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问题 多项选择题

[案例四]患者李××，女，21岁，农民。因“停经27+5周，胸闷憋气7天”入院。自诉自幼体弱，不能从事体力劳动。20岁结婚，G1P0A0L0，既往月经规律，现停经27+5周，胸闷憋气7天，夜间不能平卧。伴咳痰，为稀薄白色痰。查体：T：37℃；P：122次/分；R：23次/分；BP：125/76mmHg。口唇、甲床发绀，杵状指。心脏听诊：心律规整，心音低钝，胸骨左缘第3、4肋间闻及3/6级喷射性收缩期杂音。肺底部可闻及少量持续性湿啰音，咳嗽后不消失。腹部膨隆，宫高20cm，LOA，FHR：162bpm。水肿(++)。辅助检查：血常规：WBC8.5×109/L，N74％，HGB104g/L，Plt：148×109/L。尿常规、肝肾功能及血液生化、凝血功能、病毒七项大致正常。

该患者经积极内科处理后心力衰竭不能纠正。为减轻心脏负担，决定在严密监护下手术终止妊娠。术中出现宫缩欠佳，出血约600ml。此时以下处理措施正确的为哪些

A．给予缩宫素加强宫缩

B．给予麦角新碱加强宫缩

C．快速加压输注晶体液

D．快速输注红细胞及血浆

E．结扎子宫动脉上行支

F．结扎髂内动脉

G．结扎髂外动脉

H．经积极处理后宫缩好转，出血减少。此时探查发现肌壁问子宫肌瘤一枚，一并行子宫肌瘤切除术

I．经积极处理后宫缩好转，出血减少。此时探查发现右侧卵巢囊腺瘤，一并行卵巢肿瘤剥除术

J．经积极处理后宫缩好转，出血减少。此时探查发现阑尾慢性炎性改变，一并行阑尾切除术

答案

参考答案：A,E,F

解析：妊娠合并心脏病患者产后出血，可以应用缩宫素加强宫缩。麦角新碱是心脏病的禁忌，选择A。输注晶体液及成分输血时应注意限制速度。可以选择子宫动脉上行支、髂内动脉结扎以及试行B-lynch缝合，Cho缝合。无效时可行子宫切除术，选择E、F。手术原则应该是损伤最小、时间最短，不适合同时进行不必要的操作。

选择题
—Do you like your parents, Maria?
—Of course. Though they love me a lot, they are _______ me.

A. worried about
B. interested in
C. good for
D. strict with
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阅读理解
阅读理解。
         The Darwin Myth: The Life and Lies of Charles Darwin
                                  By Benjamin Wiker
List Price: $ 27.95
Price:$ 18.45 for a club member or when your orders are over $50
You Save: $9.50 (34%)
Product Description
      In the 150 years since the publication of Origin of Species, Charles Darwin has been considered between
two extremes-a great biologist or heretic (持异端学说者). However, the truth is much more difficult to
understand than that. In any case, Darwin's theory of evolution and natural selection had the greatest influence
in history.
      In The Darwin Myth, author Benjamin Wiker offers a full-side analysis of Darwin's theories as well as the
social, scientific, and religious effect of his work. Scientists often cause debates (争论) that will last for
generations for their new theory. Still, no scientist has caused more debates than Charles Darwin. To some
he is the revolutionary "father" of evolution. To others his theory of evolution unconsciously disagrees with
many ideas in modern eugenics. (优生学) In The Darwin Myth: The Life and Lies of Charles Darwin, author
Benjamin Wiker will make them clear.
Contents
      So who is Charles Darwin? What did he really believe and what did his research really prove? In this book,
Benjamin Wiker cuts through the myths. In The Darwin Myth, Wiker tells us:
★How Darwin set out to create a godless Theory of Evolution;
★Why many of his best friends criticized Darwin's theory, and why he never defended himself;
★Why Darwin's theory in a certain way supported slavery, an institution he hated;
★How much of what we know about Darwin comes from his autobiography (自传), which the key points
    are completely misleading.
1. If you buy three copies of The Darwin Myth at a time, how much should you pay?
[ ]
A. $88.35
B. $55.35
C. $50
D. $27.97
2. According to the passage, what is The Darwin Myth mainly about?
[ ]
A. An analysis of Darwin's theory and the debates about him.
B. A brief introduction to Darwin's life.
C. How Darwin created Theory of Evolution.
D. Why many people criticized Darwin's Theory of Evolution.
3. From the passage, we know that _____.
[ ]
A. The Darwin Myth is Darwin's autobiography
B. The debate about Darwin's theory has been going on since Origin of Species was published
C. Darwin theory agrees with modern eugenics
D. Darwin himself supported slavery
4. We can infer from the passage that _____.
[ ]
A. Darwin lost many of his best friends because of his theory
B. Darwin's autobiography has misled many readers
C. Benjamin Wiker was one of Darwin's friends who knew him well
D. The Darwin Myth will end the debates about Darwin
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