临床诊断学打印

临床诊断

1、Inquisition

1. What should be asked when you make inquisition?

1.General data: such as name, sex, age，

native, birth place, profession, marital status, source of history and estimate of reliability etc.

2.Chief complaints: It should constitute in

a few simple words the main reasons why the

patient consulted his physician, which usually includes symptoms or sign the patient is suffering.

3.History of present illness: It should be

a well-organized, sequentially developed

elaboration of patient’s chief complaint or complaints. A good history will reflect the facts that your diagnosis or impression is going to be made.

4. Past history: Health condition and

disease which the patient suffered before the present illness. Infectious disease, surgery, allergy are essential part of the case history.

5. Systems review:

The purpose of this review is twofold:

(1): A thorough evaluation of the past and present status of each body system.

(2): A double check to prevent omission of

significant data relative to the

present illness.

6. Personal history: It includes those relating to smoking and alcoholic beverages (duration and amount), sedatives, social history, profession and working condition.

1.Marital history: This review includes data concerning the health of the mate, the number of children and their physical status.

2.Menstrual history

3.Childbearing history

4.Family history: Inquire the disease of patient’s first relative which might be hereditary, such as heart disease, hypertension, diabetes etc.

2. How to ask the patient for his present history of illness?

It includes the following aspects:

(1). Onset and duration of the disease.

(2). Main symptoms, location and their character.

(3). Etiology and provoking factors.

(4). Evolution of disease

(5). Associated symptoms.

(6). Treatment and its effects.

(7). General condition, especially the dietary habit.

2、General Inspection

1. Tympany is the sound emitted by percussing ( ).

A. air-filled stomach

B.liver

C.heart

D.spleen

KEY: (A)

2. Which kind of temperature taken is the lowest?

A. orally

B. rectally

C. axillally

D.all the same

KEY: (C)

3. Which accessory nasal cavity can not be found

on body surface?

A. antrum highmori B sinus sphenoidalis. C. frontal antrum D. antrum ethmoidale

KEY: (B)

4. Which of the following disease refers to the excessive liner growth that occurs with growth hormone (GH) excess when epiphyseal growth plates are open during childhood?

A. Acromegaly

B. Gigantism

C. Cretinism

D. Rachitis

5. Healthy weight means BMI ( ).

A. <18.5

B. 18.5~25.0

C. 25.1~29.9

D. >30

6. What are general appearances during physical examination?

●Sex

●Age

●Vital sign

●Development/habitus

●Nutritional status

●Consciousness

●Speech

●Facial feature/expression

●Position/posture

●Gait

7. How to classify percussion notes?

1) Resonance It is the normal sound of the lung, not very loud but could be heard easily , and have a long duration, shown as a low pitched sound.

2) Hyperresonance Lower and longer than the resonance, very loud and very easy to be heard.

3) Tympany The pitch is higher than resonance, the duration is moderate, intensity is moderately loud, e.g. percussion on a stomach filled with gas produces such a sound.

4) Dullness Opposite to resonance, duration is not so long, pitch and intensity are both of medium degree, senses of vibration beneath the pleximeter finger is not so obvious, but sense of resistance is increased.

5) Flatness It refers to the lacking of resonance, bery similar to the sound of knocking a water-filled container. It is also considered as the extreme dullness. It is high and soft in quality. Duration is short.e

3、

一、单选题：

1、弛张热常见于A．斑疹伤寒B．风湿热C．疟疾 D．肺结核 E．淋巴瘤

2、体温持续39℃-40℃，24小时内体温波动不超过1℃，可持续数天或数周，为哪种热型

A．稽留热B．弛张热C．波状热 D．回归热 E．间歇热

3、正常人腋测法体温为

A、36.5～37℃

B、36～37℃

C、36.3～

37.2℃ D、36.5～37.5℃ E、36.5～37.7℃

4、伤寒的常见热型为

A、张弛热

B、波状热

C、稽留热

D、间歇热

E、不规则热

5、腹痛伴寒战高热，最常见的原因是

A、总胆管结石

B、输尿管结石

C、急性化脓性胆管炎

D、急性阑尾炎

E、急性胰腺炎

6、引起发热最常见的病因是

A、无菌性坏死物质吸收

B、抗原抗体反应

C、中枢性发热

D、感染性发热

E、内分泌代谢障碍

7、感染性发热最常见的病原体是

A、病毒

B、肺炎支原体

C、真菌

D、细菌

E、立克次体

8、引起发热的病因中，下列哪项属非感性发热

A、立克次体

B、变态反应

C、肺炎衣原体

D、螺旋体

E、病毒

9、一脓毒败血症患者，最高体温40.2℃, 一天内波动范围大，最低时为37.5℃、称为

A、弛张热

B、波状热

C、稽留热

D、间歇热

E、不规则热

答案：1.B 2.A 3.B 4.C 5.C 6.D 7.B 8.B 9.A

二、问答题：

1、什么叫做发热，热型？试述常见热型？

发热：当机体在致热源作用下或各种原因引起体温调节中枢的功能障碍时，体温升高超出正常范围。热型：发热患者在不同时间测得的体温数值分别记录在体温单上，将各体温数值点连接成体

温曲线，该曲线的不同形态称为热型。

临床上的常见热型：

1．嵇留热：体温恒定地维持在39~40C度以上的高水平，达数天或数周，24H内体温波动范围不超过1C度。（大叶性肺炎、斑疹伤寒及伤寒高热期）2．驰张热：体温常在39C度以上，波动幅度大，24H内波动范围超过2C度，但都在正常水平以上。（败血症、风湿热、重症肺结核、化脓性炎症）3．间歇热：体温骤升达高峰后持续数小时，又迅速降至正常水平，无热期（间歇期）可持续一天至数天，如此高热期与无热期反复交替出现。（疟疾、急性肾盂肾炎）

4．波状热：体温逐渐上升达39C度或以上，数天后又逐渐降至正常水平，持续数天后又逐渐升高，如此反复多次。（布鲁菌病）5．回归热：体温急骤上升至39C度或以上，持续数天后又骤然下降至正常水平，高热期核无热期各持续若干天后规律性交替一次。（回归热、霍奇金病、周期热）

6．不规则热：发热的体温曲线无一定规律。（结核病、风湿热、支气管肺炎）

一．体温上升期：疲乏无力，肌肉酸痛，皮肤苍白，危寒或寒战等现象。

二．高热期：寒战消失，皮肤血管由收缩转为舒张，使皮肤发红并有灼热感，呼吸加深加快，开始出汗并逐渐增多。

三．体温下降期：出汗多，皮肤潮湿。

2、试述发热的病因分类：

感染性发热：

非感染发热：

1．无菌性坏死物质的吸收：1，机械性、物理或化学性损害；

2，血管栓塞或血栓形成；

3，组织坏死与细胞破坏。

2．抗原抗体反应（风湿热，血清病，药物热，结缔组织病）

3．内分泌代谢障碍（甲亢，重度脱水）

4．皮肤散热减少（广泛性皮炎，鱼鳞癣，慢性心力衰竭）

5．体温调节中枢功能失常：1，物理性：中暑

2，化学性：重度安眠药中毒

3，机械性：脑出血，脑震荡，颅骨骨折

6．自主神经功能紊乱：1，原发性低热：

2，感染后低热：

3，夏季低热：

4，生理性低热：水肿人体组织间隙有过多的液体积聚使组织肿胀。

4、

一、单选题：

1、以下哪项不是问诊的内容

A．起病情况与患病时间 B. 诊治经过 C. 月经史 D. 伴随症状 E.腹部肌紧张

2、以下哪项不是个人史的问诊内容

A. 社会经历

B. 习惯与嗜好

C.大小便情况

D.职业

E. 出生地答案：1.E 2.C

二、简答题：

1、试述现病史问诊的内容？

现病史：是病史中的总体部分，它记述患者病后的全过程，即发生、发展、演变和诊治经过。

现病史问诊内容包括：

1．起病情况与患病时间；2。主要症状的特点；3。病因与诱因；4。病情的演变与发展；

5．伴随症状； 6。诊治经

过； 7。病程中的一般情况；

5、

Fever

1. What kind of fever may occur in lobular pneumonia?

A. remittent fever

B. intermittent fever

C. continued fever

D. undulant fever

KEY: (C)

2. Low grade fever means temperature ().

A. 37.3~38o C

B. 38~39o C

C. 39.1~41o C

D. over 41o C

KEY: (A)

3. Endogenous pyrogen is composed of the following EXCEPT ().

A.IL-1

B.IFN

C.TNF

D. microorganisms

KEY: (D)

4. How to classify the grade of fever?

The grade of fever

Low grade fever: 37.3~38o C

Moderate fever: 38~39o C

High fever: 39.1~41o C

Hyperthermia fever: over 41o C

5. Are there any associated symptoms with respect to fever?

1.Chills or rigor: as in septicemia and any

acute infections

2.Congestion of conjunctiva: as in

hemorrhagic fever

3.Herpes simplex: caused by herpes virus,

frequently seen in cases of lobar pneumonia 4.Bleeding tendency: in severe infection as

hepatitis and blood dyscrasia as leukemia 5.Lymph node enlargement: in cases of

lymphoma, of metastasis of cancer 6.Enlargement of liver and spleen: in cases

of hepatitis, leukemia

7.Arthralgia: in gout, rheumtic disease

8.Rash: drug rash, measles

9． Coma: in barbiturate poisoning, cerebral hemorrhage

6. There are six types of fever. What are they?

?Continued

T: kept at 39oC~40oC constantly Circadian variation: < 1oC

Remittent

T: >39oC circadian variation >2oC

?Intermittent

T: sudden rising (few hours) and sudden decreasing

Recurrent

T: abruptly rising to the peak, lasting for several day, sudden decrease to the normal repeatedly

?Undulant

T: rising gradually to the peak

(>39oC)decreasing gradually to the normalrepeatedly for several times

?Irregular

6、

一、简答题：

1、肥胖指超过标准体重

A.20％B．10％C．15％ D. 25％ E．30％

2、呼吸过速时呼吸频率超过

A．20次／分B．24次／分C．30次／分D．35次／分 E．25次／分

3、关于血压叙述正确的是

A．测量时被测上肢裸露，肘部高于心脏水平

B．测量时听到的第一声响时汞柱数值为收缩压 C．测量时声音突然变小而低沉为舒张压

D．正常人两上肢血压略有差异，可相差12～20mmHg

E．正常人下肢血压较上肢高10～20mmHg

4、甲状腺功能减退的面容是

A．面色苍白，表情疲惫 B．面色苍白，颜面浮肿，目光呆滞

C面容灰褐，额部有褐色色素沉着 D．面容惊愕，目光闪亮E．表情淡漠，反应迟钝

5、检查发现某患者呼吸由浅慢变为深快，又由深快变为浅慢，随之出现呼吸暂停后，又开始以上周期性变化，应诊断为

A．间停呼吸 B．叹息样呼吸 C．潮式呼吸D．库斯式呼吸 E．胸廓剧痛引起的抑制性呼吸6、贫血病人出现皮肤及粘膜苍白，较为可靠的检查是

A．面颊、皮肤、上腭粘膜 B．手背皮肤及口腔粘膜 C．耳廓皮肤

D．颈部皮肤、舌面 E．睑结膜

7、发绀不常出现的部位是

A．舌 B．唇 C．耳廓 D．肢端 E．腹部

8、伤寒或副伤寒的特征性皮疹是

A．斑疹 B．玫瑰疹 C．荨麻疹 D．斑丘疹 E．丘疹

9、玫瑰疹多出现在

A．胸腹部 B．面部 C．四肢 D．背部 E．生殖器

10、黄疸早期或轻微出现时常见的部位是

A．躯干 B．巩膜、软腭粘膜 C．手掌、脚掌 D．耳廓 E．四肢肢端

11、人体浅表淋巴结平时很小，不宜触及，无压痛，通常直径不超过

A．0．2～0．5cm B．1．0cm C．0．2cm D．0．5～1．0cm E．0．5～0．8cm

12、哪个部位对于区别药物性黄染与黄疸最有意义?

A．手掌 B．皮肤 C．巩膜 D．口腔黏膜 E．角膜

13、根据中国高血压防治指南的标准，高血压是指

A．血压>130／85 mmHg B．血压≥140／90 mmHg C．血压≥150／90 mmHg

D．血压≥1 60／90 mmHg E．血压≥160／95 mmHg

答案：1.A 2.B 3.B 4.B 5.C 6.E 7.E 8.B 9.A 10.B

11.A 12.C 13.B

二、简答题：

1、典型的步态异常有哪些？各见于何种疾病？

1，蹒跚步态—佝偻病，大骨关病，进行性肌营养不良，先天性双侧髋关节脱位。

2，醉酒步态—小脑疾病，酒精及巴比妥中毒。3，共济失调步态—脊髓痨患者。

4，慌张步态—震颤麻痹患者。

5，跨阈步态—腓总神经麻痹。

6，剪刀步态—脑性瘫痪与截瘫患者。

7，间歇性跛行—高血压，动脉硬化患者。

2、临床常见的皮疹有哪些？各有何特点？见于哪些疾病？

临床常见的皮疹有：斑疹、玫瑰疹、丘疹、斑丘疹，荨麻疹。

1，斑疹：局部皮肤发红，一般不凸出皮面。（斑疹伤寒，丹毒，风湿行多形性红斑点）

2，玫瑰疹：一种鲜红色圆形斑疹，直径2~3MM。因病灶周围血管扩张所导致，检查时拉紧附近皮肤或以手指按压可使皮疹消退，松开时又复出现，多出现于胸腹部。（伤寒与副伤寒的特征性皮疹）3，丘疹：除局部颜色改变外，病灶凸出皮面。（药物疹，麻疹，湿疹）

4，斑丘疹：在丘疹周围有皮肤发红的底盘。（风疹，猩红热，药物疹）

5，荨麻疹：为稍隆起皮面的苍白色或红色的局限性水肿。（各种过敏反应）

3、何谓黄染？常见原因有哪些？各有何特点？

黄染：皮肤黏膜发黄称为黄染。

常见原因：1，黄疸，2，胡萝卜增高。3，长期服用含有黄色素的药物。