问题 多项选择题 共用题干题

患者男,48岁。2年半前出现右手无力,拿东西费劲,吃饭困难,后慢慢抬手困难,肌肉逐渐萎缩,大小鱼际肌及手臂肌肉明显,近半年左手及双下肢逐渐无力、萎缩。查体:构音障碍,咽反射迟钝,转颈力差,双前臂可见肌束颤动,Babinski征(±),无明显客观深浅感觉障碍和共济失调。

该患者可以出现的体征是()

A.伸肌无力较屈肌明显

B.双下肢痉挛性瘫痪

C.眼肌运动障碍、晨轻暮重

D.双上肢迟缓性瘫痪

E.交叉性瘫痪、共济失调

F.节段性感觉分离

G.延髓麻痹

H.感觉障碍

I.面部感觉障碍、眼球震颤

答案

参考答案:A, B, D, G

解答题
单项选择题

George Williams, one of Scottsdale’s last remaining cowboys, has been raising horses and cattle on his 120 acres for 20 years. The cattle go to the slaughterhouse, the horses to rodeos. But Mr. Williams is stomping mad. His problems began last year when dishonest neighbours started to steal his cattle. Then other neighbours, most of them newcomers, took offence at his horses roaming on their properties.

Such grumbles are common in Arizona. The most recent Department of Agriculture census shows that 1 213 of Arizona’s 8 507 farms closed down between 1997 and 2002. Many cattlemen are moving out to remoter parts of the state.

Doc Lane is an executive at the Arizona Cattlemen’s Association, a trade group. He says Arizona’s larger ranch owners are making decent profits from selling. It is the smaller players who are the victims of rising land values, higher mortgages and stiffer city council rules. What happens all too often is that people move in next to a farm because they think the land pretty. But soon they start complaining to the council. In Mr. Williams’s case it was the horses that annoyed them. Other newcomers don’t like the noise, the pesticides and the smell of manure.

Locals worry about the precious, dwindling cowboy culture. Arizona’s tourism boards like to promote a steady interest in all things about cowboy and western. Last year more British and German tourists came than usual, and many of them were looking precisely for that. Arizona’s Dude Ranch Association fills its $ 350-a-night luxury ranches most of the year; roughly a third of the guests are European.

Many of the ranchers themselves see all this tourism as a cheeky attempt to commercialise a real and vanishing culture. In Prescott, estate agents promote "American Ranch-style" homes with posters of horse riders. On the other side of the street is Whiskey Row, a famous strip of historic cowboy bars. But in Matt’s Saloon on Saturday night, real cattlemen could not be found.

Farm folk like Mr. Knox and Mr. Williams are weighing up their options. Many will migrate to remoter places where land is cheaper and not crowded with city people. Younger ones take on side-jobs as contractors and are cattle-hands part-time. Older cowboys aren’t sure what to do.

The word "grumble" (Line 1 , Paragraph 2) most probably means ()

A. mutter

B. phenomenon

C. complaint

D. gamble