问题 问答题

急性黄疸型肝炎 [病例摘要] 男性,15岁,因发热、食欲减退、恶心2周,皮肤黄染1周来诊患者2周前无明显诱因发热达38℃,无发冷和寒战,不咳嗽,但感全身不适、乏力、食欲减退、恶心、右上腹部不适,偶尔呕吐,曾按上感和胃病治疗无好转。1周前皮肤出现黄染,尿色较黄,无皮肤搔痒,大便正常,睡眠稍差,体重无明显变化。既往体健,无肝炎和胆石症史,无药物过敏史,无输血史,无疫区接触史。查体:T37.5℃,P80次/分,R20次/分,Bp120/75mmHg,皮肤略黄,无出血点,浅表淋巴结末触及,巩膜黄染,咽(-),心肺(-),腹平软,肝肋下2cm,质软,轻压痛和叩击痛,脾侧位刚及,腹水征(-),下肢不肿。化验:血Hb126g/L,WBC5.2×109/L,N65%,L30%,M5%,plt200×109/L,网织红细胞1.0%,尿蛋白(-),尿胆红素(+),尿胆原(+),大便颜色加深,隐血(-),要求:根据以上病历摘要,请写出初步诊断、诊断依据(如有两个以上诊断,应分别写出各自诊断依据,未分别写出扣分)、鉴别诊断、进一步检查与治疗原则。

答案

参考答案:

一、诊断及诊断依据(8分)

(一)诊断黄疸原因待查:急性黄疸型肝炎可能性大4分

(二)诊断依据1.发热、全身不适、乏力、食欲减退、恶心呕吐、右上腹不适等黄疸前期表现,1周后出现黄疸2.查体发现皮肤、巩膜黄染,肝脾肿大,肝区有压痛和叩击痛3.验尿:胆红素及尿胆原均阳性1分

二、鉴别诊断(5分)1.鉴别黄疸型肝炎的类型2.溶血性黄疸3.肝外阻塞性黄疸

三、进一步检查(4分)1.肝功能(包括血胆红素)2.肝炎病毒学指标3.腹部B超

四、治疗原则(3分)1.一般治疗:休息、多种维生素、严禁饮酒等2.抗病毒治疗:包括干扰素、拉咪夫定等3.护肝药物4.中医药

完形填空
完形填空。

     Jack lived with his mother and they were very poor. One day he had to go to the market to   1   their
cow for some money. On the way, Jack met a man who gave him some magic beans(魔豆)for the 
  2  . His mother was very   3  and threw the beans out of the window. The next morning, a plant was
growing up into the sky. Jack   4   up into the clouds through the plant and saw a beautiful building. He
went   5  . Hearing a voice“Fee, Fi, Fo, Fum !”, Jack hid himself in a box. A giant(巨人) came into the
room and sat down. The giant brought out a hen (母鸡)  6   laid (下蛋) a  golden egg. After a while the
giant fell asleep. Jack jumped out of the   7  and took away the hen. But suddenly the giant woke up
and started to run   8   him. Jack climbed down the plant, and as the giant was doing that he cut   9  
down. The giant fell down on the   10  . Nobody ever saw him again. With the golden eggs, Jack and
his mother lived happily from then on.

( ) 1. A. buy    
( ) 2. A. boy    
( ) 3. A. happy  
( ) 4. A. climbed
( ) 5. A. outside
( ) 6. A. what    
( ) 7. A. box    
( ) 8. A. before  
( ) 9. A. them    
( ) 10. A. floor  

B. produce
B. cow    
B. hungry  
B. jumped  
B. inside  
B. that    
B. building
B. after  
B. him    
B. ground  

C. sell  
C. hen  
C. angry
C. looked
C. within
C. whom  
C. room  
C. into  
C. her  
C. air  

D. find  
D. egg    
D. sad    
D. flied  
D. abroad
D. it    
D. sky    
D. over  
D. it    
D. stairs

单项选择题