问题 单项选择题 共用题干题

患者女性,58岁,因“食欲缺乏、腹部不适1周,咳嗽5日;双下肺炎、双侧胸腔积液、淋巴结肿大原因待查、原发性高血压(1级中危)、精神分裂症”来诊。诊断:

①肺炎;

②转移性低分化腺癌并多发淋巴结转移。

入院第5日患者因自服过量多塞平片,呼吸、心搏骤停,给予气管插管、呼吸机辅助呼吸、锁骨下静脉穿刺、持续导尿及硫酸依替米星预防感染;同时给予肠内营养对症支持治疗。第11日患者脱机,但出现持续发热,最高体温39.2℃,双下肺可闻及湿啰音,经验选择“亚胺培南-西司他丁钠0.5g,每8小时1次,静脉滴注”抗感染治疗。第16日尿液培养出奇异变形杆菌,对亚胺培南敏感。第18日患者仍发热,体温38℃以上,加用万古霉素0.5g,每8小时1次,静脉滴注。第21日2次痰培养见耐甲氧西林金黄色葡萄球菌(MRSA),对万古霉素、替考拉宁、利奈唑胺敏感。第23日患者体温无下降,停用亚胺培南后仍然持续发热,体温38℃以上。第27日停用万古霉素,换用利奈唑胺0.6g,每12小时1次,静脉滴注。第28日患者仍发热,体温在39℃以上,痰培养见光滑球拟酵母菌,对氟胞嘧啶敏感,对氟康唑、伊曲康唑、伏立康唑均耐药。根据痰培养结果,结合患者病史和症状,加用卡泊芬净50mg抗真菌治疗,每日1次,静脉滴注。第32日患者仍发热,行纤维支气管镜保护毛刷刷检。第35日痰培养见阴沟肠杆菌,对亚胺培南、左氧氟沙星、多西环素敏感;保护性毛刷刷检见嗜麦芽窄食单胞菌,对头孢哌酮舒巴坦、左氧氟沙星敏感。遂静脉滴注头孢哌酮舒巴坦3g,每8小时1次及左氧氟沙星0.5g,每日1次,联合抗感染治疗4日,患者体温下降至37℃以下,继续应用10余日,病情稳定出院。出院诊断:

①呼吸机相关性肺炎;

②转移性低分化腺癌并多发淋巴结转移。

该患者最后一次细菌培养出“嗜麦芽窄食单胞菌”,选择头孢哌酮舒巴坦联合左氧氟沙星抗感染治疗4日,体温明显下降,说明嗜麦芽窄食单胞菌对其天然耐药的药物是()

A.头孢哌酮舒巴坦

B.多西环素

C.左氧氟沙星

D.亚胺培南-西司他丁钠

E.万古霉素

答案

参考答案:D

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     When I walked into the house after school, the first thing I noticed was a box with items I recognized from my dad's office.
     "What are you doing home?" I asked _1_.
     "Andrew, I was   2   today,"he answered quietly.
     I was sure he was joking."No, you weren't. Why are you really home?"
     Then I noticed his    3   and realized he was telling the truth. My father has always been a hard
worker and   4   himself on his career.  5   for our family has been his job, and I guess I had taken
his work  6  .
     My father's unemployment created many changes in our life. For starters, he was home all the time,
   7   meant my bed had to be made, my room   8  , and my homework done right after school. I would
come home every day to find him at the computer   9   jobs. I began to notice how down he seemed,
though he tried to be  10  . For the first time, I saw my dad as the vulnerable(易受伤害的). I   11   my
allowance(零用钱), even though it wasn't much; I felt like the right thing to do. I   12   found a parttime
job.
     After several difficult months of searching, my dad decided to go in a totally different direction. He
    13  that he never wanted to be laid off again, so he was going to start his own business.
One evening I asked if he needed help.
"  14   it doesn't interfere (妨碍) with your study," he said.
    I   15    at his office the next afternoon, and most afternoons after that for two months. I always knew
he was a hard worker, but watching him   16   really impacted me.    17   this was one of the worst
experiences for our family, it taught me a lot about dealing with adversity (逆境). Now I know that
through   18   problemsolving, I can always find Plan B to ask for help, and take risks.   19   I have
learned from my dad's understanding of business and his work ethic are two of the most important
lessons in my life, and will be my   20    for success.
( )1. A. casually        
( )2. A. carried off    
( )3. A. fairness        
( )4. A. regarded        
( )5. A. Providing      
( )6. A. for help        
( )7. A. that            
( )8. A. cleaned up      
( )9. A. answering for  
( )10. A. athletic      
( )11. A. gave up        
( )12. A. however        
( )13. A. introduced    
( )14. A. Only if        
( )15. A. showed up      
( )16. A. in charge      
( )17. A. Now            
( )18. A. alternative    
( )19. A. That          
( )20. A. consideration  
B. seriously      
B. paid off        
B. look            
B. prided          
B. Serving        
B. for sure        
B. what            
B. dried up        
B. waiting for    
B. optimistic      
B. found out      
B. always          
B. declined        
B. What if        
B. showed off      
B. in action      
B. As              
B. creative        
B. Which          
B. destination    
C. shyly          
C. seen off        
C. expression      
C. considered      
C. Giving          
C. for pleasure    
C. which          
C. divided up      
C. searching for  
C. authentic      
C. gave in        
C. also            
C. explained      
C. As if          
C. kept up        
C. in person      
C. Since          
C. attractive      
C. What            
C. education      
D. absolutely      
D. laid off        
D. weakness        
D. worked          
D. Undertaking      
D. for granted      
D. whom            
D. made up          
D. hoping for      
D. active          
D. put away        
D. well            
D. explored        
D. Even if          
D. set off          
D. in trouble      
D. Although        
D. conservative    
D. Where            
D. foundation      
单项选择题 B1型题