医师练习题--心力衰竭
<img src="https://mmbiz.qpic.cn/mmbiz_gif/8I9QqfosNdbuIadOh1573BvAVYOWd2kcxicy1oNXXXp2OL4sdVAjArXMnkN6AvsRIzwtWIiak8aF53bGa2Rdicx2w/640?wx_fmt=gif&tp=webp&wxfrom=5&wx_lazy=1" style="width: 50%; margin-bottom: 20px;"><p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">1.</span><span style="color: black;"><span style="color: black;">导致</span>左室后负荷<span style="color: black;">升高</span>的<span style="color: black;">重点</span><span style="color: black;">原因</span>是</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A.</span><span style="color: black;">肺循环高压</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">B.</span><span style="color: black;">体循环高压</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C.</span><span style="color: black;">回心血量<span style="color: black;">增多</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">D.</span><span style="color: black;">主动脉瓣关闭不全</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E.</span><span style="color: black;">红细胞压积增大</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">2.</span><span style="color: black;">对未经治疗的<span style="color: black;">病人</span>，以下<span style="color: black;">检测</span>项目，哪项结果正常时最有助于排除心力衰竭</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A.</span><span style="color: black;">心电图</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">B.</span><span style="color: black;">胸部</span><span style="color: black;">X</span><span style="color: black;">线<span style="color: black;">检测</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C.</span><span style="color: black;">冠状动脉造影</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">D.</span><span style="color: black;"><span style="color: black;">血液</span>心钠肽水平</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E.</span><span style="color: black;"><span style="color: black;">血液</span>肌钙蛋白水平</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">3.</span><span style="color: black;">慢性心力衰竭时<span style="color: black;">举荐</span><span style="color: black;">运用</span>的</span><span style="color: black;">β</span><span style="color: black;">受体阻断剂是</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A. </span><span style="color: black;">所有已上市的</span><span style="color: black;">β</span><span style="color: black;">受体阻断剂</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">B.</span><span style="color: black;">美托洛尔</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C.</span><span style="color: black;">阿替洛尔</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">D.</span><span style="color: black;">普萘洛尔</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E.</span><span style="color: black;">吲哚洛尔</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">4.</span><span style="color: black;">治疗慢性心功能不全和逆转心肌肥厚并能降低病死率的<span style="color: black;">药品</span>是</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A.</span><span style="color: black;">强心苷</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">B.</span><span style="color: black;">哌唑嗪</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C.</span><span style="color: black;">硝酸甘油</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">D.</span><span style="color: black;">酚妥拉明</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E.</span><span style="color: black;">卡托普利</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">5.</span><span style="color: black;">急性肺水肿<span style="color: black;">救治</span>时不宜<span style="color: black;">选择</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A.</span><span style="color: black;">依那普利</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">B.</span><span style="color: black;">吗啡</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C.</span><span style="color: black;">呋塞米</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">D.</span><span style="color: black;">硝普钠</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E.</span><span style="color: black;">氨茶碱</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">6.</span><span style="color: black;"><span style="color: black;">能够</span><span style="color: black;">引起</span>心力衰竭加重的<span style="color: black;">原因</span>应除外</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A.</span><span style="color: black;">感染</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">B.</span><span style="color: black;"><span style="color: black;">心率</span>失常</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C.</span><span style="color: black;">回心血量不足</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">D.</span><span style="color: black;">肺栓塞</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E.β</span><span style="color: black;">受体阻滞剂</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">7.</span><span style="color: black;">应用利尿剂治疗慢性心力衰竭时，临床应<span style="color: black;">尤其</span><span style="color: black;">重视</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A.</span><span style="color: black;">肝功能</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">B.</span><span style="color: black;">肾功能</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C.</span><span style="color: black;">血电解质与酸碱平衡<span style="color: black;">状况</span>，有<span style="color: black;">没</span>低血钾、低血镁与低血钠</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">D.</span><span style="color: black;">血尿酸<span style="color: black;">状况</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E.</span><span style="color: black;">血糖</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">8.</span><span style="color: black;">心力衰竭<span style="color: black;">病人</span>应当<span style="color: black;">怎样</span><span style="color: black;">掌控</span>活动量</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A.</span><span style="color: black;">避免一切体力活动</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">B.</span><span style="color: black;">逐步<span style="color: black;">增多</span>运动量</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C.</span><span style="color: black;">活动不受任何限制</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">D.</span><span style="color: black;">鼓励<span style="color: black;">没</span>氧运动</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E.</span><span style="color: black;">完全卧床<span style="color: black;">休憩</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">9.</span><span style="color: black;">心功能按</span><span style="color: black;"> NYHA </span><span style="color: black;">分级，心功能在</span><span style="color: black;">I</span><span style="color: black;">、</span><span style="color: black;">Ⅱ</span><span style="color: black;">级时其治疗<span style="color: black;">办法</span>是</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A.</span><span style="color: black;">应用洋地黄制剂加强心肌收缩力</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">B.</span><span style="color: black;">应用利尿剂减轻心脏前负荷</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C.</span><span style="color: black;">应用血管扩张剂减轻心脏后负荷</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">D.</span><span style="color: black;">适当<span style="color: black;">休憩</span>，避免体力劳动，防治原发病与心力衰竭诱发<span style="color: black;">原因</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E.</span><span style="color: black;">应用非洋地黄类的正性肌力<span style="color: black;">药品</span>（如多巴胺）</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">10.</span><span style="color: black;">测定左室射血分数最准确的<span style="color: black;">办法</span>是</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A.</span><span style="color: black;">超声心动图</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">B.</span><span style="color: black;">心脏核素<span style="color: black;">检测</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C.</span><span style="color: black;">左室造影</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">D.</span><span style="color: black;">右心导管<span style="color: black;">检测</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E.</span><span style="color: black;"><span style="color: black;">没</span>创心功能仪</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">11.</span><span style="color: black;">洋地黄的禁忌证是</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A.</span><span style="color: black;">右心衰</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">B.</span><span style="color: black;">舒张性心力衰竭</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C.</span><span style="color: black;"><span style="color: black;">没</span>症状心力衰竭</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">D.</span><span style="color: black;">单纯二尖瓣狭窄伴窦性<span style="color: black;">心率</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E.</span><span style="color: black;"><span style="color: black;">已然</span><span style="color: black;">运用</span>大剂量</span><span style="color: black;">β</span><span style="color: black;">受体阻滞剂者</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">12.</span><span style="color: black;">不符合舒张性心力衰竭特点的是</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A.</span><span style="color: black;">心肌肥厚</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">B.</span><span style="color: black;">左室射血分数降低</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C.</span><span style="color: black;">左室舒张期充盈降低</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">D.</span><span style="color: black;">超声心动图</span><span style="color: black;">E</span><span style="color: black;">峰</span><span style="color: black;">A</span><span style="color: black;">峰</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E.</span><span style="color: black;">心腔<span style="color: black;">体积</span>正常</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">13.</span><span style="color: black;">急性心力衰竭伴快速房颤的<span style="color: black;">病人</span><span style="color: black;">首要</span>应当<span style="color: black;">思虑</span>的治疗是</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A.</span><span style="color: black;"><span style="color: black;">掌控</span><span style="color: black;">呼气</span>道感染</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">B.</span><span style="color: black;"><span style="color: black;">掌控</span>心室率</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C.</span><span style="color: black;">纠正电解质<span style="color: black;">错乱</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">D.</span><span style="color: black;"><span style="color: black;">掌控</span>液体入量</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E.</span><span style="color: black;">加强利尿</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">14.</span><span style="color: black;">洋地黄中毒的最<span style="color: black;">靠谱</span>的诊断是</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A. </span><span style="color: black;"><span style="color: black;">吃下</span><span style="color: black;">时期</span><span style="color: black;">显现</span>恶心症状</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">B.</span><span style="color: black;"><span style="color: black;">吃下</span><span style="color: black;">时期</span><span style="color: black;">显现</span>肾功能<span style="color: black;">反常</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C.</span><span style="color: black;"><span style="color: black;">吃下</span><span style="color: black;">时期</span>新<span style="color: black;">显现</span><span style="color: black;">各样</span><span style="color: black;">心率</span>失常，以异位快速<span style="color: black;">心率</span>失常伴传导阻滞为特征</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">D.</span><span style="color: black;"><span style="color: black;">吃下</span><span style="color: black;">时期</span>心力衰竭不改善</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E.</span><span style="color: black;"><span style="color: black;">吃下</span><span style="color: black;">时期</span><span style="color: black;">显现</span>肝功能<span style="color: black;">反常</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">15.</span><span style="color: black;">提示左心衰最有诊断<span style="color: black;">道理</span>的体征是</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A.</span><span style="color: black;">左心扩大</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">B.</span><span style="color: black;">心尖区听到舒张期奔马律</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C.</span><span style="color: black;">心率增快</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">D.</span><span style="color: black;">心脏有杂音</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E.</span><span style="color: black;">肺部闻及哮鸣音</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">16.</span><span style="color: black;">右心衰<span style="color: black;">导致</span>肝大和永肿与肝硬化<span style="color: black;">导致</span>者最<span style="color: black;">重点</span>的鉴别点是</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A.</span><span style="color: black;">前者<span style="color: black;">没</span><span style="color: black;">海量</span>腹水</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">B.</span><span style="color: black;">前者有颈静脉怒张，中心静脉压<span style="color: black;">升高</span>，后者<span style="color: black;">没</span>此征象</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C.</span><span style="color: black;">前者<span style="color: black;">没</span>牌大，后者有牌大</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">D.</span><span style="color: black;">前者<span style="color: black;">血液</span>蛋白正常，后者<span style="color: black;">血液</span>蛋白降低</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E.</span><span style="color: black;">前者<span style="color: black;">没</span>黄疸，后者有黄疸</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">17.</span><span style="color: black;">下列不是心力衰竭的发病<span style="color: black;">原因</span>的是</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A.</span><span style="color: black;">冠心病</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">B.</span><span style="color: black;">高血压</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C.</span><span style="color: black;">摄盐不足</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">D.</span><span style="color: black;">风湿性心脏病</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E.</span><span style="color: black;">心肌病</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">18.</span><span style="color: black;">左心功能不全最早和最<span style="color: black;">平常</span>的症状是</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A.</span><span style="color: black;">咳嗽，咳白色<span style="color: black;">泡泡</span>样痰</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">B.</span><span style="color: black;">劳力性<span style="color: black;">呼气</span>困难</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C.</span><span style="color: black;">气短，咳粉红色<span style="color: black;">泡泡</span>样痰</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">D.</span><span style="color: black;">心悸，乏力</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E.</span><span style="color: black;">少尿</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">19.</span><span style="color: black;">诊断心力衰竭首选的<span style="color: black;">检测</span>是</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A.</span><span style="color: black;">胸壁</span><span style="color: black;">X</span><span style="color: black;">线片</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">B.</span><span style="color: black;">超声心动图</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C.</span><span style="color: black;">左心室造影</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">D.</span><span style="color: black;">运动负荷实验</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E.</span><span style="color: black;">心电图</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">20.</span><span style="color: black;"><span style="color: black;">病人</span>，男，</span><span style="color: black;">70</span><span style="color: black;">岁。高血压</span><span style="color: black;">30</span><span style="color: black;">年，夜间阵发性<span style="color: black;">呼气</span>困难</span><span style="color: black;">10</span><span style="color: black;">年，间断双下肢水肿、少尿</span><span style="color: black;">5</span><span style="color: black;">年。近</span><span style="color: black;">1</span><span style="color: black;">个月<span style="color: black;">以上</span>症状加重，伴厌食和腹胀。查体：</span><span style="color: black;">BP 180/100mmHg</span><span style="color: black;">，端坐位，心界向两侧扩大。心率</span><span style="color: black;">110</span><span style="color: black;">次</span><span style="color: black;">/</span><span style="color: black;">分，<span style="color: black;">心率</span>绝对不齐。双下肺可闻及学中小水泡音；肝肋下</span><span style="color: black;">4cm</span><span style="color: black;">，质软，有压痛，移动性浊音阳性；肝颈静脉回流征阳性；双下肢有可凹性水肿。该<span style="color: black;">病人</span>最恰当的心功能<span style="color: black;">评估</span>为</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A.</span><span style="color: black;">全心衰</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">B.</span><span style="color: black;">右心衰，失代偿</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C.</span><span style="color: black;">心功能</span><span style="color: black;">Ⅱ</span><span style="color: black;">级（</span><span style="color: black;">NYHA</span><span style="color: black;">分级</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">D.</span><span style="color: black;">心功能</span><span style="color: black;">Ⅲ</span><span style="color: black;">级（</span><span style="color: black;">NYHA</span><span style="color: black;">分级</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E.</span><span style="color: black;">心功能</span><span style="color: black;">Ⅳ</span><span style="color: black;">级（</span><span style="color: black;">NYHA</span><span style="color: black;">分级）</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">21.</span><span style="color: black;"><span style="color: black;">病人</span>、男，</span><span style="color: black;">68</span><span style="color: black;">岁。陈旧性前壁心肌梗死</span><span style="color: black;">5</span><span style="color: black;">年，<span style="color: black;">疲劳</span>后心悸、气短</span><span style="color: black;">3</span><span style="color: black;">年，双下肢水肿半年，近</span><span style="color: black;">1 </span><span style="color: black;">周气短加重，体力活动<span style="color: black;">显著</span>受限，从事<span style="color: black;">通常</span>家务活动即感喘憋，入院时心电图与</span><span style="color: black;">2</span><span style="color: black;">个月前相比<span style="color: black;">没</span>变化。该<span style="color: black;">病人</span>的心功能分级为</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A.NYHA</span><span style="color: black;">分级</span><span style="color: black;">Ⅱ</span><span style="color: black;">级</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">B.NYHA</span><span style="color: black;">分级</span><span style="color: black;">Ⅲ</span><span style="color: black;">级</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C.Killip</span><span style="color: black;">分级</span><span style="color: black;">Ⅱ</span><span style="color: black;">级</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">D.Killip</span><span style="color: black;">分级</span><span style="color: black;">Ⅲ</span><span style="color: black;">级</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E.Killip</span><span style="color: black;">分级</span><span style="color: black;">Ⅳ</span><span style="color: black;">级</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">22.</span><span style="color: black;"><span style="color: black;">病人</span>，男，</span><span style="color: black;">50</span><span style="color: black;">岁。突起<span style="color: black;">呼气</span>困难，咳粉红色<span style="color: black;">泡泡</span>痰，血压</span><span style="color: black;">190/100mmHg</span><span style="color: black;">。该<span style="color: black;">病人</span>的最佳治疗<span style="color: black;">药品</span>是</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A.</span><span style="color: black;">西地兰</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">B.</span><span style="color: black;">氨茶碱</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C.</span><span style="color: black;">硝普钠</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">D.</span><span style="color: black;">多巴酚丁胺</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E.</span><span style="color: black;">硝酸甘油</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">23.</span><span style="color: black;"><span style="color: black;">病人</span>，男，</span><span style="color: black;">56</span><span style="color: black;">岁。充血性心力衰竭，心率<span style="color: black;">长时间</span>维持在</span><span style="color: black;">100~110</span><span style="color: black;">次</span><span style="color: black;">/</span><span style="color: black;">分，口服地高辛</span><span style="color: black;">0.25mg</span><span style="color: black;">，骨</span><span style="color: black;">1</span><span style="color: black;">次</span><span style="color: black;">/</span><span style="color: black;">日，治疗</span><span style="color: black;">2</span><span style="color: black;">周后心率<span style="color: black;">没</span><span style="color: black;">显著</span>下降。为了<span style="color: black;">掌控</span>心率应<span style="color: black;">首要</span>的<span style="color: black;">办法</span>是</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A.</span><span style="color: black;"><span style="color: black;">增多</span>地高辛用量</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">B.</span><span style="color: black;">加用普罗帕酮</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C. </span><span style="color: black;">加用胺碘酮</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">D.</span><span style="color: black;">加用维拉帕米</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E.β</span><span style="color: black;">受体阻断药</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">24.</span><span style="color: black;"><span style="color: black;">病人</span>，男，</span><span style="color: black;">50</span><span style="color: black;">岁。<span style="color: black;">忽然</span><span style="color: black;">呼气</span>困难，咳粉红色<span style="color: black;">泡泡</span>样痰、<span style="color: black;">呼气</span>急促。<span style="color: black;">检测</span>：郑重：压、</span><span style="color: black;">190/110mmHg</span><span style="color: black;">，心率</span><span style="color: black;">110</span><span style="color: black;">次</span><span style="color: black;">/</span><span style="color: black;">分，律齐，<span style="color: black;">没</span>杂音，双肺底湿啰音。该<span style="color: black;">病人</span>的最佳治疗<span style="color: black;">药品</span>是</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A.</span><span style="color: black;">毛花苷</span><span style="color: black;">C</span><span style="color: black;">（西地兰）</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">B.</span><span style="color: black;">氨茶碱</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C.</span><span style="color: black;">硝普钠</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">D.</span><span style="color: black;">多巴酚丁胺</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E.</span><span style="color: black;">硝酸甘油</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">25.</span><span style="color: black;"><span style="color: black;">病人</span>，男，</span><span style="color: black;">45</span><span style="color: black;">岁。</span><span style="color: black;">2</span><span style="color: black;">年前<span style="color: black;">出现</span>心肌梗死，近</span><span style="color: black;">1 </span><span style="color: black;">个月活动后喘憋、口唇发绀、下肢水肿、双肺底可闻湿啰音。该<span style="color: black;">病人</span>可能存在的病理生理学改变有</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A.</span><span style="color: black;">交感神经系统<span style="color: black;">控制</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">B.</span><span style="color: black;">肾素</span><span style="color: black;">-</span><span style="color: black;">血管紧张素</span><span style="color: black;">-</span><span style="color: black;">醛固酮系统<span style="color: black;">控制</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C.</span><span style="color: black;">心排血量<span style="color: black;">增多</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">D.</span><span style="color: black;">水钠潴留</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E.</span><span style="color: black;">脑钠肽分泌降低</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">（</span><span style="color: black;">26-27</span><span style="color: black;">题共用备选答案）</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A.</span><span style="color: black;">卡托替利</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">B.</span><span style="color: black;">双嘧达莫（潘生丁）</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C.</span><span style="color: black;">低分子肝素</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">D.</span><span style="color: black;">甲泼尼龙（甲基强的松龙）</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E.</span><span style="color: black;">呋塞米</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">26.</span><span style="color: black;">有可能<span style="color: black;">导致</span>高钾血症的是</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">27.</span><span style="color: black;"><span style="color: black;">必要</span>监测出凝血<span style="color: black;">情况</span>的是</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">（</span><span style="color: black;">28-30</span><span style="color: black;">题共用备选答案）</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A.</span><span style="color: black;">肺气肿</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">B.</span><span style="color: black;">肺不张</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C.</span><span style="color: black;">肺水肿</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">D.</span><span style="color: black;">肺脓肿</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E.</span><span style="color: black;">肺褐色硬化</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">28.</span><span style="color: black;">慢性左心衰<span style="color: black;">引起</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">29.</span><span style="color: black;">肺末梢组织充气过度<span style="color: black;">引起</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">30.</span><span style="color: black;">急性左心衰<span style="color: black;">引起</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">（</span><span style="color: black;">31~33</span><span style="color: black;">题共用题干）</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">病人</span>，男，</span><span style="color: black;">67</span><span style="color: black;">岁。近</span><span style="color: black;">1</span><span style="color: black;">个月<span style="color: black;">显现</span>活动后心悸、气短，双肺底可闻湿啰音，腹部<span style="color: black;">检测</span>肝脾未及，双下肢<span style="color: black;">没</span>水肿。胸部</span><span style="color: black;">X</span><span style="color: black;">线<span style="color: black;">检测</span><span style="color: black;">表示</span>心胸出</span><span style="color: black;">0.66</span><span style="color: black;">，超声心动图左室舒张末径</span><span style="color: black;">6.1mm</span><span style="color: black;">，左室射血分数</span><span style="color: black;">39%</span><span style="color: black;">。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">31.</span><span style="color: black;"><span style="color: black;">病人</span>双肺湿啰音产生的<span style="color: black;">原由</span>是</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A.</span><span style="color: black;">水钠潴留</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">B.</span><span style="color: black;">心脏前负荷过大</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C.</span><span style="color: black;">心脏后负荷过大</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">D.</span><span style="color: black;">心脏收缩功能<span style="color: black;">阻碍</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E.</span><span style="color: black;">心脏舒张功能<span style="color: black;">阻碍</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">32.</span><span style="color: black;">该<span style="color: black;">病人</span><span style="color: black;">处在</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A.</span><span style="color: black;">急性心力衰竭代偿<span style="color: black;">周期</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">B.</span><span style="color: black;">急性心力衰竭失代偿<span style="color: black;">周期</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C.</span><span style="color: black;">慢性心力衰竭代偿<span style="color: black;">周期</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">D.</span><span style="color: black;">慢性心力衰竭失代偿<span style="color: black;">周期</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E.</span><span style="color: black;"><span style="color: black;">没</span>心力衰竭</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">33.</span><span style="color: black;">下列治疗原则是不适宜的是</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A.</span><span style="color: black;">强心</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">B.</span><span style="color: black;">利尿</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C.</span><span style="color: black;">扩血管</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">D.</span><span style="color: black;"><span style="color: black;">控制</span>交感神经系统</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E.</span><span style="color: black;"><span style="color: black;">控制</span>肾素</span><span style="color: black;">-</span><span style="color: black;">血管紧张素</span><span style="color: black;">-</span><span style="color: black;">醛固酮系统</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">（</span><span style="color: black;">34~38</span><span style="color: black;">题共用题干）</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">病人</span>，男，</span><span style="color: black;">57</span><span style="color: black;">岁。<span style="color: black;">发掘</span>高血压</span><span style="color: black;">5</span><span style="color: black;">年，近</span><span style="color: black;">1</span><span style="color: black;">个月<span style="color: black;">显现</span>喘憋、夜间憋醒、下肢水肿，满肺可闻及湿啰音。心电图提示陈旧前壁心肌梗死，胸片心影增大。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">34.</span><span style="color: black;">最可能的诊断是</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A.</span><span style="color: black;">高血压收缩性心力衰竭</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">B.</span><span style="color: black;">高血压舒张性心力衰竭</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C.</span><span style="color: black;">冠心病左心衰</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">D.</span><span style="color: black;">冠心病右心衰</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E.</span><span style="color: black;">冠心病全心衰</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">35.</span><span style="color: black;">缓解症状最<span style="color: black;">快速</span>的<span style="color: black;">药品</span>是</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A.</span><span style="color: black;">血管紧张素转换酶<span style="color: black;">控制</span>剂</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">B.β</span><span style="color: black;">受体阻滞剂</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C.</span><span style="color: black;">钙拮抗剂</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">D.</span><span style="color: black;">利尿剂</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E.</span><span style="color: black;">阿司匹林</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">36.</span><span style="color: black;">最迫切的化验是</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A.</span><span style="color: black;">血常规</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">B.</span><span style="color: black;">肾功能</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C.</span><span style="color: black;">肝功能</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">D.</span><span style="color: black;">脑钠肽</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E.</span><span style="color: black;">血电解质</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">37.</span><span style="color: black;">最迫切的辅助<span style="color: black;">检测</span>是</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A.</span><span style="color: black;">胸部</span><span style="color: black;">CT</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">B.</span><span style="color: black;">肝肾</span><span style="color: black;">B</span><span style="color: black;">超</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C.</span><span style="color: black;">超声心动图</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">D.</span><span style="color: black;">心脏核素<span style="color: black;">检测</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E.</span><span style="color: black;">冠脉造影</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">38.</span><span style="color: black;"><span style="color: black;">日前</span>不宜<span style="color: black;">运用</span>哪类<span style="color: black;">药品</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A.</span><span style="color: black;">血管紧张素转换酶<span style="color: black;">控制</span>剂</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">B.β</span><span style="color: black;">受体阻滞剂</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C.</span><span style="color: black;">洋地黄</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">D.</span><span style="color: black;">利尿剂</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">E. </span><span style="color: black;">螺内酯（安体舒通）</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">1</span><span style="color: black;">．【答案】</span><span style="color: black;">B</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">【解析】前负荷<span style="color: black;">指的是</span>心肌收缩之前所遇到的阻力或负荷，即在舒张末期，心室所承受的容量负荷或压力<span style="color: black;">便是</span>前负荷。后负荷<span style="color: black;">指的是</span>心肌收缩之后所遇到的阻力或负荷，又<span style="color: black;">叫作</span>压力负荷。主动脉压和肺动脉压<span style="color: black;">便是</span>左、右心室的后负荷。取决于主动脉的顺应性，血液黏度，外周血管阻力等。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">2</span><span style="color: black;">．【答案】</span><span style="color: black;">D</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">【解析】<span style="color: black;">血液</span>心钠肽<span style="color: black;">重点</span>存在于心房和心室肌内，心力衰竭时，心房、室壁张力<span style="color: black;">增多</span>，心钠肽分泌<span style="color: black;">增多</span>击二者<span style="color: black;">升高</span>的程度与心衰的严重程度成正<span style="color: black;">关联</span>。<span style="color: black;">因此呢</span>，<span style="color: black;">血液</span>心钠肽水平可<span style="color: black;">做为</span>评定心衰进程和判断预后的指标。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">3</span><span style="color: black;">．【答案】</span><span style="color: black;">B</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">【解析】可用于心力衰竭治疗的</span><span style="color: black;">β</span><span style="color: black;">受体阻断剂<span style="color: black;">重点</span>有比索洛尔、卡维地洛和美托洛尔三种。美托洛尔<span style="color: black;">选取</span>性阻滞</span><span style="color: black;">β</span><span style="color: black;">受体而<span style="color: black;">没</span>血管扩张<span style="color: black;">功效</span>，<span style="color: black;">很强</span>规模临床<span style="color: black;">实验</span>应用美托洛尔治疗缺血性或非缺血性心肌病心衰证实：相比对照组，<span style="color: black;">病人</span>不仅<span style="color: black;">能够</span>耐受用药，还可<span style="color: black;">显著</span><span style="color: black;">加强</span>运动耐量，降低死亡率。</span><span style="color: black;">β</span><span style="color: black;">受体阻断剂的禁忌证为支气管痉挛性<span style="color: black;">疾患</span>、心动过缓、二度及二度以上房室传导阻滞。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">4</span><span style="color: black;">．【答案】</span><span style="color: black;">E</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">【解析】</span><span style="color: black;">ACEI</span><span style="color: black;">类<span style="color: black;">药品</span>不仅<span style="color: black;">能够</span><span style="color: black;">控制</span>循环</span><span style="color: black;">RAS</span><span style="color: black;">，达到扩张血管，<span style="color: black;">控制</span>交感神经兴奋性从而改善心功能不全时血流动力学<span style="color: black;">阻碍</span>，减轻瘀血状态，改善左室功能；<span style="color: black;">况且</span><span style="color: black;">能够</span><span style="color: black;">控制</span>心脏组织中的</span><span style="color: black;">RAS</span><span style="color: black;">，限制和延缓心肌重塑，逆转左室肥厚，从而达到<span style="color: black;">守护</span>心肌功能，推迟心衰<span style="color: black;">发展</span>，<span style="color: black;">显著</span>改善心力衰竭<span style="color: black;">病人</span>的预后，降低病死率。卡托普利为最早用于临床的</span><span style="color: black;">ACEI</span><span style="color: black;">类<span style="color: black;">药品</span>。</span><span style="color: black;">ACEI</span><span style="color: black;">类<span style="color: black;">药品</span>不宜用于伴严重肾衰竭、双侧肾动脉狭窄和低血压的<span style="color: black;">病人</span>，妊娠哺乳期<span style="color: black;">女性</span>禁用。血管扩张剂酚妥拉明、硝酸甘油均可用于治疗慢性心功能不全，对改善血流动力学有良好效应。强心苷与哌唑嗪均可用于治疗慢性心功能不全。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">5</span><span style="color: black;">．【答案】</span><span style="color: black;">A</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">【解析】其他<span style="color: black;">药品</span>都可<span style="color: black;">快速</span>有效缓解症状，而依那普利<span style="color: black;">生效</span>慢，急性肺水肿<span style="color: black;">救治</span>时效果不<span style="color: black;">显著</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">6</span><span style="color: black;">．【答案】</span><span style="color: black;">C</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">【解析】回心血量不足，会使得前负荷减少，从而缓解心衰，故选</span><span style="color: black;">C</span><span style="color: black;">。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">7</span><span style="color: black;">．【答案】</span><span style="color: black;">C</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">【解析】<span style="color: black;">运用</span>利尿剂时应该<span style="color: black;">重视</span>钾、镁、钠等离子的变化<span style="color: black;">状况</span>，防止<span style="color: black;">显现</span>酸碱失衡和电解质失衡。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">8</span><span style="color: black;">．【答案】</span><span style="color: black;">B</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">【解析】心衰<span style="color: black;">病人</span>应<span style="color: black;">按照</span>心功能<span style="color: black;">状况</span>来确定活动量，从小量<span style="color: black;">起始</span><span style="color: black;">逐步</span><span style="color: black;">增多</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">9</span><span style="color: black;">．</span><span style="color: black;">【答案】</span><span style="color: black;">D</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">【解析】心衰的治疗<span style="color: black;">办法</span><span style="color: black;">重点</span><span style="color: black;">按照</span>心功能<span style="color: black;">状况</span>确定。<span style="color: black;">针对</span>心功能尚可时，可不给予<span style="color: black;">药品</span>治疗，仅改善生活<span style="color: black;">行径</span>方式<span style="color: black;">就可</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">10</span><span style="color: black;">．【答案】</span><span style="color: black;">C</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">【解析］<span style="color: black;">一般</span>测定左室射血分数<span style="color: black;">运用</span>的<span style="color: black;">办法</span>是心脏超声心动图，<span style="color: black;">然则</span>最准确的<span style="color: black;">办法</span>为左室造影<span style="color: black;">检测</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">11</span><span style="color: black;">．【【答案】</span><span style="color: black;">D</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">【解析】洋地黄的禁忌证<span style="color: black;">包含</span>：</span><span style="color: black;">①</span><span style="color: black;">预激<span style="color: black;">综合症</span>合并房颤：</span><span style="color: black;">②</span><span style="color: black;">完全性房室传导阻滞；</span><span style="color: black;">③</span><span style="color: black;">病态窦房结<span style="color: black;">综合症</span>；</span><span style="color: black;">④</span><span style="color: black;">单纯性重度二尖瓣狭窄；</span><span style="color: black;">⑤</span><span style="color: black;">肥厚性梗阻性心肌病；</span><span style="color: black;">⑥</span><span style="color: black;">心肌梗死伴心衰。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">12</span><span style="color: black;">．【答案】</span><span style="color: black;">B</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">【解析】左室射血分数降低为左心收缩功能下降的表现。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">13</span><span style="color: black;">．【答案】</span><span style="color: black;">B</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">【解析】房颤的心室率为</span><span style="color: black;">350 —600</span><span style="color: black;">／</span><span style="color: black;">min</span><span style="color: black;">，<span style="color: black;">首要</span>应该降低心室率，之后再实施对症支持治疗。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">14</span><span style="color: black;">．【答案】</span><span style="color: black;">C</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">【解析】洋地黄中毒时的心脏表现最<span style="color: black;">拥有</span>特征性，表现为<span style="color: black;">各样</span>各样的<span style="color: black;">心率</span>失常，其中以室性<span style="color: black;">心率</span>失常最为<span style="color: black;">平常</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">15</span><span style="color: black;">．答案】</span><span style="color: black;">B</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">【解析】奔马律提示左心室功能严重受损。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">16</span><span style="color: black;">．【答案】</span><span style="color: black;">B</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">【解析】右心衰和肝硬化的临床表现有<span style="color: black;">许多</span><span style="color: black;">类似</span>点。例如均可<span style="color: black;">显现</span>肝大和水肿，<span style="color: black;">然则</span>右心衰可<span style="color: black;">显现</span>体循环瘀血，从而<span style="color: black;">引起</span><span style="color: black;">病人</span><span style="color: black;">显现</span>颈静脉怒张，而肝硬化并<span style="color: black;">没</span>此表现。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">17</span><span style="color: black;">．【答案】</span><span style="color: black;">C</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">【解析】摄入食盐过<span style="color: black;">大都是</span><span style="color: black;">引起</span>心衰的发病<span style="color: black;">原因</span>之一。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">18</span><span style="color: black;">．【答案】</span><span style="color: black;">B</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">【解析】左心功能不全最早和最<span style="color: black;">平常</span>的表现为<span style="color: black;">呼气</span>困难，<span style="color: black;">包含</span>劳力性<span style="color: black;">呼气</span>困难、夜间阵发性<span style="color: black;">呼气</span>困难以及端坐<span style="color: black;">呼气</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">19</span><span style="color: black;">．【答案</span><span style="color: black;">1B</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">【解析】诊断心脏</span><span style="color: black;">X</span><span style="color: black;">线<span style="color: black;">检测</span>，心影<span style="color: black;">体积</span>及外形为心脏病的病因诊断<span style="color: black;">供给</span><span style="color: black;">要紧</span>的参考资料，<span style="color: black;">按照</span>心脏扩大和动态改变<span style="color: black;">亦</span>间接反映心脏功能状态；超声心动图比</span><span style="color: black;">X</span><span style="color: black;">线更准确地<span style="color: black;">供给</span>各心腔<span style="color: black;">体积</span>变化及心瓣膜结构及功能<span style="color: black;">状况</span>。运动负荷<span style="color: black;">实验</span>仅适用于慢性稳定性心衰<span style="color: black;">病人</span>。<span style="color: black;">因此</span>首选的<span style="color: black;">检测</span>是超声心动图。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">20</span><span style="color: black;">．【答案】</span><span style="color: black;">E</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">【解析】美国纽约心脏病学会（</span><span style="color: black;">NYHA</span><span style="color: black;">）分级是按诱发心力衰竭症状的活动程度将心功能的受损<span style="color: black;">情况</span>分为四级。</span><span style="color: black;">1</span><span style="color: black;">级：<span style="color: black;">病人</span><span style="color: black;">身患</span>心脏病，但<span style="color: black;">平常</span>活动量不受限制，<span style="color: black;">通常</span>活动不<span style="color: black;">导致</span>疲乏、心悸、<span style="color: black;">呼气</span>困难或心绞痛。</span><span style="color: black;">II</span><span style="color: black;">级：心脏病<span style="color: black;">病人</span>的体力活动受到轻度的限制，<span style="color: black;">休憩</span>时<span style="color: black;">没</span>自觉症状，但平时<span style="color: black;">通常</span>活动下可<span style="color: black;">显现</span>疲乏、心悸、<span style="color: black;">呼气</span>困难或心绞痛组级：心脏病<span style="color: black;">病人</span>体力活动<span style="color: black;">显著</span>受限，<span style="color: black;">少于</span>平时<span style="color: black;">通常</span>活动即<span style="color: black;">导致</span><span style="color: black;">以上</span>症状。</span><span style="color: black;">IV</span><span style="color: black;">级：心脏病<span style="color: black;">病人</span><span style="color: black;">不可</span>从事任何体力活动。<span style="color: black;">休憩</span>状态下<span style="color: black;">亦</span><span style="color: black;">显现</span>心衰的症状，体力活动后加重。<span style="color: black;">按照</span>题述，<span style="color: black;">病人</span>在<span style="color: black;">休憩</span>状态下出现心衰症状，<span style="color: black;">思虑</span>为</span><span style="color: black;">NYHA</span><span style="color: black;">分级心功能</span><span style="color: black;">NV</span><span style="color: black;">级。<span style="color: black;">重视</span>题干问题是心功能的<span style="color: black;">评估</span>而不是诊断。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">21</span><span style="color: black;">．【答案】</span><span style="color: black;">B</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">【解析】</span><span style="color: black;">Killip </span><span style="color: black;">分级常用于急性冠脉<span style="color: black;">综合症</span>的<span style="color: black;">病人</span>心功能分级。本例<span style="color: black;">病人</span>既往陈旧性前壁心肌梗死</span><span style="color: black;">5</span><span style="color: black;">年，<span style="color: black;">这次</span>入院时心电图与</span><span style="color: black;">2</span><span style="color: black;">个月前相比<span style="color: black;">没</span>变化，故<span style="color: black;">思虑</span>此次发病<span style="color: black;">没</span>新发心肌梗死，故心功能应用</span><span style="color: black;">NYHA</span><span style="color: black;">分级。<span style="color: black;">病人</span>体力活动<span style="color: black;">显著</span>受限，从事<span style="color: black;">通常</span>家务活动<span style="color: black;">爆发</span>，故<span style="color: black;">思虑</span>为</span><span style="color: black;">NYHA</span><span style="color: black;">分级</span><span style="color: black;">I</span><span style="color: black;">级。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">22</span><span style="color: black;">．【答案】</span><span style="color: black;">C</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">【解析】<span style="color: black;">思虑</span><span style="color: black;">病人</span>为急性左心衰伴血压高，硝普钠为动</span><span style="color: black;">—</span><span style="color: black;">静脉血管扩张剂能<span style="color: black;">快速</span>扩张血管，减轻心脏负荷，纠正心衰，静脉滴注后</span><span style="color: black;">2—5</span><span style="color: black;">分钟<span style="color: black;">生效</span>。硝普钠含有氰化物，用药时间不宜连续超过</span><span style="color: black;">24</span><span style="color: black;">小时。西地兰最适合用于有心房颤动伴有快速心室率，并已知有心室扩大伴左心室收缩功能不全者，</span><span style="color: black;">对二尖瓣狭窄<span style="color: black;">导致</span>肺水肿<span style="color: black;">没</span>效。氨茶碱对解除支气管痉挛<span style="color: black;">尤其</span>有效，<span style="color: black;">同期</span>有正性肌力<span style="color: black;">功效</span>，扩张外周血管和利尿<span style="color: black;">功效</span>。如有低血压可合用多巴酚丁胺，其可使<span style="color: black;">心率</span>失常<span style="color: black;">出现</span>率<span style="color: black;">增多</span>。硝酸甘油可扩张小静脉，使左室舒张末压（</span><span style="color: black;">LVEDP</span><span style="color: black;">）及肺血管压降低，<span style="color: black;">病人</span>对本药的耐受量个体差异很大。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">23</span><span style="color: black;">．【答案】</span><span style="color: black;">E</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">【解析】充血性心力衰竭又<span style="color: black;">叫作</span>慢性心功能不全，地高辛是洋地黄类<span style="color: black;">药品</span>，属于正性肌力<span style="color: black;">药品</span>。洋地黄治疗心衰时，剂量与心肌收缩效应呈线性关系，<span style="color: black;">茫然</span><span style="color: black;">增多</span>洋地黄剂量不仅易<span style="color: black;">导致</span>中毒反应，且可能加重心衰。<span style="color: black;">另一</span>胺碘酮和维拉帕米均可降低地高辛的经肾排泄率而<span style="color: black;">增多</span>中毒的可能性，<span style="color: black;">因此</span>均排除。普罗帕酮有轻度的降压和减慢心率的<span style="color: black;">功效</span>，但心衰<span style="color: black;">病人</span>禁忌。</span><span style="color: black;">β</span><span style="color: black;">受体阻滞剂对舒张性心功能不全有效，它可减慢心率，延长心室舒张期充盈时间，<span style="color: black;">增多</span>冠脉血流灌注，且可改善心肌弛缓性和顺应性。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">24</span><span style="color: black;">．【答案】</span><span style="color: black;">C</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">【解析】<span style="color: black;">按照</span>题目，初步诊断为急性左心衰伴高血压，首要的处理<span style="color: black;">办法</span>为降低血压，应<span style="color: black;">选取</span>强效降压药硝普钠。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">25</span><span style="color: black;">．</span><span style="color: black;">【答案】</span><span style="color: black;">D</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">【解析】心源性水肿的病理机制。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">26—27</span><span style="color: black;">．【答案】</span><span style="color: black;">26</span><span style="color: black;">．</span><span style="color: black;">A 27.C</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">【解析】</span><span style="color: black;">①</span><span style="color: black;">卡托普利为血管紧张素转换酶<span style="color: black;">控制</span>剂使</span><span style="color: black;">AII</span><span style="color: black;">减少，<span style="color: black;">控制</span>醛固酮分泌，使血钾<span style="color: black;">升高</span>。</span><span style="color: black;">②</span><span style="color: black;">低分子量肝素抗凝血<span style="color: black;">功效</span>较弱，抗血栓形成<span style="color: black;">功效</span>强可<span style="color: black;">导致</span><span style="color: black;">流血</span>，<span style="color: black;">亦</span>可<span style="color: black;">导致</span>血小板减少症低醛固酮血症伴高钾血症、皮肤坏死等不良反应。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">28-30</span><span style="color: black;">．</span><span style="color: black;">【答案】</span><span style="color: black;">28</span><span style="color: black;">．</span><span style="color: black;">E 29</span><span style="color: black;">．</span><span style="color: black;">A 30</span><span style="color: black;">．</span><span style="color: black;">C</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">【解析】</span><span style="color: black;">①</span><span style="color: black;">慢性左心衰<span style="color: black;">引起</span><span style="color: black;">长时间</span>肺循环高压，致肺瘀血，<span style="color: black;">引起</span>肺褐色硬化。</span><span style="color: black;">②</span><span style="color: black;">肺气肿是末梢肺组织（<span style="color: black;">呼气</span>性细支气管、肺泡管、肺泡囊和肺泡）因含气量<span style="color: black;">太多</span>伴肺泡间隔破坏，肺组织弹性减弱，<span style="color: black;">引起</span>肺体积膨大、功能降低的一种<span style="color: black;">疾患</span>状态，是支气管和肺部<span style="color: black;">疾患</span>最<span style="color: black;">平常</span>的合并症。</span><span style="color: black;">③</span><span style="color: black;">急性左心衰时心脏收缩力<span style="color: black;">忽然</span>严重减弱，心排血量急剧减少，左室舒张末压<span style="color: black;">快速</span><span style="color: black;">上升</span>，致肺静脉回流不畅，肺静脉压力快速<span style="color: black;">上升</span>，肺毛细血管压随之<span style="color: black;">上升</span>，使血管内液体渗人到肺间质和肺泡内，形成急性肺水肿。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">31-33</span><span style="color: black;">．【答案】</span><span style="color: black;">31</span><span style="color: black;">．</span><span style="color: black;">D 32</span><span style="color: black;">．</span><span style="color: black;">D 33</span><span style="color: black;">．</span><span style="color: black;">B</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">【解析】<span style="color: black;">按照</span>题目，<span style="color: black;">病人</span>的左心室功能下降，<span style="color: black;">导致</span>左心衰失代偿。<span style="color: black;">针对</span>左心衰，强心、利尿、扩血管以及<span style="color: black;">控制</span>交感神经系统和</span><span style="color: black;">RAAS</span><span style="color: black;">系统均是其治疗<span style="color: black;">办法</span>，<span style="color: black;">然则</span>该<span style="color: black;">病人</span>下肢<span style="color: black;">没</span>水肿，<span style="color: black;">因此呢</span><span style="color: black;">日前</span>尚不<span style="color: black;">必须</span>进行利尿。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">34-38</span><span style="color: black;">．【答案】</span><span style="color: black;">34E 35.D 36</span><span style="color: black;">．</span><span style="color: black;">D 37</span><span style="color: black;">．</span><span style="color: black;">C 38</span><span style="color: black;">．</span><span style="color: black;">B</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">【解析】<span style="color: black;">按照</span>心电图和临床表现，很容易诊断为冠心病全心衰。此时<span style="color: black;">病人</span>水肿严重，首选利尿剂解除水钠潴留。实验室<span style="color: black;">检测</span><span style="color: black;">能够</span><span style="color: black;">选取</span>超声心动图和脑钠肽。此时<span style="color: black;">谨慎</span><span style="color: black;">运用</span>β受体阻滞剂，避免因<span style="color: black;">控制</span>心肌功能而加重症状。</span></p>
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">分享、在看与点赞，<span style="color: black;">最少</span>我要<span style="color: black;">持有</span>一个吧</strong></p>
感谢楼主的分享！我学到了很多。 你的话语如春风拂面，让我心生暖意。 楼主发的这篇帖子，我觉得非常有道理。 你的话语如春风拂面，温暖了我的心房，真的很感谢。 期待更新、坐等、迫不及待等。
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