问题 问答题 案例分析题

简要病史:女性,45岁,消瘦、多饮、多尿半个月。请针对该案例,说明问诊内容与技巧。

答案

参考答案:

本例患者最可能是糖尿病。病史采集要点:(共15分)

1.问诊内容(13分)

(1)现病史(共10分)①发病诱因。(1分)②体重下降多少,饮食每日多少,比平时增加多少,体重与饮食的关系。(2分)③每日尿量多少,(多尿指每日尿量多于2500ml),多尿与饮水的关系如何。(2分)④伴随症状,有无心悸、怕热、性情改变等伴随症状。(2分)⑤发病以来的一般情况:大便情况等。(1分)⑥诊疗经过:是否就诊过,相应的辅助检查及结果,应用过何种治疗及效果。(2分)

(2)相关病史(共3分)①药物过敏史及外伤手术史。(1分)②与该病有关的其他病史及家族史。(2分)

2.问诊技巧(2分)

(1)条理性差、不能抓住重点。(-0.5分)

(2)没有围绕病情询问。(-0.5分)

(3)问诊语言不恰当。(-0.5分)

(4)暗示性问诊。(-0.5分)

阅读理解

There is a popular belief among parents that schools are no longer interested in spelling. No school I have ever taught in has ever ignored spelling or considered it unimportant as a basic skill. There are, however, different ideas about how to teach it, or how much priority (优先) it must be given over general language development and writing ability. The problem is how to encourage a child to express himself freely and confidently in writing without holding him back with the complexities (复杂性) of spelling.

If spelling becomes the only focal (焦点的) point of his teacher’s interest, clearly a bright child will be likely to “play safe”. He will tend to write only words within his spelling range, choosing to avoid adventurous language. That’s why teachers often encourage the early use of dictionaries and pay attention to content rather than technical ability.

I was once shocked to read on the bottom of a sensitive piece of writing about a personal experience: “This work is terrible! There are far too many spelling errors and your writing is terrible.” It may have been a sharp criticism of the pupil’s technical abilities in writing, but it was also a sad reflection on the teacher who had omitted to read the essay, which contained some beautiful expressions of the child’s deep feelings. The teacher was not wrong to draw attention to the errors, but if his priorities had centered on the child’s ideas, an expression of his disappointment with the presentation would have given the pupil more motivation (动机) to seek improvement.

小题1:Teachers are different in their opinions about _________.

A.the difficulties in teaching spelling

B.the role of spelling in general language development

C.the complexities of the basic writing skills

D.the necessity of teaching spelling小题2: The underlined expression “play safe” probably means ________.

A.to write carefully

B.to do as teachers say

C.to use dictionaries frequently

D.to avoid using words one is not sure of小题3:Teachers encourage the use of dictionaries so that ____________.

A.students will be able to express their ideas more freely

B.students will have more confidence in writing

C.students will have less trouble in correcting mistakes

D.students will learn to be independent of teachers小题4:The author seems to think that the teacher’s judgment on that sensitive piece of writing is __________.

A.unfair

B.reasonable

C.foolish

D.careless小题5:The major point discussed in the passage is ___________.

A.the importance of developing writing skills

B.the complexities of spelling

C.the correct way of marking compositions

D.the relationship between spelling and the content of a composition

单项选择题