某男性患者，55岁，于2006年9月26日因"黑便5小时"入院。患者既往有肝炎、肝硬化病史5年，于2005年3月、11月及2006年4月因肝硬化腹水"先后3次住院，病情好转出院，出院后一直服用保肝药物。本次入院前自觉乏力症状加重，恶心、未吐，排暗红色血便4次，量约1600ml。入院后查体：贫血貌，血压66／31mmHg(1mmHg＝0.133kPa)，全身皮肤黏膜及巩膜中度黄染，心肺未见异常，肝肋下未触及，脾左肋下7cm，移动性浊音阴性，双下肢无水肿。实验室检查：血红蛋白63g／L，血小板(PLT)50×10／L，总胆红素68μmol／L，结合胆红素19μmol／L，丙氨酸转氨酶(ALT)65U／L，天冬氨酸转氨酶(AST)85U／L，凝血酶原时间(PT)20秒，凝血酶原活动度(PTA)0.41，血钠127mmol／L。

住院第4天复查PT和PTA2分钟不凝(9月29日～10月12日期间5次监测)，监测血小板呈进行性下降(血小板最低达17×10／L)，部分凝血酶原时间(APTT)115秒，D-二聚体1.2mgL(正常值0～0.3mg／L)，纤维蛋白原1.1g／L(正常值2.0～4.0g／L)，纤维蛋白(原)降解产物(FDP)50g／L(正常值5～10mgL)。 根据上述表述，患者合并有

A:特发性血小板减少性紫癜 B:弥散性血管内凝血 C:骨髓异常增生综合征 D:自身免疫性溶血性贫血 E:微血管损伤 F:肝硬化脾功能亢进加重

某男性患者，61岁，无痛性全程肉眼血尿，伴腰痛，消瘦，体重下降；查体：腹软，未扪及明显包块，肾区叩痛(-)。全血细胞计数白细胞：13×10／L，中性粒细胞85%，肾功能肌酐60μmol／L，尿素氮6.1mgL，血沉20mm／h。尿常规：红细胞(++)，尿细胞学(-)。

对帮助诊断首先考虑要做的检查是

A:膀胱镜 B:泌尿系统彩超 C:腹部CT D:静脉尿路造影 E:PET

某男性患者，61岁，无痛性全程肉眼血尿，伴腰痛，消瘦，体重下降；查体：腹软，未扪及明显包块，肾区叩痛(-)。全血细胞计数白细胞：13×10／L，中性粒细胞85%，肾功能肌酐60μmol／L，尿素氮6.1mgL，血沉20mm／h。尿常规：红细胞(++)，尿细胞学(-)。

该患者最有可能的诊断是

A:肾癌 B:肾盂癌 C:膀胱癌 D:肾母细胞瘤 E:肾囊肿

某男性患者，61岁，无痛性全程肉眼血尿，伴腰痛，消瘦，体重下降；查体：腹软，未扪及明显包块，肾区叩痛(-)。全血细胞计数白细胞：13×10／L，中性粒细胞85%，肾功能肌酐60μmol／L，尿素氮6.1mgL，血沉20mm／h。尿常规：红细胞(++)，尿细胞学(-)。

若该患者准备行手术治疗，根治性手术应包括的范围不包括

A:肾周筋膜 B:肾周脂肪 C:肾和肾上腺 D:肾蒂淋巴结 E:输尿管

Hospital Mistreatment

　According to a study, most medical interns report experiencing mistreatment, including humiliation by senior doctors,   1    threatened, or physical abuse in their first year out of medical school.

The findings come from analysis of the    2    a 13-page survey mailed in January 1991 to 1, 733 second-year residents. The survey and   3    appear in the April 15th issue of the Journal of the American Medical Association.

Overall, out of the 1,277 residents   4    completed surveys, 1,185 said that they had experienced at least one incident of mistreatment in their intern year.   5     reporting incidents where they were abused, more than 45% of the residents said they had witnessed at least one incident where other persons    6     false medical records. Moreover, nearly three quarters of the residents said they had witnessed mistreatment of patients by other residents, attending physicians¹, or nurses. Almost 40% said patient mistreatment was a frequent   7    .

More than 10% of the residents said they were   8    to have enough sleep, and the average number of hours   9    sleep was 37.6. The average on-call hours during a    10     week was 56.9 hours, but about 25% of the residents said their on-call assignments were more than 80 hours some weeks.

   11     30% of the residents said they experienced some type of sexual harassment or discrimination, verbal abuse was the most common problem cited. When abusive incidents were limited to events occurring three or more times, 53% of the respondents reported that they    12    belittled or humiliated by more senior residents, while just over 21% reported someone taking credit for their work. Being “   13     tasks for² punishment,” “being pushed, kicked or hit,” and

   14     someone “threatening your reputation or career,” were reported as a more    15    occurrence by over 10% of the responding residents.

词汇：

verbal  /"vɜːb(ə)l/ adj. 言语(上)的

intern  /"ɪntɜːn/  n. 实习医师

respondent  /rɪ"spɒnd(ə)nt/  n.回答者

assignment  /ə"saɪnm(ə)nt/  n. 分配任务

belittle  /bɪ"lɪt(ə)l/  vt. 轻视；贬低

sexual  /"sekʃʊəl; -sjʊəl/  adj. 性的

humiliate  /hjʊ"mɪlɪeɪt/  vt.使蒙羞，使丢脸

harassment  /"hærəsm(ə)nt/ n. 骚扰

humiliation  /,hjuːmɪlɪ"eɪʃən/  n. 羞辱

discrimination  /dɪ,skrɪmɪ"neɪʃ(ə)n/  n. 歧视

resident  /"rezɪd(ə)nt/  adj.住院医生

abuse  /ə"bjuːz/  n.&vt. 虐待，凌辱

incident  /"ɪnsɪd(ə)nt/  n. 偶发事件，小事件

abusive  /ə"bjuːsɪv/  adj. 侮辱人的，说人坏话

witness  /"wɪtnɪs/  vt. 亲眼看见

注释：
1.attending physician:主治医师

2.take/get credit for…:因….而出名

空9

A:without B:on C:with D:because of

Dreams

　　Everyone can dream. Indeed, everyone does dream. Those who    1    that they never dream at all actually dream    2    as frequently as the rest of us,    3    they may not remember anything about it. Even those of us who are perfectly     4     of dreaming night    5    night very seldom remember those dreams in    6    detail but¹ merely retain an untidy mixture of seemingly unrelated impressions. Dreams are not simply visual-we dream with all our    7    , so that we appear to experience sound, touch, smell, and taste.
　　One of the world’s oldest    8    written documents is the Egyptian Book of Dreams. This volume is about five thousand years old, so you can    9    that dreams were believed to have a special significance even then. Many ancient civilizations believed that you    10    never wake a sleeping person as, during sleep, the soul had left the body and might not be able to return     11     time if the sleeper were suddenly    12    .
　　From ancient times to the present²    13    , people have been   14    attempts to interpret dreams and to explain their significance. There are many books available on the subject of dream interpretation, although unfortunately there are almost as many meanings for a particular dream    15     there are books.

词汇：
frequently /"friːkwəntlɪ/ adv.频繁地，经常地；时常，屡次

seldom /"seldəm/ adv.很少，不常

retain /riˈtein/ vt.保持，记住

significance /sɪg"nɪfɪkəns/ n.重要性，意义

civilisation /,sɪvɪlaɪ"zeɪʃən/ n.文明，文化

interpret /ɪn"tɜːprɪt/ vt.解释，说明，口译

interpretation /ɪntɜːprɪ"teɪʃən/ n.解释，口译

注释：

1．...very seldom remember those dreams in detail but merely retain an untidy mixture...but...不……而是……
2．From ancient times to the present...从古至今……

空9

A:awoke B:awoken C:awake D:awaken

Life Expectancy in the Last Hundred Years

　　A hundred years ago，life expectancy in developed countries was about 47: in the early 21st century, men in the United States and the United Kingdom can expect to live to about 74. Women to about 80, and these    1    are rising all the time. What has brought    2    these changes? When we look at the life    3    of people l00 years ago, we need to look at the greatest    4    of the time. In the early 20th century, these were the acute and often     5     infectious diseases such as smallpox. Many children died very young from these diseases and others, and the weak and elderly were always at risk.
　　In the    6    world these diseases are far    7    today, and in some cases have almost disappeared. A number of    8    have led to this: improvements in sanitation and hygiene, the discovery and use of antibiotics, which    9    bacterial diseases much less dangerous, and vaccinations  10  common diseases.    11   , people"s general health has improved with improvements in our general environment: cleaner air, better means of preserving food，better and warmer housing，and better understanding of nutrition.
　　Genetically，we should all be able to live to about 85 but    12    people do live longer today, there are still some big killers around that are preventing US from consistently reaching that age. The problems that affect people today are the more chronic illnesses, such as heart disease and strokes, and those    13    by viruses, such as influenza and AIDS¹. Of course, cancer is a huge killer as well. In most cases these diseases affect    14    people, but there are worrying trends in the developed world with problems such as obesity    15    more heart disease and illnesses such as diabetes at younger ages.
　　The killers today can be classed as "lifestyle diseases"，which means that it may be possible to halt their progress.

词汇：
expectancy/ ɪk"spektənsɪ/ n．预期 

acute / əˈkju:t /adj．(疾病)急性的

infectious/ ɪnˈfekʃəs/ adj．传染性的 

smallpox / ˈsmɔ:lpɒks /n.天花

sanitation/ ˌsænɪˈteɪʃn/ n．环境卫生 

hygiene/ ˈhaɪdʒi:n/ n．个人卫生 

antibiotic / ˌæntibaɪˈɒtɪk /n．抗生素

bacterial/ bæk"tɪərɪəl/ adj．细菌性的 

vaccination / ˌvæksɪ"neɪʃn /n．种痘，接种

preserve/ prɪˈzɜ:v/ vt．保藏，防止(食物)腐烂 

nutrition/ njuˈtrɪʃn/ n．营养

chronic / "krɒnɪk /adj．(疾病)慢性的 

stroke/ strəʊk/ n．中风

virus / "vaɪrəs /n．病毒 

influenza / ˌɪnflʊ"enzə /n．流行性感冒

trend/ trend/ n．趋势，倾向 

obesity/ əʊ"bi:sətɪ/ n．肥胖

diabetes/ ˌdaɪəˈbi:ti:z/ n．糖尿病 

注释：