问题 问答题

患者女性,58岁,已婚。12岁时反复多次咽喉肿痛后出现膝、距小腿、腕等大关节游走性疼痛,此种情况曾反复发作多次。26岁进行婚前体检时,其心尖区闻及收缩期杂音,近5年来在活动后有心悸、气促,近3年病情加重,并有四肢水肿,夜尿,呼吸困难、咳粉红色泡沫痰。请回答以下问题:

26岁后患的是什么病请简述其发展过程及病变,并用器官的病变解释以下临床表现:心悸、气促、咳粉红色泡沫痰、四肢水肿。

答案

参考答案:26岁后患的是风湿性心脏病、二尖瓣狭窄、合并左心衰和右心衰。风湿反复发作可引起风湿性心内膜炎,病变后期,瓣膜增厚、变硬、瓣叶相互黏连,成为慢性心瓣膜病。出现二尖瓣狭,左心房代偿性肥大。疾病后期,左心房淤血,肺静脉回流受阻,导致肺淤血,左心衰竭,患者可呼吸困难、咳粉红色泡沫痰。由于肺淤血,肺静脉压升高,通过神经反射性引起肺内小动脉收缩,使肺动脉血压升高。长期肺动脉高压使右心室代偿性扩张、肥大,最终导致右心衰竭,发生体循环淤血。患者可出四肢水肿,夜尿。

单项选择题
单项选择题

Lying in the sun on a rock, the cougar saw Jeb and his son, Tom, before they saw it. Jeb put his bag down quickly and pulled his jacket open with both hands, making himself look big to the cougar. It worked. The cougar hesitated, ready to attack Jeb, but ready to forget the whole thing, too.
Jeb took off his jacket, grasped Tom and held him across his body, making a cross. Now the cougar’s enemy looked even bigger, and it rose up, ready to move away, but unfortunately Tom got scared and struggled free of Jeb.
"Tom, No !" shouted his father.
But Tom broke and ran and that’s the last thing you do with a cougar. The second Tom broke free, Jeb threw himself on the cougar, just as it jumped from the rock. They hit each other in mid air and both fell. The cougar was on Jeb in a flash, forgetting about Tom, which was what Jeb wanted. Cougars are not as big as most people think and a determined man stands a chance, even just with his fists. As the cougar’s claws got into his left shoulder, Jeb swung his fist at its eyes and hit hard. The animal howled(吼叫) and put its head back. Jeb followed up with his other fist. Then out of the corner of his eye, Jeb saw Tom. The boy was running back to help his father.
"Knife, Tom," shouted Jeb.
The boy ran to his father’s bag, while Jeb started shouting as well as hitting, to keep the cougar’s attention away from Tom. Tom got the knife and ran over to Jeb. The cougar was moving its head in and out, trying to find a way through the wall. Jeb was making out of his arms. Tom swung with the knife, into the cougar’s back. It howled horribly and ran off into the mountains.

What do we know about cougars

A.They are afraid of noises.
B.They hesitate before they hit.
C.They are bigger than we think.
D.They like to attack running people.