问题 单项选择题 A1/A2型题

9个月婴儿,3天来无诱因出现呕吐、烦闹,2天来高热,伴发作性抽搐4次,进食少。查体:T39.2℃,囟门张力高,颈部有抵抗,双肺呼吸音粗,肝肋下4.5cm,脾肋下1.5cm。末梢血WBC17.6×109/L,中性粒细胞80%,淋巴细胞20%,CRP100mg/L。针对该患儿的用药处理,正确的是()

A.广谱抗生素

B.选择透过血-脑脊液屏障的抗生素

C.选择第三代头孢菌素

D.等待血培养结果应用抗生素

E.广谱抗生素联合使用万古霉素

答案

参考答案:C

解析:本例9个月患儿,高热、末梢血WBC17.6×10/L、中性粒细胞80%、CRP100mg/L表明有细菌感染。无诱因出现呕吐、烦闹,查体:囟门张力高,颈部有抵抗,该患儿已有颅高压。再结合患儿伴发抽搐、肝脾肿大高度怀疑化脓性脑膜炎。本病的治疗,病原菌明确前的抗生素选择:应选用对肺炎链球菌、脑膜炎球菌和流感嗜血杆菌三种常见致病菌皆有效的抗生素。目前主要选择能快速在患者脑脊液中达到有效灭菌浓度的第三代头孢菌素,包括头孢噻肟或头孢曲松,疗效不理想时可联合使用万古霉素。对β内酰胺类药物过敏的患儿可改用氯霉素(但使用的时候注意氯霉素对造血系统的抑制等副作用。本例患儿在未明确致病菌的情况下应首选三代头孢菌素进行治疗。②明确化脓性脑膜炎的诊断,无疑对于该病的致病菌为细菌。

完形填空
When I was about 12 years old, I really wanted a new bike! I __36__ my parents my birthday wish,but I knew there was little hope because my family could __37__ have that money.
On my birthday my parents told me they had my __38__ outside in the back yard. At once I __39__ out to the yard. There was my bike, __40__ it wasn’t the bike that I thought it would be. This one was pink, old and worn with age. It was so __41__! I thought I __42__ my parents’ feelings because I could see the disappointment __43__ their faces and I was sure they could see it on mine. I __44__ the old bike and rode it, feeling __45__ that I had made my parents feel this way. So I put on a smile, rode as fast as I could and didn’t __46__.
As time went by, I began to understand my parents gave me __47__ much more than just a rusty(生锈的)old bike. They gave me a life lesson about __48__. When you give something out of love, it doesn’t matter what it is in fact. What matters is the love that is in it. I like to remember this __49__ because giving a gift is not about money. It’s about how much love you can feel from it. Do remember, a gift that __50__ two dollars isn’t any less valuable(有价值的)than one that costs one hundred dollars, or even more.
小题1:
A.talkedB.spokeC.saidD.told
小题2:
A.hardlyB.quicklyC.slowlyD.easily
小题3:
A.guitarB.giftC.cakeD.card
小题4:
A.rushedB.rodeC.climbedD.came
小题5:
A.andB.orC.butD.because
小题6:
A.excitingB.interestingC.relaxingD.disappointing
小题7:
A.likedB.hatedC.hurtD.thanked
小题8:
A.onB.inC.atD.for
小题9:
A.got inB.got onC.got offD.got up
小题10:
A.surprisedB.excitedC.happyD.bad
小题11:
A.look ahead B.look backC.come upD.come down
小题12:
A.anythingB.nothingC.somethingD.everything
小题13:
A.loveB.moneyC.friendship D.knowledge
小题14:
A.ideaB.newsC.adviceD.story
小题15:
A.spendsB.costsC.paysD.offers
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