患者男，57岁。大便性状改变伴便血，进行性消瘦1年余。查体：胸膝位直肠、肛门指检，距离肛缘4cm扪及占据肠壁一周的包块，质硬，中央凹陷，边缘隆起，尚有一定活动度。终止检查指套带有血迹。
首先要考虑的诊断是
A．血栓性内痔
B．直肠癌
C．直肠腺瘤
D．克罗恩病
E．肛管癌
参考答案：B
解析： 直肠癌早期病变仅限于黏膜，无明显症状。后期症状有：①直肠刺激症状：排便不适，便不尽感，肛门下坠感，腹泻，里急后重；②癌肿破溃感染症状：大便表面带血，严重时出现脓血便，大便次数增多；③肠壁狭窄症状：开始时大便变形、变细，后期可有腹胀、腹痛、大便困难等癌肿造成的梗阻症状。全身症状可有尿频、尿痛、肝大、腹水、黄疸、贫血、消瘦、水肿等恶病质表现。该患者符合直肠癌的典型临床特征。故答案应选B。
| 阅读下面短文，根据短文内容，从短文后的选项中选出适当的选项补全短文。选项中一项为多余选项。 | ||
"Don't worry," his father said to him. "If you have enough patience, you'll find it one day." "I hope so," Victor said. Victor also liked writing. He had a penfriend in France. 63 Victor's pen-friend, Phillip,usually used new stamps to send letters. Sometimes, his mother gave him stamps to use. Once Phillip's mother gave him a big, green stamp. It looked old. When Victor received the letter, he was very surprised. On the envelope, he looked carefully at the stamp. 64 Victor was so happy. He told his sister, his mother and his father. "You see," his father said. "You did find your stamp. So, it's good to have two things in life." "What are they?" Victor asked. "Friends and patience," he answered. | ||
| A. They wrote to each other every month. B. But nobody could find the stamp. C. It was the 1974 special edition stamp. D. His mother helped him to collect stamps. E. He had almost every stamp from 1954 to 2004. |
