diff --git "a/Licensed/Theory_Questions/Year_1/Past_Paper.json" "b/Licensed/Theory_Questions/Year_1/Past_Paper.json" new file mode 100644--- /dev/null +++ "b/Licensed/Theory_Questions/Year_1/Past_Paper.json" @@ -0,0 +1,4617 @@ +[ + { + "question_num": 1, + "query": "人体作为一个有机整体,其“中心”是", + "options": { + "A": "脑", + "B": "心", + "C": "五脏", + "D": "经络", + "E": "脏腑" + }, + "answer": "C", + "reason": "五脏一体观,即构成人体的脏腑、形体、官窍等各个组成部分,通过经络的沟通联络作用,构成以五脏为中心的五个生理病理系统,系统之间在结构与功能上是完整统一的。" + }, + { + "question_num": 2, + "query": "下列各项,可见间歇热的是", + "options": { + "A": "肺炎", + "B": "风湿热", + "C": "霍奇金病", + "D": "急性肾盂肾炎", + "E": "渗出性胸膜炎" + }, + "answer": "D", + "reason": "间歇热是指体温骤升达高峰后持续数小时，又骤降至正常水平。经过1天或数天后又骤然升高,如此高热期与无热期反复交替发作,见于疟疾、急性肾孟肾炎等" + }, + { + "question_num": 3, + "query": "肾阴虚腰痛,可选用", + "options": { + "A": "独活寄生汤", + "B": "四妙丸", + "C": "归脾汤", + "D": "肾气丸", + "E": "左归丸" + }, + "answer": "E", + "reason": "腰痛肾阴虚证候:腰部隐隐作痛,酸软无力,缠绵不愈,心烦少寐,口燥咽干,面色潮红,手足心热，舌红少苔,脉弦细数。治法:滋补肾阴,濡养筋脉。代表方:左归丸加减。" + }, + { + "question_num": 4, + "query": "下列疔疮,容易损伤筋骨的是", + "options": { + "A": "烂疔", + "B": "丝红疔", + "D": "疫疔", + "C": "手足疔", + "E": "颜面疔" + }, + "answer": "C", + "reason": "根据发病部位和性质不同，行分颜面部疔疮、手足部疔疮、红丝疗、烂疗、疫疗等,其中手足疔容易损伤筋骨。" + }, + { + "question_num": 5, + "query": "具有养阴生津功效的药物是", + "options": { + "A": "生地黄", + "B": "牡丹皮", + "C": "赤芍", + "D": "紫草", + "E": "金银花" + }, + "answer": "A", + "reason": "生地黄有清热凉血、养阴生津之功,为清热凉血的要药。牡丹皮清热凉血、活血化瘀。赤芍清热凉血、化瘀止痛。紫草清热凉血,活血解毒,透疹，为预防麻疹的专药。金银花清热解毒,疏散风热" + }, + { + "question_num": 6, + "query": "下列病变引起的胸痛常沿一侧肋间神经分布的是", + "options": { + "A": "颈椎病", + "B": "胸肌劳损", + "C": "带状疱疹", + "D": "流行性胸痛", + "E": "皮下蜂窝组织炎" + }, + "answer": "C", + "reason": "带状疱疹可见沿神经分布的疱疹,疼痛呈刀割样、灼伤样,剧烈难忍,持续时间长。" + }, + { + "question_num": 7, + "query": "癌病气血双亏证的治法是", + "options": { + "A": "行气散结", + "B": "益气养血", + "C": "温阳益精", + "D": "滋肾养肝", + "E": "健脾益肾" + }, + "answer": "B", + "reason": "癌病气血双亏证证候:形体消瘦,面色无华,唇甲色淡,气短乏力,动辄尤甚,伴头昏心悸,目眩眼花,动则多汗,口干舌燥,纳呆食少,舌质红或淡,脉细或细弱。治法:益气养血，扶正抗癌。代表方:十全大补丸加减。" + }, + { + "question_num": 8, + "query": "肠痈之瘀滞证,选方为", + "options": { + "A": "大黄牡丹汤", + "B": "复方大柴胡汤", + "C": "大黄牡丹汤合红藤煎剂", + "D": "大黄牡丹汤合透脓散", + "E": "附子薏苡仁汤合透脓散" + }, + "answer": "C", + "reason": "肠痈内治常见3个证型。瘀滞证治宜行气活血，通腑泄热，用大黄牡丹汤合红藤煎剂加减。湿热证治宜通腑泄热，解毒利湿透脓,用复方大柴胡汤加减。热毒证治宜通腑排脓,养阴清热，用大黄牡丹汤合透脓散加减。" + }, + { + "question_num": 9, + "query": "《素问·六节藏象论》中，“封藏之本”所指的是", + "options": { + "A": "心", + "B": "肺", + "C": "脾", + "D": "肝", + "E": "肾" + }, + "answer": "E", + "reason": "肾中所藏之精,按其来源又有先天和后天之别。先天之精:来源于父母，与生俱来,藏于肾中,是人体生长、发育、生殖的基本物质;出生之后,有赖于后天之精的不断充养，后天之精:来源于水谷精微,由饮食水谷经脾胃化生，是维持脏腑功能活动的精微物质，又称五脏六腑之精。后天之精是维持人体生命活动的基本物质,又称为脏腑之精。故称“封藏之本”其余选项干扰性不大。" + }, + { + "question_num": 10, + "query": "夜间咳嗽较重者,可见于", + "options": { + "A": "百日咳", + "B": "胸膜炎", + "C": "大叶性肺炎", + "D": "肺结核", + "E": "肺癌" + }, + "answer": "D", + "reason": "左心衰竭、肺结核夜间咳嗽明显,可能与夜间肺瘀血加重、迷走神经兴奋性增高有关。" + }, + { + "question_num": 11, + "query": "治疗痰饮病的主要原则是", + "options": { + "A": "清热", + "B": "化痰", + "C": "温化", + "D": "利水", + "E": "逐饮" + }, + "answer": "C", + "reason": "痰饮的治疗以温化为原则,即所谓“病痰饮者,当以温药和之”。同时还应根据表里虚实的不同,采取相应的处理措施。水饮壅盛者,应祛饮以治标;阳微气虚者，宜温阳以治本;在表者,当温散发汗;在里者,应温化利水;正虚者补之;邪实者攻之;如属邪实正虚,则当消补兼施;饮热相杂者,又当温清并用。" + }, + { + "question_num": 12, + "query": "其病因属外来伤害的是", + "options": { + "A": "红丝疔", + "B": "失荣", + "C": "漆疮", + "D": "水火烫伤", + "E": "酒糟鼻" + }, + "answer": "D", + "reason": "特殊之毒包括虫毒、蛇毒、疯犬毒、漆毒、药、食物毒和疫毒、无名毒。某些人由于禀性不耐,接触生漆后而发漆疮。凡跌仆损伤、沸水、火焰、冷冻等,都可直接伤害人体。属于外来伤害。" + }, + { + "question_num": 13, + "query": "水火之宅是指", + "options": { + "B": "胃", + "A": "脾", + "D": "肝", + "C": "肾", + "E": "肺" + }, + "answer": "C", + "reason": "肾为五脏六腑之本,为水火之宅,寓真阴(即命门之水)而涵真阳(命门之火)五脏六腑之阴,非肾阴不能滋助;五脏六腑之阳非肾阳不能温养。故曰:“命门(即肾--作者注)为元气之根,为水火之宅。五脏之阴气,非此不能滋;五脏之阳气,非此不能发”(《景岳全书·传忠录·命门余义》)。" + }, + { + "question_num": 14, + "query": "《素问·痹论》中“夜卧则惊,多饮数小便,上为引如怀”是属", + "options": { + "A": "肝痹", + "B": "肾痹", + "C": "胞痹", + "D": "肠痹", + "E": "脾痹" + }, + "answer": "A", + "reason": "卧则惊,多饮,数小便,上为引如怀。”" + }, + { + "question_num": 15, + "query": "咳血肝火犯肺证者,若咳血量较多,纯血鲜红，应选用的方剂是", + "options": { + "A": "清脏汤", + "B": "泻白散", + "C": "玉女煎", + "D": "桑菊饮", + "E": "犀角地黄汤" + }, + "answer": "E", + "reason": "咳血肝火犯肺证证候:咳嗽阵作,痰中带血或纯血鲜红,胸胁胀痛,烦躁易怒，口苦,舌质红,苔薄黄,脉弦数。治法:清肝泻火，凉血止血。代表方:泻白散合黛蛤散加减。加减:肝火较甚,头晕目赤,心烦易怒者加丹皮、栀子清肝泻火。若咳血量较多,纯血鲜红，可用犀角地黄汤加三七粉冲服，以清热泻火，凉血止血" + }, + { + "question_num": 16, + "query": "外感六淫导致的外科疾病,以何者最为常见", + "options": { + "A": "风邪、湿毒", + "B": "风邪、热毒", + "C": "寒毒、湿毒", + "D": "暑毒、火毒", + "E": "热毒、火毒" + }, + "answer": "E", + "reason": "由于风、寒、、燥诸邪毒均能化热生火,故外科疾病发生,尤以“热毒”“火游最常见。" + }, + { + "question_num": 17, + "query": "具有推动呼吸和血行功能的气是", + "options": { + "A": "心气", + "B": "肺气", + "C": "营气", + "D": "卫气", + "E": "宗气" + }, + "answer": "E", + "reason": "宗气贯注于心肺,具有推动肺的呼吸、助心推动血液运行的功能。" + }, + { + "question_num": 18, + "query": "有关心源性水肿的说法错误的是", + "options": { + "A": "特点为下垂性水肿", + "B": "常伴肝颈静脉回流征阳性", + "C": "心包积液属于心源性水肿", + "D": "严重者可见腹腔积液", + "E": "可见于缩窄性心包炎" + }, + "answer": "C", + "reason": "心源性水肿的特点是下垂性水肿,主要见于右心衰竭、缩窄性心包炎等,严重者可出现胸、腹腔积液,常伴呼吸困难、心脏扩大、颈静脉怒张、肝颈静脉回流征阳性等表现。心包积液是水肿的特殊形式,不属于心源性水肿，" + }, + { + "question_num": 19, + "query": "治疗郁证心肾阴虚证,应首选的方剂是", + "options": { + "A": "天王补心丹合六味地黄丸", + "B": "安神定志丸合左归丸", + "C": "丹板消谣散会失秘产神力", + "D": "泻心汤合左归丸", + "E": "龙胆泻肝汤合半夏厚朴汤" + }, + "answer": "A", + "reason": "郁证心肾阴虚证证候:情绪不宁,心悸,健忘,失眠,多梦,五心烦热,盗汗,口咽干燥,舌红少津,脉细数。治法:滋养心肾。代表方:天王补心丹合六味地黄丸加减。" + }, + { + "question_num": 20, + "query": "皮肤变厚,干燥,脱屑,作痒,很少糜烂流水者，其痒的原因是", + "options": { + "A": "血虚", + "B": "虫淫", + "C": "热胜", + "D": "湿胜", + "E": "风胜" + }, + "answer": "A", + "reason": "中医认为“热微则痒”,即痒是因风、湿、热、虫之邪客于皮肤肌表,引起皮肉间气血不和,郁而生微热所致，或由于血虚生风燥阻于皮肤,肌肤失于濡养,内生虚热而发。皮肤变厚、干燥、脱屑,很少糜烂流水,是血虚作痒的临床表现。浸淫蔓延，黄水频流，状如虫行皮中其痒尤甚,最易传染，是虫淫作痒的临床表现:皮疹瘾疹,红灼热作痒,或只发于裸露部位，或遍布全身,甚至糜烂流滋水淋漓,结成片，常不传染,是热胜作痒的临床表现。浸淫四窜，黄水淋漓,最易沿表皮蚀烂,越腐越痒,是湿盛作痒的临床表现。走窜无定,遍体作痒,抓破血溢，随破随收不致化腐,多为干性，是风胜作痒的临床表现。" + }, + { + "question_num": 21, + "query": "《素问·玉机真脏论》称其“为孤脏,中央土以灌四旁”的脏是", + "options": { + "A": "肝", + "B": "心", + "C": "脾", + "D": "肺", + "E": "肾" + }, + "answer": "C", + "reason": "指脾脏。心.、肝、肺、肾四脏之脉各主四时中之一时,惟脾脉不得独主,故称之。《素问·玉机真脏论》:“脾脉者土也,孤脏以灌四傍者也。”张志聪注:“四时之脉,止合四脏,而脾脏之脉各王四季月十八日，不得独主于时,故为孤脏。”" + }, + { + "question_num": 22, + "query": "正常成人腋测法体温应是", + "options": { + "A": "36.0~37.0°C", + "B": "36.2~37.0°C", + "C": "36.2~37.2°C", + "D": "36.4~37.4°C", + "E": "36.5~37.5°C" + }, + "answer": "A", + "reason": "一般成人清晨安静状态,口腔(舌下)温度的正常值为36.3~37.2℃;腋窝温度的正常值为36.0~37.0℃;肛门温度的正常值为36.5~37.7℃" + }, + { + "question_num": 23, + "query": "下列选项中除哪项外,均属于消渴的病机特点", + "options": { + "A": "痰火内阻,湿热阻滞", + "B": "气阴两虚,阴阳俱衰", + "C": "正气不足,瘀血内生", + "D": "阴虚为本,燥热为标", + "E": "脏腑虚损,辨证百出" + }, + "answer": "A", + "reason": "消渴的基本病机就是阴虚燥热,进一步发展可出现气阴两虚,瘀血阻络,阴损及阳，脏腑虚损，而出现各种变证。而痰火和湿热不是消渴常见的病机演变。" + }, + { + "question_num": 24, + "query": "透托法不宜用于", + "options": { + "A": "毒气虽盛正气未衰时", + "B": "疮疡中期", + "C": "脓液不出", + "D": "肿痛未消", + "E": "肿疡初起未成脓时" + }, + "answer": "E", + "reason": "内托法是用补益和透脓药物，扶助正气,托毒外出,使早日液化成脓,或使病灶趋于局限,从而达到脓出毒泄,肿痛消退的目的。可分为透托法和补托法两类。透托法用于肿疡已成,毒盛正气不虚,肿疡尚未溃破或溃破后脓出不畅,多用于实证;补托法用于肿疡毒势方盛，正气已虚,不能托毒外出者,局部疮形平塌,根盘散漫，难溃难腐,或溃后脓水稀少，坚肿不消。注意透脓法不宜用之过早，肿疡初起未成脓时勿用。补托法在正实毒盛的情况下，不可施用。此外,内托法常与清热法同用。" + }, + { + "question_num": 25, + "query": "风性善动不居,游走不定,体现风性的特点是", + "options": { + "A": "为百病之长", + "B": "轻扬开泄", + "C": "善行而数变", + "D": "主动", + "E": "易袭阳位" + }, + "answer": "C", + "reason": "风性善行而数变:“善行”,指风性善动不居,游走不定。故风邪致病具有病位游走、行无定处的特点。如风寒湿三气杂至而引起的痹证,若见游走性关节疼痛,痛无定处,即是风邪偏盛的表现,称为“行痹”或“风痹”。“数变”指风邪致病变幻无常,发病迅速。如风疹常表现为皮肤瘙痒时作,疹块发无定处,此起彼伏,时隐时现等。而且，以风邪为先导的外感病，一般发病急，传变也较快" + }, + { + "question_num": 26, + "query": "帕金森病患者表现的步态是", + "options": { + "A": "醉汉步态", + "B": "蹒跚步态", + "C": "慌张步态", + "D": "偏瘫步态", + "E": "共济失调步态" + }, + "answer": "C", + "reason": "慌张步态指身体前倾,越走越快,有难以止步之势,见于帕金森。" + }, + { + "question_num": 27, + "query": "石淋的病机是", + "options": { + "A": "湿热蕴结于下焦,膀胱气化不利", + "B": "脾肾两虚,膀胱气化无权", + "C": "湿热蕴结于下焦,煎熬尿液，日久成砂石", + "D": "湿热蕴结于下焦，气机不利，不分清泌浊", + "E": "湿热下注膀胱,热甚灼络,迫血妄行" + }, + "answer": "C", + "reason": "石淋证候:尿中夹砂石,排尿涩痛,或排尿时突然中断，尿道窘迫疼痛，少腹拘急,往往突发,一侧腰腹绞痛难忍,甚则牵及外阴,尿中带血,舌红,苔薄黄,脉弦或带数。证机概要:湿热蕴结下焦,尿液煎熬成石,膀胱气化失司。治法:清热利湿,排石通淋。代表方:石韦散加减。" + }, + { + "question_num": 28, + "query": "发生“走黄”的原因是", + "options": { + "B": "伤津", + "A": "正虚", + "D": "邪盛", + "C": "腑实", + "E": "表实" + }, + "answer": "D", + "reason": "走黄的发生主要在于火毒炽盛,毒人营血,内攻脏腑。" + }, + { + "question_num": 29, + "query": "“金水相生”指的是", + "options": { + "A": "心肺关系", + "B": "肺肝关系", + "C": "肝脾关系", + "D": "肺肾关系", + "E": "心肾关系" + }, + "answer": "D", + "reason": "肺与肾在五行中属金和水,有母子相生关系。金能生水,肺阴充足,输精于肾，使肾阴充盛;水能润金,肾阴充盛,上润于肺,则使肺阴不虚。故言“金水相生”" + }, + { + "question_num": 30, + "query": "甲状腺I度肿大的体征是", + "options": { + "A": "不能看出也无法触及,但B超示轻度肿大", + "B": "不能看出但能触及轻度肿大", + "C": "能看见并能触及的轻度肿大", + "D": "甲状腺肿大在胸锁乳突肌以内", + "E": "甲状腺肿大超过胸锁乳突肌" + }, + "answer": "B", + "reason": "甲状腺肿大分为三度:I度指不能看出但能触及的甲状腺肿大;Ⅱ度指能看出也能触及;但不超过胸锁乳突肌的甲状腺肿大;四度指超出胸锁乳突肌的甲状腺肿大，" + }, + { + "question_num": 31, + "query": "眼睑浮肿,继而四肢全身皆肿,来势迅速,伴风寒表证,脉浮滑。治法为", + "options": { + "A": "宣肺解毒,利湿消肿", + "B": "疏风解表,宣肺行水", + "C": "温阳健脾,利水消肿", + "D": "运脾化湿，通阳利水", + "E": "益气健脾,行气化湿" + }, + "answer": "B", + "reason": "水肿,风水相搏证,治以疏风解表,宣肺行水。方选越婢加术汤。" + }, + { + "question_num": 32, + "query": "手指关节处脓肿的切口选择应", + "options": { + "A": "越过关节切开", + "B": "放射状切开", + "D": "避免越过关节", + "C": "自然纹理切开", + "E": "以脓肿为中心,放射状切开" + }, + "answer": "D", + "reason": "切口选择:选择脓肿最低点或最薄弱处进刀。一般疮疡宜循经直切;乳房部应以乳头为中心,放射状切开;面部脓肿应尽量沿皮肤自然纹理切开;手指脓肿,应从侧方切开;关节区附近的脓肿,切日尽量避免越过关节;关节人MM投调以叹口;肛旁低位脓肿，应以肛管为中心做放射状切开。" + }, + { + "question_num": 33, + "query": "下列中药中治风湿痹痛,痉挛抽搐的药物是", + "options": { + "A": "紫河车", + "B": "沙苑子", + "C": "肉苁蓉", + "D": "淫羊藿", + "E": "益智仁" + }, + "answer": "D", + "reason": "淫羊藿的功效为补肾阳,强筋骨,祛风湿。主治:①肾阳虚衰,阳遗精,筋骨痿软;②风寒湿痹，麻木拘栾" + }, + { + "question_num": 34, + "query": "肺部叩诊出现鼓音应考虑的疾病是", + "options": { + "A": "气胸", + "B": "胸膜炎", + "C": "肺气肿", + "D": "肺水肿", + "E": "肺不张" + }, + "answer": "A", + "reason": "鼓音见于大量含气腔,如气胸、浅表肺大疱、肺空洞、空洞型肺结核、溃破后的肺脓肿等。肺气肿呈过清音。" + }, + { + "question_num": 35, + "query": "疟疾病热瘴的寒热特征是", + "options": { + "A": "热少寒多", + "B": "热多寒少", + "C": "先寒后热,寒热相当", + "D": "热甚寒微,甚至壮热不寒", + "E": "寒甚热微,甚至但寒不热" + }, + "answer": "D", + "reason": "属正疟者,先寒后热,寒热相当;属温疟者,阳热偏盛,热多寒少;属寒疟者,阳虚寒盛,热少寒多。瘴疟者,阴阳极度偏盛,热甚寒微,甚至壮热不寒者为热瘴;寒甚热微,甚至但寒不热者,则为冷瘴。" + }, + { + "question_num": 36, + "query": "肿疡毒势方盛,正气已虚,不能托毒外出者,内治方药宜选用", + "options": { + "A": "透脓散", + "B": "仙方活命饮", + "C": "黄连解毒汤", + "D": "托里消毒散", + "E": "清肝解郁汤" + }, + "answer": "D", + "reason": "肿疡毒势方盛,正气已虚，不能托毒外出,当用补托法,补托法代表方剂为托里消毒散。透脓散为透托法代表方剂，仙方活命饮、黄连解毒汤、清肝解郁汤为消法。" + }, + { + "question_num": 37, + "query": "六腑共同的生理特点是", + "options": { + "A": "化生精气", + "B": "贮藏精气", + "C": "满而不实", + "D": "藏而不泻", + "E": "受盛传化水谷" + }, + "answer": "E", + "reason": "六腑共同的生理特点是受盛和传化水谷。《素问·五脏别论》:“六腑者,传化物而不藏,故实而不能满也。所以然者，水谷人曰,则胃实而肠虚,食下,则肠实而胃虚。" + }, + { + "question_num": 38, + "query": "肝脏触诊肿大较明显,质韧,轻微压痛,提示", + "options": { + "A": "脂肪肝", + "B": "肝硬化", + "C": "肝脓肿", + "D": "慢性肝炎", + "E": "急性肝炎" + }, + "answer": "D", + "reason": "慢性肝炎肝脏肿大较明显,质韧或质硬,压痛较轻;急性肝炎及脂肪肝肝脏质地稍韧,急性肝炎有压痛,脂肪肝无压痛;肝脓肿有囊性感;肝硬化早期肿大,晚期则缩小变硬,表面莹结节状，九压痈。" + }, + { + "question_num": 39, + "query": "治疗鼓胀水湿困脾证，首选的方剂是", + "options": { + "A": "中满分消丸合茵陈蒿汤", + "B": "柴胡疏肝散合胃苓汤", + "C": "实脾饮", + "D": "附子理苓汤", + "E": "茵陈五苓散" + }, + "answer": "C", + "reason": "鼓胀水湿困脾证证候:腹大胀满,按之如裹水,甚则颜面微浮,下肢浮肿,脘腹痞胀,得热则舒,精神困倦,怯寒懒动,小便少,大便溏,舌苔白腻,脉缓。治法:温中健脾,行气利水。代表方:实脾饮加减。" + }, + { + "question_num": 40, + "query": "有头组最吊见的开友症是", + "options": { + "A": "内陷", + "B": "走黄", + "C": "伤筋", + "D": "损骨", + "E": "流注" + }, + "answer": "A", + "reason": "内陷为疮疡阳证疾患过程中阴正气内虚，火毒炽盛，导致毒邪走散，正不胜邪,毒不外泄,反陷于里,客于营血,内传脏腑的一种危急疾病。因多由有头疽患者并发,故名疽毒内陷。走黄是疗疮火毒炽盛,早期失治,毒势未能及时控制,走散入营,内攻脏腑而引起的一种全身性危急疾病,是疔疮的并发症。有头疽发于肌肤间，位置相对表浅，不会伤筋损骨。流注是发于肌肉深部的急性化脓性疾病。" + }, + { + "question_num": 41, + "query": "可用“离、合、出、人”概括其循行分布特点的是", + "options": { + "A": "十五别络", + "B": "十二经别", + "C": "十二经筋", + "D": "十二经脉", + "E": "奇经八脉" + }, + "answer": "B", + "reason": "十二经别的循行特点，可用“离、合、出、人”来概括。" + }, + { + "question_num": 42, + "query": "在胸骨左缘第3~4肋间触及收缩期震颤,应考虑为", + "options": { + "A": "主动脉瓣关闭不全", + "B": "肺动脉瓣狭窄", + "C": "二尖瓣狭窄", + "D": "三尖瓣狭窄", + "E": "室间隔缺损" + }, + "answer": "E", + "reason": "胸骨左缘3~4肋间收缩期震颤,应首先考虑为室间隔缺损(先天性)。" + }, + { + "question_num": 43, + "query": "下列哪项为诊断黄疸的最重要依据", + "options": { + "B": "爪甲上黄", + "A": "齿垢黄", + "D": "目黄", + "C": "小便黄", + "E": "身黄" + }, + "answer": "D", + "reason": "黄疽的诊断依据:①目黄、肤黄、小便黄,其中目睛黄染为本病的重要特征;②常伴食欲减退、恶心呕吐、胁痛腹胀等症状;③常有外感湿热疫毒、内伤酒食不节,或有胁痛、癥积等病史。" + }, + { + "question_num": 44, + "query": "带下病的证型不包括", + "options": { + "A": "脾虚", + "B": "肾虚", + "C": "湿热", + "D": "肝郁", + "E": "湿毒" + }, + "answer": "D", + "reason": "带下病辨证主要根据带下量、色、质、气味,其次根据伴随症状及舌脉辨其寒热虚实。如带下量多色白或淡黄,质清稀,多属脚阳虚;色白质清稀如水,有冷感者属肾阳;最不甚多,色黄或赤白相兼,质稠或有臭气为阴虚挟湿;带下量多色黄,质黏稠,有臭气,或如泡沫状或色自如豆渣状,为湿热下注;带下量多,色黄绿如脓，或浑浊如米泔,质稠,恶臭难闻，属湿毒重证。" + }, + { + "question_num": 45, + "query": "《素问·经脉别论》所谓“浊气归心,淫精于脉”反映的是", + "options": { + "A": "心与大肠的关系", + "B": "心与脾的关系", + "C": "心与肺的关系", + "D": "心与小肠的关系", + "E": "心与肾的关系" + }, + "answer": "D", + "reason": "在生理上相互为用:心主血脉,心阳之温煦,心血之濡养,有助于小肠的化物;小肠化物,泌别清浊,吸收水谷精微,其浓厚部分经脾气转输于心，化血以养心脉。故说“浊气归心,淫精于脉”" + }, + { + "question_num": 46, + "query": "腹部叩诊出现移动性浊音,应首先考虑的是", + "options": { + "A": "尿潴留", + "B": "幽门梗阻", + "C": "急性胃炎", + "D": "巨大卵巢囊肿", + "E": "右心功能不全" + }, + "answer": "E", + "reason": "石心功能不全出现移动性浊音。尿潴留呈圆形浊音区,则可能为胀大的膀胱。幽门梗阻出现振水音。巨大卵巢囊肿为实音。急性胃炎在胃泡鼓音区的上界,再作水平方向叩诊,鼓音区变大。" + }, + { + "question_num": 47, + "query": "胁痛病的治疗原则是", + "options": { + "A": "疏肝理气止痛", + "B": "活血化瘀止痛", + "D": "养血柔肝止痛", + "C": "清热化湿利胆", + "E": "疏肝和络止痛" + }, + "answer": "E", + "reason": "胁痛之治疗原则当根据“通则不痛”的理论,以疏肝和络止痛为基本治则,结合肝胆的生理特点，灵活运用。实证之胁痛,宜用理气、活血、清利湿热之法;虚证之胁痛,宜补中寓通,采用滋阴、养血、柔肝之法。" + }, + { + "question_num": 48, + "query": "下列各项,易导致妇产科疾病发生的是", + "options": { + "A": "风、寒、湿", + "B": "风、湿、热", + "C": "寒、热、湿", + "D": "寒、暑、热", + "E": "寒、湿、燥" + }, + "answer": "C", + "reason": "六淫皆导致妇产科疾病,然妇女以血为本,寒、热、湿邪更易于与血相搏结而导致妇产科疾病。" + }, + { + "question_num": 49, + "query": "六淫致病,最容易引起疼痛的邪气是", + "options": { + "A": "风邪", + "B": "寒邪", + "C": "湿邪", + "D": "燥邪", + "E": "火邪" + }, + "answer": "B", + "reason": "寒性凝滞,寒邪侵人人体,阳气受损,经脉气血适于阳气温煦,则凝结阻滞,涩潜不通,不通则痛,故寒邪伤人多见疼痛症状。" + }, + { + "question_num": 50, + "query": "下列不属于神经反射的深反射的是", + "options": { + "A": "肱二头肌反射", + "B": "肱三头肌反射", + "C": "踝反射", + "D": "腹壁反射", + "E": "膝反射" + }, + "answer": "D", + "reason": "深反射检査包括肱二头肌反射、肱三头肌反射、膝反射、踝反射、桡骨骨膜反射。浅反射检查包括角膜反射、腹壁反射、提睾反射。" + }, + { + "question_num": 51, + "query": "便私干结,形体消瘦,头晕耳鸣,现便干症状缓解,仍有腰膝酸软,治疗方选", + "options": { + "A": "增液汤", + "B": "右归丸", + "C": "金匮肾气丸", + "D": "六味地黄丸", + "E": "润肠丸" + }, + "answer": "D", + "reason": "阴虚便秘,若肾阴不足者,可用六味地黄丸。" + }, + { + "question_num": 52, + "query": "下列哪项不属妊娠的生理表现", + "options": { + "A": "乳房增大", + "B": "月经不潮", + "C": "脉滑", + "D": "尿少便溏", + "E": "乳晕部着色" + }, + "answer": "D", + "reason": "妊娠的生理现象:①月经停闭;②脉滑;③妊娠反应,后常出现胃纳不香或饱胀不思饮食或恶心欲呕、择食的早孕反应。气血下注,冲脉相对较旺,机体气血相对不足，则易出现倦怠、思睡、头晕等不适。一般不影响工作,3个月内逐渐适应或消失;④子宫增大:孕后子宫育胎,变化最大。早孕40多天,可扪及子宫增大变软,子宫颈紫蓝色质软。非孕时子宫容量为5mL,至妊娠足月约5000m,增加1000倍。子宫重量,非孕时50g,至足月妊娠约1000g,增加20倍;⑤乳房变化:乳房自孕早期开始增大、发胀。乳头增大变黑,易勃起。乳晕加大变黑,乳晕外周散在褐色小结节状隆起。妊娠4~5个月，挤压乳头可有少量乳汁;⑥下腹膨隆每次妊娠一般一胎。若一孕二胎者称“双胎”或“骈胎”,一孕三胎称“品胎”。" + }, + { + "question_num": 53, + "query": "七情致病,引起“气结”的情志是", + "options": { + "A": "恐", + "B": "惊", + "C": "悲", + "D": "喜", + "E": "思" + }, + "answer": "E", + "reason": "《黄帝内经·素问·举痛论》曰:“百病生于气也。怒则气上，喜则气缓,悲则气消,恐则气下,惊则气乱,思则气结”" + }, + { + "question_num": 54, + "query": "腹膜炎最标志性的体征是", + "options": { + "A": "叩出移动性浊音", + "B": "腹部触及肿块", + "C": "肠鸣音减弱", + "D": "腹部压痛", + "E": "反跳痛" + }, + "answer": "E", + "reason": "反跳痛是腹腔内脏器的炎症已累及腹膜壁层的征象,当突然抬手时腹膜被牵拉而引起剧烈疼痛。" + }, + { + "question_num": 55, + "query": "治疗痰热郁肺咳嗽的主方是", + "options": { + "A": "桑菊饮", + "C": "泻白散", + "B": "麻杏石甘汤", + "D": "清金化痰汤", + "E": "清肺汤" + }, + "answer": "D", + "reason": "咳嗽痰热郁肺证。证候主症:咳嗽,气息粗促,或喉中有痰声,痰多质黏厚或稠黄,咯吐不爽,或咯血痰,胸胁胀���,咳时引痛,面赤,或有身热,口干而黏,欲饮水,舌质红,舌苔薄黄腻,脉滑数。治法:清热肃肺,豁痰止咳。代表方:清金化痰汤加减。" + }, + { + "question_num": 56, + "query": "经行感冒风寒证宜用方", + "options": { + "A": "荆穗四物汤", + "B": "荆苓四物汤", + "D": "桑菊饮", + "C": "银翘散", + "E": "玉屏风散" + }, + "answer": "A", + "reason": "经行感冒风寒证,主要证候每至经行期间，发热，恶寒,无汗,鼻塞流涕,咽喉痒痛,咳嗽痰稀,头痛身痛;舌淡红,苔白,脉浮紧。经血净后,诸证渐愈。治法:解表散寒,和血调经。方药:荆穗四物汤。" + }, + { + "question_num": 57, + "query": "根据十二经脉流注次序,肾经下交的经脉是", + "options": { + "A": "足少阳胆经", + "B": "手厥阴心包经", + "C": "手少阳三焦经", + "D": "手少阴心经", + "E": "足厥阴肝经" + }, + "answer": "B", + "reason": "足少阴肾经在胸中交于手厥阴心包经。" + }, + { + "question_num": 58, + "query": "成人血清钠的正常值是", + "options": { + "A": "110~120mmol/L", + "B": "121~130mmol/L", + "C": "135~145mmol/L", + "D": "150~155mmol/L", + "E": "156~160mmol/L" + }, + "answer": "C", + "reason": "成人血清钠的正常值是135~145mmol/L." + }, + { + "question_num": 59, + "query": "胸痹的主要病机为", + "options": { + "A": "气滞血瘀", + "C": "痰瘀交阻", + "E": "心脉痹阻", + "B": "寒凝气滞", + "D": "阳气虚衰" + }, + "answer": "E", + "reason": "胸痹的主要病机为心脉痹阻病位在心,涉及肝、肺、脾、肾等脏。" + }, + { + "question_num": 60, + "query": "治疗经间期出血血瘀证,应首选的方剂是", + "options": { + "A": "少腹逐瘀汤", + "B": "桂枝茯苓丸", + "C": "逐瘀止血汤", + "D": "桃红四物汤", + "E": "血府逐瘀汤" + }, + "answer": "C", + "reason": "经间期出血血瘀证主要证候:经间期出血量少或多少不一，色紫黑或有血块少腹两侧或一侧胀痛或刺痛;情志抑郁,胸闷烦踩;古茶暗或有淤点;细方药:逐瘀止血汤。" + }, + { + "question_num": 61, + "query": "五加皮具有的功效是", + "options": { + "A": "通便", + "B": "利尿", + "C": "凉血", + "D": "安胎", + "E": "和胃" + }, + "answer": "B", + "reason": "五加皮的主要功效为祛风湿强筋骨,利尿" + }, + { + "question_num": 62, + "query": "下列指标对诊断急性心肌梗死最具特异性的是", + "options": { + "A": "乳酸脱氢酶(LDH)", + "B": "血清肌酸激酶(CK)", + "C": "血清肌酸激同工酶(CK-MB)", + "D": "心肌肌钙蛋白T(cTnT)", + "E": "脑钠肽(BNP)" + }, + "answer": "D", + "reason": "诊断心肌梗死的特异性:cTnT>CK-MB>CK>LDH。BNP是心衰标志物:不用于诊断心肌梗死。" + }, + { + "question_num": 63, + "query": "癃闭瘀浊阻塞证治疗首选方剂是", + "options": { + "B": "清肺饮", + "A": "八正散", + "C": "沉香散", + "D": "补中益气汤", + "E": "代抵当丸" + }, + "answer": "E", + "reason": "八正散用于膀胱湿热癃闭的治疗,清肺饮用于肺热壅盛癃闭的治疗，沉香散用于肝郁气滞癃闭的治疗，代抵当丸用于尿路阻塞癃闭的治疗,补中益气汤用于中气不足癃闭的治疗。" + }, + { + "question_num": 64, + "query": "带下病的主要发病机理是", + "options": { + "A": "外感湿邪,损及任、带,约固无力", + "B": "肾气不足,封藏失职,阴液滑脱而下", + "C": "湿邪影响任、带,任脉不固,带脉失约", + "D": "脾虚生湿,流注下焦,伤及任、带", + "E": "肝经湿热,流注下焦,伤及任、带" + }, + "answer": "C", + "reason": "带下病的主要病机是湿邪伤及任带二脉,使任脉不固,带脉失约。" + }, + { + "question_num": 65, + "query": "金钱草具有的功效是", + "options": { + "A": "清肺润燥", + "B": "清肺化痰", + "D": "解毒消肿", + "C": "泄热通便", + "E": "清热解暑" + }, + "answer": "D", + "reason": "金钱草利尿通淋、利湿退黄清热解毒,用于热毒疮疡及毒蛇咬伤。" + }, + { + "question_num": 66, + "query": "颈动脉搏动,多见于", + "options": { + "A": "二尖瓣狭窄", + "B": "二尖瓣关闭不全", + "C": "三尖瓣关闭不全", + "D": "肺动脉瓣关闭不全", + "E": "主动脉瓣关闭不全" + }, + "answer": "E", + "reason": "安静状态下出现明显的颈动脉搏动,提示心排出是增加或脉压增大的疾病:常见于主动脉瓣关闭不全、高血压、甲状腺功能亢进症或严重贫血等。" + }, + { + "question_num": 67, + "query": "下列腹痛特点中,符合气机���滞腹痛的疼痛特点", + "options": { + "A": "腹部绵绵,时作时止", + "B": "腹部胀痛,走窜不定", + "C": "腹部胀满,疼痛拒按", + "D": "饥则痛甚,得食稍减", + "E": "腹痛急暴,得温痛减" + }, + "answer": "B", + "reason": "气机郁滞腹痛,多由肝失条达,气机不畅;或忧思伤脾,或肝郁克脾,肝脾不和,气机不利,均可引起脏腑经络气血郁滞,引起腹痛。故胀痛,且走窜痛。" + }, + { + "question_num": 68, + "query": "下列各项,不属人工流产并发症的是", + "options": { + "A": "人流综合征", + "B": "子宫穿孔", + "C": "人流后宫缩不良", + "D": "人流不全", + "E": "人流术后感染" + }, + "answer": "C", + "reason": "人工流产并发症有人流综合征、子宫穿孔、人流不全、宫颈或颈管内口粘连、人流术后感染。" + }, + { + "question_num": 69, + "query": "下列关于五行生克规律的叙述,错误的是", + "options": { + "A": "木为水之子", + "B": "火为土之母", + "C": "水为火之所不胜", + "D": "金为木之所胜", + "E": "木为土之所不胜" + }, + "answer": "D", + "reason": "本题考查五行之间的相生相克关系。《难经》中将五行相生关系比喻为母子关系,“生我”者为母,“我生”者为子。按照五行相生次序，水生木，故木为水之子;火生土,故火为土之母。《内经》中将相克关系称为“所胜”“所不胜”关系,即“克我者”为“所不胜”“我克”者为“所胜”,根据五行相克的关系,水克火,故水为火之所不胜;金克木,故金为木之所不胜;木克土，故木为土之所不胜。" + }, + { + "question_num": 70, + "query": "粪便中查到巨噬细胞,多见于", + "options": { + "A": "急性胃肠炎", + "B": "细菌性痢疾", + "C": "阿米巴痢疾", + "D": "血吸虫病", + "E": "霍乱" + }, + "answer": "B", + "reason": "类便镜检见巨细胞考虑细菌性痢疾和溃疡性结肠炎。" + }, + { + "question_num": 71, + "query": "不属于血证病机特点的是", + "options": { + "A": "迫血妄行", + "B": "气不摄血", + "D": "肾不纳气", + "C": "血不循经", + "E": "瘀血阻络" + }, + "answer": "D", + "reason": "血证的病机特点可以归结为火热熏灼、迫血妄行,气虚不摄、血溢脉外及瘀血阻络、血不循经等。" + }, + { + "question_num": 72, + "query": "下列各项,不属于子宫功能的是", + "options": { + "A": "产生月经", + "B": "排出月经", + "C": "孕育胎儿", + "D": "分娩胎儿", + "E": "抵御外邪" + }, + "answer": "E", + "reason": "子宫的主要功能是产生、排出月经;孕育、分娩胎儿。另外还有排出余血浊液、分泌生理性带下的功能。子宫的生理特点具有明显的周期性、节律性。" + }, + { + "question_num": 73, + "query": "下列关于“实”的叙述,错误的是", + "options": { + "A": "外感邪盛", + "B": "肌肤经络闭塞", + "C": "气机升降失调", + "D": "脏腑功能亢进", + "E": "气血壅滞瘀结" + }, + "answer": "C", + "reason": "实,是以邪气亢盛为矛盾主要方面的一种病理状态。邪气的致病力强盛,而正气的抗病能力未衰,正邪相搏,斗争激烈,反应明显,临床上出现一系列反应比较剧烈、有余的病理性证候,称为实证。实证常见于外感六淫和方气致病的初期和中期,或由于湿、痰、水饮、食积、气滞、瘀血等引起的内伤病证。实证较多见于体质比较壮实的患者。气机升降失调不是实的病机。" + }, + { + "question_num": 74, + "query": "心包积液的特征性体征是", + "options": { + "A": "奇脉", + "B": "交替脉", + "C": "重搏脉", + "D": "无脉", + "E": "水冲脉" + }, + "answer": "A", + "reason": "奇脉常见于心包积液和缩窄性心包炎,是心包填塞的重要体征。" + }, + { + "question_num": 75, + "query": "治疗痫病发作期的主穴是", + "options": { + "A": "水沟、百会、后溪、内关、涌泉", + "B": "印堂、丰隆、太冲、鸠尾、间使", + "C": "百会、神门、安眠、合谷、委中", + "D": "大椎、三阴交、行间、内庭、内关", + "E": "水沟、内关、足三里、照海、丰隆" + }, + "answer": "A", + "reason": "痫病发作期治疗主穴:水沟、百会、后溪、内关、涌泉;间歇期主穴:印堂、丰隆、太冲、鸠尾、间使、腰奇。痫病配穴:①痰火扰神配神门、行间、内庭;②风痰闭阻配合谷、风池、阴陵泉;③瘀阻脑络配膈俞、内关、血海;④心脾两虚配心俞、脾俞、足三里;⑤肝肾阴虚配肝俞、肾俞、三阴交。" + }, + { + "question_num": 76, + "query": "治崩三法是", + "options": { + "A": "塞流、澄源、复旧", + "B": "塞流、澄源、求因", + "C": "止血、求因、固本", + "D": "塞流、止血、澄源", + "E": "健脾、调肝、补肾" + }, + "answer": "A", + "reason": "治崩三法为塞流、澄源、复旧①塞流即是止血，用于暴崩之际，急当塞流止血防脱;②澄源即正本清源,亦是求因治本，是治疗崩漏的重要阶段，般用于出血减缓后的辨证论治,切忌不问缘由，概投寒凉或温补之剂,或专事炭涩,致犯虚虚实实之戒;③复旧即固本善后，是巩固崩漏治疗的重要阶段，用于止血后恢复健康,调整月经周期,或促排卵。治法或补肾,或扶脾,或疏肝。" + }, + { + "question_num": 77, + "query": "钩藤入汤剂宜", + "options": { + "A": "先煎", + "B": "后下", + "D": "另煎", + "C": "包煎", + "E": "烊化" + }, + "answer": "B", + "reason": "钩藤含挥发性成分，若久煎其有效成分会被破坏,因此钩藤人汤剂宜后下，故选择B。" + }, + { + "question_num": 78, + "query": "对脾肿大与腹腔肿块的鉴别,最有意义的是", + "options": { + "A": "质地", + "B": "活动度", + "C": "有无压痛", + "D": "有无切迹", + "E": "叩诊音的差异" + }, + "answer": "D", + "reason": "中度以以上脾肿大时，其右缘常可触及脾切迹，可与左肋下其他腹腔肿块相监别。" + }, + { + "question_num": 79, + "query": "下列属于手厥阴心包经的穴位是", + "options": { + "A": "关冲", + "B": "天池", + "C": "太溪", + "D": "阳池", + "E": "曲泉" + }, + "answer": "B", + "reason": "天池穴在属手厥阴心包经;在胸部,第4肋间隙,前正中线旁开5寸。主治:①咳嗽、气喘、胸闷、痰多、胸痛等胸病证,②腋下肿痛,乳痈,乳少;③瘰疬。" + }, + { + "question_num": 80, + "query": "感染邪毒产后发热的主要证候，下列哪项是错误的", + "options": { + "A": "高热寒战,热势不退", + "B": "小腹疼痛拒按", + "C": "恶露量少,色紫暗,气秽臭", + "D": "心烦口渴,尿黄,便结", + "E": "舌红,脉细数无力" + }, + "answer": "E", + "reason": "产后发热感染邪毒证,主要证候:产后高热寒战,热势不退，小腹疼痛拒按,恶露量或多或少,色紫暗如败酱,气臭秽;心烦口渴,尿少色黄,大便燥结;舌红苔黄,脉数有力。" + }, + { + "question_num": 81, + "query": "下列属于火的特性的是", + "options": { + "A": "稼穑", + "B": "曲直", + "C": "从革", + "D": "润下", + "E": "炎上" + }, + "answer": "E", + "reason": "尚书《洪范》:木曰曲直,火曰炎上,土曰稼穑,金曰从革,水曰润下" + }, + { + "question_num": 82, + "query": "关于中枢性面神经麻痹，下列说法正确的是", + "options": { + "A": "病因为面神经受损", + "B": "病灶同侧面肌瘫痪", + "C": "可出现味觉障碍", + "D": "可见于脑肿瘤", + "E": "口角歪向病灶对侧" + }, + "answer": "D", + "reason": "中枢性面神经麻痹:病因为核上组织(如皮质、脑桥、内等)受损;表现为病灶对侧颜面下部肌肉麻痹，口角歪向病灶侧;多见于脑炎、脑肿瘤、脑血管病变等。" + }, + { + "question_num": 83, + "query": "治疗面瘫所选的经脉是", + "options": { + "A": "手足阳明经", + "B": "手足太阴经", + "C": "手足少阳经", + "D": "手足厥阴经", + "E": "督脉" + }, + "answer": "A", + "reason": "面瘫的治法以祛风通络,疏调经筋为主,取局部穴、手足阳明经穴为主。" + }, + { + "question_num": 84, + "query": "小儿腹泻脾虚泻的治法为", + "options": { + "A": "健脾益气,酸甘敛阴", + "B": "清肠解毒,化湿止泻", + "C": "健脾益气,助运止泻", + "D": "疏风散寒,化湿和中", + "E": "运脾和胃,消食化滞" + }, + "answer": "C", + "reason": "小儿脾虚泻，证见大便稀溏，色淡不臭，多于食后作泻,时轻时重,面色菱黄:形体消瘦,神疲倦怠,舌淡苔白,脉缓弱,指纹淡。治法为健脾益气,助运止泻，方用参苓白术散。" + }, + { + "question_num": 85, + "query": "疾病发生的内在根据是", + "options": { + "A": "邪气偏盛", + "B": "正气不足", + "C": "邪盛正衰", + "D": "正胜邪衰", + "E": "正虚邪恋" + }, + "answer": "B", + "reason": "正气不足是疾病发生的根本原因。脏腑功能正常，正气旺盛,气血充盈，卫外固密,病邪难于侵人，则不会发生疾病;或病邪虽能侵犯人体,但正气旺盛,能够抗邪外出,使邪气不能在体内停留,疾病也不会发生。人体正气相对虚弱，卫外不同,抗邪无力的情况下,邪气乘虑而人,使人体阴阳失调,脏腑经络功能紊乱,便会��生疾病。" + }, + { + "question_num": 86, + "query": "对腹部实质性脏器病变,最简便易行的检查方法是", + "options": { + "A": "CT扫描", + "B": "X线平片", + "C": "同位素扫描", + "D": "B型超声波检查", + "E": "纤维内窥镜检查" + }, + "answer": "D", + "reason": "B型超声波检查在临床上应用广泛,常用于检测实质性脏器如肝、肾、脾、胰腺、子宫及卵巢等的大小、形态、边界及脏器内部回声等,判断有无病变及病变情况。" + }, + { + "question_num": 87, + "query": "心的募穴是", + "options": { + "A": "极泉", + "B": "膻中", + "C": "巨阙", + "D": "鸠尾", + "E": "天池" + }, + "answer": "C", + "reason": "心的募穴:巨阙。" + }, + { + "question_num": 88, + "query": "下列各项,不属于小儿添加辅食原则的是", + "options": { + "A": "由少到多", + "B": "由稠到稀", + "C": "由稀到稠", + "D": "由细到粗", + "E": "品种渐增" + }, + "answer": "B", + "reason": "添加辅助食品的原则:由少到多,由稀到稠,由细到粗,由一种到多种,在婴儿健康、消化功能正常时逐步添加。" + }, + { + "question_num": 89, + "query": "疠气与六淫邪气的主要区别是", + "options": { + "A": "多与季节气候有关", + "B": "多与地理环境有关", + "C": "体外人侵", + "D": "具有强烈传染性", + "E": "多从皮毛口鼻而人" + }, + "answer": "D", + "reason": "疠气的致病特点有发病急骤病情危笃;传染性强,易于流行;一气一病,症状相似这三个特点,故疠气与六淫邪气的区别主要在于具有强烈的传染性。" + }, + { + "question_num": 90, + "query": "下列符合漏出液的特点的是", + "options": { + "A": "能自凝", + "B": "比重>1.018", + "C": "外观呈血性", + "D": "白细胞计数>0.5x10^9/L", + "E": "无病原菌" + }, + "answer": "E", + "reason": "漏出液为非炎症因素所致,无病原菌;外观淡黄、透明或微混,浆液性;不自凝，比重<1.015。" + }, + { + "question_num": 91, + "query": "常用于治疗瘾疹、瘰疬的是", + "options": { + "A": "囧阳", + "B": "合谷", + "D": "偏历", + "C": "阳溪", + "E": "曲池" + }, + "answer": "E", + "reason": "曲池主治:①手臂痹痛、上肢不遂等上肢病证;②热病;③眩晕;④腹痛、吐泻等肠胃病证;⑤咽喉肿痛、齿痛、目赤肿痛等五官热性病证;⑥瘾疹、湿疹、瘰疬等皮外科疾患;⑦癫狂。" + }, + { + "question_num": 92, + "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": "小儿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拾头;4个月时可用手撑起上半身;6个月时能独坐片刻7个月会翻滚;8个月会爬;10个月可站立扶走;12个月后能独走;18个月可跑步和倒退行走;24个月时可双足并跳;36个月会骑三轮车。" + }, + { + "question_num": 93, + "query": "一身之气不足及其功能低下的病理状态是", + "options": { + "A": "气虚", + "B": "气滞", + "C": "气逆", + "D": "气闭", + "E": "气脱" + }, + "answer": "A", + "reason": "气不足,又称气虚,是指在疾病过程中,气的生化不足或耗散太过而致气的亏损,从而使脏腑组织功能活动减退，抗病能力下降的病理状态。" + }, + { + "question_num": 94, + "query": "下列是典型心绞痛的心电图改变的是", + "options": { + "A": "QRS波群宽大畸形", + "B": "面对缺血区导联ST段抬高,T波高尖", + "C": "面对缺血区导联Q波加宽,宽度≥0.04s", + "D": "面对缺血区导联Q波加深,深度≥R波的1/4", + "E": "面对缺血区导联ST段水平压低≥0.1mV,T波倒置" + }, + "answer": "E", + "reason": "典型心绞痛发作时,面对缺血区的导联上出现ST段水平压低,>0.1mV,T波低平或倒置。" + }, + { + "question_num": 95, + "query": "善于治疗遗尿、小便不利、癃闭等泌尿系病证的腧穴是", + "options": { + "B": "建里", + "A": "下脘", + "C": "中极", + "D": "气海", + "E": "关元" + }, + "answer": "C", + "reason": "中极主治:①遗尿、小便不利,癃闭等泌尿系病证;②遗精、阳痿、不育等男科病证;③月经不调、崩漏、阴挺、阴痒、不孕、产后恶露不止、带下等妇科病证。" + }, + { + "question_num": 96, + "query": "小儿肾病综合征气阴两虚证的治法是", + "options": { + "A": "益气健脾;利水消肿", + "B": "清热解毒,利水消肿", + "C": "活血化瘀,利水消肿", + "D": "滋阴补肾,平肝潜阳", + "E": "益气养阴,利水消肿" + }, + "answer": "E", + "reason": "小儿肾病综合征气阴两虚证治法以益气养阴，利水消肿，方选六味地黄丸加黄芪。" + }, + { + "question_num": 97, + "query": "中医治疗血虚证时，常加入一定量的补气药,其根据是", + "options": { + "A": "气能行血", + "B": "气能摄血", + "C": "气能生血", + "D": "血能生气", + "E": "血能载气" + }, + "answer": "C", + "reason": "从血液的组成上看,营气是血液的主要成分,即营气能化生血液。故选择C。" + }, + { + "question_num": 98, + "query": "传染病流行过程的基本条件", + "options": { + "A": "散发、流行、暴发", + "B": "自然因素、社会因素", + "C": "周围性、地区性、季节性", + "D": "传染源、传播途径、易感人群", + "E": "患者、病原携带者、受感染的动物" + }, + "answer": "D", + "reason": "传染病流行过程的基本条件是传染源、传播途径、易感人群。" + }, + { + "question_num": 99, + "query": "下列哪项不属于对症选穴", + "options": { + "A": "落枕取外劳宫", + "B": "肾阴不足选肾俞、太溪", + "C": "目赤取耳尖", + "D": "面瘫取牵正", + "E": "腰痛取腰痛点" + }, + "answer": "B", + "reason": "对症选穴是针对疾病的个别突出的症状而选取穴位。辨证选穴是根据疾病的证候特点，分析病因病机而辨证选取穴位的方法。所以B选项应该属于辨证选穴。" + }, + { + "question_num": 100, + "query": "胎黄伴肝脏进行性肿大,大便灰白,黄疸逐渐加深。多因", + "options": { + "A": "寒湿内蕴", + "B": "脾运失职", + "C": "肠腑阻结", + "D": "肝失疏泄", + "E": "气滞血瘀" + }, + "answer": "E", + "reason": "胎黄的病因主要为胎禀湿蕴如湿热郁蒸、寒湿阻滞,久则气滞血瘀。病变脏腑在肝胆、脾胃,其发病机理主要为脾胃湿热或寒湿内蕴,肝失疏泄，胆汁外溢而致发黄，日久则气滞血瘀。" + }, + { + "question_num": 101, + "query": "脾的阴阳属性是", + "options": { + "A": "阳中之阳", + "B": "阳中之阴", + "C": "阴中之阴", + "D": "阴中之阳", + "E": "阴中之至阴" + }, + "answer": "E", + "reason": "脾位于属阴的膈下腹中,通应于长夏之气,长夏属至阴,故谓脾为“阴中之至阴”" + }, + { + "question_num": 102, + "query": "下列各项,小细胞低色素性贫血最常见的是", + "options": { + "A": "铁粒幼细胞性贫血", + "B": "巨幼红细胞性贫血", + "C": "缺铁性贫血", + "D": "再生障碍性贫血", + "E": "骨髓病性贫血" + }, + "answer": "C", + "reason": "缺铁性贫血(IDA)是因体内铁储备耗竭形响血红蛋白合成所引起的贫血是贫血中最常见的类型，属于血红素合成异常性贫血,可发生于任何年龄。体内铁代谢异常始于铁缺乏症,包括开始时体内贮铁耗尽，继之红细胞胞低色素性贫血。" + }, + { + "question_num": 103, + "query": "体虚感冒者,宜加用", + "options": { + "A": "阴陵泉", + "B": "太冲", + "D": "尺泽", + "C": "委中", + "E": "足三里" + }, + "answer": "E", + "reason": "感冒的针灸配穴:风寒感冒配风门、肺俞;风热感冒配曲池、尺泽;夹湿配阴陵泉;夹暑配委中。体虚感冒配足三里;咽喉疼痛配少商、商阳。" + }, + { + "question_num": 104, + "query": "关于乳蛾的诊断要点,说法错误的是", + "options": { + "A": "以咽痛为主要症状", + "B": "急性乳蛾病程短", + "C": "一定伴有发热症状", + "D": "可见扁桃体肿大", + "E": "可伴有吞咽困难" + }, + "answer": "C", + "reason": "乳蛾诊断要点以咽痛、吞咽困难为主要症状。急乳蛾有发热，慢乳蛾不发热或有低热。急乳蛾起病较急，病程较短;反复发作则转化为慢乳蛾,病程较长。咽部检查:急乳蛾可见扁桃体充血呈鲜红或深红色，肿大，表面可有脓点,严重者有小脓肿;慢乳蛾可见扁桃体肿大,充血呈暗红色，或不充血，表面或有脓点，或挤压后有少许脓液溢出。实验室检查:急乳蛾及部分慢乳蛾者可见血白细胞总数及中性粒细胞增高。" + }, + { + "question_num": 105, + "query": "具有退虚热、清热燥湿功效的药物是", + "options": { + "A": "黄芩", + "B": "黄连", + "C": "胡黄连", + "D": "知母", + "E": "苦参" + }, + "answer": "C", + "reason": "胡黄连:①清虚热,用于阴虚发热,本品苦寒,有清退虚热之效,治阴虚发热，常与银柴胡、地骨皮等同用;②除疳热，用于疳积发热,本品功能清虚热、除疳热，治小儿疳积，消瘦腹胀,低热不退,常配伍党参、山楂等,如肥���丸;③清湿热,用于湿热泻痢,痔疮肿痛。本品还能清热燥湿,用于湿热泻痢、痔疮肿痛。治湿热泻痢,常与白头翁等配伍;治痔疮肿痛,可研末,以鹅胆汁调涂局部,或与刺猬皮、香配伍内服。" + }, + { + "question_num": 106, + "query": "腰椎间盘脱出所致的坐骨神经痛的体征是", + "options": { + "A": "戈登征阳性", + "B": "布鲁津斯基征阳性", + "C": "查多克征阳性", + "D": "拉塞格征阳性", + "E": "霍夫曼征阳性" + }, + "answer": "D", + "reason": "拉塞格征为坐骨神经根受刺激的表现,又称坐骨神经受刺激征。阳性见于腰椎间盘突出症、坐骨神经痛、腰骶神经根炎等。" + }, + { + "question_num": 107, + "query": "治疗瘾疹的主穴是", + "options": { + "A": "曲池、合谷、血海、膈俞、三阴交", + "B": "大椎、曲池、太冲、风池、中脘", + "C": "大椎、太冲、三阴交、血海、内庭", + "D": "血海、内庭、足三里、气海、天枢", + "E": "外关、风池、三阴交、大椎、膈俞" + }, + "answer": "A", + "reason": "瘾疹的针灸治疗处方主穴:曲池、合谷、血海、俞、三阴交、委中。配穴:风热犯表配大椎、风门;风寒束表配风门、肺俞;胃肠积热配天枢、足三里;血虚风燥配脾俞、足三里呼吸困难配天突,恶心呕吐配内关。" + }, + { + "question_num": 108, + "query": "小儿遗尿的病机多见", + "options": { + "A": "肾气不足,膀胱虚寒", + "B": "肺脾气虚,水道失约", + "C": "心肾失交,水火不济", + "D": "肝经郁热,疏泄失司", + "E": "脾肾气虚,下元不固" + }, + "answer": "A", + "reason": "遗尿多与膀胱和肾的功能失调有关,其中尤以肾气不足、膀胱虚寒为多见。" + }, + { + "question_num": 109, + "query": "在发病过程中,邪气的作用是", + "options": { + "A": "发病的重要条件", + "B": "对疾病无影响", + "C": "决定是否发病", + "D": "决定疾病的性质", + "E": "发病的决定因素" + }, + "answer": "A", + "reason": "邪气是发病的必要条件,在一定的条件下,甚至起主导作用。" + }, + { + "question_num": 110, + "query": "细菌性痢疾的病原菌中毒力最强的是", + "options": { + "A": "宋内志贺菌", + "B": "福氏志贺菌", + "C": "鲍氏志贺菌", + "D": "舒氏志贺菌", + "E": "痢疾志贺菌" + }, + "answer": "E", + "reason": "我国常见的痢疾杆菌中,痢疾志贺菌的毒力最强，感染病情较重,但抵抗力最弱;福氏志贺菌感染易转为慢性;宋内志贺菌毒力弱,感染病情轻,多不典型，但抵抗力最强。" + }, + { + "question_num": 111, + "query": "目赤肿痛属风热证者,可配用", + "options": { + "A": "鱼腰、球后", + "B": "少商、外关", + "C": "行间、侠溪", + "D": "血海、膈俞", + "E": "列缺、照海" + }, + "answer": "B", + "reason": "目赤肿痛的针灸配穴:外感风热配少商、外关;肝胆火盛配行间、侠溪。" + }, + { + "question_num": 112, + "query": "丹痧的典型舌象为", + "options": { + "A": "地图舌", + "B": "红绛舌", + "C": "霉酱苔", + "D": "镜面舌", + "E": "草莓舌" + }, + "answer": "E", + "reason": "舌质紫暗或紫红,为气血瘀滞;舌起粗大红刺,状如草莓者,常见于丹痧、皮肤黏膜淋巴结综合征。" + }, + { + "question_num": 113, + "query": "羌活与独活均能祛风解表,胜湿止痛,其区别点是", + "options": { + "A": "独活为“风药中之燥剂”,羌活则为“风药中之润剂”", + "B": "羌活的解表力弱,独活的解表力强", + "C": "羌活能够治疗阳明头痛,独活能够治疗少阳头痛", + "D": "独活善于治疗下半身的寒湿痹痛，羌活善于治疗上半身的寒湿痹痛", + "E": "独活既可治疗风寒表证,也可治疗风热表证" + }, + "answer": "D", + "reason": "羌活与独活二药，均能祛风胜湿、止痛、解表,常用治风寒湿痹和外感风寒湿表证。但羌活气味较浓,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,长于治下部风寒湿痹痛,其解表之力不及羌活。若一身尽痛,则二药常相须为用。" + }, + { + "question_num": 114, + "query": "下列伤寒各期，可见玫瑰疹的是", + "options": { + "A": "潜伏期", + "B": "初期", + "C": "极期", + "D": "缓解期", + "E": "恢复期" + }, + "answer": "C", + "reason": "玫瑰疹多于伤寒病程第6~12日出现,是极期(病程第2~3周)的典型表现，常散在分布于患者前胸和上腹部。" + }, + { + "question_num": 115, + "query": "下列哪项不是太椎穴的主治病症", + "options": { + "A": "热病、疟疾", + "B": "骨蒸潮热", + "C": "癫狂痫、小儿惊风", + "D": "腹泻、痢疾、脱肛", + "E": "风疹、痤疮" + }, + "answer": "D", + "reason": "大椎,主治:①热病、疟疾、恶寒发热、咳嗽、气喘等外感病证;②骨蒸潮热;③疯狂痫证、小儿惊风等神志病证;④项强,脊痛等脊柱病证;⑤风疹,痤疮等皮肤疾病。" + }, + { + "question_num": 116, + "query": "急惊风的“四证”是指", + "options": { + "A": "风、火、积、热", + "B": "风、痰、热、惊", + "C": "痰、积、惊、热", + "D": "惊、热、痰、火", + "E": "痰、火、积、热" + }, + "answer": "B", + "reason": "急惊风为痰、热、惊、风四证俱备,临床以高热、抽风、神昏为主要表现,多由外感时邪、内蕴湿热和暴受惊恐而引发。" + }, + { + "question_num": 117, + "query": "下列不属于七情致病的一般规律的是", + "options": { + "A": "惊则气逆", + "B": "喜则气缓", + "C": "悲则气消", + "D": "恐则气下", + "E": "怒则气上" + }, + "answer": "A", + "reason": "素问·举痛论》说:“怒则气上,喜则气缓,悲则气消,恐则气下,惊则气乱,思则气结。”" + }, + { + "question_num": 118, + "query": "伤寒患者经治疗后体温渐降,但未降至正常,此后体温再次升高,血培养阳性,属于", + "options": { + "A": "复发", + "B": "再燃", + "C": "重复感染", + "D": "混合感染", + "E": "再感染" + }, + "answer": "B", + "reason": "再燃是指体温未稳定下降至正常，而再次出现发热。而复发是指稳定退热一段时间,由于潜伏于组织内的病原体再度繁殖使初发病的症状再度出现。" + }, + { + "question_num": 119, + "query": "常用于治疗经团、滞产的穴位是", + "options": { + "A": "商阳", + "B": "合谷", + "C": "阳溪", + "D": "偏历", + "E": "曲池" + }, + "answer": "B", + "reason": "合谷,主治:①头痛、目赤肿痛、鼻衄、齿痛、口眼歪斜、耳聋等头面五官诸疾;②发热恶寒等外感病证;③热病无汗或多汗④经闭、滞产等妇产科病证;⑤上肢疼痛、不遂;⑥牙拔除术、甲状腺手术等口面五官及颈部手术针麻常用穴。" + }, + { + "question_num": 120, + "query": "蛔虫病以腹痛为主要症状,其疼痛部位主要是", + "options": { + "A": "胃脘部", + "B": "脐周部", + "C": "左下股", + "D": "右下腹", + "E": "痛无定处" + }, + "answer": "B", + "reason": "蛔虫病是感染蛔虫卵引起的小儿常见肠道寄生虫病,以脐周疼痛,时作时止，饮食异常，大便下虫,或粪便镜检有蛔虫卵为主要特征。" + }, + { + "question_num": 121, + "query": "五脏的生理功能特点是", + "options": { + "A": "传化物而不藏,实而不能满", + "B": "藏精气而不泻,满而不能实", + "C": "传化物而不藏,满而不能实", + "D": "藏精气而不泻,实而不能满", + "E": "虚实交替,泻而不藏" + }, + "answer": "B", + "reason": "五脏的功能特点是化生贮藏精气,精气对人体起到重要作用,故宜藏不宜泻。五脏所藏精气宜充满、不宜呆实,精气不断运作,才能维持五脏正常生理功能。" + }, + { + "question_num": 122, + "query": "霍乱弧菌最重要的致病物质是", + "options": { + "A": "菌毛", + "B": "鞭毛", + "C": "霍乱肠毒素", + "D": "内毒素", + "E": "荚膜" + }, + "answer": "C", + "reason": "霍乱弧菌主要通过污染的水源或饮食物经口传染。霍乱肠毒素作用于黏膜上皮细胞与肠腺使肠液过度分泌，从而患者出现上吐下泻,泻出物呈“米泔水”样并含大量弧菌，此为本病典型的特征。霍乱肠毒素是引起霍乱症状的主要物质。" + }, + { + "question_num": 123, + "query": "患者,男,48岁。咳嗽喘逆不得卧,气短气急,咳痰稀白量多呈泡沫状，口干不欲饮:头痛,恶寒,无汗,选用的治法为", + "options": { + "A": "温肺散寒,化痰降逆", + "B": "清热化痰,宣肺平喘", + "C": "补肺纳肾,降气平喘", + "D": "温肾健胖，化饮利水", + "E": "健脾益肺,宣肺降气" + }, + "answer": "A", + "reason": "外寒里饮证,证候:咳嗽喘逆不得卧,气短气急,咳痰稀白量多呈泡沫状,胸部膨满,口干不欲饮,面色青暗,周身酸楚,头痛,恶寒,无汗,舌体胖大,舌质暗淡,苔白滑,脉浮紧。治法:温肺散寒，化痰降逆。方药:小青龙汤加减。" + }, + { + "question_num": 124, + "query": "患者,男,27岁。患梅毒疳疮,质硬而润,伴横疾,口苦口干,舌红苔腻,脉弦滑,其证候是", + "options": { + "A": "痰瘀互结", + "B": "脾虚湿蕴", + "C": "肝经湿热", + "D": "气血两虚", + "E": "气阴两虚" + }, + "answer": "C", + "reason": "舌红,苔黄腻,脉弦滑而数,为肝经湿热之征。" + }, + { + "question_num": 125, + "query": "被称为“华盖”的脏是", + "options": { + "A": "肝", + "B": "心", + "C": "脾", + "D": "肺", + "E": "肾" + }, + "answer": "D", + "reason": "肺居胸腔,左右各一,上接气管、喉咙,与鼻相通。在诸脏腑中,肺位最高,故称“华盖”。" + }, + { + "question_num": 126, + "query": "人体被病原体侵袭后不出现或仅表现轻微症状，但通过免疫学的检测可发现入侵者的抗体称为", + "options": { + "A": "轻型病例", + "B": "隐性感染", + "C": "恢复期患者", + "D": "潜伏性感染", + "E": "健康携带者" + }, + "answer": "B", + "reason": "人体被病原体侵袭后不出现或仅表现轻微症状，但通过免疫学的检测可发现人侵者的抗体,称为隐性感染。" + }, + { + "question_num": 127, + "query": "患者,女,28岁。泄泻多在黎明之前，腹部作痛,肠鸣即泻,泻后则安,形寒肢冷,腰膝酸软，舌淡苔白,脉沉细，其治法是", + "options": { + "A": "温肾健脾,固涩止泻", + "B": "温中健脾,固涩止泻", + "C": "温补脾肾,涩肠止泻", + "D": "健脾补肾,化湿固涩", + "E": "补肾助阳,温中固涩" + }, + "answer": "A", + "reason": "命门火衰,脾失温煦导致黎明泄,主症是泄泻多在黎明之前,腹部作痛,肠鸣即泻,泻后则安,形寒肢冷,腰膝酸软等,辨证属于泄泻的肾阳虚衰证,其治法温肾健脾,固涩止泻。" + }, + { + "question_num": 128, + "query": "患者,男,35岁。不慎跌入盛有开水的桶中,查体可见头面部、颈部及双上肢皮肤红且有大小不等的水疱隆起，皮肤患者自述疼痛剧烈难忍。此患者的烧伤面积为，其诊断是", + "options": { + "A": "面积约为27%的浅Ⅱ度烧伤", + "B": "面积约为18%的浅Ⅱ度烧伤", + "C": "面积约为27%的亚度烧伤", + "D": "面积约为18%的工度烧伤", + "E": "面积约为9%的深Ⅱ度烧伤" + }, + "answer": "A", + "reason": "浅】'烧伤(水疱性烧伤):伤及表皮的生发层、真皮乳头层。局部红肿明显，有薄壁大水疱形成，内含淡黄色澄清液体，水疱皮如被剥脱,可见创面红润、潮湿,疼痛明显。成人头、面、颈部为9%;双上肢为2x9%,加起来为27%。" + }, + { + "question_num": 129, + "query": "气机升降指的是", + "options": { + "A": "心肺关系", + "B": "肺肝关系", + "D": "脾肾关系", + "C": "肝脾关系", + "E": "心肾关系" + }, + "answer": "B", + "reason": "肺居膈上,其气肃降;肝居膈下,其气升发。肝从左而升,肺从右而降,“左右者阴阳之道路也”(《素问·阴阳应象大论》)。肝从左升为阳道,肺从右降为阴道,肝升才能肺降肺降才能肝升,升降得宜,出人交替,则气机舒展。人体精气血津液运行以肝肺为枢转，肝升肺降,以维持人体气机的正常升降运动。因此肝肺是与气机调节关系密切的。" + }, + { + "question_num": 130, + "query": "人感染高致病性禽流感多暴发流行的季节为", + "options": { + "A": "春夏", + "B": "夏秋", + "C": "冬春", + "D": "秋冬", + "E": "全年" + }, + "answer": "C", + "reason": "禽流感一年四季均可发生,但冬、春季节多暴发流行。" + }, + { + "question_num": 131, + "query": "患者,男,59岁,下肢癌软无力一年余:加重两个月。现发热，胸痞脘闷，小便短赤涩痛,苔黄腻,脉细数。选用方药是", + "options": { + "A": "清瘟败毒饮", + "B": "清燥救肺汤", + "C": "加味二妙散", + "D": "参苓白术散", + "E": "大补阴煎" + }, + "answer": "C", + "reason": "患者为癌证之湿热浸淫,气血不运证,治宜清热利湿,通利筋脉,选用加味二妙散加减。" + }, + { + "question_num": 132, + "query": "患者,女,45岁。一侧乳房广泛紧韧肿硬,皮色紫红,皮肤呈橘皮样变,全身炎症反应不明显,应首先考虑为", + "options": { + "A": "乳岩", + "B": "乳痨", + "C": "乳痈", + "D": "乳发", + "E": "乳癖" + }, + "answer": "A", + "reason": "乳岩一般类型乳腺癌的临床表现:常为乳房内无痛肿块,边界不清,质地坚硬,表面不光滑,不易推动,常与皮肤粘连,出现病灶中心酒窝征，个别可伴乳头溢液。后期随着癌肿逐渐增大,产生不同程度疼痛,皮肤可呈橘皮样水肿、变色;病变周围可出现散在的小肿块,状如堆栗;乳头内缩或抬高,偶可见到皮肤溃疡，晚期,乳房肿块溃烂,疮口边缘不整齐，中央凹陷似岩穴,有时外翻似菜花,时渗紫红血水,恶臭难闻。癌肿转移至腋下及锁骨上时，可触及散在、数目少、质硬无痛的肿物，以后渐大，互相黏连融合成团,继而出现形体消瘦,面色苍白,憔悴等恶病质貌。" + }, + { + "question_num": 133, + "query": "心在志为", + "options": { + "A": "怒", + "B": "喜", + "C": "思", + "D": "悲", + "E": "恐" + }, + "answer": "B", + "reason": "对于情志的分类,中医学有五志说和七情说之分，五志说认为，人的情志有五，即怒、喜、思、忧、悲:肝“在志为怒”,心“在志为喜”,脾“在志为思”,肺“在志为忧”,肾“在志为恐”《素问·阴阳应象大论》),故称五志。" + }, + { + "question_num": 134, + "query": "狂犬病的特异且具有诊断价值病理变化的是", + "options": { + "A": "急性弥漫性脑脊髓炎", + "B": "脑膜多正常", + "C": "脑实质和脊髓充血水肿", + "D": "内基小体", + "E": "脊髓段病变一般比较严重" + }, + "answer": "D", + "reason": "狂大病病理变化主要为急性弥漫性脑脊髓炎,脑膜多正常，脑实质和脊髓充血、水肿及微小出血灶,咬伤部位相应的背根神经节、脊髓段病变一般比较严重,延髓、海马、脑桥、小脑等处受损也较显著。镜下可见内基小体,是本病特异且具有诊断价值的病变。" + }, + { + "question_num": 135, + "query": "患者，老年，女性,烦热口苦,渴不欲饮,小便赤涩,大便秘结!舌红,苔黄腻,脉弦数,其治法是", + "options": { + "A": "清热化湿,理气利水", + "B": "清肝泻热,通腑泻下", + "C": "理气化瘀,攻上逐水", + "D": "通阳利水,攻下逐水", + "E": "清热利湿,攻下逐水" + }, + "answer": "E", + "reason": "分析其主证,此为鼓胀之水热蕴结证型，当以清热利湿，攻下逐水为法。" + }, + { + "question_num": 136, + "query": "患者,男,25岁。晨起跑步时偶遇风后全身泛发风团,色白,伴瘙痒,发无定处,成批发生，用温水清洗后皮损很快消退，口不渴，舌淡,苔白,脉浮紧。宜选用何方治疗", + "options": { + "A": "消风散", + "B": "麻黄桂枝各半汤", + "C": "麻黄附子细辛汤", + "D": "当归饮子", + "E": "四物消风散" + }, + "answer": "B", + "reason": "患者辨为瘾疹的风寒束表证风团色白,過寒加重,得暖则减;恶寒怕冷,口不渴;舌淡红,苔薄白,脉浮紧。治法:疏风散塞止痒。方药:麻黄桂枝各半汤加减。" + }, + { + "question_num": 137, + "query": "具有“喜润恶燥”生理特性的是", + "options": { + "A": "胆", + "B": "胃", + "C": "小肠", + "D": "大肠", + "E": "膀胱" + }, + "answer": "B", + "reason": "喜润恶燥是指胃喜于滋润而恶于燥烈的特性。" + }, + { + "question_num": 138, + "query": "诊断慢性阻塞性肺疾病(COPD)的基础条件是", + "options": { + "A": "FEV₁/FVC<40%", + "B": "FEV₁/FVC<50%", + "C": "FEV₁/FVC<60%", + "D": "FEV₁/FVC<70%", + "E": "FEV₁/FVC<80%" + }, + "answer": "D", + "reason": "COPD诊断的必备条件是不完全可逆的气流受限，吸入支气管扩张剂后FEV,/FVC<70%最有助于诊断。" + }, + { + "question_num": 139, + "query": "患者男性,32岁。皮肤出现青紫斑点5日,伴有鼻衄,口渴,便秘,舌质红,苔黄,脉弦数。治疗本病首选的方剂是", + "options": { + "A": "泻白散", + "B": "十灰散", + "C": "茜根散", + "D": "归脾汤", + "E": "黄土汤" + }, + "answer": "B", + "reason": "紫斑之血热妄行证,证见:皮肤出现青紫斑点或斑块，或伴有鼻衄、齿衄、便血、尿血,或有发热,口渴,便秘,舌质红,苔黄,脉弦数。治法:清热解毒,凉血止血。代表方:十灰散加减。" + }, + { + "question_num": 140, + "query": "患者,女,43岁。人院时诊断为肠痈。现腹皮挛急,全腹压痛、反跳痛,腹胀,恶心呕吐,大便不爽,次数增多,小便频数,时时汗出,皮肤甲错,二目下陷,口干而臭，舌红苔黄糙:脉细数,其证候是", + "options": { + "A": "执毒证", + "B": "癌洪证", + "C": "湿热证", + "D": "气血两虚证", + "E": "邪热壅肺证" + }, + "answer": "B", + "reason": "患者皮肤甲错,二目下陷,口干而臭,舌红苔黄糙,脉细数,为燥热伤阴所致:腹胀,恶心呕吐,大便不爽,次数增多,小便频数,可知热毒证。" + }, + { + "question_num": 141, + "query": "麦冬的功效是", + "options": { + "A": "润肺益肾,养肝", + "B": "润肺益胃,养肝", + "C": "润肺益肾,清心", + "D": "养阴生津,润肺清心", + "E": "润肺益肾,益胃" + }, + "answer": "D", + "reason": "麦冬的功效是养阴生津,润肺清心。" + }, + { + "question_num": 142, + "query": "下列符合肺心病失代偿期强心剂应用指征的是", + "options": { + "A": "肺动脉高压", + "B": "两肺底湿啰音", + "C": "���急发绀明显", + "D": "心率大于120次/分", + "E": "感染和呼吸衰竭已控制,利尿剂无效" + }, + "answer": "E", + "reason": "肺心病失代偿期控制心力衰竭应用强心剂的指征:①感染已被控制，呼吸功能已改普,利尿剂效果不理想而反复水肿者;②合并室上性快速型心律失常者;③右心衰竭为主,无明显急性感染者;④出现急性左心衰竭者，" + }, + { + "question_num": 143, + "query": "患者平素眩晕,耳鸣。失眠多梦,急躁易怒,舌红脉弦。治疗应首选", + "options": { + "A": "大秦艽汤", + "B": "镇肝熄风汤", + "C": "龙胆泻肝汤", + "D": "地黄饮子", + "E": "天麻钩藤汤" + }, + "answer": "E", + "reason": "本题中所提供的病例,应诊断为肝阳上亢之眩晕。治疗以平肝潜阳，清火息风。首选为天麻钩藤饮。" + }, + { + "question_num": 144, + "query": "患者,女性,40岁。无意中发现背部肿块,无自觉症状,查:局部皮色不变,肿块触之柔软,呈分叶状,推之可移动,无压痛。该患者最可能的诊断是", + "options": { + "A": "痈", + "B": "背疽", + "C": "血瘤", + "D": "脂瘤", + "E": "肉瘤" + }, + "answer": "E", + "reason": "肉瘤的概念及临床表现特点肉瘤是发于皮里膜外、由脂肪组织过度增生而形成的良性肿瘤。多见于成年女性，可发于身体各部,好发于肩、背、腹、及前臂皮下。大小不一.边界清楚,皮色不变,生长缓慢,触之柔软,呈扁平团块状或分叶状,推之可移动，基底较广阔，一般无疼痛。多发者常见于四肢、胸或腹部。" + }, + { + "question_num": 145, + "query": "脾切除治疗原发免疫性血小板减少症的主要机制是", + "options": { + "A": "降低毛细血管通透性", + "B": "降低单核巨噬细胞系统活性", + "C": "减少血小板抗体的产生", + "D": "延长血小板寿命", + "E": "抑制抗原抗体反应" + }, + "answer": "C", + "reason": "脾脏产生血小板抗体,同时又通过巨噬细胞介导破坏血小板。所以脾切除术不仅减少了血小板抗体的产生，同时去除了血小板破坏的场所，是目前治疗该病最有效的方法之一" + }, + { + "question_num": 146, + "query": "哮喘发作时,缓解支气管痉挛的首选药物是", + "options": { + "A": "茶碱", + "B": "沙丁胺醇", + "C": "色甘酸钠", + "D": "异丙托溴铵", + "E": "糖皮质激素" + }, + "answer": "B", + "reason": "沙丁胺醇属于B受体激动剂,是缓解哮喘症状(支气管痉挛)的首选药。" + }, + { + "question_num": 147, + "query": "患者,男,65岁。症见呼吸急促,喉中哮鸣有声,胸膈满闷如塞,面色晦青,形寒肢冷，苔白滑，脉弦紧者。选用下列何方", + "options": { + "A": "定喘汤", + "B": "温胆汤", + "C": "控涎丹", + "D": "射干麻黄汤", + "E": "葶苈大枣泻肺汤" + }, + "answer": "D", + "reason": "本题患者为冷哮病,治宜宣肺散寒,化痰平喘,方选射干麻黄汤或小青龙汤加减。" + }, + { + "question_num": 148, + "query": "患者,女,58岁。左侧腰周出现绿豆大水疱,簇集成群,累累如串珠,排列成带状,疼痛较重,舌苔薄黄,脉弦数,其诊断是", + "options": { + "A": "接触性皮炎", + "B": "药物性皮炎", + "D": "热疮", + "C": "蛇串疮", + "E": "湿疮" + }, + "answer": "C", + "reason": "蛇串疮是一种皮肤上出现成簇水疱,呈身体单侧带状分布,痛如火燎的急性疱疹性皮肤病。好发于胸胁部，其特点是皮肤上出现红斑、水疱或丘疱疹,累累如串珠,排列成带状,沿一侧周围神经分布区出现，局部刺痛或伴界核肿大。" + }, + { + "question_num": 149, + "query": "下列各项中，不属于瓜婆功效的是", + "options": { + "A": "清肺化痰", + "B": "润肺化痰", + "C": "宣肺祛痰", + "D": "宽胸散结", + "E": "润肠通便" + }, + "answer": "C", + "reason": "瓜茭皮能清肺化痰,利气宽胸;瓜蒌仁能润肺化痰,滑肠通便,全瓜蒌兼具以上功效。" + }, + { + "question_num": 150, + "query": "Ⅱ型呼吸衰竭是指", + "options": { + "A": "PaO₂<60mmHg;PaCO₂<50mmHg", + "B": "PaO₂<55mmHg;PaCO₂>50mmHg", + "C": "PaO₂<50mmHg;PaCO₂>50mmHg", + "D": "PaO₂<60mmHg;PaCO₂>50mmHg", + "E": "PaO₂>60mmHg;PaCO₂<50mmHg" + }, + "answer": "D", + "reason": "型呼吸衰竭有缺氧伴二氧化碳潴留,血气分析见PaO,<60mmHg日PaCO,>50mmHg." + }, + { + "question_num": 151, + "query": "张某,男性,56岁。呕吐反复发作，或时做干呕，似饥而不欲食，口燥咽干，舌红少津，脉细数。此病证的证机概要是", + "options": { + "A": "肝气不疏,横逆犯胃,胃失和降", + "B": "脾胃气虚,纳运无力,胃虚气逆", + "C": "脾胃虚寒,失于温煦，运化失职", + "D": "胃阴不足，胃失濡润,，和降失司", + "E": "痰饮内停,中阳不振,胃气上逆" + }, + "answer": "D", + "reason": "呕吐之胃阴不足证证候主症：呕吐反复发作,或时作干呕,似饥而不欲食，口燥咽干,舌红少津,脉细数。证机概要:胃阴不足，胃失润,和降失司。" + }, + { + "question_num": 152, + "query": "患者,男,3岁。诊断为黄水疮,症见皮疹少而脓疱稀疏,色淡黄或淡白，四周红晕不显，破后糜烂面淡红;多有食少,面白无华，大便溏薄;舌淡,苔薄微腻,脉细,应采用的治法为", + "options": { + "A": "祛瘀生发", + "B": "益气补血", + "C": "滋补肝肾", + "D": "清暑利湿解毒", + "E": "健脾渗湿" + }, + "answer": "E", + "reason": "黄水疮脾虚湿滞证证候:皮疹少而脓疱稀疏,色淡黄或淡白，四周红晕不显，破后糜烂面淡红;多有食少，面白无华，大便溏薄;舌淡,苔薄微腻,脉濡细。治法:健脾渗湿。方药:参苓白术散加冬瓜仁、广藿香。" + }, + { + "question_num": 153, + "query": "蒲黄的功效是", + "options": { + "A": "止血,化瘀,利尿", + "B": "止血,温胃,行气", + "C": "止血,敛肺,下气", + "D": "止血,敛肺,止咳", + "E": "止泻,活血,定痛" + }, + "answer": "A", + "reason": "蒲黄的功效与作用:化瘀止血,同时不留淤;通淋利尿,治疗淋证。" + }, + { + "question_num": 154, + "query": "健康成人白细胞正常值为", + "options": { + "A": "(3.5~9.5)x10^9/L", + "B": "(4~11)x10^9/L", + "C": "(5~10)x10^9/L", + "D": "(4.5~10)X10^9/L", + "E": "(4.5~11)x10^9/L" + }, + "answer": "A", + "reason": "白细胞总数:成人(3.5~9.5)X10°/L。" + }, + { + "question_num": 155, + "query": "患者,女,45岁。不寐多梦,甚则彻夜不眠,急躁易怒,伴头晕头胀,目赤耳鸣,口干而苦,不思饮食,便秘溲赤,舌红苔黄,脉弦而数,其治法是", + "options": { + "A": "清化痰热,和中安神", + "B": "补益心脾,养血安神", + "C": "疏肝泻火,镇心安神", + "D": "清肝利胆,安神定志", + "E": "清心凉肝,镇惊宁神" + }, + "answer": "C", + "reason": "不寐之肝火扰心证证候主症:不寐多梦,甚则彻夜不眠,急躁易怒，伴头晕头胀,目赤耳鸣,口干而苦,不思饮食,便秘溲赤,舌红苔黄,脉弦而数。治法:疏肝泻火,镇心安神" + }, + { + "question_num": 156, + "query": "患者王某,42岁。丹毒发于胸腹腰胯部,皮肤红肿蔓延,摸之灼手,肿胀疼痛,伴口干且苦。舌红,苔黄腻，脉弦滑数。治疗宜选用", + "options": { + "A": "犀角地黄汤", + "B": "龙胆泻肝汤", + "C": "黄连解毒汤", + "D": "普济消毒饮", + "E": "桃红四物汤" + }, + "answer": "B", + "reason": "丹毒之肝脾湿火证证候:发于胸腹腰胯部,皮肤红肿蔓延,摸之灼手,肿胀疼痛,伴口千且苦。舌红,苔黄腻,脉弦滑数。治法:清肝泻火利湿。代表方:柴胡清肝汤、龙胆泻肝汤或化斑解毒汤加减。" + }, + { + "question_num": 157, + "query": "慢性阻塞性肺疾病最主要的病因是", + "options": { + "A": "感染", + "B": "氧化应激", + "C": "吸烟", + "D": "职业粉尘", + "E": "空气污染" + }, + "answer": "C", + "reason": "吸烟是慢性阻塞性肺疾病最主要的病因。" + }, + { + "question_num": 158, + "query": "慢性冠状动脉供血不足的心电图表现是", + "options": { + "A": "病理性Q波", + "B": "窦性心动过缓", + "C": "频发早搏", + "D": "ST段呈水平型或下垂型压低", + "E": "ST段上抬" + }, + "answer": "D", + "reason": "慢性冠状动脉供血不足:在R波占优势的导联上，S-T段呈水平型或下垂型压低>0.05mV:T波低平、双向或倒。" + }, + { + "question_num": 159, + "query": "患者,女,34岁,积块坚硬,疼痛渐重,面色萎黄,肌肉瘦削,饮食锐减,舌淡紫,无苔,脉弦细，其治法为", + "options": { + "A": "理气活血,祛瘀软坚", + "B": "理气活血,通络消积", + "C": "理气活血,软坚散结", + "D": "补益气血,化瘀消积", + "E": "通滞去积,活血化瘀" + }, + "answer": "D", + "reason": "分析患者的症状舌苔脉象,辨证属积聚之积证,正虚瘀结证,由于积块日久，血络瘀滞日甚，气血大衰,治当补益气血，化瘀消积。方可选用八珍汤合化积丸。" + }, + { + "question_num": 160, + "query": "患者,女,26岁。产后第三周出现恶寒发热,右乳肿胀疼痛,体温38.7℃,检查见右乳红肿,无波动感,舌红,苔薄黄,脉弦数。治疗方法是", + "options": { + "A": "益气健脾", + "B": "疏肝理气,化痰散结", + "C": "疏肝清胃,通乳消肿", + "D": "清热解毒,托里透脓", + "E": "泻火解毒利湿" + }, + "answer": "C", + "reason": "患者属于乳痈气滞热壅证,证见乳汁郁积结块，皮色不变或微红，肿胀疼痛。伴有恶寒发热，周身酸楚,口渴,便秘,苔薄,脉数。治法为疏肝清胃,通乳消肿，方药瓜牛劳汤加减。" + }, + { + "question_num": 161, + "query": "具有开窍醒神、辟秽止痛功效的药物是", + "options": { + "A": "麝香", + "B": "冰片", + "C": "龙骨", + "D": "苏合香", + "E": "石菖蒲" + }, + "answer": "D", + "reason": "苏合香味辛,温,归心、脾。具有开窍,辟秽，止痛功效,用于中风痰,猝然昏倒,胸痹心痛,胸腹冷痛,惊痫。" + }, + { + "question_num": 162, + "query": "当腹水量大于多少时,可以叩出移动性浊音", + "options": { + "A": "50mL", + "B": "1000mL", + "C": "1500mL", + "D": "2000mL", + "E": "2500mL" + }, + "answer": "B", + "reason": "移动性叩诊浊音:当腹腔内有1000ml以上游离波体时，患者仰卧位诊，晓部呈鼓音,腹部两侧呈浊音:侧卧位时,叩诊上侧腹部转为鼓音,下侧腹部呈浊音。这种因体位不同而出现浊音区变动的现象称为移动性浊音阳性，见于肝硬化门静脉高压症、右心衰竭、肾病综合征、严重营养不良以及渗出性腹膜炎(如结核性或自发性)等引起的腹水。" + }, + { + "question_num": 163, + "query": "患者,男,72岁。表情呆,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,舌质淡白,舌体胖大,苔白,脉沉细弱,双尺尤甚。中医诊断", + "options": { + "A": "癫证心脾两虚证", + "B": "郁证痰气郁结证", + "C": "痴呆髓海不足证", + "D": "痴呆脾肾两虚证", + "E": "痴呆痰浊蒙窍证" + }, + "answer": "D", + "reason": "痴呆之脾肾两虚证,证见: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,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,双尺尤甚。治法:补肾健脾，益气生精。代表方:还少丹加减。" + }, + { + "question_num": 164, + "query": "患者,女,32岁。颈部肿块柔韧,随吞咽动作上下移动,急躁易怒,汗出心悸,失眠多梦,消谷善饥,形体消瘦,手部震颤,其辨证为", + "options": { + "A": "肝郁气滞证", + "B": "气滞痰凝证", + "C": "肝肾不足证", + "D": "气阴两虎证", + "E": "冲任失调证" + }, + "answer": "C", + "reason": "肉瘿,气阴两虚证。证候:颈部肿块柔韧，随吞咽动作上下移动;常伴有急躁易怒、汗出心悸、失眠多梦、消谷善饥、形体消瘦、月经不调、手部震颤等;舌红,苔薄,脉弦。治法:益气养阴,软坚散结。方药:生脉散合海藻玉壶汤加减。" + }, + { + "question_num": 165, + "query": "白芥子的功效是", + "options": { + "A": "燥湿化痰,降逆止呕", + "B": "温肺化痰,散结消肿", + "C": "降气化痰,降逆止呕", + "D": "清热化痰,润肺止咳", + "E": "宣肺祛痰,利咽排脓" + }, + "answer": "B", + "reason": "白芥子辛温,能散肺寒,利气机,通经络,化寒痰,逐水饮,温通经络,又能消肿散结止痛,故正确当为B。" + }, + { + "question_num": 166, + "query": "下列各项,最符合主诉书写要求的是", + "options": { + "A": "心绞痛反复发作3年", + "B": "3年前开始多饮,多食,多尿", + "C": "患高血压病3年", + "D": "吞咽困难,进行性加重已1月余", + "E": "某医院确诊为肺癌,介绍患者来诊" + }, + "answer": "D", + "reason": "主诉为患者就诊的症状、体征,持续的时间。" + }, + { + "question_num": 167, + "query": "患者,男,18岁。前日因食过饱后即胃脘胀痛,嗳腐吞酸,大便不畅,苔厚腻,前医曾用保和丸不效，现胃脘痛而便闭，当用保和丸合下列何方治疗为最佳", + "options": { + "A": "小承气汤", + "B": "大承气汤", + "C": "枳实消痞丸", + "D": "小陷胸汤", + "E": "理中汤" + }, + "answer": "A", + "reason": "胃痛之饮食伤胃证的临证加减:若胃脘胀痛而便闭者,可合用小承气汤或改用枳实导滞丸以通腑行气。" + }, + { + "question_num": 168, + "query": "患者,男,40岁。急性子痈2天,左侧附睾肿大疼痛,阴皮肤红肿,热疼痛,少腹抽痛,舌红苔黄腻,脉滑数,治疗方剂为", + "options": { + "A": "橘核丸", + "B": "枸橘汤", + "C": "透脓散", + "D": "滋阴除湿汤", + "E": "草薜化毒汤" + }, + "answer": "B", + "reason": "子痈之湿热下注证:多见于成年人。睾丸或附睾肿大疼痛,阴爽皮肤���肿，掀热疼痛,小腹抽痛,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。治法:清热利湿,解毒消肿。方药:枸橘汤或龙胆泻肝汤加减。疼痛剧烈者,加延胡索、金铃子。" + }, + { + "question_num": 169, + "query": "下列各项中,不属于鹿茸功效的是", + "options": { + "A": "安胎", + "B": "补肾阳", + "C": "益精血", + "D": "强筋骨", + "E": "托疮毒" + }, + "answer": "A", + "reason": "鹿茸具有壮肾阳,益精血,强筋骨，调冲任，托疮毒之功效。" + }, + { + "question_num": 170, + "query": "肝炎时可出现", + "options": { + "A": "弥漫性肝肿大", + "B": "局限性肝肿大", + "C": "肝脏无变化", + "D": "肝脏缩小", + "E": "正常肝脏" + }, + "answer": "A", + "reason": "肝脏大小变化的临床意义:弥漫性肝肿大见于肝炎、脂肪肝、肝淤血、早期肝硬化、白血病、血吸虫病等:局限性肝肿大见于肝脓肿、肝囊肿(包括肝包虫病)、肝肿瘤等:肝脏缩小见于急性和亚急性重型肝炎、晚期肝硬化。" + }, + { + "question_num": 171, + "query": "患者,女,39岁。吞咽梗阻,胸膈痞闷,情志舒畅时可稍减轻,口干咽燥,舌偏红苔薄腻,脉弦滑。治疗应首选", + "options": { + "B": "涤痰汤", + "A": "通幽汤", + "D": "玉枢丹", + "C": "温胆汤", + "E": "启膈散" + }, + "answer": "E", + "reason": "喳膈之痰气交阻证证候主症吞咽梗阻,胸膈痞满,甚则疼痛,情志舒畅时稍可减轻,情志抑郁时则加重,嗳气呃逆,呕吐痰涎:口干咽燥,大便艰涩,舌质红,苔薄腻,脉弦滑。治法:开郁化痰，润燥降气。代表方:启散加减。" + }, + { + "question_num": 172, + "query": "患者,女,32岁。近月余便时疼痛剧烈，大便秘结,点滴下血,应考虑为", + "options": { + "A": "早期肛裂", + "B": "息肉痔", + "C": "肛隐窝炎", + "D": "Ⅱ期内痔", + "E": "混合痔" + }, + "answer": "A", + "reason": "肛管的皮肤全层纵行裂开并形成感染性溃疡者称肛裂。本病好发于青壮年;女性多于男性。肛裂的部位一般在肛门前后正中位,尤以后位多见，位于前正中线的肛裂多见于女性。临床上以肛门周期性疼痛、出血、便秘为主要特点。" + }, + { + "question_num": 173, + "query": "具有祛风通络、止痉功效的药物是", + "options": { + "A": "蕲蛇", + "B": "川鸟", + "C": "秦艽", + "D": "防己", + "E": "威灵仙" + }, + "answer": "A", + "reason": "蕲蛇,药性甘、咸,温。有毒。归肝经。功效祛风，通络，止疼。" + }, + { + "question_num": 174, + "query": "病理性双侧瞳孔缩小,可见于", + "options": { + "A": "青光眼", + "B": "视神经萎缩", + "C": "有机磷中毒", + "D": "脑肿瘤", + "E": "脑血管病变" + }, + "answer": "C", + "reason": "病理性双侧瞳孔缩小见于虹膜炎、有机磷中毒、吗啡中毒。" + }, + { + "question_num": 175, + "query": "惠者,男,25岁。身热,微恶风,汗少肢体酸重,头昏重胀痛,咳嗽痰黏,鼻流浊涕心烦,口渴,舌苔薄黄而腻,脉濡数。治疗应首选", + "options": { + "A": "系古伽", + "B": "组坤粉", + "C": "新加香薷饮", + "D": "桑白皮汤", + "E": "藿香正气散" + }, + "answer": "C", + "reason": "根据患者出现症见身热,微恶风,汗少,肢体酸重,头昏重胀痛,又有咳嗽痰黏，鼻流浊涕,心烦,口渴,舌苔薄黄而腻,脉数此为暑湿伤表型感冒的表现，其方用新加香薷饮加减。" + }, + { + "question_num": 176, + "query": "患者,男,32岁。右下肢麻木、发凉、怕冷2年，每行走约1km需停下休息。体格检查:右下肢皮温较对侧低,色泽苍白,右足背动脉搏动减弱。诊断考虑为", + "options": { + "A": "血栓闭塞性脉管炎", + "B": "大动脉炎", + "C": "右下肢动脉硬化性闭塞症", + "D": "右下肢深静脉血栓形成", + "E": "右下肢血栓性浅静脉炎" + }, + "answer": "A", + "reason": "脱疽的诊断:一期(局部缺血期)临床表现:患肢末端发凉,怕冷,麻木,酸痛,间歇性跛行。患肢可出现轻度肌肉萎缩，皮肤干燥,皮温稍低于健侧,皮肤指压试验可见充盈缓慢,足背动脉、胫后动脉搏动减弱,部分患者小腿可出现游走性红硬条索(游走性血栓性浅静脉炎)。" + }, + { + "question_num": 177, + "query": "甘遂的功效是", + "options": { + "A": "泻水逐饮,消肿散结", + "B": "泻下逐水,去积杀虫", + "C": "泻下逐饮,润肺止咳", + "D": "泻下逐水,凉血解毒", + "E": "泻下逐水,祛痰利咽" + }, + "answer": "A", + "reason": "甘遂的主要功效为泻水逐饮,消肿散结。用于水肿胀满,胸腹积���,痰饮积聚气逆咳喘,二便不利,风痰疯痫,痈肿疮毒。" + }, + { + "question_num": 178, + "query": "二尖瓣关闭不全时杂音为", + "options": { + "A": "吹风样", + "B": "隆隆样", + "C": "叹气样", + "D": "机器声样", + "E": "音乐样" + }, + "answer": "A", + "reason": "杂音的性质分为吹风样、隆隆样(或雷鸣样)、叹气样、机器样及乐音样等,进一步分为粗糙、柔和。如心尖区粗糙的吹风样收缩期杂音,常提示二尖瓣关闭不全:心尖区舒张中晚期隆隆样杂音是二尖瓣狭窄的特征性杂音:心尖区柔和而高调的吹风样杂音常为相对性二尖瓣关闭不全;主动脉瓣第二听诊区叹气样舒张期杂音见于主动脉瓣关闭不全;胸骨左缘第2肋间及其附近机器声样连续性杂音，见于动脉导管未闭:听诊时杂音如海鸥鸣或鸽鸣样,常见于感染性心内膜炎及梅毒性主动脉瓣关闭不全。" + }, + { + "question_num": 179, + "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": "喘证之肺气虚耗证证候主症:喘促短气,气怯声低,喉有肝声,咳声低弱,痰吐稀薄，自汗畏风,或见咳呛,痰少质黏,烦热而渴，咽喉不利,面颧潮红,舌质淡红或有苔剥,脉软弱或细数。治法:补肺益气养阴。代表方:生脉散合补肺汤加减。" + }, + { + "question_num": 180, + "query": "患者,女,29岁,已婚。近1年月经后期量少,现已停经4个月,伴五心烦热,潮热颧红,舌红少苔,脉细数。尿妊娠试验阴性，其治法是", + "options": { + "A": "理气活血通经", + "B": "豁痰活血通经", + "C": "养阴清热调经", + "D": "益气养血调经", + "E": "补肾养肝调经" + }, + "answer": "C", + "reason": "近1年月经后期量少,现已停经4个月，尿妊娠试验阴性是由月经后期发展而成的闭经。五心烦热，潮热颧红,舌红少苔,脉细数是阴虚内热表现。营阴亏耗，虚火上炎，阴血燥竭,进而闭经。所以,此为闭经之阴虚血燥证。治宜养阴清热调经。方用加减一阴煎加丹参、黄精、女贞子、制香附。" + }, + { + "question_num": 181, + "query": "具有宣肺、利水功效的药物是", + "options": { + "A": "细辛", + "B": "生姜", + "C": "麻黄", + "D": "白芷", + "E": "葛根" + }, + "answer": "C", + "reason": "麻黄功效:发汗解表,宣肺平喘,利水消肿" + }, + { + "question_num": 182, + "query": "最易触及心包摩擦感的是", + "options": { + "A": "坐位,胸骨左缘第4肋间处,浅吸气末", + "B": "卧位,胸骨左缘第2肋间处,深呼气末", + "C": "坐位,胸骨左缘第4肋间处,深呼气末", + "D": "卧位,胸骨左缘第2肋间处,深吸气末", + "E": "卧位,剑突下，屏住呼吸时" + }, + "answer": "C", + "reason": "心包摩擦感:通常在心前区域胸骨左缘第3、4肋间最易触及,心脏收缩期和舒张期均可触及，以收缩期明显。坐位稍前倾或深呼气末更易触及。" + }, + { + "question_num": 183, + "query": "患者恶寒重,发热轻,无汗,头痛,肢体疼痛,鼻塞声重,时流清涕,喉痒,舌苔薄白而润,脉浮，其治法是", + "options": { + "A": "辛温解表", + "B": "调和营卫", + "C": "散寒解肌", + "D": "散寒止痛", + "E": "发汗解肌" + }, + "answer": "A", + "reason": "上证以卫表和鼻咽症状为主,诊为感冒;恶寒重,发热轻,鼻塞声重,时流清涕属表寒之证,治宜辛温解表。" + }, + { + "question_num": 184, + "query": "患者,女,38岁。近半年来带下量少阴中干涩,阴痒,面色无华,头晕眼花,心悸失眠,神疲乏力,经行量少,色紫暗,有血块,下腹有包块,舌质暗,边有瘀点瘀斑,脉细涩，其治法是", + "options": { + "A": "滋补阴血,活血化瘀", + "B": "补血益精,活血化瘀", + "C": "补血益气,活血化瘀", + "D": "补血填精,破血下瘀", + "E": "补血益气,破血下瘀" + }, + "answer": "B", + "reason": "带下过少是指带下量明显减少，导致阴中干涩痒痛,甚至阴部萎缩者,其辨证论治如下。①肝肾亏损证:带下过少,甚至全无，阴部干涩灼痛,或伴阴痒,阴部萎缩,性交疼痛,头晕耳鸣,腰膝酸软,烘热汗出,烦热胸闷,夜寐不安,小便黄,大便干结,舌红少苔,脉细数或沉弦细,治法为补肝肾,养精益血,主方为归丸加知母、肉蓉、紫河车、麦冬;②血枯瘀阻证:带下过少,甚至全无,阴中干涩,阴痒,或面色无华,头晕眼花,心悸失眠,神��乏力,或经行腹痛,经色紫暗,有血块,肌肤甲错,或下腹有包块,舌质暗,边有瘀点瘀斑,脉细涩。治法为血益精，活血化瘀。主方为营煎加丹参、桃仁、牛膝。" + }, + { + "question_num": 185, + "query": "下列各项中,不属于蝉蜕功效的是", + "options": { + "A": "疏散风热", + "B": "透疹止痒", + "C": "息风止痉", + "D": "明目退翳", + "E": "宣通鼻窍" + }, + "answer": "E", + "reason": "蝉蜕的功效:疏散风热,透疹止痒,明目退翳,息风止痉。" + }, + { + "question_num": 186, + "query": "肠蛎动音为金属样可见于", + "options": { + "A": "麻痹性肠梗阻", + "B": "机械性肠梗阳", + "C": "低血钾", + "D": "急性肠炎", + "E": "败血症" + }, + "answer": "B", + "reason": "如肠鸣音次数多,且呈响亮、高亢的金属音,称肠鸣音亢进，见于机械性肠梗阻。" + }, + { + "question_num": 187, + "query": "患者经行肢体肿胀,按之随手而起,经血色暗有块,脘闷胁胀,善叹息;舌紫暗,苔薄白,脉弦涩。治疗应首选的方剂是", + "options": { + "B": "八物汤", + "A": "四物汤", + "C": "六君子汤", + "D": "失笑散", + "E": "五苓散" + }, + "answer": "B", + "reason": "经行浮肿之气滞血瘀证。主要证候:经行肢体肿胀,按之随手而起,经血色暗有块,脘闷胁胀,善叹息;舌紫黯,苔薄白,脉弦涩。治法:理气行带,养血调经。方药:八物汤加泽泻、母草。" + }, + { + "question_num": 188, + "query": "患者,女,32岁。2年前自然流产一次,现妊娠45天,常有腰酸腹痛下坠，阴道不时出血，色黯红，舌有瘀斑，脉沉弦。治法宜选用", + "options": { + "A": "补肾健脾,益气安胎", + "B": "清热凉血,养血安胎", + "C": "祛瘀消癥,固冲安胎", + "D": "补气养血,固肾安胎", + "E": "疏肝理气,养血安胎" + }, + "answer": "C", + "reason": "胎动不安之血瘀证主要证候宿有癥积,孕后常有腰酸腹痛下坠,阴道不时出血,色黯红,或妊娠期跌仆闪挫,继之腹痛或少量阴道出血;舌黯红,或有瘀斑,脉弦滑或沉弦。治法:祛瘀消,固冲安胎。方药:桂枝茯苓丸合寿胎丸。" + }, + { + "question_num": 189, + "query": "杜仲与续断具有的共同功效是", + "options": { + "A": "补肝肾", + "B": "安心神", + "C": "补肾阴", + "D": "行血脉", + "E": "祛风湿" + }, + "answer": "A", + "reason": "杜仲和续断共同的功效是补肝肾、强筋骨" + }, + { + "question_num": 190, + "query": "下列除哪项外,均可选择胸部X线检查进行鉴别", + "options": { + "A": "大叶性肺炎或支气管肺炎", + "B": "气胸或肺大疱", + "C": "胸腔积液是血性或脓性", + "D": "肺不张或肺实变", + "E": "肺脓肿或肺肿瘤" + }, + "answer": "C", + "reason": "胸腔积液是血性或脓性,在X线上均为灰白影,不能区分,应穿刺以鉴别。" + }, + { + "question_num": 191, + "query": "患者,男,56岁。头痛日久,其痛如锥刺，固定不移，舌质紫，脉细涩，其证候是", + "options": { + "A": "肝阳头痛", + "B": "痰浊头痛", + "C": "血虚头痛", + "D": "肾虚头痛", + "E": "瘀血头痛" + }, + "answer": "E", + "reason": "“痛如锥刺,固定不移,舌质紫,脉细涩”都是瘀血的典型表现。" + }, + { + "question_num": 192, + "query": "患者,女,54岁。绝经6年,腰背疼痛胫酸膝软，面色不华,肢倦乏力,纳少便溏,舌次迟圾有内报，台，冰班天陕老", + "options": { + "A": "脾肾两虚证", + "B": "阴阳两虚证", + "C": "肾精亏虚证", + "D": "阴虚内热证", + "E": "脾气不足证" + }, + "answer": "A", + "reason": "绝经妇女骨质疏松症之脾肾两虚证主要证候:腰背疼痛,胫酸膝软,面色不华,肢倦乏力,纳少便溏;舌质淡边有齿痕,苔薄白,脉细。治法:益肾健脾。方药:大补元煎。" + }, + { + "question_num": 193, + "query": "治疗风湿痹痛、诸骨鲠咽,应选用的药物是", + "options": { + "A": "五加皮", + "B": "桑寄生", + "C": "木瓜", + "D": "威灵仙", + "E": "羌活" + }, + "answer": "D", + "reason": "威灵仙功效:祛风湿,通经络止痛,消骨鲠。临床应用:风湿痹痛,骨鲠咽喉通行十二经脉。" + }, + { + "question_num": 194, + "query": "语颤增强见于", + "options": { + "A": "肺气肿", + "B": "气胸", + "C": "胸腔积液", + "D": "肺实变", + "E": "胸膜肥厚" + }, + "answer": "D", + "reason": "语颤增强见于以下几种情况:①肺实变,见于肺炎链球菌肺炎、肺梗死、肺结核、肺脓肿及肺癌等;②压迫性肺不张,见于胸腔积液上方受压而萎瘪的肺组织及受肿瘤压迫的��组织;③较浅而大的肺空洞，见于肺结核、肺脓肿、肺肿瘤所致的空洞。" + }, + { + "question_num": 195, + "query": "患者,男,41岁。3年来头晕伴头目胀痛,口苦,遇郁怒则加重,颜面潮红,急躁易怒,肢麻震颤，舌红苔黄，脉弦数，其中医治法是", + "options": { + "A": "化痰祛湿,健脾和胃", + "B": "益气健脾,升阳除热", + "C": "补益气血,调养心脾", + "D": "滋养肝肾,益精填髓", + "E": "平肝潜阳,清火息风" + }, + "answer": "E", + "reason": "结合题干信息,患者为内伤头痛之肝阳头痛,证见:头昏胀痛,两侧为重,心烦易怒,夜寐不宁，口苦面红，或兼胁痛,舌红苔黄,脉弦数。治法:平肝潜阳息风。代表方:天麻钩，藤饮加减。" + }, + { + "question_num": 196, + "query": "患者,女,25岁。经行时肢体疼痛麻木,肢软无力,月经量少,色淡质薄,舌质淡红，苔白,脉细弱。治疗首选", + "options": { + "A": "四物汤", + "B": "滋血汤", + "C": "人参养荣汤", + "D": "当归补血汤", + "E": "血府逐瘀汤" + }, + "answer": "D", + "reason": "经行身痛血能证,主要证候:经行时肢体疼痛麻木，肢软乏力，月经量少，色淡,质薄;面色无华;舌质淡红,苔白,脉细弱。治法:养血益气,柔筋止痛。方药:当归补血汤加白芍、鸡血藤、丹参、玉竹。" + }, + { + "question_num": 197, + "query": "积实的功效是", + "options": { + "A": "行气宽中除胀为主", + "B": "行气消痰除痞为主", + "C": "燥湿化痰和胃为主", + "D": "理气和胃降逆为主", + "E": "行气止痛散结为主" + }, + "answer": "B", + "reason": "积实功效:破气消积,化痰除痞。《药品化义》:“枳实专泄胃实,开导坚结,故主中脘以治血分,疗脐腹间实满,消痰癖,祛停水,逐宿食,破结胸,通便闭,非此不能也。若皮肤作痒,因积血滞于中,不能营养肌表,若饮食不思,因脾郁结不能运化,皆取其辛散苦泻之力也。为血分中之气药,惟此称最。”" + }, + { + "question_num": 198, + "query": "板状腹可见于", + "options": { + "A": "急性阑尾炎", + "B": "急性胆囊炎", + "C": "肠结核", + "D": "急性胃肠穿孔", + "E": "大量腹水" + }, + "answer": "D", + "reason": "弥漫性腹肌紧张多见于胃肠道穿孔或实质脏器破裂所致的急性弥漫性腹膜炎,此时腹壁常强直,硬如木板,故称为板状腹。" + }, + { + "question_num": 199, + "query": "患者,男,31岁。胃痛暴作,恶寒喜暖,脘腹得温则痛减,口淡不渴，喜热饮,舌苔薄白，脉弦紧。治疗应首选", + "options": { + "A": "藿朴夏苓汤", + "B": "桂枝汤", + "C": "小建中汤", + "D": "黄芪建中汤", + "E": "香苏散合良附丸" + }, + "answer": "E", + "reason": "胃痛之寒邪客胃证证候主症:胃痛暴作,恶寒喜暖,得温痛减,遇寒加重,口淡不渴,或喜热饮,舌淡苔薄白,脉弦紧。治法:温胃散寒,行气止痛。代表方:香苏散合良附丸加减。" + }, + { + "question_num": 200, + "query": "患者,女,23岁，人流术后阴道持续出血超过10天,夹有黑色血块，人流术后腰酸腹痛,有下坠感,常在阵发性腹痛后阴道出血增加;妇科检查子宫体软,较正常稍大，宫颈口松弛;超检查宫腔内有组织物残留。正确的诊断是", + "options": { + "A": "人流综合征", + "B": "子宫穿孔", + "C": "人流不全", + "D": "宫腔或颈管内口粘连", + "E": "人流术后感染" + }, + "answer": "C", + "reason": "人流不全诊断要点:术后阴道持续或间断出血超过10天或出血量大于月经量，夹有黑血块或烂肉样组织;术后腰酸腹痛下坠感,且由阵发性腹痛后出血增加;妇检示子宫稍大,较软,宫口松弛;hCG阳性或未降至正常;B超示宫腔内有组织残留。" + }, + { + "question_num": 201, + "query": "尤其适用于夜间哮喘及多痰哮喘患者的药物是", + "options": { + "A": "特布他林", + "B": "氨茶碱", + "C": "二羟丙茶碱", + "D": "异丙托溴铵", + "E": "东莨菪碱" + }, + "answer": "D", + "reason": "短效抗胆碱药:异丙托溴铵主要用于哮喘急性发作的治疗,多与受体激动剂联合应用,尤其适用于夜间哮喘及多痰的患者。" + }, + { + "question_num": 202, + "query": "触诊肠管或索条状包块最适用于", + "options": { + "A": "深压触诊法", + "B": "浅部滑行触诊法", + "C": "深部滑行触诊法", + "D": "双手触诊法", + "E": "冲击触诊法" + }, + "answer": "C", + "reason": "深部滑行触诊主要适用于腹腔深部包块和胃肠病变的检查。" + }, + { + "question_num": 203, + "query": "患者,女,50岁。脘腹痞满不舒,胸膈满闷,头晕目眩,身重困倦,呕恶纳��,口淡不渴,小便不利,舌苔白厚腻,脉沉滑。证属", + "options": { + "A": "饮食内停证", + "B": "痰湿中阻证", + "C": "湿热阻胃证", + "D": "肝胃不和证", + "E": "胃阴不足证" + }, + "answer": "B", + "reason": "胃痞之痰湿中阻证证候主症脘腹痞塞不舒,胸膈满闷,头晕目眩,身重困倦呕恶纳呆，口淡不渴,小便不利，舌苔白厚腻,脉沉滑。" + }, + { + "question_num": 204, + "query": "患者,女,25岁。月经9个月未行,心悸气短,头晕眼花,面色萎黄,神疲肢倦,舌淡，苔薄,脉沉缓。证属", + "options": { + "A": "肝肾不足证", + "B": "肾气虚证", + "D": "气阴两伤证", + "C": "气血虚弱证", + "E": "脾虚证" + }, + "answer": "C", + "reason": "闭经气血虚弱证,主要证候:月经周期延迟、量少、色淡红、质薄,渐至经闭不行;神疲肢倦,头晕眼花,心悸气短,面色萎黄;舌淡,苔薄,脉沉缓或细弱。治法:益气养血调经。方药:人参养荣汤。" + }, + { + "question_num": 205, + "query": "COPD典型的症状是", + "options": { + "A": "慢性咳嗽", + "B": "咳痰", + "C": "气短及呼吸困难", + "D": "喘息和胸闷", + "E": "食欲减退" + }, + "answer": "C", + "reason": "COPD的症状为慢性咳、咳痰、渐进性气短或呼吸困难、喘息和胸闷、其他(如晚期体重下降,食欲减退等)，其中最典型的是浙进性气短或呼吸闲难" + }, + { + "question_num": 206, + "query": "醉酒步态可见于", + "options": { + "A": "佝偻病", + "B": "脑瘫", + "C": "小脑病变", + "D": "脊髓疾病", + "E": "锥体外系疾病" + }, + "answer": "C", + "reason": "醉酒步态见于小脑病变、酒精中毒等。" + }, + { + "question_num": 207, + "query": "患者,男,38岁。症见痢下赤白黏冻白多赤少,或纯为白冻,伴有腹痛,里急后重,饮食乏味,胃脘饱闷,头身困重,舌质淡,苔白腻,脉缓。证属", + "options": { + "A": "虚寒痢", + "B": "寒湿痢", + "C": "休息痢", + "D": "噤口痢", + "E": "疫毒痢" + }, + "answer": "B", + "reason": "寒湿痢证候主症:腹痛拘急,里急后重,痢下赤白黏冻，白多赤少，或为纯白冻,口淡乏味,脘胀腹满,头身困重,舌质或淡,舌苔白腻,脉濡缓。" + }, + { + "question_num": 208, + "query": "患者，女，38岁。经期小腹总痛，喜温喜按,阴部空坠不适;经血量少，色淡质清;面色少华,神疲乏力;舌质淡、苔薄,脉细无力。最佳选方", + "options": { + "A": "圣愈汤", + "B": "四物汤", + "C": "归脾汤", + "D": "举元煎", + "E": "补中益气汤" + }, + "answer": "A", + "reason": "痛经气血虚弱证,主要证候:经期或经后小腹隐隐作痛,喜按,或小腹及阴部空坠不适;月经量少,色淡,质清稀;面色无华,头晕心悸,神疲乏力;舌质淡,脉细无力。治法:益气养血,调经止痛。方药:圣愈汤。" + }, + { + "question_num": 209, + "query": "不属于急性肾孟肾炎临床表现的是", + "options": { + "A": "下腹部痛", + "B": "贫血", + "C": "畏寒、发热", + "D": "膀胱刺激征", + "E": "腰痛" + }, + "answer": "B", + "reason": "急性肾盂肾炎临床表现:①泌尿系统症状:膀胱刺激征、腰痛和(或)下腹部痛、肋脊角及输尿管点压痛、肾区压痛和叩击痛;腰痛程度不一,多为钝痛、酸痛;②全身感染症状:寒战、发热、头痛、恶心呕吐、食欲不振等,体温多在38~39℃,常伴有血白细胞计数升高和血沉增快。少数患者可出现肉眼血尿。" + }, + { + "question_num": 210, + "query": "动脉粥样硬化的危险因素是", + "options": { + "A": "LDL-C", + "B": "HDL-C", + "C": "LP(a)", + "D": "TC", + "E": "TG" + }, + "answer": "A", + "reason": "低密度脂蛋白(LDL)测定的临床意义:①LDL-C增高，判断发生冠心病的危险性,LDL-C是动脉粥样硬化的危险因素之IDL-C水平增高与冠心病发病是正相关，可见于肥胖症、肾病综合征、甲状腺功能减退症、阻塞性黄疸等;②LDL-C减低,见于无B一脂蛋白血症、甲状腺功能亢进症、肝硬化和低脂饮食等。" + }, + { + "question_num": 211, + "query": "患者,女,45岁。因皮肤疮痍破溃而引发水肿,肿势自颜面渐及全身,皮肤发亮,小便不利,恶风发热,咽红,舌红苔薄黄,脉滑数。治疗应首选", + "options": { + "A": "越婢加术汤合桑白皮汤", + "B": "麻黄连翘赤小豆汤合五味消毒饮", + "C": "麻黄连翘赤小豆汤合五皮散", + "D": "麻黄连翘赤小豆汤合猪苓汤", + "E": "实脾饮合五味消毒饮" + }, + "answer": "B", + "reason": "湿毒浸淫,损伤肺脾三焦气化不利,水液肉停出现水肿,肿势自颜面浙及全身:小便不利,辨���属于湿毒浸淫证，其治法为宣肺解毒,利湿消肿,方用麻黄连翘赤小豆汤合五味消青优扣减" + }, + { + "question_num": 212, + "query": "患者,女,28岁。月经周期延后,量少色暗淡质稀,腰膝酸软,头晕耳鸣,面色晦暗,舌淡苔薄白,脉沉细。最佳方选是", + "options": { + "A": "当归地黄饮", + "B": "当归补血汤", + "C": "健固汤", + "D": "知柏地黄丸", + "E": "补肾地黄汤" + }, + "answer": "A", + "reason": "月经后期肾虚证,主要证候:周期延后,量少,色暗淡,质清稀,或带下清稀;腰膝酸软。头晕耳鸣，面色晦暗,或面部暗斑;舌淡,苔薄白,脉沉细。治法:补肾养血调经。方药:当归地黄饮。" + }, + { + "question_num": 213, + "query": "慢性肺心病患者普遍存在的酸碱失衡是", + "options": { + "A": "代谢性酸中毒", + "B": "呼吸性酸中毒", + "C": "代谢性碱中毒", + "D": "呼吸性碱中毒", + "E": "呼吸性酸中毒合并代谢性碱中毒" + }, + "answer": "B", + "reason": "慢性肺源性心脏病并发酸碱失衡时,最常见为呼吸性酸中毒:pH下降,PaCO2,升高,其次为呼吸性酸中毒合并代谢性酸中毒。亦可为呼吸性酸申毒并代谢性碱中毒:PH可正常,低血钾、低血氯,多为治疗不当所致。" + }, + { + "question_num": 214, + "query": "中等度热为", + "options": { + "A": "37.3~38°C", + "B": "39.1~41°C", + "C": "38.1~39°C", + "D": ">41°C", + "E": "39.1~40°C" + }, + "answer": "C", + "reason": "按发热的高低可分:低热为37.3~38℃;中等度热为38.1~39℃;高热为39.1~41℃;超高热为41℃以上。" + }, + { + "question_num": 215, + "query": "患者,男,32岁。秋月受风,干咳无痰咽鼻干燥,恶寒发热,头痛无汗，舌苔薄白少津,脉浮。治疗宜", + "options": { + "A": "疏风清热,宣肺化痰", + "B": "疏风散寒,宣肺止咳", + "C": "疏风清肺,润燥上咳", + "D": "燥湿化痰,理气止咳", + "E": "养阴清肺,止咳化痰" + }, + "answer": "C", + "reason": "本例为风燥犯肺之咳嗽。秋月燥邪当令,风燥伤肺,肺失清润,则干咳无痰，鼻咽干燥;风燥外客,则卫气不和,则恶寒发热头痛无汗,舌苔薄白少津,脉浮,均为燥邪袭表伤津之征象。风燥犯肺之咳嗽治疗当疏风清肺，润燥止咳。" + }, + { + "question_num": 216, + "query": "患者,女,32岁.经行面浮肢肿,按之没指,晨起头面肿甚,月经推迟,经量多，色淡质薄,腹胀,食欲不振,腰膝酸软,大便溏薄,舌淡苔白腻,脉沉缓。方选", + "options": { + "A": "肾气丸", + "B": "白术散", + "C": "健固汤", + "D": "八物汤", + "E": "真武汤" + }, + "answer": "A", + "reason": "经行浮肿脾肾阳虚证。主要证候:经行面浮肢肿，按之没指，晨起头面肿甚，月经推迟,经行量多,色淡,质薄;腹胀纳减,腰膝酸软,大便溏薄;舌淡,苔白腻,脉沉缓,或濡细。治法:温肾化气,健脾利水。方药:肾气丸合苓桂术甘汤。" + }, + { + "question_num": 217, + "query": "百部具有的功效是", + "options": { + "A": "降气化痰,止咳平喘", + "B": "止咳平喘,润肠通便", + "C": "润肺止咳,杀虫灭虱", + "D": "泻肺平喘,利水消肿", + "E": "降气化痰,杀虫灭虱" + }, + "answer": "C", + "reason": "百部具有润肺下气止咳、杀虫灭虱的功效,用于新久咳嗽,肺旁咳嗽,顿咳;外用于头虱，体虱，蛲虫病,阴痒。蜜百部润肺止咳。用于阴虚劳嗽。" + }, + { + "question_num": 218, + "query": "皮肤黏膜出血的病因不包括", + "options": { + "A": "血小板数量异常", + "B": "血小板功能异常", + "C": "血管壁结构与功能异常", + "D": "维生素K缺乏症", + "E": "肝素使用不足" + }, + "answer": "E", + "reason": "皮肤黏膜出血的病因:血管壁结构与功能异常,过敏性紫、药物性紫等;血小板数量异常,血小板数量减少或增多，血小板功能异常;凝血功能异常:包括血友病、严重肝功能不全、维生素K缺乏症;抗凝及纤维蛋白溶解异常:包括肝素使用过量、溶栓药过量、毒蛇咬伤。" + }, + { + "question_num": 219, + "query": "患者,男,56岁。吐血色红,夹有食物残渣,脘腹胀闷,口臭,便秘,大便色黑,舌红,苔黄,脉滑数,治疗宜选用", + "options": { + "A": "泻心汤合清胃散", + "B": "泻心汤合十灰散", + "C": "玉女煎合左金丸", + "D": "龙胆泻肝汤合清胃散", + "E": "清胃散合茜根散" + }, + "answer": "B", + "reason": "吐血之胃热壅盛证证候主症吐血色红或紫暗,常夹有食物残渣,脘腹胀闷,嘈杂不适，甚则作痛,吐血色红或紫暗,常夹有食物残渣，口臭,便秘,大便色黑,舌质红,苔黄腻,脉滑数。治法:清胃泻火,化��止血。代表方:泻心汤合十灰散加减。" + }, + { + "question_num": 220, + "query": "患者,女,29岁。经期或经后小腹冷痛,喜按,得热则舒,经量少,经色暗淡,腰腿酸软,小便清长。舌淡胖,苔白润,脉沉。诊断为痛经,其证型是", + "options": { + "A": "寒凝血瘀证", + "B": "阳虚内寒证", + "C": "脾肾阳虚证", + "D": "气血虚弱证", + "E": "肾气亏损证" + }, + "answer": "B", + "reason": "痛经阳内寒证,主要证候经期或经后小腹冷痛,喜按,得热则舒,经是少经色暗淡,腰腿酸软,小便清长。舌淡胖，苔白润,脉沉。治法:温经扶阳,暖宫止痛。方药:温经汤(《金匮要略》)加附子、艾叶、小茴香。" + }, + { + "question_num": 221, + "query": "原发免疫性血小板减少症的主要病因是", + "options": { + "A": "感染", + "B": "骨髓巨核细胞成熟障碍", + "C": "脾功能亢进", + "D": "免疫因素", + "E": "肝脾作用" + }, + "answer": "D", + "reason": "免疫因素是原发免疫性血小板减少症发病的主要原因。" + }, + { + "question_num": 222, + "query": "突然出现的吸气困难,临床上主要见于", + "options": { + "A": "支气管哮喘", + "B": "肺癌", + "C": "气道异物", + "D": "气胸", + "E": "肺气肿" + }, + "answer": "C", + "reason": "吸气性呼吸困难:表现为胸骨上窝、锁骨上窝、肋间隙在吸气时明显凹陷,称为“三凹征”,常伴有频繁干咳及高调的吸气性喘鸣音。见于急性喉炎、喉水肿、喉痉挛、白喉、喉癌气管异物、支气管肿瘤或气管受压等。" + }, + { + "question_num": 223, + "query": "患者,男,63岁。消渴病,口渴多饮,口舌干燥,尿频量多,舌边尖红,苔薄黄,脉数。辨证应属", + "options": { + "A": "上消肺热津伤证", + "B": "中消胃热炽盛证", + "C": "中消气阴亏虚证", + "D": "消肾阴亏虚证", + "E": "下消阴阳两虚证" + }, + "answer": "A", + "reason": "上消之肺热津伤证证候主症口渴多饮,口舌干燥,尿频量多,烦热多汗,舌边尖红，苔薄黄,脉洪数。" + }, + { + "question_num": 224, + "query": "患者,女,23岁。经行或经后两乳作胀,腰膝酸软,两目干涩,咽干口燥,五心烦热舌红少苔,脉细数,其治疗最佳选方是", + "options": { + "A": "二至丸", + "B": "沙参麦冬汤", + "C": "一贯煎", + "D": "六味地黄丸", + "E": "左归丸" + }, + "answer": "C", + "reason": "经行乳房胀痛肝肾亏虚证，主要证候:经行或经后两乳作胀作痛，乳房按之柔软无块,月经量少，色淡;两目干涩,咽干口燥,五心烦热;舌淡或舌红，少苔,脉细数。治法:滋肾养肝,和胃通络。方药:一贯煎或滋水清肝饮加麦芽、鸡内金。" + }, + { + "question_num": 225, + "query": "下列药物中,均能凉血止血、散瘀解毒消痈的是", + "options": { + "A": "小蓟、大蓟", + "B": "地榆、槐花", + "C": "三七、茜草", + "D": "白及、蒲黄", + "E": "侧柏叶、白茅根" + }, + "answer": "A", + "reason": "大蓟与小蓟二药均能凉血止血,散瘀解毒消痈，可用治血热出血证以及热毒痈肿,常相须为用。但大蓟解毒散瘀消肿、凉血止血作用较强，多用于治疗吐血、咯血及崩漏;小蓟凉血止血、解毒散瘀消肿作用弱于大蓟，但兼肥不冰,故宿疗NV。" + }, + { + "question_num": 226, + "query": "属感染性发热的疾病是", + "options": { + "A": "风湿热", + "B": "广泛性皮炎", + "C": "肝癌", + "D": "斑疹伤寒", + "E": "白血病" + }, + "answer": "D", + "reason": "斑疹伤寒属感染性发热" + }, + { + "question_num": 227, + "query": "患者,女,42岁。发热,热势不高,常在劳累后加剧，身倦乏力,气短懒言,自汗,易于感冒,食少便溏,舌质淡,苔白薄,脉细弱。辨证应属", + "options": { + "A": "阴虚发热证", + "B": "气虚发热证", + "C": "血虚发热证", + "D": "血瘀发热证", + "E": "气郁发热证" + }, + "answer": "B", + "reason": "内伤发热之气虚发热证证候主症:发热,热势或低或高,常在劳累后发作或加剧,倦怠乏力,气短懒言,自汗,易于感冒,食少便溏,舌质淡,苔薄白,脉细弱。" + }, + { + "question_num": 228, + "query": "患者,女,29岁,孕28周,近一个月腹形增长不明显，自觉有胎动，阴道少量下血，头晕,纳少,口淡,乏力,舌淡,苔白,脉细弱略滑,其辨证属于", + "options": { + "A": "气血虚弱证", + "B": "脾肾不足证", + "C": "血寒宫冷证", + "D": "脾虚湿蕴证", + "E": "心血不足证" + }, + "answer": "A", + "reason": "胎漏、胎动不安气血虚弱证主要证候:妊娠期阴道少量下血，色淡红，质稀薄,或小腹��坠而痛、腰酸,面色能白,心悸气短神疲肢倦;舌淡,苔薄白,脉细弱略滑。治法:补气养血，固肾安胎。方药:胎元饮。" + }, + { + "question_num": 229, + "query": "下列各项中,不属于慢性肾炎基本表现的是", + "options": { + "A": "蛋白尿", + "B": "血尿", + "C": "高血压", + "D": "尿痛", + "E": "肾功能受损" + }, + "answer": "D", + "reason": "慢性肾炎患者基本表现是蛋白尿、血尿、高血压、水肿,有些患者还会出现不同程度的肾功能损害，慢性肾炎患者的主要特点是缓慢进展的肾炎综合征。" + }, + { + "question_num": 230, + "query": "根据《灵枢·决气》，“液”的功能是", + "options": { + "A": "泽毛,若雾露之溉", + "B": "壅遏营气,令无所避", + "C": "宣五谷味", + "D": "补益脑髓,皮肤润泽", + "E": "发泄腠理" + }, + "answer": "D", + "reason": "《灵枢·决气》:“谷人气满,淖泽注于骨,骨属屈伸,泄泽补益脑髓，皮肤润泽是谓液。”" + }, + { + "question_num": 231, + "query": "康儿,男,3岁。面色蒸黄,形体消瘦时有口干腹胀,不思饮食,烦躁啼哭,毛发稀疏,大便如米泔,舌苔黄腻,脉细。在取相应加用的腧穴是", + "options": { + "A": "二白", + "B": "八邪", + "C": "四缝", + "D": "八风", + "E": "十宣" + }, + "answer": "C", + "reason": "四缝主治小儿疳积;八邪可治手背肿痛,手指麻木及烦热、目痛和毒蛇咬伤;十宣主治昏迷、疯痫、高热、咽喉肿痛等。" + }, + { + "question_num": 232, + "query": "患者,女,38岁,孕6月余,小便频数艰涩刺痛,尿少色黄,伴面赤心烦,喜冷饮,舌上溃疡，舌红欠润，少苔，脉细数，治疗首选", + "options": { + "A": "五苓散", + "B": "导赤散加玄参、麦冬", + "C": "保阴煎", + "D": "龙胆泻肝汤", + "E": "知柏地黄丸" + }, + "answer": "B", + "reason": "妊娠小便淋痛心火偏亢证,主要证候:妊娠期间,小便频数,尿短赤，艰涩刺痛面赤心烦,渴喜冷饮,甚者口舌生疮;舌红欠润少苔或无苔,脉细数。治法:清心泻火，润燥通淋。方药,导赤散加玄参、麦冬" + }, + { + "question_num": 233, + "query": "茯苓的功效是", + "options": { + "A": "利水渗湿", + "B": "利水渗湿,泄热", + "C": "利水渗湿,清热排脓", + "D": "利水渗湿,健脾除痹", + "E": "利水渗湿,健脾宁心" + }, + "answer": "E", + "reason": "茯苓功效:利水渗湿,健脾化痰,宁心安神,败毒抗病。药性平和,利湿而不伤正气。适量服食可作为春夏潮湿季节的调养佳品。可治小便不利、水肿胀满、痰饮咳逆、呕逆、恶阻、泄泻、遗精、淋浊、惊悸、健忘等症。所含茯苓酸具有增强免疫力、抗肿瘤以及镇静、降血糖等的作用。可松弛消化道平滑肌，抑制胃酸分泌,防止肝细胞坏死,抗菌等功效。" + }, + { + "question_num": 234, + "query": "《素问·阴阳应象大论》载“治病必求于本”,其中“本”的含义是", + "options": { + "A": "病机", + "B": "精气", + "C": "病因", + "D": "阴阳", + "E": "脏腑" + }, + "answer": "D", + "reason": "“治病必求于本”意为诊治疾病必须推求阴阳的盛衰,其中“本”指阴阳。" + }, + { + "question_num": 235, + "query": "患者,男,27岁,面部疼痛突然发作,呈闪电样、刀割样剧烈疼痛,持续数秒到2分钟:痛处有灼热感,流涎,目赤流泪,苔薄黄,脉数。治疗除取主穴外,还应选取", + "options": { + "A": "颧髎、迎香", + "B": "列缺、太阳", + "C": "丝竹空、阳白、外关", + "D": "曲池、尺泽", + "E": "太冲、三阴交" + }, + "answer": "D", + "reason": "面痛多与外感邪气、情志不调、外伤等因系有天,治法当以晚迪经络，风止痛为主。以足太阳及手足阳明经穴为主，主穴选用:攒竹、四白、下关、地仓、合谷、风池,并要随证配穴，风寒证者,加列缺;风热证者,加曲池、尺泽;气血瘀滞者,加太冲、三阴交。该患者痛处有灼热感,流涎,目赤流泪,苔黄,脉数为风热证,故选取曲池、尺泽为配穴。" + }, + { + "question_num": 236, + "query": "患者,女,27岁。结婚三年,孕3产0,自然流产3次,均在孕50天时自然殒堕。现停经7周,尿妊娠试验阳性,伴有恶心,呕吐,夜尿频多等早孕反应,2天前出现阴道少量流血，但无腰酸腹痛。B超提示:宫内早孕。妇科检查:宫口未开:子宫增大,符合停经月份。诊断为", + "options": { + "A": "堕胎", + "B": "小产", + "C": "胎堕不全", + "D": "滑胎", + "E": "胎动难留" + }, + "answer": "D", + "reason": "凡堕胎或小产连续发生3次或3次以上者,称为“滑胎”,亦称“数堕胎”“屡孕屡随”。" + }, + { + "question_num": 237, + "query": "气味芳香的药物其煎煮方法宜选用", + "options": { + "A": "先煎", + "B": "后下", + "C": "包煎", + "D": "另煎", + "E": "烊化" + }, + "answer": "B", + "reason": "气味芳香的药物都含有挥发油，“后下”能充分发挥各种芳香性药物、含挥发性成分药物的作用，保证有效成分不受损失，提高药物的疗效。" + }, + { + "question_num": 238, + "query": "《素问·经脉别论》原文:食气人胃,浊气归", + "options": { + "A": "心", + "B": "肝", + "C": "脾", + "D": "肺", + "E": "肾" + }, + "answer": "A", + "reason": "《素问·经脉别论》:“食气人胃,散精于肝,淫气于筋。食气人胃,浊气归心,淫精于脉。”" + }, + { + "question_num": 239, + "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，还应选用的穴位是", + "options": { + "A": "头维、内庭", + "B": "血海、风池", + "C": "风池、列缺", + "D": "太溪、太冲", + "E": "丰隆、太阳" + }, + "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": 240, + "query": "患者,女,46岁。阴部干涩,瘙痒灼热夜间加重,伴五心烦热，烘热汗出,腰酸腿软舌红少苔,脉细数无力。治疗首选", + "options": { + "A": "六味地黄汤", + "B": "龙胆泻肝汤", + "C": "易黄汤", + "D": "知柏地黄汤", + "E": "左归丸" + }, + "answer": "D", + "reason": "阴痒肝肾阴证,主要证候:阴部瘙痒难忍，干涩灼热,夜间加重,或会阴部肤色变浅白,皮肤粗糙,皲裂破溃;眩晕耳鸣,五心烦热,烘热汗出,腰酸腿软,口干不欲饮;舌红苔少,脉细数无丸。治法:滋阴补肾,清肝止痒。方药:知柏地黄汤加当归、栀子、白鲜皮。" + }, + { + "question_num": 241, + "query": "鉴别心肌梗死与心绞痛最有意义的心电图改变是", + "options": { + "A": "ST段抬高", + "B": "T波倒置", + "C": "病理性Q波", + "D": "冠状T波", + "E": "ST段降低" + }, + "answer": "C", + "reason": "心肌梗死时患者心肌已产生缺血性坏死，为不可逆性的病理改变,在心电图上可出现病理性Q波,在心肌梗死与心绞痛发作时都可伴有心律失常。" + }, + { + "question_num": 242, + "query": "《素问·至真要大论》载“诸厥固泄，皆属于下”,其中“固”的含义是", + "options": { + "A": "固涩", + "B": "防御", + "C": "二便不通", + "D": "通“故”", + "E": "坚固" + }, + "answer": "C", + "reason": "“厥”指寒厥和热厥;“固”指二便癌闭不通;“泄”指二便泻利不禁。“诸厥固泄，皆属于下”的含义是寒厥或热厥等厥逆之证、二便不通或泻利不些均与肾气之盛衰有关。肾阳衰于下则为寒厥,肾阴衰于下则为热厥,肾主二阴司二便,主气化,二便不通或泻利不禁均与肾气有关。" + }, + { + "question_num": 243, + "query": "患者,男,24岁。颈项强痛,活动受限头向患侧倾斜，项背牵拉痛,颈项部压痛明显，兼见恶风长悉。治疗床取土八、，M龙户日穴位是", + "options": { + "A": "内关、外关", + "B": "肩井、后溪", + "C": "风池、合谷", + "D": "血海、阴陵泉", + "E": "肾俞、关元" + }, + "answer": "C", + "reason": "题中患者以颈项强痛,活动受限,头向患侧倾斜,项背牵拉痛,颈项部压痛明显为主症,故诊断为落枕。恶风畏寒为风寒侵袭之象,故辨为风寒袭络证。落枕配穴:督脉与太阳经证配大椎、束骨;少阳经证配肩井、外关;风寒袭络配风池、合谷;气潜血瘀配内关、合谷;肩痛配肩髃,背痛配天宗。" + }, + { + "question_num": 244, + "query": "惠儿,男,6岁。皱眉眨眼,摇头耸肩,，嘴角抽动,时伴异常发声,病情时轻时重。抽动能受意志遏制，可暂时不发作。查脑电图未见异常,其诊断是", + "options": { + "A": "多发性抽搐症", + "B": "癫痫", + "C": "习惯性抽搐", + "D": "注意力缺陷多动症", + "E": "风湿性舞蹈病" + }, + "answer": "A", + "reason": "多发性抽搐的诊断要点:①起病年龄在2~12岁;②不自主的眼、面、颈肩及上下肢肌肉快速收缩，以固定方式重复出现，无节律性,抽动时可出现异常发声;③抽动能受意志遏制,可暂时不发作;④病状呈慢性过程,但病程呈明显波动性;⑤实验室检查多无异常，脑电图正常或非特异性异常,智力测试基本正常。" + }, + { + "question_num": 245, + "query": "下列各项中,属于缓慢性心律失常的是", + "options": { + "A": "并行心律性心动过速", + "B": "预激综合征", + "C": "心房扑动", + "D": "逸搏与逸搏心律", + "E": "期前收缩" + }, + "answer": "D", + "reason": "缓慢性心律失常:①窦性,实性心律过缓、窦性静止、窦性停搏;②异位性,逸搏与逸搏心律;③传导阻滞,窦房阻滞、房内阻滞、房室阻、室内阻滞;④综合征,病实综合征。" + }, + { + "question_num": 246, + "query": "根据《素问·痹论》“善胀,尻以代踵，脊以代头”为", + "options": { + "A": "肝痹", + "B": "心痹", + "C": "肾痹", + "D": "肠痹", + "E": "胞痹" + }, + "answer": "C", + "reason": "《素问·痹论》:“凡痹之客五藏者,肺痹者,烦满,喘而呕。心痹者,脉不通,烦则心下鼓,暴上气而喘,嗌干普噫,厥气上则忍肝痹者,夜卧则惊,多饮,数小便,上为引如怀。肾痹者,普胀,尻以代踵,脊以代头。脾痹者,四支懈惰,发咳呕汁,上为大塞。肠痹者,数饮而出不得,中气喘争,时发飧泄。胞痹者,少腹膀胱按之内痛,若沃以汤,涩于小便,上为清涕。”" + }, + { + "question_num": 247, + "query": "患者,男,50岁。肩关节疼痛,痛有定处,抬举困难,夜间痛甚,劳累加剧,治疗应首选", + "options": { + "A": "手太阳经穴", + "B": "近部取穴为主", + "C": "近部取穴与远部取穴相结合", + "D": "循经取穴", + "E": "手少阳经穴" + }, + "answer": "C", + "reason": "肩关节疼痛,痛有定处,抬举困难,夜间痛甚,劳累加剧,此患者所患之证为肩关节周围炎,其取穴原则应近部取穴与远部取穴相结合。手太阳经穴主要治疗肩后部疼痛。循经取穴是临床通常根据经脉循行和主治特点进行的,如《四总穴歌》所载“肚腹三里留,腰背委中求,头项寻列缺,面口合谷收”就是循经取穴的具体体现。手少阳经穴主要治疗上肢内后廉痛。" + }, + { + "question_num": 248, + "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": "擦拭法", + "B": "割治疗法", + "D": "推拿疗法", + "C": "熏洗法", + "E": "拔罐疗法" + }, + "answer": "D", + "reason": "熏洗法和擦拭法多用于局部的体表病症;割治疗法一般用于瘢证和哮喘病症;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、痰痹等证该病证为泄泻的脾虚泻，推拿疗法最为适宜，而拔罐更适合由外邪导致的泄泻。" + }, + { + "question_num": 249, + "query": "下列各项中,属于肝硬化门静脉高压表现的是", + "options": { + "A": "腹水", + "B": "肝大", + "C": "出血倾向", + "D": "肝掌", + "E": "皮肤色素沉着" + }, + "answer": "A", + "reason": "肝硬化门静脉高压的临床表现主要为脾大、侧支循环的建立和开放及腹腔积液。" + }, + { + "question_num": 250, + "query": "感染过程中最常见的表现是", + "options": { + "A": "病原体被清除", + "B": "隐性感染", + "C": "潜伏性感染", + "D": "病原体携带状态", + "E": "显性感染" + }, + "answer": "B", + "reason": "隐性感染又称亚临床感染,病原体只引起特异性免疫应答,不引起或只引起轻微的组织损伤,无临床症状，只能通过免疫学检查发现。一般隐性感染者最多见,病原携带者次之,显性感染者比率最低,但一旦出现最易识别仅少数传染病存在潜伏性感染者。" + }, + { + "question_num": 251, + "query": "患者,女,66岁,腰部冷痛重着,拘挛不可仰,舌淡,苔白,脉紧,除阿是穴、大肠俞、委中外,应选取", + "options": { + "A": "膈俞", + "B": "腰阳关", + "C": "足三里", + "D": "志室", + "E": "悬钟" + }, + "answer": "B", + "reason": "题干中出现腰部冷痛重着,拘空不可仰,舌淡,苔白,脉紧的症状为寒湿腰痛的表现，寒湿腰痛配命门腰阳关。" + }, + { + "question_num": 252, + "query": "患儿,出生10天。面目皮肤发黄,色泽晦暗,持久不退,精神萎靡,四肢欠温,纳呆,大便溏薄色灰白,小便短少,舌质淡,苔白腻,其证型是", + "options": { + "A": "湿热郁燕证", + "B": "寒湿阻滞证", + "C": "脾气虚弱证", + "D": "肝失疏泄证", + "E": "气滞血瘀证" + }, + "answer": "B", + "reason": "胎黄寒湿阻滞证证候:面目皮肤发黄,色泽晦暗,持久不退,精神,四肢欠温,纳呆,大便溏薄色灰白,小便短少,舌质淡,苔白腻。治法:温中化湿退黄。代表方剂:茵陈理中汤。" + }, + { + "question_num": 253, + "query": "间歇性上腹疼痛,多发生在餐前,进食后可缓解的疾病是", + "options": { + "A": "十二指肠炎", + "B": "慢性胃炎", + "C": "十二指肠球后溃疡", + "D": "十二指肠球部溃疡", + "E": "非溃疡性消化不良" + }, + "answer": "D", + "reason": "十二指肠球部溃疡典型表现为上腹痛,特点如下:性质可为钝痛、灼痛、胀痛剧痛、饥饿样不适。发作可有季节性,常于秋冬冬春之交发病。有周期性，即饥饿或夜间发作，进餐后缓解。病情可能反复发作,可长达数年或数十年。服用抑酸剂症状可缓解。" + }, + { + "question_num": 254, + "query": "在急性肝炎早期的治疗过程中，主要的是", + "options": { + "A": "休息", + "B": "降酶", + "C": "保肝", + "D": "抗病毒", + "E": "调节免疫" + }, + "answer": "A", + "reason": "早期应住院卧床休息,症状和黄疸消退后可起床活动,并随着病情的好转逐渐增加活动量,一般以不感到疲劳为度。急性病毒性肝炎多为自限性，一般不需抗病毒治疗。但急性丙型肝炎若发现HCV-RNA阳性,尽快开始抗病毒治疗可治愈。" + }, + { + "question_num": 255, + "query": "患者,男,45岁。关节肌肉疼痛,屈伸不利,疼痛较剧,痛有定处,遇寒痛增,得热痛减,局部皮色不红,触之不热,舌苔薄白,脉弦紧。治疗除选用阿是穴、局部经穴外,还应选用的穴位是", + "options": { + "A": "肾俞、关元", + "B": "阴陵泉、足三里", + "C": "大椎、曲池", + "D": "膈俞、关元", + "E": "膈俞、血海" + }, + "answer": "A", + "reason": "患者以关节肌肉疼痛,屈伸不利为主症,故诊断为痹证。疼痛较剧,痛有定处，遇寒痛增,得热痛减,局部皮色不红,触之不热舌苔薄白,脉弦紧均为寒邪内盛之象,故辨为痛痹。痛痹常配肾俞、关元,阴陵泉、足三里为着痹的配穴,大椎、曲池为热痹的配穴，膈俞能活血，不用于痛痹,膈俞、血海为行痹的配穴。" + }, + { + "question_num": 256, + "query": "患儿,9岁。诊断为病毒性心肌炎,现症见心悸不宁,活动后尤甚,少气懒言,神疲倦怠,头晕目眩,烦热口渴,夜寐不安,舌光红少苔,脉细数。治疗宜选用", + "options": { + "A": "葛根芩连汤", + "B": "银翘散", + "C": "炙甘草汤合生脉散", + "D": "桂枝甘草龙骨牡蛎汤", + "E": "瓜蒌薤白半夏汤合失笑散" + }, + "answer": "C", + "reason": "病毒性心肌炎之气阴亏虚证证候:心悸不宁,活动后尤甚,少气懒言,神疲倦怠,头晕目眩,烦热口渴,夜寐不安,舌光红少苔,脉细数或促或结代。治法:益气养阴，宁心复脉，代表方剂:炙甘草汤合生脉散。" + }, + { + "question_num": 257, + "query": "巨幼细胞贫血的诊断中,最有意义的指标是", + "options": { + "A": "RBC数减少比Hb下降明显", + "B": "MCV、MCH增高", + "C": "骨髓幼红细胞巨幼样变", + "D": "胃液分泌量减少", + "E": "周围血全血细胞减少伴生性粒细胞分叶过多" + }, + "answer": "C", + "reason": "巨幼细胞性贫血的特征是骨髓幼红细胞巨幼样变，因此该指标对巨幼细胞贫血的诊断最有价值。" + }, + { + "question_num": 258, + "query": "《伤寒论》原文，“伤寒汗出解之后,胃中不和,心下痞硬,干噫食臭,胁下有水气,腹中雷鸣,下利者”,治宜选用", + "options": { + "A": "甘草泻心汤", + "B": "半夏泻心汤", + "C": "生姜泻心汤", + "D": "黄连汤", + "E": "干姜黄芩黄连人参汤" + }, + "answer": "C", + "reason": "《伤寒论》:“伤寒汗出,解之后,胃中不和,心下痞硬,干噫食臭,胁下有水气!腹中雷鸣,下利者,生姜泻心汤主之。”" + }, + { + "question_num": 259, + "query": "患者,女,18岁。头痛1周,以后头部历为重，宿加锥办，王沙治疗除田阿县穴处，选取", + "options": { + "A": "天柱、后溪、昆仑", + "B": "上星、头维、合谷", + "C": "百会、通天、行间", + "D": "率谷、太阳、悬钟", + "E": "血海、合谷、申脉" + }, + "answer": "A", + "reason": "头痛如锥刺为瘀血阻滞,经脉不通,据“血实者决之”的治疗原则,取阿是穴泻之,祛瘀通络;足太阳经上的天柱和手太阳小肠经上的后溪，取之可活血祛瘀;昆仑是足太阳经的经穴,取之可清头明目。" + }, + { + "question_num": 260, + "query": "患儿为早产儿,啼哭无力,多卧少动,皮肤干皱,肌肉瘠薄,四肢不温,吮乳乏力,呛乳溢乳,腹胀腹泻，甚而水肿,指纹。治疗宜选用的方剂是", + "options": { + "A": "保元汤", + "B": "归脾汤", + "C": "温脾汤", + "D": "肾气丸", + "E": "左��丸" + }, + "answer": "A", + "reason": "胎怯脾肾两虚证证候:啼哭无力,多卧少动,皮肤干皱,肌肉薄,四肢不温,吮乳乏力,呛乳溢乳，腹胀腹泻,甚而水肿,指纹淡，治法:健脾益肾,温运脾阳。代表方剂:保元汤。" + }, + { + "question_num": 261, + "query": "治疗一切内、外痈的药是", + "options": { + "A": "连翘", + "B": "金银花", + "C": "穿心莲", + "D": "大青叶", + "E": "板蓝根" + }, + "answer": "B", + "reason": "金银花有疏散风热的功效,是治疗一切内外痈之要药。" + }, + { + "question_num": 262, + "query": "下述哪项不是艾滋病的传播途径", + "options": { + "A": "性接触", + "B": "注射及输血和血制品", + "C": "母婴传播", + "D": "器官移植", + "E": "消化道" + }, + "answer": "E", + "reason": "传播途径:①性接触传播是本病主要传播途径;②血源传播通过输血、器官移植、药瘾者共用针具等方式传播;③母婴传播感常伴有血白细胞计数升高和血沉增快。染HIV的孕妇可以通过胎盘、产程中及产后血性分泌物、哺乳等传给婴儿;④其他途径接受HIV感染者的人工授精,医务人员被HIV污染的针头刺伤或皮肤破损处受污染等。目前尚无证据证明一般日常生活接触、食物、水、昆虫能够传播本病。" + }, + { + "question_num": 263, + "query": "患者,男,24岁。目赤肿痛,眼涩难开流泪,畏光,伴发热、恶风、头痛,舌苔薄黄,脉浮数。治疗除取睛明、太阳、合谷、太冲外,还应加", + "options": { + "A": "风池、侠溪", + "B": "印堂、内庭", + "C": "少商、外关", + "D": "关冲、支沟", + "E": "四白、养老" + }, + "answer": "C", + "reason": "本证为外感风热型目赤肿痛睛明、太阳、合谷、太冲四穴配用名曰“开四关”以清热消肿,散郁止痛。外感风热配少商、外关，肝胆火盛加行间、侠溪。" + }, + { + "question_num": 264, + "query": "患儿,10岁。反复咳嗽哮喘4年余。证见咳嗽无力，声低息微，自汗畏风，面白少华,神疲懒言,形体消瘦,大便稀溏,舌淡红,苔薄白,脉细弱,其证候是", + "options": { + "A": "寒性哮喘", + "B": "肺实肾虚", + "C": "肺肾阴虚", + "D": "肺脾气虚", + "E": "脾肾阳虚" + }, + "answer": "D", + "reason": "肺脾气虚证,证候:反复感冒气短自汗,咳嗽无力,形体消瘦,神疲懒言,面白少华或萎黄,纳差,便溏,舌质淡胖,苔薄白,脉细软,指纹淡。治法:补肺固表,健脾益气。代表方剂:玉屏风散合人参五味子汤。" + }, + { + "question_num": 265, + "query": "缺铁性贫血未治疗前,外周血的主要特点是", + "options": { + "A": "红细胞计数减少最明显", + "B": "红细胞形态增大", + "C": "网织红细胞增多", + "D": "血红蛋白下降最明显", + "E": "血小板减少最明显" + }, + "answer": "D", + "reason": "缺铁性贫血是因体内铁储备耗竭,影响血红蛋白合成所引起的贫血，是贫血中最常见的类型。由此可知，在缺铁性贫血未经治疗之前,外周血主要表现就是血红蛋白下降" + }, + { + "question_num": 266, + "query": "患者,女,56岁。身体消瘦,右膝踝关节肿大明显，无明显疼痛，胃纳欠佳，口干欲饮，舌红少苔,脉细略数。治疗宜选用", + "options": { + "A": "黄芪桂枝五物汤", + "B": "桂枝附子汤", + "C": "桂枝芍药知母汤", + "D": "乌头汤", + "E": "防己黄芪汤" + }, + "answer": "C", + "reason": "原文“诸肢节疼痛,身体魁赢,脚肿如脱,头眩短气,温温欲吐,桂枝芍药知母汤主之。”" + }, + { + "question_num": 267, + "query": "患者,男,68岁。中风半身不遂,舌强语言不利，口角歪斜,如兼见面红目赤，心烦口苦,舌红苔黄,脉弦。除用主穴外,还应选用的是", + "options": { + "A": "太冲、太溪", + "B": "丰隆、合谷", + "C": "足三里、气海", + "D": "内庭、风池", + "E": "曲池、内庭" + }, + "answer": "A", + "reason": "患者中风半身不遂,舌强语言不利,口角歪斜可辩证为中经络;兼见面红目赤，心烦口苦,舌红苔黄,脉弦。可辩证为肝阳上亢证配太冲、太溪泻肝滋肾;风痰阻络配丰隆、合谷;痰热腑实配曲池、内庭、丰隆;气虚血瘀配气海、血海、足三里;阴虚风动配太溪、风池。" + }, + { + "question_num": 268, + "query": "患儿,18个月。近3个月来不思进食，神疲乏力,形体消瘦,面色苍黄,唇淡甲白,大便不调,舌淡苔白,脉细无力,指纹淡红,其证候是", + "options": { + "A": "肝肾阴虚证", + "B": "心脾两虚证", + "C": "气血亏虚证", + "D": "脾肾阳虚证", + "E": "脾胃虚弱证" + }, + "answer": "E", + "reason": "营养性缺铁性贫血脾胃虚弱证证候:长期纳食不振,神疲乏力,形体消瘦，面色苍黄,唇淡甲白，大便不调,舌淡苔白,脉细无力,指纹淡红。治法:健运脾胃,气养血。代表方剂:六君子汤。" + }, + { + "question_num": 269, + "query": "下列各项中,为治疗肺气壅遏所致喘咳的要药是", + "options": { + "A": "白芷", + "B": "细辛", + "C": "辛夷", + "D": "麻黄", + "E": "桂枝" + }, + "answer": "D", + "reason": "麻黄应用:①风寒感冒,为发汗解表之要药;②咳嗽气喘,为治肺气壅遏所致喘咳的要药;③风水水肿。此外,取麻黄散寒通滞之功,也可用治风寒痹证,阴疽,痰核。故根据题干要求,此题的正确选项是D。" + }, + { + "question_num": 270, + "query": "患者,男,25岁。发热1周,前医以“青霉素”肌注后,热不退,伴恶寒,全身疼痛，头痛，无汗，舌淡苔薄白，脉浮紧。临床辨证是", + "options": { + "A": "麻黄汤证", + "B": "桂枝汤证", + "C": "桂枝麻黄各半汤证", + "D": "葛根汤证", + "E": "麻杏石甘汤证" + }, + "answer": "A", + "reason": "麻黄汤的辨治要点:恶寒发热,头项强痛,身疼腰痛,骨节疼痛,呕逆,喘咳,无汗,口不渴,舌淡苔白而润,脉浮紧有力。" + }, + { + "question_num": 271, + "query": "患者,男,46岁,因与人争吵后,头痛:心烦易怒,口苦面赤，舌红苔黄,脉弦。除用主穴外，还应该用", + "options": { + "A": "太冲、太溪、侠溪", + "B": "合谷、内关、外关", + "C": "中冲、灵道、曲池", + "D": "三阴交、足三里", + "E": "涌泉、太白、承山" + }, + "answer": "A", + "reason": "患者争吵后发病考虑和肝阳上九、肝火上炎等相天头痛、苦面亦为肝火上炎的表现,舌红苔黄为热象,脉弦为肝证。应治以平肝降火，选用肝经太冲平肝潜阳，侠溪清肝胆热，太溪滋肾阴以达到滋水涵木之功。" + }, + { + "question_num": 272, + "query": "患儿,男,8岁。症见多动多语,冲动任性,难于制约,注意力不集中,胸中烦热,懊恼不眠,便秘尿赤,舌质红,苔黄腻,脉滑数。治疗应首选方剂是", + "options": { + "A": "龙胆泻肝汤", + "B": "泻心导赤散", + "C": "泻心汤", + "D": "清心涤痰汤", + "E": "黄连温胆汤" + }, + "answer": "E", + "reason": "注意力缺陷多动症痰火内扰证证候:多动多语,烦躁不宁,冲动任性,难以制约,兴趣多变,注意力不集中,胸中烦热,懊恼不眠,纳少口苦,便秘尿赤,舌质红,苔黄腻,脉滑数。治法:热泻火，化痰宁心。代表方剂:黄连温胆汤。" + }, + { + "question_num": 273, + "query": "不属于慢性肾炎的治疗措施是", + "options": { + "A": "应用激素及细胞毒药物", + "B": "积极控制血压", + "C": "优质低蛋白饮食及低磷饮食", + "D": "避免有损肾功能的因素", + "E": "应用血小板解聚药" + }, + "answer": "A", + "reason": "虽多数慢性肾炎的起始因素为免疫介导炎症,但多数慢性肾炎的确切病因尚不清楚,导致慢性化的因素一般认为非免疫因素占重要作用,所以一般不用激素或细胞毒性药物，其他各项均为综合治疗的组成部分。" + }, + { + "question_num": 274, + "query": "患者,男,55岁,因劳累汗出感赛，出现发热恶寒,腹满头痛身痛，大便已4日未行，舌红苔黄腻，脉浮而滑数，但饮食如故，治当选用", + "options": { + "A": "厚朴三物汤", + "B": "大柴胡汤", + "C": "大承气汤", + "D": "柴胡桂枝汤", + "E": "厚朴七物汤" + }, + "answer": "E", + "reason": "结合题干信息,提示了患者胃气米伤,饮食尚可运化,腹满是因肠中腑气不通而导致的。治以厚朴七物汤，通腑泄热、祛风解表。" + }, + { + "question_num": 275, + "query": "某女,20岁,2天前受风后出现左侧面部麻木,额纹消失,眼裂变大,鼻唇沟变浅，口角下垂歪向左侧，舌淡，苔薄白。针刺面部穴位应采用", + "options": { + "A": "直刺深刺", + "B": "多穴重刺", + "C": "轻刺浅刺", + "D": "提插泻法", + "E": "电针强刺激" + }, + "answer": "C", + "reason": "面部穴位宜轻刺浅刺，用力稍小,皮肤仅现潮红、充血为度。适用于头面部、老弱妇女患者,以及病属虚证、久病者。" + }, + { + "question_num": 276, + "query": "患儿,10岁。既往有哮喘病史,昨天受凉后,见喷、鼻塞、流清涕,今晨起气喘,喉间哮鸣,咳嗽痰黏,色黄难略,胸闷,面色红赤,夜卧不安,无汗,口渴,小便黄赤,大便干,咽红,舌质红,苔薄白,脉浮紧,其证型是", + "options": { + "A": "热性哮喘", + "B": "外寒内热", + "C": "寒性哮喘", + "D": "肺实肾虚", + "E": "肺肾阴虚" + }, + "answer": "B", + "reason": "本题考查:哮喘的中医辨证论治。依据题干患者既往有哮喘病史，诊断为哮喘。辨证:病因外感受凉后所致且脉浮紧,但患者表现为咳嗽痰黏，色黄难咯，胸闷，面色红赤夜卧不安，无汗，口渴,小便黄赤,大便干,咽红,一派热象表现,诊断为哮喘之外寒内热证，证候气喘,喉间哮鸣,咳嗽痰黏,色黄难咯,胸闷,喷嚏,鼻塞,流清涕,恶寒,发热,面色红赤,夜卧不安,无汗,口渴,小便黄赤,大便干,咽红,舌质红苔薄白或黄,脉浮紧或滑数，指纹浮红或沉紫治法:解表清里，止咳定喘。代表方剂:大青龙汤。故B正确。A、C项:均为干扰项。与题干不符,排除。D项:肺实肾虚证候表现为气喘,喉间哮鸣,持续较久,喘促胸满,动则喘甚,咳嗽,痰稀色白易咯,形寒肢冷,面色苍白或晦滞少华,神疲倦怠,小便清长,舌质淡,苔薄白或白腻,脉细弱或沉迟，指纹淡滞。治法:泻肺平喘,补肾纳气代表方剂:偏于肺实者,用苏子降气汤。偏于肾虚者,用都气丸合射干麻黄汤。与题干不符,排除。E项:肺肾阴虚证候表现为喘促乏力，动则气喘,干咳少痰,痰黏难咯,咳嗽无力,盗汗,形体消瘦,腰膝酸软,面色潮红,午后潮热,口咽干燥,手足心热,便秘,舌红少津,苔花剥,脉细数,指纹淡红。治法:养阴清热,敛肺补肾。代表方剂:麦味地黄丸。与题干不符,排除。故正确答案为B。" + }, + { + "question_num": 277, + "query": "两种功效相似的药物配合应用，可以增强原有药物的疗效,这种配伍属于", + "options": { + "A": "相使", + "B": "相须", + "C": "相反", + "D": "相畏", + "E": "相恶" + }, + "answer": "B", + "reason": "相须就是两种功效相似的药物配合应用,可以增强原有药物的疗效。如麻黄配桂枝,能增强发汗解表、祛风散寒的作用;石与知母配合,能明显增强清热泻火的治疗效果。相恶:就是两药合用，一种药物能破坏另一种药物的功效。如人参恶菜菔子,菜菔子能削弱人参的补气作用，" + }, + { + "question_num": 278, + "query": "患者,男,43岁。3月患病延余诊视发热不退已经5日，面红唇赤，虚烦不得卧，难以入眠,伴见咽干口燥,舌红少苔，脉细数。治宜", + "options": { + "A": "猪苓汤", + "B": "栀子豉汤", + "C": "泻心汤", + "D": "黄连阿胶汤", + "E": "黄连汤" + }, + "answer": "D", + "reason": "原文“少阴病,得之二三日以上,心中烦,不得卧,黄连阿胶汤主之。”黄连阿胶汤证、猪苓汤证、栀子豉汤证证治异同:三方主症都有心中烦，不得眠,且都有热象。但其病机、证候各不相同。黄连阿胶汤证由心火亢旺，肾水不足所致,故其心烦、失眠伴有舌红少苔,脉细数等阴虚内热之证。猪苓汤证属阴成水热互结之证，其心烦失眠,是阴虚内热扰乱心神,伴有呕、渴、下利等水气内停证候。栀子豉汤证是无形邪热内扰胸膈所引起,故除心烦不眠一症外，还有头汗出,甚至胸中室,心中结痛等症。" + }, + { + "question_num": 279, + "query": "患者,男,63岁,头晕目眩,伴耳鸣,遗精,舌淡,脉沉细。除风池、百会外,应加用", + "options": { + "A": "内关、太冲、行间、侠溪、太溪", + "B": "内关、太冲、头维、丰隆、中脘", + "C": "肝俞、肾俞、足三里、脾俞、胃俞", + "D": "肝俞、肾俞、足三里、太溪、悬钟、三阴交", + "E": "头维、血海、膈俞、内关、足三里、太溪" + }, + "answer": "D", + "reason": "根据题干症状诊断:眩晕虚证之肾精不足证。主穴:百会、风池、肝俞、肾俞、足三里。配穴:气血两虚证配气海、脾俞、胃俞;肾精不足证配太溪、悬钟、三阴交" + }, + { + "question_num": 280, + "query": "患儿,3岁。不思纳食,面色少华,形体偏瘦，舌淡苔薄白,其治法是", + "options": { + "A": "健脾化湿", + "B": "健脾助运", + "C": "疏肝和胃", + "D": "消食导滞", + "E": "和脾开胃" + }, + "answer": "B", + "reason": "本题考查:厌食的中医辨证论A项·健化湿适用于脾患湿感，与题干不:A符,排除。B项正确。C项:疏肝和胃适用于肝胃不和,与题干不符,排除。D项:消食导滞适用于饮食积滞,与题干不符,排除。E项:和脾开胃适用于脾失健运,与题干不符,排除。根据题干主症“不思纳食”诊断为厌食,除厌食症状外，其他症状不明显,面色少华,形体偏瘦,诊断为脾胃气虚证,治法:健脾益气，佐以助运。代表方剂:异功散、参苓白术散。故正确答案为B。" + }, + { + "question_num": 281, + "query": "我国高血压患者最主要的并发症是", + "options": { + "A": "肾脏损害", + "B": "高血压性心脏病", + "C": "脑出血与脑梗死", + "D": "冠心病", + "E": "���动脉夹层" + }, + "answer": "C", + "reason": "靶器官损害是高血压最常见的并发症,具体包括以下几个方面:①脑,见的有脑血管意外,如脑出血、脑梗死;②心脏,力衰竭:③肾脏,要为肾功能减退,如高血压肾病、肾功能衰竭;④血管,括主动脉疾病，如突发主动脉夹层、小动脉损伤,如视网膜动脉渗出、出血，严重时甚至可引发失明。" + }, + { + "question_num": 282, + "query": "男,68岁,慢性阻塞性肺疾病病史12年。动脉血气分析pH7.36,Pa0₂43mmHg，PaCO₂52mmHg,对读患者可以改善预后的措施是", + "options": { + "A": "预防性使用抗生素", + "B": "吸入糖皮质激素", + "C": "使用支气管舒张剂", + "D": "肺康复锻炼", + "E": "长期家庭氧疗" + }, + "answer": "E", + "reason": "①COPD患者根据血气分析结果，应诊断为Ⅱ型呼吸衰竭,对COPD患者并发慢性呼吸衰竭者,长期家庭氧疗可提高生活质量和生存率,对血流动力学、运动能力、精神状态均会产生有益的影响;②稳定期患者不主张预防性使用抗生素。吸入糖皮质激素可增加运动耐量、减少急性加重发作频率、提高生活质量,但不能改善预后,一般仅用于反复病情恶化。使用支气管舒张剂主要用于控制喘息症状。肺康复锻炼包括健康教育、运动锻炼、物理治疗等,为一般性治疗措施。" + }, + { + "question_num": 283, + "query": "患者,男,35岁,热邪内蕴,多食即吐,呕吐酸苦热臭,口渴,喜寒恶热,岩石便秘结，脉数苔黄,除针刺主穴之外,还可加用", + "options": { + "A": "上脘、胃俞", + "B": "膻中、丰隆", + "C": "合谷、金津、玉液", + "D": "大陵、中脘", + "E": "内关、阳陵泉" + }, + "answer": "C", + "reason": "结合题干信息患者为热邪内蕴型呕吐,主穴选取中脘、足三里、内关,配穴:寒邪客胃配上脘、胃俞;热邪内蕴配合谷、金津、玉液;饮食停滞配梁门、天枢;肝气犯胃配期门、太冲;痰饮内停配丰隆、公孙;脾胃虚寒配脾俞、胃俞。" + }, + { + "question_num": 284, + "query": "患儿,10个月。大便呈果酱色,伴阵发性哭吵,腹胀,其诊断是", + "options": { + "A": "痢疾", + "B": "肠炎", + "C": "积滞", + "D": "虫积", + "E": "肠套叠" + }, + "answer": "E", + "reason": "婴幼儿大便呈果酱色,伴阵发性哭闹,常为肠套叠。" + }, + { + "question_num": 285, + "query": "急性心肌梗死最多见的心律失常是", + "options": { + "A": "束支传导阻滞", + "C": "房性期前收缩", + "E": "房室传导阻滞", + "B": "心房颤动", + "D": "室性心律失常" + }, + "answer": "D", + "reason": "急性心梗最常见的心律失常有以下三种:①室性心律失常，其中最常见的是室性早搏,室性早搏可以成对出现，也可以演变为短阵的非持续性室性心动过速,在血管再通的过程当中,经常出现加速性室性自主心律;②室上性心律失常,室上性心律失常也是心梗中经常发生的心律失常，几乎占到所有急性心梗病例的1/3,其中最常见的为心房颤动;③缓慢型心律失常,其中包括实性心动过缓或者工度和Ⅱ度房室传导阻滞。" + }, + { + "question_num": 286, + "query": "患者,女，19岁。月经增多10多天。查:贫血，皮肤散在出血点，肝脾未扪及;Hb100g/L,WBC10x10^9/L,血小板25x10^9/L。骨髓增生活跃,全片可见巨核细胞50个,其可能的疾病是", + "options": { + "A": "再生障碍性贫血", + "B": "急性白血病", + "C": "系统性红斑狼疮", + "D": "脾功能亢进", + "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瘢的诊断要点:①广泛出血累及皮肤、黏膜及内脏:②多次检查血小板计数减少;③脾不肿大或轻度肿大;④骨髓巨核细胞数增多或正常,有成熟障碍;⑤并具备下列5项中任何1项:泼尼松治疗有效,脾切除术治疗有效，血PAIg阳性，血PAC3阳性,血小板寿命测定缩短;⑥排除继发性血小板减少症。" + }, + { + "question_num": 287, + "query": "患者,女,18岁。每次行经血量多，色些红，味皇秽,来有瘀块。常伴有便秘，口干舌红苔黄,脉弦数有力。针灸取穴为", + "options": { + "A": "三阴交、隐白、内关、太溪", + "B": "三阴交、隐白、血海、水泉", + "C": "三阴交、隐白、脾俞、足三里", + "D": "三阴交、隐白、百会、气海", + "E": "三阴交、隐白、内庭、关元" + }, + "answer": "B", + "reason": "根据症状“色紫红,有瘀块”可判断有瘀血,根据“便秘，口干。舌红苔黄,脉弦数有力”可判断有血热，故针灸治疗除用主要穴位三阴交、隐白外,应加活血清热之穴，选项B中的血海可活血清热，水泉为肾经都穴，阴经的郄穴擅治出血性疾病，在这里可调经止血。" + }, + { + "question_num": 288, + "query": "患儿,男,6岁,高热,一侧耳下腮部肿胀疼痛,坚硬拒按,张口咀嚼困难,烦躁不安,口渴欲饮,咽红肿痛,颌下肿块胀痛,纳少,大便秘结,舌质红,舌苔黄,脉滑数,其治疗宜首选", + "options": { + "A": "凉营清气汤", + "B": "黄连解毒汤", + "C": "清瘟败毒饮", + "D": "普济消毒饮", + "E": "龙胆泻肝汤" + }, + "answer": "D", + "reason": "痄腮之热毒蕴结证证候:商热,一侧或两侧耳下腮部肿胀疼痛,坚硬拒按,张口咀嚼困难,或有烦躁不安,口渴欲饮,头痛,咽红肿痛,颌下肿块胀痛,纳少,大便秘结,尿少而黄,舌质红,舌苔黄,脉滑数。治法:清热解毒,软坚散结。代表方剂:普济消毒饮。" + }, + { + "question_num": 289, + "query": "最易发生幽门梗阻的溃疡是", + "options": { + "A": "球后溃疡", + "B": "胃多发溃疡", + "C": "胃角溃疡", + "D": "胃窦溃疡", + "E": "幽门管溃疡" + }, + "answer": "E", + "reason": "消化性溃疡常见的有胃溃疡和十二指肠溃疡。幽门管位于胃远端，与十二指肠交界。幽门管溃疡上腹痛的节律性不明显，呕吐较多见,较易发生幽门梗阻、出血和穿孔等并发症。" + }, + { + "question_num": 290, + "query": "患者,女,30岁。尿痛、尿频、尿急2天,伴发热、腰痛、恶心、呕吐。血压120/80mmHg,尿常规检查有红、白细胞及白细胞管型，其诊断可能是", + "options": { + "A": "急性膀胱炎", + "B": "急性肾孟肾炎", + "C": "慢性肾盂肾炎", + "D": "急性肾炎", + "E": "慢性肾炎" + }, + "answer": "B", + "reason": "急性肾盂肾炎常发生于育龄妇女。①泌尿系统症状:出现膀胱刺激征，腰痛和(或)下腹部痛,腰痛程度不一,多为钝痛、酸痛,查体可见肋脊角及输尿管点压痛、肾区压痛和叩击痛;②全身感染症状出现寒战、发热、头痛、恶心呕吐、食欲不振等,体温多在38~39℃," + }, + { + "question_num": 291, + "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": "从本患者的症状可辨证为肺肾气虚型哮喘,治疗应补益肺肾,选项“E肺俞、气海、肾俞、足三里、太渊”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": 292, + "query": "患儿,2岁。体重7kg,形体极度消瘦,皮肤干瘪起皱，大肉已脱，皮包骨头，貌似老人,毛发干枯,面色苍白,精神萎靡,啼哭无力,腹凹如舟，久不思食，大便稀溏或便秘，舌淡嫩,苔少,脉细弱。辨证为(", + "options": { + "A": "疳气证", + "B": "疳积证", + "C": "眼疳证", + "D": "干疳证", + "E": "口疳证" + }, + "answer": "D", + "reason": "干疳证证候:形体极度消瘦皮肤干瘪起皱，大肉已脱，皮包骨头,貌似老人，毛发干枯,而色眺白,精神萎靡,啼哭无力,腹凹如舟,杳不思食,大便稀溏或便秘,舌淡嫩,苔少脉细弱。治法:补益气血。代表方剂:八珍汤。" + }, + { + "question_num": 293, + "query": "不属于肝硬化代偿期表现的是", + "options": { + "A": "脾脏轻度肿大", + "B": "肝功能轻度异常", + "C": "乏力、食欲减退", + "D": "食管胃底静脉曲张", + "E": "肝脏质地偏硬" + }, + "answer": "D", + "reason": "肝硬化代偿期临床表现:病症轻微,表现为乏力、食欲减退、腹部不适、恶心、上腹部隐痛、轻微腹泻等,病症多呈间歇性。查体示肝脏轻度肿大,质地偏硬,无或轻度压痛,脾轻度或中度肿大。肝功能检查多数正常或轻度异常。" + }, + { + "question_num": 294, + "query": "患者,男,45岁。肥胖体形,无症状,健康查体时发现尿糖阳性。空腹血糖稍高，葡萄糖耐量降低，其诊断是", + "options": { + "A": "2型糖尿病", + "B": "1型糖尿病", + "C": "糖尿病酮症酸中毒", + "D": "肾炎", + "E": "肾病" + }, + "answer": "A", + "reason": "1型糖尿病多见于青少年,其胰岛素分泌缺乏，必须依赖胰岛素治疗维持生命。2型糖尿病多见于30岁以上中、老年人，其胰岛素的分泌量并不低甚至还偏高,病因主要是机体对胰岛素不敏感(��胰岛素抵抗)。C是糖尿病的一种急性并发症，是血糖急剧升高引起的胰岛素严重不足激发的酸中毒;D、E尿中有蛋白。" + }, + { + "question_num": 295, + "query": "患者,男,25岁。胃痛拒按,食后痛甚,舌质紫暗，有斑，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、膈腧、三阴交", + "E": "足三里、内关、中脘、内庭、三阴交" + }, + "answer": "E", + "reason": "患者胃痛拒按，食后痛甚，舌质紫暗,有瘀斑,脉细涩是由于滞血瘀而引起的胃痛,所以在应在选用足三里、内关、中脘和胃止痛的基础上加用膈俞以行气活血。" + }, + { + "question_num": 296, + "query": "患儿,2岁。面色萎黄,形体消瘦,不思乳食,食则饱胀,腹满喜按,大便稀溏酸臭,夹有乳片或不消化食物残渣,舌质淡,苔白腻，脉细滑,指纹淡滞,其治法是", + "options": { + "A": "健脾助运,消食化滞", + "B": "健脾化积,和中导滞", + "C": "清热和胃,和中导滞", + "D": "运脾开胃,和中导滞", + "E": "理气和中,和中导滞" + }, + "answer": "A", + "reason": "积滞脾虚夹积证证候:面色菱黄,形体消瘦,神疲肢倦,不思乳食,食则饱胀,腹满岳按，大便油酸具，灭有乳片或不消化食物残渣,舌质淡,苔白腻,脉细滑,指纹淡滞。治法:健脾助运,消食化滞。代表方剂:健脾丸。" + }, + { + "question_num": 297, + "query": "慢性肾小球肾炎常出现的尿管型是", + "options": { + "A": "红细胞管型", + "B": "蜡样管型", + "C": "颗粒管型", + "D": "透明管型", + "E": "白细胞管型" + }, + "answer": "C", + "reason": "慢性肾炎可以出现多种管型:①透明管型,可见于急慢性肾小球肾炎当中，正常人中也可见;②红细胞管型,在慢性肾炎中，如果主要表现为镜下血尿或肉眼血尿者,可见红细胞管型;③颗粒管型，是慢性肾炎常见的管型，也是肾小管损伤,常可出现的管型;④混合管型，其是同时存在两种以上的细胞管型，识别起来比较困难,称之为混合管型,也是慢性肾炎常见的管型;腊样管型,主要见于慢性肾炎的中晚期或出现肾功能不全的情况;⑥脂肪管型，可见于慢性肾炎或肾病综合征。" + }, + { + "question_num": 298, + "query": "患者,男,60岁。慢性支气管炎、阻塞性肺气肿病史10余年，近3年来反复双下肢浮肿,3天前因受凉病情加剧，口唇发绀、神志恍惚。确定有无呼吸衰竭，最有意义的检查是", + "options": { + "A": "血气分析", + "B": "X线胸片", + "C": "血生化", + "D": "肺功能检查", + "E": "气道反应性测定" + }, + "answer": "A", + "reason": "动脉血气分析可确定是否发生呼吸衰竭及其类型。" + }, + { + "question_num": 299, + "query": "患者治疗心前区刺痛,心痛彻背,伴心慌汗出,面色晦暗,唇甲青紫,舌紫暗有瘀斑，脉涩。治疗除主穴外，应配", + "options": { + "A": "神阙、关元", + "B": "中脘、丰隆", + "C": "心俞、至阳", + "D": "血海、太冲", + "E": "心俞、脾俞" + }, + "answer": "D", + "reason": "根据题干信息:心前区刺痛心痛彻背,伴心慌汗出,面色晦暗,唇甲青紫,舌紫暗有瘀斑,脉涩。可诊断:心绞痛之气滞血瘀证,其主穴为内关、郄门、阴郄、膻中,其配穴:①气滞血瘀配太冲、血海;②寒邪凝滞配神阙、至阳;③痰浊阻络配中脘、丰隆;④阳气虚衰配心俞、至阳。故本题选D。" + }, + { + "question_num": 300, + "query": "患儿,2岁半。面色潮红,身热消瘦,手足心热,肢体拘李或强直，时或抽搐，大便干结,舌光无苔,质绛少津,脉象细数。治疗首选方剂是", + "options": { + "A": "大定风珠", + "B": "地黄饮子", + "C": "大补阴丸", + "D": "理中汤", + "E": "四逆汤" + }, + "answer": "A", + "reason": "慢惊风阴虚风动证,证候:精神疲惫,形容憔悴,面色萎黄或时有潮红，虚烦低热,手足心热,易出汗,大便干结,肢体拘挛或强直,抽搐时轻时重,舌绛少津,苔少或无苔,脉细数。治法:育阴潜阳,滋肾养肝。代表方剂:大定风珠。" + }, + { + "question_num": 301, + "query": "类风湿关节炎最早出现的关节表现是", + "options": { + "A": "疼痛", + "B": "肿胀", + "C": "活动障碍", + "D": "畸形", + "E": "晨僵" + }, + "answer": "A", + "reason": "关节痛是类风湿关节炎最早的关节症状，多呈对称性、持续性疼痛,时轻时重,伴有压痛。" + }, + { + "question_num": 302, + "query": "成年男性,全身高度浮肿半年余:检查:血压正常，腹部移动性浊音(+),尿蛋白(+++),尿中红细胞1~8/HP,血清白蛋白/球蛋白比例2.1/2.0,酚红排泄率45%。应首先考虑的是", + "options": { + "A": "门脉性肝硬化", + "B": "急性肾小球肾炎", + "C": "慢性肾炎肾病型", + "D": "慢性肾炎普通型", + "E": "慢性肾盂肾炎" + }, + "answer": "C", + "reason": "慢性肾炎是临床表现相似的一组肾小球疾病，它们共同的表现是水肿、高血压和尿异常改变。普通型病程迁延,病情相对稳定,多表现为轻度至中度的水肿、高血压和肾功能损害。尿蛋自(十~十十十),离心尿红细胞>10/HP和管型尿等。肾病型主要表现为肾病综合征，24小时尿蛋白定量>3.5g，血清白蛋白低于30g/L,水肿一般较重,伴有或不伴高脂血症。病理分型以微小病变、膜性、膜增殖、局灶性肾小球硬化等为多见。" + }, + { + "question_num": 303, + "query": "重度有机磷杀虫药中毒时,瞳孔的表现是", + "options": { + "A": "针尖样大小", + "B": "瞳孔扩大", + "C": "两侧大小不等", + "D": "形状不规则", + "E": "呈椭圆形" + }, + "answer": "A", + "reason": "有机磷农药中毒严重者可出现心动过速、血压升高、瞳孔如针尖大小、呼吸困难、肺水肿、大小便失禁、呼吸抑制、意识不清甚至深度昏迷，" + }, + { + "question_num": 304, + "query": "患者,男,43岁。腹痛、腹泻半年余,大便4~6次/日,常有脓血便及里急后重,便后腹痛多可缓解，伴消瘦等，反复查大便常规以红细胞、白细胞及巨嗞细胞为主要异常,结肠镜检查见乙状结肠末端黏膜充血，散在浅溃疡。该患者的最可能的诊断是", + "options": { + "A": "慢性细菌性痢疾", + "B": "肠易激综合征", + "C": "克罗恩病", + "D": "结肠癌", + "E": "溃疡性结肠炎" + }, + "answer": "E", + "reason": "结合患者腹痛、腹泻、脓血便以及里急后重,结肠镜检查见乙状结肠末端黏膜充血,散在浅溃疡,可以判断患者应为溃疡性结肠炎。" + }, + { + "question_num": 305, + "query": "患者,男,30岁。长期在电脑前工作近1年时感视力疲劳,两目干涩,头昏脑涨,腰膝酸痛,舌质略红,脉细涩。用药应首选的是", + "options": { + "A": "夏枯草、决明子", + "B": "龙胆草、夏枯草", + "C": "桑叶、菊花", + "D": "菊花、枸杞子", + "E": "菊花、决明子" + }, + "answer": "D", + "reason": "患者证属肝肾阴虚。肝开窍于目,肝阴血不足,肝阳上扰,则见视力疲劳，两目干涩,头昏脑胀。肾阴虚而见腰膝酸痛。菊花平肝明目,可养肝、平肝、清肝,为明目要药。枸杞子滋补肝肾,益精明目,为平补肾精肝血之品。两药常同用以养肝明目,如杞菊地黄丸。因此本题选D。" + }, + { + "question_num": 306, + "query": "患者,男,48岁。胃溃疡史12年,近2个月上腹痛失去原规律性,伴反酸、嗳气,内科治疗疗效不满意,急需的检查是", + "options": { + "A": "钡餐检查", + "B": "B超检查", + "C": "胃酸测定", + "D": "便隐血试验", + "E": "胃镜十活检检査" + }, + "answer": "E", + "reason": "若胃溃疡患者年龄在45岁以上、疼痛的节律性消失、食欲减退、体重明显减轻、粪便隐血试验持续阳性、内科治疗效果较差者,应疑诊癌变的可能,应行“胃镜十活检”检查。" + }, + { + "question_num": 307, + "query": "患者,男,45岁。有头部外伤史，头刺痛如锥，前额部尤甚,舌质暗,脉弦涩。治疗采用活血化瘀法，应选用的引经药是", + "options": { + "A": "葛根", + "B": "白芷", + "D": "柴胡", + "C": "细辛", + "E": "藁本" + }, + "answer": "B", + "reason": "白芷为治疗阳明经头痛的要药,即首选" + }, + { + "question_num": 308, + "query": "患者,男,60岁。上腹痛,食欲减退持续黑便1月余。查体:上腹触及肿应首先考虑的是", + "options": { + "A": "胃癌", + "B": "胃溃疡", + "C": "慢性萎缩性胃炎", + "D": "胃原发性淋巴瘤", + "E": "食管癌" + }, + "answer": "A", + "reason": "患者有上腹部疼痛,并触及肿块,即可基本排除BCDE。黑便是较大量胃肠道出血的表现，可排除B、C、D。结合患者的年龄，和黑便主诉,考悲胃癌。" + }, + { + "question_num": 309, + "query": "患者,男,24岁。鼻渊头痛,香臭不闻浊涕常流。用药应首选的是", + "options": { + "A": "薄荷", + "B": "藿香", + "C": "辛夷", + "D": "紫苏", + "E": "荆芥" + }, + "answer": "C", + "reason": "辛夷用于鼻渊头痛,为治鼻渊头痛要药;薄荷用于头痛目赤，咽喉肿痛;藿香治疗夏月外感风寒;紫苏用于风寒感冒,咳嗽痰多;荆芥用于外��表证。故选C" + }, + { + "question_num": 310, + "query": "患者,女,20岁。2周前开始咽痛,发热,双膝、踝、腕关节红、肿、热,痛。检查:体温38℃,心率90次/分心律齐,未闻及器质性杂音,红细胞沉降率30mm/h,抗链球菌溶血素“O”800单位。治疗应首选", + "options": { + "A": "糖皮质激素", + "B": "阿司匹林", + "C": "消炎痛", + "D": "硫唑嘌呤", + "E": "环磷酰胺" + }, + "answer": "B", + "reason": "本题考查:风湿热的诊断。根据题于,抗链球菌溶血素“O”升高,初步怀疑为链球菌感染,结合患者咽痛发热史、膝踝腕关节红肿热痛,红细胞沉降率快，可以诊断为风湿热，治疗常用的药物有水杨酸制剂(阿司匹林),故B正确,其他四项为干扰项,排除。故正确答案为B。" + }, + { + "question_num": 311, + "query": "患者,男,50岁。平素喜饮白酒,近日牙龈红肿作痛,伴口苦心烦，舌质暗红，脉沉数有力。用药应首选的是", + "options": { + "A": "黄连", + "B": "黄芩", + "C": "黄柏", + "D": "丹参", + "E": "知母" + }, + "answer": "A", + "reason": "患者是胃火旺血热,黄连善消心胃之火,本品大苦大寒,清泄而燥,药力颇强主人心、胃经,兼人肝与大肠经。作用偏于心及中焦,善清心胃之火,除中焦湿热，为治湿热火郁之要药。黄连功效:清热燥湿,泻火解毒。黄连主治病证:①湿热痞满呕吐、泻痢、黄疸;②热病高热、烦躁、神昏,内热心烦不寐,冒火牙痛、口舌生疮;③肝火犯胃呕吐吞酸;④血热妄行吐衄，痈疽肿毒,目赤肿痛,耳道疖肿,湿热疮。" + }, + { + "question_num": 312, + "query": "患者,男,57岁。高血压病史23年,高血压性心脏病史3年，近半个月血压控制不理想,劳累后出现气短、呼吸困难,伴咳嗽、咳痰、心悸、交替脉等表现，应考虑出现的并发症是", + "options": { + "A": "左心衰竭", + "B": "右心衰竭", + "C": "全心衰竭", + "D": "急性肺水肿", + "E": "肾衰竭" + }, + "answer": "A", + "reason": "左心衰竭指左心室代偿功能不全而发生的心力衰竭,临床上较为常见，以肺循环淤血为特征。根据患者的临床表现，可诊断为左心衰竭" + }, + { + "question_num": 313, + "query": "患者,男,56岁。咳嗽气喘四五年,时轻时重,近1个月以来，出现晚上低热，自觉手足心发热，心烦急躁,小便黄。应选用的与知母配伍的药物是", + "options": { + "A": "石膏", + "B": "生地黄", + "C": "天花粉", + "D": "黄柏", + "E": "玄参" + }, + "answer": "D", + "reason": "患者近一月以来,出现晚上低热,自觉手足心发热,心烦急躁,小便黄。综合考.为阴虚发热，治疗上应以清虚热，黄柏性味归经:苦,寒。归肾、膀胱经。功能主治:清热湿，泻火除蒸,解毒疗疮。用于湿热泻痢，黄疸，带下,热淋，脚气感,骨蒸劳热,盗汗,遗精,疮疡肿毒,湿疹癌痒。盐黄柏滋阴降火。用于阴虚火旺,盗汗骨蒸。" + }, + { + "question_num": 314, + "query": "患者,男,39岁。发作时先觉胃部一股气体上升,并有咀嚼、吞咽动作,喃喃自语,走动,似在找东西,呼唤无反应,持续约4分钟,其癫痫的发作类型是", + "options": { + "A": "强直一阵挛性发作", + "B": "失神发作", + "C": "复杂部分性发作", + "D": "脑缺血发作", + "E": "假性发作" + }, + "answer": "C", + "reason": "疯痫复杂部分性发作:占成年人疯痫发作的50%以上，也称为精神运动性发作。病灶多在颞叶、额叶及嗅皮质等。均有意识障碍,发作时患者对外界刺激无反应，发作后不能或部分不能复述发作的细节。①仅有意识障碍的发作:典型发作特征为发作起始出现错觉、幻觉、似曾相识感、恐惧、胃气上升感、心悸等症状,随后出现意识障碍,有时发作开始即为意识障碍,持续数分钟至数十分钟，有的仅有意识障碍;②伴有自动症的发作:患者往往先瞪视不动，然后做出协调无意识的活动如咂嘴、吞咽、搓手等,神志逐渐清醒,对发作情况完全不能回忆。" + }, + { + "question_num": 315, + "query": "患者胃肠热盛,大便秘结,腹满硬痛而拒按,潮热,神昏谵语,但又兼见面色苍白，四肢厥冷,精神萎顿,其病机是", + "options": { + "A": "真实假虚", + "B": "由实转虚", + "C": "虚中夹实", + "D": "真虚假实", + "E": "实中夹虚" + }, + "answer": "A", + "reason": "本题重点在于掌握虚实真假的辨证。由于热结胃肠,邪气大积大聚，以致经脉阻滞气血不能畅达，表现出面色苍白，四肢厥冷,精神萎顿,类似虚证的假象。" + }, + { + "question_num": 316, + "query": "女,25岁。2天前咳血痰,今日咯血量达200mL左右。既往身��健康。查体:T:37℃,右肩胛下少量细小啰音,心尖部2/6级柔和的收缩期杂音,X线胸片无异常发现。此患者应用止血药物首选", + "options": { + "A": "垂体后叶素", + "B": "6-氨基已酸", + "C": "立止血(巴曲酶)", + "D": "氨甲苯酸", + "E": "卡巴克洛(安络血)" + }, + "answer": "A", + "reason": "青年女性,突发大量咯血,肺底部细小湿啰音,为典型支气管扩张的表现。早期支扩胸片可无阳性表现。支扩患者反复咯血主要扩张的支气管动脉破裂所致,故止血治疗以血管收缩剂效果最佳。垂体后叶素可收缩小动脉,是大咯血首选止血药物。" + }, + { + "question_num": 317, + "query": "患者,男,35岁。2日来发热微恶寒口苦,胁痛,尿短黄,大便黏臭,舌红苔薄白,脉数,其证候是", + "options": { + "A": "表寒里热", + "B": "真寒假热", + "C": "表里俱热", + "D": "真热假寒", + "E": "表热里寒" + }, + "answer": "A", + "reason": "发热微恶寒为外有表寒证,尿黄便黏臭为内有里热，舌红苔薄白、脉数为表寒里热之证。" + }, + { + "question_num": 318, + "query": "患者,男,50岁。慢性支气管炎病史5年,近2~3个月咳嗽加重,痰中持续带血,伴胸闷,气急,胸痛。X线检查见肺门阴影增大。应首先考虑的是", + "options": { + "A": "慢性支气管炎", + "B": "原发性支气管肺癌", + "C": "肺炎", + "D": "肺结核", + "E": "肺脓肿" + }, + "answer": "B", + "reason": "咳嗽,咯血,胸闷,气急,X线检查见肺门阴影增大是原发性支气管肺癌。本题的答题要点在于X线下的影像改变,慢性支气管炎的X线下一般无异常表现;原发性支气管瘤,尤其中央型肺癌,多见肺门增大的阴影,类形,边缘清楚,或者分叶;肺炎及肺脓肿可见肺叶或者肺段或者沿肺纹理分布的不规则班片状高密度影,边缘密度浅而模糊，无实变征象。肺结核多见两肺尖后段和下叶背段多发病灶,密度不均与、边缘较清楚和变化较慢，易形成空洞和播散灶，有时可呈哑铃型阴影、" + }, + { + "question_num": 319, + "query": "患儿,22天。面目皮肤发黄20天,色泽鲜明如橘皮,精神疲倦,不欲吮乳，尿黄便秘,舌红苔黄,其证候是", + "options": { + "A": "肝失疏泄", + "B": "瘀积发黄", + "C": "寒湿阻滞", + "D": "湿热熏蒸", + "E": "胆道不利" + }, + "answer": "D", + "reason": "寒湿阻滞、瘀积发黄,色泽均晦暗,故可除外B、C;尿黄便秘,舌红苔黄均为热邪致病的特点,故可除外A、E。" + }, + { + "question_num": 320, + "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控制呼吸道感染中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": 321, + "query": "患者素体虚弱,自汗易感冒,近2年呼吸困难,动则气喘,呼多吸少。诊为", + "options": { + "A": "肺气虚弱", + "B": "脾气虚弱", + "C": "肺失宣肃", + "D": "肾不纳气", + "E": "肺肾阴虚" + }, + "answer": "D", + "reason": "患者素体虚弱,自汗易感冒为虚证。呼吸困难，动则气喘，呼多吸少为肾不纳气证候表现。" + }, + { + "question_num": 322, + "query": "患者,男,45岁。1个月前畏寒、腹痛、腹泻,大便带脓血,每天10次左右，伴里急后重,诊断为菌痢,服用SMZCO、黄连素,1周后好转,近1周来又腹泻、腹痛,大便每天10余次，大便常规:RBC+/HP，WBC+++/HP，PC+/HP,吞噬细胞3~4/HP,既往无腹泻史，其应诊断为", + "options": { + "A": "慢性菌痢迁延型", + "B": "慢性菌痢隐匿型", + "C": "慢性菌痢急性发作", + "D": "急性菌痢普通型", + "E": "急性菌病轻型" + }, + "answer": "E", + "reason": "慢性菌痢病程在2月以上,患者病程1个月,主诉无明显全身症状，故为急性菌痢轻型。" + }, + { + "question_num": 323, + "query": "患者,男,52岁。近来发现体重减轻症见小便频数,甚至饮一溲一,面色黧黑,腰膝酸软,形寒畏冷，阳痿不举,舌淡苔白,脉沉细无力。该病例中医病机应为", + "options": { + "A": "肾阴不足证", + "B": "肾虚水泛证", + "C": "肝肾阴虚证", + "D": "气阴两虚证", + "E": "肾阳亏虚证" + }, + "answer": "E", + "reason": "肾阳亏虚证:①概念,指肾阳亏虚,机体失却温煦，以腰膝酸冷、性欲减退、夜尿多为主要表现的虚寒证候，又名元阳亏虚证:命门火衰证:②临床表现,头目眩晕,面色能白或黧黑,腰膝酸冷疼痛,畏冷肢凉，下肢尤甚,精神萎靡,性欲减退,男子阳痿早泄、滑精精冷,女子宫寒不孕,或久泻不止,完谷不化,五更泄泻,或小便频数清长,夜尿频多,舌淡,苔白,脉沉细无力,尺脉尤甚;③辨证要点,腰膝酸冷、性欲减退、夜尿多与虚寒症状共见。" + }, + { + "question_num": 324, + "query": "患儿,男,4岁。因畏寒发热1天,精神萎靡6小时入院。查体:体温40℃,脉搏120次/分，血压68/45mmHg，浅昏迷，面色苍日，全身可见瘀斑、瘀点,瞳孔等大,颈软,克氏征(-),布氏征(-),病理征(-),血常规WBC20x10^9/L,N0.90,L0.10。对该患者快速确诊有较大意义的实验室检查是", + "options": { + "A": "皮肤瘀斑、瘀点涂片找细菌", + "B": "脑脊液常规和生化检查", + "C": "血培养", + "D": "脑脊液培养", + "E": "头部CT检查" + }, + "answer": "A", + "reason": "患者考虑为流行性脑脊髓膜炎,瘀点或脑脊液涂片寻找病原体是早期确诊的重要方法,脑脊液检查早期可不典型。" + }, + { + "question_num": 325, + "query": "患者,女,35岁。面色无华,眩晕耳鸣,视物模糊肢体麻木,经量减少,舌淡,脉细,此属", + "options": { + "A": "心血虚证", + "B": "肝阴虚证", + "C": "心气虚证", + "D": "肾阴虚证", + "E": "肝血虚证" + }, + "answer": "E", + "reason": "肝血虚证:①概念,指血液亏损,肝失养,以眩星、视力减退、经少、肢麻手颤等及血虚症状为主要表现的虚弱证侯;②临床表现,头晕眼花,视力减退或夜盲,或肢体麻木,关节拘急,手足震,肌肉动,或为妇女月经量少、色淡,甚则闭经,爪甲不荣,面白无华,舌淡,脉细;③辨证要点,眩晕、视力减退、经少、肢麻手颤等与血虚症状共见，" + }, + { + "question_num": 326, + "query": "患者,女,50岁,类风湿关节炎病史6年,可生活自理,不能参加工作,活动受限，其关节功能障碍的分级是", + "options": { + "A": "IV级", + "B": "V级", + "C": "Ⅰ级", + "D": "Ⅱ级", + "E": "Ⅲ级" + }, + "answer": "E", + "reason": "关节功能障碍分为4级:①I级,照常进行日常生活和工作;②Ⅱ级,生活自理,并参加一定工作,但活动受限;③Ⅲ级,能生活自理,不能参加工作和其他活动;④W级,常生活的自理和参与工作的能力均受限" + }, + { + "question_num": 327, + "query": "患者,男,46岁。高血压病史·10年现面红头胀,眩晕耳鸣,腰膝酸软,失眠多梦，时有遗精或性欲亢进，舌红,脉沉细弦，其病机是", + "options": { + "A": "阴虚阳亢", + "B": "阴虚内热", + "C": "阴虚火旺", + "D": "阴损及阳", + "E": "阳损及阴" + }, + "answer": "A", + "reason": "阴虚指精血或津液的亏虚。一般在正常状态下，阴和阳是相对平衡的，相互制约而协调。阴气亏损，阳气失去制约，就会产生亢盛的病理变化,生理病理性功能亢进,称为“阳亢”。因此,阴虚会引起阳气亢盛,阳亢则能使阴液耗损,两者互为因果。临床表现:形体消瘦,口燥咽干,两颧潮红,五心烦热,潮热,盗汗小便短黄,大便干结,舌红少津或少苔,脉细数等。题例中,患者“血压病史10年,现面红头胀”为阴虚致使肝阳上亢之证;“眩晕耳鸣，腰膝疫软,失眠多梦,时有遗精或性欲亢进,舌红,脉沉细弦”为阴虚之证。A项正确。" + }, + { + "question_num": 328, + "query": "患者,男,65岁,劳累后胸骨后疼痛1年余,每周2~3次,含硝酸甘油迅速缓解。4小时前剧烈胸痛伴大汗,含硝酸甘油20分钟不缓解,最有可能明显升高的心肌酶是", + "options": { + "A": "羟丁酸脱氢酶", + "B": "肌酸激酶", + "C": "乳酸脱氢酶同工酶", + "D": "天冬氨酸转氨酶", + "E": "乳酸脱氢酶" + }, + "answer": "B", + "reason": "肌酸激酶同工酶(CKMB):在起病后4小时内增高，16~24小时达高峰,3~4天恢复正常,其增高的程度能较准确地反映梗死的范围,其高峰出现时间是否提前有助于判断溶栓治疗是否成功。" + }, + { + "question_num": 329, + "query": "患者,女,23岁。狂躁妄动,胡言乱语少寐多梦,打人毁物,不避亲疏,属于", + "options": { + "A": "狂病", + "B": "脏躁", + "C": "痫病", + "D": "惊风", + "E": "癫病" + }, + "answer": "A", + "reason": "狂躁不安是指患者毫无理智，狂躁不安,胡言乱语,少寐多梦,甚者打人毁物，不避亲疏的症状。多由痰火扰乱心神所致，常见于狂病等。" + }, + { + "question_num": 330, + "query": "患者女性,67岁。发作性左胸痛5年，疼痛放射至左肩,发作持续3~4分钟，休息后可缓解。今日下午劳动时突发晕厥急诊。查体:BP90/50mmHg,神清,心率140次/分，主动脉瓣区可闻及收缩期喷射样杂音伴震颤，杂音向颈部传导，双肺呼吸音清。首先考虑的诊断是", + "options": { + "A": "主动脉扩张", + "B": "主动脉瓣狭窄", + "C": "主动脉粥样硬化", + "D": "原发性高血压病", + "E": "主动脉瓣关闭不全" + }, + "answer": "B", + "reason": "患者发作性心绞痛,休息可缓解,劳动时突发晕厥，主动脉瓣区可闻及收缩期喷射样杂音伴震顿,杂音向颈部传导，为主动脉瓣狭窄的临床表现。" + }, + { + "question_num": 331, + "query": "某患者,两年来经常汗出,以头面部为多,运动后汗出更甚,并伴有精神不振,倦怠乏力,少气懒言之症,且动辄感冒。查体:面色淡白无华,舌淡苔白,脉虚弱。此病人的出汗属于", + "options": { + "A": "阴虚盗汗", + "B": "邪正交争的战汗", + "C": "气虚自汗", + "D": "亡阴之汗", + "E": "亡阳之汗" + }, + "answer": "C", + "reason": "自汗通常具有经常汗出,活动后更甚的特点,并伴有神疲乏力,气短懒言,面色淡白,脉虚等气虚的特征。" + }, + { + "question_num": 332, + "query": "患者,男,15岁。1年来常出现写作业时铅笔跌落,伴呆坐不动约10秒。脑电图显示阵发性对称、同步的3Hz棘一慢波发放。最可能的诊断是", + "options": { + "A": "癫痫失神发作", + "B": "癫痫大发作", + "C": "癫痫失张力性发作", + "D": "癫痫单纯部分性发作", + "E": "癫痫复杂部分性发作" + }, + "answer": "A", + "reason": "失神发作即小发作,多见于儿童或少年,突然短暂的意识丧失，停止当前活动:持续5~30秒,可伴简单的自动性动作，持物可不自主掉落,但一般不会跌倒。" + }, + { + "question_num": 333, + "query": "患者呕吐吞酸,嗳气频繁,胸胁闷痛脉弦。治疗应选用", + "options": { + "A": "高良姜", + "B": "吴茱萸", + "C": "干姜", + "D": "丁香", + "E": "小茴香" + }, + "answer": "B", + "reason": "根据题干辨证为“肝胃不和”吴茱萸的功效:散寒止痛,降逆止呕,助阳止泻。用于寒滞肝脉疼痛、呕吐吞酸、虚寒泄泻。常配伍黄连,可治肝郁化火、肝胃不和的胁痛口苦,呕吐吞酸,如左金丸。" + }, + { + "question_num": 334, + "query": "患者，女，30岁，6年前开始间断性上腹痛，以夜间明显,伴反酸,1天前因进食不当感口干，心悸,头晕,肠鸣,便溏且色黑。最有可能诊断为", + "options": { + "A": "上消化道出血", + "B": "幽门梗阻", + "C": "穿孔", + "D": "胆汁返流", + "E": "胃癌" + }, + "answer": "A", + "reason": "患者便溏且色黑,幽门以上出血量小或出血速度慢，血液随肠蠕动全部进人肠内,则见黑便,故该患者考虑为上消化道出血:" + }, + { + "question_num": 335, + "query": "患者,女,38岁。一周前不慎受凉,现发热恶寒,头痛,鼻塞、浊涕常流,不辨香臭。查:鼻窦部位疼痛、压痛、红肿,鼻充血,又线或透照均见鼻窦混浊。应选用药组是", + "options": { + "A": "荆芥、防风、紫苏", + "B": "燕本、白芷、细辛", + "C": "柴胡、葛根、升麻", + "D": "辛夷、苍耳子、白芷", + "E": "薄荷、黄芩、麻黄" + }, + "answer": "D", + "reason": "辛夷、苍耳子、白芷均可治疗鼻渊,通鼻窍。" + }, + { + "question_num": 336, + "query": "患者,男,54岁。高血压病史10年,今日剧烈头痛，眩晕，恶心，呕吐。查体：血压200/120mmHg。为快速降压，应选择的是", + "options": { + "A": "硝普钠", + "B": "普萘洛尔", + "C": "硝苯地平", + "D": "降压灵", + "E": "复方降压片" + }, + "answer": "A", + "reason": "患者长期高血压病史，此次发病时血压200/120mmHg,结合发作时临床表现，考虑为高血压急症。此时为快速降压首选能直接扩张动静脉的硝普钠,降压迅速、效果显著。" + }, + { + "question_num": 337, + "query": "患者,女,48岁。咳嗽1周,咳嗽时胸背痛,咳吐大量脓痰,素有便秘,舌苔黄,脉滑数。用药应首选的是", + "options": { + "A": "柴胡、桔梗", + "B": "柴胡、枳壳", + "C": "瓜蒌仁、浙贝母", + "D": "鱼腥草、桃仁", + "E": "薏苡仁、冬瓜仁" + }, + "answer": "D", + "reason": "鱼腥草功效清热解毒,消痈排脓,利尿通淋。主治肺痈吐脓,肺热咳嗽,本品以清肺热见长，又具消痈排脓之功,故为治疗肺痈之要药。桃仁功效活血祛瘀,润肠通便，止咳平喘。主治瘀血阻滞诸证;肺痈,肠痈,肠燥便秘。咳嗽气喘。冬瓜仁、薏苡仁化痰之力弱，且不能通腑,故不选。" + }, + { + "question_num": 338, + "query": "患者,女,32岁。心悸气促2个月，咯粉红色泡沫痰。查体:面颊暗红，口唇发绀，双肺底闻及湿啰音，心尖区可闻及舒张期隆隆样杂音，下肢浮肿，其诊断是", + "options": { + "A": "肺源性心脏病", + "B": "冠心病伴心衰", + "C": "二尖瓣狭窄伴心衰", + "D": "高血压性心脏病", + "E": "二尖瓣关闭不全伴心衰" + }, + "answer": "C", + "reason": "心尖区闻及舒张期隆隆样杂音,提示二尖瓣狭窄;粉红色泡沫样痰、发绀、湿啰音,提示急性肺水肿(急性左心衰竭);下肢浮肿提示可能伴右心衰竭。" + }, + { + "question_num": 339, + "query": "患者,男,48岁。头晕目暗,两目干涩,视物晕眩,腰膝疼痛,阳痿遗精,用药应首选的药物是", + "options": { + "A": "决明子", + "B": "枸杞子", + "C": "石决明", + "D": "牡蛎", + "E": "车前子" + }, + "answer": "B", + "reason": "枸杞子功效:滋补肝肾,益精明目;主治病证:精血亏虚,腰膝酸痛,眩晕耳鸣,阳痿遗精,内热消渴，血虚萎黄,目昏不明。" + }, + { + "question_num": 340, + "query": "患者,男,50岁。反复浮肿5年,伴恶心呕吐1个月。查体:BUN61mmol/L，Scr860μmol/L,血钾6.7mmol/L。最有效的治疗方法是", + "options": { + "A": "静脉注射碳酸氢钠", + "B": "静脉注射葡萄糖酸钙", + "C": "使用高渗糖", + "D": "中药大黄灌肠", + "E": "血液透析" + }, + "answer": "E", + "reason": "根据患者表现考虑诊断为慢性肾衰竭,血肌酐(Scr)>707.2uml/L，且伴高钾血症,故首先考虑透析治疗。" + }, + { + "question_num": 341, + "query": "患者,女,45岁。平素月经不规律,现漏下不止,色淡、质稀,伴气短神疲,腰膝酸软,舌淡苔薄白,脉弱。治疗应首选", + "options": { + "A": "清热固经汤", + "B": "保阴煎", + "C": "举元煎", + "D": "补中益气汤", + "E": "固冲汤" + }, + "answer": "E", + "reason": "由题干可知患者脾肾亏虚,冲脉不固。固冲汤主治:脾肾亏虚，冲脉不固证。证见“血崩或月经过多,或漏下不止,色淡质稀，头晕肢冷,心悸气短,神疲乏力,腰膝酸软,舌淡,脉微弱。”" + }, + { + "question_num": 342, + "query": "患者,男,42岁。乙肝病史10年,近2个月右上腹胀痛加重。检查:面部有蜘蛛痣,右上腹压痛,肝肋缘下3cm,质硬,ALT40U/L,HBsAg(+),AFP500μg/L。应首先考虑的是", + "options": { + "A": "慢性乙肝活动期", + "B": "乙肝合并肝硬化", + "C": "乙肝合并胆囊炎", + "D": "原发性肝癌", + "E": "继发性肝癌" + }, + "answer": "D", + "reason": "正常血清甲胎蛋白(AFP)<25μg/L,原发性肝细胞癌患者血清AFP明显升高,一般>300μg/L,患者AFP500μg/L,故考虑为原发性肝瘤。" + }, + { + "question_num": 343, + "query": "患者外感风寒,发热,汗出恶风,鼻鸣干呕,舌苔薄白,脉浮缓者,治疗应选用", + "options": { + "A": "桂枝汤", + "B": "麻黄加术汤", + "C": "麻黄汤", + "D": "桂枝加厚朴杏子汤", + "E": "石膏汤" + }, + "answer": "A", + "reason": "由题干可知此病为外感风寒表虚证。桂枝汤适合外感风寒表虚证,解肌发表,调和营卫,辨证要点为“恶风发热,汗出头痛鼻鸣干呕,苔白不渴,脉浮缓或浮弱。”" + }, + { + "question_num": 344, + "query": "患儿,男,11岁。2年前诊断为1型糖尿病。今日在家中用胰岛素治疗后,突然发生昏迷。该患儿应首选的抢救措施是", + "options": { + "A": "小剂量胰岛素静滴", + "B": "静脉补充氯化钾", + "C": "快速补充生理盐水", + "D": "静脉补充葡萄糖", + "E": "静脉补充碳酸氢钠" + }, + "answer": "D", + "reason": "患者为1型糖尿病,使用胰岛素后发生昏迷,考虑为低血糖,是胰岛素最常见At、出" + }, + { + "question_num": 345, + "query": "患者,女,30岁。烦热干渴,头痛,牙痛,牙龈出血，舌红苔黄而干。治疗应首选", + "options": { + "A": "泻白散", + "B": "白虎汤", + "C": "龙胆泻肝汤", + "D": "玉女煎", + "E": "左金丸" + }, + "answer": "D", + "reason": "题中患者烦热干渴,头痛,牙痛,牙龈出血,舌红苔黄而干,为胃热炽盛证。血证一鼻衄之胃热炽盛证,证见:鼻衄,或兼齿衄，血色鲜红,口渴欲饮,鼻干,口干臭秽,烦躁,便秘,舌红,苔黄,脉数。治法:清胃泻火,凉血止血。代表方:玉女煎加减。" + }, + { + "question_num": 346, + "query": "患者，男，55岁。反复餐前上腹隐痛15年,近10天来上腹胀满不适,恶心、呕吐,大量呕吐后症状可缓解，呕吐物含有发酵酸性宿食。可能的诊断为", + "options": { + "A": "十二指肠溃疡并发幽门梗阻", + "B": "十二指肠溃疡并发���梗阻", + "C": "胃溃疡并发幽门梗阻", + "D": "胃溃疡并发肠梗阻", + "E": "慢性胃炎" + }, + "answer": "A", + "reason": "患者多年餐前饥饿时节律性腹痛,提示为十二指肠溃疡,呕吐发酵食物，吐后缓解提示幽门梗阻。肠梗阻腹部有肠形且呕吐物有类臭。" + }, + { + "question_num": 347, + "query": "患者感受暑湿,症见身热烦渴,小便不利。治疗应首选", + "options": { + "A": "猪苓汤", + "B": "泻白散", + "C": "六一散", + "D": "五苓散", + "E": "二妙散" + }, + "answer": "C", + "reason": "六一散清暑利湿,用于暑湿证,主症为“身热烦渴,小便不利,泄泻”。题干明确说明了“暑湿”,选项中只有六一散为祛暑剂" + }, + { + "question_num": 348, + "query": "患者,男,20岁。上呼吸道感染后2天出现水肿，血尿，尿常规蛋白阳性，Bp145/92mmHg,其尿检可能表现为", + "options": { + "A": "大量的均一红细胞", + "B": "大量的红细胞、白细胞", + "C": "大量的红细胞伴凝块", + "D": "大量的红细胞,畸形红细胞>80%", + "E": "大量的红细胞、白细胞及上皮细胞" + }, + "answer": "D", + "reason": "患者有上感史，且有血尿:水肿、蛋白尿、高血压等典型症状，考虑为慢性肾小球肾炎,尿液检查可见蛋白尿，血尿，畸形红细胞超过80%,颗粒管型。" + }, + { + "question_num": 349, + "query": "患者，女,36岁。漏下不止，血色暗淡,四肢不温，面色萎黄,舌淡苔白,脉沉细。治疗应首选", + "options": { + "A": "归脾汤", + "B": "四物汤", + "C": "黄土汤", + "D": "胶艾汤", + "E": "小蓟饮子" + }, + "answer": "C", + "reason": "根据题干辨证,此为阳虚血虚之证,归脾汤益气补血、健脾养心;四物汤主治营血虚滞证;胶艾汤养血止血，调经安胎:小蓟饮子凉血止血,利水通淋。以上均不适宜。黄土汤温阳健脾,养血止血,用于脾阳不足、脾不统血之证。症见“大便下血，先便后血,或吐血，闻血，妇人崩漏,血色暗淡,四肢不温,面色萎黄,舌淡苔白,脉沉细无力”。" + }, + { + "question_num": 350, + "query": "患者,男,40岁。男性,突然出现剧烈头痛、喷射性呕吐及抽搐,查体:体温、血压正常,脑膜刺激征(+),脑脊液呈血性。最可能的诊断为", + "options": { + "A": "脑膜炎", + "B": "高血压脑病", + "C": "蛛网膜下腔出血", + "D": "脑血栓形成", + "E": "低血糖症" + }, + "answer": "C", + "reason": "患者突发剧烈头痛伴脑膜刺激征阳性，且有血性脑脊液,提示蛛网膜下腔出血。" + }, + { + "question_num": 351, + "query": "患者,男,55岁。近日发现大便色黑，伴不规则上腹痛。查体:左锁骨上窝触及1个1cmx1.2cm大小的淋巴结,质硬,大便隐血试验(+++)。首先考虑的是", + "options": { + "A": "消化性溃疡病", + "B": "胆道感染合并出血", + "C": "胃癌", + "D": "血小板减少性紫癜", + "E": "肝硬化" + }, + "answer": "C", + "reason": "患者大便隐血试验阳性,伴长期不规则上腹痛，且有淋巴转移征象,首先考虑胃瘤。" + }, + { + "question_num": 352, + "query": "患者,女,40岁。心悸1周,检查:心电图示多个导联提前出现的宽大畸形QRS波群,其前无相关P波,其后T波与QRS波群主波方向相反,代偿间歇完全。考虑是", + "options": { + "A": "房性早搏", + "B": "室性早搏", + "C": "室内传导阻滞", + "D": "房室传导阻滞", + "E": "房室交界性早搏" + }, + "answer": "B", + "reason": "室性早搏心电图表现:提前发生的QRS波群,时限通常超过0.12秒、宽阔畸形,ST段与T波的方向与QRS波群主波方向相反,代偿间歇完全。" + }, + { + "question_num": 353, + "query": "患者,女,52岁。突发心前区疼痛，压榨、紧缩感。查体:血压160/70mmHg,心率100次/分。心电图示ST段水平型下降0.15mV。为迅速缓解症状,该患者应首先考虑的治疗是", + "options": { + "A": "普萘洛尔含服", + "B": "利多卡因静注", + "C": "普罗帕酮静注", + "D": "硝酸甘油含服", + "E": "阿司匹林口服" + }, + "answer": "D", + "reason": "患者根据临床表现和心电图,诊断为心绞痛发作,治疗首选硝酸甘油舌下含服。" + }, + { + "question_num": 354, + "query": "患者,女,42岁。因月经量多1年，出现贫血表现,经检查诊断为缺铁性贫血，其首选的治疗方法是", + "options": { + "A": "增加营养", + "B": "输血", + "C": "口服铁剂", + "D": "注射铁剂", + "E": "口服叶酸" + }, + "answer": "C", + "reason": "口服铁剂是治疗缺铁性贫血的首选方法。最常用硫酸亚铁片。105.E解析食管胃底静脉曲张破裂���出血常用的止血药物是垂体后叶素,而对于非静脉曲张破裂大出血,提高胃内PH,可有效止血，常用药物有雷尼替丁或奥美拉唑。该患者为十二指肠溃疡引起的出血，故应该选用提高pH值的药物。" + }, + { + "question_num": 355, + "query": "患者,男,36岁,十二指肠溃疡病史3年余，近日加班后频发上腹疼痛，食欲不振，乏力,1小时前突感恶心，随后呕吐暗红色血性液体,量较大，该患者应立即应用的止血药物是", + "options": { + "A": "垂体后叶素", + "B": "卡巴克洛", + "C": "氨甲环酸", + "D": "血小板悬液", + "E": "奥美拉唑" + }, + "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。" + } +] \ No newline at end of file