问题 单项选择题 案例分析题

患者男,68岁,8小时前食用自制泥螺后出现中上腹痛,伴有发热,体温约37.5℃,腹泻2次,为水样便。查体:中上腹压痛,无反跳痛,墨菲征阴性,肠鸣音活跃。

提示患者上消化道内镜检查发现十二指肠降部及以远黏膜充血、水肿、溃疡形成及黏膜下出血,病变呈节段性分布,十二指降部影像见下图。肠镜结肠内及回肠末端可见血迹,水冲后未见异常。腹部CT提示空肠及部分回肠节段性水肿、扩张。血常规提示:WBC30×109/L,Hb110g/L。便常规为红细胞(RBC)满视野,白细胞>50/HP,追问便培养结果已见革兰阳性杆菌生长。最可能的诊断是()。

A.肠白塞

B.克罗恩病

C.急性细菌性痢疾

D.溃疡性结肠炎

E.急性出血坏死性肠炎

F.肠结核

G.小肠淋巴瘤

H.缺血性肠病

答案

参考答案:E

解析:

3.该例患者急性起病,发热、腹泻考虑感染性疾病,腹部CT提示节段性病变分布,累及空肠及回肠,结合内镜检查等多项特点,符合急性出血坏死性肠炎。

4.患者腹痛加重,查体出现反跳痛,腹腔穿刺血性液体,提示可能存在肠坏死甚至穿孔,为手术治疗指征;急性出血坏死性肠炎为C型产气荚膜杆菌感染引起,临床上可以分为胃肠炎型、肠出血型、腹膜炎型、肠梗阻型、中毒休克型。各种分型表现可以同时或交替出现,临床需要注意识别。

单项选择题

(A)

Arthur Miller (1915-2005) is universally recognized as one of the greatest dramatists of the 20th century. Miller’s father had moved to the USA from Austria-Hungary, drawn like so many other by the "Great American Dream." However, he experienced severe financial hardship when his family business was ruined in the Great Depression of the early 1930s.

Miller’s most famous play, Death of a Salesman, is a powerful attack on the American system with its aggressive way of doing business and its insistence on money and social status as indicators of worth. In Willy Lowman, the hero of the play, we see a man who has got into double with his worth. Willy is "burnt out" and in the cruel world of business there is no room for sentiment: if he can’t do the work, then he is no good to-his employer, the Wagner Company, and he must go. Willy is painfully aware of this, and at loss as to what to do with his lack of success. He refuses to face the fact that he has failed and kills himself in the end.

When it was first staged in 1949, the play was greeted with enthusiastic reviews, and it won the Tony Award for Best Play, the New York Drama Critics’ Circle Award, and the Pulitzer Prize for Drama. It was the first play to win all three of these major awards.

Miller died of hear failure at his home in Roxbury, Connecticut, on the evening of February 10, 2005, the 56th anniversary of the first performance of Death of a Salesman on Broadway.

The play Death of a Salesman()

A. exposes the cruelty of the American business world

B. discusses the ways to get promoted in a company

C. talks about the business career of Arthur Miller

D. focuses on the skills in doing business

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