问题 单项选择题

患者女,50岁,因“感冒1周,劳累后胸闷、呼吸困难,夜眠咳嗽3d”来诊。2个月以来工作紧张,近1周感冒,咳嗽、咳痰,经治疗感冒症状减轻,但劳累后常感胸闷、呼吸困难,夜间睡眠卧位时常有咳嗽,需要高枕。25年前患风湿热。查体:T36.4℃,P75次/min,R24次/min,BP105/60mmHg;面部双颊紫红,口唇轻度发绀;心尖部可触及舒张期震颤,闻及舒张期隆隆样杂音,第一心音亢进及左房室瓣开放拍击音,肺动脉瓣区第二心音亢进、分裂,HR100次/min,律不齐。

提示:胸部X线片:左心房增大,后前位左缘变直,右缘双心房影,左前斜位可见左主支气管上抬,右前斜位可见食管下端后移。ECG:P波消失,f波形态大小及规律不一,R-R间隔完全不规则,心室率不规则,QRS波群形态正常。超声心动图:左房室瓣狭窄。所有检查项目中最可靠的方法是()。

A.心电图

B.眼底检查

C.运动试验

D.超声心动图

E.胸部X线片

F.心导管检查

答案

参考答案:D

填空题

Your heart suddenly starts pounding so hard you think it’s going to leap right out of your chest. You’re sweating even though it’s cold out. You feel unsteady on your feet and generally shaky, like the world around you is spinning out of control and you can’t get a grip. Your hands and feet are numb and useless. You’re gasping for breath and feel like you’re drowning.

(41)__________Genetics may be part of the explanation; women are more prone to anxiety or depression, and a history of these mood disorders makes you more likely to have a panic attack. But unhappy life experiences may also increase women’s vulnerability.

A particularly active area of research at the moment is the effect of hormones. Women seem most susceptible to panic attacks during times of hormonal changes, such as adolescence, pregnancy, and so on. Dr. Lilian Gonsalves, psychology at the Cleveland Clinic, says some scientists think that hormonal fluctuation may upset the balance of chemicals in the brain that modulate fear and anxiety, triggering a panic attack. It feels like the fight-or-flight response gone wild with no provocation. (42)__________

Fear of another attack often makes people avoid places where an attack took place, and a small percentage of sufferers may eventually become housebound, a condition called agoraphobia. (43)__________ "We used to say that you don’t die of a panic attack, but I’ve stopped saying that," says Gonsalves. "It could be that during a panic attack you get coronary spasms or an irregular heart rate. "

(44)__________There’s no single cure that works for everyone, but generally, patients use medication, cognitive behavioral therapy or some combination of the two. Cognitive behavioral therapy teaches you a range of techniques—such as relaxation exercises—to deal with everyday anxiety and stress, lessening the chances of another attack. Many people find that drugs help control the problem until they can find a behavioral therapy that works, after which drugs may no longer be necessary. Research has also shown that regular exercise.and activities such as yoga may reduce the severity and number of attacks.

(45)__________If there is nothing wrong, then your doctor will probably refer you to a psychiatrist or psychologist who can work with you on the problem over what may be a period of several months.

It takes a while to feel completely better; generally, antidepressants start working in six to eight weeks, Gonsalves says. But many patients begin to get some relief in just two weeks, she adds. In all, about 80 percent of patients will do well. In the case of the other 20 percent, who don’t respond to treatment, doctors often find that they have missed an underlying medical condition that is behind the attacks.

[A] Suffering from frequent panic attacks also means you are at higher risk of depression, substance abuse and suicide. Some research also indicates that women who have repeated attacks are at higher risk of death.

[B] Call your doctor even if you’ve had only a single attack, because these symptoms could also signal a wide range of other problems, including thyroid and heart disease. A primary-care physician will first perform a physical exam and probably order an EKG and blood tests to rule out other possible causes of the attacks.

[C] You can be standing at a bus stop or shopping at the mall without any danger in sight, and suddenly, you feel like you’re dying. The attack is generally over in a few minutes, but sometimes symptoms—especially feeling faint and dizzy—can linger for mare than an hour.

[D] Many women report experiencing their first panic attack in late adolescence. But others have no trouble until they are around 50, when their hormone levels often vary wildly. "These are high functioning women who have never seen a psychiatrist before," says Gonsalves. "They start having hot flashes and they don’t sleep. They become acutely anxious. "

[E] If you have felt all of these come on without warning, you may have just suffered a panic attack. These frightening symptoms affect women twice as often as men, although scientists are not sure why.

[F] The cure of panic attacks often depends on the cause. If your attacks are triggered by a physical condition, they should be eliminated by treating the physical cause. If you can’t find the cause, continue looking and using the above tips to control the attacks.

[G] Because of the possible consequences of untreated panic attacks, it’s important to get help early. And fortunately, there is lot of help available.

45()

单项选择题