问题 多项选择题 案例分析题

患儿男,14岁,因“腰椎疼痛6个月,下肢关节疼痛2个月”就诊。患者6个月前出现腰部疼痛,疼痛较局限,不影响患者正常步行。同月行走时摔倒,腰椎疼痛加重,腰椎片:腰1椎体压缩性骨折。卧床休息2个月,疼痛无缓解,2个月前出现双下肢膝关节及踝关节疼痛,活动后加重,无明显关节红肿及变形。复查腰椎片:胸腰椎骨质疏松。腰1~3椎体压缩性骨折。个人史:足月顺产,否认有产伤和窒息史,生后配方奶喂养至2岁,6个月逐渐添加米糊、稀饭、蛋黄等辅食,按时添加鱼肝油、钙剂,生长发育和智力同正常同龄儿,体育锻炼少,户外活动少。查体:体温36.9℃脉搏102次/分呼吸19次/分血压92/60mmHg,体型消瘦,甲状腺无明显压痛。腹软,无压痛、反跳痛及肌紧张,肠鸣音3~4次/分,腰部压痛,双下肢无水肿。

结合病史,该患者鉴别诊断有()

A.维生素D缺乏症

B.甲状旁腺功能亢进症

C.骨髓瘤

D.库欣综合征

E.白血病

F.骨肿瘤

答案

参考答案:A, B, C, E, F

解析:

1.该患者出现骨质疏松合并骨折,青年男性应考虑为继发性骨质疏松,以上各项均为继发性骨质疏松的原因,但D项病史描述无满月脸、水牛背等表现故不考虑。

2.维生素D缺乏患者应该增加日照时间,促进维生素D合成,故C错误,25-羟维生素D是维生素D状况的“晴雨表”,血清中25-羟维生素D的水平不仅预示着骨健康状况,它还是罹患癌症和其他慢性疾病风险的独立预示因子。1,25-二羟维生素D检测方法不应该用于检测维生素D缺乏,因为继发性甲状旁腺功能亢进会引起其水平看似正常甚至升高的结果。故D错误;其余各项正确。

实验题

某班同学到实验室做“测定小灯泡额定功率”的实验,被测小灯泡的额定电压为3.8 V,电阻约为10 Ω。实验室有如下器材:电源(电压约为6V左右)、电流表(0-0.6 A 0~3 A)、电压表(0-3V 0-15 V)、开关各一只,导线若干,滑动变阻器两只:R1(5Ω 0.5A)、R2(10Ω 0.5A)。

(1)请你说出在这个实验中,滑动变阻器所起的作用是:__________________。本实验中电压表应选用_______挡,滑动变阻器应选用_______。

(2)实验电路接好后,合上开关时,部分同学发现电路出现故障,主要有下列的情况,请根据现象指出故障的可能原因:

①连接好电路,闭合开关后,看到电压表指针如图偏转:____________;

②灯泡不亮、电压表示数较大、电流表无示数,取下灯泡,两表的示数不变:_____________;

(3)排除故障后,调节滑动变阻器,发现电压表的0~15 V量程已坏,为了测小灯泡的额定功率,姚远小组设计了另一种实验方案。(电阻R的阻值已知,电源电压未知)

①电路如图乙所示,连接好电路;

②开关S拨到位置1,移动滑片P至任一位置,读出电流表示数I1

③开关S拨到位置2,滑片位置不动,读出电流表示数I2

先算出灯泡的电阻和R两端电压,再根据P0=U02/RL,计算灯泡的额定功率。他们按此方案测量,发现实验结果与真实值相差较大,仔细分析后,他们认为要准确测出灯泡的额定功率,只需将上述步骤②改为____。

阅读理解

C

Depression (抑郁症)is a serious problem today. Depression causes workers to be unproductive, causing companies and countries to lose billion of dollars. One expert says that depression is like cancer because it is “widespread, costly and deadly”. Depression hits one person in five around the world.

Although people have believed depression to be a problem among the rich and educated, studies show that depression is a problem among everyone. Over any six-mouth period, between five to seven percent of the world’s population will be suffering from a serious depression.

Suicide (自杀)rates among people suffering from the disease in its extreme, or clinical form were 80 percent higher that in the population at large, and suffers were four times more likely to have heart attacks. People who suffer from depression often have problems sleeping, getting up on time, and doing work productively.

Depression, which researchers agree has its origin in the genes(基因), brings loss of of confidence and ability to concentrate-making it possible for employees and managers to work efficiently.

Depression is made more serious in China by Chinese’s by Chinese inability to face it. Many people believe that depressed people are either weak or lazy. Besides, there is no good treatment, with few specialists available.

“Most patients in China just don’t get help,” a Chinese doctor says. “In my hospital, I have to see 30 or 40 patients in a morning, and just have time to say ‘Hello, how do you feel?’”

In Western countries, people are not afraid to admit that they have depression, but most do not tell it to their boss, because they fear that their boss would fire them.

“In my experience, aging bosses are the most tilling to admit they have it, because they feel the most secure about themselves,” an American doctor says.

Hopefully, in the near future, people around the world will be able to admit that they have depression so that they can get the right treatment.

49.Which of the following is TRUE according to the passage?

A.It is widely believed that everyone may suffer from depression.

B.Depression brings great problems to its suffers in their life and work.

C.Depression is a commonly-existing problem only in rich countries.

D.The poorer and the less educated a person is, the less he will suffer from depression.

50.Compared to normal people, depressed people are likely to be__________.

A.very unconfident and often absent-minded   

B.easy to avoid being hit by heart attacks

C.working efficiently and productively

D.either weak or lazy

51.Depression becomes more serious in China because of _________.

A.the understanding of the problem   B.the lack for treatment and doctors

C.their unwillingness to tell it to their boss       D.the doctors’ careless work

52.What can we infer from the passage?

A.People are suffering from depression because of the shortage of specialists.

B.The aging bosses around the world dare to say they are depressed.

C.More and more patients will turn to specialists for help.

D.Western people are braver than Chinese people.