问题 单项选择题 案例分析题

病例摘要:男性,30岁,餐后1小时突发上腹部剧痛,很快扩散至右下腹,疼痛呈持续性,无放射,伴有恶心、呕吐。发病3小时后来院就诊。查体:血压16/9kPa(120/70mmHg),腹平软,全腹压痛、反跳痛、肌紧张,以右上腹及中上腹为甚,肝浊音界不清,肠鸣音微弱。

首选治疗方案为()。

A.镇静、止痛

B.支持治疗

C.穿刺引流

D.胃肠减压,补液观察

E.即行剖腹探查术

答案

参考答案:E

单项选择题 案例分析题
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.

Which of the following did Marc NOT do to the patients()

A.Giving them operations.

B.Amusing them.

C.Administering medicine to them.

D.Sitting by their deathbeds.