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患者，男性，32岁。因发现HBsAg阳性10年、血清转氨酶反复升高3年多而就诊。曾服用一般保肝药物，未用干扰素等抗病毒治疗。无输血、手术史。体检：一般情况可。无明显肝病面容。肝掌可疑，前胸可见3个小蜘蛛痣。肝肋下未及，脾侧位肋下刚及，稍硬。无腹水及浮肿。实验室检查：ALT 320 U/L,AST 165 U/L,BIL 23 μmol/L，TP 73 g/L,ALB 35 g/L,HBsAg（+）,HBeAg（+）,抗HBc（+）,抗HBs（-）,抗HBe（-）,HBVDNA 7×105copies/ml。B超：肝回声较粗，血管走形不清，PVD 1.3 cm，脾肋间厚4.5 cm，肋下厚3.0 cm，长2.1 cm。提问：
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Questions 4 to 7 are based on the following conversation. At the end of the conversation, you will be given 20 seconds to answer the questions.Now, listen to the conversation. What is true of Tom
患者，男性，10岁，北京郊区小学生，因发热、乏力、食欲差、恶心、呕吐1周，尿黄、眼黄2日，于1998年3月12日入院。既往无肝炎史，无用药史，无输血及手术史，近1个月内无下水史。最近学校中有同学患“肝炎”，详细情况不明。体检：发育、营养中等，巩膜中度黄染，肝肋下2 cm，有压痛，脾肋下可及。实验室检查：ALT 1100 U/L,AST 620 U/L,BIL 50 μmol/L。提问： 诊断什么病？诊断根据是什么？如何进一步确诊？
患者，男性，65岁，北京市退休教师，低热，乏力、恶心、厌油腻1周，发热持续4日，尿黄、眼黄3日，于1999年9月8日入院。幼年时曾患“黄疸型肝炎”，病原不明。近年来经常在外面就餐。家中及周围无肝炎患者。无用药史及输血、手术史。体检：发育、营养中等，巩膜明显黄染，肝肋下1 cm，无明显压痛，脾肋下可及。实验室检查：ALT 800 U/L,AST 500 U/L,BIL 85 μmol/L。提问： 此患者患的是什么病？如何确诊？
第二篇 "Wash every day and you’ll die young, my son!" People often said those words; long ago, of course. Napoleon’s wife had new clothes every month, instead of a bath. ("It’s quicker," She always said). Rich people did not often have a bath. They washed their hands and faces, but not their bodies. Many poor people did not wash at all. A young man once said to a doctor; "Soap and water have never touched my body." (And the doctor answered. "That’s true. I know... ") why didn’t people wash in those days long ago Well, they did not have water in their house. They carried water from rivers or from holes in the ground ( = wells). Towns people bought it from a water--carrier. Sometimes it was expensive; and soap was always expensive. They drank water, of course; and so they were clean inside. They did not think about the outside! And this is true; they just did not like a bath. Modern life is different. We use a lot of soap and water. And we are all quite clean. However, a few people use too much soap; and they often get ill. Who are these people Many young women work as hairdressers. They wash and then "dress" other women’s hair. That is their job, and they like it. Young hairdressers sometimes wash dirty heads on a busy day! Their hands are soapy for seven or eight hours; and that is not a good thing. A young hairdresser’s hands are often red and ugly; and she must then go to doctor. Long ago, people ______.
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