问题 多项选择题 案例分析题

患者男,52岁,因“骨痛3个月,加重伴乏力2个月”来诊。患者于3个月前无明显诱因感到胸肋部、腰背部和双下肢疼痛,活动时加重;近2个月疼痛逐渐加重,给予按摩、针灸等治疗无好转,伴活动性乏力、气促。当地查血常规示贫血;胸部CT:胸肋骨骨质密度普遍性减低,左侧第5前肋可见骨皮质不连续;放射性核素骨扫描:全身诸骨可见多发广泛骨质破坏,以颅骨、肋骨、胸腰椎和近端四肢骨为著,病变部位示踪剂明显不均匀浓聚,代谢增高。发病以来患者食欲减退,体重下降约6kg,诉排尿泡沫增多。既往体健,无特殊病史。查体:一般情况尚可,贫血貌,表浅淋巴结未扪及,脊柱无压痛和明显叩击痛,胸骨无压痛,双肺呼吸音清晰,心律规则,无杂音,腹软,无压痛,肝、脾肋下未触及,双下肢轻度压凹性水肿。实验室检查:白细胞8.8×109/L,血红蛋白76g/L,血小板205×109/L;尿常规:蛋白质(++),隐血(-);血生化检查:总蛋白48.60g/L,白蛋白27.60g/L,尿素氮10.1mmol/L,肌酐189μmol/L,乳酸脱氢酶165U/L,β2-微球蛋白6.54mg/L,血电解质,肝、肾功能大致正常。

提示患者4个疗程硼替佐米+阿霉素+地塞米松(PAD方案)诱导治疗后获得部分缓解(PR),肾功能恢复正常,无明显外周神经毒性,与其同胞弟弟人类白细胞抗原(HLA)配型完全相合。推荐的诱导后治疗包含()

A.以马法兰200mg/m2±硼替佐米为预处理方案后自体造血干细胞移植(HDT/ASCT)治疗

B.马法兰+泼尼松(MP方案)+沙利度胺

C.若第1次自体造血干细胞移植(HDT/ASCT)后治疗反应≥非常好的部分缓解(VGPR),随后给予硼替佐米或雷利度胺维持治疗

D.若第1次HDT/ASCT后治疗反应<VGPR,则行第2次HDT/ASCT或同胞供者减低剂量预处理(RIC.的异基因造血干细胞移植治疗;第2次HDT/ASCT后予以硼替佐米或雷利度胺维持治疗

E.马法兰+泼尼松(MP方案)

F.停止治疗,观察

答案

参考答案:A, C, D

阅读理解

阅读理解。

     Little Peter is a boy of nine. He began to go to school when he was six , and now he is in Grade

Three. He lives not far from the school, but he is often late for class. He likes watching TV in the

evening and goes to bed late, so he can't get up on time in the morning.

     This term, Mrs. Black, Peter's aunt , works in Peter's school. She is strict with Peter and often

tells the boy to obey the school rules and come to school on time. Yesterday morning Peter got up late.

When he hurried (赶紧) to school , it was a quarter past eight . His aunt was waiting for him at the

school gate .

     "You are ten minutes late for the first class , Peter , " Mrs. Black said angrily. "Why are you often

late for class ? " "Every time , when I get to the street corner (街道拐角), I always see a guidepost (路标). It says SCHOOL-GO SLOWLY ! "

1. Peter is in school for ______ years.

A. one and a half      

B. two      

C. three      

D. six

2. Peter is often late for school because ______.

A. he likes watching TV          

B. he doesn't like to go to school

C. he sleeps well at night

D. he can get up early in the morning

3. Mrs. Black is a ______.

A. worker      

B. teacher    

C. mother    

D. policewoman

4. The first class begins at ______.

A. ten to eight      

B. eight      

C. five past eight      

D. a quarter past eight

5. The guidepost is for ______.

A. drivers      

B. Peter      

C. students      

D. teachers

单项选择题 A3/A4型题