问题 单项选择题 案例分析题

女性,25岁,农民。怀孕3个月,突然寒战,高热,大汗,间日发作2周就诊。血涂片找到疟原虫。

病人再次疟疾发作的发病机制是()

A.疟原虫感染后不产生持久免疫

B.第一次抗疟治疗未消灭红细胞内期疟原虫

C.恶性疟原虫对抗疟药产生耐药

D.输血输入疟原虫

E.第一次抗疟治疗未杀灭肝脏内红细胞外疟原虫

答案

参考答案:E

解析:

1.间日疟发作,目前首选治疗是氯喹加伯氨喹,既可控制症状又能预防复发,但由于病人是早孕妇女,伯氨喹可产生变性血红蛋白症或溶血反应,对孕妇与胎儿均不利,故伯氨喹可在产后服用。此时可单用氯喹以控制症状,奎宁对妊娠子宫有兴奋作用,可致流产,孕妇不宜使用。阿的平与氯喹相同,主要作用于红细胞内期疟原虫,能控制疟疾症状,但少数可引起严重皮疹,造血功能障碍及精神症状,现已基本不用。乙胺嘧啶主要作用于红细胞外期疟原虫,用于疟疾的预防,对红细胞内期未成熟的裂殖体有抑制作用,但对已成熟的裂殖体无效,故控制发作效果缓慢。

2.该患者通过第一次服氯喹治疗,症状完全控制,9个月后疟疾每次发作,3个月前曾输血200ml,输血是受血者直接接受含有疟原虫滋养体的血而感染的疟疾,此种疟疾发作大多在受血后7~14天,此种可能性很小。再燃通常是由于治疗不彻底或患者免疫力低下,血中疟原虫未完全消灭,一旦免疫力降低,原虫增殖引起临床发作。患者经过正规氯喹治疗,红细胞内疟原虫应已完全杀灭,不会引起再燃。理论上讲此次发作复发、重新感染或混合感染都有可能,但由于患者初友时没使用伯氨喹,体内红细胞外期疟原虫依然存在,当抵抗力降低时,又出现原虫血症,引起复发,此种机会最大。

阅读理解

阅读理解。

      Many years ago, I lived in a building in a large city. The building next door was only a few feet away

from mine. There was a woman who lived there, whom I had never met, yet I could see her seated by her

window each afternoon.

     After several months had gone by, I began to notice that her window was dirty. Everything was unclear

through the dirty window. I would say to myself, "I wonder why that woman doesn't wash her window. It

really looks terrible."

     One morning I cleaned my room, including washing the window on the inside.

     Late in the afternoon when I finished the cleaning, I sat down by the window with a cup of coffee for a

rest. What a surprise! Across the way, the woman sitting by her window was clearly seen. Her window was

clean! 

    Then it dawned on me. I had been criticizing (批评) her dirty window, but all the time I was watching

hers through my own dirty window.

    That was quite an important lesson for me. Since then, whenever I wanted to judge (判断) someone, I

asked myself first, "Am I looking at him through my own dirty window?" Then I try to clean the window of

my own world so that I may see the world about me more clearly.

1. The writer couldn't see everything clearly through the window because _________.

A. the woman's window was dirty

B. his eyes were not good 

C. the woman lived nearby

D. his window was dirty

2. The writer was surprised that _________.

A. the woman was sitting by her window

B. the woman's window was clean

C. the woman did cleaning in the afternoon

D. the woman's window was still terrible

3. "It dawned on me"  probably means "_________ ".

A.I began to understand it

B. It surprised me

C. I knew it grew light

D. It began to get dark

4. It was clear that _________.

A. the writer had never met the woman before

B. the writer often washed the window

C. the writer helped the woman clean the window

D. they lived in a small town

5. From the passage, we can learn _________.

A. one shouldn't criticize others very often

B. one should often make his windows clean

C. one must judge himself before he judges others

D. one must look at others through his dirty window

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