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病史郭老,男性,78岁,初中文化,离休干部。因肢体抖动7年加重伴步行困难1年就诊入院。病人于7年前无明显诱因出现右手抖动,静止时明显,活动及持物时减轻,继而渐出现右下肢和左侧肢体抖动,近1年来肢体抖动加重,感步行困难,行走发僵,小步往前冲,持物进食等均有困难。持续服用美多巴治疗,近年来效果不好,有时出现不能起床活动,进食缓慢。大小便尚可,怕热,出汗多,睡眠可。已婚,育有一男两女,配偶及子女均体健。家庭关系融洽,经济状况良好,个性乐观开朗。10年前曾患脑梗死已治愈,否认高血压及心脏病病史。病人及家属对所患疾病的相关知识了解不多。
身体评估体温36.6℃,脉搏68次/分,呼吸20次/分,血压146/60mmHg。意识清醒,双侧瞳孔等大等圆,直径2.5mm,光反应灵敏;面部油脂多,表情有些呆板;咀嚼和吞咽缓慢,进食固体食物时明显;能回答问题,但语音断续,语调低,语速慢;四肢肌力正常,肌张力明显增高。呈齿轮样强直,右侧明显,可见手指“搓丸样”动作;不能扣纽扣和系鞋带,写字越写越小;步行时呈慌张步态;病理征(-),腱反射(++)。双肺呼吸音清,未闻及罗音,肝脾肋下未扪及。
实验室及其他检查血常规:血红蛋白135g/L,红细胞5.01×1012/L,白细胞8.9×109/L,血小板170×109/L;大、小便常规(-),肝肾功能正常。心电图大致正常,X线胸片示右下肺纹理增粗,头颅MRI未见明显异常。
请分析:

该病例的医疗诊断是什么

答案

参考答案:

解析:帕金森病

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阅读理解

                                              Just Around the Corner

       I have a friend named Jim.  He lived just around the corner from me,  The days go by, and before

I know it, a year is gone.  I never see my old friend's face.  He knows that I miss him too,  as I used to

ring his bell,  and he rang mine,  in the old days.   If  we were younger, things might be different, but now, we are busy, tired men.  We are even tired of playing games.

       "Tomorrow," I said to myself, "I will call on Jim just to show that I'm thinking of him. " But tomorrow

comes and tomorrow goes,  and the distance between us grows and grows.

       Around the corner! His house is only three miles away from here. One day a postman came.  "Here's a telegram (电报) for you, sir," he said.  I opened it and was surprised.  "Jim died today. " And that's what we get in the end.  Around the corner,  a friend is gone.

       So remember: If you love your friends and family, tell them and show your love to them.  When you

think that it is the right time, it might be too late.

1. Where did the writer's friend live?      

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2. Did they meet each other very often?      

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3. How far is the friend's house away? 

                                                                                                                                               

4. What happened to the writer's friend?      

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5. What should you do if you love your friends and family?      

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