diff --git "a/Licensed/Theory_Questions/Year_3/Mock.json" "b/Licensed/Theory_Questions/Year_3/Mock.json" new file mode 100644--- /dev/null +++ "b/Licensed/Theory_Questions/Year_3/Mock.json" @@ -0,0 +1,6242 @@ +[ + { + "question_num": 1, + "query": "关于体质的特点，错误的是", + "options": { + "A": "先天遗传性", + "B": "差异多样性", + "C": "绝对稳定性", + "D": "群类趋同性", + "E": "后天可调性" + }, + "answer": "C", + "reason": "体质的特点:①先天遗传性;②差异多样性;③形神一体性;④群类趋同性;⑤相对稳定性;⑥动态可变性;⑦连续可测性;⑧后天可调性。" + }, + { + "question_num": 2, + "query": "心脏瓣膜病中常出现头部搏动感及节律性点头运动的是", + "options": { + "A": "二尖瓣狭窄", + "B": "二尖瓣关闭不全", + "C": "主动脉瓣狭窄", + "D": "主动脉瓣关闭不全", + "E": "肺动脉瓣狭窄" + }, + "answer": "D", + "reason": "主动脉瓣关闭不全：急性患者轻者多无症状，重者可出现急性左侧心力衰竭及低血压；慢性者最早出现的症状为心悸、心前区不适，常有头部搏动感。多数患者晚期出现左侧心力衰竭表现。" + }, + { + "question_num": 3, + "query": "消渴并发白内障、耳聋、雀自,治疗首选", + "options": { + "A": "六味地黄汤", + "B": "石斛夜光丸", + "C": "杞菊地黄丸", + "D": "龙胆泻肝丸", + "E": "镇肝熄风汤" + }, + "answer": "C", + "reason": "消渴并发白内障、耳聋、雀直,主要病机为肝肾精血不足,不能上承耳目所致,治疗首选杞菊地黄丸滋补肝肾,益精补血。" + }, + { + "question_num": 4, + "query": "下列哪一项不是血瘤的特点", + "options": { + "A": "边界不清", + "B": "触之如海绵状", + "C": "柔软而局限", + "D": "色泽鲜红而暗紫", + "E": "盘曲如蚯蚓状" + }, + "answer": "E", + "reason": "血瘤是指体表血络扩张,纵横丛集而形成的肿瘤。可发生于身体任何部位，大多数为先天性,其特点是病变局部色泽鲜红或暗紫，或呈局限性柔软肿块,边界不清,触之如海绵状。" + }, + { + "question_num": 5, + "query": "五行调节事物整体动态平衡的机制是", + "options": { + "A": "生我", + "B": "我生", + "C": "克我", + "D": "我克", + "E": "制化" + }, + "answer": "E", + "reason": "制化,“制”,即制约、克制;“化”,即生制化是把相克联系中只有相生而没有相克,则不能维持正常的平衡,如果仅有相克而没有相生,则万物无以生化。制化是通过五行中的相生、相克,对五行中某一行旺盛之时,予以制约,防止其“亢而为害”。五行学说运用生克关系的调节,解释大自然的正常生态平衡以及人体生理平衡" + }, + { + "question_num": 6, + "query": "下列各项，不符合淤胆型肝炎临床表现的是", + "options": { + "A": "黄疸深", + "B": "自觉症状重", + "C": "皮肤瘙痒", + "D": "大便颜色变浅", + "E": "血清胆固醇升高" + }, + "answer": "B", + "reason": "淤胆型肝炎主要表现为急性病毒性肝炎较长时期的肝内梗阻性黄疸，临床自觉症状轻微，常表现有皮肤瘙痒、粪便颜色变浅，肝功能检查血清胆红素明显升高，以直接胆红素为主。ACDE项等均符合淤胆型肝炎的临床表现。" + }, + { + "question_num": 7, + "query": "内伤咳嗽的病理因素主要为", + "options": { + "A": "湿与热", + "B": "饮与热", + "C": "痰与火", + "D": "痰与寒", + "E": "湿与燥" + }, + "answer": "C", + "reason": "咳嗽的病因病机。内伤咳嗽多属于邪实与正虚并见,病理因素主要为由\"痰“与”火\"。但痰有寒热之别,火有虚实之分,痰可郁而化火,火能炼液灼津为痰。" + }, + { + "question_num": 8, + "query": "下列关于外科疾病总的发病机制的叙述,错误的是", + "options": { + "A": "气血凝滞", + "B": "经络阻塞", + "C": "营气不从", + "D": "脏腑失和", + "E": "热毒火毒" + }, + "answer": "E", + "reason": "外科疾病发病机制。外科疾病发病机制:邪正盛衰,气血凝滞,经络阻塞,脏腑失和。" + }, + { + "question_num": 9, + "query": "下列选项的表述属于证侯的是", + "options": { + "A": "痢疾", + "B": "发热", + "C": "感冒", + "D": "头痛", + "E": "心阳不振" + }, + "answer": "E", + "reason": "证,即证候。它是机体在疾病发展过程中的某一阶段或某一类型的病理概括，也标志着机体对病因作用的整体反应状态,如肝风内动、心血亏求、心阳不振,痰火扰心等。痢疾与感冒属于病;发热与头痛属于症。" + }, + { + "question_num": 10, + "query": "阵发性室上性心动过速的心电图诊断，下列哪项不正确", + "options": { + "A": "心室率150~250次/分", + "B": "节律一般规则，但亦可有不规则", + "C": "QRS波群形态可不正常", + "D": "可见到逆行P波", + "E": "起始及终止突然" + }, + "answer": "B", + "reason": "阵发性室上性心动过速的临床特点：起病及终止均突然；发作时心室率可达150～250次/分；心室节律绝对规则；心电图表现为QRS波形态可完全正常，亦可因伴有室内传导阻滞而显示QRS波形态异常；P波在部分病例中见到，但常为逆行P波，故选B。" + }, + { + "question_num": 11, + "query": "下列哪项肺痈治疗选方有误", + "options": { + "A": "初期用银翘散", + "B": "成痈期用千金苇茎汤合如金解毒散", + "C": "热毒瘀结用等苈大枣泻肺汤", + "D": "溃脓期用加味桔梗汤", + "E": "身静咳减脓少用桔梗杏仁煎" + }, + "answer": "C", + "reason": "肺痈初期宜疏散风热,清肺散邪,用银跷散。成痈期宜清肺解毒,化瘀消痈,用千金苇茎汤合如金解毒散。溃脓期应排脓解毒,用加味桔梗汤，恢复期应养阴益气清肺,用沙参清肺汤或桔梗杏仁煎。" + }, + { + "question_num": 12, + "query": "贯穿结扎法最适用的是", + "options": { + "A": "内痔嵌顿", + "B": "静脉曲张性外痔", + "C": "血栓性外痔", + "D": "赘皮外痔", + "E": "纤维型内痔" + }, + "answer": "E", + "reason": "贯穿结扎法最适用于纤维型内痔，其他疾病也可以使用,但不是最适宜的。" + }, + { + "question_num": 13, + "query": "“秋冬养阴”属于哪项养生原则", + "options": { + "A": "形神兼养", + "B": "调养脾肾", + "C": "顺应自然", + "D": "因人而异", + "E": "以上均非" + }, + "answer": "C", + "reason": "养生的原则:①顺应自然,了解和把握自然界各种变化的规律和特点,保持与自然的统一，即“天人合一”;②形神兼养,注意将调养形体与调摄精神意识活动相结合,使“形与神俱”,即保持形神合一:③调养脾肾,脾为后天之本,肾为先天之本,保养肾精“食饮有节”,才能保养脾肾;④因人而异,根据每个人的体质特点、所患疾病、生活习惯等的不同制定具体的养生方法,才能达到有效养生的目的。" + }, + { + "question_num": 14, + "query": "下列关于甲状腺功能亢进症的叙述，正确的是", + "options": { + "A": "T4、T3均增高时，才能诊断", + "B": "T4、T3均降低时，才能诊断", + "C": "仅有T3增高即可诊断", + "D": "T3增高时，T4则降低", + "E": "以上均非" + }, + "answer": "C", + "reason": "甲状腺功能亢进症仅有T3增高即可诊断。" + }, + { + "question_num": 15, + "query": "哮病发作期的病因病理关键是", + "options": { + "A": "宿痰内伏于肺", + "B": "外邪侵袭,触动伏痰", + "C": "痰气相击,气道被阻", + "D": "邪客于肺,气道不利", + "E": "脏腑虚弱,气失所主" + }, + "answer": "C", + "reason": "哮病发作期为\"伏痰\"遇诱因引触,痰随气升,气因痰阻,痰气持结,壅塞气道,肺失宣降,痰随气动,故致痰鸣如吼,气息喘促。" + }, + { + "question_num": 16, + "query": "下列各项,属外科辨别阴证、阳证要点的是", + "options": { + "A": "有无麻木", + "B": "有无脓液", + "C": "有无出血", + "D": "有无灼热", + "E": "有无瘙痒" + }, + "answer": "D", + "reason": "阴和阳属于截然相反的两个对立面寒凉属阴,温热属阳。" + }, + { + "question_num": 17, + "query": "有主水和纳气功能的脏是", + "options": { + "A": "肝", + "B": "心", + "C": "脾", + "D": "肺", + "E": "肾" + }, + "answer": "E", + "reason": "肾藏精、主水、主纳气。【解析】阴阳互藏是阴阳双方交感合和的动" + }, + { + "question_num": 18, + "query": "下列关于哮喘持续状态的紧急处理哪项是错误的", + "options": { + "A": "静滴地塞米松", + "B": "补充水、电解质", + "C": "纠正酸中毒", + "D": "吸氧", + "E": "口服氨茶碱" + }, + "answer": "E", + "reason": "哮喘持续状态的治疗：①吸氧；②迅速缓解气道痉挛，常用琥珀酸氢化可的松、甲泼尼龙或地塞米松静脉滴注或注射；③及时进行人工通气；④注意并发症：包括预防和控制感染，补充足够液体量，避免痰液黏稠，纠正严重酸中毒和调整水电解质平衡等。" + }, + { + "question_num": 19, + "query": "癃闭肺热壅盛证的主方是", + "options": { + "A": "清肺饮", + "B": "沉香散", + "C": "春泽汤", + "D": "八正散", + "E": "代抵当丸" + }, + "answer": "A", + "reason": "癃闭肺热壅盛治宜清泄肺热.通利水道,方用清肺饮。八正散用于膀胱湿热证。春泽汤用于伤暑泄泻,泄定仍渴,小便不利。沉香散用���肝郁气滞。代抵当丸用于尿道阻塞。" + }, + { + "question_num": 20, + "query": "中医外科内治法的总则是", + "options": { + "A": "温、托、补", + "B": "清、消、补", + "C": "清、补、托", + "D": "消、通、补", + "E": "消、托、补" + }, + "answer": "E", + "reason": "消、托、补三个大法是治疗外科疾病的三个总则。" + }, + { + "question_num": 21, + "query": "“本乎天者亲上，本乎地者亲下”，说明了阴阳学说的哪种关系", + "options": { + "A": "阴阳对立制约", + "B": "阴阳互根互用", + "C": "阴阳互藏", + "D": "阴阳转化", + "E": "阴阳自和与平衡" + }, + "answer": "C", + "reason": "力根源。天气下降,地气上升，古代哲学家是用“本乎天者亲上,本乎地者亲下”(《周易·乾传》)来解释的:阴中有阳则能升,阳中有阴则能降。阴阳互藏是阴阳消长与转化的内在根据。" + }, + { + "question_num": 22, + "query": "诊断肺心病的主要依据是", + "options": { + "A": "长期肺结核病", + "B": "长期慢性支气管炎", + "C": "肺动脉高压及右心室肥大", + "D": "肺动脉狭窄", + "E": "两下肢浮肿" + }, + "answer": "C", + "reason": "肺心病由慢性广泛性肺—胸疾病发展而来，呼吸和循环系统的症状常混杂出现。一般认为凡有慢性广泛性肺、胸疾病患者，一旦发现有肺动脉高压、右心室增大而同时排除了引起右心增大的其他心脏病可能时，即可诊断为本病。" + }, + { + "question_num": 23, + "query": "既治疗心悸,又治疗不寐的方剂为", + "options": { + "A": "龙胆泻肝汤", + "B": "丹栀逍遥散", + "C": "黄连温胆汤", + "D": "导炭汤", + "E": "龙胆泻肝汤合涤痰汤" + }, + "answer": "C", + "reason": "黄连温胆汤治疗心悸痰火扰心证和不寐痰热扰心证。" + }, + { + "question_num": 24, + "query": "内痔消痔灵注射法一次注射总量为", + "options": { + "A": "5~10ml", + "B": "10~15ml", + "C": "15~30ml", + "D": "20~35ml", + "E": "25~40ml" + }, + "answer": "C", + "reason": "消痔灵注射法是目前临床上广为采用的内痔治疗方法。内痔消痔灵四步注射法按四步注射完一个痔核后，同法注射其他痔核，一次注射总量15~30ml。" + }, + { + "question_num": 25, + "query": "天地万物相互联系的中介是", + "options": { + "A": "天气", + "B": "地气", + "C": "阳气", + "D": "阴阳", + "E": "精气" + }, + "answer": "E", + "reason": "精气是天地万物相互联系的中介。精气分阴阳而成天地，天地交感而生万物。天地万物相互联系,相互作用,是以精气作为中介的。" + }, + { + "question_num": 26, + "query": "伴痛风的高血压病患者，应禁用的降压药是", + "options": { + "A": "β受体阻滞剂", + "B": "钙通道阻滞剂", + "C": "利尿剂", + "D": "血管紧张素转换酶抑制剂", + "E": "血管紧张素Ⅱ受体阻滞剂" + }, + "answer": "C", + "reason": "利尿剂可作为无并发症高血压患者的首选药物，适用于轻、中度高血压，尤其是老年高血压、肥胖及并发心力衰竭者。利尿剂有噻嗪类、袢利尿剂和保钾利尿剂3类，常用噻嗪类，如氢氯噻嗪和氯噻酮、吲达帕胺等，禁用于痛风患者。" + }, + { + "question_num": 27, + "query": "下列除哪项外,均为喘证的病因", + "options": { + "A": "外邪侵袭", + "B": "饮食不当", + "C": "情志所伤", + "D": "痰热素盛", + "E": "劳欲久病" + }, + "answer": "D", + "reason": "喘证的病因有ABCE。D项病热素盛属于病理因素,可由多种因素产生,不是最根本的病因。" + }, + { + "question_num": 28, + "query": "下列除哪项外,均与脂瘤无关(", + "options": { + "A": "以四肢、面颈部为多见", + "B": "以腕、踝关节部为多见", + "C": "头面、项背、部等处常见", + "D": "治以散结化痰", + "E": "治以凉营活血" + }, + "answer": "C", + "reason": "脂瘤好发部位:头面、项背、臀部等处。" + }, + { + "question_num": 29, + "query": "《内经》说的阴阳属性之征兆是", + "options": { + "A": "寒与热", + "B": "水与火", + "C": "上与下", + "D": "内与外", + "E": "动与静" + }, + "answer": "B", + "reason": "阴阳代表着相互对立和相互关联的事物属性。事物阴阳属性的划分，一般地说，凡是剧烈的、运动着的、外向的、上升的、温热的、明亮的都属于阳;相对静止着的、内守的、下降的、寒冷的、晦暗的都属于阴。《素问·阴阳应象大论》说:“水火者,阴阳之征兆也。”阴阳属性之征兆是水与火。" + }, + { + "question_num": 30, + "query": "急性出血性坏死型胰腺炎的重要特征是", + "options": { + "A": "血淀粉酶明显升高", + "B": "休克", + "C": "恶心，呕吐", + "D": "白细胞计数增高", + "E": "血糖升高" + }, + "answer": "A", + "reason": "急性水肿型胰腺炎主要症状为腹痛、恶心、呕吐、发热。而出血坏死型胰腺炎的症状除上述情况外，又因胰腺有出血、坏死和自溶，故又可以出现休克、高热、黄疸、腹胀以至肠麻痹、腹膜刺激征以及皮下出现淤血斑等，但实验室血清淀粉酶＞250U/L为急性胰腺炎严重性的重要指标。" + }, + { + "question_num": 31, + "query": "老人夜寐早醒而无虚烦者，应选用", + "options": { + "A": "左归丸", + "C": "半夏秫米汤", + "B": "天王补心丹", + "D": "归脾汤", + "E": "涤痰汤" + }, + "answer": "D", + "reason": "产后虚烦不寐,或老人夜寐早醒而无虚烦者,多属气血不足,可选用归脾汤。" + }, + { + "question_num": 32, + "query": "不属于痈的疾病是", + "options": { + "A": "颈痈", + "B": "脐痈", + "C": "腋痈", + "D": "锁喉痈", + "E": "委中毒" + }, + "answer": "D", + "reason": "颈痈、脐痈、腋痈、委中毒均属于痈的范畴,而锁喉痈属于发的范畴。" + }, + { + "question_num": 33, + "query": "下列哪项属于心的生理特性", + "options": { + "A": "主血脉", + "B": "主通明", + "C": "主运化", + "D": "主统血", + "E": "主疏泄" + }, + "answer": "B", + "reason": "心的主要生理功能是主血脉,主薇神。心的生理特性有主通明和心气下降。" + }, + { + "question_num": 34, + "query": "慢性肾小球肾炎的主要发病机制是", + "options": { + "A": "链球菌感染", + "B": "病毒感染", + "C": "感染后免疫损害", + "D": "霉菌感染", + "E": "健存肾单位代偿性高负荷" + }, + "answer": "C", + "reason": "各种不同病理类型的慢性肾炎的发病机制起始因素多为免疫介导炎症反应，故选C。A项可为肾小球肾炎的病因，但发病机制仍为链球菌感染引起的免疫损害。BD项较不常见，而E项为肾小球肾炎的结果及加重因素。" + }, + { + "question_num": 35, + "query": "关于惊悸和怔忡,叙述不正确的是", + "options": { + "A": "怔忡每由内因引起,惊悸常由外因而成", + "B": "惊悸日久可发展为怔忡", + "C": "征忡常自觉心中惕惕，病来虽渐,但全身情况较差", + "D": "怔忡患者，又易受外惊所扰，使动悸加重", + "E": "惊悸以虚证为多,发则悸跃不能自控" + }, + "answer": "E", + "reason": "惊悸实证居多,多为阵发性。怔仲多为虚证;持续心悸,心中惕惕,不能自控,活动后加重。" + }, + { + "question_num": 36, + "query": "可能发生髋关节畸形的疾病是", + "options": { + "A": "流火", + "B": "有头疽", + "C": "环跳疽", + "D": "历节风", + "E": "髂窝流注" + }, + "answer": "C", + "reason": "环跳疽愈后常见关节畸形、僵硬、不能活动,或造成关节脱位或僵硬，而形成残废，其他均不易发生。" + }, + { + "question_num": 37, + "query": "“寒极生热”说明了阴阳之间的何种关系", + "options": { + "A": "阴阳交感", + "B": "阴阳互根", + "C": "阴阳对立", + "D": "阴阳消长", + "E": "阴阳转化" + }, + "answer": "E", + "reason": "阴阳转化是指阴阳对立的双方,在一定的条件下,可以各自向其相反的方向转化,阴可以转化为阳，阳也可以转化为阴。《素问·阴阳应象大论》所说的“寒极生热,热极生寒”是阴阳转化关系的具体体现。" + }, + { + "question_num": 38, + "query": "诊断二尖瓣狭窄最有意义的辅助检查是", + "options": { + "A": "X线胸片", + "B": "超声心动图", + "C": "心电图", + "D": "放射性核素检查", + "E": "心导管检查" + }, + "answer": "B", + "reason": "诊断二尖瓣狭窄的辅助检查。题中的五种辅助检查对诊断二尖瓣狭窄均有一定意义，而超声心动图最有意义，可出现城墙样改变，并测出二尖瓣的狭窄程度，是二尖瓣狭窄的特异性改变。" + }, + { + "question_num": 39, + "query": "不寐的病位主要在", + "options": { + "A": "心", + "B": "脑", + "C": "肝", + "D": "脾", + "E": "肾" + }, + "answer": "A", + "reason": "心主神明,神安则寐,神不安则不寐,故不论虚证实证,病因为何脏,总因火泄扰心,心神不安而致不寐,病位在心。" + }, + { + "question_num": 40, + "query": "脱疽初起,患者足背动脉、股后动脉的脉象多表现为", + "options": { + "A": "弦数", + "B": "洪大", + "C": "结代", + "D": "微弱", + "E": "绝" + }, + "answer": "D", + "reason": "脱疽的临床表现。脱疽是由于四肢末端经脉闭阻不通引起的。初起时经脉尚未完全闭阻,但阳气微弱鼓动无力,其脉微弱。" + }, + { + "question_num": 41, + "query": "阴虚风动的病因是", + "options": { + "A": "热病后期，阴津亏损", + "B": "久病耗血或年老精亏", + "C": "产后恶露日久不净", + "D": "生血不足或失血过多", + "E": "水不涵木，浮阳不潜" + }, + "answer": "A", + "reason": "阴虚风动是指阴液枯竭,筋脉失养变生内风的病理变化。多见于热病后期，阴津亏损;或由于久病耗伤,阴液大亏所致。" + }, + { + "question_num": 42, + "query": "可直接导致意识障碍的心律失常是", + "options": { + "A": "室性期前收缩", + "B": "房性期前收缩", + "C": "心室颤动", + "D": "右束支阻滞", + "E": "窦性心动过速" + }, + "answer": "C", + "reason": "心室颤动临床症状包括意识丧失、抽搐、呼吸停顿甚至死亡、听诊心音消失、脉搏触不到、血压亦无法测到，故选C。而室性期前收缩、房性期前收缩、右束支阻滞和窦性心动过速只有少数严重者出现意识障碍。" + }, + { + "question_num": 43, + "query": "各种痫病共同的特点是", + "options": { + "A": "突然意识丧失", + "B": "强直抽搐", + "C": "两目上视", + "D": "发作时怪叫声", + "E": "发作后一如常人" + }, + "answer": "E", + "reason": "痫病典型发作时突然昏倒,不省人事,两目上视,项背强直,四肢抽搞,口吐涎沫,或有异常叫声,或仅有突然呆木,两眼瞪视,呼之不应,或头部下垂,面色苍白等。局限性发作可见多种形式,如口、眼.手等局部抽搞而无突然昏倒,或凝视,误语言障碍，或无意识动作等,多数在数秒至数分钟即止。发作突然,醒后如常人。" + }, + { + "question_num": 44, + "query": "下列关于血栓性深静脉炎主要临床表现的叙述,错误的是(", + "options": { + "A": "患肢疼痛", + "B": "肿胀", + "C": "皮肤温度升高", + "D": "足背动脉搏动减弱", + "E": "浅静脉扩张" + }, + "answer": "D", + "reason": "血栓性深静脉炎以肢体肿胀、疼痛、局部皮温升高和浅静脉怒张为四大症状，足背动脉搏动减弱是脱疽的典型临床症状。" + }, + { + "question_num": 45, + "query": "津伤化燥多见于", + "options": { + "A": "肝、脾、肾", + "B": "心、肺、胃", + "C": "脾、胃、小肠", + "D": "肺、胃、大肠", + "E": "肝、肾、大肠" + }, + "answer": "D", + "reason": "津伤化燥是指津液不足，人体各组织器官和孔窍失其活润，出现干燥枯涩症状的病理变化。内燥的成因多为久病伤阴耗液,或大汗、大吐、大泻,或亡血失精,以及某些热性病过程中的热邪伤阴或湿邪化燥等。内燥病变可发生于各脏腑组织，但以肺胃及大肠为多见。" + }, + { + "question_num": 46, + "query": "治疗肺炎链球菌肺炎，停用抗生素的指征是", + "options": { + "A": "体温降至正常后3~5天", + "B": "痰培养阴性", + "C": "血培养阴性", + "D": "血常规白细胞恢复正常", + "E": "X线检查炎症吸收" + }, + "answer": "A", + "reason": "抗生素疗程通常为5～7天，体温降至正常后3～5天（肺炎临床稳定）可停药，或在退热后3天由静脉用药改为口服，维持数天，不依赖于X线检查炎症完全吸收而停药。" + }, + { + "question_num": 47, + "query": "虚喘的治疗要点不包括", + "options": { + "A": "补肺", + "B": "健脾", + "C": "泻肺", + "D": "补肾", + "E": "养阴" + }, + "answer": "C", + "reason": "喘证的治疗应分清虚实邪正。实喘治肺,以祛邪利气为主,区别寒、热、痰、气的不同,分别采用温化宣肺、清化肃肺、化痰理气的方法。虚喘以培补摄纳为主,或补肺,或健脾,或补肾,阳虚则温补,阴虚则滋养。" + }, + { + "question_num": 48, + "query": "诊断瘿病的重要体征是", + "options": { + "A": "肿块的位置", + "B": "有无压痛", + "C": "有无震颤", + "D": "是否随吞咽上下移动", + "E": "有无波动感" + }, + "answer": "D", + "reason": "甲状腺分左右两叶,覆盖并黏附在喉和气管起始部的两侧,吞咽时亦随之上下移动。甲状腺的两叶由甲状腺峡部连着，其位置一般在第二和第三气管软骨环之前。除D项外其他都是次要的特征。" + }, + { + "question_num": 49, + "query": "十二经脉中循行于腹部的经脉，自胸腹正中线向外的顺序是", + "options": { + "A": "足少阴、足阳明、足太阴、足厥阴", + "B": "足少阴、足阳明、足厥阴、足太阴", + "C": "足太阴、足阳明、足少阴、足厥阴", + "D": "足阳明、足少阴、足太阴、足厥阴", + "E": "足阳明、足本阴、足厥阴、足少阴" + }, + "answer": "A", + "reason": "循行于腹部的经脉,自胸腹正中线向外排列的顺序:足少阴经、足阳明经、足太阴经、足厥阴经。" + }, + { + "question_num": 50, + "query": "能够引起晕厥的心脏瓣膜病是", + "options": { + "A": "二尖瓣关闭不全", + "B": "主动脉瓣关闭不全", + "C": "三尖瓣关闭不全", + "D": "肺动脉瓣狭窄", + "E": "主动脉瓣狭窄" + }, + "answer": "E", + "reason": "主动脉瓣重度狭窄，心搏量减少，由于脑缺血可出现眩晕、晕厥、黑蒙。" + }, + { + "question_num": 51, + "query": "肺胀发病的主要病理因素是", + "options": { + "A": "气滞、血瘀、水饮", + "B": "气滞、水饮、痰浊", + "C": "痰浊、水饮、血瘀", + "D": "痰浊、寒邪、血瘀", + "E": "风邪、痰浊、水饮" + }, + "answer": "C", + "reason": "肺胀的病理因素主要为痰浊、水饮与血瘀互为影响,兼见同病。痰浊水饮的产生,病初由肺气郁滞,脾失健运,津液不归正化而成;渐因肺虚不能化津,脾虚不能转输,肾虚不能蒸化,痰浊潴留益甚。瘀血的产生,主要因痰浊内阻,气滞血瘀,心阳虚损,血失推动,脉失温煦所致。病理因素间互相影响,错杂并见,故选C。但气滞、寒邪.风邪只是可能在病理过程中出现,不是主要的,故不选ABDE。" + }, + { + "question_num": 52, + "query": "乳癖的特点是", + "options": { + "A": "乳块肿痛,皮色微红,按后痛其", + "B": "乳块皮肉相连,溃破脓稀薄如痰", + "C": "乳块呈卵圆形,表面光滑,推之活动", + "D": "乳块质地较软,月经后缩小", + "E": "肿块高低不平,质硬,推之不动" + }, + "answer": "C", + "reason": "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。与周围组织分界不清，与皮肤和筋膜无粘连,推之移动,腋下淋巴结不肿大。不发寒热，皮色不变,有时乳头溢出黄绿色、棕色或血性液。" + }, + { + "question_num": 53, + "query": "孤脏指的是", + "options": { + "A": "心", + "B": "肝", + "C": "脾", + "D": "肺", + "E": "肾" + }, + "answer": "C", + "reason": "脾的生理特性:脾气上升;喜燥恶湿;脾为孤脏。脾土,居中央,与四方、四时无配;脾主运化,为精血津液生化之源,四傍而长养四脏,称为后天之本。脾有孤脏之称，是人体中最大最重要的脏。" + }, + { + "question_num": 54, + "query": "引起尿路感染的病原体最多见的是", + "options": { + "A": "葡萄球菌", + "B": "变形杆菌", + "C": "副大肠埃希菌", + "D": "大肠埃希菌", + "E": "链球菌" + }, + "answer": "D", + "reason": "尿路感染最多见的病原体是大肠埃希菌，占70％，其他依次为变形杆菌、克雷伯杆菌、产气杆菌。" + }, + { + "question_num": 55, + "query": "气厥实证反复发作的原因，常是", + "options": { + "A": "亡血失津", + "B": "头部外伤", + "C": "嗜食肥甘", + "D": "思虑过度", + "E": "先天禀赋" + }, + "answer": "A", + "reason": "气厥的常见病因是情志内伤,饮食劳倦,亡血失津,痰饮内伏。" + }, + { + "question_num": 56, + "query": "热疮的主要治法是", + "options": { + "A": "凉血散瘀", + "B": "清热和营", + "C": "清热利湿", + "D": "清热解毒养阴", + "E": "清热凉血" + }, + "answer": "D", + "reason": "热疮的主要治疗方法是消热解毒养阴。初期以清热解毒治之，反复发作者以扶正祛邪并治。" + }, + { + "question_num": 57, + "query": "下列不属牡蛎功效的药物是", + "options": { + "A": "软坚散结", + "B": "息风止痉", + "C": "重镇安神", + "D": "收敛固涩", + "E": "平肝潜阳" + }, + "answer": "B", + "reason": "牡蛎功效:重镇安神,平肝潜阳,软坚散结,收敛固涩，" + }, + { + "question_num": 58, + "query": "1型糖尿病的临床表现是", + "options": { + "A": "有明显的三多一少症状", + "B": "中老年多见", + "C": "肥胖者多见", + "D": "起病缓，症状轻", + "E": "对胰岛素较不敏感" + }, + "answer": "A", + "reason": "1型糖尿病有明显的三多一少症状（多饮多尿多渴，体重减少），青少年多见，与肥胖无明显关系，婴幼儿起病常急，成年起病者可缓慢进展，在感染或应激时出现酮症及严重高血糖。治疗主要依靠胰岛素，对降糖药不敏感。" + }, + { + "question_num": 59, + "query": "苏子降气汤适合于哪种类型喘证", + "options": { + "A": "痰热郁肺", + "B": "痰浊阻肺", + "C": "表寒里热", + "D": "肝气乘肺", + "E": "上盛下虚" + }, + "answer": "E", + "reason": "苏子降气汤既有化痰降逆,又有温肾纳气的作用,适于治疗虚实夹杂,“上盛下虚\"的喘证。" + }, + { + "question_num": 60, + "query": "关于一次切开挂线法治疗肛痈的适应证,错误的是", + "options": { + "A": "肛门旁皮下脓肿", + "B": "坐骨直肠间隙脓肿", + "C": "骨盆直肠间隙脓肿", + "D": "直肠后间隙脓肿", + "E": "马蹄形脓肿" + }, + "answer": "A", + "reason": "一次切开挂线法治疗肛痈的适应证:肛隐窝感染而致的坐骨直肠间隙脓肿,骨盆直肠间隙脓肿,肛门直肠后间隙脓肿及马蹄形脓肿等。" + }, + { + "question_num": 61, + "query": "与湿浊内生关系最密切的是", + "options": { + "A": "肾的气化功能减退", + "B": "膀胱失司", + "C": "脾失健运", + "D": "肺失宣降", + "E": "三焦气化失司" + }, + "answer": "C", + "reason": "湿浊内生,又称“内湿”是指由于脾的运化水湿功能和输布津波的功能障碍，从而引起水湿痰浊替积停滞的病理变化。内湿的产生，多因素体肥胖,痰湿过盛;或因态食生冷,过食肥甘,内伤脾胃，致使脾失健运,津液的输布发生障碍所致,脾的运化功能失职是湿浊内生的关键" + }, + { + "question_num": 62, + "query": "下列哪项属于非感染性发热的疾病", + "options": { + "A": "肺结核", + "B": "肺炎", + "C": "急性肾盂肾炎", + "D": "伤寒", + "E": "血清病" + }, + "answer": "E", + "reason": "非感染性发热见于多种不同的疾病：①结缔组织病；②恶性肿瘤；③无菌性组织坏死；④内分泌疾病；⑤中枢神经系统疾病；⑥物理因素；⑦其他，如自主神经功能紊乱影响正常体温调节，可产生功能性发热，包括感染后发热和功能性低热。" + }, + { + "question_num": 63, + "query": "痢下白多者,应重用", + "options": { + "A": "温药", + "B": "凉药", + "C": "血药", + "D": "气药", + "E": "寒药" + }, + "answer": "D", + "reason": "痢疾为气血不畅,邪毒凝滞肠腑,损伤脂膜,可破伤血络,出现赤白相间。赤多为血多,应重用血药,白多为伤血不重,应重用气药。总的洽则是调和气血。" + }, + { + "question_num": 64, + "query": "脱肛外治法的治疗原则是", + "options": { + "A": "熏洗、外敷", + "B": "涂药、烙法", + "C": "收敛、固涩", + "D": "熨法、热烘", + "E": "针灸、垫棉" + }, + "answer": "A", + "reason": "脱肛外治法:①熏洗疗法,以苦参汤加石榴皮、枯矾、五倍子煎水熏洗,每天2次;②敷药疗法,以五倍子散或马勃散外敷。" + }, + { + "question_num": 65, + "query": "脾主升清的确切内涵是", + "options": { + "A": "脾的阳气主升", + "B": "脾以升为健", + "C": "脾气散精，上归于肺", + "D": "与胃的降浊相对而言", + "E": "输布津液，防止水湿内生" + }, + "answer": "C", + "reason": "脾主升清,是指脾具有将其运化和吸收的水谷精微等营养物质向上输送至心、肺等脏,通过心肺的气化作用化生气血,以营养全身,并通过脾气的升举作用维持人体内脏位置相对恒定的作用。脾的这一功能特点是以上升和升举为主，故说:“脾气主升。”" + }, + { + "question_num": 66, + "query": "下列关于非留体抗炎药治疗类风湿关节炎的叙述，错误的是", + "options": { + "A": "有效缓解症状", + "B": "不能控制病情进展", + "C": "不单独使用", + "D": "口服用药", + "E": "长期应用" + }, + "answer": "E", + "reason": "非甾体抗炎药可有效缓解类风湿关节炎的症状，但不能控制病情进展，不单独使用，不能长期应用。" + }, + { + "question_num": 67, + "query": "治疗血虚神失所养者,应首选", + "options": { + "A": "二至丸", + "B": "六磨汤", + "C": "温胆汤", + "D": "二阴煎", + "E": "养心汤" + }, + "answer": "E", + "reason": "二至丸补肝益肾,滋阴止血,用于肝肾阴虚证,排除A;六磨汤顺气导滞,用于气机郁滞证，排除’B‘；温胆汤理气化羔,清胆和胃,用于胆胃不和,痰热内扰证,排除C:二阴煎滋阴降火,安神定志,用于狂证火盛伤阴证,排除D;养心汤养血滋阴,宁心安神,用于血虚神失所养证,排除E。" + }, + { + "question_num": 68, + "query": "红丝疗的好发部位是", + "options": { + "A": "面部", + "B": "胸腹部", + "C": "四肢后侧", + "D": "四肢内侧", + "E": "四肢外侧" + }, + "answer": "D", + "reason": "红丝疔是发于四肢,皮肤呈红丝显露,迅速向上走窜的急性感染性疾病,其特点是先有手足疔疮或皮肤破损,红肿热痛,继则患肢内侧皮肤出现红丝一条或数条,迅速向躯干方向走窜,可伴恶寒发热等症状,邪毒重者可内攻脏腑,发生走黄。" + }, + { + "question_num": 69, + "query": "外邪侵袭，损伤脉络而引起出血，最为多见的邪气是", + "options": { + "A": "风", + "B": "寒", + "C": "暑", + "D": "热", + "E": "燥" + }, + "answer": "D", + "reason": "景岳全书·血证》指出:“凡治血证,须知其要,而血动之由,惟火惟气耳。”引起出血之因,最主要是热,无论实热、虚热,均可以迫血妄行而致血溢脉外,引起出血。而暑邪、燥邪、风邪只有化热之后,才能动血出血,至于寒邪,则属阴邪,只能使血脉收引凝滞,不会动血、出血,故均非正确答案。" + }, + { + "question_num": 70, + "query": "咳嗽但无痰可见于", + "options": { + "A": "急性支气管炎", + "B": "慢性支气管炎", + "C": "支气管扩张", + "D": "气胸", + "E": "支气管内膜结核" + }, + "answer": "D", + "reason": "咳嗽一般均伴咳痰，咳痰是通过咳嗽动作将呼吸道内病理性分泌物排出口腔外的病态现象。因为气胸时呼吸道内无病理性分泌物，所以虽有咳嗽，但无咳痰。而其余疾病均于呼吸道内有病理性分泌物，所以均有咳嗽伴咳痰。" + }, + { + "question_num": 71, + "query": "治疗盗汗阴虚火旺证,汗出多者应选用", + "options": { + "A": "玉屏风散加牡蛎、浮小麦、糯稻根", + "B": "归脾散加茵陈、车前子", + "C": "一贯煎加牡蛎、浮小麦、糯稻根", + "D": "当归六黄汤加牡蛎、浮小麦、糯稻根", + "E": "生脉散加栀子、柴胡" + }, + "answer": "D", + "reason": "当归六黄汤可泻实火,补真阴,结合题意,汗出多者,故还应加牡蚌、浮小麦、糯稻根收涩敛汗。" + }, + { + "question_num": 72, + "query": "下列各项,不属淋病特点的是", + "options": { + "A": "尿频尿急", + "B": "尿道刺痛", + "C": "尿道溢脓", + "D": "排尿困难", + "E": "腹股沟淋巴结肿大" + }, + "answer": "D", + "reason": "临床上以尿道刺痛、尿道口排出脓性分泌物为特征，严重时可并发包茎、尿道黏膜外翻，腹股沟淋巴结感染肿大。部分患者可有尿频、尿急、夜尿增多。无排尿困难。" + }, + { + "question_num": 73, + "query": "下列哪项是心热下移小肠的主要表现", + "options": { + "A": "口舌生疮", + "B": "面赤口渴", + "C": "小便赤色灼痛", + "D": "心烦失眠", + "E": "大便秘结" + }, + "answer": "C", + "reason": "心与小肠相为表里,心火内炽,可以下移小肠,热灼津伤而见小便赤色灼痛,故小便赤色灼痛是心热下移小肠的主要表现。" + }, + { + "question_num": 74, + "query": "糖尿病最常见最严重的急性并发症是", + "options": { + "A": "心血管病变", + "B": "非特异性感染", + "C": "肺结核", + "D": "酮症酸中毒", + "E": "低血糖昏迷" + }, + "answer": "D", + "reason": "糖尿病是一组以慢性血葡萄糖水平增高为特征的代谢疾病群。糖尿病酮症酸中毒是糖尿病最常见最严重的疾病并发症。" + }, + { + "question_num": 75, + "query": "腹痛的基本病机是", + "options": { + "A": "肝脾不和,胃气郁滞", + "B": "肝气郁结,胃失和降", + "C": "肝脾湿热,络脉不和", + "D": "脏腑失和,气血不畅", + "E": "脾胃失和,瘀血阻滞" + }, + "answer": "D", + "reason": "腹痛的病因可以有肝脾不和,胃气郁滞,肝气郁结,胃失和降,肝脾湿热,络脉不和,脾胃失和,瘀血阻滞,但是根本上病机不离“不通则痛”,各种原因都是先引起脏腑失和,气血不畅,而后发为腹痛,故基本病机是脏腑失和,气血不畅。" + }, + { + "question_num": 76, + "query": "创面边缘整齐,坚硬削直而如凿成,基底部高低不平,有稀薄臭秽分泌物,其溃疡属于", + "options": { + "A": "麻风性溃疡", + "B": "压迫性溃疡", + "C": "疮痨性溃疡", + "D": "梅毒性溃疡", + "E": "岩性溃疡" + }, + "answer": "D", + "reason": "岩性溃疡,疮面多呈翻花如岩穴,有的在溃疡底部见有珍珠样结节,内有紫黑坏死组织,渗流血水。麻风溃疡呈穿凿形,常可深及骨部。梅毒性溃疡,其边缘削直而如凿成或略微内凹，基底高低不平。" + }, + { + "question_num": 77, + "query": "诊断肺病的主要依据是", + "options": { + "A": "胸闷", + "B": "少气", + "C": "自汗", + "D": "咳喘", + "E": "水肿" + }, + "answer": "D", + "reason": "肺的病变主要反映在肺系呼吸功能活动减退,水液代谢输布失常,常见症状有咳嗽、气喘、吐痰、胸痛、咯血、声音嘶、鼻塞流涕和水肿,尤以咳喘为多见。" + }, + { + "question_num": 78, + "query": "龛影的主要X线表现是", + "options": { + "A": "圆形钡斑", + "B": "钡斑周围环绕透明带", + "C": "胃黏膜溃烂", + "D": "向腔外突出的钡斑阴影", + "E": "胃壁僵直" + }, + "answer": "D", + "reason": "消化系统疾病的影像诊断。龛影是溃疡的直接X线征象，为向腔外突出的钡斑阴影。" + }, + { + "question_num": 79, + "query": "治疗自汗、盗汗阴虚火旺证的首选方剂是", + "options": { + "A": "青蒿鳖甲汤", + "B": "知柏地黄丸", + "C": "当归六黄汤", + "D": "天王补心丹", + "E": "犀角地黄汤" + }, + "answer": "C", + "reason": "自汗、盗汗阴虚火旺证治法:滋阴降火。代表方:当归六黄汤加减。" + }, + { + "question_num": 80, + "query": "好发于儿童的癣是", + "options": { + "A": "白癣、手癣", + "B": "黄癣、白癣", + "C": "体癣、花斑癣", + "D": "脚癣、花斑癣", + "E": "黄癣、体癣" + }, + "answer": "B", + "reason": "肥疮相当于西医的黄癣,多见于农村,好发于儿童;鹅掌风相当于西医的手癣,男女老幼均可染病,以成年人多;西医的足癣多见于成人，儿童少见;西医的体癣主要见于青壮年及男性，多夏季发病;白秃疮相当于西医的白癣,多见于儿童,尤以男孩为多;紫白癜风相当于西医的花斑癣,俗称汗斑，常发于多汗体质的青壮年。" + }, + { + "question_num": 81, + "query": "根据《灵枢·天年》，三十岁，五脏大定，肌肉坚固，血气盛满，故", + "options": { + "A": "好走", + "B": "好趋", + "C": "好步", + "D": "好坐", + "E": "好卧" + }, + "answer": "C", + "reason": "灵枢·天年》以十岁为纪描述了人体生命活动的进程和发展变化规律:“人生十岁,五脏始定,血气已通,其气在下,故好走。二十岁,血气始盛、肌肉方长,故好趋。三十岁,五脏大定,肌肉坚固、血气盛满,故好步。四十岁,五脏六腑十二经络皆大盛疋\"胶埋媚疏，宋华从落，反顾斑口,华做不称，放好坐。五十岁,肝气始衰,肝叶始薄胆汁始灭,目始不明。六十岁,心气始衰,苦忧悲,血气懈惰,故好卧。七十岁,脾气虚,皮肤枯。八十岁,肺气衰,魄离,故言善误。九十岁,肾气焦,四脏经脉空虚。百岁，五脏皆虚、神皆去,形骸独居而终矣。”" + }, + { + "question_num": 82, + "query": "我国最常见的咯血原因是", + "options": { + "A": "支气管扩张", + "B": "肺结核", + "C": "二尖瓣狭窄", + "D": "肺脓肿", + "E": "支气管肺癌" + }, + "answer": "B", + "reason": "引起咯血的原因据文献报道有130多种，一般较常见的是支气管疾病、肺部疾病、心脏病及某些全身性疾病。在我国临床上肺结核咯血仍是最常见的咯血原因之一，占所有咯血总数的60％～92.4％。" + }, + { + "question_num": 83, + "query": "治疗肾虚腰痛而无明显阴阳偏盛者，可选用的方剂是", + "options": { + "A": "杜仲丸", + "B": "青娥丸", + "C": "补髓丹", + "D": "虎潜丸", + "E": "补血荣筋丸" + }, + "answer": "B", + "reason": "呈虚腰痛,偏阳虚者用右归丸,偏阴虚者用左归丸,无阴阳偏盛者用青娥丸单纯补肾。" + }, + { + "question_num": 84, + "query": "下列哪项不是疥疮的临床特点", + "options": { + "A": "好发于皮肤皱褶部位", + "B": "皮损初起为针头大小的丘疹或水疱", + "C": "幼儿可见于面部及头部", + "D": "全身遍布抓痕、结痂、黑色斑点和脓疱", + "E": "轻度瘙痒" + }, + "answer": "E", + "reason": "本病好发于皮肤细嫩、皱褶部位,常从手指缝开始,1~2周内可广泛传布至上肢屈侧、肘窝、腋窝前、乳房下、下腹部、臀沟、外生殖器、大腿内上側等处,偶尔侵犯其他部位,不侵犯头部及面部,但婴幼儿例外。皮损主要为红色丘疹、丘疱疹、小水疱、隧道、结节。结节常见于阴茎、阴、少腹等处;水疱常见于指缝;隧道为疥疮的特异性皮损,微微隆起,稍弯曲呈淡灰色或皮色,在隧道末端有个针头大的灰白色或微红的小点,为疥虫隐藏的地方。本病传染性极强,患者常有奇痒。" + }, + { + "question_num": 85, + "query": "属于既病防变的是", + "options": { + "A": "调摄精神", + "B": "锻炼身体", + "C": "起居有节", + "D": "药物预防", + "E": "早期诊治" + }, + "answer": "E", + "reason": "既病防变是指在疾病发生后,采取措施防止疾病的发展和加重,早期诊治是既病防变的措施之一;调摄精神,锻炼身体,起居有节,药物预防属于未病先防的范畴。" + }, + { + "question_num": 86, + "query": "诊断慢性阻塞性肺疾病(COPD)的必要条件是", + "options": { + "A": "胸部X线片示肺纹理增粗紊乱", + "B": "肺功能检查示阻塞性通气功能障碍", + "C": "长期大量吸烟史", + "D": "高分辨CT示肺气肿改变", + "E": "肺总量下降" + }, + "answer": "B", + "reason": "吸入支气管扩张药后FEV1＜减少且FEV1/FVC＜70％者，可确定为不完全可逆的气流受限，提示阻塞性通气功能障碍，是诊断COPD的必备条件。" + }, + { + "question_num": 87, + "query": "下列关于采用攻逐法治疗水肿的叙述中,错误的是", + "options": { + "A": "用于病初水肿严重,正气尚旺者", + "B": "用发汗、利水法无效", + "C": "用十枣汤治疗", + "D": "疗程宜长,用药宜重", + "E": "水肿退后,即行调补脾胃" + }, + "answer": "D", + "reason": "攻下逐水法是治疗阳水的一种方法,即《内经》“去菀陈莝”之意。只宜用于病初体实肿甚,正气尚旺,用发汗、利水法无效,症见全身高度浮肿,气喘,心悸,腹水,小便不利,脉沉而有力者。使用该法,宜抓住时机,以逐水为急,使水邪从大小便而去,可用十枣汤治疗,但应中病即止,以免过用伤正。水退后,即行调补脾胃,以善其后。病至后期,脾肾两亏而水肿甚者,逐水峻药应慎用。" + }, + { + "question_num": 88, + "query": "下列关于严重冻疮复温措施中,错误的是", + "options": { + "A": "口服姜汤", + "B": "少量饮酒", + "C": "输入加温葡萄糖液", + "D": "用雪搓、火烤", + "E": "将冻肢置于救护者怀中" + }, + "answer": "D", + "reason": "复温方法:对冻低患者立即施行局部或全身快速复温,用38~42℃恒热温水浸泡伤肢或浸泡全身,局部20分钟,全身30分钟内,体温迅速提高至接近正常,以指(趾)甲床出现潮红有温热感为止，不宜过久。可给予姜汤、糖水、茶水等温热饮料，亦可少量饮酒。早期复温过程中，严禁用雪搓、用火烤或冷水浴等。在急救时,如一时无法获得热水，可将冻肢置于救护者怀中或腋下复温。" + }, + { + "question_num": 89, + "query": "水火之宅是指", + "options": { + "A": "脾", + "B": "胃", + "C": "肾", + "D": "肝", + "E": "肺" + }, + "answer": "C", + "reason": "肾分肾阴和肾阳,又称元阴元阳,是机体各脏阴阳的根本。“肾为五脏六腑之本,乃水火之宅,寓真阴而涵真阳”。" + }, + { + "question_num": 90, + "query": "脾脏中度肿大指", + "options": { + "A": "脾缘不超过肋下2cm", + "B": "脾缘超过肋下2cm至脐水平线以上", + "C": "脾缘超过肋下1cm至脐水平线以上", + "D": "脾缘超过脐水平线", + "E": "脾缘超过前正中线" + }, + "answer": "B", + "reason": "脾脏肿大的测量与记录法（以厘米表示）：第Ⅰ线（又称甲乙线）指左锁骨中线与左肋缘交点至脾下缘的距离。脾脏轻中度肿大时只做第Ⅰ线测量。第Ⅱ线（又称甲丙线）指左锁骨中线与左肋缘交点至脾最远点的距离，一般应大于第Ⅰ线。第Ⅲ线（又称丁戊线）指脾右缘与前正中线的距离。超过正中线，则测量脾右缘至正中线的最大距离为正值，以“＋”表示；未超过正中线则测量脾右缘与正中线的最短距离为负值，以“-”表示。脾大分为轻、中、高三度。脾缘不超过肋下2cm为轻度肿大；超过2cm，在脐水平线以上，为中度肿大；超过脐水平线或前正中线则为高度肿大，即巨脾。此时应加测第Ⅱ线和第Ⅲ线。" + }, + { + "question_num": 91, + "query": "治疗气厥实证,应首选", + "options": { + "A": "安宫牛黄丸", + "B": "补中益气汤", + "C": "五磨饮子", + "D": "四君子汤", + "E": "通瘀煎" + }, + "answer": "C", + "reason": "厥证病机为气机逆乱、病情危急,当及时救治,醒神回厥为首要职责。气厥为内伤七情诱发,实证用理气开郁的五磨饮子,虚证用益气回阳的四味回阳汤。血厥实证用理气活血的通瘀煎。热厥证可用安官牛黄丸。补中益气汤和四君子汤药性平缓,用于厥证危急状况力量不够。" + }, + { + "question_num": 92, + "query": "浸淫四窜,黄水淋漓,最易沿表皮蚀烂,越腐越痒者,其病因是", + "options": { + "A": "风胜", + "B": "湿胜", + "C": "热胜", + "D": "虫淫", + "E": "血虚" + }, + "answer": "B", + "reason": "皮肤病以外湿居多,但有时外湿与内湿相合致病。湿邪侵入肌肤，郁结不散，与气血相搏,多发生疮疹、瘙痒、渗液、糜烂等。湿邪所致的皮肤病,其皮肤损��为水疱,或为多形性,或皮肤糜烂,常患病于下部,或浸淫四窜,滋水淋滴,病程缠绵,难以速愈。若与内湿相合,则常伴有胸闷,纳差,肢体沉重,苔白腻,脉濡缓等症状;若湿邪与寒邪相合,则伴有四肢乏力,一身肌肉疼痛,四肢受凉则肢端发冷、苍白或紫暗,苔薄白,脉迟缓等症状。" + }, + { + "question_num": 93, + "query": "以下哪项不是痰饮的致病特点", + "options": { + "A": "阻滞气血运行", + "B": "影响水液代谢", + "C": "易于蒙蔽心神", + "D": "致病广泛，变幻多端", + "E": "病位固定，病证繁多" + }, + "answer": "E", + "reason": "痰饮的致病特点,①阻滞气血运行;②影响水液代谢:③易于蒙蔽心神;①致病广泛,变幻多端。" + }, + { + "question_num": 94, + "query": "可闻及病理性支气管呼吸音的部位是", + "options": { + "A": "肩胛下区", + "B": "喉部", + "C": "胸骨上窝", + "D": "背部第6颈椎附近", + "E": "第1、第2胸椎附近" + }, + "answer": "A", + "reason": "正常人在喉部，胸骨上窝，背部第6、第7颈椎和第1、第2胸椎附近可闻及支气管呼吸音，如在正常肺泡呼吸音部位听到支气管呼吸音，即为异常支气管呼吸者，或称管状呼吸音，常见于肺组织实变、肺内大空腔、压迫性肺不张。" + }, + { + "question_num": 95, + "query": "治疗噎膈痰气交阻证,应首选", + "options": { + "A": "通幽汤", + "B": "丁香散", + "C": "启膈散", + "D": "通关散", + "E": "四七汤" + }, + "answer": "C", + "reason": "噎膈痰气交阻证宜开郁化痰,润燥降气,用启膈散。通幽汤用于瘀热内结。丁香散用于胃寒气逆的呃逆。通关散治疫喉邪郁,药难下咽。四七汤治梅核气。" + }, + { + "question_num": 96, + "query": "疼痛轻微,或隐隐作痛,皮色不变,压之酸痛,其疼痛的原因是", + "options": { + "A": "气痛", + "B": "湿痛", + "C": "痰痛", + "D": "风痛", + "E": "寒痛" + }, + "answer": "C", + "reason": "痰痛:疼痛轻微,或隐隐作痛,皮色不变，压之酸痛。见于指瘤、肉瘤。" + }, + { + "question_num": 97, + "query": "绕阴器的经脉是", + "options": { + "A": "足厥阴经", + "B": "手厥阴经", + "C": "足少阴经", + "D": "手太阴经", + "E": "足太阴经" + }, + "answer": "A", + "reason": "足厥阴肝经人毛中,环阴器" + }, + { + "question_num": 98, + "query": "逆行肾盂造影显示肾小盏杯口呈虫蚀状改变，杯口附近肾实质内有团块状造影剂与杯口相连是", + "options": { + "A": "肾结石", + "B": "肾实质肿瘤", + "C": "肾盂肿瘤", + "D": "肾脓肿", + "E": "肾结核" + }, + "answer": "E", + "reason": "泌尿系统疾病的影像诊断。肾结核造影时可以见到肾小盏破坏，肾盂积水，输尿管狭窄及膀胱改变。肾小盏杯口呈虫蚀样破坏，造影剂充盈在病变小盏附近空洞内，表现为边缘模糊，轮廓不规则的团块状阴影。" + }, + { + "question_num": 99, + "query": "血虚便秘证,阴血已复,便仍干燥,治疗应首选", + "options": { + "A": "黄芪汤", + "B": "增液汤", + "C": "润肠丸", + "D": "五仁丸", + "E": "青麟丸" + }, + "answer": "D", + "reason": "血虚便秘宜养血润燥,滋阴授便,用润肠丸。但是阴血已复,不需再滋阴养血,用五仁丸润肠即可。" + }, + { + "question_num": 100, + "query": "凡发生于颈部或耳之前后的一类岩证,面容憔悴,形体消瘦者,称之为", + "options": { + "A": "石瘿", + "B": "失荣", + "C": "石疽", + "D": "筋瘤", + "E": "血瘤" + }, + "answer": "B", + "reason": "失荣是发生于颈部及耳之前后的岩肿,因其晚期气血亏乏,面容憔悴状如树木枝叶发枯，失去荣华而命名。" + }, + { + "question_num": 101, + "query": "按五行属性分类，五化中属土者是", + "options": { + "A": "生", + "B": "长", + "C": "化", + "D": "收", + "E": "藏" + }, + "answer": "C", + "reason": "土爱稼稿,为万物之母,故为“化”五化中生属木、长属火、化属土、收属金、藏属水。" + }, + { + "question_num": 102, + "query": "中国糖尿病的控制目标中，HbAlc应达到的水平是", + "options": { + "A": "<8%", + "B": "<7.5%", + "C": "<7%", + "D": "<6.5%", + "E": "<6%" + }, + "answer": "C", + "reason": "HbA1c可反映取血前8～12周的平均血糖状况，是监测糖尿病病情的重要指标。HbA1c≥6.5％有助于糖尿病的诊断。中国糖尿病的控制目标中，HbA1c应达到的水平是＜7％。" + }, + { + "question_num": 103, + "query": "黄疽形成的关键病理因素是", + "options": { + "A": "热邪", + "B": "寒邪", + "C": "疫毒", + "D": "瘀血", + "E": "湿邪" + }, + "answer": "E", + "reason": "黄疸外因重在湿、毒,内因偏于虚、瘀。可源于疫毒外侵.温热蕴结、积聚内阻,引发胆汁外溢,或化源不、血败不华于色。但最后都会影响到肝脾,肿虚湿蕴,都见湿邪,其余病理因素可与湿相兼。" + }, + { + "question_num": 104, + "query": "下列各项,不属于子痰溃后症状的是", + "options": { + "A": "脓液清稀如痰涎", + "B": "脓液中夹有败絮状物", + "C": "疮口凹陷", + "D": "容易形成窦道", + "E": "疮口容易愈合" + }, + "answer": "E", + "reason": "子痰溃后经久不愈，" + }, + { + "question_num": 105, + "query": "复发的首要条件是", + "options": { + "A": "正气未复", + "B": "邪未尽除", + "C": "新感病邪", + "D": "过度劳累", + "E": "饮食不慎" + }, + "answer": "B", + "reason": "复发指疾病初愈或慢性疾病的缓解阶段,在某些诱因的作用下,引起疾病再度发作或反复发作的一种发病形式。引起复发的机制是余邪未尽正气未复,或慢性病变宿根未除,均可在诱因的作用下而引起复发。" + }, + { + "question_num": 106, + "query": "喷射性呕吐可见于", + "options": { + "A": "耳源性眩晕", + "B": "胃炎", + "C": "肠梗阻", + "D": "尿毒症", + "E": "脑炎" + }, + "answer": "E", + "reason": "喷射性呕吐常发生在患有脑部疾病时，如脑炎或脑部肿瘤，因颅内压增高而出现喷射性呕吐。" + }, + { + "question_num": 107, + "query": "腹痛与下列哪项无关", + "options": { + "A": "手三阴经", + "B": "足三阴经", + "C": "手少阳经", + "D": "足少阳经", + "E": "足阳明经" + }, + "answer": "C", + "reason": "腹中有肝、胆.脾、肾、大小肠、膀胱等脏腑,并为足三阴.足少阳、手足阳明、冲、任、带等经脉循行之处。不包括手少阳。" + }, + { + "question_num": 108, + "query": "烧伤面积的计算按中国九分法，双上肢面积占", + "options": { + "A": "9%", + "B": "18%", + "C": "27%", + "D": "36%", + "E": "45%" + }, + "answer": "B", + "reason": "中国九分法:双上肢面积占18%,故选B。头面、颈部为9%;躯干前后包括外阴部为27%;双下肢包括臀部为46%。" + }, + { + "question_num": 109, + "query": "下述对“脏腑辨证”的认识，不正确的是", + "options": { + "A": "脏腑的生理病理特点是脏腑辨证的依据", + "B": "八纲辨证是脏腑辨证的基础", + "C": "脏腑辨证的实质，只是对病位作出判断", + "D": "以脏腑为纲，辨明病证所在的脏腑病位", + "E": "应当分辨脏腑病位上的病因及病理性质" + }, + "answer": "C", + "reason": "脏腑辨证的实质,是辨明疾病所在的脏腑部位、病因、性质以及邪正盛衰的一种辨证方法，而不仅仅只是对病位作出判断。" + }, + { + "question_num": 110, + "query": "下列各项可见毛细血管搏动征的是", + "options": { + "A": "主动脉瓣狭窄", + "B": "主动脉瓣关闭不全", + "C": "低血压性休克", + "D": "心包积液", + "E": "心力衰竭" + }, + "answer": "B", + "reason": "毛细血管搏动征是周围血管征的一种，正常人毛细血管搏动极难看出，当脉压增大时，则可出现毛细血管搏动，常见于主动脉关闭不全、动脉导管未闭、主动脉窦瘤破裂、动静脉瘘、甲状腺功能亢进、严重贫血、老年主动脉硬化等疾患。" + }, + { + "question_num": 111, + "query": "治疗腹痛饮食积滞重证,应首选", + "options": { + "A": "保和丸", + "B": "越鞠丸", + "C": "枳实导滞丸", + "D": "积术丸", + "E": "木香顺气丸" + }, + "answer": "C", + "reason": "保和丸用于食积轻症,排除A;越鞠丸用于气郁所致的六部,排除B;枳实导滞丸消食导滞力强,用于饮食积滞重症的腹痛,故选C;枳术丸用于脾胃虑弱,湿热较盛者,排除D:木香顺气丸用于胸膈痞闷,腹胁胀满,侧重于无形气滞，排除E。" + }, + { + "question_num": 112, + "query": "一期梅毒的主要症状,多于不洁性交后出现,其时间是", + "options": { + "A": "1~2周左右", + "B": "第1周", + "C": "2~4周左右", + "D": "4~5周左右", + "E": "6~8周左右" + }, + "answer": "C", + "reason": "一期梅毒主要表现为疳疮(硬下疳),发生于不洁性交后2~4周。二期梅毒一般发生在感染后7~10周或硬下疳出现后6~8周。" + }, + { + "question_num": 113, + "query": "脾为气血生化之源的理论基础是", + "options": { + "A": "脾能运化水谷精微", + "B": "脾主升清", + "C": "脾为后天之本", + "D": "气能生血", + "E": "人以水谷为本" + }, + "answer": "A", + "reason": "脾主运化,是指脾具有把饮食水谷转化为水谷精微(即谷精)和津液(即水精)，并把水谷精微和津液吸收、转输到全身各脏腑的生理功能。饮食物的消化及其精微的吸收、转输都由脾所主,脾气不但将饮食物化为水谷精微,为化生精、气、血、津液提供充足的原料,而且能将水谷精微吸收并转输至全身" + }, + { + "question_num": 114, + "query": "某药店经营者为贪图利益而违法销售超过有效期的药品。依据《中华人民共和国药品管理法》的规定，其所在地的药品监督管理行政执法机构应给予的处罚是，没收违法销售药品和违法所得并", + "options": { + "A": "处以非法所得一倍以上三倍以下的罚款", + "B": "处以非法所得二倍以上五倍以下罚款", + "C": "处以二千元以上五千元以下的罚款", + "D": "处以违法销售药品货值金额两倍以上五倍以下的罚款", + "E": "处以违法销售药品货值金额十倍以上二十倍以下的罚款" + }, + "answer": "E", + "reason": "《中华人民共和国药品管理法》规定，生产、销售劣药的，没收违法生产、销售的药品和违法所得，并处违法生产、销售的药品货值金额10倍以上20倍以下的罚款；情节严重的，责令停产停业整顿直至吊销药品批准证明文件、药品生产许可证、药品经营许可证或者医疗机构制剂许可证。" + }, + { + "question_num": 115, + "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,脾气也虑,故主要是肺脾。" + }, + { + "question_num": 116, + "query": "内痔的主要症状是", + "options": { + "A": "便血,疼痛", + "B": "便血,有分泌物", + "C": "便血,脱出", + "D": "便血,肛门痒", + "E": "便血,异物感" + }, + "answer": "C", + "reason": "痔生于肛门齿线以上，直肠末端黏膜下的痔内静脉丛扩大、曲张形成的柔软静脉团,称为内痔。内痔是肛门直肠疾病中最常见的病种。与西医病名相同。内痔好发于截石位3、7、11点，其主要临床表现有便血、痔核脱出、肛门不适感。" + }, + { + "question_num": 117, + "query": "邪正盛衰于何种情况时可致病势迅速恶化", + "options": { + "A": "正胜邪退", + "B": "邪去正虚", + "C": "邪胜正衰", + "D": "邪正相持", + "E": "正虚邪恋" + }, + "answer": "C", + "reason": "由于机体的正气虚弱,或邪气炽盛或失治误治,机体抗御病邪的能力日趋低下，不能制止邪气的侵害作用,邪气进一步发展,机体受到的病理性损害日趋严重,病情因而趋向恶化和加剧。" + }, + { + "question_num": 118, + "query": "下列检查结果中，最能反映慢性肾炎患者肾实质严重损害的是", + "options": { + "A": "尿蛋白明显增多", + "B": "尿中白细胞明显增多", + "C": "尿中红细胞明显增多", + "D": "尿中出现管型", + "E": "尿比重固定于1.010左右" + }, + "answer": "E", + "reason": "慢性肾炎晚期则出现尿比重固定在1.010左右的等张尿，表明肾小管重吸收功能很差。" + }, + { + "question_num": 119, + "query": "治疗齿衄阴虚火旺证，首选的方剂是", + "options": { + "A": "六味地黄丸", + "B": "百合固金汤", + "C": "知柏地黄丸", + "D": "茜根散", + "E": "十灰散" + }, + "answer": "A", + "reason": "A项用于齿衄阴虚火旺证,B项用于咳血阴虚肺热证,C项用于尿血肾虚火旺证,D项用于紫班阴虚火旺证,E项用于紫班血热妄行证。" + }, + { + "question_num": 120, + "query": "蛇咬伤后(神经毒)者，其治法是", + "options": { + "A": "活血祛风", + "B": "清热解毒,凉血止血", + "C": "清利湿热,凉血息风", + "D": "凉血息风,豁痰开窍", + "E": "清热解毒,活血祛风,凉血止血" + }, + "answer": "A", + "reason": "蛇咬伤后,辨证为风毒(神经毒)者治则为活血祛风。" + }, + { + "question_num": 121, + "query": "下列哪项在心主血脉中起主导作用", + "options": { + "A": "心血充盈", + "B": "心气充沛", + "C": "心神安宁", + "D": "心搏如常", + "E": "脉道通利" + }, + "answer": "D", + "reason": "心主血脉,包括主血和主脉两方面全身血液都在脉中运行，主要依赖于心脏的搏动而输于全身,以发挥其濡养作用。血液在脉中正常运行,必须以心气充沛、血液充盈、脉道滑利为基本条件,其中心脏的正常搏动,起着主导作用。" + }, + { + "question_num": 122, + "query": "下列关于血尿素氮的改变及临床意义的叙述，正确的是", + "options": { + "A": "上消化道出血时，血尿素氮减少", + "B": "大面积烧伤时，血尿素氮减少", + "C": "严重的肾盂肾炎，血尿素氮减少", + "D": "血尿素氮对早期肾功能损害的敏感性差", + "E": "血尿素氮对早期肾功能损害的敏感性强" + }, + "answer": "D", + "reason": "血尿素氮正常值为2.9～6.4mmol/L。肾脏本身的疾病，如慢性肾炎、肾血管硬化症等可引起血尿素氮增高；肾前或肾后因素引起的尿量显著减少或无尿，如脱水、循环衰竭、尿路结石或前列腺肿大引起的尿路梗阻等均可引起血尿素氮增高；体内蛋白质过度分解疾病，如急性传染病、上消化道出血、大面积烧伤等可引起血尿素氮增高。" + }, + { + "question_num": 123, + "query": "治疗虚劳应以补益下列哪项为主", + "options": { + "A": "心、肾", + "B": "心、肺", + "C": "肺、肾", + "D": "脾、肾", + "E": "肝、肾" + }, + "answer": "D", + "reason": "因为脾为后天之本,肾为先天之本，故治疗虚劳应以补益脾肾为主。" + }, + { + "question_num": 124, + "query": "下列除哪项外,均是玉门的别称", + "options": { + "A": "胞门", + "B": "阴门", + "C": "产门", + "D": "子门", + "E": "龙门" + }, + "answer": "D", + "reason": "阴户,又称廷孔、四边、玉门、产门,龙门、胞门。子门是指子官颈口。" + }, + { + "question_num": 125, + "query": "气机郁滞引致的心脉痹阻，症状特点有", + "options": { + "A": "痛如针刺", + "B": "舌紫暗", + "C": "脉沉滑", + "D": "闷痛", + "E": "胀痛" + }, + "answer": "E", + "reason": "心脉痹阻按其病因分为瘀阻心脉痰阻心脉、寒凝心脉、气滞心脉等证。但四证表现不同。瘀阻心脉以刺痛为特点,伴见舌紫暗或见瘀斑瘀点,脉细涩或结代等察血内阻的症状;痰阻心脉以闷痛为特点,伴见体胖痰多,身重困倦,舌苔白腻,脉沉滑等预浊内盛的症状:来健心脉以痛势剧烈，天然反热痛缓为特点,故选E。" + }, + { + "question_num": 126, + "query": "最常见的呕血病因是", + "options": { + "A": "消化道肿瘤", + "B": "急性胆囊炎", + "C": "肝硬化门静脉高压", + "D": "急性胰腺炎", + "E": "消化性溃疡" + }, + "answer": "E", + "reason": "呕血是指上消化道器官（屈氏韧带以上的消化器官）疾病或全身性病症所致的急性上消化道出血，经口呕出。病因包括食管疾病，胃、十二指肠疾病，肝、胆、胰疾病，血液病，药物及其他疾病如流行性出血热、重症肝炎、尿毒症、系统性红斑狼疮等，其中，最常见的是消化性溃疡。" + }, + { + "question_num": 127, + "query": "治疗癃闭脾气不升证,应首选的方剂", + "options": { + "A": "实脾饮", + "B": "补中益气汤", + "C": "济生肾气丸", + "D": "八正散", + "E": "沉香散" + }, + "answer": "B", + "reason": "癃闭脾气不升证治法:升清降浊,化气行水。代表方:补中益气汤合春泽汤加减。" + }, + { + "question_num": 128, + "query": "下列各项,不属于妊娠生理现象的是", + "options": { + "A": "月经停闭", + "B": "乳头乳晕着色", + "C": "腹胀便秘", + "D": "脉滑,尺脉按之不绝", + "E": "晨起恶心欲呕" + }, + "answer": "C", + "reason": "妊娠生理现象:①月经停闭；②脉滑;③妊娠反应,胃纳不香、饱胀不思饮食、恶心欲吐、择食的早孕反应;④子官增大:⑤乳房变化，乳房自孕早期开始增大、发胀,乳头增大变黑,易勃起,乳加大变黑,乳晕外周有散在褐色小结节状隆起;⑥下腹膨隆。" + }, + { + "question_num": 129, + "query": "孕妇忌用的药物是", + "options": { + "A": "天花粉", + "B": "淡竹叶", + "C": "夏枯草", + "D": "密蒙花", + "E": "芦根" + }, + "answer": "A", + "reason": "天花粉能使胎盘绒毛膜滋养细胞变性坏死而引起流产,可用于中期引产,孕妇忌用。" + }, + { + "question_num": 130, + "query": "小肠以下部位出血，大便通常不会出现下列哪种情况", + "options": { + "A": "鲜红色血便", + "B": "暗红色血便", + "C": "柏油便", + "D": "洗肉水样便", + "E": "脓血便" + }, + "answer": "C", + "reason": "小肠以下部位出血，通常不会出现柏油便，只有上消化道出血使血液在肠内停留时间长，因红细胞破坏放出血红蛋白，与硫化物结合形成黑色的硫化亚铁而致柏油便，其余各项均见于小肠以下部位出血，���红色血便见于痔、肛裂或直肠肿瘤引起的出血；暗红色血便见于下消化道出血在肠内停留时间较长时；洗肉水样便见于急性出血性坏死性肠炎；脓血便见于急性细菌性痢疾和阿米巴痢疾，前者为黏液脓血便，后者为暗红色果酱样脓血便。" + }, + { + "question_num": 131, + "query": "治疗便秘热秘证,应首选", + "options": { + "A": "大黄附子汤", + "B": "麻子仁丸", + "C": "小承气汤", + "D": "润肠丸", + "E": "大磨汤" + }, + "answer": "B", + "reason": "便秘不外冷热虚实。气秘实证用六磨汤顺气导滞、降逆通便。热秘实证用大承气汤峻下热结,或麻子仁丸泻热导滞,润肠通便。气虚便秘用黄芪汤补气健脾、润肠通便。血虚便秘用润肠丸养血润燥、滋阴通便。阳虚冷秘用大黄附子汤温阳通便。" + }, + { + "question_num": 132, + "query": "与月经产生没有直接关系的脏朋是()", + "options": { + "A": "肾", + "B": "肺", + "C": "胆", + "D": "脾", + "E": "胃" + }, + "answer": "C", + "reason": "心主血,肝藏血,脾统血,胃主受纳腐熟,与脾同为生化之源,肾藏精,精化血,肺主一身之气,朝百脉而输布精微,故月经的产生与心、脾、肾、肺有关。" + }, + { + "question_num": 133, + "query": "具有固精缩尿，温脾摄睡功效的药物是", + "options": { + "A": "肉苁蓉", + "B": "沙苑子", + "C": "补骨脂", + "D": "山茱萸", + "E": "益智仁" + }, + "answer": "E", + "reason": "益智仁的功效:暖肾固精缩尿,温脾止泻摄唾。注意,补骨脂是没有摄唾的功效的,据此可以排除。" + }, + { + "question_num": 134, + "query": "对心肌缺血与心内膜下梗死的鉴别，最有意义的是", + "options": { + "A": "淀粉酶", + "B": "血清转氨酶", + "C": "γ-谷氨酰基转肽酶", + "D": "肌酸磷酸激酶", + "E": "血清碱性磷酸酶" + }, + "answer": "D", + "reason": "肌酸磷酸激酶有3种同工酶，其中CK-MB来自心肌，其诊断敏感性和特异性均极高，分别达到100％和99％，它升高的幅度和持续的时间常用于判定梗死的范围和严重性。" + }, + { + "question_num": 135, + "query": "黄疸最具特征的表现是", + "options": { + "A": "面黄", + "B": "目黄", + "C": "小便黄", + "D": "恶心纳呆", + "E": "腹胀呕吐" + }, + "answer": "B", + "reason": "目黄是诊断黄疸的重要指标,其他选项还可以见于其他疾病。" + }, + { + "question_num": 136, + "query": "治疗月经过多血瘀证,应首选的方齐是(1", + "options": { + "A": "失笑散加味", + "B": "少腹逐瘀汤", + "C": "逐瘀止血汤", + "D": "桃红四物汤", + "E": "血府逐瘀汤" + }, + "answer": "A", + "reason": "月经过多血瘀证治法:活血化瘀止血。方药:失笑散加益母草、三七、茜草。" + }, + { + "question_num": 137, + "query": "下列不属于细辛功效的是", + "options": { + "A": "解表散寒", + "B": "祛风止痛", + "C": "通窍", + "D": "燥湿止带", + "E": "温肺化饮" + }, + "answer": "D", + "reason": "细辛功效:解表散寒,祛风止痛,通窍,温肺化饮。主治:风寒感冒:头痛,牙痛,风湿痹痛:鼻渊;肺寒咳喘。" + }, + { + "question_num": 138, + "query": "下列哪项提示左心功能不全", + "options": { + "A": "脉搏强而大", + "B": "舒张早期奔马律", + "C": "奇脉", + "D": "脉搏过缓", + "E": "脉搏绝对不齐" + }, + "answer": "B", + "reason": "脉搏强而大见于高热患者。舒张早期奔马律见于器质性心脏病。奇脉见于心包积液和缩窄性心包炎。脉搏过缓常见于颅内压增高、房室传导阻滞、洋地黄中毒等患者。脉搏绝对不齐见于心房纤维颤动的患者。" + }, + { + "question_num": 139, + "query": "“病变于色者\"当取的特定穴是", + "options": { + "A": "井穴", + "B": "荥穴", + "C": "输穴", + "D": "经穴", + "E": "合穴" + }, + "answer": "B", + "reason": "《灵柩·顺气一日分为四时》云:“病在脏者,取之井:病变于色者,取之荥:病时间时甚者，取之输;病变于音者,取之经:经满而血者,病在胃及以饮食不节得病者,取之合。" + }, + { + "question_num": 140, + "query": "下列各项,易导致妇产科疾病发生的是", + "options": { + "A": "风、寒、湿", + "B": "风、湿、热", + "C": "寒、热、湿", + "D": "寒、暑、热", + "E": "寒、湿、燥" + }, + "answer": "C", + "reason": "六淫皆导致妇产科疾病,然妇女以血为本,寒热湿邪更易于与血相搏结而导致妇产科疾病。" + }, + { + "question_num": 141, + "query": "既能杀虫，又能润���止咳的药物是", + "options": { + "A": "贯众", + "B": "槟榔", + "C": "花椒", + "D": "雷丸", + "E": "榧子" + }, + "answer": "E", + "reason": "贯众的功效是清热解毒,凉血止血,杀虫;槟榔杀虫消积,行气利水,截疟;花椒温中止痛,杀虫止痒;雷丸杀虫消积;榧子杀虫消积,润肠通便,润肺止咳，故选E。" + }, + { + "question_num": 142, + "query": "下列可引起姿势性脊柱侧凸的是", + "options": { + "A": "佝偻病", + "B": "先天性斜颈", + "C": "胸膜肥厚", + "D": "一侧腰肌瘫痪", + "E": "儿童发育期坐或立姿势不良" + }, + "answer": "E", + "reason": "青少年胸段下部及腰段均后凸，多为发育期姿势不良或患脊椎骨软骨炎的后果。" + }, + { + "question_num": 143, + "query": "虚证不寐的病理变化主要与下列哪项有关", + "options": { + "A": "阴血不足", + "B": "气血两虚", + "C": "脾虚胃弱", + "D": "胆虚有热", + "E": "阳气不足" + }, + "answer": "A", + "reason": "不寐的原因很多,但总是与心脾肾及阴血不足有关,其病理变化,总属阳盛阴衰,阴阳失交，阳气不能人于阴分。" + }, + { + "question_num": 144, + "query": "下列说法不正确的是", + "options": { + "A": "月经病的治疗,应分清先病和后病", + "B": "月经病的治疗重在治本调经", + "C": "调经诸法以补肾疏肝为要", + "D": "治疗月经病要顺应不同年龄阶段论治", + "E": "治疗月经病要顺应月经周期中阴阳气血的变化" + }, + "answer": "C", + "reason": "月经病的治疗原则:重在治本调经，采用补肾、扶脾、疏肝、调理气血、调理冲任等法以调治。分清先病和后病的论治原则。本着“急则治其标，缓则治其本”的原则。施治中应注意的问题:调经诸法以补肾扶脾为要。应顺应和掌握规律:顺应月经周期中阴阳气血的变化规律。顺应不同年龄阶段论治的规律。青少年重治肾,生育期重治肝，更年期或老年重治脾。掌握虚实补泻规律,虚证月经病以补肾扶脾养血为主，实证以疏肝理气活血为主。" + }, + { + "question_num": 145, + "query": "阴虚火旺之心悸，若兼见五心烦热、梦遗腰酸者，治疗应首选", + "options": { + "A": "天王补心丹", + "B": "六味地黄丸", + "C": "麦味地黄丸", + "D": "知柏地黄丸", + "E": "金锁固精丸" + }, + "answer": "D", + "reason": "阴虚火旺之心悸,若兼见五心烦热,梦遗腰酸者,是属有液亏虚基础上以相火安动更显著、治疗应在滋养阴液的同时,重用清泻相火之品,此药以知柏地黄丸最为贴切,故选D。而A项方虽能养阴安神但消相火不足:BC项养阴为主,也是清相火力弱;E项方固精止遗,而非滋阴降火,故也是不能被选用的。" + }, + { + "question_num": 146, + "query": "反映左、右心室除极与复极全过程的是", + "options": { + "A": "靴形", + "B": "梨形", + "C": "烧瓶形", + "D": "普大型", + "E": "心腰部凸出" + }, + "answer": "B", + "reason": "A项反映心室晚期快速复极的电位和时间变化。B项代表左、右心室除极与复极的全过程。C项反映左、右心房除极过程的电位和时间变化。D项反映左、右心室除极过程的电位和时间变化。E项反映心室早期缓慢复极的电位和时间变化。" + }, + { + "question_num": 147, + "query": "与淋证的发病关系最为密切的病机是", + "options": { + "A": "脾虚中气下陷", + "B": "肾虚下元不固", + "C": "湿热蕴结下焦", + "D": "热盛迫血妄行", + "E": "气郁化火伤阴" + }, + "answer": "C", + "reason": "淋证的病机主要是湿热蕴结下焦，肾与膀胱气化不利。" + }, + { + "question_num": 148, + "query": "下列各项，不属月经病主要病因的是", + "options": { + "A": "寒热湿邪", + "B": "房劳多产", + "C": "内伤七情", + "D": "营卫不调", + "E": "体质因素" + }, + "answer": "D", + "reason": "月经病的主要病因是寒热湿邪侵袭、内伤七情、房劳多产、饮食不节、劳倦过度和体质因素。" + }, + { + "question_num": 149, + "query": "薤白的主治病证是", + "options": { + "A": "肝郁气滞", + "B": "肺热咳嗽", + "C": "虫积腹痛", + "D": "胸痹心痛", + "E": "胃寒呕吐" + }, + "answer": "D", + "reason": "薤白主治:①胸痹证,普散阴寒之凝滞,通胸阳之痹结,为治胸痹之要药;②脘腹痞满胀痛,泻痢里急后重。" + }, + { + "question_num": 150, + "query": "下列哪一项不是临终关怀的道德要求", + "options": { + "A": "认识和理解临终患者", + "B": "尊重临终患者的权利", + "C": "无须满足��终患者的意愿", + "D": "同情和关心临终患者的家属", + "E": "重视临终患者的生命质量" + }, + "answer": "C", + "reason": "临终关怀的道德要求：认识和理解临终患者；尊重临终患者的权利；满足临终患者的意愿；重视临终患者的生命质量；维护临终患者的生命尊严；同情和关心临终患者的家属等。" + }, + { + "question_num": 151, + "query": "聚证患者,食滞痰阻,痰湿较重,服六磨汤后,腑气虽通,但症状未减,舌苔白腻而不化。治疗应首选", + "options": { + "A": "二陈汤", + "B": "藿朴夏苓汤", + "C": "平胃散", + "D": "五苓散", + "E": "香苏散" + }, + "answer": "C", + "reason": "聚证若痰较重,兼有食滞,腑气虽通,苔腻不化者,可用平胃散。" + }, + { + "question_num": 152, + "query": "下列哪项不是月经先期肝郁血热证的主症", + "options": { + "A": "月经提前8天", + "B": "经量或多或少", + "C": "经色淡、质稀", + "D": "心烦易怒", + "E": "口苦咽干" + }, + "answer": "C", + "reason": "ABDE项都是肝郁血热证的临床表现。肝郁血热证经色深红或紫红、质稠" + }, + { + "question_num": 153, + "query": "功能化湿行气，温中止呕的药物是", + "options": { + "A": "藿香", + "B": "佩兰", + "C": "白豆蔻", + "D": "厚朴", + "E": "苍术" + }, + "answer": "C", + "reason": "白豆楚的功效:化湿行气,温中止呕。" + }, + { + "question_num": 154, + "query": "根据美国哈佛医学院提出的“脑死亡”概念，不能确诊“脑死亡”的条件是", + "options": { + "A": "自主运动和自主呼吸消失", + "B": "对外部刺激和内部需求毫无知觉和反应", + "C": "体温低于32.2℃或服用中枢抑制药物者", + "D": "脑电波平直或等电位", + "E": "诱导反射消失" + }, + "answer": "C", + "reason": "诊断“脑死亡”的条件：①昏迷原因明确；②排除各种原因的可逆性昏迷；③深昏迷，脑干反射全部消失，无自主呼吸。以上必须全部具备。" + }, + { + "question_num": 155, + "query": "阳明头痛的“引经药”应首选", + "options": { + "A": "葛根、白芷、知母", + "B": "羌活、川芎、蔓荆子", + "C": "柴胡、黄芩、川芎", + "D": "藁本、吴茱萸、钩藤", + "E": "细辛、白芷、羌活" + }, + "answer": "A", + "reason": "根据头痛部位的不同,参照经络循行部位选用适当的引经药,可提高疗效。太阳经常用羌活、蔓荆子、川芎。阳明经常用葛根、白芷、知母。少阳经常用柴胡、黄芩、川芎。太阴经常用苍术。少阴经常用杜仲、桑寄生、续断。厥阴经常用吴茱萸、藁本。" + }, + { + "question_num": 156, + "query": "下列哪项可诊断为闭经", + "options": { + "A": "月经来潮半年，月经停闭5个月", + "B": "产后哺乳10个月，未转经", + "C": "停止哺乳5个月已行经3次，现月经停闭7个月", + "D": "月经一年一行，无不适", + "E": "平素月经后期，现6个月未行，脉滑利，小腹隆起" + }, + "answer": "C", + "reason": "女子年逾16周岁,月经尚未来潮，或月经周期已建立后又中断6个月以上者,称为闭经。前者称原发性闭经,后者称继发性闭经。对先天性生殖器官缺如,或后天器质性损伤而无月经者,因非药物所能奏效,不属闭经讨论范畴。" + }, + { + "question_num": 157, + "query": "治疗四肢挛急疼痛，应选用的药物是", + "options": { + "A": "人参", + "B": "当归", + "C": "白芍", + "D": "阿胶", + "E": "黄芪" + }, + "answer": "C", + "reason": "白芍的主治病证:①肝血亏虚,月经不调;②肝脾不和,胸胁脘腹疼痛,四肢挛急疼痛;③肝阳上亢，头痛眩晕，" + }, + { + "question_num": 158, + "query": "对不伤害原则的解释，正确的是", + "options": { + "A": "不伤害原则就是消除任何医疗伤害", + "B": "不伤害原则就是要求医生对患者丝毫不能伤害", + "C": "因绝大多数医疗行为都存在着不同程度的伤害，所以不伤害原则是做不到的", + "D": "不伤害原则要求对医学行为进行受益与伤害的权衡，把可控伤害控制在最低限度之内", + "E": "对肿瘤患者进行化疗意味着绝对伤害" + }, + "answer": "D", + "reason": "不伤害原则的解释：不伤害原则要求对医学行为进行受益与伤害的权衡，把可控伤害控制在最低限度之内。" + }, + { + "question_num": 159, + "query": "腰痛发病的关键是", + "options": { + "A": "寒湿", + "B": "湿热", + "C": "肾虚", + "D": "气滞", + "E": "血瘀" + }, + "answer": "C", + "reason": "腰痛的内因是机体虚���,腰府失养；外因是感受风寒湿热之邪,关键在于“肾虚\"。" + }, + { + "question_num": 160, + "query": "下列除哪项外，均是经期延长血瘀证的主症", + "options": { + "A": "经行8～10天", + "B": "月经量少、色暗、有块", + "C": "小腹疼痛拒按", + "D": "腰酸腿软", + "E": "舌紫暗，脉弦涩" + }, + "answer": "D", + "reason": "经期延长血瘀证是实证,D项是虚证表现,故不选,其余皆是。" + }, + { + "question_num": 161, + "query": "槟榔的功效是", + "options": { + "A": "杀虫、消积、行气、活血", + "B": "杀虫、消积、行气、止泻", + "C": "杀虫、消积、行气、止咳", + "D": "杀虫、消积、行气、利水", + "E": "杀虫、消积、行气、止痢" + }, + "answer": "D", + "reason": "槟榔的功效是杀虫、消积、行气、利水,可治疗多种肠道寄生虫、食积气、泻痢后重、水肿等。" + }, + { + "question_num": 162, + "query": "医师开具处方时，除特殊情况外必须注明的是", + "options": { + "A": "患者体重", + "B": "药品的拉丁文", + "C": "处方药或非处方药", + "D": "临床诊断", + "E": "患者是否为过敏体质" + }, + "answer": "D", + "reason": "医师开具处方时，除特殊情况外必须注明的是临床诊断。" + }, + { + "question_num": 163, + "query": "手、足三阳经在头部的分布规律是", + "options": { + "A": "阳明在前,太阳在侧,少阳在后", + "B": "太阳在前,少阳在侧,阳明在后", + "C": "少阳在前,阳明在侧,太阳在后", + "D": "阳明在前,少阳在侧,太阳在后", + "E": "太阳在前,阳明在侧,少阳在后" + }, + "answer": "D", + "reason": "手、足三阳经在头部的分布规律是阳明在前头部,少阳在侧头部,太阳在后头部。" + }, + { + "question_num": 164, + "query": "下列各项，不属妊娠病范畴的是", + "options": { + "A": "恶阻", + "B": "胞转", + "C": "儿枕痛", + "D": "胞阻", + "E": "子冒" + }, + "answer": "C", + "reason": "产后腹痛又称儿枕痛,是产后病,其余皆是妊娠病" + }, + { + "question_num": 165, + "query": "小柴胡汤的组成药物中不含有的是", + "options": { + "A": "柴胡", + "B": "黄芩", + "C": "干姜", + "D": "人参", + "E": "大枣" + }, + "answer": "C", + "reason": "小柴胡汤的组成:柴胡、黄梦、人参甘草、半夏、生姜、大枣,故选C。" + }, + { + "question_num": 166, + "query": "依照《处方管理办法》的规定，为门(急)诊患者开具的麻醉药品注射剂，每张处方的量为", + "options": { + "A": "一次常用量", + "B": "3日常用量", + "C": "5日常用量", + "D": "7日常用量", + "E": "15日常用量" + }, + "answer": "A", + "reason": "《处方管理办法》第二十三条规定：为门（急）诊患者开具的麻醉药品注射剂，每张处方为一次常用量；控缓释制剂，每张处方不得超过7日常用量；其他剂型，每张处方不得超过3日常用量。" + }, + { + "question_num": 167, + "query": "中风的病理基础是", + "options": { + "A": "风火痰瘀", + "B": "气血逆乱", + "C": "心肝火旺", + "D": "肝阳上亢", + "E": "肝肾阴虚" + }, + "answer": "A", + "reason": "中风的病理基础是风火痰瘀这些病理因素和产物,其余选项都是病因,不是病理因素。" + }, + { + "question_num": 168, + "query": "经期延长阴虚血热证的发病机制是", + "options": { + "A": "阴虚失守，冲任不固", + "B": "肝郁气滞，疏泄失常", + "C": "肾阴不足，封藏失职", + "D": "阴虚内热，热扰冲任", + "E": "湿热下注，血热妄行" + }, + "answer": "D", + "reason": "经期延长阴虚血热证的发病机制是阴虚内热,热扰冲任。" + }, + { + "question_num": 169, + "query": "天南星的功效是", + "options": { + "A": "燥湿化痰，降逆止呕", + "B": "燥湿化痰，祛风止痉", + "C": "燥湿化痰，祛风解毒", + "D": "燥湿化痰，止咳平喘", + "E": "燥湿化痰，清热定惊" + }, + "answer": "B", + "reason": "天南星的功效为燥湿化痰,祛风止痉,故选B。" + }, + { + "question_num": 170, + "query": "有关结核杆菌引起的变态反应，下列叙述哪项是错误的", + "options": { + "A": "为身体组织对结核菌及其代谢产物产生的过敏反应", + "B": "多发生于结核菌侵人人体后4~8周", + "C": "局部可出现渗出性炎症，但不出现干酪样坏死", + "D": "结核菌素试验呈阳性反应", + "E": "可出现皮肤结节性红斑" + }, + "answer": "C", + "reason": "结核变态反应为身体组织对结核菌及其代谢产���产生的过敏反应，一般发生于结核菌侵入人体后4～8周后此种反应可使局部出现渗出性炎症，也可出现干酪样坏死，常可伴发热。此时行结核菌素试验可呈阳性反应，为结核杆菌引起的变态反应。结核菌感染后还可发生多发性关节炎、皮肤结节性红斑等。" + }, + { + "question_num": 171, + "query": "首见“疟疾”病名的医籍是", + "options": { + "A": "《内经》", + "B": "《金匮要略》", + "C": "《神农本草经》", + "D": "《诸病源候论》", + "E": "《瘟疫论》" + }, + "answer": "A", + "reason": "疟疾之名首见于《内经》，《素问。疟论》指出疟疾的病因是“疟气”,该篇还描述了疟疾发作的典型症状。" + }, + { + "question_num": 172, + "query": "以下哪项属于异位妊娠的手术适应证", + "options": { + "A": "停经时间长，疑为输卵管间质部或残角子宫妊娠者", + "B": "休克严重，内出血多或持续出血，虽经抢救而不易控制者", + "C": "妊娠试验持续阳性，包块继续长大，杀胚药无效", + "D": "愿意同时施行绝育术者", + "E": "以上均是" + }, + "answer": "E", + "reason": "输卵管妊娠确诊后,可以考虑手术治疗。有以下情况者,应立即手术:停经时间长，疑为输卵管间质部或残角子宫妊娠者休克严重，内出血多或持续出血，虽经抢救而不易控制者;妊娠试验持续阳性,包块继续长大,杀胚药无效:愿意同时施行绝育术者。在诊断早期可以保守治疗，免除手术保存生育能力。" + }, + { + "question_num": 173, + "query": "为血中气药，能上行头目，下调经水的药物是", + "options": { + "A": "川芎", + "B": "丹参", + "C": "郁金", + "D": "姜黄", + "E": "延胡索" + }, + "answer": "A", + "reason": "川川芎功效:活血行气,袪风止痛。川芎为血中气药,能上行头目,是治疗头痛要药;下调经水,治疔多种妇产科疾病。" + }, + { + "question_num": 174, + "query": "阵发性室上性心动过速最常发生于", + "options": { + "A": "冠心病者", + "B": "正常心脏者", + "C": "高血压病者", + "D": "心肌病者", + "E": "心脏瓣膜病者" + }, + "answer": "B", + "reason": "阵发性室上性心动过速最常见的是房室结内折返性心动过速，一般患者无器质性心脏病表现，不同性别与年龄均可发生。" + }, + { + "question_num": 175, + "query": "与水肿关系最为密切的脏腑是", + "options": { + "A": "肺、脾、肾", + "B": "肺、胃、肾", + "C": "心、牌、肾", + "D": "肝、脾、肾", + "E": "心、肝、肾" + }, + "answer": "A", + "reason": "水肿是由于肺失通调,脾失转输,肾失开合,膀胱气化不利,导致体内水液潴留,泛溢肌肤的一类病证。水肿与肺肿肾三脏关系最为密切。肺主通调水道,脾主运化水液,肾主气化,故水肿之病,以肾为本,以肺为标,以脾为制水之脏,故选A。心、肝、胃与水没有直接关系,故排除BCDE。" + }, + { + "question_num": 176, + "query": "妇科杂病的定义是", + "options": { + "A": "凡不属于经、带、胎、产范围的疾病", + "B": "凡不属于经、带、胎、产疾病范围，而又与妇女解剖、生理、病机特点密切相关的各种妇科疾病", + "C": "凡不属于经、带、胎、产疾病范围，而又与妇女解剖、生理、病机特点不密切相关的各种妇科疾病", + "D": "凡属于经、带、胎、产疾病范围，而又与妇女解剖、生理、病机特点无关的各种妇科疾病", + "E": "凡属于经、带、胎、产疾病范围，而又与妇女解剖、生理、病机特点密切相关的各种妇科疾病" + }, + "answer": "B", + "reason": "妇科杂病的定义为凡不属于经、带、胎、产疾病范围,而又与妇女解剖、生理、病机特点密切相关的各种妇科疾病。" + }, + { + "question_num": 177, + "query": "属于十八反的是", + "options": { + "A": "硫黄配朴硝", + "B": "石膏配知母", + "C": "藜芦配细辛", + "D": "人参配黄芪", + "E": "丁香配郁金" + }, + "answer": "C", + "reason": "十八反:甘草反甘遂v大戟、海菜、芫花;乌头反贝母、瓜蒌、半夏、白、白及;藜芦反人参沙参、丹参、玄参、细辛、芍药。" + }, + { + "question_num": 178, + "query": "下列各项，不属传染病基本特征的是", + "options": { + "A": "有病原体", + "B": "有感染后免疫性", + "C": "有流行病学特征", + "D": "有发热", + "E": "有传染性" + }, + "answer": "D", + "reason": "传染病与其他疾病相区别的本特征有四个:有病原体、有传染性、有流行病学特征和有感染后免疫，ABCE项等均属于传染病的基本���征;发热可以由感染性原因、也可以由非感染性原因引起，并不是传染病的基本特征。" + }, + { + "question_num": 179, + "query": "眩晕病机颇为复杂,归纳起来不外下列哪四个方面", + "options": { + "A": "痰、火、风、瘀", + "B": "风、痰、湿、瘀", + "C": "风、痰、瘀、虚", + "D": "痰、湿、虚、瘀", + "E": "风、火、痰、虚" + }, + "answer": "A", + "reason": "眩晕的病机。眩晕的病机较为复杂。阴虚则易肝风内动,血少则脑失所养,精亏则髓海不足,痰浊壅遏,或化火上蒙,均致眩晕,故其病机为风、火、痰、瘀。" + }, + { + "question_num": 180, + "query": "清热固经汤适合于下列哪型崩漏", + "options": { + "A": "虚热", + "B": "实热", + "C": "肾阴虚", + "D": "血瘀", + "E": "脾虚" + }, + "answer": "B", + "reason": "崩漏实热证,应首选清热固经汤。" + }, + { + "question_num": 181, + "query": "桑白皮与葶苈子既能泻肺平喘，又能", + "options": { + "A": "利水渗湿", + "B": "利水通淋", + "C": "利水消肿", + "D": "利水止泻", + "E": "利水退黄" + }, + "answer": "C", + "reason": "桑白皮与孝苈子二药均有泻肺平喘和利水消肿作用,治疗肺热咳喘及水肿、小便不利等常相须为用。桑白皮甘寒,药性较缓,长于清肺热,降肺火,多用于肺热咳喘,痰黄及皮肤水肿;葶苈子力峻,重在泻肺中水气、痰涎,邪盛喘满不得卧者尤宜,其利水作用较强,可兼治鼓胀、胸腹积水等证。" + }, + { + "question_num": 182, + "query": "右上肺中心型肺癌的典型X线表现是", + "options": { + "A": "两肺锁骨下区的片状阴影", + "B": "肺内有多发的肿块影", + "C": "肺门肿块和右肺上叶不张连在一起形成横行S状的下缘", + "D": "肺内有多发的薄壁空洞", + "E": "靠近肺门处可见支气管充气征" + }, + "answer": "C", + "reason": "中心型肺癌早期局限于黏膜内时X线无异常表现,引起管腔狭窄时可出现阻塞性肺气肿阻塞性肺炎、阻密性肺不张三种肺癌的问接征象;肿瘤同时向腔外生长或(和)伴肺门淋巴结转移时形成肺门肿块影,肺门肿块是肺癌的直接征象，发生于右上叶的肺癌,肺门肿块和右肺上叶不张连在一起形成行S状的下缘。" + }, + { + "question_num": 183, + "query": "公孙穴位于", + "options": { + "A": "第1跖骨小头后缘,赤白肉际处", + "B": "第1跖骨小头前缘,赤白肉际处", + "C": "第1跖骨趾关节部,赤白肉际处", + "D": "第1跖骨基底部前下缘,赤白肉际处", + "E": "第1跖骨基底部后下缘，赤白肉际处" + }, + "answer": "D", + "reason": "公孙穴的定位在足内侧缘,当第1趾骨基底的前下方。" + }, + { + "question_num": 184, + "query": "下列哪项不属于闭经的病机", + "options": { + "A": "气滞血瘀", + "B": "痰湿阻滞", + "C": "阴虚血燥", + "D": "气血虚弱", + "E": "湿毒壅盛" + }, + "answer": "E", + "reason": "闭经的病因有气血虚弱、气滞血瘀、肾气亏虚、阴虚血燥、痰湿阻滞。" + }, + { + "question_num": 185, + "query": "具有敛肺涩肠，下气利咽功效的药物是", + "options": { + "A": "芡实", + "B": "椿皮", + "C": "诃子", + "D": "乌梅", + "E": "莲子" + }, + "answer": "C", + "reason": "芡实益肾固精,健脾止泻,除湿止带。椿皮消热燥湿,收敛止带,止泻，止血。诃子涩肠止泻,敛肺止咳,利咽开音。乌梅敛肺止咳,涩肠止泻，安蛔止痛,生津止渴。莲子固精止带,补脾止泻,益肾作心。" + }, + { + "question_num": 186, + "query": "体温在39℃以上，每日波动2℃，此热型是", + "options": { + "A": "稽留热", + "B": "间歇热", + "C": "弛张热", + "D": "波状热", + "E": "不规则热" + }, + "answer": "C", + "reason": "发热患者的休温曲线可有一定规律,称为热型。弛张热的体温在39℃以上，但波动度大,每日达2℃以上,故选C。而其他热型各有特点,留热的体温持续于39~40℃,达数日或数周,每日波动范围不超过1℃;间歇热的体温升达高峰后持续数小时又迅速降至正常,无热期可持续一至数日，如此高热期与无热期反复交替出现，体温波动可达数度；波状热的体温逐浙升高达39℃以上，数日后又逐浙下降至低热或正常水平,如此反复多次；不规则热则发热无一定规律。" + }, + { + "question_num": 187, + "query": "位于腋窝正中,腋动脉搏动处的穴位是", + "options": { + "A": "极泉", + "B": "大包", + "C": "肩前", + "D": "天池", + "E": "肩髎" + }, + "answer": "A", + "reason": "极泉是手少阴心经穴位,定位:在腋区,肤窝正中,肤动脉搏动处。" + }, + { + "question_num": 188, + "query": "肝火引起经行头痛的特点是", + "options": { + "A": "头晕，头部绵绵作痛", + "B": "巅顶掣痛，头晕目眩", + "C": "头痛剧烈，痛如锥刺", + "D": "头部胀痛重着", + "E": "头痛如裹，头晕目眩" + }, + "answer": "B", + "reason": "肝火引起经行头痛的特点是引起肝经循行部位疼痛,故选B。" + }, + { + "question_num": 189, + "query": "治疗尿浊，应首选", + "options": { + "A": "二妙散", + "B": "八正散", + "C": "疏凿饮子", + "D": "程氏萆薢分清饮", + "E": "薏苡仁汤" + }, + "answer": "D", + "reason": "尿浊的发生或由湿热内蕴,或由脾虚气陷及肾元亏虚。前者治疗当清热化湿，首选方为程氏革分清饮。" + }, + { + "question_num": 190, + "query": "代谢性酸中毒可出现", + "options": { + "A": "潮式呼吸", + "B": "库斯莫尔呼吸", + "C": "间停呼吸", + "D": "夜间阵发性呼吸困难", + "E": "吸气性呼吸困难" + }, + "answer": "B", + "reason": "严重代谢性酸中毒时,患者可以出现节律匀齐，呼吸深而大，患者不感呼吸困难的呼吸，称为库斯莫尔呼吸,又称酸中毒大呼吸。" + }, + { + "question_num": 191, + "query": "手太阴肺经在上肢的分布是", + "options": { + "A": "内侧前廉", + "B": "外侧前廉", + "C": "内侧中行", + "D": "外侧后廉", + "E": "内侧后廉" + }, + "answer": "A", + "reason": "十二经脉在四肢的排列:手足阳经为阳明在前,少阳在中,太阳在后:手足阴经为太阴在前、厥阴在中、少阴在后。阴经分布在四肢内侧,阳经分布在四肢外侧,故手太阴肺经应是分布在上肢内例前廉。" + }, + { + "question_num": 192, + "query": "产后发热临证", + "options": { + "A": "应参照恶露的量、色、质及气味，以及兼症、舌脉，辨其虚实寒热", + "B": "应根据腹痛的性质，以及兼症、舌脉，辨其虚实寒热", + "C": "应根据发热的特点，以及兼症、舌脉，辨其虚实寒热", + "D": "应根据发热的特点、恶露、小腹痛的情况以及伴随的全身症状综合分析明辨", + "E": "应根据发热的特点、恶露特点及伴随的全身症状综合分析明辨" + }, + "answer": "D", + "reason": "产后发热,虚实轻重有别,应根据发热的特点、恶露、小腹痛的情况以及伴随的全身症状综合分析明辨。ABCE项描述的均不够准确。" + }, + { + "question_num": 193, + "query": "下列除哪组外都是镇心安神药组", + "options": { + "A": "龙骨、牡蛎", + "B": "朱砂、磁石", + "C": "龟板、鳖甲", + "D": "珍珠、琥珀", + "E": "珍珠母、紫贝齿" + }, + "answer": "C", + "reason": "龟板能滋阴潜阳,益肾健骨,养血补心;鳖甲能滋阴潜阳,软坚散结,无镇心安神作用,余药皆有镇心安神作用。" + }, + { + "question_num": 194, + "query": "下列哪种情况发生室性期前收缩，临床上应予以积极治疗", + "options": { + "A": "慢性心肌缺血", + "B": "无器质性心脏病者", + "C": "肺部感染", + "D": "急性心肌炎症或梗死", + "E": "心功能不全者" + }, + "answer": "D", + "reason": "正常人与各种心脏病患者均可发生室性期前收缩，正常人发生室性期前收缩的机会随年龄的增长而增加。心肌炎症、缺血缺氧、药物作用(如洋地价、李尼丁等)电解质系乱(如低血钾)等均可发生室性期前收缩,除治疗病因外,是否抗心律失常药物治疗应根据情况权衡利弊决定之。但在急性心肌炎症、缺血、缺氧时出现的室性期前收缩应高度重视并积极治疗,因它往往是出现致命性室性心律失常，如窒速、窒颤的先兆。" + }, + { + "question_num": 195, + "query": "分布于胸腹第一侧线的经脉是", + "options": { + "A": "足太阴脾经", + "B": "足少阴肾经", + "C": "足少阳胆经", + "D": "足阳明胃经", + "E": "足厥阴肝经" + }, + "answer": "B", + "reason": "了胸腹部侧线由内向外佐次为足少阴肾经、足阳明胃经、足太阴脾经、足厥阴肝经,故选B。A项位于第三侧线,D项位于第二侧线,E项位于第四侧线。" + }, + { + "question_num": 196, + "query": "下列除哪项外，均是妊娠禁药", + "options": { + "A": "峻下剂", + "B": "破血剂", + "C": "逐瘀剂", + "D": "和血剂", + "E": "有毒剂" + }, + "answer": "D", + "reason": "妊娠禁药或慎用药有峻下剂,破血剂,逐瘀剂,有毒剂,滑利剂,耗气、散气剂。" + }, + { + "question_num": 197, + "query": "功效为透邪解郁、疏肝理脾的方剂是", + "options": { + "A": "达原饮", + "B": "逍遥散", + "C": "四逆散", + "D": "痛泻要方", + "E": "大柴胡汤" + }, + "answer": "C", + "reason": "四逆散的功效:透邪解郁,疏肝理气。" + }, + { + "question_num": 198, + "query": "乙型脑炎(简称乙脑)的主要传染源是", + "options": { + "A": "猪", + "B": "乙脑病毒携带者", + "C": "乙脑患者", + "D": "蚊虫", + "E": "野鼠" + }, + "answer": "A", + "reason": "流行性乙型脑炎主要分布在亚洲远东和东南亚地区,经蚊传插，多见于夏秋季,临床上急起发病,有高热、意识障碍、惊厥、强直性痉挛和脑膜刺激征等,重型患者病后往往留有后进症，猪感染率高，主要传染源为猪,故选A。野鼠是流行性出血热的传染源,故E项错误。" + }, + { + "question_num": 199, + "query": "翳风穴位于", + "options": { + "A": "胸锁乳突肌后缘,平下颌角处", + "B": "乳突前下方与下颌角之间的凹陷中", + "C": "乳突后下方凹陷中", + "D": "胸锁乳突肌与斜方肌上端之间的凹陷中", + "E": "后发际正中直上0.5寸，旁开1.3寸当斜方肌外缘凹陷中" + }, + "answer": "B", + "reason": "翳风穴的定位:在耳垂后方,当乳突与下颌角之间的凹陷处。" + }, + { + "question_num": 200, + "query": "下列除哪项外，均为妊娠病的发病机制", + "options": { + "A": "血聚养胎，阴血偏虚，阳气偏亢", + "B": "胎体渐大，气机升降失调", + "C": "寒湿停聚，冲任受阻", + "D": "肾气不足，无力系胞，胎元不固", + "E": "脾胃虚弱，化源不足，影响胎元" + }, + "answer": "C", + "reason": "妊娠病的发病机制有四，一是阴血虚;二是脾肾虚:三是冲气上逆;四是气滞,如胎体浙大,气机升降失调。" + }, + { + "question_num": 201, + "query": "治疗经行乳房胀痛肝气郁结证，应首选的方剂是", + "options": { + "A": "一贯煎", + "B": "逍遥散", + "C": "丹栀逍遥散", + "D": "柴胡疏肝散", + "E": "四逆散" + }, + "answer": "B", + "reason": "经行乳房胀痛肝气郁结证治法:疏肝理气,和胃通络。代表方:逍散加麦芽、青皮、鸡内金。" + }, + { + "question_num": 202, + "query": "空腹听诊出现振水音，可见于", + "options": { + "A": "肝硬化腹水", + "B": "肾病综合征", + "C": "结核性腹膜炎", + "D": "幽门梗阻", + "E": "急性肠炎" + }, + "answer": "D", + "reason": "振水音提示胃内有液体潴留,幽门梗阻可有胃内波体潴留。" + }, + { + "question_num": 203, + "query": "在五输穴中,荣穴主要治疗", + "options": { + "A": "心下满", + "B": "身热", + "C": "体重节痛", + "D": "喘咳寒热", + "E": "逆气而泄" + }, + "answer": "B", + "reason": "特定穴:五输穴的临床应用。《难经.六十八难》日:“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": 204, + "query": "产后恶露不绝的主要病因是", + "options": { + "A": "气虚、血热、血瘀", + "B": "气虚、血虚、血瘀", + "C": "气虚、血虚、血热", + "D": "气虚、血虚、寒湿", + "E": "气虚、肝郁、血热" + }, + "answer": "A", + "reason": "产后恶解不绝的主要病因:气患、血瘀、血热。" + }, + { + "question_num": 205, + "query": "既能镇惊，又能解毒的药物是", + "options": { + "A": "朱砂", + "B": "磁石", + "C": "龙骨", + "D": "琥珀", + "E": "远志" + }, + "answer": "A", + "reason": "朱砂功效:清心镇惊,安神解毒" + }, + { + "question_num": 206, + "query": "治疗伤寒应首选的药物是", + "options": { + "A": "头孢唑啉", + "B": "氯霉素", + "C": "链霉素", + "D": "环丙沙星", + "E": "庆大霉素" + }, + "answer": "D", + "reason": "伤寒的抗菌治疗，喹诺酮类药物为首选。主要因为该类药物有以下优点：抗菌谱广，尤其对革兰阴性杆菌活性高；细菌对其产生突发耐药的发生率低；体内分布广，组织体液中药物浓度高，可达有效抑菌或杀菌水平；大多品种系口服制剂，使用方便。目前常有的该类药物有氧氟沙星、环丙沙星和依诺沙星等。" + }, + { + "question_num": 207, + "query": "手太阳小肠经与足太阳膀胱经的交接部位是", + "options": { + "A": "目外眦", + "B": "目内眦", + "C": "目中", + "D": "鼻旁", + "E": "口角旁" + }, + "answer": "B", + "reason": "手太阳小肠经与足太阳膀胱经在目内眦交接,故选B。在目外眦交接的是胆经和三焦经，在鼻旁交接的是手足阳明经。" + }, + { + "question_num": 208, + "query": "孕后出现腰酸腹痛���下腹坠胀，或阴道有少量出血者，称为", + "options": { + "A": "胞阻", + "B": "胞漏", + "C": "胎漏", + "D": "堕胎", + "E": "胎动不安" + }, + "answer": "E", + "reason": "妊娠期出现腰酸腹痛,胎动下坠,或阴道少量流血者,称为“胎动不安”,又称“胎气不安”。" + }, + { + "question_num": 209, + "query": "熟地黄的功效是", + "options": { + "A": "补血调经，活血止痛", + "B": "补血调经，润肠通便", + "C": "补血滋阴，润肺止血", + "D": "补血调经，柔肝止痛", + "E": "补血养阴，填精益髓" + }, + "answer": "E", + "reason": "热地黄药性:甘,微温。归肝、肾经功效:补血养阴，坝精益饱" + }, + { + "question_num": 210, + "query": "目前认为志贺菌致病必须具备的条件是", + "options": { + "A": "过度劳累", + "B": "暴饮暴食", + "C": "细菌变异性", + "D": "痢疾杆菌对肠黏膜上皮细胞的侵袭力", + "E": "发病季节" + }, + "answer": "D", + "reason": "目前认为志贺菌致病必须具备3个条件：一是具有介导细菌吸附的光滑性脂多糖O抗原；二是具侵袭上皮细胞并在其中繁殖的能力；三是侵袭、繁殖后可产生毒素。题目中的D项符合其中的第二个必须条件，其他选项均不符合这三个必须条件中的一项。" + }, + { + "question_num": 211, + "query": "按十二经脉的流注次序,肝经向下流注的经脉是", + "options": { + "A": "膀胱经", + "B": "胆经", + "C": "三焦经", + "D": "心经", + "E": "肺经" + }, + "answer": "E", + "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,故选E。" + }, + { + "question_num": 212, + "query": "产后三急是指", + "options": { + "A": "呕吐、泄泻、盗汗", + "B": "高热、昏迷、自汗", + "C": "心悸、气短、抽搐", + "D": "尿闭、便难、冷汗", + "E": "下血、腹痛、心悸" + }, + "answer": "A", + "reason": "产后三急指呕吐、泄泻、盗汗。" + }, + { + "question_num": 213, + "query": "善破气除痞，消食导滞的药物是", + "options": { + "A": "陈皮", + "B": "青皮", + "C": "枳实", + "D": "木香", + "E": "厚朴" + }, + "answer": "C", + "reason": "积实的应用:胃肠积泄,湿热泻痢。善破气除胀,消积导滞。" + }, + { + "question_num": 214, + "query": "下列各项，不符合道德要求的是", + "options": { + "A": "尽量为患者选择安全有效的药物", + "B": "要严格遵守各种抗生素的用药规则，尽可能开患者要求的好药，贵重药物", + "C": "在医疗过程中要为患者保守秘密", + "D": "对婴幼患儿、老年患者的用药应该谨慎，防止肾功能损害", + "E": "钻研药理知识，防止粗疏和盲目用药" + }, + "answer": "B", + "reason": "尽量为患者选择安全有效的药物，属于道德要求中的义务。在医疗过程中要为患者保守秘密属于保密。对婴幼患儿、老年患者的用药应该谨慎，防止肾功能损害属于审慎。钻研药理知识，防止粗疏和盲目用药属于审慎。" + }, + { + "question_num": 215, + "query": "膀胱经的合穴是", + "options": { + "A": "上巨虚", + "B": "下巨虚", + "C": "足三里", + "D": "委阳", + "E": "委中" + }, + "answer": "E", + "reason": "委中是膀胱的下合穴。" + }, + { + "question_num": 216, + "query": "生化汤治疗血虚寒凝，瘀阻胞宫而致的产后恶露淋漓不尽，常加用的药物是", + "options": { + "A": "桃仁、赤芍", + "B": "红花、赤芍", + "C": "蒲黄、五灵脂", + "D": "蒲黄、益母草", + "E": "黑荆芥、茜草" + }, + "answer": "D", + "reason": "生化汤治疗血虚寒凝,瘀阻胞宫而致的产后恶露淋漓不尽，常加用的药物是蒲黄、益母草,以增祛瘀止血之效。" + }, + { + "question_num": 217, + "query": "下列各项，属四神丸功用的是", + "options": { + "A": "固表止汗", + "B": "固经止血", + "C": "健脾止带", + "D": "涩肠止泻", + "E": "涩精止遗" + }, + "answer": "D", + "reason": "四神丸温补脾肾、固肠止泻,用于脾肾阳虚之肾泄证。症见“五更泄泻,不思饮食,食少不化或久泻不愈,腹痛喜温,腰酸肢冷,神疲乏力,舌淡苔薄白,脉沉迟无力”。" + }, + { + "question_num": 218, + "query": "尊重患者知情同意权，其正确的做法是", + "options": { + "A": "婴幼患儿可以由监护人决定其诊疗方案", + "B": "家属无承诺，即使患者本人知情同意也不得给予手术", + "C": "对特殊急诊患者的抢救都同样对待", + "D": "无须做到患者完全知情", + "E": "只经患者同意即可手术" + }, + "answer": "A", + "reason": "知情同意权的主体，一是成年患者本人：具有完全民事行为能力的患者，应是知情同意权的主体；二是法定代理人：对于未成年人患者，知情同意权的主体是其父母；对于精神病患者、神志不明的患者，知情同意权的主体是配偶、父母、成年子女和其他近亲属等。" + }, + { + "question_num": 219, + "query": "髀枢至膝中的骨度分寸是", + "options": { + "A": "14寸", + "B": "15寸", + "C": "16寸", + "D": "18寸", + "E": "19寸" + }, + "answer": "E", + "reason": "髀枢,即股骨大转子至膝中,即腘横纹的分寸是19寸。" + }, + { + "question_num": 220, + "query": "妊娠恶阻脾胃虚弱证的特点是", + "options": { + "A": "呕吐痰涎", + "B": "食人即吐、呕吐清涎", + "C": "呕吐黏痰", + "D": "呕吐酸水或苦水", + "E": "呕吐血性分泌物" + }, + "answer": "B", + "reason": "妊娠恶阻脾胃虚弱证的特点是恶心呕吐,甚则食人即吐,呕吐清涎。" + }, + { + "question_num": 221, + "query": "真人养脏汤主治久泻久痢的主要病机是", + "options": { + "A": "肾阳衰微", + "B": "脾胃虚寒", + "C": "肠胃寒积", + "D": "脾肾虚寒", + "E": "肝肾虚寒" + }, + "answer": "D", + "reason": "真人养脏汤的功效为涩肠固脱、温补脾肾。主治久泻久痢,脾肾虚寒证。" + }, + { + "question_num": 222, + "query": "医疗机构开展诊疗活动必须按照", + "options": { + "A": "核准的项目", + "B": "登记的项目", + "C": "核准的诊疗项目", + "D": "登记的诊疗项目", + "E": "核准登记的诊疗项目" + }, + "answer": "E", + "reason": "医疗机构必须按照核准登记或者备案的诊疗科目开展诊疗活动。" + }, + { + "question_num": 223, + "query": "外邪由皮毛传人脏腑的途径,依次是", + "options": { + "A": "络脉→孙脉→经脉", + "B": "孙脉→经脉→络脉", + "C": "经脉→孙脉→络脉", + "D": "络脉→经脉→孙脉", + "E": "孙脉→络脉→经脉" + }, + "answer": "E", + "reason": "外邪侵犯人体由表及里,先从皮毛开始,卫气充实于络脉,络脉散布于全身,密布于皮部，当外邪侵犯机体时,卫气首当其冲发挥其抗御外邪、保卫机体的屏障作用。人体最小的是孙脉,其次是络脉，最大的是经脉,故外邪由皮毛传人脏腑的途径依次为孙脉一络脉一经脉。" + }, + { + "question_num": 224, + "query": "学龄前期是", + "options": { + "A": "1周岁", + "B": "2周岁", + "C": "3～7周岁", + "D": "8～12周岁", + "E": "以上均非" + }, + "answer": "C", + "reason": "3周岁后到7周岁为学龄前期,也称幼童期。" + }, + { + "question_num": 225, + "query": "定喘汤的组成药物中含有", + "options": { + "A": "半夏、当归", + "B": "麻黄、杏仁", + "C": "桑白皮、地骨皮", + "D": "黄芩、陈皮", + "E": "苏子、橘红" + }, + "answer": "B", + "reason": "定喘汤的药物组成:白果、麻黄、苏子、甘草、款冬花、杏仁、桑白皮、炒黄芩、半夏。" + }, + { + "question_num": 226, + "query": "下述情形中，属于三级医疗事故的是造成病员", + "options": { + "A": "重度残疾", + "B": "中度残废或严重功能障碍", + "C": "轻度残废或一般功能障碍", + "D": "死亡", + "E": "重度残废或严重功能障碍" + }, + "answer": "C", + "reason": "一级医疗事故：造成患者死亡、重度残疾的；二级医疗事故：造成患者中度残疾、器官组织损伤导致严重功能障碍的；三级医疗事故：造成患者轻度残疾、器官组织损伤导致一般功能障碍的；四级医疗事故：造成患者明显人身损害的其他后果的。" + }, + { + "question_num": 227, + "query": "脾之大络,名为", + "options": { + "A": "天池", + "B": "俞府", + "C": "鸠尾", + "D": "大包", + "E": "虚里" + }, + "answer": "D", + "reason": "鸠尾是任脉的络穴,大包是脾之大络。" + }, + { + "question_num": 228, + "query": "小儿营养不良是指体重低于正常均值的", + "options": { + "A": "66％", + "B": "70％", + "C": "85％", + "D": "95％", + "E": "90％" + }, + "answer": "C", + "reason": "小儿营养不良是指体重低于正常均值的85%。" + }, + { + "question_num": 229, + "query": "九味羌活汤药备六经，其中入阳明经，治阳明经头痛的药物是", + "options": { + "A": "羌活", + "B": "白芷", + "C": "黄芩", + "D": "川芎", + "E": "细辛" + }, + "answer": "B", + "reason": "九味羌活汤是“分经论治”的代表方,其药备六经,通治四时。羌活辛温芳香，主人太阳经,治太阳头痛;白芷人阳明经,治阳明头痛;黄芩人少阳经,治少阳头痛:川芎人阴经,治顶头痛:细辛人少阴经，治少阴头痛。" + }, + { + "question_num": 230, + "query": "下列各项，属于行政处罚的是", + "options": { + "A": "罚款", + "B": "降级", + "C": "赔偿损失", + "D": "撤职", + "E": "赔礼道歉" + }, + "answer": "A", + "reason": "行政处罚包括人身罚、财产罚、行为罚、申诫罚。人身罚包括行政拘留、劳动教养；财产罚包括罚款、没收财物；行为罚包括责令停产、停业暂扣或者吊销许可证和营业执照；申诫罚包括警告、通报批评。" + }, + { + "question_num": 231, + "query": "八会穴中的髓会穴是", + "options": { + "A": "阳陵泉", + "B": "悬钟", + "C": "太湖", + "D": "膻中", + "E": "中脘" + }, + "answer": "B", + "reason": "脉会太渊,筋会阳陵泉,脏会章门，血会膈俞,肾会大杼,悬钟为髓会,膻中为气会,中脘为腑会。" + }, + { + "question_num": 232, + "query": "小儿正常舌质的颜色是", + "options": { + "A": "淡白", + "B": "淡红", + "C": "紫暗", + "D": "暗红", + "E": "绛红" + }, + "answer": "B", + "reason": "正常小儿舌体柔软、淡红润泽、伸缩自如,舌面有干湿适中的薄苔。小儿舌质较成人红嫩。新生儿舌红无苔和哺乳婴儿的乳白苔,均属正常舌象。食后或服药后对舌苔有一定影响，应予注意。小儿与成人正常舌象都是淡红舌。" + }, + { + "question_num": 233, + "query": "白虎汤的功用", + "options": { + "A": "清热生津", + "B": "清营凉血", + "C": "清热解毒", + "D": "清暑益气", + "E": "疏风清热" + }, + "answer": "A", + "reason": "白虎汤组成:石音一斤、知母六两炙甘草二两、粳米六合。功用:清热生津。主治:气分热盛证。壮热面赤,烦渴引饮,汗出恶热,脉洪大有力。" + }, + { + "question_num": 234, + "query": "根据《中华人民共和国医师法》的规定。全国医师资格考试办法的制定部门是", + "options": { + "A": "国务院", + "B": "国务院劳动部门", + "C": "国务院人事部门", + "D": "国务院卫生健康主管部门", + "E": "国务院教育行政部门" + }, + "answer": "D", + "reason": "全国医师资格考试办法的制定部门是国务院卫生健康主管部门。" + }, + { + "question_num": 235, + "query": "下列各组腧穴中,相距不是1寸的是", + "options": { + "A": "中极、关元", + "B": "下脘、中脘", + "C": "中脘、上脘", + "D": "内关、间使", + "E": "外卣胃腰、支沟" + }, + "answer": "B", + "reason": "下脘位于上腹部,脐中上2寸,前正中线上；中脘位于上上腹部,脐中上4寸,前正中线上,二者相上距2寸。" + }, + { + "question_num": 236, + "query": "小儿易患五迟、五软、解颅、遗尿等病，原因主要是", + "options": { + "A": "肺脏娇嫩", + "B": "脾常不足", + "C": "肾常虚", + "D": "稚阴稚阳", + "E": "纯阳之体" + }, + "answer": "C", + "reason": "小儿处于快速生长发育期,因而多见肾藏精、肾主骨、肾司生长等功能不足而导致的疾病。" + }, + { + "question_num": 237, + "query": "下列不属于硫黄主治病证的是", + "options": { + "A": "阳痿", + "B": "湿疹", + "C": "遗精滑精", + "D": "虚喘冷哮", + "E": "虚寒便秘" + }, + "answer": "C", + "reason": "硫黄主治:外用治疥癣,湿疹,阴疽疮疡;内服治阳痰,虚喘冷哮,虚寒便秘。" + }, + { + "question_num": 238, + "query": "下列各项，属医患关系基本内容的是", + "options": { + "A": "技术操作和服务态度", + "B": "技术方面和法律方面", + "C": "法律方面和伦理方面", + "D": "处理医者和患者的矛盾", + "E": "技术方面和非技术方面" + }, + "answer": "E", + "reason": "医患关系包括技术关系和非技术关系。" + }, + { + "question_num": 239, + "query": "用俞募配穴法治疗胃病应选下列哪组穴位", + "options": { + "A": "脾俞、周俞", + "B": "胃俞、太白", + "C": "胃俞、足三里", + "D": "脾俞、中脘", + "E": "胃俞、中脘" + }, + "answer": "E", + "reason": "俞募配穴方法的原则是脏病、虚证多取俞穴;腑病、实证多取募穴。胃病属于腑病,故应该选取募穴,胃经的募穴是中脘穴,故应该选用胃俞和中腕穴。" + }, + { + "question_num": 240, + "query": "小儿肺炎喘嗽痰热闭肺证的治法是", + "options": { + "A": "辛温宣肺，化痰止咳", + "B": "辛凉宣肺，清热化痰", + "C": "开肺化痰，止咳平喘", + "D": "清热涤痰，开肺定喘", + "E": "清热解毒，宣肺开闭" + }, + "answer": "D", + "reason": "痰热闭肺证的治法应为清热涤痰，开肺定喘。" + }, + { + "question_num": 241, + "query": "旋覆代赭汤中所用姜是", + "options": { + "A": "生姜", + "B": "干姜", + "C": "煨姜", + "D": "炮姜", + "E": "姜汁" + }, + "answer": "A", + "reason": "旋覆代赭汤中生姜用量独重。作用有三:增强和胃降逆止呕之力;辅助宜散水气以祛痰;制约代赭石寒凉之性。" + }, + { + "question_num": 242, + "query": "被传染病病原体污染的污水、污物、粪便，有关单位必须按照以下规定进行处理", + "options": { + "A": "在疾病预防控制机构的指导下进行消毒处理", + "B": "在卫生防疫机构的指导监督下进行抑菌处理", + "C": "在卫生防疫机构的指导下进行消毒处理", + "D": "由卫生防疫机构进行消毒处理", + "E": "由卫生防疫机构进行严密消毒处理" + }, + "answer": "A", + "reason": "《中华人民共和国传染病防治法》规定，对被传染病病原体污染的污水、污物、场所和物品，有关单位和个人必须在疾病预防控制机构的指导下或者按照其提出的卫生要求，进行严格消毒处理。" + }, + { + "question_num": 243, + "query": "治疗瘾疹的主穴是", + "options": { + "A": "曲池、合谷、血海、膈俞、三阴交", + "B": "曲池、太冲、大椎、风池、中脘", + "C": "大椎、太冲、血海、内庭、三阴交", + "D": "血海、内庭、气海、天枢、足三里", + "E": "外关、风池、大椎、膈俞、三阴交" + }, + "answer": "A", + "reason": "针灸治疗瘾疹的处方。针灸治疗瘾疹的主穴:膈俞.曲池、合谷、血海、三阴交。" + }, + { + "question_num": 244, + "query": "小儿“稚阴稚阳”学说，是指其生理状态为", + "options": { + "A": "阳常有余，阴常不足", + "B": "脏腑娇嫩，形气未充", + "C": "生机蓬勃，发育迅速", + "D": "脏气清灵，易趋健康", + "E": "脾常不足，肝常有余" + }, + "answer": "B", + "reason": "吴鞠通的“稚阴稚阳”理论,包括了机体柔嫩、气血未盛、脾胃虚弱、肾气未充、腠理疏松、神气怯弱、筋骨未坚等特点，,概括为“脏腑娇嫩，形气未充”。" + }, + { + "question_num": 245, + "query": "天王补心丹中的三参是", + "options": { + "A": "人参，沙参，玄参", + "B": "人参，丹参，玄参", + "C": "党参，沙参，玄参", + "D": "沙参，丹参，玄参", + "E": "党参，丹参，玄参" + }, + "answer": "B", + "reason": "天王补心丹的组成为人参、丹参、玄参、茯苓、、远志、当归、五味子、麦门冬、天门冬、柏子仁、酸枣仁、生地黄." + }, + { + "question_num": 246, + "query": "对流动人口中的传染病患者、疑似患者处理的原则是", + "options": { + "A": "就地控制、就地治疗、就地康复", + "B": "就地隔离、就地治疗、就地康复", + "C": "就地控制、就地观察、就地治疗", + "D": "就地隔离、就地观察、就地治疗", + "E": "就地观察、就地治疗、就地康复" + }, + "answer": "D", + "reason": "《突发公共卫生事件应急条例》规定，对传染病患者和疑似传染病患者，应当采取就地隔离、就地观察、就地治疗的措施。" + }, + { + "question_num": 247, + "query": "十二经脉中,多气多血之经是", + "options": { + "A": "足厥阴肝经", + "B": "足太阳膀胱经", + "C": "手阳明大肠经", + "D": "足少阳胆经", + "E": "手少阴心经" + }, + "answer": "C", + "reason": "手阳明大肠经经脉为多气多血之经。" + }, + { + "question_num": 248, + "query": "小儿面呈红色，证候多属", + "options": { + "A": "热", + "B": "湿", + "C": "燥", + "D": "虚", + "E": "实" + }, + "answer": "A", + "reason": "面呈红色多为热证,故选A。面星白色,多为寒证、虚证;面是黄色,多为脾虚证或湿浊;面呈青色,多为寒证、痛证、瘀证、水饮证。" + }, + { + "question_num": 249, + "query": "阴寒凝滞之胸痹，胸痛彻背，感寒痛甚，四肢厥冷。治疗应首选", + "options": { + "A": "通脉四逆汤", + "B": "黄芪桂枝五物汤", + "C": "瓜蒌薤白白酒汤", + "D": "金匮肾气丸", + "E": "瓜蒌薤白半夏汤" + }, + "answer": "C", + "reason": "诸阳受气于胸中而转行于背,寒邪内侵致使阳气不运,气机阻痹,故见胸痛彻背,感寒则痛甚;阳气不足故四肢厥冷��结合舌脉分析，本病属于阴寒凝滞,阳气不运之胸痹,故宜采用辛温通阳,开痹散寒的瓜蒌薤白白酒汤" + }, + { + "question_num": 250, + "query": "患者，女，32岁。饱餐后出现上腹部剧痛伴恶心呕吐，呕后腹痛反而加重，服解痉剂无效。检查:体温39℃。心率120次/分，腹部紧张。有压痛、反跳痛，血清淀粉酶350U/L，血钙1.63mmol/L。应首先考虑的是", + "options": { + "A": "急性心肌梗死", + "B": "溃疡性穿孔", + "C": "急性胰腺炎", + "D": "急性阑尾炎", + "E": "急性肠梗阻" + }, + "answer": "C", + "reason": "急性胰腺炎发病可以饱餐为诱因，体检有腹膜刺激征,血清淀粉酶升高,血钙降低。" + }, + { + "question_num": 251, + "query": "手三里位于阳溪穴与曲池穴连线上，曲池穴下", + "options": { + "A": "5寸", + "B": "4寸", + "C": "3寸", + "D": "2寸", + "E": "1寸" + }, + "answer": "D", + "reason": "手三里穴的定位在前臂背面桡侧，当阳溪与曲池穴连线上,肘横纹(曲池穴)下2寸。" + }, + { + "question_num": 252, + "query": "小儿疾病谱中最为多见的是", + "options": { + "A": "肺肾系病证", + "B": "心肺系病证", + "C": "肺脾系病证", + "D": "心肝系病证", + "E": "肝肾系病证" + }, + "answer": "C", + "reason": "小儿肺脏娇嫩、卫表未固,易为邪气所感，使肺系疾病成为儿科发病率最高的一类疾病。小儿“脾常不足”,其脾胃脏腑成而未全、脾胃之气全而未壮,因而易于因家长喂养不当、小儿饮食失节,出现受纳、腐熟、精微化生转输等方面的异常,使脾系疾病的发病率在儿科仅次于肺系病证而居第二位。" + }, + { + "question_num": 253, + "query": "治疗肺痈咳唾浊痰黄绿而味腥者，应首选", + "options": { + "A": "清金化痰汤", + "B": "千金苇茎汤", + "C": "加减泻白散", + "D": "定喘汤", + "E": "加味桔梗汤" + }, + "answer": "B", + "reason": "肺痈症见咳唾浊痰黄绿,味腥者,是病程已进人成痈期,其病理特点是热毒内盛，痰浊瘀热郁蒸成痈,故治疗宜清肺化瘀消痈，方应首选千金苇茎汤。" + }, + { + "question_num": 254, + "query": "患者，男，68岁。体能下降2年，加重伴活动后呼吸困难、气急1个月。体格检查:脉搏102次/分，呼吸24次/分，血压90/60mmHg，呼吸较急促，双肺底闻及细小水泡音。心界向左侧扩大，心音低钝，心率102次/分，节律规整，于胸骨右缘第2肋间闻及粗糙的收缩期杂音。心电图示左心室高电压。胸部X线示靴形心。拟诊为主动脉瓣狭窄伴心力衰竭，治疗中应慎用的药物是", + "options": { + "A": "抗心律失常药", + "B": "抗生素", + "C": "洋地黄", + "D": "血管紧张素转换酶抑制剂", + "E": "利尿剂" + }, + "answer": "E", + "reason": "主动脉瓣狭窄患者若伴有心力衰竭,应慎用利尿剂,以防发生有效循环血量不足。" + }, + { + "question_num": 255, + "query": "临床上治疗实、热、痛、瘀证首选", + "options": { + "A": "艾灸法", + "B": "耳针疗法", + "C": "头针疗法", + "D": "三梭针疗法", + "E": "皮肤针疗法" + }, + "answer": "D", + "reason": "三棱针放血疗法具有通经活络、开窍泻热、消肿止痛等作用,其适应范围较为广泛,凡各种实证、热证、瘀血和经络瘀滞、疼痛等均可应用。较常用于某些急症和慢性病。" + }, + { + "question_num": 256, + "query": "小儿指纹淡红，其证候是", + "options": { + "A": "虚寒", + "B": "食积", + "C": "痰热", + "D": "虚热", + "E": "实热" + }, + "answer": "A", + "reason": "指纹谈红,多为内有虚寒" + }, + { + "question_num": 257, + "query": "治疗咳逆阵作，面赤咽干口苦，每随情绪波动而增减者，应首选", + "options": { + "A": "清金化痰汤", + "B": "千金苇茎汤", + "C": "加减泻白散", + "D": "定喘汤", + "E": "加味桔梗汤" + }, + "answer": "C", + "reason": "咳逆阵作,面赤咽干口苦,随情绪波动而增减者,是为肝火犯肺之咳嗽,治疗宜清肺平肝，顺气降火,具有这种功能的方剂,首推加减泻白散。而A项方适用于痰热郁热之咳;D项方适于热哮;E项方适用于肺痈淡脓期,均非本病所宜。" + }, + { + "question_num": 258, + "query": "患者，男，60岁。有慢性支气管炎及肺心病病史。近1周感冒后出现咳嗽，吐黄痰，心悸气短加重，神志清，血气分析在正常范围。下列哪项治疗是错误的", + "options": { + "A": "抗感染", + "B": "止咳", + "C": "祛痰", + "D": "呼吸兴奋剂", + "E": "氨茶碱" + }, + "answer": "D", + "reason": "该患者处于急性加重期,ABCE项有助于去除诱因、增加血氧饱和度。呼吸兴奋剂适用于呼吸浅表、意识模糊而呼吸道通畅的呼衰患者，本例患者血气分析正常,无呼吸衰竭。" + }, + { + "question_num": 259, + "query": "下合穴中可治疗肠痈、痢疾的是", + "options": { + "A": "足三里", + "B": "上巨虚", + "C": "下巨盛", + "D": "委中", + "E": "阳酸泉" + }, + "answer": "B", + "reason": "A项足三里可以治疗痢疾,但是不能治疗肠痈,故排除;B项上巨虚穴既可以治疗痢疾,又可以治疗肠痈,故正确,其他选项没有治疗肠痛和痢疾的作用,故排除。" + }, + { + "question_num": 260, + "query": "不换金正气散治疗厌食的证候是", + "options": { + "A": "脾失健运证", + "B": "脾胃气虚证", + "C": "脾胃阴虚证", + "D": "脾胃阳虚证", + "E": "脾胃虚寒证" + }, + "answer": "A", + "reason": "厌食脾失健运证治法:调和脾胃,运脾开胃。代表方:不换金正气散。" + }, + { + "question_num": 261, + "query": "下列哪项不是桑菊饮的药物组成", + "options": { + "A": "杏仁", + "B": "连翘", + "C": "桔梗", + "D": "前胡", + "E": "薄荷" + }, + "answer": "D", + "reason": "采菊饮的组成:桑叶二钱五分、菊花一钱、杏仁二钱、连翘一钱五分、薄荷八分、苦桔梗二钱、生甘草八分、苇根二钱。" + }, + { + "question_num": 262, + "query": "患者，男，20岁，反复咳嗽，咯痰量多已2年。今天突然咯鲜血300ml。无发热，不消瘦。听诊:右下肺闻及小水泡音。应首先考虑的是", + "options": { + "A": "大叶性肺炎", + "B": "肺结核", + "C": "支气管扩张", + "D": "风湿性心脏病二尖瓣狭窄", + "E": "肺脓肿" + }, + "answer": "C", + "reason": "大叶性肺炎多有发热、寒战等感染表现,痰可为铁锈色痰,基本无咯血;肺结核多有低热:盗汗、消瘦等结核中毒表现;支气管扩张是指一支或多支近端支气管和中等大小支气管管壁组织破坏造成不可逆性扩张,其典型症状为慢性咳嗽伴大量脓痰和反复咯血;风湿性心脏病重度二尖瓣狭窄会导致肺水肿，咳粉红色痰;肺脓肿多有发热,咯脓臭痰。" + }, + { + "question_num": 263, + "query": "有关针灸治疗蛇串疮,叙述不正确的是", + "options": { + "A": "治以泻火解毒,清热利湿", + "B": "以局部阿是穴、夹脊为主穴", + "C": "疱疹局部阿是穴用围刺法", + "D": "对出现的疱疹不能用三棱针点刺", + "E": "后遗神经痛者可在局部用皮肤针" + }, + "answer": "D", + "reason": "蛇串疮可用刺络拔饶法:取疱疹处及周围皮肤,用三棱针刺破疱沙,使疱内液体流出,并拔火罐,令出血。" + }, + { + "question_num": 264, + "query": "下列除哪项外，均属病理性黄疸", + "options": { + "A": "生后24小时内出现", + "B": "黄疸10～14天消退", + "C": "黄疸退而复现", + "D": "黄疸持续加深", + "E": "黄疸3周后仍不消退" + }, + "answer": "B", + "reason": "新生儿黄疸分为生理性和病理性两大类。生理性黄疽大多在生后2~3天出现，4~6天达高峰,10~14天消退,早产儿持续时间较长,除有轻食欲不振外,一般无其他临床症状。若生后24小时内即出现黄疸,3周后仍不消退，甚或持续加深,或消退后复现,均为病理性黄疸" + }, + { + "question_num": 265, + "query": "生化汤除活血化瘀，止痛外，还具有的功用是", + "options": { + "A": "祛风", + "B": "温经", + "C": "行气", + "D": "疏肝", + "E": "除湿" + }, + "answer": "B", + "reason": "生化汤活血化瘀，止痛温经。主治产后瘀血腹痛,恶露不行,小腹冷痛。" + }, + { + "question_num": 266, + "query": "一患者受凉后咳嗽、高热、咳铁锈色痰，胸痛，随呼吸运动而加重，屏住呼吸时减轻。此患者在听诊时最易出现的体征为下列哪一项", + "options": { + "A": "哮鸣音", + "B": "鼾音", + "C": "胸膜摩擦音", + "D": "捻发音", + "E": "哨笛音" + }, + "answer": "C", + "reason": "胸膜摩擦音的临床意义。该例患者的疾病是典型的大叶性肺炎伴胸膜侵犯形成反应性胸膜炎(表现胸痛,与呼吸有关),因此听诊时应出现胸膜摩擦音。另外可能有中小水泡音，而不是鸣音、鼾音、捻发音和哨笛音。哮鸣音和哨笛音多见于支气痉挛,鼾音见于大气管病变,捻发音可见于老年人或长期卧床患者,一般无临床意义,病理况下见于早期肺泡的炎症、早期肺结核、初期肺淤血、肺膨胀不全等,故选C。" + }, + { + "question_num": 267, + "query": "属足太阴脾经的腧穴是", + "options": { + "A": "血海", + "B": "少海", + "C": "小海", + "D": "照海", + "E": "气海" + }, + "answer": "A", + "reason": "B项少海属于手少阴心经,为手少阴心经合穴;C项小海属手太阴小肠经,为手太阳小肠经合穴;D项照海穴属足少阴肾经;项气海穴为任脉上的穴位。只有A项血海为足太阴脾经的腧穴,故选A。" + }, + { + "question_num": 268, + "query": "可治疗风热感冒与时邪感冒的方剂是", + "options": { + "A": "银翘散", + "B": "桑菊饮", + "C": "新加香薷饮", + "D": "普济消毒饮", + "E": "杏苏散" + }, + "answer": "A", + "reason": "风热感冒证的方剂为银翘散加减，时邪感冒证的方剂为银翘散合普济消毒饮加减、故选A。新加香薷饮治疗暑邪感冒;桑菊饮、杏苏散治疗风寒咳嗽。" + }, + { + "question_num": 269, + "query": "观察舌形不包括下列哪项内容", + "options": { + "A": "胖大", + "B": "肿胀", + "C": "短缩", + "D": "舌疮", + "E": "裂纹" + }, + "answer": "C", + "reason": "舌形指舌体的形状,包括老嫩、胖想、肿胀、点刺、纹等,而知缩瓜古态,不属舌形" + }, + { + "question_num": 270, + "query": "患者，男，60岁。脑出血后长期卧床。2天前出现发热，咳嗽，呼吸困难等症状，胸透见两肺下叶有多数散在边缘不清小灶阴影。应首先考虑的是", + "options": { + "A": "大叶性肺炎", + "B": "干酪样肺炎", + "C": "间质性肺炎", + "D": "转移性肿瘤", + "E": "小叶性肺炎" + }, + "answer": "E", + "reason": "影像学上结合解剖特点将肺炎分:大叶性(肺泡性)肺炎,小叶性(支气管性)肺炎,间质性肺炎。在AD项胸片上大多为全肺改变，B项多伴低热、乏力、消瘦等结核表现。C项为间质的改变，结合本题临床和胸透,故选E。" + }, + { + "question_num": 271, + "query": "眼的耳穴部位在", + "options": { + "A": "耳垂2区", + "B": "耳垂5区", + "C": "耳垂4区", + "D": "耳垂6区", + "E": "耳垂9区" + }, + "answer": "B", + "reason": "眼的耳穴部位在耳垂正面中央部，即耳垂5区。" + }, + { + "question_num": 272, + "query": "缺铁性贫血的治疗原则是", + "options": { + "A": "健脾益气，滋生化源", + "B": "健运脾胃，益气养血", + "C": "补血养心，益气生血", + "D": "滋养肝肾，益精生血", + "E": "培补脾肾，化生气血" + }, + "answer": "E", + "reason": "由于本病以虚证为主,所以补其不足,培补脾肾,化生气血是本病的治疗原则。" + }, + { + "question_num": 273, + "query": "左归丸与一贯煎相同的功用是", + "options": { + "A": "滋阴", + "B": "疏肝", + "C": "补脾", + "D": "降火", + "E": "养血" + }, + "answer": "A", + "reason": "左归丸的功用为滋阴补肾,填精益髓。一贯煎的功用滋阴疏肝。两者皆有滋阴功效。" + }, + { + "question_num": 274, + "query": "患者，女，32岁。低热、胸闷、气促15天。查体:颈静脉怒张，心界向两侧明显扩大，坐位时呈三角形，仰卧位心底部浊音区增宽，此患者最可能的诊断是", + "options": { + "A": "急性心肌梗死", + "B": "缩窄性心包炎", + "C": "扩张型心肌病", + "D": "缺血性心肌病", + "E": "结核性心包炎伴心包积液" + }, + "answer": "E", + "reason": "心包积液的体征。该例中年女性患者的心界向两侧明显扩大，而且随体位变化而改变这是心包积液的典型体征,结合患者有低热,再加上心包积液最常见的病因是结核性心包炎,故选E,其余四种疾病均不含有随体位改变而发生心界变化的体征。" + }, + { + "question_num": 275, + "query": "提插补污法中,补法的操作手法是", + "options": { + "A": "轻插重提,幅度小,频率快", + "B": "轻插重提,幅度小,频率", + "C": "重插轻提,幅度大,频率快", + "D": "重插轻提,幅度小,频率快", + "E": "重插轻提,幅度小,频率慢" + }, + "answer": "E", + "reason": "提插补泻中先浅后深,重播轻提,幅度小,频率慢,操作时间短者为补法。" + }, + { + "question_num": 276, + "query": "病毒性心肌炎病初风热犯心证的治法为", + "options": { + "A": "清热解毒，养阴活血", + "B": "清化湿热，解毒达邪", + "C": "益气养阴，宁心安神", + "D": "温阳活血，养心通络", + "E": "豁痰活血，化瘀通络" + }, + "answer": "A", + "reason": "病毒性心肌炎病初风热犯心,灼伤营阴,心脉瘀阻,故治宜清热解毒,养阴活血。" + }, + { + "question_num": 277, + "query": "清气化痰丸的主治证候不包括", + "options": { + "A": "胸膈痞闷", + "B": "舌苔白腻", + "C": "脉象���数", + "D": "咳嗽痰黄", + "E": "小便短赤" + }, + "answer": "B", + "reason": "清气化痰丸功用:清热化痰、理气止咳。主治痰热壅肺所致的热痰咳嗽。症见咳嗽气喘咳痰黄稠,咳之不爽,胸痞闷,小便短赤,甚则气急呕恶,烦躁不宁,舌质红,苔黄腻,脉滑数。" + }, + { + "question_num": 278, + "query": "患者，男，50岁。慢性支气管炎病史5年。近2~3个月咳嗽加重，痰中持续带血，伴胸闷，气急，胸痛。X线检查见肺门阴影增大。应首先考虑的是", + "options": { + "A": "慢性支气管炎", + "B": "原发性支气管肺癌", + "C": "肺炎", + "D": "肺结核", + "E": "肺脓肿" + }, + "answer": "B", + "reason": "该患者中老年男性,有慢性支气炎病史,近期有咳、痰中带血,并有胸闷、气急、胸痛等,X线见肺门阴影增大,考虑原发性支气管肺癌可能性大,故选B。A项为肺纹理增粗、紊乱。CDE项应有发热。" + }, + { + "question_num": 279, + "query": "耳屏前，下颌骨髁状突后缘的腧穴是", + "options": { + "A": "下关", + "B": "听宫", + "C": "听会", + "D": "耳门", + "E": "颧髎" + }, + "answer": "B", + "reason": "听宫穴的定位:在面部,耳屏前,下颌骨踝状突的后方,张口时呈凹陷处。" + }, + { + "question_num": 280, + "query": "治疗鹅口疮心脾积热证，应首选", + "options": { + "A": "凉膈散", + "B": "泻黄散", + "C": "清热泻脾散", + "D": "泻心导赤散", + "E": "知柏地黄丸" + }, + "answer": "C", + "reason": "鹅口疮心脾积热证,选清热泻脾散;而虚火上浮证,选知柏地黄丸。" + }, + { + "question_num": 281, + "query": "饮食减少，体倦肢软，少气懒言，面色萎黄，大便稀溏，舌淡，脉虚。证属脾虚气陷证，方用", + "options": { + "A": "归脾汤", + "B": "参苓白术散", + "C": "四君子汤", + "D": "补中益气汤", + "E": "四物汤" + }, + "answer": "D", + "reason": "补中益气汤主治:①脾虚气陷证,饮食减少,体倦肢软,少气懒言,而色袭黄,大便稀溏,舌淡,脉虚、以及脱肛、子宫脱垂、久泻、久痢、川等:②气虚发热证、身热自汗,渴喜热伙、气短乏力,舌淡,脉虚大无力。" + }, + { + "question_num": 282, + "query": "患者，男，65岁。慢性支气管炎及高血压病史10年，近半年活动后自觉气短。检查:血压160/95mmHg(21.3/12.6kPa)，心脏听诊未闻及器质性杂音，两肺听诊无异常，心电图及X线显示左心室增大。应首先考虑的是", + "options": { + "A": "冠心病", + "B": "高血压性心脏病", + "C": "风心病", + "D": "肺心病", + "E": "病毒性心肌炎" + }, + "answer": "B", + "reason": "患者有长期高血压病病史,左心室增大，为长期后负荷增加所致，故选B。本患者亦有长期患慢性支气管炎,但肺心病常导致右心室肥大、右心衰,故排除D。" + }, + { + "question_num": 283, + "query": "治疗便秘气滞证,除选取主穴外,应加用的腧穴是", + "options": { + "A": "脾俞、胃俞", + "B": "气海、神阙", + "C": "关元、命门", + "D": "合谷、曲池", + "E": "中脘、行间" + }, + "answer": "E", + "reason": "便秘的气滞证患者应选用理气行滞的行间,便秘属于腑病,应选用其八会穴中脘。" + }, + { + "question_num": 284, + "query": "大便澄澈清冷、完谷不化的病机是", + "options": { + "A": "感受外邪", + "B": "伤于饮食", + "C": "脾胃虚弱", + "D": "脾肾阳虚", + "E": "气阴两伤" + }, + "answer": "D", + "reason": "脾肾阳虚,虚寒内生,命火不足,不能温煦脾土,所以见到大便澄澈清冷、完谷不化。" + }, + { + "question_num": 285, + "query": "下列哪项不是引起血瘀的常见因素", + "options": { + "A": "寒凝", + "B": "气滞", + "C": "气虚", + "D": "外伤", + "E": "阴虚" + }, + "answer": "E", + "reason": "外伤可致血瘀,因外伤损伤血络,血被不能正常运行，可致血瘀:寒凝可致血瘀，因寒邪凝滞,血液运行缓慢,可出现血瘀:气可致血瘀,因其推动血液运行的功能障碍,故可形成血瘀。气也可致血瘀,因气滞使血运不畅,故可引起血瘀。BCD项都是引起血瘀的常见因素，阴虚则火旺，火热则迫血妄行,多表现为出血。" + }, + { + "question_num": 286, + "query": "患者，男，50岁。肝硬化病史10年，以大量腹水3个月来诊。肝脾触诊应采用哪种方法", + "options": { + "A": "单手触诊法", + "B": "双手触诊法", + "C": "滑动触诊法", + "D": "钩指触诊法", + "E": "冲击触诊法" + }, + "answer": "E", + "reason": "腹部的触诊方法(冲击触诊法)。该例中年男性患者,有肝硬化病史,现门静脉高压而出现大量腹水,若触诊肝脾时，只能用冲击触诊法,而其他触诊法均不适于有大量腹水的患者。" + }, + { + "question_num": 287, + "query": "面瘫的恢复应加用", + "options": { + "A": "膏肓", + "B": "命门", + "C": "气海", + "D": "关元", + "E": "足三里" + }, + "answer": "E", + "reason": "面瘫的恢复期多数患者均存在身体虚弱,所以应配足三里。" + }, + { + "question_num": 288, + "query": "“疳者甘也”的含义是指", + "options": { + "A": "病证", + "B": "病位", + "C": "病情", + "D": "病因", + "E": "症状" + }, + "answer": "D", + "reason": "“疳者甘也”是指小儿恣食肥甘厚腻,损伤脾胃,形成疳证。" + }, + { + "question_num": 289, + "query": "下列各项，不属于弦脉所主的病证是", + "options": { + "A": "肝郁", + "B": "胃热", + "C": "诸痛", + "D": "痰饮", + "E": "疟疾" + }, + "answer": "B", + "reason": "弦脉主肝胆病,肝之实证、气逆于上、可出现咳晕,头痛:或为肝不足,疏泄失常,筋脉失养而见胁痛,四肢拘急。主痰伙，凡痰伙内停，症见喘淌,咳逆,胁胀痛,心悸短气者,可见弦脉。主诸痛凡脘腹痛,寒疝腹痛,痹痛等、均见弦脉。主疟疾,凡疟疾发热恋战交替,发有定时,或少阳病证等,亦见弦脉。亦主虚金医要略·呕吐吵下利病脉证治2云:“脉弦者虚也、胃气无余,食吐,变为反,寒在于上;医反下之,今脉反弦,故名曰虚。”" + }, + { + "question_num": 290, + "query": "患者，男，50岁。半年来经常突发胸骨后疼痛，有窒息感，持续1~5分钟，休息后迅速缓解。心电图示ST段下移及T波倒置。应首先考虑的是", + "options": { + "A": "稳定型劳累性心绞痛", + "B": "初发劳累性心绞痛", + "C": "恶化型劳累性心绞痛", + "D": "自发性心绞痛", + "E": "急性心肌梗死" + }, + "answer": "A", + "reason": "稳定型心绞痛指劳力型心绞痛，每次发作频率和诱因相同，疼痛性质和部位无改变，疼痛时限相仿（3～5分钟），休息或自服硝酸甘油后相同时间内产生疗效。发作时心电图可见ST段下移及T波倒置，故选A。B项定义为最近1个月内初次发生劳力型心绞痛；C项恶化型指3个月内疼痛的频率、程度、时限、诱因经常变动，进行性恶化。可发作于安静或熟睡时，ST段可压低或抬高；E项发作时疼痛时间常超过30分钟，且休息或硝酸甘油不缓解，心电图亦不符合，故排除。" + }, + { + "question_num": 291, + "query": "腕横纹中央,掌长肌腱与桡侧腕屈肌之间的穴位是", + "options": { + "A": "阳溪", + "B": "太渊", + "C": "大陵", + "D": "神门", + "E": "腕骨" + }, + "answer": "C", + "reason": "大陵穴的定位:在腕掌横纹的中点处;当掌长肌腱与桡侧腕屈肌腱之间。" + }, + { + "question_num": 292, + "query": "小儿癫痫痰痫证的治法是", + "options": { + "A": "祛风涤痰", + "B": "息风开窍", + "C": "健脾化痰", + "D": "通窍定痫", + "E": "豁痰开窍" + }, + "answer": "E", + "reason": "小儿疲痫痰痫证的治法是豁痰开窍。" + }, + { + "question_num": 293, + "query": "半夏厚朴汤中体现“治痰不理脾胃非其治也”的药物是", + "options": { + "A": "半夏", + "B": "厚朴", + "C": "茯苓", + "D": "生姜", + "E": "苏叶" + }, + "answer": "C", + "reason": "半夏厚朴汤方中半夏化痰散结、降逆和胃,是为君药。厚朴下气除满,助半夏散结降逆，是为臣药;茯苓甘淡渗湿健脾，以助半夏化痰，符合“治痰不理脾胃非其治也”之说:生姜和胃止呕，且可以制半夏游性:苏叶芳香行气,理肺舒肝,助朴行气宽胸，宜通郁结之气,共为佐药。" + }, + { + "question_num": 294, + "query": "患者，男，48岁。上腹部无规律胀痛3年余，常因饮食不当而发作，偶有反酸，嗳气。心血管检查无异常。应首先考虑的是", + "options": { + "A": "慢性胆囊炎", + "B": "心绞痛", + "C": "胃溃疡", + "D": "胃癌", + "E": "慢性胃炎" + }, + "answer": "E", + "reason": "中年患者，上腹部胀痛，与饮食有关，偶反酸嗳气，应为胃部疾病，结合病史，应为慢性胃炎，故选E。胃溃疡腹痛常有规律，为进食后痛；胆囊炎、心绞痛疼痛性质、部位与本例不符。" + }, + { + "question_num": 295, + "query": "百会穴在头正中线上，其具体位置在", + "options": { + "A": "人前发际7寸", + "B": "人前发际5寸", + "C": "人后发际6寸", + "D": "头顶旋毛中", + "E": "两耳连线上" + }, + "answer": "B", + "reason": "腧穴定位。百会:前发际正中直上5寸处,或两耳尖直上、头正中线上。" + }, + { + "question_num": 296, + "query": "慢惊风的治疗原则是", + "options": { + "A": "清热镇惊", + "B": "清热豁痰", + "C": "凉肝息风", + "D": "清心开窍", + "E": "以上都不是" + }, + "answer": "E", + "reason": "慢惊风的治疗,以补虚治本为主。土虚木旺,治以健脾平肝;脾肾阳患,治以温补脾肾;阴虚风动，治以育阴潜阳。" + }, + { + "question_num": 297, + "query": "下列哪项不是阴水证的临床表现", + "options": { + "A": "水肿先从下肢肿起", + "B": "下半身肿痛", + "C": "腰酸肢冷", + "D": "水肿皮薄光亮", + "E": "起病缓，病程长" + }, + "answer": "D", + "reason": "阴水证的临床表现为身肿,腰以下为甚,按之凹陷不易恢复,脘闷腹胀,纳呆食少,大便油稀,而色觥白,神疲肢倦,小便短少,舌淡,苔白滑,脉沉缓。或水肿日益加剧,小便不利,腰膝冷痛，四肢不温，畏寒神疲,而色白,舌淡胖,苔白滑,脉沉迟无力。D项为阳水的临床表现。" + }, + { + "question_num": 298, + "query": "患者，女，40岁。双手第2、第5近端指间关节和双腕关节肿痛3个月，双颞颌关节及颈椎疼痛1个月，伴晨僵1小时。对明确诊断最有意义的实验室检查是", + "options": { + "A": "C反应蛋白", + "B": "抗链球菌溶血素“O”", + "C": "抗环瓜氨酸肽抗体", + "D": "红细胞沉降率", + "E": "免疫球蛋白" + }, + "answer": "C", + "reason": "40岁女性患者，近端指骨间关节、腕关节肿痛，颈椎、颞颌关节也受累，有晨僵现象，依据以上临床表现考虑类风湿关节炎。类风湿因子或抗环瓜氨酸肽抗体检查对明确诊断有重要意义。" + }, + { + "question_num": 299, + "query": "下列各项,在五输穴中属“水”的是", + "options": { + "A": "少府", + "B": "大陵", + "C": "后溪", + "D": "曲泉", + "E": "经渠" + }, + "answer": "D", + "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项后溪是小肠经的输穴属木,D项曲泉是肝经的合穴属水,E项经渠是肺经的经穴属金。" + }, + { + "question_num": 300, + "query": "小儿夏季热的发病临床特征是", + "options": { + "A": "发热、不渴、口千、多汗", + "B": "发热、恶风、口苦、自汗", + "C": "发热、恶寒、身痛、无汗", + "D": "发热、口渴、多饮、汗闭", + "E": "发热、口干、烦躁、盗汗" + }, + "answer": "D", + "reason": "夏季热又称暑热症,是婴幼儿在暑天发生的特有的季节性疾病,临床以长期发热、口渴多饮、多尿、少汗或汗闭为特征。" + }, + { + "question_num": 301, + "query": "饥不欲食，与下列哪项关系最为密切", + "options": { + "A": "胃火炽盛", + "B": "胃强脾弱", + "C": "脾失健运", + "D": "胃阴不足", + "E": "胃气将绝" + }, + "answer": "D", + "reason": "饥不欲食指患者虽有饥饿的感觉但不进食,勉强进食虽亦很少的症状。胃阴不足，虚火内扰,则有饥饿感,阴虚失润,目之腐熟功能减退,故不能食。胃火炽盛多见消谷普饥;胖失健运多见纳呆;胃强脾弱表现多食易饥,大便溏泻:胃气将绝多见于久不欲食而突然欲食或暴食,称除中。" + }, + { + "question_num": 302, + "query": "患者，男，50岁。咳嗽2个月，痰中带血，不发热，抗感染治疗效果不明显。3次X线检查均显示右肺中叶炎症。应首先考虑的是", + "options": { + "A": "肺炎球菌肺炎", + "B": "肺结核", + "C": "肺脓肿", + "D": "肺癌", + "E": "支气管扩张" + }, + "answer": "D", + "reason": "A项经抗感染治疗后多好转，B项有结核中毒表现：低热、盗汗、消瘦、乏力等；C项有脓臭痰，X线检查有空洞及液气平面；D项常有吸烟史，咳嗽咯痰，痰中带血，X片的表现是由于肿瘤造成的阻塞性肺炎，一般抗感染治疗效果多不明显。E项为咳嗽咳痰，反复咯血，X片见双轨影。" + }, + { + "question_num": 303, + "query": "对机体不易产生适应,其动力作用颇强,能提高肌肉组织的兴奋性，对横纹肌有良好的刺激收缩作用。常用于治疗瘘证、瘫痪等的波是", + "options": { + "A": "密波", + "B": "疏波", + "C": "疏密波", + "D": "断续波", + "E": "连续波" + }, + "answer": "D", + "reason": "其他针法:电针。断续波型对机体不易产生适应,其动力作用颇强,能提高肌肉组织的兴奋性,对横纹肌有良好的刺激收缩作用。常用于治疗痿证、瘫痪等。" + }, + { + "question_num": 304, + "query": "患者，男，38岁。患急性子痈2天，恶寒发热，左侧睾丸肿大疼痛，疼痛引及子系（精索），舌红苔黄腻，脉滑数。证属湿热下注，气血壅滞，经络阻隔为患。治宜清热解毒，利湿消肿，应首选", + "options": { + "A": "透脓散", + "B": "滋阴除湿汤", + "C": "萆薢化毒汤", + "D": "龙胆泻肝汤", + "E": "橘核丸加减" + }, + "answer": "D", + "reason": "子痈是率丸或附舉化脓性疾病，此证湿热下注,治法为清热利湿，方用龙胆肝汤;子痈气滞痰凝证予以橘核丸加减。" + }, + { + "question_num": 305, + "query": "患者身患外感实热病证，兼见喘咳，气不能接续，甚则心悸气短，其病机是", + "options": { + "A": "实中夹虚", + "B": "虚中夹实", + "C": "真虚假实", + "D": "真实假虚", + "E": "因虚致实" + }, + "answer": "A", + "reason": "实中夹虚,是指病理变化以邪实为N由于邪热炽盛,煎灼液,形成实热伤,气阴两虚证、故除实热炽盛见症外兼见喘喝,气不能接续，甚则心悸气短等症。" + }, + { + "question_num": 306, + "query": "患者，女，30岁。发作时先觉胃部一股气体上升，并有咀嚼、吞咽动作，喃喃自语，走动，似在找东西，呼唤无反应，持续约5分钟，其癫痫的发作类型是", + "options": { + "A": "强直一阵挛性发作", + "B": "单纯部分性发作", + "C": "复杂部分性发作", + "D": "失神发作", + "E": "肌阵挛发作" + }, + "answer": "C", + "reason": "复杂部分性发作：均有意识障碍，发作时患者对外界刺激无反应，发作后不能或部分不能复述发作的细节。典型发作特征为发作起始出现错觉、幻觉、似曾相识感、恐惧、胃气上升感、心悸等症状，随后出现意识障碍、自动症和遗忘症；有时发作开始即为意识障碍，持续数分钟至数十分钟；有的仅有意识障碍。" + }, + { + "question_num": 307, + "query": "患者,女,65岁。恶寒发热,头痛鼻塞,倦怠无力,气短懒言,久病体弱,平时极易感冒,舌质淡,苔薄白,脉浮无力。宜用何方调治", + "options": { + "A": "补中益气汤", + "B": "参苏饮", + "C": "麻黄附子细辛汤", + "D": "保真汤", + "E": "玉屏风散" + }, + "answer": "B", + "reason": "感冒的辨证论治。综合症状、舌象、脉象的表现,该患者当辩证为感冒之气虚感冒证,治当以益气解表,方选参苏饮。" + }, + { + "question_num": 308, + "query": "患者，女，30岁。背部皮下肿块，无疼痛，生长缓慢，呈扁平分叶状，质软活动，界限清楚，皮色如常，与皮肤无粘连，其诊断是", + "options": { + "A": "肉瘿", + "B": "气瘿", + "C": "肉瘤", + "D": "失荣", + "E": "血瘤" + }, + "answer": "C", + "reason": "肉瘿、气瘿发于颈部,血瘤病变局部色泽鲜红或暗紫,失荣是发于颈部及耳之前后的岩肿。用排除法可选C。肉瘤多见于成年女性、可发于身体各部,好发于肩、背、腹、臀及前臂皮下。大小不一,边界清楚,皮色不变,生长缓慢,触之柔软,呈扁平团块状或分叶状,推之可移动,基底较广阔,一般无疼痛。" + }, + { + "question_num": 309, + "query": "患者，男，45岁。心烦不寐，眩晕耳鸣，健忘，腰酸梦遗，舌红少津，脉细数，其病变所在脏腑是", + "options": { + "A": "心、脾", + "B": "肺、肾", + "C": "肺、肝", + "D": "心、肾", + "E": "肝、胃" + }, + "answer": "D", + "reason": "心主神志,心烦不寐,病位在心;腰为肾府,腰酸梦遗,病位在肾,故选D。" + }, + { + "question_num": 310, + "query": "患者，男，40岁。乙肝病史10年，近2个月右上腹胀痛加重。检查:面部有蜘蛛痣，右上腹压痛。肝肋缘下3cm，质硬。ALT40U/L，HBsAg(+)，AFP500μg/L。应首先考虑的是", + "options": { + "A": "慢性乙肝活动期", + "B": "乙肝合并肝硬化", + "C": "乙肝合并胆囊炎", + "D": "原发性肝癌", + "E": "继发性肝癌" + }, + "answer": "D", + "reason": "患者有10年乙肝病史，且HBsAg（＋）；体检发现蜘蛛痣、右上腹压痛、肝大、质硬，为肝硬化表现；查AFP升高，故首先考虑为乙肝－肝硬化－原发性肝癌这三阶梯，目前已达第三阶段，故选D。HBV是我国原发性肝癌的重要致病因素之一。需要指出的是，AFP诊断肝细胞癌的标准应：AFP＞500μg/L持续4周，或＞200μg/L持续8周。" + }, + { + "question_num": 311, + "query": "患者,男,50岁。2年来心悸眩晕,胸闷痞满,渴不欲饮,小便短少,面浮肢肿,下肢为甚,舌质淡,舌体胖,苔白滑,脉沉细而滑。治疗宜首选", + "options": { + "A": "安神定志丸", + "B": "归脾汤", + "C": "桂��甘草龙骨牡蛎汤", + "D": "苓桂术甘汤", + "E": "天王补心丹" + }, + "answer": "D", + "reason": "该患者为心悸水饮凌心证,应振奋心阳,化气行水,宁心安神。代表方：苓桂术甘汤加减。" + }, + { + "question_num": 312, + "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，诊为气瘿。治疗宜首选", + "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": "该患者为气瘿肝郁气潜证。治宜疏肝解郁,化痰软坚,当用四海舒郁丸加减。" + }, + { + "question_num": 313, + "query": "患者自汗，多尿，滑精。是因气的何种作用失常所致", + "options": { + "A": "推动", + "B": "温煦", + "C": "防御", + "D": "固摄", + "E": "气化" + }, + "answer": "D", + "reason": "气的推动作用是指气对于人体的生长发育，以及脏腑经络等组织器官生理活动起推动和激发作用，排除A;气的温煦作用是指气是人体热量的来源,排除B气的防御作用是指护卫全身的肌表,防御外邪的人侵,排除C:气的固摄作用是指对于血液、波等波态物质具有防止其无故流失的作用:气的气化作用是指通过气的运动而产生的各种变化,排除E。" + }, + { + "question_num": 314, + "query": "患者，男，26岁。患伤寒，体温在39~40℃以上，持续了5天，且24小时内体温波动范围不超过1℃，考虑其热型为", + "options": { + "A": "稽留热", + "B": "间歇热", + "C": "波状热", + "D": "弛张热", + "E": "回归热" + }, + "answer": "A", + "reason": "稽留热指体温在39～40℃以上持续数天或数周，24小时内体温波动范围不超过1℃，多见于肺炎球菌性肺炎、伤寒等。" + }, + { + "question_num": 315, + "query": "患者,男,42岁。呼吸气促,喉中哮鸣有声。胸闷如室，口不渴,形寒怕冷，面色晦暗,舌苔白滑,脉弦紧。治疗应首选", + "options": { + "A": "二陈汤", + "B": "麻黄汤", + "C": "定喘汤", + "D": "射干麻黄汤", + "E": "平喘固本汤" + }, + "answer": "D", + "reason": "喉中哮鸣有声是哮病发作期,见“形寒怕冷,面色晦暗,舌苔白滑,脉弦紧\"为冷哮证,应宣肺散寒,化痰平喘,用“射干麻黄汤”,故选D。C项治疗热哮证;E项治疗虚哮证;AB项一为化痰,一为解表，可排除。" + }, + { + "question_num": 316, + "query": "患者，女，24岁。患腿痈1周，溃腐3天，脓腐稠厚且多，不易脱落。外用掺药应首选", + "options": { + "A": "青黛散", + "B": "八二丹", + "C": "红灵丹", + "D": "八宝丹", + "E": "三石散" + }, + "answer": "B", + "reason": "脓腐稠厚且多，不易脱落,病情比较严重,其他都是适用于早期比较轻的病证。" + }, + { + "question_num": 317, + "query": "患者身目发黄，黄色鲜明，胁下痞块，腹胀厌食，便溏尿黄，舌红苔黄腻，脉弦数，其证候是", + "options": { + "A": "湿热蕴脾", + "B": "大肠湿热", + "C": "肝火上炎", + "D": "肝胆湿热", + "E": "肝脾不调" + }, + "answer": "D", + "reason": "贠色鲜明提示为阳黄，胁下痞块提示病在肝胆(肝经循行在胁下)伴腹胀厌食，便洁尿黄，苔货腻提示有湿热。综上可知其证候为肝胆湿热湿热茹肿证以脾目运化功能障碍及湿热内殖表现为辨证要点。大肠湿热证以下痢或泄泻及湿热征象为辨证要点。肝火上炎证以肝经循行部位表现的实火炽盛症状为辨证要点。肝脾不调证以胸胁胀满、腹痛肠鸣、纳呆便溏为辨证依据。" + }, + { + "question_num": 318, + "query": "患者，男，40岁。20年前患乙型肝炎，3小时前突然呕吐鲜红色血液约1000ml，心悸，头晕，血压下降。查体:可见蜘蛛痣，脾大肋下2cm。最可能的诊断是", + "options": { + "A": "急性胃黏膜病变", + "B": "胃溃疡", + "C": "胆管癌", + "D": "食管静脉曲张破裂", + "E": "肠炎" + }, + "answer": "D", + "reason": "呕血是上消化道疾病（指屈氏韧带以上的消化器官，包括食管、胃、十二指肠、肝、胆、胰疾病）或全身性疾病所致的急性上消化道出血，血液经口腔呕出。该例中年男性患者突然大量呕血（表现是呕出鲜血1000ml，并出现心悸、头晕、血压下降等失血性休克表现），患者20年前患乙型肝炎，现在查体可见蜘蛛痣、脾肿大，因此容易有侧支循环形成，尽管未提到腹壁静脉曲张，但是如此大量的出血最可能还是食管静脉曲张（侧支循环形成）破裂出血，故选D，其余四种疾病均不支持。" + }, + { + "question_num": 319, + "query": "患者,男,67岁。久咳气逆,阵阵发作,痰少质黏,咳引胸胁疼痛，口千咽干,舌苔薄黄少津,脉象弦数,其治法宜用", + "options": { + "A": "养阴清肝,化痰止咳", + "B": "清肺化痰,宣肃肺气", + "C": "清肺润燥,化痰止咳", + "D": "清肺泻肝,化痰止咳", + "E": "滋阴润肺,清肝止咳" + }, + "answer": "D", + "reason": "咳嗽的辩证论治。综合患者症、舌、脉表现,辨病属咳嗽,辨证属肝火犯肺。肝气郁结化火,上逆侮肺,肺失肃降,则咳嗽气逆,阵阵发作:木火刑金,炼液成痰,故痰少质黏;火邪伤津,故口干咽干;肝脉布于两胁,上注于肺,肝肺络气不和,故咳引胸胁疼痛;舌苔薄黄少津,脉象弦数,为肝火肺热之证。咳嗽肝火犯肺证治当清肺泻肝,化痰止咳。" + }, + { + "question_num": 320, + "query": "患者，男，26岁。半小时前被热气灼伤右上肢，现局部疼痛剧烈，有散在水疱，个别破溃，基底部呈均匀红色、潮湿，其诊断是", + "options": { + "A": "面积约为9％的浅Ⅱ度烧伤", + "B": "面积约为4.5％的Ⅱ度烧伤", + "C": "面积约为9％的Ⅲ度烧伤", + "D": "面积约为9％的Ⅰ度烧伤", + "E": "面积约为2×9％的深Ⅱ度烧伤" + }, + "answer": "A", + "reason": "中国新九分法:将全身体表面积分为11个9%等份。成人头、面、颈部为9%;双上肢为2x9%;躯干前后包括外阴部为3x9%;双下肢包括部为5x9%+1%=46%。我国普遍采用三度四分法，即根据皮肤烧伤的深浅分为浅Ⅰ度、浅Ⅱ度、深Ⅱ度、Ⅲ度。浅Ⅱ度:伤及部分生发层或真皮乳头层。伤区红、肿、剧痛,出现水或表皮与真皮分离,内含血浆样黄色液体,水疱去除后创面鲜红、湿润、疼痛更剧、渗出多。如果无感染,1~2周愈合,其上皮再生依靠残留的生发层或毛囊上皮细胞，愈合后短期内可见痕迹或色素沉着,但不留瘢痕。" + }, + { + "question_num": 321, + "query": "一久痢患者用升提中气法治疗而愈，另一个脱肛患者也因升提中气法治疗而愈。此属于", + "options": { + "A": "因人制宜", + "B": "同病异治", + "C": "异病同治", + "D": "审因论治", + "E": "虚则补之" + }, + "answer": "C", + "reason": "异病同治,指几种不同的疾病,在其发展变化过程中出现了大致相同的病机，大致相同的证,故可用大致相同的治法和方药来治疗,如胃下垂、肾下垂、子宫脱垂、脱肛等不同的病变,在其发展变化过程中,可能出现大致相同的“中气下陷”的病理机制:表现为大致相同的证候，,故皆可用补益中气的方法来治疗。" + }, + { + "question_num": 322, + "query": "患者近来尿少，大便反复带有鲜血，查体:面部有蜘蛛痣，左肋缘下触及脾脏，腹部叩诊出现移动性浊音。应首先考虑的是", + "options": { + "A": "肾病综合征", + "B": "右心功能不全", + "C": "肝硬化", + "D": "慢性肾功能不全", + "E": "乙型肝炎" + }, + "answer": "C", + "reason": "AD项都伴有肾功能受损的指标升高，如BUN、Cr；B项会出现体循环淤血，表现为下肢浮肿、胸闷心慌等；E项多有皮肤黄染、食欲差、乏力等表现；蜘蛛痣是肝硬化的特殊体征，且患者左肋缘下触及脾脏，腹部叩诊出现移动性浊音，大便反复带有鲜血，说明已出现门脉高压，是肝硬化失代偿的表现。" + }, + { + "question_num": 323, + "query": "患者,男,23岁。咳嗽少痰,咽干鼻燥,兼见恶寒发热,头痛无汗,舌苔薄白,脉泘。当按何病证处理", + "options": { + "A": "风寒咳嗷", + "B": "风热咳嗽", + "C": "风燥咳嗽", + "D": "痰湿咳嗽", + "E": "阴虚咳嗽" + }, + "answer": "C", + "reason": "咳嗽的辨证论治。从恶寒发热、头痛、脉浮表现,可以判断为外感咳嗽。从痰少.咽干鼻燥之证可以判断为风燥伤肺之咳嗽。" + }, + { + "question_num": 324, + "query": "患者，男，48岁。因鼻部破损引起头额红肿。两目肿胀不能开视，伴形寒发热，舌红苔黄腻，脉滑数。治疗应首选", + "options": { + "A": "化斑解毒汤", + "B": "普济消毒饮", + "C": "龙胆泻肝汤", + "D": "五神汤", + "E": "仙方活命饮" + }, + "answer": "B", + "reason": "风热毒邪犯上,与血分热邪蕴结,郁阻肌肤,故见头面部皮肤焮红灼热，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，龙胆泻肝汤泻肝胆之火，仙方活命饮治疗痈证。" + }, + { + "question_num": 325, + "query": "患者，男，50岁。头晕无力，胃脘部坠胀不适已1年余，近1周加重。伴少气倦怠，面色萎黄，纳呆食少，食后腹胀，大���溏，舌淡苔白，脉细弱。X线检查见胃下垂。临床辨证是", + "options": { + "A": "脾阳虚证", + "B": "脾阴虚证", + "C": "脾虚气陷证", + "D": "肾气不固证", + "E": "寒湿困脾证" + }, + "answer": "C", + "reason": "X线检查见胃下垂提示为牌虚气陷证。" + }, + { + "question_num": 326, + "query": "患者，女，34岁。皮肤反复出血半年。检查:血红蛋白90g/L，血白细胞5.0X10^9/L，血小板46x10^9/L，骨髓增生活跃，颗粒型巨核细胞增多。应首先考虑的是", + "options": { + "A": "再生障碍性贫血", + "B": "急性白血病", + "C": "特发性血小板减少性紫癜", + "D": "脾功能亢进", + "E": "过敏性紫癜" + }, + "answer": "C", + "reason": "皮肤反复出血，外周血小板减少，骨髓增生活跃，颗粒型巨核细胞增多，可推断产板型巨核细胞减少，故首先诊断为特发性血小板减少性紫癜。检查结果未见红细胞及白细胞的减少，骨髓未见增生低下，故排除A。脾亢及过敏性紫癜不出现该患者的骨髓变化，故排除DE。患者病程半年，除巨细胞外其他系均正常，骨髓增生活跃而不是极度活跃，综合考虑可排除B，故选C。" + }, + { + "question_num": 327, + "query": "患者,男,72岁,因过劳而反复腰痛静卧痛减。2天前腰痛剧烈如刺，不能转侧，痛有定处，日轻夜重，痛处拒按，舌质暗红，苔薄白腻，脉弦涩。治宜首选何方加减", + "options": { + "A": "身痛逐瘀汤", + "B": "独活寄生汤", + "C": "左归丸", + "D": "肾着汤", + "E": "青蛾丸" + }, + "answer": "A", + "reason": "该患者诊断为瘀血腰痛,方选身痛逐瘀汤加减。" + }, + { + "question_num": 328, + "query": "患者，男，12岁。患流痰3年，溃口位于左腰部。脓水稀薄。夹有败絮样物，伴有午后潮热，夜间盗汗，口燥咽干，咳嗽痰血，舌红少苔。脉细数。内治应首选", + "options": { + "A": "阳和汤", + "B": "知柏地黄丸", + "C": "清骨散", + "D": "人参养荣汤", + "E": "六味地黄丸" + }, + "answer": "C", + "reason": "阴虚火旺破溃后流脓稀薄,夹有败絮样物,形成窦道;伴午后潮热,颧红,夜间盗汗,口燥咽干,属于阴虚火旺之象,治法为养阴除蒸;以上方药能养阴除蒸的只有消骨散，故选C。A项治疗阴疽，B项和E项治疗肾阴虚，D项阴阳双补。" + }, + { + "question_num": 329, + "query": "患者，男，35岁。2日来发热微恶寒，口苦，胁痛，尿短黄，大便黏臭，舌红苔薄白，脉数，其证候是", + "options": { + "A": "表里俱热", + "B": "表寒里热", + "C": "真寒假热", + "D": "真热假寒", + "E": "表热里寒" + }, + "answer": "B", + "reason": "发热微恶寒为外有表寒证,尿黄便黏臭为内有里热,舌红苔游白、脉数为表恋里热之证," + }, + { + "question_num": 330, + "query": "患者，男，35岁。高热2天，咳嗽、咳痰，伴右侧胸痛。X线检查右中肺实变阴影，其诊断是", + "options": { + "A": "急性支气管炎", + "B": "肺炎球菌肺炎", + "C": "肺炎支原体肺炎", + "D": "病毒性肺炎", + "E": "原发型肺结核" + }, + "answer": "B", + "reason": "本病例青壮年男性，发病急，发热、胸痛，咳嗽、咳痰，X线肺实变阴影，符合肺炎球菌肺炎的诊断；而急性支气管炎早期X线检查无异常；病毒、支原体引起的肺炎病情较轻，症状不重；肺结核多有先期的低热、乏力等结核中毒症状。" + }, + { + "question_num": 331, + "query": "患者干咳少痰,痰中带血,湖热盗汗胸闷隐痛，身体逐渐消瘦，口燥咽干，舌红少苔。脉细数，其诊断是", + "options": { + "A": "肺痨", + "B": "肺痿", + "C": "咳血", + "D": "虚劳", + "E": "肺胀" + }, + "answer": "A", + "reason": "肺痨是由于体质虚弱,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患。临床以咳嗽、咯血、潮热.盗汗及身体逐渐消瘦等为主要特征,故选A。肺胀以喘息气促、胸满憋塞为特征。咳血可以出现在各种肺系疾病中。虚劳指五脏六腑中多脏劳伤,气血阴明中多种因素虚损。" + }, + { + "question_num": 332, + "query": "患者，女，40岁。双乳肿胀疼痛，月经前加重，经后减轻。肿块大小不等，形态不一，伴乳头溢液，月经不调，腰酸乏力，舌淡苔白，脉弦细，其证候是", + "options": { + "A": "肝郁痰凝", + "B": "肝气郁结", + "C": "冲任失调", + "D": "肝郁火旺", + "E": "肝郁脾虚" + }, + "answer": "C", + "reason": "冲任失调,上则乳房痰浊凝结,故乳房肿块伴胀痛;下则经水逆乱，故月经周期系乱，量少色淡,甚或闭经;脾失健运,气血亏虚,故神疲乏力,头晕；冲为血海，隶属肝肾，冲任失调，肝气不舒，故经前加重,经水一行,肝气得舒,故经后缓减;肝肾不足,故腰酸乏力;舌淡、脉沉细为冲任失调之象。" + }, + { + "question_num": 333, + "query": "患者干咳，连声作呛，咽喉干痛，唇鼻干燥，痰少而黏，口干，伴身热恶寒，舌质红干而少津，苔薄黄，脉浮数，其证候是", + "options": { + "A": "风热犯肺", + "B": "燥邪犯肺", + "C": "痰热郁肺", + "D": "肝火犯肺", + "E": "肺阴亏耗" + }, + "answer": "B", + "reason": "干咳无痰,或痰少而黏,不易咳出为燥邪犯肺,津液被伤:肺不得泄润而失清肃,唇、舌、咽、鼻都见干燥而欠润为伤津化燥:气道失其活润，身热恶恋为肺为燥邪所袭;肺卫失宜，燥邪伤津则舌红，燥邪袭肺,苔多焚,脉浮数为燥热之象:" + }, + { + "question_num": 334, + "query": "患者，男，55岁。心电图:P波高尖，电压≥0.25mv，在Ⅱ、Ⅲ、aVF导联最突出，应诊断为", + "options": { + "A": "左心室肥大", + "B": "右心室肥大", + "C": "左心房肥大", + "D": "右心房肥大", + "E": "双侧心室肥大" + }, + "answer": "D", + "reason": "患者P波高尖，电压≥0.25mv，在Ⅱ、Ⅲ、aVF导联最突出，可诊断为右心房肥大。" + }, + { + "question_num": 335, + "query": "患者,女,29岁。外感后,突发呕吐,恶寒头痛,胸脘满闷,舌苔白腻,脉濡缓。治疗应首选", + "options": { + "A": "左金丸", + "B": "白虎汤", + "C": "小柴胡汤", + "D": "藿香正气散", + "E": "龙胆泻肝汤" + }, + "answer": "D", + "reason": "该患者外感后突发呕吐,并伴有恶寒头痛,胸脘满闷,苔昔白腻,脉濡缓,为外邪犯胃,中焦气滞,浊气上逆的典型表现,故诊为呕吐外邪犯胃证。治以疏邪解表,化浊和中,首选藿香正气散。" + }, + { + "question_num": 336, + "query": "患者，男，50岁。5年前腰部因疼痛，外贴膏药后皮肤出现局限性红肿，后起水疱，伴瘙痒，自行治疗后皮损结痂，有色素沉着，5年中病情反复发作，皮损肥厚干燥，有鳞屑，瘙痒剧烈，舌质淡红，苔薄，脉弦细数。治疗宜首选", + "options": { + "A": "黄连解毒汤", + "B": "凉膈散", + "C": "消风散合当归饮子", + "D": "龙胆泻肝汤", + "E": "化斑解毒汤合龙胆泻肝汤" + }, + "answer": "C", + "reason": "患者外贴膏药后出现病变,诊为接触性皮炎。病程长,反复发作,皮损肥厚干燥,有鳞屑，瘙痒剧烈，为血虚风燥证的典型表现。治宜养血润燥，祛风止痒,方选当归饮子合消风散加减。" + }, + { + "question_num": 337, + "query": "患者，男，19岁。近1年来，经常自觉腰膝酸软无力，工作紧张时则出现失眠，头晕，手足心热，时而阴强遗精，口干尿黄，舌红少津，脉细数，其证候是", + "options": { + "A": "心阴虚", + "B": "肾阴虚", + "C": "肝阴虚", + "D": "肝阳上亢", + "E": "肾气不固" + }, + "answer": "B", + "reason": "腰膝酸软无力,时而阳强进,说明病位在肾。手足心热，口干尿黄,舌红少,脉细数,说明病性为阴虚。" + }, + { + "question_num": 338, + "query": "患者，男，40岁。近年来反复发作全身强直，阵挛，昏睡，本次发作强直，阵挛持续时间达90分钟以上。应首先考虑的是", + "options": { + "A": "癔症性发作", + "B": "癫痫合并低钙血症", + "C": "急性脑出血", + "D": "急性脑栓塞", + "E": "癫痫持续状态" + }, + "answer": "E", + "reason": "癫痫持续状态是指1次发作持续时间超过30分钟，或者发作次数频繁且两次发作间歇期患者意识不恢复。" + }, + { + "question_num": 339, + "query": "患者黄疸日久,黄色晦暗如烟熏,纳少脘闷,大便溏,神疲畏寒,口淡不渴,舌淡苔腻脉沉迟。治疗应首选", + "options": { + "A": "茵陈蒿汤", + "B": "茵陈五苓散", + "C": "甘露消毒丹", + "D": "黄连温胆汤", + "E": "茵陈术附汤" + }, + "answer": "E", + "reason": "黄疸日久,损伤脾阳,脾运失司,寒湿内盛,故纳少脘闷,大便溏,神疲畏寒,口淡不渴,黄色晦暗如烟熏,证属阴黄的寒温内盛证型,治宜温化寒湿,健脾退黄,方用茵陈术附汤,故选E。茵陈蒿汤用于阳黄热重于湿。茵陈五苓散用于阳黄湿重于热。甘露消毒丹用于热毒内盛。黄连温胆汤用于痰热内蕴。" + }, + { + "question_num": 340, + "query": "患者，男，56岁。右小腿部红肿疼痛2天，大片皮色鲜红，压之褪色，扪之灼热，边界清楚，触痛明显，伴发热恶寒。治疗应首选", + "options": { + "A": "普济消毒饮加减", + "B": "黄连解毒汤加减", + "C": "萆薢渗湿汤加减", + "D": "五味消毒饮加减", + "E": "凉血地黄汤加减" + }, + "answer": "A", + "reason": "此证为丹毒,证属风热毒蕴,治法:疏风清热解毒。方用普济消毒饮加减。" + }, + { + "question_num": 341, + "query": "患者身热不扬，午后热甚，头身困重，舌红苔黄腻，脉濡数。此证之发热属于", + "options": { + "A": "阴虚潮热", + "B": "阳明潮热", + "C": "湿温潮热", + "D": "气虚发热", + "E": "阳明经热" + }, + "answer": "C", + "reason": "患者身热不扬,午后热甚,是湿遇热伏,郁蒸于内所导致:湿性黏滞,阻碍气机,气化不利，则见头身困重;舌红苔炎腻,脉数则是湿热内蕴的典型舌脉。根据晒干所述症状，湿温湖热是正确答案。" + }, + { + "question_num": 342, + "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": "肺瘤", + "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。肺脓肿咳脓痰。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": 343, + "query": "患者不易人睡,多梦易醒,心悸健忘,神疲食少。伴头晕目眩,四肢倦息，舌淡苔薄，脉细无力。治疗应首选", + "options": { + "A": "酸枣仁汤", + "B": "归脾汤", + "C": "交泰丸", + "D": "天王补心丹", + "E": "安神定志丸" + }, + "answer": "B", + "reason": "患者心脾两虚,治宜补养心脾,以气生血,用归脾汤,故选B。A项滋阴补血,但是补气不足。C项用于心肾不交。D项用于阴虚内热。E项用于心胆气虚。" + }, + { + "question_num": 344, + "query": "患者，女，19岁。半月前无意中发现颈部粗大，无异常不适。颈部呈弥漫性肿大，边缘不清，皮色不变，无触痛，并可扪及数个大小不等的结节，随吞咽动作而上下移动。具体诊断是", + "options": { + "A": "气瘿", + "B": "石瘿", + "C": "肉瘿", + "D": "瘿痈", + "E": "颈痈" + }, + "answer": "A", + "reason": "气瘿是颈前漫肿,边缘不清,皮色如常,按之柔软;肉瘿是甲状腺肿多呈球状,边界清楚,质地柔韧;瘿痈有急性发病史,甲状腺增大变硬,有压痛，常伴发热、吞咽疼痛等全身症状;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。根据症状首先排除E,根据以上症状选择A。" + }, + { + "question_num": 345, + "query": "患者急性发病，壮热，烦渴，面红目赤，尿黄，便干，舌苔黄，其病机是", + "options": { + "A": "阳盛格阴", + "B": "阳损及阴", + "C": "阳热偏盛", + "D": "阳盛伤阴", + "E": "阴盛格阳" + }, + "answer": "C", + "reason": "阳热偏盛,是指机体在疾病过程中所出现的一种阳偏盛,机能亢奋,代谢活动亢进,机体反应性增强，阳热过剩的病理状态。阳以热、动、燥为上于临床表现为壮热,烦渴,面红目赤,尿,便干,舌苔黄等症状。" + }, + { + "question_num": 346, + "query": "患者，男，58岁。腰痛，腰部活动受限。检查:脊柱叩击痛，坐骨神经刺激征(+)。应首先考虑的是", + "options": { + "A": "腰肌劳损", + "B": "脑膜炎", + "C": "蛛网膜下腔出血", + "D": "腰椎间盘突出", + "E": "肾下垂" + }, + "answer": "D", + "reason": "腰肌劳损腰部有压痛。脑膜炎、蛛网膜下腔出血有脑膜刺激征。腰椎间盘突出可以有腰痛，腰部活动受限。检查：脊柱叩击痛，坐骨神经刺激征（＋）。肾下垂腰部酸痛占92％，故选D。" + }, + { + "question_num": 347, + "query": "患者,男,42岁。呃逆频作,声音洪亮有力,冲逆而出,口臭烦渴,多喜冷饮,脘腹满闷,大便秘结,舌苔黄燥,脉滑数。治疗应首选", + "options": { + "A": "竹叶石膏汤", + "B": "橘皮竹茹汤", + "C": "凉膈散", + "D": "小承气汤", + "E": "泻心汤" + }, + "answer": "A", + "reason": "呃逆胃火上逆证证候:呃声洪亮有力,冲逆而出,口臭烦渴,多喜冷饮,脘腹满闷,大便秘结,小便短赤,苔黄燥,脉滑数。该患者临床表现符合呃逆胃火上逆证。治法:清胃泄热,降逆止呃。代表方:竹叶石膏汤加减。" + }, + { + "question_num": 348, + "query": "患者，男，30岁。肛门部有物反复脱出近10年，检查：脱出物呈圆锥状，长约7cm，上可见沟纹，其诊断是", + "options": { + "A": "混合痔", + "B": "内痔三期", + "C": "Ⅰ度直肠脱垂", + "D": "Ⅱ度直肠脱垂", + "E": "Ⅲ度直肠脱垂" + }, + "answer": "D", + "reason": "直肠脱垂临床分为3度。Ⅰ度脱垂:为直肠黏膜脱出，脱出物淡红色，长3~5cm,触之柔软,无弹性,不易出血,便后可自行还纳。Ⅱ度脱垂:为直肠全层脱出，长5~10cm,呈圆锥状,色淡红，表面为环状而有层次的黏膜皱襞,触之较厚有弹性,肛门松弛,便后有时需用手托回。Ⅲ度脱垂:首肠及部分乙状结肠脱出，长达10cm以上,色淡红,呈圆柱形,触之很厚,便后需用手托回。" + }, + { + "question_num": 349, + "query": "患者，女，30岁。每逢社交场合，精神紧张时立即出现腹部胀痛，痛则欲泻，泻后则痛止。平时食欲欠佳，两胁胀痛，睡眠、二便尚可，舌淡，脉缓。临床诊断最可能是", + "options": { + "A": "肝气郁结证", + "B": "肾气不固证", + "C": "肝气犯脾证", + "D": "寒湿困脾证", + "E": "肝气犯胃证" + }, + "answer": "C", + "reason": "每逢社交场合,精神紧张时立即出现病证,两胁胀痛,说明病位在肝。腹部胀痛，痛则欲泻,泻后则痛止,平时食欲欠佳,说明病位在,故为肝气犯脾证。" + }, + { + "question_num": 350, + "query": "患者，男，60岁。高血压病史15年，突发剧烈头痛、眩晕、恶心、呕吐、失语。查体：血压200/120mmHg，肢体只能在床上平行移动，神经反射消失，判断其肌力是", + "options": { + "A": "Ⅰ级", + "B": "Ⅱ级", + "C": "Ⅲ级", + "D": "Ⅳ级", + "E": "Ⅴ级" + }, + "answer": "B", + "reason": "肌力的分级如下。Ⅰ级：可见肌肉轻微收缩。Ⅱ级：肢体能在床上平行移动。Ⅲ级：肢体可以克服地心吸收力，能抬离床面。Ⅳ级：肢体能做对抗外界阻力的运动。Ⅴ级：肌力正常，运动自如。患者发病时血压200/120mmHg，结合发作时眩晕、失语、肢体只能在床上平行移动及神经反射消失的表现，可诊断为高血压脑病，Ⅱ级肌力。" + }, + { + "question_num": 351, + "query": "患者心烦不寐,心悸不安,头晕,耳鸣健忘,腰酸梦遗。五心烦热，口千津少。舌红，脉细数，其治法是", + "options": { + "A": "清心宁神,养阴除烦", + "B": "养阴生津,除烦宁神", + "C": "清火除烦,宁心安神", + "D": "滋阴降火,养心安神", + "E": "滋阴宁心,镇惊安神" + }, + "answer": "D", + "reason": "肾阴不足,心肾不交,心火上炎,故见心烦不寐,心悸不安,头晕,耳鸣健忘,腰酸梦遗,五心烦热,口干津少,舌红,脉细数。治宜滋阴降火,养心安神。" + }, + { + "question_num": 352, + "query": "患者，男，65岁。近8年来夜尿由2～3次渐增至4～5次，排尿踌躇，涩滞不畅，昨晚发生小便欲解不能，小腹急满胀痛，舌黯、脉细涩，直肠指诊前列腺增大约5.5cm×4.1cm×3.3cm，中央沟消失，质韧有弹性，光滑无结节。首先考虑的疾病是", + "options": { + "A": "泌尿系结核", + "B": "前列腺炎", + "C": "良性前列腺增生症", + "D": "膀胱结石", + "E": "神经源性膀胱炎" + }, + "answer": "C", + "reason": "前列腺增生临床以尿频、夜尿次数增多、排尿困难为主,严重者可出现小便不能。" + }, + { + "question_num": 353, + "query": "患者头晕目花，少气倦怠，腹部有坠胀感，脱肛，舌淡苔白，脉弱，其证候是", + "options": { + "A": "气滞", + "B": "气虚", + "C": "气陷", + "D": "气微", + "E": "气逆" + }, + "answer": "C", + "reason": "气陷指气虚无力升举,清阳之气不升而反下陷,内胜位置不能维固而下垂所表现的虚弱症候。此忠者腹部有坠胀感、脱肛\"故诊为气陷。" + }, + { + "question_num": 354, + "query": "患者，男，59岁。近两日来出现头晕，胸闷，心脏X线表现为左心室肥厚、增大，主动脉增宽、延长、迂曲，有肺淤血和肺水肿征象，考虑最可能的诊断是", + "options": { + "A": "高血压心脏病", + "B": "慢性肺源性心脏病", + "C": "风湿性心脏病", + "D": "心包积液", + "E": "以上都不是" + }, + "answer": "A", + "reason": "左心室肥厚、增大，主动脉增宽、延长、迂曲，有肺淤血和肺水肿征象，均为高血压心脏病X线的特征性表现。" + }, + { + "question_num": 355, + "query": "患者,女,32岁。气粗息涌,喉中痰鸣如吼,胸高胁胀,咳呛阵作,咳痰色黄或白,黏浊稠厚，咳吐不利，烦闷不安,汗出,面赤，口苦,口渴喜饮,不恶寒,舌红苔黄腻,脉滑数。治疗应首选", + "options": { + "A": "小青龙加石膏汤", + "B": "桑白皮汤", + "C": "清金化痰汤", + "D": "麻杏石甘汤", + "E": "定���汤" + }, + "answer": "E", + "reason": "该患者辨病属哮病发作期,因证属热哮。治宜消热宣肺,化痰定喘,方选定喘汤。" + }, + { + "question_num": 356, + "query": "患者，女，49岁。月经或前或后，烘热出汗，五心烦热，头晕耳鸣，腰酸乏力，舌红苔薄，脉细数。治疗应首选", + "options": { + "A": "左归丸合二至丸", + "B": "内补丸", + "C": "肾气丸", + "D": "两地汤合二至丸", + "E": "二仙汤合二至丸" + }, + "answer": "A", + "reason": "肾阴虚亏,冲任失调,血海蓄溢失常,故经行前后无定期;肾阴不足,则髓海失养,故头晕耳鸣;腰为肾之府,肾主骨,肾虚失养,则腰酸乏力;阴虚精血耗伤,烘热出汗,五心烦热;舌红苔薄,脉细数，为肾阴虚之症状。综上可诊断为绝经前后诸证之肾阴虚证,治疗应选用左归丸合二至丸加味。" + }, + { + "question_num": 357, + "query": "患者，男，50岁。自觉两目模糊，视物不清，伴有头痛，眩晕，舌红少苔，脉细弦。治疗应首选", + "options": { + "A": "升麻", + "B": "葛根", + "C": "薄荷", + "D": "柴胡", + "E": "菊花" + }, + "answer": "E", + "reason": "忠者“两目模糊,视物不清,伴有头痛,眩晕”,是因肝阳上亢,上扰头目。治宜平肝潜阳清肝明目。而E项菊花疏散风热,平抑肝阳,清肝明目，消热解毒。常用于,①风热感冒,温病初起:②肝阳眩晕,肝风实证:③目赤昏花:④疮痛肿毒,故选E。而升麻发表透疹,清热解毒,升举阳气。葛根解肌退热,透发麻疹,生津止潟,升阳止泻。薄荷疏散风热,清利头目,利透疹,疏肝行气。柴胡疏散退热,疏肝解郁,升阳举陷。" + }, + { + "question_num": 358, + "query": "患者咳嗽。查体：右侧呼吸动度减弱，右下肺叩诊出现浊音。听诊可闻及支气管呼吸音。应首先考虑的是", + "options": { + "A": "右下肺不张", + "B": "右下肺实变", + "C": "右侧胸腔积液", + "D": "右侧气胸", + "E": "肺气肿" + }, + "answer": "B", + "reason": "右下肺受肝脏影响叩诊稍浊，如在正常肺泡呼吸音部位听到支气管呼吸音，即为异常支气管呼吸者，或称管状呼吸音。常见于肺组织实变、肺内大空腔、压迫性肺不张。" + }, + { + "question_num": 359, + "query": "患者胸部膨满,痰多胸闷,心烦口苦舌苔黄腻,脉滑数。治疗应首选", + "options": { + "A": "越婢加半夏汤", + "B": "导痰汤", + "C": "六磨汤", + "D": "胃苓汤", + "E": "二陈汤" + }, + "answer": "A", + "reason": "本题患者胸部膨满,胸闷痰多,为肺胀的典型临床表现,心烦口苦为肝经痰热:舌苔黄腻，脉滑数,为湿热之征。治疗应当清热化痰,用越婢加半夏汤或桑白皮汤。导痰汤用于痰涎变盛,胸膈痞塞,或咳嗽恶心,饮食少思,排除B;六磨汤用于气泄腹急,大便秘涩,排除C;胃苓汤用于脾虚湿胜,致成黄疸,或大便泄泻,小便短少,不烦不渴,排除D,二陈汤用于湿痰证,咳嗽痰多,色白易咯,恶心呕吐,排除E。黄连温胆汤清化痰热。" + }, + { + "question_num": 360, + "query": "患者，男，43岁。左大腿内侧发现肿物10年，不疼痛，活动正常。检查：局部皮下可及1个15cm×10cm×5cm大小的肿物，质地软，表面光滑，无压痛及缩小，推之可移。应首选的治疗措施是", + "options": { + "A": "内治法", + "B": "外治法", + "C": "手术法", + "D": "针刺法", + "E": "神灯照" + }, + "answer": "C", + "reason": "肉瘤常见于成年人,好发于肩、颈、背、肩胛间、臀部、前臂等处。肿块多为单个,少数患者为多发,大小不一,呈扁平团块状,或分叶状,瘤体质地柔软似棉,外观肿形似馒,用力可以压扁,推之可以移动,与皮肤无粘连,瘤体表面皮肤如常,亦无疼痛。生长缓慢,长到一定程度后可自行停止生长而固定不变，故可判断为肉瘤,其他瘤一般会发生皮肤变化。对单发肉瘤小的可以不处理,但有明显增大趋势,或伴有疼痛,或瘤体较大者,宜行手术切除。" + }, + { + "question_num": 361, + "query": "患者小便短数，灼热刺痛，尿色黄赤，舌苔黄腻，脉数。治疗应选用", + "options": { + "A": "大蓟", + "B": "地榆", + "C": "槐花", + "D": "白茅根", + "E": "侧柏叶" + }, + "answer": "D", + "reason": "白茅根凉血止血,清热利尿,有利水消肿、利尿通淋、利湿退黄的功效。" + }, + { + "question_num": 362, + "query": "患者，男，60岁。反复咳嗽、咯痰10年。近3年每当秋冬发病，天气变暖后逐渐减轻。检查：两肺闻及散在干啰音。X线显示肺纹理增多，其诊断是", + "options": { + "A": "肺结核", + "B": "肺癌", + "C": "支气管扩张", + "D": "���气管哮喘", + "E": "慢性支气管炎" + }, + "answer": "E", + "reason": "干啰音是气流通过狭窄或部分阻塞的气道所发出的声音。病理基础为气道黏膜充血水肿、分泌物增加、平滑肌痉挛、管腔内异物、肿瘤、肉芽肿以及管壁外淋巴结或肿瘤压迫等。干啰音在吸气相与呼气相都能听到，但呼气相尤为明显，持续时间较长，声音响度和性质容易改变，部位也易变换。低音调的干啰音称为鼾音，如同熟睡中的鼾声，多发生于气管或主支气管。高音调的干啰音起源于较小的支气管或细支气管，类似于鸟叫、飞箭或哨笛音，通常称为哮鸣音。" + }, + { + "question_num": 363, + "query": "患者,女,45岁。因淋雨后突发小便频急短数,刺痛灼热,尿色黄赤,口苦,舌苔黄腻。脉濡数。治疗应首选", + "options": { + "A": "八正散", + "B": "小蓟饮子", + "C": "导赤散", + "D": "石韦散", + "E": "茜根散" + }, + "answer": "A", + "reason": "淋雨后正邪相争,突发热淋表现为小便频急短数,刺痛灼热,尿色黄赤,寒热相争故口苦，证属湿热实证。治宜消热利湿通淋。用八正散。选A。小蓟饮子用于血淋实证。导赤散用于心火亢盛。石韦散用于石淋。茜根散用于阴虚火旺的血证。" + }, + { + "question_num": 364, + "query": "患者，女，25岁，右乳肿块2年，初起肿块如花生粒大小，逐渐增大，近期伴乳房坠胀疼痛，胸闷叹息，烦躁易怒，月经不调，查右乳外侧肿块呈圆形，直径约4cm，质韧硬，表面光滑，推之活动，无压痛，乳头及腋下未见异常。苔薄，脉弦滑，其中，诊断及方药应为", + "options": { + "A": "乳癖，逍遥蒌贝散加减", + "B": "乳漏，六味地黄汤合清骨汤加减", + "C": "粉刺性乳痈，柴胡清肝汤", + "D": "乳痨，开郁散合消疬丸加减", + "E": "乳核，逍遥散合桃红四物汤加减" + }, + "answer": "E", + "reason": "该患者为乳核血瘀痰凝证。治法:疏肝活血，化痰散结。代表方:逍遥散合桃红四物汤加减。" + }, + { + "question_num": 365, + "query": "患者经期小腹胀痛拒按，胸胁乳房胀痛，经行不畅。月经色紫暗，有块。舌质紫暗，脉弦。治疗应选用", + "options": { + "A": "肉桂", + "B": "艾叶", + "C": "牡丹皮", + "D": "川芎", + "E": "青皮" + }, + "answer": "D", + "reason": "本题所述病证为血瘀经行不畅,此五个选项中,川芎为妇科要药,善治血气滞痛证,涵血调经，其余选项均无调经之功效。" + }, + { + "question_num": 366, + "query": "患者，女，45岁，因患乳腺癌在3个月前行乳腺癌根治术，术中曾输血800ml，在最近追踪检查过程中发现血清ALT150U/L，进一步查肝炎病毒感染标志物发现抗HBs阳性，丙肝抗体阳性，丁肝和戊肝抗体均阴性。该病例最可能的诊断是", + "options": { + "A": "手术后谷丙转氨酶升高", + "B": "脂肪肝", + "C": "输血后丙型肝炎", + "D": "转移性肝癌", + "E": "输血后病毒性肝炎，乙、丙肝病毒重叠感染" + }, + "answer": "C", + "reason": "根据题干可知患者3个月前乳腺癌手术输过血，现追踪检查HAVAb阳性，表明患者曾经被HAV感染，对HAV已产生免疫力，目前体内已无HAV。HAVAbIgG是一种保护性抗体，能中和HAV的感染性。HAVAbIgG可以长期存在，甚至终生能检出。抗HBs阳性说明患者曾患过乙肝，现在已经有抗体或已注射过乙肝疫苗。HCVAb阳性，说明患者感染HCV，且血清ALT150U/L，升高，所以可能患有输血后丙型肝炎。" + }, + { + "question_num": 367, + "query": "患者,女,27岁。低热3个月,时觉身热心烦,热势随情绪好坏而起伏,平时急躁易怒,胸肋胀闷,两乳作胀,月经不调,口苦,脉弦略数。治宜选用", + "options": { + "A": "龙胆泻肝汤", + "B": "柴苓温胆汤", + "C": "丹栀逍遥丸", + "D": "滋水清肝饮", + "E": "血府逐瘀汤" + }, + "answer": "C", + "reason": "内伤发热之肝郁发热的治疗。据其主症、舌肪分析,此为内伤发热之肝郁发热。是由气郁化火所致,治疗当首选丹栀逍遥丸以疏肝解郁,清肝泄热。" + }, + { + "question_num": 368, + "query": "患者，女，36岁。两大腿内侧患有钱币形红斑2枚，自觉瘙痒。边界清楚，中央有自愈趋向，多在夏季加重，其诊断是", + "options": { + "A": "紫白癜风", + "B": "圆癣", + "C": "多形性红斑", + "D": "牛皮癣", + "E": "肥疮" + }, + "answer": "B", + "reason": "圆癣,相当于西医的体癣。皮损呈圆形,或多环形,类似钱币状,为边界清楚、中心消退、外周扩张的斑块。四周可有针头大小的红色丘疹及水疱、鳞屑、结痂��，故选B。紫白癫风，相当于西医的花斑癣，俗称汗斑。牛皮癣,皮损好发于颈项、四肢伸侧、尾骶部。肥疮,相当于西医的黄癣。" + }, + { + "question_num": 369, + "query": "患者，女，50岁。体弱多病，形体消瘦，气短乏力，纳食不香，头晕心慌，面色苍白，时暖气，腹胀，经查诊断为胃下垂。应选用哪一类药物", + "options": { + "A": "味辛，升浮药", + "B": "味甘，沉降药", + "C": "味甘，升浮药", + "D": "味酸，沉降药", + "E": "味苦，沉降药" + }, + "answer": "C", + "reason": "甘:能补、能缓、能和,即有补益、缓急止痛、调和药性、和中的作用,该证属于虚证,故用材缓以补之。升浮之药能上行,提升气机,该病诊断为胃下垂,故用升浮之药以升阳举陷,故选C。" + }, + { + "question_num": 370, + "query": "患者，男，24岁。2周前患扁桃体炎，近日心悸气短，发热，出汗，疲乏，踝、膝关节游走性疼痛。查体：第一心音减弱，上肢内侧皮肤有环形红斑。应首先考虑的是", + "options": { + "A": "类风湿关节炎", + "B": "病毒性心肌炎", + "C": "心包炎", + "D": "风湿热", + "E": "特发性血小板减少性紫癜" + }, + "answer": "D", + "reason": "类风湿关节炎的临床表现主要是晨僵、关节痛、关节肿，故选D。" + }, + { + "question_num": 371, + "query": "患者,男,60岁。头痛头晕,耳鸣目眩,视物不清近2周。CT检查发现颅内占位。近日出现呕吐,面红目赤,失眠健忘,肢体麻木，咽干，大便干燥,舌质红,苔黄,脉弦。诊断是", + "options": { + "A": "脑瘤痰瘀阻窍证", + "B": "脑瘤风毒上扰证", + "C": "脑瘤阴虚风动证", + "D": "痫病痰火扰神证", + "E": "痫病风痰闭阻证" + }, + "answer": "B", + "reason": "患者颅内占位,为脑瘤。头痛头晕，耳鸣目眩,视物不消,呕吐,面红目赤,失眠健忘,肢体麻木,咽干,大便干燥,舌红苔黄,脉弦为风毒上扰证，故选B。" + }, + { + "question_num": 372, + "query": "某男，左足怕冷、疼痛、间歇性跛行1年余。1个多月来足痛转为持续性静止痛，夜间痛剧，不能入睡，足背动脉搏动消失。应诊断为", + "options": { + "A": "痹证", + "B": "脱疽", + "C": "糖尿病坏疽", + "D": "闭塞性动脉硬化症", + "E": "雷诺病（肢端动脉痉挛症）" + }, + "answer": "B", + "reason": "脱疽临床初期表现为四肢发凉，怕冷,间歇性跛行,继则以疼痛剧烈，足背动脉搏动消失为特征。" + }, + { + "question_num": 373, + "query": "患者，男，89岁。久病卧床，近日来冷汗自出，四肢厥逆，面色苍白，舌淡苔白，脉微欲绝。用药宜首选", + "options": { + "A": "肉桂，桂枝", + "B": "干姜，高良姜", + "C": "附子，干姜", + "D": "细辛，小茴香", + "E": "吴茱萸，丁香" + }, + "answer": "C", + "reason": "附子能上助心阳、中温牌阳、下补肾阳,为“回阳救逆第一品药”。用于久病体虚,阳气衰微,阴寒内盛,或大汗、大吐、大泻所致的亡阳证,多与干姜、甘草配伍。此为亡阳证,故选C." + }, + { + "question_num": 374, + "query": "患者，女，30岁。因进食海鲜后，四肢出现出血点，对称分布。检查：血象脆性嗜酸粒细胞偏高，骨髓象正常，毛细血管脆性试验阳性。应首先考虑的是", + "options": { + "A": "过敏性紫癜", + "B": "败血症", + "C": "急性粒细胞白血病", + "D": "急性型原发性血小板减少性紫癜", + "E": "慢性型原发性血小板减少性紫癜" + }, + "answer": "A", + "reason": "发作诱因为进食海鲜，可作为过敏原，四肢出现对称分布的出血点，检查示嗜酸粒细胞偏高，骨髓象正常，毛细血管脆性试验阳性，故选A。败血症常见于感染后，可见血象中性粒细胞或淋巴细胞增高，而嗜酸性粒细胞偏高，故B项不正确。检查骨髓象正常，故CDE项均不正确。" + }, + { + "question_num": 375, + "query": "患者呃声洪亮,冲逆而出,口臭烦渴喜冷饮,小便短赤,大便秘结,舌苔黄,脉滑数,其治法是", + "options": { + "A": "清胃化痰止呃", + "B": "清热化湿降逆", + "C": "清热化瘀止呃", + "D": "清胃平肝降逆", + "E": "清降泄热止呃" + }, + "answer": "E", + "reason": "阳明热盛,骨火上冲,故见呃声洪亮,冲逆而出,热灼伤津故见口臭烦渴喜冷饮,小便短赤,大便秘结,舌苔黄,脉滑数。治宜清热泻火,降逆止呃。选E。痰热内扰选A。湿热用B。瘀热内结用C，肝火犯胃用D。" + }, + { + "question_num": 376, + "query": "患者，女，21岁。手背部有5～6枚表面光滑的扁平丘疹，如针头到米粒大，呈淡褐色，���有瘙痒感，其诊断是", + "options": { + "A": "传染性软疣", + "B": "寻常疣", + "C": "掌跖疣", + "D": "丝状疣", + "E": "扁平疣" + }, + "answer": "E", + "reason": "扁瘊相当于西医的扁平疣,皮损为表面光滑的扁平丘疹,芝麻至黄豆大小,淡红色、褐色或正常皮肤颜色,数目较多,散在分布,或簇集成群,亦可互相融合,可因搔抓使皮损呈线状排列。丝状疣，皮损为单个细软的丝状突起，呈褐色或淡红色，可自行脱落,不久又可长出新的皮损。一般无自觉症状。跖疣，皮损初起为小的发亮丘疹,渐增大，表面粗糙角化，灰黄或污灰色,圆形,中央稍凹,周围绕以增厚的角质环。有明显的压痛,用手挤压则疼痛加剧。传染性软疣，皮损初起为米粒大的半球状丘疹，渐增至绿豆大，中央呈脐窝状凹陷,表面有蜡样光泽。寻常疣,初起为一个针尖至绿豆大的疣状赘生物，呈半球形或多角形，突出表面,色是灰白或污黄,表面蓬松枯槁,状如花蕊,粗糙而坚硬。" + }, + { + "question_num": 377, + "query": "患者胸部刺痛，固定不移，入夜更甚，时或心悸不宁，舌质紫暗，脉沉涩。治疗宜选用", + "options": { + "A": "艾叶", + "B": "白及", + "C": "三七", + "D": "槐花", + "E": "小蓟" + }, + "answer": "C", + "reason": "艾叶温经止血、散寒调经、安胎;白及收敛止血、消肿生肌;三七化瘵止血、活血定痛:槐花凉血止血、清肝泻火;小蓟凉血止血、散察解毒消痈,本题所述症状“舌质紫暗,脉沉涩\"提示有血察证,宜用活血止血药三七。" + }, + { + "question_num": 378, + "query": "患者，女，37岁。月经量多，皮肤散在出血点，血象：血红蛋白120g/L，白细胞8×10⁹/L，中性粒细胞0.7，淋巴细胞0.3，血小板50×10⁹/L，骨髓片巨核细胞增多。应首先考虑的是", + "options": { + "A": "特发性血小板减少性紫癜", + "B": "急性淋巴细胞性白血病", + "C": "缺铁性贫血", + "D": "过敏性紫癜", + "E": "再生障碍性贫血" + }, + "answer": "A", + "reason": "A项是一种免疫性综合病征。特点是血循环中存在抗血小板抗体，使血小板破坏过多，引起紫癜；而骨髓中巨核细胞正常或增多，幼稚化。临床表现主要为皮肤、黏膜出血，故选A。B项白细胞数明显增加，且以淋巴细胞为主；CE项都有血红蛋白的降低；D项是一种较常见的微血管变态反应性出血性疾病。表现为皮肤瘀点，多出现于下肢关节周围及臀部。" + }, + { + "question_num": 379, + "query": "患者,男,56岁。身热已退而见肢体软弱无力,肌肉瘦削,口干、咽千较甚,小便黄赤,大便干燥,舌质红,苔黄,脉细数。治疗应首选", + "options": { + "A": "清燥救肺汤", + "B": "玉女煎", + "C": "胃苓汤", + "D": "益胃汤", + "E": "桑杏汤" + }, + "answer": "A", + "reason": "萎证之肺热津伤证证候:发病急,病起发热,或热后突然出现肢体软弱无力,可较快发生肌肉瘦削,皮肤干燥,心烦口渴,咳呛少痰,咽干不利,小便黄赤或热痛,大便干蝇,舌质红,苔黄,脉细数。证机概要:肺燥伤津,五脏失润,筋脉失养。治法:清热润燥,养阴生津。代表方:清燥救肺汤加减。" + }, + { + "question_num": 380, + "query": "患者，男，73岁。左下肢内臁疮，面积5cm×5cm，现疮面仍有少许腐肉。外治应首选", + "options": { + "A": "红油膏、九一丹", + "B": "白玉膏、生肌散", + "C": "金黄膏、九一丹", + "D": "金黄膏掺桃花散", + "E": "青黛膏、九一丹" + }, + "answer": "A", + "reason": "腋疮有腐肉,可应用红油膏、九一丹外敷。长出肉芽,用白玉膏、生肌散外敷。疮面周围有湿疮者改用青黛膏。" + }, + { + "question_num": 381, + "query": "患者自幼患有痢证，近期发作较频，并见心神不安，失眠，健忘，舌淡白，脉滑。治疗应选用", + "options": { + "A": "竹茹", + "B": "茯苓", + "C": "琥珀", + "D": "合欢皮", + "E": "远志" + }, + "answer": "E", + "reason": "远志的功效:安神益智,祛痰开窍、消散痈肿。用于惊悸,失眠健忘,亦用于痰阻心窍,痛惊狂。" + }, + { + "question_num": 382, + "query": "甲亢患者，给予甲巯咪唑20mg，一日3次，在家中治疗。半月后应到医院复查", + "options": { + "A": "心率、心律", + "B": "心电图", + "C": "甲状腺大小", + "D": "白细胞计数", + "E": "突眼程度" + }, + "answer": "D", + "reason": "甲巯咪唑治疗甲状腺功能亢进症的重要副作用为粒细胞减少，往往发生突然且为致命性。可见于初始用药2～3个月之内或减量过程中，故选D。" + }, + { + "question_num": 383, + "query": "患者便血紫黯,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。治疗应首选", + "options": { + "A": "当归补血汤", + "B": "归脾汤", + "C": "黄土汤", + "D": "无比山药丸", + "E": "黄芪建中汤" + }, + "answer": "C", + "reason": "腹部隐痛,喜热饮,面色不华,神倦懒言,便溏,舌质淡,脉细为脾胃虚寒之证,治宜健肿温中,养血止血,方用黄土汤。" + }, + { + "question_num": 384, + "query": "患者，女，30岁。已婚3年不孕，月经2～3个月一行，头晕耳鸣，腰酸腿软，畏寒肢冷，性欲淡漠，舌淡苔白，脉沉细而迟。治疗应首选", + "options": { + "A": "大补元煎", + "B": "固阴煎", + "C": "补肾固冲丸", + "D": "毓麟珠", + "E": "温胞饮" + }, + "answer": "E", + "reason": "患者主症为已婚3年不孕。“头晕耳鸣,腰酸腿软,畏寒肢冷,性欲谈漠,舌淡苔白,脉沉细而迟”--肾阳虚。此证乃不孕症之肾阳虚证,代表方为温胞饮。" + }, + { + "question_num": 385, + "query": "患者，男，53岁。症见：滑精，食欲不振，纳谷不香，脘腹胀满。治疗应首选", + "options": { + "A": "五味子", + "B": "桑螵蛸", + "C": "鸡内金", + "D": "山楂", + "E": "龙骨" + }, + "answer": "C", + "reason": "鸡内金的功效:消食健胃,涩精止遗。主治:饮食积滞,小儿疳积;肾虚遗精、遗尿:砂石淋证,胆结石。" + }, + { + "question_num": 386, + "query": "患者，男，60岁。反复咳嗽，咳痰10年，近3年每当秋冬发病，天气变暖后逐渐减轻。检查：两肺闻及散在干啰音。X线显示肺纹理增多，其诊断是", + "options": { + "A": "肺结核", + "B": "肺癌", + "C": "支气管扩张", + "D": "支气管哮喘", + "E": "慢性支气管炎" + }, + "answer": "E", + "reason": "患者咳嗽、咳痰，秋冬季发病，再结合X线片表现可诊断为慢性支气管炎。" + }, + { + "question_num": 387, + "query": "患者,女,60岁。多饮、多食、多尿数年,现以善饥烦渴、口千舌燥为主。治疗应配用", + "options": { + "A": "太渊、少府", + "B": "太渊、少府", + "C": "复溜、太冲", + "D": "内庭、地机", + "E": "曲池、合谷" + }, + "answer": "D", + "reason": "根据题干证状诊断:消咳之胃热津伤证。针灸治疗:胃热津伤配内庭、地机。" + }, + { + "question_num": 388, + "query": "某患者，屡孕屡堕，腰膝酸软，甚则腰痛如折，头晕耳鸣，畏寒肢冷，小便清长，大便溏薄。舌淡苔薄而润，脉沉迟。治疗选方", + "options": { + "A": "肾气丸去泽泻加菟丝子、杜仲、白术", + "B": "补肾固冲丸", + "C": "安奠二天汤", + "D": "毓麟珠", + "E": "泰山磐石散" + }, + "answer": "A", + "reason": "先天禀赋不足,肾阳亏虚,命门火衰,冲任不温,胞宫虚寒,胎元不固,则屡孕屡堕。腰为将之府,肾阳虚则腰酸膝软。肾阳不足，阳气不达四末,故畏寒肢冷。气血不能上荣于清窍,故头晕耳鸣。膀胱气化失司则小便清长。肾阳不能温煦脾土，脾失健运则大便溏薄,故本患者为滑胎肾阳亏虚证。治疗应温补肾阳,固冲安胎。方用肾气丸去泽泻加丝子、杜仲、白术。" + }, + { + "question_num": 389, + "query": "患者，女，58岁。因暑天乘凉饮冷。出现恶寒发热。头痛脘痞，恶心，呕吐频作，食少泄泻，舌苔腻脉滑。治疗应首选", + "options": { + "A": "黄连", + "B": "藿香", + "C": "生姜", + "D": "竹茹", + "E": "紫苏" + }, + "answer": "B", + "reason": "患者“骑天乘凉饮冷”为感受寒湿,暑湿之邪,其后出现“恶心,呕吐\"可知寒湿、著湿之邪侵犯中焦牌胃，治宜化湿、止呕、解著,故香为最佳选项。黄连清热燥湿,泻火解毒。生姜解表散寒,温中止呕,温肺止咳,解毒。竹茹清热化痰,除烦止呕,凉血止血。紫苏降气化痰,止咳平喘,涧肠通便。" + }, + { + "question_num": 390, + "query": "患者，男，45岁。肥胖体形，无症状，健康查体时发现尿糖阳性。空腹血糖稍高，葡萄糖耐量降低，其诊断是", + "options": { + "A": "2型糖尿病", + "B": "1型糖尿病", + "C": "糖尿病酮症酸中毒", + "D": "肾炎", + "E": "肾病" + }, + "answer": "A", + "reason": "1型糖尿病多发生于青少年，其胰岛素分泌缺乏，必须依赖胰岛素治疗维持生命。2型糖尿病多见于30岁以后中、老年人，其胰岛素的分泌量并不低甚至还偏高，病因主要是机体对胰岛素不敏感（即胰岛素抵抗）。C项是糖尿病的一种急性并发症，是血糖急剧升高引起的酮症酸中毒。DE项尿检查有尿蛋白。" + }, + { + "question_num": 391, + "query": "患者,男,45岁。自觉心慌。时息时作,健忘失眠。治疗应首选", + "options": { + "A": "三阴交", + "B": "神门", + "C": "足三里", + "D": "太溪", + "E": "合谷" + }, + "answer": "B", + "reason": "神门穴的主治要点为心痛,心烦、健忘失眠、惊悸怔仲、痴呆、瘾狂、疙证、目黄胁痛,华中热.呕血、吐血、头痛、眩晕、失声等病证,且神门是治疗健忘失眠的要穴。" + }, + { + "question_num": 392, + "query": "患者，女，22岁，未婚。月经2～3月一行，量少色淡，质清稀，时有小腹冷痛，喜热喜按。伴有面色少华，小便清长。便溏，腰酸乏力，四肢欠温。舌淡，苔薄白，脉沉迟无力。治疗应首选", + "options": { + "A": "八珍益母丸", + "B": "十全大补丸", + "C": "艾附暖宫丸", + "D": "大补元煎", + "E": "肾气丸" + }, + "answer": "C", + "reason": "由题干月经2~3月一行,辨病为月经后期，由时有小腹冷痛,喜热喜按。伴有面色少华:小便清长,便溏,腰酸乏力,四肢欠温,舌淡,苔薄白,脉沉迟无力。辨证为虚寒证,故方选艾附暖宫丸。" + }, + { + "question_num": 393, + "query": "患者，男，45岁，胸闷，咳嗽，咳吐痰涎，色白清稀，鼻塞流涕。用药首选", + "options": { + "A": "归肺经", + "B": "归心经", + "C": "归肝经", + "D": "归膀胱经", + "E": "归脾经" + }, + "answer": "A", + "reason": "解表药是指以发散表邪、解除表证为主要作用的药物,本类药物辛散轻扬,主人肺、膀胱经,可发汗解表,部分药兼有利尿退肿、止咳平,透疹、止痛、消疮的作用。本类药物主要用于外感表证，部分药物还可用于水肿、咳喘、麻疹、风湿痹痛、疮疡初起等证而兼有表证者。" + }, + { + "question_num": 394, + "query": "王某1997年于中医药大学毕业分配到市级中医院工作，并于1998年取得了中医师执业资格。《中华人民共和国执业医师法》施行当年，其依照有关开办医疗机构的规定申请个体开业。依据《中华人民共和国执业医师法》的规定，卫生行政部门应", + "options": { + "A": "批准其个体行医资格申请", + "B": "要求其应具备主治医师资格", + "C": "要求其参加国家临床中医专业技术资格考试", + "D": "要求其能保证个体行医质量，才能予以受理申请", + "E": "要求其经执业医师注册后在医疗机构中执业满5年" + }, + "answer": "E", + "reason": "《中华人民共和国医师法》规定：执业医师个体行医，须经注册后在医疗卫生机构中执业满五年；但是，依照本法第十一条第二款规定取得中医医师资格的人员，按照考核内容进行执业注册后，即可在注册的执业范围内个体行医。" + }, + { + "question_num": 395, + "query": "患者,男,23岁。右前臂内侧有红丝一条。向上走窜，停于肘部。用砭镰疗法的操作要点是", + "options": { + "A": "沿红线两头,针刺出血", + "B": "梅花针沿红线打刺,微微出血", + "C": "用三棱针沿红线寸寸挑断,并微微出血", + "D": "用三棱针点刺出血", + "E": "梅花针沿红线打刺,微微出血,并加神灯照法" + }, + "answer": "C", + "reason": "三棱针的用法:此患者属于红丝疔，应该用三棱针挑刺,使之微徽出血。" + }, + { + "question_num": 396, + "query": "患者，女，29岁，已婚。近半年来月经后期量少现已停经4个月，伴五心烦热，潮热颧红，舌红少苔，脉细数。尿妊娠试验阴性，其治法是", + "options": { + "A": "养阴清热调经", + "B": "理气活血通经", + "C": "豁痰活血通经", + "D": "益气养血调经", + "E": "补肾养肝调经" + }, + "answer": "A", + "reason": "由题千五心烦热,潮热颧红,舌红少苔,脉细数辨证为阴虚有热,故治以养阴清热调经。" + }, + { + "question_num": 397, + "query": "患者，女，26岁，已婚。产后受寒，瘀血内阻，恶露不行，小腹冷痛。治疗应首选", + "options": { + "A": "生化汤", + "B": "复元活血汤", + "C": "四物汤", + "D": "桃核承气汤", + "E": "血府逐瘀汤" + }, + "answer": "A", + "reason": "该患者有瘀血,有寒痛,故应选择活血化察、散寒止痛的方剂，生化汤活血化,温经止痛,故选A。" + }, + { + "question_num": 398, + "query": "某药店经营者为贪图利益而销售超过有效期的药品。结果造成患者服用后死亡的特别严重后果，依据《中华人民共和国刑法》。给经营者的刑罚是", + "options": { + "A": "处3年以下有期徒刑或拘役，并处或单处罚金", + "B": "处3年以上7年以下有期徒刑，并处或单处罚金", + "C": "处3年以上10年��下有期徒刑，并处或单处罚金", + "D": "处10年以上20年以下有期徒刑，并处或单处罚金", + "E": "处10年以上有期徒刑或无期徒刑，并处罚金" + }, + "answer": "E", + "reason": "销售超过有效期的药品，结果造成患者服用后死亡的特别严重后果，依据《中华人民共和国刑法》，给经营者的刑罚处10年以上有期徒刑或无期徒刑，并处罚金。" + }, + { + "question_num": 399, + "query": "患儿，女,10岁。阵发性右上腹绞痛。伴恶心呕吐,腹部平软。用特定穴治疗，应首选", + "options": { + "A": "原穴", + "B": "络穴", + "C": "背俞穴", + "D": "八会穴", + "E": "下合穴" + }, + "answer": "E", + "reason": "治疗六腑病证均可选用各相应的下合穴。此患者所患疾病应与腑病相关,故应选用下合穴。" + }, + { + "question_num": 400, + "query": "患者，女，27岁，已婚。经来量多，周期23天，经期7天，妇科检查示子宫前位，如鸡蛋大小，质中。双侧附件（一）。应首先考虑的是", + "options": { + "A": "血崩", + "B": "经乱", + "C": "月经先期", + "D": "癥瘕出血", + "E": "月经过多" + }, + "answer": "E", + "reason": "月经过多的定义是月经量较正常明显增多,而周期基本正常。由题干经来量多,周期23天,经期7天,妇科检査无异常可判断为月经过多。" + }, + { + "question_num": 401, + "query": "太阳病，发汗未愈，风寒入里化热，身热不解，汗出而喘，舌苔薄白，脉滑数者。治疗应选用", + "options": { + "A": "泻白散", + "B": "葛根黄芩黄连汤", + "C": "麻黄杏仁甘草石膏汤", + "D": "桂枝加厚朴杏子汤", + "E": "小青龙加石膏汤" + }, + "answer": "C", + "reason": "太阳病,发汗未愈,症见身热不解汗出而喘,脉滑数而不恶风寒者,是表寒已解,入里化热,热壅迫肺所致。治当清宣肺热为主。麻黄杏仁甘草石膏汤辛凉宣泄,清肺平喘,与该证颇合,故选C。" + }, + { + "question_num": 402, + "query": "医师王某，2010年5月前在某县医院工作，后借调到县团委工作，2012年6月回县医院工作，王某应当经所在地的县级以上卫生健康主管部门委托的机构或者组织考核合格，并依法申请办理", + "options": { + "A": "准予注册手续", + "B": "中止注册手续", + "C": "注销注册手续", + "D": "变更注册手续", + "E": "重新注册手续" + }, + "answer": "E", + "reason": "中止医师执业活动2年以上应当由县级以上人民政府卫生健康主管部门或者其委托的医疗卫生机构、行业组织考核合格，并依照规定重新注册。" + }, + { + "question_num": 403, + "query": "患儿,女,8岁。遗尿3个月余,每隔3~5夜1次,面色萎黄,纳食不多,舌淡苔薄,脉细弱。治疗应首选", + "options": { + "A": "中极、关元、三阴交、膀胱俞", + "B": "中极、天枢、足三里、阴陵泉、大冲", + "C": "关元、太溪、三阴交、至阴", + "D": "气海、太冲、行间、昆仑、曲池", + "E": "曲骨、内庭、太溪、肾俞、气海" + }, + "answer": "A", + "reason": "根据患者主症,诊断为遗尿,遗尿治疗主穴:关元、中极、膀胱俞、三阴交、关元充益肾气，固摄下元。" + }, + { + "question_num": 404, + "query": "患者，女，32岁，已婚。现停经45天，尿妊娠试验阳性。2小时前因与爱人吵架出现左下腹撕裂样剧痛，伴肛门坠胀，面色苍白。体格检查：血压80/50mmHg，左下腹压痛、反跳痛明显，有移动性浊音，阴道有少量出血。应首先考虑的是", + "options": { + "A": "小产", + "B": "堕胎", + "C": "胎动不安", + "D": "异位妊娠", + "E": "妊娠腹痛" + }, + "answer": "D", + "reason": "由题干现停经45天,尿妊娠试验阳性,确定妊娠;出现左下腹撕裂样剧痛,伴肛门坠胀:面色苍白,符合异位妊娠的临床表现;体格检查为血压80/50mmHg,左下腹压痛、反跳痛明显,有移动性浊音,阴道有少量出血,也符合异位妊娠的体征,故考虑异位妊娠。" + }, + { + "question_num": 405, + "query": "患者，症见头痛发热，烦渴欲饮，水入即吐，小便不利，苔白，脉浮者。治宜选用", + "options": { + "A": "五苓散", + "B": "猪苓汤", + "C": "苓桂术甘汤", + "D": "藿香正气散", + "E": "以上均不适宜" + }, + "answer": "A", + "reason": "五苓散的功用,利水渗湿,温阳化气。主泊:膀胱气化不利之蓄水证。症见小便不利，头痛微热,烦渴欲饮,甚则水人即吐;或脐下动悸,吐涎沫而头目眩晕;或短气而咳;或水肿、泄泻;舌苔白,脉浮。" + }, + { + "question_num": 406, + "query": "患者，男，67岁。知识分子，医生以肺部肿物待查收入院。住院后确诊为肺癌，但尚未告诉患者和家属。而患者告诉医生自己无儿无女，仅与66岁的老伴相依为命，如果是肺癌，不要将病情告诉自己的老伴，以免她冠心病发作；如果动手术，可以自己签字。医生此时怎样做在道德上最佳", + "options": { + "A": "对患者家属保密，而对患者不保密", + "B": "对患者本人不保密，但如何告知家属由患者决定", + "C": "对患者和家属都保密", + "D": "对患者和家属都不保密", + "E": "对患者家属不保密，而对患者保密" + }, + "answer": "B", + "reason": "此医生在道德上最佳的做法是应尊重患者知情选择权。" + }, + { + "question_num": 407, + "query": "患者,男,45岁。关节肌肉疼痛,屈伸不利,疼痛较剧,痛有定处,遇寒痛增,得热痛减。局部皮色不红,触之不热,舌苔薄白,脉弦紧。治疗除选用阿是穴、局部经穴外，还应选用的穴位是", + "options": { + "A": "肾俞、关元", + "B": "阴陵泉、足三里", + "C": "大椎、曲池", + "D": "膈俞、关元", + "E": "膈俞、血海" + }, + "answer": "A", + "reason": "由本患者的症状可以判断本患者属于痹证之痛痹,治疗应用肾俞穴和关元穴。痛痹的病因是寒盛,取肾俞穴、关元穴,益火之源,振奋阳气而祛寒邪。" + }, + { + "question_num": 408, + "query": "患者，女，38岁，已婚。近半年来，月经23～25天一行。量少、色红、质稠，持续12～14天，咽干，潮热，舌红少苔，脉细数。应首先考虑的是", + "options": { + "A": "经期延长", + "B": "月经先期", + "C": "月经量少", + "D": "漏下", + "E": "绝经前后诸证" + }, + "answer": "A", + "reason": "经期延长的定义是月经周期基本正常,行经时间超过7天以上,甚或淋漓半月方净者。由题干近半年来月经23~25天一行,持续12~14天，可知周期正常,经期延长。" + }, + { + "question_num": 409, + "query": "湿温时疫之症见：发热倦怠，胸闷腹满，肢酸咽肿，身目发黄，颐肿口渴，小便短赤，舌淡苔白厚腻。治宜选用", + "options": { + "A": "三仁汤", + "B": "藿香正气散", + "C": "甘露消毒丹", + "D": "茵陈蒿汤", + "E": "清瘟败毒饮" + }, + "answer": "C", + "reason": "甘露消毒丹主治证。甘露消毒丹功能利湿化浊，主治湿温时疫,邪在气分，湿热并重症见发热倦怠,胸闷腹满,肢酸明肿,身目发黄,颐肿口渴,小便短赤,舌淡苔白厚腻。" + }, + { + "question_num": 410, + "query": "患者胸骨下部显著前突，左、右胸廓塌陷。肋骨与肋软骨交界处变厚增大，上下相连呈串珠状，其诊断是", + "options": { + "A": "肺结核", + "B": "佝偻病", + "C": "肺气肿", + "D": "支气管哮喘", + "E": "肺纤维化" + }, + "answer": "B", + "reason": "佝偻病胸：多见于儿童，由佝偻病所致。沿胸骨两侧各肋软骨与肋骨交界处常隆起，形成串珠状。" + }, + { + "question_num": 411, + "query": "患者,男,25岁。因夜吹风扇,晨起出现右颈项痛,转动受限，并向同侧肩部放射。针灸治疗除外劳宫、肩井、后溪、悬钟、阿是穴外，宜选取", + "options": { + "A": "血海、俞、肩髃", + "B": "合谷、曲池、大椎", + "C": "风池、内关、肩髃", + "D": "风池、合谷、肩髃", + "E": "风池、合谷、天宗" + }, + "answer": "D", + "reason": "患者为风寒袭络之落枕,除主穴外,还应配风池、合谷疏风散寒止痛,配肩髃治疗肩痛。" + }, + { + "question_num": 412, + "query": "患儿，10岁。昨天受凉后，见喷嚏、鼻塞、流清涕。今晨起喘咳，咳痰稠黄，口渴欲饮，大便干燥。查体：鼻扇，口周紫绀，咽红，双肺满布哮鸣音，舌质红，苔薄白，脉滑数，其证候是", + "options": { + "A": "寒性哮喘", + "B": "热性哮喘", + "C": "外寒内热", + "D": "肺实肾虚", + "E": "肺肾阴虚" + }, + "answer": "C", + "reason": "本证之外寒多由外感风寒所致,其内热常因外邪入热邪殖积，被外邪引动而诱发。临床辨证以外有风寒之表证,内有痰热之里证为要点。" + }, + { + "question_num": 413, + "query": "患者，男，60岁。呛咳少痰，气短自汗，口干舌燥，苔薄少津，脉虚数，证属久咳肺虚，气阴两伤。治疗应首选", + "options": { + "A": "天王补心丹", + "B": "四物汤", + "C": "酸枣仁汤", + "D": "生脉散", + "E": "朱砂安神丸" + }, + "answer": "D", + "reason": "生脉散益气生津、敛阴止汗,用于温热、暑热、耗气伤阴证;或久咳肺虚,气阴两虚证。主症可见“汗多神疲,体倦乏力,气短懒言,咽干口沟,舌干红��苔,脉虚数”。" + }, + { + "question_num": 414, + "query": "患者，男，46岁。有胃癌家族史，本人因胃部不适行胃镜检查，结果显示：幽门螺杆菌(Hp)相关性慢性胃窦炎伴重度肠上皮化生和活动性炎。对此患者最好的处理为", + "options": { + "A": "定期胃镜复查", + "B": "定期X线造影复查", + "C": "根除Hp治疗", + "D": "手术切除胃，预防胃癌", + "E": "黏膜保护剂治疗" + }, + "answer": "C", + "reason": "慢性胃炎的治疗。对Hp感染引起的慢性胃炎，特别是有活动性者及重度肠上皮化生，或存在胃癌家族史，应给予根除Hp治疗。" + }, + { + "question_num": 415, + "query": "患者,男,55岁。1年来每日黎明之前腹微痛,痛即泄泻。或肠鸣而不痛，腹部和下肢畏寒,舌淡苔白,脉沉细。治疗除取主穴外，还应加", + "options": { + "A": "胃俞、合谷", + "B": "肝俞、内关", + "C": "三焦俞、公孙", + "D": "命门、关元", + "E": "关元俞、三阴交" + }, + "answer": "D", + "reason": "由本患者的症状可知本病为泄泻之肾虚泄泻,故治疗上要配肾俞穴、命门、.关元等补肾虚的腧穴。" + }, + { + "question_num": 416, + "query": "患儿，6岁。发热3天，口腔内黏膜、齿龈溃烂，周围焮红。疼痛拒食，舌质红、苔薄黄，其诊断是", + "options": { + "A": "感冒", + "B": "口糜", + "C": "心疳", + "D": "燕口疮", + "E": "鹅口疮" + }, + "answer": "B", + "reason": "满口糜烂,色红作痛者,称为口糜;口疮发于口唇两侧者,称为燕口疮。" + }, + { + "question_num": 417, + "query": "患者脐腹疼痛，按之坚硬有块，大便不通，偶排出少许稀水，色青秽臭，口干舌燥，脉滑实。治宜选用", + "options": { + "A": "大柴胡汤", + "B": "大承气汤", + "C": "大建中汤", + "D": "葛根芩连汤", + "E": "以上都不适宜" + }, + "answer": "B", + "reason": "大承气汤的应用很广泛,主治证候复杂。在一般方剂著作中常总结为3大类:一是痞满燥实的阳明腑实征象,这组证候以股痛、腹胀、大便千结等为特征,是大承气汤的主要治疗指征:二是热结旁流证,以本题的表现为主,看似有腹泻,实是有热结,此条容易忽视:三是其他相关疾病,如痉证、狂证等有阳明腑实证者。" + }, + { + "question_num": 418, + "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。最可能的诊断是", + "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。患者突发上腹部剧痛、迅速发生全腹急性腹膜炎、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": 419, + "query": "患者,女,45岁。失眠2年,经常多梦少寐，人睡迟,易惊醒,平常遇事惊怕,多疑普感。气短头晕,舌淡，脉弦细。治疗除取主穴外,还应加", + "options": { + "A": "心俞、厥阴俞、脾俞", + "B": "心俞、肾俞、太溪、足三里", + "C": "心俞、胆俞、大陵、丘墟", + "D": "肝俞、间使、太冲", + "E": "脾俞、胃俞、足三里" + }, + "answer": "C", + "reason": "由本患者的症状可知本病为不寐之心胆气虚证。应选用心俞、胆俞、大陵、丘墟等腧穴宁心安神,补益心气。" + }, + { + "question_num": 420, + "query": "患者，女，28岁，已婚。每于经行小腹冷痛。得热痛减，月经量少，持续2～3天，色暗、质稀。腰腿酸软，舌淡苔白，脉沉细尺弱，其治法是", + "options": { + "A": "散寒除湿止痛", + "B": "温经暖宫止痛", + "C": "行气活血止痛", + "D": "利湿活血止痛", + "E": "益肾养肝止痛" + }, + "answer": "B", + "reason": "由题干每于经行小腹冷痛,辨病是痛经,由得热痛减，月经量少，持续2~3天,色暗、质稀,腰腿酸软,舌淡苔白,脉沉细尺弱,辨证为寒凝血瘀证，故治法是温经暖宫止痛。" + }, + { + "question_num": 421, + "query": "患者心胸中大寒痛，呕不能食，腹中寒，上冲皮起，见有头足，上下痛而不可触及，舌苔白滑，脉沉弦紧。治疗应首选", + "options": { + "A": "四逆汤", + "B": "当归四逆汤", + "C": "四逆散", + "D": "右归丸", + "E": "大建中汤" + }, + "answer": "E", + "reason": "大建中汤有补虚缓急,散寒痛之功用,主治虚寒腹痛。" + }, + { + "question_num": 422, + "query": "��者腹部膨隆呈球形。转动体位时形状改变不明显。应首先考虑的是", + "options": { + "A": "肝硬化", + "B": "右心功能不全", + "C": "缩窄性心包炎", + "D": "肾病综合征", + "E": "肠麻痹" + }, + "answer": "E", + "reason": "腹内积气：胃肠道内大量积气可致腹内积气，此时其形状无明显改变，可见于各种原因所致的肠梗阻或肠麻痹。" + }, + { + "question_num": 423, + "query": "患者，女，43岁。眩晕半年，加重1周。伴神疲乏力,面色晓白,时有心悸,夜寐欠安。舌淡,脉细。治疗应首选", + "options": { + "A": "风池、肝俞、肾俞、行间", + "B": "中脘、内关、解溪、头维", + "C": "百会、上星、风池、丰隆", + "D": "百会、太阳、印堂、合谷", + "E": "脾俞、足三里、气海、百会" + }, + "answer": "E", + "reason": "由本上患者的症状可知本病为眩晕之气血虚弱证。应首选百会、足三里、脾俞.胃俞、气海等腧穴调理脾胃、补益气血。" + }, + { + "question_num": 424, + "query": "下列哪项对阴痒的描述是正确的", + "options": { + "A": "妇女外阴及阴道瘙痒，甚则波及肛门周围，痒痛难忍，坐卧不宁，并伴有带下增多者，称为“阴痒”", + "B": "妇女外阴及阴道瘙痒，甚则波及肛门周围，痒痛难忍，坐卧不宁，或伴有带下增多者，称为“阴痒”", + "C": "阴痒多见于实证", + "D": "阴痒多见于虚证", + "E": "阴痒肝肾阴虚型用龙胆泻肝汤" + }, + "answer": "B", + "reason": "阴痒的定义。A项错在并伴有带下增多者,带下增多不是阴痒必须有的症状。CD项描述不严谨,生育期多实证,绝经期多虚证。E项阴痒肝肾阴虚型用知柏地黄汤。" + }, + { + "question_num": 425, + "query": "患者，女，58岁。心悸胸闷已2年，近日心悸加剧，且胸部闷痛，人夜加重，伴畏寒肢冷，舌淡胖，苔白滑，脉沉弦迟。临床诊断最可能是", + "options": { + "A": "心气虚证", + "B": "心阳虚证", + "C": "心脉痹阻证", + "D": "气虚血瘀证", + "E": "肾阳虚证" + }, + "answer": "B", + "reason": "心悸胸闷,其病位在心。畏寒肢冷,舌谈胖,苔白滑,脉沉弦迟,说明病性为用虚。综合为心阳虚证。" + }, + { + "question_num": 426, + "query": "患儿近日常感无力，精神萎靡，食欲不佳，并诉右上腹隐痛。检查：面色黄，肝于肋缘下3cm可触及，有压痛。实验室检查：尿胆红素(+)，尿胆原(+)。应首先考虑的是", + "options": { + "A": "蚕豆病", + "B": "胃炎", + "C": "胆道蛔虫症", + "D": "急性病毒性肝炎", + "E": "胆结石" + }, + "answer": "D", + "reason": "蚕豆病是由于遗传因素和食用蚕豆所引起的，而患者并无食用蚕豆史，并且肝脏发生肿大也不符合，所以排除，而胃炎不会引起黄疸，所以排除，而CE项都是与胆道梗阻有关，而发生胆道梗阻不会是隐痛，会发生剧烈的疼痛，可以排除，故选D。" + }, + { + "question_num": 427, + "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、足太阳经", + "D": "手、足厥阴经", + "E": "手、足阳明经" + }, + "answer": "E", + "reason": "由本患者的症状可知本病为中风，因风病多犯阳明,阳明为多气多血之经,阳明经气血通畅,正气得以扶助,使机体功能逐渐恢复,根据经脉循行路线,分别选取手足阳明经穴位,以达调和经脉,疏通气血的作用。" + }, + { + "question_num": 428, + "query": "患者，女，26岁，已婚。月经35天行，量少、色淡、质稀，每于行经出现大便泄泻，腰酸畏寒，四肢不温。带下清稀如水，舌淡苔白，脉沉迟，其证候是", + "options": { + "A": "脾虚", + "B": "肾虚", + "C": "湿热", + "D": "寒湿", + "E": "肝木乘脾" + }, + "answer": "B", + "reason": "从题于每于行经出现大便泄泻，辨病为经行泄泻，由腰酸畏寒，四肢不温,带下清稀如水，舌淡苔白,脉沉迟，辨证为肾虚证，" + }, + { + "question_num": 429, + "query": "肠痈初起患者，右少腹疼痛拒按，右足屈而不伸，伸则痛甚，时时发热，身汗恶寒，舌苔黄腻。治疗应首选", + "options": { + "A": "仙方活命饮", + "B": "大黄牡丹汤", + "C": "普济消毒饮", + "D": "阳和汤", + "E": "黄连解毒汤" + }, + "answer": "B", + "reason": "大黄牡丹汤由大黄涤荡肠胃,泻肠中湿热察结之毒:芒硝软坚散结,助大黄促其速下;桃仁、牡丹皮凉血、破血祛察,冬瓜子清肠中湿热,排脓消���。综观全方,是由苦寒泻下、清热除湿、活血化瘀三类组成,使其湿热、癌结从泻下驱除,气血凝滞的结聚经破血面痈肿消散。" + }, + { + "question_num": 430, + "query": "患者，男，52岁。突发脑出血，现症见头痛，呕吐，昏迷。查体：血压200/120mmHg。应迅速采取的治疗是", + "options": { + "A": "止血", + "B": "降血压", + "C": "降颅压", + "D": "维持生命体征", + "E": "防止血管痉挛" + }, + "answer": "C", + "reason": "脑出血急性期应首先降颅压，升高的血压可随颅压降低而下降。此时不能用降压药使血压降至正常水平状态。止血、维持生命体征、防止血管痉挛为次要处理方案。" + }, + { + "question_num": 431, + "query": "患者,男,45岁。大便秘结不通,排便艰难,伴腹胀痛,身热,口千口臭,喜冷饮,舌红,苔黄,脉滑数。治疗除取主穴外,还应选用的穴位是", + "options": { + "A": "足三里、三阴交", + "B": "中脘、太冲", + "C": "神阙、关元", + "D": "合谷、内庭", + "E": "气海、脾俞" + }, + "answer": "D", + "reason": "由本患者的症状可知本病为便秘之实证,故治疗应清热理气.通导肠腑,故应选用内庭和合谷穴,内庭万骨经荥穴,宜散肠胃积热,合谷穴亦可以清热。" + }, + { + "question_num": 432, + "query": "患者，女，51岁。月经不规律，精神萎靡，头晕耳鸣，腰痛如折，腹冷阴坠，形寒肢冷，舌淡苔白滑，脉沉细而迟，其治法是", + "options": { + "A": "滋肾益阴", + "B": "滋阴潜阳", + "C": "益肾清肝", + "D": "补肾扶阳，益养冲任", + "E": "温肾壮阳，填精养血" + }, + "answer": "E", + "reason": "由题干51岁,月经不规律,辨病为绝经前后诸证;由精神袭靡,头晕耳鸣,腰痛如折,腹冷阴坠,形寒肢冷,舌淡苔白滑,脉沉细而迟,辨证为肾阳虚证。因为肾阳虚，命门火衰,阳气不能外达,经脉失于温煦,故精神萎靡,头晕耳鸣,腰痛如折,腹冷阴坠，形寒肢冷;舌淡苔白滑,脉沉细而迟皆肾阳虚衰之象。治法是温肾壮阳,填精养血。" + }, + { + "question_num": 433, + "query": "患者身热，微恶风，汗少，肢体酸重，头昏重胀痛，咳嗽痰黏。鼻流浊涕，心烦，口渴，舌苔薄黄而腻，脉濡数。治疗应首选", + "options": { + "A": "银翘散", + "B": "桑菊饮", + "C": "新加香薷饮", + "D": "桑白皮汤", + "E": "藿香正气散" + }, + "answer": "C", + "reason": "湿伤表,表卫不和,故身热,微恶风,汗少,阻滞气机则肢体酸重,头昏重胀痛,犯肺则咳嗽痰黏,鼻流浊涕,暑热内扰则心烦,口渴,舌苔薄黄面腻,脉数。治疗应首选清暑祛湿解表的新加香。" + }, + { + "question_num": 434, + "query": "患者，男，50岁。既往体健，查体时发现肝右季肋下2cm处质硬、无压痛，脾可触及，ALT正常范围，肝穿刺病理有假小叶形成。应诊断为", + "options": { + "A": "慢性活动性肝炎", + "B": "慢性持续性肝炎", + "C": "代偿期肝硬化", + "D": "肝淤血", + "E": "多囊肝" + }, + "answer": "C", + "reason": "肝硬化的诊断。此患者肝脾肿大，有蜘蛛痣，因而不是慢性活动性或持续性肝炎，因无肝淤血和多囊肝的表现，因而不符合肝淤血和多囊肝，故诊断为肝硬化。" + }, + { + "question_num": 435, + "query": "患者,女,41岁。精神抑郁善忧,情绪不宁,伴胸胁胀满,脘闷嗳气。不思饮食,大便不调,脉弦。治疗除取主穴外,还应选用的穴位是", + "options": { + "A": "曲泉、膻中、期门", + "B": "行间、侠溪、外关", + "C": "通里、心俞、三阴交、太溪", + "D": "太溪、三阴交、肝俞、肾俞", + "E": "心俞、脾俞、足三里、三阴交" + }, + "answer": "E", + "reason": "由本患者的症状可知本病为抑郁证。抑郁从心而得,故选用心俞以宁心安神;又其不思饮食,故选用脾俞,调理脾胃;三阴交可以调整其心肾不交之证,足三里促进身体的恢复。" + }, + { + "question_num": 436, + "query": "患者，女，20岁，未婚。月事非时而下，量多如崩，色鲜，质稠，伴心烦，口渴欲饮，便干溲黄，面部痤疮，舌红苔薄黄，脉细数。根据治崩三法，应首选的是", + "options": { + "A": "塞流", + "B": "澄源", + "C": "复旧", + "D": "调经为本", + "E": "塞流、澄源并进" + }, + "answer": "E", + "reason": "由题干是多如崩,色鲜,质稠,伴心烦,口渴欲饮,便干溲黄,面部痤疮，舌红苔黄,脉细数,辨证为实热证,故应澄源。又量多如崩,故应塞流。" + }, + { + "question_num": 437, + "query": "患者大便时溏时泻，水谷不化，稍进油腻之物，则大便次数增多，食少，脘��胀闷，面黄，肢倦乏力，舌淡苔白，脉细弱。治疗应首选", + "options": { + "A": "四君子汤", + "B": "大建中汤", + "C": "参苓白术散", + "D": "小建中汤", + "E": "补气运脾汤" + }, + "answer": "C", + "reason": "泄泻有虚实之分,此为牌胃虚弱导致的泄泻,应用“参苓白术散”健脾益气,化湿止泻AE项健牌益气,止泻力弱:B项治疗中阳衰弱,阴寒内盛之脘腹剧痛证:D项治疗中脏虚寒之腹痛。" + }, + { + "question_num": 438, + "query": "患者突感胸闷、心前区痛，心电图显示室间隔前部心肌梗死。营养患处的动脉来自", + "options": { + "A": "左冠状动脉旋支", + "B": "右冠状动脉右旋支", + "C": "右冠状动脉后室间支", + "D": "冠状动脉前室间支", + "E": "右冠状动脉窦房结支" + }, + "answer": "D", + "reason": "前室间支是左冠状动脉主干的延续，沿前室间沟下行，绕过心尖切迹达后室间沟下部，与后室间支相吻合。前室间支分布于左心室前壁、部分右心室前壁和室间隔的前2/3部，如前室间支发生阻塞，则引起前壁心肌和室间隔前部心肌梗死。" + }, + { + "question_num": 439, + "query": "患者,女,23岁。痛经9个月,经行不畅。小腹胀痛,拒按,经色紫红,夹有血块，血块下后痛即缓解,脉沉涩。治疗应首选", + "options": { + "A": "足三里、太冲、三阴交", + "B": "中极、次髎、地机", + "C": "合谷、三阴交", + "D": "曲池、内庭", + "E": "合谷、归来" + }, + "answer": "B", + "reason": "由本患者的症状可知本病为实证。应选用散寒逐瘀,通经止痛的中极、次髎、地机。中极为任脉经穴,可通调冲任脉之气,散寒行气;次髎为治疗痛经之经验穴；地机为脾经郄穴，阴经的郗穴有止痛的功效，因此可疏调脾经经气而止痛。三穴合用，以达通经散寒、温经止痛之功效。" + }, + { + "question_num": 440, + "query": "患者，女，51岁，已婚。阴部干涩，灼热瘙痒，带下量少色黄，五心烦热，烘热汗出。口干不欲饮，舌红少苔，脉细数无力，其治法是", + "options": { + "A": "清热利湿，杀虫止痒", + "B": "清肝利湿，杀虫止痒", + "C": "滋肾降火，调补肝肾", + "D": "滋肾养阴，除湿止带", + "E": "养阴清热，燥湿止痒" + }, + "answer": "C", + "reason": "由题干阴部干涩,灼热瘙痒,辨病为阴痒;由阴部干涩,灼热瘙痒,带下最少色黄,五心烦热,烘热汗出,口干不欲饮,舌红少苔,脉细数无力,辨证为肝肾阴虚证。治法是滋肾降火,调补肝肾。" + }, + { + "question_num": 441, + "query": "患者，女，46岁。口渴，小便频数，下半身常有冷感，腰痛脚软，舌淡胖苔薄白，脉沉弦。治疗应选用", + "options": { + "A": "清燥救肺汤", + "B": "麦门冬汤", + "C": "玉液汤", + "D": "肾气丸", + "E": "左归丸" + }, + "answer": "D", + "reason": "肾气丸补肾助阳,用于肾阳不足证症见腰痛脚软,身半以下常有冷感,少腹拘急,小便不利,或小便反多、人夜尤甚,阳痿早泄,舌淡而胖,脉虚弱,尺部沉细;以及痰饮,水肿,消渴,脚气,转胞等" + }, + { + "question_num": 442, + "query": "患者，男，65岁。突感上腹部剧烈疼痛。取硝酸甘油片含服，未能缓解。查体：脸色青白。血压80/60mmHg(10.67/7.98kPa)，除心率140次/分外，心肺听诊无异常，腹平软，无压痛、反跳痛，肠鸣音存在。应首先考虑的是", + "options": { + "A": "胃痉挛", + "B": "胃穿孔", + "C": "急性胰腺炎", + "D": "心绞痛", + "E": "心肌梗死" + }, + "answer": "E", + "reason": "胃痉挛、胃穿孔、急性胰腺炎的腹部查体不可能为腹平软，无压痛、反跳痛，肠鸣音存在。心绞痛取硝酸甘油片含服，可以缓解，故选E。" + }, + { + "question_num": 443, + "query": "患者,女,26岁。下肢弛缓无力1年余。肌肉明显萎缩,功能严重受限，并感麻木，发凉,腰痛,头晕。舌红少苔,脉细数。治疗应选取何经穴为主", + "options": { + "A": "督脉经", + "B": "太阳经", + "C": "阳明经", + "D": "少阳经", + "E": "厥阴经" + }, + "answer": "C", + "reason": "由本患者的症状可知本病为萎证，本病取穴应侧重阳明之经,阳明多气多血,又主润宗筋,宗筋约束骨骼,利于关节运动,故治瘘证重在调理阳明,补益气血,舒筋通络。" + }, + { + "question_num": 444, + "query": "患儿出麻疹2天，皮疹密集成片，遍及全身，色紫红，壮热不退，烦躁不安，神昏谵妄，抽搐。治疗应首选", + "options": { + "A": "大定风珠", + "B": "羚角钩藤汤", + "C": "止痉散", + "D": "黄连阿胶汤", + "E": "清���汤" + }, + "answer": "B", + "reason": "该患儿为麻疹逆证之邪陷心肝证。本证为麻疹逆证之重证。麻毒炽盛，正不胜邪,麻毒内陷,扰神动风,故见高热、烦躁、谵妄,甚或神昏、抽搐等。疹点稠密,疹色紫黯,舌质红绛,苔黄起刺,脉数有力均为麻毒炽盛之象。治宜平肝息风、清心开窍，方用羚角钩藤汤加减" + }, + { + "question_num": 445, + "query": "咳嗽痰少，痰中带血或反复咯血。血色鲜红，口干咽燥，颧红，潮热盗汗，舌质红，脉细数。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": "E", + "reason": "题干描述的症候属于血症中的咳血阴虚肺热证,证机概要为虚火灼肺,肺失消肃,肺络受损;治法为滋阴润肺，宁络止血;代表方为百合固金汤。" + }, + { + "question_num": 446, + "query": "患儿发热，随后出现呕吐和意识障碍。应首先考虑的是", + "options": { + "A": "病毒性脑炎", + "B": "尿毒症", + "C": "癫痫", + "D": "有机磷农药中毒", + "E": "先天性心脏病" + }, + "answer": "A", + "reason": "病毒性脑炎均可引起颅压增高而发生呕吐。多不伴有恶心，但有剧烈头痛。呕吐与饮食无关。亦可伴有不同程度的意识障碍。" + }, + { + "question_num": 447, + "query": "患者微恶风寒、发热重、浊涕,痰稠或黄,咽喉肿痛,苔薄黄、脉浮数。治疗取大椎穴,宜采用的刺灸法是", + "options": { + "A": "刺络拔罐法", + "B": "毫针捻转补法", + "C": "毫针提插补法", + "D": "毫针平补平泻法", + "E": "温针灸" + }, + "answer": "A", + "reason": "感冒的辩证治法。从本患者的症状可诊断为风热感冒,治疗选取大椎穴,行刺络拔罐，刺络出血可清泻热邪。" + }, + { + "question_num": 448, + "query": "患儿，11个月。早产，生后一直人工喂养，经常泄泻。近4个月来食欲不振，面色㿠白，唇舌爪甲苍白，毛发稀黄。精神萎靡，手足欠温，舌淡苔白，指纹淡。检查：血红蛋白60g/L。治疗应首选", + "options": { + "A": "金匮肾气丸", + "B": "六味地黄丸", + "C": "右归丸", + "D": "理中丸", + "E": "小建中汤" + }, + "answer": "C", + "reason": "患儿为营养性缺铁性贫血。病在脾肾,为脾肾阳虚,当温补脾肾,益阴养血,选用右归丸加减,故选C。金匮肾气丸治疗肾阳虚证，六味地黄丸治疗肾阴虚证,理中丸治疗中焦虚寒，小建中汤治疗虚劳。" + }, + { + "question_num": 449, + "query": "患者，女，20岁。每逢生气时即咳逆阵作，口苦咽干，胸胁胀痛，咳时面赤舌红苔薄黄，脉弦数。治疗应首选", + "options": { + "A": "加减泻白散合黛蛤散", + "B": "龙胆泻肝汤合黛蛤散", + "C": "清金化痰汤合桔梗汤", + "D": "二陈汤合柴胡疏肝散", + "E": "桑白皮汤合柴胡疏肝散" + }, + "answer": "A", + "reason": "肝失条达,气郁化火,上逆侮肺,肺失肃降,故咳逆阵作,且与情绪有关。口苦干,胸胁胀痛,咳时面赤,舌红苔薄黄,脉弦数都是肝火的表现治宜清肺泻肝，化痰止咳,用加减泻白散合蛤散，其余选项只照顾到肝,或者肺,没有兼顾的。" + }, + { + "question_num": 450, + "query": "患者，女，38岁。洗衣时突发右侧肢体活动不灵。查体：意识清，失语，二尖瓣区可闻及双期杂音，心房纤颤，右侧偏瘫，上肢重于下肢，右偏身痛觉减退。应首先考虑的诊断是", + "options": { + "A": "脑血栓形成", + "B": "脑栓塞", + "C": "脑出血", + "D": "蛛网膜下腔出血", + "E": "短暂性脑缺血发作" + }, + "answer": "B", + "reason": "根据脑栓塞的诊断标准和临床特点即可作出诊断：①任何年龄均可发病，但以青壮年多见；②50％～60％患者起病时有轻度意识障碍；③局限性神经缺失症状与栓塞动脉供血区的功能相对应，约4/5脑栓塞累及大脑中动脉主干及其分支，出现失语、偏瘫、单瘫、偏身感觉障碍和局限性癫痫发作等；④大多数患者有栓子来源的原发疾病，如风湿性心脏病、冠心病和严重心律失常、心内膜炎等。" + }, + { + "question_num": 451, + "query": "患者,女,20岁。食海鲜后皮肤出现大小不等、形状不一的风团,高起皮肤,边界清楚,色红,痒,伴恶心,肠鸣泄泻,舌红,苔黄腻,脉滑数。除曲池、合谷、血海、膈俞、委中外，应加取", + "options": { + "A": "外关、风池", + "B": "足三里、天枢", + "C": "三阴交、天枢", + "D": "足三里、大横", + "E": "三阴交、风池" + }, + "answer": "B", + "reason": "上述表现属于瘾���肠胃积热证,治疗在主穴基础上加取足三里、天枢穴。" + }, + { + "question_num": 452, + "query": "患儿，1岁。突然发热，T37.8℃，伴咳嗽，流涕，纳差；1天后口腔硬腭、颊部黏膜出现疱疹，2天后出现米粒大小皮疹，以手、足、臀部为主，部分为疱疹，质地较硬，内有浑浊液体，周围绕有红晕，其诊断是", + "options": { + "A": "水痘", + "B": "风疹", + "C": "幼儿急疹", + "D": "手足口病", + "E": "猩红热" + }, + "answer": "D", + "reason": "手足口病。水痘皮疹呈向心性分布,常丘疹、疱疹、结痂并存,疱疹质地较软,疱浆清亮,风疹的皮疹特点是玫瑰色细小斑丘疹，出疹有一定顺序,24小时布满全身,伴有枕部淋巴结肿大。猩红热的皮疹为鸡皮样细小红色斑丘疹,有草莓舌，口周苍白圈,帕氏线,咽喉红肿化脓。幼儿急疹的特点为发热3~4天出疹,热退疹出。本患儿符合手足口病表现。" + }, + { + "question_num": 453, + "query": "患者，女，30岁。牙痛牵引头痛，面颊发热，其齿喜冷恶热，牙龈红肿溃烂，口气热臭，口干舌燥，舌红苔黄，脉滑数。治疗应首选", + "options": { + "A": "龙胆泻肝汤", + "B": "清胃散", + "C": "白虎汤", + "D": "玉女煎", + "E": "左金丸" + }, + "answer": "B", + "reason": "患者为周火牙痛,应清胃凉血,方选清胃散。" + }, + { + "question_num": 454, + "query": "患者，男，50岁。高血压病病史15年，未坚持服药。2小时前因情绪激动突然意识不清，双侧瞳孔不等大。应首先考虑的是", + "options": { + "A": "酒精中毒", + "B": "药物中毒", + "C": "高血压性脑出血", + "D": "脑血栓", + "E": "心功能不全" + }, + "answer": "C", + "reason": "高血压性脑出血的临床特点为突然出现剧烈头痛，并且多伴有躁动、嗜睡或昏迷。当血肿对侧出现偏瘫、瞳孔的变化，早期单侧瞳孔缩小，血肿扩大，脑水肿加重，遂出现颅内压增高，引起血肿侧瞳孔散大等脑疝危象，出现呼吸障碍，脉搏减慢，血压升高。随后即转为中枢性衰竭。出血量少时，血肿可自行吸收消散，症状逐渐缓解。" + }, + { + "question_num": 455, + "query": "患者,女,45岁。2天前感觉胁肋部皮肤灼热疼痛。皮色发红,继则出现簇集性粟粒状大小丘状疱疹，呈带状排列,兼见口苦，心烦,易怒,脉弦数。治疗除取主穴外。还应选用的穴位是", + "options": { + "A": "大椎、曲池、合谷", + "B": "行间、大敦、阳陵泉", + "C": "血海、隐白、内庭", + "D": "足三里、阴陵泉、阳陵泉", + "E": "内庭、曲池、太白" + }, + "answer": "B", + "reason": "由本患者的症状可知本病为带状疱疹的肝胆火盛证,选穴行间.大敦、阳陵泉等清泻肝胆经实火。" + }, + { + "question_num": 456, + "query": "患者，女，40岁，已婚。经血非时而下，淋漓日久不尽，色淡红，质清稀，伴神疲气短，面浮肢肿。纳呆便溏。舌淡胖，苔白，脉沉弱。治疗应首选", + "options": { + "A": "补中益气汤", + "B": "固本止崩汤", + "C": "加减苁蓉菟丝子丸", + "D": "举元煎", + "E": "归脾汤" + }, + "answer": "B", + "reason": "崩漏气虚证,方用固本止崩汤。" + }, + { + "question_num": 457, + "query": "患者恶寒较甚。发热，无汗，身体倦怠，咳嗽，咯痰无力，舌淡苔薄白，脉浮无力。治疗应首选", + "options": { + "A": "杏苏散", + "B": "参苏饮", + "C": "荆防败毒散", + "D": "葛根汤", + "E": "桂枝汤" + }, + "answer": "B", + "reason": "患者恶寒较甚,身楚倦怠,咳,咯痰无力,为气虚表现,应用参苏饮益气解表,故选B。A项治外感风寒、恶寒发热、头痛无汗:C项治疗风寒束表证:D项治太阳病,项背强几几，无汗恶风;E项治疗外感风寒,头痛发热,汗出恶风。" + }, + { + "question_num": 458, + "query": "患者心悸。查体：心律完全不规则，心率快慢不等，心音强弱绝对不一致。脉搏短绌。应首先考虑的是", + "options": { + "A": "窦性心律不齐", + "B": "房性期前收缩", + "C": "心房纤颤", + "D": "室性交界性期前收缩", + "E": "室性期前收缩" + }, + "answer": "C", + "reason": "心房纤颤的特点为心律完全不规则，心率快慢不等，心音强弱绝对不一致，脉搏短绌。" + }, + { + "question_num": 459, + "query": "患者,男,43岁。两耳轰鸣,按之不减,听力减退,兼见烦躁易怒,咽千,便秘,脉弦。治疗应首选", + "options": { + "A": "手、足太阴经穴", + "B": "手、足少阴经穴", + "C": "手、足少阳经穴", + "D": "手阳明经穴", + "E": "足太阳经穴" + }, + "answer": "C", + "reason": "由本患者的症状可知本病为耳鸣。手足少阳经脉循耳之前后,故手足少阳经脉的腧穴可以疏导少阳经气。" + }, + { + "question_num": 460, + "query": "患者，女，24岁，已婚。闭经7个月，形体肥胖，胸胁满闷，呕恶痰多，面浮足肿，舌淡苔白腻，脉沉滑，其证候是", + "options": { + "A": "肝肾不足", + "B": "气血虚弱", + "C": "痰湿阻滞", + "D": "肝血不足", + "E": "肺肾阴虚" + }, + "answer": "C", + "reason": "由题干形体肥胖,胸胁满闷,呕恶痰多，面浮足肿，舌淡苔白腻,脉沉滑,辨证为痰湿阻滞。" + }, + { + "question_num": 461, + "query": "患者，男，54岁。咳嗽气粗，痰多痰黄，面赤身热，口干欲饮，舌红苔黄腻，脉滑数，其证候是", + "options": { + "A": "痰热郁肺", + "B": "肺阴亏耗", + "C": "风燥伤肺", + "D": "风热犯肺", + "E": "风寒袭肺" + }, + "answer": "A", + "reason": "舌红苔黄腻,脉滑数。证属痰热证,故选A。" + }, + { + "question_num": 462, + "query": "患者，女，62岁。确诊2型糖尿病2年，予以合理饮食和运动治疗并口服二甲双胍500mg，每日3次。查体：身高173cm，体重78kg，血压130/90mmHg，心、肺和腹部检查未见异常。复查空腹血糖5.2mmol/L，三餐后2小时血糖分别为11.4mmol/L、13.1mmol/L和12.6mmol/L。下一步最合理的治疗是", + "options": { + "A": "禁食", + "B": "改用胰岛素", + "C": "改用磺酰脲类降血糖药", + "D": "加用磺酰脲类降血糖药", + "E": "加用α-葡萄糖苷酶抑制剂" + }, + "answer": "E", + "reason": "单用双胍类药物有一定效果但又未达到良好控制者，可与其他降糖药物联合应用，α-葡萄糖苷酶抑制剂特别适合于餐后高血糖者。" + }, + { + "question_num": 463, + "query": "患者,男,36岁。上齿剧痛3天,伴口臭，口渴，便秘，舌苔黄，脉洪。治疗应首选", + "options": { + "A": "风池", + "B": "外关", + "C": "足三里", + "D": "内庭", + "E": "地仓" + }, + "answer": "D", + "reason": "由本患者的症状可知本病为牙痛之胃火炽盛,故应选用消胃降火的合谷穴和内庭穴。" + }, + { + "question_num": 464, + "query": "患儿，11个月。泄泻2周。起病时每日泻10多次，经治疗大减，但近日仍日行3～4次，大便稀溏色淡。每于食后作泻，面色萎黄，神疲倦怠，舌质淡，苔薄白，其证候是（）", + "options": { + "A": "风寒", + "B": "湿热", + "C": "伤食", + "D": "脾虚", + "E": "脾肾阳虚" + }, + "answer": "D", + "reason": "“食后作泻”为关键症状,是脾虚泻的特征性症状。“面色袭黄,神疲倦息,舌质淡,苔薄白”进一步证实判断。本证未见肾阳虚症状，只是单纯的脾虚。" + }, + { + "question_num": 465, + "query": "患者，女，40岁。失眠3年余，面唇淡白无华，失眠多梦，心悸健忘，月经量少，舌淡白，苔薄白，脉细无力，其证候是", + "options": { + "A": "心阴虚证", + "B": "肾阴虚证", + "C": "心血虚证", + "D": "肝血虚证", + "E": "胆郁痰扰证" + }, + "answer": "C", + "reason": "失眠多梦,心悸健忘,其病位在心。面唇淡白无华,月经是少,舌淡白，苔白,脉细无力，其病性为血虚,综合为心血虚证。" + }, + { + "question_num": 466, + "query": "9岁学生，1月底因突起高热、剧烈头痛、恶心伴非喷射性呕吐1次入院。体检：神清，全身皮肤散在瘀点、瘀斑，颈项抵抗，心率120次/分，双肺无异常，腹软无压痛。化验检查：血白细胞计数20×10⁹/L，中性粒细胞0.89，淋巴细胞0.05，单核细胞0.06。最可能的诊断是", + "options": { + "A": "伤寒", + "B": "流行性脑脊髓膜炎", + "C": "结核性脑膜炎", + "D": "流行性乙型脑炎", + "E": "病毒性脑炎" + }, + "answer": "B", + "reason": "流行性脑脊髓膜炎流行季节多为冬春季，儿童多见，其主要表现为突发高热、剧烈头痛、频繁呕吐、皮肤黏膜瘀点、瘀斑及脑膜刺激征。实验室检查白细胞计数及中性粒细胞明显增高。" + }, + { + "question_num": 467, + "query": "患者,男,24岁,目赤肿痛,眼涩难开,流泪,畏光,伴发热、恶风、头痛,舌苔薄黄,脉浮数。治疗除取睛明、太阳、合谷、太冲外,还应加", + "options": { + "A": "风池、侠溪", + "B": "印堂、内庭", + "C": "少商、上星", + "D": "关冲、支沟", + "E": "四白、养老" + }, + "answer": "C", + "reason": "本题辨病为“目赤肿痛”,目赤肿痛治疗主穴:合谷,太冲、风池、晴明、太阳。配穴:风热者,加少商、上星;肝胆火盛者,加行间、侠溪,其兼症辩证为风热之证,取少商清泄阳明经热,上星点刺出血以泄热消肿。" + }, + { + "question_num": 468, + "query": "患儿，6岁。2个月来胃纳不振，精神疲倦，伴有低热，遍身汗出，微恶风寒。治疗应首选", + "options": { + "A": "玉屏风散", + "B": "牡蛎散", + "C": "生脉散", + "D": "黄芪桂枝五物汤", + "E": "当归六黄汤" + }, + "answer": "D", + "reason": "患儿主症是遍身汗出2个月,诊为汗证。遍身汗出可见于营养失调和气阴亏虚，但气阴亏虚以盗汗为主，此患儿为自汗，并无盗汗和阴虚表现,所以辨证为营卫失调。治宜调和营卫,方用黄芪桂枝五物汤。" + }, + { + "question_num": 469, + "query": "患者神疲乏力。少气懒言，常自汗出，头晕目眩，舌淡苔白，脉虚无力，其证候是", + "options": { + "A": "气虚", + "B": "气陷", + "C": "气逆", + "D": "气微", + "E": "气滞" + }, + "answer": "A", + "reason": "气少懒言,神疲乏力由于元气亏虚,脏腑组织机能减退所致,头晕目眩为气虚清阳不升,不能温养头目,自汗为气虚毛窍疏松,外卫不固，舌淡苔白为气虚无力动血脉，血不上营于舌，脉虚无力为运血无力。" + }, + { + "question_num": 470, + "query": "患者，男，50岁。突起呼吸困难，咳粉红色泡沫痰，血压25.3/13.3kPa(190/100mmHg)。该患者的最佳治疗药物是", + "options": { + "A": "毛花苷C", + "B": "氨茶碱", + "C": "硝普钠", + "D": "多巴酚丁胺", + "E": "硝酸甘油" + }, + "answer": "C", + "reason": "患者突发呼吸困难，咳粉红色泡沫痰为急性左心衰表现，现血压高，可加重心脏后负荷，从而加重心衰，故首选扩血管、降压治疗，最佳治疗药物为硝普钠。" + }, + { + "question_num": 471, + "query": "患者,男,25岁。昨天因俯身搬重物，不慎将腰部扭伤,检查:腰部正中有明显压痛点,腰痛不可俯仰,腰部侧弯尚可。针灸治疗取穴可用", + "options": { + "A": "手三里、三间", + "B": "人中、后溪", + "C": "后溪、申脉", + "D": "攒竹、昆仑", + "E": "阿是穴、大肠俞" + }, + "answer": "B", + "reason": "扭伤的辩证、处方。腰部正中有明显压痛点,腰痛不可俯仰,说明扭伤的部位主要在腰部正中督脉,急性扭伤针灸治疗主要以循经远取为主,选项人中、后溪中的人中属督脉穴,可治本经病变,后溪为手太阳小肠经穴;但后溪为八肪交会穴,通于督脉，亦可治疗督脉病证。" + }, + { + "question_num": 472, + "query": "患儿，男，10岁。患痄腮，腮部肿胀渐消退，右侧睾丸肿胀疼痛，舌红苔黄，脉数。治疗应首选", + "options": { + "A": "银翘散", + "B": "小柴胡汤", + "C": "知柏地黄丸", + "D": "龙胆泻肝汤", + "E": "普济消毒饮" + }, + "answer": "D", + "reason": "此证为痄腮变证之毒窜睾腹,治宜清肝泻火、活血镇痛,方用龙胆泻肝汤。" + }, + { + "question_num": 473, + "query": "患者，女，42岁。全身水肿，下肢明显，按之没指，小便短少，身体困重，胸闷，纳呆，泛恶，舌苔白腻，脉沉缓。治疗应首选", + "options": { + "A": "五皮饮合胃苓汤", + "B": "麻黄连翘赤小豆汤", + "C": "越婢加术汤", + "D": "实脾饮", + "E": "疏善饮子" + }, + "answer": "A", + "reason": "脾阳不足,气不化水,故浮肿,水湿下聚,故下肢为甚,按之凹陷。阳气衰微,故出现尿少。四肢冷,舌质淡胖,苔白,脉沉。治宜运脾化湿,通阳利水,故用五皮饮化湿利水,胃苓汤温阳健牌,其余选项都不全面。" + }, + { + "question_num": 474, + "query": "患者，女，54岁。心脏联合瓣膜病10年，发热1个月，体温37.2~37.6℃，厌食，消瘦，贫血貌。确诊手段首选", + "options": { + "A": "胸部X线", + "B": "血培养", + "C": "测定血红蛋白", + "D": "心肌酶检查", + "E": "测定血沉" + }, + "answer": "B", + "reason": "感染性心内膜炎是心脏瓣膜病的常见并发症，因此对于发热超过1周的心脏瓣膜病患者首先要考虑感染性心内膜炎，而血培养是诊断该病最重要的方法。" + }, + { + "question_num": 475, + "query": "患者,女,36岁,经血淋滴不净30天血色淡,质稀薄,伴面色萎黄,神疲肢倦,舌淡，苔白,脉沉细无力。除气海、三阴交、足三里、肾俞外，应加取", + "options": { + "A": "肾俞、命门", + "B": "然谷、太溪", + "C": "百会、脾俞", + "D": "隐白、血海", + "E": "隐白、地机" + }, + "answer": "C", + "reason": "崩漏虚证的主穴:气海、三阴交、肾俞、足三里。配穴:脾虚配百会、脾俞;肾虚配肾俞、太溪。" + }, + { + "question_num": 476, + "query": "患儿，5岁。麻疹第5天，壮热持续，起伏如潮，烦躁不安，目赤眵多，皮疹布发，疹点逐渐稠密，皮疹凸起，触之碍手，压之退色，大便干结，小便短少，舌质红赤，舌苔黄腻，脉数有力，其证候是", + "options": { + "A": "邪犯肺卫", + "B": "邪入肺胃", + "C": "邪毒攻喉", + "D": "邪毒闭肺", + "E": "阴津耗伤" + }, + "answer": "B", + "reason": "本证为麻毒炽盛,由表入里,邪正相争,疾病进人出疹期,屈邪人肺胃证。" + }, + { + "question_num": 477, + "query": "患者小便短赤灼热，尿血鲜红，心烦口渴，舌红，脉数，其证候是", + "options": { + "A": "肾气不固", + "B": "下焦热盛", + "C": "脾不统血", + "D": "肾虚火旺", + "E": "以上均非" + }, + "answer": "B", + "reason": "尿色鲜红,排除虚证肾气不固、脾不统血。小便短赤灼热,心烦口渴,舌红,脉数,为热象,但无肾阴虚的症状,故排除肾虚火旺。符合下焦热盛的症状,故选B。" + }, + { + "question_num": 478, + "query": "李某，自费学医后自行开业，因违反诊疗护理常规，致使患者死亡。追究其刑事责任的机关是", + "options": { + "A": "卫生行政部门", + "B": "工商行政部门", + "C": "医疗事故鉴定委员会", + "D": "管辖地人民政府", + "E": "管辖地人民法院" + }, + "answer": "E", + "reason": "《医疗事故处理条例》第六十一条，非法行医，造成患者人身损害，不属于医疗事故，触犯刑律的，依法追究刑事责任；有关赔偿，由受害人直接向人民法院提起诉讼，故选E。" + }, + { + "question_num": 479, + "query": "患者,女,31岁。右侧牙痛3天，龈肿,痛剧,伴口臭,口渴,大便3日未行,舌苔黄,脉洪。治疗除取颊车、下关穴外，还应加", + "options": { + "A": "外关、风池", + "B": "太溪、行间", + "C": "中渚、养老", + "D": "合谷、内庭", + "E": "太冲、曲池" + }, + "answer": "D", + "reason": "由本患者的症状可知本病为牙痛之胃火炽盛,故应选用清胃降火的合谷穴和内庭穴。" + }, + { + "question_num": 480, + "query": "患儿，6岁。喉核赤肿，咽喉疼痛，吞咽不利，发热重，鼻塞流涕，头痛身痛，舌质红，苔薄黄，脉浮数。治疗宜首选", + "options": { + "A": "银翘马勃散", + "B": "牛蒡甘桔汤", + "C": "养阴清肺汤", + "D": "普济消毒饮", + "E": "荆防败毒散" + }, + "answer": "A", + "reason": "该患儿为乳蛾风热搏结证。治法:疏风清热,利咽消肿。代表方:银翘马勃散。" + } +] \ No newline at end of file