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问题 单项选择题 A1/A2型题

肝硬化患者Child-Pugh分级总分是多少评估为A级（）。

A.≤4分

B.≤5分

C.≤6分

D.≤7分

E.≤8分

答案

参考答案：C

解析：肝硬化患者Child-Pugh分级标准包括5个指标：肝性脑病、腹水、总胆红素、白蛋白、凝血酶原时间，其中每个指标分成3个等级，具体如下：无肝性脑病记1分，肝性脑病1～2级记2分，3～4级记3分；无腹水记1分，轻度腹水记2分，中至重度腹水记3分；总胆红素<34μmol/L记1分，在34～51μmol/L之间记2分，>51μmol/L记3分；白蛋白≥35g/L记1分，在28～35g/L之间记2分，白蛋白≤28g/L记3分；凝血酶原时间延长1～3秒记1分，延长4～6秒记2分，延长>6秒记3分。注：PBC或PSC时，总胆红素<68μmol/L记1分，68～170μmol/L记2分，>170μmol/L记3分。将5个指标计分进行相加，根据该总和的多少将肝脏储备功能分为A、B、C三级，总分≤6分为A级，7～9分为B级，≥10分为C级。分数越高，提示肝脏储备功能越差。

填空题

Just under a year ago, a sharp drop in equatorial Pacific sea-surface temperature indicated the end of the 1997~1998 E1 Nino. Called by someone "the climate event of the century", it was by several measures the pest on record. (41)______.This is more than simply an academic question: the 1997~1998 E1 Nino severely disrupted global weather patterns and Pacific marine ecosystems, and by one estimate caused ＄033 billion in damage and cost 23,000 lives worldwide. (42)______.Clearly we have much to learn from this experience.
(43)______.Now E1 Nino more generally refers to a warming of the tropical Pacific basin that occurs roughly every three to seven years in association with a weakening of the trade winds. The opposite side of El Nino, La Nina, is characterized by per-than-normal trade winds and unusually cold sea-surface temperatures in the tropical Pacific. Both E1 Nino and La Nina are accompanied by swings in atmospheric pressure between the eastern and western Pacific. These swings are known as the Southern Oscillation. These phenomena are collectively referred to as ENSO or E1 Nino/Southern Oscillation.
The general mechanisms underlying the ENSO involve large-scale ocean-atmosphere interactions and equatorial ocean dynamics. But each El Nino and La Nina is unique in the combination of its strength, duration and pattern of development. Irregularity in the ENSO cycle can be seen both in the record dating back to the middle of the 19th century, and in other supporting data, such as lake sediments, coral growth rings and tree rings, going back hundreds or even thousands of years. (44)______.
Nonetheless, the 1997~1998 E1 Nino was an unusual one. It developed so rapidly that every month between June and December 1997 set a new monthly record high for sea-surface temperatures in the eastern equatorial Pacific. Anomalies (that is, deviations from normal) in December 1997 were the highest ever recorded along the Equator in the eastern Pacific. Moreover, before 1997~ 1998, the previous record-setting E1 Nino occurred in 1982~1983. (45)______.
Several factors may have contributed to the strength of the 1997~1998 E1 Nino. One is chaos, which some theories invoke to account for the irregularity of the ENSO cycle. Nonlinear resonances involving ENSO and the seasonal cycle have received special attention, but other chaotic interactions may affect ENSO as well. In 1997~1998, events possibly acted together to produce an extraordinarily p E1 Nino simply due to the underlying tendency towards chaos in the elimate system.
[A] So in principle, it should not be surprising that an unusually p E1 Nino occurs ever so often.
[B] Identifying why it was so p challenges our understanding of the physical mechanisms responsible for E1 Nino.
[C] From that perspective, the strength of the 1997~1998 E1 Nino may be but one manifestation of a linkage between interannual and decadal climate variations in the Pacific.
[D] These two "super E1 Ninos" were separated by only 15 years, compared with a typical 30~40 year gap between such events earlier in the 20th century.
[E] E1 Nino, Spanish for "the child" (and specifically the Christ child), is the name Peruvian fisherman gave to coastal sea-temperature warnings that first appeared around Christmas time.
[F] There were warnings of a coming E1 Nino before it occurred. But although many computer forecast models predicted that 1997 would be warm in the tropical Pacific up to three seasons in advance, none predicted the rapid development or ultimate intensity of the event before it began.
[G] In association with the Pacific Decadal Oscillation, sea-surface temperatures have generally been higher in the tropical Pacific from the Mid-1970s. Since then, there have been more E1 Ninos than La Ninas.
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单项选择题 案例分析题

男性，72岁，哮喘史40年，近5年来发生双下肢水肿，1周来哮喘加重，咳黄痰，1天中白天嗜睡，夜间失眠

下列检查对明确诊断有意义的是（）

A.血气分析

B.心电图

C.脑电图

D.脑血流图

E.超声心动图
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