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1、神经内科出科考核(英文)神经内科出科考核(英文)住院医师出科试题（神经内科）姓名：时间：一、英译中（70分）：StrokeisthethirdmostcommoncauseofdeathintheUnitedstatesandthemostcommondisablingneurologicdisorder.About750,000newstrokesoccurandabout150,000peoplediefromstrokeintheUnitedstateseachyear.Theincidenceincreaseswithage,withabouttwo-thirdsofallstroke
2、soccuringinthoseoverage65years,andissomewhathigherinmenthaninwomenandinAfrican-Amerricansthaninwhites.Riskfactorsforstrokeincludesystolicordiastolichypertension,hypercholesterolemia,cigarettesmoking,heavyalcoholconsumption,andoralcontraceptiveuse.Theincidenceofstrokehasdecreasedinrecentdecades,large
3、lybecauseofimprovedtreatmentofhypertension.Strokeisasyndromecharacterizedbytheacuteonsetofaneurologicdeficitthatpersistsforatleast24hours,reflectsfocalinvolvementofthecentralnervoussystem,andistheresultofadisturbanceofthecerebralcirculation.Theacuteonsetandsubsequentdurationofsymptomsaredocumentedby
4、thehistory.Thesiteofcentralnervoussysteminvolvementissuggestedbythenatureofthesymptoms.Itisdelineatedmorepreciselybytheneurologicexaminationandconfirmedbyimagingstudiescomputedtomography(CT)scansormagneticresonanceimaging(MRI).Avascularetiologymaybeinferredformtheacuteonsetofsymptomsandoftenfromthep
5、atientsage,thepresenceofriskfactorsforstroke,andtheoccurrenceofsymptomsandsignsreferabletotheterritoryofaparticularcerebralbloodvessel.Whenthisisconfirmedbyimagingstudies,furtherinvestigationscanbeundertakentoidentifyaspecificcause.Resttremorusuallyhasafrequencyof4-6Hzandischaracteristicofparkinsoni
6、smwhetherthedisorderisidiopathicorsecondary(ie.postencephalitic,toxic,ordrug-inducedinorigin).Therateofthetremor,itsrelationshiptoactivity,andthepresenceofrigidityorhypokinesiausuallydistinguishthetremorofparkinsonismfromotherformsoftremor.Tremorinthehandsmayappearasa“pill-rolling”maneuverthythmic,o
7、pposingcircularmovementsofthethumbandindexfinger.Theremaybealternatingflexionandextensionofthefingersorhand,oralternatingpronationandsupinationoftheforearm;inthefeet,rhythmicalternatingflexionandextensionarecommon.二、中译英（30分）纯运动性轻偏瘫面部、上肢和下肢受累程度相同，但无感觉、视觉或言语障碍。如果示腔梗所致，病变常位于对侧内囊或桥脑。纯运动性轻偏瘫也可由颈内动脉或大脑中动脉
8、闭塞、硬膜下血肿或颅内占位性病变引起。扩展阅读：神经内科出科考核(中文)住院医师出科试题（神经内科）姓名：时间：一、名词解释（每题5分，共25分）1、阿罗瞳孔；2、三偏综合征；3、真性球麻痹；4、短暂性全面性遗忘；5、癫痫持续状态；二、简答题（共25分）1、简述上运动神经元损害特点；2、晕厥与癫痫发作的鉴别要点；3、重症肌无力的分型（Osserman分型）。三、病例分析（每题25分，共50分）1、男，60岁，因右侧肢体无力1小时入急诊室，一小时前看电视时突然倒地，右侧肢体无力，意识清楚，不能言语，常用左手触摸左侧头部，立即被送来急诊室。查体：血压210/90mmHg，意识清楚，运动性失语，右侧
9、上级性面瘫，伸舌偏右，右上、下肢肌力3级，右侧腱反射活跃，右侧Babinski征（+），右半身痛觉减退，余神经系统检查不能合作。请讨论定位及定性诊断，并提出进一步检查及治疗方案。2、50岁，男，下班骑自行车20分钟回家，即感头痛，继而呕吐，伴右侧上、下肢不能活动，立即送来急诊。查体：BP23/18Kpa，P20次/分，神志恍惚，眼底动脉变细，双瞳等大约3mm，光反射正常，右侧面部及右侧偏身感觉减退，右侧鼻唇沟变浅，伸舌偏右，右侧上、下肢肌张力增高，肌力I-II度，腱反射活跃，右侧Babinski征（+），右侧Chaddock征（+），左侧正常。请讨论定位定性诊断及进一步检查和治疗方案。第 4 页 共 4 页