问题 单项选择题 案例分析题

患者,女,38岁。主诉:头晕3年,加重1周。现病史:患者3年前无诱因头晕,无头痛及肢体瘫痪,测血压160/90mmHg,间断服用心痛定降压,血压控制不详(不常测血压)。近月改为口服依那普利10mg/d,寿比山2.5mg/d,氢氯噻嗪1片,3次/日。仍有头晕,同时自觉乏力,为进一步治疗来诊。无胸痛,无发热,无活动时气短,无呕吐及腹泻。既往史:阴性。家族史:阴性。查体:T36℃,P76次/分,R18次/分,BP190/140mmHg,神清,自主体位,双肺呼吸音清,心界不大,心率76次/分,律不齐,偶可闻及早搏,无杂音。腹部查体无异常。心电图:窦性节律,偶发室早。血常规、尿常规、肝功、血糖、血脂正常。

钾2.9mmol/L,钠146mmol/L,氯104mmol/L,肌酐88μmol/L。双肾及肾上腺彩超未见异常。低钾的可能原因首先应考虑()。

A.皮质醇增多症

B.原发性醛固酮增多症

C.嗜铬细胞瘤

D.继发于慢性肾炎的高血压

E.长期服用利尿药

F.慢性肾衰所致

答案

参考答案:E

阅读理解

It was 3:21 a.m. when nineyearold Glenn Kreamer awoke to the smell of burning. Except for the cracking(爆裂声) of flames somewhere below there was not a sound in the twostorey house at Baldwin, Long Island.

With his father away on night duty at a local factory, Glenn was worried about the safety of his mother, his sister Karen, 14 and his 12-year-old brother Todd. He ran downstairs through the smokefilled house to push and pull at Karen and Todd until they sat up. Then he helped each one through the house to the safety of the garden. There, his sister and brother, taking short and quick breaths and coughing, collapsed on the lawn.

The nine-year-old boy raced back into the house and upstairs to his mother's room. He found it impossible to wake her up. Mrs Kreamer, a victim of the smoke, was unconscious, and there was nobody to help Glenn carry her to the garden. But the boy remained calm and, as a fireman said later,“acted with all the selfcontrol of a trained adult.”

On the bedroom telephone, luckily still working, Glenn called his father and, leaving Mr Kreamer to telephone the fire brigade and ambulance service, got on with the task of saving his mother.

First he filled a bucket with water from the bathroom and threw water over his mother and her bed. Then, with a wet cloth around his head he went back to the garden.

He could hear the fire engine coming up, but how would the firemen find his mother in the smokefilled house where flames had almost swallowed up the ground floor?

Grasping firmly a ball of string from the garage, Glenn raced back into the

house and dashed upstairs to his mother's room. Tying one end of the string to her hand he ran back, laying out the string as he went, through the hall and back out into the garden.

Minutes later he was telling fire chief John Coughlan:“The string will lead

you to Mother.” Mrs Kreamer was carried to safety as the flames were breaking through her bedroom floor.

1.Why did Glenn run downstairs first?

A. He wanted to find out what was happening.

B. He was worried about his mother's safety.

C. He wanted to save his sister and his brother.

D. He went to see if his father had come back from work. 

2. How did Glenn help the firemen to save his mother?

A. By throwing water all over her and her bed.

B. By carrying her to safety with his brother.

C. By pushing and pulling at her.

D. By tying a string to her hand. 

3. Who called the fire brigade and ambulance service?

A. Glenn.       B. Glenn's father.       C. Glenn's sister.    D. Glenn's neighbor. 

4.What did Glenn do to protect himself?

A. He put a wet cloth around himself.   B. He threw water all over his head.

C. He hid himself in the bathroom.      D. He rushed out to the lawn. 

5. Glenn saved his family because ________ .

A. his father had taught him to do so on the phone

B. he had learned something about the first aid

C. he had dealt with the emergency calmly and wisely

D. he had followed his mother's instruction 

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