问题 单项选择题

With 22 years on the job, Jackie Bracey could be considered a career employee of the Internal Revenue Service. But she defies any stereotype of an over-eager agent running down a reluctant taxpayer. Instead, she spends her time defending people who owe the government money. Ms. Bracey, based in Greensboro N. C., is a taxpayer advocate, a created by Congress in 1998 as part of the kinder, gentler theme adopted by the tax collection agency. Bracey and advocates at 73 Other offices nationwide, backed by 2,100 field workers and staff, go to bat for taxpayers who are in financial straits because of something the agency has done or is about to do.

Though it may seem contrary to the IRS, the advocate service not only helps taxpayers, but identifies procedural problems. The main goal, though, is for the ombudsman to step into a dispute a taxpayer is having with the IRS when it appears that something the IRS is doing, or planning, would create an undue hardship on the taxpayer. This can range from speeding up resolution of a dispute that has dragged on too long, to demanding that the IRS halt a collection action that the taxpayer can show he or she “is suffering or is about to suffer a significant hardship.”

Taxpayer ombudsmen have been around in one form or another since 1979, says Nina Olson, the national taxpayer advocate. But they were given much more power in 1998 when Congress decided that the workers would no longer report to regional directors but to her office. While this gave them a great deal more authority, outside watchdogs say more can be done. “There is a long way to go to get an agency that feels independent and emboldened to work for taxpayers”, says Joe Seep, a vice president of the Washington-based tax-advocacy group.

The taxpayers union also has complained that Congress and the Bush administration don’t seem to be taking the advocates seriously enough. Each year, the IRS group reports to Congress on the top problems that advocates see. Many of these are systemic problems that can gum up the works for both taxpayer and collector, such as a December notice from Ms. Olson that the IRS should have just one definition of a dependent child, rather than the three definitions currently used. While taxpayer advocates can help smooth things out in many cases, they cannot ignore laws.

If taxpayers haven’t made legitimate claims for credits, there’s nothing the advocate can do to reverse that course. And Olson says that while taxpayers are free to use her service, they should keep in mind that it does not replace the normal appeals process and should be the last place a citizen calls upon for help, not the first. “We’re really there for .when the processes fall down,” she says. Every state has at least one taxpayer-advocate service office.

The phrase “gum up the works” (Line 3, Para. 4) probably mean()

A.to impair the benefits

B.to bring about solutions

C.to lead to trouble

D. to improve the relations

答案

参考答案:C

解析:

[设题点] 举例处

语义理解题。文章在提到gum up the works之后,举了奥尔森女士的例子。在这个例子当中提到,法律对“未独立的子女”有三个定义,很显然这样会在工作过程中给工作者造成麻烦。所以,本题答案为[C]“造成麻烦”。

单项选择题

患者男,89岁,因“间断咳嗽、咳痰、气喘30年,加重伴发热5d”来诊。患慢性喘息性支气管炎、肺气肿30年,曾多次因咳嗽、咳痰、气喘加重及发热住院。5d前再次发作。查体:T39.4℃,P102次/min,R24次/min,BP160/70mmHg;咽部无充血,双肺满布高调哮鸣音,双下肺未闻及湿性啰音,心界不大,律齐,各瓣膜区无杂音;双下肢无水肿。血常规:WBC16.7×10/L,N0.94;血气分析:pH7.375,PaO74mmHg,PaCO48mmHg,SaO94%;肝、肾功能正常。胸部X线片:双下肺纹理增多,主动脉硬化。初步诊断:慢性喘息性支气管炎急性发作;肺气肿。予吸氧、拍背、雾化吸入,静脉滴注头孢呋辛0.5g,12h1次;静脉滴注氨茶碱注射液0.5g,每日1次;静脉滴注甲泼尼龙注射液80mg,8h1次;静脉推注盐酸氨溴索注射液,每日2次。4d后患者体温恢复正常,咳嗽、咳痰症状减轻,但气喘持续不能缓解;双肺仍满布哮鸣音。3d后患者再次出现发热,体温达38.2℃;胸部CT:右下肺感染。静脉滴注他唑巴坦钠/哌拉西林钠4.5g,8h1次;静脉滴注洛美沙星0.2g,12h1次,静脉滴注甲泼尼龙注射液,剂量调整为120mg,8h1次,同时辅予强心(毛花苷C)、利尿(呋塞米)治疗。2d后体温正常,咳嗽、咳痰、气喘症状均缓解,甲泼尼龙减量1次,停用抗生素。复查胸部CT:右肺上、下叶及左肺下叶多发团片状密度增高影,大小不一,以右下肺明显,大者3.9cm×4.4cm,右上肺病灶内可见小弧形透亮影。

进一步治疗方案是(提示肺泡灌洗液涂片发现有少量真菌菌丝,分叉成45°。患者咳嗽、咳痰加重,痰液为黏液脓痰,仍然为中、低度发热。此前已经加用静脉滴注万古霉素1g,12h1次,用药5d。)()

A.继续原治疗

B.再次加用派拉西林/他唑巴坦

C.停用抗生素,观察

D.加用二性霉素B(去氧胆酸盐)

E.加用伏立康唑

F.加大万古霉素剂量

判断题