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of rural drinking water sources, protection of drinking water sources in rural areas by the end of the delimitation of the scope of protection, complete with warning signs, isolating network protection facilities
of rural drinking water sources, protection of drinking water sources in rural areas by the end of the delimitation of the scope of protection, complete with warning signs, isolating network protection facilities
of rural drinking water sources, protection of drinking water sources in rural areas by the end of the delimitation of the scope of protection, complete with warning signs, isolating network protection facilities
公共卫生执业医师实践技能试题及答案——体格检查
小工程〔血压、眼、颈部、外周血管〕3分，大工程〔胸、心、腹、神经〕7分，各考一题，共10分。
1、血压〔3分〕
〔1〕血压计放置位置正确〔1分〕；
被检查者取坐位或仰卧位，血压计。
〔2〕血压带绑扎部位正确、松紧度适宜〔1分〕；
通常测右上肢，将袖带均匀紧贴皮肤缠于上臂，袖带下缘在肘窝上3厘米，袖带中央位于肱动脉外表。
〔3〕听诊器胸件放置部位正确〔〕；
检查者扪及被检查者肱动脉搏动后，将听诊器胸件置于搏动上〔不能塞在袖带下〕准备听诊。
〔4〕测量过程流畅〔〕。
充气至肱动脉搏动消失再升20-30mmHg，缓慢放气，第一声响为收缩压，声音消失时为舒张压。
2、眼〔3分〕
〔1〕眼球运动检查方法正确〔1分〕；
左→左上→左下→右→右上→右下〔50-60cm面对面而坐〕。
of rural drinking water sources, protection of drinking water sources in rural areas by the end of the delimitation of the scope of protection, complete with warning signs, isolating network protection facilities
of rural drinking water sources, protection of drinking water sources in rural areas by the end of the delimitation of the scope of protection, complete with warning signs, isolating network protection facilities
of rural drinking water sources, protection of drinking water sources in rural areas by the end of the delimitation of the scope of protection, complete with warning signs, isolating network protection facilities
〔2〕对光反射〔间接、直接〕检查方法正确〔1分〕；
直接：用笔形手电从斜方照入瞳孔，观察瞳孔收缩情形〔照射立即收缩，移开复原〕；间接：照一侧瞳孔时，对侧也收缩。
〔3〕调节反射检查检查方法正确〔〕；
注视1米以外的示指，然后将示指迅速移近距眼球10cm左右处，正常反响是瞳孔缩小。
〔4〕辐辏反射〔会聚反射〕检查方法正确〔〕。
注视1米以外的示指，然后将示指缓慢移近距眼球10cm左右处，正常反响是两侧眼球同时向内聚合。
3、颈部〔甲状腺、气管〕〔3分〕
〔1〕检查者与被检查者站立位置正确〔1分〕；
前方触诊：检查者位于被检者身后；前面触诊：检查者立〔坐〕于被检者对面。
〔2〕检查甲状腺手法〔包括检查者在病人前和后的手法〕〔1分〕；
后：双手拇指置于被检者颈后部，余四指绕颈部前下方，示指和中指尖于环状软骨下方触甲状腺峡部，以左手指将甲状腺推向右侧，余指触甲状腺右叶〔大小、质地、压痛、有无粘连、有无吞咽移动〕；
of rural drinking water sources, protection of drinking water sources in rural areas by the end of the delimitation of the scope of protection, complete with warning signs, isolating network protection facilities
of rural drinking water sources, protection of drinking water sources in rural areas by the end of the delimitation of the scope of protection, complete with warning signs, isolating network protection facilities
of rural drinking water sources, protection of drinking water sources in rural areas by the end of the delimitation of the scope of protection, complete with warning signs, isolating network protection facilities
前：以右手大拇指将甲状腺推向右侧，用左手拇指触摸甲状腺右叶〔大小、质地、压痛、有无粘连、有无吞咽移动〕。
〔3〕头部位置正确并能令被检查者吞咽口水〔〕；
头轻度后仰，可视诊；头侧向检查叶，可触诊。
〔4〕三手指检查气管方法、部位正确〔〕；
右手示指与环指分别置于两侧胸锁关节上，中指于胸巧衔汛サ狡埽鄄熘兄赣胧局负突分讣渚嗬耄Ｈ肆讲嗑嗬胂嗟龋芫又小？BR>
4、外周血管检查〔3分〕
〔1〕测试脉搏、脉率、脉律方法、部位正确〔2分〕；60-100次/分，平均72次/分桡动脉：用示指、中指、无名指的指腹平放于桡动脉的近手腕处，轻压至感觉最强。〔颈动脉、股动脉、肱动脉、足背动脉、颞浅动脉、耳前动脉〕
of rural drinking water sources, protection of drinking water sources in rural areas by the end of the delimitation of the scope of protection, complete with warning signs, isolating network protection facilities
of rural drinking water sources, protection of drinking water sources in rural areas by the end of the delimitation of the scope of protection, complete with warning signs, isolating network protection facilities
of rural drinking water sources, protection of drinking water sources in rural areas by the end of the delimitation of the scope of protection, complete with warning signs, isolating network protection facilities
〔2〕测毛细血管搏动方法正确〔1分〕。
用手指轻压病人指甲末端或以玻片轻压病人口唇，可使局部发白，心脏收缩时又发红，随心动周期出现红白交替改变。
5、胸部视诊〔7分〕
〔1〕能指出胸部体表主要骨骼标志、主要垂直线标志〔锁骨中线〕及主要自然陷窝〔3分〕；腋窝、胸骨上窝、锁骨上窝、胸骨上切迹、胸骨柄、胸骨角、剑突等。
〔2〕在视诊内容方面，能提到观察胸廓形状〔桶状胸、扁平胸、肋间隙是否饱满、乳房是否对称等〕〔2分〕；
正常胸廓：前后径与左右径之比为1：.
桶状胸：胸廓前后径增加，前后径与左右径几乎相等，或超过左右径，呈桶状。
扁平胸：胸廓扁平，前后径不到左右径的一半。
〔3〕能答出视诊可观察：呼吸运动、呼吸频率、呼吸节律者〔2分〕；
正常男性和儿童以腹式呼吸，女性以胸式呼吸为主；正常呼吸频率16-18次/分，呼吸与脉搏比为1：4，新生儿44次/分，>24过速，<12次过缓，正常呼吸节律规整的，异常呼吸节律有：潮式呼吸、间停呼吸、抑制性呼吸、叹息样呼吸。
of rural drinking water sources, protection of drinking water sources in rural areas by the end of the delimitation of the scope of protection, complete with warning signs, isolating network protection facilities
of rural drinking water sources, protection of drinking water sources in rural areas by the end of the delimitation of the scope of protection, complete with warning signs, isolating network protection facilities
of rural drinking water sources, protection of drinking water sources in rural areas by the end of the delimitation of the scope of protection, complete with warning signs, isolating network protection facilities
6、胸部触诊〔7分〕
〔1〕胸部〔廓〕扩张度双手触诊方法、姿势正确〔3分〕；
检查者双手置于被检者胸廓前下部对称部位，左右拇指分别沿两侧肋缘指向剑突，手掌和其余4指置前侧胸壁，嘱被检者作深呼吸，比拟两手的动度。医。学。全。在。
〔2〕双手语音震颤触诊方法正确〔2分〕；
将双手掌尺侧缘放在胸壁的对称部位，然后嘱受检者重复发出“yi〞的长音，比拟两手掌感受的震颤。
〔3〕能提到胸部触诊可触及胸膜磨擦音的，并能进行正确操作的〔2分〕；
一般在胸廓前下侧部用手掌容易触及胸膜摩擦感。
7、胸部叩诊〔7分〕
〔1〕间接叩诊时手指动作、方法、顺序正确〔4分〕；
叩诊顺序：前胸→侧胸→背部；方法：以左手中指为板指，平贴肋间隙，并与肋骨平行〔叩肩胛区可以与脊柱平行〕，用右手中指指端叩击板指第2节指骨前端，每次叩2-3次，力量需均匀，轻重适当。
of rural drinking water sources, protection of drinking water sources in rural areas by the end of the delimitation of the scope of protection, complete with warning signs, isolating network protection facilities
of rural drinking water sources, protection of drinking water sources in rural areas by the end of the delimitation of the scope of protection, complete with warning signs, isolating network protection facilities
of rural drinking water sources, protection of drinking water sources in rural areas by the end of the delimitation of the scope of protection, complete with warning signs, isolating network protection facilities
〔2〕直接叩诊手指方法正确〔1分〕；
将2-4指并拢，以其指腹对胸壁进行直接拍击。
〔3〕会叩肺移动度者〔2分〕；
首先叩出平静呼吸时肺下界，然后嘱受检者深吸气并屏住气，同时向下叩肺下界，做一标记，待受检者平表呼吸后再嘱其作深呼气并屏住气，再叩肺下界。两者之间的距离为肺下界移动度，正常值为6-8cm.
8、胸部听诊〔7分〕
〔1〕听诊方法、顺序正确〔3分〕；
取坐位或仰卧位，口微张开保持呼吸均匀，顺序：肺尖开始，由上→下、从前胸→侧胸→背部，应左右、上下进行比照。
〔2〕能表述听诊〔肺部听诊〕四种主要内容〔正常呼吸音、异常呼吸音、罗音、胸膜磨擦音〕〔4分〕；
正常呼吸音〔支气管呼吸音、肺泡呼吸音、支气管肺泡呼吸音〕、异常呼吸音〔肺泡呼吸音增强或减弱或消失、呼气音延长、粗糙性呼吸音、断续性呼吸音〕、罗音〔干罗音、湿罗音〕、胸膜摩擦音〔呼吸时脏层与壁层胸膜摩擦的声音〕。
of rural drinking water sources, protection of drinking water sources in rural areas by the end of the delimitation of the scope of protection, complete with warning signs, isolating network protection facilities
of rural drinking water sources, protection of drinking water sources in rural areas by the end of the delimitation of the scope of protection, complete with warning signs, isolating network protection facilities
of rural drinking water sources, protection of drinking water sources in rural areas by the end of the delimitation of the scope of protection, complete with warning signs, isolating network protection facilities
9、心脏视诊〔7分〕
〔1〕心脏视诊方法正确〔3分〕；
被检者取坐卧或仰卧位。
〔2〕能讲出心脏视诊主要三个内容，并能指出其部位〔心前区隆起与凹陷、心尖搏动、心前区异常搏动〕〔4分〕；
心前区隆起→心包积液；心尖搏动增强→左心室肥大、甲亢；心尖搏动减弱→心肌炎、心包积液、左侧胸腔积液。
10、心脏触诊〔7分〕
〔1〕触诊手法正确〔3分〕；
〔右手全掌→手掌尺侧→示指或中指指腹〕置于被检者心前区，确定心尖搏动的位置、强度及有无抬举性。
〔2〕能在心尖搏动区及心前区正确进行触诊〔2分〕；
〔3〕能提到触诊可触及震颤、心包磨擦感的〔2分〕；
of rural drinking water sources, protection of drinking water sources in rural areas by the end of the delimitation of the scope of protection, complete with warning signs, isolating network protection facilities
of rural drinking water sources, protection of drinking water sources in rural areas by the end of the delimitation of the scope of protection, complete with warning signs, isolating network protection facilities
of rural drinking water sources, protection of drinking water sources in rural areas by the end of the delimitation of the scope of protection, complete with warning signs, isolating network protection facilities
震颤〔如猫喘〕、心包摩擦感〔常在第4肋间可及〕。
11、心脏叩诊〔7分〕：确定心脏大小、形状、位置。
〔1〕叩诊方法、姿势、力量正确〔4分〕；
以左手中指作为叩诊板指，平置于心前区叩诊部位，坐位时板指与肋间垂直，卧位时板指与肋间平行，以右手中指借右腕关节活动叩击板指，清变浊来确定心界，顺序：左界→右界，由下→上，由外向内。左侧心尖搏动外2-3cm→逐个肋间向上→第2肋间，并作标志，测量其与胸骨中线间的垂直距离。
〔2〕会叩诊心浊音界，能答复并叩出主考官提出的某肋间心浊音界〔3分〕；
正常心界：2~3→II←2~3；2~3→III←~；2~3→IV←5~6； V←7~9 〔左锁骨中线距胸骨中线为8-10cm〕。
12、心脏听诊〔7分〕
〔1〕能正确指出心脏瓣膜各听诊区〔3分〕；5个听诊区
二尖瓣区〔~〕→肺动脉瓣区〔胸骨左缘第2肋间〕→
of rural drinking water sources, protection of drinking water sources in rural areas by the end of the delimitation of the scope of protection, complete with warning signs, isolating network protection facilities
of rural drinking water sources, protection of drinking water sources in rural areas by the end of the delimitation of the scope of protection, complete with warning signs, isolating network protection facilities
of rural drinking water sources, protection of drinking water sources in rural areas by the end of the delimitation of the scope of protection, complete with warning signs, isolating network protection facilities
主动脉瓣区〔胸骨右缘第2肋间〕→主动脉瓣第二听诊区〔胸骨左缘第3肋间〕→三尖瓣区〔胸骨左缘第4、5肋间〕。
〔2〕听诊顺序正确〔从二尖瓣区开始→肺动脉区→主动脉区→主动脉第二听诊区→三尖瓣区〕〔2分〕；好发病变顺序：二尖→主动脉→主动脉2→肺动脉→三尖瓣。
〔3〕能讲出心脏听诊主要内容〔2分〕；
听诊内容：心率〔60-100〕、心律〔规整〕、心音〔S1、S2、S3、S4〕、异常心音〔响度、音质改变，分裂〕、额外心音〔病理性、拍击音、医源性〕、心脏杂音〔出现时间、部位、传导方向、性质、强度与呼吸、体位变化的关系〕。
13、腹部视诊〔7分〕
〔1〕腹部的体表标志及分区表述正确并能在腹部指点正确〔3分〕；
分区：四区法〔脐水平及垂直线划分〕、九区法〔水平线：两侧肋弓下缘连线、两侧髂前上棘连线；垂直线：左右髂前上棘至腹中线连线的中点为两条垂直线〕。
〔2〕视诊方法正确〔2分〕；
被检者排空膀胱、低枕仰卧位，检查者于被检者右侧，自上而下全面观察。