问题 单项选择题

男,40岁,原有风湿性心脏病,主动脉瓣关闭不全,因劳累性呼吸困难1周就诊。体检:心脏向左下扩大,胸骨左缘第3、4肋间有舒张期叹气性递减型杂音,心尖部有Austin-Flint杂音。

心尖部有Austin-Flint杂音应与哪种疾病产生的杂音进行鉴别

A.室间隔缺损

B.二尖瓣关闭不全

C.三尖瓣关闭不全

D.二尖瓣狭窄

E.房间隔缺损

答案

参考答案:D

解析:在听诊上,Austin-Flint杂音与二尖瓣狭窄产生的杂音很相似,皆为心尖区舒张期杂音,但前者常发生在主动脉瓣关闭不全基础上。返流的血液影响二尖瓣开放,引起二尖瓣相对狭窄,而瓣膜本身无病变,后者为二尖瓣器质性狭窄所致。

单项选择题
单项选择题

The most thoroughly studied intellectuals in the history of the New World are the ministers and political leaders of seventeenth-century New England. According to the standard history of American philosophy, nowhere else in colonial America was “so much importance attached to intellectual pursuits.” According to many books and articles, New England’s leaders established the basic themes and preoccupations of an unfolding, dominant Puritan tradition in American intellectual life.

To take this approach to the New Englanders normally means to start with the Puritans’ theological innovations and their distinctive ideas about the church—important subjects that we may not neglect. But in keeping with our examination of southern intellectual life, we may consider the original Puritans as carriers of European culture, adjusting to New World circumstances. The New England colonies were the scenes of important episodes in the pursuit of widely understood ideals of civility and virtuosity.

The early settlers of Massachusetts Bay included men of impressive education and influence in England. Besides the ninety or so learned ministers who came to Massachusetts churches in the decade after 1629, there were political leaders like John Winthrop, an educated gentleman, lawyer, and official of the Crown before he journeyed to Boston. These men wrote and published extensively, reaching both New World and Old World audiences, and giving New England an atmosphere of intellectual earnestness.

We should not forget, however, that most New Englanders were less well educated. While few crafts men or farmers, let alone dependents and servants, left literary compositions to be analyzed, it is obvious that their views were less fully intellectualized. Their thinking often had a traditional superstitious quality. A tailor named John Dane, who emigrated in the late 1630s, left an account of his reasons for leaving England that is filled with signs. Sexual confusion, economic frustrations, and religious hope—all came together in a decisive moment when he opened the Bible, told bas father that the first line he saw would settle his fate, and read the magical words: "Come out from among them, touch no unclean thing, and I will be your God and you shall be my people." One wonders what Dane thought of the careful sermons explaining the Bible that he heard in Puritan churches.

Meanwhile, many settlers had slighter religious commitments than Dane’s, as one clergyman learned in confronting folk along the coast who mocked that they had not come to the New World fur religion. "Our main end was to catch fish.

The early ministers and political leaders in Massachusetts Bay ()

A. were famous in the New World for their writings

B. gained increasing importance in religious affairs

C. abandoned high positions before coming to the New World

D. created a new intellectual atmosphere in New England