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男性，48岁。右上腹疼痛半年，加重伴上腹部包块1个月。半年前无明显诱因出现右上腹钝痛，为持续性，有时向右肩背部放射。近1个月来，右上腹痛加重，腹胀，食欲减退，阵阵恶心，偶有发热，体温最高38.1℃。发病以来，睡眠差，腹泻，小便正常，体重下降约5kg。既往有乙型肝炎病史15年，否认疫区接触史，无烟酒嗜好，无药物过敏史。家族史中无遗传性疾病及类似疾病史。查体：T36.7℃，P78次／分，R12次／分，BP110／70mmHg。发育正常，营养一般，神志清楚可合作，全身皮肤无黄染，巩膜轻度黄染，双锁骨上窝未扪及肿大淋巴结。心肺（-）。右上腹显饱满，无腹壁静脉曲张。腹软，右上腹压痛，无反跳痛和肌紧张，右肋缘下3cm触及肝脏，边缘钝，质韧，有触痛，脾于左肋缘下未及，腹叩呈鼓音，无移动性浊音，肝上界于右锁骨中线第5肋间叩出，肝区叩痛，肠鸣音8次／分。肛门指诊未及异常。

根据检查结果，可明确诊断为（提示：检查结果发现：RBC4.5×1012/L，Hb120g／L，WBC5.6×109/L；AFP1000ng/ml；HbsAg（+），Anti-HBs（-），HBeAg（-），Anti-HBe（+），Anti-HBc（+）；ALB35.5g/L，ALT84IU/L，AST78IU/L，TBIL30μmol／L，DBIL10μmol／L，ALP188IU/L，GGT64IU/L。肝右叶实质性占位性病变，直径约8cm，肝内外胆管不扩张；肝右叶8cm×7cm边缘较模糊的低密度占位性病变，脾脏不大。）（）

A.肝硬化

B.原发性肝癌

C.继发性肝癌

D.肝血管瘤

E.肝脓肿

F.肝囊肿

答案

参考答案：B

填空题

You might think that hamburgers were invented in the United States, but that is not totally true. These (1) , or patties, actually came from Germany in the middle of the nineteenth century. They were brought to the United States by (2) who came from the city of Hamburg. That is why (3) was "hamburger steak".

However, people in other places (4) that they invented the hamburger. Perhaps we’ll never have a (5) . But there’s no question that the hamburger was a (6) . Why Perhaps because at that time, industry was growing and a kind of (7) food was needed for workers.

The hamburger became even more popular (8) when the first chain of fast food restaurants was started. This chain was called "White Castle". It served tiny hamburgers that were sold for only (9) . Then, in the 1930s there came the (10) where customers were served in their cars by waiters in uniform. And the hamburger was one of the most (11) .

By now, The hamburger was ready to (12) the world. And this happened with McDonald’s, which was actually a (13) at first. But by the early 1950s the hot dog was replaced by the hamburger. McDonald’s and other fast food restaurants (14) around the world throughout the rest of the twentieth century. McDonald’s alone has (15) for everyone person in the world.

The importance of the hamburger to (16) remains significant. About (17) of all sandwiches that are eaten are hamburgers. According to some sources, (18) of current workers in the United States had their first job at McDonald’s. But the face of the hamburger is changing (19) . Nowadays it is possible to buy a chicken burger, a turkey burger, (20) , or veggie burger.

6（）
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单项选择题

如果投资人希望监理工程师进行投资项目工程合同管理，督导设备的现场安装以及签证支付，那么( )将适合这一需要。

A．建造合同

B．管理承包合同

C．设计—建造合同

D．EPC/交钥匙合同
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