问题 单项选择题

1个月婴儿,嗜睡、吐奶2天。查体:T36℃,面色发灰,双眼凝视,前囟紧张,心率110次/分,双肺正常,脐部少许脓性分泌物,对诊断最有意义的检查是

A.脐部分泌物培养

B.脑脊液检查

C.头颅CT检查

D.血常规

E.血培养

答案

参考答案:B

解析:[解题思路] 年龄小于3个月的幼婴和新生儿化脑表现多不典型,体温可高可低,或不发热,甚至体温不升;高颅压表现可不明显,可能仅有吐奶、尖叫或颅缝开裂;惊厥可不典型,如仅见面部、肢体局灶或多灶性抽动、局部或全身性肌阵挛、或各种不显性发作;脑膜刺激征不明显。该患儿为1个月婴儿,脐部有感染灶,有嗜睡、吐奶、面色发灰、双眼凝视、前囟紧张等感染中毒症状及高颅压症状,考虑为化脓性脑膜炎,脑脊液检查是确诊本病的重要诊断依据。

选择题
单项选择题

In 1880, Sir Joshua Waddilove, a Victorian philanthropist, founded Provident Financial to provide affordable loans to working-class families in and around Bradford, in northern England. This month his company, now one of Britain’s leading providers of "home credit"— small, short-term, unsecured loans—began the nationwide rollout of Vanquis, a credit card aimed at people that mainstream lenders shun. The card offers up to £ 200 ($ 380) of credit, at a price: for the riskiest customers, the annual interest rate will be 69%.

Provident says that the typical interest rate is closer to 50% and that it charges no fees for late payments or breaching credit limits. Still, that is triple the rate on regular credit cards and far above the 30% charged by store cards. And the Vanquis card is being launched just when Britain’s politicians and media are full of worry about soaring consumer debt. Last month, a man took his own life after running up debts of £ 130000 on 22 different credit cards.

Credit cards for "sub-prime" borrowers, as the industry delicately calls those with poor credit records, are new in Britain but have been common in America for a while. Lenders began issuing them when the prime market became saturated, prompting them to look for new sources of profit. Even in America, the sub-prime market has plenty of room for growth. David Robertson of the Nilson Report, a trade magazine, reckons that outstanding sub-prime credit-card debt accounts for only 3% of the $ 597 billion that Americans owe on plastic. The sub-prime sector grew by 7.9% last year, compared with only 2.6% for the industry as a whole.

You might wonder, though, how companies can make money from lending to customers they know to be bad risks—or at any rate, how they can do it legitimately. Whereas delinquencies in the credit-card industry as a whole are around 4%-5% , those in the sub-prime market are almost twice as high, and can reach 15% in hard times.

Obviously, issuers charge higher interest rates to compensate them for the higher risk of not being repaid. And all across the credit-card industry, the assessment and pricing of risks has been getting more and more refined, thanks largely to advances in technology and data processing. Companies also use sophisticated computer programs to track slower payment or other signs of increased risk. Sub-prime issuers pay as much attention to collecting debt as to managing risk; they impose extra charges, such as application fees; and they cap their potential losses by lending only small amounts ($ 500 is a typical credit limit).

All this is easier to describe than to do, especially when the economy slows. After the bursting of the technology bubble in 2000, several sub-prime credit-card providers failed. Now there are only around 100, of which nine issue credit cards. Survivors such as Metris and Providian, two of the bigger sub-prime card companies, have become choosier about their customers’ credit histories.

As the economy recovered, so did lenders’ fortunes. Fitch, a rating agency, says that the proportion of sub-prime credit-card borrowers who are more than 60 days in arrears (a good predictor of eventual default) is the lowest since November 2001. But with American interest rates rising again, some worry about another squeeze. As Fitch’s Michael Dean points out, sub-prime borrowers tend to have not just higher-rate credit cards, but dearer auto loans and variable-rate mortgages as well. That makes a risky business even riskier.

Credit cards, such as Vanquis, are issued because()

A. credit industry has to look for further growth in a sub-market

B. the politicians began to worry about soaring consumer debt

C. there’s plenty of room for growth in the basic market

D. a big number of consumers have very poor credit records