问题 多项选择题 案例分析题

患者男,42岁。因“左跖趾关节划伤11天,突发疼痛4天”前来就诊。5天前,患者搬家时左跖趾关节被门框底边划伤,立即到当地医院就诊,门诊注射“破伤风疫苗”,清洁伤处,予“抗生素抗感染治疗”(具体不详)后返家。4天前大量饮酒后突发左跖趾关节肿胀、疼痛,活动受限,到当地医院就诊,门诊予“抗生素抗感染治疗”(具体不详)后症状无缓解。今日为进一步诊治来我院。查体:T36.7℃,BP126/80mmHg,P87次/分。营养好。左跖趾关节红肿明显、皮温稍高,有压痛,皮肤表面可见一约1cm×0.15cm×0.05cm伤口,愈合良好。有“血脂紊乱”史。平素血压及血糖正常。父亲患痛风。

若考虑予吲哚美辛治疗该患者,可用的方案为()

A.12.5mg,每日3次服用1天,改为50mg,每日3次,服用3天

B.25mg,每日3次服用1天,改为50mg,每日3次,服用3天

C.50mg,每日3次服用3天,改为25mg,每日3次,服用4~7天

D.50mg,每日3次服用14天,改为25mg,每日3次,服用3天

E.12.5mg,每日3次服用1天,改为50mg,每日3次,服用至症状缓解后

F.50mg,每日3次服用3天,改为25mg,每日3次,服用至症状缓解后

答案

参考答案:C, F

解析:

1.A和B选项提示化脓性关节炎的可能,但根据提示可以排除。C项为化脓性关节炎和痛风急性发作时共有的特点。D项为痛风和假性痛风共有的特点。E项二羟焦磷酸钙是假性痛风的特征。F项尿酸钠盐是痛风的特征。

2.该患者血压、血糖正常,不考虑选用他汀类降LDL-C。TG>2.3mmol/L,可考虑贝特类。结合其为痛风患者可选择可降低血尿酸的药,其中非诺贝特有促尿酸排泄作用,尽管目前还没有资料证明它可以降低血脂紊乱患者发生痛风的风险,但在临床上仍然可以考虑将它优先用于伴发TG升高为主的血脂紊乱的痛风患者。

判断题
完形填空

Directions: Read the following passage. Answer the questions according to the information given in the passage.

“Let’s Talk”:The Free Advice Project

A few weeks ago, I took a walk around Washington Square Park. I met all the usual people:street performers, the Pigeon Guy, a group of guitarists singing in harmony. But off to the side, sitting on a bench was a woman doing something vastly different—giving free advice.

A week or two later, I set up an interview with her and we discussed her project at length.

Lisa Podell, 32, started the Free Advice Project this past May. It began as an experiment;she sat in Washington Square Park for a day with a sign that read “Free Advice” as a simple way to reach out to people. Podell was astonished at the strong response.

Podell admits that she was doubtful at first, but now she describes the project as mutually (相互地) beneficial. People learn from her—but she also learns from them. She says that the majority of those who come to her are dealing with some pretty heavy issues, and they expect her not only to listen, but also provide real answers.

Having worked as a full time teacher and now as an adolescent advisor, Podell believes that talking things out is an important in the decision-making process.

Sometimes, people walk around all day, keeping their problems in their own head and thinking about them in the same way. Podell simply strives to provide people with perspective.

I asked if there is a future plan for the Free Advice Project. Podell said she would like to promote it to each public space in New York, which would be carried out by various volunteers across the city. 

It was truly inspiring to meet someone with such a big heart, especially in New York—where it is sometimes very hard to find anybody to listen. (303 words)

小题1:In what way was Podell different from other people in the park? (No more than 6 words)  (2 marks)

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小题2:What do people in need expect Podell to do? (No more than 10 words)  (3 marks)

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小题3:According to Podell, what should people do when making decisions?

(No more than 6 words)  (2 marks)

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小题4: How would Podell promote her project in New York?  (No more than 15 words)  (3 marks)

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