问题 多项选择题 案例分析题

患者男,66岁。腹胀伴腹围增大2周,诉有双下肢水肿,有乏力、纳差、牙龈出血。查体:神清,呼吸平,精神略委靡,BP120/70mmHg,全身皮肤、巩膜轻度黄染,肝掌(+)。肝颈反流征(-)。HR8次/分,律齐,双肺呼吸音清,未闻及明显啰音。全腹隆起,蛙状腹,软,无压痛、反跳痛,肝脾肋下未及,移动性浊音(+)。患者有糖尿病史,平时血糖控制不稳定。

提示:患者B超示腹腔大量积液。行腹腔穿刺检查+送检腹水,可能出现的检查结果是()。

A.腹水比重>1.020

B.腹水蛋白<25g/L

C.有核细胞数<300×106/L

D.腹水LDH<200U/L

E.腹水有核细胞以单核细胞为主

F.腹水细菌培养(+)

G.腹水葡萄糖≈血浆葡萄糖

答案

参考答案:B, C, D, E, G

解析:

2.患者出现腹胀伴腹围增大及双下肢水肿,牙龈出血,全身皮肤、巩膜轻度黄染,肝掌(+),移动性浊音(+)等,更多的是要考虑肝硬化所致,而非心脏和肾脏所致。肝硬化所致的腹水主要为漏出液。为了确定肝硬化的病因,需要问询饮酒、感染和药物史等。

5.患者出现神经精神症状,需考虑以下方面情况:患者有糖尿病史,高热量、高蛋白质食物一周,且有感染,故需考虑糖尿病酮症酸中毒、糖尿病高渗性昏迷可能;患者有肝硬化病史,利尿剂量大,需考虑大量利尿和感染后有无肝性脑病可能;患者为肝硬化,有凝血功能障碍,突发神志障碍,需排除脑血管意外;患者长期饮酒,需考虑戒酒后戒断综合征可能;患者有呼吸系统感染,呼吸衰竭致二氧化碳潴留致神志障碍不能排除。

阅读理解

The first robot rover to land on the Moon in nearly 40 years, China's Jade Rabbit, has begun sending back photos, with shots of its lunar lander(登月飞行器). Jade Rabbit rolled down a ramp lowered by the lander and on to the volcanic plain known as Sinus Iridum at 04:35 Beijing time on Saturday (20:35 GMT).It moved to a spot a few metres away, its historic short journey recorded by the lander. On Sunday evening the two machines began photographing each other. A Chinese flag is clearly visible on the Jade Rabbit as it stands deployed on the Moon's surface.

Ma Xingrui, chief mander of China's lunar programme, declared the mission (任务)a “plete success”. The first soft landing on the Moon since 1976 is the latest step in China's ambitious space programme, says BBC science reporter Paul Rincon.

The lander will operate there for a year, while the rover is expected to work for some three months. The Chang'e­3 mission landed some 12 days after being launched atop a Chinese­developed Long March 3B rocket from Xichang in the country's south. The official Xinhua news service reported that the lander began its descent(下降)on Saturday just after 13:00 GMT, touching down in Sinus Iridum (the Bay of Rainbows) 11 minutes later. “I was lucky enough to see a prototype rover(原型月球车) in Shanghai a few years ago ­ it's a wonderful technological achievement to have landed,” Prof Andrew Coates, from UCL's Mullard Space Science Laboratory, told BBC News.

Chang'e­3 is the third unmanned rover mission to touch down on the lunar surface, and the first to go there in more than 40 years. The last was an 840kg (1,900lb) Soviet vehicle known as Lunokhod­2, which was kept warm by polonium(钋)­210. But the six­wheeled Chinese vehicle carries a more sophisticated payload(复杂的有效负荷), including ground­penetrating radar which will gather measurements of the lunar soil and crust.

小题1:What does the text mainly talk about?

A.China's space and aeronautics industry develops quickly.

B.The importance of China's space and aeronautics industry.

C.China's Jade Rabbit Moon rover sends back first photos.

D.Chang'e­3 is the third unmanned rover mission to touch down on the lunar surface.小题2:After ________ years' hard and scientific work, the first soft landing on the Moon has made such great progress.

A.nearly 40

B.37

C.64

D.more than 40小题3:The purpose that the Chinese moon rover has visited the moon is to ________.

A.do some research about the moon

B.be the first settler on the moon

C.to plant the Chinese flag onto the moon

D.send a lovely jade rabbit onto the moon小题4:From the text, we know that the lander began its descent on Saturday just after ________ Beijing time.

A.13:00

B.20:00

C.22:00

D.21:00

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