某男，52岁。腰背疼痛半年，牙龈出血2周就诊。体检：中度贫血貌，肝肋下1cm，脾肋下刚及。化验：Hb80g／L，WBC3．8×10／L，血小板56×10／L。尿蛋白(+++)，ESR105mm／1h末，骨骼X线摄片L，L有楔形压缩，多根肋骨有虫蚀样破坏。血钙3．25mmol／L，IgG5．0g／L，IgA2．1g／L，IgM0．5s／L，IgD0．003g／L，尿本周蛋白(-)。

本例检查结果BUN20．5mmol／L，肌酐400μmol／L，AKP50U，骨髓涂片原浆加幼浆细胞0．05(5％)，成熟浆细胞0．07(7％)，患者最可能的诊断是

A:反应性浆细胞增多症 B:轻链型多发性骨髓瘤 C:非分泌性多发性骨髓瘤 D:IgG型多发性骨髓瘤 E:IgD型多发性骨髓瘤

某男性患者，39岁，缺失，近远中大面积银汞合金充填物，无松动，X线显示已行完善的根管治疗；未见明显的牙体牙髓及牙周病变

如果患者要求固定义齿修复，但5牙冠剩余牙体薄弱，最佳的处理措施是

A:烤瓷固定桥 B:烤瓷固定桥 C:行桩核恢复后，烤瓷固定桥 D:金属固定桥 E:行桩核恢复后，金属固定桥

某男性患者，36岁，缺失，做基牙，行可摘局部义齿修复

制备铸造支托凹，其颊舌径宽度约为

A:颊舌径的1／2 B:颊舌径的2／3 C:颊舌径的1／4 D:颊舌径的1／3 E:颊舌径的1／5

某男性患者，36岁，缺失，做基牙，行可摘局部义齿修复

制备铸造支托凹，其颊舌径宽度约为

A:颊舌径的1／2 B:颊舌径的2／3 C:颊舌径的1／4 D:颊舌径的1／3 E:颊舌径的1／5

某男性患者，39岁，缺失，近远中大面积银汞合金充填物，无松动，X线显示已行完善的根管治疗；未见明显的牙体牙髓及牙周病变

如果患者要求固定义齿修复，但5牙冠剩余牙体薄弱，最佳的处理措施是

A:烤瓷固定桥 B:烤瓷固定桥 C:行桩核恢复后，烤瓷固定桥 D:金属固定桥 E:行桩核恢复后，金属固定桥

某女性患者，68岁，心悸、多汗2年，曾不规律服用甲巯咪唑半年，症状缓解不佳。目前：ECG:不正常心电图，房颤。内分泌科建议I治疗。甲功生化：FT:5.6pg/ml(1.8～4.1);FT4:2.1ng/dl(0.81～1.7)，TSH:0.01μIU/ml。来核医学科行甲状腺吸I率测定。甲状腺I摄取率测定，2小时吸碘率为15%，24小时吸碘率为27%。

病人TRAb:5IU／ml(<13);TPOAb:10IU/ml(<34)；TgAb:11.3IU／ml(<115)。B超示甲状腺右叶下极3.1cm×2.1cm低回声结节，形态规则，内部回声均匀，伴囊性改变，CDFI：结节内部血流丰富，周边血流环绕，内部血流穿入规则，提示滤泡病变。其甲状腺显像可能为

A:甲状腺右叶下极"冷"结节 B:甲状腺右叶下极"凉"结节 C:甲状腺右叶下极"热"结节 D:甲状腺右叶下极"温"结节 E:甲状腺显像未见异常

某女性患者，36岁，反复心悸、畏热、多汗3年，抗甲状腺药物治疗后1年甲亢复发，目前，FT:23pg/ml(1.8～4.1);FT4:5.77ng/dl(0.81～1.7)，TSH:0.01μIU/ml。内分泌科建议I治疗。来我科做甲状腺吸I率测定。

如病人2小时吸碘率为10%，24小时吸碘率为24%。考虑可能的原因有

A:近期行增强CT检查 B:近期因咽炎曾含服华素片 C:服用避孕药物 D:停用抗甲状腺药物时间过短 E:服用口受体阻滞剂

某女性患者，36岁，反复心悸、畏热、多汗3年，抗甲状腺药物治疗后1年甲亢复发，目前，FT:23pg/ml(1.8～4.1);FT4:5.77ng/dl(0.81～1.7)，TSH:0.01μIU/ml。内分泌科建议I治疗。来我科做甲状腺吸I率测定。

如病人在检查过程中，2小时的颈部放射性计数即超过标准源，应询问

A:近期行增强CT检查 B:近期是否曾行吸碘率测定 C:是否近期在外院接受过I治疗 D:停用抗甲状腺药物时间过短 E:1～2天内曾行甲状腺显像

某女患儿，9岁，因“右膝、右颈痛9个月”来诊。伴右膝关节微热、肿，晨僵明显，颈部活动受限制。血常规：Hb 102 g/L，WBC 10.9×10/L，PLT 342×10/L；CRP 775 mg/L；ESR 110 mm/h；补体：C 392 mg/L，IgG 18.4 g/L；ASO、RF、ANA、抗dsDNA、HLA-B均（－）。诊断：幼年类风湿关节炎。

除已用药物外，还可采用的治疗措施包括(提示 给予该患儿甲氨蝶呤5 mg/周，双氯芬酸钠（扶他林）12.5 mg，2次/d治疗。)

A:急性期后应适当运动 B:可采用理疗、热敷、红外线照射 C:尽早采用阿司匹林和丙种球蛋白，以控制炎症 D:静脉滴注大剂量青霉素 E:全面保护患儿，防止其受伤 F:可加用糖皮质激素等进行抗JRA治疗

Across the Deserts

　　The SaharaDesertis the largest desert in the world. It stretches across Africa fromSenegaltoEgypt. TheSaharaDesertis an unfriendly environment. During the day it"s very hot, and at night it’s sometimes very cold. It is also difficult to find water in theSahara.

　　In 2006, Kevin Lin, Ray Zahab, and Charlie Engle decided to do something very difficult. They made the decision to run across the Sahara Desert 4,300 miles (6,920km). It seemed impossible to do, but they wanted to try. The three men liked to test themselves, and this would be a very big test.

　　On the morning of November 2, Kevin, Ray, and Charlie started their trip across theSahara. Every morning they began running at 5:00. At11 a.m. they stopped and rested until 5 p.m. Then they ran again until 9:30 in the evening. Each day they ran about 40 miles (64 km). Every day it was the same thing. They got up and ran. They listened to music on their iPods, and they ran and ran.

　　Kevin, Ray, and Charlie needed to eat a lot of food during their trip. Most people need about 2,000 calories of food each day. Kevin, Ray, and Charlie needed between 6,000 and 9,000 calories every day. That"s a lot of food! They also needed to drink a lot of water.

　　The three men had some problems on their trip, and many times they wanted to quit and go home. It was often very hot (140°F/60°C) during the day, and the heat made them sick. Their legs and feet hurt. Sometimes it was very windy, and they couldn"t see. One time they got lost. But they didn"t quit. After 111 days, Kevin, Ray; and Charlie successfully finished their trip across theSaharaDesert. They hugged each other and put their hands in the water of theRed Sea. Then they ran to a hotel to take a long shower.

　　词汇：

　　Stretch / strɛtʃ / v. 延伸，伸展

　　Calorie / "kælərɪ / n. 卡(路里)，小卡，大卡

　　Quit / kwɪt / v. 停止，放

　　注释：

They sometimes felt sick because it was so hot.

A:Right B:Wrong C:mentioned