问题 多项选择题 案例分析题

男性,50岁,左膝髌骨骨折内固定术后,卧床第10天活动后突发胸闷气短,伴有胸痛,出冷汗。查体:血压80/60mmHg,呼吸25次/分,心率100次/分,P2>A2,心电图示SⅠQⅢTⅢ、V1~V3T波倒置,动脉血气分析示低氧血症。

根据上述临床表现需完善下列哪些检查()

A.超声心动图

B.肝功能

C.冠状动脉造影

D.血清离子

E.血浆D-二聚体

F.下肢深静脉超声

G.肺功能

答案

参考答案:A, E, F

解析:

1.根据患者临床症状、体征及外伤史,初步考虑为肺栓塞,疑诊患者需完善血浆D-二聚体,动脉血气,心电图,心脏彩超,下肢静脉超声等。2.CTPA能够发现段以上肺动脉内的血栓,通气灌注扫描对亚段以下的肺栓塞有独到的诊断价值,磁共振成像避免了碘造影剂过敏的影响,对段以上的肺动脉栓子的特异性和敏感性均较高,肺动脉造影是所有检查中敏感性和特异性最高的,但其为有创检查,应注意掌握适应证。3.仅约20%的患者表现为三联征,心电图的表现为非特异性的,血浆D-二聚体的敏感性较高,特异性较低。4.根据患者的临床表现及检查,考虑为右心房血栓脱落,导致急性肺动脉血栓栓塞症,该患者以休克为主要表现,属于大面积高危患者,有溶栓适应证,无活动性出血和近期颅内出血的绝对禁忌证,可溶栓治疗。抗凝治疗为肺栓塞的基本治疗方法,吸氧可纠正低氧血症。腔静脉滤器为防止下肢深静脉大块血栓再次脱落阻塞肺动脉,该患者下肢未见血栓。5.活动性出血和近期颅内出血为绝对禁忌证,近期手术、外伤等为相对禁忌证。6.溶栓治疗主要适用于大面积肺栓塞病例,对于次大面积病例,若无禁忌证可考虑溶栓,对于血压和右心室功能正常的病例不适合溶栓,溶栓的时间窗为14天,溶栓并发颅内出血,死亡率高达50%,抗血小板药物的抗凝作用不能满足肺栓塞的抗凝要求,应用普通肝素治疗应监测APTT,低分子肝素不需要监测凝血功能。

单项选择题
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D

School kids show talents for charity

Youngsters at Fulwood High School and Arts College in Preston will show their talents to raise money for sick children. It is putting on a wonderful show on Thursday November to support Derian House Children’s Hospice(安养院)near Chorley.

Pupils are planning a night to remember, with a wide range of acts from singers and dancers to a magician. Local band Vox Population, fronted by former pupil Laurence Holt, will be playing following their recent tour of Germany. The best part of the night will be a surprise act by a group of teachers.

Tickets are available from the school priced £1.50 for pupils and £2 for adults. The show starts at 7 pm.

Grants(补助金)aim to boost recycling

Children and community groups across Lancashire have been given help to recycle more. More than 40 schools, organizations and community groups have received Waste Action Grants.

Brinscall Primary School in Chorley has been awarded 500 pounds to provide money for its Infant Fruit Waste project. The money has been used to buy a Roly Pig composter that will turn fruit waste into compost(堆肥).

Carole Lormer, from the school, said, “The children completely love the Roly Pigs. They have been feeding and turning them every day, using leftover fruit.”

For information visit www.globalrenewables.co.uk/wasteactiongrants or call 01172 642885.

Ready when you are

If you’re looking to bag that dream job, your basic maths and English skills need to be good. If you think your basic skills are a little out of practice, try taking Learnerdirect’s “Ready When You Are” challenge.

Hosted by Eamonn Holmes and Johnny Ball, it’s a fun and interactive quiz based on real life situations, which aims to help you decide where you might need to brush up on your basic skills. Log onto: www.learndirect.co.uk/ready

Good luck!

68.What information can we get from the first advertisement?

A. Laurence Holt is the main singer in the band.

B. Teachers will be surprised at the performance.

C. The show is held to celebrate students’ graduation.

D. Parents are expected to offer £2 to each pupil.

69.   How do the students in Brinscall Primary School recycle?

A. They feed pigs on the leftover fruit.

B. They turn waste fruit into fertilizer with a machine.

C. They awarded £500 to those who waste least at school.

D. They raised £500 for the Infant Fruit Waste project.

70.   “Ready when you are” is an advertisement for ________.

A. a good job.                 B. a skill learning course

C. an interactive quiz              D. an interesting website