某男，31岁，主诉3个月乏力，伴左上腹饱胀感。体检：浅表淋岜结未及，肝未及，脾肋下5cm。RBC3．6×10／L，HGB90g／L，WBC170×10／L，PLT300×10／L。分类：原粒0．01，早幼粒0．03，中幼粒0．1，晚幼粒0．4，杆粒0．34，嗜碱性粒细胞0．02，中性粒细胞碱性磷酸酶染色阴性

3年后患者出现发热，皮下出血，贫血加重，脾大肋下6cm。骨髓检查：原淋巴细胞0．76，POX染色阴性，苏丹黑染色阴性，其病情变化的原因是

A:急性淋巴细胞白血病 B:慢粒急淋变 C:慢粒急粒变 D:慢粒急单变 E:慢粒与急淋并存

某男，21岁，发热2周，体温38～39℃，检查皮肤散在紫癜。颈部及腋下可触及0.5cm×1.5cm大小琳巴结5～6个，脾肋下3cm，血红蛋白85g/L，白细胞10×10/L，血小板25×10/L。

此患者在治疗3周后，出现高热，头痛、呕吐、Kernig征(+)，应采取治疗方案

A:应用广谱抗生素 B:链霉素、雷米封、利福平联合治疗 C:化疗+鞘内注射MTX D:肾上腺糖皮质激素+先锋霉素 E:输血小板

某男性患者，65岁，体重60kg，腹痛、腹泻伴发热3天。既往体健。查体：体温38.5℃，血压80／50mmHg，心率130次／分，呼吸30次／分，全身无水肿。血常规：白细胞15.0×10／L，中性粒细胞85％，血红蛋白130g／L，血小板60×10／L。

经以上积极治疗与监护后，患者病情恶化，10小时补液6000ml，尿量维持10～15ml／h，呼吸困难加重，呼吸促，40次／分，神志淡漠，全身水肿，血压在多巴胺、去甲肾上腺素维持下100～110／50～70mmmHg，血肌酐进行性升高，10小时后查血肌酐380μmol／L，pH7.250，Pa0256mmHg，PaCO22.5mmHg，BE-10mmol／L，K5.0mol／L，现需采取的治疗措施是

A:继续补液扩容 B:CRRT C:血浆置换 D:血液灌流 E:呼吸机辅助通气 F:25g葡萄糖与6U胰岛素静脉滴注

某男性患者，46岁，油漆工人，平素身体健康，寒战、高热3天，伴鼻出血和口腔溃疡，体格检查：全身可见散在出血点，浅表淋巴结不肿大，胸骨无压痛，肝脾未触及；血分析Hb100g/L，WBC 1.0×10/L，中性粒细胞0.15，淋巴细胞0.85，血小板12×10/L，网织红细胞0.001。诊断为"重型再生障碍性贫血"。

本患者治疗首选

A:抗生素+激素+肝素 B:环孢菌素+抗生素+G-CSF C:雄性激素+抗生素+血小板输注 D:联合化疗+抗生素 E:自体骨髓移植

腰椎斜位片，正常椎弓及附件的影像呈""猎狗形""。

腰椎各解剖结构与""猎狗""的对应关系不正确的表述为

A:狗嘴为同侧横突 B:耳为同侧上关节突 C:眼为对侧椎弓根的断面 D:前腿为同侧下关节突 E:颈部为同侧椎弓峡部

某女性患者，25岁，妊娠27周出现寒战、高热、腰痛、尿痛、下腹痛，耻骨上压痛(+)。尿白细胞计数量30个/HP，尿蛋白+，血象WBC18×10。

病人还要做下列那项检查最有价值？

A:血肌酐尿素氮 B:PSP排泄试验 C:尿浓缩稀释功能测定 D:静脉肾盂造影 E:尿细菌培养 F:血常规检查 G:清洁留尿作尿沉渣涂片革兰染色检查 H:腹部CT检查

某男性患者，36岁，已婚，干部，因"左上腹疼痛伴恶心、呕吐8h"来诊。患者8h前大量饮酒后剧烈呕吐，呕吐物为胃内容物及黄绿苦水，共4次。继而上腹持续性疼痛，阵发性加剧，呈绞痛样并向左侧腰背部放射。3h前患者持续发热，全腹痛，拒按，腹胀，频繁剧烈恶心、呕吐，呕吐物为胆汁、咖啡样液体。1h前出现手足搐搦，四肢厥冷。发病来尿少。查体:T39℃，P118次/min，R20次/min，BP 90/60mmHg；意识清楚，焦虑不安，痛苦面容，皮肤、巩膜无黄染，浅表淋巴结未及；心、肺（-），腹部膨隆，脐周皮肤青紫，全腹压痛、反跳痛及肌紧张，肝、脾触诊不清，移动性浊音（+），肠鸣音减弱，实验室检查：WBC10×/L，N0.87，L 0.13，血清淀粉酶521U/L；尿淀粉酶1800U/L，腹部CT：出血坏死性胰腺炎。

该患者诊断为"急性胰腺炎"的依据有

A:血清淀粉酶 B:尿淀粉酶 C:腹部CT D:疼痛性质 E:手足搐搦，四肢厥冷 F:尿少

林某，女，39岁。因反复皮下紫癜伴月经量明显增多3月余，拟为"ITP"而收住入院。血象结果显示：红细胞3.2×10/L，血红蛋白80g/L;白细胞4.5×10/L;血小板18×10/L。

对该病人的健康指导不应包括

A:避免外伤 B:保证充足的睡眠 C:保持二便通畅 D:加强体育锻炼 E:避免情绪波动

林某，女，39岁。因反复皮下紫癜伴月经量明显增多3月余，拟为"ITP"而收住入院。血象结果显示：红细胞3.2×10[~.12gif]/L，血红蛋白80g/L;白细胞4.5×10[~.9gif]/L;血小板18×10[~.9gif]/L。

若病人突发头痛，下列措施哪项是错误的

A:立即通知主管或值班医生 B:必要时保留尿管 C:耐心安慰直至病人情绪稳定 D:迅速建立静脉通道 E:去枕平卧

How We Form First Impression

1　We all have first impression of someone we just met. But why? Why do we form an opinion about someone without really knowing anything about him or her — aside perhaps from a few remarks or readily observable traits.

2　The answer is related to how your brain, allows you to be aware of the world. Your brain is so sensitive in picking up facial traits, even very minor difference in how a person’s eyes, ears, nose, or mouth are placed in relation to each other makes you see him or her as different¹. In fact, your brain continuously processes incoming sensory information — the sights and sounds of your world. These incoming “signals” are compared against² a host of “memories” stored in the brain areas called the cortex system to determine what these new signals “mean.”

3　If you see someone you know and like at school³, your brain says “familiar and safe. ‘‘If you see someone new, it says, “new — potentially threatening.” Then your brain starts to match features of this stranger with other “known” memories；The height, weight, dress, ethnicity, gestures, and tone of voice are all matched up. The more unfamiliar the characteristics, the more your brain may say, “This is new. I don’t like this person.” Or else, “I’m intrigued. “Or your brain may perceive a new face but familiar clothes, ethnicity, gestures — like your other friends；so your brain says: “I like this person.” But these preliminary “impressions” can be dead wrong⁴.

4　When we stereotype people, we use a less mature form of thinking（not unlike the immature thinking of a very young child）that makes simplistic and categorical impressions of others. Rather than leam about the depth and breadth of people — their history, interest, values, strengths, and true character — we categorize them as jocks, geeks, or freaks.

5　However, if we resist initial stereotypical impressions, we have a chance to be aware of what a person is truly like. If we spend time with a person, hear about his or her life, hopes, dreams, and become aware of the person’s character, we use a different, more mature style of thinking — and the most complex areas of our cortex, which allow us to be humane.

词汇： 

trait / treɪ, treɪt/ n．特点，特征，特性

host / həʊst/ n．一大群，许多

simplistic / sɪm’plɪstɪk / adj．过分单纯化的

categorical / ,kætɪ’gɒrɪkl/ adj．绝对的

jock /dʒɒk / n．骗子

geek / gi:k / n．反常的人

stereotype / ’sterɪətaɪp/ v．对……产生成见

humane / hju:’meɪn, hjʊ- / adj．有人情味的，人文的

sensory / ’sensərɪ / adj．感官的，感觉的

cortex / ’kɔ:teks /n．脑皮层

ethnicity n．种族特点

intrigue / ɪn’tri:g / v．激起兴趣

freak / fri:k / n．怪人

注释：

1．Your brain is so sensitive in picking up facial traits, even very minor difference in how a person’s eyes, ears, nose, or mouth are placed in relation to each other makes you see him or her as different：从even开始到as different是个结果状语从句，相当于that even very minor ... .，而that是与主句中的so呼应的。

2．against：和……对比

3．If you see someone you know and like at school ...：如果你在学校里看见某个你认识而且喜欢的人…… like在这里是动词。

4．dead wrong：相当于completely wrong。dead wrong是口语表达用语。

B　the most complex areas of our cortex

C　the immature form of thinking of a very young child

D　the meaning of incoming sensory information

E　the sights and sounds of the world

F　an opportunity to analyze different forms of thinking

You interpret by comparing it against the memories already stored in your brain ________.

A:a stranger's less mature type of thinking B:the most complex areas of our cortex C:the immature form of thinking of a very young child D:the meaning of incoming sensory information E:the sights and sounds of the world F:an opportunity to analyze different forms of thinking