患者，男性，38岁，车祸伤半小时。查体：发绀，烦躁不安，呼吸困难。左胸第5肋间处见直径约4cm不规则创口并可闻及气体进出声。此病例的病理生理改变是（）

A.纵隔扑动造成循环衰竭

B.急性肺水肿导致气体交换降低

C.纵隔向健侧移位，伤侧肺代偿性膨胀

D.胸膜腔内压力不断升高导致呼吸衰竭

E.吸气时健侧胸膜腔内压力增高，纵隔摆向伤侧

She changed so much that I could hardly _____ her when we met again after a separation of 10 years.

[ ]

A. recognize    

B. know            

C. remember        

D. tell