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患者女，23岁，学生。间歇发热4年，伴心悸、气促2年。查体：体温38.1℃，脉搏120次/min，血压110/70mmHg。急性病容、全身皮肤有多处出血斑及出血点。两侧扁桃体肿大，两肺湿性啰音，心尖区可闻及双期杂音，肝下缘位于右锁骨中线肋下2.5cm处，脾未触及，肾区叩压痛（+），两下肢水肿，血WBC9.8×10／L，中性粒细胞0.84，淋巴细胞0.16。

明确诊断应进行的检查项目包括（）

A.血培养

B.甲状腺激素

C.超声心动图

D.ASO

E.胸部X线

F.动脉血气分析

答案

参考答案：A, C

问答题

Where one stage of child development has been left out, or not sufficiently experienced, the child may have to go back and capture the experience of it. A good home makes this possible, for example by providing the opportunity for the child to play with a clockwork car or toy railway train up to any age if he still needs to do so. (46)This principle, in fact, underlies all psychological treatment of children in difficulties with their development, and is the basis of work in child clinics.
The beginnings of discipline are in the nursery. Even the youngest baby is taught by gradual stages to wait for food, to sleep and wake at regular intervals and so on. If the child feels the world around him is a warm and friendly one, he slowly accepts its rhythm and accustoms himself to conforming to its demands. (47)Learning to wait for things, particularly for food, is a very important element in upbringing, and is achieved successfully only if too great demands are not made before the child can understand them.
Every parent watches eagerly the child’s acquisition of each new skill — the first spoken words, the first independent steps, or the beginning of reading and writing. (48)It is often tempting to hurry the child beyond his natural learning rate, but this can set up dangerous feeling of failure and states of anxiety in the child. This might happen at any stage. A baby might be forced to use a toilet too early; a young child might be encouraged to learn to read before he knows the meaning of the words he reads. (49)On the other hand, though, if a child is left alone too much, or without any learning opportunities, he loses his natural zest for life and his desire to find out new things for himself.
Learning together is a fruit source of relationship between children and parents. By playing together, parents learn more about their children and children learn more from their parents. Toys and games which both parents and children can share are an important means of achieving this co-operation. Building-block toys, jigsaw puzzles and crossword are good examples.
Parents vary greatly in their degree of strictness or indulgence towards their children. Some may be especially strict in money matters; others are severe over times of coming home at night, punctuality for meals or personal cleanliness. (50)In general, the controls imposed represent the needs of the parents and the values of the community as much as the child’s own happiness and well-being.
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单项选择题

初产妇，21岁，妊娠38周，双胎妊娠，第二胎儿娩出后10分钟，突然多量 * * 流血，血暗红。本例 * * 流血最可能的原因是

A．胎盘剥离不全
B．凝血功能障碍
C．胎盘植入
D．子宫收缩乏力
E．软产道裂伤
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