问题 问答题 案例分析题

患儿男性,1岁5个月。主诉:发热4天,全身皮疹伴耳后肿物2天。病史:患儿于4天前出现发热,体温高达39℃,伴喷嚏,2天前见面部、颈部至全身出现较多粟粒样皮疹,同时出现耳后花生米大小肿物,有触痛,在外口服"阿莫西林颗粒、清开灵、羚羊角口服液"治疗,体温降至正常,但耳后肿物逐渐增大,急来就诊。当地有类似发热、出疹性疾病。生后曾接种卡介苗、麻疹疫苗、乙肝疫苗。查体:体温37.2℃,脉搏110次/分,呼吸28次/分,体重13kg,发育正常,营养中等,热病容,神志清,精神可,呼吸平稳,面部、颈部及全身可见较多淡红色小皮疹,压之退色,疹间皮肤正常,双耳后及颈部可触及2~3个花生米大小淋巴结,活动可,稍有压痛,无红肿。前囟闭合,咽充血,颈软,胸廓无畸形,三凹征阴性,双肺呼吸音粗,未闻及干湿性啰音,心音有力,心率110次/分,律齐,腹软,肝脾肋下未触及,四肢活动可,生理反射存在,病理反射未引出。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:

1.诊断与诊断依据(8分)(1)诊断:风疹。(2)诊断依据①患儿先有高热,伴喷嚏,而后出疹。②皮疹出现顺序是自面部、颈部迅至全身,同时发现患儿双耳后均有花生米大小之肿物,压之疼痛,无咳嗽。③体格检查:精神尚好,面部、颈部及全身皮肤满布淡红色小丘疹,压之退色,疹间皮色正常,双耳后、枕后及颈部均可触及1~3枚黄豆至花生米大小之淋巴结,活动可,轻压痛,局部皮肤无红肿,咽充血,心肺腹未及异常。无病理反射。

2.鉴别诊断(5分)①麻疹。②猩红热。③幼儿急疹。

3.进一步检查(4分)①血常规。②风疹病毒特异性抗体。

4.治疗原则(3分)本病无特效药物,主要为对症和支持治疗。

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阅读理解。

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