临床诊断学课程习题

选择题（中文A.第四胸椎下缘B.气管分叉C.心房下缘D. A.矮胖体型者B.肺气肿C.D.A.脑B.酮症酸C.尿毒症酸D.神经衰A.肺气肿B.大量胸腔积液C.性肺不张D.胸壁皮下气A.肺气肿B.肺不张C.隔肌麻痹D.肺尖部结核A.大叶性B.空洞性肺结核C.性肺不张D.支气管 B.气管向患侧移位C.患侧叩诊呈浊音D.患侧语音增多选题（中文（AA.B.C.肺下界降低D.（ABCDA.慢性支气管炎B.支气管哮喘C.心源性哮喘D.A.喉部B.背部第1，2胸椎附 C.胸骨两侧第1，2肋间D.右肺肺泡呼吸音的特点是（ACA.柔和吹风样B.吸气音比呼气音弱C.音调较高时间较长D.ha左侧胸痛可见于下列哪些疾病（ABCD急性胰腺炎B.肺癌C.急性冠脉综合症D.问答题（中文答：吸气性呼吸特点,吸气费力，显著时出现三凹症，常伴干咳与高调吸气性喉鸣，提答视诊喜患侧位，患侧胸廓饱满，肋间隙增宽，呼吸运动受限，心尖搏健侧移位。触诊气管移向健侧，患侧呼吸运动减弱，语音振颤减弱或。听诊积液区呼吸音减弱或语音减弱或积液上方可闻及减弱的支气管答由于气管.支管或细支管狭窄或分阻塞,吸入或呼出时生湍流所生特点：持续时间较长,吸气及呼气时均可听及，以呼气时为明显。干罗音的强度和性质易改答1）胸膜炎症如结核性胸膜炎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 第五肋间,0.5~1.0cmC.第五肋间,0.5~1.0cm 剑突下搏动意味着肥 摩擦感表示已无积 3／6 S1 Austin-FlintDuroziez 2-55-1010-1515-2020mmHg 问答题（中文鉴别 器质性杂 部位肺动脉瓣区、心尖 小于等于2/6级 常大于等于3/6级 3/6级以上可伴有 收缩压舒张压1级高血压（度2级高血压（度3级高血压（度周围血管征是指由于脉压增大而导致周围动脉和毛细血管搏动增强的一组体征冲（AustinFlint杂音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