血液学硕士专业英语考题.doc

Too often, the physician rushes into the physical examination without looking at the patient for an unusual habitus or appearance of underdevelopment, malnutrition, or chronic illness. These findings can be important clues to the underlying etiology of disease and provide information related to the duration of illness. The skin and mucous membranes are often bypassed so that pallor, abnormal pigmentation, icterus, spider nevi, petechiae, purpura, angiomas, ulcerations, palmar erythema, coarseness of hair, puffiness of the face, thinning of the lateral aspects of the eyebrows, nail defects, and a usually prominent venous pattern on the abdominal wall are missed in the rush to examine the heart and the lungs.1 Perform systematic examination for palpable enlargement of lymph nodes for evidence of infection or neoplasia. Bilateral edema is useful in disclosing underlying cardiac, renal, or hepatic disease, whereas unilateral edema may portend lymphatic obstruction due to a malignancy that cannot be observed or palpated. 2 Carefully search for both hepatomegaly and splenomegaly. Their presence or absence is important, as are the size, the tenderness, the firmness, and the presence or the absence of nodules. In patients with chronic disorders, these organs are firm, nontender, and nonnodular. In patients with carcinoma, they may be hard and nodular. The patient with an acute infection usually has a palpably softer and more tender organ. History: 1. Patients with thrombotic thrombocytopenic purpura (TTP) typically report an acute or subacute onset of symptoms related to neurologic dysfunction, anemia, or thrombocytopenia.1) Neurologic manifestations include alteration in mental status, seizures, hemiplegia, paresthesias, visual disturbance, and aphasia.2) Fatigue may accompany the anemia.3) Severe bleeding from thrombocytopenia is unusual, although petechiae are common.2. Fever occurs in approximately 50% of patients.3. Patients also may notice dark urine from hemoglobinuria.4. Clinical differentiation of HUS and TTP can be problematic and differentiation is often based on the presence of CNS involvement in TTP and the more severe renal involvement in HUS. In HUS, an antecedent history of diarrheal illness is more often present. In fact, some investigators are suggesting a clinical classification of HUS based on the presence or absence of diarrhea.Induction therapy: Various acceptable induction regimens are available. 1) The most common approach is called ”3 and 7,” which consists of 3 days of a 15- to 30-minute infusion of an anthracycline (idarubicin or daunorubicin) or anthracenedione (mitoxantrone), combined with 100 mg/m2 of arabinosylcytosine (araC) as a 24-hour infusion daily for 7 days. Idarubicin is given at a dose of 12 mg/m2/d for 3 days, daunorubicin at 45-60 mg/m2/d for 3 days, or mitoxantrone at 12 mg/m2/d for 3 days. 2) These regimens require adequate cardiac, hepatic, and renal function. 3) Using these regimens, approximately 50% of patients achieve remission with one course. Another 10-15% enter remission following a second course of therapy. 第四题: 请写出下列缩写的对应中文。1. TTP2. ITP3. POX4. PAS 5. NAP6. CML7. AML8. ALL9. NHL10. LGL答案：养不良的表现或慢性疾病，而这些恰巧可能是潜在病因的重要线索，并且可以提供有关病程的信息，因急于检查心肺，而皮肤和粘膜经常被忽略，而漏掉了皮肤粘膜苍白、异常色素沉着、黄疸、瘀点、紫癜、蜘蛛痣、血管瘤、溃疡、掌红斑、头发粗糙（脆发病）、面部肿胀、眉毛稀疏，指甲缺失和腹壁静脉曲张。1、 完成系统体格检查可以发现可触及的肿大淋巴结做为感染和恶性肿瘤的重要证据，对称性的水肿有助于发现潜在的心、肾及肝脏疾患，而不对称的水肿可能预示着看不到或摸不到的肿瘤引起的淋巴管阻塞。2、 仔细查找有无肝、脾肿大及其大小、压痛、硬度、有无结节是很重要的，在慢性病患者，这些脏器是结实、无压痛和结节的，在肿瘤患者，这些脏器可能是质硬并有结节的，在急性感染患者，常是柔软并有压痛的。病史：1、TTP患者典型地报告了急性或亚急性与神经系统功能障碍、贫血、血小板减少有关的发病症状。1） 神经症状包括精神状态的改变、癫痫发作、偏瘫、感觉异常、视觉障碍、失语症。2） 贫血，可能伴有乏力。3） 因血小板减少而致严重出血者少见，而出血点较常见。2、约50%患者发热。3、患者也可注意到因血红蛋白尿而出现黑尿。4、HUS和TTP的临床鉴别也是有区别的：它们之间的区别经常是基于TTP的中枢神经系统症状和HUS较重的肾脏症状。HUS多有一个腹泻的前驱症状，事实上，一些调查研究显示HUS的临床应基于有无腹泻史。联合化疗：几个可耐受的诱导化疗方案是有效的。1） 最普遍的治疗方案是“3+7”方案，它包含3天每天15