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患者女，25岁，因“颜面和双下肢水肿伴少尿5个月”来诊。查体：BP140/95mmHg。实验室检查：Hb105g/L；尿蛋白（+++），尿RBC（++）；SCr145μmol/L，胆固醇10.2mmol/L，清蛋白21g/L，补体C3减低。

该患者肾穿刺活检病理改变最可能出现的是（）

A.微小病变肾病

B.系膜增生性肾小球肾炎

C.新月体肾炎

D.膜性肾病

E.系膜毛细血管性肾小球肾炎

F.局灶节段性肾小球硬化

G.间质炎性细胞浸润及纤维化

H.弥漫性肾小球系膜细胞增生

答案

参考答案：E

单项选择题

对老年性 * * 炎进行 * * 灌洗常用的药液是

A．1%乳酸
B．2%～4%碳酸氢钠
C．0.1%苯扎溴铵
D．0.1%呋喃西林
E．0.9%生理盐水
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单项选择题

My First Experience with AIDS Patients
我初次接触艾滋病人


by Marc Kielburger
I was ushered to the AIDS ward of a hospice in the slum.I would later learn that the ward did not exist，at least not officially.Not a single person in Thailand had AIDS，according to the Thai government at the time.People got"sick，"of course，sometimes"very sick."but no one had AIDS.The hospice was home to an ever-growing number of"very sick"people.
I entered the ward and was greeted by two Thai nurses.
"Thank goodness you are here，Marc，"said the first.
"You’re a doctor，right"
I shook my head.
"So you are a medical student then!"
I shook my head again.
"But you know medicine，right"
"Kinda，"I offered."I watch E.R.,every Thursday"
After a rapid exchange in Thai，the first one said，"NO problem.Get ready for your fou- hour medical school training!"
"But in my country medical school takes years!" I protested.
"We don’t have that long," she replied. "So we better get started. "
During the next few hours, I learned to clean wounds, administer IVs, treat bedsores, and dispense medicine. The work was punishing, made worse by stifling heat, frequent blackouts, and an incredible stench in the air. I tried desperately to hide my weak nerves and queasy stomach, but more than once dashed for the bathroom to throw up.
Just when it seemed my training was coming to an end, the nurse took me aside. "There are only two more things you need to know," she said. "On the left-hand side of the ward, you will find what we call the Exit Area. " As it turned out, she meant "exit" in the largest sense of the word. Terminally ill patients were hidden behind a curtain and then exited out of the ward after death. "The second thing you need to know," she continued, "is that we haven’t had a day off in three weeks. You’ll be looking after the ward by yourself for the next shift. "
My jaw dropped.
"Don’t worry, Mare," said the other nurse, patting me on the shoulder before turning to leave. "Think of this as the beginning of your residency !" And with that, they walked out. Alone and petrified, I tried unsuccessfully to keep calm.
I counted to twenty-four. That’s how many AIDS patients were in my charge. What am I going to do I thought. What can I do I fell back on my training with the Canadian government and put my talents to work. I served patients water-some with ice, some without. Next, I tried to cheer up everyone, myself included, giving enthusiastic high-fives to patient after patient. Soon enough, everyone was laughing. Some were laughing with me, others most definitely at me, but I didn’t care. As long as I could keep people smiling, I was sure it would all be fine. And it was. Until a short while later, when a patient in the Exit Area began to choke. He had fluid in his lungs and could not breathe. As I crossed the floor, I could hear the man gasping for air. Fumbling and scared, I pulled back the curtain and administered the medicine the nurses had recommended. The man didn’t respond. With nothing left to offer, I sat down and held his hand, looking into his eyes as he breathed heavily for a while and then stopped. Watching him slip away, I was hit by a feeling of anguish such as I’d never felt, either before or since. It haunts me to this day.

Why were the two Thai nurses happy to see Marc

A．Because Marc was an experienced doctor for AIDS.
B．Because Marc could amuse the patients.
C．Because Marc would offer them further medical training.
D．Because Marc would work in the ward so that they could enjoy a day off.
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