问题 多项选择题 案例分析题

患者女,75岁。因“进行性加重头晕、行走不稳、言语不利1个月”就诊。1个月前无明显诱因出现头晕、视物旋转,头晕持续时间长,与头位、体位无关,无耳鸣。后逐渐出现行走不稳,左右摇晃,言语不清,语速快,无饮水呛咳、吞咽困难,无肢体无力。既往有高血压病史,有阵发性心房颤动病史;近2个月阵发性下腹痛。查体:下腹部可触及约6cm×8cm肿物。神经系统查体:意识清楚,爆破样语言,双侧眼球位置运动正常,向双侧注视时可见旋转性眼震,双侧软腭抬举正常,双侧咽反射正常,四肢肌力5级,双上肢肌张力减低,双侧快复轮替试验欠稳准,双侧病理反射未引出。颅脑MRI:双侧小脑轻度萎缩。

为明确病变性质,该患者下一步须进行的检查包括()

A.腹部CT

B.前庭功能检查

C.全身PET-CT

D.腰椎穿刺

E.颈椎MRI

F.胸部CT

答案

参考答案:A, C, D

解析:根据临床表现定位于双侧小脑半球;查体可触及腹部肿物,为明确腹部病变性质,须行腹部CT检查;为排查肿瘤,可选择PET-CT检查;为排除脑干、小脑炎症,可进一步行腰椎穿刺检查。

填空题
阅读理解

I learned how our attitudes made a big difference in our everyday lives from my friend Mary.

She doesn’t have any pets. I happened to see her outside on a -30 degree morning walking a dog. I felt sorry for Mary, out there walking a dog that’s not hers in such cold weather. I thought maybe she was saying to herself, “Yeah, this is why I don’t have any pets! I hate walking dogs.”

Later that day I saw Mary and said, “I saw you out there walking a dog this morning. Are you unhappy because you had to walk it on such a cold day?” To my surprise, she said that she enjoyed getting out there and walking the dog and that she got good exercise because of the dog. She also said she had talked to her brother, the dog’s owner, who was on holiday in Orlando, Florida with his family. He said his children were enjoying Disney World and the resorts (胜地). His four-year-old son had breakfast with Mickey Mouse and said it was the best day in his life. Mary said, “If I can help my brother and his family have a wonderful time relaxing for a week, knowing that their pet is being loved and cared for, what more could I ask for?” She added, “It’s worth it for me to make the sacrifice (牺牲) so that they can go and have fun.”

I learned a lesson from Mary.

小题1:What do we know about Mary?

A.She liked exercising outside before that day.

B.In fact she likes taking care of dogs very much.

C.She likes helping others.

D.She was sorry for not going on holiday with her brother.小题2:Why did the author feel sorry for Mary?

A.It was a cold morning.

B.He thought Mary was suffering because of others.

C.Mary didn’t have any pets.

D.He found Mary was unhappy to walk the dog.小题3:Mary’s brother and his family could have a wonderful holiday because __________.

A.the children could have breakfast with Mickey Mouse

B.the children enjoyed Disney World and the resorts

C.Mary did not go with them

D.Mary looked after their dog小题4:What lesson did the author learn from Mary?

A.Traveling is fun, and walking dogs is also fun.

B.Walking dogs will make you feel warm.

C.Helping others is also a kind of enjoyment.

D.Walking dogs is also a kind of exercise.小题5:What can we infer from the passage?

A.The author mistook Mary that morning.

B.Mary would raise a dog after helping her brother.

C.Mary made a lot of sacrifices for her brother.

D.Mary disliked raising any pets.