问题 问答题 案例分析题

患者男性,56岁。主诉:心悸、乏力2个月。病史:患者于2个月前出现心悸、乏力,上楼吃力,家人发现面色不如以前红润,病后进食正常,但有时上腹不适。不挑食,粪便不黑,小便正常,睡眠可,略见消瘦,既往无胃病史。查体:T36.5℃,P96次/分,R18次/分,BP130/70mmHg;贫血貌,皮肤无出血点和皮疹,浅表淋巴结不大,巩膜无黄染,心界不大,心率96次/分,心律齐,心尖部可闻及收缩期吹风样杂音,肺无异常,腹平软,无压痛,肝脾未及,下肢无水肿。辅助检查:Hb75g/L,RBC3.08×1012/L,MCV76fl,MCH24pg,MCHC26%,网织红细胞1.2%,粪便隐血试验(+),尿常规(-),血清铁蛋白6μg/L,血清铁50μg/dl,总铁结合力450μg/dl。

答案

参考答案:

1.诊断及诊断依据(8分)

(1)诊断

①缺铁性贫血。

②消化道肿瘤可能大。

(2)诊断依据

①贫血症状,如心悸、乏力、贫血貌。

②血常规检查示小细胞低色素性贫血。

③有关铁的化验示缺铁。

④中年以上男性,有时胃部不适,但无胃病史;逐渐发生贫血,体重略有减轻;粪便隐血试验(+)。

2.鉴别诊断(5分)

①消化性溃疡或其他胃病。

②慢性病性贫血。

③珠蛋白生成障碍性贫血。

④铁粒幼细胞性贫血。

3.进一步检查(4分)

①骨髓检查和铁染色。

②胃镜及全消化道造影、钡灌肠或纤维肠镜。

③血清癌胚抗原(CEA.检查。

④腹部B超或CT检查。

4.治疗原则(3分)

①去除病因,若为消化道肿瘤应尽快手术。

②补充铁剂。

③若手术前贫血仍重,可输浓缩红细胞。

阅读理解

E

Last year, my boyfriend suggested that I should run the London marathon(马拉松), and I laughed. He laughed too, but he laughed too long and too loud. That made me think. I realized that he didn't believe that I could do it. That made me angry, and determined, Now he knows that I can!

Training wasn't easy, but I kept going. I didn't need special training but I did need to buy very good shoes. Each day, I went a little further. By the end of three months, I was running five days a week. Some- times in the evenings I ran 10 km; on Sunday mornings, I sometimes ran about 30 kin. I used to come home, have a shower and eat my breakfast. I felt wonderful!

On the day of the race in London, I lined up with about 30,000 other runners. The faster runners were at the front, while slower runners like me were placed further back. In that way, the professional runners and club runners were not slowed down by the amateurs(业余爱好者).

At first, there were so many runners close together that we were almost falling over each other.  We could only run very slowly but that was a good thing because it meant that we didn't rush off too quickly. Gradually the runners spread out and there was more space. There were thousands of people watching us along the route and they cheered and clapped everyone, even the slowest runner. It was wonderful!

For the first 10 km I felt very happy and my legs felt very comfortable. However, at 15 km I got a pain in my side and running became difficult, but I kept going and the pain disappeared. At the 30 km mark, I felt extremely tired, and wanted to stop, but I kept on going. I covered another 3 km and then I began to feel better again.

By the time I reached the 35 km mark, I knew I was going to get to the end of the course. Somehow that confidence made me feel lighter and faster and it seemed as if my legs flew over the last few kilometers. I passed hundreds of slower runners, some of whom had passed me earlier, and I felt wonderful! AS I came round the last bend(弯道)and saw the finishing line, I could see three runners ahead of me. I raced past all of them to finish the race in just under four hours. The winner had completed the race in 2 hours and 10 minutes, but I didn't care! I had run 42 km and completed my first marathon!

72. The writer's boyfriend laughed at her because     .

A. he thought she could run the marathon 

B. he .didn't think she could run the marathon

C. he wanted her to run the marathon        

D. she wanted to run the marathon

73. When the race began             .

A. all the faster runners were asked to stand before those slower ones

B. many runners fell over each other  

C. all the runners were asked to run slowly

D. the professional runners and club runners ran very fast

74. The hardest time for the writer was when she           

A. had run for 15 kilometers  

B. got a pain in her side

C. reached the 30 kilometer mark

D. was about to reach the finish line

75. The passage suggests that it is better to start a long race slowly             .

A. than to run at the same speed all the time 

B. than to run too fast at the beginning

C. than to run slowly at the end    

D. than to run very fast all the time

单项选择题