问题 问答题 案例分析题

患者女性,50岁。乏力、多尿伴体重减轻3年。3年前开始,无明显诱因出现全身无力,排尿增多(排尿量2000~3000ml/24h),无明显心悸、多汗症状。发病以来,食欲佳,睡眠尚可,体重减轻5kg。既往无服用特殊药物史和药物过敏史。吸烟6年,每天半包,饮酒5年,每日3~4两。查体:T36.8℃,P76次/分,R16次/分,BP135/85mmHg。神志清,营养中等,浅表淋巴结未触及。甲状腺不大,未闻及血管杂音。心肺检查未见异常。腹平软,无压痛及反跳痛,肝、脾肋下未触及,肠鸣音4次/分,双下肢不肿。实验室检查:空腹血糖9.1mmol/L,餐后2小时血糖13.8mmol/L。要求:根据以上病历摘要,请写出初步诊断及诊断依据、鉴别诊断、进一步检查与治疗原则。

答案

参考答案:

一、初步诊断及诊断依据

(一)初步诊断

2型糖尿病。

(二)诊断依据

1.患者女性,中年,慢性病程。

2.典型的临床表现乏力、多尿伴体重减轻。

3.实验室检查提示空腹及餐后血糖分别超过7.0mmol/L和11.1mmol/L。

二、鉴别诊断

1.1型糖尿病

2.甲状腺功能亢进症

3.其他原因引起的血糖升高

三、进一步检查

1.尿糖和酮体,血FT3、FT4、TSH,监测血糖变化。

2.眼底检查。

3.肝、肾功能及血脂检测、心功能检查。

四、治疗原则

1.一般治疗适当的生活指导和积极预防并发症。

2.饮食治疗。

3.降糖药物治疗或胰岛素治疗。

阅读理解

Reseachers at the University of Kansas say that people can accurately judge 90 percent of a stranger's personality simply by looking at the person’s shoes.“Shoes convey useful information about their wearers,’’the authors wrote in the new study published in the Journal of Research in Personality.

Lead researcher Omri Gillath said the judgments were based on the style,cost,color and condition of someone’s shoes.In the study,63 University of Kansas researchers looked at pictures showing 208 different pairs of shoes worn by the study’s participants.Volunteers in the study were photographed in their most commonly worn shoes,and then filled out a personality questionnaire.

Some of the results were expected:People with higher incomes most commonly wore expensive shoes,and flashier shoes were typically worn by outgoing people.However,some of the more specific results are strange enough.For example,“practical and functional’’shoes were generally worn by more“pleasant"people,while ankle boots were more linked with ‘‘aggressive’’personalities.The strangest of all may be that those who wore‘‘uncomfortable looking” shoes tend to have “calm” personalities. And if you have several pairs of new shoes or take extreme care of them,you may suffer from“attachment anxiety",spending lots of time worrying about what other people think of your appearance.There was even a political calculation in the mix with more liberal(主张变革的)types wearing“shabbier and less expensive” shoes.

The researchers noted that some people will choose shoe styles to mask their actual personalities,but researchers noted that volunteers were also likely to be unaware that their footwear choices were showing the deep side of their personalities.

小题1:What does this text mainly tell us?

A.People’s personalities call be judged by their shoes.

B.Shoes convey false information about the wearer.

C.People know little about their personalities.

D.Shoes Call hide people’s real personalities.小题2:The participants were asked to       

A.look at pictures of different shoes

B.provide pictures of their shoes

C.hand in their commonly worn shoes

D.design a personality questionnaire小题3:Which of the results is beyond people’s expectation?

A.Pleasant people like wearing uncomfortable shoes.

B.Wealthy people often wear expensive shoes.

C.Flahshier shoes are typically worn by outgoing people.

D.Aggressive people are likely to weal"ankle boots.小题4:People suffering from“attachment anxiety” tend to       

A.become a political leader

B.have a calm character

C.worry about their appearance

D.wear strange shoes小题5:The author wrote the text in order to      

A.teach how to choose shoes

B.describe different personalities

C.inform us of a new study

D.introduce a research method

单项选择题