问题 问答题 简答题

患者,男性,55岁。3个月来自觉全身乏力,恶心、呕吐,食欲不振,腹胀,常有鼻出血。近半个月来腹胀加剧而入院。既往有慢性肝炎史。体检:营养差,面色萎黄,巩膜轻度黄染,面部及上胸部可见蜘蛛痣,腹部胀满,有明显移动性浊音,下肢轻度凹陷性水肿。实验室检查:红细胞3×10/L,血红蛋白100g/L,血小板61×10/L,血清凡登白试验呈双相阳性反应,胆红素51mmol/L,血K3.2mmol/L,血浆白蛋白25g/L,球蛋白40g/L。入院后给予腹腔放液及大量呋塞米等治疗,次日患者陷入昏迷状态,经应用谷氨酸钾治疗。神志一度清醒。以后突然大量呕血,输库血100mL,抢救无效死亡。

(1)该例的原发病是什么?请说出诊断依据。

(2)分析本病例昏迷的发生诱发因素。

(3)分析本例的凝血功能。

(4)治疗措施上有无失误之处。提出你的正确治疗措施。

答案

参考答案:

(1)诊断:原发病为慢性肝炎、门脉性肝硬化。诊断依据:巩膜黄染、高胆红素血症(黄疸)、蜘蛛痣、腹水、低蛋白血症、白球蛋白比例倒置。

(2)肝性脑病发生诱因:腹腔放液、大量利尿、呕血。

(3)凝血功能障碍发生机制:本例有肝功能衰竭、肝合成凝血因子减少、血小板减少。

(4)失误之处:腹腔放液量太多、利尿药使用不当、输库血。

选择题
阅读理解
Goals are the guides all through our life. We all have goals that we are moving towards and making a great effort to achieve. This is a good thing. Or can it be bad? How many of us never reach our goals and yet we have tried so hard and really thought about nothing else? I believe the mistake most of us make is that we do not focus on our present situation.
Let me explain. Most of us see our present situation as a stepping stone that we use simply as a means of reaching our final destination. We don’t take time to truly appreciate where we are today and all the great things we already have in our lives. We should focus our attention on the journey and not on the destination, or we will miss the beautiful scenery along the way.
Let’s use our job as an example. Now most of us want a promotion. We have plans to become the manager or general manager in our companies. Unfortunately, most of us will never reach the goal, but will watch others achieve our goal instead.
What we should be doing is focusing on the job we are currently in now. Forget where we want to get to and just focus on the present. You see, what we can control is our performance in our current job. We can decide to be the best we possibly can in our current job. Now this may mean further education to have the skills we currently do not have. It may mean working harder to produce better results than our colleagues. It could simply be a change of attitude, such as stopping complaining and becoming a more devoted and supportive employee. By doing our current job to the best of our abilities, we in fact give ourselves the best chance of promotion.
So the best thing for all of us to do to achieve our goals is to just focus on what we have and where we are now. Do the best and be the best we possibly can in our current situations, and we will give ourselves the very best chance of reaching our goals in the future. We have heard the old sayings and they are true: “Rome wasn’t built in a day.”, “Patience is a virtue”, and so on.
Have patience, have appreciation of what we already have, and take time to help ourselves be the very best we can. Do these things and we will all reach our goals, but more importantly, we will enjoy our life every day.
Title
Focus on the present
Theme
To (76) ______ our goals, we should focus on what we have and where we are now.
 
Common (77)______
﹡We do not focus on our present situation.
﹡Most of us see our present situation as a stepping stone to our final destination.
﹡We do not spend the time truly (78)______ where we are today and what we already have in our lives.
(79)______—our job
﹡(80)______ the thought of getting promoted. What we should do is (81)______ our best to do our current job.
﹡To be the best in our current job, we should get further education, work harder than (82)______, stop complaining and (83)______ ourselves to our job.
Conclusion
If we are (84)______, grateful for what we have, and take time to help ourselves be the very best we can, we can not only (85)______ in the future, but also enjoy our life every day.