问题 问答题

论述复发性口疮的诊断与鉴别诊断。

答案

参考答案:复发性口疮的诊断要点:① 具有较明显的复发规律性,间歇期长短不等,有自限性,损害一般在1~2周内逐渐愈合,但腺周口疮愈合缓慢,可达数月之久。② 损害类型a. 轻型:一个或几个小溃疡,直径为2~4 mm左右。凡接近口角与唇吻合缘等处的损害易发生感染,故表面常呈致密的灰白色假膜。b. 重型:深在性的大溃疡,直径约10 mm,呈紫红或暗红色,边缘不规则隆起,中央凹陷,触诊时呈浅表性坚韧感,但基底无硬结。愈合缓慢,常可达数月之久。c. 疱疹样型:损害形态同轻型,但数量明显增加,可从十几个至几十个不等,散在性分布于角化较差区域。往往同时伴有发热、困倦、淋巴结肿大等症状。鉴别诊断:① 癌性溃疡:老年多发;好发于舌腹舌缘、口角区、软腭复合体;溃疡深或浅,浸润生长,周边硬,边缘不整齐,底部菜花状;病理显示细胞癌变;患者体弱或有恶病质;无自限性。② 结核性溃疡:中青年多发;好发于唇、前庭沟、牙槽黏膜;溃疡深在,周围轻度浸润呈鼠噬状,底部有肉芽组织;病理可见朗格汉斯巨细胞;患者有肺结核体征;无自限性。③ 创伤性溃疡:有创伤史;好发于唇、颊、舌、颊脂垫尖;溃疡形态多与损伤因素切合,周围炎症不明显,底部可有肉芽组织;病理检查为慢性炎症;患者全身状况好;溃疡无自限性。④ 坏死性涎腺化生:男性多发;好发于硬腭、软硬腭交界处;溃疡深及骨面,周围清楚、充血,边缘可隆起,底部有肉芽组织;病理显示小涎腺坏死;患者全身状况较好或弱;溃疡有自限性。

阅读理解

If you want to teach your children how to say sorry, you must be good at saying it yourself, especially to your own children. But how you say it can be quite tricky.  If you say to your children "I'm sorry I got angry with you, but …" what follows that "but" can make the apology ineffective: "I had a bad day" or "your noise was giving me a headache " leaves the person who has been injured feeling that he should be apologizing for his bad behavior in expecting an apology.

Another method by which people appear to apologize without actually doing so is to say "I'm sorry you're upset"; this suggests that you are somehow at fault for allowing yourself to get upset by what the other person has done.

Then there is the general, all covering apology, which avoids the necessity of identifying a specific act that was particularly hurtful or insulting, and which the person who is apologizing should promise never to do again. Saying "I'm useless as a parent" does not commit a person to any specific improvement.

These pseudo(假的)-apologies are used by people who believe saying sorry shows weakness. Parents who wish to teach their children to apologize should see it as a sign of strength, and therefore not resort to these pseudo-apologies.

But even when presented with examples of contrition(悔悟), children still need help to become aware of the complexities of saying sorry. A three-year-old boy might need help in understanding that other children feel pain just as he does, and that hitting a playmate over the head with a heavy toy requires an apology. A six-year-old boy might need reminding that spoiling other children's expectations can require an apology. A 12-year-old might need to be shown that taking the biscuit tin without asking permission is acceptable, but that borrowing a parent's clothes without permission is not.

1. If a mother adds "but" to an apology, _______.

A. she doesn't feel that she should have apologized

B. she does not realize that the child has been hurt

C. the child may find the apology easier to accept

D. the child may feel that he owes her an apology

2. According to the author, saying "I'm sorry you're upset" most probably means "_______".

A. You have good reason to get upset

B. I'm aware you're upset, but I'm not to blame

C. I apologize for hurting your feelings

D. I'm at fault for making you upset

3. It is not advisable to use the general, all-covering apology because _______.

A. it gets one into the habit of making empty promises

B. it may make the other person feel guilty

C. it is vague and ineffective

D. it is hurtful and insulting

4. We learn from the last paragraph that in teaching children to say sorry _______.

A. the complexities involved should be ignored

B. their ages should be taken into thinking

C. parents need to set them a good example

D. parents should be patient and tolerant

5. It can be inferred from the passage that apologizing properly is _______.

A. a social issue calling for immediate attention   B. not necessary among family members

C. a sign of social progress                    D. not as simple as it seems

名词解释