问题 单项选择题 A1/A2型题

对慢性肾功能不全患者的电解质紊乱叙述错误的是()

A.当肾小球滤过率降至20~25ml/min或更低时,肾脏排钾能力逐渐下降,此时易于出现高钾血症

B.大多患者肾衰竭早期即出现高磷血症

C.低钙血症、高磷血症,只在肾衰竭的中晚期才能检验出来,且通常不会引起临床症状

D.血磷升高可抑制近曲小管产生骨化三醇,后者是维持血钙正常的重要因素,其不足会使血钙浓度降低

E.当GFR<20ml/min时,由于肾脏排镁减少,可有轻度的高镁血症

答案

参考答案:B

解析:血磷升高,与血钙结合形成磷酸钙沉积于组织,使血钙降低,同时可抑制近曲小管产生骨化三醇,进一步降低血钙;而低血钙刺激甲状旁腺生成PTH,后者可促进尿磷排出而降低血磷浓度。故这种调节机制导致血磷在肾衰早期可以维持在正常范围内,只在肾衰中晚期(GFR<20ml/min)时才会出现高磷血症。

单项选择题
填空题

The Secret of Success

Since 1989, Dave Thomas, who died at age 69, was one of the most recognizable faces on TV. He appeared more than 800 commercials for the hamburger chain named for his daughter. "As long as it works," he said in 1991 ,"I’11 continue to do those commercials. "

Even though he was successful, Thomas remained troubled by his childhood. "He still won’t let anyone see his feet, which are out of shape because he has never had proper-fitting shoes," Wendy said in 1993 and told us that sixty-one years ago, Dave Thomas was born to a single mother, he was adopted as a baby by Rex and Auleva. Thomas of Kalamazoo in Michigan when he was six weeks old. After Auleva died when he was 5,Thomas spent years on the road as Rex traveled around seeking construction work. " He fed me," Thomas said, "and if I got out of line, he’d beat me. " "When I found out I was (adopted), I didn’t want to talk about it, and as I talked to people I grew older... I got really a lot of encouragement. " When he was 12 years old, Thomas started working at a barbecue restaurant in Knoxville, Tenne. Moving out on his own at 15, Thomas worked, first as a waiter, in many restaurant. But he had something much better in mind. "I thought if I owned a restaurant," he said, "I could eat for free. " When he was 24, meeting with Harland Sanders led Thomas to a career as a manager of a Kentucky Fried Chicken restaurant that made him a millionaire in 1968.

A year later, after breaking with Sanders, Thomas started the first Wendy’s Old Fashioned Hamburgers, in Columbus, Ohio, which set itself apart by serving made-to-order burgers. With 6,000 restaurants worldwide, the chain now makes $ 6 billion a year in sales.

Although troubled by his own experience with an adoption, Thomas, married since 1954 to Lorraine, 66, and with four grown kids besides Wendy, felt it could offer a future for other children. He started the Dave Thomas Foundation for adoption in 1992. Later, Thomas, who had left school at 15, graduated from Coconut Great High School in Florida. He even took Lorraine to the graduation dance party. The kids voted him "Most likely to succeed" Thomas is survived by his wife of 47 years, Lorraine, five children and 16 grandchildren. His foundation helps raise awareness for the 134000 foster children available for adoption, and helps make adoption more affordable. "The Dave you saw on TV was the real Dave," said his friend Pat Williams. "He wasn’t a great actor or a great speaker. " He was just Joe Everybody.

The main events of Dave’s life

In (1) he was born to a single mother. 6 weeks old he (2) as a baby by Rex an Auleva Thomas. At the age of five Thomas spent years on the road as Rex traveled around (3) . In 1944 Thomas started working at (4) in Knoxville, Tenn. 15 years old he (5) on his own. In 1954 Thomas (6) Lorraine. In (7) he met with Harland Sanders. In 1968 he became a (8) In (9) Thomas started the first Wendy’s Old Fashioned Hamburgers, in Columbus. In 1993, graduated from Coconut Great High School in Florida. " The Dave you saw on TV was the real Dave," said his friend Pat Williams. "He wasn’t a great actor or a great speaker. " He was just Joe Everybody. And in 2001, Thomas (10) .

第(3)空应填()