问题 多项选择题 案例分析题

患者女,71岁,已婚,退休工人,因“确诊肝硬化10年,黑便伴头晕、乏力2天”入院。查体:T37℃,心率100次/分,血压90/60mmHg,皮肤巩膜无黄染,浅表淋巴结无肿大,双肺呼吸音低,腹软,未见静脉曲张,全腹无压痛,肝肋下未及,脾肋下二指,移动性浊音(-),肠鸣音3~5次/分。双下肢无水肿。

提示:胸部CT提示左侧肺部感染并中等量胸腔积液,右侧少量胸腔积液。超声心动提示:左心增大,主动脉瓣退变,二尖瓣退变并轻度反流,肺动脉高压(轻度)。EF76%。PPD试验阴性,血生化提示:CK260U/L,CK-MB80U/L,LDH248U/L,TBIL57.0μmol/L,IBIL29.90μmol/L,ALB30.5g/L,AST65U/L。考虑目前可能的诊断()。

A.慢性心功能不全

B.肝硬化伴胸腔积液

C.肺部感染

D.肝硬化伴腹腔积液

E.肺结核

F.肺部肿瘤

答案

参考答案:B, C

解析:

2.门脉高压性胃肠黏膜病变的发病机制复杂,但主要是由于血流动力学改变,黏膜血流减少,黏膜上皮细胞破坏增多和修复能力降低,屏障作用受损,易受各种致病因素的攻击所致。诊断主要依靠胃镜作出诊断,肝硬化门静脉高压患者胃镜下表现出广泛黏膜红斑、马赛克征,胃黏膜特别是胃底部出现散在红点或多发的重染红点及自发性出血,多能确诊。

5.该患者考虑肝硬化胸腔积液基础上并发肺部感染,故考虑胸水为渗出液性质,渗出液特点为:多混浊,比重高于1.018;能自凝,黏蛋白试验阳性,葡萄糖定量常低于血糖水平,细胞计数>500×10/L;胸水LDH>200IU;积液/血清LDH>0.6。肝硬化胸水伴感染时,胸水性质可于渗漏之间,比重可<1.018。

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阅读理解

     "Our aim is to take our art to the world and make people understand what it is to move," said David

Belle, the founder of parkour(跑酷).

     Do you love running? It is a good exercise, yet many people find it boring. But what if making your

morning jog a creative one? Like jumping from walls and over gaps, and ground rolls? Just like the James Bond in the movie Casino Royale? Bond jumps down from a roof to a windowsill and then runs several

blocks over obstacles on the way. It is just because of Bond's wonderful performances that the sport has

become popular worldwide.

     Yes, that's parkour, an extreme street sport aimed at moving from one point to another as quickly as

possible, getting over all the obstacles in the path using only the abilities of the human body. Parkour is

considered an extreme sport. As its participants dash around a city, they may jump over fences, run up

walls and even move from rooftop to rooftop.

Parkour can be just as exciting and charming as it sounds, but its participants see parkour much more

than that.

     Overcoming all the obstacles on the course and in life is part of the philosophy(理念) behind parkour. This is the same as life. You must determine your destination, go straight, jump over all the barriers as if

in parkour and never fall back from them in your life, to reach the destination successfully. A parkour

lover said, "I love parkour because its philosophy has become my life, my way to do everything."

     Another philosophy we've learnt from parkour is freedom. It can be done by anyone, at any time,

anywhere in the world. It is a kind of expression of trust in yourself that you earn energy and confidence.

1. Parkour has become popular throughout the world because of _____.

A. its founder, David Belle

B. the film, Casino Royale

C. its risks and tricks

D. the varieties of participants

2. The underlined word "obstacles" in Paragraph 2 is closest in meaning to "_____".

A. streetsB. objects

C. barriersD. roofs

3. Which of the following is true of parkour?

A. It challenges human abilities.

B. It is a good but boring sport.

C. It needs special training.

D. It is a team sport.

4. As its participants move around a city, _____.

A. they can ask for help

B. they may choose to escape

C. they should run to extremes

D. they must learn to

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