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患者(住院号40118)女,43岁,浙江籍,务农,于1962年2月12日入院。自述于17年前第2次顺产后出现乏力、怕热、多汗、手抖、食欲显著亢进、体重相反减轻。同时颈部逐渐粗大,性情急躁易怒,并经常感到心悸、气促。近9天来因发热、咳嗽而住院。入院前1年右小腿被羊咬伤后迄今未癒。体格检查:体温38℃,脉搏94次/分,呼吸24次/分,血压150/80毫米汞柱。发育正常,显著消瘦,神志清楚。双眼突出,Moebius氏征、Stellwag氏征、Joffroy氏征均阳性。双侧扁桃体轻度肿大伴充血,颈静脉不怒张。甲状腺中等度瀰漫性肿大,有震颤及明显血管杂音。肺正常。心界叩诊不扩大,心尖与肺动脉瓣区均有Ⅱ级收缩期吹风样杂音。腹平坦,肝在肋弓下1.5厘米,剑突下2厘米,脾在肋弓下3厘米,质均中等,边绿钝,无压痛。肝颈反流阴性。右小腿前下1/3处有5×4厘米大小之浅在溃瘍,边绿尚整
Patient (hospital number 40118) Female, 43 years old, Zhejiang membership, farming, was admitted on February 12, 1962. Readme 17 years ago after the 2nd post-natal weakness, fearing heat, sweating, trembling, appetite significantly increased weight loss in the opposite. At the same time the neck gradually thick, irritable temperament, and often feel heart palpitations, shortness of breath. Nearly 9 days due to fever, cough and hospitalization. 1 year before admission, the right calf was bitten by the sheep so far healed. Physical examination: body temperature 38 ℃, pulse 94 beats / min, breathing 24 beats / min, blood pressure 150/80 mm Hg. Normal development, significant weight loss, conscious. Eyes prominent, Moebius’s sign, Stellwag’s sign, Joffroy’s sign were positive. Bilateral tonsil mild swelling with congestion, jugular vein does not anger. Thyroid moderate diffuse enlargement, tremor and obvious vascular murmur. Normal lungs. Heart percussion does not expand, apex and pulmonary valve area have grade Ⅱ systolic hair-like murmur. Abdomen flat, liver 1.5 cm under the costal arch, xiphoid 2 cm, spleen in the costal arch 3 cm, quality are medium, while green blunt, no tenderness. Liver neck reflux negative. 1/3 of the right lower leg in front of a 3 × 4 cm in the size of the ulcer, while the green is still intact