问题 问答题 简答题

病例摘要:

于某,男,50岁,2014年8月就诊。

患者于当年2月份,办公室新购衣柜后,开始出现胸闷憋气,呼吸不畅,咳嗽,咯少量白色痰,每进办公室开始发病,夜间难以平卧。而后将衣柜搬走,但仍觉胸闷,夜晚加重,咽痒咳嗽,咯少量痰,痰黄黏稠,咯吐不利。

查体:T36.7℃,P82次/分,R18次/分,BP115/80mmHg。双肺呼吸音粗,双下肺偶可闻及呼气相干啰音,未闻及湿啰音,心率82次/分,肝脾未触及,双下肢无浮肿。舌质红,苔黄腻,脉滑数。

辅助检查:血常规基本正常,胸片提示双肺纹理粗重。呼吸功能检查气道激发试验阳性。

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:

中医辨病辨证依据:

患者素有宿痰伏于肺,遇办公室新衣柜气味引触,导致痰阻气道,气道挛急,肺失肃降,肺气上逆而发为哮病。热邪炼液为痰,痰热胶结,故见痰黄黏稠,咯吐不利;热痰郁闭,肺气不得宣畅,故见胸闷;外邪与痰交争于咽喉,故见咽痒咳嗽;舌质红,苔黄腻,脉滑数均为痰热内盛之征。综观舌、脉、症,本证为热哮,病位在肺,病性为实,预后可。

西医诊断依据:

1.中年男性,反复发作性胸闷憋气,咽痒咳嗽咯痰。

2.双肺偶可闻及呼气相干啰音。

3.呼吸功能检查气道激发试验阳性。

西医鉴别诊断:

心源性哮喘指的是左心衰竭引起的喘息样呼吸困难,发作时症状与哮喘相似,但患者多有高血压、冠状动脉粥样硬化性心脏病、风湿性心脏病和二尖瓣狭窄等病史和体征。常咳粉红色泡沫痰,左心扩大,心率增快、心尖部可闻及奔马律,双肺可闻及广泛哮鸣音及湿啰音。

诊断:

中医疾病诊断:哮病

中医证候诊断:热哮证

西医诊断:支气管哮喘(急性发作期)

中医治法:清热宣肺,化痰定喘

方剂:定喘汤加减

药物组成、剂量及煎服法:

炙麻黄6g;黄芩10g;桑白皮10g;苦杏仁10g;清半夏9g;紫苏梗10g;款冬花10g;生甘草6g;鱼腥草30g;炙枇杷叶10g;蝉衣6g;地龙6g;

7剂,水煎服,每剂分早晚两次温热服

西医治疗原则与方法(药物、手术等):

1.脱离变应原,不接触新家具。

2.抗炎治疗,吸入糖皮质激素,可以选择布地奈德200μg/次,每日两次;或氟替卡松250μg/次,每日2次。

3.白三烯受体拮抗剂,孟鲁司特钠10mg,每晚口服。

4.吸入β2受体激动剂,硫酸沙丁胺醇气雾剂2喷,每晚使用。

阅读理解

John Smith was a writer, who wrote detective stories for magazines(杂志), though he never dealt with criminals(罪犯). One evening he could not finish an end for a story. He sat in his study(书房), but he had no ideas. So he decided to go to the cinema.

When he came back, he found that he had had a visitor. Someone had broken into his house. The visitor had had a drink, smoked several of his cigarettes and had read his story. The visitor left him a note. “I have read your story and I don’t think it is very good. Please read my suggestions and you can finish it. By the way, I am a thief. I’m not going to steal anything tonight. But if you become a successful writer, I will return.”

John read the thief’s suggestions. Then he sat down and wrote the rest of the story. He is still not a successful writer, and he is waiting for his “visitor” to return. Before he goes out in the evening, he always leaves a half-finished story in his study.

小题1:Detective stories are stories about_____.

A.science

B.children

C.the future

D.the police小题2:John went to the cinema because_____.

A.he was too tired

B.he wanted to look for a thief

C.he could not finish his story and hoped to get some ideas

D.he wanted to enjoy himself in the cinema小题3:The visitor came to John’s house in order to_____.

A.steal something

B.read the story

C.have a drink

D.visit the writer小题4:The visitor_____.

A.stayed in John’s house for a night

B.took some of John’s things away

C.left John some advice

D.was a good friend of John’s小题5:John would like to_____.

A.have a talk with his visitor

B.get more ideas from the visitor

C.make friends with the visitor

D.catch the visitor and take him to the police

判断题