神經(jīng)內(nèi)科出科考核(英文)
住院醫(yī)師出科試題(神經(jīng)內(nèi)科)
姓名:時間:
一、英譯中(70分):
StrokeisthethirdmostcommoncauseofdeathintheUnitedstatesandthemostcommondisablingneurologicdisorder.About750,000newstrokesoccurandabout150,000peoplediefromstrokeintheUnitedstateseachyear.Theincidenceincreaseswithage,withabouttwo-thirdsofallstrokesoccuringinthoseoverage65years,andissomewhathigherinmenthaninwomenandinAfrican-Amerricansthaninwhites.Riskfactorsforstrokeincludesystolicordiastolichypertension,hypercholesterolemia,cigarettesmoking,heavyalcoholconsumption,andoralcontraceptiveuse.Theincidenceofstrokehasdecreasedinrecentdecades,largelybecauseofimprovedtreatmentofhypertension.
Strokeisasyndromecharacterizedbytheacuteonsetofaneurologicdeficitthatpersistsforatleast24hours,reflectsfocalinvolvementofthecentralnervoussystem,andistheresultofadisturbanceofthecerebralcirculation.Theacuteonsetandsubsequentdurationofsymptomsaredocumentedbythehistory.Thesiteofcentralnervoussysteminvolvementissuggestedbythenatureofthesymptoms.Itisdelineatedmorepreciselybytheneurologicexaminationandconfirmedbyimagingstudies[computedtomography(CT)scansormagneticresonanceimaging(MRI)].Avascularetiologymaybeinferredformtheacuteonsetofsymptomsandoftenfromthepatient’sage,thepresenceofriskfactorsforstroke,andtheoccurrenceofsymptomsandsignsreferabletotheterritoryofaparticularcerebralbloodvessel.Whenthisisconfirmedbyimagingstudies,furtherinvestigationscanbeundertakentoidentifyaspecificcause.
Resttremorusuallyhasafrequencyof4-6Hzandischaracteristicofparkinsonismwhetherthedisorderisidiopathicorsecondary(ie.postencephalitic,toxic,ordrug-inducedinorigin).Therateofthetremor,itsrelationshiptoactivity,andthepresenceofrigidityorhypokinesiausuallydistinguishthetremorofparkinsonismfromotherformsoftremor.Tremorinthehandsmayappearasa“pill-rolling”maneuverthythmic,opposingcircularmovementsofthethumbandindexfinger.Theremaybealternatingflexionandextensionofthefingersorhand,oralternatingpronationandsupinationoftheforearm;inthefeet,rhythmicalternatingflexionandextensionarecommon.二、中譯英(30分)
純運動性輕偏癱面部、上肢和下肢受累程度相同,但無感覺、視覺或言語障礙。如果示腔梗所致,病變常位于對側(cè)內(nèi)囊或橋腦。純運動性輕偏癱也可由頸內(nèi)動脈或大腦中動脈閉塞、硬膜下血腫或顱內(nèi)占位性病變引起。
擴展閱讀:神經(jīng)內(nèi)科出科考核(中文)
住院醫(yī)師出科試題(神經(jīng)內(nèi)科)
姓名:時間:
一、名詞解釋(每題5分,共25分)
1、阿羅瞳孔;2、三偏綜合征;3、真性球麻痹;
4、短暫性全面性遺忘;5、癲癇持續(xù)狀態(tài);二、簡答題(共25分)
1、簡述上運動神經(jīng)元損害特點;2、暈厥與癲癇發(fā)作的鑒別要點;
3、重癥肌無力的分型(Osserman分型)。三、病例分析(每題25分,共50分)
1、男,60歲,因右側(cè)肢體無力1小時入急診室,一小時前看電視時突然倒地,右側(cè)肢體無力,意識清楚,不能言語,常用左手觸摸左側(cè)頭部,立即被送來急診室。查體:血壓210/90mmHg,意識清楚,運動性失語,右側(cè)上級性面癱,伸舌偏右,右上、下肢肌力3級,右側(cè)腱反射活躍,右側(cè)Babinski征(+),右半身痛覺減退,余神經(jīng)系統(tǒng)檢查不能合作。請討論定位及定性診斷,并提出進一步檢查及治療方案。
2、50歲,男,下班騎自行車20分鐘回家,即感頭痛,繼而嘔吐,伴右側(cè)上、下肢不能活動,立即送來急診。查體:BP23/18Kpa,P20次/分,神志恍惚,眼底動脈變細,雙瞳等大約3mm,光反射正常,右側(cè)面部及右側(cè)偏身感覺減退,右側(cè)鼻唇溝變淺,伸舌偏右,右側(cè)上、下肢肌張力增高,肌力I-II度,腱反射活躍,右側(cè)Babinski征(+),右側(cè)Chaddock征(+),左側(cè)正常。請討論定位定性診斷及進一步檢查和治療方案。
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