患者女，67岁，因“COPD恶化和肺炎”住院。期间行气管内插管机械通气。虽然临床症状好转，但试图停止机械通气时不成功。住院期间行气管造口术15d。现医师希望行非侵入性通气。血氧计监测血氧饱和度（SpO），红外线二氧化碳监测仪连接到通气装置监测终末潮气二氧化碳分压（PETCO）。第15天实验室检查：pH7.41~7.45，FiO0.40，HCO32~36mmol/L，COHb1.5%~1.8%，PaCO56~63mmHg，高铁血红蛋白（MetHb）0.8~1.0，PaO70~88mmHg，Hb132~134g/L，SaO90%~93%。

下一步处理措施是(提示第18天动脉血和非侵入检验结果：FIO0.40，HCO36mmol/L，pH7.44，COHb1.5%，PaCO60mmHg，MetHb7.8%，PaO92mmHg，Hb134g/L，SaO86%，PETCO38mmHg，SpO88%。)

A:升高FIO B:输血 C:仔细回顾前述治疗 D:调整治疗药物 E:调整通气参数 F:补液

患者男，78岁，因“发热伴咳嗽,咳痰24h”急诊入院。24h前出现寒战，体温38℃，口服对乙酰氨基酚（剂量不详）未见好转，体温升至38.6℃，并且出现咳嗽,气短,气促。送至急诊室时已处于昏睡状态。有老年痴呆病史，未予治疗。查体：BP78/42mmHg，HR119次/min，律齐，R30次/min；无黄疸，黏膜干燥。右肺背部可闻及响亮的干性啰音，触觉语颤增强；腹部柔软，无压痛，无包块及肝脾肿大，无外周水肿。实验室检查：Na134mmol/L，K5.3mmol/L，Cl96mmol/L，HCO14mmol/L，BUN31mmol/L，Scr1.3mmol/L，血糖13.4mmol/L；动脉血气：pH7.32，PaCO22mmHg，PaO62mmHg；粪隐血试验（＋）。胸部X线片：右中下肺肺炎。ECG：窦性心动过速，无心肌缺血。

与患者P(A-a)O最接近的值是

A:15 B:25 C:35 D:45 E:55 F:65

Climate Change Poses Major Risks for Unprepared Cities

A new examination of urban policies has been     1     recently by Patricia Romero Lankao．She is a sociologist specializing in climate change and     2     development．She warns that many of the world’s fast-growing urban areas，especially in developing countries．will likely¹ suffer from the impacts of changing climate．Her work also concludes that most cities are failing to   3    emissions of carbon dioxide and other greenhouse       4     ．These  gases are known to affect the atmosphere．”Climate change is a deeply local issue and poses profound threats to the growing cities of the world,” says Romero Lankao. ”But too few cities are developing effective strategies to       5      their residents."

Cities are       6      sources of greenhouse gases．And urban populations are likely to² be among those most severely affected by future climate change. Lankao’s findings³  highlight ways in which city-residents are particularly vulnerable, and suggest policy interventions that could offer immediate and longer-term       7      ．

The locations and dense construction patterns of cities often place their populations at greater risk for natural disasters. Potential      8     associated with climate include storm surges⁴ and prolonged hot weather. Storm surges can flood coastal areas and prolonged hot weather can heat     9    paved cities⁵ more than surrounding areas．The impacts of such natural events can be more serious in an urban environment．For example，a prolonged heat wave can increase existing levels of air pollution，causing  widespread health problems．Poorer neighborhoods that  may  10  basic facilities such as drinking water or a dependable network of roads，are especially vulnerable to natural disasters．Many residents in poorer countries live in substandard housing    11     access to reliable drinking water，roads and basic services. 

Local governments,     12    ,should take measures to protect their residents.”Unfortunately，they tend to move towards rhetoric     13    meaningful responses⁶,  Romero Lankao writes, ” They don’t impose construction standards that could reduce heating and air conditioning needs. They don"t emphasize mass transit and reduce      14      use. In fact, many local  governments  are taking  a hands—off  approach⁷.” Thus, she urges them to change their      15      policies and to take strong steps to prevent the harmful effects of climate change on cities.

词汇：

vulnerable / "vʌlnərəbl / adj ．易受伤害的

infrastructure / "infrə,strʌktʃə / n ．基础设施

sociologist /,səusi"ɔlədʒist /n．社会学家

substandard / ,sʌb"stændəd / adj．标准以下的

dioxide / dai"ɔksaid / ．二氧化物

floodplain /"flʌdplein / n ．泛滥平原

注释：

1. likely：很可能，或许。在本句中用作副词。

2. be likely to：很可能。likely 在本句中是形容词，用作表语。

3. findings：调查结果

4. storm surges：风暴潮

5. paved cities：铺上沥青路面的城市

6. spring up：涌现

7. rhetoric . . . responses：修辞反应。这个词的意思是：（地方政府）话讲得很漂亮，但内容空洞。

8. a hands-off approach：一种不插手的政策

空15

A:idle B:smart C:busy D:secure

Captain Cook Arrow Legend

It was a great legend while it lasted, but DNA testing has   1  ended a two-century-old story of the Hawaiian arrow carved from the bone of British explorer Captain James Cook   2  died in the Sandwich Islands¹ in 1179.

“There is  3  Cook² in the Australian Museum,” museum collection manager Jude Philip said not long ago in announcing the DNA evidence that the arrow was not made of Cook’s bone. But that will not stop the museum from continuing to display the arrow in its   4  , “Uncovered: Treasures of the Australian Museum,³” which  5  include a feather cape presented to Cook by Hawaiian King Kalani’opu’u in 1778.

Cook was one of Britain’s great explorers and is credited with   6  the “Great South Land,”  7  Australia, in 1770. He was clubbed to death in the Sandwich Islands, now Hawaii.

The legend of Cook’s arrow began in 1824   8  Hawaiian King Kamehamcha on his deathbed gave the arrow to William Adams, a London surgeon and relative of Cook’s wife, saying it was made of Cook’s bone after the fatal   9   with islanders.

In the 1890s the arrow was given to the Australian Museum and the legend continued  10  it came face-to-face with science.

DNA testing by laboratories in Australia and New Zealand revealed the arrow was not made of Cook’s bone but was more  11  made of animal bone, said Philp.

However, Cook’s fans  12  to give up hope that one Cook legend will prove true and that part of his remains will still be uncovered, as they say there is evidence not all of Cook’s body was  13  at sea in 1779. “On this occasion technology has won,⁴” said Cliff Thornton, president of the Captain Cook Society，in a  14  from

Britain. “But I am  15  that one of these days … one of the Cook legends will prove to be true and it will happen one day.”

词汇:

DNA n. 脱氧核糖核酸

Hawaiian / həˈwɑjən,hɑ:- /adj.夏威夷的

uncovered / ʌn"kʌvəd /adj.被发掘的

cape/ keɪp/ n.斗篷

credit / "kredɪt /v.把……归功于

club / klʌb /v.用棍棒打

注释：

1. Sandwich Islands：桑伟奇群岛，美国夏威夷群岛的旧称。

2.本句中的 Cook指 Cook的遗体部分，如遗骨等。

3. Uncovered：Treasures of the Australian Museum：考古发现：澳大利亚博物馆的宝藏。这是澳大利亚博物馆一个展览的名称。

4. On this occasion technology has won：在这个问题上，科技取得了胜利，这句话是指前一句中的 evidence是有科学根据的。

空15

A:safe B:weak C:sure D:lucky

Avalanche and Its Safety

An avalanche is a sudden and rapid flow of snow, often mixed with air and water, down a mountainside. Avalanches are   1   the biggest dangers in the mountains for both life and property.

All avalanches are caused by an over-burden of material, typically snowpack, that is too massive and unstable for the slope   2   supports it. Determining the critical load, the amount of over-burden which is    3    an avalanche,    4    a complex task involving the evaluation of a number of factors.      

Terrain slopes flatter than 25 degrees or steeper than 60 degrees typically have a low    5   of avalanche. Snow does not    6   significantly on steep slopes; also, snow does not    7    easily on fiat slopes. Human-triggered avalanches have the greatest incidence when the snow"s angle of rest¹ is    8   35 and 45 degrees; the critical angle, the angle at which the human incidence of avalanches is greatest, is 38 degrees. The rule of thumb² is: A slope that is    9   enough to hold snow but steep enough to ski has the potential to generate an avalanche, regardless of the angle. Additionally³, avalanche risk increases with    10   ; that is, the more a slope is disturbed by skiers, the more likely it is that an avalanche will occur.

Due to the complexity of the subject, winter travelling in the backcountry⁴ is never 100% safe. Good avalanche safety is a continuous    11   , including route selection and examination to the snowpack, weather    12    , and human factors. Several well-known good habits can also

   13   the risk. If local authorities issue avalanche risk reports, they should be considered and all warnings should be paid    14   to. Never follow in the tracks of others without your own evaluations; snow conditions are almost certain to have changed since they were made. Observe the terrain and note obvious avalanche paths where plants are    15   or damaged. Avoid traveling below others who might trigger an avalanche.

词汇：

avalanche / "ævəlæntʃ,- lɑ: ʃ / n．雪崩
snowpack / "snəʊpæk / n．积雪场
terrain / təˈreɪn / n．地形，地势
steep / sti:p / adj．险峻的，陆峭的
trigger / "trɪɡə(r) / v．引起，激发
incidence / ˈɪnsɪdəns / n．发生（率）
ski / ski: / v．滑雪
complexity / kəm"pleksətɪ / n．复杂性

注释:

1．angle of rest：这里指积雪保持静止的角度。

2．rule of．thumb：指“a broadly accurate principle，based on experience or practice rather that theory”，即“通用法则，经验法则 ”。

3．Additionally：是一个副词，用来引人新的事实或论点，意为 “此外”。

4．backcountry：人烟稀少的地区。

空15

A:missing B:grown C:big D:fresh

Singing Alarms Could Save the Blind

If you cannot see, you may not be able to¹ find your way out of a burning building — and that could be fatal. A company in Leeds could change all that²    1   directional sound alarms capable of guiding you to the exit.

Sound Alert, a company   2   the University of Leeds, is installing the alarms in a residential home for   3   people in Sommerset and a resource centre for the blind in Cumbria.   4  produce a wide range of frequencies that enable the brain to determine where the    5    is coming from.

Deborah Withington of Sound Alert says that the alarms use most of the frequencies that can be

    6   by humans. “It is a burst of white noise    7   people say sounds like static on the radio,” she says. “Its life-saving potential is great.”

She conducted an experiment in which people were filmed by thermal-imaging cameras trying to find their way out of³ a large   8   room. It    9   them nearly four minutes to find the door  10      a sound alarm, but only 15 seconds with one.

Withington studies how the brain    11   sounds at the university. She says that the   12   of a wide band of frequencies can be pinpointed more easily than the source of a narrow band. Alarms

  13   the same concept have already been installed on emergency vehicles.

The alarms will also include rising or falling frequencies to indicate whether people should go up

  14   down stairs. They were   15   with the aid of a large grant from British Nuclear Fuels.

词汇：

directional / dɪˈrɛkʃənəl, daɪ- / adj．定向的
exit / ˈɛɡzɪt, ˈɛksɪt / n．出口
install / ɪnˈstɔl / v．安装
residential / ˌrezɪˈdenʃl / adj．居住的
static / "stætɪk / n．静电噪声
potential / pəˈtɛnʃəl / n．潜力
thermal-imaging热效应成像
pinpoint / "pɪnpɔɪnt / v．精确地确定
concept / "kɒnsept / n．概念，观念
emergency / ɪ"mɜ:dʒənsɪ / n．紧急情况

grant /ɡrɑ:nt / n．授予物，准许

注释：

1.在谓语动词中，不能并列使用两个情态动词，如 may和 can就不能并列使用。如果由于表达需要，要同时用“可能”和“能够”，就得说（写）成 may be able to。 I may be may be able to come tomorrow, but 1 cannot promise. 我可能明天来，但我不可能作出承诺。

2. that指第一句所表达的意思。

3. … find their way out of…：意为“找到从……出去的路”。

空15

A:developed B:determined C:discovered D:delivered

An Intelligent Car

Driving needs sharp eyes, keen ears, quick brain, and coordination between hands and the brain. Many human drivers have all    1   and can control a fast-moving car. But how does an intelligent car control itself?

There is a virtual driver¹ in the smart car. This virtual driver¹ has “eyes,” “brains,” “hands” and “feet,” too. The minicameras    2   each side of the car are his “eyes,” which observe the road conditions ahead of it. They watch the    3   to the car’s left and right. There is also a highly

   4   driving system in the car. It is the built-in computer, which is the virtual driver’s “brain.” His “brain” calculates the speeds of    5    moving cars near it and analyzes their positions. Basing on this information², it chooses the right    6   for the intelligent car, and gives   7  to the “hands” and “feet” to act accordingly. In this way, the virtual driver controls his car.

What is the virtual driver’s best advantage³? He reacts  8  .The minicameras are  9  images continuously to the “brain.” It   10  the processing of the images within 100 milliseconds. However, the world’s best driver   11   needs one second to react.   12   , when he takes action, he needs one more second.

The virtual driver is really wonderful. He can reduce the accident    13   considerably on expressways. In this case, can we let him have the wheel⁴ at any time and in any place? Experts      14  that we cannot do that⁵ just yet⁶. His ability to recognize things is still    15   . He can now only drive an intelligent car on expressways.

词汇：

coordination / kəʊˌɔ:dnˈeɪʃən / n．协调，协同
virtual / ˈvɜ:tʃuəl / adj．虚拟的
minicamera n．微型相机
accordingly / əˈkɔ:dɪŋli / adv．相应地
millisecond / ˌmɪlɪˈsɛkənd / n．毫秒
expressway / ɪkˈspresweɪ / n．高速公路

注释：

1. virtual driver：虚拟驾驶员

2. Basing on this information：基于这些信息。 Basing on this information是现在分词短语，用作状语。

3. best advantage：昀大的优点

4. have the wheel：掌握方向盘，也就是“驾驶汽车”的意思。

5. that：that替代上一句的“ let him have the wheel at any time and in any place”。

6. just yet：迄今还。 yet意为“迄今还”，常用于否定句中。 Just修饰 yet，起强调的作用。

空15

A:unknown B:few C:untested D:limited

 Chicken Soup for the Soul：Comfort Food Fights Loneliness

Mashed potatoes, macaroni and cheese, may be bad for your arteries．    1    according to a study in Psychological Science, they’re good for your heart and    2    ．The study focuses on “comfort food¹” and how it makes people feel．

"For me   3  ,food has always played a big role in my family,” says Jordan Troisi, a graduate student² at the University of Buffalo³, and lead author⁴ on the study．The study came out of the research program of his co—author Shira Gabriel．It has    4    non-human things that may affect human emotions．Some people reduce loneliness by bonding with their    5    TV show, building virtual relationships with a pop song singer or looking at pictures of loved ones．Troisi and Gabriel wondered if comfort food could have the same effect    6    making people

think of their nearest and dearest⁵.

In one experiment, in order to make   7   feel lonely, the researchers had them write for six minutes about a fight with someone close to them．Others were given an emotionally neutral writing assignment. Then, some people in each   8    wrote about the experience of eating a comfort food and others wrote about eating a new food．  9    ,the researchers had participants    10    questions about their levels of loneliness⁶．

Writing about a fight with a close person made people feel lonely．But people who were generally   11    in their relationships would feel less lonely by writing about a comfort food．"We have found that comfort foods are consistently associated with those close to us．"says Troisi．"Thinking about or consuming these foods later then serves as a reminder of those close others．"In   12   essays on comfort food, many people wrote about the    13    of eating food with family and friends.

In another experiment,    14    chicken soup in the lab made people think more about relationships, but only if⁷ they considered chicken soup to be a comfort food．This was a question they had been asked long before the experiment, along with many other questions, so they wouldn’t remember it.

Throughout everyone’s daily lives⁸ they experience stress, often associated with our  15   with others," Troisi says．"Comfort food Can be an easy remedy for loneliness． 

词汇：

mashed /mæʃt/ adj．被捣成糊浆的

macaroni/ macaroni/ n．通心粉

cheese / tʃi:z / n．奶酪

artery/ artery / n．动脉

assignment / ə"sainmənt / n．指定作业

reminder / reminder/ n．起提醒作用的东西

remedy /remedy/ n．治疗方法，药物

virtual/"və:tʃuəl/ adj．虚拟的

注释：

1.comfort food：爽心食品

2. graduate student：研究生

3. The University of Buffalo：布法罗大学，建校于1846 年，位于水牛城（ Buffalo City) ，属于纽约州立大学，因此称为纽约州立大学水牛城分校。

4. lead author：首席作者

5. their nearest and dearest：他们最接近和最亲爱的人

6. levels of loneliness：孤独程度

7. only if: 只有（在……情况下）

8. Throughout everyone"s daily lives：在每一个人的日常生活中。through 有“贯穿”的意思。

空15

A:expressions B:estimation C:cooperation D:connections

15， 6， 11， 9， 7， 12， 3， ( )

A:13 B:12 C:15 D:10

1，27/15，2.6，51/15，（　）

A:21/15 B:21/5 C:5.2 D:6.2