问题 单项选择题 A1型题

善治忿怒忧郁之心神不宁证的是()

A.远志

B.首乌藤

C.琥珀

D.酸枣仁

E.合欢皮

答案

参考答案:E

单项选择题 案例分析题

患者女,41岁。容貌变丑10年,发现血压升高5年,血糖升高1年。10年前患者逐渐出现嘴唇变厚、鼻变大,嗓音粗,口齿不清。此后患者手脚逐渐变大,鞋号逐渐由37号增大至40号,手指变粗,伴多汗。夜间打鼾严重,曾出现过憋醒。5年前无诱因出现头痛,为双颞侧胀痛,测血压为150/90mmHg,诊为“高血压”,未规律用药。1年前体检时发现空腹血糖升高,最高达8.28mmol/L,餐后血糖14.36mmol/L。患者无明显口干、多饮、多尿,体重尚稳定。否认剧烈头痛伴恶心、呕吐史。否认怕冷、水肿、便秘。既往史(-)。个人婚育史:13岁初潮,7天/30天,33岁后月经紊乱,3~6个月来一次,G1P1。家族史(-)。PE:BP140/105mmHg,口齿不清,声音稍低沉。皮肤粗糙,潮湿,鼻翼肥厚增宽,眉弓高,下颌突出,齿裂宽,手足增宽增厚。甲状腺Ⅱ度肿大,右叶上极和左叶下极可触及1cm左右结节,质中,随吞咽活动。心界略大,肺、腹部查体无阳性体征。LAB:ACTH32.4pg/ml,24小时UFC52.2μg/24h,E20pmol/L,FSH2.0mIU/ml,LH1.34mIU/ml;PRL4.87ng/ml;IGF-1994ng/ml。

(提示该患者空腹生长激素19.4ng/ml,糖化血红蛋白8.7%,甲功:FT33.15pg/ml,FT41.59ng/dl,TSH1.901μIU/ml;视力检查提示:双颞侧偏盲,生长激素葡萄糖抑制试验结果如下:)

鞍区MRI如下图。

该患者最可能的主要诊断是()

A.肢端肥大症

B.糖尿病

C.甲状腺结节

D.睡眠呼吸暂停综合征

E.高血压

F.甲状腺功能减退

单项选择题

Questions 11~15
It’s estimated that every year 100,000 children aged 16 and under run away from home. The London Refuge, an unremarkable house on an unremarkable street, is the only place in Britain that will give them a bed. Last year it gave sanctuary to 238 children of whom the youngest was 11. What happened to the other 99,762 Nobody knows, although it’s a fair bet that some of them ended up on the streets, that some fell into inappropriate and dangerous company, that some didn’t survive. "The mere fact that they’re running away puts them at risk," says Lorna Simpson, the refuge’s deputy manager. "On the streets they’ 11 mix with other young people. They’ re so naive; they don’t understand that people who are nice to them will want payback. Our job is to make them safe. "
Simpson, a former social worker, is a calm woman of great warmth. The refuge has six beds and has been open since 1993, often with the threat of closure hanging over it. The problem has nothing to do with the quality of its service and everything to do with funding. A week’s placement costs £2. 278 and three successive governments have argued that the annual running costs of £720. 000 should be locally funded. But because it is used by children from many parts of London, and beyond, local authorities are reluctant to contribute.
The Government has now agreed to work on a strategy to support runaway children in England and Wales, which is rich after its withdrawal of funding from the refuge in December. Since then the NSPCC, National Society for the Prevention of Cruelty to Children, which runs the refuge in conjunction with St Christopher’s Fellowship, has financed it through a donation from an individual, but that money will last only until late next year. "Without this facility there’s nothing; children who run away are on the street," says Nasima Patel, the assistant director of the NSPCC. "One of the strengths of the refuge is that children who have left home can ring up directly and will get a bed and supportive staff without having to go through a process of assessment".
The refuge accommodates six children plus staff. Many of the admissions are at night and children can stay up to 21 days in three months, although most stay for three to five days. They find it through social services, through ChildLine and through word of mouth.
"Children run away from everything you can think of," Simpson says. "Arguments with step-parents, sexual abuse, alcoholic parents, being left to bring up their younger siblings, neglected children who have been failed by social services, girls who have been trafficked. We get doctors’ and lawyers’ children who run away because they want more pocket money, or want to stay out later than their parents allow. They’ve been given everything, they get to 15 and no one thinks to pull the reins in. By that time it’s too late; they rebel. "
Most of the children are from families known to social services, and for them the refuge’s ordered regimen is a welcome contrast to the chaos they know. Staff listen without judging and without encouraging dependency, trying to establish why the children have run away. The aim is to get them home or into the care of social services and, after discharge from the refuge, a family support worker is available.

What is Lorne Simpson’s concern about runaway children ______

A. They don’t understand people who are nice to them.
B. They have no direct access to the London Refuge.
C. They will distance themselves from their parents.
D. They will keep company with undesirables.