问题 问答题 简答题

心脏触诊(内容、方法、顺序)(18分)

答案

参考答案:

(1)触诊手法正确(3分);被检查者卧位,检查者在其右侧,先用右手掌自心尖部开始检查,触诊压力适当。

(2)触诊顺序正确(3分);从心尖部开始,逐渐触诊肺动脉瓣区、主动脉瓣区、第二主动脉瓣区及三尖瓣区。

(3)在心尖搏动区触诊(可用单一示指指腹)确认心尖搏动最强点,并能表达被检查者心尖搏动所在体表位置(6分);

①能够正确指出心尖搏动最强点在第几肋间。(3分)

②能够正确指出在锁骨中线内、外。(3分)

(4)触诊震颤、心包摩擦感(4分);

①震颤:用手掌或手掌尺侧小鱼际肌平贴于心前区各个部位,以触知有无微细的震动感(2分)。

②心包摩擦感:用上述触诊手法在心前区胸骨左缘第4肋间触诊。或说出如何能使触诊满意的条件(前倾位、收缩期、呼气末、摒住呼吸(1分)。)

(5)提问(5个)(2分)

①心尖搏动最强点在第4肋间锁骨中线外,考虑什么情况?(1分)答:右心室增大

②心尖搏动触不到,有什么可能?(1分)答:胸壁过厚。

③如何辨别收缩期震颤和舒张期震颤?(1分)答:可通过心尖搏动触及胸壁的时间确认为收缩期的开始。

④心前区触到舒张期震颤即肯定有器质性心脏病,对不对?(1分)答:对。

⑤心尖搏动增强见于哪些情况?答:心尖搏动增强见于左室肥大、甲状腺功能亢进、发热、贫血时,心尖搏动增强,范围大于直径2cm,尤其是左室肥大,心尖搏动明显增强。

阅读理解

London has become a cycle friendly zone after the launch of a new bike hire scheme.It has been designed to encourage more people to cycle in and around central London.

So how does it  work?First you have to sign up to the scheme to be sent a key.The key will unlock one of the bikes,which are kept at docking stations in  and around central London.You have to pay an access fee for the key and then you pay as you go,for he length of time you use the bike.

Transport for London, which runs the scheme,are hoping to have 6,000 bikes and 400 docking stations in place by the end of the year.The new hire system is hoping to ease congestion in London and is expected to generate up to 40,000 extra cycle trips a day into the city centre.London Mayor Boris Johnston launched the scheme and said London had been “filled with thousands of gleaming machines that will transform the look and feel of our streets and become as commonplace on our roads as black cabs and red buses”.

However,there  have been a few problems since the scheme was launched last Friday.On the first day some people found they couldn’t dock their bike  properly and their usage of the bike had not registered.Transport for London did admit they had been expecting a few “teething problems”and have said they wouldn’t charge for the first day as a“gesture of goodwill”.Some other people have criticized the lack of docking stations and locks for the bikes as well as the price it costs to hire the bicycles.

Despite the comments,the green-thinking London Mayor still seems very positive about things,saying,“My campaign for the capital to become the greatest big cycling city in the world has taken a gigantic pedal-powered push forwards.”

小题1:A new bike scheme has started in London to.

A.earn more money for the government

B.encourage the citizens to take exercises

C.deal with the city’s traffic problems

D.increase employment opportunities小题2:Which  is the correct order of a bike hire?

a.pay a usage charge according to the time   b.pay for the key

c.cycle in and around central London         d.sign up as a member to get a key

A.b-d-c-a

B.b-c-a-d

C.d-c-b-a

D.d-b-c-a小题3:According to he passage,the scheme         .

A.is started by volunteers in London

B.has prepared cnough cycles available

C.is expected to improve the environment

D.has become as popular as cabs and buses小题4:Which of the following is NOT the“teething problems” of the scheme?

A.People were unable to lock properly.

B.People could not dock the bikes properly.

C.People had no enthusiasm about the scheme.

D.It’s too expensive for some people to hire a bike.小题5:From the passage we know         .

A.the‘cycling revolution’failed once started

B.the scheme will be put off due to the problems

C.all the citizens in London are in favor of the scheme

D.the London Mayor has great confidence in the scheme

填空题