问题 问答题 简答题

张某,男,75岁,工人。3年前开始,常因生气或劳累后出现胸闷疼痛,通常为短暂性左侧胸痛反复发作,每次持续时间一般都在数分钟内,休息后或含服"硝酸甘油"可以缓解,在某医院经相关检查后诊断为"心绞痛",开始痛轻,未予重视。半月前,因生气后出现胸痛频发,疼痛加剧,或心前绞痛,痛引肩背,或闷窒疼痛,其痛如刺,常自行含服速效救心丸缓解,两胁胀痛。查体:T36.2℃,P84次/分,R20次/分,BP120/80mmHg。心率84次/分,律齐,肝脾未及,双下肢无浮肿。舌质暗红,有瘀斑,苔白,脉涩。辅助检查:心电图:窦性心律,心率84次/分,律齐,V1~V6导联广泛ST段轻度下移,T波低平。作出中医病证诊断及西医疾病诊断。

答案

参考答案:

中医病证诊断:胸痹,气滞血瘀证

西医疾病诊断:冠心病(不稳定型心绞痛)

解析:中医辨病辨证依据:患者以"胸闷疼痛"为主症,结合心电图检查,属于中医"心痛"范畴。患者老年男性,平素喜生气恼怒,恼怒则肝气郁结,气为血之帅,气行则血行,气滞则血瘀,瘀血阻于心脉,络脉不通,不通则痛,故见胸部刺痛,其痛如刺,且常因情绪波动而加重。舌质暗红,有瘀斑,苔白,脉涩为气滞血瘀之象;四诊合参,证属气滞血瘀。本病病位在心,病性以标实为主,病程较长,易反复发作,预后不佳。西医诊断依据:冠心病的诊断主要依赖典型的临床症状,再结合辅助检查发现心肌缺血或冠脉阻塞的证据,以及心肌损伤标志物测定判定是否有心肌坏死。发现心肌缺血最常用的检查方法包括常规心电图和心电图负荷试验、核素心肌显像。有创性检查包括冠状动脉造影和血管内超声等。但是冠状动脉造影正常不能完全否定冠心病。通常,首先进行无创且方便的辅助检查。

阅读理解

Miss Maynell and I grew to know each other through the mail. When World War II ended, I returned from Europe. We planned our first meeting at the Grand Central Station in New York.

At seven, I was in the station and waited for the girl whose heart I loved but whose face I’d never seen.

Suddenly a girl in a green suit was coming toward me. I stood up from the bench and started toward her, completely forgetting to notice that she was not wearing a rose.

“Going my way, sailor?” the girl murmured, walking away quickly. I made one step closer to her and then I saw Miss Maynell, who was well past 40, standing almost directly behind her with a red rose. I felt something even better than love. I didn’t hesitate and walked to her. “I’m John Blanchard, and you must be Miss Maynell,” I said, feeling shocked by the bitterness of disappointment. “I’m glad you could meet me. May I take you to dinner?”

The woman smiled. “I don’t know what this is about, son,” she answered. “But the young lady in the green suit begged me to wear this rose. And she said if you were to invited me to dinner, I should tell you that she is waiting for you in a big restaurant across the street. She said it was some kind of test!”

54What did John Blanchard go to the station for?        

A. To see the middle-aged woman

B. To wait for a girl from Europe.

C. To invite the woman with a rose to dinner.

D. To meet his lover as planned.

55.How could John Blanchard recognize the girl?       

A. By her green suit                              B. By her red rose

C. By her beautiful face                      D. By her pictures

56 Why did John feel disappointed? Because _______.

A. he realized that it was not love

B. he found the girl was going away

C. he failed to find the girl with a rose

D. he knew that the girl would test him.

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