内科学名词解释

内科学名词解释 1、GERD:胃食管反流病，指胃十二指肠内容物反流入食管引起烧心等症状，可引起反流性食管炎，以及咽喉，气道等食管以外得组织损害 2、X线钡影跳跃征象:在溃疡型肠结核，钡剂于病变肠段呈现激惹征象，排空很快，充盈不佳，而在病变的上，下肠段则钡剂充盈良好 3、肝肾综合症:失代偿期肝硬化出现大量腹水时，由于有效循环血容量不足及肾内血流重分布等因素，可发生肝肾综合症 4、肝肺综合症:指严重肝病，肺血管扩展和低氧血症组成的三联征 5、肝性脑病:是有严重肝病引起的，以代谢紊乱为基础，中枢神经系统功能失调得综合症，其主要临床现是意识障碍，行为失常和昏迷 6、Grey-Turner征:少数患者因胰酶，坏死组织及出血沿腹膜间隙与肌层渗入腹壁下，致两侧腹部皮肤呈暗灰蓝色 7、Zollinger-Ellison综合症:是胰腺非β细胞瘤分泌大量胃泌素所致(又称胃泌素瘤)，胃泌素可刺激壁细胞增生，分泌大量胃酸，使上消化道处于高酸环境中，导致胃，十二指肠发生多发性溃疡 8、消化性溃疡:发生在胃和十二指肠得慢性溃疡，即胃溃疡和十二指肠溃疡 9、肝硬化:是一种以肝组织弥漫性纤维化，假小叶和再生结节形成为特征得慢性肝病 10、原发性肝癌:是指肝细胞或肝内胆管细胞发生的癌 11、急性胰腺炎:是多种病因导致胰酶在胰腺内被激活后引起胰腺组织自身消化，水肿，出血甚至坏死得炎症反应 12，蛋白尿:每日尿量持续超过150mg或尿蛋白/肌酐比率》200mg/g称蛋白尿 14，尿液检查:1功能性蛋白尿 2肾小球性蛋白尿 3肾小管性蛋白尿 4溢出性蛋白尿 15，肾病综合症:各种原因所致得大量蛋白尿，低白蛋白血症，明显水肿和高脂血症的临床综合 16，肾炎综合症:以蛋白尿，血尿及高血压为特点的综合症 17，急性肾衰竭:是由各种原因引起的肾功能在短时间内突然下降而出现得临床综合症 20， 急性肾小球肾炎:AGN 是以急性肾炎综合症为主要的临床表现得一组疾病。特点是急性起病，患者出现血尿，蛋白尿，水肿和高血压，并可伴有一过性氮质血症 22，缺铁性盆血(IDA):当机体对铁得需求与供给失衡，导致体内储存铁耗尽，继之红细胞内铁缺乏，最终引起缺铁性盆血 23，再生障碍性贫血(AA):是一种获得性骨髓造血功能衰竭症，表现为骨髓造血功能低下，全血细胞减少和盆血，出血。感染综合症，免疫抑制治疗有效。(再障诊断:1全血细胞减少，网织红细胞百分数《0.01，淋巴细胞比例增高 2.一般无肝，脾大 3骨髓多部位增生减低，造血细胞减少，非造血细胞比例增高，骨髓小粒空虚 4除外引起全血细胞减少的其他疾病》 24，溶血性盆血(HA):溶血超过造血代偿时出现得盆血 25，自身免疫性溶血性盆血(AIHA):系免疫功能调节紊乱，自身抗体吸附于红细胞表面而引起得一种溶血性盆血 to develop the details of the project quality assurance systems and quality assurance goals and supervise the quality inspection departments. Quality Department is supervising quality assurance Department, directly responsible to the Chief Engineer, by controlling the raw materials, sample testing and construction process and quality control purposes. Quality Department the right to endanger the quality of construction and operation to be rejected or stopped. Substandard raw materials and not conducive to construction quality of technology ... 14.2.3 quality supervision and inspection system in order to ensure quality, the project shall be to establish a series of systems: quality assurance program; Construction technical supervision systems; Construction site management system; Construction triage and technical implementation of the programme; Quality of project reports; Site acceptance of materials, sample testing; Concrete test and mixture ratio determination; Other inspection system of supervision engineer is required. 14.2.4 quality management measures 1, job training to enhance staff quality consciousness, enhance quality, ensure quality assurance goals. 2, according to the scientific, standardized, procedures, standardized operation, implementation of personnel, posts, site inspection and acceptance procedures. 3, technicians and construction team leader before the familiar with the drawings, quality standards and quality requirements specified in the contract, while explicitly project developed by the Ministry of construction and the quality objectives. 4, technical Department Chief Engineer leading the project construction organization plan, submitted to the audit supervision engineer. 5, quality manageme 26，MDS，骨髓增生异常综合症:是一种起源于造血干细胞，以血细胞变态造血，高风险向急性白血病转化为特征得难治性血细胞质，量异常的异质性疾病 27，裂孔现象:骨髓象有核细胞显著增生，以原始细胞为主，而较成熟中间阶段得细胞缺如，并残留少量成熟粒细胞 28，特发性血小板减少性紫癜(ITP):是因血小板免疫性破坏，导致外周血中血小板减少得出血性疾病。 29，急性白血病(AL):是造血干细胞得恶性克隆性疾病，发病时骨髓中的异常得原始细胞及幼稚细胞大量增殖并广泛浸润肝，脾，淋巴结等各种脏器，抑制正常造血。表现为盆血，出血，感染和浸润等征象。(治疗:一，一般治疗:紧急处理高白细胞血症 防止感染 成分输血支持 防治尿酸性肾病 维持营养 二，抗白血病治疗，(ALL治疗，1诱导缓解治疗 长春新碱和泼尼松组成得VP ，鞘内注射地塞米松，MTX 2.诱导后治疗 6—MP和MTX联合用药 三，骨髓移植) 30，淋巴瘤:起源于淋巴结和淋巴组织，其发生大多与免疫应答过程中淋巴细胞增殖分化产生的某种免疫细胞恶变有关，是免疫系统得恶性肿瘤 31，DIC，弥漫性血管内凝血:是一种发生在许多疾病基础上，由致病因素激活凝血及纤溶系统，导致全身微血栓形成，凝血因子大量消耗并继发纤溶亢进，引起全身出血及微循环衰竭得临床综合症 32，白血病完全缓解(CR):1，白血病症状和体征完全消失，外周血粒细胞绝对值》1.5*109/L，PCT》100*109/L 2，骨髓中原粒细胞+早幼粒细胞《5%，M3型除了原粒细胞+早幼粒细胞《5%，还应无Auer小体，红细胞及巨核细胞系列正常，无髓外白血病 33，甲亢:是甲状腺本身产生甲状腺激素过多而引起甲状腺毒症 35，甲状腺危象:是甲状腺毒症急性加重得一个综合症，发生原因可能与循环内FT3水平增高，心脏和神经系统得儿茶酚胺激素受体数目增加，敏感性增强有关 36，甲状腺危象治疗:1，针对诱因治疗 2，抑制甲状腺素合成 3，抑制甲状腺激素得释放 4，普萘洛尔 5，糖皮质激素 6，降低和清除血浆甲状腺激素 7物理降温 8其他支持疗法 37，糖尿病:是一组以慢性血葡萄糖水平增高为特征得代谢疾病群。 38，糖耐量减低:空腹血糖未达到糖尿病诊断标准，但其血糖浓度高于正常，低于5.6—6.9mmol/L 39，痛风:为嘌呤代谢紊乱和尿酸排泄障碍所致血尿酸增高的一组异质性疾病。(痛风诊断:1，血尿酸增高 2，关节腔穿刺取滑囊液进行旋光显微镜检查，可发现白细胞内有双折光现象的针形尿酸盐结晶 3，痛风石活检或穿刺取内容物检查，证实为尿酸盐结晶 4，受累关节X线检查，关节腔镜检查等可协助确诊 5，有困难者用秋水仙碱诊断性治疗迅速显效，具有特征性诊断价值) 41，中毒:有毒化学物质进入人体，达到中毒量而产生损害的全身性疾病 41，阿托品化:临床表现为瞳孔放大，口干，皮肤干燥，面色潮红，心率加快，肺部湿罗音消失 on engineer. 5, quality manageme. 4, technical Department Chief Engineer leading the project construction organization plan, submitted to the audit supervisictivesquirements specified in the contract, while explicitly project developed by the Ministry of construction and the quality objeocedures. 3, technicians and construction team leader before the familiar with the drawings, quality standards and quality rence prscientific, standardized, procedures, standardized operation, implementation of personnel, posts, site inspection and accepta1, job training to enhance staff quality consciousness, enhance quality, ensure quality assurance goals. 2, according to the sures t and mixture ratio determination; Other inspection system of supervision engineer is required. 14.2.4 quality management meanical implementation of the programme; Quality of project reports; Site acceptance of materials, sample testing; Concrete tesd techty assurance program; Construction technical supervision systems; Construction site management system; Construction triage anty supervision and inspection system in order to ensure quality, the project shall be to establish a series of systems: qualiquali ation to be rejected or stopped. Substandard raw materials and not conducive to construction quality of technology ... 14.2.3struction process and quality control purposes. Quality Department the right to endanger the quality of construction and operd conquality assurance Department, directly responsible to the Chief Engineer, by controlling the raw materials, sample testing an rance systems and quality assurance goals and supervise the quality inspection departments. Quality Department is supervisingto develop the details of the project quality assu2 1、球后溃疡:是指发生在十二指肠球部以下的溃疡，多发生在十二指肠乳头的近端。具有十二指肠的临床特点，但夜间痛及放射痛多见，药物治疗效果差，较易并发出血。 3、黎明现象:既夜间血糖控制良好，也无低血糖发生，仅于黎明一段短时间出现高血糖，其机制可能为胰岛素拮抗激素分泌增多所致。 4、系统性红斑狼疮:是一种自身免疫性结缔组织病，由于体内有大量致病性自身抗体和免疫复合物，造成组织损伤，临床可以出现各个系统和脏器损害的症状 5、血尿:离心后尿沉渣镜检复高倍视野红细胞超过3个为血尿,1L尿含1ml血即呈肉眼血尿。 6、炎症性肠病:专指病因不明的炎症性肠病，包括溃疡性结肠炎和克罗恩病。 7、门脉高压症:肝硬化失代偿期由于门静脉系统阻力增加和门静脉血流量增多，导致门静脉系统内压力升高，称为~。脾大、侧支循环的建立和开放、腹水是其三大临床表现。 105/ml且为同一菌种，才能确定为真性菌尿。,105/ml。但如临床无尿路感染症状，则要求二次清洁中段尿细菌定量培养，结果细菌数,清洁中段尿细菌定量培养,105/ml。,导尿细菌定量培养,膀胱穿刺尿定性培养有细菌生长。,8、真性菌尿指: 9、急性肾衰:泛指任何原因引起的急性肾脏损伤，肾单位功能迅速减退，不能维持水、电解质、酸碱平衡和排泄代谢废物，导致BUN、SCr上升，出现高钾、代酸、少尿或无尿等一系列症状的临床综合症。 10少尿或无尿:每日尿量<400μmol/L为少尿，每日尿量<100μmol/L为无尿。 11、自身免疫性溶血性贫血:系免疫功能调节紊乱，产生自身抗体，吸附于红细胞表面而引起的一种溶血性贫血。抗人球蛋白试验大多阳性。 12、Somogyi效应:在夜间有低血糖，在睡眠中未被察觉，但导致体内升血糖的激素分泌增多，而发生低血糖后反跳性高血糖。 13、类风湿关节炎:是一个累及周围关节为主的多系统性炎症性的自身免疫性疾病，其特征性的症状为对称性、周围性多个关节慢性炎症性病变 14、蛋白尿:每日尿蛋白量持续超过150mg或尿蛋白/肌酐比率>200mg/g称为蛋白尿 15、急性肾小球肾炎:简称急性肾炎，是以急性肾炎综合征为主要临床表现的一组疾病，其特点为急性起病，患者出现血尿、蛋白水、水肿和高血压，并可伴有一过性氮质血症。 17、绿色瘤指急性粒细胞白血病患者由于粒细胞肉瘤累及骨膜，尤其眼眶部位，在有贫血时表现为绿色，称之为绿色瘤。 18、Ph染色体即t(q;22)(q34;q11)(1分)9号染色体上的原癌基因ABL易位至22号染色体的断裂集中区(BCR)形成BCR/ABL融合基因。 19、糖化血红蛋白A1:为血红蛋白中2条β链N端缬氨酸与葡萄糖非酶化结合而成，其量与血糖浓度呈正比，且为不可逆反应，正常人为8%—10%。 20、妊娠糖尿病:妊娠过程中初次发现的任何程度的糖耐量异常，不论是否需要胰岛素或单用饮食治疗，也不论分娩后这一情况是否持续，均可认为是妊娠糖尿病。 21、旁分泌:内分泌系统分泌的激素通过细胞外液局部或邻近传递。 Enginwhile explicitly project developed by the Ministry of construction and the quality objectives. 4, technical Department Chief tion team leader before the familiar with the drawings, quality standards and quality requirements specified in the contract,strucstandardized operation, implementation of personnel, posts, site inspection and acceptance procedures. 3, technicians and con ity consciousness, enhance quality, ensure quality assurance goals. 2, according to the scientific, standardized, procedures,f qualher inspection system of supervision engineer is required. 14.2.4 quality management measures 1, job training to enhance staf; Quality of project reports; Site acceptance of materials, sample testing; Concrete test and mixture ratio determination; Otgrammechnical supervision systems; Construction site management system; Construction triage and technical implementation of the proin order to ensure quality, the project shall be to establish a series of systems: quality assurance program; Construction testem andard raw materials and not conducive to construction quality of technology ... 14.2.3 quality supervision and inspection sypurposes. Quality Department the right to endanger the quality of construction and operation to be rejected or stopped. Subst ontrolly responsible to the Chief Engineer, by controlling the raw materials, sample testing and construction process and quality coals and supervise the quality inspection departments. Quality Department is supervising quality assurance Department, directto develop the details of the project quality assurance systems and quality assurance geer leading the project construction organization plan, submitted to the audit supervision engineer. 5, quality manageme3 22、主要是通过抑制环氧化物活性、减少前列腺素合成而起到抗炎、止痛、退热、消肿作用的一类抗炎药 23、隐匿型肾小球肾炎:称无症状性血尿或(和)蛋白尿，患者无水肿，高血压及肾功能损害，而仅表现为肾小球源性血尿或(和)蛋白尿的一组肾小球病。 24、单纯性蛋白尿:尿蛋白<1.0g/d,以白蛋白为主，而无血尿者，称为单纯性蛋白尿 2造血干细胞各种血细胞与免疫细胞的起始细胞，具有不断自我复制和多向分化增殖的能力 26、脾亢是一种综合征，表现为脾大，一种和多种造血细胞减少而骨髓造血细胞相应增生，脾切除后血象正常或接近正常，症状缓解。 27、Cushing综合征:为各种病因造成肾上腺分泌过多糖皮质激素(主要是皮质醇)所致疾病的总称。 28、是泛指影响骨、关节及其周围软组织如:肌肉、滑囊、肌腱、筋膜等的一组疾病。主要研究对象是弥漫性结缔组织疾病。 30、风湿性疾病:是泛指影响骨、关节及其周围软组织如肌肉、滑囊、肌腱、筋膜等的一组疾病。主要研究对象是弥漫性结缔组织疾病。 32、单纯性蛋白尿::尿蛋白<1.0g/d,以白蛋白为主，而无血尿者，称为单纯性蛋白 34、肾病综合征:各种原因所致的大量蛋白尿(>3.5g/d)，低蛋白血症(<30g/d)明显水肿和(或)高脂血症的临床综合征。 溃疡性结肠炎与结肠克罗恩(crohn病)鉴别 溃疡性结肠炎 结肠克罗恩病 克罗恩(crohn病诊断要点 症状 脓血便多见 有腹泻但脓血便少见 临床 X线 内镜 活检 切除标本 病变分布 病变连续 呈节段性 1. 非连续性 + + + 直肠受累 绝大多数受累 少见 或节段性病变 末端回肠受累 罕见 多见 2. 铺路石样表现 + + + 肠腔狭窄 少见，中心性 多见，偏心性 或纵行溃疡 瘘管形成 罕见 多见 3. 全壁性炎症 + + + + 内镜表现 溃疡浅，黏膜弥 纵行溃疡，伴周围粘膜 变 漫性充血水肿， 正常或鹅卵石样改变 4.非干酪样肉芽 + + 颗粒状，脆性增加 5.裂沟，瘘管 + + + 活检特征 固有膜全层弥漫性 裂隙状溃疡，上皮样 6.肛门部病变 + + + 性炎症，隐窝脓肿 肉芽肿，粘膜下层淋 有1.2.3者为疑诊，再加上4.5.6三项中任何一项可确诊，有 结构明显异常，杯状 巴细胞聚集，局部 第4项只要再加上1.2.3三项中得任何两项可确诊 细胞减少 炎症 1、上消化道出血的常见原因:消化性溃疡、食管胃底静志完全丧失，不能唤醒。浅昏迷时肌张力和腱反射亢进，(1分) 脉曲张破裂、急性糜烂出血性胃炎和胃癌。其他原因还有深昏迷时各种反射消失，脑电图明显异常(1.5分)。 慢性肾衰竭的分期: 食管贲门黏膜撕裂、食管癌、胆道出血、胰腺出血、血管 2、慢性肾炎的治疗原则及要点是什么, 答、1.肾贮备能力下降期:GFR减少至正常的约50%—80%，性疾病、血液病、尿毒症、急性感染、应激等。 on engineer. 5, quality manageme. 4, technical Department Chief Engineer leading the project construction organization plan, submitted to the audit supervisictivesquirements specified in the contract, while explicitly project developed by the Ministry of construction and the quality objeocedures. 3, technicians and construction team leader before the familiar with the drawings, quality standards and quality rence prscientific, standardized, procedures, standardized operation, implementation of personnel, posts, site inspection and accepta1, job training to enhance staff quality consciousness, enhance quality, ensure quality assurance goals. 2, according to the sures t and mixture ratio determination; Other inspection system of supervision engineer is required. 14.2.4 quality management meanical implementation of the programme; Quality of project reports; Site acceptance of materials, sample testing; Concrete tesd techty assurance program; Construction technical supervision systems; Construction site management system; Construction triage anty supervision and inspection system in order to ensure quality, the project shall be to establish a series of systems: qualiquali ation to be rejected or stopped. Substandard raw materials and not conducive to construction quality of technology ... 14.2.3struction process and quality control purposes. Quality Department the right to endanger the quality of construction and operd conquality assurance Department, directly responsible to the Chief Engineer, by controlling the raw materials, sample testing an rance systems and quality assurance goals and supervise the quality inspection departments. Quality Department is supervisingto develop the details of the project quality assu4 答:慢性肾炎的治疗原则和要点是;应以防止和延缓肾功血肌酐正常，患者无症状;2.氮质血症期:GFR减少至正3、叙述急性白血病的一般治疗 能进行恶化，改善或缓解临床症状及防治严重并发症为主常的约25%—50%，血肌酐高于正常，但〈450µmol /L,无答:1 紧急处理高白细胞血症:?细胞单采 ?羟基脲，要目的，而不是以消除尿中的蛋白和红细胞为主要目标。明显的症状，可有轻度贫血、多尿和夜尿;3.肾衰竭期:?头颅照射(Co60) 一般主张采取综合性防治措施，对水肿，高血压或肾功能GFR减少至正常的约10%—25%，血肌酐显著升高(约为4502.防治感染消毒隔离病房，应用细胞因子，相应培养，经不全病人应强调休息，避免剧烈运动和限制盐类摄入(2—707µmol /L)，贫血较明显，夜尿增多及水电解质失调;验性抗生素治疗。 分)。具体治疗措施如下; 4.尿毒症期:GFR减少至正常的约10%以下，血肌3(成分输血支持滤去白细胞 1) 适度控制饮食中蛋白的摄入量(1分) 酐>707µmol /L，肾衰的临床表现和血生化异常现象已十4(防治尿酸性肾病多饮水，碱化尿液，服别嘌呤醇 2) 积极控制高血压(1分) 分显著。 5(维持营养 3) 应用血管紧张素转换酶抑制剂，如巯甲丙脯酸4试述SLE的治疗要点, 4、简述糖尿病酮症酸中毒失水的原因,答:糖尿病酮症(Captopril)等(1分) 答:SLE的治疗应避免和除去日晒、寒冷、感染、妊娠、酸中毒失水由下列原因引起:1.进一步升高的血糖可加重4) 使用抗凝及抗血小板聚集的药物，如潘生丁，小某些药物等诱发或加剧因素的影响。根据不同病情，采取渗透性利尿(3分);大量酮体从肾、肺排出时又带走大量剂量阿斯片林，肝素等;(1分) 相应的措施。 水分(3分);2.蛋白质和脂肪分解加速，大量酸性代谢产5) 防治能引起肾损害的其它原因(1分); (1) 肾上腺皮质激素为首选药物，可用2-3个疗程。 物排出，加重水分丢失3.厌食、恶心、呕吐等胃肠道症状，6) 尽早明确病变性质，酌情应用激素及各种免疫抑(2) 免疫抑制剂 体液丢失，使水分入量减少。 制药物。(1分) (3) 环孢素 肝性脑病的临床分期和表现, 3、系统红斑狼疮的诊断标准是什么? (4) 霉酚酸酯 答:根据意识障碍程度、神经系统表现和脑电图改变，将答:1.颧部红斑;2.盘状红斑;3.光敏感性红斑(1分);(5) 雷公滕多甙 肝性脑病自轻微的精神改变到深昏迷分为四期(2分):一4.口腔溃疡(1分);5.非侵蚀性关节炎(1分);6.浆膜(6) 静脉注射大剂量丙种球蛋白 期(前驱期) 轻度性格改变和行为异常，应答尚正确，炎:胸膜炎或心包炎(1分);7.肾炎:蛋白尿>0.5g/d(13、简述贫血的临床表现 但吐词不清且较缓慢，可有扑翼样震颤，脑电图正常(1.5分);8.神经系统异常:抽搐或精神病(1分);9.血液学1神经系统 :头痛、失眠、记忆力减退等 分)。二期(昏迷前期) 以意识错乱、睡眠障碍、行为失异常:溶血性贫血或血细胞减少(<4000/mm3)或淋巴细2 皮肤粘膜 :苍白 常为主。有明显的神经阳性体征，患者可出现不随意运动胞减少(<1500/mm3)或血小板减少(<100000/mm3) (1分);3 呼吸系统 :呼吸加快，长期输血有含铁血黄素肺 及运动失调。脑电图有特征性异常(1.5分)。三期(昏睡10.免疫学异常:LE细胞(+)或抗DNA抗体(+)或抗Sm4 循环系统 :心率加快，慢性贫血可有心脏扩大 期) 以昏睡和精神错乱为主，肌张力增加，锥体束征常抗体(+)或华康氏试验(+);11.荧光抗核抗体(+)(15 消化系统 :消化不良，大便异常等 呈阳性，脑电图明显异常(1.5分)。四期(昏迷期) 神分)。以上11项标准有4项或4项以上符合者可诊断SLE。6 泌尿系统 :血红蛋白尿，少尿，肾功能不全 while explicitly project developed by the Ministry of construction and the quality objectives. 4, technical Department Chief tion team leader before the familiar with the drawings, quality standards and quality requirements specified in the contract,strucstandardized operation, implementation of personnel, posts, site inspection and acceptance procedures. 3, technicians and con ity consciousness, enhance quality, ensure quality assurance goals. 2, according to the scientific, standardized, procedures,f qualher inspection system of supervision engineer is required. 14.2.4 quality management measures 1, job training to enhance staf; Quality of project reports; Site acceptance of materials, sample testing; Concrete test and mixture ratio determination; Otgrammechnical supervision systems; Construction site management system; Construction triage and technical implementation of the proin order to ensure quality, the project shall be to establish a series of systems: quality assurance program; Construction testem andard raw materials and not conducive to construction quality of technology ... 14.2.3 quality supervision and inspection sypurposes. Quality Department the right to endanger the quality of construction and operation to be rejected or stopped. Subst ontrolly responsible to the Chief Engineer, by controlling the raw materials, sample testing and construction process and quality coals and supervise the quality inspection departments. Quality Department is supervising quality assurance Department, directto develop the details of the project quality assurance systems and quality assurance geer leading the project construction organization plan, submitted to the audit supervision engineer. 5, quality managemeEngin5 7 内分泌系统:甲状腺、肾上腺、性腺功能出现异常 8 生殖系统 :睾酮、女性激素分泌异常、月经过多 9 免疫系统 :红细胞的调理素作用降低，反复输血影响T细胞功能 10血液系统 :除红细胞减少外还会引起组织缺氧继发系列症状 1、慢性肾小球肾炎的治疗目的及主要措施, 目的:防止或延缓肾功能进行性恶化，改善或缓解临床症状及防治严重合并症为主要目的，而不以消除尿红细胞或微量尿蛋白为目标。(5分) 主要措施: (1)积极控制血压(1分) (2)限制食物中蛋白质磷的摄入(1分) (3)应用抗血小板药物(1分) (4)糖皮质激素和细胞素药物应用(1分) (5)避免加重肾损害因素(1分) 3、 简述糖尿病的诊断标准 (1).糖尿病症状+随机血糖?11.1mmol/L(3分);(2)空腹血糖(血浆)?7.0 mmol/L(3分);(3).OGTT中2小时血糖?11.1mmol/L;(4).需再测一次，诊断才能成立 4、简述风湿性疾病的治疗目标及原则。 目标:1)根除原发病因;2)防止始发组织损伤;3)改变正常的炎症反应;4)促进组织和功能的恢复。 原则:早期诊断;早期治疗;综合治疗。 1、哪些临床表现提示肺癌的诊断, 答:40岁以上长期重度吸烟者，有下列情况之一:(1)无明显诱因的刺激性咳嗽持续2-3周，治疗无效;(2)原有慢性呼吸道疾病，咳嗽性质改变;(3)持续或反复在短期内痰中带血，而无其他原因可解释;(4)反复发作同一部位的肺炎;(5)原因不明的肺脓肿; (6)原因不明的四肢关节疼痛及杵状指(趾);(7)X线片上有局限性肺气肿或段、叶肺不张;(8)孤立性圆形病灶和单侧性肺门阴影增大者;(9)原有肺结核病灶已稳定，而形态和性质发生改变者;(10)无中毒症状的胸腔积液，尤其是血性、进行性增加者; 3、试述溃疡性结肠炎消化系统临床表现和主要治疗药物。 答:临床主要表现为腹泻、黏液脓血便、腹痛，腹胀、食欲不振、恶心、呕吐。轻中型患者仅有左下腹轻压痛，重型和暴发型常有明显压痛和鼓肠。主要药物有氨基水杨酸制剂、糖皮质激素、免疫抑制剂。 5、如何判断上消化道出血是否停止。 答:临床上出现以下情况应考虑继续出血或再出血，反之出血已停止。1、反复呕血，或黑粪次数增加，粪质稀薄，伴有肠鸣音亢进2、周围循环衰竭的表现经充分补液输血而未见明显改善，或虽暂时好转而又恶化3、血红蛋白浓度、红细胞压积继续下降，网织红细胞计数持续增高4、补液与尿量足够的情况下，血尿素氮持续或再次增高。 2、1型糖尿病分为 、 两种亚型。 1 Graves病的临床主要表现为:----------，--------，-----------，------------。、 2肾脏的生理功能主要: 、 、 1、 原发性肾病综合征的病理类型包括:微小病变肾病，系膜增生性肾小球肾炎，系膜毛细血管肾小球肾炎，膜性肾病。 和局灶性节段性肾小球硬化。 2、 白血病的MICM的分型包括， 形态学细胞化学 、 免疫学 细胞遗传学 、 分子生物学。 3、IDA的病因包括 需铁量增加而铁摄入不足、 铁吸收障碍 、 铁丢失过多 。 2、炎症性肠病包括 溃疡性结肠炎 和 克罗恩病 。 3、急性胰腺炎局部并发症有 胰腺脓肿 、 胰腺假性囊肿 。 scientific, standardized, procedures, standardized operation, implementation of personnel, posts, site inspection and accepta1, job training to enhance staff quality consciousness, enhance quality, ensure quality assurance goals. 2, according to the sures t and mixture ratio determination; Other inspection system of supervision engineer is required. 14.2.4 quality management meanical implementation of the programme; Quality of project reports; Site acceptance of materials, sample testing; Concrete tesd techty assurance program; Construction technical supervision systems; Construction site management system; Construction triage anty supervision and inspection system in order to ensure quality, the project shall be to establish a series of systems: qualiquali ation to be rejected or stopped. Substandard raw materials and not conducive to construction quality of technology ... 14.2.3struction process and quality control purposes. Quality Department the right to endanger the quality of construction and operd conquality assurance Department, directly responsible to the Chief Engineer, by controlling the raw materials, sample testing an rance systems and quality assurance goals and supervise the quality inspection departments. Quality Department is supervisingto develop the details of the project quality assuon engineer. 5, quality manageme. 4, technical Department Chief Engineer leading the project construction organization plan, submitted to the audit supervisictivesquirements specified in the contract, while explicitly project developed by the Ministry of construction and the quality objeocedures. 3, technicians and construction team leader before the familiar with the drawings, quality standards and quality rence pr6 2、胰腺炎的局部并发症有 和 。 3、临床上将缺铁及缺铁性贫血分为 、缺铁性红细胞生成及 三个阶段。 4、根据肾病综合征患者对糖皮质激素的治疗反应，可将其分为 、 和激素抵抗型。 1、肝硬化失代偿期的两大临床表现为 和 2、急性肾小球肾炎最主要的三大临床表现是 、 浮肿 3、类风湿关节炎常见的关节临床表现有 、痛与压痛 、关节肿及 。 4、ITP的首选治疗是 。 5、糖尿病的慢性并发症大致分二大类 ， 6、急性淋巴细胞白血病患者常用的诱导缓解方案是 1，消化性溃疡:发生在胃和十二指肠得慢性溃疡，即胃溃疡和十二指肠溃疡。并发症:出血，穿孔，幽门梗阻，癌变。类型:复合溃疡 幽门管溃疡 球后溃疡 巨大溃疡 老年人消化性溃疡 无症状性溃疡。治疗:一,一般治疗，生活有规律，避免过度劳累和精神紧张 二，治疗消化性溃疡药物1.抑制胃酸药物.碱性抗酸剂，有氢氧化铝.铝碳酸镁 ;H2RA，西咪替丁，雷尼替丁，法莫替丁，尼扎替丁 ;质子泵抑制剂，奥美拉唑，兰索拉唑，雷贝拉唑，泮托拉唑 2.保护胃黏膜药物 硫糖铝，米索前列醇，枸橼酸铋钾三.根除幽门螺旋杆菌治疗 四.NSAID溃疡的治疗和预防 五.溃疡复发的预防 六.外科手术治 4，肝硬化:是一种以肝组织弥漫性纤维化，假小叶和再生结节形成为特征得慢性肝病。病因;1.病毒性肝炎 2.酒精中毒 3.胆汁淤积 4.循环障碍 5.工业毒物或药物 6.代谢障碍7营养障碍 8免疫紊乱 9.血吸虫病 。临床表现:1.代偿期:腹胀不适，恶心，上腹隐痛。肝轻度肿大，肝功能检查正常或轻度异常 2.失代偿期 (1)肝功能减退 ?全身症状;消瘦乏力，精神不振.不规则低热?消化道症状;食欲不振，上腹饱胀不适，恶心和呕吐?出血倾向和盆血:鼻出血，牙龈出血，皮肤紫癜和胃肠道出血?内分泌紊乱:雌激素增多，雄激素减少.又是糖皮质激素也减少(2)门静脉高压?脾大?侧支循环的建立和开放:食管和胃底静脉曲张，腹壁静脉曲张，痔静脉曲张?腹水。并发症:1上消化道出血2肝性脑病3感染4.肝肾综合症5肝肺综合症6原发性肝癌7电解质和酸碱平衡紊乱。治疗:一，一般治疗:休息，饮食，支持治疗.二，药物治疗:平时可用维生素和消化酶.三，腹水治疗:1限制钠，水摄入2利尿药 3放腹水加输注白蛋白4提高血浆胶体渗透压5腹水浓缩回输 6腹腔—颈静脉引流 四，门静脉高压症手术治疗 五，并发症治疗.六，肝移植手术 5，原发性肝癌:是指肝细胞或肝内胆管细胞发生的癌。临床表现:1肝区疼痛 2肝大 3黄疸 4肝硬化征象5恶性肿瘤得全身性表现 6转移灶征象。并发症:1肝性脑病2上消化道出血3肝癌结节破裂出血4继发感染。诊断:1 AFP》400ug/L，能排除活动性肝病，妊娠，生殖系胚胎源性肿瘤及转移性肝癌等，并能触及明显肿大，坚硬及有结节状肿块得肝脏或影像学检查有肝癌特征得占位性病变者。2 AFP《400ug/L，能排除活动性肝病，妊娠，生殖系胚胎源性肿瘤及转移性肝癌等，并有两种影像学检查有肝癌特征得占位性病变，或有两种肝癌标志物阳性。3.有肝癌临床表现，并有肯定的远处转移灶，并能排除继发性肝癌者 6，急性胰腺炎:是多种病因导致胰酶在胰腺内被激活后引起胰腺组织自身消化，水肿，出血甚至坏死得炎症反应。病因:1胆石症与胆道疾病 2大量饮酒和暴饮暴食 3胰管阻塞 4手术与创伤 5内分泌与代谢障碍 6感染 7药物 8其他。分型:一 急性水肿型 二 急性坏死型。临表:一 症状 1腹痛 2恶心，呕吐及腹胀 3发热 4低血压与休克 5水，电解质， strucstandardized operation, implementation of personnel, posts, site inspection and acceptance procedures. 3, technicians and con ity consciousness, enhance quality, ensure quality assurance goals. 2, according to the scientific, standardized, procedures,f qualher inspection system of supervision engineer is required. 14.2.4 quality management measures 1, job training to enhance staf; Quality of project reports; Site acceptance of materials, sample testing; Concrete test and mixture ratio determination; Otgrammechnical supervision systems; Construction site management system; Construction triage and technical implementation of the proin order to ensure quality, the project shall be to establish a series of systems: quality assurance program; Construction testem andard raw materials and not conducive to construction quality of technology ... 14.2.3 quality supervision and inspection sypurposes. Quality Department the right to endanger the quality of construction and operation to be rejected or stopped. Subst ontrolly responsible to the Chief Engineer, by controlling the raw materials, sample testing and construction process and quality coals and supervise the quality inspection departments. Quality Department is supervising quality assurance Department, directto develop the details of the project quality assurance systems and quality assurance geer leading the project construction organization plan, submitted to the audit supervision engineer. 5, quality managemeEnginwhile explicitly project developed by the Ministry of construction and the quality objectives. 4, technical Department Chief tion team leader before the familiar with the drawings, quality standards and quality requirements specified in the contract,7 酸碱平衡及代谢紊乱 二 体征 1轻症急性胰腺炎，有腹胀和肠鸣音减少，无肌紧张和反跳痛 2 重症急性胰腺炎，上腹或全腹压痛明显，并有肌紧张和反跳痛。治疗:轻症急性胰腺炎:1禁食2胃肠减压 3静脉输液，积极补充血容量 4止痛治疗 5抗生素 6抑酸治疗 。重症急性胰腺炎:一，内科治疗:监护，维持水，电解质平衡 营养支持 抗菌药物 减少胰腺分泌 抑制胰酶活性 二，内镜下Oddi括约肌切开术 三，中医中药 四，外科治疗 7，消化道出血判断:消化道出血》5—10ml粪便隐血试验阳性，出血量50—100ml可出血黑便。胃内储积血量在250—300ml可引起呕血。出血量超过400—500ml，可出现头昏，心慌，乏力等 8，急性肾小球肾炎:AGN 是以急性肾炎综合症为主要的临床表现得一组疾病。特点是急性起病，患者出现血尿，蛋白尿，水肿和高血压，并可伴有一过性氮质血症。 临表:1尿异常 2水肿 3高血压 4肾功能异常 5免疫学检查异常。 治疗:1一般治疗 2治疗感染灶 3对症治疗 4透析治疗 5中药治疗 9，肾病综合症:1尿蛋白大于3.5g/d 2血浆白蛋白低于30g/L 3.水肿 4血脂升高 临表:微小病变肾病 系膜增生性肾小球肾炎 系膜毛细血管性肾小球肾炎 膜性肾病 局灶性结节肾小球硬化 。并发症:1感染 2血栓，栓塞并发症 3急性肾衰竭 4蛋白质及脂肪代谢紊乱。治疗:一，一般治疗 凡有严重水肿，低白蛋白血症者需卧床休息。二，对症治疗 1.利尿消肿 2.减少蛋白尿 三，主要治疗——抑制免疫与炎症反应 四，中医药治疗 五，防止并发症 10，慢性肾小球肾炎得治疗目的及措施:目的:以防止和延缓肾功能进行性恶化，改善和减轻症状及防止并发症。措施:1积极控制高血压 2限制食物中的蛋白及磷的入量 3应用抗血小板药 4糖皮质激素和细胞毒物药 5避免加重肾损害得因素 11，缺铁性盆血(IDA):当机体对铁得需求与供给失衡，导致体内储存铁耗尽，继之红细胞内铁缺乏，最终引起缺铁性盆血诊断:一，ID?血清蛋白《12ug/L?骨髓铁染色显示骨髓小粒可染铁消失，铁粒幼细胞少于15%?血红蛋白及血清铁等指标尚正常 二，IDE ?ID的?+? ?转铁蛋白饱和度《15%?FEP/Hb》4.5ug/gHb?血红蛋白尚正常 三，IDA ?IDE的?+?+? ?小细胞低色素性盆血 四，病因诊断，只有明确病因，IDA才可能根治 12，特发性血小板减少性紫癜(ITP):是因血小板免疫性破坏，导致外周血中血小板减少得出血性疾病。减少因素:1血小板生成障碍 2血小板破坏或消耗过多 3血小板分布异常 诊断:1广泛出血累及皮肤，粘膜及内脏 2多次检验血小板计数减少 3脾不大或轻度肿大 4骨髓巨核细胞增多或正常，有成熟障碍 5具备下列五项中任何一项:?泼尼松治疗有效?脾切除治疗有效?PAIg阳性?PAC3阳性?血小板生存时间缩短 13，淋巴瘤:起源于淋巴结和淋巴组织，其发生大多与免疫应答过程中淋巴细胞增殖分化产生的某种免疫细胞恶变有关，是免疫系统得恶性肿瘤。淋巴瘤分期:?期 病变仅限于2和淋巴结或单个结外器官局部受累 ?期 病变累及横膈同侧二个或更多的淋巴结区，或病变局限侵犯淋巴结以外器官及横膈同侧1个以上淋巴结区。?期 横膈上下均有淋巴结病变 ?期 1个或多个结外器官受到广泛性或播散性侵犯，伴或不伴淋巴结肿大。淋巴瘤分型:1边缘区淋巴瘤 2滤泡性淋巴瘤 3套细胞淋巴瘤 4弥漫性大B细胞淋巴瘤 5 Burkitt淋巴瘤 1, job training to enhance staff quality consciousness, enhance quality, ensure quality assurance goals. 2, according to the sures t and mixture ratio determination; Other inspection system of supervision engineer is required. 14.2.4 quality management meanical implementation of the programme; Quality of project reports; Site acceptance of materials, sample testing; Concrete tesd techty assurance program; Construction technical supervision systems; Construction site management system; Construction triage anty supervision and inspection system in order to ensure quality, the project shall be to establish a series of systems: qualiquali ation to be rejected or stopped. Substandard raw materials and not conducive to construction quality of technology ... 14.2.3struction process and quality control purposes. Quality Department the right to endanger the quality of construction and operd conquality assurance Department, directly responsible to the Chief Engineer, by controlling the raw materials, sample testing an rance systems and quality assurance goals and supervise the quality inspection departments. Quality Department is supervisingto develop the details of the project quality assuon engineer. 5, quality manageme. 4, technical Department Chief Engineer leading the project construction organization plan, submitted to the audit supervisictivesquirements specified in the contract, while explicitly project developed by the Ministry of construction and the quality objeocedures. 3, technicians and construction team leader before the familiar with the drawings, quality standards and quality rence prscientific, standardized, procedures, standardized operation, implementation of personnel, posts, site inspection and accepta8 6血管免疫母细胞性T细胞淋巴瘤 7间变性大细胞淋巴瘤 8周围性T细胞淋巴瘤 9蕈样肉芽肿 14，DIC，弥漫性血管内凝血:是一种发生在许多疾病基础上，由致病因素激活凝血及纤溶系统，导致全身微血栓形成，凝血因子大量消耗并继发纤溶亢进，引起全身出血及微循环衰竭得临床综合症。诊断:1多发性出血倾向 2不易用原发病解释得微循环衰竭或休克 3多发性微血管栓塞得。症状，体征 4抗凝治疗有效 15，糖尿病诊，糖尿病症状+任意时间血浆葡萄糖水平大于等于11.1mmol/L。2，空腹血浆葡萄糖水平大于等于7.0 mmol/L。3，OGTT试验中，2hPG水平大于等于11.1 mmol/L需再测一次，予以证实，诊断才能成立。糖尿病治疗:一，健康教育 二，饮食治疗 三，体育锻炼 四，我监测血糖 五，口服药物治疗 ?促进胰岛素分泌剂 只适用于无急性并发症的T2DM，不适用与T1MD.有严重并发症的T2MD.孕妇.大手术围手术期.儿童糖尿病和全胰腺切除后等 ?双胍类 提高外周组织对葡萄糖得摄取和利用;通过抑制糖原异生和糖原分解，降低过高的肝葡萄糖输出;?α葡萄糖苷酶抑制剂 它延迟碳水化合物吸收，降低餐后血糖 ?胰岛素增敏剂 促进脂肪细胞和其他细胞分化，并提高细胞对胰岛素作用敏感性，减轻胰岛素抵抗 16，系统性红斑狼疮 SLE:是一种临床表现有多系统损害症状的慢性系统性自身免疫病，其血清具有以抗核抗体为主的大量不同的自身抗体。系统性红斑狼疮 SLE诊断标准:1，颧部红斑 2，盘状红斑 3，光过敏 4，口腔溃疡 5，关节炎 6，浆膜炎 7，肾病变 8，神经系统病变，癫痫发作 9血液系统异常，溶血性盆血或血白细胞减少 10免疫性异常，狼疮细胞阳性 11，抗核抗体阳性。以上若有至少4项，则可确定为SLE。治疗原则:早期诊断，早期治疗，病情重者，用强有力得药物控制，病情缓解后，则接受维持性治疗 一，糖皮质激素，一般用泼尼松，泼尼松龙，甲泼尼龙 二，免疫抑制剂，环磷酰胺 硫唑嘌呤 环孢素等 三，静脉注射大量丙种球蛋白 四，控制并发症及对症治疗 五，一般治疗 1,正常人尿液中每日蛋白质排泄量不超过(150mg/d)，若超过，称(蛋白尿) 2，(TSH)直接反映甲状腺功能状态其敏感性和特意性高于TT4 TT3 3，甲亢患者因白细胞减少停用抗甲状腺药物得指标为外周白细胞低于(3*109/L)或中性粒细胞低于(1.5*109/L) 4，慢性粒细胞白血病得整个病程可分为三期(慢性期)(加速期)(急变期) 5，特发性血小板减少性紫癜首选(糖皮质激素)治疗 6，脾功能亢进依据(脾大)(血细胞减少)(增生骨髓象)(脾切除后血细胞数正常) 7，肾小球肾炎临床表现(水肿)(高血压)(蛋白尿)(血尿) 8，糖尿病慢性并发症除大血管病变外，还有(微血管病变)(神经病变)(眼部病变)(糖尿病足) 9，环境因素可能诱发SLE有感染)(日光)(食物)(药物) 1,甲状腺手术并发症:1术后呼吸困难和窒息。2喉返神经损伤。3喉上神经损伤。4手足抽搐。5甲状腺危象(表现为高热，脉快，神经，循环及消化系统严重功能紊乱 2,乳腺癌的临床表现与转移途径:途径:1局部扩展2淋巴转移3血运转移。临表:早期，患侧乳房出现无痛，单发的小肿块，质硬，表面不光滑，与组织分界不清楚，不易被推动，可引起乳房局部隆起。邻近乳头的癌肿因侵入乳管使之缩短，可是乳头扁平，回缩，凹陷，癌块继续 eer leading the project construction organization plan, submitted to the audit supervision engineer. 5, quality managemeEnginwhile explicitly project developed by the Ministry of construction and the quality objectives. 4, technical Department Chief tion team leader before the familiar with the drawings, quality standards and quality requirements specified in the contract,strucstandardized operation, implementation of personnel, posts, site inspection and acceptance procedures. 3, technicians and con ity consciousness, enhance quality, ensure quality assurance goals. 2, according to the scientific, standardized, procedures,f qualher inspection system of supervision engineer is required. 14.2.4 quality management measures 1, job training to enhance staf; Quality of project reports; Site acceptance of materials, sample testing; Concrete test and mixture ratio determination; Otgrammechnical supervision systems; Construction site management system; Construction triage and technical implementation of the proin order to ensure quality, the project shall be to establish a series of systems: quality assurance program; Construction testem andard raw materials and not conducive to construction quality of technology ... 14.2.3 quality supervision and inspection sypurposes. Quality Department the right to endanger the quality of construction and operation to be rejected or stopped. Subst ontrolly responsible to the Chief Engineer, by controlling the raw materials, sample testing and construction process and quality coals and supervise the quality inspection departments. Quality Department is supervising quality assurance Department, directto develop the details of the project quality assurance systems and quality assurance g9 增大，出现真皮水肿，皮肤呈桔皮样改变。晚期，癌块固定于胸壁而不易推动，出现多数小结节，有时皮肤溃破形成溃疡，伴有恶臭，容易出血。炎性乳腺癌可出现皮肤发红，水肿，增厚，粗糙，表面温度升高。 3,开放性气胸机理:外界空气经胸壁伤口或软组织缺损处，随呼吸自由进出胸膜腔。空气出入量与胸壁伤口大小有密切关系，伤口大于气管口径时，空气出入量多，胸内压几乎等于大气压，伤侧肺将完全萎缩，丧失呼吸功能。 4,闭式胸腔引流术的适应症:1中，大量气胸，开放性气胸，张力性气胸。2胸腔穿刺术治疗下气胸增加者。3需使用机械通气或人工通气的气胸或血气胸者。4拔出胸腔引流管后气胸或血胸复发者。:气胸引流一般在前胸壁锁中线第2肋间隙，血胸则在腋中线与腋后线间第6或第7肋间隙。消毒后在局部胸壁全层做局部浸润麻醉，切开皮肤，钝性分离肌层，经肋骨上缘置于带侧孔的胸腔引流管。引流管的侧孔应深入胸腔内2—3cm。引流管外接闭式引流装置，保证胸腔内气，液体克服0.3—0.4Kpa的压力能通畅引流出胸腔，而外界空气，液体不会吸入胸腔，术后经常挤压引流管以保持官腔通畅 5,进行性气胸诊断:1持续脉搏加快，血压降低或虽经补充血容量血压仍不稳定。2闭式胸腔引流量每小时超过200ml，持续3小时。3血红蛋白量，红细胞计数和红细胞压积进行性降低，引流胸腔积血的血红蛋白量和红细胞计数与周围血象接近，且迅速凝固 6,感染性性血胸诊断:1有畏寒，高热等感染。2抽出胸腔积血1ml，加入5 ml蒸馏水，无感染呈淡红透明状，出现混浊或絮状物提示感染。3胸腔积血无感染时红细胞白细胞计数比例应与周围血相似，即500:1，感染时白细胞计数明显增加，比例达100:1可确定为感染性血胸。4积血涂片和细菌培养发现致病菌有助于诊断 7,肺癌诊断:1 X线检查:中心型肺癌X线显示突入支气管腔内的肿块阴影，管壁不规则，增厚或官腔狭窄，阻塞支气管造影可显示官腔边缘残缺或息肉样充盈缺损，官腔中断或不规则狭窄。周围性肺癌X线表现:为肺野周围孤立性圆形或椭圆形块影，直径从1—2cm到5—6cm或更大。块影轮廓不规则，常呈现小的分叶或切迹，边缘模糊毛糙，常显示细短的毛刺影。结节型细支气管肺泡X线表现:轮廓清楚的孤立球形阴影。弥漫型细支气管肺泡X线表现:浸润性病变，轮廓模糊。2，痰细胞学检查。3支气管镜检查。4纵隔镜检查。5放射性核素肺扫描检查。6经胸腔穿刺活组织检查。7转移病灶活组织检查。8胸水检查。9剖腹检查 8,腹外疝病理解剖:典型腹外疝由疝囊，疝内容物和疝外被盖等组成。疝囊是壁层腹膜的憩室样的突出部，由疝囊颈和疝囊体组成，疝囊颈是疝囊比较狭窄的部分，是疝环所在部位，又称疝门。它是疝突向体表的门户，也是腹壁薄弱区或缺损所在 10,腹部损伤临床表现:单纯性腹壁损伤可表现为受伤部位疼痛，局限性腹壁胀痛，压痛，皮下瘀斑。肝，脾，胰，肾等实质器官损伤表现为腹腔内出血，面色苍白，脉率加快，严重时脉搏微弱，血压不稳，甚至休克。肩部放射痛提示肝或脾的损伤。肝破裂伴有较大肝内胆管断裂时，有胆汁沾染腹膜。胰腺损伤伴有胰管断裂，胰液溢入腹腔，可出现明显的腹痛和腹膜刺激症。 11,腹部闭合性损伤的诊断包括:一，有无内脏损伤?详细了解受伤史?重视全身情况的观察?全面而有重点的体格检查?实验室检查。当发现下列情况，应考虑内脏受伤:1早期出现休克征象2有持续性甚至进行性腹部剧痛伴恶心，呕吐等3有明显腹膜刺激症4有气腹表现者5腹部出现移动性浊音者6有便血，呕血或尿血者7直肠指检发现前 ctivesquirements specified in the contract, while explicitly project developed by the Ministry of construction and the quality objeocedures. 3, technicians and construction team leader before the familiar with the drawings, quality standards and quality rence prscientific, standardized, procedures, standardized operation, implementation of personnel, posts, site inspection and accepta1, job training to enhance staff quality consciousness, enhance quality, ensure quality assurance goals. 2, according to the sures t and mixture ratio determination; Other inspection system of supervision engineer is required. 14.2.4 quality management meanical implementation of the programme; Quality of project reports; Site acceptance of materials, sample testing; Concrete tesd techty assurance program; Construction technical supervision systems; Construction site management system; Construction triage anty supervision and inspection system in order to ensure quality, the project shall be to establish a series of systems: qualiquali ation to be rejected or stopped. Substandard raw materials and not conducive to construction quality of technology ... 14.2.3struction process and quality control purposes. Quality Department the right to endanger the quality of construction and operd conquality assurance Department, directly responsible to the Chief Engineer, by controlling the raw materials, sample testing an rance systems and quality assurance goals and supervise the quality inspection departments. Quality Department is supervisingto develop the details of the project quality assuon engineer. 5, quality manageme. 4, technical Department Chief Engineer leading the project construction organization plan, submitted to the audit supervisi10 壁有压痛或波动感。二，什么脏器受伤，三，是否有多发性损伤。四，其他辅助检查:?诊断性腹腔穿刺术和腹腔灌洗术?X线检查?B超检查?CT检查?血管造影 12,腹部损伤，手术探查的指征是:1腹痛和腹膜刺激征有进行性加重或范围扩大者。2肠蠕动音逐渐减弱，消失或出现明显腹胀者。3全身情况有恶化趋势，出现口渴，烦躁，脉率增快或体温及白细胞计数上升者。4红细胞计数进行性下降者。5血压由稳定转为不稳定甚至下降者。6胃肠出血者。7积极救治休克而情况不见好转或继续恶化者 13,急性胃十二指肠溃疡穿孔临表:骤起上腹部刀割样剧痛，迅速波及全腹，病人疼痛难忍，面色苍白，出冷汗，脉搏细速，血压下降等表现。可伴有恶心，呕吐。当胃内容物沿右结肠旁沟向下流注时，可出现右下腹痛，疼痛也可放射至肩部.病人腹式呼吸减弱或消失，全腹压痛，反跳痛，腹肌紧张呈板样强直。叩诊肝浊音界缩小或消失，可有移动性浊音，听诊肠鸣音消失或减弱。胃十二指肠溃疡常见并发症:1急性穿孔2大出血3瘢痕性幽门梗阻。胃癌转移方式:1直接浸润。2血行转移。3腹膜种植转移。 第2/3页 4淋巴转移 22,尿失禁的4种类型:1真性尿失禁(机制:外伤手术或9,腹股沟直疝:疝囊经腹壁下动脉内侧的直疝三角区直接14,肠梗阻分类:按原因分1机械性肠梗阻2动力性肠梗阻先天性疾病引起的膀胱颈和尿道括约肌的损伤)2假性尿由后向前突出，不经过内环，也不进入阴囊 3血运性肠梗阻。按肠壁有无血运障碍分1单纯性2较窄失禁(机制:膀胱功能完全失代偿，膀胱过度充盈)3急10,胸主动脉瘤:由于先天性或后天性疾患，造成主动脉壁性。临表:腹痛，呕吐，腹胀，停止自肛门排气排便。肠迫性尿失禁(机制:严重的尿频，尿急而膀胱不受意识控正常结构的损害，尤其是承受压力和维持大动脉功能的弹 胃肠减压?矫正水，电解质紊乱制而发生排空)4压力性尿失禁(由梗阻治疗:1基础治疗? 于膀胱和尿道之间解力纤维变脆弱和破坏，主动脉在血流压力的作用下逐渐膨和酸碱失衡?防止感染和中毒。2解除梗阻:手术治疗?剖关系异常，使腹压增加，传导至膀胱和尿道的压力不等，大扩张，形成主动脉瘤 解决引起梗阻的原因?肠切除肠吻合术?短路手术?肠膀胱压力增高而没有相应的尿道压力增高) 11,继发性腹膜炎:是临床最常见腹膜炎，常继发于腹腔内造口或肠外置术。非手术治疗 23,前尿道损伤临表:1尿道出血2疼痛3排尿困难4局部空腔脏器穿孔，外伤引起的腹壁或内脏破裂，炎症，手术15,较窄性肠梗阻诊断:1腹痛发作迅速，起始为持续性剧血肿5尿外渗。后尿道损伤的临床表现:1休克2疼痛3污染或吻合口瘘等 烈疼痛，肠鸣音可不亢进。2病情发展迅速，早期出现休排尿困难4尿道出血5尿外渗及血肿 12,急性化脓性腹膜炎:是指由化脓性细菌，包括需养菌和克，抗休克治疗后改善不显著。3有明显腹膜刺激征，体24,骨折的并发症:早期:1休克2脂肪栓塞综合症3重要厌氧菌或两者混合，所引起的腹膜腔急性感染，可由细菌温上升，脉率增快，白细胞计数增高。4腹胀不对称，腹内脏器官损伤:肝脾破裂，肺损伤，膀胱和尿道损伤，直感染，物理或化学损伤引起 部有局部隆起或触及有压痛的肿块。5呕吐物，胃肠减压肠损伤等4重要周围组织损伤:重要血管，神经，脊髓损13,原发性腹膜炎:又称自发性腹膜炎，腹腔内无原发性病抽出液，肛门排出物为血性，或腹腔穿刺抽出血性液体。伤 5骨筋膜室综合症。晚期:1坠积性肺炎2褥疮3下肢灶，致病菌多为溶血性链球菌，肺炎双球菌或大肠杆菌 6经积极非手术治疗而症状体征无明显改善。7腹部X线深静脉血栓形成4感染 eer leading the project construction organization plan, submitted to the audit supervision engineer. 5, quality managemeEnginwhile explicitly project developed by the Ministry of construction and the quality objectives. 4, technical Department Chief tion team leader before the familiar with the drawings, quality standards and quality requirements specified in the contract,strucstandardized operation, implementation of personnel, posts, site inspection and acceptance procedures. 3, technicians and con ity consciousness, enhance quality, ensure quality assurance goals. 2, according to the scientific, standardized, procedures,f qualher inspection system of supervision engineer is required. 14.2.4 quality management measures 1, job training to enhance staf; Quality of project reports; Site acceptance of materials, sample testing; Concrete test and mixture ratio determination; Otgrammechnical supervision systems; Construction site management system; Construction triage and technical implementation of the proin order to ensure quality, the project shall be to establish a series of systems: quality assurance program; Construction testem andard raw materials and not conducive to construction quality of technology ... 14.2.3 quality supervision and inspection sypurposes. Quality Department the right to endanger the quality of construction and operation to be rejected or stopped. Subst ontrolly responsible to the Chief Engineer, by controlling the raw materials, sample testing and construction process and quality coals and supervise the quality inspection departments. Quality Department is supervising quality assurance Department, directto develop the details of the project quality assurance systems and quality assurance g11 5损伤性骨化6创伤性关节炎7关14,原发性肝癌:指肝细胞或肝内胆管细胞发生的癌 检查见孤立，突出胀大的肠袢，不因时间而改变位置或有节僵硬8急性骨萎缩9缺血性骨坏死10缺血性肌挛缩 15,继发性肝癌:又称转移性肝癌，常以肝外原发性癌肿所假肿瘤状阴影或肠间隙增宽，提示有腹腔积液。 25,骨折愈合过程:1血肿炎症机化期2原始骨痂形成期3引起的症状 16,高位或者低位梗阻区别:高位梗阻特点是呕吐发生早而骨板形成塑性期。骨折临床愈合标准:1局部无压痛及纵16,胆石病的分类:胆固醇结石 胆色素结石 混合性结石 频繁，腹胀不明显。低位梗阻特点是腹胀明显，呕吐出现向叩击痛。2局部无异常活动。3 X线片显示骨折处有连17,胆源性胰腺炎:胆石嵌顿在壶腹时可引起胰腺的急性和晚而次数少，并可吐粪样物 续性骨痂，骨折线已模糊。4拆除外固定后，如为上肢能慢性炎症 17,急性阑尾炎症状和体征:症状:1腹痛，典型腹痛发作向前平举1kg重物持续大1分钟，如为下肢不扶拐能在平18,Reynolds五联征:具有一般胆道感染的Charcot三联征与上腹，逐渐移向脐部。2胃肠道症状:厌食，恶心，呕地连续不行3分钟，并不少于30步，连续观察2周骨折(腹痛,寒战高热,黄疸)外,还可出现休克,神经中枢系统受抑吐，腹泻。3全身症状:早期乏力，严重时出现中毒症状，出不变性 制表现 心率增快，发热。体征:1右下腹压痛2腹膜刺激征象:26,影响骨折愈合因素:1全身因素?年龄?健康状况。219,原发性下肢静脉曲张:单纯涉及隐静脉.浅静脉伸长,迂反跳痛，腹肌紧张，肠鸣音减弱或消失3右下腹包块4可局部因素?骨折的类型和数量?骨折部位的血液供应。3曲而呈曲张状态,多发生于从事持久站立的工作,体力活动作为辅助诊断体征?结肠充气试验?腰大肌试验?闭孔软组织损伤程度。4软组织嵌入，5感染 强度高,或久坐少动的人。临表:下肢浅静脉扩张，伸长，内肌试验?经肛门直肠指检 27,椎间盘形成:是由上下软骨板，中心的髓核及四周的纤迂曲。诊断:1大隐静脉瓣膜功能试验2深静脉通畅试验18,内痔的分度:?度:便时带血，滴血或喷射状出血，便维环构成。1软骨板是厚约1mm的透明软骨，连接于椎体3交通静脉瓣膜功能试验 后出血可自行停止，无痔脱出。?度:常有便血。排便时与椎间盘之间2髓核为胶冻状胶原物质，包含软骨细胞和20,尿潴留:指膀胱内充满尿液而不能排除，常常由排尿困有痔脱出，便后可自行还纳。?度:偶有便血，排便或久胶原纤维网结构3纤维环由胶原纤维和纤维软骨组成，横难发展到一定程度引起 站，咳嗽，劳累，负重是痔脱出，需用手还纳。?:偶有断面上呈环形层状排列，前方及两侧较厚，后外侧薄，共21,尿石症:又称尿路结石，是肾结石，输卵管结石，膀胱便血，痔脱出不能还纳或还纳后又脱出 约12层 结石和尿道结石的总称。(对泌尿系统危害:引起泌尿系19,胆囊切除行胆总管探查术指证:1.术前已证实或高度怀1,反常呼吸运动:多根多处肋骨骨折将使局部胸壁失去完统直接损伤，梗阻，感染和恶性变) 疑有胆总管结石,包括梗阻性黄疸的临床表现或病史:反复整肋骨支撑而软化，出现反常呼吸运动。 22,青枝骨折:多见于儿童，骨质和骨膜部分断裂，可有成发作胆绞痛,胆囊炎:有胰腺炎病史:术中胆道造影证实有结2,连枷胸:吸气时软化区胸壁内陷，呼气时外突 角畸形。有时成角畸形不明显，仅表现为骨皮质劈裂，与石,胆道梗阻或扩张2.手术扪及胆总管内有结实,蛔虫或肿3,纵隔扑动:呼，吸气时，两侧胸膜腔压力不均衡出现周青嫩树枝被折断时相似而得名 块:或发现胆总管扩张,直径1CM以上,管壁明显增厚:胆囊期性变化，使纵隔在吸气时移向健侧，呼气时移向伤侧 23,骨筋膜室综合症:由骨，骨间隙，肌间隔和深筋膜形成结石小,可通过胆囊管进入胆总管:或发现有 1, job training to enhance staff quality consciousness, enhance quality, ensure quality assurance goals. 2, according to the sures t and mixture ratio determination; Other inspection system of supervision engineer is required. 14.2.4 quality management meanical implementation of the programme; Quality of project reports; Site acceptance of materials, sample testing; Concrete tesd techty assurance program; Construction technical supervision systems; Construction site management system; Construction triage anty supervision and inspection system in order to ensure quality, the project shall be to establish a series of systems: qualiquali ation to be rejected or stopped. Substandard raw materials and not conducive to construction quality of technology ... 14.2.3struction process and quality control purposes. Quality Department the right to endanger the quality of construction and operd conquality assurance Department, directly responsible to the Chief Engineer, by controlling the raw materials, sample testing an rance systems and quality assurance goals and supervise the quality inspection departments. Quality Department is supervisingto develop the details of the project quality assuon engineer. 5, quality manageme. 4, technical Department Chief Engineer leading the project construction organization plan, submitted to the audit supervisictivesquirements specified in the contract, while explicitly project developed by the Ministry of construction and the quality objeocedures. 3, technicians and construction team leader before the familiar with the drawings, quality standards and quality rence prscientific, standardized, procedures, standardized operation, implementation of personnel, posts, site inspection and accepta12 胰腺炎表现:或4,张力性气胸(高压性气胸):为气管，支气管或肺损伤处的骨筋膜室内肌肉和神经因急性缺血而产生的一系列早行胆管穿刺抽出脓性,血性胆汁或泥沙样胆色素颗粒 形成活瓣，气体随每次吸气进入胸腔并积累增多，导致胸期征候群 20,引起上消化道大出血5大常见病因:1,胃十二指肠溃疡 膜腔压力高于大气压 24,Colles骨折:伸直型骨折，多为腕关节处于背伸拉，手2,门静脉高压3,出血性胃炎4,胃癌5,胆道出血。判断上下5,Beck三联征:静脉压升高，心音遥远.心搏微弱，脉压掌着地，前臂旋前时受伤 消化道出血:上消化道出血表现为呕血，血色鲜红或呈棕小.动脉压降低 25,Smith骨折:屈曲型骨折，由于跌倒时，腕关节屈曲，褐色，黑粪症并有恶臭。便血提示下消化道出血 6,胸腹联合伤:穿透伤同时伤及胸腹腔内脏和膈肌，致伤手背着地受伤引起，也可由腕背部受到直接暴力打击发生 21,急性胰腺炎的手术适应证:1不能排除其他急腹症时2,物入口位于胸部 26,Barton骨折:在腕背伸，前臂旋前位跌倒，手掌着地，胰腺和胰周坏死组织继发感染3,虽然经合理支持治疗,而7,腹外疝:是由腹腔内的脏器或组织连同腹膜壁层，经腹暴力通过腕骨传导，撞击桡骨关节背侧发生骨折，腕关节临床症状继续恶化4,爆发性胰腺炎经过短期(24h)非手术壁薄弱点或孔隙，向体表突出所形成。(分为:易复性，也随之而向背侧移位 治疗多器官功能障碍仍不能得到纠正5,胆源性胰腺炎6,难复性，嵌顿性，较窄性) 27,颈椎病的分类:1神经根型颈椎病2脊髓型颈椎病3交病程后期合并肠瘘或胰腺假性囊肿 8,腹股沟斜疝:疝囊经过腹壁下动脉外侧的腹股沟管深环感神经型颈椎病4椎动脉型颈椎病 间歇性跛行:慢性动脉阻塞或静脉功能不全时,步行时可以突出，向内，向下，向前斜行经过腹股沟管，再穿过腹股28,腰椎间盘突出症:是因椎间盘变性，纤维环破裂，髓核出现小腿疼痛,迫使病人止步,休息片刻后疼痛缓解 沟管浅环，并可进入阴囊 突出刺激或压迫神经根，马尾神经所表现的一种综合症 ( )10、GHbA1C测定可反映取血前4—8周的血糖总水平) 9斜疝和直疝的鉴别: 斜疝 直疝 ( )1、一般中毒后12小时内进行人工透析效果较好。 发病年龄 多见儿童及青壮年 多见老年 ( )2、急性肾炎患者多没有急性上呼吸道感染前趋症状。 突出途径 经腹股沟管突出，可进阴囊 直疝三角突出，不进阴囊 ( )3、慢性肾炎可发生于任何年龄，但以青中年为主，男性多见。 疝块外形 椭圆或梨形，上部呈蒂柄状 半球形，基底较宽 ( )4、慢性肾功能不全非透析患者血肌酐>350uml/L可继续使用 ACEI制剂调整血压。 回纳疝块后压住深环 疝块不再突出 疝块仍可突出 ( ) 5、 慢性ITP 常见于40岁以上的妇女 精索与疝囊的关系 精索在疝囊后方 精索在疝囊前外方 ( )6、 ITP治疗首选糖皮质激素 疝囊颈与腹壁下 疝囊颈在腹壁下动脉 疝囊颈在腹壁下动脉 ( )7、 外周血中发现泪滴红细胞对诊断骨髓纤维化症有辅助价值 动脉的关系 外侧 内侧 ( )8、Graves病与桥本甲状腺炎均属于器官特异性自身免疫性疾病。 嵌顿机会 较多 极少 ( )9、糖尿病患者的多尿是由于血糖升高后的渗透性利尿引起的， 而不是饮水增多的结 果。 ( )10、糖尿病患者眼底检查发现出血并有硬性渗出属于增殖性视网 (?)6、全血胆碱酯酶测定是诊断有机磷农药中毒和判定其中毒程度的重要指标。 膜病变。 (? )7、胰腺脓肿多在急性胰腺炎起病后2~3周后发生。 1、胃溃疡患者上腹痛 strucstandardized operation, implementation of personnel, posts, site inspection and acceptance procedures. 3, technicians and con ity consciousness, enhance quality, ensure quality assurance goals. 2, according to the scientific, standardized, procedures,f qualher inspection system of supervision engineer is required. 14.2.4 quality management measures 1, job training to enhance staf; Quality of project reports; Site acceptance of materials, sample testing; Concrete test and mixture ratio determination; Otgrammechnical supervision systems; Construction site management system; Construction triage and technical implementation of the proin order to ensure quality, the project shall be to establish a series of systems: quality assurance program; Construction testem andard raw materials and not conducive to construction quality of technology ... 14.2.3 quality supervision and inspection sypurposes. Quality Department the right to endanger the quality of construction and operation to be rejected or stopped. Subst ontrolly responsible to the Chief Engineer, by controlling the raw materials, sample testing and construction process and quality coals and supervise the quality inspection departments. Quality Department is supervising quality assurance Department, directto develop the details of the project quality assurance systems and quality assurance geer leading the project construction organization plan, submitted to the audit supervision engineer. 5, quality managemeEnginwhile explicitly project developed by the Ministry of construction and the quality objectives. 4, technical Department Chief tion team leader before the familiar with the drawings, quality standards and quality requirements specified in the contract,13 失去节律性，粪便隐血持续阳性，最应考虑溃疡出血 (×)8、胃癌的癌前病变包括慢性萎缩性胃炎、胃息肉、胃溃疡、残胃炎。 2、肝硬化并自发性腹膜炎腹水介于渗出液与漏出液之间 (×)9、溃疡性结肠炎病变呈节段性分布。 3、肾病综合征病人提倡高蛋白饮食治疗。 (×)10、上消化道大出血病情急，因此止血治疗因放在一切治疗措施的首位 4、急进性肾炎应在早期作出病因诊断和免疫病理分型的基础上积极强化治疗。 ( ? )1、一般中毒后12小时内进行人工透析效果较好。 5、类白血病反应中性粒细胞碱磷酶活性降低。 (× )2、急性肾炎患者多没有急性上呼吸道感染前趋症状。 6、男性，自幼常发生黄疸，贫血检查证实为遗传性球形细胞增多症，治疗最好采用脾切除。 ( ?)3、慢性肾炎可发生于任何年龄，但以青中年为主，男性多见。 7、妊娠期糖尿病患者经饮食控制后血糖不达标一定要使用胰岛素治疗。 ( × )4、慢性肾功能不全非透析患者血肌酐>350uml/L可继续使用 ACEI制剂调整血压。 8、Graves病患者的甲状腺肿大程度应与病情轻重成正比。 ( × ) 5 慢性ITP 常见于40岁以上的妇女 9、风湿性疾病，都是自身免疫性疾病。 ( × ) 6、地中海贫血是大细胞贫血 10、弥漫性结缔组织疾病一般主张联合用药，综合治疗。 ( ?) 7、吞咽困难是缺铁性贫血的临床表现之一 1、结核性腹膜炎最主要的感染途径是肺内结核病灶血行播散。( ) ( × ) 8、再生障碍性贫血患者输血时要输全血 2、肝硬化大量腹水治疗，主张采用大量利尿剂。( ) ( ? ) 9、Graves病与桥本甲状腺炎均属于器官特异性自身免疫性疾病。 3、急性早幼粒细胞白血病患者易发生DIC。( ) ( × ) 10、GHbA1C测定可反映取血前4—8周的血糖总水平。 4、尿路感染都是由肠道革兰阴性杆菌引起的。( ) )1、全血胆碱酯酶测定是诊断有机磷农药中毒和判定其中毒程度的重要指标。 5、男性，自幼常发生黄疸，贫血检查证实为遗传性球形细胞增多症，治疗最好采用脾切除。( ) ( )2、一般中毒后12小时内进行人工透析效果较好。 6、尿毒症的替代治疗中，透析疗法可以替代肾脏的所有功能。( ) ( )3急性肾炎患者多没有急性上呼吸道感染前趋症状。 7、糖化血红蛋白的测定可反映近2—3个月的血糖控制情况。( ) ( ) 4清洁中段尿有细菌生长就可以判定为尿路感染。 8、Graves病患者的甲状腺肿大程度应与病情轻重成正比。( ) ( )5肾性贫血的主要原因是肾产生的促红细生成素减少。 9、类风湿因子阳性即可诊断为类风湿关节炎。( ) ( )6、地中海贫血是大细胞贫血 10、弥漫性结缔组织疾病一般主张联合用药，综合治疗;( ) ( )7、吞咽困难是缺铁性贫血的临床表现之一 ( )8、再生障碍性贫血患者输血时要输全血 ( )9、Graves病与桥本甲状腺炎均属于器官特异性自身免疫性疾病。 on engineer. 5, quality manageme. 4, technical Department Chief Engineer leading the project construction organization plan, submitted to the audit supervisictivesquirements specified in the contract, while explicitly project developed by the Ministry of construction and the quality objeocedures. 3, technicians and construction team leader before the familiar with the drawings, quality standards and quality rence prscientific, standardized, procedures, standardized operation, implementation of personnel, posts, site inspection and accepta1, job training to enhance staff quality consciousness, enhance quality, ensure quality assurance goals. 2, according to the sures t and mixture ratio determination; Other inspection system of supervision engineer is required. 14.2.4 quality management meanical implementation of the programme; Quality of project reports; Site acceptance of materials, sample testing; Concrete tesd techty assurance program; Construction technical supervision systems; Construction site management system; Construction triage anty supervision and inspection system in order to ensure quality, the project shall be to establish a series of systems: qualiquali ation to be rejected or stopped. Substandard raw materials and not conducive to construction quality of technology ... 14.2.3struction process and quality control purposes. Quality Department the right to endanger the quality of construction and operd conquality assurance Department, directly responsible to the Chief Engineer, by controlling the raw materials, sample testing an rance systems and quality assurance goals and supervise the quality inspection departments. Quality Department is supervisingto develop the details of the project quality assu14