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：

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• 1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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• 2最容易出现纵隔淋巴结肿大的白血病类型是

  A.急性巨核细胞白血病

  B.急性B-淋巴细胞白血病

  C.急性T-淋巴细胞白血病

  D.急性单核细胞白血病

  E.急性早幼粒细胞白血病

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• 3最容易发生弥散性血管内凝血的白血病类型是

  A.急性巨核细胞白血病

  B.急性B-淋巴细胞白血病

  C.急性T-淋巴细胞白血病

  D.急性单核细胞白血病

  E.急性早幼粒细胞白血病

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• 4急性单核细胞白血病的骨髓细胞学表现为

  A.骨髓中原粒细胞大于等于90%

  B.骨髓中颗粒增多的早粒幼细胞占30%以上

  C.骨髓中原始及幼稚单核细胞大于30%

  D.骨髓中有核红细胞大于50%，原粒及早幼粒细胞大于30%

  E.骨髓中原始巨核细胞大于30%

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• 5颗粒增多的早幼粒细胞白血病骨髓细胞学表现为

  A.骨髓中原粒细胞大于等于90%

  B.骨髓中颗粒增多的早粒幼细胞占30%以上

  C.骨髓中原始及幼稚单核细胞大于30%

  D.骨髓中有核红细胞大于50%，原粒及早幼粒细胞大于30%

  E.骨髓中原始巨核细胞大于30%

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• 6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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• 7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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• 8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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• 9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

  A.正常情况下骨髓外造血极少

  B.多见于年长儿

  C.可出现肝、脾、淋巴结肿大

  D.外周血可出现有核红细胞和（或)幼稚中性粒细胞

  E.病因去除后可恢复正常

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• 10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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