问题 单项选择题 案例分析题

患者男,56岁。手足增大、面容改变10年。10年前家人发现容貌改变,眉弓和下颌突出,口唇肥厚,鞋号从41码增至46码,伴手足发胀,间断额部胀痛,乏力、双颞侧偏盲,夜间打鼾严重,有呼吸暂停和憋醒,性功能减退、胡须生长缓慢。上述症状进行性加重,近半年体力下降,能上2层楼,劳累后感胸闷、气促。既往史及家族史(-)。PE:肢端肥大症面容,皮肤粗厚潮湿,BP160/95mmHg,HR94次/分,心界向两侧扩大,桶状胸,呼吸音粗,双下肢轻度压凹性水肿。

该患者应该选择的最佳治疗方案为()

A.经蝶垂体腺瘤切除术

B.γ刀放射治疗

C.长效生长抑素治疗

D.长效生长抑素治疗后手术治疗

E.经蝶垂体腺瘤切除术后长效生长抑素治疗

F.γ刀放射治疗后长效生长抑素治疗

答案

参考答案:D

解析:1.患者临床有肢端肥大症的临床表现,要定性诊断首先进行GH葡萄糖抑制试验,以GH抑制后的谷值作为定性诊断标准。2.患者典型肢端肥大症临床表现,GH不能抑制到1ng/ml以下,高IGF-1水平,影像学提示鞍区巨大占位,因此符合垂体侵袭性生长激素大腺瘤的诊断。

阅读理解

阅读理解。

     Years ago, when I started looking for my first job, wise advisers advised, "Barbara, be enthusiastic (热情

的)! Enthusiasm will take you further than any amount of experience." How right they were! 

     "Nothing great was ever achieved without enthusiasm." wrote Ralph Waldo Emerson. It is the paste that

helps you hang on there, then the going gets tough. It is the inner voice that whispers, "I can do it!" When

others shout, "No, you can't!" It took years and years for the early work of Barbara McClintock, a geneticist

who won the 1983 Nobel Prize in medicine, to be generally accepted, yet she didn't stop working on her

experiments. Work was such a deep pleasure for her that she never thought of stopping.

     We are all born with wide-eyed, enthusiastic wonder and it is this childlike wonder that gives enthusiastic

people such youthful air, whatever their age. At 90, Cellist Pablo Casals would start his day by playing Bach.

     As the music flowed through his fingers, his stooped shoulders would straighten and joy would reappear

in his eyes. An author and poet Samuel Ulman once wrote, "Years wrinkle the skin, but to give up enthusiasm

wrinkles the soul."

     Enthusiastic people also love what they do, regardless of money or title or power. Patricia Mellrath, retired

director of the Missouri Repertory Theater in Kansas City, was once asked where she got her enthusiasm. She

replied, "My father, a lawyer, long ago told me, 'I never made a dime until I stopped working for money.'"

     If we can't do what we love as a full-time career, we can as a hobby. Elizabeth Layton of Wellsville, Kan,

was 68 before she began to draw. This activity ended periods of depression that had troubled her for at least

30 years,and the quality of her work led one critic to say, "I am tempted to call Layton a genius."

     We need to turn the tears into sweat as we go after "what-can-be". We need to live each moment whole-

heartedly, with all our senses-finding pleasure in the sweet smell of a back-yard garden, the sim- ple picture

of a six-year-old, the beauty of a rainbow.

1. The author holds the view that _____. [ ]

A. enthusiastic people will never get old

B. enthusiasm can make you succeed and enjoy life

C. enthusiasm is more important than experience

D. enthusiasm can give people more success and fame

2. Which of the following can best explain the underlined sentence in the second paragraph? [ ]

A. Enthusiasm can give you courage and strength in difficult times.

B. If you don't have enthusiasm, you can achieve nothing.

C. Enthusiastic people never consider money and fame.

D. Enthusiastic people can gain great fame and honour.

3. The author mentions Cellist Pablo Casals in the third paragraph to show that _____. [ ]

A. music can arouse people's enthusiasm

B. enthusiasm can give people needed inspiration to succeed

C. enthusiasm can make people feel young

D. enthusiasm can keep people healthy

4. How many examples are given in the passage to show the importance of enthusiasm? [ ]

A. Three.

B. Two.

C. Four.

D. Five.

单项选择题