问题 多项选择题

病历摘要:患者女性,28岁。7天前开始发热,腹泻,经用“黄连素”等药,5天后治愈。12小时前赴宴回家即发现双下肢无力,2小时前全身无力,不能起床。体检:烦躁不安,气促,说话困难,口唇发绀,四肢肌力I级,肌张力低,腱反射减弱,痛觉存在,排尿费力,不易解出,呼吸困难。

提示;入院后第2天,病人作了气管切开,安人工呼吸机,四肢瘫痪加重,近端肌力为00。实验室检查结果:血钾4.2mmol/L(16mg/dl),钠137mmol/L(315mg/dl)。脑脊液检查结果:压力1.8kPa(184毫米水柱),白细胞2×10[~6.gif]/L(2/mm[~3.gif]),蛋白0.4克/L(40mg/dl),糖3.0mmol/L(54mg/dl)。 提问:根据检查结果和病情变化,可以排除哪些疾病?()

A、周期性瘫痪

B、低钾综合征

C、重症肌无力

D、格林——巴利综合征

E、呼吸肌麻痹

F、电解质紊乱

G、急性脊髓炎

H、脊髓灰质炎

答案

参考答案:A, B, C, F, G, H

解析:

此前,本病人诊断尚未明确。而一项诊断的确立,有时尚需必要的辅助检查,提供客观的诊断依据。此时,考生要善于充分利用试题提供的有关资料。根据提供的资料,血钾为4.2mmol/L。,血钠137mmol/L,均在正常范围。故有充分依据排除周期性麻痹、低钾综合征和电解质紊乱。至于急性脊髓炎、脊髓灰质炎、重症肌无力等,提示中未提出有关新的有助于诊断的资料,在前面均已排除。病人有四肢瘫痪,并无肺部感染和气道受阻等原因,呼吸困难显然与呼吸肌麻痹有关。此外,虽经吸氧、辅助人工呼吸,但病情仍继续加重,不得不行气管切开,安人工呼吸机,且瘫痪加重,均表明疾病仍在进展,此点符合格林一巴利综合征早期的表现。至于脑脊液检查各项指标均在正常参考值范围内,并无明显蛋白细胞分离,在本病早期,尤其在起病1周内是完全可以解释的,故不能排除,即正确的诊断是:格林一巴利综合征并呼吸肌麻痹。

阅读理解

阅读理解

     I loved music when I was young. I learned to play the guitar at 11 and I wrote my first song four years

later. My dream was to become a country singer.

After years of hard work, a record company was showing interest in me. One day during a trip to

Nashcille, a friend offered me a bit of meth (一种兴奋剂).I didn't know then that meth is the easiest,

cheapest drug to get, and also one of the most addictive. So I smoked it and that was all I thought about

for the next year and a half .I couldn't live without it.

     When the police arrested me, I looked like death. The first seven days in prison, I just slept. when I

woke up on the eighth day, I had never known such shame and guilt. I walked down the hall to the pay

phone. My mum is the sweetest person on the planet, and I knew this was going to break her heart. When

I heard her voice on the phone, I told her where I was . She just said : "son, don't you know you can't do

anything to make me not love you?"

     Her words gave me the strength to face my trouble. And I also realized this was my chance to start a

new life.

     When people know my story, I hope they will not make the same mistake as I have, but I do know that

you can overcome almost anything, especially drug abuse. That's why I share my story here.

1. Which was the writer's favorite music when he was in his teens?

A. Rock music    

B. Classical music    

C. Jazz music  

D. Country music

2. How long was the writer addicted to drug?

A. About half a year    

B. About one year    

C. One and a half years  

D. Two years

3. The writers was put into prison most probably because he _____.

A. offered others drugs  

B. took drugs

C. stopped working with a record company

D. refused to pay off all his debts

单项选择题