diff --git "a/Licensed/Theory_Questions/Year_4/Mock.json" "b/Licensed/Theory_Questions/Year_4/Mock.json" new file mode 100644--- /dev/null +++ "b/Licensed/Theory_Questions/Year_4/Mock.json" @@ -0,0 +1,6242 @@ +[ + { + "question_num": 1, + "query": "五行中火的“所胜”是", + "options": { + "A": "水", + "B": "木", + "C": "土", + "D": "金", + "E": "火" + }, + "answer": "D", + "reason": "“克我”和“我克”,在《内经》中称作“所不胜”和“所胜”;“克我”者是“所不胜”,“我克”者是“所胜”火的“所胜”,即火“所克”者;水克火,火克金、金克术,木克土,土克水。" + }, + { + "question_num": 2, + "query": "血尿伴剧烈腹痛最常见于", + "options": { + "A": "肾炎", + "B": "膀胱结核", + "C": "肾肿瘤", + "D": "泌尿系结石", + "E": "过敏性紫癜" + }, + "answer": "D", + "reason": "血尿伴肾绞痛是肾或输尿管结石的特征。血尿伴有水肿、高血压、蛋白尿，见于肾小球肾炎，排除A；膀胱结核常出现血尿伴尿频、尿急和排尿困难，排除B；血尿伴肿块，见于肾肿瘤，排除C；过敏性紫癜常出现血尿、皮肤紫癜和关节肿痛，排除E。" + }, + { + "question_num": 3, + "query": "确立以滋阴降火为肺痨治疗大法的医家是", + "options": { + "A": "张仲景", + "B": "华佗", + "C": "孙思邈", + "D": "朱丹溪", + "E": "葛可久" + }, + "answer": "D", + "reason": "朱丹训但*卢竣主平朋虚\"之说,确立了流轩降火的治疗大法." + }, + { + "question_num": 4, + "query": "乳癖的好发年龄是", + "options": { + "A": "20～40岁", + "B": "25～45岁", + "C": "40～60岁", + "D": "50～70岁", + "E": "20～25岁" + }, + "answer": "B", + "reason": "乳癖好发于25~45岁的中青年妇女,其发病率占乳房疾病的75%,是临床上最常见的乳房疾病。" + }, + { + "question_num": 5, + "query": "“太仓”所指的是", + "options": { + "A": "三焦", + "B": "胃", + "C": "小肠", + "D": "脾", + "E": "大肠" + }, + "answer": "B", + "reason": "胃是机体对饮食物进行消化吸收的重要脏器,主受纳腐熟水谷,有“太仓”、“水谷之海”之称。" + }, + { + "question_num": 6, + "query": "下列各项，最符合主诉书写要求的是", + "options": { + "A": "患高血压病3年", + "B": "心绞痛反复发作3年", + "C": "3年前开始多饮，多食，多尿", + "D": "吞咽困难，进行性加重1月余", + "E": "某医院确诊为肺癌，介绍患者来诊" + }, + "answer": "D", + "reason": "患高血压病3年、心绞痛反复发作3年有诊断术语；3年前开始多饮，多食，多尿，时间应该在症状后面；某医院确诊为肺癌，介绍患者来诊不是患者的主要症状及不适。" + }, + { + "question_num": 7, + "query": "喘证辨证时最宜首先辨别", + "options": { + "A": "寒热", + "B": "表里", + "C": "虚实", + "D": "阴阳", + "E": "外感内伤" + }, + "answer": "C", + "reason": "喘证的病理性质有虚实之分,治疗以虚实为纲,因此辩证当以辨别虚实最为重要。" + }, + { + "question_num": 8, + "query": "外科的善恶顺逆指的是", + "options": { + "A": "病情轻重程度", + "B": "正邪力量对比", + "C": "疮疡局部发展好坏", + "D": "全身脏腑功能盛衰", + "E": "综合局部、全身情况判断预后" + }, + "answer": "E", + "reason": "辨善恶顺逆。辨善恶是指对全身情况的预后判断;辨顺逆是指对局部症状体征的预后判断。" + }, + { + "question_num": 9, + "query": "《灵枢·顺气一日分为四时》说疾病病情随昼夜时间节律而变化，其病“安”的时间是", + "options": { + "A": "旦", + "B": "昼", + "C": "夕", + "D": "前夜", + "E": "后夜" + }, + "answer": "B", + "reason": "昼夜变化影响着疾病的过程，灵枢·顺气一日分为四时》说:“夫百病者,多以旦慧、昼安、夕加、夜甚。”并进一步指出:“朝则人气始生,病气衰、故旦慧;日中人气长,长则胜邪,故安:夕则人气始衰,邪气始生,故加;夜半人气如脏,邪气独居于身,故甚也。\"病“安”的时间是昼。" + }, + { + "question_num": 10, + "query": "全身肌肉松弛，对各种刺激全无反应，深浅反射均消失属于", + "options": { + "A": "中度昏迷", + "B": "浅昏迷", + "C": "深度昏迷", + "D": "嗜睡", + "E": "昏睡" + }, + "answer": "C", + "reason": "意识障碍的严重程度是不同的，最严重的深度昏迷表现为全身肌肉松弛，对各种刺激全无反应，深浅反射均消失，故选C。中度昏迷对剧烈刺激尚可出现防御反射，角膜反射减弱，瞳孔对光反射迟钝，眼球无转动；轻度昏迷的意识部分丧失，无自主运动，对疼痛刺激尚可出现痛苦表情及防御反应，反射可存在，眼球有转动；昏睡是处于熟睡状态，不易唤醒，虽在强烈刺激下可被唤醒，但很快又入睡，醒时答话含糊或答非所问；嗜睡是最轻的意识障碍，是一种病理性嗜睡，可被唤醒，并能正确回答问题和作出各种反应，但当刺激除去后又很快入睡。" + }, + { + "question_num": 11, + "query": "治疗虚劳肝阴虚者,应首选", + "options": { + "A": "玉女煎", + "B": "补肝汤", + "C": "沙参麦冬汤", + "D": "麦门冬汤", + "E": "四物汤" + }, + "answer": "B", + "reason": "玉女煎清胃热、滋肾阴,用于胃热阴虚证,排除A；沙参麦门冬汤消养肺胃、生津润燥,用于肺胃阴伤证，排除C:麦门冬汤激养肺胃,用于肺胃阴伤证，排除D；四物汤补血养肝,用于肝血虚证,排除E;补肝汤滋养肝阴,用于肝阴虚证。" + }, + { + "question_num": 12, + "query": "乳痈属热毒炽盛证，内治应首选", + "options": { + "A": "逍遥散", + "B": "透脓散", + "C": "四妙汤", + "D": "瓜蒌牛蒡汤", + "E": "牛蒡解肌汤" + }, + "answer": "B", + "reason": "乳痈成脓期热毒炽盛证,其治疗应该清热解毒、托毒透脓,方用透脓散加味。" + }, + { + "question_num": 13, + "query": "“壮水之主，以制阳光”的治法，最适于治疗的是", + "options": { + "A": "阴盛则寒之证", + "B": "阴虚则热之证", + "C": "阴盛伤阳之证", + "D": "阴损及阳之证", + "E": "阳损及阴之证" + }, + "answer": "B", + "reason": "“壮水之主,以制阳光”是王冰对于“诸寒之而热者取之阴”的注语,后又简称为“壮水制阳”“滋水制火”“滋阴涵阳”,是用滋阴壮水之法,治疗阴虚则热之证。" + }, + { + "question_num": 14, + "query": "中性粒细胞减少，一般不见于", + "options": { + "A": "风疹", + "B": "伤寒", + "C": "急性溶血", + "D": "系统性红斑狼疮", + "E": "脾功能亢进" + }, + "answer": "C", + "reason": "引起中性粒细胞减少的病因很多，可归纳为以下几个方面。①感染性疾病：病毒感染是引起粒细胞减少的常见原因，如流感、风疹，细菌感染主要是伤寒；②血液系统疾病：粒细胞减少常见于再生障碍性贫血、急性白血病、严重缺铁性贫血；③物理、化学因素：放射线、化学物质及药物均可以引起粒细胞减少，如解热镇痛药、抗生素（氯霉素）、磺胺药、部分降糖药等均可引起中性粒细胞减少；④单核巨噬细胞系统功能亢进：脾功能亢进、某些恶性肿瘤；⑤其他：系统性红斑狼疮、某些自身免疫性疾病、过敏性休克等也可有中性粒细胞减少。C项急性溶血主要是引起红细胞减少。" + }, + { + "question_num": 15, + "query": "血虚头痛的代表方剂是", + "options": { + "A": "半夏白术天麻汤", + "B": "天麻钩藤饮", + "C": "大补元煎", + "D": "加味四物汤", + "E": "芎芷石膏汤" + }, + "answer": "D", + "reason": "血虚头痛治宜养血滋阴,和络止痛，方选加味四物汤。半夏白术天麻汤用于痰浊头痛,天麻钩藤饮用于肝阳头痛,大补元煎用于肾虚头痛,芎芷石膏汤用于风热头痛。" + }, + { + "question_num": 16, + "query": "中医治疗肿瘤的原则是", + "options": { + "A": "健脾补肾", + "B": "扶正与祛邪", + "C": "理气化瘀", + "D": "益气养阴", + "E": "化痰散结" + }, + "answer": "B", + "reason": "瘤岩的治则。扶正祛邪是中医治疗癌瘤的原则。" + }, + { + "question_num": 17, + "query": "阴阳的相互转化是", + "options": { + "A": "绝对的", + "B": "有条件的", + "C": "必然的", + "D": "偶然的", + "E": "量变" + }, + "answer": "B", + "reason": "阴阳转化是指阴阳对立双方,在一定的条件下,可以各自向其相反的方向转化,是在量变基础上的质变。" + }, + { + "question_num": 18, + "query": "过清音见于", + "options": { + "A": "叩击富有弹性、含气泡正常的肺组织所产生的音响", + "B": "叩击含有大量气体的空腔脏器时出现", + "C": "叩击含气量增多、弹性减退的肺组织时出现", + "D": "叩击不含气的实质性脏器时出现", + "E": "叩击各种原因所致含气减少的肺组织时出现" + }, + "answer": "C", + "reason": "过清音的出现提示肺组织含气量增多，弹性减弱，临床常见于肺气肿。" + }, + { + "question_num": 19, + "query": "胸痹的主要病机为", + "options": { + "A": "气滞血瘀", + "B": "寒凝气滞", + "C": "痰瘀交阻", + "D": "阳气虚衰", + "E": "心脉痹阻" + }, + "answer": "E", + "reason": "前四个选项是导致心脉痹阻的原因，胸痹的表现都是心脉不通引���的疼痛,故选E。" + }, + { + "question_num": 20, + "query": "辨溃疡，疮面呈翻花或如岩穴属", + "options": { + "A": "瘰疬溃疡", + "B": "麻风溃疡", + "C": "梅毒溃疡", + "D": "岩性溃疡", + "E": "流痰溃疡" + }, + "answer": "D", + "reason": "如岩性溃疡,疮而多呈翻花如岩穴、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。瘰疬之溃疡,疮口有空腔或伴痰管,疮面肉色不鲜,脓水清稀,并夹有败架状物。附骨疽、流痰之溃疡,疮口呈凹陷形,常伴管形成。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": 21, + "query": "元神之府指的是", + "options": { + "A": "脑", + "B": "胆", + "C": "骨", + "D": "髓", + "E": "女子胞" + }, + "answer": "A", + "reason": "脑是元神之府,又名髓海。" + }, + { + "question_num": 22, + "query": "下列哪项不是谵妄的表现", + "options": { + "A": "躁动不安", + "B": "意识模糊", + "C": "定向力丧失", + "D": "幻视、幻听", + "E": "嗜睡" + }, + "answer": "E", + "reason": "谵妄的表现。谵妄是一种以兴奋性增高为主的高级神经中枢急性活动失调状态，表现为躁动不安、意识模糊、定向力丧失、感觉错乱（幻觉）、语言杂乱，而不会表现嗜睡。" + }, + { + "question_num": 23, + "query": "治疗呃逆气机郁滞证,应首选", + "options": { + "A": "丁香散", + "B": "益胃汤", + "C": "五磨饮子", + "D": "竹叶石膏汤", + "E": "橘皮竹茹汤" + }, + "answer": "C", + "reason": "呃逆气机阻滞用行气降逆、宽胸散结的五磨饮子。胃寒气逆的用温中散寒.降逆止呃的丁香散。胃火上逆用清热和胃的竹叶石膏汤或橘皮竹茹汤。气滞痰阻的用理气化痰的旋覆代赭汤。脾胃阳虚的用温补脾胃的理中丸。胃阴不足的用益气养阳的益胃汤。" + }, + { + "question_num": 24, + "query": "破伤风的命名方法是", + "options": { + "A": "以病因命名", + "B": "以部位命名", + "C": "以疾病特征命名", + "D": "以形态命名", + "E": "以范围大小命名" + }, + "answer": "A", + "reason": "以病因命名者,如冻疮、水火烫伤、破伤风、毒蛇咬伤、漆疮。" + }, + { + "question_num": 25, + "query": "女子胞的功能活动与下述哪项关系密切", + "options": { + "A": "心、肝、脾、冲脉、督脉", + "B": "心、肝、肾、冲脉、带脉", + "C": "心、肝、肾、冲脉、督脉", + "D": "冲脉、带脉、任脉、心、脾", + "E": "心、肝、脾、肾、冲脉、任脉" + }, + "answer": "E", + "reason": "女子胞功能的生理因素有三个方面:一是肾和“天癸\"的作用:二是冲、任二脉的作用:三是心、肝、脾、肾四脏的作用。" + }, + { + "question_num": 26, + "query": "改善急性左心衰竭症状最有效的药物是", + "options": { + "A": "利尿剂", + "B": "洋地黄", + "C": "钙离子拮抗剂", + "D": "β肾上腺素能受体阻滞剂", + "E": "血管紧张素转换酶抑制剂" + }, + "answer": "A", + "reason": "利尿剂是心力衰竭治疗中最常用的药物，通过排钠、排水，对缓解肺淤血症状，减轻水肿有十分显著的效果。" + }, + { + "question_num": 27, + "query": "“无虚不能作眩”,出自的医著是", + "options": { + "A": "《素问·六元正纪大论》", + "B": "《金匮要略》", + "C": "《丹溪心法》", + "D": "《景岳全书》", + "E": "《医学正传》" + }, + "answer": "D", + "reason": "《景后全书》认为\"无虚不能作眩”，《丹溪心法》主张\"无痰不作眩”。" + }, + { + "question_num": 28, + "query": "治疗虫咬皮炎热毒蕴结证，应首选的方剂是", + "options": { + "A": "普济消毒饮", + "B": "仙方活命饮", + "C": "黄连解毒汤", + "D": "龙胆泻肝汤合化斑解毒汤", + "E": "五味消毒饮合黄连解毒汤" + }, + "answer": "E", + "reason": "虫咬皮炎热毒殖结证治法:热解毒,消肿止痒。代表方:五味消毒饮合黄连解毒汤加地肤子、白鲜皮、紫荆皮。" + }, + { + "question_num": 29, + "query": "肝藏血与脾统血的共同生理功能是", + "options": { + "A": "贮藏血液", + "B": "调节血量", + "C": "统摄血液", + "D": "防止出血", + "E": "化生血液" + }, + "answer": "D", + "reason": "肝藏血,是指肝脏具有贮藏血液、淵节血量的生理功能。脾统血，是指脾具有统摄血液在经脉内运行防御其溢出脉外的功能,故肝藏血与牌统血的共同生理功能是防止出血。" + }, + { + "question_num": 30, + "query": "下列哪项是鉴别右心衰竭与肝硬化的最主要依据", + "options": { + "A": "腹水的程度", + "B": "颈静脉是否充盈", + "C": "有否全身水肿", + "D": "有否肝大", + "E": "有否脾大" + }, + "answer": "B", + "reason": "肝硬化主要表现为肝功能减退及门脉高压的症状、体征。要掌握肝硬化的各种症状、体征及其出现的原因，如出血倾向的原因，肝掌、蜘蛛痣、腹水的成因，这是历来考试的重点。肝硬化因门脉高压引起腹壁静脉曲张。右心衰竭主要表现为水肿、肝大、颈静脉怒张等。" + }, + { + "question_num": 31, + "query": "治疗便秘冷秘证，应首选", + "options": { + "A": "温脾汤", + "B": "麻子仁丸", + "C": "大承气汤", + "D": "润肠丸", + "E": "六磨汤" + }, + "answer": "A", + "reason": "便秘之冷秘证。治宜温里散寒，通便止痛,方选温脾汤加减。" + }, + { + "question_num": 32, + "query": "外科辨肿，“肿而皮肉重垂胀急，深则按之如烂棉不起，浅则光亮如水疱，破流黄水”，其成因属", + "options": { + "A": "火", + "B": "虚", + "C": "痰", + "D": "湿", + "E": "风" + }, + "answer": "D", + "reason": "湿肿而皮肉重垂胀急,深则按之如烂棉不起,浅则水亮如水疱,搔破流黄水,浸淫皮肤。而容易混淆的E项是肿势或软如棉、馒,或硬如结核，不红不热。" + }, + { + "question_num": 33, + "query": "脏腑关系中，“水火既济”指的是", + "options": { + "A": "肝与肾", + "B": "心与肾", + "C": "肝与脾", + "D": "肺与脾", + "E": "肺与肝" + }, + "answer": "B", + "reason": "肝属木,肾属水;心属火,脾属土,肺属金,水火既济指的是心、肾两脏。" + }, + { + "question_num": 34, + "query": "关于腹部触诊下列各项除哪一项外均恰当", + "options": { + "A": "被检查者可取平卧位、左右侧卧位、坐位及立位", + "B": "医生站立于被检查者右侧，前臂应与腹表面在同一水平", + "C": "医生动作轻柔，从腹痛最明显处开始", + "D": "边触诊边观察被检查者的反应及表情", + "E": "腹部触诊时五种触诊法都能用到" + }, + "answer": "C", + "reason": "腹部触诊在腹部检查中最重要，正确的检查方法对发现病变体征非常重要，检查时一般均应从健康部位开始，逐渐移向病变区域，而不能从腹痛最明显处开始，否则会因加重患者腹痛而不能继续完成检查。" + }, + { + "question_num": 35, + "query": "虚劳患者,短气自汗。声音低怯,时寒时热,平素易于感冒。舌质淡，脉弱，其证候是", + "options": { + "A": "肺气虚", + "B": "脾气虚", + "C": "肺阴虚", + "D": "脾阳虚", + "E": "肾气虚" + }, + "answer": "A", + "reason": "虚劳是多个脏腑,多种因素的虚损。肺主气,主宣发,肺气虚,故气短,声低,肺卫气虚,卫表不固,故自汗,时寒时热,易于感冒。证属肺气虚,选A。肺阴虚应有舌红苦黄脉细,故排除C。" + }, + { + "question_num": 36, + "query": "疮疡三陷证中，火陷证的治法是", + "options": { + "A": "凉血清热解毒，养阴清心开窍", + "B": "补益气血，清心安神开窍", + "C": "温补脾肾，清心开窍", + "D": "托毒透邪，养阴清心开窍", + "E": "生津养胃，清心解毒" + }, + "answer": "A", + "reason": "火陷证凉血清热解毒,养阴清心开窍为其治法。干陷证补益气血,清心安神开窍,虚陷温补脾肾。D项为托法，E项为补益之法，" + }, + { + "question_num": 37, + "query": "连接“肺主呼吸”和“心主血脉”的中心环节是", + "options": { + "A": "经脉的相互连接", + "B": "气血的相互关系", + "C": "心主营，肺主卫之间的相互作用", + "D": "宗气的贯通和运行", + "E": "以上都不是" + }, + "answer": "D", + "reason": "宗气积于胸中,上行喉咙,助肺司呼吸。呼吸的强弱与宗气的盛衰有密切联系。声音出于喉咙,喉为气出人之门户,为声音之枢,所以语言、声音的强弱,与宗气的盛衰有关。宗气聚于胸中,灌注于心脉,助心行气血。气血的运行,心搏强弱、节律、心率等,均与宗气盛衰有关,故联结“肺主呼吸”和“心主血脉”的中心环节是宗气的贯通和运行。" + }, + { + "question_num": 38, + "query": "下列各项，可出现金属样肠蠕动音的是", + "options": { + "A": "麻痹性肠梗阻", + "B": "机械性肠梗阻", + "C": "低血钾", + "D": "急性肠炎", + "E": "败血症" + }, + "answer": "B", + "reason": "肠鸣音次数增多，且呈响亮、高亢的金属音，称肠鸣音亢进，多见于机械性肠梗阻。" + }, + { + "question_num": 39, + "query": "胁痛的辨证要点,当以何者为主", + "options": { + "A": "肝胆", + "B": "气血", + "C": "虚实", + "D": "表里", + "E": "阴阳" + }, + "answer": "B", + "reason": "由于胁痛的病因病机实证以气滞、血瘀、湿热为主,三者又以气滞为先;虚证多属阴血亏损,肝失所养,所以胁痛之辨证当以气血为主。" + }, + { + "question_num": 40, + "query": "疮疡的半阴半阳证，外用药物宜选用", + "options": { + "A": "冲和膏", + "B": "太乙膏", + "C": "阳和解凝膏", + "D": "咬头膏", + "E": "以上都不是" + }, + "answer": "A", + "reason": "冲和音活血止痛,疏风祛寒,消肿软坚,适用于半阴半阳证。太乙膏性偏清凉,消肿、清火、解毒、生肌。阳和解凝膏温经和阳,祛风散寒,调气活血,化痰通络,用于疮形不红不热,漫肿无头之阴证疮疡未溃者。咬头膏具有腐蚀性，功能蚀破疮头，适用于肿疡脓成,不能自破，以及患者不愿接受手术切开排脓者。" + }, + { + "question_num": 41, + "query": "大肠的主要生理功能是", + "options": { + "A": "受盛", + "B": "传化糟粕", + "C": "化物", + "D": "泌别清浊", + "E": "通行元气" + }, + "answer": "B", + "reason": "大肠主传泻糟粕,是水谷废物排的通路。从胃的受纳、腐熟及牌的运化，经过小肠的别清浊,后由大肠排泄,构成一个水谷运化、吸收、排的过程,所以大便下利或秘结都是大肠的传导失常。" + }, + { + "question_num": 42, + "query": "治疗非重型再生障碍性贫血，应首选", + "options": { + "A": "叶酸", + "B": "维生素B12", + "C": "硫酸亚铁", + "D": "雄激素", + "E": "白消安" + }, + "answer": "D", + "reason": "再生障碍性贫血是一种获得性骨髓造血功能衰竭症。雄激素是治疗非重型再障的首选药物。C项是缺铁性贫血的最常用药物；AB项是治疗营养性巨幼细胞贫血的药物；E项是治疗慢性粒细胞白血病的药物。" + }, + { + "question_num": 43, + "query": "关于哮病的临床特征,说法不正确的是", + "options": { + "A": "具有发作性", + "B": "喉间哮鸣", + "C": "呼吸困难", + "D": "甚则不得平卧", + "E": "咯吐脓血痰" + }, + "answer": "E", + "reason": "哮病是一种发作性的痰鸣气喘疾患。临床以喉中哮鸣有声,呼吸气促困难,其则喘息不能平卧为特征。咯吐脓血者,党见于肺痫。" + }, + { + "question_num": 44, + "query": "疥疮的发病因素或致病途径是", + "options": { + "A": "由于体虚感受风、湿、虫、毒而成", + "B": "因被虫叮咬，邪毒侵入，阻于肌肤而发", + "C": "由密切接触带虫者而传染", + "D": "接触虫体的有毒毛刺，邪毒侵入肌肤，过敏而成本病", + "E": "通过体液和血液进行传染" + }, + "answer": "C", + "reason": "疥疮由人型疥虫密切接触传染，" + }, + { + "question_num": 45, + "query": "风性善动不居，游走不定，体现风性", + "options": { + "A": "为百病之长", + "B": "轻扬开泄", + "C": "善行而数变", + "D": "主动", + "E": "以上皆非" + }, + "answer": "C", + "reason": "风性普行而数变:“普行”,指风性动不居,游走不定。" + }, + { + "question_num": 46, + "query": "有关步态的描述，下列哪一项是错误的", + "options": { + "A": "蹒跚步态：走路时身体左右摇摆似鸭状步态", + "B": "醉酒步态：移步时，下肢内收过度，两腿交叉如剪刀状", + "C": "共济失调步态：行走时将足高抬，骤然落下，双目向下注视，两脚间距较宽，闭目时摇晃不稳", + "D": "慌张步态：起步后小步急速行走，身体前倾的慌张步态", + "E": "跨阈步态：患足下垂，行走时必须高抬患侧下肢" + }, + "answer": "B", + "reason": "各种步态的概念。题中对醉酒步态的描述是错误的，其描述实际上是指剪刀式步态。醉酒步态是行走时躯干重心不稳，步态紊乱呈醉酒状，不能直线走路。见于小脑疾病、酒精中毒等，其余各种步态的描述均是正确的。" + }, + { + "question_num": 47, + "query": "心悸心血不足证的治疗方剂是", + "options": { + "A": "四物汤", + "B": "人参养荣汤", + "C": "苓桂术甘汤", + "D": "归脾汤", + "E": "天王补心丹" + }, + "answer": "D", + "reason": "心悸之心血不足证,治法:补血养心,益气安神。代表方:归脾汤加减。" + }, + { + "question_num": 48, + "query": "疥疮的特异性皮损是", + "options": { + "A": "丘疹", + "B": "丘疱疹", + "C": "小水疱", + "D": "隧道", + "E": "结节" + }, + "answer": "D", + "reason": "疥疮的特点是在皮损处有灰白色浅、黑色或普通颜色的隧道。" + }, + { + "question_num": 49, + "query": "下列何经循行从耳后，进入耳中，出走耳前", + "options": { + "A": "足太阳膀胱经", + "B": "手太阳小肠经", + "C": "足阳明胃经", + "D": "手阳明大肠经", + "E": "足少阳胆经" + }, + "answer": "E", + "reason": "足少阳胆经耳部分支循行:从耳进人耳中,出走耳前到目外眦后方。" + }, + { + "question_num": 50, + "query": "导致心力衰竭前负荷不足的疾病是", + "options": { + "A": "主动脉瓣狭窄", + "B": "梗阻性心肌病", + "C": "主动脉瓣关闭不全", + "D": "二尖瓣关闭不全", + "E": "二尖瓣狭窄" + }, + "answer": "E", + "reason": "由于左心房压力和肺静脉压力升高，引起肺小动脉反应性收缩，最终导致肺小动脉硬化，肺血管阻力增高，肺动脉压力升高，左心负荷不足。重度肺动脉高压可引起右心室肥厚、三尖瓣和肺动脉瓣关闭不全和右心衰竭。" + }, + { + "question_num": 51, + "query": "治疗邪犯胸肺之悬饮宜选用", + "options": { + "A": "柴枳半夏汤", + "B": "椒目瓜蒌汤", + "C": "香附旋覆花汤", + "D": "已椒苈黄丸", + "E": "柴胡疏肝散" + }, + "answer": "A", + "reason": "悬饮的辩证治疗.悬饮之邪犯胸肺治宜和解宜利,方用柴枳半夏汤。" + }, + { + "question_num": 52, + "query": "适用于乳漏疮口漏乳不止，脓腐已脱尽后的外治法是", + "options": { + "A": "腐蚀法", + "B": "垫棉法", + "C": "切开法", + "D": "挂线法", + "E": "结扎法" + }, + "answer": "B", + "reason": "适应证适用于溃疡脓出不畅有袋脓者;或创口实道形成脓水不易排尽者;或溃疡脓腐已尽,新肉已生,但皮肉一时不能黏合者。" + }, + { + "question_num": 53, + "query": "肺经在上肢的循行部位是", + "options": { + "A": "外侧前缘", + "B": "内侧中线", + "C": "外侧后缘", + "D": "内侧前缘", + "E": "外侧中线" + }, + "answer": "D", + "reason": "太阴、阳明在前缘;厥阴、少阳在!线:少阴、太阳在后缘;阴经行于内侧,阳经行于外侧手太阴肺经,在内侧前缘。" + }, + { + "question_num": 54, + "query": "癫痫单纯部分性发作的发作时间是", + "options": { + "A": "不超过1分钟", + "B": "数分钟", + "C": "十数分钟", + "D": "数十分钟", + "E": "1小时" + }, + "answer": "A", + "reason": "癫痫单纯部分性发作一般不超过1分钟，无意识障碍，表现为简单的运动、感觉、自主神经或精神症状。" + }, + { + "question_num": 55, + "query": "腹痛湿热壅滞证,选方为", + "options": { + "A": "小承气汤", + "B": "调胃承气汤", + "C": "大承气汤", + "D": "大黄牡丹汤", + "E": "大陷胸汤" + }, + "answer": "C", + "reason": "腹痛之湿热壅滞证,治法:泄热通腑,行气导滞。代表方:大承气汤加减。" + }, + { + "question_num": 56, + "query": "药毒重复用药的潜伏期是", + "options": { + "A": "1～2天", + "B": "3～4天", + "C": "5～20天", + "D": "7天", + "E": "24小时" + }, + "answer": "E", + "reason": "药毒有潜伏期,第一次发病多在用药后5~20天内,重复用药常在24小时内发生，短者甚至在用药后瞬间或数分钟内发生。" + }, + { + "question_num": 57, + "query": "奇经八脉中既称血海又称经脉之海者是", + "options": { + "A": "冲脉", + "B": "任脉", + "C": "督脉", + "D": "带脉", + "E": "维脉" + }, + "answer": "A", + "reason": "冲脉为血海、十二经之海:任脉为脉之海;督脉为阳脉之海;带脉,约束纵行经脉,主司好女的带下;维脉,具有维护和联络全身阴经、阳经的作用。" + }, + { + "question_num": 58, + "query": "以下不能作为诊断肺心病的主要依据的是", + "options": { + "A": "右下肺动脉扩张，横径≥15mm", + "B": "肺动脉段突出", + "C": "肺型P波", + "D": "右束支传导阻滞", + "E": "V1呈R/S＞1" + }, + "answer": "D", + "reason": "右束支传导阻滞可见于多种心脏病，甚至可见于正常人，所以此项不能作为肺心病的主要诊断依据。" + }, + { + "question_num": 59, + "query": "腹痛与下列哪项无关", + "options": { + "A": "手阳明经", + "B": "足三阴经", + "C": "手少阳经", + "D": "足少阳经", + "E": "足阳明经" + }, + "answer": "C", + "reason": "腹为脾胃、大小肠、膀胱等所居之处,并为足三阴,足少阳,手足阳明,冲、任、带等经脉循行之部。手少阳经从手走头,与腹无关。" + }, + { + "question_num": 60, + "query": "治疗牛皮癣风湿蕴肤证，应首选的方剂是", + "options": { + "A": "龙胆泻肝汤", + "B": "当归饮子", + "C": "消风散", + "D": "桃红四物汤", + "E": "竹叶石膏汤" + }, + "answer": "C", + "reason": "牛皮癣风湿蕴肤证治法:祛风利湿，清热止痒。代表方:消风散加减" + }, + { + "question_num": 61, + "query": "下列与内寒形成关系密切的脏腑是", + "options": { + "A": "心肺脾", + "B": "心肝脾", + "C": "心脾肾", + "D": "肺脾肾", + "E": "肺脾肝" + }, + "answer": "C", + "reason": "内寒指机体阳气虚衰,温煦作用退，阳不制阴而虚寒内生的病理变化。多因先天禀不足,阳气素虚,或久病伤阳,或外感寒邪,过食生冷损伤阳气，以致阳气虚衰所致。内寒病机多见于·脾肾擊獼铣谷。" + }, + { + "question_num": 62, + "query": "人体铁吸收的部位主要在", + "options": { + "A": "胃部幽门", + "B": "十二指肠", + "C": "回肠上段", + "D": "空肠下段", + "E": "升结肠" + }, + "answer": "B", + "reason": "铁吸收部位主要在十二指肠及空肠上段。吸收入血的二价铁经铜蓝蛋白氧化成三价铁，与转铁蛋白结合后转运到组织或通过幼红细胞膜转铁蛋白受体胞饮入细胞内，再与转铁蛋白分离并还原成二价铁，参与形成血红蛋白。多余的铁以铁蛋白和含铁血黄素形式贮存于肝、脾、骨髓等器官的单核巨噬细胞系统。" + }, + { + "question_num": 63, + "query": "黄疸胆腑郁热证的主治方剂是", + "options": { + "A": "小柴胡汤", + "B": "大柴胡汤", + "C": "葛根芩连汤", + "D": "升麻葛根汤", + "E": "龙胆泻肝汤" + }, + "answer": "B", + "reason": "胆腑郁热证,治法:疏肝泄热,利胆退黄,代表方:大柴胡汤加减。" + }, + { + "question_num": 64, + "query": "以下为乳核肿块特点，除了", + "options": { + "A": "生长缓慢", + "B": "活动度好，表面光滑", + "C": "按之如橡皮球", + "D": "乳房皮肤有橘皮样改变", + "E": "妊娠期可迅速增大，排除恶变者" + }, + "answer": "D", + "reason": "乳房皮肤有橘皮样改变见于乳岩" + }, + { + "question_num": 65, + "query": "根据情志相胜法，可制约大怒的情志是", + "options": { + "A": "喜", + "B": "思", + "C": "悲", + "D": "恐", + "E": "惊" + }, + "answer": "C", + "reason": "情志的五行归属:怒属肝,喜属心思属脾,悲属肺,恐属肾。金克木,故悲克怒。" + }, + { + "question_num": 66, + "query": "晚期肝硬化最严重也是最常见的死亡原因是", + "options": { + "A": "上消化道出血", + "B": "原发性肝癌", + "C": "感染", + "D": "肝肾综合征", + "E": "肝性脑病" + }, + "answer": "E", + "reason": "肝性脑病是肝硬化最严重的并发症，亦是最常见的死亡原因，主要临床表现为性格行为失常、意识障碍、昏迷。" + }, + { + "question_num": 67, + "query": "治疗鼓胀气滞湿阻证宜用何方", + "options": { + "A": "中满分消丸合茵陈蒿汤", + "B": "调营饮", + "C": "柴胡疏肝散合胃苓汤", + "D": "实脾饮", + "E": "附子理苓汤" + }, + "answer": "C", + "reason": "治疗鼓胀气滞湿阻证宜用柴胡疏肝散合骨苓汤,治疗鼓胀水热蕴结证宜用中满分消丸合茵陈蒿汤,治疗鼓胀郁结水留证宜用调营饮,治疗鼓胀水湿困脾证宜用实脾饮,治疗鼓胀阳虚水盛证宜用附子理苓汤。" + }, + { + "question_num": 68, + "query": "下列外治法，可用于治疗白秃疮、肥疮的是", + "options": { + "A": "拔发法", + "B": "挑治法", + "C": "挂线法", + "D": "结扎法", + "E": "熏法" + }, + "answer": "A", + "reason": "可用于治疗白秃疮、肥疮的是拔发法。" + }, + { + "question_num": 69, + "query": "虚的病机概念，主要是指", + "options": { + "A": "卫气不固", + "B": "正气虚损", + "C": "脏腑功能低下", + "D": "气血生化不足", + "E": "气化无力" + }, + "answer": "B", + "reason": "实,是指邪气盛;虚,是指正气虚。" + }, + { + "question_num": 70, + "query": "肝硬化最常见的并发症是", + "options": { + "A": "上消化道出血", + "B": "肝性脑病", + "C": "肝肾综合征", + "D": "感染", + "E": "肝癌" + }, + "answer": "A", + "reason": "题中所列五项均为肝硬化的并发症，其中最严重的并发症是肝性脑病，但最常见的并发症是上消化道出血，多突然发生大量呕血或黑便，其余各项均相对少见。" + }, + { + "question_num": 71, + "query": "积聚中“积”的特点,说法错误的是", + "options": { + "A": "结块固定", + "B": "痛有定处", + "C": "病在血分", + "D": "是为脏病", + "E": "是为腑病" + }, + "answer": "E", + "reason": "积属有形,结块固定不移,痛有定处,病在血分,是为脏病.“是为腑病\"属于“聚”的特点。" + }, + { + "question_num": 72, + "query": "下列各项，不属溻渍法适应证的是", + "options": { + "A": "阳证疮疡初起", + "B": "阴证疮疡", + "C": "美容", + "D": "保健", + "E": "创面干燥，僵而不敛" + }, + "answer": "E", + "reason": "溻渍法适用于疮疡溃后脓水淋漓或腐肉不脱,皮肤病瘙痒、脱屑,内、外痔的肿胀疼痛等。" + }, + { + "question_num": 73, + "query": "塞因塞用不适用于", + "options": { + "A": "脾虚腹胀", + "B": "血虚便秘", + "C": "血枯经闭", + "D": "肾虚尿闭", + "E": "血瘀经闭" + }, + "answer": "E", + "reason": "因塞证而用塞法。前“塞”为塞法指补养固涩;后“塞”为塞证,指本虚标实之满胀不通的病证。脾虚腹胀,腹胀为脾虚引起,为本虚标实;血便秘、血枯经闭、肾虚尿闭均为本虚标实;血瘀经闭,瘀为实证,经闭为实证,故不能用塞因塞用治法。" + }, + { + "question_num": 74, + "query": "关于体温，以下哪项是错误的", + "options": { + "A": "正常人一天之中体温波动不超过1℃", + "B": "妇女在月经期体温会轻度升高", + "C": "进餐可引起体温轻度升高", + "D": "心肌梗死后会出现发热", + "E": "安眠药中毒可导致中枢性发热" + }, + "answer": "B", + "reason": "体温的变化。正常人体温可因测量方法不同而异，口测法（舌下温度）正常值为36.3～37.2℃。腋测法为36～37℃，肛测法为36.5～37.7℃。正常人一天之中体温波动不超1℃，下午体温略高于早晨，剧烈运动或进餐也可使体温轻度升高，妇女在月经前（不是月经期）及妊娠期体温会轻度升高，老年人因代谢率低，其体温低于青少年。病理情况下，体温升高称发热，各种病原体体会引起感染性发热，病原体以外的原因会引起非感染性发热，后者常见于：①无菌性坏死物质的吸收，如心肌梗死等；②抗原-抗体反应，如风湿热、结缔组织病等；③内分泌与代谢障碍，如甲状腺功能亢进症、重度脱水等；④体温调节中枢功能失调，如安眠药中毒导致的中枢性发热等；⑤自主神经功能紊乱，故选B。" + }, + { + "question_num": 75, + "query": "水肿属风水相搏者,最佳选方是", + "options": { + "A": "越婢加术汤", + "B": "五苓散", + "C": "五皮饮", + "D": "桂枝汤", + "E": "麻黄连翘赤小豆汤" + }, + "answer": "A", + "reason": "水肿风水相搏证,治法:疏风清热，宣肺行水。代表方:趟婢加术汤加减。" + }, + { + "question_num": 76, + "query": "下列疔疮，容易损筋伤骨的是", + "options": { + "A": "烂疔", + "B": "红丝疔", + "C": "颜面疔", + "D": "疫疔", + "E": "手足疔" + }, + "answer": "E", + "reason": "手足部疔疮是指发生于手足部的急性化脓性疾患，本病若治疗失误,容易损伤筋骨，继而影响手足功能。" + }, + { + "question_num": 77, + "query": "下列关于火热内生机制的叙述，错误的是", + "options": { + "A": "气有余便是火", + "B": "邪郁化火", + "C": "五志过极化火", + "D": "精亏血少，阴虚阳亢", + "E": "外感暑热阳邪" + }, + "answer": "E", + "reason": "火热内生的机制:①阳气过盛化火四邪郁化火;③五志过极化火;①阴虚火旺。外感暑裁阳邪为外感。" + }, + { + "question_num": 78, + "query": "慢性肾功能衰竭酸中毒患者静脉滴注碳酸氢钠后手足搐搦，常由什么原因引起", + "options": { + "A": "高血钠而脑水肿", + "B": "低钾血症", + "C": "血中游离钙降低", + "D": "血中结合钙降低", + "E": "血钙总量降低" + }, + "answer": "C", + "reason": "慢性肾衰竭酸中毒患者，如果血中游离钙降低，静脉滴注碳酸氢钠后会出现手足搐搦。" + }, + { + "question_num": 79, + "query": "下列哪项不是眩晕肝阳上亢证的主症", + "options": { + "A": "头痛", + "B": "面赤", + "C": "烦躁", + "D": "口苦", + "E": "乏力" + }, + "answer": "E", + "reason": "眩晕肝阳上亢证。主症:有眩晕,耳鸣,头目胀痛,口苦,失眠多梦,遇烦劳、郁既而加重,甚则仆倒,颜面潮红,急躁易怒,肢麻震颤,舌红苔黄,脉弦或数。" + }, + { + "question_num": 80, + "query": "下列各项，不属下肢丹毒防护要点的是", + "options": { + "A": "患者应卧床休息", + "B": "患者所用敷料、器械须严格消毒", + "C": "积极治疗脚湿气", + "D": "多饮开水，床边隔离", + "E": "保持患肢下垂位，以防热毒上攻" + }, + "answer": "E", + "reason": "患者应卧床休息,多饮开水,床边隔离。流火患者应抬高患肢,有皮肤黏脱破损者，应及时治疗,以免感染毒邪。因脚湿气致下肢复发性丹毒患者，应彻底治愈脚湿气。" + }, + { + "question_num": 81, + "query": "下列关于五脏所藏的叙述，错误的是", + "options": { + "A": "心藏神", + "B": "肝藏魂", + "C": "肺藏魄", + "D": "脾藏意", + "E": "肾藏智" + }, + "answer": "E", + "reason": "素问·宣明五气篇》:“心藏神，藏魄,肝藏魂,脾藏意,肾藏志。”" + }, + { + "question_num": 82, + "query": "下列哪种病变通常不出现蛋白尿", + "options": { + "A": "化脓性扁桃体炎引起的高热", + "B": "高血压病（3级）", + "C": "妊娠中毒症", + "D": "缺血性心脏病（心绞痛发作时）", + "E": "慢性右心功能不全" + }, + "answer": "D", + "reason": "病理性蛋白尿见于：①肾脏疾病，如肾小球肾炎、肾病综合征、肾盂肾炎、肾结核、肾肿瘤等；②继发性肾损害，如糖尿病肾病、狼疮肾病等；③肾外疾病，如发热、高血压、妊娠中毒、心功能不全等。" + }, + { + "question_num": 83, + "query": "真心痛寒凝心脉的主治方剂是", + "options": { + "A": "保元汤", + "B": "血府逐瘀汤", + "C": "四逆汤", + "D": "当归四逆汤", + "E": "四逆加人参汤" + }, + "answer": "D", + "reason": "真心痛之寒凝心脉,证候主症:胸痛彻背,胸闷气短,心悸不宁,神疲乏力,形寒肢冷,舌质淡黯,舌苔白腻，脉沉无力,迟缓或结代。证机概要:阴寒凝滞,心阳痹阻,心脉闭塞。治法:温补心阳,散寒通脉。代表方:当归四逆汤加味。" + }, + { + "question_num": 84, + "query": "乳痈初起，证属肝气不舒，胃热壅滞。内治应首选", + "options": { + "A": "逍遥散", + "B": "透脓散", + "C": "四妙汤", + "D": "瓜蒌牛蒡汤", + "E": "牛蒡解肌汤" + }, + "answer": "D", + "reason": "情志内伤,肝气郁结,郁久化热,加之产后恣食厚味,胃内积热,以致肝胃蕴热,气血凝滞，乳络阻塞,不通则痛,故乳房肿胀疼痛有块;毒热内蕴，故患侧乳房皮肤微红;邪热内盛，正邪相争,营卫失和，治法应为疏肝清胃,通乳消肿。方药瓜牛蒡汤。" + }, + { + "question_num": 85, + "query": "归经的理论基础是", + "options": { + "A": "阴阳学说", + "B": "五行学说", + "C": "运气学说", + "D": "整体观念", + "E": "脏腑经络理论" + }, + "answer": "E", + "reason": "归经的理论基础是脏腑经络理论，" + }, + { + "question_num": 86, + "query": "嗜酸性粒细胞减少见于的疾病是", + "options": { + "A": "荨麻疹", + "B": "哮喘", + "C": "伤寒", + "D": "湿疹", + "E": "血吸虫病" + }, + "answer": "C", + "reason": "嗜酸性粒细胞减少的临床意义。嗜酸性粒细胞减少主要见于长期应用肾上腺皮质激素和某些传染病（伤寒）的极期，故选C，而其余四种疾病均是引起嗜酸性粒细胞增多的常见疾病。" + }, + { + "question_num": 87, + "query": "下列哪项除外,均为鼓胀的主要特征", + "options": { + "A": "腹大如鼓", + "B": "四肢枯瘦", + "C": "皮色苍黄", + "D": "胁下或腹部痞块", + "E": "下肢水肿" + }, + "answer": "E", + "reason": "鼓胀主要为肝、脾、肾受损,气、血、水互结于腹中,以腹部胀大为主,四肢肿不其明显,其临床以腹大胀满如鼓,皮色苍黄,脉络显露为特征。" + }, + { + "question_num": 88, + "query": "乳岩的特点是", + "options": { + "A": "乳块肿痛，皮色微红，按后痛甚", + "B": "乳块皮肉相连，溃破脓稀薄", + "C": "乳块呈卵圆形，表面光滑，推之活动", + "D": "乳块质地较软，月经后缩小", + "E": "肿块高低不平，质硬，推之不动" + }, + "answer": "E", + "reason": "乳岩,多发于40~60岁的妇女,肿块多为单发,边缘不整齐,活动度差,常与皮肤粘连,质地坚硬,表面高低不平,病情发展迅速，晚期患部皮肤呈典型橘皮样改变,肿块溃破后呈菜花样,时流血水，其味恶臭,同侧腋窝淋巴结肿大坚硬,故选E。A项是乳痈的表现，B项是乳痨的表现，C项是乳核的表现，D项是乳癖的临床表现。" + }, + { + "question_num": 89, + "query": "推动人体生长发育及脏腑功能活动的气是", + "options": { + "A": "元气", + "B": "宗气", + "C": "营气", + "D": "卫气", + "E": "中气" + }, + "answer": "A", + "reason": "元气,是人体生命活动的原动力:气,是积于胸中的后天宗始之气;营气,是与血共同于脉中之气;卫气,运行于脉外,起护卫、保卫作之气。" + }, + { + "question_num": 90, + "query": "可出现发热伴眼结膜充血的是", + "options": { + "A": "尿路感染", + "B": "支气管肺炎", + "C": "流感", + "D": "麻疹", + "E": "肠炎" + }, + "answer": "D", + "reason": "发热伴结膜充血常见于麻疹、流行性出血热、斑疹伤寒、钩端螺旋体病等。" + }, + { + "question_num": 91, + "query": "肺胀痰浊壅肺证的治法是", + "options": { + "A": "化痰降气,健脾益肺", + "B": "清肺化痰,降逆平喘", + "C": "温肾健脾,化饮利水", + "D": "补肺纳肾,降气平喘", + "E": "以上均非" + }, + "answer": "A", + "reason": "痰浊壅肺证,证候主症:胸部膨满，憋闷如塞,短气喘息,稍劳即著,咳嗽痰多,色白黏腻或呈泡沫,畏风易汗,朊痞纳少,倦怠乏力,舌暗,苔薄腻或浊腻,脉小滑。证机概要:肺虚脾弱,痰浊内蕴,肺失宣降。治法:化痰降气,健脾益肺。" + }, + { + "question_num": 92, + "query": "气瘿的内治法是", + "options": { + "A": "理气解郁，化痰软坚", + "B": "化痰软坚，开郁行瘀", + "C": "疏肝理气，解郁消肿", + "D": "疏风清热，化痰散结", + "E": "疏肝健脾，化痰散结" + }, + "answer": "C", + "reason": "情志不畅,肝郁气滞,肝失调达,脾失健运,水湿停留,聚而为痰,痰气互凝,结于颈靥,故颈粗瘿肿;气本无形,怒则气长,喜则气消,故肿胀呈弥没性而边界不清,遂成本病,故首先疏肝然后消肿。" + }, + { + "question_num": 93, + "query": "在十二经脉走向中，足之三阴是", + "options": { + "A": "从脏走手", + "B": "从头走足", + "C": "从足走胸", + "D": "从足走腹", + "E": "从手走头" + }, + "answer": "D", + "reason": "手之三阴,从胸走手;手之三阳,手走头:足之三阳,从头走足;足之三阴,从足走腹。" + }, + { + "question_num": 94, + "query": "下列哪项是支气管哮喘呼吸困难的类型", + "options": { + "A": "呼气性", + "B": "吸气性", + "C": "混合性", + "D": "阵发性", + "E": "腹式呼吸消失" + }, + "answer": "A", + "reason": "呼气性呼吸困难，病变在小支气管。表现为呼气困难，呼气相对延长，伴哮鸣音。见于支气管哮喘及其他慢性阻塞性肺病。" + }, + { + "question_num": 95, + "query": "癫狂的主要病理因素不包括", + "options": { + "A": "痰", + "B": "火", + "C": "气", + "D": "療", + "E": "寒" + }, + "answer": "E", + "reason": "癫狂的病理因素以气、痰、火、瘀为主,四者有因果兼夹的关系,且多以气郁为先。" + }, + { + "question_num": 96, + "query": "最易发生走黄的疔疮发生的部位是", + "options": { + "A": "项后", + "B": "四肢", + "C": "颜面", + "D": "少腹", + "E": "背部" + }, + "answer": "C", + "reason": "凡是疗疮,均可发展为走黄,然颜面部疔疮因其所生之处经脉众多，又为诸阳所聚之地;烂疔因其病势急暴,化腐甚巨,故尤易发生走黄。" + }, + { + "question_num": 97, + "query": "《素问·生气通天论》说“大骨气势，短肌，心气抑”是由", + "options": { + "A": "味过于酸所致", + "B": "味过于苦所致", + "C": "味过于甘所致", + "D": "味过于辛所致", + "E": "味过于咸所致" + }, + "answer": "E", + "reason": "素问·生气通天论》说:“味过酸,肝气以津,脾气乃绝;味过于咸,大骨气劳,短肌,气抑;味过于甘,心气喘满,色黑,肾气不衡;味过于苦,脾气不濡,胃气乃厚;味过于辛,筋脉沮弛,精神乃央。”" + }, + { + "question_num": 98, + "query": "肺部叩诊出现实音应考虑的疾病是", + "options": { + "A": "肺炎", + "B": "胸膜炎", + "C": "肺空洞", + "D": "肺气肿", + "E": "大量胸腔积液" + }, + "answer": "E", + "reason": "大量胸腔积液肺组织被压缩，叩诊可呈实音。" + }, + { + "question_num": 99, + "query": "下列哪一项不属于内伤发热的诊断要点", + "options": { + "A": "起病缓慢,病程长", + "B": "多为低热", + "C": "多为高热", + "D": "自觉发热,体温并不高", + "E": "有反复发热史" + }, + "answer": "C", + "reason": "内伤发热是指以内伤为病因,脏腑功能失调,气、血、阴、阳失衡为基本病机,以发热为主要临床表现的病证。一般起病较缓,病程较长,热势轻重不一,但以低热为多,或自觉发热而体温并不升高。" + }, + { + "question_num": 100, + "query": "乳痈切开排脓的切口应该是", + "options": { + "A": "切口尽量大", + "B": "切口宜高", + "C": "纵切口", + "D": "横切口", + "E": "按乳络方向" + }, + "answer": "E", + "reason": "应按乳络方向切口。避免损伤乳腺导管。" + }, + { + "question_num": 101, + "query": "天癸的产生主要取决于", + "options": { + "A": "肾中精气的充盈", + "B": "脾气的健运", + "C": "肾阳的蒸化", + "D": "肝血的充足", + "E": "肾阴的滋养" + }, + "answer": "A", + "reason": "“女子七岁,肾气盛,齿更发长。二七而天癸至,任脉通,太冲脉盛,月事以时下,故有子。”\"丈夫……二八,肾气盛,天至,精气溢泻,阴阳和,故能有子……\"故肾中精气的充盈,发育到一定程度产生天癸。" + }, + { + "question_num": 102, + "query": "下列除哪项外，常可引起肝细胞性黄疸", + "options": { + "A": "疟疾", + "B": "急性甲型肝炎", + "C": "中毒性肝炎", + "D": "钩端螺旋体病", + "E": "肝癌" + }, + "answer": "A", + "reason": "能够导致肝细胞广泛损害的疾病均可发生黄疸，如病毒性肝炎、肝硬化、钩端螺旋体病、败血症、中毒性肝炎等。" + }, + { + "question_num": 103, + "query": "血厥实证的主治方剂是", + "options": { + "A": "补阳还五汤", + "B": "羚角钩藤汤", + "C": "复元活血汤", + "D": "生化汤", + "E": "失笑散" + }, + "answer": "B", + "reason": "血厥实证,证候主症:多因急躁恼怒而发,突然昏倒,不知人事,牙关紧闭,面赤唇紫,舌黯红,脉弦有力。证机概要:怒而气上,血随气升,瘀阻清窍。治法:平肝潜阳,理气通瘀。代表方:羚角钓藤汤或通瘀煎加减。" + }, + { + "question_num": 104, + "query": "治疗失荣阴毒结聚证，应首选", + "options": { + "A": "和营散坚丸", + "B": "柴胡清肝汤", + "C": "桃红四物汤", + "D": "阳和汤", + "E": "二陈汤" + }, + "answer": "D", + "reason": "治疗失荣阴毒结聚证,治宜温阳散寒,化痰散结,方药选用阳和汤加减。" + }, + { + "question_num": 105, + "query": "下列七情致病影响脏腑气机的表述，不准确的是", + "options": { + "A": "思则气结", + "B": "恐则气乱", + "C": "怒则气上", + "D": "喜则气缓", + "E": "悲则气消" + }, + "answer": "B", + "reason": "怒则气上,喜则气缓,悲则气消,恐则气下,寒则气收,惊则气乱,劳则气耗,思则气结。" + }, + { + "question_num": 106, + "query": "正常人呼吸与脉搏之比为", + "options": { + "A": "1:1", + "B": "1:2", + "C": "1:3", + "D": "1:4", + "E": "1:5" + }, + "answer": "D", + "reason": "正常人呼吸运动的频率和节律正常16～18次/分，与脉搏之比为1:4，节律均匀而整齐。" + }, + { + "question_num": 107, + "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、、三焦", + "E": "肺、脾、肝、小肠" + }, + "answer": "A", + "reason": "小便的通畅,有赖于痛和膀胱的气化。从脏腑之间的整体关系来看,水液的吸收、运化、排泄都有赖于三焦的气化和肺、脾、肾的通调、转输、蒸化。" + }, + { + "question_num": 108, + "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,故又称肛窦炎，肛隐窝炎常并发肛乳头炎和肛乳头肥大，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": 109, + "query": "七情刺激，易导致心神涣散的是", + "options": { + "A": "喜", + "B": "怒", + "C": "悲", + "D": "恐", + "E": "惊" + }, + "answer": "A", + "reason": "喜则气缓,是指过度喜乐伤心,导致心气涣散不收。" + }, + { + "question_num": 110, + "query": "方颅可见于", + "options": { + "A": "呆小症", + "B": "先天性梅毒", + "C": "脑膜炎", + "D": "脑积水", + "E": "小儿营养不良" + }, + "answer": "B", + "reason": "呆小病：小儿同时伴有智力障碍（痴呆症）。先天性梅毒：方颅。脑积水：巨颅。CE项的头颅几乎为正常。" + }, + { + "question_num": 111, + "query": "脑瘤痰瘀阻窍证的主治方剂是", + "options": { + "A": "复元活血汤", + "B": "通窍活血汤", + "C": "血府逐瘀汤", + "D": "大定风珠", + "E": "二陈汤" + }, + "answer": "B", + "reason": "脑瘤痰瘀阻窍证,证候主症:���晕头痛,项强,目眩,视物不消,呕吐,失眠健忘,肢体麻木，面唇暗红或紫暗,舌质紫暗或有瘀点、瘀斑,脉涩。证机概要:痰瘀互结,闭阻清窃。治法:息风化痰,祛瘀通窍，代表方:通窍活血汤加减。" + }, + { + "question_num": 112, + "query": "临床治疗子痰初起，常选用的方剂是", + "options": { + "A": "透脓散加减", + "B": "橘核丸加减", + "C": "阳和汤加减", + "D": "黄连解毒汤加减", + "E": "滋阴除湿汤加减" + }, + "answer": "C", + "reason": "浊痰凝结见于初起硬结期。肾子处酸胀痛,附舉硬结,子系呈条索状肿硬;无明显全身症状;苔薄,脉滑。辨证分析:肝肾亏损,脉络空虚，浊痰乘虚下注,结于肾子,脉络不通,故肾子处酸胀隐痛,附睾硬结,子系呈条索状肿硬;病属初起,仅在局部,故多无全身症状;苔薄、脉滑为浊痰凝结之象。治法宜温经通络,化痰散结。方药阳和汤加减。" + }, + { + "question_num": 113, + "query": "湿邪最易困阻的是", + "options": { + "A": "心阳", + "B": "肺气", + "C": "脾阳", + "D": "肝阳", + "E": "肾气" + }, + "answer": "C", + "reason": "湿为阴邪,易伤脾阳,因为脾性喜燥而恶湿,脾阳为湿邪所遏,则可能导致脾气不能正常运化而气机不畅,临床可见脘腹胀满,食欲不振,大便稀溏,四肢不温。" + }, + { + "question_num": 114, + "query": "下列关于血尿素氮的改变及临床意义的叙述，正确的是", + "options": { + "A": "上消化道出血时，血尿素氮减少", + "B": "大面积烧伤时，血尿素氮减少", + "C": "严重的肾盂肾炎，血尿素氮减少", + "D": "血尿素氮对早期肾功能损害的敏感性强", + "E": "血尿素氮对早期肾功能损害的敏感性差" + }, + "answer": "D", + "reason": "血尿素氮的改变见于多种肾脏疾病，肾外因素也可以影响血尿素氮。上消化道大出血，大面积烧伤时，严重的肾盂肾炎时，血尿素氮均升高，排除ABC。急性肾衰竭肾功能轻度受损时，尿素氮可无变化，肾小球滤过率下降至50以下，尿素氮才能升高，排除E。" + }, + { + "question_num": 115, + "query": "下列哪项不是痰饮病的常见病因", + "options": { + "A": "外感寒湿", + "B": "饮食所伤", + "C": "情志失调", + "D": "劳欲所伤", + "E": "久病体虚,年高体弱" + }, + "answer": "C", + "reason": "痰饮病因。外感寒湿,饮食所伤,劳欲所伤,久病体虚,年高体弱都可以影响肺,脾、肾三脏功能1而形成羔饮,都是羔詹形成的常见病因,而情志失调与痰饮形成无直接关联。" + }, + { + "question_num": 116, + "query": "脱疽的主要病因病理是", + "options": { + "A": "脾气不健，肝肾不足，寒湿侵袭，凝滞脉络", + "B": "湿热蕴结，寒湿外侵，气血瘀滞，脉络滞塞", + "C": "湿热下注，气血壅滞，经络阻隔，脉络瘀滞", + "D": "肝肾不足，气血两亏，络脉闭阻，筋骨失养", + "E": "情志郁结，气滞血瘀，脉络闭阻，筋脉失养" + }, + "answer": "A", + "reason": "脱疽主要由于脾气不健,肾阳不足,又加上外受寒冻,寒湿之邪人侵而发病。它与湿热、情志无关,故首先排除BCE。" + }, + { + "question_num": 117, + "query": "在奇经八脉中，其循行多次与手、足三阳经及阳维脉交会的是", + "options": { + "A": "冲脉", + "B": "任脉", + "C": "督脉", + "D": "阴维脉", + "E": "阳跷脉" + }, + "answer": "C", + "reason": "冲脉为十二经之海;任脉为阴脉之海;督脉为阳脉之海:阴维脉有维系、联络全身阴经的作用:阳跷脉,有交通一身阳气和调节肢体肌肉运动的作用,其循行多次与手、足三阳经及阳维脉交会的是督脉。" + }, + { + "question_num": 118, + "query": "反映左、右心房电激动过程的是", + "options": { + "A": "P波", + "B": "P-R间期", + "C": "QRS波群", + "D": "ST段", + "E": "T波" + }, + "answer": "A", + "reason": "P波为心房除极波，反映左、右心房除极过程中的电位和时间变化；P-R间期反映激动在房室交界及以后的传导过程；QRS为左、右心室除极的总总称；ST段反映心室早期缓慢复极的电位时间变化；T波为左、右心室除极与复极的全过程。" + }, + { + "question_num": 119, + "query": "黄汗的病机特点为", + "options": { + "A": "肺卫不固", + "B": "营卫不和", + "C": "阴虚火旺", + "D": "气阴两虚", + "E": "湿闭阳郁" + }, + "answer": "E", + "reason": "黄汗的病机是由于湿热内蕴引起，故选E,其余的答案都是自汗.盗汗的病机。" + }, + { + "question_num": 120, + "query": "有头疽患者若伴有消渴病，最易出现的变证是", + "options": { + "A": "走黄", + "B": "内陷", + "C": "失荣", + "D": "肺痈", + "E": "颈痈" + }, + "answer": "B", + "reason": "老年有头疽患者多发,尤其是消渴病患者,易出现内陷之证。" + }, + { + "question_num": 121, + "query": "与津液代谢关系最密切的脏腑是", + "options": { + "A": "脾胃肝", + "B": "肝胆肾", + "C": "肝肺脾", + "D": "肺肾脾", + "E": "心肾肺" + }, + "answer": "D", + "reason": "津液输布主要依靠肺、脾、肝、肾和三焦这五个脏相互协调配合来完成的。肺主宣发、肃降,通调水道;脾可输布津液;肝主疏泄,调畅气机,气行则水行:肾主水,可主持和调节人体津液代谢;三焦为水液运行的通路。津液的排泄主要与肺的宣发功能、脾的运化功能以及肾中阳气的气化作用相关。综上,可以看出,津液的代谢,虽与多个脏腑的生理功能有关,但是最为密切的是肺、脾、肾三脏。】" + }, + { + "question_num": 122, + "query": "关于结核病的呼吸系统症状，下列哪项正确", + "options": { + "A": "约1/2的患者有不同程度的咯血", + "B": "痰中带血可因空洞中血管瘤破裂造成", + "C": "炎症波及壁层胸膜时可出现剧烈胸痛", + "D": "咯血后发热持续不退，提示有结核病播散", + "E": "一般无急骤出现的呼吸困难" + }, + "answer": "D", + "reason": "结核病的临床表现。关于结核病的常见症状，一般约1/3的患者有不同程度的咯血，痰中带血多因炎性病灶的毛细血管扩张所致，而中等量以上咯血是由于空洞中血管瘤破裂造成，如损伤血管或合并支气管扩张时可发生大咯血，甚至出现血块阻塞大气道而发生急骤性呼吸困难、窒息。当病变累及壁层胸膜时，可出现相应胸壁刺痛，一般多不剧烈。根据上述分析ABCE项所列的症状描述都是不正确的。临床上显示，当咯血后发热持续不退，提示有结核病播散，应注意加强观察。" + }, + { + "question_num": 123, + "query": "麻杏石甘汤适宜治疗喘证的", + "options": { + "A": "风寒壅肺证", + "B": "痰热郁肺证", + "C": "表寒肺热证", + "D": "痰浊阻肺证", + "E": "肺气郁痹证" + }, + "answer": "C", + "reason": "喘证之表寒肺热证,证候主症:喘逆上气,胸胀或痛,息粗,鼻扇,咳而不爽,吐痰稠黏,伴形寒,身热,烦闷,身痛,有汗或无汗,口渴,舌苔薄白或黄,舌边红,脉浮数或滑。治法:解表消里,化痰平喘。代表方:麻杏石甘汤加味。" + }, + { + "question_num": 124, + "query": "关于新产后和哺乳期的生理特点，以下哪一项是错误的", + "options": { + "A": "有恶露的排出，一月左右干净", + "B": "有轻度发热、自汗等阴虚阳旺症状", + "C": "小腹轻微阵痛", + "D": "产后30分钟即可开始喂乳", + "E": "生理性闭经" + }, + "answer": "A", + "reason": "产褥期的生理特点:产后气血骤虚因此新产后可有微热、多汗等阴虚阳浮的症状。产后数日内,子官在复原过程中有阵缩,故小腹常有轻微阵痛。从子宫经阴道不断有余血浊液流出,称为“恶露”恶露先是暗红色的血液，以后血液逐渐由深变浅，其量也由多变少,无臭味,一般3周内干净。顺产者,产后30分钟即可开始哺乳。哺乳时间以8个月为宜。乳期,气血上化为乳汁，一般无月经来潮，称为生理性闭经。" + }, + { + "question_num": 125, + "query": "五味中入肺的是", + "options": { + "A": "酸", + "B": "苦", + "C": "甘", + "D": "辛", + "E": "咸" + }, + "answer": "D", + "reason": "“五味人五脏”,酸味人肝,苦味人心,甘味人脾,辛味人肺,咸味入肾。" + }, + { + "question_num": 126, + "query": "在我国，慢性二尖瓣关闭不全的最常见病因是", + "options": { + "A": "风湿性心脏病", + "B": "结缔组织病", + "C": "二尖瓣黏液样变性", + "D": "感染性心内膜炎", + "E": "二尖瓣先天异常" + }, + "answer": "A", + "reason": "慢性二尖瓣关闭不全的病因。在我国，风湿性心脏病是慢性二尖瓣关闭不全的最常见病因。" + }, + { + "question_num": 127, + "query": "外感咳嗽与内伤咳嗽的鉴别,无意义的是", + "options": { + "A": "病情的缓急", + "B": "病程的长短", + "C": "咳嗽声的高低", + "D": "疾病的新久", + "E": "疾病的虚实" + }, + "answer": "C", + "reason": "外感咳嗽,多为新病,起病急,病程短,常伴恶寒、发热、头痛等肺卫表证。内伤咳嗽,多为久病,常反复发作,病程长,可伴他脏病证。" + }, + { + "question_num": 128, + "query": "导致妇产科疾病的最重要病理机制是", + "options": { + "A": "脏腑功能失常", + "B": "气分病变", + "C": "直中", + "D": "血分病变", + "E": "冲任损伤" + }, + "answer": "E", + "reason": "妇科疾病的病因病机。脏腑功能失常、气血病变、胞宫损伤均可导致妇产科疾病；但妇产科疾病的病理机制与其他各科的区别，就在于妇产科病机直接或间接地损伤冲、任、督、带。" + }, + { + "question_num": 129, + "query": "下列贝类药，不具有制酸止痛的作用的药物是", + "options": { + "A": "瓦楞子", + "B": "海蛤壳", + "C": "石块明", + "D": "牡蛎", + "E": "乌贼骨" + }, + "answer": "C", + "reason": "石决明的功效。石决明有平肝潜用,清肝明目作用,但无制酸止痛功效，余药皆有此作用。" + }, + { + "question_num": 130, + "query": "中枢性瘫痪的特点是", + "options": { + "A": "肌张力降低", + "B": "腱反射减弱", + "C": "浅反射消失", + "D": "不出现病理反射", + "E": "肌张力增强" + }, + "answer": "E", + "reason": "中枢性瘫痪的特点：上运动神经元瘫痪，大脑皮质运动区或锥体束受损，引起对侧肢体单瘫或偏瘫，表现为瘫痪肌肉张力增高-折刀样、腱反射亢进、浅反射消失、出现病理反射，瘫痪肌肉不萎缩。" + }, + { + "question_num": 131, + "query": "肺痈,溃脓期的治法是", + "options": { + "A": "排脓解毒", + "B": "清肺解毒", + "C": "化瘀消痈", + "D": "清肺化痰", + "E": "以上均非" + }, + "answer": "A", + "reason": "了肺痈,溃脓期,证侯主症:咳吐大量浓痰,或如米粥,或痰血相兼,腥臭异常,有时咯血,胸中烦满而痛,甚则气喘不能卧,身热面赤,烦渴喜饮,舌营黄腻,舌质红,脉滑数或数实。治法:排脓解毒。" + }, + { + "question_num": 132, + "query": "固经丸治疗经期延长的适应证是", + "options": { + "A": "气虚证", + "B": "虚热证", + "C": "湿热证", + "D": "血虚证", + "E": "肾虚证" + }, + "answer": "B", + "reason": "经期延长虚热证治法:养阴清热止血。方药:两地汤合二至丸、四乌贼骨一芦茹丸或固经丸。" + }, + { + "question_num": 133, + "query": "生姜配伍生南星，可降低生南星的毒性，属于", + "options": { + "A": "相须", + "B": "相使", + "C": "相畏", + "D": "相杀", + "E": "相反" + }, + "answer": "D", + "reason": "相杀是指一种药物能减轻或消除另一种药物的毒性或副作用。" + }, + { + "question_num": 134, + "query": "流行性乙型脑炎患者的最主要的死因是", + "options": { + "A": "高热", + "B": "意识障碍", + "C": "颅内高压", + "D": "呼吸衰竭", + "E": "惊厥或抽搐" + }, + "answer": "D", + "reason": "呼吸衰竭是流行性乙型脑炎最严重的表现之一，也是最主要的死亡原因。" + }, + { + "question_num": 135, + "query": "汗证邪热郁蒸证的主治方剂是", + "options": { + "A": "龙胆泻肝汤", + "B": "清胆汤", + "C": "泻白散", + "D": "玉屏风散", + "E": "以上均非" + }, + "answer": "A", + "reason": "汗证邪热郁蒸证的主症:蒸蒸汗出，汗黏,汗液易使衣服黄染,面赤烘热,烦躁,口苦,小便色黄,舌苔薄黄,脉象弦数。证机概要:湿热内蕴,逼津外泄。治法:清肝泄热,化湿和营。代表方:龙胆泻肝汤加减。" + }, + { + "question_num": 136, + "query": "治疗经间期出血血瘀证，应首选的方剂是", + "options": { + "A": "少腹逐瘀汤", + "B": "桂枝茯苓丸", + "C": "逐瘀止血汤", + "D": "桃红四物汤", + "E": "血府逐瘀汤" + }, + "answer": "C", + "reason": "经间期出血血瘀证治法:化瘀止血。代表方:逐瘀止血汤。" + }, + { + "question_num": 137, + "query": "外感风寒或风热之邪，或痰湿壅肺，肺失宣肃，导致的音哑或失声，称为", + "options": { + "A": "子暗", + "B": "金破不鸣", + "C": "金实不鸣", + "D": "少气", + "E": "短气" + }, + "answer": "C", + "reason": "新病音哑或失声者,多属实证,多因外感风寒或风热袭肺,或痰湿肺,肺失清肃,邪闭清窍所致,即所谓“金实不鸣”。" + }, + { + "question_num": 138, + "query": "下列除哪项外，均可引起血清钾增高", + "options": { + "A": "急慢性肾功能衰竭", + "B": "静脉滴注大量钾盐", + "C": "严重溶血", + "D": "代谢性酸中毒", + "E": "代谢性碱中毒" + }, + "answer": "E", + "reason": "血清钾增高见于：①肾脏排钾减少，如急、慢性肾功能不全及肾上腺皮质功能减退等；②摄入或注射大量钾盐，超过肾脏排钾能力；③严重溶血或组织损伤，红细胞或组织中的大量钾释放入细胞外液；④组织缺氧或代谢性酸中毒时大量细胞内的钾转移至细胞外。" + }, + { + "question_num": 139, + "query": "首创六郁学说的医家是", + "options": { + "A": "张仲景", + "B": "巢元方", + "C": "朱丹溪", + "D": "虞抟", + "E": "叶天士" + }, + "answer": "C", + "reason": "《丹溪心法》将郁证列为一个专篇，提出气、湿、火、食、温、痰六郁之说。" + }, + { + "question_num": 140, + "query": "属心而络于胞中的经脉是", + "options": { + "A": "冲脉", + "B": "胞脉", + "C": "任脉", + "D": "督脉", + "E": "带脉" + }, + "answer": "B", + "reason": "ACD项皆起于胞中,E项带脉束腰一周。只有B项正确。" + }, + { + "question_num": 141, + "query": "丁香主治的病证是", + "options": { + "A": "蛔虫腹痛", + "B": "脚气肿痛", + "C": "阳虚外感", + "D": "胃寒呃逆", + "E": "寒湿痹痛" + }, + "answer": "D", + "reason": "丁香的功效:温中降逆,散寒止痛,温肾助阳。为胃寒呕逆之要药。" + }, + { + "question_num": 142, + "query": "慢性上腹痛，呕吐后缓解，可见于", + "options": { + "A": "胆石症", + "B": "反流性食管炎", + "C": "幽门梗阻", + "D": "慢性阑尾炎", + "E": "溃疡病" + }, + "answer": "C", + "reason": "腹痛特点包括部位、性质和缓解因素等，对诊断有帮助。幽门梗阻时，因食物难以通过幽门进入十二指肠，故食物堆积在胃内而引起上腹胀痛，当呕吐后会明显好转，特别是吐出隔夜食物更有诊断意义，故选C，其余疾病均与此不符。" + }, + { + "question_num": 143, + "query": "与痿证发病关系密切的脏腑是", + "options": { + "A": "肝、肾、脾、胃", + "B": "心、肝、肾、胃", + "C": "肝、肾、肺、", + "D": "心、肺、脾、胃", + "E": "心、脾、肾、胃" + }, + "answer": "C", + "reason": "萎证的病因。痿证病在肌肉筋脉，但病机关乎五脏,肝藏血主筋,肾藏精生髓,肺通调布散津液,胃游移生津,故痿证发生与肝、肾、肺、胃功能失调关系最密切。" + }, + { + "question_num": 144, + "query": "痛经的主要治疗原则是", + "options": { + "A": "调理冲任气血", + "B": "温经散寒", + "C": "行气活血", + "D": "补气养血", + "E": "清热除湿" + }, + "answer": "A", + "reason": "痛经的治疗以调理子官、冲任气血为主,遵循急则治其标,缓则治其本的原则。" + }, + { + "question_num": 145, + "query": "既治风寒表实无汗，又治风寒表虚有汗的药物是", + "options": { + "A": "麻黄", + "B": "紫苏", + "C": "桂枝", + "D": "香薷", + "E": "荆芥" + }, + "answer": "C", + "reason": "桂枝具有发汗解肌之功,倘若配伍得当,则既可以治疗风寒表实无汗,又治风寒表虚有汗。" + }, + { + "question_num": 146, + "query": "下列叙述不正确的是", + "options": { + "A": "长期慢性咳嗽——慢性支气管炎", + "B": "夜间咳嗽较明显——肺结核", + "C": "体位改变时咳嗽加剧——支气管扩张", + "D": "干性咳嗽——肺炎", + "E": "大量脓痰静置后出现分层现象——肺脓肿" + }, + "answer": "D", + "reason": "咳嗽的特点。干性咳嗽指咳嗽而无痰或痰量甚少；常见于急性咽喉炎与急性支气管炎的初期、胸膜炎、轻症肺结核、肺癌等。肺炎表现为湿性咳嗽，其他几项均正确。" + }, + { + "question_num": 147, + "query": "泄泻之内因,关键在", + "options": { + "A": "湿盛", + "B": "脾虚", + "C": "胃失和降", + "D": "肝郁", + "E": "肾虚" + }, + "answer": "B", + "reason": "外邪致泄以湿邪最为重要,其他诸多邪气需与湿邪兼夹,方易成泻;内因则以脾虚最为关键。" + }, + { + "question_num": 148, + "query": "与月经后期和月经过少的发病均有关的是", + "options": { + "A": "血热", + "B": "血虚", + "C": "血瘀", + "D": "血寒", + "E": "湿热" + }, + "answer": "B", + "reason": "月经后期的病因:肾虚、血虚、血寒、气滞。月经过少的病因为肾虚、血虚、血瘀、痰湿,故血虚为共同病因。" + }, + { + "question_num": 149, + "query": "下列解表药中兼有化湿和中功效的是", + "options": { + "A": "紫苏", + "B": "香薷", + "C": "生姜", + "D": "白芷", + "E": "防风" + }, + "answer": "B", + "reason": "紫苏解表散寒,行气宽中,解鱼蟹毒。香薷发汗解表,化湿和中,利水消肿。生姜解表散寒,温中止呕,温肺止咳,解毒。白芷解表散寒,祛风止痛,通鼻窍,燥湿止带,消肿排脓。防风祛风解表,胜湿止痛，止疼。" + }, + { + "question_num": 150, + "query": "有关高血压病的并发症，下列哪项不正确", + "options": { + "A": "心、脑、肾等器官是主要受累脏器", + "B": "眼底病变与高血压的严重程度直接有关", + "C": "恶性高血压以脑并发症最为突出", + "D": "脑卒中的发病率比心肌梗死高5倍左右", + "E": "高血压脑病症状出现可能与脑水肿有关" + }, + "answer": "C", + "reason": "高血压病的并发症。有关高血压病的脏器受累最主要为心、脑、肾，其中脑血管的并发症（脑卒中）的发病率可为心肌梗死的5倍左右；眼底的改变可反映高血压的严重程度；高血压脑病的发生机制可能为过高的血压突破脑血管自身的调节机制，使脑灌注过多，液体经血脑屏障漏出到血管周围脑组织导致脑水肿，故ABDE项的叙述是正确的。关于恶性高血压的发病机制尚不清楚，但主要的脏器病理损害以肾脏最为突出，而不是脑。" + }, + { + "question_num": 151, + "query": "湿热痢的治法为", + "options": { + "A": "清热解毒,凉血除积", + "B": "清肠化湿,调气和血", + "C": "温中燥湿,调气和血", + "D": "养阴和营,清肠化湿", + "E": "温补脾肾,收涩固脱" + }, + "answer": "B", + "reason": "湿热痢治法:消肠化湿、调气和血。代表方:芍药汤加减。" + }, + { + "question_num": 152, + "query": "下列哪项不是经期延长阴虚血热证的主症", + "options": { + "A": "月经持续8、9日，量少、色红、质稠", + "B": "小腹疼痛拒按", + "C": "咽干口燥", + "D": "手足心热", + "E": "舌红少苔，脉细数" + }, + "answer": "B", + "reason": "经期延长阴虚血热证是虚证，B项是实证表现,故选B。" + }, + { + "question_num": 153, + "query": "泽泻具有的功效是", + "options": { + "A": "泄热", + "B": "清肝", + "C": "健脾", + "D": "清肺", + "E": "解毒" + }, + "answer": "A", + "reason": "泽泻是利水消肿药,除具有利水消肿外,还能渗湿,泄热。" + }, + { + "question_num": 154, + "query": "下列药物，不能用于艾滋病治疗的是", + "options": { + "A": "齐多夫定", + "B": "双脱氧胞苷", + "C": "双脱氧肌苷", + "D": "阿糖腺苷", + "E": "拉米夫定" + }, + "answer": "D", + "reason": "目前抗HIV的药物可分为三大类：核苷类反转录酶抑制剂、非核苷类反转录酶抑制剂和蛋白酶抑制剂。核苷类反转录酶抑制剂包括齐多夫定、双脱氧胞苷、双脱氧肌苷、拉米夫定和司坦夫定等。" + }, + { + "question_num": 155, + "query": "下列哪项不是中风中经络的主症", + "options": { + "A": "语言不利", + "B": "半身不遂", + "C": "口眼喁斜", + "D": "不省人事", + "E": "手足拘挛" + }, + "answer": "D", + "reason": "不省人事\"居于中风中脏腑的症状。" + }, + { + "question_num": 156, + "query": "崩漏的治疗原则是", + "options": { + "A": "塞流与澄源结合", + "B": "澄源与复旧结合", + "C": "复旧与塞流结合", + "D": "固本与澄源结合", + "E": "急则治标，缓则治本" + }, + "answer": "E", + "reason": "治崩三法是“塞流”“澄源”“复旧”这三条要灵活运用,急则治标,缓则治本,故选E。" + }, + { + "question_num": 157, + "query": "不属于树脂类药材的是", + "options": { + "A": "乳香", + "B": "没药", + "C": "苏合香", + "D": "五倍子", + "E": "血竭" + }, + "answer": "D", + "reason": "五倍子的药材来源。五倍子为漆树科植物盐肤木或青麸杨等叶上寄生的虫瘿,余药皆属树脂类药材。" + }, + { + "question_num": 158, + "query": "流感抗病毒治疗首选的药物是", + "options": { + "A": "氯霉素", + "B": "糖皮质激素", + "C": "利巴韦林", + "D": "奥司他韦", + "E": "诺氟沙星" + }, + "answer": "D", + "reason": "奥司他韦是目前最为理想的抗病毒药物。" + }, + { + "question_num": 159, + "query": "不寐肝火扰心证，治宜", + "options": { + "A": "龙胆泻肝汤", + "B": "黄连温胆汤", + "C": "归脾汤", + "D": "黄连解毒汤", + "E": "温胆汤" + }, + "answer": "A", + "reason": "不寐之肝火扰心证,治法:疏肝泻火,镇心安神。代表方:龙胆泻肝汤加减。" + }, + { + "question_num": 160, + "query": "崩漏的主要病机是", + "options": { + "A": "阴虚火旺，经血失约", + "B": "气虚不摄，经血失约", + "C": "瘀血内阻，血不归经", + "D": "冲任损伤，经血失约", + "E": "阳盛血热，迫血妄行" + }, + "answer": "D", + "reason": "崩漏的主要病机是冲任不固,不能制约经血,使子官藏泻失常���" + }, + { + "question_num": 161, + "query": "下列清热解毒药中，兼有清肝明目功效的是", + "options": { + "A": "穿心莲", + "B": "秦皮", + "C": "白鲜皮", + "D": "熊胆", + "E": "马齿苋" + }, + "answer": "D", + "reason": "A项穿心莲清热解毒、凉血、消肿燥湿:B项秦皮清热解毒;C项白鲜皮可清热燥湿、祛风解毒:D项熊胆清热解毒、息风止痉、清肝明目;E项马齿苋可清热解毒、凉血止血、止痢。" + }, + { + "question_num": 162, + "query": "下列有关伤寒肥达反应的描述，正确的是", + "options": { + "A": "只要是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": "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O抗体效价在1∶80以下，H抗体效价在1∶160以上，才有诊断价值；有少数伤寒患者肥达反应始终呈阴性；伤寒与副伤寒有部分共同的O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；H抗体出现迟，可持续阳性数年；Vi抗体的检测可用于慢性带菌者的调查。" + }, + { + "question_num": 163, + "query": "以下哪项不是瘘证发病病机", + "options": { + "A": "肺热伤津,津液不布", + "B": "牌胃亏虚,精微不输", + "C": "湿热浸淫,气血不运", + "D": "风寒痹阻,经脉不通", + "E": "肾精不足,髓枯筋痿" + }, + "answer": "D", + "reason": "痿证的病因病机。痿证病因病机主要是肺热伤津,津伤不布;湿热浸淫,气血不运；胃亏虚,精微不输;肝肾亏损,髓枯筋瘘。风寒痹阻,经脉不通是痹证的病机。" + }, + { + "question_num": 164, + "query": "下列月经病中，除哪项外，均可由肝气郁结所致", + "options": { + "A": "经行身痛", + "B": "经行吐衄", + "C": "经行乳房胀痛", + "D": "经行浮肿", + "E": "经行头痛" + }, + "answer": "A", + "reason": "经行身痛是由于素体正气不足,营卫失调,筋脉失养,不荣而痛;或因素有寒湿留滞,经行时气血下注冲任,因寒凝血瘀,经脉阻滞,以致气血不通而身痛。" + }, + { + "question_num": 165, + "query": "具有养阴生津功效的药物是", + "options": { + "A": "生地黄", + "B": "牡丹皮", + "C": "赤芍", + "D": "紫草", + "E": "金银花" + }, + "answer": "A", + "reason": "生地黄清热凉血,养阴生津。牡丹皮清热凉血,活血祛瘀。赤芍清热凉血,散察止痛。紫草清热凉血,活血,解毒透疹。金银花清热解毒,疏散风热。" + }, + { + "question_num": 166, + "query": "有关肺炎型流感的临床表现，叙述不正确的是", + "options": { + "A": "多发生在2岁以下的小儿", + "B": "发病后24小时内出现高热", + "C": "应用抗菌药物无效", + "D": "两肺可有呼吸音减低", + "E": "肺实变体征" + }, + "answer": "E", + "reason": "肺炎型流感：较少见，可以由单纯型转为肺炎型，或直接表现为肺炎型，多发生在2岁以下的小儿，或原有慢性基础疾病者。特点是在发病后24小时内出现高热、烦躁、呼吸困难、咳血痰和明显紫绀，可进行性加重，应用抗菌药物无效，可因呼吸循环衰竭在5～10日内死亡。两肺可有呼吸音减低、湿啰音或哮鸣音，但无肺实变体征。" + }, + { + "question_num": 167, + "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、足临泣", + "D": "太冲、曲池", + "E": "太冲、阳溪" + }, + "answer": "B", + "reason": "牙齿与肾关系密切,因为肾主骨,齿为骨之余,肾阴不足,虚火上升可引起牙冰。治疗应以滋阴降火为主,取肾、肝经腧穴,有滋水涵木之效,太溪穴为肾经原穴,可以补肾阴:行间穴为肝经荥穴可以泻肝火,治疗肾虚型牙痛。" + }, + { + "question_num": 168, + "query": "下列哪项是肾气亏损证的主症", + "options": { + "A": "腹痛出现在行经之后", + "B": "腹痛喜按", + "C": "月经量少、色淡、质稀", + "D": "神疲乏力，纳少便溏", + "E": "头晕眼花，腰痛如折" + }, + "answer": "E", + "reason": "ABCD项均是痛经的主症，只有E项是肾气亏损证的主症，" + }, + { + "question_num": 169, + "query": "既能润肠通便，又能止咳平喘的药物是", + "options": { + "A": "知母", + "B": "杏仁", + "C": "决明子", + "D": "郁李仁", + "E": "火麻仁" + }, + "answer": "B", + "reason": "A项知母清热泻火、生津润燥:B项杏仁止咳平喘、润肠通便;C项决明子清热明目、润肠通便:D项郁李仁润肠通便、利水消肿;E项火麻仁润肠通便、滋养补虚。" + }, + { + "question_num": 170, + "query": "大脑中动脉血栓形成的“三偏征”的表现是", + "options": { + "A": "偏瘫、偏身感觉障碍、同向偏视", + "B": "偏瘫、偏盲、偏身感觉障碍", + "C": "偏盲、偏身感觉障碍、同侧偏瘫", + "D": "对侧偏瘫、偏身感觉障碍、网向偏盲", + "E": "交叉性偏瘫、偏视、偏身感觉障碍" + }, + "answer": "D", + "reason": "内囊一基底核出血（外侧型）可以出现三偏征，“三偏”征表现为偏瘫、偏身感觉障碍及偏盲。" + }, + { + "question_num": 171, + "query": "痿证与痹证的鉴别点，下列哪项最重要", + "options": { + "A": "肌肉是否瘦削枯萎", + "B": "关节是否肿大变形", + "C": "肢体关节是否屈伸不利", + "D": "肌肉筋骨关节有无疼痛", + "E": "肢体能否随意运动" + }, + "answer": "D", + "reason": "痿证与痹证的鉴别。痹证后期,由于肢体关节疼痛,不能运动,肢体长期废用,也有类似瘘证之瘦削枯萎者,但瘘证肢体关节一般不疼痛,而痹证则均有疼痛,故肌肉关节有无疼痛是鉴别痹证与痿证的关键。" + }, + { + "question_num": 172, + "query": "痛经寒湿凝滞证的治法是", + "options": { + "A": "理气化瘀止痛", + "B": "温经暖宫止痛", + "C": "温经活血，调经止痛", + "D": "温经除湿，化瘀止痛", + "E": "温经化痰，利湿止痛" + }, + "answer": "D", + "reason": "痛经寒湿凝滞证的治法是温经除湿，化瘀止痛,使寒散湿除，气血运行通畅，而痛经自止。" + }, + { + "question_num": 173, + "query": "具有燥湿健脾，祛风湿，发汗，明目功效的药物是", + "options": { + "A": "苍术", + "B": "厚朴", + "C": "藿香", + "D": "佩兰", + "E": "砂仁" + }, + "answer": "A", + "reason": "A项苍术燥湿健牌,祛风湿,发汗。明目:B项厚朴燥湿消痰,下气除满;C项香化湿解暑,发表止呕:D项佩兰化湿解磐:E项砂仁化湿行气温中止泻,安胎。" + }, + { + "question_num": 174, + "query": "临床上流感的潜伏期通常是", + "options": { + "A": "24小时内", + "B": "1～3日", + "C": "3～5日", + "D": "1～7日", + "E": "2周" + }, + "answer": "B", + "reason": "流感的潜伏期通常为1～3日。" + }, + { + "question_num": 175, + "query": "治疗胃痛,循经取穴可取", + "options": { + "A": "内关", + "B": "合谷", + "C": "足三里", + "D": "三阴交", + "E": "丰隆" + }, + "answer": "C", + "reason": "足三里穴是骨经腧穴,又是胃经下合穴,胃经脉循行是属骨络脾,胃经下合穴又可合治腑的病症,所以胃痛可循经取穴选足三里穴治疗。" + }, + { + "question_num": 176, + "query": "“子肠”是指", + "options": { + "A": "子宫", + "B": "输卵管", + "C": "阴道", + "D": "卵巢", + "E": "直肠" + }, + "answer": "C", + "reason": "阴道,又称子肠。“阴道”一词最早就是中医学中的固有解剖名称,且解剖位置与西医学一致。" + }, + { + "question_num": 177, + "query": "为治躁扰不宁，善于清泻三焦火邪的药物是", + "options": { + "A": "栀子", + "B": "决明子", + "C": "金银花", + "D": "夏枯草", + "E": "芦根" + }, + "answer": "A", + "reason": "栀子的功效有泻火除烦,清热利湿,凉血解毒。能清泻三焦火邪、泻心火除烦,为治热痛心烦、躁扰不宁之要药。" + }, + { + "question_num": 178, + "query": "有关人禽流感血常规及血生化检查的叙述，不正确的是", + "options": { + "A": "肝功能异常", + "B": "ALT升高", + "C": "外周血血小板增多", + "D": "亦可出现BUN的升高", + "E": "AST升高" + }, + "answer": "C", + "reason": "人禽流感血常规及血生化检查的结果：多数患者外周血白细胞、淋巴细胞和血小板不同程度减少；部分患者肝功能异常，表现为ALT、AST升高，亦可出现BUN的升高。" + }, + { + "question_num": 179, + "query": "治疗心悸,应首选", + "options": { + "A": "合谷", + "B": "尺泽", + "C": "内关", + "D": "太冲", + "E": "劳宫" + }, + "answer": "C", + "reason": "心包经腧穴主治心、胸、胃,神志病等。内关穴是心包经腧穴与奇经阴维脉相通,阴维脉可治疗心胸等疾患。因此治疗心悸应首选内关穴。E项虽是心包经腧穴,但主要功能是开窍泻热,清心安神和调阴阳,故不是最佳选择。" + }, + { + "question_num": 180, + "query": "身体无病，月经3个月一潮，称为", + "options": { + "A": "居经", + "B": "并月", + "C": "暗经", + "D": "激经", + "E": "避年" + }, + "answer": "A", + "reason": "居经又名季经,生理学名词，出《脉经》卷九,指妇女月经每三个月一行而无症状者,亦正常生理现象,不需治疗。并月是指月经规律性两月一至的特殊月经生理现象。暗经见《医宗金鉴·妇科心法要诀》,指妇女终身未见有月经来潮，但能正常孕育者。激经是指妇女受孕早期仍按月行经，既无不适症状,又无损于胎儿,俟胎儿渐长,其经自停,谓之“激经”，又称为“垢胎”“盛胎”等。古人虽言激经对胎孕无妨,但亦有不少孕妇可转化为流产，故应给予积极治疗。避年是指在身体正常情况下，月经频率为每年一次。" + }, + { + "question_num": 181, + "query": "组成内含生地黄、玄参、麦门冬的方剂是", + "options": { + "A": "炙甘草汤", + "B": "镇肝熄风汤", + "C": "一贯煎", + "D": "百合固金汤", + "E": "清瘟败毒饮" + }, + "answer": "D", + "reason": "百合固金汤的组成为生地黄、熟地黄、当归身、白芍、甘草、桔梗、玄参、贝母、麦门冬百合。" + }, + { + "question_num": 182, + "query": "下列关于艾滋病高危人群的说法，哪项是错误的", + "options": { + "A": "性工作者", + "B": "血友患者", + "C": "多次输血者", + "D": "50岁以上的人", + "E": "同性恋" + }, + "answer": "D", + "reason": "艾滋病易感人群：人群普遍易感。静脉注射吸毒者、性工作者、同性恋者、性乱者、血友病患者、多次接受输血或血制品者是感染的高危人群。" + }, + { + "question_num": 183, + "query": "阳经都穴主要用于治疗", + "options": { + "A": "脏病", + "B": "经脉病", + "C": "腑病", + "D": "痛证", + "E": "血证" + }, + "answer": "D", + "reason": "】郄穴是经脉之气深聚部位的腧穴。在临床上郄穴多用于治疗各经的急性病症。阳经郄穴主要用于治疗各种痛证。" + }, + { + "question_num": 184, + "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": "带下病的病因病机是湿邪伤及任带二脉,使任脉不固,带脉失约。" + }, + { + "question_num": 185, + "query": "治疗湿热淋证，宜选用", + "options": { + "A": "石韦", + "B": "大青叶", + "C": "板蓝根", + "D": "青黛", + "E": "山豆根" + }, + "answer": "A", + "reason": "石韦功效:利尿通淋,清肺止咳,凉血止血。用于湿热淋证,为清热利尿通淋常用药,尤宜于血淋。" + }, + { + "question_num": 186, + "query": "流行性出血热的临床五期经过顺序，正确的是", + "options": { + "A": "发热期、多尿期、低血压期、少尿期、恢复期", + "B": "发热期、低血压期、少尿期、多尿期、恢复期", + "C": "发热期、出血期、少尿期、多尿期、恢复期", + "D": "发热期、低血压期、多尿期、少尿期、恢复期", + "E": "发热期、出血期、低血压期、少尿期、恢复期" + }, + "answer": "B", + "reason": "流行性出血热典型者一般经过发热期、低血压休克期、少尿期、多尿期、恢复期五期。" + }, + { + "question_num": 187, + "query": "内关穴主治除哪项以外的病证", + "options": { + "A": "心悸,心痛", + "B": "小便不利,水肿", + "C": "胃痛,呃逆,呕吐", + "D": "失眠,疯狂,痫", + "E": "热病,疟疾" + }, + "answer": "B", + "reason": "内关的主治:心痛、心悸,胃痛、呕吐、呃逆,失眠、郁证,癫狂,热病,肘臂挛痛等。" + }, + { + "question_num": 188, + "query": "治疗性外阴、阴道冲洗，药液常用量是", + "options": { + "A": "100ml左右", + "B": "200ml左右", + "C": "300ml左右", + "D": "400ml左右", + "E": "500ml左右" + }, + "answer": "E", + "reason": "治疗性冲洗者,常用量为每次500ml,倾人阴道冲洗器具内,每天1~2次,连续冲洗至自觉症状消失。" + }, + { + "question_num": 189, + "query": "赤芍具有的功效是", + "options": { + "A": "凉血止血，杀虫", + "B": "凉血消斑，定惊", + "C": "凉血活血，退虚热", + "D": "凉血活血，解毒", + "E": "凉血活血，泻肝火" + }, + "answer": "E", + "reason": "赤芍苦泄,散瘀止痛力强,血滞诸证尤为多用,并���泻肝火,用于肝热目赤肿痛。" + }, + { + "question_num": 190, + "query": "下列各项，可在使用有效抗结核药物的同时，加用糖皮质激素的是", + "options": { + "A": "伴咯血", + "B": "空洞形成", + "C": "急性粟粒型肺结核", + "D": "干性胸膜炎", + "E": "抗结核药引起肝损伤" + }, + "answer": "C", + "reason": "急性粟粒型肺结核可在使用有效抗结核药物的同时，加用糖皮质激素。糖皮质激素在结核病的应用主要是利用抗炎、抗毒作用，仅用于结核毒性症状严重者。" + }, + { + "question_num": 191, + "query": "下列除哪项外,均是厥证的病因", + "options": { + "A": "情志内伤", + "B": "体虚劳倦", + "C": "亡血失津", + "D": "饮食不节", + "E": "盛受暑热" + }, + "answer": "E", + "reason": "引起厥证的病因主要有情志内伤、体虚劳倦.亡血失津、饮食不节等方面,其病机主要是气机突然逆乱,升降乖戾,气血阴阳不相顺接。" + }, + { + "question_num": 192, + "query": "妊娠恶阻的主要发病机制是", + "options": { + "A": "脾胃虚弱，化源不足", + "B": "肝郁气滞，失于条达", + "C": "痰湿内停，中焦受阻", + "D": "重伤津液，胃阴不足", + "E": "冲气上逆，胃失和降" + }, + "answer": "E", + "reason": "妊娠恶阻的病因病机为冲气上逆，胃失和降，" + }, + { + "question_num": 193, + "query": "桃仁与红花共同的功效是", + "options": { + "A": "活血祛瘀", + "B": "化瘀止血", + "C": "利尿消肿", + "D": "润肠通便", + "E": "止咳平喘" + }, + "answer": "A", + "reason": "桃仁活血祛察,润肠通便,止咳平喘。红花活血通经，祛察止痛，故它们的共同功效是活血化瘀。" + }, + { + "question_num": 194, + "query": "与流行性脑脊髓膜炎患者密切接触后的重要预防措施是", + "options": { + "A": "开窗通风", + "B": "隔离观察", + "C": "服用利福平", + "D": "注射青霉素", + "E": "菌苗预防注射" + }, + "answer": "C", + "reason": "流行性脑脊髓膜炎对密切接触者可服用磺胺甲唑预防，亦可用利福平。" + }, + { + "question_num": 195, + "query": "足大趾内侧趾甲根角旁约0.1寸的穴位是", + "options": { + "A": "隐白", + "B": "大敦", + "C": "厉兑", + "D": "至阴", + "E": "足临泣" + }, + "answer": "A", + "reason": "隐白定位:在足趾,大趾末节内侧，趾甲根角侧后方0.1寸(指寸)。" + }, + { + "question_num": 196, + "query": "下列哪一项可诊断为闭经", + "options": { + "A": "月经来潮后又中断3个月", + "B": "月经来潮后又中断7个月", + "C": "月经1年一行，无其他不适", + "D": "14周岁月经尚未来潮", + "E": "49周岁月经6个月余未来潮" + }, + "answer": "B", + "reason": "闭经的诊断。女子年逾16周岁,月经尚未来潮,或月经周期已建立后又中断6个月以上者,称“闭经”。“月经1年一行,无其他不适”为避年，为特殊的月经现象,不属疾病。“49周岁月经6个月余未来潮”属生理性闭经。" + }, + { + "question_num": 197, + "query": "治疗外感风热，咳嗽痰多，咽痛音哑，胸闷不舒者应首选", + "options": { + "A": "百部", + "B": "川贝母", + "C": "桔梗", + "D": "杏仁", + "E": "旋覆花" + }, + "answer": "C", + "reason": "A项百部润肺止咳:B项川贝母洁热化痰、润肺止咳;C项桔梗清化热痰、利咽排脓,治疗咳嗽痰多,胸闷不畅:D项杏仁止咳平喘:E项旋覆花降气化痰。" + }, + { + "question_num": 198, + "query": "人感染高致病性禽流感的主要传播途径是", + "options": { + "A": "消化道", + "B": "虫媒", + "C": "血液", + "D": "呼吸道", + "E": "体液传播" + }, + "answer": "D", + "reason": "传播途径主要经呼吸道传播，通过密切接触感染禽类及其分泌物、排泄物，受污染的水及直接接触病毒株被感染。" + }, + { + "question_num": 199, + "query": "位于腕背横纹桡侧,当拇短伸肌腱与拇长伸肌腱之间的凹陷中的穴位是", + "options": { + "A": "大陵", + "B": "太渊", + "C": "阳溪", + "D": "神门", + "E": "阳池" + }, + "answer": "C", + "reason": "阳溪穴定位:腕背横绕侧,当拇短伸肌腱与拇长伸肌腱之间的凹陷中。" + }, + { + "question_num": 200, + "query": "肾阳虚带下过多的主要证候，下列哪项是错误的", + "options": { + "A": "带下量多，清稀如水", + "B": "腰酸如折，畏寒肢冷", + "C": "小便清长，夜尿频繁，大便溏薄", + "D": "面色萎黄，四肢倦怠，纳少便溏", + "E": "舌淡苔白润，脉沉迟" + }, + "answer": "D", + "reason": "肾阳虚证带下过多的主证。肾阳虚衰,命门火衰,封藏失职,故带下量多,绵绵不断,清稀如水;腰为肾之府,肾虚而有腰酸如折;肾阳虚,阳气不能外达可有畏寒肢冷;肾阳虚不能上温脾阳,则大便溏薄;不能下暖膀胱,故小便清长,或夜尿频多;舌淡苔白润,脉沉迟亦为肾阳虚之征。面色萎黄,四肢倦怠,纳少便溏为脾虚征象。" + }, + { + "question_num": 201, + "query": "治疗风热郁闭，咽喉肿痛，大便秘结者，应首选", + "options": { + "A": "薄荷", + "B": "蝉蜕", + "C": "菊花", + "D": "蔓荆子", + "E": "牛蒡子" + }, + "answer": "E", + "reason": "“风热郁闭\"治宜疏风清热,\"咽喉肿痛”治宜利咽消肿，大便秘结”治宜通便。综合判断应选择具有潜肠和利明之功的疏散风热药。而牛劳子疏散风热,宣肺祛痰,利咽透疹,解毒散肿,故选E。薄荷疏散风热,清利头目,利咽透疹,疏肝行气。蝉蜕疏散风热,利明开音,透疹,明目退翳,息风止痉。二者都不具有滑肠之功。菊花疏散风热,平抑肝阳,清肝明目，清热解毒。蔓荆子疏散风热,清利头目。" + }, + { + "question_num": 202, + "query": "下列各项中，不属于流行性脑脊髓膜炎普通型临床分期的是", + "options": { + "A": "前驱期", + "B": "发热期", + "C": "败血症期", + "D": "脑膜炎期", + "E": "恢复期" + }, + "answer": "B", + "reason": "流行性脑脊髓膜炎普通型最常见，占全部病例的90％以上。分为前驱期（上呼吸道感染期）、败血症期、脑膜炎期和恢复期四期。" + }, + { + "question_num": 203, + "query": "肩胛部腧穴中,不属于手太阳小肠经的穴位有", + "options": { + "A": "曲垣", + "B": "天宗", + "C": "肩贞", + "D": "臑俞", + "E": "肩髎" + }, + "answer": "E", + "reason": "手太阳小肠经经脉腧穴:少泽、前谷、后溪、腕骨、阳谷、养老、支正,小海、肩贞、臑俞、天宗、乘风.曲垣、肩外俞、肩中俞、天窗、天容、颧髎、听宫,共19穴,左右合计38穴。肩髎穴属于手少阳三焦经。" + }, + { + "question_num": 204, + "query": "治疗产后发热血瘀证，应首选", + "options": { + "A": "小柴胡汤", + "B": "大柴胡汤", + "C": "桃红消瘀汤", + "D": "白虎汤", + "E": "生化汤加味" + }, + "answer": "E", + "reason": "产后发热感染邪毒证用五味消毒饮合失笑散或解毒活血汤;外感证用荆穗四物汤;血瘀证用生化汤加味;血虚证用补中益气汤;故选E,其余选项不正确。" + }, + { + "question_num": 205, + "query": "具有补肺益肾，纳气定喘功效的药物是", + "options": { + "A": "沉香", + "B": "磁石", + "C": "蛤蚧", + "D": "益智仁", + "E": "紫河车" + }, + "answer": "C", + "reason": "沉香行气止痛,温中止呕,纳气平喘，磁石镇惊安神,平肝潜阳,聪耳明目,纳气定喘蛤蚧补肺益肾,纳气定喘,助阳益精。益智仁暖肾固精缩尿,温脾开胃摄唾。紫河车补肾益精,养血益气。" + }, + { + "question_num": 206, + "query": "早期胃癌的定义为", + "options": { + "A": "癌肿小于1cm，无淋巴结转移", + "B": "癌肿小于2cm，无淋巴结转移", + "C": "癌浸润不超过黏膜下层，无论有无淋巴结转移", + "D": "癌浸润到肌层，无局部淋巴结转移", + "E": "癌浸润到黏膜层、黏膜下层及肌层" + }, + "answer": "C", + "reason": "早期胃癌的概念。早期胃癌的定义为癌浸润不超过黏膜下层，无论有无淋巴结转移。" + }, + { + "question_num": 207, + "query": "下列腧穴中,治疗汗证首选", + "options": { + "A": "复溜", + "B": "然谷", + "C": "太溪", + "D": "阴谷", + "E": "大钟" + }, + "answer": "A", + "reason": "复溜主治:①水肿、腹胀.腹泻等胃肠病证;②水肿、汗证(盗汗.无汗或多汗)等津液输布失调病证；③腰脊强痛,下肢痿痹。" + }, + { + "question_num": 208, + "query": "下列各项，不属于子宫脱垂中医病名的是", + "options": { + "A": "阴挺", + "B": "阴蚀", + "C": "阴痔", + "D": "产肠不收", + "E": "阴脱" + }, + "answer": "B", + "reason": "阴挺也称“阴脱”“阴菌”“阴痔”“产肠不收“”葫芦颓\"。本病相类子西医的“子宫脱垂”。阴蚀指阴疮。" + }, + { + "question_num": 209, + "query": "散剂的特点中不包括的是", + "options": { + "A": "节省药材", + "B": "吸收缓慢", + "C": "不易变质", + "D": "制作简便", + "E": "便于携带" + }, + "answer": "B", + "reason": "散剂是将药物粉碎,混合均匀,制成粉末状制剂,分为内服和外用两类。散剂的���点是制作简便,吸收较快,节省药材,便于服用及携带," + }, + { + "question_num": 210, + "query": "在医学伦理学的研究内容中不包括以下哪项内容", + "options": { + "A": "医学道德的教育、评价和修养", + "B": "医学道德中特殊问题", + "C": "伦理学产生、发展及其规律", + "D": "医学伦理学的基本原则、规范", + "E": "医学伦理学的基本理论" + }, + "answer": "C", + "reason": "医学伦理学的研究内容：①医学道德的基本理论包括医学道德的起源、本质、特点、发生发展规律、社会作用与影响，医学历史中出现的医学道德现象及其背景，医学伦理学的基本理论、医学伦理学的发展趋势等；②医学道德的规范体系包括医德的原则、规范和范畴等；③医学道德的基本实践包括医学道德教育和修养、医德评价的标准和方法、医学临床、医学科研、整个卫生保健领域、现代医学发展中的难题等。" + }, + { + "question_num": 211, + "query": "下列病证,不宜用三棱针治疗的是", + "options": { + "A": "高热惊厥", + "B": "中风脱证", + "C": "中暑昏迷", + "D": "急性腰扭伤", + "E": "喉蛾" + }, + "answer": "B", + "reason": "三棱针刺具有开窍泄热.消肿止痛、疏经通络的作用,适应范围广,凡各种实证、热证、瘀血和经络瘀滞、疼痛等均可使用。中风脱证为虚极之证，不宜用三棱针。" + }, + { + "question_num": 212, + "query": "下列各项，不属放置宫内节育器禁忌证的是", + "options": { + "A": "滴虫性阴道炎", + "B": "月经过多", + "C": "重度痛经", + "D": "宫颈口松", + "E": "足月产后3月" + }, + "answer": "E", + "reason": "放置宫内节育器禁忌证:①妊娠或妊娠可疑者;②人工流产、分娩或剖宫产后有妊娠组织物残留或感染可能者;③生殖道炎症;④生殖器官肿瘤、子宫畸形;⑤宫颈过松、重度陈旧性宫颈裂伤或子宫脱垂;⑥严重的全身性疾患;⑦月经过多。E项与以上禁忌证不符,故选E。" + }, + { + "question_num": 213, + "query": "九味羌活汤的组成药物中含有", + "options": { + "A": "白芍药", + "B": "山茱萸", + "C": "生地黄", + "D": "麦门冬", + "E": "枸杞子" + }, + "answer": "C", + "reason": "九味羌活汤的组成:羌活、防风、苍术、细辛、芎、香白芷、生地黄、黄苓、甘草。" + }, + { + "question_num": 214, + "query": "最近报道一女青年接受X光检查时，对医生让其脱掉上衣不解，甚至认为医生这样做是非常无礼的，有的甚至因此发生纠纷。此案例说明的核心伦理学问题是", + "options": { + "A": "患者的思想太封建了", + "B": "医生没有任何可指责之处", + "C": "应有女护士在旁陪伴", + "D": "医院应该在X光检查室门口出示须知", + "E": "医生没有完全尽到让患者知情同意的义务" + }, + "answer": "E", + "reason": "患者权利或医生权利。关于患者权利或医生权利，需注意医生的特殊干涉权，也是受到一定限制的。患者的权利的自主性更重要，但也仍然受到一定限制，即不能伤害到他人、社会，甚至也包括自己的生命。" + }, + { + "question_num": 215, + "query": "八会穴是指与以下哪8种精气有关的腧穴", + "options": { + "A": "气、血、脑、、筋、脉、胆、女子胞", + "B": "气、血、骨、髓、液、津、筋、脉", + "C": "气、血、脏、、脑、髓、筋、脉", + "D": "脏、腑、气、血、筋、脉、骨、髓", + "E": "脏、腑、气、血、经、脉、津、液" + }, + "answer": "D", + "reason": "八会穴,是指脏、腑、气、血、筋、脉、骨、髓等精气所会聚的腧穴。“会”,是聚会的意思。" + }, + { + "question_num": 216, + "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,甚则晕厥或休克。胎动不安有停经史，下腹部坠痛，腰痛,少是阴道出血。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，可有阴道出血，无宫颈摇举痛。" + }, + { + "question_num": 217, + "query": "柴葛解肌汤与大柴胡汤的组成药物中均含有的是", + "options": { + "A": "枳实、芍药", + "B": "桔梗、芍药", + "C": "黄芩、半夏", + "D": "黄芩、桔梗", + "E": "黄芩、芍药" + }, + "answer": "E", + "reason": "柴葛解肌汤的组成:柴胡、干葛、甘草、黄芩、羌活、白芷、芍药、桔梗。大柴胡汤的组成:柴胡、黄芩、芍药、半夏、生姜、枳实、大枣、大黄。" + }, + { + "question_num": 218, + "query": "容易闻及二尖瓣杂音的体位是", + "options": { + "A": "坐位", + "B": "立位", + "C": "平卧位", + "D": "右侧卧位", + "E": "左侧卧位" + }, + "answer": "E", + "reason": "二尖瓣器质性收缩期杂音的特点：强度常在3/6级以上，持续时间长，占据整个收缩期，可遮盖第一心音,常向左腋下传导,吸气时减弱,呼气时加强,左侧卧位时更明显,故选E。" + }, + { + "question_num": 219, + "query": "“以痛为腧”指的穴位是", + "options": { + "A": "阿是穴", + "B": "五输穴", + "C": "奇穴", + "D": "原穴", + "E": "郄穴" + }, + "answer": "A", + "reason": "阿是穴又称压痛点、天应穴、不定穴等。这一类腧穴既无具体名称,又无固定位置,而是以压痛点或其他反应点作为针灸部位。阿是穴多位于病变的附近,也可在与其距离较远的部位。临床上医生根据按压时患者有酸、麻、胀、痛、重等感觉和皮肤变化等而予以临时认定。" + }, + { + "question_num": 220, + "query": "下列各项，不属雌激素作用的是", + "options": { + "A": "促进卵泡发育", + "B": "使阴道上皮细胞脱落加快", + "C": "促使乳腺管增生", + "D": "促进第二性征发育", + "E": "促进骨中钙的沉积" + }, + "answer": "B", + "reason": "雌激素作用有促进卵泡发育、促使乳腺管增生、促进第二性征发育、促进骨中钙的沉积、使宫颈黏液分泌增加;促进外生殖器发育、丰满、色素沉着等。B项是孕激素的生理作用。" + }, + { + "question_num": 221, + "query": "治疗热毒蕴结之各种疮毒痈肿，瘰疬结核等，应选用的药物是", + "options": { + "A": "金银花", + "B": "紫花地丁", + "C": "连翘", + "D": "蒲公英", + "E": "大青叶" + }, + "answer": "C", + "reason": "连翘苦寒,主人心经,既能清心火，解疮毒,又能消散痈肿结聚,有“疮家圣药”之称。" + }, + { + "question_num": 222, + "query": "可经母婴途径传播的疾病是", + "options": { + "A": "细菌性痢疾", + "B": "流行性脑脊髓膜炎", + "C": "霍乱", + "D": "乙型肝炎", + "E": "伤寒" + }, + "answer": "D", + "reason": "乙型肝炎的传播途径:①母婴传播:②经皮传播(血液传播或医源性传播);③性接触传播；④除以上3种传播途径外,当口腔黏膜(包括牙龈)破损时有可能经口感染。通过昆虫也可能传播。" + }, + { + "question_num": 223, + "query": "耻骨联合上缘至股骨内上髁上缘的骨度分寸是", + "options": { + "A": "21寸", + "B": "22寸", + "C": "8寸", + "D": "19寸", + "E": "20寸" + }, + "answer": "C", + "reason": "了以《灵枢.骨度》篇规定的人体各部的分寸为基础,结合历代学者创用的折量分寸作为定位的依据,规定耻骨联合上缘至股骨内上髁上缘的骨度分寸是18寸,其余选项均不符。" + }, + { + "question_num": 224, + "query": "小儿正常舌象是", + "options": { + "A": "淡白", + "B": "绛红", + "C": "紫暗", + "D": "暗红", + "E": "淡红" + }, + "answer": "E", + "reason": "与成人一样,小儿的正常舌象为淡红舌,故选E。舌质淡白为心阳不足;舌质绛红为心阴不足;舌质紫暗或暗红为瘀血内阻。" + }, + { + "question_num": 225, + "query": "慢性痢疾属湿热积滞者，宜选用", + "options": { + "A": "保和丸", + "B": "乌梅丸", + "C": "香连丸", + "D": "枳实导滞丸", + "E": "健脾丸" + }, + "answer": "D", + "reason": "枳实导滞丸的主治证。实导滞丸主治湿热食积证。用于慢性痢疾屈湿热积滞者，属通因通用。" + }, + { + "question_num": 226, + "query": "以下哪项不属于患者的权利内容", + "options": { + "A": "基本医疗权", + "B": "知情同意权", + "C": "人身安全权", + "D": "保护隐私权", + "E": "社会免责权" + }, + "answer": "C", + "reason": "患者的权利内容:我国目前尚无系统的患者权利法规,只在《中华人民共和国宪法》等相关法规中可见散在的有关患者权利的内容。综合国内外关于患者权利方面的研究成果并根据我国国情,可将患者的基本权利归纳为以下几个方面:①基本医疗权；②疾病认知权；③知情同意权；④保护隐私权；⑤社会免责权;⑥经济索赔权。" + }, + { + "question_num": 227, + "query": "最早制作针灸铜人模型的医家是", + "options": { + "A": "皇甫谧", + "B": "孙思邈", + "C": "王惟一", + "D": "杨继洲", + "E": "李学川" + }, + "answer": "C", + "reason": "“针炙铜人”,简称“铜人”,指刻有穴名的人体铜像,是形象直观的针炙穴位模型。北宋王惟一创造性地用青铜铸造了两具针灸铜人。" + }, + { + "question_num": 228, + "query": "随着小儿年龄的增加", + "options": { + "A": "脉搏增快，血压增高", + "B": "脉搏增快，血压减低", + "C": "脉搏减慢，血压增高", + "D": "脉搏减慢，血压减低", + "E": "脉搏、血压均无明显变化" + }, + "answer": "C", + "reason": "随着小儿年龄的增加,小儿的脉减慢,血压增高。" + }, + { + "question_num": 229, + "query": "体观现寒热并用、辛开苦降、消补兼施配伍特点的方剂是", + "options": { + "A": "半夏泻心汤", + "B": "生姜泻心汤", + "C": "甘草泻心汤", + "D": "健脾丸", + "E": "枳实消痞丸" + }, + "answer": "A", + "reason": "半夏泻心汤,即小柴胡汤去柴胡、生姜,加黄连、干姜而成。因无半表证,故去解表之柴胡、生姜,痞因寒热错杂而成,故加寒热平调之黄连、干姜，变和解少阳之剂,而为调和肠胃之方。半夏泻心汤配伍特点:寒热互用以和其阴阳,苦辛并进以调其升降补泻兼施以顾其虚实。" + }, + { + "question_num": 230, + "query": "在分配稀有卫生资源时，不应该坚持的是", + "options": { + "A": "个人的实际需要", + "B": "个人之间的平均分配", + "C": "个人的支付能力", + "D": "个人的实际工作能力", + "E": "个人对社会的贡献" + }, + "answer": "B", + "reason": "在分配稀有卫生资源时,不应该坚持的是个人之间的平均分配。" + }, + { + "question_num": 231, + "query": "心经的都穴是", + "options": { + "A": "灵道", + "B": "通里", + "C": "少府", + "D": "神门", + "E": "阴郄" + }, + "answer": "E", + "reason": "郄穴是各经经气深缚的部位,多分布于四肢肘膝部以下。阴郄属心经郄穴,其余选项均与本题目不符。" + }, + { + "question_num": 232, + "query": "5周岁小儿的血压应为", + "options": { + "A": "70/50mmHg", + "B": "80/60mmHg", + "C": "90/60mmHg", + "D": "100/70mmHg", + "E": "110/80mmHg" + }, + "answer": "C", + "reason": "正常小儿的血压可以用以下公式计算:收缩血压(mmHg)=年龄x2+80,舒张血压为收缩血压的2/3。" + }, + { + "question_num": 233, + "query": "肾气丸中用量最大的药物是", + "options": { + "A": "附子", + "B": "桂枝", + "C": "山萸肉", + "D": "干地黄", + "E": "山药" + }, + "answer": "D", + "reason": "肾气丸中重用干地黄八两，滋阴补肾" + }, + { + "question_num": 234, + "query": "巨大脾脏常见于", + "options": { + "A": "急性粒细胞白血病", + "B": "慢性粒细胞白血病", + "C": "急性淋巴细胞白血病", + "D": "慢性淋巴细胞白血病", + "E": "肝硬化脾功能亢进" + }, + "answer": "B", + "reason": "脾大为慢性粒细胞白血病最显升著的特征。" + }, + { + "question_num": 235, + "query": "在大腿部位没有经穴的经脉是", + "options": { + "A": "胃经", + "B": "胆经", + "C": "肾经", + "D": "牌经", + "E": "肝经" + }, + "answer": "C", + "reason": "考查足经在大服部的穴位定位。胃经在大腿部有髀关等,脾经在大服部有箕门等,肝经在大腿部有足五里等,胆经在大腿部有风市等。" + }, + { + "question_num": 236, + "query": "以下各项是小儿咳嗽的病机的是", + "options": { + "A": "肺气郁闭", + "B": "肺失清肃", + "C": "肺气失宣", + "D": "肺失宣肃", + "E": "以上均非" + }, + "answer": "D", + "reason": "病变部位在肺,常涉及脾,基本病机为肺失宜肃。" + }, + { + "question_num": 237, + "query": "具有和解少阳功用的方剂是", + "options": { + "A": "葛根芩连汤", + "B": "麻杏石甘汤", + "C": "凉膈散", + "D": "小柴胡汤", + "E": "竹叶石膏汤" + }, + "answer": "D", + "reason": "葛根芩连汤解表清里。麻杏石甘汤辛凉疏表,清肺平喘。凉膈散泻火通便,清上泄下。小柴胡汤和解少阳。竹叶石音汤清热生，益气和胃" + }, + { + "question_num": 238, + "query": "在下列各项中，对患者不会造成伤害的是", + "options": { + "A": "医务人员的知识和技能低下", + "B": "医务人员的行为疏忽大意", + "C": "医务人员强迫患者接受检查和治疗", + "D": "医务人员对患者的呼叫或提问置之不理", + "E": "医务人员为治疗疾病适当地限制或约束患者的自由" + }, + "answer": "E", + "reason": "临床上可能对患者造成伤害的情况:医务人员的知识和技能低下;对患者的呼叫或提问置之不理;歧视、侮、谩骂患者或家属;强迫患者接受某项检查或治疗措施;施行不必要的检查或治疗;医务人员的行为疏忽、粗枝大叶;不适当地限制约束患者的自由;威胁或打骂患者;拒绝对某些患者提供医疗照护活动,如艾滋病患者等;拖拉或拒绝对急诊患者的抢救等。对此,医务人员负有道德资任,应该避免发生。" + }, + { + "question_num": 239, + "query": "循行“人下齿中”的经脉是", + "options": { + "A": "小肠经", + "B": "大肠经", + "C": "胃经", + "D": "脾经", + "E": "肝经" + }, + "answer": "B", + "reason": "《灵枢·经脉》:大肠手阳明之脉，起于大指次指之端，循指上廉，出合谷两骨之间，上入两筋之中，循臂上廉，入肘外廉，上臑外前廉，上肩，出髃骨之前廉，上出于柱骨之会上，下入缺盆络肺，下膈属大肠；其支者，从缺盆上颈贯颊，入下齿中，还出挟口，交人中，左之右，右之左，上挟鼻孔。" + }, + { + "question_num": 240, + "query": "按照小儿年龄分期标准，婴儿期指的是", + "options": { + "A": "从出生后脐带结扎开始到28天", + "B": "出生28天后至1周岁", + "C": "1～3周岁", + "D": "2～3周岁", + "E": "1～5周岁" + }, + "answer": "B", + "reason": "按照小儿年龄分期标准,婴儿期指的:出生28天后至1周岁为婴儿期。" + }, + { + "question_num": 241, + "query": "大连中汤的组成药物是", + "options": { + "A": "生附子、干姜、肉桂、炙甘草", + "B": "蜀椒、人参、干姜、胶饴", + "C": "蜀椒、人参、干姜、炙甘草", + "D": "蜀椒、生附子、肉桂、胶饴", + "E": "干姜、人参、桂枝、胶饴" + }, + "answer": "B", + "reason": "大建中汤组成:蜀椒、人参、干姜、胶饴。" + }, + { + "question_num": 242, + "query": "人体实验的道德要求不包括", + "options": { + "A": "必须服从医学目的", + "B": "必须取得受试者的知情同意", + "C": "必须维护受试者的利益", + "D": "坚持实验对照的原则", + "E": "把医学研究放在第一位" + }, + "answer": "E", + "reason": "人体实验的道德要求:必须服从医学目的,必须取得受试者的知情同意,维护受试者的利益,坚持实验对照的原则,但医学研究非唯一目的。" + }, + { + "question_num": 243, + "query": "下列属于原络配穴法的是", + "options": { + "A": "合谷、列缺", + "B": "冲阳、丰隆", + "C": "合谷、偏历", + "D": "太溪、大钟", + "E": "太渊、列缺" + }, + "answer": "A", + "reason": "本经原穴,与其相为表里经的络穴相互配合应用时,称为原络配穴法。合谷为阳明大肠经原穴,列缺为手太阴肺经络穴,两穴合用,即为原络配穴法,其余选项中均同属一经原穴与络穴,并非表里两经相配,故并非原络配穴法。" + }, + { + "question_num": 244, + "query": "小儿乳牙出齐的时间是", + "options": { + "A": "6个月", + "B": "1岁", + "C": "1岁半", + "D": "2岁左右", + "E": "以上均非" + }, + "answer": "D", + "reason": "生后4~10个月乳牙开始萌出,出牙顺序是先下颌后上颌,自前向后依次萌出,唯尖牙例外。乳牙在2~2.5岁出齐。" + }, + { + "question_num": 245, + "query": "下列各项，不属理中丸主治范围的是", + "options": { + "A": "阳虚失血证", + "B": "脾胃虚寒之腹痛", + "C": "中焦虚寒之小儿慢惊风", + "D": "肝胃虚寒之胃脘痛", + "E": "脾胃虚寒之胸痹" + }, + "answer": "D", + "reason": "理中丸主治:①脾胃虚寒证,脘腹绵绵作痛,喜温喜按,呕吐,大便稀溏,脘痞食少,畏寒肢冷,口不渴,舌淡苔白润,脉沉细或沉迟无力;②阳虚失血证,便血、吐血、衄血或崩漏等,血色暗淡,质清稀;③脾胃虚寒所致的胸疭;或病后多涎唾;或小儿慢惊等。【解析】乌梅丸的药物配伍意义。乌梅丸重" + }, + { + "question_num": 246, + "query": "在卫生资源分配上，形式公正是根据每个人", + "options": { + "A": "都享有公平分配的权利", + "B": "实际的需要", + "C": "能力的大小", + "D": "社会贡献的多少", + "E": "在家庭中的角色地位" + }, + "answer": "A", + "reason": "在卫生资源分配上,形式公正指每个人都享有公平分配的权利,更要强调内容的公正。" + }, + { + "question_num": 247, + "query": "��少阳胆经的络穴是", + "options": { + "A": "丰隆", + "B": "大钟", + "C": "飞扬", + "D": "光明", + "E": "藍沟" + }, + "answer": "D", + "reason": "丰隆为足阳明冒经的络穴。大钟为足少阴肾经的络穴。飞扬为足太阳膀胱经的络穴。光明为足少阳胆经的络穴。蠡沟为足厥阴肝经的络穴。" + }, + { + "question_num": 248, + "query": "小儿舌体胖嫩,舌边齿痕显著者,多见于", + "options": { + "A": "脾肾阳虚", + "B": "肺肾阴虚", + "C": "阴虚火旺", + "D": "气血瘀滞", + "E": "心脾积热" + }, + "answer": "A", + "reason": "脾肾阳虚,气化功能不足,水液代谢失常,湿阻于舌而见舌体胖嫩,受齿挤压而形成齿痕，故齿痕常与胖嫩舌同见。" + }, + { + "question_num": 249, + "query": "乌梅丸的君药是", + "options": { + "A": "乌梅", + "B": "蜀椒、细辛", + "C": "干姜、附子、桂枝", + "D": "黄连、黄柏", + "E": "人参、当归" + }, + "answer": "A", + "reason": "用乌梅为君,酸温安蛔,又能涩肠止泻止。" + }, + { + "question_num": 250, + "query": "在我国实施人类辅助生殖技术，下列各项中违背卫健委制定的伦理原则的是", + "options": { + "A": "使用捐赠的精子", + "B": "使用捐赠的卵子", + "C": "实施亲属代孕", + "D": "实施卵胞浆内单精注射", + "E": "使用捐赠的胚胎" + }, + "answer": "C", + "reason": "在我国实施人类辅助生殖技术,实施亲属代孕违背卫健委制定的伦理原则。" + }, + { + "question_num": 251, + "query": "颈椎病,病在太阳经应配", + "options": { + "A": "照海", + "B": "申脉", + "C": "昆仑", + "D": "大椎", + "E": "以上均非" + }, + "answer": "B", + "reason": "项椎病,病在太阳经配申脉。" + }, + { + "question_num": 252, + "query": "儿童注意力缺陷多动症的发病年龄多见于", + "options": { + "A": "新生儿期", + "B": "婴儿期", + "C": "幼儿期", + "D": "学龄期", + "E": "以上均非" + }, + "answer": "D", + "reason": "儿童注意力缺陷多动症男孩多于女孩,多见于学龄期儿童。" + }, + { + "question_num": 253, + "query": "导赤散主治心经有热之证，属于下列何种情况者为宜", + "options": { + "A": "气郁化火，炼液为痰，痰火内扰者", + "B": "气郁化火，心火内炽，循经上炎者", + "C": "气火内郁，暗耗阴血，虚热上炎者", + "D": "心火亢盛，烦热谵语，口舌生疮，邪实而正不虚者", + "E": "心火上炎，或下移小肠，水虚火不实者" + }, + "answer": "E", + "reason": "导赤散主治证病机。钱氏导赤散原治“小儿心热”证,后拓展为心经热盛或下移小肠之证，《医宗金鉴》以“水虚火不实”概括其病机,颇为贴切。" + }, + { + "question_num": 254, + "query": "孙思邈主张大医精诚，其中精是指", + "options": { + "A": "不断学习，提高医疗技术，有精湛的医术", + "B": "不断学习，对患者一心赴救", + "C": "不断学习，对患者一视同仁", + "D": "不断学习，有高尚医德", + "E": "不断学习，热爱救人" + }, + "answer": "A", + "reason": "孙思邈主张医生具备精和诚的精神。精就是要具有精湛的医术;所谓诚就是指医生应具有高尚的医德。" + }, + { + "question_num": 255, + "query": "三焦的下合穴是", + "options": { + "A": "委中", + "B": "阳陵泉", + "C": "委阳", + "D": "上巨虚", + "E": "下巨虚" + }, + "answer": "C", + "reason": "胃、大肠、小肠、胆,膀胱三焦的下合穴依次为足三里.上巨虚.下巨虚.阳陵泉.委中、委阳。" + }, + { + "question_num": 256, + "query": "疳积证的治法是", + "options": { + "A": "调脾健运", + "B": "消积理脾", + "C": "补益气血", + "D": "清心泻火,滋阴生津", + "E": "温阳健脾,利水消肿" + }, + "answer": "B", + "reason": "疳积证治法:消积理脾。代表方:肥儿丸。A项为疳气证的治法，C项为干疳证的治法，D项为口疳证的治法，E项为疳肿胀证的治法。" + }, + { + "question_num": 257, + "query": "首选用于治凉燥的方剂是", + "options": { + "A": "桑菊饮", + "B": "银翘散", + "C": "杏苏散", + "D": "清燥救肺汤", + "E": "麻杏石甘汤" + }, + "answer": "C", + "reason": "杏苏散方中用苏叶宣肺散邪,微温而润之,杏仁降肺止咳,合而轻宜凉燥,理肺化痰止咳为君。前胡疏风降气化痰,助杏仁、苏叶轻宜达表，理肺止咳;桔梗宣肺祛痰,枳壳降气宽胸,二者宣降并用，助杏仁、苏叶理肺消痰,共为臣。半夏燥湿化痰,皮理气化痰,茯苓健脾渗湿,既助理肺化痰之效，又杜生痰之源;生姜、大枣调和营卫共为佐。甘草润肺止咳，兼和诸药为使。诸药合用,轻宣凉燥,理肺化痰,而为轻宣凉燥的代表方剂。桑杏汤是治疗温燥的。消燥救肺汤是治疗温燥伤肺的。" + }, + { + "question_num": 258, + "query": "不属于卫生法基本原则的是", + "options": { + "A": "预防为主", + "B": "卫生工作社会化", + "C": "保护公民身体健康", + "D": "兼顾经济与社会效益", + "E": "祖国传统医学与现代医学相结合" + }, + "answer": "D", + "reason": "卫生法基本原则包括保护公民健康的原则、预防为主的原则、中西医协调发展的原则、国家卫生监督原则。" + }, + { + "question_num": 259, + "query": "治疗咽喉肿痛肺胃实热者,应加用以下哪穴", + "options": { + "A": "列缺、照海", + "B": "内庭、鱼际", + "C": "中渚、风池", + "D": "风池、外关", + "E": "太渊、曲池" + }, + "answer": "B", + "reason": "治疗咽喉肿冯肺胃实热证,在主穴基础上,配内庭、鱼际。" + }, + { + "question_num": 260, + "query": "小儿感冒风热证,治疗方剂宜用", + "options": { + "A": "桑菊饮", + "B": "银翘散", + "C": "桂枝汤", + "D": "加减葳蕤汤", + "E": "新加香薷饮" + }, + "answer": "B", + "reason": "风热感冒治法:辛凉解表。主方:银翘散加减。" + }, + { + "question_num": 261, + "query": "痛泻要方中配伍防风的主要用意是", + "options": { + "A": "祛风止痉", + "B": "散寒除湿", + "C": "散肝疏脾", + "D": "疏风宽肠", + "E": "疏风止痛" + }, + "answer": "C", + "reason": "痛泻要方补脾泻肝,其中配伍少量防风,具升散之性,与白术、白芍相伍,辛能散肝郁,香能舒脾气,具有燥湿以助止泻之功，为脾经引经之药，兼具佐使之用。" + }, + { + "question_num": 262, + "query": "《药品管理法》规定对四类药品实行特殊管理。下列药品中，不属于法定特殊管理药品的是", + "options": { + "A": "生化药品", + "B": "麻醉药品", + "C": "精神药品", + "D": "放射性药品", + "E": "医疗用毒性药品" + }, + "answer": "A", + "reason": "麻醉药品、精神药品、医疗用毒性药品、放射性药品等属于特殊管理药品。" + }, + { + "question_num": 263, + "query": "治疗郁证的主穴是", + "options": { + "A": "内关、神门、巨阙", + "B": "照海、申脉、神门、印堂、神门、百会", + "C": "内关、水沟、丰隆、后溪、照海", + "D": "百会、印堂、水沟、内关、神门、太冲", + "E": "四神聪透百会、神庭透上星" + }, + "answer": "D", + "reason": "郁证针灸治疗的主穴:百会、印堂、水沟、内关、神门、太冲。" + }, + { + "question_num": 264, + "query": "小儿水肿之脾肾阳虚证的证候特点不包括的是", + "options": { + "A": "面色潮红，口干唇赤", + "B": "神疲畏寒，四肢不温", + "C": "高度水肿，按之没指", + "D": "小便量少或无尿", + "E": "舌淡胖，脉沉细" + }, + "answer": "A", + "reason": "小儿水肿之脾肾阳虚证证候:全身浮肿,以腰腹、下肢为甚,按之深陷难起,畏寒肢冷,面白无华,神倦乏力，小便量少，甚或无尿,大使溏，舌淡胖,苔白滑,脉沉细。" + }, + { + "question_num": 265, + "query": "肾气丸中配伍少量桂枝、附子的主要用意是", + "options": { + "A": "温肾暖脾，以助阳气", + "B": "温肾助阳，散寒通脉", + "C": "温补肾阳，少火生气", + "D": "温补脾阳，化气行水", + "E": "补阳益精，温肾纳气" + }, + "answer": "A", + "reason": "肾气丸的配伍意义如柯琴所云“此肾气丸纳桂、附于滋阴剂中十倍之一,意不在补火,而在微微生火,即生肾气也”。" + }, + { + "question_num": 266, + "query": "《中华人民共和国医师法》所称医师包括", + "options": { + "A": "主治医师和主任医师", + "B": "主治医师和住院医师", + "C": "医师和助理医师", + "D": "副主任医师和主任医师", + "E": "执业医师和执业助理医师" + }, + "answer": "E", + "reason": "医师,是指依法取得医师资格,经注册在医疗卫生机构中执业的专业医务人员,包括执业医师和执业助理医师。" + }, + { + "question_num": 267, + "query": "手太阳小肠经的都穴是", + "options": { + "A": "孔最", + "B": "养老", + "C": "阳交", + "D": "交信", + "E": "外丘" + }, + "answer": "B", + "reason": "孔最为肺经的郄穴,养老为小肠经的郄穴,阳交为阳维脉的郄穴,交信为阴跷脉的郄穴，外丘为胆经的郄穴。" + }, + { + "question_num": 268, + "query": "胎黄气滞血瘀证的主治方剂是", + "options": { + "A": "茵陈理中汤", + "B": "茵陈蒿汤", + "C": "血府逐瘀汤", + "D": "桃仁承气汤", + "E": "以上均非" + }, + "answer": "C", + "reason": "胎黄之气滞血瘀证证候:面目皮肤发黄,颜色逐渐加深,晦暗无华,右胁下痞块质硬,肚腹膨胀,青筋显露,或见瘀斑、衄血,唇色暗红,舌见瘀点，苔黄。主治方剂血府逐瘀汤。" + }, + { + "question_num": 269, + "query": "朱砂安神丸组成中含有的药物是", + "options": { + "A": "栀子", + "B": "黄连", + "C": "石膏", + "D": "竹叶", + "E": "知母" + }, + "answer": "B", + "reason": "朱砂安神丸药物组成:朱砂、黄连、当归、生地黄、炙甘草。" + }, + { + "question_num": 270, + "query": "城镇中发现甲类传染病和乙类传染病中的艾滋病、肺炭疽病的患者、病原携带者和疑似患者时，国家规定的报告时间是", + "options": { + "A": "6小时以内", + "B": "7小时以内", + "C": "10小时以内", + "D": "12小时以内", + "E": "24小时以内" + }, + "answer": "A", + "reason": "责任疫情报告人发现甲类传染病和乙类传染病中的艾滋病、肺炭疽的患者、病原携带者和疑似传染病患者时,城镇于6小时内,农村于12小时内，以最快的通讯方式向发病地的卫生防疫机构报告并同时报出传染病报告卡。" + }, + { + "question_num": 271, + "query": "若辨证为痛痹,应配用", + "options": { + "A": "肾俞、关元", + "B": "气海、神阙", + "C": "肝俞、太冲", + "D": "合谷、曲池", + "E": "阴陵泉、足三里" + }, + "answer": "A", + "reason": "痹证配祥,行痹配膈俞、血海;痛痹配肾俞、关元;着痹配阴陵泉、足三里;热痹配大椎、曲池。另可根据疼痛的部位循经配穴。" + }, + { + "question_num": 272, + "query": "下列各项易并发肺炎的疾病是", + "options": { + "A": "猩红热", + "B": "水痘", + "C": "麻疹", + "D": "风疹", + "E": "幼儿急疹" + }, + "answer": "C", + "reason": "麻疹一年四季均可发病,以冬春季多见,6个月至5岁发病率较高,容易并发肺炎。" + }, + { + "question_num": 273, + "query": "紫雪的功用是", + "options": { + "A": "开窍定惊，清热化痰", + "B": "清热解毒，开窍醒神", + "C": "清热解毒，开窍安神", + "D": "化浊开窍，清热解毒", + "E": "清热开窍，息风止痉" + }, + "answer": "E", + "reason": "紫雪的功用清热开窍、息风止痉" + }, + { + "question_num": 274, + "query": "《中华人民共和国传染病防治法》规定应予以隔离治疗的是", + "options": { + "A": "疑似传染病患者", + "B": "甲类传染病患者", + "C": "甲类传染病患者和病原携带者", + "D": "乙类传染病患者和病原携带者", + "E": "除艾滋病患者、炭疽中的肺炭疽以外的乙类传染病患者" + }, + "answer": "C", + "reason": "《中华人民共和国传染病防治法》规定,医疗机构发现甲类传染病时，应当及时采取下列措施:对病人、病原携带者,予以隔离治疗,隔离期限根据医学检查结果确定;对疑似病人,确诊前在指定场所单独隔离治疗。" + }, + { + "question_num": 275, + "query": "在五输穴中,合穴主要治疗", + "options": { + "A": "心下满", + "B": "身热", + "C": "体重节痛", + "D": "喘咳寒热", + "E": "逆气而泄" + }, + "answer": "E", + "reason": "五输穴中,井主心下满,荥主身热，输主体重节痛,经主喘咳寒热,合主逆气而泄。" + }, + { + "question_num": 276, + "query": "诊断3个月至6岁小儿营养性缺铁性贫血的标准，其血红蛋白值应低于的数值是", + "options": { + "A": "110g/L", + "B": "120g/L", + "C": "80g/L", + "D": "90g/L", + "E": "100g/L" + }, + "answer": "A", + "reason": "小儿营养性缺铁性贫血:3个月~6岁血红蛋白<110g/L,6岁以上血红蛋白<120g/L。" + }, + { + "question_num": 277, + "query": "苏子降气汤组成中不包含的药物是", + "options": { + "A": "当归", + "B": "肉桂", + "C": "前胡", + "D": "厚朴", + "E": "葶苈子" + }, + "answer": "E", + "reason": "苏子降气汤的组成:紫苏子、半夏当归、甘草、前胡、厚朴、生姜、肉桂、枣子、苏叶。" + }, + { + "question_num": 278, + "query": "依据2002年9月1日实施的《医疗事故处理条例》不属于医疗事故的是", + "options": { + "A": "医疗机构违反规章造成患者重度残废", + "B": "在医疗活动中，由于患者病情异常而发生医疗意外", + "C": "医务人员违反诊疗常规，造成患者一般功能性障碍", + "D": "医务人员违反护理常规，造成患者轻度残废", + "E": "药房等非临床科室因过失导致患者人身损害" + }, + "answer": "B", + "reason": "医疗事故是指医疗机构及其医务人员在医疗活动中，违反医疗卫生管理法律、行政法规、部门规章和诊疗护理规范、常规,过失造成患者人身损害的事故。在医疗活动中，由于患者病情异常而发生医疗意外不属于违反医疗卫生管理法律、行政法规、部门规章和诊疗护理规范、常规,故选B。" + }, + { + "question_num": 279, + "query": "下列各穴中,属足太阴脾经的是", + "options": { + "A": "大横", + "B": "章门", + "C": "期门", + "D": "梁门", + "E": "带脉" + }, + "answer": "A", + "reason": "章门、期门属肝经,梁门属胃经,带脉属胆经。" + }, + { + "question_num": 280, + "query": "小儿时邪感冒的主要特点是", + "options": { + "A": "恶寒发热，鼻塞流涕，舌淡苔薄白", + "B": "发热头痛，身重困倦，舌红苔黄腻", + "C": "发热恶风，咽红肿痛，舌红苔薄黄", + "D": "起病急骤，高热恶寒，肌肉酸痛", + "E": "恶寒发热，脘腹胀痛，呕吐酸腐" + }, + "answer": "D", + "reason": "起病急骤,商热恶寒,肌肉酸痛为时邪感冒的特征。" + }, + { + "question_num": 281, + "query": "玉液汤的功用是", + "options": { + "A": "滋阴清热", + "B": "滋阴养胃", + "C": "养阴润肺", + "D": "养阴清肺", + "E": "润燥止渴" + }, + "answer": "E", + "reason": "玉波汤的功用:益气生津,润燥止渴。主治津液不布,胃燥耗津,口渴引饮;脾气亏虚,肾失封藏,水精下流,小便频数母多;肾虚胃燥,气虚胃燥津伤,困倦气短,舌嫩红而干,脉虚细无力。" + }, + { + "question_num": 282, + "query": "医师在执业活动中违反卫生行政规章制度或者技术操作规范，造成严重后果的，责令暂停执业活动，暂停期限是", + "options": { + "A": "3个月以上，6个月以下", + "B": "6个月以上，2年以下", + "C": "6个月以上，1年以下", + "D": "1年以上，3年以下", + "E": "1年以上，1年半以下" + }, + "answer": "C", + "reason": "《中华人民共和国医师法》规定，医师在执业活动中有下列行为之一的，由县级以上人民政府卫生健康主管部门责令改正,给予警告;情节严重的,责令暂停6个月以上1年以下执业活动直至吊销医师执业证书:①在提供医疗卫生服务或者开展医学临床研究中,未按照规定展行告知义务或者取得知情同意;②对需要紧急救治的患者,拒绝急救处置,或者由于不负责任延误诊治;③遇有自然灾害、事故灾难、公共卫生事件和社会安全事件等严重威胁人民生命健康的突发事件时,不服从卫生健康主管部门调遣;④未按照规定报告有关情形;⑤违反法律、法规、规章或者执业规范,造成医疗事故或者其他严重后果。" + }, + { + "question_num": 283, + "query": "既有近治作用,又具有突出远治作用的腧穴是", + "options": { + "A": "全身所有腧穴", + "B": "十二经脉中位于肘、膝关节以下的腧穴", + "C": "躯干部腧穴", + "D": "四肢部腧穴", + "E": "头面部腧穴" + }, + "answer": "B", + "reason": "十四经腧穴中,尤其是十二经脉在四肢肘、膝关节以下的腧穴,不仅能治局部病证,还可以治疗本经循行所及的远隔部位的脏腑、组织、器官的病证,有的甚至具有影响全身的作用。" + }, + { + "question_num": 284, + "query": "小儿腹泻脾虚泻的治法为", + "options": { + "A": "疏风散寒，化湿和中", + "B": "运脾和胃，消食化滞", + "C": "健脾益气，酸甘敛阴", + "D": "清肠解毒，化湿止泻", + "E": "健脾益气，助运止泻" + }, + "answer": "E", + "reason": "小儿脾虚泻的治法为健脾益气,助运止泻,方用参苓白术散。" + }, + { + "question_num": 285, + "query": "黄芪桂枝五物汤与当归四逆汤组成中均含有的药物是", + "options": { + "A": "生姜、芍药、桂枝", + "B": "大枣、桂枝、生姜", + "C": "黄芪、桂枝、芍药", + "D": "芍药、生姜、大枣", + "E": "桂枝、芍药、大枣" + }, + "answer": "E", + "reason": "黄芪桂枝五物汤组成:黄芪、桂枝、芍药、生姜、大枣。当归四逆汤的组成:当归、桂枝、芍药、细辛、通草、大枣、炙甘草,故选E。" + }, + { + "question_num": 286, + "query": "具有下列何种情形的药品属于劣药范围", + "options": { + "A": "变质的药品", + "B": "以非药品冒充药品", + "C": "未标明有效期或者更改有效期的药品", + "D": "国务院药品监督管理部门规定禁止使用的药品", + "E": "所标明的适应证或者功能主治超出规定范围的药品" + }, + "answer": "C", + "reason": "禁止生产(包括配制，下同)、销售、使用假药、劣药。有下列情形之一的,为假药:①药品所含成份与国家药品标准规定的成份不符;②以非药品冒充药品或者以他种药品冒充此种药品;③变质的药品;④药品所标明的适应症或者功能主治超出规定范围。有下列情形之一的,为劣药:①药品成份的含量不符合国家药品标准;②被污染的药品;③未标明或者更改有效期的药品;④未注明或者更改产品批号的药品;⑤超过有效期的药品;⑥擅自添加防腐剂、辅料的药品;⑦其他不符合药品标准的药品。" + }, + { + "question_num": 287, + "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": "胃之募穴是中脘,故选用胃俞、中脘。" + }, + { + "question_num": 288, + "query": "小儿遗尿的病机主要是", + "options": { + "A": "肝经郁热，疏泄失司", + "B": "脾肾气虚，下元不固", + "C": "肾气不足，膀胱虚寒", + "D": "肺脾气虚，水道失约", + "E": "心肾失交，水火不济" + }, + "answer": "C", + "reason": "遗尿多与膀胱和肾的功能失调有关,其中尤以肾气不足、膀胱虚寒为多见。" + }, + { + "question_num": 289, + "query": "下列各项，属痰湿内阻头晕临床表现的是", + "options": { + "A": "头晕胀痛", + "B": "头晕昏沉", + "C": "头晕眼花", + "D": "头晕耳鸣", + "E": "头晕欲仆" + }, + "answer": "B", + "reason": "头晕胀痛多为肝火上炎或肝阳上亢,故排除。头晕昏沉或头星且重提示痰湿内阻，故选择B。头晕眼花多为气血亏虚所致,故排除。头晕耳鸣多提示肝肾阴虚。头晕欲仆多提示风阳上扰。" + }, + { + "question_num": 290, + "query": "撰写“医家五戒十要”的医家是", + "options": { + "A": "李时珍", + "B": "陈实功", + "C": "孙思邈", + "D": "张仲景", + "E": "华佗" + }, + "answer": "B", + "reason": "陈实功所著《外科正宗》中有篇章进行论述“医家五戒”和“医家十要”,已被认为是世界上较早的成文的医德法典。" + }, + { + "question_num": 291, + "query": "属手太阳小肠经的胎穴是", + "options": { + "A": "血海", + "B": "少海", + "C": "小海", + "D": "照海", + "E": "气海" + }, + "answer": "C", + "reason": "血海穴属足太阴脾经;少海穴属手少阴心经;小海穴属手太阳小肠经;照海穴属足少阴肾经；气海穴属任脉。" + }, + { + "question_num": 292, + "query": "下列治疗积滞乳食内积证的首选方剂是", + "options": { + "A": "肥儿丸或疳积散", + "B": "消乳丸或保和丸", + "C": "健脾丸", + "D": "七味白术散", + "E": "枳实导滞丸" + }, + "answer": "B", + "reason": "小儿积滞之乳食内积证证候:不思乳食,嗳腐酸馊或呕吐食物、乳片,脘腹胀满疼痛,大便酸臭,烦躁啼哭,夜眠不安,手足心热,舌质红,苔白厚或黄厚腻,脉象弦滑,指纹紫滞。治法:消乳化食,和中导滞，代表方剂:乳积者,选消乳丸;食积者,选保和丸。" + }, + { + "question_num": 293, + "query": "脾肾亏虚的目的是", + "options": { + "A": "戴眼反折", + "B": "目睛微定", + "C": "昏睡露睛", + "D": "双睑下垂", + "E": "横目斜视" + }, + "answer": "D", + "reason": "双睑下垂多为先天不足，脾肾亏虚" + }, + { + "question_num": 294, + "query": "《药品管理法》规定：禁止药品的生产企业、经营企业和医疗机构在药品购销中给予", + "options": { + "A": "合作开发课题", + "B": "委托研发项目", + "C": "药物研究试验内容", + "D": "药品临床试验申请", + "E": "收受回扣或者其他不正当利益" + }, + "answer": "E", + "reason": "《中华人民共和国药品管理法》规定:禁止药品的生产企业、经营企业和医疗机构在药品购销中给予、收受回扣或者其他不正当利益。" + }, + { + "question_num": 295, + "query": "足三阴经相同的主治是", + "options": { + "A": "肝病、脾胃病", + "B": "肾病、脾胃病", + "C": "肺、脾、肾病", + "D": "妇科病、胃肠", + "E": "前阴病、妇科病" + }, + "answer": "E", + "reason": "脾经主治脾胃病、妇科病、前阴病，肝经主治肝病、妇科病、前阴病、肾经主治肾病、肺病、咽喉病、妇科病、前阴病。" + }, + { + "question_num": 296, + "query": "小儿泄泻各种证���中，最为多见的是", + "options": { + "A": "湿热泻", + "B": "风寒泻", + "C": "伤食泻", + "D": "脾虚泻", + "E": "脾肾阳虚泻" + }, + "answer": "A", + "reason": "泄泻发病,无不因于湿:小儿肺、脾不足,易于感受外邪,其中以外感暑热、内伤饮食居多，均为热邪或易于化热。从临床统计资料看，亦以湿热泄最多见。" + }, + { + "question_num": 297, + "query": "风痰的特征是", + "options": { + "A": "色黄黏稠", + "B": "白而清稀", + "C": "清稀多泡沫", + "D": "白滑而量多", + "E": "少而黏稠" + }, + "answer": "C", + "reason": "A项为热痰,因热邪内盛,煎熬、浓缩津液成痰。B项为寒痰,因寒邪客肺,津凝成痰,或脾虚失运,聚湿为痰。C项为风痰,故选C。D项多为湿痰,因脾失健运,水湿内停,聚而成痰。E项为燥痰,因燥邪犯肺,耗伤肺津,或肺阴虚,肺失润养所致。" + }, + { + "question_num": 298, + "query": "下列不属于突发公共卫生事件应急工作原则的是", + "options": { + "A": "分级负责", + "B": "反应及时", + "C": "措施果断", + "D": "依靠科学", + "E": "预防为主" + }, + "answer": "E", + "reason": "突发公共卫生事件应急工作的方针及原则:突发事件应急工作,应当遵循预防为主、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。E项是突发公共卫生事件应急工作方针的内容。" + }, + { + "question_num": 299, + "query": "循喉咙之后,上人颃颗的经脉是", + "options": { + "A": "足太阴脾经", + "B": "足阳明胃经", + "C": "足厥阴肝经", + "D": "足少阴肾经", + "E": "足少阳胆经" + }, + "answer": "C", + "reason": "足厥阴肝经布胁肋,循咽喉之后,上入颃颡,其余选项均为错误选项。" + }, + { + "question_num": 300, + "query": "五迟、五软之痰瘀阻滞证治疗首选方为", + "options": { + "A": "六味地黄丸合四物汤", + "B": "济生肾气丸合调元散", + "C": "通窍活血汤合二陈汤", + "D": "十全大补丸合天麻钩藤饮", + "E": "杞菊地黄丸合桃红四物汤" + }, + "answer": "C", + "reason": "五迟、五软之痰瘀阻滞证,应治以涤痰开窍,活血通络,方选通窍活血汤合二陈汤。" + }, + { + "question_num": 301, + "query": "湿热内盛的舌象是", + "options": { + "A": "舌红苔白滑", + "B": "舌淡嫩苔白滑", + "C": "舌边红苔黑润", + "D": "舌红瘦苔黑", + "E": "舌绛苔粘腻" + }, + "answer": "A", + "reason": "A项为湿热内盛之证。B项为阳虚湿盛之证。C项为肝胆热盛，痰湿久郁。D项为阴虚有热,热极津枯之证。E项为热人营血,兼有湿之证。" + }, + { + "question_num": 302, + "query": "《中华人民共和国医师法》规定医师应当履行的职责是", + "options": { + "A": "人民至上", + "B": "生命至上", + "C": "甘于奉献", + "D": "防病治病、保护人民健康", + "E": "敬佑生命" + }, + "answer": "D", + "reason": "《中华人民共和国医师法》规定,医师应当坚持人民至上、生命至上,发扬人道主义精神弘扬敬佑生命、救死扶伤、甘于奉献、大爱无疆的崇高职业精神,恪守职业道德,遵守执业规范,提高执业水平,履行防病治病、保护人民健康的神圣职资。" + }, + { + "question_num": 303, + "query": "患者胸胁疼痛,咳唾引痛,咳逆气喘息促不能平卧,喜向右侧偏卧,右侧肋间胀满,舌苔白，脉沉弦，其治法是", + "options": { + "A": "攻下逐饮", + "B": "和解宣利", + "C": "理气和络", + "D": "泻肺祛饮", + "E": "发表化饮" + }, + "answer": "D", + "reason": "咳逆气喘息促不能平卧,喜向右侧偏卧,右侧肋间胀满————饮邪,胸胁疼痛————部位为胸胁,诊断为悬饮饮停胸胁证,当泻肺祛饮,方予椒目瓜萎汤合十枣汤加减或用控涎丹加减。" + }, + { + "question_num": 304, + "query": "患儿，女，7岁。结喉处红肿绕喉，根盘散漫，肿势延及颈部两侧，按之中软，有应指感。治疗应首选", + "options": { + "A": "内服普济消毒饮", + "B": "外治以菊花汁调制玉露散箍围束毒", + "C": "半流质饮食", + "D": "切开排脓", + "E": "药线引流" + }, + "answer": "D", + "reason": "痈之大者名发。说明发的病变范围较痈为大,生于结喉处的,称为锁喉痈。根据题于提示脓已成了则密要切开排脓,其他的都是辅助疗法或早期的适应证。国家执业医师资格考试，中医执业医师" + }, + { + "question_num": 305, + "query": "独语，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": "D", + "reason": "独语是指自言自语,哺哺不休,见人则止,首尾不续者。多因心气不足,神失所养,或气郁生痰,蒙蔽心窍所致,故选D。" + }, + { + "question_num": 306, + "query": "患者，男，48岁。近1个月来，因上腹部不适，食欲减退，体重减轻而疑诊为胃癌。为确诊，首选的检查方法是", + "options": { + "A": "癌胚抗原测定", + "B": "大便隐血试验", + "C": "胃液分析", + "D": "X线钡餐检查", + "E": "胃镜检查" + }, + "answer": "E", + "reason": "癌胚抗原测定、胃液分析、大便隐血试验、X线钡餐检查均不能作为胃癌的特异性诊断标准,胃癌患者的癌胚抗原测定、胃波分析、大便隐血试验、X线钡餐不一定异常,胃镜为诊断早期胃癌的特异性诊断。" + }, + { + "question_num": 307, + "query": "患者突然昏厥,喉有痰声,或呕吐涎沫,呼吸气粗，舌苔白腻,脉沉滑。治疗宜选", + "options": { + "A": "二陈汤", + "B": "六磨汤", + "C": "温胆汤", + "D": "导痰汤", + "E": "通幽汤" + }, + "answer": "D", + "reason": "厥证的辨证论治。从患者症、舌、脉判断为痰厥，治以导痰汤行气豁痰。" + }, + { + "question_num": 308, + "query": "患者，女，25岁。口舌生疮，心烦失眠，小便黄赤，尿道灼热涩痛，口渴。舌红无苔，脉数，其病位在", + "options": { + "A": "心、脾", + "B": "小肠", + "C": "膀胱", + "D": "心、小肠", + "E": "肾、膀胱" + }, + "answer": "D", + "reason": "心与小肠:心火可以下移小肠,如尿赤尿少，小肠火上炎于心有口舌生疮。心经有热则心烦失眠,舌为心之苗,故口舌生疮,心火上炎,灼伤津液则口渴,心与小肠相表里,心移热于小肠,则小便黄赤:尿道灼热涩痛,故病位在心与小肠。" + }, + { + "question_num": 309, + "query": "属于天台乌药散组成药物的是", + "options": { + "A": "川楝子", + "B": "陈皮", + "C": "草豆蔻", + "D": "肉桂", + "E": "厚朴" + }, + "answer": "A", + "reason": "天台乌药散的组成:乌药、木香、小茴香、青皮、高良姜、槟榔、川子、巴豆,故选A。" + }, + { + "question_num": 310, + "query": "患者，男，60岁。高血压史20年，1小时前情绪激动后昏迷，查体：血压230/110mmHg，双眼向右侧凝视，左侧肢体偏瘫，左巴氏征(+)。考虑为", + "options": { + "A": "高血压性脑出血", + "B": "腔隙性脑梗死", + "C": "脑血栓形成", + "D": "短暂性脑缺血发作", + "E": "脑栓塞" + }, + "answer": "A", + "reason": "根据题干60岁老人，高血压病史20年,因情绪激动后昏迷，血压230/110mmHg,双眼凝视,肢体偏瘫,可首选考忠高血压性脑出血。" + }, + { + "question_num": 311, + "query": "患者,男,62岁。咳喘病史20年。近1月来咳逆喘促,时有神志恍惚,谵妄,烦躁不安。或有嗜睡,下肢浮肿,舌淡胖,苔白腻,脉沉细。诊断为肺胀,其证候是", + "options": { + "A": "肺肾气虚", + "B": "阳虚水泛", + "C": "痰浊壅肺", + "D": "痰热郁肺", + "E": "痰蒙神窍" + }, + "answer": "E", + "reason": "本患者有神志恍惚,谵妄,烦躁不安,或有嗜睡的表现,为神志异常,属于痰蒙神窍。" + }, + { + "question_num": 312, + "query": "患者，男，30岁。右手掌红肿热痛，整个手掌肿胀高突，掌心失去正常的凹陷，手背肿势明显，疼痛剧烈，红肿蔓延到手臂，伴发热头痛，其诊断是", + "options": { + "A": "蛇头疔", + "B": "蛇眼疔", + "C": "蛇肚疔", + "D": "托盘疔", + "E": "红丝疔" + }, + "answer": "D", + "reason": "本题所述重点在于发病部位,其发生的部位在手掌,且掌心失去正常凹陷,故诊断为托盘疔。" + }, + { + "question_num": 313, + "query": "下列诸症，除哪项外，均为里证的特点", + "options": { + "A": "但热不寒", + "B": "但寒不热", + "C": "寒热往来", + "D": "苔黄", + "E": "脉沉" + }, + "answer": "C", + "reason": "里证的特点。寒热往来属于半表半里证。" + }, + { + "question_num": 314, + "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。为确诊，下列哪项检查最重要", + "options": { + "A": "血常规", + "B": "血培养", + "C": "结核菌素试验", + "D": "痰结核菌检查", + "E": "纤维支气管镜检查" + }, + "answer": "E", + "reason": "老年男性,长期咳嗽,抗感染治疗无效时,应考虑是否为肺癌。中心型肺癌发生于支气管，易导致支气管堵塞而发生右肺中叶炎症;此时应行纤维支气管镜检査,故选E。" + }, + { + "question_num": 315, + "query": "患者,男,60岁。伙食难下,下而复吐出,呕吐物如赤豆汁,胸膈疼痛,肌肤枯槁,形体消瘦,舌质紫暗,脉细涩,其证候是", + "options": { + "A": "痰气交阻", + "B": "瘀血内结", + "C": "津亏热结", + "D": "气虚阳微", + "E": "肝肾阴虚" + }, + "answer": "B", + "reason": "噎膈瘀血内结证病机:蓄瘀留着,阻滞食道，通降失司、肌肤失养。" + }, + { + "question_num": 316, + "query": "患者，女，25岁。外阴部有成群水疱，互相融合，易破糜烂，灼热痛痒，同时伴有发热，尿频，尿急，尿痛，苔黄，脉弦，其治法是", + "options": { + "A": "健脾利湿", + "B": "疏风清热", + "C": "清热利湿", + "D": "清泻肝火", + "E": "养阴清热" + }, + "answer": "C", + "reason": "湿热下注证,其治法是清热利湿" + }, + { + "question_num": 317, + "query": "胃热患者，其口气为", + "options": { + "A": "酸臭", + "B": "奇臭", + "C": "臭秽", + "D": "腥臭", + "E": "腐臭" + }, + "answer": "C", + "reason": "A项多属食积胃肠。B项多为疳病。C项多属胃热。D项多属口腔不洁。E项多为疮疡溃脓。" + }, + { + "question_num": 318, + "query": "患者，男，40岁。确诊高血压病3年，无自觉症状。检查：血压160/95mmHg，尿常规无异常，心电图及X线显示左心室肥大。应首先考虑的是", + "options": { + "A": "高血压病1级", + "B": "高血压病2级", + "C": "高血压病3级", + "D": "急进型高血压病", + "E": "高血压脑病" + }, + "answer": "B", + "reason": "我国高血压分期标准:1级无心、脑、肾并发症;2级有轻度心、脑、肾损害之一者;3级有严重心、脑、肾损害之一者。该患者已有左心室肥大应考虑是高血压2级。本例患者高血压病史3年，排除D；无自觉症状，排除E。" + }, + { + "question_num": 319, + "query": "患者,男,42岁。胸闷且痛,心悸盗汗,头晕目眩,心烦不寐。腰酸膝软,舌红少津,脉细数,其治法是", + "options": { + "A": "益气养血,宁心和络", + "B": "补气活血,通络止痛", + "C": "益气温阳,活血通络", + "D": "滋阴益肾,养心安神", + "E": "行气活血,温经止痛" + }, + "answer": "D", + "reason": "心肾阴虚,血瘀凝滞痹阻心脉,故见胸闷且痛,后面证候俱为阴虚火旺之象,治宜滋阴益肾,养心安神,方用左归饮。" + }, + { + "question_num": 320, + "query": "患儿，女，6岁。左颈项结肿疼痛3天，皮色未变。肿块如鸡卵大，活动度存在。伴咽喉红肿，恶寒发热，头痛，舌苔薄黄，脉细数。内治应首选", + "options": { + "A": "仙方活命饮", + "B": "牛蒡解肌汤", + "C": "桑菊饮", + "D": "五味消毒饮", + "E": "五神汤" + }, + "answer": "B", + "reason": "瘿痈的特点:急性发病,结喉两侧结块,肿胀,色红灼热,疼痛,伴有寒战高热等全身症状。应与颈痈、锁喉痈相鉴别。风热痰凝证，治宜疏风清热化痰,方用牛蒡解肌汤加减。" + }, + { + "question_num": 321, + "query": "按五轮学说，上下眼睑所属脏腑是", + "options": { + "A": "心", + "B": "肝", + "C": "脾", + "D": "肺", + "E": "肾" + }, + "answer": "C", + "reason": "瞳仁属肾,称为水轮;黑睛属肝,称为风轮;两眦血络属心,称为血轮;白睛属肺,称为气轮;眼睑属脾,称为肉轮" + }, + { + "question_num": 322, + "query": "患者，女，30岁。心悸气促2个月，咯粉红色泡沫痰。查体：面颊暗红，口唇紫绀，双肺底闻及湿啰音，心尖区可闻及舒张期隆隆样杂音，下肢浮肿，其诊断是", + "options": { + "A": "肺源性心脏病", + "B": "冠心病", + "C": "二尖瓣狭窄，心功能不全", + "D": "高血压心脏病", + "E": "心包积液" + }, + "answer": "C", + "reason": "二尖瓣关闭不全典型表现为心尖部收缩期杂音，咯粉红色泡沫痰为心功能不全的表现。" + }, + { + "question_num": 323, + "query": "患者,男,60岁。胸闷疼痛,痰多气短，肢体沉重,形体肥胖,倦怠乏力,纳呆便溏,苔浊腻,脉滑。治疗应首选", + "options": { + "A": "瓜萎薤白半夏汤合涤痰汤", + "B": "枳实薤白桂枝汤", + "C": "血府逐瘀汤", + "D": "瓜萎薤白白酒汤", + "E": "柴胡疏肝散" + }, + "answer": "A", + "reason": "治宜通阳泄浊,豁痰开结,瓜蒌薤白半夏汤辛温通阳散结,合涤痰汤化痰。BD项偏于通阳,化痰不足。C项活血化瘀,用于心血瘀阻。E项用于气滞重者。" + }, + { + "question_num": 324, + "query": "患者，女，21岁。因喉炎而服���磺胺药物，继见皮肤红斑及水疱，口腔、阴部黏膜糜烂，伴有口干、便秘、溲赤、舌红苔薄、脉滑数。诊断为固定红斑型药疹，内治应首选", + "options": { + "A": "消风散合黄连解毒汤", + "B": "萆薢渗湿汤合黄连解毒汤", + "C": "犀角地黄汤合黄连解毒汤", + "D": "清营汤", + "E": "普济消毒饮" + }, + "answer": "B", + "reason": "湿热毒邪蕴蒸肌肤,故皮肤上出现红斑、水疱,甚则糜烂渗液,剧痒;热毒之邪灼伤津液则口干,大便燥结,小便黄赤;舌红、苔薄白或黄、脉滑数为湿毒蕴肤之象，宜清热利湿解毒。方选草薢湿汤合黄连解毒汤。" + }, + { + "question_num": 325, + "query": "阴虚动风证的临床特点是", + "options": { + "A": "手足蠕动", + "B": "四肢抽搐", + "C": "眩晕欲仆", + "D": "颈项强直", + "E": "头摇头痛" + }, + "answer": "A", + "reason": "阴虚动风证的临床特点。手足动是阴虚动风证的临床特点。四肢抽搐、颈项强直是热极生风的临床特点;眩晕欲仆、头摇头痛是肝阳化风的临床特点。" + }, + { + "question_num": 326, + "query": "患者，女，30岁。有风湿性关节炎病史。检查：心尖部可听到4级收缩期杂音，X线显示左心房、左心室增大。应首先考虑的心瓣膜病变是", + "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": "A", + "reason": "心尖部可听到4级收缩期杂音，为左心室收缩时血液通过二尖瓣返流至左心房，故左心房增大。长期返流将导致左心室有效泵出量不够而发生左心室代偿性肥大，故本题考虑为风心病导致二尖瓣关闭不全，故选A。" + }, + { + "question_num": 327, + "query": "患者,男,40岁。因受寒而哮喘发作，呼吸急促,喉中哮鸣,如水鸡声,咳嗽,胸膈满闷,痰少咳吐不爽,形寒怕冷,渴喜热饮,舌苔白滑,脉象浮紧。主方选", + "options": { + "A": "射干麻黄汤", + "B": "三子养亲汤", + "C": "苏子降气汤", + "D": "小青龙汤", + "E": "桂枝汤" + }, + "answer": "A", + "reason": "哮病的辩证论治。患者辨病属哮病发作期,寒哮。辩证为寒痰伏肺,遇感触发。治当温肺散寒,化痰平喘,方选射干麻黄汤。" + }, + { + "question_num": 328, + "query": "患者，女，46岁。半年来头皮、四肢出现皮损，色焮红，瘙痒，鳞屑增多，有筛状出血点，喜凉怕热，便干尿黄，舌红苔黄，脉滑数，其证候是", + "options": { + "A": "血虚肝旺", + "B": "火毒炽盛", + "C": "湿热蕴积", + "D": "血热", + "E": "风热" + }, + "answer": "D", + "reason": "此证为白疕，相当于西医的银屑病，结合喜凉怕热,便干尿黄,舌红苔黄,脉滑数,辨证属血热内蕴证。治法:清热解毒凉血。方药:犀角地黄汤或凉血地黄汤加减。" + }, + { + "question_num": 329, + "query": "下列各项，不是血虚证临床表现的是", + "options": { + "A": "经少经闭", + "B": "头晕眼花", + "C": "心烦失眠", + "D": "面色淡白", + "E": "肢体麻木" + }, + "answer": "C", + "reason": "血虚证表现为面白无华或袭黄,唇色淡白,爪甲苍白,头晕眼花,心悸失眠,手足发麻,妇女经血量少色淡,经期错后或闭经,舌淡苔白，脉细无力,故选C。心烦一般为虚热内扰所致。" + }, + { + "question_num": 330, + "query": "患者，男，40岁。十二指肠溃疡病史15年。近2个月来自感头痛、眩晕而就诊。检查：血压160/100mmHg，诊断为高血压病，下列降压药应慎用的是", + "options": { + "A": "利血平", + "B": "硝苯地平", + "C": "氢氯噻嗪", + "D": "肼屈嗪", + "E": "卡托普利" + }, + "answer": "A", + "reason": "利血平为一种吲哚型生物碱，根据其药理学特性，有精神抑郁性疾病或病史者，有溃疡病病史者、急性局限性肠炎、溃疡性结肠炎、帕金森综合征者为禁用，故选A，其他选项也为常用降压药物，亦需注意其禁忌证。" + }, + { + "question_num": 331, + "query": "患者突然跌倒,神志不清,口吐涎沫。两目上视,四肢抽搐。口中发出如猪羊叫声，移时苏醒，舌苔白腻，脉弦滑。治疗应首选", + "options": { + "A": "定痫丸", + "B": "导痰汤", + "C": "二阴煎", + "D": "涤痰汤", + "E": "控涎丹" + }, + "answer": "A", + "reason": "痫病突然发作,为急性期,两目上视,四肢抽搞,口中作叫,移时苏醒,为阳痢,舌昔白腻，脉弦滑,为风痰闭阻,治宜急速豁痰息风;开窍醒神,用定痫丸,故选A。导痰汤、涤痰汤、控省汤用于痫病急性发作或慢性��止期的化痰之用。二阴煎滋阴降火，安神定志,用于狂证火盛伤阴证。" + }, + { + "question_num": 332, + "query": "患者，男，36岁。手术后1周突然出现右下肢疼痛肿胀，皮肤色泽紫绀，皮温增高，浅静脉怒张，大腿内侧有明显压痛，并伴有低热。应首先考虑的是", + "options": { + "A": "脱疽", + "B": "血栓性浅静脉炎", + "C": "血栓性深静脉炎", + "D": "动脉硬化闭塞症", + "E": "糖尿病坏疽" + }, + "answer": "C", + "reason": "本病主要是创伤或产后长期卧床，以致肢体气血运行不畅,气滞血瘀,阻于脉络,脉络阻塞不通,营血回流受阻,水津外溢,聚而为湿。大多发生于下肢,早期出现下肢突发性、广泛性粗肿,胀痛,行走不利,皮肤温度升高，后期可见浅静脉怒张，足背动脉搏动增强" + }, + { + "question_num": 333, + "query": "以下属于温病逆传的传变现象的是", + "options": { + "A": "卫分传气分", + "B": "上焦传中焦", + "C": "气分传营分", + "D": "营分传血分", + "E": "肺病传心包" + }, + "answer": "E", + "reason": "病邪由上焦肺卫传人中焦胃,再人下焦肝肾,称之为顺传。若病邪从肺卫直接传人心包,病情恶化,称为逆传。" + }, + { + "question_num": 334, + "query": "患者，女，30岁。反复上腹痛6年，饥饿时加重，进食后减轻。近1周来进食后上腹部胀痛加重，但大量呕吐后减轻。查体：轻度脱水，上腹部膨隆有振水音。应首先考虑的是", + "options": { + "A": "多发性溃疡病", + "B": "复合性溃疡病", + "C": "胃溃疡恶变", + "D": "十二指肠溃疡伴幽门梗阻", + "E": "胃窦部溃疡伴急性穿孔" + }, + "answer": "D", + "reason": "结合患者上腹痛、饥饿痛且进食后减轻的临床表现可初步诊断为十二指肠溃疡，近来腹胀加剧、呕吐后减轻、上腹部振水音，系因食物无法从幽门口向小肠运动，应考虑为其重要并发症之一幽门梗阻导致，故选D，其他选项不会产生该患者的梗阻症状。" + }, + { + "question_num": 335, + "query": "患者,男,55岁。3个月前因胸胁部撞伤后,而出现胁肋刺痛,痛有定处，人夜痛甚，舌质紫暗,脉沉涩。治疗应首选", + "options": { + "A": "复元活血汤", + "B": "少腹逐瘀汤", + "C": "膈下逐瘀汤", + "D": "调营饮", + "E": "香附旋覆花汤" + }, + "answer": "A", + "reason": "针对瘀血阻络证(胁痛),用复元活血汤。" + }, + { + "question_num": 336, + "query": "患者，女，44岁。右足第3及第4趾缝间潮湿，糜烂，覆以白皮，渗液较多，伴有剧烈瘙痒。诊断为糜烂型脚湿气，外治应首选", + "options": { + "A": "一号癣药水", + "B": "复方土槿皮酊", + "C": "青黛膏", + "D": "雄黄膏", + "E": "红油膏" + }, + "answer": "D", + "reason": "脚湿气糜烂型可选用1:1500高锰酸钾溶液、3%硼酸溶液或二矾汤浸泡15分钟，次以皮脂膏或雄黄膏外搽。" + }, + { + "question_num": 337, + "query": "甘温除热的代表方剂是", + "options": { + "A": "小建中汤", + "B": "补中益气汤", + "C": "四君子汤", + "D": "黄芪桂枝五物汤", + "E": "升阳益胃汤" + }, + "answer": "B", + "reason": "甘温除热法为金元时期李果所创旨在应用性味甘温的药物治疗虚损引起的发热,其代表方剂为补中益气汤。" + }, + { + "question_num": 338, + "query": "患者，女，21岁。患慢性肾小球肾炎4年，两天来发热咳嗽，查体：T38℃，重症贫血貌，心界向左下扩大，心率130次/分，右肺满布湿性啰音，肝肋下1cm，无明显水肿，肾功能严重损害，胸透示右肺炎症。应选下列哪种抗生素", + "options": { + "A": "多黏菌素", + "B": "卡那霉素", + "C": "青霉素", + "D": "庆大霉素", + "E": "四环素" + }, + "answer": "C", + "reason": "慢性肾小球肾炎合并肺感染的治疗。该患者肾炎4年，两日来发热、咳嗽、心界扩大、右肺炎症，应选青霉素治疗。庆大霉素、卡那霉素具有肾毒性，不宜使用。" + }, + { + "question_num": 339, + "query": "患者脘腹痞闷,嘈杂,饥不欲食,恶心暖气,口燥咽干,大便秘结,舌红少苔,脉细数,其治法是", + "options": { + "A": "补气健牌,升清降浊", + "B": "养阴益胃,调中消痞", + "C": "清热化湿,和胃消痞", + "D": "疏肝解郁,和胃消瘤", + "E": "健脾祛湿,理气除胀" + }, + "answer": "B", + "reason": "痞满兼口燥咽干,大便秘结,舌红少苔,脉细数,为胃阴不足证,治宜养阴益胃,调中消痞。" + }, + { + "question_num": 340, + "query": "肛瘘患者，脓出稀薄不臭，淋漓不尽，伴低热盗汗，面色萎黄，神疲纳呆。检查：局部疮口潜形，周围有空腔。治疗应首选", + "options": { + "A": "二妙丸", + "B": "萆薢渗湿汤", + "C": "黄连解毒汤", + "D": "青蒿鳖甲汤", + "E": "补中益气汤" + }, + "answer": "D", + "reason": "辨证为肛漏之阴虚邪恋型、肺肾阴虚,正气不足,湿热之邪蕴于肛门,阴虚内热则见潮热盗汗等以上诸证,治宜:养阴清热。选方:青蒿鳖甲汤。" + }, + { + "question_num": 341, + "query": "咳声重浊者，多属", + "options": { + "A": "风寒", + "B": "寒湿", + "C": "痰饮", + "D": "燥热", + "E": "肺热" + }, + "answer": "B", + "reason": "咳声重浊紧闷,多属实证,是寒痰湿浊停聚于肺,肺失肃降所致。" + }, + { + "question_num": 342, + "query": "患者，男，50岁。半年来经常突发胸骨后疼痛，有窒息感，持续约1～5分钟，休息后迅速缓解。心电图示ST段下移及T波倒置。应首先考虑的是", + "options": { + "A": "稳定型劳累性心绞痛", + "B": "初发劳累性心绞痛", + "C": "恶化型劳累性心绞痛", + "D": "自发性心绞痛", + "E": "急性心肌梗死" + }, + "answer": "A", + "reason": "稳定型心绞痛指劳力型心绞痛，每次发作频率和诱因相同，疼痛性质和部位无改变，疼痛时限相仿（3～5分钟），休息或自服硝酸甘油后相同时间内产生疗效。发作时心电图可见ST段下移及T波倒置。B项定义为最近1个月内初次发生劳力型心绞痛；C项恶化型指3个月内疼痛的频率、程度、时限、诱因经常变动，进行性恶化。可发作于安静或熟睡时，ST段可压低或抬高；E项发作时疼痛时间常超过30分钟，且休息或服硝酸甘油不缓解，心电图亦不符合。" + }, + { + "question_num": 343, + "query": "患者呕吐清水痰涎,脘闷不食,头晕心悸,舌苔白腻,脉滑,其证候是", + "options": { + "A": "饮食停滞", + "B": "痰饮内阻", + "C": "气滞痰阻", + "D": "食积痰阻", + "E": "气滞食积" + }, + "answer": "B", + "reason": "呕吐清水痰涎,脘闷不食,头晕心悸,舌苔白腻,脉滑,此为呕吐的痰饮内阻证,应用\"小半夏汤合苓桂术甘汤”温中化饮,和胃降逆,故选B。" + }, + { + "question_num": 344, + "query": "患者，女，26岁，已婚。分娩时失血较多，产后小腹隐隐作痛，喜按，恶露量少、色淡，头晕耳鸣，大便干燥，舌淡苔薄，脉虚细。应首先考虑的是", + "options": { + "A": "产后血晕", + "B": "产后腹痛", + "C": "产后大便不通", + "D": "产后恶露过少", + "E": "以上均非" + }, + "answer": "B", + "reason": "产妇在产褥期内,发生与分娩或产褥有关的小腹疼痛,称为“产后腹痛”。该患者分娩时失血较多,导致产后小腹隐隐作痛,应首先考虑产后腹痛病。" + }, + { + "question_num": 345, + "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": "寸口三部分候脏腑:左寸脉为心和膻中,左关脉为肝胆和膈,左尺脉为膀胱、小肠;右寸脉为肺和胸中,右关脉为脾胃,右尺脉为肾和大肠。" + }, + { + "question_num": 346, + "query": "患者，男，30岁。高热、寒战3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": "支气管扩张", + "C": "胸膜炎", + "D": "肺炎", + "E": "肺癌" + }, + "answer": "D", + "reason": "A项往往先有急性上呼吸道感染的症状，少有胸痛、痰中带血；B项反复咳嗽咳痰、咯血；C项不会出现痰中带血，听诊为胸膜摩擦音；E项多有吸烟史，无明显感染表现。" + }, + { + "question_num": 347, + "query": "患者胸膈疼痛,食不得下而复吐,甚至水饮难下，大便坚如羊屎，面色晦滞,形体消瘦,舌红少津,脉细涩,其治法是", + "options": { + "A": "滋阴养血，破结行瘀", + "B": "益气养阴,行气化痰", + "C": "养阴润燥,降气消导", + "D": "润燥行瘀,开郁化痰", + "E": "滋阴养血,散结化痰" + }, + "answer": "A", + "reason": "患者“胸膈疼痛,食不得下而复吐”，此为噎膈的瘀血内结证,应用“通幽汤”滋阴养血,破结行瘀。" + }, + { + "question_num": 348, + "query": "患儿，男，7岁。两足趾、足背皮肤有十余枚隆起赘生物，小者如粟米，大者如黄豆，状如花蕊，表面蓬松枯槁，搔破后易出血，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": "C", + "reason": "辨证为疣:发生于皮肤浅表的良性赘生物,发于足跖部者称学跖疣,发生在手学足底或指趾间，破后易出血。A项好发于躯干和面部:C项发生于手掌,足底或指(趾)间,常在外伤部位发生;D项中年妇女较多见，多发生于颈项或眼睑部位；E项多发于青年男女,好发于颜面部和手背。" + }, + { + "question_num": 349, + "query": "患者由阴虚阳亢所致烦躁不安，心悸失眠，头晕目眩，耳鸣。治疗时应首选", + "options": { + "A": "决明子", + "B": "地龙", + "C": "钩藤", + "D": "牡蛎", + "E": "酸枣仁" + }, + "answer": "D", + "reason": "决明子清热明目,润肠通便。地龙清热定惊,通络,平喘,利尿。钩藤清热平肝,息风定惊。牡蛎重镇安神,潜阳补阴,软坚散结。酸枣仁养心益肝,安神,敛汗。患者主因是“阴虚阳亢”,治宜滋阴潜阳,故选D。" + }, + { + "question_num": 350, + "query": "患者，女，42岁。既往有风湿热史。活动气急5年，伴夜间睡眠时阵发性干咳半年，X线提示梨型心。确诊风心病二尖瓣狭窄还必须有的诊断依据是", + "options": { + "A": "二尖瓣开放拍击音", + "B": "二尖瓣区舒张中晚期隆隆样杂音", + "C": "奔马律", + "D": "Graham-Steelli杂音", + "E": "二尖瓣面容" + }, + "answer": "B", + "reason": "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，呈梨形心。" + }, + { + "question_num": 351, + "query": "患者,男,42岁。呃逆频作,声音洪亮有力,冲逆而出,口臭烦渴,多喜冷饮,脘腹满闷,大便秘结,舌苔黄燥,脉滑数。治疗应首选", + "options": { + "A": "竹叶石膏汤", + "B": "橘皮竹茹汤", + "C": "凉膈散", + "D": "小承气汤", + "E": "泻心汤" + }, + "answer": "A", + "reason": "治宜清热和胃,降逆止呕,方用竹叶石膏汤,故选A。B项降逆为主,清热不足。凉膈散泻火通便,清上泄下,用于上中二焦邪热炽盛,降逆不足。小承气汤作用部位在肠,偏下。泻心汤不能降逆。" + }, + { + "question_num": 352, + "query": "患者肛门刺痛明显，便时便后尤甚，肛门紧缩，裂口色紫黯，便秘，舌紫暗，脉涩。治疗应首选的方剂是", + "options": { + "A": "麻仁丸", + "B": "润肠汤", + "C": "六磨汤", + "D": "当归芍药汤", + "E": "大承气汤" + }, + "answer": "C", + "reason": "结合患者肛门刺痛明显,便时便后尤甚,肛门紧缩,裂口色紫暗,诊断为肛裂,舌紫暗,脉涩。辨证为气涨血瘀证,治以理气活血，润肠通便，方用六磨汤加减。" + }, + { + "question_num": 353, + "query": "患者气血虚寒，痈肿胀成不溃，或溃后久不收口，肾阳不足，畏寒肢冷，阳痿，尿频。治疗应首选", + "options": { + "A": "吴茱萸", + "B": "小茴香", + "C": "干姜", + "D": "肉桂", + "E": "丁香" + }, + "answer": "D", + "reason": "患者\"气血虚寒,痈肿脓成不溃,或溃后久不收口\"，主要是因为气血不足，而“肾阳不足，畏寒肢冷,阳痿、尿频\"则是因为肾阳虚衰,治宜生气养血,补火助阳,而肉桂能够补火助阳,加人补气药中能够鼓舞正气生长,故为最适宜的选项,余项虽然都具有温里之功,但不能鼓舞正气生长。" + }, + { + "question_num": 354, + "query": "患者，男，46岁。十二指肠溃疡病史5年，因饮食不当，突发上腹剧痛就诊，疑诊为十二指肠溃疡并发急性穿孔。明确诊断不宜进行的检查是", + "options": { + "A": "电子胃镜", + "B": "X线腹部透视", + "C": "X线钡餐", + "D": "腹部B超", + "E": "诊断性腹腔穿刺" + }, + "answer": "C", + "reason": "溃疡合并穿孔、活动性出血时禁行X线钡餐检查。" + }, + { + "question_num": 355, + "query": "患者腹痛肠鸣,泻下粪便臭如败卵,但泻而不爽,脘腹胀满,舌苔白厚而腐,脉滑。治疗应首选", + "options": { + "A": "保和丸", + "B": "藿香正气散", + "C": "葛根芩连汤", + "D": "参苓白术汤", + "E": "龙胆泻肝汤" + }, + "answer": "A", + "reason": "宿食内停,阻滞肠胃,故腹痛肠鸣。浊腐下注,故泻下娄便臭如败卵,但泻而不爽,是食滞肠胃泄泻的特点。治宜消食导滞,用保和丸。藿香正气散用于寒湿泄泻。葛根芩连汤用于湿热泄泻。黄连香薷饮用于暑湿泄泻。脾虚泄泻用参苓白术散。肝气乘脾用龙胆泻肝汤。" + }, + { + "question_num": 356, + "query": "患者，女，36岁。两大腿内侧患有钱币形红斑2枚，自觉瘙痒。边界清楚，中央有自愈趋向，多在夏季加重，其诊断是", + "options": { + "A": "紫白癜风", + "B": "圆癣", + "C": "多形性红斑", + "D": "牛皮癣", + "E": "肥疮" + }, + "answer": "B", + "reason": "圆癣,相当于西医的体癣。皮损呈圆形,或多环形,类似钱币状,为边界清楚、中心消退:外周扩张的斑块。四周可有针头大小的红色丘疹及水疱、鳞屑、结痂等,故选B。紫白风,相当于西医的花斑癣,俗称汗斑。牛皮癣,皮损好发于颈项、四肢伸侧、尾骶部。肥疮,相当于西医的黄癣。" + }, + { + "question_num": 357, + "query": "患者血瘀气滞，经行腹痛，兼风湿肩臂疼痛。治疗应选用", + "options": { + "A": "桃仁", + "B": "丹参", + "C": "红花", + "D": "姜黄", + "E": "益母草" + }, + "answer": "D", + "reason": "患者“血瘀气滞”,治宜活血行气,“风湿肩臂疼痛”治宜通经络,祛风湿除痹痛。姜黄活血行气,通经止痛,故选D。桃仁活血祛瘀,润肠通便止咳平喘。丹参活血调经,祛瘀止痛,凉血消痈,除烦安神，红花活血通经，祛止痛。益母草活血调经，利尿消肿,清热解毒。" + }, + { + "question_num": 358, + "query": "患者，男，30岁。查血压160/95mmHg，Hb85g/L，蛋白(+)，颗粒管型2～3个/HP，BUN10mmol/L，Cr220mmol/L。对该患者不宜采取", + "options": { + "A": "低蛋白饮食", + "B": "高蛋白饮食", + "C": "低钠饮食", + "D": "根据尿量多少适当限水", + "E": "低磷饮食" + }, + "answer": "B", + "reason": "慢性肾衰的治疗。患者处于慢性肾衰氮质血症期，高蛋白饮食可引起BUN水平升高，加重临床症状，不利于降低血镁和减轻酸中毒，增加健存肾单位的负荷，加快肾功能的减退。" + }, + { + "question_num": 359, + "query": "患者起病急骤,腹痛剧烈,大便频频,痢下鲜紫脓血。伴有壮热口渴，头痛烦躁,恶心呕吐，舌红绛,苔黄燥，脉滑数。治疗应首选", + "options": { + "A": "芍药汤", + "B": "白头翁汤合芍药汤", + "C": "藿香正气丸", + "D": "连理汤", + "E": "黄连阿胶汤" + }, + "answer": "B", + "reason": "患者起病急,壮热,痢下鲜紫脓血，为疫毒痢的特点。同时伴有热毒内盛的表现。治宜清热解毒,凉血止痢。方用白头翁汤合芍药汤。A项清热解毒力量不足。C项用于化湿。D项用于休息痢发作期湿热兼虚寒。E项用于阴虚火旺证。" + }, + { + "question_num": 360, + "query": "患儿，男，6岁。排便时肛门脱出一肿物，呈环形，色鲜红，便后自行回纳，有时伴有点滴出血，多染于便纸上。最可能的诊断是", + "options": { + "A": "内痔脱出", + "B": "息肉脱出", + "C": "完全性直肠脱垂", + "D": "直肠黏膜脱垂", + "E": "以上均非" + }, + "answer": "D", + "reason": "脱肛多见于幼儿、老年人、久病体弱者及身高瘦弱者。女性因骨盆下口较大及多次分娩等因素，发病率高于男性。起病缓慢，无明显全身症状，早期便后有黏膜肛门脱出，呈环状黏膜皱襞,便后能自行还纳,以后渐渐不能自然回复,须手托或平卧方能复位。日久失治,致使直肠各层组织向下移位，直肠或部分乙状结肠脱出,甚至咳嗽、蹲下或行走时也可脱出，患者常有大便不尽和大便不畅,或下腹部坠痛,腰部、腹股沟及两侧下肢有酸胀和沉重感觉。因直肠黏膜反复脱出暴露在外,常发生充血、水肿、糜烂、出血,故肛门可流出黏液,刺激肛周皮肤,可引起瘙痒。" + }, + { + "question_num": 361, + "query": "患者，男，50岁。素体肥胖，胸闷憋气，时感胸痛，甚则胸痛彻背，舌质紫暗，苔薄腻，脉弦滑。治疗应首选", + "options": { + "A": "青皮", + "B": "乌药", + "C": "薤白", + "D": "木香", + "E": "香附" + }, + "answer": "C", + "reason": "患者“素体肥胖,胸闷憋气,时感胸痛,甚则胸痛彻背”,可诊断为胸痹,其主要的病机是痰浊阻滞胸部气机,故治宜通阳散结,行气导滞。C项为治疗胸痹的要药。青皮疏肝破气,消积化滞,主要用于肝郁气滞证;气滞脘腹疼痛;食积腹痛;微痕积聚,久疟痞块。乌药行气止痛,温肾散寒,用于寒凝气滞胸股诸痛证,尿频遗尿。木香行气止痛,健脾消食,用于脾胃气滞证:泻痢里急后重;腹痛胁痛,黄疽,疝气疼痛;胸痹。香附疏肝解郁,调经止痛，理气调中,用于肝郁气滞胁痛,腹痛:月经不调,痛经,乳房胀痛;气滞腹痛。" + }, + { + "question_num": 362, + "query": "成年男性，全身高度浮肿半年余。检查：血压正常，腹部移动性浊音(+)，尿蛋白(+++)，尿中红细胞1～8/HP，人血白蛋白/球蛋白比例2.1/2.0，酚红排泄率45%。应首先考虑的是", + "options": { + "A": "门脉性肝硬化", + "B": "急性肾小球肾炎", + "C": "慢性肾炎肾���型", + "D": "慢性肾炎普通型", + "E": "慢性肾盂肾炎" + }, + "answer": "C", + "reason": "A项多见肝脾大、侧支循环建立、腹水、肝功能指标异常，少有尿液异常。B项多有前驱链球菌感染。慢性肾炎是临床表现相似的一组肾小球疾病，它们共同的表现是水肿、高血压和尿异常改变。普通型病程迁延，病情相对稳定，多表现为轻度至中度的水肿、高血压和肾功能损害。尿蛋白（+～+++），离心尿红细胞>10/HP和管型尿等。肾病型主要表现为肾病综合征，24小时尿蛋白定量>3.5g，人血白蛋白低于30g/L，水肿一般较重，伴有或不伴高脂血症。病理分型以微小病变、膜性、膜增殖、局灶性肾小球硬化等为多见。E项全身浮肿少见，尿蛋白（+～++）。" + }, + { + "question_num": 363, + "query": "患者大便秘结。欲便不得,嗳气频作,胸胁痞满,重则腹中胀痛,纳食减少,舌苔薄腻,脉弦。治疗应首选", + "options": { + "A": "四磨汤", + "B": "五磨饮子", + "C": "六磨汤", + "D": "四七汤", + "E": "柴胡疏肝散" + }, + "answer": "C", + "reason": "便秘气机郁滞证治宜顺气导滞,降逆通便。方用六磨汤。四磨汤行气降逆,宽胸散结,主治肝郁气逆证,通便导滞力不专。五磨饮子中无大黄，通便导滞不如六磨汤。柴胡疏肝散用于气郁,但本证还有有形实邪在胃肠中,故不宜。" + }, + { + "question_num": 364, + "query": "患者，女，42岁。肛门部肿物，异物感明显，时肿痛。经查可见截石位3、7、11点为静脉曲张性外痔。应首选的治疗措施是", + "options": { + "A": "注射法", + "B": "枯痔法", + "C": "结扎", + "D": "切除法", + "E": "外剥内扎法" + }, + "answer": "D", + "reason": "外痔首选切除法,取侧卧位或截石位,用组织钳提起外痔组织,用剪刀环绕其痔根四周做一梭形切口，再用剪刀分离皮下曲张的静脉丛，将皮肤及皮下组织一并切除，用凡士林纱条填嵌创面引流，无菌纱布包扎。" + }, + { + "question_num": 365, + "query": "治疗大失血、大吐泻所致体虚欲脱、脉微欲绝之证宜首选", + "options": { + "A": "西洋参", + "B": "太子参", + "C": "人参", + "D": "党参", + "E": "黄芪" + }, + "answer": "C", + "reason": "人参大补元气,补脾益肺,生津,安神,为拯危救脱的要药,适用于因大汗、大泻、大失血、或大病、久病所致元气虚极欲脱,脉微欲绝的危重证候。" + }, + { + "question_num": 366, + "query": "患者，男，68岁。高血压病史20年。近日突然意识丧失，深度昏迷，出现三偏征，伴有高热与呕血。应首先考虑的是", + "options": { + "A": "内囊-基底节出血(外侧型)", + "B": "内囊-基底节出血(内侧型)", + "C": "桥脑出血", + "D": "小脑出血", + "E": "蛛网膜下腔出血" + }, + "answer": "B", + "reason": "三偏征（偏瘫、偏盲、偏身感觉障碍）最常见于高血压病引起的内囊一基底节出血，C项表现为交叉性麻痹和感觉障碍，E项眼球运动障碍，D项为眩晕、眼球震颤、共济失调，E项可有脑膜刺激征，故选B。内囊外侧型出血多由豆纹动脉外侧枝破裂引起。血肿向内压迫内囊导致典型的对侧偏瘫和偏身感觉障碍，如为优势半球可有失语，如扩展至额、颞叶或破入脑室可致颅高压、昏迷。内囊内侧型出血典型症状以偏身感觉障碍起病，向外压迫内囊可致偏瘫；向内破入脑室或蔓延至中脑，引起垂直注视麻痹、瞳孔改变、昏迷。预后比壳核出血差。" + }, + { + "question_num": 367, + "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": "瘀血阻滞" + }, + "answer": "C", + "reason": "湿热蕴结肝胆,肝经疏泄失职,故见胁痛胸闷口苦;湿热中阻,故见纳呆,恶心呕吐:肝病及胆,胆汁外溢,故见身黄目黄,故证属肝胆湿热。" + }, + { + "question_num": 368, + "query": "患者，女，28岁。右口角疔疮2天，根深坚硬，形如钉丁状，焮热红肿，疼痛，张口不便。伴恶寒发热，舌苔腻，脉滑数。治疗应首选", + "options": { + "A": "五味消毒饮", + "B": "清暑汤", + "C": "防风通圣散", + "D": "普济消毒饮", + "E": "银翘散" + }, + "answer": "A", + "reason": "生在口角的,叫锁口疔,感受火热之邪,热毒殖于肌肤,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���饮。" + }, + { + "question_num": 369, + "query": "患者由蛔虫引起蛔厥腹痛呕吐，肺虚久咳。治疗宜首选", + "options": { + "A": "槟榔", + "B": "花椒", + "C": "乌梅", + "D": "使君子", + "E": "苦楝皮" + }, + "answer": "C", + "reason": "槟榔杀虫消积,行气,利水,截疟适用于肠道寄生虫病。花椒温中止痛，杀虫止痒。适用于虫积腹痛,有杀虫驱蛔之功。乌梅敛肺止咳,涩肠止泻,安蛔止痛,生津止渴，使君子杀虫消积。用于虫病,蛲虫病;小儿疳积。苦皮杀虫，疗癣。适用于蝈虫病,钩虫病,蛲虫病;疥癣,湿疮。" + }, + { + "question_num": 370, + "query": "患者，女，62岁。右侧肢体无力，两天后因病情渐加重就诊。血压110/80mmHg，意识清，运动性失语，右侧偏瘫。可完全排除的诊断是", + "options": { + "A": "脑梗死", + "B": "脑血栓形成", + "C": "短暂性脑缺血发作", + "D": "脑出血", + "E": "腔隙性脑梗死" + }, + "answer": "C", + "reason": "短暂性脑缺血发作的诊断。该老年女性患者晨起发病，讲话不清，一侧肢体无力，两天后病情加重，因此可完全排除短暂性脑缺血发作的诊断，因为该病历时短暂，症状持续不超过24小时，症状完全消失，一般不遗留神经功能缺损，而该患者两天后右侧偏瘫。" + }, + { + "question_num": 371, + "query": "患者,男,45岁。胃病病史5年,胃脘疼痛剧烈如刀割样,痛有定处而拒按,面色晦暗无华，唇暗，舌暗，有瘀斑，脉涩。治宜", + "options": { + "A": "消食导滞,理气和胃", + "B": "温中健脾,消导和胃", + "C": "理气活血,化瘀止痛", + "D": "泄热和中,健运脾胃", + "E": "温中化湿,健运脾胃" + }, + "answer": "C", + "reason": "胃痛的辩证论治。根据病史、症状、舌苔、脉象综合判断,患者辩证属于胃痛之瘀血阻滞之证,当用失笑散合丹参饮理气活血,化瘀止痛。" + }, + { + "question_num": 372, + "query": "患者，女，20岁，未婚。月经淋漓20日不止，色淡红，质清稀，面色晦暗，头晕耳鸣，腰膝酸软，倦怠乏力，舌淡黯，苔白润，脉沉弱。治疗应首选", + "options": { + "A": "八珍汤", + "B": "归脾汤", + "C": "加减苁蓉菟丝子丸", + "D": "右归丸", + "E": "加减一阴煎" + }, + "answer": "C", + "reason": "此为肾气虚证(崩漏);用加减苁蓉菟丝子丸。" + }, + { + "question_num": 373, + "query": "患者外感发热，邪郁肌腠，项背强痛。治疗应首选", + "options": { + "A": "荆芥", + "B": "白芷", + "C": "薄荷", + "D": "葛根", + "E": "柴胡" + }, + "answer": "D", + "reason": "思者“外感发热,邪郁肌媵,项背强痛”,治宜解肌退热。葛根解肌退热,透发麻疹,生津止渴,升阳止泻,故选D。而荆芥祛风解表,透疹消疮,止血。白芷解表散寒,祛风止痛,通鼻窍,燥湿止带,消肿排脓。薄荷疏散风热,清利头目,利咽透疹,疏肝行气。柴胡疏散退热,疏肝解郁,升阳举陷。" + }, + { + "question_num": 374, + "query": "患者，男，55岁。劳累及情绪激动后，多次出现短时间胸骨后疼痛，下列哪项血清检查对明确诊断最有参考意义", + "options": { + "A": "钾", + "B": "钠", + "C": "氯化物", + "D": "钙", + "E": "胆固醇及甘油三酯" + }, + "answer": "E", + "reason": "患者考虑为冠心病心绞痛，血脂是冠心病高发因素，应查血脂。" + }, + { + "question_num": 375, + "query": "患者腹内积块明显,硬痛不移,面暗消瘦,纳食减少,时有寒热。舌紫暗苔薄，脉细涩,砀艾其证候是", + "options": { + "A": "肝气郁滞", + "B": "食滞痰阻", + "C": "气滞血阻", + "D": "瘀血内结", + "E": "正虚瘀结" + }, + "answer": "D", + "reason": "瘀血凝结,逐日加深,故见腹内积块明显,硬痛不移,血瘀不能华色.故见面暗消瘦,肝病及脾,故纳食减少,时有寒热,证属积证的瘀血内结证。" + }, + { + "question_num": 376, + "query": "患者，女，40岁，已婚。月经规律，平时带下量多，色黄，黏稠，无臭气，纳呆，大便黏腻不爽，舌苔黄腻，脉濡数。治疗应首选", + "options": { + "A": "止带方", + "B": "内补丸", + "C": "易黄汤", + "D": "参苓白术散", + "E": "萆薢渗湿汤" + }, + "answer": "A", + "reason": "患者主症带下量多。“色黄,黏稠,无臭气,纳呆,大便黏腻不爽,舌苔黄腻,脉活数”属于湿热蕴结。代表方为止带方。" + }, + { + "question_num": 377, + "query": "患者脾虚便溏，治疗时尤应慎用的药物是", + "options": { + "A": "石膏", + "B": "芦根", + "C": "知母", + "D": "天花粉", + "E": "淡竹���" + }, + "answer": "C", + "reason": "石膏甘、辛,大寒之品,寒凉药物容易损伤脾胃，且具有滑肠之效,故脾虚便溏者尤应忌用。而知母性寒质润,有滑肠作用,故脾虚便溏者应慎用。" + }, + { + "question_num": 378, + "query": "患者，女，34岁。皮肤反复出血半年。检查血红蛋白90g/L，白细胞5.0×10⁹/L，血小板46×10⁹/L，骨髓增生活跃，颗粒型巨核细胞增多。应首先考虑的是", + "options": { + "A": "再生障碍性贫血", + "B": "急性白血病", + "C": "特发性血小板减少性紫癜", + "D": "脾功能亢进", + "E": "过敏性紫癜" + }, + "answer": "C", + "reason": "皮肤反复出血，外周血小板减少，骨髓增生活跃，颗粒型巨核细胞增多，可推断产板型巨核细胞血小板不良，故首选诊断为特发性血小板减少性紫癜。检查结果未见红细胞及白细胞的减少，骨髓未见增生低下，排除A；脾亢及过敏性紫癜不出现该患者的骨髓变化，排除DE；患者病程半年，除巨细胞外其他系均正常，骨髓增生活跃而不是极度活跃，排除B。" + }, + { + "question_num": 379, + "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": "患者,热多寒少,口渴引饮,便秘,溲赤,舌红苔黄,脉弦数,此为温疟,治宜清热解表、和解祛邪。和解表里,温阳达邪为寒洗的治法。驱邪截疟，和解表里为正疟的治法。解毒除瘴,清热保津为热瘴的治法。益气养血,扶正祛邪为劳疟的治法。" + }, + { + "question_num": 380, + "query": "患者，女，43岁。入院时诊断为肠痈。现腹皮挛急，全腹压痛、反跳痛，腹胀，恶心呕吐，大便不爽，次数增多，小便频数，时时汗出。皮肤甲错。二目下陷，口干而臭。舌红苔黄糙，脉细数，其证候是", + "options": { + "A": "积热不散，热盛肉腐", + "B": "阳明腑实，热盛伤阴", + "C": "寒湿内蕴，瘀血凝滞", + "D": "湿热内蕴，气血瘀滞", + "E": "邪毒内蕴，瘀血凝滞" + }, + "answer": "B", + "reason": "本病由于损伤胃肠,导致肠道传化失司。糟粕停滞,气滞血瘀。瘀阻久则化热,盛则肉腐成痈。大便不爽,次数增多为阳明经症状,便频数,时时汗出,皮肤甲错。二目下陷,口干而臭,为阴伤的表现。" + }, + { + "question_num": 381, + "query": "患者咽喉红肿疼痛，兼有肺热咳嗽痰多者。治疗应首选", + "options": { + "A": "射干", + "B": "鱼腥草", + "C": "马勃", + "D": "板蓝根", + "E": "山豆根" + }, + "answer": "A", + "reason": "“咽喉红肿疼痛\"治宜利咽,“肺热咳嗽痰多\"治宜清肺热止咳化痰。射干清热解毒,消，利啊,故选A。鱼腥草清热解毒,消痈排脓,利尿通淋。马勃清热解毒,利咽,止血。板蓝根清热解毒,凉血,利咽。山豆根清热解毒,利咽消肿。" + }, + { + "question_num": 382, + "query": "患者，男，65岁。近日发现大便色黑，伴不规则上腹痛。查体：左锁骨上窝触及1个1.0cm×1.2cm大小的淋巴结，质硬，大便隐血试验(+++)。应首先考虑的是", + "options": { + "A": "消化性溃疡病", + "B": "胆道感染合并出血", + "C": "胃癌", + "D": "血小板减少性紫癜", + "E": "肝硬化" + }, + "answer": "C", + "reason": "根据题干黑便，不规则上腹部疼痛，可排除A；并触及左锁骨上窝肿大的淋巴结，质硬，大便隐血试验（+++），没有血小板减少，即可排除BDE。黑便是较大量胃肠道出血的表现，结合患者的年龄和左锁骨上窝触及肿大的淋巴结，可考虑胃癌。" + }, + { + "question_num": 383, + "query": "患者,男,35岁。头痛连及项背,恶风畏寒,口不沟，舌苔薄白,脉浮紧。治疗应首选", + "options": { + "A": "瓜萎桂枝汤", + "B": "川芎茶调散", + "C": "葛根汤", + "D": "防风汤", + "E": "增液汤" + }, + "answer": "B", + "reason": "风寒外袭,故恶风畏寒,阻遏太阳经气,故头痛连及项背。口不渴,舌苔薄白,脉浮紧,都是外感风罕的表现。治宣疏风散寒,用川芎茶调散。" + }, + { + "question_num": 384, + "query": "患者，女，28岁。分娩数日后，肢体关节疼痛，屈伸不利，宛如针刺，得热则舒，伴恶寒怕风，脉浮紧。治疗应首选的方剂是", + "options": { + "A": "黄芪桂枝五物汤", + "B": "养荣壮肾汤", + "C": "独活寄生汤", + "D": "身痛逐淤汤", + "E": "桂枝汤" + }, + "answer": "C", + "reason": "由题干产后数日,遍身关节疼痛,得热则舒,伴恶寒怕风,脉浮紧,辨病为产后身痛风寒证，选用独活寄生汤养血祛风、散寒除湿。" + }, + { + "question_num": 385, + "query": "患者，男，50岁。自觉两目模糊，视物不清，伴有头痛，眩晕，舌红少苔，脉细弦。治疗应首选", + "options": { + "A": "升麻", + "B": "葛根", + "C": "薄荷", + "D": "柴胡", + "E": "菊花" + }, + "answer": "E", + "reason": "菊花功能疏散风热,平抑肝阳,清肝明目,清热解毒。用于治疗肝阳上亢,目赤昏花等证、结合题干,治疗首选菊花。" + }, + { + "question_num": 386, + "query": "患者反复呕吐隔餐食物。查体：消瘦，上腹部膨胀，并见胃型。应首先考虑的是", + "options": { + "A": "肝炎", + "B": "肝硬化", + "C": "胃炎", + "D": "幽门梗阻", + "E": "胆囊炎" + }, + "answer": "D", + "reason": "胆囊炎致呕吐有恶心征兆，吐后不觉舒服，伴有发热，无腹胀及胃肠型；幽门梗阻呕吐隔宿食物；肝炎致呕吐有恶心征兆，吐后不觉舒服，伴有黄疸、发热；肝硬化可见上腹膨隆，无胃肠型，有恶心征兆，吐后不觉舒服；胃炎无上腹膨隆及胃肠型，有恶心征兆，吐后觉舒服。" + }, + { + "question_num": 387, + "query": "忠者眩晕,精神萎靡,健忘多梦,腰膝酸软,四肢不温。形寒怯冷，舌质淡,脉沉细无力。治疗应首选", + "options": { + "A": "左归丸", + "B": "右归丸", + "C": "大定风珠", + "D": "大补元煎", + "E": "附子理中丸" + }, + "answer": "B", + "reason": "患者眩晕,见“四肢不温,形寒怯冷“，舌质淡,脉沉细无力\"属肾阳虚,治疗应选右归丸。" + }, + { + "question_num": 388, + "query": "患者，女，34岁，已婚。自然流产3次，现又停经42天，尿妊娠试验阳性。晨起恶心，近2天又有阴道出血，量少、色淡暗，伴头晕耳鸣，双腿酸软，舌淡苔白，脉沉滑尺弱。治疗应首选", + "options": { + "A": "胎元饮", + "B": "泰山磐石散", + "C": "加味阿胶汤", + "D": "举元煎", + "E": "寿胎丸" + }, + "answer": "E", + "reason": "患者主症为妊娠期阴道出血，无腰酸、腹痛、小腹下坠表现,故诊为胎漏。“头晕耳鸣,双腿酸软,香浓苔白,脉沉沿尺弱”——肾虚，比证乃胎漏之肾虚证，治宜补肾健脾,益气安胎。方用寿胎丸加减。" + }, + { + "question_num": 389, + "query": "患者夏伤暑湿，身热烦渴，小便不利，泄泻。治疗应首选", + "options": { + "A": "茯苓", + "B": "猪苓", + "C": "金钱草", + "D": "滑石", + "E": "泽泻" + }, + "answer": "D", + "reason": "针对本题所述症状,应选用兼具清热解暑功效的药物。A项茯苓利水渗湿、健牌宁心;B项猪苓利水消肿、渗湿;C项金钱草利湿退黄、利尿通淋、解毒消肿;D项滑石利水通淋、清热解导、祛湿敛疮;E项泽泻利水消肿、渗湿泄热。" + }, + { + "question_num": 390, + "query": "患者，男，70岁。2周来反复胸痛，发作与劳累及情绪有关，休息可以缓解。3小时前出现持续性疼痛，进行性加剧，伴气促，不能坐卧，血压110/70mmHg，心率120次/分，律齐，心尖部可闻及Ⅲ级收缩期杂音，双肺散在哮鸣音及湿啰音。该患者的诊断最可能是", + "options": { + "A": "风心病二尖瓣关闭不全", + "B": "扩张型心肌病", + "C": "支气管哮喘", + "D": "支气管肺炎", + "E": "急性心肌梗死并发左心衰竭" + }, + "answer": "E", + "reason": "患者反复胸痛，发作与劳累及情绪有关，休息可以缓解，为典型心绞痛症状。3小时前出现持续性疼痛，进行性加剧，应考虑急性心肌梗死。气促、不能平卧、双肺散在哮鸣音及湿性啰音为左心衰竭的表现，心尖部可闻及Ⅲ级收缩期杂音为二尖瓣乳头肌功能失调。" + }, + { + "question_num": 391, + "query": "患者平素头痛眩晕,突发半身不遂,口舌歪斜,舌强语赛,口苦,尿赤便干,舌红苔黄,脉弦数。治疗应首选", + "options": { + "A": "大秦艽汤", + "B": "补阳还五汤", + "C": "镇肝熄风汤", + "D": "苏合乔丸", + "E": "地黄饮子" + }, + "answer": "C", + "reason": "中风之证要先分清中经络还是中脏腑,此题为前者。症见“身不遂,口舌歪斜.舌强语塞，口苦,尿赤便干,舌红苔黄,脉弦数\"为肝阳上亢之证，应平肝潜阳,息风通络,用镇肝熄风汤,故选C。A项治疗风邪入络;B项治疗中风恢复期的气虚血滞证:D项豁痰开窍,治疗神昏;E项滋明补肾利窍,治疗肾精亏虚导致的语言不利。" + }, + { + "question_num": 392, + "query": "患者，女，30岁，已婚，月经25天一行，经来量多。色深红，质稠，有血块，口渴心烦。治疗应首选", + "options": { + "A": "安冲汤", + "B": "保阴煎", + "C": "两地汤", + "D": "解毒四物汤", + "E": "清热固经汤" + }, + "answer": "B", + "reason": "由题千月经25天一行,经来量多，辨病为月经过多,由色深红,质稠,有血块、口渴心烦辨证为血热证,代表方剂是保阴煎。" + }, + { + "question_num": 393, + "query": "患者寒痰咳喘，胸满胁痛。治疗时应首选的药物是", + "options": { + "A": "白芥子", + "B": "紫苏子", + "C": "杏仁", + "D": "葶苈子", + "E": "桔梗" + }, + "answer": "A", + "reason": "患者“寒痰咳喘”治宜温肺化痰,止咳平喘。白芥子温肺化痰,利气,散结消肿,故选A。紫苏子降气化痰,止咳平喘,润肠通便。杏仁止咳平喘,润肠通便。孝苈子泻肺平喘,利水消肿。桔梗宜肺,祛痰,利咽,排脓。" + }, + { + "question_num": 394, + "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": "右肾结石见右上腹剧烈疼痛，右肾区叩击痛；肝癌见右上腹间断疼痛，有压痛，无反跳痛。急性胰腺炎多因饱餐后诱发，呈持续疼痛，有压痛、反跳痛。急性胃炎有恶心，呕吐，上腹部压痛，无反跳痛；急性肝炎有发热，黄疸，恶心，呕吐，右上腹压痛。" + }, + { + "question_num": 395, + "query": "患者男70岁。小便点滴不通,短赤灼热。尿细如线，小腹胀满，口苦口黏，舌质红。苔黄腻,脉数。治疗应首选", + "options": { + "A": "八正散", + "B": "沉香散", + "C": "春洋汤", + "D": "清肺饮", + "E": "石韦散" + }, + "answer": "A", + "reason": "湿热壅积膀胱,故小便短赤灼热,甚则闭而不通,气化不利.故小腹胀满,口苦口黏,舌质红,苔黄黏,脉数都是湿热之证。治宜清热利湿,用八正散.故选A。B项用于肝郁气滞。C项用于脾气不升。D项用于肺热壅盛。E项用于温热石淋。" + }, + { + "question_num": 396, + "query": "患者，女，33岁，已婚。经血非时而下，淋漓不净，色紫暗、有块，小腹胀痛，舌紫苔薄白，脉涩。治疗应首选", + "options": { + "A": "圣愈汤", + "B": "逐瘀止血汤", + "C": "血府逐瘀汤", + "D": "少腹逐瘀汤", + "E": "膈下逐瘀汤" + }, + "answer": "B", + "reason": "首先辨病辨证、由题干经血非时而下,淋滴不净,辨病为崩漏,由色紫暗、有块,小腹胀痛，舌紫苔薄白,脉涩,辨证为血瘀证。崩漏血瘀型应首选逐瘀止血汤。" + }, + { + "question_num": 397, + "query": "患者症见骨蒸盗汗，心烦易怒，消渴多食，遗精尿赤，足膝热痛，舌红少苔，脉细数。治宜选用的方剂是", + "options": { + "A": "大补阴丸", + "B": "清骨散", + "C": "六味地黄丸", + "D": "右归饮", + "E": "当归六黄汤" + }, + "answer": "A", + "reason": "大补阴丸的主治。大补阴丸在补阴之中有强劲的清热泻火之力,所用药物是知母、黄柏。实为补泻同施。清骨散为清虚热之品组成,无补，六味地黄丸的主治与大补阴丸的主治十分接近，也是有补有泻,但是虚热不是十分亢进,就是骨蒸潮热还不是很突出;右归饮补阳,完全不能使用;当归六黄汤治疗表虚而内有实火之证。" + }, + { + "question_num": 398, + "query": "患者，女，76岁。近来时有心悸、胸闷痛，诊断为“变异型心绞痛”。首选的治疗药物是", + "options": { + "A": "卡托普利", + "B": "吗啡", + "C": "硝苯地平", + "D": "倍他乐克", + "E": "利多卡因" + }, + "answer": "C", + "reason": "钙拮抗剂阻止Ca²⁺内流，降低平滑肌细胞内Ca²⁺浓度，从而使冠状动脉扩张，如硝苯地平（心痛定），有强力冠脉扩张作用。定时服用可大幅度的减少变异型心绞痛发作。" + }, + { + "question_num": 399, + "query": "患者，女,47岁。肘关节外上方疼痛2周,肘关节活动时痛甚，局部怕凉。本病属于", + "options": { + "A": "手太阴经筋病", + "B": "手少阴经筋病", + "C": "手阳明经筋病", + "D": "手太阳经筋病", + "E": "手少阳经筋病" + }, + "answer": "C", + "reason": "肘劳,病位在肘部平三阳经筋、根据“肘关节外上方疼痛”,再结合手阳明经在上肢的循行分布,可具体判断为手阳明经筋病。" + }, + { + "question_num": 400, + "query": "患者，女，34岁，已婚。2年来月经量逐渐减少，现闭经半年。带下量少，五心烦热，盗汗失眠。口干欲饮，舌红少苔，脉细数，其证候是", + "options": { + "A": "肝肾不足", + "B": "气血虚弱", + "C": "肾阳虚弱", + "D": "脾虚", + "E": "阴虚血燥" + }, + "answer": "E", + "reason": "由题干2年来月经量逐渐减少，现闭经半年,辨病为闭经;由带下最少,五心烦热,盗汗失眠,口干欲饮,舌红少苔,脉细数,辨证为阴虚血燥。因为阴血不足,日久益甚,虚热内生,火逼水涸,血海燥涩渐涸,故月经量少，渐至闭经;阴虚日久,虚火内生,故五心烦热,盗汗失眠,口干欲饮,舌红少苔,脉细数。" + }, + { + "question_num": 401, + "query": "患者，女，45岁。因淋雨后突然小便频急短数，刺痛灼热，尿色黄赤，口苦，舌苔黄腻，脉滑数。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。治宜清热利湿通淋。方用八正散。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。两根散用于阴虚火旺的血证。" + }, + { + "question_num": 402, + "query": "患者，女，40岁。仰卧位时腹部呈蛙状，侧卧位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": "仰卧位时腹部呈蛙状，侧卧位时下侧腹部明显膨出，移动性浊阳性，提示腹腔积液。" + }, + { + "question_num": 403, + "query": "患者王某,暴病耳聋,鸣声隆隆,伴畏寒,发热,脉浮。宜在翳风、听会、侠溪、中渚基础上，加取", + "options": { + "A": "风门、合谷", + "B": "足三里、三阴交", + "C": "太冲、丘墟", + "D": "外关、合谷", + "E": "丰隆、脾俞" + }, + "answer": "D", + "reason": "上述表现属于耳聋实证之外感风邪证,治疗在主穴基础上加取外关和合谷。" + }, + { + "question_num": 404, + "query": "患者，女，28岁，已婚。经前小腹疼痛拒按。有灼热感，平素少腹时隐痛，经来时疼痛加剧。低热，经色暗红，质黏，带下黄稠，溲黄，舌红苔黄腻，脉弦数，其治法是", + "options": { + "A": "理气活血，化瘀止痛", + "B": "清热除湿，化瘀止痛", + "C": "益气补血，化瘀止痛", + "D": "养血柔肝，理气止痛", + "E": "调和营卫，化瘀止痛" + }, + "answer": "B", + "reason": "由题干经前小腹疼痛拒按,辨病为痛经,由小腹疼痛拒按,有灼热感,平素少腹时隐痛,经来时疼痛加剧,低热,经色暗红,质黏,带下黄稠,溲黄舌红苔黄腻,脉弦数,辨证为湿热瘀阻证。治法是清热除湿,化瘀止痛。" + }, + { + "question_num": 405, + "query": "患者，男，23岁。6月23日就诊。近来天气炎热，大量食用冷饮，昨夜通宵在空调低温下休息，早起感发热恶寒，头痛，胸膈满闷，恶心，呕吐1次，腹泻3次，舌苔白腻，脉濡或缓。治疗最佳选方是", + "options": { + "A": "九味羌活汤", + "B": "麻黄汤", + "C": "三仁汤", + "D": "平胃散", + "E": "藿香正气散" + }, + "answer": "E", + "reason": "藿香正气散主治内伤湿滞,外感风寒之证。本例患者发病季节、诱因和病变证候十分典型,辨证不难。麻黄汤证是无汗而喘;三仁汤证是湿温证;九味羌活汤证是外寒内热:平胃散证是牌胃湿滞、而无外感之证。" + }, + { + "question_num": 406, + "query": "患者，男，45岁。肥胖体形，无症状，健康查体时发现尿糖阳性。空腹血糖稍高，葡萄糖耐量降低，其诊断是", + "options": { + "A": "2型糖尿病", + "B": "1型糖尿病", + "C": "糖尿病酮症酸中毒", + "D": "肾炎", + "E": "肾病" + }, + "answer": "A", + "reason": "Ⅰ型糖尿病多发生于青少年，其胰岛素分泌缺乏，必须依赖胰岛素治疗维持生命。2型糖尿病多见于30岁以上中、老年人，其胰岛素的分泌量并不低甚至还偏高，病因主要是机体对胰岛素不敏感（即胰岛素抵抗）。C项是糖尿病的一种急性并发症，是血糖急剧升高引起的酮症酸中毒。DE项尿检查有尿蛋白。" + }, + { + "question_num": 407, + "query": "患者,男,48岁。头胀痛近2年,时作时止,伴目眩易怒,面赤口苦,舌红苔黄,脉弦数。治疗除取主穴外，还应选用的穴位是", + "options": { + "A": "头维、内庭、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": "肝阳上允头痛,治疗除取主穴外，还应选用的穴位是太溪、侠溪、太冲。" + }, + { + "question_num": 408, + "query": "患者，女，20岁，未婚。每于经期鼻衄，量多、色深红。心烦易怒，口苦咽干，尿黄便结。近3个月来，月经提前7天。量少、色红，舌红苔黄，脉弦数，其诊断是", + "options": { + "A": "逆经肺肾阴虚证", + "B": "月经先期血热证", + "C": "逆经肝经郁火证", + "D": "月经先期肝郁化热证", + "E": "月经过少血虚证" + }, + "answer": "C", + "reason": "经行吐衄的定义是每逢经行前后，或正值经期,出现周期性的吐血或衄血,亦有倒经、逆经之称。由题干每于经期鼻衄,辨病为逆经，由心烦易怒,口苦咽干,尿黄便结,辨证为肝经郁火证。" + }, + { + "question_num": 409, + "query": "患者脾胃虚弱，饮食内停。症见食少难消，脘腹痞闷，大便溏薄，舌苔腻微黄，脉虚弱。治疗应首选", + "options": { + "A": "健脾丸", + "B": "保和丸", + "C": "四君子汤", + "D": "参苓白术散", + "E": "木香槟榔丸" + }, + "answer": "A", + "reason": "本题辨证为脾虚食积,健脾丸健脾和胃消食。" + }, + { + "question_num": 410, + "query": "患者多食，大便每日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": "患者有多食、大便次数多等高代谢症状，且有双眼突出，提示有甲亢可能，而心律不齐、脉搏短绌为房颤的典型表现，所以本题患者有甲亢及房颤可能，而本题并未提及患者有糖尿病、风心病、高血压病、肺心病病史。" + }, + { + "question_num": 411, + "query": "患者,男，50岁。咳月余,加重1周,咳引胸胁疼痛,痰少而稠,面赤咽干,舌苔黄少津,脉弦数。治疗应首选", + "options": { + "A": "手太阴、手阳明经穴", + "B": "手太阴、足太阴经穴", + "C": "足厥阴、手太阴经穴", + "D": "足阳明、手阳明经穴", + "E": "手阳明、足厥阴经穴" + }, + "answer": "C", + "reason": "经诊断此四者为咳嗽,以肃肺理气,止咳化痰为主,当取手太阴肺经,如太渊为肺经原穴,本脏真气所注,取之肃理肺气。患者同时可见咳引胸胁疼痛及痰少而稠，面赤咽干,舌苔黄少津,则应取足厥阴穴位疏肝理气。" + }, + { + "question_num": 412, + "query": "患者，女，49岁，月经或前或后，烘热出汗，五心烦热，头晕耳鸣，腰酸乏力。舌红苔薄，脉细数。治疗应首选", + "options": { + "A": "左归丸", + "B": "内补丸", + "C": "肾气丸", + "D": "两地汤合二至丸", + "E": "二仙汤合二至丸" + }, + "answer": "A", + "reason": "由题干女,49岁,月经或前或后,烘热出汗,五心烦热,头晕耳鸣,腰酸乏力,舌红苔薄,脉细数,辨为绝经前后诸证肾阴虚证,代表方剂是左归丸。" + }, + { + "question_num": 413, + "query": "患儿，女，3岁。高热神昏，痉厥抽搐，尿赤便秘，舌红绛苔干黄，脉数有力。治宜选用", + "options": { + "A": "苏合香丸", + "B": "牛黄清心丸", + "C": "紫雪", + "D": "至宝丹", + "E": "安宫牛黄丸" + }, + "answer": "C", + "reason": "紫雪功能清热开窍,长于息风止痉,兼可泻下通便。主治温热病,热闭心包及热盛动风证。症见高热烦躁,神昏谵语,痉厥,口渴唇焦,尿赤便秘,舌质红锋,苔黄燥,脉数有力或弦数,以及小儿热盛惊厥。" + }, + { + "question_num": 414, + "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": "胃穿孔多有胃溃疡病史，突然出现剧烈腹痛伴休克；胃痉挛按压后可减轻；胃溃疡为节律性、慢性、周期性疼痛，可有压痛；胃炎有饮食不节病史，上腹部压痛；急性胃扩张有暴饮暴食史，伴恶心，上腹部压痛。" + }, + { + "question_num": 415, + "query": "患者,女,34岁。3个月前突发高热，热退后出现周身乏力，并见下肢痿软无力，食少纳呆,腹胀便溏,神疲乏力。治疗本病应选用主要经脉是", + "options": { + "A": "手足太阴经穴、夹脊穴", + "B": "手足厥阴经穴、夹脊穴", + "C": "手足少阳经穴���夹脊穴", + "D": "手足阳明经穴、夹脊穴", + "E": "手足太阳经穴、夹脊穴" + }, + "answer": "D", + "reason": "痿证的针灸治疗,治法,驱邪通络，濡养筋脉。以手足阳明经穴和夹脊穴为主。" + }, + { + "question_num": 416, + "query": "患者，女，27岁，已婚。停经46天，妊娠试验阳性。恶心呕吐，食入即吐，神疲思睡，舌淡苔白，脉滑缓。诊为妊娠恶阻，其证候是", + "options": { + "A": "脾虚痰滞", + "B": "脾胃虚弱", + "C": "气阴两虚", + "D": "肝胃不和", + "E": "以上均非" + }, + "answer": "B", + "reason": "由题干恶心呕吐,食入即吐,神疲思睡,舌淡苔白,脉滑级,辨证为脾胃虚弱。" + }, + { + "question_num": 417, + "query": "患者，男，32岁。小便频数，白如米油，凝如青糊，舌淡苔白，脉沉。治宜选用", + "options": { + "A": "金锁固精丸", + "B": "缩泉丸", + "C": "桑螵蛸散", + "D": "天台乌药散", + "E": "草薢分清饮" + }, + "answer": "E", + "reason": "草幕分清饮功能温肾利湿,分清化浊。主治下焦虚寒之膏淋、白浊。" + }, + { + "question_num": 418, + "query": "患者，男，20岁。反复咳嗽，咳痰量多已2年。今天突然咳鲜血300ml，无发热，不消瘦。听诊：右下肺闻及小水泡音。应首先考虑的是", + "options": { + "A": "大叶性肺炎", + "B": "肺结核", + "C": "支气管扩张", + "D": "风湿性心脏病二尖瓣狭窄", + "E": "肺脓肿" + }, + "answer": "C", + "reason": "支气管扩张大多继发于急慢性呼吸道感染和支气管阻塞后，反复发生支气管炎症，导致支气管壁结构破坏，引起支气管异常和持久性扩张。临床主要表现为慢性咳嗽、咳大量脓痰和（或）反复咯血。本患者临床症状及病史，支持支气管扩张诊断。" + }, + { + "question_num": 419, + "query": "某患儿,睡中遗尿,精神疲乏,肢冷畏寒,舌淡,脉沉细,除相应的背俞穴、募穴外,应选取的经脉是", + "options": { + "A": "任脉、足太阴", + "B": "任脉、足太阳", + "C": "足太阳、足少阴", + "D": "足太阳、手太阴", + "E": "足太阳、手少阳" + }, + "answer": "A", + "reason": "此为遗尿患儿,治法以调理膀胱，温肾健腺。取任脉，足太阴经以及相应背腧穴为主。" + }, + { + "question_num": 420, + "query": "患者，女，29岁。已婚2年一直未孕，既往月经周期26～28天，行经期4～6天。现停经45天，突然左下腹撕裂样剧痛，并伴头晕恶心，面色苍白。不应采取的措施是", + "options": { + "A": "妊娠试验", + "B": "腹部叩诊", + "C": "后穹隆穿刺", + "D": "立即转院", + "E": "妇科检查" + }, + "answer": "D", + "reason": "题干现停经45天,突然左下腹撕裂样剧痛,并伴头晕恶心，面色苍白,符合异位妊娠的临床表现，应采取的处理是患者平卧，采用妊娠试验腹部叩诊、后穹隆穿刺、妇科检查,以明确诊断,而不应转院,以免途中发生生命危险。" + }, + { + "question_num": 421, + "query": "患者，男，49岁。失眠多梦，惊悸怔忡，心烦神乱，舌红，脉细数。治宜选用", + "options": { + "A": "朱砂安神丸", + "B": "甘麦大枣汤", + "C": "天王补心丹", + "D": "磁朱丸", + "E": "柏子养心丸" + }, + "answer": "A", + "reason": "朱砂安神丸的主治证。朱砂安神丸功能镇心安神、消热养血。主治心火亢盛、阴血不足之神志不安证。症见失眠多梦,惊悸怔忡，心烦神乱舌红,脉细数。" + }, + { + "question_num": 422, + "query": "患者，男，22岁。支气管哮喘病史10年，今晨上班途中因吸入汽车尾气突然发作，以喘憋、呼吸困难为主，伴心悸、乏力，遂急诊。为控制发作应首选的药物是", + "options": { + "A": "沙丁胺醇气雾剂", + "B": "茶碱缓释片", + "C": "泼尼松", + "D": "酮替芬", + "E": "溴化异丙托品气雾剂" + }, + "answer": "A", + "reason": "β₂受体激动剂是缓解哮喘症状的首选药物，沙丁胺醇气雾剂属于β₂受体激动剂。" + }, + { + "question_num": 423, + "query": "患者心前区刺痛，心痛彻背,心慌汗出,面色晦暗,唇甲青紫,舌有瘀斑,脉涩。针灸治疗除主穴外，应配", + "options": { + "A": "膻中、心俞", + "B": "神阙、关元", + "C": "内关、阴郄", + "D": "血海、太冲", + "E": "心俞、脾俞" + }, + "answer": "D", + "reason": "根据患者主诉,应考虑为心绞痛之气滞血瘀证,应配太冲、血海。" + }, + { + "question_num": 424, + "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": "由题干孕后心烦少寐,渴喜冷饮，腰酸腹痛,伴阴道少量出血，舌红苔黄,脉沿数诊断为胎动不安血热证，方剂首选保阴煎。" + }, + { + "question_num": 425, + "query": "患者脘腹痞塞不舒，胸膈满闷，头晕目眩，身重困倦，呕恶纳呆，口淡不渴，舌苔白厚腻，脉沉滑。治疗应首选", + "options": { + "A": "保和丸", + "B": "泻心汤", + "C": "二陈平胃汤", + "D": "越鞠丸", + "E": "补中益气汤" + }, + "answer": "C", + "reason": "痞满伴胸满闷,头晕目眩,身重困倦,呕恶纳呆，不渴为痰湿内阻之证。治以祛湿化痰,理气宽中为法,用二陈平胃汤湿健脾,化痰理气。" + }, + { + "question_num": 426, + "query": "患者高热1周。检查：体温40℃，脉搏90次/分，血白细胞4.0×10⁹/L，嗜酸性粒细胞消失。应首先考虑的是", + "options": { + "A": "伤寒", + "B": "中毒性痢疾", + "C": "中毒性肺炎", + "D": "流行性脑脊髓膜炎", + "E": "急性病毒性肝炎" + }, + "answer": "A", + "reason": "伤寒的特点是高热，血象偏低，嗜酸粒细胞消失，骨髓象中有伤寒细胞可临床确诊。" + }, + { + "question_num": 427, + "query": "患者,男,40岁。两天来食人即吐,呕吐酸苦热臭,口渴,喜寒恶热,大便燥结，脉数苔黄。针灸取穴可选用中脘、胃俞、足三里、内关，配穴", + "options": { + "A": "合谷、金津、玉液", + "B": "上脘、脾俞", + "C": "膻中、丰隆", + "D": "下脘、璇玑", + "E": "太冲、阳陵泉" + }, + "answer": "A", + "reason": "呕吐的辨证、处方。从本患者的症状可诊断为呕吐(热收内蕴),治疗应清热降逆止呕,选项A中的各穴均能清热,故为正确答案。" + }, + { + "question_num": 428, + "query": "患者，女，29岁，已婚。妊娠中期出现腹大异常。胸膈满闷，呼吸急促，神疲肢软。舌淡胖，苔白腻，脉沉滑。应首先考虑的是", + "options": { + "A": "子肿", + "B": "子烦", + "C": "子满", + "D": "子痔", + "E": "子晕" + }, + "answer": "C", + "reason": "子满的定义是妊娠5~6月后出现腹大异常,胸膈满闷,甚则追身俱肿,喘息不得卧。题干妊娠中期出现腹大异常,胸满闷,呼吸急促,符合子满的定义,故选C。" + }, + { + "question_num": 429, + "query": "患者，男，40岁。胸膈痞闷，脘腹胀痛，嗳腐吞酸，恶心呕吐，饮食不清，脉弦滑。治疗应选用", + "options": { + "A": "左金丸", + "B": "越鞠丸", + "C": "枳实消痞丸", + "D": "厚朴温中汤", + "E": "保和丸" + }, + "answer": "B", + "reason": "越鞠丸的主治证候。越丸主治六郁证。六郁之中以气郁为主,故气滞疼痛是主要症候。左金丸主治肝气犯胃，以胃脘热痛,吞酸杂为主:枳实消痞丸所主为心下痞满,满而不痛，或疼痛不明显;厚朴温中汤有寒湿气滞;保和丸主治是食积，以食物不消为主症,气滞为次要证候。" + }, + { + "question_num": 430, + "query": "风湿性心脏病心衰服用地高辛13天，出现恶心、呕吐，室早二联律，除停用洋地黄外。治疗应首选", + "options": { + "A": "美西律", + "B": "普萘洛尔", + "C": "钾盐", + "D": "普罗帕酮", + "E": "胺碘酮" + }, + "answer": "C", + "reason": "根据患者病史及临床表现，可诊断洋地黄中毒；对于洋地黄中毒的处理，应立即停药，对快速性心律失常者，应静脉补充钾盐；有传导阻滞及缓慢性心律失常者可用阿托品0.5～1.0mg皮下或静脉注射，故选C。" + }, + { + "question_num": 431, + "query": "患者月经周期提前10天左右，月经量多,色淡质稀,神疲肢倦,纳少便溏,舌淡,脉细。针灸治疗在关元、三阴交基础上，应加取", + "options": { + "A": "足三里、脾俞", + "B": "血海、太冲", + "C": "肝俞、肾俞", + "D": "归来、子宫", + "E": "归来、命门" + }, + "answer": "A", + "reason": "根据题干症状诊断:月经先期。月经先期针灸治疗主穴:关元.三阴交、血海,配穴:实热配行间;虚热配太溪;气虚配足三里、脾俞。月经过多配隐白。" + }, + { + "question_num": 432, + "query": "患儿，3岁。筋骨萎弱，发育迟缓，坐、立、行走、牙齿的发育都晚于同龄小儿，颈项萎软，天柱骨倒，目无神采，夜卧不安，舌淡，苔少，其证型是", + "options": { + "A": "脾肾气虚", + "B": "痰瘀阻滞", + "C": "肝肾亏损", + "D": "心脾两虚", + "E": "肾阳亏虚" + }, + "answer": "C", + "reason": "肝肾亏损证。证候:筋骨萎弱，发有迟缓,坐起、站立、行走、生齿等明显迟于正常同龄小儿,头项萎软,天柱骨倒,舌淡,苔少,脉沉细无力。" + }, + { + "question_num": 433, + "query": "患者，男，43岁。口苦，心烦，胸闷不舒，入睡困难，舌质红，脉数。用药宜首选", + "options": { + "A": "栀子、淡豆豉", + "B": "栀子、竹叶", + "C": "黄连、肉桂", + "D": "酸枣仁、柏子仁", + "E": "酸枣仁、远志" + }, + "answer": "A", + "reason": "栀子苦寒清降,清泻三焦火邪,有清心除烦之效,用于邪热客心,心烦郁闷,躁扰不宁,虚烦不眠等症，每与淡豆豉配伍，以宣泄邪热，解郁除烦,如栀子豉汤。此为热邪扰心,虚烦不眠,故选A。" + }, + { + "question_num": 434, + "query": "患者，男，55岁。高血压病史20年，心电图Rv5=4.0mV，Rv5+Sv1=4.9mV，心电轴-45°，应诊断为", + "options": { + "A": "左心室肥大", + "B": "右心室肥大", + "C": "左心房及左心室肥大", + "D": "左心室高电压", + "E": "双侧心室肥大" + }, + "answer": "A", + "reason": "左心室肥大的心电图上可出现如下改变。①QRS波群电压增高：胸导联Rv₅或Rv₅＞2.5mV，Rv₅+Sv₁＞4.0mV（男性）或＞3.5mV（女性），肢体导联中，R₁＞1.5mV，RaVL＞1.2mV，RaVF＞2.0mV，R₁+S₃＞2.5mV；②可出现额面心电轴左偏；③QRS波群时间延长到0.10～0.11秒，但一般＜0.12秒；④在R波为主的导联，其ST段呈下斜型压低达0.05mV以上，T波低平、双向或倒置。" + }, + { + "question_num": 435, + "query": "患者腰部扭伤,痛在腰部正中,舌质淡红，脉弦。宜选取", + "options": { + "A": "阿是穴、腰痛点、委中、太冲", + "B": "阿是穴、腰痛点,委中、阳陵泉", + "C": "阿是穴、腰痛点、委中、太溪", + "D": "阿是穴、腰痛点、委中、手三里", + "E": "阿是穴、腰痛点、委中、大肠俞" + }, + "answer": "E", + "reason": "相关部位扭伤的针灸主穴:阿是穴、局部腧穴。爵部:阿是穴、大肠俞、腰痛点、委中。" + }, + { + "question_num": 436, + "query": "患者，女，24岁，已婚。产后10天。高热3天。下腹疼痛拒按，恶露量少、色紫暗，有臭味。烦热渴饮，尿黄便结。舌红苔黄厚，脉滑数，其证候是", + "options": { + "A": "外感风热", + "B": "阴虚内热", + "C": "血热", + "D": "血瘀", + "E": "感染邪毒" + }, + "answer": "E", + "reason": "由题干产后10天,高热3天,辨病为产后发热;由恶露量少、色紫暗,有臭味,烦热渴饮，尿黄便结,舌红苔黄厚,脉滑数,辨证为感染邪毒。" + }, + { + "question_num": 437, + "query": "肺胀患者，神志恍惚，烦躁不宁，咳逆喘促，咯痰不爽，舌暗苔淡黄而腻，脉滑数。治疗应首选", + "options": { + "A": "涤痰汤合苏合香丸", + "B": "涤痰汤合至宝丹", + "C": "玉枢丹", + "D": "菖蒲郁金汤", + "E": "通窍活血汤" + }, + "answer": "B", + "reason": "痰蒙神窍,故神志异常。痰热阻肺。治宜涤痰开窍息风。用涤痰汤涤痰，至宝丹开窍息风清热,故选B。" + }, + { + "question_num": 438, + "query": "患者，女，45岁，因患乳腺癌在3个月前行乳腺癌根治术，术中曾输血800ml，在最近追踪检查过程中发现血清ALT150U/L，进一步查肝炎病毒感染标志物发现甲肝抗体阳性，抗HBs阳性，丙肝抗体阳性，丁肝和戊肝抗体均阴性。该病例最可能的诊断是", + "options": { + "A": "手术后谷丙转氨酶升高", + "B": "脂肪肝", + "C": "输血后丙型肝炎", + "D": "转移性肝癌", + "E": "输血后病毒性肝炎，乙、丙肝病毒重叠感染" + }, + "answer": "C", + "reason": "根据题干可知患者3个月前乳腺癌手术输过血，现追踪检查HAVAb阳性，表明患者曾经被HAV感染，对HAV已产生免疫力，目前体内已无HAV。抗HBs阳性说明患者曾患过乙肝，现在已经有抗体或已注射过乙肝疫苗。HCVAb阳性，说明患者感染HCV，且血清ALT150U/L，升高，所以可能患有输血后丙型肝炎。" + }, + { + "question_num": 439, + "query": "患者,男,45岁。自觉心,时息时作,健忘失眠。治疗应首选", + "options": { + "A": "太溪", + "B": "合谷", + "C": "三阴交", + "D": "神门", + "E": "足三里" + }, + "answer": "D", + "reason": "本患者所患病症归经为手少阴心经。神门穴属于心经,可宁心安神,主要治疗心与神志病证。三阴交穴的主要功能是健肿利湿兼调胃脾;足三里主治胃肠疾病,水湿病.癫狂等神志病,并为强壮保健要穴;太溪为足少阴肾经之输穴、原穴,可治疗咽喉肿痛、齿痛、耳聋、��鸣等阴虚性五官病证,肾虚病证以及一些虚性肺部疾病,合谷为手阳明经原穴,主治五官诸疾、外感病证。" + }, + { + "question_num": 440, + "query": "患者，女，32岁，已婚。婚后4年未孕，月经3～5月一行，经量甚少，形体肥胖，头晕心悸，带下量多、质稠，面色㿠白，舌苔白腻，脉滑。治疗应首选", + "options": { + "A": "温胆汤", + "B": "二陈汤", + "C": "温胞饮", + "D": "调经助孕丸", + "E": "苍附导痰丸" + }, + "answer": "E", + "reason": "由题干婚后4年未孕,辨病为不孕症;由形体肥胖,头晕心悸,带下量多、质稠,面色白,舌苔白腻,脉滑,辨证为痰湿型,方选苍附导痰丸。" + }, + { + "question_num": 441, + "query": "患者胸胁支满，目眩心悸，短气而咳，舌苔白滑，脉弦滑。治宜选用", + "options": { + "A": "十枣汤", + "B": "五苓散", + "C": "真武汤", + "D": "五皮散", + "E": "苓桂术甘汤" + }, + "answer": "E", + "reason": "苓桂术甘汤温阳化饮、健脾利湿、用于中阳不足之痰饮证,症见胸胁支满,心悸目眩,短气而咳,舌苔白滑,脉弦滑或沉紧。" + }, + { + "question_num": 442, + "query": "患者，男，20岁。1周来发热、食欲减退、厌油、恶心呕吐、尿黄，黄疸急剧上升至血清总胆红素170μmol/L，凝血酶原活动度35%，近2天出现嗜睡，烦躁不安伴牙龈出血，皮下瘀斑。肝肋下未扪及。患者的诊断首先应想到", + "options": { + "A": "急性肝炎", + "B": "中毒性肝炎", + "C": "急性重型肝炎", + "D": "淤胆型肝炎", + "E": "慢性肝炎" + }, + "answer": "C", + "reason": "急性黄疸型肝炎又称暴发型肝炎，发病多有诱因。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，体检可见扑翼样震颤及病理反射，肝性脑病在Ⅱ度以上（按Ⅳ度划分）。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小于40％，血氨升高，出现中毒性鼓肠，肝臭，急性肾衰竭（肝肾综合征）。即使黄疸很轻，甚至尚未出现黄疸，但有上述表现者，应考虑本病的诊断。" + }, + { + "question_num": 443, + "query": "患者,女,45岁。2天前感觉胁肋部皮肤灼热疼痛，皮色发红,继则出现簇集性粟粒状大小丘状疱疹,虽带状排列，兼见口苦，心烦,易怒,脉弦数。治疗除取主穴外,还应选用的穴位是", + "options": { + "A": "大椎、曲池、合谷", + "B": "行间、大敦、阳陵泉", + "C": "血海、隐白、内庭", + "D": "足三里、阴酸泉、阳陵泉", + "E": "内庭、曲池、太白" + }, + "answer": "B", + "reason": "蛇串疮肝胆火盛,治疗应选用的穴位是行间、大敦、阳陵泉。" + }, + { + "question_num": 444, + "query": "患儿，10个月。高热烦躁，气急鼻扇，张口抬肩，喉中痰鸣，声如拽锯，口唇紫绀，其治法是", + "options": { + "A": "清热宣肺，涤痰定喘", + "B": "清热解毒，止咳化痰", + "C": "辛凉开肺，清热化痰", + "D": "清热活血，泻肺化痰", + "E": "泻肺镇咳，清热化痰" + }, + "answer": "A", + "reason": "本证多见于肺炎喘嗽的中期,痰热俱甚,郁闭于肺,而见上述诸症。临床以发热、咳嗽、痰壅、气急、鼻扇为特征,治疗以清热宣肺,涤痰定喘。" + }, + { + "question_num": 445, + "query": "患儿，3岁。自汗明显，伴盗汗，汗出以头部，肩背明显，动则益甚。面色少华，少气乏力，平时容易感冒，舌淡苔少，脉细弱，其证候是", + "options": { + "A": "表虚不固", + "B": "营卫不和", + "C": "气阴虚弱", + "D": "心脾两虚", + "E": "肝肾阴虚" + }, + "answer": "C", + "reason": "题目中强调自汗明显,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。伴见盗汗提示存在阴虚内热或气阴两虚证，面色少华,少气乏力,平时容易感冒,舌淡苔少,脉细弱等症提示气阴两虚明显。" + }, + { + "question_num": 446, + "query": "患者，男，48岁。肝硬化病史6年。1天前呕血500ml，出现神志淡漠，吐词不清且较缓慢。下列治疗措施中，错误的是", + "options": { + "A": "用酸性溶液灌肠", + "B": "硫酸镁导泻", + "C": "甘露醇导泻", + "D": "肥皂水导泻", + "E": "支链氨基酸静脉输注" + }, + "answer": "D", + "reason": "肥皂水为碱性物质，可使肠道内呈碱性，使氨增多，吸收入血后，可使血氨升高，加重肝性脑病，因此对肝性脑病患者禁用。" + }, + { + "question_num": 447, + "query": "热邪内蕴,多��即吐,呕吐酸苦热臭，口渴,喜寒恶热,大便秘结,脉数苔黄。除针刺主穴之外,还可加用", + "options": { + "A": "上脘、胃俞", + "B": "膻中、丰隆", + "C": "合谷、金津", + "D": "大陵、中脘", + "E": "内关、阳陵泉" + }, + "answer": "C", + "reason": "呕吐的辩证、处方。热政、邪内蕴型呕吐,治疗应清热降逆止哎,C项中的各穴均能清热,故为正确答案。" + }, + { + "question_num": 448, + "query": "患儿，3岁。壮热不退，气急鼻扇，张口抬肩。摇身撷肚，口唇紫绀，胸闷腹胀，大便秘结。治疗应在正确选方的基础上加", + "options": { + "A": "黄芩、连翘", + "B": "天竺黄、全瓜蒌", + "C": "丹参、红花", + "D": "牛黄夺命散", + "E": "桑白皮、沉香末" + }, + "answer": "D", + "reason": "患儿主症总结起来为“热、痰、喘、扇”四个字,由此可初步诊断为肺炎喘嗽。“壮热不退，气急鼻扇,张口抬肩,摇身撷肚,口唇紫绀,胸闷”,由此知其证候为痰热闭肺,且痰热尤重，又有便秘之证,故治疗时应加大清热涤痰力度，在原方基础上增加泄热涤痰通便药物。热甚加黄苓、连翘,痰盛加天竺黄、全瓜蒌,痰热皆盛,又兼便秘应加牛黄夺命散。" + }, + { + "question_num": 449, + "query": "患者口淡乏味，常提示的是", + "options": { + "A": "痰热内盛", + "B": "湿热蕴脾", + "C": "肝胃郁热", + "D": "脾胃虚弱", + "E": "食滞胃脘" + }, + "answer": "D", + "reason": "痰热内盛时的口味为黏腻而苦,故排除。湿热蕴脾时口味多为黏腻而甜,故排除。肝胃郁热时口味多为口酸,也需排除。脾胃虚弱时口味多为口淡,故选D。食滞胃脘口味为口酸。" + }, + { + "question_num": 450, + "query": "患者，女，30岁。月经过多史12年，近1年出现乏力，活动后心悸，气促。查血常规：血红蛋白85g/L，血涂片：成熟红细胞体积小且大小不等，血清铁80μmol/L，血清铁蛋白10μg/L。应首选的医疗措施是", + "options": { + "A": "肌内注射维生素B₁₂", + "B": "口服硫酸亚铁", + "C": "肌内注射右旋糖酐铁", + "D": "输注红细胞悬液", + "E": "皮下注射促红细胞生成素" + }, + "answer": "B", + "reason": "有慢性失血史，血红蛋白、血清铁、铁蛋白减少，诊断为缺铁性贫血。首选二价铁治疗。" + }, + { + "question_num": 451, + "query": "患者,男,75岁,咽喉微感疼痛,色暗红，人夜尤甚。针灸治疗主穴选取", + "options": { + "A": "尺泽、合谷、少商、照海", + "B": "关冲、合谷、少商、列缺", + "C": "关冲、厉兑、鱼际、内庭", + "D": "太溪、照海、鱼际、列缺", + "E": "太溪、曲池、鱼际、合谷" + }, + "answer": "D", + "reason": "根据题干症状诊断为咽喉肿痛虚证。咽喉肿痛虚证的主穴:太溪.照海、列缺、鱼际。" + }, + { + "question_num": 452, + "query": "患儿，5岁。臀部及下肢紫癜1天，呈对称性，色鲜红，瘙痒，发热，舌红，苔薄黄，脉浮数。治疗应首选", + "options": { + "A": "犀角地黄汤", + "B": "连翘败毒散", + "C": "归脾汤", + "D": "化斑汤", + "E": "大补阴丸" + }, + "answer": "B", + "reason": "此为风热伤络证(紫),用连翘败毒散。" + }, + { + "question_num": 453, + "query": "患者腹部痞胀，纳呆呕恶，肢体困重。身热起伏。汗出热不解，尿黄便溏，其舌象应是", + "options": { + "A": "舌红苔黄腻", + "B": "舌红苔黄糙", + "C": "舌绛苔少而干", + "D": "舌绛苔少而润", + "E": "舌红苔白而干" + }, + "answer": "A", + "reason": "题目中所描述症状表现为湿热脾之证。A项主热证,黄腻苔主湿热内蕴、痰饮化热或食积化热。符合题目的病机特点,故选A。B项为伤津之症。C项为阴虚火旺,热盛伤津,津液受损，也需排除。D项为阴虚之证,与题目不符。E项为燥热伤津之证,强调热盛伤津,与题目不符" + }, + { + "question_num": 454, + "query": "患者，女，24岁。头昏、乏力半年，近2年每次月经经期持续7～8天，有血块。红细胞3.0×10¹²/L，血红蛋白65g/L，血清铁蛋白10μg/L，血清叶酸16ng/ml，网织红细胞0.015。该患者最可能的诊断是", + "options": { + "A": "营养性巨幼细胞性贫血", + "B": "缺铁性贫血", + "C": "溶血性贫血", + "D": "再生障碍性贫血", + "E": "珠蛋白生成障碍性贫血" + }, + "answer": "B", + "reason": "该患者红细胞3.0×10¹²/L，血红蛋白65g/L，提示贫血。血清铁蛋白10μg/L，＜正常值（12μg/L），提示缺铁，故该患者最可能的诊断是缺铁性贫血。" + }, + { + "question_num": 455, + "query": "患者,男,42岁。胃脘胀痛,攻痛连胁;嗳气频作,并呕逆酸苦,二便如常,舌苔薄白，脉沉弦。治疗应首选", + "options": { + "A": "足阳明、足厥阴经穴", + "B": "足阳明经穴", + "C": "手、足少阳经穴", + "D": "任脉、足太阴经穴", + "E": "足太阳、督脉经穴" + }, + "answer": "A", + "reason": "从本患者的症状可诊断为胃痛(肝气犯胃型),病变部位主要在肝、胃，治疗应取胃经和肝经的穴位。" + }, + { + "question_num": 456, + "query": "患儿，2岁。半年来经常泄泻，形神疲惫，面色萎黄，大便稀薄，四肢不温，时有抽搐，其证候是", + "options": { + "A": "外感惊风", + "B": "痰食惊风", + "C": "脾肾阳虚", + "D": "土虚木亢", + "E": "阴虚风动" + }, + "answer": "D", + "reason": "忠儿长期泄泻病史,有轻度抽搐症状,由此可诊为慢惊风。患儿久泻不止，脾土受伤,肝木无制,因脾虚肝旺而出现慢惊风的早期症状，故其证候是土虚木亢。" + }, + { + "question_num": 457, + "query": "患者，男，40岁。素有高血压病病史，现眩晕耳鸣，面红头胀，腰膝酸软，失眠多梦，时有遗精或性欲亢进，舌红，脉沉弦细，其病机是", + "options": { + "A": "阴虚内热", + "B": "阴损及阳", + "C": "阴虚阳亢", + "D": "阳损及阴", + "E": "阴虚火旺" + }, + "answer": "C", + "reason": "题目中症状眩耳鸣,腰膝酸软，失眠多梦,脉沉弦细为阴虚证的表现。有高血压病病史,面红头胀,时有进精或性欲亢进,舌红则为阳热亢盛的表现。" + }, + { + "question_num": 458, + "query": "一中年男性患者因急性阑尾炎住院治疗，手术后，主管医生为使患者尽快恢复，给患者使用了一种比较贵的新型抗生素，但并没有同患者商量。患者恢复很快，几天后就可出院。出院时，患者发现自己需付上千元的药费，认为医生没有告诉自己而擅自做主，自己不应该负担这笔钱。在这个案例中，医生损害了患者的哪个权利", + "options": { + "A": "知情同意权", + "B": "疾病的认知权", + "C": "平等的医疗权", + "D": "要求保护隐私权", + "E": "患者的参与权" + }, + "answer": "A", + "reason": "患者所享受的权利：基本医疗权、知情同意权、疾病认知权、保护隐私权、监督医疗权、免除一定的社会责任权、要求赔偿权。无论在医疗的任何环节中都应考虑患者所享有的利益，不能忽视，应予以充分的尊重。同时包括实施诊疗方案的最优化原则。" + }, + { + "question_num": 459, + "query": "某患者大便不通1周余,伴腹中胀痛，胸胁痞满,纳食减少,吸气频作,舌苔薄腻,脉弦。治疗应选", + "options": { + "A": "大肠募穴、足阳明、足少阳经穴", + "B": "大肠背俞穴、手阳明经穴", + "C": "大肠背俞穴、募穴及下合穴", + "D": "大肠下合穴、足阳明经穴", + "E": "大肠募穴、足阳明、足太阳经穴" + }, + "answer": "C", + "reason": "便秘的辩证、处方。从本患者的症状可诊断为便秘(气机郁滞型),大肠俞募相配可疏通大肠腑气,下合穴上巨虚行清通腑,故为正确答案。" + }, + { + "question_num": 460, + "query": "患儿，3岁。面色少华，不思纳食，形体偏瘦。舌淡苔薄白，其治法是", + "options": { + "A": "健脾化湿", + "B": "健脾和胃", + "C": "疏肝和胃", + "D": "消食导滞", + "E": "和脾助运" + }, + "answer": "E", + "reason": "患儿主症为不思纳食,诊为厌食。除厌食外其他症状不著,精神正常。因此为厌食症初期脾失健运证，治宜调和脾胃,运脾开胃。" + }, + { + "question_num": 461, + "query": "患者，男，19岁。因考试过劳紧张，近一周来心情烦躁，入夜难眠，咽干欲饮，舌红苔黄而干，脉数，其证候是", + "options": { + "A": "心阴虚证", + "B": "气血两虚证", + "C": "肝火上炎证", + "D": "心血虚证", + "E": "心火亢盛证" + }, + "answer": "E", + "reason": "心火亢盛证。心烦躁,人夜难眠,说明患者病位在心。干欲饮,舌红苔黄而干，脉数,其病性为实火。病位结合病性，则为心火亢盛证。" + }, + { + "question_num": 462, + "query": "某药店经营者为贪图利益而销售超过有效期的药品，结果造成患者服用后死亡的特别严重后果，依据《中华人民共和国刑法》，给经营者的刑罚是", + "options": { + "A": "处3年以下有期徒刑或拘役，并处或单处罚金", + "B": "处3年以上7年以下有期徒刑，并处或单处罚金", + "C": "处3年以上10年以下有期徒刑，并处或单处罚金", + "D": "处10年以上20年以下有期徒刑，并处或单处罚���", + "E": "处10年以上有期徒刑或无期徒刑，并处或单处罚金" + }, + "answer": "E", + "reason": "《中华人民共和国药品管理法》规定的法律责任有行政责任、民事责任和刑事责任。《中华人民共和国刑法》第一百四十二条规定：生产、销售劣药，对人体健康造成严重危害的，处三年以上十年以下有期徒刑，并处罚金；后果特别严重的，处十年以上有期徒刑或者无期徒刑，并处罚金或者没收财产。药品使用单位的人员明知是劣药而提供给他人使用的，依照前款的规定处罚。" + }, + { + "question_num": 463, + "query": "患者右上腹痛,阵发性加剧,并向右肩部放射,伴有恶心、呕吐。针灸取穴除阳陵泉、日月外,还可用", + "options": { + "A": "胆囊穴、胆俞", + "B": "阑尾穴、中脘", + "C": "胆囊穴、京门", + "D": "中脘、天枢", + "E": "梁丘、太冲" + }, + "answer": "A", + "reason": "根据题干症状诊断:胆绞痛。胆绞痛的主穴:胆囊穴、阳陵泉、胆俞、日月。" + }, + { + "question_num": 464, + "query": "患儿，8岁。身体瘦弱，汗出较多，心烦少寐，寐后汗多，低热，口干，手足心热，唇舌色淡，脉细弱。治疗应首选", + "options": { + "A": "人参五味子汤", + "B": "当归六黄汤", + "C": "黄芪桂枝五物汤", + "D": "生脉散", + "E": "玉屏风散" + }, + "answer": "D", + "reason": "此患者自汗盗汗兼见，当诊为汗证。心烦少寐,低热,口干,手足心热,脉细均为阴虚之象。唇舌色淡,脉弱为气虚之象。由此诊断为汗证之气阴两虚,方用生脉散。" + }, + { + "question_num": 465, + "query": "患者恶寒发热，无汗，头痛，身痛，喘咳，其证候是", + "options": { + "A": "湿淫", + "B": "暑淫", + "C": "寒淫", + "D": "风湿", + "E": "燥淫" + }, + "answer": "C", + "reason": "寒淫治病表现为恶寒发热，无汗头痛,身痛,喘咳,鼻密,苔薄白,脉浮紧。或手足拘急四肢厥冷,脉微欲绝;或腹痛肠鸣,泄泻,呕吐等。" + }, + { + "question_num": 466, + "query": "患儿王某因发热3日到县医院就诊，接诊医师林某检查后拟诊为肾综合征出血热。因县医院不具备隔离治疗条件，林某遂嘱患儿的家长带王某去市传染病医院就诊。按照《中华人民共和国传染病防治法》的规定，林某应当", + "options": { + "A": "请上级医师会诊，确诊后再转诊", + "B": "请上级医师会诊，确诊后隔离治疗", + "C": "向医院领导报告，确诊后对王某就地进行隔离", + "D": "向当地疾病预防控制机构报告，并复印病历资料转诊", + "E": "向当地疾病预防控制机构报告，由疾病控制机构转诊" + }, + "answer": "D", + "reason": "任何单位和个人发现传染病患者或者疑似传染病患者时，应当及时向附近的疾病预防控制机构或者医疗机构报告。医疗机构对传染病应当实行传染病预检、分诊制度；对传染病患者、疑似传染病患者，应当引导至相对隔离的分诊点进行初诊。医疗机构不具备相应救治能力的，应当将患者及其病历记录复印件一并转至具备相应救治能力的医疗机构。目前国家要求二甲以上医院必须开设感染科，县级以下的基层医疗机构医务人员发现传染病患者后应及时报告。" + }, + { + "question_num": 467, + "query": "患者,男,54岁。眩晕半年,加重1周,伴少寐健忘,耳鸣,腰酸膝软,舌红,脉弦细。针灸治疗除取主穴外，还应加用", + "options": { + "A": "行间、侠溪、太溪", + "B": "头维、中脘、丰隆", + "C": "气海、俞、胃俞", + "D": "太溪、悬钟、王阴交", + "E": "气海、血海、足三里" + }, + "answer": "D", + "reason": "该患者为眩晕肾精不足证,应在主穴百会、风池、肝俞、肾俞、足三里的基础上加用太溪、悬钟、三阴交。A项用于肝阳上亢证,B项用于痰湿中阻证,C项用于气血两虚证。" + }, + { + "question_num": 468, + "query": "患儿，6岁。发病2周，全身浮肿，尿少，头晕，头痛。恶心呕吐，口中气秽，甚至昏迷，舌苔腻，脉滑数。治疗应首选", + "options": { + "A": "羚角钩藤汤", + "B": "龙胆泻肝汤", + "C": "己椒苈黄丸合参附汤", + "D": "温胆汤合附子泻心汤", + "E": "真武汤" + }, + "answer": "D", + "reason": "患儿全身浮肿,当诊断为小儿水肿。水肿分为常证和变证,该患者的特征性症状为“尿少,恶心呕吐,口中气秽,甚至昏迷”,可排除变证中的水气凌心证，主要是监别邪陷心肝证和水毒内闭证，邪陷心肝证以神志异常为主，同时可见烦躁、抽搐、晕眩、视物模糊等;水毒内闭证以尿少、尿闭为主其���出证候,故诊为水毒内闭证,方用温胆汤合附子泻心汤。" + }, + { + "question_num": 469, + "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": "气滞血瘀", + "C": "寒湿阻滞", + "D": "湿热熏蒸", + "E": "胆道不利" + }, + "answer": "D", + "reason": "而目皮肤发荧,色泽鲜明如橘皮为湿热蕴结肿胃,再蒸肝胆，致胆汁外溢。精神疲倦，不欲吮乳,尿黄便秘,舌红苔黄为湿热内蕴之证。" + }, + { + "question_num": 470, + "query": "某县为省直接管辖县，该县人民医院发生了患方认为是医疗事故的争议，患方首先提出了要进行医疗事故技术鉴定。按照《医疗事故处理条例》的规定，负责首次医疗事故鉴定工作的组织应当是", + "options": { + "A": "该县卫生行政部门", + "B": "该县医学会", + "C": "该县卫生行政部门的上级组织", + "D": "市级医学会", + "E": "省级医学会" + }, + "answer": "B", + "reason": "参见《医疗事故处理条例》第二十一条：设区的市级地方医学会和省、自治区、直辖市直接管辖的县（市）地方医学会负责组织首次医疗事故技术鉴定工作。省、自治区、直辖市地方医学会负责组织再次鉴定工作。" + }, + { + "question_num": 471, + "query": "患者,男,25岁。排便艰涩难解1周，大便千结,腹胀腹痛,口千口臭,舌红,苔黄燥,脉滑实。治疗首选的主穴是", + "options": { + "A": "天枢、大肠俞、上巨虚、支沟", + "B": "公孙、气海、三阴交、内关", + "C": "太冲、足三里、中脘、支沟", + "D": "合谷、曲池、天枢、公孙", + "E": "神阙、关元、足三里、中脘" + }, + "answer": "A", + "reason": "近取大肠募穴天枢与大肠俞同用为俞募配穴,远取大肠下合穴上巨虚,“合治内腑”,三穴同用通调大肠腑气,理肠通便;支沟宜通三焦,行气导滞,为通便之经验效穴。" + }, + { + "question_num": 472, + "query": "患儿，6岁。小便频数日久，淋漓不尽，尿液不清。畏寒怕冷，舌淡苔薄腻。治疗应首选", + "options": { + "A": "八正散", + "B": "缩泉丸", + "C": "菟丝子散", + "D": "补中益气汤", + "E": "金匮肾气丸" + }, + "answer": "B", + "reason": "小便频数,诊为尿频。根据“畏寒怕冷,手足不温,大便溏薄”可判断为脾肾气虚,治宜温补脾肾,升提固摄,方用缩泉丸。" + }, + { + "question_num": 473, + "query": "患者寒邪客于脘腹，脘腹痛甚，拒按，舌苔白厚，其脉象应是", + "options": { + "A": "结代", + "B": "滑数", + "C": "弦紧", + "D": "细涩", + "E": "迟弱" + }, + "answer": "C", + "reason": "患者主要表现为寒、痛,而弦脉主肝胆病,诸痛,痰饮,疟疾;紧脉主寒、主痛、主宿食,故该患者脉象应为弦紧。" + }, + { + "question_num": 474, + "query": "某医师，为了从个体推销商手中得到好处，多次使用未经批准的药品和消毒药剂，累计获得回扣6500元。根据相关的规定，应当依法给予该医师的行政处罚是", + "options": { + "A": "责令暂停9个月执业活动", + "B": "警告", + "C": "罚款1万元", + "D": "吊销执业证书", + "E": "没收非法所得" + }, + "answer": "D", + "reason": "①为切实加强医德医风建设，纠正医疗服务领域中收受药品回扣、红包、开单提成、乱收费等不正之风，努力树立行业作风新形象，全面加强行业作风建设，卫健委制定了《关于加强卫生行业作风建设的意见》，明确重申卫生行业纪律，对违反卫生行业纪律的行为要依法依纪严肃查处；②医务人员严禁在医疗活动中收取药品生产或经营单位发放的临床促销费、开单费、处方费、统方费等形式的变相回扣，严禁利用处方权为个人谋私利，切实做到合理用药、合理检查、合理治疗；③《关于在医疗活动中严禁临床促销费开单费等回扣行为的通知》规定，各级卫生行政部门要加强领导、监督和检查，对整顿后仍违反规定的人员，要停止6～12个月的处方权，并记入本人年度考核登记，作为执业医师资格审定的重要依据之一，情节严重的要给予相应的行政处分，构成犯罪的要移送司法机关追究刑事责任。" + }, + { + "question_num": 475, + "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。曲池为大肠经的合穴,属土,为金之母,尺泽穴为肺经的合穴。鱼际父是肺经的荥穴,荥穴主身热,故应选肺经的荥穴以清热。" + }, + { + "question_num": 476, + "query": "患儿，4岁。发热2天，纳差恶心，呕吐腹泻，口腔内可见数个疱疹。手、足掌心部出现米粒大小的斑丘疹、疱疹，疱液清亮。躯干处未见有皮疹。舌质红，苔薄黄腻，脉浮数，其证候是", + "options": { + "A": "邪伤肺卫", + "B": "邪犯肺脾", + "C": "邪炽气营", + "D": "湿热熏蒸", + "E": "湿盛阴伤" + }, + "answer": "B", + "reason": "“发热,口腔内可见数个疱疹,手、足掌心部出现米粒大小的斑丘疹、疱疹,疱液清亮，躯干处未见有皮疹”并伴有“纳差恶心，呕吐腹泻\"症状:所以诊为手足口病。“发热2天,舌质红,苔薄黄腻,脉浮数”表明有外感肺卫症状，“纳差恶心，呕吐腹泻”说明脾脏受到外邪侵袭,是外邪自口鼻而人，侵犯肺脾，不是单纯的肺卫表证,故选B。" + }, + { + "question_num": 477, + "query": "患者心烦不得卧，口燥咽干，舌尖红；脉细数，其诊断是", + "options": { + "A": "太阴病证", + "B": "厥阴病证", + "C": "少阳病证", + "D": "少阴热化证", + "E": "少阴寒化证" + }, + "answer": "D", + "reason": "A项表现为腹满欲吐,食不下，自利,口不渴,时腹自痛,舌淡苔白滑,脉沉缓而弱。B项以上热下寒为主证,表现为消渴,气上冲心，心中疼热饥而不欲食,食则吐。C项是对外感病过程的后期阶段,全身性阴阳衰惫所表现证候的概括。D项表现为心烦不得眠,口燥咽干,舌尖红少津,脉象细数。题目中描述的症状即为此。E项表现为无热恶寒，脉微细,但欲寐,四肢冷,下利清谷,呕不能食,或食人即吐,脉微欲绝,甚则身热反不恶寒,面赤。" + }, + { + "question_num": 478, + "query": "某患者因剧烈腹痛到乡卫生院就诊，因医生诊断、治疗错误，造成该患者功能障碍，经县医疗事故鉴定委员会鉴定为三级医疗事故，其家属对鉴定结论持有异议，认为应属二级医疗事故。该事故进一步处理解决的正确程序是", + "options": { + "A": "接到结论通知书15日内，向法院提起行政诉讼", + "B": "由县级医疗事故鉴定委员会重新鉴定", + "C": "接到结论通知书15日内，向上一级卫生行政部门申请复议", + "D": "由当事人所在的医院与患者家属协商解决", + "E": "此鉴定为最终鉴定结论，上报有关部门备案" + }, + "answer": "C", + "reason": "①医疗事故技术首次鉴定单位为市或省直管县（市）的医学会，再次鉴定单位为所在地省级医学会，并由不服首次鉴定的当事人在收到首次鉴定书后15日内向医疗机构所在地卫生行政部门提出再鉴定申请；②发生医疗事故争议时，患方可以复印的资料：门诊病历、住院志、体温单、医嘱单，化验单（检验报告）、医学影像检查资料、特殊检查同意书、手术同意书、手术及麻醉记录单、病理资料、护理记录及国务院卫生行政部门规定的其他病历资料，而不可复印的在《医疗事故处理条例》中没有规定，一般认为是会诊记录；③负责鉴定的医学会应在受理后5日内通知医患双方提交有关资料；医患双方收到提交有关资料的通知后10日内按要求提交有关资料、书面陈述及答辩。当事人对首次鉴定不服的，在收到首次鉴定书15日内向医方所在地卫生行政部门提出再鉴定。" + }, + { + "question_num": 479, + "query": "患者，男，65岁。耳中蝉鸣,时作时止,按之鸣声减弱,听力亦下降,伴神疲乏力，食少腹胀,便溏,脉细弱。治疗宜在听宫、翳风、太溪、肾俞基础上,加用", + "options": { + "A": "行间、丘墟", + "B": "外关、合谷", + "C": "丰隆、阴陵泉", + "D": "气海、足三里", + "E": "肾俞、肝俞" + }, + "answer": "D", + "reason": "耳鸣的辩证.处方。从上患者的症状可诊断为耳鸣,脾气虚型。针灸治疗宜加用足三里以健脾胃,补益气血,气诲以益气培元,标本兼顾,共奏补脾益气之功,故选D。" + }, + { + "question_num": 480, + "query": "患者，女，20岁，未婚。月经淋漓20日不止，色淡红，质清稀，面色晦暗。头晕耳鸣，腰腿酸软，倦怠乏力，舌淡暗，苔白润，脉沉弱。治疗应首选", + "options": { + "A": "八珍汤", + "B": "归脾汤", + "C": "加减苁蓉菟丝子丸", + "D": "右归丸", + "E": "加减一阴煎" + }, + "answer": "C", + "reason": "由题干月经淋滴20日不止辨病为崩漏,由色淡红,质清稀,面色晦��,头晕耳鸣,腰腿酸软,倦怠乏力,舌淡暗,苔白润,脉沉弱,辨证为肾气虚证。代表方剂加减苁蓉菟丝子丸。" + } +] 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