问题 单项选择题 A3/A4型题

患者女,60岁。反复咳嗽、咳痰25年,心悸、气促、下肢间歇性水肿3年,病情加重伴畏寒、发热1周入院。体检:T38℃,呼吸急促,口唇发绀,双肺叩诊过清音,中下肺有湿啰音,心率110次/分,心律齐,无杂音,双下肢重度水肿。

该病例最适当的诊断应为()

A.慢性支气管炎(慢支)

B.慢支+肺气肿

C.慢支+肺气肿+心肌病

D.慢性阻塞性肺疾病

E.慢支+肺气肿+肺源性心脏病

答案

参考答案:E

解析:根据题干,该患者"反复咳嗽、咳痰25年"符合慢性支气管炎的表现,"心悸、气促、下肢间歇性水肿3年"说明已存在右心衰竭,故诊断为肺源性心脏病;又"双肺叩诊过清音"说明存在肺气肿,所以本题诊断为慢支+肺气肿+肺源性心脏病,故选E。

选择题
单项选择题

The earliest evidence of standardized testing based on merit comes from China during the Han dynasty. The concept of a state ruled by men of ability and virtue was an outgrowth of Confucian philosophy. Standardized testing has not traditionally been a part of European pedagogy. Based on the skeptical and open-ended tradition of debate inherited from Ancient Greece, Western academia favored the essay. The use of standardized testing in the United States is a 20th century phenomenon with its origins in World War I.

One of the main advantages of standardized testing is that the results can be empirically documented ; therefore the test scores can be shown to have a relative degree of validity and reliability, as well as results which are generalizable and replicable. This is often contrasted with grades on a school transcript, which are assigned by individual teachers. Another advantage is aggregation. A well designed standardized test provides an assessment of an individual’s mastery of a domain of knowledge or skill which at some level of aggregation will provide useful information.

Though many educators recognize that standardized tests have a place in tools used to assess student achievement, critics feel that overuse and misuse of these tests is having serious negative consequences on teaching and learning. The temptation is to use the tests to define curriculum and focus instruction. What is not tested is not taught, and how the subject is tested becomes a model for how to teach the subject. Moreover, standardized test scores are problematic tools for school accountability because the examinee scores are influenced by three things: what kids learn in school, what kids learn outside of school, and innate intelligence. Critics believe this is not possible. While it is possible to use a standardized test and not let its limits control curriculum and instruction, this can result in a school putting itself at risk for producing lower test scores, with negative political consequences.

Some critics say that some children do not do well on standardized tests, despite mastery of the material, due to testing anxiety or lack of time management or test-taking skills. This reflects the fact that tests cannot directly measure student knowledge, only the ability of students to apply knowledge in a stressful situation.

Some parents are willing to pay thousands of dollars to prepare their children for tests, a financial barrier that may give children of more wealthy parents an advantage compared to less affluent families. However this criticism would probably apply even more to testing alternatives such as portfolios or essays. Many studies also show that test coaching has little effect on scores on well-buih tests. The ability of wealthy families to pay for higher-quality education is not specifically related to standardized testing.

Which one of the following factors influencing test scores is NOT criticized by some critics()

A. A good job in mastering what is tested

B. The feeling of anxiety during tests

C. Failure to have a good time arrangement

D. Skills to get a high score in tests