《诊断学=Textbook of Diagnostics：英文改编版》根据教育部《来华留学生医学本科教育（英语授课）质量控制标准暂行规定》，本着“内容遵循原著”的原则，以DeGowin’s Diagnostic Examination（ninth Edition）等为改编蓝本，对双语《诊断学》第1版进行修订，《诊断学=Textbook of Diagnostics：英文改编版》共分十七章。
目錄：
CONTENTS
Introduction 1
Chapter 1 Common Symptoms and History Taking 3
Chapter 2 History Taking and the Medical Record 22
Chapter 3 Physical Examination 31
Chapter 4 Vital Signs and Anthropomorphic Data 38
Chapter 5 Head 48
Chapter 6 Neck 60
Chapter 7 Chest 62
Chapter 8 Abdomen 111
Chapter 9 Anus， Rectum and Genitalia 124
Chapter 10 Spine and Extremities 137
Chapter 11 The Neurologic Examination 146
Chapter 12 Electrocardiography 159
Chapter 13 Principles of Diagnostic Testing 186
Chapter 14 Common Laboratory Tests 191
Chapter 15 Blood Chemistries 196
Chapter 16 Urinalysis 207
Chapter 17 Tests of Body Fluid 209
Appendix English-Chinese Vocabulary 211免费在线读Introduction
Why is Diagnosis Important?
The history and physical examination are the basis for diagnostic hypothesis generation; the first step in the diagnostic process. Accurate diagnosis precedes the three tasks central to the healing professions： ex-planation， prognostication， and therapy. These three tasks have been consistently performed by physicians throughout time and across cultures， regardless of the belief system or theory underpinning the practice： magic， faith， rationalism， or science. They provide answers to the patient’s three fundamental questions：① What is happening to me and why? ② What does this mean for my future? ③ What can be done about it and how will that change my future?
Failure to pursue a diagnosis may permit a disease to progress from curable to incurable. On the other hand， for many complaints， in otherwise healthy people with no alarm symptoms or signs， a good prognosis can be ascertained without knowing the ex-act cause of the complaint， as， for instance， an upper respiratory infection. The experienced clinician can reassure the patient that further testing is unnecessary and will not change the prognosis or treatment. It takes experience， knowledge of the medical literature， good judgment， and an understanding of the funda-mentals of clinical epidemiology and decision making to determine when pursuit of specific symptoms and signs is warranted.
The Diagnostic Examination
To reach accurate and comprehensive diagnoses， the clinician must catalog each abnormality of the pa-tient’s anatomic structure， physiologic function， and mentation. Every disease has a temporal sequence of clinical and laboratory features that differentiate it from similar conditions. During the diagnostic exam-ination， the clinician is performing two parallel tasks：① developing a problem list of the symptoms and signs requiring explanation; ② and generating physi-ologic， anatomic， and etiologic hypotheses regarding the diagnoses. Use a recursive process to work your way toward the diagnosis. First， from the history and physical examination， generate a problem list. Then make a list of possible diagnoses based upon the most probable anatomic sites and pathophysiologic process explaining the problems. Next， using the specific characteristics of this patient， differentiate the prob-abilities of each disease on your list for this patient： this is the differential diagnosis， each with a pretest probability. Now， choosing tests with appropriate likelihood ratios， these hypotheses are tested using laboratory and imaging tests this is why they call them “tests， ” they test the hypothesis. The results of the testing changes the probability of each hypothesis to the post-test probability： some are now much more probable， while others are much less probable. The clinician returns to the patient， reviews the history，and repeats specific parts of the examination to reach a new， refined differential diagnosis to be tested more specifically. This process repeats， each time returning to the patient for their ongoing history and to search for new or changing physical findings， until one or more specific diagnoses are established that fully ex-plain the patient’s illness.
The Diagnostic Hypotheses
In ranking your list or possible diagnoses， matching of the patient’s attributes with those of the hypotheti-cal disease is usually inconclusive. Several additional criteria should be applied to help identify the most likely diagnosis.
Parsimony
A diagnosis has a higher probability of being correct if it can account for all of the symptoms and signs. This is Occam’s razor： the simplest solution is likely to be correct. When one diagnosis does not explain all the findings， those that are able to account for the greatest proportion of the patient’s signs and symp-toms are more likely to be correct. Parsimony is most applicable to the previously well patient with an acute or subactue disease， the most common clinical chal-lenge faced by Sir William Osler who introduced Oc-cam’s razor to medicine. As we care for more patients with one or more chronic disease on multiple medi-cations， bear in mind that more than one pathologic process may be occurring in your patient; finding one disease or condition should not stop a vigilant search for additional problems.
Chronology
It is possible to have a perfect match of attributes between patient and disease， but if the epidemiology， onset， tempo and course of illness are not appropriate to the disease， the hypothesis is probably wrong.
Severity of Illness
Not infrequently， an inexperienced clinician will diagnose the patient’s condition as， for instance， an upper respiratory infection， whereas a more experi-enced clinician will look at the patient and suggest the diagnosis of pneumonia， explaining that the patient looks “too sick” for the first condition. The severity of illness is valid and diagnostically useful， but it is di
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