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。

关于移动性浊音,以下哪些选项是正确的?()

A.腹腔游离液体大于1000ml有意义

B.检查时患者仰卧位,暴露腹部,双下肢屈曲

C.自中间向一侧叩诊,发现浊音时,让患者向同侧转动体位再叩诊,如果呈鼓音表明浊音移动

D.转动体位时左手移动无影响,只需使被叩部位位于最高处

E.患者取平卧位,卵巢巨大囊肿时,浊音区在中间,鼓音区在两侧

F.患者取平卧位,移动性浊音,浊音区在中间,鼓音区在两侧

G.尺压试验阳性提示卵巢巨大囊肿

H.尺压试验阳性提示移动性浊音

答案

参考答案:A, B, 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

  I began to grow up that winter night when my parents and I were returning from my aunt’s house, and my mother said that we might soon be leaving for America. We were on the bus then. I was crying, and some people on the bus were turning around to look at me. I remember that I could not bear the thought of never hearing again the radio program for school children to which I listened every morning.

I do not remember myself crying for this reason again. In fact, I think I cried very little when I was saying goodbye to my friends and relatives. When we were leaving I thought about all the places I was going to see—the strange and magical places I had known only from books and pictures. The country I was leaving and never to come back was hardly in my head then.

The four years that followed taught me the importance of optimism(乐观), but the idea did not come to me at once. For the first two years in New York I was really lost—having to study in three schools as a result of family moves. I did not quite know what I was or what I should be. Mother remarried, and things became even more complex for me. Some time passed before my stepfather and I got used to each other. I was often sad, and saw no end to “the hard times.”

My responsibilities in the family increased a lot since I knew English better than everyone else at home. I wrote letters, filled out forms, translated at interviews with Immigration officers(移民局官员), took my grandparents to the doctor and translated there, and even discussed telephone bills with company representatives.

From my experiences I have learned one important rule: Almost all common troubles go away at last! Something good is certain to happen in the end when you do not give up, and just wait a little! I believe that my life will turn out all right, even though it will not be that easy.

小题1: How did the author get to know America?

A.From radio programs

B.From books and pictures

C.From her mother

D.From her relatives小题2: Upon leaving for America the author felt __________.

A.excited

B.confused

C.worried

D.amazed小题3: For the first two years in New York, the author __________.

A.often lost her way

B.did not think about her future

C.studied in three different schools

D.got on well with her stepfather小题4: What can we learn about the author from Paragraph 4?

A.She worked as a translator.

B.She attended a lot of job interviews.

C.She paid telephone bills for her family.

D.She helped her family with her English.小题5: The author believes that __________.

A.her future will be free from troubles

B.it is difficult to learn to become patient

C.there are more good things than bad things

D.good things will happen if one keeps trying

单项选择题