女性，65岁。因糖尿病8年，足跟痛1年余就诊。患者于8年前确诊为

问题多项选择题案例分析题

女性，65岁。因糖尿病8年，足跟痛1年余就诊。患者于8年前确诊为糖尿病，口服降糖药物治疗后血糖控制良好，1年前出现脚后跟疼痛，疼痛呈针刺样疼痛，伴有烧灼感，疼痛逐渐加重，夜间影响睡眠。口服芬必得、双氯芬酸钠等非甾体消炎镇痛药物效果不佳，加用盐酸曲马朵缓释片（0.1g/次，2次／日）疼痛稍缓解。此后病情逐渐加重，患者服药量渐加大至12片／日，且疼痛缓解不明显，严重影响患者睡眠、情绪。检查诊断：查体：T：36.4℃，P：85次／分，R：20次／分，BP：140/90mmHg，神志清楚，查体合作。全身皮肤无黄染。肺叩诊清音；全腹无压痛，肝、脾肋下未触及；肝肾区无叩痛。专科情况：意识清楚，反应灵敏，回答切题，配合好，言语正常。粗测嗅觉、视觉、听觉正常。面部表情无刻板，语音无减低，语速正常。双侧瞳孔等大等圆，直径约3mm，直接及间接对光反射灵敏，双侧眼睑无下垂，无明显震颤。双上肢体肌容量正常，肌力Ⅴ级，肌张力正常。双下肢体触之剧痛，尤以足跟明显。肌容量正常，肌力Ⅴ级，肌张力正常，双侧跟、膝腱反射正常，双侧巴宾斯基征阴性。

该患者药物治疗包括（）

A.抗癫痫药物：卡马西平、加巴喷丁或普加巴林等

B.应用抗抑郁药如三环类药物、五羟色胺或去甲肾上腺再摄取抑制剂或促进剂，目的是提高痛阈，减轻疼痛帮助入睡

C.非甾体类抗炎药、B族维生素

D.交感神经阻断药物：哌唑嗪、可乐定等。或采取交感神经节阻滞

E.可试用阿片受体激动剂：奇曼丁、美施康定、奥施康定等

答案

参考答案：A, B, C, D, E

完形填空。
Years ago,if a teenager had some problems in her life,she might go home and write in her diary. Now,a teenager with __1__ problems might go onto the Internet and write about them in a blog(博客)． In many ways,a diary and a blog are very __2__.So,what makes blogging different from writing in __3__ diary? The biggest difference is that blogging is much more __4__ than a diary.Usually,a teenager treats her diary like a book full of __5__ that she does not want to __6__. It's interesting that someone who writes in a blog __7__ a diary will probably write nearly the same information. I have a little sister,and sometimes I go online to read her __8__.She writes about things like waking up early for swimming practice and not studying enough for her chemistry test.__9__ I was her age,I wrote about the same things,but __10__ in my diary.Then,after I had finished writing,I would hide my diary in a secret place because I was __11__ that my sister might read it! The biggest __12__ with blogging is that anyone can read what you write.If I was angry with a friend during high school and wrote something __13__ about her in my diary,she would never know. __14__,if my sister ever wrote something bad about a friend,that friend __15__ read her blog and get angry. There are also __16__ to blogging,of course.If I was feeling sad one day and wrote in my diary, "Nobody cares about me,"__17__ would know about it.However,if my sister wrote the same sentence in her blog,her best friends would __18__ respond(回应)and tell her how much they __19__ her.Blogs help people __20__ in contact with their friends and to hear what the people around them are doing.
( )1．A.the same ( )2．A.familiar ( )3．A.a personal ( )4．A.attractive ( )5．A.thoughts ( )6．A.tell ( )7．A.instead of ( )8．A.blog ( )9．A.Since ( )10．A.only ( )11．A.angry ( )12．A.problem ( )13．A.unpleasant ( )14．A.Besides ( )15．A.should ( )16．A.reasons ( )17．A.everyone ( )18．A.happily ( )19．A.like ( )20．A.lose	B．troublesome B．special B．an ordinary B．public B．puzzles B．share B．as well as B．diary B．Although B．already B．concerned B．doubt B．wrong B．However B．will B．disadvantages B．no one B．especially B．miss B．stay	C．difficult C．similar C．a dated C．convenient C．mysteries C．publish C．in favor of C．report C．When C．still C．glad C．trouble C．mean C．Therefore C．must C．shortcomings C．anyone C．quickly C．need C．get	D．daily D．different D．a traditional D．quick D．secrets D．solve D．in spite of D．Web D．Because D．never D．worried D．mistake D．funny D．Then D．might D．advantages D．someone D．immediately D．help D．find