问题 单项选择题 案例分析题

女,24岁,近日发现左膝关节疼痛,行走困难,休息缓解,自觉左小腿上内似有肿块,压痛。查体:左膝关节活动稍受限,胫骨上端内侧肿胀,压痛。X线摄片所见左胫骨上端内侧有一肥皂泡样阴影,膨胀性生长

本例最可能的诊断是()

A.骨结核

B.骨髓炎

C.骨坏死

D.骨巨细胞瘤

E.骨软骨瘤

答案

参考答案:D

解析:

1.骨巨细胞瘤病程较长,瘤体较大,可有局部肿胀,生长较快则引起疼痛,侵及关节软骨将影响关节活动;部分患者至合并病理骨折进一步检查始被发现。典型X线征呈肥皂泡样阴影,瘤灶偏中心位,逐渐向周围膨胀,可破坏整个干骺端,骨密质变薄,有时不完整。

2.首次手术必须彻底。切除瘤体后,酌情以碎骨充填、大块植骨或带血管骨移植修补骨缺损,必要时作人工关节置换。当无法局部切除时,才作瘤灶刮除植骨,要求刮至完全正常的骨壁,否则易复发。继以液氮冷冻或50%氯化锌液涂布骨腔灭活,再填充自体松质骨。对多次刮骨后仍复发或已恶变者,应截肢或行瘤段切除。

阅读理解

Believing overweight among school children is the result of bake sales, the Education Department of New York declared that bake sales will be banned all through the states, as a part of their new “wellness”policy.

The ban gives a harder time to schools tying to earn money,because of budget difficulties. Bake sales have proven to be highly profitable toward schools with young people because the start-up costs are very small. Allie,a Roslyn High School freshman , agrees that bake sales are needed for school supplies.“l think it’s wrong for schools to ban bake sales because a lot of schools need the money to be raised. Our school could really use the money for new uniforms.”Allie also commented on the bake sales apparent cause of child overweight. “I feel that it is the student’s choice to eat the baked goods. lf they want it, let them have it.”Jessica,another Roslyn High School freshman, had a different opinion.“I feel that children can not always stay away from items such as cupcakes. It might be better if the amount of bake sales were limited, and only allowed students to buy one item.”

New York Education advisors are having trouble coming up with substitute product for students to sell. A plan of advertising healthier foods has come into play. However the department needs to consider if students will go for items like vegetables. Allie and Jessica don’t think so.“Students might not like the healthier foods. This way, the schools are gaining less money.”Allie shares. Another plan to think about is the idea of not selling food products altogether. Alternate programs are being conducted throughout New York schools,such as walk-a-thons, as a healthy way for students to earn money for their schools.

小题1:The new “wellness”policy is declared in order to_______.

A.help schools out of budget difficulties

B.reduce child overweight caused by bake food

C.help students save money spent on food

D.reduce the price of bake food sold in schools小题2:Which of the following statement about Allie is true? 

A.He is rich in experience about the bake sales at schoo1.

B.He agrees to carry out the bake sales ban at schools.

C.He attaches great importance to the school's income.

D.He attaches too much importance to students' health.小题3:According to Jessica, the cupcakes____________

A.Don't belong to the bake sales

B.Should't be banned at school

C.Mustn't be sold at schools

D.can be fully replaced by vegetables小题4:Which is both healthy and profitable way for schools to earn money?

A.The bake sales.

B.The vegetables sales

C.The walk-a-thons.

D.The food product sales.小题5:We can infer from the passage that schools in New York always______.

A.sell baked food to students

B.free students to choose food

C.find ways to earn money

D.offer chances to earn money

单项选择题