男，39岁，于5小时前参加酒宴后，突然上腹部剧痛，呈持续性阵发加剧，并伴有左肩及右腰

发布时间：2017-05-31 20:55 │ 来源：www.tikuol.com

题型：单项选择题 A3/A4型题

问题：

男，39岁，于5小时前参加酒宴后，突然上腹部剧痛，呈持续性阵发加剧，并伴有左肩及右腰背部疼痛，恶心呕吐，呕吐物为少量胃内容物。同时伴有腹胀，排气停止。曾用阿托品亦未见好转。查体：急性痛苦面容，面色苍白，烦躁不安，出冷汗，四肢发凉。BP80/40mmHg，P120次／分，心肺正常。腹部胀满，全腹压痛、反跳痛，尤以上腹显著，腹肌紧张，肠鸣音消失。可见腹壁淤斑征（GrAy-Turner）阳性，脐周青紫征（Cullen征）阳性，WBC16×10<sup>9</sup>/1，血清淀粉酶500IU（索氏），血糖>11.1mmol/L，血清钙<2mmol/L。

本病治疗措施应为（）

A.穿孔修补+腹腔引流术

B.坏死组织清除+引流术

C.胆囊造瘘术

D.剖腹探查肠造瘘术

E.肠切除+肠吻合术

考点：临床执业助理医师第三章消化系统第三章消化系统题库

题型：单项选择题 A3/A4型题

近地面的风向一般（）

A．与等压线平行

B．与等压线垂直

C．与等压线有一定的夹角

D．与水平气压梯度力平行

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题型：单项选择题 A3/A4型题

国家对社会成员的基本生活给予物质保证的社会安全制度是( )。

A．按劳分配制度

B．按需分配制度

C．社会保障制度

D．平均分配制度

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题型：单项选择题 A3/A4型题

常读常新的人鱼公主
毕淑敏

　　童话，并不只是给儿童读的。
　　我在成年之后，还常常读童话。每当烦心的时候，从书架上随手扯出的书，必是童话。比如安徒生的《海的女儿》，我就读过多遍，它也被翻译成“人鱼公主”。比较起来，我更喜欢“人鱼公主”这个名字。海的女儿，好像太阔大太神圣了些。人鱼呢，就显得神秘而灵动，还有一点点怪异。
　　大约8岁的时候，第一次读到人鱼公主的故事。读完后泪流满面，抽噎得不能自已。觉得那么可爱和美丽的公主，居然变成了大海上的水泡，真是倒霉极了。从此在很长一段时间内，看到湖面上河面上甚至脸盆里的水泡就有些发呆，心中疑惑地想，这一个水泡，是不是善良的人鱼公主变成的呢？看到风把小水泡吹破，更是分外伤感。
　　大约18岁的肘候，又一次比较认真地读了人鱼公主。也许是情窦初开，这一次很容易地读出了爱情。原来，这是一篇讲爱情的童话啊！你看，她之所以能忍受那么惨烈的痛苦，是为了自己所爱的人。她忍受了非人的折磨，在刀尖样的甲板上跳舞，她是宁肯自己死，也不要让自己所爱的人死。这是一种多么无私和高尚的不求回报的爱啊！
　　到了28岁的时候，我已经做了妈妈。这时来读人鱼公主，竟深深地关切起人鱼公主的家人来了。她的母亲在生了6个女儿之后去世了，我猜想这个女人临死之前，一定非常放心不下她的女儿，不论是最大的还是最小的。她一定是再三再四地交代给公主的祖母老皇后，要照料她的孩子，特别是最小的女儿。
　　到了38岁的时候，因为我也开始写小说，再读人鱼公主的时候，不由自主地探讨起安徒生的写作技巧来了。我有点纳闷，安徒生在写作之前，有没有一个详尽的提纲呢？我的结论是——大概没有。似乎能看到安徒生的某种随心所欲，信马由缰。当然了，大轮廓走向他是有的，这个缠绵悱恻一波三折既有血泪也有波浪的故事，一定是在他的大脑里酝酿许久了。但是，连读了几遍之后，感到结尾处好像有点画蛇添足。
　　现在，我48岁了。又读了几遍人鱼公主。这一次，我心平气和，仿佛天眼洞开，有了一番新的感悟。这是一篇写灵魂的故事。无论海底的世界怎样瑰丽丰饶，因为没有灵魂，所以人鱼公主毅然离开了自己的亲人。人鱼公主是顽强和坚定的，她选定了自己的道路就绝不回头，终于，她得到了自己终就一个灵魂的机会。在一个接一个严峻的考验之后，在肉体和精神的磨砺煎熬之后，她又踏上了寻找不朽灵魂的漫漫旅途。
　　这个悲壮而凄美的寻找灵魂的故事，是如此地动人心弦，常读常新。于是想，当我58岁……68岁……108岁（但愿能够）的时候，不知又读出了怎样的深长？
1．作者一生常读人鱼公主，感受常新。请你简要概括作者8岁、18岁、28岁、38岁时读出的内容。
　 8岁时_____________；18岁时_____________；
　 28岁时________________；38岁时_______________。
2．48岁时，作者读出人鱼公主“是一篇写灵魂的故事”。你认为这里的“灵魂”指什么？请结合文中你感受最深的词、句作一点分析。
_________________________________________________
3．品读文章的结尾，简要说说好在哪里？
_________________________________________________
4．本文突出的写作特点是巧用年龄阶段组织材料。你觉得这种方法巧在哪里？请从结构和内容两方面回答。
_________________________________________________
5．重读看过的童话故事，与作者一样，你也会有“常读常新”的感觉。请举一篇童话，谈谈你原有的认识和一点新的感悟。
_________________________________________________

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题型：单项选择题 A3/A4型题

完形填空。

     Two friends and I moved into a house off campus when I was a junior at Iowa State University. We were
all a bit   1   of our landlord, a rough middle-aged man. He gave us a lecture about paying the   2   on time and
maintaining the house and appliances.
     During the fall semester, my housemates and I threw a   3 . We sent invitations to many friends and told
everyone to come to our house on Friday night. We   4   a large crowd and everyone had a great   5 . The
last guests left in the wee (凌晨一两点) hours of the morning.
     Exhausted, we decided to sleep in and clean the house and yard the next morning. Well, you   6   it! We
were awakened about 7:00 a.m. by our   7 , who was knocking on the door. Sleepily, we let him in,   8   to
incur his wrath (招致他的怒气). Instead, he picked up a party invitation that had been   9 on the sidewalk
and asked, "Why didn't you girls invite me?" He came into the house,  10  a minor repair, and spent a few
minutes helping us pick up trash from the yard. We weren't quite sure what use to make of our unexpected
luck, but we were thrilled that our landlord had been so  11 .
    A few months later, I made a mathematical error while balancing my checkbook and my bank soon
informed me that I had bounced (跳过) a  12 . I was ashamed when I discovered that it was my rent check
and  13  I had to let my landlord know. I figured that he  14  my housemates and I as irresponsible after the
party incident and this would  15  him right. I was certain that he would drive me away.  16 , I gathered the
courage to call him and explained what had happened. He said, "I have a daughter about your age, and the
same thing happened to her  17  . Would you like to wait until next month and send a  18  payment then?"
     I've never forgotten our landlord's kindness and understanding. He also taught me an important lesson
about not judging a book by its  19 . I'm proud to say that I have not bounced a check  20  (though I have
thrown a few more parties)!

( )1. A. tired
( )2. A. rent
( )3. A. table
( )4. A. enjoyed
( )5. A. time
( )6. A. guess
( )7. A. housemate
( )8. A. expecting
( )9. A. lain
( )10. A. took
( )11. A. understanding
( )12. A. card
( )13. A. that
( )14. A. knew
( )15. A. announce
( )16. A. Somehow
( )17. A. then
( )18. A. another
( )19. A. cover
( )20. A. after

B. ashamed
B. house
B. party
B. drew
B. fun
B. are guessing
B. neighbour
B. hoping
B. laying
B. gave
B. annoying
B. bill
B. which
B. viewed
B. show
B. Meanwhile
B. once
B. double
B. colour
B. since

C. fond
C. price
C. course
C. wanted
C. joy
C. guessed
C. parents
C. thinking
C. lying
C. made
C. careful
C. account
C. what
C. looked
C. prove
C. Moreover
C. again
C. same
C. content
C. ever

D. afraid
D. money
D. landlord
D. picked
D. trouble
D. had guessed
D. landlord
D. considering
D. laid
D. lad
D. fierce
D. check
D. 不填
D. thought
D. suggest
D. However
D. later
D. large
D. title
D. before

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题型：单项选择题 A3/A4型题

使用大型养路机械进行大、中修作业时，工务段与大修段共同随机检查，发现失格处所立即组织返工。返工后仍有仍有（）处及以上达不到作业验收标准，判该千米线路为失格。

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