问题 多项选择题 案例分析题

患者,女性,69岁。因进行性肌无力伴呼吸困难、下肢水肿2个月余入院。2个月前无明显诱因出现转颈、抬肩困难,吞咽阻碍感,坐位后起立困难,上楼困难等;四肢小关节和双膝关节疼痛,但局部无红、肿和皮疹;下肢水肿进行性加重。门诊查尿常规:蛋白(++)、潜血(++)。否认高血压、糖尿病和慢性肾疾病史。查体:慢性病容,呼吸急促,全身皮肤无皮疹;双肺底可闻及裂帛音(Vel-cro音);心界略向左扩大,心率119次/分,律齐,各瓣膜听诊区未闻及病理性杂音;双下肢水肿;四肢肌肉无萎缩,四肢肌力Ⅱ~Ⅲ级,肌张力正常,腱反射消失,病理反射未引出;全身肌肉有触痛,无感觉障碍。

提示:血常规、生化、肾功正常,尿蛋白定量1.63g/24h,肝功:TP51.5/L、ALB23.2g/L、GLB28.3g/L、AST635.7U/L、AST447.1U/L、ALP102.6U/L、GGT33.2U/L、LDH1369.5U/L,CK6089.7U/L,双膝关节正侧位片提示退行性改变,胸片提示双下肺炎症、双侧肋膈角积液,心电图示窦性心动过速,T波异常(Ⅱ、Ⅲ、aVF、V4~V6低平双向,V1~V3倒置),疑急性非ST段抬高性心肌梗死,肌电图提示肌源性损害。该患者初步诊断考虑的疾病或并发症有()

A.肾小球肾炎

B.双下肺感染

C.肝功能损害

D.成人Still病

E.急性非ST段抬高性心肌梗死

F.双膝关节退行性改变

G.多发性肌炎

H.系统性红斑狼疮

I.混合型结缔组织病

答案

参考答案:A, B, C, E, F, G

单项选择题
单项选择题

Walking through my train yesterday, staggering from my seat to the buffet and back, I counted five people reading Harry Potter novels. Not children-these were real grown-ups reading children’s books,
Maybe that would have been understandable. If these people had jumped whole-heartedly into a second childhood it would have made more sense. But they were card-carrying grown-ups with laptops and spreadsheets returning from sales meetings and seminars. Yet they chose to read a children’s book.
I don’t imagine you’ll find this headcount exceptional. You can no longer get on the London Tube and not see a Harry Potter book. Nor is it just the film; these throwback readers were out there in droves long before the movie campaign opened.
So who are these adult readers who have made JK Rowling the second-biggest female earner in Britain (after Madonna) As I have tramped along streets knee-deep in Harry Potter paperbacks, I’ve mentally slotted them into three groups.
First come the Never-Readers, whom Harry has enticed into opening a book. Is this a bad thing Probably not. Writing has many advantages over film, but it can never compete with its magnetic punch. If these books can re-establish the novel as a thrilling experience for some people, then this can only be for the better. If it takes obsession-level hype to lure them into a bookshop. that’s fine by me. But will they go on to read anything else Again, we can only hope.
The second group are the Occasional Readers. These people claim that tiredness, work and children allow them to read only a few books a year. Yet now—to be part of the crowd, to say they’ve read it—they put Harry Potter on their oh-so-select reading list. It’s infuriating, and maddening. Yes, I’m a writer myself, currently writing difficult, unreadable, hopefully unsettling novels, but there are so many other good books out there, so much rewarding, enlightening, enlarging works of fiction for adults; and yet these sad cases are swept along by the hype, the faddism, into reading a children’s book.
The third group are the Regular Readers, for whom Harry is sandwiched between McEwan (英国当代作家) and Balzac, Roth (德国现代诗人) and Dickens. This is the real baffler—what on earth do they get out of reading it Why bother But if they call rattle through it in a week just to say they ve been there—like going to Longleat (朗利特山庄英国名胜) or the Eiffel Tower—the worst they’re doing is encouraging others.

According to the author, the Never-Readers ______.

A.will take up reading as their lifelong hobby

B.have got more from the book than from the film

C.may barely get interested in other books than Harry Potter

D.can hardly be driven by the crowds to read any book