问题 单项选择题 A2型题

患者女性,因发热,体温38.9℃入院,呈贫血貌,全身散在出血点,瘀斑,口腔多发溃疡,血常规示三系降低,最可能的诊断是()。

A.缺铁性贫血

B.急性白血病

C.特发性血小板减少性紫癜

D.再生障碍贫血

E.免疫性血小板减少性紫癜

答案

参考答案:D

解析:主要表现为进行性贫血、出血和感染,肝、脾、淋巴结多无肿大。根据起病急缓和病情轻重及病程长短分为急性再障和慢性再障两型。1.急性再障(重型再障Ⅰ型)较少见,起病急,发展快,早期即可出现出血及感染,随病程延长出现进行性贫血。多发生口腔、牙龈、鼻腔等黏膜及皮肤广泛出血,内脏出血多见,如消化道出血、血尿、子宫出血等。多数病例有眼底出血,约1/2病人可发生颅内出血,是本病死亡的主要原因之一。皮肤、黏膜及肺部反复感染,多合并败血症,感染不易控制。如不经治疗,多在6~12个月内死亡。2.慢性再障较多见,起病缓慢,病程长,多以贫血为主要表现,感染、出血症状较轻,经恰当治疗病情可缓解或治愈,预后相对较好。少数病例病情恶化(重型再障Ⅱ型),表现同急性再障,预后极差。辅助检查1.血象全血细胞减少,呈正细胞正色素性贫血。急性再障网织红细胞显著减少,慢性型可轻度增多,但绝对值低于正常,白细胞减少,以中性粒细胞减少为主,淋巴细胞相对增多,血小板均减少。2.骨髓象急性再障增生低下或极度低下,粒、红两系均明显减少。巨核细胞显著减少,淋巴细胞、浆细胞、组织嗜碱细胞也相对增多。慢性型增生降低或呈灶性增生,但巨核细胞均减少。

单项选择题

Modern Japan, despite its ready adoption of Western manners, is in things theatrical still faithful to the ancient feudal day. It is true that within the last few years, the old school drama has to some extent lost ground, and quite recently performances of Shakespeare’s Othello and Hamlet, and Daudet’s Sappho have been received with favor by Tokyo audiences.

The explanation of this curious survival of the old form of play, at a time when all Japan is eagerly imitating the foreigner, is undoubtedly to be found in the peculiar customs of the country. The progressive Japanese finds it easier to change his mode of dress than to reform habits bred in the bone. The old plays, lasting, as they formerly did, from early morning until nearly midnight, just suited the Japanese play-goer, who, when he does go to the theatre, makes an all-day affair of it. Indeed, theatre-going in Japan is a very serious matter, and not to be entered upon lightly or without due preparation. Recently Sada Yoko and Oto Kawakami, who learned a good deal in their foreign travels, introduced the comparatively short evening performance of three or four hours, an innovation which was at once welcomed by the better class of people. But the new arrangement found little favor with the general public, and particular indignation was aroused in the bosom of the Japanese Matinee Girl who loves to sit in the theatre as long as possible and weep over the play. For, to the young gentlewoman, the theatre is essentially the place for weeping. Japanese girls are extremely sentimental, and a play without tear-provoking situations would not appeal to them in the least.

The Japanese women are passionately devoted to the drama. It is usual for a party to book a box through a tea house connected with the theatre and at the same time make arrangements for what refreshments they wish served. The Japanese maiden makes the most elaborate preparations days beforehand. To be at the theatre on time, playgoers must rise with the sun, and all their meals, including breakfast, are eaten in the tiny box in the playhouse. It is not an easy task to reach one’s seats and once the family has settled down, nothing but a catastrophe would induce it to leave its box. The women chew candy and the men freely drink sake as the play goes on.

The emphasized difference between the Japanese play form and the foreign one is in ().

A. the length

B. the costume

C. the acting

D. the innovation

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