Physical examination of a 40-year-old man injured in an automobile accident indicates that

A 67-year-old man who is a long-term smoker presents with weight loss, a persistent cough, fever, chest pain, and hemoptysis. A chest x-ray reveals a 3.5cm hilar mass on the right and postobstructive pneumonia of the right lower lobe. Sputum cytologic is suspicious for malignant cells. Histologic examination of a transbronchial biopsy specimen reveals in infiltrating groups of cells with scant cytoplasm. No glandular structures or keratin production are seen. The nuclei of these cells are about twice the size of normal lymphocytes and do not appear to have nucleoli. Which of the following is the most likely diagnosis?

A、Large-cell carcinoma

B、Small-cell carcinoma

C、Adenocarcinoma

D、Hamartoma

【单选题】A 19-year-old man complains of “brown urine” and pain in the muscles of his arms and legs experienced while playing touch football. He has had several episodes of muscle pain during exercise, but he had not noticed darkening of his urine afterward. The pain usually resolved overnight. Physical examination reveals a well-fed male of normal stature. Reflexes and range of motion in all arms and legs are normal, but there is some paraparesis (weakness), especially in his right leg. A muscle biopsy is taken and sent for specialized resting. The patient is sent home with a recommendation to take a dietary carnitine supplement. Which of the following is the most likely diagnosis?

A、Medium-chain fatty acyl CoA dehydrogenase (MCAD) deficiency

B、Carnitine deficiency

C、Carnitine palmitoyltransferases I deficiency

D、Carnitine palmitoyltransferases II deficiency

E、Marfan syndrome

【单选题】A 7-year-old girl has 1 1-month history of foul-smelling diarrhea. Upon further inquiry, the frequency seems to be 4-6 stools per day. She has also had trouble seeing at night in the past2 weeks. Her WBC count is normal. Physical examination is entirely normal. Examination of a stool sample reveals that it is bulky and greasy. Analysis does not reveal any pathogenic microorganisms or parasites but confirms the presence of fats. Further evaluation of this patient would likely reveal which of the following conditions?

A、Lactose intolerance

B、Biliary insufficiency

C、Ileal disease

D、Diabetes

E、Giardiasis

3. Car crashes are the top (3) of American teenagers. 4. Most of the crashes result from （4） driving. 5. not paying attention to the (5) . 6. Jim Jennings from the Allstate Insurance Company says the number one cause of distracted-driving accidents is the (6) . 7. Debbie Pickford of Allstate Insurance says teens are especially at (7) from distracted driving. 8. and not just because they lack (8) on the roads. 9. She said teens don't really have fully (9) brains until they're twenty-five years old. 10. New legislation in Congress proposes to require all (10) to have what is called a graduated driver licensing system.

Wilson v Dagnall [1972] 1 QB 509 Court of Appeal (Lord Denning MR, Megaw and Stephenson LJJ) Statute – effective date Facts The plaintiff’s husband was killed in a motor accident in 1969. On 19 March 1970 she commenced proceedings claiming, inter alia, damages under the Fatal Accident Acts. The hearing was on 27 July 1971: the defendant admitted liability and formal judgment was entered on 30 July. On 1 July 1971 the Law Reform (Miscellaneous Provisions) Act 1971 received the Royal Assent and the Act stipulated that it was to come into force on 1 August 1971. The Act provided (in s4) that, in assessing damages under the Fatal Accidents Acts, no longer was account to be taken of a widow’s prospects of remarriage. As the 21- year- old plaintiff enjoyed such prospects, the judge assessed her damages as though the 1971 Act were already in force. The defendant’s appeal was heard in December 1971. Held (Lord Denning MR dissenting) The judge had been wrong to apply the 1971 Act and the plaintiff’s damages would therefore be reduced to take account of her prospects of remarriage. Megaw LJ: ‘It is natural to feel sympathy for this young widow, as against an anonymous insurance company. But it cannot be proper for a court of law to decide a case in favor of a plaintiff on the basis of sympathy, if the law of the land, as laid down in an Act of Parliament, provides otherwise. Whenever the law is changed by an Act of Parliament, there are likely to be cases which can be regarded as hard cases. That would not have been avoided if, for example, Parliament had provided- as it deliberately did not provide- that the change in the law was to take effect on the date when the Act was passed, 1st July 1971. For in that event the cases decided by the courts in the days or weeks preceding 1st July (instead of, as now, 1st August) could equally have been regarded as hard cases: hard, because they fell so close to the dividing line but on the wrong side of it for the plaintiff concerned. Yet a dividing line there must be. The only question is: what is the dividing line which Parliament has chosen to lay down? Parliament has unambiguously said that the Act is to come into operation on 1st August 1971. To my mind there is no ambiguity about that nor any doubt as to its effect. It means that Parliament has ordained that up to that date, 1st August 1971, the law is to remain as before. I do not know why Parliament so provided. But that it did so provide is beyond dispute. I should have thought it was also beyond dispute, as an essential part of the unwritten constitutional law of England, by which courts of law are ineluctably bound, that those courts must loyally give effect to what Parliament has provided, and not seek to give effect to what they may think that Parliament ought to have provided. If Parliament has made a mistake, it has full sovereign power to correct the mistake. It follows that in my judgment the learned judge could not lawfully treat s4 of the Act as though it was already in force on 27th July. The judge’s decision was wrong and contrary to law. It ordered the defendant to pay money which, in law, the defendant could not lawfully be ordered to pay to the plaintiff. I do not regard it as relevant that the delivery of the judgment or the drawing up of the order could, as a matter of fact, have been postponed by the judge until 31st July had come and gone and the Act had come into operation.’ Questions 1. How many parts can this case be divided into? What are they? 2. Which two judges agreed with the ruling? Who dissented? 3. Why did the defendant appeal? 4. Why did the judges of the Court of Appeal reverse the first ruling?