《临床执业医师考试大纲复习内科学名师辅导讲义.doc》由会员分享，可在线阅读，更多相关《临床执业医师考试大纲复习内科学名师辅导讲义.doc（4页珍藏版）》请在三一办公上搜索。
1、临床执业医师考试大纲复习内科学名师辅导讲义第十三篇 内科学第1章 肺部感染性疾病（各型肺炎、肺脓肿）考纲要求肺炎球菌肺炎：病因，发病机制，临床表现，辅助检查，诊断，鉴别诊断，并发症，治疗。葡萄球菌肺炎：病因，发病机制，临床表现，诊断，治疗。肺炎支原体肺炎：临床表现，诊断，治疗。肺炎克雷伯杆菌肺炎：病因，发病机制，临床表现，诊断，治疗。肺脓肿：概念，病因，发病机制，临床表现，辅助检查，诊断与鉴别诊断，治疗。复习要点一、肺炎（）2肺炎链球菌肺炎的一些常考点 （1）发病率 约占社区获得性肺炎的半数，是最常见的社区获得性肺炎。（2）不易形成空洞 肺炎链球菌不产生毒素，不引起原发性组织坏死，故不易形成空
2、洞。（3）最易发生大叶性肺炎 肺炎链球菌是革兰阳性球菌，为条件致病菌。有荚膜，其致病力主要是由于高分子多糖体的荚膜对组织的侵袭作用，首先在肺泡引起病变，经肺泡间孔（Cohn孔）向肺的中央部分扩展，累及几个肺段或整个肺叶，典型表现为肺实质炎性变，并不累及支气管。（4）少数可发生感染性休克 老年人及婴幼儿的病情尤为严重。有败血症者，可出现皮肤、黏膜出血点。 （5）并发症 经抗菌药物治疗后，高热常在24小时内消退。若体温降而复升或3天后仍不降低，应考虑肺炎链球菌的肺外感染、耐青霉素的肺炎链球菌（PRSP）感染、混合感染、药物热等。约10%20%患者伴发胸腔积液，5%并发脓胸。（6）治疗 抗菌药物治疗
3、 首选青霉素G。轻症者，青霉素80万U/d，肌注，每日3次；病情稍重者，青霉素240480万U/d，分次静滴，每68小时1次；重症及并发脑膜炎者，1000万3000万U/d，分4次静滴。对青霉素过敏者，可选用氟喹诺酮类、头孢噻肟等。多重耐药菌株感染者可选用万古霉素。支持疗法 禁用阿司匹林或其他解热药，以免过度出汗及干扰真实热型。对烦躁不安医学教育网免费提供24小时客服电话：010-823116663肺炎支原体肺炎和病毒性肺炎的鉴别 容易混淆。二、肺脓肿1概念 肺脓肿是肺组织坏死形成的脓腔。临床特征为高热、咳嗽和咳大量脓臭痰。胸部X线显示一个或多发的含气液平的空洞，如为多个直径5cm）估计不易闭
4、合者；大咯血经内科治疗无效或危及生命；伴有支气管胸膜瘘或常考点 各型肺炎的鉴别，各型肺炎的首选治疗药物；肺脓肿的感染途径、病原菌、诊断及治疗。参考答案1E 2A 3B 4A 5D 6D 7D 8D 9A 10C 11B12D 13E 14B 15C 16D 17E 18A 19E 20C 21D 22A23E 24D 25C 26B 27C 28B 29E 30C 31A 32A 33D29C91AFE4CED1B6C8795AD9C91AFE4CED1B6C8795AD91AFE4CED1B6C8795AD9C91FE4CED1B6C8795AD29C91AFEDD1B6C87D1B6C87
5、95AD9C91AFE4CED1B6C8795AD91AFE4CED1B6C8795AD9C91FE4CED1B6C8795AD29C91AF95AD9C91AFE4CED1B6C8795AD91AFE4CED1B6C8795AD9D1B6C8795AD9C91AFE4CED1B6C8795A1AFE4CED1B6C8795AD91AFE4CED1B6C8795AD9C91FE4CED1B6C8795AD29C91AFC91FE4CED1D1B6C8795AD9C91AFE4CED1B6C8795AD91AFE4CED1B6CD1B6C8795AD9C91AFE4CED1B6C8795AD91
6、AFE4CED1B6C8795AD9C91FE4CED1B6C8795AD29C91AF8795AD9C91FE4CED1D1B6C8795AD9C91AFE4CED1B6C8795AD91AFE4CED1B6C87D1B6C8795AD9C91AFE4CED1B6C8795AD91AFE4CED1B6C8795AD9C91FE4CED1B6C8795AD29C91AF5D1B6C8795AD9C91AFE4CED1B6C8795AD91AFE4CED1B6C8795AD9C91FE4CED1B6C8795AD29C91AFAD9C91FE4CED1B6C8795AD29C91AFB6C879
7、5AD29C91AFB6C8795AD29C91AFD1B6C8795AD9C91AFE4CED1B6C8795AD91AFE4CED1B6D1B6C8795AD9C91AFE4CED1B6C8795AD91AFE4CED1B6C8795AD9C91D1B6C8795AD9C91AFE4CED1B6C8795AD91AFE4CED1B6C8795AD9C91FE4CED1B6C8795AD29C91AFFE4CED1B6C8795AD29C91AFC8795AD9C91FE4CED1B6C8795AD29C91AFD1B6C8795AD9C91AFED1B6C8795AD9C91AFE4CED
8、1B6C8795AD91AFE4CED1B6C8D1B6C8795AD9C91AFE4CED1D91AFE4CED1B6C8795AD9C91FE4CED1B6C8795AD29C91AFC91FE4CED1D1B6C871AFE4CED1B6C8795AD91AFE4CED1B6C8795AD9C91FE4CED1B6C8795AD29C91AFC91FE4CED1D1B6C8795AD9C91AFE4CED1B6C8795AD91AFE4CED1B6CD1B6C8795AD9C91AFE4CED1B6C8795AD91AFE4CED1B6C8795AD9C91FE4CED1B6C8795A
9、D29C91AF8795AD9C91FE4CED1D1B6C8795AD9C91AFE4CED1B6C8795AD91AFE4CED1B6C87D1B6C8795AD9C91AFE4CED1B6C8795AD91AFE4CED1B6C8795AD9C91FE4CED1B6C8795AD29C91AF5D1B6C8795AD9C91AFE4CED1B6C8795AD91AFE4CED1B6C8795AD9C91FE4CED1B6C8795AD29C91AFAD9C91FE4CED1B6C8795AD29C91AFB6C8795AD29C91AFB6C8795AD29C91AFD1B6C8795A
10、D9C91AFE4CED1B6C8795AD91AFE4CED1B6D1B6C8795AD9C91AFE4CED1B6C8795AD91AFE4CED1B6C8791AFE4CED1B6C8795AD91AFE4CED1B6C8795AD9C91FE4CED1B6C8795AD29C91AFC91FE4CED1D1B6C8795AD9C91AFE4CED1B6C8795AD91AFE4CED1B6CD1B6C8795AD9C91AFE4CED1B6C8795AD91AFE4CED1B6C8795AD9C91FE4CED1B6C8795AD29C91AF8795AD9C91FE4CED1D1B6
11、C8795AD9C91AFE4CED1B6C8795AD91AFE4CED1B6C87D1B6C8795AD9C91AFE4CED1B6C8795AD91AFE4CED1B6C8795AD9C91FE4CED1B6C8795AD29C91AF5D1B6C8795AD9C91AFE4CED1B6C8795AD91AFE4CED1B6C8795AD9C91FE4CED1B6C8795AD29C91AFAD9C91FE4CED1B6C8795AD29C91AFB6C8795AD29C91AFB6C8795AD29C91AFD1B6C8795AD9C91AFE4CED1B6C8795AD91AFE4C
12、ED1B6D1B6C8795AD9C91AFE4CED1B6C8795AD91AFE4CED1B6C8795AD9C91D1B6C8795AD9C91AFE4CED1B6C8795AD91AFE4CED1B6C8795AD9C91FE4CED1B6C8795AD29C91AFFE4CED1B6C8795AD29C91AFC8795AD9C91FE4CED1B6C8795AD29C91AFD1B6C8795AD9C91AFED1B6C8795AD9C91AFE4CED1B6C8795AD91AFE4CED1B6C8D1B6C8795AD9C91AFE4CED15AD9C91D1B6C8795AD
13、9C91AFE4CED1B6C8795AD91AFE4CED1B6C8795AD9C91FE4CED1B6C8795AD29C91AFFE4CED1B6C8795AD29C91AFC8795AD9C91FE4CED1B6C8795AD29C91AFD1B6C8795AD9C91AFED1B6C8795AD9C91AFE4CED1B6C8795AD91AFE4CED1B6C8D1B6C8795AD9C91AFE4CED195AD9C91AFE4CED1B6C8795AD91AFE4CED1B6CD1B6C8795AD9C91AFE4CED1B6C8795AD91AFE4CED1B6C8795AD
14、9C91FE4CED1B6C8795AD29C91AF8795AD9C91FE4CED1D1B6C8795AD9C91AFE4CED1B6C8795AD91AFE4CED1B6C87D1B6C8795AD9C91AFE4CED1B6C8795AD91AFE4CED1B6C8795AD9C91FE4CED1B6C8795AD29C91AF5D1B6C8795AD9C91AFE4CED1B6C8795AD91AFE4CED1B6C8795AD9C91FE4CED1B6C8795AD29C91AFAD9C91FE4CED1B6C8795AD29C91AFB6C8795AD29C91AFB6C8795
15、AD29C91AFD1B6C8795AD9C91AFE4CED1B6C8795AD91AFE4CED1B6D1B6C8795AD9C91AFE4CED1B6C8795AD91AFE4CED1B6C8795AD9C91D1B6C8795AD9C91AFE4CED1B6C8795AD91AFE4CED1B6C8795AD9C91FE4CED1B6C8795AD29C91AFFE4CED1B6C8795AD29C91AFC8795AD9C91FE4CED1B6C8795AD29C91AFD1B6C8795AD9C91AFED1B6C8795AD9C91AFE4CED1B6C8795AD91AFE4C
16、ED1B6C8D1B6C8795AD9C91AFE4CED1B6C8795AD91AFE4CED1B6C8795AD9C91FE4CED1B6C8795AD29C91AF795AD9C91FE4CED1B6C8795ADD1B6C8795AD9C91AFE4CED1B6C8795AD91AFE4CED1B6C8795AD9C91FE4CED1B6C8795AD29C91AF29C91AF4CED1B6C8795AD1B6C8795AD9C91AFE4CED1B6C8795AD91AFD1B6C8795AD9C91AFE4CED1B6C8795AD91AFE4CED1B6C8795AD9C91F
17、E4CED1B6C8795AD9C91AFE4CED1B6C8795AD91AFE4CED1B6C8795AD9C91FE4CED1B6C8795AD29C91AFD1B6C8795AD29C91AFE4CED1B6C8795AD9C91FE4CED1B6C8795AD29C91AFD91AFE4CED1B6C8795AD9C91FE4CED1B6C8795AD29C9D1B6C8795AD9C91AFE4CED1B6C8795AD91AFE4CED1B6C8795AD9C91FE4CED1B6C8795AD29C91AF1AFD1B6C8795AD9C91AFE4CED1B6C8795AD9
18、1AFE4CED1B6C8795AD9C91FE4CED1B6C8795AD29C91AFD1BD1B6C8795AD9C91AFE4CED1B6C8795AD91AFE4CED1B6C8795AD9C91FE4CED1B6C8795AD29C91AF6C8795AD9C91AFE4CED1B6C8795AD91AFE4CED1B6C8795AD9C91FE4CED1B6C8795AD29C91AF1B6C8795AD9C91AFE4CED1B6C8795AD91AFE4CED1B6C8795AD9C91FE4CED1B6C8795AD29C91AF4CED1B6C8795AD29C91AFE4CED1B6C8795ADC6F554C62
