问题 单项选择题 A2型题

患者男,52岁。活动后气促,颈静脉怒张,心音遥远,肝大,下肢水肿,X线:心脏向两侧扩大,肺野清晰。最可能的诊断是()

A.充血型心肌病

B.病毒性心肌炎

C.风湿性二尖瓣狭窄并关闭不全

D.心包积液

E.肺心病

答案

参考答案:D

解析:心包积液的症状有呼吸困难、胸痛等,查体有心脏搏动减弱,心浊音界向两侧扩大,心音遥远,左肺受压征等,心室充盈严重受限时可有体循环淤血的体征,如颈静脉怒张、肝大、下肢水肿等,X线显示心影向两侧扩大呈烧瓶状。该患者符合上述表现,故本题选D。充血型心肌病即扩张型心肌病,查体无心音遥远,X线有肺淤血征象,不选A。病毒性心肌炎多有前驱感染,查体无心音遥远,部分患者可有心脏扩大,但一般不会向两侧扩大,不选B。风湿性二尖瓣狭窄伴关闭不全听诊有心脏杂音,X线有肺淤血征象,不选C。肺心病主要是右心受累,听诊无心音遥远,X线示右心扩大,且肺内有病变,不选E。

填空题
阅读理解

Watching some children trying to catch butterflies one hot August afternoon, I was reminded of an incident in my own childhood. When I was a boy of 12 in South Carolina, something happened to me that cured me forever of wanting to put any wild creature in a cage.

We lived on the edge of a wood, and every evening at dusk the mockingbirds would come and rest in the tree and sing. There isn’t a musical instrument made by man that can produce a more beautiful sound than the song of the mockingbird.

I decided that I would catch a young bird and keep it in a cage and that way have my own private musician.

I finally succeeded in catching one and put it in a cage. At first, in its fright at being captured, the bird fluttered about the cage, but eventually it settled down in its new home, I felt very pleased with myself and looked forward to some beautiful singing from my tiny musician.

I had left the cage out on our back porch(门廊), and on the second day of the bird’s captivity my new pet’s mother flew to the cage with food in her mouth . The baby bird ate everything she brought to it. I was pleased to see this. Certainly the mother knew better than I how to feed her baby.

The following morning when I went to see how my captive was doing, I discovered it on the floor of the cage, dead. I was shocked! What had happened? I had taken excellent care of my little bird, or so I thought.

Arthur Wayne, the famous ornithologist, happened to be visiting my father at the time and, hearing me crying over the death of my bird, explained what had occurred: “A mother mockingbird, finding her young in a cage, will sometimes bring it poison berries. She thinks it better for her young to die than to live in captivity.”

Never since then have I caught any living creature and put it in a cage. All living creatures have a right to live free.

小题1:The boy caught a mockingbird because___________.

A.he wanted a pet for a companion

B.he liked its beautiful feather

C.he wanted it to sing for him

D.he had just got a cage小题2:The mockingbird died because__________.

A.it ate some poisonous food the boy gave it by mistake

B.it ate the poisonous food its mother gave it

C.it was frightened to death

D.it refused to eat anything小题3:The word “ornithologist” in the last but one paragraph probably means________.

A.a religious person

B.a kind and sympathetic person

C.a schoolmaster

D.an expert in birds小题4:The most important lesson the boy learned from the incident is that______.

A.birds put in a cage won’t live long

B.you have to be very careful about the food you give to young birds

C.when you capture a young mockingbird, you should keep it away from its mother

D.freedom is valuable to all living creature.