问题 单项选择题

1岁男婴,因面色苍黄、毛发稀枯3个月。血常规示Hb89g/L,中性粒细胞变大并有分叶过多。骨髓象示:幼红细胞巨幼变。为了明确诊断,首先应选择的检查是()。

A.血清VitB6测定

B.血清VitB12测定

C.血清计酸测定

D.血清铁蛋白测定

E.血清铁测定

答案

参考答案:B

解析:
从题中的表现可判断出症状为营养性巨幼红细胞性贫血。其表现为毛发稀疏发黄,严重病例可有皮肤出血点或瘀斑。血象可见轻度或中度贫血者占大多数。患儿面色苍黄,疲乏无力。常们有肝、脾大。
营养性巨幼红细胞性贫血的实验室检查包括:
①血象。呈大细胞性贫血,可见到巨幼变的有核细胞,网织红细胞计数常减少,中性粒细胞数和血小板数常减低,中性粒细胞变大并有分叶过多现象,可见到5%以上的中性粒细胞有5个以上的核分叶。
②骨髓象。骨髓增生明显活跃,以红细胞系统增生为主,粒:红比值常倒置,各期幼红细胞增为出现巨幼变。
③维生素B12缺乏的血清学检查
(1)血清维生素B12:正常值为200~800,如小于100则提示缺乏维生素B12
(2)血清乳酸脱氢酶(LDH):明显增高;尿甲基丙二酸的排泄景增多是维生素B12缺乏的一个可靠而敏感的指标;血清胆红素水平可有中度增高。
④叶酸缺乏的血清学检查
(1)血清叶酸正常值为5~6,小于3提示叶酸缺乏。
(2)血清维生素B12和血清铁水平正常或升高;
(3)血清LDH水平明显增高。

完形填空
No More Time Out

Shawn and Thomas had always been good friends. They lived near each other, and they both loved __36__.They played baseball, touch football, and kickball. They also liked to play soccer, shoot baskets, and skateboard.When they were in the fourth grade, though, Thomas broke his __37__ in a soccer game. He had to be on crutches for six weeks.
Shawn __38__ Thomas, but what was there to do? Shawn didn’t like television or computer games. Thomas didn’t like to sit and talk. After trying three times to start a conversation, Shawn __39__ up. He said, “I’m out of here.”
For days, Shawn __40__at home, feeling guilty for not visiting Thomas again. Thomas stayed home, too, feeling __41__because Shawn wasn’t visiting him. After a week, Shawn’s mom spoke up. “It’s time for you and Thomas to get back into action! That’s why I spoke to Ms McNulty at the library. She has the perfect volunteer job for you both,” she said.
Shawn said __42__.
His mom continued, “The library sells used books to raise money. People are always __43__off books in bags and boxes. Someone has to carry the books to the storage room. Someone has to sort them into fiction (小说) and nonfiction. You and Thomas can be a team __44__.”“No, we can’t!” said Shawn. “He and I don’t want a job.” However, Shawn’s mom wouldn’t __45__ no for an answer.
Sure enough, __46__the boys began, things changed. Shawn felt strong as he carried bags and boxes through the library. Sorting books in the storage room, Thomas felt useful again. In fact, one day Thomas said, “Between you and me, Shawn, this isn’t so __47__.” Shawn smiled and agreed. They were a good team.
301 words
小题1:
A.sports B.booksC.movies D.arts
小题2:
A.arm B.hand C.legD.nose
小题3:
A.phonedB.invited C.visitedD.checked
小题4:
A.came B.gave C.turnedD.hurried
小题5:
A.stayedB.waitedC.calledD.talked
小题6:
A.tiredB.afraidC.weakD.angry
小题7:
A.nothingB.somethingC.anythingD.everything
小题8:
A.bringingB.dropping C.showingD.knocking
小题9:
A.soonB.onlyC.perhapsD.again
小题10:
A.chooseB.keepC.takeD.allow
小题11:
A.becauseB.once C.ifD.although
小题12:
A.privateB.simple C.badD.special
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