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患者，女，28岁，农民，突发昏迷2小时入院。清晨曾与爱人发生口角，既往体健，平时性情急躁。家里备有有机磷杀虫药敌敌畏。入院查体：皮肤湿冷，双瞳孔直径缩小，呼气有蒜味，双肺底有少量湿啰音，心率95次/分，律齐，无杂音。(1)患者最可能的诊断是什么?依据是什么?(2)需做哪些辅助检查确诊?(3)需与哪些疾病鉴别诊断?(4)简述其治疗原则。

答案

参考答案：

(1)该患者最可能诊断为急性有机磷杀虫药敌敌畏中毒。依据：该患者为农村青年女性，与丈夫发生口角，性情急躁，有自杀倾向，家里备有敌敌畏；该患者主要表现为毒蕈碱样症状：皮肤湿冷，瞳孔缩小，双肺湿啰音。另有有机磷杀虫药中毒特殊呼吸气味-蒜味。

(2)全血胆碱酯酶活力测定；尿中有机磷杀虫药分解产物测定。

(3)该疾病需与拟除虫菊酯类中毒及杀虫脒中毒鉴别，前者口腔和胃液无特殊臭味，胆碱酯酶活力正常。后者以嗜睡、发绀、出血性膀胱炎为主要表现而无瞳孔缩小。此外还需中暑，脑炎等鉴别诊断，中暑一般在高温环境发病，体温升高，体液丢失等。脑炎一般伴有发热等感染症状，青少年多见。

单项选择题

下列有关齿轮齿条传动机构描述错误的是（）。

A.传递的功率大

B.用于两轴中心距过大的传动

C.加工安装精度高

D.传动比恒定
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单项选择题

Passage Three

Watching movie stars light up on screen may increase the odds a child or young teen will try smoking, study findings suggest.
In this latest study, researchers at Dartmouth Medical School in Lebanon, New Hampshire found that the odds of a child smoking increased in tandem (一前一后，紧密相连) with the number of films with smoking scenes he or she had seen.
This pattern remained regardless of other smoking risk factors such as having parents or friends who smoked, poor school performance or a self-reported "rebellious" nature.
Dr. James D. Sargent and his colleagues report the findings in the December 15th issue of the British Medical Journal.
In response to the findings, the British Medical Association (BMA) called on the UK film industry to "stub out" on-screen smoking.
"When smoking is glamorized in movies, young people are encouraged to experiment with a lethal (致命的) habit," the BMA’s Dr. Vivienne Nathanson said in a statement.
And an editorial accompanying the journal report made the same challenge to Hollywood. "It is time for the entertainment industry to accept responsibility for its actions and stop serving the interests of tobacco companies," writes Dr. Stanton A. Glantz of the University of California, San Francisco.
Sargent’s team based the findings on a survey of nearly 5 000 Vermont and New Hampshire students aged 9 to 15. Students were asked whether they had seen any of 50 recent movies that the researchers had screened for the number of smoking scenes. They also answered questions about environmental risk factors for smoking, their personality traits and perceptions of their parents’ views on smoking.
The investigators found that the number of smoking instances students had seen in the movies was correlated with their odds of having tried smoking. Kids who had seen 51 to 100 smoking occurrences were 70% more likely than those who had seen fewer to have smoked. And the odds were nearly three times greater among those who had seen 150-plus smoking scenes.
According to the researchers, the effects of on-screen smoking were similar to those of having parent or sibling who smoked.
"The results indicate that exposure to tobacco use in films is pervasive," Sargent’s team writes. "More importantly, such exposure is associated with trying smoking, which supports the hypothesis that films have a role in the initiation of smoking. "
In his editorial, Glantz agrees, writing that the study "provides powerful new evidence" that smoking in movies does contribute to adolescent smoking.

According to the researchers, ______.

A．on-screen smoking has more powerful effects on children than other environmental risk factors

B．on-screen smoking has almost the same effect on children as parents’ smoking does

C．children who have seen 150-plus smoking scenes are 70% more likely than those who have seen fewer to have smoked

D．children who have never seen any smoking instances in movies are not likely to try smoking
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