患者，男性，40岁，因反复发热1个月余入院。患者1个月前无明显诱_爱下问搜题

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问题单项选择题案例分析题

患者，男性，40岁，因反复发热1个月余入院。患者1个月前无明显诱因出现发热，体温37.8℃～41.2℃，伴膝关节周围疼痛，活动不受限，无咳嗽、咳痰、腹痛、腹泻、恶心、呕吐等，在当地卫生院诊断为急性上呼吸道感染，给予头孢呋辛静脉滴注，对症治疗等，体温恢复正常。1周前患者又出现发热，伴头痛、关节疼痛、眩晕等，间断给予静滴头孢类抗生素效果不佳，遂来我院。体检：T38.4℃，P90次／分，R20次／分，BP110/72mmHg，颈静脉无怒张，胸前皮肤可见多形性瘀斑，双肺呼吸音清晰，无啰音。心界不大，心率90次／分，律齐，胸骨左缘闻及3～4肋间收缩期杂音。腹软，无压痛，无反跳痛，肝脾未触及明显肿大，双下肢无水肿。

提示：尿常规，蛋白（+）、RBC（++），血常规Hb80g/L，WBC18.6×10/L，中性94%，血沉60mm/h，心电图：Ⅱ、Ⅲ、aVF、ST段压低0.1mV，一度房室传导阻滞，血培养一次未找到细菌，心脏超声发现主动脉瓣2mm赘生物。目前诊断考虑（）

A.急性心包炎

B.急性心肌炎

C.风湿性心脏病

D.亚急性感染性心内膜炎

E.结核性心包炎

F.再生障碍性贫血

答案

参考答案：D

单项选择题

Caesar was right. Thin people need watching. I’ve been watching them for most of my adult life, and I don’t like what I see. When these narrow fellows spring at me, I quiver to my toes. Thin people come in all personalities, most of them menacing. You’ve got your "together" in person, your mechanical thin person, your condescending thin purism, your tsk-tsk thin person, your efficiency-expert thin person. All of them are dangerous.
In the first place, thin people aren’t fun. They don’t know how to goof off, at least in the best, fat sense of the word. They’ve always got to be adoing. Give them a coffee break, and they’ll jog around the block. Supple them with a quiet evening at home, and they’ll fix the screen door and lick S & H green stamps. They say things like "there aren’t enough hours in the day". Fat people never say that. Fat people think the day is too damn long already.
Thin people make me tired. They’ve got speedy little metabolisms that cause them to bustle briskly. They’re forever rubbing their bony hands together and eyeing new problems to "tackle". I like to surround myself with sluggish, inert, easygoing fat people, the kind who believe that if you clean it up today, it’ll just get dirty again tomorrow.
Some people say the business about the jolly fat person is a myth, that all of us chubbies are neurotic, sick, sad people. I disagree. Fat people may not be chortling all day long, but they’re a hell of a lot nicer than the wizened and shriveled. Thin people turn surly, mean, and hard at a young age because they never learn the value of a hot-fudge sundae for easing tension. Thin people don’t like gooey soft things because they themselves are neither gooey nor soft. They are crunchy and dull, like carrots. They go straight to the heart of the matter while fat people let things stay all blurry and hazy and vague, the way things actually are. Thin people want to face the truth. Fat people know there is no truth. One of my thin friends is always staring at complex, unsolvable problems and saying, "The key thing is fat people never say that." They know there isn’t any such thing as the key thing about anything.

Which of the following statement can best distinguish between fat and thin people

A．Fat people are sullen and gloomy whereas thin people are cheerful who know no fatigue.

B．Fat people are lazy and clumsy whereas thin people are diligent and crafty.

C．Fat people are practically reliable whereas thin people are seldom trustworthy.

D．Fat people are always feeling jaded whereas thin people never feel tired.

判断题

土地证式样由国土资源部统一制定。