问题 单项选择题 A3/A4型题

患者男,42岁。3个月前右侧腹股沟有一可变性梨形肿物。于4小时前因扛麻袋(米袋),突然增加腹压,而使肿块不能还纳,伴有剧痛、恶心呕吐,呕吐物为少许胃内容物,同时亦有腹胀、排气排便停止。查体:急性面容,BP100/70mmHg,P104次/分,心肺无异常,右阴囊部肿块(物)6cm×5cm×4cm,紧满发硬,触痛明显,精索部有柄蒂状明显增粗,而皮肤发红、触痛。腹部轻度胀满,可见肠形,肠鸣音亢进,可闻及气过水声。腹部立位X线片,亦可见阶梯状气液面。

应采取最有效的措施()

A.观察保守治疗

B.抗炎对症治疗

C.立即行疝修补术

D.高位结扎疝囊+切除肠管

E.脓肿切开引流缝合术

答案

参考答案:D

解析:1.患者呈持续性剧烈腹痛,呕吐频繁,呕吐物含咖啡样血液或出现血便;腹部体征呈不对称腹胀,有腹膜刺激征,肠鸣音减弱或消失;腹腔穿刺或灌洗为血性积液;X线检查见孤立胀大的肠袢或瘤状阴影;体温、脉搏、白细胞计数渐上升,甚至出现休克体征。依据本题患者临床特征,可按(右)绞窄性腹股沟疝合并肠梗阻诊断。故本题答案为C。2.腹股沟疝早期手术效果好、复发率低,一般均应尽早施行手术治疗,该患者为绞窄性腹股沟疝合并肠梗阻,故应在高位结扎疝囊的基础上切除肠管,故本题答案为D。3.切口感染是引起疝复发的主要原因之一,一旦发现切口感染征象应尽早处理,需加强切口感染及肠瘘并发症的防范。故本题正确答案为C。

判断题
单项选择题

Culture is activity of thought, and receptiveness to beauty and human feeling. (1) of information have nothing to do with it. A merely well-informed man is the most useless (2) on God’s earth. What we should (3) at producing is men who (4) both culture and expert knowledge in some special direction. Their expert knowledge will give them the ground to start (5) , and their culture will lead them as (6) as philosophy and as high as (7) We have to remember that the valuable (8) development is self-development, and that it (9) takes place between the ages of sixteen and thirty. As to training, the most important part is given by mothers before the age of twelve.

In training a child to activity of thought, above all things we must (10) of what I will call "inert ideas"—— that is to say, ideas that are merely (11) into the mind without being (12) , or tested, or thrown into fresh combinations.

In the history of education, the most (13) phenomenon is that schools of learning, which at one epoch are alive with a craze for genius, in a (14) generation exhibit merely pedantry and routine. The reason is that they are overlade with inert ideas. Except at (15) intervals of intellectual motivation, education in the past has been radically (16) with inert ideas. That is the reason why (17) clever women, who have seen much of the world, are in middle life so much the most cultured part of the community. They have been saved from this horrible (18) of inert ideas. Every intellectual revolution which has ever stirred humanity (19) greatness has been a (20) protest against inert ideas.

14()

A.succeeding

B.preceding

C.accompanying

D.emerging