共用题干题女性,48岁。发作性剑突下及右上腹绞痛3天,伴有寒战,半年前过类似发作史。查体:体温39℃,脉搏110次/分,血压140/85mmHg,血常规检查:WBC12×109/L,N80%,神志清楚,皮肤、巩膜轻度黄染,右肋缘下扪及肿大的胆囊、触痛。 该病人此时最有效的治疗是()
A. 胆总管切开减压、T管引流
B. 联合应用大剂量抗生素
C. 补液、恢复血容量
D. 给予糖皮质激素
E. 物理降温,支持治疗
共用题干题男性,29岁。转移性右下腹痛伴发热36小时入院,诊断为急性阑尾炎。 入院后腹痛加重,伴有寒战,体温40℃,巩膜轻度黄染,剑突下压痛,右下腹肌紧张,右下腹明显压痛、反跳痛,最可能的诊断是()
A. 急性阑尾穿孔
B. 阑尾炎合并胃穿孔
C. 腹膜炎引起溶血性黄疸
D. 门静脉炎
E. 阑尾与结肠形成内瘘
Passage Two In 1945, Reuben, a 12yearold boy, saw something in a shop window that set his heart racing. The price—five dollars—was beyond his means, but he went inside the shop anyway. Standing proud and straight in his floursack(面粉袋)shirt and washedout trousers, he asked the shopkeeper to hold it for him for some time. “Ill try,”the shopkeeper smiled. Reuben decided to raise the five dollars. Hearing the sound of hammering from a side street, he suddenly had an idea. People built their own homes in Bay Roberts, using nails purchased in sacks from a local factory. The sacks were sometimes discarded and Reuben knew he could sell them back to the factory for five cents a piece. Every day after school, Reuben went around the town, collecting nail sacks. When the school closed for the summer, Reuben wandered around the town, searching for his treasures. Often he was tired and hungry, but the thought of the object in the shop window kept him going. Sometimes his mother Dora would ask:“Reuben, where were you We were waiting for you to have dinner.” “Playing, Mum. Sorry.” Dora would look at his face and shake her head. Boys. One day in spring, he counted the coins and found that he needed 20 cents more. Could there be any sacks left anywhere in town He had to find four and sell them before the day ended. When Reuben arrived at the factory in the late afternoon, the sack buyer was about to lock up.“Mister! Please dont close up yet.”The man turned and saw Reuben, dirty and sweatstained. With four more coins in his pocket, Reuben headed for the shop and got what he wanted. Racing home, he burst through the front door.“Here, Mum! Here!”He exclaimed as he ran to her side. He placed a small box in her workroughened hand. Dora unwrapped it carefully, to save the paper. A bluevelvet jewel box appeared. She lifted the lid and saw an almondshaped brooch (胸针) with the word“Mother.” It was Mothers Day, 1946. Dora had no jewels except her wedding ring. Speechless, she smiled radiantly and gathered her son into her arms. The word“treasures”(line 3,para. 3) refers to .
A. coins
B. sacks
C. rings
D. brooches