHE. Benign
ulcers sometimes undergo malignant changes.
45
 The incisura is usually lying at the opposite the site of the ulcer. It is not a constant
alteration of gastric ulcer.
 A round translucent zone devoid of barium- This represents the edematous mucosal
lip of the crater. The wider this transparent zone, the greater the edema.
 A CORONA OF MUCOSAL RUGE, converging towards the crater. The
convergence is an index of the chronic ulcer.
 Motility varies with the location of the ulcer and its mechanical effect..
4. NEOPLASMS OF THE STOMACH
Radiographic Classification: scirrhus (Localized and Diffuse), encephaloid or fungous,
and ulcerous carcinoma (Malignant Ulcer).
1) Localized scirrhous carcinoma
 The characteristic X-ray feature of this type is a contracture of the lumen.
 The edge near the lesion may be tapering or overhanging (shouldering ).
 A common type of filling defect is the napkin ring defect, as though a napkin ring
were constricting the gastric lumen.
 The mucosal change: the normal rugae stopping short at the edge of the lesion and
being replaced by an irregular disordered pattern.
2) Diffuse scirrhous Carcinoma
 This gives rise to the common form of leather-bottle stomach or linitis plastica.
 The striking feature is the diminution in the size of the stomach.
 Its contours will, as a rule, show mild irregularities.
3) Medullary, Encephaloid, or Fungous Carcinoma
 There are irregular tumor masses, which project into the gastric lumen.
 Ulceration usually takes place in these tumor masses, further to complicate the
picture.
 The mucosal relief pattern in fungous carcinoma shows a marked and abrupt
alteration of the regular pattern into a completely irregular one in the zone involved by the
tumour.
4) Ulcerous carcinoma
 MENISCUS SIGN--- It is a translucent zone a few mm. in width, separating the large
irregular barium-filled crater from the main barium mass in the stomach and is due to the
hard-growing malignant edge of the ulcer.
To determine whether a gastric ulcer is simple or malignant from following respects:
 SIZE, Any ulcer larger than 2.5 cm. in diameter should be suspected as malignant
until it has been proved to be simple. The larger the ulcer the greater should be the suspicion.
 SHAPE. The simple ulcer tends to be hemispherical, regular in contour and sharply
defined. Malignant ulcers tend to be irregular.
 SITE-This is of importance. A malignant ulcer is variable in site, but most commonly
on the lesser curve near the pylorus. Those on the greater curve-they are uncommon-are
nearly always malignant.
 RUGE. In malignant ulcer, ruga are said to be interrupted without converging. In
46
simple longstanding chronic ulcer, which has undergone malignant degeneration, the ruga
may converge to the crater, as a result of scarring.
5. DUODENUM ULCER
Radiological features: The X-ray signs of duodenal ulcer may be grouped as follows:
 The visualized ulcer crater.
 Adjacent inflammatory, spastic and cicatricial changes in the bulb.
 Secondary disturbances in the stomach.
6. BENIGN NEW GROWTH OF CONLON
 CONTOUR: Filling defect
Benign tumors are seen as smooth rounded filling defects projecting into the lumen.
Some benign tumors, other than polyps, become pedunculated. If the stalk is long, the filling
defect may change position with change in position of the patient, or be changed on
successive examinations.
 The pattern of the mucous membrane overlying them not destroyed.
 The size of the defect varies with the size of the tumor.
 Smoothness of outline is the important diagnostic feature.
 MOTILITY: Unchanged, sometimes delay.
 POSITION: Unchanged
7. ADENOCARCINOMA OF COLON
It may be classified as globular, annular, or linear.
 Medullary adenocarcinomas are usually soft large growths projecting into the lumen
of the colon producing globular defects. Ulceration, fungation, and hemorrhage commonly
occur with this type of growth.
 Scirrhous growths tend to encircle the descending colon or sigmoid and produce
annular defects. These tumors, long known clinically as napkin-ring carcinomas because of
the way they encircle the bowel, narrow the lumen producing a narrow channel connecting
the portions of the colon above and below them.
 Both of these two types may occur ulcer. If ulcer occur in Scirrhous growth, an apple
core sign should been formed .

Independent
Study
pt 1 0.5 √
pt 2 1.5 √ √
pt 3 2 5 min √ √
pt 4 4 10 min √ √
V．Clinical practice
1. The normal, basic abnormal X-Ray signs, and common diseases of plain
abdomen，2 study hours
47
2. The normal X-ray features of gastrointestinal tract, 2 study hours
3. Basic abnormal X-Ray signs of gastrointestinal tract, 2 study hours
4. X-ray features of the common diseases of gastrointestinal tract, 4 study hours
VI. Exam patterns
Closed-book exam；
Closed-book exam score counts for 90 %; Regular performances count for 10%;Other
Syllabus editor: Xu Guiping

48
“Imaging of the Circulatory System” Course Syllabus
Course name: Imaging of the Circulatory System
1 WU Enhui. Medical imaging, 6th ed. People’s Medical Publishing House, 2008.
2 Jin Zhenyu, Medical imaging, 2th ed. People’s Medical Publishing House, 2006.
3 Zhang Yun, Li Miaoling, Qiang Yongqian. RADIOLOGY, Dean’s Office Xi’an
Jiaotong University, 2004.
1 Master normal X-ray signs of the heart and great vessels, including heart size, r heart
shape on PA, RAO, LAO views.
2 Master basic disorder X-ray signs of the heart and great vessels, including the
enlargement of four cardiac chambers and aorta of pulmonary vessel changes.
The key point of this course are The x-ray features of the normal heart and great
vessels，Radiology features of some common heart diseases and the roentgen pathological
considerations of the heart and great vessel. Furthermore ， Changes in pulmonary
vascularity in cardiac disease and The radiology features of some common heart diseases are
difficult point in this course.
1 Master normal X-ray signs of the heart and great vessels, including heart size, r heart
shape on PA, RAO, LAO views.
2 Master basic disorder X-ray signs of the heart and great vessels ,including the
enlargement of four cardiac chambers and aorta of pulmonary vessel changes.
Chapter 1 (1 Academic period）
The Radiological Signs of Normal Heart and Great Vessels
1 The methods of radiographic examination in circulatory system (6’)
1.1 Ionizing radiation
1.1.1 X-ray
1.1.2 Computed tomography
1.1.3 Angiography
1.1.4 Radionuclide imaging
1.2 Nonionizing radiation
49
1.2.1 Ultrasonography
1.2.2 MR
2 Commonly used projections of radiography and Normal conventional X-ray
appearances of heart and great vessels (35’)
2.1 Commonly used projections of radiography of heart and great vessels
2.1.1 Posterior anterior view, PA
The PA View is exposed in full inspiration. The distance between the film and the X-ray
tube should be standardized in order to permit measurement of cardiac dimensions. The
normal focal-film distance is 1.80 -2.0 metres. Patient must be in deep inspiration and
standard. The elbows of patient pushed forward in order to laterally rotate the shadow of the
scapula. With insufficient rotation, the lower corner of the scapula will be projected over the
lateral segments of the lungs.
2.1.2 Right anterior oblique view, RAO
RAO view is also called the first oblique view. It is obtained by rotating patient to the
left. The degree of rotation is approximately a 45-degree angle and is named it. This view
must be containing barium in the esophagus. The rays pass through the body from the left
behind to the right in front.
2.1.3 Left anterior oblique view, LAO
LAO view is named the second oblique view. It is obtained by rotating patient to the
right. The left shoulder is touching the cassette. The degree of rotation is about a 45-60
degree angle. The rays pass through the body from the right behind to the left in front
2.2 Normal conventional X-ray appearances of heart and great vessels
2.2.1 Posterior anterior view, PA
2.2.1.1 The border of the cardio-vascular shadow is divided into 2 edges, the right
border and the left border.
2.2.1.2 The right border is subdivided into 2 segments, upper segment and lower
segment. Upper segment is a projection of the superior vena cava in childhood or of the
ascending aorta in old patient. Lower segment is a projection of the right atrium.
2.2.1.3 The left border consists of 3 parts. The first part is a projection of the aortic
arch, named aortic knob. The second segment is a projection of pulmonary artery. The lowest
and largest segment is formed by the left ventricle
2.2.2 Right anterior oblique view, RAO
2.2.2.1 The anterior boundary from upper to lower is formed by the ascending aorta,
pulmonary artery, right ventricle and a small portion of the left ventricle.
2.2.2.2 The posterior edge is formed by the aortic arch and the left atrium. The upper
segment is the projection of the aortic arch. The lower segment is the projection of the left
atrium. The esophagus filled the barium follows a smooth curve down to the diaphragm,
with no local indentation as it passes behind the left atrium
2.2.3 Left anterior oblique view, LAO
2.2.3.1 The projection of the right atrium lies upper segment of the anterior border. The
projection of the right ventricle lies lower segment of the anterior edge.
50
2.2.3.2 The projection of the left atrium is in the upper segment of the posterior border.
The projection of the left ventricle is in the lower segment margin.
2.2.3.3 Upon the heart, aorta is present. There are ascending aorta, aortic arch and upper
part of the descending aorta
3 Physiological factors and normal variations affecting contour of heart and great
vessels (9’)
3.1 Body figure
The normal cardio-vascular shadow is classified by shape of the heart. There are three
types, the oblique, hypersthenic and hyposthenic individuals. Hypersthenic individuals
characterized by heavy trunk development usually have a short wide mediastinum, high
diaphragm and transverse, boot shaped heart. The curves of the heart are full and convex. On
the other hand, hyposthenic or asthenic individuals have a long narrow mediastinum, low
diaphragm and centrally placed, somewhat “drop shaped” heart with a prominent pulmonary
arc. Oblique individuals have between hypersthenic and hyposthenic
3.2 Age
In infant the heart is always of the transverse type, the right side being equal to left side.
It gradually alters in shape over a period of years, first tending to become narrow, later
widening a little, and reaching its adult type until after puberty
3.3 Respiration
Patient must be in deep inspiration and standard in PA view. On expiration the heart
appears larger than inspiration
3.4 Position of the Body
In bedridden patient, the patient has lost weight, so diaphragmatic level elevates, the
heart shadow is larger than standing
Chapter 2
Basic Disorder X-ray Signs of the Heart and Great Vessels Enlargement of the
heart
1 Enlargement of the heart (28’)
1.1 Left Atrial Enlargement
1.1.1 Backwards Displacement of the Esophagus
1.1.2 Elevation of the Left Main Bronchus
1.1.3 Double Contour Sign
1.1.4 Dilatation of the Left Auricle
1.2 Right Atrial Enlargement
This is the most difficult chamber enlargement to diagnose. No portion of the right
ventricle is visible on the frontal view so on this view the right ventricle has to displace the
left ventricle for the enlargement to be recognised. The apex may be displaced upwards and
outwards, rather than downwards and outwards as happens with left ventricular enlargement.
On RAO view the lower third of the anterior contour of the heart is bulges forwards. On
LAO view the lower second of the anterior border of he heart is bulged forwards
1.3 Left Ventricular Enlargement
51
The most common sign of enlargement of the left ventricle is that the shape of the left
heart bor
der bulges with the apex displaced downwards and outwards on PA view. On LAO film
the lower segment of the lower posterior contour of the heart is bulged backwards and
downwards. The common causes of enlargement of the left ventricle are aortic valve disease
(particularly aortic incompetence), mitral incompetence, systemic hypertension (once cardiac
decompensation has occurred), cardiomyopathy of many types, patent ductus arteriosus
(PDA) and ventricular septal defect (VSD) with large shunts.
1.4 Right Ventricular Enlargement
This is the most difficult chamber enlargement to diagnose. No portion of the right
ventricle is visible on the frontal view so on this view the right ventricle has to displace the
left ventricle for the enlargement to be recognised. The apex may be displaced upwards and
outwards, rather than downwards and outwards as happens with left ventricular enlargement.
On RAO view the lower third of the anterior contour of the heart is bulges forwards. On
LAO view the lower second of the anterior border of he heart is bulged forwards
1.5 General Enlargement of the Heart
General enlargement of the heart is seen in a number of different diseases of the heart,
for example, cardiomyopathy, heart failure and pericardial fluid
2 Abnormal Configuration (5’)
2.1 Round or pear-shaped heart
Enlargement of the left atrium of right ventricle mainly in the rheumatic heart disease
2.2 Boat-shaped heart
Enlargement of the left ventricle mainly in hypertensive heat disease of coronary heart
disease
2.3 General enlarged heart
In the patient with a chronic heart failure
2.4 Wooden-shoe heart
3 Aorta (2’)
3.1 Tortuosity, Elongation
3.2 Dilatation, Calcification
4 Radiological Signs of Abnormal Pulmonary Vasculature (15’)
4.1 Increased Pulmonary Blood Flow (Plethora)
Atrial septal defect, ventricular septal defect and patent ductus arteriosus are the
common anomalies in which there is shunting of blood from the systemic to the pulmonary
circuits, thereby increasing pulmonary blood flow. All the vessels from the main pulmonary
artery to the periphery of the lungs are large. This radiographic appearance is known as
pulmonary plethora
4.2 Pulmonary Arterial Hypertension
The pressure in the pulmonary arteries is dependent on cardiac output and pulmonary
vascular resistance. The conditions that cause significant pulmonary arterial hypertension all
increase the resistance to blood flow through the lungs, for e.g. ASD, VSD and PDA. The
52
radiological features common to most forms of pulmonary hypertension are enlargement of
the main pulmonary artery and hilar arteries, the vessels within the lungs being normal or
small
4.3 Pulmonary Venous Hypertension
Mitral valve disease and left ventricular failure are the common causes of an elevated
pulmonary venous pressure. In the normal upright person the lower zone vessels are larger
than those in the upper zones. In raised pulmonary venous pressure the upper zone vessels
enlarge and in severe cases become larger than those in the lower zones. This is a very useful
sign, since there is no other noninvasive method of assessing the pulmonary venous pressure.
Septal lines (Kerley B or A lines) also show pulmonary venous hypertension being formed
4.4 Decreased Pulmonary Blood Flow (Oligaemia)
To be recognizable radiological the reduction in pulmonary blood flow must be
substantial. The commonest cause the tetralogy of Fallot, where there is obstruction to the
right ventricular outflow and a ventricular septal defect that allows right to left shunting of
the blood. Pulmonary valve stenosis only causes oligaemia in extremely severe cases and
these are virtually confined to babies and very young children.
V．Practices
1．The Radiological Signs of Normal Heart and Great Vessels，4 study hours
2 ． Basic Disorder X-ray Signs of the Heart and Great Vessels Enlargement of the
heart，4 study hours
VI. Exam patterns
Closed-book exam；
Syllabus editor: Jing Chengwang

53
“CT diagnosis of Head” Course Syllabus
Course name: CT diagnosis of Head
Prerequisite courses: Anatomy/ Physiology/ Pathology/Pathophysiology/ Internal medicine/
Surgery
[1]Zhang Yun, Li Miaoling, Qiang Yongqian. Radiology, Dean’s Office Xi’an Jiaotong
University, 2004
[2] Michelle M. Smith, Timothy L. Smith. Pocket Atlas of Normal CT Anatomy of the
Head and Brain. Lippincott Williams & Wilkins, 2000
[3] Norbert Hosten, Thomas Liebig.CT Teaching Manual: A Systematic Approach to CT
Reading. Thieme, 2002
Purpose: Let the students understand the basic knowledge of CT technology and
clinical applications relevant to CT of the head
CT is a medical imaging procedure that uses computer-processed X-rays to produce
tomographic images or “slices” of specific areas of the body. CT scanning of the head is
typically used to detect infarction, tumors, calcifications, hemorrhage and bone trauma. The
course of “CT diagnosis of Head” includes three parts: basic knowledge of CT technology,
normal CT anatomy of the Head and Brain, and clinical applications of the head CT.
1. Master
 CT features of extra-cerebral and intra-cerebral hemorrhage
 CT features of cerebral infarction
2. Understand
 The basic knowledge of CT and the scanning methods of head CT
 The normal CT anatomy of the Head and Brain
 The CT features of cerebral tumors

Part 1. Basic knowledge of CT
1. History of CT
2. What is CT?
CT is a medical imaging procedure that uses computer-processed X-rays to produce
54
tomographic images or “slices” of specific areas of the body.
3. The introduction of CT machines
4. The features of CT images.
CT image is a gray scaled picture, a number of different gray scale PIXELs from black
to white ordered in a MATRIX. These pixels reflect the X-rays absorption coefficient of the
corresponding VOXELs.
5. What is CT value?
CT image not only can show the level of density with different value of each picture
element (known in computer jargon as a PIXEL), but also with X-ray absorption coefficient.
This absorption coefficient could be changed in CT value. Its unit is Hounsfield (HU).
The highest density tissue is cortical bone in human body, its CT value is about 1000
HU, the lowest one is air, about -1000 (negative1000), and water's is zero (0).
6. What are window width and window level?
WINDOW WIDTH: A CT value range of the observed adjacent tissues.
WINDOW LEVEL: An average CT value of the organization we have observed.
7. Scanning method of head CT
1) Plain CT scanning: Transverse sectional scanning without injecting contrast medium
is also called conventional brain CT.
2) Contrast enhancement CT scanning (CECT): Administration of the IV contrast
medium before scan is aimed to increase the detection rate of the disease and differential
diagnosis, which is known as contrast enhancement CT scanning. odine-based media are the
most widely used intravenous contrast agents and are usually injected to opacify the vascular
tree in different phases, depending on the rate and volume of contrast injection and the
timing of image acquisition.
3) CTA (computed tomographic angiography) is an examination that uses X-rays to
visualize blood flow in arterial vessels throughout the body, from arteries serving the brain ,
to those bringing blood to the lungs, kidneys, spleen, liver, gallbladder……
4) Reconstruction of CT images.
Part 2. CT Anatomy of head and brain
Anatomy of the Brain: CT image display the intracranial anatomy and distinguish gray
matter from white matter and nucleus. It can explicitly show different brain lobes, ventricles,
and subarachnoid space.
Special Structures: cerebellum, basal ganglia, hippocampus, internal capsule,
thalamencephalon, external capsule, pituitary gland, sylvian fissure, basilar cistern
In bone window, we can see the inner plate, the diploes, and the outer plate.
Part 3 The clinical application of brain CT
Four kinds of CT performance we can see in abnormal brain: low density, high density,
iso- density, and mixed density.
1. Cerebral Infarction
Acute cerebral necrosis caused by ischemic damage due to cerebrovascular occlusion.
The process of ischemic infarction is divided into hyper-acute stage( ＜ 6hr), acute stage
(within 6h-72h), sub-acute stage (within 72h-10d), and chronic stage.
55
CT Signs of ischemic infarction:
 Plain CT is unable to pick up hyper acute cerebral infarction.
 In the acute stage, CT shows low density area. Infarcted position and range is in
accord with blood distribution of occluded vessel. Cerebral cortex and medulla are involved
simultaneously. The infarcted area is sector, its fundus approaches endocranium, and shows
mass effect.
 Infarcted area is isodense after 2-3w that is accompanied with blur effect.
 Infarcted area displays low-density, sharply defined capsular space after 1-2 m.
2. Hemorrhage
1) Intra-Cerebral Hemorrhage
Spontaneous cerebral hemorrhage is caused by hypertension, aneurysm, vascular
malformation or cerebral tumor. Hemorrhage caused by hypertension often occurs in basal
ganglia, internal capsule, thalamencephalon, external capsule.
The process of hematoma is divided into acute stage, absorbed stage, and cystic stage.
Duration of entire process is related to the size of hematoma and age of the patient.
Signs on CT:
 CT scan is able to discover hemorrhage immediately.
 In the acute stage, hemorrhagic foci is kidney-shaped, circle or erose high density,
density is symmetrical. CT value is 60-80HU. Low-density banded dropsical image appears
around the hematoma, mass effect is obvious. Hemorrhage can enter ventricles and cavum
subarachnoidale.
 Absorbed stage begins from 3-7days. CT shows obscure image around the
hematoma. Dropsical band increase, hemorrhagic density decrease.
 Cystic stage begins after 2m. Hematoma is absorbed to form cyst attend by atrophy
of brain. Edema and mass effect disappear.
2) Epidural Hematoma
Epidural hematoma is often caused by injury of meningeal vessels. Blood accumulates
in epidural space.
Signs on CT:
 CT shows biconvex, semicircle, high-density image under internal lamina.
 Foci locates near the fracture of skull.
 It does not cross the suture line.
3) Subdural Hematoma
Subdural hematoma is caused by hemorrhage and injury of blood sinus in majority.
Blood accumulates in subdural space and extensively distributes over the cerebral surface.
Signs on CT:
 CT scan shows crescent-shaped, high-density hemorrhagic foci under the internal
lamina, which always accompany with cerebral contusion and laceration or intracerebral
hematoma, cerebral edema and mass effect in the acute stage.
 In the subacute and chronic stage, CT scan shows mixed density constituted by
slightly high-, iso-, and low- density.
4) Subarachnoid hemorrhage(SAH)
56
Subarachnoid hemorrhage can be traumatic or spontaneous. Spontaneous Subarachnoid
hemorrhage often caused by ruptured aneurysms or blood vessel abnormalities in the brain.
Blood accumulates in arachnoid space. Acute hemorrhage is most evident 2-3 days after
the acute bleed
Signs on CT:
Acute hemorrhage appears as high-attenuation (white) material that fills the normally
black subarachnoid spaces, which include the basilar cisterns(especially the suprasellar
cistern) and the sulci (especially the sylvian fissures).
3. Traumatic Brain Injury
Traumatic brain injury can be caused by a variety of mechanisms, depending on type,
force, position, direction of strength, etc.
 Cerebral contusion and laceration, intracerebral and extracerebral hemorrhage.
 Extracerebral hemorrhage includes epidural hematoma, subdural hematoma and
subarachnoid hemorrhage.
 Cerebral contusion exhibit sporadically hemorrhagic foci, cerebral edema, and
cerebral swelling. It is termed cerebral laceration if together with ruptures of meninges, brain
or vessel. Both exist simultaneously most.
 CT scan displays sporadically mottled, high-density hemorrhagic foci in the low-
density edematous area with mass effect. It also shows extensive cerebral edema and
cerebral swelling.
4. Brain tumors
The common brain tumors are astrocytic tumor, meningioma, pituitary tumor, acoustic
neuroma and metastatic tumor.
The purpose of CT scanning is to identify suspected brain tumors, and subsequently
make a locational, quantitative and qualitative diagnosis.
1) Astrocytic tumors
 Astrocytic tumors locate most in the cerebral hemispheres in adults, whereas in
cerebellum in children.
 Based on the degree of cell differentiation, astrocytomas can be classified into grade
I-IV.
 Tumors of I & II grade have clear, well-defined boundary.
 Grade III and IV tumors are diffusely infiltrative with irregular shape and ill-defined
boundary. Tumors tend to be necrosis, hemorrhage and cystic degeneration.
 Tumors locate most in the white matter.
 Grade I tumors usually appear low density, with well-defined boundary, and have
minimal mass effect. Classically, there is no or mild contrast enhancement.
 Grade II-IV tumors usually appear low, or heterogeneous dense with cystic
components. They often show irregular shape with ill-defined boundary. Mass-effect and
peritumor edema are significant. Tumors show significant enhancement with IV contrast.
2) Meningioma
 It affects middle-aged females in general.
 Meningiomas are the extra-axial dural-based lesions, at the confluence of dural septa.
57
Their preferential locations are as follows: parasagittal region over the cerebral

convexity; cerebellopontine angle; falx cerebri and tentorium cerebelli, etc.
 Tumors have complete capsula, abundant blood supply, and intratumor calcification.
 On plain CT, meningiomas appear as the well marginated, round shape masses
attached to the dura with wide base.
 The lesions are iso- or slightly hyper- dense, with intra-tumoral punctuated
calcifications. Significant edema can be seen around tumor when adjacent vessels are
compressed. Hyperostosis of adjacent skull can be seen also.
 After the administration of IV contrast, meningiomas show homogeneous
enhancement.
3)Metastatic Tumors
 Metastatic tumors are found most in elderly patients.
 Brain metastasis are from lung, breast and renal cancer via blood circulation in order.
 Metastasis tends to be multiple and to localize in the parietal and occipital lobe.
 Hemorrhage, necrosis, cystic degeneration and peritumoral edema are characteristic.
 On CT scan, metastatic lesions are often showed at the junction of white and gray
matter. They are either solitary or multiple.
 The solitary lesions are usually large in size.
 Metastatic lesions display iso- or hypo-density surrounded by edema without
contrast.
 With IV contrast, tumors show as nodular or ring-like enhancement.

Independent
Study
pt 1 0.5 h √
pt 2 0.5 h √ √
pt 3 1h √ √
1. The basic CT knowledge and scanning methods of the head, 0.5 study hours
2. The CT anatomy of head and brain，0.5 study hours
3. The CT features of common disease of the head and brain, 1 study hours
VI. Exam patterns
Closed-book exam；
Syllabus editor: Xu Guiping

58
“CT Diagnosis in Chest” Course Syllabus
Course name: CT Diagnosis in Chest
Prerequisite courses: anatomy/ physiology/ pathology/ pathophysiology/ diagnostics/ X-ray
diagnosis
[1] zhang yun,Li miaoling,Qiang yongqian.Radiology,2004, Xi’an Jiaotong University
[2] A.T.Ahuja, G.E.Antorio, K.T.Wong, et al.Case studies in medical imaging radiology
for students and trainees. New York ,Cambridge University Press, 2006.
[3] J. Hodler, G.K. von Schulthess , Ch.L. Zollikofer. Disease of the heart
chest&breast. 39th International Diagnostic Course in Davos (IDKD),Davos, 2007
Type: To understand the common use of CT scan in chest. To understand the common
diseases diagnosis in chest by CT.
Purpose: To understand the technologies and clinical applications relevant to CT
imaging of the chest.
1) To introduce the concept and equipment of CT.
2) To introduce the common use and advantages of CT scan in chest disease diagnosis.
3) To understand the technique of CT, such as windowing, HRCT, enhanced CT.
4) To understand the normal and basic disorder signs of CT in chest.
To understand the normal and basic disorder CT signs in chest.
1. Concept of Computed Tomography
It’s a method of examining body organs by scanning them with X rays and using a
computer to construct a series of cross-sectional scans along a single axis.
2. Common uses of CT scan in chest
1) further examine abnormalities found on conventional chest x-rays
2) help diagnose clinical signs or symptoms of disease of the chest
3) detect and evaluate the extent of tumors that arise in the lung and mediastinum, or
tumors that have spread there from other parts of the body
4) assess whether diseases are responding to treatment
5) help plan radiotherapy
6) demonstrate other lung disorders, such as: old or new pneumonia; tuberculosis;
59
emphysema; bronchiectasis; inflammation or other diseases of the pleura; diffuse interstitial
lung disease; evaluate the blood vessels in the chest (CT angiogram, CTA).
3. Technique of CT
(1)Routine examination: A routine examination consists of adjacent sections 5-10mm
thick taken through the area of interest(from apex to costophrenic angle)
(2)Windowing:
Window width: Determines range of CT numbers displayed on an image
Window level: Determines the location on the Hounsfield scale about which the
window width will be centered
• Lung window: to observe the lung parenchyma and bronchial anatomy(window
level:-600~-800Hu;window width: 700~1600Hu )
• Soft window: to observe the mediastinum, hila and pleural structures(window
level:30-50Hu; window width: 300~500Hu)
(3)Enhanced CT: Intravenous contrast medium is given in many cases, particularly
when the purpose of the examination is to visualize the mediastinum or hila.
(4)High resolution CT(HRCT): Thinner sections can be used to produce images with
higher spatial resolution to show details of pulmonary parenchymal disease and
bronchiectasis.
4. Advantages of CT in chest disease diagnosis
 Showing more information of abnormalities
 Demonstrating enlarged lymph node
 Knowing the shape and the precise location may make a particular diagnosis highly
likely
 Distinguishing vascular from nonvascular structures
5. CT image of normal chest
(1) Trachea tree: B1-apical segmental bronchus (right); B1+2- apical posterior
segmental bronchus (left); B3-anterior segmental bronchus; B2- posterior segmental
bronchus (right); B4-lateral segmental bronchus; B5- medial segmental bronchus; B6-apical
segmental bronchus of lower lobe; B7-medial basal segmental bronchus; B8- anterior basal
segmental bronchus; B9-lateral basal segmental bronchus; B10-posterior basal segmental
bronchus.
(2) Mediastinum structure: Brachiocephalic vein; Brachiocephalic trunk; Carotid artery;
Subclavian artery; Superior vena cava; Ascending aorta; Left pulmonary artery; Azygous
vein; Descending aorta; Right atrium; Pulmonary trunk; Left atrium; Right ventricle; Left
ventricle.
6. The basic disorder CT signs
(1) Air-space filling:
Definition: The replacement of air in the alveoli by fluid , cells or other materials.
CT signs: The shadow of it is high density with ill-defined borders
The cause of air space filling: Pulmonary edema and Consolidation
(2) Nodule, mass and solitary pulmonary nodule (SPN)
60
Definition:
 nodule: Lung spherical lesions smaller than 3cm.
 mass: Lung spherical lesions greater than 3 cm.
 SPN: A single lesion in the lung completely surrounded by lung parenchyma
(functional tissue) with a diameter less than 3 cm and without associated pneumonia,
atelectasis or lymphadenopathies.
Common cause: The usual causes are primary carcinoma, benign tumor of the lung
(hamartoma being the commonest), infective granuloma (tuberculoma being the
commonest), metastasis and lung abscess.
CT signs: Distinguish benign tumor and carcinoma according the shape, size,
appearance of the adjacent lung, other Lesions and compare with previous film.
Multiple Spherical Shadows: Multiple well-defined spherical shadows in the lungs are
virtually diagnostic of metastases. Occasionally, such a pattern is seen with pyemic
abscesses.
(3) Cavitation
The centre of the mass undergoes necrosis and is coughed out, and air is seen within the
mass.
The cause of cavitation: Lung abscesses; Tuberculosis; Primary carcinomas
(4) Collapse (atelectasis)
Collapse means loss of volume of a lung or lobe, it may be due to any of the following
bronchial obstruction, pneumothorax or pleural effusion, fibrosis of a lobe (usually following
tuberculosis), bronchiectasis and pulmonary embolus.
(5) Pneumothorax
The diagnosis of pneumothorax depends on the shrinkage of a lung, the line of pleura
forming the lung edge separates from the chest wall, mediastinum or diaphragm by air, the
blood vessel shadows disappear outside this line.
(6) Pleural effusion
The fluid in the pleural cavity can be a transudate (e.g. cardiac failure), an exudate (e.g.
pneumonia tuberculosis infection), pus or blood (e.g. malignant neoplasm, pulmonary
infarction). The CT signs of free pleural fluid and loculated pleural fluid are different.
(7) Pleural thickening
Following resolution of a pleural effusion, particularly following pleural infection or
hemorrhage, pleural thickening may occur. The appearances are similar to pleural fluid but
always smaller than the original shadow, and the CT value is higher than fluid.
(8) Pleural calcification
Irregular plaques of calcium may be seen with or without accompanying pleural
thickening . When unilateral it is likely to be due to either an old empyema, usually
tuberculous, or an old hemothorax. Bilateral pleural calcification is of due to asbestosis but it
is occasionally seen with old tuberculous disease and old hemothorax. Sometimes no cause
can be determined.
(9) Disorder of mediastinum
61
Computed tomography is currently the gold standard for the detection of mediastinal
pathology. Convention CT should be obtained to demonstrate calcifications and
hemorrhage .Contrast enhancement CT will define the enhancement patterns of the lesions
as well as their relationship with adjacent vascular and mediastinal structures. The
mediastinum is divided into anterior ,middle and posterior divisions for descriptive purposes.
Masses often cross from one compartment to the other. Mediastinal widening can be due to
many different pathological processes and usually classified according to their position in the
mediastinum. For example, dermoid cyst and thymomas in anterior mediastinum, lymphoma
and pericardial cyst in middle mediastinum, and neurogenic tumors located in posterior
mediastinum.

Independent
Study
1-5 40 min 10 min √
6 40 min 10 min √
V．Practices
CT Diagnosis in chest, 2 study hours
VI. Exam patterns
No closed-book exam；
Syllabus editor: Rong Wang

62
“CT Diagnosis in Abdomen” Course Syllabus
Course name: CT Diagnosis in Abdomen
Prerequisite courses: anatomy/ physiology/ pathology/ pathophysiology/ diagnostics/ X-ray
diagnosis
[1] zhang yun,Li miaoling,Qiang yongqian.Radiology,2004, Xi’an Jiaotong University
[2] Michael P. Federle, R. Brooke Jeffrey, Paula J. Woodward, Amir
Borhani.Diagnostic Imaging: Abdomen,2009.
Type: To understand the common use of CT scan in abdomen. To master the common
diseases diagnosis in abdomen by CT.
Purpose: To understand the technologies and clinical applications relevant to CT
imaging of the abdomen.
1) To introduce the equipment and basic concept of CT.
2) To introduce the CT anatomy of abdominal organs, etc.
3) To introduce the diagnosis of common diseases of each important abdominal organ
by CT.
To understand the normal and basic disorder CT signs in abdomen.
1. Basic Concept of Computed Tomography
It’s a method of examining body organs by scanning them with X rays and using a
computer to construct a series of cross-sectional scans along a single axis.
2. Preparation of CT scan in abdomen
1) The patients preparation, metal objects, allergies, pregnant, contrast material
2) What is plain CT scan?
3) What is contrast enhancement CT scan?
4) The three phases of enhanced scan in abdomen.
3. CT anatomy of Abdomen
1) Liver
2) Gall bladder
3) Pancreas
4) Spleen
63
5) Kidney
6) Stomach
7) Adrenal gland
8) Bladder
9) Prostate and uterus
10) Intestinal canal
11) Vessels
4. Common disease diagnosis of liver
1) Liver simple cyst:
 round or ovoid
 well-defined lesion of water density
 no enhancement.
2) Polycystic liver disease:
 multiple and variably sized cysts
 containing water-like fluids
 often concurring polycystic renal disease.
3) Hepatic cavernous hemangioma:
 low density lesion
 early clear enhancement of peripheral vascular lakes is rapidly followed by
progressive opacification of the central portions of the hemangioma
 shows progressive strengthening enhancement close to the density of the liver
parenchyma
 sign of “light bulb”
4) Hepatocellular carcinoma
 well-undefined hypodense lesion
 an early moderate degree of inhomogeneous enhancement, with rapid washout in the
portal venous phase
 sign of “fast in fast out”
5) Liver metastasis
 multiple and variably sized low density lesions
 rim enhancement
6) Liver cirrhosis
 enlarged liver with irregular contour
 non-homogenous density with diffuse nodules
 non-homogenously enhanced
7) Fatty liver
 fatty degeneration in whole or partial liver
 vessels relatively high attenuation structures against a background of low density
parenchyma
5. Common disease diagnosis of pancreas
1) Acute edematous pancreatitis
64
 diffuse enlargement of the pancreas with ill-defined edges
 obliteration of peripancreatic fat
 thicken of left anterior renal fascia
2) Acute necrosis pancreatitis
6. peripancreatic and retroperitoneal edema
 large non-enhancing areas of necrosis in the body and neck of the pancreas
3) Pancreatic pseudocyst
 well-defined large cyst arising within the pancreas
 always secondary to chronic pancreatitis
4) Pancreas carcinoma
 enlarged irregularly head of the pancreas
 low density and with necrosis
 enhancement is lower than its normal pancreas.
6. Common disease diagnosis of gallbladder and bile ducts
1) Gallbladder stone
 high or low density stone in the gallbladder
 result in expansion of bile duct
2) Gallbladder carcinoma
 soft-tissue mass in the gallbladder
 apparent enhancement
7. Common disease diagnosis of adrenal gland
1) Enlarged adrenal gland
2) Adrenal adenoma
 lesion in area of adrenal gland
 enhancement is lower than its normal adrenal gland in arterial stage
 moderate wash out in venous stage
3) adrenal metastasis
 round or ovoid lesion
 rim enhancement in arterial stage
8. Common disease diagnosis of spleen
6． Spleen injury
 transverse fracture through the spleen
 surrounding fluid
 dull edge of spleen
7． Spleen simple cyst
8． Spleen abscess
 lesion with air-fluid level
9. Common disease diagnosis of urinary tract
1． Renal simple cyst
 round lesion
 water density
65
 no enhancement
2) Polycystic renal disease
 variably sized cysts
 containing water-like fluids
 enlarged and irregular contour kidneys
3) Renal carcinoma
 mass with low density
 markedly non-homogenous enhancement in the artery phase
 contrast medium withdrawal fast in the portal venous phase
 low density areas suggesting intratumoral necrosis
10. Common disease diagnosis in pelvis
1) Bladder tumor
 nodular and cauliflower-like mass with soft-tissue density projecting from the bladder
wall into the lumen
 broad base and irregular thickening of regional bladder wall
2) Cervix carcinoma
 enlarged irregular cervix with soft-tissue density
 high density areas suggesting calcification
11. Common disease diagnosis of stomach
3. Cardia cancer
4. Stomach cancer

Independent
Study
1-5 40 min 10 min √
6 40 min 10 min √
V．Practices
CT Diagnosis in abdomen, 2 study hours
VI. Exam patterns
Syllabus editor: Yuelang Zhang

66
“MRI Diagnosis”Course Syllabus
Course name: MRI Diagnosis in CNS/Chest/Abdomen
Prerequisite courses: anatomy/ physiology/ pathology/ pathophysiology/ medical physics/
internal medicine/ surgery/X-ray diagnosis
[1] Vadim Kuperman 2000 Magnetic Resonance Imaging Principles and applications.
Academic Press,. New York, 2000
[2] Robert R. Edelman, John Hesselink, Michael Zlatkin. Clinical Magnetic Resonance
Imaging. Saunders Elsevier, 2006
Type: The fundamental physical principles of NMR to MRI, To understand the basic
characteristics of MR images, e.g., image contrast, spatial resolution, signal-to-noise ratio,
common image artifacts. To understand the common diseases diagnosis by MRI
Purpose: To understand the technologies and clinical applications relevant to MR
imaging of the head, chest, spine, body, and musculoskeletal system.
1. To introduce the history of MRI and fundamental physical principles of NMR to
MRI,
2. To understand the basic characteristics of MR images, e.g., image contrast, spatial
resolution, signal-to-noise ratio, common image artifacts.
3. To understand the common diseases diagnosis by MRI, which include the clinical
applications relevant to MR imaging of the head, chest, spine, body, and musculoskeletal
system.
1．To understand the common diseases diagnosis in CNS by MRI
2．To understand the common diseases diagnosis in chest by MRI
3．To understand the common diseases diagnosis in abdomen by MRI
Chapter one: MRI Diagnosis in CNS
1. History of MRI
2. MRI Methods of CNS
1) Conventional T1 Weighted Imaging (T1WI) and T2 Weighted Imaging(T2WI)
2) Enhanced MRI
67
3) MRI of Water-Suppression
4) MRI of Fat-Suppression
5) MR Angiography
6) Diffusion Weighted Imaging (DWI)
7) MR spectroscopy (MRS)
8) Functional MRI (fMRI)
9) MR Perfusion
10) Susceptibility-Weighted Imaging (SWI)
11) Magnetization Transfer Imaging (MTI)
3. What are T1WI and T2WI?
1) Signal Intensity (SI)
a) T1WI: White Matter > Gray Matter
b) T2WI: Gray Matter > White Matter
2) TR( time of repetition) and TE (time of echo)
a) T1WI: short TR and TE
b) T2WI: long TR and TE
3) For example: in spin echo sequence
a) T1WI: TR≤ 500ms, TE ≤ 30ms
b) T2WI: TR≥2000ms, TE ≥ 60ms
4.The Variation of MRI Signal Intensity in CNS Pathological Changes
1) Low SI in T1WI and High SI in T2WI: Water, Soft Tissue
2) Low SI in T1WI and Low SI in T2WI:Air, Stone, Calcification, Bone
3) High SI in T1WI and High SI in T2WI:Fat, Subacute Hemorrhage
4) High SI in T1WI and Low SI in T2WI:Melanoma, Hydroxide Calcium Phosphate
5.The signal intensity of diseases in MRI : CSF-like
Arachnoid Cyst/Epidermoid Cyst /Neuroepithelial Cyst /Cystic encephalomalacia
/Arachnoid Cyst
6.The signal intensity of diseases in MRI:T1WI>SI of CSF and T2WI≤SI of CSF
Cerebral Infarction /Encephalitis/Glioma /Demyelination /Edema in Brain tissue
7.The signal intensity of diseases is close to the cerebral parenchyma.
Brain tumor with high cellular density:Hydropenic Granuloma /Meningioma
8.The signal intensity of diseases in MRI: Low SI in T1WI and Low SI in T2WI
Calcification/Blood vessel/Hemosiderosis /Fahr disease
9.The signal intensity of diseases in MRI: High SI in T1WI and High SI in T2WI
Lipoma /Dermoid Cyst /Colloid Cyst /Craniopharyngioma /Rathke’s Cyst/
Angiocavernoma / Subacute Hemorrhage/Cholesterol cysts or granulomas
10.The signal intensity of diseases in MRI: High SI in T1WI and Low SI in T2WI
Colloid Cyst/Melanoma /Calcification Contained Hydroxide Calcium Phosphate
11.Contrast Media Enhanced MRI
observe the undetectable lesion in conventional MRI./differential diagnosis /Brain
Metastases: Detectable after Gd-DTPA Enhancement.
68
12.MRI of Water-Suppression (Fluid Attenuation Inversion Recovery, FLAIR)
Confirm the lesions in cortex, subcortex, ventricular surrounding./Confirm the lesions
in subarachnoid space (For example: subarachnoid hemorrhage, SAH) ./Confirm the cystic
lesions
13.MRI of Fat-Suppression
Diagnosis of the lesion with high SI in T1WI is fat. /Exhibition of fatty regions and its
surrounding regions.
14.MR spectroscopy (MRS)
In vivo measure the concentration of a number of brain metabolites. /Chemical shift and
molecular finger prints /Proton spectroscopy is most generally used./MRS of other nuclei,
such as phosphor or fluor /Single voxel and multiple voxel

Independent
Study
1-4 40 min 10 min √
5-14 40 min 10 min √
Chapter 2: MRI Diagnosis in abdomen

1. Examined Methods :Preparation: breath hold, respiratory training /Coil: surface
body-coil /Scanning: multilayer, Slice thickness: 5~8mm,Gap:1~2mm /Sequence:
TSE/FISP/T1WI/T2W Fat suppression /CEMRI (contrast
enhanced MRI)
2.The Variation of MRI Signal Intensity in Pathological Changes
Low SI in T1WI and High SI in T2WI:Water, Soft Tissue Low SI in T1WI and Low SI
in T2WI:Air, Stone, Calcification, Bone High SI in T1WI and High SI in T2WI:Fat,
Subacute Hemorrhage
High SI in T1WI and Low SI in T2WI:Melanoma, Hydroxide Calcium Phosphate
3.Challenges: Liver MR Imaging/Cardiac and respiratory movements can cause marked
image artifacts.
4.Magnetic field
0.2~0.5 Tesla, T1 value and T2 value of liver,300~400 ms and 50~60 ms
1.5 Tesla, T1 value and T2 value of liver: 450~500ms and 40~50ms；
3.0 Tesla, T1 value and T2 value of liver:600~800ms and 35~40ms ； Double blood
supply/High lipid density
5. MR Protocol:SSFSE (Single shot fast spin echo) /T2 weighted axial, coronal,
sagittal/T2w FSE/STIR axial/T1w FSE axial
6.Magnetic Resonance Cholangiopancreatography (MRCP) sequences (thin slice
SSFSE, thick slice SSFSE and 3D T2w FSE).
7.Gadolinium is administered.
8.Normal hepatic MRI--T1WI/T2WI （ FISP sequence ） /Normal hepatic contrast
69
enhanced MRA/Fat suppression MRI in normal abdomen /Liver, bile duct and bowel/Gall
Bladder, bile duct
9.Hepatic abscess
Plain Scan :T1WI：roundness with low SI, clear margin with low SI./T 2WI：marked
high SI, clear margin with low SI./Enhanced Scan: Obvious enhancement in wall of abscess,
clear boundary, cavity of abscess without enhancement.
10. Liver cancer: Plain Scan Low SI in T 1WI/High SI in T2WI /Non-homogenous in big
mass with tumor embolism in portal vein/Enhancement Scan
11.Hepatic Spongy Haemangioma:T1WI （ T1Weighted Imaging ） Low
SI/T2WI （ T2Weighted Imaging ） Increased SI with extend TE, until to SI of gall
bladder./Heavy T2 Weighted Imaging） Very prominent high SI with ”light bulb sign”
12.Hepatocirrhosis:Diffuse nodus/Metastasis in liver/Benign Liver Lesions/Focal
Nodular Hyperplasia./Pyogenic liver abscess/Hydatid cysts/Hamartoma
13.Gallstone:Roundness of hypointensity in T1WI、T2WI、MRCP./Dilatation of bile duct
with filling-defect in proximodistal side./MRCP images of abnormal secretin augmentation
suggestive of functional obstruction at the pancreatic sphincter
MRCP images – heavily T2 weighted images in a 3D display can demonstrate filling
defects as well as secondary signs such as biliary system dilatation. Cholangiocarcinoma
/Dilatation of bile duct in liver./Tumor in hepatic parenchyma./Pancreatic cancer /Local
augmentation in pancreas
14. Pelvis floor: Normal Prostate/ DCE MRI and MRS: Prostate
hyperplasia/Endometrial carcinoma /Rectal Cancer/Lymphatic Node

Independent
Study
1-5 20 min 5 min √
6-14 20 min 5 min √
Chapter 3: MRI Diagnosis in chest

1. MRI Application In 3 Important Parts:Lung /Heart/Breast
2. MRI Application In Lung
2.1 MRI Methods of Lung: Conventional T1 Weighted Imaging (T1WI) and T2
Weighted Imaging(T2WI)/Enhanced MRI /MR Angiography/MR Perfusion/Magnetization
Transfer Imaging (MTI)
3. Challenges: low proton density(80% air in lung parenchyma)/The susceptibility
artifacts at air-tissue interfaces. Bergin :lung T2 5 ～ 20ms. Hatabu: lung T2* 1.4ms /
Molecular perfusion and diffusion, washout effects and dephasing from pulmonary blood
flow (5L/min). /Cardiac and respiratory movements can cause marked image artifacts.
4. Accessorial equipment for pulmonary MRI: Electrocardiogram (ECG) Trigger
/Respiratory Navigation
70
Routine MRI Sequence for pulmonary MRI
5. Conventional Spin Echo Sequence (T1WI, T2WI):ECG combine Respiratory
trigger/Short TE
6. Single Shot Turbo Spin Echo, SSHTSE
Advantage: High scan speed, Low susceptibility effect, Without ECG and/or respiratory
trigger / Disadvantage: blur, SAR
7. 3D Turbo Gradient Echo Sequence: True-FISP for Pulmonary Embolism/ Real-time
MR with True-FISP for the detection
of acute pulmonary embolism
8. common diseases: Bronchial Cyst/Lymphoma/ Pancoast Tumor/ Lung Cancer/
Metastasis
9.Cardiac MRI
Cardiac MRI can reveal various heart conditions and disorders
Coronary artery disease /Damage caused by a heart attack /Heart failure /Heart valve
problems /Congenital heart defects /Cardiac tumors
10. MRI of coronary artery :Three-dimensional reformatted images of the right and left
coronary arteries in a healthy volunteer. The in-plane resolution is 0.7 ×1 mm. (a) Image
shows the left circumflex artery (LCx), left main coronary artery (LM), right coronary artery
(RCA), acute marginal artery into the right ventricle (RV), and sinus node (SN). (b) Image
shows the aorta (Ao), first diagonal (D1), left anterior descending artery (LAD), left
circumflex artery (LCx), left main coronary artery (LM), and right ventricular outflow tract
(RVOT). /CEMRA of coronary vasculature: Maximum-intensity projection images of an ex
vivo human heart after injection of gadopentetate dimeglumine into the coronary
vasculature, viewed from above (left) and the side (middle and right). The heart was imaged
with a high-resolution 3D spoiled GRE sequence at 1.5 T.
11.Calculation of end-diastolic and end-systolic volume
(1) Multiple contiguous short-axis SSFP images show the endocardial borders of the
ventricular cavities.
(2) Magnified view of a short-axis SSFP image show the calculated end-diastolic areas
of the right (dark gray) and left (light gray) ventricles. Because the section thickness is
known, the end-diastolic volume for each section can be calculated. The total end-diastolic
volume can then be obtained by summing the volumes for contiguous sections.
(3) Drawing illustrates the ventricular volume for an idealized right ventricle.
12.Breast MRI: as a problem-solving tool when mammograms and/or ultrasounds are
unclear; /in better defining the size of tumors and in staging breast cancer; /in evaluating
breast implants.
Breast coil: Patient lying on the table outside of the magnet with breast hanging freely
through the breast coil.
13:common diseases: Breast cancer/Infiltrating ductal cancer
71
Independent
Study
1-6 20 min 5 min √
7-13 20 min 5 min √
1. MRI Diagnosis in CNS, 2 study hours
2. MRI Diagnosis in abdomen, 2 study hours
3. MRI Diagnosis in chest, 2 study hours
VI. Exam patterns
Syllabus editor: Jian Yang

Syllabus reviewer: Yongqian Qiang
72
“Internal Medicine” Course Syllabus
Course name: Internal Medicine
Hours: 156 (96 lecture; 60 laboratory)
Intended audience: Foreign medical students
Prerequisite: no prerequisites required
《内科学》医学英文原版改变双语教材殷凯生主编科学出版社 2007 年

Type: Basic theory
Purpose: Internal Medicine is the foundational subject of all clinical medicine. The
contents of internal medicine are very important to the theory and practice of clinical
medicine. It provides the foundation to study and grasp all other clinical subjects.
Internal medicine is an important subject of clinical medicine. Internal medicine
includes respiratory, gastrointestinal, circulatory, urinary, hematological, endocrine,
metabolic and nutritional, connective tissue and rheumatic, and physical and chemical
diseases. For foreign students, the commonly encountered and important diseases of
respiratory, gastrointestinal, circulatory, urinary, hematological, endocrine, and metabolic
and nutritional diseases will be introduced. Physical and chemical diseases will be
introduced in emergency medicine. Practice will be taken by multimedia and seeing patients.
III. Teaching Methods
1．Multimedia teaching
2．Clinical practice
Chapter 1: Disorders of Respiratory System
1.1 General introduction
[Aims]
1. To master the structural and functional characteristics of respiratory system.
2. To get a brief knowledge of the diagnostic means and therapeutic principles of
respiratory diseases.
[Teaching Hour] 2h
[Teaching Contents]
1. Structure and functions of respiratory system.
2. A brief introduction of the diagnostic means of respiratory diseases.
3. Therapeutic principles of respiratory system diseases.
73
1.2 Pneumonia
[Aims]
1. The pathology and clinical manifestations.
2. The changes of chest roentgenogram, diagnosis, and differential diagnosis of
pneumococcal pneumonia.
3. The clinical manifestations and the leading management of pneumonia accompanied
with shock.
4. The characteristics of manifestations of and therapy against Staphylococcal,
Klebsiella, and Mycoplasma Pneumonia.
[Teaching Hours] 2h
[Teaching Contents]
1. Introduction, definition, classification according to etiology and anatomy.
2. Etiology and pathogenesis: Emphasizing the biologic characters, and typing.
3. Pathology of Pneumococcal pneumonia.
4. Clinical features: Emphasizing the presentations and signs of lobar consolidation, as
well as the symptoms and signs of severe pneumonia.
5. Laboratory Examinations.
6. Diagnosis; Based on the typical symptoms, signs of lobar consolidation, chest x-ray
film, and blood routines.
7. Differential diagnosis: Cheesy pneumonia, pneumonia caused by other bacteria,
acute lung abscess, bronchogenic carcinoma, and tuberculosis pleurisy with effusion.
8. Treatment: The penicillin is the antibiotics of first choice; The choice of antibiotics
for severe pneumonia; The keys therapy for septic shock.
9. Introducing the characteristics of clinical features and chest x-ray film, and the
diagnosis of Staphylococcal, Klebsiellar, and Mycoplasmal pneumonia; The effective
antibiotic therapy.
[Practice Hours] 2h
[Practice Contents]
Visiting a patients with typical pneumonia and discussing the diagnosis, differential
diagnosis, and treatment.
[Review Questions]
1. The typical manifestations and signs of Pneumococcal pneumonia.
2. The typical manifestations and key therapy of pneumonia with shock.
3. The differentiation of Pneumococcal pneumonia from of Staphylococcal, Klebsiella,
and Mycoplasma pneumonia.
1.3 Lung abscess
[Aims]
1. The diagnosis, differential diagnosis, and treatment.
2. The etiology, pathogenesis, and the pathologic changes.
3. The indications for surgical therapy.
[Teaching Hours] 2h
74
[Teaching Contents]
1. Introduction: The lung abscess is characterized by suppurative inflammation with
central necrosis and pulmonary cavities, and such clinical features as putrid sputum cough,
chest pain, and fever.
2. Etiology and pathogenesis:
3. Pathology: Emphasizing the process of pathologic changes and its relation with
clinical manifestations.
4. Clinical manifestations; Emphasizing the symptoms, signs of acute lung abscess; The
complications and features of hematogenous lung abscess.
5. Laboratory examinations: Sputum culture, blood routines, chest x-ray film.
6. Diagnosis and differential diagnosis: The diagnosis of lung abscess could
established by history, typical symptoms, signs, blood routines, and chest x-ray films,
Emphasizing the differentiation of lung abscess from pneumonia, bronchogenic carcinoma,
and cavitary pulmonary tuberculosis with concomitant infection.
7. Treatment: Emphasizing the principles of therapy for lung abscess; The penicillin is
the antibiotics of first choice, the duration of antibiotic therapy should be judged according
to whether or not the pulmonary cavities or inflammation is eliminated; Emphasizing the
significance of postural drainage, intrabronchial therapy, and the bronchoalveolar lavage
through bronchoscope; the indications of surgical therapy.
[Practice Hours] 1h
[Practice Contents]
Visiting a patient with lung abscess and showing the chest x-ray film; discussing the
diagnosis and the principles of therapy.
[Review Questions]
1. The etiology and pathogenesis of primary lung abscess; the principles of its therapy.
2. The characteristics of chest x-ray films and differentiation of lung abscess from the
cavities of pulmonary tuberculosis and lung cancer.
1.4 Pulmonary Tuberculosis
[Aims]
1. The etiology, pathogenesis, clinical manifestations, diagnosis, differential diagnosis,
the principles of chemotherapy and the usage of anti-tuberculosis drugs.
2. The characteristics of chest x-ray film and their relationship with pathologic changes.
3. The methods and the significance of the sputum examination of tubercle bacilli, and
the tuberculin test.
4. BCG vaccination, prevention, and the indications for surgical therapy.
[Teaching Hours] 4h
[Teaching Contents]
1. Introduction: The definition, transmission, and the characteristics of pathology.
A. The biology of tubercle bacilli, and their classification.
B. Transmission: M. tuberculosis is transmitted from person to person mainly via the
75
respiratory route. The relationship between immunity and allergy. Presenting the Koch’s
phenomena to explain the clinical manifestations of primary and secondary infection.
3. Pathology: The basic pathologic changes: effusion, proliferation, and caseation;
Emphasizing the evolution, development, and the spread of pulmonary tuberculosis.
4. The development of tuberculosis: The characteristics of primary pulmonary
tuberculosis, hematogenous disseminated pulmonary tuberculosis, infiltrative pulmonary
tuberculosis, and chronic fibro-cavitary pulmonary tuberculosis.
5. Clinical manifestation: The symptoms and signs.
6. Laboratory examination:
A. The sputum smears.
B. The chest X-ray film.
C. Tuberculin test.
D. Others.
7. Diagnosis and differential diagnosis: Emphasizing that the positive sputum smears of
tubercle bacilli is essential to the definite diagnosis. The chest films is very helpful for the
early finding and the monitoring of position, extension, and development of lesions, as wells
the effects of antituberculous therapy.
8. Treatment:
A. The principles of chemotherapy.
B. The procedure of chemotherapy: regular chemotherapy, short-term therapy, and
intermittent chemotherapy.
C. The regimen of chemotherapy: Emphasizing the formula, dosage, procedures, and
duration of chemotherapy.
D. The antituberculous drugs: Emphasizing the sorts, mechanisms, and major side
effects.
[Practice Hours] 2h
[Practice Contents]
Visiting a patients with typical pulmonary tuberculosis, discussing the diagnosis and
treatment, and scheming a regimen of chemotherapy.
[Review Questions]
1. The characteristics and difference of human immune and allergy.
2. The Koch’s phenomenon and its significance.
3. The procedures of finding tubercle bacilli and their significance.
4. The characteristics of each types of pulmonary tuberculosis.
5. The principles and indications of chemotherapy.
1.5 Pleural effusion
[Aims]
1. The pathogenesis, etiology, and differential diagnosis of pleural effusion.
2. The clinical features of pleural effusion.
[Teaching Hours] 2h
[Teaching Contents]
76
1. Introduction.
2. Etiology and pathogenesis.
3. Clinical manifestations.
4. Laboratory examination: Chest X-ray films, pleural biopsy, analysis of pleural fluid,
and immunological tests.
5. Diagnosis and differential diagnosis:
A. The differentiation of exudate from transudate.
B. The differential diagnosis of tuberculous, bacterial, and carcinomatous pleural
effusion.
6. Treatment: The principles of the therapy against tuberculous pleural effusion.
[Practice Hours] 2h
[Practice Contents]
Visiting a patients with pleural effusion and discussing the differential diagnosis and the
principles of the therapy.
[Review Questions]
1. The diagnosis and differential diagnosis of tuberculous pleural effusion.
2. The principles of the treatment against tuberculous pleural effusion.
1.6 Chronic obstructive pulmonary disease (COPD)/Cor pulmonale
Chronic obstructive pulmonary disease (COPD)

[Aims]
1. The definition of COPD
2. Etiology, pathogenesis, classification, and diagnostic criteria.
3. The development of COPD and its association with causative factors.
4. The measures of treatment and prevention.
[Teaching Hours] 2h
[Teaching Contents]
1. Introduction:
3. Pathology: Pathologic changes and classification.
4. Pathophysiology:
5. Clinical manifestation: Emphasizing symptoms and signs.
6. Accessory examinations:
7.Diagnosis and differential diagnosis: Established by history, signs, chest
roentgenogram, and spirometry.
8. Treatment:
[Practice Hours] 1
[Practice Contents]
Visiting the patients with typical COPD. Showing the chest x-ray films with typical
signs of emphysema.
[Review Questions]
77
1. The definition of COPD
2. The characteristics of the pathologic classification of obstructive emphysema.
Chronic Cor Pulmonale

[Aims]
1. The etiology and pathogenesis of chronic cor pulmonale.
2. The clinical features and diagnosis of chronic cor pulmonale.
3. The key principle of therapy during exacerbation and recuperation.
[Teaching Hours] 2
[Teaching Contents]
1. Introduction: Emphasizing the definition of chronic cor pulmonale.
2. Etiology: Emphasizing the three causative factors leading to the cor pulmonale,
especially obstructive emphysema.
3. Pathogenesis and pathology:
4. Clinical features:
5. Complication:
6. Laboratory examinations: The diagnostic criteria of cor pulmonale are based on chest
x- ray films, ECG, and EEG.
7. Diagnosis: The diagnosis of chronic cor pulmonale is established by the history of
chest diseases, symptoms, and signs, and could be confirmed by chest x – ray films, ECG as
well as EEG.
8. Differential diagnosis: rheumatic heart diseases, coronary heart disease, and
cardiomyopathy.
9. Treatment
A. Diuretics: The actions and side-effect; the principle of their application; the choice of
diuretics.
Monitoring of electrolytes and blood gas.
B. Digitalis: Emphasizing the criteria and principles of its rise, and the sort that should
be chosen.
C. The application of vasodilators.
D. Elimination of arrhythmia.
* The management during recuperation: Rehabilitation of lung and heart function
10. Prevention: Same as chronic bronchitis.
[Practice Hours] 2
[Practice Contents]
Visiting the patient with typical cor pulmonale; discussing the diagnosis based on their
history, signs, chest x-ray film, and ECG.
[Review Questions]
1. The etiology of chronic cor pulmonale.
2. The three causative factors of pulmonary hypertension.
3. The signs of chronic cor pulmonale during exacerbation.
78
4. The diagnostic criteria of chest x-ray film and ECG.
5. The principles of therapy and the management of heart failure.
1.7 Respiratory Failure
[Aims]
1. The definition，etiology and pathogenesis of chronic cor pulmonale.
2. The clinical features and diagnosis of respiratory failure.
3. The key principle of therapy of respiratory failure .
[Teaching Hours] 2
[Teaching Contents]
1. Introduction: Emphasizing the definition of respiratory failure.
2. Etiology:.
3. Pathogenesis and pathology:
5. Diagnosis:
6. Treatment
[Practice Hours]
[Practice Contents]
Visiting the patient with typical respiratory failure.
[Review Questions]
1. The definition of respiratory failure
2. The diagnostic criteria of respiratory failure.
3. The principles of therapy and the management of respiratory failure
1.8 Bronchial asthma
[Aims]
1. The pathogenesis of asthma
2. Clinical features, classification, diagnosis, differential diagnosis, and complications.
3. The principles of treatment and prevention; the control of episodic attack and the
management of severe asthma.
4. The new concept and development of the pathogenesis and treatment of bronchial
asthma.
5. The grade of severity of asthmatic episode.
[Teaching Hours]4h
[Teaching Contents]
1. The definition and prevalence.
2. Etiology and pathogenesis:.
3. Clinical features
A. Symptoms:
B. Physical examination:
4. Lab and skin test
A.Blood routine: eosinophilia and erythrocytosis.
B. Sputum smear and culture.
79
C. Blood gas analysis and spirometry.
D.Chest roentgenograms.
E. Measurement of the specific lgE.
F. Skin-test of allergens.
5. Diagnosis:
6. Differential diagnosis: Briefly present the differentiation of asthma from other
diseases associated with dyspnea and wheezing: left ventricular failure, chronic asthmatic
bronchitis, bronchogenic carcinoma, and eosinophilic pneumonia.
7. Complication: briefly present the complication of asthma.
8. Treatment and prevention
A. Elimination of the causative agents.
B. Controlling the episodes of the attack:
C. Improving expectoration:
D. Antibiotics:
E. Management of severe asthma: Emphasizing the multiplicity of management, the
role and values of glucocorticoids.
9. Prognosis: Rational therapy could relieve or cure asthma. If the onsets of asthma
could be controlled, prevented, and relieved, the good prognosis is expected. Otherwise the
prognosis of those with severe asthma of recurrent onsets, poorly controlled, of complicated
with cor pulmonale will be poor.
[Practice Hours] 2h
[Practice Contents]
Visiting the patients with recurrent onsets or reviewing the typical case reports;
discussing the clinical features, diagnoses, differential diagnosis, and key therapy.
[Review Questions]
1. The definition of bronchial asthma.
2. The clinical manifestation of asthma.
3. How to differentiate asthma from left ventricular failure and chronic asthmatic
asthma?
4. The key therapy of asthma and the management of severe asthma.
5. Which mechanisms are associated with the action of anti-asthma drugs?
1.9 Primary bronchogenic carcinoma
[Aims]
1. The clinical manifestations and diagnosis.
2. The early diagnosis and the principles of the treatment.
3. The etiology and pathologic classification.
[Teaching Hours] 2h
[Teaching Contents]
1. Etiology:
2. Pathology and classification.
80
A. The symptoms caused by local tumor growth.
B. The symptoms caused by invasion or obstruction of adjacent structures.
C. The symptoms caused by distant metastasis.
D. The extrathoracic symptoms caused by tumors.
4. Laboratory examination
1. The X-ray examination of the chest: Chest films, and CT.
2. The cytological examinations of the sputum.
3. The fibro-optic bronchoscopic examination.
4. Biopsy.
5. The radionuclear examination.
6. Open chest biopsy.
7. others.
5. Differential diagnosis: Pneumonia, pulmonary tuberculosis, and pleural effusion.
6. Treatment
1. Surgery is the therapy of first choice; the indications.
2. Radiotherapy.
3. Chemotherapy.
7. Prognosis.
[Practice Hours] 2h
[Practice Contents]
Visiting a patients with typical bronchogenic carcinoma and discussing the diagnosis
and treatment.
[Review Questions]
1. The histological classification.
2. The characteristics of the clinical features.
3. The diagnostic procedures.
4. The principles of the treatment: indications and warning.
Independent
Study
1.1 2 √ √ √
1.2 2 2 √ √ √ √
1.3 2 1 √ √ √ √
1.4 4 2 √ √ √ √
1.5 2 2 √ √ √ √
1.6 4 2 √ √ √ √
1.7 2 2 √ √ √ √
1.8 4 1 √ √ √ √
1.9 2 3 √ √ √ √
81
Chapter 2: Disorders of Digestive System
2.1 : General Introduction
[Aims]
1. To master the structural and functional characteristics of digestive system.
digestive diseases.
[Teaching Hour] 2h
[Teaching Contents]
1. Structure and functions of digestive system.
2. A brief introduction of the diagnostic means of digestive system diseases.
3. Therapeutic principles of digestive system diseases.
2.2: Gastritis
[Aims]
1. To master the clinical manifestations, diagnosis and treatment of gastritis.
2. To have a good knowledge about the causes of acute and chronic gastritis.
[Teaching Hours] 2h
[Teaching Contents]
Acute gastritis
1. General introduction
2. Pathogenesis The causes of acute gastritis mainly include stress, drugs (non-steroid
anti-inflammatory drugs NSAIDS), ethanol and ischemia. These factors cause gastric
mucosal barrier to disrupt and acid back-diffusion, then lead to erosion and hemorrhage.
3. Clinical presentations Primarily upper gastrointestinal bleeding
6. Diagnosis History, especially the existence of precipitating factors, is helpful. But to
establish a definitive diagnosis, gastroscopy is to be performed.
This disease should be differentiated from bleedings from peptic ulcer, gastric
carcinoma and hepatic cirrhosis.
5. Treatment
A. Removal of precipitating factors.
B. Prophylactic drugs: antacids, H2-receptor antagonists (H2RA),Proton pump inhibitors
(PPI), synthesized prostaglandins, sucralfate, etc.
C. Management of gastric bleeding.
Chronic gastritis.
1. Definition
2. Pathology
Superficial gastritis
Atrophic gastritis
Dysplasia
Metaplasia
Active phase and static phase
3. Classification and etiology
82
Type A gastritis: autoimmune
Type B gastritis: H pylori infection, bile reflux, drugs, ethanol, etc.
4. Clinical Manifestation
Type A: hypochlorhydria and pernicious anemia
Type B: dyspepsia
5. Laboratory tests and other diagnostic examinations
A. Acid secretion test (pentagastrin test)
Parietal cell antibody (PCA)
B. Endoscopy and biopsy: appearances and diagnostic value
C. H pylori detection
6. Diagnosis
7. Treatment
A. Removal of the causes. This mainly refers to eradication of H Pylori, discontinuance
of NSAIDs, and anti-bile reflux therapy.
B. Expectant treatments.
[Practice Contents] 2h
Discussion of the classification, clinical manifestations, diagnostic criteria and
treatment of gastritis.
[Review Questions]
1. Classification and pathological features of chronic gastritis.
2. Etiology and therapeutic principles of acute and chronic gastritis.
2.3: Peptic Ulcer
[Aims]
To master the etiology, pathogenesis, clinical features, complications, diagnosis and
treatment of peptic ulcer disease.
[Teaching Hours] 4h
[Teaching Contents]
Definition and epidemiology
2. Pathogenesis
3. Pathology
Location, number, size, gross appearance, histology, and evolution of the ulcer.
4. Clinical manifestations
1. Clinical characteristics
Chronicity
Periodicity
Rhythmicity
2. Symptoms
Pain: Location, nature, regularity, exacerbating factors and remitting factors
Other GI symptoms
3. Signs
83
Tenderness located in the corresponding site is the commonest sign. But this is
unspecific and has little diagnostic value.
4. Special ulcers
Giant ulcer
Postbulbar ulcer
Pyloric channel ulcer
5. Complications
Hemorrhage
Perforation and penetration
Pyloric obstruction
Gastric cancer
6. Laboratory tests and other diagnostic examinations
H pylori detection
Gastrin and acid secretion test
Gastroduodenal barium meal
Endoscopy and biopsy
7. Diagnosis
The importance of history is to be stressed. And the value of accessory examinations is
to be pointed out.
Peptic ulcer should be distinguished from functional dyspepsia, chronic gastritis,
Zollinger-Ellison syndrome, gastric carcinoma, prolapse of gastric mucosa, hookworm
disease, chronic cholecystitis and duodenitis. Differentiation between gastric ulcer and
gastric carcinoma is stressed.
8. Treatment
A. General treatment
B. Medical therapy
Drugs reducing the aggressive factors
Drugs strengthening the defensive factors
Eradication of H pylori
C. Strategy of treatment
9. Prognosis
Age and existence of complications are important prognostic factors.
1. Case interview including history taking and physical examination. Every student
fulfill a case record.
2. Watch the video of esophagogastroduodenal endoscopic examination.
[Review Questions]
1. The pathogenetic mechanism of peptic ulcer.
2. The key diagnostic criteria of peptic ulcer. (Listing the diseases to be differentiated
from peptic ulcer and the differentiating criteria, especially the differentiation between peptic
ulcer and gastric carcinoma).
84
3. The therapeutic strategy of peptic ulcer.
4. The common complications of peptic ulcer.
2.4: Ulcerative Colitis
[Aims]
1. To master the clinical manifestations, diagnosis and treatment of ulcerative colitis.
2. To have a good knowledge of the pathology of ulcerative colitis.
[Teaching Hours] 2h
[Teaching Contents]
2. Pathogenesis
The causes of ulcerative colitis have not been proved yet. Suspected pathogenetic
factors include① immunologic factors; ② infection; ③ genetic and psychogenic factors.
3. Pathology
Distribution of the lesions
Occurrence and evolution of the lesion
Toxic megacolon
Canceration
A. Gastrointestinal manifestations: diarrhea, abdominal pain and distention.
B. Systemic manifestations: fever, weight loss, anemia, etc.
C. Extragastrointestinal manifestations: abnormalities in eyes, joints and vasculature.
D. Clinical types: mild, moderate, severe or fulminant.
E. Complications: toxic megacolon, hemorrhage, perforation, intestinal obstruction,
colonic cancer, etc.
5. Accessory examinations
A. Blood and stool routines, serum proteins and electrolytes.
B. Endoscopy. Colonoscopy should be performed with care in severe cases lest it
should cause perforation.
C. Barium enema. Barium enema is contraindicated in severe or fulminant cases lest it
should initiate megacolon or aggravate patients condition.
6. Diagnosis
The diagnosis of ulcerative colitis is based on the clinical features, the demonstration of
inflammation of rectal and sigmoidal mucosa on proctosigmoidoscopy, and the exclusion of
specific infections.
These diseases should be excluded:
Bacillary dysentery
Amebiasis
Crohn’s disease
Colonic carcinoma
Radiation colitis
Ischemic colitis
85
Irritable bowel syndrome.
7. Treatment
A. General treatment
B. Drug therapy
Salicylazosulfapyridine (SASP) or 5-amino-salicylic acid(5-ASA).
Corticosteroids.
Immune-suppressing agents
C. Surgical treatment: indications
8. Prognosis
Prognosis varies according to the severity of the disease.
[Contents for Practice] 2h
See a patient with ulcerative colitis and discussion of the differential diagnosis by case
records.
[Review Questions]
1. The clinical manifestations and complications of ulcerative colitis.
2. The therapeutic strategy of ulcerative colitis.
2.5: Tuberculous Peritonitis
[Aims]
1. To master the clinical manifestations and diagnosis of tuberculous peritonitis.
2. To have a good knowledge of the pathogenesis and treatment of tuberculous
peritonitis.
[Teaching Hours] 2h
[Teaching Contents]
The incidence of tuberculous peritonitis and the term are to be introduced.
2. Pathogenesis
The routes by which Mycobacterium tuberculosis reach peritoneum are to be
introduced.
3. Pathology
Pathologically, tuberculous peritonitis is sorted into three types: exudation, adhesion
and caseation.
A. Systemic manifestations
B. Abdominal pain, tenderness, doughy abdomen, abdominal mass, ascites, etc.
C. Complications: Intestinal obstruction, perforation of the intestinal segment proximal
to obstruction, abdominal abscess, and fistula formation.
5. Accessory examinations
A. Blood routine test, erythrocyte sedimentation rate, and tuberculin skin test.
B. Examination of the peritoneal fluid
C. Radiography
D. Laparoscopy and biopsy
86
6. Diagnosis
The diagnosis of tuberculous peritonitis based on comprehensive measures(clinical
manifestations and accessory examinations). Diagnostic antituberculosis treatment is greatly
valuable. A lot of diseases may present as fever, ascites, abdominal pain or abdominal mass.
So tuberculous peritonitis should be distinguished from these diseases.
7. Treatment
A. General treatment.
B. Antituberculotic regimens.
C. Expectant treatment and corticosteroids.
D. Surgery.
[Contents for Practice] 2h
Discussion of the differential diagnosis by case records.
[Review Questions]
1. Clinical features of each type of tuberculous peritonitis.
2. Differentiation of the diseases with ascites.
2.6: Cirrhosis of the Liver
[Aims]
1. To master the clinical manifestations, diagnosis, complications and treatment of
hepatocirrhosis.
Ⅱ.To have a good knowledge of the etiology and pathophysiology of hepatocirrhosis.
[Teaching Hours] 4h
[Teaching Contents]
The concept of hepatocirrhosis is to be introduced.
2. Classification and pathogenesis
The causes of hepatocirrhosis are classified into nine groups: viral hepatitis, alcohol,
malnutrition, chronic exposure to drugs and chemicals, parasites, congestion, cholestasis,
genetic and metabolic disorders, and cryptogenic. In China, chronic viral hepatitis is the
commonest cause of hepatocirrhosis.
3. Pathology
The pathologic processes include hepatocellular necrosis, hepatocellular regeneration,
regenerative nodule formation, fibrous scarring and pseudolobule formation, consequently,
portal pressure elevated and liver function impaired.
A.Manifestations attributable to hepatic dysfunction include systemic and
gastrointestinal manifestations, hemorrhagic tendency, anemia, and manifestations associated
with hormonal disturbances.
B. Manifestations due to portal hypertension involve collateral formation,
splenomegaly, hypersplenism and ascites.
C. Changes in the size and consistency of the liver.
5. Complications
87
This section is to be introduced in detail.
The commonly encountered complications include upper gastrointestinal bleeding,
infection, hepatic encephalopathy, primary hepatocellular carcinoma, the hepatorenal
syndrome, disturbed electrolytes and acid-base imbalance.
6. Accessory tests and examinations
A. Blood and urine routine tests
B. hepatic function test, including serum proteins and prothrombin time
C. Immunological tests
D. Serum bile acids, hyaluronide, procollagens
E. Examination of the peritoneal fluid
F. Esophageal barium meal or endoscopy
G. Ultrasonography or computed tomography
H. Laparoscopy and/or liver biopsy
7. Diagnosis
The diagnostic bases include the existence of the cause, features attributable to hepatic
dysfunction and portal hypertension, liver function tests, changes in the consistency of the
liver and histology of the liver tissue.
A lot of diseases may manifest ascites, hepatomegaly, upper gastrointestinal
hemorrhage or coma, so these diseases should be ruled out before the diagnosis of
hepatocirrhosis.
8. Treatment
1. General and “liver-supporting” treatment.
2. Management of ascites.
3. Treatment of complications.
4. Management of portal hypertension.
5. Liver transplantation.
9. Prognosis
1. Factors affecting the outlook.
2. Clinical features of compensated and decompensated cirrhosis.
3. The complications of cirrhosis.
4. The pathophysiological mechanisms of ascites and its therapeutic principles.
Case interview including history taking and physical examination. Every student fulfill
a case record.
2.7: Primary Hepatic Carcinoma
[Aims]
To master the clinical manifestations, diagnosis and therapeutic principles of PHC.
[Teaching Hours] 2
[Teaching Contents]
Definition and epidemiology.
88
2. Pathogenesis
Hepatitis B and C virus, hepatocirrhosis and some carcinogens are suspected, though
not proved, to be the causes of PHC.
3. Pathology
Classification:
Metastatic routes: hematogenous, lymphogenous spread and implantation.
Primary manifestations: Progressive enlargement of the liver, pain in the liver region,
jaundice, etc.
Clinical manifestations attributable to metastasis.
Stages and types of PHC.
5. Complications
Hepatic encephalopathy, upper gastrointestinal bleeding, rupture of cancer nodule, and
secondary infections.
6. Diagnostic examinations
A.α-fetoprotein. The values of this tumor marker in the screening and clinical diagnosis
of PHC are stressed.
B. Other PHC-associated enzymes, abnormal prothrombin (AP)
C. Ultrosonography and computized tomography
D. Liver biopsy and laparotomy
7. Diagnosis
Diagnostic criteria and measures for early diagnosis are stressed.
The key points in the differentiation from active hepatitis, hepatocirrhosis and other
space occupying diseases in the liver are to be discussed.
8. Treatment
Comprehensive measures are adapted. Radical operation is adapted at early stages.
Those inoperable can undergo trans-artery embolization and/or percutaneous ethanol
injection. Local radiation and trans-artery chemotherapy yield disappointing results.
Biological response modifiers and traditional Chinese medicine are used as accessory
therapeutic measures.
9. Prognosis
The outcome of PHC is pessimistic, especially those inoperable.
case discussion
[Review Questions]
1. Diagnostic value of AFP in PHC.
2. Diagnostic criteria of PHC.
3. Differential diagnosis of PHC.
2.8: Hepatic Encephalopathy
[Aims]
To master the pathophysiology, clinical features, diagnosis and treatment of this
89
disorder.
[Teaching Hours] 2h
[Teaching Contents]
1. Definition
2. Etiology
3. Pathophysiology
Ammonia intoxication
False neurotransmitters
Amino acid imbalance
Mercaptan and short-chain fatty acids
The bases on which hepatic encephalopathy is divided into 4 stages are to be explained.
The clinical features of each stage are to be interpreted.
5. Accessary tests and examinations
A. Blood ammonia
B. Electroencephalography and evoked potentials
C. Intelligence test
D. Liver function tests
6. Diagnosis
Diagnostic criteria:
Some other diseases such as intracranial infections, intracranial vascular lesion, uremia,
diabetic encephalopathy, hypoglycemia and sedative overdose is to be ruled out since these
disorders may present coma.
7. Treatment
A. Removal of precipitating factors
B. Reduction of the production and absorption of enteric toxins
C. Clearance of toxins from blood
D. Restoration of amino acid imbalance
E. Supportive treatment
8. Prognosis
The prognosis of hepatic encephalopathy depends on the liver function. Generally,
those caused by portosystemic shunt or induced by precipitating factors have a relatively
optimistic outlook.
9. Prevention
1. Treatment of liver diseases.
2. Avoidance and removal of precipitating factors.
3. Early recognition and treatment of hepatic encephalopathy.
Patient interview or case discussion
[Review Questions]
1. Basic causes and precipitating factors of hepatic encephalopathy.
90
2. The pathophysiology of hepatic encephalopathy.
3. The diagnosis of hepatic encephalopathy.
4. Therapeutic principles of hepatic encephalopathy.
2.9: Jaundice
[Aims]
1. To master the etiological classification of jaundice and the differentiation among
hemolytic, hepatocellular and cholestatic jaundice.
2. To have a good knowledge of bilirubin metabolism and the metabolic characteristics
of bilirubin in hemolytic, hepatocellular and cholestatic jaundice respectively.
[Teaching Hours] 2h
[Teaching Contents]
The definitions of jaundice and hyperbilirubinemia
2. Bilirubin metabolism
3. Classification
4. Pathogenesis
The pathogenesis and clinical characteristics of hepatocellular and cholestatic jaundice
are the main points.
5. Differentiating measures of jaundice
A. History
B. Symptoms
C. Signs
D. Laboratory tests and imaging approaches
E. Diagnostic treatments
F. Laparotomy
Discussion about the differentiation of jaundice by typical cases.
[Review Questions]
1. Laboratory results about of bilirubin metabolism in hemolytic, hepatocellular and
cholestatic jaundice.
2. Differentiating measures of jaundice, especially between hepatocellular and
cholestatic jaundice.
2.10: Upper Gastrointestinal Hemorrhage
[Aims]
1. To master the clinical manifestations, diagnostic procedures and management of
massive upper gastrointestinal hemorrhage.
2. To know the common causes of upper gastrointestinal hemorrhage.
[Teaching Hours] 2h
[Teaching Contents]
1. Definitions of upper gastrointestinal hemorrhage and massive upper gastrointestinal
hemorrhage.
91
2. Causes
An introduction of the common causes and just a mention of the less common causes.
Hematemesis and melena
Hypovolemia
Fever
Azotemia
Changes in hemogram
4. Diagnosis
Recognition of upper gastrointestinal hemorrhage
Evaluation of blood loss
Judgment of continuous or recurrent hemorrhage
Search for the cause
5. Management
General management
Correction of hypovolemia
Cessation of bleeding
Prevention of recurrent bleeding
[Contents for practice] 2h
Case interview and discussion
[Review Questions]
1. The definition of massive upper gastrointestinal hemorrhage.
2. Causes and clinical manifestations of massive upper gastrointestinal hemorrhage.
3. Diagnostic procedure of massive upper gastrointestinal hemorrhage.
4. Resuscitation and therapeutic measures of massive upper gastrointestinal
hemorrhage.
Independent
Study
2.1 2
2.2 2 1 √ √ √ √
2.3 4 2 √ √ √ √
2.4 2 2 √ √ √ √
2.5 2 2 √ √ √ √
2.6 4 2 √ √ √ √
2.7 2 2 √ √ √ √
2.8 2 1 √ √ √ √
2.9 2 1 √ √ √ √
2.10 2 2 √ √ √ √
92
Chapter 3: Hematologic Disorders
3.1 General Introduction
[Aims]
1. To be familiar with components, physiologic functions of blood and hematopoietic
organs.
To be familiar with bone marrow structure, hematopoiesis, diagnosis of hematologic
diseases.
2. To know about lymphocytes, monocytes—macrophages lines, classification of
hematologic diseases, progress of hematology.
[Teaching Hours] 2h
[Teaching Contents]
1. Blood components (blood cells and plasma) and their important physiologic
functions.
2. Compositions of hematopoietic organs: blood, bone marrow, liver, spleen, lymph
nodes.
3. Bone marrow structure.
4. Process of blood cells formation and development
5. Lymphocytes and monocytes-macrophages lines
6. Classification and characteristics of hematologic diseases.
7. Diagnostic characteristics of hematologic diseases.
8. Progress and importance of hematology
3.2 Iron Deficiency Anemia
[Aims]
1. To master iron metabolism, causes, mechanisms, clinical features, laboratory tests,
diagnosis and treatments of IDA.
2. To know about occurrence condition, prophylaxis of IDA.
[Teaching Hours] 2h
[Teaching Contents]
1. Introduction: concept of IDA, clinical meaning of lack of iron stores, the
morphological characteristics of RBC. Introduce occurrence condition of IDA generally.
2. Iron metabolism
Introduce iron supply, absorption, transportation, distribution, store, loss, circulation in
human body.
3. Causes and mechanisms
1. Lack of dietary iron but increased requirement
2. Increased consumption
3. Malabsorption
1. Symptoms of anemia.
2. Specific features of IDA.
A. Changes in the epithelium of the skin and the gastrointestinal tract Skin, hair, nails,
93
tongue.
B. Deficiency of iron-containing enzymes.
C. Pica
5. Laboratory tests
A. Morphological examination of RBC
B. Iron metabolisms
Serum iron
Total iron-binding capacity
Transferrin saturation.
Serum ferritin and their receptors.
Erythropoiesis examination of ID. Free erythrocyte protoporphyrin (FEP). FEP/HB
C. (a) Iron stores of BM
(b) Sideroblast
(c) Serum iron
(d) Ferritin of RBC
6. Diagnosis and differential diagnosis
A. Demand
(a) Determine existence of ID
(b) Look for causes of ID
B. Diagnostic evidences
(a) History
(b) the morphological characteristics of RBC
(c) BM examination and iron staining
(d) Serum ferritin
(e) Serum iron
(f) FEP
(g) There is effect to iron supplement
Introduce sensitivity, specificity and practicability of all tests and how to use them
making differential diagnosis.
7. Treatment
A. Treatment of causes:
B. Iron supplement
(a)Introduce oral iron mainly.
Commonly used iron type, dosage, usage, side effects, curative effect, curative periods,
factors influencing iron effect.
(b)Introduce injection iron simply.
Indication, type, dose, calculating method of demanded total dose, curative effect, side
effects.
8. Prevention
Probation patients.
94
Demonstrate special signs, morphology of RBC.
Characteristics of BM and iron staining.
[Review Questions]
1. Introduce the process of iron metabolism briefly.
2. What are causes and mechanisms of IDA?
3. What are the clinical features of IDA?
Which abnormal are there in laboratory tests?
4. How to distinguish several microcytic hypochromic anemias?
5. How to treat IDA?
Which questions should be taken care?
3.3 Aplastic Anemia
[Aims]
1. To master causes, clinical features, classification, laboratory tests, diagnostic criteria,
differential diagnosis of AA.
2. To know about occurrence condition, mechanisms, pathology, treatment, prognosis
of AA.
[Teaching Hours] 2h
[Teaching Contents]
1. Introduction: concept, characteristics, occurrence condition of illness, classification.
2. Causes: related factors.
A. Drugs and chemicals
B. Physical factors
C. Viral infections
D. Others
3. Mechanisms
4. Pathology
Introduce pathologic characteristics of BM, lymphatic tissues, spleen.
5. Clinical features.
Introduce clinical characteristics of AA, emphasize the distinct of acute AA with
chronic AA (from onset, periods, major symptoms)
6. Laboratory tests
Blood film, BM smear (observed by naked-eye and classification count).
How to distinguish AA with failure of BM aspiration or bad sample?
Compare AAA with CAA.
ALP score and positive rate of granulocyte.
Value of BM biopsy.
Hematopoietic cells culture.
ECT of BM
7. Diagnostic criteria
A. Pancytopenia, reduced reticulocytes.
B. Without megalosplenia.
95
C. At least, proliferation of one place is plasia or more severe, If proliferation is normal,
the numbers of megakaryocyte must be reduced.
D. Except other diseases causing pancytopenia.
E. General anti-anemia treatment is failure (futile)
8. Differential diagnosis
point out distinction of AA with following diseases
A. PNH
B. MDS
C. Aplastic leukemia.
9. Treatment
A. Treatment of causes
B. Supportive treatment
C. Treatment of AAA and AA (II)
BMT (Bone marrow transplantation), transfusion of fetal-liver, immune suppressors
D. Treatment of CAA
Androgen, improve micro-environment, splenectomy.
10. Prognosis
Pathology, Causes of death
11. Prevention
Use drugs carefully
Work protection
Reduce to contact with substances harmful to hematopoiesis.
Demonstrate blood smear and BM smear (slides or concrete smear)
Demonstrate typical cases.
[Review Questions]
1. What are causes of AA?
2. What are clinical features and diagnostic evidences of AA?
3. Which diseases should be differentiated with AA?
4. How to treat AA?
3.4 Hemolytic Anemia
[Aims]
1. To master concept, mechanisms, classification, features, laboratory tests, diagnosis,
differential diagnosis of HA
[Teaching Hours] 2h
[Teaching Contents]
1. Introduction: definition
2. Mechanisms
Introduce aging, clearing, destructive place and destructive mechanisms of RBC
3. Pathophysiology
Introduce organism reaction after RBC destructed (abnormal reaction, compensatory
96
hyperplasia of RBC)
4. Clinical classification
According to mechanisms of occurrence of diseases
Clinical characteristics of acute HA and chronic HA complications.
6. Laboratory tests
The tests of increased destruction of RBC
The tests of compensatory hyperplasia of RBC
7. Diagnosis: whether anemia is HA or not be sure establish causes of HA
A. Patients with anemia and increased reticulocyte
B. Non-hemolytic jaundice
C. Transported carcinoma of BM
9. Treatment
Introduce corticosteroids, splenectomy, immunosuppressors, transfusion and their
notices.
Demonstrate typical cases and discuss
[Review Questions]
1. Introduce the classification of HA
2. What are clinical features of HA?
Introduce characteristics of laboratory tests of HA
3. How to diagnose HA?
3.5 Myelodysplastic Syndrome
[Aims]
1. To master classification, clinical features, laboratory tests, diagnosis, differential
diagnosis and treatment of MDS.
2. To know about causes、mechanisms and pathologic characteristics of MDS.
[Teaching Hours] 2h
[Teaching Contents]
1. Introduction
2. Causes and mechanisms: related factors possibly
3. Classification and clinical features
FAB divided MDS into five subtypes. Introduce characteristics of blood film and BM
smear of all subtypes carefully, introduce concrete manifestations of malhematopoiesis
characteristics of clinical features of all subtypes.
4. Laboratory tests
A. Characteristics of blood film and BM smear
B. Abnormal of cytogenetics.
C. Pathology
ALPC
97
Hematopoietic sites with island of pre-erythrocytes or increased erythroblasts, increased
lattice fibers.
5. Diagnosis
According to
A. Anemia, bleeding, infection.
B. Pancytopenia or two or one cell line decrease.
C. Malhematopoiesis of two cell lines at least.
D. Find ALPC or increased lattice fibers in BM biopsy samples.
E. Except of AA, erythroleukemia, Mf, megaloblastic anemia.
6. Treatment
A. Supportive treatment
B. Inductive differentiation drugs.
C. Colony stimulating factors.
D. Low dose Ara-c
E. Combined chemotherapy
F. BMT
Demonstrate slides or blood smear and BM smear, demonstrate typical cases.
[Review Questions]
1. What are the characteristics of malhematopoiesis of MDS?
2. How many subtypes is MDS classified?
What are the clinical characteristics of every subtype?
3. How to diagnose MDS?
4. How to treat MDS?
3.6 Leukemia
[Aims]
1. To master concept, clinical features, diagnosis, differential diagnosis and
chemotherapeutic principles of Leukemia.
2. To be familiar with causes, mechanisms and occurrence condition of leukemia.
3. To know about classification and prognosis of leukemia.
[Teaching Hours] 4h
[Teaching Contents]
1. Introduction
Introduce concept and characteristics of leukemia briefly.
Introduce classifications of leukemia according to mature degree of cell、nature course
or involved cell line
2. Occurrence condition of illness
Introduce related factors, such as: viruses, radiation, chemicals, genetics and other
hematologic diseases
Acute Leukemia(AL)
98
1. Classification
Introduce early symptoms carefully
Anemia, fever, bleeding.
manifestations and mechanisms of infiltration of tissues.
3. Laboratory tests
Characteristics of blood film and BM smear.
Introduce changes of cytochemical, immunology, chromosomes briefly.
4. Diagnosis
According to clinical features, blood film, BM smear.
Distinguish ALL with ANL. Cytochemical staining, immunologic test
With AA, MDS, ITP, agranulocytosis, megaloblastic anemia, Leukemoid reaction
6. Treatment
A. Supportive treatment:
B. Chemotherapy:
Treatment principles, drugs and regimens of induction remission or consolidation,
intensification of ALL and AML
Treating periods, side effects
C. Prevention and treatment of CNS leukemia
D. BMT
E. specific treatment
4. Prognosis
Natural course, survival periods.
Factors affecting prognosis
Chronic Myeloid Leukemia <CML>
Common, less, rarely symptoms. Some patients were diagnosed for health examination
or seeing doctor for other diseases, emphasize characteristics.
2. Laboratory tests
A. Blood film: leukocyte count
Classification count
B. BM smear:
Proliferafion degree.
ratio of G to E
classification count
C. Granulocyte alkaline phosphatase score
D. ph chromosome
E. Detection of uric acid and VitB12
3. Diagnosis
According to: clinical features, splenomegaly, hematologic examination, ph
99
chromosome, ALP score
with diseases of splenomegaly, leukemoid reaction and primary myelofibrosis
5. Nature course
chronic phase→accelerated phase→acute phase.
Specific characteristics of every phase.
6. Treatment
A. chemotherapy
B. α-interferon
C. BMT
D. Others
7. Prognosis
Natural course and survival periods.
Factors affecting prognosis
Demonstrate slides、blood and BM smear
[Review Questions]
1. FAB classification of AL
2. What are clinical features of Al?
What are mechanisms of manifestations of AL?
3. How to diagnose AL?
4. Describe treatment principles of AL briefly.
5. Describe diagnosis and treatment of CML briefly.
3.7 Multiple Myeloma
[Aims]
1. To master pathophysiology, clinical features, laboratory tests, diagnosis, differential
diagnosis, treatment of MM.
2. To know about causes, mechanisms, prognosis of MM.
[Teaching Hours] 2h
[Teaching Contents]
1. Introduction
3. Pathophysiology and clinical features:
Infiltrative and destructive symptoms.
Abnormal of serum protein.
Bleeding tendency.
Destruction of kidney function.
Causes of misdiagnosis.
4. Laboratory tests
Characteristics of blood film and smear, blood biochemical tests (M protein, serum ca 2+,
100
β-MG, abnormal kidney function)
Characteristics of X-ray examination
According to
A. M protein.
B. Osteoporosis.
C. Increased MM cells of BM.
Differential diagnosis
A. Reactive plasmacytosis.
B. Osteoporosis
C. Secondary carcinoma of bone.
6. Treatment
A. Chemotherapy
B. Interferon.
C. BMT.
7. Prognosis
Natural course.
Demonstrate some typical laboratory tests
[Review Questions]
1. What are the causes of misdiagnosis of MM?
2. What are evidences of diagnosing MM?
3. Which diseases should be distinguished with MM?
3.8 Bleeding Diseases
[Aims]
1. To master normal hemostasis, coagulation mechanisms, relationship of coagulation
factors with laboratory tests.
2. To master clinical distinction between bleeding diseases and coagulation diseases.
3. To know about classification of bleeding diseases
[Teaching Hours] 2h
[Teaching Contents]
1. Introduction
Concept and bleeding characteristics of bleeding diseases
2. Normal hemostasis and coagulation mechanisms
Introduce three elements of hemostasis briefly
A. Blood vessel wall.
B. Platelets.
C. Coagulation factors.
3. Classification of bleeding diseases:
A. Abnormalities of blood vessel wall
101
B. Platelet abnormalities
C. Abnormalities of coagulation.
4. Diagnosis
A. History and signs, Introduce carefully.
B. Laboratory tests
(1) Screening tests
Clinical values of BT, CRT, PC, CT, KPTT, PT, TT.
(2) Specific tests
5. Treatment
A. Remove causes, Bleeding Prevention
B. Hemostatic methods
(1) supply coagulation factors and platelets
(2) hemostatic drugs
Vit C, Vit K, corticosteroids
(3) Local method
Discuss causes, diagnosis, differential diagnosis and treatment of Bleeding Diseases
3.9 Idiopathic Thrombocytopenia Purpura
[Aims]
To master concept, mechanisms, clinical features, classification, diagnosis, differential-
diagnosis, treatment of ITP.
[Teaching hours] 2h
[Teaching Contents]
1. Introduction
Occurrence of disease.
Bleeding characteristics.
Anemia, splenomegaly.
Distinction between acute and chronic ITP.
4. Laboratory tests
Blood film, platelet count and function, BT, CRT, capillary fragility test, BM,
antiplatelet antibody.
5. Diagnosis
Diagnostic key points
With SLE, AA, AL, hypersplenism, Evans syndrome.
Distinction between acute and chronic ITP.
7. Treatment
A. Prevention and common treatment.
B. Corticosteroids.
102
C. Splenectomy.
D. Immune suppressors
E. Transfusion and platelet concentrates
F. Others: danazol, high-dose gamma-globulin, plasmapheresis.
Demonstrate typical cases
Discuss causes, diagnosis, differential diagnosis and treatment of ITP.
[Review Questions]
1. What are the three elements of physiologic hemostasis?
2. What are the characteristics of bleeding disease?
3. What are the treatment principles of bleeding diseases?
4. What are the clinical features of ITP? How to classify ITP?
5. What are the diagnostic key pointe of ITP?
How to distinguish ITP with other diseases
6. How to treat ITP?
3.10 Disseminated Intravascular Coagulation
[Aims]
1. To master the causes, mechanisms, process of DIC.
2. To master clinical features, laboratory tests, diagnostic evidences, treatment of DIC.
[Teaching Hours] 2h
[Teaching Contents]
1. Introduction
Clinical classification, four major symptoms, characteristics of all subtypes.
4. Laboratory tests
1. consumptive low coagulation stage:
Thrombocytopenia.
Prolonged PT.
Decreased fibrinogen.
2. High fibrinolysis stage
prolonged TT, increased FDP, positive 3p test.
3. Peripheral RBC morphologies
Poikilocytosis: tear, drip, pear, triangle, etc.
5. Diagnosis
Introduce diagnostic criteria.
6. Treatment
A. Remove inductive factors.
Treatment of primary diseases.
B. Heparin: indication, method, dose, periods.
C. Anti-platelet drugs: Aspirin
103
D. Supply coagulation factors.
E. Anti-fibrolysis drugs.
Discuss diagnosis and treatment of DIC.
[Review Questions]
1. What are clinical characteristics of DIC?
2. What are diagnostic evidences of DIC?
3. How to treat DIC?
3.11 Lymphoma
[Aims]
1. To master classification, clinical features, diagnosis, differential diagnosis, treatment
principles of lymphoma.
2. To be familiar with all kinds of test
3. To know about pathology and mechanisms.
[Teaching Hours] 2h
[Teaching Contents]
1. Introduction
2. Causes
Related factors: viruses, immune deficiency.
3. Pathology and classification
Introduce recent classifications of Hodgkin (HD) and non-Hodgkins lymphoma
(NHL).
Introduce pathologic changes of HD and NHL
Early symptoms,
Characteristics of lymph nodes,
Clinical manifestations of extranodal infiltration,
General symptoms,
Distinction of symptoms of HD with NHL
Complications
5. Laboratory tests:
Blood film BM smear
Lymph node biopsy
1. Superficial lymph node biopsy
Deep lymph node examination: chest x-ray, abdominal ultrasound, abdominal CT,
pelvic limb lymph node mapping, BM smear.
2. Distinguish with some lymphadenitis<TB non specific>, Distinguish with some
carcinomas causing lymphadenopathy.
7. Clinical classifications
8. Treatment: Treatment principles
104
A. Radiotherapy: indication and methods
B. Chemotherapy: indication and regimens.
C. BMT: indication and effect.
D. Operation
9. Prognosis:
Relationship of clinical stages with survival periods
Demonstrate typical cases
[Review Questions]
1. How to classify lymphoma?
2. What are clinical features of lymphoma?
3. What are treatment regimens of lymphoma?
4. How to classify lymphoma in clinical?
5. Which diseases should be distinguished with lymphoma?
Independent
Study
3.1 2
3.2 2 1 √ √ √ √
3.3 2 2 √ √ √ √
3.4 2 1 √ √ √ √
3.5 2 1 √ √ √ √
3.6 4 4 √ √ √ √
3.7 2 1 √ √ √ √
3.8 2 1 √ √ √ √
3.9 2 1 √ √ √ √
3.10 2 1 √ √ √ √
3.11 2 2 √ √ √ √
Chapter 4: Cardiovascular Disorders

4.1 General Introduction
[Aims]
1. To master the structural and functional characteristics of cardiovascular system.
cardiovascular diseases.
[Teaching Hours] 2h
[Teaching Contents]
1. The difference of cardiovascular disorders from other system and the characteristics.
2. How to learn them well.
If you like to learn and know cardiovascular disorders well, “five finger approach”
should be familiar with.
A. History
105
B. Physical examination
C. Electrocardiogram
D. Chest X-ray
E. Various other laboratory tests, for example, echocardiogram. Holter (dynamic
electrocardiogram), ECG-exercise test, etc.
4.2 Heart Failure
[Aims]
1. To learn the underlying causes of heart failure and its basic pathophysiologic
mechanisms.
2. How to recognize and treat heart failure.
[Teaching Hours] 4h
[Teaching contents]
1. The basic causes of which would involve in the heart failure development.
2. The basic mechanisms which would involve in the heart failure development.
3. Clinical manifestations, including symptoms and physical findings.
4. Heart failure diagnosis and heart function classification.
5. How to treat a heart failure patient in acute status and in chronic situation,
respectively.
[Practice Hours] 3
[Practice Contents]
After seeing a patient with chronic heart failure and reviewing the patient history,
findings from the physical examination and lab test, discuss how to recognize and treat a
patient with heart failure.
[Review questions]
After learning this chapter you should answer the following questions
1. What is difference between the systolic heart failure and the diastolic heart failure?
2. The mechanisms which involve in the heart failure development, especially heart
remodeling and neuro-humoral mechanisms in the heart failure pathogenesis and
pathophysiology.
3. How to recognize heart failure and make a diagnosis? The main diagnostic points?
4. How to classify cardiac function in a heart disorder patient?
5. How to treat a heart failure patient in acute condition? for example, a patient with
pulmonary edema?
6. Role of ACE inhibitor in the treatment of chronic heart failure?
4.3 Hypertensive Disease
[Aims]
1. To understand that essential hypertension is a worldwide popular disease and would
lead to severe cerebral and kidneys damages if the high blood pressure is not controlled well.
2. How to diagnose and treat hypertension.
[Teaching Hours] 2h
[Teaching Contents]
106
1. Hypertension is a worldwide popular disease with severe cardiovascular
complications.
2. The criteria of high blood pressure.
3. The environment factors of essential hypertension.
4. The severity of hypertension can be classified by the target-organ damage or by
blood pressure rising degrees.
5. The hypertensive end-organ damages.
6. Anti-hypertensive therapy, including non-pharmacological and drugs therapy.
[Practice Hours] 2h
[Practice Contents]
After showing a case with hypertension, review the manifestations, including the target
organ damages, and discuss the diagnostic criteria and its treatment principle.
[Review Questions]
1. What is high blood pressure? Its diagnostic criteria.
2. Differential diagnosis of high blood pressure.
3. The etiology of essential hypertension. The major envionment risk factors.
4. What are the target-organs? Implicate!
5. Hypertension classification by target organs and by blood pressure rising degrees.
6. How to treat hypertensive patients with non-pharmacological approaches?
7. The pharmacologically antihypertensive treatment, its principle and agent selection.
4.4 Acquired Valvular Heart Diseases
[Aims]
1. To understand the anatomy, pathophysiology, manifestations of common rheumatic
valve disease.
2. To understand the diagnosis, differential diagnosis, complications and treatment of
common rheumatic valve disease.
3. To understand the etiology of rheumatic heart disease.
[Teaching Hours] 2
[Teaching Contents]
1. Introductions
A. Definition and incidence.
B. Anatomy and pathology.
C. Common clinical disease.
2. Mitral Stenosis
A. Definition and etiology.
B. Anatomy and pathophysiology.
C. Clinical manifestation.
D. Diagnosis & differential diagnosis: Symptoms & signs, UCG, X-ray.
E. Complications---heart failure, atrial fibrillation, subacute infective endocarditis.
F. Treatment: Drugs, PBMV, surgery.
3. Mitral regurgitation
A. Definition.
107
B. Etiology and pathophysiology---hemodynamic.
D. Diagnosis & D. D: characteristics of systolic murmur, UCG and X-ray.
E. Complications.
6. Treatment: drugs, valve replacement.
4. Aortic Stenosis.
A. Definition & pathology.
B. Anatomy and pathophysiology.
D. Diagnosis & differential diagnosis: symptoms & signs, UCG, x-ray.
E. Complications.
F. Treatment: drugs, PBAV, surgery.
5. Aortic regurgitation
A. Definition, etiology and Pathology.
B. Pathophysiology---hemodynamic
C. Clinical manifestation
D. Diagnosis & D. D: heart murmer, UCG, and X-ray.
E. Complications
F. Treatment: drugs, valve replacement.
[Practice Hours] 2
[Practice Contents]
Visiting the patents with valve diseases and discussion.
[Review questions]
1. Review the relationship of pathophysiology and clinical manifestations of mitral
stenosis and aortic regurgitation.
2. Review the manifestations and diagnosis of mitral stenosis, mitral regurgitation,
aortic stenosis and regurgitation.
3. Common complications of rheumatic valve disease.
4. Treatment of rheumatic valve disease.
4.5 Coronary Heart Disease
[Aims]
1. To understand the manifestations, diagnosis, differential diagnosis and treatment of
different types of coronary heart disease.
2. To understand the mechanism of angina pectoris.
3. To understand the pathophysiology and pathoanatomy of angina pectoris and acute
myocardial infarctions.
[Teaching Hours] 4h
[Teaching Contents]
1. Atherosclerosis heart disease
A. Definition and incidence.
B. Anatomy and pathology.
C. Clinical types
108
a) Silent coronary heart disease
b) Angina pectoris
c) Myocardial infarction
d) Chronical heart failure
e) Cardiac arrhythmias or sudden cardiac death
2. Angina pectoris
A. definition
B. Mechanisms-imbalance of oxygen demand and supply.
C. Anatomy
D. Clinical manifestation-chest pain.
E. Laboratory, ECG, treadmill test and selective coronary angiograph.
F. Diagnosis & D. D: symptoms, ECG, SCA.
G.Treatment: drugs, PTCA, CABG.
3. Acute Myocardial infarction
A. Definition
B. Etiology and mechenism-thrombosis.
C. Anatomy and pathology-hemodynamic, Forreest & Killip’s types
D. Clinical manifestation
E. laboratory, ECG, and enzymes dynamic changes
F. Diagnosis & D. D: symptoms, ECG, eas
G. Complication
H. Treatment: drugs, PTCA, IABP
[Practice Hours] 4
[Practice Contents]
Visiting the patients with coronary heart disease and discussion
[Review Questions]
1. What are the five types of coronary heart disease?
2. What are the differential mechanism of pathophysiology in angina pectoris and
myocardial infarction? And what are the difference in diagnosis and differential diagnosis?
3. What is the typical chest pain in angina pectoris?
4. What are the characteristics of different types angina pectoris?
5. How to treat the unstable angina pectoris?
6. How to diagnose the acute myocardial infarction?
7. How to treat the acute myocardial infarction? And how to manage the complications?
4.6 Arrhythmias
[Aims]
1. To master the common classifications, etiology, clinical manifestation, diagnosis of
arrhythmias and principle of the treatment for the arrhythmias.
2. To master ECG of arrhythmias.
3. To understand the indication for cardiac pacing and radiofrequency ablation.
[Teaching Hours] 4
[Teaching Contents]
109
1. General aspects
A. Classification of the arrhythmias
Arrhythmias is classified on the basis of the site of origin, and subclassificd as too fast
or too slow
Classification of Common Arrhythmias

SITE TACHYCARDIA BRADYCARDIA
Sinus node Sinus tachycardia Sinus bradycardia
Sinus node reentry Sinus arrest
SA exit block
Atrium Atrial premature beats Non-conducted APBs
Atrial fibrillation
Atrial flutter
Atrial tachycardia
Non-paroxysmal
Digoxin
Multifocal
AV junction Reciprocating junctional tachycardia 2ºAV block (type 1)
Accelerated junctional rhythm 3ºAV block (proximal)
Junctional premature beats
His Purkinje
Accelerated ventricular rhythm 2ºAV block (type 1)
fibers
Ventricular premature beats 3ºAV block (distal)
Ventricular tachycardia
Ventricular fibrillation
B. Diagnosis of the arrhythmias

(a) History, physical examination and documentation of arrhythmia in 12-lead ECG.
Ambulatory monitoring, stress test, transtelephone ECG transmission.
(b) Electrophysiology study
2. Tachyarrhythmias
A. Mechanism
Reentry
Increased automaticity (ectopy)
Triggered automaticity
Combinations of the above
B. Extrasystoles
Etiology, clinical manifestations, typical ECG and treatment of the atrial premature
beats and those of the ventricular premature beats and those of the junctional premature
beats.
C. Tachycardias
Etiology, clinical manifestations, typical ECG and treatment of the supraventricular,
110
those of the ventricular tachycardias, the indication and the procedure of the radiofrequency
ablation.
D. Flutter and fibrillation
Etiology, clinical manifestations, typical ECG and treatment of the atrial flutter and the
fibrillation and those of the ventricular flutter and ventricular fibrillation.
E. Pre-excitation syndromes and complicating tachycardias, classification, clinical
manifestation and the picture of ECG.
F. Drug therapy of the tachyarrhythmias
G. Non-drug therapy of he tachyarrhythmias
3. Bradyarrhythmias
A. Sick sinus syndrome
Etiology, Clinical manifestation, picture of the ECG and treatment.
B. Atrioventricular block
Etiology, clinical manifestation, picture of the ECG and treatment
Various pictures of arrhythmia EKC (project film) are demonstrated and etiology,
clinical manifestation, diagnosis and treatment of the various common arrhythmias are
discussed combined with the typical cases.
[Review Questions]
1. How can we classify arrhythmias?
2. How can we differentiate various premature beats? What is the clinical significance
of the various premature beats? What are the principles of the various premature beats?
3. How can we manage the supraventricular tachycardia? How can we differentiate
supraventricular tachycardia from ventricular tachycardia?
4. What are the clinical pictures of the atrial fibrillation(including ECG pictures of atrial
fibrillation)?
5. How do we classify antiarrhythmic drugs? And how do we use them?
6. What are the etiology and clinical pictures of the sick sinus syndrome? What are the
principles of treatment for sick sinus syndrome?
7. How can we classify the atrioventricular block? What is the clinical significance of
the atrioventricular block? And what are the principles of treatment for it?
4.7 Myocardial Disease
[Aims]
1. To master the clinical manifestations, diagnosis and principles of treatment of
cardiomyopathy.
2. To understand the classification of cardiomyopathy.
[Teaching Hours] 2h
[Teaching Contents]
1. Classification of cardiomyopathy:
2. Dilated cardiomyopathy
A. The causes and pathologic aspects.
B. Clinical manifestations and laboratory tests.
111
a. Symptoms: dyspnea
b. Signs: cardiomegaly, gallop and arrhythmias.
c. Laboratory tests: X ray film, ECG, ultrasound.
C. Diagnosis
Exclude secondary cardiomyopathy and differentiated with valvular heart disease,
coronary heart disease and pericarditis.
D. Treatment
Principles of treatment
3. Hypertrophic cardiomyopathy
A. The causes and hemodynamic classification
Obstructive non-obstructive
B. Clinical manifestations and laboratory tests
a. Signs and symptoms
b. Laboratory tests: ultrasound, cardiac catheterization.
C. Diagnosis and treatment
Diagnosed the clinical characteristics and typical UCG changes.
4. Restrictive cardiomyopathy
A. Pathologic changes
B. Clinical manifestations
5. Myocarditis
Etiology, clinical manifestation and diagnosis of myocarditis, principles of treatment.
Seeing the patient with dilated cardiomyopathy and discuss the history, signs,
laboratory tests and treatment of cardiomyopathy.
[Review Questions]
1. The classification of cardiomyopathy.
2. The clinical characteristics of each type of cardiomyopathy.
3. The principles of treatment of dilated cardiomyopathy.
Independent
Study
4.1 2
4.2 4 3 √ √ √ √
4.3 2 2 √ √ √ √
4.4 4 2 √ √ √ √
4.5 4 4 √ √ √ √
4.6 4 2 √ √ √ √
4.7 4 2 √ √ √ √
Chapter 5 Disorders of the Endocrine System
5.1 Introduction
112
[Aims]
1. To understand the concepts, scope and history of endocrinology.
2. To be familiar with the physiological function and mechanism of hormones, and
function regulation of the endocrinal system.
3. To master the diagnostic principles, methods of prevention and treatment of
endocrine disorders.
[Teaching Hours] 2
[Teaching Contents]
1. Basic concepts of endocrinology
2. The physiologic functions and mechanism of hormones
3. Function regulation of the endocrine system
4. Diagnostic principles of endocrine disorders
5. The principles of prevention and treatment of endocrine disorders
6. Some progress made in endocrinology
[Practice] 4h
Lecture
[Review Questions]
1. Please name the major endocrine glands in the body.
2. How is the endocrine system modulated by feed-back control?
3. What are the principles of diagnosis and treatment of endocrine disorders?
5.2 Thyroid diseases
Hyperthyroidism
[Aims]
1. To understand the etiological classification.
2. To understand the etiology and pathogenesis of Graves’ disease(GD).
3. To grasp the clinical features(including specific features), diagnosis and differential
diagnosis.
4. To grasp the significance and affected factors of the routine thyroid function tests.
5. To grasp the principles and methods of treatment with anti-thyroid drugs, To grasp
the principles of treatment of thyroid crisis. To be familiar with the indication,
contraindication and complications of radioactive iodine therapy. To understand the
indication, contraindication of surgical ablation.
[Teaching Hours] 3
[Teaching Contents]
1. General introduction: the definition and classification of hyperthyroidism.
2. Etiology and pathogenesis
3. Pathology
Explaining the pathological changes of thyroid and Graves’ ophthalmopathy.
Explaining the extensive effects of excessive thyroid hormones on every system of the
body in the light of the physiological function of the hormones.
113
5. Specific clinical features
Graves’ cardic disease
Pretibial myxedema
Thyroid crisis
6. Laboratory test
Emphasizing the principles, affected factors and points for attention of thyroid function
tests.
A typical case of GD can be preliminarily diagnosed by clinical features. Those with
atypical clinical features must turn to necessary thyroid function tests.
Hyperthyroidism must be clinically differentiated from simple goiter, anxiety neurosis,
TB and orbital tumor.
8. Treatment
A. General measures
B. Antithyroid drugs
Mechanism, indication, administration, and the side-effects
C. Radioactive iodine
Indication, contraindication and complications
D. Surgery
Indication, contraindiction and complications
E. Symptomatic therapy
Eg administration of an adrenergic blocking agent and sedative.
F. The prevention and treatment of thyroid crisis
(1)Preventing and treating the underlying causes in time.
(2)Principles of treatment
Thyroiditis
[Aims]
1. To know the etiology and pathogenesis of chronic lymphocytic thyroiditis (HT) and
subacute thyroiditis.
2. To grasp the clinical features, laboratory tests, diagnosis and differential diagnosis of
the two thyroiditis.
3. To grasp the principles of treatment.
[Teaching Hour] 1
[Teaching Contents]
1. Chronic lymphocytic thyroiditis
2. Pathology
(1)Marked gland
(2)The state of thyroid function
(3)Clinical course
114
4. Laboratory tests
The positive anti-thyroid antibody titers.
Perchlorate discharge test.
The changes of T↓3 T↓3 and TSH concentrations.
6. Treatment
(1)The usage and course of thyroid hormones.
(2)The usags of glucocorticoids.
(3)The indication of surgery.
2. Subacute thyroiditis
A. Etiology
B. Pathology
C. Clinical features
(a) Clinical course
(b)Characteristics of the gland
(c) Functional state
D. laboratory findings
E. Diagnosis and differential diagnosis
F. Treatment
[Practice Hours] 4h
[Practice Contents]
1. Case demonstration and discussion on GD
2. Case demonstration and discussion on thyroiditis
[Review Questions]
1. What are the clinical features of HT and subacute thyroiditis, GD?
2. How to differentiate the two thyroiditis?
3. What are the methods of treating the two thyroiditis?
4. What kind of tests do the patients with hyperthyroidism need?
5. What does the treatment of GD include? What are the indication and
contraindication?
6. What are the clinical features and principles of treating thyrotoxic crisis?
5.3 Diabetes Mellitus
[Aims]
1. To understand the basic concepts and classification.
2. To be familiar with the etiology and pathogenesis.
3. To grasp the clinical features and common complications.
4. To grasp the diagnosis criteria and related differential diagnosis.
5. To grasp the principles and methods of treatment.
6. To grasp the diagnosis and treatment of diabetes ketoacidosis.
[Teaching Hours] 4h
[Teaching Contents]
115
1. Introduction
Explaining the basic concepts of the disease. Introducing the classification.
Introducing the etiologic characteristics of type I and type II DM.
3. Pathology
Explaining the pathologic characteristics of the is lest of langerhans.
4. Pathophysiology
Reviewing the metabolic disturbances of carbohydrates, proteins, lipids and water and
salt resulting from insulin deficiency or a drop in insulin activity.
Reviewing the mechanism of ketoacidosis.
A. Symptoms due to metabolic disorder: polyuria, polydipsia, polyphagia and weight
loss.
Explaining the characteristics of the two types.
B. Chronic complications
Macrovascular disease
Microvascular diseases: retinopathy, nephropathy, neuropathy and infection.
6. Laboratory tests
The normal criteria, the affected factors and the clinical significance of
A. Urine glucose and plasma glucose
B. The glucose tolerance test
C. Plasma insulin, C peptide and HbA1C
Introducing the diagnostic criteria of DM.
Being differentiated from secondary DM.
8. Treatment
1. General measures
2. Diet
3. Oral hypoglycemia agents
Introducing the mechanism of action, indication and side effects of the two types
compounds.
Introducing Acarbose-glucosidase inhibitors.
4. Insulin
Lecturing the indication, main preparation, principles and side effects of insulin.
9. Diabetic ketoacidosis
A. Precipitating factors
B. Pathophysiology and clinical features
C. Treatment
(a) Intravenous fluids
(b) Insulin
(c) Correction of electrolytes disturbance and metabolic acidosis
116
[Practice Hours] 4h
[Practice Contents]
Discussing the following in combination with case study
1. Diagnosis, differential diagnosis
2. The methods of calculating the patient’s caloric needs
3. The choice of treatment
4. The treatment of complications
[Review Questions]
1. What is the classification of Diabetes?
2. What are the diagnostic criteria?
3. What are the indication and methods of oral hypoglycemia agents and insulin?
4. What is the treatment principles of ketoacidosis?
5. What are the similarities and differences between ketoacidosis and non-ketotic
hyperosmolar syndrome?
5.5 Hypopituitarism
[Aims]
2. To grasp the clinical features, diagnosis and differential diagnosis.
3. To grasp the methods of prevention and treatment.
4. To grasp the clinical features and treatment of pituitary crisis.
[Teaching hours] 2
[Teaching Contents]
1. Introduction
Concepts
A. Symptoms due to deficiency of gonadotropins and prolactin (PRL)
B. Symptoms due to deficiency of thyrotropin (TSH)
C. Symptoms due to deficiency of corticotropin (ACTH)
D. Symptoms related to causes.
4. Laboratory tests
Explaining the direct approaches and indirect approaches to the laboratory diagnosis of
pituitary insufficiency.
The presence of pituitary deficiency should be suspected from the history and physical
examination and confirmed by laboratory testing.
Hypopituitarism should be differentiated from primary hypothyroidism and primary
adrenal insufficiency.
6. Treatment
Emphasizing the dosage, usage and cautions of thyroid hormones and glucocorticoids.
7. The clinical features and treatment of pituitary crisis
117
Emphasizing the importance and methods of instant correction of hypoglycemia,
hypotension and low temperature.
[Practice Hours] 2h
[Practice Contents]
Discussing the following in combination with case study
1. What are the causes of hypopituitarism?
2. What are the clinical features and treatment of hypopituitarism?
3. What are the clinical features and treatment of pituitary crisis?
5.6 Hypercortisolism
[Aims]
2. To grasp the clinical features, diagnosis and differential diagnosis.
3. To grasp the methods of prevention and treatment.
[Teaching Hours] 2
[Teaching Contents]
Concepts of and difference between Cushing’ s disease and Cushing’ s syndrome.
The different pathologic changes and characteristics of different classes of the
disorders.
3. Pathophysiology and clinical features
Various metabolic disorders due to excessive cortisol and their effects on each system
of the body.
1. Diagnostic procedures
2. Functional diagnosis and etiological diagnosis
3. Differentiated from obesity
Emphasizing the methods and significance of the laboratory tests.
5. Treatment
Choosing different ways of treatment according to different causes.
[Practice Hours] 2h
[Practice Contents]
Typical case demonstration
[Review Questions]
1. What are the causes and classification of hypercortisolism?
2. What are the clinical features and diagnostic procedures?
3. What are the methods of treatment?
118
Independent
Study
5.1 2 4 √ √ √ √
5.2 4 4 √ √ √ √
5.3 4 4 √ √ √ √
5.4 2 2 √ √ √ √
5.5 2 2 √ √ √ √
Chapter 6 Disorders of Urinary System

6.1 Introduction
[Aims]
1. To master the major structure and function of the kidney.
2. To master the clinical manifestations pathogenesis of the urinary diseases and
common examining target of renal function.
3. To master the diagnostic procedure and prevention and treatment principles of the
diseases of this system.
6. To understand developing trends of the nephrology.
[Teaching Hours] 2h
[Teaching Contents]
1. Major structure and function of the kidneys.
A. Renal dissect
B. The composition of the nephron and every part physiological function.
C. The composition and function of the mesangial tissue.
D. Physiological function of the kidney.
2. Common clinical manifestations of the urinary diseases and common using renal
function test.
A. Edema
B. hypertension.
C. Pain in the real region and renal colic.
D. Symptoms of the bladder irritation.
E. Abnormality of micturition.
F. Renal function tests and other special tests
(a) Renal function tests
(b) Special biochemical examination and serum examination.
(c) Renal shape and pathological examination.
3. Diagnoses and prevention and treatment principles of the urinary diseases.
A. Diagnostic procedure.
Etiogenic diagnosis.
Position diagnosis.
Pathological diagnosis.
Functional diagnosis.
119
B. The common clinical syndrome
(a) Nephrotic syndrome.
(b) Nephritic syndrome.
(c) Latent nephritic syndrome.
(d) Syndrome of the urinary tract infection.
3. Treatment principles of the urinary diseases.
[Review Questions]
1. What is proteinuria and how to form?
2. What are the common clinical syndrome of renal diseases?
What are feature about these syndromes?
3. What are the function tests about glomerular and renal tubule?
6.2 The Glomerular Diseases
[Aims]
1. To master the etiology and pathogenesis of the glomerular diseases.
2. To master the definition, characteristics of the glomerular diseases and clinical types
of the primary glomerular diseases.
3. To master the clinical manifestations, diagnoses, differential diagnoses and
prevention and treatment principles of the acute, rapidly progressive, chronic
glomerulonephritis and primary nephritic syndrome.
4. To master the clinical manifestations, diagnosis, differential diagnosis and treatment
principle of IgA mesangical nephropathy.
5. To understand pathological types of the primary glomerular diseases.
6. To know clinical significance of renal biopsy in renal diseases and indication of renal
biopsy.
[Teaching Hours] 6h
[Teaching Contents]
1. General characteristic, clinical types, and pathological types of the primary
glomerular disease.
2. Pathogenesis of the glomerular diseases-immune mediated inflammatory response.
A. Immune response.
B. Inflammatory response.
C. Non-immune, nom-inflammatory insult.
(a) Three high phenomenon
(b) Large proteinuria and glycosuria.
(c) Hypertension.
(d) Hyperlipidemia
Proteinuria, hematuria, edema, hypertension and impaired renal function.
A. Rapidly progressive glomerulonephritis.
(a) Etiology and pathogenesis
(b) Pathology.
120
(c) Clinical manifestations and laboratory findings.
(d) Diagnosis and differential diagnosis: making a definitive diagnosis depend on
renal biopsy.
Differential diagnoses
Acute renal tubular necrosis.
Obstructive nephropathy.
Good-pasture syndrome.
Other seriously glomerular diseases.
(e) Treatment
Major vigorous treatment early.
Vigorous plasma exchange + steroid + cytotoxic agents.
Intravenous “pulse” methylprednisolone.
Four unit therapy.
Dialysis and renal transplantation.
B. Chronic glomerulonephritis.
(b) Pathology.
(d) Diagnosis and differential diagnosis.
Diagnosis: clinical findings described above add course of the disease is more than
one year and removing secondary and hereditary nephritis.
(e) Treatment
1) Aims: prevent and delay loss of renal function.
2) dietetic therapy and symptomatic treatment.
3) Avoiding to using drugs that may injury kidneys.
C. Latent nephritis.
D. IgA mesangial nephropathy.
This disease is characterized by mesangial IgA deposit.
Hematuria is the most common clinical manifestation.
(b) Pathology.
1) Men affected two to three times more frequently than women.
2) Most patients are between the ages of 15 and 35.
3) Almost all patients have hematuria.
IgA nephropathy may appear nephritic syndrome, chronic nephritis, rapidly progressive
nephritic syndrome or malignant hypertension.
(d) Diagnosis and differential diagnosis
The final diagnosis depend on renal biopsy, but must exclude Henoch-Schonlein
purpura nephritis, lupus nephritis and glomerulonephritis related to cirrhosis.
1) Treatment and prognosis.
121
[Practice Hours] 4h
[Practice Contents]
[Review Questions]
1. What are clinical manifestations and treatment principles of chronic
glomerulonephritis?
2. Which diseases do chronic glomerulonephritis differential diagnose with?
3. What are diagnostic standard and treatment principles of nephritic syndrome?
4. What is IgAN? What is clinical characteristic of the IgAN?
5. How do we diagnose about rapidly progressive nephritis and IgAN?
6.3 Pyelonephritis
[Aims]
1. To master the etiology and pathogenesis of pyelonephritis.
2. To master the clinical manifestations, diagnoses, differential diagnoses and treatment
principles of acute and chronic pyelonephritis.
3. To master the fundamental concept of relapse and reinfection.
4. To know the major laboratory test of pyelonephritis.
[Teaching Hours] 2
[Teaching Contents]
A. General situation.
B. Pathogenic bacteria infection pathway and predisposing factor of pyelonephritis.
C. Briefing pathology of acute and chronic pyelonephritis.
D. Clinical manifestations.
a. Acute pyelonephritis.
Systemic symptom, urinary tract symptom and abnormal urinalysis.
b. Chronic pyelonephritis.
note: clinical characteristic and types.
E. Complications.
Perinephric abscess, renal papillary necrosis.
F. Laboratory test and other examinations.
a. Urine routine.
b. Urine bacterial examination.
c. Cell count in urine.
d. Blood routine.
e. Serum examination.
f. Renal function.
g. X-ray
h. B type ultrasonic
G. Diagnosis and differential diagnosis
a. Diagnostic basis of acute pyelonephritis: differential diagnosis with fever disease.
b. Diagnostic basis of chronic pyelonephritis and diagnostic essentials of atypical case.
H. Treatment
122
a. Acute pyelonephritis
1) General treatment
2)Using principle of the antibiotic and course of treatment and cure standard.
b. Chronic pyelonephritis
1) Searching for and getting red of predisposing factor.
2) General treatment.
3) Using principle of the antibiotic: same with acute pyelonephritis, but emphasis is
combined using drugs.
4) Treatment of the relapse reinfection and asymptomatic bacteruria.
[Practice Hours] 4h
[Practice Contents]
[Review Questions]
1. What are the pathogenic bacteria common infection pathways and predisposing
factor of urinary tract infection?
2. What are the clinical manifestations and urine examination characteristic of
pyelonephritis?
3. How do we differentiate upper and lower urinary tract infection?
4. What are using antibiotic principle and cure standard of the acute and chronic
pyelonephritis?
5. What is relapse? What is reinfection?
6.4 Chronic Renal failure
[Aims]
1. To master the common etiology and induced factor of the uremia.
2. To master the pathogenesis of the uremia.
3. To master the diagnosis differential diagnosis and treatment principle of the uremia.
4. To know the clinical symptoms producing pathogenesis and peritoneal dialysis.
5. To know principles and indication of hemodialysis and peritoneal dialysis.
6. To know important of preventing renal failure and indication of renal transplantation.
[Teaching Hours] 4
[Teaching Contents]
A. General introduction
Definition and staging standard of the chronic renal failure.
B. Etiology and pathogenesis
a. Causes of the uremia.
b. Theories of the chronic renal function failure progressive worsen.
C. Clinical manifestations and its pathogenesis
a. Gastrointestinal system.
b. Hematopoietic system.
c. Cardiovascular system
d. Neurologic system
e. Respiratory system.
123
f. Cutaneous disorder
g. Uremic osteodystrophy
h. Endocrine dysfunction
i. Metabolic dysfunction
j. Be susceptible to infection
k. A balance of water and electrolyte and acid-base.
D. Diagnosis and differential diagnosis
a. Diagnosis of the basic disease.
b. Looking for factor that aggravated patient’s condition.
E. Treatment
a. Treating basic disease and correcting factor that aggravated renal function.
b. Dietetic therapy.
c. Essential amino acids therapy
d. Chinese medicine.
e. Treatment of the complication.
f. Giving special attention in using drugs that are excretion through kidneys or have
renal toxin.
g. Follow up.
h. Dialysis: principles, methods and indications of the hemodialysis and peritoneal
dialysis.
i. Renal transplantation.
[Practice Hours] 4h
[Practice Contents]
[Review Questions]
1. What are the common causes and clinical staging of chronic renal failure?
2. What are symptoms of the uremia? How to produce these symptoms? (anemia, osteal
disease, pericarditis cardiac failure, neurologic symptoms and acidosis)
3. What are indications and methods of non-dialysis of chronic renal failure?
4. What are principles and indication of hemodialysis and peritoneal dialysis?
Independent
Study
6.1 2
6.2 6 4 √ √ √ √
6.3 2 4 √ √ √ √
6.4 4 2 √ √ √ √
1．Practice hours 68h
124
VI. Exam patterns
Closed-book exam；
Closed-book exam score counts for 100%.
Syllabus Editor: Yan Lan

Syllabus Reviewer: Bai Ling
125
“Surgery” Course Syllabus
Course name: Surgery
Intended audience: five-year clinical medicine students, five-year forensic science students,
seven-year preventive medicine students
Prerequisites: anatomy, diagnostics, pathology, pathophysiology, pharmacology,
microbiology.
[1] Ma Qingyong. Surgery. Dean’s office of Xi’an Jiaotong University, 2004.
[2] Wu Zaide, Wu Zhaohan editor. Surgery (Seventh Edition). People's Health
Publishing House, 2008.
[3] Wu Jieping et al. Urology. Shandong Science and Technology Press. 2004.
[4] Walsh, PC et al.: Campbell's Urology, 7th Ed., Science Press 2005.
[5] Emil A. Tanagho and Jack W. McAninch: Smith’s General Urology, 15th Ed.,
McGraw-Hill Companies, Inc., 2000.
Type: Surgery is an important component of medical science and clinical medicine.
Purpose: When talking about a disease process, it is not simply limited to the external
appearance of the diseases, but includes many other aspects such as pathogenesis, clinical
course, diagnosis, prevention, and treatment of a disease. With regards to treatment, one
must be able to use both surgical and non-surgical methods, and additionally be able to select
the appropriate method. Surgery topics include: basic surgical problems; surgical operations;
etiology, pathology, diagnosis, prevention and treatment principles of common surgical
diseases, and indications for surgery.
Surgery is an important component of medical science and clinical medicine. The
principle part is in the study of the etiology, epidemiology, clinical course, diagnosis, and
treatment of surgical diseases. The importance is placed on the study of the fundamental
knowledge, theory, and technical skills of surgery for the purpose of stimulating the interest
of students and developing the student’s ability to analyze and solve problems. The primary
content of the class can be separated into surgical principles which includes the foundations
of surgery, for instance, disorder of fluids and electrolytes, preoperative preparation and post,
surgical shock, surgical infection, anesthesia, trauma, etc., and monograph on commonly
seen surgical diseases and surgical procedures. Through classroom lectures, hands-on
learning, internship, and other forms of self-study, there will be ample opportunities for
students to exhibit creativity and self-initiative, allowing them to master the basic common
surgical diseases, clinical knowledge, and clinical skills. Furthermore, they will also be able
126
to cultivate their clinical thinking skills through knowing the commonly recurring surgical
diseases along with the principles of diagnosis and treatment.
1．Students are trained properly in sterile technique and basic surgical skills, as well as
in the knowledge of commonly encountered diseases, focusing on the principles of
integrating clinical knowledge with clinical skills.
2．After completing this course, the student should have a full grasp of commonly seen
diseases, basic clinical skills, and basic surgical skills.
IV. Course content and schedule
Chapter 1: Course Introduction
1. Outside the scope of surgery, know its relationship to other related disciplines.
2. Focus on how to learn surgery and how to become an accomplished surgeon.
Independent
Study
1 2 √
Chapter 2: Molecular biology in the field of surgery

1． the structure and function of genes
2． genetic diagnosis and treatment
Independent
Study
2.1 √
Chapter 3: Sterile technique

1. The concept and composition of sterile technique, surgical personnel preoperative
preparation, the preparation of the surgical area, rules for sterile technique.
Independent
Study
3.1 2 4 √
Chapter 4: Electrolyte disorders in the surgical patient

1. Pathophysiology, clinical manifestations, diagnosis, and management of hypertonic,
127
hypotonic, and isotonic water deficits. Pathophysiology, clinical manifestations, diagnosis,
and management of hypokalemia and hyperkalemia.
2. Pathophysiology, clinical manifestations, diagnosis, and management of metabolic
acidosis and metabolic alkalosis. The use of blood pH value in the diagnosis of acid-base
disorders.
3. Principles of prevention, procedures, and potential problems during treatment of
acid-base imbalances using water and electrolyte replacement therapy.
Independent
Study
4.1 2 √
Chapter 5 Blood transfusions

1. Indications for blood transfusion; blood transfusion precautions; the causes, clinical
manifestations, and prevention of transfusion complications.
2. The advantages and usage of the various blood products.
3. The types and application methods of autotransfusion.
Independent
Study
5.1 2 √
Chapter 6: Surgical shock

1. Introduction to shock
2. Hypovolemic shock
3. Septic shock
Independent
Study
6.1 4 √
Chapter 7: Multiple organ dysfunction syndrome

1. Overview of multiple organ dysfunction syndrome: definition, pathogenesis, clinical
manifestations, diagnosis, prevention, and treatment.
2. Acute renal failure
1) etiology and pathogenesis.
128
2) clinical manifestations and diagnosis of oliguria (or anuria), polyuria, and
convalescence.
3) treatment of oliguria (or anuria) and polyuria.
4) the prevention of acute renal failure.
3. Acute respiratory distress syndrome
1) basis of onset and pathogenesis.
2) clinical manifestations, diagnosis, and treatment.
Independent
Study
7.1 2 √
Chapter 8: Anesthesia
1. The concept of anesthesia; the development, current state, and clinical role of
anesthesiology; pre-operative patient evaluation and medication selection, precautions, and
purpose.
2. Commonly used methods of general anesthesia; clinical pharmacology, advantages,
and disadvantages of medicines used in general anesthesia.
3. Classification and mechanism of action of muscle relaxants.
4. Endotracheal intubation.
5. Pharmacology, usual dose and maximum dose of local anesthetics; symptoms and
treatment for toxic reactions and allergic reactions to local anesthetics; commonly used nerve
blocks.
6. Spinal anesthesia: anatomy, physiology, methods, and management of complications.
7.Indications, contraindications, and complications of controlled hypotension and
hypothermia methods.
Independent
Study
8.1 2 4 √
Chapter 9: Intensive monitoring of treatment and recovery

1. the concepts of cardiopulmonary resuscitation, early diagnosis of cardiac arrest.
2. Initial resuscitation: artificial respiration, cardiac compression.
3. Secondary resuscitation: airway management, application of external breathing
devices, monitoring, commonly used drugs and route of administration, defibrillation, fluid
therapy, and external pacing.
4. Post-resuscitation therapy: maintenance of respiratory and circulatory function,
129
cerebral resuscitation, dehydration, low temperature, high-dose corticosteroids, hyperbaric
oxygen therapy, other supportive care.
Independent
Study
9.1 2 √
Chapter 10: Pain management

1. The basic concepts and classification of pain.
2. Assessment and measurement methods for the degree of pain.
3. The scope and role of the diagnosis and treatment of pain.
4. Partial and complete nerve blocks: principles of clinical application, selection
indications, adverse reactions, and the prevention and treatment of common side-effects.
5. Diagnosis and treatment of common pathologic causes of pain.
6. Nerve block therapy.
Independent
Study
10.1 2 √
Chapter 11: Perioperative management of the patient

1. Pre-operative preparation, special preparation
2. Post-operative complications, prevention and treatment of
Independent
Study
11.1 2 √
Chapter 12: Nutrition in the surgical patient

1. The metabolic state of the body in fasting, trauma, and infection; the approaches,
methods, types, and composition of nutritional supplementation.
Independent
Study
12.1 2 √
Chapter 13: Surgical Infection
1. The classification, etiology, pathogens, pathology, clinical course, and prevention
130
principles for surgical infections. Clinical symptoms, diagnosis and prevention of sepsis and
bacteremia; pathophysiology, clinical manifestations, complications, prevention, and
treatment of tetanus; diagnosis and treatment of acute soft tissue infection. Proper use of
antibiotics.
Independent
Study
13.1 4 √
Chapter 14: Trauma and war injuries

1. Concept, classification, and pathology of trauma injuries; diagnosis and treatment of
trauma injuries
2. The principles of systematic management of war wounds, firearm injuries
Independent
Study
14.1 2 √
Chapter 15: Burns, cold injuries, bites, and stings

1. burn pathology, the effects of burn depth and area on the body, the clinical course of
extensive burns; estimation methods for burn severity, surface treatment of burns, and the
prevention of complications.
2. Etiology, pathology, clinical manifestations, acute treatment and prevention methods
for cold injury.
Independent
Study
15.1 2 √
Chapter 16: Microsurgery

1. Overview of microsurgery, the practical scope of microsurgery in various disciplines.
2. Fundamental principles of small vascular anastomosis.
Independent
Study
131
16.1 √
Chapter 17: Tumors

1. classification and etiology of tumors; growth and development, clinical
manifestations and prognosis of benign and malignant tumors; cancer screening and
diagnostic methods, and I, the cancer screening and diagnostic methods; staging and
principles of integrative therapy.
Independent
Study
17.1 2 √
Chapter 18: Transplant

Types of transplants and the progress being made at home and abroad. Types of skin
grafts, outline of the characteristics and indications for various types of skin grafting
methods; allogeneic organ transplantation.
Independent
Study
18.1 2 √
Chapter 19: Increased intracranial pressure

Definition, causes, classification, clinical manifestations, diagnosis, and treatment
principles of increased intracranial pressure; classification, common causes, clinical
manifestations, and treatment principles for cerebral hernia.
Independent
Study
19.1 2 1 √
Chapter 20: Traumatic brain injury

1. Scalp injury, skull injury, brain injury
Independent
Study
132
20.1 2 1 √
Chapter 21: Congenital malformations of the brain and spinal cord

1. Definition, clinical manifestations, classification, etiology, laboratory examinations,
common surgical treatment modalities, and postoperative complications of congenital
hydrocephalus; diagnosis and treatment of cranial and spinal bifida.
Independent
Study
21.1 2 0.5 √
Chapter 22: Intracranial intraspinal tumors

Clinical manifestations, etiology, classification, diagnosis and differential diagnosis,
and treatment of intracranial and intraspinal tumors.
Independent
Study
22.1 2 1 √
Chapter 23: Intracranial and intraspinal vascular disease

1. Etiology, clinical presentation, diagnosis and treatment of spontaneous subarachnoid
hemorrhage; clinical manifestations and diagnosis of intracranial aneurysms; classification
and clinical manifestations of intracranial and intraspinal arteriovenous malformations.
Independent
Study
23.1 2 0.5 √
Chapter 24: Facial disease (see Oral Surgery)
Chapter 25: Neck disease

1. Thyroid anatomy; etiology, clinical manifestations, and treatment principles for
simple goiter; diagnosis, indications for surgical treatment, preoperative evaluation, surgical
principles, and postoperative complications for hyperthyroidism; pathological type, clinical
manifestations, and treatment principles of thyroid cancer.
133
Independent
Study
25.1 2 4 √
Chapter 26: Breast disease

1. Local breast anatomy; etiology, clinical manifestations and treatment of acute
mastitis; clinical manifestations, diagnosis and surgical treatment of breast cancer.
Independent
Study
26.1 2 4 √
Chapter 27: Chest injury

1. Overview, clinical classification, and first aid treatment principles of chest injury.
2. The classification, clinical manifestations, diagnosis, and treatment of rib fractures.
3. The classification and pathophysiological changes of pneumothorax.
4. The clinical manifestations and treatment of hemothorax.
5. Indications, methods, and precautions of closed-suction drainage.
Independent
Study
27.1 2 1 √
Chapter 28: Chest wall disease

1. Learn about the common types, clinical manifestations, and treatment principles of
chest wall disease.
Independent
Study
28.1 2 1 √
Chapter 29: Empyema

[Self-study] (learn the etiology, clinical manifestations, and treatment principles for
empyema)
CHAPTER 30: Lung disease
134
1. Clinical manifestations and surgical treatment options for bullae, bronchiectasis,
tuberculosis, and pulmonary hydatid disease.
2. The relevant factors in the incidence, mortality, and morbidity of lung cancer.
3. Pathological classification and metastatic pathways of lung cancer.
4. Clinical manifestations, diagnosis and differential diagnosis of lung cancer.
5. The principles of medical and surgical treatment of lung cancer.
Independent
Study
30.1 2 1 √
Chapter 31: Esophageal disease

1. Epidemiology and etiology of esophageal cancer.
2. Pathological classification of esophageal cancer.
3. Clinical manifestations, diagnosis and differential diagnosis of esophageal cancer.
4. Principles, methods, indications, and contraindications of surgical treatment for
esophageal cancer.
Independent
Study
31.1 2 1 √
Chapter 32: Primary mediastinal tumors

[Self-study] (learn the types, clinical manifestations and treatment principles of
mediastinal tumors)
Chapter 33: Heart disease

1. An overview of the development of surgical treatment of heart disease, with
elaboration on cardiac surgery, closed heart surgery, open heart surgery, including the
application of cardiopulmonary bypass.
2. Indications for surgery and treatment principles for common congenital and acquired
heart diseases.
Independent
Study
135
33.1 2 √
Chapter 34: Thoracic aortic aneurysms

[Self-study] (understand the causes, clinical manifestations, and treatment principles for
thoracic aortic aneurysm)
Chapter 35: Hernia

1. Etiology, pathological anatomy, and pathological type of hernia. Anatomy of the
groin.
2. Clinical manifestations and distinguishing features of direct and indirect inguinal
hernias.
3. Basic repair principles for inguinal hernias. The differential diagnosis and surgical
repair principles for femoral hernias.
4. Surgical treatment principles for incarcerated hernias and strangulated hernias.
Independent
Study
35.1 2 4 √
Chapter 36: Abdominal injury

1. Introduction to abdominal injury.
2. Know the characteristics and management of intraabdominal injuries.
Independent
Study
36.1 2 √
Chapter 37 Acute purulent peritonitis

1. Anatomy and physiology of the peritoneum.
2. Etiology, pathology, clinical manifestations, diagnosis, differential diagnosis and
treatment options (non-surgical therapy, surgical principles, and treatment methods) for acute
diffuse peritonitis.
3. Diagnosis and treatment of abdominal abscess.
Independent
Study
37.1 2 1 √
136
Chapter 38: Gastroduodenal disease
1. Pathological features of gastroduodenal ulcer disease.
2. Pathogenesis of gastroduodenal ulcer disease.
3. Clinical classification (four types), characteristics and clinical manifestations (based
on the amount of gastric acid secretion and location) of gastric ulcers.
4. Indications for surgery for gastric ulcer.
5. Clinical manifestations of duodenal ulcer.
6. Indications for surgery for duodenal ulcer.
7. The clinical manifestations, complications and treatment principles of gastric ulcer.
8. Theoretical basis for gastrectomy in the treatment of gastroduodenal ulcer.
9. Gastrectomy methods and precautions. (major complications of Bilroth I, II, and
gastrectomy)
10. Etiology of gastric cancer.
11. The pathological features of gastric cancer
① general classification
② histological type
③ proliferation and metastasis of gastric cancer
④ clinical staging
12. Clinical manifestations, diagnosis (early diagnosis) of gastric cancer
13. The treatment principles of gastric cancer
Independent
Study
38.1 2 3 √
Chapter 39: Intestinal diseases

1. Etiology, classification, pathology and pathophysiology, clinical manifestations,
diagnosis and treatment of small bowel obstruction.
2. Differentiation between simple small bowel obstruction and small bowel obstruction
with strangulation.
3. Pathology, clinical manifestations, diagnosis and treatment of intestinal tumors,
intestinal polyps, and polyposis.
4. Clinical manifestations, diagnosis and treatment of colon cancer.
5. Clinical manifestations and treatment principles of adhesive small bowel obstruction,
obstruction secondary to roundworm, volvulus, and intussusception.
Chapters Lecture Practice Discussion Assignments Independent Project Other
137
Study
39.1 2 2 √
Chapter 40: Appendiceal disease

1. Acute appendicitis: pathology, clinical classification, clinical manifestations,
diagnosis, differential diagnosis and treatment.
2. Clinical characteristics and treatment principles for: acute appendicitis in children,
acute appendicitis in the elderly, acute appendicitis in pregnancy.
3. Chronic appendicitis: clinical manifestations, diagnosis and treatment.
4. Diagnosis and treatment of appendiceal abscess.
Independent
Study
40.1 2 √
Chapter 41: Colorectal and anal disease

1. Screening methods for the rectum and anus. Etiology, diagnosis and treatment for
perirectal and perianal abscess. Classification and treatment methods for anal fistulas.
2. Etiology, classification, clinical manifestations, diagnosis and treatment of
hemorrhoids; clinical manifestations, diagnosis and treatment of rectal prolapse and rectal
polyps.
3. Pathology, clinical manifestations, diagnosis, treatment and surgical principles for
rectal cancer; the Duke’s classification of colorectal cancer.
Independent
Study
41.1 2 2 √
Chapter 42: Liver Disease

1. Causes, diagnosis, and surgical indications for liver abscess, pyogenic liver abscess,
and amebic liver abscess.
2. Etiology, pathology, clinical manifestations, diagnosis, differential diagnosis and
treatment principles for primary liver cancer.
3. Clinical manifestations, diagnosis and treatment principles for hepatic hydatid
disease.
Independent
Study
138
42.1 2 2 √
Chapter 43: Portal hypertension

1. Overview of portal vein anatomy; etiology, pathology, clinical manifestations,
diagnosis, differential diagnosis and treatment of portal hypertension (emergency treatment
of, surgical indications for, and surgical methods of gastroesophageal variceal bleeding).
Independent
Study
43.1 2 2 √
Chapter 44: Biliary tract disease

1. Etiology and pathology of gallstone disease and biliary tract infections; the
inspection methods of the biliary system. Clinical manifestations, diagnosis, differential
diagnosis and treatment of acute cholecystitis, chronic cholecystitis, gallstones, bile duct
stones, and acute suppurative cholangitis.
2. Clinical manifestations, diagnosis, differential diagnosis and treatment of gallbladder
polyps, gallbladder and bile duct cancer.
3. Pathogenesis, clinical manifestations, diagnosis and treatment of biliary ascariasis.
Independent
Study
44.1 2 2 √
Chapter 45 The differential diagnosis and treatment principles of gastrointestinal

bleeding
1. Learn the general rules, differentiating characteristics, principles, surgical exploration
indications and steps for gastroduodenal ulcer, hemorrhagic gastritis, portal hypertension,
and biliary tract bleeding.
Independent
Study
45.1 2 √
Chapter 46 Diagnosis and differential diagnosis of the acute abdomen
139
1. The clinical assessment, diagnostic essentials, and treatment in the differential
diagnosis of the acute abdomen.
Independent
Study
46.1 2 √
Chapter 47 Pancreatic disease

Focus is on acute pancreatitis and pancreatic cancer.
1. Etiology, pathogenesis, clinical manifestations, diagnosis, classification criteria, and
principles of treatment of acute pancreatitis. Introduce the advances in research in
understanding the pathogenesis and changes in treatment which stress the importance of
individualized treatment plans.
2. Etiology and early diagnosis of pancreatic cancer, and other differentiation and
treatment principles for other periampullary neoplasms (basis for
pancreaticoduodenectomy).
Independent
Study
47.1 2 2 √
Chapter 48 Diseases of the Spleen

1. Except for severe splenic injury, review the indications and effects of splenectomy on
blood dyscrasias, hematopoietic diseases, and disorders of the spleen itself.
Independent
Study
48.1 2 √
Chapter 49: Aneurysms

1. Understand the clinical manifestations of peripheral artery aneurysms.
2. Understand the etiology, clinical manifestations, diagnosis and treatment of visceral
artery aneurysms.
3. Know the clinical manifestations, diagnosis and treatment of abdominal aortic
aneurysms.
140
Chapter 50 Peripheral vascular and lymphatic diseases
1. Anatomy of the venous system. Varicose veins of the lower limbs: etiology, clinical
manifestations, examination and diagnosis, prevention and treatment of complications,
indications for non-surgical and surgical therapy, as well as the basic requirements for
surgery.
2. Buerger’s disease: etiology, pathology, varying clinical manifestations based on
clinical course, treatment principles using Eastern and Western medicine.
Independent
Study
50.1 2 4 √
Chapter 51 Surgical examination and diagnosis of the urinary system and the
male reproductive system
1. Symptoms and features of urinary and male reproductive system diseases, such as
bladder irritation (frequency, urgency, dysuria), difficulty urinating, urinary retention, urinary
incontinence, oliguria, anuria, hematuria, pyuria, chyluria, crystals in the urine and urethral
discharge. Includes related symptoms of urinary and male reproductive system surgical
diseases such as pain, swelling and sexual dysfunction, etc.
2. Signs and examination methods of the surgical diseases of the urinary and male
reproductive systems: physical examination, laboratory tests, instrumental examinations and
imaging studies (ultrasound, X-ray, DSA, CT, MRI, MRA, MRU and radionuclide studies
and so on.
3. Symptomatic changes in urination or urine content, frequency, causes and
localization of hematuria.
4. The relationship between the symptoms of different diseases of the urinary and male
reproductive systems.
5. Indications, contraindications and precautions for instrumental urological inspection
and imaging studies.
Independent
Study
51.1 2 1 √
Chapter 52: Congenital malformations of the urinary tract and male reproductive
system
141
1. Understand the principles of surgical treatment of polycystic kidney disease.
2. Understand Klinefelter's syndrome.
Chapter 53: Urinary system injuries

1. An overview and types of urinary system injury. Etiology, pathology, clinical
manifestations, diagnosis, surgical treatment and indications, and complications of treatment
for kidney, ureteral, and bladder injury. From the regional dissected anatomy, explain the
pathology and clinical manifestations for pre-ureteral and post-ureteral injury, along with the
extent of urinary extravasation; diagnosis and treatment principles, and the management of
complications of urethral injury, along with the prevention of urethral stricture.
Independent
Study
53.1 2 1 √
Chapter 54: Urinary tract and male reproductive system infections

1. Urinary tract male reproductive system infections and risk factors. Route of
infection, diagnostic methods and treatment principles (traditional Chinese medicine).
Etiology, pathology, clinical manifestations, diagnosis and treatment principles for upper
urinary tract infections and lower urinary tract infections.
2. Types of infections, symptoms, diagnosis and treatment principles for infections of
the kidney, bladder, urethra, prostate, and epididymis.
Independent
Study
54.1 2 1 √
Chapter 55: Urinary tract and male reproductive system infections

1. Urinary tract male reproductive system infections and risk factors. Route of
infection, diagnostic methods and treatment principles (traditional Chinese medicine).
Etiology, pathology, clinical manifestations, diagnosis and treatment principles for upper
urinary tract infections and lower urinary tract infections.
2. Types of infections, symptoms, diagnosis and treatment principles for infections of
the kidney, bladder, urethra, prostate, and epididymis.
Independent
Study
142
55.1 2 1 √
Chapter 56: Obstruction of the urinary system

1. Urinary system (kidney, ureter and bladder, urethra); etiology and pathophysiology of
obstruction; the significance and routes of urinary extravasation following upper urinary
obstruction with resultant hydronephrosis. Clinical manifestations, diagnostic methods and
treatment principles for hydronephrosis.
2. Benign prostatic hyperplasia: etiology, pathology, clinical manifestations, diagnosis
and differential diagnosis, indications for non-surgical and surgical treatment, management
of treatment complications.
3. Urinary retention: etiology, clinical manifestations, diagnosis and treatment.
Treatment principles of acute urinary retention.
Independent
Study
56.1 2 1 √
Chapter 57: Urolithiasis

1. Epidemiology and cause of urolithiasis (differences in etiology of stones found in
pediatric and adult cases), the composition and characteristics of urinary stones, the
pathologic changes caused by urinary stones on the urinary system organs, as well as the
prevention of urolithiasis.
2. Upper urinary tract calculi: clinical manifestations, diagnosis, drug therapy, non-open
and open surgical treatments, and prevention of stones.
3. Clinical manifestations, diagnosis, differential diagnosis, and treatment principles for
bladder and urethral stones.
Independent
Study
57.1 2 1 √
Chapter 58: Cancer of the urinary tract and male reproductive system
1. Overview of tumors of the urinary tract and male reproductive system. Pathology,
metastatic pathways, clinical manifestations, X-ray examination, ultrasound, angiography,
differential diagnosis, surgical treatment principles, as well as the evaluation of radiation and
chemotherapy for renal cancer, Wilms’ tumor, and renal pelvis tumors.
2. Etiology and pathology of bladder cancer, diagnosis of bladder tumors - urine
cytology, cystoscopy, biopsy, bimanual palpation, contrast imaging, ultrasound examination,
CT, MRI, cystoscopy with dye; and bladder cancer staging and treatment principles.
3. Etiology, pathology, clinical manifestations, diagnosis and treatment of prostate
143
cancer, testicular cancer, and penile cancer.
Independent
Study
58.1 2 2 √
Chapter 59: Other diseases of the urinary tract and male reproductive system
1. Understand the clinical manifestations, diagnosis and differential diagnosis of
nephroptosis.
2. Understand the clinical manifestations, diagnosis and treatment principles of
varicocele.
3. Understand the clinical manifestations, diagnosis and differential diagnosis of
hydrocele.
Chapter 60: Surgical treatment of adrenal disease

1. Understand the surgical treatment of adrenal disease.
2. Understand the clinical manifestations, laboratory tests, and special examinations for
Cushing's syndrome and primary aldosteronism.
Chapter 61: Male sexual dysfunction, infertility and birth control

1. Understand male sexual function, erectile dysfunction, premature ejaculation.
2. Understand of male infertility.
3. Understand male contraception and sterilization.
Chapter 62: Introduction to orthopedic fractures

1. Definition, causes, and classification of fracture and fracture displacement; clinical
manifestations and X-ray examination of fractures; fracture complications; the factors
affecting fracture healing; emergency treatment of fractures; fracture healing process;
treatment principles for closed and open fractures.
Independent
Study
62.1 2 1 √
Chapter 63: Injury to the upper limbs and joints

1. Clavicle, surgical neck of the humerus, humeral shaft, humeral condyles, forearm
and distal radius anatomy; etiology, classification, clinical manifestations, diagnosis and
treatment of fractures.
144
2. Clinical manifestations, diagnosis and treatment of shoulder dislocation and elbow
dislocation.
Independent
Study
63.1 2 1 √
Chapter 64: Hand Injury & finger replantation

1. Hand injury diagnosis, focusing on teaching the examination and diagnosis of ulnar
nerve, radial nerve and median nerve injuries. First aid and treatment principles for hand
injuries.
Independent
Study
64.1 2 1 √
Chapter 65: Injuries of the lower limb and joints

1. Mechanisms, clinical manifestations, diagnosis and treatment of hip dislocation; the
anatomy of the femoral neck, trochanter, femur, knee ligament and meniscus; the etiology,
various types, classification, clinical manifestations, diagnosis and treatment principles of
tibial and fibular fractures. Etiology, classification, clinical manifestations and treatment
principles of ankle fractures. Clinical anatomy of the calcaneus, and classification and
treatment principles of calcaneal fractures.
Independent
Study
65.1 2 1 √
Chapter 66: Spinal and pelvic fractures
1. Clinical anatomy of the spine; etiology, classification, treatment and initial transport
of spinal fracture patients; pathology, clinical manifestations, scoring of, complications, and
treatment of spinal cord injuries. Clinical anatomy of the pelvis; classification,
complications, diagnosis and treatment of pelvic fractures.
Independent
Study
66.1 2 1 √
145
Chapter 67: Peripheral nerve injury
1. The clinical anatomy of upper and lower limb nerves and the clinical manifestations
and treatment after injury of those nerves.
Independent
Study
67.1 2 1 √
Chapter 68: Chronic musculoskeletal disease

1. Etiology, clinical features, treatment and prevention principles of chronic
musculoskeletal disease.
2. Clinical manifestations, diagnosis and differential diagnosis for lumbar strain and
lumbar bursitis.
3. Pathology, clinical manifestations, special examination and treatment of stenosing
tenosynovitis.
4. Prevalence, clinical manifestations and treatment of epicondylitis and frozen
shoulder.
Independent
Study
68.1 2 √
Chapter 69: Neck pain and Low back pain

1. Etiology and classification of neck pain and low back pain. Definition, etiology,
classification, clinical manifestations, diagnosis, differential diagnosis, treatment and
prevention of lumbar disc herniation.
2. Definition, etiology, classification, clinical manifestations, diagnosis, differential
diagnosis and treatment of cervical spondylosis.
Independent
Study
69.1 2 √
Chapter 70: Suppurative bone and joint infections

1. Routes of infection for pyogenic osteomyelitis; etiology, pathology, clinical
manifestations, clinical examination, diagnosis, differential diagnosis and treatment of acute
hematogenous osteomyelitis.
146
2. Pathology, clinical manifestations and treatment of chronic hematogenous
osteomyelitis.
3. Etiology, pathology, clinical manifestations, diagnosis and treatment of septic
arthritis.
Independent
Study
70.1 2 √
Chapter 71: Bone and joint tuberculosis

1. Predilection sites, pathological changes, clinical manifestations and treatment of
bone and joint tuberculosis.
2. Pathological classification, clinical manifestations, X-ray findings, diagnosis,
differential diagnosis and treatment of spinal tuberculosis.
3. Pathological changes, clinical manifestations and treatment of hip and knee
tuberculosis.
Independent
Study
71.1 2 √
Chapter 72: Non-suppurative arthritis

1. Understand the etiology, pathology, and classification of osteoarthritis.
2. Understand of the clinical manifestations of ankylosing spondylitis.
3. Understand the etiology, pathology, and clinical manifestations of rheumatoid
arthritis.
4. Understand the etiology, pathology, and clinical manifestations of Kashin-Beck
disease.
Chapter 73: Congenital musculoskeletal malformations
1. Understand congenital dislocation of the hip.
2. Understand congenital clubfoot.
Chapter 74 Bone Cancer

1. Primary bone tumors.
2. Definition, classification, and surgical staging of bone tumors.
3. Clinical manifestations, X-ray findings, differential diagnosis and treatment
principles of benign and malignant tumors.
4. Clinical manifestations, X-ray and treatment principles of benign tumors
147
(osteochondroma, giant cell tumor).
5. Clinical manifestations, X-ray diagnosis and treatment principles for malignant bone
tumors (osteosarcoma, Ewing sarcoma, myeloma)
6. Clinical manifestations, X-ray diagnosis and treatment principles for tumor-like
lesions of bone (bone cyst, fibrous dysplasia).
Independent
Study
74.1 2 2 √
1. General Surgery: 48 practical hours (28 hours in surgery)
2. General Surgery 20 practical hours
3. Orthopedic Surgery 8 practical hours
4. Urology 8 practical hours
5. Cardiothoracic Surgery 4 practical hours
6. Neurosurgery 4 practical hours
VI. Exam patterns
Closed-book exam;
Closed-book exam score counts for 70%; Regular assignments count for 20%; Practice
exam score counts for 10%;
Other exam patterns can be self-designed based on individual courses.
Syllabus Editor:
Syllabus Reviewer:
148
“Gynecology” Course Syllabus
Course name: Gynecology
Prerequisite courses: Anatomy, Pathology, Physiology, Embryology
[1] Gou Wenli, Ma Jun. Textbooks on Clinical Medicine For International Students,
Gynecology and Obstetrics. Dean’s Office of Xi’an Jiaotong University, November 2004
[2] Decherney, A.H., Pernoll, M.L., Current Obstetric & Gynecologic Diagnosis &
Treatment. McGraw-Hill Companies, 2007
Type: Gynecology (often abbreviated GYN or Gynae) is the one medical-surgical
specialty dealing with the female reproductive organs in their non-pregnant state,
respectively, and as such is often combined to form a single medical specialty and
postgraduate training program. This combined training prepares the practicing GYN to be
adept at the surgical management of the entire scope of clinical pathology involving female
reproductive organs, and to provide care for non-pregnant patients.
Purpose: Gynecology is a single-source reference for practitioners in both the inpatient
and outpatient setting focusing on the practical aspects of clinical diagnosis and patient
management. A continued emphasis on disease prevention and evidence-based medicine
remains paramount. In addition to diagnosis and treatment of disease, pathophysiology is a
major area of focus. The concise format facilitates quick access. Medical students will
find Gynecology to be an authoritative introduction to the specialty and an excellent source
for reference and review.
Gynecology is one of medical specialties focusing on the health of women, as we know
it today—the surgical and medical therapies, reproductive endocrinology, assisted
reproductive technologies, gynecologic oncology, urogynecology, and infectious diseases.
Preventive and Primary Care, reflects the importance of primary health care for women,
which has evolved to address preventive care, screening and family planning. General
gynecology, reviews the evaluation of pelvic infections, the management of early pregnancy
loss and ectopic pregnancy. Reproductive endocrinology summarizes the major disorders
affecting the growth, development, and function of women from puberty through
menopause. Gynecologic oncology covers benign and malignant diseases of the female
reproductive tract.
This presentation style should facilitate the study of gynecology for the student. This
subject will impress the medical student with the importance of a thorough knowledge of
149
gynecology and with the fact that the great majority of ailments encountered in
gynecological practice.
III. Goals and objectives
In the process of teaching, teachers should play the leading role in taking the student
from the shallower to the deeper, staying focused, clear, and appropriate in introducing new
achievements at home and abroad, and linking theory with practice. The teachers should
inspire the students to think independently and cultivate the student’s ability to analyze and
solve problems.
Chapter 9: Inflammatory Disease of Female Genital Tract
9.1 Infection of Female Reproductive System
9.2 Tuberculosis of Reproductive System
Purpose and Keystones
1. Be familiar with the pathogen, pathway of infection, clinical manifestation, treatment
and prevention of non-specific vulvitis, Bartholinitis, Bartholin cyst, trichomonal vaginitis,
vulvovaginal candidasis (VVC), bacterial vaginosis and atrophic vaginitis. Know about
infantile vaginitis.
2. Be familiar with the pathogenesis, clinical manifestation and management of chronic
cervicitis.
3. Be familiar with the pathogenesis, clinical manifestation and therapeutic principles of
pelvic inflammatory disease (PID).
4. Be familiar with pathway of spread, clinical manifestation, diagnosis and therapy of
genital tuberculosis (TB).
5. Be familiar with pathway of spread, clinical manifestation, diagnosis and therapy of
Sexually Transmitted Diseases (STD).
Content of Lecture
1. Introduce the defense mechanism, pathogens, pathway of spread, development and
outcome of inflammatory disease of female genital tract.
2. Focus on pathogens, pathway of spread, clinical manifestation, management and
prevention of trichomonal vaginitis, VVC and atrophic vaginitis.
3. Introduce the pathology, clinical manifestation, diagnosis and treatment of cervicitis.
4. Focus on pathology, clinical manifestation, diagnosis, differential diagnosis,
prevention and treatment of PID.
5. Focus on pathway of spread, pathology, diagnosis and treatment of genital TB.
6. Focus on pathway of spread, pathology, diagnosis and treatment of genital STD.
150
Independent
Study
9.1 4 √
9.2 2
Chapter 10: Cervical Cancer

1. Know about the pathogenesis and be familiar with the pathway of metastasis.
2. Be familiar with the early diagnosis and clinical staging.
3. Be familiar with the principles of treatment.
Content of Lecture
1. Introduce the epidemiological situation of cervical cancer both at home and abroad.
2. Introduce the pathogenesis, esp, premalignant and malignant pathogenesis of cervical
cancer.
3. Focus on the pathway of metastasis.
4. Focus on staging, clinical manifestation and diagnosis of the disease.
5. Focus on the principles of treatment.
Independent
Study
10 2
Chapter 11: Myoma of uterus

Have a good grasp of categories, clinical manifestation and principles of treatment of
uterine myoma.
Content of Lecture
1. Introduce the current situation of incidence of myoma and its etiology.
2. Introduce in detail the pathological types of degeneration.
3. Introduce in detail the clinical manifestation and diagnostic procedures of the disease.
4. Introduce in detail the surgical and conservative therapeutic options.
Independent
Study
11 2
Chapter 12: Endometrial Cancer

151
Be familiar with epidemiology, diagnosis and principles of treatment of endometrial
cancer.
Content of Lecture
1. Introduce the etiology and pathological characteristics of the disease.
2. Focus on the pathway of metastasis, clinical manifestation, diagnostic procedure and
principles of treatment.
3. Focus on the relationship between the hyperplasia of endometrium and carcinoma of
endometrium.
4. Focus on the staging.
5. Focus on significance and procedure of fractional diagnostic curettage.
Independent
Study
12 2
Chapter 13: Ovarian Neoplasm

1. Know about the histological classification, pathological features and clinical
characteristics of neoplasm of ovary.
2. Be familiar with the characteristics of common ovarian neoplasm.
3. Be familiar with the differential diagnosis between benign and malignant ovarian
tumors.
4. Be familiar with the complications of ovarian tumors.
5. Focus on the significance of early diagnosis and surgical intervention.
6. Emphasize on the significance of combination therapy (surgery and chemotherapy)
of malignant ovarian tumors.
Content of Lecture
1. General introduction of current situation of ovarian tumors.
2. Introduce the histological classification of ovarian tumors.
3. Focus on the pathology and clinical feature of several common categories of ovarian
tumors.
4. Focus on the significance of combination therapy of malignant ovarian tumors.
Independent
Study
13 4
Chapter 14: Endometriosis
152
1. Understand the etiology of endometriosis.
2. Be familiar with pathological feature of endometriosis.
3. Grasp the clinic features, diagnosis and therapeutic principles of endometriosis.
Content of Lecture
1. Introduce the definition and several pathogenesis theories of endometriosis.
2. Explain endometriosis pathology in detail.
3. Explain emphatically the clinic manifestation, non-operative and operative treatment
of endometriosis.
Independent
Study
14 2
Chapter 15: Gestational Trophoblastic Disease

1. Be familiar with the definition, pathology, clinical manifestation, diagnosis, treatment
and follow-up of hydatidiform mole.
2. Be familiar with the pathology, clinical manifestation diagnosis, differential
diagnosis, treatment and follow-up of invasive choriocarcinoma and choriocarcinoma.
Content of Lecture
1. Introduce the definition and etiology of complete and partial hydatidiform.
2. Explain the pathology, manifestation, outcome, diagnosis, differential diagnosis,
treatment and follow-up of hydatidiform.
3. Explain the definition, pathology, manifestation, diagnosis and differential diagnosis
of invasive choriocarcinoma and choriocarcinoma.
4. Explain in detail the clinic stages of gestational trophoblastic tumors (GTD).
5. Explain in detail the treatment principals (chemotherapy is the first choice) and
follow-up of GTD.
6. Introduce the pathology, manifestation, diagnosis and treatment of placental site
trophoblastic tumors (PSTT).
Independent
Study
15 2
Chapter 16: Dysfunctional Uterine Bleeding (DUB)
153
1. Understand the main causes and bleeding mechanism of DUB.
2. Grasp the clinic categories and features of DUB.
3. Be familiar with the general diagnosis methods and essential differentiated diseases.
4. Grasp the therapeutic principles and treatment methods of DUB.
Content of Lecture
1. Introduce the mainly pathogenesis factors and bleeding mechanism of DUB.
2. Explain in detail the pathology and clinic manifestations of different types of DUB.
3. Introduce several general auxiliary examinations on diagnosis of DUB.
4. Differentiate the essential differentiated diseases from DUB on homological diseases
such as abnormal pregnancy, inflammation and tumors of genital organs.
5. Explain emphatically its treatment principles and methods of DUB including general
therapy such as taking a rest, nourishment, resort anemia, principle of treatment with all
kinds of natural or combined hormone and operative therapy.
Independent
Study
16 2
Chapter 17: Amenorrhea

1. Demonstrate that the amenorrhea is a symptom not a disease in itself. It is callused by
different causes and pathogenesis mechanism.
2. Be familiar with the general diagnosis methods of amenorrhea.
3. Understand the therapeutic principles of different kinds of amenorrhea.
Content of Lecture
1. Introduce the etiology and pathogenesis mechanism of amenorrhea.
2. Explain emphatically the diagnosis procedure of amenorrhea.
3. Explain emphatically how to decide the therapeutic principles of amenorrhea
according to its different causes.
Independent
Study
17 2
Chapter 18: Infertility and Assisted Reproductive Technology (ART)

18.1 Infertility
18.2 Assisted Reproductive Technology (ART)
154
1. Know about the etiology of infertility.
2. Be familiar with the program of diagnosis and treatment principals.
3. Know about the progress of treatment of infertility, such as ART.
Content of Lecture
1. Introduce the definition and etiology of infertility (male, female, primary and
secondary etc.).
2. Explain in detail the laboratory findings and diagnosis of infertility, including history,
sperm examination, gynecologic examination, ovarian functional examination, fallopian
tubal examination, postcoital examination, ultrasound, laparoscopic examination and so on.
3. Explain in detail the treatment principals and progress of treatment. First is the
treatment aimed at the causes, such as the treatment of organic disease or adjust gonadal
function; the operation treatment and new techniques for laparoscopic and assisted
reproductive technology.
Independent
Study
18.1 2
18.2 2
Chapter 19: Contraception Control

1. Understand the important meaning of family planning.
2. Grasp the contraceptive mechanism, usage methods and contraindications of all kinds
of contraceptive methods.
3. Be familiar with the indications, contraindications and treatment of complications of
sterilization.
4. Grasp indications, contraindications and complications of artificial abortion.
Content of Lecture
1. Explain emphatically contraceptive mechanism, indication, contraindication, side
effects and the complication of inserted IUD.
2. Explain emphatically contraceptive mechanism, clinic usage, contraindications and
general side effects of oral contraception pill.
3. Explain emphatically the indications, contraindications and treatment of
complications of sterilization.
4. Explain emphatically indication and contraindication of artificial abortion, the
prophylaxis and treatment of its complications.
155
Independent
Study
19 2
1. Anatomy of Female Reproductive System, 4 study hours.
2. Physiology of Female Reproductive System, 2 study hours.
3. Ovarian Function Tests, 2 study hours.
4. Gynecologic History Collection and Record，4 study hours
5. Gynecologic Clinical Case Discussion: Abortion and Ectopic Pregnancy ， 4 study
hours
6. Operation Demonstration (Gynecology), 4 study hours
7. Clinical Case Discussion: Carcinoma of Cervix, Myoma of Uterus, Carcinoma of
Endometrium, 4 study hours
8. Clinical Case Discussion: Endometriosis, Gestational Trophoblastic Diseases,
Ovarian Tumors, 4 study hours
VI. Exam patterns
Closed-book exam
Closed-book exam score counts for 80%; Regular assignments count for 20%.
Syllabus Editor: Qiling Li (李奇灵)

Syllabus Reviewer: Xuelan Li (李雪兰)
156
“Obstetrics” Course Syllabus
Course name: Obstetrics
Intended audience: Foreign medical student
Prerequisite courses: Surgery, Medicine, Anatomy of pelvis, Embryology
[1] Cunningham, Leveno, Bloom, Hauth, Rouse. Williams Obstetrics, 23nd Edition.
The McGraw-Hill Companies, Inc, 2010
[2] Normal F. Gant, F. Gary Cunningham. Basic Gynecology and Obstetrics. Appleton
and Lange, 1993
[3] Hacker and Moore. Essentials of Obstetrics and Gynecology, 5th Edition, W. B.
Saunders, 2010
[4] Leon Speroff and Marc A. Fritz. Clinical Gynecology, Endocrinology, and
Infertility, 7th Edition, Lippincott Williams & Willkins, 2005
[5] Jones, Wentz, Burnett, Novak’s Textbook of Gynaecology, 12th Edition, Williams
and Wilkins, 1996
Type: Professional clinical course
Purpose: All undergraduate students must have three basic components; knowledge,
clinical skills and attitude in order to be enthusiastic and well motivated efficient future
doctors. This will enables the students to proceed into either general practice or other
specialties. The purpose of this subject is to develop awareness and basic understanding of
obstetrics, which including antepartum care, intrapartum care, postpartum care, and diseases
which complicate pregnancy. This preclinical instruction includes all aspects of human
reproduction. Preparation for participation in clinical activities within the specialty and the
subspecialty areas of reproductive endocrinology-infertility, maternal-fetal medicine may be
acquired through directed reading and scheduled discussions with faculty members.
Obstetrics & Gynecology is the branch of Medicine which deals with the health care of
women. It is concerned with the physiological, psychological, and pathological events of the
reproductive and menopausal processes. Obstetrics deals with all aspects of pregnancy,
including: antenatal care, normal physiology, early pregnancy problems and other
pathological events which occur during pregnancy and labor. This integrated course contain
28 hours of lectures and 36 hours of clinical practice content (including: instrument teaching,
ward rounds with bedside teaching, clinic attendance and operating room, labor ward, and
ultrasound sessions). The lecture contents include：Physiology of Pregnancy，Diagnosis of
Pregnancy，Normal Labor，Abortion，Ectopic Pregnancy，Placenta Previa， Placental
157
abruption ， preeclampsia and eclampsia ， Pregnancy Complicated Heart
Disease ， Abnormal Labor ， Amniotic fluid embolism ， Rupture of Uterus, Postpartum
hemorrhage. The experiment contents include: Physiology of pregnancy, Placenta, Villus,
Amniotic fluid ，Fetal Lie, Fetal Position, Fetal Presentation, Mechanism of Labor ，Four
Maneuvers of Leopold, External Pelvimetry, Fetal Heart Sound Examination ， Obstetric
History and Record History ， Demonstration of Partogram and the Care of Normal
Labor，Fetal Distress，Perinatal Care，Abnormal Labor，Discussion of Obstetric Case:
Pathological Pregnancy, Abnormal Labor，Operation Demonstration (Obstetrics) etc.
1. Be aware of the physiology of reproduction.
2. Develop a basic understanding of obstetrics, which includes antepartum care,
intrapartum care, postpartum care, and diseases that complicate pregnancy.
3. Preparation for participation in clinical activities.
Chapter 1: Physiology of reproduction
Purpose and key points
Know the physiological characteristics of each stage in a woman’s life.
Have a good grasp of the development of follicles and the secretion of sexual
hormones.
Have a good grasp of physiological function of sexual hormones and the clinical
significance of the periodic changes of reproductive organs.
Be familiar with the clinical manifestation of menstruation.
Have a good grasp of the regulatory mechanism of menstruation.
Teaching contents
1. Introduce the physiologic characteristics of each stage in a woman’s life.
2. Talk about the development of follicles, the secretion of sexual hormones and the
physiological function of progestogen, estrogen and androgen.
3. Put focus on explaining the function and the periodic changes of ovarian hormones
acting on reproductive organs.
4. Put focus on explaining regulatory mechanism of H-P-O axis on menstrual cycle.
Independent
Study
1 4 √ √
Chapter 2: Conception and antenatal care

2.1 Physiology of pregnancy
2.2 Diagnosis of Pregnancy
158
2.3 Antenatal care
Purpose and key points:
1. Be familiar with ovum, fertilized egg and the procedure of forming and development.
and implantation of fertilized egg.
2. Explain emphatically placenta, membrane umbilical cord, the forming of amniotic
fluid and the function of placenta.
3. Introduce the origin metabolic、volume、contenting and function of amniotic fluid.
4. Explain emphatically the feature character of the changes of contents of practice and
matches reproductive system, hematology, cardiovascular and urology system.
5. Have a good grasp of diagnostic method of pregnancy.
6. Be familiar with definition of fetal lie, fetal presentation and fetal position.
7. Know about significant of antenatal care.
8. Have a grasp of pregnant history taking, method and contents of obstetric
examination, and writing case record.
9. Be aware of the health education for pregnant women.
Teaching contents:
1. Performance the models of fertilization implantation of fertilized egg, development
of embryo, placenta, umbilical cord and amniotic fluid.
2. Performance in clinic the changes in the pregnancy woman’s body
status、skin 、breast、vaginal tract and cervix.
3. Early pregnancy diagnostic method and theory.
4. Diagnostic methods and application of second and third trimester.
5. Focus on differentiate of fetal lie, fetal presentation and festal position.
6. Introduce antenatal care contents, clinical demonstration, practice four step
maneuver, hearing fetal heart sound, pelvimetry.
7. learning history taking method and obstetric examination.
8. Filling the table of case record, and analysis the significance of each items.
9. Demonstration of health education for pregnant women. Visit health education room
for pregnant women.
Independent
Study
2.1 4 √ √
2.2 1 √
2.3 1 √
Chapter 3: Normal Labor

3.1 Physiology of labor
159
3.2 Stages of labor
1. Be familiar with the deicidal factors on labor.
2. Be familiar with the delivery labor of caput presentation.
3. Have a grasp of the procedure and the management of labor.
Teaching contents:
1. Explain emphatically three decadal flouters: strength of labor, delivery tract 、 and
fetus, demonstrate the relation ship among these factors.
2. Explain emphatically the mechanism of labor examples caput presentation.
3. Explain in detail the manifestation of false labor, diagnosis in labor, and the stage of
delivery.
4. Explain manifestation and management of three stages.
Independent
Study
3.1 1 √
3.2 1 √
Chapter 4: complications of obstetrics

4.1 Abortion
4.2 Ectopic Pregnancy
4.3 Preterm labor
4.4 Preterm rupture of membrane
1. Have a good grasp of abortion in different stages and management.
2. Be familiar with the manifestation and management of several special abortions.
3. Know the classification and definition of ectopic pregnancy.
4. Put focus on explaining the pathological changes and outcome of tubal pregnancy.
5. Put focus on explaining the manifestation, assistant diagnostic methods of tubal
pregnancy.
6. Generally introduce the differential diagnosis such as abortion, rupture a follicular or
corpus luteum cyst, pelvic inflammatory disease, acute appendicitis and torsion of ovarian
cyst.
7. Put focus on explaining the principle of management of tubal pregnancy.
8. Be familiar with the concept, etiology, diagnosis and prognosis of preterm labor。
9. Have a good grasp of the principle of management of preterm labor.
10. Have a good grasp of the concept and influence on maternal and fetus of PROM
11. Know the reasons of PROM.
12. Have a good grasp of the diagnosis of PROM and Intra-amniotic infection.
13. Have a good grasp of the principle of management of PROM.
160
Teaching content
1. Generally introduce the definition abortion.
2. Generally introduce the common causes of aborted.
3. Explain the pathology, manifestation and management of abortion in different stages
in detail.
4. Put focus on manifestation, diagnosis and management of recurrent abortion, missed
abortion and septic abortion.
5. Generally introduce the differential diagnosis, such as hydatidiform mole, tubal
pregnancy, dysfunctional uterine bleeding.
6. Put focus on the concept, etiology, diagnosis and prognosis of preterm labor
7. Generally introduce the Intra-amniotic Infection preterm labor.
8. Generally introduce the conception and etiology of PROM.
9. Put focus on the influence on the maternal and fetus of PROM.
10. Put focus on the diagnostic methods and principle of management of PROM.
Independent
Study
4.1 2 √
4.2 2 √
4.3 1 √
4.4 1 √
Chapter 5: Antepartum Hemorrhage

5.1 Placenta Previa
5.2 Placental abruption
1. Be familiar with causes of previa placenta, the different types of abnormal locations
and related manifestation.
2. The influence of previa placenta on mother and her fetus.
3. Be familiar with the key points related with diagnosis and management.
4. Be familiar with the causes, pathogenesis and manifestation of placental abruption.
5. Be familiar with the key points of diagnosis and management of abruptio placenta.
6. Know the effects of the disease on mother and her fetus and know the importance of
early management of placental abruption.
Teaching content
1. Generally introduce the causes of previa placenta.
2. Put focus on introducing the classification, manifestation and diagnosis of previa
placenta.
3. Generally introduce the complications and their effects on mother and her fetus.
4. Put focus on explaining the manage method of prevention.
161
5. Generally introduce causes, pathogenesis and pathological changes.
6. Put focus on teaching manifestation and management of abruptio placenta.
7. Generally introduce differential diagnosis such as previa placenta, threatened
premature labor.
Independent
Study
5.1 1 √
5.2 1 √
Chapter 6: Medical disorders

6.1 Pregnancy Induced Hypertension(PIH)
6.2 Pregnancy Complicated Heart Disease
6.3 Gestational Diabetes Mellitus
1. To be familiar with basic pathophysiological changes of PIH
2. To be familiar with the manifestation, diagnostic procedure of the different types and
different stages of PIH and be familiar with the differential diagnosis.
3. To be familiar with the main complications and management of them.
4. Know the effects of PIH on mother and her fetus.
5. Have a good grasp of principle of management and prevention of PIH.
6. To be familiar with interaction among the pregnancy、delivery postpartum and heart
disease.
7. To be familiar with effected factors about the prognosis of maternal and fetal.
8. To be familiar with the prophylaxis and treatment of pregnancy with heart disease.
9. To be familiar with the severity of gestational diabetes mellitus and the Interaction
between pregnancy and diabetes.
10. Have a good grasp of the manifestation, diagnosis, stages and differential diagnosis
of GDM.
11. To grasp the control measures of GDM.
Teaching content
1. Generally introduce the related causes and several perspectives of PIH pathogenesis.
2. Put focus on PIH basic pathological changes.
3. According to the pathological basis, put focus on explaining the manifestation of
different stages of PIH, the use of assistant examinations including eye ground, ECG to
make the diagnosis ascertain. Talk about the key points to discriminate PIH from chronic
hypertension and nephritis.
4. Put focus on explaining the complications of PIH.
5. Generally introduce the effects of PIH on mother and fetus.
6. According to the pathophysiological changes of PIH, Talk about the meaning of
162
management of PIH.
7. Generally introduce the prevention of PIH.
8. Introduce emphatically interaction among the pregnancy delivery and heart disease.
9. Explain emphatically the effected factors about the prognosis of mother and fetal.
10. Explain emphatically the prophylaxis and treatment of pregnancy with heart
disease.
11. Put focus on the harmful of GDM on the gravida and the fetus.
12. Put focus on the manifestation, diagnosis and differential diagnosis of GDM.
13. Put focus on the interaction of the pregnancy and Diabetes Mellitus.
14. Introduce the screening and diagnosis methods of GDM.
15. Put focus on the control measures and the treatment methods of GDM.
Independent
Study
6.1 2 √
6.2 2 √
6.3 2 √
Chapter 7: Dystocia
7.1 Abnormal uterine action
7.2 Abnormal of birth canal
7.3 Abnormal fetal position
1. Be familiar with the manifestation and meaning of diagnosis of abnormality with
strength of labor and delivery tract, fetal malposition and malpresentation.
2. Learn how to analysis the main problem about abnormal labor, be familiar with the
management principle.
3. be familiar with the possibility of complications and of abnormal pregnancy and the
prophylaxis and treatment
Contents of lecture:
1. Abnormal strength of labor:
a. explain emphatically the importance of abnormal strength of labor dairy dystocia.
b. explain emphatically the type clinic manifestation、diosmosis of abnormal strength of
labor.
c. explain emphatically influence on mother and baby and treatment of abnormal
strength of labor.
2. Abnormal delivery tract.
a. explain emphatically the type 、 diagnosis and the effects to mother and baby of
abnormal delivery tract.
b. explain emphatically the management of abnormal delivery tract
163
3. Abnormal fetus and malposition.
a. explain emphatically the causes、diagnosis and management of abnormal fetus and
malposition.
b. explain emphatically the diagnosis and management about OP, OT, breech
presentation, transverse position.
Independent
Study
7.1 3 √
7.2 1 √
7.3 2 √
Chapter 8: Complications of Intrapartum period

8.1 Amniotic fluid embolism
8.2 Rupture of Uterus
8.3 Postpartum hemorrhage
1. Be familiar with the reasons of rupture of the uterus.
2. Have a good grasp of manifestation and diagnosis of Rupture of the uterus.
3. Be familiar with the management and prevention of rupture of the uterus.
4. Have a good grasp of causes. Manifestation and diagnosis of postpartum hemorrhage.
5. Be familiar with the prevention of PPH.
6. Have a good grasp of management of PPH.
Teaching contents
1. Generally introduce the causes of rupture of the uterus.
2. Put focus on explaining manifestation and diagnosis of threatened rupture of the
uterus and rupture of the uterus.
3. Put focus on finding high risk factors in prenatal care, investigating previous labor
and let students know the importance of correct management during labor.
4. Know the meaning of preventing rupture of the uterus. Practice content and Method.
5. Introduce the main causes of PPH in detail, including ineffective, laceration of
genital tract and blotting problems.
6. Put focus on explaining the different manifestations caused by different causes.
7. Talk about prenatal care and the benefit for preventing PPH.
8. Explain the principle of management of PPH caused by different causes.
Independent
Study
164
8.1 2 √ √
8.2 1 √
8.3 1 √
1. Physiology of pregnancy, 2 study hours
2. Placenta, Villus, Amniotic fluid, 2 study hours
3. Fetal Lie, Fetal Position, Fetal Presentation, 2 study hours
4. Mechanism of Labor, 2 study hours
5. Four Maneuvers of Leopold, External Pelvimetry, Fetal Heart Sound Examination, 4
study hours
6. Obstetric History and Record History, 4 study hours
7. Partogram, the Care of Normal Labor, 2 study hours
8. Fetal Distress, 2 study hours
9. Perinatal Care, 4 study hours
10. Abnormal Labor, 4 study hours
11. Discussion of Obstetric Case, 4 study hours
12. Operation Demonstration (Obstetric), 4 study hours
VI. Exam patterns
There are two components which numerically contribute equally to the final evaluation:
Syllabus Editor: Pu Huang (黄谱)

Syllabus Reviewer: Xuelan Li (李雪兰)
165
“Pediatrics” Course Syllabus
Course Name: Pediatrics
Prerequisite courses: Diagnostics
Zhang Baoqin. Pediatrics. 军事医学出版社. 2006
Behrman.R.E, Kliegman.R.M. Nelson Textbook of Pediatrics e-dition.17th. 北京大学
医学出版社. 2007
Type: Clinical medicine course
Purpose: To understand the scope and practice of pediatric medicine
Topic: The Scope of Pediatrics

Hours: 2 lecture; 3 clinical practice
II. Topic content
(1) General concept of pediatrics
(2) Newborn period
(3) Infancy period
(4) Preschool period
(5) School period
(6) Older children and adolescent
(1).To understand the general concept of pediatrics.
(2).To aster the concept and features of newborn period, infancy period, preschool
period, school period and adolescent.
Independent
Study
1.1 40 0 10
1.2 40 0 10
1. The concept and features of infancy period.
166
2. The concept and features of preschool period.
Topic: Growth and Development
II. Topic Content
(1) the rules of growth and development
(2) the factors influencing growth and development
(3) the indicators of physical growth
(4) the behaviors and psychological development
(5) the sexual developmental and maturation
(1) to master the rules of growth and development
(2) to understand the factors influencing growth and development
(3) to master the indicators of physical growth
(4) to understand the behaviors and psychological development
(5)to understand the sexual developmental and maturation
(6). Teaching contents and arrangements
Independent
Study
1.1 45 5 √
1.2 40 10 √
Visit kindergarten. Master the measurements of weight, height, head circumference and
dentition.
167
Topic: Nutrition and Feeding
II. Topic Content
(1) The nutritional requirements of infants and children.
1). Water
2). Energy
3). Protein
4). Fat
5). Carbohydrates
6). Vitamins
7). Minerals
(2) Human milk
1). Advantage of human milk.
2). The factors influencing breastfeeding.
(3) Cow’s milk and infant formulas.
(1) To understand the nutritional requirements of infants and children.
(2) To be familiar with the average daily requirements of water, energy, protein, fat and
carbohydrates in infants and children.
(3) To master the advantage of Human milk.
(4) To know the cow’s milk and infant formulas.
Independent
Study
1.1 40 10 √
1.2 45 5 √
1.3 45 5 √
1.4 40 10 √
Visit kindergarten, Demonstrate normal diet.
[Review Question]
(1). How to measure the weight, height and head circumference?
(2). What is the normal value of weight, height and head circumference?
168
Topic: Acute Post-streptococcal Glomerulonephritis (ps-AGN)
II. Topic Content
(1) Introduction.
(2) Etiology
(3) Pathogenesis and pathology.
(4) Clinical and laboratory manifestation.
(5) Diagnosis rules.
(6) Treatment rules.
(1) To understand the etiology, pathogenesis and pathology.
(2) To master clinical and laboratory manifestations.
(3) To be familiar with the diagnosis and treatment rules.
(4) To know the prognosis.
Independent
Study
1.1 40 10 √
1.2 40 10 √
Visit patients. Case demonstration and discussion.
[Review Question]
(1). The average daily requirements of water, energy, protein, fat and carbohydrate.
(2). The advantage of Human milk.
169
Topic: Primary Nephrotic Syndrome
II. Topic Content
(1) Introduction.
(2) Pathogenesis, clinical and laboratory manifestation.
(3) Treatment.
(1) To understand the concept.
(2) To master the pathogenesis.
(3) To master the clinical and laboratory manifestation. To master the relationship
between pathogenesis and manifestation.
(4) To be familiar with the treatment.
Independent
Study
1.1 45 5 √
1.2 40 10 √
Visit patients, case demonstration and discussion.
[Review Questions]
(1). Diagnosis of primary nephritic syndrome.
(2). Steroid therapy of primary nephritic syndrome.
170
Topic: Purulent Meningitis
II. Topic Content
(1) Etiology, pathogenesis and pathology.
(2) Clinical manifestation.
1). Neonatal period
2). older infants and children.
(3) Diagnosis
(4) Complication
1). Subdural effusions and empyemas.
2). Hydrocephalus.
(5) Treatment
(1) To know the etiology, pathogenesis and pathology.
(2) To master the clinical manifestation.
(3) To master the change of CSF.
(4) To master the diagnosis.
(5) To know the complication.
(6) To be familiar with the treatment.
Independent
Study
1.1 45 5 √
1.2 45 5 √
1.3 40 10
1.4 40 10
Visiting patients case demonstration and discussion.
[Review Questions]
(1) The features of CSF in purulent meningitis.
(2) The clinical manifestation of purulent meningitis.
171
Topic: General Assessment of Newborn
II. Topic Content
(1) Classification by birth weight and gestational age.
(2) Anatomic and physiological characteristics.
1). Full term infant.
2). preterm infant.
(3) Care of the newborn.
(4) A few kinds of specific states of newborn.
(1) To master the classification of newborn
(2) To understand physical characteristics of newborn
(3) To understand the care of newborn and a few kinds of specific states.
(4). Teaching contents and arrangements
Independent
Study
1.1 40 10 √
1.2 40 10 √
Watching video and visiting patient.
[Review Questions]
(1) Definition of full term, post-term, SGA, LGA, AGA.
(2) The anatomic and physiological characteristic of full term and preterm infant.
172
Topic: Neonatal Respiratory Distress Syndrome
II. Topic Content
(1) Etiology: premature is the most important cause.
(2) Pathophysiology.
(3) Clinical signs diagnosis and differential diagnosis
(4) Treatment rules. Ventilation assistance
(1) To master the clinical manifestations and treatment principles.
(2) To understand the causes and pathophysiology.
(3) To understand the differential diagnosis.
(4) Teaching contents and arrangements
Independent
Study
1.1 45 5 √
1.2 45 5 √
(1) The clinical signs of NRDS
(2) Treatment rules of NRDS
173
Topic: Pneumonia of Newborn
II. Topic Content
(1) MAS
(2) Clinical manifestations and differential diagnosis points of infectious pneumonia.
Clinical signs are not obviously in newborn.
(3) Treatment rules. Care oxygen and antibiotics treatment
(1) To understand clinical manifestations and differential diagnosis of aspirating,
infectious pneumonia.
(2) To understand the classification of newborn pneumonia
Independent
Study
1.1 40 10 √
1.2 40 5 √
Visiting patients in wards, viewing the clinical signs, discussing case
[Review Questions]
(1)The clinical signs of infectious pneumonia of newborn.
(2)Treatment rules of infectious pneumonia of newborn.
174
Topic: Intracanial Hemorrhage
II. Topic Content
(1) Causes and mechanisms of intracranial hemorrhage of newborn
(2) Clinical manifestations
(3) Diagnosis process and treatment rules
(1) To understand the causes of intracranial hemorrhage of newborn
(2) To master the clinical signs and main points of diagnosis
(3) To understand the treatment rules
(4) Teaching contents and arrangements
Independent
Study
1.1 45 5 √
1.2 45 5 √
(1).Discussing cause and mechanism
(2).Viewing patients with intracranial hemorrhage
[Review Questions]
(2)Diagnosis process
175
Topic: Respiratory System
II. Topic Content
(1) The anatomy of respiratory system in children
(2) Etiology and prevention of respiratory infection
(3) Upper respiratory tract infection, bronchitis
(4) Clinical symptoms, signs of pneumonia and pneumonia with heart failure
(5) A few types of pneumonia
(6) Treatment of pneumonia; Antibiotics, oxygen etc
(1) To master clinical signs, diagnosis and treatment about upper respiratory tract
infections, bronchitis and pneumonia.
(2) To understand the etiology and prevention methods
(3) To understand the pathophysiology of pneumonia
Independent
Study
1.1 45 5 √
1.2 45 5 √
1.3 40 10 √
1.4 40 10 √
1.5 40 10 √
1.6 45 5 √
(1)Clinical practice Viewing patients with URTI.
(2)Ward practice Viewing patients with pneumonia, observing symptoms and signs of
pneumonia
[Review Questions]
(1) Causes of respiratory infection
(2) Symptom and signs of pneumonia
(3) Diagnosis and treatment of pneumonia with heart failure
176
Topic: Tuberculosis
II. Topic Content
(1) To understand the etiology of TB
(2) To master tuberculin test and its clinical significance
(3) To master clinical signs, terminology and treatment of primary TB
(4) To master the diagnosis, especially early diagnosis of tuberculous meningitis and its
treatment.
(1) To understand the etiology of TB
(2)To master tuberculin test and its clinical significance
(3) To master clinical signs, terminology and treatment of primary TB
(4) To master the diagnosis, especially early diagnosis of tuberculous meningitis and its
treatment.
Independent
Study
1.1 40 10 √
1.2 40 10 √
1.3 45 5 √
1.4 45 5 √
Discussing cases of causes, diagnosis and treatment
[Review Questions]
(1). Methods and significance of tuberculin test
(2). Clinical stages of tuberculosis meningitis and diagnosis
(3). Clinical manifestations of primary TB
(4). Chemotherapy of TB
177
Topic: Malnutrition
II. Topic Content
(1) Etiology, feeding factors and Disease factors.
1).order of loss of subcutaneous
2). fat
(3) Diagnoses and Differential diagnoses
(4) Prevention and treatment.
Including three measure of prevention an principles of treatment.
(5) complication
(1)To be Familiar with etiology and clinical manifestation.
(2) To master methods of treatment and prevention.
(3) To understand the complication of malnutrition.
Independent
Study
1.1 40 10 √
1.2 40 10 √
Seeing the patient with malnutrition or photo and then discussing the history signs and
treatment of malnutrition.
[Review Questions]
(1). order of loss if subcutaneous fat.
(2). methods of treatment of malnutrition
178
Topic: Rickets of vitamin D deficiency
II. Topic Content
(1) Source and transform of vitamin D the mainly source of vitamin D in human body is
cholecalciferol in skin which must be hydroxylated in liver and kidney. Three physical
functions of vitamin D.
(2) Etiology and productive mechanism
(3) Clinical manifestations.
1).Symptoms
2).Signs: especial advanced Rickets is very important. including osseous changes of
head. thorax, spinal column, extremities and pelvis and ligaments and muscles.
3). Biochemical changes
4). X rays of bones.
(4) Diagnoses and Differential diagnoses
(5) Prevention and treatment of Rickets.
Including measure of prevention and methods of treatment.
(1) To understand the source of vitamin D and it’s transform process in the human body
(2) To be familiar with the Etiology of Rickets.
(3) To master clinical manifestation、mechanism、prevention and treatment of Rickets
(4) To understand the differential diagnoses of Rickets.
Independent
Study
1.1 45 5 √
1.2 45 5 √
1.3 40 10 √
1.4 40 10 √
(1) Seeing patients or photo typical signs (The softness of the skull, caput guadratum.
Rachitie rosary, deformities of thorax, curvature of limbs and potbelly and Harrison’s
groove, scoliosis and lordosis of spinal column enlarged epiphyses )
(2) Discussing diagnosis and treatment by record of Rickets.
(3) X rays of long bone: A roentgenogram of the wrist is best for early diagnosis
(4) Chemo physical test of blood: The changes of serum, phosphatase and acid
phosphatase at differential stages of Rickets.
179
[Review Questions]
(1). Mechanism of Rickets
(2). Clinical manifestation at advanced Rickets.
(3). The measure of prevention and principles of treatment of advanced Rickets.
180
Topic: Tetany of vitamin D Deficiency
II. Topic Content
(1) Etiology: vitamin D deficiency results in falling of the serum calcium level.
(2) Mechanism: when the serum calcium level falls and failure of the parathyroids to
compensate for the low serum calcium level. Tetany may occur.
(3) Clinical manifestation
symptoms: carpopedal spasm, laryngospasm and convulsions.
Signs: Chvostek, Trousseall and Erb procedured.
(4) Diagnosis and differential diagnosis
Diagnosis of Tetany is easily made but we should also different from m\no fever
convulsions and infections of the central nervous system.
(5) Prevention and treatment
Including methods of prevention and principles and order of treatment.
(1) To be familiar with etiology and relation ship between the vitamin D deficiency and
function of parathyroids.
(2) To master diagnosis, clinical manifestation, prevention and treatment.
(3) To understand the differential diagnosis.
Independent
Study
1.1 40 10 √
1.2 40 10 √
(1) Seeing the patients or photo so as to master symptoms and signs of Tetany
(2) Discussing cases, Reviewing the diagnosis and treatment, especially order of
treatment should be firstly controlling convulsion, secondly administration of calcium,
finally administration of vitamin D.
[Review Questions]
(1) The clinical manifestation of Tetany
(2) The prevention and order of treatment
181
Topic: Infantile Diarrhea
II. Topic Content
(1) Etiology: including three causes, infection is the most common cause in China.
(2) mechanism
Including noninfectious, viral infectious and invasive bacteria and noninvasive bacterial
infectious.
(3) Clinical manifestation
1). The common one such as symptoms of digestive tract, dehydration (degree,
quality), acidosis and electrolyte disturbances.
2). The clinical characteristics of the several types enteritis.
3). Chronic diarrhea
(4) Diagnosis and Differential Diagnosis
Including stages and etiology diagnosis. There are or not complications and degree and
quality of dehydration acidosis and electrolyte disturbances.
(5) Prevention and treatment
Including measures of prevention and principles of treatment, especially Fluid therapy
should be introduced.
(1) To be familiar with Etiology of Diarrhea
(2) To master mechanism and the common clinical manifestation of Diarrhea
(3) To master the clinical characteristics of several types enteritis.
(4) To master diagnosis and treatment of diarrhea
(5) To understand prevention
Independent
Study
1.1 40 10 √
1.2 40 10 √
1.3 45 5 √
1.4 45 5 √
1.5 40 10 √
1.6 40 10 √
1.7 45 5 √
1.8 45 5 √
(1) Body liquid characteristics of balance in child
(2) The common solution in pediatrics and mixed solution
(3) Fluid therapy
1). Oral solution replacement
182
A. Oral solution: including oral sugar salt water and ORS solution.
B. Adaptation and application
2). Intravenous infusion replacement
A. adaptation
B. Three principles.
(4) Seeing the patients with dehydration (skin turgor the degree of mucous membranes
drying skin color pulse rate and so on)
(5) Discussing the case so as to master diagnosis and treatment.
[Review Questions]
(1) Mechanism of enterotoxigenic E. coli and Rotavirus enteritis.
(2) A ten kilogram girl, there is third degree and hyponatremic dehydration after she
suffers from diarrhea. Please ask you ? How to treat including fluid therapy at first 24 hour.
183
Topic: Hematopactic system Blood Characteristics And Nutritional Anemias in
Children
II. Topic Content
(1) General explanation of blood characteristic and the hematopoietic system in
children.
A: Development changes in the hematopoietic system
B: Blood analysis in normal children.
(2) Explanation of causes, etiology, Clinical manifestation Laboratory findings and
prevention of the key nutritional anemia.
A: Iron deficiency anemia(IDA)
①. Etiology:
a. metabolic characteristics of iron. Intake distribution, usage and elimination.
b. pathophysiology of iron deficiency with respect to microcytic hypochromic anemia.
②. Causes of iron deficiency: insufficient dietary intake, congenital low iron stores,
poor absorption, rapid growth, high energy consumption.
③. Clinical manifestation
General manifestation of anemia, extramedullary hematopoiesis, non-hematopoietic
symptom.
④. Laboratory evaluation:
Peripheral blood analysis, bone marrow iron studies.
⑤.Multifactorial prevention of nutritional anemia .
⑥. Treatment: treatment of cause, transfusion etc.
B. Nutritional megaloblastic Anemia (NMA)
①.Etiology and pathophysiologic basis.
The effect of vitamin B12 and folic acid on nucleic acid, metabolism and the
development of RBC.
Factor leading to deficiency (poor intake, rapid growth consumption of energy)
②. Clinical manifestation
General manifestation of anemia, neurologic symptoms(mental regression, pathologic
reflex)
③. Laboratory Findings:
Peripheral blood, bone marrow changes.
④. Prevention
⑤. Treatment
Use of vitamin b12, folic acid, Vitamin C diet therapy
(1) Have on understanding of the characteristics of blood and the hematopoietic system
in normal children.
(2) Understand the causes of anemia
184
(3) Master the pathology, etiology, diagnosis and prevention of iron deficiency, Vitamin
B12, deficiency and folic deficiency anemia.
Independent
Study
1.1 40 10 √
1.2 40 10 √
1.3 45 5 √
1.4 45 5 √
Examine patients
Demonstrate special signs, morphology of RBCs
[Review Questions]
(1) What are causes and mechanism of IDA and NMA?
(2) What are the clinical features of IDA and NMA?
(3) How to treat IDA and NMA?
185
“Lemology”Course Syllabus
Course name: Lemology
Hours: 64 (36 lecture; 28 laboratory)
Intended audience:foreign undergraduate students
Prerequisite courses: microbiology, immunology, epidemiology, pathology, physiology, biology,
biochemistry, anatomy, neurology, internal medicine
[1] Lee Goldman, Dennis Ausiello. Cecil Textbook of Medicine (24th Edition). Pennsylvania:
Elsevier , 2012.
[2] Wang YuMing. Infectious Diseases (2nd Edition). PeKing, People's Medical Publishing House,
2010.
[3] Mandell, Bennett, Dolin. Principles and Practice of Infectious Diseases (6th Edition).
Pennsylvania, Elsevier, 2005.
Purpose: The primary goal of lemology is to provide training for the undergraduate student in the
pathogenesis, clinical features, diagnosis, treatment, and prevention of a wide range of infectious diseases
encountered both domestically and internationally.
The clinical theoretical courses and clinical practice courses will discuss a wide variety of infectious
diseases, such as viral hepatitis, cholera, rash, hemorrhagic fever with renal syndrome, dysentery, typhoid,
CNS infection, malaria, and AIDS. In the lecture courses, basic theoretical knowledge will be taught, and
suggested reading will be assigned afterwards. In the following weeks, the theoretical knowledge will be
applied to enhance the student’s understanding of a specific infectious disease in the practice courses.
After that, the trainees are allowed to have contact with patients. A typical case with a given disease will
be presented, and the trainees are requested to obtain a history, perform a physical examination, collect lab
information, and make a diagnosis and treatment strategy.
1｣ｮ Trainees must complete all courses of lemology in one semester, including all lectures courses
and practice courses, a total of 64 semester hours.
2｣ｮ Satisfactory completion of all classes with a minimum of score of 60 in the final examination
(total score: closed book exam, practical exam, and regular assignments)
Chapter 1: General introduction
1｣ｮ General Introduction
This course introduces the student to lemology, including the history and general information of
infectious diseases. Emphasis is placed on epidemiology and the basic principles of diagnosis, treatment,
and prevention of infectious diseases. Public health related emerging infectious diseases is also
mentioned.
186
Independent
Study
1.1 √ √ √ √ √ √
Chapter 2: Viral Hepatitis.

Emphasis on acute and chronic viral hepatitis.
1｣ｮ Hepatitis B and D
2｣ｮ Hepatitis C
3. Hepatitis A and E
Independent
Study
1.1 √ √ √ √ √ √
1.2 √ √ √ √ √ √
1.3 √ √ √ √ √ √
Chapter 3: Cholera. The epidemiology, pathogenesis, diagnosis and treatment ofcholera are
presented.
1｣ｮ epidemiology, pathogenesis, diagnosis and treatment of cholera
Independent
Study
1.1 √ √ √ √ √ √
Chapter 4: Infectious Diseases with Rash.

An overview of common rash causing diseases, such as measles, chicken pox, rubella and scarlet
fever, are presented. Diagnosis and differential diagnosis of rash are stressed.
1｣ｮ Measles
2｣ｮ Chicken pox
3. Rubella
4. Scarlet fever
Independent
Study
1.1 √ √ √ √ √ √
1.2 √ √ √ √ √ √
1.3 √ √ √ √ √ √
1.4 √ √ √ √ √ √
Chapter 5: Hemorrhagic Fever with Renal Syndrome.
187
Clinical manifestation of hemorrhagic fever with renal syndrome are introduced. Emphasis is placed
on the early diagnosis and treatment of the oliguria phase.
1｣ｮ Clinical manifestation of hemorrhagic fever with renal syndrome
2. Early diagnosis
3. Treatment of the oliguria phase
Independent
Study
1.1 √ √ √ √ √ √
1.2 √ √ √ √ √ √
1.3 √ √ √ √ √ √
Chapter 6: Bacillary Dysentery.

The transmission, pathogenesis, diagnosis and treatment of shigellosis are presented.
1｣ｮ Transmission and pathogenesis of shigellosis
2｣ｮ Diagnosis, differential diagnosis, and treatment of shigellosis
Independent
Study
1.1 √ √ √ √ √ √
1.2 √ √ √ √ √ √
Chapter 7: Typhoid Fever.

The course introduce the trainees to the clinical aspect of typhoid fever, including pathogenesis,
epidemiology, clinical manifestation, control, and treatment.
1｣ｮ Clinical manifestation of typhoid fever
2｣ｮ Control of typhoid Fever
Independent
Study
1.1 √ √ √ √ √ √
1.2 √ √ √ √ √ √
Chapter 8: CNS Infection.

Clinical features of Japanese encephalitis, meningococcal meningitis are presented. Emphasis is
placed on the differential diagnosis of CNS infections.
1｣ｮ Japanese encephalitis
2｣ｮ Meningococcal meningitis
188
Independent
Study
1.1 √ √ √ √ √ √
1.2 √ √ √ √ √ √
Chapter 9: Malaria.
The epidemiology, pathogenesis, diagnosis and treatment of malaria are presented.
1｣ｮ Epidemiology, pathogenesis, diagnosis and treatment of malaria
Independent
Study
1.1 √ √ √ √ √ √
Chapter 10: Human immunodeficiency virus infection / acquired immunodeficiency syndrome

(HIV/AIDS).
The virology of HIV, epidemiology, transmission route, pathophysiology, signs and symptoms,
diagnosis and prevention of AIDS.
1｣ｮ Virology of HIV
2｣ｮ Clinical management of AIDS
Independent
Study
1.1 √ √ √ √ √ √
1.2 √ √ √ √ √ √
V. ClinicalPractice
1. General Introduction, 4 semester hours
2. Viral Hepatitis, 4 semester hours
3. Infectious Disease with Rash, 4 semester hours
4. Hemorrhagic Fever with Renal Syndrome, 4 semester hours
5. Infectious diarrhea, 4 semester hours
6. Febrile Diseases, 4 semester hours
7. Typhoid Fever, 4 semester hours
8. CNS Infection, 4 semester hours
VI. Assessment Methods
Closed-book exam;
Closed-book exam score counts for 60%; Regular assignments count for 20%; Experiment exam
score counts for 20%;
Other assessment methods can be self-designed based on individual courses.
189
Note: The contribution levels of professional courses are determined according to the professional
requirements of knowledge, ability, and quality cultivation. The contribution levels of basic courses are
determined according to the University requirements of knowledge, ability, and quality cultivation.
Syllabus editor:He Yingli

Syllabus Reviewer:Liu Min
190
“Neurology” Course Syllabus
Course name: Neurology
Prerequisite courses: Neuroanatomy, Pathology, Physiology.
[1] David A. Greenberg; Michael J. Aminoff; Roger P Simon. Clinical Neurology.
Copyright 2002 by McGraw-Hill, Companies Inc. Published by Beijing, People's Health
Publishing House,2002.
Type: Basic theory and Basic skill and experiment.
Purpose: This program is designed to provide the students main ideas about clinical
neurology and the teaching goals which they must reach.
Neurology is the study of etiology, pathogenesis, pathology, clinical presentation,
diagnosis, treatment and prevention about the central nervous system, peripheral nervous
system and skeletal muscle diseases. It mainly includes General Introduction, Spinal cord
disease, Peripheral Nerve disease, Cerebrovascular disease, Extrapyramidal disease,
Epilepsy, Neuromuscular junction disease, Craniocerebral Trauma, Intracranial tumor and
Increased intracranial pressure.
1．Basic theory and basic knowledge:
The etiology, pathogenesis, pathology, clinical presentation, diagnosis, treatment and
prevention of Spinal cord disease, Peripheral Nerve disease, Cerebrovascular disease,
Extrapyramidal disease, Epilepsy, Neuromuscular disease, Craniocerebral Trauma,
Intracranial tumor and Increased intracranial pressure.
2．Basic skills:
Basic neurology physical examination methods and methods of basic procedures, such
as lumbar puncture, etc.
Chapter 1: Brief Introduction
1．Teaching contents:
1) Review basic neuroanatomy knowledge
2) Disorders related with cranial nerves
a) Vision defects and ocular movement disorders
191
b) Hearing impairment and vertigo
c) Facial paresis
d) Bulbar and pseudo-bulbar palsy
3) Disorders of somatosensory and motor systems
2. Teaching goals:
1) Basic neuroanatomy principles.
2) Common signs and symptoms related with cranial nerves.
3) Clinical findings and localized neuroanatomy diagnosis of somatosensory and motor
systems.
4) Skills of general physical and neurological examinations.
Independent
Study
1 8 7 1 √ √
Chapter 2: Cerebrovascular Diseases

1. Teaching Contents:
a) Transient Ischemic Attack (TIA)
b) Complete stroke
c) Spontaneous cerebral hemorrhage and subarachnoid hemorrhage.
2.Teaching goals
1) The nature of cerebrovascular circulation.
2) The etiology and mechanisms of cerebrovascular diseases.
3) Clinical findings of various stroke.
4) Approaches to diagnosis and differential diagnosis.
5) Treatment principle of ischemic and hemorrhagic attacks.
Independent
Study
2 5 3 √ √ √
Chapter 3: Spinal cord diseases and Peripheral Nerve diseases

1. Teaching Contents
1) Definition.
2) Etiology and pathology
3) Clinical manifestations
4) Diagnosis and differential diagnosis
5) Treatment
192
2. Teaching goals
3) Principles of treatment
Independent
Study
3 5 3 √ √
Chapter 4: Extrapyramidal disease (PD)

1) Etiology and pathology
4) Treatment
2. Teaching goals
3) Principles of treatment
Independent
Study
4 3 3 √ √
Chapter 5: Epilepsy
1) Etiology
2) Classification and Clinical manifestation
3) Diagnosis
4) Therapeutic medicine choice
2. Teaching goals
2) Diagnosis principal and procedure
3) The first-chosen medication for different pattern epilepsy
193
Independent
Study
5 2 0 1 √ √
Chapter 6: Neuromuscular junction disease

1) Mechanism of neuromuscular junction transmission
2) Clinical manifestation of Myasthenia Gravis (MG)
3) Diagnosis criteria of MG
4) Therapy methods choice
2. Teaching goals
1) The characteristic Clinic findings
2) Diagnosis procedures
3) The main chosen medication for MG
Independent
Study
6 2 0 0 √ √
Chapter 7:Craniocerebral Trauma

1) Clinical classification and manifestation
2) Diagnosis
3) Therapy
2. Teaching goals
1) Clinical manifestations of closed intracranial trauma
3) The specific therapy processes
Independent
Study
7 2 3 √ √
Chapter 8: Intracranial tumor and Intracranial hypertension
194
1) Clinical manifestation
2) Diagnosis
3) Therapy
2. Teaching goals
1) Clinical manifestations, the triage main symptom of intracranial hypertension
3) Therapy
Independent
Study
8 5 3 1 √ √
1．General Introduction Practice, study hours:3.
2．Specific diseases of Neurology, study hours:19.
VI. Exam patterns
Closed-book exam；
Closed-book exam score counts for 90%; Regular assignments counts for 5%；Clinical
practical exam score counts for 5%.
Syllabus editor: Luo Guogang, Ju Xichi

Syllabus reviewer: Qu Qiumin
2013-09-18
195
“Ophthalmology” Course Syllabus
Course name: Ophthalmology
Intended audience: Medical students (non-specialists in ophthalmology)
Prerequisite courses: Diagnostics, Internal medicine, Surgery.
[1] Paul Riordan-Eva, Emmett Cunningham. Vaughan & Asbury’s General
Ophthalmology, 18th edition. USA: McGraw-Hill, 2011.
[2] American Academy of Ophthalmology. 2013-2014 Basic and Clinical Science
Course in Ophthalmology.
Type: A basic course for non-specialist of Ophthalmology.
Purpose:
1. To have a general understanding of ophthalmology and its main sub-specialties.
2. To know the basic features of some of the most common eye diseases.
3. To understand that some certain eye diseases can be closely related with systemic
diseases.
4. To know how to make the correct diagnosis and treatment of the most common eye
diseases.
5. To know the basic complete eye examination as performed by an ophthalmologist
and some specialized examination techniques.
This course is a brief introduction to general ophthalmology. It contains anatomy of the
eye, eye examinations, some of the most common diseases of external eye, anterior segment
and posterior segment of the eye, ocular disorders associated with systemic diseases. In
addition, the clinical practice course will help the students to know the basic complete eye
examination as performed by an ophthalmologist and some specialized examination
techniques. Clinical practice will include how to test visual function, how to perform direct
ophthalmoscopy, slit-lamp microscope, tonometry and some basic ideas of ophthalmic
micro-surgeries.
III. Goals and objectives
1．Lectures: PPT courseware.
2 ． Practices: eyeball model set, direct ophthalmoscopes, slit-lamp microscope,
tonometer, basic micro-surgical equipments of the eye.
196
Chapter 1: Fundamentals of ophthalmology
1.1 General introduction of ophthalmology
1.2 Anatomy and physiology of the eye
Independent
Study
1.1 20 min 5 min √
1.2 90 min 5 min √
Chapter 2: External eye diseases and cornea

2.1 External eye diseases
2.1.1 Emphasis on hordeolum, chalazion, blepharitis, acute conjunctivitis and
trachoma
2.2 Corneal disease
2.2.1 Physiology of cornea and review the anatomy of cornea
2.2.2 Emphasis on keratitis and dry eye
2.2.3 Brief introduction of corneal surgeries
Independent
Study
2.1 50 min 10 min √
2.2 50 min 10 min √
Chapter 3: Glaucoma
3.1 Review the anatomy of chamber angle and physiology of aqueous humor.
3.2 Clinical assessment in glaucoma
3.3 Classification of glaucoma, emphasis on primary angle closure glaucoma and
primary open angle glaucoma.
Independent
Study
3.1 20 min 5 min √
3.2 20 min 5 min √
3.3 45 min 5 min √
Chapter 4: Uveitis and cataract
197
4.1 Uveitis
4.1.1 Review the anatomy of the uveal tract
4.1.2 Classification and manifestations of uveitis
4.1.3 Emphasis on iritis and relationships between uveitis and some systemic diseases
4.2 Cataract
4.2.1 Review the anatomy of the lens
4.2.2 Emphasis on age-related cataract
4.2.3 Brief introduction of cataract surgery
Independent
Study
4.1 50 min 10 min √
4.2 50 min 10 min √
Chapter 5: Vitreous-retinal diseases and neuro-ophthalmology

5.1 Vitreous-retinal diseases
5.1.1 Review the anatomy of vitreous-retina
5.1.2 Emphasis on retinal vascular diseases which are associated with some systemic
diseases, age-related macular degeneration, retinal detachment
5.1.3 Brief introduction of vitreous-retinal surgeries
5.2 Neuro-ophthalmology
5.2.1 The sensory visual pathway
5.2.2 Emphasis on optic neuritis and papilledema
5.2.3 Disorders of the pupil
Independent
Study
5.1 70 min 10 min √
5.2 70 min 10 min √
Chapter 6: Optics, refraction and strabismus

6.1 Optics and refraction
6.2 Strabismus
198
Independent
Study
6.1 50 min 10 min √
6.2 50 min 10 min √
Chapter 7: Orbit and ocular trauma

7.1 Orbit
7.1.1 Anatomy of orbit and evaluation of orbital disorders
7.1.2 Imaging of the orbit
7.1.3 Emphasis on Graves’ disease
7.2 Ocular trauma
7.2.1 Classification of ocular trauma
7.2.2 Emphasis on chemical burns of the eye
Independent
Study
7.1 30 min 10 min √
7.2 70 min 10 min √
1．Ophthalmic examinations & Ophthalmic therapeutics. Help the students know how
to test visual function, how to use direct ophthalmoscope, slit lamp, and tonometer correctly.
4h
2．Show the basic techniques of ocular micro-surgeries. Show some videos of the most
common eye surgeries. 4h
3. Review of the most important eye diseases. Questions and answers. 4h
VI. Exam patterns
Syllabus editor: Dr. Jianqin Lei

Syllabus Reviewer: Dr. Qianyan Kang
199
“Otorhinolaryngology–Head and Neck Surgery ”
Course Syllabus
Course name: Otorhinolaryngology–Head and Neck Surgery
Prerequisite courses: Anatomy and Physiology of Respiratory Tract
[1] Yan Liying, Zhang Shaoqiang. Otolaryngology. Xi’an, Xi’an Jiaotong University
Press, 2004
Type: Professional clinical course
Purpose: To master the basic structure and physiology of the ear, nose, throat, trachea,
and esophagus, and to master the diseases common to them, such as acute rhinitis, chronic
rhinitis, chronic tonsillitis, chronic otitis media, foreign body in trachea, etc. To master the
basic apparatus used in the ear-nose-throat department such as the rhinoscope, tongue
depressor, head mirror, and indirect laryngoscope. To master the basic routine examination
of the ear, nose, throat, ear. How to use the upper apparatus. To master the basic treatment
principles of the common diseases in the ear-nose-throat department. To learn the basic
theory, basic knowledge, basic skill, and basic experience of the Otorhinolaryngology-Head
and Neck Surgery department.
The total content can be divided into nine parts. The first part is the general introduction
including the preface, basic equipment and applied medical principles. The second part is
Rhinology, which includes the basic anatomy and physiology of the nose, the examination of
the nasal cavity and nasal sinus, and the routine diseases in the nasal cavity and nasal sinus.
The third part is the Pharynx, including the basic anatomy and physiology of the pharynx,
basic methods of examination, tonsillitis, adenoiditis, and pharyngeal tumors. The fourth part
is the Larynx, including the anatomy and physiology of the larynx, the basic examination
methods, congenital disease, laryngeal injury, inflammatory disease, laryngeal tumor,
laryngeal obstruction. The fifth part is the diseases of the Esophagus and Trachea, including
the basic anatomy and physiology of the trachea and esophagus, foreign bodies in the trachea
and esophagus, and corrosive injury of the esophagus. The sixth part is diseases of the Ear,
including the basic examination and physiology of the ear, the congenital malformation of
the ear, injury to the ear, inflammation of the ear, the treatment of otitis and deafness, and
tumors of the ear. The seventh part is diseases of the Neck, including the anatomy and
physiology of the neck, congenital disease, neck trauma, and neck lumps. The eighth part is
200
special inflammatory diseases of Otorhinolaryngology, including tuberculosis, syphilis,
AIDS, and diseases in the ear-nose-throat. The ninth part is diseases specific to the field of
Otorhinolaryngology, including the upper respiratory disease, sinus barotraumas, and otic
barotraumas.
1. The students should master the basic anatomy and physiology of the nose, pharynx,
larynx, ear, trachea, and esophagus.
2. The students should master the application of the head mirror, rhinoscope, otoscope,
tongue depressor, and tuning fork.
Chapter one: Rhinology, Pharynx
1．The anatomy and physiology of the nose and pharynx
2．Rhinitis, Nasal sinusitis, Pharyngitis, Tonsillitis, Adenoid Hypertrophy, etc.
Independent
Study
1.1 4 4 2 √ √ √
1.2 4 4 2 √ √ √
Chapter 2: Larynx, Ear

1. The anatomy and physiology of the Larynx and Ear
2. Laryngitis, Laryngeal obstruction, Laryngeal carcinoma, Deafness, Otitis media, etc.
Independent
Study
1.1 4 4 2 √ √ √
1.2 4 4 2 √ √ √
1. Watch clinical videos: 4 study hours
2. Five basic examination methods in Otorhinolaryngology–Head and Neck Surgery
department: 4 study hours
3. The diagnosis and treatment of routine disease in Otorhinolaryngology–Head and
Neck Surgery department, such as Rhinitis, Pharyngitis, Laryngitis, Otitis media, Deafness:
4 study hours
VI. Exam patterns
Closed-book exam；
201
Closed-book exam score counts for 70%; Regular assignments count for 15%; Clinical
practical exam score counts for 15%;
Syllabus editor: Shao Yuan

Syllabus reviewer: Bai Yanxia
202
“Stomatology” Course Syllabus
Course name: Stomatology
Hours: 26 (14 lecture, 12 practice)
Intended: Foreign Medical Students
Prerequisite courses: Oral Histopathology, Oral Anatomy, and Physiology
Zhiyuan Zhang. Stomatology. Beijing: People's Health Publishing House, 2008.
Type: Stomatology is the clinical course for clinical medicine foreign students .
Purpose: to have students learn the basic theory, basic knowledge and basic technical
skill of Stomatology through the teaching process.
Stomatology is a clinical medicine which is to study the anatomy and physiology of oral
organs (tooth, periodontal tissue, lip, cheek, tongue, palate, floor of mouth), maxillofacial
bones (maxilla, mandible bone, etc.), maxillofacial soft tissue, salivary gland,
temporomandibular joint and other tissues and organs, and the occurrence, development,
diagnosis, treatment and prevention of maxillofacial diseases. It contains oral and
maxillofacial anatomy and physiology, endodontics, periodontal disease, oral mucosa
disease, oral and maxillofacial infection, oral and maxillofacial trauma, the common diseases
in oral and maxillofacial tumor.
1. Human anatomy,
2. Pathology,
3. Diagnosis,
4. Medicine,
5. Surgery
Chapter 1 The Anatomy and Physiology of Oral and Maxillofacial Regions
Vestibule of mouth; proper cavity of mouth; Teeth and periodontal tissues; Maxilla;
Mandible; Muscular, vessel and nerve of maxillofacial regions.
Independent
Study
1 2
203
Chapter 2 Examination of Oral – Maxillofacial Regions and Oral hygiene
The common instruments and method of oral examination; The basic theory and
method of oral hygiene.
Independent
Study
2 4 √
Chapter 3 The Common Diseases of Teeth and Periodontal Tissues

Dental caries; Pulpitis; periapical tissue disease; Tooth sensitivity; Tetracycline stained
teeth; Wedge-shaped defect; Chronic simplex gingivitis; Simplex Periodontitis.
Independent
Study
3 2 √
Chapter 4 Oral – Local – Anesthesia and exodontics

Common drugs of oral – local – anesthesia; Methods of anesthesia; Indication,
contraindication and complication of tooth extraction.
Independent
Study
4 2 √
Chapter 5 Infection of Oral – Maxillofacial Regions(two times)

Characteristic of infection in oral – maxillofacial regions; Pericoronitis of the mandible
third molar.
Independent
Study
5 2 √
Chapter 6 Injury of Oral – maxillofacial Regions(two times)

Characteristic of oral – maxillofacial injury; Soft tissue injury treatment of oral –
maxillofacial regions; Tooth injury treatment; Maxillary and mandibular fracture.
204
Independent
Study
6 2 √
Chapter 7 Oral Tumors – Maxillofacial Regions

Common cyst; Benign tumor; Malignant tumor.
Independent
Study
7 2 √
1. Dental caries; Pulpitis; Periapical tissue diseases; 3 hours
2. Chronic simplex gingivitis; Simplex periodontitis; 3 hours
3. Tooth extraction; 3 hours
VI. Exam patterns
Closed-book exam；
Closed-book exam score counts for 100%; Regular assignments count for 0%; Practice
exam score counts for 0%.
Syllabus editor:
Syllabus Reviewer:
205
“Dermatology & Venereology” Course Syllabus
Course name: Dermatology & Venereology
Intended audience: five-year clinical medicine foreign students
Prerequisite courses: Diagnostics, immunology, microbiology, pathophysiology,
pharmacology, etc.
[1] Liu Tong, Zhao Enbing et al. editor. Dermato-venereology. Dean’s Office of Xi’an
Jiaotong University, 2004
[2] Thomas P. Habif. Clinical Dermatology.5th Ed. Elsevier Inc, 2010
[3] Illustrated Text Book of Dermatology - J.S. Pasricha
Type: Skin diseases are quite prevalent in the community and a large number of
patients visiting any hospital outpatient department come with complaints related to skin
diseases. Most skin diseases can be easily diagnosed and managed with adequate amount of
training. We have designed a comprehensive training syllabus for the foreign five-year
clinical medicine students in Dermatology & Venereology.
Purpose: Through classroom lectures, practical class and other forms of self-study, the
aim is to train the candidates to diagnose and manage common skin diseases.
During the training the students have a comprehensive teaching in dermatology and
sexually transmitted diseases in their training period.
A. The lecture in class will be as follows:
1. Causes, diagnosis, treatment and prevention of skin diseases 2 hours
2. Drug eruption and urticaria 2 hours
3. Impetigo and herpes zoster 2 hours
4. Tinea capitis, tinea manuum, tinea pedis and scabies 2 hours
5. Psoriasis and pityriasis rosea 2 hours
6. Definition and range of sexually transmitted diseases, syphilis, gonorrhea,
3 hours
nongonococcal urethritis and condyloma acuminata
B. View in outpatient will be as follows:
1. Basic lesions of dermatology & venereology and vehicles of tropical agents 3 hours
2. The 1st view in outpatient 3 hours
3. The 2nd view in outpatient 3 hours
4. The 3rd view in outpatient
3 hours
Watching the video of common cutaneous and venereal diseases
C. Examination
206
At the end of the training a candidate should be able to:
1. Perform a clinical examination and describe the cutaneous findings in a systematic
way appropriate to dermatology and venereology.
2. Diagnose and manage common skin diseases and sexually transmitted diseases.
3. To have a broad idea and approach in the management of common skin diseases and
sexually transmitted diseases.
4. To familiarize them with the common laboratory diagnostic skills which help in the
confirmation of diagnosis.
5. To develop a compassionate attitude towards the patients and their attendants.
IV. Course contents and schedule
Chapter 1: Causes, diagnosis, treatment and prevention of skin diseases
2. Basic lesions of dermatology & venereology
3. Vehicles of tropical agents
Independent
Study
1.1 1 1 0
1.2 1 1 0
1.3 1 1 1
Chapter 2: Drug eruption and urticaria

1．Drug eruption: Etiology, Clinical features, Diagnosis and Treatment.
2．Urticaria: Etiology, Clinical features, Diagnosis and Treatment.
Independent
Study
2.1 1 1 1
2.2 1 1 0
Chapter 3: Impetigo and herpes zoster

1．Impetigo：Etiology, Clinical features, Diagnosis and Treatment.
2．herpes zoster：Etiology, Clinical features, Diagnosis and Treatment.
207
Independent
Study
1 8 7 1 √ √
Chapter 4: Tinea capitis, tinea manuum, tinea pedis and scabies

1．Tinea capitis, tinea manuum, tinea pedis：Etiology, Clinical features, Diagnosis and
Treatment.
2．Scabies：Etiology, Clinical features, Diagnosis and Treatment.
Independent
Study
4.1 1.5 1 1
4.2 0.5 1 0
Chapter 5: Psoriasis and pityriasis rosea

1．Psoriasis：Etiology, Clinical features, Diagnosis and Treatment.
2．Pityriasis rosea：Etiology, Clinical features, Diagnosis and Treatment.
Independent
Study
5.1 1.5 1 1
5.2 0.5 1 0
Chapter 6: Definition and range of sexually transmitted diseases, syphilis,

gonorrhea, nongonococcal urethritis and condyloma acuminata
1. General outline of STD: Syndrome approach to the diagnosis and management of
sexually transmitted diseases.
2. Syphilis: Etiology, Clinical features, Diagnosis and Treatment.
3. Gonorrhea and nongonococcal urethritis: Etiology, Clinical features, Diagnosis and
Treatment.
4. Condyloma acuminata: Etiology, Clinical features, Diagnosis and Treatment.
208
Independent
Study
6.1-6.2 1 1 1
6.3-6.4 1 1 0
1. Basic lesions of dermatology & venereology, vehicles of tropical agents, 3 study
hours
2. The 1st view in outpatient, 3 study hours
3. The 2nd view in outpatient, 3 study hours
4. The 3rd view in outpatient, 3 study hours
Watching the video of common cutaneous and venereal diseases.

Cases with diseases like acne vulgaris, scabies, pyoderma, pediculosis, fungal infection
of skin, alopecia, sexually transmitted diseases, auto immune diseases, bullous disorders,
papulosquamous disease, etc. are demonstrated and discussed during the posting period.
VI. Exam patterns
Closed-book exam;
Theory Examination: Separate sheet examination having the dermatology questions, for
the evaluation of theoretical knowledge of candidates in dermatology and sexually
transmitted diseases.
Closed-book exam score counts for 80%; Regular performances count for 20%;
Syllabus editor: Mu Xin

Syllabus reviewer: Mou Kuanhou
209
“Psychiatry” Course Syllabus
Course name: Psychiatry
Prerequisite courses: Diagnostic medicine, Internal Medicine, Neurology
Type: Psychiatry is an important subject of clinic medicine. It teaches general
considerations, epidemiology, clinical findings, diagnostic criteria, treatment, prognosis, etc.
of mental illness. It teaches students how to interview people who have a mental illness.
Purpose: This program is designed to provide the students main ideas about psychiatry.
This program is designed to provide the students main ideas about psychiatry. The
students will learn about schizophrenia, mood disorders, organic mental disorders, anxiety
disorder, etc.
Chapter 1: Typical Signs and Symptoms of Psychiatric Illness Defined
DSM-IV classification of mental disorders ◎
Independent
Study
1.1 50 min 10 min
1.2 30 min 10 min
Chapter 2: Dementia, Delirium, and Amnestic Disorders

1．Organic mental disorder ◎
2．Dementia ◎
3．Delirium ◎
4．Amnestic disorders
210
Independent
Study
2.1 20 min 5 min
2.2 20 min 5 min
2.3 20 min 5 min
2.4 20 min 5 min
Chapter 3: Schizophrenia
1. General Considerations and Major Etiologic Theories
2. Epidemiology
3. Clinical Findings ◎
4. Diagnostic Criteria of DSM-IV ◎
5. Treatment ○
6. Prognosis and Course of Schizophrenia
Independent
Study
3.1 20 min
3.2 15 min
3.3 30 min 5 min
3.4 10 min
3.5 10 min
3.6 10 min
Chapter 4: Mood Disorders

1. Major Depressive Disorders ◎
2. Dysthymic Disorders
3. Bipolar Disorders ◎
4. Cyclothymic Disorder
Independent
Study
4.1 35 min 5 min
4.2 10 min
4.3 35 min 5 min
4.4 10 min
Chapter 5: Anxiety Disorders
211
1. Panic Disorder with or without Agoraphobia ◎
2. Phobic Disorders: Specific Phobia and Social Phobia ○
3. Generalized Anxiety Disorder ◎
4. Obsessive-Compulsive Disorder ○
5. Somatoform Disorders
Independent
Study
5.1 30 min 5 min
5.2 30 min 5 min
5.3 30 min 5 min
5.4 30 min 5 min
5.5 10 min
Chapter 6: Hysteria
1．Conversion Disorder ◎
2．Dissociative Disorders ◎
Independent
Study
6.1 40 min 10 min
6.2 40 min 10 min
1 ． Typical Signs and Symptoms of Psychiatric Illness, Organic mental disorder, 3
study hours
2．Schizophrenia, Mood Disorders, 3 study hours
3．Anxiety Disorders, Hysteria, 3 study hours
VI. Exam patterns
Closed-book exam；
Closed-book exam score counts for 100%; Regular assignments count for 0%;
Note: 1. The contribution levels of professional courses are determined according to the
professional requirements of knowledge and ability, and quality cultivation. The contribution
knowledge and ability, and quality cultivation.
212
2. Significant contribution levels are marked by ◎, and ordinary contribution levels are
marked by ○.
Syllabus Editor: Chen Ce

Syllabus Reviewer: Kang Wanhu
213
“Emergency Medicine” Course Syllabus
Course Name: Emergency Medicine
Intended audience: five-year forensic science students, foreign medical students
Prerequisite courses: Surgery; Internal medicine; Diagnostics; Medical imaging, Obstetrics and
gynecology; Pediatrics
[1] Wang Xue. Emergency Medicine, Xi’an Jiaotong university publishing company, 2007.
[2] T.R Krome. Emergency Medicine, World Book Publishing, Xi’an, 2008.
Type: Professional course. It is to enable medical students in clinical practice to be more proficient
in the diagnosis and treatment of common diseases encountered in emergency medicine.
Purpose: to study the etiology, pathology, diagnosis, and treatment of common clinical diseases
encountered in emergency medicine.
Emergency medicine is an emerging cutting-edge discipline involving a wide range of complex
content. Its main task is not only to provide timely medical treatment and clinical support for acutely ill
patients but also to monitor and treat critically ill patients requiring intensive care. More importantly,
emergency medicine is an important component of the emergency relief system, which is involved in
disaster relief (natural disasters and man-made disasters), terrorist attack control, and other similar life-
saving systems. Emergency medicine lecture topics include: cardiopulmonary resuscitation; coma
management; poisoning (including acute organophosphate poisoning; acute carbon monoxide poisoning);
multiple organ dysfunction syndrome; differential diagnosis for chest pain; emergency management for
trauma. Practical training includes: CPR; poisoning treatment; ICU; coma management, etc.
1. Know the principles of emergency diagnostic evaluation and the principles of first aid.
2. Know the principles of observation and treatment of the disease in emergency condition.
3. Show proficiency in the theory of cardiopulmonary resuscitation and performance in any situation.
Chapter 1: Introduction
1. Understand the historical development of emergency medicine and the importance of further
advancement.
2. Understand the similarities and differences between emergency medicine and other medical
specialties.
Independent
Study
1.1 1 1
214
Chapter 2: Cardiopulmonary resuscitation
1. Know the primary evaluation and treatment in cardiopulmonary resuscitation.
2. Know how to manage special situations in cardiopulmonary resuscitation.
3. Know the secondary evaluation and treatment in cardiopulmonary resuscitation; understand airway
management and principles of mechanical ventilation.
Independent
Study
2.1 1 1
2.2 2 1
2.3 2 1
Chapter 3: Coma Management

1. Know the conception of coma and can distinguish the different consciousness disorders.
2. Know the principles of coma treatment.
Independent
Study
3.1 1 1
3.2 1 1
Chapter 4: Multiple Organ Dysfunction Syndrome

1. Know the definition and characteristics of multiple organ dysfunction syndrome.
2. Understand the pathogenesis of multiple organ dysfunction syndrome.
3. Know the treatment principles for multiple organ dysfunction syndrome.
4. Know the principles of diagnosis and treatment of sepsis.
Independent
Study
4.1 √
4.2 0.5
4.3 1
Chapter 5: Differential Diagnosis for Chest Pain

1. Know the general conception of chest pain and can distinguish the different disorders of chest
pain.
2. Know the principles of chest pain treatment.
215
Independent
Study
5.1 0.5
5.2 √
Chapter 6: Acute poisoning

1. Know the definition of poisoning and common poisons.
2. Know the treatment principles for commonly encountered poisonings.
Independent
Study
6.1 1 1
6.2 1 1
6.3 1 1
6.4 1 1
6.5 √
6.6 √
Chapter 7: Environmental injuries

1. Understand the management for commonly encountered environmental and related injuries.
Independent
Study
7.1 √
7.2 √
7.3 √
7.4 √
7.5 √
7.6 √
Chapter 8: Trauma
1. Understanding the pathophysiological processes seen in trauma.
2. Know the common procedures used in treating trauma patients.
Independent
Study
8.1 √
8.2 1
8.3 1
Chapter 9: Disaster Relief
216
1. Learn about the management of patients during disasters.
Independent
Study
9.2 √
9.3 √
9.6 √
Chapter 10: Palpitations

1. Learn about the common clinical manifestations of arrhythmias.
2. Know the treatment for life-threatening arrhythmias.
Independent
Study
11.1 √
11.2 √
Chapter 11: Acute change in mental status

1. Learn the common causes of changes in mental status.
2. Be able to diagnose and give a differential diagnosis for the common diseases that lead to acute
mental status changes.
3. Know the principles of treatment for acute mental status changes.
Independent
Study
12.1 √
12.2 √
12.3 √
12.4 √
12.5 √
12.6 √
Chapter 12: Emergency Critical Care

1. Understand the types and purposes of emergency critical care.
2. Understand the indications for use of a mechanical ventilator and know the most commonly used
ventilation mode.
3. Understand the applications of and reference values for tests used in emergency situations.
217
Independent
Study
20.2 1
20.3 1
20.4 √
Chapter 13: Emergency examination and treatment techniques

1. Understand electric defibrillation, gastric lavage, and common methods of vascular access.
2. Understand and know the indications and contraindications of endotracheal intubation.
3. Be familiar with the parts and materials used in thoracentesis, paracentesis, and closed thoracic
drainage.
Independent
Study
21.1 √
21.3 √
21.5 1
1. Endotracheal intubation study 1 hour
2. Cardiopulmonary resuscitation study 1 hour
3. Emergency surgery study 1 hour
4. Chest pain and differential diagnosis study1 hour
5. Mechanical ventilator use study 1 hour
6. Gastric Lavage study 1 hour
7. ICU, study 1 hour
VI. Exam patterns
Closed-book exam；
Closed-book exam score counts for 80%; Regular assignments count for 10%; Clinical practical
exam score counts for 10%;
Syllabus editor: Wang Xue

Syllabus reviewer: Wang Xue
218

Foreign

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Foreign

Uploaded by

Copyright:

Available Formats

CONTENTS

“Traditional Chinese Medicine” Course Syllabus...............................................................1

Chapter 3: The theory of the 5-zangs and 6-fus.

Chapter 4: Theory of qi, body fluid and blood.

Chapter 5: Pathogenic factors

Chapter 6: Diagnostic methods of TCM

Chapter 8 General Introduction to Meridians

Chapter 9 General introduction to acupoints

Chapter 10 Meridians and points

Chapter 11: Manipulation Methods

Chapter 12: Acupuncture treatment

Chapter 13 General Introduction to Chinese Massage

Chapter 14 Acting Principle

Chapter 15 Therapeutic Principles of Reinforcement and Reduction in Chinese

Chapter 16 Commonly Used Manipulations in Massage

Chapter 17 Clinical Treatment with Chinese Massage

VI. Exam patterns

Syllabus Editor: Liu Yi

Section II: Interviewing

Section III: Common Symptoms

Section IV: Physical Examination

Section V: Ultrasonic examination

Section VI: Electrocardiogram

Section VII: Laboratory diagnosis

*: The contents should be familiar.

Syllabus Editor: Yan Lan

Chapter two: BASIC SIGNS

Chapter three :TRAUMA OF THE SKELETON

Chapter four INFECTIONS OF BONE

Chapter five BONE TUMORS

Classroom time distribution Outside classroom

Syllabus editor: Qiang Yongqian

Classroom time distribution Outside classroom

Chapter two: Basic Disorder X-ray Signs of Respiratory System

Classroom time distribution Outside classroom

Classroom time distribution Outside classroom

Syllabus editor: Niu Gang

IV. Course Content and Schedule

Classroom time distribution Outside classroom

Chapter 2 The Gastrointestinal Tract

Classroom time distribution Outside classroom

Syllabus editor: Xu Guiping

Syllabus editor: Jing Chengwang

IV. Course Content and Schedule

IV. Methods of Instruction

Classroom time distribution Outside classroom

Syllabus editor: Xu Guiping

Classroom time distribution Outside classroom

Syllabus editor: Rong Wang

Classroom time distribution Outside classroom

Syllabus editor: Yuelang Zhang

Classroom time distribution Outside classroom

Chapter 2: MRI Diagnosis in abdomen

Classroom time distribution Outside classroom

Chapter 3: MRI Diagnosis in chest

Syllabus editor: Jian Yang

I. Course Type and Purpose

Chronic obstructive pulmonary disease (COPD)

Chronic Cor Pulmonale

Chapter 4: Cardiovascular Disorders

Classification of Common Arrhythmias

B. Diagnosis of the arrhythmias

Chapter 6 Disorders of Urinary System

Syllabus Editor: Yan Lan