问题 问答题 案例分析题

结核性胸膜炎案例:病例摘要:患者,男性,30岁,低热伴右侧胸痛一周。患者一周前无明显诱因出现午后低热,体温37.5℃,夜间盗汗,伴右侧胸痛,深呼吸时明显,不放射,与活动无关,未到医院检查,自服止痛药,于3天前胸痛减轻,但胸闷加重伴气短,故来医院检查,发病来进食无变化,二便正常,睡眠稍差,体重无明显变化。既往体健,否认有结核病密切接触史,吸烟10年。查体:T37.4℃,P84次/分,R20次/分,BP120/80mmHg,一般情况可,无皮疹,全身浅表淋巴结未触及,巩膜不黄,咽(-),颈软,气管稍左偏,颈静脉无怒张,甲状腺(-),右侧胸廓稍膨隆,右下肺语颤减弱,右下肺叩浊,呼吸音减弱至消失,心界向左移位,心右界叩不清,心律齐,无杂音,腹平软,无压痛,肝脾未及,下肢不肿。

答案

参考答案:

1.诊断及诊断依据初步诊断:右侧胸腔积液,结核性胸膜炎可能性大。诊断依据:(1)低热、盗汗,由开始胸痛明显(干性胸膜炎)到有积液后的胸痛减轻,ESR快;(2)右侧胸腔积液征气管、心脏左移,右下肺语颤减弱,叩浊,呼吸减低至消失。

2.鉴别诊断(1)肿瘤性胸腔积液。(2)心力衰竭致胸腔积液。(3)低蛋白血症致胸腔积液。(4)其他疾病(如SLE.致胸腔积液。

3.进一步检查(1)胸部X线片。(2)胸部B超胸腔积液定位。(3)胸腔穿刺,胸腔积液常规、生化和细菌、病理学检查。(4)PPD或血清结核抗体测定。(5)肝、肾功能检查。

4.治疗原则(1)病因治疗抗结核药。(2)胸腔穿刺放胸腔积液,合理应用糖皮质激素。

阅读理解

Long before they became doctors, lawyers, CEO’s or real estate developers, they played in garage bands and maybe even dreamed of becoming rock stars. That’s why they signed up for Rock 'n' Roll Fantasy Camp.

For nearly a week, the mostly middle-aged “campers” had practiced in the West 54th Street studios. They came from as far away as London and Tokyo and as close as Long Island and downtown New York to prepare for their moment of onstage glory.

“I feel like I’m 18 again,” said Jerry Goldberg, a 60-year-old investment banker and guitar player, whose family was in the audience.” I admit that I felt a little uncertain when I first got here, but this has turned out to be a wonderful experience, one of the greatest of my life.”

Everybody has two businesses, their own business and show business. This can be a life-changing experience for them. Mr. Daltrey, who has appeared at several fantasy camps, was asked why he keeps coming back.

“I’ve had people tell me that I shouldn’t be doing this, that it's bad for my image,” he acknowledged. “But that’s rubbish. Look, it’s all so positive, and everybody is having so much fun. So what’s bad about that?”

Jeff Munger, a drummer and rancher(农场主) said. “I’m at a point in my life where I’m going to spend my money on things I’m passionate about, and I’m absolutely crazy about music.”

Most of the campers are successful executives or professionals: a founder of the Oracle Computer Company, a businessman whose father invented the Big Mac, a plastic surgeon, presidents of health care and seafood companies.

小题1:This text is mainly about________.

A.a music course for the elderly people

B.a pop club for professional musicians

C.a rock music camp for music lovers

D.a studio for wealthy businessmen小题2:What do the middle aged campers have in common?

A.They are all interested in charity.

B.They are all passionate about music.

C.They are all retired business people.

D.They were all rock stars when they were young.小题3:According to the text, Mr. Daltrey ________.

A.once played in a garage band

B.has come with his family

C.has joined in the camp a couple of times

D.is very careful about his image小题4:We can infer from the text that the campers _________.

A.enjoy their regular jobs

B.come from different countries

C.do part-time jobs

D.have a great many fans

单项选择题