问题 单项选择题 案例分析题

患者女,59岁,因“经常头晕,左侧肢体无力3年,反应迟钝6个月”来诊。曾因“脑梗死”入院治疗4次,否认高血压、糖尿病、高血脂等病史。兄妹4人,2人有脑缺血,其中1人有偏头痛,其父亲生前有痴呆症。查体:BP120/80mmHg;意识清楚,反应迟钝,记忆力减退,计算力差,有轻度构音不清;双侧眼球运动自如,双侧瞳孔等大正圆,对光反射灵敏,伸舌左偏,张口下颌右偏;左上肢肌力0级,左下肢肌力Ⅲ级,右侧肢体肌力Ⅳ级,左侧肢体肌张力增高,腱反射亢进,右侧肢体肌张力正常,双侧巴宾斯基征(+)。颅脑MRI:脑桥急性脑梗死灶,左侧外囊、右侧丘脑陈旧性脑梗死灶,双侧脑室旁及半卵圆中心区白质脱髓鞘改变。MMSE=17,数字-符号转换测验和连线测验差,画钟试验1分。

该患者最可能的诊断是下列哪一个?()

A.多梗死性痴呆

B.进行性多灶性白质脑病

C.伴皮质下梗死和白质脑病的常染色体显性遗传性脑动脉病(CADASIL)

D.宾斯旺格病(BinswangerdiseasE.

E.线粒体脑肌病伴高乳酸血症和脑卒中样发作(MELAS)综合征

答案

参考答案:C

阅读理解

阅读理解。

     People do not analyze every problem they meet. Sometimes they try to remember a solution from the last

time they had a similar problem. They often accept the opinions or ideas of other people. Other times they

begin to act without thinking. They try to find a solution by trial and error. However, when all these methods

fail, the person with a problem has to start analyzing. There are six stages in analyzing a problem.

      First the person must recognize that there is a problem. For example, Sam's bicycle is broken, and he

cannot ride it to class as he usually does. Sam must see that there is a problem with his bicycle.

     Next the thinker must define the problem. Before Sam can repair his bicycle, he must find out the reason

why it does not work. For instance, he must determine if the problem is with the gears, the brakes, or the

frame. He must make his problem more specific.

     Now the person must look for information that will make the problem clearer and lead to possible solutions.

For instance, suppose Sam decided that his bike does not work because there is something wrong with the

gear wheels. At this time, he can look in his bicycle repair book and read about gears. He can talk to his friends

at the bike shop. He can look at his gears carefully.

      After studying the problem, the person should have several suggestions for a possible solution. Take Sam

as an illustration. His suggestions might be: put oil on the gear wheels; buy new gear wheels and replace the old

ones; tighten or loosen the gear wheels.

     Eventually one suggestion seems to be the solution to the problem. Sometimes the final idea comes very

suddenly because the thinker suddenly sees something new or sees something in a new way. Sam, for example, suddenly sees that there is a piece of chewing gum between the gear wheels. He immediately realizes the

solution to his problem: he must clean the gear wheels.

     Finally the solution is tested. Sam cleans the gear wheels and finds that afterwards his bicycle works

perfectly. In short, he has solved the problem.

1. By referring to Sam's broken bicycle, the author intends to ______.

A. illustrate the ways to repair his bicycle

B. discuss the problems of his bicycle

C. tell us how to solve a problem

D. show us how to analyze a problem

2. Which of the following is NOT true?

A. People do not analyze the problem they meet.

B. People often accept the opinions or ideas of other people.

C. People may learn from their past experience.

D. People can not solve some problems they meet.

3. As used in the last sentence, the phrase "in short" means ________.

A. in the short term

B. in detail

C. in a word

D. in the end

4. In analyzing a problem we should do all the following except .

A. recognize and define the problem

B. look for information to make the problem clearer

C. have suggestions for a possible solution

D. find a solution by trial or mistake

判断题