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2024年全國醫(yī)學(xué)英語水平考試（METS四級）綜合能力測試題及答案一
1). Celiac Sprue■(一)■1.Celiac sprue， also known as celiac disease and gluten-sensitive enteropathy， is characterized by malabsorption resulting from inflammatory injury to the mucosa of the small intestine after the ingestion of wheat gluten or related rye and barley proteins.There is clinical and histologic improvement on a strict gluten-free diet， and relapse when dietary gluten is reintroduced.Accounts of celiac sprue date back to the first century A.D.It was not until the 1940s， however， that the link to gluten ingestion was established； Dickc， a Dutch pediatrician， observed that the condition of children with celiac sprue improved during the food shortages of World War I，only to relapse after cereal supplies were restored.Until fairly recently， celiac sprue was considered uncommon in the United States，with an estimated prevalence of 1 per 3， 000 population.However， greater awareness of its presentations and the availability of new， accurate serologic tests have led to the realization that celiac sprue is relatively common， affecting 1 of every 120 to 300persons in both Europe and North America.■2.The true prevalence of celiac sprue is difficult to ascertain， because many patients have atypical symptoms or none at all A large， multicenter Italian study identified seven new cases of celiac sprue in children for each patient with established disease.The highest reported prevalence is in Western Europe and in places where Europeans emigrated，notably North America and Australia.Celiac sprue is also found in parts of northwest India， and it may be underdiagnosed in South America， North Africa， and Asia.It is rare among people from a purely African-Caribbean， Chinese， or Japanese background.In most series there is a slight female preponderance.■3.Celiac sprue results from an inappropriate T-cell-mediated immune response against ingested gluten in genetically predisposed people.The importance of genetic factors is supported by the approximately 10 percent prevalence of the disease among first- degree relatives.Over 95 percent of patients with celiac sprue express the HLA-DQ(α1 * 501，β1 * 02) heterodimer ( HLA-DQ2)，which preferentially presents gluten derived gliadin peptides on its antigen-presenting groove to stimulate intestinal mucosal T cells.The enzyme tissue transglutaminase is one of the targets of the autoimmune response in celiac sprue.The modification of gliadin by host tissue transglutaminase has a key role in enhancing the gliadin-specific T-cell response， and a single tissue transglutaminase modified peptide is the dominant a-gliadin T cell epitope and may be a target for antigen-specific peptide therapy.■4.Classically， infants with celiac sprue present between the ages of 4 and 24 months with impaired growth， diarrhea， and abdominal distention.Vomiting is common in young .infants， as are pallor and edema.The onset of symptoms is gradual and follows the introduction of cereals into the diet.The velocity of weight gain slowly decreases before weight loss ensues.Some children present with constipation， although diarrhea is more typical.Patients with severe， untreated celiac sprue may present with short statue，pubertal delay， iron and folate deficiency with anemia， and rickets.Atypical celiac sprue is usually seen in older children or adolescents， who often have no overt features of malabsorption.In addition to recurrent abdominal pain， hypertransaminasemia， recurrent aphthous stomatitis， arthralgia， and defects in dental enamel， children may have behavioral disturbances such as depression， may be irritable， and may perform poorly in school.■5.The diagnosis of celiac sprue is increasingly being made in adults.Approximately50 percent of adult patients do not have clinically significant diarrhea.iron- deficiency anemia is now the most common clinical presentation in adults with celiac sprue.Other laboratory abnormalities include macrocytic anemia due to folate (or， rarely， vitamin B12)deficiency， coagulopathy resulting from vitamin K deficiency， or vitamin D deficiency leading to hypocalcemia and an elevated alkaline phosphatase level.Other increasingly recognized extraintestinal manifestations include bone fractures， infertility， psychiatric syndromes， and various neurologic conditions ，including peripheral neuropathy， ataxia，and seizures.■6.The availability of highly sensitive and specific serologic markers greatly facilitates the diagnosis of celiac sprue.These serologic tests are used to evaluate patients with suspected disease， monitor adherence and response to a gluten- free diet， and screen patients with atypical， extraintestinal manifestations.IgA antiendomysial antibodies are usually detected by indirect immunofluorescence with the use of sections of human umbilical cord or，less commonly， monkey esophageal smooth muscle.The reported sensitivity and specificity of antiendomysial antibodies are 85 to 98 percent and 97 to 100percent， respectively.■7.Histologic examination of a biopsy specimen of the small intestine remains the diagnostic gold standard for celiac sprue.In current practice， most biopsies in children and adults are performed during upper endoscopy.Endoscopy is more reliable than previous capsule biopsy techniques， because it allows multiple specimens to be obtained， thus reducing sampling error， and because， in many cases， examination of the upper gastrointestinal tract may in itself be indicated (e.g，in iron deficiency anemia ).Specimens should be obtained from the distal duodenum ( second or third part) to avoid the architectural distortion produced by Brunner′s glands or peptic duodenitis.Absent，flattened， or scalloped duodenal folds are not specific for celiac sprue.■8.Because a gluten-free diet represents a lifetime commitment， is more expensive than a normal diet， and may limit patients socially， especially children and teenagers， it should never be recommended unless the diagnosis of celiac sprue is firmly established.There is no role for an empirical therapeutic trial of gluten withdrawal because a patient′s response is often equivocal and because the abnormal findings on both the serologic tests and small-bowel biopsy may revert to normal， making subsequent definitive diagnosis difficult.■(二)■Celiac sprue is a relatively common enteropathy which is correlated with the ingestion of dietary ( )It is difficult to determine the real prevalence of the disease because of ( )symptoms in the patients.An ( )immune response against ingested gluten is likely to result in celiac sprue.Children and adults with celiac sprue present with a wide ( )of clinical manifestations.Methods for the diagnosis of celiac sprue include serologic tests and biopsy of the small intestine taken as diagnostic( )standard.A gluten free diet will not be recommended to the patients until a definite ( )is made.Choose the correct heading for Paragraph 8( )
A.Pathogenesis of celiac sprue
B.Clinical presentations of celiac sprue in adults
C.Treatment of celiac sprue with a gluten-free diet
D.Causes and diagnosis history of celiac sprue
E.Treatment of celiac sprue with multivitamin intake
F.Diagnosis of celiac sprue with serologic tests
G.Clinical manifestations in children with celiac sprue
H.Diagnosis of celiac sprue with biopsy of the small intestine
I.Epidemiological features of celiac sprue
J.Refractory sprue and enteropathy-associated T-cell lymphoma

正確答案：C