问题 问答题 简答题

支气管哮喘(哮病)(40分)

:高某,男性,10岁。2001年10月9日初诊。

呼吸困难反复发作2年,受凉后再发2小时。患者2年来每因受凉出现鼻痒、喷嚏及流涕,继则呼吸困难,以呼气为主,喉中哮鸣有声,干咳少痰,胸闷,移时自行缓解。近半年来发作较前频繁,平均每月发作1次,未经系统治疗。现患者呼吸困难,喉中哮鸣有声,胸膈满闷,面色晦滞,口渴喜热饮。舌淡红舌苔白滑,脉弦紧。有青霉素、红霉素过敏史。其母幼时有类似病史,已20年未发作。

查体:

T37、8℃,P110次/分,R21次/分,BP130/75mmHg。发育正常,口唇发绀,见三凹征,双肺叩诊呈过清音,满布哮鸣音,心律规整,心率110次/分,未闻及杂音,肝脾未及。

辅助检查:

胸透两肺透亮度增加。1年前查支气管激发试验阳性。IgE:0、05g/L(正常范围0、0001~0、009g/L)。

答题要求:

1、根据上述病例摘要,在答题卡上完成书面辨证论治。

2、鉴别诊断:请与心源性哮喘相鉴别。

答案

参考答案:

主诉:呼吸困难反复发作2年,受凉后再发2小时(1分)

现病史:患者2年来每因受凉出现鼻痒、喷嚏及流涕,继则呼吸困难,以呼气为主,喉中哮鸣有声,干咳少痰,胸闷,移时自行缓解。近半年来发作较前频繁,平均每月发作1次,未经系统治疗。(2分)

既往史:有青霉素、红霉素过敏史(1分)

体格检查:T37、8℃,P110次/分,R21次/分,BP130/75mmHg。发育正常,口唇发绀,见三凹征,双肺叩诊呈过清音,满布哮鸣音,心律规整,心率110次/分,未闻及杂音,肝脾未及。(1分)

辅助检查:胸透两肺透亮度增加。1年前查支气管激发试验阳性。IgE:0、05g/L(正常范围0、0001~0、009g/L)。(1分)

中医辨病辨证依据(含病因病机分析):(5分)

以喉中哮鸣有声,呼吸困难为主症,诊断为哮证。寒痰伏肺,遇感引发,痰升气阻,气道不畅,以致呼吸困难而哮鸣有声。肺气郁闭,不得宣畅,则胸膈满闷。阴盛于内,阳气不能宣达,故面色晦滞。病因于寒,内无郁热,故口渴而喜热饮。舌苔白滑,脉弦紧,皆为寒盛之象。

西医诊断依据:(6分)

1、反复发作的呼吸困难、喘息,伴有胸闷咳嗽,与接触冷空气造成上呼吸道感染有关。

2、发作时双肺可闻及弥漫性、以呼气为主的哮鸣音。

3、上述症状可自行缓解。

4、有本病家族史。

5、支气管激发试验阳性,IgE:0、05g/L(升高)。

鉴别诊断:(4分)

心源性哮喘:常见于左心衰竭,多有高血压、冠心病、风湿性心脏病、二尖瓣狭窄等病史和体征,阵发性咳嗽,可咳吐粉红色泡沫样痰,两肺广泛湿啰音和哮鸣音,心尖部可及奔马律。胸部X线可见心脏增大、肺瘀血等有助于诊断。

诊断:

中医疾病诊断:哮证发作期(2分)

中医证型诊断:寒哮(2分)

西医诊断:支气管哮喘(3分)

中医治法:温肺散寒,化痰平喘。(2分)

方剂:射干麻黄汤加减。(2分)

药物组成、剂量及煎服法:(3分)

射干9g麻黄6g干姜9g细辛3g半夏9g紫菀12g款冬花12g五味子6g生姜3片大枣5枚

三剂,水煎服。日一剂,早晚分服。

西医治疗原则及方法:(5分)

1、脱离变应原。

2、药物治疗:β2受体激动剂、茶碱类、抗胆碱药解痉平喘,糖皮质激素、色苷酸钠、H1受体拮抗剂等抗炎、抗过敏。

3、对症支持,临床健康宣教。

阅读理解

Look carefully at the back of a California state quarter. A man with a walking stick is pictured there. A bird called a California condor(大秃鹫)is flying overhead. Who is this man, and why is he so important that he is featured(处于显著地位)on the back of a coin?

The man on this quarter is John Muir. Even as a child, Muir loved watching nature. As a young man, he spent much of his life exploring the beauty of the wilderness. He walked more than a thousand miles across the country, through fields and woods. John Muir liked writing about the places he visited, describing their beauty.

Muir also wrote about problems. In order to create more farmland for sheep and cattle, many trees were being cut down. This made Muir unhappy and worried, because he knew that trees were important to forests and to the animals that lived in them.Muir believed that nature should be conserved(保护)instead of being changed by human beings. He wrote articles in magazines and newspapers to spread the word about conserving forests. Soon, others began to listen.

Muir wrote letters to important people, such as President Theodore Roosevelt. The president admired Muir’s love for nature. When Roosevelt came to visit Muir in California. Muir convinced(说服)the president to go camping with him for three nights under the trees so they could talk about conservation. Later, President Roosevelt set aside 148 million acres of land for national forests and established(建立)five national parks. National parks are large areas of land that are protected from development. This means that people cannot build homes or businesses there. One of these parks is Yosemite National Park, the area that is featured on the back of the California quarter.

Though it has been almost one hundred years since John Muir died, people continue his work today. His work as a conservationist helped us to see the beauty of our natural world. John Muir made us understand the importance of protecting our earth and our resources---then, now, and for the future.

小题1:Why did President Theodore Roosevelt visit John Muir?

A.Because Roosevelt loved watching nature.

B.Because Roosevelt received letters from John Muir.

C.Because Roosevelt admired John Muir’s love for nature.

D.Because Roosevelt was sad about the problems with farmland.小题2:Why is John Muir featured on the back of a California state quarter?

A.Because he walked over a thousand miles across the country.

B.Because he helped people understand the importance of protecting the natural world.

C.Because he wrote articles to spread the word about conserving forests.

D.Because he once wrote several letters to President Theodore Roosevelt.小题3:What is the writer’s purpose of writing this article?

A.To advise readers to become active conservationists.

B.To make us interested in the story about a great man.

C.To tell us something about an important person in history.

D.To give information about how to conserve the environment.

单项选择题