diff --git "a/Licensed/Theory_Questions/Year_2/Mock.json" "b/Licensed/Theory_Questions/Year_2/Mock.json" new file mode 100644--- /dev/null +++ "b/Licensed/Theory_Questions/Year_2/Mock.json" @@ -0,0 +1,6242 @@ +[ + { + "question_num": 1, + "query": "下列事物按五行相生顺序排列正确的是", + "options": { + "A": "笑、坤、呼、笑、歌", + "B": "忧、哕、栗、咳、握", + "C": "风、暑、湿、火、寒", + "D": "羽、角、徵、商、宫", + "E": "魂、神、意、魄、志" + }, + "answer": "E", + "reason": "五神按相生顺序排序为魂、神、意魄、志。" + }, + { + "question_num": 2, + "query": "正常人两上肢血压的差别一般是", + "options": { + "A": "5~10mmHg", + "B": "11~15mmHg", + "C": "16~20mmHg", + "D": "21~25mmHg", + "E": "26~30mmHg" + }, + "answer": "A", + "reason": "正常人两上肢血压可有5~10mmHg的差别，下肢血压较上肢高20~40mmHg。" + }, + { + "question_num": 3, + "query": "腰痛患者，腰酸乏力，喜按喜揉，劳则益甚，卧则痛减，反复发作，伴有口燥咽干，手足心热，舌红少苔，脉细数，其证候是", + "options": { + "A": "瘀血", + "B": "湿热", + "C": "寒湿", + "D": "肾阴虚", + "E": "肾阳虚" + }, + "answer": "D", + "reason": "腰痛,见“腰酸乏力,喜按喜揉,劳则益甚,卧则痛减,伴有口爆咽干,手足心热,舌红少苔，脉细数\"为肾阴虚表现,应用左归丸滋补肾阴,濡养筋脉。" + }, + { + "question_num": 4, + "query": "附骨疽脓腔较深、脓液不易畅流者宜采用", + "options": { + "A": "药线引流", + "B": "垫棉法", + "C": "扩创引流", + "D": "导管引流", + "E": "以上皆非" + }, + "answer": "D", + "reason": "导管引流:将导管(或塑胶管或橡皮管)插人疮口中,引导脓水外流的一种引流方法。适用于附骨疽、流痰、流注等脓腔较深、液不易畅流者,或腹腔手术后。" + }, + { + "question_num": 5, + "query": "脏腑之精是指", + "options": { + "A": "一身之精分藏于脏腑的部分", + "B": "源于肾精的部分", + "C": "禀受于父母的部分", + "D": "源于饮食水谷精微的部分", + "E": "精血转化的部分" + }, + "answer": "A", + "reason": "一身之精分藏于脏腑,成为脏腑之精。脏腑之精,指脏腑所藏的具有活养、滋润本脏腑及其所属的形体、官窍等作用的液态精华物质。" + }, + { + "question_num": 6, + "query": "混合性呼吸困难可见于", + "options": { + "A": "喉瘤", + "B": "喉痉挛", + "C": "气胸", + "D": "脑出血", + "E": "肺气肿" + }, + "answer": "C", + "reason": "混合性呼吸困难，吸气与呼气均感费力，呼吸频率浅而快。见于重症肺炎、重症肺结核、大面积肺不张、大块肺梗死、大量胸腔积液和气胸等。" + }, + { + "question_num": 7, + "query": "咳嗽喉痒，痰中带血，口干鼻燥，或身热。舌红少津苔薄黄，脉数。治疗应首选", + "options": { + "A": "桑杏汤", + "B": "杏苏散", + "C": "沙参麦冬汤", + "D": "麦门冬汤", + "E": "百合固金汤" + }, + "answer": "A", + "reason": "风燥伤肺,肺失清润,故咳嗽喉痒,燥热伤络故痰中带血,灼津故口干鼻燥,或身热,舌红少津苔薄黄,脉数。治宜疏风清肺,润燥止咳。用桑杏汤。" + }, + { + "question_num": 8, + "query": "蛇眼疔的成脓时间为", + "options": { + "A": "2~3天", + "B": "3~5天", + "C": "5~7天", + "D": "7~10天", + "E": "2周" + }, + "answer": "A", + "reason": "成脓时间:蛇眼疔2~3天,蛇头疔约10天,蛇肚疔7~10天,托盘疔约2周,足底疔3~5天。" + }, + { + "question_num": 9, + "query": "上焦生理功能的特点是", + "options": { + "A": "若雾露之溉", + "B": "主气之升发", + "C": "通行宗、营、卫三气", + "D": "元气之别使", + "E": "主宣发与肃降" + }, + "answer": "A", + "reason": "上焦是指膈以上的脏器和组织,包括心肺两脏和头面部。《灵枢·营卫生会》:“上焦出于胃上口,并咽以上,贯膈而布胸中。”上焦的功能实际上是对心肺功能的概括,主气的升发和宣散。由于上焦位置最高,故其特点不是有升无降,而是升已而降。《灵枢·决气》“上焦开发,宣五谷味,熏肤,充身,泽毛,若雾露之溉。”《灵枢·营卫生会》将其概括为“上焦如雾”。" + }, + { + "question_num": 10, + "query": "血清总胆红素增高，以非结合胆红素为主，粪便颜色加深，常提示", + "options": { + "A": "溶血性黄疸", + "B": "肝细胞性黄疸", + "C": "胆汁淤积性黄疸", + "D": "Rotor综合征", + "E": "核黄疸" + }, + "answer": "A", + "reason": "溶血性黄疸实验室检查特点为血清总胆红素增多，以非结合胆红素为主，结合胆红素一般正常，尿胆原增多，尿胆红素阴性，具有溶血性贫血的改变，如贫血、网织红细胞增多、血红蛋白尿、骨髓红细胞系增生旺盛等。肝细胞性黄疸的特点为血清结合及非结合胆红素均增多,大便颜色通常改变不明显。胆汁瘀积性黄疸的特点为血清结合胆红素明显增多。尿胆原减少或阴性,尿胆红素阳性,大便颜色变浅。" + }, + { + "question_num": 11, + "query": "治疗胸痹，纠正脏腑偏衰时，尤其重视", + "options": { + "A": "补气温阳", + "B": "滋阴益肾", + "C": "活血通络", + "D": "养心和络", + "E": "补益心气" + }, + "answer": "E", + "reason": "胸痹治疗应先祛邪治标,后扶正治本。必要时根据虚实标本的主次,兼顾同治。标实当泻,尤重活血通脉治法;本虚宜补,尤其重视补益心气之不足。" + }, + { + "question_num": 12, + "query": "乳岩的致病因素,属", + "options": { + "A": "外感六淫邪毒", + "B": "外来伤害", + "C": "情志内伤", + "D": "饮食不节", + "E": "感受特殊之毒" + }, + "answer": "C", + "reason": "孔岩的发病主要与情志因素有很大关系,女子以肝为先天,肝主疏泄,性喜条达而恶抑郁，一般乳房的疾病都与情志因素有关。" + }, + { + "question_num": 13, + "query": "属于“五行相侮”的是", + "options": { + "A": "心病及脾", + "B": "心病及肾", + "C": "心病及肺", + "D": "心病及肝", + "E": "肝病及心" + }, + "answer": "B", + "reason": "五行学说。心属于火,肾属于水,水能克火,心病及肾的传变是逆五行相克顺序进行的，于相侮。" + }, + { + "question_num": 14, + "query": "下列各项最常出现心尖部舒张早期奔马律的是", + "options": { + "A": "心包炎", + "B": "肺源性心脏病", + "C": "左侧心力衰竭", + "D": "高度房室传导阻滞", + "E": "肺动脉瓣狭窄" + }, + "answer": "C", + "reason": "舒张早期奔马律最常见，为病理性第三心音，又称第三心音奔马律或室性奔马律，以左室奔马律占多数，所以，在心尖部容易听到。舒张早期奔马律的出现，提示心脏有严重的器质性病变，见于各种原因的心力衰竭、急性心肌梗死、重症心肌炎等。" + }, + { + "question_num": 15, + "query": "虚喘的治疗要点是", + "options": { + "A": "补肺", + "B": "健脾", + "C": "纳肾", + "D": "益气", + "E": "养阴" + }, + "answer": "C", + "reason": "虚喘乃精气不足,气阴亏耗而致肺肾出纳失常而致,病机主要是肾不纳气,故治在肺肾,以肾为主,法以培补摄纳,补肾纳气为要,故选C。" + }, + { + "question_num": 16, + "query": "下列切开法的注意事项中,错误的是", + "options": { + "A": "在关节部位,宜谨慎开刀,切口应越过关节", + "B": "血瘤、岩肿不宜切开", + "C": "患者体弱应先内服调补药,然后开刀", + "D": "面部疔疮，尤其是口鼻部位，忌早期开刀", + "E": "进刀时,刀头要求向上挑取,不宜向下割划" + }, + "answer": "A", + "reason": "在关节和筋脉的部位宜谨慎开刀,以免损伤筋脉,致使关节不利。如果患者过于体弱，应先内服调补药物,然后开切，以免晕厥。凡颜面疔疮，尤其在鼻唇部位,忌早期切开，以免疗毒走散,并发走黄危证。" + }, + { + "question_num": 17, + "query": "同病异治的实质是", + "options": { + "A": "证同治异", + "B": "证异治异", + "C": "病同治异", + "D": "证异治同", + "E": "病同治同" + }, + "answer": "B", + "reason": "中医学的基本特点是整体观念与辨证论治。辨证论治,即根据辨证的结果确定相应的治疗原则和方法,具体表现为“同病异治”和“异病同治”“同病异治”,即对同一疾病不同阶段出现的不同证型采用不同的治法:“异病同治”,即几种不同的疾病在其发展过程中,由于出现了具有同一性质的证,因而可采用同一治疗方法。可见中医治病主要着眼点在于证证同则治同,证异则治异,故同病异治的实质是证异治异，" + }, + { + "question_num": 18, + "query": "腹壁强直，硬如木板，多见于", + "options": { + "A": "大量腹水", + "B": "急性胆囊炎", + "C": "阑尾炎", + "D": "肠痉挛", + "E": "急性胃肠穿孔" + }, + "answer": "E", + "reason": "弥漫性腹肌紧张多见于胃肠大片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，故称板状腹。" + }, + { + "question_num": 19, + "query": "实证呕吐病因不正确的是", + "options": { + "A": "外邪犯胃", + "B": "痰饮内停", + "C": "肝气犯胃", + "D": "饮食停带", + "E": "胃阴不足" + }, + "answer": "E", + "reason": "呕吐的病位在胃,分实证和虚证,实证的病因可以有肝气犯胃、食滞伤骨、外政犯胃、痰饮内停;虚证因为脾胃受损,这些因表作用于胃,导致胃失和降,骨气上逆,才发生呕吐。" + }, + { + "question_num": 20, + "query": "毒蛇咬伤后，下列局部处理方法中,错误的是", + "options": { + "A": "早期结扎", + "B": "扩创排毒", + "C": "艾灸法", + "D": "烧灼法", + "E": "封闭疗法" + }, + "answer": "C", + "reason": "毒蛇咬伤局部处理:早期结扎、扩创排毒、烧灼、针刺、火罐排毒、封闭疗法、局部用药等。" + }, + { + "question_num": 21, + "query": "“夺血者无汗，夺汗者无血”说明了哪两种物质的关系", + "options": { + "A": "气与血", + "B": "气与津液", + "C": "津液与血", + "D": "津液与汗", + "E": "以上都不是" + }, + "answer": "C", + "reason": "血和津液都由饮食水谷精微化生,都具有滋润濡养作用,二者之间可以相互滋生,相互转化,这种关系称为“津血同源”。临床上如果血液亏耗:尤其是失血时，脉中血少,不能化为津液,反而需要脉外津液进人脉中,因而导致津液不足的病变,故《灵枢·营卫生会篇》说:“夺血者无汗,夺汗者无血。”" + }, + { + "question_num": 22, + "query": "甲亢危象的治疗，下列哪组最理想", + "options": { + "A": "丙硫氧嘧啶+碘剂+普萘洛尔+泼尼松", + "B": "丙硫氧嘧啶+泼尼松", + "C": "甲硫咪唑+普萘洛尔+泼尼松", + "D": "丙硫氧嘧啶+普萘洛尔+甲巯咪唑", + "E": "碘剂+甲巯咪唑" + }, + "answer": "A", + "reason": "甲亢危象的治疗，最理想的方案是丙硫氧嘧啶+碘剂+普萘洛尔+泼尼松，其中丙硫氧嘧啶可抑制T3、T4的合成和抑制T4转化为T3，碘剂能抑制上T3、T4的释放，普萘洛尔能降低周围组织对甲状腺的反应，泼尼松有拮抗应激的作用，故四种药物同时应用是最理想的治疗，而其他几组治疗组合均不够理想。" + }, + { + "question_num": 23, + "query": "怔忡的治疗大法当以哪个为主", + "options": { + "A": "滋补肝肾", + "B": "培土生金", + "C": "养血安神", + "D": "补益心脾", + "E": "温补脾肾" + }, + "answer": "C", + "reason": "心悸的治疗原则。怔仲以虚证为主，治疗以养血安神为主,如心阳不足或阳虚饮道,当补养心气,温通心阳为治。" + }, + { + "question_num": 24, + "query": "对肛管直肠癌有重要意义的简易诊断方法是", + "options": { + "A": "X线摄片", + "B": "肛门直肠指诊", + "C": "病理检查", + "D": "亚甲蓝染色", + "E": "纤维结肠镜检查" + }, + "answer": "B", + "reason": "对肛管直肠癌有重要意义的简易诊断方法是肛门直肠指诊。" + }, + { + "question_num": 25, + "query": "属于五行之“火”的是", + "options": { + "A": "宫音", + "B": "角音", + "C": "商音", + "D": "徵音", + "E": "羽音" + }, + "answer": "D", + "reason": "五音按术火土金水顺序的五行归属为角、徵、宫、商、羽,即角音属木,微音属火,宫音属土,商音属金,羽音属水。" + }, + { + "question_num": 26, + "query": "支气管哮喘呼吸困难的类型是", + "options": { + "A": "吸气性", + "B": "呼气性", + "C": "混合性", + "D": "阵发性", + "E": "腹式呼吸消失" + }, + "answer": "B", + "reason": "支气管哮喘是一种由肥大细胞、嗜酸性粒细胞、淋巴细胞等多种炎症细胞介导的气道慢性炎症。本病常存在气道高反应性和广泛的、可逆性气流阻塞。临床以反复发作的喘息、呼气性呼吸困难、胸闷或咳嗽为特征，常在夜间和(或)清晨发作。" + }, + { + "question_num": 27, + "query": "治疗不痫肝火扰心证,应首选", + "options": { + "A": "龙胆泻肝汤", + "B": "朱砂安神丸", + "C": "安神定志丸", + "D": "黄连阿胶汤", + "E": "甘麦大枣汤" + }, + "answer": "A", + "reason": "肝火扰心引起的不寐,治疗应以疏肝泻火,镇心安神为要。方用龙胆泻肝汤加减最宜。" + }, + { + "question_num": 28, + "query": "丹毒主要病因病机是血热火毒为患，发于头面部者多兼夹", + "options": { + "A": "肝脾郁热", + "B": "湿热", + "C": "风热", + "D": "胎毒", + "E": "寒湿" + }, + "answer": "C", + "reason": "丹毒的主要病因病机是血热火毒为患,发于头面部者、多兼夹风热;发于胸腹腰胯部者,多兼夹肝脾郁火;发于下肢者,多兼夹湿热;发于新生儿者,多为胎热火毒所致。" + }, + { + "question_num": 29, + "query": "属于阳的味是", + "options": { + "A": "酸、苦、咸", + "B": "辛、苦、咸", + "C": "辛、甘、淡", + "D": "甘、淡、涩", + "E": "甘、苦、淡" + }, + "answer": "C", + "reason": "五味分阴阳,辛、甘、淡属阳,酸、苦咸属阴。《素问·至真要大论》说:“辛甘发散为阳,酸苦涌泄为阴,咸味涌泄为阴,淡味渗泄为阳。”" + }, + { + "question_num": 30, + "query": "下列有关心脏杂音的描述，错误的是", + "options": { + "A": "血流加速可以产生心脏杂音", + "B": "杂音最响的部位，就是病变所在的部位", + "C": "杂音有生理性的", + "D": "杂音的强度与病变成正比", + "E": "极度狭窄时，杂音减弱或消失" + }, + "answer": "D", + "reason": "杂音的强度不应与病变的严重程度成正比，病变较重时，杂音可能较弱；相反，病变较轻时也可能听到较强的杂音。" + }, + { + "question_num": 31, + "query": "癫证最重要的病理因素是", + "options": { + "A": "气郁", + "B": "火热", + "C": "痰浊", + "D": "瘀血", + "E": "肝风" + }, + "answer": "A", + "reason": "癫证病变脏腑主要在心肝,涉及脾胃,久而伤肾。病理因素以气、痰、火、瘀为主,四者有因果兼夹的关系,且多以气郁为先。" + }, + { + "question_num": 32, + "query": "瘿病的主要病因是(", + "options": { + "A": "气滞、血瘀、痰凝", + "B": "气虚、水停、寒痰", + "C": "外邪、食滞、郁热", + "D": "血瘀、食积、痰浊", + "E": "痰浊、虫积、食滞" + }, + "answer": "A", + "reason": "瘿病的病因病机是在致病因素的作用下导致脏腑经络功能失调,气滞、血瘀、痰凝等结于颈部,逐渐形成瘿病。" + }, + { + "question_num": 33, + "query": "下列哪项不是脾的生理功能", + "options": { + "A": "水谷的受纳和腐熟", + "B": "水谷精微的转输", + "C": "水液的吸收和转输", + "D": "脏器位置的维系", + "E": "血液的统摄" + }, + "answer": "A", + "reason": "脾的生理功能:①主运化,包括运化水谷和运化水湿;②主升清,包括将水谷精微等营养物质上输于头目和维持内脏位置的相对恒定;③主统血，水谷的受纳和腐熟为胃的功能.故选A。" + }, + { + "question_num": 34, + "query": "腹痛位于右上腹部，并向右肩部放射，提示", + "options": { + "A": "肠炎", + "B": "十二指肠溃疡", + "C": "胃炎", + "D": "胆囊炎", + "E": "急性胰腺炎" + }, + "answer": "D", + "reason": "此题主要是从腹痛的部位去分析。胃、十二指肠疾病、急性胰腺炎疼痛多在中上腹部；肝、胆疾患疼痛位于右上腹。" + }, + { + "question_num": 35, + "query": "积聚治则要点不包括", + "options": { + "A": "消散为主", + "B": "行气散结", + "C": "扶正祛邪", + "D": "消补兼施", + "E": "清里和表" + }, + "answer": "E", + "reason": "积聚是正气气虚、脏腑失和,气滞、血瘀、痰浊蕴结于腹,引发腹内结块,或胀或痛为主要临床特征的病证,病机是气机阻滞.瘀血内结。积证治疗宜分初,中,未三个阶段初期属邪实,应予消散;中期收、邪实正虚,予消补兼施;后期以正虚为主,应予养正除积。" + }, + { + "question_num": 36, + "query": "治愈后,遗留有萎缩性瘢痕的皮肤病是", + "options": { + "A": "白秃疮", + "B": "肥疮", + "C": "鹅掌风", + "D": "疥疮", + "E": "白疕" + }, + "answer": "B", + "reason": "本题所给洗项中只有肥疮在愈合后留有萎缩性瘢痕。" + }, + { + "question_num": 37, + "query": "下列各项，不属肝主疏泄功能的是", + "options": { + "A": "调畅气机", + "B": "调畅情志", + "C": "促进骨骼发育", + "D": "促进脾胃的运化", + "E": "促进血液运行" + }, + "answer": "C", + "reason": "肝主疏泄的生理功能:①调畅气机,②通利气血水;③促进脾胃的运化:④调畅情志;⑤促进和调节生殖功能，其中,最基本的生理功能是调畅气机。" + }, + { + "question_num": 38, + "query": "反甲多见于", + "options": { + "A": "风湿热", + "B": "先天性心脏病", + "C": "慢性肺脓肿", + "D": "类风湿关节炎", + "E": "缺铁性贫血" + }, + "answer": "E", + "reason": "反甲，又称匙状甲，其甲板中央凹陷，四周外翻、翘起，以致在甲板的中央放一滴水不会流出，故名匙状。目前认为是缺铁和某些氨基酸代谢障碍所致，常见于缺铁性贫血、偶见于风湿热。" + }, + { + "question_num": 39, + "query": "黄土汤治疗便血的主要适应证是", + "options": { + "A": "便血色红，大便不畅或稀糖，舌质红，苔黄腻，脉濡数", + "B": "便血色红或紫黯，食少，体倦，舌质淡，脉细", + "C": "便血紫黯，甚则黑���，腹部隐痛，喜热饮，便糖，舌质淡，脉细", + "D": "便血鲜红，或有腹痛，口苦，舌质红，苔黄腻，脉濡", + "E": "便血紫黯，面色萎黄，心悸，舌质淡，脉细" + }, + "answer": "C", + "reason": "黄土汤治疗便血之脾胃虚寒证,证见便血紫黯,甚则黑色,腹部隐痛,喜热饮,面色不华，神倦懒言,便溏,舌质淡,脉细。主要由中焦虚寒,统血无力,血溢胃肠所致。治宜健脾温中,养血止血。" + }, + { + "question_num": 40, + "query": "抽动障碍脾虚痰聚证治法为", + "options": { + "A": "清肝泻火,息风镇惊", + "B": "健脾化痰,平肝息风", + "C": "滋阴潜阳,柔肝息风", + "D": "滋阴养血,柔肝息风", + "E": "益气滋阴,镇肝息风" + }, + "answer": "B", + "reason": "抽动障碍的治疗，以平肝息风为基本原则,其中脾虚痰聚证的治法为健脾化痰，平肝息风。" + }, + { + "question_num": 41, + "query": "目的视觉功能主要取决于", + "options": { + "A": "肾中精气的充盈", + "B": "肝血的充足", + "C": "脾气的健运", + "D": "肾阳的蒸化", + "E": "肾阴的滋养" + }, + "answer": "B", + "reason": "肝开窍于目,肝藏血,眼依赖肝血活养才能发挥视觉功能。《素问·五脏生成篇》说:“肝受血而能视。”" + }, + { + "question_num": 42, + "query": "下列关于内生肌酐清除率的叙述，正确的是", + "options": { + "A": "肾功能严重损害时，开始升高", + "B": "高于80ml/min提示预后不良", + "C": "肾功能损害愈重，其清除率愈低", + "D": "肾功能损害愈重，其清除率愈高", + "E": "其测定与肾功能损害程度无关" + }, + "answer": "C", + "reason": "①内生肌酐消除率低于参考值的80%以下者，则表示肾小球滤过功能减退；②内生肌酐清除率低至51~70ml/min，为肾功能轻微损害；③内生肌酐清除率31~50ml/min，为中度损害；④内生肌酐消除率30ml/min以下，为重度损害；⑤内生肌酐清除率低至10~19ml/min，为肾衰竭期；⑥内生肌酐清除率低至10ml/min，为尿毒症期或终末期肾衰竭。" + }, + { + "question_num": 43, + "query": "肺痈病情转归的关键期是", + "options": { + "A": "成痛期", + "B": "初期", + "C": "迁延期", + "D": "恢复期", + "E": "溃脓期" + }, + "answer": "E", + "reason": "溃脓期是病情顺与逆的转折点。①顺证:溃后声音清朗,脓血可稀而渐少,腥臭味转谈,饮食知味,胸胁稍痛,身体不热,坐卧如常,脉象缓滑;②进证:溃后音嗄无力,脓血如败卤,腥臭异常,气喘，鼻扇,胸痛,坐卧不安,饮食少进,身热不退,颧红,爪甲青紫带弯，脉短涩或弦急，为肺叶腐败之恶候。" + }, + { + "question_num": 44, + "query": "疮疡阳证为", + "options": { + "A": "高肿灼手,根盘紧束", + "B": "按之固定,坚硬而热不甚", + "C": "按之肿硬而不热,根盘平塌漫肿", + "D": "按之陷而不起", + "E": "病位在血脉" + }, + "answer": "A", + "reason": "阳证皮肤红赤、灼热、高肿突出、根盘收束、软硬适度、疼痛剧烈、脓汁稠厚、病位在皮肤肌肉等。热不甚、根盘平塌、按之陷凹而不起、病位在血脉为阴证的表现。" + }, + { + "question_num": 45, + "query": "所谓得气，体现的经验功能是", + "options": { + "A": "沟通经络作用", + "B": "运输渗灌作用", + "C": "感应传导作用", + "D": "调节平衡作用", + "E": "运行气血作用" + }, + "answer": "C", + "reason": "得气是一种针刺到位后,身体酸麻胀沉的感觉,正是体现经络感应传导作用。" + }, + { + "question_num": 46, + "query": "下列哪项引起的呕吐为反射性呕吐", + "options": { + "A": "急性胆囊炎", + "B": "脑膜炎", + "C": "中暑", + "D": "妊娠", + "E": "尿毒症" + }, + "answer": "A", + "reason": "反射性呕吐：①消化系统疾病，如急慢性胃炎、消化性溃疡、胃肿瘤、幽门梗阻、非溃疡性消化不良等引起的呕吐常与进食有关，多伴有恶心先兆，吐后感轻松，肠源性呕吐见于急性肠炎、急性阑尾炎、肠梗阻等，肠梗阻者常伴腹痛、肛门停止排便排气，急慢性肝炎、急慢性胆囊炎、胆石症、胆道蛔虫、急性胰腺炎、急性腹膜炎等呕吐的特点是有恶心先兆，呕吐后不觉轻松；②其他，如异味刺激、急慢性咽炎、肺炎、急性胸膜炎、肺梗死、急性心肌梗死、充血性心力衰竭、急性肾炎、急性中毒等也可引起呕吐。BCDE项引起的都是中枢性的呕吐。" + }, + { + "question_num": 47, + "query": "逆与干呕、暖气在病机上的共同点是", + "options": { + "A": "胃气上逆", + "B": "寒气上逆", + "C": "肝胃气逆", + "D": "肺胃气逆", + "E": "积热上冲" + }, + "answer": "A", + "reason": "呕吐是指胃失和降,气道于上,迫使胃中之物从口中吐出的一种病证,无物有声谓之干呕;呃逆是指胃气上逆动膈,以气逆上冲,喉间呃呃连声，声短而频,令人不能自制为主要表现的病证;嗳气乃胃气阻郁,气逆于上所致,食后多发；三者的共同病机乃“胃气上逆”,故选A。" + }, + { + "question_num": 48, + "query": "下列哪项不是丹毒的临床特点", + "options": { + "A": "病起缓慢,恶寒发热", + "B": "局部皮肤热肿胀,迅速扩大", + "C": "局部皮肤忽然变赤", + "D": "好发于小腿部", + "E": "容易复发" + }, + "answer": "A", + "reason": "丹毒系由火毒侵犯,郁于肌肤而发的一种急性感染性疾病。病起皮肤突然发红，色如丹涂,热肿胀,迅速扩大,一般好发于小腿及头面部，数日内可逐渐痊愈，但常易复发。" + }, + { + "question_num": 49, + "query": "体质对疾病的传变作用，除可影响正气强弱外，另一方面的主要作用是", + "options": { + "A": "影响病邪的“从化”", + "B": "对疾病的传变规律起决定作用", + "C": "从病位方面影响疾病传变", + "D": "对传变的方式起决定作用", + "E": "从传变的速度方面影响疾病的传变" + }, + "answer": "A", + "reason": "传变,指病变部位在脏腑经络等之间的传递转移,体质因素决定疾病的传变，主要体现在两个方面:一是通过正气强弱而决定疾病的传变;二是通过决定病邪的从化而影响传变。" + }, + { + "question_num": 50, + "query": "下列除哪项外，均可出现心电轴右偏", + "options": { + "A": "左前分支阻滞", + "B": "左后分支阻滞", + "C": "右心室肥大", + "D": "广泛心肌梗死", + "E": "垂直位心脏" + }, + "answer": "A", + "reason": "左后分支阻滞、右心室肥大、广泛心肌梗死、肺气肿、垂直位心脏等，可使心电轴右偏。左前分支阻滞、左心室肥大、大量腹水、肥胖、妊娠、横位心脏等,可使心电轴左偏。" + }, + { + "question_num": 51, + "query": "中风后遗症期是指发病", + "options": { + "A": "2周以上", + "B": "1个月以上", + "C": "2个月以上", + "D": "3个月以上", + "E": "半年以上" + }, + "answer": "E", + "reason": "急性期:发病后2周以内,中脏腑累可至1个月;恢复期:发病2周或1个月后,至半年以内;后遗症期:发病半年以上。" + }, + { + "question_num": 52, + "query": "下列各项,不属于“痒”病因的是", + "options": { + "A": "血瘀", + "B": "热胜", + "C": "湿胜", + "D": "虫淫", + "E": "风胜" + }, + "answer": "A", + "reason": "痒的病因有热胜、风胜、湿胜、虫淫、血虚。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,热则微痒;或血虚风燥阻于皮肤，肤失所养,内生虚热，热则微痒,故答案选A。" + }, + { + "question_num": 53, + "query": "利小便而实大便的理论依据是", + "options": { + "A": "脾主运化", + "B": "肺主通调水道", + "C": "小肠主受盛", + "D": "小肠主化物", + "E": "小肠主泌别清浊" + }, + "answer": "E", + "reason": "小肠的泌别清浊功能包括泌别清浊后的糟粕,分为食物残渣及废水两部分,食物残渣下降到大肠,形成类便而排出体外:多余的水分则可气化生成尿液排出体外,故对于小肠泌别清浊功能失调的患者,小便不能及时气化人膀胱,水谷并走大肠,可见大便稀薄,小便短少,治疗选用分利方法,即“利小便以实大便”" + }, + { + "question_num": 54, + "query": "下列哪项是引起头痛的全身性疾病", + "options": { + "A": "脑出血", + "B": "神经衰弱", + "C": "鼻部炎症", + "D": "颅脑外伤", + "E": "高血压病" + }, + "answer": "E", + "reason": "头痛的病因：颅内病变见于脑出血、蛛网膜下腔出血、脑肿瘤、颅脑外伤、流行性脑脊髓膜炎等。颅外病变见于颈椎病、三叉神经痛、口腔及鼻部炎症等。全身性疾病见于各种感染发热、高血压病、中毒、中暑、月经期及绝经期头痛等。神经症，如神经衰弱及癔症性头痛等。" + }, + { + "question_num": 55, + "query": "补天大造丸所治肺痨的主要病机是", + "options": { + "A": "肺阴亏虚", + "B": "虚火灼肺", + "C": "阴阳两虚", + "D": "气阴耗伤", + "E": "以上都不是" + }, + "answer": "C", + "reason": "补天大造丸滋明补阳治疗肺痨阴伤及阳,精气虚竭,肺,脾、肾俱损之气机两虚证。" + }, + { + "question_num": 56, + "query": "下列哪项不是蛛网膜下隙麻醉的适应证", + "options": { + "A": "下腹部手术", + "B": "盆腔手术", + "C": "下肢手术", + "D": "肛门及会阴部手术", + "E": "乳房手术" + }, + "answer": "E", + "reason": "蛛网膜下隙麻醉的适应证:①下腹部及盆腔手术:②下肢手术:③肛门及会阴部手术" + }, + { + "question_num": 57, + "query": "五脏共同的生理特点是", + "options": { + "A": "传化物", + "B": "实而不能满", + "C": "藏精气", + "D": "泻而不藏", + "E": "受盛传化水谷" + }, + "answer": "C", + "reason": "五胜共同的生理特点有两个方面一是化生和贮藏精气,主“藏精气”“藏而不泻”“满而不能实”。二是五脏藏神,五脏的生理活动与精神情志活动密切相关。传化物、实而不能满、泻而不藏、受盛传化水谷是六腑共同的生理特点。" + }, + { + "question_num": 58, + "query": "血管壁功能异常所致的出血性疾病为", + "options": { + "A": "感染性紫癜", + "B": "特发性血小板减少性紫癜", + "C": "血栓性血小板减少性紫癜", + "D": "血友病", + "E": "血小板增多症" + }, + "answer": "A", + "reason": "血管壁结构与功能异常：①先天性疾病，如遗传性出血性毛细血管扩张症、血管性假性血友病、家族性单纯性紫癜等；②获得性过敏性紫癜、药物性紫癜、感染性紫癜、中毒性紫癜、结缔组织疾病、维生素C缺乏症、单纯性紫癜等。" + }, + { + "question_num": 59, + "query": "疟疾患者，热多寒少，汗出不畅，头痛，骨节酸痛，口渴引饮，便秘，瘦赤，舌红苔黄，脉弦数。治疗应首选", + "options": { + "A": "柴胡桂枝干姜汤", + "B": "柴胡截疟饮", + "C": "截疟七宝饮", + "D": "小柴胡汤", + "E": "白虎加桂枝汤" + }, + "answer": "E", + "reason": "A项治疗寒疟,发作时热少寒多;BC项用于治疗正疟;D项治疗少阳证往来寒热;E项治疗温疟,发作时热多寒少,故选E。" + }, + { + "question_num": 60, + "query": "脱疽的主要病因病理是", + "options": { + "A": "脾气不健,肝肾不足,寒湿侵袭,凝滞脉络", + "B": "温热蕴结,寒湿外侵,气血瘀滞,脉络滞塞", + "C": "湿热下注,气血壅滞,经络阻隔,脉络瘀滞", + "D": "肝肾不足,气血两亏,络脉闭阻,筋骨失养", + "E": "情志郁结,气滞血瘀,脉络闭阻,筋脉失养" + }, + "answer": "A", + "reason": "脾肾阳气不足,不能温养四肢,复感寒湿之邪,则脉络凝滞,这是脱疽发生的主要病因及病理演变过程。" + }, + { + "question_num": 61, + "query": "《素问·上古天真论》说：“筋骨坚，发长极，身体盛壮”，是指女子哪个年龄段的生理表现", + "options": { + "A": "二七", + "B": "三七", + "C": "四七", + "D": "五七", + "E": "六七" + }, + "answer": "C", + "reason": "《素问·上古天真论》:“女子七岁，肾气盛,齿更发长;二七而天癸至,任脉通,太冲脉盛，月事以时下,故有子:三七,肾气平均,故真牙生而长极;四七,筋骨坚,发长极,身体盛壮;五七,阳明脉衰,面始焦,发始堕:六七,三阳脉衰于上,面皆焦,发始自;七七,任脉虚,太冲脉衰少,天癸竭,地道不通,故形坏而无子也。”" + }, + { + "question_num": 62, + "query": "下列除哪项外，均是采录“既往史”所要表述的内容", + "options": { + "A": "过去健康情况", + "B": "预防接种情况", + "C": "传染病史", + "D": "过敏史", + "E": "是否到过传染病的流行地区" + }, + "answer": "E", + "reason": "病历书写的格式与内容。病历书写格式规定：个人史项中包括居住地区情况；而既往史应采录的内容是过去健康状况、预防接种史、传染病史，过敏史等。" + }, + { + "question_num": 63, + "query": "患者咳嗽发热，胸痛，咳时尤甚，吐痰腥臭,咳吐脓血，应诊断为", + "options": { + "A": "咳嗽", + "B": "肺痨", + "C": "肺胀", + "D": "肺痛", + "E": "肺瘘" + }, + "answer": "D", + "reason": "该患者咳嗽发热,胸痛,咳时尤甚，吐痰腥臭,咳吐脓血,符合肺痈的诊断。" + }, + { + "question_num": 64, + "query": "在对瘿病肿块扪诊时,除对其肿块位置、数目、硬度、光滑度、活动度、界限进行重点检查外,还应注意的是", + "options": { + "A": "颈部活动是否受限", + "B": "颈部皮肤是否肿胀", + "C": "肿块有无震颤,气管是否移位,淋巴结是否肿大", + "D": "下颌活动是否正常", + "E": "颈静脉是否怒张" + }, + "answer": "C", + "reason": "肿块扪诊若有震颤,说明合并有甲状腺功能亢进；气管移位与否,是手术之前需要了解的内容之一；淋巴结是否肿大,多为判断瘿病性质���主要参考内容之一。" + }, + { + "question_num": 65, + "query": "脾在窍为", + "options": { + "A": "鼻", + "B": "目", + "C": "舌", + "D": "口", + "E": "耳" + }, + "answer": "D", + "reason": "脾开窍于口:肺开窍于鼻;肾开窍于耳;肝开窍于目:心开窍手舌。" + }, + { + "question_num": 66, + "query": "下列哪项是诊断缺铁最肯定的依据", + "options": { + "A": "有慢性失血史", + "B": "血涂片见典型小细胞低色素性红细胞", + "C": "转铁蛋白饱和度降低", + "D": "血清铁降低", + "E": "骨髓小粒可染铁消失" + }, + "answer": "E", + "reason": "缺铁的诊断依据。骨髓小粒可染铁是代表体内的贮存铁，骨髓小粒可染铁消失，即表示体内已无贮存铁，故可肯定诊断缺铁。而其他几项检查或病史则不能完全肯定缺铁，如在慢性疾病贫血时，虽然血清铁降低，但存铁可能正常或偏高。" + }, + { + "question_num": 67, + "query": "痞满的主要病变脏腑在", + "options": { + "A": "肝脾", + "B": "肝胃", + "C": "脾胃", + "D": "脾肾", + "E": "肝肾" + }, + "answer": "C", + "reason": "痞满的病位。痞满的主要病变脏腑在脾胃。" + }, + { + "question_num": 68, + "query": "疖热毒蕴结证的主治方剂是", + "options": { + "A": "清暑汤", + "B": "黄连解毒汤", + "C": "仙方活命饮", + "D": "败毒散", + "E": "白头翁汤" + }, + "answer": "B", + "reason": "疖,热毒蕴结证,证候:常见于气实火盛患者。好发于项后发际、背部、臀部。轻者疖肿只有一两个,多则可散发全身,或簇集一处,或此愈彼起。伴发热,口渴,溲赤,便秘,苔黄,脉数。主治方剂:黄连解毒汤。" + }, + { + "question_num": 69, + "query": "六淫邪气中，具有“重浊”特点的是", + "options": { + "A": "风", + "B": "寒", + "C": "暑", + "D": "湿", + "E": "火" + }, + "answer": "D", + "reason": "湿为阴邪,易阻過气机,损伤阳气!湿性重浊,湿性黏滞,常见恶风寒、虽然出汗但热不退、四肢困倦、关节肌肉疼痛等症状,故选D。" + }, + { + "question_num": 70, + "query": "下列哪项药物不会引起白细胞减少", + "options": { + "A": "甲巯咪唑", + "B": "氯霉素", + "C": "磺胺类", + "D": "氨基比林", + "E": "碳酸锂" + }, + "answer": "E", + "reason": "白细胞减少的病因。甲巯咪唑、氯霉素、磺胺类、氨基比林均易引起白细胞减少，碳酸锂有刺激骨髓生成粒细胞的作用，不会引起白细胞减少。" + }, + { + "question_num": 71, + "query": "眩晕的辨证中,应首辨的要点是", + "options": { + "A": "病变脏腑", + "B": "寒热虚实", + "C": "标本虚实", + "D": "虚实缓急", + "E": "外感内伤" + }, + "answer": "A", + "reason": "眩晕临证首先应辨明相关脏腑,其次辨标本虚实。眩晕病在清穷,但与肝、脾、肾三脏功能失调密切相关。肝阳上亢之眩晕兼见头胀痛、面色潮红、急躁易怒.口苦脉弦等症状。脾胃虚弱,气血不足之眩晕,兼有纳呆、乏力、面色㿠白等症状。脾失健运,痰湿中阻之眩晕,兼见纳呆呕恶、头痛苔腻诸症。肾精不足之眩晕,多兼有腰酸腿软,耳鸣如蝉等症状。" + }, + { + "question_num": 72, + "query": "痈之火毒凝结证的主治方剂是", + "options": { + "A": "五味消毒饮", + "B": "败毒散", + "C": "仙方活命饮", + "D": "银翘散", + "E": "牛蒡解肌汤" + }, + "answer": "C", + "reason": "痈,火毒凝结证,证候:局部突然肿胀,光软无头,迅速结块，皮肤焮红,少数病例皮色不变,到酿脓时才转为红色，灼热疼痛。日后逐渐扩大，变成高肿发硬。重者可有恶寒发热，头痛,泛恶，口渴，舌苔黄腻,脉弦滑或洪数等症状。主治方剂:仙方活命饮。" + }, + { + "question_num": 73, + "query": "导致虚热证的病理变化是", + "options": { + "A": "阳偏衰", + "B": "阴偏衰", + "C": "阳偏胜", + "D": "阴偏胜", + "E": "阳盛格阴" + }, + "answer": "B", + "reason": "阴偏衰,是指人体之阴气不足,滋润、宁静、潜降、成形和制约阳热的功能减退,阴不制阳,因而出现燥、热、升、动和化气太过等阳偏亢的病理状态,其病机特点多为制约阳热和滋润、内守、宁静功能减退,导致阳相对亢盛的虚热证。" + }, + { + "question_num": 74, + "query": "胆囊肿大，无压痛，伴黄疸进行性加深，多考虑", + "options": { + "A": "胆囊炎", + "B": "胆结石", + "C": "肝脓肿", + "D": "胆囊瘤", + "E": "胰头瘤" + }, + "answer": "E", + "reason": "胰头癌压迫胆总管致胆囊肿大时无压痛，但有逐渐加深的黄疸，称库瓦济埃征阳性。胆囊炎只引起胆囊的肿大；胆囊肿大，有实感性，见于胆囊结石或胆囊癌。" + }, + { + "question_num": 75, + "query": "一般说来，初痫实则", + "options": { + "A": "通之", + "B": "补之", + "C": "濡之", + "D": "燥之", + "E": "温之" + }, + "answer": "A", + "reason": "热痢清之,寒痢温之,初痢实则通之,欠痢虚则补之。痢疾的治疗禁忌:忍过早补涩,忌峻下攻伐,忌分利小便。" + }, + { + "question_num": 76, + "query": "“七恶”中,症见“皮肤枯槁,痰多音喑,呼吸喘急,鼻翼扇动”者,称为", + "options": { + "A": "心恶", + "B": "肝恶", + "C": "脾恶", + "D": "肺恶", + "E": "气血衰竭" + }, + "answer": "D", + "reason": "“七恶”:心恶、肝恶、脾恶、肺恶、肾恶、脏腑败坏、气血衰竭(脱证)。肺胜正气虚衰,气血不足,而以病邪占优势地位,预后不佳,如治疗得当,也能转化为善证、顺证。" + }, + { + "question_num": 77, + "query": "在肾主闭藏的功能活动中，最具生理意义的是", + "options": { + "A": "纳气归肾，促进元气之生成", + "B": "固摄二便，防止二便之失禁", + "C": "固摄水液，防止水液无故流失", + "D": "固摄精气，防止精气无故散失", + "E": "摄纳阳气，防止阳气浮越于上" + }, + "answer": "D", + "reason": "肾主藏精,是指肾具有贮存、封藏精气的生理作用。《素问·六节藏象论》:“肾者，主蛰,封藏之本,精之处也。”精藏于肾,能够发挥其生理效应而不流失，依赖着肾的封藏作用。在肾主闭藏的功能活动中,最具有生理意义的是固摄精气,防止精气无故散失。" + }, + { + "question_num": 78, + "query": "金属调的咳嗽多由于", + "options": { + "A": "喉炎", + "B": "喉结核", + "C": "声带炎", + "D": "纵隔肿瘤", + "E": "支气管炎" + }, + "answer": "D", + "reason": "金属调的咳嗽可由于纵隔肿瘤或支气管瘤等。声音嘶哑的咳嗽多见于声带炎、喉炎、喉癌以及喉返神经受压等。" + }, + { + "question_num": 79, + "query": "下列各项，除哪项外，均属消渴的常见变证", + "options": { + "A": "肺痨", + "B": "吐血", + "C": "中风", + "D": "痛疽", + "E": "水肿" + }, + "answer": "B", + "reason": "消渴病常可并发多种病证,肺失濡养一一肺痨;肝失濡养一一白内障;燥热内结,蕴毒成脓一一痈疽;阴虚燥热,炼液成痰,痰阻经络一一中风。" + }, + { + "question_num": 80, + "query": "丹毒湿热毒蕴证的治法是", + "options": { + "A": "清肝泻火利湿", + "B": "清肝泻火解毒", + "C": "疏风清热解毒", + "D": "凉血清热解毒", + "E": "利湿清热解毒" + }, + "answer": "E", + "reason": "丹毒,湿热毒蕴证,证候:发于下肢局部红赤肿胀、灼热疼痛,或见水疱、紫斑，甚至结毒化脓或皮肤坏死。或反复发作，可形成大脚风。伴发热胃纳不香。舌红，苔黄腻，脉滑数。治法:利湿清热解毒。" + }, + { + "question_num": 81, + "query": "“益火之源，以消阴翳”指的是", + "options": { + "A": "阴病治阳", + "B": "阳病治阴", + "C": "热者寒之", + "D": "寒者热之", + "E": "阳中求阴" + }, + "answer": "A", + "reason": "“益火之源,以消阴翳”,指的是用补阳的方法治疗阳气不足,阳不制阴而阴相对偏亢的病证,通过补阳使得阳气恢复,以消退相对偏盛的阴。阴病治阳,是指用补阳的方法治疗阳虚阴盛的病证。阳病治阴,是指用补阴的方法治疗阴虚阳亢的病证。热者寒之,是以寒治热,用于实寒证。寒者热之,是以热治寒,用于实热证。阳中求阴,是在补阴的基础上配伍补阳的方法,治疗阴偏衰的病证。" + }, + { + "question_num": 82, + "query": "属于感染性发热的是", + "options": { + "A": "广泛性皮炎", + "B": "脊髓灰质炎", + "C": "心肌梗死", + "D": "中暑", + "E": "白血病" + }, + "answer": "B", + "reason": "感染性发热包括病毒、细菌、支原热、立克次体、螺旋体、真菌、寄生虫等感染引起的发热。脊髓灰质炎是由脊髓灰质炎病毒感染引起的一种疾病，故属于感染性发热，其余选项属于非感染性发热。" + }, + { + "question_num": 83, + "query": "治疗石淋，应首选", + "options": { + "A": "程氏草分清饮", + "B": "无比山药丸", + "C": "八正散", + "D": "沉香散", + "E": "石韦散" + }, + "answer": "E", + "reason": "小便艰涩疼痛,为淋证。排尿中断，腰腹绞痛难忍,为石淋主症,如尿中排出砂石更能确诊。病机是湿热蕴结下焦,治宜清热利湿,通淋排石。用���韦散,重在通淋排石。" + }, + { + "question_num": 84, + "query": "症见结喉处红肿绕喉,根盘散漫,肿势延及颈部两侧，按之中软,有应指感。治疗应首选()", + "options": { + "A": "内服普济消毒饮", + "B": "外治以菊花汁调制玉露散箍围束毒", + "C": "半流质饮食", + "D": "切开排脓", + "E": "药线引流" + }, + "answer": "D", + "reason": "痈之大者名发。说明发的病变范国较痈为大,生于结喉处的，称为锁喉痈。" + }, + { + "question_num": 85, + "query": "火的特性是", + "options": { + "A": "曲直", + "B": "稼穑", + "C": "从革", + "D": "炎上", + "E": "润下" + }, + "answer": "D", + "reason": "水日润下;火日炎上;木曰曲直;金曰从革:土爰稼稿;故选D。" + }, + { + "question_num": 86, + "query": "十二指肠球部溃疡的直接X线征象是", + "options": { + "A": "球部充盈缺损", + "B": "球部激惹征", + "C": "球部龛影或变形", + "D": "幽门痉挛，开放延迟", + "E": "黏膜皱襞粗乱" + }, + "answer": "C", + "reason": "十二指肠溃疡：绝大部分发生在球部，溃疡已造成球部变形；球部龛影或球部变形是十二指肠溃疡的直接X线征象。间接征象：①激惹征；②幽门痉挛，开放延迟；③胃分泌增多和胃张力及蠕动方面的改变；④球部固定压痛。" + }, + { + "question_num": 87, + "query": "治疗嗜隔血内结证，应首选的方剂是", + "options": { + "A": "通幽汤", + "B": "涤痰汤", + "C": "启膈散", + "D": "玉枢丹", + "E": "丁香散" + }, + "answer": "A", + "reason": "A项用于噎膈瘀血内结证;B项用于中风中脏腑痰浊瘀闭证、痴呆痰浊蒙窍证;C项用于噎膈痰气交阻证;D项用于噎膈泛吐痰涎甚多者;E项用于呃逆胃中寒冷证。" + }, + { + "question_num": 88, + "query": "关于气瘿的描述,错误的是", + "options": { + "A": "女性发病较男性高", + "B": "一般多发于青春期", + "C": "甲状腺呈弥漫性肿大", + "D": "男性较女性发病高", + "E": "好发于中老年人" + }, + "answer": "E", + "reason": "气瘿,女性发病率较男性略高。一般多发生在青春期，在流行地区常见于入学年龄的儿童。初起时无明显不适感,甲状腺呈弥漫性肿大，腺体表面较平坦，质软不痛，皮色如常,脉体随吞咽动作而上下移动。" + }, + { + "question_num": 89, + "query": "下列情志相胜关系中，错误的是", + "options": { + "A": "怒胜思", + "B": "思胜恐", + "C": "恐胜喜", + "D": "喜胜悲", + "E": "惊胜怒" + }, + "answer": "E", + "reason": "肝主怒,心主喜,脾主思,肺主悲,肾主惊、恐。根据五行生克关系,水生木,肾为肝之母,故惊胜怒不正确。" + }, + { + "question_num": 90, + "query": "慢性阻塞性肺疾病(COPD)患者长期家庭氧疗的氧流量是", + "options": { + "A": "0.5~1L/min", + "B": "1~2L/min", + "C": "1.5~2.5L/min", + "D": "2~3L/min", + "E": "3.5~4.5L/min" + }, + "answer": "B", + "reason": "慢性阻塞性肺疾病（COPD）患者长期家庭氧疗的氧流量是1~2L/min，吸氧持续时间为10~15h/d。" + }, + { + "question_num": 91, + "query": "少腹拘急冷痛，苔白，脉沉紧，其病理", + "options": { + "A": "下焦受寒,厥阴之气失于疏泄", + "B": "肾阳不足,寒邪内侵", + "C": "脾阳不振,寒邪内侵", + "D": "寒邪内侵,阳气不运", + "E": "阴寒内盛,外寒人侵" + }, + "answer": "A", + "reason": "寒邪内阻之腹痛的治疗。分析其主症及脉象,此为下焦受寒,厥阴之气失于琉泄之腹痛。" + }, + { + "question_num": 92, + "query": "筋瘤劳倦伤气证的主治方剂是", + "options": { + "A": "补中益气汤", + "B": "参苓白术散", + "C": "当归四逆汤", + "D": "暧肝煎", + "E": "以上均非" + }, + "answer": "A", + "reason": "筋瘤之劳倦伤气证,证候:久站久行或劳累时瘤体增大，下坠不适感加重;常伴气短乏力，脘腹坠胀,腰酸;舌淡,苔薄白,脉细缓无力。治法:补中益气,活血舒筋。代表方:补中益气汤加减" + }, + { + "question_num": 93, + "query": "下列各项，与肺主通调水道功能关系最密切的是", + "options": { + "A": "气机的调节", + "B": "朝百脉", + "C": "主宣发与肃降", + "D": "司呼吸", + "E": "宗气的生成" + }, + "answer": "C", + "reason": "肺主通调水道,是指肺的宜发和肃降对体内津液的输布、运行和排泄有疏通和调节的作用。通过肺的宣发,水液向上、向外输布，布散全身,外达皮毛，代谢后以汗的形式由汗孔排泄:通过肺的肃降,水液向下、向内输送,而成为尿液生成��源,经肾蒸腾汽化,将代谢后的水液化为尿贮存于膀胱,而后排出体外。可见肺的宣发与肃降功能与其通调水道作用密切相关。" + }, + { + "question_num": 94, + "query": "下列哪项不是肝火上炎证与肝阳上亢证的共同症状", + "options": { + "A": "失眠多梦", + "B": "急躁易怒", + "C": "头重脚轻", + "D": "面红目赤", + "E": "头晕胀痛" + }, + "answer": "C", + "reason": "肝火上炎证的临床表现：头晕胀痛，痛如刀劈，面红目赤，口苦口干，急躁易怒，耳鸣如潮，甚或突发耳聋，失眠，噩梦纷纭，或胁肋灼痛，吐血、衄血，小便短黄，大便秘结，舌红苔黄，脉弦数。肝阳上亢证的临床表现：眩晕耳鸣，头目胀痛，面红目赤，急躁易怒，失眠多梦，头重脚轻，腰膝酸软，舌红少津，脉弦有力或弦细数。" + }, + { + "question_num": 95, + "query": "治疗尿血下焦湿热证,应首选", + "options": { + "A": "六味地黄丸", + "B": "十灰散", + "C": "春泽汤", + "D": "保真汤", + "E": "小蓟饮子" + }, + "answer": "E", + "reason": "小蓟饮子适用于尿血下焦湿热证，十灰散适用于热迫血行证,春泽汤为五苓散加人参,适用于气虚伤湿证,保真汤治疗阴虚火热证,无比山药丸健脾益胃,补肾培元,用于肾气不固证。" + }, + { + "question_num": 96, + "query": "乳痈正虚毒恋证的主治方剂是", + "options": { + "A": "托里消毒散", + "B": "透脓散", + "C": "瓜蒌牛劳汤", + "D": "败毒散", + "E": "二仙汤" + }, + "answer": "A", + "reason": "乳痈,正虚毒恋证,证候:溃脓后乳房肿痛虽轻,但疮口脓水不断,脓汁清称，愈合缓慢或形成乳漏。全身乏力，面色少华,或低热不退，饮食减少。舌淡，苔薄，脉弱无力。治法：益气和营托毒。方药：托里消毒散加减。" + }, + { + "question_num": 97, + "query": "与血液生成关系最密切的脏是", + "options": { + "A": "心", + "B": "肺", + "C": "脾", + "D": "肝", + "E": "肾" + }, + "answer": "C", + "reason": "牌的生理功能为主统血,脾为后天之本,气血生化之源,脾运化的水谷精微是生成血液的主要物质基础。心主血脉,推动血液在脉中运行。肝藏血,贮藏血液、调节血量、防止出血。肺朝百脉主治节,全身血液通过百脉会聚于肺,经肺的呼吸进行气体交换,将富含清气的血通过百脉输送到全身。肾主生殖繁衍,肾精化生血液。" + }, + { + "question_num": 98, + "query": "精神性呼吸困难，可见于", + "options": { + "A": "急性脑血管疾病", + "B": "癔症", + "C": "急性感染所致的毒血症", + "D": "慢性阻塞性肺气肿", + "E": "左心功能不全" + }, + "answer": "B", + "reason": "急性脑血管疾病多表现为潮式呼吸和间停呼吸。癔症多表现为精神性呼吸困难。急性感染所致的毒血症表现为潮式呼吸和间停呼吸。慢性阻塞性肺气肿多表现为呼气性呼吸困难。左心功能不全多表现为夜间阵发性呼吸困难。" + }, + { + "question_num": 99, + "query": "治疗咳血燥热伤肺重症,应首选", + "options": { + "A": "沙参麦冬汤", + "B": "桑杏汤", + "C": "百合固金汤", + "D": "麦门冬汤", + "E": "清燥救肺汤" + }, + "answer": "E", + "reason": "肺为娇脏,喜润恶燥,燥热伤肺,破伤血络,故见咳血,治宜消热润肺,宁络止血。方用桑杏汤。沙参麦冬汤重在滋养肺胃,生津润燥。百合固金汤重在滋养肺肾,化痰止咳。麦门冬汤重在滋养肺胃,降逆和中。清燥救肺汤重在益气养阴,肃降肺气，比桑杏汤的滋阴力强,用于燥热伤肺的重症。" + }, + { + "question_num": 100, + "query": "蛇头疗的好发部位是", + "options": { + "A": "指甲一侧边缘近端", + "B": "指端", + "C": "指腹", + "D": "手掌", + "E": "足底" + }, + "answer": "B", + "reason": "蛇头疔，初起指端感觉麻痒而痛，继而刺痛，灼热肿胀，色红不明显，随后肿势逐渐扩大。" + }, + { + "question_num": 101, + "query": "反治法指的是", + "options": { + "A": "顺从疾病的本质而治的一种治疗方法", + "B": "逆着疾病的本质而治的一种治疗方法", + "C": "逆着疾病的假象而治的一种治疗方法", + "D": "顺从疾病的假象而治的一种治疗方法", + "E": "反常的治疗方法" + }, + "answer": "D", + "reason": "反治法指的是顺从疾病的假象而治的一种治疗方法。" + }, + { + "question_num": 102, + "query": "下列哪项说法是错误的", + "options": { + "A": "正常人卧位时可见颈静脉充盈", + "B": "正常人坐位时可见颈静脉充盈", + "C": "右心衰竭时可见颈静脉充盈", + "D": "上腔静脉回流受阻时可见颈静脉充盈", + "E": "心包大量积液时可见颈静脉充盈" + }, + "answer": "B", + "reason": "正常人立位或坐位时颈外静脉常不显露,平卧时可稍见充盈，充盈的水平仅限于锁骨上缘至下颌角距离的下2/3以内。若取30°~45°的半卧位时静脉充盈度超过正常水平，称为颈静脉怒张。颈静脉怒张提示右房压力的升高和静脉回流受阻（静脉压增高），常见于右心衰竭、缩窄性心包炎、心包积液或上腔静脉阻塞综合征。" + }, + { + "question_num": 103, + "query": "用麻子仁丸治疗的是", + "options": { + "A": "气秘", + "B": "热秘", + "C": "冷秘", + "D": "气虚秘", + "E": "血虚秘" + }, + "answer": "B", + "reason": "便秘的辨证论治。.麻子仁丸功效为清热润肠，可以用于治疗热秘。" + }, + { + "question_num": 104, + "query": "治疗体表脓肿,实施切开引流的有利时机是", + "options": { + "A": "肿疡初起", + "B": "肿疡溃后", + "C": "脓肿中央出现透脓点", + "D": "溃疡肉芽暗红", + "E": "疮疡肿硬" + }, + "answer": "C", + "reason": "脓成方可排脓，脓肿中央出现透脓点为切开引流的最佳时机。" + }, + { + "question_num": 105, + "query": "循行于上肢内侧前缘的经脉是", + "options": { + "A": "手太阳经", + "B": "手少阳经", + "C": "手厥阴经", + "D": "手少阴经", + "E": "手太阴经" + }, + "answer": "E", + "reason": "手经循行于上肢,足经循行于下肢:阳经循行于四肢外侧,阴经循行于四肢内侧;分布于四肢内侧前缘的称太阴经;分布于四肢内侧中间的称厥阴经;分布于四肢内侧后缘的称少阴经;分布于四肢外侧前缘的称阳明经;分布于四肢外侧中间的称少阳经;分布于四肢外侧后缘的称太阳经。" + }, + { + "question_num": 106, + "query": "过清音见于", + "options": { + "A": "叩击富有弹性、含气量正常的肺组织所产生的音响", + "B": "叩击含有大量气体的空腔脏器时出现", + "C": "叩击含气量增多、弹性减退的肺组织时出现", + "D": "叩击不含气的实质性脏器时出现", + "E": "叩击各种原因所致含气减少的肺组织时出现" + }, + "answer": "C", + "reason": "过清音是属于鼓音范畴的一种变音，介于鼓音与清音之间。过清音的出现提示肺组织含气量增多，弹性减弱，临床常见于肺气肿。" + }, + { + "question_num": 107, + "query": "以下关于鼓胀的论述，不正确的是", + "options": { + "A": "鼓胀的临床表现以腹部胀大，皮色苍黄,腹壁脉络暴露为特征", + "B": "鼓胀可以由胁痛、黄疸、积聚等病迁延不愈发展而来", + "C": "鼓胀是由于各种原因导致肝脾肾三脏功能失调,气滞、血瘀、水饮互结，停于腹中而成", + "D": "根据病程和病势的发展，鼓胀可分为早、中、晚三期", + "E": "鼓胀一病,总以气血虚为主,治疗当以补益气血为先" + }, + "answer": "E", + "reason": "鼓胀的临床特征。ABCD项分别从临床症状病因、病机、病程和病势论述了鼓胀一病的特征,在治疗上以攻补兼施为原则,早期以攻邪为主，中期攻补兼施,晚期当以补虚为主,若一味补益,必将阻碍那邪气,使邪气留恋。" + }, + { + "question_num": 108, + "query": "湿邪所致外科·疾病的好发部位是", + "options": { + "A": "上部", + "B": "下部", + "C": "中部", + "D": "上肢", + "E": "背部" + }, + "answer": "B", + "reason": "湿邪致病，多混热相兼，多侵犯人体下部、患部肿胀、水疱、脓疤、糜烂流脓、瘙痒，常伴纳食不佳、胸闷呕恶、腹胀腹満、舌苔腻等症状。" + }, + { + "question_num": 109, + "query": "小儿由食积发展为痢积，体现了中医发病的", + "options": { + "A": "感邪即发", + "B": "徐发", + "C": "伏而后发", + "D": "继发", + "E": "复发" + }, + "answer": "D", + "reason": "继发指在原发疾病的基础上,继发新的疾病,其特点是新的疾病与原发病在病理上有密切联系,如肝阳上亢所致的中风,小儿食积而致的疳积等。" + }, + { + "question_num": 110, + "query": "我国高血压病最常见的死亡原因是", + "options": { + "A": "高血压危象", + "B": "急性脑血管病", + "C": "尿毒症", + "D": "心力衰竭", + "E": "缺血性心脏病" + }, + "answer": "B", + "reason": "高血压病常常导致急性脑血管病，而急性脑血管病是一种威胁中老年人生命的常见病，在我国城乡约居各类死因的第2位，是全世界引起死亡的三大病证之一。" + }, + { + "question_num": 111, + "query": "饮证与水��,同为津液病变,其不同点在于", + "options": { + "A": "邪在表在里", + "B": "正虚与邪盛", + "C": "局部与全身", + "D": "上部与下部", + "E": "饮邪的多少" + }, + "answer": "C", + "reason": "饮证分为痰饮.悬饮,溢饮、支饮,痰饮一一饮停肠胃,悬饮一一饮流胁下,溢饮一一饮溢肢体,支饮一一支撑胸肺。饮证是在机体内部的,不能肉眼观察的,有特定部位的病变。而水肿是外在的,全身性的。因此,饮证与水肿,同为津液病变,其不同点在局部与全身。" + }, + { + "question_num": 112, + "query": "下列关于刀晕的处理，错误的是", + "options": { + "A": "刀晕轻症,只要扶持患者安静平卧，室温保暖即可", + "B": "头位稍低,安静卧床", + "C": "给饮开水或糖水", + "D": "灸百会、水沟或刺合谷、少商等穴救治", + "E": "应迅速做完手术,进行急救" + }, + "answer": "E", + "reason": "轻者，只要扶持患者安静平卧，室温保暖即可，或头位稍低，安静卧床，给饮开水或糖水。重者伴有意识障碍，当灸百会、人中或刺合谷、少商等穴救治。" + }, + { + "question_num": 113, + "query": "先安未受邪之地属于", + "options": { + "A": "治病求本", + "B": "急则治标", + "C": "未病先防", + "D": "既病防变", + "E": "因时制宜" + }, + "answer": "D", + "reason": "“未病先防\"指在未病之前,采取各种措施,以防止疾病的发生,包括养生以增强正气;防止病邪侵害。“既病防变”指在疾病发生之后,力求做到:①早期诊治;②防止疾病的传变(阻截病传途径:先安未受邪之地)。0和" + }, + { + "question_num": 114, + "query": "下列疾病，蜘蛛痣有诊断意义的是", + "options": { + "A": "肝硬化", + "B": "麻疹", + "C": "猩红热", + "D": "伤寒", + "E": "药物过敏" + }, + "answer": "A", + "reason": "蜘蛛痣是由一支中央小动脉和许多向外辐射的细小血管形成，形如蜘蛛，检查时用火柴棍压迫中央，则周围扩张的小血管充血消失，多出现在上腔静脉分布的区域内，见于急、慢性肝炎及肝硬化患者。" + }, + { + "question_num": 115, + "query": "治疗行痹,应首选", + "options": { + "A": "乌头汤", + "B": "惹苡仁汤", + "C": "防风汤", + "D": "宣痹", + "E": "白虎加桂枝汤" + }, + "answer": "C", + "reason": "乌头汤温经散寒,祛风除湿,侧重温阳,用于寒重的痛痹,排除A；薏苡仁汤除湿通络,祛风散寒,侧重祛湿,用于湿重的着弊,排除B；防风汤祛风通络,散寒除湿,侧重祛风,用于风重的行弊,故选C;宜痹汤清热利温,通络止痛,用于湿热蕴于经络的湿热痹证,排除D;白虎加桂枝汤清热通络,祛风除温,用于热痹,排除E。" + }, + { + "question_num": 116, + "query": "有头疽好发于", + "options": { + "A": "项后背部", + "B": "面部", + "C": "四肢部", + "D": "臀部", + "E": "颈前两侧" + }, + "answer": "A", + "reason": "有头疽，好发于项后、背部等皮肤厚韧之处，多见于中老年人及消渴病患者，并容易发生内陷。" + }, + { + "question_num": 117, + "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": "气血蕴滞瘀结" + }, + "answer": "C", + "reason": "实是指邪气盛:气机升降失调为气机紊乱,故选C。" + }, + { + "question_num": 118, + "query": "因有机磷中毒人院治疗，在治疗过程中出现阿托品中毒，应立即给予", + "options": { + "A": "吸氧", + "B": "输液及毛果芸香碱", + "C": "毛花苷C", + "D": "哌甲酯", + "E": "呋塞米" + }, + "answer": "B", + "reason": "有机磷中毒的治疗。当有机磷中毒用阿托品治疗过程中，出现阿托品中毒时，应立即输液促进阿托品排泄，并给拟胆碱药毛果芸香碱，以对抗外周M样作用。" + }, + { + "question_num": 119, + "query": "行痹患者,关节疼痛,以肩、肘等上肢关节为甚。治疗应加用", + "options": { + "A": "杜仲、桑寄生、巴戟天", + "B": "独活、牛膝、防己、革", + "C": "羌活、白芷、威灵仙、姜黄", + "D": "川鸟、草乌", + "E": "白花蛇、乌梢蛇" + }, + "answer": "C", + "reason": "A项治疗行痹,腰背酸痛为主者；BDE项,治疗关节肿胀,疼痛为主;若行痹,关节疼痛，以肩、肘等上肢关节为甚,加“羌活.白芷、威灵仙、姜黄\",祛风通络,引药上行。" + }, + { + "question_num": 120, + "query": "不属清热法适应证的是", + "options": { + "A": "热毒内传之走黄内陷", + "B": "药物性皮炎��损色红灼热", + "C": ".疮疡溃后脓出不畅", + "D": "流痰后期,阴虚火旺,虚热不退者", + "E": "局部红、肿、热、痛" + }, + "answer": "C", + "reason": "清热法：用寒凉药物，使内蕴之热毒得以清解，是外科的主要治疔法则。“疮疡溃后脓出不畅”适用于内托法。内托法：用补益和透脓药物、扶助正气，托毒外出，使疮疡毒邪移深居浅，早日液化成脓，或使病灶趋于局限化，使邪盛者不致脓毒旁窜深溃，正虚者不致毒邪内陷、从而达到脓出毒泄，肿痛消退的目的。" + }, + { + "question_num": 121, + "query": "用寒远寒，用热远热，属于", + "options": { + "A": "因病制宜", + "B": "因地制宜", + "C": "因人制宜", + "D": "因时制宜", + "E": "因证制宜" + }, + "answer": "D", + "reason": "用寒远寒,是指秋冬季节,气候由凉变寒,阴盛阳衰,人体腠理致密,阳气内敛,此时若非大热之证,就当慎用寒凉之品,以防苦寒伤阳。用热远热,亦然,炎热的季节,慎用热性的药物。" + }, + { + "question_num": 122, + "query": "使用糖皮质激素治疗SARS下列哪项正确", + "options": { + "A": "X线胸片示大片阴影并在48小时之内病灶面积增大<50%且在正位胸片上病灶面积占双肺总面积的1/4以上", + "B": "目的在于抑制异常的免疫病理反应，减轻局部炎症反应状态", + "C": "中毒症状重，持续发热，经对症治疗3天以上，体温仍超过38℃", + "D": "达到慢性肺损伤的诊断标准", + "E": "出现ARDS" + }, + "answer": "E", + "reason": "SARS治疗应用糖皮质激素的目的在于抑制异常的免疫病理反应，减轻全身炎症反应状态。治疗指征：X线胸片示大片阴影并在48小时之内病灶面积增大＞50%且在正位胸片上病灶面积占双肺总面积的1/4以上；达到急性肺损伤的诊断标准；出现ARDS。而中毒症状重，持续发热，经对症治疗3天以上，体温仍超过38℃不属于糖皮质激素治疗的指征。" + }, + { + "question_num": 123, + "query": "治疗瘘证使用泻南方,补北方的原则，是因为该病", + "options": { + "A": "寒多热少,虚多实少", + "B": "热多寒少,虚多实少", + "C": "热多寒少,实多虚少", + "D": "寒多热少,实多虚少", + "E": "以上均非" + }, + "answer": "B", + "reason": "]瘘证日久,皆可累及肝肾,肝肾不足,阴虚火旺是结果,故热多寒少,虚多实少,治宜泻南补北,清心滋肾。" + }, + { + "question_num": 124, + "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:人流综合征,子官穿孔，人流不全，宫腔或颈管内口粘连，人流术后感染等。" + }, + { + "question_num": 125, + "query": "以阴阳失调来阐释真寒假热或真热假寒，其病机是", + "options": { + "A": "阴阳偏盛", + "B": "阳偏衰", + "C": "阴阳格拒", + "D": "阴阳互损", + "E": "阴阳离决" + }, + "answer": "C", + "reason": "阴阳格拒,是阴阳失调病机中比较特殊的一类病机,主要包括阴盛格阳和阳盛格阴两方面。是指由于某些原因引起阴和阳的一方盛极,因而壅盛于内,将另一方排斥格拒于外,迫使阴阳之间不相维系,从而形成真寒假热或真热假寒等复杂的临床现象。" + }, + { + "question_num": 126, + "query": "肝硬化腹壁静脉曲张时，其血管杂音常可被闻及的部位是", + "options": { + "A": "上腹部", + "B": "下腹部", + "C": "右侧腹部", + "D": "左侧腹部", + "E": "右肋缘下" + }, + "answer": "A", + "reason": "静脉性杂音为连续的嗡鸣声或“潺潺”声，无收缩期与舒张期性质。常出现于脐周或上腹部，尤其是腹壁静脉曲张严重处。此音提示门静脉高压时的侧支循环形成。" + }, + { + "question_num": 127, + "query": "痰浊头痛的特征是", + "options": { + "A": "头痛如裹", + "B": "头痛如裂", + "C": "头痛且空", + "D": "头痛且晕", + "E": "头痛昏蒙" + }, + "answer": "E", + "reason": "A项见于风温头痛,B项见于风热头痛,C项见于肾虚头痛,D项见于血虚头痛,E项见于痰浊头痛。" + }, + { + "question_num": 128, + "query": "妊娠足月,胎位下移,腰腹阵痛,有便意或见红者，是", + "options": { + "A": "临产", + "B": "试胎", + "C": "弄胎", + "D": "分娩", + "E": "以上均非" + }, + "answer": "A", + "reason": "临产的征兆是胎位下移、小腹坠胀、有便意或见红，故选A。分娩是指怀孕末期，即孕280天左右，胎儿及胎衣自母休阴道娩出的过程。" + }, + { + "question_num": 129, + "query": "下列各组药物中，属于配伍禁忌的是", + "options": { + "A": "巴豆与牵牛", + "B": "丁香与三棱", + "C": "牙硝与郁金", + "D": "官桂与五灵脂", + "E": "人参与石脂" + }, + "answer": "A", + "reason": "巴豆性烈最为上,偏与牵牛不顺情。" + }, + { + "question_num": 130, + "query": "胆石症患者常采取的体位是", + "options": { + "A": "强迫侧卧位", + "B": "角弓反张位", + "C": "强迫俯卧位", + "D": "强迫坐位", + "E": "辗转体位" + }, + "answer": "E", + "reason": "辗转体位：患者振转反侧，坐卧不安，见于胆石症、胆道蛔虫症、肾纹痛等。" + }, + { + "question_num": 131, + "query": "治疗湿热腰痛,应首选", + "options": { + "A": "甘姜苓术汤", + "B": "四妙丸", + "C": "羌活胜湿汤", + "D": "惹苡仁汤", + "E": "乌头汤" + }, + "answer": "B", + "reason": "腰痛实证总以祛邪活络为要,湿热者应清热利湿,舒筋通络。用四妙丸最宜,故选B。薏苡仁汤重于化温,清热力不强,其余选项均为温阳的，用于寒证。" + }, + { + "question_num": 132, + "query": "下列疾病,不会出现妇科血崩证的是", + "options": { + "A": "堕胎", + "B": "崩漏", + "C": "经行吐衄", + "D": "晚期产后出血", + "E": "小产" + }, + "answer": "C", + "reason": "血崩证以阴道急剧而大量的出血为主症,可由ABDE项引起。而C项，是指每逢经行前后或经期,出现周期性的吐血或衄血。" + }, + { + "question_num": 133, + "query": "治疗痉挛抽搐，将全蝎与蜈蚣同用，其配伍关系是", + "options": { + "A": "相反", + "B": "相恶", + "C": "相须", + "D": "相使", + "E": "相杀" + }, + "answer": "C", + "reason": "相须,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。治疗痉抽,全蝎及蜈蚣同用,两者均是息风止痉药,功效相似，同用则功效增强,为相须用药。" + }, + { + "question_num": 134, + "query": "下列哪项体征最能提示腹膜炎的存在", + "options": { + "A": "肠鸣音减弱", + "B": "叩出移动性浊音", + "C": "腹部压痛", + "D": "腹部触及肿块", + "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": 135, + "query": "腰痛患者,腰部冷痛重着,转侧不利，静卧痛不减,遇阴雨天疼痛加重,舌苔白腻,脉沉缓，其证候是", + "options": { + "A": "寒湿", + "B": "风寒", + "C": "瘀血", + "D": "湿热", + "E": "肾虚" + }, + "answer": "A", + "reason": "腰痛有寒湿、湿热.瘀血.肾虚等。寒湿之邪留着腰部,痹阻经络,气血不畅,故见腰部冷痛重着,转侧不利,静卧痛不减,湿为阴邪，故遇阴雨天疼痛加重。舌脉俱是塞湿留置之象,故为寒湿。" + }, + { + "question_num": 136, + "query": "下列哪项是月经先期实证的临床特点", + "options": { + "A": "月经量多", + "B": "月经色淡", + "C": "月经质稀", + "D": "舌淡,脉弱", + "E": "月经提前7天" + }, + "answer": "E", + "reason": "ABCD项都是气虚证的表现，E项为实证的月经先期的概念，故选E。" + }, + { + "question_num": 137, + "query": "升麻与菊花具有的共同功效是", + "options": { + "A": "透疹", + "B": "解毒", + "C": "消疮", + "D": "止血", + "E": "平肝" + }, + "answer": "B", + "reason": "升麻功效:解表透疹,清热解毒,升举阳气。菊花功效:疏散风热,平抑肝阳,清肝明目,清热解毒。" + }, + { + "question_num": 138, + "query": "慢性肾衰竭尿毒症最常见的死亡原因是", + "options": { + "A": "消化道大出血", + "B": "继发性甲状旁腺功能亢进", + "C": "心血管并发症", + "D": "尿毒症脑病", + "E": "代谢性酸中毒" + }, + "answer": "C", + "reason": "慢性肾衰竭可出现各系统并发症，其中心血管系统并发症是导致慢性肾衰竭患者死亡的最常见原因。" + }, + { + "question_num": 139, + "query": "下列哪项不是辨别中风闭证与脱证的依据", + "options": { + "A": "口开目合与口噤不开", + "B": "手撒肢冷与两手握固", + "C": "二便自遗与大小便闭", + "D": "躁动不安与静而不烦", + "E": "肢体软瘫与肢体强痉" + }, + "answer": "D", + "reason": "中风闭证与脱证的临床鉴别。由于两者均为突然昏迷不省人事,但闭证兼牙关紧闭,口噤不开,两手握固,大小便闭,肢体强痉;而脱证兼目合��张,手撒肢冷,大小便自遗,肢体软瘫,故选D。" + }, + { + "question_num": 140, + "query": "关于子宫脱垂,下列哪项是正确的", + "options": { + "A": "Ⅰ度:宫颈已脱出阴道口,宫体仍在阴道内", + "B": "病因多为气虚、血虚、肾虚", + "C": "中医文献又称为“产肠不收、葫芦颓”", + "D": "Ⅲ度:宫颈及部分宫体已脱出阴道口", + "E": "子宫托仅适用于Ⅰ度子宫脱垂者" + }, + "answer": "C", + "reason": "子宫脱垂的概念、病机、治疗。A项为Ⅱ度轻烈子宫脱垂,D项为Ⅱ度重型子宫脱垂。子宫脱垂的病因为气虚和肾虚造成带脉失约，子宫脱出。子宫托可用于Ⅰ度、Ⅱ度子宫脱垂的患者。" + }, + { + "question_num": 141, + "query": "下列药物用法错误的是", + "options": { + "A": "石斛入汤剂亦先煎", + "B": "钩藤入汤剂不宜久煎", + "C": "雷丸入汤剂宜先煎", + "D": "砂仁入汤剂宜后下", + "E": "附子入汤剂宜先煎" + }, + "answer": "C", + "reason": "中药的使用方法。雷丸含蛋白酶,加热60℃左右易于破坏而失效,不宜入煎剂,故选C。" + }, + { + "question_num": 142, + "query": "血小板减少常见于", + "options": { + "A": "脾切除术后", + "B": "急性胃出血后", + "C": "急性溶血后", + "D": "急性白血病", + "E": "以上均非" + }, + "answer": "D", + "reason": "血小板减少常见于血小板减少性紫癜、脾功能亢进、再生障碍性贫血和白血病等症。" + }, + { + "question_num": 143, + "query": "治疗久痹风、寒、湿偏盛不明显者,可选用的方剂是", + "options": { + "A": "防风汤", + "B": "薏苡仁汤", + "C": "宣痹汤", + "D": "蠲痹汤", + "E": "乌头汤" + }, + "answer": "D", + "reason": "久痹风、寒.湿偏盛不明显者,久痹风、寒.湿偏盛不明显者,可用蠲痹汤作为风寒湿痹通用的基础方进行治疗。" + }, + { + "question_num": 144, + "query": "妊娠期瘀阻胎元，使用活血化瘀药的原则是", + "options": { + "A": "治病与安胎并举", + "B": "衰其大半而止", + "C": "禁止使用", + "D": "病去即止", + "E": "慎用" + }, + "answer": "B", + "reason": "妊娠期瘀阻胎元，使用活血化瘀药的原则，“所调有故无殒,亦无殒也”，但需严格常握剂量,衰其大半而止。" + }, + { + "question_num": 145, + "query": "治疗外感风热、发热、微恶寒、头痛、咽喉肿痛、兼胸闷胁肋胀痛。应首选", + "options": { + "A": "升麻", + "B": "薄荷", + "C": "葛根", + "D": "蝉蜕", + "E": "牛蒡子" + }, + "answer": "B", + "reason": "患者\"外感风热\"发热,微恶寒”,治宜疏散风热,“头痛\"治宜清利头目,“咽喉肿痛”治宜清热利咽，“胸闷胁肋胀痛”治宜疏肝行气,薄荷疏散风热,清利头目,利咽透疹,疏肝行气,故选B。升麻升阳举陷。葛根解肌退热，透发麻疹，生津止渴，升阳止泻。蝉蜕疏散风热,利咽开音,透疹,明目退翳,息风止痉。牛蒡子疏散风热,宣肺祛痰,利透疹,解毒散肿。" + }, + { + "question_num": 146, + "query": "粪便中查到巨噬细胞，多见于", + "options": { + "A": "阿米巴痢疾", + "B": "细菌性痢疾", + "C": "急性胃肠炎", + "D": "血吸虫病", + "E": "霍乱" + }, + "answer": "B", + "reason": "细菌性痢疾时，可见大量与黏液相混的脓细胞；过敏性肠炎、肠道寄生虫病（尤其是钩虫病及阿米巴痢疾）时，粪便中可见较多的嗜酸性粒细胞，还可伴有夏克—雷登结晶。巨噬细胞体积大于一般白细胞，核较大而偏于一侧，见于细菌性痢疾。" + }, + { + "question_num": 147, + "query": "虚劳以气虚为主时,主要病变的脏是", + "options": { + "A": "肺、脾", + "B": "心、肾", + "C": "肺、肾", + "D": "脾、肾", + "E": "心、肺" + }, + "answer": "A", + "reason": "虚劳是多脏虚弱。肺主气,气虚肯定有肺。肺金脾土,肺虚日久,子盗母气,脾气也虚,故主要是肺脾。" + }, + { + "question_num": 148, + "query": "下列各项,属经行感冒常见病因的是(", + "options": { + "A": "风", + "B": "寒", + "C": "暑", + "D": "湿", + "E": "燥" + }, + "answer": "A", + "reason": "经行感冒以感受风邪为主,夹寒则为风寒,夹热则为风热。多由素体气虚，卫阳不密、经行阴血下注于胞宫,体虚益甚，此时血室正开，腠理疏松，卫气不固，风邪乘虚侵袭；或素有伏邪，随月经周期反复乘虚而发。" + }, + { + "question_num": 149, + "query": "治疗热病伤津，烦热口渴，呕逆时作，舌燥少津者。应首选", + "options": { + "A": "石膏", + "B": "知母", + "C": "天花粉", + "D": "芦根", + "E": "栀子" + }, + "answer": "D", + "reason": "针对本题所述症状,应选择兼具清热泻火、生津止渴、除烦止呕功效的药物,石膏生用清热泻火、除烦止渴;知母清热泻火、生津润燥;芦根清热泻火、生津止渴、除烦止呕、利尿:天花粉清热泻火、生津止渴、消肿排脓:栀子泻火除烦、清热利湿、凉血解毒。" + }, + { + "question_num": 150, + "query": "慢性细菌性痢疾的病程时限是", + "options": { + "A": "时限不定，反复发作", + "B": "超过2周", + "C": "超过1年", + "D": "超过6个月", + "E": "超过2个月" + }, + "answer": "E", + "reason": "急性菌痢反复发作或迁延不愈达2个月以上者，即为慢性菌痢。" + }, + { + "question_num": 151, + "query": "治疗吐血胃热壅盛证,应首选", + "options": { + "A": "玉女煎", + "B": "龙胆泻肝汤", + "C": "加味清胃散合泻心汤", + "D": "地榆散合槐角丸", + "E": "泻心汤合十灰散" + }, + "answer": "E", + "reason": "吐血胃热壅盛,治宜清泻胃火,凉血止血,方用泻心汤,名为泻心,实则泻胃。十灰散泻热凉血,收涩止血,故选E。A项用于肾阴虚胃热。B项用于肝火犯胃。C项都是泻火,无凉血止血作用,治吐血证不够合适。D项用于湿热型便血。" + }, + { + "question_num": 152, + "query": "患者宫颈脱出阴道口,宫体仍在阴道内，为", + "options": { + "A": "子宫脱垂Ⅰ度轻型", + "B": "子宫脱垂Ⅰ度重型", + "C": "子宫脱垂Ⅱ度轻型", + "D": "子宫脱垂Ⅱ度重型", + "E": "子宫脱垂Ⅲ度" + }, + "answer": "C", + "reason": "子宫脱垂分度:Ⅰ度轻型,宫颈外口距处女膜缘<4cm,未达处女膜缘；Ⅰ度重型，宫颈已达处女膜缘,阴道口可见子宫颈；Ⅱ度轻型,宫颈脱出阴道口，宫体仍在阴道内；Ⅱ度重型,部分宫体脱出阴道口；Ⅲ度:宫颈及宫体全部脱出至阴道口外。" + }, + { + "question_num": 153, + "query": "研末冲服，不入煎剂的药物是", + "options": { + "A": "鸡内金", + "B": "磺石", + "C": "琥珀", + "D": "大戟", + "E": "三七" + }, + "answer": "C", + "reason": "琥珀为古代松科植物的树脂埋藏地下经年久转化而成的化石样物质,不能人煎剂,应研末冲服。" + }, + { + "question_num": 154, + "query": "下列关于类风湿关节炎的检查中，其滴度与疾病的活动性和严重性成正比的是", + "options": { + "A": "红细胞沉降率", + "B": "抗角蛋白抗体", + "C": "抗核周因子", + "D": "抗环瓜氨酸肽抗体", + "E": "类风湿因子" + }, + "answer": "E", + "reason": "类风湿因子阳性率70%~80%，且其滴度与疾病的活动性和严重性成正比。" + }, + { + "question_num": 155, + "query": "郁证患者,咽中不适,如有物梗阻,咯之不出,咽之不下。胸中窒闷,舌苔白腻,脉弦滑,其证候是", + "options": { + "A": "气滞痰郁", + "B": "肝气郁结", + "C": "气郁化火", + "D": "痰浊上扰", + "E": "忧郁伤神" + }, + "answer": "A", + "reason": "郁证,见咽中不适,如有物梗阻,咯之不出,咽之不下,为气滞痰郁所致,应用“半夏厚朴汤”行气开郁,散结化痰。" + }, + { + "question_num": 156, + "query": "经行口糜阴虚火旺证的表现，叙述正确的是", + "options": { + "A": "经行口舌生疮，口臭", + "B": "口燥咽干,月经量少", + "C": "口干喜饮,尿黄便结", + "D": "舌苔黄厚,脉滑数", + "E": "月经量多,色深红" + }, + "answer": "B", + "reason": "经行口糜阴虚火旺证的主要证候：经期口舌糜烂，口燥咽干，月经量少，色红；五心烦热，尿少色黄；舌红,少苔,脉细数。" + }, + { + "question_num": 157, + "query": "凉血不留瘀，活血不动血，又能退无汗骨蒸的药物是", + "options": { + "A": "赤芍", + "B": "白薇", + "C": "地骨皮", + "D": "牡丹皮", + "E": "郁金" + }, + "answer": "D", + "reason": "牡丹皮功效:清热凉血,活血祛察应用:①温毒发斑,血热吐衄;②温病伤阴,阴虚发热、夜热早凉,无汗骨蒸;③血滞经闭、痛经、跌打伤痛。" + }, + { + "question_num": 158, + "query": "对长期发热的患者，怀疑为伤寒，诊断最可靠的依据是", + "options": { + "A": "血培养阳性", + "B": "肥达反应阳性", + "C": "相对缓脉", + "D": "血嗜酸性粒细胞消失", + "E": "玫瑰疹" + }, + "answer": "A", + "reason": "伤寒血培养在病程第1周阳性率最高，可达80%。" + }, + { + "question_num": 159, + "query": "治疗喘证肺气虚耗证的方药是", + "options": { + "A": "三子养亲汤合二陈汤", + "B": "生脉散���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": "喘证肺气虚耗证治宜益气补肺养阴,方用生脉散合补肺汤。A项用于喘证痰浊肺证，C项用于喘证肾阴虚证,D项用于喘证肾虚不纳证。" + }, + { + "question_num": 160, + "query": "产后三冲指的是", + "options": { + "A": "尿闭、便难、冷汗", + "B": "冲心、冲胃、冲肺", + "C": "呕吐、泄泻、盗汗", + "D": "高热、昏迷、自汗", + "E": "冲肝、冲血、冲气" + }, + "answer": "B", + "reason": "产后常见病和危重症概括为三病、三急、三冲,三病为病痉、郁冒、大便难；三急为呕吐、泄泻、盗汗；三冲为败血冲心、冲胃、冲肺。" + }, + { + "question_num": 161, + "query": "可治疗寒热虚实各种水肿的药物是", + "options": { + "A": "泽泻", + "B": "薏苡仁", + "C": "茯苓", + "D": "车前子", + "E": "香加皮" + }, + "answer": "C", + "reason": "茯苓功效:利水渗湿,健脾,宁心。本品味甘而淡,甘则能补,淡则能渗,药性平和,既可祛邪,又可扶正,利水而不伤正气,实为利水消肿之要药。可用治寒热虚实各种水肿。" + }, + { + "question_num": 162, + "query": "有关SARS临床表现中进展期体征的叙述，不正确的是", + "options": { + "A": "多发生在病程的8~14天", + "B": "发热及感染中毒症状持续存在", + "C": "肺部病变进行性加重", + "D": "肺部阴影发展缓慢", + "E": "少数患者可出现ARDS" + }, + "answer": "D", + "reason": "SARS临床表现进展期的体征：多发生在病程的8~14天，个别患者可更长。发热及感染中毒症状持续存在，肺部病变进行性加重，X线胸片检查肺部阴影发展迅速，且常为多叶病变。少数患者可出现ARDS。" + }, + { + "question_num": 163, + "query": "下列属于原络配穴法的是", + "options": { + "A": "合谷、偏历", + "B": "太溪、大钟", + "C": "太渊、列缺", + "D": "合谷、列缺", + "E": "冲阳、丰隆" + }, + "answer": "D", + "reason": "本径原穴与其相表里的络穴相互配合应用时,称为“原络配穴”,故合谷与列缺相配是原络配穴法,太渊与偏历穴相配是原络配穴法,太溪与飞扬穴相配是原络配穴法,京骨与大钟穴相配是原络配穴法,冲阳与公孙相配是原络配穴法,太白与丰隆相配是原络配穴法。" + }, + { + "question_num": 164, + "query": "子宫内膜增生早期内膜厚度为", + "options": { + "A": "0.5~1mm", + "B": "1~2mm", + "C": "2~3mm", + "D": "3~5mm", + "E": "5~7mm" + }, + "answer": "B", + "reason": "增生早期：内膜的增生与修复在月经期即已开始。在月经周期的5~7天，此期内膜较满，为1~2mm。" + }, + { + "question_num": 165, + "query": "具有消肿散结功效的药物是", + "options": { + "A": "芫花", + "B": "巴豆", + "C": "甘遂", + "D": "牵牛子", + "E": "芦荟" + }, + "answer": "C", + "reason": "芫花泻水逐饮,祛痰止咳,杀虫疗疮。巴豆峻下冷积,逐水退肿,祛痰利咽,外用蚀疮甘遂泻水逐饮,消肿散结。牵牛子泻下逐水，去积杀虫。芦苦泻下通便,清肝,杀虫。" + }, + { + "question_num": 166, + "query": "甲状腺功能亢进时最常见的心律失常类型是", + "options": { + "A": "心房颤动", + "B": "房室传导阻滞", + "C": "室性期前收缩", + "D": "房性心动过速", + "E": "交界性期前收缩" + }, + "answer": "A", + "reason": "甲状腺功能亢进症患者心血管系统体征：①心动过速，常为窦性，休息和睡眠时心率仍快；②第一心音亢进，心尖区常有2/6级以下收缩期杂音；③收缩压升高，舒张压降低，脉压增大，可见周围血管征；④心脏肥大和心力衰竭；⑤心律失常，以心房颤动、房性期前收缩等房性心律失常多见。" + }, + { + "question_num": 167, + "query": "循行分布于胸中,散络于心包的经脉是", + "options": { + "A": "足太阳膀胱经", + "B": "手太阳小肠经", + "C": "手阳明大肠经", + "D": "手少阳三焦经", + "E": "手厥阴心包经" + }, + "answer": "D", + "reason": "手少阳三焦经经络循行:手少阳三焦经,起于无名指尺侧末端,向上经小指与无名指之间、手腕背侧,上达前臂外侧,沿桡骨和尺骨之间,过肘尖,沿上臂外侧上行至肩部,交出足少阳经之后,进入缺盆部,分布于胸中,散络于心包,向下通过横膈,从胸至腹,依次属上中.下三焦,其支脉,从胸中分出,进入缺盆部,上行经颈项旁,经耳后直上,到达额角,再下行至面颊部,到达眼眶下部。另一支脉,从耳后分出,进��耳中,再浅出到耳前,经上关、面颊到目外毗。" + }, + { + "question_num": 168, + "query": "不孕症常见的证型不包括下列哪项", + "options": { + "A": "肾虚", + "B": "肝郁", + "C": "瘀滞胞宫", + "D": "脾虚", + "E": "痰湿内阻" + }, + "answer": "D", + "reason": "不孕症常见的证型有肾虚、肝郁、瘀滞胞宫、痰湿内阻四个证型。" + }, + { + "question_num": 169, + "query": "功能祛风散寒止痛，善治巅顶头痛的药物是", + "options": { + "A": "白芷", + "B": "藁本", + "C": "细辛", + "D": "吴茱萸", + "E": "苍耳子" + }, + "answer": "B", + "reason": "五种药物均有祛风散寒之功,白芷治疗阳明头痛;本则擅长治疗巅顶头痛;苍耳子善治鼻渊头痛;细辛普治少阴头痛;吴茱英普治阴头痛。" + }, + { + "question_num": 170, + "query": "正常肺泡呼吸音的最明显听诊部位在", + "options": { + "A": "喉部", + "B": "肩胛下部", + "C": "胸骨角附近", + "D": "右肺尖", + "E": "肩胛上部" + }, + "answer": "B", + "reason": "正常肺泡呼吸音的最明显听诊部位为肺泡组织较多且胸壁较薄的部位，如乳房下部、肩胛下部、腋窝下部。" + }, + { + "question_num": 171, + "query": "十二经脉中,相表里的阴经与阳经的交接部位在", + "options": { + "A": "四肢部", + "B": "胸部", + "C": "腹部", + "D": "头部", + "E": "面部" + }, + "answer": "A", + "reason": "十二经脉的交接规律是相表里的阴经与阳经在手足未端交接。同名的阳经与阳经在头面部交接。相互衔接的阴经与阳经在胸中交接。" + }, + { + "question_num": 172, + "query": "治疗经行浮肿气滞血瘀证,应首选的方剂是", + "options": { + "A": "逍遥散", + "B": "八物汤", + "C": "调肝汤", + "D": "乌药汤", + "E": "柴胡疏肝散" + }, + "answer": "B", + "reason": "治疗经行浮肿气滞血瘀证应首选的方剂是八物汤加泽泻、益母草。" + }, + { + "question_num": 173, + "query": "桑寄生、五加皮除均可祛风湿外，还具有的功效是", + "options": { + "A": "清热安胎", + "B": "利尿消肿", + "C": "定惊止痉", + "D": "温通经络", + "E": "补肝肾，强筋骨" + }, + "answer": "E", + "reason": "桑寄生祛风远,补肝肾,强筋骨,安胎。五加皮祛风湿,补肝肾,强筋骨,利水。二者均具有祛风湿,补肝肾,强筋骨作用,用于风湿痹证,筋骨瘀软。" + }, + { + "question_num": 174, + "query": "禽流感病毒致病性最强的亚型是", + "options": { + "A": "H7N7", + "B": "H5N1", + "C": "H7N5", + "D": "H9N2", + "E": "H3N2" + }, + "answer": "B", + "reason": "根据其致病性，禽流感病毒可分为高致病性、低致病性和非致病性三大类，其中H5和H7亚型为高致病型，又以H5N1致病性强，患者病情重，死亡率高。" + }, + { + "question_num": 175, + "query": "按十二经脉气血流注次序，小肠经上接", + "options": { + "A": "胆经", + "B": "心经", + "C": "胃经", + "D": "膀胱经", + "E": "三焦经" + }, + "answer": "B", + "reason": "十二经脉的气血循环流注依次是肺经、大肠经、胃经、脾经、心经、小肠经、膀胱经、肾经、心包经、三焦经、胆经、肝经、肺经,十二经脉气血循环,如环无端。" + }, + { + "question_num": 176, + "query": "治疗子肿脾虚证的代表方剂是", + "options": { + "A": "鲤鱼汤", + "B": "天仙藤散", + "C": "真武汤", + "D": "白术散", + "E": "四苓散" + }, + "answer": "D", + "reason": "子肿之脾虚证,主要证候:妊娠数月,面目四肢浮肿,或遍及全身,皮薄光亮,按之凹陷不起,面色黄白无华,神疲气短懒言,口淡而腻,脘腹胀满,食欲不振,小便短小,大便溏薄;舌淡体胖,边有齿痕，舌苔白润或腻，脉缓滑。代表方剂是白术散。" + }, + { + "question_num": 177, + "query": "砂仁具有的功效是", + "options": { + "A": "温肝", + "B": "暖肾", + "C": "温肺", + "D": "温中", + "E": "回阳" + }, + "answer": "D", + "reason": "砂仁化湿行气,温中止泻,安胎。" + }, + { + "question_num": 178, + "query": "下列各项，不属于我国民法典规定的承担民事责任方式的是", + "options": { + "A": "排除妨碍", + "B": "返还财产", + "C": "赔偿损失", + "D": "罚金", + "E": "赔礼道歉" + }, + "answer": "D", + "reason": "《中华人民共和国民法典》规定承担民事责任的方式：①停止侵害；②排除妨碍；③消除危险；④返还财产；⑤恢复原状；⑥修理、重作、更换；⑦继续履行；⑧赔偿损失；⑨支付违约金；���消除影响、恢复名誉；⑪赔礼道歉。罚金属于刑罚的附加刑。" + }, + { + "question_num": 179, + "query": "按对应顺序,耳门、听宫、听会所属的经脉分别是", + "options": { + "A": "胆经、三焦经、小肠经", + "B": "三焦经、胆经、小肠经", + "C": "三焦经、小肠经、胆经", + "D": "胆经、小肠经、三焦经", + "E": "小肠经、胆经、三焦经" + }, + "answer": "C", + "reason": "耳门属于手少阳三焦经,在耳区,耳屏上切迹与下颌骨髁突之间的凹陷中。.听宫属于手太阳小肠经,在面部,耳屏正中与下颌骨髁突之间的凹陷中。听会属于足少阳胆经,在面部,耳屏间切迹与下颌骨髁突之间的凹陷中。" + }, + { + "question_num": 180, + "query": "下列不属于痛经气血虚弱证的主症的是", + "options": { + "A": "神疲乏力,纳少便溏", + "B": "头晕眼花,腰痛如折", + "C": "腹痛出现在经期或经后", + "D": "腹痛喜按", + "E": "月经量少、色淡、质稀" + }, + "answer": "B", + "reason": "痛经之气血虚弱证,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,质消稀；面色无华,头晕心悸,神疲乏力;舌质淡,脉细无力。" + }, + { + "question_num": 181, + "query": "具有补火助阳功效的药物是", + "options": { + "A": "附子", + "B": "干姜", + "C": "细辛", + "D": "花椒", + "E": "高良姜" + }, + "answer": "A", + "reason": "本题考查温里药的各品种作用强弱、附子温里作用最强,可补火助阳,干姜、细辛、花椒、高良姜温里作用较弱,可温中散寒。看到“补火助阳应首选附子,故选A。" + }, + { + "question_num": 182, + "query": "传染性非典型肺炎典型患者的首发症状是", + "options": { + "A": "发热", + "B": "咳嗽", + "C": "呼吸困难", + "D": "腹泻", + "E": "鼻塞、流涕" + }, + "answer": "A", + "reason": "典型患者起病急，以发热为首发症状，可有畏寒，体温常超过38℃，呈不规则热、弛张热或稽留热等，热程为1~2周；伴有头痛、肌肉酸痛、全身乏力，部分患者有腹泻。常无鼻塞、流涕等上呼吸道卡他症状。" + }, + { + "question_num": 183, + "query": "期门穴的位置是", + "options": { + "A": "锁骨中线上,当第4肋间隙处", + "B": "锁骨中线上,当第5肋间隙处", + "C": "锁骨中线上,当第6肋间隙处", + "D": "锁骨中线上,当第7肋间隙处", + "E": "以上都不是" + }, + "answer": "C", + "reason": "腧穴定位。期门:乳头直下,第6肋骨间隙。" + }, + { + "question_num": 184, + "query": "崩漏的主要病机是", + "options": { + "A": "冲任不固,经血失约", + "B": "阳盛血热,迫血妄行", + "C": "阴虚火旺,经血失约", + "D": "气虚不摄,经血失约", + "E": "瘀血内阻,血不归经" + }, + "answer": "A", + "reason": "崩漏的主要病机是冲任不固,不能制约经血，使子宫藏泻失常。" + }, + { + "question_num": 185, + "query": "生用能清热化痰，姜汁炒可除烦止呕，主治胃热呕逆的药物是", + "options": { + "A": "黄连", + "B": "贝母", + "C": "竹叶", + "D": "竹茹", + "E": "芦根" + }, + "answer": "D", + "reason": "竹茹生用有清热化痰,除烦止呕,胎凉血的功效,姜汁炒可除烦止呕,主治胃热呕哕。" + }, + { + "question_num": 186, + "query": "艾滋病病毒主要侵害人体的系统是", + "options": { + "A": "免疫系统", + "B": "消化系统", + "C": "内分泌系统", + "D": "神经系统", + "E": "循环系统" + }, + "answer": "A", + "reason": "HIV主要通过杀伤CD4+T淋巴细胞使机体免疫系统功能受损。" + }, + { + "question_num": 187, + "query": "在经络系统中,具有离、人、出、合循行特点的是", + "options": { + "A": "奇经八脉", + "B": "十二经别", + "C": "十二经筋", + "D": "十二皮部", + "E": "十五络脉" + }, + "answer": "B", + "reason": "十二经别是十二正经离.人、出、合的别行部分,是正经别行深入体腔的支脉。" + }, + { + "question_num": 188, + "query": "关于子晕,说法正确的是", + "options": { + "A": "头痛", + "B": "头晕", + "C": "牙关紧闭", + "D": "遍身俱肿", + "E": "尿频、尿急" + }, + "answer": "B", + "reason": "子晕又称“妊娠眩晕”，是指妊娠期出现以头晕目眩,状若眩冒为主症，甚或眩晕欲厥，称“子晕”。" + }, + { + "question_num": 189, + "query": "既能消食化积，又能行气散瘀的药物是", + "options": { + "A": "山楂", + "B": "神曲", + "C": "莱菔子", + "D": "麦芽", + "E": "谷芽" + }, + "answer": "A", + "reason": "本题五个选项均具有消食化积之功效,山楂兼能行气散瘀;神曲可和胃;莱菔子降气化痰麦芽回乳消胀;谷芽健脾开胃。" + }, + { + "question_num": 190, + "query": "根据传染病防治法，SARS的管理应", + "options": { + "A": "按甲类管理", + "B": "按乙类管理", + "C": "按丙类管理", + "D": "各级医疗机构自行决定", + "E": "各省级卫生管理机构自行决定" + }, + "answer": "A", + "reason": "SARS是按照甲类传染病管理,预防要早发现、早报告、早隔离、早治疗。" + }, + { + "question_num": 191, + "query": "治疗昏迷,癫痫,高热,咽喉肿痛,首选", + "options": { + "A": "四缝", + "B": "十宣", + "C": "八邪", + "D": "合谷", + "E": "曲池" + }, + "answer": "B", + "reason": "腧穴的主治。十宣主治:昏迷;癫痢;高热,咽喉肿痛:手指麻木。" + }, + { + "question_num": 192, + "query": "治疗产后小便不通气虚证,应首选的方剂是", + "options": { + "A": "济生肾气丸", + "B": "加味四物汤", + "C": "化阴煎", + "D": "补中益气汤", + "E": "沉香散" + }, + "answer": "D", + "reason": "产后小便不通气虚证,主要证候:产后小便不通,小腹胀急疼痛,或小便消白，点滴而下,倦怠乏力,少气懒言,语音低微,面色少华;舌质淡,苔薄白,脉缓弱。治法:补气升消,化气行水。首选补中益气汤。" + }, + { + "question_num": 193, + "query": "地龙的功效是", + "options": { + "A": "息风，平喘，祛风湿", + "B": "息风，利尿，退黄疸", + "C": "息风，利尿，退虚热", + "D": "息风，安神，平喘咳", + "E": "息风，平喘，通经络" + }, + "answer": "E", + "reason": "地龙有清热息风,平喘,通络,利尿的作用,故选E。" + }, + { + "question_num": 194, + "query": "感染艾滋病病毒到发病，一般潜伏期为", + "options": { + "A": "6个月", + "B": "2~10年(平均5年)", + "C": "1~2年", + "D": "3~4月", + "E": "3~5天" + }, + "answer": "B", + "reason": "临床表现：潜伏期较长，一般认为2~10年可发展为艾滋病。HIV侵人人体后可分为四期：急性感染期、无症状感染期、持续性全身淋巴结肿大综合征、艾滋病期。" + }, + { + "question_num": 195, + "query": "主治虚脱,肠鸣腹痛,泄泻等症的腧穴是", + "options": { + "A": "天枢", + "B": "神阙", + "C": "中极", + "D": "中脘", + "E": "百会" + }, + "answer": "B", + "reason": "腧穴的主治。神阙可主治虚脱.中风脱证等元阳暴脱;腹痛、泄泻等肠腑病证,其他穴位不同时具备这两类主治功能。" + }, + { + "question_num": 196, + "query": "慢性盆腔炎与急性盆腔炎共有的证型是", + "options": { + "A": "湿热瘀结", + "B": "气滞血瘀", + "C": "寒湿凝滞", + "D": "气虚血瘀", + "E": "热毒炽盛" + }, + "answer": "A", + "reason": "慢性盆腔炎与急性盆腔炎的证型。慢性盆腔炎的证型:湿热瘀结、气滞血瘀、寒湿凝滞、气虚血瘀;急性盆腔炎的证型:湿热瘀结、热毒炽盛。" + }, + { + "question_num": 197, + "query": "具有活血止痛，行气解郁，凉血清心功效的药物是", + "options": { + "A": "川芎", + "B": "丹参", + "C": "延胡索", + "D": "姜黄", + "E": "郁金" + }, + "answer": "E", + "reason": "川芎活血行气、袪风止痛;丹参活血调经、祛瘀止痛、凉血消痈、除烦安神;延胡索活血行气止痛;姜黄活血止痛;郁金活血止痛、行气解郁、清心凉血、利胆退黄。" + }, + { + "question_num": 198, + "query": "传播途径中哪一项与艾滋病无关", + "options": { + "A": "性接触", + "B": "注射", + "C": "虫媒", + "D": "母婴", + "E": "器官移植" + }, + "answer": "C", + "reason": "①传染源：患者和无症状病毒携带者是本病的传染源，特别是后者；②传播途径：性接触传播、注射途径传播、母婴传播、其他途径（器官移植、人工授精等）；③高危人群：男同性恋者、性乱交者、静脉药瘾者、血友病及多次输血者为高危人群。" + }, + { + "question_num": 199, + "query": "迎香穴位于", + "options": { + "A": "鼻孔外缘,旁开0.5寸", + "B": "鼻翼外缘,旁开0.5寸", + "C": "鼻翼外缘中点,旁开0.5寸", + "D": "鼻翼上缘中点,旁开0.5寸", + "E": "平鼻孔,当鼻唇沟中" + }, + "answer": "C", + "reason": "迎香穴位于鼻翼外缘中点旁,旁开0.5寸,当鼻唇沟中。" + }, + { + "question_num": 200, + "query": "妇女终生不潮而能受孕者,称为", + "options": { + "A": "激经", + "B": "避年", + "C": "季经", + "D": "暗经", + "E": "居经" + }, + "answer": "D", + "reason": "终生不潮而却能受孕者，称为“暗经”。" + }, + { + "question_num": 201, + "query": "中阳衰微，胃有寒湿者忌用的药物是", + "options": { + "A": "太子参", + "B": "西洋参", + "C": "益智仁", + "D": "菟丝子", + "E": "山药" + }, + "answer": "B", + "reason": "太子参与山药可气阴双补,补气健脾、养胃,益智仁温脾开胃摄唾,菟丝子平补阴阳治疗脾虚便溏、中阳衰微,胃有寒湿者均可使用,西洋参偏于苦寒,养阴作用较强,易助寒湿,中阳衰微,胃有寒湿者忌用。" + }, + { + "question_num": 202, + "query": "我国实行预防接种证制度的对象是", + "options": { + "A": "儿童", + "B": "在校学生", + "C": "未成年人", + "D": "成年人", + "E": "全体社会公民" + }, + "answer": "A", + "reason": "国家对儿童实行预防接种证制度、国家免疫规划项目的预防接种实行免费，医疗机构、疾病预防控制机构与儿童的监护人应当相互配合，保证儿童及时接受预防接种。" + }, + { + "question_num": 203, + "query": "腕横纹尺侧端,尺侧腕屈肌腱桡侧凹陷中的腧穴是", + "options": { + "A": "神门", + "B": "大陵", + "C": "列缺", + "D": "太渊", + "E": "内关" + }, + "answer": "A", + "reason": "神门穴的定位:在腕部,腕掌横纹尺侧端,尺侧腕屈肌腱的桡侧凹陷处。" + }, + { + "question_num": 204, + "query": "月经病的治疗原则重在", + "options": { + "A": "治本调经", + "B": "益气养血", + "C": "疏肝养肝", + "D": "调理冲任", + "E": "以上均非" + }, + "answer": "A", + "reason": "月经病的治疗原则,重在治本调经。治本是消除导致月经病的病因和病机，调经是通过治疗使月经病恢复正常。" + }, + { + "question_num": 205, + "query": "胃溃疡患者慎用的药物是", + "options": { + "A": "百部", + "B": "海藻", + "C": "桔梗", + "D": "白果", + "E": "瓜蒌" + }, + "answer": "C", + "reason": "桔梗:性升散,凡气机上逆,呕吐、呛咳、眩、阴虚火旺咯血等不宜用,周、十二指肠溃疡者慎服。用最过大易致恶心呕吐。" + }, + { + "question_num": 206, + "query": "伤寒最具特征性的病变部位在", + "options": { + "A": "肝、胆囊", + "B": "肠系膜淋巴结", + "C": "结肠", + "D": "回肠下段集合淋巴结与孤立淋巴滤泡", + "E": "乙状结肠" + }, + "answer": "D", + "reason": "伤寒的病理特点是全身性单核一吞噬细胞系统的增生性反应，回肠下段集合淋巴结与孤立淋巴滤泡的病变最具特征性。" + }, + { + "question_num": 207, + "query": "下列胸穴中,普治面诸疾的是", + "options": { + "A": "商阳", + "B": "二间", + "C": "合谷", + "D": "阳溪", + "E": "曲池" + }, + "answer": "C", + "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": 208, + "query": "脾失统摄,冲任不固容易导致", + "options": { + "A": "经间期出血", + "B": "带下臭秽", + "C": "经行吐衄", + "D": "滑胎", + "E": "经期延长" + }, + "answer": "E", + "reason": "脾失统摄,冲任不固容易导致经期延长。" + }, + { + "question_num": 209, + "query": "适宜用开窍剂治疗的证候是", + "options": { + "A": "阳明腑实，神昏谵语", + "B": "阴虚风动，神倦瘛疭", + "C": "瘀热扰神，谵语如狂", + "D": "热陷心包，窍闭神昏", + "E": "火毒扰神，错语不眠" + }, + "answer": "D", + "reason": "A项宜用泻下剂;B项宜用滋阴剂C项宜用消热化痰之剂;D项宜用开窍剂;E项宜用消热解毒之剂。" + }, + { + "question_num": 210, + "query": "对急诊患者，当手术是抢救患者的唯一方案时，最符合医学道德的做法是", + "options": { + "A": "首先考虑患者的选择", + "B": "立即进行手术", + "C": "在征得其家属或单位同意后，立即进行手术", + "D": "放弃手术", + "E": "患者拒绝手术时可不手术" + }, + "answer": "C", + "reason": "对急诊患者，当手术是抢救患者的唯一方案时，则可以不考虑患者的拒绝，在征得家属或单位的同意后，立即进行手术，这样做虽然违背了当事人的意愿，但不违背救死扶伤的医学人道主义精神，是符合道德的。" + }, + { + "question_num": 211, + "query": "耳舟2区所主治的疾病是", + "options": { + "A": "肩关节周围炎", + "B": "手指麻木疼痛", + "C": "荨麻疹", + "D": "肘部疼痛", + "E": "腕部疼痛" + }, + "answer": "C", + "reason": "在耳轮结节前方,指区与腕区之间,即耳舟1区、2区交界处的是风溪。风溪主治寻麻疹、皮肤瘙痒症、过敏性鼻炎。" + }, + { + "question_num": 212, + "query": "下述哪项为带下病", + "options": { + "A": "女子在发育成熟期白带增多", + "B": "女子带下量多,质黏稠,有秽臭味", + "C": "妊娠初期白带量多", + "D": "月经前期白带量多", + "E": "月经后期白带量多" + }, + "answer": "B", + "reason": "健康女子阴道排出的一种阴液,色白或无色透明，其性黏而不稠,其量适中，无特殊臭气，称为生理性带下,其量不多。但在月经前后、经间期及妊娠期带下的量稍有增多。具有润泽胞宫、阴道的作用。带下的量、色、质、气味发生异常,称为带下病。" + }, + { + "question_num": 213, + "query": "配伍特点为止血之中寓以化瘀，清利之中寓以养阴的方剂为", + "options": { + "A": "十灰散", + "B": "四生丸", + "C": "咳血方", + "D": "小蓟饮子", + "E": "槐花散" + }, + "answer": "D", + "reason": "小蓟饮子的配伍意义。小蓟饮子由导赤散加小蓟、藕节、蒲、滑石、栀子、当归组成。配伍特点为止血之中寓以化瘀,使血止而不留瘀;清利之中寓以养阴,使利水而不伤正。" + }, + { + "question_num": 214, + "query": "《药品管理法》对医疗机构配制的制剂有一系列规定，下列哪项不符合上述规定", + "options": { + "A": "应当是本单位临床需要而市场上没有供应的品种", + "B": "可以部分在市场销售", + "C": "必须按照规定进行质量检验", + "D": "凭医师处方在本医疗机构使用", + "E": "不得在市场销售" + }, + "answer": "B", + "reason": "《中华人民共和国药品管理法》第七十六条规定：医疗机构配制的制剂，应当是本单位临床需要而市场上没有供应的品种，并应当经所在地省、自治区、直辖市人民政府药品监督管理部门批准；但是，法律对配制中药制剂另有规定的除外。医疗机构配制的制剂应当按照规定进行质量检验；合格的，凭医师处方在本单位使用。经国务院药品监督管理部门或者省、自治区、直转市人民政府药品监督管理部门批准，医疗机构配制的制剂可以在指定的医疗机构之间调剂使用。医疗机构配制的制剂不得在市场上销售。" + }, + { + "question_num": 215, + "query": "乳头直下,第7肋间隙的穴位是", + "options": { + "A": "章门", + "B": "期门", + "C": "带脉", + "D": "京门", + "E": "日月" + }, + "answer": "E", + "reason": "日月的定位:在上腹部,当乳头直下,第7肋间踊,前正中线旁开4寸。" + }, + { + "question_num": 216, + "query": "产后小便淋痛之肾阴亏虚证的主治方剂是", + "options": { + "A": "加味五淋散", + "B": "沉香散", + "C": "补中益气汤", + "D": "知柏地黄汤", + "E": "以上均非" + }, + "answer": "D", + "reason": "产后小便淋痛之肾阴亏虚证,主要证候:产后小便频数,淋沥不爽,尿道灼热疼痛，尿少色深黄,伴腰酸膝软,头晕耳鸣,手足心热:舌红,苔少,脉细数。主治方剂:知柏地黄汤。" + }, + { + "question_num": 217, + "query": "下列选项中，既能清湿热，又能除疳热的药物是", + "options": { + "A": "黄连", + "B": "胡黄连", + "C": "地骨皮", + "D": "银柴胡", + "E": "柴胡" + }, + "answer": "B", + "reason": "胡黄连功效:清虚热,除疳热。" + }, + { + "question_num": 218, + "query": "下列各项，不属于医德修养内容的是", + "options": { + "A": "树立正确的医德认识，在实践中进行医德品质的培养", + "B": "认真学习医学伦理学知识，进行医德理论修养", + "C": "在医疗实践中以医德原则和规范要求自己，进行认知修养", + "D": "学习国家医疗体制改革文件，进行卫生政策修养", + "E": "以正确的医德思想克服旧的道德观念的影响，进行医德信念修养" + }, + "answer": "D", + "reason": "医德修养是指在医学生和医务工作者为培养医德品质进行勤奋学习、自我教育和自我陶冶的过程与功夫以及经过长期医疗实践的磨炼所达到的医德境界，其中包括在医疗实践中所形成的情操、举止、礼貌、品行等。医德悠养的途径和方法：①与医疗实践相结合是医德修养的根本途径；②慎独是医德修养的重要途径；③自律与他律是医德品质的养成方式。" + }, + { + "question_num": 219, + "query": "治疗肾阴虚证,应首选", + "options": { + "A": "六味地黄丸", + "B": "贯煎", + "C": "清骨散", + "D": "二阴煎", + "E": "三圣散" + }, + "answer": "A", + "reason": "六味地黄丸滋阴补肾,用于肾阴虚证,故选A:一贯煎滋阴疏肝,用于肝肾阴虚证,排除B;清骨散清虑热,退骨蒸,用于阴虚内热证,排除C;二阴煎侧重滋阴,降火力量不足,排除D;三圣散涌吐风痰，用于中风闭证,排除E。" + }, + { + "question_num": 220, + "query": "月经后期常见证候不包括", + "options": { + "A": "血寒证", + "B": "肾虚证", + "C": "气滞证", + "D": "血瘀证", + "E": "痰湿证" + }, + "answer": "D", + "reason": "月经后期常见证型:肾虚证、血虚证、血寒证、气滞证、痰湿证。" + }, + { + "question_num": 221, + "query": "下列方剂组成药物中，不含有附子的是", + "options": { + "A": "实脾散", + "B": "真武汤", + "C": "乌梅丸", + "D": "温脾汤", + "E": "阳和汤" + }, + "answer": "E", + "reason": "阳和汤的药物组成:熟地黄、肉桂:麻黄、鹿角胶、白芥子、姜炭、生甘草。" + }, + { + "question_num": 222, + "query": "医学道德评价的方式有", + "options": { + "A": "内心信念", + "B": "社会舆论", + "C": "传统习俗", + "D": "以上都是", + "E": "以上都不是" + }, + "answer": "D", + "reason": "医德评价的方式有社会舆论、传统习俗和内心信念。社会舆论和传统习俗是社会评价的方式，也是一种客观评价的力量；内心信念是一种自我评价的方式，也是一种主观评价的力量。" + }, + { + "question_num": 223, + "query": "四缝穴的位置在", + "options": { + "A": "手第1~5指间,指蹼缘后方赤白肉际处", + "B": "手第1~4指掌侧,指骨关节横纹中点处", + "C": "手第2~5指掌侧,近端指骨关节横纹中点处", + "D": "手第1~4指掌侧,近端指骨关节横纹中点处", + "E": "手第2~5指掌侧,掌指关节横纹中点处" + }, + "answer": "C", + "reason": "四缝穴的定位:手第2至第5指掌侧,近端指骨关节横纹中点处,一手4穴,左右共8穴。" + }, + { + "question_num": 224, + "query": "下列各项,属于新生儿病态的是", + "options": { + "A": "马牙", + "B": "胎怯", + "C": "螳螂子", + "D": "女婴生后3~5天乳房隆起如蚕豆到鸽蛋大小，2~3周消退", + "E": "女婴生后5~7天阴道有少量流血，1~3天自止" + }, + "answer": "B", + "reason": "胎怯,是指新生儿休重低下,身材短小,脏腑形气均未充实的一种病证，又称胎弱,其余四项皆为新生儿正常生理现象。" + }, + { + "question_num": 225, + "query": "组成药物中含有连翘的方剂是", + "options": { + "A": "温胆汤", + "B": "凉膈散", + "C": "清骨散", + "D": "温脾汤", + "E": "清胃散" + }, + "answer": "B", + "reason": "温胆汤的组成:半夏、竹茹、枳实、陈皮、甘草、茯苓、生姜、大枣。凉散的组成:川大黄、朴硝、甘草、山栀子仁、薄荷叶、黄芩、连翘。骨散的组成:银柴胡、胡黄连、秦艽、鳖甲、地皮、青茜、知母、甘草。温脾汤的组成:大黄、当归、千姜、附子、人参、芒硝、甘草。清胃散的组成:升麻、生地黄、当归、川黄连、牡丹皮、石膏。" + }, + { + "question_num": 226, + "query": "从伦理学上分析，生物—心理—社会医学模式取代生物医学模式在本质上反映", + "options": { + "A": "医疗技术的进步", + "B": "以疾病为中心的医学观念", + "C": "医学道德的进步", + "D": "重视人的心理健康", + "E": "重视人的内在价值" + }, + "answer": "C", + "reason": "生物一心理一社会医学模式是20世纪70年代以后建立起来的一种全新的医学模式。这种医学模式从生物、心理、社会全面综合的水平上认识人的健康和疾病。取代生物医学模式不仅反映着医学技术进步，而且标志着医学道德进步，在更高层次上实现了对人的尊重。从生物和社会结合上理解人的生命，理解人的健康和疾病，寻找疾病现象的机制和诊断治疗方法，是对人的尊重。生物一心理一社会医学式要求医生不仅要关心患者的躯体，而且要关心患者的心理。不仅要关心患者个体，而且要关心患者的家属、关心患者的后代、关心社会。" + }, + { + "question_num": 227, + "query": "既可治疗晕厥又可治疗闪挫腰痛的穴位为", + "options": { + "A": "百会", + "B": "内关", + "C": "水泉", + "D": "水道", + "E": "水沟" + }, + "answer": "E", + "reason": "水沟主治:①昏迷、晕厥、中风、中暑,体克;②癔症、癫狂痢、急慢惊风等神志病证;③鼻塞,鼻衄、面肿、口歪、齿痛、牙关紧闭；④闪挫腰痛;⑤风水面肿。" + }, + { + "question_num": 228, + "query": "手足口病常见于几岁儿童", + "options": { + "A": "1岁", + "B": "4岁以下", + "C": "3岁以下", + "D": "10岁以上", + "E": "16岁以下" + }, + "answer": "B", + "reason": "手足口病任何年龄均可发病,多见于4岁以下儿童。" + }, + { + "question_num": 229, + "query": "具有解表通便功用的方剂是", + "options": { + "A": "麻杏石甘汤", + "B": "葛根芩连汤", + "C": "防风通圣散", + "D": "大柴胡汤", + "E": "凉膈散" + }, + "answer": "C", + "reason": "麻杏石甘汤辛凉解表,清肺平喘,葛根芩连汤解表清里,主治协热下利。大柴胡汤和解少阳,内泻热结。凉散泻火通便,清上泄下。防风通圣散解表通便。" + }, + { + "question_num": 230, + "query": "《希波克拉底誓言》的精髓是", + "options": { + "A": "为患者谋福利，绝不伤害患者", + "B": "爱人与爱艺术平行", + "C": "恪守职业道德", + "D": "尊重患者", + "E": "对患者要有同情心" + }, + "answer": "A", + "reason": "《希波克拉底誓言》全文论述的医德思想内容十分丰富，它的精髓是为患者谋利益，绝不伤害患者。" + }, + { + "question_num": 231, + "query": "与腰阳关穴在同一水平线上的腧穴是", + "options": { + "A": "胃俞", + "B": "肾俞", + "C": "膀胱俞", + "D": "大肠俞", + "E": "肝俞" + }, + "answer": "D", + "reason": "腰阳关与大肠俞均位于第四腰椎棘突下。" + }, + { + "question_num": 232, + "query": "儿童注意力缺陷多动障碍,其病在肝者,临床证候是", + "options": { + "A": "兴趣多变,做事有头无尾,记忆力差", + "B": "易于冲动,好动难静,容易发怒,常不能自控", + "C": "注意力不集中,情绪不稳定,多梦烦躁", + "D": "脑失精明,学习成绩低下,记忆力欠佳，或有遗尿、腰酸乏力", + "E": "神思涣散,活动过多,动作笨拙" + }, + "answer": "B", + "reason": "注意力缺陷多动障碍的脏腑辨证：在心者,注意力不集中,情绪不稳定,多梦烦躁；在肝者,易于冲动,好动难静,容易发怒,常不能自控;在脾者,兴趣多变,做事有头无尾,记忆力差;在肾者,脑失精明，学习成绩低下，记忆力欠佳，或有遗尿、腰酸乏力。" + }, + { + "question_num": 233, + "query": "暖肝煎与天台乌药散二方组成中均含有的药物是", + "options": { + "A": "枸杞", + "B": "当归", + "C": "肉桂", + "D": "木香", + "E": "以上都不是" + }, + "answer": "E", + "reason": "天台乌药散的药物组成:乌药、木香、小茴香、青皮、高良姜、槟榔、川棟子、巴豆。肝煎的药物组成:当归、枸杞、茯苓、小茴香、肉桂、乌药、沉香。" + }, + { + "question_num": 234, + "query": "医学伦理学发展到生命伦理学阶段，其理论基础的核心是", + "options": { + "A": "生命神圣论", + "B": "美德论", + "C": "义务论", + "D": "生命质量与生命价值", + "E": "人道论" + }, + "answer": "D", + "reason": "生命神圣观强调人的生命价值至高无上，人的生命神圣不可侵犯，但该观点缺乏人类成的理性基础，缺乏对生命的辨证分析。而生命质量和生命价值观是一种强调人的生命状态及其价值的生命观，是现代生命伦理学的核心观点。" + }, + { + "question_num": 235, + "query": "提插补泻法中，泻法的操作手法是", + "options": { + "A": "重插轻提,幅度大,频率快", + "B": "重插轻提,幅度小,频率快", + "C": "重插轻提,幅度小,频率慢", + "D": "轻插重提，幅度小,频率快", + "E": "轻插重提,幅度大,频率快" + }, + "answer": "E", + "reason": "提插补泻中先深后浅,轻插重提,幅度大,频率快,操作时间长者为泻法。" + }, + { + "question_num": 236, + "query": "小儿夏季热的临床特征除长期发热外，还见", + "options": { + "A": "口渴多饮、多尿、汗闭", + "B": "口渴多饮、多尿、多汗", + "C": "口渴多饮、少尿、多汗", + "D": "口不渴、多尿、多汗", + "E": "口不渴、少尿、汗闭" + }, + "answer": "A", + "reason": "夏季热以长期发热、口渴、多饮、多尿、汗闭为临床特征。小儿冒受暑气,灼伤肺胃之津，津亏而内热炽盛,故口渴多饮。DE项均口不渴，与夏季热不符。肺津为暑热所伤，水液无以敷布，肌腠闭塞则汗闭。BCD项之多汗则与夏季热的临床特征不符。汗与小便同源,汗闭则尿多，CE项之少尿与夏季热不符,故选A。" + }, + { + "question_num": 237, + "query": "阳和汤原方中麻黄的作用��", + "options": { + "A": "发汗解表", + "B": "宣肺平喘", + "C": "解散寒凝", + "D": "利水消肿", + "E": "助阳化气" + }, + "answer": "C", + "reason": "阳和汤方中重用熟地黄,滋补阴血,填精益髓。配以鹿角胶,补肾助阳,益精养血，二者合用,温阳养血,以治其本,共为君药。少佐以麻黄,宜通经络,与诸温和药配合,可以开合腠理,散寒凝,引阳气由里达表,通行周身。甘草生用为使,解毒而调诸药。综观全方,补血与温阳并用,化与通络相伍,益精气:扶阳气,化寒凝,通经络,温阳补血与治本,化痰通络以治标。用于阴疽,犹如离照当空,阴霾自散,故以“阳和”名之。" + }, + { + "question_num": 238, + "query": "下面关于医务人员权利的理解，不正确的是", + "options": { + "A": "医务人员享受权利的前提是履行自己的义务", + "B": "医务人员权利的范围是维护患者平等医疗权利的实现，促进患者身心健康", + "C": "医务人员享有的职业权利是其必须履行的义务", + "D": "医务人员享有的权利是患者实现自己医疗权利的满足", + "E": "医务人员权利与患者权利发生矛盾时，要求医务人员放弃权利而服从患者的权利" + }, + "answer": "E", + "reason": "医师的权利具有一定的自主性，使医务人员正当的职业道德权利受到尊重和维护，医务人员的权利和义务是相辅相成的，尊重患者的自主性，绝不意味要放弃自己的责任。" + }, + { + "question_num": 239, + "query": "属手少阴心经的腧穴是", + "options": { + "A": "照海", + "B": "气海", + "C": "血海", + "D": "少海", + "E": "小海" + }, + "answer": "D", + "reason": "A项照海是足少阴肾经的腧穴;B项气海是任脉的腧穴;C项血海是足太阴脾经的腧穴;D项少海是手少阴心经的腧穴;E项小海是手太阳小肠经的腧穴。" + }, + { + "question_num": 240, + "query": "病毒性心肌炎的发病内因是", + "options": { + "A": "痰瘀内阻", + "B": "饮食内滞", + "C": "外感风温邪毒", + "D": "湿热邪毒侵袭", + "E": "小儿素体正虚" + }, + "answer": "E", + "reason": "小儿素体正气亏虚是发病之内因，温热邪毒侵袭是发病之外因。" + }, + { + "question_num": 241, + "query": "地黄饮子中加少许薄荷的作用是", + "options": { + "A": "上行开郁", + "B": "疏散风热", + "C": "疏肝解郁", + "D": "清利头目", + "E": "利咽消肿" + }, + "answer": "A", + "reason": "地黄饮子的药物配伍意义。地黄饮子中游荷轻清上行,宜散解郁,为使药。" + }, + { + "question_num": 242, + "query": "下列除哪项外，均可出现周围性呕吐", + "options": { + "A": "洋地黄中毒", + "B": "急性胃炎", + "C": "胃穿孔", + "D": "胆囊炎", + "E": "咽部受激惹" + }, + "answer": "A", + "reason": "洋地黄引起的呕吐为中枢性呕吐故选A，其余选项均可引起周围性呕吐。" + }, + { + "question_num": 243, + "query": "一般进针的角度可分为", + "options": { + "A": "针身与皮肤表面星:90°、45°、15°", + "B": "针身与皮肤表面星:120°、45°、15°", + "C": "针身与皮肤表面星:90°、80°、70°", + "D": "针身与皮肤表面呈:90°、45°、35°", + "E": "针身与皮肤表面星:90°、45°、5°" + }, + "answer": "A", + "reason": "针刺的角度。针刺的角度是指进针时针身与皮肤表面所形成的夹角。一般分为以下3种角度:直刺是针身与皮肤表面呈90\"垂直刺入。斜刺是针身与皮肤表面呈45\"左右倾斜刺入。平刺,即横刺、沿皮刺,是针身与皮肤表面呈15\"左右或沿皮以更小的角度刺入。" + }, + { + "question_num": 244, + "query": "风热咳嗽证的主治方剂是", + "options": { + "A": "银翘散", + "B": "桑菊饮", + "C": "小青龙汤", + "D": "麻黄汤", + "E": "止嗽散" + }, + "answer": "B", + "reason": "风热咳嗽证,证候:咳嗽不爽,痰黄黏稠,不易咯出,口渴咽痛,鼻流浊涕,伴有发热恶风,头痛,微汗出,舌质红,苔薄黄,脉浮数或指纹浮紫。治法:疏风解热，宜肺止咳。代表方剂:桑菊饮。" + }, + { + "question_num": 245, + "query": "祛痰剂中常配伍的药物是", + "options": { + "A": "祛湿药", + "B": "清热药", + "C": "补气药", + "D": "收涩药", + "E": "温里药" + }, + "answer": "A", + "reason": "祛痰剂的配伍用药。痰的产生往往与脾、肺、肾三脏功能失调相关。脾失健运,则湿聚成痰;肺失宣降,则聚液成痰;肾虚不能制水,水泛亦为痰,故本类方剂多配伍健脾利湿药,有时酌配益肾之品。" + }, + { + "question_num": 246, + "query": "中医四诊的道德要求是", + "options": { + "A": "安神定志", + "B": "认真负责", + "C": "保守医密", + "D": "知情同意", + "E": "尊重患者" + }, + "answer": "A", + "reason": "中医四诊的道德要求：安神定志、实事求是。" + }, + { + "question_num": 247, + "query": "下列不属于艾灸的是", + "options": { + "A": "太乙针灸", + "B": "悬灸", + "C": "间接灸", + "D": "实按灸", + "E": "天灸" + }, + "answer": "E", + "reason": "灸法的分类。天灸又称药物灸,发泡灸,是用对皮肤有刺激性的药物,涂敷于穴位或患处,使局部充血,起泡,犹如灸疮,故名天炙。可见天灸的材料是有刺激性的药物而不是艾绒。" + }, + { + "question_num": 248, + "query": "麻疹的主要病变脏腑是", + "options": { + "A": "肺、肾", + "B": "心、肝", + "C": "心、肺", + "D": "肺、脾", + "E": "心、脾" + }, + "answer": "D", + "reason": "麻疹发病的原因,为感受麻疹时邪，其主要病变在肺脾。" + }, + { + "question_num": 249, + "query": "健脾丸的组成药物中含有", + "options": { + "A": "薏苡仁", + "B": "莱菔子", + "C": "鸡内金", + "D": "黄芪", + "E": "黄连" + }, + "answer": "E", + "reason": "健脾丸组成:白术、木香、黄连、甘草、白茯苓、人参、神曲、陈皮、砂仁、麦芽、山楂、山药、肉豆蔻。" + }, + { + "question_num": 250, + "query": "下列哪一个不属于医学伦理学的理论基础", + "options": { + "A": "生命论", + "B": "美德论", + "C": "人道论", + "D": "价值论", + "E": "公益论" + }, + "answer": "D", + "reason": "医学伦理学以生命论、人道论、美德论和公益论等为基本理论，其中，生命论包括生命神圣论、生命质量论和生命价值论；人道论中人道主义的核心是尊重患者的生命、人格、尊严、平等的医疗与健康权利以及对社会、医院、医务人员的尊重；美德论中医德品质的内容有仁慈、诚挚、严谨、公正、节操；公益论中以群体利益为重，以长远利益为重，以整体利益为重。" + }, + { + "question_num": 251, + "query": "近视且易疲劳者，其配穴是", + "options": { + "A": "心俞、脾俞、足三里", + "B": "肝俞、肾俞、太溪、太冲", + "C": "气海、脾俞", + "D": "太溪、合谷", + "E": "太溪、光明" + }, + "answer": "A", + "reason": "近视且易疲劳,为心脾两虚证,除主穴睛明,承泣、风池、光明外,还应配心俞、.俞,足三里。" + }, + { + "question_num": 252, + "query": "口疳的病位主要涉及", + "options": { + "A": "脾、肾", + "B": "心、肝", + "C": "心、脾", + "D": "肝、脾", + "E": "脾、胃" + }, + "answer": "C", + "reason": "口疳证,证候:口舌生疮,甚或满口糜烂,秽臭难闻,而赤心烦,夜卧不宁,小便短黄,或吐舌、弄舌,舌质红,苔薄黄,脉细数。疳证病位主要在脾胃，口疳除了脾，还涉及心。" + }, + { + "question_num": 253, + "query": "左金丸中黄连与吴茱萸用量比例为", + "options": { + "A": "1:1", + "B": "2:1", + "C": "3:1", + "D": "6:1", + "E": "7:1" + }, + "answer": "D", + "reason": "左金丸中黄连与吴茱萸用量比例为6:1。方中重用黄连为君,清泻肝火,使肝火得,自不横逆犯胃;黄连普清泻胃热,胃火降则其气自和,一药而两清肝胃,标本兼顾。然气郁化火之证,纯用大苦大寒既恐郁结不开,又虑折伤中阳,故又少佐辛热之吴茱萸。一者疏肝解郁,一者反佐以制黄连之寒，一者取其下气之用,以和胃降逆;一者可引领黄连人肝经,如此一味而功兼四用,以为佐使。二药合用,共收清泻肝火,降逆止呕之效。" + }, + { + "question_num": 254, + "query": "下列有关肾综合征出血热的描述，正确的是", + "options": { + "A": "发病以青少年为主", + "B": "一般不经呼吸道传播", + "C": "无明显季节性", + "D": "所有患者均有5期经过", + "E": "可有母婴传播" + }, + "answer": "E", + "reason": "肾综合征出血热的传播途径包括呼吸道传播、消化道传播、接触传播、母婴传播和虫媒传播等5种方式，故选E。" + }, + { + "question_num": 255, + "query": "针灸治疗经乱选取腧穴主要考虑以下哪些经穴", + "options": { + "A": "任脉、足太阴经穴", + "B": "任脉、足厥阴经穴", + "C": "任脉、足少阴经穴", + "D": "带脉、冲脉、任脉穴", + "E": "任脉、督脉、冲脉穴" + }, + "answer": "A", + "reason": "针灸治疗经乱的治法。经乱洽法为疏肝益肾、调理冲任。肾气旺盛,肝脾调和,冲任脉盛，则月事按时而下。以任脉及足太阴经穴为主。" + }, + { + "question_num": 256, + "query": "乳婴儿药剂用量是成人量的", + "options": { + "A": "1/6", + "B": "1/3", + "C": "1/2", + "D": "2/3", + "E": "以上均非" + }, + "answer": "B", + "reason": "小儿用药剂量常随年龄大小、个体差异、病情轻重、医者经验而不同。为方便掌握，中药汤剂可采用下列比例用药:新生儿用成人量的1/6,乳婴儿用成人量的1/3,幼儿用成人量的1/2,学龄期儿童用成人量的2/3或接近成人量。" + }, + { + "question_num": 257, + "query": "温经汤（《金匮要略》）主治证候的病因病机是", + "options": { + "A": "五劳虚极", + "B": "产后血虚受寒", + "C": "冲任虚损", + "D": "下焦蓄血", + "E": "冲任虚寒，瘀血阻滞" + }, + "answer": "E", + "reason": "温经汤主治证候皆因冲任虚寒,瘀血阻滞。" + }, + { + "question_num": 258, + "query": "《医疗纠纷预防和处理条例》规定患者在发生医疗纠纷的时候可以封存和复印病历，下列资料中哪项属于可以封存但不能复印的病历资料", + "options": { + "A": "会诊记录", + "B": "门诊病历", + "C": "手术及麻醉记录单", + "D": "病理报告单", + "E": "化验报告单" + }, + "answer": "A", + "reason": "发生医疗纠纷或医疗事故的时候患者有权查阅或复制的病历资料所包括的范围。参见《医疗纠纷和预防处理条例》第十六条：患者有权查阅、复制其门诊病历、住院志、体温单、医嘱单、化验单（检验报告）、医学影像检查资料、特殊检查同意书、手术同意书、手术及麻醉记录单、病理资料、护理记录、医疗费用以及国务院卫生主管部门规定的其他属于病历的全部资料。使用排除法即可得到本题答案。" + }, + { + "question_num": 259, + "query": "下列腧穴在五行配属中，属金的是", + "options": { + "A": "少府", + "B": "大陵", + "C": "阳溪", + "D": "后溪", + "E": "经渠" + }, + "answer": "E", + "reason": "阴经的井荥输经合属木火土金水，阳经的井荥输经合属金水木火土。A项少府是心经的荥穴属火,B项大陵是心包经的输穴属土,C项阳溪是大肠经的经穴属火,D项后溪是小扬经的输穴属木,E项经渠是肺经的经穴属金,故选E。" + }, + { + "question_num": 260, + "query": "胎怯的病变脏腑主要在", + "options": { + "A": "脾、肾", + "B": "肺、脾", + "C": "肝、肾", + "D": "肺、心", + "E": "心、脾" + }, + "answer": "A", + "reason": "胎怯的病因为先天禀赋不足,病变脏腑主要在肾与脾,发病机制为先天禀赋不足，化源未充,涵养不足,肾脾两虚,五脏失养。" + }, + { + "question_num": 261, + "query": "清气化痰丸制备中加了哪种药", + "options": { + "A": "蜜", + "B": "水", + "C": "梨汁", + "D": "姜汁", + "E": "藕汁" + }, + "answer": "D", + "reason": "清气化痰丸的组成。清气化痰丸以姜汁为丸,和胃止呕,并为开痰之先导。" + }, + { + "question_num": 262, + "query": "不属于“行政处罚”的是", + "options": { + "A": "警告", + "B": "罚款", + "C": "降职", + "D": "吊销执业医师证书", + "E": "没收违法所得" + }, + "answer": "C", + "reason": "行政处罚的种类主要有警告、罚款、没收非法财物、没收违法所得、责令停业停产、暂扣或吊销有关许可证等。" + }, + { + "question_num": 263, + "query": "治疗肾虚型牙痛除取主穴外，还应加", + "options": { + "A": "外关、风池", + "B": "太溪、行间", + "C": "太溪、外关", + "D": "太冲、曲池", + "E": "太冲、阳溪" + }, + "answer": "B", + "reason": "肾虚型牙痛应配合太溪、行间以滋肾阴。" + }, + { + "question_num": 264, + "query": "佝偻病激期的服药应是", + "options": { + "A": "日服维生素D10000~20000U", + "B": "日服维生素D5000~10000U", + "C": "日服维生素D500U", + "D": "日服维生素D400U", + "E": "日服维生素D100U" + }, + "answer": "A", + "reason": "佝偻病西医治疗:初期每天口服维生素D5000~10000U,连服1个月;激期每天口服维生素D10000~20000U,连服1个月;不能坚持口服者可肌内注射维生素D2，每次40万U(或D330万U),连用1~3次,每次间隔1个月,在给予维生素D的同时应给予钙剂每次0.5~1.0g,每天2~3次,连服2~3个月。" + }, + { + "question_num": 265, + "query": "清风散中含有“治风先治血，血行风自灭”之义的药物是", + "options": { + "A": "当归、生地黄、防风", + "B": "当归、生地黄、胡麻仁", + "C": "生地黄、防风、荆芥", + "D": "当归、生地黄、甘草", + "E": "苍术、当归、生地黄" + }, + "answer": "B", + "reason": "当归、生地贳、胡麻仁补血活血,凉血息风止痒,使“血行风自灭”。" + }, + { + "question_num": 266, + "query": "医疗机构药剂人员调配处方时的错误行为是", + "options": { + "A": "处方必须经过核对，对处方所列药品不得擅自更改", + "B": "处方所列药品缺货时用同类药品代用", + "C": "对有配伍禁忌的处方，应当拒绝调配", + "D": "对有超剂量的处方，应当拒绝调配", + "E": "必要时，经处方医师更正或者重新签字，方可调整" + }, + "answer": "B", + "reason": "医疗机构的药剂人员调配处方，必须经过核对，对处方所列药品不得擅自更改或者代用。对有配伍禁忌或者超剂量的处方，应当拒绝调配；必要时，经处方医师更正或者重新签字，方可调配。" + }, + { + "question_num": 267, + "query": "按照五行生克关系，治疗胆经实证应首选", + "options": { + "A": "足临泣", + "B": "足窍阴", + "C": "丘墟", + "D": "侠溪", + "E": "阳辅" + }, + "answer": "E", + "reason": "“实则泻其子”,胆经属于“木“,“木”生”火”，“火“为”木“之子,胆经实证,则应泻”火”所以应选用胆经上属火的穴位阳辅。" + }, + { + "question_num": 268, + "query": "治疗皮肤黏膜淋巴结综合征卫气同病证应", + "options": { + "A": "益气养阴,清解余热", + "B": "疏风清热,利湿解毒", + "C": "辛凉透表,清热解毒", + "D": "疏风解表,清热凉血", + "E": "清气凉营,解毒化瘀" + }, + "answer": "C", + "reason": "皮肤黏膜淋巴结综合征卫气同病证候:发病急骤,持续高热，微恶风,口渴喜饮,目赤咽红,手掌足底潮红,躯干皮疹显现,颈部界核肿大,或伴咳嗽,轻度泄泻,舌质红,苔薄,脉浮数。治法:辛凉透表，清热解毒。" + }, + { + "question_num": 269, + "query": "胸脘痞闷，按之则痛，或咳痰黄稠，舌苔黄腻，脉滑数者，治宜选用", + "options": { + "A": "小陷胸汤", + "B": "滚痰丸", + "C": "二陈汤", + "D": "贝母瓜蒌散", + "E": "清金化痰丸" + }, + "answer": "A", + "reason": "小陷胸汤的主治证。小陷胸汤功能清热化痰,宽胸散结。主治痰热互结的结胸证。症见胸脘痞闷,按之则痛,或心胸闷痛,或咳黄稠,舌苔黄腻,脉滑数。" + }, + { + "question_num": 270, + "query": "医疗机构的负责人、药品采购人员、医师、药师等有关人员收受药品上市许可持有人、药品生产企业、药品经营企业或者代理人给予的财物或者其他不正当利益的，由卫生健康主管部门或者本单位给予处分，没收违法所得;情节严重的，", + "options": { + "A": "记过、没收违法所得", + "B": "吊销执业许可证", + "C": "吊销执业医师证书", + "D": "警告、降职", + "E": "处分、没收违法所得" + }, + "answer": "C", + "reason": "医疗机构的负责人、药品采购人员、医师、药师等有关人员收受药品上市许可持有人、药品生产企业、药品经营企业或者代理人给予的财物或者其他不正当利益的，由卫生健康主管部门或者本单位给予处分，没收违法所得；情节严重的，还应当吊销其执业证书。" + }, + { + "question_num": 271, + "query": "针灸治疗落枕,叙述不正确的是", + "options": { + "A": "选取阿是穴,手太阳,足少阳经穴为主", + "B": "毫针用泻法", + "C": "先刺远端腧穴,后刺局部腧穴", + "D": "针刺局部腧穴时可加艾灸或点刺出血", + "E": "针刺远端腧穴时,患者应用力、大幅度地活动颈项" + }, + "answer": "E", + "reason": "先刺远端外劳宫.后溪、悬钟,持续捻转,嘱患者慢慢活动颈部,一般颈项疼痛立即缓解，再针刺局部有腧穴。风赛袭络者可局部配合艾灸,气滞血瘀者可局部配合三棱针点刺放血。" + }, + { + "question_num": 272, + "query": "治疗风疹邪犯肺卫证,应首选", + "options": { + "A": "桑菊饮", + "B": "银翘散", + "C": "透疹凉解汤", + "D": "清胃解毒汤", + "E": "普济消毒饮" + }, + "answer": "B", + "reason": "风疹邪犯肺卫选银翘散。" + }, + { + "question_num": 273, + "query": "麦门冬汤中配伍粳米、大枣、甘草的意义有", + "options": { + "A": "佐金平木", + "B": "培土生金", + "C": "扶土抑木", + "D": "滋水涵木", + "E": "益火补土" + }, + "answer": "B", + "reason": "方中重用麦门冬为君,甘寒清润,既养肺胃之阴,又清肺胃虚热。人参益气生津为臣。佐以甘草、粳米、大枣益气养胃,合人参益胃生津,胃律充足,自能上归于肺,此正“培土生金”之法。肺胃阴虚虚火上炎,不仅��机逆上,而且进一步灼津为涎,故又佐以半夏降逆下气,化其痰涎,虽属温燥之品,但用是很轻,与大剂麦门冬配伍,则其燥性减而降逆之用存且能开胃行津以润肺,又使麦门冬滋而不腻,相反相成。甘草并能润肺利咽,调和诸药,兼作使药。" + }, + { + "question_num": 274, + "query": "医师是指依法取得执业医师资格或执业助理医师资格，经注册在医疗卫生机构中执业的何种医务人员", + "options": { + "A": "专业", + "B": "药学", + "C": "医学物理工程", + "D": "护理", + "E": "医疗器械检验" + }, + "answer": "A", + "reason": "《中华人民共和国医师法》所称医师，是指依法取得医师资格，经注册在医疗卫生机构中执业的专业医务人员，包括执业医师和执业助理医师。" + }, + { + "question_num": 275, + "query": "在五输穴中,井穴主治", + "options": { + "A": "身热", + "B": "心下满", + "C": "体重节痛", + "D": "喘咳寒热", + "E": "逆气而泄" + }, + "answer": "B", + "reason": "五输穴中,井主心下满,荥主身热，输主体重节痛,经主喘咳寒热,合主逆气而泄。" + }, + { + "question_num": 276, + "query": "反复呼吸道感染恢复期治法中，错误的是", + "options": { + "A": "补气固表", + "B": "温卫和营", + "C": "温补脾肾", + "D": "疏风解表", + "E": "滋养肺脾" + }, + "answer": "D", + "reason": "反复呼吸道感染:迁延期以扶正为主,兼以祛邪。恢复期当固本为要,或补气固表，或温卫和营,或温补脾肾,或滋养肺脾。" + }, + { + "question_num": 277, + "query": "三仁汤除清利湿热外，还具有的功用是", + "options": { + "A": "理气和中", + "B": "行气和胃", + "C": "升清降浊", + "D": "通阳化气", + "E": "宣畅气机" + }, + "answer": "E", + "reason": "三仁汤的功用清利湿热、宣畅气机主治湿温初起,头痛恶寒,面色淡黄,身重疼痛,午后身热,胸闷不饥等症。用于治疗急性肾小球肾炎,肾盂肾炎,急性卡他性中耳炎,妊娠呕吐,伤寒百日咳等症。" + }, + { + "question_num": 278, + "query": "执行职务的医疗保健人员发现以下哪种情况，必须按照国务院卫生行政部门规定的时限向当地卫生防疫机构报告疫情", + "options": { + "A": "甲类、乙类和丙类传染病患者", + "B": "甲类、乙类和丙类传染病病原携带者", + "C": "甲类、乙类和丙类传染病疑似传染病患者", + "D": "甲类、乙类和监测区域内的丙类传染病患者、病原携带者、疑似传染病患者", + "E": "以上都不是" + }, + "answer": "D", + "reason": "执行职务的医疗保健人员及卫生防疫人员发现甲类、乙类和监测区域内的丙类传染病患者、病原携带者或者疑似传染病患者，必须按照国务院卫生行政部门规定的时限向当地卫生防疫机构报告疫情。" + }, + { + "question_num": 279, + "query": "治疗实热证月经先期在关元、三阴交、血海的基础上加", + "options": { + "A": "行间", + "B": "隐白", + "C": "归来", + "D": "太溪", + "E": "足三里" + }, + "answer": "A", + "reason": "针灸治疗月经不调的处方。针灸治疗月经先期的主穴:关元、三阴交、血海。实热证者,加太冲或行间:行间为肝经荥穴,能清泄肝经郁热,与关元,血海相配可清热和血,调理冲任。" + }, + { + "question_num": 280, + "query": "治疗小儿哮喘风寒束肺证的首选方是", + "options": { + "A": "苏子降气汤", + "B": "金匮肾气丸", + "C": "小青龙汤合三子养亲汤", + "D": "麻杏石甘汤合苏芋丸", + "E": "人参五味子汤合玉屏风散" + }, + "answer": "C", + "reason": "风寒束肺证,证候:气喘,喉间哮鸣,咳嗽,胸闷,痰稀色白有泡沫,喷嚏鼻塞,流清涕,唇青，形寒肢凉,无汗,口不渴,小便清长,大便溏薄,咽不红,舌质淡红,苔薄白或白滑,脉浮紧,指纹红。首选方:小青龙汤合三子养亲汤。" + }, + { + "question_num": 281, + "query": "实脾散的功用是", + "options": { + "A": "健脾和胃，消食止泻", + "B": "益气健脾，渗湿止泻", + "C": "健脾和胃，消痞除满", + "D": "温阳健脾，行气利水", + "E": "燥湿运脾，行气和胃" + }, + "answer": "D", + "reason": "实脾散温阳健脾,行气利水。主治脾肾阳虚,水气内停之阴水。身半以下肿甚,手足不温,口中不渴,胸腹胀满,大便溏薄,舌苔白腻,脉沉弦而迟者。" + }, + { + "question_num": 282, + "query": "在使用辅助检查手段时，不适宜的是", + "options": { + "A": "认真严格地掌握适应证", + "B": "可以广泛积极地依赖各种辅助检查", + "C": "有利于提高医生诊治疾病的能力", + "D": "必要检查能尽早确定诊断和进行治疗", + "E": "应从患者的利益出发决定该做的项目" + }, + "answer": "B", + "reason": "医生应从患者的利益出发决定该做的项目，B项可以广泛积极地依赖各种辅助检查不符合医德的要求，是应该阻止的行为，故选B。" + }, + { + "question_num": 283, + "query": "足三阴经从起始部至内踝上8寸段的分布是", + "options": { + "A": "厥阴在前,太阴在中,少阴在后", + "B": "厥阴在前,少阴在中,太阴在后", + "C": "少阴在前,太阴在中,厥阴在后", + "D": "太阴在前,厥阴在中,少阴在后", + "E": "太阴在前,少阴在中,厥阴在后" + }, + "answer": "A", + "reason": "足三阴经在足内踝上8寸以下为厥阴在前、太阴在中、少阴在后,至内踝上8寸以上,太阴经交出厥阴之前。" + }, + { + "question_num": 284, + "query": "治疗风痧邪犯肺卫证,应首选", + "options": { + "A": "桑菊饮", + "B": "银翘散", + "C": "透疹凉解汤", + "D": "清胃解毒汤", + "E": "普济消毒饮" + }, + "answer": "B", + "reason": "风痧邪犯肺卫证应辛凉宣透,清热利咽,方选银翘散。" + }, + { + "question_num": 285, + "query": "具有补肾健脾、益气摄血功用的方剂是", + "options": { + "A": "固冲汤", + "B": "归脾汤", + "C": "四物汤", + "D": "黄土汤", + "E": "固经丸" + }, + "answer": "A", + "reason": "固冲汤功用:固冲摄血,益气健脾主治脾肾亏虚,冲脉不固证。" + }, + { + "question_num": 286, + "query": "突发公共卫生事件包括突然发生，造成或者可能造成社会公众健康严重损害的重大", + "options": { + "A": "领导责任事件", + "B": "消防安全事件", + "C": "社会治安事件", + "D": "公众安全事件", + "E": "食物中毒" + }, + "answer": "E", + "reason": "本条例所称突发公共卫生事件（以下简称突发事件），是指突然发生，造成或者可能造成社会公众健康严重损害的重大传染病疫情、群体性不明原因疾病、重大食物和职业中毒以及其他严重影响公众健康的事件。" + }, + { + "question_num": 287, + "query": "循行于腹中线旁开2寸,胸中线旁开4寸的经脉是", + "options": { + "A": "足厥阴肝经", + "B": "手太阴肺经", + "C": "手少阴心经", + "D": "足阳明胃经", + "E": "足太阴脾经" + }, + "answer": "D", + "reason": "足阳明胃经的循行线路是其直者，从缺盆下乳肉廉,下挟脐,人气街中,即胸部距前正中线4寸,从缺盆穴到乳根穴,腹部距前正中线2寸,从不容穴到气冲穴,其余选项均与本题不符。" + }, + { + "question_num": 288, + "query": "除外哪一项均为小儿咳嗽的主要病因", + "options": { + "A": "感受外邪", + "B": "痰热蕴肺", + "C": "痰湿蕴肺", + "D": "肺气亏虚", + "E": "肾气亏虚" + }, + "answer": "E", + "reason": "小儿咳嗽的病变部位在肺,常涉及于脾,病理机制为肺失宜肃,其病因主要有感受外邪、痰热蕴肺、痰湿蕴肺、肺气亏虚、肺阴亏虚。" + }, + { + "question_num": 289, + "query": "外感热病中，正邪相争，提示病变发展转折点的是", + "options": { + "A": "战汗", + "B": "自汗", + "C": "盗汗", + "D": "冷汗", + "E": "热汗" + }, + "answer": "A", + "reason": "A项指先全身恶寒,战栗,接着大汗出,若汗出热退,脉静身凉,是邪去正复之佳兆,主疾病向愈;若汗出而身热不减,仍烦躁不安,脉来疾急,为邪胜正衰之危候,主病情恶化。B项由于阳气亏虚,不能实卫固表,媵理疏松,津液外泄,故见自汗。C项是因人睡之时,卫气人里,媵理不固,加上阴虚所生之虚热蒸津外泄,故睡时汗出;醒后卫气复归于表,腠理固密虽阴虚内热,也不能蒸津外出,故醒后汗止。D项为亡阳之汗,表现为大汗淋滴,汗出如珠,冷汗清稀,兼见面色苍白,四肢厥冷,脉微欲绝等。E项热汗,即阳汗。" + }, + { + "question_num": 290, + "query": "属于乙类传染病，但采取甲类传染病的预防和控制措施的是", + "options": { + "A": "流行性感冒", + "B": "人感染高致病性禽流感", + "C": "霍乱", + "D": "鼠疫", + "E": "艾滋病" + }, + "answer": "B", + "reason": "对乙类传染病中传染性非典型肺炎、炭疽中的肺炭疽和人感染高致病性禽流感，采取本法所称甲类传染病的预防、控制措施，其他乙类传染病和突发原因不明的传染病需要采取本法所称甲类传染病的预防、控制措施的，由国务院卫生行政部门及时报经国务院批准后予以公布、实施。" + }, + { + "question_num": 291, + "query": "中脘配胃俞治疗胃痛,应属于", + "options": { + "A": "表里经配穴", + "B": "同名经配穴", + "C": "上下配穴", + "D": "前后配穴", + "E": "左右配穴" + }, + "answer": "D", + "reason": "中脘是足阳明胃经的募穴,胃俞是足阳明胃经的背俞穴,故两穴配合应用治疗胃痛属于前后配穴,亦名腹背阴阳配穴法、俞募配穴法。上下配穴法是指将腰部以上腧穴和腰部以下腧穴配合应用的方法。" + }, + { + "question_num": 292, + "query": "小儿生理特点中所说的稚阴稚阳的含义是", + "options": { + "A": "生机蓬勃,发育迅速", + "B": "脏腑娇嫩,形气未充", + "C": "年龄越小,生长越快", + "D": "年龄越小,发育越快", + "E": "纯阳无阴,阳常有余" + }, + "answer": "B", + "reason": "①小儿生理特点:脏腑娇嫩,形气未充,生机蓬勃,发育迅速;②稚阴稚阳之说表达了小儿机体柔弱,阴阳二气均较幼稚,形体和功能未臻完善的一面。纯阳之体说明小儿生机蓬勃，发育迅速,不应理解为阳亢阴亏或有阳无阴。" + }, + { + "question_num": 293, + "query": "下列哪项不会出现口渴多饮", + "options": { + "A": "热盛伤津", + "B": "汗出过多", + "C": "泻下过度", + "D": "剧烈呕吐", + "E": "湿热内阻" + }, + "answer": "E", + "reason": "口渴多饮指口渴而饮水较多,是体内津液损伤的基本表现之一,多见于燥证、热证。比如外感热病、里热炽盛及消渴病等。A项为热病伤津BCD项均可造成津液内伤,而口渴多饮。E项并不耗津液,故口不渴。" + }, + { + "question_num": 294, + "query": "《素问·痿论》“补其荥而通其俞”及“各以其时受月”的治则体现了", + "options": { + "A": "因时制宜，辨证论治", + "B": "因人制宜，辨证论治", + "C": "因病制宜，辨证论治", + "D": "因地制宜，辨证论治", + "E": "因证制宜" + }, + "answer": "A", + "reason": "“补其荥而通其俞”的针刺治则，即针对有关脏腑经络，补其荥穴，通其俞穴，调补虚实，疏通气血；还要配以“各以其时受月”的针刺治则。“补其荥而通其俞”及“各以其时受月”的治则体现了因时制宜，辨证论治的思想。" + }, + { + "question_num": 295, + "query": "三阴交、中极、次髎三穴同用,多用于治疗", + "options": { + "A": "月经先期", + "B": "月经后期", + "C": "月经先后不定期", + "D": "痛经实证", + "E": "血枯经闭" + }, + "answer": "D", + "reason": "针灸治疗痛经的处方。痛经实证或由于情志不调,使气滞血瘀,或由寒湿之邪客于胞宫，而使气血运行不畅所致。针灸治疗当行气散寒,通经止痛,以任脉,足太阴经穴为主。三阴交、中极、次髎通调冲任,行气化瘀以止痛。" + }, + { + "question_num": 296, + "query": "硬肿症临床特征错误的是", + "options": { + "A": "全身皮肤发凉", + "B": "全身发黄", + "C": "肌肉硬肿", + "D": "哭声低微", + "E": "吸吮困难" + }, + "answer": "B", + "reason": "①硬肿症是新生儿时期特有的一种严重疾病,是由多种原因引起的局部甚至全身皮肤和皮下脂肪硬化及水肿，常伴有低体温及多器官功能低下的综合征;②硬肿症在寒冷的冬春季节多见，多发生在生后7~10天的新生儿,早产、体弱儿更易发病。" + }, + { + "question_num": 297, + "query": "咳声如犬吠样，可见于", + "options": { + "A": "百日咳", + "B": "白喉", + "C": "感冒", + "D": "肺痨", + "E": "肺痿" + }, + "answer": "B", + "reason": "A项是指咳声阵发,发则连声不绝咳声终止时声如鸡啼,因其病程较长,缠绵难愈,所以称为百日咳。B项为咳声如犬吠,伴声音嘶哑,吸气困难,故选B。C项是以鼻塞、流涕、喷、头痛、恶寒、发热、全身不适等为主要临床表现的外感疾病,虽有咳嗽,但并没有特异性。D项是指体质虚弱,气血不足感染痨虫,侵蚀肺脏所致的具有传染性的慢性虚弱性疾病,临床主要以咳嗽、咯血、潮热、盗汗及身体逐渐消瘦等为其特征。E项是由于肺叶痰弱不用,临床以咳吐浊唾涎沫为主症。" + }, + { + "question_num": 298, + "query": "“正气即急”指的是", + "options": { + "A": "患侧气血本虚，邪气停留阻滞经脉，循经肢体肌肉失于濡养，萎废无力，呈弛缓状态", + "B": "健侧气血运行通畅，肢体肌肉收放自如，呈相对紧张状态", + "C": "健侧牵引患侧肌肉，出现口眼㖞斜的症状", + "D": "肢体沉重不易举动", + "E": "言语不利，口角流涎" + }, + "answer": "B", + "reason": "中风健侧气血运行通畅，肢体肌肉收放自如，呈相对紧张状态，即“正气即急”。" + }, + { + "question_num": 299, + "query": "体质虚弱所致虚性晕厥除主穴外应选", + "options": { + "A": "气海、关元", + "B": "风池、肾俞", + "C": "合谷、太冲", + "D": "合谷、内关", + "E": "素髎、内关" + }, + "answer": "A", + "reason": "针灸治疗晕厥的处方。针灸治疗旦晕厥以督脉及手厥阴经穴为主,虚证配气海,关元穴。" + }, + { + "question_num": 300, + "query": "胎黄的病因错误的是", + "options": { + "A": "感受湿热", + "B": "寒湿阻滞", + "C": "气滞血瘀", + "D": "先天缺陷", + "E": "感染黄毒" + }, + "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,其发病机制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": 301, + "query": "证候真假常出现于疾病的", + "options": { + "A": "初期阶段", + "B": "中期阶段", + "C": "后期阶段", + "D": "危重阶段", + "E": "过渡阶段" + }, + "answer": "D", + "reason": "某些疾病在病情的危重阶段,可出现一些与疾病本质相反的“假象”,掩盖着病情的真象所谓“真”,是指与疾病内在本质相符的证候;所谓假”,是指疾病表现出某些不符合常规认识的假象，即与病理本质所反映的常规证候不相应的某些表现。" + }, + { + "question_num": 302, + "query": "“其病有类伤寒，验之之法……在一经不移”中，“在一经不移”指的是", + "options": { + "A": "温热和风皆属阳邪，两阳相合，耗劫津液而不能上荣清窍", + "B": "湿与温热相互搏结", + "C": "湿性黏腻，温热与湿邪缠绵交蒸于中焦，上蒙下流，弥漫三焦", + "D": "寒邪留恋在表，然后化热人里，经六经传变，随着传变过程其证候性质也随之改变", + "E": "湿与温合，蒸郁而蒙蔽于上，清窍为之壅塞" + }, + "answer": "C", + "reason": "因湿性黏腻，温热与湿邪缠绵交蒸于中焦，上蒙下流，弥漫三焦，相对而言传变较慢，故称“在一经不移”。" + }, + { + "question_num": 303, + "query": "患者,男,56岁。有胃炎多年,脱腹不舒,痞塞,喜温喜按,不知饥,不欲食,体倦乏力，大便溏，舌淡苔白，脉沉弱。治疗可用", + "options": { + "A": "保和丸", + "B": "四逆散", + "C": "大黄黄连泻心汤", + "D": "平胃散合二陈汤", + "E": "补中益气汤" + }, + "answer": "E", + "reason": "痞满的辩证论治。从患者的症、舌、脉表现上分析,应辩证为痞满之脾胃虚弱证,治当补气健脾,升清降浊,方当选补中益气汤加减。" + }, + { + "question_num": 304, + "query": "患者小便频数黄赤3年,尿道灼热涩痛,排尿不畅,时有点滴不通,小腹胀满,大便干燥,口苦口黏,舌暗红,苔黄腻,脉滑数。B超示前列腺6.5cmx5.5cmx5cm，光滑无结节，其治法是", + "options": { + "A": "清热利湿,消癃通闭", + "B": "补脾益气,温肾利尿", + "C": "行气活血，通窍利尿", + "D": "滋补肾阴,通窍利尿", + "E": "温补肾阳,通窍利尿" + }, + "answer": "A", + "reason": "结合患者小腹胀满,大便干燥,口苦,口黏,舌暗红,苔黄腻,脉滑数。当辩证为湿热下注证,治以清热利湿,通利膀胱,故选A。" + }, + { + "question_num": 305, + "query": "小儿出现高热，面部青紫，尤以鼻柱、两眉间及口唇四周为甚，往往属于", + "options": { + "A": "血热瘀滞", + "B": "肾阴耗竭", + "C": "气滞血瘀", + "D": "动风先兆", + "E": "湿热熏蒸" + }, + "answer": "D", + "reason": "面色青主病。面部青紫,尤以鼻柱两眉间及口唇四周为甚,是动风的特点之一。高热的小儿,惊风或欲作惊风时,风动致脉络拘急失养,故多在眉间、鼻柱、口唇四周出现青色。而ABCE项均不能引起动风,故排除。" + }, + { + "question_num": 306, + "query": "患者高热1周。检查：体温40℃，脉搏90次/分，血白细胞4.0x10^9/L，嗜酸性粒细胞消失。应首先考虑的是", + "options": { + "A": "伤寒", + "B": "中毒性痢疾", + "C": "中毒性肺炎", + "D": "流行性脑脊髓膜炎", + "E": "急性病毒性肝炎" + }, + "answer": "A", + "reason": "伤寒的临床表现有持续高热，可达39~40℃；相对缓脉，即体温每增高1℃，每分钟脉搏增加15~20次；血液检查白细胞计数大多为（3~4）×10^9/L，嗜酸性粒细胞减少或消失。中毒性痢疾血液检查白细胞计数增高，多在（10~20）×10^9/L，排除B；中毒性肺炎白细胞计数正常或稍降低，嗜酸性粒细胞计数正常或稍低，排除C；流脑白细胞计数增高，一般在（10~30）×10^9/L���排除D；急性病毒性肝炎体温大多在38~39℃之间，排除E。" + }, + { + "question_num": 307, + "query": "患者,男,32岁。近日发热,寒战时作,每日一发,热多寒少,汗出不畅,头痛,骨节酸痛,口渴引饮,便秘尿赤,舌红苔黄,脉弦数,其为何型疟疾", + "options": { + "A": "温疟", + "B": "正疟", + "C": "寒疟", + "D": "劳疟", + "E": "疟母" + }, + "answer": "A", + "reason": "疟疾的辨证论治。疟疾在辩证时，根据病情的轻重,寒热的偏盛,正气的盛衰及病程的久暂等,而确定正疟、温疟、寒疟、瘴疟或劳疟等,温疟主症:热多寒少,汗出不畅,头痛,骨节酸痛,口渴引饮,便秘尿赤,舌红,若黄,脉弦数。" + }, + { + "question_num": 308, + "query": "患者,女,50岁。5天前左足3、4趾缝足癣水疱溃破，次日局部红肿疼痛,并见红线1条向上走窜至小腿中段,边界清晰,伴有发热,左胯腹部淋巴结肿痛,其诊断是", + "options": { + "A": "流火", + "B": "流注", + "C": "青蛇毒", + "D": "蛇串疮", + "E": "红丝疔" + }, + "answer": "E", + "reason": "根据症状“局部红肿疼痛,并见红线1条向上走窜至小腿中段,边界清晰,伴有发热,左胯腹部淋巴结肿痛”可以判断为红丝疔。" + }, + { + "question_num": 309, + "query": "危重患者，突然头额冷汗大出，四肢厥冷，属于", + "options": { + "A": "亡阴", + "B": "亡阳", + "C": "阴虚", + "D": "阴虚", + "E": "以上均非" + }, + "answer": "B", + "reason": "A项表现为汗热味咸而黏,如珠如油,身体灼热、恶热,虚烦躁扰或昏,口渴欲饮,皮肤皱瘪,小便极少或无尿,面赤唇焦,舌红干瘦,脉细数疾等。B项表现为冷汗淋漓、汗质稀淡,神情淡漠或呆滞肌肤不温,肢冷畏寒,呼吸气微,面色能白,舌淡而润,脉微欲绝。C项表现为经常畏冷,四肢不温，嗜睡蝇卧,面色觥白,口淡不渴,或渴喜热饮,或口泛清涎,小便清长,大便溏薄或完谷不化,舌淡胖,苔白滑,脉沉迟或细弱等。D项表现为五心烦热,或骨蒸潮热,红盗汗,口燥咽干,心烦失眠,形体消,或眩晕耳鸣,小便短黄,大便干结,舌红少苔少津,脉细数。" + }, + { + "question_num": 310, + "query": "患者，女，38岁。Graves病甲状腺次全切除术后10年。近4个月心慌、怕热、多汗、手颤抖，体重下降5kg。血TSH、FT3、FT4检查证实甲状腺功能亢进症复发，服甲硫咪唑2周后因严重药疹而停药。下一步治疗应", + "options": { + "A": "甲硫咪唑加抗过敏药物", + "B": "改用丙硫氧嘧啶", + "C": "改用β受体阻滞剂", + "D": "再次手术治疗", + "E": "用核素131I治疗" + }, + "answer": "E", + "reason": "治疗适应证：①成人Graves病伴甲状腺肿大Ⅱ度以上；②抗甲状腺药物治疗失败或过敏；③甲状腺功能亢进症手术后复发；④甲状腺毒症心脏病或伴其他病因的心脏病；⑤甲状腺功能亢进症合并白细胞和（或）血小板减少或全血细胞减少；⑥甲状腺功能亢进症合并肝、肾等脏器损害；⑦拒绝手术治疗或有手术禁忌证者；⑧浸润性突眼者。" + }, + { + "question_num": 311, + "query": "患者,男,60岁。心悸怔忡,健忘失眠，多梦，面色不华，舌质淡，脉细，其治法是", + "options": { + "A": "滋阴养心", + "B": "滋补肝肾", + "C": "益气养阴", + "D": "养血安神", + "E": "清胃泻火" + }, + "answer": "D", + "reason": "心脾两虚主要指心血虚,牌气虚,相当于气血两虚,表现如上。治宜补益气血,养心安神。" + }, + { + "question_num": 312, + "query": "患者,女,43岁。左手中指末节红肿10天,疼痛剧烈,呈跳痛,患指下垂时更为明显，局部不可碰触。透光验脓法提示有脓。切开排脓时应选择", + "options": { + "A": "沿甲旁挑开引流", + "B": "在手指侧面做横形切口,以利引流", + "C": "在手指背面做一切口,并拔除指甲", + "D": "在指掌侧面做一纵形切口,必要时可贯穿指端到对侧", + "E": "在手指掌侧面做一纵形切口,并延伸到下一关节,以利引流" + }, + "answer": "D", + "reason": "手指脓肿,应从侧方切开,再根据症状作纵形切口。" + }, + { + "question_num": 313, + "query": "暑淫证候的表现是", + "options": { + "A": "头昏沉，嗜睡，胸脘痞闷", + "B": "口渴饮水，口唇鼻咽干燥", + "C": "发热恶热，汗出，气短神疲", + "D": "突发皮肤瘙痒，丘疹", + "E": "肠鸣腹泻，脘腹拘急冷痛" + }, + "answer": "C", + "reason": "暑淫证候临床表现为发热恶热，开多头昏,烦渴喜冷饮,神疲气短,肢倦乏力,胸懒言，食少呕恶,小便短黄灼热,舌红苔黄少津,脉虚数。或壮热昏仆,神昏谵语,面红气粗,头痛项��,四肢抽搐，舌绛干燥,脉细滑数。" + }, + { + "question_num": 314, + "query": "患者，男，25岁。发热，咳嗽3天。检查：气管位置居中，右胸呼吸动度减弱，右中肺语颤增强，叩诊呈浊音，听诊可闻及湿啰音及支气管肺泡呼吸音。应首先考虑的是", + "options": { + "A": "胸膜炎", + "B": "肺炎", + "C": "气胸", + "D": "肺不张", + "E": "肺结核" + }, + "answer": "B", + "reason": "A项还有胸痛表现，检查：气管位置向患侧偏移；C项有突发的胸痛、胸闷、呼吸困难，患者常高瘦体型，检查：气管位置向患侧偏移，叩诊鼓音，听诊患侧呼吸音减弱或消失；D项常因肺炎、肺癌等引起，伴有胸闷、呼吸困难，检查：气管位置向患侧偏移，听诊呼吸音减弱；E项多有低热、盗汗、消瘦等结核中毒表现，PPD(＋)，ACDE可排除，故选B。" + }, + { + "question_num": 315, + "query": "患者,女,50岁。5年前无明显诱因出现头晕,发作时自觉头部晕眩,步态不稳,休息后症状可有所缓解。平素常感头部昏沉不适伴耳鸣,间断服用中药治疗。3天前患者劳男后再次出现头昏沉不适，休息后症状改善不明显，遂前来就诊。刻下症见:头昏沉不适,活动后加重,神疲乏力，面色偏白,心悸少寐,纳食欠佳,二便调,舌质淡,苔薄白,脉细弱。治疗宜首选", + "options": { + "A": "天麻钩藤饮", + "B": "左归丸", + "C": "半夏白术天麻汤", + "D": "归牌汤", + "E": "通窍活血汤" + }, + "answer": "D", + "reason": "患者头晕反复发作5年,加重3天，诊断为眩晕。患者老年,气血不足,清阳不展,脑失所养,故头部昏沉不适,劳则耗气,故动则加剧,神疲乏力为气虚之象;血不养心,则心悸少寐!脾虚不运,故纳食欠佳。舌质淡,苔薄白,脉细弱,为气血亏虚之象,辩证为气血亏虚证。治法,补益气血,调养心脾。代表方:归脾汤。" + }, + { + "question_num": 316, + "query": "患者,女,31岁。产后头发星斑块状脱落,渐进性加重，毛发稀疏枯槁，触摸易脱;心悸,气短,乏力;舌淡苔白,脉细弱。治宜首选", + "options": { + "A": "八珍汤", + "B": "通窍活血汤", + "C": "七宝美髯丹", + "D": "四物汤", + "E": "六味地黄丸" + }, + "answer": "A", + "reason": "该患者产后头发呈斑块状脱落,且渐进性加重，头发稀疏枯槁，触摸易脱；伴有心悸、气短、乏力;舌质淡,舌苔白,脉象细弱。当为油风之气血两虚证。治疗当益气补血，首选八珍汤。血热风燥证选四物汤合六味地黄丸，气滞血瘀证选通窍活血汤，肝肾不足证宜七宝美髯丹。" + }, + { + "question_num": 317, + "query": "下列临床症状血虚证与血瘀证均可见的是", + "options": { + "A": "心悸", + "B": "脉涩", + "C": "手麻", + "D": "腹痛", + "E": "闭经" + }, + "answer": "E", + "reason": "备选答案中心悸、手麻是血虚心失所养、经络失于濡养的表现。血虚证见脉细无力，血瘀证见脉涩。血虚证、血瘀证均可见闭经，血虚团经因经血乏源所致;而瘀血不去,新血不生,故血瘀证亦可见闭经。" + }, + { + "question_num": 318, + "query": "患者，男，58岁。反复咳嗽、咳痰15年，心悸、气急3年。体检：双肺叩诊呈过清音：呼吸减弱，肺底部有湿啰音，剑突下心尖搏动明显，该处可闻及3/6级收缩期杂音，肺动脉瓣区第二音亢进。该例最可能的诊断为", + "options": { + "A": "慢性支气管炎(慢支)", + "B": "慢支+肺气肿", + "C": "慢支+肺气肿+肺心病", + "D": "慢支+风湿性心瓣膜病", + "E": "慢支+冠心病" + }, + "answer": "C", + "reason": "慢性肺心病的诊断。该患者反复咳嗽、咳痰15年可诊为慢支，双肺叩诊呈过清音，呼吸音减弱，肺底部有湿啰音，剑突下心尖搏动明显，该处可闻及3/6级收缩期杂音，肺动脉瓣区第二音亢进为肺气肿、肺心病体征，故选C。" + }, + { + "question_num": 319, + "query": "患者吞咽梗阻,胸膈痞闷,情志舒畅时可稍减轻,口千咽燥,舌偏红苔薄腻,脉弦滑治疗应首选", + "options": { + "A": "通幽汤", + "B": "涤痰汤", + "C": "温胆汤", + "D": "玉枢丹", + "E": "启膈散" + }, + "answer": "E", + "reason": "噎膈分痰气交阻,津亏热结、瘀血内结、气虚阳微等证型,痰气交阻用启膈散开郁化痰,润燥降气。" + }, + { + "question_num": 320, + "query": "患者,女,25岁。外阴部有成群水疱,互相融合,易破糜烂,灼热痛痒,同时伴有发热，尿频，尿急，尿痛，苔黄，脉弦，其治法是(", + "options": { + "A": "健脾利湿", + "B": "疏风清热", + "C": "清热利湿", + "D": "清泻肝火", + "E": "养��清热" + }, + "answer": "C", + "reason": "外阴部成群水疱,糜烂,灼热,瘙痒，湿热秽浊之气下注于膀胱,局部气血运行不畅,湿热熏蒸,出现尿道刺激症状。诊断为阴部热疮。辨证属湿热下注，治以清热利湿。" + }, + { + "question_num": 321, + "query": "大肠液亏证的主症是", + "options": { + "A": "口干咽燥", + "B": "口臭头晕", + "C": "便干难以排出", + "D": "舌红苔白干", + "E": "脉象细涩" + }, + "answer": "C", + "reason": "大肠液亏证的临床表现为大便秘结干燥,难以排出,常数日一行,口干咽,或伴见口臭头晕等症,舌红少津,脉细涩。本证以大便干燥难于排出为辨证要点。" + }, + { + "question_num": 322, + "query": "患者，男，20岁。持续低热、盗汗2个月，咳嗽，痰中带血。应首先考虑的是", + "options": { + "A": "肺癌", + "B": "肺结核", + "C": "肺脓肿", + "D": "肺梗死", + "E": "支气管扩张" + }, + "answer": "B", + "reason": "患者有典型的结核中毒表现：低热、盗汗。A项见于有吸烟史的年龄较大者，咳嗽咳痰，痰中带血，胸闷气急、胸痛等；C项咳脓臭痰，有发热寒战等感染表现；D项有突发性的胸痛，呼吸困难，E项有反复的咳嗽咳痰、咯血。" + }, + { + "question_num": 323, + "query": "患者,男,50岁。昏仆抽搐吐涎,两目上视,口中如作猪羊叫。平时情绪急躁，心烦失眠,咯痰不爽,口苦而干,舌红苔黄腻,脉弦滑数。治疗应首选", + "options": { + "A": "知柏地黄丸合定痫丸", + "B": "天王补心丹合定痫丸", + "C": "顺气导痰汤合二阴煎", + "D": "龙胆泻肝汤合涤痰汤", + "E": "滋水清肝饮合定痫丸" + }, + "answer": "D", + "reason": "患者昏仆抽搐吐涎,两目上视,口中如作猪羊叫,此为痫病;见“心烦失眠,咯痰不爽,口苦而干,舌红苔黄腻,脉弦滑数\"这类痰火扰神证,应用“龙胆泻肝汤合涤痰汤\"清肝泻火,化痰开窃,故选D。" + }, + { + "question_num": 324, + "query": "患者,男,50岁。右颜面部红肿疼痛伴发热2天,皮色鲜红,色如涂丹,压之褪色,扪之灼手,边界清楚,触痛明显,大便2日未行。治疗应首选", + "options": { + "A": "草薢渗湿汤加减", + "B": "五味消毒饮加减", + "C": "普济消毒饮加减", + "D": "黄连解毒汤加减", + "E": "犀角地黄汤加减" + }, + "answer": "C", + "reason": "风热毒邪犯上,与血分热邪蕴结,郁阻肌肤,故见头面部皮肤焮红灼热，风热毒邪与正气相争,故见恶寒发热;舌红、苔薄黄、脉滑数为邪热尚在表之象。治法:疏风清热解毒。方药:普济消毒饮加减。" + }, + { + "question_num": 325, + "query": "下列哪项是燥邪犯肺证与肺阴虚证的鉴别要点", + "options": { + "A": "有无发热恶寒", + "B": "有无胸痛咳血", + "C": "有无口干咽燥", + "D": "痰量的多少", + "E": "咯痰的难易" + }, + "answer": "A", + "reason": "燥邪犯肺证的临床表现为干咳无痰,或痰少而黏,不易咳出。唇:舌、咽、鼻干燥欠润,轻微发热恶痰,头身酸痛,舌尖红苔薄而干,脉浮细。肺阴虚证的临床表现为咳喘无力,气少不足以息,动则益甚,体倦懒言,声音低怯,痰多清稀,面色觥白,或自汗畏风,易于感冒,舌淡苔白、脉虚弱。二者的区别为燥邪犯肺为燥邪袭表,肺卫失宣,而见轻微发热恶寒。肺阴虚为肺阴亏损,虚热内生,以干咳无痰或痰少而黏与阴虚见症为辨证要点。" + }, + { + "question_num": 326, + "query": "患者，男，50岁。每日吸烟20支已多年。近来经常咳嗽，痰中有血丝，1周前突感呼吸困难。X线透视见右侧胸腔大片致密阴影，胸腔穿刺抽出大量血性胸腔积液。应首先考虑的是", + "options": { + "A": "结核性胸膜炎", + "B": "大叶性肺炎并发胸膜腔积脓", + "C": "肺癌转移至胸膜", + "D": "肺癌并发肺脓肿", + "E": "肺门淋巴结转移癌压迫胸导管" + }, + "answer": "C", + "reason": "患者有吸烟史，且年龄50岁，咳嗽，痰中有血丝，考虑肺癌可能大。同时胸腔穿刺抽出大量血性雄腔腔积液，更支持这一诊断，并且已发生胸膜转移，影响了胸腔积液的代谢，导致胸腔大是积液，故选C。根据胸腔积液的性质可鉴别其他选项。AB项为黄色；D项为脓性；E项为乳白色。" + }, + { + "question_num": 327, + "query": "患者,男,26岁。头痛而胀,发热恶风,面红目赤，大便秘结，口舌生疮，小便色黄，舌质红,苔薄黄,脉浮略数。治疗宜首选", + "options": { + "A": "黄连上清丸", + "B": "芎芷石膏汤加黄芩、薄荷、柴胡", + "C": "芎芷石膏汤加半夏、白术、天麻", + "D": "芎芷石膏汤加知母、花粉���石斛", + "E": "芎芷石膏汤加当归、赤芍、牡丹皮" + }, + "answer": "A", + "reason": "风热头痛证候,头痛而胀,甚则头胀如裂,发热或恶风,面红目赤,口渴喜饮,大便不畅,或便秘,溲赤,舌尖红,苔薄黄,脉浮数。该患者临床表现符合风热头痛。风热头痛代表方为芎芷石膏汤加减。烦热口渴,舌红少津者,可重用石膏,配知母.天花粉清热生津,黄苓、山栀清热泻火;大便秘结,腑气不通,口舌生疮者,可用黄连上消丸泄热通腑。" + }, + { + "question_num": 328, + "query": "患者,女,40岁。双乳肿块界限不清,经前乳房胀痛。伴有月经不调,腰酸乏为，舌质淡红,苔白,脉细。治疗应首选", + "options": { + "A": "左归丸", + "B": "开郁散", + "C": "逍遥贝蒌散", + "D": "二仙汤合四物汤", + "E": "六味地黄汤" + }, + "answer": "D", + "reason": "乳癖多见于青中年妇女,常伴有月经失调、流产史。常同时或相继在两侧乳房内发生多个大小不一的肿块,其形态不规则,或圆或扁,质韧,分散于整个乳房,或局限在乳房的一处。肿块与周围组织分界不清,与皮肤和筋膜无粘连,推之移动。乳癖是以乳房有形状大小不一的肿块,疼痛,与月经周期相关为主要表现的乳腺组织的良性增生性疾病。本证属冲任失调,应以调摄冲任为主,方用二仙汤合用四物汤。" + }, + { + "question_num": 329, + "query": "干呕呃逆，胃脘嘈杂，口干咽燥，舌红少苔，其证候是", + "options": { + "A": "食滞胃脘", + "B": "胃阴虚", + "C": "肝脾不调", + "D": "肝胃不和", + "E": "胃阳虚" + }, + "answer": "B", + "reason": "干呕呃逆为阴虚热扰,胃气上逆。胃脘嘈杂为胃阴不足,则胃阳偏亢,虚热内生,热郁胃中,气不和。口燥咽干为胃阴亏虚，上不能滋润咽喉。舌红少苔是阴虚内热的征象。" + }, + { + "question_num": 330, + "query": "患者，女，40岁。3年前发现患有风湿性心脏病，近半年来，体力活动明显受限，轻度活动即出现心悸，气短，其心功能为", + "options": { + "A": "I级", + "B": "Ⅱ级", + "C": "Ⅲ级", + "D": "IV级", + "E": "以上均非" + }, + "answer": "C", + "reason": "美国纽约心脏病学会（NYHA）1928年心功能分级。I级：患者患有心脏病但活动量不受限制，平时一般活动不引起疲乏、心悸、呼吸困难或心绞痛。Ⅱ级：心脏病患者的体力活动受到轻度的限制，休息时无自觉症状，但平时一般活动下可出现疲乏、心悸、呼吸困难或心绞痛。Ⅲ级：心脏病患者体力活动明显受限，小于平时一般活动即引起上述的症状。Ⅳ级：心脏病患者不能从事任何体力活动。休息状态下也出现心衰的症状，体力活动后加重。" + }, + { + "question_num": 331, + "query": "患者,男,60岁。黎明之前泄泻,腹痛肠鸣即泻,泻后则安,形寒怕冷,舌淡苔白,脉沉，其病机是", + "options": { + "A": "食滞肠胃", + "B": "肾阳虚衰", + "C": "寒湿困牌", + "D": "湿热伤脾", + "E": "肝气乘脾" + }, + "answer": "B", + "reason": "肾阳虚衰泄泻的特点是黎明之前泄泻,形寒怕冷。主要与寒湿客脾鉴别,寒湿泄多便溏，有脾胃被困症状,无五更泻的时间特点。" + }, + { + "question_num": 332, + "query": "张某,女,52岁。左乳癌晚期,破溃外翻如菜花，疮口渗流血水，面色苍自，动则气短,身体瘦弱,不思饮食,舌淡红,脉沉细无力,其治法是", + "options": { + "A": "疏肝解郁", + "B": "扶正解毒", + "C": "调理冲任", + "D": "化痰散结", + "E": "调补气血" + }, + "answer": "E", + "reason": "本病属于乳岩的晚期,肿块溃疡,气血亏虚,所以会面色苍白,动则气短,身体瘦弱，当前之急需要补益气血,才能抵抗邪气。" + }, + { + "question_num": 333, + "query": "具有“发中有补，散中有收，邪正兼顾，祛邪扶正，阴阳并调”配伍特点的方剂是", + "options": { + "A": "桂枝汤", + "B": "麻黄汤", + "C": "止嗽散", + "D": "小青龙汤", + "E": "九味羌活汤" + }, + "answer": "A", + "reason": "桂枝汤主治外感风寒表虚证。全方发中有补,散中有收,邪正兼顾,祛邪扶正,阴阳并调:方中桂枝与芍药用量相等,是本方外可解肌发表,内可调和营卫、调和阴阳的基本结构。" + }, + { + "question_num": 334, + "query": "患者，女，40岁。风心病5年，近半月来胃纳差，恶心，呕吐，肝区疼痛，尿少。查体：颈静脉怒张，心尖区可闻及舒张期杂音，三尖瓣区可闻及收缩期杂音，肝肋下2cm。应首先考虑的是", + "options": { + "A": "肝炎", + "B": "右心衰竭", + "C": "左心衰竭", + "D": "肝硬化", + "E": "全心衰竭" + }, + "answer": "B", + "reason": "心尖区可闻及舒张期杂音为二尖瓣狭窄的特征。颈静脉怒张、肝肋下2cm为体循环淤血，右心衰竭的表现。同时还有因体循环淤血，导致的胃肠道功能系乱，故选B。AD项无心脏杂音表现；C项为肺循环淤血，表现应为端坐呼吸、咳嗽咯痰、粉红色泡沫痰、胸闷心慌、呼吸困难等。" + }, + { + "question_num": 335, + "query": "患者,男,35岁。下痢3个月余,痢下稀薄白冻,腹部隐痛,里急后重,食少神疲,四肢不温，舌淡苔薄白，脉沉细。治疗应首选", + "options": { + "A": "桃花汤", + "B": "驻车丸", + "C": "芍药汤", + "D": "胃苓汤", + "E": "白头翁汤" + }, + "answer": "A", + "reason": "脾肾阳虚,故见上述症状,治宣温补脾肾,用桃花汤,故选A。驻车丸用于阴虚痢。芍药汤用于湿热痢。外苓汤用于寒湿痢。白头翁汤用于疫毒痢。" + }, + { + "question_num": 336, + "query": "患者,女,20岁。结喉两侧弥漫性肿大,边界不清。皮色如常,无疼痛,诊为气瘳。治疗应首选", + "options": { + "A": "海藻玉壶汤", + "B": "四海舒郁丸", + "C": "柴胡清肝汤", + "D": "逍遥散", + "E": "十全流气饮" + }, + "answer": "B", + "reason": "情志不畅,肝郁气滞,肝失调达,脾失健运,水湿停留,聚而为痰;痰气互凝,结于颈靥,故颈粗瘿肿;气本无形,怒则气长,喜则气消,故肿胀呈弥漫性而边界不清,治法宜疏肝理气,解郁消肿。当用四海舒郁丸加减。A项治疗肉瘿,B项治疗气瘿,其他选项只是治疗肝郁证,针对瘿病一般只是作为辅助治疗。" + }, + { + "question_num": 337, + "query": "呕吐吞酸，胸胁胀满，嗳气频作，脘闷食少，其证候是", + "options": { + "A": "食滞胃脘", + "B": "胃阴虚", + "C": "肝脾不调", + "D": "肝胃不和", + "E": "胃阳虚" + }, + "answer": "D", + "reason": "肝气犯胃者,肝郁化火,横逆犯胃,肝胃气机不畅,则胃脘胁肋胀闷疼痛:气郁化火,胃失和降,则嗳气吞酸,呃逆呕吐;肝失条达,心神不宁,则烦躁易怒;舌红苔薄黄,脉弦为肝气郁而化火之象。" + }, + { + "question_num": 338, + "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，血沉30mm/h，抗“O”800单位。治疗应首选", + "options": { + "A": "糖皮质激素", + "B": "阿司匹林", + "C": "吲哚美辛", + "D": "硫唑嘌呤", + "E": "环磷酰胺" + }, + "answer": "B", + "reason": "抗“〇”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，血沉快，可以诊断为风湿热。治疗常用的药物有水杨酸制剂和糖皮质激素，但对无心脏炎的患者不必使用糖皮质激素，故选B。" + }, + { + "question_num": 339, + "query": "患者发病急骤,痢下鲜紫脓血,腹痛剧烈,里急后重较甚。壮热口渴,舌红绛苔黄燥，脉滑数,其诊断是", + "options": { + "A": "湿热痢", + "B": "疫毒痢", + "C": "休息痢", + "D": "寒湿痢", + "E": "以上均非" + }, + "answer": "B", + "reason": "患者发病急骤,痢下鲜紫脓血,腹痛剧烈,可诊断为\"疫毒痢”应\"清热解毒,凉血除积\",用白头翁汤。" + }, + { + "question_num": 340, + "query": "患者,女,38岁。喉结有侧可及3cmX3cmx3cm肿物,表面光滑，质韧，无压痛。随吞咽上下移动。应首先考虑的是(了", + "options": { + "A": "气瘿", + "B": "肉瘿", + "C": "血瘿", + "D": "石瘿", + "E": "瘿痈" + }, + "answer": "B", + "reason": "气瘿是颈前漫肿,边缘不清,皮色如常,按之柔软;石瘿多见于40岁以上患者,多年存在的颈部肿块，突然迅速增大,坚硬如石表面凹凸不平，随吞咽动作而上下的移动度减少,或固定不移;瘿痈是以急性发病,结喉两侧结块,肿胀,色红灼热,疼痛为主要表现的急性炎症性疾病。根据排除法可以排除其他选项,故选B。" + }, + { + "question_num": 341, + "query": "血燥生风的病理表现，主要是", + "options": { + "A": "筋惕肉𥆧，肢麻震颤，眩晕欲仆等", + "B": "痉厥，抽搐，鼻翼扇动，目睛上吊等", + "C": "痉挛肉，手足蠕动", + "D": "肢体麻木不仁，筋肉跳动，甚则手足拘挛不伸", + "E": "皮肤干燥或肌肤甲错，或皮肤瘙痒或落皮屑" + }, + "answer": "E", + "reason": "血燥生风是指血虚津亏,失润化燥,肌肤失于濡养而致干燥瘙痒及脱屑的病理变化。主要表现为皮肤干燥或肌肤甲错,或皮肤瘙痒或落皮屑;头发多屑,颜色灰白,状如雪落,头发干枯,易于脱落,舌质淡红，舌苔薄白,脉象浮数。" + }, + { + "question_num": 342, + "query": "患者，女，30岁。患风湿热10年，诊断为风心病5年。检查：心尖部可闻及舒张期隆隆样杂音。X线显示左心房增大。应首先考虑的是", + "options": { + "A": "二尖瓣关闭不全", + "B": "二尖瓣狭窄", + "C": "主动脉瓣关闭不全", + "D": "主动脉瓣狭窄", + "E": "肺动脉瓣狭窄" + }, + "answer": "B", + "reason": "正常状态下，心室舒张期二尖瓣开放，血液自左心房流人左心室，若二尖瓣狭窄，则心尖部可闻及舒张期隆隆样杂音，为二尖瓣狭窄的特征性描述。风心病可有瓣膜赘生物而引起二尖瓣狭窄。" + }, + { + "question_num": 343, + "query": "患者,男,56岁。大便秘结,排出困难,面色无华,头晕目眩,心悸,舌淡,苔白,脉细涩,其诊断是", + "options": { + "A": "气虚便秘", + "B": "血虚便秘", + "C": "阴虚便秘", + "D": "冷秘", + "E": "气秘" + }, + "answer": "B", + "reason": "血虚的特点是面色无华,头晕目眩，心悸,舌淡,脉细涩，" + }, + { + "question_num": 344, + "query": "患者,男,30岁。便干,便后出.血并疼痛1周。检查:肛门外观可见截石位6点有一梭形裂口通向肛内,创面不深,边缘整齐，其分类应是", + "options": { + "A": "内痔", + "B": "外痔", + "C": "肛窦炎", + "D": "早期肛裂", + "E": "陈旧性肛裂" + }, + "answer": "D", + "reason": "肛裂临床上以周期性疼痛、出血、便秘为特点;发病时间短,创面不深，边缘整齐是早期肛裂的特征。" + }, + { + "question_num": 345, + "query": "脉象见动脉的主病是", + "options": { + "A": "宿食", + "B": "诸虚", + "C": "痛证", + "D": "血瘀", + "E": "风证" + }, + "answer": "C", + "reason": "动脉的主病。动脉主痛证和惊证。痛则阴阳不和,气为血所阻滞,惊则气血紊乱,脉行踩动不安,故见动脉。" + }, + { + "question_num": 346, + "query": "患者，女，17岁。不明原因的发热、牙龈出血1周。查体发现贫血，颌下及腹股沟淋巴结肿大，胸骨压痛，肝脏肋下2指。应首先考虑的是", + "options": { + "A": "败血症", + "B": "淋巴结结核", + "C": "再生障碍性贫血", + "D": "急性白血病", + "E": "急性病毒性肝炎" + }, + "answer": "D", + "reason": "急性白血病主要表现为脸色苍白自觉虚弱无力、多汗，容易感觉气促、心跳加快；半数以上的患者以发热为早期表现。发热时往往有鼻塞、流涕、咳嗽、咳痰等呼吸道感染的症状，或尿频、尿急等泌尿道感染症状。另外，有的患者出现原因不明的无痛性淋巴结肿大，以出血为早期表现者也有近40%，伴胸骨疼痛。患者出血、发热、贫血、淋巴结肿大，胸骨压痛，肝大。初步考虑为急性白血病。" + }, + { + "question_num": 347, + "query": "患者胸胁胀痛,走窜不定,情绪不佳则加重。胸闷气短,暖气频作,舌苔薄,脉弦,其证候是", + "options": { + "A": "肝胃不和", + "B": "肝络瘀阻", + "C": "肝气郁结", + "D": "肝郁化热", + "E": "肝脾不调" + }, + "answer": "C", + "reason": "胸胁胀痛,走窜不定,此为肝气郁结证,应用柴胡疏肝散疏肝理气。" + }, + { + "question_num": 348, + "query": "患者,男,27岁。1周前因外伤出现右手食指红肿热痛,肿胀呈圆柱状,皮色光亮,关节轻度屈曲,不能伸展,现局部跳痛明显,拟切开排脓。应选择的切口部位是", + "options": { + "A": "指掌侧面", + "B": "指掌正中", + "C": "手指侧面", + "D": "手指正中", + "E": "食指关节处" + }, + "answer": "C", + "reason": "蛇肚疔宜在手指侧面做纵形切口切口，长度不得超过上下指关节面，" + }, + { + "question_num": 349, + "query": "患者，全头胀痛，急躁易怒，口苦胁痛，面红目赤，便秘尿赤，舌边尖红，苔黄，脉弦数。宜首选的药物为", + "options": { + "A": "全蝎、蜈蚣", + "B": "磁石、牡蛎", + "C": "龙胆、栀子", + "D": "天麻、石决明", + "E": "川芎、川牛膝" + }, + "answer": "C", + "reason": "急躁易怒,面红目赤,舌边尖红,苔黄为实火证的表现,故选龙胆、栀子。" + }, + { + "question_num": 350, + "query": "患者，女，26岁。被人发现时躺在房间地上，呈昏迷状态。体格检查：神志不清，两瞳孔针尖大小，口角流涎，口唇紫绀，两肺满布水泡音，心率60次/分，肌肉震颤，其诊断是", + "options": { + "A": "疯痫大发作", + "B": "严重心律失常", + "C": "左心功能衰竭", + "D": "有机磷农药中毒", + "E": "安眠药中毒" + }, + "answer": "D", + "reason": "有机磷农药��毒会有神志不清，两瞳孔针尖大小（为主要诊断依据），口角流涎，口唇紫绀；两肺满布水泡音，肌肉震颤等表现。" + }, + { + "question_num": 351, + "query": "患者,女,57岁。有15年肺胀病史。1周前,劳累后出现颜面水肿,呼吸喘促难续，心悸,胸脘痞闷,尿少,怕冷,纳呆,舌苔白滑,脉沉细。治疗应首选", + "options": { + "A": "济生肾气丸", + "B": "真武汤", + "C": "实脾饮", + "D": "参附汤", + "E": "金匮肾气丸" + }, + "answer": "B", + "reason": "肺胀患者面浮尿少,怕冷,脉沉,可见肺病及肾,心肾阳虚,当以真武汤温阳利水,可配合五苓散加强利尿消肿的作用。" + }, + { + "question_num": 352, + "query": "患者,男,58岁。左耳后肿块溃破年余,只流血水,其味臭秽,疮口凹凸不平,肿硬如岩石,形体消瘦,面色无华,唇舌质淡红,脉细无力。治疗应首选", + "options": { + "A": "和营散坚丸", + "B": "化痰开郁方", + "C": "香贝养荣汤", + "D": "阳和汤", + "E": "八珍汤" + }, + "answer": "E", + "reason": "根据患者临床表现可诊断为失荣。面色无华,唇舌淡红,脉细无力均为气血亏虚之象,证属气血两亏证。治法:补益气血,解毒化瘀。代表方:八珍汤合四妙勇安汤加减。" + }, + { + "question_num": 353, + "query": "患者，女，28岁。平素体健。曾有惊吓史。现症见：心悸，善惊易恐，坐卧不安，失眠多梦，舌苔薄白，脉虚数。查体：心率122次/分，余未见异常。检查：心电图示阵发性室上性心动过速。最佳治疗方法是", + "options": { + "A": "镇惊定志，养心安神", + "B": "补血养心，益气安神", + "C": "滋阴清火，养心安神", + "D": "益气养阴，养心安神", + "E": "清热化痰，宁心安神" + }, + "answer": "A", + "reason": "善惊易恐,因受惊而心悸,为心悸心虚胆怯证。治以镇惊定志，养心安神为法,用安神定志丸。" + }, + { + "question_num": 354, + "query": "患者，男，28岁。上腹部灼痛1年，饥饿时加重，进食后可缓解，伴泛酸。查体：上腹部稍偏右有压痛。应首先考虑的是", + "options": { + "A": "慢性胃炎", + "B": "慢性胆囊炎", + "C": "十二指肠溃疡", + "D": "胰腺炎", + "E": "胃癌" + }, + "answer": "C", + "reason": "该患者青年男性，上腹部灼痛，饥饿时加重，进食后缓解，并有反酸等症状，上腹部有压痛，考虑十二指肠溃疡可能性大，故选C。D项进食后疼痛加重。" + }, + { + "question_num": 355, + "query": "患者,男,48岁。遍体浮肿,皮肤绷紧光亮,胸脘痞闷，烦热口渴，小便短赤，太便干结,舌红苔黄腻,脉数。治疗应首选", + "options": { + "A": "真武汤", + "B": "参苓白术散", + "C": "实脾饮", + "D": "五皮饮合胃苓汤", + "E": "疏凿饮子" + }, + "answer": "E", + "reason": "该患者为水肿阳水之湿热壅盛证，治宜分利湿热,方选疏凿饮子加减。" + }, + { + "question_num": 356, + "query": "患儿,颈部左侧触及一个约2cmx2cm肿块,皮肤红灼热,肿势高突,压痛明显，发热不退，其治法是", + "options": { + "A": "清热疏风,解毒化痰", + "B": "清热疏风,托里透脓", + "C": "清热疏风,泻火解毒", + "D": "清热疏风，利湿消肿", + "E": "滋阴清热,托里透脓" + }, + "answer": "A", + "reason": "颈痈具有明显的风温外感症状，内治清热疏风、解毒化痰,达到消肿止痛的目的。" + }, + { + "question_num": 357, + "query": "患者失眠，健忘，心悸，自汗出。治疗应选用", + "options": { + "A": "朱砂", + "B": "酸枣仁", + "C": "合欢皮", + "D": "远志", + "E": "磁石" + }, + "answer": "B", + "reason": "朱砂清心镇惊,安神解毒。合欢皮解郁安神,活血消肿。远志宁心安神,祛痰开窍,消散痈肿。磁石镇惊安神,平肝潜阳,聪耳明目,纳气定喘。患者失眠、健忘是因血不养神,治宜养血,自汗治宜敛汗。酸枣仁养心益肝,安神,敛汗。" + }, + { + "question_num": 358, + "query": "患者，男，48岁。近1个月来，因上腹部不适，食欲减退，体重减轻而疑诊为胃癌。为确诊，首选的检查方法是", + "options": { + "A": "瘤胚抗原测定", + "B": "大便隐血试验", + "C": "胃液分析", + "D": "X线钡餐检查", + "E": "胃镜检查" + }, + "answer": "E", + "reason": "癌胚抗原测定、胃液分析、大便隐血试验、X线钡餐检查均不能作为胃癌的特异性诊断标准，胃癌不一定见癌胚抗原测定、胃液分析、大便隐血试验、X线钡餐异常，胃镜为诊断早期胃癌的特异性诊断，故选E。" + }, + { + "question_num": 359, + "query": "患者,女,42岁。眩晕昏蒙,头重如裹:胸闷恶心,纳呆多寐,舌苔白腻,脉濡滑,其病机是", + "options": { + "A": "风湿", + "B": "气虚", + "C": "血虚", + "D": "痰浊", + "E": "肾虚" + }, + "answer": "D", + "reason": "痰浊上蒙神窃,故见眩晕昏蒙,头重如裹;痰浊中阻,故胸闷恶心,纳呆多寐。" + }, + { + "question_num": 360, + "query": "患者,女,48岁。颈前肿物,生长迅速，质地较硬,轻度疼痛,表面不平,推之不动,声音嘶哑。随吞咽活动减弱，同位素11扫描显示为冷结节。应首选的治疗措施是", + "options": { + "A": "中药外敷", + "B": "中药内服", + "C": "中药内服、外敷", + "D": "内服、外敷、熏洗", + "E": "手术治疗" + }, + "answer": "E", + "reason": "石瘿一经确诊,宜早期施行根治性切除术,其他的都是术后或术前的辅助疗法,或者保守治疗。" + }, + { + "question_num": 361, + "query": "患者，男，55岁。急躁易怒，怒时胸胁灼痛，甚则咳逆咯血，其证候是", + "options": { + "A": "金不生水", + "B": "心火灼肺", + "C": "肺金本虚", + "D": "土不生金", + "E": "木火刑金" + }, + "answer": "E", + "reason": "易怒、怒时胸胁灼痛,属肝火,咳逆咯血,为肝火犯肺,肝五行属木,肺五行属金,故证候为木火刑金。" + }, + { + "question_num": 362, + "query": "患者，男，50岁。十二指肠溃疡史5年，今日突然呕血伴休克。应首先采取的抢救措施是", + "options": { + "A": "补充血容量", + "B": "口服去甲肾上腺素水", + "C": "静脉滴注酚磺乙胺", + "D": "静滴西咪替丁", + "E": "冰水洗胃" + }, + "answer": "A", + "reason": "补充血容量是治疗失血性休克的首要措施。" + }, + { + "question_num": 363, + "query": "患者平素头晕头痛,突然昏倒,不省人事,有半侧身体不遂。牙关紧闭,面红身热,舌红苔黄腻,脉弦滑数,其诊断是", + "options": { + "A": "中风(中经络络脉空虚风邪人中)", + "B": "中风(中经络肝肾阴虚风阳上扰)", + "C": "中风(中脏腑闭证阳闭)", + "D": "中风(中脏腑闭证阴闭)", + "E": "中风(中脏腑脱证)" + }, + "answer": "C", + "reason": "有神志障碍为中脏腑。牙关紧闭为闭证。有热象为阳闭。" + }, + { + "question_num": 364, + "query": "患者,男,35岁。吸烟15年,出现右下肢麻木、发凉、间歇性跛行8年。患者初次就诊时，下列哪项措施最重要", + "options": { + "A": "使用抗生素", + "B": "使用激素", + "C": "使用免疫抑制剂", + "D": "嘱患者保暧", + "E": "嘱患者戒烟" + }, + "answer": "E", + "reason": "周围血管病。烟毒是导致周围血管病的重要因素,此类患者应当禁止吸烟。" + }, + { + "question_num": 365, + "query": "患者，男，29岁。全身皮肤发黄，伴有发热，头痛，恶心，呕吐，舌质红，舌苔黄腻，脉弦滑。治疗应选用", + "options": { + "A": "车前子", + "B": "茵陈蒿", + "C": "泽泻", + "D": "地肤子", + "E": "冬瓜皮" + }, + "answer": "B", + "reason": "茵陈苦、微寒,归脾、胃、肝、胆经,有清利湿热,利胆退黄的功效,用于黄疸,湿温,湿疹湿疮。" + }, + { + "question_num": 366, + "query": "患者咳嗽。查体：气管向左偏移，右侧胸廓较左侧饱满，叩诊出现鼓音。应首先考虑的是", + "options": { + "A": "右侧气胸", + "B": "左侧肺不张", + "C": "右下肺炎", + "D": "肺气肿", + "E": "右侧胸腔积液" + }, + "answer": "A", + "reason": "气胸时，器官向健侧移位，患侧胸部隆起，叩诊呈过清音或鼓音，听诊呼吸音减弱或消失。" + }, + { + "question_num": 367, + "query": "患者因皮肤疮痰破溃而引发水肿，肿势自颜面渐及全身，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": "肺主皮毛,脾主肌肉,肌肤疮痍湿毒内归肺脾,肺不能通调水道,脾不能运化水湿,故水湿浸淫肌肤而致水肿,小便不利。治宜宣肺解毒,利湿消肿,用麻黄连翘赤小豆汤合五味消毒饮,故选B。风水泛滥用越婢加术汤合桑白皮汤,湿热壅盛肿势严重用五皮散,阴虚有热用猪苓汤,牌阳虚衰用实脾饮。" + }, + { + "question_num": 368, + "query": "患者,女,28岁。右口角疔疮2天,根深坚硬,形如钉丁状,热红肿,疼痛,张口不便,伴恶寒发热，舌苔腻,脉滑数。治疗应首选", + "options": { + "A": "五味消毒饮", + "B": "清暑汤", + "C": "防风通圣散", + "D": "普济消毒饮", + "E": "银翘散" + }, + "answer": "A", + "reason": "焮热红肿,恶寒发热,脉数均为热象,加之疼痛,张口不便等可断定为热毒蕴结证，治则清热解毒。方用五味消毒饮。" + }, + { + "question_num": 369, + "query": "患者面色萎黄，眩晕，心悸，失眠，月经不调，兼见耳鸣，舌淡，脉弱。治疗应首选", + "options": { + "A": "骨碎补", + "B": "补骨脂", + "C": "枸杞子", + "D": "熟地黄", + "E": "黄精" + }, + "answer": "D", + "reason": "熟地黄甘、微温,归肝、肾经,有补血滋阴,益精填髓的功效,用于血虚萎黄,眩晕,心悸失眠,月经不调,崩漏等证。本品为补血要药,还可用于肾阴不足的骨蒸、潮热盗汗、遗精、消渴等,肝肾精血亏虚的腰膝酸软、眩朵耳鸣、须发早白等。" + }, + { + "question_num": 370, + "query": "患者，女，32岁。近2年来间断发生尿路刺激症状，不发热。尿液检查可见白细胞与颗粒管型。应首先考虑的是", + "options": { + "A": "急性肾炎", + "B": "慢性肾炎", + "C": "急性肾孟肾炎", + "D": "慢性肾盂肾炎", + "E": "急性膀胱炎" + }, + "answer": "D", + "reason": "肾孟肾炎常见于女性，致病菌可经短而直的尿道口逆行性感染，临床表现为尿路刺激征，尿检见炎症细胞与颗粒管型。患者病程2年间断发作，故选D。" + }, + { + "question_num": 371, + "query": "患者,男,26岁。腹痛即泻,泻下急迫或泻而不爽,粪色黄褐,质地黏稠,气味臭秽，肛门灼热,心烦口渴,小便短赤,舌质红,苔黄腻,脉滑数或濡数。应为", + "options": { + "A": "泄泻:湿热泄泻,用葛根芩连汤", + "B": "泄泻:风寒泄泻,用胃苓汤合藿香正气散", + "C": "痢疾:大肠湿热,用白头翁汤", + "D": "痢疾:寒湿痢,用胃苓汤加味", + "E": "霍乱:中阳不运,用附子理中汤" + }, + "answer": "A", + "reason": "泄泻湿热伤中证证候:泄泻腹痛,泄下急迫,或泄而不黄,粪色黄褐,气味臭秽,肛门灼热，烦热口渴,小便短黄,舌质红,苔黄腻,脉滑数或濡数。该患者临床表现符合泄泻湿热伤中证,可用葛根芩连汤清热燥湿,分利止泻。" + }, + { + "question_num": 372, + "query": "患者,男,60岁。双下肢发凉麻木已有2年。时有小腿部抽痛及间歇性跛行，近1月余足痛转为持续性静止痛,夜间痛剧，不能人睡,双足背动脉搏动消失,其诊断是", + "options": { + "A": "痛风", + "B": "雷诺病", + "C": "糖尿病足", + "D": ".动脉硬化性闭塞症", + "E": "血栓闭塞性脉管炎" + }, + "answer": "D", + "reason": "动脉硬化性闭塞症,即中医的脱疽，据双下肢发凉麻木2年,时有小腿部抽痛及间歇性跛行即可诊断;持久性静止性足痛,足背动脉搏动消失均为二期表现。" + }, + { + "question_num": 373, + "query": "患者食积气滞，脘腹胀满，大便秘结。治疗宜选用", + "options": { + "A": "使君子", + "B": "苦楝皮", + "C": "雷丸", + "D": "槟榔", + "E": "贯众" + }, + "answer": "D", + "reason": "槟榔辛、苦、温,有祛虫消积,行气利水的功效,用于多种肠道寄生虫病,食积气滞,泻痢后重,水肿,脚气肿痛。" + }, + { + "question_num": 374, + "query": "患者，男，48岁。近3年来疲劳乏力，食欲减退。间歇性鼻出血，齿龈出血。今晨进硬食后，突然呕血，并出现黑便。检查：血压明显下降，心率120次/分，腹部膨隆，有移动性浊音，肝脾触诊不满意。应首选的止血措施是", + "options": { + "A": "肌注卡巴克洛", + "B": "静滴氨甲环酸", + "C": "冰水洗胃", + "D": "三腔管压迫", + "E": "迅速补充血容量" + }, + "answer": "B", + "reason": "分析患者的临床表现、体征，考虑肝硬化出血可能大，且已有侧支循环建立、腹水等肝硬化失代偿表现，凝血功能障碍。止血应首选对全身凝血功能有改善的治疗，故选B。" + }, + { + "question_num": 375, + "query": "患者小便点滴不畅,烦渴欲饮,咽千咳嗽,舌苔薄黄,脉数。治疗应首选", + "options": { + "A": "八正散", + "B": "导赤散", + "C": "沉香散", + "D": "代抵当丸", + "E": "清肺饮" + }, + "answer": "E", + "reason": "肺热壅盛,失于肃降,不能通调水道,下输膀胱,故小便点滴不畅。肺热上壅,故烦渴欲饮,咽干咳嗽,舌苔薄黄,脉数。治宜清肺热,通水道，方用清肺饮。八正散用于膀胱湿热证。导赤散用于心火上炎。沉香散用于肝郁气滞。代抵当丸用于尿道阻塞。" + }, + { + "question_num": 376, + "query": "患者,男,38岁。两手出现皮下��水疱,疱壁破裂,叠起白皮,中心已愈,四周续起疱疹,诊断为鹅学风。外治应首选", + "options": { + "A": "雄黄膏", + "B": "皮脂膏", + "C": "疯油膏", + "D": "青熊膏", + "E": "复方土槿皮酊" + }, + "answer": "E", + "reason": "鹅掌风相当于西医的手癣,男女老幼均可染病,以成年人多见。多数单侧发病,也可染及双手。以掌心或指缝水疱或掌部皮肤角化脱屑、水疱为皮损特点。本型可选用1号癣药水、2号癣药水或复方土槿皮酊外搽。糜烂型可以皮脂膏或雄黄膏外搽，" + }, + { + "question_num": 377, + "query": "患者，皮肤，白睛色黄明润，小便色黄如浓茶，大便秘结，舌苔黄腻，脉滑数。最宜与茵陈配伍使用的药物是", + "options": { + "A": "黄芩", + "B": "黄连", + "C": "干姜", + "D": "大黄", + "E": "龙胆" + }, + "answer": "D", + "reason": "黄疸阳证又有大便秘结,故用大黄与茵陈配伍。" + }, + { + "question_num": 378, + "query": "患者，男，26岁。淋雨后寒战，发热，咳嗽。咯铁锈色痰，胸痛。查体：口唇周围有单纯疱疹，叩诊右下肺轻度浊音，听诊呼吸音减低。应首先考虑的是", + "options": { + "A": "急性支气管炎", + "B": "肺结核", + "C": "急性肺脓肿", + "D": "肺炎球菌肺炎", + "E": "病毒性肺炎" + }, + "answer": "D", + "reason": "肺炎球菌肺炎由于渗出到肺泡内的红细胞破坏后释放出含铁血黄素，混在痰中，故出现铁锈色痰。" + }, + { + "question_num": 379, + "query": "患者,男,45岁。神思恍惚,梦魂颠倒,心悸易惊,普悲欲哭,肢体困乏,饮食减少。舌质淡,脉细无力，其治法是", + "options": { + "A": "健脾养心,益气活血", + "B": "健脾养心,化痰解郁", + "C": "益气养血，化浊祛痰", + "D": "健脾养心,益气安神", + "E": "益气和胃,养心安神" + }, + "answer": "D", + "reason": "五志过极,心气耗伤,营血不足,以致心神失养,故见精神恍惚,心神不宁,心神惑乱,不能自主,故见悲忧善哭,时时欠伸。此病又名脏躁,治宜养心安神。" + }, + { + "question_num": 380, + "query": "患者,男,27岁。颈项部皮肤增厚,瘙痒反复发作1年余,局部皮肤成苔藓化,其诊断是", + "options": { + "A": "风热疮", + "B": "风瘙痒", + "C": "牛皮癣", + "D": "白屑风", + "E": "慢性湿疮" + }, + "answer": "C", + "reason": "牛皮癣是一种患部皮肤状如牛项之皮,厚而且坚的慢性瘙痒性皮肤病。因其好发于颈项部,初起多为风湿热之邪阻滞肌肤,或颈项多汗,硬领摩擦等所致。风热疮是一种斑疹色红如玫瑰，脱眉如糠秕的急性自限性皮肤病。慢性湿疮多有急性湿疮的发病过程,皮损以肥厚粗糙为主,伴有出疹、水疱、糜烂、渗出,边界欠清,病变多在四肢屈侧。风瘙痒日久皮肤可出现肥厚、苔藓样变、色素沉着以及湿疹样变。" + }, + { + "question_num": 381, + "query": "患者面色苍白，时而泛红如妆，其证型是", + "options": { + "A": "实热内炽", + "B": "阴虚火旺", + "C": "肝胆湿热", + "D": "真寒假热", + "E": "真热假寒" + }, + "answer": "D", + "reason": "戴阳证,是因久病肾阳虚衰,阴寒内盛,阴盛格阳,虚阳上越所致。可见面色苍白,时而泛红如妆,非满面通红,证真寒假热。" + }, + { + "question_num": 382, + "query": "患者，男，45岁。近日发现大便色黑，伴不规则上腹痛。检查：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": "柏油样便或呕血见于上消化道出血，如消化性溃疡、胃癌、癌致食道静脉曲张破裂。鲜血便见于下消化道出血，如慢性溃疡性结肠炎、克罗恩病、肠结核、结肠癌等。" + }, + { + "question_num": 383, + "query": "患者,女,26岁。平素急躁,一周来自觉胁腹胀满,小便不畅,尿是减少,舌红苔薄黄,脉弦。下列处方中最佳为", + "options": { + "A": "逍遥散", + "B": "八正散", + "C": "石苇散", + "D": "柴胡疏肝散", + "E": "沉香散" + }, + "answer": "E", + "reason": "该患者为癃闭肝郁气滞证,治宜疏利气机,通利小便,方选沉香散加减。" + }, + { + "question_num": 384, + "query": "患者,男,39岁。尿道虫有白色分泌物滴出3年,伴腰膝酸软,头晕目眩,失眠多梦,遗精,舌质红,少苔,脉细数。治疗宜首选", + "options": { + "A": "右归丸", + "B": "左归丸", + "C": "分消饮", + "D": "���胆泻肝丸", + "E": "知柏地黄丸" + }, + "answer": "E", + "reason": "该患者为慢性前列腺炎阴虚火旺证,治法为滋阴降火,代表方剂为知柏地黄汤加减。" + }, + { + "question_num": 385, + "query": "患者胸部刺痛，固定不移，人夜更甚，时或心悸不宁，舌质紫暗，脉沉涩。治疗应选用", + "options": { + "A": "艾叶", + "B": "白及", + "C": "三七", + "D": "槐花", + "E": "小蓟" + }, + "answer": "C", + "reason": "本题患者瘀血阻络,不通则痛,应选用活血通络的药物。艾叶温经止血，排除A。白及收敛止血,排除B。槐花凉血止血，排除D。小蓟凉血止血,排除E。三七化瘀止血,活血定痛,故选C。" + }, + { + "question_num": 386, + "query": "患者，女，26岁。近1个月来，以夜间咳嗽为主，痰中带血丝，伴低热，盗汗。应首先考虑的是", + "options": { + "A": "肺结核", + "B": "支气管扩张", + "C": "肺癌", + "D": "风湿性心脏病(二尖瓣狭窄)", + "E": "急性肺水肿" + }, + "answer": "A", + "reason": "肺结核咳嗽以夜间较重，常可出现低热、盗汗和咯血的表现。而肺癌多见于40岁以上嗜烟男性，多出现刺激性咳嗽；支气管扩张有慢性咳嗽、咯痰和反复咯血史；二尖瓣狭窄引起的夜间咯血（或粉红色泡沫痰）多出现阵发性夜间呼吸困难等，而一般不伴盗汗、低热；急性肺水肿的表现与二尖瓣狭窄引起夜间咯血相似，但不会持续1个月夜间咳嗽。" + }, + { + "question_num": 387, + "query": "患者胸胁支满,心下痞闷,胃中有振水音,食后胃胀明显,经常呕吐清水痰涎，心悸头晕,形体逐渐消瘦,舌苔白滑,脉弦细而滑,其诊断是", + "options": { + "A": "痰饮,脾阳虚弱", + "B": "悬饮,络气不和", + "C": "溢饮,寒饮内伏", + "D": "支饮,寒饮伏肺", + "E": "悬饮,饮停胸胁" + }, + "answer": "A", + "reason": "饮留骨肠为痰饮。呕吐清水痰涎，心悸头晕,形体逐渐消瘦,舌苔白滑,脉弦细而滑,为脾阳虚表现。" + }, + { + "question_num": 388, + "query": "患者,女,22岁,未婚。经期延后,量少、色暗、有血块,腹痛喜热,畏寒,舌暗苔白,脉沉紧,其治法是", + "options": { + "A": "暖宫止痛调经", + "B": "理气止痛调经", + "C": "活血行气调经", + "D": "扶阳祛寒调经", + "E": "温经散寒调经" + }, + "answer": "E", + "reason": "由题干经期延后,量少、色暗、有血块,腹痛喜热,畏寒,舌暗苔白,脉沉紧可判断为月经后期实寒证,故治法为温经散寒调经。" + }, + { + "question_num": 389, + "query": "患者腰痛以酸软为主，喜按喜揉，腰膝无力，遇劳更甚，卧则减轻。治疗应选用", + "options": { + "A": "牛膝", + "B": "桃仁", + "C": "红花", + "D": "郁金", + "E": "鸡血藤" + }, + "answer": "A", + "reason": "桃仁用治瘀血阻滞诸证,肺痈、肠痈,肠燥便秘,咳嗽气喘,排除B。红花用治血滞经闭痛经,痕积聚,胸痹心痛,排除C。郁金用治气滞血痛证,热病神昏,吐血、倒经,肝胆湿热黄疸,排除D。鸡血藤用治月经不调,痛经,闭经,风湿痹证,手足麻木,排除E。牛膝用治瘀血阻滞经闭、痛经,腰膝酸痛,下肢瘫软,淋证,水肿,小便不利,故选A。" + }, + { + "question_num": 390, + "query": "患者，女，24岁。有先天性乳头凹陷史。近1月来发现右乳晕内侧有一直径约3cm肿块，局部疼痛不适，形态不规则，边界尚清，质地硬韧，挤压后可见白色油脂样物质自乳头泌出。应首先考虑的是", + "options": { + "A": "乳晕部痈疖", + "B": "乳腺癌", + "C": "浆细胞性乳腺炎", + "D": "导管内乳头状瘤", + "E": "乳房部漏管" + }, + "answer": "C", + "reason": "浆细胞性乳腺炎，即中医的“粉刺性乳痈”，其特点是多在非哺乳期或非妊娠期发病，常有乳头凹陷或溢液，初起肿块多位于乳晕部，化脓溃破后夹有脂质样物质，易反复发作形成漏管，经久难愈。" + }, + { + "question_num": 391, + "query": "患者,男,40岁。多食易饥3个月,消瘦5kg,口千渴,大便千燥,舌苔黄,脉滑实有力，其诊断是", + "options": { + "A": "消渴(上消肺热津伤)", + "B": "消渴(中消胃热炽盛)", + "C": "消渴(下消肾阴亏虚)", + "D": "消渴(下消阴阳两虚)", + "E": "便秘(热秘)" + }, + "answer": "B", + "reason": "消渴中消胃热炽盛以多食易饥、消瘦为特点。上消肺热津伤以烦渴引饮、口舌干燥为特点.下消肾阴亏虚以尿频量多、浊如膏脂为特点。阴阳两虚以多饮多尿,并见寒象其寒为特点。" + }, + { + "question_num": 392, + "query": "患者,女,34岁,已婚。经行先后不定,经量多、色红、��稠,少腹胀痛,乳房胀痛,舌暗红苔薄黄,脉弦。治疗应首选", + "options": { + "A": "逍遥散", + "B": "小柴胡汤", + "C": "加味逍遥散", + "D": "血府逐瘀汤", + "E": "当归芍药散" + }, + "answer": "A", + "reason": "由题干经行先后不定辨病为月经先后无定期,由经量多、色红、质稠,少腹胀痛,乳房胀痛，舌暗红苔薄黄，脉弦辨证为肝郁证,代表方药为逍遥散。" + }, + { + "question_num": 393, + "query": "患者，女，38岁。咳嗽声重，咳痰稀白，恶寒无汗，舌苔薄白，脉浮紧，其证候是", + "options": { + "A": "风寒袭肺", + "B": "痰湿蕴肺", + "C": "风热犯肺", + "D": "肝火犯肺", + "E": "风燥伤肺" + }, + "answer": "A", + "reason": "风寒袭肺指风寒侵袭,肺卫失宣,以咳嗽、咯稀白痰、恶风寒等为主要表现的证候。咳声重,咯痰稀白,恶寒无汗,舌苔薄白,脉浮紧,其证候是风寒袭肺。痰稀白为寒痰的表现。" + }, + { + "question_num": 394, + "query": "患者，男，30岁。上腹突发刀割样疼痛，很快波及全腹，体温39℃，腹部呈板状，有明显压痛、反跳痛和肌紧张，肝浊音界消失，肠鸣音消失。最可能诊断是", + "options": { + "A": "急性化脓性胆囊炎", + "B": "胃十二指肠溃疡穿孔", + "C": "急性阑尾炎穿孔", + "D": "急性出血性胰腺炎", + "E": "急性梗阻性化脓性胆管炎" + }, + "answer": "B", + "reason": "胃十二指肠溃疡穿孔的诊断。患者突发上腹剧痛、迅速发生全急性腹膜炎、肝浊音界消失，最可能的诊断应是胃十二指肠溃疡穿孔。" + }, + { + "question_num": 395, + "query": "患者肢体瘘软,身体困重,足胫热气上腾,发热,胸痞脘闷,舌苔黄腻,脉滑数,其治法是", + "options": { + "A": "清热润燥,养肺生津", + "B": "清热利湿,通利筋脉", + "C": "泻南补北,滋阴清热", + "D": "补益肝肾,清热滋阴", + "E": "补益脾气,健运升清" + }, + "answer": "B", + "reason": "湿热漫淫,气血阻滞,故肢体瘘软，身体困重,胸辣朊闷,湿热蕴蒸,气机不化,故足胫热气上腾,发热。治宜清热利温,通利筋脉,故选B。肺热津伤选A：心肾不交选C“肝肾亏损选D：脾胃亏虚选E。" + }, + { + "question_num": 396, + "query": "患者,女,50岁。左股骨颈骨折7天，左下肢肿胀增粗2天,皮温升高,皮色红,胀痛，浅表静脉扩张,活动不利,舌质红,苔黄腻,脉弦滑。治疗宜首选", + "options": { + "A": "活血通脉汤", + "B": "参苓白术散", + "C": "补阳还五汤", + "D": "龙胆泻肝汤", + "E": "四妙勇安汤" + }, + "answer": "E", + "reason": "该患者左下肢肿胀增粗2天,皮温升高,皮色红,胀痛,浅表静脉扩张,活动不利,为股肿。舌质红,苔黄腻,脉弦滑,为湿热下注证。治法:清热利湿,活血化瘀。代表方:四妙勇安汤加味。" + }, + { + "question_num": 397, + "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,衄血,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": 398, + "query": "某患者，受冷风吹面后，次日晨起发现口角流涎。检查：一侧眼裂较大，不能皱额，鼻唇沟变浅，口角下垂。应首先考虑的是", + "options": { + "A": "蛛网膜下腔出血", + "B": "脑瘤", + "C": "脑梗死", + "D": "脑出血", + "E": "周围性面神经麻痹" + }, + "answer": "E", + "reason": "本题所述临床表现均可由面神经麻痹所致。面神经麻痹可分为中枢型（由脑血管病变、颅内肿瘤或炎症等引起）和周围型（由面神经核或面神经受损所致）。周围型患者，出现一侧面部肌肉麻痹，可表现出：病变侧眼裂增大，不能皱额，鼻唇沟变浅，口角下垂等。而中枢型患者，由于面神经核上部受双侧大脑皮质支配，由它发出的运动纤维支配颜面上部肌肉；面神经核下部只受对侧大脑皮质支配，由它发出的运动纤维支配颜面下部肌肉。核上组织病变时，临床表现为对侧颜面下部表情肌麻痹，可以皱额。" + }, + { + "question_num": 399, + "query": "患者,男,50岁。头晕2个月，加重3天,���有心烦,胸脘满闷,恶心呕吐,食欲不振，舌苔厚腻,脉滑。治疗应首选", + "options": { + "A": "风池、肝俞、行间、内庭", + "B": "丰隆、中脘、内关、头维", + "C": "脾俞、足三里、气海、太冲", + "D": "肝俞、血海、三阴交、合谷", + "E": "脾俞、肝俞、风池、行间" + }, + "answer": "B", + "reason": "本病为眩晕、疾湿中阻型。头晕、胸朊满闷,心烦.恶心呕吐,为痰湿中阻`.气机不畅所致,痰湿上蒙清阳可见头晕。此病证主要与痰湿有关，治疗应以健脾化痰为主,丰隆穴可健脾化痰和胃降逆，内关穴有益心安神.宽胸理气镇静作用,头维穴主要清头目。" + }, + { + "question_num": 400, + "query": "患儿,2岁。时值夏季,发热持续1月余朝盛暮衰,口渴多饮,尿多清长,无汗。面色苍白,下肢欠温,大便溏游,舌淡苔薄。治疗应首选", + "options": { + "A": "白虎汤", + "B": "新加香薷饮", + "C": "温下清上汤", + "D": "竹叶石膏汤", + "E": "王氏清暑益气汤" + }, + "answer": "C", + "reason": "患儿3岁以下,夏季发病,临床以长期发热、口渴多饮、多尿、无汗为特征,故诊为夏季热。朝盛暮衰,口渴多饮为该病上盛下虚证的主要表现。选方:温下清上汤。" + }, + { + "question_num": 401, + "query": "患者头微痛，恶寒无汗，咳嗽痰稀，鼻塞咽干，舌苔白，脉弦。治疗应选用", + "options": { + "A": "杏赤散", + "B": "麻黄汤", + "C": "止嗽散", + "D": "小青龙汤", + "E": "百合固金汤" + }, + "answer": "A", + "reason": "此为外感凉燥证,主要临床表现:头微痛,恶寒无汗,咳嗽痰稀,鼻塞咽干,苔白,脉弦!当选A以轻宜凉燥,理肺化痰。" + }, + { + "question_num": 402, + "query": "患者，女，30岁。贫血原因不明。试服铁剂治疗第6天复查血象，网织红细胞上升达5%，但未见血红蛋白增加，镜检见红细胞大小不等且中心淡染区扩大，其最可能的诊断是", + "options": { + "A": "缺铁性贫血", + "B": "急性白血病", + "C": "巨幼细胞性贫血", + "D": "阵发性睡眠性血红蛋白尿", + "E": "再生障碍性贫血" + }, + "answer": "A", + "reason": "缺铁性贫血患者每日口服铁剂后，短时间内网织红细胞计数明显升高，常于5~10天达到高峰，平均6%~8%，范围2%~16%，以后又降至正常范围内，这种反应只出现于缺铁性贫血。另外在血片中可见到红细胞染色浅淡，中心淡染区扩大，故本病例缺铁性贫血诊断成立。" + }, + { + "question_num": 403, + "query": "患者,男,48岁。大便出血,色鲜红,血量不等，有赘物垂于肛外。治疗应首选", + "options": { + "A": "承山", + "B": "大肠俞", + "C": "小肠俞", + "D": "膈俞", + "E": "血海" + }, + "answer": "A", + "reason": "本病诊断为痔疮。大便出血,并且有赘物垂于肛门外。治疗时根据“经脉所过主治所及”的道理,循经远道取膀胱经的承山穴,因膀胱经脉循行的后项支脉与腰部下来的支脉会合于膕窝中,从此向下通过腓肠肌。承山穴是膀胱经腧穴而且位于腓肠肌两肌腹之间,主治痔疮等。" + }, + { + "question_num": 404, + "query": "患者,女,35岁。带下过少,阴中干涩,头晕目眩,心悸失眠,神疲乏力,经行腹痛,舌质暗淡,边有瘀斑,脉细涩。治疗宜首选", + "options": { + "A": "左归丸加知母、肉苁蓉、紫河车、麦门冬", + "B": "血府逐瘀汤", + "C": "少腹逐瘀汤", + "D": "小营煎加丹参、桃仁、牛膝", + "E": "左归饮加三棱、我术" + }, + "answer": "D", + "reason": "带下过少,阴中干涩为精血不足且不循常道,瘀阻血脉,阴津不得敷布所致。头晕目眩为血虚不能上荣于头面。心悸失眠为血虚心失所养。神疲乏力为血虚气弱。经行腹痛是因瘀血内阻、气机不畅所致。舌质暗淡,边有瘀斑,脉细涩均为血枯瘀阻之征,故该患者可诊为带下过少血枯瘀阻证。治法:补血益精,活血化瘀。代表方:小营煎加丹参、桃仁、牛膝。" + }, + { + "question_num": 405, + "query": "患者，女，38岁。月经来潮，量多，色淡，肌热面赤，烦渴欲饮，脉洪大而虚。治疗应选用", + "options": { + "A": "归脾汤", + "B": "四物汤", + "C": "当归补血汤", + "D": "温经汤", + "E": "黄土汤" + }, + "answer": "C", + "reason": "本题辨证要点为血虚发热。当归补血汤补气生血,用于血虚发热证,症见肌热面红，烦渴欲饮,脉洪大而虚,重按无力;或妇人经期、产后血虚,发热头痛;或疮疡溃后,久不愈合。" + }, + { + "question_num": 406, + "query": "患者腹部出现由左肋下向右进行的较强蠕动波，见于下列何种病变", + "options": { + "A": "胃下垂", + "B": "胃扩张", + "C": "幽门梗阻", + "D": "胃癌", + "E": "急性胃炎" + }, + "answer": "C", + "reason": "除腹壁菲薄的多产妇和极度消瘦的老人外，正常人腹部看不见蠕动波。幽门梗阻时，由于胃的蠕动增强，常可以看到由左肋下向右进行的较强蠕动波。" + }, + { + "question_num": 407, + "query": "患者,女,56岁。经常不易人睡,常感精力不足,容易疲乏,注意力不能集中,记忆力下降,用脑稍久即感头痛、眼花。治疗应首选的腧穴是", + "options": { + "A": "水沟、内关、太冲、丰隆、后溪", + "B": "照海、申脉、神门、百会、安眠、三阴交", + "C": "风池、百会、肝俞、肾俞、足三里", + "D": "水沟、内关、大陵、神门、中冲", + "E": "印堂、鸠尾、间使、太冲、丰隆" + }, + "answer": "B", + "reason": "患者经常不易入睡,可诊断为不寐。不寐的治法为舒脑宁心,安神利眠。主穴:,百会、安眠、神门、三阴交、照海、申脉。脑为元神之府,督脉入络于脑,取督脉穴百会镇静安神,舒脑安眠;安眠穴位居头部,是治疗不寐的经验效穴;心主神明,取心之原穴神门以宁心安神:三阴交为足三阴经交会穴,能调和与不寐密切相关的肝脾肾三脏;跷脉主寤寐,司眼睑开阖,照海通阴跷脉,申脉通阳跷脉,两穴同用可调节阴阳跷脉以安神助眠。" + }, + { + "question_num": 408, + "query": "患儿,3岁。发热第4天,细小红色疹点自耳后发际起,发展至面、颈、躯干、四肢,咳嗽声重,有如犬吠,声音嘶哑,咽喉肿痛,舌红苔黄腻。治疗应首选", + "options": { + "A": "清咽下痰汤", + "B": "清金化痰汤", + "C": "竹沥达痰丸", + "D": "解肌透痧汤", + "E": "化斑解毒汤" + }, + "answer": "A", + "reason": "患儿以“细小红色疹点自耳后发际起”为主症,故可辨病为麻疹,根据其“发热,细小红色疹点自耳后发际起,发展至面、颈、躯干、四肢,咳嗽声重,有如犬吠,声音嘶哑,咽喉肿痛,舌红苔黄腻”可辨证为邪毒攻喉证,治宜清热解毒,利咽消肿,方用清咽下痰汤。清金化痰汤清热化痰,治疗咳嗽之痰热咳嗽证。竹沥达痰丸豁除顽痰，治疗痰热上壅，咳喘痰多。解肌透痧汤清热解毒利咽,治疗丹痧之邪侵肺卫证。" + }, + { + "question_num": 409, + "query": "患者，男，34岁。遗精半年，腰脊酸痛，头晕耳鸣，骨蒸潮热，虚烦盗汗，口燥咽干，舌红少苔，脉细数。治疗应选用六味地黄丸加", + "options": { + "A": "枸杞子、菊花", + "B": "知母、黄柏", + "C": "龙骨、牡蛎", + "D": "麦门冬、五味子", + "E": "黄连、麦门冬" + }, + "answer": "B", + "reason": "该证虚火上炎的表现比较重,故选B。" + }, + { + "question_num": 410, + "query": "患者，女，70岁。冠心病病史5年。今日突然心悸气短，不能平卧，咳嗽，咯粉红色泡沫样痰。应首先考虑的是", + "options": { + "A": "肺癌", + "B": "肺脓肿", + "C": "肺结核", + "D": "急性肺水肿", + "E": "支气管扩张" + }, + "answer": "D", + "reason": "肺癌剧烈干咳，痰中带血丝。肺脓肿咯脓痰。肺结核痰中带血丝，伴低热，盗汗。急性肺水肿为粉红色泡沫样痰。支气管扩张痰量较多，为湿性咳嗽。" + }, + { + "question_num": 411, + "query": "患者,男,28岁。浴后当风睡眠,醒后全身不适,发现嘴角左斜,额纹消失,面部肌肤麻木不仁,恶风,舌淡苔白,脉浮紧。治疗宜选下列哪组穴位", + "options": { + "A": "地仓、颊车、合谷、攒竹、阳白、四白、颧髎、风池、风府", + "B": "外关、耳门、曲池、攒竹、鱼腰、阳白、四白、颧髎、昆仑", + "C": "太溪、照海、鱼际、四白、太阳、足三里、百会、水沟、风池", + "D": "肝俞、牌俞、肾俞、耳门、阳白、足三里百会、水沟、风池", + "E": "颊车、中极、地机、内庭、太冲、足三里、百会、水沟、风池" + }, + "answer": "A", + "reason": "由本患者的症状可知本病为面瘫，取手足阳明经穴为主,主穴:攒竹、阳白、四白、颧髎、颊车、地仓、合谷,风寒外袭配风池、风府。" + }, + { + "question_num": 412, + "query": "患者,女,22岁。月经初潮年龄16岁,痛经6年,每于第1天出现小胆冷痛,喜温喜按,经量少、色暗淡,腰腿酸软,小便清长,舌苔白润脉沉迟。治疗应首选", + "options": { + "A": "温经汤(《妇人大全良方》)", + "B": "圣愈汤", + "C": "调肝汤", + "D": "温经汤(《金匮要略》", + "E": "金匮肾气丸" + }, + "answer": "D", + "reason": "由题干小腹冷痛,喜温喜按,经量少、色暗淡,腰腿酸软,小便清长,舌苔白润,脉沉迟。辨证为寒凝血瘀证,代表方剂少股逐瘀汤或温经汤(《金匮要略》)。" + }, + { + "question_num": 413, + "query": "患者，女，40岁。素来气血两虚，就诊时面色苍白，自诉头晕眼花四肢倦怠气短懒言，心悸怔忡，食欲减退，舌淡苔白，脉细。治疗应首选的方剂是", + "options": { + "A": "玉屏风散", + "B": "生脉散", + "C": "四物汤", + "D": "八珍汤", + "E": "圣愈汤" + }, + "answer": "D", + "reason": "根据患者的症状表现,可以不难判断患者是气血两虚证。八珍汤有益气补血的功效,故选D。" + }, + { + "question_num": 414, + "query": "患者，65岁。查体：心尖搏动出现在剑突下，且深吸气时增强，肺动脉瓣第2心音增强。应首先考虑的是", + "options": { + "A": "冠心病", + "B": "高血压心脏病", + "C": "风心病", + "D": "肺心病", + "E": "心肌炎" + }, + "answer": "D", + "reason": "心尖搏动出现在剑突下，提示右心肥厚表现，而肺动脉瓣第2心音增强，提示肺动脉压力增高，而右心肥厚及肺动脉高压，提示患者有肺心病表现。" + }, + { + "question_num": 415, + "query": "患者,男,68岁。家属代诉:患者于今日下午外出散步,突然昏仆，不省人事,半身不遂,目合口张,鼻鼾息微,遗尿,汗出，四肢厥冷,脉细弱。治疗应首选", + "options": { + "A": "督脉经穴,灸法", + "B": "任脉经穴,灸法", + "C": "背俞穴,灸法", + "D": "足阳明经穴,灸法", + "E": "足厥阴经穴,针刺用泻法" + }, + "answer": "B", + "reason": "中风脱证宜回阳固脱,取任脉经穴灸法。任脉为阴脉之海,用大艾姓重灸,以回垂绝之阳,治疗中风脱证。" + }, + { + "question_num": 416, + "query": "患者,女.33岁,已婚。每于经期大便溏泄,脘腹胀满,神疲肢软,舌淡苔薄白,脉滑。治疗应首选", + "options": { + "A": "叁苓白术散", + "B": "健固汤", + "C": "柴胡疏肝散", + "D": "痛泻要方", + "E": "四苓散" + }, + "answer": "A", + "reason": "从题干每于经期大便溏泄,辨病为经行泄泻,从症状脘腹胀满,神疲肢软,舌淡苔薄白,脉濡滑,辨证为脾虚证,用参苓白术散治疗,故选A,其余选项不合适。" + }, + { + "question_num": 417, + "query": "患者，女，45岁。因情志不畅而致咽中如有物梗阻，咯吐不出，吞咽不下，胸胁满闷。治疗应首选", + "options": { + "A": "苏子降气汤", + "B": "厚朴温中汤", + "C": "半夏厚朴汤", + "D": "天台乌药散", + "E": "越鞠丸" + }, + "answer": "C", + "reason": "根据题千主症因悄志不畅而致咽中如有物梗阻,故知此为梅核气。半夏厚朴汤行气散结、降逆化痰,主治梅核气。症见咽中如有物阻,咯吐不出,吞咽不下,胸膈满闷,或咳或呕,苔白润或白滑:脉弦滑或弦缓。" + }, + { + "question_num": 418, + "query": "患者，男，30岁。全身乏力、低热、伴左上腹肿块半年。肝肋下2cm，脾肋下7cm。化验：血红蛋白80g/L，白细胞140x10^9/L，血小板100x10^9/L，骨髓象原始粒细胞0.02，Ph染色体阳性。正确的治疗为", + "options": { + "A": "大剂量抗生素抗感染", + "B": "脾切除", + "C": "HOAP方案化疗", + "D": "羟基脲口服", + "E": "VAP方案化疗" + }, + "answer": "D", + "reason": "慢性粒细胞白血病的诊治。患者牌肿大，骨髓象原始粒细胞<10%，Ph染色体阳性支持慢性粒细胞白血病，其化疗应选用羟基脲口服。" + }, + { + "question_num": 419, + "query": "患者,男,18岁。腹痛2日，下痢赤白,里急后重,肛门灼热,口渴,舌苔黄腻,脉滑数。治疗应首选", + "options": { + "A": "合谷、中脘、气海", + "B": "合谷、天枢、上巨虚", + "C": "合谷、下脘、关元", + "D": "曲池、梁门、足三里", + "E": "曲池、上巨虚、内关" + }, + "answer": "B", + "reason": "痢疾治疗主穴:天枢、三阴交.上巨虚、合谷。痢疾主要因为暑湿之邪滞留肠腑,故取阳明之原穴合谷,大肠募穴天枢,下合穴上巨虚,三穴能通调大肠腑气,使气调而湿化滞行。" + }, + { + "question_num": 420, + "query": "患者,女,48岁。头晕耳鸣,腰酸腿软,烘热汗出,五心烦热,失眠多梦,月经系乱，舌质红，少苔，脉细数。治法为", + "options": { + "A": "滋养肾阴,佐以潜阳", + "B": "滋肾养血,养心安神", + "C": "滋阴清热,养血活血", + "D": "育阴潜阳,镇肝息风", + "E": "滋阴清热,活血化瘀" + }, + "answer": "A", + "reason": "绝经前后诸证的辨证论治。“患者,女,48岁。月经系乱,伴烘热汗出等症”指出本病为绝经前后诸证,根据其他症状辨证为肾阴虚证,故治法为滋养肾阴,佐以潜��。" + }, + { + "question_num": 421, + "query": "患者，男，40岁。胃脘胀满而痛，不思饮食，四肢倦怠，舌苔白腻，脉弦滑。治疗应选用", + "options": { + "A": "厚朴温中汤", + "B": "平胃散", + "C": "半夏泻心汤", + "D": "旋覆代赭汤", + "E": "二陈汤" + }, + "answer": "A", + "reason": "该题根据选项中各方剂的主治特性,很好排除选择。厚朴温中汤行气除满、温中燥湿:用于脾胃寒湿气潜证。症见脘腹胀满或疼痛，不思伙食,四肢倦怠,舌苔白腻,脉沉弦。" + }, + { + "question_num": 422, + "query": "患者，女，48岁。平时白带量多，终日不断，质稀清冷，腰膝酸冷，小腹发凉，小便清长，夜尿频多，舌淡苔薄白，脉沉迟。治疗应首选", + "options": { + "A": "完带汤", + "B": "金匮肾气丸", + "C": "内补丸", + "D": "止带方", + "E": "易黄汤" + }, + "answer": "C", + "reason": "根据题意可知，该患者可辨证为肾阳虚证，该证是由肾阳虚损，气化失常，水湿下注，任带失约所致，治宜温肾培元，固涩止带，治疗应首选内补丸。" + }, + { + "question_num": 423, + "query": "患者,男,50岁。腰部疼痛10余年，有劳伤史,久坐加重,病处固定不移。治疗除取主穴外，还应选用的穴位是", + "options": { + "A": "膏肓", + "B": "膈俞", + "C": "志室", + "D": "腰阳关", + "E": "环跳" + }, + "answer": "B", + "reason": "本证瘀血腰痛,取血会膈俞以消络中瘀滞。腰阳关为寒湿腰痛配穴。" + }, + { + "question_num": 424, + "query": "患者,女30岁,已婚。孕后因持重而继发腰酸腹痛。胎动下坠，精神倦怠,脉滑无力。治疗应首选", + "options": { + "A": "举元煎", + "B": "胎元饮", + "C": "固下益气汤", + "D": "加味圣愈汤", + "E": "加味阿胶汤" + }, + "answer": "D", + "reason": "由题干孕后因持重而继发腰酸腹痛,辨病为妊娠腹痛;由胎动下坠,精神倦怠,脉滑无力,辨证为气血虚弱证,治疗应首选加味圣愈汤,以气血双补。" + }, + { + "question_num": 425, + "query": "患者，男，68岁。半身不遂，口舌歪斜，语言窘涩，口角流涎，小便频数，舌黯淡苔白，脉虚而涩。治疗应首选", + "options": { + "A": "补阳还五汤", + "B": "牵正散", + "C": "小活络丹", + "D": "大秦艽汤", + "E": "地黄饮子" + }, + "answer": "A", + "reason": "补阳还五汤补气、活血、通络,用于中风之气虚血瘀证。症见半身不遂,口眼歪斜,语言涩,口角流涎,遗尿不禁,小便频数,舌暗淡苔白,脉缓无力。" + }, + { + "question_num": 426, + "query": "患者突然意识丧失，全身抽搐，面色紫绀，口吐白沫，小便失禁，5~6分钟后意识逐渐清醒。可能是", + "options": { + "A": "癔症", + "B": "舞蹈病", + "C": "癫痫", + "D": "帕金森病", + "E": "手足搐搦症" + }, + "answer": "C", + "reason": "癫痫的诊断。该患者呈现典型的癫痫发作过程，突然意识丧失，全身抽搐，面色紫绀，口吐白沫，小便失禁，短时间内停止发作，并且意识逐渐恢复，故选C，其他均不可能，因为均不会有意识丧失。" + }, + { + "question_num": 427, + "query": "患者,女，23岁。每至经期第3、第4天出现腹痛,痛势绵绵,按则痛减,月经色淡，量少,伴面色苍白,倦怠无力,舌质淡、脉细弱。治疗除三阴交外,宜选取", + "options": { + "A": "中极、次髎、太冲、地机闪", + "B": "中极、次髎、归来、地机本", + "C": "中极、气海、悬钟、归来", + "D": "足三里、气海、太溪、肾俞", + "E": "足三里、气海、脾俞、关元" + }, + "answer": "E", + "reason": "根据经期腹痛,痛势绵绵,按则痛减,月经色淡,量少,伴面色苍白,倦怠无力,舌质淡,脉细弱,可诊断为痛经气血虚弱证。痛经虚证主穴为关元、足三里、三阴交,气血虚弱者加气海.脾俞。" + }, + { + "question_num": 428, + "query": "患者,女,34岁,已婚。4年前因患子宫肌瘤自然流产1次,现妊娠43天,阴道不时少量下血,腰酸,胎动下坠,口干不欲饮,舌暗红,脉沉弦。治疗应首选", + "options": { + "A": "下瘀血汤", + "B": "固下益气汤", + "C": "补肾安胎饮", + "D": "加味圣愈汤", + "E": "桂枝茯苓丸" + }, + "answer": "E", + "reason": "由题干现妊娠43天,阴道不时少量下血,腰酸,胎动下坠,辨病为胎动不安,由口干不欲饮,舌暗红,脉沉弦,辨证为血瘀证,代表方剂是桂枝茯苓丸。" + }, + { + "question_num": 429, + "query": "某患者外感风寒，误用泻下剂后，发热头痛，汗出恶风，鼻鸣微喘，舌苔薄白，脉浮缓。治疗应选用", + "options": { + "A": "麻黄汤", + "B": "桂枝汤", + "C": "麻黄加术汤", + "D": "桂枝加厚朴杏子汤", + "E": "石膏汤" + }, + "answer": "B", + "reason": "桂枝汤适合外感风表虚证,解肌发表,调和营卫,辨证要点为恶风发热,汗出,脉浮或浮弱。" + }, + { + "question_num": 430, + "query": "一中年男性患者，结核病史5年，因咳嗽、咳痰、痰中带血、发热、消瘦加重1个月来医院检查。为排除肺癌，其鉴别主要根据", + "options": { + "A": "年龄", + "B": "全身中毒症状", + "C": "咳嗽、咳痰、咯血", + "D": "红细胞沉降率", + "E": "X线或痰液检查" + }, + "answer": "E", + "reason": "肺癌的临床表现：咳嗽咳痰，痰中带血，胸闷气急，胸痛。X线见肺占位性病变和淋巴结肿大。肺结核为结核菌感染所致的肺部病变，有低热、盗汗、消瘦、乏力等结核感染表现，同时可有咳嗽、胸闷气急、咳痰、咯血等表现，PPD(+)，痰中可找到结核菌，故可以做X线胸片和痰液检查。" + }, + { + "question_num": 431, + "query": "患者,女,26岁。痛经9年,经行不畅,小腹胀痛,拒按,经色紫红,夹有血块,脉沉涩。治疗应首选", + "options": { + "A": "足三里、太冲、三阴交", + "B": "合谷、气海、三阴交", + "C": "曲池、内庭、三阴交", + "D": "中极、次髎、地机", + "E": "合谷、归来、脾俞" + }, + "answer": "D", + "reason": "此为痛经的实证,治以通调冲任，行瘀止痛为主。中极为任脉穴,可通调冲任脉气;地机为脾经郄穴，能疏调脾经经气而止痛；次髂为治痛经的经验有效穴。" + }, + { + "question_num": 432, + "query": "患者,女,26岁,已婚。妊娠3个月,尿少色黄,尿时艰涩而痛,心烦,口舌生疮,舌红少苔,脉数。治疗应首选", + "options": { + "A": "导赤散", + "B": "加味五淋散", + "C": "知柏地黄汤", + "D": "清热通淋汤", + "E": "以上均非" + }, + "answer": "A", + "reason": "由题干妊娠3个月,尿少色黄,尿时艰涩而痛,辨病为妊娠小便淋痛;由心烦,口舌生疮、舌红少苔,脉数,辨证为心火偏亢证。方选导赤散。" + }, + { + "question_num": 433, + "query": "患者感受暑湿，症见身热烦渴，小便不利。治疗应首选", + "options": { + "A": "六一散", + "B": "猪苓汤", + "C": "泻白散", + "D": "五苓散", + "E": "二妙散" + }, + "answer": "A", + "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。" + }, + { + "question_num": 434, + "query": "患者，女，60岁。因前间壁心肌梗死3小时人院，现出现频发室早，其治疗首选的药物是", + "options": { + "A": "利多卡因", + "B": "酚妥拉明", + "C": "普罗帕酮", + "D": "维拉帕米", + "E": "普鲁卡因胺" + }, + "answer": "A", + "reason": "急性心肌梗死，伴频发室性早搏，需紧急处理，宜用利多卡因快速纠正心律失常。" + }, + { + "question_num": 435, + "query": "患者,男,30岁。口角歪向右侧,左眼不能闭合2天,左侧额纹消失,治疗应选取何经穴为主", + "options": { + "A": "手、足少阳经", + "B": "手、足太阴经", + "C": "手、足少阴经", + "D": "手、足厥阴经", + "E": "手、足阳明经" + }, + "answer": "E", + "reason": "面瘫治疗,取局部穴和手、足阳明经穴为主。" + }, + { + "question_num": 436, + "query": "患者,女,49岁。已绝经14个月,因操劳后阴道出血,量少、色淡、质清稀,神疲肢倦,食少腹胀,胸闷叹息,舌苔薄白,脉弦无力。治疗宜首选(", + "options": { + "A": "八珍汤", + "B": "固本止崩汤", + "C": "逍遥散", + "D": "安老汤", + "E": "归肾丸" + }, + "answer": "D", + "reason": "该患者为经断复来牌虚肝郁证。治法:健脾调肝,安冲止血。方药:安老汤。" + }, + { + "question_num": 437, + "query": "患者，男，41岁。一身面目俱黄，黄色鲜明，腹微满，口渴，小便不利，舌苔黄腻，脉沉数。治疗应首选", + "options": { + "A": "三仁汤", + "B": "茵陈蒿汤", + "C": "萆薢分清饮", + "D": "蒿芩清胆汤", + "E": "甘露消毒丹" + }, + "answer": "B", + "reason": "上证是明显的阳黄之证,故选B茵陈蒿汤清热、利湿、退黄,用于湿热黄疸(阳黄),症见一身面目俱黄,黄色鲜明,发热,无汗或但头汗出,口渴欲饮,恶心呕吐,腹微满,小便短赤,大便不爽或秘结，舌红苔黄腻,脉沉数或滑数有力。" + }, + { + "question_num": 438, + "query": "患者，男，40岁。曾在国外居住多年，3年前回国，近半年持续低热，伴乏力，周身淋巴结肿大，口腔黏膜反复感染，大量抗生素治疗效果不佳，���来体重减轻，血常规示：白细胞低和贫血。此时应注意哪种疾病更合适", + "options": { + "A": "结核病", + "B": "白塞病", + "C": "传染性单核细胞增多症", + "D": "艾滋病", + "E": "亚急性变应性败血症" + }, + "answer": "D", + "reason": "艾滋病期的临床表现为持续1个月以上的发热，盗汗，体重减轻10%以上，出现持续性全身性淋巴结肿大，伴有复发性口腔溃疡和不同程度的贫血及白细胞降低。" + }, + { + "question_num": 439, + "query": "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": "丝竹空、阳白、外关", + "B": "颧髎、迎香", + "C": "列缺、太阳", + "D": "曲池、外关", + "E": "太冲、三阴交" + }, + "answer": "D", + "reason": "面痛多与外感邪气、情志不调、外伤等因素有关,治法当以疏通经络,祛风止痛为主。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、外关;气血瘀滞者,加内关、三阴交。该患者痛处有灼热感,流诞,目赤流泪,苔黄,脉数为风热证,故选取曲池、尺泽为配穴。" + }, + { + "question_num": 440, + "query": "患者,女,30岁,已婚。结婚3年未孕,月经周期正常,量少,色红无血块，小腹隐痛,腰腿酸软,头晕眼花,午后低热,口千咽燥,舌红,少苔,细数,其证候是", + "options": { + "A": "肾阴虚", + "B": "肾阳虚", + "C": "脾虚", + "D": "肝郁", + "E": "痰湿" + }, + "answer": "A", + "reason": "由题干结婚3年未孕,辨病为不孕症;由月经周期正常,量少,色红无血块,小腹隐痛,腰腿酸软,头晕眼花,午后低热,口干咽燥,舌红,少苔,脉细数,辨证为肾阴虚。" + }, + { + "question_num": 441, + "query": "患者肩背痛不可回顾，头痛身重，腰脊疼痛，舌苔白，脉浮。治疗应选用", + "options": { + "A": "独活寄生汤", + "B": "三仁汤", + "C": "小青龙汤", + "D": "羌活胜湿汤", + "E": "麻黄汤" + }, + "answer": "D", + "reason": "羌活胜湿汤祛风、胜湿、止痛,用于风湿在表之痹证,症见肩背痛不可回顾,头痛身重,或腰脊疼痛,难以转侧,苔白,脉浮。" + }, + { + "question_num": 442, + "query": "患者，男，18岁。突然出现无痛性腹泻，米泔水样便。量多，大便频繁，继之出现喷射状呕吐，呕吐物为米泔水样。查体：神志淡漠，声音嘶哑，眼窝深凹，口唇干燥。应首先考虑的是", + "options": { + "A": "霍乱", + "B": "急性细菌性痢疾", + "C": "急性胃肠炎", + "D": "伤寒", + "E": "副伤寒" + }, + "answer": "A", + "reason": "霍乱的腹泻，为无痛性，无里急后重感，每日大便数次甚至难以计数，量多，每天2000~4000ml，严重者8000ml以上，初为黄水样，不久转为米泔水水样便，少数患者有血性水样便或柏油样便，腹泻后出现喷射性和边疆性呕吐，初为胃内容物继而水样、米泔样，由于剧烈泻吐，体内大量液体及电解质丢失而出现脱水表现，轻者口渴，眼窝稍陷,唇舌干燥，重者烦躁不安，眼窝下陷，两颊深凹，精神呆滞，皮肤干而皱缩失去弹性，嘶哑，四肢冰凉体温下降，故血液浓缩，脉搏细弱，心音低钝，血压下降。" + }, + { + "question_num": 443, + "query": "患者,女,62岁。腰部隐隐作痛2年，下肢酸软乏力,腰冷,脉细。治疗除选取主穴外,应加用的腧穴是", + "options": { + "A": "风府、大杼、阳陵泉", + "B": "风府、足三里、血海", + "C": "风府、三阴交、太冲", + "D": "水沟、风府、足三里", + "E": "命门、志室、太溪" + }, + "answer": "E", + "reason": "肾虚腰痛炙命门,补志室,以补肾中真阳。太溪为足少阴经之原穴,为脏病取原之意。" + }, + { + "question_num": 444, + "query": "患儿,男,12岁。癫痫发病10年,屡发不止,发时瘪疭抖动,时有眩晕，智力迟钝，腰膝酸软,神疲乏力,少气懒言,四肢不温,大便稀溏,舌淡苔白,脉沉细，其治法是", + "options": { + "A": "豁痰开窍", + "B": "息风止痉", + "C": "镇惊安神", + "D": "健脾化痰", + "E": "补益脾肾" + }, + "answer": "E", + "reason": "癫痫。根据发时瘪瘛疭抖动,时有眩晕,智力迟钝,腰膝酸软,神疲乏力,少气懒言,四肢不温,大便稀溏,舌淡苔白,脉沉细等表现,辨证为癫痫病之脾肾两虚证,治宜补益脾肾。" + }, + { + "question_num": 445, + "query": "患者，女，56岁。咳喘10年，伴见胸闷心悸，咯痰清稀，声低乏力，面白神疲，舌质���白，脉弱，其证候是", + "options": { + "A": "心肺气虚", + "B": "肺气虚", + "C": "寒邪客肺", + "D": "脾肺气虚", + "E": "肾不纳气" + }, + "answer": "A", + "reason": "患者咳喘10年必有肺气虚,胸闷心悸提示心气不足,咯痰清稀,声低乏力,面白神疲,舌质淡白,脉弱等为一派肺气虚的表现。" + }, + { + "question_num": 446, + "query": "患者，男，28岁，渔民。昨晚进食海蟹一只，晨起腹泻，稀水便，10小时内排便20余次，量多，水样，无臭味。中午呕吐3~4次，初起水样，后为米泔水样，发病后无排尿，就诊时呈重度脱水征，神志淡漠，BP80/50mmHg。下列检查均有助于诊断，除了", + "options": { + "A": "血培养", + "B": "血清凝集试验", + "C": "大便悬滴镜检", + "D": "大便碱性蛋白胨增菌培养", + "E": "大便涂片革兰染色镜检" + }, + "answer": "A", + "reason": "米泔水样便为霍乱特点。霍乱弧菌不直接侵犯人血，而是通过其肠毒素致病，故血培养无意义。" + }, + { + "question_num": 447, + "query": "患者,女,53岁。2小时前突然发现右半身麻木,口角歪斜,言语不利。现神志清，头晕目眩,苔白腻,脉弦滑,其诊断是", + "options": { + "A": "中经络,风痰阻络证", + "B": "中经络,肝阳暴亢证", + "C": "中经络,阴虚风动证", + "D": "中脏腑,气虚血瘀证", + "E": "中脏腑,阴虚风动证" + }, + "answer": "A", + "reason": "中风中经络,主症:意识清楚,半身不遂,口角歪斜,语言不利。兼肢体麻木或手足拘急，头晕目眩,苔腻,脉弦滑者为风痰阻络证。" + }, + { + "question_num": 448, + "query": "患儿,3岁。因右侧腮部肿胀2天就诊。现症见右侧腮部肿痛，恶寒发热，头痛，舌质红，苔薄白微黄，脉浮数。治疗宜首选(大)", + "options": { + "A": "柴胡葛根汤", + "B": "普济消毒饮", + "C": "仙方活命饮", + "D": "五味消毒饮", + "E": "荆防败毒散" + }, + "answer": "A", + "reason": "该患儿为痄腮邪犯少阳证。治法:疏风清热,散结消肿。代表方:柴胡葛根汤、银翘散。" + }, + { + "question_num": 449, + "query": "患者恶寒发热，头身疼痛，无汗，鼻塞流涕，脉浮紧，其舌苔应是", + "options": { + "A": "白厚", + "B": "薄白", + "C": "黄腻", + "D": "花剥", + "E": "白腻" + }, + "answer": "B", + "reason": "题目中所描述为外感表寒证。A项主邪盛人里,或内有痰、饮、水、湿,食积等,病情相对较重,故排除。B项可见于正常人,亦主表证及病情轻浅的里证、体内无明显热证者,故选B。C项主湿热内蕴、饮化热或食积化热。D项是胃气、阴不足,或气血两虚,不能上承以续生新苔所致,病情一般较复杂。E项多见于痰饮、湿阻。" + }, + { + "question_num": 450, + "query": "患者食欲减退，乏力。查体：全身及巩膜黄染，胆囊明显肿大，无压痛。应首先考虑的是", + "options": { + "A": "胰腺癌", + "B": "胰腺炎", + "C": "胆道蛔虫症", + "D": "胆囊炎", + "E": "胆结石" + }, + "answer": "A", + "reason": "患者全身及巩膜黄染，考虑阻塞性黄疸，基本排除BD。B项有暴饮暴食诱因，上腹部压痛、反跳痛，血清淀粉酶升高。C项是由各种原因引起的肠道蛔虫运动活跃，并钻人胆道而出现的急性上腹痛或胆道感染。发作时患者疼痛难以忍受。蛔虫钻人胆道所引起的胆管阻塞是不完全的，故甚少发生黄疸，主要是蛔出带入的细菌导致胆管炎症。DE项进食油腻食物后或夜间易发作，Murphy(+)，较少发生胆道的完全堵塞。A项表现为进行性的胆道梗阻，且有食欲减退、乏力的临床表现。" + }, + { + "question_num": 451, + "query": "患者,男,22岁。发热恶寒,寒重热轻,头身疼痛,鼻塞流涕,咳嗽,咯清稀,舌苔薄白,脉浮紧。治疗应选取何经穴为主", + "options": { + "A": "手少阴、手太阳、手太阴经", + "B": "手太阴、手阳明、足太阳经", + "C": "手太阴、足太阳、手少阳经", + "D": "手阳明、足阳明、手太阴经", + "E": "手太阴、手少阳、足少阳经" + }, + "answer": "B", + "reason": "风寒感冒以祛散风寒表邪为主,肺主皮毛,太阳主一身之表,太阴、阳明为表里,以达散风寒，宣肺气之目的。" + }, + { + "question_num": 452, + "query": "患儿,6岁。泄泻1天,泻下稀薄如水注,粪色深黄臭秽,夹有少量黏液。腹部时感疼痛,食欲减退,恶心欲吐,口渴引饮,舌红苔黄腻,其证候是", + "options": { + "A": "脾肾阳虚泻", + "B": "伤食泻", + "C": "风寒泻", + "D": "湿热泻", + "E": "脾虚泻" + }, + "answer": "D", + "reason": "泄泻辨��容易,重在辨证。“粪色深黄臭秽”“口渴引饮”“舌红苔黄腻”为关键症状,表明内有湿热。因此辨其证候为湿热泻,故选D。" + }, + { + "question_num": 453, + "query": "患者身热不恶寒，反恶热，烦渴喜冷饮，神昏谵语，便秘溲赤，手足逆冷，舌红苔黄而干，脉沉数有力，其证候是", + "options": { + "A": "表寒里热", + "B": "表热里寒", + "C": "真热假寒", + "D": "真寒假热", + "E": "上热下寒" + }, + "answer": "C", + "reason": "手足冷,脉沉等,似属寒证,但四肢冷而身热不恶寒反恶热，脉沉数而有力，更见烦渴喜冷饮,咽干、口臭、谵语、小便短赤,大便燥结或热痢下重,舌质红,苔黄而干等症,故选C。A项主要表现为恶寒发热,头痛身痛,口潟引饮,心烦尿黄,咳喘痰黄,舌红苔薄等。B项多表现为发热头痛,咽干汗出,食少腹胀，便溏溲清,舌体胖,苔略黄等。D项表现为身热,面色浮红,口,脉大等似属热证,但患者身虽热却反欲盖衣被,渴欲热饮而饮不多,面红时隐时现,浮嫩如妆,不像实热之满面通红,脉大却按之无力。同时还可见到四肢厥冷，下利洁谷,小便清长,否淡苔白等症状。E项是指患者在同一时间内，上部表现为热，下部表现为寒的证候。" + }, + { + "question_num": 454, + "query": "患者，女，50岁。15年前因甲亢行甲状腺次全切除术。近1个月来又感心悸、出汗、消瘦，心电图检查提示房额，心率120次/分，FT3、FT4均升高。应首先考虑的治疗措施是", + "options": { + "A": "第2次手术", + "B": "放射性131I治疗", + "C": "服抗甲状腺药与甲状腺素片", + "D": "服碘溶液", + "E": "甲状腺素片" + }, + "answer": "B", + "reason": "首先是诊断，心悸、出汗、消瘦，FT3、FT4均升高，考虑为甲状腺功能亢进症，患者15年前因甲亢行甲状腺次全切除术。心电图检查提示房颤，诊断明确，甲状腺功能亢进症复发，为甲状腺功能亢进症心脏病。患者50岁有手术史，再次手术不是首选，服碘溶液往往用于手术前和放射碘之前的准备阶段；甲状腺素片主要用于甲低。甲状腺功能亢进症心脏病首选治疗是放射碘。" + }, + { + "question_num": 455, + "query": "患者,女53岁。咳嗽月余，加重1周,咳引胸胁疼痛,痰少而稠,面赤咽干,舌苔黄少津，脉弦数。治疗应选取的主要经穴是", + "options": { + "A": "手太阴、手阳明经", + "B": "手太阴、足太阴经", + "C": "足阳明、手阳明经", + "D": "足太阴、足厥阴经", + "E": "足厥阴、手太阴经" + }, + "answer": "E", + "reason": "肝火灼肺咳嗽以手太阴、足厥阴经穴为主,以清肺热.泄肝经邪热。" + }, + { + "question_num": 456, + "query": "患儿,5岁。1年来食少饮多,皮肤干燥,大便干结,舌红少津,舌苔光剥,脉细数。治疗应首选", + "options": { + "A": "沙参麦冬汤", + "B": "增液承气汤", + "C": "养胃增液汤", + "D": "六味地黄丸", + "E": "麦门冬汤" + }, + "answer": "C", + "reason": "患儿主症为食少饮多,诊为厌食。“皮肤干燥,大便干结,舌红少津,舌苔光剥,脉细数”为脾胃阴虚的表现。治宜滋脾养胃,佐以助运，方用养胃增液汤。" + }, + { + "question_num": 457, + "query": "患者胃肠热盛，大便秘结，腹满便痛而拒按，潮热，神昏谵语，但又兼见面色苍白。四肢厥冷，精神萎靡，其病机是", + "options": { + "A": "虚中夹实", + "B": "真实假虚", + "C": "由实转虚", + "D": "真虚假实", + "E": "实中夹虚" + }, + "answer": "B", + "reason": "A项往往见于实证深重,拖延日久,正气大伤、余邪未尽的患者;亦可见于素体大虚,复感邪气的患者,其特点是以正虚为主,实邪为次。B项指疾病本身属实证,但又出现一些似乎是虚的现象,如热结肠胃,痰食滞,大积大聚之实证,却见神情沉静，身寒肢冷,脉沉伏或迟涩等症脉。C项是在疾病过程中,有些本来是实证,由于病邪久留,损伤正气,而转为虚证。D项指疾病本质属虚证,但又出现一些似乎是实的现象,如素体脾虚、运化无力,因而出现腹部胀满而痛,脉弦等症脉。E项常常发生于实证过程中正气受损的患者,亦可见于原来体虚而新感外邪的患者，它的特点是以实邪为主，正虚为次。" + }, + { + "question_num": 458, + "query": "患者，男，24岁。近3年来反复餐后3~4小时上腹痛，持续至下次进餐后才缓解。应首先考虑的是", + "options": { + "A": "消化性溃疡", + "B": "胃癌", + "C": "慢性胃炎", + "D": "胃肠神经官能症", + "E": "胆囊炎" + }, + "answer": "A", + "reason": "消化性溃疡疼痛特点为上腹部长期反复周期性发作���溃疡疼痛与饮食之间的关系具有明显的相关性和节律性。B项有上腹部持续性疼痛，进食后会加重。CDE项造成的腹痛与进食无明显相关性。" + }, + { + "question_num": 459, + "query": "患者,男,25岁。3日来头痛如裹,痛无休止,肢体困重,苔白腻,脉濡。针灸治疗除百会、太阳、风池、合谷外,宜取", + "options": { + "A": "风门", + "B": "曲池", + "C": "丰隆", + "D": "阴陵泉", + "E": "足临泣" + }, + "answer": "D", + "reason": "根据题干证状诊断:头痛之风湿头痛。针灸治疗宜配头维、阴陵泉。" + }, + { + "question_num": 460, + "query": "患儿,2岁。形体极度消瘦,面虽老人貌,皮包骨头,腹凹如舟,精神萎靡,大便溏薄,舌淡苔薄腻,其证候是", + "options": { + "A": "疳肿胀", + "B": "疳气", + "C": "疳积", + "D": "干疳", + "E": "心疳发" + }, + "answer": "D", + "reason": "干疳,亦称\"疳极”,临床表现为极度消瘦,貌似老人,腹凹如舟,精神萎靡。" + }, + { + "question_num": 461, + "query": "患者，男，50岁。咳嗽，气息喘促，胸中烦闷胀痛，痰多色黄黏稠，咳吐不爽，或痰中带血，渴喜冷饮，面红咽干，尿赤，便秘，苔黄腻，脉滑数。查体：肺底部可闻及湿性和干性啰音。治疗应首选", + "options": { + "A": "三物汤", + "B": "麻杏石甘汤加减", + "C": "二陈汤合三子养亲汤加减", + "D": "桑白皮汤加减", + "E": "小青龙汤加减" + }, + "answer": "D", + "reason": "忠者咳嗽,咳痰伴有气息喘促。查体:肺底部可闻及湿性和干性啰音。可诊断为慢性支气管炎。咳嗽,气息喘促,胸中烦闷胀痛,痰多色黄黏稠,咳吐不爽,或痰中带血,渴喜冷饮,面红咽干,尿赤便秘,苔黄腻,脉滑数,即为痰热郁肺证。方用桑白皮汤加减。治法:清热化痰·开道宣肺止咳。" + }, + { + "question_num": 462, + "query": "患者食欲和记忆力减退。检查：眼睑苍白，血红细胞、白细胞和血小板均减少。应首先考虑的是", + "options": { + "A": "再生障碍性贫血", + "B": "缺铁性贫血", + "C": "溶血性贫血", + "D": "失血性贫血", + "E": "巨幼红细胞性贫血" + }, + "answer": "A", + "reason": "再障系多种病因引起的造血障碍，导致红骨髓总容量减少，代以脂肪髓，造血衰竭，以全血细胞减少为主要表现的一组综合征。而BCDE项均只有血红细胞的降低。" + }, + { + "question_num": 463, + "query": "患儿,男,7岁。尿床2年,症见睡中遗尿,醒后方觉,神疲乏力,小便频数,盘少,食欲差,大便稀溏。舌质淡,脉沉细无力。治疗宜首选", + "options": { + "A": "关元、中极、三阴交、水分", + "B": "气海、太溪、三阴交、水道", + "C": "中渚、膀胱俞、三阴交、水道", + "D": "阴廉、中极、关元、血海", + "E": "中极、膀胱俞、三阴交、关元" + }, + "answer": "E", + "reason": "患者睡中遗尿,醒后方觉,诊为遗尿,故应选用关元培补元气,益肾固本;中极、膀胱俞为膀胱之俞募配穴，可促进膀胱之气化功能;三阴交健脾益气,益肾固本。" + }, + { + "question_num": 464, + "query": "患儿自汗，头、肩、背出汗明显,活动后加重,易感冒,神倦乏力。面色少华,四肢欠温,舌淡苔薄,脉弱,其治法是", + "options": { + "A": "调和营卫", + "B": "益气固表", + "C": "益气养阴", + "D": "益气敛汗", + "E": "敛汗潜阳" + }, + "answer": "B", + "reason": "“患儿自汗,头、肩、背出汗明显”为汗证之肺卫不固,亦称表虚不固,治宜益气固表。" + }, + { + "question_num": 465, + "query": "患者，男，70岁。神志痴呆，表情淡漠，举止失常，面色晦滞，胸闷泛恶，舌苔白腻，脉滑，其病机是", + "options": { + "A": "痰迷心窍", + "B": "痰火扰心", + "C": "心血瘀阻", + "D": "肾精亏虚", + "E": "心脾两虚" + }, + "answer": "A", + "reason": "表情淡漠,神志痴呆,举止失常多由肝气郁结,气郁生痰,痰浊上蒙心窍所致,属于癫证面色晦滞为外感湿浊之邪,湿浊郁遏中焦,清阳不升浊气上泛。脘闷作恶为胃失和降,胃气上逆。舌苔白腻,脉滑是痰浊内盛之象。" + }, + { + "question_num": 466, + "query": "患者，女，40岁。近半年多饮、多尿伴乏力，身高164cm，体重65kg。查体：血压150/110mmHg，余未见明显异常。检查：空腹血糖6.9mmol/L。此时可明确诊断的检查是", + "options": { + "A": "重复一次空腹血糖", + "B": "葡萄糖耐量试验", + "C": "测餐后2小时血糖", + "D": "测24小时尿糖、尿蛋白", + "E": "糖化血红蛋白" + }, + "answer": "B", + "reason": "当血糖高于正常范围而又��达到诊断标准，可进行葡萄糖耐量试验。而重复一次空腹血糖、测餐后2小时血糖、测24小时尿糖、尿蛋白、糖化血红蛋白均为辅助检查。但优先应查糖耐量试验。" + }, + { + "question_num": 467, + "query": "患者,女,26岁。非周期性子宫出血,盘多、色紫红、质稠,夹有血块,腹痛拒按,舌红苔黄,脉弦数。治疗应首选", + "options": { + "A": "气海", + "B": "中极", + "C": "三阴交", + "D": "隐白", + "E": "太冲" + }, + "answer": "C", + "reason": "三阴交为足三阴经之交会穴,可清泄三经之湿、热、瘀等病邪,又可疏理肝气,邪除则脾可统血。" + }, + { + "question_num": 468, + "query": "患儿,6岁。初起发热恶寒，咳嗽，咽痛,乳蛾肿大。继则眼睑浮肿,波及全身，皮肤光亮,按之凹陷即起,小便短少,尿色红赤，舌苔薄白,其证候是", + "options": { + "A": "外感风热", + "B": "风水相搏", + "C": "湿热内侵", + "D": "肺脾气虚", + "E": "脾肾两虚" + }, + "answer": "B", + "reason": "患儿有外感症状,同时有“眼睑浮肿,波及全身”的典型风水症状的表现,故选B。" + }, + { + "question_num": 469, + "query": "患者身目发黄，黄色鲜明，腹部痞满，肢体困重，便溏尿黄，身热不扬。舌红苔黄腻，脉濡数，其证候是", + "options": { + "A": "肝胆湿热", + "B": "大肠湿热", + "C": "肝火上炎", + "D": "湿热蕴脾", + "E": "寒湿困脾" + }, + "answer": "D", + "reason": "脘腹痞闷为湿热蕴结脾胃,受纳运化失职,升降失常,纳呆呕恶。肢体困重为脾为湿困，大便溏泄,小便黄为湿热蕴牌,交阻下迫。面目肌肤发黄,其色鲜明如橘子为湿热内蕴,蒸肝胆,致胆汁不循常道,外溢肌肤。身热不扬为湿過热伏,热处湿中，湿热郁蒸,舌红苔黄腻,脉活数,均为湿热内盛之象。" + }, + { + "question_num": 470, + "query": "患者高热3天，头痛，伴呕吐。检查：颈项强直，克氏征阳性，脑脊液外观混浊，细胞数2000/μl，以中性粒细胞为主。应首先考虑的是", + "options": { + "A": "结核性脑膜炎", + "B": "流行性脑脊髓膜炎", + "C": "流行性乙型脑炎", + "D": "伤寒", + "E": "中毒型菌痢" + }, + "answer": "B", + "reason": "颈项强直，克氏征阳性，初步诊断为脑膜炎。脑脊液中细胞数增加，以中性粒细胞为主，为细菌性脑膜炎。结核性脑膜炎一般表现为结核中毒症状，多为低热。流行性乙型脑炎无皮肤黏膜出血、瘀血。中毒型菌痢无脑膜刺激征，皮肤无出血。" + }, + { + "question_num": 471, + "query": "患者,男,40岁。阑尾手术后,出现小便闭塞不通,努责无效,小腹满痛,舌紫暗,脉涩。除秩边、阴陵泉、三阴交、中极、膀胱俞外，应加取", + "options": { + "A": "委阳、曲骨", + "B": "太冲、大敦", + "C": "次髎、血海", + "D": "曲骨、太冲", + "E": "次髎、太冲" + }, + "answer": "C", + "reason": "该患者为癃闭浊瘀阻塞证。癃闭配穴:膀胱湿热配委阳;肺热壅盛配尺泽；肝郁气滞配太冲;浊瘀阻塞配次髎、血海。" + }, + { + "question_num": 472, + "query": "患儿，2岁。持续壮热5天，起伏如潮,肤有微汗。烦躁不安，目赤眵多,皮疹布发,疹点由细小稀少而逐渐稠密,疹色先红后暗,皮疹凸起,触之碍手。压之褪色,大便干结,小便短少,舌质红赤,舌苔黄腻,脉数有力。治疗应首选", + "options": { + "A": "宣毒发表汤", + "B": "清解透表汤", + "C": "沙参麦冬汤", + "D": "麻杏石甘汤", + "E": "羚角钩藤汤" + }, + "answer": "B", + "reason": "发热5天后热盛出疹,未见淋巴结肿大,皮疹布发,疹点由细小稀少而逐渐稠密,疹色先红后暗,皮疹凸起,触之碍手,压之褪色。由此可以诊断为麻疹出疹期。方用清解透表汤。" + }, + { + "question_num": 473, + "query": "患者，女，17岁。面、鼻部粉刺，用手指挤压，有米粒白色脂栓挤出，颜面潮红，舌红苔黄，脉细数。证属肺经风热。治疗应首选", + "options": { + "A": "枇杷清肺饮", + "B": "桑菊饮", + "C": "银翘散", + "D": "消风散", + "E": "防风通圣散" + }, + "answer": "A", + "reason": "忠者面、鼻部粉刺,素体阳热偏盛,肺经蕴热复受风邪,上蒸颜面而致,脾气不足,运化失常,湿浊肉停,郁久化热,热灼津液,煎炼成痰,湿热瘵痰凝滞肌肤而发,治法为疏风清肺,方药为枇杷清肺饮。相当于西医的痤疮。" + }, + { + "question_num": 474, + "query": "患者，男，50岁。咳嗽、咳痰3年，每年发病持续4个月。肺底可听到散在干啰音，X线检查无异常，其诊断是", + "options": { + "A": "慢性支气管炎", + "B": "肺结核", + "C": "支气管哮喘", + "D": "肺炎球菌肺炎", + "E": "肺癌" + }, + "answer": "A", + "reason": "该患者中老年男性，咳嗽、咳痰3年，每年发病持续4个月，听诊可闻及干啰音，X线检查无异常，考虑慢性支气管炎可能性大，故选A。B项应有发热。C项听诊可闻及哮鸣音。DE项的X线检查有阴影。" + }, + { + "question_num": 475, + "query": "患者,男,55岁。患者3天前自觉右胁背部疼痛,并逐渐出现疱疹,呈现带状分布，疼痛较剧,口干苦、大便干、小便黄,脉弦,舌红苔黄。根据病情应取哪组经脉或腧穴为主", + "options": { + "A": "手足阳明经", + "B": "局部阿是穴及相应夹脊穴", + "C": "手足太阳经", + "D": "手足太阴经", + "E": "手足厥阴经" + }, + "answer": "B", + "reason": "蛇串疮的辩证、治法。根据患者的证状可诊断为蛇串疙,针灸治疗主要以局部阿是穴及相应夹脊穴为主。" + }, + { + "question_num": 476, + "query": "患儿,1岁。久泻后形体赢瘦，食欲尚可,手足心热,两目干涩,时常眨眼,畏光,夜晚视物不清。治疗宜选方", + "options": { + "A": "八珍汤", + "B": "金匮肾气丸", + "C": "知柏地黄丸", + "D": "石斛夜光丸", + "E": "沙参麦冬汤" + }, + "answer": "D", + "reason": "证属疳证兼证中的眼疳证,治疗当养血柔肝,滋阴明目,药用石斛夜光丸。" + }, + { + "question_num": 477, + "query": "患者，男，60岁。形寒便溏，完谷不化，夜尿频多清长，下肢不温，舌质淡白，脉沉细，其舌苔应是", + "options": { + "A": "透明苔", + "B": "白干苔", + "C": "黄苔", + "D": "黄腻苔", + "E": "灰苔" + }, + "answer": "A", + "reason": "由题目中描述的诸症可判定患者为牌肾阳虚证。B项常见于风热表证，不符合题意,可排除。C项主热证、里证,D项主湿热内蕴、痰饮化热或食积化热,故也要排除。E项主热极或寒盛,故排除通过排除法可确定答案为A。" + }, + { + "question_num": 478, + "query": "患者脑脊液检查结果：蛋白质定性(+++)，定量10g/L。氯化物为105mmol/L，葡萄糖为20mmol/L。可能的诊断是", + "options": { + "A": "流行性乙型脑炎", + "B": "化脓性脑膜炎", + "C": "病毒性脑膜炎", + "D": "脑膜白血病", + "E": "结核性脑膜炎" + }, + "answer": "B", + "reason": "化脓性脑膜炎脑脊液蛋白质强阳性，含量显著增加，葡萄糖明显减少或消失，氯化物稍低。结核性脑膜炎蛋白质阳性，含量增加，葡萄糖减少，氯化物明显减少，可降至102mmol/L以下。病毒性脑炎和脑膜炎的葡萄糖和氯化物正常。" + }, + { + "question_num": 479, + "query": "患者,女,17岁。痫病发作后来诊，发病前有眩晕,胸闷,现痰多,舌红,苔白腻,脉滑。针灸治疗除印堂、鸠尾、间使、太冲、丰隆外,应加用", + "options": { + "A": "曲池、神门、内庭", + "B": "合谷、阴陵泉、风池", + "C": "心俞、脾俞、足三里", + "D": "肝俞、肾俞、太溪", + "E": "丰隆、膈俞、内关" + }, + "answer": "B", + "reason": "痫病之风痰闭阻证,应配合谷、风池、阴陵泉。" + }, + { + "question_num": 480, + "query": "患儿4周前,有呼吸道感染史,现水肿,血尿,抗链球菌溶血素“O”抗体增高,身倦乏力,面色萎黄,自汗出,易感冒,纳少便溏,舌淡红,脉缓弱。治疗应首选", + "options": { + "A": "已椒苈黄丸", + "B": "泻心汤", + "C": "六君子汤", + "D": "参苓白术散", + "E": "麻黄连翘赤小豆汤" + }, + "answer": "D", + "reason": "患儿4周前,有呼吸道感染史,现浮肿,血尿,抗链球菌溶血素“O”抗体增高,可初步诊断为急性肾小球肾炎。又见身倦乏力，面色萎黄，自汗出,易感冒,纳少便溏,舌淡红,脉缓弱。是由于肺气虚卫外不固,则自汗出,易感冒;脾气虚运化失常,则纳少便溏;肺脾气虚,湿浊未清,则身倦乏力,面色萎黄,故该忠儿为肺脾气虚证,由气虚邪恋导致。治宜健脾化湿,方用参苓白术散加减。" + } +] \ No newline at end of file