儿科专业病例讨论规范格式及要求

儿科专业病例讨论规范格式及要求 儿科专业病例讨论规范格式及要求: (一)标题样式: 儿科病例讨论:男/女，x岁，主诉(或所要讨论的问题，可不只限于主诉) (二)正文样式: 【一般资料】: 性别+年龄+其他有必要交待的资料。 【主诉】: 要求同实际病历，不超过20字，高度概括病情。 【病史】: 要求完整、清晰、简练、语言规范。 具体格式不限，最好和临床病历有所区别，不要大段粘贴。 【辅助检查】: 完整，简练。 阴性结果只须一带而过。 最好有图片，单一帖图只需添加附件。 【诊断】: 诊断可以作为提问不写，交给大家讨论。 【治疗经过】: 可作为提问。 治疗经过描述层次清晰、简练，也可以作为请教，交大家讨论。 发帖当时未诊断明确，或治疗病程复杂者，应作后续报道。 【手术】: 该患者有进行手术治疗的应该做后续报道。 【病理】: 未做手术者略。 特殊病例应提供病理资料。 应该做后续报道。(手术 病理 两项，基于有些资料无法获得，不做要求) 【讨论】/【请教】: 儿科临床病例讨论相关资料 application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check 病例讨论 1、患儿，女性，出生6天。3天前发现巩膜黄染，颜面、躯干也逐渐出现黄染。无发热，无咳嗽，无呕吐，无抽搐，尿便颜色较深，食欲尚好。母孕期健康，未服过任何药物。第一胎第一产，无胎膜早破和产程延长，足月会阴侧切阴道分娩，出生体重3.5kg，Apgar评分9分。母乳量少，鲜牛乳喂养为主。未服过任何药物。父母身体健康，家族中无肝炎、结核及 0黄疸病例。体格检查:T 36C，P 120次/min，R 42次/min。发育良好，营养中等，哭声响亮，神志清楚。巩膜、颜面明显黄染，躯干及四肢可见黄染，颜色鲜亮，皮肤无水肿，无出血点及瘀斑。顶枕部有一隆起包块，5cm×7cm大小，边界清楚，未跨越颅缝，有弹性。前囟1.5cm×1.5cm，张力不高。双肺呼吸音正常。心率120次/min，节律规则。腹略饱满，脐部清洁干燥，肝脏于肋下2cm，质软，缘锐，脾脏未触及。四肢肌力及肌张力正常。觅食反 9射、拥抱反射、握持反射存在。辅助检查:(1)血常规:白细胞总数 20.0×10/L，中性粒细胞 55%，淋巴细胞 45%，血红蛋白 150g/L，网织红细胞 1%，血型“O”。(2)尿液分析:尿胆原阳性，尿胆红素阴性。(3)血总胆红素205μmol/L;结合胆红素22μmol/L。肝功能检查无异常。(4)B超示:肝、脾、胆囊无异常。 (A)目前的诊断及诊断依据是什么, (B)引起新生儿生理性黄疸加重的因素有哪些, (C)病理性黄疸的诊断要点是什么, (D)引起病理性黄疸的新生儿疾病有哪些, (E)母乳性黄疸的原因是什么, 2、男婴，13天，因皮肤发黄3天，今日拒奶而住院。足月分娩，出生时Apgar评分9分，出生体重3.3kg，生后第二天皮肤发黄，第六天已消退。自出生第10天开始皮肤发黄，并逐渐加深，吃奶差，今日拒奶，母妊娠时HbsAg(,)。体格检查:体重3.4kg，体温35.6?，心率120次/分，呼吸42次/分，哭声低，反应差，全身皮肤黄染明显，巩膜发黄，前囟平，心肺(,)。脐部残端有脓性分泌物渗出，腹略胀气，肝肋下3cm，脾肋下1cm可触及，质 9软。血白细胞27×10/L，中性88%，淋巴12%。 (A) 目前的诊断及诊断依据。 (B) 进一步作哪些检查, (C) 目前治疗的原则包括哪几方面, 3、患儿，男性，出生2天。生后3个小时家长发现呼吸费力，口周有青紫，呼吸逐渐不规则，并有呼吸暂停现象，青紫范围渐加重。不喝水，不吃奶。无发热，无咳嗽，无呕吐腹泻，无抽搐。已排胎便2次，排尿1次。患儿为第一胎，38周剖宫产，出生时Apgar评分为9分。家族史无特殊记载。体格检查:T 36?，R 66次/min。呼吸不规则，呼气时呻吟。反应低下，哭声无力。面色苍白，口周明显青紫，鼻翼扇动。心音较弱，心率 168次/min。双肺呼吸音低，可听到细小湿性罗音。腹软，肝脏于肋下2cm，脾脏未触及。四肢肌张力低下， 9末端凉，发绀。拥抱反射未引出。辅助检查:白细胞总数 12.1×10/L，血红蛋白 140g/L;胸部X线片显示两肺透过度下降，双肺均匀的细小颗粒状阴影，可见支气管充气征。 (A) 目前的诊断及诊断依据。 (B) 如何帮助确定诊断。 (C) 该病的主要病因是什么, (D) 该病的病理特征是什么, (E) 该病需与哪些疾病鉴别, checkd pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image r bloon nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testiculanic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infectiodiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chrodisease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image ra-disease nia incritical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as syndroardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response fe support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common gued card and clinical application; common liapplication; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapt2 4、患儿1岁2个月， 腹泻8天，每天10余次，黄色稀水便，体检:体重10kg，精神萎靡，皮肤弹性极差。前囟及眼窝明显凹陷，血压偏低，四肢冰冷，可见皮肤花纹，血清钠125mmol/L，血清钾2.8mmol/L，请作出诊断并制定第一天的补液。 05、患儿，女性，1 岁。因呕吐、腹泻3天入院。3天前先有发热，体温最高达39C，服退热药后发热可消退。随之出现呕吐，呕吐物为胃内容物，每日3,5次。大便变稀，量多，淡黄色，后为蛋花汤样，无特殊臭味，每日10余次。无咳嗽，无喘促，每日排尿1次。口 0渴多饮，不进食物。服“消炎药”末见好转。体格检查:T 36.5C，神志清楚，精神萎靡。皮肤弹性较差，干燥。浅淋巴结无肿大。前囟已闭。眼窝明显凹陷，哭时少泪。口唇干燥。心音有力，节律规则，心率136次/min。双肺呼吸音无异常。腹平软，未触及包块，无压痛及反跳痛，肝脏于肋下2.0cm，脾脏未触及，肠鸣音活跃。四肢活动自如，双手指发凉。神 9经系统无阳性体征。辅助检查:血常规:白细胞总数:8.5×10/L，中性粒细胞:45%，淋巴细胞:55%。大便常规:为水样便，白细胞0-3个/HP。血HCO3-为18 mmol/L。 (1)该病应诊断为: (2)诊断依据: (3)该患者儿出现低血钾的原因是什么, 06、患儿，男性，8个月。3天前起开始发热，体温在37,40.5C之间波动，咳嗽呈阵发性，有痰咯不出，引发多次呕吐，呕吐物为胃内容，混有黄色粘液痰。因呼吸困难而就诊。患病以来食欲明显下降。排稀便，一日2,4次，尿量明显减少。无抽搐。既往健康。患儿为第一胎第一产，母孕期健康，足月顺产，生后母乳喂养，规律添加辅食，生长发育过程无异常，预防接种按时进行。家族中无结核、肝炎病例。体格检查:T 39.5?，P 176次,min，R 66次,min。发育良好，营养中等，热病容，神志清楚，精神烦躁，查体哭闹。皮肤弹性尚好，无出血点，无黄染，颈部和躯干部可见风团样斑丘疹。浅表淋巴结未触及肿大。前囱未闭，约0.5cm×0.5cm，张力不高。鼻翼扇动，口周发绀，呼气伴呻吟。气管位置居中，胸廓对称，肋间隙无明显改变，吸气时可见三凹征。右肺部肩胛下叩诊浊音，听诊呼吸音减弱，可听到中小湿罗音，语音传导增强，无胸膜摩擦音。心音低钝，心率176次,min，心律规整，无杂音。腹略显膨满，无压痛及反跳痛，肝脏于肋下4.5cm，边缘钝，表面无结节，脾脏可触及边缘，肠鸣音减弱。四肢活动自如。双手及双足凉。神经系统检查无异常体征。辅助检 9查:(1)血常规:白细胞总数5.2×l0,L，中性粒细胞 81,，杆状核粒细胞 3l,，淋巴细胞 16,。(2)胸部X线片显示:双肺门影增强，肺纹理增强，右肺中叶大片密度增高阴影，双侧肋膈角锐利清晰。 (1)该患儿应诊断为什么病, (2)最可能的致病菌是哪种, 3)可能出现的并发症还有哪些, ( (4)心力衰竭主要诊断依据有哪些, 07、患儿，男性，12岁。10天来发热，体温37.5,38.5C，服“扑热息痛片”可退热。伴咳嗽，由声声干咳发展到刺激性阵咳，痰粘稠。偶有头痛，可以忍受。胸痛较明显。发病以来疲乏无力。食欲下降，尿便正常。曾在当地诊所诊断不详，使用“青霉素”和“先锋霉素V”各4天未见效，同班同学中数人有相似表现。既往史:既往健康，无药物过敏史，上小学五年级，无不良嗜好。预防接种均按时进行。父母健康，家族中无结核、肝炎等病例。体格检 0查:T 38.0C，P 96次/min，R 28次/min。发育可，营养中等，阵阵咳嗽，神志清楚，精神萎靡，查体合作。皮肤未见皮疹、出血点及水肿，浅表淋巴结无肿大。眼结膜充血，巩膜无 ge, and skills requirements: understand various image checkain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledke brrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit lidisease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor ad diation: rheumatic heart congenital heart intestinal Crohn's (Crohn)disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image ra-s and cases of study requirements: severe pneumonia in diseasepeciesevere disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) s e organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS),d acutt,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest anrt of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition supporapplication; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition suppo3 o黄染。口腔无异味，咽充血明显，双侧扁桃体?肿大。气管位置居中，甲状腺不大。胸廓对称，呼吸运动对称，肋间隙无变化，无语颤增强区，叩诊音无明显异常，双肺呼吸音无异常，深吸气时双肺底可听到细小湿罗音，偶有干罗音，无胸膜摩擦音。心音有力，心律规则，心率96次/min。腹平软，无肌紧张，无压痛和反跳痛，肝脏和脾脏未触及。四肢肌力及肌 9张力正常。神经系统检查无阳性体征。辅助检查:血常规:白细胞总数10.0×10/L，中性粒细胞 65,，淋巴细胞 35,，血红蛋白 110g/L，尿常规白细胞0,3个,HP。冷凝集试 :64(+)。 验滴度为1 (1)该病的诊断及诊断依据: (2)进一步确定病原菌的方法有哪些, 8、患儿6岁，发热、流涕、咳嗽2天，体温38,39?，诉耳鸣、头晕、恶心未吐、无痰，浅表淋巴结不大，咽红，咽峡无疱疹，双肺呼吸音粗，无罗音，心率120次/分、1,2次/分早搏，心前区第一心音低钝，肝、脾肋下未及，下肢不肿，克氏征、布氏征阴性。WBC 7.59×10/L，N 0.72。 9、患儿男，10岁，浙江定海籍，低热2周，气促伴乏力一月入院，病初淋雨后发热38?。伴腹泻水样便3-4次/日，经治疗后热退，腹泻止但患儿显乏力，活动后气促，咳嗽，轻度气喘，抗炎治疗无效。过去史和家族史无特殊。体检:T38?双肺正常，心界向左下稍大，HR:94次/分，心前区第1心音低钝，5-8次/分早搏，无杂音，肝肋下1cm尚软，下肢不肿，关节无红肿，无杵状指(趾) 。X线:示心影左下扩大;E.K.G窦性心律不齐，频发房性早搏。 910/L，N:38,， L:60,，E:心肌酶谱示 CPK:113H/L，LDH:175U/L，WBC:9.7× 2,，血沉:5mm/h，抗O :250μ，粘蛋白正常。 就病例诊断和鉴别作简要分析。 10、患儿，男性，3.5岁。患儿在哭闹中突然意识丧失，呼叫不应，面色青紫，四肢瘫软，经按压人中穴，约3min后清醒。无发热，无咳嗽，无呕吐腹泻，无外伤史，尿便正常。患儿5个月起偶有轻度青紫，后进行性加重。家长述:患儿自小喜静少动，每有活动时，即出现呼吸困难，主动蹲下片刻，可缓解。既往史:既往无其他疾病，母孕期健康，未服过药物。第一胎第一产，生后母乳喂养。生长发育大致正常。家族史无特殊记载。体格检查:T 36.5?，P 116次,min，R 38次,min，BP 12/8kPa(90/60mmHg)。发育尚可，营养中等，自动体位，表情安详，面色发绀，神志清楚，查体合作。皮肤粘膜无黄染，无出血点。浅表淋巴结无肿大。双侧瞳孔等大正圆，直径3mm，光反射迅速。双肺听诊无异常。心前区略隆起，心尖搏动弥散，心界无明显扩大，心率 116次,min，心律规则，胸骨左缘第2,4肋间可听到2,3,6级柔和的喷射性收缩期杂音，肺动脉瓣听诊区第二心音减弱。无周围血管征。腹部肝脏和脾脏未触及。四肢活动良好，四肢未端可见发绀及杵状指(趾)。双侧膝腱和跟腱反射 9存在，脑膜刺激征阴性，巴彬斯基征未引出。辅助检查:白细胞总数9.6×l0,L，血红蛋 12白 155g,L，红细胞数 6.0×10/L。脑电图无异常。 1)该病的入院诊断及诊断依据; 2)患者儿出现晕厥的原因; 3)患儿下蹲后呼吸困难缓解及出生时并无青紫的原因; 11、患儿，男性，13个月。患儿自6天前开始发热，体温39?以上，持续不退。有阵发性咳嗽伴喘憋，无痰。曾用红霉素和庆大霉静脉点滴4天无效。发病以来偶有咳嗽后呕吐，呕吐物为胃内容物。稀便，每日2,4次。无抽搐，无尿频及排尿时哭闹。食欲明显减低。既 r bloon nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testiculanic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infectiodiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chrodisease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image ra-disease nia incritical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as syndroardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response fe support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common gued card and clinical application; common liapplication; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adaptcheckd pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image 4 往史:既往身体健康，无结核、肝炎等接触史。预防接种均按时进行。母孕期基本健康。足月顺产，生后母乳喂养，比较规律地添加辅食。生长发育情况与同龄儿相比无明显差异。家族中无结核、肝炎病例。体格检查:T 39.2?，P 156次/min，R 50次/min。营养中等，神志清楚，精神萎靡，嗜睡，对刺激有反应。皮肤无出血点及黄染。浅表淋巴结无异常，双肺可听到中小湿罗音，以双侧肺底更为明显。心音低钝，心率156次/min，无杂音。腹软，肝脏于肋下2.0cm，质软，脾脏未触及，肠鸣音3,5次/min。四肢活动良好，下肢无水肿。神 9经系统检查无阳性体征。辅助检查:WBC 8.0×l0,L，L 65,，N 35,。胸部X线片显示双肺下叶局部气肿。心电图示窦性心律，心率150次/min，电轴不偏，P-R间期等于0.135S，QRS波群无明显民常，T?、Avf、V5倒置。 12、患儿，男，10岁。鼻塞、咳嗽5天，低热2天，伴胸闷、气促、烦躁，不能平卧，轻度青紫，既往无心脏病史，双肺呼吸音粗，少量中湿罗音，心界向两侧扩大，心率140次/分，S1明显低钝，肝肋下3cm，下肢轻度浮肿神经系统(,)，CPK-MB 256U，X线和EKG9示左右心室扩大，WBC 6.8×10/L。 (1)最可能的诊断是什; (2)应首先应用的药物是; (3)如何选用洋地黄制剂。 13、患者，男性，13岁。因头晕、牙龈出血于1995年在当地医院就诊。查血象三系细胞减少，骨髓增生低下，诊断为"再生障碍性贫血"，用"丙酸睾丸酮"及中药等治疗，疗效不佳。1999年起反复出现睡眠后酱油色尿，因近4天来乏力明显而就诊。体格检查:贫血貌，巩膜黄染(+)，全身浅表淋巴结不大，胸骨无压痛，两肺检查无异常，心尖部可闻及2/6级收缩期吹风样杂音，腹软，肝肋下未触及，脾肋下1.0cm。辅助检查:Hb 40g/L，RBC 1.32×12910/L，RC 0.30, MCV 95fl, MCH 31pg, WBC 3.9×10/L，中性杆状核粒细胞4%，中性分叶核粒细胞56%，L 40%;分类100个白细胞，可见晚幼红细胞4个，部分成熟红细胞有畸型 9和碎裂;PLT 90×10/L;尿胆原(++)，血清总胆红素 40.5μmol/L，间接胆红素 29.5μmol/L，BUN、肝功能检查正常;骨髓象增生明显活跃，粒:红比为0.66:1，粒系占0.32，形态正常;红系明显增生，占0.50，原红0.005，早幼红0.015，中幼红0.22，晚幼红0.26，全片可见36个巨核细胞，比例及形态正常，血小板易见;抗人球蛋白(Coombs)试验(,)，Ham试验(+)，含铁血黄素(Rous)试验(+)，糖水试验(+)。 (1)该病的诊断是什么, (2)诊断依据是什么, 14、患儿5岁，浮肿2周。体格检查见全身浮肿，精神不振，腹水征阳性，血压82.5/60mmHg。尿检示尿蛋白+ + + +，血浆白蛋白20g,L，血胆固醇6mmol/L，尿素氮3.5mmol/L。 (1)诊断应为: (2)服强的松每日35mg，1周后水肿消退，2周后尿蛋白转阴，可能的病理类型是: (3)尿蛋白转阴后选择激素减量的方案是: ?15、6岁女孩，全身浮肿4天，有头痛、眼花，尿色暗红。2周前因患急性扁桃体炎，经青霉素治疗后好转。 (1)首先应进行的检查是: (2)最有价值的实验室检查是: (3)检查结果尿蛋白(2，,3，)，尿红细胞20,30个/HP，血清总蛋白55g/L，白蛋白40g/L， ge, and skills requirements: understand various image checkain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledke brrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit lidisease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor ad diation: rheumatic heart congenital heart intestinal Crohn's (Crohn)disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image ra-s and cases of study requirements: severe pneumonia in diseasepeciesevere disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) s e organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS),d acutt,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest anrt of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition supporapplication; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition suppo5 补体C3下降。给予青霉素和低盐饮食治疗1周后，浮肿消退。最可能的诊断是: (4)最可能的病理类型是: 16、患儿，男，6岁，因反复四肢关节疼痛伴发热6个月住院。六个月前，无明显诱因患儿出现右肩关节疼痛，右上肢不能抬起，发热37,38?，进食后恶心，未吐，家长予患儿服消炎痛、胃舒平5天，病情好转。约3,4周后，患儿又出现踝关节、膝关节髋关节疼痛，夜间明显，关节疼痛严重时不能入睡，活动受限，伴发热38?左右，当地就诊，查骨关节线X未见异常，血沉明显增快，诊为"类风湿关节炎"，给予阿斯匹林、青霉素治疗3周，病情好转，自行停药。以后每月均出现四肢关节疼痛，活动受限，低热，间断服消炎痛或阿斯匹林、能缓解疼痛。住院前10天，左下肢关节痛明显，来我院内科结缔组织病专业就诊，以"肢体疼痛待查"收我院。病后精神食欲尚好，无关节肿胀，无皮疹，无鼻出血，大小便正常。查体:神志精，精神可，呼吸平稳，自动体位，无贫血貌，皮肤无黄疸、皮疹、出血点，颈、颌下、腋下、腹股沟区浅表淋巴结无肿大，咽部稍充血，双扁桃体无肿大，双肺呼吸音清，心率96次/分，心律齐，未闻杂音，肝脾未触及，左膝关节无肿胀，轻压痛，无活动受限，双胫骨轻压痛。实验室检查:血常规:WBC 7.3×109/L，GR 55%，LY 45%，RBC 6.46 129×10/L，Hb 173.g/L，Plt 227×10/L，血涂片未见异常细胞，ESR 40mm/h，骨关节线X:左膝关节干骺端处骨密度略高，骨小梁模糊，无骨破坏，无软组织肿胀。 (1)本病的可能诊断: (2)要确诊首先需进行何种检查: 3)骨髓穿刺四次均为干抽，第五次骨髓穿刺成功，骨髓象示骨髓增生活跃，粒红系统发( 育不良，原始幼稚淋巴细胞83%，胞体大小不等，以大为主，胞浆少，核染色质细，有核小体，偶见巨核细胞血小板，诊断应为, 17、患儿14个月，不爱活动，食欲减退，皮肤粘膜逐渐苍白，体格检查见肝脾淋巴结轻度 MCV 79fl，MCH 27.5pg，MCHC 0.28，血涂片中红细胞变小，中肿大，血象Hb 7.5g,L， 间淡染，网织红细胞正常，白细胞和血小板正常，骨髓象示有核红细胞增高，血红蛋白含量少，铁粒幼细胞减少，追问病史，未按时添加辅食。 (1)该患儿应诊断为; (2)有助于确诊的检查应首选; (3)恰当的治疗是什么, 18、患儿9个月，因间断腹泻2个月，面色苍白1个月住院。足月顺产，母乳喂养，按时添加辅食。体检:皮肤粘膜苍白，头发稀黄，颜面稍显浮肿，肝脾轻度肿大，Hb 80g/L，红细12胞数2.2×10/L，网织红细胞正常，骨髓象出现巨红细胞，胞核发育落后于胞浆。 (1)初步诊断为: (2)该患儿致病的主要原因是: (3)治疗除积极治疗腹泻外，首选的是: 19、患儿，女性，6岁。一周来头痛，为弥漫性胀痛，阵发性发作，初起可忍受。近2天加重，伴呕吐，呈喷射状。今日上午抽搐1次，意识丧失，角弓反张状，持续约5分钟缓解。因意识不清，口角歪斜来诊。半月来持续低热，少言，懒动，食欲减低，体重减轻明显。既往史:既往平素健康，活泼好动。预防接种史不能说清，无药物过敏史。第二胎二产，出生史及生长发育史正常。无不良嗜好。父母均健康，奶奶有“肺病”已10多年。体格检查:T 38.5?，P 102次/min，R 28次/min，BP 90/60mmHg。发育可，体质消瘦，颜面潮红，神 checkd pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image r bloon nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testiculanic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infectiodiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chrodisease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image ra-disease nia incritical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as syndroardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response fe support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common gued card and clinical application; common liapplication; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapt6 志不清，压眶反射存在。皮肤无出血点，无黄染，无水肿，腹部皮肤划痕征阳性。腋窝淋巴结可触及数个，约为花生米大小。右侧面部不能蹙额、皱眉、闭眼，鼻唇沟变浅，口角向对侧偏斜。双瞳孔等大等圆，直径4mm，对光反射略迟钝，眼球运动尚好。口腔无异常气味，伸舌无偏斜，喉发音正常。气管居中。双侧肺部无异常。心率102次/min，心音纯，心律规则。腹略胀，无肌紧张、压痛和反跳痛。肝脏于肋下2.0cm，脾脏未触及。四肢活动尚好，肌力及肌张力大致正常。双侧膝腱反射亢进，颈反射强阳性，布鲁辛基征阳性，克尼格征阳 9性，巴彬斯基征双侧阳性。辅助检查:WBC 15.0×10/L，N 39%，L 61%;胸部X 线片显示双肺肺纹理增粗，右肺中下肺野近心缘旁可见边缘模糊不清的絮状密度增高阴影，肺门有团块状阴影，界限不清。 (1)该病的诊断是: (2)出现面部体征的原因是: 、患儿，男，11个月，因发热、呕吐2天伴惊厥3次来院就诊。入院查体:体温39.2?，20 昏睡状，前囟1cm×1cm，略膨隆，紧张，颈抵抗，咽红，肺呼吸音粗，心、腹未见异常。 9克氏征、布氏征阳性，末梢血白细胞17.2×10/L，N 72%，L 28%。 (1)首先应做何检查: (2)此患儿最可能的诊断是: (3)确诊后首选抗生素组合应为: ge, and skills requirements: understand various image checkain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledke brrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit lidisease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor ad diation: rheumatic heart congenital heart intestinal Crohn's (Crohn)disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image ra-s and cases of study requirements: severe pneumonia in diseasepeciesevere disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) s e organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS),d acutt,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest anrt of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition supporapplication; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition suppo7