阿摩線上測驗
3.70歲男性病人，過去病史有高血壓及B型肝炎，最近3個月因活動時呼吸氣促而逐漸臥床，身體診察時發現病人端坐時比平躺時更覺得胸悶吸不到氣，下列身體診察何者對確定診斷最沒有幫助？
(A)Castell's sign
(B)abdominal shifting dullness
(C)diastolic rumbling heart murmur
(D)right ventricle heave
(A)Castell's sign
(B)abdominal shifting dullness
(C)diastolic rumbling heart murmur
(D)right ventricle heave
統計： A(158), B(211), C(166), D(304), E(0) #2866421
詳解 (共 9 筆)
個人覺得這題怪怪的
題目問說何者對「確定診斷」最沒有幫助
Hepatopulmonary syndrome的主要是Liver cirrhosis引起的，所以包括Ascites(Shifting dullness)、Splenomegaly(Castell's sign)、RV hypertrophy(RV heave)都是合理的。
Diastolic rumbling murmur則更像是mitral stenosis的描述，不過題目也沒有給位置。
大家可以參照下面這篇paper
http://www.annalsgastro.gr/files/journals/1/earlyview/2020/ev-04-2020-07-AG4818-0474.pdf
??
Platypnea–orthodeoxia syndrome (POS) is distinguished by breathlessness that is alleviated when lying down and is exacerbated when sitting or standing up. It is the opposite of orthopnea and is characterized by a decrease in blood oxygen saturation in the passage from supine position to orthostatism.
Cardiac cirrhosis is a term used to include the spectrum of hepatic disorders that occur secondary to hepatic congestion due to cardiac dysfunction, especially the right heart chambers. This condition may present with symptoms such as shortness of breath, paroxysmal nocturnal dyspnea, orthopnea, and leg swelling.
此題病人呼吸不穩定!以身體評估來診斷:
若以本題來看ABC選項, 其病理生理明確和併發症嚴重! 須嚴陣以待治療處理!
A parasternal heave, lift, or thrust is a precordial impulse that may be felt (palpated) in patients with cardiac or respiratory disease. Precordial impulses are visible or palpable pulsations of the chest wall, which originate on the heart or the great vessels.
而造成D的原因很多! 還需釐清鑑別!
