问题 多项选择题 案例分析题

患者男,76岁,因“腹痛、便血、腹泻1天”入院。腹痛为中下腹突发的阵发性绞痛,剧烈,肌注哌替啶(杜冷丁)未能缓解疼痛,伴呕吐数次,为胃内容物,无咖啡样物,接着解鲜红色水样便,含暗红色血凝块,3~5次/天,无里急后重,无发热。入院查体:生命征正常,无贫血貌,心肺无异常,腹部平软,右下腹及下腹正中压痛,右下腹反跳痛,腹水征阴性,肠鸣音活跃。

根据病史,考虑可能的诊断有()。

A.溃疡性结肠炎

B.克罗恩病

C.大肠癌

D.肠道血管畸形并出血

E.细菌性痢疾

F.缺血性肠炎

答案

参考答案:A, B, C, D, E, F

解析:

1.本题所列的6种情况均可能出现腹痛、便血、腹泻的情况,但老年人突发剧烈腹痛、腹泻,解鲜血便,首先应考虑缺血性肠炎。

2.患者考虑到缺血性肠炎时需详细追问患者有无可引起肠道供血障碍的疾病史如高脂血症、动脉粥样硬化、高血压、糖尿病、冠心病等病史,而长期大便干硬往往会引起痔疮、肛裂,后两者临床往往表现为便后滴血、厕纸上带血。

4.缺血性肠炎在治疗上以抗凝、扩张血管、改善微循环治疗为主,而激素及美沙拉秦类药物主要用于炎症性肠病的治疗,不适用于缺血性肠炎的治疗。

单项选择题
完形填空

Most parents, I suppose, have had the experience of reading a bedtime story to their children.And they must have 1 how difficult it is to write a 2 children's book.Either the author has aimed too 3 , so that the children can't follow what is in his (or  more often, her) story, 4 the story seems to be talking to the readers.

The best children's books are 5 very difficult nor very simple, and satisfy both the 6 who hears the story and the adult who 7 it.Unfortunately, there are in fact 8 books like this, 9 the problem of finding the right bedtime story is not 10 to solve.

This may be why many of books regarded as 11 of children's literature were in fact written for 12 .“Alice's Adventure in Wonderland”is perhaps the most 13 of this.

Children, left for themselves, often 14 the worst possible interest in literature.Just leave a child in bookshop o 15 and he will 16 willingly choose the books written in an imaginative way, or have a look at most children's comics, full of the stories and jokes which are the 17 of teachers and right-thinking parents.

Perhaps we parents should stop trying to brainwash childrensintos 18 our taste in literature.After all children and adults are so 19 that we parents should not expect that they will enjoy the 20 books.So I suppose we'll just have to compromise over that bedtime story.  

1.A.hoped      B.realized       C.told     D.said

2.A.short B.long     C.bad      D.good

3.A.easy        B.short    C.high     D.difficult

4.A.and   B.but      C.or D.so

5.A.both  B.neither C.either   D.very

6.A.child B.father   C.mother D.teacher.

7.A.hears B.buys    C.understands D.reads

8.A.few   B.many          C.a great deal of  D.a great number of

9.A.but   B.however      C.so D.because

10A.hard B.easy     C.enough D.fast

11.A.articles   B.work    C.arts      D.works

12.A.grown ups     B.girls     C.boys    D.children

13.A.difficult  B.hidden C.obvious       D.easy

14.A.are        B.show    C.find     D.add

15.A.school    B.home   C.office   D.library

16.A.more      B.less      C.able     D.be

17.A.lovingness     B.interests      C.objections    D.readings

18.A.receiving       B.accepting     C.having D.refusing

19.A.same      B.friendly       C.different      D.common

20.A.common B.avarage       C.different      D.Same