问题 问答题 案例分析题

主诉:女性,27岁,持续性左下腹痛伴恶心、呕吐3h。

病史:患者平素月经量中等,无痛经史,末次月经:2007-01-01,于2007-01-20下午3时,劳动后突然出现持续性左下腹痛,伴恶心、呕吐,休息后不缓解,无腹泻及 * * 流血,当地诊所给予"阿托品"治疗后病情无缓解,遂来院急诊。25岁结婚,孕1产1,末次生产1年前,行宫内节育器避孕2月,既往体健,否认心、肝、肾等疾患。

查体:T37℃,P100次/分,BP110/70mmHg,急性病容,痛苦貌,出冷汗,不可平卧。心肺无异常。妇科检查:外阴正常, * * 畅,分泌物少许,宫颈光滑,举痛(-),子宫前位,正常大小,可活动,无压痛,子宫左后方可及7cm×6cm×6cm包块,压痛明显,包块边界清,活动差,右侧附件区(-),后陷凹不饱满。

辅助检查:尿妊娩试验阴性,Hb110g/L,WBC10.8×109/L,PLT115×109/L。B超:可见宫内避孕环,子宫左后6.8×7.0cm囊实性包块,形状规则,盆腔内有少量积液。

答案

参考答案:

1.诊断及诊断依据(8分)

(1)诊断卵巢肿瘤蒂扭转

(2)诊断依据

①劳动后突然出现持续性左下腹痛伴恶心、呕吐,休息后不缓解。

②妇科检查子宫左后方可及7cm×6cm×6cm包块,压痛明显,包块边界清,活动差。

③尿妊娩试验阴性,Hb110/L,WBC10.8×109/L。B超:子宫左后有囊实性包块,形状规则。

2.鉴别诊断(5分)

①异位妊娠破裂。

②卵巢黄体破裂。

③外科急腹症急性阑尾炎、胃、十二指肠穿孔。

④内科腹痛急性肠炎、菌痢

3.进一步检查(4分)

①腹部X片。

②肿瘤标记物测定。

③尿、粪常规。

④腹腔镜检查。

4.治疗原则(3分)

(1)建立静脉通路、密切监测生命体征的同时积极准备手术。

(2)尽快行剖腹探查,切除肿瘤和扭转的瘤蒂。术中切下肿瘤应剖开观察肿瘤良、恶性,必要时送术中快速病理,明确性质,以确定手术范围。

(段伟卢克新)

选择题
阅读理解

阅读理解。

     Scientists have devised a way to determine roughly where a person has lived using a strand of hair, a

technique that could help track the movements of criminal suspects or unidentified murder victims.

     The method relies on measuring how chemical variations in drinking water show up in people's hair.

     "You're what you eat and drink, and that's recorded in your hair," said Thure Cerling, a geologist at

the University of Utah.

     While U.S diet is relatively identical, water supplies vary. The differences result from weather patterns. The chemical composition of rainfall changes slightly as rain clouds move.

     Most hydrogen and oxygen atoms in water are stable, but traces of both elements are also present as

heavier isotopes (同位素). The heaviest rain falls first. As a result, storms that form over the Pacific

deliver heavier water to California than to Utah.

     Similar patterns exist throughout the U.S. By measuring the proportion of heavier hydrogen and

oxygen isotopes along a strand of hair, scientists can construct a geographic timeline. Each inch of hair

corresponds to about two months.

     Cerling's team collected tap water samples from 600 cities and constructed a map of the regional

differences. They checked the accuracy of the map by testing 200 hair samples collected from 65 barber

shops. They were able to accurately place the hair samples in broad regions roughly corresponding to

the movement of rain systems.

     "It's not good for pinpointing (精确定位)," Cerling said. "It's good for eliminating many possibilities."

     Todd Park, a local detective, said the method has helped him learn more about an unidentified woman whose skeleton was found near Great Salt Lake.

     The woman was 5 feet tall. Police recovered 26 bones, a T-shirt and several strands of hair.

     When Park heard about the research, he gave the hair samples to the researchers.

     Chemical testing showed that over the two years before her death, she moved about every two

months.

     She stayed in the Northwest, although the test could not be more specific than somewhere between

eastern Oregon and western Wyoming.

     "It's still a substantial area," Park said "But it narrows it way down for me."

1. What is the scientists' new discovery?  

A. One's hair growth has to do with the amount of water they drink.

B. A person's hair may reveal where they have lived.

C. Hair analysis accurately identifies criminal suspects..

D. The chemical composition of hair varies from person to person.

2.What does the author mean by "You're what you eat and drink" (Line 1, Para.3)?

A. Food and drink affect one's personality development.

B. Food and drink preferences vary with individuals.

C. Food and drink leave traces in one's body tissues.

D. Food and drink are essential to one's existence.

3.What is said about the rainfall in America's West?  

A. There is much more rainfall in California than in Utah.

B. The water it delivers becomes lighter when it moves inland.

C. Its chemical composition is less stable than in other areas.

D. It gathers more light isotopes as it moves eastward.

4.What is the practical value of Cerling's research?

A. It helps analyze the quality of water in different regions.

B. It helps the police determine where a crime is committed.

C. It helps the police narrow down possibilities in detective work.

D. It helps identify the drinking habits of the person under investigation.