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问题 单项选择题 B型题

患者男，54岁，4个月前开始发现上腹部隐痛，消瘦，体重减轻5公斤。1周以来腰背痛明显，持续性，夜间加重，最可能的诊断是（）

A.胰头癌

B.胰体癌

C.胰腺囊肿

D.胆囊癌

E.十二指肠壶腹癌

答案

参考答案：B

解析：1.考题考点为壶腹周围癌的鉴别诊断。胰头癌和十二指肠壶腹癌均可表现为逐渐加重的黄疸，伴陶土样便，胆囊肿大，但胰头癌引起的黄疸为进行性，一般无消化道出血表现；而十二指肠壶腹癌引起的黄疸可有波动性，且可以有消化道出血表现，大便潜血阳性。胆囊癌侵及肝门部时也可引起黄疸，但一般胆囊本身无明显肿大。故答案应选E。 2.胰体癌主要临床表现为上腹部疼痛，无黄疸，随着病情的发展肿瘤可侵及腹腔神经丛，引起腰背部疼痛，呈持续性，夜间加重；胆囊癌主要表现为上腹痛，一般不放射至腰背部；胰腺囊肿主要为上腹胀痛以及压迫周围器官引起的上腹部不适，进食后症状明显，一般不引起腰背疼痛。故答案应选B。

单项选择题

顺流布置管壳式换热器中，如果冷热流体流量和比热均相同，当热流体的进出温度分别为70ºC和50ºC，冷流体温进出度分别为10ºC和30ºC时，其对数平均温度差为（）

A.20ºC；

B.36ºC；

C.45ºC；

D.60ºC
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填空题

The first two stages in the development of civilized man were probably the invention of primitive weapons and the discovery of fire, although nobody knows exactly when he acquired the use of the latter.
41) ______ Animals have a few cries that serve as signals, but even the highest apes have not been found able to pronounce words, even with the most intensive professional instruction. The superior brain of man is apparently a necessity for the mastering of speech. When man became sufficiently intelligent, we must suppose that he gradually increased the number of cries for different purposes. It was a great day when he discovered that speech could be used for narrative. There are those who think that in this respect picture language preceded oral language. A man could draw a picture on the wall of his cave to show in which direction he had gone, or what prey he hoped to catch. 42) ______
Two important stages came not so long before the dawn of written history. The first was the domestication of animals; the second was agriculture. Agriculture made possible an immense increase in the number of the human species in the regions where it could be successfully practiced. 43) ______
44) ______
These inventions and discoveries--fire, speech, weapons domestic animals, agriculture, and writing--made the existence of civilized communities possible. From about 3000 B. C. until the beginning of the Industrial Revolution less than two hundred years ago there was no technical advance comparable to these. During this long period man had time to become accustomed to his technique, and to develop the beliefs and political organizations appropriate to it. There was, of course, an immense extension in the area of civilized life. At first it had been confined to the Nile, the Euphrates, the Tigris, and the Indus, but at the end of the period in question it covered much the greatest part of the inhabitable globe. I do not mean to suggest that there was no technical progress during the time. 45) ______ (512 words)
Notes: ape 猿。pastoral nomad 田园式的游牧部落的人。the Euphrates 幼发拉底河。the Tigris底格里斯河。the Indus 印度河。in question 所谈的(在名词后作后置定语)。
[A] Probably picture language and. oral language developed side by side. I am inclined to think that language has been the most important single factor in the development of man.
[B] Another fundamental technical advance was writing, which, like spoken language, developed out of pictures, but as soon as it had reached a certain stage, it was possible to keep records and transmit information to people who were not present when the information was given.
[C] With the development of civilization, primitive people who lived in caves at that time badly needed a language, which would help them to communicate with one another.
[D] The origin of language is also obscure. No doubt it began very gradually.
[E] In fact, there was progress--there were even two inventions of very great importance, namely, gunpowder and the mariner’s compass--but neither of these can be compared in their revolutionary power to such things as speech and writing and agriculture.
[F] These were, at first, only those in which nature fertilized the soil after each harvest. Agriculture met with violent resistance from the pastoral nomads, but the agricultural way of life prevailed in the end because of the physical comforts it provided.
[G] But industry was a step in human progress to which subsequently there was nothing comparable until our own machine age.
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