问题 问答题 简答题

病例摘要:

张某,男,21岁,在校大学生。2014年9月初诊。

1周前淋雨后恶寒发热,无汗,周身疼痛,咽痛,鼻塞流涕,轻咳,自行服用泰诺林后体温降至正常,流涕减少,周身疼痛减轻,而咳嗽逐渐加重,自服甘草片、罗红霉素无效。目前咳嗽剧烈,咯痰不爽,黄色黏稠量多,咽干咽痛,鼻流黄涕,口渴多冷饮,胸闷胸痛,尿黄便干。

查体:T38.2℃,P96次/分,R24次/分,BP120/80mmHg。双肺呼吸音清,右下肺可闻及湿啰音,未闻及干啰音。心率96次/分,律齐,肝脾未及,双下肢无浮肿。舌质红,苔黄厚腻,脉滑数。

辅助检查:血常规WBC10.2×109/L,N79%。胸片:双肺纹理粗重,右下肺可见片状模糊影,考虑肺部感染可能。

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:请与肺结核相鉴别。

答案

参考答案:

中医辨病辨证依据:

外出淋雨,感受风寒。邪气未解,入里化热。邪热壅肺,灼津成痰,痰热郁遏肺气,肃降无权,故见咳嗽剧烈,咯痰不爽,黄色黏稠量多,胸闷胸痛;热邪煎灼津液,则鼻流黄涕;热伤阴津,则见咽干咽痛,渴喜冷饮尿黄;便秘为肺热腑气不通之象。舌质红,苔黄或黄腻,脉滑数皆为痰热内盛之征。

西医诊断依据:

据患者有受凉病史,有发热、咳嗽、咳痰,甚至胸痛、呼吸困难等肺实变的临床表现,痰培养、血常规、胸片的检查,即可作出诊断。

西医鉴别诊断:

肺结核:活动性肺结核常伴有低热、乏力、盗汗、咯血等症状;咳嗽和咳痰的程度与肺结核的活动性有关。X线检查可发现肺部病灶,病灶通常在上肺,痰结核菌检查阳性,老年肺结核的毒性症状不明显,常因慢性支气管炎症状的掩盖,长期未被发现,应特别注意。

诊断:

中医疾病诊断:咳嗽

中医证候诊断:痰热壅肺证

西医诊断:肺炎(右下肺)

中医治法:清热化痰止咳

方剂:桑白皮汤加减

药物组成、剂量及煎服法:

桑白皮10g;黄芩10g;栀子10g;苏子10g;苦杏仁10g;浙贝母10g;清半夏10g;黄连6g;生甘草6g;薄荷12g(后下)

7剂。水煎两次,共取汁300ml,每日1剂,分早晚两次温服

西医治疗原则与方法(药物、手术等):

1.适当休息,多保暖,多饮水。

2.对症治疗:如果体温超过38.5℃,可以使用解热镇痛药物,如对乙酰氨基酚。化痰治疗,使用盐酸氨溴索60mg,每日3次口服。

3.抗菌药物,口服或者静脉应用第二代头孢菌素、氟喹诺酮类抗生素或者阿奇霉素。

连线题
完形填空
One day a young man was standing in the middle of the town claiming that he had the most beautiful heart in the whole valley. A large crowd gathered, and they all       his heart for it was perfect.
Suddenly, an old man appeared and said, "Why, your heart is not       as beautiful as mine!" The crowd and the young man looked at the old man's heart. It was full of      . It had places where pieces had been       and other pieces put in, but they didn't       quite right. In fact, in some places whole pieces were      .
The young man laughed, "Compared with your heart, mine is perfect and yours is a      ." "Yes," said the old man, "Yours looks perfect but I would never swap with you. You see, every scar(伤疤) represents a person to whom I have given my      . I tear out a piece of my heart and give it to them,       often they give me a piece of their heart that fits into the       place in my heart. So the scars have me remember the love we      . Sometimes I have given pieces of my heart away, and the other person hasn't       a piece of his or her heart to me. These are the empty       — giving love is taking a chance. Although      , they stay open. So now do you see what true       is?"
The young man walked up to the old man,       his perfect heart, and tore a piece out. He       it to the old man. The old man placed it in his      , then took a piece from his old scarred heart and placed it in the young man's heart. The young man looked at his heart, not perfect       but more beautiful than ever, since love from the old man's heart       into his.
How sad it must be to go through life with a whole untouched heart!
小题1:
A.appreciatedB.dislikedC.hatedD.broke
小题2:
A.nearlyB.hardlyC.honestlyD.widely
小题3:
A.itemsB.scarsC.detailsD.tips
小题4:
A.formedB.addedC.designedD.removed
小题5:
A.feelB.fitC.sinkD.calm
小题6:
A.amazingB.willingC.missingD.boiling
小题7:
A.jokeB.trapC.successD.goal
小题8:
A.opinionB.powerC.voteD.love
小题9:
A.soB.butC.orD.and
小题10:
A.perfectB.emptyC.entireD.equal
小题11:
A.wantedB.spentC.sharedD.ignored
小题12:
A.lentB.returnedC.expressedD.left
小题13:
A.holesB.boxesC.roomsD.seats
小题14:
A.hopefulB.gratefulC.painfulD.peaceful
小题15:
A.beautyB.angerC.mercyD.surprise
小题16:
A.went throughB.reached intoC.gave upD.watched over
小题17:
A.employedB.packedC.rewardedD.offered
小题18:
A.pocketB.heartC.bagD.mind
小题19:
A.overB.onceC.anymoreD.apart
小题20:
A.flowedB.bentC.escapedD.burst