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锥体束病理反射(Babinski征、Oppenheim征、Gordon征)(18分)
(1)Babinski征(6分)
①检查方法正确:用竹签沿患者足底外侧缘,由后向前至小趾跟部并转向内侧。(4分)
②考生口述阳性反射特征:(2分)阳性反应为足母趾背伸,余趾呈扇形展开。
(2)Oppenheim征(5分)

①检查方法正确:检查者用拇指及示指沿被检者胫骨前缘用力由上向下滑压。(4分)
②考生口述阳性反射特征:(1分)阳性反应为足母趾背伸,余趾呈扇形展开。
(3)Gordon征(5分)
①检查方法正确:检查时用手以一定力量捏压被检者腓肠肌中部。(4分)
②考生口述阳性反射特征:阳性反应为足母趾背伸,余趾呈扇形展开。
(4) 提问(3个,由考官任选2个)(2分)
①一侧锥体束征阳性考虑什么?二侧锥体束征阳性考虑什么?(1分)
答:一侧阳性考虑锥体束受损或更高位中枢病变。双侧阳性为下运动神经传导通路病变致双侧都失去高位中枢的抑制而出现,注意1岁内小儿可以锥体束征阳性。
②正常人能否出现Babinski征(+)?(1分)
答:1岁半前儿童可出现,余为异常。
③当一侧肢体锥体束征(+)时,还需做什么体征检查?(1分)
答:检查对侧锥体束征,还有其它体征检查如运动和感觉等检查,定性定位评估病变位置。
     
 
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