问题 多项选择题 案例分析题

患者女,43岁。因“突眼3个月,双眼结膜水肿1周”就诊。患者3个月前无明显诱因出现双眼胀痛不适,被他人发现眼突,一个半月月前查甲功提示甲亢,诊断“Graves病、GO”,予以“甲巯咪唑片10mg,3次/日,普萘洛尔10mg,3次/日”治疗。后突眼逐渐加重,1个月前给予甲泼尼龙1000mg,1次/日治疗,连续治疗3天,院外泼尼松片10mg,3次/日维持,每周减量5mg,同时甲巯咪唑片10mg,1次/日,2周前复查甲功,FT1.87pmol/L,FT0.54pmol/L,TSH4.59mIU/L,血常规及电解质正常。1周前患者自行停用泼尼松,逐渐开始出现双眼球结膜水肿,右眼明显。查体:双侧甲状腺I度肿大,质软,无触痛,未闻及明显血管杂音。HR86次/分,律齐,双手细震颤(+)。眼球运动时疼痛,无自主性球后疼痛。眼部体征如下图。

为进一步治疗尚需做的检查()

A.甲状腺功能测定

B.眼眶CT

C.凝血功能

D.甲状腺摄碘率

E.血常规

F.肝功能测定

G.动态心电图

H.胸部X线片

答案

参考答案:A, B, D, E, F, H

解析:

1.美国甲状腺学会(ATA)提出判断GO活动评分方法(CAS)包括7点:①结膜充血;②结膜水肿;③眼睑水肿;④眼睑红斑;⑤泪阜肿胀;⑥眼球运动时疼痛;⑦自发性球后疼痛。以上每点各积1分,累计3分以上提示处于活动期。

2.甲状腺相关突眼患者在同时使用糖皮质激素治疗的情况下可行碘-131治疗,故B错误;病程长,慢性突眼较急性突眼更难以治疗,故E错误。其余各项均正确。部分甲亢患者眼球不突出,但有明显畏光、流泪、复视等表现。

阅读理解

Saturday morning was bright and fresh. There was a song in every heart, cheer on every face, and a  spring in every step.

Tom appeared with a bucket of white paint in one hand and a brush in the other. His Aunt Polly told him to paint the fence around the garden. It was thirty yards long and nine feet high. He felt very depressed.

Then he had a wonderful idea. He picked up his brush and started to work.

Soon Ben came along the road. He was happily eating an apple. He stopped to look at Tom. Tom went on painting and pretended(假装)not to see Ben.

“I’m going swimming,” said Ben. “Do you want to go swimming, Tom? But I guess you can’t. You have to stay and work, don’t you?”

“Work?” Tom said. “This isn’t work. I’m enjoying myself. Does a boy get a chance to paint a fence like this every day?”

Ben  thought  about  this.  Tom  continued  painting  carefully. Sometimes he stopped, stood back to look at the fence like an artist, and then added a bit more paint in just the right place. Ben was watching Tom paint with great interest. He was getting more and more eager to have a try himself.

After a while, Ben asked Tom if he would let him paint a little. Tom thought about it, and said,

“No, Ben, I can’t. You see. Aunt Polly wants it to be done well. Aunt Polly said that I must paint it with great care.”

“Oh, please, Tom,” begged Ben. “I can do it. I’ll be really careful. Just let me try. I’ll give you half of my apple. Well, I’ll give you all of it!”

“Well, all right, Ben,” said Tom. “You must be very careful.”

He gave Ben his brush with worry on his face but joy in his heart. He sat down under the tree, and started to eat Ben’s apple. All day, boys came to make fun of Tom, but they ended up staying to paint. When Ben got tired, Billy was waiting. He gave Tom a kite for a chance to paint. Then Johnny offered him twelve marbles, and so on.

By late afternoon Tom had gained all sorts of toys, and the fence had gained three  coats of paint. Later Aunt Polly came to look at the painted fence. She was so pleased with Tom’s work that she gave Tom a large cake!

小题1:Why did Tom pretend not to see Ben when he came and watched him painting?

A.He saw Ben eating an apple happily.

B.He tried to make Ben interested in it.

C.He didn’t want to go swimming with Ben at all.

D.He didn’t want Ben to share the chance to paint the fence.小题2:What do the underlined words “spring” and “coat” probably mean in the passage according to the given dictionary entries (词条)?

spring

1 [U,C]the season between winter and summer when plants begin to grow 春天;春季

2 [U]the  ability  of  a  spring  to  return  to  its original position 弹性;弹力

3 [C]a place where water comes naturally to the surface from under the ground 泉

4 [U]a cheerful, lively quality 活力;朝气

coat

1 [C]a piece of clothing with long sleeves that you wear over other clothes when you go outside 外套

2 [C]the fur or hair on an animal’s skin

(动物的)皮毛

3 [C]a layer of something such as paint that you put onto a surface覆盖层;涂层

A.4;3

B.4;2

C.3;3

D.1;3小题3:Which of the following is TRUE according to the passage?

A.Tom gained some toys by helping his friends.

B.Tom’s friends often helped him paint the fence.

C.Tom successfully tricked his friends into painting the fence.

D.Billy was the fourth boy to have the chance to paint the fence.小题4:What do you think of Tom?

A.He was honest.

B.He was smart.

C.He was shy.

D.He was stubborn.

判断题