臨床診斷學課程習題

選擇題（中文A.第四胸椎下緣B.氣管分叉C.心房下緣D. A.矮胖體型者B.肺氣腫C.D.A.腦B.酮癥酸C.尿毒癥酸D.神經(jīng)衰A.肺氣腫B.大量胸腔積液C.性肺不張D.胸壁皮下氣A.肺氣腫B.肺不張C.隔肌麻痹D.肺尖部結核A.大葉性B.空洞性肺結核C.性肺不張D.支氣管 B.氣管向患側移位C.患側叩診呈濁音D.患側語音增多選題（中文（AA.B.C.肺下界降低D.（ABCDA.慢性支氣管炎B.支氣管哮喘C.心源性哮喘D.A.喉部B.背部第1，2胸椎附 C.胸骨兩側第1，2肋間D.右肺肺泡呼吸音的特點是（ACA.柔和吹風樣B.吸氣音比呼氣音弱C.音調(diào)較高時間較長D.ha左側胸痛可見于下列哪些疾病（ABCD急性胰腺炎B.肺癌C.急性冠脈綜合癥D.問答題（中文答：吸氣性呼吸特點,吸氣費力，顯著時出現(xiàn)三凹癥，常伴干咳與高調(diào)吸氣性喉鳴，提答視診喜患側位，患側胸廓飽滿，肋間隙增寬，呼吸運動受限，心尖搏健側移位。觸診氣管移向健側，患側呼吸運動減弱，語音振顫減弱或。聽診積液區(qū)呼吸音減弱或語音減弱或積液上方可聞及減弱的支氣管答由于氣管.支管或細支管狹窄或分阻塞,吸入或呼出時生湍流所生特點：持續(xù)時間較長,吸氣及呼氣時均可聽及，以呼氣時為明顯。干羅音的強度和性質(zhì)易改答1）胸膜炎癥如結核性胸膜炎WhichoneisnottrueforsternalItisalsotermedLouisItisformedbytheprotrusionoftheconjunctioncomposedofsternumandmanabriumsterni.Itactsasanimportantlandmarkforcountingrib(paralleltothirdrib)andItindicatesthebifurcationofthetrachea,theupperleveloftheatriaofheart,thedemarcationofupperandlowerpartofmediastinum,andthefifththoracicvertebraasThedepressedregionabovetheclavicle,whichcorrespondstotheupperpartofeachlungapex,iscalled( A.Suprasternalfossa B.Supraclavicularfossa C.InfraclavicularfossaD.SuprascapularregionBarrelchestisoftenseenin C.chronichecticdisease D.p KEY:(B)Subcutaneousemphysemaatchestiscommonlyduetothefollowing injuriesofinjuriesofinjuresoflocalinfectionofbacillusaerogenesKEY:(D)Deepslowbreathing(Kussmaul’srespiration)istypicalof( KEY:(B)Tachypneaindicatestheincreasedrespiratoryrate,over )per KEY:(C)WhichofthefollowingiswrongforthelowerboundaryoftheanteriorpartwhichbeginsfromthesixthatthelevelofthesixthinterspacealongthemidclavicuarattheleveloftheeighthinterspacealongthemidaxillarytheposteriorpartofthelowerboundarythatapproacheshorizontallineattheninthriblevelbytheinferioranglelineWhichofthefollowingisA.Tidalbreathingisalsocalledcheyne-stokesCheyne-stokesrespirationwaxesandwanescyclicallysothatperiodsofdeepbreathingalternatewithperiodsofapnea(nobreathing).Ataxicbreathingischaracterizedbyunpredictableirregularity.Breathsmaybeshallowordeep,andstopforshortperiods.Ataxicbreathingislessseverethanthetidalbreathing.KEY:(D)Fremitusisdecreasedorabsentinthefollowingconditions obstructedbronchusorchronicobstructivepulmonarypleural Hyperresonancecanbeheardduringthepercussionof A. B.C..tuberculosis D.pleuraleffusionKEY:(B)WhichoneisnottrueforbronchialBronchialbreathsoundsareingeneralhigherinpitchthanvesicularorbronchovesicularsounds.ExpirationusuallysurpassesinspirationinBronchialbreathingisnormallyheardovertheItoccursonlywithpulmonaryconsolidation.KEY:(C)Theincreaseofvesicularbreathsoundsmayindicate A.pleuralfluid C.foreignbodyintrachea D.p KEY:(B)Oneofthemostcommoncausesofdecreasedorabsentbreathsoundsis fluidinthepleuralcompletebronchialobstructionKEY:(B)WhichofthefollowingcharacteristicisincorrectformoistItisformedbecauseoftherepresentstrictureorpartialobstructionofthetrachea,bronchiorbronchioles,ItisformedduetothepassageofairthroughthinsecretionsintherespiratoryItcanbecausedbyexudate,sputum,blood,mucus,orThesoundmaydiminishaftercough.KEY:(A)Howtodescribethemassofbreastintermsofpalpation①Location:Theexactlocationofthemassmustbedesignated.Generalmethodistotakethenippleasthecentralpoint,describethemassaccordingtotheclocknumbersandaxis.Furthermore,thedistanceofthemassfromthenipplemustberecordedforthesakeofaccuratelocationofthemass.②Size:Themassmustbedescribedinlength,widthandthickness,forthecomparisoninthefuturetodetermineifitprogressesorregresses.③Contour:payattentiontowhetherthemassisregularorirregular,themarginisdulloracute,andwhetheritadherestosurrondingtissueornot.Mostbenigntumorshaveasmooth,regularcontour,whereasmostmalignantmassesareconvavoconvex,withfirmedmargin.However,itmustbementionedthatinfltorylesionsmayalsohaveanirregularcontour.④Consistency:Thehardnessmustbedescribedclearly.Itmaybedescribedgenerallyassoft,cystic,moderayfirmorextremelyhard.Abenigntumorisusuallyfeltsoft,cystic;whileafirmconsistencymasswithirregularcontourusuallydenotesamalignantlesion.However,ahardregionmayalsobecausedbyinfltion.⑤Tenderness:Itshouldbeascertainedwhetherornotthelesionistender,and,ifso,towhatdegree.Aninfltoryprocessisusuallymoderayormarkedlytender,whereasmostmalignantlesionsarenotobviouslytender.⑥Mobility:Theexaminershoulddeterminewhetherthelesionislymovable.Ifitismovableincertaindirections,orfixed,hemustdeterminewetherthemassisfixedtotheskin,tothedeepstructures,ortothesurroundingbreasttissue.Mostbenignlesionshavealargemobility,infltorylesionisconsiderablyfixed,andamalignantlesioninearlystageismovable,however,astheprocessdevelopes,esfixedbecauseotherstructuresarePleasedescribetheetiologyandcharacteristicsofmoistralesandMoistrale:producedduetopassageofairthroughthinsecretionsintherespiratorytract,suchasexudate,sputum,blood,mucus,orpusetc.Thesoundcouldalsoberegasdedascracklesproducedbyreopeningofthebronchialsatinspirationwhenbronchiolarwalladheresandclosesbecauseoftenacioussecretionatexpiration.Characteristicsofmoistrales:adventioussoundsbesidesbreathsound,discreteandshortintime,oftenseriesofjeveralsoundsappear,siginificantininspirationorintheterminalphaseofinspiration,presentsometimesintheearlyphaseofexpiration,thelocationisratherfixed,qualitynotvariable,mediumandfineralecouldbepresentsimultaneously,itmaydiminishordisappearaftercough.Rhonchi:producedbecausetherepresentstrictureorpartialobstructionofthetrachea,bronchiorbronchioles,airthroughthesepassways esturbulent,thepathologicbasisforwhichisinfltorymembranouscongestionandedemaoversecretion,bronchialmuscularspasm,obstructionduetotumorandforeignbodiesinthebronchiallumen,andstrictureduetooppressianofextraluminalenlargedlymphnodesormediastinaltumors.Characteristicsofrhonchi:theyarecontinuous,relativelylong,andmusicaladventiousbreathsound.Rhochiareratherhigh-pitchedwiththebasicfrequencyofabout300-500Hz.Audiblebothduringinspirationandexpiration,ingeneralmoreprominentduringexpiration.Rhonchiareeasilyvariableinintensity,qualityandlocation,sometimestheychangeobviouslyinstantly.Trytomakedifferentialdiagnosesamongconsolidationoflungdisease,emphysema,aeis,pleuraldiffusionandpothorax

ledononededabothbothADentingDisappearedtheedonedtFullnessDiminishedtheededshedtancedDentingtheedontFullnessDiminishedtheedshedtanced 第五肋間,0.5~1.0cmC.第五肋間,0.5~1.0cm 劍突下搏動意味著肥 摩擦感表示已無積 3／6 S1 Austin-FlintDuroziez 2-55-1010-1515-2020mmHg 問答題（中文鑒別 器質(zhì)性雜 部位肺動脈瓣區(qū)、心尖 小于等于2/6級 常大于等于3/6級 3/6級以上可伴有 收縮壓舒張壓1級高血壓（度2級高血壓（度3級高血壓（度周圍血管征是指由于脈壓增大而導致周圍動脈和毛細血管搏動增強的一組體征沖（AustinFlint雜音DuroziezThebestwaytomakedistinctionbetweenpleuralfrictionsoundandpericardialfrictionsoundis( A.soundtiming soundquality C.soundrelationwithrespiration WhichoneisnottrueforgallopItisthepathologiccounterpartoftheS3andoccursatthetimeofrapiddiastolicventricularfilling.Itisabrieflow-pitchedItoccursatmiddlediastoleattheendofrapidfillingphaseofItreflexesthattheRVfunctionisdecreased.KEY:(D)Continuousmurmurcanbeheardin MitralMitralAorticPatentDuctusArteriosusKEY:(D)HowtodifferentiatebetweenS1and apex pitch,lastingtime pitchlastingtime S1 ApicalDescribethecharacteristicsofatrialfibrillationintermsofTheventricularrhythmhas ynoTheintensityofS1isTherateofheartandpulseareExinthetermauscultatoryvalvel.Mitralvalvearea:itisattheapex,inthefifthleftintercostalspace,medialtothemidclavicularline.Aorticvalvearea:therearetwoauscultatoryareaofAV,oneislocatedinthesecondrightintercostalspace,justlaltothesternum.Theotherisatthethirdorfouthintercostalspace,lefttothesternumborder.WecallitthesecondauscultatoryareaofPulmonaryvalvearea:inthesecondintercostalspacejust ltotheTricuspidvalvearea:atthelowerpartofthesternalnearthe.Thephysicianshouldadoptasystematicwayoflistening:startattheapex,thenmovetothePVarea,AVarea,secondAVarea,TVarea.PleasedescribethesignsofMitralInspection:“MitralFacies”maybepresent.TheapicalpulsemayextendtoleftPalpation:diastolicthrillmaybefeltatPercussion:Thecardiacdullnessextendtoleftinearlystageandlatertoright.Thecardiacsilhouetteislikeapear.Auscultation:Aloudsnappyfirstsoundandalocalizedrumblingdiastolicmurmurinthemid-latestagemaybeheardatapex.Theopeningsnapmaybepresent.Thepulmonarysecondsoundmaybeaccentuatedofsplitting.Doyouknowthemechanismsofheartl).IncreasedvelocityofbloodflowthoughnormalForwardflowthoughnarrowedordeformedBackwardorregurgitantflow petentAbnormalVibrationofloosestructurewithintheIncreasewithdiameterofamajorTrytomakedistinctionbetweenfunctionalmurmurandorganicanyageapexorpulmonaryvalveanylong,inallsystolicnotlong,transmittedwiththedirectionofParadoxicalpulsecanbeenfoundin A.constrictivepericarditis D.anemiaKEY:(A)11.Couldlusthedefinitionsclassificationsofbloodpressure130-85-IsolatedThemostimportantsignindicating petenceisDecreaseinintensityofBoot-likeDiastolicmurmursinaorticAustin-flint'smurmursinapicalWaterhammerpulseKEY:(C)Graham-sl'smurmurmeansdiastolicmurmurintheapicalareacausedbystructuralmitraldiastolicmurmurinaorticareacausedby diastolicmurmurinpulmonicareacausedbyrelatively diastolicmurmurinapicalareacausedbyrelativelymitraldiastolicmurmurcausedbyrelativelytricuspidstenosisKEY:(C)Whichsignreferstostructuralheartliftedapexdiscementoftheapicalimpulsetothepercussionofdullnessextended systolicmurmursinapicalwidesplittingofS2inpulmonaryareaKEY:(C)Whichofthefollowingcharacteristiciswrongastoalowerpitchedsoundthanshortereasilyheardatsupineorleft lmoreclearintheareainnerandsuperiortothecardiacmoreclearattheendofinspirationKEY:(E)WhichofthefollowingcharacteristicisnotconsistentwiththeincreaseintheintensityofS1? ventricularprematuremitralLGLatriaandventricleapartnessKEY:(A)WeakermurmurmeanslessFasterthebloodflows,loudertheThegreaterdifferenceofpressurebetweentwobordersofthestenosismakesthemurmurlouder.StrongercontractionmakesmurmurThemostseverestenosisdoesn'tmeantheloudestmurmur.KEY:(A)Whichofthefollowingcharacteristicisnotconsistentwiththetypicaldiastolicmurmurinmitralstenosis?increaseinearlyandmiddiastolicincreaseinlatediastoliclouderintheapex paniedbyS4KEY:(A)WhichofthefollowingcanoccurinleftventricularwaterhammerpulsusdicroticpulsuspulsusparadoxusKEY:(D)WhichisthemosttypicaltestfordiagnosingmitralchestX-increaseinsubcutaneousnotallaboveKEY:(E)LiftedapicalimpulseismostcommonlyseenpulmonicheartrightventricularhyperhypertensionheartnotallmentionedaboveKEY:(E)Inbloodpressuretesting,straitlycu