问题 单项选择题 A3型题

患者,27岁,男性,河北省人。突起发热伴头痛、全身疼痛、食欲不振10天,起病第5天出现全身皮疹。体格检查发现体温39.2℃,脉搏120次/分,咽喉充血,除头面部外,全身皮肤有斑丘疹和少量皮下出血点。肝脾肋下未触及。周围血液白细胞数为5.3×109/L,红细胞为4.9×1012/L.血小板为153.7×109/L。当地有类似患者,家里老鼠较多,有被蚤叮咬史。

有助于明确诊断的检查是()

A.血清肥达反应

B.检测血清中抗登革病毒的IgM抗体

C.外斐反应

D.咽拭子培养细菌

E.检测血清中抗流行性出血热病毒的抗体

答案

参考答案:C

解析:

与判断能力。预测错误率不高。常见错误:

①第1题选答"A"或"B",本例起病急,皮疹较多,分布广,无相对缓脉,无白细胞减少,不支持伤寒;患者未到过登革热流行区,周围血液白细胞和血小板均无减少,不支持登革热。应复习伤寒和登革热的临床表现与实验室检查的特点,并与地方性斑疹伤寒鉴别;

②第2题选答"A"或"B",本例临床诊断以地方性斑疹伤寒可能性大,伤寒或登革热可能性小;

③第3题选答"D",罗红霉素对立克次体病有效,应复习地方性斑疹伤寒的病原学治疗内容。要点本例的流行病学、临床表现和实验室检查结果都符合地方性斑疹伤寒的诊断;检测血清外斐反应有助于明确诊断;青霉素对立克次体病无效。

单项选择题
阅读理解

One day Marilla said, “Anne, your new teacher, Miss Stacy, spoke to me yesterday. She says you must study for the examinations for Queen’s College in two years’ time. Then if you do well, you can study at Queen’s in Charlottetown for a year, and after that you’ll be a teacher!”

“That doesn’t matter, Anne. When Matthew and I adopted you three years ago, we decided to look after you as well as we could. Of course we’ll pay for you to study.”So in the afternoons Anne and some of her friends stayed late at school, and Miss Stacy helped them with the special examination work. Diana didn’t want to go to Queen’s, so she went home early, but Gilbert stayed. He and Anne still never spoke and everybody knew that they were enemies, because they both wanted to be first in the examination. Secretly, Anne was sorry that she and Gilbert weren’t friends, but it was too late now.

For two years, Anne studied hard at school. She enjoyed learning, and Miss Stacy was pleased with her. But she didn’t study all the time. In the evenings and at weekends she visited her friends, or walked through the fields with Diana, or sat talking to Matthew.

“Your Anne is a big girl now. She’s taller than you,” Rachel Lynde told Marilla one day.

“You’re right, Rachel!” said Marilla in surprise.

“And she’s a very good girl now, isn’t she? She doesn’t get into trouble these days. I’m sure she helps you a lot with the housework, Marilla.”

“Yes, I don’t know what I’d do without her,” said Marilla, smiling.

“And look at her! Those beautiful grey eyes, and that red-brown hair! You know, Marilla, I thought you and Matthew made a mistake when you adopted her. But now I see I was wrong. You’ve looked after her very well.”

“Well, thank you, Rachel,” replied Marilla, pleased.

That evening, when Matthew came into the kitchen, he saw that his sister was crying.

“What’s the matter?” he asked, surprised. “You haven’t cried since… well, I can’t remember when.”

“It’s just… well, I was thinking about Anne,” said Marilla. “I’ll…I’ll miss her when she goes away.”

“When she goes to Queen’s, you mean? Yes, but she can come home at weekends, on the train.”

“I’ll still miss her,” said Marilla sadly.”

In June the Avonlea boys and girls had to go to Charlottetown to take their examinations.

“Oh, I do hope that I’ve done well,” Anne told Diana when she arrived back at Green Gables. “The examinations were very difficult. And I’ve got to wait for three weeks before I know! Three weeks! I’ll die!”

Anne wanted to do better than Gilbert. But she also wanted to do well for Matthew and Marilla. That was very important to her.

Diana was the first to hear the news, she ran into the kitchen at Green Gables and shouted, “Look, Anne! It’s in Father’s newspaper! You’re first… with Gilbert… out of all the students on the island! Oh, how wonderful!” Anne took the paper with shaking hands, and saw her name, at the top of the list of two hundred. She could not speak.

“Well, now, I knew it,” said Matthew with a warm smile.

“You’ve done well, I must say, Anne,” said Marilla, who was secretly very pleased.

For the next three weeks Anne and Marilla were very busy. Anne needs new dresses to take to Charlottetown.

小题1:Which of the following statements is true?

A.To be a teacher was one of Annes’ dreams.

B.Both Anne and Diana studied hard for the special examination.

C.Matthew and Marilla were Anne’s parents.

D.Anne was adopted by Matthew and Marilla.小题2:Why are Anne and Gilbert enemies? Because _____________.

A.they were competitors in school

B.they didn’t like each other

C.it wasn’t mentioned in the passage

D.their parents were enemies小题3:The paragraph “Oh Marilla! I’d love to be a teacher! But won’t it be very expensive?” should be put between___________.

A.paragraph ③ and ④

B.paragraph ⑦ and ⑧

C.paragraph ① and ②

D.paragraph ⑨ and ⑩小题4:What will be written in the following paragraph?

A.Anne’s summer holiday.

B.What will Anne talk about her college life with Diana

C.How will Miss Stacy help Anne study.

D.What will Anne do before attending college.小题5:From the passage, we can learn that _____________.

A.Miss Stay liked Anne very much

B.when Anne became a teacher, she would have lived in the family for six years

C.Marilla cried because Anne would leave for ever

D.Rachel was a teacher of Anne’s