问题 单项选择题 案例分析题

男性,33岁。近5年来反复出现上腹部疼痛,尤以饱餐后明显。今日突然出现右上腹剧痛,5小时后来院就诊。检查:T37.3℃,P100次/分,R16次/分,BPl20/80mmHg。腹平,腹式呼吸消失。全腹压痛、反跳痛,腹肌紧张明显。肝浊音界未叩出。肠鸣音弱。

对诊断最有价值的首选检查是()

A.腹部B超

B.上消化道造影

C.肛门指诊

D.腹部X线平片

E.胃镜检查

F.腹部CT

答案

参考答案:D

解析:1.立位腹部X线平片提示膈下游离气体。血常规:白细胞15.2×10/L,N90%。2.饱食后上腹痛,符合胃溃疡,急性穿孔后呈剧烈腹痛,板状腹。3.术中探查发现溃疡直径2.5cm,质硬,其中部穿孔直径0.6cm。患者一般情况允许,穿孔时间短,最恰当的治疗是行胃大部切除术。高选择性迷走神经切断术不适合胃溃疡的治疗。4.患者术后第5天,出现上腹膨胀感和呕吐,呕吐物含大量胆汁。5.毕Ⅱ式手术后,输入、输出袢通畅,胆汁可进出。输出袢可由于粘连、炎症、水肿、痉挛等原因引起梗阻,临床特点是呕吐物含大量胆汁。6.患者术后10天出现发热,体温波动于38~40℃,无其他伴随症状。除因手术操作使吻合口过小需再次手术外,一般经保守治疗均可缓解。症状的恢复期短则2~3周,长者需4~6周。7.患者术后发热应首先考虑感染,包括腹腔积液、肺部感染和伤口感染等。

单项选择题

In bringing up children, every parent watches eagerly the child’s acquisition of each new skill—the first spoken words, the first independent steps, or the beginning of reading and writing. It is often tempting to hurry the child beyond his natural learning rate, but this can setup dangerous feelings of failure and states of worry in the child. This might happen at any stage. A baby might be forced to use a toilet too early; a young child might be encouraged to learn to read before he knows the meaning of the words he reads. On the other hand, though, if a child is left alone too much, or without any learning opportunities, he loses his natural enthusiasm for life and his desire to find out new things for himself.

Parents vary greatly in their degree of strictness towards their children. Some may be especially strict in money matters. Others are strict over times of coming home at night or punctuality tot meals. In general, the controls imposed represent the needs of the parents and the values of the community as much as the child’s own happiness.

As regards the development of moral standards in the growing child, consistency is very important in parental teaching. To forbid a thing one day and excuse it the next is no foundation for morality. Also, parents should realize that "example is better than precept". If they are not sincere and do not practise what they preach, their children may grow confused, and emotionally insecure when they grow old enough to think for themselves, and realize they have been to some extent fooled.

A sudden awareness of a marked difference between their parents’ principles and their morals can be a dangerous disappointment.

The second paragraph mainly tells us that ().

A.parents should be strict with their children

B.parental controls reflect only the needs of the parents and the values of the community

C.parental restrictions vary, and are not always enforced for the benefit of the children alone

D.parents vary in their strictness towards their children according to the situation

填空题