试题与答案

患者男,65岁,因“右胸痛、发热、气促、轻度咳嗽”来诊。发病初期患者自服头孢氨苄胶囊

题型:多项选择题 案例分析题

题目:

患者男,65岁,因“右胸痛、发热、气促、轻度咳嗽”来诊。发病初期患者自服头孢氨苄胶囊无效。患者入院后拟诊上呼吸道感染,先后静脉滴注青霉素、头孢唑林钠等,但效果不佳,患者渐感胸闷、气促。胸部CT及B型超声:右侧胸腔积液伴胸膜增厚,考虑为结核性胸膜炎,换用异烟肼、链霉素及利福平等抗结核药。先后抽胸腔积液3次,共约2000 ml,为草黄色。但患者仍有发热,故转上级医院。查体:T 38 ℃,HR 22次/min,BP 135/80 mmHg。右侧呼吸运动减弱,第4前肋以下听诊为浊音。入院诊断考虑为右侧结核性渗出性胸膜炎;恶性胸腔积液;冠心病。入院后抽胸腔积液2次,为黄色,共1200 ml,相对密度1.018~1.014,李凡他试验阴性,细胞增多,以中性细胞为主,未找到肿瘤细胞。血白细胞也增高,红细胞沉降率110 mm/h,血及胸腔积液结核聚合酶链反应、血军团菌抗体、癌胚抗原及血细菌培养均为阴性,结核菌素试验阴性。胸部X线片:右侧胸膜增厚,上部有波浪状突出,右下肺密度增高,纵隔淋巴结肿大。胸膜活检,病理报告显示:细胞成分丰富,有腺癌样、肉瘤样细胞,以上皮型最多见。给予化学治疗2次,6个月后终因肿瘤广泛转移、全身衰竭死亡。

有助于明确诊断的检查是()

A.胸部CT

B.胸腔积液细胞学检查

C.胸腔镜胸膜活检

D.血液白细胞计数检查

E.支气管镜活检

F.痰脱落细胞学检查

G.胸腔积液透明质酸测定

答案:

参考答案:A, B, C, G

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