问题 问答题 案例分析题

患者男性,56岁。主诉:间断尿频、尿急、尿痛伴腰痛和发热28年,再发加重3天。病史:患者于28年前因会阴外伤后出现"下尿路狭窄",间断发作尿频、尿急、尿痛,有时伴腰痛、发热,经输注抗生素和对症处理后好转,每年发作3~4次。入院前3天无明显诱因发热达38~39℃,无寒战,伴尿痛、尿急、尿频,无肉眼血尿,无水肿,自服诺氟沙星(氟哌酸)无好转,为进一步诊治入院。发病来饮食可,大便正常,睡眠好,体重无明显变化。无结核病史,无药物过敏史。查体:T38.7℃,P110次/分,R24次/分,BP128/85mmHg;急性热病容,浅表淋巴结未触及肿大,巩膜无黄染,眼睑无水肿,心肺无异常,腹平软,下腹部轻压痛,无肌紧张和反跳痛,肝脾未触及,双肾区叩痛(+),双下肢无水肿。辅助检查:Hb122g/L,WBC24.7×109/L,中性粒细胞0.89;尿蛋白(+),尿WBC多数/HP,可见脓细胞和白细胞管型,尿RBC5~10个/HP。

答案

参考答案:

1.诊断及诊断依据(8分)

(1)诊断:慢性肾盂肾炎急性发作。

(2)诊断依据

①反复发作的尿路刺激症状,伴腰痛、发热。本次发病急剧,存在下尿路引流不畅因素。

②下腹部轻压痛,双肾区叩痛(+)。

③血WBC数和中性粒细胞比例均增高,尿蛋白(+),尿WBC多数/HP,可见脓细胞和WBC管型。

2.鉴别诊断(5分)

①下尿路感染。

②肾、尿路结核。

③ * * 综合征。

④慢性肾小球肾炎。

⑤泌尿系肿瘤。

3.进一步检查(4分)

①血培养、尿培养、尿细菌菌落计数+药敏试验。

②肾功能(BUN,Scr,尿浓缩试验,尿渗透压)。

③泌尿系影像学检查,双肾、膀胱B超。

4.治疗原则(3分)

①抗感染治疗,合理有效应用抗生素。

②去除诱因,防止复发。

单项选择题

Oxford and Cambridge University Boat Clubs have both taken the opportunity to travel to Spain this month to train in less testing weather conditions than those which have, quite literally, already blown around the UK in January of 2007.

Each group of athletes has been focused on training to the maximum, working on technique and molding themselves into two potential fighting units per Club for the 2007 Boat Race, sponsored by Xchanging. One set will be in the Blue Boat for each club and one set will race as reserves in Isis, for Oxford, and Goldie, for Cambridge.

In these modern times, the Head Coach for each club has a huge input on selection even though the crew is still named by the President. Just twenty years ago the balance was not quite the same.

The year 1987 will always be remembered in the history of this great Race as the year of the "mutiny" at Oxford. It is a tale which has since been retold and reworked in both a book and a movie.

This was the season for which mature Scottish student, Donald Macdonald, was elected President, having all ready won a Blue in 1986. Macdonald re-appointed Daniel Topolski (now a renowned rowing journalist and broadcaster) as Chief Coach.

Part of the 1986/87 squad at Oxford included American Chris Clark, now a coach at an American University, and four fellow US internationals.

Allegedly, a split appeared in the squad between the American quintet, all experienced and leading oarsmen, and those rowers closest to Macdonald. The Scot’s group were happy to follow Topolski’s regime whilst the others were not so sure.

Following a contentious seat racing trial in January of 1987, Topolski decided to move Clark to the bow-side of the beat. Clark disagreed. Topolski held firm. As a result Clark and his "group" within the squad decided not to ROW and sought a takeover.

The squabble was played out extensively in the UK national media and caught the public imagination. MacDonald sought support from the college captains and eventually won a vote of confidence by 28 votes to 11.

Without the Americans, the Oxford crew was immediately considered a lost cause. Cambridge were overwhelming favorites to win.

As it turned out, though, this was a Race which would prove why sport, and particularly The Boat Race, can be so fascinating.

It can be inferred that "Isis" and "Goldie" are the names of two ().

A. places

B. teams

C. races

D. clubs

多项选择题