问题 单项选择题

患者,女性,55岁,“踝关节疼痛”达半月余。入院后查体:大致正常。辅助检查:尿蛋白(+),血肌酐156μmol/L,血尿酸650μmol/L,其余无明显异常。医院诊断为高尿酸血症、慢性肾脏病。治疗用药为:别嘌醇片100mg,口服,3次/日;碳酸氢钠片0.5g,口服,3次/日;肾炎康复片1片,吸入,2次/日。 别瞟醇用于治疗痛风时的用药时机为()。

A.痛风发作急性期

B.急性发作终止至少2周后

C.痛风急性炎症症状还未完全消失时

D.关节炎症完全消失4周以上

E.与痛风发作无关,痛风急性发作期和缓解期均可使用

答案

参考答案:B

解析:

1.本题考查要点是“痛风合并慢性肾脏病患者的合理用药”。痛风急性期应控制关节炎症和发作,抑制粒细胞浸润和白细胞趋化,减少细胞坏死,缓解疼痛发作,应首选秋水仙碱。秋水仙碱用于痛风的急性期、痛风关节炎急性发作和预防。因此,本题的正确答案为A。

2.本题考查要点是“痛风合并慢性肾脏病患者的合理用药”。痛风早、中期以选择排酸药为主,中、晚期以选择抑酸药或促尿酸分解药为主。服用丙磺舒期间应保持摄入足量水(2500mL/d左右),并适当补充碳酸氢钠(3~6g/d)以维持尿呈碱性,保持 * * 通畅,防止形成肾结石,必要时同时服用枸橼酸钾。因此,本题的正确答案为E。

3.本题考查要点是“痛风合并慢性肾脏病患者的合理用药”。别嘌醇本身无抗白细胞趋化、抗炎或镇痛作用,在急性期应用无直接疗效,且使组织中尿酸结晶减少和血尿酸水平下降速度过快,促使关节痛风石表面溶解,形成不溶性结晶而加重炎症,引起痛风性关节炎急性发作。所以,选项B的叙述是不正确的。因此,本题的正确答案为B。

4.本题考查要点是“痛风合并慢性肾脏病患者的合理用药”。急性发作终止至少2周后可应用别嘌呤。用药初期可能诱发痛风,应用初始4~8周内可与小剂量的秋水仙碱联合应用。因此,本题的正确答案为B。

完形填空
Is there a “success personality”—some winning combination of qualities that leads almost inevitably(必然地)to achievement? If so, exactly what is that secret success formula(公式), and can anyone develop it?
At the Gallop Organization we recently focused in depth on success, inquiring into the attitudes of 1500 distinguished people selected at random from Who’s Who in America. Our research finds out a number of qualities that occur regularly among top achievers. Here is one of the most important, that is common sense.
Common sense is the most widely possessed quality of the people surveyed. Seventy-nine percent award themselves a top score in this quality. And 61 percent say that common sense is very important in contributing to their success.
To most, common sense means the ability to present sound, practical judgments on everyday affairs. To do this, one has to remove extra ideas and get right to the key points of what matters. A Texas oil and gas businessman puts it this way: “The key ability for success is simplifying. In conduction of meeting and dealing with industry reducing a complex problem to the simplest term is highly important.”
Is common sense a quality a person is born with, or can you do something to increase it? The oil man’s answer is that common sense can definitely be developed. He owes this to learning how to debate in school. Another way to increase your store of common sense is to observe it in others, learning from their—and your own—mistakes.
Besides common sense, there are many other factors that influence success: knowing your field, self-reliance, intelligence, the ability to get things done, leadership, creativity, relationships with others, and of course, luck. But common sense stands out. If you develop these qualities, you’ll succeed. And you might even find yourself listed in Who’s Who someday.
Secrets to success
Finding of the
(1)  ▲  
Top achievers have some common (2)  ▲  , one of which is common sense.
The most
important quality
79 percent of the people surveyed (3)  ▲   highly of common sense. And 61
percent say their success (4)  ▲   from this quality.
Understanding of common sense
To most, it means one is (5)  ▲   of presenting sound, practical judgments on everyday affairs by (6)  ▲   on what really counts.
(7)  ▲   to
get common sense
(8)  ▲   it through activities like learning how to debate in school.
Increasing it through mistakes by observing others.
Other factors
leading to success
(9)  ▲   from common sense, many other factors contribute to success, luck
(10)  ▲  . But common sense is the most outstanding.
1. _____________ 2. _____________ 3. ______________ 4. __________ 5. ______________
6. _____________ 7. _____________ 8. ______________ 9. __________10. ______________
判断题