问题 单项选择题 案例分析题

患儿,男,3岁,因咳嗽3天,加重伴发热1天入院。3天前受凉后出现咳嗽,渐加重,伴有痰,无犬吠样及鸡鸣样回声,在当地医院诊断"肺炎",予静滴"青霉素+头孢类抗生素"治疗(具体不详),1天前出现发热,最高39℃,并反复发生。1天前咳嗽加重,呼吸困难明显,呈端坐呼吸,不能平卧。入院查体:T39.3℃,P144次/分,R36次/分,神清,气促,唇周发绀,咽充血,扁桃体Ⅱ度肿大,未见脓点,双肺可及中细湿啰音及哮鸣音,心音有力、律齐。患儿既往体格健康,无抽搐病史,无先天性心脏病史。

胸片提示:肺炎,右肺门外透亮腔影;明显纵隔气肿;前上胸壁及双侧颈部皮下积气;右侧肺组织被压迫50%,右侧少量胸腔积液。最可能的病原体是()

A.腺病毒肺炎

B.金葡菌肺炎

C.支原体肺炎

D.呼吸道合胞病毒肺炎

E.衣原体肺炎

F.肺炎链球菌肺炎

答案

参考答案:B

解析:1.患儿初步诊断为肺炎,且对青霉素及头孢类抗生素无效,提示非肺炎链球菌肺炎。应注意有无其他系统受累及肺内并发症的可能。2.患儿存在呼吸困难,应查血气分析判断缺氧及酸碱平衡紊乱情况,查血常规及CRP判断感染中毒情况,拍胸片了解肺内病灶。4.根据患儿中毒症状较重,病情进展较迅速,并有化脓性渗出及胸腔积液、液气胸等。治疗对青霉素及头孢菌素不敏感,考虑金葡菌肺炎。

阅读理解

阅读理解。

                                                                           Letter A

Dear Mary,

      I like your programmes very much. I'm now writing to ask you something about American social

customs (社交习惯): My American friend wants me to join them in their dinner party. I am very happy

and have decided to go, but I'm a little worried about it, too. The social customs in my country are very

different from here, so I'm afraid of making mistakes.

     Should I bring a present, such as sweet or flowers? Should I arrive on time or a little late? At the dinner

table, how can I know which fork (叉子) or knife to use? How can I let the family know that I'm thankful

for their kindness

                                                                                                                                Wang Lin

                                                                            Letter B

Dear Wang Lin,

      It's a good idea to bring a small present when you go to a dinner party. Flowers are always nice, or you

may bring a bottle of wine (葡萄酒) if you know that your friends drink it.

     You should arrive on time or five to ten minutes late. Don't get there early. If you're going to be more than

fifteen minutes late, you should call and tell them.

     Try to be free at the dinner table. If you don't know about choosing the right fork or knife, just watch the

other people, and follow them. If you still have no idea of what to do ask the person next to you.

     If you like the food, say so. Of course, you'll thank them for the meal and for their kindness. It's also a

good idea to send a thank-you card the day after.

                                                                                                                                               Mary

1. Mary is possibly _______.

A. a good housewife

B. a TV hostess (主持人)

C. a member of the dinner party

D. a friend of Wang Lin's

2. When you go to a dinner party, you'd better not take _______ with you.

A. some wine

B. some flowers

C. some presents

D. some food

3. If you're asked to a dinner party but not sure about what to bring as a present, it's good to bring _______.

A. some fruits

B. a bottle of wine

C. some flowers

D. a knife and fork

4. Which of the following is NOT proper (适当的) for joining in a dinner party?

A. Get there 15 minutes earlier.

B. Make yourself at home.

C. Follow others to use forks and knives.

D. Thank your friends for the meal.

单项选择题