问题 多项选择题 案例分析题

患者男性,58岁。8年前患急性下壁、正后壁心肌梗死。8个月前无明显诱因出现发作性心悸、气短、心前区不适;2个月后症状加重住院,诊为“冠心病,心律失常-阵发房颤,房扑”。给予心律平,胺碘酮,倍他乐克等治疗好转。出院后仍有发作,持续数小时后,可自行缓解。1周前无诱因上述症状再改发作,较以往明显,不能平卧入睡,口服心律平150m/3日无效。高血压病20余年,服“尼群地平”,“倍他乐克”可控制正常口否认糖尿病、高血脂病史,查体:P96次/分,短绌BP120/80mmHg,左下肺可闻及少许干鸣音及细湿啰音。心率106次/分,心律绝对不齐,心音强弱不等,P2>A2,各瓣膜区未闻及病理性杂音。

患者经外科会诊不宜行搭桥手术。拒绝电复律及射频消融治疗房颤,既往服胺碘酮出现R-R间期长达3.1s。地高辛减至0.125mg/d后R-R间期>2s的现象消失。现服氨酰心安25mg3/d,地高辛0.125mg/d,静息心率80-90次/分。根据患者疾病及检查所见,结合有关药物作用机制,如何调整治疗()

A.继续使用二氢呲啶类钙拮抗剂

B.停二氢呲啶类药物改用ACEI类

C.停二氢呲啶类药物改用ARB类

D.继续应用β阻滞剂

E.加用地尔硫类钙拮抗剂

F.小剂量地高辛继续协同用药;继续抗凝治疗

答案

参考答案:B, C, D, E, F

阅读理解

How often do you use your car? Can you use your car less often? Do you know the following facts in the UK?

• About 50% of all car journeys are just for fun.

• Over 80% people go to work by car.

• 25% car journeys are under two miles.

• 70% car journeys are under five miles.

WALKING & CYCLING

Instead of using the car for short journeys, why not walk or ride a bicycle? Walking is a most popular form of exercise—it’s healthy and it can save you money. If you work nearby, try walking or cycling instead of driving.

BUSES

Bus companies are using new buses: some run on new fuels which produce less pollution; some have easier access for disabled and old people. There are special traffic lanes (行车道) to make bus journeys easier and more reliable. So do something to help solve the pollution problem—let the bus take you to work and your children to school.

TRAINS

All car journeys, long or short, can be hard work. For some trips it is wiser to take the train. Leave your car at home and walk, cycle or take a bus to and from the station. Train travel is fast, safe and comfortable. Train tickets are not always expensive; some are quite cheap at discount.

小题1:How many of car journeys are just for fun in the UK?  

A.25%.

B.About 50%

C.70%。

D.Over 80%.小题2:The writer believes that ________ can give children valuable road experience.

A.walking to school

B.travelling by train

C.taking new fuel buses

D.having car journeys for fun小题3:What is the main purpose of this passage?

A.To teach people how to use the buses.

B.To encourage people to travel by train.

C.To advise people to use cars less often.

D.To tell people to obey traffic rules.

单项选择题