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简要病史:男性,68岁,输血后腰痛、无尿5h。

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简要病史:男性,68岁,输血后腰痛、无尿5h。初步诊断(仅供考官参考、不计分):急性输血性溶血反应致急性肾衰竭。评分标准:(总分15分)

1.问诊内容(共13分)(1)现病史(10分)①根据主诉及相关鉴别询问(8分)输入血量是多少,有无突然烦躁不安、胸闷、头痛,有无腰背剧烈疼痛、呼吸困难、恶心、呕吐、冷汗、发绀、发热、寒战等。(3分)尿量、尿色变化情况。(2分)血型是否相合、输血前是否做过交叉配血试验、采血日期及血液储存情况等。(3分)②诊疗经过(2分)做过哪些检查。(1分)治疗用药情况如何。(1分)(2)其他有关病史(3分)有无药物过敏史。(1分)与该病有关的其他病史,有无输血史、肾病史。(2分)

2.问诊技巧(2分)条理性强、能抓住重点。(1分)能够围绕病情询问。(1分)

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The park bench was deserted as I sat down to read beneath an old willow tree. Not   36__   with life, I was down. A young boy out of breath   37  me, all tired from play. He stood right before me with his head tilted(倾斜的) down,   38   with great excitement, “Look what I found!”

In his hand was a flower, and what a   39   sight, with its petals(花瓣) all worn-not enough rain, or too little light.   40   him to take his dead flower and go off to play, I   41  a small smile and then shifted away. But instead of   42  he sat next to my side and placed the flower to his nose and declared with   43 , “It sure smells pretty and it’s beautiful, too. That’s why I   44   it; here, it’s for you.”

The flower before me was dying or dead. But I knew I   45   take it, or he might never leave. So I reached for the flower, and   46 , “Just what I need.” But instead of placing the flower in my hand, he   47  it mid-air without reason. It was then that I   48   for the very first time the boy was   49 .

I heard my voice shake, tears shone like the sun   50   I thanked him for picking the very best one. He smiled, and then ran off to play,   51  of the effect he’d had on my day.

I sat there and   52  how he managed to see a self-pitying woman beneath an old willow tree. How did he know of my self-indulged(放纵的)  53  ? Perhaps from his heart, he'd been blessed with true   54 .

55   the eyes of a blind child, at last I could see, the problem was not with the world; the problem was me. And for all of those times I myself had been blind, I vowed to see beauty, and appreciate every second that's mine.

36.A.excited     B.inspired    C.content     D.disappointed

37.A.approached      B.overlooked       C.understood       D.recognized

38.A.telling      B.saying      C.informing D.talking

39.A.unique      B.rough       C.bothering  D.pitiful

40.A.Wanting   B.Demanding      C.Persuading       D.Inviting

41.A.presented  B.adjusted    C.forced      D.delivered

42.A.declining  B.accepting  C.panicking  D.quitting

43.A.surprise    B.embarrassment C.sympathy  D.sorrow

44.A.took  B.pulled       C.attained    D.picked

45.A.should      B.can    C.may  D.must

46.A.announced       B.replied      C.declared    D.whispered

47.A.grasped    B.held  C.caught      D.seized

48.A.observed   B.confirmed C.noticed     D.concluded

49.A.strange     B.blind C.deaf  D.unimaginable

50.A.once  B.after  C.as      D.since

51.A.unaware   B.unbelievable     C.regretful   D.regardless

52.A. doubted     B. felt     C. found  D. wondered

53.   A. embarrassment   B. depression  C. hopelessness      D. effort

54.   A. sense  B. hearing      C. sight   D. ability

55.A.In     B.From C.Before      D.Through

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