病例摘要:王某,女,70岁,农民,于2011年12月6日初诊。20年来反复出现咳嗽,

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病例摘要:王某,女,70岁,农民,于2011年12月6日初诊。20年来反复出现咳嗽,咳白色泡沫样痰,时而咳黄痰,并出现气短,尤以过劳、受凉后症状明显。近1周感冒后出现少尿伴双下肢水肿,口服双氢克尿噻及氨苯蝶啶治疗效果不佳而入院。现症见:喘息气粗,烦躁,胸满,咳嗽,痰黄,黏稠难咳,身热,溲黄便干,口渴。既往体健,无食物药物过敏史。体格检查:T37.9℃,P110/min,R26/min,BP112/75mmHg。神志清楚,端坐位,呼吸略促,舌红,舌苔黄腻,脉滑数。口唇发绀,颈静脉怒张,桶状胸,肺肝界位于右锁骨中线第六肋间,叩诊过清音,双肺下野可闻及干、湿啰音。剑突下可见心脏搏动,心浊音界不易叩出,心音遥远,肺动脉瓣区第二心音亢进,三尖瓣区可闻及收缩期杂音,心律规整。心率110/min。腹软,肝脏于右锁骨中线肋缘下3.0cm,剑突下4.0cm,双下肢水肿。辅助检查:血常规示:WBC11.8×109/L,N0.88,L0.12。心电图显示:窦性心律,肺型P波,电轴右偏+120°,重度顺钟向转位,R+S≥1.05mV。胸片显示:两肺纹理增多、增粗、紊乱,右下肺动脉干扩张,肺动脉段明显突出,右心室增大征,肺功能检测:FEV%35%,MMEF800ml/s,RV/TLC70%。

答题要求:根据给出的病例资料,按住院病历的书写格式完成书面辨证施治

考点:中西医结合执业助理医师实践技能呼吸内科常见疾病呼吸内科常见疾病题库
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长期负债

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通过一段时间的学习,我们知道了化学是一门以 _________ 为基础,研究物质的 _________  _________  _________ 以及 _________ 规律的科学.

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与其他途径应用吗啡相比硬膜外腔注入吗啡镇痛的特点是()

A.对患者血压影响小

B.可以使用更大剂量的吗啡

C.仅需少量吗啡(口服的1/30,静脉注射的1/3),即可产生强大的、长时间的镇痛作用,而且副作用明显减轻

D.不会发生呼吸抑制

E.不会发生便秘和尿潴留化脓性单管炎

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日本编有几大军区?海军有几大舰队?

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[A] He is unlikely to produce such a big hit in the near future, so more of his attention is directed to revising the old song and selling it to more people.

[B] Back in the 1950s, he says, performers got only one-tenth of the share of royalties that they do now. For years, artists have, with good reason, accused big record labels of ripping them off.

[C] This month, early recordings by Elvis himself started to enter Europe’s public domain. Over the next few decades a torrent of the most popular tracks from the Beatles, the Rolling Stones and many other artists will become public property in Europe—to the pleasure of fans and the consternation of the music industry.

[D] The music industry also points out that America gives artists almost twice as much copyright protection as Europe. America has repeatedly lengthened copyright terms, with the latest reprieve, the Sonny Bono Copyright Term Extension Act of 1998, giving performers protection for 95 years after publication.

[E] But when the attention is shifted from Europe to America, artists should feel much better because the length of copyright protection there is even shorter. It seems that the American government is more interested in serving the public than the already very rich artists.

[F] Music executives want the European Commission to protect them from such unwelcome come competition by extending the copyright term.

[G] And that estimate accounts only for songs up to the end of the 1950s. Far more will be at risk as music from the 1960s and 1970s moves out of copyright.

"Every three months from the beginning of 2008," says Cliff Richard, who was once Britain’s answer to Elvis Presley, "I will lose a song." The reason is that in most European countries copyright protection on sound recordings lasts for 50 years, and (now) Sir Cliff recorded his first hit single, "Move It", in 1958. (41) ______

One of the big four music firms estimates that about 100m "deep catalogue" (ie, old) albums now sold in Europe each year will have entered the public domain by the end of 2010. Assuming a current wholesale price of $10, that could jeopardise $1 billion of revenues, or about 3% of annual recorded music sales. (42)______

Even once much of the back catalogue has entered the public domain, the big music firms can carry on selling it on CD. They will even benefit from not having to pay anything to the artist or to his estate. They will in many cases still own copyright on the original cover art. But they will face new competition from a host of providers of CDs who may undercut them. And on the internet, public domain music is likely to be free, as much of the copyrighted stuff already is on peer-to-peer networks.

(43)______Artists have rallied to the cause: U2, Status Quo and Charles Aznavour all want the 50-year limit increased. Many more acts will sign a petition this spring. Sir Cliff has spent hours complaining to the commission that composers of songs get copyright for 70 years after their death: more than performers.

(44)______

Many people believe that America has gone too far in protecting copyright at the expense of the public good, including, it seems, the commission, which said last year that it saw no need to lift its own 50-year limit. Its deadline for proposals on copyright law has slipped from this year to 2006. But governments are likely to weigh in on the issue. France, Italy and Portugal have indicated that they support an extension of the term, and Britain is likely to stick up for its own music major, EMI.

Although artists and their estates want longer copyright, the big music firms would benefit from it the most, especially in the next couple of decades, says Stephen King, chairman of the Association of United Recording Artists and manager of the Libertines. (45)______ Now they have wised up about making deals. The best guarantee of financial security—safer than clinging on to copyright—is hiring a good lawyer early on.

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