问题 单项选择题 案例分析题

患者男性,69岁。急性上腹痛6小时就诊。

提问4:为了明确诊断,接下来应首选的辅助检查为()。

A.血常规

B.肝肾功能

C.凝血功能及D-dimer

D.心电图

E.腹部X线平片

F.腹部超声

答案

参考答案:E

解析:

1.患者老年男性,急性上腹痛,病因包括:消化系统疾病,如急性胃肠炎、消化性溃疡、消化道穿孔、急性胆囊炎、胆道结石、急性胰腺炎、急性阑尾炎、肠梗阻、缺血性肠病、急性憩室炎等;消化系统以外的疾病,如急性心肌梗死、肺部感染或胸膜炎、急性肺栓塞、泌尿系结石、急性心包炎、腹主动脉夹层等。

2.患者上腹痛,起病急骤,程度剧烈,结合以往病史(既往偶有中上腹隐痛,餐前明显,进食后缓解,10年前外院胃镜诊断“消化性溃疡”。诊断高血压、糖尿病、冠心病5年),首先需要重点排除以下疾病:消化道穿孔、急性心梗、急性肺栓塞和腹主动脉夹层。

3.根据体检结果可以明确患者存在弥漫性腹膜炎体征,诊断应首先考虑消化道穿孔。

4.对于可疑消化道溃疡穿孔的患者,进一步确诊首选腹部X线平片检查证实(可见膈下游离气体)。急查血常规、肝肾功能、血淀粉酶、心肌酶、电解质、凝血功能及D-dimer等检查可证实存在急性炎症反应,除外急性胰腺炎、急性心梗、肺栓塞,并为下一步手术治疗进行准备。

5.根据上述信息可证实患者存在消化道穿孔。消化道穿孔一旦确诊,需要进行急诊手术治疗,以进行穿孔修补、腹腔冲洗、控制感染。在完善术前准备、等待手术的同时,密切观察患者生命体征,给予相应药物治疗,避免过多不必要的检查。

①禁食、禁水、胃肠减压、应用抑酸药物:尽量减少消化液进入腹腔;

②广谱抗生素治疗:选取针对G-杆菌和厌氧菌的抗生素控制腹腔感染;

③监测生命体征:警惕感染性休克。

阅读理解

请阅读下列应用文及相关信息,并按照要求匹配信息。请在答题卡上将对应题号的相应选项字母涂黑, 如选E,请涂AB, 如选F,请涂CD。

首先,请阅读下列关于名著的介绍:

A. Pride and Prejudice (Jane Austen)

The classic love story explores the lives of the five Bennet sisters at the turn of the 19th century in rural England. At that time women were not allowed to get their father’s wealth after his death, so their mother is desperate to marry them off into wealthy families. Therefore various love stories start with the question — whether marriage is for love or for money.

B. The Red and the Black (Stendhal)

Julien has a strong desire for power and glory, and for ridding himself of his low social status as the son of a tradesman. Thus, he tries every means to achieve his goal.

The two colors, red and black, symbolize his inner struggle between being sincere and false. And this conflict in his character finally brings about his downfall.

C. Jane Eyre (Charlotte Bronte)

There is great kindness and warmth in this love story. Poor and plain as Jane Eyre is, she has a strong will, sharp wisdom and great courage. She is forced to battle against a harsh employer and a rigid social order. Yet she is never defeated. Standing on her feet, she gains her own happiness in the end.

D. Oliver Twist (Charles Dickens)

It reflects people’s tragic life in Britain in the 18th century. In the story, Oliver Twist, a mild young boy, is born in the workhouse and stays there until he is made to leave. What waits for him next is the falseness of the wealthy and the depths to which poverty pushes the human spirit.

E. Gone with the wind (Margaret Mitchell)

This is an all-time best-seller by Margaret Mitchell. The story takes place during the American Civil War. It records the tragic love stories of Katie Scarlet O’Hara, a southern beauty. In the end of the story, Scarlett is left only with her Tara, a plantation which symbolizes the culture of the Old South, a place where she could ever gather her strength.

F. The Adventure of Tom Sawyer (Mark Twain)

Tom Sawyer, a naughty boy in the quiet town of St. Petersburg, unexpectedly witnesses the murder of Dr. Robinson. At first he is frightened and keeps it a secret. But at the trial of the case, he bravely exposes the real criminal. He and his friend start tracing the escaping murderer. Finally they find his dead body together with hidden treasures.

请阅读以下读者的相关信息,然后匹配他/她感兴趣的书籍:

小题1:Ben is 14 years now and is fond of reading books. He is interested in all sorts of exciting stories, such as those about adventures, detectives and treasure hunting.

小题2:Lucy is a quiet girl who likes to read in a quiet corner in the library. Her favorite stories are those with characters brave enough to face and overcome difficulties in life.

小题3:Jessica, a fan of romantic stories, has just graduated from high school. She decides to relax herself in reading different love stories this summer. By the way, she hates war.

小题4:Peter majors in literature in college. He is especially interested in the psychological description in novels and wants to talk about this in his term paper.

小题5:Sam was born in America but his family moved to Europe when he was a child. He misses the days spent in America and is extremely interested in stories about the Old South.

选择题