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2024年全國醫(yī)學英語水平考試（METS四級）考前沖刺試題及答案二,更多相關資訊請繼續(xù)查看易考吧全國醫(yī)護英語水平考試
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 1 ( )
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：D
2). Work-related Factors Influencing Home Care Nurse Intent to Remain Employed■Study results suggest that the original hypothesized model be revised to a more parsimonious depiction of factors influencing home care nurse ITR.We propose a revised model hypothesizing that each of the following nine statistically significant predictors found in this study have a direct effect on home care nurse ITR： nurse- assessed quality of care， client variety， income stability， meaningfulness of work，continuity of care， relationships with supervisors， work-life balance， satisfaction with salary and benefits， and nurse age.■Compared with the original hypothesized model (Tourangeau， Patterson， et al，2014)， the only nurse characteristic found to be associated with ITR was nurse age.The only hypothesized job characteristic found to be associated with ITR was having variety in patient assignment.Two components of conditions of home care nurse employment were found to be associated with ITR： satisfaction with pay and benefits and having income stability.Having continuity of client care was the only work structure variable that was significantly associated with ITR.Surprisingly， none of the work environment characteristics were found to be associated with ITR.Finally， all three hypothesized nurse responses to work including having work-life balance， experiencing meaningfulness of work， and nurse-assessed quality of care were found to be statistically associated with ITR.All these factors， except for nurse age， can be modified through targeted interventions to improve home care nurse ITR.( )■Study results indicate that home care nurses are encouraged to remain employed by their perceptions of the quality of care provided by their home care organization.Previous research (Flynn， 2005； Tourangeau， Patterson， et al.， 2014) supports this finding.Home care organizations should be encouraged to disseminate indicators of quality in their organizations and engage home care nurses in the development and evaluation of strategies that improve care quality.Previous research supports the finding that having greater variety of patients positively influences home care nurse ITR (Anthony & Milone-Nuzzo， 2005； Tourangeau， Patterson， et al， 2014).Home care organizations should support nurses to care for patients with a variety of needs as this allows nurses to employ a greater breadth of knowledge and skills， positively influencing their retention.( )■Continuity of care provider was also found to influence home care nurse ITR.This study finding is consistent with previous research (Ellenbecker et al.， 2006； Tourangeau，Patterson， et al， 2014).( )Home care organizations should implement nursing care models that promote continuity of care， while ensuring nurses use a variety of knowledge and skills by assigning patients that vary in age， diagnosis， and care needs.■Similar to previous research (Armstrong- Stassen & Cameron， 2005； Tourangeau，Patterson， et al， 2014)， study findings indicate that experiencing meaning in home care nursing work positively influences home care nurse ITR.Home care organizations can further strengthen positive feelings nurses have about the meaning of their work by implementing recognition and reward programs.( ) Study findings highlight the importance of positive relationships between home care nurses and their supervisors.This finding is consistent with previous research， which found that home care nurses valued competent， supportive， and accessible supervisors (Ellenbecker et al， 2006； Flynn& Deatrick， 2003； Tourangeau， Patterson， et al， 2014).Supervisors should receive adequate education and training to provide effective leadership in the unique home care work environment.Ensuring the presence of competent， accessible leadership can promote nurse ITR.■Similar to previous research (Tourangeau， Patterson， et al， 2014)， higher work-life balance was found to be positively associated with ITR.Home care organizations can facilitate improved work-life balance by addressing unmanageable workloads.( )Addressing nurse workload to improve work-life balance can promote home care nurse ITR.Similar to previous research (Armstrong -Stassen & Cameron， 2005； Denton et al， 2007； Tourangeau， Patterson， et al， 2014)， findings indicate that home care nurse ITR is positively influenced by higher satisfaction with salary and benefits and greater income stability.Home care organizations should implement strategies to address income instability such as offering opportunities for guaranteed continuous full time employment that ensures stable income levels.( )■Although the primary purpose of this study was to test and refine a model of home care nurse retention in the Ontario home care context， study results support previous theoretical work examining ITR among home care nurses in the United States (Ellenbecker et al.，2008).( )Although nine factors were found to significantly influence home care nurse ITR， there remains much to discover about home care nurses′ work environments and factors that influence their decisions to remain working for their current employers.■Additional research is needed to better understand work-related factors contributing to ITR.This knowledge will inform the development of strategies to promote home care nurse ITR.■This study provides groundwork for future research examining strategies that promote retention among home care nurses.As health care continues to shift into community settings， the retention of home care nurses will become increasingly important.Home care employers should focus on identifying modifiable factors affecting nurse retention and develop strategies modifying these factors.Ensuring nurses have adequate training and resources to provide quality patient care， improving employment conditions to increase income stability and satisfaction with pay and benefits， ensuring manageable workloads to facilitate improved work- life balance， and providing accessible， competent leaders are strategies home care employers can implement to promote retention among their nurses.Three hypothesized nurse responses to work including having work-life balance，satisfaction with pay and benefits， and nurse-assessed quality of care were found to be statistically associated with ITR.( )
A.True
B.False
C.Not mentioned

正確答案：B
3). Why and When to Consider Taking a Family Medicine Board Review Course■As with most medical specialties， there has been controversy over the past decade regarding changes to the maintenance of certification process for board-certified family medicine physicians (MC-FP) and， in particular， changes to the American Board of Family Medicine′s high stakes board exam process.Beginning in 2006， the ABF：■·Computerized and began offering its exam at an increased number of locations and times than in the past； this essentially required a major transition in the underlying testing theory and scoring process as well as an expansion in the exam′s question bank to enable the auto-generation of different exam versions that would be both secure and consistent in terms of knowledge-assessment integrity.■·Undertook a major overhaul of its exam blueprint， expanding from eight topic areas to 14， including population-based care and patient-based systems， plus eight additional modules from which test takers may choose the two they believe most salient to their clinical experience.■These changes were followed by a deep， yet short-lived decline in exam pass rates.And， while the decline was attributed ultimately to a different cause一namely the ABFM′s 2007 extension of board certification tenure from seven to 10 years (with conditions) - other trends have helped to perpetuate the idea that the exam process has become increasingly challenging for family medicine physicians.For example， the evolving structure of care delivery一in particular the dramatic increase in hospitalists as well as strong， steady growth in rates at which primary care physicians refer patients to specialists for clinical diagnosis and treatment - has reduced family medicine physicians′direct exposure to wider varieties of clinical cases， increasing the challenges of staying current with medical knowledge compared with physicians practicing in narrower specialty areas.■Family medicine physicians also practice in a much wider variety of clinical settings.For example， a PCP working for a large group practice in a wealthy suburb that encompasses separate OB， pediatric， and other subspecialties， might have a much narrower breadth of direct clinical experience from which to build new medical knowledge over time.They may also be less consistently exposed to cases more typically seen in poor， more ethnically diverse inner-city settings.Meanwhile， a PCP working for10 years in a rural private practice might see a greater variety of cases， but would be less likely to be in regular communication and sharing with other physicians and specialists.■While the addition of selectable exam modules seems intended to address real-world variability in family medicine practice， FM physicians are still challenged to keep up with ever expanding and changing arrays of medical knowledge across 14 specialty areas，quite a number of which they may never touch in daily practice.So， given these added challenges for family medicine physicians， what is the best way to go about preparing for the high -stakes ABFM recertification exam?■Top Advice for ABFM Exam Prep■Preparation leads to confidence， and confidence leads to success， says Dr.Mark Nadeau， a clinical professor and residency director in the Department of Family and Community Medicine at the University of Texas Health Science Center San Antonio，who has passed the ABFM exam on five separate occasions over the course of his career and now serves also as a senior reviewer with NEJM Knowledge+ Family Medicine Board Review.(For the full story of how Dr.Nadeau has learned to approach successful board- exam preparation， check out ABFM Exam Prep： Make Time and Make a Plan.)■Question banks (both online and print) have also become hugely popular， especially among younger physicians， because the activity of answering questions is often supported by mobile technology and can be worked into small increments of spare time during each day.In choosing question banks， focus on ones that offer plenty of practice answering clinically focused， exam-style questions that require high-level cognitive tasks such as application， analysis， and strategy versus just definition or understanding.Consider also taking advantage of adaptive learning technology (utilized by platforms such as NEJM Knowledge+) to zero in rapidly on weak spots.And be sure to complete practice questions in roughly the same distribution as the exam blueprint， as this will help in pinpointing specific knowledge gaps and directing more focused follow-up study for family physicians with major time constraints.■When to Consider Taking a Family Medicine Board Review Course■Materials set forth by board review course providers - including location-based，CD/DVD， and online- only programs一suggest that broad family medicine review courses might be best suited for physicians who：■·Have left exam prep until very late in their recertification cycles■·Are not especially disciplined about studying independently■·Are not typically strong test takers■·Have yet to experience computer-based versions of the exam■·Do not make a regular habit of keeping current with general medical knowledge via journals， conferences， peer networking， question banks， self-assessment tools， and so forth■·Have daily responsibilities such as child or elder care that can make it difficult to carve out.focused time for self directed study■·Practice family medicine in relative isolation (rural， private practice) or among patient populations lacking in ethnic， age， economic， or other forms of diversity■·Show downwardly trending test scores over time (a function of distance from academic settings and regular study)■·Have taken practice tests or utilized question banks and have performed poorly across the board (versus in just a few specific areas)■Choose Carefully■Board prep tools have weak and strong contenders， so careful research is always needed in deciding how to invest one′s time and money on specific board-review offerings.■Many review courses and other resources can be purchased conveniently online， but checking original publication dates for content as well as content revision frequencies is a must to ensure they are up to date with advances in medical knowledge (but not so u-to-date， that it overshoots the exam revision cycle) and up to date with changes in how the ABFM structures its exam to assesses knowledge.■While it is a reasonable assumption that family medicine board review courses have been developed using the ABFM exam blueprint 一meaning they portion course time appropriately across the breadth of subject areas covered in the exam一this is not a given and should always be verified when weighing family medicine board review course options.■A big positive for many family medicine board review courses is that一in addition to medical knowledge一they teach specific test.taking strategies， including how to rapidly deconstruct and decode exam questions.Family medicine review courses may also provide key insights into how questions are developed for the exam， how the exam is structured and scored， why it is important to answer every question (even by guessing)，and specific strategies for making best-possible guesses.■Family medicine board review courses may also train physicians to work more effectively in timed and computer based testing environments.When taking the actual exam， one has approximately 60 seconds to read， digest and answer each question； due to exam scoring methods， it is always best to answer every question.Practicing questions repeatedly within realistic time constraints can go a long way to relieving test-takers′anxiety.■While many family medicine review courses offer money-back guarantees， they are not as fail-safe as exam pass rates suggest.At the end of the day， each family medicine physician must make a clear and honest assessment of his or her own learning styles，capacities for retaining information and testing， and career -path priorities.■Please join our ongoing conversation about best practices for family medicine board exam review by sharing your own experiences with review courses in the comments below.The exam takers are encouraged to complete each question within a limited time as the actual exam.( )
A.True
B.False
C.Not mentioned

正確答案：A

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