问题 多项选择题 案例分析题

患者女性,16岁。病前性格内向、话少、不好与人交往。4天前开始进食少,收拾东西要走,2天前开始"呼之不应",急诊途中偶有挣扎行为,血糖2.8mmol/L,输液支持治疗后清醒,回宿舍后仍拒食,问话不答,趁看护人不备逃到表姐家的屋外,送回父母家后来回在屋子里走动或躺在床上,仍拒食、不语。1天前叫不醒,血糖2.6mmol/L,给予输液支持,因全身虚弱无力、拒食、不语抬入精神科病房治疗。既往体健。家族史阴性。查体不合作,双侧瞳孔D=2.5cm,对光反射正常,肌力及肌张力下降,腱反射减退,未引出脑膜征和病理征。精神检查:呼之有睁眼,但不语、不答、拒食,无法进行有效的交流,无任何面部表情变化和主动意向要求,不能执行任何命令。急查血糖3.2mmol/L,血钾3.0mmol/L,心电图、脑电图正常。

经上述处理,1周后患者进食明显改善,能下床活动。不能回忆生病过程,只低头说:犯错误了,对不起家人,心情不好,不能进一步解释为什么。下一步可选择的药物治疗()

A.氯丙嗪

B.氟哌啶醇

C.硫利达嗪

D.氯氮平

E.舍曲林

F.西酞普兰

G.喹硫平

H.利培酮

I.碳酸锂

答案

参考答案:E, F

解析:1.患者目前表现不语、不动、拒食,血糖、血钾的减低。未显示MECT治疗禁忌证,以输液支持和MECT治疗迅速解除患者的抑制状态。2.患者抑制缓解后,呈现自责、情感低落,可选择抗抑郁药系统治疗。3.抗抑郁药治疗期间出现的易激惹需高度怀疑是否诱发躁狂发作,在治疗上需停用抗抑郁药,换用心境稳定剂系统治疗。新型抗精神病药具有心境稳定作用。氯氮平一般不作为首选抗躁狂药。4.因碳酸锂治疗浓度与中毒浓度接近,所以需严密观察药物不良反应及定期监测药物浓度。此患者系首次发作双相情感障碍,复发率高,维持治疗至少2年以上,然后根据患者情况,再决定进一步的维持治疗时间。5.长期碳酸锂治疗,需每隔6个月检查一次甲状腺功能和肾功能。

阅读理解

阅读理解。

     We like to keep our distance from others and there are very specific social rules about how close we can

go to others in particular situations. The social distances here are approximate, of course and will vary with

people. But they are still a good general rule. Hall identified four zones that are common for Americans:

     Public Zone: >12 feet. The public zone is generally over 12 feet. That is, when we're walking around

town, we'll try to keep at least 12 feet between us and other people. Of course there're many times when we

cannot do this. We'll start to notice other people who are with in this distance. The closer they get, the more

we become aware.

     Social Zone:4-12 feet. Within the social zone, we start to feel a connection with other people. When they're

closer, then we can talk with them without having to shout, but still keep them at a safe distance. This is a

comfortable distance for people who are standing in a group but maybe not talking directly with one another.

     Personal Zone: 1.5-4feet. In the personal zone, the conversation gets more direct, and this is a good distance for two people who are talking seriously about something.

      Intimate(亲密的)Zone: <1.5 feet. When a person is within arm's reach or closer, then we can touch them

in intimate ways. Romance of all kinds happens in this space. Entering intimate zone of somebody else can be

very threatening.

     The rules about social distances vary with different groups of people. People who live in towns spend more

time close to one another. In a large and crowded city, the distances will be less than in a small town. Different

countries also have different rules about social distances. Watch a Japanese person talking at a party with a

person from a Western country. The Japanese will step in and the Westerner will step back. Speeded up, it's

like a dance around the room.

1. Which of the following shows how the text is organized? (①=Paragraph 1…)

2. In a less crowded place, an American usually keeps a stranger at a distance of _____ .

A. about 1.5 feet

B. less than 4 feet

C. about 2 feet

D. more than 12 feet

3. If eight people sit in a room and all of them don't talk directly with one another, they prefer _____.

A. Public Zone

B. Social Zone

C. Personal Zone

D. intimate Zone

4. What is the main idea of the last paragraph?

A. There're some rules about social distances

B. The Japanese are more polite than Americans

C. The rules about social distances can vary

D. Cities have fewer rules about social distances

5. What can we infer from the last paragraph?

A. The Japanese would like to dance with people from Western countries

B. The Westerner would like to keep close to people they are talking with at party

C. The Japanese would like to keep a distance from people they are talking with at party

D. The social distance between people in small towns is longer than that in large and crowded cities.

单项选择题 A1型题