问题 问答题 简答题

全身状况

答案

参考答案:

1.生命征包括体温、脉搏、呼吸、血压。

(1)体温:测量前被检查者应安静休息30分钟,测试时体温计读数应小于35℃。

1)口测法:体温计置于舌下,闭口,5分钟后读数,正常值为36.3~37.2℃。口测法测量结果可靠。婴幼儿或神志不清者不能使用。

2)肛测法:被检查者侧卧位,将肛门温度计涂润滑油后缓缓插入肛门,深度达温度计长度的一半,5分钟后读数,正常值为36.5~37.7℃。检查结果可靠。适用于小儿或神志不清者。

3)腋测法:测量前被检查者应安静休息并擦干腋窝,移走附近冷热物体,将体温计放置腋窝顶部,上臂紧贴胸壁夹紧体温计,10分钟后读数,正常值为36~37℃。腋测法使用最为广泛。体温高于正常为发热,37.3~38℃为低热,38.1~39℃为中度发热,39.1~41℃为高热,41℃以上为超高热。

(2)脉搏:见血管检查部分。

(3)呼吸:见胸部体检部分。

(4)血压:血压的测量包括直接测量法和间接测量法。

1)直接测量法:用于危重症,在动脉穿刺后直接测定动脉内压力。

2)间接测量法:使用血压计进行测量。被检查者在安静环境休息5~10分钟,采取仰卧或坐位,被测上肢裸露,伸直并轻度外展,肘部与心脏相平(坐位平第四肋间、卧位平腋中线)。袖带气囊部分对准肱动脉,紧贴皮肤缚于上臂,袖带下缘在肘横纹上2~3cm。检查者在肘窝处触知肱动脉搏动,将听诊器体件置于肘窝处肱动脉上,轻压体件与皮肤紧密接触,但不可压得过重,不得与袖带接触。然后向袖带内充气,待听诊肱动脉搏动消失,再将汞柱升高20~30mmHg后,缓慢放气,听到第一次声响的数值为收缩压,声音消失时数值为舒张压。若测量时声响突然变弱的压力读数和声音消失时测定的压力读数相差超过10mmHg,则记录三个压力数值,收缩压/变调时压力/舒张压。遇有高血压或两侧桡动脉搏动不一致者,应测量四肢血压。下肢血压测量多选用腘动脉,测量时患者取俯卧位,采用宽袖带血压计测量。

3)血压的正常值:上肢收缩压为90~139mmHg,舒张压为60~89mmHg。

4)血压的意义:

①高血压:收缩压≥140mmHg和(或)舒张压≥90mmHg为高血压,主要见于原发性高血压和继发性高血压,部分患者有"白大衣"高血压;

②低血压:血压<90/60mmHg,主要原因为心肌收缩功能下降、有效循环血量不足等,主要见于各种原因所致休克、血管迷走性晕厥发作等,往往伴有脉压缩小;

③两上肢血压不对称:两上肢血压相差>10mmHg,原因和脉搏不对称相似;

④下肢血压异常(降低):提示相应部位动脉狭窄或闭塞,见于主动脉缩窄、胸腹主动脉型大动脉炎、闭塞性动脉硬化、髂动脉或股动脉栓塞等;

⑤脉压增大和减小:脉压>60mmHg,为脉压增大,主要见于主动脉瓣关闭不全、动脉导管未闭、体循环动静脉瘘、甲状腺功能亢进、严重贫血、老年动脉硬化等;脉压<20mmHg,为脉压减小。主要见于休克、主动脉瓣狭窄、心力衰竭、心包积液、缩窄性心包炎等。

2.发育通常以年龄、智力和体格成长状态之间的关系来判断,以良好、中等、差来表示。体格成长状态指身高、体重、第二性征等。儿童应测量头围。

3.体型根据身体各部发育的外观,成年人体型分为三种:

(1)无力型:患者体型瘦长,腹上角小于90°;

(2)超力型:患者体型矮胖,腹上角大于90°;

(3)正力型:患者体型匀称,腹上角约为90°。4.营养状态根据皮肤、皮下脂肪和肌肉的情况,做出良好、中等、不良的分级。

判断脂肪充实程度的常用方法为测量前臂曲侧或上臂背侧下1/3的脂肪厚度。

(1)营养良好:皮肤黏膜红润光泽、弹性好、皮下脂肪丰满、肌肉结实。肋间隙和锁骨上窝深浅适中,肩胛部和股部肌肉丰满。

(2)营养不良:皮肤黏膜干燥、弹性差、皮下脂肪菲薄、肌肉松弛无力。肋间隙和锁骨上窝凹陷,肩胛骨和髂骨嶙峋突出。

(3)营养中等:介于两者之间。5.意识状态指被检查者对环境的知觉状态,可通过问诊并结合体格检查(感觉和神经反射)了解。分为意识清楚、嗜睡、昏睡、浅昏迷、深昏迷、谵妄等。

6.面容某些疾病所具有的特征性面容。

(1)急性病容:面色潮红、鼻翼翕动、表情痛苦;

(2)慢性病容:面容憔悴、面色灰暗、目光暗淡;

(3)贫血面容:面白唇淡、表情疲惫;

(4)肝病面容:面颊消瘦、面色灰褐、面部褐色色素沉着;

(5)肾病面容:面色苍白、眼睑水肿;

(6)甲亢面容:面容惊愕、眼裂增宽、眼球突出、目光闪烁、兴奋不安;

(7)黏液水肿面容:颜面水肿、睑厚面宽、目光迟钝、眼眉稀疏;

(8)满月面容:面圆、皮肤发红,常有痤疮和体毛增多。

7.体位被检查者休息时身体的姿势和位置。可分为:

(1)自动体位:无病、轻病、或疾病早期,被检查者活动自如,不受限制。

(2)被动体位:被检查者不能随意调整或变换体位,见于极度衰弱或意识丧失患者。

(3)强迫体位:为了减轻痛苦,患者不得不采用某种体位。

1)强迫仰卧位:见于急性腹膜炎。

2)强迫侧卧位:见于单侧胸膜病变,如大量胸水或胸膜炎。

3)强迫坐位:见于急性左心衰竭、哮喘急性发作及慢性阻塞性肺疾病急性加重等。

4)强迫蹲位:见于先天性发绀性心脏病。

5)强迫停立位:见于心绞痛患者。

6)辗转体位:见于胆石症或输尿管结石患者。

7)角弓反张位:颈及肩背肌肉强直,头后仰、背过伸,躯干呈弓形,见于破伤风患者。

8.姿势指举止的状态,可受某些疾病的影响。

9.步态被检查者行走时的姿势。壮年矫健、老年稳慢、小儿急快,皆为正常。某些疾病可表现为步态异常。

(1)蹒跚步态:左右摇摆,行如鸭步。见于佝偻病、髋关节脱位等。

(2)醉酒步态:行走时步态不稳。见于酒精中毒、小脑疾病等。

(3)共济失调步态:起步时高抬骤落、双目下视、脚间距宽。见于脊髓病变。

(4)慌张步态:小步前行、身体前倾、有难于止步之势。见于帕金森病。

口语交际,情景问答题
阅读理解

阅读理解。

     Skiing only caught on for ordinary Chinese in the mid-1990s in the country's north and northeast, but has

since developed into a pastime that can be practiced nationwide. Here are four resorts (度假胜地) worthy of

consideration.

Yabuli Ski Resort

     The ski resort, built on Yabuli Sun Mountain, part of the Changbai Mountain Range, is located in China's

northernmost province, Heilongjiang.

     It has the best snow quality, skiing trails and impressive views. Wild animals are often spotted on the site.

     The resort serves as the primary training centre for China's national teams. It also has a trail vertical drop

from 200 meters to 1 200 meters with an average drop of 700 meters.

     What's cool: The largest ski resort in China.

Beijing Huaibei International Ski Resort

     This is a great destination for snowboarders and skiers to escape the rush life of the city and is a large

recreational spot that boasts excellent ski slopes, world-class facilities, beautiful natural scenery, as well as

convenient accommodation and dining services.

     Travelers are also able to take a bird's eye view of the Great Wall by catching a cable car along 1 200

meters.

     What's cool: Close to the Great Wall and Beijing's largest ski resort.

Shennongjia Ski Resort

     Opened in 2004, the ski resort is located in the inland of Shermongjia. It covers an area of 100 000 square

meters and is only 0.5 km from the Shennongjia National Nature Reserve.

     There are ski tracks for beginners and more than 20 coaches for tourists. While experiencing the excitement

of skiing, people can also admire Shennongiia's distinctive scenery of countless different odd mountain valleys,

unknown beautiful flowers and plants.

     What's cool: Largest winter sports complex for skiers from South and Central China.

Changbai Mountain Ski Resort

     The ski resort is an ideal place for skiing and ice-skating because of its well-constructed ski tracks,

comprehensive winter sports training facilities and breathtaking environment.

     Enthusiasts can also choose other activities including motor skiing, sleigh skiing, shooting and hunting. The

area's natural hot springs are another attraction of the resort.

     What's cool: The resort is located in the heart of Changbai Mountain Nature Reserve's thick forest and has

natural hot springs.

1. The passage is intended to _____.

A. encourage people to learn skiing during holidays

B. attract people to ski in these places

C. offer services of booking tickets for skiing

D. provide people with a better understanding of skiing

2. In what way is Changbai Mountain Ski Resort different from the other three resorts?

A. It has various training facilities.

B. It has coaches for tourists.

C. It has natural hot springs.

D. It has breathtaking natural scenery.

3. China's national teams are usually trained at _____.

A. Yabuli Ski Resort

B. Shermongjia Ski Resort

C. Changbai Mountain Ski Resort

D. Beijing Huaibei International Ski Resort