725.真相(5):竟然是这样(2 / 2)

最终诊断 号西风 0 字 2021-12-08

(4)腹股沟淋巴结检查

被检者平卧,检查者站在被检者右侧,右手四指并拢,以指腹触及腹股沟,由浅及深滑动触诊,先触摸腹股沟韧带下方水平组淋巴结,再触摸腹股沟大隐静脉处的垂直组淋巴结。左右腹股沟对比检查。

(5)触及淋巴结时能表述部位、大小、质地、数量、活动度、有无粘连、压痛、局部皮肤变化等八项)

12、请演示心脏瓣膜听诊区位置及听诊顺序?

答:(1)能正确指出心脏瓣膜各听诊区;(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,逆时针方向或称倒8字。(3)能表达心脏听诊主要内容。心率、心律、正常心音、心音改变、心脏杂音、心包摩擦音等。

13、请演示心脏相对浊音界的叩诊?

答:叩出正常心浊音界,并能在胸廓体表量出心浊音界。叩诊手法同前,自左侧心尖搏动外2-3cm处开始叩诊,由外向内闻及由清变浊时作出标记,并测量其与胸骨中线垂直距离,再逐一肋间向上叩诊直至第二肋间,将其标记点画成连线。右侧方法同上,将心浊音界标记点画成连线。

14、请演示腹部液波振颤(波动感)的检查方法?

答:液波震颤:患者平卧,双腿屈曲,放松腹壁,检查者以一手掌面贴于患者一侧腹壁,另一手四指并拢稍屈曲,用指端叩击对侧腹壁或指端冲击腹壁。为防止腹壁本身的震动传至对侧,可让另一人手掌尺侧缘压于脐部腹中线上。

15、请演示右下腹疼痛的病人进行压痛和反跳痛的检查?

答:检查者用手触诊被检查者腹部出现压痛后,手指可于原处稍停片刻,使压痛感觉趋于稳定,然后迅速将手抬起,离开腹壁,被检查者感觉腹痛骤然加重。

16、请作心脏触诊检查的演示?

答⑴检查者右手掌置于被检查者心前区开始触诊。然后逐渐以手掌尺侧小鱼际或示指、中指、环指并拢,以其指腹进行触诊。触诊时手掌按压力度适当。

(2)在心尖搏动区确认心尖搏动,并能表达搏动所在体表位置;(3)触诊震颤、心包摩擦感;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。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。。

17、请演示腹壁反射的检查及听诊肠鸣音?

答:腹壁反射的检查:被检查者仰卧,下肢稍屈曲,使腹壁松弛,然而用钝头竹签分别沿肋缘下,脐平及腹股沟上的平行方向,由外向内轻划腹壁皮肤。正常反应是局部腹肌收缩。

肠鸣音听诊:

①应将听诊器胸件置于腹壁上,全面地听诊各区。

②顺序:左至右,下至上。

③正常肠鸣音:每分钟4-5次。

④肠鸣音亢进:每分钟10次以上且肠鸣音响亮、高亢。

⑤肠鸣音消失标准:3-5分钟听不到肠鸣音。

18、请演示腹部移动性浊音的检查。

答:腹腔内游离腹水>1000ml:让被检查者仰卧,自腹中部开始,向两侧腹部叩诊,出现浊音时,板指手不离开腹壁,令被检查者右侧卧,使板指在腹的最高点,再叩诊,呈鼓音,当叩诊向腹下侧时,叩音又为浊音,再令被检查者左侧卧,同样方法叩击,这种因体位不同而出现的浊音区变动现象称移动性浊音。

19.请演示踝阵挛、角膜反射的检查?

答:踝阵挛:嘱病人仰卧,髋及膝关节稍屈曲,医师一手持病人小腿,一手持病人足掌前端,用力向上使踝关节过伸,阳性为腓肠肌和比目鱼肌发生节律性收缩。角膜反射:嘱被检查者眼睛注视内上方或一侧检查者竖起的食指,避免其直视棉签,用细棉签由角膜外缘处轻触其角膜。正常时可见被检侧眼睑迅速闭合,称为直接角膜反射,同时对侧也出现眼睑闭合反应,称为间接角膜反射。

20、请进行Babinski征和Hoffmann征检查?

答:巴彬斯基征:用竹签沿患者足底外侧缘,由后向前至小趾跟部并转向内侧,阳性反应为足母趾背伸,余趾呈扇形展开。霍夫曼征:医师左手持病人腕关节上方,右手以中及食指夹持病人中指,稍向上提,使腕关节处于轻度过伸拉,然后拇指迅速弹刮患者中指指甲,由于中指伸屈肌受到牵引而引起其余四指的轻微掌屈反应为阳性。

21、请演示Babinski征、Oppenheim征的检查?

答:巴彬斯基征:用竹签沿患者足底外侧缘,由后向前至小趾跟部并转向内侧,阳性反应为足母趾背伸,余趾呈扇形展开。奥本汉姆征:检查者用拇指及示指沿被检者胫骨前缘用力由上向下滑压,阳性表现同Babinski征。

22、请演示脾脏的触诊?

答:①检查者左手绕过腹前方,手掌置于左腰部第7~10肋处,试将其脾从后向前托起,右手掌平放于上腹部,与肋弓大致成垂直方向,配合呼吸,以手指弯曲的力量下压腹壁,直至触及脾缘。②当平卧位触诊不到脾脏时,嘱被检查者取右侧卧位,右下肢伸直,左下肢屈曲,此时用双手触诊法。③临床上,常将脾肿大分为轻、中、高三度:深吸气时,脾缘不超过肋下2cm,为轻度肿大;超过2cm至脐平线以上,为中度肿大;超过脐水平线或前正中线则为高度肿大,即巨脾。能描述以上脾肿大者。

23、如何进行颈抵抗、布氏征检查?

答:颈抵抗检查操作:病人仰卧,颈部放松,下肢伸直,检查者以手上拖被检者枕部,被动做屈颈动作。如抵抗增强,即为颈强直;

布氏征检查操作:被检者仰卧,下肢伸直,检查者一手拖起被检者枕部,另一手按于其胸前,当头部被动前屈时,双髋与膝关节同时屈曲则为阳性。

(字数限制,肝肾触诊无)

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