问题 问答题 案例分析题

主诉:男性,27岁,间断低热、乏力、咳嗽2个月。

病史:患者2个月来无诱因出现咳嗽、咳少量白痰,无痰中带血,自觉午后发热,多次自测体温不超过38.0℃,乏力,盗汗,食欲较差,体重下降,口服抗生素治疗效果不明显。既往体健,无结核病接触史,无肝炎、肺结核病史,无药物过敏史。

体检:T37.6℃,P79次/分,R22次/分,BP110/70mmHg。慢性病容,消瘦,浅表淋巴结未触及肿大。右上肺呼吸音粗,未闻及啰音,腹软,腹无压痛,肝、脾未触及。

辅助检查:血常规:Hb125g/L,WBC8×109/L。胸片:右上肺絮状阴影,边缘模糊。

答案

参考答案:

1.诊断依据(8分)(1)诊断右上肺浸润性肺结核。(2)诊断依据①有午后低热、盗汗、消瘦等结核中毒症状。②有咳嗽、咳痰等呼吸道症状。③有右上肺呼吸音粗的肺部体征。④胸片示右上肺絮状影,边缘模糊。

2.鉴别诊断(5分)①肺炎(肺炎球菌肺炎)。②肺癌(中心型肺癌)。③肺炎性假瘤。

3.进一步检查(4分)①痰找结核杆菌。②血沉。③PPD试验。④必要时行支气管镜检查。

4.治疗原则(3分)①抗结核药物治疗(早期、联合、适量、规律、全程用药)。②支持疗法。

阅读理解

An important question about eating out is who pays for the meal. If a friend of yours asks you to have lunch with him, you may say something like this, “I’m afraid it’ll have to be someplace cheap, as I have little money.” The other person may say, “OK, I’ll meet you at McDonald’s.”

This means that the two agree to go Dutch, that is, each person pays for himself. He may also say, “Oh, no, I want to take you to lunch at Smith’s,” or “I want you to try the Chinese dumplings there. They are great.” This means the person wants to pay for both of you. If you feel friendly towards this person, you can go with him and you needn’t pay for the meal. You may just say, “Thank you. That would be very nice.”

American custom(风俗) about who pays for dates(约会) are much the same as in other parts of the world. In the old days, American women wanted men to pay for all the meals. But, today, a university girl or a woman in business world will usually pay her way during the date. If a man asks her for a dance outside the working hours, it means “Come, as my guest(客人).” So as you can see, it is a polite thing to make the question clear at the very beginning.

小题1:The passage mainly tells us ________.

A.how to eat out

B.where to eat out

C.what to eat out

D.who pays for the meal in different situation小题2:The underlined phrase “go Dutch” in this passage means “________” in Chinese.

A.去订餐

B.共同就餐

C.去饭店

D.各自付款小题3:Sometimes your friend takes you to lunch. It means _________.

A.he’s going to pay for your meal

B.he’s going to lend some money to you

C.he can’t understand you

D.he’ll be angry with you小题4:In America, some girls and women _________ now.

A.ask men to pay for their clothes

B.try to pay for their own meals

C.never have anything outside

D.try to pay for the men’s meals小题5:We can infer(推断) if a man asks a woman for a dance outside the working hours _________.

A.the man will pay for it

B.the woman will pay for it

C.they will go Dutch

D.another person will pay for them

单项选择题