diff --git "a/Licensed/Theory_Questions/Year_3/Past_Paper.json" "b/Licensed/Theory_Questions/Year_3/Past_Paper.json" new file mode 100644--- /dev/null +++ "b/Licensed/Theory_Questions/Year_3/Past_Paper.json" @@ -0,0 +1,6242 @@ +[ + { + "question_num": 1, + "query": "五脏中,具有“刚脏”特性的是", + "options": { + "A": "心", + "B": "肺", + "C": "脾", + "D": "肝", + "E": "肾" + }, + "answer": "D", + "reason": "肝在五脏之中属木,主疏泄体阴而用阳,故称之为“刚脏”。《素问·灵兰秘典论》说:“肝者,将军之官,谋虑出焉”" + }, + { + "question_num": 2, + "query": "方中当归与桂枝配伍以养血温经的方剂是", + "options": { + "A": "四逆汤", + "B": "四逆散", + "C": "阳和汤", + "D": "理中丸", + "E": "当归四逆汤" + }, + "answer": "E", + "reason": "当归四逆汤主治血虚寒厥证。方中当归甘温,养血和血;桂枝辛温,温经散寒,温通血脉,共为君药。" + }, + { + "question_num": 3, + "query": "导致感冒的主因是", + "options": { + "A": "寒邪", + "B": "热邪", + "C": "风邪", + "D": "湿邪", + "E": "暑邪" + }, + "answer": "C", + "reason": "感冒之病因,主要为感受风邪,导致肺卫失和，又名伤风。由于感受四时之邪的特点及禀赋体质的差异，可以表现为风寒、风热、挟暑、挟湿的不同,但总离不开风邪,风为百病之长。" + }, + { + "question_num": 4, + "query": "中医外科成为独立专科的年代是", + "options": { + "A": "商代", + "C": "秦代", + "B": "周代", + "D": "汉代", + "E": "明代" + }, + "answer": "B", + "reason": "中医外科成为独立专科是在周代,中医外科到明清时期已较为成熟，外科专著增多。" + }, + { + "question_num": 5, + "query": "“阴阳离决,精气乃绝”所反映的阴阳关系是", + "options": { + "A": "对立制约", + "B": "互根互用", + "C": "相互交感", + "D": "消长平衡", + "E": "相互转化" + }, + "answer": "B", + "reason": "阳根于阴,阴根于阳,无阳则阴无以生,无阴则阳无以化。“阴阳之理,原自互根，彼此相须，缺可埋，独阴不午，独阳不长…阴在内,阳之守也;阳在外,阴之使也”“阳损及阴…阴损及阳”等等,也是对阴阳互根互用的表达。" + }, + { + "question_num": 6, + "query": "脂瘤独有的特征是", + "options": { + "A": "数目不等,大小不一,肿形如馒,推之可移", + "B": "青筋垒垒,盘曲成团,质地柔软,表面青蓝", + "C": "瘤中心有粗大毛囊孔,可挤出臭味脂浆", + "D": "瘤体单发,质地硬韧,界限清楚,推之可移", + "E": "瘤体深隐,质地坚硬,境界清楚,推之不移" + }, + "answer": "C", + "reason": "脂瘤是以皮肤间出现圆形质软的肿块,溃破后可见粉渣样物溢出，瘤中心有粗大毛囊孔,可挤出臭味脂浆,又称粉瘤,相当于西医的皮脂腺爽肿。" + }, + { + "question_num": 7, + "query": "风寒感冒兼胸脘痞闷,食少纳呆,脉濡者,治疗应首选", + "options": { + "A": "荆防败毒散", + "B": "香苏散", + "C": "杏苏散", + "D": "羌活胜湿汤", + "E": "三仁汤" + }, + "answer": "D", + "reason": "风寒感冒治宜辛温解表，宜肺散寒,挟湿者应配以疏风祛湿，方用羌活胜湿汤。A项不能祛湿。B项理气，不能化湿。C项清宣凉燥，用于外感凉燥证。E项清热化湿，用于湿热证。" + }, + { + "question_num": 8, + "query": "翻花疮命名的依据是", + "options": { + "A": "部位", + "B": "症状", + "C": "形态", + "D": "疾病特征", + "E": "范围大小" + }, + "answer": "C", + "reason": "以形态命名者,如翻花疮、蛇头疔、蝼蛄疖、缠腰火丹、酒渣鼻、鹅掌风。" + }, + { + "question_num": 9, + "query": "五行中火的“所胜”是", + "options": { + "A": "水", + "B": "木", + "C": "土", + "D": "金", + "E": "火" + }, + "answer": "D", + "reason": "木克士,土克水,水克火,火克金,金克木，木为金所胜，即是木为金之所克,如此类推可知。" + }, + { + "question_num": 10, + "query": "地机穴位于", + "options": { + "A": "胫骨内侧面后缘,内踝尖上5寸", + "B": "胫骨内侧髁下方凹陷处", + "C": "胫骨内侧面中央，内踝尖上5寸", + "D": "胫骨内侧面中央,内踝尖上7寸", + "E": "内踝尖与阴陵泉穴的连线上，阴陵泉下3寸" + }, + "answer": "E", + "reason": "地机为郄穴,在小腿内侧,内踝尖与阴陵泉的连线上，阴陵泉下3寸。主治:痛经、崩漏、月经不调等妇科病;脾胃病;小便不利、水肿等脾不运化水湿病证。" + }, + { + "question_num": 11, + "query": "外感咳嗽的病位主要在", + "options": { + "A": "脾", + "B": "心", + "C": "肺", + "D": "肾", + "E": "肝" + }, + "answer": "C", + "reason": "外感咳嗽为六淫外邪犯肺.声eЛJ、列E令人咳,但主要与肝脾肾关系最密切，" + }, + { + "question_num": 12, + "query": "外科辨肿,肿势平坦,根盘散漫,其成因是", + "options": { + "A": "火", + "B": "风", + "C": "气", + "D": "郁结", + "E": "虚" + }, + "answer": "E", + "reason": "肿势平坦,散漫不聚,边界不清,阴证见之,为气血不充,属虚。" + }, + { + "question_num": 13, + "query": "为人体气血化生之源的脏是", + "options": { + "A": "肾", + "B": "心", + "C": "肝", + "D": "肺", + "E": "脾" + }, + "answer": "E", + "reason": "脾胃乃后天之本,气血生化之源,即脾和胃,是人体的消化系统,是人出生之后,立命的根本,化生气血的源泉。" + }, + { + "question_num": 14, + "query": "疟疾患者,热多寒少,汗出不畅,头痛，骨节酸痛,口渴引饮,便秘,溲赤,舌红苔黄,脉弦数,其治法是", + "options": { + "A": "和解表里,温阳达邪", + "B": "祛邪截疟,和解表里", + "C": "解毒除瘴,清热保津", + "D": "益气养血,扶正祛邪", + "E": "清热解表,和解祛邪" + }, + "answer": "E", + "reason": "热多寒少口渴引饮，便秘溲赤,舌红苔黄,脉弦数为热;头痛,骨节酸痛为在表,故选E。" + }, + { + "question_num": 15, + "query": "哮喘患者,气短息弱,自汗畏风,面色觥白。咳嗽痰稀,舌淡苔白,脉弱,其诊断是", + "options": { + "A": "哮病缓解期,肺虚", + "B": "哮病缓解期,脾虚", + "C": "哮病缓解期,肾虚", + "D": "虚喘,肺患", + "E": "虚喘,肾虚" + }, + "answer": "A", + "reason": "哮病日久,肺虚不能主气,气不化津,痰饮郁肺,肺气上逆,故见气短息弱，自汗畏风，面色觥白，咳嗽痰稀,舌淡苔白，脉弱。" + }, + { + "question_num": 16, + "query": "下列各项,不属确认成脓方法的是", + "options": { + "A": "按触法", + "B": "推拿法", + "C": "穿刺法", + "D": "透光法", + "E": "点压法" + }, + "answer": "B", + "reason": "按触法、穿刺法、点压法、透光法属于辨脓的方法，而推拿法则属于禁忌证。" + }, + { + "question_num": 17, + "query": "小肠的主要生理功能是", + "options": { + "A": "主运化", + "B": "主通调水道", + "C": "主受纳", + "D": "主腐熟水谷", + "E": "主泌别清浊" + }, + "answer": "E", + "reason": "小肠主受盛和化物、泌别清浊。" + }, + { + "question_num": 18, + "query": "患者,女,50岁。精神恍惚,心神不宁,多疑易惊,悲忧善哭,喜怒无常。舌质淡,脉弦。治疗应首选", + "options": { + "A": "丹栀逍遥丸", + "B": "半夏厚朴汤", + "C": "甘麦大枣汤", + "D": "归脾汤", + "E": "天王补心丹合六味地黄丸" + }, + "answer": "C", + "reason": "该患者为郁证之心神失养证,应选用甘麦大枣汤甘润缓急,养心安神。" + }, + { + "question_num": 19, + "query": "喘证的病变部位在", + "options": { + "A": "心、肺", + "B": "肺、肾", + "C": "心、肾", + "D": "脾、肾", + "E": "肺、脾" + }, + "answer": "B", + "reason": "喘证的病位主要在肺和肾,涉及肝脾。" + }, + { + "question_num": 20, + "query": "溃疡疮口太小,脓腐难去,常用的腐蚀药是", + "options": { + "A": "红灵丹", + "B": "白降丹", + "C": "七三丹", + "D": "八宝丹", + "E": "九黄丹" + }, + "answer": "B", + "reason": "白降丹,适用于溃疡疮口太小,脓腐难去,用桑皮纸或丝绵纸做成裹药,插人疮口,使疮口开大,脓腐易出。" + }, + { + "question_num": 21, + "query": "肺主气的功能与特性取决于", + "options": { + "A": "司呼吸", + "B": "宗气的生成", + "C": "全身气机的调节", + "D": "朝百脉", + "E": "主治节" + }, + "answer": "A", + "reason": "肺的呼吸调匀,是气的生成和气机调畅的根本条件。" + }, + { + "question_num": 22, + "query": "患者,女,38岁。月经来潮,量多、色淡，肌热面赤,烦渴欲饮，脉洪大而虚。治疗应选用", + "options": { + "A": "归脾汤", + "B": "四物汤", + "C": "当归补血汤", + "D": "温经汤", + "E": "黄土汤" + }, + "answer": "C", + "reason": "本题辨证要点为血虚阳浮发热,当归补血汤补气生血，用于血虚发热证,症见肌热面红，烦渴欲饮，脉洪大而虚，重按无力;或妇人经期、产后血虚,发热头痛;或疮疡溃后，久不愈合。" + }, + { + "question_num": 23, + "query": "肺胀痰浊壅肺证的治法是", + "options": { + "A": "化痰降气,健脾益肺", + "B": "宣肺化痰,止咳定喘", + "C": "宣肺定喘,健脾益气", + "D": "健脾化痰,宣肺定喘", + "E": "健脾化痰,补土生金" + }, + "answer": "A", + "reason": "肺胀痰浊壅肺证的治法是“化痰降气,健脾益肺”,故选A。" + }, + { + "question_num": 24, + "query": "下列各项,不属疔疮走黄原因的是", + "options": { + "A": "麻痘余毒未清", + "B": "误食辛热之品", + "C": "早期失治", + "D": "挤压碰撞", + "E": "过早切开" + }, + "answer": "A", + "reason": "最后四个都是走黄的原因。" + }, + { + "question_num": 25, + "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": "气的固摄作用,指气对血、精液、津液等液态物质的统摄，以防止其无故流失。气的固摄作用减弱必致血、精液、津液的耗散,脱失。" + }, + { + "question_num": 26, + "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": "青蛾丸", + "C": "补髓丹", + "D": "虎潜丸", + "E": "补血荣筋丸" + }, + "answer": "B", + "reason": "肾虚腰痛,阴虚用左归丸,阳虚用右归丸，无明显偏盛者用青娥丸。" + }, + { + "question_num": 27, + "query": "肺痨的外在致病因素是", + "options": { + "A": "燥邪", + "B": "痨虫", + "C": "痰浊", + "D": "瘀血", + "E": "水饮" + }, + "answer": "B", + "reason": "肺痨的外在致病因素是感染“痨虫”" + }, + { + "question_num": 28, + "query": "有头疽切开引流常作", + "options": { + "A": "对口引流", + "B": "一字形切口", + "C": "十字形切口", + "D": "梭形切口", + "E": "S型切口" + }, + "answer": "C", + "reason": "按疮形大小采用“十”字、双“十”字。" + }, + { + "question_num": 29, + "query": "作为机体获得对HBV免疫力及乙型肝炎患者痊愈的指标是", + "options": { + "A": "HBsAg(十)", + "B": "抗-HBs(十)", + "C": "HBeAg(+)", + "D": "抗-HBc(十)", + "E": "抗-HBe(士)" + }, + "answer": "B", + "reason": "抗-HBs就是乙肝表面抗体;是乙肝的保护性抗体，也就是说:抗-HBs阳性说明机体对乙肝病毒有了免疫力。单纯抗-HBs一项阳性,是注射乙肝疫苗并免疫成功的标志。" + }, + { + "question_num": 30, + "query": "石膏的性味是", + "options": { + "A": "辛,苦,大寒", + "B": "辛,咸,大寒", + "C": "辛,酸,大寒", + "D": "辛,甘,大寒", + "E": "甘,淡,大寒" + }, + "answer": "D", + "reason": "石膏的性味:辛,甘,大寒" + }, + { + "question_num": 31, + "query": "肺胀晚期病变为主的脏是", + "options": { + "A": "肺、脾、肾", + "B": "肺、脾、心", + "C": "肺、肾、心", + "D": "脾、肾、心", + "E": "肺、肝、肾" + }, + "answer": "D", + "reason": "肺胀为本虚标实。早期在肺,继则影响脾、肾,后期病及于心。因肺为气之主,肾为气之根,金不生水,肺伤及肾。子盗母气,肺气虚导致脾气虚。后期脾肾阳虚水饮泛溢，上凌于心。" + }, + { + "question_num": 32, + "query": "丹毒的主要病因病机是", + "options": { + "A": "风温夹痰凝结经络", + "B": "风温湿热蕴结肌肤", + "C": "外邪侵犯,血分有热,郁于肌肤", + "D": "经络阻塞,气血凝滞", + "E": "暑湿热毒流注肌间" + }, + "answer": "C", + "reason": "丹毒由于素体血分有热,外受火毒,热毒蕴结,郁阻肌肤而发。" + }, + { + "question_num": 33, + "query": "按十二脉的流注次序,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": "" + }, + { + "question_num": 34, + "query": "哺乳期乳房疼痛有肿块,按之痛重。首先考虑的诊断是", + "options": { + "A": "乳癖", + "B": "乳痈", + "C": "乳癌", + "D": "乳核", + "E": "乳痨" + }, + "answer": "B", + "reason": "乳痈是由热毒侵人乳房所引起的一种急性化脓性疾病，常发生于产后未满月的哺乳妇女,特点乳房结块，红肿热痛故结合临床表现特点，此诊断为乳痈。答案选B。" + }, + { + "question_num": 35, + "query": "治疗心悸心血不足证,应首选", + "options": { + "A": "天王补心丹", + "B": "安神定志丸", + "C": "桂枝甘草龙骨牡蛎汤", + "D": "归脾汤", + "E": "朱砂安神丸" + }, + "answer": "D", + "reason": "心悸心虚胆怯的用安神定志丸。心血不足的用归脾汤，补血养心，益气安神。肝肾阴虚火不旺者用天王补心丹,热象较著者用朱砂安神丸。心阳不足的用桂枝甘草P" + }, + { + "question_num": 36, + "query": "下列各项,与瘰疬的病因病机无关的是", + "options": { + "A": "心阳不足", + "B": "肝气郁结", + "C": "脾失健运", + "D": "肺阴不足", + "E": "肾阴亏虚" + }, + "answer": "A", + "reason": "瘰疬常因情志不畅,肝气郁结,气滞伤脾,以致脾失健运,痰湿内生,结于颈项而成。痰湿化热,或肝郁化火，下灼肾阴，热胜肉腐成脓,或脓水淋漓,耗伤气血,渐成虚损。亦可因肺肾阴亏，以致阴亏火旺，肺津不能输布,灼津为痰,痰火凝结,结聚成核。而心主神明,与本病毫无关联。" + }, + { + "question_num": 37, + "query": "最易导致疼痛的外邪是", + "options": { + "A": "风", + "B": "寒", + "C": "暑", + "D": "燥", + "E": "湿" + }, + "answer": "B", + "reason": "寒为阴邪,易伤阳气,其性凝滞,不通则痛。《内经》云“痛者,寒气多也,有寒故痛也”。考点为寒邪致病的特点。六淫内容的复习中,六淫各自的基本概念、特性、致病特征要清楚,并与诊断中的病因辨证联系起来,与内生五邪联系起来，尤其是各自所表现的临床特征性症状要清楚，这个在脏腑辨证以及中医临床科目考试中的辨证分型中大有用处。" + }, + { + "question_num": 38, + "query": "患者,女,40岁。双乳肿块界限不清，经前乳房胀痛,伴有月经不调,腰酸乏力,舌质淡红,苔白,脉细。治疗应首选", + "options": { + "A": "左归丸", + "B": "开郁散", + "C": "逍遥蒌贝散", + "D": "二仙汤合四物汤", + "E": "六味地黄汤" + }, + "answer": "D", + "reason": "此证为乳癖之冲任失调证。治法:调摄冲任。方用二仙汤合四物汤。" + }, + { + "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,总因火邪扰心，心神不安而致不寐。病位在心。" + }, + { + "question_num": 40, + "query": "检查乳房的最佳时间是", + "options": { + "A": "经前", + "B": "经后3天", + "C": "经后7~10天", + "D": "经后2周", + "E": "经后3周" + }, + "answer": "C", + "reason": "一般经后7~10天。" + }, + { + "question_num": 41, + "query": "艾滋病属于哪种病原体感染", + "options": { + "A": "革兰阴性菌", + "B": "革兰阳性菌", + "C": "真茵", + "D": "DNA病毒", + "E": "RNA病毒" + }, + "answer": "E", + "reason": "" + }, + { + "question_num": 42, + "query": "患者,女,45岁。月经不规律8个月，现阴道出血40天，量时多时少,近3天量极多，色淡、质稀,伴气短神疲,面浮肢肿,舌淡苔薄白，脉缓弱。治疗应首选", + "options": { + "A": "举元煎", + "B": "补中益气汤", + "C": "固本止崩汤", + "D": "清热固经汤", + "E": "保阴煎" + }, + "answer": "C", + "reason": "月经周期紊乱,行经时间超过半月以上，量时多时少,近3天量极多---崩漏;气短神疲,面浮肢肿,舌淡苔薄白,脉缓弱--脾虚表现,所以此为崩漏之脾虚证,治宜补气摄血，固冲止崩,方用固本止崩汤或固冲汤。" + }, + { + "question_num": 43, + "query": "狂证火盛伤阴证,其治法是", + "options": { + "A": "活血化瘀,涤痰镇静", + "B": "安神定志,祛痰降火", + "C": "降火豁痰,安神宁心", + "D": "镇心涤痰,泻肝清火", + "E": "滋阴降火,安神定志" + }, + "answer": "E", + "reason": "" + }, + { + "question_num": 44, + "query": "乳疬相当于西医学的病名是", + "options": { + "A": "乳腺爽肿", + "B": "乳腺增生病", + "C": "乳腺纤维腺瘤", + "D": "乳房异常发育症", + "E": "导管内乳头状瘤" + }, + "answer": "D", + "reason": "乳疬是以男性、儿童单侧或双侧乳晕部发生扁圆形肿块,触之疼痛为主要表现的乳房异常发育症。分为男性乳房发育异常和儿童乳房发育异常两大类，前者见于中、老年男性,多为继发性;后者见于10岁左右儿童,多为原发性。乳疬相当于西医的男性、儿童乳房发育异常症。" + }, + { + "question_num": 45, + "query": "下列各项,不属于亚急性重型肝炎并发症的是", + "options": { + "A": "脑水肿", + "B": "消化道出血", + "C": "血糖增高", + "D": "电解质紊乱", + "E": "严重感染" + }, + "answer": "C", + "reason": "亚急性重型肝炎晚期可有难治性并发症,如脑水肿，消化道大出血，严重感染,电解质紊乱及酸碱平衡失调(低钠、低钾、低镁、碱中毒等)。白细胞升高，血红蛋白下降,低血糖,低胆固醇,���胆碱酯酶" + }, + { + "question_num": 46, + "query": "下列方剂组成药物中,不含有附子的是", + "options": { + "A": "实脾散", + "B": "真武汤", + "C": "乌梅丸", + "D": "温脾汤", + "E": "阳和汤" + }, + "answer": "E", + "reason": "实脾散组成:厚朴、白术、木瓜、草果仁、槟榔、炮附子、白茯苓、炮干姜、甘草.木香、生姜、大枣。真武汤组成:茯苓、芍药、白术、生姜、附子。温脾汤组成:大黄、干姜、当归、附子、人参、芒硝、甘草。乌梅丸组成:乌梅、附子、细辛、千姜、黄连、当归、蜀椒、桂枝、人参、黄柏、蜜。阳和汤组成:熟地黄、白芥子、鹿角胶、肉桂、姜炭、麻黄、生甘草。" + }, + { + "question_num": 47, + "query": "痫病与五脏都有关系，但主要责之于", + "options": { + "A": "肺、脾", + "B": "肝、肾", + "C": "心、肝", + "D": "肺、肾", + "E": "肝、脾" + }, + "answer": "C", + "reason": "痫病的表现主要:①精神恍惚,昏不知人，责之于心;②口吐涎沫,两目上视,四肢抽搐,肝主筋,筋脉拘率,责之于肝。" + }, + { + "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": "关于流行性出血热少尿期治疗原则的叙述,错误的是", + "options": { + "A": "透析疗法", + "B": "促进利尿", + "C": "放血治疗", + "D": "大量补液", + "E": "导泻疗法" + }, + "answer": "D", + "reason": "少尿期治疗原则为“稳、促、导、透”,即稳定机体内环境,促进利尿,导泻和放血疗法,透析治疗。少尿期应严格控制液体输人量,不能大是补液。" + }, + { + "question_num": 50, + "query": "下列各项,不属胎动不安和异位妊娠鉴别要点的是", + "options": { + "A": "阴道出血", + "B": "腹痛程度、性质", + "C": "B超检测孕囊着床部位", + "D": "妇检宫颈举痛", + "E": "妇检附件包块" + }, + "answer": "A", + "reason": "异位妊娠有停经史、阴道不规则出血、突然一侧少腹撕裂样疼痛，甚则星厥或休克。胎动不安有停经史，下腹部坠痛，腰痛，少量阴道出血,难免流产时下腹阵发性疼痛,腰酸痛均加重。腹部体征:异位妊娠下腹一侧或全腹压痛、反跳痛,肌紧张不明显，可有移动性浊音。胎动不安无阳性体征。妇科检查:异位妊娠后穹隆饱胀,宫颈摇举痛,子宫稍大而软,宫旁可扪及痛性包块、后穹隆可抽出不凝血。胎动不安子宫增大与月份相符,难免流产时宫口开,可有胚胎组织阻塞" + }, + { + "question_num": 51, + "query": "治疗痫病风痰闭阻证,应首选", + "options": { + "A": "定痫丸", + "B": "涤痰汤", + "C": "顺气导痰汤", + "D": "生铁落饮", + "E": "羚角钩藤汤" + }, + "answer": "A", + "reason": "痫病的病因病机为风火气痰瘀,蒙蔽心窍,壅塞经络,气机逆乱,元神失控。风痰闭阻者应豁痰熄风，开窍定痫，用定痫丸合适,其余选项或只祛痰;或只熄风，不能开窍定痫。" + }, + { + "question_num": 52, + "query": "在肿块触诊中,不属癌性肿块特性的是", + "options": { + "A": "高低不平", + "B": "坚硬如石", + "C": "推之不能移动", + "D": "表面与皮肤粘连", + "E": "表面光滑" + }, + "answer": "E", + "reason": "ABCD项都可以成为癌症肿块的特征,而表面光滑很明显不属于癌性肿块的特性。" + }, + { + "question_num": 53, + "query": "细菌性痢疾抗菌治疗,应首选的药物是", + "options": { + "A": "青霉素", + "B": "阿奇霉素", + "C": "氯霉素", + "D": "环丙沙星", + "E": "复方新诺明" + }, + "answer": "D", + "reason": "环丙沙星是喹诺酮类药物的常用代表药物。" + }, + { + "question_num": 54, + "query": "止带方主要治疗", + "options": { + "A": "肾阳虚", + "B": "肾阴虚", + "C": "脾虚", + "D": "湿热", + "E": "湿毒" + }, + "answer": "D", + "reason": "止带方专用于止带,方中猪苓、茯苓、车前子、泽泻利水渗湿止带。适用于主h-" + }, + { + "question_num": 55, + "query": "气厥实证反复发作的原因,常是", + "options": { + "A": "精神刺激", + "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": "瘿在古代文献中,有五瘿之分,下列各项,不属于五瘿的是", + "options": { + "A": "瘿痈", + "B": "血瘿", + "C": "肉瘿", + "D": "石瘿", + "E": "筋瘿" + }, + "answer": "A", + "reason": "瘿在古代文献中,根据其临床表现以及与五脏的配属关系,分为五瘿:筋瘿、血瘿、肉瘿、气瘿、石瘿,其中筋瘿、血瘿多属颈部血管瘤以及气瘿与石瘿的合并症。" + }, + { + "question_num": 57, + "query": "传染性非典型肺炎的主要传播途径是", + "options": { + "A": "水", + "B": "体液", + "C": "飞沫", + "D": "土壤", + "E": "血制品" + }, + "answer": "C", + "reason": "飞沫传播、接触传播是SARS的传播途径，其中飞沫传播是主要的传播途径。" + }, + { + "question_num": 58, + "query": "治疗气瘿应首选", + "options": { + "A": "海藻玉壶汤", + "B": "四海舒郁丸", + "C": "开郁散", + "D": "逍遥散", + "E": "桃红四物汤" + }, + "answer": "B", + "reason": "治疗气瘿当疏肝解郁,化痰软坚。方药:四海舒郁丸加减。" + }, + { + "question_num": 59, + "query": "胃痛的治疗,主要是", + "options": { + "A": "调肝理气止痛", + "B": "调肝和胃止痛", + "C": "理气和胃止痛", + "D": "调理脾胃止痛", + "E": "调肝理脾止痛" + }, + "answer": "C", + "reason": "胃痛的基本治疗原则是理气和胃止痛，" + }, + { + "question_num": 60, + "query": "枯痔散疗法的作用机理是", + "options": { + "A": "湿性坏死疗法", + "B": "干性坏死疗法", + "C": "硬化萎缩疗法", + "D": "插药疗法", + "E": "以上均非" + }, + "answer": "B", + "reason": "枯痔散疗法是使内痔干枯坏死,作用机理为干性坏死。" + }, + { + "question_num": 61, + "query": "慢性乙型肝炎干扰素治疗的疗程是", + "options": { + "A": "小于6周", + "B": "8~12周", + "C": "24周", + "D": "1年", + "E": "2年以上" + }, + "answer": "D", + "reason": "" + }, + { + "question_num": 62, + "query": "石瘿痰瘀内结证,内治应首选的方剂是", + "options": { + "A": "四海舒郁丸", + "B": "柴胡清肝汤", + "C": "海藻玉壶汤合桃红四物汤", + "D": "养阴清肺汤", + "E": "通窍活血汤合桃红四物汤" + }, + "answer": "C", + "reason": "石瘿分痰瘀内结、瘀热伤阴证,前者方用海藻玉壶汤合桃红四物汤加减。" + }, + { + "question_num": 63, + "query": "呕吐的基本病机是", + "options": { + "A": "肝气犯胃,胃气上逆", + "B": "胃失和降,胃气上逆", + "C": "食滞伤胃,胃失和降", + "D": "外邪犯胃,胃失和降", + "E": "脾胃受损,胃失润降" + }, + "answer": "B", + "reason": "呕吐的病位在胃,病因可以有肝气犯胃、食滞伤胃、外邪犯胃、脾胃受损这些因素作用于胃,导致胃失和降,胃气上逆才发生呕吐，故呕吐的基本病机是胃失和降胃气上逆。" + }, + { + "question_num": 64, + "query": "治疗失荣早期气郁痰结证，应首选", + "options": { + "A": "和营散坚丸", + "B": "柴胡清肝汤", + "C": "桃红四物汤", + "D": "化痰开郁方", + "E": "二陈汤" + }, + "answer": "D", + "reason": "此为肝郁痰凝,阻隔经络所致。治法宜舒肝解郁,化痰散结,故选D。A项散结效果好,但是不能化痰;B项只是疏肝，不能散结;C项化痰和散结效果都不好。E项化痰效果好,但是不能散结。" + }, + { + "question_num": 65, + "query": "对伤寒诊断及预后有指导意义的检查是", + "options": { + "A": "血白细胞总数", + "B": "肥达反应", + "C": "嗜酸粒细胞计数", + "D": "血小板计数", + "E": "肝功能" + }, + "answer": "C", + "reason": "只有嗜酸粒细胞计数对诊断及预后均有意义,伤寒患者该细胞减少或消失,若高于5%可除外伤寒,病情好转时该细胞逐渐恢复正常。" + }, + { + "question_num": 66, + "query": "患者,女,48岁。颈前肿物,生长迅速，质地较硬,轻度疼痛,表面不平,推之不动,声音嘶哑,随吞咽活动减弱,同位素扫描显示为冷结节。应首选的治疗措施是", + "options": { + "A": "中药外敷", + "B": "中药内服", + "C": "中药内服、外敷", + "D": "内服、外敷、熏洗", + "E": "手术治疗" + }, + "answer": "E", + "reason": "此证乃石瘿,为恶性肿瘤,一旦确诊，宜早期手术切除。" + }, + { + "question_num": 67, + "query": "下列哪项不是痰饮内阻证呕吐的特征", + "options": { + "A": "呕吐清水痰涎", + "B": "脘闷不食", + "C": "头眩心悸", + "D": "胸胁疼痛", + "E": "脉滑" + }, + "answer": "D", + "reason": "痰饮内阻证的特点,脾不运化,故脘闷不食;胃气不降,故呕吐清水痰涎;水饮上犯清阳，故头眩;水气凌心，故心悸;痰从内成北旺语日脚安疮船头气涉山疯引起,本证无。" + }, + { + "question_num": 68, + "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": 69, + "query": "腹痛、腹泻黏液脓血便,伴发热恶寒,最可能的诊断是", + "options": { + "A": "细菌性痢疾", + "B": "阿米巴痢疾", + "C": "急性胃肠炎", + "D": "流行性脑脊髓炎", + "E": "霍乱" + }, + "answer": "A", + "reason": "各种传染病的鉴别如下:细菌性痢疾腹痛重,粪便量少,为黏液脓血便,多有发热。" + }, + { + "question_num": 70, + "query": "下列关于流行性出血热发热期三痛的叙述，正确的是", + "options": { + "A": "全身酸痛、头痛、眼眶痛", + "B": "头痛、腓肠肌痛、腰痛", + "C": "腹痛、腰痛、眼眶痛", + "D": "头痛、腰痛、眼眶痛", + "E": "全身酸痛、腰痛、眼眶痛" + }, + "answer": "D", + "reason": "" + }, + { + "question_num": 71, + "query": "治疗噎膈气虚阳微证,偏于肾虚者,应首选", + "options": { + "A": "启膈散", + "B": "五汁安中饮", + "C": "通幽汤", + "D": "右归丸", + "E": "左归丸" + }, + "answer": "D", + "reason": "噎膈痰气交阻证用A;津亏热结证用B;瘀血内结证用C;气虚阳微证偏于肾虚者用右归丸，故选D;左归丸偏于治疗肾阴虚。" + }, + { + "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": "水肿的关键病位是", + "options": { + "A": "心", + "B": "肝", + "C": "肺", + "D": "脾", + "E": "肾" + }, + "answer": "E", + "reason": "水肿的病位在肺、脾、肾,关键在肾。" + }, + { + "question_num": 74, + "query": "患者,女,23岁,已婚。孕后心烦少寐，渴喜冷饮,腰酸腹痛,伴阴道少量出血,舌红苔黄,脉滑数。治疗应首选", + "options": { + "A": "清热固经汤", + "B": "保阴煎", + "C": "加味阿胶汤", + "D": "加味圣愈汤", + "E": "以上均非" + }, + "answer": "B", + "reason": "此为胎动不安之血热证,治宜凉血，养血安胎,代表方为保阴煎。" + }, + { + "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": "流脑皮肤瘀点、瘀斑不断增加，考虑DIC,应及早应用的药物是", + "options": { + "A": "青霉素", + "B": "甘露醇", + "C": "头孢菌素", + "D": "肾上腺皮质激素", + "E": "肝素" + }, + "answer": "E", + "reason": "流行性脑脊髓膜炎如皮肤瘀点、瘀斑不断增加，且融合成片，并有血小板明显减少者,应及早应用肝素治疗。" + }, + { + "question_num": 78, + "query": "下列关于感染过程的描述,错误的是", + "options": { + "A": "病原体与人体相互作用,相互斗争的过程称为感染过程", + "B": "感染过程的构成必须具备病原体、人体和外环境三个因素", + "C": "病原体的致病力包括毒力、侵袭力、病原体数量和变异性", + "D": "病原体侵入的数量越大,出现显性感染的危险也越大", + "E": "病原体侵入人体,发病意味着感染过程的开始" + }, + "answer": "E", + "reason": "构成传染过程必须具备三个因素:病原体、人体和它们所处的外环境。病原体侵人人体能否发病,取决于病原体的致病能力和机体的免疫功能两个因素。病原体的致病能力与侵袭力、毒力、数量、变异性等因素有关。机体与病原体在相互作用中可出现五种不同程度的表现:①病原体被清除;②隐性感染;③显性感染;④病原携带状态;⑤潜伏性感染。" + }, + { + "question_num": 79, + "query": "治疗久泻不止,不宜过用", + "options": { + "A": "健脾", + "B": "补肾", + "C": "升提", + "D": "固涩", + "E": "分利" + }, + "answer": "E", + "reason": "泄泻日久,耗伤正气,多属虚证,脾虚者宜健脾,排除A;肾虚者应补肾,排除B;中气下陷者应升提,排除C;久泻不止宜固涩,排除D;久泻不止不可分利太过，以免重伤阴液,故选E。" + }, + { + "question_num": 80, + "query": "直肠的全长应为", + "options": { + "A": "3~4.5cm", + "B": "10cm", + "C": "12cm", + "D": "15cm", + "E": "18cm" + }, + "answer": "C", + "reason": "直肠上端在第2~3骶椎水平与乙状结肠相连接,在骶尾骨前面下行，于尾骨尖稍下方终止于齿状线，并与肛管连接。直肠全长12cm。" + }, + { + "question_num": 81, + "query": "在五输穴中,荥穴主要治疗", + "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": "《难经·六十八难》说:“井主心下满,荥主身热,输主体重节痛,经主喘咳寒热,合主逆气而泻。”" + }, + { + "question_num": 82, + "query": "霍乱传播途径中作用最突出的是", + "options": { + "A": "苍蝇", + "B": "鼠", + "C": "水", + "D": "蚊子", + "E": "恙螨" + }, + "answer": "C", + "reason": "霍乱经类-口途径传播,在传播因素中,水、食物、生活接触、昆虫媒介(特别是苍帽)均可的一他成交错地传播本病，其中水与食物常可引起人群中水型或食物型暴发,危害较大。" + }, + { + "question_num": 83, + "query": "治疗寒湿痢,应首选", + "options": { + "A": "胃苓汤", + "B": "桃花汤", + "C": "连理汤", + "D": "黄土汤", + "E": "真人养脏汤" + }, + "answer": "A", + "reason": "寒湿痢为寒湿之邪内盛,属于实证,用温化寒湿、调气和血的胃苓汤。虚寒痢用温补脾肾的桃花汤、收涩固脱的真人养脏汤。休息痢发作期虚实夹杂，既要温补脾肾、又要清肃邪毒，用连理汤，黄土汤温阳健脾，养血止血，用于脾不统血的失血证。" + }, + { + "question_num": 84, + "query": "肛隐窝炎的并发症是", + "options": { + "A": "肛口肿胀", + "B": "肛口疼痛", + "C": "肛口出血", + "D": "肛乳头炎", + "E": "肛口潮湿" + }, + "answer": "D", + "reason": "肛隐窝炎是指发生在肛窦肛门瓣的急慢性炎症性疾病，故又称肛买炎肛隐窝炎常并发肚乳头炎和肚乳头肥大，其临床特征是肛门部胀痛不适和肛门部潮湿有分泌物。肛隐窝炎是肛周脓肿的重要原因。" + }, + { + "question_num": 85, + "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": "郄穴", + "E": "下合穴" + }, + "answer": "D", + "reason": "郄穴可以治疗本经和相应脏腑病证，尤其是急性病证方面独特疗效，如急性胃病用梁丘,咯血用孔最。" + }, + { + "question_num": 86, + "query": "霍乱患者最早出现的病理生理改变是", + "options": { + "A": "急性肾衰竭", + "B": "急性肾上腺皮质功能不全", + "C": "急性心功能不全", + "D": "脑功能障碍", + "E": "大量水分及电解质丢失" + }, + "answer": "E", + "reason": "霍乱肠毒素与宿主肠黏膜上皮细胞受体结合,使细胞分泌功能增强，大量分泌水及电解质，导致水及电解质大量丧失,可引起血液浓缩,低血容量性休克,水及电解质紊乱，代谢性酸中毒由于胆计分泌减少及肠液分泌量大，严重者出现米泔水样排泄物。" + }, + { + "question_num": 87, + "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,滋阴通便,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": 88, + "query": "肛管直肠瘤的早期症状除便血外，还可见", + "options": { + "A": "大便变形", + "B": "腹胀肠鸣", + "C": "脱出不纳", + "D": "排便习惯改变", + "E": "肛门潮湿" + }, + "answer": "D", + "reason": "锁肛痔是指肛管直肠瘤后期,肿块堵塞肛门,引起肛门狭窄,大便困难，犹如锁住肛门一样,故称锁肛痔。相当于西医的肛管直肠癌,其临床特点是便血、排便习惯改变、直肠肛管肿块。" + }, + { + "question_num": 89, + "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": "听宫在下颌骨髁状突的后方,张口取穴。" + }, + { + "question_num": 90, + "query": "治疗喘证痰热郁肺证,应首选", + "options": { + "A": "桑白皮汤", + "B": "麻杏石甘汤", + "C": "苏子降气汤", + "D": "定喘汤", + "E": "泻白散" + }, + "answer": "A", + "reason": "喘证痰热郁肺证当清热化痰,宣肺平喘,方予桑白皮汤加减。" + }, + { + "question_num": 91, + "query": "黄疸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、湿热蕴结、积聚内阻,引发胆汁外溢，或化源不足、血败不华于色。但最后都会影响到肝脾,脾虚湿蕴,都见湿邪,其余病理因素可与湿相兼" + }, + { + "question_num": 92, + "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": "容易形成瘘管", + "E": "疮口容易愈合" + }, + "answer": "E", + "reason": "子痰是发生于附睾部的慢性化脓性疾病。溃破后脓液清稀,或带豆腐渣样絮状物,腥味较浓,易形成长期不愈合的阴部窦道。疮口凹陷,形成瘘管,愈合缓慢,或虽愈合,反复发作,全身虚热不退,病久不愈:故E项是不正确的,不属于本病的症状。" + }, + { + "question_num": 93, + "query": "中风左侧肢体瘫痪的患者应取", + "options": { + "A": "左侧顶颞前斜线和顶颞后斜线", + "B": "右侧顶颞前斜线和顶颞后斜线", + "C": "右侧顶颞后斜线", + "D": "左侧顶额后斜线", + "E": "左侧颞后线" + }, + "answer": "B", + "reason": "顶颞前斜线的主治:分为5等份，上1/5治疗对侧下肢和躯干瘫痪,中2/5治疗上肢瘫痪，下2/5治疗中枢性面瘫、运动性失语、流涎、脑动脉粥样硬化等。顶颞后斜线主治感觉异常，也分5等份,与顶颗前斜线5等份对应部位一样。" + }, + { + "question_num": 94, + "query": "患者泄泻腹痛,泻下急迫,粪色黄褐，气味臭秽,肛门灼热,烦热口渴,舌质红，苔黄腻,脉滑数。治疗应首选", + "options": { + "A": "藿香正气散", + "B": "不换金正气散", + "C": "葛根苓连汤", + "D": "白头翁汤", + "E": "芍药汤" + }, + "answer": "C", + "reason": "此患者为湿热壅滞,方予葛根芩连汤加减" + }, + { + "question_num": 95, + "query": "治疗胀水湿困脾证,应首选", + "options": { + "A": "柴胡疏肝散合胃苓汤", + "B": "实脾饮", + "C": "中满分消丸", + "D": "调营饮", + "E": "附子理苓汤" + }, + "answer": "B", + "reason": "臌胀分类有气滞湿阻、水湿困脾、水热蕴结、瘀结水留、阳虚水盛、阴虚水停。本证水湿困脾,故腹大胀满，按之如裹水,颜面浮肿;脾不运化故胸脘胀闷;阳气不足则遇热则舒,精神困倦,怯寒懒动,小便少,大便溏,舌苔白腻,脉缓。治宜温阳健脾,行气利水,用实脾饮。气滞湿阻用柴胡疏肝散。阳虚水停,用附子理苓汤。瘀结水留用调营饮" + }, + { + "question_num": 96, + "query": "前列腺炎的主要临床表现是", + "options": { + "A": "无痛性血尿", + "B": "精液中有血", + "C": "尿中有血,并有腰部剧痛", + "D": "尿频、进行性排尿困难", + "E": "尿频急而痛,尿末常有白色分泌物" + }, + "answer": "E", + "reason": "临床症状常会出现尿频、尿急、尿痛、尿道内灼热不适和尿末会滴出白色分泌物。" + }, + { + "question_num": 97, + "query": "面部疼痛突然发作,呈闪电样、刀割样剧痛,持续数秒到2分钟,痛处有灼热感,流涎，目赤流泪,苔薄黄,脉数。治疗除取主穴外，还应选取", + "options": { + "A": "丝竹空、阳白、外关", + "B": "颧髎、迎香", + "C": "列缺、太阳", + "D": "曲池、尺泽", + "E": "太冲、三阴交" + }, + "answer": "D", + "reason": "面痛多与外感邪气、情志不调、外伤因素有关,治法当以疏通经络，祛风止痛为主。该患者痛处有灼热感,流涎，目赤流泪,苔黄,脉数为风热证,故选取曲池、尺泽为配穴。" + }, + { + "question_num": 98, + "query": "治疗胃痛脾胃虚寒证,应首选", + "options": { + "A": "小建中汤", + "B": "理中丸", + "C": "附子理中丸", + "D": "良附丸", + "E": "黄芪建中汤" + }, + "answer": "E", + "reason": "胃痛脾胃虚寒证治当温中健脾,和胃止痛,予黄芪建中汤加减。" + }, + { + "question_num": 99, + "query": "阳明头痛,可选用的引经药是", + "options": { + "A": "羌活、蔓荆子", + "B": "羌活、川芎", + "C": "葛根、白芷", + "D": "柴胡、川川芎", + "E": "吴茱萸、藁本" + }, + "answer": "C", + "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、本。" + }, + { + "question_num": 100, + "query": "深静脉血栓形成的最大危险性是", + "options": { + "A": "水肿", + "B": "肺栓塞", + "C": "下肢坏死", + "D": "患肢增粗", + "E": "浅静脉扩张" + }, + "answer": "B", + "reason": "本病早期可出现急性股动脉痉挛和肺动脉栓塞两种危重性并发症。" + }, + { + "question_num": 101, + "query": "患者,男,48岁。头胀痛近2年,时作时止,伴目眩,易怒,面赤口苦,舌红苔黄,脉弦数。治疗除取主穴外应选用", + "options": { + "A": "头维、内庭、三阴交", + "B": "血海、风池、足三里", + "C": "风池、列缺、太阳", + "D": "太溪、侠溪、太冲", + "E": "丰隆、太阳、风门" + }, + "answer": "D", + "reason": "本证属肝阳上亢头痛,主穴为百会、头维、风池,肝阳头痛加太冲、太溪、侠溪。" + }, + { + "question_num": 102, + "query": "治疗胸痹心血瘀阻证的代表方剂是", + "options": { + "A": "生脉饮", + "B": "瓜蒌薤白白酒汤", + "C": "血府逐瘀汤", + "D": "瓜蒌薤白半夏汤", + "E": "苏合香丸" + }, + "answer": "C", + "reason": "心血瘀阻导致的胸痹应活血化瘀,通脉止痛,故用血府逐瘀汤。" + }, + { + "question_num": 103, + "query": "中风之中脏腑与中经络的鉴别要点是", + "options": { + "A": "神志不清", + "B": "半身不遂", + "C": "语言不利", + "D": "肢体软瘫", + "E": "口舌歪斜" + }, + "answer": "A", + "reason": "中风有中经络、中脏腑之分,而神志障碍的有无是其划分的标志，故选A。半身不遂、语言不利、肢体瘫软、口舌歪斜是中风中经络和中脏腑的共同表现，故排除BCDE." + }, + { + "question_num": 104, + "query": "下列哪项不是附骨疽的临床特点", + "options": { + "A": "好发于儿童", + "B": "多发于脊柱骨", + "C": "局部胖肿,疼痛彻骨", + "D": "溃后脓水淋漓,不易收口", + "E": "可成实道,损筋伤骨" + }, + "answer": "B", + "reason": "附骨疽是一种毒邪深沉、附着于骨的化脓性疾病,其特点是多发于四肢长骨,局部胖肿,附筋着骨,推之不移,疼痛彻骨溃后脓水淋漓,不易收口,可成实道,损伤筋骨。好发于2~10岁的男孩。多发于四肢长骨,发病部位以胫骨为主,其次为股骨、肱骨、桡骨。一般不发于脊柱骨。" + }, + { + "question_num": 105, + "query": "患者、男、20岁突发胸闷，气急，咳嗽。听诊:两肺满布哮鸣音。应首先考虑的是", + "options": { + "A": "慢性支气管炎喘息型", + "B": "急性支气管炎", + "C": "心源性哮喘", + "D": "支气管哮喘", + "E": "气胸" + }, + "answer": "D", + "reason": "患者属于青少年,突然起病,带哮鸣音的呼气性呼吸困难,咳���,听诊两肺满布哮鸣音,符合支气管哮喘的特点。" + }, + { + "question_num": 106, + "query": "血分热盛可见", + "options": { + "A": "强硬舌", + "B": "瘦舌", + "C": "点刺舌", + "D": "歪斜舌", + "E": "老舌" + }, + "answer": "C", + "reason": "" + }, + { + "question_num": 107, + "query": "疟疾患者,热多寒少,汗出不畅,头痛,骨节酸痛,口渴引饮,便秘,溲赤,舌红苔黄,脉弦数,其治法是", + "options": { + "A": "和解表里,温阳达邪", + "B": "祛邪截疟,和解表里", + "C": "解毒除瘴,清热保津", + "D": "益气养血,扶正祛邪", + "E": "清热解表,和解祛邪" + }, + "answer": "E", + "reason": "本证既有疟疾在外的表证又有在里的热证表现，故为温疟。治宜清热解表,和解祛邪。A项用于寒疟。B项用于正疟，C项用于热瘴。D项用于劳疟。" + }, + { + "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": "不寐实证,其病位多在", + "options": { + "A": "心、脾、肾", + "B": "心、肝、小肠", + "C": "心、肺、大肠", + "D": "心、脾、肝", + "E": "肝、胃、心" + }, + "answer": "E", + "reason": "不寐的病位在心,与肝、脾肾密切相关,其中不寐实证与肝、胃、心相连。" + }, + { + "question_num": 110, + "query": "下列各项,不属于流行性出血热发热期治疗原则的是", + "options": { + "A": "控制感染", + "B": "减轻外渗", + "C": "透析疔法", + "D": "改善中毒症状", + "E": "预防DIC" + }, + "answer": "C", + "reason": "发热期治疗原则:控制感染,减轻外渗,改善中毒症状和预防DIC。低血压休克期治疗原则:积极补充血容量，注意纠正酸中毒和改善微循环功能。少尿期治疗原则:“稳、促、导、透”,即稳定机体内环境,促进利尿，导泻和透析治疗。" + }, + { + "question_num": 111, + "query": "水肿的关键病位是", + "options": { + "A": "心", + "B": "肝", + "C": "肺", + "D": "脾", + "E": "肾" + }, + "answer": "E", + "reason": "《景岳全书》指出:凡水肿等症,乃肺、脾、肾三脏相干之病,盖水为至阴,故其本在肾;水化于气,故其标在肺;水惟畏土，故其治在脾,故最关键的是肾，" + }, + { + "question_num": 112, + "query": "一烧伤患者。体温不升,呼吸气微,表情淡漠,神志恍惚。嗜睡,语言含糊不清,四肢厥冷,汗出淋漓,舌光无苔,脉细,其证候是", + "options": { + "A": "火热伤津", + "B": "阴伤阳脱", + "C": "火毒内陷", + "D": "气血两伤", + "E": "脾胃虚弱" + }, + "answer": "B", + "reason": "火毒侵人营血,内攻脏腑导致脏腑失和,阴阳平衡失调,津液严重耗伤表情淡漠,神志恍惚,嗜睡,语言含糊不清,四肢厥冷,汗出淋漓,属于阳脱之象。" + }, + { + "question_num": 113, + "query": "4周岁小儿的身长应为", + "options": { + "A": "90cm", + "B": "98cm", + "C": "103cm", + "D": "105cm", + "E": "110cm" + }, + "answer": "C", + "reason": "出生时身高约为50cm。生后第一年增长最快,2周岁后至青春期身高增长平稳,每年约7cm。2岁后至12岁儿童的身高:身高(cm)=75+7*年龄。因此，本题算式:75+7*4=103。" + }, + { + "question_num": 114, + "query": "丁型肝炎的潜伏期是", + "options": { + "A": "2~6周", + "B": "4~24周", + "C": "4~20周", + "D": "2~9周", + "E": "2~26周" + }, + "answer": "C", + "reason": "各型肝炎的潜伏期长短不E开IH火E丙型肝炎为2~26周，丁型肝炎为4~20周，戊型肝炎为2~9周。" + }, + { + "question_num": 115, + "query": "与石淋的发病关系最为密切的病机是", + "options": { + "A": "脾虚中气下陷", + "B": "肾虚下元不固", + "C": "湿热蕴结下焦", + "D": "热盛迫血妄行", + "E": "气郁化火伤阴" + }, + "answer": "C", + "reason": "脾虚中气下陷多为气淋虚证,遇劳即发则为劳淋，肾虚下元不固不能制约脂液则为膏淋,热盛破血妄行的是血淋，气郁化火伤阴，少腹作胀,小便艰涩而痛的属气淋实证,湿热蕴结下焦,尿液受其煎熬，日久杂质结为砂石,则为石淋，" + }, + { + "question_num": 116, + "query": "肌肉强直性痉挛是破伤风的典型症状之一,其首先出现的部位是", + "options": { + "A": "上肢", + "B": "下肢", + "C": "头面", + "D": "颈项", + "E": "躯干" + }, + "answer": "C", + "reason": "破伤风时肌肉强直性痉挛首先从头面部开始,进而延展至躯干四肢。" + }, + { + "question_num": 117, + "query": "婴儿(<1岁)服用的中药煎出量是", + "options": { + "A": "10~20ml", + "B": "21~30ml", + "C": "31~40ml", + "D": "41~50ml", + "E": "60~100ml" + }, + "answer": "E", + "reason": "" + }, + { + "question_num": 118, + "query": "患者,男,50岁。胸痛剧烈,痛无休止，伴身寒肢冷，气短喘促，脉沉微。治疗应选用的方剂是", + "options": { + "A": "乌头赤石脂丸", + "B": "四逆加人参汤", + "C": "瓜蒌桂枝汤", + "D": "当归四逆汤", + "E": "参附汤" + }, + "answer": "A", + "reason": "胸痛剧烈--胸痹，治宜温通散寒,方用乌头赤石脂丸。" + }, + { + "question_num": 119, + "query": "癃闭的病位虽在膀胱,但与本病关系密切的脏腑还有", + "options": { + "A": "肺、脾、肾、三焦", + "B": "肺、肾、胃、三焦", + "C": "肝、脾、肾、小肠", + "D": "肺、脾、胃、三焦", + "E": "肺、脾、肝、小肠" + }, + "answer": "A", + "reason": "癃闭表现为尿量减少,排尿困难,甚至小便闭塞不通。小便的通畅,有赖于肾和膀胱的气化作用,但从脏腑之间的整体关系来看，水液的吸收、运行、排泄,还有赖于三焦的气化,肺、脾、肾的通调、转输、蒸化。因此癃闭除与膀胱有关外,还和肺、脾、肾、三焦有密切关系。" + }, + { + "question_num": 120, + "query": "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，凉血熄风", + "D": "凉血熄风,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": "暑淫证候的表现是", + "options": { + "A": "头昏沉,嗜睡,胸脘痞闷", + "B": "口渴饮水,口唇鼻咽干燥", + "C": "发热恶热,汗出,气短神疲", + "D": "突发皮肤瘙痒、丘疹", + "E": "肠鸣腹泻,脘腹拘急冷痛" + }, + "answer": "C", + "reason": "暑淫证临床表现:发热恶寒,汗出,口渴喜饮,气短,神疲,肢体困倦,小便短黄,舌质红,苔白或黄,脉虚数(暑性炎热升散,耗气伤津);或发热,猝然昏倒,汗出不止,气喘,甚至昏迷、惊厥、抽搐等;或见高热、神昏、胸闷、腹痛、呕恶、无汗等。" + }, + { + "question_num": 122, + "query": "胸痹阴寒凝滞证,其临床特点是", + "options": { + "A": "胸部刺痛,人夜尤甚", + "B": "胸闷隐痛,时作时止", + "C": "胸闷如室,气短喘促", + "D": "胸闷气短,畏寒肢冷", + "E": "胸痛彻背,感寒痛甚" + }, + "answer": "E", + "reason": "胸痹阴寒凝滞者表现为胸痹(心痛如绞,心痛彻背)十阴寒凝滞(胸闷气短,寒象)十气候骤冷或感寒而发或加重、胸部刺痛。" + }, + { + "question_num": 123, + "query": "治疗郁证日久,阴虚火旺者,应首选", + "options": { + "A": "丹栀逍遥散", + "B": "知柏地黄丸", + "C": "天王补心丹", + "D": "六味地黄丸", + "E": "滋水清肝饮" + }, + "answer": "E", + "reason": "丹栀逍遥散疏肝解郁,清肝泻火,用于气郁化火的郁证初期,排除A;知柏地黄丸滋阴降火，用于肾阴虚火旺证,排除B天王补心丹滋阴养血,补心安神，用于心阴亏虚的郁证,排除C;六味地黄丸滋阴补肾,用于肾阴不足证,排除D;滋水清肝饮由六味地黄丸合丹栀逍遥散加减而成,滋养阴精,补益肝肾的作用更强，适用于郁证日久,阴虚火旺之人,故选E。" + }, + { + "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。子门是指子宫颈口。" + }, + { + "question_num": 125, + "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。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": "疏凿饮子" + }, + "answer": "A", + "reason": "小便短少,身体困重,胸闷纳呆，泛恶,舌苔白腻,脉沉缓为水湿浸溃,故选五皮饮合胃苓汤。" + }, + { + "question_num": 126, + "query": "治疗肺炎喘嗽肺脾气虚证,应首选", + "options": { + "A": "人参五味子汤", + "B": "沙参麦冬汤", + "C": "参附龙牡救逆汤", + "D": "四君子汤", + "E": "玉屏风散" + }, + "answer": "A", + "reason": "肺炎喘嗽后期阴虚肺热证用沙参麦冬汤,肺脾气虚证用人参五味子汤。" + }, + { + "question_num": 127, + "query": "提出“止血、消瘀、宁血、补血”治血四法的医著是", + "options": { + "A": "《血证论》", + "B": "《景岳全书》", + "C": "《医林改错》", + "D": "《临证指南医案》", + "E": "《先醒斋医学广笔记》" + }, + "answer": "A", + "reason": "清代唐容川《血证论》中提出治血四法。《景岳全书》强调火与气为发病原因。《先醒斋医学广笔记》提出治吐血三要法:宜行血不宜止血、宜补肝不宜伐肝、宜降气不宜降火。" + }, + { + "question_num": 128, + "query": "下列哪项不是天癸臻熟的条件", + "options": { + "A": "肾气充盛", + "B": "脾气健旺", + "C": "已18岁", + "D": "精血充实", + "E": "肾阴充盛" + }, + "answer": "C", + "reason": "天癸,源于先天,藏之于肾受后天水谷精微的滋养，人体发育到一定时期,肾气旺盛,肾中真阴不断得到充实，天癸逐渐成熟。C项是男女天癸初至后的年龄，不是成熟的年龄。" + }, + { + "question_num": 129, + "query": "猩红热可见的舌改变是", + "options": { + "A": "牛肉舌", + "B": "毛舌", + "C": "草莓舌", + "D": "裂纹舌", + "E": "镜面舌" + }, + "answer": "C", + "reason": "" + }, + { + "question_num": 130, + "query": "具有行气导滞、攻积泄热功用的方剂", + "options": { + "A": "舟车丸", + "B": "保和丸", + "C": "枳实消痞丸", + "D": "木香槟榔丸", + "E": "枳实导滞丸" + }, + "answer": "D", + "reason": "木香槟榔丸行气导滞、攻积泄热,用于积滞内停、湿蕴生热证,症见“脘腹痞满胀痛,赤白痢疾,里急后重,或大便秘结，舌苔黄腻,脉沉实”。" + }, + { + "question_num": 131, + "query": "痰饮的治疗原则是", + "options": { + "A": "宣肺", + "B": "健脾", + "C": "温化", + "D": "补肾", + "E": "发汗" + }, + "answer": "C", + "reason": "痰饮总的病理性质是阳虚阴盛,为阴邪,遇寒则凝,得温则行,故总的治疗原则应以温阳化饮为根本，以振奋阳气，开发腠理,通行水道,故选C;若有肺失宣降,可佐以宣肺,脾阳虚可健脾,肾阳虚可补肾,饮停于表可发汗，但这些都是配合方法，总的治则还是温化,故排除ABDE。" + }, + { + "question_num": 132, + "query": "中医学女性生殖轴的概念是", + "options": { + "A": "脑一肾一天癸一胞宫", + "B": "天癸一冲任一气血一胞宫", + "C": "肾一天癸一气血-胞宫", + "D": "肾一天癸一冲任一胞宫", + "E": "天癸一肾-冲任一胞宫" + }, + "answer": "D", + "reason": "D项为女性生殖轴的概念。" + }, + { + "question_num": 133, + "query": "患者,男,73岁。左下肢内廉疮,面积8cmx5cm,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": "廉疮有腐肉,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,故选A。" + }, + { + "question_num": 134, + "query": "治疗咳嗽迁延不愈或愈而复发,应首选", + "options": { + "A": "止嗽散", + "B": "三拗汤", + "C": "桑杏汤", + "D": "泻白散", + "E": "华盖散" + }, + "answer": "A", + "reason": "止嗽散疏风润肺,用于风寒咳嗽,迁延不愈或愈而复发者。" + }, + { + "question_num": 135, + "query": "下列各项,除哪项外,均是消渴发病的主要病机", + "options": { + "A": "燥热", + "B": "气虚", + "C": "阴虚", + "D": "气滞", + "E": "水停" + }, + "answer": "E", + "reason": "消渴的基本病机是阴虚为本,燥热为标,故排除AC;阴阳互根互用,消渴病久可阴伤及气,见气虚,故排除B;阴虚内热损耗津液,则血脉为之虚涩而成血瘀,故排除D;只有水停不属于消渴发病的主要病机，故选E。" + }, + { + "question_num": 136, + "query": "妊娠8、9个月时,或腹中痛,痛定仍然如常者,称为", + "options": { + "A": "试胎", + "B": "弄胎", + "C": "垢胎", + "D": "盛胎", + "E": "滑胎" + }, + "answer": "A", + "reason": "A项指妊娠八九个月时:或腹中痛,痛定如常者。B项指若月数已足，腹痛或作或止，腰不痛。CD项指孕后仍按月行经而产子者。《本草纲目·论月水》:“有受胎之后，月月行经而产子者,是谓盛胎，俗名垢胎。”E项凡堕胎或���产发生3次或3次以上者。" + }, + { + "question_num": 137, + "query": "疟疾患者,热多寒少,汗出不畅,头痛,骨节酸痛,口渴引饮,便秘,溲赤,舌红苔黄,脉弦数。治疗应首选", + "options": { + "A": "柴胡桂枝干姜汤", + "B": "柴胡截疟饮", + "C": "截疟七宝饮", + "D": "小柴胡汤", + "E": "白虎加桂枝汤" + }, + "answer": "E", + "reason": "根据脉证为温疟,选白虎加桂枝汤清热解表。" + }, + { + "question_num": 138, + "query": "经乱无期,出血淋漓不尽,色鲜红,质稍稠，头晕耳鸣，腰膝酸软。治疗应首选", + "options": { + "A": "固阴煎", + "B": "六味地黄丸", + "C": "大补元煎", + "D": "左归丸", + "E": "归肾丸" + }, + "answer": "D", + "reason": "此证为崩漏肾阴虚证,治宜滋肾益阴，固冲止血，代表方为左归丸合二至丸。" + }, + { + "question_num": 139, + "query": "治疗阴虚发热,应首选", + "options": { + "A": "六味地黄丸", + "B": "一贯煎", + "C": "清骨散", + "D": "二阴煎", + "E": "三圣散" + }, + "answer": "C", + "reason": "六味地黄丸滋阴补肾,用于肾阴虚证,排除A;一贯煎滋阴疏肝,用于阴虚肝郁证,排除B;清骨散清虚热,退骨蒸,用于阴虚内热证,故选C;二阴煎侧重滋阴,降火力量不足,排除D;三圣散用于涌吐风痰,排除E。" + }, + { + "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": "治疗痿证使用泻南方,补北方的原则是因为该病", + "options": { + "A": "寒多热少,虚多实少", + "B": "热多寒少,虚多实少", + "C": "热多寒少,实多虚少", + "D": "寒多热少,实多虚少", + "E": "以上均非" + }, + "answer": "B", + "reason": "痰证日久,皆可累及肝肾:肝肾不足,阴虚火旺是结果,故热多寒少,虚多实少,治宜泻南补北,清心滋肾。" + }, + { + "question_num": 142, + "query": "患者,男,60岁。平咳少痰,气短自汗，口千舌燥,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、敛阴止吴执耗气你阳证，成久吃肺磨田泪归气阴两虚证,主症可见“汗多神疲,体倦乏力,气短懒言,咽干口渴,舌干红少苔,脉虚数”。" + }, + { + "question_num": 143, + "query": "虚劳以气虚为主时,主要病变的脏是", + "options": { + "A": "肺、脾", + "B": "心、肾", + "C": "肺、肾", + "D": "脾、肾", + "E": "心、肺" + }, + "answer": "A", + "reason": "虚劳是多脏虚弱。肺主气，气虚肯定有肺。肺金脾土，肺虚日久，子盗母气,脾气也虚,故主要是肺脾。" + }, + { + "question_num": 144, + "query": "下列月经病的治疗,错误的是", + "options": { + "A": "重在治本调经", + "B": "分清先病和后病", + "C": "急则治标,缓则治本", + "D": "顺应不同年龄阶段论治", + "E": "多用辛温暖官之品" + }, + "answer": "E", + "reason": "月经病的三条治疗原则是重在治本调经,分清先病和后病,急则治标,缓则治本。治疗月经病又要顺应和掌握的规律:一是顺应月经周期中阴阳气血的变化规律;二是顺应不同年龄阶段论治的规律;三是掌握虚实补泻规律。" + }, + { + "question_num": 145, + "query": "治疗湿热腰痛,应首选", + "options": { + "A": "甘姜苓术汤", + "B": "四妙丸", + "C": "羌活胜湿汤", + "D": "薏苡仁汤", + "E": "乌头汤" + }, + "answer": "B", + "reason": "湿热腰痛应清热利湿,舒筋止痛,方选四妙丸。" + }, + { + "question_num": 146, + "query": "五行中具有“曲直”特性的是", + "options": { + "A": "木", + "B": "火", + "C": "土", + "D": "金", + "E": "水" + }, + "answer": "A", + "reason": "水曰润下,火曰炎上,木曰曲直,金曰从革,土爱稼穑，" + }, + { + "question_num": 147, + "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": "虚劳的病损部位主要在五脏,尤以脾肾两脏更为重要,为先后天之本。" + }, + { + "question_num": 148, + "query": "治疗月经先期阳盛血热证,应首选", + "options": { + "A": "清经散", + "B": "逍遥散", + "C": "当归芍药散", + "D": "导赤散", + "E": "柴胡疏肝散" + }, + "answer": "A", + "reason": "月经先期阳盛血热证方药选清经散。" + }, + { + "question_num": 149, + "query": "患者,男,45岁。胁痛口苦,胸闷纳呆,恶心、呕吐,目黄身黄,舌苔黄腻,脉弦滑数,其证候是", + "options": { + "A": "肝气郁结", + "B": "肝郁化火", + "C": "肝胆湿热", + "D": "肝阴不足", + "E": "瘀而阳滞" + }, + "answer": "C", + "reason": "胸闷纳呆,苔腻,脉滑湿象。加之胁痛口苦,病位在肝胆,故为肝胆湿热。" + }, + { + "question_num": 150, + "query": "患者,女,40岁。呕吐痰涎,伴头晕,胸痞,心悸,舌苔白,脉滑。治疗除取主穴外，还应加", + "options": { + "A": "列缺、尺泽", + "B": "膻中、丰隆", + "C": "曲池、外关", + "D": "风池、尺泽", + "E": "列缺、合谷" + }, + "answer": "B", + "reason": "呕吐治疗主穴:内关、胃俞:足三里、中脘。配穴:寒吐者,加上脘、公孙;热吐者,加商阳、内庭,并可用金津、玉波点刺出血;食滞者,加梁门、天枢;痰饮者,加膻中、丰隆;该患者头晕、胸痞、脉滑为痰饮内阻证，" + }, + { + "question_num": 151, + "query": "治疗虚劳脾胃阴虚者,应首选", + "options": { + "A": "玉女煎", + "B": "益胃汤", + "C": "沙参麦冬汤", + "D": "麦门冬汤", + "E": "一贯煎" + }, + "answer": "B", + "reason": "玉女煎清胃热,滋肾阴,用于胃热阴虚证,排除A;益胃汤滋补阴津,生津益胃,用于胃阴虚证,故选B;沙参麦冬汤清养肺胃,生津润燥,用于肺胃阴伤证,排除C;麦门冬汤滋养肺胃,用于肺胃阴伤证,排除D;一贯煎滋阴疏肝,用于阴虚肝郁证,排除E。" + }, + { + "question_num": 152, + "query": "下列哪项不是月经后期虚寒证的主症", + "options": { + "A": "经期延后,量少色淡、质清稀", + "B": "小腹空痛,心悸失眠", + "C": "腰酸无力", + "D": "小便清长,大便稀溏", + "E": "脉沉迟或细弱无力" + }, + "answer": "B", + "reason": "B项为月经后期血虚证的主症。" + }, + { + "question_num": 153, + "query": "带下病的主要发病机制是", + "options": { + "A": "外感湿邪,损及任、带,约束无力", + "B": "肾气不足,封藏失职,阴液滑脱而下", + "C": "湿邪影响任、带,任脉不固,带脉失约", + "D": "脾虚生湿,流注下焦,伤及任、带", + "E": "肝经湿热,流注下焦,伤及任、带" + }, + "answer": "C", + "reason": "带下病包括带下过多和带下过少。带下过少的病机为阴液不足。" + }, + { + "question_num": 154, + "query": "下列各项中属乙类传染病的是", + "options": { + "A": "霍乱", + "B": "鼠疫", + "C": "传染性非典型肺炎", + "D": "风疹", + "E": "流行性感冒" + }, + "answer": "C", + "reason": "根据《中华人民共和国传染病防治法》及其实施细则，将法定传染病分为三类:甲类、乙类和丙类，其中,鼠疫和霍乱属于甲类，风疹和流行性感冒属于丙类，传染性非典型肺炎被列入法定乙类传染病，按甲类传染病管理。" + }, + { + "question_num": 155, + "query": "下列各项,属着痹特点的是", + "options": { + "A": "疼痛游走不定", + "B": "痛势较剧,痛有定处", + "C": "关节酸痛、重着、漫肿", + "D": "关节肿胀局限,见皮下结节", + "E": "关节肿胀僵硬,疼痛不移" + }, + "answer": "C", + "reason": "痹证分热痹、着痹、行痹、痛痹四种。分别以热、湿、风、寒为主要病邪。着痹以湿为重,湿性重着,特点是关节酸痛、重着、漫肿。" + }, + { + "question_num": 156, + "query": "下列各项,不属月经先后不定期肾虚证主要症状的是", + "options": { + "A": "经行或先或后", + "B": "月经量少色淡暗", + "C": "小腹冷痛拒按", + "D": "头晕耳鸣腰痛", + "E": "舌淡苔白,脉细弱" + }, + "answer": "C", + "reason": "除C项外均是,C项为寒邪致病特点。" + }, + { + "question_num": 157, + "query": "患者呼吸急促,喉中哮鸣有声,胸膈满闷,咳嗽痰少,形寒畏冷,舌苔白滑,脉弦紧,其治法是", + "options": { + "A": "温肺化痰,纳气平喘", + "B": "温肺散寒,化痰平喘", + "C": "温肺散寒,止咳化痰", + "D": "温肺化痰,散寒解表", + "E": "散寒温脾,化痰平喘" + }, + "answer": "B", + "reason": "喉中哮鸣有声--哮病;咳嗽痰少,形寒畏冷,舌苔白滑,为寒痰伏肺,痰升气阻,肺失宣降。此为哮病之冷哮,故选B。" + }, + { + "question_num": 158, + "query": "流行性出血热患者全身各组织器官都可有充血、出血、变性、坏死,表现最为明显的器官是", + "options": { + "A": "心", + "B": "肺", + "C": "肾", + "D": "脑垂体", + "E": "胃肠" + }, + "answer": "C", + "reason": "流行性出血热的病理解剖可见脏器中肾脏病变最明显。肉眼可见肾脂肪囊水肿、出血,镜检肾小球充血，基底膜增厚;肾小管受压而变窄或闭塞;间质有细胞浸润。" + }, + { + "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": "腰痛的内因是素体虚衰,腰腑失养;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": "黄疸患者,身目俱黄,黄色鲜明,恶心欲吐,发热恶寒,无汗身痛,小便短赤,舌苔薄黄腻,脉弦滑。治疗应首选", + "options": { + "A": "大柴胡汤", + "B": "小柴胡汤", + "C": "麻黄连翘赤小豆汤", + "D": "茵陈背汤", + "E": "犀角散" + }, + "answer": "D", + "reason": "黄疽,身目俱黄,黄色鲜明:小便短赤,热重于湿,故当清热通腑,利湿退黄,方用茵陈蒿汤。" + }, + { + "question_num": 162, + "query": "HIV造成机体免疫功能损害主要侵犯的细胞是", + "options": { + "A": "CD4⁺T淋巴细胞", + "B": "CD8⁺T淋巴细胞", + "C": "B淋巴细胞", + "D": "NK细胞", + "E": "浆细胞" + }, + "answer": "A", + "reason": "CD4*T淋巴细胞在HIV直接和间接作用下，细胞功能受损和大量破坏,导致细胞免疫缺陷。虽然同时还侵犯其他类型免疫细胞:单核吞噬细胞、B淋巴细胞、NK3外主要的还是CD4+T淋巴细胞,故选A。" + }, + { + "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，阳明在例,大阳在后", + "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": "治疗崩漏实热证,应首选", + "options": { + "A": "保阴煎", + "B": "固本止崩汤", + "C": "清热固经汤", + "D": "清热调血汤", + "E": "左归丸" + }, + "answer": "C", + "reason": "崩漏实热证，应首选清热固经汤。" + }, + { + "question_num": 165, + "query": "患者,女,50岁。5天前左足3、4趾缝足癣水疱溃破，次日局部红肿疼痛，并见红线!条向上走窜至小腿中段,边界清晰,伴有发热，左胯腹部淋巴结肿痛。诊断是", + "options": { + "A": "流火", + "B": "流注", + "C": "青蛇毒", + "D": "蛇串疮", + "E": "红丝疗" + }, + "answer": "E", + "reason": "红丝疗的临床表现:好发于四肢,多先在皮肤生疔部位或皮肤破损处见红肿热痛,继则在皮肤上起红丝一条或多条，迅速向躯干方向走窜，上肢可停于肘部或腋部，下肢可停于腋窝或胯间。" + }, + { + "question_num": 166, + "query": "普通型流脑临床特征性体征是皮肤", + "options": { + "A": "瘀点或瘀斑", + "B": "水疱", + "C": "黑痂", + "D": "斑丘疹", + "E": "脓肿" + }, + "answer": "A", + "reason": "70%左右的流脑患者皮肤黏膜可见瘀点或瘀斑。病情严重者瘀点、瘀斑可迅速扩大，且因血栓形成发生大片坏死。" + }, + { + "question_num": 167, + "query": "循行于上肢内侧中线的经脉是", + "options": { + "A": "手太阳经", + "B": "手少阳经", + "C": "手厥阴经", + "D": "手少阴经", + "E": "手太阴经" + }, + "answer": "C", + "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侧前廉。" + }, + { + "question_num": 168, + "query": "下列各项,不属导致崩漏常见病因的是", + "options": { + "A": "脾虚", + "B": "肾虚", + "C": "血虚", + "D": "血瘀", + "E": "血热" + }, + "answer": "C", + "reason": "崩漏常见病因是脾虚、肾虚、血瘀、血热。" + }, + { + "question_num": 169, + "query": "患者,男,40岁。喉结两侧各有1个3cmx2cmX1cm，表面光滑，质地韧，无压痛，随吞咽上下活动的肿物。为明确诊断，应首选的检查方法是", + "options": { + "A": "胸颈部X线", + "B": "血常规", + "C": "血气分析", + "D": "T3、T4", + "E": "131I扫描" + }, + "answer": "E", + "reason": "在结喉正中一侧或双侧有单个肿块,呈圆形或椭圆形,表面光滑,质韧有弹性,可随吞咽而上下移动,生长缓慢,一般无任何不适,据此可以判断为肉瘿。辅助检查:甲状腺同位素扫描显示肉瘿多为温结节，爽肿多为凉结节,伴甲亢者多为热结节。" + }, + { + "question_num": 170, + "query": "下列有关伤寒肥达反应的描述,正确的是", + "options": { + "A": "只要阳性就有明确诊断价值", + "B": "阴性结果即可除外伤寒", + "C": "可根据“O”抗体效价的不同区别伤寒或副伤寒", + "D": "“H”抗体出现较早,消失快,更有利于诊断", + "E": "检测Vi抗体可用于慢性带菌者的调查" + }, + "answer": "E", + "reason": "分析肥达反应的结果时,应注意以下几点:正常人血清中可能有低效价凝集抗体存在,通常抗体效价在1:80以上，H抗体效价在1:160以上，才有诊断价值，故A项错误;有少数伤寒患者肥达反应始终呈阴性,B项错误;伤寒与副伤寒有部分共同的抗原,体内产生相同的O抗体,故不能通过O抗体效价区别伤寒或副伤寒，C项也错误;H抗体出现迟,可持续阳性数年，D项错误;Vi抗体的检测可用于慢性带菌者的调查,故选E。" + }, + { + "question_num": 171, + "query": "与女子妊娠密切相关的经脉是", + "options": { + "A": "督脉", + "B": "任脉", + "C": "冲脉", + "D": "带脉", + "E": "阴维脉" + }, + "answer": "B", + "reason": "任脉调节全身阴经经气，妊娠需要阴血，故与女子妊娠密切相关的经脉是任脉。" + }, + { + "question_num": 172, + "query": "下列哪项不是闭经与痛经的共同病机", + "options": { + "A": "气血虚弱", + "B": "气滞血瘀", + "C": "肺肾阴虚", + "D": "肝肾不足", + "E": "寒凝血瘀" + }, + "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": 173, + "query": "患儿,男,7岁。睡中遗尿,白天小便频而量少,劳累后遗尿加重,面白气短,食欲缺乏(食欲不振)，大便易溏,舌淡苔白,脉细无力治疗除取主穴外,还应选用的是", + "options": { + "A": "神门、阴陵泉、胃俞", + "B": "气海、肺俞、足三里", + "C": "次髎、水道、三阴交", + "D": "百会、神门、内关", + "E": "关元俞、肾俞、关元" + }, + "answer": "B", + "reason": "脾肺气虚者,加脾俞、肺俞足三里;该患者劳累后加重,为气虚表现,“气短,食欲不振,大便易溏”为肺脾气虚,以脾气虚为主。" + }, + { + "question_num": 174, + "query": "下列中毒性细菌性痢疾的治疗措施错误的是", + "options": { + "A": "抗菌治疗", + "B": "扩充血容量", + "C": "纠正代谢性酸中毒", + "D": "血管活性药物的应用", + "E": "纠正代谢性碱中毒" + }, + "answer": "E", + "reason": "本病病情凶险,应密切观察,采取对症治疗为主的综合抢救措施，治疗措施包括病原治疗和对症治疗。病原治疗应用有效抗菌药物静脉滴注做抗菌治疗A项正确。对症治疗,重点是针对休克的相关治疗,包括迅速扩充血容量纠正代谢性酸中-子A0V护重要脏器等，BCD项正确，E项错误，故选E。" + }, + { + "question_num": 175, + "query": "起于足跟内侧的经脉是", + "options": { + "A": "阳跷脉", + "B": "阴跷脉", + "C": "阴维脉", + "D": "阳维脉", + "E": "冲脉" + }, + "answer": "B", + "reason": "A项阳跷脉起于足跟外侧B项阴跷脉起于足跟内侧，0项阴维脉起于小腿内侧,D项阳维脉起于足跗外侧。" + }, + { + "question_num": 176, + "query": "闭经虚证的发病机制是", + "options": { + "A": "多产房劳或久病伤肾", + "B": "血海空虚,无血可下", + "C": "脾胃虚弱,化源不足", + "D": "思虑过度,损伤心脾", + "E": "素体阴虚或久病伤血" + }, + "answer": "B", + "reason": "闭经虚证主要是因为肾气不足,或肝肾亏损，或脾胃虚弱,或阴虚血燥导致精亏血少，冲任血海空虚,源断其流，无血可下。" + }, + { + "question_num": 177, + "query": "治疗哮喘病之虚哮证,应首选", + "options": { + "A": "三子养亲汤", + "B": "六君子汤", + "C": "平喘固本汤", + "D": "金水六君煎", + "E": "金匮肾气丸" + }, + "answer": "C", + "reason": "虚哮是哮病久发,痰气瘀阻,肺肾两虚,摄纳失常,故治疗用平喘固本汤补肺纳气,降气化痰。" + }, + { + "question_num": 178, + "query": "发生霍乱时,对疫区接触者的检疫期是", + "options": { + "A": "3天", + "B": "5天", + "C": "7天", + "D": "9天", + "E": "12天" + }, + "answer": "B", + "reason": "患者和带菌者是霍乱的主要传染源,患者在发病期间,可连续排菌，时间一般为5日。对接触者应严密检疫5日，留类培养并服药预防。" + }, + { + "question_num": 179, + "query": "心包经的原穴是", + "options": { + "A": "神门", + "B": "间使", + "C": "大陵", + "D": "内关", + "E": "太渊" + }, + "answer": "C", + "reason": "神门是心经的原穴,大陵是心包经的原穴，内关是心包经的络穴，太渊是肺经的原穴。" + }, + { + "question_num": 180, + "query": "痛经之所以随月经周期而发作,与下列哪项有关", + "options": { + "A": "寒凝胞中", + "B": "经期胞中血虚邪盛", + "C": "经期冲任气血变化急骤", + "D": "冲任血虚、胞宫失养", + "E": "湿热蕴结胞中" + }, + "answer": "C", + "reason": "痛经之所以随月经周期而发作，又与经期及经期前后特殊生理状态有关,未行经期间，由于冲任气血平和,致病因素尚不足以引起冲任、子宫气血瘀滞或不足，故平时不发生疼痛。经期前后,血海由满盈而泻溢,气血盛实而骤虚,子宫、冲任气血变化较平时急剧,易受致病因素干扰,加之体质因素的影响,导致子宫、冲任气血运行不畅或失于煦濡,不通或不荣而痛。" + }, + { + "question_num": 181, + "query": "患者,男,42岁。呼吸气促,喉中哮鸣有声,胸闷如室,口不渴,形寒畏冷,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": "哮病之冷哮,故选射干麻黄汤宣肺散寒,化痰平喘。" + }, + { + "question_num": 182, + "query": "腹痛、腹泻、黏液脓血便,伴发热恶寒，最可能的诊断是", + "options": { + "A": "细菌性痢疾", + "B": "阿米巴痢疾", + "C": "急性胃肠炎", + "D": "流行性脑脊髓膜炎", + "E": "霍乱" + }, + "answer": "A", + "reason": "腹痛、腹泻、黏液脓血便,伴发热恶寒符合细菌性痢疾的典型症状，故选A。阿米巴痢疾多不发热，粪便检查为暗红或果酱色血便,故排除B;急性胃肠炎无发热症状;大便多为黄色水样便,故可排除C;流行性脑脊髓炎无典型的胃肠道症状,可排除D;霍乱一般无发热，多数不伴腹痛(O139血清型发热、腹痛比较常见)类便检查可见黏液和少许的红、白细胞,可初步排除E。" + }, + { + "question_num": 183, + "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": 184, + "query": "治疗痛经湿热下注证,应首选", + "options": { + "A": "清热调血汤", + "B": "龙胆泻肝汤", + "C": "知柏地黄汤", + "D": "血府逐瘀汤", + "E": "加味逍遥散" + }, + "answer": "A", + "reason": "治疗痛经湿热下注证，应首选清热调血汤。" + }, + { + "question_num": 185, + "query": "患者尿血日久,体倦乏力,气短声低,面色不华,舌质淡,脉弦弱。治疗应首选", + "options": { + "A": "知柏地黄丸", + "B": "无比山药丸", + "C": "小蓟饮子", + "D": "归脾汤", + "E": "十灰散" + }, + "answer": "D", + "reason": "体倦气短,面色不华,舌淡脉弱,辨为脾虚,故诊为尿血之脾不统血证,当补中健脾,益气摄血,方用归脾汤" + }, + { + "question_num": 186, + "query": "下列不支持艾滋病诊断的是", + "options": { + "A": "口咽念珠菌感染", + "B": "持续发热", + "C": "头痛,进行性痴呆", + "D": "皮肤黏膜出血", + "E": "慢性腹泻" + }, + "answer": "D", + "reason": "高危人群存在下列情况两项或两项以上者,应考虑艾滋病的可能:①近期体重下降10%以上;②慢性咳嗽或腹泻3个月以上;③间歇或持续发热1个月以上;④全身淋巴结肿大;⑤反复出现带状疱疹或慢性播散性单纯疱疹感染;⑥口咽念珠菌感染。ABE项均支持艾滋病的诊断。结合艾滋病的临床表现,艾滋病在4期主要出现5种表现,其中神经系统症状主要表现有头痛、疯痫、进行性痴���和下肢瘫痪等，故C项也支持艾滋病诊断。艾滋病对皮肤黏膜造成的损害，主要是肿瘤和感染等;并不出现出血症状,故皮肤黏膜出血不能作为艾滋病诊断的依据,故选D。" + }, + { + "question_num": 187, + "query": "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": 188, + "query": "圣愈汤治疗痛经的适应证是", + "options": { + "A": "气血虚弱", + "B": "肝肾亏损", + "C": "心肝血虚", + "D": "血虚气滞", + "E": "气滞血瘀" + }, + "answer": "A", + "reason": "圣愈汤的组成是人参、黄芪合四物汤。方中药物气血同补。" + }, + { + "question_num": 189, + "query": "患者大便不干硬,虽有便意,临厕努挣无力,挣则出短气,便后疲乏,面色白,舌淡嫩苔薄,脉虚,其治法是", + "options": { + "A": "补脾和胃", + "B": "温阳通便", + "C": "益气补肺", + "D": "温中健脾", + "E": "益气润肠" + }, + "answer": "E", + "reason": "据舌脉辨为气虚秘,故治宜益气润肠,黄芪汤主之。" + }, + { + "question_num": 190, + "query": "下列各项,不支持流行性脑脊髓膜炎诊断的脑脊液检查是", + "options": { + "A": "外观混浊呈脓性", + "B": "蛋白质含量高", + "C": "细胞数<0.5x10^6/L,以单核细胞为主", + "D": "糖含量明显减少", + "E": "氯化物含量减少" + }, + "answer": "C", + "reason": "脑脊液检查是流行性脑脊髓膜炎明确诊断的重要依据。发病过程中，脑脊液压力升高,外观浑浊呈脓性,故A项正确;蛋白质含量增高,糖及氯化物含量均减少,故BDE项正确;白细胞计数常高达1.0X10'/L以中性粒细胞为主,故C项错误，" + }, + { + "question_num": 191, + "query": "下列经脉循行除哪项外,都经过心", + "options": { + "A": "手厥阴经", + "B": "手少阳经", + "C": "手太阳经", + "D": "手阴明经", + "E": "足少阴经" + }, + "answer": "D", + "reason": "手厥阴心经起于心中;手少阳三焦经经脉散络于心包;手太阳小肠经交会于大椎,向下进人缺盆部,联络心脏;足少阴肾经其支脉从肺出来络心，注入胸中，故ABCE项均排除,只有手阳明大肠经未经过心。" + }, + { + "question_num": 192, + "query": "止带方适用于带下病的哪种证候", + "options": { + "A": "肾阳虚", + "B": "肾阴虚", + "C": "脾虚", + "D": "湿热", + "E": "湿毒" + }, + "answer": "D", + "reason": "止带方适用于带下病的湿热下注证。肾阳虚代表方剂内补丸;肾阴虚代表方剂知柏地黄汤;脾虚证代表方剂是完带汤;湿毒蕴结证代表方剂是五味消毒饮。" + }, + { + "question_num": 193, + "query": "太阳经头痛一般表现在", + "options": { + "A": "巅顶部", + "B": "颞部", + "C": "顶颞部", + "D": "前额部", + "E": "后枕部" + }, + "answer": "E", + "reason": "太阳经头痛表现在后枕部。" + }, + { + "question_num": 194, + "query": "高热、头痛、呕吐,全身皮肤散在瘀点，颈项强直,最可能的诊断是", + "options": { + "A": "结核性脑膜炎", + "B": "流行性脑脊髓膜炎", + "C": "流行性乙型脑炎", + "D": "伤寒", + "E": "中毒性细菌性痢疾" + }, + "answer": "B", + "reason": "高热、头痛、呕吐,全身皮肤散在瘀点,颈项强直等均为流行性脑脊髓膜炎的典型症状，首先考虑流行性脑脊髓膜炎;结核性脑膜炎,结核中毒症状之一是低热，排除A;流行性乙型脑炎皮肤一般无瘀点，排除C伤寒常有中毒性脑病的表现，无脑膜刺激征皮疹的典型特征为玫瑰疹,排除D;中毒性细菌性痢疾一般无脑膜刺激征,排除E。" + }, + { + "question_num": 195, + "query": "治疗滞产应首选", + "options": { + "A": "合谷", + "B": "太冲", + "C": "足三里", + "D": "血海", + "E": "至阴" + }, + "answer": "A", + "reason": "合谷穴的主治要点:头痛、齿痛、目赤肿痛、咽喉肿痛、失声、口眼歪斜、半身不遂、痄腮、疔疮、经团、腹痛、牙关紧闭、小儿惊风、鼻衄、耳鸣耳聋、发热恶寒、无汗、多汗、瘾疹、疟疾、产等病。" + }, + { + "question_num": 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": "患者，女，29岁。外威后，突发呕叶，亚50串老十29发寒头痛,胸脘满闷,舌苔白腻,脉缓。治疗应选", + "options": { + "A": "左金丸", + "B": "白虎汤", + "C": "小柴胡汤", + "D": "藿香正气散", + "E": "龙胆泻肝汤" + }, + "answer": "D", + "reason": "外受风寒之邪,或夏令暑湿秽浊之气,内扰胃腑浊气上逆,故突然呕吐，邪束肌表,营卫失和,故发热恶寒头痛。湿浊中阻,气机不利,故胸脘满闷。苔白腻,脉缓,皆为湿浊蕴阻之证,以疏邪解表,芳香化浊为法,用香正气散芳香化浊,散寒解表。" + }, + { + "question_num": 198, + "query": "复发的概念是", + "options": { + "A": "患者在感染某种病毒的基础上又感染其他病毒", + "B": "传染病患者进人恢复期后,已稳定退热一段时间,由于潜伏于组织内的病原体再度繁殖,使发热等初发症状再度出现", + "C": "传染病患者进人恢复期后,高热未退，又感染其他病原体引起发热加重", + "D": "传染病患者在恢复期,体温未稳定下降至正常，又再度升高", + "E": "以上都不对" + }, + "answer": "B", + "reason": "有些传染病患者进入恢复期后，已稳定退热一段时间，由于潜伏于组织内的病原体再度繁殖,使发热等初发症状再度”" + }, + { + "question_num": 199, + "query": "治疗痛经,在下列穴位中应首选", + "options": { + "A": "漏谷", + "B": "阳陵泉", + "C": "冲门", + "D": "地机", + "E": "公孙" + }, + "answer": "D", + "reason": "地机穴的主治要点为腹痛、泄泻、小便不利、水肿、月经不调、遗精、腰痛不可俯仰、食欲不振等病，其他选项均无治疗妇科疾病的功效，" + }, + { + "question_num": 200, + "query": "下列哪项不是寿胎丸的组成药物", + "options": { + "A": "菟丝子", + "B": "杜仲", + "C": "桑寄生", + "D": "续断", + "E": "阿胶" + }, + "answer": "B", + "reason": "寿胎丸的组成药物有苑丝子、桑寄生、续断、阿胶。" + }, + { + "question_num": 201, + "query": "治疗肺痈溃脓期,应首选", + "options": { + "A": "千金苇茎汤", + "B": "加味桔梗汤", + "C": "如金解毒散", + "D": "桔梗杏仁煎", + "E": "桔梗白散" + }, + "answer": "B", + "reason": "肺痈溃脓期为热壅血瘀,血败肉腐,痈肿内溃,脓液外泄,治以排脓解毒，方用加味桔梗汤加减。" + }, + { + "question_num": 202, + "query": "下列哪项是感染HBV后最早出现的血清学标志", + "options": { + "A": "抗-HBc", + "B": "HBcAg", + "C": "抗-HBs", + "D": "HBeAg", + "E": "HBsAg" + }, + "answer": "E", + "reason": "HBSAg是感染HBV后最早出现的血清学标志,感染后4~7周血清中开始出现,而后出现ALT升高及症状、体征等是HBV现症感染指标之一,可见于急性乙型肝炎潜伏期、急性期患者以及各种慢性HBV感染者。" + }, + { + "question_num": 203, + "query": "下列穴位与关元相平的是", + "options": { + "A": "归来", + "B": "大赫", + "C": "大横", + "D": "外陵", + "E": "水道" + }, + "answer": "E", + "reason": "水道穴的定位:在下腹部当脐中下3寸,距脐正中线2寸，与关元穴相平,故选E。归来穴在脐中下4寸,与中极穴相平,故排除。" + }, + { + "question_num": 204, + "query": "下列哪项是产后用药三禁", + "options": { + "A": "活血、通便、消导", + "B": "大汗、峻下、利小便", + "C": "清热、凉血、滋阴", + "D": "祛寒、开郁、化瘀", + "E": "以上均非" + }, + "answer": "B", + "reason": "产后用药三禁,即禁大汗以防亡阳;禁峻下以防亡阴;禁通利小便以防亡津液。" + }, + { + "question_num": 205, + "query": "治疗阴虚发热,应首选", + "options": { + "A": "六味地黄丸", + "B": "一贯煎", + "C": "清骨散", + "D": "二阴煎", + "E": "三圣散" + }, + "answer": "C", + "reason": "阴虚发热治当滋阴清热,故用清骨散,因其有清虚热,退骨蒸的功效" + }, + { + "question_num": 206, + "query": "不属医院感染的是", + "options": { + "A": "本次感染直接与上次住院有关", + "B": "由于创伤或非生物性因子刺激而产生的炎症表现", + "C": "新生儿在分娩过程中获得的感染", + "D": "医务人员在医院工作期间获得的感染", + "E": "由于诊疗措施激活的潜在性感染" + }, + "answer": "B", + "reason": "" + }, + { + "question_num": 207, + "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���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跖骨基底的前下方。" + }, + { + "question_num": 208, + "query": "下列各项,不属产后发热病因的是", + "options": { + "A": "感染邪毒", + "B": "外感", + "C": "血瘀", + "D": "血虚", + "E": "阳盛血热" + }, + "answer": "E", + "reason": "产后发热病因有感染邪毒、外感、血瘀、血虚。" + }, + { + "question_num": 209, + "query": "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": "不易人睡,多梦易醒——不寐;神疲食少,头晕目眩,四肢倦怠为心脾两虚之证,故用归脾汤补心脾,养血安神。" + }, + { + "question_num": 210, + "query": "下列各项,不属中国古代医德思想内容的是", + "options": { + "A": "救死扶伤、一视同仁的道德准则", + "B": "仁爱救人、赤诚济世的事业准则", + "C": "清廉正直、不图钱财的道德品质", + "D": "认真负责、一丝不苟的服务态度", + "E": "不畏权贵、忠于医业的献身精神" + }, + "answer": "D", + "reason": "中国古代医德思想内容包括仁爱救人、赤诚济世的事业准则;清廉正直、不图钱财的道德品质;不畏权贵、忠于医业的献身精神;救死扶伤、一视同仁的道德准则;一心救治、不畏艰苦的服务态度。" + }, + { + "question_num": 211, + "query": "下列穴位归经,错误的是", + "options": { + "A": "太白--肝经", + "B": "列缺--肺经", + "C": "合谷--大肠经", + "D": "阳陵泉--胆经", + "E": "阴陵泉--脾经" + }, + "answer": "A", + "reason": "太白穴是脾经的输穴:原穴。" + }, + { + "question_num": 212, + "query": "生化汤的组成药物是", + "options": { + "A": "当归、川芎、桃仁、炮姜、炙甘草", + "B": "当归、川芎、桃仁、赤芍、炙甘草", + "C": "当归、芎、生地黄、白芍、炙甘草", + "D": "当归、川芎、桃仁、红花、益母草", + "E": "当归、川芎、红花、赤芍、益母草" + }, + "answer": "A", + "reason": "生化汤的组成药物有当归、川芎、桃仁、炮姜、炙甘草。" + }, + { + "question_num": 213, + "query": "患者,女,45岁。因情志不畅而致咽中如有物梗阻,咯吐不出,吞咽不下,胸胁满闷。治疗应首选", + "options": { + "A": "苏子降气汤", + "B": "厚朴温中汤", + "C": "半夏厚朴汤", + "D": "天台乌药散", + "E": "越鞠丸" + }, + "answer": "C", + "reason": "半夏厚朴汤行气散结、降逆化痰,主治梅核气,症见“咽中如有物阻,咯吐不出,吞咽不下,胸膈满闷,或咳或呕,苔白润或白滑,脉弦滑或弦缓”。半夏厚朴汤病机关键为情志不畅,肝气郁结,肺胃宣降失常,津液运化失常,聚津为痰,与气相搏,结于咽喉,即痰气互结于咽喉。" + }, + { + "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": "心经的原穴是", + "options": { + "A": "神门", + "B": "间使", + "C": "大陵", + "D": "内关", + "E": "太渊" + }, + "answer": "A", + "reason": "A项神门是心经的原穴、输穴;其他选项的穴位均不在心经上，均排除,故选择A。" + }, + { + "question_num": 216, + "query": "生化汤治疗血被寒凝,瘀阻胞宫而致的产后恶露淋漓不爽,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": "生化汤治疗血被寒,瘀阳胞宫而致的产后恶露淋漓不爽，常加用的药物是蒲黄、益母草,以增祛瘀止血之效。" + }, + { + "question_num": 217, + "query": "《突发公共卫生事件应急条例》规定:突发事件应急工作应当遵循的原则是", + "options": { + "A": "完善并建立监测与预警手段", + "B": "预防为主,常备不懈", + "C": "积极预防,认真报告", + "D": "及时调查,认真处理", + "E": "监测分析,综合评价" + }, + "answer": "B", + "reason": "飞突发公共卫生事件应急条例》规定:“突发事件应急工作,应当避循预防为主、常备不懈的方针,贯彻统一领导、分级负责、反应及时、措施果断、依靠科学、加强合作的原则。”" + }, + { + "question_num": 218, + "query": "尊重患者知情同意权,其正确的做法", + "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": "治疗胎位不正最常用的腧穴是", + "options": { + "A": "合谷", + "B": "至阴", + "C": "三阴交", + "D": "太冲", + "E": "足三里" + }, + "answer": "B", + "reason": "至阴穴的主治要点:头痛、鼻塞、鼻衄、目痛、胞衣不下、胎位不正、难产等" + }, + { + "question_num": 220, + "query": "桂枝茯苓丸的组成是", + "options": { + "A": "桂枝、茯苓、牡丹皮、芍药、红花", + "B": "桂枝、茯苓、牡丹皮、芍药、桃仁", + "C": "桂枝、茯苓、牡丹皮、芍药、牛膝", + "D": "桂枝、茯苓、牡丹皮、芍药、丹参", + "E": "桂枝、茯苓、牡丹皮、芍药、莪术" + }, + "answer": "B", + "reason": "桂枝茯苓丸的组成是桂枝茯苓、牡丹皮、芍药、桃仁。" + }, + { + "question_num": 221, + "query": "下列除哪项外,均是舌颤动的病因", + "options": { + "A": "气血两虚", + "B": "亡阳伤津", + "C": "热极生风", + "D": "酒毒所伤", + "E": "心脾有热" + }, + "answer": "E", + "reason": "心脾有热多见于吐舌和弄舌,故选E。" + }, + { + "question_num": 222, + "query": "在使用辅助检查手段时,不适宜的是", + "options": { + "A": "认真严格地掌握适应证", + "B": "可以广泛积极地依赖各种辅助检查", + "C": "有利于提高医生诊治疾病的能力", + "D": "必要检查能尽早确定诊断和进行治疗", + "E": "应从患者的利益出发决定该做的项目" + }, + "answer": "B", + "reason": "使用辅助检查手段时认真严格地掌握适应证是必须首先要遵守的;必要检查能尽早确定诊断和进行治疗并且有利于提高医生诊治疾病的能力;医生应从患者的利益出发决定该做的项目，故B项可以广泛积极地依赖各种辅助检查明显不符合医德的要求，是应该阻止的行为。" + }, + { + "question_num": 223, + "query": "太溪穴位于", + "options": { + "A": "内踝下缘凹陷处", + "B": "外踝下缘凹陷处", + "C": "内踝前下方凹陷中", + "D": "外踝高点与跟腱之间凹陷处", + "E": "内踝高点与跟腱之间凹陷处" + }, + "answer": "E", + "reason": "太溪穴的定位:在足内侧内踝后方，当内踝尖与跟腱之间的凹陷处。" + }, + { + "question_num": 224, + "query": "《景岳全书·泄泻》云:泄泻之本,无不由于", + "options": { + "A": "脾、胃", + "B": "肝、胆", + "C": "心、小肠", + "D": "肺、大肠", + "E": "肾、膀胱" + }, + "answer": "A", + "reason": "泄泻主要病变在脾胃。" + }, + { + "question_num": 225, + "query": "朱砂安神丸中泻火除烦的药物是", + "options": { + "A": "栀子", + "B": "黄连", + "C": "石膏", + "D": "竹叶", + "E": "知母" + }, + "answer": "B", + "reason": "方中黄连苦寒,人心经,清心泻火,以除烦热为臣。" + }, + { + "question_num": 226, + "query": "道德是人们在社会生活实践中形成的,决定基础是", + "options": { + "A": "社会基础", + "B": "经济基础", + "C": "权力基础", + "D": "良心基础", + "E": "尊重基础" + }, + "answer": "B", + "reason": "道德是人们在社会生活实践中形成的,并由经济基础决定的,用善恶标准去评价，依靠社会舆论、内心信念和传统习俗为指导的,调节人与人、人与自然之间关系的行为原则���规范的总和。" + }, + { + "question_num": 227, + "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四陷中", + "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": 228, + "query": "最早提出烧灼法断脐预防脐风的儿科专著是", + "options": { + "A": "《小儿药证直诀》", + "B": "《小儿卫生总微论方》", + "C": "《幼科发挥》", + "D": "《保婴撮要》", + "E": "《幼幼集成》" + }, + "answer": "B", + "reason": "《小儿卫生总微论方》是最早提出烧灼法断脐预防脐风的儿科专著。" + }, + { + "question_num": 229, + "query": "越鞠丸中以行气为主的药物是", + "options": { + "A": "木香", + "B": "沉香", + "C": "香附", + "D": "枳壳", + "E": "厚朴" + }, + "answer": "C", + "reason": "越鞠丸行气解郁。方中香附辛香人肝,行气开郁为君药，" + }, + { + "question_num": 230, + "query": "被美国的《生命伦理学百科全书》列为世界古典医药道德文献的是", + "options": { + "A": "《黄帝内经》", + "B": "《通鉴外纪》", + "C": "《千金要方》", + "D": "《外科正宗》", + "E": "《帝王世纪》" + }, + "answer": "D", + "reason": "明代陈实功在《外科正宗》中对我国古代医德做了系统总结，他概括的“医家五戒十要”被美国1978年出版的《生命伦理学百科全书》列为世界古典医药道德文献之一。" + }, + { + "question_num": 231, + "query": "“循喉咙之后,上人颃颡”的经脉是", + "options": { + "A": "足厥阴肝经", + "B": "足少阴肾经", + "C": "足少阳胆经", + "D": "足太阴脾经", + "E": "足阳明胃经" + }, + "answer": "A", + "reason": "足厥阴肝经的走行:起于大趾丛毛之际，上循足跗上廉,去内踝一寸，上踝八寸,交出太阴之后,上腘内廉,循股阴,人毛中,过阴器,抵小腹,夹胃属肝络胆,上贯,布胁肋,循喉咙之后,上人颃,连目系,上出额,与督脉会于巅，其支者，从目系下颊里，环唇内,其支者,复从肝,别贯,上注肺。" + }, + { + "question_num": 232, + "query": "4周岁小儿的身长应为", + "options": { + "A": "90cm", + "B": "98cm", + "C": "100cm", + "D": "103cm", + "E": "110cm" + }, + "answer": "D", + "reason": "2岁后至12岁儿童的身长:身长(cm)=75+7x年龄。4岁小儿按此公式，身长应为103cm。" + }, + { + "question_num": 233, + "query": "血府逐瘀汤除活血祛瘀外，还具有的功用是", + "options": { + "A": "散结消痞", + "B": "温经散寒", + "C": "补气通络", + "D": "行气止痛", + "E": "疏肝解郁" + }, + "answer": "D", + "reason": "血府逐瘀汤活血祛瘀,行气止痛。主治上焦瘀血,头痛胸痛,胸闷呃逆,失眠不寐,心悸怔忡,瘀血发热,舌质暗红,边有瘀斑或瘀点，唇暗或两目暗黑，脉涩或弦紧等症。" + }, + { + "question_num": 234, + "query": "以人的自然素质的高低、优劣为依据,衡量生命对自身、他人和社会存在价值的一种伦理观是", + "options": { + "A": "功利论", + "B": "道义论", + "C": "生命质量论", + "D": "生命神圣论", + "E": "生命价值论" + }, + "answer": "C", + "reason": "生命质量论,是以人的自然素质的高低、优劣为依据,衡量生命对自身、他人和社会存在价值的一种伦理观，" + }, + { + "question_num": 235, + "query": "治疗癃闭、遗尿的穴位是", + "options": { + "A": "太冲", + "B": "大陵", + "C": "神门", + "D": "内关", + "E": "阴郄" + }, + "answer": "A", + "reason": "太冲穴主治头痛、眩晕、目赤肿痛、口、胁痛、遗尿、疝气、崩漏、月经不调、痫、呕逆、小儿惊风、下肢痿痹" + }, + { + "question_num": 236, + "query": "“纯阳”学说是指小儿", + "options": { + "A": "发育迅速", + "B": "脏腑娇嫩", + "C": "有阳无阴", + "D": "阳亢阴亏", + "E": "形气未充" + }, + "answer": "A", + "reason": "“纯”指小儿先天所禀的元阴元阳未曾耗散，“阳”指小儿的生命活力,犹如旭日之初生,草木之方萌,蒸蒸日上,欣欣向荣。“纯阳”是指小儿生机蓬勃、发育迅速的生理特点。" + }, + { + "question_num": 237, + "query": "患者眩晕头痛,胸膈痞闷,恶心呕吐,舌苔白腻,脉弦滑。治宜选用", + "options": { + "A": "温胆汤", + "B": "镇肝熄风汤", + "C": "羚角钩藤汤", + "D": "天麻钩藤饮", + "E": "半夏白术天麻汤" + }, + "answer": "E", + "reason": "半夏白术天麻汤主治风痰上扰证。眩晕,头痛,胸膈痞闷，恶心呕吐，舌苔白腻,脉弦滑" + }, + { + "question_num": 238, + "query": "影响医患关系的主要因素不包括", + "options": { + "A": "医生方面", + "B": "病人方面", + "C": "管理方面", + "D": "道德方面", + "E": "社会方面" + }, + "answer": "D", + "reason": "影响医患关系的因素主要存在于医务人员、患者及其家属、医疗体制以及法律等方面。①医生方面:医生的医疗观道德修养、服务态度和责任感等;②病人方面:不遵守就医道德、对医务人员不信任等;③管理、社会方面:医院管理制度上的缺陷、国家对卫生事业的资金投人不足、社会上的不正之风仍然存在、卫生法规不够健全等。" + }, + { + "question_num": 239, + "query": "治疗昏迷、高热,应首选", + "options": { + "A": "四缝", + "B": "曲池", + "C": "八邪", + "D": "合谷", + "E": "十宣" + }, + "answer": "E", + "reason": "十宣穴的主治要点:昏迷，癫痫，高热，咽喉肿痛，是急救的要穴。" + }, + { + "question_num": 240, + "query": "小儿患病后易趋康复的主要原因是", + "options": { + "A": "心常有余", + "B": "肝常有余", + "C": "稚阴稚阳", + "D": "脏腑已成", + "E": "脏气清灵" + }, + "answer": "E", + "reason": "与成人相比,小儿的机体生机蓬勃,脏腑之气清灵，随拨随应，对各种治疗反应灵敏;并且小儿宿疾较少，病情相对单纯因而，小儿为病虽具有发病容易、传变迅速的特点,但一般说来,病情好转的速度较成人快，疾病痊愈的可能也较成人大。" + }, + { + "question_num": 241, + "query": "自汗、盗汗并见,其病机是", + "options": { + "A": "精血亏虚", + "B": "阴阳两虚", + "C": "阳气不足", + "D": "津液不足", + "E": "以上均非" + }, + "answer": "B", + "reason": "自汗多见于气虚或阳虚证常伴有气短乏力，神疲畏寒,舌淡脉弱等症。盗汗多见于阴虚内热或气阴两虚证,常伴有颧红,潮热,咽干,舌红少苔等症。二者并见可以见于气阴两或者阴阳两虚。" + }, + { + "question_num": 242, + "query": "不属于临床诊疗道德原则的是", + "options": { + "A": "生命价值原则", + "B": "最优化原则", + "C": "身心统一原则", + "D": "保密原则", + "E": "知情同意原则" + }, + "answer": "C", + "reason": "临床诊疗的道德原则:①最优化原则;②知情同意原则;③保密原则;④生命价值原则。" + }, + { + "question_num": 243, + "query": "针刺肌肉浅薄部位的腧穴,常用的进针法是", + "options": { + "A": "指切", + "B": "挟持", + "C": "舒张", + "D": "提捏", + "E": "套管" + }, + "answer": "D", + "reason": "A项指切适用于短针的进针,B项挟持适用于长针的进针，C项舒张适用于皮肤松弛部位腧穴的进针，D项提捏适用于皮肉浅薄部位的进针，E项套管可以代替押手，但是不常用,排除。" + }, + { + "question_num": 244, + "query": "小儿指纹色紫主证为", + "options": { + "A": "燥", + "B": "热", + "C": "寒", + "D": "滞", + "E": "瘀" + }, + "answer": "B", + "reason": "指纹的辨证纲要可归纳为“浮沉分表里,红紫辨寒热,淡滞定虚实，玉关测轻重”。小儿指纹色紫主证为热。" + }, + { + "question_num": 245, + "query": "有形实邪闭阻气机所致的疼痛，其疼痛性质是", + "options": { + "A": "胀痛", + "B": "灼痛", + "C": "冷痛", + "D": "绞痛", + "E": "隐痛" + }, + "answer": "D", + "reason": "A项主气滞,多属肺肝胃肠气滞之证,排除A。B项属热证,多属火热之邪GI又N七中1tm除。C项属寒证,因寒邪侵人脏腑、经络所致者,多属实寒证;因阳气不足,脏腑形体失于温煦所致者,多属虚寒证,排除C。D项多因有形实邪阻闭气机，或寒邪凝潜气机所致,故选D。E项多属虚证，由于精血亏损或阳虚生寒，脏腑、形体失于充养、温煦而致,也要排除。" + }, + { + "question_num": 246, + "query": "医学道德评价的方式为", + "options": { + "A": "社会舆论、媒体介入、传统习俗", + "B": "自我认识、媒体介入、传统习俗", + "C": "社会舆论、内心信念、传统习俗", + "D": "社会舆论、内心信念、媒体介入", + "E": "内心信念、传统习俗、自我认识" + }, + "answer": "C", + "reason": "医学道德评价的方式:①内心信念是指医务人员发自内心地对道德义务的深刻认识、真诚信仰和强��的责任感，是医务人员对自己行为进行善恶评价的内在动力，是医德品质构成的基本要素,也是医德评价的重要方式,内心信念是通过职业良心发挥作用的，一个具有高尚医德品质的医务工作者，能通过内心自律调整着自己的医疗行为，能自觉地正确对待来自社会的评价和监督;②社会舆论是指公众对某种社会现象、行为和事件的看法和态度,即公众的认识,社会舆论可以形成一种强大的精神力量,调整人们的道德行为，指导人们的道德生活,是医德评价中最普遍、最具有影响力的方式，在医德评价中起着重要作用;-中2ra2步积累和形成的一种普遍的、稳定的、世代相传的行为方式、行为规范和道德风尚。传统习俗被社会广泛承认，并根深带固地存在于人们的观念之中。医德传统是传统习俗的一个组成部分,是体现着医学职业特点的价值观" + }, + { + "question_num": 247, + "query": "治疗丹毒首选的拔罐法是", + "options": { + "A": "留罐法", + "B": "走罐法", + "C": "留针拔罐法", + "D": "刺血拔罐法", + "E": "闪罐法" + }, + "answer": "D", + "reason": "丹毒属于毒血瘀积于皮肤应该用刺血拔罐法，故选D。" + }, + { + "question_num": 248, + "query": "下列除哪项外,均可使用培元补肾法", + "options": { + "A": "解颅", + "B": "五迟", + "C": "五软", + "D": "哮喘", + "E": "肺炎喘嗽" + }, + "answer": "E", + "reason": "培元补肾法主要适用于小儿胎禀不足，肾气虚弱及肾不纳气之证;如解颅、五迟、五软、遗尿、哮喘等,而肺炎喘嗽外因责之于感受风邪，或由其他疾病传变而来;内因责之于小儿形气未充,肺脏娇嫩,卫外不固。" + }, + { + "question_num": 249, + "query": "视物旋转动荡,如在舟车之上,称为", + "options": { + "A": "目昏", + "B": "目痒", + "C": "目眩", + "D": "雀目", + "E": "内障" + }, + "answer": "C", + "reason": "A项为视物昏暗,模糊不清。B项是指睑边、眦内、甚则痒连睛珠,痒极难忍为主症,但睛珠完好,视力也正常。临床上由于风、火、湿热、血虚均可引起目痒。C项俗称眼花,两眼发黑,眼冒金花,或眼前如有蚊蝇飞动的自觉症状,常兼头晕,轻者闭目可止重者如坐车船,旋转不定。D项指白昼视力正常,每至黄昏视物不清,如雀之盲。E项中医称之为圆翳内障，圆翳内障本病是指晶珠混浊视力缓降,渐至失明的慢性眼病" + }, + { + "question_num": 250, + "query": "关于人类胚胎干细胞研究的伦理原则不正确的是", + "options": { + "A": "安全和有效原则", + "B": "防止商品化原则", + "C": "知情同意原则", + "D": "尊重原则", + "E": "效用原则" + }, + "answer": "E", + "reason": "人类胚胎干细胞研究和应用的伦理原则包括以下几点。①尊重原则:爱惜和尊重胚胎,只允许对14天内的人体胚胎用于研究;②知情同意原则:只允许使用自愿捐献的生殖细胞或辅助生殖多余的胚胎,供者必须是自愿捐献,贯彻知情同意原则;③安全和有效原则:在使用人类胚胎干细胞治疗疾病时，必须经动物实验有效，并设法避免给病人带来伤害。不允许将捐献胚胎重新植入妇女子宫,不允许将人类配子与动物配子相结合④防止商品化原则:禁止买卖人体胚胎，并避免妇女故意制造胚胎。" + }, + { + "question_num": 251, + "query": "耳穴“脾”位于", + "options": { + "A": "耳舟", + "B": "耳轮", + "C": "耳甲", + "D": "耳垂", + "E": "三角窝" + }, + "answer": "C", + "reason": "耳穴“脾”的部位,在耳甲腔的后上部,即耳甲13区,故选C。" + }, + { + "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”其脾胃之体成而未全、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": "下列除哪项外,均提示病情严重,预后不良", + "options": { + "A": "目暗睛迷", + "B": "舌苔骤剥", + "C": "脉微欲绝", + "D": "抽搐吐沫", + "E": "昏迷烦躁" + }, + "answer": "D", + "reason": "ABCE项均为脏腑精气将绝,形体极度衰弱的表现，此种情况一旦出现多为病重失神之象,预后不良。D项为神乱意识障碍的主要临床表现，尚未达到病情严重预后不良的程度,故选D。" + }, + { + "question_num": 254, + "query": "关于医德教育意义的叙述,不正确的为", + "options": { + "A": "有助于形成医务人员的内在品质", + "B": "形成稳定的性格特点", + "C": "是促进医学科学工作发展的重要措施", + "D": "形成良好医德医风的重要环节", + "E": "有助于培养医务人员的人文素养" + }, + "answer": "B", + "reason": "医学道德教育的意义:①有助于形成医务人员的内在品质,是把医学道德原则和规范转化为内心信念的重要环节;②有助于培养医务员的人文亲养和道德情换，是形成良好医德医风的重要环节;③有助于培养高素质的医学人才，是促进医学科学工作发展的重要措施。" + }, + { + "question_num": 255, + "query": "用俞募配穴法治疗胃病应选下列哪组穴位", + "options": { + "A": "脾俞、胃俞", + "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，胃经的苏穴是中脘穴,故应该选用胃俞和中脘穴。" + }, + { + "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": "指纹淡红,多为内有虚寒。" + }, + { + "question_num": 257, + "query": "主水饮,肾虚水泛,气血受困的面色特点是", + "options": { + "A": "面色白", + "B": "面色黧黑", + "C": "眼眶黑", + "D": "面色紫黑", + "E": "黄如烟熏" + }, + "answer": "B", + "reason": "黑色主肾虚、水饮、血瘀、寒证,由此便可排除AE项。A项主虚寒、气血不足、失血。B项多提示瘀血内停,考虑到题目中坦烈的气内平用比洪而再山斯SI区虚水饮或寒湿带下。D项提示气滞血瘀。E项为寒湿瘀滞所致。" + }, + { + "question_num": 258, + "query": "我国依法制定卫生行政法规的国家机构是", + "options": { + "A": "国务院", + "B": "卫生行政部门", + "C": "最高人民法院", + "D": "全国人大及其常委会", + "E": "地方人民政府" + }, + "answer": "A", + "reason": "卫生行政法规是指由国务院制定发布的有关卫生方面的专门行政法规其法律效力低于卫生法律。" + }, + { + "question_num": 259, + "query": "采用背俞穴治疗皮肤痒疹,应首选", + "options": { + "A": "肝俞", + "B": "肺俞", + "C": "脾俞", + "D": "三焦俞", + "E": "心俞" + }, + "answer": "B", + "reason": "背俞穴可以治疗与脏腑经脉相连属的组织器官所发生的病证。肺主皮毛,所以皮肤痒疹应属于肺经的病证，故应该选用肺俞穴治疗。" + }, + { + "question_num": 260, + "query": "小儿感冒夹痰的病机是", + "options": { + "A": "肺脏娇嫩", + "B": "先天不足", + "C": "乳食积滞", + "D": "脾胃湿困", + "E": "肾气不足" + }, + "answer": "A", + "reason": "由于小儿肺脏娇嫩,感邪之后,失于宣肃,气机不利，津液不得输布而内生痰液,痰壅气道,则咳嗽加剧,喉间痰鸣,此为感冒夹痰。" + }, + { + "question_num": 261, + "query": "下列各项,与牙齿干燥如枯骨关系最密切的是", + "options": { + "A": "热盛伤津", + "B": "阳明热盛", + "C": "胃阴不足", + "D": "肾阴枯涸", + "E": "肺阴亏虚" + }, + "answer": "D", + "reason": "齿为骨之余,骨为肾所主。正常人牙齿洁白润泽而坚固，是肾气旺盛，津液充足的表现,牙齿干燥,甚者齿如枯骨，为胃津已伤或肾阴枯竭。" + }, + { + "question_num": 262, + "query": "下列关于肾综合征出血热发热期三痛的叙述，正确的是", + "options": { + "A": "全身酸痛、头痛、眼眶痛", + "B": "头痛、腓肠肌痛、腰痛", + "C": "腹痛、腰痛、眼眶痛", + "D": "头痛、腰痛、眼眶痛", + "E": "全身酸痛、腰痛、眼眶痛" + }, + "answer": "D", + "reason": "肾综合征出血热发热期三痛是头痛、腰痛、眼眶痛。" + }, + { + "question_num": 263, + "query": "下列腧穴在五行配属中,属火的是", + "options": { + "A": "少府", + "B": "大陵", + "C": "后溪", + "D": "曲泉", + "E": "经渠" + }, + "answer": "A", + "reason": "阴经的井荥输经合属木火士金水，阳经的井荥输经合属金水木火士。A项少府是心经的荣穴属火，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": 264, + "query": "肺炎喘嗽的基本病机是", + "options": { + "A": "肺气失宣", + "B": "肺失清肃", + "C": "肺气上逆", + "D": "邪热闭肺", + "E": "痰热内蕴" + }, + "answer": "D", + "reason": "肺炎喘嗽的基本病机是邪热闭肺。" + }, + { + "question_num": 265, + "query": "气血两虚证的舌象是", + "options": { + "A": "舌体淡瘦", + "B": "舌淡齿痕", + "C": "舌尖芒刺", + "D": "舌暗瘀点", + "E": "舌红裂纹" + }, + "answer": "A", + "reason": "A项多见于心脾两虚,气血不足,故选A。B项多由气虚、阳虚、津液内停所致。C项多为心火亢盛。D项为气血郁滞:E项为阴虚内热证。" + }, + { + "question_num": 266, + "query": "医学伦理学最古老、最有生命力的医德范畴是", + "options": { + "A": "医疗保留", + "B": "医疗公正", + "C": "医疗权利", + "D": "医疗荣誉", + "E": "医疗义务" + }, + "answer": "A", + "reason": "医学道德范畴是反映医学道德现象及其特征和关系等普遍本质的基本概念。而最古老、最有生命力的医德范畴是医疗保留。医疗公正、医疗权利、医疗荣誉和医疗义务均是医学伦理学的基本范畴。" + }, + { + "question_num": 267, + "query": "治疗风火牙痛,除选取主穴外,应加用的腧穴是", + "options": { + "A": "太溪、行间", + "B": "太溪、外关", + "C": "太冲、曲池", + "D": "太冲、阳溪", + "E": "外关、风池" + }, + "answer": "E", + "reason": "风火牙痛应加用外关、风池穴,以疏风降火。" + }, + { + "question_num": 268, + "query": "治疗小儿口疮脾胃积热证,应首选", + "options": { + "A": "清胃散", + "B": "清热泻脾散", + "C": "六味地黄丸", + "D": "泻心导赤汤", + "E": "凉膈散" + }, + "answer": "E", + "reason": "口疮中脾胃积热证标准方剂为凉膈散,清热解毒,通腑泻火。如果有大便不实的症状,才可以考虑清热泻脾散。心火上炎证用泻心导赤汤。虚火上浮证用六味地黄丸。清胃散主治胃火牙痛。" + }, + { + "question_num": 269, + "query": "语言謇涩,病因多属", + "options": { + "A": "热扰心神", + "B": "痰火扰心", + "C": "风痰阻络", + "D": "心气不足", + "E": "心阴大伤" + }, + "answer": "C", + "reason": "语言謇涩指的是神志清楚思维正常,但言语不流利，吐词不清晰者,多因风痰阻络所致。" + }, + { + "question_num": 270, + "query": "下列白细胞减少症的病因中,属粒细胞破坏过多的是", + "options": { + "A": "内毒素血症", + "B": "周期性粒细胞减少症", + "C": "恶性肿瘤", + "D": "化学毒物", + "E": "脾功能亢进" + }, + "answer": "E", + "reason": "粒细胞破坏过多超过骨髓代偿能力发生粒细胞减少，见于严重败血症、慢性炎症、脾功能亢进、结缔组织疾病和药物所致免疫性粒细胞减少。" + }, + { + "question_num": 271, + "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、行闻" + }, + "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": 272, + "query": "以下哪项不符合注意力缺陷多动症的临床特征", + "options": { + "A": "男性发病多于女性", + "B": "注意力不集中", + "C": "智力低下", + "D": "动作过多", + "E": "冲动任性" + }, + "answer": "C", + "reason": "注意力缺陷多动症患儿上课时注意力不集中,学习成绩差,但一般智力正常。" + }, + { + "question_num": 273, + "query": "唐代以前所称的哕是指", + "options": { + "A": "呃逆", + "B": "嗳气", + "C": "恶心", + "D": "干呕", + "E": "噫气" + }, + "answer": "A", + "reason": "古称的“哕”,俗称“打呃”也就是呃逆,是指胃气上逆导致膈肌拘挛，声自咽部冲出,发出一种不由自主的呃呃声,故选A。B项是指胃中气体上出咽喉而发出的长而缓的声音,古称“噫”,俗称“打饱”。C项又称反胃,指胃气上逆,泛恶欲吐之证。D项为胃失和降,胃气上逆所致,有声无物为干呕。E项n!A8名是响,其声长而缓,古代称为噫气,亦属胃气失和而上逆的一种表现，与短促冲击有声的呃逆不同。" + }, + { + "question_num": 274, + "query": "受理申请医师注册的卫生健康主管部门除本法规定不予注册的情形外。应当自收到申请之日��多少日内准予注册，将注册信息录人国家信息平台，并发给医师执业证书。", + "options": { + "A": "15日", + "B": "20日", + "C": "30日", + "D": "40日", + "E": "45日" + }, + "answer": "B", + "reason": "受理申请医师注册的卫生健康主管部门除本法规定不子注册的情形外，应当自收到申请之日起20日内准予注册,将注册信息录入国家信息平台，并发给医师执业证书。" + }, + { + "question_num": 275, + "query": "面瘫的恢复应加用", + "options": { + "A": "膏肓俞", + "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": 276, + "query": "小儿厌食脾失健运证的治法是", + "options": { + "A": "调和脾胃,运脾开胃", + "B": "健脾益气,佐以温中", + "C": "滋脾养胃,佐以助运", + "D": "运脾化湿,消积开胃", + "E": "补脾开胃,消食助运" + }, + "answer": "A", + "reason": "小儿厌食脾失健运证的治法是调和脾胃，运脾开胃。" + }, + { + "question_num": 277, + "query": "顿咳常见于", + "options": { + "A": "青年", + "B": "老年", + "C": "小儿", + "D": "女性", + "E": "男性" + }, + "answer": "C", + "reason": "咳声阵发,发则连声不绝咳声终止时声如鸡啼,称为顿咳,因其病程较长,缠绵难愈,所以也称为百日咳,多见于小儿,为风邪与伏痰搏结,郁而化热，阻遏气道所致,故选C。" + }, + { + "question_num": 278, + "query": "直接作用于中枢神经系统,使之兴奋或抑制，连续使用能产生依赖性的药品是", + "options": { + "A": "毒性药品", + "B": "放射性药品", + "C": "解毒药品", + "D": "精神药品", + "E": "麻醉药品" + }, + "answer": "D", + "reason": "精神药品是指直接作用于中枢神经系统,使之兴奋或抑制,连续使用能产出依赖性的药品" + }, + { + "question_num": 279, + "query": "五输穴中所行为", + "options": { + "A": "井", + "B": "荥", + "C": "输", + "D": "经", + "E": "合" + }, + "answer": "D", + "reason": "《灵枢·九针十二原》所载:“所出为井,所溜为荣,所注为输,所行为经,所人为合。”" + }, + { + "question_num": 280, + "query": "疳证的基本病理改变为", + "options": { + "A": "脾胃虚弱,运化失健", + "B": "脾胃虚弱,乳食停滞", + "C": "脾失运化,水湿内停", + "D": "脾胃不和,生化乏源", + "E": "脾胃受损,津液消亡" + }, + "answer": "E", + "reason": "疳证的病变部位主要在脾胃,病机为脾胃失健,生化乏源,则气血不足,津液亏耗,肌肤、筋骨、经脉失于濡养，日久成疳。" + }, + { + "question_num": 281, + "query": "肝胃蕴热的口味是", + "options": { + "A": "口中泛酸", + "B": "口中酸馊", + "C": "口甜黏腻", + "D": "口中味苦", + "E": "口中味咸" + }, + "answer": "A", + "reason": "A项多属肝胃蕴热。B项多属食积胃肠。C项多属湿热蕴脾。D项多属肝胆火旺。E项多属肾病。" + }, + { + "question_num": 282, + "query": "慢性支气管炎偶有轻微咳嗽,少量痰液,采取下列哪项措施最为合适", + "options": { + "A": "应用抗生素治疗", + "B": "少量镇咳剂", + "C": "应用支气管扩张剂以利排痰", + "D": "提高机体抗病能力,避免上呼吸道感染", + "E": "应用少量激素,减少气道非特异性炎症" + }, + "answer": "D", + "reason": "慢性支气管炎缓解期的主要治疗措施:加强锻炼,增强体质，提高免疫功能,积极预防上呼吸道感染。" + }, + { + "question_num": 283, + "query": "用背俞穴治疗耳聋,应首选", + "options": { + "A": "肺俞", + "B": "三焦俞", + "C": "肝俞", + "D": "肾俞", + "E": "脾俞" + }, + "answer": "D", + "reason": "背俞穴可以治疗与脏腑经脉相连属的组织器官所发生的病证。肾开窍于耳;故治耳聋应选用肾经的背俞穴。" + }, + { + "question_num": 284, + "query": "诊断3个月~6岁小儿营养性缺铁性贫血的标准,其血红蛋白值应低于的数值是", + "options": { + "A": "80g/L", + "B": "90g/L", + "C": "100g/L", + "D": "110g/L", + "E": "120g/L" + }, + "answer": "D", + "reason": "3个月~6岁小儿营养性缺铁性贫血的标准，其血红蛋白值小于等于110g/L;6岁以上的血红蛋白值应小于120g/L。" + }, + { + "question_num": 285, + "query": "按寸口脉分候脏腑,左关脉可候", + "options": { + "A": "心与膻中", + "B": "肾与小腹", + "C": "脾与胃", + "D": "肝、胆与膈", + "E": "肺与胸中" + }, + "answer": "D", + "reason": "寸关尺分候脏腑,历代医家说法不一，目前多以下述为准。左寸可候:心与膻中;右寸可候:肺与胸中;左关可候:肝胆与膈;右关可候:脾与胃;左尺可候:肾与小腹;右尺可候:肾与小腹。" + }, + { + "question_num": 286, + "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": 287, + "query": "治疗行痹,在取主穴的基础上,应加", + "options": { + "A": "膈俞、血海", + "B": "肾俞、关元", + "C": "阴陵泉、足三里", + "D": "大椎、曲池", + "E": "合谷、内关" + }, + "answer": "A", + "reason": "行痹在取主穴的基础上加膈俞、血海,行痹属风邪偏盛、取血海、膈俞以活血,乃“治风先治血，血行风自灭”之义。痛痹取B项肾俞、关元,着痹取C项阴陵泉、足三里" + }, + { + "question_num": 288, + "query": "小儿汗证的常见病因是", + "options": { + "A": "气虚", + "B": "阴虚", + "C": "阳虚", + "D": "血虚", + "E": "体虚" + }, + "answer": "A", + "reason": "小儿汗证的常见病因是气虚。" + }, + { + "question_num": 289, + "query": "下列哪项不是火淫的临床表现", + "options": { + "A": "壮热口渴", + "B": "面红目赤", + "C": "烦躁不宁", + "D": "舌质红绛", + "E": "脉象濡数" + }, + "answer": "E", + "reason": "壮热,口渴,面红目赤,心烦,汗出,或烦躁谵妄,衄血,吐血,斑疹,或躁扰发狂,或见痛脓,舌质红绛，脉象洪数或细数。可见题目中脉象的描述与火淫的临床表现不符。" + }, + { + "question_num": 290, + "query": "属于丙类传染病的病种是", + "options": { + "A": "艾滋病", + "B": "肺结核", + "C": "传染性非典型肺炎", + "D": "人感染高致病性禽流感", + "E": "流行性和地方性斑疹伤寒" + }, + "answer": "E", + "reason": "《中华人民共和国传染病防治法》规定管理的传染病分甲类、乙类、丙类三类。丙类传染病包括流行性感冒、流行性腮腺炎、风疹、急性出血性结膜炎、麻风病、流行性和地方性斑疹伤寒、黑热病、包虫病、丝虫病:除霍乱、细菌性和阿米巴性痢疾、伤寒和副伤寒以外的感染性腹泻病" + }, + { + "question_num": 291, + "query": "治疗中风闭证,除选太冲、劳宫外还应为", + "options": { + "A": "水分", + "B": "水沟", + "C": "下关", + "D": "申冲", + "E": "丰隆" + }, + "answer": "B", + "reason": "中风病的闭证应选用平肝熄风、清心豁痰、醒脑开窍的十二井穴、水沟、太冲等穴位。" + }, + { + "question_num": 292, + "query": "急性肾小球肾炎血清补体C,一过性明显下降,恢复正常的时间是(", + "options": { + "A": "2~3周", + "B": "4~5周", + "C": "6~8周", + "D": "9~11周", + "E": "12~15周" + }, + "answer": "C", + "reason": "急性肾小球肾炎血清补体C,一过性明显下降,恢复正常的时间是6~8周。" + }, + { + "question_num": 293, + "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,大便溏稀,面色觥白,神疲肢倦,小便短王沙艺白滑脉沉绍，成水曲日治机剧小便不利,腰膝冷痛,四肢不温,畏寒神疲,面色能白,舌淡胖,苔白滑，脉沉迟无力。D项为阳水的临床表现。" + }, + { + "question_num": 294, + "query": "疫情责任报告人发现乙类传染病患者、病源携带者或疑似传染病患者时,向发病地卫生防疫机构报告传染病。报告的时限为", + "options": { + "A": "城镇于3小时内,农村于6小时内", + "B": "城镇于6小时内,农村于10小时内", + "C": "城镇于6小时内,农村于12小时内", + "D": "城镇于6小时内,农村于24小时内", + "E": "城镇于12小时内,农村于24小时内" + }, + "answer": "E", + "reason": "责任疫情报告人发现乙���传染病患者、病原携带者和疑似传染病患者时,城镇于12小时内,农村于24小时内向发病地的卫生防疫机构报出传染病报告卡。" + }, + { + "question_num": 295, + "query": "治疗遗尿伴夜梦多,除主穴外,应加", + "options": { + "A": "肾俞、内关", + "B": "肾俞、肺俞", + "C": "肺俞、足三里", + "D": "百会、神门", + "E": "脾俞、内关" + }, + "answer": "D", + "reason": "遗尿伴有夜梦多应该宁心安神，故应选用百会神门等穴位" + }, + { + "question_num": 296, + "query": "麻疹的特殊体征是", + "options": { + "A": "高热", + "B": "咳嗽", + "C": "眼泪汪汪", + "D": "喷嚏流涕", + "E": "麻疹黏膜斑" + }, + "answer": "E", + "reason": "麻疹是感受麻疹时邪引起的一种以发热，咳嗽咽痛，鼻瑟流涕，眼泪汪汪,畏光,口腔两颊近白齿处可见麻疹黏膜斑为特征的疾病。" + }, + { + "question_num": 297, + "query": "阳明经证与腑证的鉴别要点是", + "options": { + "A": "有无发热", + "B": "有无汗出", + "C": "有无神志改变", + "D": "有无燥屎内结", + "E": "有无舌苔黄燥" + }, + "answer": "D", + "reason": "阳明经证,是指阳明病邪热弥漫全身,充斥阳明之经,肠中并无燥屎内结所表现出的临床证候。阳明腑证，是指阳明经邪热不解,由经人腑,或热自内发,与肠中糟粕互结,阻塞肠道所表现出的临床证候。阳明腑证较经证为重，往往是阳明经证进一步的发展。误用发汗使津液外泄，于是肠中干燥，热与糟粕充斥肠道,结而不通,则脐腹部胀满疼痛,大便秘结" + }, + { + "question_num": 298, + "query": "门脉性肝硬化并伴有上消化道出血时，下列哪项可诱发肝性脑病", + "options": { + "A": "口服去甲肾上腺素", + "B": "肥皂水灌肠清除积血", + "C": "硫酸镁导泻", + "D": "静脉输入止血芳酸", + "E": "静脉点滴支链氨基酸" + }, + "answer": "B", + "reason": "胃肠道大量积血时,血中富含的蛋白质被肠道细菌分解产生氨。当PH>6时,NH:弥散人血。肥皂水是碱性的,灌肠可提高肠道pH，早致Nm增扣还发旺性脑病。" + }, + { + "question_num": 299, + "query": "治疗肾虚型牙痛除取主穴外,还应加", + "options": { + "A": "外关、风池", + "B": "太溪、行间", + "C": "太溪、外关", + "D": "太冲、曲池", + "E": "太冲、阳溪" + }, + "answer": "B", + "reason": "肾虚型牙痛应配合太溪、行间以滋肾阴。" + }, + { + "question_num": 300, + "query": "治疗风疹邪郁肺卫证,应首选", + "options": { + "A": "桑菊饮", + "B": "银翘散", + "C": "透疹凉解汤", + "D": "清胃解毒汤", + "E": "普济消毒饮" + }, + "answer": "B", + "reason": "风疹邪郁肺卫证的方药为银翘散。" + }, + { + "question_num": 301, + "query": "患者关节疼痛重着,四肢酸困沉重,头重如裹,其病因是", + "options": { + "A": "风邪", + "C": "暑邪", + "B": "寒邪", + "D": "湿邪", + "E": "痰饮" + }, + "answer": "D", + "reason": "湿性重浊" + }, + { + "question_num": 302, + "query": "必须按照国务院卫生行政部门的有关规定。严格执行消毒隔离制度，防止发生院内感染和医源性感染的机构是", + "options": { + "A": "疾病控制中心", + "B": "卫生监督所", + "C": "预防保健机构", + "D": "医疗保健机构", + "E": "卫生行政管理机构" + }, + "answer": "D", + "reason": "《中华人民共和国传染病防治法实施办法》第十四条:医疗保健机构必须按照国务院卫生行政部门的有关规定，严格执行消毒隔离制度，防止医院内感染和医源性感染。" + }, + { + "question_num": 303, + "query": "患者恶寒重,发热轻,无汗,头痛,肢体疼痛,鼻塞声重,时流清涕,喉痒,舌苔薄白而润,脉浮,其治法是", + "options": { + "A": "散寒解肌", + "B": "辛温解表", + "C": "调和营卫", + "D": "散寒止痛", + "E": "发汗解肌" + }, + "answer": "B", + "reason": "风寒束表,卫阳被郁,故恶寒重,发热轻,无汗,清阳不展络脉失和,故头痛,肢体疼痛，肺气失宣故鼻塞声重,时流清涕,喉痒,证属风寒束表,治宜辛温解表。" + }, + { + "question_num": 304, + "query": "患者,男,38岁。左额面部疔疮,根深坚硬,形如钉丁状,红肿灼痛,伴发热,恶寒,头痛等全身症状,舌红苔腻,脉滑数,其治法是", + "options": { + "A": "清热消肿", + "B": "和营消肿", + "C": "清热凉血", + "D": "清热解毒", + "E": "和营托毒" + }, + "answer": "D", + "reason": "本病总以火热之毒为患,感受火热之邪,热毒蕴于肌肤，以致营卫不��，经络阻隔,气血凝滞;气不通则肿,血不通则痛;火为阳邪,性热而色赤,故皮色红而灼热;毒邪炽盛,与正气相搏,故首先要清热解毒。" + }, + { + "question_num": 305, + "query": "患者久病,畏寒喜暖,形寒肢冷,面色白,蜷卧神疲,小便清长,下利清谷,偶见小腿浮肿,按之凹陷如泥。舌淡,脉迟，其病机是", + "options": { + "A": "阳气亡失", + "B": "阳盛格阴", + "C": "阳损及阴", + "D": "阳气偏衰", + "E": "阳盛耗阴" + }, + "answer": "D", + "reason": "阳气亡失的临床表现为大汗淋漓,汗稀而凉,肌肤手足逆冷,精神疲惫,神情淡漠,排除A;阳盛格阴临床表现为壮热面红、气粗、烦躁,脉数有力,病势严重的情况下可出现四肢厥冷,脉象沉等假寒之象，排除B;阳损及阴的临床表现为四肢厥冷，下利清谷,又可见阳浮于外之症,如身热反不恶寒，面天贝71汉烈有龙现为壮热、尿赤、便干、口干欲饮、脉细数等,排除E。" + }, + { + "question_num": 306, + "query": "患者,男,45岁。咳嗽、咳痰5年、近3年每年持续咳嗽、咳痰3~4个月。肺部X线检查仅见肺纹理增粗，其诊断是", + "options": { + "A": "肺结核", + "B": "支气管哮喘", + "C": "慢性支气管炎", + "D": "肺脓肿", + "E": "支气管扩张" + }, + "answer": "C", + "reason": "患者中老年男性,咳嗽、咳痰近3年持续发作,每年发病持续3~4个月，胸部X线仅见肺纹理增粗,考虑慢性支气管炎可能性大。AD项有发热。B项应有气急。E项应有大量脓痰，" + }, + { + "question_num": 307, + "query": "患者,女,20岁。每遇生气后即咳逆阵作。口苦咽干,胸胁胀痛,咳时面赤,舌红苔薄黄,脉弦数,其证候是", + "options": { + "A": "痰热郁肺", + "B": "旺肺气访", + "C": "肝火犯肺", + "D": "阴虚火旺", + "E": "肺热津伤" + }, + "answer": "C", + "reason": "每遇生气后即咳逆阵作,口苦咽干,胸胁胀痛,咳时面赤,舌红苔薄黄,脉弦数,为咳嗽之肝火犯肺证。" + }, + { + "question_num": 308, + "query": "患者,男,27岁。左眉上出现一坚硬肿块,约1cmx1cm,中有一粟粒样脓头,坚硬根深,如钉丁之状,疼痛剧烈,左上眼睑肿胀明显。不能睁眼,伴发热头痛，其诊断是", + "options": { + "A": "痈", + "C": "疖", + "B": "发", + "D": "疔疮", + "E": "有头疽" + }, + "answer": "D", + "reason": "疔疮的特征是疮形如粟,坚硬根深,状如钉丁之状。" + }, + { + "question_num": 309, + "query": "患者发病初期恶寒发热,头痛无汗,咯吐白痰，舌苔白,脉浮紧。2日后壮热而不恶寒,面赤口渴,溲赤便干,舌红而干,脉数,其证候是", + "options": { + "A": "真热假寒", + "B": "表热里寒", + "C": "表寒里热", + "D": "由寒转热", + "E": "真寒假热" + }, + "answer": "D", + "reason": "发病初期恶寒发热,头痛无汗,咯吐白痰,舌苔白,脉浮紧,2日后壮热而不恶寒,面赤口渴,溲赤便干,舌红而干,脉数,其证候是由寒转热。初起为表寒，后转为里热实证。" + }, + { + "question_num": 310, + "query": "患者,65岁。查体:心尖搏动出现在剑突下。且深吸气时增强，肺动脉瓣第二心音增强。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": "心肌炎" + }, + "answer": "D", + "reason": "A项多有心绞痛,胸闷心慌,心电图有心肌缺血改变;B项有高血压基础病;C项有风湿病史，出现关节游走性疼痛，且风心病常不累及肺动脉瓣;D项有肺部基础疾病,深吸气时增强,肺动脉瓣第二心音增强,有肺高压表现，且心脏增大明显,有心肺功能不全表现;E项多由病毒感染引起,可有发热、疲乏、多汗、心慌、气急、心前区闷痛等。检查可见期前收缩、传导阻滞等心律失常。谷草转氨酶、肌酸磷酸激酶增高,血沉增快。心电图、X线检查有助于诊断。" + }, + { + "question_num": 311, + "query": "患者,男,27岁。干咳少痰,咳声短促,痰中带血。五心烦热，时有盗汗,形体消瘦。胸部闷痛隐隐,舌红少苔,脉细数,其诊断是", + "options": { + "A": "内伤咳嗽,肺阴亏耗", + "B": "肺痨,肺阴亏损", + "C": "哮病,肺虚", + "D": "喘病,肺虚", + "E": "虚劳,肺阴虚" + }, + "answer": "B", + "reason": "题干所述都是阴虚的特征病位在肺,故为肺阴亏损。" + }, + { + "question_num": 312, + "query": "患者,女,28岁。右口角疗疮2天,根深坚硬,形如钉丁状,掀热红肿,疼痛,张口不便。伴恶寒发热,舌苔腻,脉滑数。治疗应首选", + "options": { + "A": "五味消毒饮", + "B": "清暑汤", + "C": "防风通圣散", + "D": "普济��毒饮", + "E": "银翘散" + }, + "answer": "A", + "reason": "生在口角的,叫锁口疗,感受火热之邪,热毒蕴于肌肤，以致营卫不和，经络阻隔,气血凝滞;气不通则肿,血不通则痛;火为阳邪,性热而色赤,故皮色红而灼热;毒邪炽盛,与正气相搏,属于热毒蕴结,故应清热解毒,用五味消毒饮。" + }, + { + "question_num": 313, + "query": "患者,男,56岁。因情急恼怒而突发头痛而胀,继则昏厥仆倒。呕血，不省人事。肢体强痉,舌红苔黄,脉弦,其病机是", + "options": { + "A": "气郁", + "B": "气逆", + "C": "气脱", + "D": "气陷", + "E": "气结" + }, + "answer": "B", + "reason": "气郁,因情志不舒,气机郁结所致,症见胸满胁痛,噫气腹胀,排除A;气逆,指气上逆不顺而出现的病变证候,火热之气逆乱上冲之证;气脱,指机体正气虚怯,元气衰惫,气随血脱,阴阳欲离而出现的危重证候:排除C;气陷,是指在气虚的病变基础上;以气的升清功能不足和无力升举为主要特征的病理状态,排除D;气结,指气留滞不行,排除E;患者生气后,气不往下，反往上走,出现头胀继而晕厥,为气逆证,故选B。" + }, + { + "question_num": 314, + "query": "患者,男,30岁。高热寒战2天,胸痛伴咳嗽,痰中带血。听诊:右肺中部可闻及湿啰音。应首先考虑的是", + "options": { + "A": "急性支气管炎", + "B": "肺炎", + "C": "肺结核", + "D": "肺癌", + "E": "支气管哮喘" + }, + "answer": "B", + "reason": "患者病程短才2天,2天后就出现胸痛,伴咳嗽,痰中带血,排除CD,无喘息,呼吸闲难、哮鸣音,排除E,伴高热寒战,考虑炎症可能大。急性支气管炎临床以咳嗽伴(或不伴)有支气管分泌物增多为特征。而痰中带血是肺炎的一种表现。" + }, + { + "question_num": 315, + "query": "患者,女,40岁。平素善惊易恐,因受惊而心悸1个月余,坐卧不安,少寐多梦,舌苔薄白,脉虚弦。治疗应首选", + "options": { + "A": "归脾汤", + "B": "炙甘草汤", + "C": "朱砂安神丸", + "D": "天王补心丹", + "E": "安神定志丸" + }, + "answer": "E", + "reason": "心为神舍,心气不足则神浮不敛,心悸不安,少寐多梦,胆气虚则善惊易恐。心虚胆快治宜镇惊定志,养心安神，用安神定志丸。心脾两虚用归脾丸。气血阴阳俱虚用炙甘草汤。心火偏亢，阴血不足用朱砂安神丸。阴亏内热,滋阴清热用天王补心丹。" + }, + { + "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,故选B,其他都是适用于早期比较轻的病证。" + }, + { + "question_num": 317, + "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": "心烦不寐,舌红少津,脉细数为心阴虚的表现,眩晕耳鸣,健忘,腰酸梦遗为肾阴虚的表现。" + }, + { + "question_num": 318, + "query": "患者,男,20岁。咳嗽伴低热,盗汗,乏力1个月。X线检查显示右肺尖云雾状阴影。应首先考虑的是", + "options": { + "A": "肺炎球菌肺炎", + "B": "慢性支气管炎", + "C": "病毒性肺炎", + "D": "肺结核", + "E": "肺癌" + }, + "answer": "D", + "reason": "患者有结核中毒表现:低热,盗汗,乏力,且胸片的病变部分为结核的好发部位(尖背段)，故选D,其余各项，虽都可有发热咳嗽,但都无结核感染特征性临床表现，" + }, + { + "question_num": 319, + "query": "患者胸闷气短甚则胸痛彻背,心悸汗腰酸乏力，思寒肢冷，唇用淡白，舌淡白脉沉微欲绝。治疗应首选", + "options": { + "A": "参附汤合右归饮", + "B": "人参养荣汤合左归饮", + "C": "炙甘草汤合生脉散", + "D": "苓桂术甘汤合左归丸", + "E": "苏合香丸合左归饮" + }, + "answer": "A", + "reason": "胸痹共同特点为胸闷心痛:其中心肾阳虚，阴寒内盛证可见胸痛彻背，心悸汗出,腰酸乏力,畏寒肢冷,唇甲淡白,舌淡中I9MET，有业痛,用参附汤合右归饮。人参养荣汤合左归饮、炙甘草汤合生脉散用于气阴两虚证。苓桂术甘汤合左归丸适用于阴虚寒湿证。苏合香丸合左归饮适用于心肾阴虚心痛急性发作期。" + }, + { + "question_num": 320, + "query": "患者,男,50岁。1周前项后发际处突发一肿块,红肿热痛,渐���加剧,其后出现多个粟米样脓头,部分溃破溢脓,其治法是", + "options": { + "A": "凉血祛风,行瘀通络", + "B": "凉血清热,解毒利湿", + "C": "和营托毒,清热利湿", + "D": "清热解毒,活血通络", + "E": "养阴清热,托毒透邪" + }, + "answer": "C", + "reason": "根据本题题干可判断为有头疽之火毒蕴滞,治法:清热利湿,和营托:故选C,其他都不属于有头疽的治疗范畴,故不考虑。" + }, + { + "question_num": 321, + "query": "患者久病湿疹,面垢多眵,大便清泄时发下痢脓血，小溲浑浊不清,湿疹浸淫流水舌苔白厚腻,脉潘滑。病属湿邪为患，此证反映了湿邪的哪种性质", + "options": { + "A": "重浊", + "B": "黏腻", + "C": "趋下", + "D": "秽浊", + "E": "类水" + }, + "answer": "D", + "reason": "浊,即秽浊,多指分泌物秽浊不清。湿邪致病可出现各种秽浊症状，如面垢眵多、大便溏泻、下痢黏液脓血、小便浑浊:妇女白带过多、湿疹浸淫流水等，都是湿性秽油的步理5d" + }, + { + "question_num": 322, + "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片见双轨彤，" + }, + { + "question_num": 323, + "query": "患者突然仆倒，昏不知人,口吐自沫,四肢抽搐,口中喊叫,无口眼歪斜及半身不遂其诊断是", + "options": { + "A": "中风", + "B": "痉证", + "C": "痫证", + "D": "厥证", + "E": "眩晕" + }, + "answer": "C", + "reason": "痫病的特点如上,一昏二抽三无后遗症。痉证不昏迷,厥证、眩晕不抽搐，中风有口眼歪斜、半身不遂的后遗症。" + }, + { + "question_num": 324, + "query": "患者,男,48岁。背部生疮,初起肿块上有一粟粒样脓头，抓破后局部肿痛加剧，色红灼热,脓头相继增多。溃后如蜂窝状，伴有寒热头痛,纳呆,便秘,溲赤,舌质红,苔黄,脉弦数,其诊断是", + "options": { + "A": "疔", + "B": "疱", + "C": "有头疽", + "D": "发", + "E": "痈" + }, + "answer": "C", + "reason": "有头疽初期患处起一肿块:上有粟粒样脓头，肿块渐向四周扩大,脓头增多,色红灼热,高肿疼痛。伴发热恶寒、头痛纳差。溃脓期肿块进一步增大，疮面渐渐腐烂，形似蜂窝，肿块范围常超过10cm，甚至大于30cm。伴壮热、口渴便秘、溲赤等。收口期脓腐渐尽,新肉开始生长,逐渐愈合。" + }, + { + "question_num": 325, + "query": "患者,男,40岁。腰酸膝软,眩晕耳鸣,精神萎,性机能减退,并有遗精,早泄,其病因是", + "options": { + "A": "劳力过度", + "B": "房劳过度", + "C": "劳神过度", + "D": "劳心过度", + "E": "安逸过度" + }, + "answer": "B", + "reason": "房劳过度,性生活不节制导致肾精耗伤,如《素问·宣明五气》说:五劳所伤,久视伤血,久卧伤气,久坐伤肉,久立伤骨,久行伤筋。过度安逸指过度安闲，不劳动及运动。" + }, + { + "question_num": 326, + "query": "患者,男,26岁。心悸,气促1年。查体:两颊暗红,颈静脉明显怒张，下肢浮肿。心浊音界向左扩大，心尖区可闻及舒张期隆隆样杂音,肝右肋下4cm。质软,有压痛,肝颈静脉回流征阳性。应首先考虑的是", + "options": { + "A": "二尖瓣狭窄并发右心衰竭", + "B": "二尖瓣关闭不全后期所致右心衰竭", + "C": "主动脉瓣狭窄并发左心衰竭", + "D": "主动脉瓣关闭不全并发左心衰竭", + "E": "肺源性心脏病致右心衰竭" + }, + "answer": "A", + "reason": "心尖区可闻及舒张期隆隆样杂音为二尖瓣狭窄的听诊特点，两颊暗红为二尖瓣面容,颈静脉明显怒张，下肢浮肿，肝右肋下4cm,质软,有压痛,肝颈静脉回流征阳性等为体循环淤血，右心衰竭表现,故选A。二尖瓣关闭不全为心尖部收缩期杂音。主动脉瓣3助间舒张期杂音，主兰阳不今次胞母大第2-动脉瓣狭窄为胸骨右第2~3肋间收缩期杂音，左心衰时表现为肺水肿、肺淤血，咯粉红色泡沫痰。" + }, + { + "question_num": 327, + "query": "患者胃痛,脘腹胀满,嗳腐吞酸,吐不消化食物，大便不爽,舌苔厚腻,脉滑,其治法是", + "options": { + "A": "理��消胀", + "B": "消食导滞", + "C": "理气和胃", + "D": "消食健脾", + "E": "和胃止呕" + }, + "answer": "B", + "reason": "患者胃痛有明显的伤食史,吐不消化食物,食积中阻,故脘腹胀满,嗳腐吞酸。治宜消食导滞,故选B。肝胃气滞选A胃气壅滞选C。脾胃虚弱选D。胃气上逆选E。" + }, + { + "question_num": 328, + "query": "患者,男,48岁。因鼻部破损引起头额红肿。两目肿胀不能开视，伴形寒发热，舌红苔黄腻,脉滑数,治疗应首选", + "options": { + "A": "化斑解毒汤", + "B": "普济消毒饮", + "C": "龙胆泻肝汤", + "D": "五神汤", + "E": "仙方活命饮" + }, + "answer": "B", + "reason": "风热毒邪犯上,与血分热邪蕴结,郁阻肌肤,故见头面部皮肤红灼热，风热毒邪与正气相争,故见恶寒发热;舌红、苔黄、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": 329, + "query": "患者,男,72岁。素体气虚,复感外邪恶寒较重,无发热,鼻塞流涕,头痛无汗,肢体倦怠乏力,咳嗽咯痰无力。舌质淡,苔薄白,脉浮。诊断为气虚感冒。据此判断气的功能减退主要体现在", + "options": { + "A": "推动作用", + "B": "温煦作用", + "C": "防御作用", + "D": "固摄作用", + "E": "中介作用" + }, + "answer": "C", + "reason": "" + }, + { + "question_num": 330, + "query": "患者,女,30岁。10年前患风湿热,检查心尖部听到舒张期隆隆样杂音。X线显示左心房增大。应首先考虑的是", + "options": { + "A": "二尖瓣关闭不全", + "B": "二尖瓣狭窄", + "C": "主动脉瓣关闭不全", + "D": "主动脉瓣狭窄", + "E": "肺动脉瓣狭窄" + }, + "answer": "B", + "reason": "患者有风湿热病史,并出现心脏杂音,考虑风湿性心脏瓣膜病。且心尖部听到舒张期隆隆样杂音为二尖瓣狭窄特有的杂音,且二尖瓣狭窄导致左房血液瘀滞,增大故选B。A项为心尖部收缩期杂音;C项为胸骨右缘第2-3肋间舒张期杂音:D项为胸骨右缘第2~3肋间收缩期杂音;E项为胸骨左缘第2~3肋间收缩期杂音。" + }, + { + "question_num": 331, + "query": "患者以胃脘痞塞,满闷不舒为主;按之杂软，压重,反复发作,病程没长。多因饮食、情志、起居、寒温等因素诱发,其诊断是", + "options": { + "A": "胃痛", + "B": "臌胀", + "C": "痞满", + "D": "胸痹", + "E": "结胸" + }, + "answer": "C", + "reason": "痞满的特点是胃脘痞塞,满闷不舒,按之柔软,压之不痛,望无胀形。胃痛以胃中疼痛为主,可有压痛。胀以腹部外形胀大如鼓为特点。胸痹疼痛部位在心胸，以胸闷胸痛，心悸气短为主症。结胸病位在胸不在胃。" + }, + { + "question_num": 332, + "query": "患儿,男,12岁。患流痰3年,溃口位于左腰部,脓水稀薄,夹有败架样物,伴有午后潮热,夜间盗汗,口燥咽干,咳嗽血，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,瓶红，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清骨散,故选C。A项治疗阴疽,BE项治疗肾阴:D项阴阳双补。" + }, + { + "question_num": 333, + "query": "患者,女,25岁。口舌生疮,心烦失眠小便黄赤,尿道灼热涩痛，口渴。舌红无苔,脉数，甘宿位在", + "options": { + "A": "心、脾", + "B": "小肠", + "C": "膀胱", + "D": "心、小肠", + "E": "肾、膀胱" + }, + "answer": "D", + "reason": "心与小肠:心火可以下移小肠,如尿赤尿少,小肠火上炎于心有口舌生疮。心经有热则心烦失眠，舌为心之苗,故口舌生疮,心火上炎,灼伤津液则口渴,心与小肠相表里，心移热于小肠,则小便黄赤，尿道灼热涩痛,故病位在心与小肠。" + }, + { + "question_num": 334, + "query": "患者,男,60岁。高血压病史15年,突发剧烈头痛,眩晕,恶心,呕吐,失语。查体:无肢体活动障碍。血压200/120mmHg(26.6/16kPa)，神经反射正常。应首先考虑的是", + "options": { + "A": "急进型高血压", + "B": "缓进型高血压", + "C": "高血压脑病", + "D": "高血压性脑出血", + "E": "高血压性心脏病" + }, + "answer": "C", + "reason": "患者发病时血压200/120mmHg,结合发作时眩晕、失语的表现,可诊断为高血压脑病,故选C。肢体活动无障碍神经反射正常,故排除D。本病例无心脏损伤的直接证据,故排除E。" + }, + { + "question_num": 335, + "query": "患者,女,29岁。外感后,突发呕吐,恶寒头痛。胸脘满闷，舌苔白腻,脉缓。治疗应首选", + "options": { + "A": "左金丸", + "B": "白虎汤", + "C": "小柴胡汤", + "D": "藿香正气散", + "E": "龙胆泻肝汤" + }, + "answer": "D", + "reason": "外感后突发呕吐,胸脘满闷,舌苔白腻,兼见表证,为外感寒湿。治宜解表祛邪,和胃降逆,用香正气散,其余都不适用于外感寒湿证。" + }, + { + "question_num": 336, + "query": "患者,女,28岁。产后乳房胀痛,位于乳房外上方皮肤掀红，肿块形似鸡卵，压痛明显,按之中软,有波动感,伴壮热口渴。切开弓流的部位及切口是", + "options": { + "A": "循乳络方向做放射状切口", + "B": "乳晕旁弧形切口", + "C": "脓肿处作任意切口", + "D": "以乳头为中心的弧形切口", + "E": "脓肿波动明显处作切口" + }, + "answer": "A", + "reason": "一般采用与乳头方向呈放射状的切口，切口位置选择脓肿稍低的部位:切口长度与脓腔基底的5沉建盼不致袋脓,但需避免手术损伤乳络形成乳瘘。因为乳腺每一腺叶有单独的腺管(乳管)呈放射状聚向乳头，并分别开口于乳头。" + }, + { + "question_num": 337, + "query": "患者心烦失眠,狂躁妄动,伴有高热,咽干口燥,小便短赤,大便秘结,其病因是", + "options": { + "A": "风邪", + "B": "燥邪", + "C": "暑邪", + "D": "火邪", + "E": "痰饮" + }, + "answer": "D", + "reason": "" + }, + { + "question_num": 338, + "query": "典型心绞痛胸部疼痛的部位是", + "options": { + "A": "心尖部", + "B": "左肩背部", + "C": "胸部左侧", + "D": "胸骨体上段或中段的后方", + "E": "胸部右侧" + }, + "answer": "D", + "reason": "心绞痛以发作性胸痛为主要临床表现,疼痛部位主要在胸骨体上段或中段之后,可波及心前区,有手掌大小范围,故本题选D。" + }, + { + "question_num": 339, + "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,脘腹胀闷,面黄,肢倦乏力,舌淡苔白,脉细弱,其治法是", + "options": { + "A": "健脾益气", + "B": "益胃升阳", + "C": "健脾益胃", + "D": "健脾温中", + "E": "温补脾胃" + }, + "answer": "A", + "reason": "大便时溏时泻,水谷不化:稍进油腻之物,则大便次数增多,为久泻虚证，比幽子日4HHH/-2E女t白,脉细弱,为脾气虚之象,未见明显的脾阳虚寒证,胃气虚证、中气下陷证,故只需健脾益气。" + }, + { + "question_num": 340, + "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，故月经周期紊乱，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": 341, + "query": "患者年高体衰,病属虚寒,久已卧床不起。今日晨起突然面色泛红，烦热不宁，语言增多,并觉口渴,舌淡,脉大而无根,其病机是", + "options": { + "A": "阴盛格阳", + "B": "阳虚阴盛", + "C": "阳损及阴", + "D": "阳气亡失", + "E": "阴阳离决" + }, + "answer": "A", + "reason": "患者病属虚寒,阴寒之邪壅结于内,逼迫阳气外越,使阴阳气不相顺接，而有热象,此为阴盛格阳。" + }, + { + "question_num": 342, + "query": "患者,男,42岁。既往脾大,HBsAg阳性。今晨排柏油样便约200ml。应首先考虑的是", + "options": { + "A": "急性糜烂性胃炎", + "B": "消化性溃疡", + "C": "肝硬化", + "D": "白血病", + "E": "胃癌" + }, + "answer": "C", + "reason": "患者有乙肝病史,且已出现肝硬化门脉高压的临床表现:脾大,故柏油样便应考虑食管胃底侧支循环内压力过高破裂出血的结果,故选C。AB项胃肠道出血量少，很少出现柏油样便。D项可有脾大,但无其他上述症状。E项不会出现脾大，且与乙肝无关。" + }, + { + "question_num": 343, + "query": "患者腹痛,里急后重,下痢赤白相杂,肛门灼热,小便短赤。舌苔微黄,脉滑数,其治法是", + "options": { + "A": "清热解毒,调气行血", + "B": "清热化湿,理气止痛", + "C": "清���凉血,和胃利湿", + "D": "清肠和胃,利湿解毒", + "E": "清胃利湿,和胃通降" + }, + "answer": "A", + "reason": "湿热之邪毒积滞肠中,气血被阻,传导失司,故腹痛,里急后重。湿热毒邪伤肠破血,故下痢赤白相间。湿热下注，肛门灼热,小便短赤,舌苔微黄,脉滑数,都是湿热壅盛，气血不畅表现。治宜清热解毒，调气行血。" + }, + { + "question_num": 344, + "query": "患者,男,48岁。两乳内发现疼痛性肿物1周。检查:肿物大小约3cm×3cm×1cm。质地中等,有压痛,位于乳晕中央，界限清楚可移动。应首先考虑的是", + "options": { + "A": "乳癖", + "B": "乳痨", + "C": "乳疬", + "D": "乳岩", + "E": "乳腺增生病" + }, + "answer": "C", + "reason": "乳疬是以男性、儿童单侧或双侧乳晕部发生扁圆形肿块,触之疼痛为主要表现的乳房异常发育症。一侧或双侧乳晕部出现扁圆形肿块，质地中等或稍硬，边缘清楚:或单侧乳房明显增大,或双侧乳房呈对称性或不对称性增大,大小不一,状如发育期的少女乳房。多伴有乳房胀痛和轻度压痛。" + }, + { + "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、燥为特点,阳盛病机易于出现化然学药型，风映品壮热,烦渴,面红目赤,尿黄,便干,舌苔黄等症状。" + }, + { + "question_num": 346, + "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、Scr;B项会出现体循环淤肤黄染、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": 347, + "query": "患者大便不干硬,虽有便意,临厕努挣无力,挣则汗出短气,便后疲乏,面色能白,舌淡嫩苔薄,脉虚,其治法是", + "options": { + "A": "补脾和胃", + "B": "温阳通便", + "C": "益气补肺", + "D": "温中健脾", + "E": "益气润肠" + }, + "answer": "E", + "reason": "肺脾气虚,运化失职,大肠传导无力,故虽有便意,临厕努挣无力,气虚故挣则汗出短气,便后疲乏,面色白,舌淡嫩苔薄,脉虚,均为气虚之征。治宜益气,便秘都要润肠。" + }, + { + "question_num": 348, + "query": "患者,女,50岁,未婚。右乳内上方可及2cm×2cm×2cm肿物,无疼痛,质地韧，不光滑,界限不清,基底不粘连,推之可移动。应首先考虑的是", + "options": { + "A": "乳癖", + "B": "乳疬", + "C": "乳痨", + "D": "乳岩", + "E": "乳腺增生病" + }, + "answer": "C", + "reason": "乳痨是以乳房结块如梅李不痛,边界不清,皮肉相连,肿块化脓,溃后脓出稀薄,疮口不易收敛,病程缓慢为主要表现的结核性疾病,故选C。而其他选项虽然有的可以见到界限不清和推之可移,但是只有乳痨前期无疼痛的症状。" + }, + { + "question_num": 349, + "query": "患者痰壅气逆,咳嗽喘逆,痰多胸闷,食少难消,舌苔白腻,脉滑。治疗宜选用", + "options": { + "A": "山楂", + "B": "莱菔子", + "C": "神曲", + "D": "鸡内金", + "E": "麦芽" + }, + "answer": "B", + "reason": "本题五个选项均具有消食化积之功效,山楂兼能行气散瘀;莱菔子降气化痰;神曲可和胃;鸡内金涩精止遗、化坚消石;麦芽回乳消胀。本题所述症状中有痰壅气逆、痰多胸闷,可用莱菔子降气化痰,故选B。" + }, + { + "question_num": 350, + "query": "患者,男,40岁。乙肝病史6年。近半月肝区持续性疼痛。胃纳差，黄疸，消瘦。查体:肝肋下4cm,质硬,表面不平,压痛。应首先考虑的是", + "options": { + "A": "慢性肝炎", + "B": "肝脓肿", + "C": "肝硬化", + "D": "继发性肝瘤", + "E": "原发性肝癌" + }, + "answer": "E", + "reason": "原发性肝癌的症状:肝痛、乏力、纳差、消瘦是最具特征性的临床症状体征:进行性肝肿大为最常见的特征性体征之一。肝质地坚硬,表面及边缘不规则,常呈结节状,少数肿瘤深埋于肝实质内者则肝表面光滑,伴或不伴明显压痛。肝右叶膈面癌肿可使右侧膈肌明显抬高。有脾肿大、腹水、黄疸、肝区血管杂音、肝区摩擦音,故选E。A项查体:质韧,表面光滑,压痛不明显;B项有发热、寒战等感染表现;C项多有门脉高压的表现;D项多有原发肿瘤的表现。" + }, + { + "question_num": 351, + "query": "患者,男,60岁。久患胁痛,悠悠不休,遇劳加重,头晕目眩,口干咽燥,舌红少苔,脉弦细。治疗应首选", + "options": { + "A": "柴胡疏肝散", + "B": "逍遥散", + "C": "杞菊地黄丸", + "D": "一贯煎", + "E": "二阴煎" + }, + "answer": "D", + "reason": "肝阴不足,阴血难以濡养肝络,故见胁痛悠悠不休,劳则耗气,故遇劳加重,精血亏虚故头晕目眩,口干咽燥,舌红少苔,脉弦细。证属肝阴不足,治宜养阴柔肝,方用一贯煎。柴胡疏肝散、逍遥散用于肝气郁结。杞菊地黄丸用于肝肾阴虚。二阴煎用于滋养肾肺" + }, + { + "question_num": 352, + "query": "患者,女,42岁。乳头溢出血性液体1周,同时伴有急躁易怒,胸胁胀痛,口苦咽干，舌红苔黄,脉弦数,其证候是", + "options": { + "A": "阴虚火旺", + "B": "肝郁脾虚", + "C": "肝郁火旺", + "D": "脾虚失摄", + "E": "气阴两虚" + }, + "answer": "C", + "reason": "乳衄是以乳窍溢出血性液体,乳头或乳晕部触及可活动的质软、不痛肿块为主要表现的乳房肿瘤。由于情怀抑郁，肝气不舒,郁而化火,灼伤血络,迫血妄行,旁走横溢而发;或由于思虑伤脾,统血无权,血流胃经,溢于乳窍而成，其只有肝郁火旺和脾不统血两个证型，所以与情志有关的只有肝郁火旺。" + }, + { + "question_num": 353, + "query": "患者外感风邪,头痛较甚。伴恶寒发热，目眩鼻塞。舌苔薄白脉浮。治疗宜选用", + "options": { + "A": "川芎", + "B": "丹参", + "C": "郁金", + "D": "牛膝", + "E": "益母草" + }, + "answer": "A", + "reason": "川芎、郁金为活血止痛药，丹参、益母草、牛膝为活血调经药,本题所述为外感风邪所致头痛,故可排除调经药BDE,J芎可祛风止痛，上行头目。为治头痛要药,郁金则偏重于清热凉血、利胆退黄,故排除C。" + }, + { + "question_num": 354, + "query": "患者,男,24岁。暴食后突然上腹剧恶心,呕吐，发热。检查:腹部较软，上腹压痛。血清淀粉酶增高，其诊断是", + "options": { + "A": "急性胃肠炎", + "B": "消化性溃疡急性穿孔", + "C": "胆囊炎", + "D": "急性胰腺炎", + "E": "心肌梗死" + }, + "answer": "D", + "reason": "血清淀粉酶增高为急性胰腺炎的特征性改变。患者有暴饮暴食诱因，并出现消化道症状和上腹部压痛,故选D。A项多因不洁的饮食或冷热变化引起，无血清淀粉酶增高;B项有溃疡史，且穿孔后会出现腹膜炎体征,腹壁紧张度增加;C项在进食油腻食物和夜间易发作;E项有心前区疼痛。" + }, + { + "question_num": 355, + "query": "患者黄疸日久,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,证属阴黄的寒湿内盛证型,治宜温化寒湿,健脾退黄,方用茵陈术附汤。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": 356, + "query": "患者,女,62岁。已确诊为右乳岩,胸胁胀满,嗳气频频,纳呆懒言,口苦咽干,舌淡苔薄白,脉弦滑,其证候是", + "options": { + "A": "肝肾不足", + "B": "脾胃不和", + "C": "情志郁结", + "D": "气血两亏", + "E": "冲任失调" + }, + "answer": "C", + "reason": "乳岩的病因主要有情志失调、饮食不节、冲任不调,还有经气虚弱的情况。本病例胸胁胀满,暖气频频,纳呆言,口苦咽干,显然是肝郁之象,故可以判断为情志郁结。" + }, + { + "question_num": 357, + "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,善治血瘀气滞痛证,活血调经,其余选项均无调经之功效。" + }, + { + "question_num": 358, + "query": "患者,女,30岁。尿频、尿痛2天。检查:体温38°C,右肾区叩击痛。尿蛋白(±),尿中红细胞2~4/HP,白细胞20~30/HP。应首先考虑的是", + "options": { + "A": "急性膀胱炎", + "B": "急性肾炎", + "C": "急性肾盂肾炎", + "D": "尿道综合征", + "E": "右肾结石" + }, + "answer": "C", + "reason": "A项无肾区叩击痛;B项临床上表现为急性起病,以血尿、蛋白尿、水肿、高血压和肾小球滤过率下降为特点;D项反复发作尿频、尿急、尿痛、膀胱里急后重、排尿困难等症状。而尿常规化验正常，中段尿培养无菌生长，谓之尿道综合征。尿道综合征的特点:发病快、消失也快,呈周期性发作,发作周期不定。E项为突然发作的阵发性刀割样疼痛,疼痛剧烈难忍,有时有大汗、恶心呕吐。可有肉眼血尿,结石并发感染时，尿中出现脓细胞,有尿频、尿痛症状。" + }, + { + "question_num": 359, + "query": "患者,女,53岁。腹中可及积块,软而不坚。固着不移,胀痛并见,舌苔薄,脉弦,其证候是", + "options": { + "A": "肝气郁滞", + "B": "瘀血内结", + "C": "气滞血阻", + "D": "气滞痰阻", + "E": "气虚血瘀" + }, + "answer": "C", + "reason": "气滞血阻,结为积块,固着不移为血,胀痛为气,此为特点,属积证初期，故软而不坚，印证气血同病,故选C。不只是气,排除A。瘀血内结为中期,肿块明显硬痛不移,非此证,排除B。痰、虚未见,排除DE。" + }, + { + "question_num": 360, + "query": "患者,女,52岁。颈前结喉右侧肿物3cm×3cm×2cm,质地较硬，表面不光，不能随谷咽而上下移动，同时伴有局部疼痛，音哑,临床考虑为石瘳。行同位素扫描，其结果多是", + "options": { + "A": "温结节", + "B": "热结节", + "C": "冷结节", + "D": "无改变", + "E": "中性结节" + }, + "answer": "C", + "reason": "甲状腺同位素扫描,多显示为凉结节(或冷结节)。" + }, + { + "question_num": 361, + "query": "患者腰痛以酸软为主,喜按喜揉,腿膝无力,遇劳更甚,卧则减轻。治疗应选用", + "options": { + "A": "牛膝", + "B": "桃仁", + "C": "红花", + "D": "郁金", + "E": "鸡血藤" + }, + "answer": "A", + "reason": "牛膝兼能补肝肾强筋骨;桃仁兼能润肠通便;红花兼能祛瘀止痛;郁金兼能利胆退黄;鸡血藤兼能祛风通络。本题所述病证腰膝酸软，遇劳则其,为肾虚所致筋骨无力,故选A。" + }, + { + "question_num": 362, + "query": "膀胱炎最易发生于", + "options": { + "A": "女性婴幼儿", + "B": "50岁以上男性", + "C": "育龄妇女", + "D": "老年妇女", + "E": "青年男性" + }, + "answer": "C", + "reason": "膀胱炎属于下尿路感染女性尿道特点为宽,短，直。此解剖特点可以使细菌更容易通过尿道进入下尿路甚至上尿路;女性经血是细菌最好的培养基,经期不注意卫生也会导致感染机会增加;性生活也是重要因素,因其可以使得细菌逆行感染膀胱或后尿道。" + }, + { + "question_num": 363, + "query": "患者,男,60岁。腹胀大如鼓,按之如爽裹水,有波动感。应首先考虑的是", + "options": { + "A": "水饮", + "B": "痞满", + "C": "积聚", + "D": "水臌", + "E": "内痈" + }, + "answer": "D", + "reason": "臌胀是肝脾肾功能失调,气血水互结于腹内。临床以腹部胀大如鼓为特点,其中偏于水停的按之如囊裹水,有波动感,叫水臌。水饮多停留于体内空腔或体位低下之处,不会胀大如鼓。积聚以腹中结块为主症。痞满是腹中自觉有胀满之感,按之却柔软无物。" + }, + { + "question_num": 364, + "query": "患者,男,48岁。肩背皮肤浅层肿块与皮肤粘连,瘤体表面中心有黑色粗大毛孔挤压时有臭脂浆溢出，其诊断是", + "options": { + "A": "脂瘤", + "B": "肉瘤", + "C": "流痰", + "D": "血瘤", + "E": "筋瘤" + }, + "answer": "A", + "reason": "在肿块表面皮肤常可见针头大开口,略带黑色,挤之有白色分泌物溢出，且有臭气。" + }, + { + "question_num": 365, + "query": "患者,女,36岁。面色萎黄,头晕眼花:心悸失眠。舌淡少苔，脉细弱。治疗应首选", + "options": { + "A": "酸枣仁", + "B": "合欢皮", + "C": "磁石", + "D": "远志", + "E": "朱砂" + }, + "answer": "A", + "reason": "患者“面色萎黄,头晕眼花心悸失眠”,此为血虚不能养神,治宜养血柔肝,安神。而酸枣仁养心益肝,安神,敛汗,故酸枣仁为正确选项。合欢皮解郁安神，活血消肿。磁石镇惊安神,平肝潜阳,聪耳明目,纳气定喘。远志宁心安神,祛痰开窍,消散痈肿。朱砂清心镇惊,安神解毒。四种药物虽然都能安神,但不具有养血之功，" + }, + { + "question_num": 366, + "query": "患者因腹胀,全身疼痛就诊。检查:脾肋缘下6cm,血液白细胞计数160X10^9/L。可见各阶段幼稚粒细胞少许。应首先考虑的是", + "options": { + "A": "脾功能亢进", + "B": "门脉性肝硬化", + "C": "急性粒细胞白血病", + "D": "慢性粒细胞白血病", + "E": "急性淋巴细胞白血病" + }, + "answer": "D", + "reason": "全身疼痛、查体脾肋缘下6cm,血液白细胞计数显著增加，见各阶段幼稚粒细胞而非幼稚淋巴细胞，故选D,而非E。脾大多见于脾功能亢进、急性淋巴细胞白血病及慢性粒细胞白血病。脾功能亢进可见三系均血中亦可见幼稚粒细胞,但不是各阶段均能见到,且脾大少见。" + }, + { + "question_num": 367, + "query": "患者头痛以前额为甚,面红,牙痛,便干,舌红苔黄,脉弦。处方用药加用白芷,除治疗效应外,其引经报使作用在", + "options": { + "A": "少阳经", + "B": "太阳经", + "C": "阳明经", + "D": "少阴经", + "E": "厥阴经" + }, + "answer": "C", + "reason": "前额痛为阳明经循行部位，且白芷入阳明经。" + }, + { + "question_num": 368, + "query": "患者,男,45岁。左上臂内侧有一肿块,呈半球形。暗红色，质地柔软,状如海绵，压之可缩小。应首先考虑的是", + "options": { + "A": "气瘤", + "B": "筋瘤", + "C": "脂瘤", + "D": "血瘤", + "E": "肉瘤" + }, + "answer": "D", + "reason": "血瘤可发生于身体任何部位,但以四肢、躯干、面颈部多见。常在出生后即发现,随着年龄增长而长大，长到某种程度后,可停止进展。瘤体外观呈暗红色或紫蓝色，亦可为正常皮色，小如豆粒，大如拳头，质地柔软,状如海绵，压之可缩小，肢体活动时胀大。" + }, + { + "question_num": 369, + "query": "患者失眠,健忘,心悸,自汗出。治疗应选用", + "options": { + "A": "朱砂", + "B": "酸枣仁", + "C": "合欢皮", + "D": "远志", + "E": "磁石" + }, + "answer": "B", + "reason": "患者“失眠、健忘”是因血不养神,治宜养血，“自汗”治宜敛汗。酸枣仁养心益肝,安神,敛汗,故选B。朱砂清心镇惊,安神解毒。合欢皮解郁安神,活血消肿。远志宁心安神,祛痰开窍,消散痈肿。磁石镇惊安神平肝潜阳,聪耳明目,纳气定喘。" + }, + { + "question_num": 370, + "query": "患者,女,20岁。四肢皮肤反复出现紫斑1年。检查:肝、脾不大,轻度贫血,血小板60x10^9/L,骨髓颗粒型巨核细胞比例增加,其诊断是", + "options": { + "A": "急性白血病", + "B": "再生障碍性贫血", + "C": "脾功能亢进", + "D": "过敏性紫癜", + "E": "特发性血小板减少性紫癜" + }, + "answer": "E", + "reason": "特发性血小板减少性紫癜是小儿最常见的出血性疾病，其特点是自发性出血，血小板减少，出血时间延长和血块收缩不良。骨髓中巨核细胞的发育受到抑制，故选E。A项特点是由造血干细胞恶变而形成的一个原始细胞克降取代了正常骨髓。B项再障系多种病因引起的造血障碍，导致红骨髓总容量减少,代以脂肪髓,造血衰竭,以全血细胞减少为主要表现的一组综合征。C项临床表现为脾肿大、一种或多种血细胞减少,而骨髓造血细胞相应增生,可经脾切除而缓解。" + }, + { + "question_num": 371, + "query": "患者眩晕,头重如蒙,胸闷恶心,食少寐多,舌苔白腻,脉滑。治疗应首选", + "options": { + "A": "苓桂术甘汤", + "B": "半夏白术天麻汤", + "C": "黄连温胆汤", + "D": "半夏厚朴汤", + "E": "半夏秫米汤" + }, + "answer": "B", + "reason": "痰浊中阻,清阳不升,可致眩晕,头重如蒙,气机不利;故胸闷恶心,食少寐多,舌苔白腻,脉滑,均为痰湿壅盛之证。治宜燥湿祛痰，健脾和胃,用半夏白术天麻汤:选B。苓桂术甘汤用于阳虚水盛。黄连温胆汤用于痰热壅盛。半夏厚朴汤用于痰气交阻。" + }, + { + "question_num": 372, + "query": "患儿,男,9岁。头皮部初起丘疹色红,灰白色鳞屑成斑,毛发干枯,容易折断,易于拔落而不疼痛。已有年余,自觉瘙痒,其诊断是", + "options": { + "A": "肥疮", + "B": "牛皮癣", + "C": "白秃疮", + "D": "白疤", + "E": "圆癣" + }, + "answer": "C", + "reason": "白秃疮病变初起,头皮覆盖有圆形或不规则形的灰白色鳞屑的斑片，小者如豆,大者如钱日久蔓延,扩大成片。毛发干枯,容易折断,易于拔出,而不疼痛,多数在离头皮0.2~0.8cm处头发自行折断，长短参差不齐。在接近头皮的毛发干外围，常有灰白色菌鞘围绕，自觉癌痒。发病部位以头顶、枕���居多。白疤皮损为厚积的银白色鳞屑性斑片，头发呈束状，无断发现象，并有薄膜现象及筛状出血。" + }, + { + "question_num": 373, + "query": "患者自幼患有痫证,近期发作较频,并见心神不安。心悸,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": "党参", + "E": "远志" + }, + "answer": "E", + "reason": "远志能开心气而宁心安神通肾气而强志不忘,祛痰开窍,用于疯痫、惊狂。本题所述症状较适宜。竹茹清热化痰、茯苓清热、琥珀重镇安神、党参补气。" + }, + { + "question_num": 374, + "query": "患者男,14岁。患1型糖尿病2年，近日在家中用胰岛素治疗，突然发生昏迷，其昏迷原因最可能是", + "options": { + "A": "糖尿病高渗性昏迷", + "B": "乳酸性酸中毒", + "C": "呼吸性酸中毒", + "D": "尿毒症酸中毒", + "E": "低血糖昏迷" + }, + "answer": "E", + "reason": "1型糖尿病应用胰岛素治疗的常见并发症为胰岛素应用过量导致低血糖:进而昏迷。AB项亦为糖尿病常见并发症，但与本题背景不符。CD项与本题关系不大。" + }, + { + "question_num": 375, + "query": "患者突然昏仆,不省人事,肢体软瘫目合口张,鼻鼾息微,手撒肢冷,汗多，二便自", + "options": { + "A": "中经络", + "B": "阳闭证", + "C": "阴闭证", + "D": "脱证", + "E": "后遗症" + }, + "answer": "D", + "reason": "中风根据有无神志障碍分为中经络、中脏腑。中脏腑又有闭证和脱证之分。闭证又分阴阳。根据病程可分为急性期慢性期、后遗症期。脱证乃阳气外脱，以突然昏仆,不省人事,肢体软瘫,目合口张,鼻鼾息微,手撒肢冷,汗多,二便自遗,舌痿,脉微欲绝为主症。" + }, + { + "question_num": 376, + "query": "患者,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,偶有瘙痒感,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，呈褐色或谈红色，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，表面租椎用化，从更或污次巴，热形，中哭相口，后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,色呈灰白或污黄,表面蓬松枯槁,状如花蕊,粗糙而坚硬。" + }, + { + "question_num": 377, + "query": "患者咳嗽痰白清稀。食少便溏,下肢轻度浮肿。舌淡苔白，脉弱。治疗应选用", + "options": { + "A": "党参", + "B": "甘草", + "C": "山药", + "D": "白术", + "E": "黄柏" + }, + "answer": "D", + "reason": "患者脾失健运,不能运化水湿,则湿聚成痰,故见“咳嗽痰白清稀,下肢轻度浮肿”脾失健运,则水谷不化,故见“食少便溏”。治宜健脾益气,燥湿利尿。白术健脾益气,燥湿利尿,止汗,安胎,故选D。党参补脾肺气,补血,生津。甘草补脾益气,祛痰止咳,缓急止痛,清热解毒，调和诸药。山药补脾养胃，生津益肺,补肾涩精。黄柏清热燥湿,泻火除蒸,解毒疗疮。" + }, + { + "question_num": 378, + "query": "患者,26岁。近1个月来,以夜间咳嗽为主。痰中带血丝，伴低热，盗汗。应首先考虑的是", + "options": { + "A": "肺结核", + "B": "支气管扩张", + "C": "肺癌", + "D": "风湿性心脏病(二尖瓣狭窄)", + "E": "急性肺水肿" + }, + "answer": "A", + "reason": "肺结核痰中带血丝,伴低热,盗汗。支气管扩张痰量较多,为湿性咳嗽。肺癌剧烈干咳,痰中带血丝。风湿性心脏病(二尖瓣狭窄)多为咯血,痰为暗红色。急性肺水肿为粉红色泡沫样痰。" + }, + { + "question_num": 379, + "query": "患者,女,15岁。浮肿3月余,下肢为甚,按之凹陷不易恢复,心悸,气促,腰部冷痛尿少，四肢冷,舌质淡胖,苔白,脉沉,其证候是", + "options": { + "A": "湿毒浸淫", + "B": "湿热壅盛", + "C": "脾阳虚衰", + "D": "水湿浸渍", + "E": "肾气衰微" + }, + "answer": "C", + "reason": "脾阳不足,气不化水,故浮肿,水湿下聚,故下肢为��,按之凹陷。水气上凌心肺,故心悸,气促。腰为肾府,故腰部冷痛。阳气衰微,故出现尿少，四肢冷，舌质淡胖,苔白,脉沉。" + }, + { + "question_num": 380, + "query": "患者,男,25岁。患梅毒疳疮。外治应选用", + "options": { + "A": "青黛散", + "B": "青吹口散", + "C": "鹅黄散", + "D": "生肌散", + "E": "桃花散" + }, + "answer": "C", + "reason": "皮肤掀红,烂斑时,外用鹅黄散、结毒灵。" + }, + { + "question_num": 381, + "query": "患者腰膝酸软乏力,失眠多梦,心悸健忘。治疗宜选用", + "options": { + "A": "麦门冬", + "B": "百合", + "C": "龟甲", + "D": "续断", + "E": "巴戟天" + }, + "answer": "C", + "reason": "续断、巴戟天补阳,麦门冬百合、龟甲补阴。本题所述症状腰膝酸软，属肾阴虚,故排除补阳药DE,麦门冬兼能润肺清心,百合兼能清心安神、养胃阴、清胃热;龟甲兼能养血补心，正好治疗题中所述失眠多梦心悸健忘的心阴血虚的症状，故选C。" + }, + { + "question_num": 382, + "query": "患者咳嗽。查体:气管向左偏移。右侧胸廓较左侧饱满，叩诊出现鼓音。应首先考虑的是", + "options": { + "A": "右侧气胸", + "B": "左侧肺不张", + "C": "右下肺炎", + "D": "肺气肿", + "E": "右侧胸腔积液" + }, + "answer": "A", + "reason": "由气管移位可考虑患者存有胸腔、肺、纵隔及单侧甲状腺的病变。气管左移、右侧胸腔较左侧饱满,提示该侧气胸或胸腔积液病变;叩诊为鼓音，应考虑诊断为右侧气胸。左侧肺不张时，左胸可出现凹陷，叩诊呈浊音;右下肺炎时,气管无移位,右下肺叩诊呈浊音或实音;肺气肿气管无移位，叩诊过清音。" + }, + { + "question_num": 383, + "query": "患者,女,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。治宜清热利湖通淋。用八正散。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": 384, + "query": "患者,女,20岁,未婚。近4个月月经提前8~10天,量多、色淡、质稀,神疲肢倦,小腹空坠,舌淡。脉缓弱。诊为月经先期，其证候是", + "options": { + "A": "气虚", + "B": "脾虚", + "C": "肾虚", + "D": "血虚", + "E": "阴虚" + }, + "answer": "A", + "reason": "由题干量多、色淡、质稀,神疲肢倦,小腹空坠,舌淡，脉缓弱可知应属于虚证。月经先期的病因病机主要是气虚和血热:故用排除法可知选A。" + }, + { + "question_num": 385, + "query": "患儿,男,2岁。面色萎黄,发育不良,形体明显瘦小,行迟,骨软无力,囟门不合。治疗应首选", + "options": { + "A": "白芍", + "B": "玉竹", + "C": "杜仲", + "D": "当归", + "E": "鹿茸" + }, + "answer": "E", + "reason": "白芍养血敛阴,柔肝止痛:平抑肝阳。常用于肝血亏虚，月经不调;肝脾不和,胸胁脘腹疼痛，四肢挛急疼痛;肝阳上亢,头痛眩晕。玉竹养阴润燥,生津止渴。常用于肺阴虚证;胃阴虚证;热伤心阴，烦热多汗,惊悸。杜仲补肝肾,强筋骨,安胎。常用于肾虚腰痛及各种腰痛;胎动不安,习惯性流产当归补血调经,活血止痛，润肠通便。常用于血虚、血瘀诸证。鹿茸补肾阳,益精血，强筋骨,调冲任,托疮毒。常用于肾阳虚衰,精血不足证;肾虚骨弱,腰膝无力或小儿五迟;妇女冲任虚寒,崩漏带下;疮疡久溃不敛,阴疽疮肿内陷不起。" + }, + { + "question_num": 386, + "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": 387, + "query": "患者,男,60岁。因发热咳嗽,而出现小便不畅,点滴不爽,烦渴欲饮,呼吸急促,舌红苔薄白,脉数,其病机是", + "options": { + "A": "肾元亏虚", + "B": "湿热蕴结", + "C": "脾气不升", + "D": "肺热壅盛", + "E": "气机阻滞" + }, + "answer": "D", + "reason": "肺热壅盛,失于肃降,不能通调水道,下输膀胱,故小便点滴不畅。肺热上壅,故烦渴欲饮,咽干咳嗽,舌苔薄黄,脉数。" + }, + { + "question_num": 388, + "query": "患者,女,35岁,已婚。月经后期,40~50天一行,量少、色暗、时有血块,小腹较胀,乳房胀痛,舌略暗苔薄,脉弦,其证候是", + "options": { + "A": "血寒", + "B": "血虚", + "C": "肾虚", + "D": "气滞", + "E": "血瘀" + }, + "answer": "D", + "reason": "由题干量少、色暗、时有血块,小腹较胀,乳房胀痛,脉弦可知为气滞,尤其是“胀”字是气滞的特征。" + }, + { + "question_num": 389, + "query": "患者,女,30岁。产后5天,右侧乳房红肿胀痛,触摸到硬块,大便如常,小便色黄治疗应首选", + "options": { + "A": "大青叶", + "B": "蒲公英", + "C": "淡竹叶", + "D": "栀子", + "E": "知母" + }, + "answer": "B", + "reason": "大青叶治疗高热斑疹,温病发热咽痛,疮痈丹毒等。淡竹叶用于治疗热病烦渴、心火亢盛、口舌生疮及尿赤涩痛。栀子万宿疗然讷少安约。F石大盈壮热之证。蒲公英清热解毒、利湿，主治热毒疮疡痈肿,尤善治乳痈。题干表明患者为乳痈,小便色黄为热淋表现,故选B。" + }, + { + "question_num": 390, + "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": "肺瘤", + "C": "支气管扩张", + "D": "支气管哮喘", + "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，部位也易恋换。低音调的干音称为肝音,如同熟睡中的声,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": 391, + "query": "患者吐血缠绵不止,时轻时重,血色暗淡,神疲乏力,心悸气短,面色苍白,舌质淡,脉细弱，其治法是", + "options": { + "A": "健脾和胃,宁络止血", + "B": "和中宁络,凉血止血", + "C": "益气养阴，宁络止血", + "D": "健脾益气,摄血止血", + "E": "健脾升阳,化瘀止血" + }, + "answer": "D", + "reason": "脾气不足,摄血无力,故吐血缠绵不止,时轻时重,血色暗淡,神疲乏力心悸气短,面色苍白,舌质淡,脉细弱都属脾虚表现。治宜健脾益气,摄血止血。无气阴两症状,故不选℃。脾阳虚、瘀血症状都不明显故不选E。" + }, + { + "question_num": 392, + "query": "患者,女,22岁,未婚。月经2~3月-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": "艾附暧宫丸", + "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,咯吐痰涎,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": "归肾经", + "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,主入肺、膀胱经,可发汗解表,部分药兼有利尿退肿、止咳平喘、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": "患者多食,大便日2~3次。查体:血压140/60mmHg(18.62/7.98kPa)。双眼突出，心律不齐，脉搏短绌。应首先考虑的是", + "options": { + "A": "糖尿病合并缺血性心脏病", + "B": "风心病伴心房纤颤", + "C": "高血压性心脏病伴心房纤颤", + "D": "肺心病伴心房纤颤", + "E": "甲状腺功能亢进症伴心房纤颤" + }, + "answer": "E", + "reason": "根据患者主诉和双眼突出的特征性表现，可初步断定为甲状腺功���亢进,根据排除法可选E." + }, + { + "question_num": 395, + "query": "患者,女,48岁。时常汗出,恶风,周身酸楚。时寒时热,舌苔薄白,脉缓,其治法是%", + "options": { + "A": "益气固表", + "B": "调和营卫", + "C": "滋阴降火", + "D": "清肝泄热", + "E": "益气化湿" + }, + "answer": "A", + "reason": "时常汗出为自汗。气虚不固,故恶风,周身酸楚,时寒时热。治宜益气固表,用玉屏风散。营卫不和者调和营卫。阴虚盗汗者滋阴降火。肝郁化火者清肝泄热。气虚挟湿者益气化湿。" + }, + { + "question_num": 396, + "query": "患者,女,30岁,已婚。月经先后无定期。质稀、少,腰痛,头晕,舌淡少苔,脉沉细尺弱,其证候是", + "options": { + "A": "肝郁", + "B": "肝血不足", + "C": "阴虚", + "D": "肾虚", + "E": "气血虚弱" + }, + "answer": "D", + "reason": "月经先后无定期的病因一是肝郁,一是肾虚,由题干可知是虚证。" + }, + { + "question_num": 397, + "query": "患者,男,18岁。恶寒发热,头痛身痛,无汗而喘,舌苔薄白,脉浮紧。治疗应首选", + "options": { + "A": "小青龙汤", + "B": "桂枝汤", + "C": "九味羌活汤", + "D": "麻黄汤", + "E": "大肯龙汤" + }, + "answer": "D", + "reason": "该证为外感风寒表实证故当选麻黄汤。辨证要点恶寒发热，脉浮紧" + }, + { + "question_num": 398, + "query": "患者突感胸闷、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": "右冠状动脉右缘支", + "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": "前空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,常与右冠状动脉的后室间支相吻合。前室间支分布于左、右心室前壁的一部分和室间隔的前2/3部,如前室间支受阻塞,则引起前壁心肌及室间隔前部心肌梗死。" + }, + { + "question_num": 399, + "query": "患者牙痛剧烈,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": "风门", + "E": "内庭" + }, + "answer": "E", + "reason": "内庭穴是荣穴,具有清胃泻火、理气止痛的功效,其主治为齿痛、口喝喉痹、鼻衄、腹痛、腹胀、痢疾、泄泻、足背肿痛热病、胃痛吐酸等。" + }, + { + "question_num": 400, + "query": "患者,女,30岁,已婚。经行量多,色淡红,质清稀,伴有神疲肢倦,气短懒言,小腹空坠,面白,舌淡,苔薄。脉细弱,其证候是", + "options": { + "A": "血虚", + "B": "气虚", + "C": "血瘀", + "D": "血热", + "E": "阴虚" + }, + "answer": "B", + "reason": "由题干经行量多,色淡红,质清稀,伴有神疲肢倦,气短懒言,小腹空坠,面色晄白,舌淡,苔薄,脉细弱,辨病为月经过多,辨证为气虚证。" + }, + { + "question_num": 401, + "query": "患者,男,58岁。近日感冒风寒,头痛,身热恶寒,热轻寒重,无汗肢冷,倦怠嗜卧,面色苍白,语言低微,舌淡苔白,脉浮大无力。治疗应首选", + "options": { + "A": "再造散", + "B": "败毒散", + "C": "桂枝汤", + "D": "小柴胡汤", + "E": "九味羌活汤" + }, + "answer": "A", + "reason": "从题干辨证,该证表证未除,有阳虚气虚之象,故选扶正解表之剂，以助阳益气,解表散寒,故选A。该题辨证要点身热恶寒、肢冷、倦怠嗜卧、语言低微、脉浮大无力。" + }, + { + "question_num": 402, + "query": "患者,女,40岁。仰卧时腹部呈蛙状，侧卧时下侧腹部明显膨出。应首先考虑的是", + "options": { + "A": "胃肠胀气", + "B": "腹腔积液", + "C": "巨大卵巢囊肿", + "D": "肥胖", + "E": "子宫肌瘤" + }, + "answer": "B", + "reason": "当腹腔内大最积液时,在仰卧位时腹部外形呈宽而扁状,称为蛙腹。坐位时下腹部明显膨出常见于肝硬化门脉高压症、右心衰竭、缩窄性心包炎、肾病综合征、结核性腹膜炎、腹膜转移癌等。" + }, + { + "question_num": 403, + "query": "患者,男,48岁。头胀痛近2年,时作时止。伴目眩易怒,面赤口苦,舌红苔黄,脉弦数。治疗除取主穴外,还应选用", + "options": { + "A": "头维、内庭、三阴交", + "B": "血海、风池、足三里", + "C": "风池、列缺、太阳", + "D": "太溪、侠溪、太冲", + "E": "丰隆、太阳、风门" + }, + "answer": "D", + "reason": "本患者所患头痛为肝阳上亢的头痛,所选穴位应为肝经穴位，太冲为肝经原穴,平肝潜阳、清利头目,疏经止痛;太溪穴为肾经原穴,滋水涵木,育阴潜阳。" + }, + { + "question_num": 404, + "query": "患者,女,27岁,未婚。月经周期33天,经期持续8~10余日,量少,色红,质稠,伴经行腹痛隐隐。平时乳房胀痛。应首先考虑的是", + "options": { + "A": "经行乳房胀痛", + "B": "月经后期", + "C": "经期延长", + "D": "痛经", + "E": "漏下" + }, + "answer": "C", + "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，甚或淋半月方净者。" + }, + { + "question_num": 405, + "query": "患者壮热面赤,汗出恶热,烦渴欲饮，脉洪大。治疗应首选", + "options": { + "A": "黄连解毒汤", + "B": "竹叶石膏汤", + "C": "白虎汤", + "D": "麻黄杏仁甘草石膏汤", + "E": "大承气汤" + }, + "answer": "C", + "reason": "白虎汤清热生津，主治阳明气分热盛证,症见身大热，汗大出，口大渴，脉洪大的四大症。" + }, + { + "question_num": 406, + "query": "患者,女,20岁。突然发作上腹痛,按压后疼痛程度减轻。应首先考虑的是", + "options": { + "A": "胃溃疡", + "B": "胃痉挛", + "C": "胃炎", + "D": "急性胃扩张", + "E": "胃穿孔" + }, + "answer": "B", + "reason": "胃溃疡为饥饿痛,为隐痛。胃痉挛为剧烈疼痛,按压后缓解。胃炎为隐痛或者灼热痛。急性胃扩张、胃穿孔疼痛剧烈目拒按。" + }, + { + "question_num": 407, + "query": "患者,男,50岁。腰部疼痛10年余，有劳伤史,久坐加重,痛处固定不移。治疗除取主穴外,还应选用的穴位是", + "options": { + "A": "膏肓", + "B": "膈俞", + "C": "志室", + "D": "腰阳关", + "E": "环跳" + }, + "answer": "B", + "reason": "由本患者的症状可以看出本病为腰痛,有腰肌劳损,即血瘀证。因此除主穴外应选膈俞活血化瘀。" + }, + { + "question_num": 408, + "query": "患者,女,35岁,已婚。患崩漏1年余。经血非时而至,经量甚多、色淡、质稀,面色苍白,气短懒言,大便不成形,舌淡苔薄白,脉沉弱,其证候是", + "options": { + "A": "肾阴虚", + "B": "肾阳虚", + "C": "脾虚", + "D": "血瘀", + "E": "以上均非" + }, + "answer": "C", + "reason": "由题干经量甚多、色淡、质稀,面色苍白,气短言,大便不成形,舌淡苔薄白,脉沉弱,辨证为脾气虚证。因为脾虚中气虚弱或下陷，则冲任不固，血失统摄而发崩漏。气虚火不足，故经血色淡质稀，面色苍白，气短懒言。大便不成形，舌淡苔薄白，脉沉弱皆为脾气虚之证。" + }, + { + "question_num": 409, + "query": "患者,男,48岁。近日腹痛便秘,胁下偏痛,发热,手足厥逆,舌苔白腻,脉弦紧。治疗应首选", + "options": { + "A": "大承气汤", + "B": "温脾汤", + "C": "麻子仁丸", + "D": "济川煎", + "E": "大黄附子汤" + }, + "answer": "E", + "reason": "从题干辨证,主证为便秘注意该证虽有发热，但其告象为白腻，且有手足厥逆之症,可知其发热当为寒邪凝滞导致的气郁发热,其胁下偏痛亦为寒邪凝聚厥阴所致。脉弦紧可表明内有寒实，故当温里散寒通便止痛,故选E。" + }, + { + "question_num": 410, + "query": "患者,男，24岁。近3年来反复餐后3~4小时上腹痛，持续至下次进餐后才缓解。应首先考虑的是", + "options": { + "A": "消化性溃疡", + "B": "胃癌", + "C": "慢性胃炎", + "D": "胃肠神经官能症", + "E": "胆囊炎" + }, + "answer": "A", + "reason": "节律性溃疡疼痛与饮食之间的关系具有明显的相关性和节律性。在一天中,早晨3.点至早餐的一段时间,胃酸分泌最低,故在此时间内很少发生疼痛。十二指肠溃疡的疼痛好在两餐之间发生，持续不减直至下餐进食或服制酸药物后缓解。一部分十二指肠溃疡患者,由于夜间的胃酸较高，尤其在睡前曾进餐者,可发生半夜疼痛。胃溃疡疼痛的发生较不规则,常在餐后1小时内发生,经1~2小时后逐渐缓解，直至下餐进食后再复出现上述节律。" + }, + { + "question_num": 411, + "query": "患者,女,40岁。呕吐痰涎。伴头晕胸痞,心悸,舌苔白,脉滑。治疗除取主穴外，还应加", + "options": { + "A": "列缺、尺泽", + "B": "膻中、丰隆", + "C": "曲池、外关", + "D": "风池、尺泽", + "E": "列缺、合谷" + }, + "answer": "B", + "reason": "由本患者的症状可知本病为痰饮停蓄之呕吐。治疗上应和胃降逆，行气止呕,化痰止吐,故应加用化痰之要穴丰隆,止吐之要穴膻中。" + }, + { + "question_num": 412, + "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。���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": 413, + "query": "患者感受暑湿,症见身热烦渴,小便不利。治疗应首选", + "options": { + "A": "六一散", + "B": "猪苓汤", + "C": "泻白散", + "D": "五苓散", + "E": "二妙散" + }, + "answer": "A", + "reason": "六一散清暑利湿,用于暑湿证,主症为身热烦渴,小便不利,泄泻。" + }, + { + "question_num": 414, + "query": "患者饱餐后上腹部持续疼痛1天。查体:上腹部压痛、反跳痛。应首先考虑的是", + "options": { + "A": "急性胃炎", + "B": "急性胰腺炎", + "C": "急性肝炎", + "D": "右肾结石", + "E": "肝癌" + }, + "answer": "B", + "reason": "急性胰腺炎腹痛为钝痛刃割样痛、钻痛或绞痛,向腰背部呈带状放射水肿型3~5天即缓解,出血坏死型发展较快可引起全腹痛。" + }, + { + "question_num": 415, + "query": "患者,男,22岁。发热恶寒,寒重热轻。头痛身痛，,鼻塞流涕。咳嗽,咯痰清稀。舌苔薄白，脉浮紧。治疗应首选", + "options": { + "A": "手太阴、手阳明、足太阳经穴", + "B": "手少阴、手太阳、手太阴经穴", + "C": "手太阴、足太阳、手少阳经穴", + "D": "手太阴、手少阳、足少阳经穴", + "E": "手阳明、足阳明、手太阴经穴" + }, + "answer": "A", + "reason": "由本患者的症状可知本病为感冒之风寒感冒,所以应首选手太阴肺经疏风散寒;手阳明大肠经与肺经相表里，所以其经穴能协助肺经经穴疏风散寒;外感风寒首先犯太阳而伤肺卫,故选足太阳膀胱经的腧穴以解表宣肺。" + }, + { + "question_num": 416, + "query": "患者,女,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": 417, + "query": "患者,女,50岁。发热盗汗,面赤心烦,口干唇燥,便结溲黄,舌红,脉细数。治疗应首选", + "options": { + "A": "大补阴丸", + "B": "六味地黄丸", + "C": "当归六黄汤", + "D": "清骨散", + "E": "牡蛎散" + }, + "answer": "C", + "reason": "当归六黄汤滋阴泻火，固表止汗。用于阴虚火旺盗汗，主症见发热盗汗,面赤心烦,口干唇燥,大便干结,小便黄赤舌红苔黄,脉数。" + }, + { + "question_num": 418, + "query": "患者食欲和记忆力减退。检查:眼睑苍白。血红细胞、白细胞和血小板均减少。应首先考虑的是", + "options": { + "A": "再生障碍性贫血", + "B": "缺铁性贫血", + "C": "溶血性贫血", + "D": "失血性贫血", + "E": "巨幼红细胞性贫血" + }, + "answer": "A", + "reason": "再生障碍性贫血红细胞白细胞和血小板均减少。缺铁性贫血为小细胞低色素性贫血:MCV<80fl,MCHC<32%溶血性贫血红细胞计数下降、血清间接胆红素增多。失血性贫血由于血管收缩，红细胞计数、血红蛋白和血细胞比容反见增高，但在几小时内，组织液进人血循环而使血液稀释，红细胞计数和血红蛋白的降低与出血的严重程度一致。巨幼红细胞性贫而重者全而细胞减少,红细胞大小不等,中性粒细胞分叶过多。" + }, + { + "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,多疑善感。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,32岁,已婚。患痛经2年,每于行经第1~2天,小腹冷痛,喜热,拒按,经量少,色暗,有块,舌苔白腻,脉沉紧,其证候是", + "options": { + "A": "气滞血瘀", + "B": "阳虚内寒", + "C": "湿热下注", + "D": "肝肾虚损", + "E": "寒湿凝滞" + }, + "answer": "E", + "reason": "由题干小腹冷痛,喜热,拒按,经量少,色暗,有块,分析为寒邪致病,舌苔白腻,为湿邪致病特点，故本病为寒湿之邪侵发，致气血运行不畅而致的痛经。" + }, + { + "question_num": 421, + "query": "患者,男,60岁。呛咳少痰,气短自汗,口干古燥，苔薄少津，脉虚细。治疗应首选", + "options": { + "A": "生脉散", + "B": "贝母瓜葵散", + "C": "百合固金汤", + "D": "清燥救肺汤", + "E": "麦门冬汤" + }, + "answer": "A", + "reason": "气短自汗表明了气虚，口干舌燥,苔薄少津表明了津虚,脉虚细为气津两伤的表现，而且没有数脉，说明没有阴虚内热。生脉散益气生津止汗。" + }, + { + "question_num": 422, + "query": "患者,男,50岁。乙肝病史6年,呕血1天。检查:腹壁静脉曲张。肝肋未触及脾肋下3cm，腹水征(+),HBsAg(+),白蛋白降低,A/G<1,谷丙转氨酶升高,其诊断为", + "options": { + "A": "慢性肝炎", + "B": "肝硬化合并上消化道出血", + "C": "消化性溃疡合并上消化道出血", + "D": "白血病", + "E": "原发性肝癌" + }, + "answer": "B", + "reason": "肝硬化诊断依据:①病毒性肝炎、长期饮酒病史;②肝功能减退和门静脉高压症的临床表现;③肝脏质地坚硬有结节感;④肝功能实验阳性;⑤肝活检有假小叶形成并发症:上消化道出血、肝性脑病、感染、肝肾综合征、原发性肝癌、电解质和酸碱平衡紊乱等。" + }, + { + "question_num": 423, + "query": "患者,男,28岁。1天前因饮食不洁，出现腹痛腹泻。下痢赤白，里急后重，肛门灼热,心烦口渴。小便短赤,舌苔黄腻,脉滑数。治疗除选取主穴外，应加用的腧穴是", + "options": { + "A": "中脘、上脘", + "B": "中脘、内关", + "C": "曲池、内庭", + "D": "脾俞、下脘", + "E": "行间、足三里" + }, + "answer": "C", + "reason": "由本患者的症状可知本病为痢疾之湿热痢,应选用曲池和内庭，两穴均可清热利湿,去除病因，以达治疗痢疾的作用。" + }, + { + "question_num": 424, + "query": "患者,女,36岁,已婚。经行时肢体疼痛麻木,肢软无力，月经量少,色淡质薄,面色无华,舌淡,苔白，脉细弱。治疗应首选", + "options": { + "A": "八珍汤", + "B": "当归补血汤", + "C": "血府逐瘀汤", + "D": "趁痛丸", + "E": "圣愈汤" + }, + "answer": "B", + "reason": "由题干经行时肢体疼痛麻木,辨病为经行身痛。由肢软无力,月经量少，色淡质薄,面色无华,舌淡,苔白,脉细弱,辨证为血虚证。代表方剂是当归补血汤。" + }, + { + "question_num": 425, + "query": "患者,男,58岁。胸满而痛,遇冷易诱发,伴下利，口不渴,不欲饮食,舌淡苔白,脉沉细而弦。治疗应选用", + "options": { + "A": "大建中汤", + "B": "小建中汤", + "C": "厚朴温中汤", + "D": "吴茱萸汤", + "E": "理中丸" + }, + "answer": "E", + "reason": "理中丸主要适用于脾胃虚寒,运化失司所致之证，上述诸症皆为中虚有寒,不能运化,升降失常,清浊相干所致的脾胃虚寒证,故选用本方。" + }, + { + "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": "蚕豆病是由于进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，而胃炎不会引起黄疸,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,20岁。昨日起大便泄泻,发病势急，一日5次,小便减少。治疗应首选", + "options": { + "A": "上巨虚、太溪、肾俞、命门", + "B": "足三里、公孙、脾俞、太白", + "C": "关元、天枢、足三里、冲阳", + "D": "天枢、上巨虚、阴陵泉、水分", + "E": "内庭、上巨虚、神阙、中脘" + }, + "answer": "D", + "reason": "由本患者的症状可知本病为急性泄泻,治疗应该除湿导滞、疏调肠胃,应首选天枢、阴陵泉、上巨虚、水分等腧穴。天枢为大肠的募穴,调理胃肠传导功能;阴陵泉为脾经的合穴,疏调脾气,健脾利湿;上巨虚为大肠的下合穴,通调胃肠气机,运化湿滞;水分可以调节水电解质紊乱。" + }, + { + "question_num": 428, + "query": "患者,女,26岁,已婚。月经35天一行,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���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": "从题千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": "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": 430, + "query": "某患者在一码头食冷稀饭一碗,次日突起腹泻,一天20余次,继之呕吐,无明显腹痛。查体:体温36.5°C,中度失水,血压75/53mmHg。大便镜检:WBC0~1/HP，疑为霍乱。应考虑做那项检查确诊", + "options": { + "A": "大便涂片染色检查", + "B": "SS培养基大便培养", + "C": "血培养", + "D": "大便悬滴镜检", + "E": "大便碱性培养基培养" + }, + "answer": "E", + "reason": "大便碱性培养基(增菌)培养:所有怀疑霍乱患者粪便,除作显微镜检外,均应作增菌培养。粪便留取应在使用抗菌药物之前,且应尽快送到实验室作培养。增菌培养基一般用pH8.4的碱性蛋白胨水，36~37℃培养6~8小时后表面能形成菌膜。此时应进一步作分离培养,并进行动力观察和制动试验，这将有助于提高检出率和早期诊断" + }, + { + "question_num": 431, + "query": "治疗咳嗽肝火犯肺证,应首选", + "options": { + "A": "肝俞、鱼际、侠溪、阴陵泉", + "B": "肺俞、尺泽、阳陵泉、太冲", + "C": "中府、丰隆、肺俞、太渊", + "D": "列缺、合谷、中府、章门", + "E": "肝俞、肺俞、太渊、章门" + }, + "answer": "B", + "reason": "咳嗽应选用肺俞穴,肝火犯肺则应选用降火之尺泽、阳陵泉、太冲等穴位。尺泽为肺之合穴,合治内腑,宣降肺气、化痰止咳。" + }, + { + "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": "患者51岁,月经不规律辨病为绝经前后诸证;由精神萎靡,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，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": "患者跌打损伤后,瘀血留于胁下，痛不可忍。治疗应选用", + "options": { + "A": "血府逐瘀汤", + "B": "温经汤", + "C": "生化汤", + "D": "复元活血汤", + "E": "大黄座虫丸" + }, + "answer": "D", + "reason": "复元活血汤活血祛瘀、疏旺通络，用于跌打相伤，癌血阳滞之证有特征性的主症胁肋瘀肿,痛不可忍" + }, + { + "question_num": 434, + "query": "20岁男性患者,发热起病,体温38°C,3天后体温下降伴周身乏力,食欲不振,恶心呕吐,近2天发现尿色深如豆油样,胆红素定量80μmol/L,抗HBs(+),抗HAVIgM(+),巩膜及皮肤中度黄染,肝区轻度叩痛，肝肋下触及1.0cm,质软,脾侧卧未及,胆囊区无压痛。此患者目前主要治疗措施", + "options": { + "A": "保肝治疗", + "B": "卧床休息", + "C": "调节免疫功能治疗", + "D": "抗病毒治疗", + "E": "支持治疗" + }, + "answer": "B", + "reason": "(1)急性肝炎的治疗方法。以一般对症治疗及支持治疗为主，急性期应进行隔离,症状明显及有黄疸者应卧床休息。清淡饮食,适当补充维生素,避免饮酒和损害肝脏药物。一般不采用抗病毒药物治疗，但急性丙肝例外。(2)慢性肝炎的治疗方法。包括干扰素、核苷类似物、利巴韦林和免疫调节治疗(3)乙肝干扰素治疗指征:①HBV有活动性复制;②肝炎处于活动期;③HBV-DNA血浓度低;④抗HBcIgM阳性" + }, + { + "question_num": 435, + "query": "患者,女,43岁。眩晕2个月,加重1周,昏眩欲仆,神疲乏力,面色觥白,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、侠溪", + "B": "丰隆、中脘、内关、解溪、头维", + "C": "百会、上星、风池、丰隆、合谷", + "D": "脾俞、足三里、气海、百会", + "E": "百会、太阳、印堂、合谷" + }, + "answer": "D", + "reason": "由本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": 436, + "query": "患者,女,27岁,已婚。近几个月来带下最多、黏稠、色黄,胸闷心烦,纳少便溏,舌淡红苔黄略腻,脉细,其治法是", + "options": { + "A": "清热利湿止带", + "B": "健脾利湿止带", + "C": "健脾益气止带", + "D": "清热解毒止带", + "E": "补肾健脾止带" + }, + "answer": "A", + "reason": "由题干带下量多、黏稠、色黄,胸闷心烦,纳少便溏,舌淡红苔黄略腻,脉细,诊断为带下过多湿热下注证，治法是清热利湿止带。" + }, + { + "question_num": 437, + "query": "患者,男,41岁。一身面目俱黄,黄色鲜明,腹微满,口渴,小便不利,舌苔黄腻,脉沉数。治疗应首选", + "options": { + "A": "三仁汤", + "B": "茵陈蒿汤", + "C": "草薜分清饮", + "D": "蒿芩清胆汤", + "E": "甘露消毒丹" + }, + "answer": "B", + "reason": "题干描述是明显的阳黄之证,故选B。茵陈汤清热、利湿、退黄,用于湿热黄疸(阳黄),症见一身面目俱黄,黄色鲜明，发热,无汗或但头汗出，口渴欲饮,恶心呕吐，腹微满,小便短赤,大便不爽或秘结,舌红苔黄腻,脉沉数或滑数有力。" + }, + { + "question_num": 438, + "query": "患者有肝硬化史,因劳累病情复发，黄疸进行性加深,乏力,腹胀,出现腹水，下肢浮肿,化验ALT200UL,血清白蛋白28g/L,总胆红素30mmol/L,凝血酶原时间24秒，其诊断为", + "options": { + "A": "肝硬化失代偿", + "B": "急性重型肝炎", + "C": "亚急性重型肝炎", + "D": "慢性重型肝炎", + "E": "胆汁性肝硬化" + }, + "answer": "D", + "reason": "①根据流行病学、临床表现和实验室检查,结合患者的具体情况及动态变化进行综合分析,并根据特异性检查作出病原学诊断;②需要与中毒性肝炎、肝外阻塞性黄疸、传染性单核细胞增多症等鉴别。" + }, + { + "question_num": 439, + "query": "患者,男,66岁。小便滴沥不爽,排出无力,甚则点滴不通,精神疲惫。兼见面色就白,腰膝酸软，畏寒乏力,舌质淡。除主穴外，治疗还应选用", + "options": { + "A": "太溪、复溜", + "B": "曲骨、委阳", + "C": "太冲、大敦", + "D": "中极、膀胱俞", + "E": "血海、三阴交" + }, + "answer": "A", + "reason": "由本患者的症状可知本病为癌闭证虚证之肾阳不足证,故在主穴的基础上应该加用温肾助阳的复溜、太溪穴。" + }, + { + "question_num": 440, + "query": "患者,女,24岁,已婚。停经49天时诊为早孕，近3天少量阴道流血，尿妊娠试验(+)既往曾2次流产,其诊断是", + "options": { + "A": "妊娠腹痛", + "B": "胎动不安", + "C": "胎漏", + "D": "堕胎", + "E": "滑胎" + }, + "answer": "C", + "reason": "胎漏的定义是妊娠期间，阴道不时有少量出血。时出时止，或淋漓不断,而无腰酸、腹痛、小腹下坠。题干符合此定义。胎动不安有腰酸、腹痛、下坠,或伴有少量的引导出血、脉滑。妊娠腹痛是妊娠期因胞脉阻滞或失养,发生小腹疼痛。堕胎是凡妊娠12周内,胚胎自然殒堕。滑胎是凡堕胎或小产连续发生3次或3次以上。" + }, + { + "question_num": 441, + "query": "患者心下痞满,不欲饮食,倦怠乏力,大便不调,舌淡苔白腻,脉沉弦。治疗应选用", + "options": { + "A": "保和丸", + "B": "健脾丸", + "C": "枳实消痞丸", + "D": "半夏厚朴汤", + "E": "木香槟榔丸" + }, + "answer": "C", + "reason": "枳实消痞丸消痞除满、健脾和胃,用于脾虚气滞、寒热互结证,症见心下痞满,不欲饮食,倦怠乏力，大便不畅,苔腻而微黄,脉弦。" + }, + { + "question_num": 442, + "query": "患者,男,40岁。不规则发热半年余，反复抗生素治疗无效，明显消瘦，侨居国外多年，临床考虑是否同艾滋病感染有关，下列哪项检查更有价值", + "options": { + "A": "痰培养", + "B": "胸部CT", + "C": "血清抗HIV", + "D": "HIV分离", + "E": "CD₄⁺/CD₈⁺比值,CD₄⁺计数" + }, + "answer": "E", + "reason": "①常规检查:有不同程度的贫血和白细胞计数降低，常发现尿蛋白;②免疫学检查:T细胞绝对计数下降,CDT淋巴细胞计数也下降,对有丝分裂原的皮肤试验,如链激酶、植物血凝素等常呈阴性���应;③血清学检查:HIV抗体或HIV抗原出现阳性。" + }, + { + "question_num": 443, + "query": "患者,女,40岁。呕吐清水,胃部不适食久乃吐,喜热畏寒,身倦,便溏,小便可,舌苔白，脉迟。治疗除取主穴外,还应加", + "options": { + "A": "上脘、胃俞", + "B": "肝俞、太冲", + "C": "肾俞、太溪", + "D": "胆俞、丘墟", + "E": "次髎、血海" + }, + "answer": "A", + "reason": "由本患者的症状可知本病为呕吐之寒性呕吐，故选穴上应配胃俞穴、上脘穴以温胃散寒止吐。" + }, + { + "question_num": 444, + "query": "患儿,22天。面目皮肤发黄20天,色泽鲜明如橘皮,精神疲倦,不欲吮乳,尿黄便秘,舌红苔黄,其证候是", + "options": { + "A": "肝失疏泄", + "B": "瘀积发黄", + "C": "寒湿阻滞", + "D": "湿热熏蒸", + "E": "胆道不利" + }, + "answer": "D", + "reason": "湿热熏蒸是由于孕母素体湿盛或内蕴湿热之毒，遗于胎儿，或因胎产之时、出生之后,婴儿感受湿热邪毒所致。热为阳邪，黄色鲜明如橘皮,故选D。寒为阴邪,故黄色晦暗。若为瘀积发黄，可伴肚腹胀满,右胁下结成痞块。湿热露蒸、寒湿阻滞最终导致肝失疏泄、胆道不利,胆汁外溢而致发黄。" + }, + { + "question_num": 445, + "query": "患者,女,36岁,已婚。面色萎黄,神疲乏力,气短懒言,食少便溏,月经淋漓不断,经血色淡，舌淡无苔，脉沉细无力，其病机是", + "options": { + "A": "脾不统血", + "B": "脾肾阳虚", + "C": "气血两虚", + "D": "脾肺气虚", + "E": "肝血不足" + }, + "answer": "A", + "reason": "脾不统血证主要表现为面色袭黄或苍白无华,神疲乏力，气短懒言,或食少便溏,并见出血，或便血,或溺血,肌衄,鼻衄,或妇女月经过多、崩漏,舌淡,脉细无力等,该病例符合此证的临床表现,故选A。" + }, + { + "question_num": 446, + "query": "患者,男。发现乙肝2年，出现乏力,腹胀,食欲不振,病情不稳定,查体:慢性肝病容,肝肋下触及1.0cm,质中等,脾界扩大,血清ALT200UL,白蛋白3.5g/L,球蛋白3.6g/L，应诊为", + "options": { + "A": "慢性迁延性肝炎", + "B": "慢性活动性肝炎", + "C": "慢性重型肝炎", + "D": "肝硬化", + "E": "淤胆型肝炎" + }, + "answer": "B", + "reason": "" + }, + { + "question_num": 447, + "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痿证,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，故治痿证重在调理阳明,补益气血,舒筋通络。" + }, + { + "question_num": 448, + "query": "患儿,9个月。发热,微汗,鼻塞流涕咽红,夜间体温升高,又见惊惕啼叫。夜卧不安舌质红,苔薄白,指纹浮紫,其诊断是", + "options": { + "A": "夜啼", + "B": "感冒夹痰", + "C": "感冒夹惊", + "D": "急惊风", + "E": "小儿暑温" + }, + "answer": "C", + "reason": "由“发热,微汗,鼻塞流涕咽红”可判断为感冒，而又因为“又见惊惕啼叫”即判断为夹惊。" + }, + { + "question_num": 449, + "query": "久病患者,纳食减少,疲乏无力,腹部胀满,但时有缓减,腹痛而喜按，舌胖嫩而苔润。脉细弱而无力，其病机是", + "options": { + "A": "真实假虚", + "B": "真实病证", + "C": "真虚假实", + "D": "真虚病证", + "E": "虚中夹实" + }, + "answer": "C", + "reason": "本题描述疾病本质属虚证,但又出现一些似乎是实的现象。素体脾虚、运化无力,因而出现腹部胀满而痛,脉弦等症脉,故选C。" + }, + { + "question_num": 450, + "query": "患者,男,35岁。病程2个月,轻度乏力,腹胀,皮肤瘙痒,粪便颜色变浅,肝肋下2cm触及,梗阻性黄疸,肝胆B超未见肿瘤、结石,肝外胆管无扩张，应诊断为", + "options": { + "A": "梗阻性黄疸", + "B": "胆汁性肝硬化", + "C": "慢性活动性肝炎", + "D": "淤胆型肝炎", + "E": "慢性肝囊炎" + }, + "answer": "D", + "reason": "" + }, + { + "question_num": 451, + "query": "患者,女,35岁。胃脘部隐痛,痛处喜按,空腹痛甚,纳后痛减,伴胃脘灼热,似饥而不欲食,咽干口燥,大便干结。舌红少津,脉弦细。治疗应首选", + "options": { + "A": "内关、天枢、中脘、膈俞", + "B": "内关、足三里、中脘、胃俞", + "C": "内关、天枢、中脘、太冲", + "D": "内关��足三里、中脘、下脘、梁门", + "E": "足三里、中脘、内关、三阴交、内庭" + }, + "answer": "E", + "reason": "由本患者的症状可知本病为胃痛之虚证。应首选温中健脾，和胃止痛的中脘、脾俞、胃俞、足三里以及滋阴降火的内庭、三阴交、内关等腧穴。" + }, + { + "question_num": 452, + "query": "患儿,2岁。咳嗽2周,日轻夜重，咳后伴有深吸气样鸡鸣声,吐出痰涎或食物后暂时缓解,不久又复发作，昼夜达十余次，舌质红,舌苔黄,脉滑数。治疗应首选", + "options": { + "A": "桑白皮汤合葶苈大枣泻肺汤", + "B": "苏子降气汤合黛蛤散", + "C": "麻杏石甘汤合苏葶丸", + "D": "麻黄汤合葶苈大枣泻肺汤", + "E": "泻白散合黛蛤散" + }, + "answer": "A", + "reason": "由“咳后伴有深吸气样鸡鸣声，舌质红,舌苔黄,脉滑数”可判断为痰热咳嗽证,而治法为清肺化痰止渴,故选A。麻杏石甘汤合苏芋丸清肺涤痰，止咳平喘治疗热性哮喘;苏子降气汤合黛蛤散降逆平喘,清肺除烦,治疗上实下虚之咳喘;麻黄汤治疗风寒表证;泻白散合黛蛤散清肺平肝、顺气治疗肝火犯肺之咳嗽。" + }, + { + "question_num": 453, + "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鼓动血脉,血不上营于舌,脉虚无力为运血无力。" + }, + { + "question_num": 454, + "query": "患者,女,19岁,农民。12月在水利工地上突起发热,伴头痛,眼眶痛,腰痛。病程第4天就诊时热已退，血压偏低,球结膜水肿，出血,胸背部见条索点状瘀斑。前1天24小时尿量340ml,该病例最可能的诊断是", + "options": { + "A": "败血症", + "B": "血小板减少性紫瘢", + "C": "流行性出血热", + "D": "钩端螺旋体病", + "E": "急性肾小球肾炎" + }, + "answer": "C", + "reason": "流行性出血热的分期如下。①潜伏期:4~46天,一般为?~14天,临床特征有发热、出血、肾损害三大表现,典型病例病程中有发热期、低血压休克期、少尿期、多尿期和恢复期五期经过;②发热期:发热、全身中毒症状(三痛征)毛细血管损伤(三红征)和肾损害;③低血压休克期:全身中毒症状及出血现象更加明显，皮肤及黏膜出血点增多;④少尿期:一般以24小时尿量少于500ml为少尿,少于50ml为无尿;⑤多尿期:一般出现在病程的9~14天,持续时间短者1天,长者可达数月;⑥恢复期:多尿期后，尿量逐渐恢复为2000ml,症状、体征基本消失，一般尚需1~3个月才能完全恢复。" + }, + { + "question_num": 455, + "query": "患者,男,32岁。恶寒发热2天,伴咽喉肿痛,口渴,舌苔薄黄。治疗除取主穴外,还应选用的穴位是", + "options": { + "A": "风门、肺俞", + "B": "外关、身柱", + "C": "曲池、中府", + "D": "阴陵泉、委中、中冲", + "E": "曲池、尺泽、鱼际" + }, + "answer": "E", + "reason": "由本患者的症状可知本病为风热感冒,应选用肺经、大肠经上的腧穴。曲池为大肠经的合八，属土，为金之母，尺洋入为肺经的合穴。鱼际穴是肺经的荥穴，荥穴主身热,故应选肺经的荥穴以清热。" + }, + { + "question_num": 456, + "query": "患儿,10岁。昨天受凉后,见喷、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,其内热则常因外邪人里化热、痰热内伏被外邪引动而诱发。临床辨证以外有风寒之表证,内有痰热之里证为要点。" + }, + { + "question_num": 457, + "query": "患者,女,53岁。腹中可扪及积块,软而不坚,固着不移,胀痛并见,脉弦,其证候是", + "options": { + "A": "肝气郁滞", + "B": "瘀血内结", + "C": "气滞血阻", + "D": "气滞痰阻", + "E": "气虚血瘀" + }, + "answer": "C", + "reason": "气为血帅,气滞则血凝,腹中可扪及积块,胀痛并见为肝气郁滞,疏泄失职,舌苔薄脉弦,为气滞血瘀之证。" + }, + { + "question_num": 458, + "query": "某学校发生霍乱病例数例,其密切接触者无任何症状，体查无异常，血、尿常规正常,对���切接触者应采取", + "options": { + "A": "霍乱菌苗预防接种", + "B": "预防性服药", + "C": "严格检疫5天并给予预防性服药", + "D": "医学观察3天", + "E": "待出现症状后立即进行隔离治疗" + }, + "answer": "C", + "reason": "" + }, + { + "question_num": 459, + "query": "患者,女,22岁。月经不调,常提前7天以上,甚至10余日一行。治疗应首选", + "options": { + "A": "足三里、脾俞、太冲", + "B": "命门、三阴交、足三里", + "C": "关元、三阴交、血海", + "D": "气海、三阴交、归来", + "E": "关元、三阴交、肝俞" + }, + "answer": "C", + "reason": "由本患者的症状可知本病为月经先期。应选用清热调经的关元、血海、三阴交。关元为任脉经穴，足三阴经之交会，故为调理冲任之要穴;血海调理血分;三阴交为妇科疾病的要穴。" + }, + { + "question_num": 460, + "query": "患儿,7岁。曾咳喘反复发作。现面色觥白,气短懒育,倦怠乏力,自汗怕冷,舌淡苔薄,脉细无力。治疗应首选", + "options": { + "A": "玉屏风散", + "B": "六君子汤", + "C": "金匮肾气丸", + "D": "二陈汤", + "E": "参苓白术散" + }, + "answer": "A", + "reason": "“曾咳喘反复发作”此为交代病史,所给信息不足以作出诊断,但此与解题关系不大，不需理会。自汗怕冷,说明肺气虚而卫表不固。面色能白,气短懒言,倦怠乏力,自汗怕冷,舌淡苔薄均为气虚表现。由此可诊断为肺气虚。治宜补肺固表,方用玉屏风散,故选A。六君子汤主治脾胃气虚兼有痰湿金匮肾气丸主治肾阳不足;二陈汤主治痰湿咳嗽;参苓白术散主治脾胃气虚挟湿。" + }, + { + "question_num": 461, + "query": "患者,男,60岁。腹胀大如鼓,按之如褒裹水,有波动感。应首先考虑的是", + "options": { + "A": "水饮", + "B": "痞满", + "C": "积聚", + "D": "水臌", + "E": "内痈" + }, + "answer": "D", + "reason": "脘部痞满,按之较硬而疼痛者属实证,多因实邪聚结胃脘所致;按之濡软而无痛者属虚证，多因胃腑虚弱所致;脘部按之有形而胀痛,推之辘辘有声者，为胃中有水饮。按之局部灼热，痛不可忍者，为内痈，按之如蠢裹水，且腹壁凹痕者,为水;以手叩之如鼓,无波动感,按之亦无凹痕者,为气。根据题目,故选D。" + }, + { + "question_num": 462, + "query": "患者,男,20岁。发热起病3天后，自行缓解,高度乏力，腹胀,黄疸进行加深，病程第9天出现躁动,神志不清,重度黄疸，肝界缩小，应诊断为", + "options": { + "A": "急性黄疸型肝炎", + "B": "急性重型肝炎", + "C": "亚急性重型肝炎", + "D": "慢性重型肝炎", + "E": "中毒性肝炎" + }, + "answer": "B", + "reason": "患者高度乏力,腹胀(严重消化道症状),黄疸进行加深(肝损害加快),病程第九天(时间短)出现躁动(性格改变),神志不清(提示肝性脑病)，重度黄疸(肝损害严重),肝界缩小(提示严重肝损害)。典型的急性黄疸型肝炎临床经过的阶段性较明显，分为三期。发热期持续5~7天。黄疸期持续2~6周,在1~3周时黄疸达高峰。恢复期多持续1~2个月。各期的症状体征相对重型较轻，不会出现象题干中所表现的病情进展非常迅猛的情况,故不选A。患者在第9.天表现为肝性脑病等肝功能衰竭的症状体征,结合起病时间和临床表现诊断为急性重型肝炎。详见急性重型肝炎的临床表现。急性重型肝炎又称暴发性肝炎。以急性黄疸型肝炎起病，但病情发展迅猛,2周内出现极度乏力，严重消化道症状,出现神经、精神症状,表现为嗜睡、性格改变、烦躁不安、昏迷等,体检可见扑翼样震顿及病理反射,肝性脑病在Ⅱ度以上。黄疸急剧加深,胆酶分离,肝浊音界进行性缩小,有出血倾向，PTA<40%，血氨升高，出现中毒性鼓肠，肝臭,急性肾功能衰竭。即使黄疸很轻，甚至尚未出现黄疸,但有上述表现者,应考虑本病。" + }, + { + "question_num": 463, + "query": "患者,男,50岁。右额面部束带状刺痛5天。局部皮肤潮红,皮疹呈簇状水疱,排列如带状,小便黄,大便干,舌红苔薄黄,脉弦。治疗除取血海、三阴交、太冲外。还应加", + "options": { + "A": "曲池、合谷、大椎", + "B": "外关、合谷、侠溪", + "C": "尺泽、合谷、大椎", + "D": "风池、合谷、膈俞", + "E": "曲池、合谷、支沟" + }, + "answer": "E", + "reason": "由本患者的症状可知本病为蛇丹，其选穴应为合谷、曲池、支沟等。合谷、曲池配合可以疏导阳明经气，支沟穴可以疏调三焦之气。" + }, + { + "question_num": 464, + "query": "患儿,2岁。泄泻2天，大便日行10余次,质稀如��,色黄混浊。精神不振，口渴心烦,眼眶凹陷,皮肤干燥,小便短赤,舌红少津苔少,其治法是", + "options": { + "A": "消食化积", + "B": "疏风散寒", + "C": "敛阴生津", + "D": "渗湿止泻", + "E": "清热利湿" + }, + "answer": "C", + "reason": "“口渴心烦,眼眶凹陷,皮肤干燥,小便短赤,舌红少津,苔少”表明患儿阴津耗伤,此为泄泻之变证。治疗时除止泻外应及时敛阴生津。" + }, + { + "question_num": 465, + "query": "患者曾发高热。热退而见口鼻、皮肤干燥,形瘦,目陷,唇舌干燥,舌紫绛,边有瘀斑、瘀点,其病机是", + "options": { + "A": "津液不足", + "B": "津亏血瘀", + "C": "津枯血燥", + "D": "津停气阻", + "E": "气阴两亏" + }, + "answer": "B", + "reason": "口鼻、皮肤干燥,形瘦,目陷,唇舌干燥是因津亏使皮肤口唇咽失去润滋养,故是干燥不荣之象。舌紫绛边有瘀斑、瘀点皆为瘀血内阻之象。" + }, + { + "question_num": 466, + "query": "患儿,男,4岁。发热,头痛,皮疹近2天,突发精神极度萎靡,皮肤瘀斑增多融合成片，面色苍白,四肢厥冷,脉搏细速,血压11/6kPa,脑膜刺激征阴性。考虑最有可能的诊断是", + "options": { + "A": "流行性脑脊髓膜炎普通型", + "B": "暴发性流行性脑脊髓膜炎休克型", + "C": "金黄色葡萄球菌败血症", + "D": "流行性乙型脑炎", + "E": "肾病综合征出血热" + }, + "answer": "B", + "reason": "暴发性流行性脑脊髓膜炎休克型多见于儿童，以高热、呕吐、惊厥起病患儿于短时间内出现全身皮肤、黏膜广泛瘀点和瘀斑，并迅速扩大融合。随后出现面色苍白、四肢末端厥冷、紫绀、皮肤发花、脉搏细数，血压下降等周围循环衰竭表现。" + }, + { + "question_num": 467, + "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": 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,男,50岁。咳嗽喘促,呼多吸少动则益甚。声低息微,腰膝酸软,舌淡,脉沉细,两尺无力,其病机是", + "options": { + "A": "肺气虚损", + "B": "肺阴虚亏", + "C": "肺肾气虚", + "D": "肺肾阴虚", + "E": "肾气虚衰" + }, + "answer": "C", + "reason": "咳嗽喘促为肺气虚的表现,呼多吸少动则益甚,声低息微,腰膝酸软为肾气虚的表现。舌淡为气虚，脉沉细，两尺无力为肾气虚的表现。由此可见患者肺肾两脏气虚,降纳无权。" + }, + { + "question_num": 470, + "query": "患者,40岁,是同性恋者。近日出现腹泻,消瘦,低热，经多方检查,最后诊断为艾滋病，问下列哪组药物对艾滋病病毒有抑制作用", + "options": { + "A": "α-干扰素", + "B": "叠氮脱氧胸苷", + "C": "喷他脒", + "D": "胸腺素", + "E": "核糖核酸" + }, + "answer": "B", + "reason": "" + }, + { + "question_num": 471, + "query": "患者,女,21岁。食鱼虾后皮肤出现片状风团,瘙痒异常。治疗取神阙穴，所用的方法是", + "options": { + "A": "针刺", + "C": "拔罐", + "B": "隔盐灸", + "D": "隔姜灸", + "E": "艾条灸" + }, + "answer": "C", + "reason": "患者食鱼虾后皮肤出现片状风团,瘙痒异常,为食物过敏的现象,属中医瘾疹。瘾疹可用拔罐法治疗，在神穴拔火罐,留罐5分钟,取下再拔罐留5分钟,如此3次为1次治疗。神阙穴一般不针。瘾疹治宜疏风和营,病在营血。隔盐灸有回阳、救逆、固脱的功效。隔姜灸有温胃止呕，散寒止痛的功效。艾条灸有温经散寒，扶阳固脱，消察散结的功效。" + }, + { + "question_num": 472, + "query": "患儿,男,6岁。皱眉眨眼,摇头耸肩:嘴角抽动,时伴异常发声,病情时轻时重,抽动能受意志遏制,可暂时不发作。查脑电图未见异常,其诊断是", + "options": { + "A": "习惯性抽搐", + "B": "多发性抽搐症", + "C": "疯痫", + "D": "注意力缺陷多动症", + "E": "风湿性舞蹈病" + }, + "answer": "B", + "reason": "由“皱眉眨眼,摇头耸肩嘴角抽动,时伴异常发声”可诊为多发性抽搐专14006搐,如眨眼、皱眉、龇牙或咳嗽。发病前常有一些诱因,症状轻,预后好,但此症与多发性抽搐症并无严格界限,有些病儿可发展为多发性抽搐症。癫痫的主症为猝然仆倒,不省人事，四肢抽搐,项背强直,口吐涎沫,牙关紧闭，目睛上视,瞳仁散大，对光反射迟钝或消失。注意力缺陷多动症以注意力不集中、自我控制差，动作过多、情绪不稳、冲动任性,伴有学习困难,但智力正常或基本正常为主要临床特征，风湿性舞蹈病是风湿热主要表现之一,表现为四肢较大幅度的无目的而不规则的舞蹈样动作,生活经常不能自理，常伴肌力及肌张力减低,并可有风湿热其他症状。" + }, + { + "question_num": 473, + "query": "患者脘腹胀满疼痛,拒按,嗳腐吞酸:厌食呕恶,痛而欲泻,泻后痛减,舌苔厚腻,脉滑实,其首选的方剂是", + "options": { + "A": "大承气汤", + "B": "丁香散", + "C": "益胃汤", + "D": "保和丸", + "E": "枳实导滞丸" + }, + "answer": "E", + "reason": "患者为腹痛饮食积进证用枳实导滞丸以消食导滞,理气止痛，" + }, + { + "question_num": 474, + "query": "患者已确诊为艾滋病,为了防止其感染其他人，应采取哪项措施预防更合理", + "options": { + "A": "饮食隔离", + "B": "呼吸道隔离", + "C": "避免探视", + "D": "严格管理患者的排泄物、医用器械", + "E": "注射疫苗" + }, + "answer": "D", + "reason": "" + }, + { + "question_num": 475, + "query": "患者,男,31岁。自泪,伴头痛发热,脉浮数。治疗除取主穴外,还应选用", + "options": { + "A": "太渊、风池", + "B": "上星、少商", + "C": "行间、侠溪", + "D": "太溪、鱼腰", + "E": "外关、四白" + }, + "answer": "B", + "reason": "由本患者的症状可知本病为目赤肿痛之风热证,故在选穴的过程中应选用上星、少商、风池等腧穴疏散风热。" + }, + { + "question_num": 476, + "query": "患儿,9岁。水肿从眼睑开始,迅速波及全身,皮肤光亮,按之凹陷即起，尿少色赤，伴咽红肿痛,肢体酸痛,苔薄白,脉浮,其治法是", + "options": { + "A": "疏风宣肺,利水消肿", + "B": "清热利湿,凉血止血", + "C": "清热解毒,淡渗利湿", + "D": "温运中阳，行气利水", + "E": "滋阴补肾,淡渗利水" + }, + "answer": "A", + "reason": "患儿主症为水肿。“水肿从眼睑开始,迅速波及全身，皮肤光亮，按之凹陷即起”为风水水肿的典型表现;“咽红肿痛，肢体酸痛,苔薄白,脉浮”表明邪在肺卫,所以该病为小儿水肿的风水相搏证。治当疏风宣肺,利水消肿。" + }, + { + "question_num": 477, + "query": "患者,男,50岁。咳喘20日余,现咳嗽痰少,口燥咽干,形体消瘦,腰膝酸软,颧红盗汗。舌红少苔,脉细数,其病机是", + "options": { + "A": "肺气虚损", + "B": "肺阴虚亏", + "C": "肺肾阴虚", + "D": "肺肾气虚", + "E": "肾气虚衰" + }, + "answer": "C", + "reason": "题目中患者咳喘20日余:多为肺气亏虚,久病及肾;咳嗽痰少，口燥咽干,形体消瘦,舌红少苔，脉细数提示阴虚证;腰膝酸软,颧红盗汗提示肾阴亏虚。" + }, + { + "question_num": 478, + "query": "医师甲经执业医师注册，在某医疗机构执业。1年后，该医师受聘到另一医疗机构执业,其改变执业地点的行为", + "options": { + "A": "医疗机构允许即可", + "B": "应到准予注册的卫生健康主管部门办理变更注册手续", + "C": "无须经过准予注册的卫生行政部门办理变更注册手续", + "D": "任何组织和个人无权干涉", + "E": "只要其医术高明,就不受限制" + }, + "answer": "B", + "reason": "改变执业地点的行为应到准予注册的卫生健康主管部门办理变更注册手续。" + }, + { + "question_num": 479, + "query": "患者，女，72岁。1小时前,突然昏仆,不省人事。半身不遂,目合口张,遗尿,汗出,四肢厥冷。脉细弱。治疗应首选", + "options": { + "A": "背俞穴,灸法", + "B": "任脉经穴,灸法", + "C": "督脉经穴,灸法", + "D": "足阳明经穴,灸法", + "E": "足厥阴经穴,毫针泻法" + }, + "answer": "B", + "reason": "由患者突然昏仆，不省人事,目合口张,遗溺,手撒,四肢厥冷,脉细弱等症状，可判断患者所患病为中风中脏腑，且为脱证。可用灸法回阳固脱。当选任脉之经穴扶助元阳。" + }, + { + "question_num": 480, + "query": "患儿,1岁。发热1天,全身见散在细小淡红色皮疹,喷嚏,流涕,偶有咳嗽,精神不振,胃纳欠佳,耳后淋巴结肿大,咽红,舌苔薄白,其诊断是", + "options": { + "A": "麻疹", + "C": "风疹", + "E": "水痘", + "B": "奶麻", + "D": "丹痧" + }, + "answer": "C", + "reason": "风疹与麻疹、奶麻(幼儿急风惊的火别区华比中有压痛,其次是发热当天到1天出疹。麻疹有麻疹黏膜斑”的特殊体征;奶麻有“热退疹出”的特点。" + } +] \ No newline at end of file