问题 问答题 案例分析题

患者,男性,35岁。发热伴全身酸痛半个月,加重伴出血倾向5天。患者半月前无明显诱因发热,T38.9℃,伴全身酸痛。轻度咳嗽,无痰。二便正常。自服"速效伤风胶囊"无效。5天前上述症状加重,牙龈出血。发病以来,食欲差,失眠,体重稍减轻。否认肝炎、肺结核、糖尿病等病史,无药物过敏史。查体:T38.2℃,P90次/分,R18次/分,BP130/80mmHg。贫血貌。前胸皮肤散在针尖大小出血点,双侧腹股沟触及数枚蚕豆大小之淋巴结,无压痛,质地较硬。咽部充血,扁桃体不大,胸骨轻压痛。HR90次/分,律齐。肺部叩诊清音,右下肺散在湿啰音。腹部平软,肝脾未触及,双下肢不肿。辅助检查:血Hb85g/L,RBC2.4×1012/L,WBC25.2×109/L,PLT25×109/L,原幼细胞35%。尿粪常规(-)。要求:根据以上病历摘要,请写出初步诊断、诊断依据(如有两个以上诊断,应分别写出各自诊断依据,未分别写出扣分)、鉴别诊断、进一步检查与治疗原则。

答案

参考答案:

1.初步诊断

(1)急性白血病;

(2)肺部感染。

2.诊断依据

(1)急性白血病:

①中年男性,急性起病。发热伴全身酸痛半个月,加重伴出血倾向5天。

②查体:贫血貌,皮肤出血点,浅表淋巴结肿大,胸骨压痛。

③血常规示RBC、PLT减少,WBC增高,原幼细胞35%。

(2)肺部感染:

①轻度咳嗽,无痰;

②T38.2℃,右下肺散在湿啰音。

3.鉴别诊断

①白血病类型鉴别;

②再生障碍性贫血;

③骨髓增生异常综合征;

④血小板减少性紫癜。

4.进一步检查

①骨髓穿刺检查,必要时骨髓活检;

②进行MIC分型检查。

③胸片、痰细菌学检查;

④腹部B超;

⑤肝肾功能检查。

5.治疗原则

①对症治疗:止血、抗感染。

②化疗:根据白血病类型选择合适的化疗方案。

③有条件者,在完全缓解后行骨髓移植。

阅读理解

阅读理解

     Bernice Gallego sat down one day this summer, as she does pretty much every day,and began listing

items on eBay. She dug into a box and pulled out a baseball card. She stopped for a moment and

admired the picture. "Red Stocking B. B. Club of Cincinnatti," the card read, under the reddish brown

color photo of ten men with their socks pulled up to their knees.

     As a collector and seller, it's her job to spot old items that might have value today. It's what Bernice,

72, and her husband, Al Gallego, 80, have been doing since 1974 at their California antique store.

     This card, she figured, was worth selling on eBay. She took a picture, wrote a description and put it

up for auction.She put a $10 price tag on it, deciding against $15 because it would have cost her an

extra 20 cents. Later that night she got a few odd inquiries---someone wanting to know whether the

card was real, someone wanting her to end the caution and sell him the card immediately.

     The card is actually 139 years old. Sports card collectors call the find "extremely rare" and estimate

the card could fetch five, or perhaps, six figures at caution.

     Just like that, Bernice is the least likely character ever for a rare-baseball card story. "I didn't even

know baseball existed that far back," Gallego says, "I don't think that I've ever been to a baseball game."

The theory is that the card came out of a storage space they bought a few years back. It is not uncommon

in their line of work to buy the entire contents of storage units for around $200.

     When she met with card trader Rick Mirigian, she found out what the card was-an 1869 advertisement with a picture of the first professional baseball team, the Cincinnatti Red Stocking.

     "When I came to meet her and she took it out of a sandwich bag and she was smoking a cigarette, I

almost fainted," Mirigian says. " They've uncovered a piece of history that few people will ever be able to

imagine. That card is history. It's like unearthing a Mona Lisa or a Picasso."

1.What can we conclude from paragraph 3?

A. Bernice had to pay some fees for her card on eBay.

B. Bernice wanted to end the caution that night.

C. Bernice decided to sell the card for $15.

D. EBay charged her 20 cents for the card.

2. The underlined word "fetch" in paragraph 4 most probably means "_______".

A. go and bring  

B. add up to  

C. go down to  

D. be sold for

3. From the passage we may learn that _______.

A. Bernice is a baseball fan 

B. Bernice is the last person to purchase the rare-baseball card

C. Bernice unexpectedly became the owner of the rare-baseball card

D. Bernice didn't realize the value of the card until she put it up for auction

4.What would be the best title for the passage?

A. A Surprisingly Valuable Discovery

B. The History of the Baseball Card

C. Bernice Gallego-A lucky collector  

D. Sports Card Collectors

单项选择题