问题 单项选择题 案例分析题

患者,男性,60岁。因"半月内反复右肢乏力、言语不能3次"入院。既往有高血压、糖尿病史。入院查体:右利手,血压180/100mmHg,血糖12mmol/L,神经系统检查无阳性体征,头颅CT检查未见异常。经治疗,上述症状未再发生,出院后坚持门诊治疗。2个月后,患者又因"右肢乏力伴言语不能2小时"再次入院。查体:神清,血压180/105mmHg,血糖10mmol/L,双眼左凝,运动性失语,右鼻唇沟浅,伸舌不能,右肢肌力2级,右巴氏征(+)。

若选择溶栓治疗,血压应控制在()

A.收缩压≤140mmHg,及舒张压≤90mmHg

B.收缩压≤160mmHg,及舒张压≤95mmHg

C.收缩压≤180mmHg,及舒张压≤105mmHg

D.收缩压≤185mmHg,及舒张压≤110mmHg

E.收缩压≤220mmHg,及舒张压≤120mmHg

F.收缩压≤130mmHg,及舒张压≤90mmHg

答案

参考答案:D

解析:

1.短暂性脑缺血发作是指局灶性脑缺血导致的突发短暂性、可逆性神经功能缺损。发作持续数分钟,通常在30分钟内完全恢复。诊断主要依靠病史。

2.运动性语言中枢位于优势大脑半球额下回后部,该部位由大脑中动脉供血。患者为右利手,故左侧大脑半球为优势半球,选E。

3.短暂性脑缺血发作的治疗,首先应针对病因治疗,如控制血压、血糖等,其次是预防性药物治疗,包括:抗血小板聚集、抗凝治疗、应用血管扩张剂、脑保护治疗等。

4.短暂性缺缺血发作着超过2小时仍未缓解,通常进展为脑梗死。

5.超早期溶栓治疗对恢复梗死区血流灌注、减轻神经元损伤、挽救缺血半暗带最具意义。

6.脑梗死急性期在血压的控制上因治疗方案不同而异,溶栓者应控制于收缩压≤185mmHg及舒张压≤110mmHg水平,否则易并发脑出血;非溶栓者应控制于收缩压≤220mmHg或舒张压≤120mmHg水平,切忌过度降压使脑灌注压降低,导致脑缺血加剧。

完形填空

Born in 1949, Diana Nyad took an early interest in swimming as a sport and was a Florida State High School swimming champion. Like many young athletes, she had Olympic dreams, but a serious illness kept her from competing in the Games. The disappointment didn’t stop her from going forward. Instead, she became interested in marathon swimming. A brilliant athlete, she was well-conditioned for spending long periods of time in the water. As a long-distance swimmer, she would compete against herself and the obstacles presented by distance, danger, cold, and exhaustion.

For ten years Nyad devoted herself to becoming one of the world’s best long-distance swimmers. In 1970, she swam a ten-mile marathon in Lake Ontario, setting the women’s record for the course. In 1972 she set another record by swimming 102.5 miles from an island in the Bahamas to the coast of Florida. Then she broke a third record when swimming around Manhattan Island in 1975.

Nyad attempted to swim the distance between Florida and Cuba in 1978. Though the span of water is less than 100 miles wide, it is rough and dangerous. After battling the water for two days, she had to give up for the sake of her own health and safety. Even so, she impressed the world with her courage and strong desire to succeed. For Nyad her strength of purpose was just as important as reaching Cuba. That is how she defined success. It did not matter that her swim came up short; she believed she had touched the other shore.

When Nyad ended her career as a swimmer, she continued to try new things---travelling the world as a reporter, writing books and giving public speeches about her life. Diana Nyad works to inspire others, just as she did when she swam the waters of the world.

小题1: What prevented Nyad from taking part in the Olympic Games? (No more than 5 words)

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小题2:What does the underlined word “obstacles” mean? (1 word)

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小题3:What achievement did Nyad make in 1970? (No more than 10 words.)

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小题4:Why did Nyad believe that she had touched the other shore? (No more than 10 words)

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单项选择题