急诊医学专业英语

第1页共3页DalianMedicalUniversity大连医科大学硕士研究生试卷2010年级专业外语试卷学号姓名命题单位：大医二院教研室：急诊医学教研室主任审核签字：阅卷人：一二三四五总分分数英译汉：EmergencyDiagnosisandAssessmentofICHandItsCausesRapidrecognitionanddiagnosisofICHareessentialbecauseofitsfrequentlyrapidprogressionduringthefirstseveralhours.Theclassicclinicalpresentationincludestheonsetofasuddenfocalneurologicaldeficitwhilethepatientisactive,whichprogressesoverminutestohours.Thissmoothsymptomaticprogressionofafocaldeficitoverafewhoursisuncommoninischemicstrokeandrareinsubarachnoidhemorrhage.HeadacheismorecommonwithICHthanwithischemicstroke,althoughlesscommonthaninsubarachnoidhemorrhage.VomitingismorecommonwithICHthanwitheitherischemicstrokeorsubarachnoidhemorrhage.Increasedbloodpressureandimpairedlevelofconsciousnessarecommon.However,clinicalpresentationalone,althoughhelpful,isinsufficienttoreliablydifferentiateICHfromotherstrokesubtypes.TheearlyriskofneurologicaldeteriorationandcardiopulmonaryinstabilityinICHishigh.IdentificationofprognosticindicatorsduringthefirstseveralhoursisveryimportantforplanningthelevelofcareinpatientswithICH.ThevolumeofICHandgradeontheGlasgowComaScale(GCS)onadmissionarethemostpowerfulpredictorsofdeathby30days.Hydrocephaluswasanindependentindicatorof30-daydeathinanotherstudy.Conversely,corticallocation,mildneurologicaldysfunction,andlowfibrinogenlevelshavebeenassociatedwithgoodoutcomesinmediumtolargeICH.BecauseofthedifficultyindifferentiatingICHfromischemicstrokebyclinicalmeasures,emergencymedicinepersonneltriageandtransportpatientswithICHandischemicstroketohospitalssimilarly.Asdescribedbelow,patientswithICHoftenhavegreaterneurologicalinstabilityandriskofveryearlyneurologicaldeteriorationthandopatientswithischemicstrokeandwillhaveagreaterneedforneurocriticalcare,monitoringofincreasedintracranialpressure(ICP),andevenneurosurgicalintervention.Thislevelofcaremayexceedthatavailableatsomehospitals,eventhosethatmeetthecriteriaforprimarystrokecenters.Thus,eachhospitalthatevaluatesandtreatsstrokepatientsshoulddeterminewhethertheinstitutionhastheinfrastructureandphysiciansupportto考生须知1、检查所发试卷是否和自己所报科目一致，试卷有无缺页、漏印、字迹模糊，如有可举手请求换卷。2、必须将自己的学号、姓名、专业班级写在试卷指定位置上。3、在试卷密封线以外填写姓名、学号或写有与答题内容无关的语句和作其它标记的试卷一律作废，后果自负。第2页共3页DalianMedicalUniversitymanagepatientswithmoderate-sizedorlargeICHsorhasaplantotransferthesepatientstoatertiaryhospitalwiththeappropriateresources.InitialclinicaldiagnosticevaluationofICHatthehospitalinvolvesassessmentofthepatient’spresentingsymptomsandassociatedactivitiesatonset,timeofstrokeonset,age,andotherriskfactors.Thepatientorwitnessesarequestionedabouttrauma;hypertension;priorischemicstroke,diabetesmellitus,smoking,useofalcoholandprescription,over-thecounter,orrecreationaldrugssuchascocaine;useofwarfarinandaspirinorotherantithrombotictherapy;andhematologicdisordersorothermedicaldisordersthatpredisposetobleeding,suchassevereliverdisease.Thephysicalexaminationfocusesonlevelofconsciousnessanddegreeofneurologicaldeficitafterassessmentofairway,breathing,circulation,andvitalsigns.Inseveralretrospectivestudies,elevatedsystolicbloodpressure_160mmHgonadmissionhasbeenassociatedwithgrowthofthehematoma,butthishasnotbeendemonstratedinprospectivestudiesofICHgrowth.Fever_37.5°Cthatpersistsfor_24hoursisfoundin83%ofpatientswithpooroutcomesandcorrelateswithventricularextensionofthehemorrhage.Brainimagingisacrucialpartoftheemergentevaluation.Computedtomography(CT)andmagneticresonancescansshowequalabilitytoidentifythepresenceofacuteICH,itssizeandlocation,andhematomaenlargement.Deephemorrhagesinhypertensivepatientsareoftenduetohypertension,whereaslobarhemorrhagesinnonhypertensiveelderlypatientsareoftenduetocerebralamyloidangiopathy;however,asubstantialnumberoflobarhemorrhagesinhypertensivepatientsmaybeduetohypertension,andbothdeepandsuperficialhemorrhagesmaybecausedbyvascularabnormalitiesandothernonhypertensivecauses.CTmaybesuperioratdemonstratingassociatedventricularextension,whereasmagneticresonanceimaging(MRI)issuperioratdetectingunderlyingstructurallesionsanddelineatingtheamountofperihematomaledemaandherniation.ACTscanwithcontrastmayidentifyanassociatedaneurysm,arteriovenousmalformation,ortumor.CTangiographymayprovideadditionaldetailinpatientswithsuspectedaneurysmorarteriovenousmalformation.CThasalsoclarifiedthenaturalhistoryofICH.OneprospectivestudyofspontaneousICHinthemid-1990sdemonstratedthatanincreaseinvolumeof_33%isdetectableonrepeatedCTexaminationin38%ofpatientsinitiallyscannedwithin3hoursafteronset.IntwothirdsofcaseswithgrowthinvolumeofICH,thisincreasewasevidentwithin1hour.GrowthofthevolumeofICHwasassociatedwithearlyneurologicaldeterioration.Hematomagrowthisassociatedwithanearly5-foldincreaseinclinicaldeterioration,pooroutcome,anddeath.ThelobarlocationofICHincreasestheriskoflong-termrecurrencebyafactorof3.8.MRIperformsaswellasCTinidentifyingICH.Inonemulticenterstudyofacutestrokewithin6hoursofonset,gradient-echoMRIwasasaccurateasCTfortheidentificationofacutehemorrhageandmoreaccurateforidentificationofchronichemorrhage.Inanotherunder-6-hourmulticenterdiagnostictrial,MRIsho