€¦ · web view课程名称：病理生理学 . 课程时间：第4学期. 课程安排:...

1．课程简介课程名称：病理生理学课程时间：第 4 学期课程安排: 总课时数 54

科目授课学时数理论课 39

实验 15

总课时 54

课程简介：病理生理学作为天津医科大学 211 院校的国家级留学品牌课程

和国家级双语示范课程，课程培养的目标是培养掌握基础知识与基础理论、具有基本实验技能、具有分析与解决问题能力和开拓创新精神的高素质医学留学生。病理生理学研究疾病的发生、发展和转归的规律及其机制，它的内容主要包括：总论、基本病理过程和各系统器官病理生理学三个部分。病理生理学是基础医学和临床医学的桥梁学科，不仅在基础医学和临床各学科起到“桥梁”的作用，而且与多学科密切交叉，它从功能和代谢的角度，解释疾病的本质和基本原理，实验病理生理学通过复制人类疾病的动物模型，根据病因和发病机制进行实验治疗，提高学生的动手能力和独立思考和分析综合

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能力。课程使学生全面地认识和揭示疾病的本质，理解疾病发展过程中机体的机能、代谢变化与临床表现之间的内在联系，为疾病的防治提供理论和实验依据，在留学生医学教育中起着非常重要的作用。COURSE INTRODUCTION

Name of Course: Pathophysiology

Time of Course: The 4th semester

Curriculum arrangement: Total teaching hours 54

Subject Teaching hours

Lecture 39

Experiment 15

Total 54

COURSE DESCRIPTION:

As the National Brand Course in China for International Students in English and

the national excellent bilingual model course, the aim is to develop the students’

abilities of mastering the basic medical knowledge and theory, to train their

experiment skills and competence in analyzing and solving problems and creation.

Pathophysiology is a discipline to investigate the mechanisms of the occurrence,

development and prognosis of the disease. The main content of pathophysiology

includes three parts----- the general introduction to pathophysiology, the basic

pathological process of disease and the substantial systematic pathophysiology.

Pathophysiology functions as a bridge between the basic medicine and the clinical

medicine. It keeps the cross relationship with many disciplines. In addition, it explains

the essence and the basic principle of disease from the aspect of function and

metabolism. Specifically, by means of animal model, the curriculum of

pathophysiological experiments could improve the students’ abilities of operation,

thinking independently, analysis and comprehension. This curriculum helps students

understand the essence of disease deeply and thoroughly and the inherent relation

between the change of function and metabolism of human body. Moreover, it provides

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some theoretical and experimental evidence to prevent disease. Therefore,

pathophysiology plays a key role in the medical education for overseas students.

2. 教学大纲

Syllabus of Pathophysiology

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Department of Pathophysiology

2014.4

Syllabus of Pathophysiology

(For International Students)

PREFACE

This syllabus is based on the outline of Pathophysiology teaching for international

medical students. The overall objective of this curriculum is to provide the basic

principles of Pathophysiology. Total credit hours of Pathophysiology are 54. The

credit hours of lecture are 39.

THEORY

CONSPECTUS OF DISEASE

OBJECTIVES

The course enables candidates to

1. Understand the purpose of learning pathophysiology.

2. Understand the characteristics of pathophysiology and the methods of studying.

3. Master the concept and causes of disease.

4. Master the general rules for pathogenesis of disease and the process of disease.

COURSE CONTENTS

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1. Complex nature of disease

(1) Concepts of disease

(2) Disease as abnormal state

(3) Disease as incapacitating state

(4) Health and disease

2. Pathophysiologic processes

(1) Etiology

(2) Pathogenesis

(3) Clinical manifestations

(4) Implications for treatment

(5) Future possibilities

ALTERATIONS IN FLUID, ELECTROLYTE HOMEOSTASIS

OBJECTIVES


1. Master the distribution, the homeostasis and the regulation mechanism of body

fluid.

2. Master the characteristics, the effects on body, and clinical manifestations of 3

types of dehydration.

3. Master the concept, the causes and the clinical manifestations of water

intoxication.

4. Be familiar with the causes, the effects, and the therapeutic principles of

dehydration.

5. Master the causes and effects on body and on heart of hypokalemia and

hyperkalemia.

6. Be familiar with the metabolic process of potassium.

7. Be familiar with the disorders of the metabolism of magnesium, calcium and

phosphorus.

COURSE CONTENTS

1. Body fluid homeostasis

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2. Fluid imbalances

3. Principles of electrolyte homeostasis

4. Electrolyte imbalances

(1) Disorders of sodium and water metabolism

① Hypotonic dehydration

② Hypertonic dehydration

③ Isotonic dehydration

(2) Disorder of potassium metabolism

① Normal potassium metabolism

Internal potassium distribution

Regulation of potassium homeostasis

Physiological function of potassium

② Disorders of potassium metabolism

Hypokalemia and potassium deficiency

Hyperkalemia

EDEMA

OBJECTIVES


1. Master the mechanism of edema.

2. Master the classification and mechanism of brain edema.

3. Be familiar with the mechanisms of heart edema, hepatic edema, and renal

edema.

4. Understand the effects and therapeutic principle of edema.

COURSE CONTENTS

1. Concept and classification

2. Formation of tissue fluid

3. Mechanism of edema

(1) Formation of tissue fluid exceeds regurgitation of tissue fluid

① Rise of hydrostatic pressure in capillary

② Decrease of plasma colloid osmotic pressure

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③ Increase of capillary permeability

④ Decrease of lymphatic return

(2) Retention of sodium and water

① Decrease of glomerular filtration rate

② Increase of reabsoption of sodium and water in renal tubules

③ Glomerulotubular imbalance

4. Heart edema, hepatic edema, and renal edema

5. Brain edema

(1) Concept of brain edema

(2) Classification and clinical manifestation

① Vasogenic brain edema

② Cytotoxic brain edema

③ Interstitial brain edema

6. Therapeutic principle

ALTERATIONS IN ACID-BASE HOMEOSTASIS

OBJECTIVES


1. Be familiar with the regulation of acid-base balance.

2. Master the parameters and its significance in acid-base disorders.

3. Master the causes, the compensatory processes, and the effects of 4 types of acid-

base disorders.

4. Understand the therapeutic principle.

COURSE CONTENTS

1. Acid-base homeostasis

(1) Buffers

(2) Respiratory contribution

(3) Renal contribution

2. Parameters

(1) pH

(2) PCO2

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(3) CO2CP

(4) SB

(5) AB

(6) BB

(7) BE

(8) AG

3. Acid-base imbalances

(1) Metabolic acidosis

① Etiology

② Classification

③ Compensation

④ Changes of acid-base parameters and electrolytes

⑤ Alterations of metabolism and function

⑥ Principles of prevention and treatment

(2) Respiratory acidosis

① Etiology

② Compensation

③ Changes of acid-base parameters and electrolytes

④ Alterations of metabolism and function

⑤ Principles of prevention and treatment

(3) Metabolic alkalosis

① Etiology

② Classification

③ Compensation

④ Changes of acid-base parameters and electrolytes

⑤ Alterations of metabolism and function

⑥ Principles of prevention and treatment

(4) Respiratory alkalosis

① Etiology

② Classification and compensation

③ Changes of acid-base parameters and electrolytes

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④ Alterations of metabolism and function

⑤ Principles of prevention and treatment

(5) Mixed acid-base imbalances

① Respiratory acidosis and metabolic acidosis

② Respiratory alkalosis and metabolic alkalosis

③ Respiratory acidosis and metabolic alkalosis

④ Metabolic acidosis and respiratory alkalosis

⑤ Metabolic acidosis and metabolic alkalosis

SHOCK

OBJECTIVES


1. Understand the classification and etiology of shock.

2. Master the changes of microcirculation and the alterations of factors during

shock.

3. Master the effects of shock.

4. Master the characteristics and therapeutic principle of hypodynamic shock and

hyperdynamic shock.

5. Master the pathological changes of shock lung.

COURSE CONTENTS

1. Classification

(1) Etiology

(2) Hypovolemic shock, vasogenic shock, and cardiogenic shock

(3) Hypodynamic shock and hyperdynamic shock

2. Mechanism

(1) Disturbance of microcirculation

① Ischemic anoxia stage (compensatory stage)

② Stagnant anoxia stage (decompensatory stage)

③ Microcirculatory failure stage (Disseminated intravascular coagulation stage)

(2) Factors

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① Catecholamine

② Angiotensin II

③ Antidiuretic hormone

④ Thromboxane A2

⑤ Myocardial depressant factor

⑥ Endothelin

⑦ Histamine

⑧ Kinin

⑨ Endorphin

3. Clinical manifestations

4. Alterations of functions of inner organs

5. Alterations in metabolism

6. Treatment

DISSEMINATED INTRAVASCULAR COAGULATION (DIC)

OBJECTIVES


1. Master the concept of DIC.

2. Master the clinical manifestation and the mechanism of bleeding in DIC.

3. Master the mechanism of DIC

4. Be familiar with the promoting causes and causes of DIC.

COURSE CONTENTS

1. The process of coagulation

2. Evaluation of coagulation

3. Coagulation disorders

4. Mechanism

(1) Damage of endothelium of the vessel widely, activating intrinsic coagulation

system

(2) Release tissue factor into blood, activating extrinsic coagulation system

(3) Destruction of blood cells

(4) Disorders of microcirculation

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(5) Formation of immunocomplex

(6) Other agglutinant released into blood

5. Promoting causes：(1) Impairment in reticulo-endothelial system

(2) Disturbance of hepatic function

(3) Hypercoagulability state

(4) Microcirculation disturbance

(5) Anoxia and acidosis

(6) Over dose of antifibrinolysis agent

6. Stages

(1) Hypercoagulation

(2) Consumptive hypocoagulation

(3) Secondary hyperfibrinolysis

7. Effects and clinical manifestations

(1) Bleeding

(2) Shock

(3) Multiple organs failure

(4) Microangiopathic hemolytic anemia

8. Treatment

HYPOXIA

OBJECTIVES


1. Master the concept of hypoxia.

2. Master the etiology and classification of hypoxia.

3. Master the mechanisms and characteristics of hypoxia.

4. Be familiar with the alterations of metabolism and function during hypoxia.

5. Understand the prevention and treatment.

COURSE CONTENTS

1. Parameters of blood oxygen

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(1) Partial pressure of oxygen

(2) Oxygen capacity

(3) Oxygen content

(4) Oxygen saturation

2. Classification, etiology and mechanisms of hypoxia

(1) Hypotonic hypoxia

① Etiology and mechanisms of hypotonic hypoxia

② Characteristics of blood O2

(2) Hemic hypoxia

① Etiology and mechanisms of hemic hypoxia


(3) Circulatory hypoxia

① Etiology and mechanisms of circulatory hypoxia


(4) Histogenous hypoxia

① Etiology and mechanisms of histogenous hypoxia


3. Alterations of metabolism and function in the body

(1) Alterations of respiratory systems

① Compensatory response

② Injury manifestation

(2) Alterations of circulatory systems



(3) Alterations of hematologic systems



(4) Alterations of central nerve systems

(5) Alterations of tissues and cells


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4. Pathophysiological basis of prevention and treatment

RESPIRATORY FAILURE

OBJECTIVES


1. Master the etiology of respiratory failure.

2. Master the mechanism of pulmonary encephalopathy.

3. Be familiar with the effects of respiratory failure.

4. Understand the mechanism of acute respiratory distress syndrome (ARDS).

COURSE CONTENTS

1. Acute respiratory failure

(1) Classification

(2) Etiology

① Disorders of restriction ventilation and obstruct ventilation

② Dysfunction of gas exchange

③ Mismatch of ventilation/perfusion

(3) Changes of function and metabolism

① Acid-base imbalance

② Changes of respiratory system

③ Changes of central nervous system

④ Changes of circulatory system

⑤ Changes of urinary system


① Diagnosis

② Treatment

2. Adult respiratory distress syndrome

(1) Etiology

(2) Pathogenesis


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(4) Diagnosis

(5) Treatment

HEART FAILURE

OBJECTIVES


1. Master the pathogenesis of heart failure.

2. Master the mechanism of dyspnea during heart failure, the mechanism of

paroxysmal nocturnal dyspnea and orthopnea.

3. Master the cardiac compensation during heart failure.

4. Be familiar with the hemodynamic changes of heart failure.

5. Understand the causes and promoting causes of heart failure.

COURSE CONTENTS

1. Etiology and classification

2. Promoting causes

3. Compensatory mechanisms

(1) Cardiac compensation

(2) Systemic compensation

4. Pathogenesis

(1) Decreased myocardial contractility

(2) Diastolic dysfunction

(3) Altered signal transduction

(4) Excessive cardiac hypertrophy

5. Changes of function and metabolism

(1) Changes of circulatory system

(2) Changes of respiratory system

(3) Changes of digestive system

(4) Changes of urinary system

(5) Acid-base imbalance

6. Clinical manifestations

A. Left heart failure

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B. Right ventricular failure

7. Pathophysiologic basis of prevention and treatment

HEPATIC ENCEPHALOPATHY

OBJECTIVES


1. Master the pathogenesis of hepatic encephalopathy: the theory of ammonia

intoxication, the theory of false neurotransmitters and the theory of amino acid

imbalance.

2. Be familiar with the causes of hepatic encephalopathy.

3. Be familiar with the effects on body during hepatic insufficiency.

COURSE CONTENTS

1. Hepatic insufficiency

(1) Metabolic disorders

(2) Disorders in production of bile salts and elimination of bilirubin

2. Hepatic encephalopathy

(1) Etiology and classification

(2) Pathogenesis

① Ammonia intoxication theory

② False neurotransmitters theory

③ Amino acid imbalance theory

(3) Precipitating factors of hepatic encephalopathy

(4) Prevention and principle of treatment

(5) Hepatorenal syndrome

RENAL FAILURE

OBJECTIVES


1. Master the etiology and pathogenesis of acute renal failure.

2. Master the changes of 3 stages of acute renal failure.

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3. Be familiar with the causes and mechanism of chronic renal failure.

4. Be familiar with the effects of uremia.

COURSE CONTENTS

1. Acute renal failure

(1) Etiology and classification

① Prerenal acute renal failure

② Intrarenal acute renal failure

③ Postrenal acute renal failure

(2) Pathogenesis

(3) Clinical phases

(4) Alterations of metabolism and function

① Urinary abnormalities

② Water and electrolytes imbalance

③ Acid-base imbalance

(5) Pathophysiological basis of prevention and treatment

2. Chronic renal failure

(1) Etiology and pathogenesis

(2) Alterations of metabolism and function

① Disorders of urine

② Disorders of water and sodium balance

③ Disorders of potassium balance

④ Metabolic acidosis

⑤ Renal azotemia

⑥ Renal hypertension

⑦ Calcium, phosphate and bone metabolism

⑧ Renal anemia and bleeding tendency

3. Uremia

(1) Etiology and pathogenesis

(2) Alteration of metabolism and function

① Neuromuscular abnormalities

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② Cardiovascular and pulmonary abnormalities

③ Hematological abnormalities

④ Gastrointestinal abnormalities

⑤ Endocrine and metabolic abnormalities

⑥ Dermatologic abnormalities

⑦ Immunologic abnormalities

(3) Pathophysiological basis of prevention and treatment

ISCHEMIA REPERFUSION INJURYOBJECTIVES


1. Learn the concepts and mechanisms of ischemia reperfusion injury

2. Understand the effects of ischemia reperfusion injury on the vital organs.

COURSE CONTENTS

1. The concept of ischemia reperfusion injury, causes and governing factors

2. The mechanism of ischemia reperfusion injury

3. The effects on the vital organs

4. Developments in ischemia reperfusion injury

PRACTIALS

VIRTUAL EXPERIMENT—PULMONARY EDEMA

OBJECTIVES


(1) To learn how to create an animal model of pulmonary edema.(2) Observe the manifestations of pulmonary edema and understand the mechanisms

COURSE CONTENTS

1. Animal: Rabbit (virtue)

2. Requirements: Independent learning and answer questions

(1) What is the definition of pulmonary edema ?.

(1) To learn how to create an animal model of pulmonary edema.

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(2) What are the roles of adrenalin?

(3) How to catch and hold the rabbit?

(4) How to judge the anesthesia of the rabbit is satisfied ?.

(5) How to do tracheal intubation?

(6) How to calculate the pulmonary coefficient? What is the normal range ?.

(7) What are the manifestations of pulmonary edema?

EDEMA

OBJECTIVES


1. Master the method of establishing an animal model of edema.

2. Master the effects of plasma colloid osmotic pressure during edema.

3. Be familiar with the method of preparing an infusion device.

COURSE CONTENTS

1. Animal: Toad

2. Requirements

(1) Prepare an infusion device.

(2) Destroy the cerebrospinal cord.

(3) Prepare the rear limbs of toad.

(4) Inject heparin into a vein to prevent coagulation.

(5) Infuse a solution which only contains electrolytes to dilute blood to decrease the

plasma colloid osmotic pressure via an artery.

(6) Observe the effects of the decrease of plasma colloid osmotic pressure during

edema.

(7) Observe the changes of weight and appearance during edema.

(8) Use plasma to treat this type of edema.

HYPOXIA

OBJECTIVES


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1. Master the method of establishing the animal models of hypoxia caused by

oxygen deficiency or carbon monoxide poisoning.

2. Master the mechanisms of hypoxic hypoxia and hemic hypoxia.

3. Be familiar with the clinical manifestations during hypoxia.

COURSE CONTENTS

1. Animal: Mouse

2. Requirements

(1) Connect an oxygen consumption device.

(2) Establish an animal model with hypotonic hypoxia.

(3) Observe the clinical manifestations during hypoxia, such as cyanosis, respiratory

rate, etc.

(4) Calculate the amount of oxygen consumption.

(5) Produce carbon monoxide and create the animal with CO intoxication.

(6) Observe the manifestations during CO intoxication.

(7) Use oxygen to treat CO intoxication.

(8) Take blood from the canthus using glass capillary tube.

HEMORRHAGIC SHOCK

OBJECTIVES


1. Master the method of establishing an animal model of hemorrhagic shock.

2. Master the manifestations and changes of microcirculation during hemorrhagic

shock.

3. Be familiar with the process and mechanism of hemorrhagic shock.

4. Understand the therapy of hemorrhagic shock.

COURSE CONTENTS

1. Animal: Rabbit

2. Requirements

(1) Induce general anesthesia using urethane.

(2) Insert a ‘Y’ tube into trachea.

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(3) Insert a tube into the external jugular vein.

(4) Insert a tube into the common carotid artery.

(5) Measure the arterial blood pressure, heart rate and respiration rate.

(6) Withdraw blood from the artery to induce hemorrhagic shock.

(7) Observe the mesenteric microcirculation during this process.

(8) Transfuse via a vein.

(9) Observe the microvascular effect of norepinephrine.

HYPERKALEMIA AND TREATMENT

OBJECTIVES


1. Master the method of establishing an animal model of hyperkalemia

2. Master the treatment for hyperkalemia

COURSE CONTENTS

1. Animal: Rabbit

2. Requirements

(1) Induce general anaesthesia

(2) Intravenous injection

(3) Observe and record ECG (electrocardiogram)

(4) Induce hyperkalemia by infusion of 5% KCl and observe the change of ECG

(5) Treat hyperkalemia by infusion of 5% CaCl2 and observe the change of ECG

(6) Observe the condition and size of the heart

3. 教学方法

3.1 能根据课程内容和听课学生的背景和特点，灵活运用多种恰当的教学方法，有效调动学生学习积极性，促进学生学习能力发展。

对尚无任何临床与科研经验的医学院校的在读留学生而言，由

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于初次接触、内容抽象，不能很好地将所学的病理生理学基础理论知识中的规律与机制和临床病例、科学实验研究的进展相互联系起来，因而往往是理解困难、死记硬背，不易引起和激发学生自主学习的积极性，学习效率不高。我们尝试根据教学内容的重点和难点，灵活运用多种恰当的教学方法，有效调动学生学习积极性，促进学生学习能力发展，同时将基础性、研究性、前沿性，和学科最新发展成果、新版国外教材的教学理念和教改教研成果引入教学。

课堂启发讨论式互动教学：加强师生互动的教学;采用启发式教学方法。开展问题式学习、教学方法的研究与实践，较好地调动了学生学习的积极性，促进、激发学生积极思考，突出重点，及时做好小结注重学生的动手能力和解决问题能力的培养，提高留学生的素

质和培养团队精神。改革传统授课方式，增加与临床病例相结合的自主学习教学，

与临床病例结合进行实验目的教学，建立疾病动物模型，进行机制研究。激发学生的学习兴趣。采用临床、科学实验相结合的病理生理学教学模式，灵活展开教学内容，以真正提高教学效率。利用病例教学，使病理生理理论教学具有明确的目标性、深刻的启发性、突出的实践性、充分的自主性和较强的综合性，培养和提高医学留学生分析和解决实际问题的能力、深化医学临床课教学改革，提高教学质量。

采用我们自编的留学生专用实验教材和习题集供学生复习使用。用“激励法”评价学生实验表现，利用与评分相结合的鼓励机

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制及各个关键环节，将其出勤、实验操作、实验报告和值日等情况与实验课成绩挂勾，并通过鼓励的方式反映到学生的成绩中，注重学生的动手能力和解决问题能力的培养。3.2 恰当充分地使用现代教育技术手段开展教学活动，并在激发学生学习兴趣和提高教学效果方面取得实效。随着科学进步与发展，知识信息量庞大，而教师的授课时间有

限，必须从过去传授知识转变为指导学生掌握本学科基本理论和技能的方式，使学生们具备自主学习，自主获取知识的能力，将他们由被动接受知识改为主动学习者，并树立自主学习，终身学习的理念。我们同时也更加注意课堂上重点和难点的概括，专业英语的培养，有关知识点的最新进展的介绍。恰当充分地使用现代教育技术手段开展教学活动，完善精品课程网络，开展网络课程建设，建立教师教学信箱，方便学生自主学习。

由于来华留学生受到宗教、文化背景等因素影响，对于动物实验普遍存在反感或畏惧。在确保基本技能基本操作能够完成的基础上，我们和相关研发公司合作，将虚拟机能实验平台进行了改版和补充，增加了英文版的虚拟实验平台，方便了外国留学生的实验教学。机能学实验建立了无线局域网平台，学生可通过这个平台实现提交实验报告、完成实验考试等实验内容。该实验室还自主开发了计算机辅助机能实验考试系统，不仅节约了实验资源、还提高了考试效率。机能实验室建立的基于网络的虚拟机能实验平台，涵盖了机能学实验 53

项实验内容，学生可完全实现实验预习、自主学习等学习过程。这项22

工作还在进行之中，争取不断完善，使其进一步适应来华留学生的实验教学。同时，开展虚拟实验教学也适应国际上提出的“3R”理论，即在医学实验，特别是教学实验中，提倡“减少使用实验动物 reduce，替代动物尽量选择非动物实验 replacement 和优化动物实验 refinement.上述方法激发了学生学习兴趣，提高了留学生教学的教学效果，为适应培养具有创新精神的高水平医学留学生创造了良好条件。3.3 重视学习过程管理，采用多种方式检查学生学习情况，注意巩固学生学习成果，适时安排平时测验和考试。

重视学习过程管理，采用多种方式检查学生学习情况，注意巩固学生学习成果。我们用“激励法”评价学生实验表现，利用与评分相结合的鼓励机制，调动学生的学习和探索积极性。由于留学生的知识水平有很大差异，有些比较积极，善于思考，动手能力强; 而有些学习积极性差，上课迟到、不积极参与手术、实验后不清理器械和实验室卫生等。为鼓励留学生积极参与实验，培养团队合作和良好的实验习惯，我们尝试利用分数评价相关的“☆”来评价学生整个实验的表现，包括准时出勤、实验操作、讨论、报告书写、甚至打扫实验室卫生，表现好的同学均可得到一个“☆”，作为最终评价实验分数的参考。就拿上课迟到来说，为鼓励同学准时出勤，在上课前教师为每一位准时出勤的同学画一个“☆”，当上课铃声响后，教师停止记录考勤，准时上课，这时如果有迟到的同学，不论如何辩解，我们都会告诉同学: “☆”是对准时上课的同学的鼓励，请下次上课准时。

23

这样，在第二次实验课时，迟到现象消失，学生的学习状态也明显改善。我们还将类似的评价方法应用于实验的全部过程以及各个关键环节，将其出勤、实验操作、实验报告和值日等情况与实验课成绩挂勾，并通过鼓励的方式反映到学生的成绩中，有助于调动留学生的学习积极性。

我们注重实验过程评价包括实验态度评价（占 10%）、实验操作评价（占 20%）、实验报告评价（占 20%）。总结性评价包括实验操作考核（占 40%）和实验理论考核（占 10%）。病理生理学实行理论考试和实践考试相结合。注重学生的动手能力和解决问题能力的培养和评价；对于优秀的留学生作业，在学生中予以表扬，分析其优点，并在学生中鼓励讨论和积极动脑筋分析报告和查阅资料，提高学生分析问题解决问题的能力，并适时安排平时测验和考试。

TEACHING METHODS

According to the course content and the background of international

students, a variety of teaching methods were used to effectively mobilize

students’ learning enthusiasm, and elevate their learning abilities in

pathophysiology.

Pathophysiology serves as a bridge between basic medicine and clinical

medicine. Because college students in their third year have no clinical and research

experience yet when they begin to learn pathophysiology, it is hard for them to

understand the etiology and mechanisms of pathophysiology. In order to improve the

teaching quality ， teachers in the department of pathophysiology have explored

several methods for their teaching, including introducing to students related clinical

cases, evaluations related to the encouragement on students’ performances in the

class, interactive teaching and discussion．It is found that these explorations are not

24

only welcomed by international students，but also improved our teaching quality at

the same time.

--Heuristic teaching method and problem-based learning (PBL) were used in our

teaching in order to stimulate students’ interests.

--We pay attention to cultivation of students’ practical ability, problem-solving

ability, and the teamwork spirit as well.

--In contrast to traditional teaching methods, we combined clinical case and

experimental disease model with theoretical pathological teaching and independent

learning. With clinical cases and experimental results analysis, medica1 students

became more and more interested in understanding and learning the basic theories in

pathophysiology． This teaching method effectively stimulates students’ learning

interest, and improves their analysis ability as well as problem solving ability. It is

good for their studying theories in pathophysio1ogy and elevating the clinical and

basic research ability of medical students.

--Self-composed textbook, guide book on experiment, and exercise books were used

for international students to help them better understand the main points of

pathophysiology. With the development of science and technology, knowledge

advances at a fast pace. So the ideas of the newest edition of pathophysiology

textbooks were incorporated into the pathology education. In addition to the basic

knowledge of pathophysiology, we also introduced the knowledge of the most recent

advances.

--Evaluations related to the encouragement on students’ performances were used.

Evaluations including attendance, performance of students during the experiment,

experiment report and instruments and lab cleaning. We focused on cultivating

practice ability and problem-solving ability of international students, so that every

international student would try their best and take part in the practice class of the

course.

Make full use of modern educational technology in teaching and learning

activities, which is effective to stimulate students’ learning interest.

We make full use of modern educational technology in teaching and learning

activities, and improve the quality of curriculum network; so teachers can leave their

25

e-mail box to the students after class in order to facilitate students’ self-directed

independent learning.

Because of the influence of the factors such as religion, cultural background et

al, some of the international students are afraid of doing experiments on animals.

Disgust or fear often occurs. We are developing an English version of internet based

functional experimental virtual platform by cooperating with companies. The internet

based functional laboratory covers 53 experiments so that students can complete self-

directed learning, hand in their experimental reports, and complete the experimental

examination on this platform. This work is still in progress. Its advantage lies in the

“3R”, that is, reducing the usage of experimental animals; selecting non-animal

experiment for replacement; and optimizing animal experiment refinement.

Emphasizing on the process learning, checking students’learning efficiency,

and timely arranging quiz or test to evaluate students’ performance.

To foster teamwork and good laboratory practice, we tried to use score

evaluation-related " " to evaluate students’ performance throughout the experiment,☆

including on-time attendance, experimental operations, experiment report, and

laboratory cleaning. Good students can get more " " as reference to their final☆

scores. This method works very well to arouse the enthusiasm of student.

Pathophysiology combined theoretical examination and examination in practice.

In practical class, we highlight the evaluation of students’ performance during the

whole process of the experiment, including attendance, taking part in operation,

experiment report evaluation, and instruments cleaning et al. We encourage students

to discuss and analyze the experimental results using their basic theories and creative

ideas; we also aimed to focus on cultivating students’ practical ability as well as

problem-solving ability.

4. 参考书目

TEXT BOOKS RECOMMENDED

1. Sue E. Huether. Understanding Pathophysiology, 5th edition. 2011.

2. Le Tao, et al. First Aid Q&A for the USMLE STEP 1. 2012

3. Le Tao, et al. First Aid Q&A for the BASIC SCIENCES: Organ Systems. 2012

26

4. Porth CM, et al. Essentials of Pathophysiology. 2011

5. Mccancer KL, et al. Pathophysiology. 2010

6. Porth CM, et al. Pathophysiology. 2009

7. Lee-Ellen C, Copstead. Perspectives on Pathophysiology. 2000.

8. Barbara L, Bullock. Pathophysiology – Adaptations and Alterations in Function, 4 th

edition. 1999.

9. Wang Jianzhi, Chen Guoqiang. Textbook of Pathophysiology, 1st edition. Science

Publishing House. 2006.

10. Wang Jianzhi, Jin Huining. Pathophysiology. 1st edition. People’s medical

Publishing House. 2005.

11. Kong Xianshou. Contemporary Pathophysiology. Shanghai. 1993.

5. 考试形式和成绩分配

总分100

1).理论考试（70分）：(1)期末考试（50分）(2)小测验（10分）(3)讨论和自主学习（10分）2).实验考试（30分）:

包括对出勤实验操作实验报告回答问题实验室卫生等全过程的评价

27

EXAMANATION & MARKS DISTRIBUTION

1). Theory Exam: 70 marks：(1) Final examination (50 marks)

(2) Quiz (10 marks)

(3) Discussion and independent learning (10 marks)

2). Practical Exam: 30 Marks

The evaluation of all the 5 experimental classes (6 marks each). Including the

attendance, operation performances, experimental reports, answer questions, cleaning

the instruments and the lab, et al.

6. 学时分配

学时分配：54 （1 个学期）理论课:病理生理学课程的内容包括概论、基本病理过程及系统病理生理学三个知识模块：模块一：概论疾病的概念: 3 学时模块二：基本病理过程水电解质的平衡紊乱: 3 学时水肿: 3 学时

28

钾代谢紊乱: 3 学时酸碱平衡紊乱: 3 学时休克: 3 学时弥漫性血管内凝血: 3 学时缺氧: 3 学时缺血再灌注损伤: 3 学时模块三：系统病理生理学讲述各系统疾病的共同发生规律和主要器官的功能衰竭，如心功能不全、肺功能不全、肾功能不全、肝功能不全。呼吸衰竭: 3 学时心力衰竭: 3 学时肝性脑病: 3 学时肾功能衰竭: 3 学时

病理生理学实验课虚拟实验: 3 学时水肿: 3 学时缺氧: 3 学时失血性休克: 3 学时高钾血症及治疗: 3 学时

合计: 54 学时

29

TEACHING HOURS DISTRIBUTION

Total numbers of teaching hours are approximately 54 (one semester)

Distribution of teaching hours for theory and practicals are as follows

The theoretical class include three modules：Module 1：Concept

CONSPECTUS OF DISEASE 3 HOURS

Module 2：Basic pathological process

ALTERATIONS IN FLUID, ELECTROLYTE HOMEOSTASIS 3 HOURS

EDEMA 3 HOURS

DISORDER OF POTASSIUM METABOLISM 3 HOURS

ALTERATIONS IN ACID-BASE HOMEOSTASIS 3 HOURS

SHOCK 3 HOURS

DISSEMINATED INTRAVASCULAR COAGULATION (DIC) 3 HOURS

HYPOXIA 3 HOURS

ISCHEMIA-REPERFUSION INJURY 3 HOURS

Module 3：Systemic pathophysiology

RESPIRATORY FAILURE 3 HOURS

HEART FAILURE 3 HOURS

HEPATIC ENCEPHALOPATHY 3 HOURS

RENAL FAILURE 3 HOURS

The practical class include：VIRTUE EXPERIMENT 3 HOURS

EDEMA 3 HOURS

HYPOXIA 3 HOURS

HEMORRHAGIC SHOCK 3 HOURS

HYPERKALEMIA AND TREATMENT 3 HOURS

TOTAL: 54 HOURS

30

7. 教学进度天津医科大学基础医学院教学进度表

学年第学期专业：年级：班级：课程名称：　　周次 Week

日期 Date

讲课内容 Contents

学时 Teaching

hours

节次Time

主讲教师 Teachers

实验内容 Experiment Contents

学时 Teaching hours

实验教师 Experiment teacher

1 　　　　　　　　23456 　　　　　　　7 　　　　　　　　8

31

9

10

11

12

13

14

15

16

17 　　　　　　　　18 　　　　　　　　19 　　　　　　　

总学时理论实验　　　　　上课时间上课地点主任签字：

32

2012 级 13-14 学年（2）留学生教学进度表

课程名称：Pathophysiology 班级：Class 1 （5 groups）学时数主讲教师职称项目

周次理论课内容实验课内容日期星期节次

1 14.02.25 Tue 1~3

2 14.03.04 Tue 1~3 Edema 　 3 Zhang Lijun Professor

3 14.03.11 Tue 1~4 Disorder of

potassium metabolism

　 4 Di HongjunAssociate professor

4 14.03.18 Tue 1~3 Hypoxia 　 3 Deng Yanqiu Professor

5 14.03.25 Tue 1~3 Shock 　 3 Deng Yanqiu Professor

6 14.04.01 Tue 1~3 Acid-base balance and imbalance (1)


7 14.04.08 Tue 1~4Acid-base balance and imbalance(2) /

DIC　 4 Di Hongjun

Associate professor

8 14.04.15 Tue 1~4 Respiratory failure 　 4 Yao Xiaomei Professor

9 14.04.22 Tue 1~4Hepatic

insufficiency　 4 Yao Xiaomei Professor

10 14.04.29 Tue 1~3 Heart failure 　 3 Zhang Lijun Lecturer

11 14.05.06 Tue 1~3 　

Vitual experiments

3

Di Hongjun ( Associate professor)

Yao Xiaomei (Professor)

Deng Yanqiu ( Professor) Zhang Lijun (Lecturer), et

al.

12 14.05.13 Tue 1~3 　 Hypoxia 3

34

13 14.05.20 Tue 1~3 　 Edema 3

14 14.05.27 Tue 1~3 　 Hyperkalemia 3

15 14.06.03 Tue 1~4 　 Hemorrhagic shock 4

16 14.06.10 Tue 1~4Acute renal failure

Chronic renal failure

　 4

Lecturer

理论课地点：留学生楼 102 实习课地点：主楼 6 楼 2014 年 2 月

2012 级 13-14 学年（2）留学生教学进度表课程名称：Pathophysiology 班级：Class 2（5 groups）

项目理论课内容实验课内容学时数主讲教师职称周次日期星期节次

1 14.02.26 Wed 5~7

Conspectus of disease

Disorder of water and electrolyte

metabolism

　 3 Zhang Lijun Professor

2 14.03.05 Wed 5~7 Edema 　 3 Zhang Lijun Professor

3 14.03.12 Wed 5~8 Disorder of

potassium metabolism


4 14.03.19 Wed 5~7 Hypoxia 　 3 Deng Yanqiu Professor

5 14.03.26 Wed 5~7 Shock 　 3 Deng Yanqiu Professor

6 14.04.02 Wed 5~7 　 Vitual experiments

3Di Hongjun

( Associate professor)

Yao Xiaomei (Professor)

Deng Yanqiu ( Professor)

Zhang Lijun (Lecturer), et al.

7 14.04.09 Wed 5~7 　 Hypoxia 3

8 14.04.16 Wed 5~7 　 Edema 3

9 14.04.23 Wed 5~7 　 Hyperkalemia 3

10 14.04.30 Wed 5~8 　 Hemorrhagic shock

4

35

11 14.05.07 Wed 5~7 Acid-base balance and imbalance (1)


12 14.05.14 Wed 5~8Acid-base balance and imbalance(2) /

DIC　 4 Di Hongjun

Associate professor

13 14.05.21 Wed 5~8 Respiratory failure 　 4 Yao Xiaomei Professor

14 14.05.28 Wed 5~8 Hepatic

insufficiency　 4 YaoXiaomei Professor

15 14.06.04 Wed 5~7 Heart failure 　 3 Zhang Lijun Lecturer

16 14.06.11 Wed 5~8Acute renal failure

Chronic renal failure

　 4 Zhang Lijun Lecturer

理论课地点：留学生楼 201 实习课地点：主楼 6 楼 2014 年 2 月

8. 教案书写要求

国际学院关于规范留学生教学教案书写要求为了进一步规范从事留学生教学教师的教案，现将该教案（讲稿）的书写要求建议如

下:

一、教案（讲稿）是教师本人编写制定的处理教材与组织课堂教学的课程教学方案。一

门课程的教案（讲稿）应包括课程、章节及一次授课三个层面的教学内容、教学基本要求、

教学手段、教学方法设计，主要解决教什么、怎么教的问题。教案（讲稿）的教学内容要严

格按教学大纲编写，并根据社会发展及对人才培养的新要求及时增加和补充前沿内容。

36

二、就一次课而言，教案（讲稿）的内容原则上应包括本次课的教学目的和教学要求、

教学内容、教材分析、时间安排、作业布置、教学后记等方面。其中，教学目的和教学要求是

课堂教学活动围绕的中心和力求达到的目标；教学内容是教案（讲稿）的主体，要按引入

新课、讲授、总结与巩固三方面详细设计；教材分析则要找出本次课的重、难点及关键，并

确立突出重点、克服难点、抓住关键的方案；时间安排要求教师在有效的时间内，根据教学

内容合理安排好教学时间；作业布置一项，要求教师在课毕进行归纳小结，并适当布置预

习和复习作业，为下一轮的讲课做好铺垫工作；教学后记是教案（讲稿）执行情况的经验

总结，目的在于改进和调整教案（讲稿），为下一轮课讲授设计更加良好的教学方案。三、教案（讲稿）设计的详细与否，可因人而异，一般来说，年轻教师的教案（讲

稿）、第一次开课教师的教案（讲稿）必须详细写，同时应该有相应的电子教案（讲稿）。

国际医学院

二 00八年十二月十九日

37

9. 授课教案

天津医科大学国际学院

留学生教学教案

课程名称： PATHOPHYSIOLOGY

38

天津医科大学国际学院制

Teaching Plan for International Students, TMU

Title of the Course：PATHOPHYSIOLOGY Chapter: Ischemia-reperfusion injury

Class： Grade: Department: Pathophysiology

Teaching Objectives ;

Teaching Requirements

1. Master the concept and mechanism of ischemia-reperfusion injury.2. Master the Injury ischemia-reperfusion to vital organs.3. Be familiar to the causes and governing factors of ischemia-reperfusion injury.4. Understand the basis of prevention and treatment of ischemia-reperfusion injury.

Teaching Content

And Time

Allotment

1. Concept, Causes and Governing factors of ischemia-reperfusion injury. 50 min2. Mechanisms of ischemia-reperfusion injury 80 min

(1) Injury of free radicals (2) Calcium overload (3) The role of leukocyte (4) No reflow phenomena

3. Ischemia-reperfusion injury to vital organs 30 min4. Pathophysiological basis of prevention and treatment 30 min5. Summery and questions 10min

Teaching Focus;

Difficult Problems and

their Solutions

Emphasis: Concept, mechanisms and the injury to vital organs of ischemia-reperfusion

Difficult Points: Concept, Mechanisms of ischemia-reperfusion injury

Postscript Concept: Ischemia-reperfusion injury; Respiratory burst; Calcium OverloadAnswer Questions -What are the causes and governing factors of I/R injury?

-What are the mechanisms of I/R injury?-What’s the definition of no-reflow phenomenon and possible

explantations

Memo Reference Material

39

1. Wang Jianzhi, Chen Guoqiang. Textbook of Pathophysiology. Beijing: Science Publish Company. (First Edition). 2006，32. Chen Zhuchu. Pathophysiology. Beijing ： People’s Medical Publishing House.(First Edition). 2005，73. Zhu Xueliang. Clinical Pathophysiology.(For internal used)，20064. Sue. Huether, Kathryn L. Understanding Pathophysiology. Mc Cance. Mosby Inc. (Second Edition). 2000.


Title of the Course：PATHOPHYSIOLOGY Chapter: Disorders of sodium and water metabolism




1. Master the distribution, the homeostasis and the regulation mechanism of body fluid.

2. Master the characteristics, the effects on body, and clinical manifestations of 3 types of

dehydration.

3. Master the concept, the causes and the clinical manifestations of water intoxication.

4. Be familiar the causes, the effects, and the therapeutic principles of dehydration.

Teaching Content

And Time

Allotment

1. Physiological review 20 min2.Classification of water-electrolyte metabolism disorders 60 min3. Dehydration 100 min

(1) Hypertonic dehydration (2) Hypotonic dehydration(3) Isotonic dehydration

Teaching Focus; Difficult Problems and their Solutions

Key points: Characteristics, causes, effects on the body of three types dehydrationDifficult points: body’s changes and manifestations of hypertonic dehydration and hypotonic dehydration.Requirements: Grasp key point;

Familiarize with the causes and effects of dehydration on the body;Know treatment principles.

Postscript 1. What are the characters of three types dehydration (definition)?2. Why the patient with hypertonic dehydration less occurs circulatory failure in early stage of dehydration?3. If a patient with serious diarrhea only was replenished 0.5% glucose solution, what will occur?

40

Memo Reference Material 1. Wang Jianzhi, Chen Guoqiang. Textbook of Pathophysiology. Beijing: Science Publish Company.(First Edition). 2006，32.Chen Zhuchu. Pathophysiology. Beijing ： People’s Medical Publishing House.(First Edition). 2005，73. Zhu Xueliang. Clinical Pathophysiology.(For internal used)，20064. Sue. Huether, Kathryn L. Understanding Pathophysiology. Mc Cance. Mosby Inc. (Second Edition). 2000.

Teaching Plan for International Students, TMUTitle of the Course：PATHOPHYSIOLOGY Chapter: Edema




1. Master the mechanism of edema.

2. Master the classification and mechanism of brain edema.

3. Be familiar the mechanisms of heart edema, hepatic edema, and renal edema.

4. Understand the effects and therapeutic principle of edema.

Teaching Content

And Time

Allotment

1. Concept 20 min2. Pathogenesis

(1) Imbalance of exchange between intra- and extra-vascular fluids 40 min(2) Imbalance of exchange between intra- and extra-body fluid-- retention of water and

sodium in the body 40 min3. Effects on the body 60 min4. Principle of treatment 20 min

Teaching Focus;

Difficult Problems and their Solutions

Key points: Definition, pathogenesis of edema; types of brain edema and characteristics of different brain edema.

Difficult points: Exchange between intra- and extra-vascular fluid, mechanisms of retention of water and sodium

Requirements: Grasp key points;Know effects of edema on the body

Postscript 1. What is edema?2. Increased capillary permeability may lead to edema, please describe its mechanism.

Memo Reference Material 1. Wang Jianzhi, Chen Guoqiang. Textbook of Pathophysiology. Beijing: Science Publish

41

Company.(First Edition). 2006，32.Chen Zhuchu. Pathophysiology. Beijing ： People’s Medical Publishing House.(First Edition). 2005，73. Zhu Xueliang. Clinical Pathophysiology.(For internal used)，20064. Sue. Huether, Kathryn L. Understanding Pathophysiology. Mc Cance. Mosby Inc. (Second Edition). 2000.

Teaching Plan for International Students, TMUTitle of the Course：PATHOPHYSIOLOGY Chapter: Disorders of metabolism of potassium




1. Grasp definition of hypokalemia or hyperkalemia 2. Master causes and manifestations of hypokalemia or hyperkalemia 3. Master the causes and effects on body and on heart of hypokalemia and

hyperkalemia.

4. Be familiar the metabolic process of potassium.

5. To know treatment principles

Teaching Content

And Time

Allotment

1. Distribution and function of potassium 30min 2. Causes and manifestations of hypokalemia 60min

3. Causes and manifestations of hyperkalemia 50min 4. Treatment and case study 10min

Teaching Focus;


Difficult part: Effects on the heart during hyperkalemia and hypokalemiaMaster causes and manifestations of hypokalemia and hyperkalemiaKnow the principles of treatment

Postscript

1. What is the concept of hypokalemia and hyperkalemia? 2. Compare hypokalemia and hyperkalemia (concept, causes and effects).

3. How to daignose hypokalemia and hyperkalemia

Memo Reference Material 1. Wang Jianzhi, Chen Guoqiang. Textbook of Pathophysiology. Beijing: Science Publish Company.(First Edition). 2006，32.Chen Zhuchu. Pathophysiology. Beijing ： People’s Medical Publishing House.(First

42

Edition). 2005，73. Zhu Xueliang. Clinical Pathophysiology.(For internal used)，20064. Sue. Huether, Kathryn L. Understanding Pathophysiology. Mc Cance. Mosby Inc. (Second Edition). 2000.

Teaching Plan for International Students, TMUTitle of the Course：PATHOPHYSIOLOGY Chapter: Alterations in acid-base homeostasis




1. Be familiar the regulation of acid-base balance.

2. Master the parameters and its significance in acid-base disorders.

3. Master the causes, the compensatory processes, and the effects of 4 types of acid-base

disorders.

4. Understand the therapeutic principle.

Teaching Content

And Time

Allotment

1. Acid-base homeostasis 20 min

2. Parameters 30 min

3. Acid-base imbalances

(1) Metabolic acidosis 30 min

(2) Respiratory acidosis 30 min

(3) Metabolic alkalosis 30 min

(4) Respiratory alkalosis 30 min

(5) Mixed acid-base imbalances 10 min

Teaching Focus;


Key points: Definition of 4 types of acid-base disorders Difficulty: The manifestation and regulation under the 4 typesof acid-base disorders

Postscript 1. How does the body control pH? 2. What are pH, PaCO2, and HCO3

-? What are their normal ranges? 3. What are the concepts of 4 primary acid-base imbalances? 4. What are the causes of metabolic acidosis? 5. Can respiratory acidosis and respiratory alkalosis exist at the same time? Why?


43


Teaching Plan for International Students, TMUTitle of the Course：PATHOPHYSIOLOGY Chapter: Shock

Class ： Grade: Department: Pathophysiology



1. Understand the classification and etiology of shock.

2. Master the changes of microcirculation and the alterations of factors during shock.

3. Master the effects of shock.

4. Master the characteristics and therapeutic principle of hypodynamic shock and

hyperdynamic shock.

5. Master the pathological changes of shock lung.

Teaching Content

And Time

Allotment

1. Classification 30 min

2. Mechanism 60 min

3. Clinical manifestations 60 min

4. Alterations of functions of inner organs 10 min

5. Alterations in metabolism 10 min

6. Treatment 10 min

Teaching Focus;


Difficulty: The mechanism and factors in different stages

(1) Ischemic anoxia stage (compensatory stage)

(2) Stagnant anoxia stage (decompensatory stage)

(3) Microcirculatory failure stage (Disseminated intravascular coagulation stage)

Postscript1. What is the concept of shock?

2. According to the causes, shock can be classified into 4 types, what are they? 3. How many stages are there in hypovolemic shock? What are they? 4. What are the compensatory mechanisms in hypovolemic shock? 5. What is MTF? 6. What is shock lung?


44


Teaching Plan for International Students, TMUTitle of the Course：PATHOPHYSIOLOGY Chapter: Hypoxia




1. Master the concept of hypoxia.

2. Master the etiology and classification of hypoxia.

3. Master the mechanisms and characteristics of hypoxia.

4. Be familiar the alterations of metabolism and function during hypoxia.

5. Understand the prevention and treatment.

Teaching Content

And Time

Allotment

1. Parameters of blood oxygen 60 min

2. Classification, etiology and mechanisms of hypoxia 60 min

3. Alterations of metabolism and function in the body 50 min

4. Pathophysiological basis of prevention and treatment 10 min

Teaching Focus;


Difficulty: The using of blood oxygen, the mechanism of hypoxia, the mechanism of different hypoxia

Postscript 1. What is the concept of hypoxia? 2. What is PaO2, O2 content? And their normal value? 3. What is cyanosis? 4. How about the characteristics of blood O2 during the four types of hypoxia? 5. What is the mechanism of carbon monoxide poisoning? 6. What is the significance of the curve shifting to the right?

Memo Reference Material 1. Wang Jianzhi, Chen Guoqiang. Textbook of Pathophysiology. Beijing: Science Publish Company.(First Edition). 2006，32.Chen Zhuchu. Pathophysiology. Beijing ： People’s Medical Publishing House.(First Edition). 2005，7

45

3. Zhu Xueliang. Clinical Pathophysiology.(For internal used)，20064. Sue. Huether, Kathryn L. Understanding Pathophysiology. Mc Cance. Mosby Inc. (Second Edition). 2000.

Teaching Plan for International Students, TMUTitle of the Course：PATHOPHYSIOLOGY Chapter: Heart failure




1. Master the pathogenesis of heart failure.

2. Master the mechanism of dyspnea during heart failure, the mechanism of paroxysmal

nocturnal dyspnea and orthopnea.

3. Master the cardiac compensation during heart failure.

4. Be familiar the hemodynamic changes of heart failure.

5. Understand the causes and promoting causes of heart failure.

Teaching Content

And Time

Allotment

1. Introduction2. Causes and precipitating causes 30 min3. Compensatory mechanisms in heart failure 60 min4. Mechanisms of heart failure 60 min

(1) Depressed myocardial contractility(2) Altered diastolic properties of the ventricles

5. Functional and metabolic alterations of the body 30 min

Teaching Focus;


Key points: Definition of heart failure, compensation mechanisms and limitation, pathogenesis of heart failure,mechanisms of dyspnea resulting from heart failure

Difficult points: Explanation of high-output heart failures, mechanisms of excessive myocardial hypertrophy resulting in heart failure, �pathogenesis of heart failure.

Requirements: Grasp key points; know precipitating causes and types of dyspnea resulting from heart failure well.

Postscript 1. Heart failure, Tonogenic dilatation, Dyspnea,, Myocardial hypertrophy (concentric hypertrophy, eccentric hypertrophy)

2. Compensatory mechanism in heart failur3. Mechanism of heart failure (depressed myocardial contractility)


46



Title of the Course：PATHOPHYSIOLOGY Chapter: Respiratory failure




1. Master the etiology of respiratory failure.

2. Master the mechanism of pulmonary encephalopathy.

3. Be familiar the effects of respiratory failure.

4. Understand the mechanism of acute respiratory distress syndrome (ARDS).

Teaching Content

And Time

Allotment

1. Definition of respiratory failure 10min 2. Classification of RF 20min

3. Causes and pathogenesis of RF 80min 4. Manifestation of Rf and ARDS 30min

5. Treatment principles of RF 10min

Teaching Focus;


Difficult part: ventilation-perfusion mismatchingMaster definition and pathogenesis of RF and mechanisms of pulmonary encephalopathy.

Know the causes, classification, manifestations and treatment principles of RF

Postscript 1. What is definition of RF……..2. What are the causes of diffusion disorders?3. Explain the mechanisms of pulmonary encephalopathy.4. What are the types of ventilation-perfusion mismatching? Explain their causes and mechanism in detail.

Memo

Reference Material 1. Wang Jianzhi, Chen Guoqiang. Textbook of Pathophysiology. Beijing: Science Publish Company.(First Edition). 2006，32.Chen Zhuchu. Pathophysiology. Beijing ： People’s Medical Publishing House.(First Edition). 2005，7

47

3. Zhu Xueliang. Clinical Pathophysiology.(For internal used)，20064. Sue. Huether, Kathryn L. Understanding Pathophysiology. Mc Cance. Mosby Inc. (Second Edition). 2000.

Teaching Plan for International Students, TMUTitle of the Course：PATHOPHYSIOLOGY Chapter: Hepatic encephalopathy




1. Master the pathogenesis of hepatic encephalopathy: the theory of ammonia intoxication, the theory of false neurotransmitters and the theory of amino acid imbalance.

2. Be familiar the causes of hepatic encephalopathy.3. Be familiar the effects on body during hepatic insufficiency.4. Master the precipitating factors of hepatic encephalopathy 5. Know the treatment principles of hepatic encephalopathy

Teaching Content

And Time

Allotment

1. Concept of hepatic encephalopathy 10min2. Clinical grading and classification of HE 20min3. Pathogenesis of HE 80min

4. Precipitating Factors of HE 30min 5. Treatment principles of HE 10min

Teaching Focus;


Difficult part: ammonia intoxication Master concept, pathogenesis and precipitating Factors of HEKnow clinical grading, classification and principles of treatment

Postscript 1. What are the definition of hepatic encephalopathy and false neurotransmitters?

2. Outline the three hypotheses of the pathogenesis of hepatic encephalopathy?

3. What are the precipitating factors of HE?

Memo

Reference Material 1. Wang Jianzhi, Chen Guoqiang. Textbook of Pathophysiology. Beijing: Science Publish Company.(First Edition). 2006，32.Chen Zhuchu. Pathophysiology. Beijing ： People’s Medical Publishing House.(First

48

Edition). 2005，73. Zhu Xueliang. Clinical Pathophysiology.(For internal used)，20064. Sue. Huether, Kathryn L. Understanding Pathophysiology. Mc Cance. Mosby Inc. (Second Edition). 2000.

Teaching Plan for International Students, TMUTitle of the Course：PATHOPHYSIOLOGY Chapter: Acute renal failure




1. Grasp the etiologyand pathogenesis of acute renal failure.2. Master the body changes in three stages of acute renal failure.

3. Know the treatment principles of acute renal failure

Teaching Content

And Time

Allotment

1. Introduction and Concept ……….30min2. Causes and Pathogenesis ………..50min3. Clinical courses ………………… 60min 4. Treatment principles 10min

Teaching Focus;


Difficulty: Alterations of metabolism and function

(1) Urinary abnormalities

(2) Water and electrolytes imbalance

(3) Acid-base imbalance

Postscript1. The concept of ARF, Azotemia, oliguria, anuria. 2. What are the clinical manifestations during the oliguria phase in ARF? 3. What are the pathogenesis of ARF?4. What are the common causes in ARF?5. Describe the mechanism of polyuria during the polyuria phase in ARF

MemoReference Material 1. Wang Jianzhi, Chen Guoqiang. Textbook of Pathophysiology. Beijing: Science Publish Company.(First Edition). 2006，32.Chen Zhuchu. Pathophysiology. Beijing ： People’s Medical Publishing House.(First Edition). 2005，73. Zhu Xueliang. Clinical Pathophysiology.(For internal used)，20064. Sue. Huether, Kathryn L. Understanding Pathophysiology. Mc Cance. Mosby Inc.

49

(Second Edition). 2000.

Teaching Plan for International Students, TMUTitle of the Course：PATHOPHYSIOLOGY Chapter: Chronic renal failure

Class： Grade: Department: Pathophysiology Teaching

Objectives ; Teaching

Requirements

1. To grasp the concept of CRF and uremia..2. To master cinical manifestations of CRF. 3. To know causes and pathogenesis of CRF, and manifestations of uremia

Teaching Content

And Time

Allotment

1. Concept, causes and Pathogenesis of CRF 30min2. Clinical courses and manifestations of CRF……70min3. Uremia ………………… 50min

Teaching Focus;


Difficulty: Alterations of metabolism and function

(1)Disorders of urine (2)Disorders of water and sodium balance

(3)Disorders of potassium balance (4)Metabolic acidosis

(5) Renal azotemia (6)Renal hypertension (7)Calcium, phosphate and bone

metabolism (8) Renal anemia and bleeding tendency

Postscript1.What is the mechanism of Ca-P metabolism dysfunction in CRF?2.What substances may cause uremia?3.What functional disturbances were happened in patients with uremia?

Memo Reference Material 1. Wang Jianzhi, Chen Guoqiang. Textbook of Pathophysiology. Beijing: Science Publish Company.(First Edition). 2006，32.Chen Zhuchu. Pathophysiology. Beijing ： People’s Medical Publishing House.(First Edition). 2005，73. Zhu Xueliang. Clinical Pathophysiology.(For internal used)，20064. Sue. Huether, Kathryn L. Understanding Pathophysiology. Mc Cance. Mosby Inc. (Second Edition). 2000.

50

Teaching Plan for International Students, TMUTitle of the Course：PATHOPHYSIOLOGY Chapter: DIC




1. Master the concept of DIC.

2. Master the clinical manifestation and the mechanism of bleeding in DIC.

3. Master the mechanism of DIC

4. Be familiar the promoting causes and causes of DIC.

Teaching Content

And Time

Allotment

1. Causes 20 min

2. Mechanism 60 min

3. Promoting causes： 30 min

4. Stages 20 min

5. Effects and clinical manifestations 30 min

6. Lab examination and treatment 20 min

Teaching Focus;


The mechnaism of (1) Bleeding(2) Shock(3) Multiple organs failure (4)

Microangiopathic hemolytic anemia during DIC

Postscript 1 .What is DIC?2. What are the effects and clinical manifestations of DIC?3. What are the mechanism of DIC?4. What are the promoting causes of DIC?

Memo Reference Material 1. Wang Jianzhi, Chen Guoqiang. Textbook of Pathophysiology. Beijing: Science Publish Company.(First Edition). 2006，32.Chen Zhuchu. Pathophysiology. Beijing ： People’s Medical Publishing House.(First Edition). 2005，73. Zhu Xueliang. Clinical Pathophysiology.(For internal used)，20064. Sue. Huether, Kathryn L. Understanding Pathophysiology. Mc Cance. Mosby Inc.

51

(Second Edition). 2000.

Teaching Plan for International Students, TMU (Experiment)


Course：Pathophysiology Content： Virtual Experiment --Pulmonary edema

Student：Clinical medicine Grade international studentMethod： Virtual Experiment Teaching hour：3 Purpose and require：

1. To learn how to create an animal model of pulmonary edema.2. Observe the manifestations of pulmonary edema and understand the mechanisms.

The management of teaching hour：

Explain the main steps of experiment—20 minPractice—130 min

PurposeMaster：The method to create an animal model of pulmonary edema, and the

the manifestations of pulmonary edema and understand the mechanisms

Term： pulmonary edema; tracheal intubation; pulmonary coefficientQuestions：1. What is the definition of pulmonary edema ?2. What are the roles of adrenalin?3. How to catch and hold the rabbit?4. How to judge the anesthesia of the rabbit is satisfied?5. How to do tracheal intubation? 6. How to calculate the pulmonary coefficient? What is the normal range?7. What are the manifestations of pulmonary edema?

Reference books： Functional Experiment Publishing house of Tianjin University

52


Course：Pathophysiology Content： Hypoxia

Student：Clinical medicine Grade international student

Course：Pathophysiology Content： EdemaStudent：Clinical medicine Grade international studentReference book：Functional Experiment GuideMethod： Experiment Teaching hour：3 Purpose and require： Master how to create an animal model with edema ，discuss the mechanism of this

edema, the effects of changes of plasma colloid osmotic pressure on edemaThe management of teaching hour：

Explain the main steps of experiment—30 minPractice—120 min

PurposeMaster：The method to create an animal with edema（toad）Discuss ： The effects of changes of plasma colloid osmotic pressure on

edema，when there is a decrease or increase of plasma colloid osmotic pressure， what is the result？

Terms： Edema， plasma colloid osmotic pressureQuestions：

1．During intravenous infusion of Ren solution, what happen to the body weight? Why?

2．During 20% G, how about the body weight？why？Reference books： Functional Experiment Publishing house of Tianjin University

53

Reference book：Functional Experiment Guide

Method： Experiment Teaching hour：3

Purpose and require： To master the method to create the animal model with hypoxia, to observe the effects

of hypoxic hypoxia and CO poisoning on the body.

The management of teaching hour： Explain the main steps of experiment—30 min

Practice—120 min

Purpose

Master：The method to create the animal model with hypoxia

Discuss: The different effects of hypoxic hypoxia and CO poisoning on body.

Terms： cyanosis，cherry-red.

Questions： 1．What are the clinical manifestation of hypoxia？

2．What is the difference of blood color between hypoxic hypoxia and CO poisoning.



54

Course：Pathophysiology Content： Hemorrhagic shock

Student：Clinical medicine Grade international student

Reference book：Functional Experiment Guide

Method： Experiment Teaching hour：3

Purpose and require： To master the method of an animal model with hemorrhagic shock, observe the changes of BP during shock, discuss the effects of vasoactive agent on shock at different stage.


Practice—170 min

Purpose

Master：The method to create an animal model with hemorrhagic shock

Observe the changes of BP during shock

Discuss：What are the effects of vasoactive agent on shock at different stage?

Term： Hemorrhagic shockQuestions:

1．What are the different changes at different stage of hemorrhagic shock?

2. What is the treatment of hemorrhagic shock?


55


Course：Pathophysiology Content: HyperkalemiaStudent：Clinical medicine Grade international student Reference book：Functional Experiment GuideMethod： Experiment Teaching hour：3 Purpose and require： To maser the method of the rabbit model with hyperkalemia, to master how to insert a needle into the ear marginal vein, how to induce general anesthesia and how to observe the changes of ECG.


Practice—120 min

PurposeMaster： The method of the rabbit model with hyperkalemia, to master how

to insert a needle into the ear marginal vein , how to induce general anesthesia and how to observe the changes of ECG..

Discuss：Why does the ECG change when hyperkalemia develops? Why can we treat the rabbit with 10% CaCl2? What is the mechanism of the changes of the condition and size of the heart when the rabbit died of hyperkalemia?

Term： Hyperkalemia Questions：1．What are the ECG change when hyperkalemia develops?2．What is the condition and size of the heart when the rabbit died of hyperkalemia.


56

10. 教学计划变更执行审批表天津医科大学国际医学院教学计划变更执行审批表

班级课程名称教师

教学计划变更方案

及变更原因

审批意见

签字

57

年月日

审批编号

11. 调课申请表天津医科大学国际医学院教师调整课程申请表

班级课程名称教师

排定上课时间排定上课地点调整后上课时间调整后上课地点

调课理由教学主管领导

意见

58

12. 课堂和实验室纪律规范

天津医科大学国际医学院学生课堂和实验室纪律规范（中英文）课堂是教师向学生传播知识和技能的地方，是学生学习吸收将来神圣职业所需本领的

圣堂。为了使学生能够在一个整洁、和谐、安静、有序的环境充分学到所教的知识和技能，颁

布如下规定，希望学生严格遵守。1、学生应勤奋学习，自觉遵守课堂和实验室规定和学习纪律。按时上课，认真听

讲。2、因病、因特殊原因请假者，应到留学生办公室请假。病假必须有医院证明，并

及时报告老师。凡未请假而缺课者，均按旷课论。3、学生应按照课程安排准时来教室上课，不得旷课和无故迟到；迟到十分钟按

旷课论。4、上课期间不得随便出入教室，不准接打手机、吸烟、吃东西、喝饮料。上课时不

59

准出教室接打手机。5、上课期间不得与他人交谈、睡觉、听音乐，不得影响别人听课。6、上课期间不得请假；中途离开者，按照旷课论处。7、严格遵守实验室的规定和纪律。实验课、临床见习、实习必须穿白大衣；遵照老

师的要求积极动手完成实验、见习和实习课程。实验结束后，主动帮助老师收

拾好实验用具、打扫卫生。8、损坏实验设备者要照价赔偿。

本规定自公布之日起执行。

天津医科大学国际学院

2008-12-23

Discipline Standard in Classroom and Laboratory

Classroom is a sacred place where the teachers spread knowledge and skills; it is also where the students study and absorb all the professional knowledge for their future career. In order to give students a tidy, harmonious, quiet and orderly environment so that they can sufficiently get the knowledge, we hereby issue the following rules, and we hope every student will observe them

60

strictly.

1. You should study hard, and willingly observe the rules and disciplines for classrooms and laboratories. You should attend the class on time, and listen to the teachers carefully.

2. If you have to take a day off and be absent from class, you need to come to the foreign student office and ask for it. If you are sick, you need to present the medical certificate from the doctor, and report to your teacher in time. If you don’t do so, it will be regarded as truancy.

3. You should come to your classroom on time according to your timetable, you can’t play truant or be late for class. If you are more than 10 minutes late for class, it is regarded as truancy.

4. During class time, you can’t go in and out of the classroom. You can’t make or receive phone calls from your mobile phone. Smoking is strictly forbidden, and no food or drinks are allowed inside the classroom. Besides, you can’t go outside the classroom to make or receive phone calls.

5. You can’t talk to other students during class. No sleeping or listening to music. You can’t interfere others listening to the lecture.

6. You can’t ask for a leave during class time; if you leave the classroom half way through the class, this will be regarded as truancy.

7. You should observe the rules and disciplines in the laboratory. You have to wear lab-coat during experiment, clinical observation and internship. You should actively do and finish what you are required by your teacher in a hand-on approach. Upon finishing the experiment, you should voluntarily help the teacher clean the lab and put the things back neatly.

8. If you break anything in the lab, you have to pay for it.

These rules and disciplines take effect from the date when it is issued.

International Medical School, TMU

2008-12-25

13. 学生实验报告Experiment:

Class： Name： Roll No.：[Principle]

61

[Method]

[Results]

[Discussion]

62

14. 监考记录及考场规则

63

天津医科大学国际医学院监考记录20 ___---20___学年第____学期期____考试

考试科目：______________ 年级：______________

考试时间：______________ 专业：______________

考试地点：______________ 班级：______________

1.监考老师及考生是否于考前 15 分钟进入考场？是否2.考前是否宣读考试规定？是否3.是否核查了考生的有关证件？是否4.是否准确统计了考生人数？是否

考场人数：__________名，实考__________名，缺考__________名。缺考学生记录：序号姓名学号

5.违纪考生记录：

6.是否按时收回试卷？是否7.监考教师签字：备注

Examination Rules for International Students

64

1. You must enter the examination room 15 MINUTES before the time scheduled for the commencement of

the examination.

2. You must leave all of your study materials and bags in the front of the examination room and put your

Student Card on the upper left corner of your desk for check.

3. You must write your roll number and your name on the examination paper first.

4. During the examination, you are not allowed to bring your mobile phones into the examination room.

5. You must observe absolute silence in the examination room. You must not communicate by word of mouth

or otherwise with other students. You must not borrow any stationery (e.g. pens, rulers, erasers, calculators,

etc.) from others during the examination. You must not peep at other students’ papers or exchange papers

with others.

6. You must use black or dark blue ball-point pens / pens for writing answers. Examination papers completed

by pencils or red pens will be null (examination questions which require drawing pictures excluded).

7. You must observe the prevailing non-smoking rule in the examination room. Food and drink are also not

allowed.

8. You must remain seated at the end of the examination. You must not communicate with other students

while all completed examination papers are being collected by the invigilators

9. You must not talk or discuss outside the examination room after submitting your paper in advance, as this

may disturb other students who may still be sitting for the examination.

International Medical College

15. 巡考记录65

200 —— 200 学年第学期（期中、末）考试领导巡视考场记录

时间：地点：记录：

签字：

66

16. 试卷套头Mid/Final term Examination Paper (A/B)

for International Students, Grade 2009

（1st /2nd Semester, 20 ——20 ）Course：(教师填写) Class： Name： Roll No.：

-1-

Serial No. I II III IV V VI VII VIII IX X TotalScore

Marking Person

□I.1.2.

□II.1.2.

□III.1.2.

□IV.1.2.

67

-2-

□V.1.2.

□VI.1.2.3.

68

Course： Class： Name： Roll No.：

-3-

装订线

69

17. 试卷样卷及答案

Final Examination Paper (A)

for International Students, Grade 2010

（2nd Semester, 2011——2012）Course：Pathophysiology Class： Name： Roll No.：

装订线

Serial No. I II III IV V VI VII TotalScore

Marking Person

□I. Type A multiple choice questions (6%) Fill the only one correct answer in the following table

1 2 3 4 5 6

1. The most significant change in heart failure is A. Decreased blood pressureB. Absolutely or relatively decreased cardiac outputC. Increased blood volumeD. Decreased difference of arteriovenous oxygen content E. Decreased arterial partial pressure of oxygen

2. The medicine which can increase the normal neurotransmitters and enhance its competitive effect is A. Sodium glutamate B. Glutamic acid C. L-Dopa D. Arginine E. Lactulose

3. During oliguric stage of ARF, infusing massive water may result in A. Water intoxication B. Edema C. Hypokalemia D. Hypotension E. Decreased NPN

4. Which one of the following is the most common disease for developing to the concentric hypertrophy? A. Hyperthyroidism B. Severe anemia C.VitB1 insufficiency D. Hypertension

E. Aortic valves incompetence

70

-1-

5. Upper respiratory tract infection can promote the development of heart failure, the most basic mechanism of it is

A. Fever increases body’s metabolismB. Endotoxin inhibits heart function C. Increased heart rate reduces the blood flow of coronary arteryD. External respiration dysfunction

E. Oxygen consumption increases or oxygen supply decrease in myocardium6. Which of the following is related to Group II respiratory failure?

A. Only hypoxemia is present B. Oxygen concentration in nasal tube can be >30%C. Oxygen concentration in nasal tube can be >50% D. Oxygen concentration in nasal tube be controlled < 30%E. Related to diffusional disorder

□II. Type X multiple choice questions (4%) For each question, there are five choices. Among these choices, two or more than

two answers are correct. Chose all correct answers and fill them into the following table.

1 2 3 4

1. Which of the following dysfunctions may lead to respiratory failure? A. Central nervous system B. Thoracic cage and the respiratory muscles C. Airways D. Pulmonary gas-exchange units

E. Pulmonary circulation2．The mechanisms of renal hypertension are involved in

A. Sodium and water retention B. Decreased production of hypotensive substances in kindneyC. Increased secretion of rennin D. Increased intracellular fluidE. Hyperkalemia

71

-2-

Course： Class： Name： Roll No.：3. The mechanisms of ammonia intoxication impairing energy metabolism in brain include

A. Excessive consumption of ATP B. Decreased α-ketoglutaric acidC. Excessive consumption of NADH D. Excessive production of phenylethylamine

E. Inadequacy production of acetyl coenzyme A (acetyl CoA)4. Which of the following belong to ventilatory disorders?

A. Restrictive hypoventilationB. Obstructive hypoventilationC. Central airway obstructionD. Diffusion disorderE. Peripheral airway obstruction

□III. Term explanations (21%)

1. CO2 narcosis

2. Respiratory failure

3. Eccentric hypertrophy

4. Endogenous hepatic encephalopathy

装订线

72

5. Heart failure

6. Uremia

7. Acute renal failure

□IV. Fill in blanks (10%)

1. For the ARF patients, the most serious complication is , the most dangerous stage is .

2. The mechanism of CRF is not fully understood, the hypotheses accepted by most scholars include , and .

3. False neurotransmitters leading to hepatic encephalopathy mainly refer to and .

4. Dyspnea resulted from left heart failure may manifest as , and .

□V. True or false. If it is false, you need to correct it (10%)

1. To facilitate optimal gas exchange, the respiratory membrane must be both sufficiently thick and adequate surface area.

( )

2. Extrathoracic obstruction may lead to expiratory dyspnea; intrathoracic

73

obstruction may lead to inspiratory dyspnea.( )

3. Right heart failure results in pulmonary circulation congestion and pulmonary edema; left heart failure may lead to systemic circulation congestion and general edema.

( )

4. Myocardial hypertrophy is a kind of chronic compensation in the body, which is resulted from a long-term overload on heart.

( )

5. The hypothesis of plasma amino acid imbalance indicates branched chain amino acids (BCAA) increase and aromatic amino acids (AAA) decrease.

( )

6. GABA is a major inhibitory neurotransmitter in the central nervous system.

( )

7. The most reliable parameter for estimating the degree of renal insufficiency is plasma NPN level.

( )

□VI. Questions to be answered briefly (20%)

1. What are the arterial blood gas changes in diffusional disorder in respiratory failure? Why? (6%)

2. What are the precipitating factors of hepatic encephalopathy? (7%)3. Please briefly describe the mechanisms of heart failure (7%)

□VII. Questions to be answered in detail (25%)

1. The patient with CRF can develop to anemia. What are the mechanisms of renal anemia? (8%)

2. Please describe cardiac compensations occurred in cardiac insufficiency briefly. (8%)

3. What are the Ventilation-Perfusion match (in the normal subject) and mismatch types (ventilation-Perfusion imbalance)? (9%)

74

-3-

Tianjin Medical UniversityFinal Examination for International Student (2012.6) A (Answer)

Ⅰ. Type A multiple choice questions (6%) Fill the only one correct answer in the following table

1 2 3 4 5 6B C A D E D

Ⅱ. Type X multiple choice questions (4%) For each question, there are five choices. Among these choices, two or more than two answers are

correct. Chose all correct answers and fill them into the following table.1 2 3 4

ABCDE ABC ABCE ABCE

III. Term explanations (21%)1. CO2 narcosis: The most important signs of hypercapnia originate from the disturbances in

the central nervous system when the PaCO2 reaches 10.7kPa (80mmHg). 2. Respiratory failure is a severe dysfunction of external respiration. It is generally defined as

in rest: PaO2＜8kPa(60mmHg), with/ without PaCO2 ＞6.67 kPa(50mmHg)3. Eccentric hypertrophy refers to a type of myocardial hypertrophy, which results from the

long-term volume overload and increased tension of the ventricular wall in diastolic stage. It characterizes as increased length of the myocardial fibers, sarcomeres hyperplasia arranged in series and cardiac chamber dilation.

4. Endogenous hepatic encephalopathy: The occurrence of endogenous hepatic encephalopathy mostly doesn’t have apparent precipitating factor, it is a final consequence of extensive liver cell destruction resulted from virus or toxic hepatitis, developing with acute course.

5. Heart failure is a pathologic process in which the systolic or / and diastolic function of myocardium is/are impaired. As a result, cardiac output decreases absolutely or relatively, and is unable to meet body’s requirement for metabolism at a normal venous return.

6. Uremia is a clinical syndrome that occurs in the most severe stage either of the ARF or CRF. Besides disorders of water-electrolytes metabolism, disturbance of acid-base balance and dysfunction of renal endocrine, the patient manifests a serious of autotoxic symptoms caused by accumulated metabolic waste and endogenous poisons.

7.Acute renal failure: Acute renal failure refers to an acute deterioration of renal excreting function over a period of hours to days, resulting in oliguria, anuria, accumulation of nitrogenous wastes in the blood, and disorders of water-electrolyte metabolism and acid-base balance.

Ⅳ. Fill in blanks (10%) 1. Hyperkalemia Oliguria stage2. Intact nephron hypotheses

Trade-off hypotheses Glomerular hyperfiltration hypotheses

3. Phenylethanolamine Hydroxyphenyl ethanolamine 4. Exertion dyspnea Orthopnea Paroxysmal nocturnal dyspnea

75

V. True or false. If it is false, you need to correct it (14%)1. × To facilitate optimal gas exchange, the respiratory membrane must be both sufficiently

thin and adequate surface area.2. × Extrathoracic obstruction may lead to inspiratory dyspnea; intrathoracic obstruction

may lead to expiratory dyspnea.3. × Left heart failure results in pulmonary circulation congestion and pulmonary edema;

right heart failure may lead to systemic circulation congestion and general edema.4. √5. The hypothesis of plasma amino acid imbalance indicates that branched chain amino

acids (BCAA) decrease and aromatic amino acids (AAA) increase. 6. √7. The most reliable index for estimating the degree of renal insufficiency is clearance of

endogenous creatinine.

Ⅵ. Questions to be answered briefly (20%)1. What are the arterial blood gas changes in diffusional disorder in respiratory failure?

Why? (6%)PaO2 decrease without PaCO2 increase. (2%)Because the dissolubility of CO2 in water is greater than that of O2, CO2 is much more easily diffused through the alveolar-capillary membrane. CO2 can be removed in time, result in normal PaCO2(4%)

2. What are the precipitating factors of hepatic encephalopathy? (7%)①gastrointestinal bleeding; (1%)②disturbances of electrolytes and acid-base balance; (1%)③azotemia and increased exogenous nitrogen load; (1%)④infection; (1%)⑤constipation; (1%)⑥massive paracentesis; (1%)⑦others, such as excessive taking anesthetic, hypnotic or alcohol. (1%)

3. Please briefly describe the mechanisms of heart failure (7%) The mechanisms of heart failure includes: ①depressed myocardial contractility; (2%)

②diastolic dysfunction of ventricle and depressed ventricular compliance; (3%) ③ asynergia of ventricular systole and diastole (2%)

Ⅶ. Questions to be answered in detail (25%)1. The patient with CRF can develop to anemia. What are the mechanisms of renal anemia?

(8%)The mechanisms of renal anemia include:

① decreased production of erythropoietin; (2%)② hematopoietic function of bone marrow is suppressed by uremic toxin, such as bone

marrow fibrosis due to elevated blood PTH and toxic effects of aluminum; (2%)③ uremic poisons decrease the activity of ATPase, leading to cell swell and break (2%)④ toxins inhibits ion reabsorption from the gut. (2%)

76

2. Please describe cardiac compensations occurred in cardiac insufficiency briefly. (8%)Cardiac compensations include:

a) by cardiac (myocardial) tonogenic dilatation to increase the force of myocardial contraction; (2%)

b) catecholamine released from cardiac sympathetic never and adrenal medulla increases the force of myocardial contraction; (2%)

c) increased heart rate increases the cardiac output; (2%)d) myocardial hypertrophy enhances the force of myocardial contraction. (2%)

3. What are the Ventilation-Perfusion match (in the normal subject) and mismatch types (ventilation-Perfusion imbalance)? (9%)

In the normal subject, ventilation and perfusion must be matched. A typical resting alveolar ventilation is 4 L/min, while pulmonary artery blood flow is 5 L/min. This yields an overall ratio of ventilation to perfusion of 0.8Ventilation-Perfusion imbalance (3%)(1) Wasted perfusion:Venous admixture (V/Q <0.8).

Underventilated lungs in relation to their perfusion with blood, which is characterized by a decreased ratio of V/Q(<0.8), thus blood passes from pulmonary arteries into pulmonary veins without receiving adequate of oxygen or losing sufficient of carbon dioxide (3%).

(2) Wasted ventilation :Deadspace-like ventilation : In cases of vascular obstruction caused by emboli reduces pulmonary blood flow to certain alveoli. Since ventilation is not typically depressed, so poor perfusion in relation to their ventilation with air, which is then characterized by an increased ratio of V/Q(>0.8) (3%).

77

18. 试卷批阅要求

天津医科大学国际医学院关于规范考试试卷批阅操作的要求为加强留学生批阅试卷的规范化，现将批阅考试试卷操作的有关要求通知如下：

一、批阅试卷统一用红色笔。

二、批阅过程中统一用给分的方法标记每项结果，给分用“+X 分”表示，每题批阅

后统一在题号前写出该题得分。

三、试卷卷首的得分统计表务必填写齐全；阅卷人在试卷首卷上签字。

四、在将各题得分汇总成卷面总成绩时，务必认真细致，保证准确无误。

五、卷面分数如有改动，应由改动人在改动处签名。

各单位务请将以上要求通知到每一位任课教师，并研究具体的检查督促措施。

78

国际医学院

二零零八年十二月十九日

79

19. 成绩分析记录天津医科大学国际学院 - 学年第学期课程考核试卷分

析记录一、基本情况课程名称　课程代码　主讲教师试卷来源 □1.试题库□2.试卷库□3.校内统一命题□4.校外教师命题□5.任课教师命题　阅卷方式 □1.微机阅卷 □2.流水阅卷 □3.任课教师阅卷阅卷教师考试方式 □1.闭卷 □2.开卷 □3.上机 □4.综述 □5.论文 □6.设计 □7.其它考试方法 □1.笔试 □2.口试 □3.实际操作考试对象年级：专业：应考人数实考人数考试时间：

二、成绩分析统计人数　　　　　　　　　　　　　　　　

30 　　　　　　　　　　　　　　　28 　　　　　　　　　　　　　　　　26 　　　　　　　　　　　　　　　　24 　　　　　　　　　　　　　　　　22 　　　　　　　　　　　　　　　　20 　　　　　　　　　　　　　　　　18 　　　　　　　　　　　　　　　　16 　　　　　　　　　　　　　　　　14 　　　　　　　　　　　　　　　　12 　　　　　　　　　　　　　　　　10 　　　　　　　　　　　　　　　　8 　　　　　　　　　　　　　　　　6 　　　　　　　　　　　　　　　　4 　　　　　　　　　　　　　　　　2 　　　　　　　　　　　　　　　　0 　　　　　　　　　　　　　　　　

30 35 40 45 50 55 60 65 70 75 80 85 90 95 100

80

成绩情况最高分 ; 最低分 ; 平均分百分记分制

成绩分布人数百分比成绩＜ 60 　

60 ≤ 成绩 ≤ 65 　65 ＜成绩 ≤ 70 　70 ＜成绩 ≤ 75 　75 ＜成绩 ≤ 80 　80 ＜成绩 ≤ 85 　85 ＜成绩 ≤ 90 　90 ＜成绩 ≤ 95 　95 ＜成绩 ≤ 100 　

三、综合分析难度评价容易□；较容易□；适中□；偏难□；难□；

试题份量偏多□; 适中□; 偏少□; 三基型(基本知识.基本理论.基本技能)( %)；综合运用型( %)；提高扩展型( %)；实际考试所用时间：多数学生在规定时间内完成□；多数学生完不成□；多数学生只用了(1/3□)(1/4□)(2/3□)时间

卷面质量安排合理:是□,否□; 规范用字:是□,否□;笔迹工整:是□,否□;图表准确清晰:是□,否□;

答题出错较多的主要原因 1.试题较难□；2.学生对基本知识、基本理论掌握不扎实□；3.学生分析应用能力较差□； 4.教学过程中有疏漏□；

试题覆盖面 60%以下□；60-69%□；70-79%□；80-89%□；90-100%□。

试卷综合分析与评价　

四、改进意见

　81

课程负责人签字：年月日

82

天津医科大学2011-2012 学年第二学期 2010 级临床医学留学生病理生理学试题分析报

告标题：试卷试题分析标准报告===========================

试卷份数: 30

试卷题数: 47

============

试卷实得分分段人数统计:

满分段,10,9,8,7,6,5,4,3,2,1段,0 分段,平均分数(以下顺序相同)

0 3 11 10 4 0 0 0 1 0 0 0 77.3966

试卷均值：77.3966

试卷难易度：.774

试卷自相关区分度：8.1902

试卷自相关加权区分度：8.1902

================

试题 1题型：　正态分布试题均值：　.7586

试题难易度：　.6897

83

试题自相关区分度：　.3329

试题自相关加权区分度：　.3329

试题互相关区分度：　2.3112

试卷与试题趋势相关系数：　1.3997

该题实得分分段人数统计:

20 0 0 0 0 4 0 0 0 0 0 5 .7586





试题互相关区分度：　-.2738

试卷与试题趋势相关系数：　-.1494


15 0 0 0 0 5 0 0 0 0 0 9 .6034



84



试题互相关区分度：　.3508

试卷与试题趋势相关系数：　.1939


21 0 0 0 0 0 0 0 0 0 0 8 .7241








11 0 0 0 0 13 0 0 0 0 0 5 .6034



85






17 0 0 0 0 3 0 0 0 0 0 9 .6379








26 0 0 0 0 0 0 0 0 0 0 3 .8966

试题 7题型：　正态分布试题均值：　1

试题难易度：　1

86

试题自相关区分度：　0

试题自相关加权区分度：　0

试题互相关区分度：　0

试卷与试题趋势相关系数：　0


29 0 0 0 0 0 0 0 0 0 0 0 1








18 0 0 0 0 6 0 0 0 0 0 5 .7241

试题 9题型：　正态分布试题均值：　1.3793


87






17 0 0 0 0 6 0 0 0 0 0 6 1.3793

试题 10

题型：　正态分布试题均值：　.6897







20 0 0 0 0 0 0 0 0 0 0 9 .6897

试题 11

题型：　正态分布试题均值：　2.8276


88






25 0 0 0 3 0 0 1 0 0 0 0 2.8276

试题 12








3 0 0 0 0 11 0 0 0 0 0 15 .5862

试题 13



89






11 0 0 11 0 4 0 0 0 0 0 3 1.4655

试题 14








22 0 0 0 0 1 0 0 0 0 0 6 1.5517

试题 15



90






17 0 2 0 6 0 0 1 0 0 0 3 2.3793

试题 16








26 0 0 0 0 0 0 0 0 0 0 3 .8966

试题 17

题型：　正态分布试题均值：　1


91






29 0 0 0 0 0 0 0 0 0 0 0 1

试题 18








20 0 0 0 0 0 0 0 0 0 0 9 .6897

试题 19



92






13 0 0 0 0 0 0 0 0 0 0 16 .4483

试题 20








29 0 0 0 0 0 0 0 0 0 0 0 1

试题 21



93






13 0 0 0 0 0 0 0 0 0 0 16 .4483

试题 22








27 0 0 0 0 0 0 0 0 0 0 2 .931

试题 23



94






20 0 0 0 0 0 0 0 0 0 0 9 .6897

试题 24








25 0 0 0 0 0 0 0 0 0 0 4 .8621

试题 25



95






21 0 0 0 0 0 0 0 0 0 0 8 .7241

试题 26








7 0 0 0 0 0 0 0 0 0 0 22 .2414

试题 27



96






7 0 0 0 0 0 0 0 0 0 0 22 .2414

试题 28








6 0 0 0 0 0 0 0 0 0 0 23 .2069

试题 29



97






12 0 0 0 0 0 0 0 0 0 0 17 .4138

试题 30








23 0 0 0 0 0 0 0 0 0 0 6 .7931

试题 31



98






0 0 0 0 0 0 0 0 0 0 0 29 0

试题 32








15 0 0 0 0 0 0 0 0 0 0 14 .5172

试题 33



99






27 0 0 0 0 1 0 0 0 0 0 1 1.8966

试题 34








25 0 0 3 0 1 0 0 0 0 0 0 1.9138

试题 35



100






26 0 0 1 0 2 0 0 0 0 0 0 1.9138

试题 36








24 0 0 2 0 3 0 0 0 0 0 0 1.8621

试题 37



101






23 0 0 3 0 2 0 0 0 0 0 1 1.8103

试题 38








24 0 0 4 0 0 0 0 0 0 0 1 1.8621

试题 39



102






27 0 0 0 0 0 0 0 0 0 0 2 1.8621

试题 40








20 0 0 6 0 2 0 0 0 0 0 1 1.7586

试题 41



103






28 0 0 0 0 0 0 0 0 0 0 1 1.931

试题 42








25 0 0 2 0 1 0 0 0 0 0 1 1.8621

试题 43



104

试题自相关区分度：　1.1986

试题自相关加权区分度：　1.1986




21 0 3 0 1 1 0 1 0 0 0 2 5.1724

试题 44








27 0 0 0 0 0 1 0 1 0 0 0 4.7586

试题 45



105






23 0 2 0 1 0 1 0 0 0 0 2 4.4138

试题 46








18 1 2 2 1 2 2 0 0 0 1 0 10.2069

试题 47



106






4 0 3 5 3 7 0 1 3 2 0 1 7.2414

========================================

============

试题实得分分段人数统计一览表:

满分段,10,9,8,7,6,5,4,3,2,1段,0 分段,平均分数(以下顺序相同)

第 1 题: 20 0 0 0 0 4 0 0 0 0 0 5 .7586

第 2 题: 15 0 0 0 0 5 0 0 0 0 0 9 .6034

第 3 题: 21 0 0 0 0 0 0 0 0 0 0 8 .7241

第 4 题: 11 0 0 0 0 13 0 0 0 0 0 5 .6034

第 5 题: 17 0 0 0 0 3 0 0 0 0 0 9 .6379

第 6 题: 26 0 0 0 0 0 0 0 0 0 0 3 .8966

第 7 题: 29 0 0 0 0 0 0 0 0 0 0 0 1

第 8 题: 18 0 0 0 0 6 0 0 0 0 0 5 .7241

第 9 题: 17 0 0 0 0 6 0 0 0 0 0 6 1.3793

第 10 题: 20 0 0 0 0 0 0 0 0 0 0 9 .6897

第 11 题: 25 0 0 0 3 0 0 1 0 0 0 0 2.8276

107

第 12 题: 3 0 0 0 0 11 0 0 0 0 0 15 .5862

第 13 题: 11 0 0 11 0 4 0 0 0 0 0 3 1.4655

第 14 题: 22 0 0 0 0 1 0 0 0 0 0 6 1.5517

第 15 题: 17 0 2 0 6 0 0 1 0 0 0 3 2.3793

第 16 题: 26 0 0 0 0 0 0 0 0 0 0 3 .8966

第 17 题: 29 0 0 0 0 0 0 0 0 0 0 0 1

第 18 题: 20 0 0 0 0 0 0 0 0 0 0 9 .6897

第 19 题: 13 0 0 0 0 0 0 0 0 0 0 16 .4483

第 20 题: 29 0 0 0 0 0 0 0 0 0 0 0 1

第 21 题: 13 0 0 0 0 0 0 0 0 0 0 16 .4483

第 22 题: 27 0 0 0 0 0 0 0 0 0 0 2 .931

第 23 题: 20 0 0 0 0 0 0 0 0 0 0 9 .6897

第 24 题: 25 0 0 0 0 0 0 0 0 0 0 4 .8621

第 25 题: 21 0 0 0 0 0 0 0 0 0 0 8 .7241

第 26 题: 7 0 0 0 0 0 0 0 0 0 0 22 .2414

第 27 题: 7 0 0 0 0 0 0 0 0 0 0 22 .2414

第 28 题: 6 0 0 0 0 0 0 0 0 0 0 23 .2069

第 29 题: 12 0 0 0 0 0 0 0 0 0 0 17 .4138

第 30 题: 23 0 0 0 0 0 0 0 0 0 0 6 .7931

第 31 题: 0 0 0 0 0 0 0 0 0 0 0 29 0

第 32 题: 15 0 0 0 0 0 0 0 0 0 0 14 .5172

第 33 题: 27 0 0 0 0 1 0 0 0 0 0 1 1.8966

108

第 34 题: 25 0 0 3 0 1 0 0 0 0 0 0 1.9138

第 35 题: 26 0 0 1 0 2 0 0 0 0 0 0 1.9138

第 36 题: 24 0 0 2 0 3 0 0 0 0 0 0 1.8621

第 37 题: 23 0 0 3 0 2 0 0 0 0 0 1 1.8103

第 38 题: 24 0 0 4 0 0 0 0 0 0 0 1 1.8621

第 39 题: 27 0 0 0 0 0 0 0 0 0 0 2 1.8621

第 40 题: 20 0 0 6 0 2 0 0 0 0 0 1 1.7586

第 41 题: 28 0 0 0 0 0 0 0 0 0 0 1 1.931

第 42 题: 25 0 0 2 0 1 0 0 0 0 0 1 1.8621

第 43 题: 21 0 3 0 1 1 0 1 0 0 0 2 5.1724

第 44 题: 27 0 0 0 0 0 1 0 1 0 0 0 4.7586

第 45 题: 23 0 2 0 1 0 1 0 0 0 0 2 4.4138

第 46 题: 18 1 2 2 1 2 2 0 0 0 1 0 10.2069

第 47 题: 4 0 3 5 3 7 0 1 3 2 0 1 7.2414

试卷各题按各卷总分由高至低排列的分数一览表========================================

==

情况说明1. 命题主要考核点及大纲要求：

本课程要求学生掌握病理生理学基本概念，机制及对机体的影响。在本次考试中，有名词解释、简答题、判断题、论述题和单选题，用于考察学生对基础知识掌握情况、综合分析

109

问题能力情况。2. 命题难易程度、覆盖面：命题难易程度适中。在本次考试中，命题全面覆盖了教学大纲要求的知识面，覆盖面较好。3. 学生掌握情况及存在问题分析：

1）通过阅卷和各题型得分的分析，可知：试卷中选择题得分率较高，试题难易度 P值符合国内标准，说明学生对基本概念普遍

掌握较好，知识点较扎实。2）影响考试成绩的因素及应注意的问题：① 个别学生学习的目的性和自主性较差，受周围环境影响，学习比较浮躁。②一些学生学习该课程的方法还需改进，在学习或复习时缺乏对相关知识的融会贯通。个别学生不能较好地在整体水平理解物质代谢以及相关联系，导致分数偏低。

4. 任课教师为提高教学质量今后应采取的措施：1）本门课程授课内容多，因此授课教师在课堂上加强学生专业英文词汇的学习，帮助学生尽快进入学习状态。2）课程中重要知识点布置课下练习，督促学生及时完成。严格要求学生，必须独立完成作业。3）在教学活动中，采取多种教学手段来激发学生的学习兴趣，注意对学生学习方法

的正确引导。4）在教学过程中多与学生辅导员沟通，及时反映学生的情况，通过辅导员做好学生

的思想工作，引导他们尽快转换学习方法，增加自我控制的能力。

110

20. 试卷保存登记表天津医科大学国际医学院试卷保存登记表

课程名称学时学分考试时间适用专业出题教师审定人试卷号

注：该表中的试卷号要同时在电子文档试卷中注明21. 专家听课评价表

112

天津医科大学国际医学院专家听课记录表授课教师所在院系：年月日星期第节至第节

课程名称授课教师职称教材版本教室教学班号

授课主要内容

授课主要优点、特点及改进建议

听课教师：备注

113

22. 同行听课评价表天津医科大学国际医学院同行听课评价表

开课单位：课程名称： □ 公共基础课 □ 学科基础课 □ 专业课授课教师：年龄层次：□老 □中 □青授课班级：应到人数：实到人数教材版本：课堂讲授内容：听课后总体印象：□优 □良 □中 □差听课后的分项评价：请在下列各评价项目之后的相应评价等级位置填入您的选项，只限单选。选项标准：A完全同意，B 同意，C一般，D 不同意，E完全不同意

评价项目 A B C D E

1 讲课有热情，精神饱满2 讲课有感染力，能吸引学生的注意力3 对问题的阐述深入浅出，有启发性4 对问题的阐述简练准确，重点突出，思路清晰5 对课程内容娴熟，运用自如6 讲述内容充实，信息量大

7教学内容能反映或联系学科发展的新思路，新概念，新成果

8 能给予学生思考、联想、创新的启迪9 能调动学生情绪，课堂气氛活跃10 能有效地利用各种教学媒体11 学生上课迟到、早退、缺勤等情况12 学生遵守课堂纪律情况

114

13 学生听课学习状态对课堂内容或其它方面的具体意见或建议：

天津医科大学国际学院 2008.9制表听课人签字：听课时间：地点：

23. 学生听课反馈表Teaching Evaluation

Pathophysiology Department

Semester: Date:

Course: PATHOPHYSIOLOGY

Topic of Course

Teacher’s Name

Evaluation:

Suggestion:

115

24. 学生反馈评价表Pathophysiology Teaching Feedback

This form is a serious attempt to get feedback from you regarding the quality of instruction you have received. Your honest and constructive opinion will be helpful to improve our teaching level. Please take your time and answer carefully all the questions below, where appropriate, according to the following scale.

1. What was the most impressive thing when you were learning

Pathophysiology (about teacher, chapter or others)?

2. What aspects of this course were most beneficial to you?

3. What do you suggest for this course?

117

25. 教研室备课记录

____________学年第______学期基础医学院教学备课记录

年月日教研室主讲人参加人员

学生年级、专业

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备课内容摘要

119

€¦ · web view课程名称：病理生理学 . 课程时间：第4学期. 课程安排:...

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