案例：14个月男婴，因面色苍白6个月余，发热2天就诊。平日食欲缺乏，不肯进辅食。查体：T 38.4℃，体重8.5kg，指甲菲薄、脆弱，心前区可闻及Ⅱ～Ⅲ级收缩期吹风样杂音，双肺呼吸音粗，未闻及啰音，肝肋下2.5cm，脾肋下2cm，血常规示 Hb 71g/L，RBC 3.0×1012/L，WBC 13.9×109/L，PLT 167×109/L，MCV 77fL，MCH 23pg，MCHC 30%。以下有关髓外造血的描述，不正确的是

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• 1案例：14个月男婴，因面色苍白6个月余，发热2天就诊。平日食欲缺乏，不肯进辅食。查体：T 38.4℃，体重8.5kg，指甲菲薄、脆弱，心前区可闻及Ⅱ～Ⅲ级收缩期吹风样杂音，双肺呼吸音粗，未闻及啰音，肝肋下2.5cm，脾肋下2cm，血常规示 Hb 71g/L，RBC 3.0×1012/L，WBC 13.9×109/L，PLT 167×109/L，MCV 77fL，MCH 23pg，MCHC 30%。骨髓成为唯一造血场所的时间是

  A.胚胎6个月后

  B.胚胎8个月

  C.出生2～5周后

  D.出生3～6周后

  E.出生6个月后

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• 2案例：14个月男婴，因面色苍白6个月余，发热2天就诊。平日食欲缺乏，不肯进辅食。查体：T 38.4℃，体重8.5kg，指甲菲薄、脆弱，心前区可闻及Ⅱ～Ⅲ级收缩期吹风样杂音，双肺呼吸音粗，未闻及啰音，肝肋下2.5cm，脾肋下2cm，血常规示 Hb 71g/L，RBC 3.0×1012/L，WBC 13.9×109/L，PLT 167×109/L，MCV 77fL，MCH 23pg，MCHC 30%。肝、脾增大的原因，最可能是

  A.白血病

  B.心力衰竭

  C.髓外造血

  D.乙型肝炎

  E.CMV感染

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• 3案例：3-year-old plump， healthy-appearing toddler came to your office for her health maintenance examination. In discussing her dietary history with her mother， you found that the child refused solid food，instead preferring to drink cow’s milk almost exclusively. The parents tried to cut her off once，but could not endure the subsequent whining and gave in to her demands for milk. Her blood pressure， heart rate， and respiratory effort were normal. Her complete blood count was significantly reduced with a hemoglobin level of 70g/L and an MCV level of 60fL.The following statements describe changes after oral iron therapy in the child， which of the followings is true?

  A.Subjective improvement can occur within 24 hours.

  B.Reticulocytosis peaks at 3 weeks after starting iron.

  C.Iron absorption is improved by drinking tea.

  D.The hemoglobin level will return to normal within a week.

  E.Oral iron replacement should be ceased when the hemoglobin level returns to normal.

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• 4案例：3-year-old plump， healthy-appearing toddler came to your office for her health maintenance examination. In discussing her dietary history with her mother， you found that the child refused solid food，instead preferring to drink cow’s milk almost exclusively. The parents tried to cut her off once，but could not endure the subsequent whining and gave in to her demands for milk. Her blood pressure， heart rate， and respiratory effort were normal. Her complete blood count was significantly reduced with a hemoglobin level of 70g/L and an MCV level of 60fL.Appropriate therapy should include：

  A.Transfusion of whole blood to get her to a normal hemoglobin，and then initiation of oral iron replacement.

  B.Discussion with the family about dietary changes， and then initiation of oral iron replacement.

  C.Intramuscular iron injection and follow-up visit in 1 week.

  D.Hospital admission to monitor vital signs.

  E.Reassuring the parents that the behavior and laboratory findings are normal.

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• 5案例：3-year-old plump， healthy-appearing toddler came to your office for her health maintenance examination. In discussing her dietary history with her mother， you found that the child refused solid food，instead preferring to drink cow’s milk almost exclusively. The parents tried to cut her off once，but could not endure the subsequent whining and gave in to her demands for milk. Her blood pressure， heart rate， and respiratory effort were normal. Her complete blood count was significantly reduced with a hemoglobin level of 70g/L and an MCV level of 60fL.The most likely diagnosis for this child is

  A.Lead poisoning

  B.Iron deficiency anemia

  C.Thalassaemia

  D.Anemia caused by folic acid deficiency

  E.Aplastic anemia

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• 6案例：14个月男婴，因面色苍白6个月余，发热2天就诊。平日食欲缺乏，不肯进辅食。查体：T 38.4℃，体重8.5kg，指甲菲薄、脆弱，心前区可闻及Ⅱ～Ⅲ级收缩期吹风样杂音，双肺呼吸音粗，未闻及啰音，肝肋下2.5cm，脾肋下2cm，血常规示 Hb 71g/L，RBC 3.0×1012/L，WBC 13.9×109/L，PLT 167×109/L，MCV 77fL，MCH 23pg，MCHC 30%。关于小儿骨髓造血不正确的是

  A.胚胎第6周时出现骨髓

  B.胚胎第6个月后骨髓造血功能渐趋稳定

  C.出生后主要是骨髓造血

  D.婴儿期所有骨髓全部参与造血

  E.年长儿红骨髓仅限于胫骨、胸骨、骨盆和肩胛骨

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• 7案例：3个月女婴，G1P1，39周足月顺产。母乳喂养。因面色苍白1个月就诊。无发热、咳嗽，母奶多，吃奶可，无呕吐，尚未添加辅食。大、小便正常。查体：呼吸平稳，精神、反应可，能逗笑，巩膜无黄染。心肺听诊无异常。腹软，肝肋下1.5cm，剑突下2.5cm，质软边缘锐。脾肋下刚触及。神经系统阴性。血常规示 WBC 11×109/L，淋巴细胞64%，中性粒细胞36%，Hb 100g/L，RBC 3×1012/L，PLT 125×109/L。该婴儿目前的状况属于

  A.正常婴儿

  B.轻度贫血

  C.肝炎

  D.肝大待查

  E.肝肿瘤

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• 8案例：3个月女婴，G1P1，39周足月顺产。母乳喂养。因面色苍白1个月就诊。无发热、咳嗽，母奶多，吃奶可，无呕吐，尚未添加辅食。大、小便正常。查体：呼吸平稳，精神、反应可，能逗笑，巩膜无黄染。心肺听诊无异常。腹软，肝肋下1.5cm，剑突下2.5cm，质软边缘锐。脾肋下刚触及。神经系统阴性。血常规示 WBC 11×109/L，淋巴细胞64%，中性粒细胞36%，Hb 100g/L，RBC 3×1012/L，PLT 125×109/L。根据病历中提供的信息，该婴儿尚需的进一步检查是

  A.暂时无须进一步检查

  B.骨髓穿刺

  C.肝功能

  D.肝脏B超

  E.肝脏CT

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• 9案例：3个月女婴，G1P1，39周足月顺产。母乳喂养。因面色苍白1个月就诊。无发热、咳嗽，母奶多，吃奶可，无呕吐，尚未添加辅食。大、小便正常。查体：呼吸平稳，精神、反应可，能逗笑，巩膜无黄染。心肺听诊无异常。腹软，肝肋下1.5cm，剑突下2.5cm，质软边缘锐。脾肋下刚触及。神经系统阴性。血常规示 WBC 11×109/L，淋巴细胞64%，中性粒细胞36%，Hb 100g/L，RBC 3×1012/L，PLT 125×109/L。该婴儿目前的诊断考虑为

  A.轻度缺铁性贫血

  B.婴儿生理性贫血

  C.小细胞低色素性贫血

  D.CMV感染

  E.肝母细胞瘤

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• 10案例：3个月女婴，G1P1，39周足月顺产。母乳喂养。因面色苍白1个月就诊。无发热、咳嗽，母奶多，吃奶可，无呕吐，尚未添加辅食。大、小便正常。查体：呼吸平稳，精神、反应可，能逗笑，巩膜无黄染。心肺听诊无异常。腹软，肝肋下1.5cm，剑突下2.5cm，质软边缘锐。脾肋下刚触及。神经系统阴性。血常规示 WBC 11×109/L，淋巴细胞64%，中性粒细胞36%，Hb 100g/L，RBC 3×1012/L，PLT 125×109/L。该婴儿的处理为

  A.给予铁剂口服液

  B.喂养指导、随访

  C.输血

  D.护肝治疗

  E.抗肿瘤治疗

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