兒科學(xué)考試名解包含英文大題縮印版

1、兒科英文名解Classification of Neonate（新生兒分類(lèi)） Full term infant（足月兒）:Neonate whose gestational age(GA) is between 37 weeks and 42 weeksPreterm infant(早產(chǎn)兒):Neonate whose GA is less than 37 weeksPost-term infant（過(guò)期兒）:Neonate whose GA is more than 42 weeksLow birth weight neonate(LBW)（低出生體重兒）:Neonate whose BW

2、is less than 2500g Very low birth weight neonate(VLBW)（極低出生體重兒）: Neonate whose BW is less than 1500gNormal birth weight neonate（正常體重兒）: Neonate whose BW is between 2500g and 4000gMacrosomia neonate（巨大兒）: Neonate whose BW is over 4000gSmall for gestational age(SGA)（小于胎齡兒）:Infants whose BW are under P

3、10 of the same GA infantsBWAppropriate gestational age(AGA)（適于體重兒）: Infants whose BW are ranging from P10 to P90 of the same GA infantsBWLarge gestational age(LGA)（大于胎齡兒）: Infants whose BW are above P90 of the same GA infantsBWEarly newbore（早期新生兒）:Neoborn less than 1 weekLate newbore（晚期新生兒）:Neoborn

4、aging from 2 weeks to 4 weeks 2.Neutral temperature（中性溫度）:An appropriate environmental temperature which can keep a neoborns normal temperature and can keep the least oygen cousuming,the least metabolism rate ,the least energy evaporated, so is called neutral temperature . 3. Apnea（呼吸暫停）: when asphy

5、xia of fetal or neoborn occurs, the respirate inhabitated and reflexal heart rate decreased because of lack of oxygen ,so is called apnea. 4. Physiological body weight decline（生理性體重下降）: Intate deficiency, fatal stool paused and water losed after birth can make physical body weight decline (3%-9%), a

6、nd it reaches its lowest point in3 or 4 day and returns to its birth weight in 7 to 10 days . 5. Physiological anemia（生理性貧血） : When neonate of 23 months, RBC drops to 110g/L, neonate occurs mild anemia .It will take 3 months to recover . 6. Physiological diarrhea（生理性腹瀉） : Physiological diarrhea usua

7、lly occurs in infants little than 6 months .They appear puffy and often have eczema .Soon after delivery , they may have diarrhea, whose times are increasing .However, there is no other symptoms and the infants have good appetites. Physical diarrhea does not affect the growth. Recent researches foun

8、d that the diarrhea is a particular type of intolerance of lactose. The stool may recover normality after appending the complements. 7. Project Immunity（計(jì)劃免疫） : According to characteristics of childrens immunity and the conditions of communicable diseases ,people had drawn up a kind of immunity prog

9、rams, namely project immunity. People inoculate some organico-product in order to progress the level of immunity , control and eliminate the communicable diseases. 8.Serious Pneumonia（重癥肺炎）:Serious Pneumonia is a kind of pneumonia. Respiratory system together with other systems are invaded,meanwhile

10、,the general toxic symptom is also apparent. 9.The Division of Respiratory tract（上下呼吸道分界）: The respiratory tract is divided into 2 parts,the upper respiratory and the lower respiratory, by the ring-formed gristle. 10.Discrepant Cyanosis（差異性紫紺）: Discrepant Cyanosis occurs in PDA. Because of PDA, the

11、blood moves from the aorta to the pulmonary artery. If this abnormality lasted so long that the pressure of pulmonary is higher than the aorta, there will lead to right-to-left shunts and appear cyanosis in the second half of the body. 11.Colostrum（初乳）: Colostrum is the first milk produced by the da

12、m which contains antibodies (immunoglobulins) which provide crias with immunity (passive immunity). There is no transfer of immunoglobulins across the placenta and neonatal crias are not capable of producing their own antibodies. They must rely on their passive immunity for the first few weeks of li

13、fe. This makes colostrum essential to the health of any cria. A cria who does not receive enough. 12. Eisenmenger syndrome（Eisenmenger 綜合征）: Eisenmenger syndrome occurs in patients with large congenital cardiac or surgically created extracardiac left-to-right shunts. These shunts initially cause inc

14、reased pulmonary blood flow. Subsequently, usually before puberty, pulmonary vascular disease causes pulmonary hypertension, ultimately resulting in reversed or bidirectional shunt flow with variable degrees of cyanosis. 13.Additional nursing（補(bǔ)授法）: When the breast milk is not enough, the baby within

15、 6 months can be feed partly with breast milk and partly with other nutritions each time. 14.Substitutional nursing（代授法）: When the breast milk is enough but the mother cant feed the baby in time, the baby can be feed with other nutritions like milk for some times. 15.Malnutrition（營(yíng)養(yǎng)不良）: It is a dise

16、ase caused by lacking of energy and protein. It often happens to the baby within 3 years old with symptoms of weight-losing, fat-losing, edema and functional disorders. 16. Obesity（肥胖癥）: Obesity is defined as an excessively high amount of body fat or adipose tissue in relation to lean body mass. 17.

17、 Koplik spots（麻疹黏膜斑）: ulcerations on buccal mucosa around Stensen duct; spotty enanthema in oral cavity, may precede rash 18. Harrison's groove（郝氏溝）: The distal end of the ribs are weak and may be depressed by the negative intrathoracic pressure developed during respiration with a resultant semi

18、coronal impression being found at the costal attachment of the diaphragm, leading to the formation of Harrison's groove. 19. Rachitic rosary（佝僂病串珠）: a radiographic appearance of the costochondral junctions of the middle ribs in rickets. This appearance results from the presence of bulky growth p

19、lates at the bone or cartilage junctions. 20. Chvostek's sign（Chvostek's 征）: Chvostek's sign is contraction of the muscles of the eye, mouth or nose, elicited by tapping along the course of the facial nerve. The examiner taps gently over the facial nerve in front of the ear. This is a si

20、gn of a latent tetany. 21. Trousseau sign（Trousseau 征）: It is carpal spasm after 5 minutes of inflation of a pressure cuff between the patients systolic pressure and diastolic pressure.This measure assesses nerve irritability and is more specific for tetany of vitamin D deficiency. 22.Severe asthma（

21、重癥哮喘） including acute serious asthma attack , lasting status of asthma and deterioration of intractable asthma. 23. Persistant asthma（哮喘持續(xù)狀態(tài)）: It is a condition of severe acute attack of asthma which can not be released by proper drug in 24 hours. 24. Tuberculous infection（結(jié)核感染）: It is an infection

22、of tubercle bacillus. In this condition, the patients test of tuberculin and the test of serum PPD-IgM or IgG antibody are positive. But the tubercle focus can not be found in patients body. 25. Endogenous infection（內(nèi)源性感染）: When the patient eat too much or the components of the food are not balanced

23、 ,the process of the digestion will be slowed down. And the food which can not be fully digested will stay in the upper part of the small intestine. Then the PH of the intestinal carvity will decreased. It leads to a result that the bacteria from the lower part of the intestine will move up and mult

24、ip;y . The food then will be ferment and rot by those bacteria. 26 Aschoff body（風(fēng)濕小體） :It is aone of the tiny lumps in heart muscle that are typical of rheumatic heart disease and consist of swollen collagen ,cells and fibrils. 27 Primary complex:（原發(fā)綜合征） It is a combination of primary focus of infec

25、tion in the lung parenchyma and caseous involvement of the regional lymph nodes ,usually hilar nodes. 28 Corticoid sensitivity（激素敏感） referring to proteinuria became negative ,edema disappeared within 8 weeks after corticoid therapy., 29 Partial corticoid sensitivity（激素部分敏感） : Edema disappeared withi

26、n 8 weeks after corticoid therapy but proteinuria is still + +. 30 Corticoid dependent（激素依賴(lài)） : Sensitive to corticoid relieved rapidly after treatment but relapse occurs when the dose reduced or stopped within 2 weeks ,again relieved when resuming full doses or restart treatment and this repeated 2

27、to 3 times. 31 Corticoid resistant（激素耐藥） : Referring to the protein in the urine is still over + when the treatment has been for full 8 weeks. 32 Relapse（復(fù)發(fā)） and repetition（反復(fù)） : Proteinuria has been become negative and the hormone treatment has stopped for morethan 4 weeds ,again the protein in the

28、 urine is over + is called relapse ;If the above symptoms during treatment is defined as repetition. Frequent relapse（頻復(fù)發(fā)） and frequent repetition（頻反復(fù)） : Refers to relapse or repetition occurs not less than twice within 6 months. 33 Extra-medulla hemopoiesis（髓外造血） :In order to adapt to the anemia ca

29、used by infection or hemolysis and so on. After birth especially at infant stage , the live is enlarged for regaining the hemopoietic state. In fetal state this may accompanied by splenolymphomegaly ,nucleated red cells and premature neutrophils can be found in peripheral blood . This specific react

30、ion of infants hemopoietic organs is called extra-medullar hemopoiesis. 34.Physiological hemolysis（生理性溶血）: Fetal is in the environment of low PO2, so the quantity of RBC is large. After birth, PO2 rises. The quantity of RBC is relatively surplus, so many of them are vulnerable to be destroyed. The l

31、ife of neonatal RBC is short, too. 35 Anemia（貧血） : The numbers of erythrocytes or the concentration of hemoglobin per volume in the tipping circulation is under normal. According to the data from WHO, the lower limit of hemoglobin in 6 months to 6-year old children is 110g/L.6 to 14 years old is 120

32、g/L,the hemoglobin increases 4 percent as altitude raises every 1000 meters; lower than these numbers is called anemia .36 Tripod sign（十字架征） : Positive sign is when child sits up ,he has to push the bed behind himself with whose hands to keep his position. 37.Physiological jaundice（生理性黃疸）: Because o

33、f the feature of neonatal bilirubin metabolism ,approximately 50%-60% mature baby and more than 80% premature baby will emerge jaundice within 2 or 3 days after birth and reach the peak at the fourth or the fifty day . If the body is in good heath, jaundice will vanish within 2 weeks in mature baby

34、and prolong to 3 or 4 weeks in premature baby. 38.Pathological jaundice（病理性黃疸）: 1) The jaundice emerges during the 1st 24hours on the new born. 2) The bilirubin in the serum is higher than from 205.2 to 256.5 umol/L or raise 85 umol/L per day. 3) The jaundice of term delivery lasts more than 2 weeks

35、. The jaundice of premature lasts more than 4 weeks. 4) The jaundice relapses. 5) The conjunctive bilirubin is more than 24 umol/L. 39.Pharyngo-conjunctival fever（咽結(jié)合膜熱）: Its a disease which is caused by virus and is on epidemic in spring and summer, with the feature of fever, pharyngitis and conjun

36、ctivitis. High fever, pharynache, tingle in eyes and pharyngeal congestion. Conjunctivitis emerged in one or two sides and lymph nodes of cervix and behind the ear are common and sometimes accompanied by gastrointestinal symptoms . Its process is one to two weeks . 40 Herpangina（皰疹性咽峽炎）: It is cause

37、d by Coxackie group A virus and often seen in summer and spring. It can spread in children collective organization. It is characterized by fever, pharyngitis, tingling in eyes, pharyngeal congestion ,herpes with flush around about 2 to 4 mm in diameter can be found on pharyngepalatal arch uvula , so

38、ft palate ,ulceration formed after splitting ,the course is about 1 weeks .簡(jiǎn)述嬰兒期的保健原則及重點(diǎn)：提倡母乳喂養(yǎng)，合理添加輔食，指導(dǎo)斷奶；定期做健康檢查和體格測(cè)量；預(yù)防疾病，防止意外，促進(jìn)生長(zhǎng)發(fā)育；完成基礎(chǔ)計(jì)劃免疫；促感知覺(jué)的發(fā)展，加強(qiáng)體格鍛煉。1.喂養(yǎng) 2. 清潔衛(wèi)生 3 消毒隔離 4 預(yù)防接種簡(jiǎn)述母乳喂養(yǎng)的優(yōu)點(diǎn)：一、營(yíng)養(yǎng)豐富，出乳含豐富的SIgA；二、鈣磷比適當(dāng)，鈣吸收好；三、經(jīng)濟(jì)方便；四、加快乳母產(chǎn)后子宮復(fù)原；五、增進(jìn)母子感情。簡(jiǎn)述營(yíng)養(yǎng)不良的分型及并發(fā)癥：（1）消瘦型：能量缺乏為主。（2）浮腫型：蛋白質(zhì)缺乏為主

39、（3）消瘦浮腫型。并發(fā)癥(complication) ：1. 營(yíng)養(yǎng)性小細(xì)胞性貧血：營(yíng)養(yǎng)不良最常見(jiàn)的并發(fā)癥。2. 各種維生素缺乏：最常見(jiàn)的維生素A缺乏，另外還有維生素D、C、E缺乏等。3. 感染：如上呼吸道感染、泌尿系統(tǒng)感染等。（舉例說(shuō)明）4. 自發(fā)性低血糖。簡(jiǎn)述維生素缺乏性佝僂病病因：日照不足、維生素D攝入不足、生長(zhǎng)過(guò)速、疾病因素、藥物影響簡(jiǎn)述維生素缺乏性佝僂病激期的骨骼改變：出現(xiàn)PTH功能亢進(jìn)，鈣、磷代謝失常的典型骨骼改變，6月內(nèi)，指尖稍用力壓迫枕骨或頂骨后部可有壓乒乓球樣感覺(jué)，78月變成“方盒樣”頭型及方頭，“佝僂病串聯(lián)”，“手 足鐲”，1歲左右，“雞胸樣畸形”嚴(yán)重佝僂病小兒胸廓的下緣形成

40、一水平凹陷，即肋膈溝或郝氏溝。簡(jiǎn)述單純性肥胖癥的病因及肥胖癥分度：攝入過(guò)多、活動(dòng)過(guò)少、遺傳和環(huán)境因素、出生體重、性別因素。根據(jù)身高標(biāo)準(zhǔn)體重，超過(guò)同意升高人群的20%29%為輕度肥胖，3049%為中度肥胖，50%以上為中度肥胖。嬰兒添加輔食的原則：由少到多、由稀到稠、由細(xì)到粗、由一種到多種、天氣炎熱和嬰兒患病時(shí)，應(yīng)暫緩添加新品種簡(jiǎn)述早產(chǎn)兒的外觀特點(diǎn)：外觀特點(diǎn) 早產(chǎn)兒越早產(chǎn)則皮膚越薄嫩、組織含水量多、有凹陷性壓痕、色紅、皮下脂肪少、肌肉少、指甲短軟，同時(shí)軀干部的胎毛越長(zhǎng)、頭部毛發(fā)則越少且短，頭較大，囟門(mén)寬，耳殼平軟與顱骨相貼，胸廓軟，乳暈呈點(diǎn)狀，邊緣不突起，乳腺小或不能摸到。腹較脹，陰囊發(fā)育差。男

41、性早產(chǎn)兒的睪丸常在外腹股溝中，在發(fā)育過(guò)程中漸降至陰囊內(nèi)。女性越早產(chǎn)者則其小陰唇越分開(kāi)而突出。手足底皺痕少。簡(jiǎn)述生理性黃疸和病理性黃疸的區(qū)別：新生兒病理性黃疸A 生后24小時(shí)內(nèi)出現(xiàn)黃疸B 血清膽紅素>205mol/L（12mg/dl）C 足月兒黃疸持續(xù)>2周，早產(chǎn)兒黃疸持續(xù)>4周D 黃疸退而復(fù)現(xiàn)E血清結(jié)合膽紅素大于34mol/L（2mg/dl） 新生兒生理性黃疸A 生后25天出現(xiàn)黃疸B 一般情況良好C 足月兒14天內(nèi)消退D 早產(chǎn)兒4周內(nèi)消退簡(jiǎn)述新生兒晚期代謝性酸中毒的原因及表現(xiàn)：晚期代酸的產(chǎn)生主要是內(nèi)源性酸產(chǎn)生與腎臟泌酸之間的不平衡性，也即酸產(chǎn)生的正平衡有關(guān)，這種不平衡性可源于

42、內(nèi)源性蛋白質(zhì)合成酸異常升高，腎泌酸異常減低或兩者兼而有之。1.病史 人工喂養(yǎng)，有攝入較高酪蛋白的病史，特別是早產(chǎn)兒。2.體重不增 雖攝入熱卡已達(dá)150kcal/kg，蛋白質(zhì)已達(dá)5g/kg，病兒體重卻增長(zhǎng)緩慢或不增，尤以低出生體重兒較明顯。3.反應(yīng)低下 精神萎靡，哭鬧少，食欲低下，皮膚蒼白，口周發(fā)青，肌張力稍低下;極低出生體重兒可表現(xiàn)有嗜睡，呼吸暫停。4.呼吸深長(zhǎng) 除個(gè)別嚴(yán)重酸中毒外，一般呼吸深長(zhǎng)均不明顯。簡(jiǎn)述新生兒肺透明膜病的發(fā)病機(jī)制、診斷要點(diǎn)：肺泡萎陷 缺氧酸中毒 肺小A痙攣 肺A壓力增高 卵圓孔、動(dòng)脈導(dǎo)管開(kāi)放 右向左分流 肺組織缺氧加重 肺毛細(xì)血管通透性增高 纖維蛋白滲出 肺透明膜形成 氣

43、體交換受限。表現(xiàn)為出生后6小時(shí)內(nèi)呼吸窘迫、呼氣呻吟。X線表現(xiàn)為毛玻璃樣改變、支氣管充氣征、白肺、肺容量減少。簡(jiǎn)述新生兒缺氧缺血性腦病的發(fā)病機(jī)制及治療原則：1、腦血流改變 2次血液重新分布以代償缺血缺氧。有選擇性易損性：若窒息缺氧為急性完全性，代償無(wú)效，腦損傷發(fā)生在代謝最旺盛部位：丘腦及腦干核2、腦組織生化代謝改變 生化代謝改變：低血糖、代酸、可能的與發(fā)病相關(guān)的途徑：能量代謝障礙、氧自由基、興奮性氨基酸、鈣超負(fù)荷等。3、神經(jīng)病理學(xué)改變 足月兒：皮質(zhì)梗死、深部灰質(zhì)核壞死。早產(chǎn)兒：腦室周?chē)鲅?、腦室內(nèi)出血、白質(zhì)病變。治療原則：及早治療，綜合治療，序貫治療，足夠療程新生兒窒息ABCDE復(fù)蘇：復(fù)蘇方案

44、A（air way）盡量吸盡呼吸道粘液 B（breathing）建立呼吸道。增加通氣C（circulation）維持正常循環(huán)，保證足夠心搏出量 D（drug）藥物治療 E（evaluation） 評(píng)價(jià)。前三項(xiàng)為重要，其中A是根本，通氣是關(guān)鍵 。川崎病的診斷標(biāo)準(zhǔn)：不明發(fā)熱5天以上，伴下列5項(xiàng)臨床表現(xiàn)中4項(xiàng)者，排除其他疾病后，即可診斷為川崎?。? 周?chē)w的變化：急性期掌跖紅斑，手足硬性水腫；恢復(fù)期指趾端膜狀脫皮2 多形性紅斑 3 眼結(jié)合膜充血，非化膿性 4 唇充血破裂 口腔黏膜彌漫充血，舌乳頭呈草莓舌 5 頸部非化膿性淋巴結(jié)腫大（直徑大約1.5cm）簡(jiǎn)述高滲性脫水的特征：伴有細(xì)胞外液減少的高鈉血

45、癥，其特征是失水多于失鈉，血清鈉濃度150mmol/L，血漿滲透壓310mOsmL。肺炎分類(lèi)：一、病理：大葉性肺炎、支氣管肺炎和間質(zhì)性肺炎。二、病因：病毒性、細(xì)菌性、支原體、衣原體、原蟲(chóng)性、真菌性、非感染性病因。三、病程：急性（病程<1個(gè)月），遷延性（病程13個(gè)月），慢性（病程>3個(gè)月）。四、病情：輕癥除呼吸系統(tǒng)外無(wú)全身中毒癥狀重癥除呼吸系統(tǒng)外出現(xiàn)其他系統(tǒng)表現(xiàn)，全身中毒癥狀明顯，發(fā)生生命體征危象。小兒肺炎抗生素治療原則主要包括以下幾點(diǎn)：根據(jù)病原菌選用敏感藥物；早期治療；聯(lián)合用藥；選用滲入下呼吸道濃度高的藥物；足量足療程，重癥宜靜脈給藥。新生兒肺炎：常由B族鏈球菌或腸桿菌引起，前者首

46、選青霉素，后者可選用氨芐青霉素，第2、3代頭孢菌素治療；葡萄球菌肺炎：可選用抗內(nèi)酰胺酶抗生素，如苯唑青霉素，耐藥者選用萬(wàn)古霉素；流感嗜血桿菌肺炎：可選用阿莫西林加克拉維酸；支原體、衣原體感染：可選用紅霉素、羅紅霉素、阿齊霉素等環(huán)內(nèi)酯類(lèi)藥物?？股匾话銘?yīng)使用到體溫控制后57天，支原體肺炎至少用藥23周，葡萄球菌肺炎療程宜長(zhǎng)，6周左右。試述金黃色葡萄球菌肺炎的臨床特點(diǎn)：多見(jiàn)于1歲以?xún)?nèi)小嬰兒，在呼吸道感染和皮膚感染后突然高熱不退，年長(zhǎng)兒持續(xù)高熱，新生兒低熱或無(wú)熱甚至體溫不升。起病急、呼吸道癥狀出現(xiàn)早，肺炎進(jìn)展迅速、皮膚花紋，有麻疹樣、猩紅樣皮疹。嘔吐、腹瀉、腹脹如鼓?；純簾┰晔人?，嚴(yán)重者驚厥，休克。

47、肺部體征出現(xiàn)亦早臨床癥狀與胸片所見(jiàn)可不一致。試述小兒肺炎合并發(fā)心力衰竭的診斷標(biāo)準(zhǔn)：突然煩躁不安，面色蒼白或發(fā)灰，心率明顯增快；安靜時(shí)嬰兒每分鐘160次以上，幼兒每分鐘140次以上，不能用體溫增高或呼吸困難來(lái)解釋。有時(shí)出現(xiàn)心音低鈍、奔馬律，頸靜脈怒張或心臟擴(kuò)大等。呼吸困難，發(fā)紺加重，安靜時(shí)呼吸頻率嬰兒達(dá)60次/分以上，而幼兒則達(dá)40次/分以上。肝臟在短期內(nèi)增大1.5cm以上，或在肋下3cm以上，伴有顏面、肢體浮腫，尿量減少等。試述肺炎合并心力衰竭的治療原則：除鎮(zhèn)靜、給氧外，增強(qiáng)心肌收縮力；減慢心率，增加心搏出量；減輕鈉水儲(chǔ)留，減輕心臟負(fù)荷。支氣管肺炎時(shí)應(yīng)用腎上腺皮質(zhì)激素的目的及指征是什么：糖皮質(zhì)

48、激素可減少炎癥滲出，解除支氣管痙攣，改善血管通透性和微循環(huán)，減輕顱內(nèi)壓。適用于中毒癥狀明顯；嚴(yán)重憋喘，胸膜有滲出伴腦水腫、中毒性腦病、感染性休克、呼吸衰竭時(shí)。嬰幼兒哮喘的診斷依據(jù)：A喘息發(fā)作3次B 肺部出現(xiàn)哮鳴音，呼氣相延長(zhǎng)C 喘息癥狀突然發(fā)作D具有特應(yīng)性體質(zhì)，如過(guò)敏性濕疹、過(guò)敏性鼻炎等E 一、二級(jí)親屬中有哮喘病史咳嗽F排除其他引起喘息發(fā)作的疾病變異性哮喘的診斷依據(jù)：A 咳嗽持續(xù)或反復(fù)發(fā)作>1個(gè)月B 臨床無(wú)感染征象，或經(jīng)較長(zhǎng)期抗生素治療無(wú)效C 支氣管擴(kuò)張劑可使咳嗽發(fā)作緩解D 有個(gè)人或家族過(guò)敏史E氣道呈高反應(yīng)性，支氣管激發(fā)試驗(yàn)陽(yáng)性D排除其他引起慢性咳嗽的疾病哮喘持續(xù)狀態(tài)的處理：A 吸O 2

49、 B 補(bǔ)液糾正酸中毒C 糖皮質(zhì)激素類(lèi)靜脈滴注D 支氣管擴(kuò)張劑法樂(lè)四聯(lián)癥的畸形組成如何：右室流出道梗阻；室間隔缺損；主動(dòng)脈騎跨；右心室肥厚。簡(jiǎn)述室間隔缺損的血流動(dòng)力學(xué)改變：起初肺血流量的增多，可通過(guò)肺循環(huán)阻力的自身調(diào)節(jié)使肺動(dòng)脈壓改變不明顯，長(zhǎng)期的肺血流量的增加，肺小動(dòng)脈發(fā)生痙攣，肺小動(dòng)脈長(zhǎng)期痙攣，管腔內(nèi)膜增厚，中層肌肉肥厚，管壁纖維長(zhǎng)，管腔狹窄，使肺循環(huán)阻力日益增高，產(chǎn)生嚴(yán)重的肺動(dòng)脈高壓。肺動(dòng)脈高壓發(fā)展到一定程度，左向右分流量逐步減少，出現(xiàn)雙向分流，最后形成右向左分流為主，使體循環(huán)的血氧含量降低，臨床上出現(xiàn)紫紺，即Eisenmenger綜合征，此時(shí)，左心室的負(fù)荷減輕，而右心室的負(fù)荷進(jìn)一步加重。簡(jiǎn)

50、述房間隔缺損的血流動(dòng)力學(xué)改變：出生時(shí)及新生兒早期右房壓力可略高于左房，可出現(xiàn)右向左分流，出現(xiàn)暫時(shí)性的青紫，隨著肺循環(huán)血量的增加，左心房壓力超過(guò)右心房時(shí)，分流轉(zhuǎn)為左向右，分流量的大小取決于缺損大小及兩側(cè)心室順應(yīng)性而不同。右心房接受上下腔靜脈回流的血，又接受左心房分流的血，導(dǎo)致右心房、右心室舒張期負(fù)荷過(guò)重，因而使右心房及右心室增大，肺循環(huán)血量增多，而左心室、主動(dòng)脈及體循環(huán)血量則減少。如缺損較大產(chǎn)生大量的左向右分流時(shí)，肺動(dòng)脈壓力則不同程度的增高，少數(shù)病人晚期出現(xiàn)肺血管硬化而致梗阻性的肺動(dòng)脈高壓，當(dāng)右心房的壓力超過(guò)左心房時(shí)，血自右向左分流出現(xiàn)持續(xù)青紫法樂(lè)四聯(lián)癥患兒為何會(huì)突然昏厥：肺動(dòng)脈狹窄的基礎(chǔ)上，突

51、然發(fā)生該處肌部痙攣，引起一過(guò)性肺動(dòng)脈梗阻，使腦缺氧加重發(fā)作。年長(zhǎng)兒常速頭痛、頭昏。病毒性心肌炎臨床診斷依據(jù)：1心功能不全、心源性休克或心腦綜合征 2 心臟擴(kuò)大（X線或超聲心動(dòng)圖具有表現(xiàn)之一）3心電圖改變：R波為主的兩個(gè)或兩個(gè)以上導(dǎo)聯(lián)ST-T改變持續(xù)四天以上 4CK-MB升高或心肌肌鈣蛋白陽(yáng)性二、病原學(xué)診斷依據(jù)：確診指標(biāo)：分離到病毒用病毒核酸探針查到病毒核酸特異性病毒抗體陽(yáng)性參考依據(jù)：糞便、血液分離到病毒，血中特異性IgM抗體陽(yáng)性。病毒性心肌炎的治療：1 休息 2 藥物治療：抗病毒治療、改善心肌營(yíng)養(yǎng)、大劑量丙種球蛋白、糖皮質(zhì)激素、抗心衰治療、心律紊亂治療左向右分流型先天性心臟病的共同特征： 一般

52、情況下無(wú)青紫，當(dāng)哭鬧、患肺炎或心功能不全時(shí)右心壓力>左心即出現(xiàn)青紫；肺循環(huán)量易患肺炎，X線見(jiàn)肺門(mén)血管影增粗； 體循環(huán)量生長(zhǎng)發(fā)育遲緩；心前區(qū)有粗糙的收縮期雜音，于胸骨左緣最響。急性腎炎嚴(yán)重病例的臨床表現(xiàn)：高血壓腦病、嚴(yán)重循環(huán)充血和急性腎功能衰竭。腎病綜合征的診斷標(biāo)準(zhǔn)：特點(diǎn)：大量蛋白尿；低白蛋白血癥；高脂血癥；明顯水腫。為必備條件。單純性腎病與腎炎性腎病的區(qū)別。單純性腎病：1、大量蛋白尿，持續(xù)時(shí)間 > 2周 2、低蛋白血癥 3、高脂血癥 4、不同程度水腫。腎炎型腎病 上述特征加以下四項(xiàng)之一者：尿RBC多次>10/HPF,并證實(shí)為腎小球源性血尿者；反復(fù)出現(xiàn)或持續(xù)高血壓 （排出激素所

53、致）學(xué)齡兒童>130/90mmHg 學(xué)齡前兒童>120/80mmHg；持續(xù)性氮質(zhì)血癥 BUN > 107mmolL （排出血容量不足所致）；血補(bǔ)體C3反復(fù)簡(jiǎn)述小兒生理性貧血的原因：小兒出生后建立了肺呼吸，血氧飽和度由胎兒時(shí)期的45%升至95%，血氧飽和度成倍的增加使紅細(xì)胞生成素明顯減少，骨髓造血功能下降，這是最主要的原因； 胎兒紅細(xì)胞的壽命比出生后制造的紅細(xì)胞壽命短生后胎兒紅細(xì)胞逐漸破壞； 生后3個(gè)月是體重增長(zhǎng)最快的階段，血容量增加很多，紅細(xì)胞被稀釋。簡(jiǎn)述營(yíng)養(yǎng)性缺鐵性貧血的血象特點(diǎn)：血紅蛋白降低比紅細(xì)胞減少明顯，呈小細(xì)胞低色素性貧血。血涂片可見(jiàn)紅細(xì)胞大小不等，以小細(xì)胞為多，中

54、央淡染區(qū)擴(kuò)大。網(wǎng)織紅細(xì)胞數(shù)正?；蜉p度減少。簡(jiǎn)述小兒缺鐵性貧血的診斷依據(jù)：一般表現(xiàn)（皮膚粘膜逐漸蒼白，易疲乏，頭暈耳鳴）；二、髓外造血表現(xiàn)（肝脾輕度腫大）； 35簡(jiǎn)簡(jiǎn)述小兒結(jié)核病具活動(dòng)性的指標(biāo)：結(jié)核菌素試驗(yàn)強(qiáng)陽(yáng)性反應(yīng)；3歲、尤其是1歲嬰兒未接種卡介苗而結(jié)核菌素試驗(yàn)陽(yáng)性者；有發(fā)熱及其他結(jié)核中毒癥狀者；排出物中找到結(jié)核菌；胸部X線檢查顯示活動(dòng)性原發(fā)型肺結(jié)核改變者； 血沉加快而無(wú)其他原因解釋者；纖維支氣管鏡檢查有明顯支氣管結(jié)核病變者。簡(jiǎn)述病毒性腦炎的臨床特點(diǎn)：臨床上主要表現(xiàn)為腦實(shí)質(zhì)損害的癥狀和顱內(nèi)高壓征，如發(fā)熱、頭痛、嘔吐、抽搐，嚴(yán)重者出現(xiàn)昏迷。但由于病毒侵犯的部位和范圍不同，病情可輕重不一，形式亦多

55、樣。簡(jiǎn)述小嬰兒化膿性腦膜炎的臨床特點(diǎn)：急性起病，上呼吸道感染癥狀，如咽痛、流涕，進(jìn)入敗血期后出現(xiàn)高熱、畏寒、寒戰(zhàn)。70%的病例皮膚粘膜出現(xiàn)暗或紫紅色大小不等、分布不勻的瘀點(diǎn)、瘀斑。12日后進(jìn)入腦膜炎期，出現(xiàn)顱內(nèi)高壓，表現(xiàn)為頭痛加劇，嘔吐頻繁（呈噴射狀）及腦膜刺激癥（即頸項(xiàng)強(qiáng)直，角弓反張克、布氏征陽(yáng)性），血壓升高，常有怕光、狂燥甚至呼吸衰竭等。身痛煩躁不安和表情呆滯等毒血癥表現(xiàn)，嚴(yán)重者出現(xiàn)譫妄、昏迷。嬰幼兒（2歲以下）因顱骨縫及囟門(mén)未閉，腦膜炎癥狀常不典型，表現(xiàn)為高熱、嘔吐、拒食、哭鬧不安，甚至驚厥，雖無(wú)腦膜刺激征，但前囟門(mén)飽滿(mǎn)有助診斷?；撔阅X膜炎合并硬膜下積液的臨床特點(diǎn)：1歲內(nèi)及流感嗜血桿菌

56、腦膜炎多見(jiàn)。在治療中體溫不退或熱退數(shù)日后復(fù)升。病程中出現(xiàn)進(jìn)行性前囟飽滿(mǎn)、顱縫分離、頭圍增大、嘔吐、驚厥、意識(shí)障礙等。顱透光檢查和CT掃描有助于診斷。最后確診有賴(lài)于硬膜下穿剌放出積液。試述先天性甲狀腺功能減低癥的病因：甲狀腺不發(fā)育或發(fā)育不全，可能與體內(nèi)存在抑制甲狀腺細(xì)胞生長(zhǎng)的免疫球蛋白有關(guān)；其次為甲狀腺素合成途徑中酶缺陷（為常染色體隱性遺傳?。?；促甲狀腺激素缺陷與甲狀腺或靶器官反應(yīng)低下所致者少見(jiàn)。目前繼發(fā)感染致甲狀腺功能低下者增多。如何判斷一個(gè)新生兒的黃疸是病理的：1生后24h小時(shí)內(nèi)出現(xiàn)黃疸2.血清膽紅素足月兒>221umol/L(12.9mg/dL)早產(chǎn)兒>257umol/L(15

57、mg/dL)或每天上升>85umol/L(5mg/dL)3.黃疸持續(xù)時(shí)間足月兒>2周,早產(chǎn)兒>4周4.黃疸退而復(fù)現(xiàn)或加重5.血清結(jié)合膽紅素聞>34umol/L(2mg/ dL)具備上述任何一條均可診斷定性.雞胸：佝僂病時(shí)，由于肋骨向胸部?jī)?nèi)陷，致使胸骨向外突出形成雞胸。漏斗胸：何僂病時(shí)，由于肋骨跟部?jī)?nèi)陷，致使胸骨向內(nèi)凹陷，可形成漏斗胸。胎糞栓綜合征：由于濃縮稠厚的胎糞積聚在直腸內(nèi)，形成膠胨樣胎糞栓，不能將其排出。少尿：新生兒生后48小時(shí)正常尿量一般每小時(shí)為1-3ml/kg，每小時(shí)1.0ml/kg為少尿。無(wú)尿：新生兒生后48小時(shí)正常尿量一般每小時(shí)為1-3ml/kg，每小時(shí)0

58、.5ml/kg為無(wú)尿。腎病綜合征：是由于腎小球?yàn)V過(guò)膜的通透性增高，導(dǎo)致大量血漿白蛋白自尿中丟失而引起一種臨床癥狀，以大量蛋白尿低白蛋白血癥、高脂肪血癥和不同程度水腫為特征。驚厥：是全身或局部骨骼肌突然發(fā)生不自主收縮，常伴意識(shí)障礙。計(jì)劃免疫： 有計(jì)劃地對(duì)小兒進(jìn)行各種預(yù)防接種，以提高人群免疫水平，達(dá)到控制和消滅傳染病的目的。圍生期： 指出生前、后的一個(gè)特定時(shí)期，我國(guó)將圍生期定義為自妊娠28周至出生后7天。新生兒肺透明膜?。憾喟l(fā)生于早產(chǎn)兒是由于缺乏肺表面活性物質(zhì)所引起。 新生兒窒息：是指嬰兒出生時(shí)天呼吸或呼吸抑制者，若出生時(shí)無(wú)窒息，而每分鐘后出呼吸抑制者也稱(chēng)為窒息。 胎糞吸入綜合征：是指胎兒在宮內(nèi)或娩出過(guò)程中被胎糞污染的羊水，發(fā)生氣道阻塞，肺內(nèi)尿癥和一系列全身癥狀，多見(jiàn)于足月兒和過(guò)期產(chǎn)兒。新生兒敗血癥：是指病原菌侵入嬰兒血循環(huán)，在其中生長(zhǎng)、繁殖、產(chǎn)生素素，由此造成全身各系統(tǒng)的嚴(yán)重病變，并需排除引起這種異常病理生理狀態(tài)的非感染因素。肺門(mén)舞蹈：肺血增多的先心病，X線檢查可發(fā)現(xiàn)肺蛋炎充血，肺動(dòng)脈段突出，肺門(mén)血管影增粗。因此，肺門(mén)搏動(dòng)強(qiáng)烈，稱(chēng)肺門(mén)舞蹈病。肋骨串珠：佝僂病時(shí)肋骨與肋軟骨交界處，由于骨樣組織增生，可觸及或看到增球狀隆起，多見(jiàn)于第4肋以下，第710最顯著，上下排列成患珠樣，稱(chēng)為肋骨串珠。 三凹征：