问题 多项选择题 案例分析题

患者女性,48岁。体温37.9℃,关节肿痛5年,加重2个月。血尿酸水平正常,ASO阴性,PPD阴性,抗结核抗体(-)

该患者可能的诊断包括()。

A.类风湿关节炎

B.干燥综合征

C.强直性脊柱炎

D.风湿性关节炎

E.痛风性关节炎

F.骨关节炎

G.骨关节结核

答案

参考答案:A, C, F

解析:

1.该患者关节肿痛5年,就诊时低热,血尿酸水平正常,ASO阴性,PPD阴性,抗结核抗体阴性,因此应首先不考虑干燥综合征、风湿性关节炎、痛风性关节炎和骨关节结核等诊断,而类风湿关节炎、强直性脊柱炎和骨关节炎的可能性均存在

2.患者双手指关节屈曲畸形,应首先考虑类风湿性关节炎,而RF、抗CCP抗体、抗RA33抗体和抗核周因子抗体等自身抗体与类风湿关节炎的发生与发展密切相关。HI。A-B27基因分型主要用于排除强直性脊柱炎。而肥达反应主要用于伤寒的诊断;RPR是梅毒的血清学试验

3.目前的研究显示90%以上的强直性脊柱炎患者HLA-B27DNA阳性

4.抗CCP抗体阳性对类风湿关节炎诊断的特异性高达90%

5.类风湿关节炎患者体内的RF或其他自身抗体与相应靶抗原结合形成免疫复合物,沉积于关节滑膜即可引起类风湿关节炎,因此Ⅲ型超敏反应(免疫复合物型超敏反应)参与了关节肿痛的发生。

6.类风湿关节炎为一种Ⅲ型超敏反应,疾病活动期消耗大量补体,因此血清总补体溶血活性、血清C3和C4水平均可显著降低。血清CRP和ESR在疾病活动期可显著升高。IgA型RF也是类风湿关节炎活动期的指标。IgM型RF是最常见的类风湿因子。

阅读理解

As a young boy, I sometimes traveled the country roads with my dad. He was a rural mill carrier, and on Saturdays he would ask me to go with him. Driving through the countryside was always an adventure: There were animals to see, people to visit, and chocolate cookies if you knew where to stop, and Dad did.

In the spring, Dad delivered boxes full of baby chickens, and when 1 was a boy it was such a fun to stick your finger 'through one of the holes of the boxes and let the baby birds peck on your fingers.

On Dad' s final day of work, it took him well into the evening to complete his rounds because at least one member from each family was waiting at their mailbox to thank him for his friendship and his years of service. "Two hundred and nineteen mailboxes on my route." he used to say, "and a story at every one. " One lady had no mailbox, so Dad took the mail in to her every day because she was nearly blind. Once inside, he read her mail and helped her pay her bills.

Mailboxes were sometimes used for things other than mail. One note left in a mailbox read. "Nat, take these eggs to Marian; she's baking a cake and doesn't have any eggs. " Mailboxes might be buried in the snow, or broken, or lying on the groom:. bat the mail was always delivered On cold days Dad might find one of his customers waiting for him with a cup of hot chocolate. A young wrote letters but had no stamps, so she left a few button on the envelope in the mailbox; Dad paid for the stamps. One businessman used to leave large amounts of cash in his mailbox for Dad to take to the bank. Once, the amount came to 8 32,000.

A dozen years ago, when I traveled back to my hometown on the sad occasion of Dad’s death,  the mailboxes along the way reminded me of some of his stories. I thought I knew them all, but that wasn't the case.

As I drove home, I noticed two lamp poles, one on each side of the street. When my dad was around, those poles supported wooden boxes about four feet off the ground. One box was painted green and the other was red, and each had a long narrow hole at the top with white lettering: SANTA CLAUS, NORTH POLE. For years children had dropped letters to Santa through those holes.

I made a turn at the comer and drove past the post office and across the railroad tracks to our house. Mom and I were sitting at the kitchen table when I heard footsteps. There, at the door, stood Frank Townsend, Dad's postmaster and great friend for many years. So we all sat down at the table and began to tell stories.

At one point Frank looked at me with tears in his eyes. " What are we going to do about the letters this Christmas?" he asked.

"The letters?"

'I guess you never knew. "

"Knew what?"

" Remember, when you were a kid and you used to put your letters to Santa in those green and red boxes on Main Street? It was your dad who answered all those letters every year. "

I just sat there with tears in my eyes. It wasn’t hard for me to imagine Dad sitting at the old table in our basement reading those letters and answering each one. I have since spoken with several of the people who received Christmas letters during their childhood, and they told me how amazed they were that Santa had known so much about their homes and families.

For me, just knowing that story about my father was the gift of a lifetime.

小题1:It can be inferred from the passage that the writer regarded his travels with Dad us_____.

A.great chances to help other people

B.happy occasions to play with baby chickens

C.exciting experience* with a lot of fun

D.good opportunities to enjoy chocolate cookies小题2:The writer provides the detail about the businessman to show that_____.

A.Dad had a strong sense of duty

B.Dad was an honest and reliable man

C.Dad had a strong sense of honor

D.Dad was a kind and generous man小题3:According to the passage, which of the following impressed the writer most?

A.Dad read letters for a blind lady for years.

B.Dad paid for the stamps for a young girl.

C.Dad delivered some eggs to Marian.

D.Dad answered children's Christmas letters every year.小题4:The method the writer uses to develop Paragraph 4 is______.

A.offering analyses

B.providing explanations

C.giving examples

D.making comparisons小题5:What surprised the children most when they received letters in reply from Santa Claus every year?

A.Santa Claus lived alone in the cold North Pole.

B.Santa Claus answered all their letters every year.

C.Santa Claus had unique mailboxes for the children.

D.Santa Claus had so much information about their families.小题6:Which of the following is the best title for the passage?

A.The Mail

B.Christmas Letters

C.Special Mailboxes

D.Memorable Travels

填空题