问题 单项选择题

男性,46岁,因外伤后腹痛,面色渐苍白,出冷汗,急诊入院。查血压下降,行剖腹探查,术中见腹腔内出血、脾损伤故行脾切除。标本见脾门处向外达下缘不规则被膜及实质破裂,破裂处切面有凝血块,镜下出血区边缘见急性炎症,该患者应诊断为()

A.脾梗死

B.血管瘤

C.完全性脾破裂

D.被膜下脾破裂

E.淤血性脾肿大

答案

参考答案:C

解析:脾破裂以病因不同分为外伤性和病理性两类,后者称自发性脾破裂。外伤性脾破裂大体上又分被膜下和完全性,尤其是临床上非开放性腹外伤的脾破裂,如果发生在被膜下,可表现为腹痛而一段时间后出现休克的症状和体征,病理检查应注意标本是否有完整的被膜即有无小的裂痕或裂隙,表面如有凝血块应查其下是否有破裂处。镜下破裂早期见急性炎症反应,而延迟性切脾者可见破裂处多有含铁血黄素沉着或肉芽组织。自发性破裂者,因病因不同其组织学改变也不同。

单项选择题 A1/A2型题
单项选择题

"You are not here to tell me what to do. You are here to tell me why I have done what I have already decided to do," Montagu Norman, the Bank of England’s longest-serving governor (1920-1944), is reputed to have once told his economic adviser. Today, thankfully, central banks aim to be more transparent in their decision making, as well as more rational. But achieving either of these things is not always easy. With the most laudable of intentions, the Federal Reserve, America’s central bank, may be about to take a step that could backfire.

Unlike the Fed, many other central banks have long declared explicit inflation targets and then set interest rates to try to meet these. Some economists have argued that the Fed should do the same. With Alan Greenspan, the Fed’s much-respected chairman, due to retire next year-after a mere 18 years in the job-some Fed officials want to adopt a target, presumably to maintain the central bank’s credibility in the scary new post-Greenspan era. The Fed discussed such a target at its February meeting, according to minutes published this week. This sounds encouraging. However, the Fed is considering the idea just when some other central banks are beginning to question whether strict inflation targeting really works.

At present centra1 banks focus almost exclusively on consumer-price indices. On this measure Mr. Greenspan can boast that inflation remains under control. But some central bankers now argue that the prices of assets, such as houses and shares, should also somehow be taken into account. A broad price index for America which includes house prices is currently running at 5.5%, its fastest pace since 1982. Inflation has simply taken a different form.

Should central banks also try to curb increases in such asset prices Mr. Greenspan continues to insist that monetary policy should not be used to prick asset-price bubbles. Identifying bubbles is difficult, except in retrospect, he says, and interest rates are a blunt weapon: an increase big enough to halt rising prices could trigger a recession. It is better, he says, to wait for a housing or stockmarket bubble to burst and then to cushion the economy by cutting interest rates-as he did in 2001-2002.

And yet the risk is not just that asset prices can go swiftly into reverse. As with traditional inflation, surging asset prices also distort price signals and so can cause a misallocation of resources-encouraging too little saving, for example, or too much investment in housing. Surging house prices may therefore argue for higher interest rates than conventional inflation would demand. In other words, strict inflation targeting-the fad of the 1990s-is too crude.

It is implied in the fourth paragraph that Mr. Greenspan is skeptical of ()

A. the stipulation of anti-monopoly rules and regulations

B. the intervention by central banks in asset prices

C. the prevention of economic recession

D. the countdown by the Federal Reserve of new economic upheavals