diff --git "a/Licensed/Theory_Questions/Year_1/Mock.json" "b/Licensed/Theory_Questions/Year_1/Mock.json" new file mode 100644--- /dev/null +++ "b/Licensed/Theory_Questions/Year_1/Mock.json" @@ -0,0 +1,6242 @@ +[ + { + "question_num": 1, + "query": "“吐下之余,定无完气”的理论依据是", + "options": { + "A": "气能生津", + "B": "气能行津", + "C": "气能摄津", + "D": "津能生气", + "E": "津能载气" + }, + "answer": "E", + "reason": "津能载气,津液大量耗失,气失其依附而出现暴脱亡失的病理变化,如《金匮要略心典·痰饮篇》说:“吐下之余,定无完气。”" + }, + { + "question_num": 2, + "query": "慢性上腹痛,呕吐后缓解,可见于", + "options": { + "A": "胆石症", + "B": "反流性食管炎", + "C": "幽门梗阻", + "D": "慢性阑尾炎", + "E": "溃疡病" + }, + "answer": "C", + "reason": "腹痛特点包括部位、性质和缀解因素等，对诊断有帮助，幽门梗阻时，因失误难以通过幽门进人十二指肠,故食物堆积在胃内而引起上腹胀痛，当呕吐后会明显好转,特别是吐出隔夜食物更有诊断意义,故选C,其余疾病均与此不符。" + }, + { + "question_num": 3, + "query": "古人采用验痰和验口味的方法以诊断的疾患是", + "options": { + "A": "肺痨", + "B": "肺痈", + "C": "哮病", + "D": "喘证", + "E": "咳嗽" + }, + "answer": "B", + "reason": "验痰法:肺痈思者咳，吐在水中，沉者是痈脓,浮者是痰。《医学人门·卷五·肺痈肺》说:“肺痈……,咳唾脓血腥臭,置之水中则沉。”验口味:肺痈患者吃生黄豆或生豆汁不觉其腥。《寿世保元·肺痈》曾说:“用黄豆一粒,子病人口嚼,不觉豆之气味,是肺痈也。”" + }, + { + "question_num": 4, + "query": "血栓性浅静脉炎的发病原因是", + "options": { + "A": "寒湿之邪外侵", + "B": "湿热之邪外侵", + "C": "外感风热之邪", + "D": "肝肾不足,气虚血亏", + "E": "胃积热下迫" + }, + "answer": "B", + "reason": "血栓性浅静脉炎因湿邪为患,与热搏结致使气血不畅形成。" + }, + { + "question_num": 5, + "query": "在病理状态下会出现“清气在下,则生飧泄”的脏腑是", + "options": { + "A": "肝", + "B": "心", + "C": "脾", + "D": "肺", + "E": "肾" + }, + "answer": "C", + "reason": "在病理上,脾气不升,水谷夹杂而下将出现泄泻其则完谷不化，正如《素问·阴阳应象大论》说:“清气在下,则生飧泄。”" + }, + { + "question_num": 6, + "query": "持续性胸痛常由下列疾病引起,但除外", + "options": { + "A": "心绞痛", + "B": "肺栓塞", + "C": "胸膜炎", + "D": "肺炎", + "E": "急性心包炎" + }, + "answer": "A", + "reason": "胸痛持续的时间长短因引起的疾病不同而异,炎症(如胸膜炎、肺炎、急性心包炎)栓塞或梗死(如肺栓塞和心肌梗死)肿瘤(如肺癌胸转移)等所致的胸痛一般均呈持续性,而由血管痉李狭窄引起的缺血性疼痛(如心绞痛)常是阵发性的。" + }, + { + "question_num": 7, + "query": "下列各项,不是实证不寐的病理因素的是", + "options": { + "A": "肝郁化火", + "B": "心肾不交", + "C": "食滞", + "D": "痰浊", + "E": "胃腑不和" + }, + "answer": "B", + "reason": "不寐的病机有虚实之分,实证由肝郁化火,痰热内扰,阳盛不得人于阴而致;虚证多由心脾两虚,心虚胆怯,心肾不交,水火不济,心神失养,阴虚不能纳阳而发。" + }, + { + "question_num": 8, + "query": "以疾病特性命名的外科疾病是", + "options": { + "A": "背疽", + "B": "肺痈", + "C": "破伤风", + "D": "白驳风", + "E": "流注" + }, + "answer": "E", + "reason": "A项为部位命名,B项为脏腑命名,C项为病因命名，D项为颜色命名,E项为疾病特性命名,故选E。" + }, + { + "question_num": 9, + "query": "有机整体的“中心”是", + "options": { + "A": "脑", + "B": "心", + "C": "五脏", + "D": "经络", + "E": "脏腑" + }, + "answer": "C", + "reason": "整体观念。五脏、六腑、奇恒之腑、形体、官窍、四肢百骸等复杂的组织结构,在经络系统“内属于脏腑,外络于肢节”的联络作用下,经精、气、血、津液等物质的作用,构成了以五脏为中心，以心为主宰的内外联系、自我调节和自我适应的有机整体。有机整体的“中心”是五脏。" + }, + { + "question_num": 10, + "query": "长期使用解热药或激素类药后,常出现的热型是", + "options": { + "A": "消耗热", + "B": "不规则热", + "C": "回归热", + "D": "稽留热", + "E": "弛张热" + }, + "answer": "B", + "reason": "因解热药或糖皮质激素的应用,可使某些疾病的特征性热型变得不典型或是不规则热型。" + }, + { + "question_num": 11, + "query": "咳嗽初起,用药不当,易致“闭门留寇”下列哪类药物最为明显", + "options": { + "A": "镇咳药", + "B": "通下药", + "C": "温补药", + "D": "苦寒药", + "E": "收涩药" + }, + "answer": "E", + "reason": "收涩之药大多数性味酸涩,主要作用是收敛固涩,若应用于咳嗽初起,邪气正盛之时,必然导致邪气滞留,邪恋正虚,病情难以治愈。" + }, + { + "question_num": 12, + "query": "下列不属于痈的是", + "options": { + "A": "颈痈", + "B": "腋痈", + "C": "臀痈", + "D": "脐痈", + "E": "委中毒" + }, + "answer": "C", + "reason": "痈包括颈痈、腋痈、脐痈、委中毒。臀拥和锁喉痈屈于发。" + }, + { + "question_num": 13, + "query": "《素问·五脏生成篇》说:多食甘,则", + "options": { + "A": "肉胝而唇揭", + "B": "骨痛而发落", + "C": "脉急而爪枯", + "D": "脉凝泣而变色", + "E": "皮槁而毛拔" + }, + "answer": "B", + "reason": "多食咸,则脉凝泣而变色;多食苦,则皮槁而毛拔;多食辛,则筋急而爪枯;多食酸,则肉胝而唇揭;多食甘,则骨痛而发落." + }, + { + "question_num": 14, + "query": "对放射治疗最敏感的肺癌是", + "options": { + "A": "鳞癌", + "B": "腺癌", + "C": "肺泡癌", + "D": "小细胞肺癌", + "E": "大细胞肺癌" + }, + "answer": "D", + "reason": "手术治疗为非小细胞肺癌的主要治疗方法,鳞癌比腺癌和大细胞癌术后效果好。小细胞肺癌主张先化疗、后手术。放疗对小细胞肺癌效果较好,其次为鳞癌和腺癌。" + }, + { + "question_num": 15, + "query": "治疗胃痛饮食停滞证，应首选", + "options": { + "A": "良附丸", + "B": "理中汤", + "C": "保和丸", + "D": "小建中汤", + "E": "大建中汤" + }, + "answer": "C", + "reason": "胃痛有明显的伤食史,吐不消化食物,食积中阻,故脘腹胀满,吸腐吞酸,治宜消食导滞,用保和丸,故选C。寒邪客、气寒凝用良附丸。脾阳虚用理中丸、大小建中汤。" + }, + { + "question_num": 16, + "query": "下列各项,不属辨认成脓方法的是", + "options": { + "A": "按触法", + "B": "推拿法", + "C": "穿刺法", + "D": "透光法", + "E": "点压法" + }, + "answer": "B", + "reason": "按触法、穿刺法、点压法、透光法属于辨脓的方法,而推拿法则属于禁忌证。" + }, + { + "question_num": 17, + "query": "“动极者镇之以静,阴亢者胜之以阳”说明了阴阳之间的什么关系", + "options": { + "A": "阴阳对立", + "B": "阴阳互根", + "C": "阴阳平衡", + "D": "阴阳转化", + "E": "阴阳制约" + }, + "answer": "E", + "reason": "《类经附·医易》“动极者镇之以静,阴亢者胜之以阳”,说明了动与静、阴与阳的相互制约的关系。以静镇动,以阳胜阴,是阴阳之间相互制约关系的具体应用。" + }, + { + "question_num": 18, + "query": "对急性支气管炎与流行性感冒的鉴别，最有意义的是", + "options": { + "A": "发热", + "B": "咳痰", + "C": "肺部啰音", + "D": "白细胞计数", + "E": "流行病学史" + }, + "answer": "E", + "reason": "发热、咳痰等为急性支气管炎和流行性感冒都可具有的临床表现，急性支气管炎和流行性感冒若无合并并发症的话基本不会有肺部啰音。" + }, + { + "question_num": 19, + "query": "痰饮的治疗原则为", + "options": { + "A": "宣肺", + "B": "健脾", + "C": "温化", + "D": "补肾", + "E": "发汗" + }, + "answer": "C", + "reason": "痰伙总的病理性质是阳虚阴盛,为阴邪,遇寒则凝,得温则行,故总的治疗原则应以温阳化饮为根本,以振奋阳气，开发理,通行水道,故选C;若有肺失宣降,可佐以宣肺,脾阳虚可健脾,肾阳虚可补肾,饮停于表可发汗,但这些都是配合方法，总的治则还是温化，故排除ABD" + }, + { + "question_num": 20, + "query": "溃疡疮口太小,脓腐难去,常用的腐蚀药是", + "options": { + "A": "红灵丹", + "B": "白降丹", + "C": "七三丹", + "D": "八宝丹", + "E": "九黄丹" + }, + "answer": "B", + "reason": "白降丹,适用于溃疡疮口太小,脓腐难去,用桑皮纸或丝绵纸做成裹药,插人疮口，使疮口开大,脓腐易出。" + }, + { + "question_num": 21, + "query": "说肺为娇脏的主要依据是", + "options": { + "A": "肺主一身之气", + "B": "肺外合皮毛", + "C": "肺朝百脉", + "D": "肺为水之上源", + "E": "肺气通于天,不耐寒热" + }, + "answer": "E", + "reason": "肺为娇脏,是指肺为清虚之脏,轻清肃静,不容纤芥,不耐邪气之侵,肺气通于天,不耐寒热,故为娇嫩之��。" + }, + { + "question_num": 22, + "query": "巨大脾脏常见于", + "options": { + "A": "急性粒细胞白血病", + "B": "慢性粒细胞白血病", + "C": "急性淋巴细胞白血病", + "D": "慢性淋巴细胞白血病", + "E": "肝硬化脾功能亢进" + }, + "answer": "B", + "reason": "巨大脾脏可见于慢性粒细胞白血病急性变,故选B。急性白血病、肝硬化脾功能亢进时可见脾大,但多为轻至中度。" + }, + { + "question_num": 23, + "query": "胸痹气阴两虚证胸痛的类型为", + "options": { + "A": "胸闷重而心痛微", + "B": "心胸隐痛", + "C": "心痛如绞", + "D": "心痛憋闷或灼痛", + "E": "心悸而痛" + }, + "answer": "B", + "reason": "胸痹气阴两虚证证候:心胸隐痛,时作时休,心悸气短,动则益甚,伴倦怠乏力,声息低微面色白易汗出,舌质淡红,舌体胖且边有齿痕,苔薄白,脉虚细级或结代。" + }, + { + "question_num": 24, + "query": "不属溻渍法适应证的是", + "options": { + "A": "阳证疮疡初起", + "B": "阴证疮疡", + "C": "美容", + "D": "保健", + "E": "创面干燥,僵而不敛" + }, + "answer": "E", + "reason": "溻是将饱含药液的纱布或棉絮湿敷患处,淡是将患处浸泡在药液中。溻渍法是通过湿敷淋洗、浸泡对患处的物理作用,以及不同药物对患部的药效作用，从而达到治疗目的的一种方法。湖溃法用于阳证疮疡初期、半阴半阳证及阴证疮疡、美容、保健等。" + }, + { + "question_num": 25, + "query": "治疗血行瘀滞,多配用补气、行气药,是由于", + "options": { + "A": "气能生血", + "B": "气能行血", + "C": "气能摄血", + "D": "血能生气", + "E": "血能载气" + }, + "answer": "B", + "reason": "气与血的关系:气能生血;气能行血;气能摄血,而为气母。血屈阴而主静，血波不能自行其循行有赖于气的推动。气行则血行，气潜则血瘀;故治疗血行瘀滞,多配用补气、行气药。" + }, + { + "question_num": 26, + "query": "长期服用某些抗生素,可产生", + "options": { + "A": "黄腻苔", + "B": "白腻苔", + "C": "积粉苔", + "D": "剥落苔", + "E": "黑腻苔" + }, + "answer": "E", + "reason": "饮食或药品对舌苔的影响:①过食肥甘之品及服大量镇静剂--舌苔厚腻;②长期服用抗生素--舌苔黑腻或霉腐苔;③某些饮食或药物,会使舌苔染色,称为染苔,如牛奶、豆浆、钡剂、椰汁等可使舌苔变自、变厚。" + }, + { + "question_num": 27, + "query": "肺痨的外在致病因素是", + "options": { + "A": "燥邪", + "B": "痨虫", + "C": "痰浊", + "D": "瘀血", + "E": "水饮" + }, + "answer": "B", + "reason": "肺痨的外在致病因素是感染“痨虫”" + }, + { + "question_num": 28, + "query": "下列哪项不是疖病的临床特点", + "options": { + "A": "好发于项后发际部、臀部", + "B": "好发于冬、春季节", + "C": "好发于消渴患者", + "D": "可发生于身体各处", + "E": "此愈彼起,日久不愈,反复发作" + }, + "answer": "B", + "reason": "疖是一种生于皮肤浅表的急性化脓性疾患,随处可生,小儿、青年多见。本病多发于发际、背部、臀部,但有因治疗或护理不当形成“姑疖”，或反复发作、日久不愈的“多发性疖病”,则不易治愈。消渴病患者或脾虚便溏患者,病久后气阴双亏,容易感染邪毒，而致多发性疖病。" + }, + { + "question_num": 29, + "query": "十二经脉之气“结、聚、散、络”于关节的体系是", + "options": { + "A": "浮络", + "B": "经筋", + "C": "别络", + "D": "孙络", + "E": "经别" + }, + "answer": "B", + "reason": "十二经筋是十二经脉之气“结、聚散、络”于筋肉、关节的体系,是十二经脉的附属部分是十二经脉循行部位上分布于筋肉系统的总称，它有连缀百骸,维络周身,主司关节运动的作用。" + }, + { + "question_num": 30, + "query": "肺心病肺动脉高压形成的主要原因是", + "options": { + "A": "肺细小动脉痉挛", + "B": "肺血管玻璃样改变", + "C": "血容量增加", + "D": "右心室肥大", + "E": "左心衰竭" + }, + "answer": "A", + "reason": "肺心病最常见的病因是COPDCOPD可引起缺氧,缺氧又可导致肺部细小动脉痉挛促使肺血管构型改建,无肌细动脉肌化、肺小动脉中膜增生肥厚,导致肺部循环阻力的升高,使肺动脉压升高,最终导致右心室肥大、扩张,其中,肺细小动脉痉挛起了关键性作用。" + }, + { + "question_num": 31, + "query": "肺胀晚期病变为主的脏是", + "options": { + "A": "肺、脾、肝", + "B": "肺、脾、心", + "C": "肺、肾、心", + "D": "脾、肾、心", + "E": "肺、肝、肾" + }, + "answer": "D", + "reason": "肺胀为本虚标实。早期在肺,继则影响脾、肾,后期病及于心。因肺为气之主，将为气之根金不生水,肺伤及肾。子盗母气,肺气虚导致脾气虚后期脾肾阳虚水饮泛溢，上凌于心。" + }, + { + "question_num": 32, + "query": "调制箍围药,取其清凉解毒作用的,应选用", + "options": { + "A": "醋", + "B": "葱", + "C": "鸡子清", + "D": "麻油", + "E": "丝瓜叶汁" + }, + "answer": "E", + "reason": "以醋调者,取其散瘀解毒;以酒调者取其助行药力;以葱、姜、韭、蒜捣汁调者,取其辛香散邪;以菊花汁、丝瓜叶汁、银花调者,取其清凉解，而其中用丝瓜叶汁调制的玉露治疗暑天疖肿效果较好;以鸡子清调者,取其缓和刺激;以油类调者取其润泽肌肤。" + }, + { + "question_num": 33, + "query": "“寒从中生”的主要机制是", + "options": { + "A": "肺气不足,寒饮内停", + "B": "胸阳不振,阴寒内盛", + "C": "恣食生冷,寒伤中阳", + "D": "脾肾阳气不足,阴寒内盛", + "E": "痰湿内阻,从阴化寒" + }, + "answer": "D", + "reason": "寒从中生是指机体阳气虚衰,温煦气化功能减退,虚寒内生的病理变化。寒从中生与肾阳虚不足有关。脾为后天之本,为气血生化之源,脾阳能达于肌肉四肢。肾阳为人身阳气之根,能温煦全身脏腑组织,故脾肾阳气虚衰,则温煦失职;最易表现虚寒之象,而尤以肾阳虚衰为关键。" + }, + { + "question_num": 34, + "query": "肺癌由原发癌肿引起的症状是", + "options": { + "A": "咳嗽,咯血,胸闷,气急", + "B": "胸痛", + "C": "吞咽困难", + "D": "头痛,呕吐,共济失调", + "E": "厌食,肝区疼痛,黄疸" + }, + "answer": "A", + "reason": "咳嗽是原发癌肿引起的肺癌最常见的早期症状,另外,咯血、喘鸣、胸闷、气急、体重下降发热也是原发癌肿引起的主要症状。而胸痛、吞咽困了H区疼痛等是肝外转移引起的症状。" + }, + { + "question_num": 35, + "query": "辛凉解表平剂代表力刀", + "options": { + "A": "银翘散", + "B": "桑菊饮", + "C": "白虎汤", + "D": "麻杏石甘汤", + "E": "小青龙汤" + }, + "answer": "A", + "reason": "桑菊饮为辛凉轻剂,银翘散为辛凉平剂,白虎汤为辛凉重剂。" + }, + { + "question_num": 36, + "query": "外科辨肿，“肿而皮肉重垂胀急,深则按之如烂棉不起,浅则光亮如水疱,破流黄水”其成因属", + "options": { + "A": "风", + "B": "虚", + "C": "火", + "D": "湿", + "E": "痰" + }, + "answer": "D", + "reason": "湿肿而皮肉重垂胀急,深则按之如烂棉不起,浅则光亮如水疤,搔破流黄水,浸淫皮肤。" + }, + { + "question_num": 37, + "query": "气机升降出人的枢纽是", + "options": { + "A": "肝肺", + "B": "肺肾", + "C": "脾胃", + "D": "肝胆", + "E": "心肾" + }, + "answer": "C", + "reason": "胃气以下行为顺,胃气和降,则水谷得以下行。脾气以上行为顺,脾气上升,精微物质得以上输,所以气机升降出人的枢纽是脾胃" + }, + { + "question_num": 38, + "query": "左心衰竭时，最早出现和最重要的症状是", + "options": { + "A": "咳嗽", + "B": "咯痰", + "C": "咯血", + "D": "乏力", + "E": "呼吸困难" + }, + "answer": "E", + "reason": "左心衰竭以肺淤血及心排血量降低表现为主,其中呼吸困难是左心衰竭最早出现和最重要的症状,咳嗽、咯痰、咯血、乏力同时也是左心衰竭的症状,但最早出现和最重要症状是呼吸困难。" + }, + { + "question_num": 39, + "query": "肺痈溃脓期的治法是", + "options": { + "A": "清肺化瘀消痈", + "B": "养阴补肺消痈", + "C": "清肺解表", + "D": "排脓解毒", + "E": "清热解毒" + }, + "answer": "D", + "reason": "肺痈初期宜疏散风热,清肺散邪,用银翘散。成痈期宜清肺解毒,化瘀消痈,用千金苇茎汤合如金解毒散。溃脓期应排脓解毒，用加味桔梗汤。恢复期应养阴益气清肺,用沙参清肺汤或桔梗杏仁煎。" + }, + { + "question_num": 40, + "query": "以下哪项不是失荣的临床特征", + "options": { + "A": "面容憔悴", + "B": "舌体萎缩", + "C": "形体消瘦", + "D": "状如枯树", + "E": "颈部或耳前后肿块" + }, + "answer": "B", + "reason": "失荣指颈部或耳前后肿块,伴面容憔悴、形体消瘦、状如枯树。" + }, + { + "question_num": 41, + "query": "元气耗损和功能减退,脏腑功能低下抗病能力下降的病机是", + "options": { + "A": "气虚", + "B": "气脱", + "C": "血虚", + "D": "津亏", + "E": "气陷" + }, + "answer": "A", + "reason": "气虚,是指气的推动、温煦、防御、固摄和气化功能的减退，从而导致机体的某些功能活动低下或衰退,抗病能力下降等衰弱的现象;气脱，是指气不能内守而外脱,不符合本题,排除B;气陷,是气的上升不及或下降太过，排除E;元气耗损和功能减退,与血和津液无关,排除CD。" + }, + { + "question_num": 42, + "query": "肺结核化疗时,一线强化每日用药的药物组成为", + "options": { + "A": "异烟肼+对氨基水杨酸+卷曲霉素", + "B": "异烟肼+利福平", + "C": "异烟肼+乙胺丁醇", + "D": "异烟肼+对氨基水杨酸", + "E": "异烟肼+链霉素+利福平" + }, + "answer": "E", + "reason": "目前国内第一线抗结核药:异烟肼、利福平、链霉素、吡嗪酰胺。特点:疗效好,毒性低。" + }, + { + "question_num": 43, + "query": "肺痈患者,咳吐大量脓血痰,气味腥臭异常,舌红苔黄腻,脉滑数,其病期是", + "options": { + "A": "初期", + "B": "成痈期", + "C": "溃脓期", + "D": "恢复期", + "E": "慢性期" + }, + "answer": "C", + "reason": "肺痈分初期、成脓期、溃脓期、恢复期。溃脓期的特点是咳吐大量脓血痰,气味腥臭异常。" + }, + { + "question_num": 44, + "query": "以下哪种病易引起肺梗死", + "options": { + "A": "廉疮", + "B": "脱疽", + "C": "股肿", + "D": "青蛇毒", + "E": "压疮" + }, + "answer": "C", + "reason": "股肿的并发症。股肿如果血栓脱落,可引起肺栓塞。" + }, + { + "question_num": 45, + "query": "可用阴阳互根互用解释的是", + "options": { + "A": "寒极生热", + "B": "阴病治阳", + "C": "阴中求阳", + "D": "寒者热之", + "E": "重阴必阳" + }, + "answer": "C", + "reason": "寒极生热,说明了阴阳相互转化的关系;阴病治阳,是指用补阳的方法治疗阳虚不能制阴所引起的阴病;阴中求阳,是在补阳的基础上配合补阴的方法,是阴阳互根互用关系的具体体现;寒者热之即以热治寒，是阴阳相互制约关系的具体体现;重阴必阳，是阴阳相互转化关系的具体体现。" + }, + { + "question_num": 46, + "query": "典型心绞痛患者,含服硝酸甘油片后，缓解的时间一般是", + "options": { + "A": "21~30分钟", + "B": "1~2分钟", + "C": "5~10分钟", + "D": "11~20分钟", + "E": "15分钟之内" + }, + "answer": "B", + "reason": "典型心绞痛发作是突然发生的位于胸骨体上段或中段之后的压榨性、闷胀性或窒息性疼痛,亦可能波及大部分心前区,可放射至左肩左上肢前内侧,舌下含硝酸甘油,如有效心绞痛应于1~3分钟内缓解。" + }, + { + "question_num": 47, + "query": "痫病与五脏均有关联,但主要责之于", + "options": { + "A": "肺、心", + "B": "肝、肾", + "C": "心、肝", + "D": "肺、肝", + "E": "肝、脾" + }, + "answer": "C", + "reason": "痈病的表现主要:①精神恍惚,昏不知人,责之于心;②口吐涎沫,两目上视,四肢抽搐;肝主筋,筋脉拘挛,责之于肝" + }, + { + "question_num": 48, + "query": "正确的乳房检查方法是", + "options": { + "A": "以手掌放于乳房上轻轻按摩", + "B": "四指并拢,用指腹平放于乳房上轻柔按摩", + "C": "以食指先触到肿物,并仔细区别与周围组织的关系", + "D": "以食指首先触摸是否有肿物存在,并注意是否活动", + "E": "以手托起乳房,用另一手仔细触摸" + }, + "answer": "B", + "reason": "先检查健侧乳房,再检査患侧,以便对比。将手指并拢平放乳房上轻轻按触，切勿用手指去抓捏，否则会将所抓捏的腺体组织错误地认为乳房肿块。以乳头为中心，将乳房分为四个象限，依次检查乳房外上(包括腋尾部)-外下-内下→内上各象限及中央区做全面检查。先查健侧，后查思侧,故选B。" + }, + { + "question_num": 49, + "query": "中医之“证”的含义是", + "options": { + "A": "症状和体征的总称", + "B": "认识疾病的过程中所确立的证候", + "C": "疾病过程中某一阶段或某一类型的病理概括", + "D": "疾病过程中表现出的个别、孤立的现象", + "E": "选择适当的治疗和措施来处理疾病的思维和实践过程" + }, + "answer": "C", + "reason": "证,即证候,是疾病过程中某一阶段或某一类型的病理概括,一般由一组相对固定的、有内在联系的、能揭示疾病某一阶段或某一类型病变本质的症状和体征构成。" + }, + { + "question_num": 50, + "query": "下列哪项不是自发性心绞痛的特点", + "options": { + "A": "休息或夜间发作", + "B": "可持续15~30分钟", + "C": "含服硝酸甘油片不易缓解", + "D": "心电图出现异常Q波", + "E": "血清酶一般正常" + }, + "answer": "D", + "reason": "心电图出现异常Q波为陈旧性心肌梗死的表现,而非自发性心绞痛。自发性心绞痛可于非体力活动时发作,病情加重则含服硝酸甘油不级解,持续时间较稳定性心绞痛长,但血清酶一般正常此点与心肌梗死区别。" + }, + { + "question_num": 51, + "query": "治疗痫病风痰闭阻址,应首选", + "options": { + "A": "定痫丸", + "B": "涤痰汤", + "C": "生铁落饮", + "D": "顺气导痰汤", + "E": "羚角钩藤汤" + }, + "answer": "A", + "reason": "痫病的病因病机为风火气痰瘀,蒙蔽心窍,壅塞经络,气机逆乱,元神失控。风痰闭阻者应豁痰息风,开窍定痫,用定痫丸合适,其余选项或只祛痰,或只息风,不能开窍定痫。" + }, + { + "question_num": 52, + "query": "在肿块触诊中,不属癌性肿块特性的是", + "options": { + "A": "高低不平", + "B": "坚硬如石", + "C": "推之不能移动", + "D": "表面与皮肤粘连", + "E": "表面光滑" + }, + "answer": "E", + "reason": "ABCD项都可以成为癌症肿块的特征,而表面光滑很明显不属于癌性肿块的特性。" + }, + { + "question_num": 53, + "query": "观察“虚里”变化,以了解其盛衰的是", + "options": { + "A": "元气", + "B": "宗气", + "C": "营气", + "D": "卫气", + "E": "脏腑之气" + }, + "answer": "B", + "reason": "《素问·平人气象论》说:“胃之大络,名曰虚里,贯络肺。出于左孔下,其动应衣,脉宗气也。”临床上常以“虚里”处(相当于心尖搏动部位)的搏动情况和脉象变化来测知宗气的盛衰。" + }, + { + "question_num": 54, + "query": "萎缩性胃炎,胃黏膜的病理改变是", + "options": { + "A": "充血,水肿", + "B": "糜烂,出血", + "C": "肥厚,粗糙", + "D": "灰暗,变薄", + "E": "渗出" + }, + "answer": "D", + "reason": "萎缩性胃炎的胃黏膜表面反复受到损害后导致黏膜固有腺体萎缩,甚至消失。因此,胃黏膜有不同程度的变薄,颜色灰暗,并常伴有肠上皮化生,炎性反应及不典型增生,其余选项均不是萎缩性胃炎的表现。" + }, + { + "question_num": 55, + "query": "眩晕的治疗原则为", + "options": { + "A": "化痰止呕,和胃降逆", + "B": "补气养血,祛风止眩", + "C": "补虚泻实,调整阴阳", + "D": "补肾填精,降逆止眩", + "E": "泻肝滋阴,活血通窍" + }, + "answer": "C", + "reason": "眩晕的治疗原则为补虚泻实,调整阴阳" + }, + { + "question_num": 56, + "query": "下列关于外科疾病致病因素的叙述错误的是", + "options": { + "A": "气血瘀滞,经络阻塞", + "B": "外感六淫邪毒", + "C": "感受特殊之毒", + "D": "外来伤害", + "E": "房室损伤" + }, + "answer": "A", + "reason": "外科疾病致病因素。外科疾病致病因素有外感六淫,内伤七情,饮食不节,外来伤害,劳伤虚损,感受特殊之毒,痰饮瘀血。" + }, + { + "question_num": 57, + "query": "六淫之中只有外感而无内生的邪气是", + "options": { + "A": "寒", + "B": "风", + "C": "暑", + "D": "湿", + "E": "火" + }, + "answer": "C", + "reason": "风、寒、暑、湿、火均可外感;风,有内生肝风;寒,有内生寒;湿,有内生类湿;火,有内生肝火;只有暑邪只能外感,不能内生,故选C。" + }, + { + "question_num": 58, + "query": "慢性肾衰竭患者最早出现与最常见的症状是", + "options": { + "A": "水肿", + "B": "食欲不振、恶心", + "C": "贫血", + "D": "电解质紊乱", + "E": "少尿" + }, + "answer": "B", + "reason": "食欲不振、恶心、呕吐常为慢性肾衰竭患者最早出现与最常见的症状。" + }, + { + "question_num": 59, + "query": "胸痹重证，阴寒极盛者，其治法", + "options": { + "A": "散寒化痰通络", + "B": "理气通阳化瘀", + "C": "芳香温通止痛", + "D": "益气温阳散寒", + "E": "回阳救逆固脱" + }, + "answer": "C", + "reason": "胸痹重证,阴寒极盛者,其治法是芳香温通止痛”予鸟头赤石脂丸。" + }, + { + "question_num": 60, + "query": "廉疮创面流水潮红,周围皮肤红肿痒痛,治疗宜用", + "options": { + "A": "八正散", + "B": "草薜渗湿汤", + "C": "黄连解毒汤", + "D": "五神汤", + "E": "托里消毒散" + }, + "answer": "B", + "reason": "根据临床特征辨证为湿热下注,所以选革郝渗湿汤。" + }, + { + "question_num": 61, + "query": "最易导致疼痛的外邪是", + "options": { + "A": "风", + "B": "寒", + "C": "暑", + "D": "燥", + "E": "湿" + }, + "answer": "B", + "reason": "寒性凝滞,即凝结阻滞不通的意思;不通则痛,故寒邪最易导致疼痛的发生。" + }, + { + "question_num": 62, + "query": "有助于鉴别再障与急性白血病的是", + "options": { + "A": "感染发热", + "B": "皮肤、黏膜出血", + "C": "贫血苍白", + "D": "胸骨压痛", + "E": "网织红细胞减少" + }, + "answer": "D", + "reason": "胸骨压痛是急性白血病的特有体征。" + }, + { + "question_num": 63, + "query": "心血瘀阻所致之心悸,治宜选用", + "options": { + "A": "丹参饮", + "B": "桃仁红花煎", + "C": "血府逐瘀汤", + "D": "桃红四物汤", + "E": "通幽汤" + }, + "answer": "B", + "reason": "心血瘀阻之心悸治当活血化瘀、理气通络,方选桃仁红花煎。" + }, + { + "question_num": 64, + "query": "治疗失荣早期气郁痰结证，应首选", + "options": { + "A": "和营散坚丸", + "B": "柴胡疏肝汤", + "C": "桃红四物汤", + "D": "化痰开郁方", + "E": "二陈汤" + }, + "answer": "D", + "reason": "此为肝郁痰凝,阻隔经络所致,故治法宜疏肝解郁,化痰散结,故选D。A项散结效果好但是不能化痰;B项只是疏肝，不能散结;C项化痰和散结效果都不好。E项化痰效果好,但是不能散结。" + }, + { + "question_num": 65, + "query": "《素问·五藏生成》说“人卧血归于”的脏是", + "options": { + "A": "肝", + "B": "心", + "C": "脾", + "D": "肺", + "E": "肾" + }, + "answer": "A", + "reason": "肝藏血,具有调节血量的作用，《素问·五藏生成》说:“人卧则血归于肝。”" + }, + { + "question_num": 66, + "query": "下列各项中,有助于白血病分型诊断及治疗监测的是", + "options": { + "A": "血象", + "B": "骨髓象", + "C": "细胞化学染色", + "D": "细胞遗传学检查", + "E": "血生化" + }, + "answer": "D", + "reason": "细胞遗传学检查有助于白血病分型诊断及治疗监测。细胞化学染色有助于急性白血病分类鉴别,白血病确诊靠骨髓象。" + }, + { + "question_num": 67, + "query": "哪型胃痛可用失笑散治疗", + "options": { + "A": "胃阴亏耗", + "B": "瘀血停胃", + "C": "湿热中阻", + "D": "脾胃虚寒", + "E": "寒邪客胃" + }, + "answer": "B", + "reason": "瘀血停胃之胃痛用失笑散合丹参饮加减治疗,寒邪客胃之周痛用香苏散合良附丸加减治疗,湿热中阻之胃痛用清中汤加减治疗,胃阴亏耗之胃痛用一贯煎合芍药甘草汤加减治疗,脾胃虚寒之胃痛用黄芪建中汤加减治疗。" + }, + { + "question_num": 68, + "query": "治疗脱疽的基本原则是", + "options": { + "A": "温阳通脉,活血化瘀", + "B": "疏风清热,解毒消肿", + "C": "清热凉血,舒张血管", + "D": "疏肝行气,软坚化瘀", + "E": "调和营卫,疏通经络" + }, + "answer": "A", + "reason": "脱疽是由于寒邪侵袭或元阳不足:导致四肢末端经脉闭塞，气血运行受阻，不能养四末引起的,故治疗以温阳通脉,活血化瘀为原则。" + }, + { + "question_num": 69, + "query": "升浮药物大多具有的性味为", + "options": { + "A": "味酸、苦、咸,性温、热", + "B": "味辛、酸,性寒、热", + "C": "味辛、甘,性温、热", + "D": "味酸、苦、成,性寒、凉", + "E": "味辛、甘,性寒、凉" + }, + "answer": "C", + "reason": "药物的升降浮沉与四气五味有关一般来讲,味属辛、甘,气属温、热的药物,大都是升浮药,如麻黄、升麻、黄芪等药;味属苦、酸、咸,性属寒、凉的药物,大都是沉降药,如大黄、芒硝、山楂等。" + }, + { + "question_num": 70, + "query": "下列除哪项外,均可选择胸部X线检查进行鉴别", + "options": { + "A": "胸腔积液是血性或脓性", + "B": "大叶性肺炎或支气管肺炎", + "C": "气胸或肺大泡", + "D": "肺不张或肺实变", + "E": "肺脓肿或肺肿瘤" + }, + "answer": "A", + "reason": "诊断胸腔积液,X线检查能明确积液的存在,但难以区别液体的性质。" + }, + { + "question_num": 71, + "query": "悬饮病可见", + "options": { + "A": "胁肋胀痛,太息易怒", + "B": "胁肋灼痛,面红目赤", + "C": "胁肋刺痛,固定不移", + "D": "胁肋胀痛,身目发黄", + "E": "胸胁胀痛,患侧肋间饱满" + }, + "answer": "E", + "reason": "悬饮病是饮留胁下,主要临床表现为胸胁胀痛,患侧肋间饱满。" + }, + { + "question_num": 72, + "query": "失荣初期的治法是", + "options": { + "A": "益气养荣,疏肝散结", + "B": "调补气血,化痰散结", + "C": "解郁化痰,活血散结", + "D": "益气养阴,疏肝解郁", + "E": "养血柔肝,化痰散结" + }, + "answer": "C", + "reason": "初期:颈部或耳之前后肿块,形如粟子,顶突根深,按之坚硬,推之不移,皮色不变,局部无热及疼痛,全身无明显不适,为肝郁痰凝,阻隔经络所致,故治法宜疏肝解郁,化痰散结,其他都是气血亏虚的中后期治法。" + }, + { + "question_num": 73, + "query": "治疗风湿痹证,腰膝酸痛,下肢痿软无力,遇劳更甚者,应首选", + "options": { + "A": "防己", + "B": "秦艽", + "C": "五加皮", + "D": "豨莶草", + "E": "蕲蛇" + }, + "answer": "C", + "reason": "从题干辨证,要求所选药物具有祛风湿、补肝肾、强筋骨的作用,五加皮有此效,可用于肝肾不足,风湿痹痛。ABD项为祛风湿热药,E项为祛风寒湿药,均无补肝肾、强筋骨的作用。" + }, + { + "question_num": 74, + "query": "引起病理性血糖升高的原因不包括下列哪种疾病", + "options": { + "A": "甲状腺功能亢进症", + "B": "嗜铬细胞瘤", + "C": "糖尿病", + "D": "肾上腺皮质功能亢进症", + "E": "胰岛细胞瘤" + }, + "answer": "E", + "reason": "病理性高血糖:①各型糖尿病及甲状腺功能亢进、Cushing病、肢端肥大症、啫铬细胞瘤等内分泌疾病;②颅外伤、颅内出血、脑膜炎等引起颅内压升高刺激血糖中枢以及在疾病应激状态时:③脱水、血浆呈高渗状态(高热、呕吐、腹泻)。" + }, + { + "question_num": 75, + "query": "下列除哪项外,均是厥证的病因", + "options": { + "A": "情志内伤", + "B": "体虚劳倦", + "C": "亡血失津", + "D": "饮食不节", + "E": "感受暑热" + }, + "answer": "E", + "reason": "厥证的基本病机是气机逆乱,升降失常,阴阳之气不相顺接。病位较深,病因多直接损伤内脏。E项为外感，不是内伤，" + }, + { + "question_num": 76, + "query": "下列各项中，需用砭镰法治疗的", + "options": { + "A": "托盘疔", + "B": "颜面部疔", + "C": "红丝疔", + "D": "蛇眼疗", + "E": "蛀节疔" + }, + "answer": "C", + "reason": "夜镰法适用于急性阳证疮疡,如下肢丹毒、红丝疔及疖、疮、痈肿初期、外伤瘀血肿痛、痔疮肿痛等。" + }, + { + "question_num": 77, + "query": "心气虚证与心阳虚证主要的共见症是", + "options": { + "A": "面白神疲", + "B": "脉细无力", + "C": "舌质淡白", + "D": "形寒肢冷", + "E": "心悸气短" + }, + "answer": "E", + "reason": "心阳虚多由心气虚发展而来,故见心悸或怔忡、气短自汗、脉弱或结代等心气虚的定位症状,又有形寒肢冷、面色白、舌淡胖、苔白滑等虚寒的心阳虚特有症,故心悸气短是两证主要的共见症。" + }, + { + "question_num": 78, + "query": "粒细胞缺乏症可出现的临床表现是", + "options": { + "A": "进行性贫血", + "B": "皮肤、鼻腔等处发生坏死性溃疡", + "C": "皮肤、黏膜出血", + "D": "频繁性呕吐", + "E": "胸骨压痛" + }, + "answer": "B", + "reason": "粒细胞缺乏症体检时口腔、咽峡、阴道、直肠或肛门等处有坏死性溃疡及脓肿,有肝脾肿大及淋巴结肿大,尤其颌下和颈淋巴结,故选B。A项见于慢性出血、白血病;C项见于血小板减少;D项见于胃肠道疾病及颅内高压;E项见于白血病。" + }, + { + "question_num": 79, + "query": "下列不是口僻症状的是", + "options": { + "A": "口眼歪斜", + "B": "口角流涎", + "C": "言语不清", + "D": "半身不遂", + "E": "耳后疼痛" + }, + "answer": "D", + "reason": "口僻俗称吊线风,主要症状是口眼歪斜,但常伴耳后疼痛,口角流涎,言语不清，而无半身不遂或神志障碍等表现。多因正气不足，风邪人脉络，气血痹阻所致，不同年龄均可罹患。" + }, + { + "question_num": 80, + "query": "直肠癌早期便血的特点是", + "options": { + "A": "便血鲜红,便后停止,呈间歇性", + "B": "无痛性便血,血色鲜红,不与大便相混", + "C": "黏液血便，鲜红或暗红，最不多,呈持续性", + "D": "便血鲜红,是不多,肛门呈周期性疼痛", + "E": "少许黏液或血丝在类便前流出" + }, + "answer": "C", + "reason": "便血是直肠癌最常见的早期症状大便带血,血为鲜红或暗红,量不多,常同时伴有黏液呈持续性,此时常被误认为“痔疮”。病情进一步发展可出现大便次数增多,有里急后重,排便不尽感,粪便中有血、脓、黏液,并有特殊的臭味。" + }, + { + "question_num": 81, + "query": "数情交织伤及的脏腑是", + "options": { + "A": "心、肺、脾", + "B": "心、肝、肾", + "C": "心、脾、肾", + "D": "心、肾、肺", + "E": "心、肝、脾" + }, + "answer": "E", + "reason": "心肝脾三脏在人体生理和情志活动中发挥着重要作用，故情志内伤,数情交织，多伤心肝脾。" + }, + { + "question_num": 82, + "query": "少量咯血是指每日咯血量", + "options": { + "A": "<200ml", + "B": "<170ml", + "C": "<150ml", + "D": "<130ml", + "E": "<100ml" + }, + "answer": "E", + "reason": "每日咯血量<100ml为少量咯血:100~500ml为中等量略血,在500ml以上或一次咯血量300~500ml为大量咯血。" + }, + { + "question_num": 83, + "query": "胸痛彻背,心悸气促,面色唇甲青紫!大汗淋漓，四肢厥冷,脉沉微欲绝,其病机是", + "options": { + "A": "阴津枯竭,阳气欲脱", + "B": "阳虚水泛,上凌心肺", + "C": "阳气虚衰,水湿内盛", + "D": "阳气虚衰,心阳欲脱", + "E": "阴津耗竭,虚阳浮越" + }, + "answer": "D", + "reason": "从症、舌、脉判断为阳气虚衰,心阳欲脱之危候,治当回阳救逆固脱" + }, + { + "question_num": 84, + "query": "下列关于内治法应用的叙述,错误的是", + "options": { + "A": "治疗外科疾病都应严格遵循消、托、补法的顺序", + "B": "治疗肿疡早期用消法", + "C": "治疗肿疡中期用托法", + "D": "治疗溃疡后期用补法", + "E": "托法中应用黄芪主要是透脓而不是补气" + }, + "answer": "A", + "reason": "消、托、补法是外科内治总的治则其应用应根据临床中疾病的发生发展过程，特别是三个发展阶段,所确立的治疗原则。但绝不是每种外科病的内治严格避循消、托、补法的顺序。" + }, + { + "question_num": 85, + "query": "热闭、寒闭神昏,均常选用的药物是", + "options": { + "A": "石菖蒲", + "B": "麝香", + "C": "牛黄", + "D": "羚羊角", + "E": "苏会香" + }, + "answer": "B", + "reason": "麝香功效:开窍醒神,活血通经,消肿止痛,催生下胎,寒闭、热闭皆能治疗。" + }, + { + "question_num": 86, + "query": "心电图正常P波的时间是", + "options": { + "A": "≦0.06秒", + "B": "≦0.12秒", + "C": "≦0.20秒", + "D": "≦0.30秒", + "E": "≦0.40秒" + }, + "answer": "B", + "reason": "P波:由心房的激动所产生。前-半主要由右心房所产生,后一半主要由左心房所产生。正常人P波的时间一般小于0.12秒,振幅在肢体导联般小于0.25mV,胸导联一般小于0.2mV。" + }, + { + "question_num": 87, + "query": "夏令感受暑湿,呕吐而并见心烦口渴者,首选的方剂是", + "options": { + "A": "小承气汤", + "B": "黄连温胆汤", + "C": "三仁汤", + "D": "黄连香薷饮", + "E": "五磨饮子" + }, + "answer": "D", + "reason": "夏令感受暑湿,呕吐而并见心烦口渴者,用香正气散去香燥甘温之药,加人黄连、佩兰荷叶以清暑解热,或改用黄连香器饮加减" + }, + { + "question_num": 88, + "query": "下列各项,不属瘿痈特征的是", + "options": { + "A": "颈中两侧结块", + "B": "皮色不变", + "C": "微有灼热", + "D": "疼痛牵引至耳后枕部", + "E": "容易化脓" + }, + "answer": "B", + "reason": "瘿痈是以急性发病,结喉两侧结块肿胀,色红灼热,疼痛为主要表现的急性炎症性疾病，而B项皮色不变的只有气瘿和石疼的前期，其他瘿病均有皮色改变。" + }, + { + "question_num": 89, + "query": "豆蔻与草果共有的作用为", + "options": { + "A": "温中行气", + "B": "除痰", + "C": "化湿温中", + "D": "截疟", + "E": "行气利水" + }, + "answer": "C", + "reason": "豆薇化湿,行气,温中止呕,开胃消食。草果燥湿温中,截疟除痰。" + }, + { + "question_num": 90, + "query": "下列除哪项外,均可引起中枢性呕吐", + "options": { + "A": "耳源性眩晕", + "B": "洋地黄中毒", + "C": "尿毒症", + "D": "胆囊炎", + "E": "妊娠反应" + }, + "answer": "D", + "reason": "引起中枢性呕吐的情况:①中枢神经系统疾病(如脑血管疾病、肿瘤、外伤、偏头痛等):②全身性疾病(如感染、内分泌与代谢紊乱等);③药物反应与药物中毒(如洋地黄、吗啡中毒)。" + }, + { + "question_num": 91, + "query": "呃逆的基本治法是", + "options": { + "A": "理气化瘀降逆", + "B": "疏肝解郁降逆", + "C": "和胃降逆止呃", + "D": "健脾温中止呃", + "E": "清热和胃止呃" + }, + "answer": "C", + "reason": "呃逆一证,总由胃气上逆而成,故理气和胃,降逆止呃为基本治法,故选C。而造成胃气上逆的原因又有很多,兼有血瘀的用理气化瘀降���,兼有肝郁气滞的用疏肝解郁降逆,兼有脾阳不足的健脾温中止呃,兼有胃热的清热和胃止呃。" + }, + { + "question_num": 92, + "query": "石瘿的病因病理是", + "options": { + "A": "肝郁胃热,挟痰上壅,气血凝滞,瘀滞结喉", + "B": "情志内伤,肝脾气逆,气血湿痰,凝滞结喉", + "C": "肝肾不足,肾火郁结,挟痰上攻,凝滞结喉", + "D": "脾肾阳虚,脾虚不运,津波留聚,凝结颈部", + "E": "肺脾两亏,津液不布,留聚成痰,凝结颈部" + }, + "answer": "B", + "reason": "石瘿由于情志内伤,肝气郁结,脾失健运,痰湿内生,气郁痰浊结聚不散,气则血瘀,积久瘀凝成毒,气郁、痰浊、瘀逛三者痼结，上逆于颈部而成。" + }, + { + "question_num": 93, + "query": "使用化痰药治疗癫痫惊厥者最常配的是", + "options": { + "A": "清热、消食药", + "B": "平肝息风、安神药", + "C": "安神、理气药", + "D": "安神、泻下药", + "E": "补虚、消食药" + }, + "answer": "B", + "reason": "使用化痰药治疗痫、惊、眩晕昏迷者，最常配伍平肝息风、开窍、安神药。" + }, + { + "question_num": 94, + "query": "医学人道主义的核心内容是", + "options": { + "A": "尊重患者", + "B": "同情患者", + "C": "医生对患者尽义务", + "D": "患者的自主权利", + "E": "以上都不是" + }, + "answer": "A", + "reason": "医学伦理学以生命论、人道论、美德论和公益论等为基本理论,其中,生命论包括生命神圣论、生命质量论和生命价值论;人道论中人道主义的核心是尊重患者的生命、人格、尊严、平等的医疗与健康权利以及对社会、医院、医务人员的尊重;美德论中医德品质的内容有仁慈、诚挚、严谨、公正、节操;公益论中以群体利益为重,以长远利益为重,以整体利益为重。" + }, + { + "question_num": 95, + "query": "治疗鼓胀水湿困脾证,应首选", + "options": { + "A": "柴胡疏肝散合胃苓汤", + "B": "实脾饮", + "C": "中满分消丸", + "D": "调营饮", + "E": "附子理苓汤" + }, + "answer": "B", + "reason": "胀分类有气滞湿阻、水湿困脾、水热蕴结、瘀结水留、阳虚水盛、阴虚水停。本证水湿困脾,故腹大胀满,按之如裹水,颜面浮肿;脾不运化故胸脘胀闷;阳气不足则遇热则舒,精神困倦,怯寒动，小便少,大便溏,舌苔白腻,脉。治宜温阳健脾,行气利水，用实脾饮。气滞湿阻用柴胡疏肝散。阳水停用附子理苓汤。瘀结水留用调营饮。" + }, + { + "question_num": 96, + "query": "前列腺炎的主要临床表现是", + "options": { + "A": "无痛性血尿", + "B": "精液中有血", + "C": "尿中有血,并有腰部剧痛", + "D": "尿频、进行性排尿困难", + "E": "尿频急而痛,尿末常有白色分泌物" + }, + "answer": "E", + "reason": "临床症状常会出现尿频、尿急、尿痛、尿道内灼热不适和尿末会滴出白色分泌物。" + }, + { + "question_num": 97, + "query": "上以清肺,中以凉胃,下泻肾火的药物是", + "options": { + "A": "黄柏", + "B": "栀子", + "C": "知母", + "D": "地骨皮", + "E": "生地黄" + }, + "answer": "C", + "reason": "知母归肺、胃、肾经,能清胃泻火,清肺润燥,滋阴降火,治疗温热病,肺胃实热证、肺热咳嗽、阴虚火旺之骨蒸潮热、阴虚消渴等,故选C。" + }, + { + "question_num": 98, + "query": "下列各项,可抑制细胞色素氧化酶活性的是", + "options": { + "A": "有机磷杀虫药", + "B": "重金属", + "C": "一氧化碳", + "D": "氰化物", + "E": "硫化物" + }, + "answer": "D", + "reason": "有机磷杀虫药抑制胆碱酯酶,氰化物抑制细胞色素氧化酶,重金属抑制含巯基的酶类等。" + }, + { + "question_num": 99, + "query": "厥阴经头痛,可选用的引经药是", + "options": { + "A": "羌活、蔓荆子", + "B": "羌活、川芎", + "C": "葛根、白芷", + "D": "柴胡、川芎", + "E": "吴茱萸、藁本" + }, + "answer": "E", + "reason": "根据头痛部位的不同,参照经络循行部位选用适当的引经药,可提高疗效。太阳经常用羌活、蔓荆子、川芎。阳明经常用根、白芷、知母。少阳经常用柴胡、黄芩、川芎。太阴经常用苍术。少阴经常用杜仲、桑寄生、续断。厥阴经常用吴茱英、本。" + }, + { + "question_num": 100, + "query": "深静脉血栓形成的最大危险性是", + "options": { + "A": "水肿", + "B": "肺栓塞", + "C": "下肢坏死", + "D": "患肢增粗", + "E": "浅静脉扩张" + }, + "answer": "B", + "reason": "本病早期可出现急性股动脉痉挛和肺动脉栓塞两种危重性并发���。" + }, + { + "question_num": 101, + "query": "既能燥湿止带,又能消肿排脓的药物是", + "options": { + "A": "鸟贼骨", + "B": "白蔹", + "C": "白芷", + "D": "苍术", + "E": "白果" + }, + "answer": "C", + "reason": "白芷的功效为解表散风,通窍，止痛,燥湿止带,消肿排脓。余药均不兼有燥湿止带和消肿排脓的作用,故选C。" + }, + { + "question_num": 102, + "query": "流行性出血热患者全身各组织器官都可有充血、出血、变性、坏死,表现最为明显的器官是", + "options": { + "A": "心", + "B": "肺", + "C": "肾", + "D": "胃肠", + "E": "脑垂体" + }, + "answer": "C", + "reason": "流行性出血热的病理解剖可见脏器中肾脏病变最明显。肉眼可见肾脂肪囊水肿、出血,镜检肾小球充血,基底膜增厚;肾小管受压而变窄或闭塞;问质有细胞浸润。" + }, + { + "question_num": 103, + "query": "中风之中脏腑与中经络的鉴别要点是", + "options": { + "A": "神志不清", + "B": "半身不遂", + "C": "语言不利", + "D": "肢体软瘫", + "E": "口舌歪斜" + }, + "answer": "A", + "reason": "中风有中经络、中脏腑之分,而神志障碍的有无是其划分的标志,故选A。半身不遂、语言不利、肢体瘫软、口舌歪斜是中风中经络和中脏腑的共同表现,故排除BCDE" + }, + { + "question_num": 104, + "query": "肿而不硬,皮色不泽,不红不热,常伴有酸痛,其肿的性质是", + "options": { + "A": "热肿", + "B": "寒肿", + "C": "风肿", + "D": "痰肿", + "E": "湿肿" + }, + "answer": "B", + "reason": "热肿为肿而色红,皮薄光泽,掀热疼痛。寒肿为肿而不硬，皮色不泽,不红不热,常伴有酸痛。风肿为漫肿宣浮,或游走不定,不红微热,轻微疼痛。湿肿为肿而皮肉重垂胀急,深按如烂棉不起，浅则水亮如水疱,搔破流黄水,浸淫皮肤。痰肿为肿势或软如棉,或硬如馒,不红不热。" + }, + { + "question_num": 105, + "query": "具有活血止痛、消肿生肌功效的药组是", + "options": { + "A": "乳香、没药", + "B": "红花、桃仁", + "C": "血竭、儿茶", + "D": "五灵脂、续断", + "E": "自然铜、骨碎补" + }, + "answer": "A", + "reason": "乳香、没药的功效为活血止痛,消肿生肌,故选A。" + }, + { + "question_num": 106, + "query": "下列脊椎病变,除哪项外,脊椎叩痛常为阳性", + "options": { + "A": "脊椎结核", + "B": "棘间韧带损伤", + "C": "骨折", + "D": "骨质增生", + "E": "椎间盘脱出" + }, + "answer": "D", + "reason": "在受损部位可产生叩击痛。叩击痛阳性可见于脊椎结核、骨折及椎问盘突出、棘间韧损伤。" + }, + { + "question_num": 107, + "query": "水饮凌心所致心悸的临床表现是", + "options": { + "A": "心悸眩晕、胸闷痞满", + "B": "心悸不安,胸闷气短", + "C": "心悸不安,阵发心痛,唇甲青紫", + "D": "心悸不宁,心烦少寐", + "E": "以上都不对" + }, + "answer": "A", + "reason": "水饮凌心所致心悸的临床表现:心悸眩晕、胸闷痞满、渴不欲饮、水肿、小便少等。" + }, + { + "question_num": 108, + "query": "可用于疮疡阴证的外用药是", + "options": { + "A": "回阳玉龙散", + "B": "红灵丹", + "C": "白降丹", + "D": "八二丹", + "E": "九一丹" + }, + "answer": "A", + "reason": "回阳玉龙散功能温阳活血,祛腐化痰,用于溃疡阴证。" + }, + { + "question_num": 109, + "query": "芦根、淡竹叶的共同功效,除清热除烦外,还可", + "options": { + "A": "利尿", + "B": "生津", + "C": "止呕", + "D": "排脓", + "E": "凉血" + }, + "answer": "A", + "reason": "淡竹叶的功效:清热泻火,除烦止渴,利尿通淋。芦根的功效:清热泻火,生津止渴，除烦，止呕,利尿。" + }, + { + "question_num": 110, + "query": "在胸骨左缘第3、第4肋间触及收缩期震颤，应考虑为", + "options": { + "A": "主动脉瓣关闭不全", + "B": "室间隔缺损", + "C": "二尖瓣狭窄", + "D": "三尖瓣狭窄", + "E": "肺动脉瓣狭窄" + }, + "answer": "B", + "reason": "在胸骨右缘第2肋间触及收缩期震颤，应考虑为主动脉瓣狭窄;在胸骨左缘第2肋间触及收缩期震颤,应考虑为肺动脉瓣狭窄;在胸骨左缘第3、第4肋间触及收缩期震颤,应考虑为室间隔缺损;在胸骨左缘第2肋间触及连续性震颤,应考虑为动脉导管未闭;在心尖区触及舒张期震颤,应考虑为二尖瓣狭窄;在心尖区触及收缩期质颤,应考虑为重度工尖瓣关闭不全。" + }, + { + "question_num": 111, + "query": "治疗黄疸阴黄证,应首选", + "options": { + "A": "麻黄连翘赤小豆汤", + "B": "栀子柏皮汤", + "C": "茵陈五苓散", + "D": "茵陈术附汤", + "E": "茵陈蒿汤" + }, + "answer": "D", + "reason": "黄疸阴黄包括寒湿阻退证和脾虚湿滞证,前者治疗首选茵陈术附汤,后者治疗首选黄芪建中汤,故选D。" + }, + { + "question_num": 112, + "query": "一烧伤患者。体温不升,呼吸气微,表情淡漠,神志恍惚。嗜睡,语言含糊不清,四肢厥冷,汗出淋漓,舌光无苔,脉细,其证候是", + "options": { + "A": "火热伤津", + "B": "阴伤阳脱", + "C": "火毒内陷", + "D": "气血两伤", + "E": "脾胃虚弱" + }, + "answer": "B", + "reason": "火毒侵人营血,内攻脏腑,导致脏腑失和,阴阳平衡失调,津液严重耗伤,表情淡漠,神志恍惚,嗜睡,语言含糊不清,四肢厥冷,汗出淋漓,属于阳脱之象。" + }, + { + "question_num": 113, + "query": "下列各项中,不属青皮主治病证的是", + "options": { + "A": "胸胁胀痛", + "B": "乳房胀痛", + "C": "食积腹痛", + "D": "疝气疼痛", + "E": "呕吐呃逆" + }, + "answer": "E", + "reason": "青皮性较峻烈,行气力猛,苦泄下行,偏人肝胆,能疏肝破气,散结止痛,消积化滞。主治肝郁乳房胀痛或结块,胁肋胀痛,疝气疼痛,食积腹痛微痕积聚等。" + }, + { + "question_num": 114, + "query": "用于急性心肌梗死合并心源性休克的血管扩张剂是", + "options": { + "A": "卡托普利", + "B": "硝普钠", + "C": "硝苯地平", + "D": "美托洛尔", + "E": "氯沙坦" + }, + "answer": "B", + "reason": "急性心肌梗死合并心源性休克时常用硝普钠或硝酸甘油静脉滴注,直至左心室充盈压下降。" + }, + { + "question_num": 115, + "query": "与石淋的发病关系最为密切的病机是", + "options": { + "A": "脾虚中气下陷", + "B": "肾虚下元不固", + "C": "湿热蕴结下焦", + "D": "热盛迫血妄行", + "E": "气郁化火伤阴" + }, + "answer": "C", + "reason": "脾虚中气下陷多为气淋虚证,遇劳即发则为劳淋,肾虚下元不固不能制约脂液则为音淋热盛破血妄行的是血淋,气郁化火伤阴少腹作胀，小便艰涩而痛的属气淋实证,湿热蕴结下焦，尿液受其煎熬,日久杂质结为砂石,则为石淋。" + }, + { + "question_num": 116, + "query": "肌肉强直性痉挛是破伤风的典型症状之一,其首先出现的部位是", + "options": { + "A": "上肢", + "B": "下肢", + "C": "头面", + "D": "颈项", + "E": "躯干" + }, + "answer": "C", + "reason": "肌肉强直性痉率首先从头面部开始,进而延展至躯千四肢。" + }, + { + "question_num": 117, + "query": "既可田治外感风寒，又可用于外感风热的药物是", + "options": { + "A": "麻黄", + "B": "防风", + "C": "桂枝", + "D": "紫苏", + "E": "羌活" + }, + "answer": "B", + "reason": "防风祛风解表,胜湿止痛,止疼。配伍得当,既可用治外感风寒,又可用于外感风热，其余药物均能够发汗解表,常用于风寒感冒。" + }, + { + "question_num": 118, + "query": "下列哪项不属于意识障碍", + "options": { + "A": "嗜睡", + "B": "抽搐", + "C": "意识模糊", + "D": "谵妄", + "E": "昏迷" + }, + "answer": "B", + "reason": "轻度意识障碍包括意识模糊、嗜睡状态和朦胧状态。中度意识障碍包括混浊状态或精神错乱状态、谵妄状态。重度意识障碍包括昏睡状态或浅昏迷状态、昏迷状态、深昏迷状态和木状态，" + }, + { + "question_num": 119, + "query": "癃闭的病位虽在膀胱,但与本病关系密切的脏腑还有", + "options": { + "A": "肺、脾、肾、三焦", + "B": "肺、肾、胃、三焦", + "C": "肝、脾、肾、小肠", + "D": "肺、脾、胃、三焦", + "E": "肺、脾、肝、小肠" + }, + "answer": "A", + "reason": "症闭表现为尿量减少,排尿困难其至小便闭塞不通。小便的通畅,有赖于肾和膀胱的气化作用,但从脏腑之间的整体关系来看,水液的吸收、运行、排泄,还有赖于三焦的气化,肺、脾、肾的通调、转输、蒸化。因此癃闭除与膀胱有关外，还和肺，脾、肾、三焦有密切关系。" + }, + { + "question_num": 120, + "query": "经断复来脾虚肝郁证的出血表现是", + "options": { + "A": "量少,色淡,质稀", + "B": "量少,色鲜红,质稠", + "C": "量多,色紫红", + "D": "色深红,质稠", + "E": "淋漓不断,夹有杂色带下,恶臭" + }, + "answer": "A", + "reason": "A项见于脾虚肝郁证,B项见于肾阴虚证,C项见于湿热下注证，D项见于血热证，E项见于湿毒瘀结证。" + }, + { + "question_num": 121, + "query": "蜜炙桑叶多用于", + "options": { + "A": "清肺热", + "B": "疏风热", + "C": "清肝热", + "D": "清血热", + "E": "润肺燥" + }, + "answer": "E", + "reason": "桑叶疏散风热、清肺润燥、平肝明目、凉血止血。蜜炙能增强润肺止咳作用,可润肺燥。看到“蜜炙”就想到“润燥”,故选E。" + }, + { + "question_num": 122, + "query": "下列除哪项外,均可为正常的叩诊音", + "options": { + "A": "震水音", + "B": "清音", + "C": "鼓音", + "D": "浊音", + "E": "实音" + }, + "answer": "A", + "reason": "叩诊音临床上分为清音、鼓音、过清音、浊音和实音5种。" + }, + { + "question_num": 123, + "query": "厥证的基本病机是", + "options": { + "A": "气虚下陷,清阳不升", + "B": "气机逆乱,升降乖戾", + "C": "痰随气升,上蒙清窍", + "D": "失血过多,气随血脱", + "E": "气血凝滞,脉络瘀阻" + }, + "answer": "B", + "reason": "厥证是由阴阳失调,气机逆乱所引起,以突然昏倒,不省人事,四肢厥冷为主要表现的一种病证。厥证的病因可以有气虚下陷,清阳不升,痰随气升,上蒙清窍,失血过多,气随血脱,气血凝滞,脉络瘀阻,但是最终都引起气机逆乱，升降失常,阴阳之气不相顺接而致,故排除ACDE。" + }, + { + "question_num": 124, + "query": "小儿硬肿症重症的肛温", + "options": { + "A": "高于腋温", + "B": "等于腋温", + "C": "低于腋温", + "D": "高于正常", + "E": "等于正常" + }, + "answer": "C", + "reason": "新生儿。硬肿症早期棕色脂肪代偿产热良好,肛温高于肢温;重症者能耗竭时,肛温低于腋温。" + }, + { + "question_num": 125, + "query": "既能息风止痉,又能祛风湿,止痹痛的药物是", + "options": { + "A": "羚羊角", + "B": "石决明", + "C": "决明子", + "D": "天麻", + "E": "珍珠" + }, + "answer": "D", + "reason": "A项羚羊角兼能散血解毒、解热镇痛;B项石决明平肝潜阳，兼能消肝明目;C项决明子平抑肝阳，兼能明目、润肠通便;D项天麻兼能祛风通络、止痹痛;E项珍珠兼能明目消、解毒生肌、润肤养颜。" + }, + { + "question_num": 126, + "query": "出现交叉性瘫痪的脑出血是", + "options": { + "A": "脑外出血", + "B": "小脑出血", + "C": "脑桥出血", + "D": "丘脑出血", + "E": "壳核出血" + }, + "answer": "C", + "reason": "一侧脑桥少量出血,表现为交叉性瘫痪,两眼向病灶侧凝视麻痹,但多数累及两侧脑桥出血破人第四脑室,迅速出现深度昏迷、双侧瞳孔针尖样缩小、四肢瘫痪和中枢性高热的特征性体征,并出现中枢性呼吸障碍和去脑强直，多于数天内死亡。" + }, + { + "question_num": 127, + "query": "治疗久泻不止，不宜过用", + "options": { + "A": "固涩", + "B": "补肾", + "C": "分利", + "D": "健脾", + "E": "升提" + }, + "answer": "C", + "reason": "治疗久泻不宜分利太过，以防劫其津液。健脾是一种补法,适用于脾虚湿胜导致的泄泻，可以治疗久泻不止。补肾也是一种补法,适用于肾阳虚衰所致的泄泻，同样可以治疗久泻不止。固涩，是治疗久泻不止的一种基本方法。升提,适用于中气不足，脾虚下陷，不能固摄所致的泄泻，也可以治疗久泻不止。" + }, + { + "question_num": 128, + "query": "治疗胎黄湿热惠燕证首选方是", + "options": { + "A": "犀角散", + "B": "栀子柏皮汤", + "C": "茵陈蒿汤", + "D": "甘露消毒丹", + "E": "茵陈五苓散" + }, + "answer": "C", + "reason": "胎黄湿热熏蒸证治疗当清热利湿故用茵陈蔷汤加减。" + }, + { + "question_num": 129, + "query": "巴豆内服剂最是", + "options": { + "A": "0.3~0.6g", + "B": "0.7~0.9g", + "C": "0.1~0.3g", + "D": "0.01~0.03g", + "E": "0.5~1g" + }, + "answer": "C", + "reason": "巴豆有大毒,内服多制成巴豆霜用0.1~0.3g,多入丸散。" + }, + { + "question_num": 130, + "query": "肺动脉高压早期的X线表现是", + "options": { + "A": "双肺纹理增多", + "B": "双肺透亮度增加", + "C": "右下肺动脉主干增宽", + "D": "右心房肥大", + "E": "右心室肥厚、扩张" + }, + "answer": "C", + "reason": "常见循环系统疾病的影像诊断。肺动脉高压表现:右下肺动脉干扩张,肺动脉段中度凸出或其高度>3mm,中心肺动脉扩张和外周分支纤细。" + }, + { + "question_num": 131, + "query": "哮病发作期的主要病机是", + "options": { + "A": "外邪侵袭,肺失宣降", + "B": "肺失宣肃,肺气上逆", + "C": "痰气搏结,气道被阻", + "D": "邪袭于���,肺气不利", + "E": "肺脏虚弱,气失所主" + }, + "answer": "C", + "reason": "“痰”为根本,发作期“伏痰”遇诱因引触,痰随气升,气因痰阻,气排结,塞气道;故痰鸣如吼,气息喘促,故发作期的病机主要是痰气搏结:气道被阻,其他选项也是一些病因,但非病机。" + }, + { + "question_num": 132, + "query": "下列作为调经的具体原则,错误的是", + "options": { + "A": "扶脾", + "B": "调理气血", + "C": "疏肝", + "D": "清热凉血", + "E": "补肾" + }, + "answer": "D", + "reason": "调经是通过治疗使月经病恢复正常,即避循《内经》“谨守病机”“谨察阴阳所在而调之,以平为期”的宗旨,采用补肾、扶脾、疏肝、调理气血、调理冲任等法以调治。" + }, + { + "question_num": 133, + "query": "泻下药中有效成分不溶于水，宜人丸散的药物是", + "options": { + "A": "芒硝", + "B": "番泻叶", + "C": "火麻仁", + "D": "牵牛子", + "E": "甘遂" + }, + "answer": "E", + "reason": "甘遂有效成分不溶于水,宜入丸散;芒硝宜冲人药汁或开水溶化后服;番泻叶用开水泡服，人汤剂应后下;火麻仁和牵牛子均可人汤剂。" + }, + { + "question_num": 134, + "query": "胸腔大量积气患者触觉语颤表现的是", + "options": { + "A": "增强", + "B": "减弱或消失", + "C": "稍增强", + "D": "正常", + "E": "无变化" + }, + "answer": "B", + "reason": "语音展颤的强弱受到发音的强弱、音调的高低、胸壁的厚薄以及气道通畅程度的影响，减弱或消失主要见于肺泡内含气量过多、支气管阻塞大量胸腔积液或气胸、胸膜高度增厚粘连、胸壁皮下气肿或皮下水肿。" + }, + { + "question_num": 135, + "query": "下列哪项不是癫狂病的主症", + "options": { + "A": "语无伦次", + "B": "躁妄打骂", + "C": "喜怒无常", + "D": "流涎抽搐", + "E": "神志痴呆" + }, + "answer": "D", + "reason": "疯证以沉默痴呆,语无伦次,静而多喜为特征,狂证以喧扰不宁,躁妄打骂,动而多怒为特征,流涎抽搐不是本病的常见症状。" + }, + { + "question_num": 136, + "query": "妊娠8、9个月时,或腹中痛,痛定仍然如常者,称为", + "options": { + "A": "试胎", + "B": "弄胎", + "C": "垢胎", + "D": "盛胎", + "E": "滑胎" + }, + "answer": "A", + "reason": "A项,指妊娠八九个月时,或腹中痛,痛定如常者。B项,指若月数已足,腹痛或作或止，腰不痛。CD项,指孕后仍按月行经而产子者。《本草纲目·论月水》:“有受胎之后,月月行经而产子者，是谓盛胎,俗名垢胎。”E项,指凡堕胎或小产发生3次或3次以上者。" + }, + { + "question_num": 137, + "query": "下列均可用于治疗水火烫伤的组药是", + "options": { + "A": "地榆、槐角、小蓟", + "B": "地榆、大黄、虎杖", + "C": "大黄、芒硝、丹参", + "D": "黄苓、黄连、黄柏", + "E": "紫草、地榆、郁金" + }, + "answer": "B", + "reason": "地榆苦寒能泻火解毒,味酸涩能敛疮,为治水火烫伤之要药,可单味研末麻油调敷,或配大黄粉,或配黄连、冰片研末调敷。大黄治烧烫伤，可单用粉,或配地榆粉,用麻油调敷患处。虎杖治水火烫伤,痈肿疮毒,毒蛇咬伤。虎杖人血分,有凉血消热解毒作用。若水火烫伤而致皮肤灼痛或溃后流黄水者，单用研末,香油调敷,亦可与地榆、冰片共研末,调油敷患处。" + }, + { + "question_num": 138, + "query": "对诊断急性胰腺炎最有价值的血清酶检查是", + "options": { + "A": "谷草转氨酶", + "B": "淀粉酶", + "C": "碱性磷酸酶", + "D": "谷丙转氨酶", + "E": "乳酸脱氢酶" + }, + "answer": "B", + "reason": "急性胰腺炎最有价值的血清酶检查是血尿淀粉酶。" + }, + { + "question_num": 139, + "query": "下列各项,不属感染过程中病原体作用的是", + "options": { + "A": "侵袭力", + "B": "抵抗力", + "C": "数量", + "D": "毒力", + "E": "变异性" + }, + "answer": "B", + "reason": "抵抗力是人体对病原体的抵抗能力的描述。感染过程中病原体的致病作用包括侵袭力、毒力、数量、变异性。" + }, + { + "question_num": 140, + "query": "哺乳期最佳断乳时间是", + "options": { + "A": "6个月", + "B": "8个月", + "C": "9个月", + "D": "10个月", + "E": "12个月" + }, + "answer": "B", + "reason": "哺乳时间一般以8个月为宜。" + }, + { + "question_num": 141, + "query": "下列何药内服的用法不合适", + "options": { + "A": "牛黄:每日0.15~0.35g,人丸、散服", + "B": "马勃:每日2~6g,包煎", + "C": "熊胆粉:每日0.25~0.5g,人丸、散服", + "D": "青黛:每日1~3g,宜冲服或人丸散服", + "E": "鸦胆子:治痢疾每次10~30粒，水煎服" + }, + "answer": "E", + "reason": "鸦胆子清热解毒,止痢,截疟,腐蚀赘疣。主治痢疾、疟疾,外治赘疣、鸡眼。用法与用量:内服,0.5~2g,以干龙眼肉包裹或装人胶包裹吞服亦可压去油制成丸剂、片剂服，不宜人煎剂。外用适量。" + }, + { + "question_num": 142, + "query": "对诊断系统性红斑狼疮最有意义的检查是", + "options": { + "A": "免疫球蛋白测定", + "B": "抗核抗体", + "C": "总补体溶血活力测定", + "D": "玫瑰花试验", + "E": "淋巴细胞转化试验" + }, + "answer": "B", + "reason": "抗核抗体常用于弥漫性结缔组织病的诊断,尤其是抗核抗体中的抗双链(天然)DNA抗体对诊断系统性红斑狼疮有较高的特异性。" + }, + { + "question_num": 143, + "query": "消渴病机特点应除外以下哪项", + "options": { + "A": "阴虚为本,燥热为标", + "B": "阴津亏损,燥热偏盛", + "C": "血脉瘀滞", + "D": "阴阳俱虚", + "E": "下盛上虚,郁火伤阴" + }, + "answer": "E", + "reason": "消渴的基本病机是阴虚为本,燥热为标,故排除AB;阴阳互根互用,消渴病久可阴伤及阳,见阴阳俱虚、故排除D;阴虚内热,损耗津液,则血脉为之虚涩而成血瘀,故排除C。" + }, + { + "question_num": 144, + "query": "下列哪项不是直接导致冲任损伤的因素", + "options": { + "A": "邪毒感染", + "B": "郁怒悲伤", + "C": "房劳多产", + "D": "跌扑闪挫", + "E": "寒湿之邪" + }, + "answer": "B", + "reason": "肝主疏泄,调畅情志,若郁怒悲伤,肝气郁结,则为气滞,冲任失畅,血海蓄意失常,可导致月经先后不定期，其余选项均为直接导致冲任损伤的因素。" + }, + { + "question_num": 145, + "query": "川棟子,槟榔当具有的功效是", + "options": { + "A": "杀虫行气", + "B": "杀虫利水", + "C": "行气利水", + "D": "行气疏肝", + "E": "行气健脾" + }, + "answer": "A", + "reason": "川棟子可行气止痛,杀虫;槟榔可杀虫消积,行气利水,截疟,故共同的功效为杀虫行气。" + }, + { + "question_num": 146, + "query": "诊断非ST段抬高的心肌梗死,价值最大的实验室指标是", + "options": { + "A": "肌钙蛋白", + "B": "肌酸激酶", + "C": "天门冬氨酸氨基转移酶", + "D": "乳酸脱氢酶", + "E": "肌酸激酶同工酶" + }, + "answer": "A", + "reason": "根据典型的临床表现、典型的心电图改变以及血清肌钙蛋白和心肌酶的改变，一般可确定诊断。对于非ST段抬高的心肌梗死,肌钙蛋白测定的诊断价值更大。" + }, + { + "question_num": 147, + "query": "痫证的主要病位是", + "options": { + "A": "心、脾、肾", + "B": "肺、脾、肾", + "C": "肝、脾、肾", + "D": "心、肝、肺", + "E": "心、肝、肾" + }, + "answer": "C", + "reason": "痫证大多由于七情失调,先天因素脑部外伤,饮食不节,劳累过度,或患他病之后造成肝脾、肾的损伤所致。" + }, + { + "question_num": 148, + "query": "虚性闭经的发病机制是", + "options": { + "A": "先天不足,精血亏损", + "B": "冲任不足,血海空虚", + "C": "冲任气血失调", + "D": "脾气虚弱,化源不足", + "E": "脏腑功能虚衰" + }, + "answer": "B", + "reason": "闭经的病因病机:虚者,精亏血少冲任血海空虚,源断其流，无血可下;实者,冲任受阻,血海阻隔,经血不得下行。" + }, + { + "question_num": 149, + "query": "既能凉血止血，又能收敛止血、解毒敛疮的药物是", + "options": { + "A": "侧柏叶", + "B": "大蓟", + "C": "苎麻根", + "D": "地榆", + "E": "山栀" + }, + "answer": "D", + "reason": "地榆性寒苦降,味涩收敛,有凉血泄热、收敛止血作用,可用于各种出血证,尤宜于下焦血热所致的便血、痔血等,还能解毒敛疮,为治疗烫伤的要药。" + }, + { + "question_num": 150, + "query": "对肺炎的病原学诊断中，以下哪种方法可提高细菌的检出率", + "options": { + "A": "午后深咳留痰", + "B": "PCR检测", + "C": "行咽拭子培养", + "D": "留取痰的浆液部分培养", + "E": "同时进行需氧菌和厌氧菌的培养" + }, + "answer": "B", + "reason": "聚合酶链反应(PCR)检测可提高病原体检出率。" + }, + { + "question_num": 151, + "query": "治疗大肠癌瘀毒内阻证,首选的方剂是", + "options": { + "A": "血府逐瘀汤", + "B": "复元活血汤", + "C": "膈下逐瘀汤", + "D": "通窍活血汤", + "E": "少腹逐瘀汤" + }, + "answer": "C", + "reason": "血府逐瘀汤主要祛上焦胸部之瘀膈下逐瘀汤主要祛中焦腹部之瘀，少腹逐瘀汤主要祛下焦盆腔之瘀,通窍活血汤主要祛头部消窍之瘀,复元活血汤除有活血化瘀消积之功，还可行气化滞,故治疗大肠癌瘀毒内阻证，应选用膈下逐瘀汤。" + }, + { + "question_num": 152, + "query": "寿胎丸治疗胎动不安的适应证候是", + "options": { + "A": "肾虚证", + "B": "血热证", + "C": "脾虚证", + "D": "血瘀证", + "E": "气血虚弱证" + }, + "answer": "A", + "reason": "胎动不先贤求证治法，永坚体目益气安胎。代表方:寿胎丸加党参、白术或滋肾育胎丸。" + }, + { + "question_num": 153, + "query": "为治疗积滞便秘之要药的是", + "options": { + "A": "芒硝", + "B": "番泻叶", + "C": "巴豆", + "D": "大黄", + "E": "火麻仁" + }, + "answer": "D", + "reason": "大黄的应用:积滞便秘。有较强泻下作用,能荡涤胃肠,推陈致新，为治疗积滞便秘之要药。" + }, + { + "question_num": 154, + "query": "上腹壁反射的反射中枢位于", + "options": { + "A": "胸髓7~8节段", + "B": "胸髓9~10节段", + "C": "胸髓11~12节段", + "D": "腰髓1~2节段", + "E": "腰髓3~4节段" + }, + "answer": "A", + "reason": "上腹壁反射的反射中枢在胸髓7~8节段,中腹壁反射的反射中枢在胸髓9~10节段，下腹壁反射的反射中枢在胸髓11~12节段,提密反射的反射中枢在腰髓1~2节段。" + }, + { + "question_num": 155, + "query": "下列各项,属着痹特点的是", + "options": { + "A": "疼痛游走不定", + "B": "痛势较剧,痛有定处", + "C": "关节酸痛、重着、漫肿", + "D": "关节肿胀局限,见皮下结节", + "E": "关节肿胀僵硬,疼痛不移" + }, + "answer": "C", + "reason": "痹证分热痹、着痹、行痹、痛痹四种。分别以热、湿、风、为主要病邪。着痹以湿为重,湿性重者,特点是关节酸痛、重者、没肿。" + }, + { + "question_num": 156, + "query": "婴儿(<1岁)服用的中药煎出量", + "options": { + "A": "10~20m1", + "B": "21~30ml", + "C": "31~40ml", + "D": "41~50ml", + "E": "60~100ml" + }, + "answer": "E", + "reason": "为方便计算,可采用下列比例用药:新生儿用成人量的1/6,乳婴儿用成人量的1/3,幼儿用成人量的1/2,学龄儿童用成人量的2/3或接近成人用量。一般成人煎药量为200ml,经计算婴儿(<1岁)服用的中药煎出量是66.7ml。" + }, + { + "question_num": 157, + "query": "槟榔用作杀姜片虫时,其用量是", + "options": { + "A": "5~10g", + "B": "10~15g", + "C": "15~20g", + "D": "20~30g", + "E": "30~60g" + }, + "answer": "E", + "reason": "槟榔用法用量:煎服,3~10g,单用驱杀绦虫、姜片虫时30~60g,生用力佳,炒用力缓;鲜者优于陈久者。" + }, + { + "question_num": 158, + "query": "引起吸气性呼吸困难的疾病是", + "options": { + "A": "气管肿瘤", + "B": "慢性阻塞性肺气肿", + "C": "支气管哮喘", + "D": "气胸", + "E": "大块肺不张" + }, + "answer": "A", + "reason": "吸气性呼吸困难其病因主要是由气管上段及咽喉部的阻塞性疾病引起,如咽后脓肿、喉炎、肿瘤、异物、白喉等" + }, + { + "question_num": 159, + "query": "头痛患者,疼痛日久,其痛如锥刺,固定不移,舌质紫,脉细涩,其证候是", + "options": { + "A": "肝阳", + "B": "痰浊", + "C": "血虚", + "D": "肾虚", + "E": "瘀血" + }, + "answer": "E", + "reason": "头痛日久，痛久人络，致瘀血内阻脑脉,故痛如锥刺,固定不移,舌质紫,脉细涩。证属瘀血头痛。" + }, + { + "question_num": 160, + "query": "月经先后不定期的主要发病机制是", + "options": { + "A": "肝郁气滞,疏泄失调", + "B": "肾气不足,封藏失职", + "C": "脾气虚弱,统摄无权", + "D": "湿热下注,任带不固", + "E": "气血失调,血海蓄溢失常" + }, + "answer": "E", + "reason": "月经先后不定期的主要发病机制是肝肾功能失调,冲任功能紊乱，血海蓄溢失常。" + }, + { + "question_num": 161, + "query": "肉豆蔻与白豆蔻均具有的功效是", + "options": { + "A": "涩肠止泻,下气平喘", + "B": "温中散寒,行气消胀", + "C": "温中行气,燥湿止带", + "D": "收敛固涩,制酸止痛", + "E": "涩肠止泻,敛肺止咳" + }, + "answer": "B", + "reason": "肉豆蔻涩肠止泻,温中行气;白豆蔻化湿行气,温中止呕,故二者均具有的功效是温中散寒,行气消胀。" + }, + { + "question_num": 162, + "query": "HIV造成机体免疫功能损害主要侵犯的细胞是", + "options": { + "A": "CD4⁺T淋巴细胞", + "B": "CD8⁺T淋巴细胞", + "C": "B淋巴细胞", + "D": "NK细胞", + "E": "浆细胞" + }, + "answer": "A", + "reason": "CD4*T淋巴细胞在HIV直接和间接作用下,细胞功能受损和大是破坏,导致细胞免疫缺陷。虽然同时还侵犯其他类型免疫细胞:单核吞噬细胞、B淋巴细胞、NK细胞损伤及HIV感染后的免疫应答异常。最主要的还是CD4+T淋巴细胞,故选A。" + }, + { + "question_num": 163, + "query": "喘证的临床表现应除外哪一项", + "options": { + "A": "呼吸困难", + "B": "鼻翼扇动", + "C": "张口抬肩", + "D": "难以平卧", + "E": "喉中痰鸣" + }, + "answer": "E", + "reason": "喘证是以呼吸困难,甚至张口抬肩换恐扇动,不能平卧为特征的病证，而喉中痰鸣是哮病的临床表现。" + }, + { + "question_num": 164, + "query": "下列哪项不是带下病的病因", + "options": { + "A": "感受湿邪", + "B": "脾虚湿注", + "C": "肺阴亏虚", + "D": "湿热下注", + "E": "肾阳虚衰" + }, + "answer": "C", + "reason": "导致带下的主要原因是湿邪,包括内外湿邪,其中,脾肝肾是产生内湿之因。脾脾失健运,水湿内生。" + }, + { + "question_num": 165, + "query": "虎杖的功效是", + "options": { + "A": "活血调经,清热利湿,解毒消疮,化痰平喘", + "B": "散瘀止痛,清热解毒,利湿退黄,化痰止咳", + "C": "活血定痛,清热利湿,解毒通便,化痰止咳", + "D": "活血通络,祛湿退黄,清热解毒,利尿通便", + "E": "活血消癥,利湿退肿,解毒疗疮,化痰通便" + }, + "answer": "B", + "reason": "虎杖的功效是利湿退黄,消热解毒散瘀止痛,化痰止咳,泻热通便" + }, + { + "question_num": 166, + "query": "胃溃疡最主要的症状是", + "options": { + "A": "嗳气、反酸", + "B": "恶心、呕吐", + "C": "呕吐、黑便", + "D": "上腹疼痛", + "E": "食欲减退" + }, + "answer": "D", + "reason": "胃溃疡的主要症状是上腹部疼痛。嗳气、反酸可见于反流性食管炎，BCE项均不是胃溃疡的特征。" + }, + { + "question_num": 167, + "query": "癌癃闭病因病理除膀胱湿热、肺热壅盛脾气不升、肾阳衰惫、肝郁气滞外,还有", + "options": { + "A": "邪热内侵", + "B": "寒邪阻络", + "C": "气湿升降", + "D": "浊瘀阻塞", + "E": "三焦气闭" + }, + "answer": "D", + "reason": "癃闭病因病理:有虚实之分。膀胱湿热、肺热壅盛、肝郁气滞、浊瘀阻塞以致膀胱气化不利为实，脾气不升、肾阳衰众导致膀胱气化无权者为虚。" + }, + { + "question_num": 168, + "query": "异位妊娠已破损型的休克型需急诊处理，下列哪项不属于其中的处理措施", + "options": { + "A": "患者平卧,立即检测生命体征", + "B": "急査血常规、血型及交叉配血", + "C": "立即吸氧,开通静脉通道", + "D": "有条件者同时服用参附汤回阳救逆", + "E": "直接手术治疗" + }, + "answer": "E", + "reason": "异位妊娠已破损型的休克型属于急、危、重症,表现为突发下腹剧痛,伴肛门下坠;面色苍白,四肢厥冷或冷汗淋漓,恶心呕吐,血压不稳或下降,可烦躁不安。临床需要紧急处理。ABCD项均为临床处理措施。若腹腔内出血多,或经以上处理休克仍不能纠正者,应立即手术治疗。" + }, + { + "question_num": 169, + "query": "羌活胜湿汤与九味羌活汤的组成药物中均含有的是", + "options": { + "A": "防风、川芎", + "B": "黄芩、川芎", + "C": "羌活、藁本", + "D": "羌活、独活", + "E": "羌活、蔓荆子" + }, + "answer": "A", + "reason": "羌活胜湿汤的组成:羌活、独活、本、防风、甘草、川芎、荆子。九味羌活汤的组成:羌活:防风、苍术、细辛、川芎、白芷、生地黄、黄芩、甘草。" + }, + { + "question_num": 170, + "query": "下列关于感染过程的描述,错误的是", + "options": { + "A": "病原体与人体相互作用,相互斗争的过程称为感染过程", + "B": "感染过程的构成必须具备病原体、人体和外环境三个因素", + "C": "病原体侵入人体,临床上出现相应的症状、体征则意味着感染过程的开始", + "D": "病原体侵入的数量越大，出现显性感染的危险也越大", + "E": "病原体的致病力包括毒力、侵袭力、病原体数量和变异性" + }, + "answer": "C", + "reason": "病原体通过各种途径进人人体,就意味着感染过程的开始，而临床上是否出现相应的症状、体征,则取决于病原体的致病力和机体的免疫功能。" + }, + { + "question_num": 171, + "query": "与女子妊娠密切相关的经脉是", + "options": { + "A": "督脉", + "B": "任脉", + "C": "冲脉", + "D": "带脉", + "E": "阴维脉" + }, + "answer": "B", + "reason": "任脉调节全身阴经经气,妊娠需要阴血,故与女子妊娠密切相关的经脉是任脉。" + }, + { + "question_num": 172, + "query": "治疗经间期出血血瘀证，应首选", + "options": { + "A": "清肝止淋汤", + "B": "左归丸", + "C": "两地汤合二至丸", + "D": "逐瘀止血汤", + "E": "调肝汤" + }, + "answer": "D", + "reason": "治疗经间期出血血瘀证,应首选逐瘀止血汤。" + }, + { + "question_num": 173, + "query": "大黄牡丹汤中配伍大黄的意义在于", + "options": { + "A": "泻肠中湿热瘀结之毒", + "B": "泻下通便,荡涤肠胃", + "C": "清热泻火止血", + "D": "生肌敛疮", + "E": "清热解毒消肿" + }, + "answer": "A", + "reason": "大黄牡丹汤方中大黄泻火逐瘀,通便解毒;牡丹皮凉血清热,活血散瘀,二者合用,共泻肠腑湿热瘀结,为方中君药。芒硝软坚散结,协大黄荡涤实热,促其速下;桃仁普破血,助君药以通瘀滞,俱为臣药。冬瓜仁清痢利湿,导肠腑垢浊,排脓消痈,是为佐药。本方攻下泄热与逐瘀并用，使结瘀湿热速下，痛随痢减,痈肿得消,诸症自愈。" + }, + { + "question_num": 174, + "query": "甲类传染病是指", + "options": { + "A": "SARS、狂犬病", + "B": "黑热病、炭疽", + "C": "高致病性禽流感、天花", + "D": "鼠疫、霍乱", + "E": "伤寒、流行性出血热" + }, + "answer": "D", + "reason": "甲类传染病:鼠疫、霍乱;乙类传染病:传染性非典型肺炎(SARS)、艾滋病、病毒性肝炎脊髓灰质炎、狂犬病等;丙类传染病:流行性感冒、流行性腮腺炎、风疹、麻风病等,故选D。SARS、狂犬病、炭疽、流行性出血热和高致病性禽流感均属于乙类传染病。" + }, + { + "question_num": 175, + "query": "起于足跗外侧的经脉是", + "options": { + "A": "阳跷脉", + "B": "阴跷脉", + "C": "阴维脉", + "D": "阳维脉", + "E": "冲脉" + }, + "answer": "D", + "reason": "A项阳跷脉起于足跟外侧,B项阴跷脉起于足跟内侧，C项阴维脉起于小腿内侧，D项阳维脉起于足跗外侧,E项冲脉起于胞中。" + }, + { + "question_num": 176, + "query": "滑胎气血虚弱证的主方是", + "options": { + "A": "补肾固冲丸", + "B": "泰山磐石散", + "C": "肾气丸", + "D": "育阴汤", + "E": "桂枝茯苓丸" + }, + "answer": "B", + "reason": "治疗滑胎气血虚弱证宜益气养血，固冲安胎,代表方剂是泰山石散。" + }, + { + "question_num": 177, + "query": "玉屏风散与牡蛎散相同的功用是", + "options": { + "A": "固表", + "B": "涩肠", + "C": "止遗", + "D": "固冲", + "E": "补肾" + }, + "answer": "A", + "reason": "玉屏风散益气固表止汗。牡蛎散益气固表,敛阴止汗。" + }, + { + "question_num": 178, + "query": "发生霍乱时,对疫区接触者的检疫期是", + "options": { + "A": "3天", + "B": "5天", + "C": "7天", + "D": "9天", + "E": "12天" + }, + "answer": "B", + "reason": "患者和带菌者是霍乱的主要传染源,患者在发病期间,可连续排菌,时间一般为5日。对接触者应严密检疫5日，留类培养并服药预防。" + }, + { + "question_num": 179, + "query": "心包经的络穴是", + "options": { + "A": "神门", + "B": "间使", + "C": "大陵", + "D": "内关", + "E": "太渊" + }, + "answer": "D", + "reason": "神门是心经的原穴,大陵是心包经的原穴,内关是心包经的络穴，太湖是肺经的原穴。" + }, + { + "question_num": 180, + "query": "痛经之所以随月经周期而发作，与下列哪项有关", + "options": { + "A": "寒凝胞中", + "B": "经期胞中血虚邪盛", + "C": "经期冲任气血变化急骤", + "D": "冲任血虚、胞宫失养", + "E": "湿热蕴结胞中" + }, + "answer": "C", + "reason": "痛经之所以随月经周期而发作，又与经期及经期前后特殊生理状态有关,未行经期间，由于冲任气血平和,致病因素尚不足以引起冲任、子官气血瘀滞或不足,故平时不发生疼痛。经期前后，血海由满盈而泻溢,气血盛实而骤虚,子宫、冲任气血变化较平时急剧,易受致病因素干扰,加之体质因素的影响，导致子官、冲任气血运行不畅或失于煦,不通或不荣而痛。" + }, + { + "question_num": 181, + "query": "由逍遥散变化为黑逍遥散,属于", + "options": { + "A": "药味加减的变化", + "B": "药量增减的变化", + "C": "剂型更换的变化", + "D": "药味加减和药量增减变化的联合运用", + "E": "药���增减和剂型更换变化的联合运用" + }, + "answer": "A", + "reason": "黑逍遥散出自《医略六书·女科指要》是由逍迅散加生地黄或熟地黄而成，" + }, + { + "question_num": 182, + "query": "根据突发事件应急处理的需要,有权紧急调集人员、储备的物资、交通工具以及相关设施、设备;必要时,对人员进行疏散或者隔离,并可以依法对传染病疫区实行封锁的是", + "options": { + "A": "县级以上地方人民政府卫生行政主管部门", + "B": "县级以上地方人民政府", + "C": "所在地省级人民政府", + "D": "突发事件应急处理指挥部", + "E": "国务院卫生行政主管部门" + }, + "answer": "D", + "reason": "突发公共卫生事件应急条例》规定,突发事件发生后，国务院设立全国突发事件应急处理指挥部负责对全国突发事件应急处理的统一领导、统一指挥。省、自治区、直辖市人民政府成立地方突发事件应急处理指挥部,负资领导、指挥本行政区域内突发事件应急处理工作，故选，" + }, + { + "question_num": 183, + "query": "眩晕的发生,与哪些脏腑关系密切", + "options": { + "A": "肺、脾、肾", + "B": "心、肝、肾", + "C": "肝、肾、脾", + "D": "肺、胃、肾", + "E": "心、脾、肾" + }, + "answer": "C", + "reason": "眩晕的病因病机主要与肝阳上亢脾失健运,痰湿中阻,脾胃虚弱,气血不足,肾精不足有关,故眩晕与肝、脾、肾关系密切。" + }, + { + "question_num": 184, + "query": "下列不属于宫内节育器禁忌证的是", + "options": { + "A": "急性盆腔炎", + "B": "重度贫血", + "C": "正常产后3个月", + "D": "重度子宫脱垂", + "E": "月经过多过频" + }, + "answer": "C", + "reason": "宫内节育器禁忌证:放置节育器前必须排除妊娠的存在,如已发现妊娠者，应先终止妊娠;生殖器官炎症,如急性盆腔炎、阴道炎、重度官颈烂等;月经系乱，如近3个月月经过多，月经频发或不规则阴道流血，重度痛经等;生殖器肿瘤、官颈口过松:重度子宫脱垂等;严重的全身性疾患,如心力衰竭、重度贫血等;严重的出血性疾患。" + }, + { + "question_num": 185, + "query": "在使用注意方面,宜从小量开始,缓缓增加，以免阳升风动，头晕目赤的药物是", + "options": { + "A": "巴戟天", + "B": "石斛", + "C": "鳖甲", + "D": "杜仲", + "E": "鹿茸" + }, + "answer": "E", + "reason": "鹿茸甘、咸,温。归肾、肝经。补肾阳、益精血,强筋骨,调冲任,托疮毒。服用本品宜从小量开始,缓缓增加,不可骤用大量，以免阳升风动、头晕目赤或伤阴动血。凡发热者均当忌服。" + }, + { + "question_num": 186, + "query": "下列不支持艾滋病诊断的是", + "options": { + "A": "口咽念珠菌感染", + "B": "持续发热", + "C": "头痛,进行性痴呆", + "D": "皮肤黏膜出血", + "E": "慢性腹泻" + }, + "answer": "D", + "reason": "高危人群存在下列情况两项或两项以上者,应考虑艾滋病的可能:①近期体重下降10%以上;②慢性咳嗽或腹泻3个月以上;③间歇或持续发热1个月以上;④全身淋巴结肿大;⑤反复出现带状疱疹或慢性播散性单纯疱疹感染;⑥口咽念珠菌感染ABE项均支持艾滋病的诊断。结合艾滋病的临床表现,艾滋病在4期主要出现5种表现，其中神经系统症状主要表现有头痛、疲痫、进行性痴呆和下肢瘫痪等故C项也支持艾滋病诊断。艾滋病对皮肤黏膜造成的损害,主要是肿瘤和感染等,并不出现出血症状,故皮肤黏膜出血不能作为艾滋病诊断的依据,故选D。" + }, + { + "question_num": 187, + "query": "《内经》提出的“治痿者独取阳明”是指", + "options": { + "A": "益气、养血、活血", + "B": "补肾精、清心火", + "C": "补脾胃、清胃火、祛湿热", + "D": "益气、养血、通络", + "E": "补肝肾、强筋骨" + }, + "answer": "C", + "reason": "内经》提出“治痿者独取阳明”,是指补脾胃、消胃火、祛湿热以调养五脏的一种重要指施" + }, + { + "question_num": 188, + "query": "治疗阴疮寒湿证，应首选的方剂是", + "options": { + "A": "仙方活命饮", + "B": "龙胆泻肝汤", + "C": "蛇床子散", + "D": "草游渗湿汤", + "E": "托里消毒散" + }, + "answer": "E", + "reason": "阴疮寒湿证治法:温经散寒,除湿消疮。代表方:阳和汤或托里消毒散。" + }, + { + "question_num": 189, + "query": "附子人汤剂宜", + "options": { + "A": "泡服", + "B": "另煎", + "C": "后下", + "D": "先煎", + "E": "烊化" + }, + "answer": "D", + "reason": "先煎:主要指有效成���难溶于水的一些金石、矿物、介壳类药物,应打碎先煎,煮沸20~30分钟,再下其他药物同煎,以使有效成分充分析出,如磁石、代赭石、生铁落、龙骨、牡蛎、石决明、龟甲、整甲等。此外,附子、乌头等毒副作用较强的药物,宜先煎45~60分钟后再下他药，久煎可以降低毒性，安全用药。" + }, + { + "question_num": 190, + "query": "洋地黄毒性反应所致室性期前收缩伴低血钾治疗宜首选", + "options": { + "A": "β受体阻滞剂", + "B": "普鲁卡因胺", + "C": "可不需治疗", + "D": "静脉注射利多卡因", + "E": "氯化钾" + }, + "answer": "E", + "reason": "洋地黄中毒所致的室性期前收缩应立即停用洋地黄,给予苯妥英钠或氯化钾等治疗。" + }, + { + "question_num": 191, + "query": "治疗滞产,应首选", + "options": { + "A": "合谷", + "B": "太冲", + "C": "足三里", + "D": "血海", + "E": "伏兔" + }, + "answer": "A", + "reason": "合谷穴的主治要点:头痛、齿痛、目赤肿痛、咽喉肿痛、失声、口眼歪斜、半身不遂、痄腮、疔疮、经闭、腹痛、牙关紧闭、小儿惊风、鼻衄、耳鸣耳聋发热恶寒、无汗、多汗、瘾疹、疟疾、产等病。" + }, + { + "question_num": 192, + "query": "绝经前后诸证的产生机制主要是", + "options": { + "A": "肝血不足,冲任亏虚", + "B": "脾气虚弱,冲任失养", + "C": "肾气虚衰,天癸渐竭", + "D": "心肾不交,冲任失调", + "E": "心脾血虚,冲任俱虚" + }, + "answer": "C", + "reason": "妇女在绝经前后,肾气虚衰,天癸浙竭,冲任二脉虚衰,由于体质因素,肾虚天癸竭的过程加剧,难以较迅速地适应这一阶段的过渡，使阴阳失去平衡,脏腑气血不相协调,因而出现诸多证候。" + }, + { + "question_num": 193, + "query": "能补火助阳,益阳消阴,作用温和持久，为治命门火衰之要药的是", + "options": { + "A": "附子", + "B": "干姜", + "C": "鹿茸", + "D": "肉桂", + "E": "高良姜" + }, + "answer": "D", + "reason": "肉桂的应用:阳痿,宫冷。能补火助阳,益阳消阴,作用温和持久,为治命门火衰之要药，" + }, + { + "question_num": 194, + "query": "下列有关国家对传染病防治的方针与办法最恰当的提法是", + "options": { + "A": "预防为主、防治结合、统一管理", + "B": "预防为主、防治结合、分类管理", + "C": "预防为主、防治结合、分级管理", + "D": "预防为主、防治结合、分片管理", + "E": "预防为主、防治结合、层级管理" + }, + "answer": "B", + "reason": "国家对传染病防治实行预防为主的方针,防治结合、分类管理、依靠科学:依靠群众。" + }, + { + "question_num": 195, + "query": "经络系统中能加强表里两经在浅层相互联系的主要是", + "options": { + "A": "奇经八脉", + "B": "十五络脉", + "C": "十二经别", + "D": "十二经筋", + "E": "十二皮部" + }, + "answer": "B", + "reason": "经络系统:别络的作用。四肢部的十二经别络,加强了十二经中表里两经的联系,沟通了表里两经的经气,补充了十二经脉循行的不足。" + }, + { + "question_num": 196, + "query": "治疗子满应首选的方剂是", + "options": { + "A": "五苓散", + "B": "白术散", + "C": "参苓白术散", + "D": "五皮散", + "E": "鲤鱼汤" + }, + "answer": "E", + "reason": "子满治法:健脾利水,养血安胎。方药:鲤鱼汤加黄芪、桑白皮或当归芍药散。" + }, + { + "question_num": 197, + "query": "五苓散和猪苓汤的组成药物中均有", + "options": { + "A": "猪苓、白术、茯苓", + "B": "猪苓、白术、泽泻", + "C": "茯苓、白术、泽泻", + "D": "本苓，猪苓、泽泻", + "E": "茯苓、猪苓、车前子" + }, + "answer": "D", + "reason": "猪苓汤由猪苓、茯苓、泽泻、阿胶、滑石共五味中药组成;五苓散由猪苓、茯苓、泽泻、桂枝、白术共五味中药组成。" + }, + { + "question_num": 198, + "query": "下列各项,不属于传染病诊治工作道德要求的是", + "options": { + "A": "重视消毒隔离", + "B": "遵守国家相关法律", + "C": "合理使用医疗资源", + "D": "具有无私奉献精神", + "E": "严格疫情报告制度" + }, + "answer": "C", + "reason": "传染科室的道德要求:①热爱本职工作,具有无私奉献精神;②坚持预防为主的积极防疫思想;③严格执行消毒隔离制度,防止交叉感染;④遵守国家法律规定,及时上报疫情。" + }, + { + "question_num": 199, + "query": "下列腧穴在五星配属中，属火的是", + "options": { + "A": "少府", + "B": "大陵", + "C": "后溪", + "D": "曲泉", + "E": "经渠" + }, + "answer": "A", + "reason": "特定穴:五输穴的五行配属。五输穴的五行属性按照“阴井木”“阳井金”的规律进行配属,阴经的井、荥、输、经、合分别配属木、火、土、金、水;阳经的井、荥、输、经、合分别配属金、水、木、火、土。" + }, + { + "question_num": 200, + "query": "子宫内膜的周期性变化中,分泌晚期的子宫内膜厚度", + "options": { + "A": "8mm", + "B": "9mm", + "C": "10mm", + "D": "11mm", + "E": "12mm" + }, + "answer": "C", + "reason": "分泌晚期,是在月经周期的第24~28日,此期为月经来潮前期，子宫内膜厚度达10mm,并是海绵状，" + }, + { + "question_num": 201, + "query": "参苓白术散中具有芳香醒脾之功的药物是", + "options": { + "A": "桔梗", + "B": "砂仁", + "C": "藿香", + "D": "佩兰", + "E": "厚朴" + }, + "answer": "B", + "reason": "参苓白术散的配伍意义:方中人参白术、茯苓益气健脾渗湿为君。配伍山药、莲子肉助君药以健脾益气,兼能止泻;并用白扁豆、苡仁助白术茯苓以健脾渗湿,均为臣药。更用砂仁醒脾和胃,行气化滞,是为佐药。桔梗宣肺利气,通调水道，又能载药上行,培土生金;炒甘草健脾和中,调和诸药,共为佐使。综观全方,补中气,渗湿浊,行气滞,使脾气健运,湿邪得去,则诸症自除。" + }, + { + "question_num": 202, + "query": "下列哪项符合二度I型房室传导阻滞的心电图表现", + "options": { + "A": "P-P间期及P-R间期均不等", + "B": "相邻的P-P间期进行性缩短", + "C": "包含受阻P波在内的R-R间期小于正常P-P间期的两倍", + "D": "最常见的传导比例为2:1", + "E": "受阻P波前的一个P-R间期延长" + }, + "answer": "C", + "reason": "二度工型房室传导阻滞的心电图表现:①P-R间期进行性延长直至一个P波受阻不能下传心室;②相邻R-R间期进行性缩短,直至一个P波不能下传心室;③包含受阻P波在内的R-R间期小于正常实性P-P间期的两倍;最常见的房室传导比例为3:2或5:4。根据此标准,只有C项描述的符合二度I型房室传导阻滞的心电图表现。" + }, + { + "question_num": 203, + "query": "下列经脉循行除哪项外,都经过心", + "options": { + "A": "手厥阴经", + "B": "手少阴经", + "C": "手太阳经", + "D": "手阳明经", + "E": "足少阴经" + }, + "answer": "D", + "reason": "手厥阴经:起于胸中,属心包络:手少阴经:起于心中;手太阳经:向下进人缺盆部,联络心;足少阴经:肺部支脉、从肺分出,联络心。" + }, + { + "question_num": 204, + "query": "下列哪项是产后用药“三禁”", + "options": { + "A": "活血、通便、消导", + "B": "大汗、峻下、利小便", + "C": "清热、凉血、滋阴", + "D": "祛寒、开郁、化瘀", + "E": "以上均非" + }, + "answer": "B", + "reason": "产后用药“三禁”,即禁大汗以防亡阳,禁峻下以防亡银,禁通利小便以防亡津液。" + }, + { + "question_num": 205, + "query": "归脾汤除益气补血外,还具有的功用是", + "options": { + "A": "健脾养心", + "B": "补血调血", + "C": "敛阴止汗", + "D": "滋阴复脉", + "E": "益阴降火" + }, + "answer": "A", + "reason": "归脾汤的功用:益气补血,健脾养心。" + }, + { + "question_num": 206, + "query": "急性化脓性骨髓炎骨改变的X线表现在发病多长时间可出现", + "options": { + "A": "即刻", + "B": "3天内", + "C": "3~7天", + "D": "1~2周", + "E": "2周以上" + }, + "answer": "E", + "reason": "急性化脓性骨髓炎X线表现:①发病后2周内，可见肌间隙模糊或消失，皮下组织与肌间分界模糊等;②发病2周后可见骨改变。" + }, + { + "question_num": 207, + "query": "下列各项,除哪项外,均为各种淋证的共同表现", + "options": { + "A": "小便频急", + "B": "腰部酸痛", + "C": "淋沥涩痛", + "D": "尿血而痛", + "E": "小腹拘急" + }, + "answer": "D", + "reason": "小便频急,淋沥涩痛,小腹拘急,为各种淋证的主症,另腰痛、低热、小腹坠胀是淋证的伴随症状，“尿血而痛”是血淋的表现，并非共同症状。" + }, + { + "question_num": 208, + "query": "下列各项,不属产后发热病因的是", + "options": { + "A": "感染邪毒", + "B": "外感", + "C": "血瘀", + "D": "血虚", + "E": "阳盛血热" + }, + "answer": "E", + "reason": "产后发热病因有感染邪毒、外感、血瘀、血虚。" + }, + { + "question_num": 209, + "query": "补阴剂中属“纯补无泻”的方剂是", + "options": { + "A": "六味地黄丸", + "B": "清骨散", + "C": "大补阴丸", + "D": "左归丸", + "E": "一贯煎" + }, + "answer": "D", + "reason": "左归丸主治真阴不足证,具有滋阴补肾,填精益髓之功，为纯补之剂" + }, + { + "question_num": 210, + "query": "下列各项,不属中国古代医德思想内容的是", + "options": { + "A": "救死扶伤、一视同仁的道德准则", + "B": "仁爱救人、赤诚济世的事业准则", + "C": "清廉正直、不图钱财的道德品质", + "D": "认真负责、一丝不苟的服务态度", + "E": "不畏权贵、忠于医业的献身精神" + }, + "answer": "D", + "reason": "中国古代医德思想内容包括仁爱救人、赤诚济世的事业准则;清廉正直、不图钱财的道德品质;不畏权贵、忠于医业的献身精神;救死扶伤、一视同仁的道德准则;一心救治、不畏艰苦的服务态度。" + }, + { + "question_num": 211, + "query": "十二经脉的命名,主要包含了下列哪些内容", + "options": { + "A": "阴阳、五行、脏腑", + "B": "五行、手足、阴阳", + "C": "手足、阴阳、脏腑", + "D": "脏腑、手足、五行", + "E": "以上均非" + }, + "answer": "C", + "reason": "十二经脉的名称是古人根据阴阳消长所衍化的三阴三阳,结合经脉循行于上肢和下肢的特点,以及与脏腑相属络的关系而定的,故十二经脉的命名主要包含了手足、阴阳、脏腑。" + }, + { + "question_num": 212, + "query": "产后郁冒,属产后哪项之一", + "options": { + "A": "“三冲”", + "B": "“三急”", + "C": "“三病”", + "D": "“三禁”", + "E": "“三审”" + }, + "answer": "C", + "reason": "新产妇人有三病:一者病痉,二者病郁冒，三者大便难。" + }, + { + "question_num": 213, + "query": "月经过多,血色紫黑稠黏,手足心热,腰膝酸软,舌红,脉弦数者,治疗应当选用", + "options": { + "A": "易黄汤", + "B": "固冲汤", + "C": "固经丸", + "D": "桑螵蛸散", + "E": "逍遥散" + }, + "answer": "C", + "reason": "固经丸主治阴虚血热之崩漏。功用滋阴清热，固经止血。" + }, + { + "question_num": 214, + "query": "伤寒菌血液培养,阳性率最高的时间", + "options": { + "A": "第1周", + "B": "第2周", + "C": "第3周", + "D": "第4周", + "E": "第5周" + }, + "answer": "A", + "reason": "伤寒菌进行血培养时在病程的第1~2周阳性率高达80%~90%第3周降到50%，以后更低,所以题中问阳性率最高时,排除CDE。而第1周时病情在初期，症状逐渐明显，这时阳性率逐浙升高,所以在第1周末的时候会达到高峰。" + }, + { + "question_num": 215, + "query": "肺经的原穴是", + "options": { + "A": "神门", + "B": "间使", + "C": "大陵", + "D": "内关", + "E": "太渊" + }, + "answer": "E", + "reason": "E项太渊是肺经的原穴;其他选项的穴位均排除。" + }, + { + "question_num": 216, + "query": "女子婚后未避孕,有正常性生活,丈夫查精液常规正常，同居2年未受孕者,称为", + "options": { + "A": "断绪", + "B": "不育", + "C": "全不产", + "D": "五不女", + "E": "绝对不孕" + }, + "answer": "C", + "reason": "原发性不孕,古称全不产,继发性不孕,古称断绪。" + }, + { + "question_num": 217, + "query": "原方用法要求药后“多饮暖水”的是", + "options": { + "A": "生脉散", + "B": "五苓散", + "C": "玉屏风散", + "D": "桑螵蛸散", + "E": "参苓白术散" + }, + "answer": "B", + "reason": "五苓散的用法。五苓散服法要求“多饮暖水,汗出愈”目的在于以水热之气,助人体阳气,资其发汗,使表邪从汗而解" + }, + { + "question_num": 218, + "query": "在下列各项中,最能反映医患关系性质的是医务人员与患者之间的", + "options": { + "A": "信托关系", + "B": "陌生人之间的关系", + "C": "主动一被动关系", + "D": "类似父(母)子间的关系", + "E": "商品关系" + }, + "answer": "A", + "reason": "医患关系是以社会主义法制为保障建立起来的信托关系。社会主义法制的根本职能是保护人民群众的合法权益,患者就医和医者行医同样受到法律保护。社会主义法制保护了医生为患者提供医疗卫生保健和康复的特殊职权，使之可以获得患者身体、心理、隐私等信息;患者为了诊治疾病的要而信任医生,将必要的信息告诉医生,并委托医生为其解除疾苦。因此，两者是建立在信赖基础上的特殊人际关系。" + }, + { + "question_num": 219, + "query": "治疗胎位不正最常用的腧穴是", + "options": { + "A": "合谷", + "B": "至阴", + "C": "太冲", + "D": "三阴交", + "E": "足三里" + }, + "answer": "B", + "reason": "至阴穴的主治要点:头痛、鼻塞、鼻衄、目痛、胞衣不下、胎位不正、难产等。" + }, + { + "question_num": 220, + "query": "下列癞痕的定义,正确的是", + "options": { + "A": "癞多为恶性,痕多为良性", + "B": "癞有形可征,固定不移,痛无定处", + "C": "瘦聚散无常,推之可移,痛有定处", + "D": "妇人下腹结块,或痛,或胀,或满", + "E": "癞属气病,痕属血病" + }, + "answer": "D", + "reason": "痕为妇人下腹结块,或痛,或胀或满,或异常出血。有形可征,固定不移,痛有定处;痕聚散无常,推之可移,痛无定处。属血病,属气病。" + }, + { + "question_num": 221, + "query": "羌活胜湿汤和独活寄生汤的共同功用是", + "options": { + "A": "祛风除湿止痛", + "B": "利水渗湿", + "C": "解表祛湿", + "D": "芳香化湿", + "E": "解表止痛" + }, + "answer": "A", + "reason": "①羌活胜湿汤祛风,胜湿,让痛,独活寄生汤祛风湿，止痹痛,益肝肾,补气血;②羌活胜湿汤用于内伤头痛之风湿头痛，本方羌活、独活共用,独活寄生汤用于痹证肝肾两虚证、产后身痛风寒证;③羌活气味较浓,发散解表力强,普治上部风寒湿痹痛,独活气味较淡,性较和缓,普治下部风寒湿痹痛,解表力不及羌活。" + }, + { + "question_num": 222, + "query": "生命价值论指的是", + "options": { + "A": "生命神圣与人道论的统一", + "B": "生命神圣与生命质量的统一", + "C": "美德论与义务论的统一", + "D": "生命质量与生命价值论的统一", + "E": "义务论与公益论的统一" + }, + "answer": "B", + "reason": "生命价值论是生命神圣与生命质量统一的理论" + }, + { + "question_num": 223, + "query": "太溪穴位于", + "options": { + "A": "内踝下缘凹陷处", + "B": "外踝下缘凹陷处", + "C": "内踝前下方凹陷中", + "D": "外踝高点与跟腱之间凹陷处", + "E": "内踝高点与跟腱之间凹陷处" + }, + "answer": "E", + "reason": "太溪穴的定位:在足内侧内踝后方当内踝尖与跟腱之间的凹陷处。" + }, + { + "question_num": 224, + "query": "提出小儿生理特点为“稚阳未充,稚阴未长者也”的著作是", + "options": { + "A": "《颇风经》", + "B": "《温病条辨》", + "C": "《幼科要略》", + "D": "《幼科发挥》", + "E": "《小儿药证直诀》" + }, + "answer": "B", + "reason": "清代医家吴鞠通通过长期临床观察,从阴阳学说出发,认为小儿时期的机体柔嫩、气血未充、脾胃薄弱、肾气未充、媵理疏松、神气怯弱、筋骨未坚等特点可以归纳:“稚阳未充,稚阴未长者也。”故选《温病条辨》。" + }, + { + "question_num": 225, + "query": "朱砂安神丸中泻火除烦的药物是", + "options": { + "A": "栀子", + "B": "黄连", + "C": "石膏", + "D": "竹叶", + "E": "知母" + }, + "answer": "B", + "reason": "方中黄连苦寒,人心经,清心泻火以除烦热为臣药。" + }, + { + "question_num": 226, + "query": "在临床医学研究中要求对资料保密,以下哪一点是不属于该范畴的", + "options": { + "A": "对研究资料严加保密", + "B": "对研究成果严加保密", + "C": "医师与患者之间的保密", + "D": "研究者与受试者之间的保密", + "E": "研究者与双盲对象之间的保密" + }, + "answer": "B", + "reason": "医学科研成果要用于社会和全人类，不能严加保密。" + }, + { + "question_num": 227, + "query": "联系舌根,分散于舌下的经脉是", + "options": { + "A": "足厥阴肝经", + "B": "足少阴肾经", + "C": "足太阴脾经", + "D": "足阳明胃经", + "E": "足少阳胆经" + }, + "answer": "C", + "reason": "足厥阴肝经过阴器,连目系、环唇内,故排除;足少阴肾经循喉咙,挟舌本,故排除;足太阴脾经挟咽,连舌本,敝舌下,故本项正确;足阳明胃经起于鼻,入上齿,环口挟唇,循喉咙,故排除;足少阳胆经起于目锐眦·下耳后,人耳中.出耳前,故排除" + }, + { + "question_num": 228, + "query": "小儿多发性抽动症病位主要在", + "options": { + "A": "心", + "B": "肝", + "C": "脾", + "D": "肺", + "E": "肾" + }, + "answer": "B", + "reason": "小儿多发性抽搐症的病位主要在肝,与心、脾、肾密切相关。" + }, + { + "question_num": 229, + "query": "越鞠丸中以行气为主的药物是", + "options": { + "A": "木香", + "B": "沉香", + "C": "香附", + "D": "枳壳", + "E": "厚朴" + }, + "answer": "C", + "reason": "越鞠丸行气解郁。方中���附辛香人肝,行气开郁为君药。" + }, + { + "question_num": 230, + "query": "医德范畴审慎主要是指", + "options": { + "A": "对自己行为是否符合道德准则的自我评定", + "B": "医务人员理性上自尊的表现", + "C": "对患者高度负责的精神和严谨的科学作风", + "D": "医务人员在道德上应该履行的职责", + "E": "医务人员对自己和他人行为之间关系的内心体验" + }, + "answer": "C", + "reason": "医德审慎是指医师在行为之前的周密思考和行为过程中的小心谨慎、细心操作。" + }, + { + "question_num": 231, + "query": "经络系统中,具有维持人体正常运动功能的是", + "options": { + "A": "十二经脉", + "B": "十五络脉", + "C": "十二经别", + "D": "十二经筋", + "E": "十二皮部" + }, + "answer": "D", + "reason": "A项十二经脉是调节十二经气血的经脉;B项十五络脉加强了十二经中表里两经的联系从而沟通了表里两经的经气:C项十二经别不但加强了十二经脉的内外联系,更加强了经脉所络属的脏腑在体腔深部的联系:D项十二经筋具有约束骨骼，屈伸关节,维持人体正常运动功能的作用:E项十二皮部起者保卫机体,抗御外邪和反映病证的作用。" + }, + { + "question_num": 232, + "query": "睡眠时两眼开而不合,病机多属于", + "options": { + "A": "心经积热", + "B": "肝火上炎", + "C": "脾气虚弱", + "D": "肺热壅盛", + "E": "肾阴亏虚" + }, + "answer": "C", + "reason": "眼睑为脾所主,睡眠时两眼开而不合是脾气虚弱的表现。" + }, + { + "question_num": 233, + "query": "能够收敛固涩、益气生津、补肾宁心的药物是", + "options": { + "A": "乌梅", + "B": "浮小麦", + "C": "麻黄根", + "D": "山茱萸", + "E": "五味子" + }, + "answer": "E", + "reason": "五味子功效:收敛固涩,益气生津，补肾宁心。" + }, + { + "question_num": 234, + "query": "医德评价中最普遍、最重要的一种方式是", + "options": { + "A": "社会舆论", + "B": "内心信念", + "C": "传统习俗", + "D": "幸福指数", + "E": "医德荣誉" + }, + "answer": "A", + "reason": "社会舆论是指公众对某种社会现象、行为和事件的看法和态度,即公众的认识。社会舆论可以形成一种强大的精神力量,调整人们的道德行为,指导人们的道德生活,是医德评价中最普遍、最具有影响力的方式,在医德评价中起着重要作用。" + }, + { + "question_num": 235, + "query": "捻转补泻法的补法操作是", + "options": { + "A": "捻转角度大,频率慢,用力轻", + "B": "捻转角度小,频率慢,用力轻", + "C": "捻转角度大,频率快，用力轻", + "D": "捻转角度小,频率慢，用力重", + "E": "捻转角度小,频率快,用力重" + }, + "answer": "B", + "reason": "捻转补泻:针下得气后,捻转角度小,用力轻,频率慢,操作时间短,结合拇指向前、食指向后(左转用力为主)者为补法泻法各项操作与之相反。" + }, + { + "question_num": 236, + "query": "小儿能独走的时间一般是", + "options": { + "A": "8个月", + "B": "10个月", + "C": "12个月", + "D": "16个月", + "E": "18个月" + }, + "answer": "C", + "reason": "新生儿仅有反射性活动(如吮吸、吞咽等)和不自主的活动;1个月小儿睡醒后常做伸欠动作;2个月时扶坐或侧卧时能勉强抬头;4个月时可用手撑起上半身;6个月时能独坐片刻;8个月会爬;10个月可扶走;小儿12个月会独走。" + }, + { + "question_num": 237, + "query": "眩晕头痛,胸膈痞闷,恶心呕吐,舌苔白腻,脉弦滑者,治宜选用", + "options": { + "A": "温胆汤", + "B": "镇肝熄风汤", + "C": "羚角钩藤汤", + "D": "天麻钩藤饮", + "E": "半夏白术天麻汤" + }, + "answer": "E", + "reason": "半夏白术天麻汤主治风痰上扰证眩晕,头痛,胸膈痞闷,恶心呕吐,舌苔白腻,脉弦滑。" + }, + { + "question_num": 238, + "query": "受理申请医师注册的卫生健康主管部门对不符合条件不予注册的，应当自受理申请之日起多少日内书面通知申请人，并说明理由", + "options": { + "A": "15日", + "B": "20日", + "C": "30日", + "D": "40日", + "E": "45日" + }, + "answer": "B", + "reason": "受理申请医师注册的卫生健康主管部门对不符合条件不予注册的，应当自受理申请之日起20个工作日内书面通知申请人和其所在医疗卫生机构,并说明理由。" + }, + { + "question_num": 239, + "query": "心经的郄穴是", + "options": { + "A": "少府", + "B": "神门", + "C": "阴郄", + "D": "灵道", + "E": "通里" + }, + "answer": "C", + "reason": "少府是心经的荥穴，神门是心经的原穴,阴郄是心经的都穴,通里是心经的络穴。" + }, + { + "question_num": 240, + "query": "在以下疾病中,推拿疗法效果较好的是", + "options": { + "A": "咳嗽", + "B": "肺炎喘嗽", + "C": "哮喘", + "D": "泄泻", + "E": "紫癜" + }, + "answer": "D", + "reason": "小儿推拿常用于治疗小儿泄泻、厌食、腹痛等。" + }, + { + "question_num": 241, + "query": "小柴胡汤主治证候,不包括", + "options": { + "A": "往来寒热", + "B": "烦渴引饮", + "C": "心欢音职", + "D": "口苦咽干", + "E": "脉弦" + }, + "answer": "B", + "reason": "小柴胡汤主治:①伤寒少阳证,往来寒热,胸胁苦满,默默不欲饮食,心烦喜呕,口苦,咽干，目眩，舌苔进白，脉弦者;②热人血室证,妇人中风，经水适断,寒热发作有时;③黄疸、疟疾,以及内伤杂病而见少阳证者。" + }, + { + "question_num": 242, + "query": "下列药物,不能用于艾滋病治疗的是", + "options": { + "A": "齐多夫定", + "B": "双脱氧胞苷", + "C": "双脱氧肌苷", + "D": "阿糖腺苷", + "E": "拉米夫定" + }, + "answer": "D", + "reason": "目前抗HIV的药物可分为3大类核苷类逆转录酶抑制剂、非核苷类逆转录酶抑制剂和蛋白酶抑制剂,核苷类逆转录酶抑制剂包括齐多夫定、双脱氣胞苷、双脱氧肌苷、拉米夫定和司坦夫定等,故ABCE项均能用于女滋病治疗;而阿糖腺苷主要应用于疱疹病毒感染的抗病毒治疗，对艾滋病治疗无效，故选D。" + }, + { + "question_num": 243, + "query": "针刺皮肤松弛部位的腧穴,常用的进针法是", + "options": { + "A": "指切", + "B": "挟持", + "C": "舒张", + "D": "提捏", + "E": "套管" + }, + "answer": "C", + "reason": "A项指切适用于短针的进针,B项挟持适用于长针的进针,C项舒张适用于皮肤松弛部位腧穴的进针,D项提捏适用于皮肉浅薄部位的进针，E项套管可以代替手，但是不常用，排除。" + }, + { + "question_num": 244, + "query": "小儿肺炎喘嗽与咳嗽的鉴别要点是", + "options": { + "A": "咳嗽剧烈", + "B": "高热不退", + "C": "气急鼻扇", + "D": "痰涎壅盛", + "E": "大便干结" + }, + "answer": "C", + "reason": "小儿肺炎喘嗽和咳嗽都可见咳嗽剧烈、高热不退、痰涎壅盛、大便干结等症状,只有气急鼻扇是两者的监别要点。" + }, + { + "question_num": 245, + "query": "附子与干姜具有的相同功效为", + "options": { + "A": "温中止呕", + "B": "温经止痛", + "C": "补火助阳", + "D": "回阳散寒", + "E": "温肺化饮" + }, + "answer": "D", + "reason": "附子功效:回阳救逆,补火助阳,散寒止痛。千姜功效:温中散寒,回阳通脉,温肺化饮。" + }, + { + "question_num": 246, + "query": "根据《中华人民共和国传染病防治法》的规定,有关单位应当按照国家规定，对以下人员来取有效的保护措施和医疗保健措施", + "options": { + "A": "从事传染病预防、医疗的人员", + "B": "从事传染病科研、教学的人员", + "C": "现场处理疫情的人员", + "D": "在生产、工作中接触传染病病原体的人员", + "E": "以上均是" + }, + "answer": "E", + "reason": "根据《中华人民共和国传染病防治法》第六十四条,对从事传染病预防、医疗、科研、教学现场处理疫情的人员,以及在生产、工作中接触传染病7\"A有效的卫生防护措施和医疗保健措施并给予适当的津贴。" + }, + { + "question_num": 247, + "query": "治疗丹毒首选的拔罐法是", + "options": { + "A": "留罐法", + "B": "走罐法", + "C": "留针拔罐法", + "D": "刺血拔罐法", + "E": "闪罐法" + }, + "answer": "D", + "reason": "丹毒属于毒血瘀积于皮肤,应该用刺血拔法,故选D。" + }, + { + "question_num": 248, + "query": "下列除哪项外,均可使用培元补肾法", + "options": { + "A": "解颅", + "B": "五迟", + "C": "五软", + "D": "哮喘", + "E": "肺炎喘嗽" + }, + "answer": "E", + "reason": "培元补肾法主要适用于小儿胎察不足,肾气虚弱及肾不纳气之证,如解颅、五迟、五软、遗尿、哮喘等,而肺炎喘嗽外因责之于感受风邪,或由其他疾病传变而来;内因责之于小儿形气未充,肺脏娇嫩,卫外不固。" + }, + { + "question_num": 249, + "query": "有形实邪闭阻气机所致的疼痛,其疼痛性质是", + "options": { + "A": "胀痛", + "B": "灼痛", + "C": "冷痛", + "D": "绞痛", + "E": "隐痛" + }, + "answer": "D", + "reason": "胀痛是气滞致痛��特点;灼痛是火邪致痛的特点;冷痛是寒邪致痛的特点;绞痛是有形实邪致痛的特点;隐痛是虚证疼痛的特点。" + }, + { + "question_num": 250, + "query": "关于人类胚胎干细胞研究的伦理原则,不正确的是", + "options": { + "A": "安全和有效原则", + "B": "防止商品化原则", + "C": "知情同意原则", + "D": "尊重原则", + "E": "效用原则" + }, + "answer": "E", + "reason": "人类胚胎干细胞研究和应用的伦理原则。①尊重原则:爱惜和尊重胚胎,只允许将14天内的人体胚胎用于研究;②知情同意原则:只允许使用自愿捐献的生殖细胞或辅助生殖多余的胚胎,供者必须是自愿捐献，贯彻知情同意原则;③安全和有效原则:在使用人类胚胎干细胞治疗疾病时，必须经动物实验有效,并设法避免给患者带来伤害,不允许将捐献胚胎重新植人妇女子官,不允许将人类配子与动物配子相结合;④防止商品化原则:禁止买卖人体胚胎,并避免妇女故意制造胚胎。" + }, + { + "question_num": 251, + "query": "隔姜灸可用于治疗", + "options": { + "A": "寒性呕吐腹痛", + "B": "哮喘", + "C": "瘰疬", + "D": "疮痍", + "E": "小儿脐风" + }, + "answer": "A", + "reason": "隔姜灸常用于因寒而致的呕吐、腹痛以及风寒痹痛等,有温胃止呕、散寒止痛的作用。" + }, + { + "question_num": 252, + "query": "小儿“地图舌”是由于", + "options": { + "A": "肺气虚弱", + "B": "脾阳亏虚", + "C": "脾失健运", + "D": "宿食内停", + "E": "胃之气阴不足" + }, + "answer": "E", + "reason": "舌苔花剥,状如地图,时隐时现,经久不愈,多为胃之气阴不足所致。" + }, + { + "question_num": 253, + "query": "气逆证的病变以下列哪些脏腑为多见", + "options": { + "A": "心肝胃", + "B": "心肺肝", + "C": "肺胃肾", + "D": "肾肝脾", + "E": "肺胃肝" + }, + "answer": "E", + "reason": "气逆证以肺胃之气上逆和肝气升发太过的病变为多见。" + }, + { + "question_num": 254, + "query": "医德修养的根本途径和方法是", + "options": { + "A": "自我批评", + "B": "学习、立志", + "C": "患者监督", + "D": "躬行、慎独", + "E": "医疗实践" + }, + "answer": "E", + "reason": "与医疗实践相结合是医学道德修养的根本途径。" + }, + { + "question_num": 255, + "query": "四缝穴的位置在", + "options": { + "A": "手第一至第五指间,指蹼缘后方赤白肉际处", + "B": "手第一至第四指掌侧,指骨关节横纹中", + "C": "手第二至第五指掌侧,近端指骨关节横纹中点处", + "D": "手第一至第四指掌侧,近端指骨关节横纹中点处", + "E": "手第二至第五指掌侧,掌指关节横纹中点处" + }, + "answer": "C", + "reason": "四缝穴的定位:手第二至五指学侧近端指骨关节横纹中点处，一手4穴,左右共8穴。" + }, + { + "question_num": 256, + "query": "“治崩三法”是指", + "options": { + "A": "止血、固脱、调经", + "B": "调经、固本、善后", + "C": "补肾、扶脾、调肝", + "D": "塞流、澄源、复旧", + "E": "以上都是" + }, + "answer": "D", + "reason": "崩漏的治法。治崩三法是指塞流、澄源、复旧。" + }, + { + "question_num": 257, + "query": "舌淡胖嫩而见黄滑润苔,其主病为", + "options": { + "A": "阳虚水湿不化", + "B": "痰湿内停", + "C": "内有食积", + "D": "湿热不化", + "E": "脾虚运化无权" + }, + "answer": "A", + "reason": "舌胖嫩表示阳虚水湿不化;苔滑润表示水湿内停,故只有A项为正确答案。" + }, + { + "question_num": 258, + "query": "关于人体实验的国际性著名文件是", + "options": { + "A": "《夏威夷宣言》", + "B": "《赫尔辛基宣言》", + "C": "《希波克拉底哲言》", + "D": "《东京宣言》", + "E": "《悉尼宣言》" + }, + "answer": "B", + "reason": "关于人体实验的国际性著名文件是《赫尔辛基宜言》。" + }, + { + "question_num": 259, + "query": "耻骨联合上缘至股骨内上髁上缘的骨度分寸是", + "options": { + "A": "18寸", + "B": "19寸", + "C": "20寸", + "D": "21寸", + "E": "22寸" + }, + "answer": "A", + "reason": "耻骨联合上缘至股骨内上髁上缘的骨度分寸是18寸。" + }, + { + "question_num": 260, + "query": "小儿感冒夹痰的病机是", + "options": { + "A": "肺脏娇嫩", + "B": "先天不足", + "C": "乳食积滞", + "D": "脾胃湿困", + "E": "肾气不足" + }, + "answer": "A", + "reason": "由于小儿肺脏娇嫩,感邪之后,失于宣肃,气机不利,���液不得输布而内生液,痰壅气道,则咳嗽加剧,喉间痰鸣,此为感冒夹痰。" + }, + { + "question_num": 261, + "query": "下列各项,与牙齿干燥如枯骨关系最密切的是", + "options": { + "A": "热盛伤津", + "B": "阳明热盛", + "C": "胃阴不足", + "D": "肾阴枯涸", + "E": "肺阴亏虚" + }, + "answer": "D", + "reason": "齿为骨之余,骨为肾所主。正常人牙齿洁白润泽而坚固，是肾气旺盛，津波充足的表现，牙齿干燥,甚者齿如枯骨,为胃津已伤或肾阴枯竭。" + }, + { + "question_num": 262, + "query": "下列不符合无伤原则的是", + "options": { + "A": "对症下药，合理配伍", + "B": "避免操作失误造成医疗伤害", + "C": "对孕妇行X线检查且未告知可能的风险", + "D": "适当限制约束精神病患者的自由", + "E": "选择受益最大伤害最小的治疗方案" + }, + "answer": "C", + "reason": "无伤原则(底线原则):①努力避免不应有的医疗伤害;②杜绝有意和责任伤害;若不能有利于,至少不伤害。" + }, + { + "question_num": 263, + "query": "治疗感冒的主穴是", + "options": { + "A": "列缺、合谷、风池、大椎、太阳", + "B": "列缺、合谷、大椎、风门、肺俞", + "C": "列缺、合谷、曲池、尺泽、鱼际", + "D": "列缺、合谷、大椎、风门、迎香", + "E": "列缺、合谷、曲池、太阳、少商" + }, + "answer": "A", + "reason": "针灸治疗感冒的主穴:列缺、合谷大椎、太阳、风池。" + }, + { + "question_num": 264, + "query": "肺炎喘嗽的基本病机是", + "options": { + "A": "肺气失宣", + "B": "肺失清肃", + "C": "肺气上逆", + "D": "邪热闭肺", + "E": "痰热内蕴" + }, + "answer": "D", + "reason": "肺炎喘嗽的基本病机是邪热闭肺。" + }, + { + "question_num": 265, + "query": "二妙散的功用是", + "options": { + "A": "清热利水", + "B": "清热燥湿", + "C": "清热养阴", + "D": "利湿消肿", + "E": "解毒化湿" + }, + "answer": "B", + "reason": "二妙散功用:清热燥湿。主治:湿热下注证。症见筋骨疼痛，下肢瘘软无力，足膝红肿疼痛,或湿热带下,或下部湿疮等，小便短赤，舌苔黄腻者。" + }, + { + "question_num": 266, + "query": "1976年美国学者提出的医患关系基本模式是", + "options": { + "A": "主动-被动型,互相-合作型,平等参与型", + "B": "主动-合作型,相互-指导型，共同参与型", + "C": "主动-配合型,指导-合作型,共同参与型", + "D": "主动-被动型，指导-合作型，共同参与型", + "E": "主动-被动型，共同参与型,父权主义型" + }, + "answer": "D", + "reason": "1976年美国学者提出的医患之间技术性关系基本模式为主动被一动型，指导一合作型，共同参与型。" + }, + { + "question_num": 267, + "query": "治疗风火牙痛,除选取主穴外,应加用的腧穴是", + "options": { + "A": "大退、丁", + "B": "太溪、外关", + "C": "太冲、曲池", + "D": "太冲、阳溪", + "E": "外关、风池" + }, + "answer": "E", + "reason": "风火牙痛应加用外关、风池穴,以疏风降火。" + }, + { + "question_num": 268, + "query": "治疗小儿口疮心火上炎证，应首选", + "options": { + "A": "清胃散", + "B": "清热泻脾散", + "C": "六味地黄丸", + "D": "泻心导赤汤", + "E": "凉膈散" + }, + "answer": "D", + "reason": "口疮中脾胃积热证标准方剂为凉散,清热解毒,通腑泻火,如果有大便不实的症状;可以考虑清热泻脾散。心火上炎证用泻心导赤汤。虚火上浮证用六味地黄丸。清胃散主治胃火牙痛。" + }, + { + "question_num": 269, + "query": "脾气虚、脾阳虚、脾气下陷的共同症状是", + "options": { + "A": "便溏肢倦", + "B": "肢体困重", + "C": "脘腹坠胀", + "D": "肢体浮肿", + "E": "舌淡而胖" + }, + "answer": "A", + "reason": "脾气虚、脾阳虚、脾气下陷三证都可见脾气虚的临床表现,故便溏肢倦是脾气虚、脾阳虚、脾气下陷的共同症状,本题考査“脾气虚、脾阳虚、脾气下陷证的临床表现甄别”" + }, + { + "question_num": 270, + "query": "下列人体实验类型中,不需要付出道德代价的是", + "options": { + "A": "自体实验", + "B": "自愿实验", + "C": "欺骗实验", + "D": "强迫实验", + "E": "天然实验" + }, + "answer": "E", + "reason": "人体实验的类型包括自体实验、自愿实验、强迫实验。这些实验都需要付出道德代价，天然实验也是人体实验的类型，但其不需要付出道德代价。成部门除医师法规定不予注册的情形外，���当自受理申请之日起20日内准予注册,将注册信息录人国家信息平台,并发给医师执业证书。" + }, + { + "question_num": 271, + "query": "针灸治疗痴呆的主穴，除百会、印堂四神聪、内关外,还包括", + "options": { + "A": "膈俞、太冲", + "B": "太溪、悬钟", + "C": "丰隆、中脘", + "D": "肝俞、肾俞", + "E": "足三里、气海" + }, + "answer": "B", + "reason": "痴呆的主穴:百会、印堂、四神聪、内关、太溪、悬钟。督脉人络脑,心主神明,取督脉穴百会、印堂,心包经络穴内关,与四神聪相配,能醒脑调神;脑为髓海,肾主骨生髓,取髓会悬钟、肾之原穴太溪,可充养髓海,健脑益智。" + }, + { + "question_num": 272, + "query": "下列各项,可见咳嗽痰多,色黄稠黏喉中痰鸣症状的是", + "options": { + "A": "风寒咳嗽", + "B": "风热咳嗽", + "C": "痰热咳嗽", + "D": "痰湿咳嗽", + "E": "气虚咳嗽" + }, + "answer": "C", + "reason": "痰热咳嗽以“咳嗽痰多,痰稠色黄,喉中痰鸣,不易咯出”为特征,故选C。风寒咳嗽以“起病急,咳嗽频作、声重,咽痒,痰白清稀”为特征;风热咳嗽以“咳嗽不爽,痰黄黏稠”为特征;痰湿咳嗽以“痰多壅盛,色白而稀”为特征;气虚咳嗽以“咳嗽无力,痰白清稀”为特征。" + }, + { + "question_num": 273, + "query": "腻苔的特征是", + "options": { + "A": "苔质颗粒疏松,揩之可去", + "B": "苔质颗粒细腻致密,揩之不去", + "C": "舌面上出现饭粒样糜点", + "D": "苔质颗粒不清,垢浊胶结", + "E": "苔质粗大而厚,揩之可去" + }, + "answer": "B", + "reason": "腻苔的特征表现为苔质颗粒细腻致密,揩之不去,刮之不脱,故选B。苔质颗粒疏松,粗大而厚,揩之可去是腐苔的特征;舌面上出现饭粒样点是霉腐苔的表现特征;苔质颗粒不清,垢浊胶结是垢苔或浊苔的表现特征" + }, + { + "question_num": 274, + "query": "受理申请医师注册的卫生健康主管部门除医师法规定不予注册的情形外。应当自受理申请之日起多少日内准予注册，将注册信息录人国家信息平台，并发给医师执业证书.", + "options": { + "A": "15日", + "B": "20日", + "C": "30日", + "D": "40日", + "E": "45日" + }, + "answer": "B", + "reason": "受理申请医师注册的卫生健康主管部门除医师法规定不予注册的情形外，应当自受理申请之日起20日内准予注册,将注册信息录人国家信息平台,并发给医师执业证书。" + }, + { + "question_num": 275, + "query": "下列各穴中,常用于保健并具有强壮作用的穴位是", + "options": { + "A": "百会", + "B": "肾俞", + "C": "脾俞", + "D": "足三里", + "E": "气海俞" + }, + "answer": "D", + "reason": "以上各选项只有足三里穴具有强壮作用,为保健要穴。" + }, + { + "question_num": 276, + "query": "捏脊疗法通过对督脉与膀胱经捏拿，达到调整脏腑功能的目的,常用于治疗", + "options": { + "A": "心悸、怔忡", + "B": "咳嗽、哮喘", + "C": "五迟、五软", + "D": "疳证、婴儿泄泻", + "E": "遗尿、尿频" + }, + "answer": "D", + "reason": "儿科治法概要。捏脊疗法通过对督脉与膀胱经捏拿,达到调整阴阳、疏通经络、调和气血、恢复脏腑功能的目的,常用于治疗疳症、婴儿泄泻及脾胃虚弱的患儿。" + }, + { + "question_num": 277, + "query": "绛舌白滑腻苔提示", + "options": { + "A": "热极伤津", + "B": "湿热内盛伤及脾胃", + "C": "营分有湿，气分有热", + "D": "阴虚火旺复感寒湿之邪", + "E": "气血瘀阻，痰湿内阻" + }, + "answer": "D", + "reason": "绛舌主里热亢盛、阴虚火旺、瘀血:舌苔白滑腻主寒湿、寒痰,寒饮、寒食积滞。绛舌白滑腻苔可提示阴虚火旺复感寒湿之邪。属营分有热，气分有湿。" + }, + { + "question_num": 278, + "query": "直接作用于中枢神经系统,使之兴奋或抑制，连续使用能产生依赖性的药品是", + "options": { + "A": "毒性药品", + "B": "放射性药品", + "C": "解毒药品", + "D": "精神药品", + "E": "麻醉药品" + }, + "answer": "D", + "reason": "精神药品是指直接作用于中枢神经系统,使之兴奋或抑制，连续使用能产生依赖性的药品。" + }, + { + "question_num": 279, + "query": "与寤寐关系密切的经脉是", + "options": { + "A": "心经、阳维脉", + "B": "心经、阴维脉", + "C": "阳维脉、阴维脉", + "D": "阳跷脉、阴跷脉", + "E": "督脉、脾经" + }, + "answer": "D", + "reason": "阴阳跷脉主睡眠。阴阳跷脉功能失于平衡,则出现不寐，" + }, + { + "question_num": 280, + "query": "疳证的基本病理改变为", + "options": { + "A": "脾胃虚弱,运化失健", + "B": "脾胃虚弱,乳食停滞", + "C": "脾失运化,水湿内停", + "D": "脾胃不和,生化乏源", + "E": "脾胃受损,津液消亡" + }, + "answer": "E", + "reason": "疳证的病变部位主要在脾胃,病机为脾胃失健,生化乏源,则气血不足,津液亏耗,肌肤、筋骨、经脉失于养,日久成疳。" + }, + { + "question_num": 281, + "query": "患者出现头重如裹,脘痞苔腻,肢体困疲,属", + "options": { + "A": "热证", + "B": "暑证", + "C": "燥证", + "D": "湿证", + "E": "寒证" + }, + "answer": "D", + "reason": "湿性重浊,故临床表现以感觉重着为特点。" + }, + { + "question_num": 282, + "query": "因抢救急危患者,未能及时书写病历，有关医务人员应当在抢救结束后据实补记时限的法定要求为", + "options": { + "A": "2小时以内", + "B": "4小时以内", + "C": "6小时以内", + "D": "8小时以内", + "E": "10小时以内" + }, + "answer": "C", + "reason": "《医疗纠纷预防和处理条例》第十五条规定:“因紧急抢救未能及时填写病历的，医务人员应当在抢救结束后6小时内据实补记，并加以注明。" + }, + { + "question_num": 283, + "query": "用有前入治疗耳耸,应自选", + "options": { + "A": "肺俞", + "B": "三焦俞", + "C": "肝俞", + "D": "肾俞", + "E": "脾俞" + }, + "answer": "D", + "reason": "背俞穴可以治疗与脏腑经脉相连属的组织器官所发生的病证。肾开窍于耳，故治耳聋应选用肾经的背俞穴。" + }, + { + "question_num": 284, + "query": "诊断3个月至6岁小儿营养性缺铁性贫血的标准，其血红蛋白值应低于的数值是", + "options": { + "A": "80g/L", + "B": "90g/L", + "C": "100g/L", + "D": "110g/L", + "E": "120g/L" + }, + "answer": "D", + "reason": "3个月~6岁小儿营养性缺铁性贫血的标准,其血红蛋白值小于等于110g/L;6岁以上的血红蛋白值应小于120g/L。" + }, + { + "question_num": 285, + "query": "病室有烂苹果样气味,见于", + "options": { + "A": "消渴危重病证", + "B": "肾衰", + "C": "有机磷中毒", + "D": "溃腐疮疡", + "E": "脏腑衰败" + }, + "answer": "A", + "reason": "口中散发烂苹果样气味,即酮体气味,多为消渴病危重期;病室氨味多见于肾衰者;有机磷中毒可有蒜臭味;溃腐疮疡多有腐臭气;脏腑衰败多有尸臭味。" + }, + { + "question_num": 286, + "query": "血清总胆红素、结合胆红素、非结合胆红素均中度增加，可见于", + "options": { + "A": "蚕豆病", + "B": "胆石症", + "C": "珠蛋白生成障碍性贫血", + "D": "急性黄疸型肝炎", + "E": "胰头癌" + }, + "answer": "D", + "reason": "肝细胞性黄疸时结合与非结合胆红素均中度增高，尿胆红素阳性，尿胆原增加、正常或减少。" + }, + { + "question_num": 287, + "query": "治疗行痹,在取主穴的基础上，应加", + "options": { + "A": "膈俞、血海", + "B": "肾俞、关元", + "C": "阴陵泉、足三里", + "D": "大椎、曲池", + "E": "合谷、内关" + }, + "answer": "A", + "reason": "行痹在取主穴的基础上加膈俞、血海，行痹属风邪偏盛、取血海，膈俞以活血，乃“治风先治血，血行风自灭”之义。痛痹取B项肾俞、关元,着痹取C项阴陵泉、足三里。" + }, + { + "question_num": 288, + "query": "小儿泄泻发病率较高的季节是", + "options": { + "A": "春夏", + "B": "夏秋", + "C": "秋冬", + "D": "冬春", + "E": "四季无差异" + }, + "answer": "B", + "reason": "小儿泄泻一年四季均可发生,以夏秋季节发病率为高。" + }, + { + "question_num": 289, + "query": "下列哪项不是火淫的临床表现", + "options": { + "A": "壮热口渴", + "B": "面红目赤", + "C": "烦躁不宁", + "D": "舌质红绛", + "E": "脉象濡数" + }, + "answer": "E", + "reason": "火淫:壮热,口渴,面红目赤,心烦汗出,或烦躁谵妄,衄血,吐血,斑疹,或躁扰发狂,或见痈脓,舌质红绛,脉象洪数或细数。可见题目中脉象的描述与火淫的临床表现不符。" + }, + { + "question_num": 290, + "query": "属于丙类传染病的病种是", + "options": { + "A": "艾滋病", + "B": "肺结核", + "C": "传染性非典型肺炎", + "D": "人感染高致病性禽流感", + "E": "流行性和地方性斑疹伤寒" + }, + "answer": "E", + "reason": "中华人民共和国传染病防治法》规定管理的传染病分甲类、乙类、丙类三类。丙类传染病包括流行性感冒、流行性腮腺炎、风疹、急性出血性结膜炎、麻风病、流行性和地方性斑伤寒、黑热病、包虫病、丝虫病,除霍乱、细菌性和阿米巴性痢疾、伤寒和副伤寒以外的感染性腹泻病。" + }, + { + "question_num": 291, + "query": "治疗中风闭证,除选太冲、劳宫外还应为", + "options": { + "A": "足三里", + "B": "丰隆", + "C": "下关", + "D": "中冲", + "E": "百会" + }, + "answer": "B", + "reason": "中风病的闭证应选用平肝息风、清心豁痰、醒脑开窍的十二井穴、水沟、丰隆等穴位。" + }, + { + "question_num": 292, + "query": "慢脾风的病理机制主要是", + "options": { + "A": "湿热内蕴", + "B": "脾虚肝亢", + "C": "脾肾阳衰", + "D": "气血不足", + "E": "阴虚风动" + }, + "answer": "C", + "reason": "慢脾风,即慢惊风脾肾阳衰证,病至于此,为虚极之候,阳虚极而生内风。" + }, + { + "question_num": 293, + "query": "以肺气不宣,鼻窍不利见证的属", + "options": { + "A": "风邪袭表证", + "B": "风邪犯肺证", + "C": "风客肌肤证", + "D": "风邪中络证", + "E": "风盛行痹证" + }, + "answer": "B", + "reason": "外邪易从肺系而人,风邪侵袭肺系肺气失宜,窍不利,则见咳、咽喉痒痛、鼻密、流清涕或喷嚏等症,而为风邪犯肺证。" + }, + { + "question_num": 294, + "query": "腹痛、腹泻、黏液脓血便,伴发热恶寒，最可能的诊断是", + "options": { + "A": "细菌性痢疾", + "B": "阿米巴痢疾", + "C": "急性胃肠炎", + "D": "流行性脑脊髓膜炎", + "E": "霍乱" + }, + "answer": "A", + "reason": "腹痛、腹泻、黏液脓血便,伴发热恶寒符合细菌性痢疾的典型症状，首选A。阿米巴痢疾多不发热,粪便检查为暗红或果酱色血便,故可排除B;急性周肠炎无发热症状,大便多为黄色水样便,故可a上.3少除D;霍乱一般无发热,多数不伴腹痛(O,血清型发热、腹痛比较常见),粪便检查可见黏液和少许的红、白细胞,故可排除E。" + }, + { + "question_num": 295, + "query": "脐上4寸,前正中线旁开2寸的腧穴是", + "options": { + "A": "不容", + "B": "承满", + "C": "梁门", + "D": "关门", + "E": "滑肉门" + }, + "answer": "C", + "reason": "不容在上腹部,脐中上6寸,距前正中线2寸。承满在上腹部，脐中上5寸,距前正中线2寸。梁门在脐中上4寸，前正中线旁开2寸。关门位于人体的上腹部,脐中上3寸,距前正中线2寸。滑肉门在上腹部、脐中上1寸,距前正中线2寸。" + }, + { + "question_num": 296, + "query": "下列哪一项不是妊娠病", + "options": { + "A": "妊娠恶阻", + "B": "胎动不安", + "C": "妊娠腹痛", + "D": "妊娠外感", + "E": "子满" + }, + "answer": "D", + "reason": "妊娠病的定义和范围。妊娠病是指妊娠期间,发生与妊娠有关的疾病。常见的妊娠病:妊娠恶阻,妊娠腹痛,异位妊娠,胎漏,胎动不安,堕胎,小产,滑胎,胎不长,胎死不下,子满,子肿,子晕,子病子嗽,妊娠小便不通,妊娠小便淋痛,妊娠瘙痒症,妊娠贫血,难产等。妊娠外感为妊娠期间发生外感，与妊娠无关,所以不属于妊娠病。" + }, + { + "question_num": 297, + "query": "下列各项不属亡阳证表现的是", + "options": { + "A": "脉微欲绝", + "B": "唇舌淡白", + "C": "气息微弱", + "D": "汗出稀冷", + "E": "四肢温和" + }, + "answer": "E", + "reason": "亠阳证的表现为大汗出、汗冷、味淡微黏、身凉恶寒、四肢厥冷、卧神疲,口淡不渴,或喜热饮,舌淡白润,脉微欲绝。" + }, + { + "question_num": 298, + "query": "《突发公共卫生事件应急条例》规定，医疗卫生机构应当对传染病做到", + "options": { + "A": "早发现、早观察、早隔离、早治疗", + "B": "早报告、早观察、早治疗、早康复", + "C": "早发现、早报告、早隔离、早治疗", + "D": "早发现、早报告、早隔离、早康复", + "E": "早预防、早发现、早治疗、早康复" + }, + "answer": "C", + "reason": "《突发公共卫生事件应急条例》第四十二条规定:有关部门、医疗卫生机构应当对传染病做到早发现、早报告、早离、早治疗,切断传播途径,防止扩散。" + }, + { + "question_num": 299, + "query": "外劳宫位于手背", + "options": { + "A": "第2、第3掌骨间,掌指关节后凹陷中", + "B": "第2、第3掌骨间,掌指关节后0.5寸四陷中", + "C": "第3、第4掌骨间,掌指节后0.5寸凹陷中", + "D": "第3、第4掌骨间,掌指关节后凹陷中", + "E": "第2、第3掌骨间,掌指关节后1寸凹陷中" + }, + "answer": "B", + "reason": "腧穴定位。外��宫位于手背,第2、第3掌骨间,学指关节后0.5寸凹陷中。" + }, + { + "question_num": 300, + "query": "下列哪项不是天癸成熟的条件", + "options": { + "A": "肾气充盛", + "B": "脾气健旺", + "C": "已18岁", + "D": "精血充实", + "E": "肾阴充盛" + }, + "answer": "C", + "reason": "天癸,源于先天,藏之于肾,受后天水谷精微的滋养,人体发育到一定时期,肾气旺盛,肾中真阴不断得到充实，天癸逐渐成熟。C项是男女天癸初至后的年龄,不是成熟的年龄。" + }, + { + "question_num": 301, + "query": "患者,男,70岁。患有“冠心病”8年今上午突然心痛剧作,面色青灰,冷汗淋漓，四肢厥冷,呼吸微弱,舌淡白,苔白润,脉微欲绝，其证候是", + "options": { + "A": "心阳虚证", + "B": "寒凝心脉证", + "C": "痰阻心脉证", + "D": "气滞心脉证", + "E": "心阳暴脱证" + }, + "answer": "E", + "reason": "该患者患有“冠心病”8年,今上午突然心痛剧作,说明患者病位在心。面色青灰,冷汗淋滴,四肢冷,呼吸微弱,舌淡白,苔白润,脉微欲绝,是亡阳的典型表现,故患者为心阳暴脱证。" + }, + { + "question_num": 302, + "query": "当传染病暴发、流行时,经省、自治区、直辖市政府决定，可以对其实行封锁的地区是", + "options": { + "A": "甲类传染病疫区", + "B": "乙类传染病疫区", + "C": "甲类和乙类传染病疫区", + "D": "甲、乙、丙三类传染病疫区", + "E": "甲、乙、丙三类传染病疫区都不可以实行封锁" + }, + "answer": "A", + "reason": "《中华人民共和国传染病防治法》国家执业医师资格考试中医执业医师第四十三条规定,省、自治区、直辖市人民政府可以决定对本行政区域内的甲类传染病疫区实施封锁。" + }, + { + "question_num": 303, + "query": "患者,女,60岁。20年前有肺结核病史。现症:咳吐浊唾涎沫,其质较黏稠，咳声不扬,气急喘促,口渴咽燥,午后潮热,形体消瘦皮毛干枯，舌质红而干，脉虚数，其诊断是", + "options": { + "A": "肺痿虚热证", + "B": "肺痿虚寒证", + "C": "肺热之上虚寒证", + "D": "肺胀之肺肾阴虚证", + "E": "肺痨之气阴耗伤证" + }, + "answer": "A", + "reason": "据20年肺痨病史及咳吐浊唾涎沫的典型表现，首先考虑为肺痰。再据口咽，午后潮热等症辨证为虚热证" + }, + { + "question_num": 304, + "query": "某患者半小时前被热气灼伤两前臂现局部疼痛剧烈,有散在水疱,个别破溃,基底部呈均匀红色、潮湿,其诊断是", + "options": { + "A": "面积约为6%的浅Ⅱ度烧伤", + "B": "面积约为4.5%的浅Ⅱ度烧伤", + "C": "面积约为9%的Ⅲ度烧伤", + "D": "面积约为9%的Ⅰ度烧伤", + "E": "面积约为9%的深Ⅱ度烧伤" + }, + "answer": "A", + "reason": "烧伤面积中国新九分法将全身体表面积分为11个9%等份。成人头、面、颈部为9%,双上肢为2x9%,躯干前后包括外阴部为3x9%,双下肢包括臀部为5x9%+1%=46%。双前臂的面积为6%,有散在水疱,个别破溃,诊断为浅Ⅱ度烧伤。" + }, + { + "question_num": 305, + "query": "患者恶寒发热,无汗,头痛,身痛,喘咳,其证候是", + "options": { + "A": "湿淫", + "B": "暑淫", + "C": "寒淫", + "D": "风淫", + "E": "燥淫" + }, + "answer": "C", + "reason": "寒淫证指寒邪侵袭机体,阳气被遏，以恶寒甚、无汗、头身或胸腹疼痛、苔白、脉弦紧为主要表现的实寒证候，" + }, + { + "question_num": 306, + "query": "患者,女,30岁。尿频、尿痛2天。检查:体温38°C,右肾区叩击痛。尿蛋白(±),尿中红细胞2~4/HP,白细胞20~30/HP。应首先考虑的是", + "options": { + "A": "急性膀胱炎", + "B": "急性肾炎", + "C": "急性肾盂肾炎", + "D": "尿道综合征", + "E": "右肾结石" + }, + "answer": "C", + "reason": "A项无肾区叩击痛;B项临床上表现为急性起病,以血尿、蛋白尿、水肿、高血压和肾小球滤过率下降为特点:D项反复发作尿频、尿急、尿痛、里急后重、排尿困难等症状。而尿常规化验正常,中段尿培养无菌生长,谓之尿道综合征。尿道综合征的特点:发病快、消失也快,呈周期性发作,发作周期不定。项为突然发作的阵发性刀割样疼痛，疼痛剧烈难忍，有时有大汗、恶心呕吐。可有肉眼血尿,结石并发感染时,尿中出现脓细胞,有尿频、尿痛症状。" + }, + { + "question_num": 307, + "query": "患者,女,45岁。7月发病,身热,微恶风,汗出,肢体酸重疼痛,头昏胀痛,咳嗽痰黏,鼻流浊涕,胸闷泛呕,心烦口渴,不欲多饮,舌苔薄黄而腻,脉濡数。治宜选用", + "options": { + "A": "藿香正气散", + "B": "银翘散", + "C": "川芎茶调散", + "D": "玉枢丹", + "E": "新加香薷饮" + }, + "answer": "E", + "reason": "此题考查感百的辨证论治。夏季感冒,感受当令之暑邪,多夹湿。湿伤表,表卫不和，则发热恶风汗出,湿阻滞,气机不展,故肢体酸重疼痛、头昏胀痛、胸闷欲呕;暑湿犯肺,肺气不消,故鼻塞流浊涕,咳嗽痰黏;舌苔薄黄而腻,脉数均为暑热挟湿之征象,故辨证为暑湿感冒·治宜消暑去湿解表，方选新加香器饮。" + }, + { + "question_num": 308, + "query": "患者,男。肛门左侧皮下有一肿物5天,焮红热痛,按之应指,其诊断是", + "options": { + "A": "坐骨直肠间隙脓肿", + "B": "骨盆直肠间隙脓肿", + "C": "直肠后间隙脓肿", + "D": "肛门旁皮下间隙脓肿", + "E": "直肠脱出嵌顿" + }, + "answer": "D", + "reason": "肛痈的发生绝大部分与肛隐窝炎有关,其临床特点是发病急骤、肛周剧痛,伴全身高热,脓肿破溃后易形成瘘管。由于肛痈发生的部位不同，可有不同的名称,如生于肛门旁皮下者,名肛门旁皮下脓肿;生于坐骨直肠窝者,名坐骨直肠窝脓肿;生于骨盆直肠窝者,名骨盆直肠窝脓肿;生于直肠后间隙者,名直肠后间隙脓肿，其中，肛门旁皮下脓肿红、肿、热、痛明显,脓成按之应指。" + }, + { + "question_num": 309, + "query": "患者,男,46岁。腹痛腹泻2天,日泻10余次水便,经治已缓,目前口渴心烦,皮肤干瘪,眼窝凹陷,舌淡白苔薄黄,脉细无力,其证候是", + "options": { + "A": "津亏", + "B": "阴虚", + "C": "亡阴", + "D": "外燥", + "E": "实热" + }, + "answer": "A", + "reason": "腹痛腹泻2天,日泻10余次水便导致津液大最流失,津液亏少,不能充养、润脏器、组织、官窍,则见口渴心烦、皮肤干瘪,眼窝凹陷等一派干燥少津的症状;阴虚火旺,则苔薄黄;舌淡白,脉细无力均为津亏之征。" + }, + { + "question_num": 310, + "query": "患者,男,28岁。高血压病病史半年。近日头痛加重,恶心,呕吐,心悸,气短。检查:血压190/135mmHg,眼底视网膜出血，心电图示左室肥厚,心肌劳损,其诊断是", + "options": { + "A": "高血压脑病", + "B": "缓进型高血压病", + "C": "脑血管痉挛", + "D": "急进型高血压病", + "E": "急性心力衰竭" + }, + "answer": "D", + "reason": "高血压脑病时,血压急剧升高、头痛、呕吐、烦躁、抽搐和意识障碍;急进型高血压是血压突然升高,并伴有视网膜病变(Ⅲ级眼底),如呈W级眼底,有视神经乳头水肿,则称为恶性高血压;缓进型高血压多发于40岁以上,起病隐匿,病程可达数十年,早期无任何症状,偶尔在查体时发现血压升高;脑血管痉李临床上常出现颅内压增高(头痛、呕吐、眼底水肿出现或加重),意识障碍加重;急性心力衰竭时，患者常突然感到极度呼吸困难,端坐呼吸,恐惧表情,烦躁不安，频频咳嗽,咯大量白色或血性泡沫痰液等。结合该患者症状体征,可判断为急进型高血压,故选D。" + }, + { + "question_num": 311, + "query": "患者,女,53岁。胸闷重而心痛微,痰多气短,肢体沉重,形体肥胖,遇阴雨天而易发作或加重,舌体胖大,边有齿痕,苔浊腻,脉滑", + "options": { + "A": "疏肝理气,活血通络", + "B": "辛温散寒,宣通心阳", + "C": "活血化瘀,通脉止痛", + "D": "益气养阴,活血通脉", + "E": "通阳泄浊,豁痰宣痹" + }, + "answer": "E", + "reason": "患者胸闷重而心痛，诊断为胸痹。痰多气短,肢体沉重,形体肥胖,舌体胖大,边有齿痕苔浊腻,脉滑,为痰浊闭阻证。应通阳泄浊,豁痰宜代表方:栝葵薤白半夏汤合涤痰汤加减。" + }, + { + "question_num": 312, + "query": "患者,男,34岁。头皮瘙痒,头屑多,毛发干枯脱落,口千口渴,便干;舌质偏红,苔薄黄,脉细数。治宜首选的是", + "options": { + "A": "消风散合当归饮子", + "B": "茵陈昔汤", + "C": "参苓白术散", + "D": "四物汤", + "E": "六味地黄丸" + }, + "answer": "A", + "reason": "瘙痒、毛发干枯脱落,口干口渴及舌脉均为脂溢性皮炎风热血燥证的表现，故治疗宜首选消风散合当归饮子加减以祛风清热,养血润燥。" + }, + { + "question_num": 313, + "query": "患者,女,53岁。腹中可扪及积块,软而不坚，固着不移,胀痛并见，脉弦,其证候是", + "options": { + "A": "肝气郁滞", + "B": "瘀血内结", + "C": "气滞血瘀", + "D": "气滞痰阻", + "E": "气虚血瘀" + }, + "answer": "C", + "reason": "腹中可扪及积块,气为血之帅,气滞则血凝,胀痛并见为肝气郁滞,疏泄失职，舌苔薄脉弦为气滞血瘀之征。" + }, + { + "question_num": 314, + "query": "患者频发房���期前收缩,自觉心悸不适，心率90次/分。可以选用以下何种药物治疗", + "options": { + "A": "普萘洛尔", + "B": "美西律", + "C": "地西泮(安定)", + "D": "地高辛", + "E": "奎尼丁" + }, + "answer": "A", + "reason": "房性期前收缩通常无需治疗。当有明显症状或因房性期前收缩触发室上性心动过速时,应给予治疗。治疗药物包括B受体阻滞剂普茶洛尔、普罗帕酮、莫雷西嗪等。" + }, + { + "question_num": 315, + "query": "患者,女,40岁。平素善惊易恐,因受惊而心悸1个月余,坐卧不安,少寐多梦,舌苔薄白,脉虚弦。治疗应首选", + "options": { + "A": "归脾汤", + "B": "炙甘草汤", + "C": "朱砂安神丸", + "D": "天王补心丹", + "E": "安神定志丸" + }, + "answer": "E", + "reason": "心为神舍,心气不足则神浮不敛,心悸不安,少寐多梦,胆气虚则善惊易恐。心虚胆怯治宜镇惊定志,养心安神,用安神定志丸。心脾两虚用归脾丸。气血阴阳俱虚用炙甘草汤。心火偏亢，阴血不足用朱砂安神丸。阴亏内热，滋阴消热用天王补心丹，" + }, + { + "question_num": 316, + "query": "患者,男,50岁。右颜面部红肿疼痛伴发热2天,皮色鲜红,色如涂丹,压之褪色,扪之灼手,边界清楚,触痛明显，大便2天未行。治疗宜首选", + "options": { + "A": "草群渗湿汤加减", + "B": "五味消毒饮加减", + "C": "普这消毒饮加减", + "D": "黄连解毒汤加减", + "E": "犀角地黄汤加减" + }, + "answer": "C", + "reason": "丹毒发于颜面,皮色鲜红,压之褪色,触痛明显,属风热毒殖证,治宜疏风清热解毒,方选普济消毒饮加减。" + }, + { + "question_num": 317, + "query": "患者久病湿疹,面垢多眵,大便溏泄,时发下痢脓血。小溲浑浊不清，湿疹浸淫流水,舌苔白厚腻,脉潘滑。病属湿邪为患，此证反映了湿邪的哪种性质", + "options": { + "A": "重着", + "B": "黏腻", + "C": "趋下", + "D": "秽浊", + "E": "类水" + }, + "answer": "D", + "reason": "湿性重浊,“重”即沉重或重着之意，“浊”即秒浊,多指分泌物秽浊不清而言。湿邪致病可出现多种秽浊症状,如面垢眵多、大便溏泄、下痢黏液脓血、小便浑浊、妇女白带过多、湿疹浸淫流水等都是湿性秽浊的病理反映。患者大便泄，时发下痢脓血,小波浑浊不清,反映的是湿邪秽浊的特性。" + }, + { + "question_num": 318, + "query": "患者,男,50岁。反复上腹痛15年,腹痛常在饭后，持续1~2小时。近半年疼痛加剧,食欲减退，体重减轻。检查：贫血貌，左锁骨上触及肿大淋巴结,血沉46mm/h,大便隐血试验持续阳性。应首先考虑的是", + "options": { + "A": "慢性胆囊炎发作", + "B": "十二指肠溃疡发作", + "C": "胃溃疡伴幽门梗阻", + "D": "胃溃疡恶变", + "E": "复合性溃疡病" + }, + "answer": "D", + "reason": "胃溃疡最常见的症状为上痛,而患者在饭后股痛,提示为胃溃疡。而近期的疼痛突然加剧,食欲减退,体重减轻均提示癌变;检查中又见贫血貌和肿大的淋巴结,故选D。ABCE项一般不引起淋巴结肿大,C项的主要症状应为因梗阳导致的呕吐。" + }, + { + "question_num": 319, + "query": "患者,男,70岁。喘促气短,声低气怯,咳声低弱,咳痰稀白。自汗畏风，舌淡红苔薄白,脉弱无力。治疗应首选", + "options": { + "A": "三子养亲汤合二陈汤", + "B": "生脉散合补肺汤", + "C": "七味都气丸合生脉散", + "D": "参蛤散合金匮肾气丸", + "E": "苏子降气汤合二陈汤" + }, + "answer": "B", + "reason": "肺虚气失所主,故喘促气短,声低气怯,咳声低弱,气不化津故咳痰稀白,肺虚卫外不固,自汗畏风,舌淡红苔游白,脉弱无力。治宜益气补肺，用生脉散合补肺汤。痰浊阻肺用三子养亲汤合二陈汤。肾阴虚用七味都气丸合生脉散。肾气虚用参蛤散合金医肾气丸。上实下虚用苏子降气汤合二陈汤。" + }, + { + "question_num": 320, + "query": "患者,男,78岁。患背部有头疽月余:局部疮形平塌,根盘散漫,疮色紫滞,溃后脓水稀少,伴有唇燥口于。便艰溲短,舌质红,脉细数。内治应首选", + "options": { + "A": "仙方活命饮", + "B": "竹叶黄芪汤", + "C": "托里消毒散", + "D": "知柏地黄汤", + "E": "清骨散" + }, + "answer": "B", + "reason": "阴波亏虚,虚火内生,复感湿热毒邪，阴无水制火热之邪，而便毒蕴更甚，故疮色紫滞，疼痛剧烈;毒其走散，故疮脚散漫,疮形平塌:阴波不足,无以化脓,故属于阴虚火炽。治法:滋阴生津,清热解毒。方药:竹叶黄芪汤加减。" + }, + { + "question_num": 321, + "query": "患者,男,40���。腰膝酸软,眩晕耳鸣，精神萎靡,性机能减退,并有遗精、早泄,其病因是", + "options": { + "A": "劳力过度", + "B": "房劳过度", + "C": "劳神过度", + "D": "思虑过度", + "E": "安逸过度" + }, + "answer": "B", + "reason": "房劳过度,是指性生活不节,房事过度。肾藏,主封藏。肾精不宜过度耗泄,若房事过频则耗伤肾精,临床常出现腰膝酸软、眩晕耳鸣,精神类,性机能减迟,或遗精、早泄、阳瘘等肾精虚或肾气不固之症。" + }, + { + "question_num": 322, + "query": "患者,男,19岁。在烈日下打篮球1小时，大汗后出现头痛、头晕、胸闷、心悸、恶心，并有腹肌疼痛。体格检查:体温38.3°C,脉率108次/分，血压90/60mmHg。意识清楚,面色潮红,双肺未闻及干、湿性啰音,心律齐。最有可能的诊断是", + "options": { + "A": "热痉挛", + "B": "热衰竭", + "C": "低血糖", + "D": "热射病", + "E": "脱水" + }, + "answer": "A", + "reason": "高温大汗后出现心悸、头晕伴股肌疼痛最可能为热痉挛。" + }, + { + "question_num": 323, + "query": "患者高热烦躁,神昏谵语,颈项强直,甚则角弓反张,舌质红绛,苔黄少津,脉细数。当用", + "options": { + "A": "尺北", + "B": "竹叶石膏汤", + "C": "清营汤", + "D": "白虎加人参汤", + "E": "生脉数" + }, + "answer": "C", + "reason": "该患者的表现为痉证之心营热盛证,方用清营汤。" + }, + { + "question_num": 324, + "query": "患者,男,48岁。背部生疮,初起肿块上有一粟粒样脓头,抓破后局部肿痛加剧,色红灼热,脓头相继增多。溃后如蜂窝状，伴有寒热头痛,纳呆,便秘,溲赤,舌质红,苔黄,脉弦数,其诊断是", + "options": { + "A": "疔", + "B": "疱", + "C": "有头疽", + "D": "发", + "E": "痈" + }, + "answer": "C", + "reason": "有头疽初期患处起一肿块,上有粟粒样脓头,肿块渐向四周扩大,脓头增多,色红灼热，高肿疼痛。伴发热恶寒、头痛纳差。溃脓期肿块进一步增大,疮面渐渐腐烂，形似蜂窝，肿块范围常超过10cm,甚至大于30cm。伴壮热、口渴便秘、溲赤等。收口期脓腐渐尽,新肉开始生长,逐渐愈合。" + }, + { + "question_num": 325, + "query": "患者久病,畏寒喜暖,形寒肢冷,面色白,蜷卧神疲,小便清长,下利清谷,偶见小腿水肿，按之凹陷如泥，舌淡，脉迟，其病机是", + "options": { + "A": "阳气亡失", + "B": "阳盛格阴", + "C": "阳损及阴", + "D": "阳气偏衰", + "E": "阳盛耗阴" + }, + "answer": "D", + "reason": "阳气亡失的临床表现为大汗淋汗稀而凉,肌肤手足逆冷,精神疲惫,神情淡漠,排除A;阳盛格阴的临床表现为壮热、面红、气粗、烦躁、脉数有力,病势严重的情况下可出现四肢厥冷，脉象沉等假恋之象、排除B:阳损及阴的临床表现为四肢冷下利清谷,又可见阳浮于外之证,如身热反不恶寒，面颊泛红等假热之象,排除C;阳盛耗阴的临床表现为壮热、溲赤、便干、口干欲饮、脉细数等,排除E。" + }, + { + "question_num": 326, + "query": "患者,女,40岁。既往有风湿性心脏病史，近一周出现咳嗽、咳痰,双下肢浮肿，不能平卧。该患者还可能出现下列哪项体征", + "options": { + "A": "呼吸过缓", + "B": "深大呼吸", + "C": "潮式呼吸", + "D": "呼吸过速", + "E": "叹息样呼吸" + }, + "answer": "D", + "reason": "患者为中年女性,因患风湿性心脏病,近一周出现心力衰竭,表现为全心衰竭(左心衰竭--不能平卧;右心衰竭--下肢浮肿),因而可能会出现呼吸过速。呼吸过速是指呼吸频率>24次/分,见于心力衰竭、发热、疼痛、贫血和甲状腺功能亢进症等。呼吸过缓是指呼吸频率<12次/分,见于麻醉剂或镇静剂过量和颅内压增高等:深大呼吸见于代谢性酸中毒时,如糖尿病酮症酸中毒和尿毒症酸中毒等;潮式呼吸多见于中枢神经系统疾病,如脑炎、脑血栓等,也可见于巴比妥中毒和尿毒症、糖尿病酮症酸中毒等:叹息样呼吸多为功能改变,见于神经衰弱、精神紧张或抑郁症,故选D。" + }, + { + "question_num": 327, + "query": "患者胃痛,脘腹胀满,嗳腐吞酸,吐不消化食物,大便不爽,舌苔厚腻,脉滑,其治法是", + "options": { + "A": "理气消胀", + "B": "消食导滞", + "C": "理气和胃", + "D": "消食健脾", + "E": "和胃止呕" + }, + "answer": "B", + "reason": "患者胃痛有明显的伤食史,吐不消化食物,食积中阻,故脘腹胀满,吸腐吞酸。治宜消食导滞,故选B。肝胃气滞选A。日气张选C。胃虚弱选D。胃气上逆选E。" + }, + { + "question_num": 328, + "query": "患者,男,48岁。因鼻部破损引起头额红肿。两目肿胀不能开视，伴形寒发热，舌红苔黄腻,脉滑数。治疗应首选", + "options": { + "A": "化斑解毒汤", + "B": "普济消毒饮", + "C": "龙胆泻肝汤", + "D": "五神汤", + "E": "仙方活命饮" + }, + "answer": "B", + "reason": "风热毒邪犯上,与血分热邪蕴结,郁阻肌肤,故见头面部皮肤红灼热,风热毒邪与正气相争,故见恶寒发热;舌红苔黄腻、脉滑数为邪热之象。治法:疏风消热解毒。方药:普济消毒饮加减。龙胆泻肝汤泻肝胆之火,仙方活命饮治疗痈证。" + }, + { + "question_num": 329, + "query": "患者,女,53岁。有痢疾病史.2年,现症见时痢时歇,缠绵经年,饮食减少,倦怠神疲,畏寒懒言,发作时便下赤白,里急后重。舌质淡,苔腻,脉虚数。治疗宜首选", + "options": { + "A": "附子理中汤", + "B": "黄连阿胶汤", + "C": "胃苓汤", + "D": "连理汤", + "E": "芍药汤" + }, + "answer": "D", + "reason": "休息痢证候:下痢时发时止,迁延不愈,常因饮食不当、受凉、劳累而发,发时大便次数增多,夹有赤白黏冻,腹胀食少,倦怠嗜卧,舌质淡,苔腻,脉活软或虚数。该患者临床表现符合休息痢。治法温中清肠,调气化滞。代表方:连理汤加减。" + }, + { + "question_num": 330, + "query": "患者,女,30岁。10年前患风湿热,检查心尖部听到舒张期隆隆样杂音。X线显示左心房增大。应首先考虑的是", + "options": { + "A": "二尖瓣关闭不全", + "B": "二尖瓣狭窄", + "C": "主动脉瓣关闭不全", + "D": "主动脉瓣狭窄", + "E": "肺动脉瓣狭窄" + }, + "answer": "B", + "reason": "患者有风湿热病史,并出现心脏杂音,考虑风湿性心脏瓣膜病。且心尖部听到舒张期隆隆样杂音为二尖瓣狭窄特有的杂音，且二尖狭窄导致左房血波察滞,增大,故选B。A项为心尖部收缩期杂音:C项为胸骨右缘第2~3肋间舒张期杂音;D项为胸骨右缘第2~3肋间收缩期杂音;E项为胸骨左缘第2-3肋间收缩期杂音。" + }, + { + "question_num": 331, + "query": "患者以胃脘痞塞,满闷不舒为主,按之柔软,压之不痛,望无胀形。发病缓慢，时轻时重,反复发作,病程漫长。多因饮食、情志、起居、寒温等因素诱发,其诊断是", + "options": { + "A": "胃痛", + "B": "鼓胀", + "C": "痞满", + "D": "胸痹", + "E": "结胸" + }, + "answer": "C", + "reason": "痞满的特点是胃脘痞塞,满闷不舒按之柔软,压之不痛,望无胀形。胃痛以胃中疼痛为主,可有压痛。胀以腹部外形胀大如效为特点。胸痹疼痛部位在心胸,以胸闷胸痛，心悸气短为主症。结胸病位在胸不在胃。" + }, + { + "question_num": 332, + "query": "患者,女,40岁。双乳肿胀疼痛,月经前加重,经后减轻。肿块大小不等,形态不一，伴乳头溢液,月经不调，腰酸乏力，舌淡苔白脉弦细,其证候是", + "options": { + "A": "肝郁痰凝", + "B": "肝气郁结", + "C": "冲任失调", + "D": "肝郁火旺", + "E": "肝郁脾点" + }, + "answer": "C", + "reason": "冲任失调,上则乳房痰浊凝结,故乳房肿块伴胀痛;下则经水逆乱，故月经周期亲乱，最少色淡,甚或闭经;脾失健运,气血亏虚,故神疲乏力,头晕;冲为血海,隶属肝肾,冲任失调,肝气不舒,故经前加重,经水一行,肝气得舒,故经后缓减;肝肾不足,故腰酸乏力;舌淡、脉沉细为冲任失调之象。" + }, + { + "question_num": 333, + "query": "患者,女,25岁。口舌生疮,心烦失眠,小便黄赤,尿道灼热涩痛,口渴。舌红无苔，脉数,其病位在", + "options": { + "A": "心、脾", + "B": "小肠", + "C": "膀胱", + "D": "心、小肠", + "E": "肾、膀胱" + }, + "answer": "D", + "reason": "心与小肠:心火可以下移小肠,如尿赤尿少,小肠火上炎于心有口舌生疮。心经有热则心烦失眠,舌为心之苗,故口舌生疮;心火上炎,灼伤津液则口渴;心与小肠相表里,心移热于小肠,则小便黄赤,尿道灼热涩痛,故病位在心与小肠。" + }, + { + "question_num": 334, + "query": "患者,男,60岁。高血压病病史15年突发剧烈头痛，眩晕,恶心，呕吐,失语。查体：无肢体活动障碍。血压200/120mmHg(26.6/16kPa)，神经反射正常。应首先考虑的是", + "options": { + "A": "急进型高血压", + "B": "缓进型高血压", + "C": "高血压脑病", + "D": "高血压性脑出血", + "E": "高血压性心脏病" + }, + "answer": "C", + "reason": "患者发病时血压200/120mmHg,结合发作时眩晕、失语的表现,可诊断为高血压脑病,故选C。但肢体活动无障碍,神经反射正常,故排除D。本病例无心脏损伤的直接证据，故排除E。" + }, + { + "question_num": 335, + "query": "患��,女,29岁。外感后,突发呕吐,恶寒头痛。胸脘满闷，舌苔白腻，脉缓。治疗应首选", + "options": { + "A": "左金丸", + "B": "白虎汤", + "C": "小柴胡汤", + "D": "藿香正气散", + "E": "龙胆泻肝汤" + }, + "answer": "D", + "reason": "外感后突发呕吐,胸脘满闷,舌苔白你记-了元19华m-3后员、:-0URZ用强香正气散,其余都不适用于外感寒湿证。" + }, + { + "question_num": 336, + "query": "患儿,男,9岁。头皮部初起丘疹色红,灰白色鳞屑成斑,毛发干枯,容易折断,易于拔落而不疼痛，已有年余，自觉瘙痒，其诊断是", + "options": { + "A": "肥疮", + "B": "牛皮癣", + "C": "白秃疮", + "D": "白疤", + "E": "圆癣" + }, + "answer": "C", + "reason": "白秃疮相当于西医的白癣,是头癣的一种,多见于儿童,男性多于女性,特点为灰白色鳞屑成斑,毛发干枯,容易折断,青春期可自愈,秃发也能再生,不遗留瘢痕。" + }, + { + "question_num": 337, + "query": "患者,男,40岁。午后突然出现呕吐，多为清水痰涎,脘闷不食,不思饮食,舌质淡苔白腻,脉滑。治疗宜首选", + "options": { + "A": "理中汤", + "B": "香砂六君子汤", + "C": "温脾汤", + "D": "小半夏汤合苓桂术甘汤", + "E": "小半夏汤合茯苓汤" + }, + "answer": "D", + "reason": "呕吐之痰伙内阻证证候:呕吐清水痰,脘闷不食,头眩心悸,舌苔白腻,脉滑。治法:温中化饮,和胃降逆。代表方:小半夏汤合苓桂术甘汤加减。" + }, + { + "question_num": 338, + "query": "典型心绞痛胸部疼痛的部位是", + "options": { + "A": "心尖部", + "B": "左肩背部", + "C": "胸部左侧", + "D": "胸骨体上段或中段的后方", + "E": "胸部右侧" + }, + "answer": "D", + "reason": "心绞痛以发作性胸痛为主要临床表现,疼痛部位主要在胸骨体上段或中段之后,可波及心前区,有手掌大小范围,故选D。" + }, + { + "question_num": 339, + "query": "患者,女,28岁。平日情绪急躁,心烦失眠,口苦而干,便秘,突发昏仆抽搐,尖叫吐涎,牙关紧闭,舌红苔黄腻,脉弦滑数。治疗应首选", + "options": { + "A": "定痫丸", + "B": "六君子汤", + "C": "大补元煎", + "D": "甘麦大枣汤", + "E": "龙胆泻肝汤合涤痰汤" + }, + "answer": "E", + "reason": "突发昏仆抽搐,尖叫吐涎,牙关紧闭,为痛病。平日情绪急躁,心烦失眠，口苦而干,便秘,为肝火痰热证。治宜清肝泻火，化痰宁心，用龙胆泻肝汤合涤痰汤。定痫丸用于阳痫发作期。六君子汤用于脾虚类盛。大补元煎用于肝肾阴虚。甘大枣汤用于心阴不足。" + }, + { + "question_num": 340, + "query": "患者,男,26岁。行注射治疗后，出现臀部结块坚硬,漫肿不红,病情进展缓慢，无全身症状,舌苔白腻,脉缓,其诊断是", + "options": { + "A": "臀痈", + "B": "肉瘤", + "C": "流痰", + "D": "内陷", + "E": "无头疽" + }, + "answer": "A", + "reason": "臀痈是发生于臀部肌肉丰厚处范围较大的急性化脓性疾病，中肌内注射引起者俗称针毒结块。湿痰凝滞证表现为漫肿不红,结块坚硬,病情进展缓慢,多无全身症状。" + }, + { + "question_num": 341, + "query": "患者,女。因流产失血过多,导致月经不调,久不怀孕,其病在", + "options": { + "A": "阴跷脉、阳跷脉", + "B": "阴维脉、阳维脉", + "C": "督脉、任脉", + "D": "冲脉、任脉", + "E": "阴跷脉、阴维脉" + }, + "answer": "D", + "reason": "冲脉调节十二经气血,任脉调节月经,妊养胎儿,故病在冲脉和任脉。" + }, + { + "question_num": 342, + "query": "患者,女,26岁,已婚。突发尿痛、尿频、尿急,腹痛半天。检查:肾区无叩痛,尿中白细胞(++)，菌培养为大肠埃希菌,其诊断是", + "options": { + "A": "急性肾盂肾炎", + "B": "肾结核", + "C": "急性膀胱炎", + "D": "肾结石", + "E": "慢性肾炎" + }, + "answer": "C", + "reason": "急性膀胱炎发病急骤,常在过于劳累、受凉、长时间憋尿、性生活后发病,病程一般持续1~2周自行消退或治疗后消退,其特点是发病“急”炎症反应“重”、病变部位“浅”。常见的症状有尿频、尿急、尿痛、脓尿和终末血尿,甚至全程肉眼血尿。患者肾区无叩痛,可基本排除ABDE;尿中白细胞(++),菌培养为大肠埃希菌，可排除BE;且急性起病，可排除BDE。" + }, + { + "question_num": 343, + "query": "患者因劳累过度,出现形体倦怠,头晕泛恶,纳食不佳,厌油腻,1周后出现两目黄染,后皮肤亦黄、鲜亮,伴胁痛,脘胀,口干而苦,小便黄,大便秘结,舌苔黄腻,脉弦数。诊断为", + "options": { + "A": "湿热蕴蒸,湿重于热之黄疸", + "B": "湿热蕴蒸,热重于湿之黄疸", + "C": "寒湿阻遏之黄疸", + "D": "热毒炽盛之黄疸", + "E": "晚亏血电之黄疸" + }, + "answer": "B", + "reason": "湿热蕴阻中焦,蒸肝胆,胆汁外溢,发为黄疸,热为阳邪,故色鲜明。热灼液,故口苦咽干,尿赤便秘。肝胆火盛,故胁胀闷痛。舌红苔贯,脉弦滑数,都是热重于湿的表现。若为湿，应以头身困重、脘腹痞闷、食欲减退、呕恶便溏等湿困于脾的表现为主,故为热重于湿。" + }, + { + "question_num": 344, + "query": "患者,女,18岁。因牙龈肿痛,服用消炎止痛片，引发全身丘疹、红斑、风团,热作痒,伴恶寒发热,舌苔薄黄,脉浮数。诊断为药疹,治疗应首选", + "options": { + "A": "桑菊饮", + "B": "银翘散", + "C": "黄连解毒汤", + "D": "消风散", + "E": "清营汤" + }, + "answer": "D", + "reason": "药疹特点是发病前有用药史,并有一定的潜伏期，常突然发病，皮损形态多样，可泛发或限于局部,患者全身丘疹、红斑、风团,热癌痒,伴恶寒发热,舌苔薄黄,脉浮数等均为风热在表之证。治法当祛风清热,方用消风散。" + }, + { + "question_num": 345, + "query": "患者,男,61岁。久病咳喘,吐痰稀白。舌苔白腻,因过用温燥之品,今咳喘加剧,吐痰黄稠,舌苔黄腻。这种变化属于", + "options": { + "A": "阴消阳长", + "B": "阳消阴长", + "C": "阴证转阳", + "D": "阳证转阴", + "E": "阴虚阳亢" + }, + "answer": "C", + "reason": "寒湿为阴证,现吐痰贯稠,舌苔荧腻,转为湿热,为阴证转阳。" + }, + { + "question_num": 346, + "query": "患者反复感染,出血2个月。检查:全血细胞减少,肝、脾、淋巴结肿大。骨髓象及淋巴结活检均发现异常组织细胞及多核巨组织细胞，其诊断是", + "options": { + "A": "急性淋巴细胞白血病", + "B": "慢性再生障碍性贫血", + "C": "特发性血小板减少性紫癜", + "D": "恶性组织细胞病", + "E": "慢性粒细胞白血病" + }, + "answer": "A", + "reason": "白血病急性期可见红细胞、血小板减少,淋巴细胞性白血病还可见肝脾淋巴结肿大，B项可见全血细胞减少,但肝、脾一般不肿大。" + }, + { + "question_num": 347, + "query": "患者,男,62岁。表情呆滞,沉默寡言记忆减退，失认失算,口齿含糊,词不达意，伴腰膝酸软,肌肉萎缩,食少纳呆,气短懒言，口涎外溢,腹痛喜按,鸡鸣泄泻,舌质淡白,舌体胖大,苔白,苔少,脉沉细弱,双尺尤甚。治疗宜首选", + "options": { + "A": "还少丹", + "B": "补阳还五汤", + "C": "人参养荣汤", + "D": "七福饮", + "E": "转呆汤" + }, + "answer": "A", + "reason": "痴呆脾肾两虚证证候:表呆沉默寡言,记忆减退,失认失算,口齿含糊,词不达意伴腰膝酸软,肌肉萎缩,食少纳呆、气短懒言,口涎外溢,或四肢不温,腹痛喜按,鸡鸣泄泻,舌质淡白,舌体胖大,苔白,或舌红,苔少或无苔,脉沉细弱,双尺尤共。该患者临床表现符合痴呆肿肾两虚证。治法:补肾健脾,益气生精。代表方:还少丹加减" + }, + { + "question_num": 348, + "query": "患者,男,30岁。近1周出现腰骶部及会阴部疼痛，小便频急,茎中热痛,尿色黄浊苔黄腻,脉滑数。直肠指诊,前列腺饱满肿胀，有明显压痛,光滑无硬节,诊为前列腺炎，其病因病机是", + "options": { + "A": "肾阴不足", + "B": "湿热蕴结", + "C": "气滞血瘀", + "D": "中气下陷", + "E": "肾虚不固" + }, + "answer": "B", + "reason": "小便频急,茎中热痛,尿色黄浊,苔黄腻,脉滑数都是湿热蕴结的征象。" + }, + { + "question_num": 349, + "query": "患者痰壅气逆,咳嗽喘逆,痰多胸闷,食少难消,舌苔白腻,脉滑。治疗宜选用", + "options": { + "A": "山楂", + "B": "莱菔子", + "C": "神曲", + "D": "鸡内金", + "E": "麦芽" + }, + "answer": "B", + "reason": "本题五个选项均具有消食化积之功效,A项山楂兼能行气散瘀;B项莱菔子降气化痰;C项神曲可和胃;D项鸡内金涩精止遗、化坚消石;E项麦芽回乳消胀。本题所述症状中有痰壅气逆、痰多胸闷,可用莱菔子降气化痰,故选B。" + }, + { + "question_num": 350, + "query": "某患者,患急性心肌梗死后第2天出现少尿,血压75/50mmHg，烦躁不安，面色苍白，表情淡漠,皮肤湿冷,大汗淋漓,脉细弱无力。应首先考虑的是", + "options": { + "A": "左心衰竭", + "B": "低血糖反应", + "C": "心源性休克", + "D": "急性肾衰竭", + "E": "心肌梗死后综合征" + }, + "answer": "C", + "reason": "急性心肌梗死急性期常有急性左心衰竭和心源性休克发生，但急性左心衰竭��发时往往血压升高,进而也可以发生心源性休克,但除上述休克表现外多伴有严重气急、端坐呼吸、咳泡沫样痰等。而心肌梗死后综合征发生于梗死后数周至数月内，表现为发热、胸痛、气急、咳嗽等。" + }, + { + "question_num": 351, + "query": "患者,男,60岁。久患胁痛,悠悠不休,遇劳加重,头晕目眩,口干咽燥,舌红少苔,脉弦细。治疗应首选", + "options": { + "A": "柴胡疏肝散", + "B": "逍遥散", + "C": "杞菊地黄丸", + "D": "一贯煎", + "E": "二阴煎" + }, + "answer": "D", + "reason": "肝阴不足,阴血难以活养肝络,故见刚油悠悠\"术EnXP成>晕目眩,口干咽燥,舌红少苔,脉弦细。证属肝阴不足治宜养阴柔肝,方用一贯煎。柴胡疏肝散、逍巡散用于肝气郁结。杞菊地荧丸用于肝肾阴虚。二阴煎用于滋养肺肾。" + }, + { + "question_num": 352, + "query": "患者,女,26岁。月经前双侧乳房胀痛明显,检查时可及双乳房肿块，大小不等,有索条状、结节型及片块状。月经后症状减轻。诊断为", + "options": { + "A": "乳核", + "B": "乳岩", + "C": "乳癖", + "D": "乳痨", + "E": "乳痈" + }, + "answer": "C", + "reason": "乳癖以双乳房可触及肿块，大小不等,疼痛且与月经周期密切有关为特征。" + }, + { + "question_num": 353, + "query": "患者外感风邪,头痛较甚。伴恶寒发热，目眩鼻塞。舌苔薄白脉浮。治疗宜选用", + "options": { + "A": "川芎", + "B": "丹参", + "C": "郁金", + "D": "牛膝", + "E": "益母草" + }, + "answer": "A", + "reason": "A项川芎、C项郁金为活血止痛药B项丹参、E项益母草、D项牛膝为活血调经药，本题所述为外感风邪所致头痛,故可排除调经药BDE,川营可祛风止痛，上行头目,为治头痛要药,郁金则重于清热凉血、利胆退黄,故排除C" + }, + { + "question_num": 354, + "query": "患者,男,24岁。暴食后突然上腹剧痛。恶心，呕吐，发热。检查:腹部较软，上腹压痛。血清淀粉酶增高，其诊断是", + "options": { + "A": "急性胃肠炎", + "B": "消化性溃疡急性穿孔", + "C": "胆囊炎", + "D": "急性胰腺炎", + "E": "心肌梗死" + }, + "answer": "D", + "reason": "血清淀粉酶增高为急性胰腺炎的特征性改变。患者有暴饮暴食诱因,并出现消化道症状和上腹部压痛,故选D。A项多因不洁的饮食或冷热变化引起,无血清淀粉酶增高:B项有溃疡史，且穿孔后会出现腹膜炎体征,腹壁紧张度增加:C项在进食油腻食物和夜间易发作;E项有心前区疼痛。" + }, + { + "question_num": 355, + "query": "患者,男,43岁。诊为聚证。见食滞痰阻,痰湿较重,服六磨汤后,腑气虽通,但症状未减，古台日腻而不化。治疗且自选", + "options": { + "A": "二陈汤", + "B": "藿朴夏苓汤", + "C": "平胃散", + "D": "五苓散", + "E": "香苏散" + }, + "answer": "C", + "reason": "聚证若痰湿较重,兼有食滞,腑气虽通,苔腻不化者,可用平胃散加山楂、六曲。" + }, + { + "question_num": 356, + "query": "患者,男,38岁。患急性子痈2天,恶寒发热,左侧睾丸肿大疼痛,疼痛引及子系(精索),舌红苔黄腻,脉滑数。治疗宜首选", + "options": { + "A": "透脓散", + "B": "滋阴除湿汤", + "C": "草薜化毒汤", + "D": "橘核丸", + "E": "枸橘汤" + }, + "answer": "E", + "reason": "子痈湿热下注证证候:多见于成年人。皋丸或附率肿大疼痛,阴皮肤红肿,热疼痛，少腹抽痛,局部触痛明显,脓肿形成时,按之应指,伴恶寒发热。苔黄腻,脉滑数。患者临床表现符合子痈湿热下注证。治法:清热利湿,解毒消肿。代表方:枸柄汤或龙胆泻肝汤加减。疼痛剧烈者，加延胡索、金铃子。" + }, + { + "question_num": 357, + "query": "患者呕吐吞酸,嗳气频繁,胸胁闷痛脉弦。治疗应选用", + "options": { + "A": "干姜", + "B": "高良姜", + "C": "吴茱萸", + "D": "丁香", + "E": "小茴香" + }, + "answer": "C", + "reason": "“患者呕吐”病位在胃,胁肋为肝经所过,故肝郁气滞可见“暖气频繁,胸胁闷痛,脉弦”综合判断,该患者为肝郁犯胃,治宜疏肝解郁,降逆止呕。吴茱英不但可散寒止痛，同时可以疏肝解郁，降逆止呕,兼能制酸止痛,治肝郁犯胃的胁痛口苦，与黄连配伍,如左金丸。干姜温中散寒,回阳通脉,温肺化饮。高良类温中止痛,温中止呕。丁香温中降逆,散寒止痛,温肾助阳。小茴香散寒止痛,理气和胃。" + }, + { + "question_num": 358, + "query": "患者,男,60岁。咳嗽,吐痰,反复发作5年,近1周症状加重。检查:体温正常,两肺散在干、湿啰音。血白细胞11.0x10^9/L,中性��细胞0.8。应首先考虑的是", + "options": { + "A": "急性支气管炎", + "B": "慢性支气管炎急性发作", + "C": "肺结核", + "D": "支气管哮喘", + "E": "肺瘤" + }, + "answer": "B", + "reason": "慢性支气管炎的诊断标准为每年咳嗽、咳痰时间超过3个月,连续2年以上,本例患者病史5年,可认为该息者符合慢性支气管类诊断。近年来加重,且两肺闻及干湿啰音,白细胞、中性粒细胞增多,为肺部感染征象。" + }, + { + "question_num": 359, + "query": "患者,女,70岁。久患肺病,反复发作,本次旧疾又发。呼吸浅短难续,咳声低怯，胸满短气,张口抬肩。倚息不能平卧,咳嗽,痰白如沫,咯吐不利,舌淡暗,脉沉细无力。诊断为肺胀，其证候是", + "options": { + "A": "痰瘀阻肺", + "B": "肺肾气虚", + "C": "外寒内饮", + "D": "脾肾阳衰", + "E": "心肾阳衰" + }, + "answer": "B", + "reason": "肺肾气虚的特点是久病反复,呼吸浅短难续,张口拾肩,倚息不能平卧,咳声低怯,咯吐不利。后与阳虚监别,本证无明显的阳虚水盛浮肿、畏寒肢冷之象。" + }, + { + "question_num": 360, + "query": "患者,男,40岁。左侧脚趾发麻,皮肤干燥,毫毛脱落,趾甲增厚变形,呈干性坏疽,口干欲饮,便秘溲赤,舌质红,苔黄,脉弦细数。治疗宜首选", + "options": { + "A": "阳和汤", + "B": "顾步汤", + "C": "四妙勇安汤", + "D": "桃红四物汤", + "E": "独活寄生汤" + }, + "answer": "B", + "reason": "口于欲饮,便秘溲赤,结合干性坏疽,诊为脱疽热毒伤阴证。治法:消热解毒,养阴活血。代表方:顾步汤加减。" + }, + { + "question_num": 361, + "query": "患者痰壅气逆,咳喘痰多,胸闷食少甚则不能平卧。治疗宜选用的药物是", + "options": { + "A": "紫苏子、白芥子、莱菔子", + "B": "紫菀、款冬花、川贝母", + "C": "桑叶、贝母、北沙参", + "D": "杏仁、麻黄、甘草", + "E": "麻黄、石膏、杏仁" + }, + "answer": "A", + "reason": "患者“痰气逆,咳喘痰多,胸闷食少”,是因气滞痰食阻滞,治宜降气快膈,化痰消食,方用三子养亲汤。" + }, + { + "question_num": 362, + "query": "患者,男,48岁。乙肝病史10年,因乏力、低热、腹胀、少尿就诊。体格检查;巩膜黄染,腹部膨隆,移动性浊音(+)。肝略小，脾大,超声显示肝内纤维增殖，肝硬化结节形成,门静脉增宽,其治疗措施不妥的是", + "options": { + "A": "卧床休息", + "B": "每天钠盐摄人量<5g", + "C": "给予复方氨基酸和清蛋白", + "D": "合用保钾和排钾利尿剂", + "E": "每天进水量不超过800ml" + }, + "answer": "E", + "reason": "肝硬化患者如果有稀释性低钠血症、难治性腹水,应严格控制进水量在800一1000ml之间。" + }, + { + "question_num": 363, + "query": "患者喘促日久,动则喘甚,呼多吸少,气不得续,汗出肢冷,跗肿,面青唇紫,舌淡苔白,脉沉弱。治疗应首选", + "options": { + "A": "平喘固本汤合补肺汤", + "B": "金医肾气丸合参蛤散", + "C": "参附汤合黑锡丹", + "D": "生脉散合补肺汤", + "E": "生脉地黄汤合金水六君煎" + }, + "answer": "B", + "reason": "肺虚气失所主,故喘促气短,声低气怯,咳声低弱,肺病及肾,肾气虚,故动则喘甚,呼多吸少,气不得续,汗出肢冷,舌淡红苔薄白,脉弱无力。治宜补肾纳气,用金医肾气丸合参蛤散。" + }, + { + "question_num": 364, + "query": "某脱疽患者患趾(指)喜暖怕冷,麻木酸胀疼痛，多走疼痛加剧,稍歇痛减，皮肤苍白,触之发凉,跌阳脉搏动减弱;舌淡,苔白腻,脉沉细，其治则应为", + "options": { + "A": "温阳通脉散寒", + "B": "养营益气", + "C": "活血通络止痛", + "D": "温补肾阳", + "E": "补养气血为主" + }, + "answer": "A", + "reason": "寒湿阳络证电卧(指)克暖怕冷，麻木,酸胀疼痛,多走疼痛加剧,稍歇痛减,皮肤苍白,触之发凉,跌阳脉搏动减弱;舌淡,苔白腻,脉沉细。治法:温阳散寒，活血通络。" + }, + { + "question_num": 365, + "query": "患者,女,25岁。妊娠8周,下列除哪组药外,均不宜服用", + "options": { + "A": "巴豆、牵牛子、商陆", + "B": "三棱、莪术、水蛭", + "C": "斑蝥、廨香、虻虫", + "D": "当归、阿胶、丹参", + "E": "附子、干姜、肉桂" + }, + "answer": "D", + "reason": "妊娠禁忌药:水银、砒霜、雄黄、轻粉、斑蝥、马钱子、酥、川乌、草乌、蔡芦、胆矾、瓜带,巴豆、甘遂、大、芫花、牛子、商陆、廨香、干漆、水蛭、虻虫、三棱、莪术等。慎用药:牛膝、川芎、红花、桃仁、姜黄、牡丹皮、枳实、枳壳、大贠、泻叶、芦��芒硝、附子、肉桂等,故选D。" + }, + { + "question_num": 366, + "query": "患者食欲减退,乏力。查体:全身及巩膜黄染，胆囊明显肿大,无压痛。应首先考虑的是", + "options": { + "A": "胰腺癌", + "B": "胰腺炎", + "C": "胆道蛔虫症", + "D": "胆囊炎", + "E": "胆结石" + }, + "answer": "A", + "reason": "黄疸伴胆囊肿大多因胆总管有梗阻,常见于胰腺癌、壶腹癌、胆总管癌等。" + }, + { + "question_num": 367, + "query": "患者头痛以前额为甚,面红,牙痛,便干，古红音黄,脉弦。处方用药加用白芷，除治疗效应外,其引经报使作用在", + "options": { + "A": "少阳经", + "B": "太阳经", + "C": "阳明经", + "D": "少阴经", + "E": "厥阴经" + }, + "answer": "C", + "reason": "前额痛为阳明经循行的部位,且白芷人阳明经" + }, + { + "question_num": 368, + "query": "患者,男,45岁。左上臂内侧有一肿海绵/T分庄比子龙力口压之可缩小。应首先考虑的是", + "options": { + "A": "气瘤", + "B": "筋瘤", + "C": "脂瘤", + "D": "血瘤", + "E": "肉瘤" + }, + "answer": "D", + "reason": "血瘤可发生于身体任何部位,但以四肢、躯干、面颈部多见。常在出生后即发现，随着年龄增长而长大,长到某种程度后,可停止进展。体外观呈暗红色或紫蓝色,亦可为正常皮色，小如豆粒，大如拳头，质地柔软,状如海绵,压之可缩小,肢体活动时胀大。" + }, + { + "question_num": 369, + "query": "患者,女,38岁。头痛连及项背,遇风则痛甚,恶风寒喜裹头戴帽,口不渴,苔薄白，脉浮。用药宜首选", + "options": { + "A": "发散风寒药", + "B": "发散风热药", + "C": "活血祛瘀药", + "D": "理气药", + "E": "祛风湿药" + }, + "answer": "A", + "reason": "发散风寒药主要用于外感风寒所致恶寒发热,无汗或汗出不畅,头痛身痛,口不,舌苔薄白,脉浮等风寒表证,该证风寒表证,故选A。" + }, + { + "question_num": 370, + "query": "患者,女,20岁。四肢皮肤反复出现紫斑1年。检查：肝、脾不大，轻度贫血，血小板660x10^9/L,骨髓颗粒型巨核细胞比例增加，其诊断是", + "options": { + "A": "急性白血病", + "B": "再生障碍性贫血", + "C": "脾功能亢进", + "D": "过敏性紫癜", + "E": "特发性血小板减少性紫癜" + }, + "answer": "E", + "reason": "特发性血小板减少性紫是小儿最常见的出血性疾病,其特点是自发性出血，血小板减少,出血时间延长和血块收缩不良。骨髓中巨核细胞的发育受到抑制,故选E。A项特点是由造血干细胞恶变而形成的一个原始细胞克隆取代了正常骨髓。B项再生障碍性贫血系多种病因引起的造血障碍，导致红骨髓总容量减少,代以脂肪髓,造血衰竭,以全血细胞减少为主要表现的一组综合征。C项临床表现为脾大、一种或多种血细胞减少,而骨髓造血细胞相应增生,可经脾切除而级解，" + }, + { + "question_num": 371, + "query": "患者胸胁胀闷,嗳气食少,每因抑郁恼怒之时,发生腹痛泄泻,舌淡红,脉弦,其治法是", + "options": { + "A": "调理脾胃", + "B": "疏肝理气", + "C": "抑肝扶脾", + "D": "泻肝和胃", + "E": "疏肝和胃" + }, + "answer": "C", + "reason": "肝气郁滞,乘犯脾胃,故胸胁胀闷嗳气食少,并于抑郁恼怒之时加重,气滞于中则腹痛脾运无权,水谷下趋则泄泻,俱是肝气乘脾之象,治应抑肝扶脾。" + }, + { + "question_num": 372, + "query": "新生儿在上腭中线和齿龈部位有散在黄白色、碎米粒样颗粒,称为", + "options": { + "A": "马牙", + "B": "板牙", + "C": "螳螂子", + "D": "口疮", + "E": "鹅口疮" + }, + "answer": "A", + "reason": "大多数婴儿在出生后4~6周时,口腔上腭中线两侧和齿龈边缘出现一些黄白色的小点，很像是长出来的牙齿,俗称“马牙”医学上称为上皮珠。" + }, + { + "question_num": 373, + "query": "患者,男,30岁。夜间外出着衣薄,次日恶寒发热,头身疼痛,后背发凉，无汗,舌苔薄白,脉浮紧。用药宜首选", + "options": { + "A": "荆芥、防风", + "B": "麻黄、桂枝", + "C": "桂枝、白芍", + "D": "羌活、白芷", + "E": "紫苏、香薷" + }, + "answer": "B", + "reason": "该证属风寒表实证,麻黄味辛发散性温散寒,功能开胶理,透毛窍,发汗解表以散风寒，为辛温解表要药,多用于外感风寒,恶寒无汗,发热头痛脉浮而紧的感冒重证,即风寒表实证，每与桂枝相须为用,如麻黄汤,故选B。" + }, + { + "question_num": 374, + "query": "患者,男,14岁。患1型糖尿病2年，近日在家中用胰岛素治疗，突然发生昏迷���其昏迷原因最可能是", + "options": { + "A": "糖尿病高渗性昏迷", + "B": "乳酸性酸中毒", + "C": "呼吸性酸中毒", + "D": "尿毒症酸中毒", + "E": "低血糖昏迷" + }, + "answer": "E", + "reason": "1型糖尿病应用胰岛素治疗的常见并发症为胰岛素应用过最导致低血糖,进而昏迷,故选E。AB项亦为糖尿病常见并发症，但与本题背景不符。CD项与本题关系不大。" + }, + { + "question_num": 375, + "query": "患者突然昏仆,不省人事,肢体软瘫目合口张,鼻鼾息微,手撒肢冷,汗多,二便自进,舌痿。脉微欲绝,其中风属", + "options": { + "A": "中经络", + "B": "阳闭证", + "C": "阴闭证", + "D": "脱证", + "E": "后遗症" + }, + "answer": "D", + "reason": "中风根据有无神志障碍分为中经络、中脏腑。中脏腑又有闭证和脱证之分。闭证又分阴阳。根据病程可分为急性期、慢性期、后遗症期。脱证乃阳气外脱,以突然昏仆,不省人事,肢体软瘫,目合口张,肝息微,手撒肢冷,汗多,二便自遗,舌痿,脉微欲绝为主症。" + }, + { + "question_num": 376, + "query": "患者,男,24岁。转移性右下腹痛6小时,临床诊为肠痈。现除轻度腹痛外，尚有轻度发热,恶心纳呆,小便微黄,大便干结,舌苔厚腻,脉弦滑,其治法是", + "options": { + "A": "理气行瘀,疏化导滞", + "B": "行气祛瘀,通腑泄热", + "C": "理气透脓,通腑泄热", + "D": "行气祛瘀,通腑排脓", + "E": "理气活血,通腑透脓" + }, + "answer": "B", + "reason": "结合患者恶心纳呆,小便微黄,大便干结,舌苔厚腻,脉弦滑。辨证为湿热证。而通腑泄热是治疗肠痈的关键,肠痈初期表现有气滞血瘀表现，治疗当配合行气祛瘀。" + }, + { + "question_num": 377, + "query": "患者咳嗽痰白清稀。食少便溏,下肢轻度浮肿。舌淡苔白，脉弱。治疗应选用", + "options": { + "A": "党参", + "B": "甘草", + "C": "山药", + "D": "白术", + "E": "黄柏" + }, + "answer": "D", + "reason": "患者脾失健运,不能运化水湿,则湿聚成痰,故见“咳痰白清稀，下肢轻度浮肿”脾失健运,则水谷不化,故见“食少便溏”。治宜健脾益气,燥湿利尿。白术健脾益气，湿利尿、止汗,安胎,故选D。党参补肿肺气,补血,生津。甘草补脾益气,祛痰止咳,缓急止痛,消热解毒,调和诸药。山药补脾养胃,生津益肺,补肾涩精。柏清热燥湿,泻火除蒸，解毒疗疮。" + }, + { + "question_num": 378, + "query": "患者,女,26岁。近1个月来,以夜间咳嗽为主。痰中带血丝,伴低热，盗汗。应首先考虑的是", + "options": { + "A": "肺结核", + "B": "支气管扩张", + "C": "肺瘤", + "D": "风湿性心脏病(二尖瓣狭窄)", + "E": "急性肺水肿" + }, + "answer": "A", + "reason": "肺结核痰中带血丝,伴低热,盗汗支气管扩张痰虽较多,为湿性咳嗽。肺癌剧烈干咳,痰中带血丝。风湿性心脏病(二尖瓣狭窄)多为咯血，为暗红色。急性肺水肿为粉红色泡沫样痰。" + }, + { + "question_num": 379, + "query": "患者,女,15岁。浮肿3月余,下肢为甚,按之凹陷不易恢复,心悸,气促,腰部冷痛，尿少，四肢冷，舌质淡胖,苔白,脉沉,其证候是", + "options": { + "A": "湿毒浸淫", + "B": "湿热壅盛", + "C": "脾阳虚衰", + "D": "水湿浸淫", + "E": "肾气衰微" + }, + "answer": "C", + "reason": "脾阳不足,气不化水,故浮肿,水湿下聚,故下肢为甚,按之凹陷。水气上凌心肺,故心悸，气促。腰为肾府,故腰部冷痛。阳气衰微，故出现尿少,四肢冷,舌质淡胖,苔白,脉沉。" + }, + { + "question_num": 380, + "query": "患者,男,30岁。便后肛门部疼痛、出血反复发作10年。检查:肛门外观截石位6点有结缔组织外痔,并有梭形裂口通向肛内，边缘不齐,创面较深,术中见肛管狭窄明显。应首选的治疗措施是", + "options": { + "A": "注射疗法", + "B": "扩肛疗法", + "C": "切开疗法", + "D": "纵切横缝", + "E": "肛裂侧切" + }, + "answer": "D", + "reason": "本病属于陈旧性肛裂伴有肛管狭窄,应选择纵切横缝。扩肛法适应证为早期肛裂,无结缔组织外痔、肛乳头肥大者;切开疗法适应证为陈旧性肛裂伴有结缔组织外痔或肛乳头肥大者。" + }, + { + "question_num": 381, + "query": "患者外感风寒,恶寒发热。无汗,腹痛,吐泻,舌苔白腻。治疗宜选用", + "options": { + "A": "麻黄", + "B": "桂枝", + "C": "香薷", + "D": "防风", + "E": "白芷" + }, + "answer": "C", + "reason": "麻贠发汗解表、宜肺平喘、利水消肿:桂枝发汗解肌、温通筋脉、助阳化气:香薇发汗解表、化湿和中、利水消肿;防风祛风解表、胜湿止痛、痉;白芷解表散寒、祛风止痛、通鼻窍、燥湿止带、消肿排脓、祛风止痒。本题所述病证中有“吐泻”提示脾失调,选取有化湿和中功效的香较好,故选C" + }, + { + "question_num": 382, + "query": "患者咳嗽。查体:气管向左偏移。右侧胸廓较左侧饱满，叩诊出现鼓音。应首先考虑的是", + "options": { + "A": "右侧气胸", + "B": "左侧肺不张", + "C": "右下肺炎", + "D": "肺气肿", + "E": "右侧胸腔积液" + }, + "answer": "A", + "reason": "由气管移位可考虑患者存有胸腔肺、纵及单侧甲状腺的病变。气管左移、右侧胸腔较左侧饱满,提示该侧气胸或胸腔积液病变;叩诊为鼓音,应考忠诊断为右侧气胸。左侧肺不张时,左胸可出现凹陷,叩诊呈浊音;右下肺炎时,气管无移位,右下肺叩诊呈浊音或实音;肺气肿气管无移位,叩诊过清音。" + }, + { + "question_num": 383, + "query": "患者,女,55岁。两个月来关节肿大窜痛,屈伸不利,恶风怕冷,虽已治疗,症无改善,又增关节局部灼热，口干便燥,脉滑稍数,舌苔薄黄。主方选用", + "options": { + "A": "白虎桂枝汤", + "B": "薏苡仁汤", + "C": "防风汤", + "D": "桂枝芍药知母汤", + "E": "犀角散" + }, + "answer": "D", + "reason": "痹证之行痹的治疗。据其主症、舌脉分析,此为痹证之行痹。由风寒湿邪留滞经络,阻气血所引起,且邪有化热之象。治疗当首选寒热并用的桂枝芍药知母汤,祛风通络,散寒除湿清热,故选D。" + }, + { + "question_num": 384, + "query": "患者,女,36岁,已婚。经行时肢体疼痛麻木，肢软无力，月经量少，色淡质稀面色无华，舌淡，苔白，脉细弱。治疗应首选", + "options": { + "A": "八珍汤", + "B": "当归补血汤", + "C": "血府逐瘀汤", + "D": "趁痛丸", + "E": "圣愈汤" + }, + "answer": "B", + "reason": "根据主症可知此为经行身痛。肢体疼痛、麻木--血虚不能养筋脉,经行时气血亦感不足,四肢百骸失于荣养;经行最少,色淡--血虚冲任血海不足;面色无华,舌淡,苔白,脉细弱--血虚表现。此证为经行身痛之血虚证，治宜柔筋止痛,代表方为当归补血汤加减。" + }, + { + "question_num": 385, + "query": "患者,女,30岁。产后5天,右侧乳房红肿胀痛。触摸到硬块，大便如常,小便色黄:治疗应首选", + "options": { + "A": "大青叶", + "B": "蒲公英", + "C": "淡竹叶", + "D": "栀子", + "E": "知母" + }, + "answer": "B", + "reason": "患者“右侧乳房红肿胀痛,触到硬块”可诊断为乳痂，“小便色炎\"可知有热存在。治宜消热解毒,消散结。而公英清热解毒,消肿散结,利湿通淋,故为正确选项。大青叶消热解毒，凉血消斑。淡竹叶洁热泻火，除烦,利尿。栀子泻火除烦，洁热利湿,凉血解毒。您栀子凉血止血。知母清热泻火，生津润燥。" + }, + { + "question_num": 386, + "query": "患者,男,60岁。慢性支气管炎病史20年。近半年活动后心悸，气短。查体:有肺气肿体征，两肺散在干、湿啰音。剑突下可见心尖搏动,肺动脉瓣区第二心音亢进。应首先考虑的是", + "options": { + "A": "冠心病", + "B": "肺心病", + "C": "风心病", + "D": "高血压性心脏病", + "E": "心肌炎" + }, + "answer": "B", + "reason": "肺心病的诊断应该包括病史:有慢性支气炎、肺疾病、胸病变、肺血管病变等原发疾刑史:成衣H光(网加成生不它音),体检有肺动脉瓣区第二心音亢进(为右心室肥大的表现)。" + }, + { + "question_num": 387, + "query": "患者呕吐多为清水痰涎,脘闷不食,头晕心悸,舌苔白腻。脉滑,其证候为", + "options": { + "A": "饮食积滞", + "B": "痰饮内阻", + "C": "脾胃虚弱", + "D": "脾阳虚衰", + "E": "气滞痰阻" + }, + "answer": "B", + "reason": "脾不运化,痰饮内阻,胃气不降,故见呕吐清水痰涎,脘闷不食。水饮上犯清阳，故头晕心悸。" + }, + { + "question_num": 388, + "query": "患者,女,20岁,未婚。近4个月月经提前8~10天。量多、色淡、质稀,神疲肢倦,小腹空坠，舌淡,脉缓弱。诊为月经先期,其证候是", + "options": { + "A": "气虚", + "B": "实热", + "C": "虚热", + "D": "肝郁血热", + "E": "阳盛血热" + }, + "answer": "A", + "reason": "由题干量多、色淡、质稀,神疲肢倦,小腹空坠,舌淡,脉缓弱可知应属于虚证。" + }, + { + "question_num": 389, + "query": "患者,男,20岁。心悸不安,体弱气短!虚烦眠差,咽干口燥,舌淡少苔,脉结代。治疗应选用", + "options": { + "A": "天王补心丹", + "B": "炙甘草汤", + "C": "归脾汤", + "D": "生脉散", + "E": "朱砂安神丸" + }, + "answer": "B", + "reason": "此为阴血阳气虚弱,心脉失养之证辨证要点为脉结代,故选B。" + }, + { + "question_num": 390, + "query": "患者,男,60岁。慢性支气管炎病史20年,肺心病病史5年。近1周感冒后咳嗽，吐黄痰,心悸气短加重。下列哪项治疗原则是最重要的", + "options": { + "A": "止咳", + "B": "祛痰", + "C": "抗感染", + "D": "强心", + "E": "利尿" + }, + "answer": "C", + "reason": "肺心病的治疗原则:①控制呼吸道感染,呼吸道感染是发生呼吸衰竭和心力衰竭的最常见诱因,故需积极应用药物予以控制;②改善呼吸功能;③控制心力衰竭,强心利尿;④控制心律失常;⑤应用肾上腺皮质激素;⑥并发症的处理。" + }, + { + "question_num": 391, + "query": "患者吐血缠绵不止,时轻时重,血色暗淡,神疲乏力,心悸气短,面色苍白,舌质淡,脉细弱，其治法是", + "options": { + "A": "健脾和胃,宁络止血", + "B": "和中宁络,凉血止血", + "C": "益气养阴,宁络止血", + "D": "健脾益气,摄血止血", + "E": "健脾升阳，化瘀止血" + }, + "answer": "D", + "reason": "脾气不足,摄血无力,故吐血缠绵不止,时轻时重,血色暗淡,神疲乏力,心悸气短,面色苍白,舌质淡,脉细弱都属脾虚表现。治宜健脾益气，摄血止血。无气阴两虚症状，故不选C。脾阳虚、瘀血症状都不明显,故不选E。" + }, + { + "question_num": 392, + "query": "患者,女,28岁,已婚。月经50天一行,量少、色淡、质稀,小腹隐痛,喜热喜按,腰酸无力，大便溏薄,小便清长,舌淡苔白,脉沉细而迟。治疗应首选", + "options": { + "A": "温经汤(《金匮要略》)", + "B": "艾附暖宫丸", + "C": "温胞饮", + "D": "大补元煎", + "E": "人参养荣汤" + }, + "answer": "A", + "reason": "由主症和兼症可知此病为月经后期的血虚寒证。治法为扶阳祛寒调经。主方为温经汤。" + }, + { + "question_num": 393, + "query": "患者,男,50岁。昨日起憎寒壮热,头项强痛,肢体酸痛,无汗,鼻塞声重,咳嗽有痰,胸膈痞闷。舌淡苔白，脉浮而按之无力。治宜选用", + "options": { + "A": "参苏饮", + "B": "败毒散", + "C": "再造散", + "D": "柴葛解肌汤", + "E": "普济消毒饮" + }, + "answer": "B", + "reason": "败毒散主治气外感证。证见憎寒壮热,头项强痛,肢体酸痛,无汗,鼻塞声重,咳嗽有痰胸膈痞满,舌淡苔白,脉浮而按之无力。" + }, + { + "question_num": 394, + "query": "患者,女,42岁。反复低热、腰酸3年。夜尿增多6个月。曾多次尿培养有大肠埃希菌。尿常规;蛋白1.1g/L,红细胞4~5/HP。下列各项中确诊慢性肾盂肾炎最可靠的检查方法是", + "options": { + "A": "肾脏MRI检查", + "B": "中段尿培养", + "C": "静脉肾盂造影", + "D": "尿素氮、肌酐检测", + "E": "肾脏CT扫描" + }, + "answer": "C", + "reason": "慢性肾孟肾炎诊断要点:①反复发作的尿路感染病史;②影像学显示肾外形凹凸不平且双肾大小不等,或静脉肾孟造影见肾盂肾益变形、缩窄;③合并持续性肾小管功能损害。" + }, + { + "question_num": 395, + "query": "患者,女,39岁。劳累后出现饮食减少,食后胃脘不舒,倦怠乏力，大便溏薄,面色萎黄,舌淡苔薄白,脉弱,辨证为", + "options": { + "A": "脾气虚", + "B": "心脾两虚", + "C": "脾胃阴虚", + "D": "脾阳虚", + "E": "脾肾阳虚" + }, + "answer": "A", + "reason": "虚劳中气虚证特点。从舌脉症表现看,本患者出现的症状是由于脾虚失于健运、不能化生水谷精微造成的,故辨证当为脾气虚。" + }, + { + "question_num": 396, + "query": "患者,女,23岁,已婚。产后5天高热寒战,小腹疼痛拒按,恶露初时量多,后量少色紫黯如败酱、有臭气,烦躁口渴,大便秘结小便短赤，舌红苔黄,脉滑数有力，其诊断是", + "options": { + "A": "产后发热外感证", + "B": "产后发热血瘀证", + "C": "产后发热感染邪毒证", + "D": "产后腹痛的瘀证", + "E": "产后恶露过少血瘀证" + }, + "answer": "C", + "reason": "疾病的诊断主要根据主诉中最先描述的症状,故本题诊断为产后发热。根据特点、恶露情况、兼证及舌脉,辨证为感染邪毒,故C项为正确答案腹痛、恶露是少属伴随症状,故不选DE。外感发热应伴表证,血瘀发热为乍寒乍热,故不选AB。" + }, + { + "question_num": 397, + "query": "患者,男,18岁。恶寒发热，头痛身痛,无汗而喘,舌苔薄白,脉浮紧。治疗应首选", + "options": { + "A": "小青龙汤", + "B": "桂枝汤", + "C": "九味羌活汤", + "D": "麻黄汤", + "E": "大青龙汤" + }, + "answer": "D", + "reason": "该证为外感风寒表实证,故当选麻黄汤。辨证要点恶寒发热,脉浮紧。" + }, + { + "question_num": 398, + "query": "患者,男,26岁。近年来有多次强直，阵挛，昏睡发作，一般数分钟内意识恢复,发作前胸腹有气上冲感。属于癫痫的哪种发作类型", + "options": { + "A": "大发作", + "B": "失神小发作", + "C": "精神运动发作", + "D": "局限性发作", + "E": "癫痫持续状态" + }, + "answer": "A", + "reason": "大发作又称全身性发作，半数有先兆,如上腹部不适。发作时有些患者先发出尖锐叫声,后即有意识丧失而跌倒,有全身肌肉强直、呼吸停顿,数秒钟后,有阵李性抽掐,抽搐后全身松弛或进入昏睡(昏睡期),此后意识逐渐恢复,故选A。B项无全身痉率现象，C项精神运动性发作以有不规则及不协调动作,如吮吸、咀嚼、寻找为主,D项局限性发作为一侧口角、手指或足趾的发作性抽动或感觉异常，E项痫持续状态发作时间大于30分钟。" + }, + { + "question_num": 399, + "query": "患者,男,54岁。1年来腹大胀满,形似蛙腹,朝宽暮急,面色苍黄,脘闷纳呆,肢冷水肿,小便短少不利,舌体胖,舌质淡,苔淡白，脉沉细无力。治疗应选用的方剂是", + "options": { + "A": "实脾饮", + "B": "调营饮", + "C": "茵陈术附汤", + "D": "柴胡疏肝散合胃苓汤", + "E": "附子理苓汤" + }, + "answer": "E", + "reason": "该患者腹大胀满,形似蛙腹,诊为鼓胀。朝宽暮急,面色苍黄,脘闷纳呆,肢冷水肿,小便短少不利,舌体胖,舌质淡,苔淡白,脉沉细无力,为脾肾阳虚,不能温煦,水湿内聚的典型表现,故诊为鼓胀P:个座子理苓汤或济生肾气丸。" + }, + { + "question_num": 400, + "query": "某女小腹包块,带多色黄、臭秽,少腹及腰骶部疼痛而胀,经期加重,尿少色黄,月经量多,舌红,苔黄腻,脉弦滑数,其治法是", + "options": { + "A": "活血散结消癞", + "B": "清热解毒凉血", + "C": "化痰除湿、活血消癥", + "D": "行气活血,化瘀消疲", + "E": "清热利湿,化瘀消癥" + }, + "answer": "E", + "reason": "根据主证及兼证可判断此病例为癥痕湿热瘀阻型，治以清热利湿,化瘀消。" + }, + { + "question_num": 401, + "query": "患者,男,40岁。腰部冷痛重着,转侧不利,逐渐加重,静卧病痛不减,寒冷和阴雨天则加重,舌质淡,苔白腻,脉沉而迟缓,其治法是", + "options": { + "A": "培补肝肾,舒筋止痛", + "B": "散寒行湿,温经通络", + "C": "活血化瘀,通络止痛", + "D": "补肾壮阳,温煦经脉", + "E": "益气养血,濡养筋脉" + }, + "answer": "B", + "reason": "寒湿腰痛证候:腰部冷痛重着,转侧不利,逐渐加重,静卧病痛不减,寒冷和阴雨天则加重,舌质淡,苔白腻,脉沉而迟缓。该患者临床表现符合寒湿腰痛。治法:散寒行湿，温经通络。代表方:甘姜苓术汤加减" + }, + { + "question_num": 402, + "query": "患者,男,45岁。高血压病3年，血压150/95mmHg,同时患有糖尿病。该患者高血压病应诊断为", + "options": { + "A": "高血压1级,低危组", + "B": "高血压1级,高危组", + "C": "高血压1级,极高危组", + "D": "高血压1级,中危组", + "E": "高血压2级,低危组" + }, + "answer": "B", + "reason": "根据国际统一标准，高血压的分级:1级高血压为140~159/90~99mmHg;2级高血压为160~179/100~109mmHg:3级商血压>180/110mmHg。本题血压150/95mmHg属于1级高血压，又根据高血压患者有无心血管疾病的危险因素与靶器官损密悄况,将其分为低、中、高、极高危4个组,其中,合并糖尿病患者;不论血压在何水平,有无其他心血疾病危险因素均属于商危组。" + }, + { + "question_num": 403, + "query": "患者,男,48岁。头胀痛近2年,时作时止。伴目眩易怒,面赤口苦,舌红苔黄,脉弦数。治疗除取主穴外，还应选用", + "options": { + "A": "头维、内庭、三阴交", + "B": "血海、风池、足三里", + "C": "风池、列缺、太阳", + "D": "太溪、侠溪、太冲", + "E": "丰隆、太阳、风门" + }, + "answer": "D", + "reason": "本患者所患头痛为肝阳上亢的头痛,所选穴位应为肝经穴位，太冲为肝经原穴,平肝潜阳、清利头目,疏经止痛;太溪穴为肾经原穴，滋水涵木,育阴潜阳。" + }, + { + "question_num": 404, + "query": "患者,女,24岁,已婚。妊娠4个月，肢体肿胀,肿势从足部渐发展到腿部，皮色不变,随按随起,胸闷胁胀,头晕胀痛,舌苔薄腻脉弦滑。治疗宜首选", + "options": { + "A": "健脾利水汤", + "B": "真武汤", + "C": "天仙藤散", + "D": "猪苓汤", + "E": "白术散" + }, + "answer": "C", + "reason": "患者妊娠4月,肢体肿胀,诊为子肿。肿势从足部渐发展到腿部，皮色不变，随按随起胸闷胁胀,头晕胀痛,舌苔薄腻,脉弦滑,为气滞证的表现。治法:理气行滞,除湿消肿。代表方:天仙藤散或正气天香散。" + }, + { + "question_num": 405, + "query": "患者汗出恶风,微劳尤甚,易于感冒，体倦乏力,面色少华,舌苔薄白,脉细弱。治疗应首选", + "options": { + "A": "黄芪汤", + "B": "补肺汤", + "C": "玉屏风散", + "D": "桂枝汤", + "E": "补中益气汤" + }, + "answer": "C", + "reason": "患者肺气亏虚,肌表疏松,表卫不固而汗出恶风,且易于感冒;动则耗气,气不摄汗,故汗出益甚;气虚则体倦乏力，面色少华。结合舌脉分析，本病属于肺卫不固之汗证,故采用益气固表的玉屏风散,故选C。" + }, + { + "question_num": 406, + "query": "14岁初中二年级女学生，患Graves病。治疗宜选用", + "options": { + "A": "抗甲状腺药物", + "B": "立即手术治疗", + "C": "¹³¹I治疗", + "D": "镇静剂", + "E": "鼓励多食海带" + }, + "answer": "A", + "reason": "Grayes病主要治疗方法为抗甲状腺药物治疗、手术治疗和放射性核素工治疗三种:此例是.14岁的女学生,甲亢初治，首选治疗是选用抗甲状腺药物。年龄25岁以下为放射性碘治疗的禁忌证。海带含有大量碘，大剂虽碘可抑制甲状腺激素的合成、减少甲状腺充血,因而可迅速减轻甲状腺功能亢进症状,使甲状腺缩小、变硬。但这个作用是暂时的.3~4周后碘的这种作用渐渐消失,症状再现,称为碘作用“逸脱”,更主要是逸脱后甲状腺中浓聚的大量碘和以后继续服食的海带中碘作为合成甲状腺激素的原料,影响抗甲状腺药物的治疗作用。此期间如果发生甲状腺危象,用碘即已无效,故Gravcs病应忌食含食物和药物。" + }, + { + "question_num": 407, + "query": "患儿,女,10岁。阵发性右上腹绞痛。伴恶心呕吐，腹部平软。用特定穴治疗，应首选", + "options": { + "A": "原穴", + "B": "络穴", + "C": "背俞穴", + "D": "八会穴", + "E": "下合穴" + }, + "answer": "E", + "reason": "下合穴的主治功能是治疗六病证。此患者所患疾病应与腑病相关,故应选用下合穴。" + }, + { + "question_num": 408, + "query": "患者,女,35岁,已婚。患崩漏1年余。经血非时而至,经量甚多、色淡、质稀，面色苍白,气短懒言,大便不成形,舌淡苔薄白，脉沉弱,其证候是", + "options": { + "A": "肾阴虚", + "B": "肾阳虚", + "C": "脾虚", + "D": "血瘀", + "E": "以上均非" + }, + "answer": "C", + "reason": "由题干经母甚多、色淡、质稀,而色苍白,气短懒言,大便不成形,舌淡苔薄白,脉沉弱,辨证为脾气虚证。因为脾虚中气虚弱或下陷，则冲任不固,血失统摄而发崩漏。气虚火不足，故经血色淡质稀,面色苍白,气短懒言，大便不成形,舌淡苔白,脉沉弱,皆为脾气虚之证。" + }, + { + "question_num": 409, + "query": "患者,男,43.岁。患乙型肝炎半年余症见两胁胀满,口苦,食欲不振,有时欲呕,咽喉发干,舌苔薄白,脉弦。宜选何方治疗", + "options": { + "A": "大柴胡汤", + "B": "四逆散", + "C": "柴胡疏肝散", + "D": "小柴胡汤", + "E": "逍遥散" + }, + "answer": "D", + "reason": "小柴胡汤的主治有七大症,是寒热往来,胸胁苦满,心烦喜呕,默默不欲饮食,口苦,咽干,目眩。仔细对照，本例患者表现极其相似。而备选答案的大柴胡汤应该具备承气汤的阳明证,柴胡疏肝散以气滞为主，而逍遥散应该有血虚之症，都不合适" + }, + { + "question_num": 410, + "query": "患者,男，68岁。高血压病病史20年，近日突然意识丧失，深度昏迷，出现三偏征,伴有高热与呕血。应首先考虑的是", + "options": { + "A": "内囊一基底节出血(外侧型)", + "B": "内囊一基底节出血(内侧型)", + "C": "桥脑出血", + "D": "小脑出血", + "E": "蛛网膜下腔出血" + }, + "answer": "B", + "reason": "三偏征(偏瘫、自、偏身感觉障碍)最常见于高血压病引起的内一括底节出血，C项表现为交叉性麻痹和感觉障碍、眼球运动降碍，D项为眩晕、眼球展频、共济失调,E项可有脑刺激征,故选B。内亵外侧型出血多由豆纹动脉外侧枝破裂引起。血肿向内压迫内爽导致典型的对侧偏瘫和偏身感觉障碍,如为优势半球可有失语,如扩至额、叶或破人脑室可致颅高压、昏迷。内爽内侧型出血典烈症状以偏身做觉障侍正病，可卡1人2总头距:他文脑室或蔓延至中脑，引起垂直注视麻疭、孔改变、昏迷,预后比壳核出血差��" + }, + { + "question_num": 411, + "query": "患者锁骨上窝中疼痛。在肺俞穴处出现结节压痛,其病变部位在", + "options": { + "A": "手太阳经", + "B": "手阳明经", + "C": "手太阴经", + "D": "手厥阴经", + "E": "手少阴经" + }, + "answer": "C", + "reason": "肺俞为肺的背俞穴，俞”穴是脏腑之气输注于背部的腧穴。俞为阳,均分布在背部的膀胱经内,为阴病行阳的重要位置,每一脏腑均有各自所属的俞穴。俞穴与各自所居脏腑有密切关系。在临床止每一脏、腑发生病变时,常在所属的俞穴出现疼痛、过敏或结节、条索状物等异常表现。患者在肺俞穴处出现结节压痛，且锁骨上窝中疼痛，而锁骨上宽即缺盆部病证由肺经所主,故其病变部位在手太阴经。" + }, + { + "question_num": 412, + "query": "患者,女,36岁,已婚。两次月经中间,阴道少量出血,色鲜红,头晕腰酸。夜寐不宁,五心烦热。舌质红,苔薄,脉细数,其治法是", + "options": { + "A": "益气补肾,固冲止血", + "B": "滋肾养阴,固冲止血", + "C": "养阴清热，固冲止血", + "D": "补肾养肝,固冲止血", + "E": "益气养阴,凉血清热" + }, + "answer": "B", + "reason": "由题干两次月经中间,阴道少量出血判断为经间期出血，由色鲜红，头晕腰酸,夜不宁:五心烦热,舌质红,苔薄,脉细数辨证为肾阴虚证。治法滋肾养阴,固冲止血。" + }, + { + "question_num": 413, + "query": "患儿,男,8岁。面腮肿胀2天,伴发热,咽喉及颈部疼痛,有类似疾病接触传染史，舌燥口渴，舌红苔白兼黄,脉浮数有力。宜用方剂", + "options": { + "A": "普济消毒饮", + "B": "养阴清肺汤", + "C": "银翘散", + "D": "黄连解毒汤", + "E": "仙方活命饮" + }, + "answer": "A", + "reason": "普济消毒饮主治痄腮,即腮腺炎局部肿胀疼痛,红肿不明显,由于是疫病,故有接触传染史，其他方剂不是主治该证的。" + }, + { + "question_num": 414, + "query": "患者饱餐后上腹部持续疼痛1天。查体:上腹部压痛、反跳痛。应首先考虑的是", + "options": { + "A": "急性胃炎", + "B": "急性胰腺炎", + "C": "急性肝炎", + "D": "右肾结石", + "E": "肝癌" + }, + "answer": "B", + "reason": "总性肤腺炎腹痛为饨痛、割样痛、钻痛或纹痛,向腰背部星带状放射,水肿型3~5天即缓解,出血坏死型发展较快可引起全腹痛。" + }, + { + "question_num": 415, + "query": "患者,男,22岁。发热恶寒,寒重热轻。头痛身痛,鼻塞流涕。咳嗽,咯痰清稀。舌苔薄白,脉浮紧。治疗应首选", + "options": { + "A": "手太阴、手阳明、足太阳经穴", + "B": "手少阴、手太阳、手太阴经穴", + "C": "手太阴、足太阳、手少阳经穴", + "D": "手太阴、手少阳、足少阳经穴", + "E": "手阳明、足阳明、手太阴经穴" + }, + "answer": "A", + "reason": "由本患者的症状可知本病为感冒之风寒感冒,所以应首选手太阴肺经疏风散寒:手阳明大肠经与肺经相表里，所以其经穴能协助肺经经穴疏风散赛;外感风寒首先犯太阳而伤肺卫,故选足太阳膀胱经的腧穴以解表宣肺。" + }, + { + "question_num": 416, + "query": "患者,女,25岁,已婚。月经周期先后不定,量多如注。持续十余日不净，婚后半年，未避孕未孕。可诊断为", + "options": { + "A": "月经先后无定期", + "B": "崩漏", + "C": "月经过多", + "D": "经期延长", + "E": "不孕症" + }, + "answer": "B", + "reason": "月经先后无定期只有周期不定，但是不涉及经量的变化,故A项错误。月经过多是经量增多,经期延长是经期的延长,两者都不涉及周期的变化,故CD两项错误。婚后1年未避孕而未孕者称为不孕症,故E项错误。崩漏是指经期、周期、经是均发生异常改变的病变,故选B。" + }, + { + "question_num": 417, + "query": "患者,女,50岁。发热盗汗,面赤心烦,口干唇燥,便结溲黄,舌红,脉细数。治疗应首选", + "options": { + "A": "大补阴丸", + "B": "六味地黄丸", + "C": "当归六黄汤", + "D": "清骨散", + "E": "牡蛎散" + }, + "answer": "C", + "reason": "当归六黄汤滋阴泻火,固表止汗用于阴虚火旺盗汗，主症见发热盗汗,面赤心烦，口干唇燥,大便干结,小便黄赤,舌红苔黄,脉数。" + }, + { + "question_num": 418, + "query": "患者食欲和记忆力减退。检查:眼睑苍白。血红细胞、白细胞和血小板均减少。应首先考虑的是", + "options": { + "A": "再生障碍性贫血", + "B": "缺铁性贫血", + "C": "溶血性贫血", + "D": "失血性贫血", + "E": "巨幼红细胞性贫血" + }, + "answer": "A", + "reason": "再生障碍性贫血红细胞、白细胞和血小板均减少。缺铁性贫血为小细胞低色素性贫血:MCV<80FI,MCHC<32%，溶血性贫血红细胞计数下降、血清间接胆红素增多。失血性贫血由于血管收缩,红细胞计数、血红蛋白和血细胞比容反见增商但在几小时内、组织液进人血循环而使血液，红细胞计数和血红蛋白的降低与出血的严重程度一致。巨幼红细胞性贫血重者全血细胞减少，红细胞大小不等中性粒细胞分叶过多。" + }, + { + "question_num": 419, + "query": "老年患者,症见排尿无力,甚则点滴不出,小腹胀满,精神不振,面色白,少气懒言,舌淡脉细缓。治疗宜采用", + "options": { + "A": "毫针深刺", + "B": "温灸疗法", + "C": "放血疗法", + "D": "电针疗法", + "E": "叩刺疗法" + }, + "answer": "B", + "reason": "本患者年老体虚,其证为阳气亏虚,膀胱气化不利所致,治应益气温阳,宜采用温灸疗法,该疗法具有温通经脉，回阳救逆及防病保健等功效,阳虚体弱者尤为适宜。亳针深刺、放血疗法、电针疗法及叩刺疗法等治疗方法刺激性较强，多适用于身强体壮及实证患者。" + }, + { + "question_num": 420, + "query": "患者阴部瘙痒较甚,外阴红肿灼痛白带量多,色黄,质稠,秽臭,胸胁胀痛,心烦易怒,口苦口腻,目赤肿痛,耳聋耳鸣,小便短赤舌质红,苔黄腻,脉弦数,其首选方是", + "options": { + "A": "完带汤", + "B": "龙胆泻肝汤", + "C": "五味消毒饮", + "D": "草游渗湿汤", + "E": "知柏地黄汤" + }, + "answer": "B", + "reason": "阴痒的辨证论治。BCDE项均可治疗阴痒,但根据兼证带下量多、黄稠,有臭气,胸胁胀痛,心烦易怒,口苦口腻,目赤肿痛,耳聋耳鸣,舌苔黄腻,脉弦数,为肝经湿热表现,故选B。" + }, + { + "question_num": 421, + "query": "患者症见烦热干渴，头痛牙痛，齿龈出血,舌红苔黄而干,或消渴善饥，属少阴不足，阳明有余。治宜选用", + "options": { + "A": "琼玉膏", + "B": "玉女煎", + "C": "玉液汤", + "D": "增液汤", + "E": "清胃散" + }, + "answer": "B", + "reason": "患者属胃热阴虚,有虚火上炎之征象,玉女煎消胃滋阴更适合" + }, + { + "question_num": 422, + "query": "患者,男,50岁。乙肝病史6年,呕血1天。检査:腹壁静脉曲张。肝肋下未触及，脾肋下3cm,腹水征(+)，HBsAg(+),白蛋白降低,A/G<1,谷丙转氨酶升髙,其诊断为", + "options": { + "A": "慢性肝炎", + "B": "肝硬化合并上消化道出血", + "C": "消化性溃疡合并上消化道出血", + "D": "白血病", + "E": "原发性肝瘤" + }, + "answer": "B", + "reason": "肝硬化诊断依据:①病毒性肝炎、长期伙酒病史;②肝功能减退和门静脉高压症的临床表现;③肝脏质地坚硬有结节感:④肝功能实验阳性:⑤肝活检有假小叶形成并发症，上消化道出血、肝性脑病、感染、肝肾综合征、原发性肝脑、电解质和酸破平衡紊乱等。" + }, + { + "question_num": 423, + "query": "患者,男,28岁。1天前因饮食不洁出现腹痛腹泻。下痢赤白，里急后重，肛门灼热,心烦口渴。小便短赤,舌苔黄腻,脉滑数。治疗除选取主穴外，应加用的腧穴是", + "options": { + "A": "中脘、上脘", + "B": "中脘、内关", + "C": "曲池、内庭", + "D": "脾俞、下脘", + "E": "行间、足三里" + }, + "answer": "C", + "reason": "由本患者的症状可知本病为痢疾之湿热痢,应选用曲池和内庭，两穴均可清热利湿，去除病因，以达治疗痢疾的作用" + }, + { + "question_num": 424, + "query": "患者,女,28岁。产后乳房胀痛,位于乳房外上方皮肤掀红，肿块形似鸡卵，压痛明显,按之中软,有波动感,伴壮热口渴。切开引流的部位及切口是", + "options": { + "A": "循乳络方向做放射状切口", + "B": "乳晕旁弧形切口", + "C": "脓肿处作任意切口", + "D": "以乳头为中心的弧形切口", + "E": "脓肿波动明显处作切口" + }, + "answer": "A", + "reason": "一般采用与乳头方向呈放射状的切口,切口位置选择脓肿稍低的部位,切口长度与脓腔基底的大小一致,使引流通畅不致袋脓,但需避免手术损伤乳络形成乳痰。因为乳腺每一腺叶有单独的腺管(乳管)呈放射状聚向乳头，并分别开口于乳头，故选A。" + }, + { + "question_num": 425, + "query": "患者项背强直,头痛,恶寒发热;肢体酸重。舌苔白腻,脉浮紧,其治法是", + "options": { + "A": "疏散风寒,调和气血", + "B": "散寒祛风,解肌发汗", + "C": "祛风散寒,和营燥湿", + "D": "辛温解表,散寒止痛", + "E": "疏风散寒,化痰通络" + }, + "answer": "C", + "reason": "风寒束表,故头痛,恶寒发热;湿阻经络,故肢体酸重;舌苔白腻,脉浮紧,为寒湿在表之象。营卫不和,风寒束表,治宜祛风散寒,和营湿,故选C,其余未提到湿的治疗。" + }, + { + "question_num": 426, + "query": "患者，男，58岁。腰痛，腰部活动受限。检查;脊柱叩击痛,坐骨神经刺激征(+)。应首先考虑的是", + "options": { + "A": "腰肌劳损", + "B": "脑膜炎", + "C": "蛛网膜下腔出血", + "D": "腰椎间盘突出", + "E": "肾下垂" + }, + "answer": "D", + "reason": "腰肌劳损腰部有压痛。脑炎、网膜下腔出血有脑脱刺激征。腰椎问盘突出可以有腰痛,腰部活动受限。检查:并柱叩击痛，坐骨神经激征(十)。肾下垂腰部酸痛占92%." + }, + { + "question_num": 427, + "query": "患者,男,20岁。昨日起大便泄泻,发病势急，一日5次，小便减少。治疗应首选", + "options": { + "A": "上巨虚、太溪、肾俞、命门", + "B": "足三里、公孙、脾俞、太白", + "C": "关元、天枢、足三里、冲阳", + "D": "天枢、上巨虚、阴陵泉、水分", + "E": "内庭、上巨虚、神阙、中脘" + }, + "answer": "D", + "reason": "由本患者的症状可知本病为急性泄泻,治疗应该除湿导滞、疏调肠胃,应首选天枢、阴陵泉、上巨虚、水分等穴。天枢为大肠的穴,调理胃肠传导功能;阴陵泉为脾经的合穴，疏调脾气，健脾利湿;上巨虚为大肠的下合穴,通调胃肠气机,运化湿滞;水分可以调节水电解质亲乱:" + }, + { + "question_num": 428, + "query": "患者,女,40岁。月经规律,平时带下量多、色黄白、有臭气,纳呆。大便黏腻不爽，舌苔黄腻,脉濡数，其证候是", + "options": { + "A": "脾虚", + "B": "肾阳虚", + "C": "肾阴虚", + "D": "湿热", + "E": "热毒" + }, + "answer": "D", + "reason": "由题干带下量多、色黄白、有臭气,纳呆,大便黏腻不爽,舌苔黄腻,脉数,诊断为带下过多湿热下注证。" + }, + { + "question_num": 429, + "query": "患者,男,40岁。咳嗽气促,咯痰量多,痰质黏稠而黄,咯吐不爽,胸胁胀满,面赤身热。口干，舌红苔黄腻，脉滑数。治疗应首选", + "options": { + "A": "止嗽散", + "B": "桑菊饮", + "C": "二陈汤", + "D": "清金化痰汤", + "E": "加减泻白散" + }, + "answer": "D", + "reason": "痰热壅阻肺气,肺失清肃,故见咳嗽气促,咯痰量多,痰质黏稠而黄,咯吐不爽,胸胁胀满,面赤身热,口干,舌红苔黄腻,脉滑数,俱是痰热郁肺的表现,治宜清热化痰,肃肺止咳,故选D。止嗽散用于风寒袭肺。桑菊饮用于风热犯肺。二陈汤用于痰湿蕴肺。加减泻白散用于肝灭犯肺。" + }, + { + "question_num": 430, + "query": "患者,男,70岁。今日胸痛发作频繁.2小时前胸痛再次发作,含化硝酸甘油不能缓解。检查:血压90/60mmHg,心律不齐。心电图Ⅱ、Ⅲ、aVF导联ST段抬高呈弓背向上的单向曲线。应首先考虑的是", + "options": { + "A": "心绞痛", + "B": "急性心包炎", + "C": "急性前间壁心肌梗死", + "D": "急性下壁心肌梗死", + "E": "急性广泛前壁心肌梗死" + }, + "answer": "D", + "reason": "总性期心梗数小时后,心电图0、Ⅲ、aVF导联ST段抬高,弓背向上，与直立的T波连接,形成单向曲线,在临床意义上,可诊断为总性下心肌梗死。" + }, + { + "question_num": 431, + "query": "患者产后乳少，或见乳房胀满疼痛或见乳房柔软无胀感，针灸治疗应选用", + "options": { + "A": "乳根、太冲、期门", + "B": "乳根、膻中、少泽", + "C": "肝俞、太冲、期门", + "D": "乳根、脾俞、足三里", + "E": "中脘、天枢、期门" + }, + "answer": "B", + "reason": "该患者诊断为缺乳。乳根疏通阳明经气而催乳;胆中为气会,调气通络而催乳;少泽为通乳之经验穴。三穴合用,共达催乳、通乳之功。" + }, + { + "question_num": 432, + "query": "患者,女,30岁,已婚。孕50天。呕吐酸水或苦水。胸满胁痛，暖气叹息,烦渴口苦。舌淡红,苔微黄,脉滑数。治疗应首选", + "options": { + "A": "小半夏加茯苓汤", + "B": "香砂六君子汤", + "C": "四君子汤", + "D": "苏叶黄连汤", + "E": "橘皮竹茹汤" + }, + "answer": "E", + "reason": "由题干孕50天,呕吐酸水或苦水胸满胁痛,吸气叹息,烦渴口苦,舌淡红,苔微黄,脉滑数,诊断为妊娠恶阻肝胃不和证，代表方剂是橘皮竹茹汤。" + }, + { + "question_num": 433, + "query": "患者跌打损伤后,瘀血留于胁下，痛不可忍。治疗应选用", + "options": { + "A": "血府逐瘀汤", + "B": "温经汤", + "C": "生化汤", + "D": "复元活血汤", + "E": "大黄鏖虫丸" + }, + "answer": "D", + "reason": "复元活血汤活血祛瘀、疏肝通络用于跌打损伤、瘀血阻滞之证。有特征性的主症胁肋瘀肿,痛不可忍。" + }, + { + "question_num": 434, + "query": "患者因腹胀、全身疼痛就诊。检查:脾肋缘下6cm,血液白细胞计数160x10^9/L。可见各阶段少量幼稚粒细胞。应首先考虑的是", + "options": { + "A": "脾功能亢进", + "B": "门脉性肝硬化", + "C": "急性粒细胞白血病", + "D": "慢性粒细胞白血病", + "E": "急性淋巴细胞白血病" + }, + "answer": "D", + "reason": "全身疼痛、查体脾肋缘下6cm，血液白细胞计数显著增加，见各阶段幼稚粒细胞而非幼稚淋巴细胞,排除E。脾大多见于功能亢进、急性淋国家执业医师资格考试中医执业医师巴细胞白血症及慢性粒细胞白血病。A项脾功能亢进可见三系均减少。B项门脉性肝硬化可有脾功能亢进的表现。C项血中亦可见幼稚粒细胞，但不是各阶段均能见到,且脾大少见。" + }, + { + "question_num": 435, + "query": "患者,男,50岁。肩周疼痛,以肩后部为重，疼痛拒按，除肩部穴外，还应选取的是", + "options": { + "A": "手太阳小肠经穴", + "B": "手阳明大肠经穴传仍心", + "C": "手三阳三焦经决", + "D": "足少阳胆经穴", + "E": "足太阳膀胱经穴" + }, + "answer": "A", + "reason": "该患者诊断为漏肩风,疼痛以肩后部为主者为手太阳经证，应取手太阳小肠经穴。疼痛以肩前外部为主者为手阳明经证,以肩外侧为主者为手少阳经证,以肩前部为主者为手太阴经证。" + }, + { + "question_num": 436, + "query": "患者,女,30岁,已婚。产后恶露4周不止,淋漓滞涩,量时多时少,色紫暗有块,腹痛拒按,块下痛减。舌紫暗,边尖有瘀斑瘀点，脉沉弦涩，其治法是", + "options": { + "A": "补气摄血固冲", + "B": "补气活血止血", + "C": "活血化瘀止血", + "D": "养阴清热止血", + "E": "破血逐瘀行气" + }, + "answer": "C", + "reason": "产后恶露不绝血瘀型的治法。产后4周恶露不止,属产后恶露不绝;根据恶露量、色、质及伴随症状、舌脉,属血瘀证,治以活血化瘀止血。" + }, + { + "question_num": 437, + "query": "患者,女,36岁。症见倦怠乏力,食少便溏,四肢不温,月经量多，上臂和大腿皮下有瘀斑,心悸心慌。舌淡苔薄白，脉沉迟。治宜选用", + "options": { + "A": "归脾汤", + "B": "参苓白术散", + "C": "理中汤", + "D": "当归四逆汤", + "E": "胶艾四物汤" + }, + "answer": "A", + "reason": "归脾汤的病机是思虑伤脾,导致血虚，血不养心，故而心悸心慌。脾虚不能统血，故出现月经量多。该例患者特征明显,故而容易判断，" + }, + { + "question_num": 438, + "query": "患者,女，25岁。婚后1周，高热，尿频、尿急、尿痛,尿中白细胞40个/高倍视野,可见白细胞管型,其诊断是", + "options": { + "A": "急性肾炎", + "B": "慢性肾炎急性发作", + "C": "急性肾盂肾炎", + "D": "慢性肾盂肾炎", + "E": "膀胱炎" + }, + "answer": "C", + "reason": "新婚妇女若不注意外阴卫生,尿道附近的细菌很容易进人尿道和膀胱,甚至随尿波返流人肾盂,引起上尿路感染,临床表现为发热、尿路刺激征,尿中白细胞增多或白细胞管型。膀胱炎很少出现白细胞管型,故排除E。" + }, + { + "question_num": 439, + "query": "患者,女,68岁。突发右侧肢体活动不利,言语不清,口角流涎,伸舌右偏、口角喝斜，血压180/100mmHg,腹胀，便秘3天未行脉弦，舌暗红苔黄腻。应在主穴的基础上加用", + "options": { + "A": "太溪、风池", + "B": "丰隆、合谷", + "C": "气海、血海", + "D": "曲池、内庭、丰隆", + "E": "太冲、太溪" + }, + "answer": "D", + "reason": "根据患者突发右侧肢体活动不利言语不清,口角流涎,伸舌右偏,口角喝斜的症状可判断为中风中经络，患者同时兼有便秘,脉弦，舌暗红苔黄腻等征象,可辨证为痰热腑实。中风中经络主穴:水沟、内关、三阴交、极泉、尺泽、委中。配穴:肝阳暴亢配太冲、太溪;风痰阻络配丰隆、合谷;痰热腑实配曲池,配太涩、风池" + }, + { + "question_num": 440, + "query": "患者,女,48岁。带下量多,黄绿如脓,质黏腻,臭秽难闻,小腹疼痛,腰骶酸痛,烦热头晕，口苦咽干，小便短赤，大便干结,舌红苔黄腻,脉滑数,其证型是", + "options": { + "A": "脾虚证", + "B": "肾阴虚证", + "C": "湿热下注证", + "D": "热毒蕴结证", + "E": "阴虚夹湿证" + }, + "answer": "D", + "reason": "由题干带下量多,黄绿如脓,诊断为带下病。由质��腻,臭秽难闻,小腹疼痛,腰骶酸痛,烦热头晕，口苦咽干,小便短赤,大便干结,舌红苔黄腻,脉滑数,辨证为热毒殖结证。" + }, + { + "question_num": 441, + "query": "患者,男,32岁。3日来头痛如裹,痛无休止,肢体困重,苔白腻,脉。针刺治疗的配穴为", + "options": { + "A": "风门、列缺", + "B": "曲池、大椎", + "C": "丰隆、中脘", + "D": "阴陵泉、头维", + "E": "足临泣、太冲" + }, + "answer": "D", + "reason": "患者头痛如裹,痛无休止,肢体困重,苔白腻,脉,为风湿头痛,应配阴陵泉、头维。头痛的主穴:太阳、百会、风池、阿是穴、合谷(太阳会风池谷)。配穴:太阳头痛--天柱、后溪、昆仑;阳明头痛--印堂、内庭;少阳头痛--率谷、外关、足临泣厥阴头痛--太冲、内关;风寒头痛--风门、列缺;风热头痛--曲池、大椎;风湿头痛--头维、阴陵泉;肝阳上亢--太冲、太溪;痰浊头痛--丰隆、中脘;瘀血头痛--血海、膈俞;血虚头痛--脾俞、足三里" + }, + { + "question_num": 442, + "query": "伤寒患者在病程第2~3周体温逐渐下降,尚未达到正常温度,体温又再次升高，持续5~7天后才正常，血培养阳性，其诊断是", + "options": { + "A": "伤寒复发", + "B": "伤寒再燃", + "C": "并发肠出血", + "D": "并发肠穿孔", + "E": "中毒性肝炎" + }, + "answer": "B", + "reason": "伤寒再燃,是指部分患者在进人恢复期前,体温尚未下降至正常时又重新升高,5~7天后才正常，血培养阳性，" + }, + { + "question_num": 443, + "query": "治疗胃痛拒按,食后痛甚,舌质紫暗有瘀斑,脉细涩者,针灸取穴是", + "options": { + "A": "足三里,内关、中脘、胃俞、三阴交", + "B": "足三里、内关、中脘、下脘、三阴交", + "C": "足三里、内关、中脘、太冲、三阴交", + "D": "足三里、内关、中脘、膈俞、三阴交", + "E": "足三里、内关、中脘、内庭、三阴交" + }, + "answer": "D", + "reason": "胃痛的主穴:中脘、足三里、内关;瘀血停胃配加膈俞、三阴交。" + }, + { + "question_num": 444, + "query": "患儿,3岁,体重14kg,身长86cm。该患儿的生长发育状况为", + "options": { + "A": "体重正常,身长偏高", + "B": "体重正常,身长偏低", + "C": "体重偏高,身长正常", + "D": "体重偏高,身长偏低", + "E": "体重偏低,身长正常" + }, + "answer": "B", + "reason": "临床可用以下公式推算小儿体重:1岁以上体重(kg)=8+2x年龄。2岁后至12岁儿童的身高(身长):身高(cm)=70+7x年龄,将患儿的年龄代人计算，其理想体重应该为14kg,理想身长为91cm,对比后可知体重正常，身长偏低，" + }, + { + "question_num": 445, + "query": "患者,女,36岁,已婚。面色萎黄,神疲乏力,气短懒言,食少便溏,月经淋漓不断,经血色涨，舌然无药，脉沉细无力，其病机是", + "options": { + "A": "脾不统血", + "B": "脾肾阳虚", + "C": "气血两虚", + "D": "脾肺气虚", + "E": "肝血不足" + }, + "answer": "A", + "reason": "脾不统血证主要表现为面色萎黄或苍白无华,神疲乏力,气短懒言,或食少便溏,并见出血,或便血,或衄血,肌衄,鼻衄,或妇女月经过多、崩漏,舌淡,脉细无力等。该病例符合此证的临床表现故选A。" + }, + { + "question_num": 446, + "query": "患者,女,26岁。被人发现时躺在公园一角落呈半昏迷状态。查体:神志不清，两瞳孔针尖样大小,口角流涎,口唇发绀,两肺满布水泡音,心率60次/分。肌肉有震颤。应首先考虑的是", + "options": { + "A": "癫痫大发作", + "B": "严重心律失常", + "C": "左心功能衰竭", + "D": "有机磷农药中毒", + "E": "安眠药中毒" + }, + "answer": "D", + "reason": "有机磷农药中毒,抑制了胆碱酯酶的活性,造成组织中乙酰胆碱的积聚,使有胆碱能受体的器官功能发生障碍,表现为毒样症状,即由脏器平滑肌、腺体、汗腺等M受体兴奋而引起的症状，如多汗、流涎、视力模糊、瞳孔缩小;烟碱样症状,即由交感神经节和横纹肌活动异常所引起的症状，如骨骼肌兴奋出现肌纤维震额。结合本病例为年轻女患者被发现躺在公园角落,考虑为寻短见自服农药导致,故选D，其余选项不会同时出现毒草样症状及肌纤维震额" + }, + { + "question_num": 447, + "query": "患者,女,59岁。两膝关节红肿热痛尤以右膝部为重,痛不可触,关节活动不利,并见身热，口渴，舌苔黄燥,脉滑数。治疗除选用犊鼻、梁丘、阳陵泉、膝阳关外,还应加", + "options": { + "A": "大椎、曲池", + "B": "肾俞、关元", + "C": "脾俞、气海", + "D": "脾俞、胃俞", + "E": "肾俞、合谷" + }, + "answer": "A", + "reason": "从患者的症状可辨证为热痹，治疗除局部、循经取穴外，应加疏风清热消肿的穴位。大椎、曲池有疏风清热消肿之功效，" + }, + { + "question_num": 448, + "query": "患儿，出生3天。体短形瘦，头大囟张,头发稀黄,耳壳软,哭声低微,肌肤不温,指甲软短,骨弱肢柔,指纹淡,其治法是", + "options": { + "A": "益精充髓,补肾温阳", + "B": "健脾益肾,温运脾阳", + "C": "温经散寒,活血通络", + "D": "益气温阳,通经活血", + "E": "大补元气,温阳固脱" + }, + "answer": "A", + "reason": "该患儿为胎怯肾精薄弱证。治法:益精充髓,补肾温阳。代表方:补肾地黄丸。" + }, + { + "question_num": 449, + "query": "患者,男,32岁。临房事早泄,随之疲软,兼有食欲不振。针灸治疗除关元、三阴交、肾俞外,还应选用的配穴是", + "options": { + "A": "命门、太溪", + "B": "心俞、脾俞、足三里", + "C": "中脘、足三里", + "D": "命门、阳陵泉", + "E": "神门、心俞" + }, + "answer": "C", + "reason": "患者临房时早泄,随之疲软,诊为阳痿。主穴:关元、三阴交、肾俞。配穴:肾阳不足配命门、太溪;惊恐伤肾配志室、胆俞;心脾两虚配心俞、脾俞、足三里;湿热下注配曲骨、阴陵泉;肝郁气滞配太冲、内关;失眠多梦配神门、心俞;食欲不振配中脘、足三里;腰膝酸软配命门、阳陵泉。" + }, + { + "question_num": 450, + "query": "患者,女,18岁。2周前患扁桃体炎,近日心悸，气短，发热，出汗。踝、膝关节游走性疼痛。查体:心率110次/分。第1心音减弱。上肢内侧皮肤有环形红斑。应首先考虑的是", + "options": { + "A": "病毒性心肌炎", + "B": "类风湿性关节炎", + "C": "风湿热", + "D": "亚急性感染性心内膜炎", + "E": "系统性红斑狼疮" + }, + "answer": "C", + "reason": "小儿风湿热的临床表现:皮肤环形红斑,多见于躯干及四肢屈侧,虽环形或半环形,边缘稍隆起，呈淡红色,环内皮肤颜色正常。此种红斑常于摩擦后表现明显，1天之内可时隐时现，消退后不遗留脱屑及色素沉者。" + }, + { + "question_num": 451, + "query": "患者,女,32岁。行经后小腹部绵绵作痛，喜按，月经色淡，量少。治疗应首选", + "options": { + "A": "三阴交、中极、次髎", + "B": "足三里、太冲、中极", + "C": "丰隆、天枢、气穴", + "D": "阴陵泉、中极、阳陵泉", + "E": "三阴交、足三里、气海" + }, + "answer": "E", + "reason": "由本患者的症状可知本病为痛经之虚证。应选用三阴交、足三里、气海调补气血、温养冲任。" + }, + { + "question_num": 452, + "query": "患儿,7岁。发热1天。恶寒,无汗头痛,鼻塞流清涕,喷咳嗽,口不渴,咽不红,舌苔薄白,脉浮紧,其证候是", + "options": { + "A": "风寒感冒", + "B": "风热感冒", + "C": "暑邪感冒", + "D": "感冒挟滞", + "E": "感冒挟痰" + }, + "answer": "A", + "reason": "风寒感冒证的症状为恶寒，无汗头痛,鼻塞流清涕,喷咳嗽,口不渴,咽不红,舌苔薄白,脉浮紧,故选A。风热感冒以“发热重,有汗或少汗,咽红肿痛,舌红,苔薄黄或指纹浮紫”为特征;暑邪感冒发于夏季,以“发热,头痛,身重困倦,食欲不振,舌红,苔黄腻”为特征;感冒挟痰以“咳嗽加剧,痰多,喉间痰鸣”为特征;感冒挟滞以“脘腹胀满,不思饮食,大便不调,小便短黄,舌苔厚腻,脉滑”为特征。" + }, + { + "question_num": 453, + "query": "患者,男,34岁。患“神经性头痛”已3年,每月发作2~3次,每次头痛延续1~2天,头胀痛欲裂、耳鸣、目赤、口苦、烦躁易怒,溲赤便干，舌边红，苔薄黄，脉弦数。临床诊断是", + "options": { + "A": "肝经风热证", + "B": "肝火上炎证", + "C": "肝阳上亢证", + "D": "肝阴虚证", + "E": "肝胆湿热证" + }, + "answer": "B", + "reason": "头胀痛欲裂,耳鸣,烦躁易怒，口苦,脉弦,说明病位在肝。目赤,溲赤便干,舌边红，苔薄黄,脉弦数说明病性为热,故为肝火上炎证。" + }, + { + "question_num": 454, + "query": "患者,女,22岁。急性病毒性心肌炎住院2周，24小时动态心电图监测结果为夜间出现间歇性二度房室传导阻滞，呈文氏现象，心率为51次/分。此时应首选的处理是", + "options": { + "A": "人工心脏起搏", + "B": "异丙肾上腺素静脉滴注", + "C": "激素治疗", + "D": "维持原治疗", + "E": "干扰素治疗" + }, + "answer": "D", + "reason": "文氏现象为二度工型房室传导阻滞。二度1型房室传导阻滞心室率不太慢者,无须接受治疗。" + }, + { + "question_num": 455, + "query": "患者,男,70岁。患“哮喘”病30余年,冬季为重平素身倦乏力,气息短促,动则汗出,舌质淡,脉细无力。某医师欲用灸法施治，可采用", + "options": { + "A": "大椎、风门、肺俞、膻中,秋季治疗", + "B": "大椎、风门、肺俞,夏季治疗", + "C": "肺俞、太渊、尺泽、合谷,秋季治疗", + "D": "肺俞、太渊、尺泽、合谷,夏季治疗", + "E": "肺俞、气海、肾俞、足三里、太渊,夏季治疗" + }, + "answer": "E", + "reason": "哮喘的辨证、处方。从本患者的症状可辨证为肺肾气虚,治疗应补益肺肾,E项中肺俞、太渊、肾俞可补益肺肾,其他穴位也能补益气血。采用灸法宜冬病夏治,故应夏季治疗。" + }, + { + "question_num": 456, + "query": "患儿流涕、咳嗽3天后,高热不退,咳嗽喘促,鼻扇。喉中痰声辘辘,口唇紫绀，其证候是", + "options": { + "A": "风寒闭肺", + "B": "风热闭肺", + "C": "痰热闭肺", + "D": "痰热咳嗽", + "E": "心阳虚衰" + }, + "answer": "C", + "reason": "本证多见于肺炎喘的中期,痰热俱甚,郁闭于肺,而见上述诸症。临床以发热、咳、痰壅、气急、鼻为特征。" + }, + { + "question_num": 457, + "query": "患者,男,56岁。因情急恼怒而突发。肢体强痉,舌红苔黄,脉弦,其病机是", + "options": { + "A": "气郁", + "B": "气逆", + "C": "气脱", + "D": "气陷", + "E": "气结" + }, + "answer": "B", + "reason": "气郁,因情志不舒,气机郁结所致,症见胸满胁痛,噫气腹胀,排除A;气逆,指气上逆不顺而出现的病变证候，火热之气逆乱上冲之证；气脱，指机体正气虚怯,元气衰惫,气随血脱,阴阳欲离而出现的危重证候,排除C;气陷,是指在气虚的病变基础上,以气的升消功能不足和无力升举为主要特征的病理状态,排除D;气结,指气留滞不行,排除E;患者生气后,气不往下,反往上走,出现头胀,继而晕厥,为气逆证,故选B。" + }, + { + "question_num": 458, + "query": "患者,男,53岁。1天前因“十二指肠球部溃疡并出血”急诊入院，静脉输注奥美拉唑及输血1000ml后，血压80/50mmHg，还自觉头晕、心慌,2小时排黑便3次。进一步处理的最佳选择措施是", + "options": { + "A": "口服奥美拉唑", + "B": "静脉滴注垂体加压素", + "C": "继续快速输血", + "D": "气囊压迫止血", + "E": "手术治疗" + }, + "answer": "E", + "reason": "患者输血后血压80/50mmHg,自觉头晕、心慌,2小时排黑便3次,提示患者仍继续出血。消化性溃疡并出血经积极内科治疗仍有活动性出血者，应学握时机进行手术治疗。指征:①年龄>50岁并伴动脉硬化、经治疗24小时后出血不止;②严重出血经内科积极治疗后仍出血不止;③近期曾反复多次出血;④合并幽门梗阻、胃穿孔或疑有癌变者。" + }, + { + "question_num": 459, + "query": "患者女，22岁，月经不调，常七天以上,甚至10余日一行。治疗应首选", + "options": { + "A": "足三里、脾俞、太冲", + "B": "命门、三阴交、足三里", + "C": "关元、三阴交、血海", + "D": "气海、三阴交、归来", + "E": "关元、三阴交、肝俞" + }, + "answer": "C", + "reason": "由本患者的症状可知本病为月经先期。应选用清热调经的关元、血海、三阴交。关元为任脉经穴，足三阴经之交会，故为调理冲任之要穴;血海调理血分;三阴交为妇科疾病的要穴。" + }, + { + "question_num": 460, + "query": "患儿,8个月。咳阵作20余日，咳毕有回声,面部潮红，舌向外伸,咳时涕泪俱出,剧则呕吐,每日发作十余次,夜间为甚,目睛微赤,眼睑浮肿,口渴引饮,盗汗,舌质红,苔薄净。治疗应首选", + "options": { + "A": "桑菊饮", + "B": "三拗汤", + "C": "麻杏石甘汤", + "D": "桑白皮汤", + "E": "沙参麦冬汤" + }, + "answer": "E", + "reason": "患儿病程日久,分析证候,属百日咳之恢复期,证屈痰热留肺,久咳未愈,肺阴必损,治以清养肺阴,佐以化痰止咳,方选沙参麦冬汤。" + }, + { + "question_num": 461, + "query": "患者,男,60岁。腹胀大如鼓,按之如爽裹水,有波动感。应首先考虑的是", + "options": { + "A": "水饮", + "B": "痞满", + "C": "积聚", + "D": "水臌", + "E": "内痈" + }, + "answer": "D", + "reason": "脘部痞满,按之较硬而疼痛者属实证,多因实邪聚结胃脘所致;按之活软而无痛者属虚证,多因胃腑虚弱所致;脘部按之有形而胀痛,推之辘辘有声者,为胃中有水饮;按之局部灼热,痛不可忍者，为内痈;按之如裹水,且腹壁凹痕者,为水;以手叩之如鼓,无波动感,按之亦无凹痕者,为气。根据题目,故选D。" + }, + { + "question_num": 462, + "query": "患者,���,20岁。近2周自觉乏力,食欲不振。厌油，腹胀。检查:巩膜无黄染，肝肋缘下2cm,有压痛。谷丙转氨酶升高。应首先考虑的是", + "options": { + "A": "急性肝炎", + "B": "慢性肝炎", + "C": "重型肝炎", + "D": "淤胆型肝炎", + "E": "肝炎肝硬化" + }, + "answer": "A", + "reason": "患者有乏力,食欲不振,厌油的症状说明肝脏出现问题，而体检发现肝脏肿大并且有压痛,谷丙转氨酶升高,而没有消瘦的症状,并且发病较急,考虑急性肝炎。" + }, + { + "question_num": 463, + "query": "患者,男,35岁。因近日工作紧张,休息欠佳,双目肿痛,兼口苦,烦热,便秘,脉弦滑,辨证为", + "options": { + "A": "风热型目赤肿痛", + "B": "肝胆火盛型目赤肿痛", + "C": "肝阳上亢型目赤肿痛", + "D": "胃火上扰型目赤肿痛", + "E": "以上都不是" + }, + "answer": "B", + "reason": "目赤肿痛的辨证。从患者的“双目肿痛,口苦,烦热,脉弦滑”等症状可判断为肝胆火盛型目赤肿痛。" + }, + { + "question_num": 464, + "query": "患儿,2岁。泄泻2天,大便日行十余次,质稀如水,色黄混浊。精神不振，口渴心烦,眼眶凹陷,皮肤干燥,小便短赤,舌红少津苔少,其治法是", + "options": { + "A": "消食化积", + "B": "疏风散寒", + "C": "酸甘敛阴", + "D": "渗湿止泻", + "E": "清热利湿" + }, + "answer": "C", + "reason": "“口渴心烦,眼眶凹陷,皮肤干燥:小便短赤,舌红少津,苔少”表明患儿阴耗伤,此为泄泻之变证。治疗时除止泻外应及时敛阴生津。" + }, + { + "question_num": 465, + "query": "患者,女,55岁。心悸、胸闷、气短,活动后加剧已3年。面色淡白,神疲乏力,语声低微,人夜不能安睡,舌淡苔白,脉弱,其证候是", + "options": { + "A": "心气虚证", + "B": "心阳虚证", + "C": "心血虚证", + "D": "肺气虚证", + "E": "肺阳虚证" + }, + "answer": "A", + "reason": "心悸、胸闷,其病位在心;气短,神疲乏力,语声低微,其病性为气虚,综合为心气虚证。" + }, + { + "question_num": 466, + "query": "患者，女，55岁。体重76kg，身高160cm。因多饮、多尿确诊为2型糖尿病。经饮食治疗和运动锻炼，2个月后空腹血糖为8.8mmol/L,餐后2小时血糖13.0mmol/L。进一步治疗应选择", + "options": { + "A": "加磺酰脲类降血糖药物", + "B": "加双胍类降血糖药物", + "C": "加胰岛素治疗", + "D": "加口服降血糖药和胰岛素", + "E": "维持原饮食治疗和运动" + }, + "answer": "A", + "reason": "此题考查糖尿病的治疗，该女性患者体重76kg,身高160cm。计算体重指数=体重(kg)/身高(m)”,该患者的体重指数是29.7,属超重，对肥胖伴2型糖尿病一般首选双胍类降糖药物,因其能降低过高的血糖,降低体重,不增加胰岛素水平,对血糖在正常范围者无降血糖作用，而磺酰脲类降糖药物对一些肥胖伴2型糖尿病常无效。该患者目前尚无应用胰岛素的指征，而仅维持原饮食治疗和运动不能有效控制血糖,故选B." + }, + { + "question_num": 467, + "query": "患者,男,70岁。家属代诉:患者于今晨起床后半小时,突然昏仆，不省人事，目合口张,遗,手撒,四肢厥冷,脉细弱。治疗用隔盐灸，应首选", + "options": { + "A": "肾俞、太溪", + "B": "关元、神阙", + "C": "脾俞、足三里", + "D": "胃俞、三阴交", + "E": "三焦俞、内关" + }, + "answer": "B", + "reason": "由患者突然昏仆,不省人事,目合口张,遗溺,手撒,四肢厥冷,脉细弱等症状,可判断患者所患病为中风中脏腑,且为脱证，治疗应回阳固脱，用隔盐灸,首选关元、神阙穴。关元为任脉和足三阴经交会穴,可扶助元阳;神阙为生命之根蒂,真气所系,可回阳固脱。" + }, + { + "question_num": 468, + "query": "患儿,2岁。纳差2个月,腹泻1周平素食欲不振,挑食偏食。近日大便日行3~4次,食后作泻。面色萎黄,舌淡苔白,指纹淡红。治疗应首选", + "options": { + "A": "熏洗法", + "B": "擦拭法", + "C": "割治疗法", + "D": "推拿疗法", + "E": "拔罐疗法" + }, + "answer": "D", + "reason": "该病证为厌食证的脾胃虚弱证,推拿疗法最为适宜，而拔罐更适于有外邪导致的泄泻。再洗法和擦拭法多用于局部的体表病证;割治疗法一般用于疳证和哮喘病证;拔罐疗法有祛风、散寒、止痛的作用,多用于小儿肺炎喘嗽、腹痛、哮喘、遗尿等;推拿疗法有促进气血流行、经络通畅、神气安定、脏腑调和的作用,临床中多用于泄泻、惊风、腹痛等证。" + }, + { + "question_num": 469, + "query": "患者,女,30岁。3个月前突发高热热退后出现周身乏力，并见���肢痿软无力，食少纳呆,腹胀便溏,神疲乏力。治疗本病应选用哪组经脉为主", + "options": { + "A": "手足少阳经穴、夹脊穴", + "B": "手足阳明经穴、夹脊穴", + "C": "手足太阳经穴、夹脊穴", + "D": "手足太阴经穴、夹脊穴", + "E": "手足厥阴经穴、夹脊穴" + }, + "answer": "B", + "reason": "痿证的治法:祛邪通络,活养筋脉。以手足阳明经穴和夹脊穴为主。" + }, + { + "question_num": 470, + "query": "患者,男,30岁。劳累时心悸,胸骨后疼痛1年,查体可闻及主动脉瓣区收缩期粗糙的喷射性杂音,主动脉瓣区第二心音减弱。X线检查示:左房扩大和升主动脉扩张，可能的诊断是", + "options": { + "A": "冠心病心绞痛", + "B": "非梗阻性肥厚型心肌病", + "C": "主动脉瓣狭窄", + "D": "主动脉瓣关闭不全", + "E": "高血压性心脏病" + }, + "answer": "C", + "reason": "主动脉瓣狭窄主要临床表现为呼吸困难、心绞痛和晕;重要体征为主动脉瓣区收缩期喷射样杂音,常伴震额;X线检查可见左心室扩大，升主动脉扩张。因此,本例可能的诊断为主动脉瓣狭窄" + }, + { + "question_num": 471, + "query": "患者,女,40岁。呕吐清水,胃部不适!食久乃吐,喜热畏寒,身倦,便溏,小便可,舌苔白,脉迟。治疗除取主穴外,还应加", + "options": { + "A": "上脘、胃俞", + "B": "肝俞、太冲", + "C": "肾俞、太溪", + "D": "胆俞、丘墟", + "E": "次髎、血海" + }, + "answer": "A", + "reason": "从本患者的症状可诊断为呕吐(寒邪犯胃型),治疗应温中散寒和胃，A项中的上脘可理气降逆止呕,胃俞加灸可温中散寒和胃止呕。" + }, + { + "question_num": 472, + "query": "患儿,2岁。不能言语,精神呆滞,智力低下,发稀萎黄,四肢萎软,口角流涎,纳食欠佳,大便秘结,舌淡胖,苔少,指纹色淡,其诊断是", + "options": { + "A": "五迟、五软,肝肾不足证", + "B": "五迟、五软,心脾两虚证", + "C": "五迟、五软,痰瘀阻滞证", + "D": "佝偻病,心脾两虚证", + "E": "疳证,心脾两虚证" + }, + "answer": "B", + "reason": "五迟、五软。患儿2岁不能言语精神呆滞,智力低下,发稀袭黄,四肢萎软,口角流涎，纳食欠佳,大便秘结,舌淡胖,苔少,指纹色淡,其证候表现符合五迟、五软之心脾两虚证。" + }, + { + "question_num": 473, + "query": "患者，男，58岁。最近半年腰痛，畏寒肢冷,五更泻,舌淡胖,脉沉细,其证属", + "options": { + "A": "脾胃虚弱证", + "B": "肾阳虚证", + "C": "阳虚水泛证", + "D": "寒邪侵袭证", + "E": "以上均非" + }, + "answer": "B", + "reason": "腰痛,畏寒肢冷,五更泻,舌淡胖脉沉细是肾阳虚证的主要表现" + }, + { + "question_num": 474, + "query": "患者,男,65岁。慢性喘息型支气管炎病史20余年,近5年来间断出现下肢浮肿，7天前受凉后咳、痰、喘加重,难以入睡,时有躁动,以下治疗错误的是", + "options": { + "A": "抗感染", + "B": "化痰", + "C": "利尿", + "D": "营养支持", + "E": "安眠药镇静" + }, + "answer": "E", + "reason": "患者为老年男性,有慢性肺疾病、近5年来间断出现下肢浮肿,考虑慢性肺源性心脏病可能性大。现因感染诱发病情加重,应给予抗感染、化痰、解痉平喘、营养支持和改普右心功能等治疗。但应避免给予镇静剂，以免出现呼吸中枢受抑制，加重通气功能障碍，甚至诱发肺性脑病" + }, + { + "question_num": 475, + "query": "患者,女,40岁。呕吐痰涎,伴头晕,防兴还应加", + "options": { + "A": "列缺、尺泽", + "B": "膻中、丰隆", + "C": "曲池、外关", + "D": "风池、尺泽", + "E": "列缺、合谷" + }, + "answer": "B", + "reason": "从本患者的症状可诊断为呕吐(痰饮内阻型),治疗应理气化痰降逆止呕，B项胞中能宽胸理气除胸痞,丰隆能化痰,故为正确答案" + }, + { + "question_num": 476, + "query": "患儿,1岁1个月。突发高热4天,神智正常,现热已退，肌肤出现玫瑰色丘疹，皮疹始发于躯干,很快延及全身，肤无痒感。舌质偏红,苔薄少津,指纹淡紫,其治法是", + "options": { + "A": "清热生津,以助康复", + "B": "辛凉透表,清宣肺卫", + "C": "清凉解毒,透疹达邪", + "D": "疏风解表,清热解毒", + "E": "疏风清热,利湿解毒" + }, + "answer": "A", + "reason": "根据患儿症状及舌脉表现，可知此为奶麻毒透肌肤证,治法为清热生津，以助康复，故选A。" + }, + { + "question_num": 477, + "query": "患者曾发高热，热退而见口鼻、皮肤干燥,形瘦,目陷,唇舌干燥,舌紫绛边有瘀斑、瘀点，其病机是", + "options": { + "A": "津液不足", + "B": "津亏血瘀", + "C": "津枯血燥", + "D": "津停气阻", + "E": "气阴两亏" + }, + "answer": "B", + "reason": "高热之后津液不足,血行不畅,而致瘀血内生,血瘀证以痛如针刺,痛有定处,拒按,唇舌爪甲紫暗,舌质有瘀斑为辨证要点。患者舌紫绛边有瘀斑、瘀点为血瘀之象" + }, + { + "question_num": 478, + "query": "患者,女,30岁。半小时前家人发现其神志不清,既往无特殊病史。检查发现呕吐物有大蒜味,双侧瞳孔明显缩小。应首先考虑定", + "options": { + "A": "有机磷农药中毒", + "B": "阿托品中毒", + "C": "糖尿病酮症酸中毒", + "D": "尿毒症", + "E": "肝性脑病" + }, + "answer": "A", + "reason": "A项为大蒜味,且瞳孔缩小;B项瞳孔扩大;C项呼气中有烂苹果味;D项由于代谢物蓄积和水、电解质和酸碱平衡紊乱以致内分泌功能失调而引起机体出现的一系列自体中毒症状;E项有肝臭味。" + }, + { + "question_num": 479, + "query": "患者,女,72岁。1小时前，突然昏仆,不省人事。半身不遂,目合口张,遗尿,汗出,四肢厥冷。脉细弱。治疗应首选", + "options": { + "A": "背俞穴,灸法", + "B": "任脉经穴,灸法", + "C": "督脉经穴,灸法", + "D": "足阳明经穴，灸法", + "E": "足厥阴经穴,毫针泻法" + }, + "answer": "B", + "reason": "由患者突然昏仆,不省人事，目合口张,遗溺,手撒,四肢厥冷,脉细弱等症状,可判断患者所患病为中风中脏腑，且为脱证。可用灸法回阳固脱。当选任脉之经穴扶助元阳。" + }, + { + "question_num": 480, + "query": "患儿,1岁。发热1天,全身见散在细小淡红色皮疹,喷嚏,流涕,偶有咳嗽,精神不振,胃纳欠佳,耳后核肿大,咽红,舌苔薄白,其诊断是", + "options": { + "A": "麻疹", + "B": "奶麻", + "C": "风疹", + "D": "丹痧", + "E": "水痘" + }, + "answer": "C", + "reason": "风疹与麻疹、奶麻(幼儿急疹)、丹痧的鉴别要点是耳后界核肿大有压痛，其次是发热当天到1天出疹。麻疹有“麻疹黏膜斑”的特殊体征;奶麻有“热退疹出”的特点。" + } +] \ No newline at end of file