问题 单项选择题 案例分析题

患者男,67岁。退休职员。因“多饮、多尿7年,乏力半年”入院。患者7年前体检发现空腹血糖13.5mmol/L,诊断为糖尿病,给予格列齐特80mg,每日2次,口服治疗。空腹血糖控制在8mmol/L左右,餐后血糖控制10mmol/L左右。近3年来因血糖控制欠佳改用胰岛素治疗,现采用诺和灵30R早20U晚18U,空腹血糖控制在7mmol/L左右,餐后血糖控制在14mmol/L左右。近半年来渐出现乏力,易疲劳,视物模糊,偶有双下肢水肿。此次为进一步明确诊断入院。体检:T、P、R均正常,BMI25.4kg/m2,BP135/90mmHg,一般情况可,心肺听诊无异常,双下肢无水肿。

该患者营养治疗方案()

A.1.0g/(kg·d)

B.0.8g/(kg·d)

C.1.0g/(kg·d)+α酮酸片

D.0.8g/(kg·d)+α酮酸片

E.0.6g/(kg·d)+α酮酸片

F.0.8g/(kg·d)

答案

参考答案:B

解析:

1.该患者起病时>40岁,口服降糖药有效,体型肥胖,故糖尿病分型诊断倾向2型。该患者存在视物模糊和间断性双下肢水肿,故而需考虑是否存在糖尿病肾病和糖尿病视网膜病变的可能,需进一步完善相关检查以明确。

2.糖尿病视网膜病变:微血管瘤是糖尿病视网膜病变的特征性改变,属于单纯期病变。糖尿病肾病的诊断:半年内3次微量白蛋白尿超过30mg/24h,同时合并存在糖尿病视网膜病变。慢性肾脏疾病(CKD)分期:存在尿检异常,eGFR>90ml/(min·1.73m)为CKD1期;eGFR60~90ml/(min·1.73m)为CKD2期;eGFR60~30ml/(min·1.73m)为CKD3期;eGFR15~30m/(min·1.73m)为CKD4期;eGFR<15ml/(min·1.73m)为CKD5期。该患者根据MDRD公式计算可知GFR97.38ml/(min·1.73m)>90ml/(min·1.73m),因此CKD分期为1期。

3.糖尿病肾病和视网膜病变等微血管病变早期治疗以强化降糖治疗为基础的控制血压血脂、改善微循环综合治疗,并检测各项指标的变化。

4.对处于eGFR>60ml/(min?1.73m)的患者,营养治疗,可不使用α酮酸片,因此只需要蛋白质的日摄入量0.8g/kg。

阅读理解

Big Brothers Big Sisters is based on the simplicity and power(力量) of friendship.It is a program which provides friendship and fun by matching vulnerable young people (ages 7-17) with a volunteer adult who can be both a role model and a supportive friend.

Volunteer tutors come from all walks of life—married, single, with or without children. Big Brothers and Big Sisters are not replacement parents or social workers. They are tutors: someone to trust, to have fun with, to talk and go to when needed.

A Big Sister and Little Sister will generally spend between one and four hours together three or four times each month for at least twelve months. They enjoy simple activities such as a picnic at a park, cooking, doing sports or going to a football match. These activities improve the friendship and help the young person develop self-respect, confidence and life direction.

Big Brothers Big Sisters organizations can be found throughout the world. It is the largest and most well-known provider of tutor services internationally and has been operating for 25 years.

Emily and Sarah have been matched since 2008. Emily is a 15-year-old girl who has experienced some difficulties being accepted by her schoolmates at school. “ I was pretty sure there was something wrong with me.”

Emily’s mum came across Big Brothers Big Sisters and thought it would be of benefit to Emily by “providing different feedback about herself other than just depending on schoolmates to measure(测量) her self-worth.

Sarah wanted to get involved(使参与) in a volunteer program. “I googled it and found out how to be a part of it. I thought it would be fun for me to get involved in making time to do something because sometimes it is all work and no play.”

Big Brothers Big Sisters has been of great benefit and enjoyment to both Emily and Sarah. They love and look forward to their time together and the partnership has certainly helped Emily be more comfortable in being the wonderful and happy girl she is!

小题1:According to the passage, “vulnerable young people” are probably those who are   _________.

A.popular at school

B.rather weak physically

C.easily hurt emotionally

D.confident in themselves小题2:A volunteer is usually expected to work within a year for at least______.

A.72 hours

B.48 hours

C.36 hours

D.24 hours小题3:Why did Sarah want to get involved in the program?

A.She felt a bit bored with her life.

B.She used to be a volunteer.

C.She needed a part-time job.

D.She wanted to get a difficult job.小题4:What is the purpose of Big Brothers Big Sisters?

A.To offer students public services.

B.To help students improve their grades.

C.To organize funny sport activities for young people.

D.To provide partnership and fun for young people.

单项选择题