问题 单项选择题

(91~93题共用题干)
男性,65岁。2个月来反复发作胸骨后疼痛,发作与劳累关系不大,常在半夜或凌晨5时发作。

该患者首选的治疗是

A.硝酸酯类

B.日受体阻滞剂

C.钙拮抗剂

D.抗血小板治疗

答案

参考答案:C

解析:[考点] 变异型心绞痛的诊断和治疗

[分析]: 该老年患者胸骨后疼痛的发作呈定时性,常在半夜或凌晨发作,而劳累运动或情绪激动等心肌耗氧量增加的情况则较少诱发,符合变异型心绞痛;心电图可见符合冠状动脉分布的相关导联的ST段抬高,这是由于正常冠状动脉突然痉挛所致,此型心绞痛患者发生/b肌梗死的危险性较大;变异型心绞痛的发病机制是冠状动脉痉挛,所以首选的治疗是钙拮抗剂,抗血小板治疗也可选用,但不是首选,而β受体阻滞剂和硝酸酷类疗效不佳。

判断题
单项选择题

I came across an old country guide the other day. It listed all the tradesmen in each village in my part of the country, and it was impressive to see the great variety of services which were available on one’s own doorstep in the late Victorian countryside.

Nowadays a superficial traveler in rural England might conclude that the only village tradesmen still flourishing were either selling frozen food to the inhabitants or selling antiques to visitors. Nevertheless, this would really be a false impression. Admittedly there has been a contraction of village commerce, but its vigor is still remarkable.

Our local grocer’s shop, for example, is actually expanding in spite of the competition from supermarkets in the nearest town. Women sensibly prefer to go there and exchange the local news while doing their shopping, instead of queueing up anonymously at a supermarket. And the proprietor knows well that personal service has a substantial cash value.

His Prices may be a bit higher than those in the town, but he will deliver anything at any time. His assistants think nothing of bicycling down the village street in their lunch hour to-take a piece of cheese to an old-age pensioner who sent her order by word of mouth with a friend who happened to be passing. The more affluent customers telephone their shopping lists and the goods are on their doorsteps within an hour. They have only to hint at a fancy for some commodity outside the usual stock and the grocer, a red-faced figure, instantly obtains it for them.

The village gains from this sort of enterprise, of course. But I also find it satisfactory because a village shop offers one of the few ways in which a modest individualist can still get along in the world without attaching himself to the big battalions of industry or commerce.

Most of the village shopkeepers I know, at any rate, are decidedly individualist in their ways. For example, our shoemaker is a formidable figure: a thick-set, irritable man whom children treat with marked respect, knowing that an ill-judged word can provoke an angry eruption at any time. He stares with contempt at the pairs of cheap, mass-produced shoes taken to him for repair: has it come to this, he seems to be saying, that he, a craftsman, should have to waste his skills upon such trash But we all know he will in fact do excellent work upon them. And he makes beautiful shoes for those who can afford such luxury.

The local grocer’s shop is expanding even though () .

A.town shops are more attractive

B.town shops are larger and less well-known

C.people like to shop where they are less well-known

D.people get extra service in townshops