问题 多项选择题

[案例二十三]


女性,48岁。因“与人吵架后斜颈、咀嚼动作增多、脾气大、烦躁半年余”求治。患者半年前与人吵架后怄气,随即出现斜颈,咀嚼动作增多,感到脚底冒冷气,容易疲劳,躺在床上休息时,不能很轻松入睡。食欲明显减退,焦躁不安,常因小事发脾气,事后又非常后悔。由于反复发作,患者极为痛苦。经营一家水果店,生意基本未受影响,家庭支持好。家族史:两系三代无精神病史。性格:内向,不善言谈。

要确诊患者疾病性质,你认为以下哪些选项要优先考虑

A.追问既往史,既往是否有躯体疾病等,

B.立刻注射肉毒杆菌治疗

C.头颅MRI、胸部平片、心电图

D.向家属交代病情,防自杀行为

E.立刻住封闭式病房治疗

F.详细体格检查

G.立刻给予左旋多巴治疗

答案

参考答案:A,C,F

解析: 该患者临床表现斜颈,咀嚼动作增多等症状,应首先考虑中枢神经系统器质性病变,可以通过询问病史、细致的神经系统体格检查及头颅MRI扫描等辅助检查,综合结果予以诊断。对于该患者而言,首先要进一步询问既往病史,做体格检查(包括神经系统检查)及必要的辅助检查如头颅:MRI。在排除器质性病变后,则根据患者起病有一定心因,病情反复发作及症状性质,社会功能基本不受影响等特点,考虑诊断为“功能性”疾病。在确诊为锥体外系疾病之前,不应首先考虑给予左旋多巴治疗。在未确诊是肌肉挛缩之前,不应注射肉毒杆菌。

完形填空

阅读下面短文并回答问题, 然后将答案写到答题卡相应的位置上(请注意问题后的字数要求)。

When my friends went to college in great delight, I restarted my senior high school life.My spirit sank.Surrounded by strange classmates, I felt like I was in a maze and was sorry about myself.There were some complex feelings in my minds.I was frightened, nervous and lonely.

To make matters worse, I recalled my failure again and again, which put more pressure on me than I could bear.As a result, I was always feeling down during class time.

My teacher found me spiritless.One day he asked me to come to his office and told me about his attitude towards life: we might suffer from mistakes, but it’s important to learn lessons from them.All the pains and the embarrassing things we experience are part of the process.So keep up your spirit! At last, he added, “If you are optimistic, things you want may happen to you!”

Warmth rushed through my soul.I suddenly found the sun shining again when I stepped out of his office.

With the teacher’s help, I eventually got over my depression.From then on, I no longer bowed my head and began smiling to my classmates.I would put up my hand confidently in class and play with my new friends in my spare time.Meanwhile, I was gradually embraced by my classmates.

Now faced with fierce competition, we all study hard because we know that every second counts.Moreover, there is an atmosphere of mutual trust and respect between us.I love my class; I love my classmates!

To be frank, I still have a thirst for my dream university, but I’m not afraid of failure because I can profit by it.With parents and teachers’ encouragement, I’m quite certain of my success and I’m sure I can fly high.

小题1: Why was the writer in low spirits at the beginning? (No more than 10 words)

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小题2: What did the teacher expect the writer to do? (No more than 10 words)

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小题3: What is the main idea of Paragraph 5? (No more than 15 words)

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小题4: The underlined word “embraced” in paragraph 5 means ______.(No more than 5 words)

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小题5: What does the writer think of failure now? (No more than 10 words)

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多项选择题