本帖最后由 鬼才 于 2011-7-13 09:33 编辑
流行性感冒 Influenza (1) Intern: Good Morning, Dr. Zhang. 实习医生:张医生,您好。 Dr. Zhang: Good Morning. Let’s makethe morning ward-round. 张医生:您好,咱们查房吧。 Intern: OK, This is a new patient who was hospitalized last night because of febrile convulsion. He is a two – year – old boy. 实习医生:好的,这是一名昨天夜里新收的病人,因高热惊厥入院,是个两岁的男孩。 Dr. Zhang: How about his temperature? Have any antipyretics and sedatives been given? 张医生:他的体温情况如何?给过解热药和镇静抗惊厥药了吗? Intern: his temperature is as high as 40.2℃(centigrade). Aspirin has been given orally.the dose is 150mg. And Sodium Luminal was given intramuscularly. The dose is 75mg. Drugs have already quieted him down. 实习医生:他体温高达40.2℃,已给阿司匹林150mg口服及鲁米那75mg肌注,药物已经使他安静下来了。 Dr. Zhang: Anything else? 张医生:还给什么了? Intern: Also gave him some fluid, I mean, 500ml of 10% glucose solution with vitamine C 1.0g by intravenous drip, and placed an ice bottle on his forehead. 实习医生:还给他静点了液体,10%葡萄糖液500ml 加维生素C 1g,并在他前额上放置了冰袋。 Dr. Zhang: Well done. Pass me his medical record, Please. 张医生:干得好,请把他的病历递给我。 Intern: Here it is. 实习医生:好。 Dr. Zhang: Thank you. Let me see … Present illness. 张医生:谢谢,让我们来看一下……现病史吧。 Intern: The boy had a fever the day before yesterday,with clear nasal discharge, mild cough, headache, sore throat, anorexia, vomiting and mild diarrhea. His parent regardedit as common cold, and gave him some Aspirin. The following day, Penicillin was given by intramuscular injection, with does of 400 000U each time, twice a day. It seeme not effective. 实习医生:这孩子前天开始发烧,伴流清涕。轻咳,头痛、咽痛、食欲不振、呕吐及轻微腹泻。家长认为是感冒,服了阿司匹林。次日肌注青霉素40万U,每日二次,看起来没什么效果。 (2) Dr. Zhang: Has he ever had the history of febrile convulsion? 张医生:他既往有高热惊厥史吗? Intern: Yes. The attack occurs each time his temperature is over 39℃(centigrade). 实习医生:有,每当他体温超过39℃时,就会发生高热惊厥。 Dr. Zhang: Is there an epidemic fever in his kindergarten? 张医生:他们幼儿园里有发烧流行吗? Intern: Yes, Two-thirds of children in his kindergarten have fever this week. They have the symptoms similar to his. 实习医生:有,这周幼儿园里有三分之二的孩子都发烧了,症状与他相似。 Dr. Zhang: I see, let me take physical examination for him. 张医生:我明白了,来给他查体吧。 Intern: No abnormal signs except for redness and enlargement of his tonsils. 实习医生:除了双侧扁桃体充血、肿大外,无其他异常。 Dr. Zhang: No rashes? 张医生:无皮疹吗? Intern: No. 实习医生:没有。 Dr. Zhang: Any blood test? 张医生:做血液检查了吗? Intern: Yes. White blood cell show WBC 4000/mm3, N 34%, L 66%. May I think of this case as the infection of upper respiratory tract? 实习医生:验过了,白细胞总数4000/mm3(4×109/L)中性34%,淋巴60%,我可以认为这个病例是上呼吸道感染吧? Dr. Zhang: Yes, but what's the causative pathogen? 张医生:可以,但病原是什么呢? Intern: Upon analysis of clinical characteristic, laboratory and epidemic data, we can almost confirm the diagnosis of influenza. The causative pathogen is surely influenza virus, do you agree? 实习医生:依据临床特征,实验室及流行病资料,我们几乎可以确诊为流感了,那病原当然是流感病毒了,你同意吗? Dr. Zhang: Yes, I think so. It'll be much more perfect that we have the evidence about isolation of virus. 张医生:同意,要是有病毒分离的依据就更完整了。 Intern: May I consider the prognosis of influenza is generally good? 实习医生:可否认为流感的预后一般说来是良好的? Dr. Zhang: Yes, in general speaking, it's not poor, but it's no harm to keep an eye on the underlying problem, for example, brain damage, myocarditis, etc. Oh, it's time for us to give our orders. Stop here. 张医生:一般来说,预后良好,但留心那些潜在的问题是有益的,如脑损害,心肌炎等。哦,我们该开医嘱了,就到这里吧。 |