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问题 单项选择题

男性，46岁，右季肋部不适、食欲下降两年，腹胀、下肢浮肿一个月，近四天来腹痛、发热、腹胀加重。体检：脾肋下 2.0cm，移动性浊音(+)，Hb72g/I， ALB26g/L，，腹水检查：淡黄色，比重 1.017，蛋白25g/L，细胞总数 6.0×109/L，白细胞5.6×109/L，中性80%。最可能的判断是

A．肝硬化合并结核性腹膜炎

B．肝硬化合并自发性腹膜炎

C．肝硬化门静脉血栓形成

D．肝硬化合并原发性肝癌

E．肝肾综合征

答案

参考答案：B

解析：
病人为非特异性消化道症状，但出现腹水和脾大，贫血及低蛋白血症，强烈提示肝硬化腹水的可能，且腹水检查支持为漏出液，但白细胞数＞5.0×109/L，且中性占优势，加之病史中近日出现腹痛和发热，首先应考虑肝硬化合并自发性腹膜炎。

阅读理解与欣赏

阅读下文，完成2题。

采用老式治疗方法一年后，雅各布听到了坏消息：肺部的癌细胞死灰复燃。然而，医生这一次显得成竹在胸，似乎另有高招。原来，两种瞄准癌细胞更精确、毒性大为减弱的抗癌新药，已得到美国食品药物管理局（FDA）的批准。从那时以来，另有两种新药也获得了批准。雅各布在休斯敦M.D.安德森癌症中心的医生，吸收她参与一项由这些药物中的两种组合而成的临床试验。“病情大有好转，疗效之明显，恰似夜晚与白昼般一清二楚。”雅各布解释说，“我每天服药一片，每三个星期进行一次前后持续30分钟的输液。”在饮用这杯试验性质的“鸡尾酒”近一年后，她发现自己的原发性肺癌缩小了50％以上。

作为最早得益于这种锁定目标更加精确、从分子层面向疾病发动袭击的疗法的癌症病人，雅各布经历的奇迹是令人振奋的。老式的化疗和放疗犹如锋刃迟钝的武器，它们在杀戮恶性细胞的同时也殃及健康细胞。这类治疗的毒性过于剧烈，远不是大多数病人能够忍受的。相比之下，新一代药物则好比是精确导弹，既能命中肿瘤目标，又将伴随而来的对人体的损害减小到最低限度。这些药物一经与先进的技术，诸如按分子特征和病人的DNA筛选来划分肿瘤的方法结合使用，就能将癌症由致命恶疾转化为一种可无限期周旋的慢性病。“治疗模式正在发生变化，”约翰斯·霍普金斯学院的癌症专家戴维·西德朗斯基博士说，“目标明确的新药即将问世，我们得琢磨使用它们的途径。”

要有效地与癌症斗争，必须展开相关的侦探工作，而这一切得从跟踪恶性细胞本身做起。从本质上说，肿瘤是一个突变的累积过程。由于DNA（脱氧核糖核酸）的原因，它不受控制地生长，在遗传误差层层加码的重压下挣扎着，直至变得不稳定和无法修复自身为止。科学家通过对这些突变的研究，可以了解大量有关特定癌细胞是如何转化成恶性和它用来获取生长所需营养的分子路径的信息。在这些突变中，有一个或多个可能被证明是肿瘤的致命弱点，亦即使它面对特效药败下阵来的弱点。

3、小题1:与“（癌症）治疗模式正在发生变化”一语的含义不相符合的一项是

A．新的疗法目标更为准确，是从分子层面向疾病发动袭击的。

B．新的治癌模式非常独特，其方法是让患者饮用鸡尾酒，来达到治疗目的。

C．新的治癌方法既能治疗癌症，又能把对人体的损害减少到最低限度。

D．把新药与先进的技术相结合，这将是一种更为理想的治疗模式。4、小题2:根据原文提供的信息，以下推断正确的一项是

A．采用新药治疗后，雅各布死灰复燃的肺癌将完全治愈。

B．新一代的治癌药物在临床应用中可以避免对人体的损害。

C．由于专家的不断探索试验，人类有望改变癌症作为致命恶疾的现状。

D．做好了恶性细胞的跟踪工作，癌症的治疗问题也就迎刃而解了。
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    My son Joey was born with club feet (畸形足) .  The doctors told us that with ___1___   he would
be able to walk   2  but would never run very well. The first three years of his   3    were spent in surgery(手术) . By the time he was eight, you wouldn't know he had a 4  when you saw him walk.
     The children in our   5   ran around as most children do during play,and Joey would jump right in and
 run and play,too. We never told him that he probably wouldn't be   6  to run as well as the other children. So he didn' t know.
      In seventh grade he   7  to go out for the cross-country team. Every day he trained with the team. He worked harder and ran more than any of the others. Perhaps he 8  that the abilities that seemed to come   9  to so many others did not come naturally to him. 10  the entire team runs, only the top seven runners
have the 11   to score points for the school. We didn't tell him he probably would never make the team,
so he didn't know.
     He    12   to run four to five miles a day , every day-even the day he had a fever. I was   13 , so I went to look for him after school. I found him running alone. I asked him how he felt.
" 14  ," he said. He had two more miles to go. The   15  ran down his face and his eyes were glassy from
his fever. Yet he looked  16   ahead and kept running. We never told him he   17  run four miles with a fever. So he didn't know.
     Two weeks later the names of the team runners were 18  . Joey was number six on the list. Joey had
made the team. He was in seventh grade-the other six team members were all eight-graders. We never
told him he couldn't   19  to make the team. We never told him he couldn't do it. We never told him he
couldn't do all those things. So he didn't know. He   20  did it.

( )1.A. examination
( )2.A. silently    
( )3.A. school      
( )4.A. confidence  
( )5.A. neighborhood
( )6.A. pleased    
( )7.A. refused    
( )8.A. sensed      
( )9.A. suddenly    
( )10.A. If        
( )11.A. strength  
( )12.A. continued  
( )13.A. upset      
( )14.A. Sorry      
( )15.A. tears      
( )16.A. obviously  
( )17.A. couldn't  
( )18.A. discovered
( )19.A. expect    
( )20.A. seldom     		B. experiment
B. usually  
B. life      
B. problem  
B. city      
B. cetain    
B. decided  
B. understood
B. actually  
B. Since    
B. benefit  
B. had      
B. angry    
B. Okay      
B. heat      
B. anxiously
B. wouldn't  
B. called    
B. like      
B. just      		C. excitement  
C. normally    
C. illness    
C. success    
C. family      
C. able        
C. remembered  
C. learned    
C. naturally  
C. Although    
C. intelligence
C. wanted      
C. worried    
C. Right      
C. sweat      
C. straight    
C. mustn't    
C. completed  
C. fail        
C. always      		D. treatment    
D. quickly      
D. time        
D. comfort      
D. childhood    
D. willing      
D. promised    
D. drove        
D. possibly    
D. Because      
D. chance      
D. indicated    
D. disappointed
D. Absolute    
D. failure      
D. typically    
D. needn't      
D. examined    
D. try          
D. never       
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