临床医学专业04级八年制内科学教案

临床医学专业04级八年制《内科学》教案

姓 名 授课题目 授课班级 胡必杰 业务职称 肺炎pneumonia 2004级八年制班 教授 聘任授课职位 学时数 授课日期 授课教授 2 2007年9月 一、教学目的（掌握、熟悉、了解的具体内容） Objectives To understand the definition, classification (mainly community-acquired pneumonia and hospital-acquired pneumonia), common etiological pathogens, pathology, clinical manifestation, X-ray and CT imaging, clinical and etiological diagnosis, antimicrobial therapy and prevention of pneumonia. Contents Requested points: 1. Definition and classifications of pneumonia: including community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP) or nosocomial pneumonia (NP), typical and atypical pneumonia, immune-compromised host pneumonia, ventilator associated pneumonia (VAP). 2. Common etiologic agents of CAP and HAP 3. Clinical manifestation, X-ray and CT imaging 4. Main points for clinical diagnosis, differential diagnosis, methods for etiological diagnosis 5. Principal of antimicrobial therapy Understand: 1. Pathogenesis, focus on possible routes of CAP 2. Pathogens of atypical Pneumonia 3. Criteria for severe community acquired pneumonia 4. Main points of etiologic pathogens and antibiotic choice for 6 CAP groups (I, II, IIIa, IIIb, IVa, IVb) 5. Main items for prevention of HAP 二、执行方案： (一) 内容及时间分配 1．Epidemiology and definition of pneumonia 5min 2．Classifications & Terminology 6min 3．Pathogenesis, pathophysiology and pathology 6min 4．Epidemiology and pathogens of CAP 8min 5．Manifestation and General Lab Examinations of CAP 10min 6．Clinical and microbiological diagnosis of CAP 10min 7．Treatment of CAP 10min 8．Prophylaxis for CAP 2min 8．Epidemiology and pathogens of HAP 8min 9．Pathogenesis and risk factors of HAP 5min 10．Etiological pathogens of HAP 7min 11．Diagnosis and differential diagnosis of HAP 5min 12．Antibiotic treatment and prevent of HAP 8min (二)重点和难点 1．Classifications of pneumonia 2．Characteristics of CAP and HAP 3．Microbiological diagnosis of pneumonia 4．Main points of etiologic pathogens and antibiotic choice 5．Possible routes for microorganisms from outside to the lung (三)中文和英文关键词 社区获得性肺炎Community Acquired Pneumonia 医院内肺炎Nosocomial Pneumonia OR Hospital Acquired Pneumonia 呼吸机相关肺炎Ventilator Associated Pneumionia 大叶性肺炎Lobar (segmental) Pneumonia 节段性肺炎 segmental Pneumonia 小叶性（支气管肺炎）lobular （bronchopneumonia) Pneumonia 间质性肺炎Interstitial Pneumonia 非典型肺炎Atypical Pneumonia 免疫功能受损宿主肺炎Immune-compromised Host Pneumonia (ICHP) 细菌，病毒，真菌，寄生虫 Bacterial, viral, fungal, parasitic 肺炎链球菌Streptococcus pneumoniae 青霉素不敏感肺炎链球菌Penicillin-Nonsensitive Streptococcus Pneumoniae 流感嗜血杆菌Haemophilus influenza 甲氧西林敏感金黄色葡萄球菌methicillin-sensitive staphylococcus aureus,MSSA 甲氧西林耐药金黄色葡萄球菌methicillin-resistance staphylococcus aureus, MRSA 肺炎克雷伯杆菌Klebsiella Pneumoniae 大肠埃希杆菌Escherichia coli 肠杆菌属,变形杆菌,沙雷菌Enterobacter, Proteus, Serratia 铜绿假单胞菌Psuedomonas aeroginosa 不动杆菌Acinetobacter 厌氧菌Anaerobic bacteria 肺炎衣原体Chlamydia Pneumoniae 分枝杆菌Mycobacterium 肺炎链球菌肺炎Pneumococcal Pneumonia 金葡菌肺炎Staphylococcal Pneumonia 克雷伯杆菌肺炎Klebsiella Pneumonia 支原体肺炎Mycoplasma Pneumonia 军团菌肺炎Legionella Pneumonia 肺孢子菌肺炎 Pneumocystis pneumonia （PCP） 经气管穿刺吸引Transtracheal aspiration （TTA） 气管内吸引Endotracheal aspiration （ETA） 防污染双套管毛刷Protected specimen brush （PSB） 支气管肺泡灌洗Bronchial alveolar lavage （BAL） 经胸壁肺穿刺吸引Lung aspiration （LA） 细胞学筛查Cytological screening 抗菌药物Antimicrobial Agents 青霉素G penicillin G, 苯唑西林Oxicillin 阿莫西林/克拉维酸Augmentin,氨苄西林/舒巴坦ampicillin/sulbactam 头孢菌素（头孢唑啉，头孢呋辛，头孢曲松）cephalosporins 大环内酯类（红霉素,阿奇霉素，克拉霉素）Macrolide（erythromycin, Azithromycin, Clarithromycin） 氨基糖苷类（阿米卡星）Aminoglycoside （amikacin） 四环素（强力霉素）Tetracycline（Doxycycline） 克林霉素clindamycin 氟喹诺酮类（左氧沙星、莫西沙星、加替沙星）Fluroquinolone (levofloxacin, moxifloxacin, gatifloxacin) 碳青霉烯类carbepenem 万古霉素Vancomycin (四)复习和思维题（请用英文出两道选择题，一道简答题。） 1. Which one is most suitable choice for treating pneumonia caused by MRSA among the 2. Which description about Pneumococcal pneumonia is wrong? A．generally occurs sporadically but most frequently in winter 3. Describe the main methods that might be used for microbiological diagnosis of pneumonia. 三、参考书及文献目录 1．Harrison’s Principle of internal medicine. - 16th Ed. (2005) 2．《实用内科学》陈灏珠主编，人民卫生出版社2005，第12版

B．the most common identifiable cause of bacterial pneumonia C．accounts for 2/3 of bacteremic CAP D．most commonly in persons at age extremes E．almost no healthy persons are carriers of pneumococci following antimicrobial agents? A．Oxicillin B．Ampicillin/sulbactam C．1st cepholasporins D．3rd cepholasporins E．Vancomycin

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