女性，38岁。因四肢刺痛麻木不适4年伴行走困难，如踩棉花状半年_爱下问搜题

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女性，38岁。因四肢刺痛麻木不适4年伴行走困难，如踩棉花状半年来诊。患者有胃病史10年，无反酸。曾检查血糖正常。体检有中度贫血症。为明确诊断需进一步检查的是（）

A.肌电图检查

B.骨髓穿刺

C.血清维生素B测定

D.头颅CT检查

E.脑电图检查

答案

参考答案：C

解析：患者为中年女性，有多年胃病史，无反酸，有中度贫血表现伴四肢运动感觉障碍，特别是下肢深感觉受损引起行走如踩棉花状，提示可能为长期胃病后内因子缺乏，引起维生素B吸收不足，造成巨幼红细胞性贫血，神经系统多发性损害引起亚急性脊髓联合变性，应该首先检查血中维生素B浓度，有利于针对病因治疗。

完形填空

When I was a little girl, I found love in a box all because of a class assignment. On a Friday night I   36  at the dinner table, “My teacher said we have to bring a box, a special box, for our valentines on Monday”.
Mother said, “We’ll see,” and she continued eating.
What did “We’ll see” mean? I had to have that box,   37  my second grade Valentine’s Day would be a disaster. Maybe they didn’t love me enough to help me with my   38  .
All Saturday I waited   39  and with Sunday arriving, my concern increased. However, I   40  that an enquiry about the box would   41  anger or loud voices, for in my house children only asked once. More than that   42  trouble.
Late Sunday afternoon, my father called me into the kitchen. The table was covered with different kinds of colorful   43  . A (n)   44  shoebox rested on top of it.   45  flooded through me when Daddy said, “Let’s get started   46  your project.”
In the next hour my father   47  the shoebox into an impressive valentine box. Colorful paper covered the ugly cardboard with red hearts   48  to what I considered all the right places. He sang while he worked. When he finished, he was so delighted that a   49  smile spread across his face. “What do you think of that?” he asked.
I answered him with a hug.
But inside,   50  danced all the way to my heart. It was the first time that my father had devoted so much   51  to me, for his world consisted only of work.
The holiday party arrived, and my classmates put cards and presents into the valentine boxes. Laughter filled our classroom until dismissal time   52 .
On the way home, I held out my valentine box for the world to   53  . The love that filled it meant more to me than all the valentines inside.
The valentine box became a symbol of his love that   54  through decades of other Valentine’s Days. My father gave me other gifts through the years, but none   55  compared with the love I felt within the limits of the old, empty shoebox.

C．disappointedly

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