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2024年全國(guó)醫(yī)學(xué)英語(yǔ)水平考試（METS四級(jí)）考前沖刺試題及答案五,更多相關(guān)資訊請(qǐng)繼續(xù)查看易考吧全國(guó)醫(yī)護(hù)英語(yǔ)水平考試
1). (一)■Effects of Aspirin on Risk and Severity of Early Recurrent Stroke After Transient Ischaemic Attack and Ischaemic Stroke■1Antithrombotic treatment is important in the immediate management of most acute ischaemic vascular events.Since aspirin is available in many households，public education materials recommend self-administration by patients who develop acute chest pain， in addition to seeking immediate medical attention.Prehospital self-administration of aspirin is discouraged after stroke because of concerns about possible intracerebral haemorrhage.However， haemorrhage is a rare cause of TIA (transient ischaemic attack) symptoms and it accounts for less than 5% of minor strokes.Although public education should continue to persuade people with transient neurological symptoms to seek medical attention immediately， where this is possible， self- administration of aspirin after transient unfamiliar symptoms might also be appropriate， particularly in rural settings or in less developed countries where access to medical services will be delayed.■2The risk of recurrent stroke is up to 10% in the week after a TIA or minor stroke.Urgent medical treatment seems to reduce that risk by as much as 80%， but many patients delay seeking medical attention， often for several days or weeks， even when they make a correct self- diagnosis.Public education campaigns， such as the FAST test television campaign， have decreased delays to presentation after major stroke， but there has been little improvement in presentation rates after TIA or minor stroke.In a recent population-based study in the UK， half of recurrent strokes in the days after a TIA occurred prior to medical attention being sought for the initial event， and the situation is likely to be worse in many parts of the developing world in which access to emergency services is poor.■3There are， however， few published data from randomised trials for the effect of aspirin on risk of early recurrent stroke after TIA or minor stroke， and no data for its effect on severity； evidence of apparently major benefits of urgent medical treatment generally comes only from observational studies.Randomised trials of aspirin versus placebo in longer-term secondary prevention showed only a 13%relative reduction in risk of recurrent stroke with aspirin.Trials of short-term treatment of hospitalised acute stroke also reported a 13% reduction in the 4 week risk of recurrent stroke or intracerebral haemorrhage， but the effect of aspirin on risk or severity of recurrence after more minor stroke was not reported.Yet，observational studies suggest potentially substantial early benefits of aspirin after TIA or minor stroke.In the EXPRESS study， urgent treatment with antiplatelet drugs， blood pressure-lowering drugs， and statins reduced the early risk of stroke by 80%； much of this decrease was hypothesised to have been due to aspirin.Severity of recurrent cerebral events was also reduced in EXPRESS， which might also have been due to aspirin.■4 In the absence of published randomised evidence of the effect of aspirin on risk and severity of early recurrent stroke after TIA or minor stroke，we reanalysed individual patient data and reviewed original paper records on early outcomes from all available trials of aspirin versus placebo in secondary prevention after TIA or ischaemic stroke.To inform on possible mechanisms of action， we also aimed to study the time course of the interaction between effects of aspirin and dipyridamole in secondary prevention of stroke.Aiming to more reliably estimate the very early time course of onset of effects of aspirin， we also studied risk of recurrent ischaemic stroke in trials of aspirin in treatment of acute stroke，stratified by severity of the pre-randomisation neurological deficit.■5Pooling the individual patient data from all randomised trials of aspirin versus control in secondary prevention after TIA or ischaemic stroke， we studied the effects of aspirin on the risk and severity of recurrent stroke， stratified by the following time periods： less than 6 weeks， 6-12 weeks， and more than 12 weeks after randomisation.We compared the severity of early recurrent strokes between treatment groups with shift analysis of modified Rankin Scale (mRS) score.To understand possible mechanisms of action， we also studied the time course of the interaction between effects of aspirin and dipyridamole in secondary prevention of stroke.In a further analysis we pooled data from trials of aspirin versus control in which patients were randomised less than 48h after major acute stroke，stratified by severity of baseline neurological deficit， to establish the very early time course of the effect of aspirin on risk of recurrent ischaemic stroke and how this differs by severity at baseline.■6We pooled data for 15，778 participants from 12 trials of aspirin versus control in secondary prevention.Aspirin reduced the 6 week risk of recurrent ischaemic stroke by about 60% and disabling or fatal ischaemic stroke by about 70%， with greatest benefit noted in patients presenting with TIA or minor stroke.The effect of aspirin on early recurrent ischaemic stroke was due partly to a substantial reduction in severity.These effects were independent of dose， patient characteristics， or aetiology of TIA or stroke.Some further reduction in risk of ischaemic stroke accrued for aspirin only versus control from 6-12 weeks， but there was no benefit after 12 weeks.By contrast， dipyridamole plus aspirin versus aspirin alone had no effect on risk or severity of recurrent ischaemic stroke within 12 weeks， but dipyridamole did reduce risk thereafter (0.76， 0.63-0.92， p=0.005)， particularly of disabling or fatal ischaemic.We pooled data for 40，531 participants from three trials of aspirin versus control in major acute stroke.The reduction in risk of recurrent ischaemic stroke at 14 days was most evident in patients with less severe baseline deficits， and was substantial by the second day after starting treatment.■7Our analyses of data from trials of aspirin in secondary prevention after TIA or ischaemic stroke show that the effect of aspirin on risk of early recurrent events has been underestimated.We show substantial reductions in the early risk of all stroke， ischaemic stroke， and acute myocardial infarction.We also found that a major part of the early benefit of aspirin was due to a previously unrecognized reduction in severity of early recurrent ischaemic stroke， resulting in 80%～90%reductions in the early risk of disabling or fatal recurrent ischaemic stroke after TIA or minor stroke.Although these trials recruited few patients in first few days after TIA or stroke， we found similar reductions in risk of recurrent ischaemic stroke with aspirin in trials of acute ischaemic stroke.■8Our findings confirm that medical treatment substantially reduces the risk of early recurrent stroke after TIA or minor stroke and identify aspirin as the key intervention.Medical services should give aspirin as soon as possible and public education should be aimed at self-administration after unfamiliar transient neurological symptoms suggestive of threatened stroke.The considerable early benefit from aspirin warrants public education about self-administration after possible TIA.The previously unrecognised effect of aspirin on severity of early recurrent stroke， the diminishing benefit with longer-term use， and the contrasting time course of effects of dipyridamole have implications for understanding mechanisms of action.■(二)Aspirin is recommended for ( )prevention after transient ischaemic attack (TIA) or minor stroke.However， the risk of major stroke is very high for only the first few days afterwards， and observational studies show substantially greater benefits of ( ) medical treatment with aspirin in the acute phase.The randomized trials show a relative ( )in risk of recurrent stroke with aspirin.The authors hypothesised that the short-term benefits of early aspirin have been ( )So the time course of the interaction between effects of aspirin and dipyridamole in preventing stroke was also studied.They conclude that medical treatment can greatly reduce the risk of early ( )stroke and stress the importance of( ) of aspirin.The considerable early benefit from aspirin can help public get the knowledge and apply aspirin by themselves after possible TIA.choose the most suitable subheading from list A-J for Paragraph 5 ( )
A.Aspirin identified as the key intervention of recurrent stroke after TIA or minor stroke
B.Findings of our research
C.Original data used to study time course of drug interaction and risk of recurrent ischaemic stroke
D.Different trials and observational studies of aspirin
E.Effects of aspirin on risk of early recurrent stroke underestimated
F.Short-term and long-term studies
G.Effects of aspirin on the risk and severity of recurrent stroke
H.Prehospital self- administration of aspirin encouraged after transient unfamiliar symptoms
I.Effects of aspirin on the prevention of recurrent stroke
J.Seeking medical attention after TIA or minor stroke delayed

正確答案：G
2). Hepatology Service Rotation Curriculum■Hepatologists： Hugo R.Rosen， MD； Gregory T.Everson， MD； Lisa M.Forman，MD； James“Jay”Burton， Jr.MD■Educational Purpose and Goals■The hepatology rotation allows residents and fellows to refine history and physical exam skills， develop experience in management of a variety of hepatological diseases.The hepatology inpatient service will consist of a Physician′s Assistant， a Hepatology Intern， a Hepatology Fellow and a Hepatology Attending.Most months a resident will be part of the team as well，■Principal Teaching Methods■A.Supervised Direct Patient Care： Residents encounter patients admitted to the hepatology service at University of Colorado Hospital and are responsible for admitting patients to the service between the hours of 8 a.m.to 5 p.m.， M- F.In addition to supervising the residents and caring for patients on the hepatology service， fellows are responsible for managing post transplant patients on the surgical service.■B.Required Conferences： In addition to the required general medicine conferences(and GI conferences for fellows) the hepatology team members must attend Patient Selection Committee， Thursdays 7 a.m， Liver Pathology Conference， Thursday， 8 a.m.and Hepatobiliary Conference， Friday Noon.■C.Didactic Sessions： We hold twice weekly on- service teaching seminars， which are taught by the fellows or attendings.Potential topics are the items listed in sectionⅢ.A.as well as transplantation issues for internists， liver disease in pregnancy and evaluation of hepatic mass.■Educational Content■A.Mix of Diseases： Encountered patients have a variety of hepatological disorders which may include the following： Asymptomatic elevation in LFTs，NASH， alcoholic hepatitis， acute hepatitis， fulminant hepatic failure， chronic hepatitis (HCV， HBV， AlCAH， Drug induced， Wilson′s Disease)，hemochromatosis， PBC/PSC， and cirrhosis.■B.Patient Characteristics： Pre and post transplant patients are either managed primarily by the hepatologists or referred from other gastroenterologists (quaternary referrals).■C.Learning Venues： Inpatient setting at the University of Colorado Health Sciences Center.■D.Procedures： Certain procedures will be performed by the intern under supervision of resident/hepatology fellow and attending.These include： IV access， paracentesis，thoracentesis， NG tube placement， and flexible sigmoidoscopy.All GI procedures including EGD， colonoscopy and liver biopsy will be done by the hepatology fellow under the supervision of the hepatology attending.■Principal Ancillary Educational Materials■A.All fellows are provided with the Fellowship Handbook including the fellows curriculum and learning objectives for each rotation prior to the start of fellowship.The hepatology curriculum and learning objectives are distributed to each fellow and resident prior to the start of the hepatology rotation.■B.Residents and fellows are provided with additional targeted reading materials specifically chosen by the hepatology attendings.The set of articles includes key information about the diagnosis， treatment and management of hepatological diseases and is reviewed annually to ensure it is up to date.■C.Computer based resources are available to residents and fellows at the University of Colorado Hospital to facilitate patient care， education and communication.■Methods of Evaluation■A.Resident Performance： Residents are evaluated by attendings via New Innovations at the end of the rotation.It is expected that the residents receive ongoing verbal feedback from both the hepatology fellows and attendings throughout the rotation.The evaluation form centers around the 6 ACGME competencies and completed evaluations are available to the residents online at any time.■B.Program and Faculty Performance： The residents and fellows evaluate attendings at the end of the hepatology rotation.These evaluations are anonymous to ensure the residents/ fellows can be completely open.The evaluations are held from the faculty until sufficient evaluations are completed as to further guarantee anonymity.These evaluations are tools used by the Division Head when conducting annual performance reviews.The curriculum can help the residents and fellows improve their( )
A.skills in asking about history
B.physical exam skills
C.experience in diagnosis and treatment of diseases
D.all of the above

正確答案：D
3). Hepatology Service Rotation Curriculum■Hepatologists： Hugo R.Rosen， MD； Gregory T.Everson， MD； Lisa M.Forman，MD； James“Jay”Burton， Jr.MD■Educational Purpose and Goals■The hepatology rotation allows residents and fellows to refine history and physical exam skills， develop experience in management of a variety of hepatological diseases.The hepatology inpatient service will consist of a Physician′s Assistant， a Hepatology Intern， a Hepatology Fellow and a Hepatology Attending.Most months a resident will be part of the team as well，■Principal Teaching Methods■A.Supervised Direct Patient Care： Residents encounter patients admitted to the hepatology service at University of Colorado Hospital and are responsible for admitting patients to the service between the hours of 8 a.m.to 5 p.m.， M- F.In addition to supervising the residents and caring for patients on the hepatology service， fellows are responsible for managing post transplant patients on the surgical service.■B.Required Conferences： In addition to the required general medicine conferences(and GI conferences for fellows) the hepatology team members must attend Patient Selection Committee， Thursdays 7 a.m， Liver Pathology Conference， Thursday， 8 a.m.and Hepatobiliary Conference， Friday Noon.■C.Didactic Sessions： We hold twice weekly on- service teaching seminars， which are taught by the fellows or attendings.Potential topics are the items listed in sectionⅢ.A.as well as transplantation issues for internists， liver disease in pregnancy and evaluation of hepatic mass.■Educational Content■A.Mix of Diseases： Encountered patients have a variety of hepatological disorders which may include the following： Asymptomatic elevation in LFTs，NASH， alcoholic hepatitis， acute hepatitis， fulminant hepatic failure， chronic hepatitis (HCV， HBV， AlCAH， Drug induced， Wilson′s Disease)，hemochromatosis， PBC/PSC， and cirrhosis.■B.Patient Characteristics： Pre and post transplant patients are either managed primarily by the hepatologists or referred from other gastroenterologists (quaternary referrals).■C.Learning Venues： Inpatient setting at the University of Colorado Health Sciences Center.■D.Procedures： Certain procedures will be performed by the intern under supervision of resident/hepatology fellow and attending.These include： IV access， paracentesis，thoracentesis， NG tube placement， and flexible sigmoidoscopy.All GI procedures including EGD， colonoscopy and liver biopsy will be done by the hepatology fellow under the supervision of the hepatology attending.■Principal Ancillary Educational Materials■A.All fellows are provided with the Fellowship Handbook including the fellows curriculum and learning objectives for each rotation prior to the start of fellowship.The hepatology curriculum and learning objectives are distributed to each fellow and resident prior to the start of the hepatology rotation.■B.Residents and fellows are provided with additional targeted reading materials specifically chosen by the hepatology attendings.The set of articles includes key information about the diagnosis， treatment and management of hepatological diseases and is reviewed annually to ensure it is up to date.■C.Computer based resources are available to residents and fellows at the University of Colorado Hospital to facilitate patient care， education and communication.■Methods of Evaluation■A.Resident Performance： Residents are evaluated by attendings via New Innovations at the end of the rotation.It is expected that the residents receive ongoing verbal feedback from both the hepatology fellows and attendings throughout the rotation.The evaluation form centers around the 6 ACGME competencies and completed evaluations are available to the residents online at any time.■B.Program and Faculty Performance： The residents and fellows evaluate attendings at the end of the hepatology rotation.These evaluations are anonymous to ensure the residents/ fellows can be completely open.The evaluations are held from the faculty until sufficient evaluations are completed as to further guarantee anonymity.These evaluations are tools used by the Division Head when conducting annual performance reviews.Fellows are responsible for( )
A.evaluating the performance of residents
B.teaching seminars
C.performing surgeries on ICU patients
D.presiding the required conferences

正確答案：B

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