问题 单项选择题 案例分析题

男,33岁,车祸致左股骨开放性骨折伴严重的肌肉挫伤,给与石膏绷带包扎,伤后2天,诉左大腿疼痛加重,胀痛明显,止痛剂无效,伴烦躁不安,体温38.5度,脉搏120次/分,出汗较多。查体:打开石膏绷带见受伤部位肿胀明显,伤口有大量浆液性渗出,皮下有捻发音,皮肤呈大理石样花纹,伤口恶臭

下列对诊断最有帮助的是()

A.血培养

B.伤口分泌物涂片检查

C.骨髓培养

D.血常规

E.超声检查

答案

参考答案:B

解析:(1)A本题目为问题解决型,考查气性坏疽的诊断。本患者左股骨开放性骨折伴严重的肌肉挫伤,石膏绷带包扎后出现大腿疼痛加重,胀痛明显,止痛剂无效,伴发热、脉速等全身症状。受伤部位明显肿胀,伤口有大量浆液性渗出,皮下有捻发音,皮肤呈大理石样花纹,恶臭味,是气性坏疽的典型表现。由于本病相对少见,所以经验不足的话,容易误诊。最常见的混淆的疾病是筋膜室综合征,患肢出现胀痛,肿胀明显但无渗液、恶臭及捻发音,无发热、脉快等全身中毒症状,故可鉴别;伤口一般厌氧菌感染肿胀不会很严重,无恶臭的渗液,但可能有少量皮下气体,发展相对较慢,易鉴别。至于骨髓炎、脓毒症有特殊表现,容易鉴别。本题目正确答案是A(3)D本题目是相应的气性坏疽的治疗,为问题解决型题目。气性坏疽发生后应该病变区多处、广泛切开减压,纠正水、电解质紊乱。由于细菌是厌氧菌,高压氧可提高局部氧含量,抑制细菌生长。气性坏疽杆菌对青霉素敏感,应首选,庆大霉素无效。所以正确答案是D。

单项选择题
完形填空
阅读下面短文,从短文后各题所给的四个选项中,选出可以填入空白处的最佳选项,并在答题卡上将该项涂黑。
One night I decided to spend some time building a happier and closer relationship with my daughter. For several weeks she had been  16 me to play chess(棋) with her, so I suggested a game and she eagerly ___17__. It was a school night, however, and at nine o’clock my daughter asked if I could __18__ my moves, because she 19___ to go to bed; she had to get up at six in the morning. I ___20 she had strict sleeping habits,  21 I thought she ought to be able to  22 some of this strictness. I said to her, “  23 , you can stay up late for once. We’re having   24 .” We played on for another fifteen minutes, during which time she looked   25 . Finally she said, “Please, Daddy, do it quickly.” “No,” I replied. “If you’re going to play it  26 , you’re going to play it slowly.” And so we   27  for another ten minutes, until __28 my daughter burst into tears, and  29 that she was beaten.
Clearly I had made  30 . I had started the evening wanting to have a  31 time with my daughter but had 32 my desire to win to become more  33 than my relationship with my daughter. When I was a child, my desire to win  34  me well. As a parent, I  35 that it got in my way. So I had to change.
小题1:
A.guidingB.askingC.trainingD.advising
小题2:
A.allowedB.expectedC.repliedD.accepted
小题3:
A.changeB.repeatC.hurryD.pass
小题4:
A.agreedB.neededC.beggedD.hated
小题5:
A.knewB.learnedC.guessedD.heard
小题6:
A.soB.forC.butD.or
小题7:
A.put upB.take upC.pick upD.give up
小题8:
A.As usualB.Go aheadC.By the wayD.Come on
小题9:
A.patienceB.luckC.funD.success
小题10:
A.excitedB.proudC.anxiousD.angry
小题11:
A.wellB.againC.fairlyD.regularly
小题12:
A.discussedB.continuedC.countedD.argued
小题13:
A.nervouslyB.immediatelyC.strangelyD.suddenly
小题14:
A.promisedB.admittedC.wonderedD.discovered
小题15:
A.a mistakeB.a decisionC.an attemptD.an effort
小题16:
A.freeB.differentC.fullD.happy
小题17:
A.managedB.recognizedC.allowedD.reduced
小题18:
A.importantB.attractiveC.practicalD.interesting
小题19:
A.offeredB.servedC.controlledD.taught
小题20:
A.realizedB.apologizedC.imaginedD.explained