问题 单项选择题 案例分析题

患者男性,60岁。原有肺心病病史。近1周来发热、咳脓痰;神志恍惚、睡眠颠倒2天。体检:球结膜水肿,发绀,颈静脉充盈,两肺湿啰音。心率120次/min,律齐,血压90/60mmHg,下肢水肿,尿蛋白(+)。

为明确诊断首选检查()。

A.胸部X线

B.痰细菌培养

C.动脉血气分析

D.尿素氮、肌酐

E.头颅CT

答案

参考答案:C

解析:患者有肺心病史,因呼吸道感染诱发本病急性发作,出现神志恍惚、睡眠颠倒,首先考虑由于呼吸功能衰竭所致缺氧、二氧化碳潴留引起的肺性脑病。患者需要行胸部X线检查了解肺部感染情况,血常规检查WBC增高,痰细菌培养寻找病原菌,动脉血气分析和电解质测定了解酸碱失衡的状况,以及是否伴随电解质紊乱,血尿素氮、肌酐检查了解是否发生肾前性肾功能不全,患者无泌 * * 感染征象,无需尿培养,肺性脑病不需颅脑CT检查;结合病史及血气分析结果,可诊断呼吸性酸中毒,根据慢性呼吸性酸中毒预计代偿公式,[HCO]预计值为24+(70-40)×0.4±3(33-39),而实测[HCO]为36mmol/L,说明患者是单纯性呼吸性酸中毒。治疗后,患者出现烦躁,手足搐搦,伴有低钾和低氯,考虑发生了代谢性碱中毒,代谢性碱中毒时神经肌肉兴奋性增加,可引起手足搐搦,但不排除可能同时发生低血钙。此时患者应进行血气分析,严密监测血电解质,并纠正电解质紊乱(如补充氯化钾等),同时进行给氧、抗感染等对症治疗以及原发病治疗。此时给予碳酸氢钠会加重碱中毒,患者无血液透析指征。

多项选择题
完形填空

Directions: Read the passage carefully. Then answer the questions or complete the statements in the fewest possible words.

This was no ordinary class. The students who came together were all science or engineering professors at Cornell University. They had interrupted their research to accept an invitation to take part in an unusual experiment: “an interesting week of poetry”. This class was part of a study to answer the questions: Why is science difficult for many non-science students?

The students in the poetry class listened to lectures and took notes. They had reading tasks and had to write three short papers. All students noticed one thing—the importance of spoken words. In science and engineering classes, the instructors put tables and drawings on the blackboard. But in this poetry class, the instructors just talked. They didn’t write anything on the board.

The scientists and engineers noticed one similarity between science and poetry. In both subjects, students need to find layers of meaning. Some layers are simple, clear, and on the surface; other layers are deeper and more difficult. This search for different levels of meaning doesn’t happen much in undergraduate science classes, but it is important later, in graduate school. And it is always important in humanities(人文科学).

Both the poetry instructors and their students learned something about teaching from this experience. One poetry instructor, for example, now sees the importance of using informational charts as he teaches. Most of the scientists agreed on several points. First, humanities classes might help science students to see patterns and decide which information is important. Second, the poetry class was fun. One engineer decided, “We need to change the way we teach engineering to make it an enjoyable experience for students.” But perhaps the most important result of the experience was this: All of the professors began to think about how they teach and how they can teach better.

(Note: Answer the questions or complete the statements in NO MORE THAN TWELVE WORDS.)

小题1:Why was this class very unusual?

小题2:The experiment was designed to help teachers find out ________.

小题3:The poetry class was different from science and engineering classes in that __________.

小题4:What influence did the experiment had on those professors?