问题 多项选择题 案例分析题

患者男,39岁。主诉“间断腹痛、腹泻10余年,加重伴有黏液脓血便1年”入院。该患者10余年前开始出现间断腹泻,最多每日排黄色不成形便3~4次,伴有下腹痛,便后腹痛缓解,未予系统诊治;1年前患者腹痛腹泻症状加重,伴有黏液脓血便,现最多每日10余次,有里急后重,有腹痛便后缓解,伴有腹胀,食欲缺乏,无恶心呕吐,近1年体重下降约5kg。

对于该患者应用哪些药物需慎重?()

A.头孢菌素

B.鸦片酊

C.甲硝唑

D.复方地芬诺酯

E.阿托品

F.洛哌丁胺

G.布桂嗪

H.整肠生

I.氯化钾片

答案

参考答案:B, D, E, F

解析:

2.结肠镜检查比钡剂灌肠检查准确,有条件宜做结肠镜检查,且该患者病史时间长,不能除外溃疡性结肠炎,重型溃疡性结肠炎患者不宜做钡剂灌肠检查,以免加重病情或诱发中毒性巨结肠。该患者黏液脓血便,现最多每日10余次,故暂不宜行钡剂灌肠检查。粪便病原学检查目的是要排除感染性结肠炎,肿瘤标记物CEA除外结肠肿瘤,血p-ANCA及AS-CA分别为溃疡性结肠炎和克罗恩病的相对特异性抗体,同时检测这两种抗体有助于溃疡性结肠炎和克罗恩病的诊断和鉴别诊断。

3.患者慢性腹泻,粪便为黏液脓血便,大便潜血:(+++),RBC10/HP,WBC15/HP。3次便细菌培养阴性。肠镜结果显示:直肠至肝曲黏膜明显充血、水肿,多发性浅表溃疡,黏膜质脆,触之易出血。结肠镜下黏膜活检见弥漫性慢性炎症细胞浸润。血p-ANCA(+)。综合以上病史及检查最可能的诊断为溃疡性结肠炎。

4.该患者病情为活动期,给予半流质饮食,同时静脉营养支持。患者腹泻次数大于每日6次,血沉大于30mm/h,血红蛋白小于100g/L,为重型,需给予糖皮质激素治疗,可口服及静脉注射。同时应用氨基水杨酸制剂。病变累及直肠、乙状结肠可行灌肠治疗,灌肠药物通常可应用5-氨基水杨酸、地塞米松、锡类散、庆大霉素、云南白药等。患者血白细胞明显增高提示合并感染,予抗生素治疗,及对症止泻治疗。对于内科治疗效果不理想而严重影响生活质量,或虽然用糖皮质激素可控制病情但糖皮质激紊不良反应太大不能耐受者才可考虑手术治疗。

5.对于溃疡性结肠炎患者,使用抗胆碱能药物或止泻药如地芬诺酯、洛哌丁胺或鸦片酊宜慎重,重症患者使用有诱发中毒性巨结肠的危险。

单项选择题
问答题

A Frenchman, the psychologist Alfred Binet, published the first standardized test of human intelligence in 1905. (46)But it was an American, Lewis Terman, a psychology professor at Stanford, who thought to divide a_test taker’s "mental age," as revealed by that score, by his or her biological age to derive a number that he called "IQ". It would be hard to think of a pop-scientific coinage that has had a greater impact on the way people think about themselves and others.

(47)No country: embraced the IQ more thoroughly than the U.S., where millions of people have their IQ measured annually, many with a direct descendant of Binet’s original test, although not necessarily for the purpose Bin et intended. He developed his test as a way of identifying public school students who needed extra help in learning, and that is still one of its leading uses.

But the broader and more controversial use of IQ testing has its roots in a theory of intelligence—part science, part sociology—that developed in the late 19th century, before Binet’s work and entirely separate from it. (48)Championed first by Charles Darwin’s cousin Francis Galton, it held that intelligence was the most valuable human attribute, and that if people who had a lot of it could be identified and put in leadership positions, all of society would benefit.

Terman believed IQ tests should be used to conduct a great sorting out of the population, so that young people would be assigned on the basis of their scores to particular levels in the school system, which would lead to corresponding socioeconomic destinations in adult life. The beginning of the IQ-testing movement overlapped with the eugenics movement—hugely popular in America and Europe among the "better sort".

In 1958 a British sociologist named Michael Young coined the word "meritocracy" to denote a society that organizes itself according to IQ-test scores. Terman and many other early advocates of IQ testing had in mind the creation of an American meritocracy, though the word didn’t exist then. (49)They believed IQ tests could be the means to create, for the first time ever, a society in which advantage would go to the people who deserved it rather than to those who had been born into it.

In order to believe this, though, you have to believe that merit and a score on an IQ test are the same thing. (50)Long before IQ was invented, America prided itself on beinga country without a class system, in which people of talent and industry would rise and be rewarded. The advent of intelligence tests did not dramatically affect the degree of social mobility in the U.S.—at least not enough for any change to show up in the social-science data.

(48)Championed first by Charles Darwin’s cousin Francis Galton, it held that intelligence was the most valuable human attribute, and that if people who had a lot of it could be identified and put in leadership positions, all of society would benefit.