问题 问答题 案例分析题

病历摘要男性,56岁。头晕、头痛15年,突发视物模糊2小时。15年前患者出现头晕、头痛,活动或情绪激动时明显,当时在卫生所测血压较高(具体值不详),诊断"高血压病"。曾不规律服用"降压0号",血压波动于140~190/90~11OmmHg。平时日常活动不受限制。2小时前受噩耗刺激后突发头痛、眩晕、视物模糊,呕吐胃内容物多次。患病以来情绪烦躁,无胸痛及肢体活动障碍,大小便正常。既往史:有高胆固醇血症10年,吸烟30年,20~60支/日。母亲患有高血压病。查体:T36.4℃,P98次/分,R20次/分,BP220/130mmHg,神志清楚,双眼睑无水肿,口唇无发绀,伸舌居中。颈静脉无怒张,甲状腺无肿大。双肺呼吸音粗,未闻及干、湿性啰音。心界不大,心率98次/分,律齐,心尖部可闻及3/6级收缩期杂音,无心包摩擦音。腹平软,无压痛、反跳痛,肝脾肋下未触及,未闻及血管杂音,肠鸣音4次/分,无下肢水肿,双侧足背动脉搏动可触及。辅助检查:血生化TG0.96mmo/L,LDL-C4.63mmol/L,K+4.46mmo/L,Na+140.1mmol/L。血管超声示:左颈总动脉轻度硬化伴斑块形成。

答案

参考答案:

初步诊断及诊断依据

初步诊断:1.高血压病3级(极高危)2.高血压危象3.心功能Ⅰ级4.高胆固醇血症

诊断依据:1.有诱因和危险因素:如活动、情绪激动,有30年吸烟史(20~30支/日)、高胆固醇血症及高血压病家族史。2.突发头痛、眩晕、视物模糊及呕吐。3.平时日常活动不受限制;血压220/130mmHg,心尖部可闻及3/6级收缩期杂音。4.血管超声示左颈总动脉斑块形成。LDL-C升高。

鉴别诊断1.脑血管疾病2.嗜铬细胞瘤3.心脏瓣膜病4.冠心病

进一步检查:1.头颅CT。2.血、尿儿茶酚胺或其他代谢物3-甲氧基-4-羟基苦杏仁酸(VMA.及肾上腺CT。3.超声心动图。4.动态观察心动图、心肌坏死标记物。5.血电解质及眼底检查。

治疗原则:1.迅速降低血压:采用静脉途径给药。2.控制性降压:降血压逐步降到正常水平。3.合理选择降压药。4.避免使用的药物:如利舍平(利血平)、强力的利尿药。5.低盐、低脂饮食。

选择题
阅读理解

阅读理解

     I don't know how I became a writer, but I think it was because of a certain force in me that had to

write and that finally burst through and found a channel.My people were of the working class of people.

My father, a stonecutter, was a man with a great respect and veneration (崇敬) for literature.He had a

tremendous memory, and he loved poetry, and the poetry that he loved best was naturally of the

rhetorical kind that such a man would like.Nevertheless it was good poetry, Hamlet's Soliloquy,

Macbeth, Mark Antony's "Funeral Oration", Grey's "Elegy", and all the rest of it.I heard it all as a child;

I memorized and learned it all.

     He sent me to college to the state university.The desire to write, which had been strong during all my

days in high school, grew stronger still.I was editor of the college paper, the college magazine, etc., and

in my last year or two I was a member of a course in play writing which had just been established there.

I wrote several little oneact plays, still thinking I would become a lawyer or a newspaper man, never

daring to believe I could seriously become a writer.Then I went to Harvard, wrote some more plays

there, became obsessed with (着迷于) the idea that I had to be a playwright, left Harvard, had my plays

rejected, and finally in the autumn of 1926, how, why, or in what manner I have never exactly been able

to determine.But probably because the force in me that had to write at length sought out its channel, I

began to write my first book in London.I was living all alone at that time.I had two rooms-a bedroom

and a sitting room-in a litter square in Chelsea in which all the houses had that familiar, smoked brick and

creamyellowplaster look.

1. We may conclude, in regard to the author's development as a writer, that his father________.

A. made an important contribution

B. insisted that he choose writing as a career

C. opposed his becoming a writer

D. insisted that he read Hamlet in order to learn how to be a writer

2. The author believes that he became a writer mostly because of________.

A. his special talent

B. his father's teaching and encouragement

C. his study at Harvard

D. a hidden urge within him

3. The author________.

A. began to think of becoming a writer at Harvard

B. had always been successful in his writing career

C. went to Harvard to learn to write plays

D. worked as a newspaper man before becoming a writer

4. The author really started on his way to become a writer______.

A. when he was in high school

B. when he was studying at Harvard

C. when he lived in London

D. after he entered college

5. What can we learn about the author's life in the autumn of 1926?

A. He left Harvard and got married.

B. He couldn't make up his mind what to do.

C. He started his dream as a writer.

D. He began to think seriously what to do.