问题 多项选择题 案例分析题

患者男,56岁,因“活动后心悸、呼吸困难32年,加重伴夜间不能平卧1年”来诊。诊断为风湿性心脏病,联合瓣膜病变,左房室瓣狭窄,主动脉瓣关闭不全,肺动脉高压,心功能Ⅲ级。目前口服氢氯噻嗪、美托洛尔和地高辛。查体:体重65kg;意识清醒,合作,HR88次/min,律不齐;BP135/55mmHg;R18次/min,双肺呼吸音粗糙。头颈及四肢均未见异常,双下肢无水肿,肝颈静脉回流征(-)。ECG:心房颤动;胸部X线片:心胸比例为0.77,肺血增多;超声心动图:左心房、左心室明显增大,左房室瓣增厚,解剖面积0.74cm2;主动脉瓣增厚、瓣尖有钙化,关闭不全,彩色多谱勒:舒张期主动脉瓣有大量反流,左心室舒张末径81mm。术前血常规、凝血功能和生化检查基本正常。拟在中低温体外循环(CPB)下行左房室瓣和主动脉瓣机械瓣替换术。

如果你作为该患者的麻醉前访视医师需要考虑麻醉前用药,叙述正确的是()。

A.术前用药应让患者处于嗜睡状态,尽量消除患者术前的紧张情绪

B.口服降压药物应服用至手术当天

C.麻醉前用药不足,可因紧张致患者交感神经兴奋,从而引发心动过速,甚至急性肺水肿

D.吗啡用量过大可引起全身静脉扩张,回心血量减少,血压下降

E.吗啡可抑制呼吸,产生缺氧和二氧化碳蓄积,加重肺动脉高压

F.吗啡过量也导致心动过缓,加重主动脉瓣反流

答案

参考答案:A, B, C, D, E, F

阅读理解

From age eight to eleven, I studied at a small school in Bath, England. It was a small school of four classes, with about twenty-five children in each class according to age. For the most part, one teacher had to teach all subjects. However, sometimes the headteacher , Mr. Ronald Broaches would come in and spend an hour or so.

He was a large man with a very happy nature. He had a sense of humor and would be glad in telling the children small stories which make us laugh.

I found that he took great interest in me and he quickly found that I enjoyed puzzles. He would stop me as I was going to class and take a piece of paper out of his pocket, often with a puzzle on it. As time went on, they slowly gave me an interest in math and problem –solving that stays with me to this day.

To this day, I can remember Mr. Broaches’ cheerful cry of “Well done!” whenever I got a problem right. I shall always be thankful that our  paths crossed.

Mr. Bruoaches died just two weeks after I won the 1993 Nobel Prize in Physiology and Medicine. Unfortunately, I had no chance to speak to him before he died. I learnt late that he had heard of my success and I will always hope that he knew the deep influence he had made on my life.

小题1:The writer spent ______study at the school in Bath, England.

A.three years

B.six years

C.one year

D.two years小题2:The writer’s success shows us ___________.

A.Mr. Broaches often gave him some puzzles only for fun .

B.they had the same interest

C.Mr. Broaches found and developed his interest

D.Mr. Broaches was his father’s friend.小题3:From the story, we can guess the writer______.

A.liked language lessons very well.

B.was a good football player

C.was good at math

D.had a great dream小题4:The writer felt sorry because________________.

A.Mr. Broaches passed away before he won the Nobel Prize

B.he didn’t express his thanks before Mr. Broaches died.

C.he couldn’t find Mr. Broaches after he grew up

D.Mr. Broaches didn’t know about his success.小题5:The best title for the passage is ________.

A.The Story of Mr. Broaches

B.The History of Nobel Prize

C.My Early School Life

D.An Important Teacher in My Life

解答题