问题 单项选择题 A3/A4型题

患者女性,65岁,皮肤、巩膜黄染30天,伴皮肤瘙痒、厌食、乏力、消瘦、小便黄、大便发白等;既往史无特殊。体检:皮肤、巩膜黄染,腹部无压痛反跳痛,肝区无叩击痛,可及肿大的胆囊,腹水征阴性。实验室检查:TBil:25mg/dl、DBil:20mg/dl、CA199:12u/ml、CA50:8u/ml;影像学检查:B超:低位胆道梗阻、肝内外胆管扩张,胰头不大;CT:低位胆道梗阻、肝内外胆管扩张、胰管扩张(双管征),胰腺未见明显占位;十二指肠低张造影:十二指肠曲不大、降部黏膜紊乱,未见明确的充盈缺损。

患者行胸部CT提示双肺广泛转移,行ERCP后血胆红素降至接近正常,下列关于后续治疗的选择,合理的是()。

A.该患者总的治疗原则为姑息治疗,以局部治疗为主

B.仅行壶腹部放疗

C.如患者一般情况差(PS>2),可考虑分子靶向治疗,首选易瑞沙

D.如患者一般情况可,可以全身化疗为主,配合局部姑息性放疗

E.该患者总的治疗原则以最大限度杀灭肿瘤,争取达到PR或CR

答案

参考答案:D

阅读理解

阅读理解。

     Yellowstone is a huge park covering over 3,400 square miles in Wyoming, Montana and Idaho. It can be

reached by air to Cody or Jackson, 50 miles from the entrances (入口) . There is no train service nearby.

Limited (有限的) bus service is used from some of the towns near it. Once in the area, a car is almost a must.

The park has 5 entrances, which are open from May to October . It is a good idea to plan a trip during the

good weather, but except big crowds and show traffic. Parts of the park are open in the winter for snow

sports.

     Be sure to come prepared for different weather at any time of the year. Take enough of your clothing

so you will be prepared for unexpected changes in temperature. Take good walking shoes and thick socks,

if you are going to do any hiking. You can also see the park on horseback.

     If you want to learn about Yellowstone, the National Park Service has many talks, films and tours to

help you to understand it .

1. How large is Yellowstone National Park? 

    ______________________________________________

2. What is a must if you are in the area?

    ______________________________________________

3. Why are parts of the park open in winter?

    ______________________________________________

4. What do you need to take while going to do any hiking?

    ______________________________________________ 

5. Where can you find more information about Yellowstone? 

    ______________________________________________

选择题