问题 多项选择题 案例分析题

患者男,39岁。因“多汗、易饥、多食伴双眼畏光、流泪2年余,右眼球结膜水肿1年余”就诊。患者2年前出现多汗、易饥、多食,伴颈部粗大、双手震颤,伴双眼畏光流泪,经检查诊断为:甲状腺功能亢进症。甲巯咪唑治疗6个月,感双眼畏光流泪好转,自行停药。1年前突眼加重,并出现右眼球结膜水肿,查甲功:FT37.58ng/dl、FT43.58ng/dl、TSH0.047μIU/ml,双眼超声:双侧眼球后条形低回声,考虑增粗的眼肌。查体:双侧甲状腺Ⅱ度肿大,质软,无触痛,未闻及明显血管杂音。HR92次/分,律齐,双眼睑闭合不全、水肿,无明显红斑,结膜充血、水肿,无明显泪阜水肿,双眼突度20mm,右侧眼睑挛缩+2mm。眼球运动时无疼痛,无自主性球后疼痛。

突眼体征包括()

A.Stellwag征

B.Babinski征

C.Oppenheim征

D.Graefe征

E.Gordon征

F.Mobius征

G.Joffroy征

答案

参考答案:A, D, F, G

解析:

1.甲状腺相关突眼鉴别诊断包括:①白血病;②炎症性眼球突出如眼球筋膜炎、眼眶蜂窝织炎、海绵窦血栓性静脉炎等;③头部外伤性眼球突出;④鼻窦肿瘤;⑤眼眶炎性假瘤;⑥眶脑膜瘤;⑦颈动脉-海绵窦瘘;⑧眼眶转移性肿瘤。

2.甲亢突眼眼部改变包括:上眼睑挛缩,眼裂增宽(Dalrymple征),上眼睑移动滞缓(vonGraefe征):眼睛向下看时上眼睑不能随眼球向下移动,可在角膜上缘看到白色巩膜。眼睛慈祥或呈惊恐眼神(staringoffrightenedex-pression),瞬目减少(Stellwag征),向上看时前额皮肤不能皱起(Joffroy征),两眼内聚减退或不能(Mobius征)等;而B、C、E项为病理征。

阅读理解

阅读理解。

     I live in a very over populated beach area in the Los Angeles, and I love the beautiful sights. But because

of many people, lots of things are easy to be out of order, and sometimes it's also easy to become angry.

Today was a day I wish I did not get out of bed. I mean that if I did not have to wake up and deal with all

the things that I have to deal with every day, it would have been wonderful.

     I had a cup of coffee this morning and that was my meal for breakfast, not healthy I know. Anyway,

my stomach was sounding like a truck. So, I jumped in my car and decided to buy some food.

     I was in line at Taco Bell and the line was like a long snake! Finally I got to place my order, but a young

girl in nice clothes pulled in (汽车停靠) and was stuck (被困住) in such a way that unless I moved for her,

she wouldn't be able to get out. So I backed up (倒车) and waved her into my place in the front of the line.

     I was surprised that this young girl did not say thanks. I was a little unhappy about it because I thought

that I had done something nice for a change. After the girl received her food and drove away, I pulled into

the ordering spot, not mad but hungry, and the employee said, "Hi, that girl just paid for your food."

     That food was the most satisfying nourishment (营养品) my body had ever taken! If just by chance you

are that person who bought my food, I should say "Thank you!"

1. The underlined part "very over populated" probably means "____".

A. 环境嘈杂的

B. 人口密集的

C. 交通拥挤的

D. 水源污染的

2. From the first paragraph, we can infer (推断) that the story happened in _____.

A. England

B. Canada

C. Australia

D. America

3. What happened to the author according to the passage?

A. He remained lying in bed all the morning.

B. He didn't feel well after drinking a cup of coffee.

C. He made room for a girl who jumped the queue.

D. He had a quarrel with a girl who didn't stand in line.

4. How did the young girl show her thanks to the author?

A. She got out of her car and said thanks.

B. She drove away with her own food.

C. She received her food and waved goodbye.

D. She paid for the author's food without his knowing.

5. The best title for the passage might be _____.

A. Kindness is spreading (传播)

B. Patience is necessary

C. Being calm is important in accidents

D. Being cool can change the world

单项选择题