问题 问答题 案例分析题

【病例摘要】患者,男,35岁。患者6天前由于受凉引起恶寒发热,头痛,全身不适,鼻塞流涕,咽喉疼痛。现症:咳嗽频作,吐少量白黏痰,胸痛,咽喉干痛,咳痰,胸骨后灼痛,时感喘息,食欲差,二便调。查体:T37.3℃,P88次/分,R21次/分,BP126/80mmHg。急性病容,咽部略红,双扁桃体无肿大,心律齐,双肺叩诊呈清音,听诊双肺呼吸音粗糙,未闻及干湿啰音,舌淡红,苔薄白,脉浮紧。辅助检查:WBC7.6×109/L,N0.51,L0.49;尿常规正常;胸片未见异常;心电图正常。【答题要求】(1)根据上述病例摘要,完成书面辨证论治。(2)请与大叶性肺炎相鉴别。

答案

参考答案:

一、西医诊断依据

(1)咳嗽、咳痰1天。

(2)急性病容,咽部略红,双扁桃体无肿大,心律齐,双肺叩诊呈清音,听诊双肺呼吸音粗糙,未闻及干湿啰音。

(3)血常规:WBC7.6×109/L,N0.51,L0.49。

二、西医鉴别诊断

急性支气管炎与大叶性肺炎均可继发于上呼吸道感染之后,但急性支气管炎以刺激性咳嗽、咳痰为特点,或有喘息、发热,血白细胞总数正常,淋巴细胞百分比可增高,肺部X线片正常或肺纹理增粗,大叶性肺炎典型症状为寒战、高热、胸痛、咳嗽、咯铁锈色痰,查体可见患侧呼吸运动减弱,局部叩浊音,语颤增强,可闻管状呼吸音及湿啰音,血白细胞总数及中性粒细胞百分比均明显升高,肺部X线片呈大片均匀致密阴影,呈叶、段分布。

三、中医辨证依据与病因病机分析

1.中医辨证依据风寒燥邪袭肺,肺失宣降,故咳嗽频作、时感喘息,燥邪灼精为痰,则吐少量白黏痰;燥邪伤肺则胸痛、咽喉干痛;舌淡红、苔薄白、脉浮紧均为风寒燥邪袭表之象。

2.病因病机分析风寒燥邪袭肺,肺失宣降。

四、入院诊断

1.西医诊断急性支气管炎。

2.中医疾病诊断咳嗽。

3.中医辨证诊断风寒燥邪袭肺。

五、中医治疗

1.中医治法疏风散寒,润肺止咳。

2.所选方剂名称止嗽散加减。

3.药物组成、剂量及煎服法桔梗9g、紫菀9g、百部6g、荆芥6g、前胡6g、杏仁3g、陈皮6g、生甘草6g;3剂,水煎服,日一剂,分两次服用。

六、西医治疗原则与方法

1.一般治疗注意保暖,卧床休息,保持室内空气流通等。

2.祛痰药可用急支糖浆等。

3.解痉平喘药可选氨茶碱、沙丁胺醇(舒喘灵)等。

4.氧疗如有呼吸困难可吸氧。

5.如合并细菌感染应给予抗生素治疗。

单项选择题
阅读理解
阅读理解。
A. defensive B. common C. fact D. fear E. consciousness
F. values G. rush H. questioned  I. unlikely J. unusually

     Ten years after the attacks on the World Trade Center and the Pentagon on September 11, 2001, America
has come out of the smoke a very different country. Nearly 3,000 people died on September 11.
     Suddenly America had to wake up to the    1   that not everyone loves the USA. Members of al-Qaeda, the
militant group that carried out the attacks, were angry about US support for the Israelis against Palestinians in
the Middle East, about US troops in Saudi Arabia, and about sanctions (制裁) against Iraq.
     "September 11 and the years that followed were a shock to our national    2  ," said Nicholas Burns,
American ambassador to NATO at the time. The struck not only concrete and steel, but also Americans' faith
in their power. The   3  that America had lost control of events was widespread.
     Historian Douglas Brinkley said 9/11 put America into a   4  "crouch". It started a mad   5    for protection.
The government agreed to measures that pulled apart privacy.
     In the name of fighting terrorism, the US launched wars in Iraq and Afghanistan. More than 6,000
Americans have died. Tens of thousands of ordinary people in those countries have also lost their lives. But
casualties are only part of the story. The world was shocked by photographs of Americans torturing Iraqis in
Abu Ghraib prison in Baghdad. David Goldstein, a reporter with The Kansas City Star,    6    American
behavior:"Has torturing so-called terrorists saved American lives or made the    7   we trumpet around the
world weaker?…Is that who we've become?" However, a brief moment of national unity did occur straight
after 9/11."Americans were coming together in an    8  powerful way… in the ashes. We live in a bittersweet
memory of that collective tragedy and collective possibility," said filmmaker Ken Burns. September 11 was
that kind of   9   moment. When it was over, the Earth still turned in its usual way and the stars in the sky
shone as before. But the universe had shifted somehow.